Mübeccel Arslan

The place of computed tomography as a guidance modality in percutaneous nephrostomy: analysis of a 10-year single-center experience.

Background: Percutaneous nephrostomy (PCN) has been established as an effective technique for urinary decompression or diversion. This procedure may be performed with the guidance of fluoroscopy, ultrasonography, a combination of fluoroscopy and ultrasonography, computed tomography (CT), or magnetic resonance imaging. Purpose: To retrospectively review experience with CT-guided PCN over a 10-year period in a single center. Material and Methods: All CT-guided PCN procedures performed in adults at our institution between 1995 and 2005 were evaluated. In 882 patients, 1113 nephrostomy catheters were inserted. Interventional radiologists or radiology residents under direct attending supervision inserted all catheters. During the PCN procedure, bleeding, sepsis, and injuries to adjacent organs were regarded as major complications. Clinical events requiring nominal therapy with no sequelae were regarded as minor complications. Results: PCN procedures were performed via 1–3 punctures in patients with grades 0–1 and 2 hydronephrosis, and via 1–2 punctures in patients with grade 3 hydronephrosis. They were carried out with a procedure time ranging from 9 to 26 min. All PCNs were considered as technically successful, and no major complications were observed. There were minor complications including transient macroscopic hematuria (28.6%, 19.9%, and 4.9% in patients with hydronephrosis grades 0–1, 2, and 3, respectively) and perirenal hematomas in a total of eight patients. No patient required additional intervention secondary to complications of the PCN procedure. Conclusion: CT-guided PCN is an efficient and safe procedure with major and minor complication rates below the accepted thresholds. It can be used for the management of patients requiring nephrostomy insertion in inpatient settings, and might be a preferable procedure in patients with minimal or no dilatation of the renal pelvis.

Comparison of CT-Guided Sclerotherapy with Using 95% Ethanol and 20% Hypertonic Saline for Managing Simple Renal Cyst

Objective We wanted to compare the efficacies of 95% ethanol and 20% hypertonic saline (HS) sclerotherapies that were performed in a single session under CT guidance for the management of simple renal cysts. Materials and Methods A prospective series of 74 consecutive patients (average age: 57.6 ± 8.1 years) with simple renal cysts were enrolled in this study. They were randomized into two groups and 95% ethanol or 20% HS, respectively, corresponding to 25% of the aspiration volume, was injected. Treatment success was determined six months later with follow-up clinical evaluation and performing ultrasonography. Results The sclerotherapy was accepted as technically successful without major complications in all except two patients who were excluded because of a communication between the simple renal cyst and the pelvicalyceal collecting system. Thirty-six patients in the ethanol group received sclerotherapy with 95% ethanol and 36 patients in the HS group underwent sclerotherapy with 20% HS. The complete regression ratio of the ethanol group was significantly higher (94% versus 72%, respectively) than that of the HS group. There was one patient with partial regression in each group. The failure ratio of the ethanol group was significantly lower (3% versus 25%, respectively) than that of the HS group. Conclusion Ethanol sclerotherapy under CT guidance is a successful and safe procedure and it can be used for the treatment of simple renal cysts. Sclerotherapy with 95% ethanol is more effective than 20% HS sclerotherapy. Sclerotherapy with HS may be an option for patients preferring to undergo a less painful treatment procedure.

Radiological study of the intumescentia septi nasi anterior

Intumescentia septi nasi anterior (ISNA) is a common anatomical variation that is not routinely noticed by surgeons or radiologists. ISNA is a mucosal bulging located on each side of the anterior part of the septum. The aim of this study was to investigate the prevalence of ISNA in different ages and sexes. In this study, computerized tomography (CT) scans of the paranasal sinus were obtained from 595 patients who had symptoms of chronic sinusitis. Among 595 subjects, ISNA was found in 332 (55.79 per cent) of subjects. It was found more frequently in males than females in every age group. Although ISNA is a common anatomical variation, it is generally overlooked. This is the first report on ISNA in different age groups and sexes.

Magnetic Resonance Imaging of the Clivus and Its Age-Related Changes in the Bone Marrow

Background The clivus is a bone region between dorsum cella and foramen magnum. It can be evaluated very clearly in routine brain magnetic resonance imaging (MRI) dueto its central location. Objectives Quantitative and qualitative evaluation of the clivus and its changes according to age in a group of healthy people. Patients and Methods The transition of clival bone marrow to fatty marrow by the increasein age is examined by MRI in 105 men and 105 women who had no clival and bone marrow pathology on MRI. The clivus/pons, clivus/CSF intensity values and clival bone marrow imaging patterns according to age groups were prospectively evaluated using a 1.5 Tesla MR device. Results When age groups were individually compared, there were meaningful statistical differences both in men and women in terms of clivus/CSF and clivus/pons intensity ratios (both Ps < 0.05). Clivus/pons and clivus/CSF intensity ratios were found to be increased with age in all cases. The distribution of age groups according to stages in all individuals was statistically meaningful (P < 0.05). When the appearance patterns of both genders in every ten-fold age were examined, stage III bone marrow was observed more in elder ages. Conclusions As a result, besides the fact that standard ranges determined for clivus/CSF, clivus/pons intensity ratios according to age may be used in the assessment of potential pathological cases involving bone marrow; they can also be leading in the diagnosis of bone marrow diseases when taken into consideration together with clinical and laboratory data.

Cherubism: an unusual cause of bilateral mandibular swellings

Abstract Cherubism is a benign, hereditary giant cell lesion of the jaws, that appears in children as a bilateral painless swellings, between the ages of 2 and 5 years and progress until puberty, when it spontaneously regresses. In this report, we present a hereditary case of cherubism with a review of the literature and discuss the radiologic characteristics of the condition.

Sonographic evaluation of jugulodigastric and juguloomohyoid lymph nodes.

The jugulodigastric (JD) and juguloomohyoid (JO) lymph nodes are levels II and III cervical lymph nodes corresponding to the upper and middle internal jugular chains, respectively. The aim of this study is to delineate the sonographic properties of these two nodes, which are commonly encountered in routine neck sonography, in subjects with normal neck ultrasound findings. Atypical findings can make it difficult to differentiate benign from malignant lymph nodes. The JD and JO lymph nodes of 126 subjects were examined by ultrasonography, and size, shape, presence of echogenic hilus and Doppler activity were recorded. Among the lymph nodes examined, 31.6% were not elliptical. Proportionally more of the JO than the JD nodes were round; there was a significant difference in roundness index between them (P < 0.05). An echogenic hilus was demonstrated in 223 of the 252 JD nodes and in 161 of the 252 JO nodes. Significantly more of the lymph nodes with roundness index <2 lacked a visible echogenic hilus. There was a positive correlation between the visibility of an echogenic hilus and Doppler activity. Normal jugulodigastric and juguloomohyoid lymph nodes are relatively prominent in the upper and middle jugular chains, respectively. Awareness of variations in the sonographic appearance of these nodes could preclude unnecessary procedures. Clin. Anat. 29:943–948, 2016.

Kronik obstrüktif akciğer hastalığında orbital kan akım değişikliklerinin renkli doppler ultrasonografi ile değerlendirilmesi

Ozet Amac . Kronik obstruktif akciger hastaligi (KOAH) olgularinin okuler kan akim hizlarini olcup okuler hemodinaminin etkilenip etkilenmedigini saptamaktir. Yontem. 2009-2010 yillari arasinda Global Initiative for Chronic Obstructive Lung Disease (GOLD) kriterlerine gore degerlendirilerek 20’er kisilik 4 gruba ayrilan KOAH tanili 80 hasta ve rastgele secilen 63 saglikli birey olmak uzere toplam 143 olgunun Renkli doppler ultrasonografi (RDUS) teknigi ile santral retinal arter (SRA) ve oftalmik arter (OA) pik sistolik hizlari (PSH), end diastolik hizlari (EDH), rezistif indeksleri (RI) ve santral retinal ven (SRV) akim hizlari olculdu. Bulgular. SRA ve OA PSH ve RI degerlerinde gruplarda anlamli yukseklikler saptanirken (p 0,05). SRV akim hizlarinda anlamli bir bicimde yukseklik saptandi (p 0.05). Furthermore significant increase of CRV measurements was detected (p<0.05). Conclusion. We thought that the changes of PSV and RI parameter in CRA and OA depend on hypoxia with COPD causes systemic and local inflammatory metabolites due to distortion of retinal auto regulatory mechanism. The elevation increase CRV is attributed to amount of blood return to the ophthalmic vein by means of ocular blood flow increase, and to the increased central venous blood pressure related to COPD. Keywords: Color Doppler ultrasonography, ocular blood flow, chronic obstructive pulmonary disease

Metabolik sendromda ürik asit düzeyi ile nonalkolik yağlı karaciğer hastalığı arasındaki ilişki

Ozet Amac. Bu calismanin amaci metabolik sendrom (MS) hastalarinda non-alkolik yagli karaciger hastaliginin (NAYKH) sikligini ve serum urik asit degeri ile arasindaki iliskiyi arastirmaktir. Yontem. Calismaya 26’si erkek ve 34’u kadin toplam 60 MS olgusu ile 21’i erkek ve 21’i kadin toplam 42 saglikli birey alindi. On iki saatlik aclik sonrasi alinan kan orneklerinde; aclik kan sekeri (AKŞ), trigliserid, yuksek dansiteli lipoprotein, dusuk dansiteli lipoprotein (LDL), urik asit duzeyleri ve insulin degerlerine bakildi. Insulin direncini belirlemek icin HOMA-IR formulu kullanildi. Karaciger yaglanmasinin derecesi ultrasonografik olarak degerlendirildi. Bulgular. Calismamizda MS grubundaki urik asit duzeyleri, kontrol grubu olgularinin urik asit duzeylerinden istatistiksel olarak anlamli olacak sekilde yuksekti (p<0,05) ve MS komponentleri arttikca urik asit seviyelerinin de yukseldigi gozlendi. MS olgularimizda %78,3 oraninda karaciger yaglanmasinin oldugu; urik asit degerlerinin bu hastalarda anlamli derecede yuksek oldugu, bu artisin yaglanmanin derecesi ile dogru orantili oldugu saptandi. Sonuc. MS ile serum urik asit degeri ve NAYKH arasinda yakin bir iliski mevcuttur. Calismamizda ozellikle serum urik asit seviyesinin artisi karacigerdeki yaglanmanin derecesi ile dogrudan baglantili bulunmustur. Bundan yola cikarak, serum urik asit seviyesi artisinin, NAYKH’nin patogenezinde rol oynayabilecegini dusunmekteyiz. Anahtar sozcukler: Metabolik sendrom, karaciger yaglanmasi, urik asit Abstract Aim. The purpose of this study is to investigate the frequency of non-alcoholic fatty liver disease (NAFLD) in patients diagnosed as metabolic syndrome (MS) and also to find out its relation with serum uric acid levels. Methods. A total of 60 MS patients (26 male, 34 female) and 42 healthy individuals (21 male, 21 female) were included in the study. After a fasting period of 12 hours, serum glucose, triglyceride, high density lipoprotein, low density lipoprotein, uric acid and insulin levels were determined. HOMA-IR formula was used to determine insulin resistance. Ultrasonography was used in showing the grade of hepatosteatosis. Results. Mean serum uric acid level of the MS group was significantly higher than the control group in our study (p<0.05) and we observed that serum uric acid levels increase as the number of MS components increase. We found the frequency of hepatosteatosis in our metabolic syndrome patients to be 78.3%. Serum uric acid levels were significantly elevated in these patients and this elevation showed a positive correlation with the grade of hepatosteatosis. Conclusion. There is a close relationship between MS and serum uric acid levels and also with NAFLD. Especially the increase in serum uric acid levels were found to be directly related with the degree of hepatosteatosis. Relying on this fact; we think that the increased uric acid levels in MS patients could have played a role in the NAFLD pathogenesis. Keywords: Metabolic syndrome, hepatosteatosis, uric acid