Muzaffer Saglam

The effect of obstructive sleep apnea on olfactory functions.

The aim of this study was to investigate the effect of obstructive sleep apnea (OSA) on the parameters of olfactory functions (odor threshold, odor discrimination, and odor identification tests) for orthonasal olfaction, retronasal olfactory testing, and olfactory bulb (OB) volumes.

The incidence of left atrial diverticula in coronary CT angiography

PURPOSE The aim of this study was to characterize the frequency and location of left atrial diverticula by using multidetector computed tomography (MDCT). MATERIALS AND METHODS Cardiac imaging was performed for 454 patients using 64MDCT. Most patients were being examined for coronary artery disease. All images were interpreted by two radiologists on a three-dimensional workstation using multiplanar reformatting, maximum intensity projection, and volumerendering. Diverticula were characterized by localization and diameter. RESULTS A total of 207 atrial diverticula were diagnosed in 186 (41%) of the 454 patients in this study. The diameters of left atrial diverticula ranged from 2 mm to 16 mm, with an average diameter of 5.2 mm. Left atrial diverticula were located anterosuperiorly in 166 patients (36.6%), anteriorly in four patients (0.9%), anteroinferiorly in three patients (0.7%), inferolaterally in one patient (0.2%), inferomedially in two patients (0.4%), laterally in two patients (0.4%), posterosuperiorly in one patient (0.2%), and superiorly in seven patients (1.5%). CONCLUSION Left atrial diverticula are frequently detected during routine cardiac computed tomography angiography examinations. From the Departments of Radiology, and Cardiology, GATA Haydarpasa Teaching Hospital, İstanbul, Turkey.

Optimized imaging techniques for testicular masses: fast and with high accuracy

SummaryObjectiveThe purpose of this study is to determine the effectiveness of the diffusion-weighted magnetic resonance imaging (DWI) of the differentiation of benign and malignant testicular masses.MethodsFifteen male patients who admitted to our clinic with the diagnosis of testicular mass detected by ultrasound were enrolled to this study. The patients were between 20 and 61 years old (mean 25.7). Apparent diffusion coefficient (ADC) values were measured from ADC maps of lesion and normal testicular tissue. In addition, mean signal intensity (SI) measurements were obtained by using b: 1,000 of normal testicular tissue and lesion with three regions of interest (ROI). SI ratio values are obtained by dividing the value lesion SI to the normal testicular parenchyma SI. Histopathology of orchiectomy materials and ADC values and lesion SI rates were compared statistically.ResultsThere were no significant correlation (p = 0.97) between ADC values of benign and malign lesions and histopathological diagnosis in Student’s t test. There were statistically significant relationship with the histopathology of the lesion and the SI ratio in Student’s t test (p = 0.027).ConclusionsDWI is an effective method in differentiation of benign and malignant testicular masses. Important information can be obtained about nature of testis masses with quantitative measurements of the ADC and ratio of SI.ZusammenfassungZielDer Zweck dieser Studie ist es, die Wertigkeit der Diffusions-gewichteten Magnetresonanz Bildgebung (DMB) in der Differenzierung von benignen und malignen Hodentumoren zu erfassen.MethodikFünfzehn Männer, die an unsere Klinik mit im Ultraschall festgestellten Hodentumoren zugewiesen worden waren, wurden in die Studie aufgenommen. Das Alter der Patienten lag zwischen 20 und 61 Jahren (im Mittel 25,7). Apparente Diffusionskoeffizienten (ADK) wurden von Gebieten der Läsion und vom normalen Hodengewebe gemessen. Zusätzlich wurde Messungen der mittleren Signalintensität (SI) von Gebieten der Tumoren mit drei regions of interest (ROI) und vom normalen Hodengewebe durchgeführt. Die SI Quotienten wurden durch Division des SI Werte, die über der Läsion erhoben wurden, durch die im normalen Hodenparenchym gemessenen errechnet. Die Pathohistologie des Orchiektomie Materials wurden mit den ADK sowie mit den Tumor SI Quotienten statistisch verglichen.ErgebnisseIm Student’s t-Test bestand keine signifikante Beziehung (p = 0,97) zwischen den ADK Werten und den benignen, beziehungsweise den malignen Tumoren. Die Beziehung zwischen dem pathohistologischem Ergebnis und den SI Quotienten war im Student t-Test signifikant (p = 0,027).SchlussfolgerungenDie DMB ist eine Methode, die zur Differenzierung von malignen und benignen Hodentumoren gut geeignet ist. Wichtige Informationen über die Art des Hodentumors können mit quantitativen Messungen der ADK und den SI Quotienten gewonnen worden.

Two Different Presentations of Sinus of Valsalva Aneurysm

Sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly that can be congenital or acquired. We report 2 cases of SVA. The first case involves a 59‐year‐old male presenting with frequent syncope. Echocardiogram revealed a large right SVA obstructing the right ventricular outflow tract (RVOT). The second case involves a 21‐year‐old female presenting with sudden onset chest pain and a continuous machinery murmur. Echocardiogram revealed a ruptured right SVA into the right atrium. Although advanced percutaneous techniques have been implemented in the correction of this anomaly, open‐heart surgery with or without aortic valve replacement remains the treatment of choice.

A new variation in coronary artery anatomy: type VII dual left anterior descending artery

A 53-year-old man presented with chest pain. Laboratory and electrocardiography findings were normal. Echocardiography showed a normokinetic wall motion with left ventricular ejection fraction at 60%. Coronary computed tomography angiography identified no evidence of atherosclerosis and stenosis. However, an aberrant long left anterior descending (LAD) artery originating from the right coronary sinus and a short LAD originating from the left main coronary artery (LMCA) were observed. After running from the right coronary sinus, the long LAD segment coursed intramyocardially within the septal crest and entered the anterior interventricular groove (AIVG) below the termination point of the short LAD. The short LAD terminated high in the AIVG after originating from the LMCA (Fig. 1A, B). The septal perforators originated from both short and long LAD, and the diagonal branches originated from the short LAD (Fig. 2A, B). Dual LAD is a rare anomaly and has been categorised into 6 subtypes based on the origin, course, and termination of the short and long LAD (Table 1) [Maroney J, Klein LW. Catheter Cardiovasc Interv, 2012; 80: 626–629]. Because of its influence on surgical or angiographic intervention strategies, recognition of this anomaly is important. In dual LAD, there are a short and a long LAD segments within the AIVG. The short LAD typically arises from the LMCA and terminates high in the AIVG. The long LAD may have a more variable origin, course around the short segment, and return to the AIVG distally [Spindola Franco H et al. Am Heart J, 1983; 105: 445–455; Agarwal PP, Kazerooni EA. Am J Roentgenol, 2008; 191: 1698–1701]. We present a novel type of dual LAD — type VII — which does not fit within the traditional classification system.

Minimizing the radiation dose in coronary CT angiography using prospective ECG-triggering, low tube voltage and iterative reconstruction technologies

We read with interest the article by Tomizawa about radiation doses in computed tomography (CT) coronary angiography [1]. We aimed to capture a cardiac image using an effective radiation dose of 0.34 mSv, with 320-slice multi-detector computed tomography (MDCT). The coronary tree was demonstrated in detail (Fig. 1). We achieved this result using prospective ECG-triggering, iterative reconstruction and a low tube voltage of 80 kVp because the patient was so slender (Fig. 2). Scanning was performed with a minimal phase window centered at 75 %. CT coronary angiography of the heart is the fastest imaging technique in cardiovascular imaging. The major concern about this modality is the radiation exposure to the patient. The 320-slice MDCT can image the heart in one heart beat with excellent image quality and a low radiation dose. 3D images with excellent spatial resolution demonstrate the coronary anatomy very clearly. Performing prospective ECG-triggering, low tube voltage imaging in non-obese patients, and the use of iterative reconstruction technologies may help to achieve a radiation dose smaller than 0.5 mSv [2]. MDCT must be the first choice of imaging for the investigation of coronary artery disease and anomalous coronary arteries, especially in young patients. Fig. 1 The median dose length product (DLP) of this MDCT cardiac imaging was 24.5 mGy cm (white box) that corresponds to an effective dose of 0.34 mSv (conversion factor: 0.014)

Coexistence of Left Ventricular Noncompaction and Aortic İnterruption

A 22-year-old male patient was admitted to our hospital cardiology service suffering from dyspnea on exertion. On his physical examination, there were a 2/4 diastolic murmur in aortic valve area and a 3/6 systolic murmur both in the apical region and through the posterior chest wall. ECG showed normal sinus rhythm and left ventricular hypertrophy criteria. Real time two and three-dimensional transthoracic echocardiography (TTE) showed a mild regurgitant bicuspid aortic valve and a spongy appearance of the left ventricular wall (Fig. 1A–D).There were also dilatation of ascending aorta and the hypoplasia of the distal part of aortic arch and the descending thoracic aorta. In accordance with these TTE findings, contrast-enhanced magnetic resonance imaging (MRI) of the heart and the computerized tomography angiography (CTA) of the thoracic aorta was performed to demonstrate the pathology and to make a further evaluation. Spongy appearance of the left ventricular wall compatible with left ventricular noncompaction was seen in his contrast-enhanced cardiac MRI (Fig. 1E). We saw also regurgitation through the aortic valve during systolic phase in MRI CINE Sequence and diffuse myocardial hypertrophy of the left ventricle. Interruption at the level of distal aortic arch and hypoplasia of the descending thoracic aorta was seen in his CTA (Fig. 1F,G). Because the interruption is located distal to the left subclavian artery, it is a type A aortic interruption (AI) according to the classification by Celoria and Patton. Dilatation of the ascending aorta and the collateral vascular structures were the additional findings in his CTA (Fig. 1H).

Pseudo-Meigs’ syndrome associated with struma ovarii

A 55-year-old woman presented to a gynaecologist with abdominal pain and postmenopausal bleeding. Her medical history included nothing of particular note. Physical examination revealed a mild abdominal distension and a palpable mass in the lower abdomen. The patients serum CA-125 level was 120 U/ml (normal value <30 U/ml), while the carcinoembryonic antigen, α-fetoprotein, CA-199, CA-153 and thyroid stimulating hormone levels were within the normal range. Gynaecological vaginal ultrasound showed mild ascites in her pelvis and an echogenic solid mass in the right ovary. Endometrial double wall thickness was measured as 1 cm. On abdominal CT, non-enhanced …

Another reason for abdominal pain: mesenteric panniculitis

A 50-year-old man was admitted to an emergency department with umbilical abdominal pain. His medical history included nothing of particular note. Physical examination revealed a mild abdominal distention and a palpable mass in the left upper quadrant. Laboratory tests only showed increased erythrocyte sedimentation rate (35 mm/h). Abdominal ultrasonography showed multiple mesenteric lymph nodes and increase in the mesenteric echogenicity. On contrast-enhanced abdominal CT imaging, a hyperattenuated fatty mass encasing a misty mesentery (non-specific sign, increased attenuation of the mesentery), multiple mesenteric …

The role of coronary CT angiography in diagnosis of patent foramen ovale.

PURPOSE We aimed to examine the incidence of patent foramen ovale (PFO) and atrial septal aneurysms (ASA) in the Turkish population using coronary computed tomography angiography (CTA); assess the feasibility of coronary CTA for PFO diagnosis by conducting a comparison with transthoracic echocardiography (TTE); and determine the diagnostic role and characteristics of the interatrial tunnel, free flap valve (FFV), and shunts. METHODS The present study was conducted retrospectively and included a sample of 782 patients. Coronary CTA results for all patients were evaluated for the following parameters: the presence of PFO, the degree of contrast jet (if present due to PFO), ASA existence, free flap valve (FFV) length, and PFO tunnel diameters (1 and 2). Coronary CTA and TTE results for PFO detection were also compared for 19 patients who underwent both procedures. RESULTS PFO was present in 118 patients (15%). In 19 patients who underwent both CTA and TTE, the shunt was present in 15 patients on TTE compared with nine patients on CTA. The sensitivity and specificity of CTA for shunt existence were 53% (8/15) and 75% (3/4), respectively. FFV was observed on CTA in 118 patients (15%). No significant relationship was observed between shunt existence and FFV length (P = 0.148), or between shunt existence and tunnel diameter-1 (P = 0.638) or diameter-2 (P = 0.058). ASAs were present in 16 patients (2%), while accompanying PFO was present in three patients (2.4%). CONCLUSION Coronary CTA constitutes a more practical and efficient alternative to TTE for PFO diagnosis. Further, it allows the clear visualization of anatomical details of the interatrial tunnel, shunts, and associated abnormalities and detects ASAs.