Nuri Erdogan

Ocular blood flow in patients with obstructive sleep apnea syndrome (OSAS).

BackgroundSleep-related disorders are among the important risk factors for neurovascular diseases. Obstructive sleep apnea syndrome (OSAS) is characterized by snoring, excessive daytime sleepiness, and insomnia. Our aim was to investigate the presence of glaucoma in patients with OSAS and to reveal vascular pathology related to the pathogenesis of glaucoma in those patients.Patients and methodsThe study included 31 patients with OSAS and 25 control subjects. Orbital Doppler ultrasonography was used to determine the resistivity index (RI) in the ophthalmic artery and central retinal artery. All patients and controls underwent perimetric examination.ResultsThe prevalence of glaucoma in the group of patients with OSAS was 12.9% (4/31); all of these 4 patients with glaucoma were in the “severe” OSAS group. No statistically significant difference was found between ophthalmic artery resistivity index (OARI), central retinal artery resistivity index (CRARI), and intraocular pressure (IOP) between patients and controls (p > 0.05). There was a positive correlation between OARI and mean defect (MD), CRARI and MD, and CRARI and loss variance (LV) values (p < 0.05). There was also a positive correlation between IOP and the apnea-hypopnea index (AHI) (p = 0.001).ConclusionsIn patients with OSAS, a high prevalence was found and it is interesting to note that all of the four glaucoma patients were in the severe OSAS group. The positive correlation observed between IOP and AHI suggests that increased IOP values may reflect the severity of OSAS. The positive correlation between OARI and MD and also between CRARI and MD as well as LV suggests that visual field defects may be due to optic nerve perfusion defects and these field defects also increase as the RI increases.

Prevalence of epididymal, seminal vesicle, prostate, and testicular cysts in autosomal dominant polycystic kidney disease

OBJECTIVES To assess the prevalence of cysts in the epididymis, seminal vesicles, prostate, and testes of patients with autosomal dominant polycystic kidney disease (ADPKD) and determine their clinical significance. Extrarenal cystic involvement is a well-known manifestation of ADPKD. Although a few reports exist about cysts in the epididymis, seminal vesicles, prostate, and testes, the true prevalence of cysts in these organs is not well known. METHODS A prospective study, consisting of 104 male patients and 62 male controls, was designed at three medical centers to evaluate the prevalence of epididymal, seminal vesicle, prostatic, and testicular cysts in patients with ADPKD by abdominal, transrectal, and scrotal ultrasound examinations. RESULTS Among the 104 patients, epididymal cysts were present in 19 (18%), seminal vesicle cysts were present in 41 (39%), and prostatic cysts were present in 7 patients (7%); the proportion in the control group was 24% (P >0.05), 2% (P <0.01), and 5% (P >0.05), respectively. Testicular cysts were detected in only 3 control patients. Of the 104 patients, 96 were married, and primary infertility was present in 5 patients (5%). CONCLUSIONS We suggest that seminal vesicle cysts are frequent in ADPKD; epididymal cysts are not uncommon in ADPKD, but the frequency is not higher than in the control group; ADPKD should be looked for in patients with seminal vesicle cysts; and additional studies are necessary to evaluate the association between epididymal and seminal vesicle cysts and infertility in patients with ADPKD.

Effect of age, breast size, menopausal and hormonal status on mammographic skin thickness.

Background/purpose: The localized or generalized skin thickness detected on mammography may reflect an underlying pathology of breast or a systemic disease involving the skin. The aim of this report is to describe the range of normal breast skin thickness in women using a film‐screen mammographic technique.

CT anatomy of pterygopalatine fossa and its communications: a pictorial review

In this article, we present a pictorial review computed tomography (CT) anatomy of pterygopalatine fossa and its communications. Since it represents a major pathway for spread of inflammatory or neoplastic disease between the various compartments, being familiar with the high resolution CT appearance of pterygopalatine fossa and its communications is necessary in selected cases. The diagnostic difficulties in determining the intercompartmental spread is discussed.

In vivo nephroprotective efficacy of propolis against contrast-induced nephropathy

PURPOSE Contrast agents administered in diagnostic imaging or interventional procedures of clinical radiology may cause contrast-induced nephropathy (CIN). Preventive measures against CIN involve pharmaceutical pretreatments, such as N-acetylcystein (NAC) or calpain, but alternative medicines can also be helpful. This study aims to assess the prospects of a natural compound, propolis, as a potential nephroprotector against a specific contrast agent, diatrizoate. METHODS In vivo experiments were performed on 35 male rats in five groups: control, diatrizoate alone, and pretreatments with propolis, NAC, or calpain one hour before diatrizoate administration. Three days later, blood and renal tissue samples were collected and quantitatively processed for determining induced changes in critical biomarkers malondialdehyde (MDA), glutathione (GSH), glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), and catalase (CAT), as well as serum creatinine and plasma urea. RESULTS Diatrizoate increased creatinine (113%), urea (400%), and MDA (162%) levels and decreased GSH (-71%), SOD (-69%), GSH-Px (-77%), and CAT (-73%) levels. Evaluating the response of each pretreatment provided sufficient evidence that propolis was as effective as either NAC or calpain, but consistently more prominent in restoring the MDA, GSH, SOD, and GSH-Px levels close to their normal range. This outcome demonstrated the nephroprotective effect of propolis against CIN. CONCLUSION Propolis protects renal tissue against toxicity, free radicals, and other adverse effects induced by diatrizoate. This function is most likely exerted through the antioxidant and antitoxic activities of propolis.

Color Doppler Imaging of Ocular Hemodynamic Changes in Behçet Disease and Uveitis Patients with Different Etiologies

Purpose: To investigate blood flow velocity changes and resistivity index values of orbital vessels in Behçet disease with or without ocular involvement, in uveitis patients with different etiologies, and in healthy volunteers. Methods: Subjects were divided into four groups: those with ocular involvement in Behçet disease (group I), those without ocular involvement in Behçet disease (group II), uveitis patients with different etiologies (group III), and a control group (group IV). Twenty-seven eyes in group I, 14 eyes in group II, 25 eyes in group III, and 27 eyes in group IV were investigated. The blood flow in the central retinal artery (CRA), ophthalmic artery (OA), nasal posterior ciliary artery (NPCA), and the temporal posterior ciliary artery (TPCA) was measured using color Doppler ultrasonography (CDU) to determine the peak systolic velocity (PSV), end diastolic velocity (EDV), and resistivity index (RI). Results: The PSV and EDV value of CRA in groups I, II, and III were found to be significantly lower than those in the control group (p < 0.05 for each). The PSV and EDV values of TPCA and NPCA in groups I, II, and III were significantly lower than those in the control group (p < 0.05 for each). Resistivity indexes of all arteries were higher in groups I, II, and III than the control group. The PSV and EDV in CRA, TPCA, and NPCA in Behçet disease patients with ocular involvement were significantly lower than all other groups (p < 0.05). Conclusions: There are significant reductions in the blood flow values of the orbital arteries in patients with Behçet disease and uveitis patients with different etiologies when compared with healthy volunteers. The decrease in blood flow values in Behçet disease is more evident in patients with ocular involvement than the patients without ocular involvement. This might be the result of occlusive vasculitis, which is frequently seen in the retinal vessels of patients with Behçet disease.

Common Bile Duct Stones Detected After Cholecystectomy:Advancement into the Duodenum via the Percutaneous Route

AbstractPurpose: To report our experience in the use of percutaneous extraction of common bile duct stones detected in the post-cholecystectomy period. Methods: Forty-two patients in whom endoscopic cannulation and/or sphincterotomy had failed or could not be done due to several reasons underwent balloon dilatation of the ampulla of Vater and subsequent advancement of the stones via the percutaneous transhepatic route or T-tube tract. Results: The procedure was successful in 42 cases. In three patients, stones were crushed in the common bile duct and pushed as fragments into the duodenum. In all cases transient adverse effects were observed. There were no major complications. All cases were checked with ultrasonography for 6 months after the procedure. Conclusion: Percutaneous extraction of common bile duct stones is an effective method of treatment with a high success rate, low complication rate and shorter hospital stay. It may serve as an alternative method in cases where endoscopic removal of stones fails.

Preferences of referring physicians regarding the role of radiologists as direct communicators of test results.

PURPOSE Currently, there is a growing need for patient-centered radiology in which radiologists communicate with patients directly. The aim of this study is to investigate the preferences of referring physicians (RPs) regarding direct communication between radiologists and patients. METHODS This study was conducted in a single academic hospital using a survey form. The survey items investigated the preferences of RPs regarding: 1. who should be the communicator of test results when a patient with abnormal findings requests information (the options were the radiologist; another health professional with communication skills training (CST); and the RP with CST); and 2. how the communication activity should be conducted if the radiologist is obliged (or chooses) to communicate with the patient directly (the options were that the disclosure should be limited to the findings in the radiology report; the radiologist should emphasize that the RP is the primary physician; and the communication activity should be conducted in accordance with guidelines established by consensus). The respondents were 101 RPs from various fields of specialty; they were asked to rate the items using a 5-point Likert scale. The effects of age, sex, field of specialty (surgical vs. nonsurgical), and total years of experience as a medical specialist on the ratings were statistically compared. RESULTS Most RPs preferred that the radiologist transmit the information to the RP without communicating directly with the patient (89.1%). Although 69.3% of the RPs declared that health professionals with CST have priority in communication, 86.1% declared that the RP should be the person who received CST. If the radiologist communicates with patients directly, the RPs favored that 1. the disclosure should be limited to the findings in the radiology report (95%); 2. the communication activity should include an emphasis on the RP as the patients primary agent (84.1%); and 3. communication should be conducted in accordance with guidelines established by consensus (73.2%). The percentage of strong opinions did not change significantly with regard to age, sex, field of specialty, or total years of experience, except that surgeons expressed strong disagreement with delegating the communication activity to another health professional who received CST (χ² = 9.9; P = 0.042). CONCLUSION These findings may serve as a basis to implement institutional and national policies for patient-centered radiology.

Stereologic orbital volume measurements in zygomatic fractures.

PURPOSE To evaluate the efficacy of stereologic methods to measure the orbital volume using computed tomography images of patients with zygomatic fractures. MATERIALS AND METHODS The present study was retrospectively conducted using hard-copy computed tomography images acquired during the postoperative period of 22 patients with unilateral zygomatic fractures. Orbital volume measurements were performed on the surgically treated and contralateral normal orbits using stereologic methods. The estimates obtained from both sides were compared statistically using the paired samples t test. The measurements were repeated by 2 different observers to estimate the interobserver variability. RESULTS When both observers were taken into account, the mean volume in the normal and surgically treated orbits was 23.6 +/- 3.2 and 24.4 +/- 3.1 cm(3), respectively. A statistically significant difference was noted between the surgically treated and normal orbits (P < .05). The volumes of 16 treated orbits were enlarged by 5.8% +/- 3.8% and 6 were diminished by 2.7% +/- 1.4%. A very high statistical correlation was noted between the 2 observers (R > .95). The total time consumed for calculation in each patient (2 orbits) was 9 to 12 minutes. CONCLUSIONS Stereologic estimation of the orbital volume is an easy, practical, and time-saving procedure that can be performed on readily available, hard-copy computed tomography images. The high interobserver agreement observed in our study shows that it can be safely used in the quantitative detection of preoperative and postoperative volume changes.

Denoising of arterial and venous Doppler signals using discrete wavelet transform: Effect on clinical parameters

In this paper, the effects of a wavelet transform based denoising strategy on clinical Doppler parameters are analyzed. The study scheme included: (a) Acquisition of arterial and venous Doppler signals by sampling the audio output of an ultrasound scanner from 20 healthy volunteers, (b) Noise reduction via decomposition of the signals through discrete wavelet transform, (c) Spectral analysis of noisy and noise-free signals with short time Fourier transform, (d) Curve fitting to spectrograms, (e) Calculation of clinical Doppler parameters, (f) Statistical comparison of parameters obtained from noisy and noise-free signals. The decomposition level was selected as the highest level at which the maximum power spectral density and its corresponding frequency were preserved. In all subjects, noise-free spectrograms had smoother trace with less ripples. In both arterial and venous spectrograms, denoising resulted in a significant decrease in the maximum (systolic) and mean frequency, with no statistical difference in the minimum (diastolic) frequency. In arterial signals, this leads to a significant decrease in the calculated parameters such as Systolic/Diastolic Velocity Ratio, Resistivity Index, Pulsatility Index and Acceleration Time. Acceleration Index did not change significantly. Despite a successful denoising, the effects of wavelet decomposition on high frequency components in the Doppler signal should be challenged by comparison with reference data, or, through clinical investigations.