Omer Fatih Nas

Choosing the appropriate side for subcutaneous port catheter placement in patients with mastectomy: ipsilateral or contralateral?

PurposeTo evaluate long-term clinical follow-up results of implanting subcutaneous port catheters (SPCs) on ipsilateral or contralateral with mastectomy side in patients with axillary lymph node dissection.MethodsA total of 73 patients composed of ipsilateral (34 catheters) and contralateral (39 catheters) groups, with SPCs were included. All patients had lumpectomy or modified radical mastectomy for breast cancer. Ipsilateral and contralateral groups had similar patient characteristics.ResultsFive late complications were seen in the ipsilateral group and 2 late complications in the contralateral group. No statistical significant difference was seen between two groups in regard to late complications. Four complications of the ipsilateral group were classified as major group C and 1 as major group D, while 1 complication of the contralateral group was classified as minor group B and 1 as major group C according to Society of Interventional Radiology (SIR) classification. No statistical significant difference was seen between complication rates of two groups in regard to SIR classification.ConclusionsSPC related complications do not differ in regard to ipsilateral or contralateral side selection on mastectomized patients with breast cancer and lymph node dissection. SPCs can be implanted on ipsilateral or contralateral sides of the operation in these patients.

Effectiveness of percutaneous vertebroplasty in patients with multiple myeloma having vertebral pain

PURPOSE We aimed to assess the effectiveness, benefits, and reliability of percutaneous vertebroplasty (PV) in patients with vertebral involvement of multiple myeloma. METHODS PV procedures performed on 166 vertebrae of 41 patients with multiple myeloma were retrospectively evaluated. Most of our patients were using level 3 (moderate to severe pain) analgesics. Magnetic resonance imaging was performed before the procedure to assess vertebral involvement of multiple myeloma. The following variables were evaluated: affected vertebral levels, loss of vertebral body height, polymethylmethacrylate (PMMA) cement amount applied to the vertebral body during PV, PMMA cement leakages, and pain before and after PV as assessed by a visual analogue scale (VAS). RESULTS Median VAS scores of patients decreased from 9 one day before PV, to 6 one day after the procedure, to 3 one week after the procedure, and eventually to 1 three months after the procedure (P < 0.001). During the PV procedure, cement leakage was observed at 68 vertebral levels (41%). The median value of PMMA applied to the vertebral body was 6 mL. CONCLUSION Being a minimally invasive and easily performed procedure with low complication rates, PV should be preferred for serious back pain of multiple myeloma patients.

Rare use of twin Solitaire® stents in the double waffle-cone technique for endovascular treatment of a wide-necked bifurcation aneurysm

Endovascular treatment of wide-necked bifurcation aneurysms may be challenging. The waffle-cone technique can be used in these aneurysms in case of acute angulation between parent artery and distal artery of the aneurysm. Solitaire® stent (Ev3, Irvine, CA, USA) has the significant advantage of mitigating the potential complication risks. This study reports the second case in the literature in which endovascular treatment of a wide-necked bifurcation aneurysm with the double waffle-cone technique by using twin Solitaire® stents proved to be successful.

Single-stage endovascular treatment in patients with severe extracranial large vessel stenosis and concomitant ipsilateral unruptured intracranial aneurysm.

PURPOSE We aimed to evaluate the safety and effectiveness of single-stage endovascular treatment in patients with severe extracranial large vessel stenosis and concomitant ipsilateral unruptured intracranial aneurysm. METHODS Hospital database was screened for patients who underwent single-stage endovascular treatment between February 2008 and June 2013 and seven patients were identified. The procedures included unilateral carotid artery stenting (CAS) (n=4), bilateral CAS (n=2), and proximal left subclavian artery stenting (n=1) along with ipsilateral intracranial aneurysm treatment (n=7). The mean internal carotid artery stenosis was 81.6% (range, 70%-95%), and the subclavian artery stenosis was 90%. All aneurysms were unruptured. The mean aneurysm diameter was 7.7 mm (range, 5-13 mm). The aneurysms were ipsilateral to the internal carotid artery stenosis (internal carotid artery aneurysm) in five patients, and in the anterior communicating artery in one patient. The patient with subclavian artery stenosis had a fenestration aneurysm in the proximal basilar artery. Stenting of the extracranial large vessel stenosis was performed before aneurysm treatment in all patients. In two patients who underwent bilateral CAS, the contralateral carotid artery stenosis, which had no aneurysm distally, was treated initially. RESULTS There were no procedure-related complications or technical failure. The mean clinical follow-up period was 18 months (range, 9-34 months). One patient who underwent unilateral CAS experienced contralateral transient ischemic attack during the clinical follow-up. There was no restenosis on six-month follow-up angiograms, and all aneurysms were adequately occluded. CONCLUSION A single-stage procedure appears to be feasible for treatment of patients with severe extracranial large vessel stenosis and concomitant ipsilateral intracranial aneurysm.

Contribution of thin slice (1 mm) oblique coronal proton density-weighted MR images for assessment of anteromedial and posterolateral bundle damage in anterior cruciate ligament injuries.

PURPOSE To evaluate the diagnostic efficacy of using additional oblique coronal 1 mm proton density-weighted (PDW) MR imaging of the knee for detection and grading anterior cruciate ligament (ACL), anteromedial bundle (AMB) and posterolateral bundle (PLB) injuries. MATERIALS AND METHODS We prospectively assessed preoperative MR images of 50 patients (36 men, 14 women; age range, 18-62 years). First, we compared the diagnostic performance of routine sagittal (3 mm) and additional oblique coronal images (1 mm) for ACL tears. Then, we compared the tear types (AMB or PLB) and grade presumed from oblique coronal MR imaging with arthroscopy. RESULTS Arthroscopy revealed ACL tear in 24 (48%) patients. There was significant difference between sagittal images and arthroscopy results for ACL tear recognition (p<0.001). No significant difference was detected for oblique coronal images when compared with arthroscopy results (p=0.180). Sensitivity and specificity values for ACL tear diagnosis were 37.04% and 95.65% for sagittal images; 74.07% and 91.30% for oblique coronal images. There was no significant difference between arthroscopy and oblique coronal MR images in grading AMB and PLB injuries (p>0.05). CONCLUSION Addition of thin slice oblique coronal images to conventional sequences could better contribute to better verifying the presence of ACL tear and in determining its grade.

Spontaneous occlusion of cerebral arteriovenous malformation following partial embolization with Onyx.

Management options for brain arteriovenous malformations (AVMs) are surgery, radiosurgery, and endovascular embolization. The aim of partial embolization in endovascular treatment is to make total resection possible. However, increased risk of bleeding in partial embolization creates some controversies about treatment options. Spontaneous total occlusion of cerebral AVMs following partial obliteration with embolization agents is a rarely seen condition. We present a case with an AVM vanishing from right posterior cerebral artery which spontaneously occluded following partial embolization with Onyx liquid agent.

The effect of gigantomasty on vertebral degeneration: A computed tomography study

The main reason for waist and back pain in patients with gigantomasty is increased thoracic kyphosis and lumber lordosis. These symptoms and abnormal spinal angulations regress after reduction mammoplasty operations. However, the effect of chronic mechanical stress caused by gigantomasty on the spinal degenerative process is not clear yet. In this study with computed tomography it is shown that degenerative spondylosis is more widespread and severe in patients with large breasts.

Selective bilateral renal artery embolization with tris-acryl microspheres in focal segmental glomerulosclerosis

Renal artery embolization (RAE) was originally used only in patients with symptomatic hematuria and palliation of metastatic renal cancer. Nowadays, RAE is used for the treatment of renal medical diseases, renal lesions such as angiomyolipoma [1,2] and vascular malformations and for preoperative reduction of vascularization of renal masses. RAE is getting more popular due to its minimally invasive nature. Various embolization agents are used in RAE; the most frequently used are metallic microcoils. Additionally polyvinyl alcohol (PVA), ethanol, gelatin sponge and trisacryl gelatin microspheres can be used as well [2]. Primary focal segmental glomerulosclerosis (PFSGS) is the cause of 20—30% of nephrotic syndrome in the adult population. It is the most common cause of idiopathic glomerular diseases and nephrotic proteinuria. More than 50% of these may progress to end-stage renal disease (ESRD) in 5—10 years

Opacification of nondilated bile ducts through the gallbladder as an aid to percutaneous transhepatic biliary drainage

PURPOSE The purpose of this study was to retrospectively assess the potential of percutaneous transhepatic biliary drainage (PTBD) in patients with nondilated bile ducts (NDBD) using a transgallbladder opacification of the bile ducts. PATIENTS AND METHODS Eight patients with NDBD (7 men, 1 women; median age, 65 years; Q1-Q3, 35-69 years; range, 22-77 years) who underwent PTBD after opacification of the bile ducts through the gallbladder were evaluated. Opacification of NDBD was performed using a retrograde injection of contrast material through the gallbladder. The opacified peripheral NDBD was punctured percutaneously and a drainage catheter was introduced under fluoroscopy guidance. The success and safety of the procedure were assessed. RESULTS PTBD could be achieved in 6/8 patients (75%) and no significant complications were observed. The biliary tree opacification was attempted but could not be achieved due to biliary sludge that obstructed the cystic duct in 2/8 patients (25%). Two minor complications in two different patients were observed consisting of transient hemobilia and chills. CONCLUSION Opacification of the bile ducts using a transgallbladder approach appears to be a safe and successful procedure for PTBD in patients with NDBD.

Percutaneous Coil Embolization for the Treatment of a Giant Brachial Artery Pseudoaneurym in a Child

Brachial artery pseudoaneurysm is a rare phenomenon. When a diagnosis of brachial artery pseudoaneurysm is established, early and appropriate treatment should be performed as soon as possible to prevent possible complications, such as hemorrhage, rupture, and upper limb and finger losses. Open surgical repair is usually the cornerstone of treatment; however, we here report a case of giant brachial pseudoaneurysm in a 2-year-old girl, which was successfully treated with percutaneous coil embolization.