Onur Ergun

Bronchial to Coronary Artery Fistulas: An Important Sign of Silent Coronary Artery Disease and Potential Complication during Bronchial Artery Embolization

Coronary artery fistulas are rare and usually asymptomatic congenital anomalies generally diagnosed incidentally during coronary angiographies. Herein, we present a case of bronchial to coronary artery fistula which was diagnosed incidentally during bronchial artery embolization. Embolization was performed successfully without complication, and an underlying important coronary artery stenosis was subsequently found by coronary computed tomography angiography.

Covered Stent-Graft Treatment of a Postoperative Common Carotid Artery Pseudoaneurysm

Background Extracranial carotid artery pseudoaneurysms are rare cases resulting from trauma, mycotic infection, head and neck carcinomas or complications related to their treatment. Trauma is the most common cause of carotid artery pseudoaneurysms. They can also present after surgery, most commonly following endarterectomy, which is a rare cause with an estimated incidence of 0.3–0.6%. Case Report A 26-year-old male patient was admitted with swelling in his left neck after left carotid endarterectomy. Angiography confirmed pseudoaneursym in the left carotid bulb and it was treated successfully with two heparin-bonded covered stent grafts. Conclusions Endovascular treatment of carotid pseudoaneurysms with covered stent-grafts is a safe and efficient method providing definitive arterial reconstruction. But series with longer follow-up periods are needed to evaluate patient compatibility to lifelong antiplatelet theraphy.

Cystic schwannoma of the axillary region: imaging findings of a rare disease. Case report.

Schwannomas are well capsulated, benign, and slowly growing tumors which originate from Schwann cells of peripheral nerve sheath. The incidence of schwannomanas in the axillary region is not common. This rarity causes misdiagnosis at the radiological evaluation. In this case we present the imaging and histopathological findings of a cystic schwannoma located in the axillary fossa of a 47-year-old female patient mimicking complex cyst, lymphadenopathy or hydatid cyst in radiological evaluation. Although lymphadenopathy, lymphatic malformation, lipoma, cyst, hidradenitis suppurativa or dermatofibroma are the most frequent lesions to be considered, peripheral nerve sheath should also be kept in mind in the differential diagnosis of axillary masses.

The effect of early routine grommet insertion on management of otitis media with effusion in children with cleft palate.

PURPOSE The aim of the study is to compare long term otoscopic and audiological findings of cleft palate patients with or without early grommet insertion. METHODS Cleft palate patients followed-up in Hacettepe University between 2008 and 2013 were included in the study. Age, gender, cleft types and palate surgery data, grommet tube insertion history and otological - audiological evaluations of the patients were recorded. Patients were evaluated in three groups according to grommet insertion history: A-early routine grommet insertion, B-grommet insertion during follow-up, C-no grommet insertion. Otological and audiological findings were compared. RESULTS There were 154 patients in the study, with a median age of 7.7 years. There were 67 patients in group A (43.5%), 22 patients in group B (14.3%) and 65 patients in group C (42.2%). OME was identified significantly higher in group A and normal otoscopic examination findings were higher in group C. Complications showed a higher rate than other otoscopic findings in group B patients. There was no significant difference for any frequencies in between the groups in terms of mean air-bone gap (ABG) values. There were 20 grade I, 25 grade II, 77 grade III and 32 grade IV patients in the study according to the Veau classification. CONCLUSION Prophylactic grommet insertion may not be applied as some cleft palate patients with no OME. Wait and see protocol can be recommended for these patients, and they should be followed-up up closely to avoid complications. If the effusion does not recover or tympanic membrane changes occur in follow-up, grommet insertion should be considered.

Angiographic evaluation of branching pattern and anatomy of the aortic arch

OBJECTIVE The study aimed to investigate anatomical variations in branching pattern and anatomy of the aortic arch, and the prevalence of each type. METHODS Between September 2011 and November 2013, angiographic studies of 270 patients (144 male, 126 female) were analyzed retrospectively for variations in branching pattern and anatomy of the aortic arch. Patient mean age was 59.8 years (range, 13-88). Branching variations were found and divided into subtypes. Patients were also classified according to arch anatomy. Incidence of variations and types of aortic arch were statistically analysed. RESULTS Analysis of the 270 patients revealed six types of branching pattern. Type I, classical pattern arch with three branches (TB, LCC, LS), was observed in 198 cases (73.3%). Type II (bovine arch), the most commonly observed variation, in which LCC originates from TB, was observed in 58 cases (21.5%). Type III, in which the left vertebral artery arises from the arch, was seen in seven cases (2.6%). Type IV, a combination of types II and III, was observed in three cases (1.1%). Type V, common origin of common carotids, LS and aberrant RS, was found in three cases (1.1%). Type VI (avian type), arch with only two branches, was observed in one case (0.4%). When patients were classified according to aortic arch anatomy, Type 1, Type 2 and Type 3 were observed in 195, 40 and 35 patients respectively. CONCLUSION Knowledge of the variations and anatomy of the aortic arch is essential during interventional procedures and neck-thorax surgery.

Shear Wave Sonoelastography Findings of Testicles in Chronic Kidney Disease Patients Who Undergo Hemodialysis

OBJECTIVE Chronic kidney disease (CKD) is known to cause significant deterioration in the function of the testicles and sexual dysfunction in male patients who undergo hemodialysis. The aim of this study was to show the changes in the testicles that occur as a result of hypogonadism secondary to CKD and to analyze the elasticity of the parenchyma by shear wave sonoelastography. MATERIALS AND METHODS In our study we included 28 male patients who undergo dialysis three times per week and 25 healthy volunteers. Firstly, B-mode ultrasonographic evaluation was performed in both testicles for structural analysis and to detect the presence of focal lesions. Afterward, the stiffness of the parenchyma was measured in kilopascals by shear wave sonoelastography. RESULTS The CKD group had lower right, left, and mean testicular volumes (p<0.001). The CKD group also displayed greater right, left, and mean testicular parenchymal stiffness (p<0.001). CONCLUSION CKD patients who undergo hemodialysis demonstrated significant changes in testicular size and stiffness in comparison to healthy volunteers.

[The effect of clinical, laboratory and radiologic results on treatment decision and surgical results in patients admitted to the emergency department with blunt abdominal trauma due to traffic accident].

BACKGROUND The purpose of this study was to evaluate the effect of clinical, laboratory and radiological results on treatment decision and surgical results in patients with blunt abdominal trauma, who were admitted to the emergency department due to traffic accident. METHODS Two hundred and twenty-two patients with blunt abdominal trauma were included into this retrospective study. Pearson chi square, Mann-Whitney U test and logistic regression methods were used for statistical analysis. RESULTS All patients were analyzed by complete blood count and biochemistry and abdominal sonography. Eighty-two patients were also evaluated by CT. Twenty-three patients underwent surgery. Positive findings on physical examination, sonography and CT, increased white blood cell count and liver function tests, decreased hemoglobin were associated with the need for surgery. DISCUSSION For the surgical evaluation of patients with blunt abdominal trauma, a reliable physical examination is not possible when the patients have concomitant injuries causing disturbing pain, or when the patients are unconscious. Laboratory tests should be interpreted with the clinical and radiologic analysis. Radiologic procedures play an important role in the management of patients with blunt abdominal trauma, especially for intubated patients.

Ruptured Iliac Artery Aneurysm Coincident with Polycystic Kidney

A 75-year-old man was admitted to the emergency room due to three day history of right lower quadrant pain. On physical examination, he had abdominal tenderness. He had a past medical history of bilaterally enlarged polycystic kidneys and a polycystic liver (Figure 1). A computed tomogram with contrast showed a 6 cm aneurysm of the right thrombosed internal iliac artery aneurysm (IIAA) and large (approximately 12cm) retroperitoneal haematoma formation anterior to the aneurysm (Figure 2). The patient underwent an immediate laparotomy as he became unstable. Intra-operative findings confirmed rupture of the right IIAA and aneurysm was ligated proximally. Isolated IIAA is rare. Unless rupture occurs, they usually remain asymptomatic. Autosomal dominant polycystic kidney disease (ADPKD) has been associated with several aneurysms, most notably intracranial, but not internal iliac. We present a patient with ruptured IIAA as coincident with ADPKD. IIAA presents late with signs and symptoms of an acute abdomen or local compressive symptoms and has a high incidence of rupture because of its location and being asymptomatic. In addition, the mortality rates (60%) are high. Therefore, in the differential diagnosis of right lower quadrant pain, ruptured IIAA especially in patients with ADPKD should be kept in mind .

Value of duplex Doppler ultrasonography for the evaluation of dysfunctional hemodialysis access arteriovenous fistulas prior to endovascular interventions

To demonstrate accuracy of duplex Doppler ultrasonography (DUS) for the evaluation of native‐vein arteriovenous fistula (AVF) dysfunction in end‐stage renal disease patients.

Pelvic abscess drainage: outcome with factors affecting the clinical success

PURPOSE We aimed to evaluate the success and complication rates of image-guided pelvic abscess drainage with emphasis on factors affecting the clinical success. METHODS During a 7-year period, 185 pelvic abscesses were treated in 163 patients under ultrasonography and fluoroscopy (n=140) or computed tomography (n=45) guidance with transabdominal (n=107), transvaginal (n=39), transrectal (n=21) and transgluteal (n=18) approaches. Abscess characteristics (etiology, number, size, intrastructure, microbiological content, presence of fistula), patient demographics (age, sex, presence of malignancy, primary disease, antibiotic treatments), procedure-related factors (guidance method, access route, catheter size) and their effects on clinical success, complications, and duration of catheterization were statistically analyzed. RESULTS Technical and clinical success rates were 100% and 93.9%, respectively. Procedure-related mortality or major complications were not observed. Minor complications such as catheter dislodgement, obstruction, or kinking were detected in 6.7% of the patients. Clinical failure was observed in 10 patients (6.1%). Fistulization was observed in 14 abscesses. Fistulization extended the duration of catheter use (P < 0.001) and decreased the clinical success rate (P < 0.001). The presence of postoperative malignant, complex-multilocular abscesses, and fungus infection in the cavity extended catheter duration (P < 0.001, P = 0.018, and P = 0.007, respectively), whereas the presence of sterile abscess and endocavitary catheterization reduced the catheter duration (P = 0.009 and P = 0.011, respectively). CONCLUSION Image-guided pelvic abscess drainage has high clinical success and low complication rates. The only factor affecting the clinical success rate is the presence of fistula.