Orhan Solak

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.

Is It Possible to Anesthetize Palatal Tissues With Buccal 4% Articaine Injection?

PURPOSE The aim of this study was to evaluate the presence of probable diffused local anesthetic solution at and anesthesia of palatal tissues after buccal injection of 4% articaine hydrochloride (HCl) with 1:100,000 epinephrine or 1:200,000 epinephrine at the premolar and molar region. MATERIALS AND METHODS Thirty volunteers received maxillary buccal injections of 4% articaine HCl with 1:100,000 epinephrine or 1:200,000 epinephrine bilaterally to the first premolar or first molar. Magnetic resonance images were obtained before and 5 minutes after local anesthetic injections, and a visual evaluation was done to determine the presence of local anesthetic solution at palatal tissues. Anesthesia of palatal tissues after buccal injection was assessed by needle-prick stimulation pain with a visual analog scale (VAS). The Kruskal-Wallis test was used for comparison of the VAS values. RESULTS The visual evaluation of the magnetic resonance images did not show any signal change as an indicator of the presence of local anesthetic solution at the palatal region. Most of the volunteers described moderate or severe pain with needle-prick stimulation. The mean VAS score for needle-prick stimulation was 86.33 +/- 39.45 mm (1:100,000 epinephrine) and 87.0 +/- 36.28 mm (1:200,000 epinephrine) in the first premolar region and 57.20 +/- 46.69 mm (1:100,000 epinephrine) and 75.53 +/- 49.78 mm (1:200,000 epinephrine) in the molar region (P > .05). CONCLUSION We could not establish the presence of anesthesia or 4% articaine HCl at the palatal tissues after buccal injection. Maxillary tooth removal without palatal injection requires further objective investigations.

Effect of deferoxamine and sympathectomy on vasospasm following subarachnoid hemorrhage.

We examined the effects of subarachnoid hemorrhage (SAH) and treatment with deferoxamine (DFO) or sympathectomy on vascular smooth muscle function, as well as the underlying mechanisms involved, by recording the responses to nor-adrenaline and serotonin in isolated carotid arteries in vitro. All studies were performed before and 7 days after SAH. An experimental subarachnoid hemorrhage model was created in rabbits by injecting autologous arterial blood into the subarachnoid space of the rabbits via cisterna magna punction. During the chronic stage of vasospasm following SAH deferoxamine (DFO) was given to the animals and cervical and periarterial sympathectomy was performed in the other groups of animals. In isolated carotid arteries noradrenaline (10(-8) to 10(-4) mol/l) and serotonin (10(-8) to 10(-4) mol/l) produced concentration-dependent contractions. These contractile responses were significantly enhanced in animals 7 days after SAH compared to controls and did not return to control values in carotid arteries obtained from animals treated with DFO or sympathectomy for 7 days after SAH. These results show that SAH causes supersensitivity in the carotid as well as cerebral arteries during the first week after SAH and could contribute to the development of cerebral vasospasm. Both treatment with DFO and sympathectomy after SAH did not reduce the contractile responses to noradrenaline and serotonin in the carotid arteries. In conclusion, treatment with DFO or sympathectomy during the chronic stage of vasospasm after SAH did not affect the vascular responses of the extradural part of the carotid artery to vasoactive substances.

Determination of Lateral Ventricle and Brain Volume in Children with Stereological Method Using MRI

Aunque el desarrollo del cerebro es mas activo durante el periodo de la vida intrauterina, los procesos de mielinizacion y arborizacion afectan a la estructura del cerebro durante la infancia y la adolescencia. El desarrollo del cerebro es activo en los primeros anos de la vida, y sigue siendo asi durante unos 15 anos despues de la gestacion. Cambios volumetricos en el cerebro son afectados segun el sexo. La comprension de la variabilidad del volumen del cerebro humano durante el desarrollo es importante para la interpretacion de los estudios de neuroimagen en la infancia. Por lo tanto, el objetivo de este estudio fue determinar, a traves de resonancia nuclear magnetica, los efectos de las diferencias de sexo en el volumen cerebral (VC), en el volumen del ventriculo lateral (VL) y la relacion porcentual de los volumenes del cerebro y del ventriculo lateral (% VLVC) de 90 ninos sanos entre 6-17 anos de edad, en ambos sexos. Los ninos fueron divididos en tres grupos de edad: 6-9, 10-13 y 14-17. El VC y el VL se calcularon utilizando el principio de Cavalieri, ademas de la relacion porcentual RLBV. El VC del grupo 6-9 anos fue significativamente menor que el de los otros dos grupos (p 0,05). El promedio general del grupo VL de 6-9 anos fue mayor que los otros dos, sin diferencia significativa entre ambos sexos. El VC siguio aumentando hasta los 10-13 anos en ambos sexos. Mientras LV aumento hasta los 10-13 anos de edad en los ninos, se observo en las ninas una relacion negativa con cambios de BV.

Absence of the Arteria Profunda Femoris

circumflexus femoris medialis and a. circumflexus femoris lateralis emerged from a. profunda femoris. In the third case it was detected that at left low extremity a. profunda femoris did not exist, and at right low extremity a. circumflexus femoris lateralis emerged from a. p rofunda femoris, and a. circumflexus femoris medialis emerged from a. femoralis. In the fourth case at left low extremity there was no a. profunda f emoris and at right low extremity it was seen that at a. profunda femoris and a. femoralis were in unsteady course. The absence of a. profunda femo ris had 0,4%. The results were discussed by comparing with literature data.

Sivas Yöresinde Preterm Bebeklerde Peri İntraventriküler Kanama

The aim of this study was to determine the prevalence of peri intraventricular hemorrhage in pretem infants aged between 28 37 gestational weeks in Sivas province The study was carried out on 47 preterm infants in the unit of neonatology of Cumhuriyet University Hospital The mean gestational age of the study group was 34 2±2 4 weeks Birth weights ranged from 600 gr to 2350 gr mean 1443±429 gr Of the 47 preterm infants 44 were evaluated by cranial ultrasonography and 3 were evaluated by cranial computed tomography Perintraventricular hemorrhage was detected in 19 of the 47 infants 40 4 The gestational ages and birth weights of the infants with peri intraventricular hemorrhage were significantly low Respiratory distress syndrome was the statistically significant factor among the neonatal factors in relation to peri intra ventricular hemorrhage The mortality rate of peri intraventricular hemorrhage was 78 9 percent Key words: Peri Intraventricular Hemorrhage Cranial Ultrasonographyx