Yasemin Bilgili

Risky anatomic variations of sphenoid sinus for surgery

We searched for the surgically risky anatomic variations of sphenoid sinus and aimed to compare axial and coronal tomography in detection of these variations. Fifty-six paranasal tomography images (112 sides) were evaluated for coronal, axial and both coronal and axial images. Tomographic findings including bony septum extending to optic canal or internal carotid artery; protrusions and dehiscences of the walls of internal carotid artery, optic nerve, maxillary nerve and vidian nerve; extreme medial course of internal carotid artery; patterns of aeration of the anterior clinoid process; and Onodi cells were evaluated. The results were classified as “present, absent, suspicious-thin (only for dehiscence) or no-consensus”. The results of each plane were compared with that of the result of the both planes together. Kappa coefficient and Chi-square tests were used to compare both planes. Twelve cadaveric dissections were performed to reveal the proximity of sphenoid sinus to surgically risky anatomic structures. Endoscopy was applied to five cadavers. 18 evaluations were classified as ‘no-consensus’. We detected 34, 35, 34 and 40 protrusions of internal carotid artery, optic nerve, maxillary nerve, vidian nerve, respectively. Dehiscences were present in 6, 9, 4 and 8, and suspicious-thin in 8, 10, 16 and 25 in canals of internal carotid artery, optic nerve, maxillary nerve and vidian nerve, respectively. Bony septum to internal carotid artery and optic nerve was observed in 30 and 22 cases. We observed 9 extreme medial courses of internal carotid artery, 27 aerated clinoid process and 9 Onodi cells. Axial images were superior in detection of bony septum to internal carotid artery and Onodi cells; while the coronal images were more successful in detection of protrusion of optic nerve and vidian nerve, and dehiscense of maxillary nerve and vidian nerve (P<0.05). In cadaveric dissections, the septa were inserted into the bony covering of the carotid arteries in two sinuses (8.3%). Detailed preoperative analysis of the anatomy of the sphenoid sinus and its boundaries is crucial in facilitating entry to the pituitary fossa and reducing intraoperative complications. Coronal tomography more successfully detects the sphenoid sinus anatomic variations.

Accuracy of Skeletal Age Assessment in Children From Birth to 6 Years of Age With the Ultrasonographic Version of the Greulich-Pyle Atlas

Objectives. For the evaluation of skeletal age, the methods of Greulich‐Pyle and Tanner‐Whitehouse are generally used in clinical practice. Our investigation was undertaken to determine whether the ultrasonographic version of the Greulich‐Pyle atlas is capable of assessing skeletal age. If so, we aimed to describe the standards for the ultrasonographic version of the Greulich‐Pyle atlas for each year during the first 6 years of life. Methods. Ninety‐seven subjects underwent left hand and wrist radiography and ultrasonographic examination for bone age assessment during a 1.5‐year study. Estimated bone ages derived from the plain radiography and “hand and wrist ultrasonography charts” interpreted by use of the Greulich‐Pyle atlas were compared statistically. Results.The estimated bone ages from plain radiography and hand and wrist ultrasonography charts interpreted by use of the Greulich‐Pyle atlas were significantly correlated; 71.1% of male patients had the same age in both methods, and in 84.4% of patients, the difference was less than 6 months. In 65.5% of female patients, both methods revealed the same age, and in 88.5% of them, the difference was less then 6 months. Conclusions. The ultrasonographic version of the Greulich‐Pyle atlas can be used to estimate bone age even in ultrasonography departments. This method is highly correlated and a valid alternative to plain radiography for bone age estimation. This enables estimation of skeletal age in ultrasonography departments easily without exposing the patient to radiation.

Short‐term effect of latanoprost on ocular circulation in ocular hypertension

Purpose: To determine the short‐term effects of latanoprost on retrobulbar circulation in ocular hypertension.

Sildenafil Does Not Alter Retrobulbar Hemodynamics in Postural Variations

Objectives: In the present study, we aimed to investigate the postural changes of systemic blood pressure, retrobulbar blood flow velocities, and intraocular pressure as a response to sildenafil. Material and methods: A total of 28 healthy volunteers with an average age of 51.4 ± 0.5 years (range: 46–53 years) were divided into two groups: study group (Group 1) and control group (Group 2). After baseline measurements of retrobulbar blood velocity in the ophthalmic, central retinal, and posterior ciliary arteries using color Doppler imaging and intraocular pressure were noted in both groups, sildenafil citrate (50 mg) was given to the participants in Group 1. All parameters were then re-measured in the sitting and supine positions. Mann-Whitney U test, Friedman variant analysis, and Wilcoxon two-related sample test were used to evaluate changes of these parameters with regard to position in both groups. Results: Changing from a sitting to a supine position decreased the systolic and diastolic blood pressures in both groups. These changes were not statistically significant between groups (p > 0.05). Intraocular pressure showed statistically insignificant increases in the supine position in both groups (p > 0.05). There were no statistically significant differences between the two groups with regard to the retrobulbar hemodynamic parameters in two (sitting and supine) positions (p > 0.05). Conclusion: This is the first clinical study on the effects of sildenafil on retrobulbar and systemic hemodynamics in postural variations. Retrobulbar hemodynamics, intraocular pressure, and systemic blood pressure are the same in patients who use recommended doses of sildenafil as in physiological conditions.

Evaluation of Differences Between Observers and Automatic-Manual Measurements in Calculation of Doppler Parameters

Objective. We aimed to search for differences between observers and automatic and manual measurements in calculations of Doppler parameters. Methods. The middle cerebral artery (MCA), central retinal artery, ophthalmic artery (OA), common carotid artery (CCA), vertebral artery (VA), popliteal artery (PA), interlobar renal artery (IRA), and arcuate renal artery (ARA) were evaluated in 20 healthy subjects bilaterally. Peak systolic velocity (PSV), end‐diastolic velocity (EDV), time‐averaged maximum velocity (TAMAX), resistive index (RI), and pulsatility index (PI) were measured from the same spectrum manually by 3 observers and automatically. Results of 4 measurements were compared by analysis of variance and Pearson tests. Results. The comparison of the 4 measurements revealed significant differences for most parameters except TAMAX of the OA, VA, and ARA and PSV, EDV, and PI of the PA. An automatic calculator yielded lower PSV, RI, and PI values (except the MCA and PA) and higher EDV values compared with manual measurements. The magnitudes of difference were in the range of 1% to 16% for velocities and 4% to 14% for RI and PI. The means of difference were 3.185 cm/s for PSV of the CCA and 0.054 for RI of the IRA. Correlation was high for PSV, EDV, and TAMAX in all arteries (except TAMAX of PA) and relatively low for PI and RI in most of the arteries. Conclusions. Although our study was performed on healthy subjects, our results showed that, in most cases, readers and the automatic approach disagreed on evaluation of Doppler parameters. This may be important in preventing false diagnoses in cases with Doppler values close to upper limits and may necessitate establishment of new limits for each method.

Quantitative analysis of liposuction with B mode ultrasound.

BackgroundThe objective of this study was to determine whether ultrasonography is a reliable method for monitoring subcutaneous fat thickness in the quantitative analysis of liposuction results.MethodsSubcutaneous fat thicknesses before and 2 months after liposuction in prespecified areas were measured in 14 patients using a 7.5-MHz ultrasound scanner. Pre- and postoperative subcutaneous fat thicknesses were compared statistically.ResultsThe thicknesses of pre- and postoperative subcutaneous fat layers were statistically different.ConclusionUltrasound is a valuable tool for perioperative guidance, preoperative planning, and quantitative analysis of the procedure results.

BETTER VISUALIZATION OF VERMIFORM APPENDIX WITH TISSUE HARMONIC IMAGING COMPARED TO CONVENTIONAL SONOGRAPHY

Background: Surgery of appendicitis carries 7-11% negative appendectomy rates. Sonographically visualized normal appendix precludes unnecessary computed tomography (CT) examination and may reduce negative appendectomy rates. Tissue harmonic imaging (THI) has been reported to improve the overall image quality. Objective: We aimed to assess whether THI is more successful than conventional ultrasonography (US) in detecting normal and pathologic appendices. Patients and Methods: The study was performed on 185 patients who applied for routine US examinations in whom clinical findings of appendicitis were detected in 25. We searched for the appendix; applying both THI and conventional US to each patient, one before and the other after the routine US examinations. Patients were divided into two groups; one was evaluated first with conventional US and the other first with THI. When the appendix was found, localization, diameter and time spent for visualization were recorded. Twelve patients were operated; all of whom had appendicitis pathologically. Two methods were compared for: 1. Success rates in all patients; female, male and child groups separately; 2. Visualization of pathologic and normal appendices; 3. Time for visualization of appendix; 4. Comparison of success rates in the adult and child population. The relationship between the rate of visualization and body mass index was evaluated. Results: The appendix was visualized better by THI in all patients, and in the female and male groups (P < 0.001). In children, both methods were more successful compared to adults (P < 0.001, compared to male group, P < 0.001, compared to female group), with no difference between the methods (P = 0.22). When only the normal appendices were concerned, there was significant difference between both methods (P < 0.000). Both methods detected pathologic appendices better than normal ones, with a higher ratio for THI (P = 0.022 for the THI group, and χ2 = 7.22, P = 0.07 for the conventional US group). THI visualized the appendix faster. Both methods were more successful in lean patients (P = 0.004 for THI, P = 0.001 for conventional US imaging). Conclusions: THI visualizes appendix better than conventional US. It is a simple and time saving method that may eliminate further diagnostic imaging, and it may decrease negative appendectomy rates and related complications.

Ultrasonografide Rastlantısal Olarak Saptanan Polipoid Gastrointestinal Sistem Lezyonları: Ultrasonografi, Bilgisayarlı Tomografi ve Kolonoskopi Bulguları

406 eknolojik gelişmeler sayesinde manyetik rezonans ve bilgisayarlı tomografi (BT) inceleme sonuçları, gastrointestinal sistemin değerlendirilmesinde, konvansiyonel baryumlu tetkikler ve endoskopik incelemelerin başarı oranlarına yaklaşmaya başlamıştır. Her iki inceleme yöntemi, kanserler dışında küçük boyutlu poliplerin bulunmasında da başarılı sonuçlar vermektedir. Ayrıca BT, kolonografi küçük kolorektal poliplerin tanısında non invaziv bir yöntem olarak kullanılabilir.1 Ultrasonografi (USG) ise, geliştirilen sono-enterokolonografi ve hidrokolonik USG teknikleri ile, kanserleri ve 7 mm’den büyük polipleri, diğer iki yönteme oranla daha düşük oranlarda olmakla birlikte saptayabilmektedir. HidrokoUltrasonografide Rastlantısal Olarak Saptanan Polipoid Gastrointestinal Sistem Lezyonları: Ultrasonografi, Bilgisayarlı Tomografi ve Kolonoskopi Bulguları