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Öğe Cardiac CT evaluation of left atrial diverticulum and accessory appendage(Springer Science and Business Media Deutschland GmbH, 2022) Şimşek, Sadullah; Özmen, Cihan Akgül; Kansu, YaseminBackground: The aim of this study was to evaluate the prevalence, location, size, and morphological features of the left atrial accessory appendage and diverticulum with cardiac computed tomography. Cardiac computed tomography obtained consecutively from 1415 patients with normal ECG findings during a 2-year period were analyzed. Left atrial appendage and diverticulum type, location, and size were recorded and analyzed according to age and gender. Results: Cardiac computed tomography of 1415 (796 males and 619 females) participants aged 44.1 + 12.2 years old were re-evaluated, and 238 atrial diverticulum were found in 234 (16.5%) patients, accessory appendage in 93 (6.5%), and atrial diverticula and accessory appendage together in eight (0.56%) patients. The atrial diverticulum was most frequently observed in the anterosuperior localization (n = 157, 49.2%). One hundred and twenty-three (52%) of the atrial diverticulum were cystic, and 107 (45%) were tubular form. Accessory appendage was observed most frequently in the anterior superior location (n = 65, 20.4%). Conclusions: The frequency of left atrial diverticulum was found to be 16%, and the frequency of accessory appendage was 6%, consistent with the majority of the literature. Left atrial diverticulum and accessory appendage were detected more frequently in men than in women. Cystic form is more common in left atrial diverticulum.Öğe External auditory canal obstruction due to tuberous sclerosis complex angiofibromas: a case report(Springer, 2022) İşlek, Akif; Şimşek, SadullahBackground: Tuberous sclerosis complex (TSC), an autosomal dominant genetic disorder and auricula and external auditory canal (EAC) involvement, is rare. Surgical excision is rarely recommended for cutaneous lesions. Case presentation: A 31-year-old male patient was admitted with a complaint of left fullness, discharge, and conductive hearing loss. Symmetrical nodular cutaneous lesions on the malar region, tragus, and lateral portion of the EAC bilaterally were noted. The patient had diagnosed with TSC during adolescence clinically and genetically. Surgery was planned to obtain a favorable, self-cleaning EAC rather than total excision of angiofibromas. Angiofibromas on the EAC and tragus were excised. The defect was repaired by sliding a fasciocutaneous island flap inferiorly created in the preauricular area. No EAC stenosis or angiofibroma recurrence was observed during follow-up. Discussion: Surgical excision for this clinical entity provides satisfactory management even if it was not routinely recommended for other skin lesions.Öğe A fatal rhino-orbit-cerebral mucormycosis infection aggravated by coronavirus disease-2019(Sociedade Brasileira de Medicina Tropical, 2022) İşlek, Akif; Şimşek, SadullahRhino-orbit-cerebral mucormycosis is an opportunistic infection caused by Rhizopus spp., Mucor spp., and other mucormycosis with high morbidity and mortality1 .The main risk factors for mucormycosis include uncontrolled diabetes mellitus, diabetic ketoacidosis, other forms of metabolic acidosis, corticosteroid treatment, organ or bone marrow transplantation, neutropenia, trauma and burns, malignant hematologic disorders, and iron overloadÖğe Morbidity and mortality associated with fracture of the sternum due to blunt trauma, by fracture type and location(Colegio Brasileiro de Radiologia, 2022) Şimşek, Sadullah; Özmen, Cihan Akgül; Onat, SerdarObjective: To examine the relationship that the types and locations of fractures of the sternum have with mortality and morbidity. Materials and Methods: We analyzed the records of 115 patients diagnosed with fracture of the sternum, due to blunt trauma, between 2007 and 2018. Records of computed tomography studies were obtained from the radiology archive of a tertiary teaching hospital. The type of fracture was classified as linear, displaced, or comminuted, whereas the fracture location was classified as the manubrium, body, or xiphoid process. Results: A total of 108 patients were included in the study. Of those patients, 92 (85.2%) were male and 16 (14.8%) were female. The etiology was a traffic accident in 72 cases (62.6%) and a fall from height in 36 (31.3%). The mean age was 42.1 ± 17.7 years for males and 53.9 ± 20.0 years for females. The mortality rate was 11.1%. Among the 12 deceased patients, the mean age was 44.4 ± 18.3 years. The fracture was located exclusively in the manubrium in 64 patients (59.3%), exclusively in the body of the sternum in 41 (38.0%), and in both locations in three (2.7%), whereas none were located in the xiphoid process. Morbidity rates were higher in the patients with fractures of the manubrium than in those with fractures of the body of the sternum, as was the incidence of accom-panying bone fractures and organ injuries. The fracture was linear in 44 patients (40.7%), displaced in 62 (57.4%), and comminuted in 30 (27.8%). The mortality was significantly higher for comminuted fractures than for the other fracture types (p = 0.045; ? = 4.40). Conclusion: Fracture of the manubrium can be indicative of the severity of trauma and has a poor prognosis.Öğe Nasal steroid use and osteitis development in chronic rhinosinusitis with nasal polyps(Springer Medizin, 2022) Şimşek, Sadullah; İşlek, AkifObjectives: Osteitis and tissue remodeling are infammatory processes associated with the severity of chronic rhinosinusitis with nasal polyps (CRSwNP). Nasal steroids are the mainly recommended therapeutics in the treatment of the disease, and besides their benefcial efects, they may worsen osteitis via osteopenia. This study aimed to search for the coalescence of osteitis in CRSwNP and nasal steroid use (NSU). Methods: A cross-sectional study was designed. Patients who underwent paranasal sinus computed tomography (PNSCT) imaging were queried, and the sino‐nasal outcome test-22 (SNOT-22) was completed. Regular NSU was defned as a continued treatment for 2 months in the last 6 months. The cumulative period of NSU during the last 6 months was determined and classifed as no use or, for 1 to 3 months, or more than 3 months. Lund-MacKay scores (LMS) and Global Osteitis Scores (GOS) were calculated for 10 sinuses via PNSCT. Results: Sixty-two patients were included in the study. The mean GOS score was 5.7±1.7 points higher in patients with regular NSU (p=0.002, 95% CI: 9.2–2.2, t-test). LMS and SNOT-22 scores also were signifcantly higher for patients with regular NSU (p=0.036 and<0.001 consecutively). The mean GOS score showed a signifcant increase according to the cumulative period of NSU (p<0.001, one-way ANOVA test). Similarly, LMS and SNOT-22 scores were also signifcantly associated with the duration of total NSU. GOS score showed a signifcant positive high correlation with LMS and SNOT-22 scores (p<0.001, r=0.608 and r=0.753 consecutively). Conclusions: This association found between the severity of GOS and NSU is probably due to the severity of the disease. However, it may question the value of the NSU efect in the development of osteitis. The presence of NSU should be investigated in future histopathological studies. Level of evidence: IVÖğe Posttravmatik sternum kırıklarının lokalizasyonu, eşlik eden bulguların korelasyonu ve mortalite ilişkisi(Dicle Üniversitesi, Tıp Fakültesi, 2018) Şimşek, Sadullah; Özmen, Cihan AkgülSternum toraks ön duvarını oluşturan kemik yapı olup, manubriyum, korpus ve ksifoid çıkıntı kısımlarından oluşur. Sternum kırıklarının en yaygın nedenleri motorlu araç kazaları ve batın-toraksa yönelik künt travmalardır. Bilgisayarlı tomografi teknolojisindeki gelişmeler, görüntülemenin yaygınlaşan kullanımı ve emniyet kemeri takma zorunluluğu nedeniyle bu kırıkların travmalar içindeki oranı artmıştır. Tüm trafik kazalarının % 4'ünde ve künt abdominal travmaların %3-8'inde sternum kırıkları izlenmektedir. Sternum kırıklarına sahip hastaların üçte birinde eş zamanlı yaralanmalar izlenmektedir. Çalışmamızda sternum kırığı bulunan hastalarda kırık yerini ve kırık yerinin eşlik eden bulgularla ilişkisini saptamayı amaçladık. Çalışmamızda 2007- Eylül 2018 tarihleri arasında hastanemize travma nedeniyle başvuran sternum kırığı saptanan 115 hasta retrospektif olarak çalışma grubumuzu oluşturmaktadır. Hastalar PACS (Picture Archiving Communication System) arşiv sisteminde tüm planlarda değerlendirilmiştir. Çalışmaya dahil edilen hastaların 99'u erkek (%86), 16'sı kadın (%14) idi. Hastaların minimum yaşı 11, maksimum 87 idi. Hastaların ortalama yaşı erkeklerde 53,94 ± 20 yıl, kadınlarda 41.40 ± 17.60 yıl olarak hesaplandı. Hastalarımızın 103'ü (%89,6) sağ kalmış olup, 12'si (%10,4) hayatını kaybetti. Sonuç olarak sternum kırıkları en sık manubriyumda olup lineer tip kırık izlenmektedir. Manubriyumda kırık saptanan hastalarda ek toraks patolojileri korpus kırıklarına göre daha fazla izlenmiştir. Sternum kırığı saptanan toraks travmalarında intratorasik yaralanma olarak en sık akciğer kontüzyonu ve kot kırıkları görülmektedir. Ayrıca kırık lokalizasyonu ile eşlik eden bulgular arasında pozitif korelasyon saptadık.Öğe Radiological examination of cranial, ear-nose-throat, and maxillofacial system findings of Dyke-Davidoff-Masson syndrome in 28 patients(Ediciones Doyma, S.L., 2021) Şimşek, Sadullah; İşlek, AkifObjectives: It was aimed to detail the intracranial and ear–nose–throat-maxillofacial (ENT-MF) system findings of Dyke–Davidoff–Masson Syndrome (DDMS), and to examine the association in a larger sample according to current literature. Patients and methods: The study was designed retrospectively. Cranial magnetic resonance (MRI) and computed tomography (CT) Imaging records of patients were re-examined. Outcome parameters were identified as patients' demographics, the emergence of the central nervous system (CNS) pathologies, the asymmetric pneumatization of the skull bones, and ENT-MF system presentation. The correlation of the cranial and ENT-MF system findings was evaluated with Spearmen correlation analysis. Results: Radiological images of 28 patients were examined. The number of men was 21 (75.0%) and the number of females was 7 (25.0%). The mean age of the patients was 23.6 ± 10.6 (min. 1, max. 44). DDMS involvement detected on the right side in 15 (53.6%) of the patients. Cerebral atrophy (n = 28, 100%), lateral ventricular dilatation (n = 26, 96.3%) and corpus callosum damage (n = 19, 67.9%) were most frequent findings respectively. Cerebellar atrophy (n = 4, 14.3) and venous sinus dominance (n = 4, 14.3) were the rarest pathologies. Facial asymmetry (n = 15, 53.6%) and frontal sinus hyperpneumatization (n = 15, 53.6%) were the most frequent findings in the ENT-MF system. Increased calvarial thickness showed a high positive correlation with facial asymmetry and frontal sinus hyperpneumatization (p = 0.002, r = 0.571 and 0.024, r = 0.424, respectively). Conclusion: DDMS may occur with different radiological findings depending on the level of cerebral damage. Facial asymmetry often accompanies the disease and it should be considered in clinical practice of facial plastic and maxillofacial surgery.Öğe Subclavian steal syndrome with otologic findings(Türkiye Klinikleri Yayınevi, 2020) Sizer, Bilal; Şimşek, Sadullah; Yılmaz, Ümit; Baylan, Müzeyyen YıldırımSubclavian "steal" syndrome is a condition that causes re-verse flow and changes in the flow pattern from the vertebral artery to the subclavian artery on the same side as a result of severe stenosis or ob-struction in the proximal section of the subclavian artery before deliv-ery to the vertebral artery. Subclavian steal syndrome is mostly asymptomatic due to collaterals to the head, neck and shoulders, but as a result of subclavian steal syndrome, neurotological symptoms can sometimes be seen due to vertebrobasias insufficiency as the verte-brobasilar arterial system feeds the peripheral, central auditory and vestibular systems. We found it appropriate to present a patient com-plained of tinnitus and hearing loss in the right ear, and we detected sub-clavian steal syndrome during the differential diagnosis we made based on these complaints. For this reason, patients with dizziness, hearing loss, or tinnitus should undergo a careful neurotological examination, and consideration given to a finding of vertebrobasilar insufficiency due to subclavian steal syndrome, although this is rarely seen.Öğe Unusual imaging characteristics of thoracic hydatid disease(Colegio Brasileiro de Radiologia, 2022) Şimşek, Sadullah; Özmen, Cihan AkgülCystic echinococcosis (hydatid disease) is a zoonotic parasitic disease, caused by ingestion of Echinococcus granulosus eggs, that can result in cyst formation anywhere on the body. Hydatid disease is frequently seen in regions where there is human-animal contact and poor socioeconomic development. The prevalence of the disease ranges from 0 to 79 cases/100,000 population. Hydatid cysts are typically found in the liver and lungs, being less common in other parts of the body. Computed tomography or magnetic resonance imaging is often used in order to clarify the sites affected by a hydatid cyst, such as the cranial and thoracic regions, which also facilitates the surgical evaluation and minimizes complications. Although rare, hydatid cysts in atypical locations can provoke unusual complications, with unpredictable findings and symptoms. This essay discusses the radiological aspects of rare thoracic hydatid cysts.Öğe Value of magnetic resonance spectroscopy for diagnosis of creatine deficiency syndrome(Georg Thieme Verlag KG, 2021) Şimşek, Sadullah; Hattapoğlu, Salih; Ekici, FaysalCreatine deficiency syndromes are congenital metabolic diseases characterized by decreased cerebral creatine levels as a result of disorders in creatine synthesis and transport. Therefore, magnetic resonance spectroscopy is a valuable tool for diagnosis. This disease can be explained by congenital disorders occurring in three forms at different stages of the creatine metabolic pathway. Two of disorders arise autosomal recessively in creatine biosynthesis, arginine-glycine amidinotransferase, and guanidinoacetate methyltransferase enzyme deficiency. The third disorder occurs as a result of an SLC6A8 variant in the form of creatine carrier protein deficiency. In this article, a patient with SLC6A8 carrier deficiency is presented.
