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Öğe Broken Racz catheter during application (Case report)(Kare Publ, 2006) Karaman, Haktan; Akay, Hatice Ozturkmen; Turhanoglu, SelimThe most important complication of lumber disc hernia operations is Failed Back Surgery Syndrome (FBSS), which goes with fibrotic adhesions at the surgical site. The primary treatment applied to the cases that develop FBSS is the placement of Racz catheter under floroscopy and application of epidural neuroplasty which is a three-day procedure. However, this intervention, from which patients benefit a great deal, has some important complications during and after the application. One of these complications is that some pieces of Racz catheter may be broken out and retain at some levels of epidural space and subcutaneous tissue during placement and removal. General approach is to remove the retaining piece surgically. However, there is a less common view that, instead of removing the retaining piece, the patient should be followed up strictly and regularly in terms of neurologic complications. In our case, we decided to perform epidural neuroplasty to the patient diagnosed as FBSS. However, during the placement of the catheter, it was trapped in the left side of L-5-S-1 foramen by accident due to dense fibrotic tissues, and the subcutaneus part retained in the epidural space. Monthly follow-ups for 12 month were proposed to the patient, while surgery was not recommended. At the end of this period, no sign of infection was observed and neurologic and radiologic findings of the patient did not worsen. It is also interesting that a remarkable recovery was observed in the patient's clinical situation.Öğe A Case of Radial Scar: Findings of Mammography and MRI(Ortadogu Ad Pres & Publ Co, 2011) Ozmen, Cihan Akgul; Demirkazik, Figen Basaran; Akpinar, Meltem Gulsun; Akay, Hatice Ozturkmen; Ariyurek, MacitRadial scar is an idiopathic entity that represents a diagnostic challenge due to its similarity with breast cancer radiologically. The screening mammography of a 65-year-old female patient revealed asymmetrical parenchymal distortion. Breast ultrasound showed minor cysts and magnetic resonance imaging detected adjacent nodules with no contrast enhancement. Then, the lesion was excised with the help of mammography-guided needle localization method. Pathologic diagnosis was moderate ductal epithelial hyperplasia and radial scar. Although radial scar is a benign breast lesion, it mimics breast cancer mammographically and sonographically.Öğe Clinical and cranial magnetic resonance imaging (MRI) findings of 21 patients with serious hyperbilirubinemia(Sage Publications Inc, 2008) Katar, Selahattin; Akay, Hatice Ozturkmen; Taskesen, Mustafa; Devecioglu, CelalThis study aims to compare neurological examination and cranial magnetic resonance imaging (MRI) findings in patients with serious hyperbilirubinemia. Twenty-one serious hyperbiluribinemic term neonates (6 girls, 15 boys) who underwent exchange transfusions were included in the study. Neurological examination findings, body weight, age at admission, blood culture, urine culture, urine analysis, C-reactive protein, thyroxine, thyroid-stimulating hormone, total and indirect bilirubin levels, causes of hyperbilirubinemia (blood group typing, glucose-6-phosphate dehydrogenase, blood smear, tandem mass), treatment and duration of follow-up, auditory test results, and cranial MRI findings were evaluated. All patients were term neonates with an average body weight of 2943 +/- 533 g. The mean age at admission was 4.47 +/- 2.22 days, and the mean bilirubin level was 35.0 +/- 10.8 mg/dL. Exchange transfusion was performed once in all, except 4 patients who needed 2 transfusions. Kernicterus findings were found in 76% of patients on neurological examination, and cranial MRI detected a pathological finding in 71% of patients. In 2 patients, cranial MRI showed kernicterus findings, despite normal neurological examination. In contrast, in 3 patients, despite kernicterus findings in neurological examination, cranial MRI was normal. Although cranial MRI has an important place in the diagnosis of kernicterus, it does not always correlate with clinical findings. We believe that studies with larger series are warranted.Öğe Diameters of normal thoracic vascular structures in pediatric patients(Springer France, 2009) Akay, Hatice Ozturkmen; Ozmen, Cihan Akgul; Bayrak, Aylin Hasanefendioglu; Senturk, Senem; Katar, Selahattin; Nazaroglu, Hasan; Taskesen, MustafaPurpose To determine the normal range of aortic and pulmonary artery diameters on chest CT, and to search a constant ratio when the diameters of thoracic vascular structures are compared with an internal reference. Methods Contrast-enhanced chest CT scans of 133 pediatric patients were retrospectively evaluated. Diameters of ascending and descending aorta, main pulmonary artery, right and left pulmonary arteries and a constant thoracic vertebra were measured. The mean ratios of thoracic vascular diameters to the diameter of the thoracic vertebra were calculated. Results There was a positive correlation between the age of the patients and vascular diameters. The mean ratios of vascular diameters to the diameter of thoracic vertebra, ranged from 1.1 for the ascending aorta to 0.70 for the right and left pulmonary arteries, were consistent. Conclusions Diameters of thoracic vascular structures increase with age. The consistent vertebral to vessel ratios can be useful in evaluation of chest CT of pediatric patients.Öğe The frequency of intracranial arterial fenestrations: A study with 64-detector CT-angiography(Elsevier Ireland Ltd, 2011) Bayrak, Aylin Hasanefendioglu; Senturk, Senem; Akay, Hatice Ozturkmen; Ozmen, Cihan Akgul; Bukte, Yasar; Nazaroglu, HasanFenestration is a vascular variation that begins with a common origin, then splits into two parallel luminal channels and rejoins distally. Potential association between anomalies of cerebral circulation and increased occurrence of aneurysm makes intracranial arterial fenestrations important. The planning of intracranial arterial interventions may be complicated if a fenestration occurs proximal to the site of intended treatment. This study is planned to determine the frequency of fenestrations on CT angiography and to search whether there is relationship between aneurysms and fenestrations. CT angiographies of 395 consecutive patients, performed by 64-detector CT, were retrospectively reviewed for aneurysms and fenestrations. Overall fenestration frequency, fenestration frequency in patients with and without aneurysm, and aneurysm frequency in patients with and without fenestration were searched. Demographic characteristics of patients were also compared. Overall fenestration frequency was 12.9%. Vertebrobasilar system (5.56%) and anterior communicating region (5.32%) were the two most frequent sites of fenestration. The rate of fenestrations was not significantly different between patients who had and did not have aneurysms. Mean age was significantly higher, and females were predominant in patients with aneurysms. However our results did not show significant difference in age and sex of patients with fenestrations. The frequency of fenestrations in this study is higher than in previously published radiological studies, suggesting that fenestrations are relatively common. There is no significant relationship between the frequency of aneurysms and fenestrations. (C) 2009 Elsevier Ireland Ltd. All rights reserved.Öğe Horseshoe lung associated with rare bilateral variant of scimitar syndrome: demonstration by 64-slice MDCT angiography(Springer, 2008) Akay, Hatice Ozturkmen; Kervancioglu, Mehmet; Nazaroglu, Hasan; Katar, Selahattin; Ozmen, Cihan Akgul; Kilinc, Ilhan; Senturk, SenemScimitar syndrome with bilateral abnormal venous drainage and horseshoe lung is extremely rare. These rare complex anomalies were diagnosed in a 5-year-old boy by 64-slice multidetector CT (MDCT). This technique provides high-quality visualization of vascular, bronchial and parenchymal structures in a single session, such that no further invasive techniques are required. One obvious disadvantage of MDCT is the radiation exposure, especially in paediatric patients. The use of a single phase of contrast material administration reduces radiation exposure. The workstation platforms of MDCT systems allow multiplanar 2-D and 3-D postprocessing. As a result, various complex pathologies, such as that discussed here, can be diagnosed following a single imaging session with a certain precision.Öğe Isolated traumatic gallbladder rupture: US findings and the role of repeat US in diagnosis(Springer, 2008) Akay, Hatice Ozturkmen; Senturk, Senem; Cigdem, M. Kemal; Bayrak, Aylin H.; Ozdemir, ErdalWe represent the US findings of isolated gallbladder rupture caused by blunt abdominal trauma in a 13-year-old boy. At the initial US examination, although a pericholecystic fluid collection was observed, the mildly collapsed gallbladder was regarded as a contracted gallbladder. Even though the patient was haemodynamically stable, repeat US examination after 24 h revealed gallbladder perforation. In haemodynamically stable trauma patients repeated US examinations can be useful and are strongly recommended.Öğe Migration of ventriculoperitoneal shunt into the lung by passing through the liver and the diaphragm(Aves, 2009) Nazaroglu, Hasan; Ozkan, Umit; Ozmen, Cihan Akgul; Akay, Hatice Ozturkmen; Senyigit, AbdurrahmanThoracic complications are rare after shunt placement for drainage of cerebrospinal fluid to treat hydrocephalus. We report a case of a ventriculoperitoneal shunt catheter that migrated into the lung by passing through the liver and the diaphragm. To our knowledge, there is no previously published report of a ventriculoperitoneal shunt that has migrated into the lung by a transdiaphragmatic and transhepatic route.Öğe OUR APPLICATIONS OF PERCUTANEOUS VERTEBROPLASTY IN VERTEBRA PLANA TYPE COMPRESSION FRACTURES ASSOCIATED WITH OSTEOPOROSIS(Gunes Kitabevi Ltd Sti, 2011) Karaman, Haktan; Akay, Hatice Ozturkmen; Taze, Hatice Aslanhan; Kaya, Sedat; Kavak, Gonul Olmez; Balkan, BedihT he indication area of percutaneous vertebroplasty, which was first applied successfully for the management of aggressive vertebral hemangioma in 1987 in France, has grown in the years. One of these indications is osteoporotic vertebral compression fractures. Osteoporosis, common amongst elderly patients causes significant compression fractures. Most of the fractures that do not cause pressure on the spinal canal are successfully treated with percutaneous vertebroplasty. However most authors, claiming that in cases of severe vertebral compression fracture ( vertebra plana) associated with osteoporosis, cement leakage developing due to technical difficulties may cause dangerous complications such as emboli, death and disability, asserted that the application of percutaneous vertebroplasty is contraindicated. This study, presenting successful percutaneous vertebroplasty in two patients with the vertebra plana type compression fracture associated with osteoporosis, underlines that as long as it is performed meticulously, the complication risk in percutaneous vertebroplasty is very low.Öğe A Rare Cause of Dysphonia: Laryngeal Lipoma: Differential Diagnosis(Ortadogu Ad Pres & Publ Co, 2009) Ozmen, Cihan Akgul; Nazaroglu, Hasan; Yildirim, Muezeyyen; Akay, Hatice Ozturkmen; Bayrak, Aylin H.Although lipomas are the most common benign tumors of mesenchymal origin, laringeal lipomas are rare. We report a case of laryngeal lipoma with computed tomography (CT) and magnetic resonance imaging (MRI) findings. A mass filling the left pyriform sinus was detected on the examination of a 52-year-old man admitted with dysphonia. The mass was originated from lateral side of left aryepiglottic fold, extending to subglottic area on the neck CT and MRI scans. The radiologic findings were compatible with laryngeal lipoma. Laryngeal lipoma, although rare, should be kept in mind for the differential diagnosis of patients admitted with dysphonia.Öğe USE OF MIDAZOLAM DURING TRANSRECTAL ULTRASONOGRAPHY GUIDED PROSTATE BIOPSY: EFFECTS OF SEDATION AND RETROGRADE AMNESIA(Aves, 2005) Atug, Fatih; Akay, Ferruh; Akay, Hatice Ozturkmen; Eksioglu, Ali; Bircan, KamuranIntroduction: Urologists perform approximately 500.000 prostate biopsies per year in United States of America. Currently there is no universally agreed standard of analgesia. Several studies evaluating the tolerance of transrectal ultrasound (TRUS) guided biopsies showed that moderate to severe pain was associated with the procedure. Patients may not return for repeat biopsies due to unpleasant experience with prior biopsies. Large number of patients perceives the procedure painful with major psychological trauma. Midazolam is used for gastrointestinal endoscopies because of its sedative and amnestic effects. To this end, we evaluated the feasibility of midazolam and retrograde amnesia effect in patients undergoing transrectal prostate biopsy. Materials and Methods: A total of 52 patients undergoing TRUS-guided prostate biopsy were enrolled into the study. Indications for biopsy were increased prostate specific antigen (PSA) or abnormal digital rectal examination of the prostate. Patients were given midazolam as a bolus injection (70 mcg/kg, maximum total dosage: 5 mg) before the biopsy procedure. All patients were examined in left lateral decubitus position and TRUS biopsies were performed with a 7 MHz probe. Four core biopsies were obtained from the each lobe of the prostate. After completion of biopsy, flumazenil (0.5 mg IV) was used to reverse the effects of midazolam. All patients were placed on oxygen saturation monitorization during the procedure. The degree of sedation, degree of pain, side effects and retrograde amnesia were evaluated with a validated questionnaire by the surgeon and patient. A visual analog scale (VAS) was used to asses the pain score and Ramsey sedation score was used to asses the sedation score. The Ramsey sedation scale scores between 2 and 4 were accepted as satisfactory degree of sedation. Results: After injection of midazolam, sedation was achieved in all patients in a short period of time. Ninety-six percent of patients exhibited procedural amnesia, characterized by an inability to recall neither the initial probe insertion nor the biopsy procedure. Only two patients remembered some parts of the procedure. Forty four patients (%85) were willing to undergo re-biopsy if needed. These patients stated that they will undergo a second biopsy only under the same conditions. Eight patients (%15) refused to undergo any further diagnostic test or examination. The mean pain score of patients was 1.96 +/- 0.69. The Ramsey sedation scale scores ranged between 2 and 4 in all patients. Nausea and vomiting due to midazolam were not observed in our study, and we did not see any complication related to midazolam usage. Conclusion: In this study we found high satisfaction rates, lower pain scores and lower anxiety in patients undergoing TRUS guided biopsies due to sedative and amnestic effects of midazolam. This resulted in higher acceptability of a repeat biopsy procedure, if indicated. Besides its sedative properties, midazolam can be used as an effective agent during TRUS-guided prostate biopsies due to its procedural amnesia effect, which results in minimal psychological trauma to patients.Öğe VESICOURETERAL REFLUX INCIDANCE IN CHILDREN WITH URINARY STONE DISEASE(Aves, 2005) Akay, Ali Ferruh; Uzun, Fatih; Akay, Hatice Ozturkmen; Aflay, Ugur; Sahin, HayrettinIntroduction: In spite of the frequent association of urinary infection with vesicoureteric reflux and urinary calculi, the coexistence of vesicoureteric reflux and calculi is rare. Four factors (urinary calculi, urinary tract infection, structural changes at the uretero vesical junction and reflux) may interact in these cases. In this prospective study we studied the prevalence of vesicoureteral reflux (VUR) in children with urinary stone disease. Materials and Methods: Between September 2000 and March 2004 we evaluated the prevalence of VUR in children with urinary stone disease. In all patients history, physical examination, biochemical and microbiologic analyses were done before the treatment of stone disease. We did voiding cystouretrography in all patients. Patients were divided based on surgical method, including extracorporeal shock wave lithotripsy (ESWL), endoscopy and open surgery. Some patients required combined treatment. After the treatment of stone disease, all patients with VUR received suppressive antibiotic treatment. During follow up period surgical treatment was applied when necessary. Results: Fifty children between 1.5 and 13 years old (median 6.75 years) were included in this study. 41 of patients (82%) were male, 9 (18%) were female. In 37 of patients stone was located only in kidney, 8 were located in urethra, 2 had kidney and bladder stones, 2 had kidney and urethra stones simultaneously. Only 1 patient had bladder stone. In 6 patients (3 male, 3 female) VUR was diagnosed with voiding cystouretrography. Of the patients 2 had bilateral reflux (1 patient with bilateral calculi and the other with left kidney and bladder calculi), 2 had right side reflux (1 had urethra calculi and 1 has contralateral kidney calculi), 2 had left side reflux (1 on ipsilateral kidney calculi and 1 on ipsilateral ureteral calculi). The prevalence of VUR was 12%. Conclusion: In children with urinary stone disease one must always remember that VUR can be seen simultaneously. So if necessary VSUG should always be applied. All patients with urinary stones, particularly staghorn calculi, and urinary tract infection have to be examined for vesicouretral reflux, after the stone or stones have been removed and appropriate antimicrobial therapy has been given.
