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Öğe Adrenal bez kalınlığının multi-dedektörlü bilgisayarlı tomografi ile değerlendirilmesi(Modestum Publishing Ltd., 2012) Hamidi, Cihad; Göya, Cemil; Hattapoğlu, Salih; Çetinçakmak, Mehmet Güli; Teke, Memik; Dusak, Abdurrahim; Kuday, SuzanAmaç: Bu çalışmanın amacı anatomik detayın daha iyi değerlendirildiği multi-dedektörlü bilgisayarlı tomografi ile adrenal bez boyutlarını ve her iki taraftaki adrenal bezler arasında kalınlık farkının olup olmadığını araştırmaktır. Gereç ve yöntem: Adrenal bez patolojisi bulunmayan, adrenal bez dışı kitlesi olmayan 100 hasta bilateral adrenal bez kalınlıkları açısından 16 ve 64 dedektörlü bilgisayarlı tomografi ile retrospektif olarak incelendi. Bulgular: Ölçümler sonucunda her iki adrenal bez ortalama medial ve lateral bacak kalınlıkları arasında istatistiksel olarak anlamlı farklılık saptandı (p< 0.001, p=0.035). Her iki adrenal bez gövdeleri arasında ise istatistiksel olarak anlamlı farklılık saptanmadı (p=0.611). Sonuç: Sol adrenal bez sağa nazaran varyatif olarak kalın izlenmiş olup, adrenal bez kalınlıkları standardizasyonu açısından daha geniş çalışmalara ihtiyaç duyulmaktadır.Öğe Arterial distensibility in patients with ruptured and unruptured intracranial aneurysms: Is it a predisposing factor for rupture risk?(Int Scientific Information, Inc, 2013) Dusak, Abdurrahim; Kamasak, Kaan; Goya, Cemil; Adin, Mehmet E.; Elbey, Mehmet A.; Bilici, AslanBackground: A risk factor assessment that reliably predicts whether patients are predisposed to intracranial aneurysm (IA) rupture has yet to be formulated. As such, the clinical management of unruptured IA remains unclear. Our aim was to determine whether impaired arterial distensibility and hypertrophic remodeling might be indicators of risk for IA rupture. Material/Methods: The study population (n=49) was selected from consecutive admissions for either unruptured IA (n=23) or ruptured IA (n=26) from January to December 2010. Hemodynamic measures were taken from every patient, including systolic and diastolic blood pressure using a sphygmomanometer. Unruptured IA and ruptured IA characteristics, including aneurysmal shape, size, angle, aspect ratio, and bottleneck factor, were measured and calculated from transverse brain CT angiography images. With ultrasound, the right common carotid artery intima-media thickness was measured, as well as the lumen diameter during systole and diastole. Arterial wall strain, distensibility, stiffness index, and elastic modulus were calculated and compared between patients with unruptured IAs and ruptured IAs. A p-value less than 0.05 was considered statistically significant. Results: General demographic data did not differ between patients with unruptured IAs and ruptured IAs. Greater mean intima-media thickness (p=0.013), mean stiffness index (p=0.044), and mean elastic modulus (p=0.026) were observed for patients with ruptured IAs. Moreover, mean strain (p=0.013) and mean distensibility (p=0.024) were decreased in patients with ruptured IAs. Conclusions: Patients with ruptured IAs demonstrated decreased arterial distensibility and increased intima-media thickness at the level of the carotid arteries. By measuring these parameters via ultrasound, it may be possible to predict whether patients with existing IAs might rupture and hemorrhage into the subarachnoid space.Öğe Comparative Analysis of Percutaneous Excision and Radiofrequency Ablation for Osteoid Osteoma(Int Scientific Information, Inc, 2023) Atic, Ramazan; Alemdar, Celil; Elci, Serhat; Dusak, Abdurrahim; cacan, Mehmet Akif; Ozkul, Emin; Aytekin, Mahmut NedimBackground: This retrospective study aims to compare the efficacy of computed tomography-guided percutaneous excision and radiofrequency ablation in the treatment of osteoid osteoma. Material/Methods: We evaluated 40 patients with osteoid osteoma who underwent either percutaneous excision or radiofrequency ablation between 2012 and 2015. The cohort consisted of 10 female and 30 male patients, with a mean age of 15.1 years (range: 4-27 years) and a mean follow-up time of 19.02 months (range: 11-39 months). Percutaneous excision was performed in 20 patients, while radiofrequency ablation was performed in the remaining 20 patients. Results: The success rates of percutaneous excision and radiofrequency ablation were comparable, with unsuccessful outcomes observed in 10% and 5% of patients, respectively. The reasons for failure in the percutaneous excision group were attributed to a marking error and incomplete excision of the wide-based nidus. Complications were limited to pathological fracture (n=1) and deep infection (n=1) in the percutaneous excision group, while no complications were encountered in the radiofrequency ablation group. Conclusions: Both percutaneous excision and radiofrequency ablation demonstrate high success rates in treating osteoid osteoma. However, radiofrequency ablation offers the advantage of a quicker return to daily activities without the need for activity restrictions or splints. While being a more cost-effective option, percutaneous excision should be considered cautiously to minimize potential complications.Öğe A comparison of percutaneous trephine excision and open surgery in the treatment of osteoid osteoma(Springer, 2016) Alemdar, Celil; Cacan, Mehmet Akif; Dusak, Abdurrahim; Ozkul, Emin; Atic, Ramazan; Kapukaya, AhmetPurpose The aim of this study was to compare CT-assisted percutaneous excision, which is a closed, economic method and a more cosmetic approach, and open surgery in the treatment of osteoid osteoma. Materials and methods Fifty-three patients (12 female and 41 male patients) who had percutaneous excision (n = 24) and open surgery (n = 29) were evaluated retrospectively. The mean age was 16.6 years and the mean duration of follow-up was 53.5 months. During percutaneous excision, a trephine was advanced through the labeling wire and the site, including the nidus, was excised en-bloc and the incision walls were curetted. During the open surgery, the localization of the nidus was marked using c-arm X-ray and the nidus was accessed by lifting the cortical bone, layer-by-layer, using burr. The nidus was excised and its cavity curetted. Results The result was successful in 22 and a failure in three patients who had closed excision. The result was successful in 20 and a failure in nine patients who had open surgery. The mean duration of operation was 44.37 minutes in the percutaneous excision group and 80.6 minutes in the open surgery group. There was no difference in the pre-operative VAS values between the two groups, whereas the post-operative VAS values were statistically significantly different. There was also a statistically significant difference in the duration of the operation and the length of the hospital stay between the groups. Conclusion Percutaneous excision with trephine is a more successful, effective, minimally invasive, safe and a better cosmetic approach in the treatment of osteoid osteoma. This method is also a cheap method that does not require expensive equipment.Öğe Giant myxoid liposarcoma of descending mesocolon origin(Termedia Publishing House Ltd, 2014) Uslukaya, Omer; Taskesen, Fatih; Aliosmanoglu, Ibrahim; Arikanoglu, Zulfu; Gul, Mesut; Dusak, AbdurrahimLiposarcomas are one of the most common primary lesions of the retroperitoneal region. They rarely exhibit intra-abdominal location. Because the symptoms emerge later on, they often remain unnoticed until they grow large. Our aim in this paper is to present a case of myxoid liposarcoma of descending mesocolon origin, 40 cm wide and weighing 7000 g, seen in a 47-year-old male patient. No cases at this weight and radius, originating from descending mesocolon, belonging to the myxoid sub-type, were found in our literature scan.Öğe İndirekt inguinal herni kesesine uzanan danbıl şeklinde mesane divertikülü(Avrasya Üroonkoloji Derneği, 2016) Dusak, Abdurrahim; Alan, Bircan; Utangaç, Mehmet Mazhar; Bilici, AslanMesane çıkım obstruksiyonlarında özellikle benign prostat hiperplazilerinde, mesanede intraluminal basınç artışına sekonder, artmış trabekülasyon ve divertikül formasyonu sık karşılaşılan bulgulardandır. Mesane divertikülleri boyut artışı göstererek potansiyel boşluklara uzanım göstermesi nadirdir. Bu çalışmada indirekt inguinal herni kesesine uzanan mesane divertikülü olgusunu literatür ışığında sunmayı planladık.Öğe Investigation of the retrorenal colon frequency using computed tomography in patients with advanced scoliosis(Springer France, 2014) Onder, Hakan; Dusak, Abdurrahim; Sancaktutar, Ahmet Ali; Goya, Cemil; Bulut, MehmetThe aim of this study is to investigate the frequency of retrorenal colon in patients with advanced scoliosis. The existence of retrorenal colon was retrospectively investigated in 550 patients with vertebral scoliosis who had undergone abdominal CT scans at our institution between January 2008 and March 2012. The investigation was also carried out on a control group of 200 patients without scoliosis. Among the 550 patients with scoliosis, 100 patients had advanced scoliosis necessitating treatment. Among these 100 patients with advanced scoliosis, retrorenal colon was detected in a total of 25 patients (25 %). The variation was observed on the right side in eight patients (two males, six females) (8 %), on the left side in 15 patients (five males, ten females) (15 %), and bilaterally in two patients (both females) (2 %). In the control group consisting of 200 individuals, retrorenal colon was detected in seven subjects (3.5 %), among which six were on the left and one was on the right. The difference between the incidence of retrorenal colon observed in the patients with advanced scoliosis and those without scoliosis was found to be statistically significant (p < 0.001). Since the frequency of retrorenal colon in patients with advanced scoliosis is significantly higher than the control group without scoliosis, the risk of experiencing complications during renal interventions including renal biopsy is also higher. Therefore, these patients should undergo a detailed CT examination before these procedures, and renal interventions should be planned according to findings.Öğe Karotis intima-media kalınlığının koroner arter hastalık şiddetini belirleyen Gensini skoru ile ilişkisi(Dicle Üniversitesi Tıp Fakültesi, 2015) Alan, Bircan; Hattapoğlu, Salih; Dusak, Abdurrahim; Aktan, AdemAmaç: Bu çalışmada karotis intima media kalınlığının (KİMK) koroner arter hastalarında (KAH) hastalığın ciddiyetini göstermede objektif bir bulgu olan Gensini skoru ile ilişkisini araştırmayı amaçladık. Yöntemler: Göğüs ağrısı nedeniyle kardiyoloji kliniğine başvurmuş, koroner anjiyografisi yapılarak KAH tespit edilen 76 hasta (41 erkek, 35 kadın) (yaş ortalaması 60.7±11.2 yıl; yaş aralığı 42-83 yıl) çalışmaya dahil edildi. Tüm hastalarda Gensini skoru hesaplanarak <25 (hafif KAH) ve ≥25 (ciddi KAH) olmak üzere 2 gruba ayrıldı. Tüm gruplarda KİMK ölçüldü. Gruplar arasında KİMK ile gensini skoru (KAH şiddeti) karşılaştırıldı. Bulgular: Ciddi KAH grubu ile hafif KAH grubu karşılaştırıldığında, ciddi KAH gurubunda KİMK anlamlı düzeyde yüksekti [sırasıyla 1,2±0,16 (aralık: 0,90-1,50) ve 0,97±0,07 (aralık: 0,90-1,10), p <0,01]. KİMK ile Gensini skoru, yaş, vücut kitle indeksi (VKİ) ve LDL kolesterol arasında anlamlı korelasyonunlar saptandı [sırasıyla, r=0,365, p<0,01; r=0,327, p=0,03; r=-0,341, p<0,01; ve r= 0,385, p<0,01). Sonuç: Koroner arter hastalarında hastalığın ciddiyetini belirlemede kullanılan objektif bir kriter olan Gensini skoru ile KİMK arasında anlamlı bir ilişki bulundu.Öğe Magnetic Resonance Imaging in Children under Anesthesia: The Relationship between the Degree of Information Provided to Parents and Parents' Anxiety Scores(Hindawi Ltd, 2014) Guzel, Abdulmenap; Atli, Abdullah; Dogan, Erdal; Celik, Feyzi; Tufek, Adnan; Dusak, Abdurrahim; Sen, VelatBackground. We aimed to investigate the correlation between the anxiety scores of parents whose children are administered anesthesia for magnetic resonance imaging (MRI) and the level of information provided to them before the MRI. The study included 146 children and their parents. The demographic information of the children and their parents was recorded. The parents were divided into two groups. In Group I, the patient's medical history and physical exam findings were recorded on a standard consultation form by an anesthesiologist. In Group II, the parents were additionally provided with more detailed information on how the anesthesia would be administered and the drugs to be used and their side effects and complications. The anxiety scores of the parents were found to be lower in Group II. A higher level of education was associated with higher anxiety scores. Intergroup comparison detected lower anxiety scores for Group II parents whose education levels were up to high school. However, no change upon receiving detailed information was detected in the anxiety scores of parents with higher education levels. In conclusion, this may lower the anxiety scores in parents informed about details of anesthesia administration and may raise parents' sense of confidence in the doctor.Öğe Multiplanar reformatted CT enterography in acute abdomen(Maltepe University, 2016) Dusak, Abdurrahim; Alan, Bircan; Güzel, Abdulmenap; Çakmak, Muharrem; Taşkesen, Fatih; Göya, Cemil; Bilici, AslanAim: To investigate the correlation between surgical - histopathological data and CT enterography CTE in patients with acute abdomen due to mecanical ileus. Methods: Ninety one 46 female, 45 male; 44±11 year- old consecutive acute abdomen cases admitted to emergency department and operated in general surgery department with a preoperative diagnoses of mechanical ileus were included in this study. CTE was carried-out using Multi sliced CT 64 detector CT, Philips Brilliance . Subjects were scanned from xiphoid process to symphysis pubis during a single breath-hold. Correlation analyses were done between radiological findings and surgical and histopathological findings. Result: Gastrointestinal tract GIT obstruction finding was evident in 82% of subjects with mecanical ileus and acute abdomen. Sensitivity and specificity of CTE was 85% and 55% respectively in terms of demonstration of etiopathology. 80% of cases had small bowel obstruction and remaining 20% had large bowel obstruction. Bridled ileus, mass, hernia, mesenteric ischemia, perforation, peritonitis carcinomatosa, volvulus, invagination, narrowed anastomosis, torsion, abscess, gossypiboma, gallstone ileus and malrotation were among underlying etiological factors. Statistically significant correlation found between GIT obstruction and findings such as mesenteric stranding, intra abdominal free fluid, string of pearls sign and transition-zone. In contrary, bowel wall thickening, mass lesion, faeces sign, peritoneal nodule, whirl sign, target sign, intra abdominal free air, pneumatosis intestinalis were not statistically significantly correlated with GIT obstruction. Conclusion: CT Entherography is an efficient imaging modality with high diagnostic value in demonstrating the existence and etiopathology of bowel obstruction.Öğe Pelvic And Bilateral Symetric Lower Extremities Involvement Of Extensive Fetal Cystic Lymphangioma: A Case Report(Düzce Üniversitesi, 2015) Dusak, Abdurrahim; Durmaz, Mehmet Sedat; Bilici, Aslan; Alan, BircanExtensive fetal cystic lymphangioma is a rare congenital malformation of the lymphatic system.Their prognosis depends on the size and location of the lesions as well as other accompanyinganomalies. Our case was 35 years, fetal BPD was 27 weeks . Herein, we present a case ofextensive fetal cystic lymphangioma that began at the pelvic area and symmetrically spannedthe bilateral proximal and distal lower extremities. Numerous extensive and sharplycircumscribed, thin walled multilobular cystic lesions in different sizes were observed in thesubcutaneous superficial and deep soft tissue beginning from the pelvic area and extending toboth lower extremities to the distal in the fetüs. To our knowledge, a case involving bothextremities has not yet been reported in the literatureÖğe The potential role of BMI, plasma leptin, nesfatin-1 and ghrelin levels in the early detection of pancreatic necrosis and severe acute pancreatitis: A prospective cohort study(Elsevier Science Bv, 2014) Turkoglu, Ahmet; Boyuk, Abdullah; Tanriverdi, Mehmet Halis; Gunduz, Ercan; Dusak, Abdurrahim; Kaplan, Ibrahim; Gumus, MetehanBackground: Early prediction of disease severity in acute pancreatitis (AP) is crucial. The aim of this study was to investigate the body-mass index (BMI), plasma leptin, nesfatin-1 and ghrelin levels as potential markers predicting peripancreatic necrosis and severity in acute pancreatitis. Methods: In the study period, 97 consecutive patients with AP were prospectively analysed. Severe AP was defined according to the Atlanta Criteria. BMI was also calculated. To measure plasma Leptin, Nesfatin-1 and Ghrelin concentrations, the blood samples were obtained from patients within 24 hours of admission. Results: Out of 97 patients, 92(70 females, 22 males) were considered eligible for analysis. Of the 92 patients, 30 patients (32.6%) were assessed as severe pancreatitis. BMI and leptin levels were significantly higher in patients with severe pancreatitis. The pooled sensitivity and specificity of BMI as a predictor for the development of pancreatic necrosis were 0.90(95% CI = 0.56-0.99) and 0.70(95% CI = 0.58-0.79), respectively; with an overall area under curve value of 0.78. The pooled sensitivity and specificity of leptin levels as a predictor for development of pancreatic necrosis were 1(95% CI = 0.69-1) and 0.73(95% CI = 0.62-0.82), respectively; with an overall area under curve value of 0.82. Nesfatin-1 and ghrelin levels showed no significant difference in patients with mild pancreatitis (6.97 +/- 0.84 ng/ml and 2.3(1.0-9.9); respectively) and severe pancreatitis (6.74 +/- 0.65 ng/ml and 2.0(1.9-9.9); respectively) (p = 0.1923 and 0.8531; respectively). Conclusion: BMI and plasma leptin levels both were correlated with the severity of pancreatitis. Leptin levels showed better area under the curve, sensitivity and specificity values compared to BMI in prediction of pancreatic necrosis. Nesfatin-1 and ghrelin levels were not found to be predictors of the severity of disease. (C) 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.Öğe Radiological Imaging Features of Fasciola hepatica Infection A Pictorial Review(Medknow Publications & Media Pvt Ltd, 2012) Dusak, Abdurrahim; Onur, Mehmet R.; Cicek, Mutalip; Firat, Ugur; Ren, Tianbo; Dogra, Vikram S.Fascioliasis refers to a zoonosis caused by Fasciola hepatica, a trematode infecting herbivores, but also occurs in humans who ingest the metacercaria found in fresh water plants. Infection in humans is common in developing countries and is also not uncommon in Europe. Diagnosis of this infection is difficult, as the history and symptoms are nonspecific and stool analysis for eggs is negative until the disease is in an advanced state by when the parasite has reached the biliary system. The clinical course consists of two phases; first a hepatic parenchymal phase in which immature larvae invade the liver parenchyma, followed by a ductal phase characterized by the excretion of larvae into the bile ducts. Parenchymal Phase: Ultrasonography (US) findings are nonspecific in this early phase. Computerized tomography (CT) may demonstrate subcapsular low attenuation regions in the liver. Magnetic Resonance imaging (MRI) can also be utilized to establish liver parenchymal involvement, and is better than CT in characterizing hemorrhagic lesions, as well as identifying more lesions relative to CT. Ductal Phase: US examination is most useful at this stage, with its ability to demonstrate the live movement of the worms within the dilated ducts. A CT demonstrates dilated central biliary ducts with periportal tracking, whereas, mild ductal dilatation is poorly appreciated under MRI. Therefore, familiarity with the multimodality imaging features of fascioliasis, in combination with an available confirmatory enzyme-linked immunoassay, would be most helpful for early diagnosis.Öğe A Rare Finding During a Common Procedure: Xanthogranulomatous Cholecystitis(Int College Of Surgeons, 2014) Taskesen, Fatih; Arikanoglu, Zulfu; Uslukaya, Omer; Oguz, Abdullah; Aliosmanoglu, Ibrahim; Dusak, Abdurrahim; Turkcu, GulXanthogranulomatous cholecystitis is a rare variant of chronic cholecystitis characterized by severe proliferative fibrosis and accumulation of lipid-laden macrophages in regions of destructive inflammation. Xanthogranulomatous cholecystitis clinically and radiologically mimics early-stage gallbladder cancer, with wall thickening on computed tomography. The study included 14 xanthogranulomatous cholecystitis patients that were identified following retrospective analysis of the records of 1248 patients that underwent cholecystectomy between 2005 and 2011. Mean age of the 5 male and 9 female patients was 56.7 years. All 14 patients had gallbladder stones; 10 had a history of acute cholecystitis, 1 had cholangitis, and 2 presented with obstructive jaundice. A right-upper quadrant mass was palpable in 2 patients. All patients underwent cholecystectomy. Open surgery was planned and performed in 6 of the 14 patients, and laparoscopic cholecystectomy was planned in 8 patients, but was converted to open surgery in 1 case. In total, 1 patient developed wound infection, 1 patient had postoperative pneumonia, and 1 patient developed intraabdominal hematoma. None of the patients in the series died. Xanthogranulomatous cholecystitis is difficult to diagnose, both preoperatively and intraoperatively, and definitive diagnosis depends exclusively on pathological examination. Xanthogranulomatous cholecystitis should be a consideration in all difficult cholecystectomy cases.Öğe The relationship between perimesencephalic subarachnoid hemorrhage and deep venous system drainage pattern and calibrations(Elsevier Science Inc, 2014) Buyukkaya, Ramazan; Yildirim, Nalan; Cebeci, Hakan; Kocaeli, Hasan; Dusak, Abdurrahim; Ocakoglu, Gokhan; Erdogan, CuneytBackground and purpose: The purpose of this study is to investigate the relationship between Rosenthal basal vein (BVR) type and diameter and perimesencephalic nonaneurysmal subarachnoid hemorrhage (P-SAH). Materials and methods: Aneurysmal subarachnoid hemorrhage (A-SAH), P-SAH, and control groups were evaluated, and BVRs were classified by type. BVR diameters in patients were measured. Results: There was a statistically significant difference of BVR drainage types between groups (P=.002). BVR diameters of patients with normal drainage pattern in P-SAH group were significantly smaller than those in both other groups (P<.001). Conclusion: There is a relationship between P-SAH and BVR primitive drainage type. P-SAH risk increases in parallel with decreasing caliber of BVR in patients with normal drainage pattern.(C) 2014 Elsevier Inc. All rights reserved.Öğe The role of initial radiologic and clinical manifestations in predicting the prognosis for pneumonia caused by H1N1 influenza virus(Ame Publishing Company, 2014) Goya, Cemil; Yavuz, Alpaslan; Hamidi, Cihad; Cetincakmak, Mehmet Guli; Teke, Memik; Hattapoglu, Salih; Dusak, AbdurrahimObjective: The aim of this study is to investigate the prognostic values of initial radiologic findings and preexisting medical conditions in pneumonia caused by H1N1 influenza virus that were obtained during the novel swine-origin influenza A (H1N1) virus (S-OIV) pandemic spread. Methods: Thirty-nine patients hospitalized due to H1N1 infection between September and December 2009 were retrospectively evaluated regarding the radiologic and clinical aspects. The thoracic computed tomography (CT) findings of all patients were assessed and accompanying conditions that may raise the morbidity were stated. The patients were divided into two groups as those who needed the intensive care unit administration and those treated with brief hospitalization; initial radiologic findings and preexisting medical situations of patients were compared among both groups respectively in terms of their prognostic value. Results: In 39 patients with H1N1 infection (21 males and 18 females; mean age of 53.9 +/- 14 in range between 19 and 99 years); the necessity of intensive care was significantly higher in patients with solely chronic obstructive pulmonary disease (COPD) (P=0.008, Odds ratio: 27) or co-existence of COPD and malignity (Odds ratio: 13); however, no statistically significant difference between two groups was observed regarding the radiologic facts or other combinations of accompanying medical conditions in terms of any effects to the prognosis. Conclusions: In the H1N1 (S-OIV) pandemic, we observed that merely the contribution to the diagnostic process; the radiologic features have no significance as being prognostic indicator. Additionally; the superposition of H1N1 infection in patients with either COPD or COPD by malignity was stated to be a potential risk factor in terms of increased morbidity.Öğe Role of Renal Resistive Index in Predicting the Severity of Coronary Artery Disease in Patients with Mild to Moderate Renal Insufficiency(2016) Alan, Bircan; Dusak, Abdurrahim; Aktan, AdemAmaç: Çalışmamızda hafif orta renal yetersizliği olan hastalarda renal resistive indeksini (RRİ)saptayarak bunun renal fonksiyonlar ve koroner arter hastalığının (KAH) şiddetiyle ilişkisini araştırdık. Materyal ve Metot: Çalışmaya koroner angiografisi yapılarak KAH tanısı konmuş 41 erkek,35 kadın toplam 76 hasta alındı. Tüm hastalarda renal doppler ultrasonografi (US) ile RRİ' leri ölçüldü. Renal parankim kalınlığı, böbrek uzunluk ve genişlikleri ölçüldü. Gensini risk skorlama sistemiyle KAH şiddeti skorlanarak hastalar hafif-KAH (Gensini skoru <= 20) ve şiddetli-KAH (Gensini skoru > 20) olmak üzere iki guruba ayrılarak karşılaştırıldı. Ayrıca tüm hastalarda glomerular filtrasyon hızı (eGFR) hesaplanarak 3 ayrı sub gruba ayrıldı ve RRI ile ilişkisi araştırıldı. Bulgular: Gensini skoruna göre şiddetli KAH olanlarda hafif KAH olanlara göre anlamlı derecede yüksek RRİ değerleri saptandı [0,62 (0,58-0,71)] karşı [0,71 (0,63-0,78)], p < 0,01]. Böbrek uzunluğu, böbrek genişliği, böbrek parankim kalınlıkları arasında anlamlı fark saptanmadı. eGFR, şiddetli KAH'lı hastalarda hafif KAH grubuna göre anlamlı derecede düşüktü(p= 0,02). eGFR değerlerine göre evrelendirilen KAH'lı hastalarda ,renal yetersizlik evresi ile RRİ arasında anlamlı ilişki saptanmıştır. Evre 1 (GFR>=90) olanlarda RI [0,63(0,59-0,68)], evre 2 olanlarda RI [0,77(0,71-0,84)],evre 3 olanlarda ise RI [0,81(0,73-0,85)]idi, (p<0,01). RRİ değerinin hafif ciddi koroner arter hastalığı tanısında, sensivite % 77, spesifite % 66 bulundu. Sonuç: RRI değerleri KAH' lı hastalarda hastalık şiddetine paralel şekilde artış göstermektedir. İlaveten renal yetersizlik derecesi artıkça RRİ değerleri artmaktadır. Doppler US ile RRİ ölçümü KAH şiddetini saptamada aynı zamanda böbrek fonksiyon ve mikrosirkülasyonu hakkında noninvaziv bir yöntem olarak ilave bilgiler sağlayabilirÖğe An unusual pacemaker malposition and delayed diagnosis(Dicle Üniversitesi Tıp Fakültesi, 2015) Alan, Bircan; Dusak, Abdurrahim; Çetinçakmak, Mehmet G.; Alan, SaitTransvenous right ventricular pacing usually shows a left bundle branch block (LBBB) pattern. When right bundle branch block (RBBB) pattern appears after the insertion of an electrode, perforation or malposition of the pacing lead usually occurs. However, when the pacing lead that is inserted into the coronary sinus or right ventricle extends to right ventricle septum, RBBB pattern may appear. Echocardiography, due to inadequate echo images or reflections, may result in early clinical misdiagnosis since it cannot be evaluated well. Another reason for the errors in diagnosis is that cardiologists generally relegate telegraphy evaluations to a second plan. Here, we present a case of pacemaker malposition, which was diagnosed using X-ray radiography after multiple failed evaluations with echocardiography.Öğe Venous Intravasation as a Complication and Potential Pitfall During Hysterosalpingography: Re-Emerging Study with a Novel Classification(Medknow Publications & Media Pvt Ltd, 2013) Dusak, Abdurrahim; Soydinc, Hatice E.; Onder, Hakan; Ekinci, Faysal; Goruk, Neval Y.; Hamidi, Cihat; Bilici, AslanObjectives: Presently, hysterosalpingography (HSG) is used as a means to evaluate women with infertility and repetitive pregnancy loss. Venous intravasation is a complication and potential pitfall during HSG and analogous procedures including hysteroscopy. The aim of our study was to assess the venous intravasation and to obtain critical information for more secure and more accurate procedures. In particular, the primary goal of the present study was to compare HSG without and with intravasation to identify differences seen on HSG and to assess the predisposing factors of intravasation. The secondary goal was to describe clinical- and imaging-based novel classification of intravasation. Materials and Methods: This study included a patient cohort of 569 patients who underwent HSG between 2008 and 2011 at our center in the absence (control group) or presence (study group) of intravasation. Intravasation classified from level 0 (no intravasation) to level 3 (severe intravasation) was compared with preprocedural (demographic and clinical) and procedural (HSG) data. Data were analyzed using Statistical Package for Social Sciences (SPSS) statistical software. Results: Of the 569 patients undergoing HSG, 528 showed no intravasation and 41 (7.2%) patients showed intravasation when associated with preprocedural (leukocytes, menometrorrhagia, secondary infertility, ectopic pregnancy, abortus, polycystic ovaries, endometriosis, and interventions) and procedural (pain, scheduling, endometrial-uterine nature, and spillage) parameters. Moreover, intravasation was lower in women with smooth endometrium, triangular uterus, and homogeneous peritoneal spillage. No association was found between age, tubal patency, increased pressure, and intravasation. Conclusions: Using a novel classification method, intravasation can be observed in women during HSG and associates with preprocedural and procedural predisposing factors in subsumed conditions. This classification method will be useful for improving the efficiency and accuracy of HSG and related procedures by minimization of severe complications caused by intravasation.
