Aims: This prospective study aimed to compare the long-term follow-up findings of patients with s... more Aims: This prospective study aimed to compare the long-term follow-up findings of patients with short-segment thoracolumbar instrumentation with the long-term follow-up findings results of patients with long-segment thoracolumbar instrumentation. Methods: Patients who underwent surgery for a thoracolumbar junction spine fracture were included in this study. The patient's age, gender, and neurological impairment, "AOSpine Classification Scale", "Visual Analog Scale (VAS)", "modified Japanese Orthopedic Association (mJOA)" and "Oswestry Disability Index (ODI)" scores, pedicle and/or pars interarticularis fractures, anterior, middle, and posterior height loss of the fractured vertebral body (mm), the height loss rate of the fractured vertebra, angulation degree, sagittal and axial spinal canal diameters (mm) and presence of bone fragment extending into the spinal canal on CT images were recorded at admission to the hospital, and the end of the sixth month after surgical intervention. Duration of anesthesia and surgery time, the amount of bleeding during the surgery, the radiation level (mGy) released by fluoroscopy, performing laminectomy, length of stay in the intensive care unit, and hospital were recorded. Additionally, the stability and integrity of the instrumentation were examined with dynamic X-ray images. Results: Preoperative fractured vertebra collapse rates (t=4.175, p=0.001) and surgery times (t=4.175, p=0.001) were different between groups. In the long-segment group, preoperative VAS scores (Z=-2.687, p=0.007), mJOA scores (Z=-2.585, p=0.010), and ODI scores (t=53.253, p<0.001) were different from postoperative long-term follow-up values. In addition, in the short segment group, preoperative VAS scores (Z=-2.214, p=0.027), mJOA scores (Z=-2.333, p=0.020), and ODI scores (t=48.338, p<0.001) were different from the postoperative long-term follow-up values. ROC-curve analysis and Logistic Regression analysis results revealed that any study parameter could not predict the decision-making for inserting screws into the fractured vertebra, the need for laminectomy, the risk of developing postoperative instability, or the worse prognosis risk of mJOA. Conclusion: This study's results showed that short-segment instrumentation, which is performed by inserting a screw into the fractured vertebra, is as effective as long-segment instrumentation in providing both clinical and radiological improvement in patients. At the same time, it has advantages such as less operating time, less surgical bleeding, and short anesthesia time. However, it was determined that no parameter of the study could predict the placement of screws in the fractured spine, the need for laminectomy, the risk of postoperative instability, or the prognosis risk of mJOA. Therefore, it was concluded that conducting this study on a larger patient population would be appropriate.
Intercontinental Journal of Internal Medicine, Nov 28, 2023
Aims: Adrenal incidentalomas (AI) are adrenal masses that are detected incidentally in imaging st... more Aims: Adrenal incidentalomas (AI) are adrenal masses that are detected incidentally in imaging studies performed for different reasons in people who do not have any complaints suggestive of adrenal gland disease. The overall prevalence, approximately just over 4%, increases with age. AI is detected in approximately 10% of people over the age of 70. In this context, we thought that CT imaging, which is already used in the diagnosis and follow-up of AI, can contribute to the evaluation of muscle and bone mass without creating additional costs. Methods: In this retrospective study, 39 patients who were followed up with nonfunctional adrenal incidentaloma (NFAI) by the endocrinology department and 30 healthy individuals with normal adrenal imaging in the abdominal CT examination as the control group were included. Patients with chronic diseases or drug use that may affect bone and muscle mass, and individuals in the postmenopausal period were excluded in this study. Endocrine tests performed to exclude autonomous cortisol secretion, pheochromocytoma and primary hyperaldosteronism; VMA and fractionated metanephrines in 24-hour urine, cortisol values after 1 mg dexamethasone suppression test, baseline serum dehydroepiandrosterone sulfate (DHEAS) levels and plasma aldosterone (ng/dl)/renin (ng/ml/hour) ratio were measured. Autonomous cortisol production was excluded in patients with serum cortisol below 1.8 mcg/dl after 1 mg dexamethasone suppression. Results: 39 patients with NFAI and 30 healthy volunteers participated in the study. In the NFAI group, 69.2% (n=27) were female and 30.8% (n=12) were male. In the healthy control group 63.3% (n=19) of the people were female and 37.7% (n=11) were male. There was no statistically significant difference between the two groups in terms of gender (p=061). The mean age of the NFAI group is 43 and the mean age of the control group is 49, and there was no statistically significant difference in age between the two groups (p=0.06). No decrease was found in BMD and paravertebral muscle mass values in the measurements made at L1-3 vertebral level with CT in NFAI patients. Further studies are needed in a larger patient population where the results are evaluated together with the femur and vertebral BMD measurements by DXA method, and muscle strength and performance are evaluated in addition to muscle mass in terms of sarcopenia.
Aim is to investigate the effect of contrast enhanced dynamic flow ultrasonography in characteris... more Aim is to investigate the effect of contrast enhanced dynamic flow ultrasonography in characterisation of liver masses. Forty patients with fortyfour focal liver lesions were first examined with conventional ultrasonography, color doppler, power doppler and contrast enhanced dynamic flow ultrasonography. Definite diagnosis of the lesions were as follows; 6 HCC, 13 metastases, 21 hemangiomas, 1 FNH, 2 hydatid cysts and 1 regeneration nodule. These lesions were then examined by dynamic flow ultrasonography with levovist 2,5/4 gr flk (contrast agent that contains galactose and palmitic acid). The vascular phase (arterial-portal) and parenchymal phase enhancement patterns were investigated. Accepting the arterial phase enhancement and later phase perfusion defect as a malignancy criteria, the sensitivity and specificity were 73,6% and 100% respectively. Accepting the later phase contrast enchancement as a benignity criteria, the sensitivity and specificity were 100% and 89,4% respectively. The sensitivity and specificity of the nodülar enhancement in hemangiomas were 95,2% and 100% respectively. The sensitivity and specificity, demonsrating the tumour vessel of HCC in arterial and portal phases were 66.6% and 100% respectively. Contrast enhanced dynamic flow ultrasonography is an effective method in characterisation of liver masses.
Journal of health sciences and medicine, Jun 18, 2020
It was aimed to compare the patients having clinical and radiological diagnosis of femoroacetabul... more It was aimed to compare the patients having clinical and radiological diagnosis of femoroacetabular impingement syndrome with the control group by magnetic resonance imaging, and alpha angle and the central corner angle described by Wiberg. Routine hip MRIs were analyzed retrospectively between January 2016 and May 2019. Clinically and radiologically, patients diagnosed with cam, pincer, and mixed FAI were recorded. A control group matching age and sex was created. The alpha angle was determined as the angle between the line drawn from the center of the femoral neck to the center of the femoral head in axial T1A magnetic resonance imaging, and the line drawn from the center of the femoral head to the point where the femoral head begins to turn towards the neck.Central corner angle of Wiberg's was measured as the angle between the perpendicular line drawn from the center of the femoral head to the acetabulum on the coronal T1A images and the line connecting the outermost point of the acetabulum. Measurements were compared statistically in both groups. p<0.05 was considered statistically significant. Results: 16 of 28 patients (18 men, 10 women) with FAI had impingement in both hips and a total of 44 hips were examined. There were 9 cam, 23 pincer and 12 mixed impingement cases in the patient group. When FAI and control groups were compared, alpha and Wiberg's angles were found to be significantly different (p<0.05). In subgroup analysis, there was a significant difference between cam type and control group, mixed type and control group, pincer type and cam type, pincer type and mixed type in terms of alpha angles (p<0.05). For Wiberg's angles, a significant difference was found between pincer type and control group, mixed type and control group, pincer type and cam type, mixed type and cam type (p<0.05). Cut off values were 54.45 (auc=0.64) for alpha angle and 37.30 (auc=0.83) for Wiberg angle. Alpha angle measurement cam type and Wiberg angle measurement provide useful information for the diagnosis of pincer type impingement with MRI.
İntrarenal apseler, akut piyelonefritin komplikasyonu olarak veya hematojen yolla gelişebilmekted... more İntrarenal apseler, akut piyelonefritin komplikasyonu olarak veya hematojen yolla gelişebilmektedir. Piyelonefritin komplikasyonu olarak gelişen apseler genellikle kortekste, medullada veya her ikinde birlikte yerleşir ve etken genellikle Gram negatif enterik bakterilerdir. Hematojen yolla oluşan apseler ise genellikle kortekste yerleşir, tektir ve etken de hemen her zaman stafilokoklardır. Tanıda idrar mikroskopisi normal olabileceği için, bilgisayarlı tomografi veya ultrasonografi gibi görüntüleme yöntemlerinin önemi büyüktür. İntrarenal abseler, özellikle çocuklarda, erken tedavi edilmediğinde böbrek hasarına yol açabilir. Tedavide antibiyoterapi genellikle tek başına yeterli olabilmekle birlikte, özellikle büyük boyuttaki apselerde cerrahi girişime ihtiyaç duyulabilmektedir. Bu çalışmada sadece medikal tedavi ile düzelen, multiple renal apseleri olan bir olguyu sunmayı amaçladık.
Cranial ultrasound is a valuable bedside technique and procedure of choice to image the intravent... more Cranial ultrasound is a valuable bedside technique and procedure of choice to image the intraventricular hemorrhage (IVH). Moreover, anatomical variants of the neonatal brain should be known to avoid of misinterpretation. The term of split choroid plexus was described as a cleft in the choroid plexus, which could be partial or complete in the anterior portion, giving a lobular appearance. We presented the case of split choroid plexus in a late premature infant and we aimed draw attention to the fact that it can be confused with IVH.
Medicine Science | International Medical Journal, 2018
Diabetic retinopathy (DR) is a complication of diabetes mellitus (DM) that may causes blindness. ... more Diabetic retinopathy (DR) is a complication of diabetes mellitus (DM) that may causes blindness. The vitreous is an extracellular matrix and it may have changes through liquefaction and syneresis in patients with DM, even in those without apparent DR. Diffusion-weighted imaging (DWI) is a new technique provide tissue contrast relying on difference with the diffusion of water molecules among tissues, which can be measured by the apparent diffusion coefficient (ADC) value. We aimed to investigate the vitreous of patients in different stages of DR using diffusion-weighted imaging technique. This prospective study included a group of 100 patients with DR and 100 members of an age-and gender-matched control group. All groups were tested using a head coil in conduction with a Achieva 1.5T magnetic resonans imaging (MRI) system (Philips Medical Systems, Best, The Netherlands). The mean ADC values were calculated and used for statistical comparisons. Mean duration of diabetes was 12.22±10.13 years in patients. Compared to controls, both eyes of the DR group had statistically and significantly lower values of ADC (p=0.025 and p=0.002, respectively). No significant correlations were found among the ADC values and central macular thickness, disease duration and stage of DR (all p>0.05) in patients. Mean ADC values revealed no significant differences among the subgroups of patients at different stages of DR (all p>0.05). Decreased ADCs in the vitreous of diabetes patients seem to be associated with the presence of diabetic retinopathy.
Purpose: Aim of the study is to make a clinical evaluation of parameters used in prosthesis desig... more Purpose: Aim of the study is to make a clinical evaluation of parameters used in prosthesis design for the humeral component applied in arthroplasty of the proximal upper extremity. Methods: In our study the plain shoulder radiographs were used of 195 (101 male, 94 female) patients aged 18-65 years (mean age, 38.8 ± 11.5 years; males 35.4 ± 11.6 years, females 42.5 ± 10.2) with soft tissue trauma, but no degenerative or structural disorder in the shoulder joint (fracture, tumour, osteoarthritis etc.). Measurements were made on the radiograph of Head Height (HH), Frontal Base Diameter of the Head (FBD), 3 points at 3 cm intervals from proximal to distal of the medullar canal at surgical neck Endosteal Diameter (ED1, ED2 and ED3 respectively), Neck-Shaft Angle (NSA) and Head- Neck Angle (HNA). Results: According to the results, in the comparison of Groups I and III except the mean values of HH and ED1 in other parameters, no statistically significant difference was determined. In the ...
Sonographically visualising the normal appendix precludes unnecessary examination and may reduce ... more Sonographically visualising the normal appendix precludes unnecessary examination and may reduce negative appendectomy rates. In addition, the appendix cannot always be displayed successfully with ultrasonography (US). In this study, we aimed to investigate the effects of age, sex, and body mass index (BMI) on the detection of a normally vermiform appendix by US. The study included 173 patients who applied for routine US examinations with no clinical findings of appendicitis. Age, BMI (only in adult patients), and gender were recorded. We searched for the appendix in each patient using both tissue harmonic imaging (THI) and conventional US after the routine US examinations. When the appendix was found, localisation and diameter were recorded. The two methods were compared in all patients, and the relation between the rate of visualisation and BMI was determined. The appendix was found in 59% of the patients: 50% of women, 41% of men, and 93% of children. Statistically, the detection...
Intrarenal apseler, akut piyelonefritin komplikasyonu olarak veya hematojen yolla gelisebilmekte... more Intrarenal apseler, akut piyelonefritin komplikasyonu olarak veya hematojen yolla gelisebilmektedir. Piyelonefritin komplikasyonu olarak gelisen apseler genellikle kortekste, medullada veya her ikinde birlikte yerlesir ve etken genellikle Gram negatif enterik bakterilerdir. Hematojen yolla olusan apseler ise genellikle kortekste yerlesir, tektir ve etken de hemen her zaman stafilokoklardir. Tanida idrar mikroskopisi normal olabilecegi icin, bilgisayarli tomografi veya ultrasonografi gibi goruntuleme yontemlerinin onemi buyuktur. Intrarenal abseler, ozellikle cocuklarda, erken tedavi edilmediginde bobrek hasarina yol acabilir. Tedavide antibiyoterapi genellikle tek basina yeterli olabilmekle birlikte, ozellikle buyuk boyuttaki apselerde cerrahi girisime ihtiyac duyulabilmektedir. Bu calismada sadece medikal tedavi ile duzelen, multiple renal apseleri olan bir olguyu sunmayi amacladik.
Journal of Surgical Arts Cerrahi Sanatlar Dergisi, Feb 4, 2011
Aim is to investigate the effect of contrast enhanced dynamic flow ultrasonography in characteris... more Aim is to investigate the effect of contrast enhanced dynamic flow ultrasonography in characterisation of liver masses. Forty patients with fortyfour focal liver lesions were first examined with conventional ultrasonography, color doppler, power doppler and contrast enhanced dynamic flow ultrasonography. Definite diagnosis of the lesions were as follows; 6 HCC, 13 metastases, 21 hemangiomas, 1 FNH, 2 hydatid cysts and 1 regeneration nodule. These lesions were then examined by dynamic flow ultrasonography with levovist 2,5/4 gr flk (contrast agent that contains galactose and palmitic acid). The vascular phase (arterial-portal) and parenchymal phase enhancement patterns were investigated. Accepting the arterial phase enhancement and later phase perfusion defect as a malignancy criteria, the sensitivity and specificity were 73,6% and 100% respectively. Accepting the later phase contrast enchancement as a benignity criteria, the sensitivity and specificity were 100% and 89,4% respectively. The sensitivity and specificity of the nodülar enhancement in hemangiomas were 95,2% and 100% respectively. The sensitivity and specificity, demonsrating the tumour vessel of HCC in arterial and portal phases were 66.6% and 100% respectively. Contrast enhanced dynamic flow ultrasonography is an effective method in characterisation of liver masses.
Aim is to investigate the effect of contrast enhanced dynamic flow ultrasonography in characteris... more Aim is to investigate the effect of contrast enhanced dynamic flow ultrasonography in characterisation of liver masses. Forty patients with fortyfour focal liver lesions were first examined with conventional ultrasonography, color doppler, power doppler and contrast enhanced dynamic flow ultrasonography. Definite diagnosis of the lesions were as follows; 6 HCC, 13 metastases, 21 hemangiomas, 1 FNH, 2 hydatid cysts and 1 regeneration nodule. These lesions were then examined by dynamic flow ultrasonography with levovist 2,5/4 gr flk (contrast agent that contains galactose and palmitic acid). The vascular phase (arterial-portal) and parenchymal phase enhancement patterns were investigated. Accepting the arterial phase enhancement and later phase perfusion defect as a malignancy criteria, the sensitivity and specificity were 73,6% and 100% respectively. Accepting the later phase contrast enchancement as a benignity criteria, the sensitivity and specificity were 100% and 89,4% respectively. The sensitivity and specificity of the nodülar enhancement in hemangiomas were 95,2% and 100% respectively. The sensitivity and specificity, demonsrating the tumour vessel of HCC in arterial and portal phases were 66.6% and 100% respectively. Contrast enhanced dynamic flow ultrasonography is an effective method in characterisation of liver masses.
Superior mesenteric artery syndrome is an uncommon cause of duodenal obstruction, and its manifes... more Superior mesenteric artery syndrome is an uncommon cause of duodenal obstruction, and its manifestations are generally associated with compression on the third part of the duodenum between the abdominal aorta and superior mesenteric artery. Case Presentation: In this report, a patient is described presenting with epigastric pain and weight loss due to superior mesenteric artery syndrome. The patient has also nutcracker syndrome, which is the compression of the left renal vein between the aorta and the superior mesenteric artery at its origin. Conclusions: In addition to an appropriate clinical history, CT findings indicating decreased aortomesenteric angle and a shortened aortomesenteric distance can suggest the diagnosis for both the superior mesenteric artery syndrome and accompanying nutcracker syndrome.
Nutcracker syndrome (NCS) is a rare pathology, caused by compression of the left renal vein (LRV)... more Nutcracker syndrome (NCS) is a rare pathology, caused by compression of the left renal vein (LRV) between the abdominal aorta (AA) and the superior mesenteric artery (SMA), due to reduction of the angle between AA and SMA. This leads to LRV varices, left gonadal vein varices and therefore, the pelvic congestion syndrome. For this reason, coexistence of NCS and pelvic congestion syndrome has been described. It manifests by hematuria, proteinuria, and nonspecific pelvic pain secondary to pelvic congestion, dyspareunia and persistent genital arousal. We report a 27-year-old woman who experienced hematuria and left flank pain. The diagnosis of NCS accompanied by pelvic congestion syndrome was missed initially, but later on the diagnosis was made by color Doppler ultrasound, abdominal computed tomography (CT) and CT angiography that were later performed. She refused interventional and surgical treatments, and was lost to follow up.
Background & Objective:Diffusion-weighted MR imaging and apparent diffusion coefficient (ADC) val... more Background & Objective:Diffusion-weighted MR imaging and apparent diffusion coefficient (ADC) values provide significant structural information about tissues in multiple sclerosis (MS).The goal of this study was to evaluate the ADC values in the hippocampus and amygdala in MS. Methods:Thirtyeightpatients with MS and 41 healthy individualswere included in the study. ADC values were measured bilaterallyfrom three different pointsin the hippocampus and amygdala in MS patients and were compared with those of the controls. An analysis of varianceposthoc test was used to analyse the differences among mean ADC values between MS and control groups.Results:The mean ADC values of both sides of thehippocampus and the left amygdala in MS patients were lower than the control group. The mean ADC values of the right amygdala in MS patients were lower than the control group, but the difference was not statistically significant. Conclusion:We observed restricted diffusion in the hippocampus and amygdala in MS patients contrary to information in the literature.
Background: Surgery of appendicitis carries 7-11% negative appendectomy rates. Sonographically vi... more 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. 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 χ 2 = 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.
We evaluated the effect of olfactory deficiency caused by sinonasal polyposis using a magnetic re... more We evaluated the effect of olfactory deficiency caused by sinonasal polyposis using a magnetic resonance imaging (MRI) evaluation. In this retrospective study, 33 adult patients with bilateral chronic rhinosinusitis with nasal polyps (CRSwNP) (Group 1) and 30 healthy subjects without nasal polyps (Control, Group 2) were included. On coronal T2 weighted SPIR images of the MRI, the olfactory bulb (OB) volume and the olfactory sulcus (OS) depth were measured; the same action was performed on the axial T1 weighted images, for the corpus amygdala and insular gyrus areas.
Objectives In this study, the nasolacrimal canal was examined proximal and distally in patients w... more Objectives In this study, the nasolacrimal canal was examined proximal and distally in patients with septum deviation to investigate the relationship between septum deviation and nasolacrimal canal (NLC) diameter and to reveal its relationship with maxillary sinus (MS) diameter. Methods Preoperative paranasal sinus computed tomography (PNSCT) images of 50 male and 50 female adult patients who underwent septoplasty were examined, and the deviated side (ipsilateral) and opposite side (contralateral) NLC diameters were measured at the proximal and distal parts. Moreover, bilateral MS height, anteroposterior and horizontal diameters were also measured. Results There were no significant differences between the NLC diameter of the ipsilateral and contralateral sides, either proximally or distally (p > 0.05). As a result of the measurements, it was observed that the NLC was wider in the proximal part than in the distal part without being affected by the deviation side (p < 0.05). Lik...
OBJECTIVES. We investigated peripheral smell regions in patients with central vertigo by cranial ... more OBJECTIVES. We investigated peripheral smell regions in patients with central vertigo by cranial magnetic resonance imaging (MRI). MATERIAL AND METHODS. In this study, 137 adult patients were included by selecting cranial MRI images from the hospital’s PACS system, covering both recent and past records. The first group included 68 adult patients suffering from central vertigo, and the control group (Group 2) 69 healthy individuals, who had no central vertigo. Measurements of olfactory bulb (OB) volume and olfactory sulcus (OS) depth were taken from all groups. RESULTS. The study found that the OB volume of the group with central vertigo was significantly lower compared to the control group (p<0.05). However, there were no significant differences in the OS depth between the two groups (p>0.05). In both groups, there were no significant variations in OB volume between the right and left sides (p>0.05). Additionally, both the central vertigo group and the control group showed ...
Aims: This prospective study aimed to compare the long-term follow-up findings of patients with s... more Aims: This prospective study aimed to compare the long-term follow-up findings of patients with short-segment thoracolumbar instrumentation with the long-term follow-up findings results of patients with long-segment thoracolumbar instrumentation. Methods: Patients who underwent surgery for a thoracolumbar junction spine fracture were included in this study. The patient's age, gender, and neurological impairment, "AOSpine Classification Scale", "Visual Analog Scale (VAS)", "modified Japanese Orthopedic Association (mJOA)" and "Oswestry Disability Index (ODI)" scores, pedicle and/or pars interarticularis fractures, anterior, middle, and posterior height loss of the fractured vertebral body (mm), the height loss rate of the fractured vertebra, angulation degree, sagittal and axial spinal canal diameters (mm) and presence of bone fragment extending into the spinal canal on CT images were recorded at admission to the hospital, and the end of the sixth month after surgical intervention. Duration of anesthesia and surgery time, the amount of bleeding during the surgery, the radiation level (mGy) released by fluoroscopy, performing laminectomy, length of stay in the intensive care unit, and hospital were recorded. Additionally, the stability and integrity of the instrumentation were examined with dynamic X-ray images. Results: Preoperative fractured vertebra collapse rates (t=4.175, p=0.001) and surgery times (t=4.175, p=0.001) were different between groups. In the long-segment group, preoperative VAS scores (Z=-2.687, p=0.007), mJOA scores (Z=-2.585, p=0.010), and ODI scores (t=53.253, p<0.001) were different from postoperative long-term follow-up values. In addition, in the short segment group, preoperative VAS scores (Z=-2.214, p=0.027), mJOA scores (Z=-2.333, p=0.020), and ODI scores (t=48.338, p<0.001) were different from the postoperative long-term follow-up values. ROC-curve analysis and Logistic Regression analysis results revealed that any study parameter could not predict the decision-making for inserting screws into the fractured vertebra, the need for laminectomy, the risk of developing postoperative instability, or the worse prognosis risk of mJOA. Conclusion: This study's results showed that short-segment instrumentation, which is performed by inserting a screw into the fractured vertebra, is as effective as long-segment instrumentation in providing both clinical and radiological improvement in patients. At the same time, it has advantages such as less operating time, less surgical bleeding, and short anesthesia time. However, it was determined that no parameter of the study could predict the placement of screws in the fractured spine, the need for laminectomy, the risk of postoperative instability, or the prognosis risk of mJOA. Therefore, it was concluded that conducting this study on a larger patient population would be appropriate.
Intercontinental Journal of Internal Medicine, Nov 28, 2023
Aims: Adrenal incidentalomas (AI) are adrenal masses that are detected incidentally in imaging st... more Aims: Adrenal incidentalomas (AI) are adrenal masses that are detected incidentally in imaging studies performed for different reasons in people who do not have any complaints suggestive of adrenal gland disease. The overall prevalence, approximately just over 4%, increases with age. AI is detected in approximately 10% of people over the age of 70. In this context, we thought that CT imaging, which is already used in the diagnosis and follow-up of AI, can contribute to the evaluation of muscle and bone mass without creating additional costs. Methods: In this retrospective study, 39 patients who were followed up with nonfunctional adrenal incidentaloma (NFAI) by the endocrinology department and 30 healthy individuals with normal adrenal imaging in the abdominal CT examination as the control group were included. Patients with chronic diseases or drug use that may affect bone and muscle mass, and individuals in the postmenopausal period were excluded in this study. Endocrine tests performed to exclude autonomous cortisol secretion, pheochromocytoma and primary hyperaldosteronism; VMA and fractionated metanephrines in 24-hour urine, cortisol values after 1 mg dexamethasone suppression test, baseline serum dehydroepiandrosterone sulfate (DHEAS) levels and plasma aldosterone (ng/dl)/renin (ng/ml/hour) ratio were measured. Autonomous cortisol production was excluded in patients with serum cortisol below 1.8 mcg/dl after 1 mg dexamethasone suppression. Results: 39 patients with NFAI and 30 healthy volunteers participated in the study. In the NFAI group, 69.2% (n=27) were female and 30.8% (n=12) were male. In the healthy control group 63.3% (n=19) of the people were female and 37.7% (n=11) were male. There was no statistically significant difference between the two groups in terms of gender (p=061). The mean age of the NFAI group is 43 and the mean age of the control group is 49, and there was no statistically significant difference in age between the two groups (p=0.06). No decrease was found in BMD and paravertebral muscle mass values in the measurements made at L1-3 vertebral level with CT in NFAI patients. Further studies are needed in a larger patient population where the results are evaluated together with the femur and vertebral BMD measurements by DXA method, and muscle strength and performance are evaluated in addition to muscle mass in terms of sarcopenia.
Aim is to investigate the effect of contrast enhanced dynamic flow ultrasonography in characteris... more Aim is to investigate the effect of contrast enhanced dynamic flow ultrasonography in characterisation of liver masses. Forty patients with fortyfour focal liver lesions were first examined with conventional ultrasonography, color doppler, power doppler and contrast enhanced dynamic flow ultrasonography. Definite diagnosis of the lesions were as follows; 6 HCC, 13 metastases, 21 hemangiomas, 1 FNH, 2 hydatid cysts and 1 regeneration nodule. These lesions were then examined by dynamic flow ultrasonography with levovist 2,5/4 gr flk (contrast agent that contains galactose and palmitic acid). The vascular phase (arterial-portal) and parenchymal phase enhancement patterns were investigated. Accepting the arterial phase enhancement and later phase perfusion defect as a malignancy criteria, the sensitivity and specificity were 73,6% and 100% respectively. Accepting the later phase contrast enchancement as a benignity criteria, the sensitivity and specificity were 100% and 89,4% respectively. The sensitivity and specificity of the nodülar enhancement in hemangiomas were 95,2% and 100% respectively. The sensitivity and specificity, demonsrating the tumour vessel of HCC in arterial and portal phases were 66.6% and 100% respectively. Contrast enhanced dynamic flow ultrasonography is an effective method in characterisation of liver masses.
Journal of health sciences and medicine, Jun 18, 2020
It was aimed to compare the patients having clinical and radiological diagnosis of femoroacetabul... more It was aimed to compare the patients having clinical and radiological diagnosis of femoroacetabular impingement syndrome with the control group by magnetic resonance imaging, and alpha angle and the central corner angle described by Wiberg. Routine hip MRIs were analyzed retrospectively between January 2016 and May 2019. Clinically and radiologically, patients diagnosed with cam, pincer, and mixed FAI were recorded. A control group matching age and sex was created. The alpha angle was determined as the angle between the line drawn from the center of the femoral neck to the center of the femoral head in axial T1A magnetic resonance imaging, and the line drawn from the center of the femoral head to the point where the femoral head begins to turn towards the neck.Central corner angle of Wiberg's was measured as the angle between the perpendicular line drawn from the center of the femoral head to the acetabulum on the coronal T1A images and the line connecting the outermost point of the acetabulum. Measurements were compared statistically in both groups. p<0.05 was considered statistically significant. Results: 16 of 28 patients (18 men, 10 women) with FAI had impingement in both hips and a total of 44 hips were examined. There were 9 cam, 23 pincer and 12 mixed impingement cases in the patient group. When FAI and control groups were compared, alpha and Wiberg's angles were found to be significantly different (p<0.05). In subgroup analysis, there was a significant difference between cam type and control group, mixed type and control group, pincer type and cam type, pincer type and mixed type in terms of alpha angles (p<0.05). For Wiberg's angles, a significant difference was found between pincer type and control group, mixed type and control group, pincer type and cam type, mixed type and cam type (p<0.05). Cut off values were 54.45 (auc=0.64) for alpha angle and 37.30 (auc=0.83) for Wiberg angle. Alpha angle measurement cam type and Wiberg angle measurement provide useful information for the diagnosis of pincer type impingement with MRI.
İntrarenal apseler, akut piyelonefritin komplikasyonu olarak veya hematojen yolla gelişebilmekted... more İntrarenal apseler, akut piyelonefritin komplikasyonu olarak veya hematojen yolla gelişebilmektedir. Piyelonefritin komplikasyonu olarak gelişen apseler genellikle kortekste, medullada veya her ikinde birlikte yerleşir ve etken genellikle Gram negatif enterik bakterilerdir. Hematojen yolla oluşan apseler ise genellikle kortekste yerleşir, tektir ve etken de hemen her zaman stafilokoklardır. Tanıda idrar mikroskopisi normal olabileceği için, bilgisayarlı tomografi veya ultrasonografi gibi görüntüleme yöntemlerinin önemi büyüktür. İntrarenal abseler, özellikle çocuklarda, erken tedavi edilmediğinde böbrek hasarına yol açabilir. Tedavide antibiyoterapi genellikle tek başına yeterli olabilmekle birlikte, özellikle büyük boyuttaki apselerde cerrahi girişime ihtiyaç duyulabilmektedir. Bu çalışmada sadece medikal tedavi ile düzelen, multiple renal apseleri olan bir olguyu sunmayı amaçladık.
Cranial ultrasound is a valuable bedside technique and procedure of choice to image the intravent... more Cranial ultrasound is a valuable bedside technique and procedure of choice to image the intraventricular hemorrhage (IVH). Moreover, anatomical variants of the neonatal brain should be known to avoid of misinterpretation. The term of split choroid plexus was described as a cleft in the choroid plexus, which could be partial or complete in the anterior portion, giving a lobular appearance. We presented the case of split choroid plexus in a late premature infant and we aimed draw attention to the fact that it can be confused with IVH.
Medicine Science | International Medical Journal, 2018
Diabetic retinopathy (DR) is a complication of diabetes mellitus (DM) that may causes blindness. ... more Diabetic retinopathy (DR) is a complication of diabetes mellitus (DM) that may causes blindness. The vitreous is an extracellular matrix and it may have changes through liquefaction and syneresis in patients with DM, even in those without apparent DR. Diffusion-weighted imaging (DWI) is a new technique provide tissue contrast relying on difference with the diffusion of water molecules among tissues, which can be measured by the apparent diffusion coefficient (ADC) value. We aimed to investigate the vitreous of patients in different stages of DR using diffusion-weighted imaging technique. This prospective study included a group of 100 patients with DR and 100 members of an age-and gender-matched control group. All groups were tested using a head coil in conduction with a Achieva 1.5T magnetic resonans imaging (MRI) system (Philips Medical Systems, Best, The Netherlands). The mean ADC values were calculated and used for statistical comparisons. Mean duration of diabetes was 12.22±10.13 years in patients. Compared to controls, both eyes of the DR group had statistically and significantly lower values of ADC (p=0.025 and p=0.002, respectively). No significant correlations were found among the ADC values and central macular thickness, disease duration and stage of DR (all p>0.05) in patients. Mean ADC values revealed no significant differences among the subgroups of patients at different stages of DR (all p>0.05). Decreased ADCs in the vitreous of diabetes patients seem to be associated with the presence of diabetic retinopathy.
Purpose: Aim of the study is to make a clinical evaluation of parameters used in prosthesis desig... more Purpose: Aim of the study is to make a clinical evaluation of parameters used in prosthesis design for the humeral component applied in arthroplasty of the proximal upper extremity. Methods: In our study the plain shoulder radiographs were used of 195 (101 male, 94 female) patients aged 18-65 years (mean age, 38.8 ± 11.5 years; males 35.4 ± 11.6 years, females 42.5 ± 10.2) with soft tissue trauma, but no degenerative or structural disorder in the shoulder joint (fracture, tumour, osteoarthritis etc.). Measurements were made on the radiograph of Head Height (HH), Frontal Base Diameter of the Head (FBD), 3 points at 3 cm intervals from proximal to distal of the medullar canal at surgical neck Endosteal Diameter (ED1, ED2 and ED3 respectively), Neck-Shaft Angle (NSA) and Head- Neck Angle (HNA). Results: According to the results, in the comparison of Groups I and III except the mean values of HH and ED1 in other parameters, no statistically significant difference was determined. In the ...
Sonographically visualising the normal appendix precludes unnecessary examination and may reduce ... more Sonographically visualising the normal appendix precludes unnecessary examination and may reduce negative appendectomy rates. In addition, the appendix cannot always be displayed successfully with ultrasonography (US). In this study, we aimed to investigate the effects of age, sex, and body mass index (BMI) on the detection of a normally vermiform appendix by US. The study included 173 patients who applied for routine US examinations with no clinical findings of appendicitis. Age, BMI (only in adult patients), and gender were recorded. We searched for the appendix in each patient using both tissue harmonic imaging (THI) and conventional US after the routine US examinations. When the appendix was found, localisation and diameter were recorded. The two methods were compared in all patients, and the relation between the rate of visualisation and BMI was determined. The appendix was found in 59% of the patients: 50% of women, 41% of men, and 93% of children. Statistically, the detection...
Intrarenal apseler, akut piyelonefritin komplikasyonu olarak veya hematojen yolla gelisebilmekte... more Intrarenal apseler, akut piyelonefritin komplikasyonu olarak veya hematojen yolla gelisebilmektedir. Piyelonefritin komplikasyonu olarak gelisen apseler genellikle kortekste, medullada veya her ikinde birlikte yerlesir ve etken genellikle Gram negatif enterik bakterilerdir. Hematojen yolla olusan apseler ise genellikle kortekste yerlesir, tektir ve etken de hemen her zaman stafilokoklardir. Tanida idrar mikroskopisi normal olabilecegi icin, bilgisayarli tomografi veya ultrasonografi gibi goruntuleme yontemlerinin onemi buyuktur. Intrarenal abseler, ozellikle cocuklarda, erken tedavi edilmediginde bobrek hasarina yol acabilir. Tedavide antibiyoterapi genellikle tek basina yeterli olabilmekle birlikte, ozellikle buyuk boyuttaki apselerde cerrahi girisime ihtiyac duyulabilmektedir. Bu calismada sadece medikal tedavi ile duzelen, multiple renal apseleri olan bir olguyu sunmayi amacladik.
Journal of Surgical Arts Cerrahi Sanatlar Dergisi, Feb 4, 2011
Aim is to investigate the effect of contrast enhanced dynamic flow ultrasonography in characteris... more Aim is to investigate the effect of contrast enhanced dynamic flow ultrasonography in characterisation of liver masses. Forty patients with fortyfour focal liver lesions were first examined with conventional ultrasonography, color doppler, power doppler and contrast enhanced dynamic flow ultrasonography. Definite diagnosis of the lesions were as follows; 6 HCC, 13 metastases, 21 hemangiomas, 1 FNH, 2 hydatid cysts and 1 regeneration nodule. These lesions were then examined by dynamic flow ultrasonography with levovist 2,5/4 gr flk (contrast agent that contains galactose and palmitic acid). The vascular phase (arterial-portal) and parenchymal phase enhancement patterns were investigated. Accepting the arterial phase enhancement and later phase perfusion defect as a malignancy criteria, the sensitivity and specificity were 73,6% and 100% respectively. Accepting the later phase contrast enchancement as a benignity criteria, the sensitivity and specificity were 100% and 89,4% respectively. The sensitivity and specificity of the nodülar enhancement in hemangiomas were 95,2% and 100% respectively. The sensitivity and specificity, demonsrating the tumour vessel of HCC in arterial and portal phases were 66.6% and 100% respectively. Contrast enhanced dynamic flow ultrasonography is an effective method in characterisation of liver masses.
Aim is to investigate the effect of contrast enhanced dynamic flow ultrasonography in characteris... more Aim is to investigate the effect of contrast enhanced dynamic flow ultrasonography in characterisation of liver masses. Forty patients with fortyfour focal liver lesions were first examined with conventional ultrasonography, color doppler, power doppler and contrast enhanced dynamic flow ultrasonography. Definite diagnosis of the lesions were as follows; 6 HCC, 13 metastases, 21 hemangiomas, 1 FNH, 2 hydatid cysts and 1 regeneration nodule. These lesions were then examined by dynamic flow ultrasonography with levovist 2,5/4 gr flk (contrast agent that contains galactose and palmitic acid). The vascular phase (arterial-portal) and parenchymal phase enhancement patterns were investigated. Accepting the arterial phase enhancement and later phase perfusion defect as a malignancy criteria, the sensitivity and specificity were 73,6% and 100% respectively. Accepting the later phase contrast enchancement as a benignity criteria, the sensitivity and specificity were 100% and 89,4% respectively. The sensitivity and specificity of the nodülar enhancement in hemangiomas were 95,2% and 100% respectively. The sensitivity and specificity, demonsrating the tumour vessel of HCC in arterial and portal phases were 66.6% and 100% respectively. Contrast enhanced dynamic flow ultrasonography is an effective method in characterisation of liver masses.
Superior mesenteric artery syndrome is an uncommon cause of duodenal obstruction, and its manifes... more Superior mesenteric artery syndrome is an uncommon cause of duodenal obstruction, and its manifestations are generally associated with compression on the third part of the duodenum between the abdominal aorta and superior mesenteric artery. Case Presentation: In this report, a patient is described presenting with epigastric pain and weight loss due to superior mesenteric artery syndrome. The patient has also nutcracker syndrome, which is the compression of the left renal vein between the aorta and the superior mesenteric artery at its origin. Conclusions: In addition to an appropriate clinical history, CT findings indicating decreased aortomesenteric angle and a shortened aortomesenteric distance can suggest the diagnosis for both the superior mesenteric artery syndrome and accompanying nutcracker syndrome.
Nutcracker syndrome (NCS) is a rare pathology, caused by compression of the left renal vein (LRV)... more Nutcracker syndrome (NCS) is a rare pathology, caused by compression of the left renal vein (LRV) between the abdominal aorta (AA) and the superior mesenteric artery (SMA), due to reduction of the angle between AA and SMA. This leads to LRV varices, left gonadal vein varices and therefore, the pelvic congestion syndrome. For this reason, coexistence of NCS and pelvic congestion syndrome has been described. It manifests by hematuria, proteinuria, and nonspecific pelvic pain secondary to pelvic congestion, dyspareunia and persistent genital arousal. We report a 27-year-old woman who experienced hematuria and left flank pain. The diagnosis of NCS accompanied by pelvic congestion syndrome was missed initially, but later on the diagnosis was made by color Doppler ultrasound, abdominal computed tomography (CT) and CT angiography that were later performed. She refused interventional and surgical treatments, and was lost to follow up.
Background & Objective:Diffusion-weighted MR imaging and apparent diffusion coefficient (ADC) val... more Background & Objective:Diffusion-weighted MR imaging and apparent diffusion coefficient (ADC) values provide significant structural information about tissues in multiple sclerosis (MS).The goal of this study was to evaluate the ADC values in the hippocampus and amygdala in MS. Methods:Thirtyeightpatients with MS and 41 healthy individualswere included in the study. ADC values were measured bilaterallyfrom three different pointsin the hippocampus and amygdala in MS patients and were compared with those of the controls. An analysis of varianceposthoc test was used to analyse the differences among mean ADC values between MS and control groups.Results:The mean ADC values of both sides of thehippocampus and the left amygdala in MS patients were lower than the control group. The mean ADC values of the right amygdala in MS patients were lower than the control group, but the difference was not statistically significant. Conclusion:We observed restricted diffusion in the hippocampus and amygdala in MS patients contrary to information in the literature.
Background: Surgery of appendicitis carries 7-11% negative appendectomy rates. Sonographically vi... more 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. 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 χ 2 = 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.
We evaluated the effect of olfactory deficiency caused by sinonasal polyposis using a magnetic re... more We evaluated the effect of olfactory deficiency caused by sinonasal polyposis using a magnetic resonance imaging (MRI) evaluation. In this retrospective study, 33 adult patients with bilateral chronic rhinosinusitis with nasal polyps (CRSwNP) (Group 1) and 30 healthy subjects without nasal polyps (Control, Group 2) were included. On coronal T2 weighted SPIR images of the MRI, the olfactory bulb (OB) volume and the olfactory sulcus (OS) depth were measured; the same action was performed on the axial T1 weighted images, for the corpus amygdala and insular gyrus areas.
Objectives In this study, the nasolacrimal canal was examined proximal and distally in patients w... more Objectives In this study, the nasolacrimal canal was examined proximal and distally in patients with septum deviation to investigate the relationship between septum deviation and nasolacrimal canal (NLC) diameter and to reveal its relationship with maxillary sinus (MS) diameter. Methods Preoperative paranasal sinus computed tomography (PNSCT) images of 50 male and 50 female adult patients who underwent septoplasty were examined, and the deviated side (ipsilateral) and opposite side (contralateral) NLC diameters were measured at the proximal and distal parts. Moreover, bilateral MS height, anteroposterior and horizontal diameters were also measured. Results There were no significant differences between the NLC diameter of the ipsilateral and contralateral sides, either proximally or distally (p > 0.05). As a result of the measurements, it was observed that the NLC was wider in the proximal part than in the distal part without being affected by the deviation side (p < 0.05). Lik...
OBJECTIVES. We investigated peripheral smell regions in patients with central vertigo by cranial ... more OBJECTIVES. We investigated peripheral smell regions in patients with central vertigo by cranial magnetic resonance imaging (MRI). MATERIAL AND METHODS. In this study, 137 adult patients were included by selecting cranial MRI images from the hospital’s PACS system, covering both recent and past records. The first group included 68 adult patients suffering from central vertigo, and the control group (Group 2) 69 healthy individuals, who had no central vertigo. Measurements of olfactory bulb (OB) volume and olfactory sulcus (OS) depth were taken from all groups. RESULTS. The study found that the OB volume of the group with central vertigo was significantly lower compared to the control group (p<0.05). However, there were no significant differences in the OS depth between the two groups (p>0.05). In both groups, there were no significant variations in OB volume between the right and left sides (p>0.05). Additionally, both the central vertigo group and the control group showed ...
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Papers by Mikail İnal