THE EFFECTS OF SHORT/LONG-TERM ADMINISTRATION OF DUAL ANTIPLATELET THERAPY ON RESTENOSIS IN PATIENTS WITH CAROTID ARTERY STENTING

Background: There is no consensus on the duration of dual antiaggregant therapy after carotid stenting. This study aimed to evaluate the early contribution of dual antiaggregant therapy for three or six months to stent restenosis. Objective: This study aimed to identify the correlation between stent restenosis and the duration of dual antiplatelet therapy (DAPT) in carotid artery stenting (CAS) subjects by retrospectively scanning a CAS procedure dataset. Methods: Patients who underwent a CAS procedure received dual DAPT (acetylsalicylic acid (ASA) + clopidogrel) were recruited for this study. The first group was the patients who received dual antiaggregants for three months, and the second group was the patients who received dual antiaggregants for six months. Patients' demographic characteristics, comorbidities, and radiological results were reviewed. Follow-up activities for the following six months were assessed for stent status, complications, and new ischemic lesions. Results: A total of 65 patients received ASA (acetylsalicylic acid) + clopidogrel for six months, while the remaining 118 patients were treated for three months. The restenosis rates were not significantly different between the two groups. The complication and adverse event frequencies were also similar. Conclusion: This study revealed that the efficacy of 3-month and 6-month DAPT is similar regarding the restenosis frequency, and there are no significant differences in complication frequency

A rare coronary artery anomaly - type X dual left anterior descending artery: a case report with brief literature review

Introduction: Type X dual left anterior descending artery (LAD), which is a rare subtype of coronary artery anomalies and newly defined in the literature, usually presents an asymptomatic clinical course and is detected incidentally in diagnostic angiography. However, in the presence of obstructive disease, myocardial revascularization may be required. It is critical to identify the presence of Type X dual LAD in order to prevent misdiagnoses in coronary angiography and to prevent complications during angioplasty or surgical myocardial revascularization. We present a case of rare type X dual LAD coronary anomaly presented with chest pain. Case presentation: A 66-year-old female patient was admitted to the hospital with the complaints of atypical chest pain and palpitations. Examinations revealed sinus tachycardia, mitral valve calcific degeneration, mild tricuspid valve insufficiency, and left atrial dilatation on echocardiography, hyperlipidemia and normal troponin I value. Coronary artery disease risk (according to the Framingham risk score) was low (8%), and coronary coronary computed tomography angiography (CCTA). The calcium score was calculated as 1782 Agatston. There were calcified atheroma plaques in the left main coronary artery (LMCA) ostium and distal section causing less than 25% stenosis. A well-developed diagonal branch of LAD was observed. The LAD calibration was thin and terminated at the proximal of anterior interventricular sulcus (AIVS). Therefore, it was evaluated as short LAD. A long LAD was detected, which was arising from the right coronary sinus with a separate ostium, reached the AIVS at the midventricular level after a pre-pulmonic course in front of the right ventricular outflow tract and extended to the apex. The long LAD was located in front of the right ventricle, close to the anterior chest wall. As there were no signs of myocardial ischemia or injury, calcified lesions in coronary arteries were nonstenotic (excluding thus acute coronary syndrome as cause of chest pain) the medical treatment with antilipidemia and hypertension and atherosclerosis modifying medications has been started and she was discharged with recommendations to continue treatment, modify risk factors for coronary artery disease and follow-up visits were scheduled. Conclusion: Our case demonstrated that rare dual type X LAD can be detected by CCTA in a patient evaluated for chest pain. CCTA is a useful tool for detection of coronary anomalies, that should be sought in patients with chest pain, absence of acute myocardial injury and low Framingham risk score

Efficacy of the endovascular ovarian vein embolization technique in pelvic venous congestion syndrome

Purpose: Pelvic pain, either related or unrelated to menstruation, is especially common in women of reproductive age. Thirty-nine per cent of all women suffer from chronic pelvic pain at some point in their lives, and pelvic venous congestion syndrome (PVCS) is the cause of this pain in 30% of cases. The aim of this study was to determine factors affecting the success of endovascular venous embolization used in the treatment of PVCS, and to present the longterm treatment results. Material and methods: The data of 144 female patients who underwent endovascular ovarian vein embolization for PVCS between January 2012 and July 2020 were retrospectively analysed. Results: Pain management was determined to be very successful in 37 (25.6%) patients, successful in 55 (38.1%), and unsuccessful in 52 (35.3%). Treatments using a coil alone were significantly more successful in pain management than those involving the use of different materials in addition to the coil (p = 0.036). In addition, patients with unilateral insufficiency before the procedure were found to have more successful pain management than those with bilateral insufficiency (p = 0.041). Reproductive/postmenopausal state and parity did not have a statistically significant effect on treatment efficacy (p = 0.250 and p = 0.573, respectively). Conclusions: Endovascular pelvic venous embolization is an important option in the treatment of PVCS due its less invasive and reproducible nature

Clinical features and risk factors of angiography headache and evaluation of its relationship to primary headaches

Introduction. Angiography headache is defined as a new headache caused directly by cerebral angiography. We aimed to investigate the prevalence and clinical characteristics of angiography headache, and its relationship with primary headaches.Material and methods. This single-centre prospective cohort study was carried out in our tertiary healthcare centre. Patients who had undergone a diagnostic cerebral angiography procedure between March 2016 and June 2017 were included in the study. During and after the procedure, we evaluated the patients in terms of occurrence of headache, and, if present, details about time to onset of headache after cerebral angiography, duration of headache, accompanying symptoms (nausea, vomiting, photophobia and phonophobia), and degree and severity of pain.Results. A total of 226 patients were included in the study. The prevalence of angiography headache was found to be 22.1% (n = 50). While angiography headache started in the first six hours in 92% (n = 46) of the patients, it started after 24 hours of the angiography procedure in only 4% (n = 2). Compressive headache was the most common type, described by 64% of the patients, whereas 4% of the patients described pricking or stabbing sensations. Angiography headache was associated with female gender, higher educational level, and a history of primary headache.Conclusion. Angiography headache is an important clinical entity that must be considered during and after angiography. Experiencing angiography headache is more common among patients with a history of primary headache

Kemik tümörlerinin görüntülenmesinde bilgisayarlı tomografinin yeri

TEZ781Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 1990.Kaynakça (s. 103-118) var.118 s. : rnk. res. ; 30 cm.

Ovarian vein diameters measured by MDCT in women without evidence of pelvic congestion syndrome

Objectives: The purpose of this study was to clarify reference values for ovarian veins diameters in women without evidence of primary or secondary pelvic venous insufficiency and to determine factors influencing these parameters. Methods: Multidetector computed tomography images and medical records of 197 women were retrospectively reviewed. The patients’ age, body mass index and history of parturition were examined. Results: Diameters of right ovarian veins (ROV) and left ovarian veins (LOV) ranged from one to six mm (mean 2.9 (1.0) mm, 3.2 (1.2) mm, respectively). The reference values for ROVs diameters were between 0.9 mm and 4.9 mm (95% CI 2.7-3.0 mm), while the reference values for LOVs diameters ranged from 0.8 mm to 5.5 mm (95% CI 3.0-3.3 mm). ROV diameter was significantly narrower than LOV diameter (2.9 (1.0) vs 3.2 (1.2) mm, p=0.031). Ovarian veins diameters were smaller in elderly patients (p=0.001 and p=0.002), and larger in nulliparous women (p=0.002) and those with higher individual frequency of parturition (p=0.05). There was a tendency to higher values of veins size in presence of drainage variation. Multiple regression analysis revealed presence of negative significant relationship of ROV size with age, positive association with parturition frequency and anatomical drainage variation of ovarian veins. ROVs and LOVs diameters did not differ in subgroups of normal weight, overweight and obese patients (p>0.05). Conclusions: The present study demonstrated significant reduction of ovarian veins diameters with advancement in age of patients, while increased ovarian veins diameters were related positively to parturition history and higher parturition frequency index. There was a negative relationship of right ovarian veins size with age, and positive association with parturition frequency and drainage variation. Only individual parturition frequency had an independent association with left ovarian vein diameter

Unenhanced spiral CT in the diagnosis of acute appendicitis

AMAÇ Kontrastsız spiral bilgisayarlı tomografinin (BT) akut apandisit tanısındaki rolünü değerlendirmek. GEREÇ VE YÖNTEM Akut apandisit kliniği bulunan 34'ü (%52) kadın, 31'i (%48) erkek toplam 65 hastaya oral ve intravenöz kontrast madde verilmeden spiral modda BT inceleme yapıldı. Alınan topogram üzerinde L1 vertebra üst platosu düzeyinden iliyak kanat üst kesimine kadar 10 mm kolimasyon ve 8 mm/sn masa hızı; bu düzeyden asetabuler çatı düzeyine kadar ise 5 mm kolimasyon ve 5 mm/sn masa hızı ve 1.5 sn'lik kesit süresi kullanılarak çekim gerçekleştirildi. BT'de transvers çapı 6 mm'den fazla olan apendiks ve/veya apendikolite eşlik eden apendiks çevresinde iltihabi değişikliklerin gözlenmesi akut apandisit varlığını düşündürdü. BT sonuçları cerrahi uygulanan hastalarda operasyon bulguları ve patoloji sonuçları ile karşılaştırıldı. Operasyona alınmayan hastalar ise 3 ay süresince takip edildi. BULGULAR BT'de 65 hastanın 28'sinde (%43) akut apandisit düşünüldü ancak bunların 25'inde %38) operasyon ve patolojik inceleme sonucunda akut apandisit saptandı. Yirmibir (%32) hasta BT'de normal olarak değerlendirilirken; 16 hastada (%25) akut apandisite benzer klinik yaratan apandisit dışı patolojiler saptandı. Olguların 25’i gerçek pozitif, 35’i gerçek negatif, 3’ü yalancı pozitif ve 2’si yalancı negatifti. Kontrastsız spiral BT incelemenin akut apandisit tanısındaki duyarlılığı %93, özgüllüğü %92, doğruluk oranı %95, pozitif tahmin değeri %89 ve negatif tahmin değeri %95 olarak bulundu. SONUÇ Akut apandisit kliniği bulunan hastaların değerlendirilmesinde kontrastsız spiral BT doğru, güvenilir ve etkili bir yöntemdir. Ayrıca akut apandisit belirtilerini taklit eden diğer patolojileri göstermesi de avantajdır.PURPOSE: To evaluate the role of unenhanced spiral computed tomography (CT) in the work-up of patients with suspicious symptoms of acute appendicitis. MATERIALS AND METHODS: Sixty-five patients with suspected acute appendicitis (34 (52%) women and 31 (48%) men), were studied with spiral CT without administration of IV or oral contrast. From the upper L1 vertebral plate to the superior border of the iliac wings, slices of 10 mm collimation with 8 mm/sec table speed were taken, and from that level to the acetabular roof level, 5 mm thick slices were obtained with a table speed of 5 mm/sec and tube rotation time of 1.5 sec. The diagnosis of acute appendicitis was made by seeing a dilated appendix vermiformis greater than 6 mm in diameter and/or an appendicolith accompanied by periappendiceal inflammatory changes. The findings were compared with surgical and pathological results. Those patients who were not operated on were followed-up for 3 months. RESULTS: Acute appendicitis was diagnosed in 28 (43%) of the 65 patients. Of the 28 patients with a CT diagnosis of acute appendicitis, 25 (38%) had acute appendicitis proven by surgery and pathology. Twenty-one (32%) patients had a normal CT study and 16 (25%) patients had non-appendiceal pathologies. There were 25 true-positives, 35 true negatives, 3 false positives and 2 false negatives. Non-contrast helical CT had a sensitivity of 93%, specificity of 92%, accuracy of 95%, positive predictive value of 89% and negative predictive value of 95% in the diagnosis of acute appendicitis. CONCLUSION: Non-contrast CT is an accurate, reliable and efficacious method in the diagnosis of acute appendicitis. It also has the advantage of showing other pathologies mimicking the symptoms of acute appendicitis

Endovascular treatment in orificial occlusive lesions of vertebral artery

Objectives: Vertebral artery (VA) stenosis is found in 20%of patients with posterior fossa ischemia. Endovasculartreatment has become more preferable to be used in thetreatment of VA orificial occlusive lesions referring to therecent developments. In this study, we aimed to present theclinical results and to show the success of the endovasculartreatment in occlusive lesions localized in VA orifice.Materials and Methods: In our retrospective study, 28patients undergoing endovascular intervention between2010 and 2013 for symptomatic occlusive lesion in VAorifice were examined. The patients were diagnosed withDoppler ultrasonography, following extensive neurologicalexamination. Consequently, stent implantation with digitalsubtraction angiography device was applied in interventionalradiology unit. Demographical, angiographical, clinicalinformation of subjects, as well as data regarding thestenosis before and after the procedure were recorded.Results: Endovascular treatment was applied to 19patients with left vertebral (67.8%), eight patients withright vertebral (28.5%), and one patient with left and rightvertebral lesions (3.5%). Technical success rate was 100%.One total occlusion (3.5%), three 95% to 99% stenosis(10.5%) and one 70% stenosis were seen during follow-up.Among the patients, two with 95% to 99% stenosis weretreated endovascularly again. In early (0-3 months) term,primary and secondary patency rate was 100%. For mid-(4-6 months) term, primary and secondary patency was96.4%. At long term, primary and secondary rates were86.9% and 91.3%, respectively.Conclusion: Endovascular treatment, combined withoptimal medical therapy, is an effective treatment methodin orificial occlusive lesions of VA

Evaluation of the Ophtalmic Artery Flow Pattern with Color-Doppler Ultrasonography in the Patients with Carotid Artery Stenosis

Purpose: To assess whether ophtalmic artery flow patterns reflect the status of cerebral circulation in patients with carotid artery stenosis. Material and Method: Twenty-four patients including 14 men and 10 women, with varying degrees of monolateral or bilateral carotid artery stenosis were included in the study. Patients' ages ranged between 32 and 79 years (mean 60). The control group was composed of 12 subjects without carotid artery stenosis who had undergone digital substaction angiography for different purposes. Digital substraction angiography and color-Doppler ultrasonography were performed in all the patients and the control group. Degrees of carotid artery stenosis and flow patterns and velocities, pulsatility and resistance indices of ophtalmic arteries of two groups were compared. Results: Significant differences in ophtalmic artery flow patterns and velocities, pulsatility and resistance indices between those patients with carotid artery stenosis of more than 70% and the control group were recorded. Conclusion: Imaging of the ophtalmic artery with color-Doppler ultrasonography is a useful and cost-effective method that reflects the status of cerebral circulation in patients with carotid artery stenosis

Irreversible blindness: An unusual complication of the Caldwell-Luc operation

Paranasal sinus surgery is frequently used for the management of allergic, infectious and neoplastic sinus diseases by otolaryngologists. Ophthalmic complications are rare but their occurrence may result in morbidity. Optic nerve injury, extraocular muscle injury, intraorbital hemorrhage, periorbital emphysema, and nasolacrimal duct and sac injury are the ophthalmic complications of sinus surgery. We present a case with orbital complications following the Caldwell-Luc operation.Paranasal sinus surgery is frequently used for the management of allergic, infectious and neoplastic sinus diseases by otolaryngologists. Ophthalmic complications are rare but their occurrence may result in morbidity. Optic nerve injury, extraocular muscle injury, intraorbital hemorrhage, periorbital emphysema, and nasolacrimal duct and sac injury are the ophthalmic complications of sinus surgery. We present a case with orbital complications following the Caldwell-Luc operation