Reply: Pseudoexfoliation syndrome and cardiovascular disease: studies must control for all cardiovascular risk factors

[No Abstract Available

Oculomotor Nerve Palsy and Vascular Causes: a Case Report

Seksen iki yaşındaki kadın hasta sağ göz kapağında düşüklük, çift görme ve göz hareketlerinde kısıtlılık şikayetleriyle kliniğimize başvurdu. Yapılan muayenede sağda pitozis ile birlikte içe, yukarı ve aşağı bakış kısıtlılığı görüldü. İki ay önce şikayetleri ortaya çıktığında başka bir merkezde yapılan muayenesinde bulgularımızdan farklı olarak anizokori (sağ>sol)saptanmıştı. Hipertansiyon tedavisi gören hastaya 3. sinir felci ön tanısıyla kranyal manyetikrezonans ve manyetik rezonans anjiyografi tetkikleri yapıldı. Sol mediyal oksipital lob ve para hipokampal girus kortekslerinde subakut dönemde sol posterior serebral arter infarktı ileuyumlu kortikal lezyon izlendi. Sağ internal karotid arterin tam tıkalı, sol vertebral ve posterior komünikan arterin hipoplazik olduğu görüldü. Bir ay sonra tüm belirti ve bulgular kendiliğinden düzeldiA 82 years old female patient admitted to our clinic with ptosis of the right eye, restriction of eye movements and double vision. In physical examination, with ptosis in the right eye, there were also movement restrictions to upward, downward and inward directions. Two months before when first symptoms appeared, in the medical centre that our patient admitted, there was also anisocoria (right>left) that was not present in our physical examination. With possible diagnosis of third cranial nerve palsy, cranial MRI and MRI angiography procedures were performed for our patient taking antihypertensive medications. Lesions suitable for subacute infarction of left posterior cerebral artery watershed were seen in left medial occipital lobe and para hippocampal gyrus cortex. Right internal carotid artery was totally ocluded and left vertebral and posterior comminican artery were hypoplasic. After one month, all lesions were subsided spontaneously

Lymphangioma: Surrounding the ovarian vein and ovary

Lymphangiomas are usually benign lesions seen in the head and neck region in children. Intra-abdominal localisation is rare and the majority of these cases are in early childhood. Retroperitoneal lymphangiomas constitute approximately 1% of all lymphangiomas. They are generally diagnosed incidentally, may be asymptomatic or may present with a palpable abdominal mass. A limited number of cases of ovarian lymphangiomas have been reported in women, whereas there are no reported cases of paraovarian localisation. We present a rare case of lymphangioma located in bilateral paraovarian region and along the left ovarian vein with radiological findings

Persistent headache in a postpartum patient: the investigation and management

Postdural puncture headache (PDPH) is the most common complication of obstetric regional anaesthesia and the most likely cause of headache in a woman who underwent epidural anaesthesia during delivery. Cerebral venous sinus thrombosis (CVST) is an uncommon cause of postpartum headache. Anaesthesia in obstetrics may lead to long-lasting intracranial hypotension resulting in CVST. CVST is a serious pathology with high mortality if misdiagnosed, but its correct and rapid diagnosis offers the opportunity for early treatment. Cranial magnetic resonance imaging (MRI) is an important modality in the diagnosis of both CVST and intracranial hypotension. The latter condition may be treated either by an epidural blood patch or bed rest and hydration. We report a case of a 36-year-old woman who developed CVST and multiple venous infarcts after an attempted epidural procedure during delivery. She was treated conservatively with bed rest, hydration and low-molecular-weight heparin and the patient recovered completely. Copyright 2013 BMJ Publishing Group. All rights reserved

A case report of brain abscess caused by carbapenem- resistant Klebsiella pneumoniae

The treatment of infections caused by carbapenem-resistant Klebsiella pneumoniae (CR-Kp) strains is difficult due to the limited antimicrobial options and high mortality. There are many reports on intracranial infections caused by CR-Kp, but only a few on brain abscesses caused by CR-Kp. Here, we present a case of brain abscess caused by CR-Kp successfully treated with combined antibiotics. A 26-year-old male patient was admitted to our hospital due to high fever and headache. His past medical history includes a surgical intervention due to an acute subdural hematoma, performed at an external healthcare center. After the current diagnosis of cerebral abscess, he underwent two surgeries. During the procedure, multiple cerebral abscesses were drained and capsulotomies were performed under ultrasound guidance. The combination of meropenem and vancomycin was started. The contents of the abscesses were sent to the microbiology and pathology laboratory. On the 3rd day of treatment, the medical team was informed that CR-Kp grew in an abscess culture. The patient's treatment was changed to meropenem + colistin + tigecycline. The patient developed electrolyte disturbances during the follow-up and this was considered an adverse effect of colistin. On the 41st day of treatment, colistin was discontinued, fosfomycin was added, and meropenem and tigecycline were maintained. Treatment was discontinued on the 68th day, when the patient was discharged. The general condition of the patient, who has been followed up for two years, is satisfactory. The treatment of CR-Kp infections should be individualized, and the pharmacokinetics and pharmacodynamics of antibiotics should be considered in each case

The evaluation of the effect of pilocarpine induced accomodation on anterior chamber depth in pseudophakic eyes using magnetic resonance imaging

Amaç: Tek parçalı ve 3 parçalı hidrofobik akrilik göz içi lensi (GİL) implante edilmiş hastalarda, siklopentolat hidroklorür (HCI) ve pilokarpin HCI’nin ön kamera derinliğine (ÖKD) etkisinin karşılaştırılması. Gereç ve Yöntem: Komplikasyonsuz saydam kornea kesili fakoemülsifikasyon ve GİL implantasyonu yapılmış 19 hastanın 19 gözü değerlendirildi. Hastaların 9’una (grup 1) tek parçalı (AcrySof SA60AT, Alcon) ve 10’una da (grup 2) 3 parçalı (AcrySof MA60BM, Alcon) katlanabilir, hidrofobik akrilik GİL implante edilmişti. Hastaların opere edilen gözlerinin ÖKD’ leri üç gün arayla, sırasıyla pilokarpin HCI %2 ve siklopentolat HCI %1 damlatıldıktan sonra T2 ağırlıklı manyetik rezonans görüntüleri kullanılarak aksiyel ve sagittal planda hesaplandı. Cerrahi ile manyetik rezonans görüntüleme arasındaki ortalama süre grup 1’de 16,1, grup 2’de 13.7 aydı. Wilcoxin ve Mann-Whitney U testleri ile grup içi ve gruplar arası kıyaslamalar yapıldı. Bulgular: Pilokarpin HCI sonrası ortalama ÖKD, grup 1 de 3,67 ± 0,39 mm ve grup 2’de 4,06 ± 0,24 mm idi (p=0,35). Siklopentolat HCI sonrası ÖKD, grup 1’de 3,70±0,37 mm ve grup 2’de 4,01 ± 0,20 mm idi (p=0,53). Pilokarpin HCI ve siklopentolat HCI sonrası ÖKD arasındaki ortalama fark, grup 1 ve grup 2’de, sırasıyla 0,027±0,087 mm ve -0,045±0,10 mm idi (p>0,05). Sonuç: Fakoemülsifikasyon ve GİL implantasyonu sonrası uzun dönemde siklopentolat HCI ve pilokarpin HCI, tek parçalı ve üç parçalı hidrofobik akrilik GİL’de anlamlı bir aksiyel harekete neden olmamaktadır.Aim: To compare the effect of cyclopentolate hydrochloride (HCI) and pilocarpine HCI on anterior chamber depth (ACD) between single-piece and three-piece hydrophobic acrylic intraocular lens (IOL) after uneventful phacoemulsification using magnetic resonance imaging. Material and Method: Nineteen eyes of 19 patients who had uneventful sutureless clear corneal phacoemulsification with IOL implantation were included in the study. Nine eyes (group 1) had single-piece (AcrySof SA60AT, Alcon) and 10 eyes (group 2) had three-piece (AcrySof MA60BM, Alcon) foldable hydrophobic acrylic IOL. ACD was measured in the axial and sagittal T2 weighted magnetic resonance images after 2% pilocarpine HCI installation. Three days later, the same procedure was repeated after 1% cyclopentolate HCI installation. The average time interval between surgery and MR imaging was 16.1±0.9 months in group 1 and 13.7±0.8 months in group 2. Statistical analysis were performed with the Mann-Whitney U test between groups and the Wilcoxon signed rank test within them. Results: The average ACD after pilocarpine HCI instillation was 3.67±0.39 mm and 4.06 ± 0.24 mm in group 1 and group 2, respectively (p=0.35). The average ACD after cyclopentolate HCI instillation was 3.70±0.37 mm and 4.01±0.20 mm in group 1 and group 2, respectively (p=0.53). The difference between the average ACD after pilocarpine HCI and cyclopentolate HCI instillations were 0.027±0.087 mm and -0.045 ± 0.10 mm in group 1 and group 2, respectively (p>0.05). Conclusion: Pilocarpine HCI and cyclopentolate HCI do not cause a significant axial shift on single-piece and three-piece hydrophobic acrylic IOL in the late period after phacoemulsification and IOL implantation

Renal artery stenosis and abdominal aorta aneurysm in patients with pseudoexfoliation syndrome

Purpose To evaluate the renal arteries and abdominal aorta in patients with pseudoexfoliation syndrome (PEX). Design Prospective, case-control study. Methods The study involved 49 patients with PEX and 42 control subjects. Abdominal aorta and renal arteries were examined by Doppler ultrasonography. In both renal arteries (proximal and distal portions) and abdominal aorta, the peak systolic velocity (PSV) was measured. Renal artery stenosis (RAS) was defined as the renal artery PSV >150 cm/s or renal-to-aortic ratio (RAR) >3.0. Patients who had an abdominal aortic diameter >3 cm were recorded. Computed tomographic angiography was performed to confirm these findings in patients with RAS and/or abdominal aorta aneurysm. Results The mean PSV in the proximal renal artery was 88.3 cm/s in PEX group and 79.5 cm/s in control group (P = 0.314); in distal renal artery was 91.7 cm/s in PEX group and 93.0 cm/s in control group (P = 0.794); in abdominal aorta was 76.0 cm/s in PEX group and 65.2 cm/s in control group (P = 0.046). RAS was observed in nine patients with PEX and in only one patient without PEX (P = 0.017). Seven out of 10 patients with RAS (six patients in PEX group; one patient in control group) had hypertension. Abdominal aorta aneurysm was observed in four patients in PEX group but not in control group (P = 0.061). Conclusions Our study has demonstrated that there is a significant association between PEX and RAS. The abdominal aorta aneurysm may be seen in patients with PEX

What is the Effect of Pseudoexfoliation Syndrome on Renal Function in Patients without Glaucoma?

Purpose: To evaluate renal function in patients with pseudoexfoliation syndrome. Materials and Methods: This prospective, cross-sectional, case-control study involved 49 patients with pseudoexfoliation syndrome (PEX) and 42 control subjects. Renal function was examined by biochemical parameters and Doppler ultrasonography. Serum creatinine, blood urea nitrogen, urea levels, urine microalbumin level and creatinine clearance were measured. Renal volume, resistive index and pulsatility index were calculated using Doppler ultrasonography. Results: The mean laboratory values for both groups were as follows: Creatinine, PEX: 0.81 +/- 0.28 mg/dL - Control: 0.79 +/- 0.22 mg/dL; urea, PEX: 31.6 +/- 9.7 mg/dL - Control: 32.2 +/- 8.4 mg/dL; blood urea nitrogen, PEX: 14.8 +/- 4.6 mg/dL - Control: 15.1 +/- 4.0 mg/dL; creatinine clearance, PEX: 89.1 +/- 35.6 mL/min - Control: 99.0 +/- 47.2 mL/min; microalbumin, PEX: 5.8 +/- 22.7 mg/dL - Control: 2.7 +/- 6.0 mg/dL. The differences between groups were not significant (p > 0.300). Renal volume, resistive index and pulsatility index values were similar in both groups (p > 0.200). Conclusions: This study showed that pseudoexfoliation syndrome does not affect biochemical and ultrasonographic parameters associated with renal function

Orbita Taban Kırığının Üçüncül Onarımı veAşırı Düzeltmeye Bağlı Artmış Göz İçi Basıncı

Sol orbita taban kırığı nedeniyle iki kez orbitotomi ve implant konulması işlemi yapılmış 62 yaşındaki erkek hasta, çift görme ve solgözde küçülme şikayetleriyle kliniğimize başvurdu. Orbita bilgisayarlı tomografi incelemesinde implantların orbita anatomisine uygunyerleştirilmediği görüldü. Transkonjonktival inferior orbitotomi yapılarak implantlar düzeltildi ve yeni implantlar konuldu. Üçüncülonarımdan sonra göz içi basıncı ciddi derecede yükseldi. Yeniden orbitotomi yapılarak bir implant çıkarıldı; diğer implantın yeri de-ğiştirildi. Cerrahi sonrası ikinci ayda çift görme tümüyle, enoftalmi tatminkar derecede düzeldi. Orbita taban kırığı onarımında im-plantların uygunsuz yerleşimi, orbital kompartman sendromu ve göz içi basıncı artışına neden olabilir. Geç dönemde yapılan cerrahi-lerde başarılı sonuçlar elde etmek mümkündür

Analysis of predictive and preventive factors for access complications associated with vascular closure devices in complicated endovascular procedures

Purpose: The main goal is to evaluate the effectiveness of angioseal and starclose vascular closure devices (VCDs) in high-risk patients under intensive anticoagulation who require therapeutic angiographic procedures and to discuss which factors are important in complications associated with VCDs. Materials and methods: Medical records of the patients who underwent therapeutic complex interventional vascular procedures were reviewed retrospectively. One hundred sixty-six patients were divided into two groups regarding VCDs used for access-site closure after the procedure: group 1, (angioseal); group 2, (starclose). Data including patients’ demographics and comorbidity information, procedural characteristics, and complications were analyzed. Results: The device deployment success rate was 100%. For the procedural characteristics, there was no significant difference between the groups except access site (P = 0.016) and sheath size > 6F (P = 0.0001). No major complications had occurred in none of the patients. Minor complications including hematoma, access-site pain, and access-site infection, except prolonged hemostasis did not differ significantly between groups. The patients’ demographic and periprocedural factors were not significantly correlated with the development of complications. Conclusion: Contrary to published reports, our study showed that demographic and periprocedural factors may not be responsible for the vascular access-site complications associated with VCDs. © 2021, Japan Radiological Society