Examination of liver metastases with contrast enhanced ultrasonography

Objectives: To investigate the effect of contrast enhanced ultrasonography in examination of liver metastasesMaterials and methods: Totally 13 metastatic liver lesions were examined in 13 cases. These lesions were examined by dynamic contrast enhanced ultrasonography with Levovist 2.5/4 gr. flk (contrast agent that contains galactose and palmitic acid). Vascular phase (arterial-portal) and parenchymal phase enhancement patterns were investigated in these lesions.Results: The sensitivity and specifity of vascular phase enhancement and later phase perfusion defect in these lesions were found as %76.92 and %100 respectively. Conclusion: Dynamic contrast enhanced ultrasonography is an effective method in characterization of liver metastase

Better Visualization of Vermiform Appendix With Tissue Harmonic Imaging Compared to Conventional Sonography

INAL, MIKAIL/0000-0003-0642-7913WOS: 000347164400012PubMed: 25780548Background: 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. Patients and Methods: 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 chi(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

Nutcracker Syndrome Accompanying Pelvic Congestion Syndrome; Color Doppler Sonography and Multislice CT Findings: A Case Report

INAL, MIKAIL/0000-0003-0642-7913WOS: 000343525300002Nutcracker 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

Morphometric Analysis of the Fronto-maxillary Sinuses in Adult Patients with Traumatic Septal Deviations

SIMSEK, GOKCE/0000-0001-5281-0986; INAL, MIKAIL/0000-0003-0642-7913;WOS: 000459551200008PubMed: 31975665Objective: The aim of the current study was to investigate a change in the volume of the frontal and maxillary sinuses in patients with nasal septum deviations due to physical trauma. Materials and Methods: Paranasal sinus computed tomography data of 100 patients admitted to Kirikkale University medical faculty hospital between November 2013 and June 2014 were retrospectively analyzed. The side of the nasal septal deviation, the deviation angle, the severity of the deviation, and bilateral frontal and maxillary sinus volumes were calculated using a computer program. The relationship between sinus volumes and deviated septum characteristics was investigated. Results: The maxillary sinus volumes did not differ between the two genders. However, the female patients had significantly decreased frontal sinus volumes when compared with the male patients (p < 0.05). A right-sided septal deviation was found to be associated with a significantly decreased maxillary sinus volume (p < 0.001), and the severity of the deviation was a significant determinant of the maxillary sinus volume (p < 0.001). The age of the patient at the time of the septal trauma was significantly associated with their maxillary sinus volumes. Patients who had experienced this trauma after 12 years of age had significantly increased maxillary sinus volumes when compared with those who experienced the trauma before the age of 12. Conclusion: A distorted septal anatomy was found to be a significant parameter for developing paranasal sinuses. Right-sided and severe traumatic deviations with an onset before the age of 12 were significantly associated with a decreased maxillary sinus volume

Apendiksin ileal segmentlerden sonografik olarak ayırtedilebilmesi için gerekli kriterler: farklı bir bakış açısı

Amaç: Biz bu çalışmada normal veya patolojik apendiksin ileal segmentlerden sonografik olarak ayırtedilebilmesi için gerekli yeni ve objektif kriterler tespit etmeyi amaçladık.Materyal ve Metodlar: Normal ve patolojik apendikslerin, ileumun ikinci ve üçüncü formlarının transvers ultrasonografik kesitleri üzerinde milimetrik olarak uzun çap, kısa çap, ortalama çap, dairesellik indeksi, ve çap indeksi hesaplandı.Bulgular: Dairesellik indeksi, sirkülarite indeksi ve uzun çap, normal veya patolojik apendiksin ileal segmentlerden ayırtedilmesinde yüksek oranda sensitivite ve spesifisite gösterdi.Sonuç: Dairesellik indeksi, sirkülarite indeksi ve uzun çap normal veya patolojik apendiksin ileumdan ultrasonografik olarak ayırtedilmesinde objektif ve etkin kriterlerdirAim: We aimed to establish the new and objective criteria that can be used for distinguishing the normal or pathological appendix from ileal segments sonographically.Materials and Methods:Long diameter, short diameter, mean diameter, circularity index (CI), and diameter index (DI) in mm on transverse images of normal and pathological appendices, and the others form of the ileum, were calculated. Results:DI, CI, long dimension show high sensitivity and specificity in discrimination of the normal or pathological appendix from ileal segments.Conclusion: DI, CI, and long dimension are effective and objective criteria for distinguishing normal or pathological appendix from ileum sonographicall

Apendiksin ultrasonografik sınıflamasına farklı bir bakış açısı

Amaç: Biz bu çalışmada farklı lokalizasyonlardaki apendiksleri inceleyerek önceki literatürden farklı bir sınıflama yapmayı ve böylece appendiksin sonografik incelemesini kolaylaştırmayı amaçladık.Materyal ve metod: Çalışma bizim departmanımıza pelvik veya batın ultrasonografisi amacı ile başvuran 362 ardışık hasta üzerinde gerçekleştirildi. Normal sonografik apendiks kriterleri maksimum çapı 6 mm olan, komprese olan, kör sonlanan tübüler yapı olarak belirlendi. Appendiksler ultrasonografi ile incelendi ve kaydedildi, referans çizgisi olarak da sağ iliak fossadaki iliak damarlar alındı.Bulgular: Apendiksler yerleşim yerine göre 1-8 sınıfa ayrıldı. Tip 1 iliak damarları geçen (85.5%),tip 2 iliak damarların hemen yanında (2.41%), tip 3 çekumun inferior ve lateralinde (1.93%), tip 4 sağ parakolik olukta (4.34%), tip 5 tamamen retroçekal (1.93%), tip 6 çekumun anteriorunda (1.45%), tip 7 umblikusa uzanan (0.97%) and tip 8 çekal malpozisyonla birlikte subhepatik yerleşim (1.45%).Sonuç: Bu çalışmada literatürde daha önceden tanımlanandan farklı olarak yeni bir sınıflama sistemi ortaya konulmuştur. Normal ve anormal apendikslerin en sık görülen yerleşimi iliak damarları geçen tip 1 olarak izlendi. İkinci en sık görülen yerleşim ise sağ parakolik olukta izlenen tip 4 idi. İki farklı ilginç yerleşim ise umblikusa uzanan tip 7 ile subhepatik alana uzanan tip8 idiAim:We intended to detect various appendix localisations with a classification system different from those used in previous literature to facilitate the sonographic detection of the appendix.Patients and methods: The study was performed on 362 consecutive patients who applied to our department for abdominal or pelvic US examination to our department. The sonographic criterion used to diagnose a normal appendix was visualization of the full extension of a compressible, blind-ending tubular structure with a maximum transverse diameter of 6 mm. Appendices were evaluated by US and localisations were recorded and classified according to the reference line passing through the iliac vessels in the right iliac fossa.Results: Each appendix was classified as type 1 to 8 according to its location. Type 1 crossed the iliac vessels (85.5%), type 2 was medial to the iliac vessels (2.41%), type 3 was inferior and lateral to the cecum (1.93%), type 4 was in the right paracolic gutter (4.34%), type 5 was completely retrocecal (1.93%), type 6 was in front of the cecum (1.45%), type 7 extended to the umbilicus (0.97%) and type 8 was subhepatic with cecal malposition (1.45%).Conclusion: The study demonstrated a new classification system (types 1-8) different from those described in previous literature. The most common position of the normal and abnormal appendices in our study was crossing the iliac vessels (type 1). The second most common position was the right paracolic gutter (type 4). Two interesting localisations extended to the umbilicus (type 7) and appeared in the subhepatic space (type 8

Evaluation of tendinosis of the long head of the biceps tendon by strain and shear wave elastography

INAL, MIKAIL/0000-0003-0642-7913; kultur, turgut/0000-0002-2420-5153WOS: 000436420000012PubMed: 29730686Aim: To investigate strain (SE) and shear wave elastography (SWE) characteristics of the long head of the biceps tendon (LHBT) tendinosis in comparison with magnetic resonance imaging (MRI) findings. Material and methods: Twenty patients with a MRI diagnosis of tendinosis and twenty healthy subjects with normal LHBT in MRI were prospectively examined by SE and SWE. SE color mapping was divided into four types in accordance with elasticity designs: type I predominantly blue (hardest tissue), type II predominantly blue-green (hard tissue), type III predominantly green (intermediate tissue), type IV predominantly green-yellow-red (soft tissue). Quantitative measurements of LHBT hardness with SWE were analyzed in kilopascals (kPa). Results: In the tendinosis group SE types in transverse scan were I in 24% of tendons, II in 50%, III in 25%, and in longitudinal scan I in 15%, II in 75%, and III in 10%. In the control group SE types in transversescan were II in 10% of tendons, III in 55%, IV in 35%, and in longitudinal scan II in 10%, III in 55%, and IV in 35%. SWE values in transverse scan were 38.32 +/- 7.2 kPa in the tendinosis group and 18.6 +/- 3.1 kPa in the control groupand in longitudinal scan 39.42 +/- 7.4 kPa in the tendinosis group, and 20.62 +/- 4.6 in the control group. There was a statistically significant difference in terms of elasticity patterns between the tendinosis and control groups (p<0.001). The receiver operating characteristic curve analysis was perfect and a cut-off value of tranverse 25.8 kPa and longitudinal, 24.6 kPa shear values had very high sensitivity and specificity for tendinosis. Conclusion: SE and SWE may be useful diagnostic tools for LHBT tendinosis when considering usability, cost effectiveness, and patient preference compared to MRI.Kirikkale University Medical Faculty Scientific Research ProjectKirikkale UniversityKirikkale University Medical Faculty Scientific Research Project has provided funding for prospective sono-elastography examination

Superior Mesenteric Artery Syndrome Accompanying With Nutcracker Syndrome: A Case Report

INAL, MIKAIL/0000-0003-0642-7913WOS: 000347167300005PubMed: 25763192Introduction: 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

Is There a Relationship Between Optic Canal, Foramen Rotundum, and Vidian Canal?

INAL, MIKAIL/0000-0003-0642-7913; celebi, umut orkun/0000-0003-2539-2525WOS: 000357569600141PubMed: 26080202Objectives: In this retrospective study, we investigated the relationship between paranasal sinus, optic canal, foramen rotundum, and vidian canal measurements. Methods: Computed tomographic (CT) images of 320 adult subjects and 640 sides (right and left) were used. Paranasal sinus dimensions, optic canal (OC), foramen rotundum (FR), vidian canal (VC), bilateral FR (FRFR), bilateral vidian canal (VCVC), VC-foramen rotundum (VCFR), and VC-optic canal (VCOC) distances were measured. Results: Right VCFR (6.06 mm), and right and left VCOC values (20.34 and 20.31 mm) of the males were significantly higher than those of the females (5.50, 18.91, and 18.80 mm, respectively). Foramen rotundum, OC, and VC values were positively correlated with each other. There was also positive correlation between FR width and maxillary sinus height. Increase of OC width was related to increase in FR width and area, VCVC distance; and decrease in maxillary sinus width. There was positive correlation between FRFR, VCVC, VCFR, and VCOC distance values. There was negative correlation between VC width and area; VCVC, VCFR, and VCOC distance; and maxillary sinus, ethmoid sinus, and sphenoid sinus measurement values. As these sinuses pneumatized more, VC width and area values decreased. Conclusion: As a conclusion, the paranasal sinus, OC, VC, and FR values showed relationship with each other. Before performing craniofacial and/or skull base surgeries, CT view should be taken to evaluate the localization and the course and dimensions of the OC and vidian nerve. It should be kept in mind that in the presence of more pneumatized paranasal sinuses in CT views, VC dimensions decreased