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Biomedical subjects

Devrim Akinci

Publications and source records attributed to Devrim Akinci.

At least 19 recordsLinked to original sources
PubMed2006

Cytomegalovirus-related congenital nephrotic syndrome with diffuse mesangial sclerosis.

This case report describes congenital nephrotic syndrome in a 2-month-old girl associated with cytomegalovirus infection. Histological examination on renal biopsy showed diffuse mesangial sclerosis and cytomegalic inclusion bodies in the tubular cells and in some glomeruli. Cytomegalovirus (CMV) polymerase chain reaction (PCR) titer in serum was high. Remission of pulmonary and renal symptoms was achieved with ganciclovir in 3 weeks. No recurrence of proteinuria was observed during the follow-up period of 14 months. These finding suggested a causal relationship between congenital nephrotic syndrome and cytomegalovirus infection.

Adult↗
PubMed2006

Extensive cervical-mediastinal cystic lymphatic malformation treated with sclerotherapy in a child with Klippel-Trenaunay syndrome.

Klippel-Trenaunay syndrome is a rare congenital disorder characterized by combined vascular malformations, varicosities, and limb enlargement. A child case of Klippel-Trenaunay syndrome with a large cervicomediastinal cystic lymphatic malformation and a vascular mass on the chest wall has been presented to demonstrate combined use of conservative and surgical approaches in this syndrome. Cystic lymphatic malformation was treated by sclerotherapies including ultrasound-guided transthoracic bleomycin injection into mediastinal cyst, which was tried for the first time in the literature, and vascular chest wall tumor necessitated surgical excision.

Cysts↗
PubMed2006

Percutaneous treatment of Wirsung's duct stenosis secondary to chronic pancreatitis: balloon dilatation and insertion of a plastic stent.

Chronic pancreatitis is one of the indications for pancreatic duct stenting. The success rate of endoscopic stenting of the pancreatic duct is very high (98%). Reports of percutaneous stenting of the Wirsung's duct are very sparse. We present a case with Wirsung's duct stenosis secondary to chronic pancreatitis, which was treated by percutaneous antegrade balloon dilatation and insertion of a plastic stent. We also report on the long-term follow-up of this patient.

Catheterization↗
PubMed2006

Radiofrequency ablation of unresectable hepatic tumors.

PURPOSE: To evaluate the efficacy and safety of radiofrequency ablation (RFA) in the treatment of primary and metastatic liver malignancies. MATERIALS AND METHODS: Twenty-nine consecutive patients who have primary (n=9) and metastatic (n=20) liver malignancies were treated with RFA. The total number of lesions were 62 at the initiation of treatment and 28 new lesions were diagnosed at the follow-up period. Totally, 84 lesions were ablated with RFA technique at 46 sessions. Primary tumors that gave rise to metastatic lesion were all colorectal cancer except one with gallbladder carcinoma. The greatest tumor diameter immediately before treatment was 0.8-5 cm with a mean of 2.5 cm. RESULTS: In the hepatocellular carcinoma (HCC) group, 1 patient was lost to follow-up, 5 deceased due to extensive disease, and 3 are still on the follow-up. In the metastatic liver disease group, 8 patients died due to progression of disease, 1 deceased due to stroke, and 3 were lost to follow-up. Nine patients with HCC had 14 nodules with a mean of 1.75 lesions/patient and 20 patients had 70 metastatic lesion with a mean of 3.1 lesions/patient. Residual viable neoplastic tissue was found at control computed tomography in 1 (1/14) lesion and recurrence occurred in 3 (3/14) lesions in HCC group. Recurrence occurred in 7 lesions (7/70) of 4 patients (4/20) in the metastatic liver disease group. Drainage requiring empyema took place in 1 patient and skin burn was observed in 2 as complications due to procedure. CONCLUSION: RFA of primary and metastatic liver malignancies is a safe and effective tool for local control of disease in unresectable hepatic malignancies.

Adolescent↗
PubMed2005

Long-term results of single-session percutaneous drainage and ethanol sclerotherapy in simple renal cysts.

PURPOSE: To demonstrate the efficacy and long-term results of the single-session ethanol sclerotherapy in simple renal cysts. MATERIALS AND METHODS: Ninety-eight cysts in 97 patients (range: 18-76 years; mean age, 54 years) were included in the study. Indications were determined as flank pain in 74, hydronephrosis in 12, hypertension in 8, patient reassurance due to increasing cyst size in three patients. Mean follow-up period was 24.4 months. Procedures were performed with the guidance of fluoroscopy and ultrasonography at all times using 5-7 Fr pigtail catheters. After the cystogram that was obtained in all cases, 95% ethanol with a volume of 30-40% of the cyst volume was used as a sclerosing agent on an outpatient basis. Maximum volume of the injected ethanol was 200 ml. Follow-up examinations were performed 1, 3, 6 and 12 months after the procedure and once every year thereafter. RESULTS: Average cyst volume reduction was 93% at the end of the first year. The cysts disappeared completely in 17 (17.5%) patients. After the procedure, in 67 (90%) patients improvement in flank pain was noted. Sixty-one (82%) patients were free of pain and in 6 (8%) of them the pain decreased. Normotension was obtained in 7 (87.5%) of the 8 hypertensive patients and no hydronephrosis was detected in 10 (83.3%) of the 12 patients after the procedure. Second intervention was required in 2 (2%) patients due to recurrence of cysts and related symptoms. One (1%) patient had small retroperitoneal hematoma that resolved spontaneously and in another (1%) patient spontaneous hemorrhage was detected into the cyst 1 year after the procedure. No other complication was detected during the procedure and follow-up. CONCLUSION: Percutaneous treatment of simple renal cysts with single-session sclerotherapy is a safe, effective and minimally invasive procedure and can be used as an alternative to multiple-session sclerotherapy with comparable results. High volume, up to 200 ml ethanol can be used without adverse effects for large renal cysts.

Adolescent↗
PubMed2005

Celiac ganglia block.

Pain occurs frequently in patients with advanced cancers. Tumors originating from upper abdominal viscera such as pancreas, stomach, duodenum, proximal small bowel, liver and biliary tract and from compressing enlarged lymph nodes can cause severe abdominal pain, which do not respond satisfactorily to medical treatment or radiotherapy. Percutaneous celiac ganglia block (CGB) can be performed with high success and low complication rates under imaging guidance to obtain pain relief in patients with upper abdominal malignancies. A significant relationship between pain relief and degree of tumoral celiac ganglia invasion according to CT features was described in the literature. Performing the procedure in the early grades of celiac ganglia invasion on CT can increase the effectiveness of the CGB, which is contrary to World Health Organization criteria stating that CGB must be performed in patients with advanced stage cancer. CGB may also be effectively performed in patients with chronic pancreatitis for pain palliation.

Abdominal Neoplasms↗
PubMed2005

U-shaped association of body mass index with inflammation and atherosclerosis in hemodialysis patients.

OBJECTIVE: High body mass index (BMI) is associated with mortality in the general population, whereas obesity is suggested to confer a survival advantage in hemodialysis (HD) patients. However, underlying mechanisms are yet to be elucidated. We examined the cross-sectional association of BMI with inflammatory and nutritional markers and atherosclerosis in HD patients. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: One hundred and nine maintenance HD patients in the Hacettepe University Hospital Haemodialysis Unit were studied. METHODS: Data on demographics, comorbidity, and anthropometry were obtained by patient interviews. Atherosclerosis was assessed by B-mode Doppler ultrasonography on common carotid artery. Serum markers of inflammation, nutrition, and lipid metabolism, including C-reactive protein (CRP), albumin, prealbumin, homocysteine and lipoproteins, were measured by standard methods. MAIN OUTCOME MEASURE: Distribution of inflammatory and nutritional markers and prevalence of atherosclerosis in underweight, normal, overweight, and obese HD patients. RESULTS: CRP levels were significantly higher in obese and underweight HD patients compared with normal and overweight patients (P < .05). The prevalence of atherosclerosis was significantly higher in underweight and obese patients (54.5% and 50%) compared with normal and overweight patients (25.7% and 33%) (P < .05). CONCLUSIONS: In the present study, obesity is associated with inflammation and atherosclerosis. An obesity-related survival advantage should be modified by other factors such as race, comorbid conditions, body composition, and nutritional status.

Adult↗
PubMed2005

Percutaneous hepaticogastrostomy in a patient with complete common duct obstruction after right hepatectomy.

Complete bile duct obstruction that cannot be traversed by a guide wire can be challenging for the interventional radiologist. Although hepaticogastrostomy, which can be an alternative for such cases, has been performed under fluoroscopic and endoscopic guidance previously, this technique can be simplified by using only fluoroscopy. This technique was used in a patient who had complete common bile duct obstruction after hepatic resection. The patient initially had a good clinical outcome and stayed symptom-free for 5 months but eventually developed biliary epithelial hyperplasia and required placement of another metallic stent.

Adenocarcinoma↗
PubMed2005

Diaphragmatic mesothelial cysts in children: radiologic findings and percutaneous ethanol sclerotherapy.

OBJECTIVE: We describe CT, MR, and sonography findings of diaphragmatic mesothelial cysts and the results of percutaneous treatment with ethanol. All cysts were bilobulate and showed extrahepatic location between the right liver lobe and diaphragm. CONCLUSION: Radiologic findings are helpful in diagnosing diaphragmatic mesothelial cysts, which should be managed conservatively. Percutaneous ethanol sclerotherapy should be the first choice of treatment if necessary.

Child↗
PubMed2005

Fat-containing lesions of the liver: cross-sectional imaging findings with emphasis on MRI.

OBJECTIVE: The purpose of this pictorial essay is to identify different types of liver lesions that contain fat. Cross-sectional imaging findings of fat- or lipid-containing lesions can help in characterizing focal liver lesions. We searched our archive retrospectively and reviewed the literature for fat-containing liver lesions and identified 16 different types. CONCLUSION: These lesions can contain macroscopic fat (i.e., angiomyolipoma, lipoma, liposarcoma, hydatid cyst, lipopeliosis, adrenal rest tumor, pseudolipoma, hepatic teratoma, pericaval fat, extramedullary hematopoiesis, and metastases) or intracellular lipid (i.e., focal steatosis, adenoma, focal nodular hyperplasia, regenerative nodules, and hepatocellular carcinoma). CT, MRI, and sonographic findings of these lesions can help in characterization by allowing specific diagnosis or narrowing the differential diagnosis of liver lesions.

Diagnosis, Differential↗
PubMed2004

Single-session percutaneous ethanol sclerotherapy in simple renal cysts in children: long-term follow-up.

BACKGROUND: Simple renal cysts are rare in children and managed conservatively unless symptomatic. OBJECTIVE: To demonstrate the efficacy and long-term results of single-session ethanol sclerotherapy in symptomatic simple renal cysts in children. MATERIALS AND METHODS: Three simple renal cysts in three children (age 1, 5 and 16 years) were included in the study. Indications for treatment were flank pain (n = 1), hypertension (n = 1), and increasing cyst size and urinary tract infection (n = 1). The mean follow-up period was 5.5 years (range 3-7 years). The procedures were performed with the guidance of US and fluoroscopy and under IV sedation. After the cystogram, 95% ethanol with a volume of 40% of the cyst volume (but not more than 100 ml) was used as the sclerosing agent. RESULTS: Two cysts disappeared completely, while the volume reduction was 99% for the third cyst at the end of the first year. CT demonstrated calcification of the cyst without an enhancing soft-tissue component in the third one 7 years after sclerotherapy. After the procedures, hypertension and pain resolved without any medication. There were no complications during the procedures or during follow-up. Cytological examination was unremarkable in all patients. CONCLUSIONS: Percutaneous treatment of symptomatic simple renal cysts in children with single-session ethanol sclerotherapy is a safe, effective and minimally invasive procedure. Calcification owing to sclerotherapy can be observed on follow-up.

Adolescent↗
PubMed2004

Long-term results of celiac Ganglia block: correlation of grade of tumoral invasion and pain relief.

OBJECTIVE: We evaluated the long-term results and response rates of celiac ganglia block to the level of tumor invasion of the celiac region. SUBJECTS AND METHODS. Forty-one patients each with an inoperable intraabdominal carcinoma who were referred to our department for celiac ganglia block were included in this study. Tumor invasion of the celiac ganglia region was graded on a four-point scale according to CT features (grade I = no invasion, grade II = invasion < 50%, grade III = invasion > 50%, and grade IV = complete invasion). Subjective pain levels (0 = no pain, 10 = worst pain) were obtained from the patients, and objective criteria (change in daily analgesic doses) were noted before the procedure and during the follow-up to determine effectiveness of the celiac ganglia block. RESULTS: Celiac ganglia block was successfully performed in all 41 patients (100%). In 39 (95%) of 41 patients, pain decreased significantly after the procedure, and the pain level did not change in the remaining two patients. Major complications were not encountered in any of the patients. Minor complications were observed in 35 patients (85%). Mean pain intensity and mean daily analgesic consumption significantly decreased after the procedure in all four groups. The amount of pain decrease for these two parameters was inversely related to degree of invasion. Responses of the patients were obtained at the end of the first week after the procedure and remained unchanged during long-term follow-up. CONCLUSION: Percutaneous celiac ganglia block, particularly when performed in earlier stages of ganglia invasion, is an effective, easy, and safe procedure with successful long-term results.

Abdominal Neoplasms↗
PubMed2004

MDCT angiography of the extremities in pediatric patients: initial experience.

OBJECTIVE: We studied the feasibility of extremity MDCT angiography in pediatric patients with congenital anomalies, an extremity mass, and a suspected arterial occlusion. CONCLUSION: In pediatric patients, MDCT angiography of the extremities with a short imaging time and a low dose of contrast material is feasible and can be used as a noninvasive alternative to conventional angiography.

Angiography↗
PubMed2004

[Outcomes of percutaneous cholecystostomy in patients with high surgical risk].

PURPOSE: To evaluate the effectiveness of the percutaneous cholecystostomy with the follow up results of our patients. MATERIALS AND METHODS: We retrospectively evaluated the medical records of 37 patients who underwent percutaneous cholecystostomy. Eighteen female and 19 male patients were included into this study between the ages of 7 and 88 years. All of our patients had acute cholecystitis or eventually developed acute cholecystitis except one. Seven year old male patient with Non-Hodgkin lymphoma underwent percutaneous cholecystostomy due to elevation of liver function tests and direct bilirubin. Since he had dilated intrahepatic biliary ducts due to a lymphadenopathy compression at portal hilus, percutaneous cholecystostomy was performed to decompress the biliary system to decrease the bilirubin and liver function tests to normal levels for initiating appropriate chemotherapy protocol. All the procedures were carried under fluoroscopic and sonographic guidance through transhepatic or transperitoneal approach with 6 to 10 F drainage catheters. RESULTS: Recovery from the acute cholecystitis symptoms was achieved in 31 patients (86%) in follow-up. No procedure-related mortality was observed. The only major complication was intraperitoneal bleeding due to underlying coagulopathy which was treated with blood transfusion. Eight patients (21.6%) died in 30 days after the percutaneous intervention procedure. In the patient with Non-Hodgkin lymphoma at the age of 7, however, the procedure to decrease the bilirubin levels was successful and chemotherapy was given subsequently; he had died after 31 days due to his aggressive primary disease. Catheterization times were between 2 days and 60 days due to accompanied diseases. Six patients (16.7%) were finally undergone to cholecystectomy after the risks for surgery had been reduced. ERCP was performed in 2 patients (5.6%) for stone extraction from common bile duct. Eighteen patients (50%) were recovered from the acute illness and following the control cholangiograms, catheters were taken out consequently. CONCLUSION: Percutaneous cholecystostomy under ultrasonographic and fluoroscopic guidance is a cost-effective, easy to perform and reliable procedure with low complication and high success rates for critically ill patients with acute cholecystitis.

Adolescent↗
PubMed2002

Percutaneous cholecystostomy.

Percutaneous cholecystostomy (PC), a technique that consists of percutaneous catheter placement in the gallbladder lumen under imaging guidance, has become an alternative to surgical cholecystostomy in recent years. Indications of PC include calculous or acalculous cholecystitis, cholangitis, biliary obstruction and opacification of biliary ducts. It also provides a potential route for stone dissolution therapy and stone extraction. Under aseptic conditions and ultrasound guidance, using local anesthesia, the procedure is carried out by using either modified Seldinger technique or trocar technique. Transhepatic or transperitoneal puncture can be performed as an access route. Several days after the procedure transcatheter cholangiography is performed to assess the patency of cystic duct, presence of gallstones and catheter position. The tract is considered mature in the absence of leakage to the peritoneal cavity, subhepatic, subcapsular, or subdiaphragmatic spaces. Response rates to PC in the literature are between the range of 56-100% as the variation of different patient population. Complications associated with PC usually occur immediately or within days and include haemorrhage, vagal reactions, sepsis, bile peritonitis, pneumothorax, perforation of the intestinal loop, secondary infection or colonisation of the gallbladder and catheter dislodgment. Late complications have been reported as catheter dislodgment and recurrent cholecystitis. PC under ultrasonographic guidance is a cost-effective, easy to perform and reliable procedure with low complication and high success rates for critically ill patients with acute cholecystitis. It is generally followed by elective cholecystectomy, if possible. However, it may be definitive treatment, especially in acalculous cholecystitis.

Aged↗