Biomedical subjects
Publications and source records attributed to Ramazan Kutlu.
Although we found lack of a decrease in nocturnal blood pressure, impaired heart rate variability, and diastolic dysfunction in patients with Behcet's disease, we could not demonstrate whether or not this finding has a prognostic value in patients with this disease.
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Rhizomelic chondrodysplasia punctata is a member of genetic peroxisomal disorders. Delayed myelination, which is probably related to the inadequacy of plasmalogens biosynthesis, is an important feature of this disorder. Direct assessment of neuropathologic aspects of RCDP syndrome such as neuronal degeneration and delayed myelination is possible with MR spectroscopy. In this report, MR spectroscopy findings (decreased Cho/Cr and increased Ins-Gly/Cr ratios and increased levels of mobile lipids) of a rhizomelic chondrodysplasia punctata case supporting delayed myelination are presented. This is the second report of MR spectroscopy examination of the specific brain metabolic changes associated with rhizomelic chondrodysplasia punctata.
Sandhoff's disease is a rare, genetic lysosomal storage disease leading to delayed myelination or demyelination. Although neuroimaging findings in this disease have been reported previously, magnetic resonance spectroscopy findings have not been reported. In this report, we present magnetic resonance imaging and magnetic resonance spectrscopy features of two cases with Sandhoff's disease. Magnetic resonance spectroscopy revealed findings indicating widespread demyelination in both cases and neuroaxonal loss and anaerobic metabolism in the second case. Magnetic resonance spectroscopy could provide useful information in the explanation of the clinical picture of cases with Sandhoff's disease.
PURPOSE: To describe successful management of massive pulmonary embolism suffered by a patient with an unsecured intracranial aneurysm. CASE REPORT: An anterior communicating artery aneurysm was found 10 days after a 50-year-old woman was admitted to the intensive care unit with subarachnoid hemorrhage. The patient developed severe acute dyspnea before planned surgery; imaging demonstrated thrombus in the right and left pulmonary arteries. Heparin was contraindicated, so an emergent coil embolization procedure was undertaken. In the same session, recombinant tissue plasminogen activator was administered directly into the thrombus. After 2 hours of thrombolysis and intermittent mechanical fragmentation, lung perfusion improved, and the patient's symptoms abated. CONCLUSIONS: Mechanical fragmentation together with fibrinolytic agent administration is a safe and effective treatment for pulmonary embolism after securing cerebral aneurysms.
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OBJECTIVE: To evaluate hemodynamic changes in mesenteric arteries in patients with Behçet disease with and without gastrointestinal symptoms. METHODS: Doppler sonography of mesenteric arteries was performed in 25 symptomatic and 15 asymptomatic patients having Behçet disease and in 25 healthy control subjects. The peak systolic, minimal, and mean velocities, resistive and pulsatility indexes, inner diameter, cross-sectional area, and blood flow volume of mesenteric arteries were evaluated. The results were compared between patient groups and controls. RESULTS: The mesenteric artery flow was significantly greater in patients in the symptomatic group than in those in the asymptomatic group or in controls. In the superior mesenteric artery, mean velocity and mean blood flow volume (0.35 +/- 0.18 m/s and 711 +/- 404 mL/min, respectively; P < .0001) in the symptomatic group were significantly higher than in the asymptomatic group (0.16 +/- 0.07 m/s and 305 +/- 168 mL/min, respectively) or in controls (0.15 +/- 0.07 m/s and 290 +/- 123 mL/min, respectively). The mean peak systolic velocity (1.23 +/- 0.47 m/s; P < .005) in the symptomatic group was significantly higher than in controls (0.93 +/- 0.23 m/s). In the inferior mesenteric artery, mean velocity and mean blood flow volume (0.25 +/- 0.10 m/s and 139 +/- 79 mL/min) in the symptomatic group were significantly higher than in the asymptomatic group (0.16 +/- 0.07 m/s; P < .006; and 78 +/- 26 mL/min; P < .007) or in controls (0.17 +/- 0.07 m/s; P < .003; 83 +/- 48 mL/min; P < .004). CONCLUSIONS: In this study, symptomatic patients with gastrointestinal Behçet disease were associated with a significant increase in mesenteric artery flow that could be evaluated easily on spectral patterns of arteries during Doppler sonography. The Doppler sonographic findings also revealed that intestinal involvement in patients with Behçet disease without gastrointestinal symptoms is not significantly different from that of healthy controls.
BACKGROUND AND PURPOSE: Subacute sclerosing panencephalitis (SSPE) is a rare, progressive, inflammatory neurodegenerative disease. Our aim was to determine the metabolic abnormalities of brain in early- and late-stage SSPE by using MR spectroscopy and to assess areas of involvement in the early stages when MR imaging findings were normal. METHODS: Children with stage II (n = 3) or III (n = 3) SSPE and 10 healthy, age-matched children underwent MR imaging, multivoxel MR spectroscopy, and short-echo single-voxel MR spectroscopy (SVS). Areas of involvement in the brain were determined with chemical shift imaging. For SVS, 2 x 2 x 2-cm voxels were placed in the frontal subcortical white matter (FSWM) and parieto-occipital white matter (POWM). N-acetylaspartate (NAA)/creatine (Cr), choline (Cho)/Cr, myo-inositol (Ins)/Cr, and NAA/Cho ratios were calculated. RESULTS: Comparisons of NAA/Cr, Cho/Cr, Ins/Cr and NAA/Cho ratios between patients and control subjects showed significant differences in FSWM and POWM (P <.01). In patients with SSPE, NAA/Cr ratios in POWM were significantly less than those in FSWM (P <.01). NAA/Cr ratios in patients with stage II SSPE and those in the control group were not significantly different; this may reflect the absence of neuronal loss. Decreased NAA/Cr, increased Cho/Cr and Ins/Cr ratios, and increased lactate and lipid peaks were found in patients with stage III SSPE. CONCLUSION: MR spectroscopy showed findings suggestive of inflammation in stage II and findings of demyelination, gliosis, cellular necrosis, and anaerobic metabolism in stage III. MR spectroscopy could be a promising technique for early diagnosis and treatment planning in cases of SSPE.
OBJECTIVES: To evaluate the possible relationship between concha bullosa, nasal septal deviation and sinusitis. PATIENTS AND METHODS: Paranasal sinus computed tomography scans of patients suffering from rhinosinusitis were examined. Fifty-four patients with concha bullosa were included in the study. The relationship between concha bullosa, nasal septal deviation and sinusitis was investigated. RESULTS: A statistically significant relationship between unilateral concha bullosa and nasal septal deviation was found (p < 0.01). The relationships of unilateral and bilateral concha bullosa with sinusitis, and bilateral concha bullosa with nasal septal deviation were not statistically significant (p > 0.05). CONCLUSION: In order to define the relation between the concha bullosa, nasal septal deviation and sinusitis, more detailed investigations are needed.
BACKGROUND: Abdominal aortic aneurysm formation is among the arterial complications of Behcet's disease. Weakness and fragility of aortic walls leads to the development of arterial complications like pseudoaneurysms. CASE PRESENTATION: A case of huge saccular abdominal aortic aneurysm in a young Behcet patient who was successfully treated with endovascular stent graft placement is reported, diagnostic and interventional procedures are discussed, and mid-term follow-up results are presented. CONCLUSIONS: Endovascular treatment of abdominal aortic aneurysm complications of young Behcet patients who are not suitable for open surgery and need intervention could be an alternative treatment modality even without performing preprocedural angiography.
BACKGROUND: Testicular microlithiasis is a rare, usually asymptomatic, non-progressive disease of the testes associated with various genetic anomalies, infertility and testicular tumors. According to our literature search, there is no specific data about Doppler findings in this disease. CASE PRESENTATION: Doppler findings of three cases of testicular microlithiasis during last two years in our institution are presented. CONCLUSIONS: Although our hypothesis was to find increased Doppler parameters due to intratesticular arterial compression, our findings suggest that there are no Doppler findings specific to testicular microlithiasis.
PURPOSE: Corpus cavernosum electromyography has been widely done to evaluate autonomic dysfunction in patients with erectile dysfunction. We assessed the value of corpus cavernosum electromyography, evoked cavernous activity and penile sympathetic skin responses for their accuracy in determining autonomic involvement in cases of erectile dysfunction. MATERIALS AND METHOD: We evaluated 75 men with erectile dysfunction by corpus cavernosum electromyography, evoked cavernous activity and penile sympathetic skin response tests at our neurourology laboratory. The etiology of dysfunction was vascular, neurogenic, psychogenic or mixed based on a detailed medical and sexual history, physical examination, electrophysiological and laboratory studies, penile color Doppler ultrasonography, and cavernosography and/or cavernosometry. Autonomic involvement was clinically assessed by systemic findings, such as orthostatic hypotension, impaired gastrointestinal motility, sinus dysrhythmia and secretomotor changes. A concentric electromyography needle placed in the right cavernous body was used to record corpus cavernosum electromyography and evoked cavernous activity. The right median nerve was stimulated electrically with 13 to 16 mA. to determine evoked cavernous activity and the penile sympathetic skin response. The latter response was recorded with silver disc electrodes placed on the left cavernous body. All tests were performed using an electromyography/evoked potential machine. We determined the relationships among corpus cavernosum electromyography, evoked cavernous activity and penile sympathetic skin response tests in respect to etiological factors. RESULTS: The 56 patients with normal corpus cavernosum electromyography activity had also evoked cavernous activity and a penile sympathetic skin response except for 1 with no penile sympathetic skin response but evoked cavernous activity. None of these patients had autonomic neuropathy. Of the 19 patients without corpus cavernosum electromyography activity 11 had evoked cavernous activity, including 10 with no autonomic neuropathy. The remaining 8 patients had no evoked cavernous activity, of whom 7 had autonomic neuropathy. A penile sympathetic skin response was recorded in 18 men with absent corpus cavernosum electromyography. CONCLUSIONS: Due to false-negative results on corpus cavernosum electromyography and penile sympathetic skin response testing evoked cavernous activity seems more reliable for determining autonomic involvement in the pathophysiology of erectile dysfunction.
Glutaric aciduria type I is an uncommon inborn error of metabolism. It is a serious disease, often with a fatal outcome. Magnetic resonance imaging findings and the clinical course of monozygotic twin females with glutaric aciduria type I who were admitted with acute encephalopathic crisis symptoms 3 days after immunization for poliovirus are presented in this report. Magnetic resonance imaging findings revealed hyperintensity in the putamen, head of the left caudate nucleus, and globus pallidus, periventricular white matter (on T(2)-weighted images), arachnoid cysts in bilateral temporal regions, and enlargement of the sylvian fissures. Glutaric aciduria type I should be included in the differential diagnosis of patients with acute encephalopathic crisis occurring shortly after poliovirus immunization. Typical magnetic resonance findings guide urinary organic acid analysis in these patients.
Spinal cord injury with or without trauma has been reported in the perinatal period. The prognosis depends primarily on diagnosis of the level, extent and nature of the lesion, established by correlations between clinical, imaging and electrophysiological data. A 25-day-old boy with normal birth weight delivered at term by cesarean section was transferred to Inönü University Turgut Ozal Medical Center because of respiratory distress and brachial diplegia. A suspicious medullary lesion on cervical computerized tomography was confirmed as an intramedullary lesion extending from C3 to D1 on magnetic resonance imaging (MRI). Emergent surgery consisting of exposure of the lesion site and interlaminar direct puncture of the lesion under fluoroscopy revealed that the pathology was an intramedullary hematoma. The partial evacuation of the lesion with direct puncture, the patient's neurological improvement and close follow-up of the patient with ultrasonography, electrophysiology and MRI are discussed in the light of recent literature.
PURPOSE: The purpose of our study was to evaluate the relationship between the splenoportal hemodynamics in patients with cirrhosis and the stage of the disease. METHODS: Patients with cirrhosis were grouped according to modified Child-Pugh scoring into stages A, B, and C of cirrhosis. A control group of healthy volunteers was included. After gastroenterologic clinical and laboratory examinations, all participants underwent a splenoportal Doppler sonographic evaluation in which the vessels' diameter, area, and blood flow velocity were measured and blood flow rate and the congestion index in the splenoportal venous system were calculated. RESULTS: Seventy-five patients with cirrhosis (25 women and 50 men) were enrolled; the control group consisted of 30 healthy volunteers (15 women and 15 men) with no liver disease. The mean age (+/- standard deviation) of the patients was 54.4 +/- 14.8 years (range, 13-80 years) and of the control subjects was 47.3 +/- 14.5 years (range, 18-72 years). No significant differences in vessel diameter, blood flow velocity, and blood flow rate were found in the main and left portal veins between the study group and the control group. In the right portal vein, we found decreases in the vessel diameter, blood flow velocity, and blood flow rate, and in the splenic vein, we found increases in vessel diameter and blood flow rate. The congestion index was increased in the main portal and splenic veins but was unchanged in the left portal vein. CONCLUSIONS: Although our data indicate that there is no difference in Doppler sonographic parameters of the main portal vein according to Child-Pugh scores, the hemodynamic differences between the left and right branches of the portal vein may be clinically useful in patients with cirrhosis.