Biomedical subjects

Tulin Yildirim

Publications and source records attributed to Tulin Yildirim.

13 recordsLinked to original sources

PubMed2005

Retained surgical sponge (gossypiboma) after intraabdominal or retroperitoneal surgery: 14 cases treated at a single center.

BACKGROUND AND AIMS: The objective of this study was to present the etiology, clinical presentation, diagnosis, and management for 14 cases of gossypiboma [retained surgical sponge (RSS)] treated at a single center and to emphasize the importance of this potential complication. METHODS: Data for 14 cases of RSS treated between January 1999 and December 2004 were retrospectively assessed. The details of preoperative evaluation, demographic features, and operative findings were recorded. Use of, and findings from, abdominal x-ray, ultrasonography, computed tomography, magnetic resonance imaging, and upper-gastrointestinal endoscopy were also noted. RESULTS: In all cases, the RSS was surgically removed. Thirteen of the 14 patients were symptomatic, and the most frequent finding was nonspecific abdominal pain and intestinal obstruction. Four patients required urgent surgery because the sponges were causing intestinal obstruction or intraabdominal sepsis. Based on history, physical examination findings, and diagnostic imaging, RSS was diagnosed preoperatively in five of the patients. Postoperative complications, including surgical site infection and evisceration, occurred in five cases. CONCLUSION: RSS can lead to significant medical and legal problems between the patient and the doctor. RSS may be incorrectly diagnosed preoperatively, which can lead to unnecessary invasive diagnostic procedures and operations. Strict measures must be taken to prevent this complication.

Abdomen↗

PubMed2005

MRI evaluation of cranial bone marrow signal intensity and thickness in chronic anemia.

BACKGROUND AND PURPOSE: The aim is to assess the magnetic resonance imaging (MRI) findings for cranial bone marrow (CBM) signal intensity and thickness in patients with chronic anemia and compared these with findings in healthy subjects. We also investigated the relationships between CBM changes and age, type of anemia (hemolytic versus non-hemolytic), and severity of anemia. METHODS: We quantitatively evaluated CBM signal intensity and thickness on images from 40 patients with chronic anemia (20 with congenital hemolytic anemia (HA) and 20 with acquired anemia) and compared these to findings in 28 healthy subjects. The intensity of CBM relative to scalp, white matter (WM), gray matter (GM), and muscle intensity was also investigated in patients and subjects in the control group. The sensitivity and specificity of CBM hypointense to GM and CBM hypointense to WM as markers of anemia were evaluated. Relationships between age and CBM thickness/intensity, and between anemia severity (hemoglobin (Hb) level) and CBM thickness/intensity were evaluated. RESULTS: Cranial bone marrow signal intensity was lower in the chronic anemia patients than in the controls (P<0.001). In the control group, CBM intensity was higher than GM intensity, whereas the opposite was true in the patient group. The finding of CBM hypointense to GM was 85% sensitive and 67% specific as a marker of anemia. The corresponding statistics for CBM hypointense to WM were 90 and 46%. The patients had thicker CBM than the controls (temporal, P<0.05; parietal, P<0.005). The subgroup with hemolytic anemia had thicker parietal CBM than the subgroup with non-hemolytic anemia (NHA) (P<0.05) and exhibited thicker temporal and parietal CBM than the controls (temporal, P<0.05; parietal, P<0.001). The CBM thicknesses in the non-hemolytic anemia subgroup were similar to control values (P>0.05 for both). There were no correlations between age and CBM intensity or thickness, or between anemia severity and CBM intensity or thickness. CONCLUSION: Patients with chronic anemia exhibit lower CBM signal intensity on MRI than healthy subjects. Patients with hemolytic anemia have thicker CBM than patients with non-hemolytic anemia or healthy individuals. Decreased CBM intensity may indicate that the patient has anemia, and increased CBM thickness may specifically point to hemolytic anemia. These MRI findings may signal the need for further evaluation for the clinician.

Adult↗

PubMed2005

Hepatic vein Doppler waveform in patients with diffuse fatty infiltration of the liver.

OBJECTIVE: To determine the incidence of abnormal hepatic vein Doppler waveform in patients with diffuse fatty infiltration of the liver (FIL). MATERIALS AND METHODS: In this prospective study, 40 patients with diffuse FIL and 50 normal healthy adults who served as control group underwent hepatic vein (HV) Doppler ultrasonography. The patients with the diagnosis of FIL were 23 men (57.5%) and 17 women aged 30-62 years (mean age +/- S.D., 42 +/- 12 years). Subjects in the control group were 27 men (54%) and 23 women aged 34-65 years (mean age +/- S.D., 45 +/- 14 years). The diagnosis of FIL was confirmed with computed tomography density measurements. The waveforms of HV were classified into three groups: regular triphasic waveform, biphasic waveform without a reverse flow, and monophasic or flat waveform. Etiological factors for FIL were diabetes mellitus (DM), hyperlipidemia and obesity (body mass index > 25). Serum lipid profile was obtained from all the patients with FIL. RESULTS: Seventeen of the 40 patients (43%) with FIL had an abnormal HV Doppler waveform, whereas only one of the 50 (2%) healthy subjects had an abnormal waveform. The difference in the distribution of normal Doppler waveform pattern between the patients and the control group was significant (P < 0.001). No differences were found in the behaviour of the hepatic vein Doppler waveform in relation to the different etiologic factors for FIL (P > 0.05). There was not any correlation between the degree of fat infiltration and the hepatic vein waveform pattern (P = 0.60). CONCLUSION: Patients with fatty liver has a high rate of an abnormal hepatic vein Doppler waveform pattern which can be biphasic or monophasic. We could not find a relation between the etiological factors for FIL and the occurrence of an abnormal HV Doppler waveform.

Adult↗

PubMed2005

Successful medical treatment of intracranial abscess caused by Brucella spp.

An unusual presentation of unilateral cerebellar abscesses due to neurobrucellosis observed in a patient is reported. He gave a history of fever, headache, vomiting and had unilateral cerebellar signs. The abscess was detected on magnetic resonance imaging (MRI) and analysis of cerebrospinal fluid revealed neurobrucellosis. Patient treated by only antibiotics therapy, evolving to complete clinical and radiological resolution, without neurosurgical intervention. We are presenting a case of cerebellar abscess due to neurobrucellosis diagnosed by MRI, treated medically, and had both radiologic and clinical follow-up. We also made a review of the literature concerning the cerebellar abscess due to neurobrucellosis.

Adult↗

PubMed2005

Silent cerebral infarct in patients with mitral valve prolapse.

It is still not clear whether mitral valve prolapse (MVP) is a risk factor for ischemic stroke. The aim of this study was to evaluate whether uncomplicated MVP is a risk factor for silent cerebral ischemic events. Fifty-two patients with uncomplicated MVP and 46 control subjects without MVP were included in the study. All subjects were evaluated for silent cerebral infarct (SCI) with a magnetic resonance imaging. Five (9.6%) of the patients who had MVP but no other risk factors for ischemic cerebral events had SCI. The results suggest that uncomplicated MVP is a risk factor for SCI, and that patients with MVP should receive anti-platelet-aggregating drugs.

Adolescent↗

PubMed2005

Hypothalamic hamartoma associated with a craniopharyngeal canal.

Hypothalamic hamartoma is a rare congenital lesion. We present the case of a 7-year-old girl who suffered from precocious puberty, the cause of which was diagnosed by using MR imaging and CT as pedunculated hypothalamic hamartoma associated with a large craniopharyngeal canal and sellar spine mimicking pituitary duplication.

Child↗

PubMed2004

US-guided placement of temporary internal jugular vein catheters: immediate technical success and complications in normal and high-risk patients.

OBJECTIVE: To evaluate the technical success and immediate complication rates of temporary internal jugular vein (IJV) haemodialysis catheter placement in normal and high-risk patients. METHODS AND MATERIALS: Two-hundred and twenty temporary internal jugular vein catheters inserted under ultrasound guidance in 172 patients were prospectively analyzed. Of 172 patients, 93 (54%) were males and 79 (46%) were females (age range, 18-83; mean, 56.0 years). Of 220 catheters, 171 (78%) were placed in patients who had a risk factor for catheter placement like patients with disorder of haemostasis, poor compliance, and previous multiple catheter insertion in the same IJV. Forty-seven (21.3%) procedures were performed on bed-side. A catheter was inserted in the right IJV in 178 procedures (80.9%) and left IJV in 42 procedures. Of 172 patients, 112 (65%) had only one catheter placement and the rest had had more than one catheter placement (range, 1-5). RESULTS: Technical success was achieved in all patients (100%). Average number of puncture was 1.24 (range, 1-3). One hundred and eighty-three insertions (83.1%) were single-wall punctures, whereas 37 punctures were double wall punctures. Nine (4%) minor complications were encountered. Inadvertent carotid artery puncture without a sequel in four procedures (1.8%), oozing of blood around the catheter in three procedures (1.4%), a small hematoma in one procedure (0.4%), and puncture through the pleura in one procedure (0.4%) without development of pneumothorax. Oozing of blood was seen only in patients with disorder of haemostasis. CONCLUSION: Ultrasound-guided placement of internal jugular vein catheters is very safe with very high success rate and few complications. It can safely be performed in high-risk patients, like patients with disorders of haemostasis and patients with previous multiple catheter insertion in the same vein.

Adolescent↗

PubMed2004

Angular pregnancy.

Angular pregnancy, a type of cornual pregnancy, is a rare obstetric complication that can be life-threatening. In this situation, the embryo is implanted in the lateral angle of the uterine cavity, medial to the uterotubal junction and round ligament. Angular pregnancy must be distinguished from interstitial pregnancy, in which the embryo is implanted lateral to the round ligament. The report presented here describes a case of angular pregnancy that was diagnosed by endovaginal ultrasonography and magnetic resonance imaging. Laparoscopy can be useful for guiding dilatation and curettage in angular pregnancies, and may circumvent the need for invasive surgery or hysterectomy.

Adult↗

PubMed2004

Color Doppler analysis of vertebral arteries: correlative study with angiographic data.

OBJECTIVE: Color Doppler ultrasonography is the most widespread diagnostic procedure in obstructive disease of the arteries supplying the brain. To our knowledge, there are only a few correlative color Doppler ultrasonographic and angiographic studies of the vertebral arteries, especially in patients who have flow-restrictive stenosis at the carotid bifurcation. The main purpose of this prospective study was to evaluate diameter, flow volume, and time-averaged mean velocities of angiographically verified normal vertebral arteries without collateral flow. The second purpose was to try to establish a threshold value for the flow volume of the vertebral artery. METHODS: One hundred twenty patients referred for carotid angiography with a normal vertebrobasilar system and with no patent posterior communicating arteries were investigated with color Doppler ultrasonography. Luminal diameter, time-averaged mean velocity, peak systolic velocity, and flow volume values were calculated for each patient. The parameters were compared between sexes, in different age groups, in patients with carotid stenosis of 50% or less and greater than 50%, and in patients who had clinical signs of vertebrobasilar insufficiency versus those who had not. RESULTS: We have found no significant difference in evaluated parameters with the degree of associated carotid stenosis or vertebrobasilar insufficiency. Diameter and flow volume values on the left side were higher than on the right side. CONCLUSIONS: We found similar flow volume values of vertebral arteries in both sexes and both groups of patients with carotid stenosis of 50% or less and greater than 50%. All parameters did not differ in patients with stenosis of 50% or less and greater than 50% and in patients with and without clinical signs of vertebrobasilar insufficiency.

Adult↗

PubMed2003

Hemispheric cerebrovascular venous thrombosis due to closed head injury.

CASE REPORT: We present the case of an 8-month-old infant who was admitted to our Neurosurgery Department with venous infarction related to sagittal sinus thrombosis. The infarction was radiologically detected 5 days after the baby had undergone surgery for acute subdural hematoma due to a closed head injury. RESULTS AND CONCLUSIONS: Cerebrovascular venous thrombosis is a rare clinical entity that has multiple causes and variable presenting symptoms. There is no consensus on overall strategy concerning surgical, radiosurgical, or medical therapy (anti-coagulation, thrombolytic, and anti-edema treatment), and exactly how, when, or in which cases these should be applied. The treatment planning should be based on clinical findings, and should be modified according to the clinical course. In this case, the clinical and radiological findings regressed with symptomatic treatment alone.

Brain Edema↗

PubMed2003

Multi-organ cavernous hemangiomas: case report.

Hemangiomas are rare benign tumors of vascular origin and multiple location of these tumors in different organs is extremely unusual. We report a case with multiple hemangiomas, characterized by calvarial, hepatic and suspicious costal involvement. Organ involvement and multiplicity of the neoplasm made our case very interesting and distinct. Our search of the English literature has revealed that no similar case has ever been published.

Adult↗

PubMed2002

Small bowel obstruction due to phytobezoar: CT diagnosis.

Small bowel phytobezoars are rare and are almost always obstructive. The literature contains few reports on the radiological findings for primary small bowel bezoars. There is also very little published on CT results with this lesion, but the features of the scan are characteristic. We present the CT findings in a patient with an obstructive small bowel phytobezoar, and emphasize the diagnostic value of CT.

Bezoars↗

PubMedDate not supplied

Subclavian steal syndrome from the ipsilateral vertebral artery.

We present two cases of subclavian steal syndrome from the ipsilateral vertebral artery (VA) to the subclavian artery (SCA), one with the left VA originating from the aortic arch and the other with the left VA originating very close to the origin of the SCA, proximal to the occluded segment. In both cases, angiographic demonstration of these anatomic variations and successful endovascular treatment are presented.

Aged↗