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Purpose: This study aims to evaluate the incidence of clinically silent embolic cerebral infarctions and associated risk factors following diagnostic cerebral angiography with diffusion-weighted imaging (DWI). Material and methods: A total of 71 cerebral digital subtraction angiograms (42 male, 29 female, average age: 56.0 ± 15.0) obtained using nonionic contrast material were prospectively evaluated. To assess embolic events, before and after (1-3 days) angiography, DWI was performed. The risk factors for embolic ischemic brain changes such as the patient's age and sex, atherosclerotic vessel wall disease, type of indication for catheter angiography, the number and size of the catheters, anatomic variants, selective/nonselective catheterization, contrast media volume, and time of procedure were determined. Fisher's exact tests and Student t-tests were used for the statistical analyses of outcomes. Results: Thirteen new silent ischemic lesions were identified in 7 out of 71 patients who underwent diagnostic cerebral angiography. Embolic cerebral lesions were often 6-10mm in diameter. According to the findings in this study, there was a strong correlation between diffusion abnormality and patient age, which was considered risk factors (p < 0.05). However, there were no significant correlations between other risk factors and the lesions’ appearance (p > 0.05). Conclusions: In elderly patients, the angiographic procedures should be performed meticulously and DWI in all patients obtained routinely, even if the regular neurological examination shows they are healthy. In this way, the presence of microemboli and clinical results can be evaluated.

Objective: Cerebellum plays quite important in our balance by coordinating the control and synergistic movements of the skeletal muscles. There are many studies in which the volume of the cerebellum is measured and different methods are used. Manual measurements are accepted as the gold standard in these studies, but these measurements are not commonly used due to time and difficulty. The present study aims to compare the cerebellum volume using three different methods.Materials and Methods: In this study, MR images of 18 men aged between 22 and 30 years were used in the Department of Radiology of Erciyes University Gevher Nesibe Hospital. In the total cerebellum volume measurements, sagittal images were calculated using the Manual (ImageJ), MRICIoud and VolBrain (CERES) methods.Results: Manual and VolBrain measurements were performed to determine the volume of the cerebellum. The total volume of the cerebellum was 136.36 +/- 12.36 cm(3) in manual calculation 125.46 +/- 17.26 cm(3) in VolBrain and MRICloud1 46.81 +/--20.16.Conclusion: In this study, it was seen that the three methods used to measure the volume of the cerebellum were compatible with each other. Because VolBrain volume values are close to the manual method, cerebellum volumes can be obtained by routinely using them.

Secondary and tertiary hyperparathyroidism is an important problem of chronic kidney disease. Brown tumor is a benign, unusual, reactive lesion as a result of disturbed bone remodeling, from long-standing increase in parathyroid hormone level. Brown tumors may cause morbidity due to pressure symptoms on neural structures and spontaneous bone fractures. Herein, we presented a peritoneal dialysis patient with tertiary hyperparathyroidism under calcand calcitriol treatment for 4 years due to refusing of the parathyroidectomy operation. She admitted to hospital for sudden onset back pain with difficulty in gait and walking, and imaging studies showed an expansile mass lesion in the thoracic spine. She was operated for mass and diagnosed with brown tumor. After operation, she lost the ability of walking than become paraplegic and she underwent rehabilitation program. Preventive measures including calcitriol and cinacalcet may cause a modest decrease in parathyroid hormone levels but it should be remembered for the development of bone complications such as brown tumor formation in patients with moderate elevated PTH levels, especially those with tertiary hyperparathyroidism. Parathyroidectomy should be performed without delay in these cases.

Stent-assisted coiling using low-profile, self-expandable and retrievable stents is a valid option in endovascular treatment of challenging intracranial aneurysms. This study aims to evaluate the feasibility and efficacy of ACCLINO 1.9 F and ACCLINO Flex stent systems, designed for use as adjunctive products in coil embolization of intracranial aneurysms. Case files of 47 patients, and 52 aneurysms in total, treated with at least one ACCLINO 1.9 F or ACCLINO Flex stent were retrospectively evaluated. Technical success, complications, and angiographic outcomes were assessed based on immediate post-procedural controls along with 6th and 12th month angiograms. Mechanical untoward event rate, including asymptomatic complications, is 9.6 % (five out of 52 aneurysms). Failed dual-stenting attempt rate is 15.4 % (two out of 13). Overall procedure-related morbidity is 4.2 % with no neurologic sequelae. Initial occlusion rate is 90.4 % (47 aneurysms). One patient had residual filling in the aneurysm neck, which was stable throughout follow-up. The remaining four cases had spontaneous follow-up occlusion. Recanalization rate at 6th month is 2.1 % with one aneurysm requiring retreatment. One patient was lost to follow-up. There is no mortality associated with treatment. Stent–assisted coil embolization with ACCLINO stents in single or dual configurations is a feasible treatment option for challenging intracranial aneurysms. Follow-up results are encouraging; techniques were effective in complex cases and there were no clinically significant adverse outcomes.

Objective: To evaluate the relationship between adenoma lateralization and the variations in petrosal sinus drainage. Materials and Methods: A total of 24 patients diagnosed as ACTH dependent Cushing Syndrome (CS) in the Department of Endocrinology and Metabolism Disorders between May 2006 and May 2012 were evaluated. The patient files for data, including laboratory results and imaging records, were analyzed retrospectively. MRI was performed using a 1.5-T scanner. The femoral vein was cannulated using the Seldinger technique and bilateral venous sheaths were inserted for bileteral inferior petrosal sinus sampling (BIPSS). Results: Microadenomas were detected with MRI in 12 patients. Right lateralization has been determined in 12 patients (54.5%), left lateralization in 5 patients (22.7%) and central gradient in 2 patients (22.8%). No peripheral/central gradient was obtained by BIPSS in 3 patients compatible with an ectopic source of ACTH. Pituitary surgery was performed in 19 patients. Conclusion: BIPSS may avoid unnecessary pituitary surgery. Asymmetric drainage may affect the results of lateralization. This study suggest that drainage variations may have subgroups.

Objective: To evaluate the feasibility and efficacy of transjugular liver biopsy in patients with contraindicated percutaneous biopsy. Materials and Methods: Between June 2005 and April 2010, 97 patients who were admitted for transjugular liver biopsy were enrolled in this retrospective study. All liver biopsies were obtained using an 18 gauge Quick-Core liver biopsy set through the right hepatic vein via the internal jugular vein. Clinical indication, histopathological diagnosis, and complications were noted. Results: Primary technical success was achieved in 93 (95.8%) patients. Hepatic veins could not be catheterized and opacified in two patients and in the remaining two patients the veins could be opacified and catheterized but we were not able to pass the biopsy needle into the hepatic vein because of the acute angle between the inferior vena cava and hepatic veins. At least two specimens were obtained from each patient. The most frequent histopathological diagnosis was cirrhosis. A subcutaneous hematoma around the puncture side was encountered in one patient. Conclusion: Transjugular liver biopsy is a feasible and effective alternative in patients with contraindication for percutaneous biopsy. Turkish Başlık: Transjuguler Karaciğer Biyopsisi; 97 Hastanın Sonuçları Anahtar Kelimeler: Transjuguler karaciğer biyopsisi, karaciğer biyopsisi, karaciğer sirozu Amaç: Perkütan biyopsinin kontrendike olduğu hastalarda transjuguler karaciğer biyopsisinin etkinliğini değerlendirmektir. Hastalar ve Yöntem: Haziran 2005-Nisan 2010 tarihleri arasında transjuguler biyopsi yapılan 97 hasta çalışmaya dahil edildi. Bütün biyopsiler 18 gauge Quick-Core biyopsi seti ile internal juguler venden girilerek sağ hepatik ven yoluyla yapıldı. Klinik endikasyon, histopatolojik tanı ve komplikasyonlar kaydedildi. Bulgular: Teknik başarı 93 hastada (%95,8) sağlandı. İki Hastada hepatik venler kateterize ve opasifiye edilemedi. İki hastada ise hepatik ven kateterize ve opasifiye edilmesine rağmen, inferior vena kava ile hepatik ven arasındaki akut açılanma nedeni ile biyopsi iğnesi karaciğere ilerletilemedi. Her hastadan en az iki örnek alındı. Histopatolojik tanıların çoğu sirozdu. Bir hastada giriş yerinde cilt altı hematom gelişti. Sonuç: Perkütan biyopsinin kontrendike olduğu durumlarda transjuguler karaciğer biyopsisi etkili ve uygulanabilir alternatif yöntemdir.

BACKGROUND.: Our purpose was to evaluate the effectiveness of bedside sonography (US) in the detection of pneumothorax secondary to blunt thoracic trauma. METHODS.: In this prospective study, 240 hemithoraces of 120 consecutive patients with multiple trauma were evaluated with chest radiographs (CXR) and bedside thoracic US for the diagnosis of pneumothorax. CT examinations were performed in 68 patients. Fifty-two patients who did not undergo CT examinations were excluded from the study. US examinations were performed independently at bedside by two radiologists who were not informed about CXR and CT findings. CXRs were interpreted by two radiologists who were unaware of the US and CT results. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CXR and US were calculated. RESULTS.: One hundred thirty-six hemithoraces were assessed in 68 patients. A total of 35 pneumothoraces were detected in 33 patients. On US, the diagnosis of pneumothorax was correct in 32 hemithoraces. In 98 hemithoraces without pneumothorax, US was normal. With US examination, there were three false-positive and three false-negative results. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of US were 91.4%, 97%, 91.4%, 97%, and 97%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CXR were 82.7%, 89.7%, 68.5%, 95%, and 89.5%, respectively. CONCLUSIONS.: Bedside thoracic US is an accurate method that can be used in trauma patients instead of CXR for the detection of pneumothorax.

Summary Objective The primary aim of the study was to compare the efficacy of Oct-LAR and surgery in terms of controlling IGF-1 and GH levels and tumour volumes. The second aim was to compare two primary treatment modalities in terms of side effects such as pituitary insufficiency, cholelithiasis, metabolic parameters and the effect on quality of life (QoL). Design The study was a randomized, prospective study. Patients The 22 patients were consecutively randomized to Oct-LAR and surgical treatment groups. Results Baseline serum IGF-1 level, tumour volume and GH levels were comparable in the Oct-LAR and surgery groups. No significant differences were detected between the Oct-LAR and the surgery groups in terms of IGF-1 and GH levels at the 3rd and 6th months, but at 12th month, preglucose GH was found to be lower in the surgical treatment group. IGF-1 control and complete biochemical response rates were found to be 27% and 64%, in the Oct-LAR and surgical treatment groups, respectively. The mean percentage of tumour volume reduction was found to be 26%, 30% and 31% in the Oct-LAR group vs 64%, 74% and 79% in the surgery group at the 3rd, 6th and 12th months, respectively. Conclusion Primary surgical treatment seems to be slightly more effective than Oct-LAR in terms of biochemical response and IGF-1 control, besides tumour volume reduction, in patients with acromegaly with noninvasive tumours. Oct-LAR is associated with more side effects such as cholelithiasis and glucose metabolism disorders and is more expensive.

A 45-year-old man who developed brain radionecrosis in the right frontal and left temporoparietal lobes after receiving whole brain radiotherapy and stereotactic radiosurgery for primary central nervous system lymphoma. Since high dose steroid treatment failed and he declined to undergo surgery, he was referred to hyperbaric oxygen (HBO) therapy. Both clinical and radiological findings improved after HBO therapy. Steroid requirements were also reduced. HBO therapy may have a potential value in treatment of brain radionecrosis. J. Surg. Oncol. 2009;100:732–735. © 2009 Wiley-Liss, Inc.

The vertebral artery terminating in the posterior inferior cerebellar artery is rare but it may cause cerebellar infarction when total occlusion of the vertebral artery occurs. Therefore treatment of vertebral artery stenosis in these patients is crucial. Surgical treatment of osteal vertebral artery stenosis is possible but is associated with approximately 4% mortality and up to 20% risk of procedural complications including perioperative VA occlusion, Horner syndrome, lymphatic injury and injury to the phrenic, vagus, laryngeal and thoracic nerves. Therefore percutaneous angioplasty with or without stent placement is emerging as an alternative treatment method with a high success rate and good initial angiographic outcome. Percutaneous angioplasty of the VA origin is associated with an approximately 15% restenosis rate. Stent placement is believed to decrease the incidence of elastic recoil and restenosis. Herein we present a rare symptomatic case with an anomalous, small-caliber right VA terminating in the PICA which was successfully treated with a drug-eluting stent.

We aimed to define the diffusion-weighted magnetic resonance (MR) imaging features of intracranial cystic lesions and to investigate possible special features for the differential diagnosis. One hundred and twenty patients with intracranial cystic lesions were included in the study. There were 29 arachnoid cysts, eight epidermoid cysts, 34 primary tumors, 18 abscesses, 29 metastases and two hydatid cysts. Echo-planar diffusion-weighted MR imaging was obtained in addition to conventional cranial MR scans. The morphologic features of the cystic portion and the wall of the cyst and signal intensities on diffusion-weighted images were evaluated. All abscesses and epidermoid cysts were hyperintense on diffusion-weighted images. Arachnoid cysts, hydatid cysts, primary tumors, and metastases were hypointense except five cystic tumors. These five primary or metastatic necrotic tumors showed high signal intensity on diffusion-weighted images due to hemorrhage or superinfection. The walls of the cystic tumors were usually hyperintense on diffusion-weighted images in contrast to the wall of the abscesses, which were iso-hypointense. This was a statistically significant finding for the differentiation between tumors and abscesses (P

Purpose: The purpose of this study was to evaluate the effectiveness of percutaneous arterial embolization in patients with penetrating peripheral arterial trauma., PURPOSE:The purpose of this study was to evaluate the effectiveness of percutaneous arterial embolization in patients with penetrating peripheral arterial trauma.MATERIALS AND METHODS:Twelve patients with penetrating peripheral arterial trauma were treated with percutaneous arterial embolization between 2002 and 2007. All injuries were secondary to penetrating stab wounds. Active bleeding (eight patients), recurrent bleeding episodes (one patient), persistent pain and mass (one patient), leg edema, claudication, swelling (one patient), local hyperemia, and pain (one patient) were the presenting symptoms. Microcatheter systems were used for catheterization. We used n-butyl cyanoacrylate mixture as the embolizing agent in all patients.RESULTS:On angiograms the inferior gluteal artery (one patient), internal pudendal artery (one patient), perforating branch of the profundal femoral artery (six patients), superficial femoral artery (one patient), peroneal artery (two patients), and anterior tibial artery (one patient) were found to be injured. In all patients, the source of arterial bleeding could be reached, and a safe embolization was achieved. Nontarget embolization due to backflow of n-butyl cyanoacrylate mixture was detected in two patients and inguinal hematoma at the puncture site occurred in one patient.CONCLUSIONS:We conclude that embolization-particularly n-butyl cyanoacrylate embolization-is technically feasible in patients with penetrating peripheral arterial trauma.

Complications such as arteriovenous, arteriocalyceal fistula, pseudoaneurysm, or perinephric hematoma occur in allografted and native kidneys after interventional procedures. When these complications are not detected and treated immediately, they might be associated with a poor allograft prognosis. Reoperation may produce parenchymal injuries, therefore, endovascular embolization may be a preferred treatment modality. Herein we report an arteriocalyceal fistula and an arteriovenous fistula in a transplant kidney that were detected after biopsy and nephrostomy, respectively, they were treated with endovascular coil embolization. Percutaneous treatment is a safe and effective method for arteriocalyceal fistula and arteriovenous fistula following interventional procedures in renal allografts.

Postoperative angina is generally caused by subclavian artery stenosis or flow diversion in anomalous or large unligated side branches of the left internal mammary artery. Previously, surgery was the treatment method for unligated side branches, but with the improvements of interventional techniques, it is shown that endovascular treatment is also effective in these patients. Herein, we present successful endovascular treatment of a large unligated intercostal side branch causing recurrent angina.