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Introduction: National data on asthma characteristics and the factors associated with uncontrolled asthma seem to be necessary for every country. For this purpose, we developed the Turkish Adult Asthma Registry for patients with asthma aiming to take a snapshot of our patients, thereby assigning the unmet needs and niche areas of intervention. Methods: Case entries were performed between March 2018 and March 2022. A web-based application was used to record data. Study outcomes were demographic features, disease characteristics, asthma control levels, and phenotypes. Results: The registry included 2053 patients from 36 study centers in Turkey. Female subjects dominated the group (n = 1535, 74.8%). The majority of the patients had allergic (n = 1158, 65.3%) and eosinophilic (n = 1174, 57.2%) asthma. Six hundred nineteen (32.2%) of the patients had obese asthma. Severe asthma existed in 670 (32.6%) patients. Majority of cases were on step 3–5 treatment (n: 1525; 88.1%). Uncontrolled asthma was associated with low educational level, severe asthma attacks in the last year, low FEV1, existence of chronic rhinosinusitis and living in particular regions. Conclusion: The picture of this registry showed a dominancy of middle-aged obese women with moderate-to-severe asthma. We also determined particular strategic targets such as low educational level, severe asthma attacks, low FEV1, and chronic rhinosinusitis to decrease uncontrolled asthma in our country. Moreover, some regional strategies may also be needed as uncontrolled asthma is higher in certain regions. We believe that these data will guide authorities to reestablish national asthma programs to improve asthma service delivery.

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.

© 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.Purpose: To report the results of the endovascular treatment of acute-massive head and neck bleeding in a single center and underline the value of computerized tomography-angiography and endovascular treatment of this desperate patient group. Methods: Forty-eight patients who suffered from acute-massive head and neck bleeding and in whom conservative treatment options had failed were included in the study. To localize the site of the bleeding, computerized tomography-angiography was obtained above the supra-aortic level. Depending on the type and site of bleeding, an urgent angiographic evaluation and appropriate endovascular treatment procedure were performed in the same session immediately. Complete control of all active bleeding was determined as “technical success” at the end of the procedure. Results: The majority of the endovascular treatment indications were tumoral mass bleedings in this study. Eight patients, all of which had head and neck tumors as the cause of the bleeding underwent repeated interventional procedures due to acute re-bleeding. All patients left the angiography unit with technical success and dramatic clinical improvement. Two patients had procedure-related severe complications, such as contrast-induced nephropathy and acute cerebrovascular accident. One patient died due to massive re-bleeding during the follow-up period. Conclusion: Computerized tomography-angiography is a successful imaging method to reveal the location and cause of bleeding. Endovascular treatment of acute-massive head and neck bleeding is an effective and life-saver treatment option that can be used successfully with relatively low-risk potential.

Aim To present an alternative endovascular treatment option for the vein of Galen aneurysmal malformation by ethylene-vinyl alcohol copolymer embolization via a double-lumen balloon microcatheter. Material and methods A female patient was suspected with the vein of Galen aneurysmal malformation in the prenatal period and diagnosed choroidal type vein of Galen aneurysmal malformation. Once the patient was symptomatic with severe cardiac failure, an endovascular treatment decision was made. In the first step, a mixture of N-butyl cyanoacrylate-lipiodol was used for embolization. In the second session of the treatment, ethylene-vinyl alcohol copolymer was administered through a double-lumen balloon microcatheter. Results Complete cure of the aneurysmal malformation was obtained by no filling was observed in arterial feeders, collapsed appearance of the vein of Galen, and arterial-venous shunts at the end of the five-year follow-up period with magnetic resonance imaging and angiography. Conclusion Ethylene-vinyl alcohol copolymer embolization via double-lumen balloon microcatheter provides an alternative and effective endovascular treatment option for the vein of Galen aneurysmal malformations using less contrast agent in less procedural time. Also, the possibility of spontaneous regression of residual aneurysmal malformations with small feeders should be considered.

© 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.Purpose: Our aim was to determine the long-term safety and efficacy of the Flow Re-Direction Endoluminal Device (FRED) in this multicenter study with prospective design. Materials-method: This study included 136 consecutive patients with 155 aneurysms treated between March 2013 and June 2016 in 10 centers. Twenty-two (16.2%) patients presented with rupture of the index aneurysm. Large/giant aneurysms comprised 1/3 of the cohort. Adjuvant coil use during the treatment was 15.5%. The effectiveness measure in the study was the percentage of aneurysms with stable occlusion at follow-up. Results: Vascular imaging follow-up was performed at least once in 131/136 (96.3%) patients with 148/155 (95.5%) aneurysms up to 75 months (mean: 37.3 months; median: 36 months according to latest follow-up), and 102/155(65.8%) aneurysms in 90/136 (66.2%) patients had ≥ 24-month control. According to the latest controls, the overall stable occlusion rate was 91.9% (95% CI, 87.5 to 96.3%). Three out of 148 aneurysms with follow-up were retreated (2%, 95% CI 0.0 to 4.3%). Adverse events were noted in 19/136 (14%, 95% CI, 9 to 21%) patients with a morbidity of 1.5% (95% CI, 0.0 to 3.5%). Mortality was 1/136 (0.7%, 95% CI, 0.02 to 2.2%) and was unrelated to aneurysm treatment. In-stent stenosis (ISS) was detected in 10/131 of the patients with follow-up (7.6%, 95% CI; 3.1 to 12.2%), only one being symptomatic. No adverse events have occurred in any of the patients with follow-up after 24 months, except the one resulting from ISS. Conclusion: In the treatment of cerebral aneurysms which were candidates for flow diversion technique, this study showed long-term efficacy of FRED with good safety and occlusion rates.

Purpose The purpose of this study was to evaluate the technical and clinical results of fluoroscopy-guided placement of pull-type mushroom-retained gastrostomy tubes. Materials and methods This retrospective study included 102 patients (61 men, 41 women) with a mean age of 59 years ± 16.3 (SD) (range, 18–94 years) who had fluoroscopy-guided placement of pull-type mushroom-retained gastrostomy tubes. All procedures were performed after inflating the stomach with air via an orally inserted 5-Fr catheter by retrograde catheterization of the esophagogastric junction. Demographic data, results of the procedures and complications were evaluated. Results A technical success was observed in 101/102 patients, yielding a technical success rate of 99%. Complications due to the procedure were observed in 17/102 patients yielding a procedure-related complication rate of 16.7%. Procedure-related complications included peristomal superficial cellulitis (6/102; 5.9%), peristomal abscess (4/102; 3.9%), subcutaneous hematoma (3/102; 2.9%), peristomal leakage (2/102; 2%), inadvertent removal of the tube (1/102; 1%) and death due to procedure-related peritonitis (1/102; 1%). Conclusion Fluoroscopy-guided placement of pull-type mushroom-retained gastrostomy tubes is a feasible and effective method for enteral nutrition.

Knowing the volumetric changes in brain can allow for the estimation of the disease progression of various neurodegenerative disorders. Many studies have been shown that the volumetric changes in the some brain structures especially including the dopaminergic neurons, in patients with Parkinson's disease (PD). The objective of this study was to compare intracerebral ventricles volume in patients with PD and healthy subjects to compare an automated atlas-based method (MRIStudio software) and a manual method (ImageJ). T1-weighted brain Magnetic Resonance Imaging (MRI) data of 21 patients with PD and 20 healthy individuals were used to calculate the intracerebral ventricle volumes. Measurement results obtained by ImageJ were considered as the gold standard. We found a significant increase in the left occipital part of the lateral ventricle volume in the patients with PD compared to the control subjects (p 0.05). Also, no significant difference was found between the two methods of measurement (p 0.05), meaning that a substantial agreement was found between the results obtained with the atlas-based analysis and manual method. The present study showed that MRIStudio can be performed easily and accurately on routine MRI scans for which the total intracerebral ventricles volume is to be estimated in PD. We suggest that, the attained volume values of intracerebral ventricles may provide a precious data for volumetric dependences of the anatomical structures in several clinical conditions.

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.

Aim: The aim of the present study was to determine the demographic characteristics, localization of emboli, imaging findings, National Institutes of Health Stroke Scale (NIHSS) scores, and complications of patients who received intravenous (iv) tissue plasminogen activator (t-PA) due to early period of ischemic cerebrovascular disease (CVD) during the 6-year period in a tertiary level emergency department of a university hospital.Materials and Methods: The study was retrospectively performed in 65 patients aged ≥18 years and who underwent iv t-PA with a diagnosis of ischemic CVD. Demographic data, such as age, gender, and smoking, were obtained by examining the medical records of the patients. The baseline Glasgow Coma Scale, NIHSS, start time of the event, time of admission to the hospital, and prognosis of the patients were recorded.Results: Intracranial hemorrhage was detected in 16.9% of the patients after treatment. On examination of the patients’ outcome, a total of 32.3% (n=21) died after therapy. A significant correlation was observed between high NIHSS score and complications.Conclusion: In our study, a high NIHSS score at the time of admission has been found to increase both the risk of intracerebral hemorrhagic complication and mortality. We hypothesize that iv t-PA treatment gives successful results despite the complications, and emergency physicians should be more courageous in their application.

Aim: Moyamoya disease (MMD) is a rare, progressive and oclusive cerebrovascular disorder, predominantly affecting the terminal segment of the internal carotid arteries (ICA) and its main branches. The purpose of this study is to evaluate the clinical course and severity of MMD in pediatric patients. Material and Method: We examined 5 consecutive pediatric patients with MMD, focusing on clinical and radiological features, the therapy and outcome over the 58-month follow-up period. Results: The study population consisted of 3 boys and 2 girls. The mean age at diagnosis of patients was 7.2 ± 3.4 years (age range: 3-10 years). The mean duration of follow-up was 30.4 ± 17.4 months (follow-up interval: 12-58 months). Neurological findings at presentation included: motor deficit in 4 patients (80.0%), epileptic seizures in 2 patients (40.0%), movement disorders in 3 patients (60.0%), and headache in 1 patients (20.0%). There was areas of infarction on brain MRI in all patients. Angiographic findings included: internal carotid artery stenosis in all patients, anterior cerebral artery stenosis in 3 patients, middle cerebral artery stenosis in 3 patients, posterior cerebral artery stenosis in 2 patients, and vertebral artery stenosis in 1 patient. Enoxaparine therapy was started to all patients. Subdural hematoma developed in 1 patient during follow-up. Cerebral infarctions recurred despite medical treatment in 4 patients. Discussion: Although this disease is rare, it is an important cause of pediatric stroke. MMD shows different clinical course and disease severity in childhood. Early diagnosis and appropriate treatment are crucial.

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.

Purpose The purpose of this study was to analyze the outcome of percutaneous management of residual common bile duct (CBD) stones in patients with surgically inserted T-tube in CBD after cholecystectomy. Material and methods Between April 2001 and August 2015, 89 patients (52 women, 37 men) with a mean age of 55.7 years ± 18 (SD) (range, 22–88 years) underwent percutaneous sphincteroplasty and stone expulsion into the duodenum with a Fogarty balloon catheter through the T-tube tract for residual CBD stones. All patients had previously undergone open cholecystectomy with CBD exploration and T-tube insertion 7 to 60 days (mean, 14.4 days) before the procedure. Results of the procedure and complications were evaluated by a review of clinical notes, imaging and laboratory findings. Results The procedure was successful in 87/89 patients (97.7%). Complete CBD clearance was achieved in a first session in 86 patients (96.6%). One patient (1.1%) needed a second session. The procedure was unsuccessful in 2 patients (2.2%) due to inappropriate position of T-tube and stone impaction into the cystic duct remnant. Two complications (2.2%) including intra-abdominal bile collection and distal CBD stricture were observed after the procedure. Conclusion Percutaneous CBD expulsion into the duodenum through the T-tube tract is a non-traumatic, effective and safe method for the treatment of residual CBD stones in patients who had cholecystectomy and T-tube insertion.

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

Metastasis to the eye is rare but it may be the presenting symptom. Therefore awareness of the radiological findings of metastasis may aid in establishing its diagnosis. Here we report an ocular metastasis of small cell carcinoma of the lung presenting with pulmonary and ocular manifestations.

We report a patient who developed a large arteriovenous fistula in right lower extremity after gunshot injury. Because other endovascular methods failed, the patient was successfully treated with concomitant use of detachable latex balloon and N-butyl-2-cyanoacrylate (NBCA). The combination of detachable balloon and NBCA can be effectively used for endovascular treatment of peripheral arteriovenous fistulas in selected cases when effective embolization could not be achieved with other embolizing agents or their various combinations.

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.

Vertebral artery injury including thrombosis, arteriovenous fistula (AVF), pseudo-aneurysm and hemorrhage may be iatrogenic or due to penetrating or blunt trauma. Although mostly asymptomatic, vertebral artery injury may also present with vertebrobasilar insufficiency findings, cephalgia, radicular pain or myelopathy due to blockade of arterial flow, arterial steal phenomenon and venous hypertension. The gold standard for diagnosis is digital subtraction angiography (DSA). Doppler ultrasonography, magnetic resonance-angiography and computerized tomography-angiography are also helpful. Endovascular treatment is now used more commonly. We present a case with sharp bread knife injury of the vertebral artery that was also complicated with a vertebrojugular fistula and pseudo-aneurysm together with the diagnostic and management options and a review of the current literature.

Background Although stroke among children is rare, it can cause significant morbidity and mortality. We aim to share our experience of children with arterial ischemic stroke. Methods The initial symptoms, demographical features, risk factors, neurological examination, neuroradiological findings, and clinical follow-up data of 130 Turkish children seen between 2002 and 2013 were retrospectively analyzed. Results Sixty-eight patients were male. Thirty of the children were aged from 1 to 12 months (seven of them died in this period). Focal neurological signs were the most common presentation, and hemiplegia or hemiparesis were the most common focal signs. Underlying risk factors were detected in 103 patients. Infections and congenital heart disease were the most common risk factors. Seven of the nine children with recurrent arterial ischemic strokes had one or more underlying diseases (moyamoya disease in two children along with factor V Leiden mutation, tuberculous meningitis, congenital heart disease, homocystinuria, and hemiconvulsion-hemiplegia-epilepsy syndrome). The arterial ischemic stroke was located in the middle cerebral circulation in 68 (36 left and 32 right) and in the posterior cerebral artery in 41. Eighteen children died. The neurological outcome was assessed in 98 children. Of these children, 66 children have neurological deficits and 52 children have seizures. Stroke in the first year of life is more often fatal. Recurrent stroke is associated with poor prognosis. Conclusion Tuberculous meningitis is still a risk factor for arterial ischemic stroke in Turkey. Arterial ischemic stroke in the first year of life and recurrent arterial ischemic stroke represent poor prognostic features.

A 22-year-old pregnant woman presented with a painful swelling in the right groin. Sonography was performed to confirm a presumptive diagnosis of inguinal hernia based on physical examination. Gray-scale sonography examination revealed bilateral inguinal cystic lesion expanding with the Valsalva maneuver. Color Doppler imaging demonstrated multiple prominent vessels with retrograde venous flow during Valsalva maneuver. Bilateral round ligament varicosities were diagnosed and inguinal hernia was excluded by sonographic findings. Round ligament varicosities should be considered in the differential diagnosis of groin swelling during pregnancy. (C) 2010 Wiley Periodicals, Inc. J Clin Ultrasound 38:512-514, 2010; Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/jcu.20697

Aseptic meningitis related to hydrogel-coated coils is a known complication, but it is extremely rare after platinum bare coil aseptic meningitis. Here we report the development of aseptic meningitis causing brain stem and cerebellar infarct in a patient with a giant aneurysm treated with bare platinum coils. We conclude that aneurysm size is an important factor affecting the occurrence of aseptic meningitis associated with stroke.

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.

OZET Introduction Methanol has a molecular weight of 32 g/mol. It is freely miscible with water, ethanol, and many organic solvents. Methanol is water-soluble and easily crosses the blood-brain barrier (1).Methanol poisoning has a rare incidence, however, it presents with a high morbidity and mortality. Generally, it is encountered after an attempted suicide or an accidental intake. Methanol poisoning affects the optic nerve and central nervous system, particularly the basal ganglia, potentially leading to visual impairment, blindness, diz-ziness, seizures, and coma (2, 3). Patients present with symptoms such as blindness, motor dysfunction, rigidity, hypokinesia, and other Parkinson-like signs (2, 4). In this study, we aimed to underscore the importance of MRI findings in a patient that presented with late signs of serious intoxication in whom we were unable to evaluate serum methanol and ethanol levels. Case Report A 32-year-old unconscious man was admitted to the Emergency Department because of vomiting and severe meta-bolic acidosis with an arterial pH of 6.79 (normal range 7.35-7.45). The anion gap was 32 mmol/L (8-16 mmol/L), whereas HCO

The aim of this study is to evaluate the correlation between clinical presentation and the extent of cortical involvement in patients with polymicrogyria. The magnetic resonance imaging findings of 26 patients were evaluated for the location and distribution of polymicrogyria. Presence of asphyxia at birth and serological tests for TORCH infections, the presence and type (spastic, flaccid) of motor deficits, mental development, microcephaly, and epilepsy were noted. Nineteen patients had bilateral, whereas seven had unilateral involvement. Patients with unilateral polymicrogyria presented later with milder symptoms. The most encountered symptom in patients with bilateral involvement was mental motor retardation (MMR) (89%) and speech problems (84%). The clinical presentations of patients with asphyxia and positive serological tests for cytomegalovirus (CMV) were worse. All patients with positive serological tests for CMV had bilateral involvement. The perisylvian region was affected in five (71%) patients with unilateral involvement. The most encountered presenting symptom in these patients was epilepsy. Cerebral palsy was seen in three (43%) of the patients, and all of them had left hemiparesis. Microcephaly, MMR, and speech delay were detected in one (14%) of the patients. Late presenting epilepsy may be a predictor of a unilateral polymicrogyria and is associated with relatively good prognosis. CMV infection and the presence of asphyxia are predictors of worse prognosis.

Purpose: To determine the efficacy of periprostatic nerve block (PPNB) for control of transrectal ultrasound (TRUS)-guided multicore prostate biopsy-related pain. Methods: A total of 106 cases with suspicion of prostate cancer underwent TRUS-guided multicore prostate biopsy under local anesthesia using a total of 10 ml of 1% lidocaine for each patient. Lidocaine was injected around the neurovascular bundle at the base of the prostate just lateral to the seminal vesicle-prostate junction. The pain score was assessed using visual analog pain score from 0 to 10. All patients were questioned for whether they would accept repeat biopsy or not, if necessary. Results: Pain score ranged from 0 to 5 (mean: 1.4). Thirty-five percent (37/106) of patients reported a score of 0, whereas 17% (18/106), 32% (34/106), 8.4% (9/106), 6.7% (7/106), 0.9% (1/106) reported pain scores of 1, 2, 3, 4, and 5, respectively. There were no pain scores of 6–10. Answers for the question “would you accept repeat biopsy or not, if necessary?” was “yes” for 82% (87/106) of the patients. Conclusions: PPNB prior to multi-core TRUS-guided prostate biopsy is an easy, safe, and effective technique for the control of procedure-related pain. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound, 2011

Bevacizumab, which is a humanized monoclonal antibody against vascular endothelial growth factor, is used to treat metastatic cancers of the colon. Adverse effects common with bevacizumab treatment are hypertension, arterial-venous thrombosis, bleeding, gastrointestinal perforation, and proteinuria. To date, there have been no reports of refractory seizure following treatment with bevacizumab. We describe a patient who presented with refractory generalized tonic-clonic seizures after receiving last dose of bevacizumab for treatment of metastatic colorectal cancer with FOLFIRI and bevacizumab regimen.

We describe the case of a 70-year-old woman who had a left proatlantal intersegmental artery disclosed during carotid artery angiography with the findings of carotid-basilar anastomosis which originated from the petrous segment of the ICA and was filling the horizontal segment of the vertebral artery. Awareness of this vascular variation can prevent morbidity and mortality associated with carotid ligation or carotid endarterectomy, especially when an incomplete circle of Willis is present.

Hydatid disease is a serious public health problem in endemic areas. Percutaneous treatment is an effective alternative to surgical and medical therapy in hydatid liver disease (HLD).To present clinical and radiological results of percutaneous treatment of HLD in children.Twenty-five children (16 males; age range, 5-15 years; mean age, 9.6 years) with a total of 30 hydatid cysts of the liver underwent ultrasound US guided percutaneous treatment using hypertonic saline as the scolicidal agent.The percutaneous procedure was successful in all patients. All children were asymptomatic at follow-up. A hypersensitivity reaction occurred in one child (4%) during the procedure. No other complications occurred. The reduction in cyst volume was 14-100% (mean, 64%) at follow-up (mean 13.8 months). On US at follow-up, the treated cysts were semisolid with a heterogeneous echo pattern (n = 17), solid hypoechoic (n = 10) or solid with calcification (n = 2). One treated cyst disappeared sonographically.Percutaneous treatment of HLD is effective, safe and well-tolerated in children.

Purpose To describe the popliteal and distal branching patterns detected by digital subtraction angiography. Materials and methods The popliteal branching patterns were analyzed in 535 extremities (270 right, 265 left). Of these, 226 limbs were evaluated bilaterally, while 83 were evaluated unilaterally. The branching patterns were classified according to the level of branching and the presence of hypoplasia or aplasia of the distal branches. Results Four hundred and seventy-two (88.1%) limbs had a normal level of popliteal artery branching. Type IA was the most frequently encountered pattern. High division of the popliteal artery was seen in 30 (5.6%) limbs. Type IIA was the most frequently encountered pattern among these limbs. Type IIC was not seen. We encountered a new pattern characterized by high division of the peroneal artery with a trifurcation pattern and an anterior tibial artery with a proximal medial course and a distal lateral course. We called this pattern Type IID. Thirty-three (6.1%) limbs exhibited hypoplasia/aplasia of the distal branches. Type IIIA was the most frequently encountered pattern among these limbs. Conclusion Variations that occur in nearly 10% of patients should be understood because they may affect the choice of management strategy.

Purpose The aim of this study is to compare the diagnostic performance of 16-row computed tomographic angiography (MDCTA) with digital subtraction angiography (DSA) for the detection and characterization of intracranial aneurysms in patients with nontraumatic subarachnoid hemorrhages (SAH). Materials and methods One-hundred and twelve consecutive patients with suspected intracranial aneurysm underwent both 16-row MDCTA and DSA. The MDCT angiograms were interpreted in a blinded fashion by using combination with VRI, MIP and MPR techniques. Sensitivity specificity and accuracy were calculated for the CTA and DSA. The results were compared with each other. The DSA reader's interpretation was accepted as the reference standard. Results A total of 164 aneurysms were detected at DSA in 112 patients, no aneurysms were detected by DSA and MDCTA in 16 patients. Eight aneurysms were missed by MDCTA. The overall sensitivity, specificity, and accuracy of MDCTA on a per-aneurysm basis were 95.1%, 94.1%, and 95%, respectively. According to the size of the aneurysm less than 3 mm; sensitivity, specificity and diagnostic accuracy of MDCTA were 86.1%, 94.1%, 88.6%, respectively. Conclusion This study suggests that MDCTA is equally as sensitive as DSA in the detection of intracranial aneurysms of greater than 3 mm, and it also reveals 100% detection rate for ruptured aneurysms.

Introduction. Lymphocytic hypophysitis (LH) is an autoimmune disorder associated with the infiltration of the pituitary gland by lymphocytes leading to different degrees of hypopituitarism. Females are affected more frequently than males and the disease is usually associated with pregnancy or postpartum period. Case. We present a case of LH who was first diagnosed with diabetes insipidus and hyperprolactinemia. In the follow-up, the patient developed growth hormone, gonadotropin, and thyroid stimulating hormone deficiency. The typical appearance of increased stalk thickness and diffuse homogenous contrast enhancement of pituitary on magnetic resonance imaging resulted in empty sella by time. Conclusion. The present case demonstrates the natural course of LH over a 13-year period in which the empty sella was the final outcome.

OBJECTIVE. Our aim was to describe the technique of direct CT venography and to describe various forms of venous anomalies detected with CT venography in patients with Klippel-Trenaunay syndrome., OBJECTIVE: Our aim was to describe the technique of direct CT venography and to describe various forms of venous anomalies detected with CT venography in patients with Klippel-Trénaunay syndrome. CONCLUSION: MDCT is helpful for visualizing the full length of extremities and for evaluating length and thickness on one image.

In chronic aorto-iliac occlusive disease, pre-existing renal artery stenosis may give rise to sufficient development of collateral blood flow and prevent ischaemic symptoms for a long time and therefore may cause delay in diagnosis. An early diagnosis of aorto-iliac disease is necessary in order to avoid fatal outcome. Duplex scanning is generally used to rule out a renal artery stenosis. This can generally detect the occlusion, but has some drawbacks such as obesity gas interposition, accessory renal arteries or the anatomy of the left renal artery, which may hinder complete examination of both renal arteries and may give rise to misdiagnosis. On the other hand, CT may provide detailed anatomic information. In this paper, we present a case of total aortorenal occlusion mimicking renal artery stenosis on duplex scanning.

The left internal mammary artery (IMA) is the preferred native graft for left anterior descending revascularisation owing to its favourable long-term patency and resistance to atherosclerosis. Incomplete ligation of the IMA side branches may cause recurrent angina due to flow diversion. Reoperation for ligating this unligated side branches may be performed but damage to the internal mammary artery or saphenous graft are the potential complications of this procedure. Therefore less invasive endovascular methods should be preferred. In this paper we report a patient with recurrent angina due to a large unligated left internal mammary artery side branch that was succesfully treated with percutaneous coil embolisation.

We present a patient with intractable postpartum hemorrhage resulting from uterine artery pseudoaneurysm despite bilateral hypogastric artery ligation who was successfully treated by an endovascular approach via the collateral route. Although there is a good argument for postponing surgery until transcatheter embolization has been attempted, this case shows that embolization can still be successful even if the iliac vessels have been ligated.