Makale Arama

Aim

The decision to start treatment in sarcoidosis is made based on clinical and radiological findings and changes in pulmonary function test findings during follow-up, and more useful tools are needed in treatment management. F-18 fluorodeoxyglucose (18F-FDG) positron required important tomography / computed tomography (PET/CT) contains important information about the extent of sarcoidosis. On the other hand, the neutrophil/lymphocyte ratio (NLR) opens as a good prognostic marker for tissue-related inflammation. This study evaluated the relationship between the 18F-FDG PET/CT findings of sarcoidosis and NLR and other clinical findings.

Material and methods

The data of the patient who was diagnosed with sarcoidosis after 18F-FDG PET/CT examination in our clinic were retrospectively reviewed. Patients' age, gender, NLR values, smoking status, extrathoracic involvement and symptoms, and 18F-FDG PET/CT findings were compared.

Results

This study consisted of 41 patients. There was a strong correlation between NLR and whole body total lesion glycolysis (TLG), and moderate correlation between  MAIA and NLR (r values: 0.852, 0.660, both of them p value: <0.001, respectively). There was a significant difference between the groups showing only thoracic involvement and additional extrathoracic involvement with MAIA, TLG and NLR values (p values,: 0.002, 0.001 and, 0.003, respectively). In the classification made according to the symptoms of the patients, there was no significant difference between the groups with SUVmax, MAIA, TLG and NLR values. Median values were found to be significantly higher in the elderly group (p values: 0.037 and 0.040, respectively). In the classification made according to gender; there was no significant difference in both PET/CT parameters and NLR values.

Conclusion

The close relationship between the NLR value, which is accepted as a prognostic indicator in sarcoidosis, and the 18F-FDG PET / CT findings which show the involvement of the disease in the whole body, may provide the clinician with significant benefits in treatment management.

According to the fundamental nature of penile erection, insufficiency of the arteriel blood supply to the corpora cavernosa caused by an organic arteriel disease is found in a large fraction of case. Our experience in the treatmen of stenoses or obstruction of the common iliac arteries with PTA, rotacs and intra-arteriel stents in 27 patients, between 38-63 years of ages, are reported. Clinical finding were lower limb claudicatio in all patients and impotence in 12 patients. The underlying disease was atherosclerosis in all 27 patients. Restitution of potency was recorded 4-12 months after the PTA or intravasccular stent application. After the intervention of procedures in 9 (%75) of the 12 patients, potency was succesliilly restored. As a results we think that radiological interventional procedures are succesfull in treatment of impotency which has arteriel etiology.

The aim of the study is to determine the effectiveness of CT area measurements in order to çuantify hypertrophy produced by exercise in quadriceps muscle in patient with osteoarthritis of the knee. Thirty patients with knee os- teoarthritis who diagnosed clinically and radiologically were divided into three groups each consists of ten sub- jects. The first group took part in isometric, the second group isometric Progressive resistance, and the third group Progressive resistance for 4 weeks. At the beginning and end of the treatment, computerized tomographic sections were taken from the thigh. One of the sections was taken from 10 cm above subpatellar margin for vas­ tus lateralis (VL) and vastus medialis (VM), the other from midpoint of interline betvveen umbilicus and subpatellar end for vastus intermedius (VI) and rectus femoris (RF). Cross-sectional areas of the thigh, quadriceps totally, and the heads of the quadriceps were measured. İn addition, the circumference of the thigh was measured ma- nually. İsometric exercise (IE) produced hypertrophy only in RF (p<0.01), Progressive resistance exercise (PRE) in VM, VL, and VI (pcO.OI), and isometric Progressive resistance exercise (İPRE) in VM and VI (p<0.01), and VL (p<0.001). İn cotralateral thigh, PRE produced more hypertrophy than IPRE. The resistance exercises were more effective to produce hypertrophy in quadriceps muscle totally. Only in PRE group, the increase in cross-sectional areas and circumferences of the thigh were statistically significant. We conclude that the CT techniques are ne- cessary to asses the degree of muscle hypertrophy, and CT measurements provide more useful information than manual measurements of the circumference of the thigh.

With the rapid technological advances, ultrasonography (US) has become an important breast imaging procedure in the last decade. In addition to the complementary role to mammography and magnetic resonance imaging, today it has an important place in interventional situations such as guiding needle aspiration, core needle biopsy and presurgery needle localization. American College of Radiology has developed “The Breast Imaging Reporting and Data System” (BIRADS) lexicon to standardize the terminology in the US reports. This lexicon includes the descriptors from several feature categories, the assessment of findings and the recommendation of the action to be taken. Six morphologic features were described for solid breast masses: shape, orientation, margin, lesion boundary, internal echo pattern and posterior acoustic features. Despite the known overlap between benign and malignant features, typical signs of benignity were oval shape, gently lobulation, homogenous hyperechogenity, parallel orientation; typical signs of malignity were irregular shape, antiparallel orientation, noncircumscribed margin, echogenic halo, decreased sound transmission. The purpose of this article was to discuss reliability of these BIRADS US lexicon descriptors in the differentiation of benign from malignant solid masses of the breast.

Lung cancer is the most common among cause of cancer deaths in worldwide. NSCLC represent between 80% to 85% of all the diagnosed lung cancers cases. Systemic chemotherapy for patients with NSCLC has limited impact on overall survival. Patients eligible for chemotherapy should be selected carefully. The aim of this study analyzed prognostic factors for survival in NSCLC patients. We retrospectively reviewed 741 NSCLC patients between 2000 and 2012. Ten potential prognostic variables were chosen for analysis in this study. Univariate and multivariate analyses were conducted to identify prognostic factors associated with survival. Univariate and multivariate statistical methods were used to determine prognostic factors. Among the 10 variables of univariate analysis, three variables were identified to have prognostic significance: performans status (PS), diabetes mellitus (DM) and stage. Multivariate analysis included the 3 prognostic significance factors in univariate analysis. Multivariate analysis by Cox proportional hazard model showed that PS was considered independent prognostic factors for survival, as were DM and stage. In conclusion, PS, DM and stage were identified as important prognostic factors in NSCLC patients. These findings may also facilitate pretreatment prediction of survival and can be used for selecting patients for treatment.

Objective: To evaluate the chest roentgenogram and CT findings of 63 patients with pulmonary hydatid disease. Methods: Sixty-three (27 female and 36 male, aged between 3 and 76 years) patients with surgically proven pulmonary hydatid cysts were included to the study. Chest roentgenogram and thorax CT were obtained from all the patients. Radiological features (number, localization, diameter, internal architecture) were determined. Results: On CT examination, 107 cysts were determined but on 78 of 107 cysts were detected on chest roentgenogram. Single cysts were seen in 36 patients, while multiple cysts were seen in 27 on CT. Eighteen cysts were larger than 10 cm in diameter. CT scan showed crescent sign (3 patients), water lily sign (9 patients), air-fluid level (11 patients), dry cyst sign (8 patients), and homogenous shadow (46 patients). In addition, atelectasis (n 17), pleural effusion (n 29), and pericystic infiltration (n 38) were also seen on CT. On the other hand, 58 cysts were homogenous and 20 cysts were rüptüred on chest roentgenogram. Conclusion: Although chest roentgenogram is helpful for diagnosis of pulmonary hydatid disease, CT examination must be done to evaluation nature and localization of cysts.

Eosinophilic pulmonary diseases (EPD) are defined as a group of diseases characterized by the in crease of eosinophils in the air way and/or lung tissue. While a part of the sedis orders mainly affects the pulmonary, others show systemic in volvement. Chronical eosinophilic pneumonia (CEP) should be kept in mind in the existence of subacute or chronic respiratory and general symptoms, alveoler and/or bloode osinophilia and peripheral pulmonary in filtrates on chest radiography. A 53-year-old male patient was admitted to our clinic with on going complaints of cough, occasional fever and malaise for six months. When two-sided apical, subapical and the infiltration around hiluses were detected on chest x-ray, the case was hospitalized with the prediagnosis of pulmonary tuberculosis. Eosinophilia in hemogram, bilateral infiltrative lesions with irregular contours and bilateral cystic bronc hiectasis foci were detected on high resolution computed tomography (HRCT). Bronchoscopy revealed purulent secretions and thick mucous in hibations. No specific etiologic cause was defined in the etiology, and the case wase valuated as CEP. Due to unusual bronchoscopic and radiological findings, the case was presented and discussed.

İn this article, CT features of 21 cases with be-nign and 21 cases with malignant pleural diseases were described. Features that are helpful in distinc-tion malignant from bening pleural disease were, mediastinal pleural invasion, nodular and more than 1 cm tickening in pleura. The specıficities of these findings were 77%, 93%, 100% and sen,.sitivities 50%, 50%, 33%, respectively. High contrast en-hancement that does not show significant differenpe was detected in all malignant lesions and benign in-fectious pleural diseases. Consequently, it has been emphasized that CT is a useful radiologic method in detertnining of pleural lesions and, their extentions and, in the differential diagnosis of benign and malignant conditions.

Objectives:

Customer satisfaction surveys are a routine device used to assess performance. Surveys are used in hospitals to check physician and patient satisfaction. Hamad Medical corporation’s (HMC) histopathology laboratory is College of American pathologists (CAP) accredited with highly trained pathologists and technical staff that routinely undertake various educational courses and are involved in research related activities. The lab has state of the art staining and immunohistochemistry service as well. However, it was felt that not all clinicians are very comfortable approaching pathologists and some many times experience problems either contacting lab staff or updating histopathology orders. Hence to narrow down the problems encountered by the clinicians and improve the specimen flow through the lab along with the communication between clinician and pathologist, that we deem vital, we designed this pilot survey.

Methods:

The survey questionnaire was made online with 15 questions in total and the link was electronically mailed to all Consultant and Specialist physicians in Hamad medical corporation (HMC). Around 3500 emails were sent out but only 105 surveys were filled in two months’ time. The survey included questions pertaining to multiple facets of quality of histopathology services and information regarding the participant.

Results:

The overall satisfaction was highest for Multidisciplinary presentations (96%) and lowest (77%) for timeliness of reporting. The satisfaction was above 90% for clarity and format, Diagnostic accuracy and pathologists’ responsiveness to problems. Thirty six percent of the people rated MDT presentations as excellent while 46% of the people thought overall quality of professional interaction was good. The areas of improvement, as per this survey, was timeliness of reporting and notifications of significant abnormal results (overall satisfaction 79%). Majority of the people who took the survey (36%) were from internal medicine and half were members of multidisciplinary meetings (49%). Seventy-one of percent of the participants were from Hamad General hospital (HGH), while rest were from the other hospitals under HMC.

Conclusion:

The response rate for the survey was low, hence another survey with a wider reach, preferably by paper, is required to get more representative data. In general, the clinicians at HGH are satisfied with the services provided by the histopathology laboratory. Areas of improvement include Turnaround time (TAT), avoidance of descriptive reports and better communication with the ordering clinician.

Keywords:

Quality control, quality improvement, survey, histopathology, Laboratory

Hepatic hydatid cyst perforation into the biliary tree may involve the small intrahepatic bile dutcs, common hepatic duct or common bile dutc. On sonogram, dilatation of intra and extrahepatic biliary tract was demonstrawd in two cases with jaıındice that is a compiication of hydatid cyst. Ultra-sonography (US) and percutaneus transhepatic cho-langiography (PTC) showed that hydatid cyst foud at porta hepatis causes to compression to the extra-hepatic biliary tract in one case. Ultrasonography (US) and computed tomography (CT) disclosed that cystic mass localized in medial segment of the left liver lobe and porta hepatis caus-es to the same finding as well as in one case. Preop-erative radiologicfindings vere confirmed surgically in 4 cases.

68-year –old male patient was being accepted from a special clinic to us with a presumed diagnosis of right upper lobe tumor .The patient has a respiratory distress,weight loss,palpitations. Mediastinal enlargement was seen in the upper right chest film. Thoracic computed tomography was noticed a mass nearly 5x7x3 size which connection with cervical area and deviated from outside the trachea,compressing right lobe anterobasal segment . Thyroid hormone tests were performed and showed hyperthyroidism .The patient took anthyroid agent only 1 month and then taken operation elective conditions .We performed operation with a general surgery cervical insision after parsial median sternotomy. Total troidectomy was performed, after the realised cervical troid upper side of neck and then tracheal , borned from intrathoracic component preserved vascular and paratroid structure.The specimen nearly 5x7x3 cm which called noduler collaidal guatr from the pathology .The patient was discharged without any problem by giving thyroid hormone.

Aim: It was aimed to investigate  the relationship of disease clinical stage between the maximum diameter of primer lesion (LEGÇ), maximum of standardized uptake value (SUVmax), mean of standardized uptake value (SUVmean), tumor volüme (TV) and total lesion glycolysis (TLG) values derived from positron emission tomography/computed tomography (PET/CT) images.

Method: The information of 130 lung cancer patients diagnosed histopathologically between 01.01.2012 and 31.12.2014 in Necmettin Erbakan University Nuclear Medicine Department of Meram Medical Faculty scanned for PET-CT for lung cancer diagnosis and staging,  were included in this study. The values of the maximum diameter of primer lesion, SUVmax, SUVmean, TLG and MTV derived from PET-CT scanning and their histopathological subtypes, other clinical and radyological information of patients were noted. The non-small cell lung cancer patients were graded according to tumor diameter, nodal and involvement metastasis (TNM) staging system using clinical information, PET-CT and other radyological test results if any. On the other hand, the small cell carcinoma diagnosed were categorised as limited or extensive stage.

Findings: In this study, the mean age of 118 men and 12 women,  totally 130 patients, was evaluated  63,46 ±9,96 ( range 40-87 age ). The patients were classified as 106 non-small cell lung Cancer (NSCLC) (81.5%) ve 24 small cell lung cancer (SCLC) (18.5%).  The  histopathologically diagnosed NSCLC patients were consists of  62 squamous cell cancers, 39 adeno cancers, and 5  other types (3 carcinoid tumors, 1 large cell cancer and 1 sarcomatoid tumor). 

Results: In our study, it was observed that there was no significant relationship between the maximum diameter of the lesion, SUVmax, SUVmean, MTV and TLG values among SCLC and NSCLC patients. Additionally, it was also found that there was no correlation between these parameters and the SCLC stage.  The maximum diameter of the lesion, SUVmax, SUVmean, MTV and TLG parameters were related with stage.

Conclusion: Higher SUVmax, SUVmean, TV, and TLG values of the primary tumor were determined to predict the more advanced clinical stage in NSCLC. This relationship between metabolic parameters and the clinical stage suggest that PET / CT may be valuable in terms of providing prognostic information in NSCLC.

A series of 460 cases of hydatid cyst of the lung has been studied. Preoperative diagnosis has been made radiologically in 90<,-, of the cases. In 395 cases, cystotomy has been performed with subsequent capitonnage, while, wedge resection has been performed in 27 cases, with lobectomy in 15 cases and segment resection in 23 cases. Following a careful he-rnorrhage control, two drains have been placed in the thorax and the thoracic cavity has been closed. Recurrence occured in two cases (0.43 %), three cases resulted in exitus (0.65 %); no recurrence has been encountered in other cases as revealed by post-operative follow-up cheks within a period of theree years after operation.

Occult breast cancer is a type of cancer with no symptoms found upon physical examination on the breasts or which can not be radiologically shown. It generally manifests itself with axillary metastasis with no known primary tumor. Breast cancer in males is rarely seen. Occult breast cancer, on the other hand, is even rarer and only case reports were found in literature. A 46-year-old male patient had excisional biopsy at another medical facility because of a palpable mass on his right armpit. The pathological diagnosis had stated that the patient had adenocarcinoma metastasis with symptoms implying an infiltrative ductal carcinoma metastasis of the breast. Abdominal and thoracic tomography, upper and lower gastrointestinal system endoscopy procedures were performed on the patient in order to determine the primary focus. Breast ultrasonography, breast magnetic resonance imaging and positron emission tomography were also performed. Upon not being able to detect any positive findings, the patient was considered to have occult breast carcinoma and modified radical mastectomy was performed. In conclusion, in the presence of metastatic lymph node with no known primary tumor in the axillary, the possibility of occult breast cancer should be taken into consideration even if the patient is male.

Skeletal muscle metastasis from non-small-cell lung cancer (NSCLC) is a rare event and the optimal treatment strategy is still unknown. Herein we report a case with biceps metastasis from NSCLC. A 50-year-old man with a distant biceps metastasis due to NSCLC is presented. One month after chemo-radiotherapy and adjuvant chemotherapy the patient was readmitted with a painful mass located on the right biceps brachii muscle. A biopsy of the painful mass disclosed the muscle metastasis pulmonary adenocarcinoma. The patient was treated with palliative radiotherapy and systemic chemotherapy was planned. At the end of the palliative radiotherapy his pain was disappeared. Two months later (18 months after the diagnosis) the patient died of respiratory failure. Palliative radiotherapy may be a good treatment option for patient with muscle metastasis from NSCLC.

The results in 58 congenitally dislocated hips in 43 children who were between one and a half four years okl have been reviewed. There were 35 girls and 8 boys. Open reduciion (OR) was perfortned in one hip, Salter's innornintne osteolotny (S10) was perforrned in three hips, OR and SIO were perfortned in 43 hips, OR, SfO derotation varus and fernoral shortenin were performed 11 patients. Ali of the patients have been followed at least one yer (average nventy-two months). Using Severin classification of radiographic evalualion, 48 hips (83 per cent) vere telated as excellent, 6 hips (10 per cent) as good, one hip (2 per cent) as fair and three hips (5 per cent) as failure. Clinical avaluation was made using Mc Kay's criteria and 47 hips (81 per cera) were related as excellent. Seven hips (12 per sent) as good, three hips (5 per cent) as fair, one hip (2 per cent) as failure. Avascular necrosis developed in one mortn.al side, there was one redislocation

Since it has first observed in April 2009, the swine origin Influenza A virus infection, spreaded worldwide and cases of dead increased. Untill now the number papers in literature about the radiological signs caused by the desease is extremely low. In this review we aimed to overview the H1N1 and collect the data in literature about radiological signs of the desease.

From June 1983 to September 1989, 51 patients with displaced fractures of the femoral neck were treated by Thornpson arihroplasty. The avarege age at operation was 64.8 years. There were 18 men (40 per sent) and 33 women (60 per cent) The postero-lateral approach to the hip was used at al! operations. There was one dead, one dislocation and one fibular nerve injury as early complication. The resulis after 34 hips studied at follow-up. Among 34 patients, 24 of !hem were controlled radiologically. One asetabular erosion, one asetabular protrusion and one loosening of prothesis were found as a lale complication.

In this study two cases were presented, whom had suspicion of intraabdominal gunshot wound and were followed conservatively despite the misleading radiological results, and we aimed to emphasize the importance of anamnesis and physical examination. Abdominal tomography results of two male patients aged 20 and 34, who were admitted to the emergency department with gunshot wounds in early phase, revealed that the patients had gunshot pellets in their gastrointestinal tracts. Upon observing that the patients had no peritoneal irritation signs, incongruous with the radiological results, their anamnesis were questioned in a more detailed manner. Ultimately, it was learnt that both patients had been hunting and had eaten game meat a short while before the incident. We thought that the gunshot pellets seen in their intestines were related to the game meat they had eaten and the patients were discharged without any problems following medical follow-up. These cases, which were seen to have gunshot pellets in the gastrointestinal tract as revealed by abdominal tomography results and were followed-up medically without any problems, show that, well questioned anamnesis alongside with careful physical examination and monitorization principles prove to be significant in preventing unnecessary laparotomy procedures in patients receiving medical follow-up after intra-abdominal gunshot injuries.

Testicular adrenal rest tumor (TART) is a benign testicular tumor that was seen in male patients with a history of congenital adrenal hyperplasia. It is often localized as bilateral. It can cause infertility. Differential diagnosis includes, Leydig and Sertoli cell tumors, seminomas and other germ cell tumors. Ultrasonography and magnetic resonance imaging are radiological imaging methods used in the diagnosis of TART. In this article, clinical features, radiological findings and differential diagnosis of TART is presented.

Hepatocellular carcinoma (HCC) generally develops as a consequence of underlying liver disease, most commonly viral hepatitis. The development of HCC follows an orderly progression from cirrhosis to dysplastic nodules to early cancer development, which can be reliably cured if discovered before the development of vascular invasion (typically occurring at a tumor diameter of approximately 2 cm). If resection is not possible because of poor liver function, vascular invasion and metastasis. To prevent tumor progression while waiting, nonsurgical treatments including percutaneous radiofrequency ablation, and transarterial chemoembolization are employed.

Purpose: In this study, contrubitions of computed tomography (CT) and magnetic resonance imaging (MRI) were researched in the diagnosis of benign paranasal sinüs (PNS) lesions. Materials and methods: According to the clinical findings, between January 2001 – February 2004, 30 cases have been studied who were thought to have benign lesions belonging to nasal cavity, PNS or neighboring structures. CT and MRI studies are made to the all case. Inner structure characteristics, locations and radiological apperarances coursing pathological diagnosis of lesions in CT and MRI have been assessed. Results: The histopathological diagnoses of lesions were mucocele (8), odontogenic cysts (4), fibrous dysplasia (3), inverted papilloma (2), hemangioma (2), menengioma (2), schwannoma, osteoma, osteochondroma, paget disease, ameloblastom, giant cell tumor, central giant cell granuloma. Whwn assessed according to pathological results, sensitivity of CT and MRI were found to be 86.6% and 83.3% respectively. In 3 cases showing radiological malign feature (1 giant cell tumor, 2 inverted papillomas) the correct diagnosis was made histopathologically. Canclusion: CT is an effective method to show bone expansion and destructions, tumors originated from bone and intratumoral calcifications. MRI offers better the inner structures of cystic lesions, intratumoral hemorhages and differentiation of tumor from inflammation. Therefore, CT and MRI should be used jointly in the evaluation of the PNS lesions.

A retrospective study was performed to investigate the mortality among the patients hospitalized in department of chest diseases Dicle University medical school clinic. The patients passed out in this clinic in the period from January 2004 to May 2009 were evaluated. It was determined that totally 4417 patients were hospitalized (8892 hospitalization) in this period and 384 (8.6%) of them resulted in death. The mean age of the patients was 66.8±15.3 and 92 (33%) were women and 187 (67%) were men. The principal causes of their mortality were pneumonia in 92 patients (33.1%), chronic obstructive pulmonary disease (COPD) in 87 (31.2%) patients, pulmonary cancer in 52 (18.6%) patients, tuberculosis (TB) in 18 (6.5%) patients, pulmonary thromboembolism (PE) in 18 (6.5%) patients and another diseases in 12 (4,2%). When the accompanying diseases were evaluated, no additional diseases were determined in 130 (46.6%) patients; 41 patients (14.7%) had cardiac disorders, 22 patients (7.9%) had cancers outside the lungs, 18 patients (6.5%) had cor pulmonale, 17 patients (6.1%) had neurologic disorders, 15 patients (5.4%) had renal diseases, 10 patients (3.6%) had diabetes mellitus (DM), 9 patients (3.1%) had TB and 17 patients (6.1) had unclassified disorders. In conclusion, we think that the knowledge about their mortality rates and the causes of mortality is useful for every clinic for their approach to the patients and considering the accompanying diseases is helpful to decrease the mortality

Demonstrating the imaging findings of asymptomatic giant thymolipoma mimicking cardiomegaly is aimed. A paracardiac mass was detected with 32-year-old male patient afterwards demonstration of cardiomegaly on a posterior-anterior (PA) chest x-ray examination taken for a routine control. Computed tomography (CT) showed a mass, localized in the anterior mediastinum, with smooth margins, showing no significant invasion of adjacent structures, and including fat density with fibrous component. The diagnosis was reported as thymolipoma histopathologically after transthoracic biopsy. On a preoperative magnetic resonance (MR) examination, taken for detailing the limits of the lesion, the mass showed hyperintensity on both T1 and T2 weighted images, and suppression on fat saturated T2 weighted images. No invasion of adjacent structures was detected. A thymolipoma may reach a large size without symptoms due to its great pliability. It can mimic cardiomegaly on x-ray images. Adipose tissue on CT is helpful in the diagnosis. MRI gives valuable information in determining the exact boundaries of the lesion.

We were reported a case of Pott's disease with bilateral pleural effusion in a 67-year- old male patient. The primary çare physician commenced anti-microbial therapy by considering the non-specific pleuritis. hovvever, four months after his first complatins, Progressive back pain and weakness of lower limbs was occured. By further examination, we diagnosed an active tuberculous spondylitis of the 7th and 8th thoracic vertebrae. Operative intervention was undertaken because of neurological findings. VVe also started anti-tuberculous chemotherapy. A proper clinical and redaiological response to chemoterapy and surgery was observed at the last follow-up.

Cystic lesions of the parathyroid gland are uncommon. Although majority of patients with cystic parathyroid adenoma present with mild hypercalcemia, some may present with parathyroid crisis which can be a life-threatening clinical condition. In this article, we present a patient who applied to emergency service with symptoms of acute parathyroid crisis, was diagnosed parathyroid adenoma with cystic degeneration and treated. A 46 years old male patient was applied to emergency service with confusion. In blood analyses, calcium level was 16,6 mg/dl and akut kidney failure was determined. In radiological imagination, parathyroid adenoma with cystic degeneration was determined and patient was treated minimal invasive parathyroidectomy.After the operation, parathormon and calcium levels were returned the normal levels. Parathyroid cysts are uncommon, and they are classified as functional or nonfunctional so far as hypercalcemia. Functional cystic parathyroid adenomas are very rare. These patients can approach with symptoms of hyperparathyroidism or parathyroid crisis. Parathyroid adenomas with cystic degeneration and functional parathyroid cysts should be considered about causes of primary hyperparathyroidism and acute parathyroid crisis.

Despite advanced diagnostic methods, diagnosis of small intestinal tumors is hard and they are generally detected at an advanced stage. These cancers may form emergency cases that need to be addressed surgically like bleeding, obstruction, and perforation or insidious abdominal pain and weight loss. We present our clinical experiences and the short term results of 29 patients with primary small intestinal tumors who had undergone emergency surgical procedures. The data of these 29 patients treated at our clinic between 2005 and 2011 were retrospectively evaluated. Study parameters included the patients’ demographic, clinical, radiological, and pathological characteristics. All the cases underwent emergency surgery. 16 of the patients were male, while 13 were female, and their mean age was 62 (35-80). Intestinal obstruction was detected in 19 of the cases, while perforation in 6, and mesenteric ischemia in 4. Tumors were located in the ileum in 14 patients, in the jejunum in 10, and in the duodenum in 5. The most frequent pathological diagnoses were GIST with 8 cases and adenocarcinoma with 8 cases. The most frequently performed surgical procedures were small intestinal resection and anastomosis. Four patients developed surgical site infection and three had anastomotic leaks in the post-op period. Mortality was seen in five patients in the early post-op period. Tumors of the small intestine are very rare. The findings are non-specific and advanced diagnostic methods are needed during the diagnostic process. They generally cause clinical conditions that necessitate emergency surgery. The timing of the treatment is a significant factor determining survival.

The scolocidal solutions which are used in surgi-cal treatment of hydatid cysts such as forrrzaldehite (%2), hypertonic sodyum chloride (%20), povidone iodine (%1) and silver nitrate (%05) were performed to the biliary tract of 50 dogs each group including 10 dogs and the lesions were evaluated histopatho-logically and radiologically. As to the histopathologir findings of liver le-sions and cholangitis and radiological findings of sclerosing cholangitis, there was no significant dif-ference between scolocidal solutions groups (p>0.05) but the dillerence between scolocidal solutions and control group was significant (p<0.01). We concluded that ali scolocidal agents has toxic ellects to the liver and biliary tract.

Organizing pneumonia (OP) is characterized histopathology cally by tufts of fibroblasts and immature collagen filling of respiratory bronchioles and alveoli. Symptoms are usually nonspecific and include cough and dyspnea. Radiograph cally, OP frequently manifests as patchy bilateral infiltrates that can be relapsing and migratory. Cryptogenic organizing pneumonia (COP) may be defined as having non-specific symptoms which can ultimately be described as a subset of the OP that cannot be attributed to any reason. Forty-nine-year-old female patient admitted with the complaints of 2 year exertional dyspnea and 20 day dry cough. The patient was diagnosed of pneumonia and prescribed with antibiotics; however, no improvement was observed in her complaints and lung graphics. The physical examination of the patient, routine laboratory analyses, collagen tissue markers and bronchoscopy were normal. In chest X-Ray, there were 4 nodular density approximately 1 cm in size, in the upper zone. In thorax CT, there were irregular contours multiple nodules, and the biggest one was approximately 35x7 mm in the upper lobes and in the superior of the left lower lobe of lungs. Acid fast bacteria was negative at bronchoalveolar lavage. The patient was diagnosed COP as clinically and radiologically. Then, systemic cortico steroid therapy was started. A complete clinical recovery was observed in the sixth month of the treatment and at the control thorax CT displayed that nodular lesions were disappeared completely. In the cases that were not respond to antibiotic therapy and patients having radiologically mobile and temporary infiltrations may be taken into consideration in the differential diagnosis.

Lymphocytic adenohypophysitis is a rare disease associated with late pregnancy and early postpartum. Autoimmune mechanism is blamed as cause. İt is frequent in females, and may be misdiagnosed as pituitary adenoma. 29 years-old -female with 2 children presented with headache follovving cryptic tonsillitis. Recently she had problems vvith her Vision. Clinical and radiological work up including magnetic rezonance imaging revealed a mass in the sellar and suprasellar region. She undervvent surgical decompression follovving functional hormona! studies. Histopathologic evaluation of the specimen was reported as lymphocytic hypophysitis. Differential diagnosis of lymphocytic hypophysitis from that of adenoma is important in planning surgery. Relation to the pregnancy, a severe hypopituitarism, edematous anterior and posterior pituitary lobe are in favour of lymphocytic hypophysitis. But certain diagnosis is made via histopathologic diagnosis. İt is thought to be autoimmune in origin especially in pregnant or recently delivered vvomen. But in nonpregnant persons it may start or be aggravated after an infection as it is in our patient.

Ovarian cysts rarely reach enormous dimensions. The giant ones could be get mixed with mesenteric cysts, lymphangioma, local ascites or peritoneal inclusion cysts. We presented a case in which the preoperative evaluations revealed a lymphangioma eventhough the final hystopathological diagnosis was an endometriotic cyst (a type of benign ovarian cyst). Cystic lesions related to gonadal structures should be kept in mind when you’re dealing with giant cystic structures which are encountered rarely as a result of physical and laboratory examination at acute abdomen. The fertility situation and wish of patient should be considered when the treatment algoritm with an interdisciplinary approach are drawn .

Tuberculosis is a disease that can mostly be diagnosed, and may involve all organs; however also may frequently mimic other disease of the involved organs and sometimes causes diagnostic problems. In our case we presented a patient that we thought to be lung cancer, however diagnosed as tuberculosis after the evaluations. We think that in countries with high tuberculosis incidence and prevalence such as our country, tuberculosis should be kept in mind in differential diagnosis in every clinical and radiological feature.

Novvadays, patients suffering from blunt abdominal trauma are examined by abdominal ultrasonography, routinly. Subcapsular bleeding of the spleen in these patients can be overlooked if there isn't free fluid in the abdominal cavity, ultrasonographic examination carried out in suboptimal contitions and after the trauma attention was in- tensified on the Central nervous system injury. İn 3 cases who have been examined by abdominal ult­ rasonography just after the trauma, any pathological finding was not been determined related with their spleen also examined by upper abdominal computed tomography because of their some complaints after the trauma (1 wk-1 yr) and splenic subcapsular hematomas were establised in these patients. İn patients with delayed de- velopment of splenic subcapsular hematoma following abdominal trauma can cause late rupture of the spleen, so we think that the patients suffering from blunt abdominal trauma must be examined by the control radiological methods after the trauma.

Tumors arising from urinary bladder diverticula is a rare lesion. 76-year-old man who was presented with hematüria examined with radiologic methods. Tumoral lesions reaching into diverticula and bladder cavity were detected by ultrasonography, computed tomography and magnetic resonance imaging. Particularly, computed tomography and magnetic resonance imaging are confident to determine diverticular neoplasms.

Intracerebral calsifications revealed accumulation of calcium and various minerals in basal ganglia, cerebellum and centrum semiovale. They are usually detected as an incidental radiological finding. They are mostly seen as hereditary, idiopatic or in the disorders of calcium and parathormone metabolism. They may be presented with very different and examination findings. The etiology and management of intracerebral calcifications in different cases were evaluated in the present study.

Erector spinae plane block (ESPB), one of the popular regional anesthesia techniques in recent years, has first been used for upper thoracic neuropathic pain. Later, it has been used in many different indications for both acute and chronic pain treatment at different lower thoracic and lumbar levels. Our limited experience demonstrates that bilevel bilateral sacral ESPB is an easy and effective method in the treatment of perianal chronic intermittent pain. However, many issues, such as the application site, the volume of local anesthetics and the sensory blockade, still remain being investigated. Due to the lack of clinical research, our review is currently unable to support the evidence and routine use of sacral ESPB. We consider that anatomical radiological and  clinical studies are needed to elucidate the efficacy and mechanism of action of sacral ESPB

Penetrating trauma of the spine can be rarely seen. A 28 year old male patient admitted to our emergency clinic with cutter injury. A two-centimeter skin incision was determined at the patient’s lumbar region. Neurological examination was with in the normal range. A metallic cutter tip was seen at the lumbar tomography and lumbar plain radiograph at the level of L1 corpus and L1-2 disc space. The patient operated at emergency settings. Under general anesthesia the patient was taken into left side lateral decubitus position. Previous skin incision enlarged to the anterolateral direction. Surgical dissection was advanced to the anterolateral direction from posterior aspect. Left L1 and L2 processus transversus was reached. Then the cutter tip was seen at the L1 corpus and L1-2 disc space just lateral from the nevre root. The cutter tip was withdrawn slowly without laminectomy. The main goal of the surgical treatment for neurologically intact patients with penetrating injuries is to remove the foreign object with minimal damage to the patient in the light of radiological studies. The foreign object should be removed from the spine because late neurological deficits can be seen in these patients.

Hepatic artery aneurysms are a rare but a clinically significant phenomenon. Because most patients are asymptomatic, the diagnosis is usually made as an incidental finding during radiological examinations. Rupture is the main complication that occurs in 60%- 80% of the cases. In this case we aim to present ultrasonography findings of a hepatic artery aneurysm.

391 cases were examined by US (Ultrasonography) at the department of Radiology of Medical Faculty of Selçuk University, between May 25, 1985 and December 30, 1985. Hydatid csyt to have localized in the liver in twenty three cases, in the liver and abdomen in one case, in the liver and left kidney in one case, liver ci.rrhose characteriezd by splenomegaly, acsites and the increase of connective tissue in twenty cases and solid (tumour) lesion in eight cases were determined in the liver. US findings were compared wi.th operation findigns. The diagnosed csyt. US has become a guide for clinical diagnostic studies and to determine operation indication.

Neurogenic tumors ocur at all part of the body but most common site is the posterior mediastinum in thorax. In this study, the patients with neurogenic tumor were evaluated clinical and radiological signs in our hospital between January 1999 and December 2003. Of thirty patients were (11 male and 19 female) their range aged from 20 to 70 mean 41.7±11.8. Histological types were 17 (%57) neurofibromas. 7(23%) schwannomas, 4(13%) ganglioneurinomas, 2(7%) malign schwannomas. Twenty-four (80%) of neurogenic tumors were in posterior mediastinum and the others were in different areas in thorax.

The malignant tumors of bone are more common than benign tumors. The bone tumors is the smallest group in all tumors. For this reason, knowledge and experience required for the diagnostic approach. Osteochondroma is the most common benign bone tumor. The lesion can be single, multiple forms are rarely seen. This condition is known as osteochondromatosis or diaphyseal aklazi. Diaphyseal aklazi (DA) is a rare hereditary disorder of cartilage differentiation and inherited as an autosomal dominant. Chondrosarcoma that especially for the development of new lesions occurring after termination of puberty should be evaluated. In this case report presented the two brothers who are diagnosed with DA come in with the complaint of short stature. One of the patients was 15-year-old girl and the other was a 14-year-old male. A common complaint of both short stature and non-painful swelling of bones. The patients were diagnosed with diyafizyal aklazi according to typical family history, physical examination findings, and radiographic findings.

Femoral shaft fractures are mostly seen in children and all cases of this condition require hospital admission. In school-age children (5 to 12 years), femoral fractures may be treated with elastic nails or spica cast. The current study aims to compare the outcomes of elastic nail to the immediate spica cast method for school-age children with femoral fracture. We evaluated the patients who had undergone immediate hip spica cast (IHSC as Group 1; n=31) or flexible intramedullary titanium nail (FITN as Group 2; n=31) for femoral fracture. Age, sex, cause of fracture, localization of the fracture, cost of treatment, times of hospitalization, radiologic and clinical assessment of femoral union, condition of the wound and soft tissue, times of union and walking were recorded. The mean followup was 58 (26-62) months. All fractures were healed. The time for weight-bearing and walking were shorter (39/52) in Group 2 than it was in Group 1 (52/63). In terms of cost, IHSC (114.99$) was cheaper than FITN (380.82$). Although IHSC is still a a widely accepted method of treatment, with the use of modern surgical techniques and implants, satisfactory outcomes of fracture healing can make FITN a better surgical option among all other treatments.

Almost all of the thyroid diseases, which are rather common in our society, are curable, therefore it brings the necessity of early, east, not harmful and economic methods for the diagnosis. The diagnosis and treatment of thyroid diseases have gained a new perspective with use of high-resolution realtime ultrasonography in superficial organs and tissue. In this study, scintigraphic and ultrasonographic findings of 57 cases, in which scintigraphy and ultrasonography was used and histopathological results which were proven with surgery were compared with surgery findings. Although 2 false negative cases were been in ultrasonography, 18 false negative cases were observed in scintigraphy. It was found that the sensitivity of ultrasonography was 96%, while it was found 68% in scintigraphy. In both methods no false positive cases were observed The studies which have been done formerly and our' results give the impression that in diagnosis of thyroid diseases, ultrasonography which is not harmful, cheap, noninvasive, nonionized, easily applicable and highly sensitive, is a radiologic-rnethod of diagnosis which is necessary to be used firstly and routinely.

In this report 2365 cases that were diagnosed at the Department of Pathology of Medical School of Selçuk University between 1988-1992 are examined by age, sex, organ distribution and histopathological types. The ratio of lung carcinoma in men and skin carcinoma in women were the highest.

Fever of unknown origin is defined as the following a temperature greater than 38.3°C (101°F) on several occasions, more than 3 weeks’ duration of illness, and failure to reach a diagnosis despite 1 week of inpatient investigation. Evaluation of patients with FUO is complicated because there are multiple etiologic factors and new ones are adding in literature every day. A 24years old man was performed contrast enhanced CT for FUO and abdominal pain, show trombus in portal vein and superior mezenteric vein. On examination, metiltetrahidrofolate reductase gene polimorphism is detected in the etiology of trombus. The patient’s fever and abdominal pain improved after 5 day treatment of Clexane 0,8 ml. A further doppler sonography show partial regression in trombus by which time the patient’s symptoms resolved. We aimed to present clinical and radiologic imaging findings in a case of portal and superior mesenteric vein trombus associated with MTFHR-C677T gene polimorphism which is a rare cause of FUO and we didn’t meet in the literature.

It is sometimes very difficult to distinguish between cardiovascular diseases and respiratory diseases, taking into account only physical examination findings. Symptoms of respiratory distress in premature babies may be due to congenital heart disease, congestive heart failure, hyaline membrane disease, aspiration syndrome, pneumonia, pneumothorax, lobar emphysema, pulmonary agenesis or hypoplasia and a metabolic disorder. Traditional radiology has often helped us clinically. From the wider ductus arteriosus to the fetus, the pressure of the pulmonary arterial system to the aorta is equal. Therefore, pulmonary hypertension is a feature of normal fetal circulation.

We analyzed the different parameters of the 95 cases with pulmonary carcinoma hospitalized in Chest De-partment of Süleyman Demirel University Medical Faculty rn June1995- July1998 years and we made a general evaluatiorı of the cases. Squamous cell carcinoma was present in 33.7%, adenocarcinoma in 25.3%, small carcinoma in 13.7%, large cell carcinoma in 2.1% and metastatic carcinoma in 8.4%. 16.9% of patients had na histapathologic diagnoses. Of these patients, 9.46% was in stage I, 13.51% was in stage Il, 18.92% was in stage II1A, 2702% was in stage I/IB and 31.08% was in stage IV. 81.05% of patients were smokers, when amount was considered, it was 50.70 packlyear for small cell carcinoma, 44.75 packlyear for metastatic lung cancer, 43.75 packlyear for squamous celf carcinoma and 38.00 packlyear for adenocarcinoma. When clinical findings were considered, cough (68.4%) and weight loss (63.4%) were seen most in patients. While central localization was seen 76.9% in small cell carcinoma, 62.5% in squamous cell carcirıoma; peripheric localization (71.0%) was seen mostly in adenocarcinoma. Parancimal infiltration was detected most often in squamous cell carcinorrıa (72%), soliter nodule in metastatic lung carcinoma (63%), neoplastic cavity in large cell carcinoma (50%), pleural effusion iri adenocarcinoma (46%) and mediastinal enlargement in small cell carcinoma (54%). Histopathologic diagnoses were detected by means of bronchoscopic biopsy and lavage (51.89%), sputum cytology (17.73%), pleural punc-Non and biopsy (17.73%) and transthoracal fine needle biopsy (12.65%).

Hydatid cyst was diagnosed in thirty seven cases exatnined by sonography at the Department of Radiology, Medical School of Republic University, Sivas between March, 1986 and November, 1987. Sonographic findins were compared with surgical findings. Ultrasonographic criteria of abdominal cyst hydatides were represented.

Mesenteric cysts are rare intra-abdominal tumors. The goal of this study is to analyze the clinical symptoms and the pathological features of mesenteric cysts and the surgical approaches. The data of 17 patients who had surgeries because of mesenteric cysts between 2005 and 2012 at our clinic were evaluated retrospectively. Eleven (65%) of our patients were female, while six (35%) were male and the median age was 32 (17-70). The most frequently seen clinical presenting complaint of our patients was abdominal pain and abdominal mass. The mesenteric cysts were most frequently located in the small intestine mesentery (70.5%). The cyst sizes varied between 2 and 25 cm. The most frequently performed surgical procedure was enucleation (76%). While surgical site infection was seen in two patients, anastomosis leak was seen in one and this patient had loop ileostomy. The mean period of hospitalization was 8 (2-17) days. No mortality cases were seen in the post-op period. Mesenteric cysts are rare intra-abdominal masses. They can be seen in different localizations within the abdominal cavity. Patients are generally diagnosed by radiological methods. The rate of recurrence is low following total excision and it has a good prognosis. Although laparoscopic resection is a preferred method, physicians should secure total resection in malign cases and the cyst should not be perforated.

Purpose: Cross sectional imaging technigues more widely available in the recent years for evaluation of uterine lesions. We discussed the primary contribution of US, CT, and MRI methods in the diferential diagnosis of uterine masses. Materials and methods: We evaluated the spectrum of US, CT, and MRI findings of the 15 uterine masses. Transabdominal sonography, enhanced and nonenhanced CT seans were performed in ali cases. Moreover, sagittal and axlal T1 weighted as well as T2 weighted, and fat-saturated unenhanced and gadolinium-enhanced MR images of the pelvic region. We compared our radiologic diferential diagnosis with pathologic diagnosis. Results: Seven of 15 cases had myoma, 3 had adenomyosis, 3 had endometrial carsinoma, and 2 had servix carcinoma. Correct diferential diagnosis was established in 11 (73%) out of 15 cases with US, in 12 (80%) with CT, and in 13 (87%) with MRI. Conclusion: MRI is the imaging method best suited for evaluation of uterine lesion than other imaging technigues. Since ultrasonography allows deiiation of the uterine masses in at least two scanning planes, this method should be preferred as the first method of searehing for uterine lesions.

To determine the contribution of imaging techniques for diagnosis and therapy planning of patients with parotid masses. 16 patients (10 female, 6 male; between 13-75 age; mean age 41.12±16.97 years) were evaluated retrospectively. Age, gender, clinical characteristics of patients, imaging studies which were performed preoperatively, location and characteristics of masses and invasion to the surrounding tissue, histopathologic examination of surgery specimens were evaluated in the current study. Histopathologic examinations of specimens revealed that all cases were benign. Histopathologic findings revealed no malignancy. Histopathologically, lesion was diagnosed as pleomorphic adenoma in 11 patients (%68.75) and Warthin tumor in 5 patients (%31.25). The mass was located in left parotid gland in 8 (%50) patients and in right parotid gland in 8 (%50) patients. Preoperative, ultrasound (US) was performed in 7 patients; computed tomography (CT) was performed in 9 patients; magnetic resonance imaging (MRI) was performed in 5 patients. US should be the initial investigation of choice for patients with parotid masses because of superficial location. US is effective, inexpensive, nonradiation, non-invasive, practical and does not require sedation in diagnosis parotid masses. Deeply located tumors and malign tumors should be evaluated with CT or MRI. CT or MRI alone is sufficient for evaluation.

Aim: Vertebrobasillar insufficiency (VBI) is a common problem of elderly patients. However, diagnosis of VBI is generally difficult. The aim of this study was to determine the findings and efficiencies of MRA and CDUS in the diagnosis of VBI. Material and Method: We examined 40 patients (20 men, 20 women, mean age: 54.83±14.36 years) having signs and symptoms of VBI and 20 controls of the same age and sex. All of the patients, underwent cervical MRA, CDUS, cranial MRI. The diameter measurements and systolic and diastolic flow velocities of the vertebral arteries were compared between study and control group. Posterior circulation was also evaluated by cranial MRI in patients with VBI. Results: By CDUS, 9 patients with oclusion, 5 patients with kink or stenosis and 6 patients with only hypoplasia, and 2 patients with insufficient flow were diagnosed. MRA showed occlusion in 14 patients, stenosis in 4 patients, kink in 6 patients, tortuosity in 6 patients, and fenestration in one patient. MRA of the remaining 5 patients were normal. Cranial MRI of 7 patients was abnormal. On MRA, there was distal oclusion in five out of 14 patients having oclusion. CDUS showed low velocity and high resistance in the extracranial segment of these vessels. Conclusion: When only the extracranial pathologies of vertebral arteries were in concern, CDUS specifity was 81,5% and sensitivity was 84,6% according to MRA. If all the vertebrobasillary system pathologies were in concern CDUS sensitivity and specifity according to MRA were 57,1% and 60%, respectively.

Ion our artichle, afamale women with ne-urofibroma was presented. Radiological and Cli-nical diagnosis could not been made preoperatively. Neurofibroma has been diagnosed with his-topathological examination of specimen taken at operation. Complication was not seen during the postoperative period.

A retrospeetive study was done of the treatrnent of closed and open fractures of the tibia in 133 patients with 140 fractures. These patients vith shafi fractures of tibia were treated at the Department of Orthopaedics and Trawıatology of the Selçuk Oniversitiy Hospital, between 1983 and 1989 The mean oge al initiation of treatrnent was 32 years. Their ages ranged from 13 to 72 years old. ln all, 96 fractures were closed and 44 were opera. Traffic accidents were the most cause of the injury. In 96 patients, the tibial fracture was the only inju.ry, i,x 37 patients other injuries also were present. 7 patients had bilaterall tibial fractures. The patients were followed al least unlu/ to clinical and radiographical union of the fracture. Iri (his series, the overall succes rates in healing of the fractures with open and closed method_v were highly satisfactory

The radiologic apperance of telangiectatic osteosarcoma is usually a osteolitic and destructive lesion with only minimal ituralesional sclerosis. Histologically, large cvstic blood spaces seperated bv thin fibrous septa and lined .sarcoma cell were noted. The age and sex distnibition or clinical signs and semptoms are the same as those of ordinaty osteosarcomas. An example of telangiectatic osteosarcoma, localised on the proximal pan of femur has been presemed. The new siglus on the entity has been reviewed.

Simple renal cysts are asymptomatic incidental findings; however, for a small subset of benign renal cysts, patients may present with pain, hematuria, urinary infection, pyelocaliceal obstruction or hypertension. Laparoscopic cyst ablation is an effective minimally invasive modality for the treatment of benign renal cyst. Our aim was to show the ultrasonic energy safe and effective method during laparoscopic renal cyst excision. In our clinic 14 patients underwent operated laparoscopic renal cyst excision with transperitoneal approach between January 2006 and February 2010. Trocar port for camera was inserted to the peritoneum in order to open the told line, gerato fascia and fat over the cyst. Harmonic™ scissor with the cautery was used to incise the cyst wall. Mean age of the patients was 58,1 years. Mean operation and hospitalization times were 59,2 minutes and 1,57 days, respectively. We did not need the fourth trocar during operation and the operation was finished. There was no complication in this procedure. Mean follow-up time was years. In long-term follow-up period symptomatic recurrence was observed in one patient and someone else be observed radiologic recurrence. We believe that using ultrasonic device is safe and effective method in laparoscopic cyst decortication. However, prospective controlled trials are needed to evaluate the other energy sources.

 Moyamoya disease is an entity, which is caused by obstruction or stenosis in the area between the internal carotid artery, and anterior and middle cerebral arteries, identified angiographically, and does not have an exactly known etiology. The most frequent symptoms of onset are hemorrhage in adults and ischemia in children. In this paper, we present a case of Moyamoya disease which was diagnosed with a 21 year old male patient who was admitted to our emergency department with headache, nausea vomiting and left hemiparasi complaints and whose radiological findings showed right basal ganglia hemorrhage.

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Breast cancer is the most frequently diagnosed cancer in women and second cancer leading death among cancer deaths in women (after lung cancer). Simultaneous bilateral breast cancer is seen 1-2% and metachronous 5-8%. Bilateral breast cancer has worse prognosis than unilateral breast cancer. Locoregional recurrences after mastectomy is often occure in bone, muscle, skin or subcutaneous tissue of the chest wall, and that was seen approximately until 2 years. In skin metastases; asymmetric nodules, eritematose rash, itching, bleeding, ulceration, symptoms and signs such as necrotic exuda can be seen. Breast cancer treatment should be made by a multidisciplinary team. Radiotherapy in these patients are curative or palliative. In this case, we aimed to show the effectiveness of the electron beam in modern radiotherapy.

Esophagail benign tumors are limited seen lesions. Rarely located at the upper one third part of the esophagus. Endoscopic removal of osephagial polyps has been declared infrequently. The procedure hast technically difficulties and after the polypectomy hemostasis can be hard. We performed a successful endoscopic polypectomy handlig a polypectomy loop to ablate the polyp in a 60-year-old woman patient. Leiomyoma of upper esophagus is a rare clinical situation. The diagnosis of esophageal leiomyomas must be achieved both endoscopic and radiologic examinations. Saline injection can be a useful method for endoscopic resections of pediculed polyps.

A patient presented with a gunshot injury to his left shoulder. On his examination, there were no symptoms or signs except an entrance hole in front of his left shoulder. There was no bullet exit hole. Radiologic examination revealed a left clavicular fracture and a dense image suggestive of a metal at the distal portion of the right clavicle just in front of the right glenohumoral joint. İt is very interesting and unusal that a bullet tracing its way from the left shoulder to the right vvithout damaging any internal organ, vascular structure and nerves.

İn the manegement of CDH, the first 18 monhs of lıfe i,r by far the most critical period. The ezcellent results that can be obtained by early treatment. The goal of treattnent is to return the femoral head to its normal relationship within the acetebulum and rnaintain 'his position until pathologic change reverse... The early results of 164 CD1-1 in 97 patients have been reviewed between 1983 and 1987. 68 patients who were between 6 days and 6 monihs old were treated by triple diapers, Wrejka pillows and vonRosen splints. 29 patients who were between 1,5 months and 17 months old. were treated by closed reduction under general anesthesia and immobolization in a hip-spica cast. All of the hips were normal clinically. Radiologically there were subluxation in one hip and avascular necrosis in three hips.

\r\n Tubal torsion is a very rare case, especially in pregnancy. We present a case of a patient of 24 weeks gestation that was admitted to our clinic with acute abdomen. Radiological and biochemical investigations did not reveal the cause of abdominal pain which resulted in laparatomic exploration. During the operation, the Morgagni cyst, previously explored by ultrasonographic examination, and the right fallopian tube were found twisted among themselves. Cystectomy and detorsion was performed of the Morgagni cyst and the fallopian tube, respectively.  

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Aim: To determine the primary success rate and follow up results of renal artery stenting or balloon angioplasty in controlling renovascular hypertension and renal failure in patients with renal artery stenosis. Method: Before balloon angioplasty and stenting; renal angiography and Doppler ultrasonography findings were evaluated and also findings of MRA were estimated if present.The clinical estimation of the cases were made upon to renal functions, hypertension values and the changes of the number of medicines used. Results: Balloon expandable stents were placed in 32 renal arteries of 37 patients. Balloon angioplasty were used in 7 renal arteries of 37 patients (22 men, 15 women; mean age 50.24). There were hypertension in all of the patients. In 12 patients; there were disturbed renal functions. In order to determine the activity of the cure of the disease, the patients are followed by measuring blood pressures and serum creatinin levels before and after the stenting and balloon angioplasty. Stenosis rate was 30-100% (mean 74.15%).The lesions were ostial in 15 patients, truncal in 24 patients. Mean follow up time was 21.2 months (3-84 months). Hypertension was cured in 9 (24.33%) patients, improved in 19 (51.35%).patients In 9 (24.33%) patients there was no respond. In 12 patients with disturbed renal function, 8 (22.22%) patients showed improvement, 4 (11.10%) patients showed deterioration and 4 (11.10%) patients were stable. Conclusion: Revascularization of renal artery stenosis with stenting and balloon angioplasty is a simple, efficient and safe procedure. In patients with uncontrolled hypertension and progressive renal failure; revascularization of renal ar tery stenosis with stenting and baloon angioplasty pointed out impor tant clinical benefit.

A case of pneumatosis cystoides intestinalis involving only the ileum is reported with clinical, radyologic, histopathological and operation findings by the review of the literatüre.

Endometriosis is the presence of normal endometrial tissue outside the uterus. Scar endometriosis is a rare pathology resulting after obstetric and gynecologic surgery procedures on abdominal wall which is not pre-diagnosed in differential diagnosis by general surgeons. Six cases referred to General Surgery outpatient clinic with mass on abdominal wall that have been totally excised and diagnosed as endometriosis in pathology laboratory between 2008-2012 , have been reviewed retrospectively with clinic, radiologic and pathologic findings. The presenting symptoms of six pateints were different; four of them referred with cyclic pain and swelling and two with nonspesific symptoms to general surgery outpatient clinic. All of the masses have been totally excised and diagnosed as endometriosis in pathology laboratory. Scar endometriosis should be considered in differential diagnosis of incisional abdominal wall masses in females referring to General Surgery.

The disease was first described by Scheuermann as the dorsal kyphosis of juveniles in 1920. Scheuermann's disease is the most common cause of thoracic hyperkyphosis in adolescence. There are two sub-types: thoracic and thoracolumbar / lumbar. Histologically, when the irregularities in the vertebral end plates are examined, collagen fibrils are seen to decrease or vanish. As a result, end-plate continuity deteriorates and Schmorl nodules appear when the disc material protrudes into the corpus. Deformations cause wedging in the vertebral corpus, resulting in narrow angled kyphotic deformity. In the large series, the prevalence is up to 8%, and the genetic transition and mechanical stress come into prominence in the epidemiology of the disease. Pain can be accompanied by deformity in symptomatic state. Classical radiological features include irregular vertebral endplates and kyphosis more than 45 degrees with 5 degrees of wedging in 3 or more vertebrae. In some cases, minimal scoliosis may accompany to kyphosis. Periodic radiologic follow-up is recommended for patients below 50 degrees of kyphosis. Bracing is appropriate in uncompleted skeletal maturation with kyphosis up to 75 degrees. In cases above 75 degrees, it is appropriate to perform surgical treatment when bracing is unsuccessful in adolescence and presence of exceeding pain despite the conventional methods and obvious deformity in adults. 

Our case was pre-diagnosed with appendicitis but during the surgery it was seen that the patient had cecal diverticulum perforation. Further, as the dissection continued appendicitis with retrocecal subserous localization was identified. The goal of our study is to underline the possibility that appendicitis in a rare localization can be overlooked in patients diagnosed with simultaneous cecal diverticulum complications. Although cecal diverticulum is a rare lesion, there are some difficulties regarding its diagnosis and treatment since its symptoms are similar to acute appendicitis when there is a complication. It can hardly be differentiated from acute appendicitis through physical examination and radiological imagining methods are mostly insufficient. Therefore, patients are generally diagnosed intraoperatively. Acute appendicitis is one of the most frequent causes of acute abdomen. Appendectomy, too, is the most frequently performed surgery among intraabdominal emergency surgical procedures. A good anamnesis and a careful and sufficient physical examination are very significant in the diagnosis of acute appendicitis. Alongside these, various laboratory and imaging techniques can be utilized. Although the appendix can be seen in different localizations, the retrocecal site is one of the rare localizations among all. In patients presenting to the emergency departments with complaints of right lower quadrant pain, many diseases, led by appendicitis, based on the patient’s age and sex should be taken into consideration. The possibility that these diseases may co-exist should always be remembered and, therefore, intra-operational exploration should be performed thoroughly.

Preoperative clinical evaluation remains the basis in determination of an appropriate surgical procedure for the patient with otologic disease. Sometimes, howereri after a most complete clinical and radiogical work-up, the clinician will be in doubt about the correct diagnosis. Explarotary tympanotomy provides a unique and helpful, safe and minor surgical procedure that allows direct visualization of contents of the middle ear. In this article, thirteen patients who had exploratory tympanotomy for hearing loss and contemporary indications for exploratory tympanotomy were discussed.

in this study, the quality control tests are performed on diagnostic x-ray systems using simple methods. These quality control tests include the measurements of linearity, grid, reproducibility, exposure time, half value layer (HVL), x-ray light congruous, beam alignment tube output, screen-film contact, screen with different speed, dark room and the quality control of the film processing.

In a diabetic person, foot malformations frequently occur due to neuropathy, infection and vascular disorders. Radiographic destruction of bones was detected in 16 of 70 diabetic patients (10 type 1.60 type II). In 7 of these 16 patients, erythema, ulceration and gangrenous lesions were detected on the skin of the feet. Radiological destruction of the foot bones was demonstrated in 9 of 55 diabetic patients without skin lesions and gangrene. No relationship could be established between the duration of diabetes and the patient's age and foot lesions. Heart failure is the most important factor that accelerates skin lesions. Also, poor foot hygiene provokes the event. Therefore, in order to prevent complications that may occur in the diabetic foot, it is necessary to keep the patient away from foot care and provoking factors.

In this study, thirty cases af laringeal carcinoma which diagnosed in our clinic between November-1994 June-1996 are compared by preoperative CT, laryngoscopy and postoperative speciemen findings. By laryngoscopy one could evaluate the status the mucosal lining and vocale cord motility. Lımitations of the cord vocale motility is attributed to deep invasion of the tumour but, the exact dimensions of the tumour could not be estimated. The conventional radiologic examination methods da not add any useful knowledge to the laryngoscopy. The com-puted tomograpic examination is useful to determine the precise anatomic localization and spread of the tumour which is very useful ta surgeon to choose the surgical treatment method. We concluded that CT is valuable di-agnostic method in evaluating the preepiglottic area, paraglottic area, subglottic area and the inferior areas of the larynx which is obstructed by the large laryngeal masses and the cartilage invasion which could not be evaluated by laryngoscopy and other conventional radiological methods. Also we concluded that there may be wrong de-cisions about the cartilage invasion due to the irreguler calcifications and microinvasions by CT examination. In the evaluation of the small mucosal lesions CT could yield false negative results and these lesions could be more accurately determined by laryngoscopy. CT evaluation of the laryngeal carcinoma patient prior to surgical in-tervantion is an additional diagnostic tool to the laryngoscopy and very useful for the determination of the best conservative surgical method.

The most serious complication of Paget's disease is the sarcomataus degeneration. Two cases of bone sarcoma in Paget's disease were diagnosed and treated at the University Hospital, departrnent of orthopaedy and Traumatology between 1983 and 1988. Histologically, lesions were osteogenic sarcoma and it is radiographically found ta be osteolitic. Pain, pathologic fracture and tender swelling were constant features. Femur and humerus were the affected bones. Overall prognosis for !hese patients were poor.

Mediastinoscopy is a widely used technique in the diagnosis of staging of lung cancer and primary and secondary mediastinal disease. İt was reported that mediastinoscopy was greater than sensitivity of %75 and specificity of % 90. We retrospectively revievved 24 mediastinoscopy performed in our clinic betvveen January 1999 and December 2002. There were 17 men and 7 women aged from 24 to 77 (mean age 57 years ) and the duration of operation was 30- 60 minutes. Eight patients had mediastinoscopy for the staging of lung cancer and sixteen patients for diagnosis of mediastinal mass. İn 3 of 8 patients N2 and N3 disease was identified. İt was suggested that these patients were inoperable. İn six- teen patients with mediastinal disease, sarcoidosis was diagnosed in 5 patients, non small celi lung cancer in 4 patients, tuberculosis in 4 patients, lymphoma in one patient, lung fibrosis and reactive lymph nodes in two patients. There were no complications and mortality in our cases. We conclude that mediastinoscopy is highly effective and safe procedure in the diagnosis of mediastinal diseases and staging of the lung cancers.

Aim: Lipoma arborescens is a rare intra-articular disease whose etiopatogenesis remains unknown.It was the aim to describe the radiological findings and to discuss the differential diagnosis. Case Report: Lipoma arborescens is a lesion characterized by the replacement of the subsynovial tissue by fat cells giving rise to a villous proliferation. It commonly affects the knee. Accurate diagnosis is important for surgical treatment. A 34-year-old patient who was suffering from a pain in his knee joint was examined by convansional radiography, computerized tomography, and magnetic resonance imaging. The lesion was diagnosed as lipoma arborescens especially with magnetic resonance imaging. Conclusion: The characteristic MR features of lipoma arborescens which has nonspecific clinical findings allows an accurate diagnosis.

Paget’s disease is the most frequent disorder of bone after osteoporosis characterized by excess bone growth due to increased osteoclast activitiy. It is usually seen in older males. Patients are often asymptomatic but sometimes bone pain, fractures, neurological and hearing problems can be seen. Although the pathogenesis of disease is not clear, genetical factors are thought to play role on pathogenesis. Paget’s disease is diagnosed by elevated serum alkaline phosphatase activity and abnormal radiological findings. Bisphosphonates are useful in controlling disease activity. Here, we present a patient admitted to our clinic with severe pelvic and back pain, mimicking sacroiliitis, diagnosed via bone sintigraphy as Paget’s disease in contrast to normal alkaline phosphatase levels.

Colon and rectum cancer, is called for colorectal cancer. Colorectal cancer, is a major health problem especially of developed western countries. The prevalence in U.S., Canada, Britain France, Germany varies between 40-60 per thousand faces. In the United States per year is approximately 150.000, in Europe, 170,000 ,a million new cases are seen all in the world. The prevalence of new cases of cancer in the U.S. in the third place receives 11%, while in European countries after lung cancer is the most common cause of cancer death (1).

The aim of this study was to evaluate the cytologic and histopathologic results of sputum, bronchial lavage fluid, and biopsy materials and to compare their diagnostic Utilities especially in the patiets with malignity. Sputum and bronchial lavage cytologies and bronchial biopsies send to the pathology department of medical faculty between January 1996 and December 2000 were reevaluated by archive scanning. Malign lung cytologies and biopsies were compared with each other, as well as diagnostic distribution of cytology. Of the 1140 sputum cytology mate­ rial, 8.7% had malignant diagnosis. For the patient having single sputum specimen, the rate of malign diagnosis was 2.2%, and for those multipl sputum specimens 18.1%>. Of the 283 bronchial lavage material, 8.6% had malig­ nant diagnosis. The rates of malignant diagnosis were 6.8% and 24.2% for the patient having single lavage spec­ imen and multipl specimens respectively. The number of the patient with negative malignity for biopsy and posi­ tive malignity for sputum was 31 and similaly lavage positive and biopsy negative was 10. Cytologic diagnoses were negative in 41 of the 63 patients who having both each material (sputum, lavage biopsy) and diagnosed with biopsies. İn this patients when sputum and bronchial lavage are evaluated with together the rate of positive diag­ nosis was 34.9°/o, for sputum it self 30.2%> and for bronchial lavage 17.5%>. İn the 185 patient considered to have malignity positive results were obtained in the rates of 62.7%, 29.8%, 11.49% and 84.9% for biopsy, sputum, lavage and ali, respectively. As conclusion, repeated sputum cytologies increases the rate of positive diagnosis as much as 8 times, and bronchial lavage 3.5 times. Positive diagnoses will significantly increases if three diagnos­ tic methods are evaluated with together (p<0.001). İn the case of biopsy failure, the diagnostic importance sputum and bronchial lavage is further increasing.

Aim: Coughing is a common symptom in childhood. The cough last for over 4 to 6 weeks and also which makes patients the family and the doctor feel discomfort is called chronic cough. If this cough last long and repeats, it has to be investigated. After a detailed history and physical examination, distinctive studies have to be made. The purpose of this study is to evaluate the patients, which have been made flexible bronchoscopy because of chronic cough, by their clinical, laboratory and bronchoscopic findings. Material and Method: In this study we evaluated 23 patients with chronic cough; which were examined between January 2002 and December 2006 in Pediatric Chest Unit of Hacettepe University. Patients have cough for over 4 to 6 weeks, without specific chest X Ray findings, gastroesophageal reflux and problem with their immunologic system were and because of all these reasons they have been made bronchoscopy. The patients files are analyzed retrospectively by their demographic, clinic and bronchoscopic findings. Results: The study consisted of 23 patients: (12 males/11 females). The age of the patients vary between 1 and 13,8 years (mean age: 5 years). All patient’s radiological findings were normal without one patient. This patient’s have bronchial abnormalities in sanal bronchoscopy. When it is observed with flexible bronchoscopy ten patients have abnormal findings. Two patients have foreing body aspiration in their left main bronchus, two patients have tracheomalasia, three patients have hyperemia and secretions infection and two have bronchial abnormalites.In six patients’ bronchoalveolar lavage microorganism grew. Three patients have lipid laden macrophage and two patients whose previous gastroesophageal reflux scintigraphie were negative then found in and started treatment Conclusion: Although flexible bronchoscopy is an invasive technique, it evaluates respiratory system’s functional, anatomic characteristics well and it is a valuable technique in finding the etiology of chronic cough.

In 33 patients with peptic ulcer which were included by radiologic and clinic examination and history were evaluated for hematologic values. These patients should not have a history of gastrointestinal hemorrhage and occult blood and parasites in stool. These patients group were compared with 10 normal people who had not peptic ulcer and gastric compliants and no prominent anemia. At the end of the study; the patient group had a ligde dillerence from the normal group in 1lb, red blood cell count, PCV. There was important dillerence between the values of iron and total Iran binding capacity.

Organ tuberculosis is an important problem for the public health in devoloping countries. Tuberculosis can be seen on any part of the gastrointestinal tract from mouth to anus. Esophageal tuberculosis is very rarely seen with 0.14% prevalance. It usually originates from mediastinal tuberculous lymphadenopathy. We report a 55-year-old woman who admitted to our hospital with complaints of dysphagia, weight loss, audinophagia and epigastric pain. The chest radiography revealed a linear opacity compatible with fibrotic tape was seen on chest x-ray. Thorax CT examination revealed milimetric calcified lymph nodes at subcarinal and the right hilar region, thickening of proximal part of esophageal wall through carinal leveland subsegmenter collapse on left lower lobe. Ulcerative lesion with dimension of 1×1 cm localized in the 19th cm of the esophagus was seen on upper gastrointestinal endoscopy, suggesting esophageal carcinoma. Biopsy revealed necrotizing granulomatous ulceration which resembled tuberculosis. After antituberculous chemotherapy, the endoscopy repeated in end of the 2nd month of antituberculous therapy and the recovery of ulcer lesion was seen and the biopsy showed no signs of tuberculosis. Conclusion; esophageal tuberculosis should be kept in mind at differential diagnosis in patients who have complaints of dysphagia and loss weight and radiological signs.

Background: Tyrosine rich crystals (TC) are curious structures, rarely encountered at histopathology, more so at cytology. These crystals have been documented exceptionally in various non-neoplastic and neoplastic lesions of salivary gland, lacrimal gland and rarely in larynx. The finding of these crystals in nasolabial cyst has not been reported till date.

Case: A 35-year-old female with a clinical and radiologic diagnosis of nasolabial cyst underwent fine needle aspiration cytology (FNAC). Tyrosine crystals in singles and in groups assuming ‘petaloid’ and ‘daisy head’ forms were noted along with few lymphocytes and histiocytes. Amylase crystals were also noted.

Conclusion:  Regardless of the precise cause, cytologic recognition of TC is important to avoid confusion. Identification of these crystals at FNAC is a matter of avid observation and encourages cytopathologist for meticulous examination of all fluids. The case also highlights that the occurrence of TC is not restricted to SG and the circumstances in which it occurs is diversified.

Aim: In this study, it is aimed to evaluate a complex and rare variation on branches of femoral artery and to review related literature. Case report: During routine dissections in laboratory of the Department of Anatomy, it is determined that deep femoral artery, medial femoral circumflex artery and lateral femoral circumflex artery had originated from femoral artery in the right thigh of 65-yearold cadaver. Conclusion: Studies related with the variations on femoral artery and its branches may be information source in preventing complications during surgical approachs and especially invasive radiologic procedures like angiography.

Localized solitary fibrous tumor of the pleura is a rarely seen tumor of the pleura beyond It’s unclear histogenesis, differantiation, malignity potential, and clinical behaviour. They are usually seen in 5-8. decades and more than 50 % of the cases are asymptomatic. The most important prognostic factors are the size, cellularity, and resectability of the tumor. For these reasons in surgical treatment wide resection is advised. İn this article, two female patients who were 48 and 53 year-old are reported with the diagnosis of localized solitary fibrous tumor originated from diaphragmatic pleura. The tumors removed successfully and the patients did not have any complication postoperatively. Because of the rareness of localized solitary fibrous tumor of the pleura it is thought to be worth reporting.

Intraspinal synovial cysts are uncommon lesions. İn this article a 72 year-old woman who developed a spinal synovial cyst at the left side of L4-5 disk space is reported. Beside her clinical signs and symptoms, magnetic resonance imaging, operative andpathological findings are presented. Treatment options, clinical, radiological and pathological aspects of intraspinal synovial cysts are discussed.

Post-traumatic pseudocysts of lung are rarely seen complications of blunt chest traumas. Usually spontaneous resolution is seen in 2- 4 months after trauma, but a few of them are get into abscess or tension cyst formation after Progressive expansion and in these circumstances surgical resection is indicated. Radiologically they are frequently seen as thin-wall cysts consisting air-liquid levels. Unless they had a drainage bronchus in the beginning they are usually seen as pulmonary hematomas due to hemorrhage. 14/e herein report 15, 17, 47 and 49 year old four cases who were hospitalized for blunt chest traumas in our clinic. Three of them were male and one was female. Ali the pseudocysts localized in the right lung, and in two of the case the cysts resolved in a period of 2.5 and 4 months with medical treatment. But in two cases surgical treatment needed for their Progressive expansions.

ANTEGRAD URETERAL STENTING; INDICATIONS - METHODS - COMPLICATIONS AND RADIOLOGICAL APPROACH TO  COMPLICATIONS

 

Abstract:

Objectives

The aim of this study is to evaluate the indications, success rate, complications, technical success enhancing method, methods of antegrad ureteral stenting and the radiological management of complications due to retrograde and antegrade ureteral stenting in the treatment of ureteral obstructions and ureteral leaks caused by malignant and benign etiologies.

Materials and Methods

In this retrospective study, fluoroscopy and US-guided antegrade ureteral stenting procedures between January 2016 and December 2018 were examined. The study included 110 antegrade ureteral stenting and percutaneous nephrostomy in a total of 78 patients with 25 female patients (32.05 %), a mean age of 65.87 (20-90) and 53 male patients (67.94%) with a mean age of 68.73 (30-90).  Demographic data, antegrade ureteral stenting indications, procedure results and complications were evaluated for each patient.

Results

Antegrade ureteral stenting is a good alternative for patients with retrograde ureteral stent placement and already with percutaneous nephrostomy catheters. It has a high technical success rate and low complication risk. The use of the equipment used in other radiological procedures in antegrade ureteral stenting increases the technical success. Malposition,  perforation, hemorrhage, urinoma, abscess complications such as retrograde or antegrade ureteral stenting can be managed by radiological methods.

Key Words: Double J Ureteral stent, Ureteral obstruction, Percutaneous, Antegrade, Hydronephrosis,

Aim: Familial Mediterranean fever, is the most common and well known disease in hereditary periodic fever syndromes at the present time. In this review we summarized the disease, which was seen frequently in our country, and newly treatment methods. Main findings: Familial Mediterranean fever was described in a Jewish girl in 1908. Generally it was seen in Armenians, Sefaradian Jew, Arabians and Anatolian Turks. Pathogenesis of the disease was not clear. Characteristic feature of the disease is acute fever attacks accompanied with abdominal pain, chest pain and joint pain. The most important complication is type AA amiloidosis. There is no specific laboratory or radiological finding. Colchicum which is used in the treatment, decreases frequency of attacks and prevents from development of amiloidosis. Result: Aproximately 1/4 patients are resistive to colchicum treatment. There are some studies which shows adding interferon a, selective seratonine reuptake inhibitors and biological agents to the treatment are effective in these patients.

İn this study, evaluation of antibiotic usage in the community of Konya district was aimed. 206 patients, who used antibiotics during the last month were included in the study. A questionnaire form was applied face to face to the patients. 18 % of the patients did not have a health assurance. İt was found that antibiotics were proposed to 91.3 % of the patients by doctors. İt was determined that about 3/4 of the patients used antibiotics for respiratory infections. Radiological examinations were the most requested examination and amoxicilline-klavulanat was the most frequently used antibiotic by the patients. 44.7 % of the patients declared feeling healthy as the reason of quitting the antibiotic use. There was no significant relation betvveen antibiotic usage properties and educational level of the community. İt was concluded that, the doctors should also be educated with the community about acceptable antibiotic usage.

Surgical treatment was performed in 21 hips of 18 children aged 5-11 years with congenital hip dislocation. Open reduction, Salter or triple osteotomy and femoral osteotomies were performed. The patients, 15 girls and three boys, were followed for at least one year. It was evaluated radiologically according to the Severin classification and 19 hips (90%) were found to be very good and good, and two hips (10%) bad. Re-dislocations occurred in two hips and one of them developed avascular necrosis of the femoral head.

Tumors In This study, anti-HCV seropozitivity was inves-tigated in 46 new diagnosed patients with different solid tumors without hepatocelluler carcinoma, which they have not received any transfusion or sur-gical operation. The positivity was evaluated using by second generation ELISA system. Patients are consist of 14 lung cancer (Ca), 7 lymphoma, 5 breast Ca, 5 hipernephroma and 15 other tumors. Anti-HCV positivity was in 5 (10.8%) of 46 pa-tients, and 4 of this positive patients were with lung Ca (4114,28.5%), and 1 was with brain Ca (113). ALT levels were normal, serum iron and iron-binding capacily were decrased in all patients, hae-moglobin and haemotocrit were also decreased in 73.9% of patients. In addition, 3 patients (6.5%) HBsAg, 21 patients (45.6%) anti HBc were found to be positive. As a result, the high positivity of anti-HBc while the HBsAg was low positive showed that there was IIBV infection, and the HCV infecton was alsa expected with the same transmission ways. Anti-HCV positivity as a marker of HCV infection-which can produce the chronic carrier state is more expected in cancer patients. They have allected immun status than normal population, but 4 of 5 posi-tivity was in Lung Ca patients is of great interest.

Foreign body aspiration (FBA) is a serious problem especially in pediatric age group. Delay in diagnosis and intervention can lead to a life-threatening condition. Young children are more concerned with the environment and neuromuscular mechanisms do not develop sufficiently. Factors such as lack of molar teeth and failure to perform chewing are the main causes of high FBA in children under 3 years of age. It is of vital importance that the patient is referred to a hospital where a rigid bronchoscopy can be performed quickly after the diagnosis. We retrospectively evaluated 47 patients who were treated in our clinic such as clinical symptoms, age, gender, foreign body (FB), location, positive radiological findings, and duration of stay.

47 patients; 29 male (63%), 18 female (37%), age ranging from 3 months to 8 years. The age of the 37 patients (80%) was below the age of 3 years. The main complaint at the time of admission was cough (80%) in 37 patients, wheezing in 23 patients (50%), shortness of breath in 15 patients (32.6%), infection in 5 patients (10.8%), high in 2 patients. there was fever (4.3%). In 37 patients (78%), the foreign body was of organic origin (such as inside or outside the shell, peanuts, hazelnut pieces) while in 10 patients (22%), an inorganic foreign object was found (such as a pen tip, a toy part, plastic parts, etc.). FB was located in the right main bronchus in 18 patients (39%), in the left main bronchus in 25 patients (51%) and in the trachea in 4 patients (8.7). There were no radiological findings in 18 patients (39%). Although 11 patients (23.9%) were anamnesis, their findings were normal. Twenty-three patients applied to our clinic within the first 24 hours after the event, and 24 patients were admitted to our clinic 24 hours after the event.

Although the results were generally consistent with the literature, the left main bronchus was 51% in terms of the localization of FB.

A 8- mounth- old gir! was referred to our laboratory because of Down Syndrome. She had had phenotypical features as mild mental retardation, flated nasal bridge, low- set and malformed ears. İn detailed family history, her mother had had an carbon monoxide poisoning during proband’s pregnancy and an abortus before her. Chromosome analysis was carried on peripheral blood lymphocytes culture, using standart technigues and chromosomes were identified by using GTG, C and NOR- banding. Her karyotype was foundjo be 46, XX, t (4q;22q), inv(9). Family studies were shovved that neither her mother nor her father had carried this translocation but inv(9) was inherited from her mother to our patient. Our patient who seems as though a de novo balanced translocation carrier was discussed under the light of literatüre with her biochemical, radiologic and clinic features.

Hydatid cyst is a parasitic infestation caused by Echinococcus granülosus. In this study we present a pulmonary hydatid cyst case that has radiological and bronchoscopic view like a malign mass. A 17 year-old male patient. He has cough, sputum and hemoptysis complaints. He has 10 kg weight loss in last two mounths. Thorax computed tomography showed a consolide lesion in the the right upper lobe. Fiberoptic bronchoscopy was performed in this case. There was an endobronchial hump lesion covered with necrotic tissue, in the right upper lobe anterior segment. The result of bronchoscopic biopsy was reported as ‘hydatid cyst’. We found a cystic lesion at the left liver lobe in abdominal ultsonography. Patient transferred for operation at thoracic surgery department. Hydatid cyst was rejected by operation. Hydatid cyst is usually located in the lower lobes of the lungs. Although cyst has classic radiologic, bronchoscopic findings, we should think hydatid cyst in different radiological and bronchoscopic findings too.

The assesment of the renal arteries is par-ticuhırlv inıporraın in the derection of a re-novaseuhır cause of hypertension. İi was in-,estigıred the ejfectivene•s of color doppler ultrasonography (CDU) in the detection 50 % or greater diameter reducing the srenosis in renal ar-ten, irr this study. The studv was done in the De-partment of Urology and Radiology, University of Ankara, Medical School between March 1993 and December 1994. The findings of color doppler ult-rasonography in 20 hypertensive patients were com-pared with the results of renal angiography. It was demonstrared 39 main and 4 accessories renal ar-teries irr these 20 pariems by angiography. An-giographv detnonstrared the stenosis in 5 main renal arte.ries and in. one accessory renal artery. It was derermined the occhısion in 4 tnain renal arteries. The maximum systolic velocity and th.e ratio of ma-ximum systolic velocitv in renal artery to that in ab-dominai aorta (RAR) were calculated with CDU in all patients. The average procedure time per pa-ıients with CDU was 42+4 (38 + 53) minutes. It was demonstrated 87,1% of the main arteries and only 1 (25%) of the accessory vessels by CDU. A nuıximum systolic velociry value of greater than 100 emisec and a RAI? value of 3.50 or greater were chosen as the criteria foı- SIC110SiS. The first criteria in the di-agnosis of renal artey stenosis was more useful. Ac-coı-ding rrı this crireria. we found 67 % sensitivity and 93% specifieity in diagnosing 6 renal artey ste-nosis with CD U. concluded, that CDU is not an ahernative to angiographv with the technology and criteria used, and the technology of CDU should be improved and the diagnostic criterias should be standardized to increase the effecriveness of CDU irr diagnosis of renal arterv stenosis.

Spinal epidural abscess is a very rare and dangerous lesion. We present here spondylodiscitis case developed follovving iatrogenic spinal epidural abscess. The patient was operated on by surgical drainage and appropriate antibiotic therapy. Improvement was seen postoperatively. İn this article, the clinical outcome, radiological findings, and management prothocoles of spinal epidural abscess and spondylodiscitis are discussed with revievv of the literatüre.

\r\n Brown tumors are benign, but locally aggressive tumors that may emerge as a rare complication of prolonged hyperparathyroidism. They may be clinically and radiologically confused with bone metastases. Browns tumors show increased metabolic activity on F-18 FDG-PET/CT just as metastatic bone lesions. In this study, we present a patient who underwent PET/CT to seek a primary focus with the presumed diagnosis of  multiple bone metastasis, and Brown tumor was suspected because no primary focus was detected on imaging and increased FDG enhancement was seen in parathyroid locations, and the diagnosis was confirmed with further investigations. Herein, we aimed to underline that Brown tumors should be kept in mind in the differential diagnosis in patients who are clinically and radiologically considered to have bone metastasis. 

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During 1996 and 1999, we applied MVAC in 27 patients whose final stage bladder tumor depends on pathological and radiological bases at urological department. 15.4 % had complete response, 34.6 % had partial clinical response, 34.8 % hadn’t any clinical response and 19.7% had progression. One of the patient died due to a wide spreed tumor metastasis and neutropenic sepsis during the treatment. The most common side-effects were nausea- vomiting, transient renal failure, leucopenia, and trombocytopenia. M-VAC therapy showed it’s beneficial effect by decreasing the stage so providing TUR possibility and other alternative surgical procedurs.

Morgagni's hernia are uncommon and it is the least common congenital diaphragmatic hernia. This condition affects the right side more frequently than the left. In adulthood, the majority of cases are asyomtomatic or produce minimal symptoms. Most Morgagni herniations in aduls are recognized ro-entgenographically. We present a case of Morgagni hernia in a 69 years old man suffering from occasioonally a pain at the right upper part of abdomen.

Duplication of Gasrointestinal Tractus is a rarely seen congenital abnormality. İn our clinic a patient is operated because of ileum duplication. This case is reported with clinical, radyological and operation findings by the review of the literatüre.

Purpose: It was aimed to present the clinical and functional results of the patients who underwent tumor resection and endoprosthetic reconstruction due to malignant tumor around the elbow.

Methods: 14 patients who underwent tumor resection and endoprosthetic reconstruction due to malignant tumor in the elbow circumference between 2011-2018 in our clinic were included in the study. While 4 of the patients were primary tumors (1 fibromixoid sarcoma, 1 leimyosarcoma, 1 multiple myeloma and 1 ewing sarcoma), 10 were distant organ metastases (4 breast cancer, 3 lung cancer, 1 stomach cancer, 1 renal cell cancer and 1 thyroid cancer). Musculoskeletal Tumour Society (MSTS) score and Mayo elbow performance score (MEPS) and survival were evaluated.

Results: The minimum follow-up period of the patients was 7 months, and the maximum follow-up period was 55 months. The mean MEPS score of the patients was 67.5 ± 12.0 (range, 45-90), and the mean of the MSTS score was 19.4 ± 2.3 (range, 16-24). Recurrence occurred at follow-up in 3 patients and exitus at follow-up in 7 patients. In this study, the median survival time of the patients was 44 months. The 1-year survival rate was 70.1% while the 3-year survival rate was 54.5%.

Conclusion: Pain and functional results are satisfactory in patients who undergo tumor resection and endoprosthetic reconstruction due to malignant tumor around the elbow. In the future, studies with larger patient series are needed.

Onun karın ameliyatı bir araştırıcı laparotomidir. Mümkün olan her halükarda araştırılmalıdır. Bu yolla normal yapı görülerek ve tıslayarak tanınır ve böylece anormal bir durum varlığının farkına varmak ve bunu ortaya koymak mümkün olur. Arasıra önemli bulgular keşfedilir ve semptomlara sebep olan ve şüphelenilmeyen, akla gelmeyen kzyonlann alternatif ile alternatif teşhis laparatomid konulabilir (1). Hiçbir şartta keşif; dikkatli klinik muayene, uygun laboratuvar testleri, endoskopi, radyoloji ve modern tekniklerinin yerine konulamaz (2, 3, 4).

Between 1983 and 1990, 182 patients with 189 tibial shaft fracture were diagnosed al the Department of Orthopaeclics and Traumatology in the Faculty of Medicine of Selçuk University. The mean age was 36 years with a range of 13 to 84 years. A hundred and seventy five patients had unilateral and 7 patient bilateral tibial shaft fracture. 165 tibial shaft fracture in 158 patients had been folowed and evaluated for treatment results. nese patients were followed at least a duration until the fracture were healed clinically and radiographically. A highly satisfacwry results were obtained with opera and closed treatment.

Behrers's disease is a systemic disease which does not show destructive arthritis in joints sacroiliitis ankle enthesopatia (Achilles tendinits and plantar fasciitis) and iemporomandibular arthritis were cli-nically and radiologically compared in 40 patients with Behcet's Disease and 23 control groups. There was a statistically significant differance in the ra-diological findings of both groups while there was clinically no significant differance between them (P<0.05). Clinical and radiological findings of ankle enthesopathia and temporo-mandibular joint arthritis were the same. It was concluded that although ankle and temporo-mandibular joint complaints are found during the Behcers Disease, those complaints were specific for the disease and were not more than those found in normal population.