Makale Arama

Aim: The aim of this study was to evaluate the efficacy of gadoxetic acid and gadopentate dimeglumine in the evaluation of liver metastases of patients with gastrointestinal malignancy by magnetic resonance. Patients and Methods: A total of 50 patients were diagnosed gastrointestinal malignancies histopathologically were included in the study and their hepatic metastases were examined by magnetic resonance for two contrast agent. Results: There was no statistically significant difference for these contrast agent at arterial, portal and late phase series. (p>0.05) But we found a statistically significant difference between the series obtained at the 20th minutes after administration of gadoxetic acid and late phase for gadopentate dimeglumine for hepatic parenchymal and metastatic lesion intensity. (p<0.05) After the administration of gadoxetic acid, arterial, portal, late phase and the 20th minute series intensity of hepatic enhancement significantly reduced. At this time there was not a significant enhancement of the metastatic lesions. (p>0.05) When the hepatic parenchymal enhancement increased and the enhancement of metastatic lesions reduced, thus the enhancement difference between normally hepatic parenchyma and metastatic lesions might help the detection of the lesions. Conclusion: Gadoxetic acid, a hepatoceluler contrast agent, have important diagnostic contribution to the assessment of the patients with liver metastases of gastrointestinal malignancies by magnetic resonance imaging.

Today, age of childbearing women is increasing because of social and economic conditions. Although gynecological cancers are seen in old age, some of them may occur in reproductive age. With recent advances in the fields of surgery, pathology and chemotherapy, low risk patient group can be identified in gynecological cancers. Fertility sparing surgery appears as a parallel development in current cancer treatment, when considering the emotional condition, physical appearance, sexual function and fertility desire of the patient.

To evaluate the hysterectomies carried out in our clinic for a period of two years. The study retrospectively evaluates the clinical and demographic characteristics of the 853 patients that had abdominal hysterectomy and vaginal hysterectomy procedures with various indications for the two years from January 2008 to December 2009 in Selcuk University, Faculty of Medicine, Gynecology and Obstetrics Department. In our clinic, the most common indication for hysterectomy was myoma uteri and the procedure was performed on 358 (41.9%) patients between the years 2008 and 2009. The second most common indication was gynecological malignancies and hysterectomy was performed on 161 (18.8%) patients. The ratio of abdominal hysterectomy (total and subtotal) was determined to be 93.6%, whereas the ratio of vaginal hysterectomy was 6.4%. As well as hysterectomy, bilateral salpingo ooforectomia (BSO) was also performed in 453 (53.1%) cases. We have seen 0.5% bladder injury, 0.37% ureter injury and 0.37% bowl injury in the abdominal hysterectomy group. In vaginal hysterectomy group, there was 1 case (1.85%) with bladder injury. With various indications such as myoma uteri, gynecological malignancy, uterovajinal prolapse, endometriosis and peripartum hemorrhage, hysterectomy is the most commonly performed operation by gynecologists. Although, the relative advantages and disadvantages of the abdominal, vaginal, and laparoscopic hysterectomy types are known, abdominal hysterectomy is still the most common procedure in our clinic.

Purpose: In the case of the skeletal muscie metastasis of lung cancer the authors report radiographic, CT scan and MRI findings of painful masses in the femoral regions. Muscle biopsy revealed extensive infiltration of the muscle with carcinoma cells. Case: A 68 year-old man presented with a large cavitary lesion with thickened wall in the left hilus on radiogrraphy and CT scan. The diagnosis of the lung cancer was made by bronchoalveolar lavage. The radiograph did not Show any soft tissue mass, except periosteal reaction. MRI showed a tumoral mass in the right quadriceps muscle with signal intensity slightly lower on T1-weighted and higher in T2-weighted images than surrounding muscle tissue.Needle biopsy revealed metastatic squamous cell carcinoma. The patient died six month later. Conclusion: MRI is more useful technique than the other methods for determination of the localization, the relationship of the surrounding tissues and the manifestations of metastatic masses on the skeletal muscle due to malign tumor of the lung.

Benign cysts of Mullerian type present as pelvic mass in perimenopausal and postmenopausal women mimicking ovarian malignancy. Herein, a case of benign uterine mullerien cyst detected in a woman with postmenopausal uterine bleeding resistant to medical treatment and operated with a preoperative diagnosis of right ovarian simple cyst is presented. Differential diagnosis is also discussed. Sixty two years old postmenopausal woman presented with complaint of abdominal pain and vaginal bleeding. A cystic mass of 4x3 cms thougth to be originated from right ovary was determined on pelvic ultrasound. The patient with postmenopausal uterine bleeding resistant to medical treatment of 6 months given before went to surgery with a preoperative diagnosis of right ovarian simple cyst. After pathologic examination, the cyst was diagnosed as benign uterine mullerien cyst.

The metastatic ovarian tumors constitute 3 to 8% of all and 10 to 30% of malignant ovarian tumors. The common primary sites for metastatic disease to the ovaries include the colon stomach, breast and the genitoürinary tract. Hematolojic malignancies, including lymhoma and leukemia, also involve the ovaries. Clinical history, tumor markers, tumor morphological-histological features and imaging features are useful to distinguish secondary ovarian tumors from primary ovarian tumors. Magnetic Resonance imaging (MRI) provides useful information for characterization of various ovarian benign or malign masses. The use of MRI for diagnosis of ovarian masses includes consideration of morphologic characteristics and signal intensity characteristics on T1 and T2-weighted images. It is important to determine the ovarian metastasis due to change the method of treatment. İn this case we present MRI an ultrasound findings of bilateral ovarian metastasis of lobular breast cancer.

The cavernous sinus thrombosis is a very rare and life-threatening condition. The mortality rate remains high, and significant morbidity includes residual cranial nerve palsies and blindness. The causes of cavernous sinus thrombosis are infectious or aseptic. We report well-progressed a rare case of aseptic thrombosis of the cavernous sinus in an older patient.

Pericardial cysts and diverticula compose %7 of all mediastinal masses. Pericardial cysts and diverticula are generally present at right cardiophrenic sinus also within left cardiophrenic sinus, superıor mediastinum, aortic arch level and left hilum. Pericardial cysts and diverticula are lesions which resemble themselves in shape, localiaztion and symptoms. Radiography, CT and MRI has demonstrative importance in their diagnosis. We want to present similarities and differences of symptoms, diagnosis and treatment of pericardial cysts and diverticula which are important in differential diagnosis of mediastinal cystic lesions within these 3 cases.

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.

Aim: To report an immature teratoma case that was differentiated from mature teratoma. Case report: A 29 year old woman consulted to Gynecology and Obsterics clinic vvith pelvic pain. İn the histoıy of the patient, it was un- derstood that she had left sided ooferectomy due to left ovarial cyst. At that time the ovarial pathologyhad been reported as normal. İn the pelvic examination of the patient a pelvic mass that can not be differentiated from ute- rus was detected. İn the pelvic ultrasonography of the patient, at the right ovarial area a smooth bordered hete- rogenous mass that had calcified areas vvith in the body, and that was measured as to be 11x11 cm and found to have solid and cystic components was detected.İn the laboratory finding AFP: 10,5 (0-7), CEA: 6,4 (0-4,1), CA 125: 32,9 (0-21), CA19.9: 322 (0-18,4), CA 15.3 :24,5 (7,5-53 ), HCG < 1 was found. The patient had been operated, the right ovarial mass extirpation and right ooferectomy had been done. The diagnosis vvith the histopathological examination of the mass was defined as immature teratoma grade-l. Conclusion: İt is needed to get several biop- sies of the pathological spesimen in order not to skip. The immature components of the teratomas and neural com­ ponents should be shown vvith immunohistochemical methods.

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.

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.

Dyke-Davidoff-Masson Syndrome (DDMS) is rarely seen and a clinical entity with features of drug-resistant epileptic seizures, cerebral hemiatrophy, contralateral hemiparesia, facial asymmetry, mental retardation or learning disability. A 27 year-old-male patient presented with complaint of seizure. His first attack was occurred when he was three-days-old. His seizures were complex partial seizures. He has used varios of antiepileptics but seizures could not be controlled since he was three-years-old. Neurological examination revealed mild hemiparesis, hyperactive deep tendon reflexes and Babinsky’s sign positivity at the right side. Magnetic resonance imaging (MRI) of the brain revealed left cerebral cortical hemiatrophy. The patient was diagnosed with DDMS considering that learning difficulties in additon to the above clinical features. He has used 1000 mg/day carbamezepine and 200 mg/day topiramate for 10 months and he is seizure free now. Absence, complex partial or secondary generalized seizures may seen in patients with DDMS. Surgical procedures like hemispherectomy may be performed in patients who have frequent and drug-resistant seizures. In our patient, seizures were controlled with oral antiepileptic drugs without any need of surgery. This case is presented because of the rarity of the syndrome and demonstratively of the brain MRI.

Objective: The aim was to review the hormonal status, treatment and histopathological diagnosis of patients admitted to our endocrinology outpatient clinic with the diagnosis of adrenal incidentaloma.

Material and Methods:Between 2015-2018, 217 patients with adrenal incidentaloma who were admitted to the endocrinology outpatient clinic were included in the study. 1 mg overnight dexamethasone suppression test (DST), 24 hour urine free cortisol, 24-hour urine methanephrine and normetanephrine levels were evaluated in all patients.Patients who also have hypertension or hypokalemiawere screened for the plasma aldosterone/renin activity ratio. CT or MRI imaging properties of adrenal incidentalomas were screened.

Results: In the evaluation of cases; 180 (83%) of the masses were evaluated as non-functional and 37 (17%) as functional. Of the 37 patients evaluated as having functional adrenal mass; 10 (4.6%) pheochromocytoma, 5 (2.3%) Cushing's syndrome, 9 (4.1%) subclinical Cushing’s syndrome and 13 (6%) primary hyperaldesteronism were detected. In 180 patients who were evaluated as having non-functional adrenal mass; metastatic disease in 7 (3 non-small cell lung cancer, 1 breast cancer, 1 prostate carcinoma and 2 unknown primary cancer), myelolipoma in 4, ganglioneuroma in 1, hydatid cyst in 1, adrenocortical carcinoma in 2 patients were detected.

Conclusion: According to the results of this study, it is not uncommon for adrenal incidentalomas to be functional. It may be malignant in some cases. For this reason, adrenal incidentaloma is a condition that should be examined both in terms of
functionality and malignancy potential.

\r\n Synesthesia is a phenomenon in which stimulation of one sensory system leads to a different experience in a second sensory system. There is more than sixty types of Synesthesia, like grapheme-color, sound-color (chromesthesia), sound-movement, sound-flavor, color- flavor etc. have been identified so far. Synesthesia is seen in 4% in general population. The grapheme-color and sound-color Synesthesia are the most common types. A case is discussed that has auditory-visual and smell-color types Synesthesia started at 6 yo but currently she has had fewer symptoms than before. An active psychiatric pathology is not found in clinical evaluation.  There is neither significant patient history nor family history for psychiatric disorders other than a younger sister who has similar symptoms. She has not experienced any seizures or trauma. Her MRI and EEG were within normal limits. Functional MR imaging showed greater activation in the cerebral hemisphere that indicate lateralization. Since there is a positive familial history, we might consider genetic predispositions.

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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.

Uraemia is a syndrome of clinical and metabolic abnormalities that develop in parallel with deteriorating renal function. The neurological consequences of uraemia are similar in many ways to the central nervous system effects of other metabolic and toxic disorders. There are several recent case reports of acute movement disorders with bilateral basal ganglia involvement in diabetic uraemic patients. We studied MRI and DWI findings of a patient with diabetus mellitus and chronic renal failure who developed acute ensepholopathy. Patients with diabetes mellitus and chronic renal failure may be progress to acute ensepholopathy. After hemodialysis semptoms are regressed; MRI can be used succesfully at acute phase and after hemodialysis.

Abdominal actinomycosis is a rare infectious disease caused by an anaerobic bacterium actinomyces israeli. Pelvic actinomycosis is generally associated with the use of intrauterin devices (IUD). This chronic suppurative infection can mimic pelvic malignancy. The diagnosis of the disease is frequently miss preoperatively. The surgeons must be aware of this rare complication in order to avoid an extensive surgical procedure. Case: We present the case of a 31 year old premenoposal woman with an abdominal pain and a history of IUD us efor 6 years. On physical examination the patient had tenderness on right lower abdomen and a palpable cystic mass 8x10 cm in size on pelvic bimanual examination. A preoperative transvaginal USG showed a 9x9 cm cystic mass originated from right ovary. The patient was taken to the emergency operating suite with the diagnosis of torsion of the right cystic ovary by gynaecologist. During the exploratory laparotomy we observed an extensive diffusely infiltrating process involving right adnexa, sigmoid colon sacrum and right pelvic Wall. A loop of jejunum was adherent to this infiltrating process and a mass 5x6 cm in size was palpated in sigmoid colon. These findings were highly suggestive of a colonic carcinoma and the patient was consulted with a general surgeon intraoperatively. Right salpingo -ooferectomy + sigmoid resection + segmental jejunal resection was performed. Pathologic findings showed chronic inflammatory tissue with evidence of actinomycosis. Conclusion: The case described here underlines that surgeons must be aware of this unusual infectious disease in the differential diagnosis of pelvic mass.

Aim: We aimed to evaluate the relationship between magnetic resonance (MR) enterography and diffusion magnetic resonance imaging (MRI) investigations in inflammatory bowel disease (IBD) patients during active inflammation and remission phases. 

Patients and Methods: We included patients diagnosed with IBD between 01.12.2015-31.08.2016 at our hospital. 47 patients were included; 30 were male (63.8%) and 17 were female (36.2%). Thirty two (68.1%) of them had ulcerative colitis and 15 (31.9%) had Crohn’s disease. Standard institutional sequences for upper and lower abdomen scan included: sagittal and axial T2 TRUFI, axial and coronal fat suppressed T2 TRUFI and coronal and axial T1 VIBE following intravenous (at 60 seconds) contrast medium administration. First group of patients (n=10) had MRI investigations both at active and remission phases, whereas in the second group of patients (n=37) apparent diffusion coefficient (ADC) values, bowel wall thickness and contrast enhancement grades were compared between actively inflamed and non-inflamed bowel segments.

Results: A statistically significant difference was found regarding ADC values and bowel wall thickness measurements in the first group of patients when compared between active and remission phase MRI investigations (p=0.005). Bowel wall contrast enhancement degree did not differ between active and remission phases in the first group (p=0.059). In the second group, there was a statistically significant difference between active and normal bowel segments regarding ADC values, bowel wall thickness and contrast enhancement (p<0.001).

Conclusion: MR enterography and diffusion MRI may be beneficial to determine the degree of inflammation and response to treatment in IBD patients.

İnternal derangement of temporomandibular joint (TMJ) has been described as abnormal relationship beetween the disc, articular eminence, fossa and condyl. İn this study it vvas compared to magnetic resonance imaging and clinical findings of internal derangement of TMJ. Hundered seventy nine joints of hundered patients, who vvere referred from Selçuk University Faculty of Dentistry with daim of internal derangement in their TMJ vvere examined by MRI. Examination vvas performed at closed and opened mouth position in T1, T2, proton vveighted oblique sagittal plane and closed mouth position in coronal plane. These joints vvere joints vvas divided into four groups as normal, reducted (RA), İrreducted (IRA) and with or vvithout degenerative joint changes according to MRI findings. Clinically they vvere classified as in early, intermediate and late stage. Most of the cases vvere in intermediate (%37) and late (%43) stages. İn early, intermediate, late stages the joints vvere determined normal: 66%, 42%, 10%; RA .26%, 44%, 23%; IRA: 8%, 14%, 67% by MRI respectively. İn RA and IRA joints pain 64%, 83%, limited mouth opening 23%, 66%, clicing 62%, 26%, crepition 11%, 39% vvere found by clinical examination, respectively. Degenerative change of osseos component at the joints vvere freçuently seen in the joints vvith IRA and crepitation. İn the clinical examination of TME vvere significant findings. Also the presence of osseos degenerative changes, vvhich could not be determined by clinical examination, are very important. Because they influence the treatment type and effctivity. We think that in determination of TME joint disfunction, clinical examination and MR findings should be evaluated together.

It is known that development of lacunar infarcts were seen due to involvement of lentikulositrial and talamoperforan arteries in hypertension and diabetes mellitus. In this study, we aimed to compare ADC (apparent diffusion coefficient) values of basal ganglia and talamus free of lacunar infarct in patients with diabetes mellitus and hypertension and individuals who have not any systemic diseases. Cranial MR imagings of 52 patients with hypertension, 8 patients with diabetes mellitus and 116 patients with a symptom like headache or vertigo but without any systemic disease were analyzed for ADC values at the levels of caudat nucleus, thalamus and lentiform nucleus. Results were evaluated for statistically. Statistically important difference was found between individuals without systemic disease and patients with diabetes mellitus for ADC values of left lentiform nucleus (p< 0.05). Statistically important difference was determined between hypertensive patients and healthy individuals for ADC values of both thalamus and lentiform nucleus (p<0.05). Even there is no distinct lacunar infarct, differences in ADC values of basal ganglia and thalamus in patients with diabetes mellitus and hypertension may represent microscopic chronic ischemia or developing lacunar infarct.

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.

Vesicovaginal fistula cases treated in our clinic betvveen 1983-1998 has been evaluated retrospectively. Etiologic causes and approaches to treatment have been discussed. 70.6 % of the cases were caused by gynecologic re- asons vvhereas the remaining 29.4 % were due to obstetric reasons. Three cases treated by electrocoagulation, eleven cases by transabdominal-transvesical approach and another three by transvaginal approach. After eva- luation of the results, 66.6% (2/3) success rate has been reached with electrocoagulation while this rate was 100% (3/3) at transvaginal methods and 72.7% (8/11) with transabdominal-transvesical approach. Three cases which failed at the first application of transabdominal-transvesical method ended up with recovery after the se- cond treatment with the same method. Although the number of cases are not enough to give a solid decision, we concluded that the transvaginal approach may be preferred as a first method in vesicovaginal fistula by con- sidering the lesser amount of morbidity, minimum blood loss, easiness of operation and control över the operated area, shorter hospital stay and simultaneous treatment of stress incontinance.

Pulmonary edema following the obstruction of an upper airway is an uncomman and unpredictable clinical situation. In this case report, it was aimed to discuss the ethiology, pathophsiology, diagnosis and treatment methods of negative pressure pulmonary edema (NPPE) that developed just after the resolution of laringopasm in the patient who underwent to gynecologic operation. Early diagnosis and treatment can affect the mortality and morbidity in NPPE.

Aim: To assess prospectively the role of resistive indicies (RI) in determining the response to radiotherapy by transvaginal color doppler ultrasound (TVCDUS) and to correlate the results with MRI findings. Material and Method: 13 patients with advanced stage (>stage IIA) cervical cancer evaluated by MRI of the pelvis and TVUS before and 6 months after radiotherapy treatment. The mean resistive indicies before and after daiotherapy were measured from the periphery and the center of the tumor and were compared. These values were further correlated with both MR findings and RI values of the control group. Results: B mode TVUS identified the mass of all patients before therapy. RI measured 0.20-0.82 (mean=0.52) and 0.70-0.99 (mean=0.81) before and after the radiotherapy respectively in 13 patients. 11 showed full response clinically and accordingly, MR showed no residual tumor. MR examination and US showed residual tumor in two patients. The increase in RI before and after the radiotherapy was statistically significant (p=0.001) in the full response group. RI did not increase in two patients with residua. The mean RI measured from the control group was 0.65 and was significantly higher than the RI of the patients measured before therapy. Conclusion: Spectral features of TVCDUS can be a good alternative in the follow up response of cervix carcinoma to therapy, since a significant correlation between MRI findings and RI measurements are found.

Intraventricular hemorrhage (IVH) is a common complication associated with delivery in preterm neonates. Germinal matrix, subependymal layer of lateral ventricle is the most occurring site of intraventricular hemorrhage. IVH is imaged as a hyperechogenic area and ventriculomegaly on ultrasonography, but it is detected easily by fetal magnetic resonance imaging (MRI). The present case was referred to our clinic due to ventriculomegaly on ultrasonography. Germinal matrix was determined on the fetal cranium with ultrasonography and intrauterine MRI at 30th weeks of gestation. The pregnancy was terminated by cesarean section due to severe preclampsia. Fetal MRI should be performed to confirm the diagnosis on the cases with suspect ventriculomegaly.

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.

This report includes, the cases 446 (totalmy 6090) who applied at the Obstetrics and Gynecology Department of Medical School at Selçuk University, between the 1988-1989. 446 vaginal cultures and smears that taken from women with genital discharge have been sent to laboratuary. Cultures and anilbiogramks at the laboratory of microbiology Department at Selçuk Medical School and smears at the laboratory of Patology Department al selcuk Medical School have been examined. Therapie has started appreciated get hold of results and geynecologic diagnosis of paiients. Il has been study, that giyen information about genital hygien and cervical malignancy in our region.

Unicornuate uterus with rudimentary horn is the rarest congenital anatomic anomaly of women genital system and usually develops following insufficient development of Mullerian ducts causing many life threatening obstetrical and gynecologic complications unless diagnosed and managed properly. We present a 31 years old patient applied to our clinic with a his-tory of 4 months amenorrhea and progressively incerasing low abdominal pelvic pain. Abdominal sonographic examination revealed a nonviable fetus at 16 weeks of gestation, lying in a rudimentary horn. Elective laparotomy was performed and the unrupture rudimentary horn with a nonviable fetus was totally excised by laparatomy. Post-operative recovery was uneventful. The need for a high index of suspicion and the role of ultrasonography in the accurate diagnosis is highlighted.

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.

Objective: Mucormycosis is an infrequent opportunistic fungal infection which may cause an aggressive and invasive soft tissue necrosis. It is usually developed in patients with immune system deficiency, and rarely seen in immunocompetant patients.  We report prognosis and treatment of the immunocompetant patients that developed facial cutaneous mucormycosis after short term corticosteroid therapy.

Material and Method: The patients who were admitted to Manisa Celal Bayar University Hospital after multitrauma and given short term corticosteroids due to cranial and spinal injuries and became immuncompromised and diagnosed as facial cutaneous mucormycosis between 2016 and 2018 were included in the study. Prognosis, medical and surgical treatment outcomes of therapy is reported.

Results: One patient with malar and maxillary involvement was treated with medical therapy and serial debridements and infection was cured. Reconstruction with free flaps were done, acceptable functional and aesthetic results were achieved. Two patients had adequate therapy and reconstructed with local flaps.   One patient was not operated due to recurrent fungal osteomyelitis and intracranial inflammatory findings, and regression in MRI was seen.

Conclusion: Mucormycosis should be kept in mind in contaminated wound infections in patients who have been treated with corticosteroids even for a short time after multitrauma. Rapid, repetitive and aggressive debridemants should be performed and reconstruction should be planned after cure of the fungi.

Introduction: Our aim is to evaluate the cardiac involvement of Neurofibromatosis type 1  patients in our region and to compare them with other clinical findings. In this study, we wanted to show the frequency and variety of cardiac involvement.

Material and Methods: Patients diagnosed with Neurofibromatosis type 1  in Hatay Mustafa Kemal University Medical Faculty Pediatric Neurology Clinic between 01/09/2019 and 01/09/2020 were included in the study. The patients included in the study were examined by a Pediatric Cardiology Specialist, and echocardiography and electrocardiography were taken. Demographic information, examination findings, brain magnetic resonance images were collected from the files of the patients. Electrocardiography and echocardiography were examined and recorded by the Pediatric Cardiology Specialist.

Results: We accepted 17 patients from our center to the study. Six patients (35.3%) were diagnosed with sporadic Neurofibromatosis type 1, while 11 patients (64.7%) had familial Neurofibromatosis type 1. All of our patients had cafe au late spots on the skin. In addition, 10 (58.8%) patients also had axillary and / or inguinal freckles. We detected optic glioma in 3 of our patients with ocular involvement, and lish nodules in 3 of them with papillary edema. When we looked at central nervous system involvement, we encountered various involvements in brain MRIs of 8 (47%) patients. In our cardiac examination, we found QT length in 1 patient’s electrocardiography. In the echocardiography we performed for the detection of cardiac structural pathologies, we detected nodular appearance compatible with subendocardial neurofibroma in 3 patients, mitral insufficiency in 3 patients, patent foramen ovale in 1 patient, atrial septal defect in 1 patient, and bicuspid aorta in 1 patient.

Discussion: In our study, unlike the literature, subendocardial nodular hyperechogenic appearance was present in 3 patients. Although these findings are quite rare, subendocardial nodular hyperechogenic images in 3 of our 17 patients suggest that this pathology may be more common. In addition, one of our patients had a long QT. As far as we know, this is the first case of Neurofibromatosis type 1 and Long QT syndrome. In conclussion; Cardiac involvement in patients with Neurofibromatosis type 1 could more common than mentioned in the literature.

Langerhans cell histiocytosis is a group of idiopathic disorders characterized by the abnormal proliferation of specialized bone marrow-derived Langerhans cells. In this report, we present a rare case of Langerhans cell histiocytosis with CT and MRI in a 2 yearold-boy who developed symptomatic diabetes insipidus and multiple bone ,cranial, lung and spleen metastases during the disease course. A 2-year-old male patient was hospitalized due to complaints of cough, fever, vomitting, diarrhea, achromasia, weakness and rash. Chest X-ray revealed reticulonodular infiltration in both lung fields. Thorax CT revealed diffuse micro and macro nodular type infiltration in both lung parenchyma. On CT and MRI revealed common lytic lesion of skull, vertebra and iliac bone. There are infundibular thickening and absence of posterior pituitary intensity on MRI of pituitary gland. The spleen involvoment is determined by abdominal CT. The diagnosis is confirmed with biopsy of iliac bone. Langerhans cell histiocytosis should be in the differential diagnosis in children having widespread lung, bone, pituitary gland, and spleen involvement on MRI and CT.

In a fifteen years old girl compleining from lom-her and inguinal pain hydropyonephrosis with sto-nes in pelvic kidney has been determined after an in-vestigation with pelvic mass. Not very seldom this sort of patients apply to other clinics.

The aim of this study was to compare laparoscopy to laparotomy in the management of patients with suspected adnexal torsion. Seventy two patients with initial diagnosis of adnexal torsion that presented to our clinic with acute abdomen or were referred from other centers between January 2007 and December 2009 were included in this retrospective analysis. Data regarding age, gravidity, parity, size of adnexal mass, pre-operative and post-operative hemoglobin values, operation time and duration of hospitalization of patients that had adnexal detorsion, cystectomy, oopherectomy, total abdominal hysterectomy and bilateral salpingo-oopherectomy (TAH-BSO) performed via laparoscopy or laparotomy were recorded. Twenty eight patients were treated laparoscopically while 44 patients had laparotomy. In the laparoscopy group 6 cases had detorsion, 17 had detorsion and cystectomy and 5 cases had salpingo-oopherectomy. In the laparotomy group 3 had detorsion, 17 had detorsion and cystectomy, 7 had salpingo-oopherectomy and 17 patients had TAHBSO. Laparoscopy group consisted of young patients with low parity, operation time was shorter in laparoscopy group and the patients were discharged more rapidly. Average adnexal mass size was bigger in laparotomy group. Adnexal torsion is one of gynecological emergency that require urgent operation the most appropriate surgical approach is laparoscopy especially in patients who want to preserve their fertility.

The aim of this prospective study is to evaluate the results of our total laparoscopic hysterectomy (TLH) cases. Forty one patients underwent TLH due to benign or malign disorders were reviewed prospectively between January 2013 and April 2014. Rigid instruments 10 mm telescope, and advanced bipolar energy modalities were used during the procedure. A primary 10-mm trocar was inserted directly through a 1-cm sub umbilical incision. The laparoscope was inserted through this trocar after insufflation of the abdominal cavity with 3–4 L of CO2. The second and third incisions were performed in the avascular right and left lower quadrant of the abdomen and two ancillary 5-mm trocars were inserted through these incisions. Uterine manipulation was performed by using RUMI® II. During the removal of the specimen, if necessary, intracorporeal myomectomy and morcellation were performed before the uterus and ovaries were delivered intact through the vagina. A 0-Vicryl suture was used for close the vaginal cuff. The sutures were passed through the left and right uterosacral and cardinal ligaments in all patients. All procedures were performed by the same surgeon. The mean age of the cases, body mass indexes (BMI), duration of operations, the amounts of blood loss, rates of complications and post operative hospital stay were assessed. The indications of for hysterectomies were, 16 myoma uteri, 6 medical treatment-resistant abnornal uerine bleeding, 5 benign ovarian cyst, 4 adenomyozis, 3 myoma uteri+ovarian cyst, 2 endometrial polyp, 2 endometrioma, 2 endometrial hyperplasia and 1 early stage cervical cancer. The mean age of patients were 47.5 (30-68 years), mean BMI of patients were 30.2 (24-44), mean specimen weight was 215.9 (90-650 gr), mean operation duration was 107.9 (60-210 min), mean blood loss was 81.1 (30-300 ml), mean preoperative hemoglobin (Hb) was 12.5±0.9 gr/ dl, mean postoperative Hb was 11.5±0.8, and the mean hospital stay was 2.5 (2-4 days). There were no intraoperative complications. Late postoperative complication was vaginal vault infection in 2 cases. Total laparoscopic hysterectomy is safe and feasible method for gynecological diseases. Careful selection of patients is critical for obtaining the best results.

Ultrasonography, Doppler ultrasonography and magnetic resonance imaging findings of three cases with choroidal metastasis were evaluated. Two of the cases were women, and one was man. They had pancreas, breast and bronchoalveolar carcinomas, respectively. Two cases presented with blurred Vision. The case with bronchoalveolar carcinoma was detected during the magnetic resonance imaging procedure for cerebral metastasis. İn one of the three patients immediate hypoechogenic, in the remaining two patients hyperechogenic lesions vvhich were protrused to the posterior wall of the globe determined by ultrasography. Doppler ultranography demonstrated that the lesions were vascularised. The lesions were hyperintense in two, and isointense in one case; ali of them were hypointense on T2- vveighted images. İn cases of primary malignancy with eye complaints, radiologic evaluation can be helpful in the elimination of eye metastasis.

Magnetic resonance imaging provides high contrast, anatomic delineation of the neck and is useful for preoperative localization of abnormal parathyroid glands in patients with persistent or recurrent hyperparathyroidism. Magnetic resonance imaging findings of the parathyroid masses are reported in three patients with hyperparathyroidism.

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.

Aim: Diagnosed with multifocal dystonia, the subjects without trauma, exposure to toxic substances, metabolic diseases or the history of chronic drug use were aimed to be discussed in light of literature. Case Report: A 62- year-old man was recruited to our clinic with the complaints of the pain on the right half of the neck, tenderness, contractions on both hands, more definite on the right. In his history, it was determined that the pain on the right half of the neck had been present for two years and the complaint of contraction on the right hand had just started after the right neck pain, and that contraction on the left hand had existed for one year. On his physical examination, a mass which could palpably be felt, in size of 1x1 cm, of neatly framed and tender was observed on the right half of the neck. On the neurologic examination, dystonia existed on both hands, more marked on the right, and tonus had increased on both upper extremities in the nature of rigidity. On the cervical MRI, definite protrusion on C5-6, left paramedian protrusion on C5-6, C6-7 and cord impression on C5-6 were present. Conclusion: What makes our case remarkable is timely correlation between pain on right half of neck and beginning of dystonia on right upper extremity. Chronic pain could lead to movement disorder in the form of dystonia by disinhibitation of the silent spinal cord central pattern generator by causing hyperexitability of spinal interneurons.

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.

ABSTRACT

Objective: Endometrial cancer is the most common malignancy of the female genital tract and the fourth leading cancer among women. Our aim is to share the surgical treatment and results of endometrial cancer cases in our gynecological oncology clinic.

Material and Methods: In this study, the records of 164 endometrial cancer patients operated by the same surgical team between 2009-2019 were reviewed retrospectively. The clinical, surgical and histopathological features of the patients are presented here. Four patients who had sarcoma as a result of pathology, 7 patients who underwent complementary surgery and 1 patient with a second primary tumor were not included in the study.

 

Results: The mean age of the patients included in our study was 61.3 and the mean body mass index was 25.8. According to the postoperative pathology results; mean tumor size was 3.4 cm and mean number of collected lymph nodes was 28.8. Lymph node metastasis was observed in 19 patients and all of the metastases were in pelvic lymph nodes. Endometrioid type adenocarcinoma was seen in 81% of the patients. Myometrial invasion > 50% in 81 patients (49.4%). Twenty patients (12.2%) had cervical involvement, 11 patients (6.7%) had adnexal involvement and 28 patients (17.1%) had lymphovascular area invasion. 76 patients (46.3%) were grade 1, 61 patients (37.2%) were grade 2, 19 patients (11.6%) were grade 3. When the patients were staging according to the FIGO system in 2009, 70 (42.7%) stage 1A, 58 (35.4%) stage 1B, 12 (7.3%) stage 2, 3 (1.8%) stage 3A 17 patients (10.4%) were stage 3C1 and 4 patients (2.4%) were stage 4.

Conclusion: Endometrial cancer is the most common gynecological cancer, and it is usually diagnosed at an early stage as a result of early signs. Tumor size, depth of myometrial invasion and histopathologic grade are used to evaluate the risk of the disease, but studies with a higher number of high stage patients will be more useful in determining the risk.

Definitive diagnosis was made on 41 female patienıs diagnosed to suffer from pelvic ınassa and subjected to US. CT examination of these cases were ıncıde and the US CT findings obtained discussed lin the light of literature.

İn this study, totally 203 patients with iron deficiency anemia who had been hospitalised and became therapy in our department between January 1996-June 2000 were examined. Of the patients143 were female and 60 were male, mean age was 45.09+17.11 year in females and 58.43+14.75 year in male. The mean values of erythrocyte were 3.673.007±677.929/mm3 İn females, 3.520.333±780.210/mm3 in males, haemoglobin was 8.49+2.2 g/dl in females, 7.42±2.3 g/dl in males, hematocrit was 27.1+6.3 % İn females, 23.9+6.3 % in males, mean corpusculer volüme was 70.2±9.3 fl in female, 66.9+10.4 fl in males, serum iron was 27.66±8.5 mcg/dl in females, 25.97+8 mcg/dl in males, serum iron binding capacity was 383.94±56.11 mcg/dl in females, 389.72±48.4 mcg/dl in males, serum ferritin was 4.73+3.3 ng/ml in females, 5.05±3.3 ng/ml in males. Chronic gastrointestinal bleeding and gynecologic bleeding were found to be the most commen causes of iron deficiency anemia in females vvhereas chronic gastrointestinal bleeding in males.

Hemangiomas are the most common congenital lesions and they are the most common tumors of childhood(1). Vascular malformations are common lesions accounting for approximately 7% of all benign tumours(2). Although the head and neck region comprises only 14% of the body surface, 65% of hemangiomas arise from this region(1). MRI in the diagnosis of hemangiomas and hemangiomas regressed with medical therapy in childhood is a very useful imaging method for assessing response to treatment.

Aim: Spinal arteriovenous malformation is a rare pathology located in the dura along the spinal canal. Multi-detector computed tomographic (MDCT) angiography is a recently developed imaging technique. We present findings of magnetic resonance (MR) imaging and multi-detector computed tomographic angiography in 16-year-old patient with spinal arteriovenous malformations. Case report: MR images showed signal voids dilated vessels at the surface of the spinal cord at C1-2 level. Also, multi-detector computed tomographic angiography demontrated dilated varix-like vessels. The patient was diagnosed as having a spinal arteriovenous malformation. Result: Multi-detector computed tomographic angiography can be a non-invasive usefulness technique in detect the spinal arteriovenous malformatios.

In this study, 60 women who had undergone gynecologic operations or laparo~ies ımder ge-neral anaesthesia allocated randonly into three groups (which had 20 patients each) ta receive patient-controlled analgesia with either meperidine combined 141th antiemetics (in group one with on-dansetron and group two with metoclopramide) m-meperidine alone (group 3-placebo). Bolus doses of meperidine 20 mg, and ondansetron 0,5 nig or me-toclopramide 2,7 mg ?vere used with a lockout time of 5 min. During the first 24 h after surgery the mean (range) dose of ondansetron in the on-dansetron group was 2,9 ± 0,9 nıg and me-toclopramide in the metoclopramide group 14,5 ± 4,3 mg. Signıficantly ftwer patients in ondansetron and mewclopramide groups had nausea (P<0,01 and 0,05 respectively). Side effects were not ob-served in any patient. Significantly More patient had the opinion that patient controlled analgesia had provided excellent analgesia when antiemetics were used.

Aim: Investigate the role of Magnetic Resonance Imaging (MRI) in the evaluation of response of the locally
advanced rectal cancer to the chemoradiotheraphy (CR T).
Patients and Methods: T2-weighted and Diffusion Weighted Imaging (DWI) of 24 cases with locally advanced
rectal cancer who have undergone total mesorectal excision 6-8 weeks following the CRT between 2015 and
2020 were evaluated retrospectively. The evaluated radiological parameters were as follows; Tumor morphology,
localization, length, mrT/mrN stages, and extramural vascular invasion (EMVI). Post-CRT MRI residue scoring
was performed (0: No residual tumor, 1: No significant residual tumor, fibrotic wall thickening, 2: Residual tumor
present). Regression grading was as follows; 1: No tumor, 2: Good response, mostly fibrosis, 3: Fibrosis and
mucin more than 50%, 4: Slight response, 5: No response.
Results: There was a significant decrease in the craniocaudal length of tumor and a significant increase
in the mean ADC of tumor after CRT (p=0.001). A significant and high correlation was observed between
histopathological T (pT) and post-CRT mrT (r=0.54, p=0.006). There was a significant correlation between pre-
CRT EMVI and perineural invasion (PNI) (r=0.53, p=0.008). A significant correlation was found between residue
scoring and regression grading (r=0.6; p=0.001), pT (r=0.48; p=0.02), and tumor length (r:0.51; p=0.01). There
was a significant correlation between regression grading and EMVI (r=0.43, p=0.036), PNI (r=0.46, p=0.02), pT
(r=0.41; p=0.048), pN (r=0.55; p=0.006), and metastatic/total lymph node ratio (r=0.46; p=0.02).
Conclusion: Post-CRT MRI is highly correlated with postoperative pathological evaluation of the locally
advanced rectal cancer. MRI is highly successful in re-staging as well as primary staging. The evaluation of
treatment response by MRI regression grading may contribute to the surgical planning.

Intrauterine devices (IUDs) are the most commonly used method of contraception, worldwide, especially in developing countries. Uterine perforation by an IUD is a rare but an important complication of IUD insertion. In this case report; we present, a patient who had “a neglected lost IUD”, in whom string of IUD was not seen in her follow up examination. The patient was told that in spite of the absence of the string; it will reserve its contraceptive effect. The patient had uneventful pregnancy and delivered at term. Thirty eight years old patient who had gravida 4, parity 4 was referred to our clinic because of lost IUD. In her history she had normal vaginal delivery before 2 years, after 6 weeks IUD was introduced in a health centre. She had pelvic pain and consulted the same health centre where she was told that the string was not seen but it will reserve its contraceptive effect. The patient got pregnant and delivered a full term baby. She had normal gynecological examination uterus and adnexa were normal in ultrasonographic examination but an echo of IUD was seen in Douglas. The IUD was extracted laparoscopically. We think that uterine perforation occurred during insertion of the IUD and it passed to Douglas pouch. For patients who have IUDs with lost string we should determine the location of the IUD. Uterine perforation should be thought of when empty uterine cavity is seen.

The purpose of this study was to present, through a retrospective case series, results of the patients who were treated arthroscopically for anterior glenohumeral instability. We evaluated 41 patients. Mean follow-up of the patients were 45 months (range 32-80). There were 4 (10%) female and 37 (90%) male with a mean age of 32 (range 24- 44). There were 27 (65%) right and 14 (35%) left shoulders. Dominant side was injured in 25 patients. All of the patients were suffered from a traumatic shoulder dislocation. Many etiological factors are responsible for these traumatic dislocations like swimming, falling on the side while playing soccer or volleyball or a direct trauma to the shoulder. MRI was performed before the surgery and it was found to be a Bankart lesion for all the patients. Also, all patients were evaluated according to Rowe and Constant scores. Postoperatively, mean Rowe score was 87 (range 15-100) and mean Constant score was 95 (range 88-100). Excellent resuls were obtained in 33 (80.5) patients. There were 8 (19.5) patients of recurrences and 2 of them had arthroscopic revision surgery and Laterjet procedure was performed for the latter 2 patients. Arthroscopic shoulder surgery is a long learning curve, requiring the training process but also has the advantages of less bleeding, easy rehabilitation and wound healing. As a result, this effective method can be performed for recurrent shoulder instability patients with less complication rates.

The patient has blunt abdominal pain and asyptomatic. The diagnosis of morgagni hernia is X-Ray pnemoperiteneum and CT. The patiend was re-pair surgical treatment. THe diagnosis of silent mor-gagni hernia can he revealed bly using modern ima-ging techniques such as CT or MRI.