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Öğe Abscess in adenomyosis mimicking a malignancy in a 54-year-old woman(2003) Erguvan R.; Meydanli M.M.; Alkan A.; Edali M.N.; Gokce H.; Kafkasli A.Background: Although there are a few reports describing abscess formation in endometriotic foci no report of abscess formation arising de novo within adenomyosis appears in the literature. Preoperative diagnosis of adenomyosis is frequently difficult because of non-specific signs and symptoms. Synchronous pelvic pathologies such as leiomyoma, endometrial polyp, endometrial hyperplasia, as well as endometrial cancer may cause differential diagnostic problems. Case: A 54-year-old postmenopausal woman complaining of inguinal pain, nightsweats and hot flashes is presented. Radiologic examinations of the pelvis revealed a 95 x 85 mm leiomyoma-like lesion including a 53 x 43 mm cystic space and 9 x 6 mm papillary formation within the uterus raising clinical suspicion of malignancy. A total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed accompanied by a frozen section diagnosis. The frozen section revealed an abscess formation arising in a focus of adenomyosis. The postoperative period of the patient was uneventful. Conclusion: The present case, to our knowledge, is the first report representing abscess formation in adenomyosis. Abscess arising within adenomyosis can strongly raise the suspicion of endometrial cancer, particularly if the patient is postmenopausal. If endometrial cancer cannot be ruled out with definitive histopathological diagnosis in the preoperative period, a frozen section becomes mandatory during surgical intervention.Öğe Adrenoleukodystrophy: single voxel MR spectroscopy findings (case report)(2004) Alkan A.; Kutlu R.; Aslan M.; Yakinci C.Adrenoleukodystrophy is a rare genetic disorder. Histopathological features of this disorder include demyelination and axonal loss in white matter. We describe a six-year-old boy with significantly decreased N-acetyl-aspartate (NAA)/Creatin (Cr), increased Choline (Cho)/Cr and Myo-inositol (MI)/Cr in parieto-occipital white matter by MR spectroscopy. In contrast to the normal appearance of frontal white matter on MR imaging, increased Cho/Cr and MI/Cr ratios were detected on MR spectroscopy. These changes in involved areas could be an indication of neuroaxonal loss, demyelination and gliosis.Öğe Associated brain anomalies and clinical findings in corpus callosum dysgenesis(2003) Alkan A.; Kutlu R.; Baysal T.; Sigirci A.; Altinok T.; Orkan I.; Hallaç T.PURPOSE: The aim of this study was to evaluate the relationship between the types of the corpus callosum dysgenesis, the associated brain anomalies and clinical findings. MATERIALS AND METHODS: We analyzed the MR imaging findings in 169 patients with callosal dysgenesis. Corpus callosum dysgenesis was categorized into agenesis, hypogenesis and hypoplasia. The associated brain anomalies and clinical findings were evaluated. RESULTS: Associated brain anomalies were observed in 148 patients (87.5%). Twenty-one patients (12.4%) had isolated corpus callosum dysgenesis. Dysgenesis included agenesis in 22 (%13), hypogenesis in 46 (27.2%), and hypoplasia in 101 (59.7%) patients. The clinical findings were most commonly observed in patients with hypoplasia. CONCLUSION: The presence of corpus callosum dysgenesis is a strong indication of possible associated brain anomalies. Corpus callosum dysgenesis and associated brain anomalies should be investigated in children with developmental delay, seizures and microcephaly.Öğe Atlanto-axial subluxation associated with Rubinstein-Taybi syndrome(Elsevier BV, 2003) Si?irci A.; Yakinci C.; Alkan A.; Aslan M.; Si?irci A.; Kutlu R.A case of atlanto-axial subluxation in a 5-year-old boy with Rubinstein-Taybi syndrome (RTS) is presented and the imaging findings are evaluated. To the best of our knowledge, atlanto-axial subluxation has not been reported in association with this syndrome. © 2003 Elsevier Ireland Ltd. All rights reserved.Öğe Bilateral seminal vesicle and unilateral renal agenesis in case with primary infertilism(2007) Erdem G.; Karakaş M.H.; U?ra-ces M.; Alkan A.; Altinok T.; Do?anay S.Introduction: Agenesia of the seminal vesicle is an uncommon cause of the male infertility. While unilateral agenesia of seminal vesicle is observed in 0.6-1% of male population, bilateral agenesia is extremely rare. These malformations may be associated with unilateral or bilateral agenesia of the vas deferens or unilateral renal agenesia. 70-80% of the cases with bilateral agenesia of the seminal vesicle have gene mutations related to cystic fibrosis. In his article we presented the ultrasenographic and magnetic resonance imaging findings of bilateral agenesia of the seminal vesicle and unilateral renal agenesia in primary infertile case who has not cystic fibrosis. Materials and Methods: Pelvic magnetic resonance imaging (MRI) and abdominal ultrasonography was utilized in 29 years old male patient with primary infertility. Results: Bilateral seminal vesicle agenesis was found in MRI. In spermiogram, neither live nor dead spermium was detected. Abdominal ultrasonography was yielded as unilateral renal agenesis and contralateral compensatris hypertrophy consecutively on left and right sides. Conclusion: Pelvic and transrectal ultrasonography gives valuable data on investigation of the etiology of primary infertility. Pelvic MRI is important to distinguish the hypoplasia and the agenesis of the seminal vesicle.Öğe Celiac ganglion blockade: the effectiveness of CT guided percutaneous anterior approach(2003) Alkan A.; Durak A.C.; Ozcan N.; Kutlu R.; Baysal T.; Sigirci A.PURPOSE: To investigate the effectiveness and safety of celiac ganglion blockade in cases with abdominal malignancies who are narcotic analgesic dependent for control of severe abdominal pain. MATERIALS AND METHODS: A total of 30 celiac ganglion blockades were performed in 27 patients between the ages of 19 and 75. A 22 G Chiba needle was placed through the percutaneous anterior approach into the celiac ganglion region under the guidance of CT, and 98% alcohol was administered. The procedure was repeated in three cases due to insufficient response. RESULTS: In 24 (88.8%) of the 27 cases, the severity of pain decreased. Total relief of the pain was achieved in 13 (48.1%) cases. In 9 (33.3%) cases pain was controlled with non-narcotic analgesics. In 2 (7.4%) cases, the dose of the narcotic analgesic decreased. There was no change in the severity of the pain in 3 (11.1%) cases. Transient complications were diarrhea in 4 (14.8%), hypotension in 6 (22.2%) cases and hemiparesis in one (3.7%) case. CONCLUSION: Celiac ganglion blockade through the percutaneous anterior approach under the guidance of CT should be preferred for the control of pain in the early periods in cases with abdominal malignancies, especially gastric and pancreatic, due to easy performance, safety, lower incidence of complications, high success rate and low cost.Öğe Clinical outcomes of neonatal hypoxic ischemic encephalopathy evaluated with diffusion-weighted magnetic resonance imaging(2006) Da? Y.; Firat A.K.; Karakaş H.M.; Alkan A.; Yakinci C.; Erdem G.Purpose: Detection of early phase neurological deficit in babies with hypoxic-ischemic encephalopathy (HIE) is the most important step to determine the appropriate preventive treatment methods. Diffusion-weighted imaging (DWI) is the most sensitive radiological modality to detect ischemic changes in the brain, in their earliest phase. Herein, we present the results of our study about the role of DWI in the diagnosis and determining the prognosis of HIE in neonates. Materials and methods: The study included 36 cases (4 preterm, 32 term babies) who were diagnosed with HIE within 24 hours of birth and classified according to modified Samat staging. They were examined for the presence of neurological sequelae at 3 and 6 months of age with electroencephalography (EEG), visual evoked potential (VEP), brainstem auditory evoked potential (BAEP), and Denver II developmental screening tests. All 36 patients underwent conventional magnetic resonance (MR) imaging and DWI within the first 24 hours of birth; survivors underwent repetitive imaging exams at the end of the first week and then after a month. Results: Seventeen stage I cases (47%), 12 stage II cases (33%), and 7 stage III cases (20%) were detected. DWI obtained within the first 24 hours showed high sensitivity (100%) in detecting the permanent neurological sequelae but with very low specificity (20%). The negative predictive value of DWI in this period was 100%; however, in DWI obtained at the end of the first month, not only its sensitivity was preserved, but its specificity reached 80%. The negative predictive value of DWI in this period was preserved and the positive predictive value improved. The importance of DWI in detecting sequelae at the end of the first month was also demonstrated by McNemar (p = 0.250) and Kappa (Kappa = 0.719) tests. There was no difference between conventional MR imaging and DWI in detecting sequelae at the end of first month. Conclusion: DWI is superior to other imaging modalities in detecting ischemia; not only because of its high sensitivity in the early phase, but also because of its high sensitivity and specificity in the late phase. Moreover, with its high negative predictive value, DWI can be used for excluding the possibility of sequelae development in the early phase of HIE cases for medico-legal purposes. © Turkish Society of Radiology 2006.Öğe Computed tomography guided percutaneous nephrostomy(2003) Baysal T.; Soylu A.; Saraç K.; Alkan A.; Dusak A.; Sarier M.Objectives: We investigated the value of computed tomography guided nephrostomies'in patients with absent or minimal pelvicaliceal dilatation and with different kidney anatomy and localization without using ultrasound and fluoroscopy. Material and Methods: We attempted 48 computed tomography guided nephrostomy placements in 40 patients. Both puncture of collecting system and placement of the catheters were made under computed tomography guidance. The Seldinger method was used in all procedures. Results: Percutaneous nephrostomies were successfully achieved in all patients without major complications. There were minimal dilatation of the pelvicaliceal systems in 28 (58.3%) of 48 nephrostomies. Four patients had obesity, and another 4 had rotation anomaly. One patient had both ectopic located and malrotated kidney. One patient had subcapsular haematoma and another one had retrorenal colon variation. Eighteen of the percutaneous nephrostomies were made intercostally. Single puncture was used in 35 (73%) and twice puncture were used in 13 (27%) procedures. The time necessary for the procedure ranged from 17-36 min (mean 28 min). Conclusion: Computed tomography guided percutaneous nephrostomy is a safe method with low rate of complications especially in patients with obesity, without pelvicaliceal dilatation or with minimal dilatation and patients with ectopic, malrotated kidneys and retrorenal colon variations.Öğe Diffusion-weighted magnetic resonance imaging and magnetic resonance spectroscopy features of abdominal viscera in a patient with Gaucher's disease(Malaysian Journal of Medical Sciences, 2014) Kalayci T.O.; Erdem G.; Kutlu R.; Kahraman A.; Alkan A.A 46-year-old woman with Gaucher's disease (GD) consulted our clinic for abdominopelvic magnetic resonance imaging (MRI), as physical examination had revealed hepatosplenomegaly. Upper abdominal MRI showed massive hepatosplenomegaly and innumerable hypointense splenic nodules on T1-weighted images. Diffusion-weighted MRI (DW-MRI) and magnetic resonance spectroscopy (MRS) were performed to liver parenchyma and splenic nodules. MRS revealed lactate, lipid, acetate, and alanine peaks in splenic nodules, and choline, creatine, lipid, myo-inositol-glycine, and lactate peaks in the liver parenchyma. The DW-MRI showed diffusion restriction in splenic nodules. It was concluded that MRI is a reliable method for the diagnosis and follow up of GD. Coupling DW-MRI and MRS allows quantitative evaluation, thereby increasing the efficacy of the method. This is the first report in the literature presenting advanced abdominal MRI findings in GD. © Penerbit Universiti Sains Malaysia, 2014.Öğe Doppler waveforms and blood flow parameters of the superior and inferior mesenteric arteries in patients having Behçet disease with and without gastrointestinal symptoms: Preliminary data(John Wiley and Sons Ltd, 2003) Si?irci A.; Şenol M.; Aydin E.; Kutlu R.; Alkan A.; Altinok M.T.; Yolo?lu S.Objective. To evaluate hemodynamic changes in mesenteric arteries in patients with Behçet disease with and without gastrointestinal symptoms. Methods. Doppler sonography of mesenteric arteries was performed in 25 symptomatic and 15 asymptomatic patients having Behçet disease and in 25 healthy control subjects. The peak systolic, minimal, and mean velocities, resistive and pulsatility indexes, inner diameter, cross-sectional area, and blood flow volume of mesenteric arteries were evaluated. The results were compared between patient groups and controls. Results. The mesenteric artery flow was significantly greater in patients in the symptomatic group than in those in the asymptomatic group or in controls. In the superior mesenteric artery, mean velocity and mean blood flow volume (0.35 ± 0.18 m/s and 711 ± 404 mL/min, respectively; P < .0001) in the symptomatic group were significant]y higher than in the asymptomatic group (0.16 ± 0.07 m/s and 305 ± 168 mL/min, respectively) or in controls (0.15 ± 0.07 m/s and 290 ± 123 mL/min, respectively). The mean peak systolic velocity (1.23 ± 0.47 m/s; P < .005) in the symptomatic group was significantly higher than in controls (0.93 ± 0.23 m/s). In the inferior mesenteric artery, mean velocity and mean blood flow volume (0.25 ± 0.10 m/s and 139 ± 79 mL/min) in the symptomatic group were significantly higher than in the asymptomatic group (0.16 ± 0.07 m/s; P < .006; and 78 ± 26 mL/min; P < .007) or in controls (0.17 ± 0.07 m/s; P < .003; 83 ± 48 mL/min; P < .004). Conclusions. In this study, symptomatic patients with gastrointestinal Behçet disease were associated with a significant increase in mesenteric artery flow that could be evaluated easily on spectral patterns of arteries during Doppler sonography. The Doppler sonographic findings also revealed that intestinal involvement in patients with Behçet disease without gastrointestinal symptoms is not significantly different from that of healthy controls.Öğe Effects of testicular microlithiasis on Doppler parameters: Report ofthreecases(BioMed Central Ltd., 2002) Kutlu R.; Sigirci A.; Baysal T.; Alkan A.; Sarac K.Background: Testicular microlithiasis is a rare, usually asymptomatic, non-progressive disease of the testes associated with various genetic anomalies, infertility and testicular tumors. According to our literature search, there is no specific data about Doppler findings in this disease. Case presentation: Doppler findings of three cases of testicular microlithiasis during last two years in our institution are presented. Conclusions: Although our hypothesis was to find increased Doppler parameters due to intratesticular arterial compression, our findings suggest that there are no Doppler findings specific to testicular microlithiasis.Öğe An en-plaque tentorial lesion in a pregnant woman: Follow-up with MRI (2003:2a)(2003) Alkan A.; Parlak M.; Baysal T.; Sigirci A.; Kutlu R.; Altinok T.[No abstract available]Öğe En-plaque tuberculomas of tentorium in a pregnant woman: Follow-up with MRI (2003:2b)(Springer Verlag, 2003) Alkan A.; Parlak M.; Baysal T.; Sigirci A.; Kutlu R.; Altinok T.En-plaque tuberculoma is a rare manifestation of CNS tuberculosis and presents as a solitary, focal, caseous plaque-like lesion. It is difficult to differentiate en-plaque like meningeal tuberculoma from true primary or secondary meningeal neoplasia. Good response to antituberculosis treatment in a patient with tuberculosis history and typical MR findings confirm the diagnosis. We present the follow-up MR imaging findings of a case in which an en-plaque tuberculoma on tentorium was diagnosed during pregnancy in a patient with a history of tuberculosis. To the best of our knowledge, en-plaque tuberculomas of tentorium during pregnancy have not been reported before.Öğe An isolated acute pisiform fracture: Usefulness of magnetic resonance imaging(2004) Altinok M.T.; Ertem K.; Si?irci A.; Alkan A.The incidence of pisiform fracture is very low, and generally it is associated with other carpal or distal radial injuries. We present the case of an acute isolated pisiform fracture suspected on plain films and diagnosed on magnetic resonance imaging (MRI). MRI revealed a fracture line within the pisiform bone and helped to exclude additional fractures and soft-tissue injuries. Immobilization in a short arm cast was applied for 4 weeks, and the patient had good clinical response.Öğe Modulating effect of selenium on gills of fish exposed to heavy metals(2011) Orun I.; Talas Z.; Alkan A.The present study was performed to understand the preventive effect of selenium (Se4+) on heavy metal stress induced by Cd2+ and Cr3+ in rainbow trout. Changes in glutathione peroxidase (GSH-Px), catalase (CAT) and superoxide dismutase (SOD) activity, and in malondialdehyde (MDA) level in gill tissue of rainbow trout after 7 days of exposure to Cd 2+ and Cr3+ were investigated in the presence and absence of Se4+. Heavy metals treated groups exhibited significant decreases (P<0.05) in GSH-Px, CAT, SOD activities of gill, and an increase (P<0.05) in MDA levels, compared to the control. In the presence of Se4+, GSH-Px activity and SOD activity were found to be higher and MDA levels were lower compared with in its absence. In the light of our findings, it could be stated that Cd2+ and Cr3+ lead to dramatic changes in biochemical parameters and selenium caused these parameters to converge to control levels when it was administered concurrently with these heavy metals. Selenium fully or partially restored enzyme activities. Lipid peroxidation was also decreased in selenium treated groups. © by psp.Öğe MR spectroscopy features of normal appearing white matter in patients with lung cancer(Scientific Publishers of India, 2017) Dogan A.; Sigirci A.; Ermis H.; Aytemur Z.A.; Baysal T.; Alkan A.; Yologlu S.Context: Spectroscopic imaging can be helpful to identify metabolite changes in a normal appearing brain parenchyma after MR imaging in patients with lung cancer. Aims: To detect metabolic changes in the cerebellar and cerebral normal appearing white matter with single-voxel H-MR spectroscopy (MRS) in patients with lung cancer. Methods and material: MRS was performed in the Cerebellar White Matter (CWM) and Parietal White Matter (PWM) of patients with lung cancer (n=38; age range: 44-82 y; mean age: 66.1 ± 8.7) and an age-matched control group (n=32; age range: 42-80 y; mean age: 62.9 ± 8). Biopsies of lung masses showed 25 Non-Small Cell Lung Cancer (NSCLC) and 13 Small Cell Lung Cancer (SCLC). NAA/Cr, NAA/Cho and Cho/Cr ratios were calculated. Statistical analysis used: The unpaired-t test was used for the assessment of metabolite ratio differences between patients and control subjects. Mann-Whitney U test was used among SCLC, NSCLC, and control group for the evaluation of metabolite ratio differences. Results: The Cho/Cr ratios in the CWM were significantly lower in the patients compared to controls (p=0.03). The Cho/Cr ratio of patients with SCLC was significantly lower in PWM than both NSCLC (p=0.02) and control group (p=0.03). Conclusion: Decreased Cho/Cr ratio possibly represents increased uptake of Cho or reduced brain function. These results may be important in assessing patients with lung cancer in order to help with treatment planning and prognosis. © 2017, Scientific Publishers of India, All rights reserved.Öğe MR spectroscopy in the differential diagnosis of focal brain lesions in neurofibromatosis type 1 patients(2003) Alkan A.; Kutlu R.; Sigirci A.; Baysal T.; Altinok T.; Dusak A.; Saraç K.PURPOSE: To determine the role of MR spectroscopy in the differential diagnosis of focal brain lesions in neurofibromatosis type 1. MATERIALS AND METHODS: Fifteen patients with neurofibromatosis type 1 were evaluated by routine MRI and single voxel MR spectroscopy (TE: 31). The posterior parietal white matter of 20 age-matched healthy volunteers constituted the control group. NAA/Cr, Cho/Cr and MI/Cr ratios were calculated and compared with the control group. RESULTS: A total of 58 focal brain lesions were detected by MR imaging. When patients with hamartomas and gliomas were compared with the control group, a decrease in the NAA/Cr ratio, and a significant increase in Cho/Cr and MI/Cr ratios were found. The decrease in the NAA/Cr ratio and the increase in Cho/Cr and MI/Cr ratios of gliomas were significant when compared with hamartomas. With MRI and MR spectroscopy findings, 52 hamartomas and 6 gliomas were detected. CONCLUSION: Since MR spectroscopy has the ability to detect cellular metabolic changes, it could provide additional information to MR imaging about the differential diagnosis and treatment planning of focal parenchymal lesions in neurofibromatosis type 1.Öğe Multiseptate gallbladder in a child with chronic abdominal pain: Ultrasonography, magnetic resonance imaging and magnetic resonance cholangiography findings(Elsevier BV, 2003) Kocakoc E.; Kiris A.; Alkan A.; Bozgeyik Z.; Sen Y.; Ozdemir H.Multiseptate gallbladder is a very rare congenital malformation of the gallbladder. We present the magnetic resonance imaging, ultrasonography and magnetic resonance cholangiography appearance of a multiseptate gallbladder in a 9-year-old boy. To our knowledge, this is the first description of the magnetic resonance imaging and magnetic resonance cholangiography appearance of a multiseptate gallbladder. © 2002 Elsevier Science Ireland Ltd. All rights reserved.Öğe Pseudoaneurysm of the internal jugular vein after mumps: Ultrasonographic evaluation(Elsevier BV, 2003) Si?irci A.; Kuranel S.; Kutlu R.; Alkan A.; Altinok T.We report a case of pseudoaneurysm following mumps infection in the left internal jugular vein with sonography and Doppler ultrasound findings. The diagnosis was confirmed during surgical exploration. To the best of our knowledge, this is the first case report of an internal jugular vein false aneurysm in the literature. © 2002 Elsevier Science Ireland Ltd. All rights reserved.Öğe Pulmonary embolism after penile deep dorsal vein embolization with n-butyl-2-cyanoacrylate and lipiodol mixture(Elsevier BV, 2004) Kutlu R.; Soylu A.; Alkan A.; Turker G.Venogenic erectile dysfunction is an important problem. Embolization of draining veins through penile deep dorsal vein is an effective alternative endovascular treatment procedure. We report a 27-year-old male with venogenic erectile dysfunction who developed pulmonary embolism after penile deep dorsal vein embolization with n-butyl-2-cyanoacrylate (NBCA) and lipiodol mixture. Although it is uncommon, due to inherent possible complications of liquid embolic material n-butyl-2-cyanoacrylate and lipid soluble contrast material lipiodol, symptomatic pulmonary embolism could be seen after deep dorsal vein embolization if the amount of lipiodol is increased and repeat injection is performed without performing a control venogram. © 2003 Elsevier Ireland Ltd. All rights reserved.
