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Öğe Color Doppler sonography examination of partially obstructed kidneys associated with ureteropelvic junction stone before and after percutaneous nephrolithotripsy(Blackwell Publishing Asia, 2005) Kiliç, S; Altinok, MT; Ipek, D; Beytur, A; Baydinç, YC; Günes, GAim: To evaluate resistive index (RI) changes before and after unilateral percutaneous nephrolithotripsy in chronic partially obstructed kidneys due to ureteropelvic junction (UPJ) stones. Methods: Intrarenal RI of obstructed and contralateral normal kidneys of 18 patients were recorded immediately before the operations and at postoperative days 1, 7 and 30. Postoperative RI measurements were compared with baseline values for all patients without grouping and separately for different groups according to the preoperative RI value of the obstructed kidney. Results: Mean age and symptom duration were 27.5 years and 43.8 weeks, respectively. Preoperatively and at all postoperative controls, kidney diameters and renal parenchyma thicknesses were normal in all patients. Mean RI of obstructed kidneys decreased from 0.68 to 0.63 for all patients (P = 0.032), from 0.64 to 0.63 for those with preoperative RI < 0.70 (P = 0.850) and from 0.73 to 0.62 for those with preoperative RI >= 0.70 (P = 0.001). In patients with preoperative RI >= 0.70 in obstructed kidney, significant RI decreases were recorded at postoperative day 7 and RI differences between obstructed and contralateral kidneys disappeared after then. No difference was present pre- and postoperatively between the mean RI of obstructed and contralateral kidneys of the patients with RI < 0.70. Mean RI of contralateral kidneys were normal preoperatively and showed no significant change postoperatively. Conclusions: Preoperative RI levels may indirectly reflect the presence of functionally significant obstruction in chronic obstructed kidneys related to UPJ stones. Patients with RI >= 0.70 may have a good indication for a surgical approach. Normalization of high RI occurs rapidly after percutaneous nephrolithotripsy.Öğe Doppler waveforms and blood flow parameters of the superior and inferior mesenteric arteries in patients having Behcet disease with and without gastrointestinal symptoms -: Preliminary data(Amer Inst Ultrasound Medicine, 2003) Sigirci, A; Senol, M; Aydin, E; Kutlu, R; Alkan, A; Altinok, MT; Yologlu, SObjective. To evaluate hemodynamic changes in mesenteric arteries in patients with Behcet disease with and without gastrointestinal symptoms. Methods. Doppler sonography of mesenteric arteries was performed in 25 symptomatic and 15 asymptomatic patients having Behcet 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 significantly 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<.0031; 83±48 mL/min; P<.004). Conclusions. In this study, symptomatic patients with gastrointestinal Behcet 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 Behcet disease without gastrointestinal symptoms is not significantly different from that of healthy controls.Öğe Rare case of neuroendocrine small cell carcinoma of the endometrium with paraneoplastic membranous glomerulonephritis(Pensiero Scientifico Editor, 2003) Meydanli, MM; Erguvan, R; Altinok, MT; Ataoglu, O; Kafkasli, ASmall cell carcinomas are well-recognized tumors known to occur predominantly in the lung. These neoplasms are occasionally associated with a variety of paraneoplastic syndromes. Four cases of paraneoplastic glomerulopathy associated with small cell lung carcinoma have been reported. However, there have been no reports in the literature indicating an association between endometrial small cell carcinoma and paraneoplastic glomerulopathy. We report a case of neuroendocrine small cell carcinoma of the endometrium associated with membranous glomerulonephritis (MGN), which appeared to be a component of an unusual paraneoplastic syndrome. A 33-year-old multiparous woman presented with abnormal vaginal bleeding and abdominal bloating. Endometrial biopsy revealed neuroendocrine small-cell carcinoma of the endometrium. On the eighth day of hospitalization the patient suddenly developed renal failure. Renal biopsy revealed MGN, probably due to tumor-antigen-related immune complex deposition. Small cell carcinoma of the endometrium may be associated with paraneoplastic MGN. Medical staff should take into account the possibility of a preexisting glomerular injury when managing a patient with small cell carcinoma of the endometrium.Öğe Sonographic evaluation of the carpal tunnel after provocative exercises(Amer Inst Ultrasound Medicine, 2004) Altinok, MT; Baysal, O; Karakas, HM; Firat, AKObjective. Dynamic carpal tunnel syndrome (CTS) is a subtype of CTS in which symptoms usually subside with rest and return with repetitive motions. In this subgroup, nerve conduction studies, performed at rest, are often inconclusive. In this study, the diagnostic value of provocative sonography was evaluated in patients with dynamic CTS. Methods. Twenty wrists of 13 patients with dynamic CTS and 10 control subjects were investigated with sonography before and immediately after provocative exercises imitating work-related stresses. In addition to conventional indices (palmar displacement, nerve area at the middle level, and swelling ratio before and after exercise), 2 newly formed indices (provocative nerve area ratio and provocative palmar displacement ratio) were investigated. Results. In the pre-exercise period, there were no significant differences between patients and control subjects regarding palmar displacement and the swelling ratio. The difference was significant (P = .035) for the nerve area at the middle level. In the post-exercise period, all parameters were significantly different between patients and control subjects. The nerve area at the middle level and the swelling ratio had higher significance (P < .0001) than palmar displacement (P = .015). The post-exercise swelling ratio had the highest sensitivity (95%) in diagnosing dynamic CTS when a cutoff value of 1.26 was used. The provocative palmar displacement ratio had high sensitivity (80%) and the highest specificity (90%) for a cutoff value of 1.28. Conclusions. Provocative exercises increase sensitivity and specificity and contribute to the sonographic diagnosis of dynamic CTS. This examination should be performed if electrodiagnostic test results are negative.
