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Öğe Bilgisayarlı tomografi eşliğinde perkütan nefrostomi(Türk Üroloji Dergisi/Turkish Journal of Urology, 2003) Baysal, T.; Soylu, A.; Saraç, K.; Alkan, A.; Dusak, A.; Sarıer, M.Öz: Bu çalışmada ultrasonografi veya floroskopi yardımı olmadan bilgisayarlı tomografi (BT) eşliğinde yapılan perkutan nefrostomilerin (PN), özellikle pelvikalisiyel dilatasyonu minimal olan veya hiç olmayan hastalarla, böbrek anatomisi ve yerleşimi normalden farklı hastalardaki yeri araştırıldı. Çalışmaya toplam 40 hastaya BT eşliğinde uygulanan 48 PN'nin (8 hastada bilateral) verileri dahil edildi. Uygulama Seldinger yöntemine uygun olarak yapıldı ve BT hem pelvikalisiyel sisteme iğne girişinde hem de kateter yerleştirmede kullanıldı. Perkutan nefrostomi hastaların tümünde başarıyla gerçekleştirildi. İşlemler sırasında herhangi bir majör komplikasyon gözlenmedi. Perkutan nefrostomi uygulanan 48 böbreğin 28'inde (%58.3) minimal pelvikalisiyel genişleme mevcuttu. Hastaların 4'ünde obezite, 4'ünde ise böbrek rotasyon anomalisi mevcuttu. Bir hastanın böbreği hem ektopik yerleşimli hem rotasyon anomalisine sahipti. Bir hastada önceki PN girişimine bağlı olarak subkapsüler hematom ve bir başka hastada böbrek posterolateraline doğru uzanan kolon segmenti mevcuttu. Perkutan nefrostomi işlemlerinin 18'i interkostal aralıktan yapıldı. Perkutan nefrostomi 35 (%73) işlemde tek iğne girişi ile gerçekleştirilirken. 13 (%27) işlemde ikinci kez tekrarlanan iğne girişi ile pelvikalisiyel sisteme ulaşıldı. İşlem süresi ortalama 28 dk (17-36 dk) idi. Bilgisayarlı tomografi eşliğinde PN obez hastalarda, pelvikalisiyel dilatasyonu olmayan veya minimal olan, böbrek anatomisi ve yerleşimi normalden farklı veya retrorenal yerleşimli kolon varyasyonuna sahip hastalarda güvenle kullanılabilecek komplikasyon oranı düşük, güvenli bir yöntemdir. Başlık (İngilizce): Computed tomography guided percutaneous nephrostomy Öz (İngilizce): 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 Blindness following Rupture of Hepatic Hydatid Cyst: A Case Report(Medical Univ Bialystok, 2009) Yucel, N.; Kayaalp, C.; Liceli, A.; Baysal, T.; Yilmaz, M.A 19 year-old woman admitted to Emergency Department with hypotension, sudden loss of vision and acute abdominal pain. Ultrasound and computed tomography demonstrated an occipital infarct in brain and ruptured intraperitoneal cyst of hydatid liver disease. Urgent laparotomy was performed and it included aspiration of cyst contents, peritoneal washing and drainage. Her vision loss improved by 15 hours postoperatively but generalized seizures were started. Weakness in all extremities was present. Cranial MRI demonstrated ischemia in the areas of middle, posterior and anterior cerebral arteries. She was discharged from the hospital with severe neurological deficits (unable to walk, not able to eat herself). Neurological deficits were improved with physiotherapy after two years. There was no recurrence of hydatid cysts in the follow-up of three years. We assumed that anaphylaxis after intraperitoneal rupture of hydatid liver cyst resulted with hypotension and reduced cerebral perfusion, caused the acute vision loss and other neurological symptoms. This unusual presentation of intraperitoneal rupture should be kept in mind particularly in endemic areas of hydatid disease.Öğe The evaluation of MDCT and quantitative first-pass perfusion in lung cancers(Verduci Publisher, 2013) Yildirim, I. O.; Baysal, T.; Celik, M. R.OBJECTIVES: The aim of this study was the in vivo evaluation of tumor angiogenesis in lung cancers grouped according to their histopathological diagnosis, localization and necrosis characteristics determined using CT first-pass parameters. MATERIALS AND METHODS: The study was performed between January and April 2012 on 44 patients consisting of 38 males and 6 females who were diagnosed with lung cancer as a result of cytological and/or histopathological evaluations. Patients who had not received radiotherapy and/or chemotherapy previously were included in the study. Images were obtained for each patient by using the 64-detector MDCT scanner. Colored perfusion maps were created from the obtained images. Perfusion parameter measurements were performed by placing ROI at 3 different locations in the solid sections, avoiding the necrotic cystic areas of the masses. Obtained BV, BF, TTP, and MTT perfusion parameters were recorded. RESULTS: The BF values of central and peripherally located lung cancers that showed normal distribution were found to be statistically significantly different. No statistically significant difference was found between TTP values. The BV values of central and peripherally located lung cancers that did not show normal distribution showed a statistically significant difference. There was a statistically significant difference between the BV and BF values of lung cancer with and without necrosis that did not show a normal distribution and the BV and BF values of lung cancers with and without necrosis. CONCLUSIONS: Non-invasive evaluation of tumor perfusion of first-pass perfusion CT in lung cancers provides valuable information about tumor angiogenesis. However, we believe that peripheral and solid lung cancers will benefit more from treatments such as anti-angiogenetic drugs, radiotherapy and chemotherapy more than the centrally located and necrotic lung cancers and that perfusion CT will play a greater role in the evaluation of the efficiency of these treatments in the future.Öğe Vascular calcification is not related to serum fetuin-A and osteopontin levels in hemodialysis patients(Springer Netherlands, 2018) Ulutaş, O.; Taşkapan, MC.; Doğan, A.; Baysal, T.; Taşkapan, H.Introduction: Vascular calcification (VC) in hemodialysis (HD) patients is a sign of severe cardiovascular disease and can predict cardiovascular outcomes. Fetuin-A and osteopontin (OPN) inhibit VC. Serum fetuin-A levels are lower in patients with end-stage kidney disease (ESKD) and in those who are on chronic HD therapy. However, there are limited data concerning OPN in patients who are on dialysis. The aim of our study was to determine VC in HD patients, the relationship between VC and 25-OH-vitamin D, fetuin-A, and OPN levels, and independent predictors of VC. Materials and methods: Ninety-three patients with ESKD on HD therapy were recruited. Among these patients, 44 were male and 49 were female. The patient group was compared with a group of 20 healthy controls of similar age and sex. A plain radiograph of the hand was taken using a mammography machine for the evaluation of VC. Serum fetuin-A, OPN, and 25-OH-vitamin D levels of both patients and controls were measured. Results: VC was detected in 45 (48.4%) HD patients. When patients were compared with healthy controls, fetuin-A levels (p < 0.029) were significantly lower in patients, whereas OPN (p < 0.000) and VC (p < 0.002) were significantly higher in the patient group. Age [odds ratio (OR) 1.036], the presence of diabetes mellitus (DM) (OR 17.527), and high parathyroid hormone (PTH) levels (OR 1.002) were independent predictors of VC in a logistic regression model including the following factors: age, the presence of DM, HD duration, and serum albumin, phosphate, PTH, 25-OH-vitamin D, fetuin-A, OPN, and calcium levels. No significant correlation was found between patients with VC and patients without VC in terms of fetuin-A, OPN, and 25-OH-vitamin D levels. Conclusions: VC is a frequent sign in patients undergoing HD and is not related to serum fetuin-A and osteopontin levels. Age, the presence of DM, and high PTH levels were independent predictors of VC in patients undergoing HD. Further studies are warranted to understand the mechanism underlying and the factors contributing to VC.Öğe Vascular calcification is not related to serum fetuin-A and osteopontin levels in hemodialysis patients(Springer, 2018) Ulutas, O.; Taskapan, M. C.; Dogan, A.; Baysal, T.; Taskapan, H.Vascular calcification (VC) in hemodialysis (HD) patients is a sign of severe cardiovascular disease and can predict cardiovascular outcomes. Fetuin-A and osteopontin (OPN) inhibit VC. Serum fetuin-A levels are lower in patients with end-stage kidney disease (ESKD) and in those who are on chronic HD therapy. However, there are limited data concerning OPN in patients who are on dialysis. The aim of our study was to determine VC in HD patients, the relationship between VC and 25-OH-vitamin D, fetuin-A, and OPN levels, and independent predictors of VC. Ninety-three patients with ESKD on HD therapy were recruited. Among these patients, 44 were male and 49 were female. The patient group was compared with a group of 20 healthy controls of similar age and sex. A plain radiograph of the hand was taken using a mammography machine for the evaluation of VC. Serum fetuin-A, OPN, and 25-OH-vitamin D levels of both patients and controls were measured. VC was detected in 45 (48.4%) HD patients. When patients were compared with healthy controls, fetuin-A levels (p < 0.029) were significantly lower in patients, whereas OPN (p < 0.000) and VC (p < 0.002) were significantly higher in the patient group. Age [odds ratio (OR) 1.036], the presence of diabetes mellitus (DM) (OR 17.527), and high parathyroid hormone (PTH) levels (OR 1.002) were independent predictors of VC in a logistic regression model including the following factors: age, the presence of DM, HD duration, and serum albumin, phosphate, PTH, 25-OH-vitamin D, fetuin-A, OPN, and calcium levels. No significant correlation was found between patients with VC and patients without VC in terms of fetuin-A, OPN, and 25-OH-vitamin D levels. VC is a frequent sign in patients undergoing HD and is not related to serum fetuin-A and osteopontin levels. Age, the presence of DM, and high PTH levels were independent predictors of VC in patients undergoing HD. Further studies are warranted to understand the mechanism underlying and the factors contributing to VC.
