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    Intracerebral Hemorrhage Related With Penicillium Species Following Deceased-Donor Liver Transplant
    (Baskent Univ, 2021) Yonder, Huseyin; Akbulut, Sami; Kocaaslan, Huseyin; Ince, Volkan; Karadag, Nese; Demirtas, Gokhan; Selimoglu, Ayse
    Early or late posttransplant opportunistic infections are among the leading complications after liver transplant. The source of early posttransplant opportunistic infections is usually the patient, the implantation of an infected graft, contamination during a surgical procedure, or invasive interventions performed at the intensive care unit. A 10-year-old male patient with Wilson disease (Pediatric End-Stage Liver Disease Score of 42, Child-Pugh score of 12, total bilirubin 40 mg/dL, platelet count 55 000/mL, hemoglobin level 6.3 g/dL, albumin level 1.7 g/dL, urinary copper level 4305 mu g/24 h) was closely monitored in the pediatric intensive care unit of our liver transplantation center for care of a worsened general status. A deceased- donor liver transplant was performed using a right lobe liver graft (ex vivo split) obtained through the national organ sharing network. The patient developed rightward deviation of eyes and altered consciousness after the procedure and underwent cranial magnetic resonance imaging and computerized tomography examinations. The cranial magnetic resonance image, taken on the third postoperative day, revealed lesions consistent with embolic infarction, and the computed tomography scan, taken on the eighth day, showed intracerebral hemorrhage. Decompressive craniotomy, which included hematoma drainage and catheter placement, was performed. Culture and histopathologic examinations of the hematoma material revealed a Penicillium species of fungi. However, the patient died before a definitive diagnosis was made. The aim of this report is to raise awareness on early posttransplant opportunistic infections of the central nervous system presenting with intracranial hemorrhage following liver transplant.
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    Is cerebral spinal fluid flow associated with body mass index and head circumference in healthy children? A phase contrast magnetic resonance imaging study
    (Springer, 2020) Demirtas, Gokhan; Sigirci, Ahmet; Ozturk, Mehmet; Gorkem, Sureyya Burcu; Kilic, Betul; Gungor, Serdal
    Background The aim of this study was to investigate the relationship between age, gender, body mass index (BMI), and head circumference (HC) and cerebral spinal fluid (CSF) flow dynamics in the pediatric population. The prospective study included a total of 137 participants, 75 boys and 62 girls, ranging in age from 2 to 204 months. Quantitative evaluation of CSF flow was made by using phase contrast magnetic resonance imaging (PC-MRI) in the axial plane at the level of the aqueductus cerebri. Flow dynamics were recorded as peak and mean velocity (cm/s); cranial, caudal, and net volume (ml); and aqueductus cerebri area (mm(2)). Correlation between baseline descriptive parameters, including age, gender, BMI, and HC, and the aforementioned CSF flow dynamics were investigated. Results The net volume was significantly lower in girls (p= 0.002). There was no association between age and aqueduct area, mean velocity, and cranial volume. The peak velocity was remarkably higher in children (p= 0.03), whereas cranial and net volume were found to be lower in infants (p= 0.04 andp= 0.03, respectively). Notably, cases with HC below normal values had lower cranial, caudal, and net volume and aqueductus cerebri area (p= 0.01,p= 0.03,p= 0.03, andp= 0.04, respectively). There was no association between BMI and indicators of CSF flow dynamics in PC-MRI. Conclusion BMI and HC may be associated with CSF flow dynamics in children. A smaller HC is accompanied by a lower forward flow volume, reverse flow volume, net volume, and aqueductal diameter. These points should be remembered during the design of further trials on determinants of CSF flow in children.
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    Unusual Symptomatic Multipartite Patella Associated with Quadriceps Fat Pad Edema
    (Ubiquity Press Ltd, 2016) Ozdemir, Zeynep Maras; Gormeli, Cemile Ayse; Kahraman, Aysegul Sagir; Demirtas, Gokhan; Gormeli, Gokay
    Partite patella is a known cause of anterior knee pain, especially in adolescents and young males, although most patients are asymptomatic. Symptomatic partite patella is usually revealed on magnetic resonance imaging (MRI) as bone marrow edema within the opposing bone fragments. We present a case of unusual bilateral symptomatic multipartite patella in an adult who presented with quadriceps fat pad edema and mass effect as well as slightly edematous signal changes within the bone fragments on MRI. This case indicates that symptomatic partite patella can also present with edema-like imaging findings in the adjacent soft tissue due to chronic mechanical irritation.