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Öğe Analysis of magnetic resonance imaging findings of children with neurologic complications after liver transplantation(Springer-Verlag Italia Srl, 2017) Ozturk, Mehmet; Akdulum, Ismail; Dag, Nurullah; Sigirci, Ahmet; Gungor, Serdal; Yilmaz, SezaiObjective To analyze the magnetic resonance imaging findings in children diagnosed with neurologic complications after liver transplantation (LT). Materials and methods A total of 39 patients diagnosed with neurologic complications following LT between 2010 and 2016. Neuroradiologic imaging was performed using cranial magnetic resonance imaging (MRI). Descriptive statistics regarding age, gender, type of complication, diagnostic and therapeutic modalities were calculated and presented as number and percentage. Results Our series consisted of 18 girls and 21 boys. Cryptogenic hepatitis (n = 13, 32%), metabolic diseases (Wilson's disease, tyrosinemia and glycogen storage disease) (n = 7, 18%) and fulminant toxic hepatitis (n = 4, 11%) constitute the most frequent indications for LT. The indications for neuroradiological imaging were convulsion and alteration of mental status. Conclusion These central nervous system complications may present in a variable spectrum and convulsions and altered mental state were the most frequent clinical pictures. Imaging studies were normal in approximately one-third of cases; the most frequent pathologic findings were diffuse cerebral edema, atrophy, and PRES. Clinical history, careful examination and integrated analysis of radiologic data as well as close collaboration and multidisciplinary approach are of utmost importance for establishing the diagnosis rapidly and accurately.Öğe Analysis of magnetic resonance imaging findings of children with neurologic complications after livertransplantation(Sprınger-verlag ıtalıa srl, vıa decembrıo, 28, mılan, 20137, ıtaly, 2017) Ozturk, Mehmet; Akdulum, Ismail; Dag, Nurullah; Sigirci, Ahmet; Gungor, Serdal; Yilmaz, SezaiObjective To analyze the magnetic resonance imaging findings in children diagnosed with neurologic complications after liver transplantation (LT). Materials and methods A total of 39 patients diagnosed with neurologic complications following LT between 2010 and 2016. Neuroradiologic imaging was performed using cranial magnetic resonance imaging (MRI). Descriptive statistics regarding age, gender, type of complication, diagnostic and therapeutic modalities were calculated and presented as number and percentage. Results Our series consisted of 18 girls and 21 boys. Cryptogenic hepatitis (n = 13, 32%), metabolic diseases (Wilson's disease, tyrosinemia and glycogen storage disease) (n = 7, 18%) and fulminant toxic hepatitis (n = 4, 11%) constitute the most frequent indications for LT. The indications for neuroradiological imaging were convulsion and alteration of mental status. Conclusion These central nervous system complications may present in a variable spectrum and convulsions and altered mental state were the most frequent clinical pictures. Imaging studies were normal in approximately one-third of cases; the most frequent pathologic findings were diffuse cerebral edema, atrophy, and PRES. Clinical history, careful examination and integrated analysis of radiologic data as well as close collaboration and multidisciplinary approach are of utmost importance for establishing the diagnosis rapidly and accurately.Öğe Canavan Disease: A Rare Form Of Leukodystrophy(2017) Dogan, Gulec Mert; Sigirci, AhmetCanavan disease (CD) is a rare autosomal recessive leukodystrophy characterized by spongy degeneration of the white matter of brain. It is characterized by accumulation of N-acetyl aspartic (NAA) acid in mitochondria which inhibits myelin synthesis. Axial hypotonia, ataxia, defects in cognitive functions, defective visual follow and sucking, irritability and macrocephaly are seen in the patients. Increased high NAA peaks are seen magnetic resonance spectroscopy (MRS). Here we report a case with defective head control and could not sit without support who had no other symptoms before. She had axial hypotonia and bilateral nystagmus on neurological examination. The diagnosis of CD is based on these clinical findings and radiologic evaluations.Öğe A case of cardiac cyst hydatid with multiple system involvement(2021) Dogan, Gulec Mert; Dogan, Sait Murat; Tasolar, Sevgi; Okut, Gokalp; Sigirci, Ahmet; Elkiran, Ozlem; Karakurt, CemsitThe larval form of the Echinococcus granulosus causes cystic echinococcosis. The liver and the lungs are the most commonly affected organs. Echinococcosis can also be present in other organs although it is rare. We reported a case with sacral bone, cardiac, lung and liver involvement. Clinical and radiological findings of this unique case were discussed. At the Thoracic Computed On the thoracic computed tomography (CT) scan of a 16-year-old female patient was seen multiple parenchymal and subpleural nodular lesions and a cystic mass in the right ventricular cavity. Echocardiographic examination of the patient also observed on CT. Most cases of cardiac cystic echinococcosis were occurred on adult patients, while only 20 cases were in children. For the 20 reported cases in children, there were 9 cases of cardiac echinococcosis involving left ventricle. Because of the possible complications in the presence of cardiac hydatid cyst, treatment should be surgery.Öğe A Case of Cleidocranial Dysplasia with a Novel Mutation and Growth Velocity Gain with Growth Hormone Treatment(Galenos Yayincilik, 2019) Camtosun, Emine; Akinci, Aysehan; Demiral, Emine; Tekedereli, Ibrahim; Sigirci, AhmetCleidocranial dysplasia (CCD) is a rare congenital autosomal dominant skeletal disorder that is characterized by hypoplasia or aplasia of clavicles, failure of cranial suture closure, dental anomalies, short stature and other changes in skeletal patterning and growth. The gene responsible for pathogenesis has been mapped to the short arm of chromosome 6p21, core binding factor alpha-1 (CBFA1) or runt related transcription factor-2 (RUNX2). Here we describe a CCD patient with a novel mutation in the RUNX2 gene. A five-and-a-half year old girl presented with severe short stature, dysmorphic facial appearance (hypertelorism, prominent forehead, high palate, midfacial hypoplasia), macrocephaly, large anterior fontanelle, increased anteroposterior chest diameter. Her shoulders were close to each other and her bilateral clavicles appeared short on physical examination. Bilateral hypoplastic clavicles, coxa valga, hypoplasia of iliac bones, wide symphysis pubis and phalangeal dysplastic features were detected on her skeletal X-ray examination. She was diagnosed as having CCD. Molecular analysis detected a novel heterozygous mutation 'NM_001024630.3p.T155P(c.463A > C)' in the RUNX2 gene. At age seven years and two months old, because of her severe short stature, growth hormone (GH) treatment was started and she responded well to GH therapy with no adverse effects. In conclusion, hypoplasia or aplasia of the clavicles, failure of cranial suture closure, dental anomalies and short stature should bring CCD to mind. We present a novel mutation in the RUNX2 gene for CCD. We obtained growth velocity gain with GH treatment in our patient.Öğe A case of gliosarcoma in a child with neurofibromatosis type 1(2020) Dogan, Gulec Mert; Sigirci, Ahmet; Cengiz, Aslinur; Erbay, Mehmet Fatih; Gokce, HasanGliosarcoma (GS) is a rarely seen form of glioblastoma. These tumors are mostly seen in males older than 60 years of age. It is extremely rare in pediatric central nervous system (CNS) tumors. In this case report, we present a 3-year-old boy with a giant gliosarcoma. Magnetic resonance (MR) imaging and histopathologic findings are discussed. A 3 year-old boy with a clinically diagnosed NF-1 was admitted to the emergency department with a complaint of intractable vomiting. Magnetic resonance imaging (MRI) of the brain was suggestive of a large lobulated mass lesion in the left parietal lobe extending to the vertex and slightly compressing the left lateral ventricle. The final histopathologic diagnosis of the tumor was considered as gliosarcoma. To our knowledge, this case constitutes the first youngest case with neurofibromatosis type 1 reported in the literature in all pediatric cases of GS.Öğe A case of pediatric infratentorial oligodendroglioma(2019) Dogan, Gulec Mert; Sigirci, Ahmet; Samdanci, EminePediatric posterior fossa tumors most commonly are pilocytic astrocytomas (PA), ependymomas, medulloblastomas, and atypical teratoid rhabdoid tumor (ATRT). MRI has some special radiological findings which can be used in the differential diagnosis. We report on the radiologic images and the clinical course of a 3 year-old-girl with oligodendroglial tumor arising from the cerebellum. There were no focal deficits in the neurological examination. MRI revealed a left cerebellar lesion extending into the left cerebellopontine region causing a pressure and shift in the fourth ventricle, pons and mesencephalon. She underwent a left occipital craniectomy and total tumor decompression. In the pathological examination, mainly oligodendroglial cells were seen in the tumor and they had round nucleus and perinuclear halos. No recurrence was detected at MRI and CT at 6 months postoperatively. Except for the following most common tumors as PA, ependymoma, medulloblastoma and AT/RT in the posterior fossa, the oligodendroglioma must be considered in the differential diagnosis.Öğe The Change in the Renal Pelvis Anterior-Posterior Diameter Between Prevoiding and Postvoiding Status, and Its Correlation With Vesicoureteral Reflux(Lippincott Williams & Wilkins, 2020) Akdulum, Ismail; Akyuz, Melih; Gurun, Enes; Ozturk, Mehmet; Tabel, Yilmaz; Sigirci, AhmetIn this study, our aim was to evaluate the significance of the change in renal pelvis anterior-posterior diameter (RPAPD) before and after micturition between vesicoureteral reflux (VUR)-positive and -negative patients to whom had voiding cystourethrography (VCUG) was performed. In this study, 69 children, age ranging from 0 to 12 years, were included. Before the VCUG imaging, the RPAPD was measured first with a full bladder and then after urination via ultrasound (US). The differences between in RPAPD measurements were noted and values compared made among VUR-positive and -negative children. Data distribution was inhomogeneous, and the Wilcoxon Sign Rank test was utilized instead of Student t test. There was no statistically significant difference in prevoiding and postvoiding RPAPD in VUR (+) and VUR (-) patients (P = 0.672). There was no statistically significant relation between VUR and the presence of hydronephrosis (P = 0.126). Vesicoureteral reflux is more common in patients with urinary tract infections (UTI) (P = 0.001). There was no statistically significant relationship between prevoiding and postvoiding RPAPD change and VUR diagnosis (P = 0,164). Ultrasound is the modality of choice for urinary system evaluation. Diagnosis of hydronephrosis via US is not sufficient in predicting VUR; however, indirect findings may reveal the diagnosis. A decrease in RPAPD in postvoiding US evaluation may not rule out the VUR diagnosis for this reason further imaging modalities, such as VCUG, should be taken into consideration for the patients with clinical suspicion.Öğe Classical Maple Syrup Urine Disease successfully treated with living donor liver transplantation(2021) Dogan, Gulec Mert; Dogan, Sait Murat; Okut, Gokalp; Sigirci, Ahmet; Yilmaz, SezaiMaple syrup urine disease (MSUD) is a disease that causes ketoacid accumulation in body. Diffusion-weighted imaging (DWI) is an important imaging modality for the diagnosis. Two children were diagnosed with MSUD at the neonatal period. They had uncontrolled ketosis and epileptic seizures although they were in compliance with their medical nutrition. Their DWIs were similar and showed high signal intensity localized within the myelinated white matter areas. Both of the patients were treated with living donor liver transplantation. The patients with classic form of MSUD are normal at birth. If the disease is not diagnosed and treated early, it can lead to serious neurological complications. Most researchers conclude that, the best choice for detecting MSUD encephalopathy in newborns is DWI. The traditional treatment of MSUD had been a protein-restricted diet until the liver transplantation became an alternative and better option for the cure of the patients..Öğe Clinical and Imaging Findings in Childhood Posterior Reversible Encephalopathy Syndrome(Iranian Child Neurology Soc, 2018) Gungor, Serdal; Kilic, Betul; Tabel, Yilmaz; Selimoglu, Ayse; Ozgen, Unsal; Yilmaz, Sezai; Sigirci, AhmetObjective Posterior reversible encephalopathy syndrome (PRES) is characterized by typical radiologic findings in the posterior regions of the cerebral hemispheres and cerebellum. The symptoms include headache, nausea, vomiting, visual disturbances, focal neurologic deficits, and seizures. The aim of this study is to evaluate the clinical and radiological features of PRES in children and to emphasize the recognition of atypical features. Materials & Methods We retrospectively examined 23 children with PRES from Mar 2010-Apr 2015 in Inonu University Turgut Ozal Medical Center in Turkey. We compared the clinical features and cranial MRI findings between underlying diseases of PRES. Results The most common precipitating factors were hypertension (78.2%) and medications, namely immunosuppressive and antineoplastic agents (60.8%). Manifestations included mental changes (100%), seizures (95.6%), headache (60.8%), and visual disturbances (21.7%) of mean 3.6 (range 1-10) days' duration. Cranial magnetic resonance imaging (MRI) showed bilateral occipital lesions in all patients, associated in 82.6% with less typical distribution of lesions in frontal, temporal or parietal lobes, cerebellum, corpus callosum, basal ganglia, thalamus, and brain stem. Frontal involvement was predominant, observed in 56.5% of patients. Clinical recovery was followed by radiologic resolution in all patients. Conclusion PRES is often unsuspected by the clinician, thus radiologists may be the first to suggest this diagnosis on an MRI obtained for seizures or encephalopathy. Atypical MRI finding is seen quite often. Rapid diagnosis and treatment are required to avoid a devastating outcome.Öğe Clinical and ımaging findings in childhood posterior reversible encephalopathy syndrome(Iranıan journal of chıld neurology, 2018) Güngör, Serdal; Kılıç, Betül; Tabel, Yılmaz; Selimoğlu, Ayşe; Özgen, Ünsal; Yılmaz, Sezai; Sigirci, AhmetObjective Posterior reversible encephalopathy syndrome (PRES) is characterized by typical radiologic findings in the posterior regions of the cerebral hemispheres and cerebellum. The symptoms include headache, nausea, vomiting, visual disturbances, focal neurologic deficits, and seizures. The aim of this study is to evaluate the clinical and radiological features of PRES in children and to emphasize the recognition of atypical features. Materials & Methods We retrospectively examined 23 children with PRES from Mar 2010-Apr 2015 in Inonu University Turgut Ozal Medical Center in Turkey. We compared the clinical features and cranial MRI findings between underlying diseases of PRES. Results The most common precipitating factors were hypertension (78.2%) and medications, namely immunosuppressive and antineoplastic agents (60.8%). Manifestations included mental changes (100%), seizures (95.6%), headache (60.8%), and visual disturbances (21.7%) of mean 3.6 (range 1-10) days' duration. Cranial magnetic resonance imaging (MRI) showed bilateral occipital lesions in all patients, associated in 82.6% with less typical distribution of lesions in frontal, temporal or parietal lobes, cerebellum, corpus callosum, basal ganglia, thalamus, and brain stem. Frontal involvement was predominant, observed in 56.5% of patients. Clinical recovery was followed by radiologic resolution in all patients. Conclusion PRES is often unsuspected by the clinician, thus radiologists may be the first to suggest this diagnosis on an MRI obtained for seizures or encephalopathy. Atypical MRI finding is seen quite often. Rapid diagnosis and treatment are required to avoid a devastating outcome.Öğe Comparison of posterior cranial fossa morphometric measurements in Chiari type I patients with and without syrinx cavity on magnetic resonance imaging(Int Scientific Information Inc, 2022) Dogan, Gulec Mert; Sigirci, Ahmet; Tetik, Bora; Pasahan, Ramazan; Onal, Cagatay; Arslan, Ahmet K.Purpose: To compare the posterior fossa measurements of Chiari type I malformation (CHM1) patients with and without syrinx and with a control group. Material and methods: The patients with syrinx were divided into 2 groupd according to syrinx width/cord width (S/C) ratios: group 1 - S/C ratio < 50%; group 2 - S/C ratio > 50%. The length of the clivus, the AP length of the foramen magnum, the AP length of the posterior fossa, the perpendicular distance between the McRae line and (a) the splenium of corpus callosum, (b) the pons, and (c) the fastigium of the 160 patients and of the 160 control patients were statistically compared. In addition, the measurements of the patients with and without syrinx, according to the S/C ratio, were statistically compared. Results: Syrinx was present in 59 (36.8 %) of the 160 patients. The S/ C ratio was < 50% in 30 (50.9 %) of them, and S/C ratio > 50% in 29 (49.1%) of them. All the measurements in the patient group, except of the AP length of the foramen magnum, were statistically significantly lower than in the control group (p = 0.001). There was no significant difference in the measurements of the patients with syrinx group 1 and the patients without syrinx, but the AP length of posterior fossa was statistically significantly lower in the patients with syrinx group 2 than the patients without syrinx (p = 0.03). Conclusion: The S/C ratio can be a guide to the underlying aetiology.Öğe Comparison of Urinary Tract Dilatation and Society of Fetal Urology systems in the detection of vesicourethral reflux and renal scar(Int Scientific Information Inc, 2021) Dogan, Gulec Mert; Sigirci, Ahmet; Cengiz, Aslinur; Tasolar, Sevgi Demiroz; Yildiz, Turan; Tabel, Yilmaz; Elmas, Ahmet TanerPurpose: The presence and degree of hydronephrosis is very important in the management of many diseases of the urinary tract. In this study, we aim to compare the sensitivity and specificity of 2 classification systems that are used for hydronephrosis grading in ultrasound, for reflux and scar detection. The classification systems were the Society of Fetal Urology (SFU) and Urinary Tract Dilatation (UTD). Material and methods: Ultrasounds and dimercaptosuccinic acid scintigraphies (DMSA) of all patients who underwent voiding cystourethrogram (VCUG) due to urinary tract infection were examined retrospectively. DMSA was accepted for scar detection and VCUG for reflux detection as reference methods. SFU classification was used for hydronephrosis in ultrasound reports, and UTD classification was made over the reports. Sensitivity, specificity, and positive and negative predictive values of UTD and SFU classification systems for reflux and scar detection were calculated, and these 2 systems were compared. Results: 103 (39%) of the patients were male and 162 (61%) were female. Pathologies were detected in 192 (35%) of 530 kidneys in ultrasound. In 110 (42%) of the children, reflux was detected in VCUG. Scars in DMSA were detected in only 16% (44) of 266 kidneys. Sensitivity, positive and negative predictive values of the UTD classification system were statistically significantly higher than the SFU system for scar and reflux detection (p < 0.01). Conclusions: If we use the UTD system in ultrasounds of patients with urinary tract infections, children reported as UTD 0 may not need VCUG, which reduces radiation exposure to children and the cost of the diagnostic interventions.Öğe Diaphragmatic Mesothelial Cyst: Radiological Appearance and Follow-Up Results During Childhood(Lippincott Williams & Wilkins, 2021) Akdulum, Ismail; Ozturk, Mehmet; Karatoprak, Sinan; Akyuz, Melih; Sigirci, Ahmet; Boyunaga, Oznur LemanTo identify radiological findings of diaphragmatic mesothelial cysts (DMC) in the pediatric age group and to assess follow-up outcomes. In this study, 27 pediatric age group patients were evaluated with ultrasonography (US), computed tomography (CT), or magnetic resonance imaging due to various clinical indications and diagnosed with DMC from May 2014 to September 2018. Age, sex, imaging indications and DMC localization, volumes in the first diagnosis, and follow-ups were retrospectively evaluated. Descriptive statistics were used for age, sex, imaging indications, and volume are presented as numbers and percentages. Ages range from 5 months to 13 years. Nine girls and 18 boys included in this study. The most common imaging indications were abdominal pain, diarrhea, and obesity. The mean volume of DMC was at first 2.62 and 2.45 mL during the follow-ups. There was volume reduction in 24 cases, and no change in 3 cases. Mean follow-up duration was 22.4 months. The US imaging findings were similar for all cases, bilobular cystic lesion with fat indentation between the cyst and liver parenchyma. The typical localization and lateral fat sign are useful in differential diagnosis of DMC from cystic lesions of liver. The US is a very effective and beneficial radiological method for diagnosis and follow-up. Routine clinical and sonographic follow-ups may be sufficient for asymptomatic patients with stable cyst volume.Öğe Diffusion-weighted imaging features of brain in obesity(Elsevier Science Inc, 2008) Alkan, Alpay; Sahin, Ibrahim; Keskin, Lezan; Cikim, Ayse Sertkaya; Karakas, Hakki Muammer; Sigirci, Ahmet; Erdem, GulnurPurpose: Obesity is characterized by an altered distribution of body fluid. However, distribution of fluid (extracellular/intracellular) in brain tissues has not been studied in obese subjects yet. The purpose of this study was to detect possible brain diffusion changes especially in satiety and hunger related centers in obese subjects by diffusion weighted imaging (DWI). Methods: Conventional MRI and DWI of the brain was obtained from 81 obese patients (obese=68, morbid obese= 13) and 29 age-matched, nonobese. The apparent diffusion coefficient (ADC) values were calculated in hypothalamus; amygdala; hippocampal gyrus-1 thalamus; insula; cingulate gyrus; orbitofrontal, dorsomedial and dorsolateral frontal, middle temporal and occipital cortex; cerebellum; midbrain and corpus striatum. Results: The ADC values of hypothalamus, hippocampal gyrus, amygdala, insula, cerebellum and midbrain were significantly increased in patients (n:81) when compared to nonobese subjects. The ADC values of thalamus, hippocampal gyrus, amygdala, orbitofrontal, occipital, dorsolateral and middle temporal cortex, insula and midbrain were significantly increased in morbid obese when compared to nonobese subjects. The ADC values of orbitofrontal and occipital cortex were significantly higher in morbid obese than the values in the obese. The body mass index positively correlated with ADC values of amygdala, insula, orbitofrontal and middle temporal cortex. Conclusion: We observed increased ADC values of distinct locations related to satiety and hunger that suggest altered fluid distribution and/or vasogenic edema in obese subjects. Awareness of this abnormalities in brain tissue composition/function in obesity may contribute to better understanding of the underlying mechanisms. (0 2008 Elsevier Inc. All rights reserved.Öğe The effects of hydrostatic reduction and operative manual reduction on the success of intussusception reduction(2018) Gurunluoglu, Kubilay; Tasci, Aytac; Gozukara Bag, Harika; Sigirci, Ahmet; Demircan, MehmetAim: Intussusception is the most common cause of bowel obstruction in children aged 3 months to 6 years. Ultrasonically guided Hydrostatic reduction (UGHR) and operative manual reduction (OMR) are among the treatment methods. The aim of this study is to compare the effects of UGHR and OMR techniques on successful reduction in children with intussusception. Material and Methods: This study was performed retrospectively between January 2015 and May 2018. The data of intussusception child patients were reviewed. A total of 63 patients’ records were reached. A total of 31 UGHR procedures and 32 OMR procedures were recorded. Demographic data, recurrence, reduction success of UGHR and OMR patients were calculated and evaluated statistically. Results: No significant difference was found in terms of demographic information. There was no recurrence in both groups. While rate of successful reduction of patient with UGHR is 77.4%, OMR’s success is 87.5%. There was no statistically significant difference in terms of reduction success. It was determined that what was important in the reduction success was the first application time. Conclusions: When we evaluated our results, we found that the factor affecting the reduction success in a patient with intussusception was not the method of reduction. We found that the most important factor affecting reduction success was the time between onset of symptoms and initiation of reduction. If this is less than 24 hours, we have found that the reduction success is very good.Öğe Evaluation of aqueductal cerebrospinal fluid flow dynamics with phase-contrast cine magnetic resonance imaging in normal pediatric cases(Elsevier Science Inc, 2016) Ozturk, Mehmet; Sigirci, Ahmet; Unlu, SerkanPurpose: This study aimed to determine differences according to age groups and gender in the parameters of aqueductal cerebrospinal fluid (CSF) flow in childhood using phase-contrast cine magnetic resonance imaging (MRI) method. Materials and methods: This prospective study included 47 boys and 36 girls for a total of 83 healthy children. The cases were divided into three groups depending on age as infants (1-12 months), children (12-120 months), and adolescents (120-204 months). To quantitatively evaluate CSF flow, images in the transverse plane were taken at the cerebral aqueduct level using the phase-contrast MR angiography technique in a 1.5-T MR unit. Peak and average velocity (cm/s), cranial direction, caudal direction and net volume (ml), and aqueduct area (mm2) were calculated. To assess differences between the groups, a one-way analysis of variance and least significant difference tests were used. Results: A statistically significant difference was determined between children and adolescents in peak velocity and caudal direction volume (P=.012 and P=.039, respectively) and between infants and children in cranial direction volume (P=.036). Peak velocity, cranial direction, and net volume were higher in boys (P=.050, P=.016, and P=.029, respectively). There were no differences by age and gender in the aqueduct area. Conclusion: In conclusion, this study determined the normal values for the CSF flow parameters of velocity, volume, and aqueduct area using phase-contrast MRI in healthy children. Velocity and volume parameters varied according to age and sex and were not affected in the aqueductal area. Published by Elsevier Inc.Öğe Evaluation of Early and Late Complications of Pediatric Liver Transplantation with Multi-slice Computed Tomography: A High-Volume Transplant Single-Center Study(Aves, 2021) Ozturk, Mehmet; Dag, Nurullah; Sigirci, Ahmet; Yilmaz, SezaiBackground: To present abdominal multi-slice computed tomography (MSCT) results following transplantation in pediatric patients with a liver transplantation (LT), and to create awareness of early (<3 months) and late (>3 months) complications that may occur. Methods: This retrospective study included 119 children with an LT performed in our hospital from 2014 to 2017. The descriptive statistics relating to patients' age, gender, transplantation indications, transplantation technique, and MSCT findings were calculated, and are presented as numbers and percentages. The complications were divided into 4 groups: vascular, biliary, parenchymal, and extraparenchymal. Results: The LT procedures were performed with organs from living donors for 83 patients, and from deceased donors for 36 patients. Hepatic artery and portal vein complications were mostly seen in the early period (n = 18), and hepatic vein complications were also observed in the late period (n = 6). The most commonly encountered biliary complications were stenosis/stricture (n = 13) and bile leak/ bilioma (n = 9). Stenosis/stricture frequently occurred in the late period. The most common parenchymal complications were ischemic infarct (n = 8) in the early period, and abscess (n = 4) and recurrent hepatoblastoma (n = 2) in the late period. Hematoma (n = 7), intestinal perforation (n = 3), and focal spleen infarct (n = 3) were among the most commonly observed extraparenchymal abdominal complications. Conclusion: The complications occurring after pediatric LT varied according to the time after surgery and the transplantation technique used. Using MSCT, different abdominal complications can be assessed simultaneously, greatly contributing to diagnosis and treatment.Öğe Evaluation of in vivo cerebral metabolism on proton magnetic resonance spectroscopy in patients with impaired glucose tolerance and type 2 diabetes mellitus(Elsevier Science Inc, 2008) Sahin, Ibrahim; Alkan, Alpay; Keskin, Lezzan; Cikim, Ayse; Karakas, Hakki M.; Firat, Ahmet K.; Sigirci, AhmetThe aim of this study was to investigate possible metabolic alterations in cerebral tissues on magnetic resonance spectroscopy (MRS) in patients with impaired glucose tolerance (IGT) and with type 2 diabetes mellitus (T2-DM). Twenty-five patients with T2-DM, 13 patients with IGT, and 14 healthy volunteers were included. Single-voxel spectroscopy (TR: 2000 ms, TE: 31 ms) was performed in all subjects. Voxels were placed in the frontal cortex, thalamus, and parietal white matter. N-acetylaspartate (NAA)/creatine (Cr), choline (Cho)/Cr, and myo-inositol (MI)/Cr ratios were calculated. Frontal cortical Cho/Cr ratios were increased in patients with IGT compared to control subjects. Parietal white matter Cho/Cr ratios were significantly higher in patients with IGT when compared to patients with T2-DM. In the diabetic group, frontal cortical MI/Cr ratios were increased, and parietal white matter Cho/Cr ratios were decreased when compared to the control group. Frontal cortical NAA/Cr and Cho/Cr ratios and parietal white matter Cho/Cr ratios were decreased in diabetic patients with poor glycemic control (AlC>10%). AlC levels were inversely correlated with frontal cortical NAA/Cr and Cho/Cr ratios and with parietal white matter Cho/Cr ratios. T2-DM and IGT may cause subtle cerebral metabolic changes, and these changes may be shown with MRS. Increased Cho/Cr ratios may suggest dynamic change in membrane turnover in patients with IGT. Diabetic patients with poor glycemic control may be associated with neuronal dysfunction/damage in brain in accordance with AlC levels and, in some, extend with insulin resistance. (C) 2008 Elsevier Inc. All rights reserved.Öğe Evaluation of Risk Factors for Arteriovenous Fistula Failure in Patients Undergoing Hemodialysis(Aves, buyukdere cad 105-9, mecıdıyekoy, sıslı, ıstanbul 34394, turkey, 2016) Sari, Funda; Taskapan, Hulya; Sigirci, Ahmet; Akpinar, BesirObjective: The aim of the present study is to evaluate the relationship between demographic characteristics, hematological and biochemical parameters, and elements of the coagulation system that may predispose a person to thrombosis or to anatomical and functional parameters in Doppler ultrasonography scanning and the maturation and adequacy of arteriovenous fistulas. Materials and Methods: Overall, 36 patients who underwent a native arteriovenous fistula operation were included. Biochemical parameters, hematological parameters, the coagulation system, and a Doppler ultrasonography evaluation were performed before an arteriovenous fistula operation on day 1 after the fistula operation and at the time point when the arteriovenous fistula became dysfunctional. Results: A thrombus occurred between 1 and 73 days (mean: 28.4 +/- 26.1) in 10 patients. It was found that the female gender (p<0.001), presence of thrill (p=0.014), quality of vein (p<0.001), peak systolic velocity and end-diastolic velocity of the radial artery at the snuffbox region on day 1 after the operation (p=0.035 and p=0.049, respectively), and the cephalic vein diameter in the Brescia-Cimino region (p=0.011) were associated with thrombosis formation. No relation was found among blood pressure, fistula region, quality of artery, spasm of artery and vein, hematologic and biochemical parameters, coagulation parameters, active protein C resistance, anti-cardiolipin antibody, D-dimer, C-reactive protein, or erythrocyte sedimentation rate and thrombosis formation (p>0.05). Conclusion: Thrombosis occurs at a relatively early period in approximately a quarter of arteriovenous fistulas. Female gender, quality of vein, and the absence of thrill in the post-operative period are important factors in thrombosis formation.
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