Makale Koleksiyonu
Bu koleksiyon için kalıcı URI
Güncel Gönderiler
Öğe The diagnostic value of neurogranin in patients with carbon monoxide poisoning: Can it show early neurological damage?(W B Saunders Co-Elsevier Inc, 2021) Yeşilyurt, Ömer; Cömertpay, Ertan; Vural, Sevilay; Eroğlu, Oğuz; Badem, Nermin Dindar; Çankaya, İmran; Bilgili, Yasemin KaradenizBackground and aim: Carbon monoxide poisoning is a toxicological emergency that causes neurological complications. High serum neurogranin can be detected in acute or chronic conditions where brain tissue is damaged. This study aimed to investigate the diagnostic value of serum neurogranin level and its role in demonstrating neurological damage in patients admitted to the emergency department with carbon monoxide poisoning. Materials and methods: The study was conducted prospectively on patients with carbon monoxide poisoning (patient group) and healthy volunteers (control group). Demographic characteristics and scrum neurogranin level of all participants and symptoms at admission, neurological examination findings, laboratory results, and Diffusion-Weighted Magnetic Resonance Imaging results of the patient group were recorded. We used an independent sample t-test to compare neurogranin levels and bivariate correlation analysis to compare the relationship between serum neurogranin levels and data belonging to the patient group. Results: Sixty eight participants (patient group, n- 36; control group, n- 32) were included in the study. Serum neurogranin level was significantly higher in patients with carbon monoxide poisoning (0.31 +/- 0.16 ng/ml) compared to control group (0.22 +/- 0.10 ng/ml) (p = 0.015). The mean Glasgow Coma Scale of the patients with carbon monoxide poisoning was 14.59 +/- 0.23, and of Diffusion Weighted Magnetic Resonance Imaging results were completely normal in 94.4% (n = 34). There was no correlation between serum neurogranin level and Diffusion Weighted Magnetic Resonance Imaging results (r = -0.011; p = 0.953). Conclusion: Serum neurogranin level may be a new diagnostic biomarker in patients admitted to the emergency department with carbon monoxide poisoning. The high serum neurogranin levels detected in patients with normal diffusion-weighted imaging after carbon monoxide poisoning suggest that there is neurological damage in these patients, even if imaging methods cannot detect it. (C) 2021 Elsevier Inc. All rights reserved.Öğe Temporal CT Evaluation of the Relationships between Basic Anatomical Structures and the Round Window: Importance for the Cochlear Implant Surgery(Thieme Medical Publ Inc, 2024) Asal, Nese; Muluk, Nuray Bayar; Sarıkaya, Pelin Zeynep BekinObjectives In the present study, we investigated the round window (RW) and neighboring anatomical structures using temporal computed tomography (CT) which are important for cochlear implant (CI) electrodes. Methods In this retrospective study, the temporal CT images of 112 adult patients (45 males and 67 females) were evaluated. We classified mastoid pneumatization, and measured RW diameter, RW-carotid canal (CC) distance, RW-facial nerve mastoid segment (FNMS) distance, RW-pyramidal eminence distance, RW-jugular bulb (JB) distance, and RW-internal acoustic canal (IAC) distance. Additionally, RW-cochlea angle and RW-facial nerve angle were also measured. Results RW diameters in males were significantly higher than those in females bilaterally ( p < 0.05). RW-CC distance and RW-JB distance were both smaller than 10mm. RW-IAC distance was 2.54 to 2.68mm, and RW-FNMS distance was 4.20 to 4.40mm. RW-cochlea angle ranged from 39.62 to 41.91degrees and RW-FN angle ranged from 17.28 to 18.40degrees. Males showed better mastoid pneumatization values ( p < 0.05). In higher RW diameters, RW-JB distance decreased, and in pneumatized mastoids, RW-JB distance increased. RW-JB distance and RW-CC distance were detected to increase together ( p < 0.05). Conclusion RW is crucial anatomic structure for CI surgeries. RW diameters are between 1.21 and 1.35mm and lower in the females. Males exhibited better mastoid pneumatization values than the females, and CC and JB distances from RW were farther in well-pneumatized mastoids. Future studies should include comprehensive clinical and surgical findings.Öğe Radiological Evaluation of the Effect of Laryngopharyngeal Reflux on the Thickness of Inferior Turbinate, Maxillary Sinus Mucosa and Nasal Septal Body(Springer India, 2024) Taş, Burak Mustafa; Sarıkaya, Pelin Zeynep Bekin; Şencan, Ziya; Cömert, Ela; Muluk, Nuray BayarBackground We investigated the relationship between Laryngopharyngeal Reflux (LPR) and maxillary sinus mucosal thickness (MSMT), inferior turbinate mucosal thickness (ITMT), inferior turbinate width (ITW) and nasal septal body thickness (NSBT), which can be signs of chronic rhinosinusitis and allergic rhinitis.Methods The study, which included 87 patients, was designed as two groups. While 42 of the patients were included in the Laryngopharyngeal Reflux group, 45 were included in the control group. Age and gender information of the patients were noted. MSMT, ITMT, ITW and NSBT values were measured in patients who had Paranasal Sinus Computed Tomography. MSMT, ITMT and ITW were measured as right and left. Both groups were evaluated in terms of these values.Results Right ITMT, bilateral ITW and MSMT values were found to be significantly higher in the LPR group than in the control group (p < 0.05). MSMT values were higher in males (p < 0.05). The left-ITT and NSBT values were not significantly different between the LPR group and the control group, but both values were higher in the LPR group than in the control group (p > 0.05). In the LPR group, there were positive correlations between ITMT and ITW values of the right side; and left side separately (p < 0.05).Conclusion It has been shown that Laryngopharyngeal Reflux increases maxillary sinus mucosal thickness, inferior turbinate thickness and width, and nasal septal body thickness, which can be signs of chronic rhinosinusitis and allergic rhinitis. The negative effects of LPR on nasal and paranasal mucosa and structures were demonstrated in this study.Öğe Can subcoracoid effusion be a more specific finding for subscapularis tear among rotator cuff pathologies on magnetic resonance imaging?(Mosby-Elsevier, 2023) Bahadir, Batuhan; Sarikaya, Baran; Kaya, İbrahim; Oklaz, Burak; Sarikaya, Pelin Zeynep Bekin; Kanatli, UlunayHypothesis and Background: Magnetic resonance imaging (MRI) is a well-known, noninvasive diagnostic method for rotator cuff tendon pathologies that are not very sensitive for subscapularis tendon tears. Subcoracoid effusion (SE) is an easily recognizable radiologic sign on MRI. In this study, we aimed to examine the relationship of SE with rotator cuff tear and to investigate whether SE could be a supportive finding in the diagnosis of subscapularis tear in preoperative MRI. Our hypothesis was that SE was a more specific finding of subscapularis tear than other rotator cuff tears. Methods: The data of patients who underwent shoulder arthroscopy in our clinic between 2017 and 2021 were analyzed retrospectively. Four groups were included in the study: patients with a rotator cuff tear accompanied by a subscapularis tear (group 1, n = 273), patients with isolated subscapularis tear (group 2, n = 57), patients with rotator cuff tear with intact subscapularis tendon (group 3, n = 190), and patients without any rotator cuff pathology (group 4, n = 263). Arthroscopic video records and MRIs of all patients were evaluated retrospectively. Subscapularis tendon tears were classified according to the Lafosse classification. Results: There was a statistically significant difference between the groups in terms of the presence of SE on MRI (P = .001). The presence of SE in group 1 and group 2 was statistically significantly higher than that in both group 3 and group 4 (P = .001), and there was no significant difference between group 3 and group 4 (P > .05). A significant relationship was found between Lafosse classification and SE (P = .001). When the diagnostic powers of the detection of SSC tear and the presence of SE on MRI for SSC tear were compared, Kappa values were 0.615 (P = .001) and 0.701 (P = .001), and overall diagnostic accuracy rates were 80.3% and 85.5%, respectively. Conclusion: We conclude that SE is a more specific finding for subscapularis tears than other rotator cuff pathologies. We suggest that SE on MRI should also be considered in patients with a rotator cuff tear in whom a subscapularis tear was not detected in preoperative MRI and that the subscapularis tendon should be carefully evaluated during surgery in cases where the effusion is positive. (c) 2022 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.Öğe Aseptic meningitis caused by Coronavirus OC43 in a child: A case report(Bayrakol Medical Publisher, 2022) Demirbaş, Yasemin; Alpcan, Ayşegül; İnal, Mikail; Güney, Şeyma; Tursun, Serkan; Kandur, YaşarHuman coronavirus OC43 (HCoV-OC43) is one of the coronaviruses that cause the mild cold. On the other hand, extra-respiratory manifestations such as cen-tral nervous system infections with HCoV-OC43 are very rarely reported. We present a case of a previously healthy immunocompetent child with acute aseptic meningitis, as a result of HCoV-OC43 who admitted to the emergency department with a complaint of unconsciousness.. Respiratory tract and cerebrospinal fluid culture showed HCoV-OC43 in viral screening. During the follow-up period, the patient was completely asymptomatic, with normalized consciousness. The clinicians should keep in mind that HCoV-OC43 can be the etiological agent in the differential diagnosis of aseptic meningitis in immunocompetent individuals with reversible neurological symptoms.Öğe Analysis of radiological measurement parameters that can predict the type of treatment to be applied in odontoid fractures: Clinical research(Wolters Kluwer Medknow Publications, 2023) Öğden, Mustafa; Erdoğan, Ahmet Melih; Karagedik, Mustafa İlker; Başer, Selçuk; Bulut, İbrahim Umud; Sevimoğlu, Özge; Yüksel, UlaşIntroduction: Although various conservative and surgical treatment methods have been proposed, treatment options for patients with odontoid fractures remain controversial. This study was conducted to determine some demographic and radiological measurement parameters that can predict treatment options in patients with odontoid fractures. Materials and Methods: The patients were separated into the surgery (-) group (n = 9) and the surgery (+) group (n = 10). Patient data were recorded of age, gender, type of odontoid fracture, morphological measurement results obtained from computed tomography images, treatment regimens, duration of stay in the hospital, and mortality rate. In the operating room, a halo-vest corset or Philadelphia-type cervical collar was applied to the surgery (-) patients after the reduction of the fracture under fluoroscopy. Anterior odontoid lag screw fixation was performed on surgery (+) patients. Results: The amount of displacement of the fractured odontoid, the distance between the C1 vertebra and the odontoid process, the angle between the posterior wall of the odontoid process and the posterior wall of the clivus, the slip angle, and the anterior to posterior width of the spinal canal were not different between the groups. No difference was determined between the groups in respect of the amount of lateral displacement of the odontoid process in the spinal canal in the axial plane and the angle of the fractured odontoid process with the C2 vertebral body. Conclusion: This preliminary study showed that the demographic data and radiological measurement parameters analyzed in the present study could not be used as predictive markers either in decision-making for treatment modality or mortality risk.Öğe Analysis of Biochemical, Hormonal and Radiological Morphological Measurement Values in Patients with Empty Sella: A Clinical Study(Georg Thieme Verlag Kg, 2024) Özdemir, Alemiddin; Erdoğan, Ahmet Melih; Sevimoğlu, Özge; Durgun, Efe Barış; Ermiş, Süha Alp; Yalçın, Rümeysa; Karaca, Yusuf EminObjective This study investigated the relationship between radiological morphological findings and hormone levels in patients with empty sella. Methods Patients (32 female, 3 male) with empty sella detected on radiological images were grouped as partial empty sella (PBS) group (subarachnoid space volume < 70%) and total empty sella (TBS) group (subarachnoid space volume > 70%). Age, gender, sella volume, pituitary gland thickness, the ratio of subarachnoid space height to pituitary gland height, and diaphragm sellae diameter were measured on radiological images. All patients' blood count results, biochemistry results, and serum hormone values were recorded. Results Age, complete blood count, serum biochemistry parameters, and hormone levels were not different between PBS and TBS groups. Correlation analysis revealed a negative correlation between gender and subarachnoid space invasion volume, between gender and sagittal width of the sella turcica (ST), between cortisol level and ST axial diameter, between progesterone level and ST axial diameter, between testosterone level and ST axial diameter, between adrenocorticotropic hormone level and ST axial diameter, between TSH level and subarachnoid space invasion rate, between free T4 level and diaphragm sellae sagittal width, and between free T4 level and ST sagittal width. Conclusion This study showed that some serum hormone values may decrease when the sella tursica dimensions or the volume of subarachnoid space invading the sella tursica increase in patients with empty sella, and therefore, periodic follow-up of hormone levels and radiological images of these patients would be appropriate.Öğe A Comparison of Diagnostic Accuracy of Superior Semicircular Canal Dehiscence in MDCT and MRI, and Coexistence with Tegmen Tympani Dehiscence(Thieme Medical Publ Inc, 2021) İnal, Mikail; Muluk, Nuray Bayar; Şahan, Mehmet H.; Asal, Neşe; Şimşek, Gökçe; Arıkan, Osman K.Objective Tegmen tympani dehiscence in temporal multidetector computed tomography (MDCT) and superior semicircular canal dehiscence may be seen together. We investigated superior semicircular canal dehiscence in temporal MDCT and temporal magnetic resonance imaging (MRI). Methods In this retrospective study, 127 temporal MRI and MDCT scans of the same patients were reviewed. In all, 48.8% (n = 62) of cases were male, and 51.2% (n = 65) of cases were female. Superior semicircular canal dehiscence and superior semicircular canal-temporal lobe distance were evaluated by both MDCT and MRI. Tegmen tympani dehiscence was evaluated by MDCT. Results Superior semicircular canal dehiscence was detected in 14 cases (5.5%) by temporal MDCT and 15 cases (5.9%) by temporal MRI. In 13 cases (5.1%), it was detected by both MDCT and MRI. In one case (0.4%), it was detected by only temporal MDCT, and in two cases (0.8%), it was detected by only temporal MRI. Median superior semicircular canal-to-temporal distance was 0.66 mm in both males and females in temporal MDCT and temporal MRI. In both temporal MDCT and temporal MRI, as superior semicircular canal-to-temporal lobe distance increased, the presence of superior semicircular canal dehiscence in temporal MDCT and temporal MRI decreased. Tegmen tympani dehiscence was detected in eight cases (6.3%) on the right side and six cases (4.7%) on the left side. The presence of tegmen tympani dehiscence in temporal MDCT and the presence of superior semicircular dehiscence in MDCT and MRI increased. Conclusion Superior semicircular canal dehiscence was detected by both MDCT and MRI. Due to the accuracy of the MRI method to detect superior semicircular dehiscence, we recommend using MRI instead of MDCT to diagnose superior semicircular canal dehiscence. Moreover, there is no radiation exposure from MRI.Öğe Idiopathic Hypereosinophilic Syndrome as a Rare Cause of Stroke: A Case Report(Turkish Neurological Soc, 2021) Turğut, Esra; Alpua, Murat; Yalçın, Selim; Coşkun, Oya; Bilgili, Mirace Yasemin Karadeniz; Açıkgöz, Ergin Ayaşlıoğlu; Coşkun, ÖzlemHypereosinophilic syndrome (HES) is a rare hematological disease that causes organ damage by eosinophil infiltration in the tissue with increased eosinophil production in the bone marrow. HES is a rare but important cause of stroke. Central nervous system involvement findings can be serious and life-threatening. Eosinophil values should be examined as the cause of stroke, and hypereosinophilia should be suspected, especially in young patients with no etiology. Reported herein is a case of a 47-year-old female patient who was followed up with the diagnosis of acute cerebrovascular disease due to idiopathic HES.Öğe Pancreas and kidney changes in type 2 diabetes patients: the role of diffusion-weighted imaging(Tubitak Scientific & Technological Research Council Turkey, 2021) Şahan, Mehmet Hamdi; Özdemir, Adnan; Asal, Nese; Karadeniz Bilgili, Yasemin Mirace; Doğan, Adil; Güngüneş, AşkınBackground/aim: The aim of this study was to compare renal and pancreatic apparent diffusion-coefficient (ADC) values of diabetic patients and control subjects and to examine their potential association with several diabetes-related clinical parameters. Materials and methods: A total of 80 sex-and age-matched patients were included in the study. Of them, 40 were patients with type 2 diabetes and 40 were nondiabetic participants. Abdominal diffusion-weighted MRIs of both groups were retrospectively reviewed. Diabetes-related clinical parameters were recorded. Results: The difference between the mean ADC values of the patient group and the control group was significant (p = 0.012). It was also found that the mean pancreatic ADC values of diabetic patients and the control group significantly differed (p = 0.02). Besides, there were positive correlations between the mean pancreatic ADC values and age, Hb1Ac level, treatment type, and disease duration (p < 0.05). While eGFR values positively correlated with the mean renal ADC values (p < 0.05), there were negative correlations between such values and age, serum creatinine level, and disease duration (p < 0.05). Conclusion: Renal and pancreatic ADC values of diabetic patients could potentially play a role, as markers of renal and pancreatic functions, in clinical decisions in the follow-up of such patients.Öğe Unilateral isolated alar ligament rupture in an adult female patient(Kare Publ, 2021) Keskil, Semih; Yüksel, Ulaş; Bilgili, Yasemin Karadeniz; Babacan, AvniOnly seven cases of isolated unilateral rupture of the alar ligament had been previously reported. The authors report the first adult female case of this rare injury. The patient in their case, a 36-year-old female presented after a trauma due to falling, and at that moment, she had fainted due to a sudden pain between the neck and head. The radiological examinations [magnetic resonance imaging (MRI) and X-rays] had been interpreted as normal. She had a positive Alar ligament test at the right side, and a thin section craniovertebral junction computed tomography was obtained which revealed an asymmetrically left-sided odontoid process and a new MRI revealed a right-sided alar ligament rupture. Th us she underwent a bilateral greater occipital nerve block together with pulse radiofrequency and trigger point injection at splenius capitis, levator scapula, and trapezius followed by the application of a halo orthosis to be worn for 3 months. The patient was found to be pain-free in the follow-up examinations. With pure unilateral alar ligament rupture, the atlantooccipital joint is not disrupted and the craniovertebral junction is not destabilized. To date, only eight cases of isolated unilateral alar ligament rupture have been reported one of which was a 25 years old male; all of whom presented with marked neck pain and treated by external immobilization for 4 weeks to 4 months and our case is the first adult female patient.Öğe Differentiation of benign and malignant superficial soft tissue lesions using real-time strain elastography(Tubitak Scientific & Technological Research Council Turkey, 2021) Annaç, Gökçe; Canyigit, Murat; Tan, Sinan; Aksam, Ersin; Süngü, Nuran; Arslan, HalilBackground/aim: To evaluate benign and malignant cutaneous-subcutaneous lesions using real-time strain elastography (RTSE) and to compare the findings with histopathologic results. Materials and methods: Over a period of 10 months, 72 patients (38 with benign and 34 with malignant cutaneous and subcutaneous lesions) were prospectively included in this study. Elasticity patterns and strain ratios were examined for each lesion. Lesions were evaluated in 4 groups as yellow-red (soft; pattern-1), green-yellow (moderate; pattern-2), blue-green (hard; pattern-3) and blue (hardest; pattern-4). The stiffness of the lesions was displayed with strain ratios by comparing of a nearby reference tissue. The recorded images were compared with histopathologic findings. Results: On sonoelastograms, considering patterns 1-2 as benign and patterns 3-4 as malignant, the sensitivity, specificity, and positive and negative predictive values for the differentiation of malignant from benign lesions were 100%, 68.5%, 74%, and 100%, respectively. Considering a cut-off value of the strain ratio as > 3.05, the sensitivity, specificity, and positive and negative predictive values were 91%, 89%, 88%, and 92%, respectively. The area under the curve (AUC: 0.972) showed the excellent ability of strain elastography to differentiate benign and malignant lesions. Conclusion: RTSE is an important imaging tool to differentiate benign and malignant superficial soft tissue lesions. Our results suggest that RTSE can be used to predict malignancy since malignant lesions are more confidentially diagnosed than benign superficial soft tissue lesions on elastograms.Öğe Evaluation of the anterior shoulder instability using ultrasound shear wave elastography(Turkish Joint Diseases Foundation, 2023) Sarıkaya, Pelin Zeynep Bekin; Sarıkaya, Baran; Bozkurt, Celal; Dere, Osman; Batur, Elif Balevi; Duşak, AbdurrahimObjectives: This study aims to evaluate the soft tissue stiffness which has a prominent role in shoulder instability using ultrasound (US) shear wave elastography (SWE) and to compare the results with healthy shoulders. Patients and methods: Between December 2018 and January 2020, a total of 33 male patients (mean age: 26 +/- 4.3 years; range, 18 to 35 years) who underwent arthroscopic repair for traumatic isolated anterior glenohumeral instability were included in this prospective study. The shoulder girdle was evaluated with US SWE in patients with traumatic anterior instability. Deltoid (D), supraspinatus (SS), infraspinatus (IS), subscapularis (SSC), and long head of biceps (LHB) tendons forming the shoulder girdle and anterior labrum (L) were evaluated with SWE. The elasticity and velocity of the tissues were quantitatively measured. The operated shoulders of 33 patients due to isolated traumatic anterior instability were named Group 1, while the healthy shoulders of these patients were named Group 2. Thirty volunteers with healthy shoulders were considered as the control group (Group 3, n=30). Results: All three groups were compared in terms of SS, D, LHB, and SSC tendon velocity and elasticity; however, no statistically significant difference was observed among the groups (p < 0.05). The anterior labrum of these three groups did not significantly differ in terms of SWE measurements (p < 0.05). Conclusion: The stiffness of shoulder girdle muscle tendons and labrum measured with US SWE does not constitute a risk factor for traumatic anterior shoulder instability.Öğe A new ventricular index based on coronal brain magnetic resonance images in patients with idiopathic normal pressure hydrocephalus(Tubitak Scientific & Technological Research Council Turkey, 2023) Yılmazsoy, Yunus; Arslan, Serdar; Özdemir, Adnan; Korkmazer, Bora; Kızılkılıç, Osman; Kafadar, Ali MetinBackground/aim: The aim of this study was to assess the effectiveness of a new quantitative index for the diagnosis of idiopathic normal pressure hydrocephalus. Materials and methods: This retrospective study was conducted at Istanbul University Cerrahpasa Medical Faculty between January 2016 and November 2022. A total of 31 patients diagnosed with idiopathic normal pressure hydrocephalus were included in the study group and 48 patients were included in the control group. Measurement via the new Index was performed on a coronal section of magnetic resonance imaging at the level of the anterior commissure. Results: The new Index's mean diagnostic performance was 1.16 +/- 0.08 in the study group, significantly lower (p < 0.0001) than the mean of 1.43 +/- 0.10 in the control group. When a cutoff value of 1.23 was used for the new index, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rates were 96.1%, 90.7%, 80.6%, 98%, and 91.3%, respectively. Conclusion: The new Index described here is an effective, feasible, reproducible, highly sensitive, and specific quantitative method that can contribute to the improved diagnosis of patients with idiopathic normal pressure hydrocephalus.Öğe Anatomical Considerations: The Relationship Between The Vertebral Artery And Transverse Foramina At Cervical Vertebrae 1 To 6 In Patients With Vertigo(2018) Kültür, Turgut; Muluk, Nuray Bayar; Iyem, Cihan; Inal, Mikail; Burulday, Veysel; Alpua, Murat; Çelebi, Umut OrkunObjective: In this study, we aimed to investigate the relationship between the size of the vertebral artery and that of the transverse foramina at the C1 to C6 vertebral level in patients suffering from vertigo thought to be related to vertebrobasilar insufficiency (VBI). Materials and Methods: In this retrospective study, two groups were compared in terms of cervical computed tomography (CT): 22 adult patients with vertigo; and a control group consisting of 23 healthy adult indivıduals. Measurement of the vertebral artery and transverse foramina (i.e. sagittal and transverse dimensions, plus area) were performed bilaterally at levels C (cervical vertebra) 1 to C6. Results: For the cases group, at C6 level the right vertebral artery area, sagittal and transverse diameter were larger than in the control group at the level of statistical significance. At C1 level, the area of the right transverse foramina in the cases group was significantly higher than in the control group. At levels C1 to C5, the values obtained for vertebral artery area were positively correlated with the values for the ipsilateral transverse foramina (transverse foramen sagittal and transverse dimensions plus areas). Where the sagittal or transverse dimensions of the transverse foramina, or the area of the transverse foramina were found to be decreased, vertebral artery areas were also observed to have decreased at C1 to C5 levels. Conclusion: We concluded that a decrease in diameter of the bony structures or transverse foramina may cause a decrease in the cross-sectional area of the vertebral artery on the ipsilateral side. Since it is only the left vertebral artery which is dominant for cerebral blood flow, any compensatory increase in right vertebral artery area cannot offset decreased cerebral blood flow. Decreased blood flow (i.e. VBI) on the left side may play a role in the development of vertigo.Öğe Palyatif Bakım Ünitesinde Yatan Hastalar İçin Yapılan Harcamalara Genel Bakış: Tek Merkez Deneyimi(2020) Karahan, İrfan; Özdemir, AdnanAMAÇ: Palyatif bakım, yaşamı tehdit eden hastalıkları olan bireylerde yaşam kalitesini artırmayı hedefleyen yaklaşım olarak özetlenebilir. Ülkemizde palyatif bakım ünitelerinin sayısı son zamanlarda artmış olup, harcamalarıyla ilgili ayrıntılı veri bulunmamaktadır. Bu çalışmada hastanemiz palyatif bakım ünitesindeki harcama gruplarının belirlenmesi amaçlanmıştır. GEREÇ VE YÖNTEM: Kırıkkale Üniversitesi, Tıp Fakültesi, İbn-i Sina Palyatif Bakım Ünitesi’nde Mart 2019-Aralık 2019 arasında yatan 333 hastanın arşiv kaydı hasta harcamaları açısından retrospektif olarak incelendi. Harcamalar; ilaçlar ve medikal tedavi, laboratuvar incelemeleri, radyolojik inceleme ve girişimler, tıbbi malzemeler ve diğer harcamalar olarak gruplandı. BULGULAR: Gruplar arasında en pahalı harcama türü ilaç ve medikal tedaviydi. İlaçların içerisinde de en pahalı grubun antibiyotikler olması dikkati çekti. SONUÇ: Giderlerin belirlenmesi; palyatif bakımın doğru kullanımı ve düzgün planlama için önemli olabilir. İlaç ve özellikle antibiyotik giderlerinin ön planda olması akılcı ilaç kullanımının önemini vurgulayabilir.Öğe Biseps Uzun Başı Tendon Subluksasyonunda Biseps-Glenoid Açısı Ve Subskapularis Tendon Patolojileri Arasındaki İlişkinin Mrg İle Değerlendirilmesi(2018) Şahan, Mehmet Hamdi; Asal, NeşeAmaç: Manyetik rezonans görüntülemede (MRG) biseps uzun başı tendonunda (BUBT) subluksasyon tespit edilen olgularda biseps-glenoid açısındaki değişkenliklerin tespiti ve subskapularis tendon patolojileri ile ilişkisinin değerlendirilmesi amaçlandı. Gereç ve Yöntem: Ocak 2014-Mart 2018 tarihleri arasında Kırıkkale Üniversitesi Tıp Fakültesi Radyoloji Anabilim Dalı’nda çekilen omuz manyetik rezonans görüntüleri incelendi. BUBT’da subluksasyon olan 30 hasta ve subluksasyon olmayan 32 kontrol hastası karşılaştırıldı. T2 ağırlıklı oblik-koronal MRG görüntülerde, BUBT’un supraglenoid tuberküle yapışma düzeyinden geçen kesitte, biseps tendonuna çizilen paralel çizgi ile glenoid kemik çatıya çizilen teğet çizgi arasındaki biseps glenoid açısı ölçüldü. Ayrıca subskapularis tendon patolojileri normal, parsiyel ve tam kat yırtık açısından analiz edildi. Bulgular: BUBT’da subluksasyon olan grupta 12 erkek, 18 kadın olup yaş ortalaması 61.0±13.6 yıl idi. BUBT’da subluksasyon olmayan grupta 14 erkek, 18 kadın olup yaş ortalaması 55.9±14.0 yıl idi. Subluksasyon olan grupta bisepsglenoid açı ortalaması 84.1º±4.9º ve subluksasyon olmayan grupta 92.8º±4.7º idi (p<0.05). BUBT’da subluksasyon olan olguların da %80’inde subskapularis tendon patolojisi mevcuttu. Sonuç: BUBT’da subluksasyon olan hastalarda, bisepsglenoid açı değerleri, subluksasyon olmayanlara göre düşüktür. BUBT subluksasyonu tanısında arada kalınan olgularda biseps-glenoid açı ölçümü yardımcı olabilir. Ayrıca BUBT subluksasyonuna, subskapularis tendon patolojileri sıklıkla eşlik etmektedir.Öğe Korpus Kallosumun Difüzyon Ağırlıklı Ve Konvansiyonel Manyetik Rezonans Görüntüleme İle Yaşa Göre Değerlendirilmesi(2018) Karasu, Rabia; Bilgili, YaseminAmaç: Difüzyon ağırlıklı görüntüleme, beyin dokusunun canlılığı hakkında fikir veren önemli bir yöntem olup kuvvetli manyetik alan gradientleri kullanılmaktadır. Buna bağlı olarak difüzyon ağırlıklı görüntüleme tekniği su moleküllerinin mikroskopik hareketlerindeki değişikliklerin saptanmasını mümkün kılmaktadır. Çalışmamızda, difüzyon ağırlıklı görüntüleme ile su moleküllerinin aksonlar boyunca olan hareketlerinden yararlanarak elde edilen Apparent Diffusion Coefficient (ADC) değişikliklerinin yaşa göre değişiminin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Çalışmamıza dahil edilen 94 olgunun ADC haritaları üzerinden korpus kallosumun farklı bölgelerinden ADC değerleri değerlendirildi. Bulgular: ADC değerinin minimum ve maksimum değerleri 0.589-0.819 mm²/sn x 10-³, ortalama ADC değeri ise 0.735 ± 0.043 mm²/sn x 10-³ olarak bulunmuştur. Çalışmamızda yaş arttıkça, korpus kallosumun ortalama ADC değerlerinde istatistiksel olarak belirgin derecede artış bulunmuştur (p <0.01). Sonuç: İlerleyen yaşla beyaz cevherdeki suyun difüzyon kabiliyetindeki artış yönündeki teorimiz, verilerimizdeki istatistiksel olarak anlamlı sonuçlarla desteklenmiştir. Yani suyun korpus kallosumda difüzyon kabiliyetinin yaş ilerledikçe arttığı saptanmıştır. Sonuç olarak, fonksiyonel bir görüntüleme yöntemi olan difüzyon ağırlıklı görüntüleme, yaşlanmaya bağlı değişiklikleri sayısal olarak da ortaya koyabilen bir yöntemdir.Öğe Asperger sendromunda proton manyetik rezonans spektroskopi: Nöropsikolojik testlerle ilişkisi(2009) Öner, Özgür; Özgüven, Halise Devrimci; Öktem, Ferhunde; Yağmurlu, Banu; Baskak, Bora; Ölmez, Şenay; Munir, KerimAmaç: Daha önceki çalışmalarda otizm spektrum bozukluklarında zihin kuramı (ZK) sorunları olduğu gösterilmiştir, ancak bu olgularda ZK performansı ile beyin nörokimyasal bulguları arasındaki ilişki incelenmemiştir. Bu çalışmanın amacı 1H Manyetik Rezonans Spektroskopi (MRS) yöntemiyle dorsolateral prefrontal korteks (DLPFK) ve anterior singulat korteks (ASK) N-Asetil-Aspartat (NAA)/Kolin (Cho), NAA/Kreatin (Cr) ve Cho/Cr değerlerinin ZK performansı ile ilişkisinin incelenmesidir. Yöntem: Onüç sağ elini kullanan, yetişkin erkek Asperger Sendromu (AS) olgusu (yaş 17-37) ve bu olgularla yaş, cinsiyet, el kullanımı ve Weschler Yetişkinler İçin Zeka Ölçeği, Gözden Geçirilmiş Form Toplam Zeka Bölümü bakımlarından benzeştirilmiş 20 sağlıklı kontrol çalışmaya dahil edilmiştir. Bulgular: Bulgular AS olgularının ZK performansının anlamlı şekilde daha düşük olduğunu göstermiştir. DLPFK NAA/Cho düzeyi ZK puanı ile ters korelasyon göstermektedir (r=-.738, p=. 004). Öte yandan ZK performansı ile DLPFK Cho/Cr arasında düz korelasyon bulunmaktadır (r=. 656, p=. 015). ASK MRS değişkenleri ile ZK performansı arasında ise anlamlı bir ilişki bulunmamıştır. Tartışma: Sonuçlar DLPFK Cho düzeyi arttıkça AS olgularında ZK performansının arttığını düşündürmektedir.Öğe Beyin Difüzyon Ağırlıklı Manyetik Rezonans Görüntüleme Tetkikinde Akut İskemili Hastalarda Görünen Difüzyon Katsayısı Ölçümlerinin Değerlendirilmesi(2018) Hırslı, Canan; Bilgili, YaseminAmaç: Difüzyon ağırlıklı görüntüleme ile akut iskemisi olan hastalarda, iskemik “kor” dan ne kadar uzaklıkta görünen difüzyon katsayısı değerlerinin normale ulaştığının tespiti amaçlandı. Gereç ve Yöntem: Akut iskemisi olan 44 hasta çalışmamıza dahil edildi. Difüzyon ağırlıklı görüntüleme ile iskemi alanı dış sınırına 4mm, 8mm ve 12 mm uzaklıktan dörder ölçüm yapılarak görünen difüzyon katsayısı değerleri elde edildi. Bu değerler simetrik noniskemik hemisfer ile istatistiksel olarak kıyaslandı. Bulgular: Dört ve 8 mm uzaklıktaki dörder ölçümün ortalaması noniskemik hemisferdeki simetrik ölçümlerin görünen difüzyon katsayısı değerlerinden istatistiksel olarak anlamlı düzeyde düşük olarak saptanırken, 12 mm uzaklıkta elde olunan ölçümler ile noniskemik hemisferdeki ölçümler arasında istatistiksel olarak anlamlı farklılık saptanmadı. Sonuç: Çalışmamız verileri ışığında ve mevcut hasta grubunda iskemik kor dokusundan 12 mm mesafede görünen difüzyon katsayısı değerlerinin; hücresel düzeyde difüzyonun karşı hemisferle eş düzeye geldiği sonucuna varılmıştır. Bu mesafenin manyetik rezonans perfüzyon tetkiki ile kurtarılabilir penumbra dokusu ile ne kadar örtüştüğünün saptanması, difüzyon ağırlıklı görüntülemenin kontrastsız ve kısa sürede elde edilebilen bir tetkik olarak penumbra tespitinde kullanılabilme olasılıklarını gündeme getirmektedir
