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Öğe ANOMALOUS ORIGIN OF BOTH VERTEBRAL ARTERIES COMBINED WITH ABERRANT RIGHT SUBCLAVIAN ARTERY AND TRUNCUS BICAROTICUS(Nobel Ilac, 2012) Tuncel, Sedat Alpaslan; Cagli, Bekir; Sengul, Ersin; Unlu, ErcumentWe present a 50-year-old woman who was admitted to our institution with headache. Magnetic resonance angiography examination revealed truncus bicaroticus, aberrant right subclavian artery and bilateral vertebral artery anomalies in which the right vertebral artery and left vertebral artery orginates from right common carotid artery and aortic arch respectively. To our knowledge, coexistence of these anomalies is the first report in the English literature. The awareness of these variations is of great importance especially in endovascular intervention and head and neck surgery.Öğe Central Neurocytoma: Computed Tomography and Magnetic Resonance Imaging Findings(Journal Neurological Sciences, 2012) Arslanoglu, Atilla; Tuncel, Sedat Alpaslan; Ataoglu, Omur; Orbay, ToygunCentral neurocytoma is a very rare intraventricular brain tumor that has a favorable prognosis. It occurs mostly in young adults and usually located in the lateral ventricles near to foramina Monro. We report the radiological findings of a case of 39-year-old woman with acute headache. A Computed Tomographic (CT) showed a mass in the midline of the lateral ventricles with extension to the foramen of Monro. The tumor was 28x38x48 mm in size. At CT, the tumor has heavy calcifications on noncontrast scans. T1-weighted magnetic resonance (MR) images, showed a tumor of mixed signal intensity. T2-weighted MR images revealed inhomogeneous signal intensity. The lesion enhanced homogeneously after administration of contrast material. The tumor was attached to the septum pellucidum and to the lateral walls of the lateral ventricles. Tumor totally resected, histopathologic sections of the lesion was reported as Central neurocytoma. Postoperative period was good. Central neurocytoma should be included in the differential diagnosis of intraventricular brain tumors like oligodendroglioma, choroids plexus papilloma, ependymoma, subependymoma, subependymal giant cell astrocytoma, and meningioma.Öğe Effectiveness of Thoracic Ultrasonography in the Evaluation of the Severity of Pulmonary Involvement in Patients With Systemic Sclerosis(Turkish League Against Rheumatism, 2016) Cakir Edis, Ebru; Hatipoglu, Osman N.; Pamuk, Omer N.; Mutlucan Eraslan, Renginar; Aktoz, Meryem; Tuncel, Sedat AlpaslanObjectives: This study aims to investigate the effectiveness of thoracic ultrasonography (USG) in a single session in the evaluation of the severity of pulmonary involvement in systemic sclerosis. Patients and methods: A total of 48 consecutive systemic sclerosis patients (2 males, 46 females; mean age 50.8 +/- 11.9 years; range 21 to 76 years) followed-up in our center were included. A thoracic USG using a linear probe was performed for each patient to evaluate the parenchymal involvement by two pulmonary disease specialists. The number of B-lines (B-lines described USG sign of interstitial lung fibrosis) was recorded. Systolic pulmonary artery pressure was measured by means of using a phase probe to evaluate pulmonary hypertension in the same sequence. The same day, pulmonary function tests were conducted. Warrick score was calculated according high resolution computed tomography (HRCT) images which were evaluated independently from each other by a radiologist and a pulmonary disease specialist. Medsger severity scale was calculated for each patient according to the results of HRCT findings, pulmonary function test, and systolic pulmonary artery pressure. Results: The number of B-lines detected on thoracic USG was correlated with the Warrick score (r=0.89; p=0.0001) and Medsger disease scale (r=0.55; p=0.0001) and negatively correlated with diffusing capacity of carbon monoxide (r=-0.56; p=0.0001) and forced vital capacity (r=-0.46; p=0.001). When HRCT was accepted as the gold standard; the sensitivity, specificity, positive predicted value, and negative predicted value for thoracic USG were 100%, 84.2%, 90.6%, and 100%, respectively. If thoracic USG was used instead of HRCT for the evaluation of Medsger scale, the results changed in only one of the 48 patients. Conclusion: Thoracic USG showed good correlation with HRCT findings for the evaluation of pulmonary parenchymal involvement in systemic sclerosis. Therefore, USG might be a noninvasive and useful tool for the long-term follow-up of systemic sclerosis patients after initial examination with USG and HRCT.Öğe Efficacy of diffusion-weighted magnetic resonance imaging in the evaluation of extrahepatic cholestasis-related hepatic fibrosis(Tubitak Scientific & Technological Research Council Turkey, 2015) Ayvaz, Suleyman; Tuncel, Sedat Alpaslan; Can, Guray; Cagli, Bekir; Karaca, Turan; Demirtas, Selim; Elmaoglu, MuhammedBackground/aim: To investigate the efficacy of diffusion-weighted magnetic resonance imaging (DWI) in the diagnosis and staging of fibrosis induced by experimental bile duct ligation (BDL). Materials and methods: Twenty-four rats were divided randomly into four groups: control, BDL - 3 days, BDL - 2 weeks, and BDL - 4 weeks. DWI was performed with b-values of 100 and 500 on the rats from control group at day zero, on the rats from the BDL - 3 days group at the end of day 3, on the rats from the BDL - 2 weeks group at the end of day 14, and on the rats from the BDL - 4 weeks at the end of day 28. Results: When fibrosis scores generated in all groups were evaluated together, a strong negative correlation was detected between fibrosis scores and apparent diffusion coefficient (ADC) values measured using b 100 and b 500. ADC values obtained using b 100 were found to be significantly higher compared to the fibrosis observed in both the BDL - 2 weeks and BDL - 4 weeks groups (P < 0.003 and P < 0.001, respectively). Conclusion: We think that DWI may be an alternative to liver biopsy for the diagnosis and staging of hepatic fibrosis with underlying extrahepatic cholestasis.Öğe Efficacy of diffusion-weighted MRI in the differentiation of all liver hydatid cyst types(Wiley, 2016) Koken, Deniz; Cagli, Bekir; Tuncel, Sedat Alpaslan; Sengul, Ersin; Yilmaz, Erdem; Unlu, Mehmet ErcumentIntroductionThe aim of this study was to evaluate the efficacy of diffusion-weighted images (DWIs) in the differentiation of hydatid cysts (HCs) of the liver. MethodsIn this prospective study, 54 patients with 92 HC lesions were evaluated. The mean apparent diffusion coefficient (ADC) values of each lesion were calculated using the ADC maps derived from the DWIs at b-values of 50, 500 and 1000s/mm(2). We compared the mean ADC values of the different HC types, which had already been classified using the sonographic criteria. A receiver operator curve (ROC) analysis was used for determining the diagnostic performance of the ADC values of the HC types. ResultsWhen the mean ADC values of each type of HC were compared using each of the b-values, no statistically significant differences were obtained between (cystic echinococcosis) CE1 and CE2 or CE3, CE2 and CE3, CE3 and CE4, or CE4 and CE5. In addition, the mean ADC values of CE1 and CE2 were significantly higher than those of CE4 and CE5. For discrimination between types CE1, CE2 and CE3, and types CE4 and CE5, the sensitivity and specificity values were, respectively, 75.9 and 89.5 for the b50 DWI, 87.0 and 86.8 for the b500 DWI, and 75.9 and 89.5 for the b1000 DWI in the ROC analysis. ConclusionDiffusion-weighted imaging may be useful for providing additional data to determine the type of HC, and for differentiating types CE1, CE2 and CE3 from types CE4 and CE5.Öğe Endovascular Stent-Graft Treatment of Giant Celiac Artery Pseudoaneurysm(Int Scientific Information Inc, 2015) Tuncel, Sedat Alpaslan; Gulcu, Aytac; Yilmaz, Erdem; Ciftci, Taner; Goktay, Ahmet YigitBackground: Visceral artery aneurysms (VAAs) comprise an uncommon but life-threatening vascular disease. When rupture is the first clinical presentation, mortality rate reaches 70%. Increased use of crosssectional imaging has led to a greater rate of diagnosis (40-80%) of asymptomatic VAAs. In the past, surgery was the treatment of choice for VAAs carrying high risk of mortality and morbidity. Case Report: A 22-year-old man, who had undergone gastric, pancreatic and aortic surgery 2.5 years earlier, presented with progressive abdominal pain. Multidetector computed tomography scan revealed an 8-cm celiac pseudoaneurysm. We report a giant celiac pseudoaneurysm treated with stent-graft implantation. Conclusions: Endovascular treatment of VAA is a safe and effective method alternative to surgery.Öğe Extraspinal Incidental Findings on Routine MRI of Lumbar Spine: Prevalence and Reporting Rates in 1278 Patients(Korean Radiological Soc, 2015) Tuncel, Sedat Alpaslan; Cagli, Bekir; Tekatas, Aslan; Kirici, Mehmet Yadigar; Unlu, Ercument; Genchellac, HakanObjective: The aim of the present study was to determine the prevalence and reporting rate of incidental findings (IF) in adult outpatients undergoing lumbar magnetic resonance imaging (MRI). Materials and Methods: Re-evaluation of a total of 1278 Lumbar MRI images (collected from patients with a mean age of 50.5 years, range 16-91 years) captured between August 2010-August 2011 was done by a neuroradiologist and a musculoskeletal radiologist. IFs were classified according to organ or system (liver, gallbladder, kidney, bladder, uterus, ovary, lymph node, intestine and aorta). The rate of reporting of a range of IF was examined. The outcome of each patient's treatment was evaluated based on review of hospital records and by telephone interviews. Results: A total of 253 IFs were found in 241 patients (18.8% of 1278). Among these, clinically significant IFs (n = 34) included: 2 renal masses (0.15%), 2 aortic aneurysms (0.15%), 2 cases of hydronephrosis (0.15%), 11 adrenal masses (0.86%), 7 lymphadenopathies (0.55%), 6 cases of endometrial or cervical thickening (0.47%), 1 liver hemangioma (0.08%), 1 pelvic fluid (0.08%) and 2 ovarian dermoid cysts (0.15%). Overall, 28% (71/253) of IFs were included in the clinical reports, while clinically significant findings were reported in 41% (14/34) of cases. Conclusion: Extraspinal IFs are commonly detected during a routine lumbar MRI, and many of these findings are not clinically significant. However, IFs including clinically important findings are occasionally omitted from formal radiological reports.Öğe Korpus Kallozum Spleniumunda Postinfeksiyöz GeçiciLezyon: Olgu Sunumu(2014) Güven, Harun Mest; Ünlü, Ercüment; Tuncel, Sedat Alpaslan; Asil, Talip; Çağlı, BekirAcil servise bilinç bulanıklığı, yüksek ateş ve baş ağrısı şikayeti ile başvuran 39 yaşındaki erkek hastanın yapılan kranyal manyetik rezonans görüntüleme (MRG)'sinde korpus kallozum splenium (KKS) kesiminde difüzyon kısıtlaması gösteren fokal lezyon izlendi. Beyin omurilik sıvısı (BOS) analizi ile birlikte hastaya meningoensefalit ön tanısı ile medikal tedavi başlandı. Kliniği hızla düzelme gösteren hastanın bir ay sonra yapılan kontrol kranyal MRG incelemesinde, korpus kallozumdaki lezyonunun tümü ile ortadan kalktığı görüldü. Bulgular KKS'nin postinfeksiyöz geçici lezyonu ile uyumlu olarak değerlendirildi. Bu lokalizasyon ve radyolojik özellikler spesifik olmayıp çeşitli viral ve bakteriyal enfeksiyonlarla ilişkili ensefalit/ensefalopati yada antiepileptik ilaç kullanan epilepsi hastalarında da görülebilmektedir.Öğe Lumbar Opening Pressure and Radiologic Scoring in Idiopathic Intracranial Hypertension: Is There Any Correlation?(Int Scientific Information Inc, 2017) Tuncel, Sedat Alpaslan; Yilmaz, Erdem; Cagli, Bekir; Tekatas, Aslan; Celik, Yahya; Unlu, Mehmet ErcumentBackground: To investigate correlation between lumbar opening pressure (LOP) and radiological scores based on cranial MRI and contrast-enhanced MR venography in patients with idiopathic intracranial hypertension (IIH). Material/Methods: Patients with IIH who underwent brain MRI and contrast-enhanced MR venography before measurement of LOP between 2010-2014 were evaluated retrospectively. Three experienced radiologists (blinded to LOP values) evaluated a total of 51 patients. They reached a consensus on the presence or absence of 6 radiological findings identified in the literature as characteristic for IIH: empty sella, perioptic dilation, optical tortuosity, flattening of the posterior globe, swelling of the optic disc, and bilateral transverse sinus stenosis. The radiological score was obtained by giving 1 point for the presence of each finding, with the highest possible score of 6 points. The correlation between the calculated radiological scores and LOP was evaluated. Results: There was no significant correlation between LOP and radiological scores (r=0.095; p=0.525, Spearman's rank coefficient). Similarly, no significant correlation was detected between LOP and each of the radiological findings (partial empty sella [p=0.137], perioptic dilation [p=0.265], optical tortuosity [p=0.948], flattening of the posterior globe [p=0.491], swelling of the optic disc [p=0.881], and bilateral dural sinus stenosis [p=0.837], Mann-Whitney U test). Conclusions: There was no significant correlation between LOP and reliable radiological features of IIH.Öğe MRI Findings in Biliary Cystadenoma(Modestum Ltd, 2014) Can, Guray; Tuncel, Sedat Alpaslan; Genchallac, Hakan; Puyan, Fulya Oz; Ibis, CemBiliary cystadenoma is a rare cystic hepatic neoplasm. We herein present a 44 year-old female patient with biliary cystadenoma focusing on difficulties in diagnosis because of lack of specific findings with imaging, and the need for surgery. As biliary cystadenomas have high recurrence risks and malignant transformation potential, careful follow-up should not be underestimated. Proper surgical resection of the lesion may be considered the most suitable diagnostic and therapeutic procedure, and prognosis is generally excellent after removal of the tumor.Öğe Pediatrik yaş grubu obez hastalarda hepatostetoza bağlı hepatik arter akım volümü değişikliğinin değerlendirilmesi(2014) Tuncel, Sedat Alpaslan; Koçyiğit, Ali; Demircioğlu, Fatih; Hızlı, Şamil; Çakmakçı, HandanÖzet Amaç: Pediatrik yaş grubunda obeziteye bağlı hepatosteatozun hepatik arterin akım volümü (HAV) üzerine olan etkisinin, Doppler ultrasonografi kullanılarak araştırılması amaçlandı. Gereç ve yöntem: Yaşları 8.5 ile 17 yıl arasında değişen, normal vücut kitle indeksine sahip 32 ve obez vücut- kitle indeksine sahip 42 hastada, HAV Doppler ultrasonografi ile değerlendirildi. Bulgular: Obez hasta grubu ile normal grup arasında HAV ortalamaları arasında anlamlı fark saptanmadı (p>0.05). Hepatosteatoz derecesinin artışı ile HAV de artış izlenmekle birlikte, istatistiksel anlamda farklılık bulunmadı (p>0.05). Obezite ile hepatosteatoz arasında güçlü korelasyon izlendi (r=0.638). Sonuç: Obeziteye bağlı hepatosteatozun derecesindeki artış ile HAV de göreceli artış izlenmekte olup, bu parametrenin kullanımı rutin takip incelemelerde sınırlı olarak katkı sağlayabilir.Öğe Posterior Reversible Leukoencephalopathy Secondary to Gemcitabine(Turkish Neurological Soc, 2014) Tekatas, Aslan; Cagli, Bekir; Tuncel, Sedat Alpaslan; Kirici, Mehmet Yadigar; Unlu, Ercument[Abstract Not Available]Öğe A Rare Case of Acute Abdomen: Perforation Secondary to Intramural Hematoma at Rectosigmoid Region(Derman Medical Publ, 2013) Yagmurkaya, Orhan; Kahya, Eyup; Aksoy, Huseyin; Tuncel, Sedat Alpaslan; Albayrak, DoganIntramural hematoma is a clinical situation which is secondary to anticoagulant therapy. In this study, a chronic atrial fibrilation patient taking anticoagulant, had perforation at rectosigmoid region which was secondary to intramural hematoma, is presented. Our case was a eighty-three-year-old male presented with acute abdomen at emergency room. In computerized tomography, intraabdominal free air and hematoma at rectosigmoid region were seen. Due to these, the decision of immidiate exploration was made. This should be noted that intramural hematoma can emerge in patientd on anticoagulant theraphy without trauma. Additionally, it shold be considered that intramural hematoma can lead to lethal complication such as perforation.Öğe A Rare Cause of Headache and Increased Intracranial Pressure: Primary Leptomeningeal Melanomatosis(Turkish Neurological Soc, 2014) Tekatas, Aslan; Gemici, Yagmur I.; Tuncel, Sedat Alpaslan; Cagli, Bekir; Tastekin, Ebru; Unlu, Ercument; Celik, YahyaPrimary leptomeningeal melanomatosis is a rare central nervous system neoplasm originating from leptomeningeal melanocytes. The cases can be presented with focal neurologic deficit, seizure, neuropsychiatric symptoms or increased intracranial pressure symptoms along with encephalitis or meningitis. Diagnosis can be made upon imaging studies, cytopathologic examination of cerebrospinal fluid and biopsy. Biopsy can return false negative since the leptomeningeal involvement is not diffuse. In this study, a case is presented who admitted to hospital with leptomenengitis symptoms such as headache, fever and altered state of consciousness and developed additional neurologic signs after months. First biopsy came out as normal while the second one did as positive. This case has been found worth presenting since this is a tumor of rare existence and the diagnosis was made upon the second biopsy.Öğe Tissue factor pathway inhibitor and thrombin-activatable carboxypeptidase B for prediction of early atherosclerosis in gouty arthritis(Pergamon-Elsevier Science Ltd, 2014) Uyanik, Mehmet Sevki; Pamuk, Gulsum Emel; Pamuk, Omer Nuri; Tuncel, Sedat AlpaslanBackground: Gouty arthritis (GA) is a chronic inflammatory arthritis in which both clinical and subclinical atherosclerosis are more frequent. The dynamic equilibrium between coagulation and fibrinolysis is impaired in inflammatory diseases. We determined TFPI and TAFI antigen levels in GA patients and evaluated their association with subclinical atherosclerosis. Methods: We included 45 GA patients (41 males, 4 females; mean age: 51.6 years) and 25 asymptomatic hyperuricemic (AHU) subjects (19 males, 6 females; mean age: 48.1 years). Cardiovascular risk factors were determined. TAFI and TFPI levels were determined by ELISA. B-mode ultrasonography was used to detect subclinical atherosclerosis. Results: Cardiovascular risk factors were similar in both groups. The carotid IMT was significantly higher in GA group than in AHU group (0.74 +/- 0.23 mm vs. 0.61 +/- 0.13 mm, p = 0.009). TFPI level was significantly higher in GA group than in AHU group (86.2 +/- 48.9 ng/mL vs. 25.8 +/- 21.4 ng/mL, p < 0.001); TAFI antigen was significantly higher in AHU group (22.6 +/- 3.6 ng/mL vs. 25.7 +/- 5.3 ng/mL, p = 0.006) than in GA patients. Atherosclerotic plaque formation was more frequent in GA group (p = 0.041). When GA patients with and without plaques were compared, the first group had significantly higher mean age (p = 0.01) and TFPI level (p = 0.028). TFPI level correlated with carotid IMT (r = 0.302; p = 0.028). Logistic regression analysis showed that age (OR: 1.236, 95%CI: 1.059-1.443, p = 0.007) and TFPI (OR: 1.031, 95%CI: 1.008-1.054, p = 0.008) were independent risk factors for the presence of plaques. Conclusions: GA patients had more frequent subclinical atherosclerosis than subjects with AHU. Higher TFPI levels in GA patients -probably associated with enhanced endothelial damage-were related to subclinical atherosclerosis. Lower TAFI levels in GA pointed to impaired fibrinolysis. (C) 2014 Elsevier Ltd. All rights reserved.Öğe VITREOUS HUMOR DIFFUSION MEASUREMENTS FROM DIFFUSION-WEIGHTED IMAGING IN IDIOPATHIC INTRACRANIAL HYPERTENSION(Literatura Medica, 2016) Cagli, Bekir; Tuncel, Sedat Alpaslan; Yilmaz, Erdem; Tekatas, Aslan; Ermis, VeliBackground - Idiopathic intracranial hypertension is a disease with uncertain etiology. It is not caused by an intracranial mass lesion or hydrocephalus and is characterized by abnormal elevation of intracranial pressure and normal composition of the cerebrospinal fluid. The orbita and intracranial area are closely related anatomically. Elevated intracranial pressure can be transmitted to the orbita through the cerebrospinal fluid around the optic nerve sheath changes at the vitreous humor on diffusion-weighted imaging have not been systemically studied in idiopathic intracranial hypertension. Purpose - The purpose of this study was to investigate diffusion changes in the vitreous humor in patients with intracranial hypertension. Methods - In this retrospective study, 25 patients with papilledema and who had been definitively diagnosed with idiopathic intracranial hypertension and 20 control participants were evaluated. Control subjects and patients were scanned with a 1.5 Tesla magnetic resonance imaging. Apparent diffusion coefficient maps were obtained from diffusion-weighted imaging with a b value of 1000 s/mm(2) and apparent diffusion coefficient values were automatically calculated. These images were obtained by a radiologist who was blinded to the details of the study for center of each vitreous humor and the body of lateral ventricle. The mean apparent diffusion coefficient values of each vitreous humor and the body of the lateral ventricle were calculated for each group (control group and patients) and quantitative comparisons were performed. Results - There were no statistically significant differences in mean apparent diffusion coefficient values of the right vitreous humor, left vitreous humor and the body of the lateral ventricle between the patients with idiopathic intracranial hypertension and the control group (p=0.766, p=0.864, p=0.576, respectively). Discussion - Vitreous humor is a closed system and has no direct relationship with the cerebrospinal fluid or cerebral tissue and although morphological changes occur in the orbital structures, including the optic disk and optic nerve in idiopathic intracranial hypertension, the indirect effects of these changes on the vitreous humor may be too subtle to measure. Conclusion - We did not find a significant difference in the mean apparent diffusion coefficient value of the vitreous humor between the patients with idiopathic intracranial hypertension and the control group. However, future studies will be necessary to determine if changes in the vitreous humor can be used to diagnose intracranial hypertension.