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Öğe Acute abdomen caused by brucellar hepatic abscess(Elsevier Singapore Pte Ltd, 2007) Ibis, Cem; Sezer, Atakan; Batman, Alli K.; Baydar, Serkan; Eker, Alper; Unlu, Ercument; Kuloglu, FigenBrucellosis is a zoonotic infection that is transmitted from animals to humans by ingestion of infected food products, direct contact with an infected animal, or aerosol inhalation. The disease is endemic in many countries, including the Mediterranean basin, the Middle East, India, Mexico, Central and South America and, central and southwest Asia. Human brucellosis is a systemic infection with a wide clinical spectrum. Although hepatic involvement is very common during the course of chronic brucellosis, hepatic abscess is a very rare complication of Brucella infection. We present a case of hepatic abscess caused by Brucella, which resembled the clinical presentation of surgical acute abdomen.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 Bilateral basal ganglionic lesions due to transdermal methanol intoxication(Elsevier Sci Ltd, 2009) Karaduman, Fatih; Asil, Talip; Balci, Kemal; Temizoz, Osman; Unlu, Ercument; Yilmaz, Arif; Utku, UfukMethanol is a clear, colorless, and highly toxic liquid with a similar smell and taste to ethanol, and is found in many commercial products such as solvents and cleaning fluids. Severe methanol intoxication occurs after suicidal or accidental oral ingestion of solvents. A few patients with methanol intoxication via the transdermal route have been reported. We present a 47-year-old woman with acute transdermal methanol intoxication admitted to the emergency department with weakness, blurred vision, bilateral areactive mydriasis, and deterioration of consciousness. (C) 2009 Elsevier Ltd. All rights reserved.Öğe Bilateral choroidal metastases as an initial manifestation of small-cell carcinoma of the lung(Turkish Assoc Tuberculosis & Thorax, 2006) Kocak, Zafer; Tabakoglu, Erhan; Benian, Omer; Bayir, Gulden; Unlu, Ercument; Uzal, CemThe occurence of clinically symptomatic intraocular metastases as an initial manifestation of primary neoplasm is rare event. The recognition of metastatic ocular tumors is important since they indicate a poor prognosis. Prompt diagnosis and treatment can significantly improve the quality of life for these patients. We report the case of a 48-year-old man presenting with a two-week history of left sided intraocular pain with blurring of vision and headache, which are the first signs of small-cell lung carcinoma.Öğe Color and duplex doppler sonography to detect sacroiliitis and spinal inflammation in ankylosing spondylitis.: Can this method reveal response to anti-tumor necrosis factor therapy?(J Rheumatol Publ Co, 2007) Unlu, Ercument; Pamuk, Omer Nuri; Cakir, NecatiObjective. To investigate the role of color and duplex Doppler ultrasound (CDDUS) in the detection of sacroiliac (SI) and spinal inflammation, as well as response to anti-tumor necrosis factor (TNF) therapy in patients with ankylosing spondylitis (AS). Methods. We included 39 consecutive patients with AS followed at our center and 14 healthy controls. In the AS and control groups, blood vessels in SI joints and lumbar vertebral (LV) and thoracal vertebral (TV) paraspinal areas were investigated by CDDUS. When the artery was found, the resistive index (RI) was measured by CDDUS. Disease activity characteristics (ESR, CRP, BASDAI, and BASMI) were evaluated in patients with AS. In 11 patients for whom anti-TNF therapy was indicated, CDDUS measurements were performed before and on Week 12 of therapy. Results. In patients with AS, RI values of SI joints and of LV and TV areas were lower than in controls (all p <= 0.01). In AS patients with active disease according to BASDAI, RI values of TV (p = 0.0013) and LV (p = 0.027) were significantly lower than in the inactive group. In the group with active AS, SI RI was nonsignificantly lower (p = 0.16). After anti-TNF therapy, there were significant increases in mean SI RI (p = 0.028) and LV RI (p = 0.039), and a nonsignificant increase in TV RI (p > 0.05). Conclusion. CDDUS may be an alternative, less expensive, and easier method for detecting inflammation secondary to increased SI and spinal vascularization and in evaluating response to anti-TNF therapy in AS.Öğe Computed Tomographic and Magnetic Resonance Imaging Findings of Asymptomatic Intra-Abdominal Gastrointestinal System Lipomas(Lippincott Williams & Wilkins, 2008) Genchellac, Hakan; Demir, Mustafa K.; Ozdemir, Huseyin; Unlu, Ercument; Temizoz, OsmanLipomas are common benign mesenchymal neoplasms documented in literature. This study aimed to describe the computed tomographic (CT) and magnetic resonance imaging (MRI) findings of gastrointestinal system lipomas, all of which are incidentally found in routine abdominal imaging studies. Lipomas were depicted as homogeneous, nonenhancing, well-marginated lesions consistent with adipose tissue on CT and MRI The density measurements on CT images consistent with fat are virtually diagnostic. Lipomas can incidentally be found and should be considered in the differential diagnosis of soft tissue gastrointestinal system-related masses. Computed tomographic or MRI examinations can correctly diagnose a lipoma nonoperatively, thereby allowing better treatment planning..Öğe Contrast-enhanced MR 3D angiography in the assessment of brain AVMs(Elsevier Ireland Ltd, 2006) Unlu, Ercument; Temizoz, Osman; Albayram, Sait; Genchellac, Hakan; Hamamcioglu, M. Kemal; Kurt, Imran; Demir, M. KemalBackground and purpose: Digital subtraction angiography (DSA) is the current reference standard for the diagnosis, assessment, and management of brain arteriovenous malformations (AVMs). The purpose of this study was to compare the diagnostic utility of three-dimensional (3D) time-off-light (TOF) magnetic resonance angiography (MRA) and contrast-enhanced 3D MRA in patients with intracranial arteriovenous malformations (AVMs) in different sizes and locations. The AVM diagnosis was proved via DSA and almost half of the patients had also hematoma. Materials and methods: Two radiologists, experienced on neurovascular imaging and independent from each other, retrospectively reviewed two MRA techniques and DSA with regard to the assessment of feeding arteries, AVM nidus, and venous drainage patterns on 20 patients with 23 examinations by scoring system. Disagreements were resolved by consensus. Results: An excellent agreement between contrast-enhanced MRA and DSA was found in order to assess the numbers of arterial feeders and draining veins (Spearman r=0.913, P<0.001). The average scores in contrast-enhanced MRA for feeders, nidi, and drainers were respectively 2.26, 2.69, and 2.48, while in TOF-MRA they are 1.96, 1.35, and 0.89, respectively. Conclusion: Compared to TOF-MRA, 3D contrast-enhanced MRA is useful for visualization by subtraction technique of malformation components presented by hematoma or by haem product. On the other hand, for the cases presented by slow or complex flow that is especially in around or nidi or around the venous portion is also advantageous because of the independence from flow-related enhancement. Therapeutic effects were clearly demonstrated in three follow-up patients. A major limitation of this technique is the low spatial resolution. Since there is such a limitation, arterial feeder of a case with micro-AVM is not detected by contrast-enhanced MRA and nidus for the same case was observed retrospectively. In this respect, we believe that 3D contrast-enhanced MRA is a less invasive and inexpensive angiographic tool, but not a safe substitute for DSA. Yet, it can be a beneficial supplement to DSA in patients with cerebral AVMs at both initial diagnosis and at follow-up processes after therapy. (C) 2006 Elsevier Ireland Ltd. All rights reserved.Öğe CT-angiographic demonstration of hepatic collateral pathways due to superior vena cava obstruction in Behcet disease(Turkish Soc Radiology, 2010) Temizoz, Osman; Genchellac, Hakan; Yekeler, Ensar; Demir, Mustafa Kemal; Unlu, Ercument; Ozdemir, HuseyinBehcet disease (BD) is a chronic multisystemic inflammatory disorder, mainly characterized by recurrent oral and genital ulcers, skin lesions, and uveitis. Large vein thrombosis in BD is unusual; when present, it is most frequently seen in the inferior or superior vena cava (SVC). The authors describe an unusual hepatic pseudolesion caused by abnormal focal enhancement through collateral pathways to the liver in two BD patients with SVC occlusion on three-dimensional multi-detector computed tomography, using volume rendering and maximum intensity projection techniques. BD should be suspected in patients presenting a focal increased hepatic enhancement area with collaterals caused by occlusion of the SVC without evidence of a hypercoagulable state or malignant mediastinal or thoracic venous inlet obstruction.Öğe Diaphragmatic movements in ankylosing spondylitis patients and their association with clinical factors: an ultrasonographic study(Springer Heidelberg, 2012) Unlu, Ercument; Pamuk, Omer Nuri; Erer, Burak; Donmez, Salim; Cakir, NecatiWe compared diaphragmatic motion between ankylosing spondylitis (AS) patients and controls, as assessed by the ultrasonographic method. We included 33 consecutive AS patients (19 males, 14 females) followed up at our center and 14 apparently healthy controls (8 males, 6 females) into our study. AS patients fulfilled the modified New York classification criteria for AS. Patients' demographic and clinical data, functional parameters, and radiographic findings were recorded down. By evaluating the motion of right and left diaphragm during deep expirium and inspirium, the mean diaphragmatic motion was determined by ultrasonography. Diaphragmatic motion in AS patients was less than in controls, but the difference was not significant (68.9 +/- A 17 mm vs. 77.8 +/- A 22.4 mm, P = 0.14). Diaphragmatic motion in AS patients who were active according to BASDAI score (> 4) was not different from inactive patients (70.4 +/- A 20.5 vs. 67.5 +/- A 13.5, P > 0.05). The mean diaphragmatic motion had a positive correlation with occiput-to-wall distance (r = 0.35, P = 0.048); and negative correlations with cervical rotation (r = -0.45, P = 0.01) and modified Schober test (r = -0.34, P = 0.05) in AS patients. We did not detect any association of mean diaphragmatic motion with thoracic expansion on deep expiration. Diaphragmatic motion in AS does not differ significantly from the control group. Factors like disease activation, chest expansion, and the severity of radiographic findings do not affect diaphragmatic motion. There is no compensatory increase in diaphragmatic motion in AS.Öğe Differential diagnosis of spinal epidural meningioma and hemangioma at MR imaging(Radiological Soc North America, 2007) Demir, Mustafa Kemal; Ozdemir, Huseyin; Unlu, Ercument; Temizoez, Osman; Genchellac, Hakan[Abstract Not Available]Öğe The Effect of Admission Blood Pressure on the Prognosis of Patients with Intracerebral Hemorrhage That Occurred during Treatment with Aspirin, Warfarin, or No Drugs(Informa Healthcare, 2012) Balci, Kemal; Utku, Ufuk; Asil, Talip; Celik, Yahya; Tekinaslan, Ilkay; Ir, Nasif; Unlu, ErcumentBackground. Hypertension is the most important modifiable risk factor for intracerebral hemorrhage (ICH), but blood pressure (BP) management during the acute phase of ICH is still controversial. Approximately one-fourth of ICHs occur during treatment with warfarin or aspirin. Aim. This study was designed to determine the effect of admission BP on the early prognosis of ICH patients by dividing them into three groups (warfarin, aspirin, and no drugs). Methods. Three hundred and sixty-nine patients with supratentorial ICH were divided into three groups according to medication. Each group was evaluated in terms of prognosis and the risk for mortality based on the modified Rankin Scale (mRS) score at discharge (good prognosis: mRS <= 3; poor prognosis: mRS > 3). The effect of admission BP on prognosis was evaluated for each group. Results. The inhospital mortality rate was 72% for ICH patients treated with warfarin, 41.6% for ICH patients treated with aspirin, and 35% for ICH patients treated with no drugs. Admission mean arterial blood pressure (MABP) values were higher in patients with poor prognosis compared with patients with good prognosis for the aspirin (P = .002) and no-drug (P = .001) groups, but not in the warfarin (P = .067) group. Conclusion. A high MABP at admission was found to be an independent predictor of poor prognosis for ICH patients treated with aspirin or with no drugs, but not for ICH patients treated with warfarin.Öğe Efficacy of Three-Dimensional Contrast-Enhanced Magnetic Resonance Angiography (3D CE-MRA) in the Diagnosis of Thoracic Outlet Syndrome(Galenos Publ House, 2011) Unlu, Ercument; Kabayel, Derya Demirbag; Ozdemir, Ferda; Cagli, Bekir; Tuncel, Sedat A.Objective: The purpose of this study is to evaluate the effect of various upper extremity positions (adduction-abduction) on vascular structures in contrast-enhanced three-dimensional MR angiographic studies performed in patients with thoracic outlet syndrome. Materials and Methods: Twenty-two consecutive patients with clinical symptoms of neurovascular thoracic outlet syndrome were examined by 1.0 T MR unit. Examinations were studied by three-dimensional contrast-enhanced MR angiography with the arms positioned in abduction and adduction in the same patients. Results: In twenty-one of 44 subclavian arteries, impingement or stenosis with different degrees were found. Majority of lesions were localized in the costoclavicular region. Venous phase sequences of contrast-enhanced MR angiography showed compression of the subclavian vein in the 17 areas. Conclusion: Thoracic outlet syndrome remains controversial in both diagnosis and treatment, particulary in patients with no muscle atrophy, hand ischemia findings or venous stasis symptoms. Three-dimensional contrast-enhanced MR angiography is noninvasive and requires neither ionizing radiation nor administration of iodinated contrast material- and may be used to diagnose early compression findings and stenosis of the subclavian vessels.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 The first case of de novo B-cell prolymphocytic leukemia with central nervous system involvement: Description of an unreported complication(Pergamon-Elsevier Science Ltd, 2009) Pamuk, Guelsuem Emel; Puyan, Fulya Oz; Unlu, Ercument; Ozturk, Erman; Demir, Muzaffer[Abstract Not Available]Öğe Frequency, Distribution and Severity of Prevalent Osteoporotic Vertebral Fractures in Postmenopausal Women(Turkish Neurosurgical Soc, 2013) Kilincer, Cumhur; Demirbag Kabayel, Derya; Cagli, Bekir; Unlu, Ercument; Wicki, Barbara; Ozdemir, FerdaAIM: Assessment of previous vertebral fractures provides useful information to predict future fracture risk. This study aimed to determine the frequency, distribution and severity of prevalent osteoporotic vertebral fractures in postmenopausal women. MATERIAL and METHODS: Data on patient characteristics, bone densitometry values, and spine radiographs (T2-L5) were reviewed in 232 postmenopausal women admitted to our osteoporosis clinic. RESULTS: Prevalent vertebral fractures were detected in 28 (12.1%) women (95%Cl: 7.8 16.3). Fifteen women (6.5%) had mild fractures and 13 (5.6%) had moderate or severe fractures according to Genant's semi-quantitative technique. The T-score was associated with the presence of prevalent vertebral fractures (OR= 0.61; 95%Cl: 0.38-0.96, P= 0.034). The most frequently fractured vertebrae were T11 and T12, followed by T7 and T9. Sixty percent of fractures were wedge-type while 40% were biconcave. The frequency of wedge-type fractures at the T11-T12 levels (93.8%) was higher compared to that at all other levels (44.1%) (P= 0.001). CONCLUSION: We determined the frequency, distribution, and severity of prevalent fractures and identified certain distribution patterns of fracture locations and types. To verify our results and detect possible predictive factors for fracture risk, population-based larger trials are needed.Öğe Granulomatous hypophysitis: presentation and MRI appearance(Churchill Livingstone, 2006) Unlu, Ercument; Puyan, Fulya Oz; Bilgi, Selcuk; Hamamcioglu, M. KemalGranulomatous hypophysitis (GrHy) is a relatively rare inflammatory disease compared with lymphocytic hypophysitis. Only a few cases with magnetic resonance imaging (MRI) findings have been reported to date. We describe the MRI findings for two patients with GrHy with unusual histories and clinical outcomes. (c) 2006 Elsevier Ltd. All rights reserved.Öğe Incidental Pancreatic Lipomas: Computed Tomography Imaging Findings with Emphasis on Diagnostic Challenges(Elsevier Science Bv, 2010) Temizoz, Osman; Genchellac, Hakan; Unlu, Ercument; Kantarci, Fatih; Umit, Hasan; Demir, Mustafa KemalPurpose: The purpose of this study was to describe the computed tomography (CT) findings of pancreatic lipomas of 9 cases, with emphasis to diagnostic challenges. Methods: Between March 2006 and April 2008, 9 patients with pancreatic lipomas that were diagnosed by CT were reviewed in the present study. Clinical data and CT features of these 9 cases were retrospectively analysed. The patient population included 5 men and 4 women, aged 42-81 years (mean age, 65.8 years). The patients were followed up for at least 2 years with control CTs. Results: In all 9 cases, a well-bordered nodular fat density lesion was incidentally detected in the pancreas. Four of the lesions had a lobulated contour, and 2 of them had septations. Two of the lipomas were located in the head, 3 in the neck, 3 in the corpus, and 1 in the tail. The CT densitometric values were between -90 and -120 HU, with a mean value of 106 HU. No pancreatic or biliary dilatation or compression to the adjacent structures was seen. All the cases had control CTs, and the lipomas remained unchanged during the follow-up period. Histopathologic confirmation of the diagnosis was not planned for the cases. Conclusion: Lipomas are rarely encountered in the pancreas. They often are diagnosed coincidentally as small, well-circumscribed, encapsulated, homogeneous, mature adipose masses on imaging studies. Imaging follow-up strategy or histopathologic confirmation is not necessary in asymptomatic patients.Öğe Intracranial hypotension is a rare cause of orthostatic headache: a review of the etiology, treatment and prognosis of 13 cases(Kare Publ, 2013) Guler, Sibel; Cagli, Bekir; Utku, Ufuk; Unlu, Ercument; Celik, YahyaObjectives: The aim of this investigation is to examine the causes, clinical picture, treatment, and prognosis of spontaneous intracranial hypotension, a rare cause of orthostatic headache, among the cases presenting in our clinic. Methods: Thirteen cases (5 males and 8 females), diagnosed with spontaneous intracranial hypotension in our clinic between January 1st, 2009 and October 30th, 2011, were included in this study. The presenting symptoms, treatment, findings on cranial magnetic resonance imaging, cerebrospinal fluid pressure measured at lumbar puncture (in available patients), and the healing period of the patients were recorded. Results: Five patients with orthostatic headache and accompanying symptoms were treated with bed rest, increase in oral fluid intake, intravenous hydration and caffeine, and experienced a complete recovery. Complete recovery was observed in two patients (15.3%) within 10 days, in another two (15.3%) within 15 days and in one patient (7.6%) within 21 days. Headache and other clinical symptoms significantly regressed within 30 days in four patients (37.6%) who received similar treatment, but a mild headache persisted intermittently during follow-up in these individuals. As the headache had not resolved after 30 days, an epidural blood patch was applied in these four cases (37.6%) and the clinical picture completely improved within 10 to 15 days. Conclusion: Spontaneous intracranial hypotension should primarily be suspected in cases complaining about postural headache and contrast-enhanced cranial imaging should be performed. The presence of cranial nerve paralysis and pyramidal tract signs should b considered. Conservative treatments should be considered initially, however if conservative treatments fail, epidural blood patches must be applied.Öğe Oncocytic carcinoma of the parotid gland(Karger, 2006) Caloglu, Murat; Yurut-Caloglu, Vuslat; Altaner, Semsi; Huseyinova, Gulara; Unlu, Ercument; Karagol, Hakan; Uzal, CemBackground: Oncocytic carcinoma is a rare tumor of major salivary glands. Despite being described 5 decades ago, not much is known about these rare tumors. Histochemical or electron microscopic confirmation of the oncocytic nature of the tumor cell is needed for differential diagnosis. The main treatment modality is surgery with or without adjuvant radiotherapy. Malignant oncocytomas have the potential risk of developing distant metastases and demand long term follow-up after therapy. Case Report: A 58-year old man presented with a recurrent mass in the left parotid gland with a prior diagnosis of monomorphic adenoma in the same localization which had been treated by tumor excision in July 2002. Left superficial parotidectomy followed by radiotherapy into tumor bed and upper neck were carried out in September 2004. To date, he has had no evidence of recurrence for 14 months. Conclusion: For an accurate approach in the management of patients, oncocytic adenocarcinoma should be considered in the differential diagnosis of lesions of the parotid gland, most of which are benign.Öğe Phase inversion harmonic imaging improves assessment of renal calculi(John Wiley & Sons Inc, 2008) Ozdemir, Huseyin; Demir, Mustafa Kemal; Temizoz, Osman; Genchellac, Hakan; Unlu, ErcumentPurpose. To compare phase inversion harmonic imaging (PIHI) with fundamental imaging (FI) in the evaluation of renal calculi. Methods. Thirty adult patients with renal calculi (17 men, 13 women; mean age 44 years [range, 25-71]) underwent transabdominal sonographic examination of the urinary system. Both kidneys and renal calculi were examined with PIHI and A. Overall renal con picuity, calculus visibility, and clarity of posterior shadowing were assessed subjectively using a 4-point scale (0 being the worst, 3 being the best). The maximum diameter of the calculi was measured using both techniques. The effect of body mass index on qualitative scoring and quantitative measurements was evaluated. Results. PIN improved overall renal conspicuity compared with A (p < 0.001). The visibility of the calculi and clarity of posterior shadowing were significantly better with PIHI than with A (p, < 0.001 for both parameters). The maximum diameter of calculi was larger with PIHI than with FI (p < 0.001). The superiority of PIHI over FI regarding overall conspicuity of the kidney, visibility of the calculus, and clarity of posterior shadowing scores increased in the obese group (p < 0.001 for all 3 parameters). The mean calculus diameter difference between the 2 techniques was significantly higher in the obese group. Conclusion. The routine use of PIHI is recommended in the evaluation of renal calculi. (c) 2007 Wiley Periodicals, Inc.