Browsing by Author "Harman, M"

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Abdominal Hydatid Disease: Long-Term Results of Percutaneous Treatment
(Blackwell Munksgaard, 2004) Etlik, O; Arslan, H; Bay, A; Sakarya, ME; Harman, M; Temizoz, O; Unal, O
Purpose: To evaluate the effectiveness of percutaneous treatment under sonographic guidance in abdominal hydatid cysts. Material and Methods: Fifty-two hydatid cysts in 33 patients were treated using a percutaneous approach under sonographic guidance. Forty-five cysts were located in the liver, 6 in the spleen, and I in the pancreas. Forty-nine cysts were type 1, and 3 were type II. Thirty-one cysts in 15 patients were treated with puncture and aspiration of the contents, injection of hypertonic saline solution, and respiration (PAIR); 15 cysts in 14 patients were treated with puncture, aspiration of cyst contents, injection of hypertonic saline solution, drainage, and injection of sclerosing agent (PAIDS); and 6 cysts in 4 patients were treated with puncture, aspiration of cyst contents, injection of sclerosing agent, and re-aspiration (mPAIDS). Hypertonic saline or alcohol was used as a scolicidal agent. The follow-up period was between 17 and 53 months. Results: A decrease in the dimensions of the cysts, solidification of the contents, and irregularity in the walls of cysts, all of which were considered signs of cure, were found in all patients. Recurrence was observed in one case and anaphylaxis in one. Conclusion: Percutaneous treatment of abdominal hydatid cysts is a safe, easily applicable, well-tolerated, and effective method.
Brain Abscess Drainage by Use of Mr Fluoroscopic Guidance
(Amer Soc Neuroradiology, 2005) Ünal, O; Sakarya, ME; Kiymaz, N; Etlik, O; Kayan, M; Kati, I; Harman, M
We describe herein the use of MR fluoroscopic guidance in the drainage of abscess cavities. We percutaneously drained 12 brain abscesses in 11 patients. A 0.3T open MR imaging system was used. Sixteen drainages were performed in 12 abscesses. Repeat drainage was needed in three recurrences and one residual lesion. No serious complications were seen. MR fluoroscopy-guided percutaneous brain abscess drainage in an open MR imaging system is feasible.
Brucellar Spondylodiscitis -: Mri Diagnosis
(Elsevier Science inc, 2001) Harman, M; Unal, Ö; Onbasi, KT; Kiymaz, N; Arslan, H
Early diagnosis of bruccellar spondylodiscitis is often difficult because of the long latent period. Radiographs of the spine, bone scan, and computed tomography (CT) scan provide insufficient data. Among 25 patients with brucellar spondylodiscitis studied by magnetic resonance imaging (MRI), 9 were in the acute stage and 16 were in the chronic stage. MRI is the investigation method of choice in diagnosing brucellar spondylodiscitis. (C) 2001 Elsevier Science Inc. All rights reserved.
A Case of Antiphospholipid Syndrome Presenting With Pulmonary Truncus and Main Pulmonary Artery Thrombosis
(Springer, 2005) Sayarlioglu, M; Topcu, N; Harman, M; Guntekin, U; Erkoc, R
In patients with antiphospholipid syndrome (APS), thromboembolism and pulmonary hypertension are the most common pulmonary manifestations. Thrombotic obstruction at the level of the main and/or proximal pulmonary arteries is rare. We report a 40-year-old woman without any history of previous arterial and/or venous thrombosis who presented with severe dyspnea and was found to have pulmonary hypertension and positivity for anticardiolipin antibodies. Computed tomography revealed pulmonary truncus thrombosis extending to both right and left pulmonary arteries. The patient and her family refused surgical treatment. She had a prolonged hospital course, was unresponsive to thrombolytic, anticoagulant, antiplatelet, and immunosuppressive treatments, and died of right ventricle and respiratory failure 5 weeks later. This is the first reported case with thrombosis of pulmonary truncus and main pulmonary arteries concurrent with APS.
Chronic Pseudoaneurysm of the Aortic Arch: a Case Report
(Blackwell Publishing, 2005) Kutay, V; Harman, M; Ekim, H; Yakut, C
Pseudoaneurysm of the thoracic aorta is a rare condition and usually occurs following blunt trauma. It is almost fatal in the absence of prompt surgical treatment. We describe the case of a 56-year-old male suffering from intermittent nonmassive hemoptysis, mild dysphagia, and atypic chest pain for 1 month who has no history of trauma. A saccular aneurysm at the aortic arch between left common carotid artery and left subclavian artery was diagnosed by magnetic resonance imaging. Intraoperatively, compression of surrounding structures including trachea and esophagus by the aneurysmal sac (6 x 8 cm in diameter) was seen. Pseudoaneurysm adherent to the upper lobe of the left lung was resected and entire aortic arch replacement with a prosthetic graft was performed. Postoperative course was uneventful and neither specific changes on histologic examination nor any evidence of infection could be detected.
Coexistent Thyroid Pathologies and High Rate of Papillary Cancer in Patients With Primary Hyperparathyroidism
(Acta Medical Belgica, 2004) Kösem, M; Algün, E; Kotan, Ç; Harman, M; Öztürk, M
Thyroid carcinoma and benign thyroid diseases associated with primary hyperparathyroidism (PHPT) may cause difficulties in the diagnosis, localization and therapy of PHPT. In this study, we analysed coexistent thyroid pathologies in 51 patients who underwent neck exploration with a diagnosis of PHPT between 1999-2002. Five hundred thirteen patients who underwent thyroidectomy for nodular thyroid disease without a parathyroid pathology in histopathological examination served as controls. In patients with PHPT there were 43 cases (84.3%) of coexistent thyroid pathology. Nine patients (17.6%) had coexistent papillary thyroid cancer. Nine patients (17.6%) had lymphocytic thyroiditis, two (3.9%) had benign thyroid adenoma and 24 (47%) had nodular hyperplasia. In one patient (2%), there was intrathyroidal metastasis from a parathyroid cancer. One patient had coexistent lymphocytic thyroiditis and multi-focal papillary cancer. One of the two cases with thyroid adenomas was Hurthle cell type. In the control group only 28 patients (5.5%) had thyroid malignancy (27 papillary cancer and one follicular cancer). In conclusion, the coexistent thyroid pathologies are highly prevalent in patients with PHPT and pre- and intra-operative thyroid examination should be performed to avoid overlooking important thyroid pathologies.
Contrast-Enhanced Ct and Mri Findings of Atypical Hepatic Echinococcus Alveolaris Infestation
(Springer, 2005) Etlik, Ö; Bay, A; Arslan, H; Harman, M; Kösem, M; Temizöz, O; Dogan, E
Diagnosis of liver infestation by Echinococcus alveolaris (EA) is based on serological and radiological findings. In this report, we present a 15-year-old girl with atypical hepatic EA infestation showing central punctate calcifications and contrast enhancement on the portal and late phases of CT and MRI. CT showed a hypodense mass involving more than half of the liver with prominent central calcifications. MRI revealed hypointense signal of the infiltrative mass on both T1- and T2-weighted images. Contrast enhancement is a unique finding in hepatic EA infestation that may cause difficulties with diagnosis. MRI may provide invaluable information in the diagnosis of EA infestation of the liver, either by disclosing the infiltrative pattern of infestation without significant effect to vascular structures, or by the signal characteristics.
Demonstrating the Effect of Theophylline Treatment on Diaphragmatic Movement in Chronic Obstructive Pulmonary Disease Patients by Mr-Fluoroscopy
(Elsevier Sci Ireland Ltd, 2004) Etlik, O; Sakarya, ME; Uzun, K; Harman, M; Temizoz, O; Durmus, A
Introduction: The purpose of this study was to determine the increase in diaphragmatic excursion of patients with chronic obstructive pulmonary disease (COPD) treated with theophylline by MR-fluoroscopy which is an innovative method to demonstrate effectiveness of this treatment. Materials and methods: Investigations were performed on a 0.3 T open MR unit. MR-fluoroscopy images of 30 patients with COPD were obtained before and after theophylline treatment. Diaphragmatic movement values were recorded for evaluation. Results: The response of the diaphragmatic movement in COPD patients treated with theophylline was evaluated by MR-fluoroscopy and an increase of 48% in diaphragmatic contractility was determined after the treatment. The increase in contractility was found to be parallel with respiratory function tests and clinical status. Conclusion: Diaphragmatic movement and response to the medical therapy in patients with COPD can be evaluated by MR-fluoroscopy method which can allow accurate measurements. (C) 2003 Published by Elsevier Ireland Ltd.
Desmoplastic Medulloblastoma in a 48-Year Male
(Tohoku Univ Medical Press, 2004) Bayram, I; Ibiloglu, I; Ugras, S; Yilmaz, N; Harman, M
Medulloblastoma is a malignant invasive embryonal tumor of the cerebellum with preferential manifestation in children. The peak of occurrence is seven years of age Seventy percent of medulloblastomas occur in individuals Younger than 16. In adulthood, 80% of medulloblastomas arise in the 21-40 years age group. A 48-year-old male patient was admitted to the hospital with complains of headache, ataxia, morning vomitting and difficulty in speech was operated with the diagnosis of presence of mass of 4 x 7 cm size retaining a diffuse homogenous contrast in the posterior fossa. The diagnosis of desmoplastic medulloblastoma was given after histopathological examination. Immunohistochemical examination revealed that neoplastic cells showed staining with neuron-specific enolase and synaptophysin but not with glial fibrillary acidic protein. This lesion showed nodular, reticulin free-zones (pale islands) surrounded by densely packed, highly, proliferative cells. The pale regions within the tumor did not contain retictifin fibers. Desmoplastic medulloblastoma is encountered especially in adulthood. This type of tumor rarely occurs beyond the fifth decade of life. We present a case of desmoplastic medulloblastoma in a 48-year-old male. - desmoplastic medulloblastoma; adulthood; posterior fossa (C) 2004 Tohoku University Medical Press.
Direct Percutaneous Embolization of a Carotid Body Tumor With N-Butyl Cyanoacrylate
(Blackwell Munksgaard, 2004) Harman, M; Etlik, Ö; Ünal, Ö
We report ultrasound-guided direct percutaneous injection of n-butyl cyanoacrylate for preoperative embolization of carotid body tumor in a 50-year-old patient. Angiographic road map assistance was used for protection of parent arteries during the injection. After embolization, complete devascularization of the tumor was achieved without complications. The tumor was removed surgically with minimal blood loss. This procedure is effective and promising for preoperative embolization of carotid body tumors.
Evaluation of the Patellofemoral Joint With Kinematic Mr Fluoroscopy
(Elsevier Science inc, 2002) Harman, M; Dogan, A; Arslan, H; Ipeksoy, U; Vural, S
Objective: The aim of this study was to evaluate the diagnostic effectiveness of kinematic magnetic resonance fluoroscopy (KMRF) on patients with patellofemoral incongruency. Materials and methods: 17 patients (20 knees) and 10 healthy volunteers (20 knees), all men (mean age 29.4 years, S.D. 9, range 16-50), were included to our study. Only male subjects were studied because of potential biomechanical differences between sexes. KMRF was used to perform kinematic MR imaging of patellar alignment and tracking in 10 healthy Subjects and 17 patients with a provisional clinical diagnosis of abnormal patellofemoral joints. The patellofemoral joints were examined with the knee in different angles of active flexion. At each knee position, real time kinematic and axial MRF image Was used to focus on the sagittal plane, followed by an axial image focused through the middle of the patella. Three angles were measured: patellar tilt angle (PTA), sulcus angle (SA) and congruence angle (CA). Results: Five patterns of malalignment were identified and studied. Two patellofemoral joints were normal, 10 had lateralization of the patella, 2 had patellar tilt, 2 had lateralization and patellar tilt (i,e. excessive lateral pressure syndrome) and 4 had medialization of the patella. Conclusion: KMRF is an effective method in evaluating patellofemoral incongruency. Short time duration of investigation, ability to get nearly real time images, suitable temporal contrast resolution and investigation from very different angles of knee are important advantages of the method. (C) 2002 Elsevier Science Inc. All rights reserved.
Fibrosing Mediastinitis and Thrombosis of Superior Vena Cava Associated With Behcet's Disease
(Elsevier Sci Ireland Ltd, 2003) Harman, M; Sayarlioglu, M; Arslan, H; Ayakta, H; Harman, E
We present CT, MRI and venography findings in 13-year boy with mediastinal fibrosis and superior vena cava (SVC) thrombosis associated with Behcet's disease. Fibrosing mediastinitis is an excessive fibrotic reaction that occurs in the mediastinum and may lead to compression of mediastinal structures (especially vascular). This condition is usually idiopathic, though many (and perhaps most) cases in the USA are thought to be caused by an abnormal immunologic response to Histoplasma capsulatum infection. SVC syndrome secondary to extrinsic compression by mediastinal fibrosis combined with Behcet's disease has rarely been described. Radiological investigations of this syndrome are necessary to avoid a useless anticoagulant therapy. (C) 2003 Elsevier Science Ireland Ltd. All rights reserved.
Incidence of Retro-Aortic Left Renal Vein and Its Relationship With Varicocele
(Springer, 2005) Arslan, H; Etlik, Ö; Ceylan, K; Temizoz, O; Harman, M; Kavan, M
The retro-aortic left renal vein (RLRV) is a malformation characterized by the presence of a vessel that drains the left renal blood up to the inferior vena cava crossing behind the aortic artery. Varicocele is defined as venous dilation of the pampiniform plexus, and the left side is the most commonly affected. Several theories concerning the possible aetiology of varicocele are reviewed in the literature, but RLRV was not mentioned as an aetiologic factor of varicocele. in this study we investigated the percentage of RLRVs and their relation with varicocele. A total of 1,125 contrast-enhanced abdominal CT scans was examined to identify RLRVs. RLRVs were found in nine women (1.6%) and ten men (1.7%). We performed scrotal Doppler ultrasonography (US) for all affected men except one. Varicocele of varying degrees was found in seven of the nine male patients with RLRV (77%). RLRV could be one of the aetiological factors in the development of varicocele, and the cases with RLRV should be examined by scrotal Doppler US for the presence of varicocele.
Intracardiac Extension of Intravenous Leiomyoma
(Texas Heart inst, 2005) Kutay, V; Tuncer, M; Harman, M; Ekim, H; Yakut, C
Intravenous leiomyoma with intracaval and intracardiac extension is a rare benign neoplasm affecting women. We report a case in which an intravenous leiomyoma originated from the right iliac vein and extended through the inferior vena cava into the right atrium. The correct diagnosis was made intraoperatively after resection of the intracardiac extension of the tumor, which was 28 cm in length. At the 2nd stage of the operation, a right common iliac venotomy enabled the removal of all residual tumor from the inferior vena cava.
Malignant Meningioma in a 3-Year Girl
(Lippincott Williams & Wilkins, 2006) Bayram, I; Kiymaz, N; Harman, M; Ugrath, S
Malignant Pheochromocytoma With Peritonitis Carcinomatosa
(Lippincott Williams & Wilkins, 2005) Algün, E; Kösem, M; Alici, S; Harman, M; Güler, O; Kotan, E
Pheochromocytomas and functioning paragangliomas are rare tumors arising from the primitive neural crest. Approximately 10% of adrenal pheochromocytomas are malignant. Malignant pheochromocytomas usually recur in the retroperitoneum or appear as metastatic deposits in bone, lung, or liver. Here, we report a 51-year-old woman with malignant pheochromocytoma with a peritoneal metastasis, which is a very unusual metastatic site. She was referred to the hospital with headache, abdominal pain, and ileus. A right adrenal mass was surgically removed in May 1997. Pathologic examination revealed pheochromocytoma and capsular with adjacent muscle invasion. During the next 3 years, the patient remained well. The disease recurred in 2001, with hypertensive episodes and peritonitis carcinomatosa. Further investigation revealed no other metastatic sites. Peritoneal metastasis is very rare in malignant pheochromocytoma and generally is attributed to direct peritoneal seeding during surgery.
Mr Arthrography in Chondromalacia Patellae Diagnosis on a Low-Field Open Magnet System
(Elsevier Science inc, 2003) Harman, M; Ipeksoy, U; Dogan, A; Arslan, H; Etlik, O
Objective: The purpose of this study was to compare the diagnostic efficacy conventional MRI and MR arthrography (MRA) in the diagnosis of chondromalacia patella (CP) on a low-field open magnet system (LFOMS), correlated with arthroscopy. Subjects and methods: Forty-two patients (50 knees) with pain in the anterior part of the knee were prospectively examined with LFOMS, including T1-weighted, proton density-weighted and T2-weighted sequences. All were also examined T1-weighted MRI after intraarticular injection of dilue gadopentetate dimeglumine. Two observers, who reached a consensus interpretation, evaluated each imaging technique independently. Thirty-six of the 50 facets examined had chondromalacia shown by arthroscopy, which was used as the standard of reference. The sensitivity, specificity and accuracy of each imaging technique in the diagnosis of each stage of CP were determined and compared by using the McNemar two-tailed analysis. Results: Arthroscopy showed that 16 facets were normal. Four (30%) of 13 grade 1 lesions were detected with T1. Four lesions (30%) with T2 and three lesions (23%) with proton-weighted images were detected. Seven (53%) of 13 grade 1 lesions were detected with MRA. Grade 2 abnormalities were diagnosed in two (33%) of six facets with proton density-weighted pulse sequences, two (33%) of six facets with T1-weighted pulse sequences, in three (50%) of six facets with T2-weighted pulse sequences, in five (83%) of six facets with MRA sequences. Grade 3 abnormalities were diagnosed in three (71%) of seven facets with proton density- and T1-weighted images, five (71%) of seven facets with T2-weighted pulse sequences, six (85%) of seven facets with MRA sequences. Grade 4 CP was detected with equal sensitivity with T1-, proton density- and T2-weighted pulse sequences, all showing seven (87%) of the eight lesions. MRA again showed these findings in all eight patients. All imaging techniques were insensitive to grade 1 lesions and highly sensitive to grade 4 lesion, so that no significant difference among the techniques could be shown. Conclusion: All imaging technique studied had high specificity and accuracy in the detection and grading of CP; however, MRA was more sensitive than T1-weighted and proton density-weighted MR imaging on a LFOMS. Although the arthrographic techniques were not significantly better than T2-weighted imaging, the number of false-positive diagnosis was greatest with T2-weighted MRI. (C) 2003 Elsevier Science Inc. All rights reserved.
Mri Findings of Hepatic Alveolar Echinococcosis
(Elsevier Science inc, 2003) Harman, M; Arslan, H; Kotan, C; Etlik, O; Kayan, M; Deveci, A
Diagnosis of liver infestation by alveolar echinococcosis (AE) is based on serologic, sonographic and computed tomography (CT) findings. Experience with magnetic resonance imaging (MRI) demonstrates that features of this disease are limited. CT and MRI findings of 14 cases with hepatic AE were compared in this report. We have described the MRI appearance of hepatic AE, which exhibits variable signal intensities on T1- and T2-weighted images. Fibrous and parasitic tissue showed low signal both on T1- and, generally, on T2-weighted images. In a few cases, a high signal on T2-weighted images may be observed, due either to central necrotic zones or to small peripheral cyst. MRI than by CT was more easily identified central necrosis. However, MRI seemed to be less effective than CT in allowing us to reach a positive diagnosis, due to its inability to show microcalcifications. In addition, MRI may not reveal small lesions. In most cases, T1-weighted images revealed more clearly than CT did the margins of the lesions and the hepatic extension, especially to hepatic veins, vena cava and perihepatic spaces. (C) 2003 Elsevier Inc. All rights reserved.
Peroral Ct Enterography With Lactulose Solution
(Amer Roentgen Ray Soc, 2005) Arslan, H; Etlik, Ö; Kayan, M; Harman, M; Tuncer, Y; Temizöz, O
Objective: The objective of our study was to evaluate lactulose solution as a new oral contrast agent with the use of peroral CT enterography to determine the adequacy of luminal distention and conspicuity of the bowel wall. CONCLUSION. Peroral CT enterography performed with lactulose solution is a simple and noninvasive method of evaluating the small bowel by obtaining good distention. It can also be used at routine abdominal examinations as a negative contrast agent instead of iodinated oral contrast medium, especially for CT angiography.
Popliteal Artery Pseudoaneurysm
(John Wiley & Sons inc, 2004) Harman, M; Irmak, H; Arslan, H; Arslan, Ü; Kayan, M
Brucellosis is still a public health problem, particularly in developing countries. After the primary infection subsides, a chronic stage characterized by nonspecific manifestations can develop, during which it may not be possible to isolate Brucella organisms and agglutination test titers may or may not be high. We present the case of a 49-year-old man who had only nonspecific symptoms and a 2-month history of a pulsatile painful swelling in his right popliteal region. He had no history of trauma or surgery in that region, but he did ingest unpasteurized milk products. The patient's agglutination test titers were high, and Brucella melitensis was isolated from a bone marrow culture. Color Doppler sonography, T2-weighted MRI, and digital subtraction angiography were performed. Treatment with ultrasound-guided compression of the pseudoaneurysm failed because of high blood flow in its neck. Aneurysmectomy was undertaken, and the excised material was consistent with that from a mycotic pseudoaneurysm. Although both MRI and angiography provided useful information, the color Doppler sonography findings were characteristic of a pseudoaneurysm in the popliteal artery, and only that modality could detect the flow dynamics within the pseudoaneurysm. (C) 2003 Wiley Periodicals, Inc.