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Öğe Diagnostic Performance of Superb Microvascular Imaging and Other Sonographic Modalities in the Assessment of Lateral Epicondylosis(Wiley, 2018) Arslan, Serdar; Karahan, Ali Yavuz; Oncu, Fatih; Bakdik, Suleyman; Durmaz, Mehmet Sedat; Tolu, IsmetObjectives-The aim of this study was to compare the diagnostic performance of different sonographic modalities for diagnosing lateral epicondylosis. Methods-A total of 50 symptomatic and 50 asymptomatic common extensor tendons in 44 patients with lateral epicondylosis, and 25 healthy participants were prospectively examined by B-mode sonography, color Doppler imaging, power Doppler imaging, Superb Microvascular Imaging (SMI; Toshiba Medical Systems Corporation, Tokyo, Japan), and strain elastography. We evaluated blood flow in common extensor tendons by using a grading system with color Doppler imaging, power Doppler imaging, and SMI. The diagnostic performance of the modalities was compared. Results-When a cutoff value of hypoechogenicity was used for the mean strain ratio, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy rates were 92.0%, 94%.0, 93.9%, 92.2%, and 93.0%, respectively. When a cutoff point of grade 1 was used, the sensitivity, specificity, PPV, NPV, and accuracy rates were 26.0%, 10.0%, 10.0%, 57.5%, and 63.0, for color Doppler imaging; 40.0%, 10.0%, 10.0%, 62.5%, and 70.0% for power Doppler imaging; and 84.0%, 94.0%, 93.0%, 85.5%, and 89.0% for SMI. When a cutoff value of 3.94 was used for the mean strain ratio, the sensitivity, specificity, PPV, NPV, and accuracy rates were 78.0%, 92.0%, 90.7%, 80.7%, and 85.0%, respectively. A statistically significant correlation was detected between SMI, strain elastography, and visual analog scale scores (P < .001). Conclusions-The combination of SMI and B-mode sonography was found to have excellent diagnostic performance for lateral epicondylosis. Neovascularzation in patients' tendons with lateral epicondylosis was identified much better with SMI compared to color or power Doppler imaging.Öğe Early Computed Tomography Findings of Novel Coronavirus Disease 2019 (COVID-19) Pneumonia(Briefland, 2020) Yilmaz, Pinar Diydem; Kadiyoran, Cengiz; Bakdik, Suleyman; Poyraz, Necdet; Vatansev, HulyaBackground: Novel coronavirus disease (COVID-19) pneumonia is caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), which is highly contagious and threatens human health. Chest computed tomography (CT) is an accurate imaging modality for diagnosis and follow-up. Objectives: To investigate early CT features of COVID-19 pneumonia. Methods: Retrospective study. Sixty-three patients with COVID-19 pneumonia (28 men, 35 women; age range, 21 - 85 years; mean, 59 years) confirmed by reverse transcription-polymerase chain reaction (RT-PCR) were enrolled in this retrospective study and CT findings were evaluated. Patients were classified into three groups for estimating COVID-19 pneumonia, according to CT features. Results: Nineteen (30%) patients classified as out of COVID-19 pneumonia had normal CT findings. Twenty-eight (44%) patients, classified as highly suggestive for COVID-19 pneumonia, had typical findings for COVID-19 pneumonia. In highly suggestive for COVID-19 pneumonia group most common CT features were peripheral (64%), multilobar (96%), patchy, and round (54%) ground-glass opacity (GGO) (57%). Air bronchogram (93%), crazy-paving patterns (79%), and vascular thickening (61%) were the mostcommon special findings. We only detected these rare findings such as halo sign, reverse halo sign, lymphadenopathy, pleural and pericardial effusion, pleural thickening, and fibrotic lines in patients with COVID-19 with chronic diseases. Conclusions: The early CT findings are peripheral, multilobar, patchy, and round ground glass opacities accompanied by vascular thickening, crazy-paving pattern, or air bronchogram sign. Rare findings are only seen in the presence of concomitant diseases.Öğe The effect of the palmaris longus muscle on wrist flexion and extension strength(Ios Press, 2017) Karahan, Ali Yavuz; Bakdik, Suleyman; Ozen, Kemal Emre; Arslan, Serdar; Karpuz, Savas; Yilmaz, Nihal; Yildirim, PelinBACKGROUND: The palmaris longus (PLM) is a fusiform-shaped muscle that appears in the superficial flexor compartment of the forearm. It has been suggested that PLM is a phylogenetically degenerate metacarpophalangeal joint flexor. OBJECTIVE: The aim of this study was to compare the strength of wrist flexion and extension in healthy volunteers with and without the PLM. METHODS: Sixty-four healthy subjects, 30 men and 34 women, 18-22 years old were enrolled in this study. The database consisted of 128 wrist tests. The inclusion criteria were as follows: sedentary lifestyle, unknown musculoskeletal disorders and right-handedness. Musculoskeletal ultrasound imaging was used for assessing the presence of PLM. A hand-held digital dynamometer was used to assess the peak force of wrist extension and flexion. Data were analyzed separately for women and men RESULTS: The existence of right-sided PLM was 73.3% in male subjects and 55.9% in female subjects. For men, the strength of wrist flexion was 36.03 +/- 13.92 N and 34.24 +/- 12.23 N for the right and left side, respectively. For women, the respective strengths were 16.20 +/- 7.29 N and 15.26 +/- 6.79 N. For both sexes, there was no statistically significant difference between those with and without a PLM (p > 0.05). There was also no significant difference in the agonist/antagonist (flexion/extension) ratio of the wrist between those with and without a PLM in both sexes and sides. CONCLUSIONS: The existence or absence of PLM plays no role in the strength of either the flexors or extensors of the wrist.Öğe Effectiveness of Superb Microvascular Imaging for the differentiation of intraductal breast lesions(Soc Romana Ultrasonografe Medicina Biologie-Srumb, 2018) Bakdik, Suleyman; Arslan, Serdar; Oncu, Fatih; Durmaz, Mehmet Sedat; Altunkeser, Aysegul; Eryilmaz, Mehmet Ali; Unlu, YasarAims: The aim of this study was to compare the diagnostic performance of superb microvascular imaging (SMI) and power Doppler imaging (PDI) for the differentiation of intraductal breast lesions. Materials and methods: A total of 54 intraductal breast lesions (39 benign, 10 atypical, and 5 malignant) in 53 patients were examined using B-mode ultrasonography, PDI, and SMI. Vascularity grading, distribution of microvessels, and penetrating vessels were evaluated using each Doppler technique. The diagnostic performances of both methods were compared. Results: SMI was more efficient in detecting flow signals than PDI (p=0.004). The highest diagnostic accuracy rates were achieved with SMI using vascular grading. When hypervascularity was used as a cut-off value to differentiate malignant and atypical lesions from benign lesions, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 66.6%, 80.7%, 66.6%, 80.7%, and 75.6% for PDI, and 86.6%, 76.9%, 68.4%, 90.9%, and 80.4% for SMI, respectively. Conclusions: SMI is more sensitive than PDI for detecting subtle blood flow in intraductal breast lesions with statistical significance. This novel and promising vascular imaging technique may be helpful in B-mode ultrasonography to distinguish intraductal breast lesions.Öğe The effects of sevoflurane anesthesia on hemodynamics and cerebral artery diameters in endovascular treatment of intracranial aneurysm: A pilot study(Turkish Assoc Trauma Emergency Surgery, 2021) Arican, Sule; Bakdik, Suleyman; Hacibeyoglu, Gulcin; Yilmaz, Resul; Koc, Osman; Tavlan, Aybars; Uzun, Sema TuncerBACKGROUND: Cerebral autoregulation is a steady-state of cerebral blood flow despite major changes in arterial blood pressure. Inhalation anesthetics are cerebral vasodilators. In <1 MAC values, the net effect is a moderate decrease in cerebral blood flow and maintenance of responsiveness to carbon dioxide. This study aims to investigate the effects of steady-state sevoflurane anesthesia on hemodynamic and cerebral artery diameter measurements in patients undergoing flow diverter device placement under general anesthesia. METHODS: Forty-six patients aged 18-70 years who underwent flow diverter devices under general anesthesia were included in this study. Routine monitoring was performed on the patients. Mean arterial pressure (MAP) values were recorded. Internal carotid artery, middle cerebral artery and anterior cerebral artery diameter measurements were made from digital subtraction angiography (DSA) images of patients with anterior aneurysms. Baseline artery, right posterior cerebral artery and left posterior cerebral artery diameter measurements were made from DSA images of patients with posterior aneurysms. These measurements were recorded as preoperative measurements. The same measurements were made from the DSA images performed before the Flow diverter device placement procedure performed under steady-state sevoflurane anesthesia for the same patients. These measurements were recorded as peroperative measurements. RESULTS: The average age of the patients was 56.6 +/- 15.1. The MAP of the patients before induction was 76.28 +/- 5.13 mmHg, MAP after induction was 64.36 +/- 3.23 mmHg, and MAP during sevoflurane anesthesia was 68.26 +/- 4.30 mmHg, there was a statistically significant difference. There was a statistically significant difference between the preoperative and perioperative values of anterior cerebral artery diameters. There was a strong relationship between the MAP change percentage and the ICA diameter change percentage (p<0.001, p=-0.785) and a moderate relationship between the MCA diameter change percentage (p=0.033, p=-0.338). CONCLUSION: In patients undergoing flow diverter devices, <1 MAC sevoflurane has a hemodynamic effect and creates significant vasodilation in the cerebral artery diameters.Öğe The effects of sevoflurane anesthesia on hemodynamics and cerebral artery diameters in endovascular treatment of intracranial aneurysm: A pilot study(Turkish Assoc Trauma Emergency Surgery, 2021) Arican, Sule; Bakdik, Suleyman; Hacibeyoglu, Gulcin; Yilmaz, Resul; Koc, Osman; Tavlan, Aybars; Uzun, Sema TuncerBACKGROUND: Cerebral autoregulation is a steady-state of cerebral blood flow despite major changes in arterial blood pressure. Inhalation anesthetics are cerebral vasodilators. In <1 MAC values, the net effect is a moderate decrease in cerebral blood flow and maintenance of responsiveness to carbon dioxide. This study aims to investigate the effects of steady-state sevoflurane anesthesia on hemodynamic and cerebral artery diameter measurements in patients undergoing flow diverter device placement under general anesthesia. METHODS: Forty-six patients aged 18-70 years who underwent flow diverter devices under general anesthesia were included in this study. Routine monitoring was performed on the patients. Mean arterial pressure (MAP) values were recorded. Internal carotid artery, middle cerebral artery and anterior cerebral artery diameter measurements were made from digital subtraction angiography (DSA) images of patients with anterior aneurysms. Baseline artery, right posterior cerebral artery and left posterior cerebral artery diameter measurements were made from DSA images of patients with posterior aneurysms. These measurements were recorded as preoperative measurements. The same measurements were made from the DSA images performed before the Flow diverter device placement procedure performed under steady-state sevoflurane anesthesia for the same patients. These measurements were recorded as peroperative measurements. RESULTS: The average age of the patients was 56.6 +/- 15.1. The MAP of the patients before induction was 76.28 +/- 5.13 mmHg, MAP after induction was 64.36 +/- 3.23 mmHg, and MAP during sevoflurane anesthesia was 68.26 +/- 4.30 mmHg, there was a statistically significant difference. There was a statistically significant difference between the preoperative and perioperative values of anterior cerebral artery diameters. There was a strong relationship between the MAP change percentage and the ICA diameter change percentage (p<0.001, p=-0.785) and a moderate relationship between the MCA diameter change percentage (p=0.033, p=-0.338). CONCLUSION: In patients undergoing flow diverter devices, <1 MAC sevoflurane has a hemodynamic effect and creates significant vasodilation in the cerebral artery diameters.Öğe Endovascular treatment of intracranial aneurysms using the Woven EndoBridge (WEB) device: retrospective analysis of a single center experience(Elsevier Science Inc, 2020) Kaya, Hasan E.; Bakdik, Suleyman; Keskin, Fatih; Erdi, Mehmet F.; Koc, OsmanIntroduction: Woven EndoBridge (WEB) is an innovative device for the treatment of intracranial aneurysms especially wide-necked bifurcation aneurysms. Here we present our experience with the WEB device. Material and methods: Patients treated using only the WEB device between September 2014 and November 2018 were included in the study. Follow up imaging studies and medical records of the patients were retrospectively reviewed. Results: Forty-two aneurysm of 42 patients (27 female, 15 male; median age: 56, range: 32-76) were treated using the WEB device. The mean diameter of the aneurysms was 6.6 mm (range: 3-12 mm). The neck diameter was >= 4 mm in 57% of the aneurysms. The locations of the aneurysms were the middle cerebral artery bifurcation in 29 (69%), basilar tip in 5 (12%), anterior communicating artery in 5 (12%), internal carotid artery tip in 2 (5%), and M1 segment of the middle cerebral artery in 1 (2%) of the patients. Five patients had subarachnoid hemorrhage due to aneurysm rupture. The device could be successfully deployed in all of the cases. There were control imaging studies available for 36 patients who were followed up for a median of 7 months (range: 1-33 months). Adequate occlusion was observed in 35 of these 36 patients (97%). There was no treatment related morbidity or mortality. Conclusion: Although long term follow-up data are not available, WEB intrasaccular flow disruptor seems to be effective and safe for intracranial bifurcation aneurysm treatment in the mid-term follow up.Öğe Long-term results of percutaneously treated multiple hepatic and splenic hydatid cysts in a pregnant woman(J Infection Developing Countries, 2018) Bakdik, Suleyman; Arslan, Serdar; Oncu, FatihHydatid disease is caused by Echinococcus granulosus, which is endemic worldwide. This parasitic tapeworm can produce cysts in almost every organ of the body; however, the liver and lungs are the most frequently targeted. 37-year-old multigravida woman with a 10-week pregnancy in whom multiple splenic and liver hydatid cysts were detected by ultrasound. All splenic and liver hydatid cysts were treated percutaneously under US guidance during the 14th week of pregnancy. The catheterization method was used in the treatment of all hydatid cysts. Alcohol was also used as scolicidal and sclerosing agent in all procedures. There were no major complications. A cystobiliary fistula developed in a hydatid cyst treated in the liver. A healthy baby was delivered vaginally at term.Öğe New surgical technique applied with urological instruments in bilobar multiple hepatolithiasis: Ultra-mini percutaneous hepatolithotomy(Aves, 2017) Ozturk, Ahmet; Sonmez, Mehmet Giray; Bakdik, Suleyman; Goger, Yunus Emre; Ozkent, Mehmet Serkan; Aksoy, Faruk; Belviranli, MetinIntrahepatic bile duct stones may emerge with manifestations as chronic stomach ache, cholestasis, cholangitis, abscess, post-obstructive atrophy and liver cirrhosis presentation may occur. Thus the treatment of symptomatic hepatolithiasis patients should be provided. Different methods such as biliary decompression, endoscopic, percutaneous or open surgery are recommended for the treatment of patients with intrahepatic gallstones. The aim of the treatment is to extract the stones and regain biliary drainage. But the treatment regimen to be applied should be determined after examining the age, performance condition, general condition of the patient and location of the stone carefully. In this case, we presented a young female patient who had many unsuccessful surgical interventions due to coledochal cyst and congenital malformation in bile ducts, had large stones in right and left intrahepatic bile ducts and in whom we provided complete stone-free condition through Ultra-Mini Percutaneous Hepatolithotomy (UM-PHL) using urological instruments.Öğe Percutaneous treatment of hepatic cystic echinococcosis: the success of alcohol as a single endocavitary agent in PAIR, catheterization, and modified catheterization techniques(Springer-Verlag Italia Srl, 2018) Bakdik, Suleyman; Arslan, Serdar; Oncu, Fatih; Tolu, Ismet; Eryilmaz, Mehmet AliThis retrospective study aims at demonstrating the success rate, effectiveness, and advantages of alcohol as a scolicidal and sclerosing agent for the percutaneous treatment of liver hydatid cysts. A total of 554 liver hydatid cysts obtained from 347 patients admitted between January 2008 and February 2016 were retrospectively investigated. Of these, 435 (78.5%), 91 (16.4%), and 28 (5%) were classified as Gharbi type 1, 2, and 3, respectively. Type 1 and 2 cysts were treated using PAIR (puncture, aspiration, injection, respiration) and single puncture catheterization methods; type 3 lesions were treated using a modified catheterization technique. Alcohol was used as a scolicidal and sclerosing agent in all procedures. After excluding three lesions (0.5%) because of lack of parenchymal support during catheterization, 274 (49.7%), 250 (45.3%), and 27 (4.9%) of 551 lesions were treated with PAIR, single puncture catheterization, and modified catheterization techniques, respectively. Therefore, a 99.5% of technical success rate was obtained. Major complications in 2 patients (0.5%) and minor complications were observed in 36 patients (10.3%). Mean hospital stay was 1.55 +/- 2.3 days (range: 0-23 days). Patients were followed-up for mean 19.6 months (range: 6-83 months), during which recurrences were detected in 19 patients (5.4%). The use of alcohol as a scolicidal and sclerosing agent during the percutaneous treatment of liver hydatid cysts is associated with a high success rate and low rates of recurrence and complications, and should be considered an important alternative to surgical procedures.Öğe Ultra-mini Percutaneous Hepatolithotomy in Patients With Large and Multiple Hepatolithiasis(Lippincott Williams & Wilkins, 2021) Ozturk, Ahmet; Sonmez, Mehmet Giray; Bakdik, Suleyman; Ecer, Gokhan; Altinkaya, Nurullah; Ataseven, Huseyin; Aksoy, FarukBackground: In this study, we applied the ultra-mini percutaneous hepatolithotomy (UM-PHL) technique on hepatolithiasis patients with multiple and large stones on which other minimally invasive methods failed, and our aim was to report its results, sharing in series for the first time. Materials and Methods: Preoperative and postoperative data, laboratory parameters, radiologic findings, and preoperative and postoperative details were recorded for a total of 14 patients for whom the UM-PHL technique was applied between April 2017 and December 2019. As all patients had multiple stones and extreme stone load and had bile duct surgery, they did not have a normal anatomy. All patients were radiologically confirmed to have had preprocedural magnetic retrograde cholangiopancreatography. Results: Operation duration of the patients was 137.6 +/- 44.9 minutes, while intraoperative blood loss was 69.2 +/- 24.9 mL, drainage catheter removal time was 2.85 +/- 0.86 days, and the hospitalization time was 4.28 +/- 2.55 days. Intraoperative balloon dilation was applied to enlarge the stricture area in 5 patients (35.7%). On the basis of the Clavien-Dindo classification, grade 2 complication was observed in 2 patients (14.2%) due to postoperative cholangitis. Patients were followed up for an average of 15 months, and nonsymptomatic radiologic stone recurrence was detected in the 12th month control of 1 patient (7.1%). Conclusion: The UM-PHL technique is a successful method that facilitates stone clearance by providing minimal dilatation through percutaneous intervention and by using instruments with small diameter, and it can safely be applied with its low complication level, low recurrence ratio, and short hospitalization time.