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Öğe Application of first-pass contrast bolus tracking sequence for the assessment of morphology and flow dynamics in cardiac MRI(Aves, 2013) Paksoy, Yahya; Ozbek, Orhan; Gumus, Serter; Koc, Osman; Nayman, Alaaddin; Kerimoglu, UlkuPURPOSE There are two well-known indications for first-pass perfusion in the literature. First is the evaluation of Myocardial ischemia, and the other is the evaluation of tumor vascularity. Our aim was to assess the value of a first-pass Contrast bolus tracking sequence (FPCBTS) for cases unrelated to these pathologies. MATERIALS AND METHODS A total of 35 patients (age range, 1 day to 66 years; mean age, 10.4 +/- 19.2 years; median age, 4.5 months) with suspected congenital (n=31) and acquired (n=4) heart and great vessel disease Were included in the study. All the patients underwent cardiac magnetic resonance imaging (MRI) and FPCBTS, and 20 patients underwent contrast enhanced magnetic resonance angiography (CE-MRA). We used cardiac MRI and CE-MRA for anatomic evaluation and FPCBTS for dynamic flow evaluation. RESULTS Truncus arteriosus, double outlet right ventricle, tetralogy of Fallot; corrected transposition of great arteries, atrial and ventricular septal defect, aortic rupture, cardiac hydatid cyst, tricuspid atresia, anomalous pulmonary venous return; and interrupted aorta were detected using the technique described here. Septal defects in six patients arid atrial aneurysm in two patients were excluded. The shunt gap and flow direction of the septal defects, a ruptured Wall in a dissected aorta, a hydatid cyst, and the atrial relationship in two cases with paracardiac masses Were diagnosed easily using this dynamic evaluation technique. CONCLUSION FPCBTS Can be performed in addition to cardiac MRI and CE-MRA to reveal flow dynamics and morphology.Öğe Budd-chiari syndrome and renal arterial neurysms due to behcet disease: a rare association(African Field Epidemiology Network-Afenet, 2015) Batur, Abdussamet; Dorum, Meltem; Yuksekkaya, Hasan Ali; Koc, OsmanBehcet's disease is a multisystemic vasculitis of unknown etiology with a chronic relapsing course. Vasculitis in Behcet's disease with predominant vascular involvement is the only vasculitis that affects both arteries and veins of any size. Involvement of the renal artery and inferior vena cava is rare among the arteries and veins, respectively. When disease affect the veins, it is in the form of thrombosis. Arterial complications include aneurysms, stenosis and occlusions. Both rupture of arterial aneurysm and occlusion of suprahepatic veins, causing Budd-Chiari syndrome, are associated with a high mortality rate. Vascular involvement is more common in male patients than in female patients. Men and patients with a younger age of onset present with a more severe prognosis. In this case report, we describe a very rare cause of intrarenal arterial aneurysm's rupture with previous Budd-Chiari syndrome due to Behcet's disease and successful angiographic embolization of actively bleeding aneurysm.Öğe Clinical efficacy and safety of transcatheter embolization for vascular complications after percutaneous nephrolithotomy(Termedia Publishing House Ltd, 2017) Poyraz, Necdet; Balasar, Mehmet; Gokmen, Ibrahim Erdem; Koc, Osman; Sonmez, Mehmet Giray; Aydin, Arif; Goger, Yunus EmreIntroduction: Percutaneous nephrolithotomy (PNL) is the preferred procedure for safe and effective surgical treatment of kidney stones. Hemorrhage is the most serious complication of PNL, resulting from pseudoaneurysm (PA) or arteriovenous fistula (AVF), and can usually be controlled with conservative treatment. Aim: To evaluate endovascular treatments and outcomes of vascular complications observed after PNL. Material and methods: We retrospectively reviewed data on 19 patients who underwent renal embolization due to post-PNL renal artery bleeding between March 2005 and September 2016. Embolization materials included embolization coils and glue. The incidence of post-PNL vascular complications and their endovascular treatments, outcomes, and the follow-up data were analyzed. Results: Nineteen (1.1%) of 1,609 patients (mean age: 44.9 years, range: 19-75 years) underwent angiography and subsequent transcatheter embolization to control bleeding. The mean time to onset of hemorrhage was 7.2 days after PNL (range: 3-18 days). The PNL entry site was the lower calyx in 15 patients, the middle calyx in 3, and the upper calyx in 1. PA, AVF, and PA plus AVF occurred in 14, 5, and 3 of the 19 renal angiography patients, respectively. Embolization of the affected vessels was successful in all 19 patients. The embolization materials of coil, glue, and coil plus glue were used in 16, 3, and 2 patients, respectively. Conclusions: Severe hematuria is a rare complication of PNL and can be successfully treated with transcatheter embolization.Öğe Congenital Carotid-Jugular Fistula in a Child A Case Report(Sage Publications Inc, 2014) Erdi, Fatih; Kaya, Bulent; Keskin, Fatih; Koc, Osman; Karatas, Yasar; Kalkan, ErdalCongenital carotid-jugular (CJ) fistula of the neck is a very rare clinical entity that has various causes. The CJ fistulas are particularly prone to complications unlike other peripheral arteriovenous fistulas. The aim of this report is to present a case of a CJ fistula between the external carotid and the external jugular vein, which was successfully closed with detachable balloon by an endovascular approach. A 14-year-old child was admitted to our clinic with a pulsatile neck swelling. There was no previous history of trauma. A high-flow fistula between the external carotid and the external jugular vein was determined. The fistula was closed with detachable balloon by an endovascular approach. The postoperative angiogram demonstrated complete resolution of the fistula. Endovascular treatment of CJ fistulas with detachable balloons is a safe and less traumatic technique and may be an effective alternative to the open surgery in selected patients.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 management of a collateral network aneurysm in a patient with spontaneous internal carotid artery occlusion(Sage Publications Inc, 2015) Kaya, Bulent; Erdi, Fatih; Keskin, Fatih; Kalkan, Erdal; Koc, OsmanSpontaneous non-moyamoya'' arterial occlusion of the intracranial arteries is very unusual. Progressive occlusion of a major intracranial artery, independently from the etiology, can lead to the development of collateral arterial networks that supply blood flow to distal territories beyond the occlusion. These collateral arteries are typically small and conduct low flows, but the hemodynamic stress within them can lead to aneurysm formation within the collateral network. In this report we present a case of spontaneous internal carotid artery occlusion and collateral network aneurysm for the first time in the literature and discuss the main features of the etiology and endovascular treatment of this rare, challenging aneurysm.Öğe Endovascular Stent-graft Placement for the Emergency Treatment of Ruptured Descending Aortic Aneurysm(Aves, 2014) Koc, Osman; Batur, Abdussamet; Karabekmez, Leman Gunbey; Gormus, Niyazi; Cil, Barbaros; Vural, AlaattinRuptured aortic aneurysm is a condition that requires emergency treatment because of its high mortality rate. In this case, we presented the emergency endovascular treatment of a ruptured descending thoracic aortic aneurysm. A female patient, admitted to the emergency with sudden onset back pain, was treated by emergency endovascular stent-graft after CT angiography examination. According to endovascular treatment, surgical treatment has a high mortality and morbidity rate in the treatment of the ruptured descending thoracic aortic aneurysms. The endovascular stent-graft treatment is applied safely and successfully to the intervention of this pathology.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 Epstein-Barr virus encephalitis: findings of MRI, MRS, diffusion and perfusion(Turkish J Pediatrics, 2011) Ozbek, Orhan; Koc, Osman; Paksoy, Yahya; Aydin, Kursad; Nayman, AlaaddinOzbek O, Koc O, Paksoy Y, Aydin K, Nayman A. Epstein-Barr virus encephalitis: findings of MRI, MRS, diffusion and perfusion. Turk j Pediatr 2011; 53: 680-683 Epstein-Barr virus is an infection that is known as infectious mononucleosis. Even though the central nervous system is not a primary region of involvement of this disease, neurological complications are reported rarely. In this case report, we evaluated a 15-month-old male who presented to the pediatric neurology clinic due to high fever and a neurologic attack. His serological tests and radiological examinations (magnetic resonance imaging (MRI), MR spectroscopy (MRS), diffusion-weighted imaging (DWI) and MR perfusion) were consistent with Epstein-Barr virus encephalitis, which is a very rare complication of infectious mononucleosis. Additionally, we discuss the MRI, MRS, DWI and MR perfusion findings of our case, which were different from other cases reported in the literature.Öğe Evaluation of post-operative flow and diameter changes in brachial and ulnar arteries in coronary artery bypass surgery patients in which the radial artery is used as graft(Turkish Soc Cardiology, 2015) Isik, Mehmet; Yuksek, Tahir; Dereli, Yuksel; Gormus, Niyazi; Durgut, Kadir; Koc, OsmanObjective: The radial artery is widely used in coronary bypass surgery. In these patients, forearm and hand circulation is provided by the ulnar artery. This study aimed to investigate post-operative changes in flow and diameter in brachial and ulnar arteries in patients undergoing coronary bypass surgery in which the radial artery is used as graft. Methods: Between September 2007 and September 2008, 20 patients (16 men, 4 women; mean age 57.8 years; range 44 to 70 years) underwent elective coronary bypass surgery at our clinic. The radial artery was used as graft in all cases. Pre-operatively, adequacy of the ulnar artery for forearm circulation was investigated by Allen test and duplex ultrasonography. Basal flow and diameter values of the brachial and ulnar arteries were measured. Control duplex ultrasound measurements were performed at three months post-operatively. Flow and diameter changes in the brachial and ulnar arteries were recorded. Results: Significant increase was shown in ulnar artery flow and diameter values in post-operative measurements. A significant increase was observed in brachial artery diameter, accompanied by a relative decrease in flow value. There were no mortality or ischemic complications in our study. Transient paresthesia as a neurological complication was observed in 4 patients. Conclusion: Radial artery use for coronary bypass surgery leads to significant changes in ulnar and brachial arteries. All flow and diameter changes can be detected by color Doppler ultrasonography in the early stages. These adaptation mechanisms show that the radial artery can be safely harvested as graft material.Öğe Extradural spinal chondromyxoid fibroma mimicking intradural mass lesion: MR and MR myelographic images(Elsevier Science Inc, 2015) Keskin, Fatih; Erdi, M. Fatih; Kalkan, Havva; Karatas, Yasar; Koc, Osman[Abstract Not Availabe]Öğe First clinical multicenter experience with the new Pipeline Vantage flow diverter(Bmj Publishing Group, 2023) Vollherbst, Dominik F.; Cekirge, H. Saruhan; Saatci, Isil; Baltacioglu, Feyyaz; Onal, Baran; Koc, Osman; Rautio, RiittaBackground Flow diversion is an innovative and increasingly used technique for the treatment of intracranial aneurysms. New flow diverters (FDs) are being introduced to improve the safety and efficacy of this treatment. The aim of this study was to assess the safety, feasibility, and efficacy of the new Pipeline Vantage (PV) FD. Methods Patients with intracranial aneurysms treated with the PV at 10 international neurovascular centers were retrospectively analyzed. Patient and aneurysm characteristics, procedural parameters, complications, and the grade of occlusion were assessed. Results 60 patients with 70 aneurysms (5.0% with acute hemorrhage, 90.0% located in the anterior circulation) were included. 82 PVs were implanted in 61 treatment sessions. The PV could be successfully implanted in all treatments. Additional coiling was performed in 18.6%, and in-stent balloon angioplasty (to enhance the vessel wall apposition) in 24.6%. Periprocedural technical complications occurred in 24.6% of the treatments, were predominantly FD deployment problems, and were all asymptomatic. The overall symptomatic complication rate was 8.2% and the neurological symptomatic complication rate was 3.3%. Only one symptomatic complication was device-related (perforator artery infarctions leading to stroke). After a mean follow-up of 7.1 months, the rate of complete aneurysm occlusion was 77.9%. One patient (1.7%) died due to aneurysmal subarachnoid hemorrhage which occurred before treatment, unrelated to the procedure. Conclusions The new PV FD is safe and feasible for the treatment of intracranial aneurysms. The short-term occlusion rates are promising but need further assessment in prospective long-term follow-up studies.Öğe Intracerebral Pial Arteriovenous Fistula With Aneurysm(Lippincott Williams & Wilkins, 2015) Keskin, Suat; Gokmen, Erdem; Koc, Osman; Cengiz, Sahika L.[Abstract Not Availabe]Öğe Neo-vascularisation of musculocutaneous and muscle flaps after division of the major vascular supply: An experimental study(Elsevier Sci Ltd, 2013) Gundeslioglu, Ayse Ozlem; Selimoglu, Nebil; Toy, Hatice; Koc, OsmanBackground and aim: Experimental studies have shown that musculocutaneous flaps are not dependent on a major pedicle for survival after 7-8 days, as revascularisation occurs from surrounding well-nourished tissue. However, muscle component loss in myocutaneous flaps after pedicle division has been reported. No study that examines the nature of the vascular ingrowth from underlying beds by blocking the peripheral cutaneous beds has been conducted in musculocutaneous and skin-covered muscle flaps. This study was designed to investigate the origin of the dominant source of neo-vascularisation after interruption of the major vascular supply in island musculocutaneous and island skin-covered muscle flaps by blocking neo-vascularisation from wound edges and the recipient bed. Method: Twenty-eight rats were divided into four experimental groups. In group I, a cutaneous maximus musculocutaneous island flap (MCIF) was raised, and the wound edges of the flap were blocked with a silastic sheet. In group II, an MCIF was raised, and the recipient bed was blocked with silastic. In group III, an island cutaneous maximus muscle flap (IMF) was raised as an island flap covered by a full-thickness skin graft (FTSG), and the wound margins were blocked with silastic. In group IV, an IMF was raised as an island flap covered by an FTSG, and the recipient bed was blocked with a silastic sheet. On the seventh postoperative day, vessel ligation was performed in each animal. Microangiographic studies and histopathological evaluations were performed 14 days after the first operation. Results: In microangiographic studies, neo-vascularisation was more prominent in groups II and IV (the groups in which the recipient beds were blocked) than in groups I and III (the groups in which the wound edges were blocked). Upon histopathological examination, the number of vessels was significantly lower in group I and group III than in group II and group IV (p < 0.001). Conclusions: Our findings revealed that neo-vascularisation from either the recipient bed or the wound edges was sufficient to ensure full flap survival in musculocutaneous flaps, and skin-grafted muscle flaps do not need major axial vessels 7 days after flap elevation in rats if the recipient bed or wound edges are well-vascularised. The results also indicated that revascularisation mainly comes from the peripheral wound edges and is independent of flap type. (C) 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.Öğe Preventive Effects of Intraperitoneal Selenium on Cerebral Vasospasm In Experimental Subarachnoid Hemorrhage(Lippincott Williams & Wilkins, 2010) Kocaogullar, Yalcin; Ilik, Kemal; Esen, Hasan; Koc, Osman; Guney, OnderVasospasm is an important cause of morbidity and mortality with subarachnoid hemorrhage (SAH). The effect of intraperitoneal administration of selenium, which is an antioxidant on cerebral vasospasm was investigated in an experimental model. By means of intracisternal blood injection model, SAH was induced in 24 rabbits, which were randomly divided into 3 groups (group I = control group, group 2 = SAH alone group, and group 3 = SAH plus selenium group). Basilar artery angiography was performed on day 0 and day 3 as described. Intraperitoneal selenium (0.05 mg/kg) treatment was started after the induction of SAH and administered once a day. Three days later, the animals were killed and the basilar artery was examined histologically for the luminal diameter and thickness of the arterial muscular wall. The mean values for the measurements of angiographic luminal diameter, pathologic luminal area.. Muscular wall thickness derived from the blind observer were analyzed statistically. There was no statistically significant difference in basal angiographic luminal diameter evaluation between groups 1-2-3 (P > 0.005). But in third day angiography; comparison of Group 2 and group 1-3 showed statistically significant differences (P < 0.001). In pathologic investigation; there was statistically significant difference in luminal area and muscular wall thickness of the basilar artery between groups 1, 2, and 3 (P < 0.005). Intraperitoneal selenium treatment was found effective by increasing the angiographic diameter, pathologic luminal area and reducine muscular wall thickness measurements. This is the first study to show that intraperitoneal administration of selenium is effective in preventing vasospasm after SAH in rabbits.Öğe Radiofrequency ablation of a rare pathology: vertebral intraosseous lipoma(Elsevier Science Inc, 2016) Ozbek, Orhan; Keskin, Fatih; Kaya, Hasan Emin; Guler, Ibrahim; Nayman, Alaaddin; Koc, Osman[Abstract Not Availabe]Öğe Radiology guided antegrade GASTROSTOMY deployment of mushroom (pull type) catheters with classical and modified methods in patients with oropharyngeal, laryngeal carcinoma, and anesthesia risk(British Inst Radiology, 2021) Bakdik, SuLEYMAN; Keskin, Muharrem; oncu, Fatih; Koc, OsmanObjective: The aim of study is to evaluate the results of deployment of Percutaneous Radiological Gastrostomy (PRG), which is a good alternative to Surgical Gastrostomy (SG), with transoral approach in cases where Percutaneous Endoscopic Gastrostomy (PEG) is contraindicated, difficult or unsuccessful, in patients with high risk of American Society of Anesthesiologists with four scores. In addition, we aimed to demonstrate the advantages of mushroom pull type catheters over push type gastrostomy catheters. Methods: This retrospective study included a total of 40 patients (18 females and 22 males) aged 21-92 years who underwent PRG with the antegrade transoral approach. PRG was performed by retrograde passing through the esophagus or snaring the guidewire from the stomach and taking out of the anterior abdominal wall. Patients' demographic data, indications for PRG, procedural outcomes and complications were screened and recorded. Results: PRG was performed in 39 of 40 patients included in the study. Technical success rate was 97.5%. Procedure-dependent major complications such as death, aspiration, colon perforation, and deep abscess were not observed. Aspiration occurred in the first patient during the first feeding on the day after the procedure. Major complication rate was 2.5%. The total minor complication rate was 17.5% in 7 patients; parastomal leakage in 2 patients (5%), skin rash and infection in 3 (7.5%) patients, minor bleeding in 2 (5%) patients with oropharynx cancer, minimal bleeding from the gastrostomy catheter 1 week after the procedure in 1 (2.5%) patient. None of the cases had buried buffer. Tube functionality was preserved in all patients without any damage. Conclusion: Mushroom tip (pull type) gastrostomy catheter is a safe treatment method for patients requiring prolonged feeding because of wide diameter, endurance, long staying opening duration, less excessive dilatation and parastomal leakage, and no need for gastropexy. Lower cost and easier access are advantageous for mushroom tip pull type catheters compared to push type gastrostomy catheters in our country. The less invasive PRG is an alternative option in patients who are difficult to administer PEG, are at high anesthesia risk and cannot be sedated. Advances in knowledge: This article is valuable in terms of its contribution to develop an alternative radiological method for the deployment of gastrostomy tubes in medical difficult patients. This method has shortened the duration of the procedure and increased the success rate in patients with difficulty in transition from the stomach to the esophagus or with difficulty in the upper gastrointestinal tract. Mushroom tip catheters can be placed successfully by radiological methods.Öğe Radiology guided antegrade GASTROSTOMY deployment of mushroom (pull type) catheters with classical and modified methods in patients with oropharyngeal, laryngeal carcinoma, and anesthesia risk(British Inst Radiology, 2021) Bakdik, SuLEYMAN; Keskin, Muharrem; oncu, Fatih; Koc, OsmanObjective: The aim of study is to evaluate the results of deployment of Percutaneous Radiological Gastrostomy (PRG), which is a good alternative to Surgical Gastrostomy (SG), with transoral approach in cases where Percutaneous Endoscopic Gastrostomy (PEG) is contraindicated, difficult or unsuccessful, in patients with high risk of American Society of Anesthesiologists with four scores. In addition, we aimed to demonstrate the advantages of mushroom pull type catheters over push type gastrostomy catheters. Methods: This retrospective study included a total of 40 patients (18 females and 22 males) aged 21-92 years who underwent PRG with the antegrade transoral approach. PRG was performed by retrograde passing through the esophagus or snaring the guidewire from the stomach and taking out of the anterior abdominal wall. Patients' demographic data, indications for PRG, procedural outcomes and complications were screened and recorded. Results: PRG was performed in 39 of 40 patients included in the study. Technical success rate was 97.5%. Procedure-dependent major complications such as death, aspiration, colon perforation, and deep abscess were not observed. Aspiration occurred in the first patient during the first feeding on the day after the procedure. Major complication rate was 2.5%. The total minor complication rate was 17.5% in 7 patients; parastomal leakage in 2 patients (5%), skin rash and infection in 3 (7.5%) patients, minor bleeding in 2 (5%) patients with oropharynx cancer, minimal bleeding from the gastrostomy catheter 1 week after the procedure in 1 (2.5%) patient. None of the cases had buried buffer. Tube functionality was preserved in all patients without any damage. Conclusion: Mushroom tip (pull type) gastrostomy catheter is a safe treatment method for patients requiring prolonged feeding because of wide diameter, endurance, long staying opening duration, less excessive dilatation and parastomal leakage, and no need for gastropexy. Lower cost and easier access are advantageous for mushroom tip pull type catheters compared to push type gastrostomy catheters in our country. The less invasive PRG is an alternative option in patients who are difficult to administer PEG, are at high anesthesia risk and cannot be sedated. Advances in knowledge: This article is valuable in terms of its contribution to develop an alternative radiological method for the deployment of gastrostomy tubes in medical difficult patients. This method has shortened the duration of the procedure and increased the success rate in patients with difficulty in transition from the stomach to the esophagus or with difficulty in the upper gastrointestinal tract. Mushroom tip catheters can be placed successfully by radiological methods.Öğe Renal artery embolization in severe nephrotic syndrome(Wiley-Blackwell, 2016) Solak, Yalcin; Koc, Osman; Ucar, Ramazan; Ozbek, Orhan; Ergenc, Hasan; Gaipov, Abduzhappar; Turk, SuleymanIntroduction Severe nephrotic syndrome is associated with increased morbidity and mortality. Renal artery embolization (RAE) has been used in a number of renal diseases such as renal tumors, arteriovenous fistulas etc. However, data regarding benefits of RAE in patients with symptomatic severe proteinuria is limited. We decided to evaluate role of RAE in the setting of severe symptomatic nephrotic syndrome. Methods Eight patients who had undergone transcatheter renal artery embolization with polyvinyl alcohol (PVA) were included. Clinico-demographic characteristics as well as baseline laboratory data including level of proteinuria, serum albumin, C-reactive protein and LDL cholesterol levels were recorded for each patient. After RAE, outpatient clinic control laboratory values were also assessed. Findings All patients except one underwent bilateral RAE (four simultaneous or three sequential). Two patients experienced postembolization syndrome characterized by flank pain, fever, and leukocytosis, which was self-limited and responded to analgesics in all patients. There was no technical complications associated with RAE procedure. All patients became anuric except one. Serum albumin levels increased and serum LDL-cholesterol levels decreased considerably in treated patients. Discussion Renal artery embolization with the purpose of amelioration in nephrotic syndrome complications was effective and free of major technical complications in our patients.
