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Öğe A case of Takayasu arteritis presenting with renovascular hypertension(OrtadogŸu Reklam Tanitim Yayincilik Turizm Egitim Insaat Sanayi ve Ticaret A.S., 2016) Battal, Fatih; Yildirim, Şule; Adam, Gürhan; Aylanç, Nilüfer; Binneto?lu, Fatih Köksal; Kasapçopur, ÖzgürTakayasu arteritis (TA) that affects aorta and large vessels is rare rheumatological disease. In patients with Takayasu arteritis, hypertension is an important symptom which occurs as a result of narrowing of renal arteries and/or aorta. A 14-years-old girl was referred with facial flashing and tenderness on her face. Hypertension was found in upper limbs. Femoral pulses were weak and there was an abdominal murmur. On MR angiography, there was occlusion in aorta and renal arteries. The patient was diagnosed as TA, with increased acute phase reactants. After an antiinflammatory, an antihypertensive and immunsuppresive treatment, patient's clinical complaints and laboratory findings were under control. In this case, we want to emphasize the importance of blood pressure measurement and four limb pulse examination in childhood in routine physical assesment. In differential diagnosis of secondary hypertension, TA should be kept in mind. © Copyright 2016 by Türkiye Klinikleri.Öğe A rare cause of respiratory distress in newborns: Case report of a premature infant with congenital cystic adenomatoid malformations type 3(2014) Reşorlu, Mustafa; Topalo?lu, Naci; Uysal, Fatma; Adam, Gürhan; Karata?, Ozan; Kaymaz, Nazan; Yildirim, ŞuleCongenital cystic adenomatoid malformations (CCAMs) are hamartomatous lesions of pulmonary airway which are characterized by proliferations of terminal brochioles. They are usually infiltrated to one lobe. These patients are during the postnatal period at a level of 80% and adult patients are rare. We report a case of Stocker type 3 CCAM which caused respiratory distress in a premature born infant weighing 1940 g who was delivered by emergency caesarean section. Radiological imaging results revealed CCAM. He subsequently underwent right lobectomy. Pathological examination showed immature airspaces and interstitium, including bronchioles and cartilage as type 3 CCAM. CCAM should be considered in newborns with respiratory distress.Öğe A rare reason of mechanical intestinal obstruction; phytobezoar images for clinicians(TIP ARASTIRMALARI DERNEGI, 2014) Cıkman, Oztekin; Ozkan, Omer Faruk; Adam, Gürhan; Tas, Sukru; Ademoglu, Serkan; Karaayvaz, MuammerMechanical intestinal obstruction is defined as the partial or total blockage of the passage of digested food in gastrointestinal system towards the distal. If intestinal obstruction is not treated properly it can cause high incidences of morbidity and mortality. The most frequent cause is adhesion after surgery but etiological cause changes frequently with age. Known symptoms of intestinal obstructions are nausea, vomiting, abdominal ache and distention in the abdomen. In our study we aimed to present a 70 year old patient with intestinal obstruction due to phytobezoar who developed sepsis, with the help of current literature. © 2014, TIP ARASTIRMALARI DERNEGI. All rights reserved.Öğe A rare reason/cause of esophageal obstruction: Steakhouse syndrome(Yuzuncu Yil Universitesi Tip Fakultesi, 2016) Çıkman, Öztekin; Taş, Şükrü; Kiraz, Hasan Ali; Özkan, Ömer Faruk; Adam, Gürhan; Karaayvaz, MuammerSteakhouse syndrome is an esophageal acute obstruction, due to improperly chewed meat. In most cases the etiology cannot be exactly shown, it is seen more frequently in patients with motility disorders in the lower esophageal sphincter and in alcoholics. Medical history and endoscopic examination are the first to be done for diagnosis. The endoscopic removal of foreign body after the diagnosis of obstruction is the most effective treatment method. © 2016, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.Öğe AĞRILI TOTAL OFTALMOPAREZİ İLE SEYREDEN İNDİREKT KAROTİKOKAVERNÖZ FİSTÜL OLGUSU I(2014) Özkan, Adile; Adam, Gürhan; Güllüoğlu, Halil; Çınar, Celal; Uysal, Fatma; Reşorlu, Mustafa; Özdemir, HüseyinÖzet 84 yaşında kadın hasta iki haftadır sağ göz kapağında düşme ve ağrı şikayeti ile başvurdu. Nörolojik muayenesinde sağ gözde her yöne hareketlerinin kısıtlılık ve pitoz saptandı. Sağ gözde direkt ve indirekt ışık refleksi pozitifti. Olgunun görme keskinliği tam olarak değerlendirildi. Kraniyal magnetik rezonans anjiografi tetkikinde 3 D TOF slab sekansında ,superior oftalmik vende dilatasyon ve kavernöz sinüste sinyal artışı izlendi. Serebral anjiografide (DSA) sağda kavernöz sinüs düzeyinde bilateral eksternal karotid arterin multipl meningeal dalından beslenen sağ inferior petrosal sinüse ve superior oftalmik vene direne olan indirekt KKF saptandı. Transvenöz yolla kavernöz sinüs ve inferior petrosal ven koil embolizasyon yöntemi ile fistülde total oklüzyon sağlandı . Tedavi sonrası dördüncü haftada hastanın sağ göz ağrısı tamamen geçti, pitoz ve göz hareketlerindeki kısıtlılık tama yakın düzeldi.Öğe Bilateral anterior inferior cerebellar infarction presenting severe vertigo and hearing loss(Turkish Society of Cerebrovascular Diseases, 2016) Özkan, Adile; Balci, Ça?daş; Şen, Halil Murat; Adam, Gürhan; Özişik Karaman, Handan IşinAnterior inferior cerebellar (AICA) infarctions are rarely seen, and bilateral AICA infarctions are mostly seen in the literature as case reports. Herein, a rare case with bilateral AICA infarction with severe vertigo, nausea and vomiting is presented. A sixty-nine-year-old woman was seen with the complaints of vertigo, tinnitus, nause, vomiting and hearing loss. In neurological examination, a dysarthric speech, horizontal nystagmus, bilateral peripheral facial palsy, right trigeminal hypoesthesia and mild ataxia were also noted. Mild sensorineural hearing loss (%30) was detected in the left ear through audiogram examination. In cranial MR imaging, a bilateral AICA infarction was reported. In addition, there were also bilateral hypoplastic posterior cerebral artery (PCA) and basilar artery stenosis in cranial MR angiography. The sympomts were partially disappeared following anti-platelet treatment. As in this case, in a patient with vertigo, AICA infarct should be kept in mind and detailed neurological examination should be performed. Copyright © 2012 TBDHD.Öğe Concomitant subclavian coronary steal syndrome, renal artery stenosis and coronary artery stenosİs(2013) Altun, Burak; Adam, Gürhan; TemIz, Ahmet; GazI, Emine; Saçar, MustafaConcomitant coronary and peripheral artery disease is frequent,but subclavian coronary steal syndrome,renal artery stenosis and coronary artery stenosis is rare. We report 68 year old man presented with complaints of sudden elevation of blood pressure,typical angina pectoris at rest exacerbated by selective exercise of the left upper limb. He underwent staged interventions.Öğe Dermatomyositis complicated case with muscular hematoma(Çanakkale Onsekiz Mart Üniversitesi, 2014) Aylanç, Nilüfer; Reşorlu, Mustafa; Adam, Gürhan; Karatağ, Ozan; Uysal, Fatma; Öğretmen, ZerrinA 62 years old woman diagnosed with dermatomyositis went to MRI examination because of her left hip pain and on her imaging findings the high signal intensities on iliopsoas, proximal thigh muscles and some pelvic muscles we determined, in addition there was no any contrast enhancement. However, there are haemorrhages on her left psoas muscle. We evaluated these findings as haemorrhagic myositis, which is the rare situation seen during follow up such these patients.Öğe Evaluation of CT severity index, Ranson and APACHE II and Ranson scores for clinical course and mortality in mechanically ventilated patients depend to severe pancreatitis(2017) Korkmaz, Mehmet; Uyar, Mehmet; Bor, Canan; Adam, Füsun; Koçak, Erdem; Çınar, Celal; Adam, GürhanAmaç: komplikasyonlar sıklıkla görülmektedir. Bu çalışmada, akut pankreatite bağlı gelişen pulmoner komplikasyonlar nedeniyle mekanik ventilasyon uygulanan hastalarda bilgisayarlı tomografi şiddet indeksi (CTSI) ve geleneksel iki farklı skorlama sistemi olan APACHE II ve Ranson skorlama sistemlerinin uygulanabilirliği ve güvenilirliğinin karşılaştırılması amaçlandı. Gereç ve Yöntem: Çalışmaya, akut pankreatit tanısı ile mekanik ventilasyon uygulanan toplam 36 hasta dahil edildi. Mortalite oranlarının öngörülmesi için CTSI, APACHE II ve Ranson skorlama sistemleri kullanıldı. Bulgular: Toplam 36 hasta içinden sağ kalan hasta sayısı dokuz (%25) idi. Mortalite oranları yoğun bakımda %66.6 (n=24), hastanede ise %75 (n=27) olarak bulundu. Mortaliteyi öngörme konusunda 17'nin üzerinde APACHE II skoru en yüksek sensitivite (%64) ve spesifiteye (%66) sahipti. Bu oranları sırasıyla 4'ün üzerinde CTSI skoru (sensitivite %60, spesifite %40) ve 6 'nın üzerinde Ranson skoru (sensitivite %50, spesifite %46) takip etmekteydi. Sonuç: Bu çalışmada, akut pankreatite bağlı gelişen pulmoner komplikasyonlar nedeniyle yoğun bakımda mekanik ventilasyon uygulanan hastalarda mortaliteyi öngörme konusunda yüksek APACHE II, Ranson skoru ve CTSI skorlarının bağımsız birer belirleyici olduğu bulundu. Ancak APACHE II skorunun bu tür hastalarda; mortalite oranlarını öngörmede en güvenilir ve etkili bir skorlama sistemi olduğu belirlendi.Öğe Evaluation of lower extremity perfusion in organ scintigraphy in patients who are planned for amputation(Yusuf Haydar ERTEKİN, 2017) Tan, Yusuf Ziya; Özdemir, Semra; Adam, Gürhan; Kaymaz, BurakIntroduction: No method alone is enough to take the amputation decision in the lower extremity. Therefore, in our study, the contribution of organ perfusion scintigraphy to the evaluation of lower extremity perfusion was investigated.Methods: Our study was retrospectively designed and investigated patients applying for evaluation before amputation, and with Tc-99m sestamibi organ perfusion scintigraphy performed. The research included a total of 21 patients (18 male, 3 female, mean age 67.2 ± 10.6 years). The patients had OPS results and the results of other investigation methods (DUSG and CTA) comparatively evaluated. Statistically the diagnostic value of OPS was compared with the other investigation methods.Results: There was no statistically significant difference between patients in both groups in terms of demographic data, risk factors and accompanying diseases. Twenty-one patients had both OPS and DUSG performed while only eleven patients had CTA performed. The results of the evaluations found that 5 of the 21 patients had amputation performed. The results were positive in all three tests of amputated patients. Conclusion: Considering that peripheral arterial disease is a functional problem, it is understood that weighted morphological and limited hemodynamic data are inadequate for clinical evaluation and therefore physiological and functional examination methods are needed. For this reason, OPS is a valuable nuclear medicine method that can be used additionally in patients with amputation planned especially in the evaluation of lower extreme perfusionÖğe Evaluation of lower extremity perfusion in organ scintigraphy in patients who are planned for amputation(Yusuf Haydar ERTEKİN, 2017) Tan, Yusuf Ziya; Özdemir, Semra; Adam, Gürhan; Kaymaz, BurakIntroduction: No method alone is enough to take the amputation decision in the lower extremity. Therefore, in our study, the contribution of organ perfusion scintigraphy to the evaluation of lower extremity perfusion was investigated.Methods: Our study was retrospectively designed and investigated patients applying for evaluation before amputation, and with Tc-99m sestamibi organ perfusion scintigraphy performed. The research included a total of 21 patients (18 male, 3 female, mean age 67.2 ± 10.6 years). The patients had OPS results and the results of other investigation methods (DUSG and CTA) comparatively evaluated. Statistically the diagnostic value of OPS was compared with the other investigation methods.Results: There was no statistically significant difference between patients in both groups in terms of demographic data, risk factors and accompanying diseases. Twenty-one patients had both OPS and DUSG performed while only eleven patients had CTA performed. The results of the evaluations found that 5 of the 21 patients had amputation performed. The results were positive in all three tests of amputated patients. Conclusion: Considering that peripheral arterial disease is a functional problem, it is understood that weighted morphological and limited hemodynamic data are inadequate for clinical evaluation and therefore physiological and functional examination methods are needed. For this reason, OPS is a valuable nuclear medicine method that can be used additionally in patients with amputation planned especially in the evaluation of lower extreme perfusion. Giriş: Alt ekstremitelerin amputasyonuna karar vermede tek bir yöntem yeterli değildir. Bu nedenle, çalışmamızda, alt ekstermite değerlendirilmesinde Organ Perfüzyon Sintigrafisinin(OPS) katkısı araştırıldı.Yöntem: Çalışmamız retrospektif olarak düzenlenmiş olup kliniğimize Ortopedi Kliniği tarafından amputasyon öncesi değerlendirme amaçlı başvuran ve Tc-99m sestamibi organ perfüzyon sintigrafisi yapılmış hastalar incelendi. Araştırmaya total olarak 21 hasta (18 erkek ve 3 kadın, yaş ortalamaları 67,2 ± 10,6) dahil edildi. Hastaların Tc-99m sestamibi Organ Perfüzyon Sintigrafisi sonuçları ile diğer inceleme yöntemleri (Dopler USG ve BTAnjio) ile karşılık olarak değerlendirildi. İstatiksel olarak OPS'nin tanı değeri diğer inceleme yöntemleri ile karşılaştırıldı.Bulgular: Her iki gruptaki hastalar arasında demografik veriler, risk faktörleri ve eşlik eden hastalıklar açısından istatistiksel olarak anlamlı fark yoktu. Yirmi bir hastaya hem OPS hem de DUSG uygulanırken, sadece onbir hastada CTA yapıldı. Değerlendirmeler sonucunda, 21 hastanın 5'inde amputasyon gerçekleştirildi. Ampute edilen hastaların her üç testinde de sonuçlar pozitif saptandı. Sonuç: Periferik arter hastalığının fonksiyonel bir sorun olduğu göz önüne alınırsa ağırlıklı morfolojik ve sınırlı hemodinamik verilerin klinik değerlendirme açısından yetersiz olduğu ve bu nedenle de fizyolojik ve fonksiyonel inceleme yöntemlerine ihtiyaç bulunduğu anlaşılmaktadır. Bu nedenle de OPS özellikte alt ekstreme perfüzyonun değerlerlendirilmesinde özellikle amputasyon planlanan hastalarda ilave olarak faydalanılabilecek değerli bir nükleer tıp yöntemidir.Öğe Evaluation of Platelet Distribution Width and Mean Platelet Volume in Patients With Carotid Artery Stenosis(Sage Publications Inc, 2015) Adam, Gürhan; Koçak, Erdem; Özkan, Adile; Reşorlu, Mustafa; Çınar, Celal; Bozkaya, Halil; Kurt, TolgaPlatelets contribute to the pathogenesis of atherosclerosis. Platelet activation has been linked with increased mean platelet volume (MPV) and platelet distribution width (PDW). We investigated the association between PDW, MPW, and the degree of carotid artery stenosis (CS). Patients (n = 229) were divided into 3 groups according to the North American Symptomatic Carotid Endarterectomy Trial criteria. Demographic and clinical features were collected retrospectively. Correlation analysis showed a positive association between PDW and the degree of CS. However, there was no significant correlation between CS and MPV. Moreover, we observed that PDW and low-density lipoprotein cholesterol were independent predictors of the degree of CS. This study showed that PDW, not MPV, is related to the degree of CS. Platelet distribution width could be a useful biomarker for CS. Whether targeting PDW will be of clinical benefit remains to be established.Öğe Laparoscopic cholecystectomy in cirrhotic patients with symptomatic cholelithiasis(TIP ARASTIRMALARI DERNEGI, 2014) Buluş, Hakan; Koçak, Erdem; Coşkun, Ali; Köklü, Seyfettin; Adam, GürhanGallstones are twice as common in cirrhotic patients as in the general population. Laparoscopic cholecystectomy (LC) was originally contraindicated in cirrhotic patients because of the associated portal hypertension and coagulopathy. But nowadays, it is not considered contraindicated. This study examined the safety of LC in Child’s class A-B patients. All the cirrhotic patients with gallstones who underwent LC between September 2008-October 20011 have been included in the study. All the cirrhotic patients with Child-Pugh class A and B cirrhosis undergoing LC were included in the study. Demographic characteristics and other parameters including initial presentation, conversion rate, complication rate, mortality, and duration of hospital stay, timing operative were investigated. 21 patients with Child-Pugh A (76.1%) and Child Pugh B (23.8%), liver cirrhosis, (F/M 4/21) underwent LC. The mean age was approximately 61.1±14 years. Two patients (9.5%) developed postoperative wound infection, and mean hospital stay was 3.8 (2-12) days. Of the 21 cases, 2 (9.5%) were converted to open cholecystectomy. The mean operation time was 82.5±15 minutes. Intra-operative and postoperative complications occurred in 3 patients (14.2%) in the form of liver bed bleeding. LC is a safe and effective alternative for the treatment of symptomatic cholelithiasis in patients with well-compensated Child´s Class A and Class B cirrhosis. The laparoscopic approach offers advantages of less blood loss, shorter operative time, and shorter length of hospitalization in patients with cirrhosis compared to open cholecystectomy. © 2014, TIP ARASTIRMALARI DERNEGI. All rights reserved.Öğe Persistan Sol Süperior Vena Kava: Nadir Bir Olgu Sunumu(2016) Reşorlu, Mustafa; Aylanç, Nilüfer; Adam, Gürhan; Özcan, Sedat; Eker, NebilPersistan sol süperior vena kava, genel popülasyonda %0,3-0,5 prevalansa sahip nadir görülen vasküler bir anomalidir. Sol anterior kardinal venin obliterasyonundaki yetersizlik sonucunda meydana gelmektedir ve konjenital kalp hastalığı olanlarda sıklığı artmaktadır. Bu olgularda aynı zamanda sağ süperior vena kava da sıklıkla mevcuttur. Persistan sol süperior vena kava tanısı genellikle kardiyovasküler görüntüleme sırasında insidental olarak konulmaktadır.Öğe Right Aortic Arch with Aberran Left Subclavian Artery; Accompanied with Crossed Pulmonary Arteries: A Rare Association(2016) Aylanç, Hakan; Aylanç, Nilüfer; Binnetoğlu, Fatih Köksal; Battal, Fatih; Adam, Gürhan; Tekin, Mustafa; Kaymaz, Nazan[Abstract Not Available]Öğe Stapler ile yapılan kolorektal anastomoz hattındaki kanamanın koil embolizasyonu ile tedavisi: Olgu sunumu(2015) Taş, Şükrü; Özkul, Faruk; Adam, Gürhan; Arık, Muhammed Kasım; Çıkman, ÖztekinAlt gastrointestinal sistem(AGİS) kanamaları klinik olaraksık görülen bir tablodur. Çok nadir olmakla beraberkolorektal rezeksiyon sonrası meydana gelen anastomozhattındaki kanamalarda AGİS kanama nedenleriarasındadır. Bu tip kanamalar genelde kendi kendinisınırlayan niteliktedir. Stapler ile kolorektal anastomozsonrası bu hastaların %1'inde meydana gelen ve hastanınhemodinamisini bozan şiddetli kanamalar için farklıdiagnostik ve terapatik yöntemler tanımlanmıştır. Bumakalede de daha önce sigmoid kolon rezeksiyonu vehartman kolostomi ameliyatı yapılan; sirküler stapleryardımıyla kolorektal anastomoz yapılarak kolostomisikapatılan ve postoperatif dönemde an astomoz hattındagelişen pseoudo anevizmaya bağlı şiddetli kanamanınendovasküler koil embolizasyon yöntemi ile tedavi edilen62 yaşındaki erkek hasta sunulmaktadır.Öğe The treatment of bleeding with coil embolization in colorectal anastomosis performed with stapler:A case report(Bolu Abant İzzet Baysal Üniversitesi, 2015) Taş, Şükrü; Özkul, Faruk; Adam, Gürhan; Arık, Muhammed Kasım; Çıkman, ÖztekinLower gastrointestinal systemLGISbleeding is a frequently encountered manifestation. Although it is rarely seen, LGIS bleeding is one of the reasons of bleeding occurring in anastomosis line following a colorectal resection. These types of bleedings are generally self-limiting. Various diagnostic and therapeutic methods are defined for severe bleedings that damage patient’s hemodynamics and occur in 1% of the patients following colorectal anastomosis with stapler. In this article 62 years old male patient to whom sigmoid colon resection and Hartman colostomy surgery is performed and whose colostomy is closed with circular stapler by colorectal anastomosis and whose severe pseudoaneurysmal bleeding developed in post-operative period in anastomosis line is treated with endovascular coil embolization method, is presented. Alt gastrointestinal sistem AGİSkanamaları klinik olarak sık görülen bir tablodur. Çok nadir olmakla beraber kolorektal rezeksiyon sonrası meydana gelen anastomoz hattındaki kanamalarda AGİS kanama nedenleri arasındadır. Bu tip kanamalar genelde kendi kendini sınırlayan niteliktedir. Stapler ile kolorektal anastomoz sonrası bu hastaların %1'inde meydana gelen ve hastanın hemodinamisini bozan şiddetli kanamalar için farklı diagnostik ve terapatik yöntemler tanımlanmıştır. Bu makalede de daha önce sigmoid kolon rezeksiyonu ve hartman kolostomi ameliyatı yapılan; sirküler stapler yardımıyla kolorektal anastomoz yapılarak kolostomisi kapatılan ve postoperatif dönemde anastomoz hattında gelişen pseoudo anevizmaya bağlı şiddetli kanamanın endovasküler koil embolizasyon yöntemi ile tedavi edilen 62 yaşındaki erkek hasta sunulmaktadır.Öğe Türkiye'nin İki Farklı Bölgesindeki Osteoporozun Karşılaştırılması(2014) Gölge, Umut Hatay; Kömürcü, Erkam; Kaymaz, Burak; Göksel, Ferdi; Güzel, Yunus; Adam, Gürhan; Erbay, PırılAmaç: İklim ve coğrafi farklılıklarının kemik mineral dansitometrisi üzerine etkisinin incelenmesi.Gereç ve Yöntem: İki farklı bölgedeki osteoporoz düşünülen ve bu nedenle Dual Enerji X-ray Absorpsiyometri (DXA) çekilen toplam 2457 hastanın dosyaları retrospektif olarak değerlendirildi ve çalışmaya dahil edildi. Ayrıca hastaların; yaşları, cinsiyetleri, vücut kitle indeksi (VKİ) ve osteoporoz etyolojileri kaydedildi.Bulgular: Çalışmaya dahil edilen hastaların femur boynu ve lomber omurga DXA ölçümleriyle osteoporoz tanısı konulan 927 hasta ile osteopeni tanısı konulan 907 hasta tespit edildi. Gruplar arası yaş, cinsiyet, VKİ açısından anlamlı fark izlenmedi. Her iki bölgedeki aynı yaş ve cinsiyetteki hastaların lumbal bölge L1-4 T skoru ile femur boyun T skoru karşılaştırıldığında anlamlı bir fark olduğu görüldü (p<0,001).Sonuç: Osteoporozla mücadele ve tedavisinde coğrafi ve iklim farklılıklarının kemik yoğunluğu üzerine etki etmesinden dolayı bu farklılıkların da gözönüne alınarak koruyucu ve tedavi edici metodlar konusunda bölgesel yeni stratejiler geliştirilmelidir.
