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    Acute and delayed traumatic diaphragmatic ruptures presenting at the emergency service: what are we missing?
    (Sage Publications Ltd, 2013) Alar, T.; Dedeoglu, E.; Bulut, T.; Yapucu, M. U.; Dedeoglu, B.
    Introduction: Diaphragmatic rupture is rarely a cause of death by itself. It is especially difficult to diagnose diaphragmatic ruptures in patients with unstable vital signs who present at the emergency service with concurrent chest, abdomen, and extremity injuries as a result of blunt trauma. We evaluated the diagnostic processes, clinical findings and treatment results of acute and delayed traumatic diaphragmatic ruptures (TDR) cases that presented at the emergency service. Methods: A total of 29 patients that underwent surgical treatment with a diagnosis of TDR among 1021 patients that presented at the Canakkale State Hospital Emergency Service with acute or delayed thoracoabdominal trauma were retrospectively investigated. The age, gender, trauma etiology, diagnosis duration, injury severity score (ISS), rupture location, accompanying organ injuries, operation type, inpatient duration, morbidity and mortality were recorded on prepared forms to analyse the cases. Results: The mean age of the 29 patients with TDR was 45.31 +/- 17.76 years with and 20 (69%) males and 9 (31%) females. The trauma was blunt in 22 (76%) and penetrating in 7 (24%) cases. The TDR was acute in 16 (55%) and delayed in 13 (45%) patients. The surgery for TDR treatment consisted of with thoracotomy in 16 (55%) patients, laparotomy in 11 (38%) patients and both thoracotomy and laparotomy in 2 (7%) cases. Mortality occurred in 3 (10%) patients that presented at the acute stage. Conclusions: The patients undergoing thoracoabdominal trauma, should be explained the probability, although low, of rupture of the diaphragm. These patients should be followed up and it should be emphasized that they should absolutely tell this trauma history to the physician who examines them when they present at the emergency service.
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    CAN DIFFUSION WEIGHTED MAGNETIC RESONANCE IMAGING DIFFERENTIATE BETWEEN INFLAMMATORY-INFECTIOUS AND MALIGNANT PLEURAL EFFUSIONS?
    (Assoc Royal Soc Scientifiques Medicales Belges, 2015) Karatag, O.; Alar, T.; Kosar, S.; Ocakoglu, G.; Yildiz, Y.; Gedik, E.; Gonlugur, U.
    Aim: To assess exudative pleural effusions with diffusion-weighted magnetic resonance imaging (DW-MRI) in order to determine non-invasive differentiation criteria for inflammatory-infectious and malignant effusions. Materials and methods: Thirty-two patients with pleural effusions underwent DW-MRI with 4 different b values (10, 500, 750 and 1000 s/mm(2)). ADC maps were generated automatically. Signal intensity and ADC values were measured. Following MRI, pleural fluid of 10-15 ml was obtained and analyzed. AUC values were compared for different diffusion levels of ADC and SI measurements. The relationship between ADC values and pleural effusion LDH and total protein levels was examined. Results: The cut-off values obtained from signal intensity and ADC measurements to differentiate exudates with malignant pathology were not found to be statistically significant. In the inflammatory-infectious group, a significant negative correlation was observed between ADC values and pleural fluid LDH measurements in all b values. In the malignant group, a significant positive correlation was observed between ADC values and pleural fluid total protein measurements in b values of 500 and 1000. Conclusion:Infectious/inflammatory and malignant effusions overlap strongly and cannot therefore be differentiated using DW MRI.
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    Thoracic vertebra and rib destruction: What if not cancer?
    (2012) Alar, T.; Kosar, S.; Degirmenci, Y.; Alkan, B.; Cosar, M.
    An 18-year-old female presented at our hospital with complaints of fatigue for the last 4-5 months, together with numbness and weakness in both lower extremities in the last month. Neurological examination revealed hypoesthesia in the lower right extremity, paraparesis of bilateral lower extremities, a hyperactive deep tendon reflex (DTR) and positive bilateral Babinski sign. The radiology examinations showed septated multiple cystic lesions, with the largest 36x28 mm, destructing the proximal 3rd rib together with the 3 rdthoracic vertebra body, extending to the lower level of 7 th cervical vertebra in the subdural region and compressing the spinal cord. The patient was taken to surgery immediately and the described cystic lesions were removed without being ruptured, together with corpectomy to T3 vertebra and partial resection of the third rib. Posterior transpedicular fusion was performed to the T2-6 spaces. There was no peroperative or postoperative complication. Histopathological examination of the material revealed "hydatid cyst". The patient was followed-up on 10 mg/kg albendazole treatment. Postoperative follow-ups at 1, 2 and 3 months revealed normal function tests and no motor deficit or pathological reflex besides DTR hyperactivity.