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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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    Can the addition of a paracervical block to systemic or local analgesics improve the pain perceived by the patient during hysterosalpingography?
    (Taylor & Francis Inc, 2014) Hacivelioglu, S.; Gencer, M.; Gungor, A. Cakir; Kosar, S.; Koc, E.; Cosar, E.
    The aim of the present study was to investigate whether the addition of a paracervical block to local intrauterine anaesthesia or the use of an intramuscular non-steroidal anti-inflammatory drug was effective for pain control during and at 30 min after hysterosalpingography (HSG). A total of 120 patients undergoing hysterosalpingography were randomised into four groups. Patients received intramuscular dexketoprofen trometamol with or without a paracervical block or intracavitary lidocaine instillation with or without paracervical block. The primary outcome was the overall pain score from the four stages of the procedure. The lowest pain scores were observed in the patients receiving dexketoprofen trometamol with a paracervical block, whereas the highest pain scores were observed in patients with intracavitary lidocaine instillation without a paracervical block (p = 0.021). No beneficial effect was found when a paracervical block (PCB) was added to either systemic or local analgesics. The combination of intramuscular dexketoprofen and a paracervical block with plain lidocaine produced the best pain relief during the three specified steps and at up to 30 min after the HSG procedure.
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    Role of twinkling artifact in characterization of urinary calculi
    (Ene Ediciones Sl, 2011) Alan, C.; Kocoglu, H.; Kosar, S.; Karatag, O.; Resit Ersay, A.; Erhan, A.
    Introduction: Stone characterization is becoming important before decision of treatment such as percutaneous nephrolithotomy (PCNL) and extracorporeal shock wave lithotripsy (ESWL). Some studies have reported that the twinkling artifact (color-flow ultrasonography artifact) may be useful to detect urinary stones. This study aims to determine whether the presence or absence of the twinkling artifact is correlated with the chemical composition of the stones. Material and method: Patients with renal stones >= 0.5 cm were included in a prospective study. Sixty patients were examined with x-ray film, intravenous pyelography, non-contrast computerized tomography, and color and spectral doppler ultrasonography. The artifact was considered grade 1 when occupied only one portion of the acoustic shadowing and when the artifact occupied the entire acoustic shadowing was considered grade 2. Patients with stones smaller than 2 cm were treated with SWL and patients with stones larger than 2 cm were treated with PCNL. Results: No artifact (grade 0) was detected in 11 subjects, grade 1 in 25 and grade 2 in 24. Significant relationship was found between the increase in twinkling artifact and stone size (p < 0.001). When the relation between the composition of the stones and the twinkling artifact was analyzed, artifact was detected nearly in all of the calcium oxalate dihydrate and calcium phosphate stones; whereas the artifact was detected in more than half of the calcium oxalate monohydrate and uric acid stones. In ESWL group it was observed that as the grade of the twinkling artifact increases, the number of required ESWL sessions decreases (p < 0.001). In PCNL group twinkling artifact was found in all of the patients (100%) with roughly surfaced stones. Conclusion: The roughness of stone surface is the most important factor in terms of formation of the twinkling artifact in kidney stones. This artifact can beat use in anticipating the breakability of the stones of those patients to be treated with applied ESWL. One might anticipate that cases where the size of the stone is larger than 2 cm but no twinkling artifact is detected are calcium oxalate monohydrate, which is one of the stones with highest level of breakability. (C) 2011 AEU. Published by Elsevier Espana, S.L. All rights reserved.
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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.