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Öğe Assessment of Myometrial Invasion in Endometrial Cancer by Transvaginal Sonography, Doppler Ultrasonography, Magnetic Resonance Imaging and Frozen Section(BMJ PUBLISHING GROUP, 2009) Ozdemir, Suna; Celik, Cetin; Emlik, Dilek; Kiresi, Demet; Esen, HasanObjective: We aimed to compare the diagnostic performance of transvaginal sonography (TVS), magnetic resonance imaging (MRI). and intraoperative frozen section in the assessment of myometrial invasion and to evaluate intratumoral blood flow in any myometrial invasion with transvaginal Color Doppler Ultrasonography (TV-CDU). Methods: This prospective Study included 64 women consecutively diagnosed with endometrial carcinoma. The Subjects were evaluated by TVS, MRI, and TV-CDU by 2 radiologists with a special training in gynecology. Intraoperatively, a frozen section was obtained and processed for interpretation by a blinded pathologist. Sensitivity, specificity, negative, and positive predictive values were calculated for each imaging modality and frozen section with regard to assessment of myometrial invasion. The intratumoral blood flow was evaluated by TV-CDU. Results: Transvaginal sonography, MRI, and frozen section showed no statistical significant differences in overall diagnostic performance for the preoperative and intraoperative assessment of any myometrial invasion, although frozen section seemed to be slightly superior to the imaging techniques. The positive rate of intratumoral blood flow was higher in deep myometrial invasion, but statistical significance was not obtained. The mean value of resistance index was significantly lower in the cases with deep myometrial invasion. Conclusions: Transvaginal sonography with concomitant TV-UCD is low-cost, easily performed, and repeated technique for particularly deep myometrial invasion. Because of its high costs and time-consuming, MRI may be recommended in the cases with poor quality of TVS. Because depending solely oil imaging methods Could lead to insufficient treatment Schedules, intraoperative frozen section should also be performed for myometrial assessment.Öğe Be Aware of Bone Marrow Edema Syndrome in Ankle Arthroscopy: A Case Successfully Treated with Iloprost(W B Saunders Co-elsevier Inc, 2006) Arazi, Mehmet; Yel, Mustafa; Uguz, Bilgehan; Emlik, DilekBone marrow edema syndrome (BMES) is a nontraumatic syndrome characterized by disabhng joint pain. The disease occurs especially in the hip joint, and the ankle joint has been reported in the English-language literature to be affected only rarely. We describe here the case of an adult with BMES in both ankle joints, She has been treated with nonsteroidal anti-inflammatory drugs and physical therapy, as well as ankle arthroscopy, all of which have been unsuccessful. BMES was diagnosed on the basis of clinical and magnetic resonance imaging (MRI) findings. The patient was treated with iloprost (Ilomedin. Schering AG, Berlin, Germany); the course of therapy consisted 6 of 5 infusions of 40 mu g of iloprost in 500 mL of sodium chloride solution, given over 6 hours on 5 consecutive days. MRI at the third monthly visit showed nearly complete resolution of bone marrow 7 edema. The patient was followed for 2 years and 6 months and was completely asymptomatic. This case report suggests the need for orthopaedic surgeons to know about BMES. Before all-arthroscopic interventions are performed, MRI views should be evaluated carefully. Iloprost infusion therapy seems to be effective and safe in the management of BMES.Öğe Böcek Sokmasına Bağlı Anaflakside MRG Bulguları: Olgu Sunumu(2001) Aydoğdu Kıreşi, Demet; Emlik, Dilek; Ak, Ahmet; Karabacakoğlu, Aydın; Karaköse, SerdarAnamnezinde böcek ısırması olan, anaflaksinin klinik bulguları ile birlikte bilinç kaybı ile gelen olgunun manyetik rezonans görüntüleme (MRG) bulguları literatür bilgileri ile birlikte tartışıldı. Olgu sunumu: 29 yaşında, daha önceden hiçbir şikayeti olmayan, hasta yakınları tarafından böcek ısırması anamnezi verilen olguda fizik muayenede anaflaksiye ait bulgular, bilinç kaybı ve hipotansiyon mevcuttu. MRG'de bilateral parieto-oksipital bölgede gri cevherde, bilateral kaudat nukleusta ve putamende T1'de hipo-T2'de hiperintens lezyonlar görüldü. Sonuç: Yetişkinlerde görülen hipoksik iskemik beyin hasarının nadir sebeplerinden biri olan böcek sokmasına bağlı anaflakside manyetik rezonans görüntüleme bulguları tanıda yardımcı olabilir.Öğe Case 161: Hydatid Disease with Water Lily Sign Manifesting as a Soft-Tissue Mass in the Calf of a Child(Radiological Soc North America, 2010) Kerimoğlu, Ülkü; Kapıcıoğlu, Safa; Emlik, Dilek; Arazi, Mehmet; Ural, OnurHistory An 8-year-old girl presented with pain and tenderness of 6 months duration in the distal part of her calf above the left ankle. She denied having experienced any trauma, and her clinical history was otherwise normal. A physical examination revealed a tender mass associated with redness on the skin. As part of the diagnostic imaging protocol, conventional radiography of the ankle was performed. This was followed by 1.5-T magnetic resonance (MR) imaging (Symphony; Siemens Medical Systems, Erlangen, Germany) for further evaluation.Öğe A case of Burkitt lymphoma re-presenting as periportal hepatic and multiple organ infiltration(CIG MEDIA GROUP, LP, 2008) Kiresi, Demet; Gunbey, Leman; Koksal, Karabekmez Yavuz; Emlik, DilekBurkitt lymphoma (BL) is a high-grade, B-cell-originated pediatric malignancy that is a type of non-Hodgkin lymphoma involving different organs. Mediastinal mass, ascites, peritoneal thickening, and infiltration of the small intestine, kidney, and liver were found in our patient. In this case, we describe the radiologic appearances and possible infiltration patterns of multi-organ BL. Also, we discuss infiltration of the periportal area, such as hypodense lesions in the liver, which is rarely seen in BL.Öğe A Case With Prepontine (Clival) Arachnoid Cyst Manifested as Trigeminal Neuralgia(WILEY-BLACKWELL, 2008) Genc, Emine; Dogan, Ebru Apaydin; Kocaogullar, Yalcin; Emlik, Dilek(Headache 2008;48:1525-1539) Most cases of "idiopathic" trigeminal neuralgia are thought to originate from vascular compression of the trigeminal root entry zone. In this case, we describe a young man presenting with the symptoms of trigeminal neuralgia associated with a prepontine (clival) arachnoid cyst.Öğe Clinical and Imaging Findings in the Alveolar Echinococcosis(BENTHAM SCIENCE PUBL LTD, 2009) Emlik, Dilek; Odev, Kemal; Kiresi, Demet A.; Karakose, Serdar; Gok, MehmetAim: To review the imaging features of alveolar echinococcosis in eight patients with involvement of different organs. Material and Methods: Ultrasound (US) and computed tomography (CT) examinations were performed in all patients, and magnetic resonance imaging (MRI) and color Doppler ultrasound (CDUS) were performed for two patients. Three patients had involvement of only the liver; two had involvement of lung and liver; one had involvement of only the lung; one had involvement of liver and sternum; and one had lung, liver, and adrenal involvement. The diagnosis was confirmed by histopathologic examination in all patients. Results: The lesions located in the liver were generally seen as heterogeneous hypoechogenic on US, hypodense on CT, and hypointense solid masses on MRI. These masses included necrosis and calcifications. Vascular flow on CDUS and contrast enhancement on CT and MRI were not observed in any of the lesions. On CT, lung lesions were seen as multiple, nodular, well-defined or ill-defined opacities; some had cavitations caused by necrosis. Conclusion: Knowledge of imaging characteristics of alveolar echinococcosis makes it possible to provide an early diagnosis radiologically. In addition, radiologic findings have an important role in the follow-up. Ultrasound, CT, and MRI are complementary methods in the diagnosis of alveolar echinococcosis.Öğe Comparison of two different approches to the pterygomaxillary junction in Le Fort I osteotomy(MOSBY-ELSEVIER, 2008) Dolanmaz, Dogan; Esen, Alparslan; Emlik, Dilek; Candirli, Celal; Kalayci, Abdullah; Cicekcibasi, AynurObjective. The purpose of this study was to compare the damage before and after down fracture in Le Fort I osteotomies performed with and without the separation of pterygomaxillary junction using curved osteotomes in a cadaver model. Study design. The study sample comprised 6 cadavers aged between 55 and 70 years (mean age: 63.8 years). Three cadavers were partially edentulous, 2 cadavers still maintained a full complement of teeth and 1 cadaver was edentulous. Le Fort I osteotomy was performed on all cadavers. Pterygomaxillary osteotomies were only performed on the right sides whereas the left sides were left intact. Subsequently, the maxilla was mobilized by applying digital pressure on the anterior maxillary segment. Computed tomography scans of each specimen were obtained before surgery, after surgery-before down fracture and after down fracture to document secondary fractures. Results. Before the down fracture, secondary fractures were found in only 1 specimen (right side), whereas after the down fracture, secondary fractures were found in 5 specimens by CT. After the down fracture, the rate of occurrence of secondary fractures was 62% in the right side and 38% in the left side. Conclusion. With respect to the results of the present study, the use of osteotomes for pterygomaxillary dysjunction increases the incidence of fractures in maxillary osteotomy. However, the occurrence of almost all fractures subsequent to down fracture suggests the presence of possible bony splits that could not be diagnosed by radiographic examination immediately after maxillary osteotomy may have become apparent or transformed into fractures following down fracture.Öğe Complementary Use of NBCA with the Amplatzer Vascular Plug for Embolization of a High-Flow Traumatic Hepatic Arteriovenous Fistula(SPRINGER, 2009) Koc, Osman; Cil, Barbaros Erhan; Peynircioglu, Bora; Emlik, Dilek; Ozbek, Orhan[Abstract not Available]Öğe CT measurement of trunk muscle areas in patients with chronic low back pain(TURKISH SOC RADIOLOGY, 2007) Kamaz, Muezeyyen; Kiresi, Demet; Oguz, Hasan; Emlik, Dilek; Levendoglu, FundaPURPOSE The objective of this study was to determine the cross-sectional area changes of the paraspinal, isolated multifidus, quadratus lumborum, psoas, and the gluteus maximus muscles with CT in patients with chronic low back pain. MATERIALS AND METHODS In this study, we evaluated 36 patients with chronic low back pain and 34 healthy volunteers. The mean age of the patients was 43.2 +/- 6.9 years (range, 30-58 years) and the mean age of control group was 44.4 +/- 6.9 years (range, 31-61 years). We defined pain that lasts more then one year as chronic pain. Female patients were selected for standardization. All patients were housewives. None of the patients or controls engaged in physical activity other than routine housework. We used a visual analog scale and the Oswestry Pain Questionnaire for clinical evalu ation. We made CT cross-sections of the paraspinal muscles at the upper and lower endplates of L4, and of the gluteus maximus at the head of the interfoveal level. RESULTS In the patient group the multifidus, psoas, and quadratus lumborum cross-sectional areas were smaller than in the control group, and the P values were P=0.002, P=0.042, and P=0.047, respectively, at the L4 endplate. At the L4 endplate level, cross-sectional areas of the multifidus and paravertebral muscles in the patient group were smaller than in the control group, and the difference was statistically significant (P=0.001, P=0.010, respectively). We did not find any significant difference between the patient and the control groups in gluteus maximus cross-sectional area. CONCLUSION Chronic low back pain caused atrophy of the paraspinal, isolated multifidus, quadratus lumborum, psoas, and the gluteus maximus muscles to varying degrees, which was most prominent in the multifidus. Atrophy was noted in all of the studied muscles, except the gluteus maximus. The reliability of CT in measuring the cross-sectional areas of the back muscles was acceptable.Öğe Dev Safra Kesesi Tümörü: Olgu Sunumu(2003) Kıreşi, Aydoğdu Demet; Emlik, Dilek; Ödev, KemalSafra kesesi tümörü gastrointestinal sistemin 5. sıklıkta görülen patolojilerindendir. Genellikle komşu organlara direk yayılım, lokal lenf nodu metastazı ya da yaygın metastatik hastalık şeklinde tesbit edilir. Radyolojik yöntemler tanı koymada faydalı olmaktadır. Bu yazıda dev boyutlara ulaşmasına rağmen hastada non spesifik şikayetlere neden olan ve karaciğer invazyonu dışında diğer komşu organ metastazı olmayan dev safra kesesi tümörü olgusu sunulmuştur.Öğe Differential diagnosis of dumbbell lesions associated with spinal neural foraminal widening: Imaging features(ELSEVIER IRELAND LTD, 2009) Kivrak, Ali Sami; Koc, Osman; Emlik, Dilek; Kiresi, Demet; Odev, Kemal; Kalkan, ErdalComputed tomography (CT) and magnetic resonance imaging (MRI) reliably demonstrate typical features of schwannomas or neurofibromas in the vast majority of dumbbell lesions responsible for neural foraminal widening. However, a large variety of unusual lesions which are causes of neural foraminal widening can also be encountered in the spinal neural foramen. Radiologic findings can be helpful in differential diagnosis of lesions of spinal neural foramen including neoplastic lesions such as benign/malign peripheral nerve sheath tumors (PNSTs), solitary bone plasmacytoma (SBP), chondroid chordoma, superior sulcus tumor, metastasis and non-neoplastic lesions such as infectious process (tuberculosis, hydatid cyst), aneurysmal bone cyst (ABC), synovial cyst, traumatic pseudomeningocele, arachnoid cyst, vertebral artery tortuosity. In this article, we discuss CT and MRI findings of dumbbell lesions which are causes of neural foraminal widening. (C) 2008 Elsevier Ireland Ltd. All rights reserved.Öğe An Epidural Emphysema Due to the Tracheal Laceration That Occurred After a Blunt Trauma: an Extremely Rare Condition(Oxford Univ Press Inc, 2003) Arıbaş, Olgun Kadir; Kanat, Fikret; Emlik, Dilek[Abstract not Available]Öğe Evaluation of Cervical Involvement in Endometrial Cancer by Transvaginal Sonography, Magnetic Resonance Imaging and Frozen Section(Taylor & Francis Inc, 2010) Çelik, Ç.; Özdemir, S.; Kıreşi, Demet; Emlik, Dilek; Tazegül, A.; Esen, H.This study was undertaken to compare the diagnostic performance of transvaginal sonography (TVS), magnetic resonance imaging (MRI), and frozen section for detection of cervical involvement in endometrial cancer. The study included 64 consecutive patients with endometrial cancer. The subjects were evaluated with TVS and MRI by two radiologists and the frozen sections by a pathologist. The diagnostic accuracies of TVS, MRI and frozen section were compared using the McNemar test. The accuracy rates of TVS, MRI and frozen section were 90.6%, 92.2% and 95.5%, respectively. There were no statistical significant differences in overall diagnostic performance for the preoperative and intraoperative assessment of cervical involvement, although frozen section seemed to be slightly superior to the imaging techniques. TVS and MRI have similar performance in determination of cervical involvement. However, although time consuming and expensive, MRI may be recommended in cases with poor quality TVS. Frozen section may be advocated where preop-tests are equivocal.Öğe First case report of neurobrucellosis associated with hydrocephalus(ELSEVIER SCIENCE BV, 2008) Guney, Figen; Gumus, Haluk; Ogmegul, Aysegul; Kandemir, Bahar; Emlik, Dilek; Arslan, Ugur; Tuncer, InciBrucellosis is a common zoonosis in many parts of the world, including Mediterranean and Middle Eastern countries. The disease is primarily related to occupations at risk, such as veterinarians, farmers, laboratory technicians, abattoir workers, and others working with animals and their products. Neurologic complications of brucellosis are quite rare, ranging from 1.7 to 10% of those infected. To date, no cases of neurobrucellosis with hydrocephalus have been reported. A 38-year-old right-handed farmer complained of headaches, nausea, vomiting, gait disturbance, and sweating for 2 days. He also complained of bilateral hearing loss of 4 months duration. On neurologic examination, dysmmetry, dysdiadochokinesis, ataxia on the left, and bilateral sensorineural hearing loss existed. On cranial MRI, a communicating hydrocephalus was noted. Because the patient consumed fresh sheep cheese and was a farmer, brucellosis was considered in the differential diagnosis. Brucella agglutination was positive with a 1/320 titer in the blood and a 1/80 titer in the cerebrospinal fluid. Ceftriaxone, doxycycline, and rifampicin were administered and by the fourth week of treatment, the ataxia was markedly improved, and the patient was able to walk without support. His cranial MRI demonstrated a total regression of the hydrocephalus. As a result, we suggest that neurobrucellosis should be considered in patients with hydrocephalus, especially if they live in an endemic area for brucellosis, even in the absence of other systemic signs. (c) 2008 Elsevier B.V. All rights reserved.Öğe Intrathoracic Extrapulmonary Hydatid Disease: Radiologic Manifestations(Elsevier Science Bv, 2010) Emlik, Dilek; Kireşi, Demet; Sunam, Güven Sadi; Kıvrak, Ali Sami; Ceran, Sami; Ödev, KemalHydatidosis is a parasitic disease caused by the larvae of Echinococcus granulosus and rarely by Echinococcus alveolaris. It is endemic to South America, North Africa, Asia, Australia, and the Middle East [1,2]. The definitive hosts are foxes and, less commonly, dogs and cats. Humans are infected by direct contact with an infected animal or by ingestion of contaminated food or fluids. Echinococcal embryos migrate through the intestinal mucosa, and, in 60%e70% of cases, reach the liver via the portal system [1]. They can then enter the systemic circulation via the porta caval anastomoses and be carried by the bloodstream to any organ or tissue in the body. Alternatively, the eggs can be inhaled and cause primary lung disease [2]. Intrathoracic extrapulmonary hydatid disease is very rare but can occur in the pleural space, extrapleural region, pleural fissure, chest wall, mediastinum, pericardium, myocardium, and diaphragm [1]. In this pictorial essay, we present the clinical manifestations and imaging features of patients with hydatid cysts (HC) in the extrapulmonary sites of the thorax.Öğe Mesenteric Ischemia: An unusual presentation of fistula between superior mesenteric artery and common hepatic artery(BAISHIDENG PUBLISHING GROUP INC, 2004) Kayacetin, Ertugrul; Karakose, Serdar; Karabacakoglu, Aydin; Emlik, DilekChronic mesenteric ischemia is an uncommon condition associated with a high morbidity and mortality. We reported a 36-year old women with postprandial abdominal pain due to chronic mesenteric ischemia caused by a fistula between superior mesenteric and common hepatic artery.Öğe Morphometric Analyses of the Development of Nasal Cavity in Human Fetuses: An Anatomical and Radiological Study(ELSEVIER IRELAND LTD, 2010) Yılmaz Altuntaş, Neslihan; Çiçekçibaşı, Aynur Emine; Emlik, Dilek; Yilmaz, Mehmet Tugrul; Keleş, Bahar; Salbacak, AhmetObjective: It was aimed to research the morphometric development of the nasal cavity with dissection and radiological scanning methods and to detect anatomical variations. Design: Retrospective study. Setting: Departments of Anatomy and Radiology, Meram Medical Faculty, Selcuk University. Patients: Dissection stage was performed on 80 spontaneously aborted fetuses (40 males and 40 females) (63 second trimesters and 17 third trimesters) between 13 and 40 weeks of gestation. Radiological scanning stage was carried out on 40 spontaneously aborted fetuses (19 males and 21 females) (12 second trimesters and 28 third trimesters) with multi-detector computed tomography. Methodology: One hundred and sixty nasal cavities and related structures were examined by means of bilateral dissection. Reference images were obtained in the axial plane with 3-mm collimation using multi-detector computed tomography (MDCT; Sensation 64, Siemens, Erlangen, Germany). These reference images were sent to the workstation (Leonardo, Siemens, Germany) and three-dimensional (axial, sagittal, and coronal) reformatted images with 1 mm thickness were obtained via multiplanar imaging method. Results: In the dissected fetuses 16 suprema nasal conchae were determined. Six (15%) NSDs (four towards the left and two towards the right) were detected on radiological sections. The angle between the virtual line from sphenoidal sinus ostium through limen nasi and the horizontal plane was 32.72 +/- 3.3 degrees on average. Conclusion: It was thought that some anatomic variations (e.g. suprema nasal concha, nasal septum deviation) occur in the fetal period; however, other certain differences (e.g. Onodi, Haller, and Agger nasi cells, concha bullosa) might be with effects of environmental factors (trauma and chronic infections) in postnatal period.Öğe Pneumomediastinum and Pneumopericardium Due to Intracavitary Aspergilloma: an Unusual Complication of Fungal Pneumonia(SPRINGER-VERLAG, 2002) Ödev, Kemal; Çalışkan, Ümran; Emlik, Dilek; Koç, Hasan; Koç, SaadetWe describe a 14-year-old boy with acute lymphatic leukaemia who developed pneumomediastinum. and pneumopericardium as a complication of invasive pulmonary aspergillosis.Öğe Preoperative Assessment of Myometrial and Cervical Invasion in Endometrial Carcinoma: Comparison of Multi-section Dynamic MR Imaging Using a Three Dimensional FLASH Technique and T2-Weighted MR Imaging(Wiley, 2010) Emlik, Dilek; Kıreşi, D.; Özdemir, S.; Çelik, Ç.; Karaköse, S.Introduction: We aimed to show the diagnostic performance of magnetic resonance imaging by comparing T2-weighted images and dynamic 3D MR images in the assessment of myometrial and cervical invasion by endometrial carcinoma. Methods: This prospective study included 53 women consecutively diagnosed with endometrial carcinoma. The subjects were evaluated by TSE T2-weighted images and 3D FLASH-VIBE dynamic MR images by two radiologists with a special training in gynecology. Sensitivity, specificity, negative and positive predictive values were calculated for each imaging modality with regard to assessment of myometrial and cervical invasion. Results: The diagnostic accuracy of TSE T2-weighted and dynamic 3D FLASH-VIBE MR imaging for the identification of any myometrial invasion were estimated as 64% and 84%, respectively. In the differentiation of deep myometrial invasion from the superficial invasion, the diagnostic accuracy of TSE T2-weighted and dynamic 3D FLASH-VIBE MR images were 75.5%, and 88.7%, respectively. Additionally, in the determining of deep myometrial invasion the sensitivity, the specifity, PPV, and NPV were 76%, 75%, 50%, and 90.9% on T2-weighted images, respectively; 100%, 85%, 68.4%, and 100% on dynamic 3D MR images, respectively. The diagnostic accuracy of TSE T2-weighted and dynamic 3D FLASH-VIBE MR images for cervical invasion by endometrial carcinoma were 86%, and 92%, respectively. Conclusion: The multiplanar capabilities of MRI are invaluable to evaluate spreading and margins of an endometrial mass, and the 3D dynamic MR techniques offer the advantages of increased coverage and high spatial resolution. Three dimensional dynamic MR imaging may be recommended in the especially postmenouposal cases before performing potentially curative treatments.