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Öğe An analysis of meniscal extrusion and associated knee joint lesions by magnetic resonance imaging(TURKISH ASSOC ORTHOPAEDICS TRAUMATOLOGY, 2009) Kiresi, Demet; Ertekin, Ersen; Yel, Mustafa; Açıkgözoğlu, SaimObjectives: We investigated the frequency of meniscal extrusion and associated knee joint lesions by magnetic resonance imaging (MRI) in patients with meniscal tears. Methods: We retrospectively evaluated MRI findings of 100 patients (41 males, 59 females; mean age 54 +/- 10 years; range 27 to 76 years) with meniscal tears in 126 knee joints. Using coronal images, extrusion was defined as a distance of >= 3 mm between the peripheral border of the meniscus and the edge of the tibial plateau. All the knees were assessed with respect to the localization and type of meniscal tear and extrusion, accompanying joint effusion. cruciate ligament pathologies, and degenerative bone and cartilage changes. Results: Meniscal extrusion was detected in 31 knee joints (24.6%), with a mean extrusion of 3.72 mm. At I extrusions were found to be in the posterior horn of the medial meniscus and were associated with radial tears (n=18, 58.1%), radial-oblique tears (n=9, 29%), complex tears (n=2, 6.5%), and flap tears (n=2, 6.5%). Meniscal tears with extrusion differed significantly from those without extrusion with respect to the localization of all the tears being in the posterior horn of the medial meniscus (100% vs. 60%) and the higher frequency (58.1% vs. 20%) of radial tears (p<0.05). There were no significant differences in the types and frequencies of accompanying pathologies seen in meniscal tears with and without extrusion (p>0.05). Conclusion: Meniscal extrusion is a common finding particularly in osteoarthritis. It is mostly seen in the medial meniscus and accompanied by radial tears. Therefore, its presence should alert to the possibility of a radial tear extending to the meniscal root.Öğe Anatomic and radiologic analysis of the atlantal part of the vertebral artery(ELSEVIER SCI LTD, 2009) Cengiz, Sahika Liva; Cicekcibas, Aynur; Kiresi, Demet; Kocaogullar, Yalcin; Cicek, Onur; Baysefer, Alper; Buyukmumcu, MustafaThe horizontal third segment (V3h) of the vertebral artery (VA) in 7 cadavers (14 sides) was dissected and the anatomical measurements recorded. Measurements from 24 healthy individuals (48 sides) were taken for comparison using multislice CT scanning. The distance between the medial Lip of the VA V3h and the line passing through the mid point of the posterior tuberculum of the atlas was marked as length A. The distance between the medial tip of the VA V3h and the point penetrating the dura mater was classified as length B. The angle between these lines was the alpha (a) angle. Measurements were taken when the head was in a neutral position, as well as in maximum right and left rotation, extension and flexion. In cadavers, the mean alpha angle (+/- S.D.) was 82.42 +/- 10.34 degrees and 83.21 +/- 10.81 degrees on the right and left side, respectively. On multislice CT scanning, the mean a angle was 81.64 +/- 10.15 degrees on the right and 83.77 +/- 10.65 degrees, on the left. These angles varied with the position of the head. (C) 2008 Elsevier Ltd. All rights reserved.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 Bone marrow edema syndrome of the third metatarsal bone: a rare cause of metatarsalgia treated with Iloprost(SPRINGER, 2011) Arazi, Mehmet; Kiresi, DemetBone marrow edema syndrome (BMES) is a non-traumatic clinical condition characterized by typical pattern of changes on magnetic resonance imaging (MRI). The disease rarely occurs in the forefoot region. A 37-year-old woman was diagnosed with BMES of the third metatarsal bone with typical MRI findings. She was successfully treated with iloprost infusion therapy consisted of infusion of 40 mu g of iloprost in 500 ml of sodium chloride solution given over 6 h daily, for five consecutive days. In conclusion, BMES should be kept in mind, as one of the causes of severe pain of forefoot region, and iloprost seems to be an effective treatment method for BMES.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 Comparison of the efficacy of low doses of methylprednisolone, acetaminophen, and dexketoprofen trometamol on the swelling developed after the removal of impacted third molar(MEDICINA ORAL S L, 2015) Eroglu, Cennet-Neslihan; Ataoglu, Hanife; Yildirim, Gulsun; Kiresi, DemetBackground: The aim of the present study was to compare the efficacy of low doses of methylprednisolone, acetaminophen and dexketoprofen trometamol, which are among the drug groups used in our clinic, on postoperative swelling developing after removal of impacted third molar. Material and Methods: The three group of patients received either 40 mg methylprednisolone or 300 mg acetaminophen or 12.5 mg dexketoprofen trometamol one hour before the procedure, according to the patient groups. The patients in the methylprednisolone group were injected with methylprednisolone at a dose of 20 mg 24 hour after the procedure and prescribed 300 mg acetaminophen as rescue analgesic. During the postoperative period, the doses that were given before the procedure were continued 3 times a day for 2 days in the acetaminophen and dexketoprofen trometamol groups. Maximal swelling was assessed preoperatively and at the postoperative 48 hours by ultrasound images. Results: Swelling was 34% lower in the methylprednisolone than in the other groups; however, no statistically significant difference was found between the groups. The acetaminophen and dexketoprofen trometamol groups exhibited clinical results close to each other. Conclusions: Combination of low doses of methylprednisolone and acetaminophen provide a safe and adequate clinical success on swelling.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 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 Effect of low-dose dexketoprofen trometamol and paracetamol on postoperative complications after impacted third molar surgery on healthy volunteers: A pilot study(MEDICINA ORAL S L, 2014) Eroglu, Cennet-Neslihan; Durmus, Ercan; Kiresi, DemetObjectives: The aim of the present study was to investigate the analgesic and anti-inflammatory effects of dexketoprofen trometamol (DT) and paracetamol on deep acute somatic pain and inflammation in patients undergoing impacted third molar surgery. This study was planned to present benefits that we could obtain with low burden of drug. Study Design: Effects of drugs, which were administered preemptively before the procedure, on pain, mouth-opening limitation, and swelling were assessed by visual analogue scale (VAS), magnetic resonance imaging (MRI), and mouth-opening measurement. Following surgery, time intervals when the patients first need to receive the drug were measured. Results: The VAS scores of the patients were lower in the side treated with DT than that in the paracetamol treated side. There was no significant difference between the groups in terms of mouth-opening limitation. MRI recordings revealed that swelling was lower in the side treated with paracetamol than DT treated side. Conclusions: Administration of the drugs before surgery contributed to the postoperative patient comfort. The analgesic activity of 12.5 mg dose of DT was similar to, even better than, the analgesic activity of 500 mg dose of paracetamol; however, DT had insufficient anti-inflammatory efficacy.Öğe The Mandibular Landmarks about the Facial Artery and Vein with Multidetector Computed Tomography Angiography (MDCTA): an Anatomical and Radiological Morphometric Study(SOC CHILENA ANATOMIA, 2012) Cicekcibasi, Aynur Emine; Yilmaz, Mehmet Tugrul; Kiresi, Demet; Seker, MuzafferThe aim of this study was to investigate the course of the facial vessels according to several mandibular landmarks in living individuals using multidetector computed tomography angiography (MDCTA) to determine these related to sex and side. This study was conducted in the Radiology Department, Meram Faculty of Medicine, Necmettin Erbakan University (Konya, Turkey). In total, sixty faces from 30 specimens (15 males and 15 females) with symptoms and signs of vascular disease were evaluated for the facial vessels by MDCTA scan. The facial vessel parameters were measured according to the reference points (mandibular angle, mental protuberance, mental foramen and facial midline). The distance from the point at which the facial artery first appears in the lower margin of the mandible to the mandibular angle for right and left facial artery were observed as 3.53 +/- 0.66 cm and 3.31 +/- 0.73 cm in males, respectively. These distances were determined as 2.91 +/- 0.52 cm and 3.35 +/- 0.48 cm in females. MDCTA is a new, powerful, safe and noninvasive test to demonstrate the vasculature of the head. Bony structures and neighboring vessel morphology can be evaluated by this technique in cases of trauma with suspected vessel injuries and when considering patient selection for flap surgery.Öğe The morphometric analysis of the V2 and V3 segments of the vertebral artery: Normal values on MDCT(PERGAMON-ELSEVIER SCIENCE LTD, 2009) Kiresi, Demet; Gumus, Serter; Cengiz, Sahika Liva; Cicekdbasi, AynurA potential hazard in midline posterior fossa craniectomy may be the injury of vertebral artery. That's why vertebral artery evaluation prior to surgery may prevent dangerous complications. Advancements in multidetector computed tomography (MDCT) have provided detailed demonstration of the vertebral artery at the craniocervical junction and its relationships with atlas and axis. We aimed to define the normal anatomic relationship of the V2 and V3 part of the vertebral artery on MDCT. In total, 33 patients underwent MDCT angiography scan with suspected cranial aneurysm. V2 and V3 segments of vertebral artery were evaluated. Eight measurements (B, C, D, E, G, H, X, and Y line) were taken from MDCT images. For B and C, a line initially passing through the body of axis and spinous process and determining the midline was formed. Then, the vertical distance of vertebral artery from the level of transverse foramen of axis and loop to this midline was measured. For D and G, the vertical distance of vertebral artery to the midline from the upper and lower margin levels of transverse foramen of atlas was measured after a line establishing the midline passing through the anterior and posterior tubercles of atlas was drawn first. For E, transverse diameter of vertebral artery was measured at the loop level of V2 segment. For H, the vertical distance at the point where vertebral artery entered dura in the line passing from the midline of foramen magnum at anterior-posterior plane was measured. For X and Y, two different points of horizontal part of the vertebral artery were determined. One of these two points was the lateral one which was the origin of the horizontal part in the transverse foramen, the other was the intersection point on atlas. Average distances for both sides from transverse foramen of the axis, the loop of axoatlantal part and the lower border of the atlas of the vertebral artery to the midline were 20.97 mm on the right, 22.29 mm on the left; 27.19 mm on the right, 28.34 mm on the left; and 25.75 mm on the right and 27.21 mm on the left, respectively. Average distances for both sides from the upper border of the atlas, and at its penetration through dura were 27.40 mm on the right, 28.94 mm on the left; and 10.90 mm on the right and 10.93 mm on the left, respectively. Distances between spinous process and intersection of vertebral artery with horizontal part were 35.79 mm on the right and 36.63 mm on the left laterally, and 22.27 mm on the right and 22.62 mm on the left medially. MDCT angiography is a powerful test to demonstrate the vasculature of the head and neck. Bony structures and adjacent vessel morphology can be evaluated by this technique. The evaluation of craniocervical region prior to surgery with MDCT may be helpful to avoid intraoperative vascular injuries. (C) 2009 Elsevier Ltd. All rights reserved.Öğe A new reversible ischemic neurologic deficit model in dogs(INT SCIENTIFIC INFORMATION, INC, 2008) Oeguen, Cemile Oeztin; Tastekin, Guengoer; Kiresi, Demet; Eser, Olcay; Uestuen, Mehmeet ErkanBackground: The aim of this study was to produce an internal carotid artery (ICA) occlusion model in dogs that can be used for studying the effects of surgical revascularization procedures. Material/Methods: After left frontoparictal craniectomy, the ICA and arterial circle of the brain were coagulated and transected, letting the middle cerebral artery be perfused by the contralateral ICA by way of the rostral cerebral artery in five mongrel dogs. Magnetic resonance imaging (MRI) and brain single-photon emission computed tomography (SPECT) were performed during the first 24 to 48 hours and 7 to 10 days after the operation. Paired t and Wilcoxon matched pair tests were used for statistics (p < 0.05). Results: All the dogs had postoperative hemiparesis that returned to normal after 7 to 10 days. Early MRI showed cerebral ischemia in the left parietal cortical area extending to the subcortical white matter, sparing the basal ganglion and the internal capsule. Early brain SPECT demonstrated hypoperfusion corresponding to the same area. This area became significantly restricted to a small cortical area in late MRI and SPECT images (p < 0.05). Conclusions: It is conlcuded that, as symptoms resolved spontaneously, this model can be used as a "reversible ischemic neurological deficit" model for diagnostic imaging and pharmacological studies.Öğe The Role of MDCT in Craniocervical Junction Pathologies: Pictorial Review(BENTHAM SCIENCE PUBL LTD, 2009) Kiresi, Demet; Kadiyoran, CengizIntroduction: Craniocervical junction pathologies are seldom pathologies having a vital importance because of their location. That's why preoperative correct evaluation and detection of relation with adjacent tissue of this area pathologies is important for proper treatment plan. Multidetector computed tomography (MDCT) imaging is an improving and being a widely used method recently in many areas of medicine. It is possible to evaluate the peripheric vascular structures, anatomic variations or vascular pathologies with MDCT angiography (MDCTA). Methods: The arcuate foramen is an anatomical variant of the atlas vertebra: anterior and posterior osseous bridges or ponticles can arch over the vertebral artery, to a greater or lesser degree, transforming the arterial groove into a canal. Dissection of the vertebral artery leading to thrombotic occlusion or ischaemia from narrowing of the arterial lumen has been described in trauma. There are fistula between a dural branch of the spinal ramus of a radicular artery and an intradural medullary vein in spinal vascular malformations. MDCT angiography is feasible and is an alternative technique in diagnosis spinal vascular malformations. The craniovertebral junction (CVJ) is a funnel-shaped structure comprised of the clivus and foramen magnum and the upper two cervical vertebrae. The most frequent neoplastic lesions of the craniovertebral junction are meningiomas, neurinomas, chordomas, paragangliomas, epidermoids, dermoids and chondrosarcomas.
