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Biomedical subjects

Okan Akhan

Publications and source records attributed to Okan Akhan.

At least 37 records · Page 2Linked to original sources
PubMed2005

Percutaneous hepaticogastrostomy in a patient with complete common duct obstruction after right hepatectomy.

Complete bile duct obstruction that cannot be traversed by a guide wire can be challenging for the interventional radiologist. Although hepaticogastrostomy, which can be an alternative for such cases, has been performed under fluoroscopic and endoscopic guidance previously, this technique can be simplified by using only fluoroscopy. This technique was used in a patient who had complete common bile duct obstruction after hepatic resection. The patient initially had a good clinical outcome and stayed symptom-free for 5 months but eventually developed biliary epithelial hyperplasia and required placement of another metallic stent.

Adenocarcinoma↗
PubMed2005

Diaphragmatic mesothelial cysts in children: radiologic findings and percutaneous ethanol sclerotherapy.

OBJECTIVE: We describe CT, MR, and sonography findings of diaphragmatic mesothelial cysts and the results of percutaneous treatment with ethanol. All cysts were bilobulate and showed extrahepatic location between the right liver lobe and diaphragm. CONCLUSION: Radiologic findings are helpful in diagnosing diaphragmatic mesothelial cysts, which should be managed conservatively. Percutaneous ethanol sclerotherapy should be the first choice of treatment if necessary.

Child↗
PubMed2005

Fat-containing lesions of the liver: cross-sectional imaging findings with emphasis on MRI.

OBJECTIVE: The purpose of this pictorial essay is to identify different types of liver lesions that contain fat. Cross-sectional imaging findings of fat- or lipid-containing lesions can help in characterizing focal liver lesions. We searched our archive retrospectively and reviewed the literature for fat-containing liver lesions and identified 16 different types. CONCLUSION: These lesions can contain macroscopic fat (i.e., angiomyolipoma, lipoma, liposarcoma, hydatid cyst, lipopeliosis, adrenal rest tumor, pseudolipoma, hepatic teratoma, pericaval fat, extramedullary hematopoiesis, and metastases) or intracellular lipid (i.e., focal steatosis, adenoma, focal nodular hyperplasia, regenerative nodules, and hepatocellular carcinoma). CT, MRI, and sonographic findings of these lesions can help in characterization by allowing specific diagnosis or narrowing the differential diagnosis of liver lesions.

Diagnosis, Differential↗
PubMed2004

Single-session percutaneous ethanol sclerotherapy in simple renal cysts in children: long-term follow-up.

BACKGROUND: Simple renal cysts are rare in children and managed conservatively unless symptomatic. OBJECTIVE: To demonstrate the efficacy and long-term results of single-session ethanol sclerotherapy in symptomatic simple renal cysts in children. MATERIALS AND METHODS: Three simple renal cysts in three children (age 1, 5 and 16 years) were included in the study. Indications for treatment were flank pain (n = 1), hypertension (n = 1), and increasing cyst size and urinary tract infection (n = 1). The mean follow-up period was 5.5 years (range 3-7 years). The procedures were performed with the guidance of US and fluoroscopy and under IV sedation. After the cystogram, 95% ethanol with a volume of 40% of the cyst volume (but not more than 100 ml) was used as the sclerosing agent. RESULTS: Two cysts disappeared completely, while the volume reduction was 99% for the third cyst at the end of the first year. CT demonstrated calcification of the cyst without an enhancing soft-tissue component in the third one 7 years after sclerotherapy. After the procedures, hypertension and pain resolved without any medication. There were no complications during the procedures or during follow-up. Cytological examination was unremarkable in all patients. CONCLUSIONS: Percutaneous treatment of symptomatic simple renal cysts in children with single-session ethanol sclerotherapy is a safe, effective and minimally invasive procedure. Calcification owing to sclerotherapy can be observed on follow-up.

Adolescent↗
PubMed2004

Evaluation of kidney damage in patients with acute lymphoblastic leukemia in long-term follow-up: value of renal scan.

In order to evaluate potential long-term kidney damage of childhood leukemia and risk factors affecting renal damage, we studied 116 children treated for acute lymphoblastic leukemia (ALL) using the St. Jude Total XI and XIII protocols in 1991-1998. The median follow-up period after the completion of treatment was 35 months. The following parameters were examined: urinalysis, urinary creatinine (Cr), calcium (Ca), phosphorus, beta2-microglobulin, glomerular filtration rate (GFR), tubular phosphorus reabsorption (TPR), and renal function tests. Radiological evaluation included renal ultrasonography (US), and renal scans with DMSA or MAG-3 were performed. Blood chemistry and renal US patients were normal in all patients except two. GFR, TPR, urinary Ca/Cr, beta2-microglobulin, and renal scan were abnormal in 19.0%, 16.4%, 13.8%, 6.0%, and 40.5% of patients, respectively. The abnormality rate in GFR was significantly higher in patients <2 years of age. TPR abnormality was found to be significantly higher in patients who did not have G-CSF. An abnormal renal scan was associated with Hb < 10 g/dL, kidney infiltration, or hypertension at presentation and also occurred patients who underwent methotrexate treatment with frequent intervals during the follow-up period. Patients should be followed-up after cessation of therapy with the conventional tests mentioned above. In case of any abnormality, further detailed tests should be performed; renal scan seems to be more predictive for renal damage.

Adolescent↗
PubMed2004

Long-term results of celiac Ganglia block: correlation of grade of tumoral invasion and pain relief.

OBJECTIVE: We evaluated the long-term results and response rates of celiac ganglia block to the level of tumor invasion of the celiac region. SUBJECTS AND METHODS. Forty-one patients each with an inoperable intraabdominal carcinoma who were referred to our department for celiac ganglia block were included in this study. Tumor invasion of the celiac ganglia region was graded on a four-point scale according to CT features (grade I = no invasion, grade II = invasion < 50%, grade III = invasion > 50%, and grade IV = complete invasion). Subjective pain levels (0 = no pain, 10 = worst pain) were obtained from the patients, and objective criteria (change in daily analgesic doses) were noted before the procedure and during the follow-up to determine effectiveness of the celiac ganglia block. RESULTS: Celiac ganglia block was successfully performed in all 41 patients (100%). In 39 (95%) of 41 patients, pain decreased significantly after the procedure, and the pain level did not change in the remaining two patients. Major complications were not encountered in any of the patients. Minor complications were observed in 35 patients (85%). Mean pain intensity and mean daily analgesic consumption significantly decreased after the procedure in all four groups. The amount of pain decrease for these two parameters was inversely related to degree of invasion. Responses of the patients were obtained at the end of the first week after the procedure and remained unchanged during long-term follow-up. CONCLUSION: Percutaneous celiac ganglia block, particularly when performed in earlier stages of ganglia invasion, is an effective, easy, and safe procedure with successful long-term results.

Abdominal Neoplasms↗
PubMed2004

[Outcomes of percutaneous cholecystostomy in patients with high surgical risk].

PURPOSE: To evaluate the effectiveness of the percutaneous cholecystostomy with the follow up results of our patients. MATERIALS AND METHODS: We retrospectively evaluated the medical records of 37 patients who underwent percutaneous cholecystostomy. Eighteen female and 19 male patients were included into this study between the ages of 7 and 88 years. All of our patients had acute cholecystitis or eventually developed acute cholecystitis except one. Seven year old male patient with Non-Hodgkin lymphoma underwent percutaneous cholecystostomy due to elevation of liver function tests and direct bilirubin. Since he had dilated intrahepatic biliary ducts due to a lymphadenopathy compression at portal hilus, percutaneous cholecystostomy was performed to decompress the biliary system to decrease the bilirubin and liver function tests to normal levels for initiating appropriate chemotherapy protocol. All the procedures were carried under fluoroscopic and sonographic guidance through transhepatic or transperitoneal approach with 6 to 10 F drainage catheters. RESULTS: Recovery from the acute cholecystitis symptoms was achieved in 31 patients (86%) in follow-up. No procedure-related mortality was observed. The only major complication was intraperitoneal bleeding due to underlying coagulopathy which was treated with blood transfusion. Eight patients (21.6%) died in 30 days after the percutaneous intervention procedure. In the patient with Non-Hodgkin lymphoma at the age of 7, however, the procedure to decrease the bilirubin levels was successful and chemotherapy was given subsequently; he had died after 31 days due to his aggressive primary disease. Catheterization times were between 2 days and 60 days due to accompanied diseases. Six patients (16.7%) were finally undergone to cholecystectomy after the risks for surgery had been reduced. ERCP was performed in 2 patients (5.6%) for stone extraction from common bile duct. Eighteen patients (50%) were recovered from the acute illness and following the control cholangiograms, catheters were taken out consequently. CONCLUSION: Percutaneous cholecystostomy under ultrasonographic and fluoroscopic guidance is a cost-effective, easy to perform and reliable procedure with low complication and high success rates for critically ill patients with acute cholecystitis.

Adolescent↗
PubMed2003

[Staging of urinary bladder tumors with CT and MRI].

PURPOSE: The purpose of this study was to evaluate the performance of spiral CT and MRI in patients with bladder tumor. MATERIALS AND METHODS: In this study, patients with suspected urinary bladder tumor were evaluated by abdominal CT and MRI. This study included 32 patients. In 23 cases, transurethral resection (TUR), and in 9 cases radical cystectomy was performed. Additionally, pelvic lymph node dissection was performed in 9 patients. RESULTS: According to the pathological results of TUR-performed patients; the accuracy of spiral CT and MRI in preoperative staging of bladder tumors was 41.6% and 83.3%, respectively. The accuracy of spiral CT and MRI in preoperative staging of bladder tumors were 66.6% and 77.7% in patients who underwent radical cystectomy. Pelvic lymph node involvement was evaluated properly with MRI and CT. CONCLUSION: In the preoperative staging of bladder tumors, MRI is superior to CT. The superiority is more definite especially in early stage tumors.

Adult↗
PubMed2003

[The role of spiral CT in the preoperative evaluation of malignant gastric neoplasms].

PURPOSE: The purpose of this study was to evaluate the performance of spiral CT in preoperative staging in patients with gastric cancer. MATERIALS AND METHODS: A total of 28 patients with an established diagnosis of 24 gastric adenocarcinoma, 2 gastric lymphoma, 1 carcinoid tumor, 1 leiomyosarcoma were evaluated with spiral CT for serosal invasion, pancreatic invasion, metastasis and peritoneal involvement. Results were compared with surgical and pathological staging. RESULTS: The accuracy of spiral CT in determining the depth of tumor invasion, pancreatic invasion, lymph node metastasis, peritoneal metastasis, liver metastasis and splenic metastasis were 82% (23/28), 96% (27/28), 82% (23/28), 96% (27/28), 100% (28/28) and 100% (28/28) respectively. The differentiation between T2-T3, T3-T4, N0-N1, N1-N2, N2-N3 were possible in 83% (15/18), 92% (23/25), 79% (15/19), 73% (8/11), and 89% (8/9). The accuracy of spiral CT in overall TNM staging of gastric adenocarcinomas was 67% (16/24). CONCLUSION: Spiral CT is an effective tool in the preoperative staging of gastric malignancies.

Adenocarcinoma↗
PubMed2002

CT attenuation of colorectal polypoid lesions: evaluation of contrast enhancement in CT colonography.

The aim of this study was to calculate pre- and postcontrast CT attenuation values of benign colorectal polyp and carcinoma lesions detected by virtual colonoscopy, and to investigate whether contrast enhancement of these lesions can be potentially used for differentiation from residual fluid in the colon. Fifteen benign polyps and 21 colorectal carcinoma lesions detected by virtual colonoscopy in 18 patients were included in our study. All of the polyps and carcinoma lesions were confirmed by colonoscopic biopsy. Measurement of CT attenuation values was performed in precontrast (supine) and postcontrast (prone) scans for each polyp and carcinoma. The CT attenuation values of residual fluid in the colon was also measured from the same location before and after intravenous contrast administration. On unenhanced CT scan mean attenuation values of benign polyps and colorectal carcinomas were 32.4 and 42.6 HU, respectively. Following contrast enhancement, mean attenuation value increased to 78.9 HU for polyps and 90.7 HU for carcinomas. Increase in the CT attenuation values of these lesions was significant ( p<0.0001). Mean CT attenuation value of residual fluid before and after administration of IV contrast were 14.6 and 13.8 HU, respectively. The difference between CT attenuation value of residual fluid in the colon before and after contrast material was not significant ( p=0.29). Colorectal benign polyps and carcinomas demonstrate significant enhancement following contrast administration and use of intravenous contrast material during virtual colonoscopy may help in some cases in differentiating these solid lesions from residual colonic fluid that does not enhance.

Colonic Polyps↗
PubMed2002

Unusual imaging findings in Wilson's disease.

We present unusual imaging findings in the liver of a patient with Wilson's disease. On US, the liver contours were irregular and its echogenicity was increased with multiple, small hypo- and hyperechoic nodules. Prominent perihepatic fat layer was noted to be increased in thickness. On CT and MR, multiple, small, enhancing nodules were detected in the liver in the early arterial phase after administration of intravenous contrast material. Biopsy was consistent with chronic parenchymal liver pathology with dysplastic changes but without evidence of hepatocellular carcinoma. To our knowledge, dysplastic nodules enhancing at the arterial phase and thickened perihepatic fat layer have not been previously reported in patients with Wilson's disease.

Adult↗
PubMed2002

Hepatobiliary manifestations of cystic fibrosis in children: correlation of CT and US findings.

MATERIAL AND METHODS: Abdominal US and CT scans of 50 pediatric cystic fibrosis (CF) patients were evaluated to search for specific data that can be attributed to the involvement of the hepatobiliary system. The liver findings of the two patients who were HBs antigen carriers were excluded from the study. RESULTS: 30 out of 48 patients had at least one abnormal finding of liver on CT and/or US. Although increased echogenicity of the liver was detected in 24 of 48 patients (50%), only six of these (12%) were regarded as steatosis according to CT criteria of low attenuation values. CT and US scans both showed unique multilobular fatty pattern, described as "pseudomasses" in three patients. Increased periportal echogenicity was seen in 18 (37%) patients on US, while CT could not demonstrate any sign of increased periportal thickness. Findings of cirrhosis were present in five patients with either modalities. Lymph nodes of less than 10-15 mm in diameter were detected at the hepatico-duodenal ligament in 18 (37%) patients. Anomalies of the gallbladder (absence or microgallbladder or stone) were detected in 12 cases (24%). CONCLUSION: Although US is the most widely used modality in CF patients, CT and US correlation will help to better delineate the abnormalities between steatosis and periportal fibrosis and increase the sensitivity of the imaging methods to achieve the most accurate diagnosis.

Adolescent↗
PubMed2002

Involvement of the thyroid and the salivary glands in childhood non-Hodgkin's lymphomas at initial diagnosis.

OBJECTIVE: The clinical spectrum of childhood non-Hodgkin's lymphoma (NHL) is different from that in adults, with frequent extranodal involvement. We searched the incidence and radiological appearance of the secondary involvement of the thyroid and salivary glands by ultrasonography (US) to assess its importance for staging of the disease. MATERIALS AND METHODS: We examined the thyroid, parotid and submandibulary glands of 43 children with NHL, age ranging between 9 months and 17 years, by US. RESULTS: According to US findings, involvement of the parotid gland was very common as detected in 18 of the cases with NHL (41%). It was the most common organ involved in lymphoma. Lymphomatous infiltration of the thyroid gland, with bilateral multiple focal lesions, was detected in two patients and proved by fine needle aspiration biopsy in all cases (5%). Salivary gland and thyroid involvement changed staging in three (6%) of the patients, however, the treatment plan was unchanged. CONCLUSIONS: This study shows that anatomic sites, known to be very rarely involved at the initial presentation of the disease is actually more commonly involved in childhood NHL. However, it does not cause any significant change in the treatment planning or in the survival.

Adolescent↗