Search PubMed⌕ Search

Biomedical subjects

Okan Akhan

Publications and source records attributed to Okan Akhan.

54 records · Page 3Linked to original sources
PubMed2002

Percutaneous radiologic gastrostomy.

Gastrostomy is a preferred method of nutrition in patients with impaired ability to eat. Although surgical gastrostomy is a well-established method and has been widely performed in the last century, beginning with early 1980s, percutaneous gastrostomy techniques, either endoscopic or radiologic, has widely gained acceptance. As percutaneous methods have been shown to be an effective, safe, easy to perform and low-cost techniques with low morbidity and mortality rates, nowadays percutaneous gastrostomy is the first method of choice in need of nutrition in patients with functioning gut. In this article authors review the technique of percutaneous radiologic gastrostomy, as well as indications, contraindications, variations of technique, ethical considerations, controversies and comparison with surgical and endoscopic methods.

Contraindications↗
PubMed2002

Percutaneous drainage of abdominal abcess.

The mortality in undrained abdominal abscesses is high with a mortality rate ranging between 45 and 100%. The outcome in abdominal abscesses, however, has improved due to advances in image guided percutaneous interventional techniques. The main indications for the catheter drainage include treatment or palliation of sepsis associated with an infected fluid collection, and alleviation of the symptoms that may be caused by fluid collections by virtue of their size, like pancreatic pseudocele or lymphocele. The single liver abscesses may be drained with ultrasound guidance only, whereas the multiple abscesses usually require computed tomography (CT) guidance and placement of multiple catheters. The pancreatic abscesses are generally drained routinely and urgently. Non-infected pancreatic pseudocysts may be simply observed unless they are symptomatic or cause problems such as pain or obstruction of the biliary or the gastrointestinal tract. Percutaneous routes that have been described to drain pelvic abscesses include transrectal or transvaginal approach with sonographic guidance, a transgluteal, paracoccygeal-infragluteal, or perineal approach through the greater sciatic foramen with CT guidance. Both the renal and the perirenal abscesses are amenable to percutaneous drainage. Percutaneous drainage provides an effective and safe alternative to more invasive surgical drainage in most patients with psoas abscesses as well.

Abdominal Abscess↗
PubMed2002

Percutaneous cholecystostomy.

Percutaneous cholecystostomy (PC), a technique that consists of percutaneous catheter placement in the gallbladder lumen under imaging guidance, has become an alternative to surgical cholecystostomy in recent years. Indications of PC include calculous or acalculous cholecystitis, cholangitis, biliary obstruction and opacification of biliary ducts. It also provides a potential route for stone dissolution therapy and stone extraction. Under aseptic conditions and ultrasound guidance, using local anesthesia, the procedure is carried out by using either modified Seldinger technique or trocar technique. Transhepatic or transperitoneal puncture can be performed as an access route. Several days after the procedure transcatheter cholangiography is performed to assess the patency of cystic duct, presence of gallstones and catheter position. The tract is considered mature in the absence of leakage to the peritoneal cavity, subhepatic, subcapsular, or subdiaphragmatic spaces. Response rates to PC in the literature are between the range of 56-100% as the variation of different patient population. Complications associated with PC usually occur immediately or within days and include haemorrhage, vagal reactions, sepsis, bile peritonitis, pneumothorax, perforation of the intestinal loop, secondary infection or colonisation of the gallbladder and catheter dislodgment. Late complications have been reported as catheter dislodgment and recurrent cholecystitis. PC under ultrasonographic 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. It is generally followed by elective cholecystectomy, if possible. However, it may be definitive treatment, especially in acalculous cholecystitis.

Aged↗
PubMed2002

Comparison of ultrasonography with magnetic resonance imaging in the diagnosis of temporomandibular joint internal derangements: a preliminary investigation.

OBJECTIVE: This study aimed to compare ultrasonography (US) with magnetic resonance imaging (MRI) with respect to the diagnosis of temporomandibular joint (TMJ) internal derangements. STUDY DESIGN: The study group consisted of 23 patients with a chief complaint of TMJ discomfort who were tentatively diagnosed by means of head-neck examination as having TMJ internal derangements and a control group of 9 volunteers who had no sign of TMJ internal derangements. All the patients were then examined by means of MRI and US. RESULTS: The results showed perfect agreement between MRI and US in the diagnosis of TMJ internal derangements (kappa = 1.000; P =.0001). CONCLUSION: MRI and US can be used to define the disk and its position, as well as the presence of TMJ internal derangements.

Adolescent↗
PubMed2002

Cardiac hydatid cyst and pulmonary hydatidosis in a child.

Hydatidosis in the lungs is unusual, and a cardiac localization occurs rarely. We report a child with cardiac hydatid cyst that developed during albendazole treatment for preceding multiple pulmonary hydatid lesions. The cardiac lesion was treated by surgical excision, and the pulmonary cysts improved with a combination of praziquantel and albendazole therapy.

Albendazole↗
PubMed2001

Percutaneous treatment of a parotid gland hydatid cyst: a possible alternative to surgery.

Although the most involved organs are liver and lung, hydatid cysts are very rarely seen in the head and neck region. Only a few cases with hydatid cyst in parotid gland have been reported in the literature. We present the findings of 18 months of follow-up of a case with a hydatid cyst in parotid gland treated percutaneously by using PAIR technique. To our knowledge, this is the first case of parotid gland hydatid cyst who underwent percutaneous treatment. Percutaneous treatment of parotid hydatid cyst seems to be a safe and effective procedure as a possible alternative to surgery.

Adult↗
PubMed2001

Imaging of abdominal tuberculosis.

The concept of "abdominal tuberculosis" in this review refers to peritoneum and its reflections, gastrointestinal tract, abdominal lymphatic system, and solid visceral organs, as they are subject to varying degrees of involvement alone or in combination. Some features, including free or loculated ascites with thin-mobile septa, smooth peritoneal thickening and enhancement, misty mesentery with large lymph nodes, smudged omental involvement, and advanced ileocecal changes demonstrated by US, CT, or gastrointestinal series are deemed suggestive radiological findings. The diagnosis still requires a high index of suspicion, once the suggestive features have been demonstrated by imaging modalities.

Diagnosis, Differential↗
PubMedDate not supplied

Choledochal cysts in children: evaluation with three-dimensional sonography.

In this report, we describe the application of 3-dimensional (3D) sonography for diagnosing choledochal cysts in 3 girls who were 18 months, 2 years, and 11 years old. The 3D images that were obtained during the sonographic examination revealed that all 3 patients had a type I choledochal cyst and also demonstrated dilatation of the biliary tracts. The 3 patients then underwent surgical excision of their cysts, cholecystectomy, and hepaticojejunostomy. Besides its other clinical applications, 3D sonography promises to be a valuable adjunct to conventional 2-dimensional imaging for the evaluation of choledochal cysts in pediatric patients.

Child↗
PubMedDate not supplied

Percutaneous drainage of 300 intraperitoneal abscesses with long-term follow-up.

The purpose of the study was to evaluate the efficacy of percutaneous drainage of intraperitoneal abscesses with attention to recurrence and failure rates. A retrospective analysis of percutaneous treatment of 300 intraperitoneal abscesses in 255 patients (147 male, 108 female; average age: 38 years; range: 40 days to 90 years) for whom at least 1-year follow-up data were available was performed. Abscesses were drained with fluoroscopic, sonographic, or computed tomographic guidance. Nine abscesses were drained by simple aspiration; catheter drainage either by Seldinger or trocar technique was used in the remaining 291 abscesses with 6F to 14 F catheters. Initial cure and failure rates were 68% (203/300) and 12% (36/300), respectively. Sixty-one abscesses (20%) were either palliated or temporized. The recurrence rate was 4% (12/300) and nine of them were cured by recatheterization, whereas three of them were treated by medication or surgery. The overall success and failure rates were 91% (273/300) and 9% (27/300), respectively, with temporized, palliated, and recatheterized recurred abscesses. The 30-day mortality rate was 3.1% (8/255). The mean duration of catheterization was 13 days. Intraperitoneal abscesses with safe access routes should be drained percutaneously because of high success and low morbidity, mortality, and recurrence rates.

Abscess↗
PubMedDate not supplied

Complete resolution of an alveolar echinococcosis liver lesion following percutaneous treatment.

Herein we present a 63-year-old male patient with a solid hepatic alveolar echinococcosis diagnosed by surgical biopsy. His liver lesion, which was infected, was drained by percutaneous catheterization. The lesion surprisingly disappeared completely after the treatment. The patient was followed-up without any symptoms for 20 months after the drainage. As alveolar echinococcosis of the liver behaves like a slow-growing liver cancer, the disappearance of our patient's lesion was a very unusual and rare outcome, which, to the best of our knowledge, has never been published in the literature.

Drainage↗
PubMedDate not supplied

Percutaneous placement of peritoneal port-catheter in patients with malignant ascites.

We report our experience with a radiologically placed peritoneal port-catheter in palliation of malignant ascites. Port-catheters were successfully placed under ultrasonographic and fluoroscopic guidance in seven patients (five women, two men) who had symptomatic malignant ascites. The long-term primary patency rate was 100%. The mean duration of catheter function was 148 days. Seven patients had a total of 1040 port-days. Two patients received intraperitoneal chemotherapy via the port-catheter. There were no procedure-related mortality and major complications. Minor complications such as ascitic fluid leakage from the peritoneal entry site, migration of the catheter tip to the right upper quadrant, and reversal of the port reservoir occurred in four patients. None of these complications affected the drainage and required port explantation. In patients with symptomatic malignant ascites, a peritoneal port-catheter can provide palliation and eliminate multiple hospital visits for repeated paracentesis with high patency and low complication rates.

Adult↗
PubMedDate not supplied

Missed total occlusion due to the occipital artery arising from the internal carotid artery.

A 56-year-old man was referred for digital subtraction angiography (DSA) with an ultrasound diagnosis of right proximal internal carotid artery (ICA) stenosis for possible carotid artery stenting. DSA revealed total occlusion of the ICA and an occipital artery arising from the stump and simulating continuation of the ICA. An ascending pharyngeal artery also arose from the same occipital artery. This case is of interest because this is a rare variation besides being a cause of misdiagnosis at carotid ultrasound.

Angiography, Digital Subtraction↗
PubMedDate not supplied

Percutaneous transcatheter ethanol sclerotherapy and catheter drainage of postoperative pelvic lymphoceles.

The aim of this study is to investigate the efficacy and long-term results of percutaneous transcatheter ethanol sclerotherapy (PTES) for postoperative pelvic lymphocele treatment. Fifty-two patients who were referred for lymphocele treatment were included in this study. Sixty lymphoceles of 52 patients were treated by percutaneous treatment with or without ethanol sclerotherapy. Lymphoceles developed in 47 and 5 patients, who underwent gynecologic malignancy operation (31 ovarian cancer, 6 cervix cancer, 10 endometrial cancer) and renal transplantation, respectively. Lymphoceles were catheterized by ultrasonography and fluoroscopy guidance using the Seldinger technique. Lymphoceles smaller than 150 mL underwent single-session ethanol sclerotherapy and the others were treated by multiple-session ethanol sclerotherapy. In 10 patients, percutaneous ethanol sclerotherapy could not be performed and they were treated only by percutaneous catheter drainage. The mean lymphocele volume was 329 mL (15-2900 mL). The mean catheterization duration was 11.8 days (1-60 days). The mean follow up time was 25.8 months (2-64 months). The initial treatment was successful in 46 out of 50 (91%) lymphoceles treated with PTES and 7 out of 10 (70%) lymphoceles treated with percutaneous catheter drainage. Minor complications (secondary infection and catheter dislodgement) were noted in seven (11.6%) patients. Recurrence developed in four and three patients who were treated by PTES and percutaneous catheter drainage, respectively. Five of these patients were treated with PTES without further recurrence. Percutaneous transcatheter ethanol sclerotherapy is an effective and reliable method for the treatment of postoperative lymphoceles.

Adolescent↗
PubMedDate not supplied

Combination of extremity computed tomography angiography and abdominal imaging in patients with musculoskeletal tumors.

PURPOSE: To introduce a comprehensive computed tomography (CT) protocol for the evaluation of patients with musculoskeletal tumors by combining extremity CT angiography and abdomen CT in a dynamic multidetector CT study. METHODS: Single contrast bolus was used for each study in 4 patients with musculoskeletal tumors involving the lower extremities. Extremity CT angiography and abdominal CT were acquired sequentially by 4-channel multidetector CT. Technical parameters for extremity CT angiography were as follows: detector collimation, 4 mm x 1 mm; pitch, 1.75; slice thickness, 1.25 mm; reconstruction interval, 1 mm; coverage, 42 cm; and table speed, 14 mm/s. Thick and thin maximum intensity projections, volume renderings, and multiplanar reformats with or without bone subtraction were used to display vascular supply of the extremity mass and adjacent vascular structures. RESULTS: Satisfactory images of the extremity arterial system and abdomen were obtained in all patients. The mean delay time for CT angiography was 25 seconds. Extremity CT angiography demonstrated feeding arteries of a fibular giant cell tumor and a large lymphomatous mass. The same protocol was used for the evaluation of a distal tibial osteosarcoma and a fibular chondrosarcoma. In 2 patients, early venous return was noted, indicating vascularity of the tumors. In all patients, the relation of osseus masses to adjacent vascular structures was visualized as well as the bony anatomy. CONCLUSION: Extremity CT angiography and abdominal staging CT can be combined in a single dynamic multidetector CT protocol in patients with musculoskeletal tumors, resulting in a reduction of costs, acquisition time, and contrast dose as well as an improvement in patient management. The same protocol can also be used in trauma patients.

Adult↗
PubMedDate not supplied

Preoperative multidetector computed tomography diagnosis of a seminoma originating from an undescended testis by "testicular vascular pedicle" sign.

We report a 65-year-old man with a palpable right lower quadrant mass who underwent multidetector computed tomography (MDCT) examination. Preoperative diagnosis of seminoma was possible by demonstration of "testicular vascular pedicle" sign by MDCT. We describe CT findings of the "testicular vascular pedicle" sign in this report.

Aged↗
PubMedDate not supplied

Hypercalciuria and nephrocalcinosis in cystic fibrosis patients.

The objective of this study was to determine the frequency of nephrocalcinosis and hypercalciuria in cystic fibrosis (CF) patients, and to search possible causes of this phenomenon. Forty-three CF children (24 boys, 19 girls; mean age 64.9 months, range 5 months-18 years) were included in this study. Plasma sodium, potassium, chloride, BUN, creatinine, calcium, phosphorus, magnesium, alkaline phosphatase; spot urine sodium, potassium, chloride, creatinine, calcium, magnesium; and serum 25-hydroxyvitamin-D levels were measured in all patients. Urine samples were examined for microscopic hematuria. Fractional sodium, potassium, chloride excretion and estimated glomerular filtration rate (GFR) were calculated. All patients underwent renal ultrasonography. Hypercalciuria, nephrocalcinosis and microscopic hematuria were detected in 15 patients (34.2%), 10 patients (23.2%) and two patients (5%), respectively. There was no significant but borderline correlation between 25-hydroxyvitamin-D levels and hypercalciuria (r: 0.308, p:0.05). There were no correlations between Shwachman clinical scoring system results and hypercalciuria (r: 0.221, p: 0.148) and age and hypercalciuria (r: -0.229, p: 0.135). Patients with chronic Pseudomonas colonization showed no hypercalciuria or nephrocalcinosis. There was no difference for plasma biochemical results, renal function tests, hypercalciuria and nephrocalcinosis between CF patients who had or had not experienced pseudo Bartter's syndrome (PBS) before. There was no relation between detected CF mutations of the patients and hypercalciuria and nephrocalcinosis. These results suggested that it is a primary abnormality of calcium metabolism in the kidney.

Adolescent↗
PubMedDate not supplied

Effect of percutaneous biliary drainage on serum levels of tumor markers in patients with obstructive jaundice.

BACKGROUND/AIMS: Some tumor markers such as CA 19-9 are shown to be increased in obstructive jaundice due to either benign or malignant causes. In this study the clinical importance of raised serum levels of tumor markers have been evaluated, with particular reference to obstructive jaundice and percutaneous biliary drainage. METHODOLOGY: We conducted a prospective longitudinal before-after trial. Twenty-one patients with obstructive jaundice were investigated, 5 with benign obstruction and 16 with malignant disease. All patients were examined with abdominal CT prior to biliary drainage. All patients underwent percutaneous transhepatic cholangiography, and 20 of 21 patients underwent percutaneous biliary drainage within 3 days after the CT examination. RESULTS: The mean CA 19-9 at presentation was lower in the group with benign disease (95 +/- 60.9 IU/mL) than those with malignancy (461.9 +/- 331.4 IU/mL). The mean CA 19-9 level in the benign group 1 week after drainage was 12 +/- 11.8 IU/mL. The mean CA 19-9 level in the malignant group after drainage was 249.7 +/- 279.5 IU/mL. CONCLUSIONS: A prominently high serum CA 19-9 level at the presentation and a high serum CA 19-9 level after successful biliary drainage should prompt investigation for a malignant etiology of obstructive jaundice.

Adult↗