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Öğe Baş-boyun kitlelerinde kontrastlı boyun MRG, difüzyon ağırlıklı MRG bulguları ve histopatolojik değerlendirme(Bolu Abant İzzet Baysal Üniversitesi, 2011) Coşgun, Zeliha; Gürel, SafiyeBaş boyun kitlelerinde preoperatif dönemde benign-malign ayrımının yapılması ve buna göre uygun tedavinin seçimi önemlidir. MRG yumuşak doku lezyonlarının karakterizasyonunda diğer radyolojik modalitelerin önünde yer almaktadır. Bununla birlikte konvansiyonel MRG incelemeleri baş-boyun kitlelerinin preoperatif tanısında yetersiz kalabilmektedir. Bu çalışmadaki amacımız kliniğimize refere edilmiş hastalarda baş-boyun kitlelerinin kontrastlı MRG, difüzyon ağırlıklı MRG ve histopatolojik inceleme bulgularının değerlendirilmesidir.Çalışmamıza Temmuz 2008 ile Haziran 2011 tarihleri arasında Abant İzzet Baysal Üniversitesi Tıp Fakültesi Radyodiagnostik Anabilim Dalına baş-boyun kitlesi ön tanısı ile gönderilen ve kontrastlı boyun MRG ile difüzyon ağırlıklı MRG tetkiki yapılan, insizyonel biyopsi veya operasyon sonrası benign ya da malign kitle tanısı almış 42 hasta dahil edildi. MRG'de artefakt nedeniyle sağlıklı değerlendirme yapılamayan hastalar çalışma dışı bırakıldı. Kontrastlı boyun MRG ve difüzyon ağırlıklı MRG tetkikleri, radyolojik kriterler (sinyal intensitesi, kontrastlanma özelliği, ADC katsayısı vb.) belirlendikten sonra, on yıllık deneyimi olan bir radyolog tarafından değerlendirildi. Histopatolojik değerlendirme, hasta ve ADC değeri hakkında önbilgisi olmayan bir patolog tarafından yapıldı. İstatitiksel değerlendirmede tanımlayıcı istatistik, ki kare testi ve Mann Whitney U testi kullanıldı. p<0,05 istatistiksel olarak anlamlı kabul edildi.44 hastanın MRG incelemesinden iki tanesi artefakt nedeniyle çalışma dışı bırakıldı. 42 olguda toplam 42 adet kitle saptandı. Kırkiki kitlenin 25'i benign, 17'si malign idi. Sinyal özellikleri, içyapı, kistik alan varlığı, kontrastlanma özelliği gibi MRG bulgularının benign-malign ayrımında yeterli olmadığı bulundu. Benign lezyonların ortalama ADC değeri 0,128x10-3±0,053 mm² /sn, malign lezyonların ortalama ADC değeri 0,100x10-3±0,026, mm²/sn idi. Benign lezyonlarda ADC değeri malign lezyonlara oranla anlamlı olarak daha yüksek bulundu (p=0.032). Histopatolojik değerlendirme sonucu yassı hücreli karsinomlarda nükleus sitoplazma oranı 0,25-2, schwannomda 0,25, plazmositomda 0,5-0,6, lipomda 0,01, malign epitelyal tümörde 2, malign melanom infiltrasyonunda 2-5, indiferansiye malign tümör infiltrasyonunda 1,5-2,3, diffüz büyük hücreli B lenfomada 3-4, bazoskuamöz karsinomda 2 olarak belirlendi.Tümör stroma oranı yassı hücreli karsinomda 1,5-4 arasındaydı değişmekteydi. Warthin tümöründe stroma oldukça dens idi. 20 hastada nekroz değerlendirilebilmiş olup 14 hastada nekroz saptanmadı, 3 hastada hafif dereceli, 1 hastada orta dereceli, 2 hastada belirgin nekroz vardı. Matriks-epitel oranı pleomorfik adenomlarda 0,5- 4 arasında değişmekteydi.Sonuç olarak; Konvansiyonel MRG sekansları baş-boyun kitlelerinin tanısında önemli olmakla birlikte örtüşen bulgular nedeniyle yeterli değildir. Konvansiyonel MRG'ye ek olarak uygulanan DAG yöntemi ise benign-malign ayırımında tanıya katkısı olan etkin bir yöntemdir. DAG yönteminde ölçülebilen ADC değeri benign lezyonlarda malignlere kıyasla anlamlı olarak daha yüksektir.Öğe Can inferior vena cava diameter and collapsibility index be a predictor in detecting preoperative intravascular volume change in pediatric patients?(Sciendo, 2021) Coşgun, Zeliha; Dağıstan, Emine; Coşgun, Mehmet; Öztürk, HayrettinBackground: Inferior vena cava (IVC) ultrasound measurement is a reliable indicator used in the assessment of intravascular volume status. The aim of this study was to evaluate intravascular volume changes in pediatric patients by measuring the IVC diameter and collapsibility index (CI) in children whose oral feeding was restricted preoperatively. Material and Methods: From May 2018 to October 2018, a total of 55 pediatric patients who were scheduled for surgery were included in this prospective, observational, cohort study. Fasting and satiety IVC diameters and CIs of patients were determined by ultrasonographic evaluation twice: in the preoperative preliminary evaluation, when the patients were satiated, and before surgery, during a fasting period of 6-8 hours. Ultrasonographic data were recorded and compared between fasting and satiety periods. Results: In the grey scale (B-mode), mean IVC diameter was significantly higher when the patients were satiated, compared to the measurements made just before surgery during the fasting period. In the M-mode, the mean IVC diameter was significantly higher only during the inspiratory phase when the patients were satiated, while during the expiratory phase it was detected to be statistically similar. Mean CI was significantly higher in the immediate preoperative period, compared to the assessment made when satiated. Conclusion: Preoperative ultrasound IVC diameter and CI measurement can be a practical and useful method for evaluating preoperative intravascular volume in children.Öğe Changes in the size of breast lesions during menstrual cycle observed by ultrasound: an initial study.(Allied Acad, 2017) Dağıstan, Emine; Canan, Arzu; Halıcıoğlu, Sıddıka; Coşgun, Zeliha; Gürel, SafiyePurpose: We aimed to evaluate changes in size of breast lesions during menstrual phases. Material and methods: In this prospective study, 46 women aged 18-35 years old who were referred to our radiology clinic for breast sonography and had cystic or solid breast lesions larger than 5 mm were enrolled to the study. Breast ultrasound (US) was performed at two different times; one within 5 days before and one within 5 days after menstrual bleeding. Anteroposterior and transverse length of the lesions were measured. Results: In total, 145 breast lesions were detected by US. Of these lesions, 6 were visualized in premenstrual phase but were not observed in postmenstrual phase. 6 lesions different were not visualized in premenstrual, but were detected in postmenstrual phase. One hundred and twenty-three lesions were visualized by US both in luteal and follicular phases. Conclusions: Timing of breast US might cause false results and unnecessary further investigations. Therefore, we suggest that breast US in women should be performed in follicular phase of the menstrual cycle.Öğe Could hemogram parameters be predictors of dementia in elderly patients?(Taylor & Francis Ltd, 2019) Dağıstan, Emine; Coşgun, ZelihaObjective: To study red cell distribution width (RDW), RDW to platelet ratio (RPR) and mean platelet volume to platelet ratio (MPR), novel inflammatory markers of routine hemogram, of patients with or without dementia, according to the grade of the disease established by Fazekas's score in magnetic resonance imaging (MRI). Methods: A total of 1342 cases that undergone cranial MRI study were retrospectively analyzed. Patients without a previous stroke and over 45 years were enrolled in the study. Demographic and laboratory characteristics of the participants were obtained from institutional computerized database. Subcortical and periventricular white matter were evaluated in axial FLAIR images according to Fazekas's grading scale. Univariate and multivariate analysis were performed for assessing the predictors of Fazekas's grading scale. Results: MPR of Fazekas 0, Fazekas 1, Fazekas 2 and Fazekas 3 groups were 3, 3, 4 and 3%, respectively. MPR difference between study groups was not significant (p = .32). RPR of Fazekas 0, Fazekas 1, Fazekas 2 and Fazekas 3 groups were 6, 7, 7 and 7%, respectively. RPR difference between study groups was significant (p < .001). Conclusion: We suggest that increased RDW and RPR values may indicate higher Fazekas's score and dementia in cranial imaging studies. The radiologist should pay particular attention in interpretation of cranial MRI of these patients.Öğe The effect of anteriorly located sigmoid sinus on postoperative hearing gains: A case-control study(Springer India, 2021) Güneş, Akif; Karalı, Elif; Ural, Ahmet; Coşgun, Zeliha; Dağıstan, EmineThere are many studies on the effects of temporal bone anatomical variations on a mastoid pneumatization. Considering the effects of the anatomic variations on mastoid pneumatization, it is considered that many anatomic variations may affect graft success rates and postoperative hearing threshold gains. We aimed to evaluate the effects of various anatomic variations on postoperative hearing gains among patients undergoing tympanoplasty. This retrospective cohort study conducted in a tertiary-care university hospital. This study enrolled 57 patients who underwent primary type 1 tympanoplasty operation using the temporal muscle fascia. The patients were divided into two groups as those with an anteriorly located sigmoid sinus (group 1), and no anatomic variation (group 2). Airway gain values at the frequency range of 250 Hz-8000 Hz and pure tone average (PTA) value were calculated preoperatively and at postoperative sixth month. The gains attained by the patient groups with anatomic variations were compared with group 2. There were significant differences between Group 1 and Group 2 in terms of the airway frequencies of 250, 500, 2000, 4000 Hz, and PTA value. We detected a lesser postoperative hearing gain in patients with an anteriorly located SS. We believe that anatomic variations that may affect middle ear and mastoid cavity may also affect postoperative hearing gain.Öğe Effects of sagittal balance differences on spondylolisthesis(Atha Comunicacao & Editora, 2019) Coşgun, Zeliha; Dağıstan, Emine; Dağıstan, YaşarObjectives: This study aimed to compare the lumbar lordosis (LL) and spinopelvic parameters of patients with stage 1-2 spondylolisthesis to those of the normal population and demonstrate the importance of these parameters in sagittal balance. Methods: The lumbosacral parameters on the lateral radiographs of a total of 125 patients were retrospectively compared. Lumbosacral parameters including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis angle (LLA), L5 incidence (L5I), L5 slope (L5S), and sacral table angle (STA) were compared between groups. Results: Comparison of the parameters between groups revealed no sex-based differences (p > 0.05). Conclusions: Abnormal sagittal spinopelvic parameters are commonly examined for their effects on the development of spondylolisthesis and should be used in routine practice. We found that the low SS values in our study, unlike those of other similar studies, may be a compensatory mechanism developed to reduce pain and maintain sagittal balance.Öğe Extraspinal findings on routine lumbar spinal MR imaging: Prevalence and etiologies in 4012 patients(2020) Dağıstan, Emine; Coşgun, ZelihaAim: To investigate the prevalence and reporting rates of incidental findings (IF) in the routine magnetic resonance imaging (MRI) of the lumbar spine, and to emphasize their clinical importance. Methods: A total of 4012 lumbar MRI taken between January 2014 and December 2016 were reevaluated. The low back pain and sciatalgia those suspected for lumbar spinal pathology were chosen for this study. Extra-spinal abnormalities were classified according to a modified CT Colonography Reporting and Data System (C-RADS) and analyzed. Results: The mean age of patients was 49, 83 (range 17-87) years. Of the cases, 2472 were women and 1540 were men. In 3834 cases, disk pathology was observed. In 1282 cases extraspinal pathology was detected. The largest group in the study consisted of C-RADS E2 with 1048 patients (82.5%). There were 195 patients (28.3%) in the C-RADS E3 group and 23 (1.8%) patients in the C-RADS E4 group, potentially important. Conclusion: Our results show that random extra-spinal abnormalities in the lumbar spine MRI, are very common and systematic evaluation and proper reporting of MRI are crucial.Öğe The incidence of deep venous thrombosis in Parkinson's disease(Taylor & Francis Ltd, 2023) Afşin, Emine; Coşgun, Zeliha; Kurul, Ramazan; Türkoğlu, Şule AydınIntroductionVenous thromboembolism is one of the causes of sudden death in Parkinson's Disease (PD). Few studies have investigated the correlation between PD and deep venous thrombosis (DVT). This study aimed to investigate the frequency of DVT in PD patients prospectively.Material and MethodDemographic characteristics of 37 PD patients without known risk factors for DVT, disease duration, Hoehn-Yahr (H - Y) stage, oxygen saturation (SpO2) and heart rate values with pulse oximetry, use of assistive devices, waist and knee circumference measurements, and modified Medical Research Council (mMRC) dyspnea score was recorded. Both legs were evaluated for thrombus by Doppler venous ultrasound (US).ResultsWith the H-Y stage of the disease duration, a positive correlation was determined between the H-Y stage and mMRC. Disease duration was negatively correlated with BMI and positively correlated with the need for assistance. Assistive device use was positively associated with age and mMRC. DVT was detected in only one patient. When our patients' files were reviewed after 1.5 years, one patient was hospitalized with the diagnosis of submassive pulmonary embolism.ConclusionAttention should be paid to the development of DVT in elderly patients with advanced stages of PD, progression in the H-Y stage, use of assistive devices, and progression in dyspnea scoring. There is also a need for studies on the benefit of DVT prophylaxis in PD patients with a high risk of venous thromboembolism.Öğe Laryngeal chondrosarcoma of the thyroid cartilage(Federation of Turkish Pathology Societies, 2021) Düzcü, Selma Erdoğan; Coşgun, Zeliha; Astarcı, Hesna MüzeyyenLaryngeal chondrosarcoma is rare and accounts for 0.2% of all larynx malignancies. Although chondrosarcoma is the most common sarcoma seen in the larynx, laryngeal involvement by cartilage tumors is rare. In this article, we aimed to present the differential diagnosis of chondrosarcoma located in the thyroid cartilage, which is a rare site, in a 75-year-old male patient. The patient underwent total laryngectomy by the otolaryngology department. The macroscopy of the laryngectomy material sent to the pathology laboratory revealed a 3x2 cm tumor with a polypoid extension to the lumen from the bottom of the right vocal cord. Although clinical and radiological findings are important in the diagnosis, the definite diagnosis is based on the pathological examination. It is especially important to differentiate the lesion from chondromas.Öğe Quantitative assessment of visceral and subcutaneous fat with hepatosteatosis by computed tomography in metabolic syndrome(Cukurova Univ, Fac Medicine, 2022) Aydın, Mehmet Maruf; Dağıstan, Emine; Coşgun, ZelihaPurpose: We aimed to evaluate visceral and subcutaneous fat tissue and its association with hepatosteatosis on computed tomography (CT) scans to determine cut-off criteria for metabolic syndrome, measure abdominal obesity directly based on the visceral fat tissue area (VFTA) rather than indirectly based on waist circumference and obtain supportive findings by density measurements in addition to the VFTA measurements. Materials and Methods: The Hounsfield unit (HU) values, visceral, subcutaneous fat areas and HU values of 108 patients diagnosed with metabolic syndrome (MS) were determined according to the National Cholesterol Education Program Adult Treatment Panel III 2001 Criteria by retrospectively analyzing their abdominal CT images taken for various reasons. The relationships of the obtained values with each other and to MS were evaluated. Results: The strongest predictor of MS was VFTA, and 156.47 cm(2) was the most significant value with 74.1% sensitivity and 58.6% specificity. An HU value of -102.99 for visceral fat tissue density (VFTD) was found as the second most significant finding with 75% sensitivity and 57.6% specificity. The VFTA values of the patients with hepatosteatosis were higher, and increased VFTA values were associated with lower VFTD values. Conclusion: The most important supportive finding was the demonstration of the possibility of measuring abdominal obesity, which has an important place among criteria, directly by measuring VFTA, rather than indirectly based on waist circumference.Öğe A rare cough complication: Internal oblique muscle hematoma(Elsevier Inc., 2021) Afşin, Emine; Coşgun, ZelihaCough-related hematomas occur most frequently in the rectus sheath and retroperitoneum while lateral abdominal wall hematomas are rarely reported. Intramuscular hematoma might be mistaken for tumors and acute inflammatory diseases of the abdomen. A definite diagnosis is made with computerized tomography. In the case presented in this study, a 78-year-old female patient who had cough and shortness of breath for 1 week applied to the outpatient clinic with complaints of ecchymosis on the left side of the abdomen accompanied by swelling and pain under the left rib. The International Normalized Ratio of the patient, who used Warfarin sodium 5mg / day for mitral valve replacement, was in the effective range (INR: 2.4). Superficial ultrasound revealed a heterogeneous lesion with a well-circumscribed, hypoechoic and locally cystic component in the lateral abdominal wall in the left subcostal area. On computerized tomography, the lesion in the left internal oblique muscle of 27 × 60 mm, heterogeneous density, and with smooth borders was classified as Type 2 hematoma. Hemodynamics of the patient were stable and did not exceed INR 3 in follow-up, and there was no decrease in hemoglobin values. The patient's ecchymosis disappeared on the fifth day, and control ultrasonography showed the hematoma was partially resorbed. The aim of this study is to emphasize that conservative methods should be applied and surgery should be avoided as much as possible in internal oblique muscle hematoma. © 2021Öğe Role of the optic nerve sheath diameter in the assessment of the effectiveness of decompressive surgery after malignant middle cerebral artery infarction(Assoc Arquivos Neuro- Psiquiatria, 2022) Şenol, Özgür; Coşgun, Zeliha; Dağıstan, Emine; Demiryürek, Bekir Enes; Cancan, Seçkin EmreBackground After a case of stroke, intracranial pressure (ICP) must be measured and monitored, and the gold standard method for that is through an invasive technique using an intraventricular or intraparenchymal device. However, The ICP can also be assessed through a non-invasive method, comprised of the measurement of the optic nerve sheath diameter (ONSD) through ultrasound (US). Objective To evaluate the ICP of patients who underwent wide decompressive craniectomy after middle cerebral artery (MCA) infarction via preoperative and postoperative ONSD measurements. Methods A total of 17 patients, aged between 34 and 70 years, diagnosed with malignant MCA infarction with radiological edema and mid-line shift, who underwent decompressive surgery, were eligible. From the records, we collected data on age, sex, preoperative and postoperative Glasgow Coma Scale (GCS) scores, National Institutes of Health Stroke Scale (NIHSS) score, the degree of disability in the preoperative period and three months postoperatively through the scores on the Modified Rankin Scale (MRS), and the preoperative and postoperative midline shift measured by computed tomography (CT) scans of the brain. Results Preoperatively, the mean GCS score was of 8 (range: 7.7-9.2), whereas it was found to be of 12 (range 10-14) on the first postoperative day ( p = 0.001). The mean preoperative NIHSS score was of 21.36 +/- 2.70 and, on the first postoperative day, it was of 5.30 +/- 0.75 ( p < 0.001). As for the midline shift, the mean preoperative value was of 1.33 +/- 0.75 cm, and, on the first postoperative day, 0.36 +/- 0.40 cm ( p < 0.001). And, regarding the ONSD, the mean preoperative measurement was of 5.5 +/- 0.1 mm, and, on the first postoperative day, it was of 5 +/- 0.9 mm ( p < 0.001). Conclusion The ocular US measurement of the ONSD for the preoperative and postoperative monitoring of the ICP seems to be a practical and useful method.Öğe Sonographic evaluation of pulmonary interstitial edema in patient with preeclampsia(Lippincott Williams & Wilkins, 2021) Gökkuş, Halil; Coşgun, Zeliha; Coşgun, Mehmet; Ekici, Mustafa Ayhan; Kalaycıoğlu, OyaThe aim of this study was to sonographically detect pulmonary edema, which is a major problem in pregnant women with preeclampsia, in the interstitial phase. We evaluated 41 preeclampsia patients and 21 control subjects prospectively. In the preeclampsia group, 26 patients had severe features, whereas the other 15 patients had none. To detect early fluid loading in lungs, sonographic B lines were counted from the intercostal space by using ultrasonography, and left ventricular loading findings were examined for corporation by using transthoracic echocardiography both before and after birth. In severe preeclampsia, the number of B lines before and after birth is statistically significant compared with the other groups. In addition, the total number of B lines calculated at 24 hours after delivery was significantly lower than that calculated before delivery (P < 0.018). In terms of prenatal E values, a statistically significant difference was found between all groups (P < 0.001). A strong positive and statistically significant relationship was found between B lines and prenatal E/e ' (r = 0.768; P < 0.001). The overall accuracy rate of the prenatal E/e ' and E value for estimation of the B line number classification is 0.791 (95% confidence interval, 0.674-0.908; P < 0.001) and 0.829 (95% confidence interval, 0.722-0.936; P < 0.001), respectively. Pulmonary edema is a serious complication in patients with severe preeclampsia and may be detected interstitially in some patients, even if it does not occur clinically.
