A 26-year-old male presented to a Level 1 trauma center following a motorcycle crash. Workup of h... more A 26-year-old male presented to a Level 1 trauma center following a motorcycle crash. Workup of his injuries demonstrated a grade 5 liver laceration with active extravasation, grade 5 kidney laceration, right apical pneumothorax, and a sternal fracture. The patient underwent hepatic artery embolization with interventional radiology (IR) followed by an exploratory laparotomy, liver packing, and small bowel resection with primary anastomosis. Four days post-op, the patient developed dyspnea, tachycardia, and decreasing oxygen saturation. Computed tomography pulmonary angiography demonstrated perihepatic fluid compressing the right atrium and inferior vena cava. Percutaneous perihepatic drain placement with aspiration of 700 mL bilious fluid resulted in immediate resolution of the compression. He subsequently underwent endoscopic retrograde cholangiopancreatography (ERCP) with stenting of the ampulla nine days later. The patient was discharged ten days post-ERCP with oral amoxicillin/c...
Diagnostic and interventional radiology (Ankara, Turkey), 2005
To determine the diagnostic value of magnetic resonance (MR) urography in children with urinary t... more To determine the diagnostic value of magnetic resonance (MR) urography in children with urinary tract dilatation. Twenty-five children between the ages of 4 months and 13 years (19 males and 6 females, mean age 6.5 years) were evaluated with T2 weighted and contrast-enhanced T1 weighted MR sequences. Results were compared with findings obtained with ultrasonography (n=25), intravenous urography (n=18), Tc99m- DTPA scintigraphy (n=16), and/or micturating cystouretrography (n=13). MR urography provided a superior imaging of urinary system dilatation, the site and the etiology of obstruction, and both regular and complicated kidney duplication than did conventional imaging methods. MR urography that used T2 weighted sequences was able to demonstrate 29 of 32 (90.6%) abnormal renal collecting systems. Fourteen of 21 (66.7%) normal systems were revealed by heavily T2 weighted images. Forty-six of 51 (90.2%) renal collecting systems could be shown by T1 weighted sequences. With this seque...
Objective: We wanted to present the results of percutaneous management of ureteral injuries that ... more Objective: We wanted to present the results of percutaneous management of ureteral injuries that were diagnosed late after cesarean sections (CS). Materials and Methods: Twenty-two cases with 24 ureteral injuries that were diagnosed late after CS underwent percutaneous nephrostomy (PN), antegrade double J (DJ) catheter placement and balloon dilatation or a combination of these. The time for making the diagnosis was 21 50.1 days. The injury site was the distal ureter in all cases (the left ureter: 13, the right ureter: 7 and bilateral: 2). Fifteen complete ureteral obstructions were detected in 13 cases. Ureteral leakage due to partial (n = 4) or complete (n = 3) rupture was noted in seven cases. Two cases had ureterovaginal fistula. All the cases were initially confirmed with antegrade pyelography and afterwards they underwent percutaneous nephrostomy. Balloon dilatation was needed in three cases. Antegrade DJ stents were placed in 10 cases, including the three cases with balloon di...
As microvascular surgery increases in popularity, the need for techniques to monitor the patency ... more As microvascular surgery increases in popularity, the need for techniques to monitor the patency of small blood vessels after operation has assumed increasing importance. The ideal monitoring technique must be readily available, simple, quick, non-invasive and inexpensive and have a high accuracy rate. Harrison et al. have defined some of these properties of ideal monitoring, but currently there is no ideal method (1). There are numerous methods for monitoring vascular patency, such as angiography, laser Doppler, oximetry, fluorescein and thermometry, but no technique which fulfills all of the ideal criteria has yet been devised (1-7). Currently, laser Doppler imaging is the most popular monitoring technique, as described by Copeland; however, the set up may cost over US $30,000 (2). Color Doppler sonography equipment with a higher frequency transducer is available in every university hospital for multipurpose usage, and it is a relatively inexpensive monitoring technique. We used D...
Radioembolization of inoperable primary or metastatic liver cancers with Yttrium-90 (Y-90) labele... more Radioembolization of inoperable primary or metastatic liver cancers with Yttrium-90 (Y-90) labeled radiomicrospheres is a treatment modality with its efficacy established. It is possible to administer curative doses of radiation to the tumor tissue while preserving normal liver parenchyma to a large extent with selective intraarterial radionuclide therapy performed with Y-90 labeled microspheres. Selective intraarterial radionuclide therapy with SIRSpheres® was approved by Turkish Ministry of Health for the treatment of inoperable liver cancers in April 2008. In this study, the results of selective intraarterial radionuclide therapy performed with SIR-Spheres® for the first time in Turkey in a 32-year-old male patient with inoperable liver metastasis due to medullary thyroid carcinoma are presented.
Hospital infections are serious concerns for health care workers and patients. Needle stick injur... more Hospital infections are serious concerns for health care workers and patients. Needle stick injuries, blood contacts, airborne infections and any kind of contamination pose a risk for hospital infections. The risk of hospital infection has been increased in radiology since the number of the patients and the exposure time between patients and radiology workers have increased especially with the usage of new modalities in the last three decades. Hospital infection risk and some universal standards and policies for protection were summarized in this article.
Purpose: To evaluate the vascular patency of microanastomoses in rats with color Doppler ultrason... more Purpose: To evaluate the vascular patency of microanastomoses in rats with color Doppler ultrasonography. Materials and Methods: 15 superficial femoral and 15 carotid arterial end-to-end anastomoses were performed in 30 white rats. All arteries were evaluated pre- and post-operatively by color Doppler ultrasonography with a 7.5 mHz linear transducer (Acuson 128HP). All results were correlated with surgery after final Doppler evaluation. Results: The subjects were divided into three groups: (a) patent anastomosis; (b) partial occlusive anastomosis; (c) total occlusive anastomosis. The predictive value ratios for the patency group was 100% (15/15), that for the partial occlusive group was 67% (6/9) and that for the total occlusive group was 83% (5/6). Conclusion: Color Doppler ultrasonography is avaible and useful for evaluation of the vascular patency of microanastomosis.
Persistent sciatic artery (PSA) is a rare congenital anomaly of the circulation of the lower limb... more Persistent sciatic artery (PSA) is a rare congenital anomaly of the circulation of the lower limb that results from the persistence of an artery that normally regresses early in embryonic development. PSA is usually an incidental finding and is exceedingly rare to find bilaterally. We present the case of a rare presentation of PSA that resulted in a favorable outcome for a patient who sustained a gunshot wound to his midthigh and discuss the history, embryology, anatomy, classification schema, imaging evaluation, complications, diagnosis, and management of PSA. PSAs are of doubtful clinical significance when found incidentally at imaging; however, individual patient symptoms, unique arterial anatomy, and the PSA classification best determine the appropriate treatment options.
Arteriovenous (AV) fistulae, pseudoaneurysms, and lacerations may occur during disc surgery. AV f... more Arteriovenous (AV) fistulae, pseudoaneurysms, and lacerations may occur during disc surgery. AV fistula after lumbar disc surgery is rare. Early diagnosis and treatment of vascular complications associated with disc surgery is essential due to their high mortality and morbidity rates. We report a case report who was presented with fistulous shunt between right common iliac artery and inferior vena cava fifteen days after operation for herniated discs at L4-L5 and L5-S1 levels. Treatment was transcatheter covered stent placement at the fistulous site of right common iliac artery using a self expandable stent-graft. We suggest use of minimally invasive interventional techniques in the management of suitable vascular injuries following lumbar disc surgery.
We report a 31-year-old woman with end-stage cervical carcinoma who suffers both lower intestinal... more We report a 31-year-old woman with end-stage cervical carcinoma who suffers both lower intestinal and vaginal bleeding. A selective internal iliac arteriogram demonstrated pseudoaneurysm formation in the vaginal branch of the left internal iliac artery. There was also a fistula between the pseudoaneurysm and the lower intestinal segments. Selective transcatheter coil embolization was performed, and the bleeding was treated successfully. We conclude that the internal iliac artery should be evaluated first in patients with advanced pelvic malignancy when searching for the source of lower gastrointestinal (GI) bleeding. Additionally, transcatheter arterial embolization is a safe and effective treatment technique.
Diagnostic and interventional radiology (Ankara, Turkey), 2007
To determine whether uterine artery embolization (UAE) prior to myomectomy is more effective than... more To determine whether uterine artery embolization (UAE) prior to myomectomy is more effective than myomectomy alone. The study included 15 consecutive infertile women with uterine fibroids > 10 cm (Group I) that underwent UAE with spherical particles using a microcatheter technique and a unilateral femoral approach between March 2005 and January 2007. The day after embolization all cases underwent myomectomy since the protocol for large fibroids in our hospital is myomectomy only. The control group was composed of 15 patients who underwent myomectomy only (Group II). Group II was established based on fibroid size (14 +/- 3 cm). Operating time, estimated blood loss and transfusion, complications, and hospital stay were calculated by retrospective chart reviews, and comparisons were made between the groups with Student's t-test. Mean operating time was 138 min in Group I and 240 minutes in Group II (P < 0.01). Mean estimated blood loss was 250 ml in Group I and 690 ml in Grou...
A 26-year-old male presented to a Level 1 trauma center following a motorcycle crash. Workup of h... more A 26-year-old male presented to a Level 1 trauma center following a motorcycle crash. Workup of his injuries demonstrated a grade 5 liver laceration with active extravasation, grade 5 kidney laceration, right apical pneumothorax, and a sternal fracture. The patient underwent hepatic artery embolization with interventional radiology (IR) followed by an exploratory laparotomy, liver packing, and small bowel resection with primary anastomosis. Four days post-op, the patient developed dyspnea, tachycardia, and decreasing oxygen saturation. Computed tomography pulmonary angiography demonstrated perihepatic fluid compressing the right atrium and inferior vena cava. Percutaneous perihepatic drain placement with aspiration of 700 mL bilious fluid resulted in immediate resolution of the compression. He subsequently underwent endoscopic retrograde cholangiopancreatography (ERCP) with stenting of the ampulla nine days later. The patient was discharged ten days post-ERCP with oral amoxicillin/c...
Diagnostic and interventional radiology (Ankara, Turkey), 2005
To determine the diagnostic value of magnetic resonance (MR) urography in children with urinary t... more To determine the diagnostic value of magnetic resonance (MR) urography in children with urinary tract dilatation. Twenty-five children between the ages of 4 months and 13 years (19 males and 6 females, mean age 6.5 years) were evaluated with T2 weighted and contrast-enhanced T1 weighted MR sequences. Results were compared with findings obtained with ultrasonography (n=25), intravenous urography (n=18), Tc99m- DTPA scintigraphy (n=16), and/or micturating cystouretrography (n=13). MR urography provided a superior imaging of urinary system dilatation, the site and the etiology of obstruction, and both regular and complicated kidney duplication than did conventional imaging methods. MR urography that used T2 weighted sequences was able to demonstrate 29 of 32 (90.6%) abnormal renal collecting systems. Fourteen of 21 (66.7%) normal systems were revealed by heavily T2 weighted images. Forty-six of 51 (90.2%) renal collecting systems could be shown by T1 weighted sequences. With this seque...
Objective: We wanted to present the results of percutaneous management of ureteral injuries that ... more Objective: We wanted to present the results of percutaneous management of ureteral injuries that were diagnosed late after cesarean sections (CS). Materials and Methods: Twenty-two cases with 24 ureteral injuries that were diagnosed late after CS underwent percutaneous nephrostomy (PN), antegrade double J (DJ) catheter placement and balloon dilatation or a combination of these. The time for making the diagnosis was 21 50.1 days. The injury site was the distal ureter in all cases (the left ureter: 13, the right ureter: 7 and bilateral: 2). Fifteen complete ureteral obstructions were detected in 13 cases. Ureteral leakage due to partial (n = 4) or complete (n = 3) rupture was noted in seven cases. Two cases had ureterovaginal fistula. All the cases were initially confirmed with antegrade pyelography and afterwards they underwent percutaneous nephrostomy. Balloon dilatation was needed in three cases. Antegrade DJ stents were placed in 10 cases, including the three cases with balloon di...
As microvascular surgery increases in popularity, the need for techniques to monitor the patency ... more As microvascular surgery increases in popularity, the need for techniques to monitor the patency of small blood vessels after operation has assumed increasing importance. The ideal monitoring technique must be readily available, simple, quick, non-invasive and inexpensive and have a high accuracy rate. Harrison et al. have defined some of these properties of ideal monitoring, but currently there is no ideal method (1). There are numerous methods for monitoring vascular patency, such as angiography, laser Doppler, oximetry, fluorescein and thermometry, but no technique which fulfills all of the ideal criteria has yet been devised (1-7). Currently, laser Doppler imaging is the most popular monitoring technique, as described by Copeland; however, the set up may cost over US $30,000 (2). Color Doppler sonography equipment with a higher frequency transducer is available in every university hospital for multipurpose usage, and it is a relatively inexpensive monitoring technique. We used D...
Radioembolization of inoperable primary or metastatic liver cancers with Yttrium-90 (Y-90) labele... more Radioembolization of inoperable primary or metastatic liver cancers with Yttrium-90 (Y-90) labeled radiomicrospheres is a treatment modality with its efficacy established. It is possible to administer curative doses of radiation to the tumor tissue while preserving normal liver parenchyma to a large extent with selective intraarterial radionuclide therapy performed with Y-90 labeled microspheres. Selective intraarterial radionuclide therapy with SIRSpheres® was approved by Turkish Ministry of Health for the treatment of inoperable liver cancers in April 2008. In this study, the results of selective intraarterial radionuclide therapy performed with SIR-Spheres® for the first time in Turkey in a 32-year-old male patient with inoperable liver metastasis due to medullary thyroid carcinoma are presented.
Hospital infections are serious concerns for health care workers and patients. Needle stick injur... more Hospital infections are serious concerns for health care workers and patients. Needle stick injuries, blood contacts, airborne infections and any kind of contamination pose a risk for hospital infections. The risk of hospital infection has been increased in radiology since the number of the patients and the exposure time between patients and radiology workers have increased especially with the usage of new modalities in the last three decades. Hospital infection risk and some universal standards and policies for protection were summarized in this article.
Purpose: To evaluate the vascular patency of microanastomoses in rats with color Doppler ultrason... more Purpose: To evaluate the vascular patency of microanastomoses in rats with color Doppler ultrasonography. Materials and Methods: 15 superficial femoral and 15 carotid arterial end-to-end anastomoses were performed in 30 white rats. All arteries were evaluated pre- and post-operatively by color Doppler ultrasonography with a 7.5 mHz linear transducer (Acuson 128HP). All results were correlated with surgery after final Doppler evaluation. Results: The subjects were divided into three groups: (a) patent anastomosis; (b) partial occlusive anastomosis; (c) total occlusive anastomosis. The predictive value ratios for the patency group was 100% (15/15), that for the partial occlusive group was 67% (6/9) and that for the total occlusive group was 83% (5/6). Conclusion: Color Doppler ultrasonography is avaible and useful for evaluation of the vascular patency of microanastomosis.
Persistent sciatic artery (PSA) is a rare congenital anomaly of the circulation of the lower limb... more Persistent sciatic artery (PSA) is a rare congenital anomaly of the circulation of the lower limb that results from the persistence of an artery that normally regresses early in embryonic development. PSA is usually an incidental finding and is exceedingly rare to find bilaterally. We present the case of a rare presentation of PSA that resulted in a favorable outcome for a patient who sustained a gunshot wound to his midthigh and discuss the history, embryology, anatomy, classification schema, imaging evaluation, complications, diagnosis, and management of PSA. PSAs are of doubtful clinical significance when found incidentally at imaging; however, individual patient symptoms, unique arterial anatomy, and the PSA classification best determine the appropriate treatment options.
Arteriovenous (AV) fistulae, pseudoaneurysms, and lacerations may occur during disc surgery. AV f... more Arteriovenous (AV) fistulae, pseudoaneurysms, and lacerations may occur during disc surgery. AV fistula after lumbar disc surgery is rare. Early diagnosis and treatment of vascular complications associated with disc surgery is essential due to their high mortality and morbidity rates. We report a case report who was presented with fistulous shunt between right common iliac artery and inferior vena cava fifteen days after operation for herniated discs at L4-L5 and L5-S1 levels. Treatment was transcatheter covered stent placement at the fistulous site of right common iliac artery using a self expandable stent-graft. We suggest use of minimally invasive interventional techniques in the management of suitable vascular injuries following lumbar disc surgery.
We report a 31-year-old woman with end-stage cervical carcinoma who suffers both lower intestinal... more We report a 31-year-old woman with end-stage cervical carcinoma who suffers both lower intestinal and vaginal bleeding. A selective internal iliac arteriogram demonstrated pseudoaneurysm formation in the vaginal branch of the left internal iliac artery. There was also a fistula between the pseudoaneurysm and the lower intestinal segments. Selective transcatheter coil embolization was performed, and the bleeding was treated successfully. We conclude that the internal iliac artery should be evaluated first in patients with advanced pelvic malignancy when searching for the source of lower gastrointestinal (GI) bleeding. Additionally, transcatheter arterial embolization is a safe and effective treatment technique.
Diagnostic and interventional radiology (Ankara, Turkey), 2007
To determine whether uterine artery embolization (UAE) prior to myomectomy is more effective than... more To determine whether uterine artery embolization (UAE) prior to myomectomy is more effective than myomectomy alone. The study included 15 consecutive infertile women with uterine fibroids > 10 cm (Group I) that underwent UAE with spherical particles using a microcatheter technique and a unilateral femoral approach between March 2005 and January 2007. The day after embolization all cases underwent myomectomy since the protocol for large fibroids in our hospital is myomectomy only. The control group was composed of 15 patients who underwent myomectomy only (Group II). Group II was established based on fibroid size (14 +/- 3 cm). Operating time, estimated blood loss and transfusion, complications, and hospital stay were calculated by retrospective chart reviews, and comparisons were made between the groups with Student's t-test. Mean operating time was 138 min in Group I and 240 minutes in Group II (P < 0.01). Mean estimated blood loss was 250 ml in Group I and 690 ml in Grou...
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