Browsing by Author "Pabuscu, Y"
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Item Comparison of contrast-enhanced T1-weighted and 3D constructive interference in steady state images for predicting outcome after hearing-preservation surgery for vestibular schwannomaKocaoglu, M; Bulakbasi, N; Ucoz, T; Ustunsoz, B; Pabuscu, Y; Tayfun, C; Somuncu, IWe compared contrast-enhanced T1-weighted and 3D constructive interference in steady state (CISS) sequences for demonstrating possible prognostic factors in hearing-preservation surgery for vestibular schwannoma. We studied 22 patients with vestibular schwannomas having hearing-preservation surgery. Postoperatively six (27%) had a facial palsy and eight (36%) had hearing loss. There was a significant correlation between the size of the tumour and facial palsy (r= -0.72). Both techniques adequately demonstrated all tumours. Involvement of the fundus of the internal auditory canal (IAC) and a small distance between the lateral border of the tumour and the fundus were correlated significantly with hearing loss (r= -0.81 and -0.75, respectively). The 3D-CISS sequence, by virtue of its high contrast resolution was superior to T1-weighted images (P<0.05) for detection of the fundal involvement. The direction of displacement of the facial nerve did not correlate with facial palsy or hearing loss. We think that 3D-CISS images better show the features influencing surgical outcome, but that contrast-enhanced T1-weighted images are required for diagnosis.Item Doppler Sonographic Findings in Testicular MicrolithiasisSerter, S; Orguc, S; Gumus, B; Ayyildiz, V; Pabuscu, YObjective The aim of this prospective study was to compare the resistive index (RI) values, which is a parameter of testicular parenchymal perfusion, in testicular microlithiasis (TM) cases and normal cases. Materials and Methods 2179 volunteers, all healthy men (17-42 years of age) from the Annual Army Reserve Officer Training Corps training camp were included in the study. A screening scrotal ultrasound was performed and all men diagnosed with TM underwent a scrotal Doppler ultrasonography scan (US). US examinations were performed for subjects with TM and without TM as a control group and RI was determined. Results 53 men with TM were identified in the 2179 US. Spectral Doppler examination was applied to 50 randomly selected cases (100 testicles) without TM and 92 testicles with TM, 39 cases (78 testicles) with bilateral and 14 cases with unilateral involvement. However, 48 normal testicles (17 bilateral and 14 unilateral) and 47 testicles with TM (15 bilateral and 17 unilateral, 10 of which were cases with bilateral TM) where flow from the centripetal artery could be obtained and analyzed were included in the statistical analysis for resistive indices There was no significant difference regarding the RI and spectral examinations between subjects with and without TM An interesting finding was the twinkling artifact observed in three cases. Conclusion: Microliths did not alter the RI values and thus had no influence on testicular perfusion on Doppler US examinationItem The role of facial canal diameter in the pathogenesis and grade of Bell's palsy: a study by high resolution computed tomographyCelik, O; Eskiizmir, G; Pabuscu, Y; Ulkumen, B; Toker, GTIntroduction: The exact etiology of Bell's palsy still remains obscure. The only authenticated finding is inflammation and edema of the facial nerve leading to entrapment inside the facial canal. Objective: To identify if there is any relationship between the grade of Bell's palsy and diameter of the facial canal, and also to study any possible anatomic predisposition of facial canal for Bell's palsy including parts which have not been studied before. Methods: Medical records and temporal computed tomography scans of 34 patients with Bell's palsy were utilized in this retrospective clinical study. Diameters of both facial canals (affected and unaffected) of each patient were measured at labyrinthine segment, geniculate ganglion, tympanic segment, second genu, mastoid segment and stylomastoid foramen. The House-Brackmann (HB) scale of each patient at presentation and 3 months after the treatment was evaluated from their medical records. The paired samples t-test and Wilcoxon signed-rank test were used for comparison of width between the affected side and unaffected side. The Wilcoxon signed-rank test was also used for evaluation of relationship between the diameter of facial canal and the grade of the Bell's palsy. Significant differences were established at a level of p = 0.05 (IBM SPSS Statistics for Windows, Version 21.0.; Armonk, NY, IBM Corp). Results: Thirty-four patients - 16 females, 18 males; mean age +/- Standard Deviation, 40.3 +/- 21.3 - with Bell's palsy were included in the study. According to the HB facial nerve grading system; 8 patients were grade V, 6 were grade IV, 11 were grade III, 8 were grade II and 1 patient was grade I. The mean width at the labyrinthine segment of the facial canal in the affected temporal bone was significantly smaller than the equivalent in the unaffected temporal bone (p = 0.00). There was no significant difference between the affected and unaffected temporal bones at the geniculate ganglion (p = 0.87), tympanic segment (p = 0.66), second genu (p = 0.62), mastoid segment (p = 0.67) and stylomastoid foramen (p = 0.16). We did not find any relationship between the HB grade and the facial canal diameter at the level of labyrinthine segment (p = 0.41), tympanic segment (p = 0.12), mastoid segment (p = 0.14), geniculate ganglion (p = 0.13) and stylomastoid foramen (p = 0.44), while we found significant relationship at the level of second genu (p = 0.02). Conclusion: We found the diameter of labyrinthine segment of facial canal as an anatomic risk factor for Bell's palsy. We also found significant relationship between the HB grade and FC diameter at the level of second genu. Future studies (MRI-CT combined or 3D modeling) are needed to promote this possible relevance especially at second genu. Thus, in the future it may be possible to selectively decompress particular segments in high grade BP patients. (C) 2016 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial. Published by Elsevier Editora Ltda.Item Doppler ultrasonography imaging of hemodynamic alteration of retrobulbar circulation in type 1 diabetic children and adolescents without retinopathyOvali, GY; Ersoy, B; Tuncyurek, O; Urk, V; Ozkol, M; Ozhan, B; Baser, E; Pabuscu, YAim: We aimed to investigate the retrobulbar blood circulation using Colour Doppler Imaging (CDI) in type 1 diabetic children and adolescents who had no diabetic retinopathy and to compare the results with their healthy peers. Methods: Forty-nine patients with type 1 diabetes mellitus with no retinopathy on fundoscopic examination were included in the study. Forty-nine healthy children were defined as the control group. Central retinal artery (CRA), ophthalmic artery (OA) and posterior ciliary artery (PCA) were examined with Doppler US bilaterally. Peak systolic velocity (PSV), end diastolic velocity (EDV) and resistive indices (RI) for each artery were recorded. Results: Blood flow velocity of the OA was significantly different in diabetic patients (p < 0.05). EDV of the OA was significantly higher (p = 0.011) and RI was significantly lower (p = 0.027) in patients with diabetes duration of longer than 5 years. RI of the CRA was significantly higher in patients who had higher microalbuminuria levels (p = 0.016). Conclusion: EDV of the OA increases and RI of the OA decreases in diabetes duration longer 5 years. Raised AER increases RI of the CRA. These findings may be the initial changes in the arterial circulation before vascular rigidity develops. (c) 2007 Elsevier Ireland Ltd. All rights reserved.Item Prevalence of testicular microlithiasis in an asymptomatic populationSerter, S; Gümüs, B; Ünlü, M; Tunçyürek, Ö; Tarhan, S; Ayyildiz, V; Pabuscu, YObjective. Testicular microlithiasis is a rare, usually asymptomatic, finding of the testes associated with various genetic anomalies and infertility. It is also widely believed that testicular microlithiasis is strongly associated with testicular tumor. The aim of this prospective study was to determine the true prevalence of testicular microlithiasis in an asymptomatic population by means of ultrasound screening. Material and methods. Healthy male volunteers (17-42 years old) were recruited from the annual Army Reserve Officer Training Corps training camp at Manisa, Turkey. A screening genitourinary history was obtained and a physical examination and screening scrotal ultrasound scan were performed. All men diagnosed with testicular microlithiasis underwent complete clinical evaluations, physical examinations and determination of tumor markers. Results. Fifty-three men with testicular microlithiasis were identified from the 2179 ultrasound scans, giving a prevalence of testicular microlithiasis of 2.4% in this asymptomatic population. The age (mean +/- SD) of subjects with testicular microlithiasis was 23.9 +/- 4.2 years (range 20-31 years). Conclusion. Our results suggest that there is no significant association between TM and testicular cancer, although it is difficult to rule out such an association without further studies with a longer follow-up period.Item Testicular Tumor and Testicular Microlithiasis: Doppler US ApproachSerter, S; Orguc, S; Tuncyurek, O; Gümü, B; Tarhan, S; Ayyildiz, V; Pabuscu, YItem The role of patellar tendon morphometry on anterior knee painTuncyurek, O; Ozkol, M; Ozic, U; Pabuscu, YTo investigate the morphometry of patellar tendon with magnetic resonance imaging (MRI) and to reveal the relation between patellar tendon properties and anterior knee pain (AnKP). Twenty-three patients with AnKP and nine healthy individuals were included in the study. Patients with knee anomaly that may cause AnKP were excluded from the study. The patellar tendon examination was performed on sagittal and coronal sections of MRI. Freehand technique was used to frame the area of tendon and calculations were done by generic software. There were 23 patients in AnKP (+) and 9 individuals in AnKP (-) group. The morphometric results were not different among groups (p = 0.2). Higher body mass index was correlated with increased patellar tendon surface area in women (R (2) = 0.37). Patellar tendon length, thickness and surface area do not seem as a significant parameter to explain the aetiology of AnKP. Given the well-defined role of patellar tendon to support knee kinetics, the clinical value of tendon morphometry is to be determined.Item VASCULAR CALCIFICATION AND GROWTH ARREST SPECIFIC PROTEIN 6 LEVELS IN CHRONIC RENAL DISEASEToraman, A; Cetintepe, L; Elbi, H; Taneli, F; Yildiz, R; Duzgun, F; Pabuscu, Y; Horasan, GD; Kürsat, SIntroduction: Cardiovascular disease is the main cause of mortality and morbidity in chronic renal failure. It's known that vascular calcification (VC) and carotid intima media thickness (CIMT) are strongly associated with cardiovascular diseases. Growth arrest specific protein 6 (Gas6) is a vitamin K-dependent protein and regulates various processes such as proliferation, cell survival, migration and inflammation. Gas6 is known to protect endothelial cells and vascular smooth muscle cells against apoptosis by inhibiting Bcl-2 induced Caspase 3 activation. The relationship between Gas6 and cardiovascular diseases has been demonstrated in many mouse models and cell cultures. However, there are conflicting reports whether Gas6 levels are increasing or decreasing in human studies of diabetic and/or chronic renal failure. In present study the aim was to examine plasma Gas6 levels and its relation with CIMT and coronary artery calcification score (CACS) in chronic kidney disease (CKD) patients. Methods: Total of 137 patients of which 32 chronic hemodialysis and 105 predialysis patients as well as 73 healthy controls were enrolled in the study. Human Gas6 levels in serum samples were studied by ELISA method. CIMT was measured by ultrasonography. CACS was measured by multislice computed tomography. Results: The mean age was 54.37 +/- 16.61 years in dialysis group, 55.20 +/- 14.80 years in predialysis group and 53.26 +/- 9.04 years in control group. Serum creatinine was 0.78 +/- 0.16 mg/dl in the control group and 1.96 +/- 1.64 mg/dl in the predialysis and 5.94 +/- 1.55 mg/dl in the dialysis group. 24 hours urine protein levels were significally higher in the dialysis group than the predialysis and the control group. CIMT values were similar in predialysis and dialysis groups. These values were significantly higher than control group. Although CACS was higher in dialysis group than predialysis and control group, the results were not statistically significant since the distribution range was very wide. Gas6 was 98.84 +/- 53.32 ng/mL in the control group and statistically higher than dialysis (63.85 +/- 38.92 ng/mL) and predialysis groups (54.96 +/- 38.49 ng/mL) (p=0.001). Gas6 levels were lower in diabetic patients than non-diabetics (53.69 +/- 35.26 ng/mL, 69.26 +/- 47.50 ng/mL, p=0.023, respectively). Negative correlation was detected between Gas6 and age, BMI, CACS, carotid IMT and proteinuria. In the logistic regression analysis, Gas6 remained significantly associated with BMI, CIMT and proteinuria. Conclusion: In our study, a negative correlation of Gas6 with BMI, CACS, CIMT and proteinuria and lower Gas6 levels in diabetic patients support that decreased Gas6 levels in chronic renal failure may have a role in vascular calcification through altered glucose tolerance, chronic inflammation, endothelial dysfunction and increased apoptosis. Our study has an importance because it is the first study showing a relation between Gas6 and proteinuria, CACS and carotid IMT in patients with chronic renal failure.Item Successful treatment of abdominal aorto-right atrial fistula by vascular plug: A previously unreported cardiac malformationAlkan, F; Pabuscu, Y; Çetin, M; Coskun, SItem A mass screening survey of cystic echinococcosis by ultrasonography, Western blotting, and ELISA among university students in Manisa, TurkeyKilimcioglu, AA; Girginkardesler, N; Korkmaz, M; Özkol, M; Düzgün, F; Östan, I; Pabuscu, Y; Dinç, G; Ok, ÜZCystic echinococcosis (CE) is one of the most important zoonotic diseases in a wide geographic area, including Turkey. In the present project, a total of 4275 students from Celal Bayar University, Manisa, Turkey, were screened by ultrasonography (US) and specific antibodies for CE were examined by Western blotting (WB) and ELISA in finger prick blood samples of 2034 of 4275 volunteered students. We aimed to report the apparent prevalence of CE based on different diagnostic procedures and to compare WB and ELISA with US in diagnosis of CE in a mass screening setting. Six new cases were diagnosed as CE by US during the survey. In addition to these cases, three students were also detected to have been previously operated and pathologically confirmed for hepatic CE. US revealed parenchymal changes in these cases in concordance with their operation history; so, the prevalence of CE by US was calculated as 0.21% (9/4275) (95%CI, 0.11-0.39%) among university students in Manisa. Bands were detected at 8, 28, 32, 38, 42, 47, 70 and 90 kDa by WB and the cases were considered to be positive for CE when at least three of the bands were seen together. Apparent prevalence of CE by ELISA and WB were found to be 2.11% (43/2034) (95%CI, 1.57-2.83%) and 0.25% (5/2034) (95%CI, 0.10-0.57%), respectively. Of the six US positive cases, WB was positive in only one case with two cysts in the liver. All of four cases with liver involvement were positive by ELISA. The high prevalence of CE among university students in Manisa indicated that CE is a major health problem in this area of Turkey. Our results supported that WB is rather difficult and not feasible as a mass screening test and may not be effective for confirmation especially in asymptomatic cases. As a result, we recommend US to be used initially in mass screening surveys for CE followed by confirmation by ELISA for suspected cases. Further examination primarily by chest X-ray followed by computed tomography and/or magnetic resonance imaging, if needed, should be recommended for US negative, ELISA and WB positive individuals who may have non-abdominal cysts. (C) 2013 Elsevier B.V. All rights reserved.Item Is Melatonin Protective in Contrast Material Related Renal Failure?Tuncyurek, O; Gunay, O; Taneli, F; Ayhan, S; Nese, N; Pabuscu, YAim: The aim of the study was to investigate the effect of melatonin on the renal injury resulting from radiocontrast media and myoglobinuria in male Wistar albino rats. Material and Method: 50% glycerol at equal amounts was intramuscularly administered to both hind legs of all animals under ether anesthesia at the dose of 10 mg/kg. Three hours later, the groups were administered the following: Group I (number: 7): Iopromide(Ultravist -300 (R)) at the dose of 2 ml/kg (intracardiac); Group II (number: 7): Iopromide(Ultravist -300 (R)) and intraperitoneally administered Melatonin at the dose of 10 mg/kg (Melatonin was dissolved in 7.5% absolute ethanol and further dilutions were made in saline.); and Group III (number: 7): 2 ml/kg of sterile physiologic saline (Control group). The levels of Uurea, Ccreatinine and Ccystatin C were studied on the blood samples collected. The renal samples were evaluated by 2two distinct pathologists who did not know the protocol. Results: There was no difference in the values of Creatinine and cystatin c between Groups 2 and 3 (p=0.9; 0.2). Discussion: In conclusion, we evaluated the possible prevention of contrast-induced oxidative stress in the kidney with using melatonin. However, additional clinical studies are needed to evaluate the role of preventive melatonin treatment in humans.Item Multislice computed tomographic measurements of optic nerve sheath diameter in brain injury patientsÖzsaraç, M; Düzgün, F; Gölcük, Y; Pabuscu, Y; Bilge, A; Irik, M; Yilmaz, HBACKGROUND: Currently, the measurement of optic nerve sheath diameter (ONSD) has been offered as a possible indicator of intracranial pressure (ICP). Increased ICP is observed during intracranial injury. The objective of this study was to evaluate the relationship between increased ONSD and positive intracranial findings from multislice computed tomography (CT) of the brain. METHODS: In total, CT scans of 161 patients were retrospectively reviewed. The image that showed the largest ONSD was magnified five times. RESULTS: The CT scan revealed intracranial lesions in 54 patients and no intracranial lesions in 107 patients. A significant relationship was observed between positive CT findings and increased ONSD: 5.60 +/- 0.75 mm vs. 5.35 +/- 0.75 mm (p=0.038). The area under the receiver operating characteristic curve was 0.600 (95% confidence interval, 0.508-0.692; p<0.039). A cut-off value of >= 5.0 mm had a sensitivity and specificity of 80% and 36%, respectively. CONCLUSION: This study demonstrated a significant yet poor relationship between intracranial injury and increased ONSD from the multislice CT scan. Severe structural changes in the brain and trauma that causes bleeding have only limited effects on the extension of the optic nerve.Item Pelvic floor function and anatomy after childbirthBaytur, YB; Serter, S; Tarhan, S; Uyar, Y; Inceboz, U; Pabuscu, YOBJECTIVE: To investigate pelvic floor musclefunction and anatomy after childbirth in continent women differing in obstetric history. STUDY DESIGN: Young, continent women, age range 20-40 years, were recruited into 3 groups: I elective prelabor cesarean delivery (n = 12); 2. vaginal delivery (n = 15); and 3. age-matched nulliparas as controls (n = 13). Pelvic floor muscle strength was measured by a perineometer and also assessed by vaginal palpation. Magnetic resonance imaging of the pelvic floor at rest and on maximal strain was performed. Statistical analysis was carried out using SPSS 10.0 (Chicago, Illinois) for Windows (Microsoft, Redmond, Washington); p < 0.05 was considered significant. RESULTS: Pelvic floor muscle strength was not different between the vaginal delivery and cesarean groups. The descent of the bladder and cervix on straining was greater in the subjects who delivered vaginally than in the cesarean delivery and nulliparous groups. There was a positive and significant correlation between the duration of labor and the area of the levator sling and also between birth weight and the descent of the cervix on straining. CONCLUSION: The results of this study show that delivery method does not affect pelvic muscle strength.Item Comparison of 3 physical therapy modalities for acute pain in lumbar disc herniation measured by clinical evaluation and magnetic resonance imagingUnlu, Z; Tascl, S; Tarhan, S; Pabuscu, Y; Islak, SObjective: This study measures and compares the outcome of traction, ultrasound, and low-power laser (LPL) therapies by using magnetic resonance imaging and clinical parameters in patients presenting with acute leg pain and low back pain caused by lumbar disc herniation (LDH). Methods: A total of 60 patients were enrolled in this study and randomly assigned into I of 3 groups equally according to the therapies applied, either with traction, ultrasound, or LPL. Treatment consisted of 15 sessions over a period of 3 weeks. Magnetic resonance imaging examinations were done before and immediately after the treatment. Physical examination of the lumbar spine, severity of pain, functional disability by Roland Disability Questionnaire, and Modified Oswestry Disability Questionnaire were assessed at baseline, immediately after, and at I and 3 months after treatment. Results: There were significant reductions in pain and disability scores between baseline and follow-up periods, but there was not a significant difference between the 3 treatment groups at any of the 4 interview times. There were significant reductions of size of the herniated mass on magnetic resonance imaging after treatment, but no differences between groups. Conclusions: This study showed that traction, ultrasound, and LPL therapies were all effective in the treatment of this group of patients with acute LDH. These results suggest that conservative measures such as traction, laser, and ultrasound treatments might have an important role in the treatment of acute LDH.Item Perfusion computed tomography could be a new tool for single-session imaging of ureteric obstructive pathology: an experimental study in ratsYilmaz, O; Ovali, GY; Genc, A; Tarhan, S; Ozcan, T; Tuncyurek, O; Pabuscu, Y; Taneli, CBackground/Purpose: Perfusion imaging redefines computed tomography (CT) as a technique that can now depict vascular physiology in addition to detailed anatomy. The major clinical applications of perfusion CT are in acute stroke and oncology. Currently, there are very limited data on the application of perfusion CT in urology. The aim of the present study is to investigate the potential value of perfusion CT in anatomic and functional evaluation of obstruction in a single session on experimental hydronephrosis model in rats. Thus, we evaluate the perfusion CT in a new clinical application. Methods: Twenty-eight rats were randomly allocated into 4 groups each consisting of 7 rats. At the third week of experimental intervention, postoperative renogram curves and perfusion parameters of the right kidneys' cortex and pelvis were assessed by CT. The right ureter was Sutured as proximal complete obstruction in group 1, as distal complete obstruction in group 2, and as proximal partial obstruction in group 3. Group 4 served as the sham control group. Computed tomography was performed with single-slice tomography. Dynamic examination was performed with the help of perfusion software through contrast-enhanced tomography examination. Results: In all study groups, the aorta time/density curves showed a rapid increase after a rapid decrease, and the duration to reach peak concentration in the normal kidney cortex was observed to be later than the aorta as expected. In groups 1, 2, and 3, the duration to reach peak concentration lengthened and the peak concentration values decreased. The time/density curves gradually increased as a result of the accumulation of the contrast agent in the pelvis, and a peak was observed at the end of the procedure in all study groups. In groups 1, 2, and 3, a statistically significant decrease (P = .01, P = .01, and P = .01, respectively) was observed in the peak concentration values of the contrast agent in comparison to group 4. The flow and blood volume values gradually decreased as the grade of the obstruction increased and the localization of the obstruction or grade of obstruction moved closer to the kidney. Conclusion: In Conclusion, perfusion CT technique, performed in a single session, is a useful method for anatomic visualization, together with functional evaluation, in the diagnosis of ureteric obstructive pathology of experimental hydronephrosis model. (C) 2009 Elsevier Inc. All rights reserved.Item Perfusion CT evaluation in experimentally induced testicular torsionOvali, GY; Yilmaz, O; Tarhan, S; Genc, A; Demireli, P; Tunçyurek, O; Unden, C; Taneli, C; Pabuscu, YIntroduction: in this Study, we define the characteristics of perfusion computed tomography (CT) in an experimental model of testicular torsion. Methods: Twenty male Sprague-Dawley rats were included for the study. Torsion was applied to 10 rats and perfusion CT was performed in the first hour to evaluate the following perfusion parameters: blood flow (BF), blood volume (BV) and time to peak (TTP) values. Detorsion was done for the same rats, and perfusion CT was repeated 2 hours later to evaluate reperfusion. Ten rats were left as part of the control group. Results: There is significant statistical correlation between the BF and BV values in the torsion and control groups (p = 0.001 and p = 0.001, respectively). There is no statistical correlation of the TTP parameters between the groups. No correlation was found between torsion and detorsion perfusion parameters. Conclusion: Perfusion CT can demonstrate the testicular perfusion insult in an experimental model of torsion. Perfusion CT may be an alternative method for diagnosis of torsion in indeterminate cases. Following detorsion an interval of 2 hours is not sufficient for demonstrating luxury perfusion of the testis.Item Sonographic-Guided Injection of Corticosteroid in the Treatment of Lateral EpicondylitisUnlu, Z; Tarhan, S; Ovali, GY; Pabuscu, YObjective: In this study the advantage of ultrasonography [US] in diagnosis and therapy of lateral epicondylitis [LE] was investigated in patients with lateral elbow pain and clinically diagnosed as LE. Methods: Fifty-two patients with LE were examined using sonography. For the patients in whom normal US examination was found, a blind injection of methylprednisolone 20 mg and 0.5 ml one percent lignocaine was performed [Group 1]. The patients whose clinical diagnosis was confirmed with US received a sonographic-guided injection of methylprednisolone 20 mg and 0.5 ml one percent lignocaine [Group 2]. Outcome measurements were performed at baseline, two weeks, one month, and three months. Pain and functional status were assessed using a visual analog scale, physical functioning and bodily pain scales of the Medical Outcomes Study 36 Item Short-Form Health Survey, a patient-rated forearm evaluation questionnaire, and a patient-specific functional scale. Painless grip strength bilaterally was also measured. Results: Twenty-four [46.2 percent] patients had a normal-appearing common extensor origin on US. The group in which diagnosis of LE was confirmed on US and sonographic-guided corticosteroid injections improved significantly from the baseline to the third month follow up [P 0.000] in both clinical assessment and physical examination findings. Conclusions: Our case series suggested that sonography of the common extensor origin can be used to confirm LE in patients with lateral elbow pain. Although sonographic-guided injections produced more clinical improvement, further studies are needed to determine effectiveness of sonographic-guided injections.Item Transient left paraduodenal herniaOvali, GY; Orguc, S; Unlu, M; Pabuscu, YA 52-year-old woman with acute deterioration of recurrent abdominal pain was admitted to the hospital. Spiral computed tomography (CT) of abdomen was performed. A left paraduodenal hernia was identified on CT. There was no clinical sign or imaging finding suggesting intestinal obstruction or mesenteric ischemia. She refused surgical intervention since her pain was intermittant and decreasing. On the fifth day of hospitalization the patient's pain resolved completely and the follow-up CT demonstrated regression of the herniation. (c) 2005 Elsevier Ltd. All rights reserved.Item Anatomic and hemodynamic evaluation of renal venous flow in varicocele formation using color Doppler sonography with emphasis on renal vein entrapment syndromeUnlu, M; Orguc, S; Serter, S; Pekindil, G; Pabuscu, YObjective. To investigate the anatomic and hemodynamic properties of testicular venous drainage and its effects on varicocele formation and reflux using color Doppler ultrasound (US) with emphasis on renal vein entrapment syndrome. Material and methods. Upper abdominal and scrotal US examinations of 35 varicocele patients and 35 healthy male subjects were performed in the supine position during rest, during a Valsalva maneuver and in the erect position. The aortomesenteric angle and distance (AMA and AMD, respectively), peak mean velocities (PVs) and diameters of different segments of renal veins, testicular vein diameters and duration of flow inversion were measured. Results. In the varicocele group, the lateral segment of the left renal vein (LRV) had a larger diameter and slower PV, and the medial segment of the LRV had a smaller diameter and faster PV. The diameter of the dominant draining vein correlated with the PV of the medial and lateral segments of the LRV, whereas there was no correlation between the diameter of the dominant draining vein and the diameters of the right renal vein (RRV) and the lateral segment of the LRV or the PV of the RRV. The duration of flow inversion correlated with the diameter and PV of the medial segment of the LRV. No correlation between the diameters and PVs of the RRV and the lateral segment of the LRV was detected. Conclusions. The decreases in the AMA, AMD, diameter of the medial segment of the LRV and PV of the lateral segment of the LRV, and the increases in the PV of the medial segment of the LRV and the diameter of the lateral segment of the LRV in varicocele patients in all positions suggest the entrapment or impingement of the left renal vein between the aorta and the superior mesenteric artery. This has been defined as the nutcracker phenomenon, which is known to affect varicocele formation.Item Radiation safety in invasive pain medicineYentür, EA; Bayindir, P; Pabuscu, YInvasive procedures have been an inseparable part of contemporary pain medicine. As a result, flouroscope has been an indispensable equipment in our daily practice but this development brings some questions into mind like how much knowledge do we have about the operation of flouroscope, ionizing radiation and radiation safety? We aimed to give basic information about radiation physics, ionizing radiation. Besides, important points about radiation safety will be specially emphasized.