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Öğe Chest CT imaging features of progressive phase covid-19 pneumonia and evolution of findings(Carbone Editore, 2021) Erok, Berrin; Atça, Ali Önder; Kıbıcı, KenanIntroduction: In the natural course of COVID-19 (coronavirus disease 2019) pneumonia, four stages have been described with aggrevation and extention of the lesions in the progressive stage and a more slower increase toward the maximum involvements in the peak stage before the absorption phase. A distinct pattern and time course of evolution is observed depending on the severity of the disease. Materials and methods: We aimed to present chest CT findings of advanced stage Covid-19 pneumonia observed in our patients with rRT-PCR test-confirmed COVID-19, from the March 15 to August 15 2020. Results: As the disease progress more central involvement of the lung with increased GGOs (with or withot reticulation) and consolidations occur and may be accompanied by development of organizing changes appearing usually as irregular, frequently linear consolidative opacities with possible bronchial changes. In addition, rarely encountered extraparenchymal findings and some atypical CT features unexpected to be identified in new coronavirus disease can be observed. In the survival patients this progressive period is followed by the absorption phase, which may or may not be accompanied by irreversible pulmonary changes like fibrosis or cystic formations. Conclusion: We believe that being familier with chest CT manifestations of advanced stage Covid-19 pneumonia and the changes throughout the disease process will be helpful in the management of Covid-19 pneumonia. Moreover, Covid-19 pneumonia can still be the concern in the presence of atypical findings either due to a coinfection/superinfection or as rarely occuring features with currently unknown mechanisms.Öğe Could the COVID-19 infection have a better prognosis than expected in pediatric hematology oncology and bone marrow transplant patients?(Scientific Letter, 2021) Öner, Özlem Başoğlu; Aksoy, Barış Adaklı; Sütçü, Murat; Çipe, Funda; Atça, Ali Önder; Bozkurt, Ceyhun; Fışgın, TunçCoronavirus disease 2019 (COVID-19) is a pandemic that spread rapidly worldwide (1). So far, very few reports concerning the impact of COVID-19 among patients with pediatric hematologic-oncologic diseases are available (2). We aimed to describe the clinical features, prevalence, treatments, and outcomes in the COVID-19 patient population.Öğe Decompression and neurolysis of the lateral femoral cutaneous nerve in the surgical treatment of meralgia paresthetica and the results(Georg Thieme Verlag Kg, 2021) Kıbıcı, Kenan; Erok, Berrin; Atça, Ali ÖnderMeralgia paresthetica (MP), also known as Bernhardt-Roth syndrome, is a peripheral neuropathy of the primary sensory lateral femoral cutaneous nerve (LFCN). Its diagnosis is challenging, because it can mimic other clinical conditions particularly associated with upper lumbar spine or pelvis. Patients present with pain and paresthesia over the anterolateral thigh. Diagnosis is usually based on clinical examination and is supported by sensory nerve conduction (SNC) studies. The initial treatment is always conservative. In limited number of patients who are refractory to conservative managements, surgical treatment via decompression/neurolysis or neurectomy is concerned. There is still no consensus on which surgical technique is the best and the first choice. We retrospectively analyzed the surgical outcomes of 12 nonobese patients who underwent decompression/neurolysis between the years 2013 and 2018. Bilateral SNC studies were performed in all cases which supported the diagnosis. We applied conservative treatments for 3 months in addition to the treatments previously applied in other centers. Surgery was recommended for the patients who were refractory to these treatments. Preoperative and postoperative pain levels during follow-up visits were evaluated with visual analogue scale (VAS). A retrospective analysis was performed on preoperative and postoperative 6th month VAS scores. The mean preoperative VAS value was 8.75 +/- 0.62 and the postoperative VAS value at the sixth month was 1.17 +/- 0.72. A significant reduction in the pain was shown (p < 0.05). Our surgical results showed that decompression/neurolysis of the LFCN should be concerned as the primary surgical approach to avoid negative outcomes of resection surgeries.Öğe Exploring the validity of ACDF with peek cages in sports activity patients with cervical spondylosis(2023) Erok, Berrin; Kıbıcı, Kenan; Atça, Ali ÖnderBackground The research aims to determine the outcomes of single or multilevel ACDF with polietereterketon (PEEK) cages in 152 patients (237 cages) with a focus on the cage instability in terms of migration and subsidence that may occur in the early postoperative period. Method 176 consecutive patients who had undergone single-or multilevel anterior cervical discectomy with PEEK cage for cervical syndolysis (CDDH) from January 2015 to January 2021 were retrospective evaluated.152 patients (237 PEEK cages) who were found to be suitable for the study criteria were included. Results Cage migration was observed in 15 cages in 12 patients without relevant clinical complaints. There was no case of superior migration of the cage into the superior end plate and no posterior or sideways migration. Subsidence was not detected in any cage, and functional radiological examination was present in all cases with maintained intervened disc distance height during the follow-ups. Discussion and conclusion: PEEK cages without anterior plate instrumentation and using postoperative neck collars in single -level and multilevel ACDF provide reliable and valid clinical and radiological results.Öğe Mammography, ultrasonography and sonoelastography findings of granular cell tumor in accessory axillary breast(Aves, 2017) Yılmaz, Ebru; Yılmaz, Ayhan; Pehlivan, Esmehan; Erok, Berrin; Doğan, Sebahat Nacar; Yıldız, Hülya Kurt; Atça, Ali ÖnderThe main objective of breast imaging is to detect and differentiate benign lesions from malignant ones with higher accuracy rates. Recent studies have reported that sonoelastography (SE) is helpful for distinguishing benign and malignant solid breast masses and shows higher specificity than B-mode ultrasound (US) alone. Granular cell tumors are rare stromal tumors. While mammographically, they appear to be indistinctly marginated asymmetric density, sonographically the lesion generally shows acoustic shadowing and an irregular shape. In our case, in addition to mammography and US findings, we evaluated SE findings as well. The elasticity value and elasticity ratio showed similarity with malignant masses; therefore, we conclude that SE has no additional contribution to diagnosis of these lesions.Öğe Neuroimaging fndings of posterior reversible encephalopathy syndrome (PRES) following haematopoietic stem cell transplantation in paediatric recipients(BMC, 2021) Atça, Ali Önder; Erok, Berrin; Aydoğdu, SelimeBackground: Haematopoietic stem cell transplantation (HSCT) is used worldwide in various malignant and nonmalignant childhood diseases, including haematologic, genetic, autoimmune and metabolic disorders, and is the only curative treatment for many of these illnesses. The survival rates of many childhood diseases have been increased due to HSCT treatment. However, associated complications are still important for management. Central nervous system (CNS) complications in paediatric HSCT recipients can be associated with high morbidity and signifcantly contribute to mortality. Posterior reversible encephalopathy syndrome (PRES) is one of the most common CNS complications in patients with neurological symptoms following HSCT. Magnetic resonance imaging (MRI) is the modality of choice and shows typical bilateral vasogenic oedema at the posterior parts of the cerebral hemispheres; however, various atypical imaging manifestations can also occur. In this study, we retrospectively examined CNS complications in our paediatric HSCT recipients with a focus on the typical and atypical neuroimaging manifestations of PRES following HSCT. Methods: We retrospectively reviewed the medical records of 300 consecutive paediatric HSCT recipients from January 2014 to November 2018. A total of 130 paediatric HSCT recipients who experienced neurological signs and symptoms and were evaluated with neuroimaging studies following HSCT were enrolled in the study. The timing of CNS complications was defned according to immune status, including the pre-engraftment period (<30days after HSCT), the early postengraftment period (30–100days after HSCT), and the late postengraftment period (>100days after HSCT), which were defned as phases 1, 2 and 3, respectively. Results: Overall, 130 paediatric HSCT recipients experienced neurological signs and symptoms and therefore underwent neuroimaging examinations. Among these 130 patients, CNS complications were present in 23 patients (17.6%, 23/130), including 13 (56.5%) females and 10 (43.5%) males with a median age of 8.0 years (range, 8months to 18.0 years). Among these 23 patients, 14 cases of PRES (60.9%), 5 (21.7%) cases of leukoencephalopathy, 3 cases of acute subdural haemorrhage (ASDH) (13%) and 1 (4.3%) case of fungal CNS infection were identifed by neuroimaging. On MRI, typical parietooccipital vasogenic oedema was present in 78.5% of the PRES cases (11/14). The following atypical neuroimaging manifestations were observed: isolated involvement of the bilateral frontal lobes in 1 case, isolated cerebellar vermis involvement in 1 case, and isolated basal ganglia involvement in 1 case. Restricted difusion associated with cytotoxic damage was demonstrated in 2 of 14 cases, one of which also showed subacute cytotoxic injury with ADC pseudonormalization. Conclusion: Paediatric HSCT recipients presenting with CNS signs and symptoms should be evaluated by neuroimaging studies for timely diagnosis and early management. PRES is the most common CNS complication and may present with atypical MRI manifestations, which should not dissuade a PRES diagnosis in appropriate clinical settings.Öğe Pulmonary cavitation in COVID-19 pneumonia; is it primary or secondary?(Fsg Communications Ltd, 2020) Erok, Berrin; Kıbıcı, Kenan; Atça, Ali ÖnderA wide variety of chest computed tomography (CT) findings have been reported in patients with Covid-19 pneumonia. Pulmonary cavitation, although reported in a few cases of Covid19 pneumonia in the literature, is an uncommon finding to be identified in viral pneumonia and is considered among atypical CT features of Covid-19. In an attempt to adress to this issue, We want to emphasize the possibility of secondary infections in Covid-19, presenting with pulmonary cavitations as in our patient demonstrating a large sized pulmonary cavity when he was in intensive care unit (ICU).With consideration of a superinfection, bronchoscopy was performed and revealed growth of Acinetobacter in bronchoalveolar lavage (BAL) culture. As a result, secondary infections are common particularly in severely ill Covid-19 patients with much greater frequency in ICU. In cases of cavitary lesions superinfection should always be considered and accurate targetted treatment according to susceptibility testing should be started immediatelly, for better clinical outcomes.Öğe Radiation-induced brachial plexopathy in breast cancer and the role of surgical treatment(Georg Thieme Verlag Kg, 2020) Kıbıcı, Kenan; Erok, Berrin; Atça, Ali ÖnderObjective We aimed to evaluate improvement in the pain, motor, and sensory functions after neurosurgical intervention, by objective methods in patients with radiation-induced brachial plexopathy (RIBP), as a complication of radiotherapy (RT). Materials and Methods In our study, 11 patients, who experienced grade 3 or 4 brachial plexopathy according to the LENT-SOMA (late effects of normal tissue-subjective, objective, management, analytic) side-effect index, as a complication of RT which was performed after being operated for breast cancer, were included. In the postoperative period pain, sensation, and motor function loss were followed. Results There was apparent regression in the pain. The mean visual analogue scale (VAS) value decreased to 4 from the preoperative VAS value of 9.4. However, no significant improvement was observed in either sensory and motor functions. Conclusion RIBP is a progressive disease in breast cancer patients after radiotherapy. Evaluation of the results of applied surgical treatments and changes in the results with time is important to direct the treatment. Neurolysis should only be considered when other treatment methods fail and should be considered as an irreversible and potentially permanent procedure.Öğe Radiologic findings of primary localized amyloidosis of urinary bladder(2018) Atça, Ali Önder; Yılmaz, Ebru; Sönmez, Devrim; Erok, Berrin; Yılmaz, AyhanPrimary localized amyloidosis of the urinary bladder is a very rare disease with only 200 cases reported in the literature. However, it is an important condition because it can be easily confused with malignancy. It is most frequently observed during the fifth and sixth decade of life without sex preponderance. The classical presenting symptoms include painless gross hematuria and irritative lower urinary tract symptoms. The treatment of choice is transurethral resection, and histopathological evaluation is essential for the diagnosis and exclusion of malignancy. A close follow-up of the patient is required because of frequent recurrences. We present a case of primary localized amyloidosis of the urinary bladder with radiologic findings of a patient presenting with painless gross hematuria and mild dysuria.Öğe Retrograde cerebral venous air embolism and the anatomical pathway of air bubbles: A case report(2020) Erok, Berrin; Kıbıcı, Kenan; Atça, Ali ÖnderPneumocephalus due to cerebral venous air embolism is an uncommon phenomenon. It results from retrograde progression of low weight air bubbles into dural venous sinuses during manipulation of a venous catheter, more frequently a central venous catheter through the subclavian and the jugular veins. However, it may also occur in relation with a peripheral intravenous catheter as in our case. We report a 91 year old female patient with congestive heart failure who had been examined in our emergency department two days previously due to dyspnea and received diuretic treatment through a peripheral intravenous line. She presented with vomiting and headache without obvious neurological deficits. Non-contrast cranial CT scan revealed wide spread punctate air bubbles inside and outside the cranial vault (pneumocephalus), within the venous system. The pneumocephalus was considered as iatrogenic due to the previous peripheral venous catheterization that resulted in retrograde migration of air bubbles through various venous connections into dural venous sinuses and extracranial veins. Since cerebral venous air embolism is a potentially serious complication of various medical procedures, it should be considered in differential diagnosis of nontraumatic headache and vomiting especially when there is a recent manipulation of venous lines. Cranial CT scan is helpful for early diagnosis.
