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Battal B.,Sarikamis Military Hospital | Kocaoglu M.,Gulhane Military Medical School | Atay A.A.,Gulhane Military Medical School | Bulakbasi N.,Gulhane Military Medical School
Upsala Journal of Medical Sciences | Year: 2010

Peliosis is a rare benign disorder that is characterized by the presence of diffuse blood-filled cystic spaces and can occufr in the liver, spleen, bone-marrow, and lungs. We present a 10-year-old boy with Fanconi anemia who presented with peliosis hepatis due to androgen treatment. Magnetic resonance (MR) imaging revealed multiple non-enhancing masses. Some of the lesions revealed fluid-fluid levels and extrahepatic extension on MR images. Diffusion-weighted (DW) imaging showed restricted diffusion. Fluid-fluid levels and extrahepatic extensions are unusual findings for hepatic peliotic lesions. In addition, DW imaging findings of peliosis hepatis have not been reported previously. © 2010 Nordic Orthopedic Federation.


Yetkin S.,Diyarbakir Military Hospital | Aydin H.,Sleep Diary Sleep Research Center | Ozgen F.,Gulhane Military Medical School
Psychiatry and Clinical Neurosciences | Year: 2010

Aims: The purpose of the present study was to investigate sleep structure in post-traumatic stress disorder (PTSD) patients with and without any psychiatric comorbidities. The relationship between sleep variables and measurements of clinical symptom severity were also investigated. Methods: Sleep patterns of 24 non-medicated male PTSD patients and 16 age- and sex-matched normal controls were investigated on polysomnography on two consecutive nights. Six PTSD-only patients and 15 PTSD patients with major depressive disorder (MDD) were also compared to normal controls. Sleep variables were correlated with PTSD symptoms. Results: Compared to the normal controls, the PTSD patients with MDD had difficulty initiating sleep, poor sleep efficiency, decreased total sleep time, decreased slow wave sleep (SWS), and a reduced rapid eye movement (REM) sleep latency. The PTSD patients without any comorbid psychiatric disorders had moderately significant disturbances of sleep continuity, and decreased SWS, but no abnormalities of REM sleep. REM sleep latency was inversely proportional to the severity of startle response. SWS was found to be inversely correlated with the severity of psychogenic amnesia. Conclusions: PTSD patients have disturbance of sleep continuity, and SWS deficit, without the impact of comorbid depression on sleep. The relationship between SWS and the inability to recall an important aspect of trauma may indicate the role of sleep in the consolidation of traumatic memories. The relationship between the severity of the startle response and REM latency may suggest that REM sleep physiology shares common substrates with the symptoms of PTSD. © 2010 Japanese Society of Psychiatry and Neurology.


Battal B.,Gulhane Military Medical School | Kocaoglu M.,Gulhane Military Medical School | Bulakbasi N.,Gulhane Military Medical School | Husmen G.,Edremit Military Hospital | And 2 more authors.
British Journal of Radiology | Year: 2011

Cerebrospinal fluid (CSF) spaces include ventricles and cerebral and spinal subarachnoid spaces. CSF motion is a combined effect of CSF production rate and superimposed cardiac pulsations. Knowledge of CSF dynamics has benefited considerably from the development of phase-contrast (PC) MRI. There are several disorders such as communicating and non-communicating hydrocephalus, Chiari malformation, syringomyelic cyst and arachnoid cyst that can change the CSF dynamics. The aims of this pictorial review are to outline the PC MRI technique, CSF physiology and cerebrospinal space anatomy, to describe a group of congenital and acquired disorders that can alter the CSF dynamics, and to assess the use of PC MRI in the assessment of various central nervous system abnormalities. © 2011 The British Institute of Radiology.


Birkent H.,Gulhane Military Medical School | Sardesai M.,University of Washington | Hu A.,University of Washington | Merati A.L.,University of Washington
Laryngoscope | Year: 2013

Objectives/Hypothesis In-office percutaneous injection laryngoplasty is a common treatment for glottal insufficiency. Our objective was to prospectively study voice outcomes and patient tolerance of the procedure. Study Design Prospective case series. Methods Consecutive adult patients undergoing awake injection laryngoplasty were recruited. Voice Handicap Index (VHI)-30; Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V); and vocal Grade, Roughness, Breathiness, Asthenia and Strain (GRBAS) were evaluated prior to injection and 2 months postinjection. Visual analog scale (VAS) was completed by the patient before and after the procedure to quantify the amount of discomfort. Results Thirty-five subjects enrolled; 26 (15 male, 11 female; mean age 61.6±13.2 years) had complete data. All components of VHI improved significantly: functional (P=0.0006), emotional (P=0.0004), physical (P=0.009), and total (P=0.0006). CAPE-V also improved significantly (P=0.003). All components of GRBAS, except for roughness, improved significantly: grade (P=0.004), roughness (P=0.718), breathiness (P=0.023), asthenia (P=0.023), and strain (P=0.03). Patient expectations on the tolerance of the procedure was similar to what they reported immediately afterward (P=0.803). Conclusions Injection laryngoplasty is an effective method of treating glottal insufficiency, as measured by voice outcomes. Patients have realistic expectations on the procedure experience and find it tolerable. This is the first prospective study of injection laryngoplasty outcomes. Level of Evidence 4. Laryngoscope, 2013 Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.


Battal B.,Gulhane Military Medical School | Akgun V.,Golcuk Military Hospital | Kocaoglu M.,Gulhane Military Medical School
Diagnostic and Interventional Radiology | Year: 2012

Diffusion-weighted imaging has recently been incorporated into extra-neurological pediatric imaging protocols because of its various clinical advantages. Because diffusion-weighted imaging does not require intravenous contrast media, it can be safely used in patients with reduced renal function. Furthermore, diffusion-weighted imaging can be performed within several minutes by using the echo planar imaging technique. Its clinical advantages include improved tissue characterization, as well as the ability to assess organ functionality, monitor the treatment response after chemotherapy or radiation therapy and predict patient outcomes. The aims of this pictorial essay were to explain the physical principles underlying diffusion-weighted imaging, to outline the interpretation of diffusion-weighted images and apparent diffusion coefficient maps, and to list the extra-neurological applications of diffusion- weighted imaging in children. © Turkish Society of Radiology 2012.


Tosun F.,Gulhane Military Medical School | Arslan H.H.,Gulhane Military Medical School | Karslioglu Y.,Gulhane Military Medical School | Deveci M.S.,Gulhane Military Medical School | Durmaz A.,Gulhane Military Medical School
Annals of Otology, Rhinology and Laryngology | Year: 2010

Objectives: Nasal polyps develop as a result of chronic inflammation, mostly accompanied by pronounced eosinophil leukocyte infiltration. In this study we aimed to investigate the relationship between eosinophil density in nasal polyps and the postoperative recurrence rate of this disease. Methods: Forty-two patients who underwent endoscopic sinus surgery for massive nasal polyposis by one surgeon were included in the study. The eosinophil leukocyte densities in nasal polyps were determined retrospectively on histologic slides by use of computer-assisted image analysis software. The patients were assigned to group 1, in whom nasal polyps contained up to 3 eosinophils per 1,000 μm2, and group 2, in whom nasal polyps contained 4 or more eosinophils per 1,000 μm2. The postoperative recurrence rates of nasal polyps were compared in the two groups. Results: There were 20 patients in group 1 and 22 patients in group 2. Postoperative polyp recurrence was detected in 5 of 20 patients (25.0%) in group 1 and in 18 of 22 patients (81.8%) in group 2 during the 30-month postoperative followup period (p < 0.05). Conclusions: The eosinophil density of nasal polyps can be used to get an estimate of the postoperative recurrence risk. Eosinophil-rich nasal polyps have a higher postoperative recurrence rate. © 2010 Annals Publishing Company. All rights reserved.


Battal B.,Gulhane Military Medical School | Hamcan S.,Gulhane Military Medical School | Akgun V.,Gulhane Military Medical School | Sari S.,Gulhane Military Medical School | And 3 more authors.
European Radiology | Year: 2015

Objectives: To determine frequency, imaging features and clinical significance of herniations of brain parenchyma into dural venous sinuses (DVS) and/or calvarium found on MRI. Methods: A total of 6160 brain MRI examinations containing at least one high-resolution T1- or T2-weighted sequence were retrospectively evaluated to determine the presence of incidental brain herniations into the DVS or calvarium. MRI sequences available for review were evaluated according to their capability to demonstrate these herniations. Patients’ symptoms and clinical findings were recorded. Results: Twenty-one (0.32 %) brain parenchyma herniations into the DVS (n = 18) or calvarium (n = 3) in 20 patients were detected. The most common locations of the herniations were the transverse sinuses (n = 13) and those involving inferior gyrus of the temporal lobe (n = 9). High-resolution T1- and T2-weighted sequences were equally useful in the detection of these brain herniations. According to clinical symptoms, brain herniations were considered to be incidental but headaches were present in nine patients. Conclusion: Brain herniations with surrounding cerebrospinal fluid (CSF) into the DVS and/or calvarium are incidental findings and not proven to be associated with any symptoms. Although rare, these herniations are more common than previously recognized and should not be confused with arachnoid granulations, clots or tumours. Key points: • Brain herniations into the DVS are more common than previously assumed.• The most frequent locations are the transverse sinus.• These herniations are incidental findings.• The relationship between brain herniation into DVS and headache is uncertain.• High-resolution MR sequences are most useful in detection of brain herniations. © 2015 European Society of Radiology


Akay S.,Gulhane Military Medical School | Kocaoglu M.,Gulhane Military Medical School | Emer O.,Gulhane Military Medical School | Battal B.,Gulhane Military Medical School | Arslan N.,Gulhane Military Medical School
Journal of Medical Imaging and Radiation Oncology | Year: 2013

Introduction To discuss the accuracy of the whole-body diffusion-weighted imaging with background body signal suppression (WB-DWIBS) technique performed in the 3.0-T system. Methods We studied 17 patients who underwent positron emission tomography (PET)/CT and WB-DWIBS examinations for staging their diseases. The DWIBS pulse and echo-planar imaging-short T1 inversion recovery single-shot pulse sequences were performed for WB-DWIBS. A PET/CT scan was performed with 18-fluorodeoxyglucose. The lesions were localised and counted in both of the examinations, and WB-DWIBS was evaluated for the neoplastic tissue detection rate, while PET/CT was accepted as the reference standard modality. Results The WB-DWIBS scan had a room occupation time of 32-35 min. All of the metastasis positive patients (n = 12) detected with PET/CT were also detected with WB-DWIBS (100%). In our patient group, there were a total of 109 bone metastases on PET/CT scans, and 93 of them (85.3%) were demonstrated with WB-DWIBS. We detected 128 metastatic lymph nodes on PET/CT, and 123 of them (96.3%) were demonstrated with WB-DWIBS. There were a total of 17 liver metastases on PET/CT, and 15 of them (88.2%) were detected with WB-DWIBS. There was no statistically significant difference between the two imaging modalities in detecting bone, lymph node and liver metastases (P > 0.05). Conclusions WB-DWIBS is a non-invasive technique that may successfully detect the spreading of the tumoural tissue in cancer patients when compared with PET/CT. © 2013 The Authors. Journal of Medical Imaging and Radiation Oncology © 2013 The Royal Australian and New Zealand College of Radiologists.


Battal B.,Gulhane Military Medical School | Akgun V.,Golcuk Military Hospital | Karaman B.,Gulhane Military Medical School | Bozlar U.,Gulhane Military Medical School | Tasar M.,Gulhane Military Medical School
Journal of Computer Assisted Tomography | Year: 2011

OBJECTIVE: To determine the normal anatomical features and variations of the bronchial arterial system and to determine the relationship among ectopic bronchial arteries, location (right-left) of the bronchial arteries, and variations of the aortic arch in patients as well as the sex of the patients who underwent multidetector computed tomographic angiography of the thorax for various reasons. METHODS: A total of 163 patients who underwent multidetector computed tomographic angiography of the thoracic vascular structures for various reasons were analyzed retrospectively. The right and left bronchial arteries were analyzed individually, and normal anatomic features and variations were recorded. The χ and Mann-Whitney U tests were used to evaluate relationships among the patients' sex, side and number of the bronchial arteries, aortic arch variations, and bronchial artery variations. RESULTS: There were 432 bronchial arteries (right, 229; left, 203) in 163 patients (117 men, 46 women; mean age, 51.7 years). All of the patients have at least one bronchial artery (mean, 2.65; maximum, 5). The number and diameters of the bronchial arteries were statistically higher on the right side. The number of the bronchial arteries was significantly higher in the men (P < 0.05). Ectopic bronchial arteries were present in 43 (26.4%) of the 163 patients. Aortic arch variations were present in 27 (22.5%) of 120 patients with normal bronchial arteries and in 11 (25.6%) of the 43 patients with ectopic bronchial arteries. There was no statistically significant correlation between aortic arch variations and ectopic bronchial arteries (P = 0.861). CONCLUSIONS: The anatomic features of the bronchial arteries show differences between individuals and the sexes. Multidetector computed tomographic angiography allows a precise and detailed evaluation of bronchial arterial system. © 2011 Lippincott Williams & Wilkins, Inc.


Karakoc O.,Gulhane Military Medical School | Akcam T.,Gulhane Military Medical School | Birkent H.,Gulhane Military Medical School | Arslan H.H.,Gulhane Military Medical School | Gerek M.,Gulhane Military Medical School
Journal of Craniofacial Surgery | Year: 2013

Objective: The aim of this study was to obtain normative nasalance scores for adult and children subjects speaking Turkish language and obtain a reference for normality when nasality is evaluated. Methods: Mean nasalance scores were obtained from 35 normal-speaking children aged 7 to 13 years, and 125 adults aged 18 to 69 years during the repetition of 3 nasalance passages that were categorized according to the amount of nasal consonants (oral, oronasal, and nasal passages). The Nasometer (model 6400) was used to obtain nasalance scores for the 3 reading passages. Results: Group mean ± SD nasalance scores of children for oral passage, oronasal passage, and nasal passage were 15.14 ± 4.81, 37.76 ± 4.42, and 49.23 ± 6.95, respectively. Nasalance scores for the adult group were 13.46 ± 6.26, 37.84 ± 6.13, and 50.28 ± 7.77, respectively. There were significant differences in mean nasalance scores for oral versus nasal materials both for children and adult groups. Conclusions: The present study provides normative nasalance scores for Turkish-speaking children and adults. The results indicated acceptable differentiation between oral and nasal materials. Copyright © 2013 by Mutaz B. Habal, MD.

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