Publications by authors named "Ahmet Aslan"

99 Publications

Artificial intelligence system for automatic deciduous tooth detection and numbering in panoramic radiographs.

Dentomaxillofac Radiol 2021 Mar 4:20200172. Epub 2021 Mar 4.

Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Ataturk University, Erzurum, Turkey, Turkey.

Objective: This study evaluated the use of a deep-learning approach for automated detection and numbering of deciduous teeth in children as depicted on panoramic radiographs.

Methods And Materials: An artificial intelligence (AI) algorithm (CranioCatch, Eskisehir-Turkey) using Faster R-CNN Inception v2 (COCO) models were developed to automatically detect and number deciduous teeth as seen on pediatric panoramic radiographs. The algorithm was trained and tested on a total of 421 panoramic images. System performance was assessed using a confusion matrix.

Results: The AI system was successful in detecting and numbering the deciduous teeth of children as depicted on panoramic radiographs. The sensitivity and precision rates were high. The estimated sensitivity, precision, and F1 score were 0.9804, 0.9571, and 0.9686, respectively.

Conclusion: Deep-learning-based AI models are a promising tool for the automated charting of panoramic dental radiographs from children. In addition to serving as a time-saving measure and an aid to clinicians, AI plays a valuable role in forensic identification.
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http://dx.doi.org/10.1259/dmfr.20200172DOI Listing
March 2021

Investigation into the effects of static and electric fields on bone healing process: An experimental tibial fracture model study in Wistar-Albino male rats.

North Clin Istanb 2021 23;8(1):8-14. Epub 2020 Nov 23.

Department of Orthopaedics and Traumatology, Suleyman Demirel University Faculty of Medicine, Isparta, Turkey.

Objective: In this experimental study, we aimed to investigate whether 0 Hz-Static and 50 Hz-Electric fields have an effect on bone healing.

Methods: In this study, 45 male Wistar-Albino rats were equally and randomly separated into three groups as follows: a 0 Hz-Static electric field (SEF), a 50-Hz low-frequency electric field (LFEF) and a control group. A manual fracture was performed in the left tibia diaphysis of all rats, and fractures were fixed using circular plaster over the knee. The LFEF group was exposed to 50 Hz electric field for 30 minutes a day, five days a week, for a total of eight weeks. The SEF group was exposed to 0 Hz electric field within the same time interval. The control group was held in identical environmental conditions, without exposure to electric field. Periodic radiographs were taken from all the animals. At the end of this study, rats were sacrificed and mechanical/histopathologic examinations were performed.

Results: Radiologic, mechanical and histologic scores of the LFEF group were lower than those of the SEF and control groups; however, no significant difference was found in group comparisons in terms of average histologic and radiologic scores (p>0.05).

Conclusion: Results extracted from the current study suggest that 0-hz static and 50-hz electric field exposures affect bone healing tissue of tibial fracture models in rats, although it is not significant.
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http://dx.doi.org/10.14744/nci.2020.04764DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7881430PMC
November 2020

Detection Of Lung Cancer On Computed Tomography Using Artificial Intelligence Applications Developed By Deep Learning Methods And The Contribution Of Deep Learning To The Classification Of Lung Carcinoma.

Curr Med Imaging 2021 Feb 4. Epub 2021 Feb 4.

Kutahya Health Sciences University Research and Training Center, Kutahya, . Turkey.

Background: In every year, lung cancer is an important cause of deaths in the world. Early detection of lung cancer is important for treatment, and non-invasive rapid methods are needed for diagnosis.

Introduction: In this study, we aimed to detect lung cancer using deep learning methods and determine the contribution of deep learning to the classification of lung carcinoma using a convolutional neural network (CNN).

Method: A total of 301 patients with diagnosed with lung carcinoma pathologies in our hospital were included in the study. In the thorax computed tomography (CT) performed for diagnostic purposes prior to treatment. After tagging the section images, tumor detection, small-non-small cell lung carcinoma differentiation, adenocarcinoma-squamous cell lung carcinoma differentiation, and adenocarcinoma-squamous cell-small cell lung carcinoma differentiation were sequentially performed using deep CNN methods.

Result: In total, 301 lung carcinoma images were used to detect tumors, and the model obtained with the deep CNN system had 0.93 sensitivity, 0.82 precision, and 0.87 F1 score in detecting lung carcinoma. In the differentiation of small cell-non-small cell lung carcinoma, the sensitivity, precision and F1 score of the CNN model at the test stage were 0.92, 0.65, and 0.76, respectively. In the adenocarcinoma-squamous cancer differentiation, the sensitivity, precision, and F1 score were 0.95, 0.80, and 0.86, respectively. The patients were finally grouped as small cell lung carcinoma, adenocarcinoma, and squamous cell lung carcinoma, and the CNN model was used to determine whether it could differentiate these groups. The sensitivity, specificity, and F1 score of this model were 0.90, 0.44, and 0.59, respectively for this differentiation.

Conclusion: In this study, we successfully detected tumors and differentiated between adenocarcinoma-squamous cell carcinoma groups with the deep learning method using the CNN model. Due to their non-invasive nature and success of the deep learning methods, they should be integrated into radiology to diagnose lung carcinoma.
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http://dx.doi.org/10.2174/1573405617666210204210500DOI Listing
February 2021

Cystic renal diseases: role of ultrasound. Part II, genetic cystic renal diseases.

Med Ultrason 2020 Nov 4. Epub 2020 Nov 4.

Department of Radiology, Koc University School of Medicine, Istanbul, Turkey.

Kidney cysts are quite common in adults. Though small simple renal cysts in an adult over 30-40 years of age are not too unusual, however, if the same cysts are seen in a child, and especially if there are additional findings, then several diagnostic possibilities may come to mind. The role of ultrasound, together with the help of intravenous contrast agents and Doppler mode, are very critical in describing the morphologic features and follow-up of the complex or multiple and bilateral renal cysts. These sonographic signs are occasionally specific for diagnosis, but in many cases sonographic clues should be evaluated together with the other genetic and clinical data to reach diagnosis.The first part of this pictorial essay included the introduction into the subject and the classification of non-genetic cystic renal diseases. The key features for the non-genetic cystic renal diseases are illustrated. In the second part, eye-catching features of genetic cystic renal diseases are demonstrated.
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http://dx.doi.org/10.11152/mu-2690DOI Listing
November 2020

Cystic renal diseases: role of ultrasound. Part I, non-genetic cystic renal diseases.

Med Ultrason 2020 Oct 27. Epub 2020 Oct 27.

Department of Radiology, Koc University School of Medicine, Istanbul, Turkey.

Kidney cysts are quite common in adults.  Though small simple renal cysts in an adult over 30-40 years of age are not too unusual, however, if the same cysts are seen in a child, and especially if there are additional findings, then several diagnostic possibilities may come to mind. The role of ultrasound, together with the help of intravenous contrast agents and Doppler mode, is very critical in describing the morphologic features and follow-up of the complex or multiple and bilateral renal cysts. Sonographic signs are occasionally specific for diagnosis, but in many cases they should be evaluated together with the other genetic and clinical data to reach a diagnosis.The first part of this pictorial essay includes "non-genetic cystic renal diseases" and the second part will include "genetic cystic renal diseases".
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http://dx.doi.org/10.11152/mu-2689DOI Listing
October 2020

An artificial intelligence proposal to automatic teeth detection and numbering in dental bite-wing radiographs.

Acta Odontol Scand 2020 Nov 11:1-7. Epub 2020 Nov 11.

Department of Mathematics and Computer Science, Faculty of Science, Eskisehir Osmangazi University, Eskisehir, Turkey.

Objectives: Radiological examination has an important place in dental practice, and it is frequently used in intraoral imaging. The correct numbering of teeth on radiographs is a routine practice that takes time for the dentist. This study aimed to propose an automatic detection system for the numbering of teeth in bitewing images using a faster Region-based Convolutional Neural Networks (R-CNN) method.

Methods: The study included 1125 bite-wing radiographs of patients who attended the Faculty of Dentistry of Ordu University from 2018 to 2019. A faster R-CNN an advanced object identification method was used to identify the teeth. The confusion matrix was used as a metric and to evaluate the success of the model.

Results: The deep CNN system (CranioCatch, Eskisehir, Turkey) was used to detect and number teeth in bitewing radiographs. Of 715 teeth in 109 bite-wing images, 697 were correctly numbered in the test data set. The F1 score, precision and sensitivity were 0.9515, 0.9293 and 0.9748, respectively.

Conclusions: A CNN approach for the analysis of bitewing images shows promise for detecting and numbering teeth. This method can save dentists time by automatically preparing dental charts.
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http://dx.doi.org/10.1080/00016357.2020.1840624DOI Listing
November 2020

Identifying the predictors of estimated glomerular filtration rate after partial nephrectomy with a nonlinear regression model.

Int J Clin Pract 2020 Oct 16:e13763. Epub 2020 Oct 16.

Department of Urology, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.

Purpose: To evaluate the effect of partial nephrectomy on renal function and to identify predictors of estimated glomerular filtration rate (eGFR) at 6 months after partial nephrectomy.

Methods: Medical data of 154 consecutive patients who underwent partial nephrectomy for a renal mass between January 2015 and March 2020 were retrospectively analysed. The primary outcome measure was eGFR at 6 months postoperatively. An ordinary least regression analysis using a restricted cubic spline for continuous variables was performed to examine the association between primary outcome measure and candidate predictors.

Results: Of the patients, 66 (42.9%) were females and 88 (57.1%) were males with a median age of 60 (range, 50 to 67) years. The median baseline eGFR was 90.40 (range, 74.96 to 102.97) mL/min/1.73 m , while the median eGFR at 6 months was 77.12 (range, 61.06 to 91.93) mL/min/1.73 m (P < .001). Baseline eGFR (regression coefficient (β) = 22.7, 95%CI: 18.8 to 26.5, P < .001) was found to be most significant predictor with the postoperative eGFR levels at 6 months. In addition, advanced tumour size (β = -3.17, 95%CI: -5.33 to -1.01, P < .001) and presence of hypertension (β = -3.48, 95%CI: -6.96 to -0.003, P = .049) were also found to be inversely associated with the postoperative eGFR levels at 6 months.

Conclusion: Baseline eGFR values, tumour size, and presence of hypertension are significant predictors of eGFR values in the mid-term in patients undergoing partial nephrectomy.
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http://dx.doi.org/10.1111/ijcp.13763DOI Listing
October 2020

Voriconazole-treated aspergillus vertebral osteomyelitis in an immunocompetent patient.

J Orthop Sci 2020 Oct 7. Epub 2020 Oct 7.

Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University, Istanbul, Turkey. Electronic address:

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http://dx.doi.org/10.1016/j.jos.2020.09.003DOI Listing
October 2020

Analysis of routine blood markers for predicting amputation/re-amputation risk in diabetic foot.

Int Wound J 2020 Dec 5;17(6):1996-2004. Epub 2020 Oct 5.

Department of Orthopaedics and Traumatology, Alanya Alaaddin Keykubat University, Alanya, Turkey.

Diabetic foot is challenging progressive disease which requires multisystemic control. Neuropathy, arteriopathy, and cellular responses should treated collaboratively. Despite all medical advances, diabetic foot can highly resulted with amputation and also re-amputation can be required because of failed wound healing. In this study, we aimed to investigate the relation between blood parameters and amputation events. Diabetic 323 patients include to the study who referred to orthopaedic clinic for amputation. Amputation levels (amputation levels phalanx, metatarsal, lisfranc, syme, below knee, knee-disarticulation, above-knee amputation) and re-amputations recorded and compared with routine blood parameters. Re-amputation was observed at 69 patients. The significant difference detected between lower albumin, higher HbA1c, higher CRP levels (P < 0.05) in regards to gross amputation levels, and increased wound depth. Furthermore, lower albumin levels and higher levels of WBC, HbA1c, CRP, and Creatinine were detected in re-amputation levels. Especially, HbA1c, CRP, and Creatinine levels were found as upper bound of reference line for re-amputation. The statistically optimal HbA1c cutoff point for diabetes was ≥7.05%, with a sensitivity of 86% and a specificity of 59%. In according to our results, simple blood parameters can be useful for observing the progress of amputation in diabetic foot. Particularly, lower albumin, and higher HbA1c, CRP, and Creatinine levels detected as related with poor prognosis. Besides, screening of HbA1c level seems to be highly sensitive for detecting of re-amputation possibility.
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http://dx.doi.org/10.1111/iwj.13491DOI Listing
December 2020

Effects of Zoledronic Acid Treatment on Fracture Healing, Morbidity and Mortality in Elderly Patients with Osteoporotic Hip Fractures.

Strategies Trauma Limb Reconstr 2019 Sep-Dec;14(3):126-131

Department of Orthopaedics and Traumatology, Alaaddin Keykubat University, Alanya, Antalya, Turkey.

Background: In this study, the effects of zoledronic acid (ZolA) administered at different times to patients undergoing surgical treatment for hip fracture were investigated.

Materials And Methods: Ninety patients who underwent surgical treatment for osteoporotic (OP) hip fractures between February 2013 and September 2016 in our hospital were included in the study. After surgical treatment, patients were allocated into three groups: group I-patients who had osteosynthesis using proximal femoral nail (PFN) for an intertrochanteric fracture of the femur were given ZolA within 1 week after fracture and before discharge; group II-patients who had osteosynthesis using the PFN for an intertrochanteric fracture of the femur were given ZolA within 1 month after fracture post-discharge; group III-patients in the same age group who had a hemiarthroplasty (HA) for an intertrochanteric fracture of the femur were administered ZolA before discharge. In addition, all patients were given daily oral calcium and vitamin D3. The Radiographic Union Score for Hip (RUSH), Harris Hip Score (HHS), and bone mineral density (BMD) were used at the follow-up as evaluation criteria, and complications were noted.

Results: There were no significant differences between groups in terms of demographic data and laboratory outcomes ( > 0.05). Radiographic Union Score for Hip scores were similar between groups I and II ( > 0.05). Fracture union occurred by the sixth month in all patients whose results were evaluated. No statistically significant difference was found between three groups ( > 0.05). There was no difference between the three groups in the hip and vertebrae BMD and scores ( > 0.05). When and BMD scores before treatment were compared with those at 1 year after treatment, a benefit from ZolA treatment was observed in all three groups ( < 0.05).

Conclusion: This study shows that the timing of ZolA administration has no effect on fracture healing and complication incidence in elderly patients with hip fractures. In addition, ZolA was found to be beneficial in increasing BMD of both femur and vertebra in all groups, but there was no significant difference between the groups.

Clinical Significance: The study demonstrated that ZolA may be used early in the treatment of osteoporotic hip fractures with PFN.

How To Cite This Article: Sargin S, Konya MN, Gulcu A, Effects of Zoledronic Acid Treatment on Fracture Healing, Morbidity and Mortality in Elderly Patients with Osteoporotic Hip Fractures. Strategies Trauma Limb Reconstr 2019;14(3):126-131.
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http://dx.doi.org/10.5005/jp-journals-10080-1439DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7368358PMC
August 2020

Squamous cell carcinoma originated from chronic osteomyelitis sinus tract in tibia.

Authors:
Ahmet Aslan

Jt Dis Relat Surg 2020 18;31(2):405-407. Epub 2020 Jun 18.

Alanya Alaaddin Keykubat Üniversitesi, Eğitim ve Araştırma Hastanesi, Ortopedi ve Travmatoloji Kliniği, 07425 Alanya, Antalya, Türkiye.

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http://dx.doi.org/10.5606/ehc.2020.75084DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7489158PMC
June 2020

Are fragility fractures being treated properly?

Jt Dis Relat Surg 2020 18;31(2):403-404. Epub 2020 Jun 18.

Turkish Joint Diseases Foundation, Mustafa Kemal Mah., Dumlupınar Bul., 274/2, C2 Blok, Ofis 5, 06900 Çankaya, Ankara, Türkiye.

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http://dx.doi.org/10.5606/ehc.2020.57894DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7489160PMC
June 2020

Rare presentation of inflammatory myofibroblastic tumor in the kidney.

Radiol Case Rep 2020 Aug 17;15(8):1266-1270. Epub 2020 Jun 17.

Department of Radiology, King Hamad University Hospital, Manama, Bahrain.

Inflammatory myofibroblastic tumor (IMT) is a rare pathologic entity that has been mostly described in the lung. It has been reported in nearly every organ, with occurrence in the kidney being extremely rare. IMT has nonspecific clinical and radiological findings and often mimics a malignant process. This is a case discussing the radiologic and pathologic findings of a renal IMT in a 35-year-old female who underwent radical nephrectomy for a right renal pelvis mass that was mistaken for transitional cell carcinoma.
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http://dx.doi.org/10.1016/j.radcr.2020.05.043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7305367PMC
August 2020

Association Between C-Reactive Protein to Albumin Ratio and Left Ventricular Thrombus Formation Following Acute Anterior Myocardial Infarction.

Angiology 2020 10 22;71(9):804-811. Epub 2020 Jun 22.

Department of Cardiology, 420101Trabzon Ahi Evren Training and Research Hospital, University of Health Science, Trabzon, Turkey.

Left ventricular thrombus (LVT) is associated with inflammatory response in survivors with anterior ST-elevation myocardial infarction (STEMI). The C-reactive protein to albumin ratio (CAR) has been proposed as a marker of inflammation. However, there is a lack of data with respect to the role of CAR in LVT development. We investigated the relationship between CAR and LVT development in patients with anterior STEMI treated percutaneously; 955 consecutive patients were enrolled and LVT was observed in 126 (13.2%) patients. Clinical, demographic, and laboratory parameters were recorded. The CAR was significantly higher in patients with LVT (12.6 [8.6-16.1] vs 18.1 [11.5-23], < .001). Other independent predictors for LVT development were lower ejection fraction, the presence of left ventricular apical aneurysm, proximal left anterior descending lesion location, glycoprotein IIb/IIIa inhibitors treatment, >1 diseased arteries, higher total protein level, neutrophil count, and peak creatine kinase myocardial band activity. In conclusion, the CAR may be useful as a simple tool for predicting LVT development among survivors of anterior STEMI.
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http://dx.doi.org/10.1177/0003319720933431DOI Listing
October 2020

Usefulness of whole blood viscosity estimated by de Simeone's formula to predict left ventricular thrombus formation within one year following acute anterior myocardial infarction.

Biorheology 2020 ;57(1):37-51

Department of Cardiology, Trabzon Ahi Evren Training and Research Hospital, University of Health Science, Trabzon, Turkey.

Background: Despite improvements in treatment of ST-segment myocardial infarction (STEMI), thrombus formation in the left ventricle is still a concerning complication that may lead to systemic thromboembolism and stroke.

Objectives: To evaluate the predictive value of estimated whole blood viscosity (WBV) for left ventricular thrombus development in patients surviving an acute anterior myocardial infarction (AAMI).MATERIALS \& METHODS:Seven hundred eighty AAMI patients who were treated percutaneously were enrolled consecutively. Serial echocardiographic examinations were performed within 24h of admission, before hospital discharge, and at 1, 3, 6 and 12 months following hospital discharge. WBV was calculated according to de Simones formula.

Results: One hundred patients (12.8%) developed thrombus formation within one year following AAMI. Patients with left ventricular thrombus (LVT) had significantly higher WBV values. Supramedian values of WBV at both low (0.5 sec-1) and high (208 sec-1) shear rates were found to be an independent predictor of LVT development.

Conclusion: As an easily accessible parameter, WBV might be a useful predictor of LVT formation within one year following acute anterior myocardial infarction.
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http://dx.doi.org/10.3233/BIR-200240DOI Listing
April 2021

Risk factors for mortality and survival rates in elderly patients undergoing hemiarthroplasty for hip fracture.

Acta Orthop Traumatol Turc 2020 Mar;54(2):138-143

Department of Orthopaedics and Traumatology, Muğla Sıtkı Koçman University, School of Medicine, Muğla, Turkey.

Objective: The aim of this study was to analyze the relationship between mortality and possible risk factors in elderly patients surgically treated with hemiarthroplasty for hip fracture and to determine mortality rates and yearly survival outcome in a selected cohort.

Methods: A total of 92 patients (51 men (55.4%) and 41 women (44.6%); mean age: 76.47 years) who underwent hemiarthroplasty for hip fracture were included into the study. The following data associated with risk factors were recorded for 92 patients: age, gender, pre-fracture activities of daily living (ADL), type of fracture, American Society of Anesthesiologists (ASA) score, therapeutic procedure, type of anesthesia, length of time after fracture until operation, postoperative mobility, and duration of hospitalization. A multivariate logistic regression test was used to evaluate the correlation between the risk factors and first- and second-year mortality rates. Third-year mortality rate after surgery was analyzed and compared with the general mortality rate in a similar population of the same age group living in the same city.

Results: The mortality rate was 18.5% (17 patients) after the first-year follow-up and 25% (23 patients) after the second year. The mortality risk after hip fracture was found to be 11.7 times greater than the similar age group population in the third year. In addition, there was a significant relationship between a low (dependent) preoperative ADL score, advanced age (>80 years), male gender, high ASA score and poor ability to walk (unable to walk), and first- and second-year mortalities (p<0.05). However, no significant relationship was found between fracture type, fracture side, anesthesia type, time from fracture to surgery, or duration of hospitalization and mortality (p>0.05).

Conclusion: Advanced age, male gender, a high ASA score, a dependent preoperative ADL score, and a postoperative inability to walk were determined to be the most important risk factors affecting mortality in elderly patients with hip fracture. The mortality risk was 11.7 times greater than that of a population with similar characteristics.

Level Of Evidence: Level IV, Therapeutic study.
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http://dx.doi.org/10.5152/j.aott.2020.02.298DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7286162PMC
March 2020

Change in Frequency and Predictors of Erectile Dysfunction With Changes in the International Index of Erectile Function-Erectile Function Domain Score in Patients With ST-Elevation Myocardial Infarction: A Prospective, Longitudinal Study.

J Sex Med 2020 06 25;17(6):1101-1108. Epub 2020 Mar 25.

Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.

Background: Erectile dysfunction (ED) has been proposed as an early indicator for future coronary and peripheral vascular disease.

Aim: We aimed to investigate the longitudinal change in proportion and predictors for ED with changes in erectile function domain (EFD) of the International Index of Erectile Function-15 (IIEF-15) in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PPCI).

Methods: Between December 2018 and June 2019, 286 male patients aged between 40 and 70 years who were treated with PPCI for STEMI were included. The patients were asked to complete the IIEF-EFD form 3 days after the procedure for the evaluation of baseline erectile functions. During follow-up 3 months after the index procedure, the patients were asked to refill the IIEF-EFD form. Both baseline and third-month IIEF-EFD scores were calculated, and the patients were classified into ED severity groups as per the IIEF-EFD scores. A linear mixed model was used to identify predictors of ED at 3 months.

Outcomes: This study identifies the prevalence and predictors of ED with STEMI who underwent PPCI.

Results: The median age was 54 (range 48-61) years. The median IIEF-EFD scores at 3 days and 3 months were 25.5 (range 20.0-27.0) and 22.00 (range 18.25-25.00), respectively. Half of the patients were found to have ED with varying severity as per baseline IIEF-EFD scores. This rate increased to 79% at the 3-month follow-up visit. The IIEF-EFD scores of the patients decreased over time (P < .001). Advanced age (β = -0.603, se = 0.192, P = .002), presence of three-vessel coronary artery disease (β = -3.828, se = 0.783, P < .001), and diabetes (β = -2.934, se = 0.685, P < .001) were found to be inversely associated with the IIEF-EFD scores.

Clinical Implications: Advanced age, presence of three-vessel disease, and diabetes mellitus are the indicators of sexual rehabilitation needs in patients after STEMI.

Strengths & Limitations: This is the first study investigating the predictor variables for the development of ED after coronary artery disease treatment. The limitations include the lack of evaluation of anxiety and depression and the measurements of testosterone levels.

Conclusion: The prevalence of ED was high among patients with coronary artery disease, and the frequency of ED increased during 3-month follow-up. Advanced age, three-vessel disease, and diabetes were significant predictors of ED with changes in IIEF-EFD score in patients with STEMI who underwent PPCI. Karabay E, Karsiyakali N, Cinier G, et al. Change in Frequency and Predictors of Erectile Dysfunction With Changes in the International Index of Erectile Function-Erectile Function Domain Score in Patients With ST-Elevation Myocardial Infarction: A Prospective, Longitudinal Study. J Sex Med 2020;17:1101-1108.
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http://dx.doi.org/10.1016/j.jsxm.2020.03.002DOI Listing
June 2020

Is electromagnetic guidance system superior to a free-hand technique for distal locking in intramedullary nailing of tibial fractures? A prospective comparative study.

Ulus Travma Acil Cerrahi Derg 2020 Mar;26(2):280-286

Department of Orthopedics and Traumatology, Balikesir University Faculty of Medicine, Balikesir-Turkey.

Background: Intramedullary nailing (IMN) technique is the gold standard for the treatment of closed fractures of the lower extremity long bones. For orthopedic surgeons, one of the most important problems in IMN procedures is the fixation of distal locking screws (DLS). Accurate and rapid placement of DLSs with minimal radiation exposure is crucial. In this study, we aimed to compare the results of two different distal locking methods concerning surgery duration and radiation exposure in patients who underwent osteosynthesis of tibia fractures with IMN.

Methods: In this prospective study, the results of 56 patients who met the inclusion and exclusion criteria from 72 patients were evaluated. Patients were divided into two groups according to the distal screwing method. Group 1 (n=29) comprised patients who used free-hand technique (FHT) for distal locking, while Group 2 (n=27) consisted of patients who used electromagnetic guidance system (EMGS) for distal locking. Demographic and medical data of the patients, duration of surgery time, amount of bleeding, total fluoroscopy counts, the time elapsed for distal locking, the measure of radiation exposure, number of attempts for distal screw locking, incorrect screw placements, complications and follow-up time were recorded. The groups were compared concerning demographic data and clinical results.

Results: There was no statistically significant difference between the groups about gender and side (p=0.928 and p=0.432, respectively). The mean age in Group-1 was higher than that of Group-2, and the difference was statistically significant (p=0.012). However, there was no statistically significant difference in length of hospital stay in Group-1 (p=0.140). On the other hand, in Group-2, the number of distal shots, fluoroscopy duration, effective radiation dose and operation duration were lower compared to Group-1, although this difference was not statistically significant (p=0.057, 0.073, 0.058 and 0.056, respectively). Failure was encountered in distal locking during the first attempt in three cases in Group-1 and in two cases in Group-2. Aseptic nonunion was observed in one patient in both groups.

Conclusion: Both the FHT distal screwing technique and the EMGS distal screwing technique are highly effective methods for distal locking. The duration of operation, the duration of the fluoroscopy and radiation exposure were similar. FHT can be preferred for distal locking in conventional intramedullary nail applications, as it is effective, easy and inexpensive.
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http://dx.doi.org/10.14744/tjtes.2020.94490DOI Listing
March 2020

Cardiometabolic risk factors in Turkish children with hepatosteatosis.

Turk J Pediatr 2019 ;61(5):714-722

Departments of Cardiology, Istanbul Medeniyet University, Göztepe Training and Research Hospital, Kadıköy, Istanbul, Turkey.

Aslan A, Erdemli S, Durukan Günaydın G, Aslan M, Yazar RÖ, Kabaalioğlu A, Ağırbaşlı MA. Cardiometabolic risk factors in Turkish children with hepatosteatosis. Turk J Pediatr 2019; 61: 714-722. We aimed to investigate the prevalence of cardiometabolic (CM) risk factors (impaired fasting glucose ( > 100 mg/dL), high blood pressure, overweight or obesity, high serum triglycerides (TG) and low serum high-density lipoprotein cholesterol levels) in children with hepatosteatosis detected by abdominal ultrasound. Children whom ultrasound examination revealed hepatic steatosis were included in the study. Medical records, anthropometric and biochemical parameters were reviewed for the presence of the CM risk factors. Presence of ≥3 risk factors was defined as metabolic syndrome (MS). One hundred and forty-eight children and adolescents (67 boys, 81girls, and mean age 12.1±2.7 years) with hepatosteatosis were included. Sonographic hepatosteatosis grades of 1, 2 and 3 were observed in 111 (75%), 33 (22.3%), and 4 (2.7%) subjects, respectively. MS was observed in 36 patients (24.3%). The number of CM risk factors and degree of hepatic steatosis were correlated (r=0.183, p=0.026). Serum TG levels in girls and age in boys were significantly associated with the presence of medium to severe hepatosteatosis (grades 2 or 3) (R2=.342, =.040 and R2=.538, p=.001, respectively). CM risk factors and MS are common in children with hepatosteatosis. The presence and grade of hepatosteatosis on ultrasound can be used as surrogate markers of MS and CM risk in children.
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http://dx.doi.org/10.24953/turkjped.2019.05.010DOI Listing
July 2020

Comparison of single event multilevel surgery and multiple surgical events in the lower extremities of children with spastic cerebral palsy.

Eklem Hastalik Cerrahisi 2019 Dec;30(3):217-23

Department of Orthopedics and Traumatology, Alanya Alaaddin Keykubat University, Faculty of Medicine, 07425 Alanya, Antalya, Turkey.

Objectives: This study aims to compare patients treated with single event multilevel surgery (SEMS) and multiple surgical events (MSE) for disorders of the lower extremities due to cerebral palsy (CP).

Patients And Methods: The study included 130 patients (74 males, 56 females; mean age 7.7±4 years; range, 4 to 13 years) who were retrospectively staged preoperatively and at the final follow-up with the Gross Motor Function Classification System (GMFCS). The patients were divided into two groups as group 1 (MSE) and group 2 (SEMS). Gross Motor Function Measure-88 (GMFM-88) was used as evaluation criteria and visual analog scale was used to measure family satisfaction.

Results: In the final follow-up, group 2 had better GMFM-88 D and E scores (p=0.037 and p=0.045, respectively). Similarly, family satisfaction was better in group 2 (p=0.047). There was a difference between preoperative and final follow-up GMFCS stages (I, II, III) of all patients (21÷53÷56 and 53÷49÷28; respectively, p<0.001). A total of 3.8 (range, 2-7) operations were performed per child.

Conclusion: In this study, SEMS contributed significantly to movement, posture and independence of children with CP compared to MSE. Single event multilevel surgery also increased family satisfaction.
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http://dx.doi.org/10.5606/ehc.2019.66516DOI Listing
December 2019

Relationship between plasma Atherogenic index and final pathology of Bosniak III-IV renal masses: a retrospective, single-center study.

BMC Urol 2019 Sep 13;19(1):85. Epub 2019 Sep 13.

Department of Urology, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Tibbiye Street. No: 23 34668 Uskudar /, ISTANBUL, Turkey.

Background: There is an increased incidence of renal cell carcinoma (RCC) in patients with metabolic syndrome who usually have high levels of serum triglyceride (TG) and low high-density lipoprotein-cholesterol (HDL-C). Plasma atherogenic index (PAI) is the logarithmic ratio of serum TG level to HDL-C and related to cardiovascular diseases. In this study, we aimed to determine the accuracy of PAI in determining renal malignancy in localized renal masses preoperatively.

Methods: Totally 169 patients who were diagnosed with Bosniak III-IV lesions by imaging modalities and treated in our hospital with partial or radical nephrectomy were retrospectively analyzed using institutional renal cancer database between 2013 and 2018. Preoperative images were evaluated by two experienced radiologists. The patients were divided into two groups according to their postoperative pathological diagnosis as malignant or benign tumors. The PAI of each patient was calculated and the statistical significance of PAI in predicting malignancy for renal masses was analyzed using uni- and multivariable analyses.

Results: Of patients, 109 (64.5%) were males and 60 (35.5%) were females with a median age of 61 (33-84) years. Median tumor size was 6.5 (2-18) cm. Pathological diagnosis was malignant in 145 (85.8%) and benign in 24 (14.2%) patients. There was no statistically significant difference in serum TG levels between malignant and benign cases (p > 0.05). The HDL-C levels were significantly lower in malignant cases (p = 0.001). Median PAI value was 0.63 (0.34-1.58) and significantly higher in malignant cases (p = 0.003). The PAI cut-off value for malignancy was ≥0.34. The sensitivity was calculated as 88.2% and specificity as 45.8%, the positive predictive value as 90.8, negative predictive value as 39.3, and odds ratio as 6.37 (95% CI: 2.466-16.458). In multivariable analysis, gender, smoking status, and hypertension had no effect on malignancy, whereas PAI and HDL-C were independent risk factors (p = 0.003 and p = 0.003, respectively). The risk of malignancy was 5.019 times higher, when PAI was > 0.34 (95% CI: 1.744-14.445) in multivariable logistic regression analysis.

Conclusions: The PAI can be used as a predictive tool in suspicion of malignant renal masses. In case of a benign pathology, PAI levels may be encouraging for surgeons for nephron-sparing surgery.
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http://dx.doi.org/10.1186/s12894-019-0514-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6743186PMC
September 2019

Clinical, radiological and patient-reported outcomes in intra-articular calcaneal fractures: Comparison of conservative and surgical treatment.

Eklem Hastalik Cerrahisi 2019 Aug;30(2):143-8

Department of Orthopedics and Traumatology, Alanya Alaaddin Keykubat University, Faculty of Medicine, 07425 Alanya, Antalya, Turkey.

Objectives: This study aims to compare the radiological, clinical and patient-reported outcomes of patients with intra-articular calcaneus fractures treated conservatively or surgically.

Patients And Methods: Fifty-four patients (30 males, 24 females; mean age 41.0 years; range, 18 to 73 years) treated due to calcaneus fracture were included in the study. Twenty-nine patients underwent conservative treatment (group 1) and 25 patients underwent surgical treatment (group 2). The fractures were classified according to Sanders. At the final follow-up, patients' Bohler's angle, The American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score and Foot Function Index (FFI) were used to evaluate their radiological, clinical and patient-reported outcomes. Postoperative complications were also noted.

Results: The fracture was at the right foot in 28 patients and the left foot in 26 patients. The mean follow-up duration was 41.1±23.2 months (range, 24 to 126 months). No statistically significant differences were found between the groups in terms of gender, fracture side, mean age, or follow-up duration (p=0.951, p=0.571, p=0.326, and p=0.620, respectively). According to Sanders classification, 18 patients were type 2 and 11 patients were type 3 in group 1, while 11 patients were type 2 and 14 patients were type 3 in group 2. However, there was no statistically significant difference between the groups in terms of the type of the fracture (p=0.184). On the other hand, the outcomes were significantly better for group 2 compared to group 1 in terms of the Bohler's angle, AOFAS and FFI scores (p=0.004, p=0.003 and p=0.006, respectively). In group 1, subtalar arthritis developed in three patients. In group 2, wound healing problems and superficial infection developed in three patients, while subtalar arthritis developed in two patients.

Conclusion: Surgical treatment is more effective in intra-articular calcaneus fractures compared to conservative treatment according to clinical, radiological and patient-reported outcomes. In addition, wound problems should be considered in surgical management.
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http://dx.doi.org/10.5606/ehc.2019.66447DOI Listing
August 2019

Toxocara related peritonitis: A case report and review of literature.

Parasitol Int 2019 Dec 4;73:101950. Epub 2019 Jul 4.

Department of Infectious Diseases, Göztepe Training and Research Hospital, Istanbul Medeniyet University, Dumlupınar Mahallesi, D100 No:98, 34000 Kadıköy/İstanbul, Turkey.

Toxocariasis is a clinical syndrome caused by the larvae of two ascarid nematodes, namely, Toxocara canis and T. cati that live in dogs and cats as definitive hosts. Humans acquire Toxocara infection by accidental consumption of eggs contaminated foods, soil, water or larvae encapsulated in the viscera or meats of various paratenic hosts e.g., chicken. After oral ingestion, the ova hatch and the free larvae penetrate the intestinal wall to migrate to distant tissues throughout the body. Larvae may also infiltrate the intestinal wall and cause enteritis and mass occupying lesions. Here, we present a T. canis related gastroenteritis and peritonitis case successfully treated with albendazole. We reviewed the literature and found seven previously published Toxocara related peritonitis cases. To our knowledge, this is the first review about non-disseminated toxocariasis that restricted to the intestine and presented as eosinophilic ascites due to peritoneal inflammation. The most common abdominal symptoms were abdominal pain and nausea, and the most common findings were eosinophilic infiltrations on endoscopic biopsy specimens and eosinophilia in the peripheric blood samples.
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http://dx.doi.org/10.1016/j.parint.2019.101950DOI Listing
December 2019

Evaluation of Ovarian Vascularity in Children by Using the "Superb Microvascular Imaging" Ultrasound Technique in Comparison With Conventional Doppler Ultrasound Techniques.

J Ultrasound Med 2019 Oct 28;38(10):2751-2760. Epub 2019 Mar 28.

Faculty of Medicine, Department of Radiology, İstanbul Medeniyet University, Istanbul, Turkey.

Objectives: The aim of this study was to assess the feasibility of the novel "superb microvascular imaging" (SMI) Doppler ultrasound technique to detect ovarian vascularity in healthy children and to compare it with the conventional Doppler ultrasound techniques.

Methods: This prospective study included 140 girls, aged 3 to 18 years, for which an abdominal ultrasound study was requested in the pediatrics outpatient clinics for suspicion of nonovarian pathologies. Nineteen individuals were excluded from the study due to incomplete ultrasound scanning. For the remaining 121 cases, gray scale ultrasound evaluation was performed followed by color Doppler imaging, power Doppler imaging, advanced dynamic flow, color SMI, and monochrome SMI to detect the presence and degree of vascularity in the ovaries. Ultrasound scanning was performed for all participants by the same doctor by using curvilinear probe via the suprapubic approach, and the images were independently evaluated by 3 different observers. The images were assessed with regard to the degree of vascularity and the presence of artifacts.

Results: A total of 146 ovaries (42 right, 54 left, and 25 bilateral) were examined by sonography. The mean interrater agreement regarding the detection of vascularity was moderate for the color Doppler imaging, power Doppler imaging, advanced dynamic flow, and monochrome SMI techniques (κ = 0.514-0.551) and substantial for the color SMI technique (κ = 0.636) (P < .001). The techniques were found to be statistically significant for detecting vascularity: monochrome SMI > color SMI > power Doppler imaging > color Doppler imaging > advanced dynamic flow (P < .001).

Conclusion: SMI is a promising tool that can detect ovarian vascularity more effectively than the conventional Doppler ultrasound techniques.
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http://dx.doi.org/10.1002/jum.14983DOI Listing
October 2019

Localized Breast Amyloidosis.

Eur J Breast Health 2019 Jan 24;15(1):63-66. Epub 2018 Oct 24.

Department of Pathology, Gaziosmanpaşa Taksim Training and Research Hospital, İstanbul, Turkey.

Localized amyloidosis in the breast is a very rare disease and may mimic malignant lesions. A 60-year-old woman who had a history of breast-conserving surgery presents with a new a well-defined oval opacity accompanied by many round tight clustered micro- and macrocalcifications on mammograms. It could not be visualized sonographically due to the intense posterior acoustic shadowing of the fat necrosis areas and contrast enhancement was not detected in this area on the dynamic contrast enhanced magnetic resonance images. At pathological examination breast amyloidosis was detected. Amyloidosis of the breast is a rare disease, but it can mimic malignancy and should be included in the differential diagnosis.
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http://dx.doi.org/10.5152/ejbh.2018.4104DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6385720PMC
January 2019

Role of iliac crest tangent in correct numbering of lumbosacral transitional vertebrae

Turk J Med Sci 2019 Feb 11;49(1):184-189. Epub 2019 Feb 11.

Background/aim: The iliac crest tangent (ICT) has recently emerged as a reliable landmark to correctly number the lumbosacral transitional vertebrae (LSTV). We retrospectively evaluated the reproducibility and accuracy of the ICT as a landmark in subjects without disc degeneration.

Materials And Methods: Fifty-eight patients with LSTV [19 female, 41 (26–52) years] and 55 controls without LSTV [23 female, 40 (26–55) years] who had undergone spinal computed tomography were included. The ICT was drawn on the coronal images, with the cursor in the sagittal view set to the posterior ⅓ of the vertebral body located one level above the LSTV. When more than 1.25 vertebral body was counted below the ICT, the LSTV was considered as S1, otherwise it was considered as L5. The gold standard was counting the vertebrae craniocaudally.

Results: The interobserver agreement was good for determining ICT level (Cohen’s kappa = 0.78, P < 0.001). The rate of correct numbering by ICT in the LSTV group was significantly less than in the controls (43.1% vs. 96.4%, respectively, P < 0.001). Patients with sacralization had a significantly lower correct numbering rate than patients with lumbarization (33.3% vs. 63.2%, respectively, P = 0.03).

Conclusion: ICT does not seem to be a reliable landmark for correct numbering of LSTV in patients with no intervertebral disc degeneration.
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http://dx.doi.org/10.3906/sag-1807-258DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7350831PMC
February 2019

The utility of ADC measurement techniques for differentiation of low- and high-grade clear cell RCC.

Pol J Radiol 2018 21;83:e446-e451. Epub 2018 Sep 21.

Department of Radiology, Istanbul Medeniyet University Göztepe Training and Research Hospital, Kadikoy, Istanbul, Turkey.

Purpose: To evaluate the diffusion properties of clear cell renal cell carcinoma (ccRCC) on magnetic resonance imaging (MRI) concerning their Fuhrman nuclear grades and sizes, and to compare the diagnostic performance of two ROI placement techniques for apparent diffusion coefficient (ADC) measurement (entire mass vs. only the darkest region of the mass).

Material And Methods: Fifty-one ccRCC were enrolled in the study and grouped into low-grade ccRCC (Fuhrman grade 1 and 2, = 37) and high-grade ccRCC (Fuhrman grade 3 and 4, = 14). Selective ADC (Sel-ADC) measurement was performed by placing a circular ROI that included the darkest region of the tumour on ADC map images. Extensive ADC (Ext-ADC) measurement was performed by drawing an ROI that covered the entire tumour.

Results: The Sel-ADC value was lower in high-grade ccRCC ( = 0.019), whereas the Ext-ADC value did not show a statistically significant difference ( = 0.42). Sel-ADC value of a ≤ 1.405 mm/s has a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy value of 78.6, 72.2, 73.87, 77.13, and 75.4, respectively, to differentiate high-grade from low-grade ccRCC. The size and Fuhrman grade of the ccRCC were inversely correlated with the Sel-ADC value; however, the correlations were weak ( = -0.322, = 0.021 and = -0.376, = 0.006, respectively). There was no difference between ADC values of small (≤ 4 cm) and large (> 4 cm) ccRCCs.

Conclusions: The ADC value of the darkest region in solid part of the ccRCC may play a role in predicting the nuclear grade of ccRCC.
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http://dx.doi.org/10.5114/pjr.2018.80207DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6334124PMC
September 2018

The value of syntax score to predict new-onset atrial fibrillation in patients with acute coronary syndrome.

Ann Noninvasive Electrocardiol 2019 07 7;24(4):e12622. Epub 2019 Jan 7.

Department of Cardiology, Trabzon Ahi Evren Training and Research Hospital, University of Health Science, Trabzon, Turkey.

Background And Aim: New-onset atrial fibrillation (NOAF) has been associated with poor outcome in patients with acute coronary syndromes (ACS). Also, Syntax score (SS) is a scoring system that is derived from angiographic images and is associated with long-term mortality and major adverse cardiac events. In this study, we aimed to assess the relationship between SS and NOAF with known predictors of atrial fibrillation.

Methods: In a prospective, single-center, cross-sectional study, 692 patients who were diagnosed with coronary artery disease for the first time were enrolled consecutively. NOAF was defined as atrial fibrillation, which was documented after hospital admission. SS was calculated by a computer software. Multivariable logistic regression analyzes were used to detect the relationship between variables and NOAF.

Results: New-onset atrial fibrillation was detected in 82 patients (11.8%). Patients with NOAF had higher SS (22, interquartile range 18.3-25.1, vs. 12, interquartile range 7-19.5, p < 0.001). According to multivariable logistic regression analysis for NOAF, SS were independently and significantly associated (OR, 1.103; 95% confidence interval, 1.047-1.163; p < 0.001). Other independent predictors of NOAF were TIMI flow <3, C reactive protein, left ventricular ejection fraction, left atrial volume index and E/E' ratio. The optimal cut-off value for SS was 18 for the development of NOAF with 82% sensitivity and 68% specificity (area under the curve: 0.795, 95% confidence interval 0.749-0.841, p < 0.001).

Conclusion: Syntax score may be helpful to identify for patients who would develop atrial fibrillation in the setting of ACS.
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http://dx.doi.org/10.1111/anec.12622DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6931656PMC
July 2019

Abdominal wall endometriosis in patients with a history of cesarian section.

Ann Ital Chir 2018 ;89:425-430

Objective: The aim of this study is to review the characteristics, intraoperative and radiological findings of abdominal wall endometriosis (AWE).

Methods: This retrospective observational cohort study was executed through analysis of the medical records of patients who underwent excision of AWE between January 2000 and June 2017. All the diagnoses were confirmed pathologically. Characteristics, intraoperative and radiological findings of patients with AWE were and analyzed.

Results: Each of the 20 patients had a history of at least one prior cesarean section. The main presenting symptoms were pain (70%). Ultrasonography and/or magnetic resonance imaging was performed in 95% and 45 % of the patients, respectively. One patient (5%) was investigated by 18 Fluorodeoxyglucose positron emission tomography - computed tomography. The preoperative radiological diagnosis was correcting in 55 % of the cases. The mean diameter of the masses was 4.7 ± 1.53 cm. Recurrence was found only in one patient during 36-month follow-up.

Discussion: Meticulous anamnesis, accurate clinical examination and proper imaging studies, are important guides for diagnosis.

Conclusion: AWE should be kept in mind when pain or mass is detected on the abdominal wall of women who have cesarean section history.

Key Words: Abdominal wall endometriosis, Cesarean section, Radiology, Scar endometriosis.
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June 2019

Takayasu Arteritis Presenting as Renovascular Hypertension and Renal Failure in a Patient with Factor VII Deficiency.

Eurasian J Med 2018 Oct;50(3):210-212

Department of Cardiology, Istanbul Medeniyet University School of Medicine, İstanbul, Turkey.

A 23-year-old female patient with factor VII (FVII) deficiency was admitted with severe hypertension and renal failure. Brachial arterial pressures were 230/120 and 220/115 mm/Hg on the right and left arms, respectively. There was no blood pressure difference between the arms. Renal artery Doppler ultrasonography revealed bilateral severe renal artery stenosis (RAS). Contrast-enhanced magnetic resonance imaging angiography (CE-MRA) revealed severe mural irregularities, contrast enhancement in the aorta and its branches, and long-segment stenosis starting in the abdominal aorta and extending into the proximal renal arteries. The diagnosis of Takayasu arteritis (TA) complicated by RAS in a patient with FVII deficiency was established. This is the first case of concomitant TA and factor VII deficiency in the literature. In conclusion, TA complicated with RAS should be kept in mind in the etiology of secondary hypertension, even when there is no blood pressure difference between the arms in patients. CE-MRA is an accurate, sensitive, and safe imaging method for diagnosing vasculitis, even in the early phases of the disease, and should be considered for evaluating the activity and response to treatment in patients with TA.
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http://dx.doi.org/10.5152/eurasianjmed.2018.17324DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6263223PMC
October 2018