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Öğe Acute necrotizing encephalopathy: Case report(2012) Güzel A.; Karasaliho?lu S.; Ünlü E.; Küçüku?urluo?lu Y.; Bulut H.Acute necrotizing encephalopathy (ANE) is a very rare disease in childhood. Most of the cases have been reported from far Eastern countries, and rarely from Western countries. The clinical course of ANE is rapidly progressive. The clinical features consist of hyperpyrexia, convulsions, recurrent vomiting and coma. Most of the patients die within a few days or result in severe neurological sequel. It is characterized with multifocal symmetrical and necrotic lesions in the central nervous system. We presented a 3 years 6 months old male with clinical and radiological findings of ANE in this case report. Copyright © 2012 by Türkiye Klinikleri.Öğe Bilateral anterior cerebral artery territory infarction(Turkish Society of Cerebrovascular Diseases, 2006) Asil T.; Balci K.; Ünlü E.; Kabayel L.; Çelik Y.Bilateral anterior cerebral artery infarction is extremely rare and characterized with akinetic mutism, quadriparesis. Bilateral anterior cerebral artery infarction must be considered in differential diagnosis of other cerebrovascular diseases, toxic, degenerative and infectious reasons. The other cerebrovascular causes of akinetic mutism are vasospasm following the rupture of anterior communicating artery, paramedian thalamic and thalamomesencephalic strokes. We presented here two patients with anterior cerebral artery infarction who had quadriparesis and akinetic mutism.Öğe A case of isolated bilateral renal metastases from carcinoma of the lung(2004) Uzal M.C.; Koçak Z.; Uygun K.; Altaner Ş.; Gözen S.; Ünlü E.Renal metastases in patients with history of cancer may mimic primary renal tumors. When the kidneys are the only known pathological sites in patients with locally controlled disease, the differentiation of renal metastases and primary renal cell carcinoma may be very difficult clinically and radiologically. A case of lung carcinoma developing isolated bilateral renal metastases that was recognized ante mortem is described.Öğe Color and duplex Doppler sonography to detect sacroiliitis and spinal inflammation in ankylosing spondylitis. Can this method reveal response to anti-tumor necrosis factor therapy?(2007) Ünlü E.; Pamuk Ö.N.; Çakir N.Objective. To investigate the role of color and duplex Doppler ultrasound (CDDUS) in the detection of sacroiliac (SI) and spinal inflammation, as well as response to anti-tumor necrosis factor (TNF) therapy in patients with ankylosing spondylitis (AS). Methods. We included 39 consecutive patients with AS followed at our center and 14 healthy controls. In the AS and control groups, blood vessels in SI joints and lumbar vertebral (LV) and thoracal vertebral (TV) paraspinal areas were investigated by CDDUS. When the artery was found, the resistive index (RI) was measured by CDDUS. Disease activity characteristics (ESR, CRP, BASDAI, and BASMI) were evaluated in patients with AS. In 11 patients for whom anti-TNF therapy was indicated, CDDUS measurements were performed before and on Week 12 of therapy. Results. In patients with AS, RI values of SI joints and of LV and TV areas were lower than in controls (all p ? 0.01). In AS patients with active disease according to BASDAI, RI values of TV (p = 0.0013) and LV (p = 0.027) were significantly lower than in the inactive group. In the group with active AS, SI RI was nonsignificantly lower (p = 0.16). After anti-TNF therapy, there were significant increases in mean SI RI (p = 0.028) and LV RI (p = 0.039), and a nonsignificant increase in TV RI (p > 0.05). Conclusion. CDDUS may be an alternative, less expensive, and easier method for detecting inflammation secondary to increased SI and spinal vascularization and in evaluating response to anti-TNF therapy in AS.Öğe Early postoperative results of our carotis endarterectomy + patch plasty operations(2001) Duran E.; Canbaz S.; Ege T.; Sunar H.; Çakir B.; Ünlü E.We reviewed early results of five carotid endarterectomy + patch plasty operations that we operated at last one year. Unilateral carotid endarterectomy + saphena magna vein or syntetic patch plasty performed to six patients who had stroke or Transient Ischemic Attack (TIA) history. There were no mortality or serebrovasculary events at postoperatively.Öğe An increased frequency of gallbladder stones in rheumatoid arthritis patients. Factors related to gallbladder stone formation(2006) Pamuk Ö.N.; Ümit H.; Ünlü E.; Köker I.H.; Çakir N.Objective. In this study, we determined the frequency of gallbladder stone (GBS) in rheumatoid arthritis (RA) patients and evaluated factors which could affect the formation of GBS - such as lipids and the GB motilities of the patients. Methods. One hundred and thirteen RA patien ts (92F, 21M, mean disease duration: 8.9 years) and 117 healthy controls (94F, 23M) were included. In all RA patients, the clinical findings were recorded down; biochemical parameters and body mass index (BMI) were determined; and, abdominal ultrasonography was performed. In addition, 16 RA patients and 20 controls who were age-matched were randomly chosen for GB emptying monitored by ultrasound at 30-minute intervals for 2 hours after a mixed meal. Fasting volume (FV), residual volume (RV) and ejection fraction (EF) for all GBs were assessed. Results. There was a tendency towards a higher frequency of GBS including cholecyctectomy (11 GBS, 11 cholecystectomy, 19.5%) in RA patients when compared to controls (8 GBS, 5 cholecystectomy, 11.1%) (p = 0.08). The frequency of GBS plus cholecyctectomy in female RA patients (22.8%) was significantly higher than the control group (11.7%, p = 0.044). Logistic regression analysis showed that only older age was significantly associated with the presence of GBS in RA (OR:1.05, p = 0.048). There was no difference between the 2 groups in FV (p > 0.05). RV, PRV and EF were significantly higher in RA patients than in the control group (p < 0.05). Conclusions. We diagnosed a higher frequency of GBS in female RA patients when compared to controls. Impaired GB motility in RA patients might contribute to an increased incidence of GBS development. © Copyright Clinical and Experimental Rheumatology 2006.Öğe A rare cause of shoulder pain: Radiation induced plexopathy: A case report(2007) Kabayel D.D.; Özdemir F.; Ünlü E.; Balci K.; Bilgili N.Brachial plexopathy (BP) is a rare cause of the shoulder pain. The radiation-induced brachial plexopathy that it is a type of BP may be occured after supraclavicular and upper thoracal region irradiation. We describe a unique case with right shoulder pain of the RP that occurred after treated for carcinoma of the breast. A 48-year-old woman has right shoulder pain and weakness. The breast canser patient who diagnosed four years ago was treated with postoperative radiation therapy for five weeks after radical mastectomy by a standardized. At physical examination manual assessment of shoulder muscle strength was found 2/5. Pain measured by the Visual Analog Scale (VAS) value was 9. Electromyographic study and magnetic resonance imaging (MRI) revealed BP. In this case, MRI could not distinguish between a delayed radiation injury and tumor infiltration. The diagnosis was clarified with an PET and tumor infiltration was not detected. The VAS value improved from 9 before the medical treatment to 3 after gabapentin and amitriptilin treatment. The risk of BP after supraclavicular lymph node irradiation in breast cancer patients with shoulder pain remains constant for a considerable portion of the patient's life. Gabapentin and amitriptilin were a really useful treatment of pain due to BP.Öğe Reversible hepatocerebral degeneration-like syndrome due to portovenous shunts(2013) Güler S.; Utku U.; Tezel A.; Ünlü E.Ataxia and tremor are rare manifestations of hepatocerebral degeneration due to portovenous shunts. Ammonia is a neurotoxin that plays a significant role in the pathogenesis of hepatic encephalopathy. A 58-year old male patient was assessed with the complaints of gait disturbance, hand tremor, and impairment of speech. His neurological examination revealed dysarthric speech and ataxic gait. Bilateral kinetic tremor was noted, and deep tendon reflexes of the patient were hyperactive. Serum ammonia level was found to be 156.9 ?g/dL. Cranial magnetic resonance (MR) imaging revealed increased signal intensity in bilateral globus pallidus on T1-weighted axial sections, and bilateral prominent hyperintense lesions in the middle cerebellar peduncles on T2-weighted axial sections. On his abdominal MR portography, multiple portohepatic venous collaterals were noted in the right and left lobes of liver parenchyma in 2D FIESTA axial MR sections. To our knowledge, we reported the first case of acquired hepatocerebral degeneration presenting with cerebral symptoms without any hepatic findings in which clinical improvement was noted, and hyperammonemia disappeared following medical treatment.
