Hamamci A.,Sabanci University |
Kucuk N.,Anadolu Medical Center |
Karaman K.,Anadolu Medical Center |
Engin K.,Anadolu Medical Center |
Unal G.,Sabanci University
IEEE Transactions on Medical Imaging | Year: 2012
In this paper, we present a fast and robust practical tool for segmentation of solid tumors with minimal user interaction to assist clinicians and researchers in radiosurgery planning and assessment of the response to the therapy. Particularly, a cellular automata (CA) based seeded tumor segmentation method on contrast enhanced T1 weighted magnetic resonance (MR) images, which standardizes the volume of interest (VOI) and seed selection, is proposed. First, we establish the connection of the CA-based segmentation to the graph-theoretic methods to show that the iterative CA framework solves the shortest path problem. In that regard, we modify the state transition function of the CA to calculate the exact shortest path solution. Furthermore, a sensitivity parameter is introduced to adapt to the heterogeneous tumor segmentation problem, and an implicit level set surface is evolved on a tumor probability map constructed from CA states to impose spatial smoothness. Sufficient information to initialize the algorithm is gathered from the user simply by a line drawn on the maximum diameter of the tumor, in line with the clinical practice. Furthermore, an algorithm based on CA is presented to differentiate necrotic and enhancing tumor tissue content, which gains importance for a detailed assessment of radiation therapy response. Validation studies on both clinical and synthetic brain tumor datasets demonstrate 80%-90% overlap performance of the proposed algorithm with an emphasis on less sensitivity to seed initialization, robustness with respect to different and heterogeneous tumor types, and its efficiency in terms of computation time. © 2011 IEEE.
Erken H.Y.,Anadolu Medical Center |
Akmaz I.,Anadolu Medical Center |
Takka S.,Academic Hospital |
Kiral A.,Anadolu Medical Center
Journal of Hand Surgery: European Volume | Year: 2015
We performed a retrospective review of 12 patients with dorsal oblique and transverse amputations of the distal thumb who were treated with a volar cross-finger flap from the index finger. The mean patient follow-up period was 28 months postoperatively (range: 19-43 months). There were no instances of flap loss, infection, or donor site complication in our series. The mean Semmes-Weinstein monofilament testing scores on the injured thumb and the donor site were 0.65 g (range: 0.16-2 g) and 0.51 g (range: 0.16-1 g), respectively. The mean 2-point discrimination testing scores on the injured thumb and the donor site were 4.5 mm (range: 3-8 mm) and 4.3 mm (range: 3-7 mm), respectively. This study suggests that the volar cross-finger flap using the index finger is a reliable technique in repairing dorsal oblique and transverse amputations of the distal thumb.Type of study/level of evidence: Therapeutic IV © The Author(s) 2014.
Erken H.Y.,Anadolu Medical Center |
Takka S.,Academic Hospital |
Akmaz I.,Academic Hospital
Journal of Hand Surgery | Year: 2013
Purpose We report our experience, treatment protocol, and 2-year follow-up results of 24 fingertip replantations treated using the artery-only technique without vein or nerve repair. Methods We performed a retrospective review of 24 patients who had undergone fingertip replantation at the same center between 2005 and 2011. All patients in this study had complete fingertip amputation at or distal to the distal interphalangeal joint of the fingers or interphalangeal joint of the thumb. Patients with incomplete and complete amputations who had undergone vein and/or nerve repair along with artery repair were excluded. All patients received the same protocol including removal of the nail at the surgery and intravenous heparin 70 U/kg administered at the time of arterial anastomosis. After surgery, the nailbed was mechanically made to bleed with a sterile needle and mechanically scrubbed with a heparin-saline gauze. All patients received the same postoperative medical treatment protocol until physiological outflow was restored. Successful replantation was confirmed with clinical observation. Results Twenty-one of the 24 fingertip replantations (88%) were successful. The mean length of hospital stay was 7 days (range, 4-9 d). Fifteen of 22 patients required blood transfusion. The average amount of blood transfusion was 1.2 U (range, 0-3 U). Conclusions This study shows that the described technique and protocol reconstructed circulation without vein anastomosis and with a high success rate. Furthermore, adequate sensory recovery without any nerve repair had occurred by the 2-year follow-up. Type of study/level of evidence Therapeutic IV. © 2013 by the AmericanSociety for Surgery of the Hand. All rights reserved.
Okmen A.S.,Istanbul Memorial Hospital |
Okmen E.,Anadolu Medical Center
Turk Kardiyoloji Dernegi Arsivi | Year: 2010
Split right coronary artery (RCA) is a congenital anomaly of the coronary arteries where either two separate arteries arise from the aortic trunk or RCA bifurcates into two major arteries immediately after its origin from the right sinus of Valsalva. We present two cases (59-year-old male, 50-year-old female) who sought treatment for exercise-induced angina pectoris. Coronary angiography revealed a split RCA in both cases. In the first case, the RCA consisted of two well-developed arteries bifurcating immediately after its origin from the sinus of Valsalva. In the second case, the RCA split from adjacent ostia into two major arteries almost identical in size. In both cases, the split RCAs had a parallel course. Both patients were scheduled to receive medical treatment and had an uneventful follow-up of 15 and 11 months, respectively.
Hakko E.,Anadolu Medical Center |
Ozkan H.A.,Anadolu Medical Center |
Karaman K.,Anadolu Medical Center |
Gulbas Z.,Anadolu Medical Center
Transplant Infectious Disease | Year: 2013
Introduction: Cerebral toxoplasmosis is a rare but fatal complication in hematopoietic stem cell transplant patients, which mostly is caused by reactivation of latent disease. Methods: In this study, we report an analysis of cerebral toxoplasmosis in a series of 170 allogeneic stem cell transplant patients during a 30-month period at our institution. Results: Among these allogeneic stem cell transplant patients, 5 were diagnosed with cerebral toxoplasmosis by brain magnetic resonance imaging and polymerase chain reaction of Toxoplasma gondii DNA. The incidence of cerebral toxoplasmosis was found to be 2.94%. Conclusion: Mortality rate is known to be very high in cerebral toxoplasmosis; therefore, it is life saving to diagnose the disease in the early stages and start treatment promptly, especially in high-endemic countries like Turkey. © 2013 John Wiley & Sons A/S.
Yetiser S.,Anadolu Medical Center |
Ince D.,Anadolu Medical Center
Otology and Neurotology | Year: 2015
Objectives To compare the diagnostic value of the head-bending test (HBT), lying-down positioning test (LDPT) and patient's report to identify the affected canal in video-nystagmographically (VNG) confirmed patients with lateral canal benign paroxysmal positional vertigo (LC-BPPV). Study Design Case series with chart review. Setting Head-bending, lying-down positioning and the head-roll maneuver (HRM) under VNG guidance. The data were collected in a referral community hospital. Patients Seventy-eight patients (32 apogeotropic and 46 geotropic nystagmus) with LC-BPPV who had been recruited between 2009 and 2013 were enrolled in the study. Main Outcome Measures Patients were tested with the HRM and then were asked about subjectively worse side. Later, they were subjected to HBT when sitting and the LDPT. The results were compared and studied with the 1-way ANOVA and chi-square tests. Statistical significance was set at p < 0.05. Results Affected side was identified by HRM in 75% of patients with apogeotropic nystagmus and 95.6% of patients with geotropic nystagmus. Approximately 65.6% of patients with apogeotropic and 52% of patients with geotropic nystagmus had nystagmus during LDPT. However, its comparability with HRM was low. However, treatment plan based on LDPT results alone provided relief of symptoms in additional 12.5% of patients with apogeotropic and in 2.2% of patients with geotropic nystagmus. Approximately 63% of patients with apogeotropic and 56% of patients with geotropic nystagmus were able to tell the worse side. Nystagmus comparable with HRM during HBT was low and not diagnostic. Conclusion HRM has the greatest diagnostic value of positioning tests in LC-BPPV in this study. LDPT provides some contribution in the diagnosis of LC-BPPV but much less than HRM. Patients' subjective feeling of vertigo was also a useful test. However, HBT was not as sensitive as other measures in uncertain cases. © 2015, Otology & Neurotology, Inc.
Oktenli C.,Anadolu Medical Center |
Celik S.,GATA Haydarpasa Training Hospital
International Journal of Hematology | Year: 2012
Familial Mediterranean fever is an autosomal recessive disease occurring in populations originating from the Mediterranean basin. This autoinflammatory syndrome is caused by mutations in the Mediterranean FeVer (MEFV) gene. MEFV encodes a 781 amino acid protein known as pyrin. Pyrin is an important modulator of apoptosis, inflammation, and cytokine processing. In more recent pilot studies, inherited variant analysis of the MEFV gene in patients with hematologic neoplasm showed an unexpectedly high frequency of these variants in the gene. Here, we summarize the current state of knowledge of the relationship between inherited variants in the MEFV gene and hematologic neoplasms. Although no single underlying defect could be targeted in all hematologic neoplasms, it will be important to fully exploit the mechanisms underlying the neoplasm promoting role of inherited variants in MEFV. However, it is unclear how inherited variants in the MEFV gene are associated with tumor susceptibility or promotion in hematologic neoplasms. Further investigations are needed to determine the actual role of the MEFV gene in pathogenesis of these neoplasms. © 2012 The Japanese Society of Hematology.
Yakar H.K.,Anadolu Medical Center |
Pinar R.,Yeditepe University
Asian Pacific Journal of Cancer Prevention | Year: 2013
Background: Measuring effects of cancer on family caregivers is important to develop methods which can improve their quality of life (QOL). Nevertheless, up to now, only a few tools have been developed to be used in this group. Among those, the Caregiver Quality of Life Index-Cancer Scale (CQOLC) has met minimum psychometric criteria in different populations in spite of conflicting results. The present study was conducted to evaluate reliability and validity of CQOLC among Turkish cancer family caregivers. Materials and Methods: The CQOLC was administered to 120 caregivers, along with Beck Depression Inventory (BDI), Medical Outcomes Study MOS 36- Item Short Form Health Survey (SF-36), State-Trait Anxiety Inventory (STAI), and Multidimensional Scale of Perceived Social Support (MSPSS). Internal consistency and test-retest stability were used to investigate reliability. Construct validity was examined by using known group method, convergent, and divergent validity. For the known group method, we hypothesized that CQOLC scores would differ between depressed and non-depressed subjects. We investigated convergent validity by correlating scores for CQOLC with scores for other similar measures including SF-36 and STAI. The MSPSS was completed at the same time as CQOLC to provide divergent validity. Results: The values for internal consistency and test-retest correlation were 0.88 and 0.96, respectively. The CQOLC discriminated those who were depressed from those who were not. Convergent validity supported strong correlations between CQOLC scores and two main component scores (PCS, MCS) in SF-36 although there was a weak correlation between CQOLC and STAI scores. Regarding divergent validity, the correlation between CQOLC and MSPSS was in the low range, as expected. Conclusions: The Turkish CQOLC is a reliable and valid tool and it can be utilized to determine QOL of family caregivers.
Erken H.Y.,Anadolu Medical Center |
Ofluoglu O.,Dr Lutfi Kirdar Kartal Training And Research Hospital |
Aktas M.,Istanbul University |
Topal C.,Dr Lutfi Kirdar Kartal Training And Research Hospital |
Yildiz M.,Dr Lutfi Kirdar Kartal Training And Research Hospital
International Orthopaedics | Year: 2012
Purpose: Pentoxifylline (PTX) is a derivative of methylxanthine and is used in peripheral vascular and cerebrovascular diseases for its effect on the regulation of blood circulation. We investigated whether PTX could be beneficial for femoral head osteonecrosis associated with steroid through these effects. Methods: Sixty mature Leghorn type chickens were chosen and divided into three groups. The 25 chickens in group A were given a weekly dose of 3 mg/kg/week methylprednisolone acetate intramuscularly. Four chickens in group B died after the first drug injection and were excluded from the study. Therefore, the remaining 21 chickens in group B were additionally given 25 mg/kg/day pentoxifylline intramuscularly, along with the steroid medication as given in group A. The ten chickens in group C were not given any injections, as they were accepted as the control group. After the sacrifice of the animals at week 14, both femoral heads were taken from each animal. The animals which died along the course of the study also underwent pathological examination but were not a part of the statistical analysis. Results: In this study, steroid induced femoral head osteonecrosis has been experimentally observed in chickens after high doses of corticosteroid therapy. The chickens were given pentoxifylline in order to prevent the effects of steroid on bones and bone marrow. The results showed that chickens are suitable osteonecrosis models, and that steroid causes adipogenesis and necrosis in the bone marrow and the death of the subchondral bone. Conclusions: The results of this study hint at the assumption that PTX may have a positive benefit on ONFH. PTX seems to minimise the effects of the steroid and reduce the incidence of ONFH. © Springer-Verlag 2012.
Yetiser S.,Anadolu Medical Center
Balkan Medical Journal | Year: 2015
Background: Carotid artery abnormality in the middle ear is a rare clinical condition. Recognition of the problems related with this abnormality is important since it may mimic vascular tumors. Any intervention with incomplete evaluation can be fatal. Case Report: A 23-year-old girl with carotid abnormality and sensorineural hearing loss, unsteadiness and tinnitus is presented. She was followed for 2 months elsewhere assuming that she had Meniere’s disease and had previously received some medication for otitis media with effusion. Conclusion: Tomography and magnetic resonance imaging of the temporal bone are very helpful for visualization of an aberrant carotid in the middle ear. Radiological presentations are the reduced caliber of the aberrant carotid, an absence of cranial opening of carotid canal, tubular coursing along the medial wall of the middle ear in continuity with the horizontal carotid canal, dehiscence of the lateral carotid plate and enlargement of the tympanic canalicus. © 2015 Trakya University Faculty of Medicine.