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Ceylan D.,Marmara University | Ceylan D.,Sakarya University | Tatarli N.,Marmara University | Tatarli N.,Drlutfi Kirdar Kartal Education And Research Hospital | And 8 more authors.
Acta Neurochirurgica | Year: 2012

Background It is widely believed that the main function of denticulate ligaments (DLs) is to stabilize the spinal cord within the vertebral canal. The aim of this study was to assess the anatomical and histological structure of the DLs and to document any regional differences. Methods Five formalin-fixed adult cadavers were used. The DLs were exposed via the posterior approach, and detailed anatomy and histology of these structures were documented. Results The main findings were: (1) each DL is composed of a single narrow fibrous strip that extends from the craniovertebral junction to T12, and each also features 18-20 triangular extensions that attach to the dura at their apices; (2) the triangular extensions are smaller and more numerous at the cervical levels, and are larger and less numerous at the thoracic levels; (3) the apices of the extensions attach to the dura via fibrous bands at cervical levels (each band 3-5 mm long) and lower thoracic levels (21-26 mm long), whereas they attach directly to the dura at upper thoracic levels; (4) the narrow fibrous strip of the DL features longitudinally oriented collagen fibers, whereas the triangular extensions are composed of transverse and obliquely oriented collagen fibers. The collagen fibers are thicker and more abundant at the cervical than at the thoracic levels. Conclusion DL histology and anatomy are strongly correlated with the function of this structure at different spinal levels. It is important to have accurate knowledge about DLs as these structures are relevant for clinical procedures that involve the spinal cord or craniovertebral junction. © Springer-Verlag 2012.

Cesur S.,Ankara Nuclear Research And Training Center | Yildiz E.,Ankara Nuclear Research And Training Center | Irmak H.,Ankara Nuclear Research And Training Center | Gulay Z.,Dokuz Eylul University | And 8 more authors.
Turkiye Klinikleri Journal of Medical Sciences | Year: 2012

Objective: The aim of this study was to determine the frequency of metallobeta-lacta- mase (MBL) enzyme in Pseudomonas aeruginosa strains resistant to carbapenem (imipenem or/and meropenem) in seven regions of Turkey and to assess the minimal inhibitory concentration (MIC) levels of drugs used in treatment such as colistin, aztreonam, polymyxin B and rifampin. Overall 186 Pseudomonas aeruginosa (P.aeruginosa) strains resistant to carbapenem from 8 provinces (Ankara, Konya, Antalya, İstanbul, İzmir, Diyarbaki{dotless}r, Van and Trabzon) representing 7 different geographical regions of Turkey were included in the study. Material and Methods: The presence of MBL in P. aeruginosa strains resistant to carbapenem was investigated by combined disk methods with imipenem and EDTA absorbed imipenem disk. The MBL positivity was determined in the strains. Additionally, susceptibility to aztreonam, colistin, polymyxin B, and rifampin was established by the E-test method. Results: MBL enzyme positivity was detected in 58 out of 186 strains (31.2%). There was statistically significant difference between regions in terms of MBL positivity, with the highest rates in Antalya (52%), and İstanbul (50%) and the lowest in Diyarbaki{dotless}r (6%). Aztreonam sensitivity was detected in 134 (72%) strains; 155 (83.3%) were sensitive to colistin and 148 (79.6%) to polymixine. No strain (0%) was sensitive to rifampin. Conclusion: In conclusion, the overall mean rate of MBL positivity was 31.2%, which is quite high. Therefore, it will be beneficial to confirm the MBL positivity of strains with molecular methods, to review regional antibiotic surveillance data at certain intervals and to share the obtained data with relevant institutions in order to prevent the regional spread of these strains. Thus, it is essential to record and monitor systematically the antibiotic surveillance data. © 2012 by Türkiye Klinikleri.

Mayadagli A.,Dr Lutfi Kirdar Kartal Education And Research Hospital | Gul S.K.,Dr Lutfi Kirdar Kartal Education And Research Hospital | Bilici A.,Istanbul University | Oruc A.F.,Dr Lutfi Kirdar Kartal Education And Research Hospital | And 5 more authors.
Journal of B.U.ON. | Year: 2014

Purpose: Akt, also known as protein kinase B (PKB), is an intracellular signal transduction protein activated by growth hormones. PKB/Akt is frequently activated in a variety of cancer types, but its role in the development and progression of lung cancer has not been completely elucidated yet. The aim of the present study was to determine the prognostic value of PKB/Akt in non-small cell lung cancer (NSCLC). Methods: A total of 32 tumor samples from NSCLL patients were examined before treatment. The staining characteristics of the cases were evaluated in terms of age, stage (T and N), response to therapy, histological type, tumor size, and ECOG performance status (PS). Results: No statistical correlation was found between PKB/ Akt expression and gender, ECOG PS and stage (T and N), while significant correlation between cytoplasmic PKB/akt expression and age was detected (p<0.05). In addition, squamous cell carcinoma histology was significantly associated with both nuclear and cytoplasmic staining (p=0.033), and tumor size ( <5 cm) was correlated with nuclear PKB/Akt expression (p=0.03). Both overall survival (OS) and progression-free survival (PFS) were similar in patients with and without both nuclear and cytoplasmic PKB/Akt expression. Conclusion: Our results showed that although PKB/Akt was not associated with survival in NSCLC patients, it may be a potential therapeutic target for NSCLC; more studies with higher numbers of patients are needed to verify this hypothesis.

Misirlioglu A.,Drlutfi Kirdar Kartal Education And Research Hospital | Misirlioglu A.,Dr Lutfi Kirdar Kartal Education And Research Hospital | Karaca M.,Drlutfi Kirdar Kartal Education And Research Hospital | Avci G.,Canakkale Onsekiz Mart University | Akoz T.,Drlutfi Kirdar Kartal Education And Research Hospital
Journal of Craniofacial Surgery | Year: 2011

Axial pattern flaps are characterized by a single vascular pedicle that supplies the whole flap and carry the danger of flap loss. For this reason, monitoring and early identification of vascular perfusion is important for flap prognosis. The most commonly used method for flap monitoring is clinical assessment, but it has certain limitations. The bioelectrical properties of tissues can be affected by ischemic conditions, and a preliminary study showed that the bioelectrical resistance of blood was decreased under thrombotic conditions. In this controlled study, the resistance values of the axial flaps were calculated during thrombosis. A total of 28 rats were randomly divided into a control group (n = 14) and an experimental group (n = 14). Axial flaps were elevated based on the inferior epigastric pedicle. For the ischemic group, microvascular clamps were placed in the ischemic group to produce artificial thrombosis from day 1 of the experiment. Bioelectrical resistance was measured every 30 minutes for the first 6 hours and then daily after that. The resistance values from the ischemic group decreased progressively, and 150 minutes after the clamping, the difference became statistically significant (P < 0.05). The results showed that the assessment of flap resistance is a valuable tool and may allow early recognition of a compromise in the vascular system before clinical signs become obvious. Copyright © 2011 by Mutaz B. Habal, MD.

Bilici A.,Drlutfi Kirdar Kartal Education And Research Hospital | Dane F.,Marmara University | Seker M.,Drlutfi Kirdar Kartal Education And Research Hospital | Ustaalioglu B.B.O.,Drlutfi Kirdar Kartal Education And Research Hospital | And 9 more authors.
Digestive Diseases and Sciences | Year: 2011

Background: The prognostic significance of the subclassification of pT2 tumors and the association of these categories with other clinicopathological factors in gastric cancer patients were investigated. Methods: A total of 224 patients with pT2 gastric cancer who had undergone curative gastrectomy and lymph node dissection were retrospectively analyzed. The prognostic role of the subclassification of pT2 tumors was evaluated by univariate and multivariate analysis. Results: Of 224 patients, 75 (33.5%) were classified as having pT2a tumors and 149 (66.5%) as having pT2b tumors. The prevalence of large-sized tumors (P < 0.003), lymph node involvement (P < 0.018), and lymphatic (P = 0.016), blood vessel (P = 0.001), and perineural invasion (P = 0.001) was significantly higher for pT2b tumors than for pT2a tumors. The rate of recurrence for pT2a cancers was significantly lower than that for pT2b cancers (P = 0.001).Median overall survival (OS) times and three-year OS of patients with a pT2b tumor were significantly worse than for patients with a pT2a tumor (P < 0.001).When patients were analyzed according to lymph node involvement, the prognosis of patients with pT2aN 1 cancers was significantly better than that of patients with pT2bN 1 (P < 0.001). Multivariate analysis indicated that the pT2 subdivision was an independent prognostic factor for OS (P = 0.006), as were pN stage, clinical stage, and recurrence. Conclusion: Our results showed that subclassification of pT2 tumors into pT2a or pT2b was an important prognostic indicator for patients with pT2 gastric cancers who underwent curative gastrectomy. In the TNM staging system, subdivision of pT2 tumors should be undertaken routinely to detect gastric cancer patients who have a poor prognosis and to define patients more accurately in terms of their mortality after curative resection in accordance with the new 2010 AJCC TNM staging classification. This may also help as a guide to more appropriate therapy for tumors with subserosal invasion (old pT2b or new pT3). © 2011 Springer Science+Business Media, LLC.

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