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Kocer N.,Istanbul University | Islak C.,Istanbul University | Kizilkilic O.,Istanbul University | Kocak B.,Istanbul University | And 2 more authors.
Journal of Neurosurgery | Year: 2014

Object. Flow diverter (FD) stents are relatively new and important devices in the treatment of cerebral aneurysms. The Flow Re-Direction Endoluminal Device has been recently released for clinical use. The authors' aim in this paper is to report their initial single-center FRED experience with short-term results. Methods. Between February 2012 and May 2013, 33 patients with 37 aneurysms (35 unruptured and 2 previously ruptured aneurysms) were treated with the FRED. Clinical and radiological data of the patients were retrospectively reviewed. Results. In all patients only 1 device was used without any additional device or material, such as a stent or coil. All procedures were successfully performed. The procedural complication rate was 3% (1 of 33). Thirty patients underwent clinical and radiological follow-up. During the follow-up period, changes in stent morphology, such as "fish mouth" and "foreshortening" phenomena, occurred in 5 patients. The mortality and permanent morbidity rates were 0%. The complete occlusion rates were 32% (6 of 19) at 0-1 month, 67% (8 of 12) at 2-3 months, 80% (4 of 5) at 4-6 months, and 100% (8 of 8) at 7-12 months. The rates for some aneurysms were assessed at more than one time point. Conclusions. The FRED has an ability to serve neurointerventionalists in the treatment of cerebral aneurysms with its different technical advantages. The occlusion rates with FRED are similar to those with other FD devices. However, these short-term results need to be confirmed with mid- and long-term follow-up results of multicenter large series. ©AANS, 2014.


De Luca Canto G.,Federal University of Santa Catarina | De Luca Canto G.,University of Alberta | Pacheco-Pereira C.,University of Alberta | Aydinoz S.,GATA Haydarpasa Teaching Hospital | And 5 more authors.
Sleep Medicine Reviews | Year: 2015

The overall validity of biomarkers in the diagnosis of obstructive sleep apnea (OSA) remains unclear. We conducted a scoping review to provide assessments of biomarkers characteristics in the context of obstructive sleep apnea (OSA) and to identify gaps in the literature. A scoping review of studies in humans without age restriction that evaluated the potential diagnostic value of biological markers (blood, exhaled breath condensate, salivary, and urinary) in the OSA diagnosis was undertaken. Retained articles were those focused on the identification of biomarkers in subjects with OSA, the latter being confirmed with a full overnight or home-based polysomnography (PSG). Search strategies for six different databases were developed. The methodology of selected studies was classified using an adaptation of the evidence quality criteria from the American Academy of Pediatrics. Additionally the biomarkers were classified according to their potential clinical application. We identified 572 relevant studies, of which 117 met the inclusion criteria. Eighty-two studies were conducted in adults, 34 studies involved children, and one study had a sample composed of both adults and children. Most of the studies evaluated blood biomarkers. Potential diagnostic biomarkers were found in nine pediatric studies and in 58 adults studies. Only nine studies reported sensitivity and specificity, which varied substantially from 43% to 100%, and from 45% to 100%, respectively. Studies in adults have focused on the investigation of IL-6, TNF-α and hsCRP. There was no specific biomarker that was tested by a majority of authors in pediatric studies, and combinatorial urine biomarker approaches have shown preliminary promising results. In adults IL-6 and IL-10 seem to have a favorable potential to become a good biomarker to identify OSA. © 2014 Elsevier Ltd.


Kendirli M.T.,University of Virginia | Kendirli M.T.,GATA Haydarpasa Teaching Hospital | Rose D.T.,University of Virginia | Bertram E.H.,University of Virginia
Epilepsia | Year: 2014

Objective Penetrating brain injury (PBI) has the highest risk for inducing posttraumatic epilepsy, and those PBIs with retained foreign materials such as bullet fragments carry the greatest risk. This study examines the potential contribution of copper, a major component of bullets, to the development of epilepsy following PBI. Methods Anesthetized adult male rats received a penetrating injury from the dorsal cortex to the ventral hippocampus from a high speed small bit drill. In one group of animals, copper wire was inserted into the lesion. Control animals had only the lesion or the lesion plus stainless steel wire (biologically inert foreign body). From 6 to up to 11 months following the injury the rats were monitored intermittently for the development of epilepsy with video-electroencephalography (EEG). A separate set of animals was examined for possible acute seizures in the week following the injury. Results Twenty-two of the 23 animals with copper wire developed chronic epilepsy, compared to three of the 20 control rats (lesion and lesion with stainless steel). Copper was associated with more extensive injury. The control rats with epilepsy had larger lesions. In the acute injury group, there was no difference in the incidence of seizures (83% lesion plus stainless steel, 70% lesion plus copper). Significance Copper increases the risk for epilepsy and may increase damage over time, but there were no differences between the groups in the incidence of acute postinjury seizures. Lesion size may contribute to epilepsy development in lesion-only animals. Copper may be an independent risk factor for the development of epilepsy and possible secondary injury, but lesion size also contributes to the development of epilepsy. The consequences of prolonged exposure of the brain to copper observed in these animals may have clinical implications that require further evaluation. © Wiley Periodicals, Inc. © 2014 International League Against Epilepsy.


Yildiz H.,GATA Haydarpasa Teaching Hospital | Karabudak O.,GATA Haydarpasa Teaching Hospital | Dogan B.,GATA Haydarpasa Teaching Hospital | Harmanyeri Y.,GATA Haydarpasa Teaching Hospital
British Journal of Dermatology | Year: 2011

Background The pathophysiological mechanism of chronic urticaria is still poorly understood and its aetiology is considered to have an autoreactive basis. Autologous serum skin tests (ASSTs) and autologous plasma skin tests (APSTs) comprise the simplest ways for diagnosing autoreactive urticaria (with autoantibodies, histamine-releasing factor and coagulation factors, especially thrombin) in a clinical setting. However, there are still some questions about the specificity of these tests. Objectives To evaluate the role of autoreactivity in the pathogenesis of chronic urticaria by means of measuring plasma prothrombin fragments 1 + 2, which are used as markers of thrombin, and to compare the APST with the ASST. Methods Forty-two patients (19 men and 23 women; mean age 35·7 years, range 28-76) and 35 healthy volunteers (19 men and 16 women; mean age 30·3 years, range 20-80) were included in the study. APST, negative (ASST, sodium citrate, saline) and positive (histamine) control tests were performed in the patient and control groups. The levels of plasma prothrombin fragments 1 + 2 were also assessed. Results When the APST was evaluated without negative controls, it was positive in 67% of patients. However, the APST was positive in 0% when it was evaluated with negative controls. Levels of prothrombin fragments 1 + 2 were found to be elevated in patients with chronic idiopathic urticaria. Conclusions We suggest that as negative control tests were not performed along with the APST in previous studies, the APST showed a high rate of positivity. Thus, the use of APST for evaluating autoreactivity in clinical practice is not superior to the use of ASST and further studies should be conducted. © 2011 British Association of Dermatologists.


Mutluoglu M.,Gulhane Military Medical Academy Haydarpasa Teaching Hospital | Uzun G.,Gulhane Military Medical Academy Haydarpasa Teaching Hospital | Turhan V.,GATA Haydarpasa Teaching Hospital | Gorenek L.,GATA Haydarpasa Teaching Hospital | And 2 more authors.
Journal of Diabetes and its Complications | Year: 2012

Purpose: To assess the reliability of cultures of superficial swabs (SS) by comparing them with cultures of concomitantly obtained deep tissue (DT) specimens in patients with diabetic foot ulcers. Methods: We reviewed clinical and microbiological data from patients with diabetes who presented during a two-year period to our hyperbaric medicine center with a foot ulcer. We identified patients who had at least one concomitantly collected SS and DT pair of specimens sent for culture. Results: A total of 89 culture pairs were available from 54 eligible patients, 33 (61.1%) of whom were hospitalized. Wounds were infected in 47 (87.0%) of the patients and 28 (51.9%) patients had received antibiotic therapy within the previous month. Overall, 65 (73%) of the SS and DT pairs had identical culture results, but in 11 (16.9%) cases the cultures were sterile; thus, only 54 (69.2%) of the 78 culture-positive pairs had identical results. Compared with DT, SS cultures yielded ≥ 1 extra organism in 10 (11.2%) cases, missed at least one organism in 8 (9.0%), and were completely different in 6 (6.7%). When compared to DT culture results, SS cultures had a positive predictive value of 84.4%, negative predictive value of 44.0%, and overall accuracy of 73.0%. Conclusions: In patients with diabetic foot ulcers, results of specimens for culture taken by SS did not correlate well with those obtained by DT. This suggests that SS specimens may be less reliable for guiding antimicrobial therapy than DT specimens. © 2012 Elsevier Inc. All rights reserved.


Mutlu H.,GATA Haydarpasa Teaching Hospital | Sivrioglu A.K.,GATA Haydarpasa Teaching Hospital | Sonmez G.,GATA Haydarpasa Teaching Hospital | Velioglu M.,GATA Haydarpasa Teaching Hospital | And 3 more authors.
Clinical Imaging | Year: 2012

Objective: The purpose of the study was to differentiate between benign and malignant thyroid nodules using nodule-spinal cord signal intensity and nodule apparent diffusion coefficient (ADC) ratios on diffusion-weighted magnetic resonance imaging (DW-MRI). Materials and Methods: Forty-four patients (27 females, 17 males; mean age, 49 years) with nodules who underwent DW-MRI were included in this study. The images were acquired with 0, 50, 400 and 1000 s/mm 2 b values. ADC maps were calculated afterwards. Fine needle aspiration biopsies (FNAB) were performed at the same day with DW-MRI acquisition. The diagnosis in patients where malignity was detected after FNAB was confirmed by histopathologic analysis of the operation material. The signal intensities of the spinal cord and the nodule were measured additionally, over b-1000 diffusion-weighted images. Nodule/cord signal intensity (SI) ratios were obtained and the digital values were calculated by dividing to ADC values estimated for each nodule. Statistical analysis was performed. Results: The (nodule SI-cord SI)/nodule ADC ratio is calculated in the DW images, and a statistically significant relationship was found between this ratio and the histopathology of the nodules (P<.001). The ratio was determined as 0.27 in benign and 0.86 in malignant lesions. The result of receiver operating characteristic (ROC) analysis was statistically significant, and the area under curve (100%) was considerably high. The threshold value was calculated as 0.56 according to the ROC analysis. According to this threshold value, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rates for (nodule SI/cord SI)/ADC ratios in differentiating benign from malignant thyroid nodules are calculated as 100%, 97%, 83%, 100%, and 98%, respectively. Conclusion: We have found that (nodule/cord SI)/nodule ADC ratio has the highest values for sensitivity and specificity among the tests defined for characterization of nodules. © 2012 .


Dogan B.,GATA Haydarpasa Teaching Hospital | Karabudak O.,GATA Haydarpasa Teaching Hospital | Basekim C.,GATA Haydarpasa Teaching Hospital | Karabacak E.,Kasimpasa Navy Hospital
European Journal of Dermatology | Year: 2010

The first case demonstrating the association of a port wine stain with pneumosinus dilatans was reported in 2003 by Dogan B et al. The current study is an extension of that case report, attempting to demonstrate that the association of pneumosinus dilatans and port wine stain is clinically significant and warrants clinical evaluation in patients with port wine stains. We aimed to evaluate the patients with or without facial port wine stains if they had pneumosinus dilatans. Twenty-three patients with port-wine stains, and 20 controls without port wine stains were compared. Facial CT scan were performed on each of the 43 subjects and analysed for radiological evidence of pneumosinus dilatans. A grading system was used to assess the extent of sinus enlargement noted on CT. Statistical analysis was also done. Ten out of 20 controls had minimal enlargement, 22 out of 23 patients with a port-wine stain had minimal to marked enlargement. The differences of having pneumosinus dilatans or not and the severity of enlargement between controls and patients were statistically significant (p = 0.001; p = 0.00001 respectively) This study showed that the association of port wine stain and pneumosinus dilatans was not a coincidence and the diminished density of peristructural nerves might be the common cause of these two pathological conditions, especially when they are together.


Mutluoglu M.,GATA Haydarpasa Teaching Hospital | Sonmez G.,GATA Haydarpasa Teaching Hospital | Sivrioglu A.K.,GATA Haydarpasa Teaching Hospital | Ay H.,GATA Haydarpasa Teaching Hospital
Acta Orthopaedica Belgica | Year: 2012

Transient osteoporosis of the hip (TOH) is a rare clinical condition with usually an unknown aetiology and which typically develops in middle-aged men, or in women in the third trimester of their pregnancy. It is characterized by transient osteopenia and by gradually increasing pain associated with a limitation of the range of motion of the hip. Bone marrow oedema is a typical but nonspecific finding in TOH. A 33-year-old female patient presented with severe hip pain one month after delivery. Her history was unremarkable except for a Hashimoto's Disease of 8 years' duration. Magnetic resonance imaging (MRI) showed significant bone marrow oedema with increased signal intensity in the femoral head on T2-weighted images. A diagnosis of TOH was made and the patient received a total of 30 sessions of hyper-baric oxygen (HBO) at 2.4 ATA, 2 hours each, in a multiplace chamber. Over the course of HBO treatment, her pain was gradually relieved and she became asymptomatic after one month together with a complete recovery of the range of motion of the hip. MRI of the hips 10 weeks after onset of HBO therapy showed normal signal intensity on T2-weighted images. © 2012, Acta Orthopædica Belgica.


Velioglu M.,GATA Haydarpasa Teaching Hospital | Kizilkilic O.,Istanbul University | Selcuk H.,BakIrkoy Sadi Konuk Research and Education Hospital | Kocak B.,Istanbul University | And 3 more authors.
Neuroradiology | Year: 2012

Introduction: Endovascular treatment of intracranial aneurysms has been an effective treatment option. In this paper, we report our experience with the Silk stent (SS) for endovascular treatment of complex intracranial aneurysms and present periprocedural events, immediate results, delayed complications, and imaging and clinical follow-up results. Methods: We retrospectively examined angiographic images and clinical reports of 76 consecutive patients with 87 intracranial aneurysms who were treated with SSs between March 2008 and June 2011. Results: All aneurysms could be successfully covered technically using implanted SSs, with an overall mortality of 6.6 %. Two transient morbidities (2.6 %) and three permanent morbidities due to embolic events (3.9 %) were observed. Unexpected procedural technical events occurred in 18 procedures (18/78, 23.1 %). Control angiographies were performed in all 71 patients with 82 aneurysms (100 %). Mean angiographic follow-up time was 17.5 ± 11.1 months [range 2-48 months]. Sixteen of the 71 patients with 19 aneurysms had only early angiographic controls in the first 6 months while remaining 55 patients with 63 aneurysms (77.5 %) had late controls after 6 months. Overall control angiographic occlusion rates were as follows: 87.8 % (72/82) total occlusion, 8.5 % residual aneurysm filling, and 3.7 % residual neck filling. The general in-stent stenosis rate in controls was 5.6 % and the stented parent artery occlusion rate was 4.2 %. Five (6.6 %) aneurysms ruptured after stent implantation in our series. Conclusion: The Silk stent is an effective tool for the treatment of challenging aneurysms, which have previously demonstrated higher re-growth rates and technical problems, despite unexpected higher hemorrhage rates after treatment and deployment difficulties. © 2012 Springer-Verlag.


De Luca Canto G.,Federal University of Santa Catarina | De Luca Canto G.,University of Alberta | Pacheco-Pereira C.,University of Alberta | Aydinoz S.,GATA Haydarpasa Teaching Hospital | And 4 more authors.
Journal of Clinical Sleep Medicine | Year: 2015

Objective: The purpose of this systematic review is to evaluate the diagnostic value of biological markers (exhaled breath condensate, blood, salivary and urinary) in the diagnosis of OSA in comparison to the gold standard of nocturnal PSG. Methods: Studies that differentiated OSA from controls based on PSG results, without age restriction, were eligible for inclusion. The sample of selected studies could include studies in obese patients and with known cardiac disease. A detailed individual search strategy for each of the following bibliographic databases was developed: Cochrane, EMBASE, MEDLINE, PubMed, and LILACS. The references cited in these articles were also crosschecked and a partial grey literature search was undertaken using Google Scholar. The methodology of selected studies was evaluated using the 14-item Quality Assessment Tool for Diagnostic Accuracy Studies. Results: After a two-step selection process, nine articles were identified and subjected to qualitative and quantitative analyses. Among them, only one study conducted in children and one in adults found biomarkers that exhibit sufficiently satisfactory diagnostic accuracy that enables application as a diagnostic method for OSA. Conclusion: Kallikrein-1, uromodulin, urocotin-3, and orosomucoid-1 when combined have enough accuracy to be an OSA diagnostic test in children. IL-6 and IL-10 plasma levels have potential to be good biomarkers in identifying or excluding the presence of OSA in adults. © 2015 Clinical Sleep Medicine.

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