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Gurleyik G.,Haydarpasa Numune Teaching and Research Hospital | Aktekin A.,Haydarpasa Numune Teaching and Research Hospital | Aker F.,Haydarpasa Numune Teaching and Research Hospital | Karagulle H.,Haydarpasa Numune Teaching and Research Hospital | Saglam A.,Haydarpasa Numune Teaching and Research Hospital
Journal of Breast Cancer | Year: 2012

Purpose: Idiopathic granulomatous lobular mastitis (IGLM) is a rare chronic inflammatory disease of the breast with obscure etiology that mimics invasive carcinoma both clinically and radiologically. The treatment of IGLM remains controversial. The aim of proper management is to use a combination of medical and surgical treatment of this benign condition to achieve a good cosmetic result and low recurrence rate. Methods: A retrospective analysis of 19 patients with IGLM is performed based on the findings of clinical, radiological, and pathological examinations. The results of two treatments are presented: medical treatment with oral corticosteroids, and consecutive surgical excision after a follow-up period of 20 months (range, 6-75 months). Results: The majority of patients treated in this paper were young (mean, 34 years) parous women with a history of hormonal medication use. The main clinical finding is large, irregular, and painful mass. Hypoechoic lobulated, irregular tubular or oval shaped masses had been imaged by ultrasound. Mammographic findings were an ill-defined mass, enlarged axillary lymph nodes, asymmetric density, and architectural distortion. Diagnoses of IGLM had been established by cytological or histological examination. Symptoms subside and inflammatory changes regressed with medical treatment. The remaining lesions were excised by consecutive breast conserving surgery. The disease recurred in one patient during the follow-up period. Conclusion: IGLM is an inflammatory breast disease found in young women who present with a large painful irregular mass, which mimics carcinoma, as a physical change. Breast imaging modalities are not helpful to differentiate IGLM from invasive cancer. The correct diagnosis is established by cytological or histological examination. Medical treatment with corticosteroids provides significant regression of the inflammatory disease, allowing more conservative surgery. Consecutive surgical excision of the remaining lesions with good cosmetic results provides definitive treatment and reduces the risk of recurrence. © 2012 Korean Breast Cancer Society. All rights reserved.

Hakan T.,Memorial Ataehir Hospital | Aker F.V.,Haydarpasa Numune Teaching and Research Hospital
Folia Neuropathologica | Year: 2016

Rosette-forming glioneuronal tumour (RGNT) of the fourth ventricle is one of the newly described primary tumours of the central nervous system. These tumours have two components of both neurocytic and glial areas but usually the glial component of the tumour predominates. They have biphasic cytoarchitecture with two elements; neurocytic rosettes resembling Homer-Wright rosettes, and astrocytic component resembling a pilocytic astrocytoma. They are low-grade tumours with lack of histopathological signs of malignancy. Here, clinical, magnetic resonance, computed tomography (CT) and pathological features of rosette-forming glioneuronal tumour of posterior fossa are presented. A 29-year-man was admitted with an acute neurological deterioration. A three ventricular hydrocephalus and a hypo-density around vermis in the posterior fossa were seen in his CT scans. He did well after an emergency external ventricular drainage. He had an elective operation and a mass that was reported to be a rosette-forming glioneuronal tumour of the fourth ventricle was excised.

Hakan T.,Haydarpasa Numune Teaching and Research Hospital | Toklu H.Z.,Marmara University | Biber N.,Haydarpasa Numune Teaching and Research Hospital | Ozevren H.,Haydarpasa Numune Teaching and Research Hospital | And 3 more authors.
Neurological Research | Year: 2010

Objective: The overproduction of reactive oxygen species and resultant damage to cellular proteins or lipids of cell membranes and DNA by free radicals are the underlying mechanisms of many neuropathologies. Cyclooxygenase-2 (COX-2) inhibitors have been suggested to be neuroprotective by reducing prostanoid and free radical synthesis, or by directing arachidonic acid metabolism through alternate pathways. This study investigated the putative neuroprotective effect of the COX-2 inhibitor, meloxicam, in a rat model of diffuse brain injury. Methods: Sprague-Dawley rats were subjected to traumatic brain injury with a weight-drop device using 300 g-1 m weight-height impact. The groups were: control, meloxicam (2 mg/kg, i.p.), trauma and trauma + meloxicam (2 mg/kg, i.p.). Forty-eight hours after the injury, neurological examination scores were measured, the animals were decapitated and brain tissues were taken. Brain edema and blood-brain barrier (BBB) permeability were evaluated by wet-dry weight method and Evans blue (EB) extravasation respectively. In brain tissues, malonedialdehyde, glutathione, myeloperoxidase and Na/K-ATPase levels were measured. Results: The neurological examination scores mildly increased in trauma groups 48 hours after the induction of trauma. Meloxicam treatment improved the altered neurological status. The trauma caused a significant increase in brain water content that was partially reversed by meloxicam. Meloxicam also reduced the EB extravasation indicating the preservation of the BBB integrity. Meloxicam treatment also significantly reduced the increase in malondialdehyde and myeloperoxidase levels and restored glutathione content of the brains that had been significantly increased after trauma. Conclusion: Meloxicam exerts neuroprotective effect by preserving BBB permeability and by reducing brain edema (probably by its anti-inflammatory properties) in the diffuse brain injury model. © 2010 W. S. Maney & Son Ltd.

Atalay S.,Haydarpasa Numune Teaching and Research Hospital | Elci A.,Acibadem Hospital | Kayadibi H.,Iskenderun Military Hospital | Onder C.B.,Haydarpasa Numune Teaching and Research Hospital | Aka N.,Haydarpasa Numune Teaching and Research Hospital
Annals of Laboratory Medicine | Year: 2012

Background: We aimed to investigate the diagnostic utility of osteocalcin (OC), undercarboxylated osteocalcin (ucOC), and alkaline phosphatase (ALP) in pre- and postmenopausal women for femoral neck, L1-4, and L2-4 bone mineral density (BMD) values by taking into consideration their age, body mass index (BMI), and menopausal status. Methods: Premenopausal (N=40) and postmenopausal cases (N=42) were classified as 25-34 or 35-45 yr of age and within the first 5 yr or 5 yr or more after the onset of menopause, respectively. Results: Among the groups, statistical differences were found for age, BMI, OC, ucOC, ALP, femoral neck BMD, L1-4 BMD, and L2-4 BMD. The highest serum OC, ucOC, and ALP levels were observed in cases within the first 5 yr after the onset of menopause, probably due to a more rapid bone turnover rate. The best predictors for the femoral neck osteoporosis were ALP, OC, and calcium (areas under the ROC curve [AUC]=0.882, 0.829, and 0.761, respectively), and those for L1-4 and L2-4 osteoporosis were OC, ALP, and ucOC (AUC=0.949, 0.873, and 0.845; and 0.866, 0.819, and 0.814, respectively). Multiple logistic regression analysis revealed that the most discriminative parameter for osteoporosis was OC. Conclusions: These results indicate that serum OC levels, with or without ucOC and ALP, may be useful to monitor follow-up changes that currently cannot be assessed with BMD and to diagnose femoral neck, L1-4 spine, and L2-4 spine osteoporosis. © The Korean Society for Laboratory Medicine.

Gurleyik G.,Haydarpasa Numune Teaching and Research Hospital | Aker F.,Haydarpasa Numune Teaching and Research Hospital | Aktekin A.,Haydarpasa Numune Teaching and Research Hospital | Saglam A.,Haydarpasa Numune Teaching and Research Hospital
Journal of Breast Cancer | Year: 2011

Purpose: The negative sentinel lymph node (SLN) biopsy avoids conventional axillary dissection in patients with breast cancer with clinically negative axilla. Despite negative SLN, there is a risk of leaving involved non-SLN behind in the axilla. We investigated the predictive power of tumor characteristics for non-SLN metastasis. Methods: Lymphatic mapping with blue dye method for SLN biopsy and level 1-2 axillary dissections were performed to establish axillary status in 59 patients with T1 and T2 breast cancer and clinically negative axilla. Tumor's characteristics were histopathologically established to assess their association with non-SLN metastasis. Results: The axilla was malignant in 23 (39%) patients. The SLN alone was metastatic in 10, both SLN and non-SLN in 9, and non-SLN alone in 4 (7%) patients. The false negative rate for SLN biopsy was 10% in our series. The rate of positive non-SLN was found as 0% in T1a-b, 19% in T1c, and 40% in T2 tumors (p=0.035). Lymphovascular invasion was positive in 14 (61%) patients with axillary metastasis (p<0.001), and in 10 (77%) patients with non-SLN involvement (p<0.001). Conclusion: We concluded that there was a small risk of involved non-SLN despite negative SLN. Tumor size (near or greater than 2 cm) was significantly associated with non-SLN metastasis. Peritumoral lymphovascular invasion was a positive predictor of the metastatic involvement in non-SLNs. © 2011 Korean Breast Cancer Society.

Hakan T.,Haydarpasa Numune Teaching and Research Hospital | Ersahin M.,Haydarpasa Numune Teaching and Research Hospital | Somay H.,Haydarpasa Numune Teaching and Research Hospital | Aker F.,Haydarpasa Numune Teaching and Research Hospital
Turkish Neurosurgery | Year: 2011

Pseudoaneurysms of the superficial temporal artery are mostly traumatic in origin. Here, a case of a superficial temporal artery aneurysm that emerged following a recraniotomy is presented. A 59-year-old woman was admitted with subarachnoid hemorrhage. She underwent a pterional craniotomy and clipping of a saccular aneurysm of middle cerebral artery bifurcation. A control digital subtraction angiography on the 3rd postoperative day revealed partial filling of the aneurysm and a revision was performed. The second control digital subtraction angiography on the 4th postoperative day of the revision showed a pseudoaneurysm of the left superficial temporal artery. The pseudoaneurysm was excised successfully under local anesthesia. In conclusion, pseudoaneurysm of the superficial temporal artery should be considered among the early postoperative complications of the surgical procedures at the superficial temporal artery territory. Although some conservative approaches are used, excision of the aneurysm is recommended for treatment.

Hakan T.,Haydarpasa Numune Teaching and Research Hospital
Journal of Neurosciences in Rural Practice | Year: 2012

Despite low back pain being common in pregnancy, cauda equina syndrome is rare. Misdiagnosis and delay in treatment may cause neurological sequelae including urinary and fecal incontinence, sexual dysfunction in patients. A case of cauda equina syndrome in a pregnant woman at 25-week gestation is presented here. The patient underwent an emergency, standard lumbar microdiscectomy under general anesthesia on prone position. Neither the patient nor the baby had any complication related to surgery.

PubMed | Haydarpasa Numune Teaching and Research Hospital
Type: Journal Article | Journal: Turkish neurosurgery | Year: 2016

Oxidation products following subarachnoid hemorrhage (SAH) are among the causative substances of cerebral vasospasm and poor outcome. Ozone (O3) is a gas that contains three atoms of oxygen with a cyclic structure. It has been suggested that application of low-dose ozone has an antioxidant effect and provides resistance to oxidative stress. We investigated the effect of oxygen-ozone therapy on rat femoral artery vasospasm.Twenty-four male Sprague-Dawley rats were randomly separated into vasospasm, vasospasm + ozone and control groups. The femoral artery vasospasm model was used. Rats in the vasospasm + ozone group were given 4 mL of ozone (20 /mL) daily for 7 days. Femoral arteries were examined by light microscopy for histological changes and morphometric analysis. Kruskal Wallis test and Mann Whitney U tests were used for the statistical analysis. The values of p < 0.01 and p < 0.05 were recognized as statistically significant.Ozone treatment reduced the morphometric changes as irregularity of the elastic lamina, disruption of the endothelial cells, vacuolization and hemorrhages that caused by vasospasm. The measurements of the wall thickness (p=0.003; p < 0.01) and lumen diameter (p=0.001; p < 0.01) showed statistically significant difference (p < 0.01) between the vasospasm and vasospasm+ozone groups.Ozone therapy may be useful in the treatment of post-hemorrhagic vasospasm.

PubMed | Istanbul Medeniyet University, Florida College, Marmara University, Okan University and Haydarpasa Numune Teaching and Research Hospital
Type: | Journal: Neurourology and urodynamics | Year: 2016

Alpha lipoic acid (LA) was shown to exert neuroprotection in trauma-induced spinal cord injury (SCI), which is frequently associated with urinary bladder complaints in patients with SCI. Accordingly, the protective effects of LA on biochemical and histological changes in bladder as well as functional studies were assessed.Wistar albino rats were divided as control, SCI, and LA (50mg/kg/day, ip) treated SCI groups (SCI+LA). The standard weight-drop (100g/cm force at T10) method was used to induce a moderately severe SCI. One week after the injury, neurological examination was performed and the rats were decapitated. Bladder samples were taken for histological examination, functional (isolated tissue bath) studies, and for the measurement of biochemical parameters (malondialdehyde, MDA; gluthathione, GSH; nerve growth factor, NGF; caspase-3, luminol and lucigenin chemiluminescences).SCI caused a significant (P<0.001) increase in the detrusor muscle thickness. It increased the contractility responses to carbachol and relaxation responses to papaverine (P<0.05-0.001). There were also significant alterations in MDA, caspase-3, luminol, and lucigenin chemiluminescences with concomitant decreases in NGF and GSH (P<0.05). LA treatment reversed histological and functional (contraction and relaxation responses) changes induced by SCI (P<0.05-0.001), but no significant recovery was observed in the impaired neurological functions.These results indicate that LA have a beneficial effect in improving the bladder tonus via its antioxidant and anti-inflammatory actions following SCI.

PubMed | Trabzon Surmene State Hospital, Nigde Bor State Hospital, Fatih Sultan Mehmet Teaching and Research Hospital, Nigde State Hospital and Haydarpasa Numune Teaching and Research Hospital
Type: Journal Article | Journal: Journal of clinical monitoring and computing | Year: 2016

TOF (train-of-four) monitoring provides objective data in application of neuromuscular blocking agent. Thus, applicator-based differences are eliminated and optimum muscle relaxation is maintained during operation. In the present study, we aimed to compare the effects of target-controlled infusion system and standard TOF monitoring, on use of rocuronium. ASA I-II patients, who were aged between 18 and 75years and scheduled for elective abdominal surgery at Haydarpaa Numune Training and Research Hospital, were enrolled in the study. In order to evaluate neuromuscular blockade, the patients in Group 1 were connected to the acceleromyography device of the target-controlled infusion pump (Veryark-CLMRIS-I-China) while the ones in Group 2 were connected to the routinely used acceleromyography device (TOF Watch SX). There was no significant difference between groups regarding patient characteristics, the durations of anaesthesia and surgery, quality of intubation, time to extubation and time to recovery (TOF ratio of 0.9). Intubation time was significantly longer in Group 1 (Automated group) as compared to Group 2 (Control group) (p<0.05). The total rocuronium amount used in Group 1 was found to be significantly higher than the amount used in Group 2 (p<0.05). There was no clinical evidence of residual neuromuscular blockage or reoccurrence of neuromuscular blockage in any patient in either group. Both methods can be used for administration of neuromuscular blocker agent during moderate time anesthesia. No advantage was noted when rocuronium was administered via automatical infusion pump during anaesthesia.

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