Browsing by Author "Altinors, Nur"

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Aneurysmal Bone Cyst in a Renal Transplant Patient
(2022) Sahinturk, Fikret; Sonmez, Erkin; Altinors, Nur; Terzi, Aysen; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0002-0471-3177; 31324137; AAJ-8097-2021; AAI-7972-2021
Aneurysmal bone cysts constitute 1% to 2% of all primary bone tumors. They are rapidly growing benign bone tumors. Nearly 80% of aneurysmal bone cysts occur in the first 20 years of life, and most are primary tumors. Aneurysmal bone cysts are mostly benign, locally aggressive, and highly vascularized tumors. Generally, the period required for postoperative recovery and new bone formation is long. The relapse rate can be up to 50%. Although computed tomography and magnetic resonance imaging scans are the preferred diagnostic methods, biopsy is the most necessary prerequisite to confirm diagnosis, as aspects of these cysts can show similarity to many other bone lesions. Correct histopathologic diagnosis is important since malignancies may be seen in transplant recipients.
Balloon Kyphoplasty Is a Safe and Effective Option for the Treatment of Vertebral Compression Fractures in Solid-Organ Transplant Recipients
(2020) Sonmez, Erkin; Comert, Serhat; Akdur, Aydincan; Karakaya, Emre; Gulsen, Salih; Yilmaz, Cem; Altinors, Nur; Haberal, Mehmet; 0000-0002-7535-1804; 0000-0002-8726-3369; 0000-0002-3462-7632; 0000-0002-5693-3542; 0000-0002-4879-7974; 0000-0002-2353-8044; 27063841; AAJ-5746-2021; AAA-3068-2021; AAJ-8097-2021; AAI-8820-2021; AAD-5466-2021; AAK-2948-2021
Objectives: Solid-organ transplant recipients are at great risk for osteoporotic vertebral compression fractures because of both underlying pretransplant bone diseases and posttransplant immunosuppressive treatments. Balloon kyphoplasty is a minimally invasive procedure that is used to treat painful osteoporotic vertebral compression fractures. It involves injection of polymethylmethacrylate into the vertebral body to stabilize the fracture and to alleviate the pain immediately. In this study, we report the results of balloon kyphoplasty for treatment of vertebral compression fractures in solid-organ transplant recipients. Materials and Methods: We retrospectively reviewed 512 liver transplant and 2248 kidney transplant procedures that were performed in our center between 1985 and 2015. Seven transplant recipients with a total of 10 acute, symptomatic vertebral compression fractures who were unresponsive to conservative treatment for 3 weeks underwent balloon kyphoplasty. Clinical outcome was graded using the visual analog scale. Radiographic evaluation included measurement of the segmental kyphosis by the Cobb method. Results: There were 4 female and 3 male patients in our study group. Ages of patients ranged from 56 to 63 years with an average age of 58.8 years. The affected vertebral levels varied from T12 to L4. Mean follow-up after balloon kyphoplasty was 3.4 years, and mean time interval from transplant to balloon kyphoplasty was 8.6 years. Statistically significant difference is evident 3 years after transplant surgery (P < .05). Sagittal alignment improved (> 5 degrees) in 2 of 7 patients (28%). Conclusions: Transplant recipients are at great risk in terms of vertebral compression fracture development, especially within 1 year after transplant. Although conservative treatment has been the first treatment choice for vertebral compression fracture, long treatment time and high costs may be needed to achieve cure. Experience with our small patient population showed that balloon kyphoplasty was effective and safe for obtaining rapid pain relief and earlier mobilization with fewer complications.
Brain Computed Tomography and Magnetic Resonance Imaging in Neurological Complications of Liver and Kidney Transplantation
(2018) Rahatli, Feride Kural; Agildere, Muhtesem; Donmez, Fuldem Yildirim; Can, Ufuk; Benli, Sibel; Gulsen, Salih; Altinors, Nur; Haberal, Mehmet; 0000-0002-4226-4034; 0000-0003-4223-7017; 0000-0003-4502-106X; 0000-0001-8689-417X; 0000-0002-9975-3170; 0000-0002-7535-1804; 0000-0002-3462-7632; AAL-9808-2021; AAB-5802-2020; AAE-5528-2021; AAJ-2999-2021; AAJ-4403-2021; AAJ-5746-2021; AAJ-8097-2021
Brain Death and Transplant in Islamic Countries
(2016) Altinors, Nur; Haberal, Mehmet; 0000-0002-3462-7632; 27805511; AAJ-8097-2021
Objectives: The aim of this study was to investigate the present status regarding brain death, its consequences, and transplant activities in Islamic countries. Materials and Methods: A thorough literature survey was conducted about transplant activities in Islamic countries, and the Turkish Ministry of Health Web site was analyzed. Expert opinions about the issue were obtained. Results: The present status of brain death and transplant activities has shown a heterogeneous appearance in the Islamic world. Our literature survey clearly revealed that transplant is still in its early stages in many Islamic states. The legislative framework, infrastructure, and related education needs radical improvements in these states. Conclusion: The concept of death has to be redefined and a consensus should be reached about brain death. The pioneer countries like Turkey, Iran, and Saudi Arabia. which already have considerable experience in transplant, should share their expertise and know ledge with the countries that need guidance.
Cervical Spinal Ependymoma With Hemorrhage in a Renal Transplant Patient
(2022) Sahinturk, Fikret; Dere, Umit Akin; Kirnap, Mahir; Sonmez, Erkin; Altinors, Nur; Ozen, Ozlem; Haberal, Mehmet; https://orcid.org/0000-0002-0471-3177; https://orcid.org/0000-0002-6678-6224; 30251937; AAI-7972-2021; N-1435-2014
Ependymomas are the most common intramedullary spinal tumors in adults and constitute around 20% of all spinal tumors in adults. There are 3 subgroups of ependymomas according to World Health Organization classification: subependymoma or myxopapillary (grade 1), ependymoma (grade 2), and anaplastic (grade 3). Therapy for patients is aimed at safe and total surgical removal and, in selected cases, postoperative radiotherapy. Bleeding from a spinal ependymoma, with subsequent urgent surgery, is extremely rare. Here, we present a case of a renal transplant patient who had a cervical ependymoma. Although a considerable volume of peritumoral blood was observed during surgery, the patient had no neurologic deficits and no signs of deterioration.
The Economics of Organ Transplantation
(2018) Altinors, Nur; Haberal, Mehmet; 0000-0002-3462-7632; 29528004; AAJ-8097-2021
To determine the cost effectiveness of transplantation, we analyzed the financial economics of the organ and tissue transplant process. We compared the cost of this process with traditional modalities for treating end-stage liver and kidney disease. Medical, surgical, legal, social, ethical, and religious issues are important in organ transplant procedures. Government, health insurance companies, and uninsured individuals are affected by the financial economics of organ transplantation. The distribution of financial burden differs among countries and is dependent on the unique circumstances of each country.
Hydatid Cyst of the Cerebellopontine Angle
(2022) Dere, Umit A.; Sahinturk, Fikret; Oktay, Kadir; Altinors, Nur; 0000-0002-0471-3177; 0000-0002-0471-3177; 35263906; N-1435-2014; AAI-7972-2021
Hydatid disease is caused by Echinococcus granulosus. The liver is the first organ of entry, while the central nervous system is affected in about 2% of cases. Primary brain hydatid cyst is extremely rare. The cysts are generally located in cerebral lobes. Here, we reported a 68-year-old Syrian immigrant woman with hydatid cyst in the left cerebellopontine angle. The patient presented gait disturbance, asymmetrical palatal arcs, negative gag reflex, and disturbed cerebellar tests on the left side. The patient was operated via suboccipital craniotomy. The cyst ruptured during manipulation, but it was totally removed.
Intracranial Fungal Infection After Solid-Organ Transplant
(2018) Sahinturk, Fikret; Demirkaya, Hamiyet; Dere, Umit Akin; Sonmez, Erkin; Altinors, Nur; Moray, Gokhan; Haberal, Mehmet; 0000-0002-0471-3177; 0000-0002-6678-6224; 0000-0002-5693-3542; 0000-0003-2498-7287; 0000-0002-3462-7632; 29528023; AAI-7972-2021; N-1435-2014; AAI-8820-2021; AAE-1041-2021; AAJ-8097-2021
Neurologic complications after solid-organ transplant reveal a great spectrum of pathologies. Intracranial hemorrhages, cerebral ischemic lesions, infarctions, lymphoproliferative disorders, and infections, including aspergillosis, have been observed after liver transplant. Fungi constitute nearly 5% of all central nervous system infections, mainly occurring in immunocompromised patients. The most common causative agent is Aspergillus species. It presents either as maxillary sinusitis or pulmonary infection. Brain involvement of Aspergillus carries a high rate of mortality. Aspergillosis presents in the forms of meningitis, mycotic aneurysms, infarctions, and mass lesions. Aspergillosis does not have a specific radiologic appearance. Parenchymal aspergillosis has heterogenous signal intensity (hypointense on T1-weighted and hyperintense on T2-weighted images). Here, we present 3 patients who underwent solid-organ transplant and developed central nervous system aspergillosis. Different modalities of neurosurgical intervention were performed in combination with chemotherapy as part of their fungal therapy.
Microsatellite Instability in Glioblastoma: Is It Really Relevant in Tumor Prognosis?
(2019) Tepeoglu, Merih; Borcek, Pelin; Ozen, Ozlem; Altinors, Nur; 31529454
AIM: To evaluate the frequency and prognostic significance of microsatellite instability (MSI) in patients with glioblastoma (GBM immunohistochemical analysis of mismatch repair (MMR) proteins was performed. MATERIAL and METHODS: A total of 71 patients with GBM who underwent surgery between 2011 and 2019, were included in the study. MMR protein expression was examined using immunohistochemistical analysis of tumor tissue samples; the association between the MMR status and clinicopathological findings was evaluated. RESULTS: Immunohistochemical analysis revealed expressions of MLH1, MSH2, MSH6, and PMS2 proteins in 67 (94.4%), 65 (91.5%), 67 (94.4%), and 64 (90.1%) patients, respectively. Among the 71 patients, 64 (90.1%) expressing all MMR proteins were considered microsatellite stable (MSS), and 7 (9.9%) patients showing loss of at least one of the MMR proteins were considered to show MSI. Tumor recurrence was noted in 25 (39.1%) patients in the MSS GBM group, and 4 (57.1%) patients in the MSI GBM group (p=0.433). The overall median survival was 30.65 +/- 5.1 and 10.71 +/- 5.2 months in the MSS GBM and MSI GBM groups, respectively (p=0.059). CONCLUSION: The results of this study showed no significant relationships between MMR protein expression and recurrence rates or overall survival in patients with GBM.
Presence of Matrix Metalloproteinase-2 and Tissue Inhibitor Matrix Metalloproteinase-2 Gene Polymorphisms and Immunohistochemical Expressions in Intracranial Meningiomas
(2014) Coven, Ilker; Ozer, Ozge; Ozen, Ozlem; Altinors, Nur; Sahin, Feride Iffet; https://orcid.org/0000-0001-6731-2461; https://orcid.org/0000-0001-7308-9673; https://orcid.org/0000-0001-7308-9673; 25259564; ITT-4755-2023; AAC-7232-2020; AAC-7232-2020
Object. Meningiomas are benign extraaxial tumors with a slow progression. Some of them, in spite of being benign in nature, may show an aggressive progression pattern. To investigate the behavioral characteristics of meningiomas, researchers have studied matrix metalloproteinases (MMPs), their tissue inhibitors (TIMPs), interstitial collagens, proteins, vascular endothelial growth factors (VEGF), and tumor necrosis factors. Methods. In this study, the authors investigated MMP2 and TIMP2 gene polymorphisms in formalin-fixed paraffin-embedded tissue samples obtained from meningioma patients who had previously undergone surgery at the authors' institution. In addition, brain invasion, Ki-67 index, and MMP-2 and TIMP-2 expressions were investigated using immunohistochemical methods. MMP2 (735C>T, 1575G>A, 1306C>T) and TIMP2 (418G>C, 303C>T) gene polymorphisms were investigated from paraffin-embedded tissue sections using the polymerase chain reaction restriction fragment length polymorphism method. Results. There were statistically significant differences between genotype (p = 0.001) and allele frequencies (p = 0.001 and OR 7.4 [95% CI 1.5-36.2]) in patient and control groups for MMP2 1306C>T polymorphism. The authors did not find a statistically significant difference for other polymorphisms. GA genotype was found to be more frequent when brain invasion was suspected for MMP2 1575G>A polymorphism (p = 0.006), There was not a statistically significant difference for other MMP2 or TIMP2 gene polymorphisms. Conclusions. The authors' results support the importance of MMPs and their tissue inhibitors in meningioma pathogenesis. In future studies, these gene polymorphisms, especially MMP2 1306C>T and 1575G>A, should be investigated for meningioma or brain invasion susceptibility in larger study groups.
Transplant Ethics
(2016) Altinors, Nur; Haberal, Mehmet; 0000-0002-3462-7632; 27805507; AAJ-8097-2021
Objectives: The aim of this study was to review and discuss the great variety of ethical issues related to organ donation, organ procurement, transplant activities, and new ethical problems created as a result of technologic and scientific developments. Materials and Methods: An extensive literature survey was made, and expert opinions were obtained. Results: The gap between demand and supply of organs for transplant has yielded to organ trafficking, organ tourism, and commercialism. This problem seems to be the most important issue, and naturally there are ethical dilemmas related to it. A wide number of ideas have been expressed on the subject, and different solutions have been proposed. Conclusion: The struggle against organ trafficking and commercialism should include legislation, efforts to increase deceased-donor donations, and international cooperation. China's policy to procure organs from prisoners sentenced to death is unethical, and the international community should exert more pressure on the Chinese government to cease this practice. Each particular ethical dilemma should be taken separately and managed.
Turkish Contribution to Journal of Neurosurgery and Acta Neurochirurgica
(2017) Altinors, Nur; Comert, Serhat; Sonmez, Erkin; Altinel, Faruk; 0000-0002-5693-3542; 0000-0002-8326-3900; 27593822; AAI-8820-2021; AAJ-5382-2021
AIM: To evaluate the contribution of Turkish scientists to four journals published by Journal of Neurosurgery (JNS) Publishing Group and to Acta Neurochirurgica (AN) and to its Supplement (ANS). MATERIAL AND METHODS: We reviewed every issue of those journals to December 2015 for the total number of articles, articles produced from studies performed entirely in Turkey, and for publications overseas co-authored by the Turkish scientists using the websites of these journals. Citations were searched using "Web of Science" and "Google Scholar" databases. RESULTS: The total number of articles published was 19822 for JNS, 3227 for JNS Spine, 2526 for JNS Pediatrics and 2997 for Neurosurgical Focus. Turkish contribution was 556 articles. 337 (60.61%) articles were the products of studies performed entirely in Turkey, while 219 (39.38%) articles came from overseas, co-authored by Turkish scientists. Overall contribution was 1.94%. A total of 6469 articles were published in AN. 340 papers were the products of studies performed entirely in Turkey. Turkish scientists working overseas co-authored 37 articles. Total contribution was 377 articles (5.82%). 4134 papers had been published in ANS. Contribution was 69 articles (1.66%). CONCLUSION: Turkish contribution to these journals has started late. The gap has been compensated with publications in the last two decades. Manuscripts of higher scientific level with greater number of citations are needed to increase Turkish contribution to such journals.
Vertebral Body Lipoma An Unusual Pathology Treated With Kyphoplasty
(2018) Sahinturk, Fikret; Dere, Umit Akin; Sonmez, Erkin; Altinors, Nur; Terzi, Aysen; 0000-0002-0471-3177; 0000-0002-6678-6224; 0000-0002-5693-3542; 0000-0002-1225-1320; 30226833; AAI-7972-2021; N-1435-2014; AAI-8820-2021; F-7546-2013
Study Design. Case report. Objective. This case report is unique since this is the first vertebral lipom case that was treated by kyphoplasty alone. Summary of Background Data. Vertebral lipoma is extremely rare and our search of the English literature has revealed 20 patients in 16 reports. Methods. A 32-year-old female patient was admitted to our neurosurgery department with the chief complaint of low back pain that had lasted nearly 1 year. A lumbar MR suggested a hemangioma and the patient was operated on. Results. On microscopic examination, the lesion was seen to have a widely infiltrating appearance of mature fat tissue between bone trabeculae diagnosis was intraosseous lipoma. Conclusion. We believe that the management should be surgical total removal of the lesion even in incidentally found cases in order to obtain histologic diagnosis and pain relief.