Browsing by Author "Caner, Hakan"

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Biphasic Pulmonary Blastoma Associated with Cerebral Metastasis
(2016) Kilic, Dalokay; Yilmaz, Cem; Tepeoglu, Merih; Vural, Cigdem; Caner, Hakan; 26768884
Pulmonary blastoma is a very rare malignant tumor of the lungs. A biphasic pulmonary blastoma was histologically diagnosed by a characteristic finding as it was mainly constituted of immature tumor tissue that had both epithelial and mesenchymal components. We present a case of a 68-year-old man with biphasic pulmonary blastoma. The patient underwent cranial metastatectomy and left lung upper lobectomy. Although the tumor was resected, there was rapid metastasis to the cranial, liver, kidney and multiple bones. Although radiotherapy and chemotherapy were administrated, the patient died about 6 months postoperatively. Close follow-up and aggressive chemotherapy should be considered for such tumours. In the light of this case, the authors review the pathologic, clinical, radiological and therapeutic features of this very rare malignant lung tumor.
Core curriculum (CC) of spinal surgery: a step forward in defining our profession
(2014) Acaroglu, Emre; Kahraman, Serdar; Senkoylu, Alpaslan; Berk, Haluk; Caner, Hakan; Ozkan, Secil
Objective: The aim our study was to establish a core curriculum (CC) for spine surgery incorporating knowledge, skills and attitudes to help define spine surgery as a medical specialty and serve as a guide for specific spine surgery training. Methods: A committee was established to prepare the CC. Five modules were established; Basic Sciences, Spinal Trauma, Degenerative Spine Diseases, Destructive Spine Pathologies and Spinal Deformity. Prepared CC modules were evaluated in a consensus meeting, translated and reevaluated in a second consensus meeting before being accepted as final. Results: In the five modules, 54 subject headings (19 for Basic Sciences, 10 for Spinal Trauma, 4 for Degenerative Spine Diseases, 4 for Destructive Spine Pathologies and 17 for Spinal Deformity) and 165 specific subjects (59 for Basic Sciences, 32 for Spinal Trauma, 10 for Degenerative Spine Diseases, 23 for Destructive Spine Pathologies and 41 for Spinal Deformity) were defined. Learning outcomes and entry and exit criteria were defined for all subjects. Conclusion: This CC may form the basis of spinal surgery training, defining spinal surgery as a medical specialty and help us spine surgeons to develop better defined identities.
The Effects of Proanthocyanidin on Vasospasm After Experimental Subarachnoidal Hemorrhage in Rats
(2018) Yilmaz, Cem; Cansever, Tufan; Kırceli, Atilla; Ozen, Ozlem Isiksacam; Aydemir, Fatih; Akar, Aykan; Caner, Hakan; 30192366
AIM: Delayed ischemic neurological deficit (DIND) and cerebral vasospasm (CV) remain the most common and debilitating neurological complications following aneurysmal subarachnoidal hemorrhage (SAH). Many reports demonstrate the importance of proanthocyanidins (PR) on the vascular system, including endothelium-dependent relaxation of blood vessels. These effects of PR on the cerebral vascular system were examined in this study. MATERIAL and METHODS: Fifty-two adult Sprague-Dawley male rats were used for the experimental double hemorrhage model. They were divided to control, sham, pre- and post-interventional treatment groups. 100 mg/kg PR was administered for the treatment for respect to groups. Basilar artery diameter (BAD) and arterial wall thickness were measured and the apoptosis ratio of the endothelial cells was calculated. Arterial walls were examined electron microscopically (EM). RESULTS: There were significant differences between the groups except control and pre-SAH (p=0.37) and post-SAH and preSAH groups (p=0.15) with respect to BAD. According to arterial wall thickness, apoptosis ratio, and grading, there were significant differences between the groups except control and pre-SAH (p=0.85, p=0.49 and p=0.18 respectively) and SAH and post-SAH (p=0.08, p=0.21 and p=0.24 respectively) groups. EM findings revealed that pro-apoptotic and pro-necrotic degenerated endothelial cells with seldom vacuolization in post-SAH treatment group which were more serious in SAH group. CONCLUSION: Pre-SAH administration of PR induces better vasodilatation and protection of basilar artery (BA) from vasospasm (VS), which could yield neuroprotective and vasodilatator effects. In addition, PR appears to be involved in relieving oxidative damage, with an antioxidant-antiapoptotic-antinecrotic effect that may contribute to vascular dilation.
Intraosseous angiolipoma of the frontal bone with a unique location: A clinical and pathological case illustration and review of the literature
(2014) Atilgan, Alev Ok; Terzi, Aysen; Agildere, Muhtesem; Caner, Hakan; Ozdemir, B. Handan
Here, we report a case of a 16-year-old female patient was referred with scalp swelling and headache. Her neurological examination was normal and imaging of the skull revealed a well-defined lytic lesion measuring 15 mm x 6 mm to the right of the frontal bone. She was operated on with a prediagnosis of Langerhans cell histiocytosis. A wide excision with negative margins was made and the defect was reconstructed with a titanium plate. Subsequently, the lesion was histopathologically diagnosed as an angiolipoma of the frontal bone. The postoperative period was uneventful and she remained well during 1-year follow-up with no evidence of recurrence. Angiolipomas are rare benign lipomatous lesions located mostly in subcutaneous tissue of the forearm or trunk and frequently occur before puberty or in young adults. They are not common in bones. To the best of our knowledge, this is the first angiolipoma of the frontal bone reported.
Ratlarda deneysel subaraknoid kanama ile oluşturulan serebral vazospazm etyopatogenezinde rol oynayan apopitozis ve lipid peroksidasyonunun önlenmesinde sildenafil'in rolü
(Başkent Üniversitesi Tıp Fakültesi, 2007) Gökce, Emre Cemal; Caner, Hakan
Subaraknoid kanama sonrası gelişen vazospazmın meydana gelişi ve oluşum mekanizmaları ile ilgili yapılan klinik ve labaratuar çalışmalar neticesinde, bu patolojik durumun multifaktöriyel ve içiçe girmiş bir çok biyokimyasal reaksiyonlar sonucunda oluştuğu düşünülmektedir. Ancak anevrizma rüptürü neticesinde subaraknoid alana olan kanamada eritrositlerin hemolizi sonucunda ortaya çıkan oksihemoglobinin, vasküler ve nöronal yapılarda patolojik süreci başlatan bir çok reaksiyonda rol alması nedeniyle vazospazmın oluşumuna neden olan en önemli faktörlerden biri olduğu kabul edilmektedir. Bununla beraber hemoglobine olan affinitesi oksijenden 1000 kat daha fazla olduğu tespit edilen Nitrik oksid adlı moleküler yapının keşfiyle beraber, SAK sonrası miktarının azalmasının, vazospazm gelişiminde çok önemli bir faktör olduğu ileri sürülmektedir(1). Oksihemoglobinin ve diğer kan hücrelerinin kanama sahasında başlattığı inflamasyon, serbest radikal üretimi, lipid peroksidasyonu ve apopitoz, vasküler yapılarda vazospazma neden olarak damarsal yapıların konstrikte olmasına ve nöronal ve vasküler yapıların iskemiye girmesine neden olmaktadır. Vasküler endotelyal hücrelerde olan bu hasar ve serbest radikal üretimi nedeniyle NO’in hem yapımı azalmakta hemde varolan NO tüketilerek damarlar konstrikte olmaktadır. Bu amaçla vazodilatatör, antienflamatuar, antioksidan ve serebral kan akımı regülasyon özellikleri olan NO’in miktarının arttırılmasının vazospazmda iyi bir tedavi seçeneği olacağını düşündük. Bu amaçla fosfodiesteraz V inhibitör etkisi ile NO-cGMP yolağının artımına neden olan, klinikte erektil disfonksiyon ve pulmoner hipertansiyon tedavisinde kullanılan sildenafil sitratın vazospazm tedavisindeki etkilerini araştırmak amacıyla deneysel çalışmamızı gerçekleştirdik. Bu çalışmada 7 adet Sprague-Dawley cinsi ağırlıkları 245-550 gr arası olan erkek ratlardan oluşan 4 grup oluşturuldu. Grup 1’de yer alan ratlara hiç bir işlem uygulanmadan sakrifikasyon uygulandı. Grup 2’de yer alan ratların sisterna magnalarına 0.4 cc/kg’a otolog arteryal kan verilerek deneysel subaraknoid kanama oluşturuldu. Grup 3’te yer alan ratlara aynı şekilde subaraknoid kanama oluşturularak kanamadan hemen sonra 5 mg/kg/gün sildenafil oral olarak verildi. Grup 4’te yer alan ratlarada aynı usulde deneysel subaraknoid kanama oluşturularak kanamadan hemen sonra 15 mg/kg/gün sildenafil oral verildi. Deneyde, östrojenin iskemide eksitoksisiteyi, glutamat reseptör etkinliğini ve immun enflamasyonu azaltarak akson myelinizasyonunu sinaptogenezisi ve dendritik dallanmayı arttırarak nöroprotektif etki göstermesi nedeniyle erkek rat kullanıldı(2). Subaraknoid kanama yapılan tüm ratlar 48.saatte sakrifiye edildi. Tüm ratların baziller arterlerinden 3’er kesit alınarak baziller arterin çapı freeware imaj analiz sistemleri (ImageJ, version 1.341; National Institutes of Health, Bethesda, MD) bilgisayar programı ile ölçüldü. Lipid peroksidasyon değerleri için baziller arterin beslediği serebellumdan örnekler alındı ve tiyo barbitürik asit yöntemi ile nmolTBA/g yaş doku olarak hesaplandı. Gruplardaki baziller arter kesitlerindeki apopitozu göstermek amacıyla In Situ Cell Detection Kit, POD (Roche, Germany) kullanıldı. Apopitotik indeks immünreaktif nukleusların total endotel hücre sayısına oranı ile hesaplandı. Sonuçlar yüzde olarak ifade edildi. Buna göre boyanma saptanmayan kesitler Grade 0, %0-24 oranında apopitoz Grade 1, %25-49 arasındakiler Grade 2, %50-74 arasındakiler Grade 3 ve %75-100 oranında arteriyal apopitotik hücre boyanması gösterenler Grade 4 olarak ifade edildi. In Situ Cell Detection Kit ile yapılan çalışmalarda apopitotik hücrelerle beraber nekrotik hücrelerde de TUNEL reaksiyonunun yanlış pozitif reaksiyona neden olmasından dolayı kaspaz 3, kaspaz 8, p53 ve sitokrom c adlı apopitotik markerlarda çalışılmıştır(3). Çalışmamızda sitokrom c’yi apopitotik mitokondriyal yolağı, kaspaz 8’i kaspaz bağımlı yolağı, kaspaz 3’ü kaspaz bağımlı ve bağımsız yolun ortak ürünü, p53’ü ise tüm apopitotik sürecin en önemli markerı olduğu için kullandık(100,101). Buna göre SAK grubundaki ratların baziller arterler kesit alanlarının kontrol grubuna göre %57 oranında daraldığı, sildenafil 5mg/kg/gün verilen grupta ise daralmanın kontrol grubu olan grup 1’e göre %16.8 olduğu tespit edildi. Sildenafil 15 mg/kg/gün verilen grupta ise bu daralmanın %7.1 olduğu görüldü. Elde edilen kesit alanları istatiksel açıdan Post Hoc Tukey testi ile karşılaştırıldığında sildenafilin vazospazma karşı koruyucu etkisinin olduğu saptandı (p<0.0001). Lipid peroksid değerlerine bakıldığında SAK oluşturulan Grup 2’deki lipid peroksid değerinin kontrol grubu olan grup 1’e göre belirgin olarak arttığı görüldü. Tedavi gruplarındaki lipid peroksid miktarlarının grup 2’deki değerlere göre anlamlı derecede azaldığı tespit edildi (p<0.0001). Gruplardaki In Situ Cell Detection Kit (POD (Roche, Germany) ile yapılan immunohistokimyasal boyama yöntemi ile apopitotik hücre oranlarına baktığımızda grup 2, 3 ve 4’teki apopitotik hücre yüzdelerinin sırasıyla %88, %83 ve %81 olduğu, kontrol grubundaki apopitotik hücre yüzdesinin %0 olduğu saptandı. Kaspaz 3, kaspaz 8, sitokrom c ve p53 ile yapılan incelemede herhangi bir işlem yapılmayan kontrol grubu grup 1de endotelyal hücrelerde apopitotik bir boyanma saptanmazken, tedavi grupları ile SAK grubu arasında apopitotik endotelyal hücreler incelendiğinde herhangi bir fark saptanmadı. Tedavi gruplarının apopitoz üzerinde herhangi bir etkisinin olmadığı görüldü. Sonuçlar dahilinde sildenafilin vazospastik damarlar üzerindeki iyileştirici etkisi ve lipid peroksidasyonunu önlemedeki anlamlı sonuçları nedeniyle yakın gelecekte vazospazm tedavisinde yer alabilecek bir ilaç olduğuna inanıyoruz. Apopitozu engellemenin vazospazm oluşumunu engellemeyeceğini, vasküler ve nöronal hücreleri canlı tutmada yeterli olmadığını, tedavinin amacının ve asıl önem verilmesi gereken konunun kan pıhtısının kimyasal reaksiyonlarını engellemek, lipid peroksidasyon oluşumunu önlemek ve NO miktarını arttırmak olduğunu düşünüyoruz. After fulfilling many clinical and experimental studies about the mechanism of cerebral vasospasm following subarachnoidal hemorrhage, it is thought that this pathologic disease to become after many connecting reactions and it is multifactorial. It is widely accepted that oxyhemoglobine, appearing following hemolysis of erythrocytes in the subarachnoidal space as a result of bleeding after rupture of an aneurysm, is the most important factor in the pathogenesis of vasospasm because of acting in many reactions causing the pathological process against the vascular and neuronal tissues. However since the discovery that nitric oxide, an endothelial derived relaxing factor has 1000 times higher affinity for hemoglobin than oxygen, it is put forward that decreased NO availibility following SAH is one of the most important factor in vasospasm(1). Vasoconstriction, vasospasm of the vessels and ischemia in the neurons and vascular tissue cells is the cause of inflammation, free radical production, lipid peroxidation and apoptosis developing after oxyhemoglobin and other blood products. Because of the damage in the vascular endothelial cells and production of free radicals, either decreasing NO availibility or running out of the present NO, cause of conctriction of the vessels. As we take into consideration of decreased levels of NO and antiinflamatuar, vasodilatation, antioxidan and cerebral blood flow regulation effect of NO; we thought that increasing the amount of NO availibility would be a good option in the treatment of vasospasm. We carried out our experimental study aiming at searching out the effect of sildenafil citrate PDE V inhibitor on cerebral vasospasm, which are currently approved for the treatment of erectil dysfunction and pulmonary hypertension by increasing NO-cGMP pathway. In this study 7 male Sprague-Dawley rats weighting between 245-550 grams were grouped into 4 groups. In group 2 ,3 and 4 the cisterna magna was aseptically punctured with a needle and 0.5 ml/kg of autologous arterial blood obtained by directly puncturing the femoral artery was slowly injected intracisternally. Group 1 (Control) rats were sacrificed and submitted to biochemical study without surgical manipulation. Group 3 and group 4 after administering the blood intracisternally, received 5 mg/kg and 15 mg/kg sildenafil respectively for 2 days, respectively. Estrogen has a neuroprotective effect by decreasing excitotoxicity, glutamate receptor activity and immun inflamation and by increasing axonal myelinization, synaptogenesis and dendtritic branch so that we used male rats in the experiment. All rats were decapitated following sacrification using high dose anesthetic agent on the second day. The rats basillary artery were sectioned from three seperate zones and three sections were obtained from each rat. Basillary artery luminal sectional areas were measured using freeware computerized image-analyse systems (ImageJ, version 1.341; National Institutes of Health, Bethesda, MD). For lipid peroxidation study cerebellum section samples from the rats fed by basillary artery were taken. The concentration of lipid preoxides was measured by thiobarbituric acid test. Immunohistology using the ApopTag Peroxidase In Situ Apoptosis Cell Detection Kit, POD (Roche, Germany) was used to demonstrate apoptosis in a cross section of basillary artery. Apoptotic index was calculated as the number of the immunoreactive nuclei per total number of endothelial cells, expressed as a percentage. No positive staining of endothelial cells with the ApopTag have been expressed as Grade 0, 0-24% immunostaining of endothelial cells as Grade 1, 25-49% as Grade 2, 50-74% as Grade 3, 75-100% immunostaining of endothelial cells have been expressed by Grade 4. Considering possible false positive results in TUNEL reaction in necrotic cells, each section was immunostained using for p53 (Clone Pab 240, mouse monoclonal antibody, NeoMarkers), caspase 3 (CPP32, NeoMarkers), caspase 8 (FLICE, NeoMarkers) and cytochrome c (Clone 7H8.2C12, mouse monoclonal antibody, NeoMarkers). Under light microscope examination, the positivity for all of these antibodies was calculated as positive and negative in the endothelial cells of basillary artery. In our atudy we used cytochrome c, representing the apoptotic mithocondrial pathway; caspase 8 respresenting the caspase dependent pathway, caspase 3 representing the both caspase dependent and independent pathway and p53 playing the essential role in the whole apoptotic cascade. In the SAH group(Group 2) the basillary artery circumferences constriction rate was 61.7% compared with the control group (Group 1). In the SC (5mg/kg)-treated SAH group, the basillary artery circumference contriction rate was 16.8% and in the SC-treated 15mg/kg SAH group this rate was 7.1% compared with the control group (Group 1). For the comparison of the effect of SC treatment after SAH, a Post Hoc Tukey test was performed between the groups. P value was less than 0.05 was considered significant. The results of group 1 between group 2, group 1 between group 3 and group 1 between group 4 was regarded as statistically significant (p<0.0001). As we take a look at the lipid peroxide results , lipid peroxide values in SAH group (group 2) was significantly higher compared with gruop 1(p<0.0001). the lipid peroxide values in the treatment groups (group 3 and group 4) was significantly decreased compared with group 2 (p<0.0001). We observed that sildenafil has prevented lipid peroxidation. The apoptotic cells rate, the immunostaining with In Situ Cell Detection Kit (POD (Roche, Germany)in the groups were 0%, 88%, 83% and 81%, respectively. With the immunostaining using for p53, caspase 3, caspase 8 and cytochrome c, there was no actual apoptotic nuclei in group 1. In group 2, 3 and 4 there was no significant difference in the number of apoptotic nuclei among these groups. In conclusion no preventing effect of sildenafil has been detected against apoptosis. In conclusion, we believe sildenafil will take a part in the treatment of vasospasm in the future because of improving effect on the vessels and preventing effect of lipid peroxidation. We think that impeding apoptosis is not enough to cure vasospasm and not enough to keep the cells alive; the main aim of the treatment and the most important issue is to hinder the chemical reactions of the blood cells in the subarachnoid region and lipid peroxidation and to increase NO availibility.
The Retrospective Analysis of the Effect of Balloon Kyphoplasty to the Adjacent-segment Fracture in 171 Patients
(2014) Civelek, Erdinc; Cansever, Tufan; Yilmaz, Cem; Kabatas, Serdar; Gulsen, Salih; Aydemir, Fatih; Altnors, Nur; Caner, Hakan; https://orcid.org/0000-0002-3988-4064; https://orcid.org/0000-0002-2353-8044; https://orcid.org/0000-0003-2691-6861; https://orcid.org/0000-0002-7535-1804; https://orcid.org/0000-0002-3400-9025; 24795949; ABI-6105-2020; AAK-2948-2021; AAA-3069-2020; AAJ-5746-2021
Study Design: Analysis of the adjacent-segment fractures in 171 balloon kyphoplasty (BK)-performed patients. Objective: The purpose of this study was to investigate the risk factors for new symptomatic vertebral compression fractures (VCF) after BK. Summary of Background Data: Although there are many studies about the incidence and possible risk factors for occurrence of adjacent-level fractures, there is no consensus on the increased risk of adjacent-level fractures after BK. Methods: We performed a retrospective analysis of 171 patients treated with percutaneous kyphoplasty. The follow-up period was 41.04 +/- 21.78 months. The occurrence of new symptomatic VCF was recorded after the procedure. We evaluated the variables of patient age and sex, the amount of injected cement, the initial kyphotic angle (KA) of VCF, the change of the KA after BK, the severity of osteoporosis, and the percentage of height restoration of the vertebral body. Furthermore, possible risk factors were reported for new symptomatic VCFs. Results: The only 2 factors identified as being significantly associated with adjacent-level fractures were the sex (P=0.001) of the patient and the preoperative KA (P=0.013). The patients with new symptomatic compression fracture had higher initial KA than those without fractures. The female group had higher risk than the male group in occurrence of the new vertebra fractures. The severity of the osteoporosis (low bone mineral density) was not a determinant in occurrence of the new VCF after BK. Conclusions: If the patients experience severe or mild back pain with higher preoperative KA, especially in the first 2 months, then they deserve detailed radiologic examination. To avoid subsequent fracture in the same or adjacent level, vertebral body should be filled adequately and sagittal balance should be obtained with KA correction. BK alone did not influence the incidence of subsequent VCF.