Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Transarterial Chemoembolization Combined with Simultaneous Thermal Ablation for Solitary Hepatocellular Carcinomas in Regions with a High Risk of Recurrence(2023) Ozen, Ozgur; Boyvat, Fatih; Zeydanli, Tolga; Kesim, Cagri; Karakaya, Emre; Haberal, Mehmet; 0000-0001-7122-4130; 37455470; JVO-4809-2024; AAD-5996-2021; AAD-5466-2021; F-4230-2011; AAN-1681-2021Objectives: We evaluated the safety and efficacy of transarterial chemoembolization combined with percutaneous thermal ablation (radiofrequency or microwave ablation) in the treatment of solitary hepatocellular carcinoma tumors ranging from 2 to 4.5 cm at subdiaphragmatic, subcapsular, or perivascular locations. Materials and Methods: Fifteen patients (12 men, mean [range] age of 66.6 +/- 10.88 [34-75] y) who received transarterial chemoembolization combined with simultaneous percutaneous radiofrequency ablation (n = 5) or microwave ablation (n = 10) for hepatocellular carcinoma in regions with high risk of recurrence (subdiaphragmatic, subcapsular, or perivascular) between 2012 and 2018 were evaluated. We retrospectively investigated tumor diameter and localization, success rate, safety, local efficacy (imaging at month 1 after treatment), local tumor response (3 months posttreatment), local tumor progression, intrahepatic distant recurrence, overall survival and complications. Results: Tumor diameter ranged from 20 to 45 mm (mean 31.7 +/- 7.37 mm). Hepatocellular carcinoma diameter was 2 to 3 cm in 7 patients and 3.1 to 4.5 cm in 8 patients. The technical success rate was 100%, with no life-threatening complications. At enhanced imaging at 1-month follow-up, the complete necrosis rate was 100%; at 3 months, 100% of patients had a complete response. During a mean follow-up of 26 +/- 13.6 months, 7 patients (46.7%) had tumor progression. Three patients (20%) had local tumor response, and 4 patients (26.7 %) experienced distant recurrences in the untreated liver. The mean local tumor progression and mean intrahepatic distance recurrence times were 11 months and 29.5 months, respectively. Overall survival rates were 100% at 1 year, 73% at 3 years, and 47% at 5 years. Conclusions: Transarterial chemoembolization combined with simultaneous percutaneous thermal ablation is safe, feasible, and effective in enhancing the local control rate for solitary hepatocellular carcinoma ranging from 2 to 4.5 cm in regions with high risk of recurrence.Item Does Renal Function Affect Gadolinium Deposition in the Brain?(2018) Rahatli, Feride Kural; Donmez, Fuldem Yildirim; Kibaroglu, Seda; Kesim, Cagri; Haberal, Kemal Murat; Turnaoglu, Hale; Agildere, Ahmet Muhtesem; 0000-0002-4226-4034; 0000-0003-4502-106X; 0000-0002-3964-268X; 0000-0002-8964-291X; 0000-0002-8211-4065; 0000-0002-0781-0036; 0000-0003-4223-7017; 29857863; AAL-9808-2021; AAE-5528-2021; AAJ-2956-2021; AAD-5996-2021; R-9398-2019; AAK-8242-2021; AAB-5802-2020Objective: Was to compare T1 signal intensity ratios of dentate nucleus to cerebellar white matter (DN/cerebellum), dentate nucleus to pons (DN/pons) and globus pallidus to thalamus (GP/thalamus) in patients with normal renal function and in patients on chronic hemodialysis. To find out if renal function affects the deposition of gadolinium in brain after administration of linear gadolinium based contrast agents (GBCA). Methods: Seventy eight contrast enhanced brain MRIs (Magnetic Resonance Imaging) with linear GBCA of 13 patients on chronic hemodialysis and 13 patients with normal renal function retrospectively evaluated. The DN/ pons, DN/cerebellum and GP/thalamus signal intensity ratios were measured from each brain MRI on unenhanced axial T1 weighted images. Results: In hemodialysis group statistically significant increase in the signal intensity ratios of DN/pons, DN/ cerebellum and GP/thalamus were found between the first and the last brain MRIs (p = .001). The increase in the signal intensity ratios of DN/pons, DN/cerebellum and GP/thalamus between the first and the last brain MRIs in control group were not significant (p > 0.05). The signal intensity increase in DN and globus pallidus were significantly higher in hemodialysis group than control group (p < 0.05). Conclusions: Patients on hemodialysis had significantly higher DN and GP signal intensity increase compared to the patients with normal renal function. Renal function affects the rate of gadolinium deposition in the brain after administration of linear GBCA.Item Effects of the Cerebral Aneurysm Treatment Method on Coil Packing Density and Its Relationship with the Ostium Area(2022) Kesim, Cagri; Ozcan, Umit Can; Yildirim, Erkan; https://orcid.org/0000-0002-8964-291X; https://orcid.org/0000-0002-4447-0296; 35283278; AAD-5996-2021; AAM-3467-2021Purpose: To test the following hypotheses: (a) balloon or stent assistance increases coil packing density (CPD) in the endovascular treatment of intracranial aneurysms, and (b) CPD correlates to ostium area (OA) and aneurysm volume (AV). Materials and Methods: This retrospective study included 60 aneurysms (54 ruptured and 6 unruptured) treated with simple coiling (SC) (n = 18), balloon-assisted coiling (BAC) (n = 7), or stent-assisted coiling (SAC) (n = 35) at the authors' institution between August 2017 and December 2019. AV and OA measurements were obtained from 3-dimensional digital subtraction angiography images using commercial software. Coil sizes were retrieved from patient files, and coil volume (CV) measurements were obtained from https://www.angiocalc.com/. Analysis of covariance, multivariate covariance analysis, and Pearson correlation analyses were performed. Results: The median value for AV, CV, CPD, and OA was 63.4 mm(3) (range, 5.5-1,771.4 mm(3)), 23.13 mm(3) (range, 2.03-296.95 mm(3)), 33.29% (range, 13.41%-81.02%), and 10.7 mm(2) (range, 2.7-49.9 mm(2)), respectively. Multivariate analysis showed that the CPD values were not significantly different among the treatment groups, although OA significantly differed between the SC and SAC groups (P <.05). Pearson correlations showed that similar to AV, OA was negatively correlated with CPD (r = -0.321, P <.05). Conclusions: The CPD value in cerebral aneurysms treated with BAC or SAC did not differ from that in aneurysms treated with SC.Item Fifteen Years Of Central Catheter Applications And Outcomes In Intensive Care Patients: A Single-Center Pediatric Experience(2022) Silahli, Musa; Kesim, Cagri; https://orcid.org/0000-0003-0944-7178; https://orcid.org/0000-0002-8964-291X; 35100890; AAD-5996-2021Background: To investigate the clinical outcome of central line placement in the pediatric age group and to evaluate the risk factors for central line-associated bloodstream infection (CLABSI). Methods: We retrospectively examined the outcomes and CLABSI risk factors of pediatric patients aged 0-17 years admitted to intensive care units who had central catheters placed between January 2005 and December 2020. Results: Of the 2718 catheter admissions, 1502 catheter admissions were eligible for the regression and other outcome analyses. Fifty-seven percent of the study group were umbilical artery and vein catheters and 43% were other central catheter admissions, including ultrasound-guided catheter admissions. Logistic regression analysis showed us that right internal jugular vein (RIJV) (OR = 1.5, 95% CI = 1.15-2.02, p = 0.030) was the insertion site and ultrasound-guided interventional radiology catheter placement was the technique (OR = 1.7, 95% CI = 1.07-2.90, p = 0.024), duration of catheter stay (OR = 1.07, 95%CI = 1.06-1.08, p < 0.001), catheter placement in patients older than 2 years (OR = 2.42, 95% CI = 1.69-3.45, p < 0.001), were risk factors for CLABSI. Conclusion: Although CLABSI has variable risk factors, the most important risk factor seems to be the length of catheter stay.Item Influenza viruses and SARS-CoV-2 in adult: 'Similarities and differences'(2021) Torun, Serife; Kesim, Cagri; Suner, Aynur; Botan Yildirim, Berna; Ozen, Ozgur; Akcay, Sule; 0000-0002-8964-291X; 0000-0001-7122-4130; 0000-0001-7730-1379; 34957739; AAD-5996-2021; AAN-1681-2021Introduction: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), causing a global pandemic starting from December 2019, showed a course that resulted in serious mortality in the world. In order to understand SARSCoV-2 better, here we aimed to compare the similar and different characteristics of Influenza viruses occurring in the same season with SARS-CoV-2. Materials and Methods: A total of 144 patients (31 patients with COVID-19, 62 patients with H1N1 influenza, and 51 patients with influenza B) were included in the study. Demographic findings, chronic diseases, laboratory values, chest x-ray, and chest CT findings of the patients were evaluated retrospectively. Results: Median age of the COVID-19 patients and rate of male patients were higher than other patient groups (55 years; p< 0.001) (61% male; p< 0.001). The most common chronic medical conditions were hypertension and diabetes. Platelet numbers and alanine aminotransferase values were significantly higher in COVID-19 patients. Radiologically, bilateral (74.2%) and nonspecific distribution (58.1%), ground-glass opacities with consolidation (51.6%), patchy image (25.8%), ground-glass opacities with interstitial changes (22.6%) and halo sign (22.6%) were quite evident than other groups in COVID-19 patients (p< 0.05). Conclusion: We suggest that due to the higher PLT values observed in COVID-19 patients, initiation of anticoagulant therapy should be considered in the early stage and routine follow-up with d-dimer and fibrinogen should be applied for suspected patients. Moreover, attention should be paid in terms of possible liver toxicity of the drugs to be used in treatment due the higher ALT values observed in COVID-19 patients. Since we did not detect SARS-CoV-2 and influenza viruses concurrently in the same patient, it may be helpful to focus on only one virus in a patient with symptoms, and radiographic differences can be used to differentiate COVID-19 from influenza.Item Can unenhanced brain magnetic resonance imaging be used in routine follow up of meningiomas to avoid gadolinium deposition in brain?(2019) Rahatli, Feride Kural; Donmez, Fuldem Yildirim; Kesim, Cagri; Haberal, kema Murat; Turnaoglu, Hale; Agildere, Ahmet Muhtesem; 0000-0002-8211-4065; 0000-0002-8964-291X; 30343167; R-9398-2019; AAB-5802-2020; AAD-5996-2021; AAE-5528-2021Purpose: We hypothesized that unenhanced brain MRI can be used in follow up of patients with intracranial meningioma to avoid gadolinium deposition in the brain and allow measurement of meningioma dimensions from pre-contrast T2-weighted images. Methods: Dimensions of meningiomas were measured on pre-contrast T2, post-contrast T1 weighted images. Results: The sizes of meningiomas in post-contrast axial T1-weighted images were similar with that in pre-contrast axial T2-weighted images. Signal intensity increase was detected in dentate nucleus and globus pallidus (P < 0.05). Conclusion: Gadolinium deposition could be avoided in patients with meningioma by using unenhanced brain MRI for follow up scans.