TR-Dizin İndeksli Açık & Kapalı Erişimli Yayınlar
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Item EVALUATION OF EPICARDIAL FAT AND CAROTID AND FEMORAL INTIMA-MEDIA THICKNESSES IN GERIATRIC PATIENTS WITH END-STAGE RENAL DISEASE(2020) Gunesli, Aylin; Yilmaz, Mustafa; Yalcin, Cigdem; Tekkarismaz, Nihan; Alkan, Ozlem; 0000-0002-2557-9579; 0000-0001-5483-8253; 0000-0001-7631-7395; S-6973-2016; AAM-4284-2021; AAD-9088-2021Introduction: Although atherosclerotic cardiovascular diseases and cardiovascular risks are known to increase in patients with end-stage renal disease, it is not clear whether these risks increase in the geriatric patient population as well. This study aims to evaluate these risks in geriatric patients with end-stage renal disease by evaluating epicardial fat and carotid and femoral intima-media thicknesses, known as markers, for subclinical atherosclerosis and cardiovascular risks. Materials and Methods: This cross-sectional study included 52 patients who started to receive chronic hemodialysis treatment after the age of 65 years (mean age 73.92 +/- 5.63) years with end-stage renal failure and 51 healthy volunteers (mean age: 74.49 +/- 4.63 years). Epicardial fat and carotid and femoral intima-media thicknesses were measured and compared between these groups. Results: Carotid intima-media and epicardial fat thicknesses were significantly higher in the patient group than in the control group (0.91 +/- 0.08 vs. 0.71 +/- 0.1 mm, p<0.001 and 0.84 +/- 0.17 vs. 0.75 +/- 0.17 cm, p=0.01, respectively). However, no significant difference was observed in femoral intima-media thickness between the two groups (0.58 +/- 0.07 vs. 0.56 +/- 0.97 mm, p=0.266). Correlation analysis revealed a significant positive correlation between the duration of dialysis and epicardial fat and carotid intima-media thicknesses (r=0.611, p<0.001 and r=0.337, p=0.015, respectively). Furthermore, regression analysis revealed a significant relationship between the duration of dialysis and carotid intima-media thickness (beta=0.657, p=0.001). Conclusion: Epicardial fat and carotid intima-media thicknesses increase in geriatric patients with end-stage renal disease but with no significant changes in femoral intima-media thickness, indirectly suggesting that subclinical atherosclerosis and cardiovascular risks are increased in these patients.Item Blood pressure limits affecting carotid artery injury: a cross sectional study(2020) Guenesli, Aylin; Acibuca, Aynur; Altin, Cihan; Gezmis, Esin; Tekindal, Mustafa Agah; Yalcin, Cigdem; Alkan, Ozlem; 0000-0002-3444-8845; 0000-0001-7526-3460; 0000-0002-1001-6028; 0000-0001-5483-8253; AAE-8301-2021; ABG-4047-2020; AAM-4169-2021; AAM-4284-2021Purpose: Although it is well known that high blood pressure causes undesirable effects on carotid arteries, it is not clear as to which threshold value this effect starts. The aim of this study is to evaluate and determine this threshold. Materials and Methods: This cross-sectional study included a total of 308 individuals in the following groups; group 1: individuals with systolic blood pressure (SBP) <120 mmHg and diastolic blood pressure (DBP) <80 mmHg (optimal), group 2: SBP 120-129 mmHg and/or DBP 80-84 mmHg (normal), group 3: SBP 130-139 mmHg and/or DBP 85-89 mmHg (high-normal), group 4: SBP 140-159 mmHg and/or DBP 90-99 mmHg, group 5: SBP 160-179 mmHg and/or DBP 100-109 mmHg, and group 6: SBP >= 180 mmHg and/or DBP >= 110 mmHg. Carotid distensibility and elasticity were measured in all groups. Results: A statistically significant difference was determined between the groups in carotid distensibility and elasticity. SBP>135.5 mmHg started to affect carotid distensibility with 78.2% sensitivity and 74.6% specificity, and DBP>86.5 mmHg with 79.3% sensitivity and 71.6% specificity. Carotid elasticity was seen to be affected by SBP>137.5 mmHg with 80.4% sensitivity and 73.1% specificity, and DBP>88.5 mmHg with 79.1% sensitivity and 73.8% specificity. Conclusion: Carotid distensibility and elasticity decreases with increasing blood pressure. Individuals in high-normal group should be evaluated in terms of carotid disease, and it may be necessary to start treatment early in these patients.Item Knosp and Hardy Grading Systems are Useful in Predicting Persistence of Male Hypogonadism in Prolactinomas Following Prolactin Normalization(2020) Bagir, Gulay Simsek; Gunesli, Aylin; Haydardedeoglu, Filiz Eksi; Bakiner, Okan Sefa; Alkan, Ozlem; Ertorer, Melek Eda; 0000-0001-7357-8709; ABI-3705-2020Objective: Despite serum prolactin normalization and tumor shrinkage being obtained using dopamine agonist treatment, hypogonadism may persist in several men with prolactinomas. In this study, we evaluated the effects of tumor magnetic resonance imaging features on the persistence of hypogonadism among normoprolactinemic men with prolactinomas objectively using Knosp and Hardy grading systems. Material and Methods: The patients with prolactinomas who achieved serum prolactin normalization using cabergoline therapy were evaluated, respectively. The extent of tumor growth was evaluated on the basis of Knosp and Hardy grading systems both at diagnosis and six months of medical therapy with serum prolactin normalization. Results: A total of 28 cases (18 macro- and 10 microprolactinomas) were included. After six months of treatment with cabergoline, all microprolactinoma patients with hypogonadism at baseline showed recovery (3, 100%). Moreover, nine of 14 macroprolactinoma patients with hypogonadism at inclusion recovered at the end (group 1), and five did not (group 2). Baseline Knosp grades and Hardy numbers did not differ between groups. However, higher Knosp grades and Hardy numbers were observed in patients who consistently had low serum testosterone in the sixth month (group 2) (p=0.01, p=0.02, respectively). All patients in group 2 had invasive tumors (Hardy number III-IV) both at inclusion and the sixth month according to this classification. Conclusion: We demonstrated that macroprolactinomas with persistent hypogonadism despite serum prolactin normalization more commonly showed cavernous sinus invasion and sellar destruction. We proposed that Knosp and Hardy grading systems are useful in predicting the persistence of male hypogonadism in prolactinomas following prolactin normalization.Item Tuberous sclerosis complex; a single center experience(2015) Erol, Ilknur; Savas, Tulin; Sekerci, Sevda; Yazici, Nalan; Erbay, Ayse; Demir, Senay; Saygi, Semra; Alkan, Ozlem; 26078697Aim: This study was planned with the aim of retrospectively reviewing the clinical and laboratory findings and therapies of our patients diagnosed with tuberous sclerosis and redefining the patients according to the diagnostic criteria revised by the 2012 International Tuberous Sclerosis Complex Consensus Group and comparing them with the literature. Material and Methods: 20 patients diagnosed with tuberous sclerosis complex in the Pediatric Neurology Clinic were examined retrospectively in terms of clinical findings and therapies. The diagnoses were compared again according to 1998 and 2012 criteria. Results: It was observed that the complaint at presentation was seizure in 17 of 20 patients and hypopigmented spots on the skin in 3 of 20 patients. On the initial physical examination, imaging findings related with the disease were found in the skin in 17 of the patients, in the eye in 5, in the kidneys in 7 and in the brain in 17. No cardiac involvement was observed in the patients. Infantile spasm was observed in 7 of the patients who presented because of seizure (n=17), partial seizure was observed in 7 and multiple seizure types were observed in 3. It was found that sirolimus treatment was given to 9 of 20 patients because of different reasons, 7 of these 9 patients had epileptic seizures and sirolimus treatment had no effect on epileptic seizures. According to 2012 diagnostic criteria, no marked change occured in the diagnoses of our patients. Conclusions: It was observed that the signs and symptoms of our patients were compatible with the literature. Molecular genetic examination was planned for the patients who were being followed up because of possible tuberous sclerosis complex. It was observed that sirolimus treatment had no marked effect on the seizure frequency of our patients.Item Wernicke Encephalopathy after Gastrointestinal Surgery(2015) Saygi, Semra; Savas, Tulin; Alkan, Ozlem; Erol, IlknurWe herein describe a child operated for acute abdomen who developed Wernicke's encephalopathy (WE) secondary to prolonged total parenteral nutrition (TPN) that lacked vitamin B1 supplementation. The author concluded that surgeons, child neurologists, pediatricians and radiologists need to be aware of the predisposing factors and symptoms of WE. Clinicians need to keep in mind that ophthalmoplegia, ataxia or altered mental status could be findings of WE.Item Diffusion-Weighted MRI in Cranial Bone Marrow Metastasis(2015) Alkan, Ozlem; Pekoz, Burcak Cakir; Altinkaya, NaimePurpose: Diffusion-weighted MR imaging (DW-MRI) is generally applied to diagnose intra-axial brain pathologies such as parenchyma metastasis, abscesses, and infarcts in patients with systemic cancer. This study aimed to evaluate the DW-MRI findings in cranial bone marrow metastases to facilitate diagnosis. Material and Methods: Conventional MR imaging and DW-MRI findings of 57 patients with cranial bone marrow metastases were evaluated retrospectively. These images were evaluated by two neuroradiologists for lesion detection and lesion consciousness. Reader agreement was assessed by. statistics. Results: Fifty-seven patients exhibited 113 cranial bone marrow metastases. The sensitivities of DW-MRI and the apparent diffusion coefficient to detect cranial bone metastasis for all types of primary malignancy were 86% and 90%, respectively. The sensitivities of T1-weighted imaging (T1WI), fluid attenuation inversion recovery, contrast-enhanced fat-suppressed (CE-FS) T1WI, and T2WI sequences to detect cranial bone metastasis were 93%, 90%, 89%, and 84%, respectively. Regarding lesion conspicuousness, DW-MRI was equivalent to CE-FS T1WI and equivalent or superior to non-contrast conventional sequences in most of the cranial bone marrow metastases. Interobserver agreement was excellent. Conclusions: DW-MRI is generally indicated not only to assess the diagnosis of parenchyma involvement, but also to discover the cranial bone marrow metastasis in patients with systemic cancer.Item Radiological Imaging after Treatment in High-Grade Glial Tumor(2015) Alkan, OzlemHigh-grade glial tumors are the most common primary brain tumor in adults. The current standard of care for high-grade glial tumors includes surgical resection followed by combination of radiation with temazolomide treatment and adjuvant temozolomide. The Macdonald Criteria are currently the most widely used guideline for assessing response to therapy in patients with high-grade glial tumors. These are based on the size of the contrast-enhancing lesion in MR imaging. Recently, nontumoral changes in enhancement have been found. It is now clear that evaluation of gadolinium enhancement alone is not adequate to characterize tumor regression or progression. MR diffusion, MR perfusion, MR spectroscopy, and PET imaging will be important adjuncts to traditional imaging for tumor assessment. We review MR imaging findings following high-grade tumor treatment.Item Imaging findings of spondylodiscitis(2016) Alkan, Ozlem; Altinkaya, NaimeSpondylodiscitis is an infection of the intervertebral disc and adjacent vertebral bodies. Magnetic resonance imaging is the method of choice for the spondylodiscitis. The characteristic findings in the spondylodiscitis are hypointense on T1-weighted (W) image and hyperintense on T2W and fat-saturation T2W images, contrast enhancement on contrast-enhanced T1W with fat saturation images in the disc space and adjacent vertebral bodies, and phlegmon or abscess of the paraspinal soft tissues and epidural space. Phlegmon shows homogenous contrast enhancement, while abscess shows peripheral ring-enhancement on contrast-enhanced T1W with fat saturation images. Differentiation of tuberculous, brucellar and pyogenic spondylodiscitis is radiological difficult. Features that also favor tuberculosis infection include multilevel disease, large paravertebral abscess, meningeal involvement and subligamentous spread. Brucellar spondylodiscitis most commonly affects the lumbar spine. Bone destruction is less severe than in tuberculous spondylodiscitis. Osteophyte formation at the anterior vertebral endplate is typical.Item Cardiac rhabdomyoma associated with tuberosclerosis complex in a newborn(2016) Torer, Birgin; Cetinkaya, Bilin; Arslan, Alevi; Alkan, Ozlem; Erol, Ilknur; Gulcan, Hande; 0000-0002-3530-0463; 0000-0003-0866-7339; 0000-0003-4444-0027; 0000-0001-7526-3460; AAK-4825-2021; AAF-1346-2021; V-1112-2019; AAM-4169-2021Cardiac rhabdomyomas are the most comman cardiac tumors in children. They are hamartomatous benign tumors composed of myocytes. They often presents as multiple lesions involving the ventricular cavities. Rhabdomyomas are usually detected in utero by fetal echocardiography. Although patients with cardiac rhabdomyomas are generally asymptomatic these tumors may cause heart failure, severe arrhyhmias and sudden death. Cardiac rhabdomyomas are often associated with tuberosclerosis and they may be the earliest manifestation of tuberosclerosis. Here, we report a newborn infant with antenatally detected cardiac rhabdomyomas associated with tuberosclerosis and we want to emphasize that other diagnostic features of tuberosclerosis should be evaluated in patients with cardiac rhabdomyomas.Item Prognostic Impact of Histologic Subtype in Non-Small Cell Lung Cancer Patients Treated with Gamma Knife Radiosurgery: Retrospective Analysis of 104 Patients(2017) Tufan, Kadir; Aydemir, Fatih; Cekinmez, Melih; Kardes, Ozgur; Sarica, Feyzi Birol; Topkan, Erkan; Sonmez, Erkin; Alkan, Ozlem; Ugurluer, Gamze; Altınors, Nur; 0000-0002-5693-3542; 0000-0003-2854-941X; 0000-0001-8120-7123; 0000-0003-1509-4575; 0000-0001-9658-9005; 0000-0001-9985-0184; 27593758; AAI-8820-2021; P-5895-2018; AAG-2213-2021; AAK-1686-2021AIM: In this study, factors affecting survival, local failure, distant brain failure, whole brain failure and whole-brain radiation therapy (WBRT) free survival according to histological subtypes were investigated in patients with brain metastases from non-small cell lung cancer (NSCLC). MATERIAL and METHODS: Patients with positive pathology reports for adenocarcinoma (ACA) and squamous cell carcinoma (SCC) were included in the study. Seventy-eight ACA and 26 SCC patients were included in the study. Patients with previous history of cerebral metastasis surgery and WBRT were excluded from the study. RESULTS: The median survival was calculated as 12.6 months for patients with ACA and 5.9 months for patients with SCC. One-year distant brain failure was calculated as 65.1% in ACA patients and 39.6% in SCC patients. One-year whole brain failure was calculated as 58.1% in ACA patients and 39.6% in SCC patients. The one-year freedom from WBRT rate was calculated as 72.8% in ACA patients and 56.3% in SCC patients. SCC histology was considered as a significant factor in deterioration of overall survival in multivariate analysis. SCC histology, the increase in the number of metastases and RPA class were factors that caused an increase in distant brain failure. Also, SCC histology, the increase in the number of metastases and RPA class were factors that caused an increase in whole brain failure. CONCLUSION: SCC histology may be an important prognostic factor for overall survival. Also, due to high distant brain failure rate in SCC histology, WBRT can be added to treatment early.