TR-Dizin İndeksli Açık & Kapalı Erişimli Yayınlar
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Item Significance of the Cerebellopontine Cistern Cross-Sectional Area and Trigeminal Nerve Anatomy in Trigeminal Neuralgia: An Anatomical Study Using Magnetic Resonance Imaging(2020) Gunesli, Aylin; Tufan, Kadir; 0000-0003-1509-4575; 32091126; AAK-1686-2021AIM: To evaluate the relationship between trigeminal neuralgia (TN) and potential magnetic resonance imaging (MRI)-related measurements in patients with TN. MATERIAL and METHODS: Retrospective analysis of 104 patients with TN was performed. MRI studies of 98 healthy controls were included in the study to compare the parameters with TN patients' measurements. MRI measurements of cerebellopontine cistern (CPC) cross-sectional area, trigeminal-pontine angle (TPA) width, and trigeminal nerve cisternal segment length and thickness were assessed on both symptomatic and asymptomatic sides using 1.5T MRI with constructive interference in steady-state sequences. The images were interpreted by two radiologists blinded to the affected sides of the patients. RESULTS: There were significant differences between the symptomatic and asymptomatic sides in terms of mean trigeminal nerve length (8.8 +/- 2.34 mm vs. 9.39 +/- 2.29 mm; respectively, p=0.001) and thickness (20.9 +/- 9.6 mm(2) vs. 25 +/- 9.98 mm(2), respectively; p<0.001). The median cerebellopontine cistern cross-sectional area was considerably lower on the symptomatic side compared with the asymptomatic side [201 mm(2) (interquartile range=93) vs. 224.5 mm(2) (interquartile range=77), respectively; p<0.001]. There were no significant differences between the trigeminal-pontine angle width on either side (38.32 +/- 10.38 vs. 38.78 +/- 10.9, respectively; p=0.679). There were no statistically significant differences between the right and left sides regarding these parameters in the control group. CONCLUSION: Smaller CPC cross-sectional area, trigeminal nerve length, and trigeminal nerve thickness on MRI were demonstrated to commonly exist on the symptomatic side in patients with TN. We suggest that this narrow space may increase the risk of vascular compression on the nerve.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 Comparison of carotid elasticity and distensibility between patients with end-stage renal disease and healthy volunteers(2020) Gunesli, Aylin; Torer, Nihan TekkarismazPurpose: The incidence of cardiovascular events increased in patients with end-stage renal disease, but it is not clear how renal failure affects carotid arteries. The aim of this study is to evaluate this affect. For this purpose, the elasticity and distensibility which are markers of subclinical carotid atherosclerosis were measured and compared in patients with end-stage renal disease and healthy population. Materials and Methods: The study was planned as crosssectional. A total of 119 subjects (61 patients and 58 control) were enrolled into the study. Carotid elasticity and distensibility were measured and compared between the groups. In addition, we investigated whether there was a significant correlation between the duration of dialysis and carotid elasticity and distensibility. Results: Carotid elasticity and distensibility were significantly lower in the patient group than in the control group (0.12 +/- 0.02 vs. 0.23 +/- 0.04, p < 0.001, and 7.47 +/- 0.51 vs. 9.42 +/- 0.73, p < 0.001, respectively). Correlation analysis revealed a significant positive correlation between the duration of dialysis and carotid elasticity and distensibility (r = -0.783, p < 0.001 ve r = -0.385, p = 0.002, respectively). Conclusion: Carotid elasticity and distensibility decreased in patients with end-stage renal disease. These results may suggest an increased risk of subclinical atherosclerosis in the carotid arteries in this patient group and may indirectly suggest that the increase in the risk of cerebrovascular event is caused by atherosclerosis in the carotid arteries.Item Simultaneous balloon angioplasty and stent implantation in supraaortic multiple stenosis(2020) Gunesli, Aylin; Akgul, ErolPurpose: The aim of this study was to evaluate the success and complications of endovascular treatment in supraaortic multiple stenotic lesions Materials and Methods: The study was planned as a retrospectively. The records of patients who underwent percutaneous interventional treatment for multiple stenosis in the supraaortic vessels between January 1, 2004 and December 31, 2009 were reviewed. Percutaneous endovascular intervention was decided with doppler ultrasonography, magnetic resonance imaging, computed tomography or digital subtraction angiography provided that more than 50% stenosis was detected in the supraaortic vessels. Patients with at least 2 severe stenosis who underwent multiple interventional procedures in one session were included in the study. Results: A total of 34 patients (mean age 60.4 +/- 12.5 years and 6 female (17.4%)) were included in the study. A total of 74 lesions were treated in 34 patients. Stents were used in all procedures. No mortality or serious morbidity was observed during follow-up. The technical success of the procedure was 100%. Restenosis was observed in 4 patients (11.7%) at a mean follow-up of 29.5 +/- 18.3 months. Three of these patients were re-treated. Conclusion: According to the results of our study, endovascular intervention can be safely performed in occlusive atherosclerotic vascular disease of the supraaortic branches. Mortality and morbidity of this treatment is very low. In patients with restenosis during follow-up, re-intervention can be performed safely. If multiple lesions are present in the same patient group, multiple interventions are a safe treatment option.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.