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Kocyigit D, Keser N, Simsek E, Bozyel S, Dalgic Y, Seker M, Korkmaz Y, Guler A, Cinar T, Erturk M. Perspectives on the use of digital health technologies in cardiology among specialists from an ESC member country: results from a survey. Eur Heart J 2022. [PMCID: PMC9619648 DOI: 10.1093/eurheartj/ehac544.2799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Digital health technologies (DHTs) have the potential of facilitating both physicians' and patients' lives with regards to the diagnosis, treatment and follow-up of cardiovascular disease. A huge acceleration in relevant research has been noted particularly after the COVID-19 pandemic. Purpose The goal of this study was to determine the reasons for using DHTs in cardiology, as well as the perceived barriers to its use. Methods An electronic survey with 43 question multiple-choice questionnaire was conducted between January 10-March 3, 2022. National cardiac society member cardiology fellows in training and specialists were contacted via e-mail (n=2789). Results 308/2789 (11.04%) subjects responded to the survey (72.40% males, 62.01% aged 30–44 years). 42.53% and 44.81% were affiliated with university hospitals and state hospitals, respectively. 88/297 (29.63%) stated having at least good understanding of DHTs in cardiology. 44.16% utilized smart devices to track their own health status. 117/290 (40.34%) and 193/299 (64.55%) used social media platforms to share medical information with their patients and other physicians, respectively. WhatsApp and Instagram were the most popular platforms for sharing with patients (92/117, 78.63% and 48/117, 41.03%), while WhatsApp and Twitter were the most popular platforms for sharing with other physicians (151/193, 78.24% and 91/193, 47.15%). Considerations and recommendation/utilization patterns of DHTs by physicians are summarized in Table 1. Perceived barriers to the use of DHTs in cardiology is shown on Figure 1 (A: physician-related, B: patient-related, C: technical). Conclusion Findings suggest that nearly half of the physicians use DHTs to collect their own health data and use social media to disseminate health information. The majority of physicians believe that DHT is beneficial to both themselves and their patients, and that DHT use in cardiology has increased as a result of the COVID-19 pandemic. To overcome the challenges to the use of DHTs in cardiology, a multilayered collaborative effort involving patient and professional organizations, as well as technical stakeholders and lawmakers, is required. Funding Acknowledgement Type of funding sources: None.
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Affiliation(s)
| | - N Keser
- Health Sciences University Sultan Abdulhamid Han Training and Research Hospital, Cardiology , Istanbul , Turkey
| | - E Simsek
- Ege University Faculty of Medicine, Cardiology , Izmir , Turkey
| | - S Bozyel
- Health Sciences University Derince Training and Research Hospital, Cardiology , Kocaeli , Turkey
| | - Y Dalgic
- Health Sciences University Derince Training and Research Hospital, Cardiology , Kocaeli , Turkey
| | - M Seker
- Health Sciences University Sultan Abdulhamid Han Training and Research Hospital, Cardiology , Istanbul , Turkey
| | - Y Korkmaz
- Health Sciences University Sultan Abdulhamid Han Training and Research Hospital, Cardiology , Istanbul , Turkey
| | - A Guler
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Cardiology , Istanbul , Turkey
| | - T Cinar
- Health Sciences University Sultan Abdulhamid Han Training and Research Hospital, Cardiology , Istanbul , Turkey
| | - M Erturk
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Cardiology , Istanbul , Turkey
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Elshamy W, Soylemez B, Sayyahmelli S, Keser N, Baskaya MK. Transcavernous Resection of a Giant Extensive Chondrosarcoma with Endoscopic Assistance. Skull Base Surg 2022; 83:e644-e645. [PMID: 36068908 PMCID: PMC9440939 DOI: 10.1055/s-0041-1727124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 01/09/2021] [Indexed: 10/28/2022]
Abstract
AbstractChondrosarcomas are one of the major malignant neoplasms which occur at the skull base. These tumors are locally invasive. Gross total resection of chondrosarcomas is associated with longer progression-free survival rates. The patient is a 55-year-old man with a history of dysphagia, left eye dryness, hearing loss, and left-sided facial pain. Magnetic resonance imaging (MRI) showed a giant heterogeneously enhancing left-sided skull base mass within the cavernous sinus and the petrous apex with extension into the sphenoid bone, clivus, and the cerebellopontine angle, with associated displacement of the brainstem (Fig. 1). An endoscopic endonasal biopsy revealed a grade-II chondrosarcoma. The patient was then referred for surgical resection. Computed tomography (CT) scan and CT angiogram of the head and neck showed a left-sided skull base mass, partial destruction of the petrous apex, and complete or near-complete occlusion of the left internal carotid artery. Digital subtraction angiography confirmed complete occlusion of the left internal carotid artery with cortical, vertebrobasilar, and leptomeningeal collateral development. The decision was made to proceed with a left-sided transcavernous approach with possible petrous apex drilling. During surgery, minimal petrous apex drilling was necessary due to autopetrosectomy by the tumor. Endoscopy was used to assist achieving gross total resection (Fig. 2). Surgery and postoperative course were uneventful. MRI confirmed gross total resection of the tumor. The histopathology was a grade-II chondrosarcoma. The patient received proton therapy and continues to do well without recurrence at 4-year follow-up. This video demonstrates steps of the combined microsurgical skull base approaches for resection of these challenging tumors.The link to the video can be found at: https://youtu.be/WlmCP_-i57s.
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Affiliation(s)
- Walid Elshamy
- Department of Neurological Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States
- Department of Neurological Surgery, Ain Shams University, Faculty of Medicine, Cairo, Egypt
| | - Burcak Soylemez
- Department of Neurological Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Sima Sayyahmelli
- Department of Neurological Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Nese Keser
- Department of Neurological Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Mustafa K. Baskaya
- Department of Neurological Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States
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Selcuk M, Keskin M, Cinar T, Gunay N, Dogan S, Cicek V, Kilic S, Asal S, Yavuz S, Keser N, Orhan A. Prognostic significance of N-Terminal Pro-BNP in patients with COVID-19 pneumonia without previous history of heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The objective of the present research was to evaluate the possible association between the N-terminal pro-brain type natriuretic peptide (NT-proBNP) levels and in-hospital mortality in coronavirus disease 2019 (COVID-19) pneumonia patients who did not have pre-existing heart failure (HF).
Methods
A total of 137 consecutive patients without pre-existing HF and hospitalized due to COVID-19 pneumonia were enrolled into the current research. The main outcome of the research was the in-hospital death. The independent parameters linked with the in-hospital death were determined by multivariable analysis.
Results
A total of 26 deaths with an in-hospital mortality rate of 18.9% was noted. Those who died were older with an increased frequency of co-morbidities such as hypertension, chronic kidney disease, coronary artery disease, stroke and dementia. They had also increased white blood cell (WBC) counts and had elevated glucose, creatinine, troponin I, and NT-pro-BNP levels but had decreased levels of hemoglobin. By multivariable analysis; age, NT-pro-BNP, WBC, troponin I, and creatinine levels were independently linked with the in-hospital mortality. After ROC evaluation, the ideal value of the NT-pro-BNP to predict the in-hospital mortality was found as 260 ng/L reflecting a sensitivity of 82% and a specificity of 93% (AUC:0.86; 95% CI: 0.76–0.97).
Conclusion
The current research clearly shows that the NT-proBNP levels are independently linked with the in-hospital mortality rates in subjects with COVID-19 pneumonia and without HF. Thus, we believe that this biomarker can be used as a valuable prognostic parameter in such cases.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- M Selcuk
- Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - M Keskin
- Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - T Cinar
- Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - N Gunay
- Ümraniye Training and Research Hospital, Cardiology, Istanbul, Turkey
| | - S Dogan
- Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - V Cicek
- Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - S Kilic
- Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - S Asal
- Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - S Yavuz
- Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - N Keser
- Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - A.L Orhan
- Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
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Keskin M, Borklu EB, Dogan S, Ozturk B, Tenekecioglu E, Keser N, Orhan AL. Effect of the number of parity on right heart chamber quantification. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Pregnancy is a process that causes several physiological changes including all systems as well as cardiovascular system. Ventricular hypertrophy and dilation of cardiac chambers are seen as a result of these changes. Although there are studies about pregnancy-related changes in echocardiographic examination; there is no data about the long-term effects of parity on these alterations. Therefore, we have evaluated the long-term effect of pregnancy on right ventricular (RV) dilation and RV hypertrophy and their relation to the parity number.
Methods
This prospective study included a total of 600 women (200 consecutive women who had no parity, 200 women who had a parity number of 1 to 4 and 200 women who had a parity number of more than 4). Right chambers' measurements were compared between the groups.
Results
In echocardiographic analysis, RV and right atrial dimensions and areas and RV wall thickness were higher in parous women. On the other hand, RV systolic function parameters were significantly lower in parous women. These significant changes showed a gradual increase or decrease by increasing parity number. By multivariate hierarchical logistic regression analysis, the 4 independent factors that increased the risk of RV dilation were age (OR: 1.16 CI: 1.10 – 1.20), body mass index (OR: 1.05, CI: 1.02 to 1.08), smoking (OR: 1.87, CI: 1.28 to 4.02), and giving a birth (OR: 3.94 CI: 1.82 – 8.81). There were also independent relationship between the number of parity and RV hypertrophy even after adjustment for several confounders.
Conclusion
Pregnancy-related physiological changes mostly resolve after delivery. This study about long-term effects of pregnancy on RV has demonstrated that there is a significant relation between the number of parity and either RV dilation or RV hypertrophy. Each parity had also additive effect on these changes.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Keskin
- Sultan II. Abdulhamid Han Training and Research Hospital, Cardiology, Istanbul, Turkey
| | - E B Borklu
- Dr Lutfi Kirdar Kartal Training and Research Hospital, Cardiology, Istanbul, Turkey
| | - S Dogan
- Sultan II. Abdulhamid Han Training and Research Hospital, Cardiology, Istanbul, Turkey
| | - B Ozturk
- Kahramanmaras Sutcu Imam University, Cardiology, Kahramanmaras, Turkey
| | | | - N Keser
- Sultan II. Abdulhamid Han Training and Research Hospital, Cardiology, Istanbul, Turkey
| | - A L Orhan
- Sultan II. Abdulhamid Han Training and Research Hospital, Cardiology, Istanbul, Turkey
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Derin Cicek E, Keser N, Is M, Ates O. Can intracranial vertebral artery hypoplasia be an etiopathogenetic factor for Barré-Lièou Syndrome other than arcuate foramen? A retrospective clinical study and review of the literature. Turk Neurosurg 2021; 32:571-577. [PMID: 34664696 DOI: 10.5137/1019-5149.jtn.32794-20.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM The arcuate foramen (AF) variation localized on the vertebral artery (VA) sulcus posterior to the atlas has complete and incomplete types. Complete-type AF can exert pressure on the VA that passes through it, resulting in vertebrobasilar insufficiency finding, a Barré-Lièou syndrome (BLS) component. In patients with BLS, complaints could be decreased by the surgical decompression of VA at the AF level. However, a reliable theory regarding BLS has not yet been established; in addition, the reason why some of the cases do not respond to AF decompression has not been fully elucidated. We assumed that intracranial VA (V4) hypoplasia may be the main factor of the pathophysiology of BLS and aimed to investigate the possibility of their co-occurrence. MATERIAL AND METHODS Cervical computed tomography and magnetic resonance angiography images of 139 patients aged 14-88 years with head and neck pain and dizziness were retrospectively evaluated. RESULTS Of the patients, 19.4% exhibited complete AF variation and 32.4% exhibited VA hypoplasia (VAH); 10% of the patients with VAH had accompanying contralateral complete AF variation. There was no significant relationship between complete AF variation and contralateral and ipsilateral VAHs (right side: p = 0.527 and p = 0.433, respectively; left side: p = 1.000 and p = 0.740, respectively). CONCLUSION Our findings indicate that V4 hypoplasia cannot be the main factor of BLS pathophysiology. However, the rarity of the relationship may suggest why some cases do not respond to decompressive surgery.
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Affiliation(s)
- Esin Derin Cicek
- University of Health Sciences Istanbul Fatih Sultan Mehmet Training and Research Hospital
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6
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Keser N, Elshamy W, Chen X, Velioglu M, Is M, Xu Y, Eroksuz M, Ermutlu I, Huryol C, Jian R, Ates O. Challenges in Using the Posterior Inferior Cerebellar Artery for Revascularization of the Anterior Inferior Cerebellar Artery: A Microsurgical Anatomic Study. World Neurosurg 2021; 150:e591-e599. [PMID: 33753318 DOI: 10.1016/j.wneu.2021.03.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/12/2021] [Accepted: 03/13/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND A bypass is usually required to prevent ischemia during the treatment of anterior inferior cerebellar artery (AICA) aneurysms. The intracranial (IC)-to-IC bypass provides several advantages over the extracranial-to-IC bypass in the posterior fossa. However, there are only 2 case reports about AICA revascularization with the posterior inferior cerebellar artery (PICA). We aimed to investigate the microsurgical anatomical challenges for PICA to AICA anastomosis. METHODS Ten cadaveric heads injected with colored silicone were inspected on both sides using a lateral transcondylar approach. After the donor and recipient arteries were examined from the posterior side, neurovascular contents of the posterior fossa were excised and the origin, course, and variations of both arteries were investigated from the anterior view. The diameters of the AICA and PICA segments and the intersegment distance were measured. RESULTS PICA variations and posteromedial origins from the vertebral artery were identified in 8 of the 20 right and 6 of the 20 left sides, and the first segment of the PICA was not present in 7 sides. Furthermore, in 18 sides, the PICA was trapped between the lower cranial nerves and dentate ligaments. Therefore the donor artery could not be brought closer than 1 cm to the recipient artery in 19 sides. Moreover, AICA variations were identified in 6 sides, and in 12 sides, the diameter of the recipient artery was <1 mm. CONCLUSIONS The mostly PICA-related issues made PICA-to-AICA anastomosis unfeasible in all cadaveric heads included in the study.
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Affiliation(s)
- Nese Keser
- Department of Neurosurgery, University of Health Sciences, Istanbul Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey.
| | - Walid Elshamy
- Ain Shams University Faculty of Medicine, Department of Neurosurgery, Cairo, Egypt
| | - Xinpu Chen
- Zhengzhou University School of Medicine, Department of Neurosurgery, Zhengzhou, China
| | - Murat Velioglu
- Department of Radiology, University of Health Sciences, Istanbul Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Merih Is
- Retired Neurosurgeon, Department of Neurosurgery, University of Health Sciences, Istanbul, Turkey
| | - Yinfu Xu
- The Second People's Hospital of Liaocheng Shandong University, Department of Neurosurgery, Liaocheng Shandong, China
| | - Melih Eroksuz
- Marmara University School of Medicine, Institute of Neurological Sciences, Department of Neurosurgery, Istanbul, Turkey
| | - Ilcim Ermutlu
- Department of Neurosurgery, University of Health Sciences, Istanbul Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Cagin Huryol
- Bakirkoy Dr Sadi Konuk Training and Research Hospital, Department of Radiology, Istanbul, Turkey
| | - Ruan Jian
- Chongqing University Cancer Hospital, Department of Neurosurgery, Chongqing, China
| | - Ozkan Ates
- Koc University School of Medicine Hospital, Department of Neurosurgery, Istanbul, Turkey
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Cinar T, Hayiroglu M, Cicek V, Asal S, Atmaca M, Keser N, Orhan A. Incidence and predictors of left atrium thrombus in acute ischemic stroke patients without atrial fibrillation: a single center cohort study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The present study aimed to determine independent predictors of left atrial thrombus (LAT) in acute ischemic stroke patients without atrial fibrillation (AF) using transesophageal echocardiography (TEE).
Material and methods
In this single center, retrospective cohort study, we enrolled 149 consecutive acute ischemic stroke patients. All of the patients underwent TEE examination to detect LAT within 10 days following admission. Multivariate logistic regression analysis was performed to assess independent predictors of LAT.
Results
Among all cases, 14 patients (9.3%) had a diagnosis of LAT on TEE examination. In a multivariate analysis; a previous diagnosis of cerebrovascular accident, elevated mean platelet volume (MPV), low left ventricle ejection fraction (EF) and a reduced left atrium appendix (LAA) peak emptying velocity were independent predictors of LAT. The area of MPV under the receiver operating characteristic curve analysis was 0.70 (95% CI: 0.57–0.83; p=0.011). With the optimal cut-off value of 9.45, MPV had a sensitivity of 71.4% and a specificity of 63% to predict LAT.
Conclusion
Patients with low ventricle EF and elevated MPV should undergo further TEE examination for the possibility of cardio-embolic source. In addition, this research may provide novel information with respect to the applicability of MPV to predict LAT in acute ischemic stroke patients without AF.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Cinar
- Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - M.I Hayiroglu
- Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - V Cicek
- Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - S Asal
- Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - M.M Atmaca
- Sultan Abdülhamid Han Training and Research Hospital, Neurology, Istanbul, Turkey
| | - N Keser
- Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - A.L Orhan
- Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
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Keser N, Is M, Ceman D, Somay A. Locally Used Antibiotics for Spinal Infection Prophylaxis and Their Effects on Epidural Fibrosis: an Experimental Laminectomy Study in Rats Using Rifamycin and Gentamycin. Inflammation 2018; 42:714-720. [PMID: 30413905 DOI: 10.1007/s10753-018-0929-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The study aims to assess the effects of antibiotics (ABs), which are typically used in spinal infection prophylaxis, on the formation of epidural fibrosis (EF). Specifically, we investigated the effect of rifamycin and gentamycin on EF formation in laminectomized rats. Thirty-two rats were randomly and equally divided into four groups as follows: laminectomy and physiological saline (0.9% NaCl) solution (control); laminectomy and rifamycin; laminectomy and gentamicin; and laminectomy and a mixture of rifamycin and gentamicin. Laminectomy was performed on L1 and L2 vertebrae in all rats. One month after spinal surgery, spinal tissue samples surrounding the laminectomy were cut with a microtome and stained with hematoxylin-eosin and Masson's trichrome. The histopathological analysis included examining the extent of EF, fibroblast cell density, and cartilage and bone regeneration. Statistical analysis was performed using the IBM SPSS Statistics 22 program (SPSS IBM, Turkey). A value of p < 0.05 was considered statistically significant. EF value differences between the AB treatment groups and the control group were statistically significant (p = 0.030). Specifically, binary comparisons indicated that the EF value was significantly higher in the rifamycin group than that in the control group (p = 0.003; p < 0.05). Our study suggests that locally applied ABs, especially rifamycin, should be diluted before administration to the epidural space.
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Affiliation(s)
- Nese Keser
- Department of Neurological Surgery, Istanbul Fatih Sultan Mehmet Education and Research Hospital, University of Health Sciences, E-5 Karayolu Uzeri, 34752, İcerenkoy-Atasehir, Istanbul, Turkey.
| | - Merih Is
- Department of Neurological Surgery, Istanbul Fatih Sultan Mehmet Education and Research Hospital, University of Health Sciences, E-5 Karayolu Uzeri, 34752, İcerenkoy-Atasehir, Istanbul, Turkey
| | - Duygu Ceman
- Department of Neurological Surgery, Haydarpasa Numune Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Adnan Somay
- Department of Pathology, Istanbul Fatih Sultan Mehmet Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Keser N, Kuskucu A, Is M, Celikoglu E. Familial Chiari Type 1: A Molecular Karyotyping Study in a Turkish Family and Review of the Literature. World Neurosurg 2018; 121:e852-e857. [PMID: 30315983 DOI: 10.1016/j.wneu.2018.09.235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/28/2018] [Accepted: 09/29/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The etiology of Chiari I malformation (CMI) has not been fully elucidated. Therefore, we performed a genetic study of a Turkish family in which 3 sisters had a diagnosis of CMI with or without syringomyelia. METHODS In a family with 7 children, 4 daughters complained of occipital headaches. In 2 of these daughters, CMI had been diagnosed during their 30s, and CMI plus syrinx had been diagnosed in the other daughter in her 40s. Cranial magnetic resonance imaging of the fourth daughter who had developed headaches during her 30s showed normal findings. Because the other siblings in the family were asymptomatic, radiological examinations were not performed. The family had a history of distant consanguineous marriage between parents. Additionally, the father had died, and the mother was asymptomatic, with radiologically normal findings. Array comparative genome hybridization studies were performed for 12 persons from 3 generations of this family. RESULTS None of the 12 cases examined harbored copy number variations. CONCLUSIONS This family with 3 sisters having CMI suggested a possible autosomal recessive single-gene etiology. Cases of familial CMI are unusual but important to study because they could reveal the specific genes involved in posterior fossa/foramen magnum structure and function and provide insights into the cause of sporadic cases.
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Affiliation(s)
- Nese Keser
- Department of Neurological Surgery, TR University of Health Sciences, Istanbul Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey.
| | - Aysegul Kuskucu
- Department of Genetics, Yeditepe University Faculty of Medicine, Istanbul, Turkey
| | - Merih Is
- Department of Neurological Surgery, TR University of Health Sciences, Istanbul Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - Erhan Celikoglu
- Department of Neurological Surgery, TR University of Health Sciences, Istanbul Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
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Keser N, Kula O, Is M, Yardimcioglu I. Prevalence of Anomalously Originating Occipital Artery in a Group of Turkish Individuals: A Retrospective Study using Angiography. Turk Neurosurg 2018; 29:335-339. [PMID: 29757452 DOI: 10.5137/1019-5149.jtn.23232-18.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AIM To investigated the prevalence of anomalously originating occipital artery (OA) using angiography in a group of Turkish individuals. MATERIAL AND METHODS The images recorded in the picture archiving and communication system for a total of 114 patients, in which the whole vertebral artery, as well as the external carotid artery (ECA) and its branches, were visualized, were retrospectively reviewed. Images were obtained using a Toshiba INFNX-i 8000V (Canon Medical Systems, Otawara, Tochigi, Japan) angiography device. RESULTS We diagnosed 11 cases (12 arteries) with anomalously originating OA, representing a prevalence of 9.64%. In 7 cases, the ascending pharyngeal artery and OA originated with a common root from the ECA (8 arteries); and in 4 patients, OA originated from the distal part of the ECA (C1 vertebral level). CONCLUSION As for many vascular structures, the prevalence of OA variations may vary according to the population under question and the examination method used. Our study has shown that in a sample from the Turkish population, the prevalence of anomalously originating OA was much higher than that stated in the literature, which used magnetic resonance angiography. To avoid complications, the high prevalence of this anomaly must be taken into account during surgeries that require the use of OA, endarterectomies, and endovascular interventions.
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Affiliation(s)
- Nese Keser
- University of Health Sciences, Istanbul Fatih Sultan Mehmet Education and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
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Keser N, Avci E, Soylemez B, Karatas D, Baskaya MK. Occipital Artery and Its Segments in Vertebral Artery Revascularization Surgery: A Microsurgical Anatomic Study. World Neurosurg 2018; 112:e534-e539. [DOI: 10.1016/j.wneu.2018.01.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 01/08/2018] [Accepted: 01/11/2018] [Indexed: 10/18/2022]
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Keser N, Akpinar P, Is M, Aktas I. Irreversible Footdrop as a Consequence of Neglected Knee Pain in an Adolescent with a Peroneal Intraneural Ganglion Cyst. World Neurosurg 2018; 111:307-310. [DOI: 10.1016/j.wneu.2017.12.168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/23/2017] [Accepted: 12/27/2017] [Indexed: 11/30/2022]
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Abstract
Bone mineral density (BMD) might be a risk factor for lumbar disc herniation (LDH) in young adults, but there is not enough data concerning this effect. Several studies have been performed on elderly and osteoporotic patients. Thus, we aimed to investigate the effect of BMD on the etiopathogenesis of LDH in young adults.One hundred patients (mean age: 38.45 ± 8.92 years; 50 men and 50 women) were enrolled this case-control study and classified into 2 groups, as follows. The case group (G-I) included 50 patients with symptomatic LDH who were hospitalized in the Physical Medicine and Rehabilitation Clinic, and the control group (G-II) included 50 patients with lower back pain but no finding of LDH detected using magnetic resonance imaging. Patients in the G-II were recruited among those admitted to the outpatient clinic at the time of the study, and whose age and sex were matched to those of the study group. Women in menopause were excluded from the study. BMD analysis by dual energy x-ray absorptiometry was performed in both groups.The mean values of the femur neck and lumbar spine BMD were 1.02 ± 0.13 and 1.19 ± 0.14 g/cm, respectively. There was no statistically significant relationship between BMD and LDH in this population.This result may mean that in a normal range, BMD does not exert a compressive load on the lumbar discs in young adults and therefore may not lead to LDH by this mechanism and the load.
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Affiliation(s)
| | - Arzu Atici
- Physical Medicine and Rehabilitation Department, TR University of Health Sciences, Istanbul Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | | | - Pinar Akpinar
- Physical Medicine and Rehabilitation Department, TR University of Health Sciences, Istanbul Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | | | - İlknur Aktas
- Physical Medicine and Rehabilitation Department, TR University of Health Sciences, Istanbul Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
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Keser N, Dortcan N, Cikla U, Uluc K, Celikoglu E, Is M, Gurer B. Semivertical Incision: An Aesthetically and Electrophysiologically Effective Mini-Incision Technique for Carpal Tunnel Decompression. Med Sci Monit 2017. [PMID: 28627507 PMCID: PMC5486888 DOI: 10.12659/msm.902343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background The purpose of this study was to present the clinical results of our retrospective series of carpal tunnel release (CTR) operations. For these operations we used a unique type of incision, for the first time, for treatment of carpal tunnel syndrome (CTS) consisting of a 1-cm semi-vertical (SV) incision made into the wrist crease for macroscopic open CTR. Material/Methods This retrospective study included 114 patients (101 females and 13 males) with CTR who were operated upon in our neurosurgery clinic between December 2010 and June 2015. Patient ages ranged from 35 to 83 years (mean 55.05±12.04 years). In total, 127 hands (73 right and 54 left) were operated upon using the SV skin incision technique. After an average follow-up of 18 months (ranging from 6 to 30 months), clinical and electrophysiological (EP) evaluations were performed. Results A review of the English language literature published since 1957, when Phalen first popularised the diagnosis and treatment of this disease, determined that no previous reports of the mini-open incision technique as described in our study have been published. In our retrospective patient case review, we found that after operations using the SV incision technique, statistically significant differences were detected in electromyography (EMG) improvements (p<0.01). In addition, patients who showed improvement in EMG studies (n=90) were satisfied with the result of their surgery. Conclusions Our study demonstrated that 1-cm skin SV incision was a cosmetically satisfying, fast, and safe approach to CTR that was not only clinically effective but also electrophysiologically effective.
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Affiliation(s)
- Nese Keser
- Department of Neurosurgery, Istanbul Fatih Sultan Mehmet Education and Research Hospital, T.R. Health Sciences University, Istanbul, Turkey
| | - Nimet Dortcan
- Department of Electrophysiology Laboratory, Istanbul Fatih Sultan Mehmet Education and Research Hospital, T.R. Health Sciences University, Istanbul, Turkey
| | - Ulas Cikla
- Department of Neurosurgery, The University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Kutluay Uluc
- Department of Neurosurgery, The University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Erhan Celikoglu
- Department of Neurosurgery, Istanbul Fatih Sultan Mehmet Education and Research Hospital, T.R. Health Sciences University, Istanbul, Turkey
| | - Merih Is
- Department of Neurosurgery, Istanbul Fatih Sultan Mehmet Education and Research Hospital, T.R. Health Sciences University, Istanbul, Turkey
| | - Bora Gurer
- Department of Neurosurgery, Istanbul Fatih Sultan Mehmet Education and Research Hospital, T.R. Health Sciences University, Istanbul, Turkey
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15
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Keser N, Celikoglu E, Aydın İH, Ozbay N. The outcome of a pregnant woman with a minor head injury: an ossified subdural hematoma (OSDH). J Surg Case Rep 2017; 2017:rjx048. [PMID: 28458854 PMCID: PMC5400446 DOI: 10.1093/jscr/rjx048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 02/27/2017] [Indexed: 11/14/2022] Open
Abstract
We experienced an ossified subdural hematoma (OSDH), which is an extremely rare form of chronic subdural hematoma (SDH), in the dominant hemisphere of a 35-year-old woman. She presented to our outpatient clinic with a complaint of a headache; she had previously experienced a head injury while she was pregnant. We performed surgery with extreme caution because the lesion was attached to the surrounding tissue. Since an OSDH is an extremely rare form of chronic SDH, neurosurgeons might not experienced them during their daily practice. Additionally, head injuries received during pregnancy should be taken seriously, and after delivery, the patient should undergo cranial computed tomography, even if she is asymptomatic.
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Affiliation(s)
- Nese Keser
- Department of Neurological Surgery, Istanbul Fatih Sultan Mehmet Education and Research Hospital, Health Sciences University, Istanbul,Turkey
| | - Erhan Celikoglu
- Department of Neurological Surgery, Istanbul Fatih Sultan Mehmet Education and Research Hospital, Health Sciences University, Istanbul,Turkey
| | - İmam H Aydın
- Department of Neurological Surgery, Istanbul Fatih Sultan Mehmet Education and Research Hospital, Health Sciences University, Istanbul,Turkey
| | - Nurver Ozbay
- Department of Pathology, Istanbul Fatih Sultan Mehmet Education and Research Hospital,, Health Sciences University, Istanbul,Turkey
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16
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Cikla U, Swanson KI, Tumturk A, Keser N, Uluc K, Cohen-Gadol A, Baskaya MK. Microsurgical resection of tumors of the lateral and third ventricles: operative corridors for difficult-to-reach lesions. J Neurooncol 2016; 130:331-340. [PMID: 27235145 PMCID: PMC5090015 DOI: 10.1007/s11060-016-2126-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/07/2016] [Indexed: 12/19/2022]
Abstract
Tumors of the lateral and third ventricles are cradled on all sides by vital vascular and eloquent neural structures. Microsurgical resection, which always requires attentive planning, plays a critical role in the contemporary management of these lesions. This article provides an overview of the open microsurgical approaches to the region highlighting key clinical perspectives.
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Affiliation(s)
- Ulas Cikla
- Department of Neurological Surgery, School of Medicine, University of Wisconsin-Madison, CSC, K4/822, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Kyle I Swanson
- Department of Neurological Surgery, School of Medicine, University of Wisconsin-Madison, CSC, K4/822, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Abdulfettah Tumturk
- Department of Neurological Surgery, School of Medicine, University of Wisconsin-Madison, CSC, K4/822, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Nese Keser
- Department of Neurological Surgery, School of Medicine, University of Wisconsin-Madison, CSC, K4/822, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Kutluay Uluc
- Department of Neurological Surgery, School of Medicine, University of Wisconsin-Madison, CSC, K4/822, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Aaron Cohen-Gadol
- Goodman Campbell Brain and Spine, Indiana University Department of Neurological Surgery, Indianapolis, IN, USA
| | - Mustafa K Baskaya
- Department of Neurological Surgery, School of Medicine, University of Wisconsin-Madison, CSC, K4/822, 600 Highland Avenue, Madison, WI, 53792, USA.
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17
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Gunduz Y, Akdemir R, Ayhan LT, Keser N. Can Doppler flow parameters of carotid stenosis predict the occurrence of new ischemic brain lesions detected by diffusion-weighted MR imaging after filter-protected internal carotid artery stenting? AJNR Am J Neuroradiol 2014; 35:760-5. [PMID: 24651818 DOI: 10.3174/ajnr.a3904] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Carotid angioplasty and stent placement are increasingly being used for the treatment of symptomatic and asymptomatic carotid artery disease. Carotid angioplasty and stent placement carry an inherent risk of distal cerebral embolization, precipitating new brain ischemic lesions and neurologic symptoms. Our purpose was to evaluate the frequency of new ischemic lesions found on diffusion-weighted imaging after protected carotid angioplasty and stent placement and to determine the association of new lesions with ICA Doppler flow parameters. MATERIALS AND METHODS Fifty-two patients (mean age, 68 ± 11 years) with 50%-69% (n = 20, group 1) and ≥70% (n = 32, group 2) internal carotid artery stenosis underwent carotid angioplasty and stent placement with distal filter protection. DWI was performed before and 48 hours after carotid angioplasty and stent placement. RESULTS Thirty-three (63.4%) patients showed new lesions. The average number of new postprocedural lesions was 3.4 per patient. Most of the postprocedural lesions were <5 mm (range, 3-23 mm), cortical and corticosubcortical, and clinically silent. Group 2 had a significantly higher number of new lesions compared with group 1 (P < .001). A significant relationship was found between ICA Doppler flow parameters and the appearance of new lesions. CONCLUSIONS The appearance of new ischemic lesions was significantly related to the Doppler flow parameters, particularly peak systolic velocity.
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Affiliation(s)
- Y Gunduz
- From the Departments of Radiology (Y.G., L.T.A.)
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18
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Cakar M, Akdemir R, Vatan M, Gunduz H, Keser N. PP-029 ENTRAPPED THROMBUS IN A PATENT FORAMEN OVALE WITH DYSLIPIDEMIA. Int J Cardiol 2013. [DOI: 10.1016/s0167-5273(13)70233-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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19
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Albrecht P, Ringelstein M, Müller AK, Keser N, Dietlein T, Lappas A, Foerster A, Hartung HP, Aktas O, Methner A. Degeneration of retinal layers in multiple sclerosis subtypes quantified by optical coherence tomography. Mult Scler 2012; 18:1422-9. [PMID: 22389411 DOI: 10.1177/1352458512439237] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Optical coherence tomography can be used to assess retinal degeneration in multiple sclerosis (MS). Thinning of the retinal nerve fibre layer and macular thickness have been well characterized, but newer devices allow quantification of all retinal layers. OBJECTIVES The objective of this study was to evaluate the thickness of the paramacular retina, peripapillary retinal nerve fibre layer, and deeper paramacular layers in MS patient subgroups, using state-of-the-art optical coherence tomography. METHODS Using a Heidelberg Engineering Spectralis device, we performed paramacular volumetric retinal scans and circular peripapillary fibre-layer scans, manually segmenting different retinal layers into single horizontal foveal scans in 95 patients with definite MS (42 relapsing-remitting, 41 secondary progressive, 12 primary progressive), plus 91 age- and sex-matched controls. RESULTS Even without a history of optic neuritis, all MS subgroups had significant thinning of the peripapillary retinal nerve fibre layer, the paramacular retinal thickness and the retinal ganglion cell- and inner plexiform layer. Only in primary progressive MS was the inner nuclear layer significantly reduced. CONCLUSIONS Our findings indicate a primary retinal pathology involving the inner nuclear layer in primary progressive MS. Results in eyes without history of optic neuritis suggest possible subclinical episodes of optic neuritis or retrograde trans-synaptic degeneration of retinal ganglion cells and their axons.
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Affiliation(s)
- P Albrecht
- Department of Neurology, Heinrich-Heine University Düsseldorf, Moorenstraße 5, Düsseldorf, Germany.
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20
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Durat G, Keser N. PP-108 CAN GENERAL HEALTH CARE QUESTIONNAIRE GUIDE US IN MANAGING HYPERTENSIVE PATIENTS? Int J Cardiol 2012. [DOI: 10.1016/s0167-5273(12)70328-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Keser N, Çinar N, Doğu Ö, Gündüz H, Altinkaynak S. PP-002 ANY DIFFERENCE IN SOCIODEMOGRAPHIC VARIABLES AND RISK FACTORS OF PATIENTS HOSPITALISED WITH CARDIOVASCULAR DISEASE (CVD)? Int J Cardiol 2012. [DOI: 10.1016/s0167-5273(12)70241-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Yiginer O, Keser N, Ozmen N, Cingozbay B, Kardesoglu E, Tokatli A, Isilak Z, Uz O, Uzun M, Kilicaslan F, Cebeci B. PP-140: CLASSIC MITRAL VALVE PROLAPSE CAUSES ENLARGEMENT IN LEFT VENTRICLE, INDEPENDENTLY FROM MITRAL REGURGITATION. Int J Cardiol 2011. [DOI: 10.1016/s0167-5273(11)70372-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Ogrendik M, Hakguder A, Keser N. Treatment of rheumatoid arthritis with ornidazole. A randomized, double-blind, placebo-controlled study. Rheumatology (Oxford) 2006; 45:636-7. [PMID: 16436488 DOI: 10.1093/rheumatology/kel020] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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24
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Eryonucu B, Koldas L, Ayan F, Keser N, Sirmaci A. Comparison of the first dose response of fosinopril and captopril in congestive heart failure: a randomized, double-blind, placebo controlled study. Jpn Heart J 2001; 42:185-91. [PMID: 11384079 DOI: 10.1536/jhj.42.185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to compare the safety and tolerability of recommended initial doses of fosinopril (FOS) with those of captopril (CAP), in diuretic-treated, salt depleted "high risk" patients with congestive heart failure. Thirty patients were randomized in a double blind fashion to receive a single dose of either FOS 10 mg, CAP 6.25 mg or placebo. CAP produced a significant early and brief fall in BP, while the first-dose hypotensive response with FOS did not differ significantly from placebo. Baseline plasma angiotensin converting enzyme (ACE) activity was similar in all groups. Only CAP showed an acute and significant fall in plasma ACE activity, whereas FOS and placebo did not change ACE activity. There was no correlation between mean arterial pressure or percentile change in mean arterial pressure and plasma ACE activity. Also no correlation was found between high or low ACE activity level and first dose hypotension. The practical importance of the results are: For patients with congestive heart failure. FOS and CAP have different effects on BP after the first dose, and this effect may be dependent on the plasma ACE activity level. FOS produces ACE inhibition and BP changes similar to placebo so it is the safer choice for the treatment of congestive heart failure.
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Affiliation(s)
- B Eryonucu
- Department of Cardiology, Istanbul University Cerraphasa Medical Faculty, Turkey
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25
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Altinmakas S, Dagdeviren B, Uyan C, Keser N, Gümüş V, Pektaş O. Prediction of viability by pulsed-wave Doppler tissue sampling of asynergic myocardium during low-dose dobutamine challenge. Int J Cardiol 2000; 74:107-13. [PMID: 10962109 DOI: 10.1016/s0167-5273(00)00226-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Dobutamine stress echocardiography is widely used to predict reversible left ventricular dysfunction, but evaluation with this method is subjective. Pulsed-wave tissue Doppler imaging is a new technique that allows to obtain quantitative data on wall motion velocities of different myocardial segments through sample-volume placement. Therefore, this tool in combination with DSE may be suitable for identifying viability in asynergic myocardium. To evaluate this, in 40 patients (mean age 57+/-9) with resting dyssynergy (akinesis in 52, hypokinesis in 30) baseline wall motion scores and tissue Doppler variables were collected before and after 5 min infusion of 10 microg/kg per min dobutamine. Forty-six of 82 segments were classified as viable (a reduction in segmental score of at least one grade) according to follow-up echocardiography that was performed 4 weeks after revascularization. While myocardial S velocity percent increase in viable segments was 45+/-10, the increase was 25+/-12 in necrotic segments (n=36) during 10 microg dobutamine infusion (P=0.0001). Assuming 35% as a cut-off for viability the increase in S velocities by DSE yielded an 89% sensitivity and 86% specificity for predicting post-revascularization functional recovery. In conclusion, pulsed-wave tissue Doppler imaging of asynergic myocardium during dobutamine stress echocardiography can identify the viability quantitatively.
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Affiliation(s)
- S Altinmakas
- Cardiology Department, Maltepe University, Istanbul, Turkey.
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26
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Abstract
We report the case of a 62-year-old male patient with left main coronary artery originating from the pulmonary trunk, severe mitral insufficiency, and huge right coronary artery aneurysm. He is the oldest such patient among those reported in the literature, surviving to the sixth decade without any anginal symptoms. He is also the first such case with such a huge and calcified right coronary artery aneurysm and a prominent collateral from the noncoronary circulation.
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Affiliation(s)
- S Arsan
- Marmara Hospital, Istanbul, Turkey.
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27
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Cakalagaoglu C, Keser N, Alhan C. Brucella-mediated prosthetic valve endocarditis with brachial artery mycotic aneurysm. J Heart Valve Dis 1999; 8:586-90. [PMID: 10517403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
A 39-year-old female with a Hall-Kaster mitral prosthesis developed fever, general malaise and arthralgia 15 years after valve replacement for rheumatic mitral valve disease. Prosthetic valve endocarditis was identified after serial laboratory, clinical and echocardiographic examinations. Penicillin G (40 x 106 units/day, i.v.) + gentamicin (240 mg/day, i.v.) was started as initial therapy. The patient showed no signs of recovery, and penicillin G was replaced with vancomycin (1,000 mg/day, i.v.). There was a gradual reduction in spiking fever, and prominent reductions in erythrocyte sedimentation rate and white cell count. Meanwhile, a tender and pulsatile mass developed in the anterior surface of the left arm; peripheral angiography yielded a diagnosis of brachial artery aneurysm. A successful aneurysmectomy with saphenous vein interposition was performed. Histopathology of the lesion revealed mycotic aneurysm. An initial control SAT for Brucella of 1/80(+) was found to increase. A detailed history showed the patient to have consumed unpasteurized dairy products. Doxycyline (200 mg/day, oral) + co-trimoxazole (2,700 mg/day, oral) + rifampicin (600 mg/day, oral) was administered to treat brucellosis. Later, doxycyline caused intolerable gastrointestinal side effects and was replaced by ciprofloxacin (1,000 mg/day, oral). Subsequently, the patient made an uneventful recovery within one week. Antibiotic treatment was continued for 12 months, with complete resolution of vegetation and paravalvular leakage. During a four-year follow up, the patient showed no signs of relapse.
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Affiliation(s)
- C Cakalagaoglu
- Department of Cardiovascular and Thoracic Surgery, Siyami Ersek Heart and Research Hospital, Turkey
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