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Engel-Haber E, Snider B, Botticello A, Eren F, Kirshblum S. Clinical Subsets of Central Cord Syndrome: Is it a Distinct Entity from Other Forms of Incomplete Tetraplegia for Research? J Neurotrauma 2024. [PMID: 38581474 DOI: 10.1089/neu.2023.0613] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2024] Open
Abstract
Central cord syndrome (CCS) is the most prevalent and debated incomplete spinal cord injury (SCI) syndrome, with its hallmark feature being more pronounced weakness of the upper extremities compared to the lower extremities. Varying definitions encapsulate multiple clinical features under the single umbrella term of CCS, complicating evaluation of its frequency, prognosis discussions, and outcomes research. Oftentimes, people with CCS are excluded from research protocols, as it is thought to have a favorable prognosis, but the vague nature of CCS raises doubts about the validity of this practice. The objective of this study was to categorize CCS into specific subsets with clear quantifiable differences, to assess whether this would enhance the ability to determine if individuals with CCS or its subsets exhibit distinct neurological and functional outcomes relative to others with incomplete tetraplegia. This study retrospectively reviewed individuals with new motor incomplete tetraplegia from traumatic SCI who enrolled in the Spinal Cord Injury Model Systems (SCIMS) database from 2010 to 2020. Through an assessment of the prevailing criteria for CCS, coupled with data analysis, we used two key criteria, including the severity of distal upper extremity weakness (i.e., hands and fingers) and extent of symmetry, to delineate three CCS subsets: Full CCS, Unilateral CCS, and Borderline CCS. Of the 1,490 participants in our sample, 17.5% had Full, 25.6% Unilateral, and 9% Borderline CCS, together encompassing more than 50% of motor incomplete tetraplegia cases. Despite the increased sensitivity and specificity of these subsets compared to existing quantifiable criteria, substantial variability in clinical presentation was still observed. Overall, individuals meeting CCS subset criteria showed a higher likelihood of AIS D grade compared to those with motor incomplete tetraplegia without CCS, from admission to the 1-year follow-up. The upper extremity motor score (UEMS) for those with CCS was lower on admission, a difference that diminished by discharge, while their lower extremity motor score (LEMS) consistently remained higher compared to those without CCS. However, these neurological distinctions did not result in significant functional differences, as lower and upper extremity functional outcomes at discharge were mostly similar to those with motor incomplete tetraplegia, with some significant differences observed within those with AIS D grade. The AIS grade seems to remain the foremost determinant influencing neurological and functional outcomes, rather than the diagnosis of CCS. We recommend that future studies consider incorporating motor incomplete tetraplegia into their inclusion/exclusion criteria, instead of relying on criteria specific to CCS. While there remains clinical value in characterizing an injury pattern as CCS and perhaps using the different subsets to better characterize the impairments, it does not appear to be a useful research criterion.
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Affiliation(s)
- Einat Engel-Haber
- Rutgers New Jersey Medical School, 12286, Physical Medicine and Rehabilitation, 183 South Orange Avenue, Suite F 1555, Newark, New Jersey, United States, 07101
- Kessler Foundation, 158368, 1199 Pleasant Valley Way, West Orange, New Jersey, United States, 07052;
| | - Brittany Snider
- Rutgers New Jersey Medical School, 12286, Physical Medicine & Rehabilitation, Newark, New Jersey, United States
- Kessler Foundation, 158368, West Orange, New Jersey, United States
- Kessler Institute for Rehabilitation, 21326, West Orange, New Jersey, United States;
| | - Amanda Botticello
- Rutgers New Jersey Medical School, Physical Medicine and Rehabilitation, Newark, New Jersey, United States
- Kessler Foundation, West Orange, New Jersey, United States;
| | - Fatma Eren
- East Carolina University, 3627, Department of Internal Medicine, Greenville, North Carolina, United States;
| | - Steven Kirshblum
- Kessler Institute for Rehabilitation, 21326, West Orange, New Jersey, United States, 07052-1419;
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Danışan G, Taydaş O, Özdemir M, Ateş ÖF, Küpeli A, Öğüşlü U, Erkin A, Neşelioğlu S, Eren F. Dynamic thiol-disulphide homeostasis as a biomarker for predicting the development of contrast medium-associated acute kidney injury in the endovascular treatment of peripheral arterial disease: should intravenous N-acetylcysteine be given before the procedure? Clin Radiol 2023; 78:466-472. [PMID: 36941180 DOI: 10.1016/j.crad.2023.02.016] [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] [Received: 11/22/2022] [Revised: 02/15/2023] [Accepted: 02/27/2023] [Indexed: 03/11/2023]
Abstract
AIM To determine the predictive ability of serum thiol-disulphide levels for contrast medium-associated acute kidney injury (CA-AKI) after endovascular treatment (EVT) of peripheral arterial disease (PAD) and evaluate the efficacy of intravenous N-acetylcysteine (NAC) in preventing CA-AKI. MATERIAL AND METHODS This double-blind, randomised controlled study included 85 consecutive adult patients who underwent EVT for PAD. Patients were divided into NAC negative (NAC-) and positive (NAC+) groups. While the NAC- group received only 500 ml saline, the NAC + group received 500 ml saline plus intravenous 600 mg NAC before the procedure. Intra- and intergroup patient characteristics, procedural details, preoperative thiol-disulphide levels, and ischaemia-modified albumin (IMA) levels were recorded. RESULTS There was a significant difference between NAC- and NAC + groups regarding native thiol, total thiol, disulphide/native thiol ratio (D/NT), and disulphide/total thiol ratio (D/TT). There was also a significant difference between the NAC- (33.3%) and NAC+ (13%) groups in CA-AKI development. Logistic regression analysis showed that the D/TT (OR 2.463) and D/NT (OR 2.121) were the most influential parameters for CA-AKI development. In the receiver operating characteristic (ROC) curve analysis, the sensitivity of native thiol to detect the development of CA-AKI was 89.1%. The negative predictive values of native thiol and total thiol were 95.6% and 94.1%, respectively. CONCLUSION The serum thiol-disulphide level can be used as a biomarker to detect CA-AKI development and reveal patients with a low risk for CA-AKI development before EVT of PAD. Furthermore, thiol-disulphide levels allow for the indirect quantitative monitoring of NAC. Preprocedural intravenous NAC administration significantly inhibits CA-AKI development.
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Affiliation(s)
- G Danışan
- Sakarya University Faculty of Medicine, Department of Radiology, Sakarya, Turkey.
| | - O Taydaş
- Sakarya University Faculty of Medicine, Department of Radiology, Sakarya, Turkey
| | - M Özdemir
- Sakarya University Faculty of Medicine, Department of Radiology, Sakarya, Turkey
| | - Ö F Ateş
- Sakarya University Faculty of Medicine, Department of Radiology, Sakarya, Turkey
| | - A Küpeli
- Kanuni Training and Research Hospital, Department of Radiology, Trabzon, Turkey
| | - U Öğüşlü
- Medicana International Hospital, Department of Radiology, Istanbul, Turkey
| | - A Erkin
- Sakarya University Faculty of Medicine, Department of Cardiovascular Surgery, Sakarya, Turkey
| | - S Neşelioğlu
- Ankara City Hospital, Department of Biochemistry, Ankara, Turkey
| | - F Eren
- Ankara City Hospital, Department of Biochemistry, Ankara, Turkey
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Snider BA, Eren F, Reeves RK, Rupp R, Kirshblum SC. The International Standards for Neurological Classification of Spinal Cord Injury: Classification Accuracy and Challenges. Top Spinal Cord Inj Rehabil 2023; 29:1-15. [PMID: 36819931 PMCID: PMC9936898 DOI: 10.46292/sci22-00036] [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: 02/17/2023]
Abstract
Background Successful utilization of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) requires a comprehensive understanding of its rules, terminology, and several complex concepts. There have been no studies investigating classification accuracy since the newest ISNCSCI revision (2019). Objectives To evaluate classification accuracy of SCI professionals using the 2019 ISNCSCI edition, identify common mistakes and areas of confusion, and assess associations between experience in ISNCSCI classification and performance. Methods Members of the International Spinal Cord Society (ISCoS) and attendees of the ISCoS Annual Scientific Meeting 2021 were invited to complete an online survey that included six ISNCSCI cases to classify. Results A total of 107 persons completed the survey, with overall classification accuracy of 74.6%. Accuracy was highest for injury completeness (95.3%) and sensory level (91.1%) and lowest for motor zone of partial preservation (ZPP; 54.7%) and ASIA Impairment Scale (AIS) grade (57.3%). Newer concepts, including the appropriate documentation of non-SCI conditions and classification of ZPP in incomplete injuries, contributed to several common errors. There was a significant association between overall classification accuracy and self-rated experience in the ISNCSCI classification (p = .017). Experience with the ISNCSCI examination, experience in SCI medicine, and occupation were not found to be significantly associated with overall classification accuracy. Conclusion Classification accuracy of an international cohort of SCI professionals was modest but greater than previous reports. Knowledge deficits about the 2019 ISNCSCI updates are prevalent and contribute to common classification errors. Further training in the utilization of the ISNCSCI is needed.
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Affiliation(s)
- Brittany A. Snider
- Kessler Institute for Rehabilitation, West Orange, New Jersey
- Kessler Foundation, West Orange, New Jersey
- Rutgers New Jersey Medical School, Department of Physical Medicine and Rehabilitation, Newark, New Jersey
| | - Fatma Eren
- Kessler Foundation, West Orange, New Jersey
- Rutgers New Jersey Medical School, Department of Physical Medicine and Rehabilitation, Newark, New Jersey
| | - Ronald K. Reeves
- Mayo Clinic College of Medicine, Department of Physical Medicine and Rehabilitation, Rochester, Minnesota
| | - Rüdiger Rupp
- Heidelberg University Hospital, Heidelberg, Germany
| | - Steven C. Kirshblum
- Kessler Institute for Rehabilitation, West Orange, New Jersey
- Kessler Foundation, West Orange, New Jersey
- Rutgers New Jersey Medical School, Department of Physical Medicine and Rehabilitation, Newark, New Jersey
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Eren F, DeLuca R, Kirshblum S. Frequency of turning in bed at home in persons with chronic spinal cord injury. J Spinal Cord Med 2022; 45:390-394. [PMID: 32808913 PMCID: PMC9135412 DOI: 10.1080/10790268.2020.1800965] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Objective: To determine the routine turning frequency of persons with chronic spinal cord injury (SCI) in bed at night in their home environment.Design: An online questionnaire consisting of 22 questions.Setting: Free standing SCI rehabilitation facility.Participants: Persons between ages 18-75 with a traumatic SCI for ≥3 months, and living at home.Interventions: None.Outcome measures: Questionnaire-based evaluation of turning frequency of persons with SCI.Results: 86 subjects (70 men) with traumatic SCI completed the survey; 66.3% with tetraplegia and 41.9% with a neurological complete SCI. Almost every participant (96%) recalled being counseled on the importance of turning in bed at night upon discharge from their rehabilitation facility with 48.4% recalling the frequency recommended as every 2 h. At present, 25.6% of subjects reported turning every 2 h, 15.1% every 3 h, 15.1% every 4 h, 3.5% every 6 h, and 40.7% of respondents stated that they do not turn regularly at night.Conclusion: Although frequently recommended for repositioning at night in bed every two hours for persons with chronic SCI, especially for those at risk for pressure injuries, only 25.6% of individuals report turning at this frequency and 40.7% report not turning at night time regularly. The reasons for limited turning may be multi-factorial, however, this finding may serve as a call to practitioners to best determine the most appropriate turning frequency that can meet compliance of the individual with SCI, as well as maintain skin protection in the chronic period after injury.
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Affiliation(s)
- Fatma Eren
- Kessler Foundation, West Orange, New Jersey, USA,Department of PM&R, Rutgers New Jersey Medical School, Newark, New Jersey, USA,Correspondence to: Fatma Eren, 1199 Pleasant Valley Way, West Orange, New Jersey07052, USA; Ph: 973-243-6916. Supplemental data for this article can be accessed on the publisher’s website. https://doi.org/10.1080/10790268.2020.1800965
| | - Robert DeLuca
- Kessler Institution for Rehabilitation, West Orange, New Jersey, USA
| | - Steven Kirshblum
- Kessler Foundation, West Orange, New Jersey, USA,Department of PM&R, Rutgers New Jersey Medical School, Newark, New Jersey, USA,Kessler Institution for Rehabilitation, West Orange, New Jersey, USA
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Abstract
Objective: The current diagnostic criteria of autonomic dysreflexia (AD) is based solely on systolic blood pressure (SBP) increases from baseline without regard to changes in diastolic blood pressure (DBP). During urodynamics in persons with SCI at or above the sixth thoracic level (T6), we evaluated diastolic blood pressure (DBP) changes related with AD episodes.Design: Retrospective review of blood pressures recorded during urodynamics.Setting: Outpatient SCI urology program in a free standing rehabilitation center.Participants: Persons with spinal cord injury at or above the T6 level.Interventions: Urodynamic procedures performed between August 2018 to January 2019, as well as their prior testing for up to 10 years.Outcome Measures: Systolic and diastolic blood pressures were recorded during the procedure and episodes of AD defined as SBP >20 mmHg above baseline.Results: Seventy individuals accounting for 282 urodynamic tests were reviewed. AD occurred in 43.3% (122/282) of all urodynamics tests. The mean maximum SBP and DBP increase from baseline for those with AD were 35.5 ± 10.9 mmHg and 19.0±9.4 mmHg, respectively. There was a concomitant rise of DBP >10 mmHg with a SBP rise of >20 mmHg in 76.2% (93/122) of urodynamic tests. An elevation of DBP >10 mmHg was recorded in 23.8% (38/160) of urodynamics that did not have AD by the SBP definition.Conclusion: DBP increments of >10 mmHg with concurrent SBP increases of >20 mmHg occurs in the majority of AD episodes. Given the significance of cardiovascular complications in chronic SCI, further work is warranted to determine the significance of DBP elevations for defining AD.
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Affiliation(s)
- Steven Kirshblum
- Kessler Institute for Rehabilitation, West Orange, New Jersey, USA,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA,Kessler Foundation, West Orange, New Jersey, USA,Correspondence to: Steven Kirshblum, 1199 Pleasant Valley Way, West Orange, New Jersey07052, USA; Ph: 973-243-6916.
| | - Fatma Eren
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA,Kessler Foundation, West Orange, New Jersey, USA
| | - Ryan Solinsky
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - Kathryn Gibbs
- Kessler Institute for Rehabilitation, West Orange, New Jersey, USA,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Katharine Tam
- VA St. Louis Health Care System, St. Louis, Missouri, USA
| | - Robert DeLuca
- Kessler Institute for Rehabilitation, West Orange, New Jersey, USA
| | - Todd Linsenmeyer
- Kessler Institute for Rehabilitation, West Orange, New Jersey, USA,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA,Kessler Foundation, West Orange, New Jersey, USA
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Yildirim T, Yesilada E, Eren F, Apaydin H, Gulbay G. Assessment of plasma microRNA potentials as a non-invasive biomarker in patients with axial spondyloarthropathy. Eur Rev Med Pharmacol Sci 2021; 25:620-625. [PMID: 33577015 DOI: 10.26355/eurrev_202101_24620] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE It is assumed that abnormally expressed MicroRNAs (miRNAs) may be present in the plasma of patients with radiographic axial spondyloarthropathy (rad-AxSpA). Thus, the present study was conducted with the aim of investigating the expression profile of miRNAs in patients with rad-AxSpA. PATIENTS AND METHODS A total of 15 patients diagnosed with rad-AxSpA according to the Assessment of the SpondyloArthritis International Society (ASAS) classification criteria and nine healthy controls matched for age and gender were included in the study. Demographic data were collected, and disease activity was evaluated using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Peripheral blood samples were collected, and miRNAs were extracted. The expression of microRNAs was analyzed using quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) by the miScript miRNA PCR Array Human Inflammatory Response and Autoimmunity. RESULTS A total of 84 miRNA profiles were evaluated, and expressions in the study and control groups were compared. When compared to the control group, 6 miRNAs (miR-125b-5p, miR-144-3p, miR-19a-3p, miR-20a-5p, miR-29c-3p, miR-30b-5p) were detected to be upregulated, and 42 miRNAs were detected to be downregulated in the rad-AxSpA group. A p-value < 0.05 was accepted as statistically significant. A significant association was found between miR-145-5p and BASDAI (p = 0.04941). MiR-144-3p, miR-302b-3p, miR-381-3p, miR-497-5p, miR-511-5p, and miR-9-5p were found to be significantly upregulated in the HLA-B27+ patients (p = 0.03063). CONCLUSIONS Abnormal miRNA expressions were detected in the plasma of the patients with rad-AxSpA. It was concluded that comprehensive studies should be continued to define these miRNAs as diagnostic biomarkers for rad-AxSpA in order to detect its association with Ankylosing Spondylitis disease activity.
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Affiliation(s)
- T Yildirim
- Inonu University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Malatya, Turkey.
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Abstract
The predominant tool used to predict outcomes after traumatic spinal cord injury (SCI) is the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), in association with the American Spinal Injury Association (ASIA) Impairment Scale (AIS). These measures have evolved based on analyses of large amounts of longitudinal neurological recovery data published in numerous separate studies. This article reviews and synthesizes published data on neurological recovery from multiple sources, only utilizing data in which the sacral sparing definition was applied for determination of completeness. Conversion from a complete to incomplete injury is more common in tetraplegia than paraplegia. The majority of AIS conversion and motor recovery occurs within the first 6-9 months, with the most rapid rate of motor recovery occurring in the first three months after injury. Motor score changes, as well as recovery of motor levels, are described with the initial strength of muscles as well as the levels of the motor zone of partial preservation influencing the prognosis. Total motor recovery is greater for patients with initial AIS B than AIS A, and greater after initial AIS C than with motor complete injuries. Older age has a negative impact on neurological and functional recovery after SCI; however, the specific age (whether >50 or >65 years) and underlying reasons for this impact are unclear. Penetrating injury is more likely to lead to a classification of a neurological complete injury compared with blunt trauma and reduces the likelihood of AIS conversion at one year. There are insufficient data to support gender having a major effect on neurological recovery after SCI.
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Affiliation(s)
- Steven Kirshblum
- Kessler Institute for Rehabilitation, West Orange, New Jersy, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Kessler Foundation, West Orange, New Jersey, USA
| | - Brittany Snider
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Fatma Eren
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Kessler Foundation, West Orange, New Jersey, USA
| | - James Guest
- Neurological Surgery, Miller School of Medicine, Miami, Florida, USA
- The Miami Project to Cure Paralysis, Miami, Florida, USA
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Kirshblum SC, DeLauter G, Eren F, Pomeranz B, DeLuca R, Hammerman S, Gans BM. Screening for Deep Vein Thrombosis in Persons With COVID-19 Upon Admission to an Inpatient Rehabilitation Hospital. Am J Phys Med Rehabil 2021; 100:419-423. [PMID: 33819922 DOI: 10.1097/phm.0000000000001729] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The aim of the study was to determine the prevalence of deep venous thrombosis detected by duplex screening and risk factors associated with deep venous thrombosis in patients with COVID-19 upon admission to an inpatient rehabilitation hospital. DESIGN This is a retrospective review. SETTING The setting is three freestanding inpatient rehabilitation hospitals operating as one system. PARTICIPANTS The participants are consecutive patients with a diagnosis of COVID-19 admitted to an inpatient rehabilitation hospital without a diagnosis of deep venous thrombosis or screening duplex ultrasound prior to transfer. INTERVENTIONS A duplex ultrasound of lower limbs was performed upon admission to inpatient rehabilitation hospital. OUTCOME MEASURES Primary outcome was the percentage of admission patients with a lower limb deep venous thrombosis. Secondary factors included potential risk factors for a positive screen for deep venous thrombosis. RESULTS A lower limb deep venous thrombosis was diagnosed in 22% (25/113) of the patients tested, with eight patients (7.1%) having a proximal deep venous thrombosis. Risk factors for screening positive for a deep venous thrombosis included being male, younger, and having been on a ventilator during the acute illness. CONCLUSIONS The high rate of deep venous thrombosis observed in these patients suggests that the risk of venous thromboembolic disorders after severe COVID-19 illness is considerable and surveillance measures of such patients should be undertaken.
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Affiliation(s)
- Steven C Kirshblum
- From the Kessler Institute for Rehabilitation, West Orange, New Jersey (SCK, BP, RD, BMG); Rutgers NJ Medical School, Newark, New Jersey (SCK, FE, BP, BMG); Kessler Foundation, West Orange, New Jersey (SCK, FE, BMG); and Select Medical Corporation, Mechanicsburg, Pennsylvania (SCK, GD, BP, SH, BMG)
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Yurdakul OV, Kilicoglu MS, Rezvani A, Kucukakkas O, Eren F, Aydin T. How does cross-education affects muscles of paretic upper extremity in subacute stroke survivors? Neurol Sci 2020; 41:3667-3675. [PMID: 32506358 DOI: 10.1007/s10072-020-04506-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Received: 01/12/2020] [Accepted: 05/30/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION This study aimed to evaluate the benefits of adding electromuscular stimulation (EMS) to the flexors of wrist muscles on the nonparetic limb in conventional stroke training to strengthen homologous agonist and antagonist muscles on the paretic side in patients with subacute stroke. METHODS The EMS group patients (n = 15) received conventional therapy for 30 sessions for 6 weeks (60 min/session) with 30 min of electrical stimulation to their nonparetic forearm using wrist flexors, with 5 min of pre- and post-warm-up. The transcutaneous electrical nerve stimulation (TENS) group patients (n = 15) received the same conventional rehabilitation training with 30 min of conventional antalgic TENS at a barely sensible level to their nonparetic forearm. The Fugl-Meyer motor function assessment for upper extremity (FMA-UE), functional independence measure (FIM), Brunnstrom staging of recovery for hand, maximum and mean wrist flexion force (flexionmax and flexionmean), and wrist extension force (extensionmax and extensionmean) of paretic untrained limb were evaluated before and after the treatment. RESULTS EMS and TENS group patients improved similarly in terms of FMA-UE, FIM, and Brunnstrom staging for hand recovery. However, flexionmax and flexionmean of the paretic limb increased more in the EMS group than in the TENS group. Extensionmax and extensionmean on the paretic side increased in the EMS group but did not differ in the TENS group. CONCLUSION Cross-education via EMS may have a beneficial effect as an adjunct to conventional treatment methods. This study is retrospectively registered and is available at www.clinicaltrials.gov (ID: NCT04113369).
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Affiliation(s)
- Ozan Volkan Yurdakul
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Blv. 34093 Fatih, Istanbul, Turkey.
| | - Mehmet Serkan Kilicoglu
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Blv. 34093 Fatih, Istanbul, Turkey
| | - Aylin Rezvani
- Department of Physical Medicine and Rehabilitation. Faculty of Medicine, Medipol University, TEM otoyolu. 34214 Bagcilar, Istanbul, Turkey
| | - Okan Kucukakkas
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Blv. 34093 Fatih, Istanbul, Turkey
| | - Fatma Eren
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, 185 S Orange Ave, Newark, NJ, 07103, USA
| | - Teoman Aydin
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Blv. 34093 Fatih, Istanbul, Turkey
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Keskin Y, Kilic G, Taspinar O, Posul SO, Halac G, Eren F, Erol E, Urkmez B, Aydin T. Effectiveness of home exercise in pregnant women with carpal tunnel syndrome: Randomized Control Trial. J PAK MED ASSOC 2020; 70:202-207. [PMID: 32063607 DOI: 10.5455/jpma.1846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of a home exercise programme in pregnant patients with carpal tunnel syndrome. METHODS The randomised, single-blind, controlled clinical study was conducted at Vakif University School of Medicine, Istanbul, Turkey, From December 2017 to June 2018 and comprised pregnant women with carpal tunnel syndrome (CTS) . Clinical evaluation of each patient was performed by a blind researcher and (EMG) Electromyography measurements were performed by another blind researcher. Patients were divided into two groups with normal and (mild or moderate) CTS based on EMG results and clinical examination. Patients with symptoms, clinical signs and CTS in EMG were included in group 1, while patients whose symptoms and clinical evaluation (such as Tinel, Phalen, Reverse Phalen and Durkan's test) were positive but not CTS in EMG were included in group 2. Exercise forms were given to both groups and they were asked to perform the exercises stated in the form in 3 sets each day and 10 repetitions in each set. The Sick Boston Carpal Tunnel Syndrome Questionnaire was administered face-to-face to collect data which was analysed using SPSS 22. RESULTS Of the 33 subjects, 19(57.6%) were in patient group 1 and 14(42.4%) in control group 2. The overall mean age of the sample was 28.84±3.62 years. There were no significant differences between the groups in terms of symptoms and clinical tests (p>0.05). The symptom severity scale between the groups was significantly high in group 1 (p<0.05). Patients receiving treatment showed a decrease in symptom severity and functional capacity, but only the former showed a significant decrease in group 2 (p>0.05). CONCLUSIONS Nerve and tendon slip exercises for patients with mild to moderate carpal tunnel syndrome symptoms were found to be simple and reliable methods that could be applied to patients to increase their functionality and to reduce the severity of the disease.
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Affiliation(s)
- Yasar Keskin
- Department of Physical Medicine and Rehabilitation, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Gokhan Kilic
- Department of Gynecology and Obstetrics, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Ozgur Taspinar
- Department of Physical Medicine and Rehabilitation, Istinye University, Istanbul, Turkey
| | - Sevde Ozer Posul
- Department of Physical Medicine and Rehabilitation, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Gulistan Halac
- Department of Neurology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Fatma Eren
- Department of Physical Medicine and Rehabilitation, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Esra Erol
- Department of Physical Medicine and Rehabilitation, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Berna Urkmez
- Department of Physical Medicine and Rehabilitation, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Teoman Aydin
- Department of Physical Medicine and Rehabilitation, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
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Kirshblum S, Eren F. Anal reflex versus bulbocavernosus reflex in evaluation of patients with spinal cord injury. Spinal Cord Ser Cases 2020; 6:2. [PMID: 31934354 PMCID: PMC6946655 DOI: 10.1038/s41394-019-0251-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/30/2019] [Accepted: 10/27/2019] [Indexed: 12/14/2022] Open
Abstract
The examination of sacral reflexes provides an important method to differentiate an upper motor neuron vs lower motor neuron spinal cord injury (SCI). Two common sacral mediated reflexes used as part of the neurological assessment include the bulbocavernosus reflex (BCR) and anal reflex. As the clinical information from these tests are similar, we suggest that the anal reflex provides a better first option as a non-invasive clinical assessment of sacral reflex status in clinical practice in SCI as the testing for the anal reflex is less intrusive and already being performed as part of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) by pinprick stimulation of the S4-5 dermatome.
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Affiliation(s)
- Steven Kirshblum
- Kessler Institution for Rehabilitation, West Orange, NJ USA
- 2Department of PM&R, Rutgers New Jersey Medical School, Newark, NJ USA
- 3Kessler Foundation, West Orange, NJ USA
| | - Fatma Eren
- 2Department of PM&R, Rutgers New Jersey Medical School, Newark, NJ USA
- 3Kessler Foundation, West Orange, NJ USA
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Eren F, Inanır NT, Gurses MS, Eren B, Gundogmus UN, Ioan B. DEATH DUE TO CARDIAC ANGIOSARCOMA: AUTOPSY CASE REPORT. IJMMR 2019. [DOI: 10.11603/ijmmr.2413-6077.2019.1.10155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background. Primary tumors of the heart are rarely detected at autopsy, especially angiosarcomas which are primary malignant one. Objective. We presented autopsy case of cardic angiosarcoma with morphologic findings. Methods. We described adult man died in emergency service of the hospital. Results. Reported case was 33 year-old-man who was died in emergency service of hospital where he was taken when he was ill after leaving home. According the prosecution documents, and the expressions of family, it was reported that he had a heart disease; his symptoms repeated 3 day ago before he died, he thought to attend the Cardiology Clinic due to his symptoms. At autopsy on macroscopic internal examination, mass with rough surface in the right atrium, hematoma at the posterior of the right atrium, blood in the pericardia, nodular lesions in hemorrhagic appearance in the sections of lung, liver and spleen were detected. In histopathologic examination; in the heart angiosarcioma as primary malign heart tumor and metastatic masses in the liver, spleen and lung were detected. Conclusions. We aimed to discuss cardiac angiosarcoma case with autopsy and histopathologic findings in the aspect of medico legal literature.
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Gündüz N, Akpınar Aslan E, Eren F, Sodan Turan H, Öztürk M, Tural Ü. Analysis of 24-Hour Heart Rate Variability among Panic Disorder Patients without Previous Drug Treatment and Comorbid Disorders. Turk Psikiyatri Derg 2019; 30:236-244. [PMID: 32594484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE One of the METHODS used to assess autonomic nervous system dysfunction in the etiology of panic disorder (PD) is heart rate variability (HRV). HRV is controlled by the sympathetic and parasympathetic (vagal) branches of the autonomic nervous system and reflects the capacity of autonomic stimulation by the parasympathetic system. The aim of this study was to evaluate heart rate variability (HRV) time domain parameters based on twenty four hour holter ECG analysis among drug-naive patients with panic disorder (PD) without any other medical and psychiatric comorbidity. METHOD The study group consisted of 41 patients with PD and 46 healthy controls. Participants were evaluated with SCID-1 for psychiatric diagnoses. Then Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Panic Disorder Severity Scale (PDSS) and Clinical Global Impression Scale (CGI-S) were applied to participants. Twenty four hour Holter ECG outcomes were analyzed on a computer program and time domain parameters were evaluated. RESULTS Among the parameters analyzed from HRV, SDANN was significantly higher (p <0.001); duration of RMSSD, NN50 and pNN50 were lower in PD group than the control group (p = 0.003, p = 0.005, p = 0.047, respectively). In the correlation analysis, there was a moderate negative correlation between CGI-S and NN50 and pNN50. In logistic regression analysis, the increase in SDNN was found to increase the probability of PD by 1.11 (95% CI, 1.010-1.209); the increase in SDANN was found to decrease the probability of PD by 0.892 (95% CI, 0.818-0.973), and the increase in pNN50 was found to decrease the probability of PD by 0.523 (95% CI, 0.342-0.801). CONCLUSION The data obtained in our study confirm that there is a decrease in some HRV parameters like RMSSD, NN50 and pNN50 reflecting parasympathetic activity among patients with PD.
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Kolu E, Buyukavci R, Akturk S, Eren F, Ersoy Y. Comparison of high-intensity laser therapy and combination of transcutaneous nerve stimulation and ultrasound treatment in patients with chronic lumbar radiculopathy: A randomized single-blind study. Pak J Med Sci 2018; 34:530-534. [PMID: 30034410 PMCID: PMC6041553 DOI: 10.12669/pjms.343.14345] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Objective: To compare the effects of high-intensity laser therapy (HILT) and a combination of transcutaneous nerve stimulation (TENS) with ultrasound (US) therapy on pain and functionality in patients with chronic lumbar radiculopathy. Methods: This prospective randomized comparative study was conducted in Department of physical medicine and rehabilitation, Turgut Ozal Medicine Center, Malatya, Turkey from April 2016 to September 2016. A total of 54 patients with chronic lumbar radiculopathy were enrolled in this study. The patients were randomly divided into two groups: Group 1 (n:27) received 10 sessions of a combination of hot pack, TENS, US and exercise, and Group 2 (n:27) received hot pack, HILT and exercise. The outcomes measured were low back with unilateral leg pain level measured by visual analog scale (VAS) and functionality measured with the Oswestry Disability Index (ODI) at the end of the therapy and four weeks later. p-value less than 0.05 considered statistically significant. Results: In two groups, VAS (low back with unilateral leg pain) and ODI scores showed significant changes. At the end of the 2 weeks intervention, participants in Group-1 showed a significantly greater decrease in pain than participants in Group-2. Statistically significant differences in pain variation and functionality (VAS and ODI) were observed four weeks after treatment sessions for participants in the TENS+US therapy group compared with participants in the HILT group. Conclusion: HILT and TENS+US combined with exercise were effective treatment modalities in decreasing the VAS and ODI scores. TENS+US combined with exercises were more effective than HILT combined with exercise.
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Affiliation(s)
- Emine Kolu
- Emine Kolu, Inonu University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Malatya, Turkey
| | - Raikan Buyukavci
- Raikan Buyukavci, Inonu University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Malatya, Turkey
| | - Semra Akturk
- Semra Akturk, Inonu University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Malatya, Turkey
| | - Fatma Eren
- Fatma Eren, Inonu University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Malatya, Turkey
| | - Yuksel Ersoy
- Yuksel Ersoy, Inonu University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Malatya, Turkey
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Eren F, Çete AÖ, Avcil S, Baykara B. Emotional and Behavioral Characteristics of Gifted Children and Their Families. ACTA ACUST UNITED AC 2018; 55:105-112. [PMID: 30057449 DOI: 10.5152/npa.2017.12731] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 12/21/2015] [Accepted: 12/21/2016] [Indexed: 11/22/2022]
Abstract
Introduction To compare the quality of life, areas of social, emotional, behavioural and mental problems and family functionality of gifted children and children of normal intelligence. Methods The study included 49 gifted children aged 9-18 years and 56 age and gender-matched healthy children of normal intelligence. The Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL), and the Children's Depression Rating Scale were applied to all the cases. The Quality of Life Scale for Children, the Depression Scale for Children, the Trait-State Anxiety Inventory, and the Strengths and Difficulties Questionnaire- Adolescent Form were completed by all the participants. All the parents completed the Family Evaluation Scale, the Strengths and Difficulties Questionnaire- Parents Form and the Parents Form of the Quality of Life Scale for Children. Results Compared to children of normal intelligence, gifted children described themselves as more inattentive and lively, social functionality was reported to be low and they had a worse perception of their physical health status. Gifted boys were determined to have more depressive symptoms than gifted girls. The parents of boys of normal intelligence reported lower academic performance than the parents of giftedboys. This difference was not determined for girls between the cases and comparative groups. Conclusion All the findings obtained in this study suggest that gifted children are at risk in respect of mental health. Therefore, to be able to become healthy adults in a biopsychosocial aspect, it is important for the future of gifted children that this status can be identified at an early age, that they can receive appropriate education, that support and counselling are provided for emotional needs and that parents and teachers are fully informed.
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Affiliation(s)
- Fatma Eren
- Yıldırım Beyazıt University, Yenimahalle Training and research Hospital, Department of Child and Adolescent Mental Health and Disease, Ankara, Turkey
| | | | - Sibelnur Avcil
- Medical Faculty of Adnan Menderes University, Department of Child and Adolescent Mental Health and Disease, Aydın, Turkey
| | - Burak Baykara
- Medical Faculty of Dokuz Eylül University, Department of Child and Adolescent Mental Health and Disease, İzmir, Turkey
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Tokuc B, Eren F, Saraçoğlu GV. Knowledge, Attitudes and Practice about Cervical Cancer Screening among Women Living in Edirne. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx186.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B Tokuc
- Trakya University Health Center for Medical Research and Practice, Edirne, Turkey
| | - F Eren
- Trakya University Health Center for Medical Research and Practice, Edirne, Turkey
| | - G Varol Saraçoğlu
- Trakya University Health Center for Medical Research and Practice, Edirne, Turkey
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Maki K, Nieman K, Eren F, Cassens M. Modeling of the Relationships between the Consumption of Commonly Consumed Dietary Fats/Oils and Mortality. J Acad Nutr Diet 2017. [DOI: 10.1016/j.jand.2017.08.061] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Affiliation(s)
- Fatma Eren
- Araklı State Hospital/Psychiatry Clinic, Trabzon, Turkey
| | - Nesrin Dilbaz
- Üsküdar University Human and Society Sciences Faculty, İstanbul, Turkey
| | | | - Ömer Turan
- Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Nermin Gündüz
- Erzurum Region Training and Research Hospital, Erzurum, Turkey
| | - Hatice Turan
- Moodist Psychiatry and Neurology Hospital, İstanbul, Turkey
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Guzeloz Z, Demiral AN, Eren F, Adigul M, Capar AE, Cakmakci H, Yilmaz S, Tufekci O, Oren H, Çetingoz R. The Effect of Dose-Volume Parameters on Central Nervous System Relapse in Pediatric Patients with Acute Leukemia Receiving Prophylactic Cranial Irradiation. Gulf J Oncolog 2017; 1:24-29. [PMID: 28797998] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2017] [Indexed: 06/07/2023]
Abstract
AIM OF THE STUDY To investigate the effects of dosevolume parameters of brain parenchyma, optic nerves (ONs) and cribriform plate (CP), which were determined on central nervous system (CNS) control in pediatric leukemia patients who have undergone prophylactic cranial irradiation (PCI) at our department. PATIENTS AND METHODS In the current study, the records of 14 patients were examined retrospectively. Along with the minimum and maximum doses for brain and CP, D95% (minimal dose received by the 95% volume of a structure) and V95% (percent volume of target receiving 95% of prescribed dose) could be obtained from the dose-volume histogram. Statistical analyses were conducted using the Mann Whitney test in SPSS-15. RESULTS ALL/AML ratio was 9/5. CNS relapse was observed only in 2 patients. The minimum dose was 1249 (1100-1782) cGy, 1036 (547-1651) cGy, 856 (308-1460) cGy and 1234 (922-1727) cGy for brain parenchyma, right ON, left ON and CP, respectively. The value of D95%/D was 1.01 (1-1.06) and 0.99 (0.92- 1.06) for brain parenchyma and CP, respectively. V95% was 99.8 % (98.6%-100%) and 98.1% (80.5%-100%) for brain parenchyma and CP, respectively. The analyses revealed that none of the target tissue dose-volume parameters for PCI affected CNS relapse (p>0.05). CONCLUSION In our study; it was found that the dosevolume parameters of the brain, CP and ONs did not have any effect on CNS relapse. Along with the other clinical factors, the scarce number of patients included in the study might have concealed the effects of parameters related to RT.
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Affiliation(s)
- Zeliha Guzeloz
- Dept of Radiation Oncology, SBU Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ayse Nur Demiral
- Dept of Radiation Oncology, Dokuz Eylül Univ Faculty of Medicine, Izmir, Turkey
| | - Fatma Eren
- Dept of Physical Med and Rehab, Bezmi Alem Univ Faculty of Medicine, Istanbul, Turkey
| | - Mehmet Adigul
- Dept of Radiation Oncology, Dokuz Eylül Univ Faculty of Medicine, Izmir, Turkey
| | - Ahmet Ergin Capar
- Dept of Radiology, SBU Tepecik Training and Research Hospital, Izmir, Turkey
| | - Handan Cakmakci
- Dept of Radiology, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
| | - Sebnem Yilmaz
- Dept of Pediatric Hematology, Dokuz Eylül Univ Faculty of Medicine, Izmir, Turkey
| | - Ozlem Tufekci
- Dept of Pediatric Hematology, Dokuz Eylül Univ Faculty of Medicine, Izmir, Turkey
| | - Hale Oren
- Dept of Pediatric Hematology, Dokuz Eylül Univ Faculty of Medicine, Izmir, Turkey
| | - Riza Çetingoz
- Dept of Radiation Oncology, Dokuz Eylül Univ Faculty of Medicine, Izmir, Turkey
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Erbarut Seven I, Mollamemisoglu H, Eren F. Reliability of reporting the presence of transformation zone material in Papanicolaou smears using an automated screening system. Cytopathology 2016; 28:280-283. [PMID: 28008671 DOI: 10.1111/cyt.12411] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVE This study was conducted to evaluate the reliability of using an interactive automated screening system (IAS) to determine the presence of endocervical and/or metaplastic cells (transformation zone material; TZM) in liquid-based cytology (LBC) Papanicolaou (Pap) smear slides. MATERIALS AND METHODS A series of LBC Pap smears was manually screened to determine the presence or absence of TZM. The results were compared to those obtained through IAS. RESULTS ThinPrep® Imaging System (Imager)-assisted screening indicated that 22.4% of the slides did not contain TZM in cases in which previous manual screening revealed that 100% of the slides did contain TZM. CONCLUSION The reliability of determining TZM through IAS is limited. Manual screening of the slides appears to be necessary to report the presence of TZM accurately.
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Affiliation(s)
- I Erbarut Seven
- Department of Pathology, School of Medicine, Marmara University, Istanbul, Turkey
| | - H Mollamemisoglu
- Department of Pathology, School of Medicine, Marmara University, Istanbul, Turkey
| | - F Eren
- Department of Pathology, School of Medicine, Marmara University, Istanbul, Turkey
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Cavus SY, Dilbaz N, Darcin AE, Eren F, Kaya H, Kaya O. Alterations in Serum BDNF Levels in Early Alcohol Withdrawal and Comparison with Healthy Controls. ACTA ACUST UNITED AC 2016. [DOI: 10.5455/bcp.20120731055756] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | - Nesrin Dilbaz
- Uskudar University, Neuropsychiatry Hospital, Istanbul - Turkey
| | - Asli Enez Darcin
- Psychiatry Service of Kayseri Training and Research Hospital, Kayseri - Turkey
| | - Fatma Eren
- Psychiatry Service of Erzurum Regional Training and Research Hospital, Erzurum - Turkey
| | - Hasan Kaya
- Psychiatry Service of Merzifon State Hospital, Amasya - Turkey
| | - Ozlem Kaya
- Psychiatry Service of Ankara Numune Training and Research Hospital, Ankara - Turkey
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Eren F, Oksuz S, Karagöz H, Melikoğlu C, Ulkur E. Multi-digit contracture release using medial sural artery perforator flap with syndactylization-desyndactylization method. Hippokratia 2015; 19:366-368. [PMID: 27703311 PMCID: PMC5033151] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND The medial sural artery perforator flap, with a long pedicle, has tremendous potential for applications in a variety of soft tissue defects. It can be used for reconstruction of multi-digit contractures of the palmar region. MATERIALS AND METHODS We present herein the key features of the management of postburn multi-digit volar contractures, using medial sural artery perforator flaps with the syndactylization and desyndactylization method. We describe the use of the free medial sural artery perforator flap in two patients, to reconstruct complex composite hand defects including the second, third, fourth and fifth digits following thermal burns. RESULTS Both flaps healed uneventfully. In both patients, the hand contractures released completely and adequate joint motion was achieved after a 3-month period of physiotherapy. CONCLUSIONS The thin medial sural artery perforator flap permits high accuracy of soft tissue reconstruction of the hand and reduces the morbidity at the donor site. The MSAPF is a useful flap in areas such as the hands, in the case of soft tissue deficiency and tendon exposition. Hippokratia 2015; 19 (4): 366-368.
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Affiliation(s)
- F Eren
- Plastic and Reconstructive Surgery Department, GATA Haydarpasa Training Hospital, Istanbul, Turkey
| | - S Oksuz
- Plastic and Reconstructive Surgery Department, GATA Haydarpasa Training Hospital, Istanbul, Turkey
| | - H Karagöz
- Plastic and Reconstructive Surgery Department, GATA Haydarpasa Training Hospital, Istanbul, Turkey
| | - C Melikoğlu
- Plastic and Reconstructive Surgery Department, Sifa University Faculty οf Medicine, Izmir, Turkey
| | - E Ulkur
- Plastic and Reconstructive Surgery Department, GATA Haydarpasa Training Hospital, Istanbul, Turkey
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Xanmemmedov E, Coban E, Ciftci-Kavaklıoglu B, Acar E, Eren F, Kale N, Soysal A. The role of platelet count and mean platelet volume in clopidogrel resistance in ischemic stroke patients. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.1454] [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] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ozler S, Oztas E, Tokmak A, Ergin M, Eren F, Karakas N. The association of serum thiol disulphide homeostasis with cardiovascular risk in obese adolescent polycystic ovary syndrome patients. Fertil Steril 2015. [DOI: 10.1016/j.fertnstert.2015.07.381] [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] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ozen G, Deniz R, Eren F, Erzik C, Aydin S, Inanc N, Direskeneli H, Atagunduz P. FRI0212 Associations of ERAP1, IL23R and PTGER4 Polymorphism with Radiographic Severity of Ankylosing Spondylitis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2501] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ozcan H, Yucel A, Avşar U, Cankaya E, Yucel N, Gözübüyük H, Eren F, Keles M, Aydınlı B. Kidney Transplantation Is Superior to Hemodialysis and Peritoneal Dialysis in Terms of Cognitive Function, Anxiety, and Depression Symptoms in Chronic Kidney Disease. Transplant Proc 2015; 47:1348-51. [DOI: 10.1016/j.transproceed.2015.04.032] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Türkmen İnanır N, Eren F, Akgöz S, Eren B, Çetin S, Gündoğmuş UN, Çomunoğlu N, Çomunoğlu C. The importance of hemosiderin deposition in the infant brain: an autopsy study. Hippokratia 2015; 19:164-171. [PMID: 27418767 PMCID: PMC4938109] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND/AIM Iron is an essential element involved in many metabolic processes. Presence and accumulation of iron in various body systems can result in different outcomes. Its accumulation in the central nervous system (CNS) cannot be detected routinely by application of hematoxylin-eosin staining. Detection of the presence of hemosiderin in the brain and cerebellum by application of Perls' dye is of importance in cases of infant deaths. MATERIAL AND METHODS In this study, brain and cerebellar specimens obtained from 52 eligible infants (aged 0-1 years) autopsied in our institute between the years 2010 and 2013, independent of the cause of death, were analyzed in order to detect possible presence of hemosiderin. Perls' dye was used to detect histopathological staining intensity and distribution of hemosiderin in the brain and cerebellum. RESULTS Cases did not differ significantly as for the patients' age and gender (p =0.473), type of the culprit trauma (p =0.414), death/crime scene (p =0.587), and diagnosis groups (p =0.550). In this autopsy study blue colored hemosiderin granulations, stained with Perls' dye were detected in the brain (n: 39, 75%), and cerebellum (n: 35, 67.3%). A weakly negative, but significant correlation was detected between the postmortem interval and intensity values of cerebellar hemosiderin (Spearman's correlation coefficient: -0.381, p =0.024). A statistically significant difference was found between the distribution scores of cerebral hemosiderin in cases with and without trauma history (p =0.03). Median cerebral hemosiderin distribution scores were 2.5 and 2, respectively. CONCLUSIONS The detection of a correlation between the presence of cerebral and cerebellar hemosiderin, and postmortem interval in the age group of 0-1 years, should be interpreted as an important finding in the analysis of cerebral iron. The presence of hemosiderin in the CNS may be a significant finding in the elucidation of infant deaths and this procedure should be carried out on a routine basis.Hippokratia 2015; 19 (2):164-171.
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Affiliation(s)
- N Türkmen İnanır
- Forensic Medicine Department, Uludağ University Medical Faculty, Council of Forensic Medicine of Turkey, Bursa Morgue Department, Bursa, Turkey
| | - F Eren
- Bursa Morgue Department, Council of Forensic Medicine of Turkey, Bursa, Turkey
| | - S Akgöz
- Biostatistics Department, Çanakkale Onsekizmart University Medical Faculty, Çanakkale, Turkey
| | - B Eren
- Bursa Morgue Department, Council of Forensic Medicine of Turkey, Bursa, Turkey
| | - S Çetin
- Kayseri Morgue Department, Council of Forensic Medicine of Turkey, Kayseri, Turkey
| | - U N Gündoğmuş
- Forensic Medicine Institute, Istanbul University, Council of Forensic Medicine of Turkey, Istanbul, Turkey
| | - N Çomunoğlu
- Pathology Department, Istanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - C Çomunoğlu
- Pathology Department, Acıbadem University Medical Faculty, Istanbul, Turkey
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Deniz R, Ozen G, Yilmaz-Oner S, Alibaz-Oner F, Erzik C, Aydin SZ, Inanc N, Eren F, Bayalan F, Direskeneli H, Atagunduz P. Familial Mediterranean fever gene (MEFV) mutations and disease severity in systemic lupus erythematosus (SLE): implications for the role of the E148Q MEFV allele in inflammation. Lupus 2014; 24:705-11. [PMID: 25413357 DOI: 10.1177/0961203314560203] [Citation(s) in RCA: 10] [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: 04/08/2014] [Accepted: 10/28/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Observed low prevalence of SLE among familial Mediterranean fever (FMF) patients in several large cohorts suggests a possible protective effect of the MEFV mutations from SLE. In contrast, SLE patient carriers for the common MEFV mutations had rather complex disease expression with an increased frequency of febrile episodes and pleurisy and a decreased renal complication rate. Our aim was to investigate the prevalence of MEFV gene mutations in patients with SLE and their effect on organ involvement in a well-defined group of biopsy-proven SLE nephritis patients. MATERIAL AND METHOD The prevalence of four MEFV gene mutations (M694V, M680I, V726A and E148Q) was investigated in 114 SLE patients and effect on disease severity was analyzed in patients with biopsy-proven SLE nephritis. RESULTS None of the SLE patients fulfilled the revised Tel-Hashomer criteria. Fourteen of 114 SLE patients (12.2%) were found to carry at least one MEFV mutation. A single patient in the SLE-Nephritis group was compound heterozygous for M694V/M680I mutations and only one patient in the SLE-Mild group was homozygous for E148Q mutation. Carrier frequency was similar to controls in SLE patients (12.2 vs 18.8%, p = 0.34). After the exclusion of the less penetrant E148Q mutation, re-analysis revealed an association between exon 10 mutations and SLE nephritis (p = 0.050, odds ratio (OR) = 4.16, 95% confidence interval (CI) = 1.04-16.6). Carrier rate for the E148Q mutation decreased in the SLE group (controls vs. SLE = 20/186 vs. 3/114, p = 0.08) and E148Q mutation was absent in SLE nephritis (controls vs. SLE nephritis = 20/186 vs. 0/47, p = 0.016, OR = 11.69, 95% CI = 0.69-197.13). CONCLUSIONS Carrier rate for the studied MEFV mutations was slightly lower in the SLE group, which is in agreement with previous observations that FMF may confer some protection from SLE. Exon 10 mutations were associated with SLE nephritis after the exclusion of the E148Q mutation. The significance of the E148Q as a disease-causing mutation is controversial, and whether E148Q substitution is a polymorphism generally affecting inflammatory pathways is not addressed in the current literature. In this regard, absence of the E148Q mutation in SLE nephritis may serve as a clue for further investigation into its role as a general modulatory polymorphism for inflammation. This clarification is necessary to conclude whether other more penetrant MEFV gene mutations confer susceptibility to nephritis in SLE.
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Affiliation(s)
- R Deniz
- Marmara University Faculty of Medicine, Istanbul, Turkey
| | - G Ozen
- Marmara University Faculty of Medicine, Department of Rheumatology, Istanbul, Turkey
| | - S Yilmaz-Oner
- Marmara University Faculty of Medicine, Department of Rheumatology, Istanbul, Turkey
| | - F Alibaz-Oner
- Marmara University Faculty of Medicine, Department of Rheumatology, Istanbul, Turkey
| | - C Erzik
- Marmara University Faculty of Medicine, Department of Medical Biology, Istanbul, Turkey
| | - S Z Aydin
- Goztepe Training and Research Hospital, Department of Rheumatology, Istanbul, Turkey
| | - N Inanc
- Marmara University Faculty of Medicine, Department of Rheumatology, Istanbul, Turkey
| | - F Eren
- Marmara University Faculty of Medicine, Department of Medical Biology, Istanbul, Turkey
| | - F Bayalan
- Marmara University Faculty of Medicine, Department of Rheumatology, Istanbul, Turkey
| | - H Direskeneli
- Marmara University Faculty of Medicine, Department of Rheumatology, Istanbul, Turkey
| | - P Atagunduz
- Marmara University Faculty of Medicine, Department of Rheumatology, Istanbul, Turkey
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Öksüz S, Eren F, Sever C, Ülkür E. Frostbite injury of the breast: a case report. Ann Burns Fire Disasters 2014; 27:105-106. [PMID: 26170785 PMCID: PMC4396791] [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] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Indexed: 06/04/2023]
Abstract
This paper presents an unusual case of frostbite injury to the breast area caused by faulty cryotherapy application. Cryotherapy, commonly used by patients and health professionals, relieves pain and edema after trauma and sports injuries. However, applying cold therapy is not common for surgical procedures involving soft tissue. The frostbite injury to the breast presented here occurred due to persistent use of a self-prepared ice pack following a needle aspiration biopsy. Cold exposure to soft tissue may cause frostbite. It is crucial to inform patients about proper application of cryotherapy and possible complications, particularly for the procedures in which cold therapy is not widely used.
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Affiliation(s)
- S. Öksüz
- Gulhane Military Medical Academy, Haydarpasa Training Hospital, Department of Plastic and Reconstructive Surgery, Burn Unit, Istanbul, Turkey
- University of Pittsburgh Medical Center, Department of Plastic Surgery and VCA lab., McGowan Institute of Regenerative Medicine, Pittsburgh PA, USA
| | - F. Eren
- Gulhane Military Medical Academy, Haydarpasa Training Hospital, Department of Plastic and Reconstructive Surgery, Burn Unit, Istanbul, Turkey
| | - C. Sever
- Gulhane Military Medical Academy, Haydarpasa Training Hospital, Department of Plastic and Reconstructive Surgery, Burn Unit, Istanbul, Turkey
| | - E. Ülkür
- Gulhane Military Medical Academy, Haydarpasa Training Hospital, Department of Plastic and Reconstructive Surgery, Burn Unit, Istanbul, Turkey
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Deniz R, Ozen G, Yilmaz-Oner S, Alibaz-Oner F, Eren F, Alhan O, Inanc N, Direskeneli H, Atagunduz P. THU0400 Familial Mediterranean Fever Gene (MEFV) Mutations and Disease Severity in Systemic Lupus Erythematosus (SLE); Implications on the Role of the E148Q MEFV Allele on Inflammation. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2116] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Olcay A, Cakmak H, Bigmurad T, Eren F, Keskin K, Yıldız A, Canturk E, Kayhan B. OP-051 SLOW AD HOC PERCUTANEOUS CORONARY INTERVENTION STRATEGY AND CORONARY DIAMETERS. Int J Cardiol 2013. [DOI: 10.1016/s0167-5273(13)70052-4] [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: 12/01/2022]
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Tanboga I, Eren F, Altınok B, Peker S, Ertugral F. The effect of low level laser therapy on pain during dental tooth-cavity preparation in children. Eur Arch Paediatr Dent 2012; 12:93-5. [DOI: 10.1007/bf03262786] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Eren B, Türkmen N, Comunoglu N, Oz B, Senel B, Eren F. Sudden death due to a rare brain tumor: an autopsy case. Soud Lek 2012; 57:60-61. [PMID: 23121034] [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: 06/01/2023]
Abstract
UNLABELLED Sudden death in persons with intracranial neoplasms is a rare mechanism of death detected in the forensic autopsies. 10 years-old girl was brought to a local clinic death shortly after analgesic therapy for headache. Autopsy findings showed a large, solid cerebellar mass. Histological diagnosis was pilomyxoid astrocytoma, low-grade tumor with features alike to pilocytic astrocytomas. In this case report we present and discuss rare autopsy case of pilomyxoid astrocytoma from medicolegal point of view. KEYWORDS sudden death - brain - pilomyxoid astrocytoma - autopsy.
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Affiliation(s)
- B Eren
- Council of Forensic Medicine of Turkey, Bursa Morque Department, Turkey. drbulenteren@@gmail.com
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Comunoglu C, Comunoglu N, Eren B, Tanrlöver O, Türkmen N, Gündogmuş UN, Eren F. Age-related histopathological changes in the cardiac conducting system in the Turkish population: an evaluation of 202 autopsy cases. Folia Morphol (Warsz) 2012; 71:178-182. [PMID: 22936554] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Histopathological features of the cardiac conducting system (CCS) in the Turkish population have not been investigated previously. MATERIAL AND METHODS We examined CCS of 202 autopsy heart specimens dissected between the years 2004 and 2005 in Bursa Forensic Medicine Institution. Of the 202 cases from all age groups, 154 were males and 48 were females. RESULTS In our cases, an increase in fibrous and adipose tissue concordant with age, indicating an age-related nature, were detected. Fibrous and fatty tissue infiltration appeared at the age of 35. Fatty infiltration started between the ages 20 and 34 years at the sinoatrial node (SAN). There was no relationship between obesity and fatty tissue infiltration in SAN and atrioventricular node (AVN). In 4 cases calcification and in 19 cases inflammation was observed. Amyloid accumulation was not present. In 7 cases myocardial infarction not involving CCS was seen. In 1 case fibroelastoma was detected. CONCLUSIONS In the Turkish population age-related fibrosis and fatty infiltration in CCS appeared at the age of 35 years and increased with age. Fatty infiltration in the SAN started at a younger age than that reported in the literature. In cases where the cause of death could not be determined, we could not detect lethal pathological features. However, we think that examination of the CCS will improve the quality of autopsy diagnosis.
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Affiliation(s)
- C Comunoglu
- Department of Pathology, Near East University Faculty of Medicine, Nicosia, North Cyprus.
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Alahdab YO, Eren F, Giral A, Gunduz F, Kedrah AE, Atug O, Yilmaz Y, Kalayci O, Kalayci C. Preliminary evidence of an association between the functional c-kit rs6554199 polymorphism and achalasia in a Turkish population. Neurogastroenterol Motil 2012; 24:27-30. [PMID: 21951831 DOI: 10.1111/j.1365-2982.2011.01793.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [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: 12/13/2022]
Abstract
BACKGROUND C-kit-positive interstitial cells of Cajal (ICC) of the lower esophageal sphincter are reduced in achalasia. Two functional gene polymorphisms (rs2237025 and rs6554199) within the c-kit gene may affect its transcriptional activity. In this pilot study, we hypothesized that these polymorphisms would be associated with achalasia. METHODS Genomic DNA was extracted and real-time PCR reactions were used to determine the rs2237025 and rs6554199 c-kit polymorphisms in 88 Turkish patients with achalasia and 101 healthy controls. KEY RESULTS The frequency of the T allele of rs6554199 was significantly higher in patients with achalasia [odds ratio (OR): 1.55; 95% confidence interval (CI), 1.03-2.34; P = 0.038] compared with the G allele. Under a dominant model of inheritance, the carriage of at least one T allele was significantly more frequent in patients with achalasia (80.7%) than in controls (65.3%; OR: 2.21; 95% CI, 1.13-4.33; P = 0.022). No association of the c-kit rs2237025 polymorphism with achalasia was detected. CONCLUSIONS & INFERENCES Despite the small sample size and the possibility of a false positive finding, our preliminary data support the hypothesis that the T allele of the c-kit rs6554199 polymorphism may be associated with achalasia in the Turkish population. These findings need to be replicated in other racial-ethnically diverse populations.
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Affiliation(s)
- Y O Alahdab
- Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey
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Yilmaz Y, Yonal O, Eren F, Atug O, Hamzaoglu HO. Serum levels of soluble receptor for advanced glycation endproducts (sRAGE) are higher in ulcerative colitis and correlate with disease activity. J Crohns Colitis 2011; 5:402-6. [PMID: 21939913 DOI: 10.1016/j.crohns.2011.03.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [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] [Received: 12/15/2010] [Revised: 03/17/2011] [Accepted: 03/18/2011] [Indexed: 02/08/2023]
Abstract
UNLABELLED Interaction of the receptor for advanced glycation endproducts (RAGE) with its ligands results in expression of inflammatory mediators, activation of NF-κB, and induction of oxidative stress, all of which have been implicated in the pathogenesis of inflammatory bowel diseases (IBD). Soluble receptor for advanced glycation endproducts (sRAGE) has recently emerged as a reliable biomarker of inflammation in numerous RAGE-mediated disorders. OBJECTIVE To assess sRAGE levels in adult patients with IBD. METHOD Serum was collected from adult patients with Crohn's disease (CD, 56 patients), ulcerative colitis (UC, 60 patients), and healthy controls (HC, 113 subjects). Levels of sRAGE were determined by enzyme-linked immunosorbent assay. RESULTS Serum sRAGE levels were elevated in IBD compared to HC and were higher in UC patients compared to CD and HC. Levels of sRAGE were significantly higher in the serum of UC patients with active disease compared to patients with inactive disease, but no association with the Montreal Classification was evident. Serum sRAGE was lower in CD patients with biological therapies. CONCLUSIONS These findings suggest that serum levels of sRAGE are altered in patients with intestinal inflammation and may reflect distinct immunoinflammatory pathogenesis of UC and CD.
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Affiliation(s)
- Y Yilmaz
- Department of Gastroenterology, Marmara University, School of Medicine, Istanbul 34899, Turkey.
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Sancak S, Jaeschke H, Eren F, Tarcin O, Guellueoglu B, Sen LS, Sever Z, Gozu HI, Bircan R, Akalin S, Paschke R, Eszlinger M. High prevalence of TSHR/Gsα mutation-negative clonal hot thyroid nodules (HNs) in a Turkish cohort. Horm Metab Res 2011; 43:562-8. [PMID: 21773967 DOI: 10.1055/s-0031-1280829] [Citation(s) in RCA: 7] [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: 10/18/2022]
Abstract
Whereas the majority of hot thyroid nodules are caused by somatic TSH-receptor mutations, the percentage of TSH-receptor mutation negative clonal hot nodules (HN) and thus the percentage of hot nodules likely caused by other somatic mutations are still debated. This is especially the case for toxic multinodular goiter (TMNG). 35 HNs [12 solitary hot nodules (SHN), 23 TMNG] were screened for somatic TSHR mutations in the exons 9 and 10 and for Gsα mutations in the exons 7 and 8 using DGGE. Determination of X-chromosome inactivation was used for clonality analysis. Overall TSHR mutations were detected in 14 out of 35 (40%) HNs. A nonrandom X-chromosome inactivation pattern was detected in 18 out of 25 (72%) HNs suggesting a clonal origin. Of 15 TSHR or Gsα mutation negative cases 13 (86.6%) showed nonrandom X-chromosome inactivation, indicating clonal origin. The frequency of activating TSHR and/or Gsα mutations was higher in SHNs (9 of 12) than in TMNGs (6 of 23). There was no significant difference for the incidence of clonality for HNs between TMNGs or SHNs (p: 0.6396). Activating TSHR and/or Gsα mutations were more frequent in SHNs than in TMNG. However, the frequency of clonality is similar for SHN and TMNG and there is no significant difference for the presence or absence of TSHR and/or Gsα mutations of clonal or polyclonal HNs. The high percentage of clonal mutation-negative HNs in SHN and TMNG suggests alternative molecular aberrations leading to the development of TSHR mutation negative nodules.
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Affiliation(s)
- S Sancak
- Section of Endocrinology and Metabolism, Marmara Medical School, Istanbul, Turkey.
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Altinok B, Tanboga I, Peker S, Eren F, Bakkal M, Peker F. The effect of laser-activated Acidulated Phosphate Fluoride on enamel submitted to erosive solution only: an in vitro preliminary evaluation. Eur J Paediatr Dent 2011; 12:13-16. [PMID: 21434729] [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: 05/30/2023]
Abstract
AIM The purpose of this in vitro study was to evaluate the potential effect of laser therapy on the prevention of erosive demineralisation either alone or combined with acidulated phosphate fluoride gel on human enamel. It was hypothesized that such a treatment would decrease enamel solubility. STUDY DESIGN Efficacy of 2940 nm Er:YAG laser with preset parameters--alone or combined with APF (Acidulated Phosphate Fluoride) gel--was tested on freshly extracted human permanent molars. MATERIALS AND METHODS Ten sound human third molars were sectioned into 5 surfaces (2 x 3 mm) with hard tissue microtome and were randomly allocated into different treatment groups as follows. The Vicker's hardness of each surface was obtained at the baseline. Group 1, negative control group: no treatment. Group 2, positive control group: only 1.23% APF gel (Denti-Care gel, Medicom) 1 minute application. Group 3: irradiated with surface modification mode (2940 nm, 1.2j/cm², 10 Hz, 300 μm) Er:YAG laser. Group 4: Er:YAG laser application following 1.23% APF gel. Group 5: 1.23% APF gel following Er:YAG laser application. The demineralisation process was obtained by immersion of specimens in a soft drink for 10 minutes and then the Vickers hardness was reevaluated. STATISTICS For statistical analyses within groups the Kruskal Wallis test was used, while for comparing groups the paired sample t test (significance p<0.05) was used. RESULTS The difference in microhardness values of each group obtained following the treatments was not statistically significant (p>0.05). Beside, no statistical difference was found in Vickers value related to the application of fluoride prior or after laser therapy. Conclusion Er:YAG laser irradiation alone or combined with APF decreased the enamel solubility but combined treatment did not show any significant additional effect.
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Affiliation(s)
- B Altinok
- Department of Pediatric Dentistry, School of Dentistry, University of Marmara, Istanbul, Turkey.
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Alsan CI, Vinh-Hung V, Eren F, Abacioğlu U. Adenoid cystic carcinoma of the Bartholin's gland: case report and systematic review of the literature. EUR J GYNAECOL ONCOL 2011; 32:567-572. [PMID: 22053678] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Adenoid cystic carcinoma (ACC) of the Bartholin's gland is a rare malignancy of the female genital tract. Seventy-nine cases have been reported in the literature. A 40-year-old women presented to our clinic with twice locally recurrent ACC of Bartholin's gland of the left vulva despite hemivulvectomy. Adjuvant radiotherapy was delivered after the third resection. There was no local recurrence after three years follow-up, although she developed lung metastases that remain under control with oral cyclophosphamide. Our case confirms the literature review, which indicates a slow growing tumor with frequent local recurrences (30%) and distant metastases (31%). Adjuvant radiotherapy and/or chemotherapy should be considered in the management of ACC of Bartholin's gland.
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Affiliation(s)
- Cetin I Alsan
- Radiation Oncology, Marmara University, Istanbul, Turkey.
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Eren F, Aydin O, Gök N, Eren B, Comunoglu N, Comunoglu C. Ovarian enlargement associated with massive oedema. J PAK MED ASSOC 2008; 58:43-45. [PMID: 18297978] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Massive ovarian oedema is a rare entity described as accumulation of oedema fluid within the ovarian stroma, separating normal follicular structures. Our case was a 27-year-old woman who presented with a large solid pelvic mass after recurrent episodes of self-limited abdominal pain. On physical examination, she had left abdominal tenderness with minimal rebound and guarding. With a diagnosis of malignant ovarian tumor, an exploratory laparotomy was done and a twisted ovarian mass was found which was excised completely. Histopathological evaluation of the mass revealed massive oedema of the ovary. Massive ovarian oedema should be suspected in women at the fertile age range with solid enlargement of the ovary.
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Affiliation(s)
- F Eren
- Department of Pathology and Gynaecology-Obstetrics, Sevket Yilmaz Public Hospital, Bursa, Turkey
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Başgül A, Gökaslan H, Kavak ZN, Güdücü N, Eren F. Squamous cell carcinoma developing in a huge dermoid cyst of the ovary in an 80-year-old woman--case report. EUR J GYNAECOL ONCOL 2007; 28:63-6. [PMID: 17375712] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
A case of an 80-year-old patient with squamous cell carcinoma originating from a huge septated dermoid cyst of the right ovary is reported. There were bilateral dermoids in the patient. The tumor sizes were 30 x 40 x 20 cm and 4 x 3 x 5 cm in the right and left ovary, respectively, confirmed by ultrasound and computed tomography. Squamous cell carcinoma arose in the solid part of a huge dermoid cyst of the left ovary. Total abdominal hysterectomy and bilateral salpingo-oophorectomy, omentectomy and appendectomy were performed. The tumor was confined to the right ovary. The patient was categorized as FIGO Stage IA. She recovered uneventfully and there was no evidence of recurrence in the early-stage case during one year of follow-up. The clinical and pathological features, treatment modalities and prognosis of squamous cell carcinoma are described.
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Affiliation(s)
- A Başgül
- Department of Obstetrics and Gynecology, Bilim University, Istanbul, Turkey
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Gökaslan H, Yörük P, Pekin T, Kavak Z, Eren F. Bilateral metastatic breast cancer as the first manifestation of ovarian cancer: case report. EUR J GYNAECOL ONCOL 2005; 26:336-8. [PMID: 15991541] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Breast metastasis from primary ovarian cancer is extremely rare. The rarity of this finding may be the reason for its common misinterpretation as primary breast carcinoma. DESIGN Case report. SETTING A university hospital. RESULTS A case of a patient with primary ovarian papillary serous cystadenocarcinoma who initially presented with a solitary bilateral breast mass and abdominal distention is reported. CONCLUSIONS Blood-borne metastasis from the ovary to the breast can show a varied clinical picture that should be differentiated from that of primary breast carcinoma.
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Affiliation(s)
- H Gökaslan
- Department of Obstetrics and Gynecology, Marmara University School of Medicine, Istanbul, Turkey
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Abstract
In this study, we have investigated the frequency and clinical significance of glandular cells in posthysterectomy vaginal smears. The slides of vaginal cuff smears of 290 patients were reviewed. The glandular cells were categorized into three groups: (1) squamous metaplastic-like cells; (2) columnar endocervical-like cells; and (3) small round cuboidal cells. Glandular cells were found in 39 (13%) of the 290 vaginal smears. Group 1 type cells were seen in 76% (n = 30), group 2 type cells in 38% (n = 15) and group 3 type cells in 47% (n = 19) of the smears. In 19 (48%) of the smears combination of two or three groups were seen. The presence of glandular cells showed a strong association with inflammation/repair as a background finding in the smears. No correlation could be found between the presence of atrophy and history of chemotherapy or radiotherapy. Apart from these there was a prominent increase in reporting benign glandular cells after the application of the current Bethesda 2001 reporting criteria in our laboratory. As a result our study showed that the finding of glandular cells in posthysterectomy vaginal smears is more frequent than expected and most of them could be related to inflammatory and regenerative processes in the absence of a clearly identified underlying cause.
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Affiliation(s)
- F Eren
- Department of Pathology, Marmara University School of Medicine, Istanbul, Turkey.
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Erkanli S, Eren F, Pekin S, Bagis T. BCL-2 and P53 expression in endometrial carcinoma. J Exp Clin Cancer Res 2004; 23:97-103. [PMID: 15149157] [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: 04/29/2023]
Abstract
Our aim was to compare the results of bcl-2 expression in endometrial carcinoma with clinicopathological prognostic factors along with p53 accumulation. In addition, p53 expression was compared to different subtypes of endometrial carcinoma. Immunohistochemical staining was performed on formalin-fixed, paraffin embedded tissue sections by using Bcl-2 Supersensitive Mouse Anti-Bcl-2 Oncoprotein (Biogenex AM287-5M) for bcl-2 immunostaining and Supersensitive Mouse Anti-p53 Suppressor Gene Product (1801) (Biogenex AM 240-5M) for p53 immunostaining. 9 out of 9 cases of proliferative endometrium, 5/5 cases of endometrial hyperplasia without atypia, 5/5 cases with atypia, and 21/35 cases of endometrial carcinoma showed bcl-2 protein expression. Bcl-2 expression was not related to age, surgical stage, or histopathological features, nor was there an inverse correlation between bcl-2 and p53 expression in endometrial carcinoma. p53 expression was detected in 3/4 cases of serous papillary carcinoma, whereas only 5/31 cases of endometrioid carcinoma showed p53 expression. Bcl-2 expression decreased in endometrial carcinomas, and mechanisms other than p53 may play a role in the regulation of bcl-2 expression in endometrial carcinoma. Abnormal p53 protein expression is an important event in the development of serous tumors, which may explain partly why they are more aggressive than their endometrioid counterparts where p53 expression does not play a major role.
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Affiliation(s)
- S Erkanli
- Dept. of Obstetrics and Gynecology, Baskent University School of Medicine, Adana, Turkey.
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Tahan V, Avsar E, Karaca C, Uslu E, Eren F, Aydin S, Uzun H, Hamzaoglu HO, Besisik F, Kalayci C, Okten A, Tozun N. Adrenomedullin in cirrhotic and non-cirrhotic portal hypertension. World J Gastroenterol 2003; 9:2325-7. [PMID: 14562402 PMCID: PMC4656487 DOI: 10.3748/wjg.v9.i10.2325] [Citation(s) in RCA: 10] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: Adrenomedullin (ADM) is a potent vasodilator peptide. ADM and nitric oxide (NO) are produced in vascular endothelial cells. Increased ADM level has been linked to hyperdynamic circulation and arterial vasodilatation in cirrhotic portal hypertension (CPH). The role of ADM in non-cirrhotic portal hypertension (NCPH) is unknown. plasma ADM levels were studied in patients with NCPH, compensated and decompensated cirrhosis in order to determine its contribution to portal hypertension (PH) in these groups.
METHODS: There were 4 groups of subjects. Group 1 consisted of 27 patients (F/M: 12/15) with NCPH due to portal and/or splenic vein thrombosis (mean age: 41 ± 12 years), group 2 consisted of 14 patients (F/M: 6/8) with compensated (Child-Pugh A) cirrhosis (mean age: 46 ± 4), group 3 consisted of 16 patients (F/M: 6/10) with decompensated (Child-Pugh C) cirrhosis (mean age: 47 ± 12). Fourteen healthy subjects (F/M: 6/8) (mean age: 44 ± 8) were used as controls in Group 4. ADM level was measured by ELISA. NO was determined as nitrite/nitrate level by chemoluminescence.
RESULTS: ADM level in Group 1 (236 ± 61.4 pg/mL) was significantly higher than that in group 2 (108.4 ± 28.3 pg/mL) and group 4 (84.1 ± 31.5 pg/mL) (both P < 0.0001) but was lower than that in Group3 (324 ± 93.7 pg/mL) (P = 0.002). NO level in group 1 (27 ± 1.4 μmol/L) was significantly higher than that in group 2 (19.8 ± 2.8 μmol/L) and group 4 (16.9 ± 1.6 μmol/L) but was lower than that in Group 3 (39 ± 3.6 μmol/L) (for all three P < 0.0001). A strong correlation was observed between ADM and NO levels (r = 0.827, P < 0.0001).
CONCLUSION: Adrenomedullin and NO levels were high in both non-cirrhotic and cirrhotic portal hypertension and were closely correlated, Adrenomedullin and NO levels increased proportionally with the severity of cirrhosis, and were significantly higher than those in patients with NCPH. Portal hypertension plays an important role in the increase of ADM and NO. Parenchymal damage in cirrhosis may contribute to the increase in these parameters.
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Affiliation(s)
- V Tahan
- Gastroenterology Institute, Marmara University, Turkey.
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Pekin T, Yildizhan B, Eren F, Pekin O, Yildizhan R. Adenocarcinoma, adenoacanthoma, and mixed adenosquamous carcinoma of the endometrium. EUR J GYNAECOL ONCOL 2002; 22:151-3. [PMID: 11446483] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
PURPOSE To determine the frequency of endometrial adenocarcinoma (AC) with squamous cell differentiation and to compare the histopathologic and clinical characteristics of patients with adenoacanthoma (AA) and adenosquamous carcinoma (AS) to evaluate possible prognostic differences. MATERIALS AND METHODS Two hundred forty patients with endometrial carcinoma (72.2% AC, 21.25% AA, 6.25% AS) treated at the Department of Gynecologic Oncology of Marmara University Hospital, between January 1986 and December 1997, were reviewed. The diagnoses of the diseases were made with fractional D&C, and the definitive therapy for all patients was carried out at the same hospital. Extrafascial hysterectomy + BSO with or without pelvic and para-aortic lymph node dissection, and omentectomy according to the FIGO staging and grading system were performed. RESULTS AC and AS had median ages around 60 years with a similar percent distribution of postmenopausal patients (around 74%). AA had an earlier median age of 51 years which reflects an incidence of only 50% postmenopausal patients. There was a tendency for AA to be of low-grade malignancy (72%), 51% of AC were of low-grade, while only 20% of AS were low-grade tumors. There was no difference for any of the three pathological entities in survival by FIGO stages. Over 80% of the tumors were Stage I and about 10% were Stage II, with less than 10% in Stages III and IV. CONCLUSION Considering the more modern and uniform approaches in therapy for these tumors, there seems to be no differences in prognosis for adenocarcinoma with or without squamous elements. The neoplasms AC, AA and AS should be regarded, and consequently approached, as any low-grade adenocarcinoma of the endometrium.
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Affiliation(s)
- T Pekin
- Dept. of Gynecological Oncology, Marmara University Hospital, Istanbul, Turkey
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Pekin T, Eren F, Pekin O. Leiomyosarcoma of the broad ligament: case report and literature review. EUR J GYNAECOL ONCOL 2001; 21:318-9. [PMID: 10949406] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
A 56-year-old woman with leiomyosarcoma of the broad ligament discovered in the outpatient clinic in Marmara University Medical School is presented. Treatment consisted of total abdominal hysterectomy and bilateral salpingo-oophorectomy. After a one-year disease-free interval, the patient underwent a repeat laparotomy and recurrence of the previously excised malignant tumor was removed. The patient received external radiotherapy to the pelvis with linear accelerator.
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Affiliation(s)
- T Pekin
- Department of Obstetrics and Gynecology, School at Medicine, University of Marmara, Istanbul, Turkey
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Kavak ZN, Başgül A, Eren F, Ceyhan N. Angiomyofibroblastoma of the vulva: a rare but distinct entity. Acta Obstet Gynecol Scand 2000; 79:612-3. [PMID: 10929966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- Z N Kavak
- Department of Obstetrics & Gynecology, Marmara University Medical School, Istanbul, Turkey
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Kiliç T, Pamir MN, Küllü S, Eren F, Ozek MM, Black PM. Expression of structural proteins and angiogenic factors in cerebrovascular anomalies. Neurosurgery 2000; 46:1179-91; discussion 1191-2. [PMID: 10807251 DOI: 10.1097/00006123-200005000-00032] [Citation(s) in RCA: 148] [Impact Index Per Article: 6.2] [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: 11/26/2022] Open
Abstract
OBJECTIVE The goal of this study was to describe the expression of matrix proteins and angiogenic factors in cerebrovascular malformations. METHODS Forty-six cerebrovascular malformations were immunohistochemically investigated with a battery of staining for five structural proteins (collagen IV, collagen III, smooth muscle actin, fibronectin, and laminin), and three angiogenic factors (vascular endothelial growth factor [VEGF], basic fibroblast growth factor [bFGF], and transforming growth factor alpha [TGFalpha]). The lesions consisted of 34 arteriovenous malformations (AVMs), 10 cavernous malformations (CMs), and 2 venous angiomas. Expression intensity for each histological layer in the abnormal vessel wall was graded and compared. RESULTS AVM endothelia and subendothelia expressed more laminin and collagen IV than the same layers of CMs. Conversely, CMs expressed more fibronectin than AVMs. CM endothelia exhibited more prominent staining for smooth muscle actin than AVM endothelia. AVMs and CMs expressed VEGF in the endothelium and subendothelium, and TGFalpha in endothelial and perivascular layers. However, unlike AVMs, CMs expressed bFGF in the endothelium as well. The brain tissue intermingled within AVMs also expressed growth factors. Modified glial cells in the brain tissue adjacent to CMs expressed bFGF and TGFalpha, but not VEGF. Venous angiomas did not express the studied growth factors and mainly consisted of structural proteins of angiogenically mature tissue. CONCLUSION Expression characteristics of structural proteins reveal that AVMs and CMs have different immunohistological properties. This study provides strong confirmation of previous findings of VEGF and bFGF immunoexpression in AVMs and CMs. It adds new information on TGFalpha expression in these malformations and on expression of the angiogenic factors in venous angiomas.
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Affiliation(s)
- T Kiliç
- Department of Neurosurgery, Institute of Neurological Sciences, Marmara University, Istanbul, Turkey
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Tüney D, Baltacioğlu F, Ahiskali R, Aribal ME, Eren F, Biren T. Large-cell calcifying Sertoli cell tumour of the testis: associated organ anomalies. Australas Radiol 1999; 43:382-4. [PMID: 10901943 DOI: 10.1046/j.1440-1673.1999.433686.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A case is reported of unilateral, focal large-cell calcifying Sertoli cell tumour (LCCSCT) of the testis associated with complex endocrine disorders and cardiac myxomas. It is believed that there are two distinct groups of patients with this tumour: those who have complex dysplastic syndromes and bilateral and multifocal tumours; and those without any syndromes but who have unilateral and focal tumours. The presented case differs in that, although the patient has a unilateral focal tumour, unique organ anomalies, such as renal agenesis and inferior vena cava duplication, are also present. These anomalies with LCCSCT have not been reported before.
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Affiliation(s)
- D Tüney
- Department of Radiology, Marmara University Hospital, Altunizade, Istanbul, Turkey.
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