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Guzel E, Aydin K, Baydar Toprak O. Prediction of mortality and the development of critical illness in the course of COVID-19 with tertiary hospital data: vaccines? Critical illness scores? Mortality scores? Eur Rev Med Pharmacol Sci 2023; 27:5893-5908. [PMID: 37401327 DOI: 10.26355/eurrev_202306_32829] [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: 07/05/2023]
Abstract
OBJECTIVE Even though COVID-19 affects some risk groups more severely than others, there are still unknowns concerning the intensive care procedure and death in non-risk categories, making it vital to identify critical sickness and fatality risk factors at this time. The purpose of this study was to look into the efficacy of critical illness and mortality scores, as well as other risk factors in COVID-19. PATIENTS AND METHODS Two hundred twenty-eight inpatients diagnosed with COVID-19 were included in the study. Sociodemographic, clinical, and laboratory data were recorded and risk calculations were made with the help of web-based patient data-based calculation programs called COVID-GRAM Critical Illness and 4C-Mortality score. RESULTS The median age of 228 patients included in the study was 56.5 years, 51.3% of them were males, and ninety-six (42.1%) were unvaccinated. According to the multivariate analysis, the factors affecting the development of critical illness were cough [odds ratio=0.303, 95% CI (0.123,0.749), p=0.010], creatinine [odds ratio=1.542, 95% CI (1.100, 2.161), p=0.012], respiratory rate [odds ratio=1.484, 95% CI (1.302, 1.692), p=0.000], COVID-GRAM Critical Illness Score [odds ratio=3.005, 95% CI (1.288, 7.011), p=0.011]. Factors affecting survival were vaccine status [odds ratio=0.320, 95% CI (0.127,0.802), p=0.015], blood urea nitrogen (BUN) [odds ratio=1.032, 95% CI (1.012, 1.053), p=0.002], respiratory rate [odds ratio=1.173, 95% CI (1.070, 1.285), p=0.001], COVID-GRAM-critical-illness score [odds ratio=2.714, 95% CI (1.123, 6.556), p=0.027]. CONCLUSIONS The findings suggested that risk assessment might employ risk scoring, such as COVID-GRAM Critical Illness, and that immunization against COVID-19 will reduce the occurrence of mortality.
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Affiliation(s)
- E Guzel
- Department of Chest Diseases, Faculty of Medicine, Cukurova University, Adana, Turkey.
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Aydin K, Puthuran M, Onal Y, Barburoglu M, Chandran A, Berdikhojayev M, Gravino G, Senturk YE, Aygun S, Velioglu M, Sencer S. The Angiographic and Clinical Follow-up Outcomes of the Wide-Necked and Complex Intracranial Aneurysms Treated With LVIS EVO-Assisted Coiling. Neurosurgery 2023; 92:827-836. [PMID: 36729762 DOI: 10.1227/neu.0000000000002283] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 09/30/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The Low Profile Visible Intraluminal Support EVO (LVIS EVO) is a self-expandable braided stent, which was recently introduced for the treatment of intracranial aneurysms. Full visibility of the stent and a relatively high metal coverage ratio are the unique features of the LVIS EVO. OBJECTIVE To assess the safety, efficacy, and midterm durability of LVIS EVO stent-assisted coiling for the treatment of wide-necked intracranial aneurysms. METHODS The endovascular databases were reviewed to identify patients treated with LVIS EVO-assisted coiling. The technical success and immediate clinical/angiographic outcomes were assessed. Periprocedural and delayed complications were evaluated. The follow-up angiographic/clinical outcomes were investigated. The preprocedural/follow-up neurological statuses were assessed with the modified Rankin Scale. RESULTS One hundred three aneurysms in 103 patients (63 females) with a mean age of 54.9 ± 11.3 years were included. The mean maximum sac diameter was 6.2 ± 2.9 mm. The procedural technical success rate was 100%. Immediate postprocedural angiography showed complete occlusion in 77.7%. The mean duration of the angiographic follow-up was 8.8 ± 3.6 months. Follow-up angiography showed complete aneurysm occlusion in 89% of the 82 patients with angiographic follow-up. Recanalization was observed in 7.3% of 82 patients. Two patients (2.4%) required retreatment. In addition, 8.7% of the patients had at least 1 complication, and 2.9% of the patients developed a permanent morbidity. All patients had mRS scores ≤2. CONCLUSION The results of this study demonstrate that SAC with LVIS EVO is a relatively safe, efficient, and durable treatment for wide-necked and complex intracranial aneurysms.
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Affiliation(s)
- Kubilay Aydin
- Department of Interventional Radiology, Koc University Hospital, Topkapi, Istanbul, Turkey
- Department of Neuroradiology, Istanbul University, Istanbul Faculty of Medicine, Capa, Istanbul, Turkey
| | - Mani Puthuran
- The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Yilmaz Onal
- Department of Neurosurgery, JSC Central Hospital, Almaty, Kazakhstan
| | - Mehmet Barburoglu
- Department of Neuroradiology, Istanbul University, Istanbul Faculty of Medicine, Capa, Istanbul, Turkey
| | - Arun Chandran
- The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | | | - Gilbert Gravino
- The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Yunus Emre Senturk
- Department of Interventional Radiology, Koc University Hospital, Topkapi, Istanbul, Turkey
| | - Serhat Aygun
- Department of Interventional Radiology, Koc University Hospital, Topkapi, Istanbul, Turkey
| | - Murat Velioglu
- The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Serra Sencer
- Department of Neuroradiology, Istanbul University, Istanbul Faculty of Medicine, Capa, Istanbul, Turkey
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Drumm B, Herning A, Klein P, Raymond J, Abdalkader M, Huo X, Chen Y, Siegler JE, Peacock M, Schonewille WJ, Liu X, Hu W, Ji X, Li C, Alemseged F, Liu L, Nagel S, Strbian D, Rebello LC, Yaghi S, Qureshi MM, Fischer U, Tsivgoulis G, Kaesmacher J, Yamagami H, Puetz V, Sylaja PN, Marto JP, Sacco S, Kristoffersen ES, Demeestere J, Conforto AB, Meyer L, Kaiser DPO, Reiff T, Aydin K, Romoli M, Diana F, Lobotesis K, Roi D, Masoud HE, Ma A, Mohammaden MH, Doheim MF, Zhu Y, Sang H, Sun D, Ton MD, Raynald, Li F, Lapergue B, Hanning U, Yang Q, Lee JS, Thomalla G, Yang P, Liu J, Campbell BCV, Chen HS, Zaidat OO, Qiu Z, Nogueira RG, Miao Z, Nguyen TN, Banerjee S. Basilar artery occlusion management: An international survey of middle versus high-income countries. Interv Neuroradiol 2022:15910199221143190. [PMID: 36514286 DOI: 10.1177/15910199221143190] [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: 12/15/2022] Open
Abstract
BACKGROUND AND PURPOSE Two early basilar artery occlusion (BAO) randomized controlled trials (RCTs) did not establish the superiority of endovascular thrombectomy (EVT) over medical management. Yet many providers continued to recommend EVT. The goal of the present article is to compare physicians' diagnostic and management strategies of BAO among middle-income and high-income countries (MICs and HICs, respectively). METHODS We conducted an international survey from January to March 2022 regarding management strategies in acute BAO, to examine clinical and imaging parameters influencing clinician management of patients with BAO. We compared responses between physicians from HIC and MIC. RESULTS Among the 1245 respondents from 73 countries, 799 (64.2%) were from HIC, with the remaining 393 (31.6%) from MIC. Most respondents perceived that EVT was superior to medical management for acute BAO, but more so in respondents from HIC (98.0% vs. 94.2%, p < 0.01). MIC respondents were more likely to believe further RCTs were warranted (91.6% vs. 74.0%, p < 0.01) and were more likely to find it acceptable to enroll any patient who met a trial's criteria in the standard medical treatment arm (58.8% vs. 38.5%, p < 0.01). CONCLUSIONS In an area where clinical equipoise was called into question despite the lack of RCT evidence, we found that respondents from MIC were more likely to express willingness to enroll patients with BAO in an RCT than their HIC counterparts.
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Affiliation(s)
- Brian Drumm
- Department of Stroke Medicine, 8946Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
- Department of Stroke Medicine, Chelsea and Westminster NHS Trust, London, UK
| | - Ana Herning
- Department of Neurology, 1836Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
| | - Piers Klein
- Department of Radiology, 1836Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jean Raymond
- Department of Radiology, Interventional Neuroradiology Division, 25443Centre Hospitalier de l'Universite de Montreal, Montreal, Canada
| | - Mohamad Abdalkader
- Department of Radiology, 1836Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Xiaochuan Huo
- Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Beijing, China
| | - Yimin Chen
- Department of Neurology, Foshan Sanshui District People's Hospital, Foshan, China
| | - James E Siegler
- Department of Neurology, Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA
- Department of Neurology, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Meabh Peacock
- Department of Stroke Medicine, 8946Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | | | - Xinfeng Liu
- Department of Neurology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Wei Hu
- Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xunming Ji
- Department of Neurosurgery, 71044Xuanwu Hospital, Beijing, China
| | - Chuanhui Li
- Department of Neurology, 71044Xuanwu Hospital, Beijing, China
| | - Fana Alemseged
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Liping Liu
- Department of Neurology, 105738Beijing Tiantan Hospital, Beijing, China
| | - Simon Nagel
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
- Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Daniel Strbian
- Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Beijing, China
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | | | - Shadi Yaghi
- Department of Neurology, 23325Rhode Island Hospital, 6752Brown University, Providence, RI, USA
| | - Muhammad M Qureshi
- Department of Radiology, 1836Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Urs Fischer
- Department of Neurology, Bern University Hospital, 27210University of Bern, Bern, Switzerland
- Department of Neurology, Basel University Hospital, 27209University of Basel, Bern, Switzerland
| | - Georgios Tsivgoulis
- Second Department of Neurology "Attikon" University Hospital, 68993National and Kapodistrian University of Athens, Athens, Greece
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, Bern, Switzerland
| | - Hiroshi Yamagami
- Department of Stroke Neurology, 13707National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Volker Puetz
- Department of Neurology, 39063University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Dresden Neurovascular Center, 39063University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - P N Sylaja
- 29354Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - João Pedro Marto
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Espen Saxhaug Kristoffersen
- Department of Neurology, 60483Akershus University Hospital, Lørenskog, Norway
- Department of General Practice, University of Oslo, Oslo, Norway
| | - Jelle Demeestere
- Neurology Department, Leuven University Hospital, Leuven, Belgium
| | | | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel P O Kaiser
- Dresden Neurovascular Center, 39063University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Institute for Neuroradiology, 39063University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Tilman Reiff
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Kubilay Aydin
- Interventional Neuroradiology, Koc University Hospital, 37516Istanbul University, Istanbul, Turkey
| | - Michele Romoli
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy
| | - Francesco Diana
- Neuroradiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Kyriakos Lobotesis
- Department of Stroke Medicine, 8946Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Dylan Roi
- Department of Stroke Medicine, 8946Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Hesham E Masoud
- Department of Neurology, 12302SUNY Upstate Medical University, Syracuse, NY, USA
| | - Alice Ma
- 60086Royal North Shore Hospital, Sydney, Australia
| | | | - Mohamed F Doheim
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yuyou Zhu
- Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Hongfei Sang
- Department of Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dapeng Sun
- Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Beijing, China
| | - Mai Duy Ton
- Stroke Center, 434407Bach Mai Hospital, Hanoi Medical University, Hanoi, Vietnam
- Vietnam National University-University of Medicine and Pharmacy, Hanoi, Vietnam
| | - Raynald
- Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Beijing, China
| | - Fengli Li
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | | | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Qingwu Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Jin Soo Lee
- Department of Neurology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Götz Thomalla
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurologie, Hamburg, Germany
| | - Pengfei Yang
- Neurovascular Center, Changhai Hospital, Naval Medical University, China
| | - Jianmin Liu
- Neurovascular Center, Changhai Hospital, Naval Medical University, China
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Hui-Sheng Chen
- Department of Neurology, 74643General Hospital of Northern Theatre Command, Shenyang, China
| | - Osama O Zaidat
- Neuroscience and Stroke Program, Bon Secours Mercy Health St Vincent Hospital, Toledo, OH, USA
| | - Zhongming Qiu
- Department of Neurology, The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China
| | - Raul G Nogueira
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Zhongrong Miao
- Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Beijing, China
| | - Thanh N Nguyen
- Department of Radiology, 1836Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, 1836Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
| | - Soma Banerjee
- Department of Stroke Medicine, 8946Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
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Aydin K, Berdikhojayev M, Cay F, Barburoglu M, Nurzhan S, Aygun S, Sencer S, Arat A. Safety, Efficacy, and Durability of Stent-Assisted Coiling Treatment of M2 (Insular) Segment MCA Aneurysms. AJNR Am J Neuroradiol 2022; 43:560-567. [PMID: 35301223 PMCID: PMC8993191 DOI: 10.3174/ajnr.a7461] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/17/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Most distal MCA aneurysms are located within the insular segment, which lies between the limen insulae and circular sulcus. However, experience is limited in the microsurgical and endovascular management of insular segment MCA aneurysms. In this multicenter retrospective case series, we aimed to investigate the safety, efficacy, and durability of stent-assisted coiling for treatment of insular segment MCA aneurysms. MATERIALS AND METHODS A retrospective review was performed to identify patients with insular MCA aneurysms that were treated with stent-assisted coiling. The technical success of the procedures and the initial and follow-up clinical and angiographic outcomes were assessed. Periprocedural and delayed complications were reviewed. RESULTS Twenty-seven aneurysms in 27 patients with a mean age of 53.3 (SD,11.3) years were included. The mean size of the aneurysms was 6.3 (SD 2.6) mm. Endovascular procedures were successfully performed in all patients. Immediate postprocedural angiography revealed complete aneurysm occlusions in 81.5%. Periprocedural complications developed in 7.4% without causing permanent morbidity. A delayed thromboembolic complication resulted in a minor permanent morbidity in 1 patient (3.7%). There was no mortality. The mean duration of angiographic follow-up was 19.5 (SD, 9.8) months. The last follow-up examinations showed complete occlusion in 92.6%. During the follow-up period, none of the treated aneurysms showed recanalization. CONCLUSIONS The results of this study demonstrate that stent-assisted coiling with a low-profile self-expandable stent is a feasible and relatively safe technique for endovascular treatment of insular segment complex MCA aneurysms. Additionally, it provides an effective and durable treatment for insular MCA aneurysms.
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Affiliation(s)
- K Aydin
- From the Department of Interventional Neuroradiology (K.A., S.A.), Koç University Hospital, Topkapi, Istanbul, Turkey
- Department of Neuroradiology (K.A., M. Barburoglu, S.S.), Istanbul Faculty of Medicine, Capa, Istanbul University, Istanbul, Turkey
| | - M Berdikhojayev
- Department of Neurosurgery (M. Berdikhojayev, S.N.), JSC Central Hospital, Almaty City, Kazakhstan
| | - F Cay
- Department of Radiology (F.C., A.A.), Hacettepe University Medical School, Hacettepe Hospitals, Sihhiye, Ankara, Turkey
| | - M Barburoglu
- Department of Neuroradiology (K.A., M. Barburoglu, S.S.), Istanbul Faculty of Medicine, Capa, Istanbul University, Istanbul, Turkey
| | - S Nurzhan
- Department of Neurosurgery (M. Berdikhojayev, S.N.), JSC Central Hospital, Almaty City, Kazakhstan
| | - S Aygun
- From the Department of Interventional Neuroradiology (K.A., S.A.), Koç University Hospital, Topkapi, Istanbul, Turkey
| | - S Sencer
- Department of Neuroradiology (K.A., M. Barburoglu, S.S.), Istanbul Faculty of Medicine, Capa, Istanbul University, Istanbul, Turkey
| | - A Arat
- Department of Radiology (F.C., A.A.), Hacettepe University Medical School, Hacettepe Hospitals, Sihhiye, Ankara, Turkey
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Ucar HK, Arhan E, Aydin K, Hirfanoglu T, Serdaroglu A. Comparison of 2017 ILAE and Semiological seizure classifications before and after video-EEG monitoring in childhood epilepsy. Eur Rev Med Pharmacol Sci 2022; 26:2343-2352. [PMID: 35442488 DOI: 10.26355/eurrev_202204_28463] [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: 06/14/2023]
Abstract
OBJECTIVE Our aim in this study is to evaluate epilepsy classification in children with epilepsy before monitoring (based on information received from the family) and after monitoring (based on video-EEG) by comparing two separate classification systems, namely the 2017 International League Against Epilepsy (ILAE) and Semiological Seizure Classification (SSC) systems. Classifications and methods were compared in terms of simplicity, intelligibility, and applicability during daily outpatient care. PATIENTS AND METHODS The study was performed with 230 recorded seizures of 173 patients aged between 1 and 18 years who underwent video-EEG monitoring and clinical seizure recordings. Seizure types and video-EEG data of the patients were recorded. Seizures were first classified based on information obtained from the parents of the patients in interviews, recorded as "before video-EEG monitoring classification," and a second characterization, based on video EEG-monitoring, was subsequently recorded as "after video-EEG monitoring classification". The consistency of both seizure classifications was evaluated. RESULTS For both classifications, autonomic seizures were the least congruent seizures (κ=0.27, κ=-0.005). The families generally described the seizures very well; the consistency before and after video-EEG monitoring was good. Focal seizures with impaired awareness were most common in the 2017 ILAE classification (κ=0.6), while for the SSC simple motor seizures were most common (κ=0.84). Among subtypes, clonic-tonic seizures were the most common, and the second most common subtype was dialeptic (κ=0.67). Overall, the harmony between the SSC and ILAE systems was good. The rate of good and excellent coefficients of concordance for both the SSC and 2017 ILAE was determined as 77.8% for the expanded SSC, 48% for the 2017 ILAE, 71.4% for the basic SSC, and 60% for the 2017 ILAE. CONCLUSIONS In practice, it is difficult to determine seizure patterns reliably in cases of childhood epilepsy. Parents, however, can generally describe seizures very well. Although the SSC seems to be superior, both the SSC and 2017 ILAE systems can be applied in daily use. Such classification enables the rise of new concepts and a better understanding of disease groups. The continuing development of classification systems will lead to advancements for patients.
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Affiliation(s)
- H K Ucar
- Department of Pediatric Neurology, Gazi University, Faculty of Medicine, Besevler, Ankara, Turkey.
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Barburoglu M, Aydin K, Onal Y, Cengiz D, Velioglu M. Feasibility and Results of the Stentectomy Procedure Performed as Rescue Treatment for Acute Thrombosis of Self-Expandable Intracranial Stents: A Case Series. Oper Neurosurg (Hagerstown) 2022; 22:277-283. [DOI: 10.1227/ons.0000000000000143] [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] [Received: 07/21/2021] [Accepted: 11/28/2021] [Indexed: 11/19/2022] Open
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Ucar HK, Arhan E, Aydin K, Hirfanoglu T, Serdaroglu A. Electrical status epilepticus during sleep (ESES) in benign childhood epilepsy with Centrotemporal spikes (BCECTS): insights into predictive factors, and clinical and EEG outcomes. Eur Rev Med Pharmacol Sci 2022; 26:1885-1896. [PMID: 35363337 DOI: 10.26355/eurrev_202203_28334] [Citation(s) in RCA: 2] [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 Benign childhood epilepsy with centro-temporal spikes (BCECTS), otherwise known as benign rolandic epilepsy, is the most common focal epilepsy in childhood. This study aimed to evaluate the development and resolution of ESES in children with BCECTS and evaluate the clinical and electroencephalography (EEG) parameters associated with prognosis. PATIENTS AND METHODS Resolution of ESES was defined as the reduction of the spike-wave index (SWI) to <50%. The SWI short method, measurements from the first 180 s of non-rapid eye movement; and the conventional method, measurements from total NREM stage 2, SW count during the first 60 and 180 s of NREM, SW localization, and ESES type were determined. RESULTS Of a total of 126 BCECTS patients, 33, including 13 females, 20 males, who developed ESES during follow-up, were included in the study. ESES remission was observed in 42.4% (n = 14) of the patients. The median time to remission was 10.5 months. The rate of resolution was 87.9 % for the entire population. The mean age at resolution was 9.8 ± 2.05 years and the mean time to resolution was 8.8 months. CONCLUSIONS The data demonstrated that age at ESES diagnosis, the time between BCECTS diagnosis and the onset of ESES, time to resolution of ESES, ESES remission, and seizure freedom after ESES were significantly associated with prognosis. The early recognition of ESES evolution in children with BECTS, the better understanding of the relationship between age at ESES diagnosis and remission and prognosis, and timely intervention can prevent long-term sequelae.
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Affiliation(s)
- H K Ucar
- Department of Pediatric Neurology, Adana City Training and Research Hospital, Adana, Turkey.
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Aydin K, Stracke P, Berdikhojayev M, Barburoglu M, Mosimann PJ, Suleimankulov N, Sarshayev M, Sencer S, Chapot R. Safety, Efficacy, and Durability of Stent Plus Balloon-Assisted Coiling for the Treatment of Wide-Necked Intracranial Bifurcation Aneurysms. Neurosurgery 2021. [DOI: 10.1093/neuros/nyaa590_s127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Aydin K, Stracke P, Berdikhojayev M, Barburoglu M, Mosimann P, Suleimankulov N, Sarshayev M, Sencer S, Chapot R. In Reply: Safety, Efficacy, and Durability of Stent Plus Balloon-Assisted Coiling for the Treatment of Wide-Necked Intracranial Bifurcation Aneurysms. Neurosurgery 2021; 89:E274-E276. [PMID: 34409998 DOI: 10.1093/neuros/nyab323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Kubilay Aydin
- Department of Neuroradiology Istanbul Medical Faculty Istanbul University, Istanbul, Turkey.,Department of Interventional Radiology Koc University Hospital, Istanbul, Turkey
| | - Paul Stracke
- Department of Neuroradiology and Intracranial Endovascular Therapy Alfried Krupp Krankenhaus, Essen, Germany
| | | | - Mehmet Barburoglu
- Department of Neuroradiology Istanbul Medical Faculty Istanbul University, Istanbul, Turkey
| | - Pascal Mosimann
- Department of Neuroradiology and Intracranial Endovascular Therapy Alfried Krupp Krankenhaus, Essen, Germany
| | | | - Marat Sarshayev
- Department of Neurosurgery JSC Central Clinical Hospital, Almaty City, Kazakhstan
| | - Serra Sencer
- Department of Neuroradiology Istanbul Medical Faculty Istanbul University, Istanbul, Turkey
| | - Rene Chapot
- Department of Neuroradiology and Intracranial Endovascular Therapy Alfried Krupp Krankenhaus, Essen, Germany
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Aydin K, Stracke P, Berdikhojayev M, Barburoglu M, Mosimann PJ, Suleimankulov N, Sarshayev M, Sencer S, Chapot R. Safety, Efficacy, and Durability of Stent Plus Balloon-Assisted Coiling for the Treatment of Wide-Necked Intracranial Bifurcation Aneurysms. Neurosurgery 2021; 88:1028-1037. [PMID: 33575798 DOI: 10.1093/neuros/nyaa590] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 07/28/2020] [Accepted: 11/15/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Wide-necked bifurcation aneurysms remain a challenge for endovascular surgeons. Dual-stent-assisted coiling techniques have been defined to treat bifurcation aneurysms with a complex neck morphology. However, there are still concerns about the safety of dual-stenting procedures. Stent plus balloon-assisted coiling is a recently described endovascular technique that enables the coiling of wide-necked complex bifurcation aneurysms by implanting only a single stent. OBJECTIVE To investigate the feasibility, efficacy, safety, and durability of this technique for the treatment of wide-necked bifurcation aneurysms. METHODS A retrospective review was performed of patients with wide-necked intracranial bifurcation aneurysms treated with stent plus balloon-assisted coiling. The initial and follow-up clinical and angiographic outcomes were assessed. Preprocedural and follow-up clinical statuses were assessed using modified Rankin scale. RESULTS A total of 61 patients (mean age: 54.6 ± 10.4 yr) were included in the study. The immediate postprocedural digital subtraction angiography revealed complete aneurysm occlusion in 86.9% of the cases. A periprocedural complication developed in 11.5% of the cases. We observed a delayed ischemic complication in 4.9%. There was no mortality in this study. The permanent morbidity rate was 3.3%. The follow-up angiography was performed in 55 of 61 patients (90.1%) (the mean follow-up period was 25.5 ± 27.3 mo). The rate of complete aneurysm occlusion at the final angiographic follow-up was 89.1%. The retreatment rate was 1.8%. CONCLUSION The results of this study showed that stent plus balloon-assisted coiling is a feasible, effective, and relatively safe endovascular technique for the treatment of wide-necked bifurcation aneurysms located in the posterior and anterior circulation.
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Affiliation(s)
- Kubilay Aydin
- Department of Neuroradiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.,Department of Interventional Radiology, Koc University Hospital, Istanbul, Turkey
| | - Paul Stracke
- Department of Neuroradiology and Intracranial Endovascular Therapy, Alfried Krupp Krankenhaus, Essen, Germany
| | | | - Mehmet Barburoglu
- Department of Neuroradiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Pascal J Mosimann
- Department of Neuroradiology and Intracranial Endovascular Therapy, Alfried Krupp Krankenhaus, Essen, Germany
| | | | - Marat Sarshayev
- Department of Neurosurgery, JSC Central Clinical Hospital, Almaty City, Kazakhstan
| | - Serra Sencer
- Department of Neuroradiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Rene Chapot
- Department of Neuroradiology and Intracranial Endovascular Therapy, Alfried Krupp Krankenhaus, Essen, Germany
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Akgul E, Onan HB, Islek I, Tonge M, Durmus Y, Barburoglu M, Azizova A, Erol C, Hakyemez B, Sencer S, Aydin K, Arat A. Flow diverter stents in the treatment of recanalized intracranial aneurysms. Interv Neuroradiol 2021; 27:481-489. [PMID: 33509011 DOI: 10.1177/1591019921990507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We assessed the safety and efficacy of flow diverter stents (FDSs) in the treatment of recanalized or residual intracranial aneurysms treated endovascularly. MATERIALS & METHODS Patients whose recanalized or residual aneurysms were treated with FDSs in five tertiary hospitals were reviewed retrospectively. The patients' demographic data, aneurysm characteristics, types of previous treatment, and clinical complications, or serious adverse events associated with FDSs, as well as the results of neurological and angiographic follow-up assessments, were recorded. RESULTS Eighty-six patients (37 males) with 87 aneurysms were included in this study. Eighty (91.9%) aneurysms were in the anterior and seven (8.1%) in the posterior circulation. The initial treatment methods were the primary coiling or balloon remodeling technique in 69 (79.3%) and stent-assisted coiling in 18 (20.7%) aneurysms. The endovascular procedure was successful in all patients. Complications occurred in four patients, for a total complication rate of 4.6%. A technical complication developed in one patient (1.2%). An in-stent thrombosis treated with tirofiban was seen in two cases. Late in-stent stenosis exceeding 50% was treated with balloon angioplasty in one patient. The mean length of follow-up was 21.0 months. The first angiographic follow-up (3-6 months) revealed the complete occlusion of 74 aneurysms (85.1%). While 76 aneurysms (87.4%) were occluded at the last angiographic follow-up (mean: 26.0 months), 11 aneurysms (12.6%) were still filling. Morbimortality was zero. CONCLUSION The drawback of endovascular treatment is aneurysmal remnants or recurrences, which is safely and durably amenable to flow diversion.
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Affiliation(s)
- Erol Akgul
- Interventional Neuroradiology Section, Radiology Department, International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Hasan Bilen Onan
- Radiology Department, School of Medicine, Cukurova University, Adana, Turkey
| | - Irem Islek
- Radiology Department, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Mehmet Tonge
- Neurosurgery Department, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Yavuz Durmus
- Radiology Department, Bursa Yuksek Ihtisas Education and Research Hospital, Bursa, Turkey
| | - Mehmet Barburoglu
- Department of Neuroradiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aynur Azizova
- Radiology Department, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Cengiz Erol
- Radiology Department, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Bahattin Hakyemez
- Radiology Department, School of Medicine, Uludag University, Bursa, Turkey
| | - Serra Sencer
- Department of Neuroradiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Kubilay Aydin
- Department of Neuroradiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.,Department of Interventional Neuroradiology, Faculty of Medicine, Koc University, Istanbul, Turkey
| | - Anil Arat
- Radiology Department, School of Medicine, Hacettepe University, Ankara, Turkey
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12
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Doganci S, Ince ME, Ors N, Yildirim AK, Sir E, Karabacak K, Eksert S, Ozgurtas T, Tasci C, Dogan D, Ozkan G, Cosar A, Gulcelik MA, Aydin K, Yildirim V, Erdol C. A new COVID-19 prediction scoring model for in-hospital mortality: experiences from Turkey, single center retrospective cohort analysis. Eur Rev Med Pharmacol Sci 2020; 24:10247-10257. [PMID: 33090436 DOI: 10.26355/eurrev_202010_23249] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Although many studies reported prognostic factors proceeding to severity of COVID-19 patients, in none of the article a prediction scoring model has been proposed. In this article a new prediction tool is presented in combination of Turkish experience during pandemic. MATERIALS AND METHODS Laboratory and clinical data of 397 over 798 confirmed COVID-19 patients from Gülhane Training and Research Hospital electronic medical record system were included into this retrospective cohort study between the dates of 23 March to 18 May 2020. Patient demographics, peripheral venous blood parameters, symptoms at admission, in hospital mortality data were collected. Non-survivor and survivor patients were compared to find out a prediction scoring model for mortality. RESULTS There was 34 [8.56% (95% CI:0.06-0.11)] mortality during study period. Mean age of patients was 57.1±16.7 years. Older age, comorbid diseases, symptoms, such as fever, dyspnea, fatigue and gastrointestinal and WBC, neutrophil, lymphocyte count, C-reactive protein, neutrophil-to-lymphocyte ratio of patients in non-survivors were significantly higher. Univariate analysis demonstrated that OR for prognostic nutritional index (PNI) tertile 1 was 18.57 (95% CI: 4.39-78.65, p<0.05) compared to tertile 2. Performance statistics of prediction scoring method showed 98% positive predictive value for criteria 1. CONCLUSIONS It is crucial to constitute prognostic clinical and laboratory parameters for faster delineation of patients who are prone to worse prognosis. Suggested prediction scoring method may guide healthcare professional to discriminate severe COVID-19 patients and provide prompt intensive therapies which is highly important due to rapid progression leading to mortality.
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Affiliation(s)
- S Doganci
- Department of Cardiovascular Surgery, Gülhane School of Medicine, Health Sciences University, Ankara, Turkey.
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13
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Holsman KK, Haynie AC, Hollowed AB, Reum JCP, Aydin K, Hermann AJ, Cheng W, Faig A, Ianelli JN, Kearney KA, Punt AE. Ecosystem-based fisheries management forestalls climate-driven collapse. Nat Commun 2020; 11:4579. [PMID: 32917860 PMCID: PMC7486947 DOI: 10.1038/s41467-020-18300-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 08/10/2020] [Indexed: 11/25/2022] Open
Abstract
Climate change is impacting fisheries worldwide with uncertain outcomes for food and nutritional security. Using management strategy evaluations for key US fisheries in the eastern Bering Sea we find that Ecosystem Based Fisheries Management (EBFM) measures forestall future declines under climate change over non-EBFM approaches. Yet, benefits are species-specific and decrease markedly after 2050. Under high-baseline carbon emission scenarios (RCP 8.5), end-of-century (2075–2100) pollock and Pacific cod fisheries collapse in >70% and >35% of all simulations, respectively. Our analysis suggests that 2.1–2.3 °C (modeled summer bottom temperature) is a tipping point of rapid decline in gadid biomass and catch. Multiyear stanzas above 2.1 °C become commonplace in projections from ~2030 onward, with higher agreement under RCP 8.5 than simulations with moderate carbon mitigation (i.e., RCP 4.5). We find that EBFM ameliorates climate change impacts on fisheries in the near-term, but long-term EBFM benefits are limited by the magnitude of anticipated change. Ecosystem Based Management measures developed to prevent overfishing could be particularly important under climate change. Here the authors combine climate and fish stock modelling to show that EBM cap implementation reduces climate-driven fishery declines under RCP 4.5 and 8.5 before midcentury. However, there are thermal tipping points beyond which potential collapses are predicted.
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Affiliation(s)
- K K Holsman
- National Oceanic and Atmospheric Administration, Alaska Fisheries Science Center, 7600 Sand Point Way N.E., Seattle, WA, 98115, USA. .,School of Aquatic and Fishery Sciences, University of Washington, Seattle, WA, 98195, USA.
| | - A C Haynie
- National Oceanic and Atmospheric Administration, Alaska Fisheries Science Center, 7600 Sand Point Way N.E., Seattle, WA, 98115, USA
| | - A B Hollowed
- National Oceanic and Atmospheric Administration, Alaska Fisheries Science Center, 7600 Sand Point Way N.E., Seattle, WA, 98115, USA.,School of Aquatic and Fishery Sciences, University of Washington, Seattle, WA, 98195, USA
| | - J C P Reum
- National Oceanic and Atmospheric Administration, Alaska Fisheries Science Center, 7600 Sand Point Way N.E., Seattle, WA, 98115, USA.,School of Aquatic and Fishery Sciences, University of Washington, Seattle, WA, 98195, USA.,Institute for Marine and Antarctic Studies and Centre for Marine Socioecology, University of Tasmania, Hobart, TAS 7001, Australia
| | - K Aydin
- National Oceanic and Atmospheric Administration, Alaska Fisheries Science Center, 7600 Sand Point Way N.E., Seattle, WA, 98115, USA.,School of Aquatic and Fishery Sciences, University of Washington, Seattle, WA, 98195, USA
| | - A J Hermann
- Joint Institute for the Study of the Atmosphere and Ocean, now Cooperative Institute for Climate, Ocean, and Ecosystem Studies, University of Washington, Seattle, WA, 98195, USA.,Ocean Environment Research Division, NOAA/Pacific Marine Environmental Laboratory, Seattle, WA, 98115, USA
| | - W Cheng
- Joint Institute for the Study of the Atmosphere and Ocean, now Cooperative Institute for Climate, Ocean, and Ecosystem Studies, University of Washington, Seattle, WA, 98195, USA.,Ocean Environment Research Division, NOAA/Pacific Marine Environmental Laboratory, Seattle, WA, 98115, USA
| | - A Faig
- School of Aquatic and Fishery Sciences, University of Washington, Seattle, WA, 98195, USA
| | - J N Ianelli
- National Oceanic and Atmospheric Administration, Alaska Fisheries Science Center, 7600 Sand Point Way N.E., Seattle, WA, 98115, USA.,School of Aquatic and Fishery Sciences, University of Washington, Seattle, WA, 98195, USA
| | - K A Kearney
- National Oceanic and Atmospheric Administration, Alaska Fisheries Science Center, 7600 Sand Point Way N.E., Seattle, WA, 98115, USA.,Joint Institute for the Study of the Atmosphere and Ocean, now Cooperative Institute for Climate, Ocean, and Ecosystem Studies, University of Washington, Seattle, WA, 98195, USA
| | - A E Punt
- School of Aquatic and Fishery Sciences, University of Washington, Seattle, WA, 98195, USA
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14
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Aydin K, Balci S, Sencer S, Barburoglu M, Umutlu MR, Arat A. Y-Stent-Assisted Coiling With Low-Profile Neuroform Atlas Stents for Endovascular Treatment of Wide-Necked Complex Intracranial Bifurcation Aneurysms. Neurosurgery 2019; 87:744-753. [DOI: 10.1093/neuros/nyz516] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 09/20/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Y-stent-assisted coiling is one of the eligible techniques for the treatment of complex bifurcation aneurysms. In majority of previous literature, Y-stenting has been performed using stents that could be delivered through large profile microcatheters that are often difficult to manipulate during navigation through sharply angled side branches. Attempts to navigate with these large profile catheters might cause serious complications during Y-stenting procedure.
OBJECTIVE
To investigate the safety, feasibility, and efficacy of Y-stent-assisted coiling procedure with Neuroform Atlas stents for the treatment of complex bifurcation aneurysms; Neuroform Atlas is a recently introduced open-cell stent that can be delivered though low-profile microcatheters.
METHODS
We identified the patients with intracranial bifurcation aneurysms treated by Y-stent-assisted coiling procedure with Neuroform Atlas stents. We assessed the immediate postoperative and follow-up clinical and angiographic outcomes. We also investigated the periprocedural and delayed complications.
RESULTS
A total of 30 aneurysms in 30 patients were included in the study. Y-stenting was successfully performed without any technical complications in all cases (100%). Immediate postprocedural angiography revealed total aneurysm occlusion in 83.3% of patients. The mean angiographic follow-up time was 11.8 mo. The last follow-ups showed complete occlusion in 93.3% of patients. There was no mortality in this study. A procedure-related complication developed in 6.7% and resulted in permanent morbidity in 3.3% of patients.
CONCLUSION
Neuroform Atlas stent combines the advantages of low-profile deployment microcatheters with an open-cell structure to achieve a successful Y-stenting procedure. Y-stent-assisted coiling with Neuroform Atlas stents provides a safe and effective endovascular treatment for wide-necked complex bifurcation aneurysms.
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Affiliation(s)
- Kubilay Aydin
- Neuroradiology Division, Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Department of Interventional Radiology, Koc University Hospital, Istanbul, Turkey
| | - Sinan Balci
- Department of Radiology, Hacettepe University Hospital, Ankara, Turkey
| | - Serra Sencer
- Neuroradiology Division, Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Barburoglu
- Neuroradiology Division, Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Muzaffer Reha Umutlu
- Neuroradiology Division, Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Anil Arat
- Department of Radiology, Hacettepe University Hospital, Ankara, Turkey
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15
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Aydin K, Stracke CP, Barburoglu M, Yamac E, Berdikhojayev M, Sencer S, Chapot R. Long-term outcomes of wide-necked intracranial bifurcation aneurysms treated with T-stent-assisted coiling. J Neurosurg 2019; 134:39-48. [PMID: 31812140 DOI: 10.3171/2019.9.jns191733] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 07/20/2019] [Accepted: 09/24/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The endovascular treatment of complex bifurcation aneurysms possessing a neck that incorporates multiple side branches remains a surgical challenge. Double-stent-assisted coiling techniques, such as those with stents in an X and Y configuration, enable the endovascular treatment of wide-necked complex intracranial bifurcation aneurysms. However, the intraluminal struts at the intersection point in X- and Y-stents are not amenable to endothelialization, which may lead to thromboembolic complications. Stenting in the T configuration is a relatively new double-stent coiling technique. T-stenting differs from X- or Y-stenting in that there are no overlapping or intersecting stent segments. Promising short-term results of T-stent-assisted coiling were recently reported. However, the long-term results have not yet been demonstrated. This retrospective study investigated the long-term angiographic and clinical results in patients with wide-necked complex intracranial bifurcation aneurysms treated with T-stent-assisted coiling. METHODS A retrospective review was performed to identify patients with wide-necked complex intracranial bifurcation aneurysms treated with T-stent-assisted coiling at 4 institutions. The technical success and the initial and follow-up clinical and angiographic outcomes were assessed. Aneurysm filling status was assessed according to the Raymond classification. Periprocedural and delayed complications were reviewed. The neurological status of the patients was evaluated using the modified Rankin Scale (mRS). RESULTS One hundred two aneurysms in 102 patients (54 females), whose mean age was 57.9 ± 13.0 years, were included in the study. T-stenting was performed successfully in all patients. Immediate postprocedural angiography revealed complete occlusion in 83.3% of patients. Periprocedural complications developed in 13.7%, resulting in permanent morbidity in 1.9% and death in 1%. Eighty patients (78.4%) had at least one follow-up DSA examination performed at 6 months or later following the endovascular procedure. The mean duration of angiographic follow-up was 30.0 ± 16.3 months. The last follow-up examinations showed complete occlusion in 90.0% of patients. During the follow-up period, only 1 patient (1.3%) required retreatment. Delayed thromboembolic complications were observed in 4 patients (3.9%) without permanent morbidity. The mRS scores of all patients at the last clinical follow-up were between 0 and 2. CONCLUSIONS The short-term angiographic findings showed that T-stent-assisted coiling is a feasible and effective endovascular method to treat wide-necked complex bifurcation aneurysms. The long-term angiographic follow-up results suggest that T-stent-assisted coiling provides a durable treatment for wide-necked complex bifurcation aneurysms with favorable clinical outcomes, demonstrating the long-term safety of T-stent-assisted coiling.
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Affiliation(s)
- Kubilay Aydin
- 1Department of Neuroradiology, Istanbul University, Istanbul Medical Faculty, Capa
- 2Department of Interventional Radiology, Koç University Hospital, Istanbul, Turkey
| | - Christian Paul Stracke
- 3Department of Neuroradiology and Intracranial Endovascular Therapy, Alfried Krupp Krankenhaus, Essen, Germany; and
| | - Mehmet Barburoglu
- 1Department of Neuroradiology, Istanbul University, Istanbul Medical Faculty, Capa
| | - Elif Yamac
- 3Department of Neuroradiology and Intracranial Endovascular Therapy, Alfried Krupp Krankenhaus, Essen, Germany; and
| | | | - Serra Sencer
- 1Department of Neuroradiology, Istanbul University, Istanbul Medical Faculty, Capa
| | - René Chapot
- 3Department of Neuroradiology and Intracranial Endovascular Therapy, Alfried Krupp Krankenhaus, Essen, Germany; and
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16
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Kilickap S, Demirci U, Bugdayci F, Tural D, Korkmaz T, Paydas S, Yilmaz C, Turna H, Sezer A, Cinkir HY, Okutur K, Erman M, Eralp Y, Cabuk D, Isikdogan A, Demirkazik A, Karaoglu A, Yazilitas D, Senler FC, Yumuk P, Coskun H, Yildiz I, Oztop I, Beypinar I, Aydin K, Kaplan M, Meydan N, Olmez O, Ozyilkan O, Seber S, Arslan C, Sendur M, Cicin I. P1.14-15 Lorlatinib in ALK- or ROS1-Positive Non-Small Cell Lung Cancer Patients: Experience from an Early Access Program in Turkey. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Akbal N, Aydin K, Tezcan ME. Metabolic syndrome is not uncommon in treatment-naïve rheumatoid arthritis patients. Neth J Med 2019; 77:204-209. [PMID: 31391326] [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: 06/10/2023]
Abstract
OBJECTIVES Rheumatoid arthritis (RA) is an independent risk factor for cardiovascular disease (CVD). Glucocorticoids are often used in the management of RA and might also contribute to the increased risk of metabolic syndrome (metS). Identifying metabolic alterations earlier and treating them together with disease-modifying therapy may be associated with better outcomes. Here, we aimed to investigate the frequency of metS and its components in treatment-naïve RA patients. METHODS Fifty-three newly diagnosed treatment-naïve RA patients and 55 control subjects were enrolled. MetS was diagnosed using Adult Treatment Panel III report-defined criteria. We evaluated the metS-related metabolic and anthropometric alterations between the groups. RA patients were subdivided and those with and without metS were also compared with respect to disease-related parameters. RESULTS MetS was more common in treatment-naïve newly diagnosed RA patients compared to controls (25 of 53 (47.1%) vs 9 of 55 (16.4%), respectively (p = 0.001; OR, 4.56; 95% CI 1.86-11.16). All evaluated anthropometric and metabolic parameters were similar in both groups. However, there was a trend to lower LDL and HDL cholesterol levels in RA patients. Furthermore, among those with metS, the number of fulfilled metS criteria items were higher in RA patients, compared to controls (p < 0.001). Interestingly, more RA patients fulfilled metS criteria with a glucose measurements item compared to controls (p < 0.001). CONCLUSION MetS was more common in newly diagnosed and treatment-naïve RA patients compared to controls. MetS, along with tendency to present paradoxical and atherogenic lipid profiles in RA patients, may be among the underlying mechanisms of increased CVD.
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Affiliation(s)
- N Akbal
- Departments of Family Medicine, University of Health Sciences, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
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18
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Ugurlucan M, Akay HT, Erdinc I, Oztas DM, Conkbayir C, Aslim E, Yildiz CE, Aydin K, Alpagut U. Anticoagulation strategy in patients with atrial fibrillation after carotid endarterectomy. Acta Chir Belg 2019; 119:209-216. [PMID: 30189792 DOI: 10.1080/00015458.2018.1497569] [Citation(s) in RCA: 5] [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] [Indexed: 10/28/2022]
Abstract
Aim: Carotid artery stenosis and atrial fibrillation are diseases of the aging patient population. Literature lacks precise anticoagulation treatment protocols for patients with atrial fibrillation following carotid endarterectomy. We present our experiences with anticoagulation strategy in this particular patient population. Patients and methods: Between June 2001-September 2017, 165 patients with chronic or paroxysmal atrial fibrillation out of 1594 cases from three different institutions whom received Coumadin and aspirin and required carotid endarterectomy were reviewed, respectively. Mean age was 63.4 ± 7.9 years. Male/female ratio was 102/63. There were 67 diabetic and 138 hypertensive cases. Results: Patients are followed a mean of 64.4 ± 16.9 months. Early mortality occurred in two patients due to intracranial bleeding and heart failure. Another patient was lost due to intracerebral hemorrhage and 16 other patients died due to various causes in the late follow-up. Three patients required exploration against bleeding. Conclusion: Combination of warfarin with an aim to keep the INR value between 2 and 3, and aspirin at a dosage of 100 mg per day seemed feasible and in our modest patient cohort. Further studies including multicenter larger data are warranted in order to establish a precise anticoagulation treatment protocol for patients with atrial fibrillation after carotid endarterectomy.
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Affiliation(s)
- Murat Ugurlucan
- Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Hakki Tankut Akay
- Department of Cardiovascular Surgery, Baskent University Medical Faculty, Ankara, Turkey
| | - Ibrahim Erdinc
- Cardiovascular Surgery Clinic, Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Didem Melis Oztas
- Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Cenk Conkbayir
- Department of Cardiology, Near East University Medical Faculty, Lefkosa, Cyprus
| | - Erdal Aslim
- Cardiovascular Surgery Clinic, Acibadem University Fulya Hospital, Istanbul, Turkey
| | - Cenk Eray Yildiz
- Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Kubilay Aydin
- Department of Radiology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Ufuk Alpagut
- Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
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19
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Aydin K, Men S, Barburoglu M, Sencer S, Akpek S. Initial and Long-Term Outcomes of Complex Bifurcation Aneurysms Treated by Y-Stent-Assisted Coiling with Low-Profile Braided Stents. AJNR Am J Neuroradiol 2018; 39:2284-2290. [PMID: 30409852 DOI: 10.3174/ajnr.a5869] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 09/18/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Coiling complex intracranial bifurcation aneurysms often necessitates the implantation of double stents in various configurations, such as Y-stent placement. Low-profile braided stents have been introduced recently to facilitate the endovascular treatment of wide-neck aneurysms. We aimed to investigate the feasibility, safety, efficacy, and durability of Y-stent-assisted coiling with double low-profile braided stents for the treatment of complex bifurcation aneurysms. MATERIALS AND METHODS A retrospective review was performed to identify patients who were treated using Y-stent-assisted coiling with low-profile braided stents. Technical success was assessed, as were initial and follow-up clinical and angiographic outcomes. Periprocedural and delayed complications were reviewed. Preprocedural and follow-up clinical statuses were assessed using the modified Rankin Scale. RESULTS Forty patients with 40 intracranial aneurysms were included in the study. Y-stent placement was successfully performed in all cases. Immediate postprocedural digital subtraction angiography images revealed total aneurysm occlusion in 72.5% of cases. The mean angiographic follow-up time was 24.8 months. The last follow-up angiograms showed complete occlusion in 85% of patients. During follow-up, only 1 patient showed an increase in the filling status of the aneurysm and that patient did not require retreatment. There was no mortality in this study. The overall procedure-related complication rate, including asymptomatic complications, was 17.5%. A permanent morbidity developed in 1 patient (2.5%). CONCLUSIONS The long-term angiographic and clinical outcomes of this retrospective study demonstrate that Y-stent-assisted coiling using low-profile braided stents is an effective, relatively safe, and durable endovascular treatment for wide-neck and complex bifurcation aneurysms.
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Affiliation(s)
- K Aydin
- From the Department of Radiology (K.A., S.S.), Neuroradiology Division, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Department of Radiology (K.A., M.B.), Koç University Medical School, Istanbul, Turkey
| | - S Men
- Department of Radiology (S.M.), Dokuz Eylul University, Izmir, Turkey
| | - M Barburoglu
- Department of Radiology (K.A., M.B.), Koç University Medical School, Istanbul, Turkey
| | - S Sencer
- From the Department of Radiology (K.A., S.S.), Neuroradiology Division, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - S Akpek
- Department of Radiology (S.A.), VKV American Hospital, Istanbul, Turkey
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Aydin K, Barburoglu M, Oztop Cakmak O, Yesilot N, Vanli ENY, Akpek S. Crossing Y-Solitaire thrombectomy as a rescue treatment for refractory acute occlusions of the middle cerebral artery. J Neurointerv Surg 2018; 11:246-250. [DOI: 10.1136/neurintsurg-2018-014288] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 12/13/2022]
Abstract
BackgroundMechanical thrombectomy using a stent retriever has become the standard of care for acute large-vessel occlusions in the anterior circulation. Clots that are refractory to single stent retriever thrombectomy remain a challenge for neurointerventionalists.ObjectiveTo assess the efficacy and safety of double stent retriever (crossing Y-Solitaire) thrombectomy as a rescue treatment for acute middle cerebral artery (MCA) occlusions that are refractory to single stent retriever thrombectomy.MethodsWe retrospectively reviewed the databases of our hospitals to identify patients who presented with an acute MCA occlusion and were treated with crossing Y-Solitaire thrombectomy. The angiographic (Thrombolysis in Cerebral Infarction (TICI) scale) and clinical outcomes (National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores) and complications were assessed.ResultsTen patients were included in the study. The median initial NIHSS score and Alberta Stroke Program Early CT Score (ASPECTS) were 19.0 and 9.6, respectively. Crossing Y-Solitaire thrombectomy was performed as a rescue technique after unsuccessful single Solitaire thrombectomy passes in all cases. Successful recanalization (TICI 2b/3) was achieved in 8 (80%) patients. We observed asymptomatic reperfusion hemorrhages in 2 (20%) patients. No procedural related complications were seen other than reversible vasospasms in 5 (50%) patients. Sixty percent of the patients had a mRS score of between 2 and 0 at 90 days after the procedure. There was no mortality.ConclusionCrossing Y-Solitaire thrombectomy seems to be an effective and safe alternative rescue technique to treat refractory MCA bifurcation occlusions that are refractory to standard thrombectomy procedures.
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Callewaert F, Velev V, Kumar P, Sahakian AV, Aydin K. Inverse-Designed Broadband All-Dielectric Electromagnetic Metadevices. Sci Rep 2018; 8:1358. [PMID: 29358737 PMCID: PMC5778146 DOI: 10.1038/s41598-018-19796-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/08/2018] [Indexed: 12/02/2022] Open
Abstract
This paper presents a platform combining an inverse electromagnetic design computational method with additive manufacturing to design and fabricate all-dielectric metadevices. As opposed to conventional flat metasurface-based devices that are composed of resonant building blocks resulting in narrow band operation, the proposed design approach creates non-resonant, broadband (Δλ/λ up to >50%) metadevices based on low-index dielectric materials. High-efficiency (transmission >60%), thin (≤2λ) metadevices capable of polarization splitting, beam bending, and focusing are proposed. Experimental demonstrations are performed at millimeter-wave frequencies using 3D-printed devices. The proposed platform can be readily applied to the design and fabrication of electromagnetic and photonic metadevices spanning microwave to optical frequencies.
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Affiliation(s)
- F Callewaert
- Department of Electrical Engineering and Computer Science, Northwestern University, Evanston, IL, 60208, USA
| | - V Velev
- Department of Physics and Astronomy, Northwestern University, Evanston, IL, 60208, USA
| | - P Kumar
- Department of Electrical Engineering and Computer Science, Northwestern University, Evanston, IL, 60208, USA
- Department of Physics and Astronomy, Northwestern University, Evanston, IL, 60208, USA
| | - A V Sahakian
- Department of Electrical Engineering and Computer Science, Northwestern University, Evanston, IL, 60208, USA
| | - K Aydin
- Department of Electrical Engineering and Computer Science, Northwestern University, Evanston, IL, 60208, USA.
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Abstract
OBJECTIVE To compare the diagnostic value of the SARC-F combined with calf circumference (SARC-CalF) with the standard SARC-F to screen sarcopenia in community-dwelling older adults. DESIGN Cross-sectional, diagnostic accuracy study. SETTING Geriatric outpatient clinic of a university hospital. PARTICIPANTS Older adults >= 65 years. MEASUREMENTS Muscle mass (bioimpedance analysis device), muscle strength (hand grip strength-Jamar hydraulic hand dynamometer), and physical performance (usual gait speed). Four currently used diagnostic criteria [European Working Group on Sarcopenia in Older People (EWGSOP), Foundation for the National Institutes of Health (FNIH), International Working Group on Sarcopenia (IWGS), and Society on Sarcopenia Cachexia and Wasting Disorders (SCWD) criteria] were applied. SARC-CalF was performed by using two different calf circumference threshold: standard cut-off 31 cm (SARC-CalF-31) and national cut-off 33 cm (SARC-CalF-33). The sensitivity/specificity analyses of the SARC-CalF and SARC-F tools were run. We used the receiver operating characteristics curves and the area under the receiver operating characteristics curves (AUC) to compare the diagnostic accuracy to identify sarcopenia. RESULTS We included 207 subjects; 67 male and 140 female with a mean age of 74.6±6.7 years. The prevalence of sarcopenia ranged from 1.9% to 9.2%. The sensitivity of SARC-F was between 25% (EWGSOP) and 50% (IWGS); specificity was about 82%. For SARC-CalF-31 and SARC-CalF-33 sensitivity was in general similar -between 25-50%- which pointed out that SARC-CalF was not superior to SARC-F for sensitivity in this sample. Corresponding specificities for SARC-CalF-31 and SARC-CalF-33 were higher than SARC-F and were between 90-98%. Additionally, the AUC values, which indicates the diagnostic accuracy of a screening test, were in general higher for SARC-CalF-33 than the SARC-F and SARC-CalF-31. CONCLUSIONS We reported that addition of calf circumference item to SARC-F tool improved the specificity and diagnostic accuracy of SARC-F but it did not improve the sensitivity in a community-dwelling Turkish older adult population sample that had low prevalence of sarcopenia. The performance of SARC-CalF tool to screen sarcopenia is to be studied in different populations and living settings.
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Affiliation(s)
- G Bahat
- Dr. Gülistan Bahat, MD, Istanbul University Istanbul Medical School Department of Internal Medicine Division of Geriatrics Capa, 34093, Istanbul, Turkey, Telephone: +90 212 414 20 00- 31478, 33090, Fax: +90 212 414 22 48, +90 212 532 42 08,
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Yardan T, Baydin A, Genc S, Cokluk C, Acar E, Aydin K. A Case of Spontaneous Spinal Epidural Haematoma in the Emergency Department Associated with Warfarin Therapy. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791001700410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Spontaneous spinal epidural haematoma (SSEH) is a neurosurgical emergency that requires early diagnosis and treatment. An 88-year-old man presented to the emergency department with complaints of weakness in the legs, walking deficit, incontinence and back pain for the last two days. He had been on warfarin therapy for 5 years for atrial fibrillation. There was no antecedent trauma. The neurological examination revealed hypoesthesia below the T6 level, anaesthesia below the T10 level and complete paraplegia of both lower extremities. The INR level was 7.81 on admission. Magnetic resonance imaging revealed a posterolateral epidural haematoma extending from T2 to L5. He was given fresh frozen plasma and vitamin K in the emergency department. Emergency thoracic and lumbar laminectomy was performed by neurosurgeons. The probability of SSEH should be investigated in any patient under anticoagulation therapy who presents with signs of spinal compression in the emergency department.
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Affiliation(s)
| | | | | | - C Cokluk
- Ondokuz Mayis University, Faculty of Medicine, Department of Neurosurgery, Samsun, Turkey
| | | | - K Aydin
- Ondokuz Mayis University, Faculty of Medicine, Department of Neurosurgery, Samsun, Turkey
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Aydin K, Sencer S, Barburoglu M, Berdikhojayev M, Aras Y, Sencer A, İzgi N. Midterm results of T-stent–assisted coiling of wide-necked and complex intracranial bifurcation aneurysms using low-profile stents. J Neurosurg 2017; 127:1288-1296. [DOI: 10.3171/2016.9.jns161909] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVECoiling of wide-necked and complex bifurcation aneurysms frequently requires implantation of double stents in various configurations. T-stent–assisted coiling involves the nonoverlapping implantation of 2 stents to protect the daughter vessels of bifurcation and is followed by coiling of the aneurysm. The authors studied the feasibility, efficacy, and safety of the T-stent–assisted coiling procedure as well as the midterm angiographic/clinical outcomes of patients with wide-necked bifurcation intracranial aneurysms treated using this technique.METHODSThe authors retrospectively identified patients with wide-necked bifurcation intracranial aneurysms treated using double-stent–assisted coiling with a T-stent configuration.RESULTSTwenty-four patients with 24 aneurysms and a mean of age of 51.91 years were identified. The most common locations were the middle cerebral bifurcation (45.8%) and anterior communicating artery (35.7%). T stentings were performed using low-profile stents. The procedures were performed with a technical success rate of 95.8%, and an immediate total occlusion rate of 79.2% was achieved. We observed periprocedural complications in 16.7% of cases and a delayed thromboembolic event in 4.2%. The complications caused permanent morbidity in 1 patient (4.2%). No deaths occurred. The mean angiographic follow-up duration was 9.3 months. The total occlusion rate at the last follow-up was 81.2%. The recanalization rate was 4.5%. Modified Rankin Scale scores of all patients at the last follow-ups were between zero and 2.CONCLUSIONST-stent–assisted coiling using low-profile stents is a feasible, effective, and relatively safe endovascular technique used to treat wide-necked and complex intracranial aneurysms. The midterm angiographic and clinical outcomes are outstanding.
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Affiliation(s)
- Kubilay Aydin
- 1Department of Radiology, Neuroradiology Division, and
- 2Department of Radiology, Koc University Hospital, Topkapi, Istanbul, Turkey; and
| | - Serra Sencer
- 1Department of Radiology, Neuroradiology Division, and
| | | | | | - Yavuz Aras
- 4Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Capa
| | - Altay Sencer
- 4Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Capa
| | - Nail İzgi
- 4Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Capa
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Ugurlucan M, Onal Y, Oztas DM, Canbay C, Demir I, Sayin OA, Kilickesmez O, Cakir MS, Aydin K, Alpagut U. Cerebral Protection with a Temporary Ascending Aorta-External Carotid Artery Bypass during Common Carotid Artery Revascularization. Ann Vasc Surg 2017; 46:368.e13-368.e17. [PMID: 28890061 DOI: 10.1016/j.avsg.2017.08.026] [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: 07/11/2017] [Revised: 08/02/2017] [Accepted: 08/03/2017] [Indexed: 10/18/2022]
Abstract
Atherosclerosis is a systemic disease, and multiarterial involvement is common. Involvement of all the supra-aortic arteries may occur in the same patient making cerebral revascularization challenging. In this report, we present complete supra-aortic revascularization, that is, revascularization of the bilateral common carotid and subclavian arteries in a 51-year-old male patient with occluded brachiocephalic trunk, left subclavian artery, and proximally stenotic left common carotid artery. A temporary ascending aorta to left external carotid artery bypass provided meticulous cerebral protection with pulsatile cerebral flow in the presence of a proximal arterial clamp; hence, a neurologically uneventful procedure during bilateral common carotid artery revascularization.
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Affiliation(s)
- Murat Ugurlucan
- Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey.
| | - Yilmaz Onal
- Department of Radiology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Didem Melis Oztas
- Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Cagla Canbay
- Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Ibrahim Demir
- Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Omer Ali Sayin
- Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Ozgur Kilickesmez
- Department of Radiology, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Mehmet Semih Cakir
- Department of Radiology, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Kubilay Aydin
- Department of Radiology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Ufuk Alpagut
- Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
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Aydin K, Barburoglu M, Sencer S, Berdikhojayev M, Coskun B, Akpek S. Flow Diversion with Low-Profile Braided Stents for the Treatment of Very Small or Uncoilable Intracranial Aneurysms at or Distal to the Circle of Willis. AJNR Am J Neuroradiol 2017; 38:2131-2137. [PMID: 28882859 DOI: 10.3174/ajnr.a5362] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/03/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The endovascular treatment of aneurysms located at or distal to the circle of Willis and not amenable to coiling remains a challenge. We report our experience with flow-diversion treatment using low-profile braided stents as a stent monotherapy procedure for treating distally located very small or uncoilable aneurysms. MATERIALS AND METHODS We retrospectively reviewed our data bases to identify patients with aneurysms located at or distal to the circle of Willis who were treated with stent monotherapy using low-profile braided stents. The immediate and follow-up angiographic findings and clinical status of the patients were assessed. RESULTS Twenty aneurysms in 19 patients were included in the study. The mean size of the aneurysms was 4.7 ± 2.4 mm. Patients were treated via telescopic implantation of 2 stents for 11 aneurysms; single-stent placement was used for the remaining aneurysms. The technical success rate was 95%. We observed a technical complication in 1 case (5.3%) and a late ischemic event in another (5.3%). The final angiographies during a mean follow-up of 14.7 months showed complete aneurysm occlusion in 73.7%. The complete occlusion rate of the aneurysms treated with telescopic stent placement was 81.8%. The modified Rankin scale scores of all patients at the last follow-up were between 0 and 2. CONCLUSIONS Flow diversion with low-profile braided stents as a stent monotherapy procedure for very small or uncoilable intracranial aneurysms located at or beyond the circle of Willis is a promising, relatively safe, and durable endovascular procedure.
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Affiliation(s)
- K Aydin
- From the Department of Radiology (K.A., M.Barburoglu, S.S.), Neuroradiology Division, Istanbul Faculty of Medicine, Istanbul University, Capa, Istanbul, Turkey .,Department of Radiology (K.A.), Interventional Radiology Unit, Koç University School of Medicine, Koç University Hospital, Topkapi, Istanbul, Turkey
| | - M Barburoglu
- From the Department of Radiology (K.A., M.Barburoglu, S.S.), Neuroradiology Division, Istanbul Faculty of Medicine, Istanbul University, Capa, Istanbul, Turkey
| | - S Sencer
- From the Department of Radiology (K.A., M.Barburoglu, S.S.), Neuroradiology Division, Istanbul Faculty of Medicine, Istanbul University, Capa, Istanbul, Turkey
| | - M Berdikhojayev
- Department of Neurosurgery (M.Berdikhojayev), JSC Central Clinical Hospital, Almaty City, Kazakhstan
| | - B Coskun
- Department of Radiology (B.C., S.A.), Vehbi Koc Vakfi American Hospital, Nisantasi, Istanbul, Turkey
| | - S Akpek
- Department of Radiology (B.C., S.A.), Vehbi Koc Vakfi American Hospital, Nisantasi, Istanbul, Turkey
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Ugurlucan M, Onal Y, Oztas DM, Sayin OA, Aydin K, Alpagut U. How to Clamp and Bypass if There Is Single Artery Supply to the Head and That Contains Severe Stenosis? Ann Thorac Surg 2017; 103:e293-e295. [PMID: 28219575 DOI: 10.1016/j.athoracsur.2016.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 07/22/2016] [Accepted: 09/01/2016] [Indexed: 11/18/2022]
Abstract
Takayasu arteritis manifests with arterial occlusions and aneurysms. Revascularization is sometimes challenging, especially when carotid arteries are affected. In this report, we present a carotid artery revascularization technique in a patient who was admitted with orthostatic and postprandial transient ischemic attacks, resulting in a diagnosis of bilaterally occluded subclavian and vertebral arteries, occluded left common carotid artery, and severely stenosed right common carotid artery. Clamping of the right carotid artery was a challenge; however, our technique provides a neurologically safe revascularization.
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Affiliation(s)
- Murat Ugurlucan
- Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey.
| | - Yilmaz Onal
- Department of Radiology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Didem Melis Oztas
- Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Omer Ali Sayin
- Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Kubilay Aydin
- Department of Radiology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Ufuk Alpagut
- Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
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Karaca I, Aydin K, Yavuzkir M, Ilkay E, Akbulut M, Isik A, Arslan N. Predictive Value of C-reactive Protein in Patients with Unstable Angina Pectoris Undergoing Coronary Artery Stent Implantation. J Int Med Res 2016; 33:389-96. [PMID: 16104442 DOI: 10.1177/147323000503300404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/17/2022] Open
Abstract
In-stent restenosis is a major problem following coronary stent implantation, and inflammation plays an active role. We evaluated the effectiveness of the inflammatory marker C-reactive protein (CRP) as a predictor of in-stent restenosis after successful stent implantation, in 86 patients with unstable angina pectoris. Plasma CRP was measured in all patients before the procedure, and at 48-72 h and 1, 2 and 3 months post-procedure. An angiographic loss of 50% at follow-up was accepted as in-stent restenosis. We found negative and positive predictive values of the pre-procedural plasma CRP for determining 6-month in-stent restenosis of 34% and 61%, respectively. We also found a strong correlation between the 3-month post-procedural CRP value and 6-month in-stent restenosis; the negative and positive predictive values being 8% and 76%, respectively. In conclusion, we showed that a plasma CRP value > 3 mg/l in the third month after coronary stent implantation was a strong predictor of angiographic in-stent restenosis.
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Affiliation(s)
- I Karaca
- Department of Cardiology, Firat University School of Medicine, Elaziğ, Turkey.
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Akcakaya MO, Aydoseli A, Aras Y, Sabanci PA, Barburoglu M, Alkir G, Sencer A, Sencer S, Aydin K, Kiris T, Hepgul K, Unal OF, Barlas O, Izgi N. Clinical course of nontraumatic nonaneurysmal subarachnoid hemorrhage: a single institution experience over 10 years and review of the contemporary literature. Turk Neurosurg 2016; 27:732-742. [DOI: 10.5137/1019-5149.jtn.18359-16.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Barburoglu M, Aydin K. Rescue Retrieval of a Fully Deployed Low-Profile Intracranial Stent After Acute Occlusion. World Neurosurg 2016; 85:349-52. [DOI: 10.1016/j.wneu.2015.08.066] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 08/28/2015] [Accepted: 08/29/2015] [Indexed: 11/28/2022]
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Öztürk Z, Arhan E, Aydin K, Hirfanoğlu T, Tümer L, Okur I, Serdaroğlu A, Akbaş Y, Karaoğlu B. COBALAMIN C DEFICIENCY WITH INFANTILE SPASM AND CUTANEOUS FINDINGS: A UNIQUE CASE. Genet Couns 2016; 27:399-403. [PMID: 30204970] [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: 06/08/2023]
Abstract
Cobalamin C (CbIC) deficiency is a rare disorder of vitamin B12 metabolism which results from impaired conversion of both its active forms methylcobalamin and adenosylcobalamin. Early onset cblC typically presents in the first year of life with hypotonia, lethargy, seizures, microcephaly, hydrocephalus, developmental delay and other multisystem involvement including hematologic, ocular, renal, hepatic and cardiac symptoms. We report a case of a female infant with cblC deficiency who presented with seizures, developmental delay and hypopigmented cutaneous lesions. To our knowledge, the patient is the first diagnosed with cblC deficiency who had skin hypopigmentation.
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Tezcan ME, Temizkan O, Ozderya A, Melikoglu M, Aydin K, Sargin M, Temizkan S. Color Doppler analysis of female reproductive vasculature in Behçet's disease. Reumatismo 2015; 67:103-8. [PMID: 26876189 DOI: 10.4081/reumatismo.2015.836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 12/15/2015] [Accepted: 12/17/2015] [Indexed: 11/23/2022] Open
Abstract
Behçet's disease (BD) may affect female reproductive vasculature. We aimed to evaluate Doppler sonographic characteristics of female reproductive vasculature and also ovarian volume, endometrial thickness (EMT) and antral follicle count of BD patients in comparison with a healthy control group. Seventeen premenopausal women aged between 18-45 years with BD, and a control group of 31 age- and body mass index-matched healthy women was included in the study. Uterine, spiral and intraovarian artery blood flow were examined by Doppler sonography in the late follicular phase. Resistance index, pulsatility index and systolic/diastolic ratio were recorded together with ovarian volume, EMT and antral follicle count. In particular this is a pilot study including the evaluation of the spiral and uterine arteries in BD. Doppler sonographic parameters, ovarian volume, EMT and antral follicle count of BD patients and healthy controls were not found to be statistically different. As a result of our analysis, we found similar Doppler sonographic features of both BD patients and the control group. Further studies conducted on a larger sample population with more aggressive BD symptoms may reveal the actual effect of BD on the female reproductive system.
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Affiliation(s)
- M E Tezcan
- Department of Rheumatology, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul.
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Abstract
AIM Acromegaly is associated with increased thyroid cancer risk. We aimed to analyze the frequency of point mutations of BRAF and RAS genes, and RET/PTC, PAX8/PPARγ gene rearrangements in patients with acromegaly having differentiated thyroid cancers (DTC) and their relation with clinical and histological features. MATERIALS AND METHODS 14 acromegalic patients (8 male, 6 female) with DTC were included. BRAF V600E and NRAS codon 61 point mutations, RET/PTC1, RET/PTC3, and PAX8/PPARγ gene rearrangements were analyzed in thyroidectomy specimens. We selected 14 non-acromegalic patients with DTC as a control group. RESULTS 2 patients (14.3%) were detected to have positive BRAF V600E and 3 patients (21.4%) were detected to have NRAS codon 61 mutation. NRAS codon 61 was the most frequent genetic alteration. Patients with positive mutation had aggressive histologic features more frequently than patients without mutations. Comparison of the acromegalic and non-acromegalic patients with DTC revealed that BRAF V600E mutation was more frequent in non-acromegalic patients with DTC (14.2% vs. 64.3%, p=0.02). RET/PTC 1/ 3, PAX8/PPARγ gene rearrangements were not detected in any patient. None of the patients including the patients with positive point mutations had recurrence, and local and/or distant metastasis. CONCLUSION NRAS codon 61 is the most frequent genetic alteration in this acromegaly series with DTC. Since acromegalic patients have lower prevalance of BRAF V600E mutation, BRAF V600E mutation may not be a causative factor in development of DTC in acromegaly. Despite the relation of BRAF V600E and NRAS codon 61 mutations with aggresive histopathologic features, their impact on tumor prognosis remains to be defined in acromegaly in further studies.
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Affiliation(s)
- K Aydin
- Department of Endocrinology and Metabolism, Hacettepe University School of Medicine, Ankara, Turkey
| | - C Aydin
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Turkey
| | - S Dagdelen
- Department of Endocrinology and Metabolism, Hacettepe University School of Medicine, Ankara, Turkey
| | - G G Tezel
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Turkey
| | - T Erbas
- Department of Endocrinology and Metabolism, Hacettepe University School of Medicine, Ankara, Turkey
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Aydin K, Arat A, Sencer S, Barburoglu M, Men S. Stent-Assisted Coiling of Wide-Neck Intracranial Aneurysms Using Low-Profile LEO Baby Stents: Initial and Midterm Results. AJNR Am J Neuroradiol 2015; 36:1934-41. [PMID: 26021624 DOI: 10.3174/ajnr.a4355] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/25/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Low-profile self-expandable stents were recently introduced for the treatment of wide-neck intracranial aneurysms. This study investigated the initial and midterm clinical and angiographic results of LEO Baby stent-assisted coiling in the treatment of wide-neck intracranial aneurysms. MATERIALS AND METHODS A retrospective review was performed to identify patients who were treated with LEO Baby stent-assisted coiling. Eighty patients with 80 wide-neck intracranial aneurysms were included in the study. Eleven patients (13.8%) presented with subarachnoid hemorrhage. All patients were treated with LEO Baby stent-assisted coiling. Technical success and immediate postprocedural clinical and angiographic outcomes were evaluated. Seventy-three patients attended angiographic and clinical follow-up for a mean duration of 7.2 ± 3.8 months. Periprocedural and delayed complications were reviewed. Preprocedural and follow-up clinical statuses were assessed by using the modified Rankin Scale. RESULTS The technical success rate of the procedure was 97.5%. The immediate postprocedural angiography revealed a complete occlusion of the aneurysm in 75% of the 80 patients. The last follow-up angiograms showed complete occlusion in 85.7% of the 77 patients with an angiographic follow-up. Of the 77 patients with a follow-up angiography, 6.5% showed an increase in the filling status of the aneurysm and 5.2% required retreatment. The overall procedure-related complication rate, including asymptomatic complications, was 11.3%. The permanent morbidity rate was 3.8%. There was no mortality in this study. CONCLUSIONS This case series demonstrates the relative safety, efficacy, and midterm durability of the LEO Baby stent-assisted coiling procedure for the treatment of wide-neck intracranial aneurysms.
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Affiliation(s)
- K Aydin
- From the Department of Radiology (K.A., S.S., M.B.), Neuroradiology Division, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - A Arat
- Department of Radiology (A.A.), School of Medicine, Hacettepe University, Ankara, Turkey
| | - S Sencer
- From the Department of Radiology (K.A., S.S., M.B.), Neuroradiology Division, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - M Barburoglu
- From the Department of Radiology (K.A., S.S., M.B.), Neuroradiology Division, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - S Men
- Department of Radiology (S.M.), Dokuz Eylul University, Izmir, Turkey
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Akgoz A, Barburoglu M, Aydin K, Sencer S, Men S, Arat A. E-140 initial and mid-term clinical and angiographic results of leo baby stent-assisted coiling treatment of wide-necked intracranial aneurysms. J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011917.214] [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: 11/04/2022]
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Akmangit I, Aydin K, Sencer S, Topcuoglu OM, Topcuoglu ED, Daglioglu E, Barburoglu M, Arat A. Dual stenting using low-profile LEO baby stents for the endovascular management of challenging intracranial aneurysms. AJNR Am J Neuroradiol 2015; 36:323-9. [PMID: 25234031 DOI: 10.3174/ajnr.a4106] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Endovascular treatment of wide-neck, complex, and distally located cerebral aneurysms is a challenging issue. This study evaluated the safety and efficacy of dual stent placement by using a low-profile stent system (LEO Baby) for the treatment of challenging distal intracranial aneurysms. MATERIALS AND METHODS We retrospectively reviewed patients in whom at least 1 LEO Baby stent was used in the context of dual stent placement for the treatment of intracranial aneurysms. Patients who were treated with dual stent-assisted coil embolization and telescopic implantation of LEO Baby stents were included in the study. Clinical and angiographic findings, procedural data, and follow-up are reported. RESULTS Twelve patients were included in this study. Three patients presented with subarachnoid hemorrhage in the subacute-chronic phase, and the remaining patients had unruptured aneurysms. Nine patients were treated by using the dual stent-assisted coiling method. X- (nonintersecting), Y- (intersecting and reversible), T-, and parallel-stent configurations were performed for the dual stent-assisted coiling procedures. Three patients were treated by using telescopic stent placement for a flow diverter-like effect. The procedures were successful in all cases. Technical complications without a significant clinical adverse event developed in 2 patients. The 3- and 6-month control MRAs and DSAs demonstrated complete occlusion of the aneurysms in all patients except 1. All patients had good clinical outcomes on follow-up (mRS ≤1). CONCLUSIONS The results of this small study showed the feasibility of dual stent placement by using low-profile LEO Baby stents to treat distally located complex intracranial aneurysms.
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Affiliation(s)
- I Akmangit
- From the Department of Radiology (I.A., E.D., A.A.), Ankara Numune Education and Research Hospital, Ankara, Turkey Department of Radiology (I.A., O.M.T., A.A.), School of Medicine, Hacettepe University, Ankara, Turkey
| | - K Aydin
- Neuroradiology Division (K.A., S.S., M.B.), Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - S Sencer
- Neuroradiology Division (K.A., S.S., M.B.), Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - O M Topcuoglu
- Department of Radiology (I.A., O.M.T., A.A.), School of Medicine, Hacettepe University, Ankara, Turkey
| | - E D Topcuoglu
- Department of Radiology (E.D.T.), School of Medicine, Ufuk University, Ankara, Turkey
| | - E Daglioglu
- From the Department of Radiology (I.A., E.D., A.A.), Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - M Barburoglu
- Neuroradiology Division (K.A., S.S., M.B.), Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - A Arat
- From the Department of Radiology (I.A., E.D., A.A.), Ankara Numune Education and Research Hospital, Ankara, Turkey Department of Radiology (I.A., O.M.T., A.A.), School of Medicine, Hacettepe University, Ankara, Turkey
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Yilmaz G, Caylan R, Aydin K, Topbas M, Koksal I. Effect of Education on the Rate of and the Understanding of Risk Factors for Intravascular Catheter–Related Infections. Infect Control Hosp Epidemiol 2015; 28:689-94. [PMID: 17520542 DOI: 10.1086/517976] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Accepted: 10/10/2006] [Indexed: 11/03/2022]
Abstract
Objective.Intravascular catheters are indispensable tools in modern medical therapy. In spite of their great benefits, however, the widespread use of catheters leads to several complications, including infections that cause significant morbidity, mortality, and economic losses for hospitalized patients.Design.This study was conducted at Farabi Hospital, a 495-bed facility at Karadeniz Technical University Medical School in Trabzon, Turkey, and involved 3 separate periods: preeducation, education, and posteducation. Patients with intravascular catheters were monitored daily, as were the results of their physical examinations. The information acquired was recorded in a questionnaire.Results.During the preeducation period (October 2003 through March 2004), 405 intravascular catheters inserted into 241 patients were observed for 5,445 catheter-days. Seventy-one cases of intravascular catheter-related infection (CRI) were identified, giving a CRI rate of 13.04 infections per 1,000 catheter-days. The catheter-related bloodstream infection (CRBSI) rate was 8.3 infections per 1,000 catheter-days, and the exit-site infection (ESI) rate was 3.5 infections per 1,000 catheter-days. During the posteducation period (June through November 2004), 365 intravascular catheters inserted into 193 patients were observed for 5,940 catheter-days. Forty-five cases of CRI were identified, giving a rate of 7.6 infections per 1,000 catheter-days. The CRBSI rate was 4.7 infections per 1,000 catheter-days, and the ESI rate was 2.2 infections per 1,000 catheter-days. When findings from the 2 periods were compared, it was determined that education reduced CRI incidence by 41.7%.Conclusion.CRI can be prevented when hospital personnel are well informed about these infections. We compared the knowledge levels of the relevant personnel in our hospital before and after theoretical and practical training and identified a significant increase in knowledge after training (P < .0001 ). Parallel to this, although still below ideal levels, we identified a significant improvement in the incidence of CRI during the posteducation period (P = .004). The rate was low for the first 3 months of this period but increased 2.08 times after the third month. In conclusion, regular training for the residents in charge of inserting intravascular catheters and the nurses and interns who maintain the catheters is highly effective in reducing the rate of CRI in large teaching hospitals.
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Affiliation(s)
- G Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey.
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Gurkas E, Kartal A, Aydin K, Kucukçongar A, Dilber C, Ceylaner S. REVERSIBLE CLINICAL AND MAGNETIC RESONANCE IMAGING FINDINGS IN LATE-ONSET COBALAMIN C DEFECT. Genet Couns 2015; 26:425-430. [PMID: 26852513] [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: 06/05/2023]
Abstract
Cobalamin C (Cbl C) disease is an inborn error of intracellular cobalamin metabolism. Two distinct clinical types are defined according to the age of onset. We describe an 8 year old girl with late-onset Cbl C disease presenting with neuropsychiatric symptoms. Mutation analysis revealed homozygous c.394C>T (p.R132X) mutation in the MMACHC gene. Serial magnetic resonance imaging (MRI) before and after the treatment are provided. MRI of the brain before treatment showed bilateral patchy focal hyperintensities in the white matter and cortical atrophy. After treatment with intramuscular hydroxycobalamin, oral folinic acid, oral betaine, normalization of MRI findings can be achieved in addition to clinical improvement. We present this case to draw attention to the reversibility of clinical and MRI findings in the late onset Cbl C disease after treatment.
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Gungor O, Ozkaya AK, Hirfanoglu T, Dilber C, Aydin K. A rare mutation in EIF2B4 gene in an epileptic child with vanishing white matter disease: a case report. Genet Couns 2015; 26:41-46. [PMID: 26043506] [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: 06/04/2023]
Abstract
A 12-month old boy presented with intractable seizures present since 3-month of age. He had, previously, been admitted numerous times to the pediatric emergency room for intractable and prolonged seizures during the course of his disease. Differential diagnosis was made to exclude several inborn metabolic disorders, including vitamin B6 deficiency, biotinidase deficiency and nonketotic hyperglycinemia. Although the initial brain MRI revealed a mild cerebral and cerebellar white matter involvement, follow-up images showed diffuse cerebral and cerebellar white matter dysmyelination, progressive rarefaction and cystic degeneration. A genetic analysis was performed for vanishing white matter (VWM) disease and a homozygote c. 1091G>A mutation was detected at the EIF2B4 gene. This case emphasizes the fact that VWM disease may present with refractory seizures since early infancy.
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Aydin K, Arat A, Sencer S, Hakyemez B, Barburoglu M, Sencer A, İzgi N. Treatment of ruptured blood blister-like aneurysms with flow diverter SILK stents. J Neurointerv Surg 2014; 7:202-9. [DOI: 10.1136/neurintsurg-2013-011090] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [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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Akin S, Aydin K, Gürlek ÖA. Low prevalence of growth hormone deficiency in Turkish patients with Hashimoto's thyroiditis. J Endocrinol Invest 2014; 37:25-9. [PMID: 24464447 DOI: 10.1007/s40618-013-0008-y] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 11/17/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Hashimoto's Thyroiditis (HT) is frequently isolated, but may also be associated with other autoimmune disorders. Autoimmune hypophysitis can result in growth hormone deficiency (GHD). Various prevalences of GHD have been reported in HT in several different ethnic populations. AIM The aim of this study was assessing the prevalence of GHD in Turkish population with HT. MATERIALS AND METHODS Two hundred twenty-seven (208 females and 19 males, mean age 40.1 ± 10.8 years, range 18-64 years) patients with euthyroid HT were included. RESULTS All patients were euthyroid with or without T4 treatment (median TSH 2.2 mIU/L, range 0.2-4.2 mIU/L; median FT4 15.6 pmol/L, range 12-22 pmol/L; and median FT3 4.5 pmol/L, range 3.0-6.2 pmol/L), and median TPO-Ab was 817 IU/mL (range 63 to >3,000). One hundred and thirty-six of them were using medications including L-thyroxine (59.9 %). Insulin-like growth factor-I (IGF-I) levels of 210 patients (92.5 %) were normal. Glucagon stimulation testing in 17 subjects revealed GHD (peak <3 mcg/L) in two subjects. We then performed insulin tolerance test (ITT) to both of them as the gold standard confirmatory test. One patient had no GH response to ITT, either. Our data reveal the prevalence of GHD (based on low IGF-I and ITT result) in this particular group of Turkish HT patients as 0.4 %. CONCLUSION We conclude that the isolated GHD is rarely observed in HT in our population. The prevalence of GHD is 0.4 % in this particular group of Turkish HT patients suggesting that routine investigation of GHD is not mandatory.
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Affiliation(s)
- S Akin
- Department of Endocrinology and Metabolism, Hacettepe University Medical School, Sıhhiye, Ankara, Turkey
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Aydin K, Okutur SK, Bozkurt M, Turkmen I, Namal E, Pilanci K, Ozturk A, Akcali Z, Dogusoy G, Demir OG. Effect of epidermal growth factor receptor status on the outcomes of patients with metastatic gastric cancer: A pilot study. Oncol Lett 2013; 7:255-259. [PMID: 24348859 PMCID: PMC3861593 DOI: 10.3892/ol.2013.1662] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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] [Received: 04/03/2013] [Accepted: 10/17/2013] [Indexed: 01/18/2023] Open
Abstract
The expression of epidermal growth factor receptor (EGFR) has been linked to clinical outcome in several solid tumors. However, the clinical significance of EGFR (c-erbB1) in gastric cancer remains unclear. The present study was designed to detect the clinical implications of EGFR in the Turkish population. Paraffin-embedded tissue microarrays containing gastric cancer tissue were obtained from 30 patients. EGFR expression was detected using immunohistochemistry. The correlation of this biomarker to the clinicopathological features and survival of patients with gastric cancer was studied. The overall positivity rate of EGFR was 63.3%. EGFR expression was significantly correlated with an improved progression-free survival (PFS) and overall survival (OS) rate (P=0.039 and 0.01, respectively). EGFR expression is a good prognostic marker for patients with gastric cancer.
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Affiliation(s)
- K Aydin
- Department of Medical Oncology, Istanbul Bilim University, Istanbul, Turkey
| | - S K Okutur
- Department of Medical Oncology, Istanbul Bilim University, Istanbul, Turkey
| | - M Bozkurt
- Department of Medical Oncology, Istanbul Bilim University, Istanbul, Turkey
| | - I Turkmen
- Department of Pathology, Istanbul Bilim University, Istanbul, Turkey
| | - E Namal
- Department of Medical Oncology, Istanbul Bilim University, Istanbul, Turkey
| | - K Pilanci
- Department of Medical Oncology, Istanbul Bilim University, Istanbul, Turkey
| | - A Ozturk
- Department of Medical Oncology, Istanbul Bilim University, Istanbul, Turkey
| | - Z Akcali
- Department of Medical Oncology, Istanbul Bilim University, Istanbul, Turkey
| | - G Dogusoy
- Department of Pathology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - O G Demir
- Department of Medical Oncology, Istanbul Bilim University, Istanbul, Turkey
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Tiryaki-Sonmez G, Ozen S, Bugdayci G, Karli U, Ozen G, Cogalgil S, Schoenfeld B, Sozbir K, Aydin K. Effect of exercise on appetite-regulating hormones in overweight women. Biol Sport 2013; 30:75-80. [PMID: 24744470 PMCID: PMC3944580 DOI: 10.5604/20831862.1044220] [Citation(s) in RCA: 19] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2013] [Indexed: 11/25/2022] Open
Abstract
Over the past decade, our knowledge of how homeostatic systems regulate food intake and body weight has increased with the discovery of circulating peptides such as leptin, acyl ghrelin, des-acyl ghrelin and obestatin. These hormones regulate the appetite and food intake by sending signals to the brain regarding the body's nutritional status. The purpose of this study was to investigate the response of appetite-regulating hormones to exercise. Nine overweight women undertook two 2 h trials in a randomized crossover design. In the exercise trial, subjects ran for 60 min at 50% of maximal oxygen uptake followed by a 60 min rest period. In the control trial, subjects rested for 2 h. Obestatin, acyl ghrelin, des-acyl ghrelin and leptin concentrations were measured at baseline and at 20, 40, 60, 90 and 120 min after baseline. A two-way ANOVA revealed a significant (P < 0.05) interaction effect for leptin and acyl ghrelin. However, changes in obestatin and des-acyl ghrelin concentration were statistically insignificant (P > 0.05). The data indicated that although acute treadmill exercise resulted in a significant change in acyl ghrelin and leptin levels, it had no effect on plasma obestatin and des-acyl ghrelin levels.
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Affiliation(s)
- G Tiryaki-Sonmez
- Department of Health Sciences, Lehman College, The City University of New York, Bronx, New York, USA
| | - S Ozen
- School of Physical Education and Sports, Abant Izzet Baysal University, Bolu, Turkey
| | - G Bugdayci
- Department of Biochemistry, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - U Karli
- School of Physical Education and Sports, Abant Izzet Baysal University, Bolu, Turkey
| | - G Ozen
- School of Physical Education and Sports, Abant Izzet Baysal University, Bolu, Turkey
| | - S Cogalgil
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - B Schoenfeld
- Department of Health Sciences, Lehman College, The City University of New York, Bronx, New York, USA
| | - K Sozbir
- School of Physical Education and Sports, Abant Izzet Baysal University, Bolu, Turkey
| | - K Aydin
- School of Physical Education and Sports, Abant Izzet Baysal University, Bolu, Turkey
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Akun E, Okutur K, Seber S, Korkmaz T, Aydin K, Bozkurt M, Namal E, Hasbal B, Tecimer C, Demir G. Safety and tolerability of first-line bevacizumab in metastatic colorectal cancer. J BUON 2012; 17:669-676. [PMID: 23335523] [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
PURPOSE To determine the clinical features of bevacizumab-associated toxicities in metastatic colorectal cancer (MCRC) patients. METHODS The medical records of 60 patients with MCRC who were treated with chemotherapy including bevacizumab in the first-line setting were retrospectively evaluated. RESULTS Bevacizumab was administered along with irinotecan plus 5-fluorouracil7sol;leucovorin (5-FU/LV) to 44 patients, 57horbar;FU7sol;LV+oxaliplatin to 8 patients, capecitabine+oxaliplatin to 6 patients and 5-FU/LV to 2 patients. The total number of the cycles received was 381 (median 6, range 17horbar;13). The most common bevacizumab-related toxicity was grade 1-2 bleeding (28%) followed by hypertension (17%). Grade 1-2 proteinuria was seen in 8% of the patients (no grade 3-4 proteinuria). Arterial thromboembolic events (ATE) were not observed, however 3 patients (5%) had experienced grade 3-4 venous thromboembolic events. In 3 patients (5%) grade 1-2 wound complications were seen (delayed wound healing in the place of the venous access device in 2, and wound infection in 1). In addition, gastrointestinal perforation (GIP) was seen in 3 (5%) patients. Two of the patients were treated by surgical intervention and one patient died of sepsis. CONCLUSION Bevacizumab is well tolerated when combined with various chemotherapy regimens. As bevacizumab is becoming widely used in the routine oncology practice, further studies which investigate the mechanism of bevacizumab-associated toxicities are warranted to develop effective management strategies for these adverse events.
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Affiliation(s)
- E Akun
- Gayrettepe Florence Nightingale Hospital, Department of Internal Medicine, Istanbul, Turkey
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Ozcan E, Aydin K, Baser G, Guclu-Ustundag O, Korachi M, Ekinci F. Evaluation of shalgam juice antiproliferative activity against a colon cancer cell line. N Biotechnol 2012. [DOI: 10.1016/j.nbt.2012.08.320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Canpolat U, Aydin K, Yorgun H, Sunman H, Gürses K, Dural M, Kaya E, Aytemir K, Usman A, Kabakçi G, Oto A, Tokgözoğlu L. PP-306 HEART RATE RECOVERY IN YOUNG MEN WITH HYPOGONADOTROPIC HYPOGONADISM. Int J Cardiol 2012. [DOI: 10.1016/s0167-5273(12)70483-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Aydin K, Uysal S, Yakut A, Emiroglu B, Yılmaz F. N-acetylaspartate concentration in corpus callosum is positively correlated with intelligence in adolescents. Neuroimage 2011; 59:1058-64. [PMID: 21983183 DOI: 10.1016/j.neuroimage.2011.08.114] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 08/23/2011] [Accepted: 08/29/2011] [Indexed: 10/17/2022] Open
Abstract
The corpus callosum is the largest white matter bundle in the brain and integrates inter-hemispheric cortices during sensory-motor and high-order cognitive processes. The aim of the present study was to investigate the associations between the metabolite concentrations in the corpus callosum and intelligence among adolescents. Thirty male adolescents aged between 14 and 16 years were included into the study. We measured the intelligence quotient (IQ) scores of the subjects by using the Wechsler Intelligence Scale for Children-Revised (verbal, performance and full-scale IQ) test. We used proton MR spectroscopy to measure the absolute concentrations of N-acetylasparate (NAA), creatine (Cr) and choline (Cho) in the genu, midbody and isthmus/splenium regions of the corpus callosum. We also measured the whole brain parenchymal size and used it as a confounding factor in the statistical analyses. We assessed the correlations between neurometabolite concentrations and verbal, performance and full-scale IQ scores. We found a significant positive correlation between the whole brain parenchymal size and the full-scale IQ scores. And, the NAA concentration in the isthmus/splenium region was positively correlated with the performance IQ and full-scale IQ scores. NAA is a marker of neuro/axonal integrity. NAA concentration in white matter is related to the structural and functional integrity of axonal fibers. The positive correlation of the IQ scores with the NAA concentrations in the isthmus/splenium region indicates that more efficient inter-hemispheric data transfer between parieto-occipital cortices may enhance intellectual performance.
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Affiliation(s)
- Kubilay Aydin
- Istanbul University, Istanbul Faculty of Medicine, Department of Radiology, Capa, Istanbul, Turkey.
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Abstract
Background To evaluate the changes in brain metabolites by H1 magnetic resonance spectroscopy in two patients with electrical status epilepticus. Case Description Two boys (aged 6 and 7 years) with electrical status epilepticus in sleep have been evaluated. N-acetyl aspartate levels were slightly elevated, and showed no decline in the postictal period. Creatine and choline levels were similar to that in controls. No evidence of neuronal cell damage was seen. Conclusion Electrical status epilepticus is a balanced condition of hypermetabolism, when not accompanied with seizure.
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Affiliation(s)
- Burak Tatli
- Department of Pediatric Neurology. Istanbul Medical Faculty, Fatih-Istanbul, Turkey
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Okutur K, Bassülü N, Aydin K, Bozkurt M, Namal E, Tecimer C, Mandel N, Akgali Z, Dogusoy G, Demir G. 5083 POSTER The Predictive and Prognostic Significance of PTEN, P27 and PI3K Expression in HER2 Overexpressing Metastatic Breast Cancer. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71525-8] [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: 11/26/2022]
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