Ankara Üniversitesi Tıp Fakültesi Mecmuası

Ankara Üniversitesi Tıp Fakültesi Mecmuası

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  • Publisher: Galenos Yayinevi
  • Country of publisher: turkey
  • Date added to EuroPub: 2019/Nov/23

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  • Language of fulltext: english, turkish

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  • Open Access Statement: No
  • Year open access content began: 1994
  • Does the author retain unrestricted copyright? False
  • Does the author retain publishing rights? False

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This journal has '25' articles

Stereotactic Radiofrequency Deep Brain Lesioning in Treatment of Dystonia

Stereotactic Radiofrequency Deep Brain Lesioning in Treatment of Dystonia

Authors: Ümit Eroğlu, Muhittin Cenk Akbostancı, Ali Savaş
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Abstract

Objectives: Movement disorders are neurologic diseases that affect speed, quality and feasibility of muscle contractions. Aim of this study is, to assess the surgical outcomes of radiofrequency lesioning through deep brain stimulation (DBS) in a group of patients and comparing these results to the formerly known conventional procedures. Materials and Methods: This study involved 25 dystonia patients in whom radiofrequency lesioning through DBS procedures were performed between 1997 and 2003. All of the patients were examined by the same neurologist and examined due to UPDRS, Fahn-Burke-Marsden dystonia rating scales pre and post operatively. Results: Eighteen male (72%) and seven female (28%) patients (range=14-65 years, mean=26.6 years) with diagnosis of general dystonia (n=11,44%), hemidystonia (n=8, 34%) and dystonic tremor (n=6, 24%) enrolled in the study. Twenty patients with secondary dystonia involved 18 cerebral palsies, one multiple sclerosis and one poststroke dystonia cases. Conclusion: Gpi DBS seems to be a more considerable approach for primary dystonia patients. Radiofrequency deep brain lesioning can be defined as a successful method for secondary dystonia treatment and must be implicated among treatment options.

Keywords: Dystonia, Thalamotomy, Campotomy, Movement Disorders, Stereotaxic
Microsurgical Anatomy of the Fourth Ventricle

Microsurgical Anatomy of the Fourth Ventricle

Authors: Ümit Eroğlu
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Abstract

Objectives: The fourth ventricle is an important midline cavity located between the pons and the cerebellum. Surgical lesions in the cavity are frequently encountered by the neurosurgical lesions. The knowledge regarding the important anatomical structure and neighborhoods allows for a safer and better surgery. Materials and Methods: This study was planned to investigate the microsurgical anatomy of the 4th ventricle. Five formalin-fixed specimens were used for in this study. The arteries were perfused with red silicone and vessels with blue silicone. Results: Dissections were performed by gradually exposing the fourth ventricle. Dissection was performed under microscape and was photographed. Conclusion: The anatomy of the 4th ventricle will be discussed in this paper.

Keywords: The fourth ventricle, Microsurgery, Anatomy, Neurosurgery
Clinical Results and Surgical Details of Lamina Terminalis Fenestration in Patients with High Grade Subarachnoid Haemorrhage: One Year Experience of A Single Institute

Clinical Results and Surgical Details of Lamina Terminalis Fenestration in Patients with High Grade Subarachnoid Haemorrhage: One Year Experience of A Single Institute

Authors: Onur Özgüral, Eyyub SM Al-Beyati, Bilal Shukuruyev, Fatih Yakar, İhsan Doğan, Ümit Eroğlu, Melih Bozkurt
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Abstract

Objectives: Lamina terminalis fenestration is a method used to reduce hydrocephalus risk secondary to subarachnoid haemorrhage in cerebral aneurysm surgery. The aim of our article is to report our clinical experience in these patients and examine the short-term results of this procedure. Materials and Methods: We evaluated 10 patients with high-grade subarachnoid hemorrhage who underwent surgical clipping for cerebral aneurysm between 2014 and 2015 in our clinic. Results: Hydrocephalus developed in three of the 10 patients. One of these three patients had hydrocephalus in the preoperative period. In addition, hydrocephalus regressed in he postoperative period in three patients with hydrocephalus preoperatively. Conclusion: Lamina terminalis fenestration is an easy and effective procedure that can be applied to provide cerebral relaxation before surgical clipping and reduce the risk of developing hydrocephalus after clipping.

Keywords: Aneurysm, Subarachnoid Hemorrhage, Lamina Terminalis
Comparasion Between Mitotic Activity, Ki-67 Index and Platelet Volume Index as a Prognostic Marker in Gliablastomas

Comparasion Between Mitotic Activity, Ki-67 Index and Platelet Volume Index as a Prognostic Marker in Gliablastomas

Authors: Tolga Turan Dündar
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Abstract

Objectives: An elevated platelet count is considered an independent prediction of survey in glioblastoma and various other intracranial entities. Activity of the tumor microcirculation resulting in platelet activation and release of several cytokines and factors from activated platelets has been suggested to play an active role in neuro-inflammation. Ki-67 index and mitotic activity are markers which could be showed proliferation in the glial tumor. High Ki-67 expression and mitosis rate of high grade glial tumors have been more aggressive clinical progression, poor prognosis, more vascular invasion than low. Recently, Mean Platelet Volume (MPV) to platelet count (PLT) ratio has become a trend indicator to anticipate the outcome of a patient suffering from intracranial pathologies. The study aims to determine first time whether the comparison of the Volume Index (PVI) as an immune response marker with the Ki-67 and mitotic activity could be used as a prognostic factor in gliablastoma (WHO Grade IV). Materials and Methods: In the retrospective study, we studied 65 patients diagnosed with glioblastoma who had inclusion and exclusion criteria. The correlation between PVI, Ki-67 and mitotic activity was examined all cases after pathologically diagnosed, by the routine processes of the pathological preparates. PVI was calculated from pre-operative first complete blood count (CBC) and was defined as MPV value (fL)x100/PLT (per 1000). The Kolmogorov-Smirnov test and Spearman’s correlation coefficient was used in the analysis of the interrelationship. Results: The correlation between the PVI, Ki-67 and mitotic index was found to be leak statistically correlation. Conclusion: It was determined that PVI is decreased, Ki-67 immunoreactivity and mitotic index are increased. The PVI may be used as a prognostic, predictive factor for glioblastoma. Nevertheless, further studies concerning the prognosis of glioblastoma are needed to confirm this hypothesis.

Keywords: Glioblastoma, GBM, Platelets, Mean Platelet Volume, Platelet Volume Index, PVI
Morphometric Analysis of the Clivus in Human Dry Skulls: A Radioanatomical Study

Morphometric Analysis of the Clivus in Human Dry Skulls: A Radioanatomical Study

Authors: Hakan Özalp, Orhan Beğer, Osman Erdoğan, Engin Kara, Vural Hamzaoğlu, Yusuf Vayisoğlu, Ahmet Dağtekin, Ahmet Hakan Öztürk, Celal Bağdatoğlu, Derya Ümi...
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Abstract

Objectives: This study aims to reveal morphometric properties of the clivus including length, width and angle to the base of the skull from the perspective of skull base procedures. Materials and Methods: Twenty-four human dry skulls were included in the inventory of Mersin University Medical Faculty Anatomy Department. Direct anatomic measurements (DAM) were performed using digital caliper and digital image analysis software. Radiological analysis was performed using computed tomography (CT). Results: The length and inner surface area of the clivus for DAM and CT were 25.17±3.98/24.83±3.91 mm and 546.51±66.44/523.37±87.48 mm2, respectively. Clival angle (Welcher angle) for DAM and CT was 126.12±9.51°/124.37±10.86°. No statistically significant difference was found between the numerical data obtained by DAM and CT (p>0.05). Conclusion: Considering that clivus anomalies are associated with diseases such as platybasia, basilar invagination, CHARGE syndrome or Chiari type I, the data of the present study can be used for the detection of clivus anomalies as well as choosing the type of approach to the skull base.

Keywords: Clivus, CHARGE, Chiari I, Platybasia
Epidemiological Profile of Pediatric Ear Nose Throat Emergencies

Epidemiological Profile of Pediatric Ear Nose Throat Emergencies

Authors: Zahide Çiler Büyükatalay, Ahmed Majid Naji Agha Oghali, Sibel Yıldırım, Rıdvan Kılıç, Gürsel Dursun
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Abstract

Objectives: Ear, nose and throat (ENT) diseases are among the most common pathologies in the community, some of which may have high morbidity and mortality if early diagnosis and appropriate treatment approaches are not applied. Pediatric patients form an important part of emergency department admissions. The emergency diseases observed in children are different from the adult patient group and the diagnosis and treatment approaches differ accordingly. The aim of this study is to investigate the epidemiological features and approach methods among the pediatric patients presenting to the emergency department. Materials and Methods: Between 2016 and 2017, the data of 1732 patients younger than 18 years who were referred by the pediatric emergency to ENT department were retrospectively reviewed. Age, gender, admission Complaints, diagnosis, additional diseases, radiological and laboratory tests and treatment approaches were evaluated. Results: Among the patients included in the study, 751 were male (52.4%), 681 were female (47.5%); The average age was 7.2 years. Altı yüz seksen yedi (48.8%) patients were referred for rhinologic reasons, 515 (36.9%) patients had otologic complaints, while 73 (5.09%) patients had oral cavity and 44 (3.5%) patients had head and neck region related complains. The number of hospitalized patients was 41 (2.86%) patients. Yirmi dokuz (2.02%) patients were treated with surgical intervention. Conclusion: The majority of patients presenting with ENT related complains to pediatric emergency services may be examined and treated in the emergency unit without referring to ENT department. Most of the referred patients complain from simple trauma, minor epistaxis or simple infections. However, patients presenting with severe trauma or a foreign body that can cause aspiration should be evaluated as soon as possible and treated accordingly.

Keywords: Emergency, Pediatrics, Trauma, Foreign Body
Are Plasma Neutrophil Gelatinase Associated Lipocalin Levels Diagnostic in Uncomplicated Urinary Tract Infections?

Are Plasma Neutrophil Gelatinase Associated Lipocalin Levels Diagnostic in Uncomplicated Urinary Tract Infections?

Authors: Behnan Gülünay, Onur Polat, Ahmet Burak Oğuz, Arda Demirkan, Merve Ekşioğlu, Müge Günalp
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Abstract

Objectives: Acute uncomplicated lower urinary tract infections are among the most common causes for emergency department visits and empirical antibiotic prescriptions. The purpose of this study was to determine whether the serum levels of the neutrophil gelatinase associated lipocalin (NGAL) molecule were important in the diagnosis and follow-up of non-complicated lower urinary tract infections. Materials and Methods: This was a cross-sectional, prospective study conducted from September 15, 2013 to April 15, 2014 in an academic emergency department. Eighty patients were enrolled in the study group and 40 healthy subjects in the control group. The patients had acute uncomplicated lower urinary tract infections with pyuria detected in a complete urinary test. All of the patients had their leukocyte, neutrophil, C-reactive protein (CRP), erythrocyte sedimentation rate, and NGAL levels evaluated before and after the treatment, and correlation among these parameters were investigated. Results: In the study group, the plasma leukocyte, neutrophil, and CRP levels before the treatment were significantly higher compared to the aftertreatment period (p<0.001). There was no significant difference found between the before-treatment and after-treatment levels of serum NGAL (p=0.091). Conclusion: Measuring plasma leukocyte, neutrophil, and CRP levels can support the diagnosis for urinary tract infections. However, plasma NGAL levels are not useful parameters for diagnosing non-complicated lower urinary tract infections.

Keywords: Biomarkers for Infection, Neutrophil Gelatinase Associated Lipocalin, Urinary Tract Infections
Surgical Treatment in Bronchiectasis: Results of 191 Patients

Surgical Treatment in Bronchiectasis: Results of 191 Patients

Authors: Murat Özkan, Mehmet Ali Sakallı, Bülent Mustafa Yenigün, Gökhan Kocaman, Cabir Yüksel, Serkan Enön, Ayten Kayı Cangır, Şevket Kavukçu
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Abstract

Objectives: To investigate the long-term follow-up results of the patients who underwent surgery with bronchiectasis and whether there is a difference in clinical results compared to complete or incomplete resection. Materials and Methods: A total of 191 patients who underwent surgery with the diagnosis of bronchiectasis were enrolled in Ankara University Faculty of Medicine Department of Thoracic Surgery between 1990 and 2002. The age and the gender of the patients, preoperative symptoms, localization of disease, resection indications, type of resection, complications encountered in the postoperative period, operative mortality and the association between complete/incomplete resection and postoperative symptoms were evaluated, retrospectively. Results: The indications for surgery were failure of medical therapy in 181 patients (94.8%), massive hemoptysis in five (2.6%), lung abscess in three (1.6%) and bronchiectasis due to foreign body aspiration in two (1%). In the postoperative period, 173 patients could be followed up clinically and radiologically with an average of 4.6 years (1 month to 10 years). When complete resection and incomplete resection results were compared, of the 155 patients who underwent complete resection, 135 (87.1%) were asymptomatic, 18 (11.6%) had a significant regression, and two (1.3%) had no change of preoperative symptoms, of the 18 patients who underwent incomplete resection, 14 (77.8%) had a significant regression, while 4 (22.2%) had no change of preoperative symptoms. The results of complete resection were significantly better than those of incomplete resection (p<0.05). Conclusion: Symptomatic localized bronchiectasis cases are the most appropriate candidates for surgical treatment. Resection should be complete. Incomplete resection is the most important determinant in the continuation of symptoms after surgical treatment.

Keywords: Bronchiectasis, Surgical Treatment, Surgery
Acute Mesenteric Ischemia and Splenic Infarct After Coronary Bypass Surgery: An Analysis of 32 Patients

Acute Mesenteric Ischemia and Splenic Infarct After Coronary Bypass Surgery: An Analysis of 32 Patients

Authors: Çağdaş Baran, Mehmet Çakıcı, Evren Özçınar, Ali İhsan Hasde, Ömer Arda Çetinkaya, Serkan Durdu, Mustafa Bahadır İnan, Mustafa Şırlak, Ahmet Rüçhan Aka...
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Abstract

Objectives: Acute mesenteric ischemia and other end organ emboli are serious life-threatening complications after open-heart surgery. In this study, we evaluated the outcome of patients with mesenteric ischemia and splenic infarction after cardiac surgery. Materials and Methods: From January 2010 to November 2017, all patients (5607) who underwent open-heart surgery were analysed, and patients with registered acute mesenteric ischemia and splenic infarct (32) were retrospectively reviewed. Results: Five thousand six hundred and seven patients were included in this study, of which 32 (0.57%) patients suffered from acute mesenteric ischemia and splenic infarct. Intraoperatively, splenic infarction was detected in six patients who were pre-diagnosed as mesenteric ischemia. In these patients, the symptoms completely improved after the splenectomy and all the patients survived. Only two of 26 patients were survived after segmentary bowel resection. Overall mortality was 24 (%75). Age (p=0.03), need for dialysis (p=0.01), emergency cardiac operation (p=0.05), peripheral arterial disease (p=0.001), and high risk Euroscore (p=0.0001) were significantly different compared to the control group. Mesenteric ischemia was significantly higher in off- pump coronary artery bypass patients (p=0.0001). The time of cardiopulmonary bypass in mesenteric ischemia group was significantly higher than the control group (p=0.0001). Conclusion: Acute mesenteric ischemia is still highly mortal, after cardiac surgery. Splenic infarct symptoms may mimic mesenteric ischemia. Mesenteric ischemia is more common in high-risk cardiac operations. Prompt diagnosis and treatment can be life-saving.

Keywords: Mesenteric Ischemia, Splenic Infarction, Cardiac Surgery
Case Report and Review of Literature: Patient with Malignant Pheochromocytoma

Case Report and Review of Literature: Patient with Malignant Pheochromocytoma

Authors: Mustafa Gürbüz, Neslihan Özyurt, Akın Fırat Kocaay, Çiğdem Soydal, Filiz Çay Şenler
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Abstract

Pheochromocytomas are catecholamine-secreting neuroendocrine tumors that arise from chromaffin cells of the adrenal medulla. At least 10 percent of pheochromocytomas are malignant. A diagnosis of malignant pheochromocytoma can only be made by identifying tumor deposits in tissues that do not normally contain chromaffin cells. The clinical course of malignat pheochromocytoma is highly variable, with reported five-year survival rates that range widely from 12 to 84 percent. We report a rare case of a 38-year-old female who have malignant pheochromocytoma. We review the classic and current literature regarding management of this uncommon tumor.

Keywords: Malignant Pheochromocytoma, Treatment, Adrenal, Neuoroendocrine

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