[Show abstract][Hide abstract] ABSTRACT: Surgery is regarded as a common treatment option for patients with mesial temporal lobe epilepsy due to hippocampal sclerosis but sometimes deciding this diagnosis can be very difficult. We aim to investigate the shape differences in the temporal lobe of mesial temporal sclerosis epilepsy patients compared with healthy controls, investigating the side difference and, if present, assessing the clinical application of this situation.
The MRI scans of mesial TLE patients and controls were retrospectively reviewed. Temporal lobe data were collected from the two-dimensional digital images. Standard anthropometric landmarks were selected and marked on each digital image using TPSDIG 2.04 software. Eight anatomic landmarks were marked on images. A generalized Procrustes analysis was used to evaluate the shape difference. The shape deformation of the temporal lobe from control to patient was evaluated using the TPS method.
There were statistically significant TL shape differences between groups. High level deformations for the left and right side from the control to patient group were seen in the TPS graphic. The highest deformation was determined at the inferior lateral temporal midpoint of the middle temporal gyri and superior temporal landmark points of both the right and left sides.
Our study for the first time demonstrated temporal shape differences in TLE patients using a landmark-based geometrical morphometric method by taking into consideration the topographic distribution of TL.
[Show abstract][Hide abstract] ABSTRACT: This study aimed to investigate the effectiveness and additive value of T2W 3-dimensional sampling perfection with application optimized contrast (3D-SPACE) with variant flip-angle mode in imaging of all types of hydrocephalus. Our secondary objective was to assess the reliability of 3D-SPACE sequence and correspondence of the results with phase-contrast magnetic resonance imaging (PC-MRI)-based data.
Forty-one patients with hydrocephalus have undergone 3-T MRI. T2W 3D-SPACE sequence has been obtained in addition to routine hydrocephalus protocol. Cerebrospinal fluid circulation, presence/type/etiology of hydrocephalus, obstruction level scores, and diagnostic levels of confidence were evaluated separately by 2 radiologists. In the first session, routine sequences with PC-MRI were evaluated, and in another session, only 3D-SPACE and 3-dimensional magnetization prepared rapid acquisition gradient echo sequences were evaluated. Results obtained in these sessions were compared with each other and those obtained in consensus session.
Agreement values were very good for both 3D-SPACE and PC-MRI sequences (P < 0.001 for all). Also, the correlation of more experienced reader's 3D-SPACE-based scores and consensus-based scores was perfect (κ = 1, P < 0.001).The mean value of PC-MRI-based confidence scores were lower than those obtained in 3D-SPACE and consensus sessions.
T2W 3D-SPACE sequence provides morphologic cerebrospinal fluid flow data. It is a noninvasive technique providing extensive multiplanar reformatted images with a lower specific absorption rate. These advantages over PC-MRI make 3D-SPACE sequence a promising tool in management of patients with hydrocephalus.
[Show abstract][Hide abstract] ABSTRACT: Object:
The goal of this study was to determine the value of the 3D sampling perfection with application-optimized contrasts using different flip-angle evolutions (3D-SPACE) technique in the evaluation of endoscopic third ventriculostomy (ETV) patency.
Twenty-six patients with ETV were examined using 3-T MRI units. Sagittal-plane 3D-SPACE with variant flip-angle mode, 3D T1-weighted (T1W), and 3D heavily T2-weighted (T2W) images were obtained with isotropic voxel sizes. Also, sagittal-axial plane phase-contrast cine (PC)-MR images were obtained. The following findings were evaluated: diameters of stoma and third ventricle, flow-void sign on 3D-SPACE and PC-MR images, integrity of the third ventricle on heavily T2W images, and quantitative PC-MRI parameters of the stoma. Obtained sequences were evaluated singly, in combination with one another, and all together.
The mean area, flow, and velocity values measured at the level of stoma in patients with patent stoma were significantly higher than those measured in patients with closed stoma (p < 0.05). There was significant correlation among PC-MRI, 3D-SPACE, and 3D heavily T2W techniques regarding assessment of ETV patency (p < 0.001). The 3D-SPACE technique provided the lowest rate of ambiguous results.
The 3D-SPACE technique seems to be the most efficient one for determination of ETV patency. The authors suggest the use of 3D-SPACE as a stand-alone first-line sequence in addition to routine brain MRI protocols in assessing patients with ETV, thereby decreasing scan time and reserving the use of a combination of additional sequences such as PC-MRI and 3D heavily T2W images in suspicious or complex cases.
Journal of Neurosurgery 04/2015; 122(6):1-9. DOI:10.3171/2014.10.JNS14298 · 3.74 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
Myeloproliferative disorders (MPDs) are clonal hematologic malignancies originating at the level of the pluripotent hematopoietic stem cell. Matrix metalloproteases (MMPs) are proteolytic enzymes that contribute to all stages of malignancy progression. Genetic variants in the MMP genes may influence the biological function of these enzymes and change their role in carcinogenesis and progression. To our knowledge, this is the first investigation of associations between the -735 C/T and -1562 C/T polymorphisms in the MMP2 and MMP9 genes, respectively, and the risk of essential thrombocytosis (ET), and polycythemia vera (PV).
Materials and methods:
The case-control study included JAK2V617F mutation positive 102 ET and PV patients and 111 controls. Polymorphisms were determined by using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and electrophoresis.
No statistically significant differences were detected between patient (ET+PV) and control groups regarding genotype distribution for MMP2 gene-735 C/T and MMP9 gene -1562 C/T polymorphisms and C/T allele frequency (p>0.050). Statistically borderline significance was observed between PV and control groups regarding genotype distribution for the MMP9 gene -1562 C/T polymorphism (p=0.050, OR=2.26, 95%Cl=0.99-5.16).
Consequently this study supported that CC genotype of MMP9 gene -1562 C/T polymorphism may be related with PV even if with borderline significance.
Asian Pacific journal of cancer prevention: APJCP 02/2015; 16(2):443-449. DOI:10.7314/APJCP.2015.16.2.443 · 2.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: In 70% of patients with cervical dystonia (CD), the clinical presentation includes the symptom of pain. In this study, we aimed to define the types and clinical characteristics of the pain and to investigate whether this pain is a result of central sensitization by evaluating pre- and post-botulinum toxin (BoNT) treatment pain threshold values using electrical stimulation. Methods: The study enrolled a total of 35 patients with CD who received BoNT therapy. The patients were evaluated using the pain evaluation scale and Unified Dystonia Rating scale (UDRS) before and after BoNT therapy. The pain threshold values obtained from dystonic muscles, the contiguous or contralateral muscle without dystonic activity and a normal reference muscle with distant localization were recorded through electrical stimulation with EMG guidance, and all values obtained before and after BoNT therapy were compared. Results: No difference was found between the pain threshold values obtained from dystonic muscles before and after treatment. While no difference was observed across genders or VAS groups in terms of pain threshold values, the UDRS (duration and motor severity factor) scores showed significant decreases after treatment with BoNT in patients with painful dystonia and in patients with painless dystonia. Conclusions: The absence of a difference in pre- and post- BoNT treatment pain threshold values in dystonic muscles might be explained by the absence of central sensitization. Pain relief in dystonic patients might occur secondary to decreases in dystonic muscle contractions.
[Show abstract][Hide abstract] ABSTRACT: Introduction:
Recent studies report reduced vascular compliance and elevated levels of fibroblast growth factor 23 (FGF23) in patients with autosomal dominant polycystic kidney disease (ADPKD) and preserved kidney function. In the present study, we investigated the relationship between vascular compliance and FGF23 in patients in early phases of ADPKD.
Materials and methods:
We studied 54 ADPKD patients with preserved kidney function and 24 healthy individuals. All participants underwent noninvasive pulse wave analysis in order to determine large arterial elasticity index (LAEI) and small arterial elasticity index (SAEI) using a modified Windkessel model. Levels of FGF23 in addition to several cardiovascular risk factors were evaluated. Linear regression analyses were performed to determine independent correlates of LAEI, SAEI, and FGF23.
In the ADPKD group, 33 patients were hypertensive and the remaining patients were normotensive. Serum FGF23 levels of both ADPKD groups were significantly higher than that in the controls. Both hypertensive and normotensive ADPKD patients had lower LAEI and SAEI levels compared to the controls. There was no significant correlation between vascular compliance parameters and FGF23 levels. Having ADPKD was independently associated with increased FGF23 levels and decreased SAEI.
Fibroblast growth factor 23 was found substantially elevated and arterial compliance was found significantly decreased in early ADPKD patients regardless of hypertension. However, there was no significant correlation between FGF23 levels and arterial function parameters. Additional studies are required to determine possible mechanisms of these disturbances and cardiovascular effects of FGF23 in ADPKD patients.
[Show abstract][Hide abstract] ABSTRACT: Background
Nasal congestion that is not present before pregnancy represents a distinct clinical entity called pregnancy rhinitis. The aim of this study is to evaluate the clinical characteristics of nasal physiology over the course of pregnancy.Methods
The study was conducted with 85 pregnant women and 26 nonpregnant controls. We measured nasal airway patency objectively via acoustic rhinometry (ARM) and anterior rhinomanometry (RMM) and subjectively via the Nasal Obstruction Symptom Evaluation (NOSE) scale in each trimester and compared the results to those of the controls.ResultsThe NOSE scores of control and pregnant women showed no difference (p = 0.866). Minimal cross-sectional area (MCA1; minimal cross sectional area at nasal valve and MCA2; minimal cross sectional area at the level where the head of inferior turbinate is placed) decreased significantly between the first and third trimesters: first trimester 0.37 cm2, third trimester 0.31 cm2. There was no difference between each trimester with regard to total nasal resistance. The correlation analysis between the NOSE score and both total volume and MCA1 in all patients showed no significance (r = −0.10, p = 0.318; r = −0.04, p = 0.654, respectively).Conclusion
Pregnancy affects nasal physiology adversely and impairs nasal breathing in some women. However, based on the findings of this study, we concluded that this clinical entity may not be considered as a disease without complementary symptoms despite the presence of objective changes in nasal parameters.
International Forum of Allergy and Rhinology 10/2014; 5(2). DOI:10.1002/alr.21438 · 2.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the role of adiponectin and visfatin in the pathophysiology of pre-eclampsia (PE) and how their concentrations correlate with the severity of the disease and neonatal outcomes.
A prospective case-control study was carried out in 52 preeclamptic and 28 healthy pregnant women during the third trimester. The maternal plasma concentrations of adiponectin and visfatin were determined. Neonatal outcomes were also recorded.
Mean maternal plasma adiponectin concentrations in healthy pregnant women did not differ significantly from those of mild PE and severe PE groups. The plasma adiponectin levels of PE patients with small for gestational age (SGA) and those without SGA did not differ significantly, but the median plasma visfatin concentration of patients with SGA fetus was significantly higher if the patient was preeclamptic (p = 0.036).
The severity of preeclampsia did not change the plasma levels of adiponectin and visfatin, but the median plasma visfatin concentration of patients with SGA fetuses were significantly higher if the patient was preeclamptic. Altered levels of adipocytokines strongly imply that the regulation of adipocytokines in PE is different and more complex compared to that in healthy pregnancy.
[Show abstract][Hide abstract] ABSTRACT: To compare the efficacy and patients' tolerance of a new mixed biphasic oral contrast solution with routine biphasic oral contrast agent in magnetic resonance (MR) enterography (MRE).
Thirty-seven patients (group 1) had MRE with the new mixture, whereas 14 patients (group 2) had MRE with biphasic oral contrast agent (lactulose). Magnetic resonance enterography images were evaluated by 2 experienced radiologists. Each intestinal segment was evaluated for luminal distension (LD), distinction from the surrounding tissue (wall conspicuity), and the confidence of radiologist for evaluation of the specified segment (radiological evaluation confidence). Comparisons between the 2 groups were performed using the Mann-Whitney U test. Interrater and intrarater agreement values were obtained. In addition, patients' acceptability and tolerance were assessed.
The new mixture was more effective than the oral contrast agent used in group 2 for LD, wall conspicuity, and radiological confidence. The values of interrater and intrarater agreement in scoring LD, wall conspicuity, and radiological confidence were generally moderate.
Our new mixture allowed good-quality enterographic images, and this solution was well tolerated by patients. In addition, this mixture is useful for evaluation of small bowels and colonic segments. We suggest the use of it for enterographic examinations.
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: Cardiovascular problems are a major cause of morbidity and mortality in patients with autosomal dominant polycystic kidney disease (ADPKD). Our knowledge about cardiovascular events after renal transplantation in ADPKD patients are limited. This study aimed to compare arterial stiffness and cardiovascular risks in renal transplant recipients (RTRs) with and without ADPKD. MATERIAL and METHODS: 29 control patients with normal coronary angiography, 22 RTRs without ADPKD and 12RTRs with ADPKD were studied. Arterial elasticity was determined by applanation tonometry in all participants. RESULTS: Age, height, weight, waist measurement, small artery elasticity index(SAEI) and fasting blood glucose were signifi cantly lower in patients with a kidney transplant (n=34) than in control subjects. Duration of dialysis before transplantation, family history of coronary artery disease, and mean age were signifi cantly higher in ADPKD compared to non ADPKD transplant patients. Arterial elasticity measurements (SAEI, LAEI) were the same in the two groups. CONCLUSION: SAEI levels were significantly lower in RTRs compared with the control group. However, the presence of ODPBH did not affect measurements of arterial stiffness in this population.
[Show abstract][Hide abstract] ABSTRACT: Radiofrequency ablation (RFA) of the inferior turbinates is a popular surgical intervention that aims to reduce turbinate volume. However, in a few studies, the amount of volume loss was analyzed objectively.
The aim of this study was to investigate the effects of RFA on the inferior turbinate by comparing its volume before and 6 weeks after surgery via computed tomography (CT) and the change in minimal cross-sectional areas (MCAs) via acoustic rhinometry objectively.
Eighteen patients who underwent RFA with the diagnosis of isolated bilateral inferior turbinate hypertrophy were enrolled in the study. All patients were evaluated pre- and postoperatively with paranasal CT and acoustic rhinometry quantitatively for the assessment of inferior turbinate volume decrement and nasal cavity volume increment. Also, the subjective relief of obstructive symptoms was assessed with a visual analogue scale.
There were significant reductions in volume for both right and left turbinates in the tomographic evaluation (p = .007 and .004, respectively). Acoustic rhinometry revealed nonsignificant increments for both MCA1 and MCA2 values except MCA2 of the right side. We also indicated a statistically significant correlation between the mean volume reduction in CT and improvement in mean MCA2 volume (2 to 5 cm from the nostril) obtained from acoustic rhinometric data in 36 turbinates (r = .337, p = .044).
We showed that the use of RFA was highly effective in both reducing turbinate volume (demonstrated by radiologic findings and rhinometric analysis) and improving obstructive symptoms in patients with an isolated inferior turbinate.
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 08/2012; 41(4):274-81. DOI:10.2310/7070.2012.00036 · 0.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: An activating mutation of Janus kinase 2 (JAK2-V617F) was previously described in chronic myeloproliferative disorders (MPD). In previously published studies, the frequency of the JAK2-V617F mutation was determined to be 80-90 % for patients with polycythemia vera (PV) and 40-70 % for essential thrombocythemia (ET). In this study, we analyzed the relationship between the JAK2-V617F mutation and clinical-hematological parameters in Turkish patients with MPD and compared these findings with published studies from other geographic regions. A total of 148 patients were studied; of which, 70 were diagnosed with PV and 78 with ET. The mutation status of JAK2 was determined using a tetra-primer polymerase chain reaction. We found that 80 % of the PV group and 42 % of the ET group were positive for the JAK2-V617F mutation. When all patients were analyzed, the levels of white blood cells, hemoglobin and splenomegaly were significantly different in patients with the JAK2-V617F mutation (p < 0.05). To our knowledge, this study is the first to evaluate the relationship between MPD and JAK2-V617F in Turkish patients. The JAK2-V617F mutation is frequently detected in the Turkish patients with MPD, and especially in patients with PV. Hence, it would be useful to include JAK2 mutation screening in the initial evaluation of patients suspected to have MPD.
[Show abstract][Hide abstract] ABSTRACT: Polymorphisms in the X-ray repair cross complementing 1 (XRCC1) gene have been found to be associated with susceptibility to various types of cancers. We investigated the association between the XRCC1 gene Arg399Gln polymorphism and the susceptibility to lung cancer in Turkish patients. To determine the association of this polymorphism with the risk of lung cancer in Turkish patients, a hospital-based case-control study was designed, involving 67 patients with lung cancer and 60 control subjects with no cancer history who were matched for age and gender. XRCC1 genotypes (Arg/Arg, Arg/Gln, and Gln/Gln) were determined using polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP) analysis on genomic DNA. No statistically significant relationship was determined between the lung cancer and control groups (p>0.05). Among the patients, 61% were Arg/Arg, 28% were Arg/Gln, and 11% were Gln/Gln. Among the controls, 50% were Arg/Arg, 38% were Arg/Gln, and 12% were Gln/Gln. There was no difference in the distribution of XRCC1 genotypes or the frequencies of the Arg (75% versus 69%) and Gln (25% versus 31%) alleles between the lung cancer patients and controls. Our results suggest that the XRCC1 gene Arg399Gln polymorphism is not associated with an increased risk for the development of lung cancer in Turkish patients.
[Show abstract][Hide abstract] ABSTRACT: To evaluate and compare the effectiveness of magnesium sulfate (MgSO(4)) and mannitol in the treatment of posterior reversible encephalopathy syndrome (PRES) in eclamptic women.
This retrospective analysis includes 62 eclamptic women between 22 and 40 weeks of gestation who were diagnosed with PRES in a tertiary care center. To treat neurological symptoms, 34 women received magnesium sulfate (Group 1) and the remaining 28 received 20% mannitol (Group 2) at the discretion of treating physician.
Ten patients from both Group 1 (29%) and Group 2 (35.7%) were normotensive at admission. 59 of 62 patients presented with seizure. All patients underwent fluid attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI). Parietooccipital region and cerebellum were the most commonly affected areas. The duration of treatment was significantly shorter in Group 1 than Group 2 (p < 0.001). Neurological examinations and the recovery after treatment were significantly better in favor of MgSO(4) group (p = 0.039).
Mannitol is not superior to magnesium sulfate in achieving neurological recovery. Magnesium sulfate seems to be the agent of choice for treatment of PRES.
Archives of Gynecology 03/2012; 286(2):287-93. DOI:10.1007/s00404-012-2268-8 · 1.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: PURPOSE: This prospective study aimed to evaluate the use of three-dimensional sampling perfection with application-optimized contrasts using different flip-angle evolutions (3D-SPACE) in the diagnosis of spontaneous third ventriculostomy (STV) and to compare it with phase-contrast cine magnetic resonance imaging (PC-MRI). METHODS: PC-MRI and 3D-SPACE images were obtained in 15 patients with hydrocephalus for evaluation of STV as well as in 10 control cases. The presence of STV was evaluated visually by two experienced radiologists on both PC-MRI and 3D-SPACE images, and the results were statistically compared. RESULTS: There was a strong correlation between PC-MRI and SPACE scores for both readers (correlation coefficient [r]=0.784; P=0.001). There was also a good correlation between PC-MRI scores and consensus-based results. Interobserver reliabilities were strong for all STV scores. In addition, there was excellent correlation between 3D-SPACE scores and consensus-based results (first reader's kappa value: 0.87; second reader's kappa value: 1). CONCLUSION: 3D-SPACE can provide morphological-physiological information for the evaluation of STV with no need for additional PC-MRI analysis or other sequences. As a non-invasive test, it can also be included among the first line of choices of MRI sequences for patients with obstructive hydrocephalus.
Journal of Neuroradiology 02/2012; 40(1). DOI:10.1016/j.neurad.2011.12.003 · 1.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We investigated the effects of short-term use of atorvastatin on CD34+/VEGF-R2+/CD133+/CD45- endothelial progenitor cell (EPC) count after on-pump coronary artery bypass surgery (CABG).
Between Feb-2010 and May-2010, we randomly assigned, in a placebo-controlled, double-blind study, 60 consecutive patients who underwent isolated, first-time CABG to receive either 14-day atorvastatin (40 mg/day) or placebo preoperatively. Urgent CABG and recent myocardial infarction were excluded. EPCs were quantified (cells/μl) by flow cytometric phenotyping obtained from venous blood samples collected preoperatively (T(1)), 6-hours (T(2)), and on the 5th day postoperatively (T(3)). Levels of markers of inflammation and serum cardiac troponin I were also measured preoperatively and daily until day-5 after surgery.
There were no differences in baseline risk factors including cholesterol profiles, and EuroSCORES between the groups. The composite primary end-point, favored statin group with higher amount of circulating, early EPC count (cells/μl) at all time points compared with placebo (T(1), 2.30±0.02 versus 1.58±0.03, p<0.001; T(2), 5.00±0.06 versus 2.19±0.06, p<0.001; T(3), 3.03±0.08 versus 1.78±0.02, p<0.001). Postoperative hsCRP rise were inversely correlated with EPC count, and were significantly lower in the statin group (T(1), 0.8 ± 0.1 versus 2.2±1.5, p<0.001; T(2), 72.9±3.2 versus 96.0±3.6, p<0.001; T(3), 4.3±1.2 versus 11.4±4.1, p<0.001). Furthermore, the incidence of postoperative atrial fibrillation was significantly lower in the statin group compared to placebo (3.3% versus 23%, p=0.02).
Short-term atorvastatin use increases circulating early EPCs both pre- and post-operatively and is associated with better preservation of sinus rhythm and reduced hsCRP levels. (ClinicalTrials.gov number, NCT01096875).
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to describe the magnetic resonance imaging (MRI) findings in patients with ischiofemoral impingement (IFI) and to evaluate the reliability of these MRI findings.
Seventy hips of 50 patients with hip pain and quadratus femoris muscle (QFM) edema and 38 hips of 30 control cases were included in the study. The QFM edema and fatty replacement were assessed visually. Ischiofemoral space (IFS), quadratus femoris space (QFS), inclination angle (IA), hamstring tendon area (HTA), and total quadratus femoris muscle volume (TQFMV) measurements were performed independently by two musculoskeletal radiologists. The intra- and interobserver reliabilities were obtained for quantitative variables.
IFS, QFS, and TQFMV values of the patient group were significantly lower than those of controls (P < 0.001). HTA and IA measurements of the patient group were also significantly higher than in controls (P < 0.05). The QFM fatty replacement grades were significantly higher in the patient group than in the control group (P < 0.001). Inter- and intra-observer reliabilities were strong for all continuous variables.
Clinicians and radiologists should be aware of IFI in patients with hip or groin pain, and MRI should be obtained for the presence of the QFM edema/fatty replacement, narrowing of the IFS-QFS, and other features that may help in the clinical diagnosis of IFI for the proper diagnosis and treatment of the disease.