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8. Bilateral posteroventral GPi-DBS in a patient with tourette's syndrome - A rapidly effective but under-utilized therapy

Author

Onder, Halil, Kertmen, Hayri, Kocer, Bilge, Ercan, Elif, and Comoglu, Selcuk

Subjects
Tourette's syndrome -- Care and treatment, Health
Abstract

Byline: Halil. Onder, Hayri. Kertmen, Bilge. Kocer, Elif. Ercan, Selcuk. Comoglu Dear Editor, Tourette syndrome (TS) is defined as a childhood neurobehavioral disorder that is characterized by the presence of [...]

Published
2023

11. The overlap in neuroimaging findings between idiopathic normal pressure hydrocephalus and progressive supranuclear palsy

Author

Önder, Halil, Kocer, Bilge, Turan, Aynur, Kertmen, Hayri, and Comoglu, Selcuk

Subjects
Diagnosis, Differential -- Methods, Hydrocephalus -- Diagnosis, Neuroimaging -- Methods, Progressive supranuclear palsy -- Diagnosis, Health
Abstract

Byline: Halil. Önder, Bilge. Kocer, Aynur. Turan, Hayri. Kertmen, Selcuk. Comoglu Background: The neuroimaging findings of brain stem atrophy resembling progressive supranuclear palsy (PSP) radiology are common in idiopathic normal [...]

Published
2022

14. The detailed Investigation of eyelid-opening apraxia after subthalamic nucleus deep brain stimulation

Author

Comoglu, Selcuk, Kocer, Bilge, Kertmen, Hayri, and Onder, Halil

Subjects
Eyelids -- Case studies -- Health aspects, Apraxia -- Case studies -- Causes of, Brain stimulation -- Case studies -- Complications and side effects, Health
Abstract

Byline: Selcuk. Comoglu, Bilge. Kocer, Hayri. Kertmen, Halil. Onder Letter to Editor, A-67-year-old right-handed male patient with akinetic rigid Parkinson's disease (PD) had undergone subthalamic nucleus deep brain stimulation (STN-DBS) [...]

Published
2022

19. Metastatic diffuse follicular variant papillary thyroid cancer without cervical lymph node metastasis presenting with symptoms related to hypopituitarism

Author

Kızılgül, Muhammed, primary, Bayır, Ömer, additional, Uçan, Bekir, additional, Akhanlı, Pınar, additional, Düğer, Hakan, additional, Sencar, Muhammed Erkam, additional, Kertmen, Hayri, additional, Yılmazer, Demet, additional, Yazılıtaş, Doğan, additional, Saylam, Güleser, additional, Korkmaz, Mehmet Hakan, additional, and Çakal, Erman, additional

Published
2023
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20. A rare cause of thyrotoxicosis: TSH-secreting pituitary adenoma

Author

Çalapkul, Murat, Sencar, Muhammed Erkam, Ünsal, İlknur Öztürk, Kayıhan, Serdar, Kızılgül, Muhammed, Özbek, Mustafa, Kertmen, Hayri, and Çakal, Erman

Subjects
Thyrotoxicosis, Tiroid stimulan hormon salgılayan hipofizer adenom, Tirotoksikoz, Oktreotid, Octreotide, Hyperthyroidism, Hipertiroidi, Thyroid stimulating hormone secreting pituitary adenoma
Abstract

Bu çalışma,18-22 Mayıs 2022 tarihlerinde Antalya’da düzenlenen 43. Türkiye Endokrinoloji ve Metabolizma Hastalıkları Kongresi‘nde bildiri olarak sunulmuştur. Tiroid stimüle edici hormon (TSH) salgılayan hipofiz adenomu (TSHoma) tirotoksikozun nadir görülen sebeplerinden biridir. Tanı genellikle uygunsuz TSH yüksekliğinin araştırılması ya da hipofizer insidentalomanın tetkiki sırasında konulmaktadır. Olgumuz bilinen poliskistik over sendromu olan 26 yaşında kadın hasta olup altı aydır olan titreme, terleme ve baş ağrısı yakınmalarıyla kliniğimize başvurdu. Laboratuvar analizlerinde serum serbest T3 ve T4 düzeyi yüksek iken TSH düzeyi normal sınırlarda saptandı. Seks hormonu bağlayıcı globülin (SHBG) düzeyi normal sınırlardaydı Manyetik rezonans görüntüleme sonucunda hipofiz bezinde makradenom izlendi. TRH uyarı testine TSH yanıtı saptanmadı. TSHoma tanısı alan hastada preoperatif oktreotid ve metimazol tedavisi ile ötiroidizm sağlandıktan sonra hipofiz cerrahisi uygulandı. Cerrahi materyalin histopatolojik incelemesinde fibrotik değişikliklerle birlikte prolaktin ile pozitif, TSH ile negatif boyanma izlendi. Bu olgu sunumunda SHBG düzeyi normal ve TSH boyaması negatif olmasına rağmen uygunsuz TSH salınımı nedeniyle TSHoma tanısı alan bir hastayı sunmayı amaçladık. Thyroid-stimulating hormone (TSH) secreting pituitary adenoma (TSHoma) is one of the rare causes of thyrotoxicosis. The diagnosis is usually made during investigating inappropriate TSH elevation or pituitary incidentaloma. Our patient, a 26-year-old female patient, known to have polycystic ovary syndrome, was admitted to our clinic with complaints of tremor, sweating, and headache for six months. Laboratory analysis showed serum free T3 and T4 levels were elevated, while TSH levels were within normal limits. Sex hormone binding globulin (SHBG) level was within normal limits. Macroadenoma was observed in the pituitary gland at magnetic resonance imaging. TSH secretion did not increase much in response to the thyrotropin-releasing hormone. The patient was diagnosed with TSHoma, and pituitary surgery was performed after euthyroidism was achieved with preoperative octreotide and methimazole treatment. Positive staining with prolactin and negative staining with TSH were observed along with fibrotic changes in the histopathological examination of the surgical material. We aimed to present a patient diagnosed with TSHoma due to inappropriate TSH secretion, although her SHBG level was normal and TSH staining was negative in the current case report.

Published
2022

23. Endonasal endoscopic approach for sellar metastatic pathologies: a national observation

Author

Kahilogullari, Gokmen, primary, Bayatli, Eyup, additional, Geyik, Murat, additional, Cabuk, Burak, additional, Beton, Suha, additional, Gunaldi, Omur, additional, Tanrıverdi, Osman, additional, Cetinalp, Nuri Eralp, additional, Tarkan, Ozgur, additional, Yıldırım, Ali Erdem, additional, Guner, Yahya Efe, additional, Nehir, Ali, additional, Goksu, Ethem, additional, Akyuz, Mahmut, additional, Isikay, İlkay, additional, Duz, Bulent, additional, Celtikci, Emrah, additional, Kertmen, Hayri, additional, Köktekir, Ender, additional, Camlar, Mahmut, additional, Bahçecioğlu Mutlu, Adile Begüm, additional, Cansız Ersoz, Cevriye, additional, Bozdag, Sinem Civriz, additional, Berker, Mustafa, additional, and Ceylan, Savas, additional

Published
2022
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28. Endonasal endoscopic approach for sellar metastatic pathologies: a national observation.

Author

Kahilogullari, Gokmen, Bayatli, Eyup, Geyik, Murat, Cabuk, Burak, Beton, Suha, Gunaldi, Omur, Tanrıverdi, Osman, Cetinalp, Nuri Eralp, Tarkan, Ozgur, Yıldırım, Ali Erdem, Guner, Yahya Efe, Nehir, Ali, Goksu, Ethem, Akyuz, Mahmut, Isikay, İlkay, Duz, Bulent, Celtikci, Emrah, Kertmen, Hayri, Köktekir, Ender, and Camlar, Mahmut

Subjects
PATHOLOGY, ENDOSCOPIC surgery, METASTASIS, CRANIAL nerves, SYMPTOMS, NASAL tumors
Abstract

Sellar metastases are rare lesions. Recent improvements in diagnosis and treatment strategies have prolonged survival but increased the probability of metastatic tumors. Evaluation with clinical symptomatology and meticulous laboratory examination is crucial. We present our multicenter national study on sellar metastases to evaluate and underline the main clinical, endocrine, and radiological considerations regarding the diagnosis and endonasal endoscopic management of such rare lesions. A medical literature-based retrospective study was planned across 13 neurosurgical centers in Turkey, where a data survey was conducted to collect information regarding sellar metastases surgically treated using the endoscopic endonasal approach, including clinical presentation, radiographic features, primary tumor origin, histopathological confirmation, time to metastasis, treatment, and patient outcomes. Between 2010 and 2020, 54 patients (22 women [40.7%] and 32 men [59.3%]) who underwent surgery with the endonasal endoscopic approach and had pathologically proven sellar metastases (overall incidence, 0.54%) were included. Of the patients, 59.3% had no known malignancy and presented with new-onset symptoms, 79.6% reported headache, 51.9% complained of some degree of visual deficits, and 50% had cranial nerve symptoms. Tissue biopsy was performed in 7.4% of the patients, whereas gross or subtotal resection was achieved in the remaining patients. To our knowledge, this is the largest series of patients surgically treated with the endonasal endoscopic approach for sellar metastases. For these patients, the treatment focus should be on management modalities for increasing quality of life instead radical treatment options with survival benefit. [ABSTRACT FROM AUTHOR]

Published
2023
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36. Ischemia Modified Albumin Levels in Spinal Cord Ischemia/Reperfusion Injury: an Experimental Study

Author

Uzun, Özlem, Menteşe, Ahmet, Türedi, Süleyman, Gürer, Bora, Kertmen, Hayri, Hasanbaşoğlu, Altuğ, Yılmaz, Erdal Reşit, Uzun, Özlem, Menteşe, Ahmet, Türedi, Süleyman, Gürer, Bora, Kertmen, Hayri, Hasanbaşoğlu, Altuğ, and Yılmaz, Erdal Reşit

Abstract

Giriş: Spinal kord iskemi/reperfüzyon hasarında iskemi nedenli oksidatif stres önemli yer teşkil eder. Ischemia-modifiye albumin (IMA), yeni kullanıma giren, iskemi ve oksidatif stresin duyarlı bir biyomarkırı olup, daha önce iskemik spinal kord hasarında çalışılmamıştır. Bu çalışmada deneysel spinal kord iskemi hasarında IMA düzeylerindeki değişikler incelendi. Metod: Elliüç adet yetişkin, erkek, 2,5-3 kg ağırlıklarında, Yeni Zelanda tavşanına aort oklüzyon metodu kullanılarak spinal kord iskemisi oluşturuldu. Denekler 10 gruba (sham, iskemi ve değişik zaman aralıklarında iskemi/reperfüzyon yapılan gruplar ve kontrolleri) ayrıldı. IMA, doku ve kan malondialdehyde (MDA) ve myeloperoxidase (MPO) aktivite düzeyleriyle histopatolojik hasar skorları karşılaştırıldı. Bulgular: IMA düzeylerinin iskemiyi takiben hızlı bir şekilde arttığı gözlemlendi. Reperfüzyonu takiben ise kontrol gruplarıyla aynı düzeye düştüğü izlendi. Serum IMA düzeylerinin zamanla yükseldiği kontrol ve I/R grupları karşılaştırıldığında görüldü. Ancak IMA düzeyleriyle kan ve doku MDA ve MPO düzeyleri arasında korelasyon tespit edilmedi (tüm kıyaslamalar için p>0,05). Histopatolojik skorlar ile serum IMA ve MDA düzeyleri arasında düşük korelasyon görüldü. Sonuçlar: Bu çalışmanın sonuçlarında spinal kord iskemi/reperfüzyon hasarında yüksek IMA düzeyleri tespit edildi. Yüksek IMA düzeylerinin spinal kord iskemisinin ve komplikasyonun bir göstergesi olabileceği sonucuna varıldı., Background: Spinal cord ischemia/reperfusion (I/R) injury involves evident ischemia- mediated oxidative stress. Ischemia-modified albumin (IMA) has emerged as a novel and sensitive ischemia and oxidative stress biomarker, although it has not been previously investigated in ischemic spinal cord injury (SCI). This study was therefore intended to investigate serum IMA levels in a rabbit model of experimentally induced ischemic SCI. Method: Spinal cord ischemia was induced in 53 mature, male New Zealand rabbits weighing 2.5-3 kg using the aortic occlusion model. Animals were divided into 10 groups (sham, ischemia and different duration I/R groups and their respective controls). IMA, tissue and blood malondialdehyde (MDA), tissue and blood myeloperoxidase (MPO) activity levels and histopathological damage scores were then compared. Results: Ischemia-modified albumin levels rose rapidly when ischemia was induced to the spinal cord. They then declined to levels similar to those of the control groups when reperfusion was established. Serum IMA levels exhibited a tendency to rise over time in both the control and I/R groups compared to the sham group. We observed no correlation between IMA levels and blood and tissue MDA and MPO levels (p;gt;0.05 for all correlations). We determined only a low correlation between histopathological score and serum IMA and MDA levels. Conclusions: The results from this pioneering study identified a high level of IMA in spinal cord I/R injury, indicating that IMA is a potentially valuable diagnostic or predictive technique for ischemic SCI and its complications.

Published
2021

37. Ischemia Modified Albumin Levels in Spinal Cord Ischemia/Reperfusion Injury: an Experimental Study

Author

Gürer, Bora, Menteşe, Ahmet, Hasanbaşoğlu, Altuğ, Kertmen, Hayri, Türedi, Süleyman, Uzun, Özlem, Yılmaz, Erdal Reşit, Gürer, Bora, Menteşe, Ahmet, Hasanbaşoğlu, Altuğ, Kertmen, Hayri, Türedi, Süleyman, Uzun, Özlem, and Yılmaz, Erdal Reşit

Abstract

Giriş: Spinal kord iskemi/reperfüzyon hasarında iskemi nedenli oksidatif stres önemli yer teşkil eder. Ischemia-modifiye albumin (IMA), yeni kullanıma giren, iskemi ve oksidatif stresin duyarlı bir biyomarkırı olup, daha önce iskemik spinal kord hasarında çalışılmamıştır. Bu çalışmada deneysel spinal kord iskemi hasarında IMA düzeylerindeki değişikler incelendi. Metod: Elliüç adet yetişkin, erkek, 2,5-3 kg ağırlıklarında, Yeni Zelanda tavşanına aort oklüzyon metodu kullanılarak spinal kord iskemisi oluşturuldu. Denekler 10 gruba (sham, iskemi ve değişik zaman aralıklarında iskemi/reperfüzyon yapılan gruplar ve kontrolleri) ayrıldı. IMA, doku ve kan malondialdehyde (MDA) ve myeloperoxidase (MPO) aktivite düzeyleriyle histopatolojik hasar skorları karşılaştırıldı. Bulgular: IMA düzeylerinin iskemiyi takiben hızlı bir şekilde arttığı gözlemlendi. Reperfüzyonu takiben ise kontrol gruplarıyla aynı düzeye düştüğü izlendi. Serum IMA düzeylerinin zamanla yükseldiği kontrol ve I/R grupları karşılaştırıldığında görüldü. Ancak IMA düzeyleriyle kan ve doku MDA ve MPO düzeyleri arasında korelasyon tespit edilmedi (tüm kıyaslamalar için p>0,05). Histopatolojik skorlar ile serum IMA ve MDA düzeyleri arasında düşük korelasyon görüldü. Sonuçlar: Bu çalışmanın sonuçlarında spinal kord iskemi/reperfüzyon hasarında yüksek IMA düzeyleri tespit edildi. Yüksek IMA düzeylerinin spinal kord iskemisinin ve komplikasyonun bir göstergesi olabileceği sonucuna varıldı., Background: Spinal cord ischemia/reperfusion (I/R) injury involves evident ischemia- mediated oxidative stress. Ischemia-modified albumin (IMA) has emerged as a novel and sensitive ischemia and oxidative stress biomarker, although it has not been previously investigated in ischemic spinal cord injury (SCI). This study was therefore intended to investigate serum IMA levels in a rabbit model of experimentally induced ischemic SCI. Method: Spinal cord ischemia was induced in 53 mature, male New Zealand rabbits weighing 2.5-3 kg using the aortic occlusion model. Animals were divided into 10 groups (sham, ischemia and different duration I/R groups and their respective controls). IMA, tissue and blood malondialdehyde (MDA), tissue and blood myeloperoxidase (MPO) activity levels and histopathological damage scores were then compared. Results: Ischemia-modified albumin levels rose rapidly when ischemia was induced to the spinal cord. They then declined to levels similar to those of the control groups when reperfusion was established. Serum IMA levels exhibited a tendency to rise over time in both the control and I/R groups compared to the sham group. We observed no correlation between IMA levels and blood and tissue MDA and MPO levels (p;gt;0.05 for all correlations). We determined only a low correlation between histopathological score and serum IMA and MDA levels. Conclusions: The results from this pioneering study identified a high level of IMA in spinal cord I/R injury, indicating that IMA is a potentially valuable diagnostic or predictive technique for ischemic SCI and its complications.

Published
2021

42. Vasoconstrictive effects of levobupivacaine on the basilar artery in the rabbit

Author

Ergil, Julide, Kertmen, Hayri, Sayın, Murat, Gürer, Bora, Yılmaz, Erdal Reşit, Özkan, Derya, Arıkök, Ata Türker, Kanat, Mehmet Ali, and Şekerci, Zeki

Subjects
Experimental Research, vasoconstriction, basilar artery, subarachnoid, levobupivacaine
Abstract

Introduction Spinal anesthesia is a widely used technique of the modern practice of anesthesia. Spinal cord ischemia is a rare but catastrophic complication of spinal anesthesia which may be caused by a direct vasoconstrictive effect of the local anesthetic. Although the vasoconstrictive effects of levobupivacaine have been widely studied, the vasoconstrictive effects of this drug on the intradural arteries have never been studied. The aim of this study is to evaluate whether levobupivacaine has vasoconstrictive effects on the basilar artery in rabbits. Material and methods Thirty male New Zealand white rabbits were divided randomly into three groups of ten rabbits each: group 1 (control); group 2 (0.125% levobupivacaine); group 3 (0.25% levobupivacaine). The cisterna magna was punctured as described below, then 1 ml of saline or 0.125% or 0.25% levobupivacaine was injected into the cisterna magna in 10 min by an infusion pump in groups 1, 2 and 3 respectively. All animals were euthanized by perfusion-fixation 30 min after the procedure. The luminal area and the size of the cross-sectional area for each basilar artery were measured. Results Both 0.125% and 0.25% levobupivacaine infusion caused significant vasoconstriction. Vasoconstriction was more significant for the 0.125% concentration. Conclusions The results of this study indicated that both 0.125% and 0.25% concentrations of levobupivacaine caused significant vasoconstriction of the basilar artery when administered into the subarachnoid space. This may constitute proof that subarachnoid administration of levobupivacaine may diminish the spinal cord blood flow, causing ischemia.

Published
2015

44. HİPOFİZ MAKROADENOMUNA BAĞLI ATİPİK GÖRME ALANI OLAN BİR OLGU Atypical Visual Field in a Case of Pituitary Macroadenoma

Author

ARSLAN, Neşe, KÖŞKER, Mustafa, KERTMEN, Hayri, and GÜRDAL, Canan

Subjects
Hipofiz adenomu, Monoküler temporal hemianopsi, Makroadenom
Abstract

Bu yazıda hipofiz makroadenomunda beklediğimiz klasik bitemporal hemianopsi şeklinde izlenengörme alanı defektinin aksine ağrısız monoküler temporal hemianopsi olan 28 yaşında genç kadınbir hastanın görme alanı kaybının özelliklerini ve patofizyolojisini tartışmayı amaçladık. En iyi düzeltilmişgörme keskinliği sağ gözde 7/10 ve sol gözde ise 10/10 idi. Nispi afferent pupiller defekt(APD) sağ gözde pozitifti. Optik sinir sağ gözde hafif soluktu. Monoküler temporal görme alanıdefekti ve sağ optik disk solukluğu mevcuttu. Hasta beyin cerrahisinde hipofiz makroadenomu tanısıylaopere edildi. Cerrahi sonrası yapılan muayenede hastanın baş ağrısı ve göz ağrısı şikâyetleridüzelmişti ama sağ temporal görme alanındaki defektte düzelme izlenmedi. Sonuç olarak göz kliniğinegörme azalması yada görme kaybı ile başvuran hastalara görme alanı testi uygulanmasıgerekmektedir bu şekilde erken tedavi ve muhtemel cerrahi sonrası görmede ve görme alanındaiyileşme de elde edilebilir.ABSTRACTWe aimed to discuss the characteristics and pathophysiology of a 20-year-old female patientwith an unusual visual field loss as a painless monocular temporal hemianopia unlike the classicbitemporal hemianopia. The best-corrected visual acuity was 7/10 in the right eye and 10/10 inthe left eye. Relative afferent pupillary defect (RAPD) in the right eye was positive. Monocularvisual field defect and pale optic disc was observed in the right eye. The patient was operatedwith the diagnosis of pituitary macroadenoma in the neurosurgery clinic. In the postoperativeexamination, the patient’s headache & ocular pain complain were improved but no improvementwas observed in the visual field defect. Patients attending to the ophthalmology clinics withdecrease in visual acuity should undergo visual field examination. In this way, early treatment andprobable postoperative visual field improvement could be obtained.

Published
2017

50. Comparative effects of methylprednisolone and tetracosactide (ACTH1-24) on ischemia/reperfusion injury of the rabbit spinal cord.

Author

Kertmen, Hayri, Celikoglu, Erhan, Ozturk, Ozden Caglar, Gürer, Bora, Bozkurt, Huseyin, Kanat, Mehmet Ali, Arikok, Ata Turker, Erguder, Berrin Imge, Sargon, Mustafa Fevzi, and Sekerci, Zeki

Subjects
*METHYLPREDNISOLONE, *REPERFUSION injury, *SPINAL cord injuries, *ABDOMINAL surgery, *MYELOPEROXIDASE, *LABORATORY rabbits
Abstract

Introduction: Tetracosactide is an engineered peptide that applies the same biological impacts as the endogenous adrenocorticotropic hormone. Previous studies indicated that tetracosactide has anti-inflammatory, antioxidant and neurotrophic activity. In this study, we hypothesized that tetracosactide may have protective effects in spinal cord ischemia-reperfusion injury.Material and Methods: Rabbits were randomized into the accompanying four groups of eight animals each: group 1 (control), group 2 (ischemia), group 3 (methylprednisolone) and group 4 (tetracosactide). In the control group, just a laparotomy was performed. In the various groups, the spinal cord ischemia model was made by the impediment of the aorta only caudal to the renal vein. Neurological assessment was conducted with the Tarlov scoring system. Levels of myeloperoxidase, malondialdehyde and catalase were analyzed, similar to the activities of xanthine oxidase and caspase-3. Histopathological and ultrastructural assessments were additionally performed.Results: After ischemia-reperfusion injury, increments were found in the tissue myeloperoxidase levels (p < 0.001), malondialdehyde levels (p < 0.001), xanthine oxidase action (p < 0.001) and caspase-3 movement (p < 0.001). Conversely, both serum and tissue catalase levels were diminished (p < 0.001 for both). After the administration of tetracosactide, declines were seen in the tissue myeloperoxidase levels (p < 0.001), malondialdehyde levels (p = 0.003), xanthine oxidase action (p < 0.001) and caspase-3 movement (p < 0.001). Conversely, both the serum and tissue catalase levels were expanded (p < 0.001). Besides, tetracosactide treatment indicated enhanced results related to the histopathological scores (p < 0.001), the ultra-structural score (p = 0.008) and the Tarlov scores (p < 0.001).Conclusions: The findings showed for the first time that tetracosactide shows significant neuroprotective activity against ischemia-reperfusion injury of the spinal cord. [ABSTRACT FROM AUTHOR]

Published
2018
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