Publications by authors named "Hakan Akgun"

32 Publications

The impact of hydroxychloroquine and azithromycin on the corrected qt interval in patients with the novel Coronavirus disease 2019.

Rev Assoc Med Bras (1992) 2021 Jul;67(7):979-984

Eskisehir Osmangazi University, Medical Faculty Department of Cardiology - Eskisehir, Turkey.

Objective: With the coronavirus disease 2019 (COVID-19) continuing to spread all over the world, although there is no specific treatment until now, hydroxychloroquine and azithromycin have been reported to be effective in recent studies. Although long-term use of hydroxychloroquine and azithromycin has been reported to cause QT prolongation and malign arrhythmia, there is not enough data about the effect of short-term use on arrhythmia. Therefore, this study aims to assess the effect of hydroxychloroquine alone and hydroxychloroquine + azithromycin on corrected QT (QTc).

Methods: A baseline electrocardiogram and on-treatment baseline electrocardiogram were retrospectively collected in COVID-19 patients who received hydroxychloroquine and/or azithromycin. The QTc interval was calculated, and the baseline and peak QTc intervals were compared. In addition, the peak QTc intervals of monotherapy and combination therapy were compared.

Results: Of the 155 patients included, 102 (65.8%) patients were using hydroxychloroquine, and 53 (34.2%) patients were using hydroxychloroquine + azithromycin combination. The use of both hydroxychloroquine alone and hydroxychloroquine + azithromycin combined therapy significantly prolonged the QTc, and the QTc interval was significantly longer in patients receiving combination therapy. QTc prolongation caused early termination in both groups, 5 (4.9%) patients in the monotherapy group and 6 (11.3%) patients in the combination therapy group.

Conclusion: In this study, patients who received hydroxychloroquine for the treatment of COVID-19 were at high risk of QTc prolongation, and concurrent treatment with azithromycin was associated with greater changes in QTc.
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http://dx.doi.org/10.1590/1806-9282.20210380DOI Listing
July 2021

Intramedullary nailing versus minimally invasive plating in the treatment of distal tibial extra-articular fractures: Comparison of cost analysis in Turkey.

Ulus Travma Acil Cerrahi Derg 2021 Sep;27(5):558-564

Department of Orthopaedics and Traumatology, Erzincan Binali Yıldırım University Faculty of Medicine, Erzincan-Turkey.

Background: Minimally invasive percutaneous plate osteosynthesis (MIPO) and intramedullary nailing (IMN) are the two most commonly used methods for distal tibial extra-articular fractures; however, the ideal treatment is still on debate. The aim of this study was to compare MIPO and IMN in the treatment of distal tibial extra-articular fractures in terms of cost analysis according to health insurance records in Turkey.

Methods: The data of patients who underwent either MIPO or IMN for the treatment of distal tibial extra-articular fractures between 2013 and 2018 were analyzed in this retrospective study. Patients' clinical data, as well as the overall expenses from the first admission until return to work including hospitalization, and all outpatient controls had been reviewed from the hospital's billing department. The total amount of money paid per month by Turkish National Social Security Institution to the patient until the patient's returns to work were also recorded.

Results: 118 consecutive patients (35 female-83 male) with the mean age of 37.2±13.4 were participated to the study. IMN group consisted of 57 patients with a mean age of 36.7±12.8 years, and MIPO group consisted of 61 patients with a mean age of 37.8±13.6 years. No significant differences were observed between study groups in terms patients' age, gender, fracture classification (AO/OTA: Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association), soft-tissue injury (Tscherne classification), presence of type 1 open fracture, and presence of accompanying fibula fracture. There was no statistical difference between two groups in terms of pre-operative hospital stay (p=0.713). However, the mean length of hospital stay was significantly higher in the MIPO group (p=<0.001). The means of number of total outpatient controls, time to union, and return to work were also significantly higher in the MIPO group (p=0.005, p<0.001 and p<0.001, respectively). The mean hospital cost until discharge and the mean total cost until return to work were significantly higher in the MIPO group (p=0.001 and 0.001, respectively). The mean total costs of hospital stay and outpatient controls were also significantly higher in the MIPO group (p=0.001 and 0.004, respectively). The mean implant costs did not significantly differ between groups (p=0.179).

Conclusion: According to the results acquired from the present study, IMN is a better option compared to MIPO for the treatment of extra-articular distal tibial fractures in terms of costs paid by the national health insurance in Turkey.
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http://dx.doi.org/10.14744/tjtes.2020.65635DOI Listing
September 2021

Adolescent tibial tubercle fractures in the time of the COVID 19: A single orthopedic trauma center experience.

J Orthop Sci 2021 Jun 26. Epub 2021 Jun 26.

Department of Orthopedics and Traumatology, Baltalimani Bone Diseases Training and Research Hospital, Baltalimanı Hisar Caddesi 62, 34470, Istanbul, Turkey. Electronic address:

Background: The purpose of this study is to assess the incidence and clinical characteristics of adolescent tibial tubercle fractures (TTFs) during the COVID-19 pandemic by sharing our experiences.

Methods: Pediatric patients aged between 0 and 18 years old with confirmed diagnosis of TTFs who were treated at our center between April 2020 and May 2020 were included in the study. In addition to demographics, mechanism injury, treatment modalities, complications were also noted.

Results: Sixteen patients were included in the study. The mean age was 14.8 ± 0.9 years (range: 13-16 years). The mean BMI of patients was 26.3 ± 2.3 kg/m (range: 23.2-30.4 kg/m). According to the BMI-for-age percentiles growth chart, eight patients (50%) were overweight, and eight patients (50%) were at a risk of being categorized as overweight. The most common cause for the injury was jumping due to basketball (50%). Twelve of 16 patients were treated operatively by open reduction and internal fixation. The remaining 4 patients were treated non-operatively with long leg cast.

Conclusion: The incidence of TTFs was 16 cases over about two months during the pandemic isolation period. Our results demonstrated that all adolescent TTFs occurred during periods when outdoor activities were permitted. This finding may be explained by sudden athletic activity after prolonged immobilization. We observed that all of our patients were male and either overweight or at risk of being overweight.
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http://dx.doi.org/10.1016/j.jos.2021.06.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8234023PMC
June 2021

Benefits of treatment with favipiravir in hospitalized patients for COVID-19: a retrospective observational case-control study.

Virol J 2021 05 25;18(1):102. Epub 2021 May 25.

Department of Internal Medicine, Kayseri City Hospital, Muhsin Yazıcıoğlu Bulvarı No: 77, 38080, Kocasinan, Kayseri, Turkey.

Background: Although more than a year past since COVID-19 was defined, there is no specific treatment yet. Since COVID-19 management differs over time, it is hard to determine which therapy is more efficacious. In this study, we aimed to evaluate the efficacy of the regimen with Favipiravir (FPV) and determine if the timing of FPV addition offers any improvement.

Methods: A retrospective observational case-controlled cohort study was performed between March and September 2020, including adults with COVID-19 in a single-center in Turkey. We categorized patients into age-sex matched three groups, group 1 (n = 48) and group 2 (n = 48) included patients treated with the combination of FPV plus Hydroxychloroquine (HQ) early and late, respectively. Group 3 (n = 48) consisted of patients on HQ monotherapy. In Group 2, if the respiratory or clinic condition had not improved sufficiently, FPV was added on or after day 3.

Results: We found that starting FPV early had an impact on PCR negativity and the progression of the disease. 'No progression' was defined as the absence of a new finding in the control radiological examination and the absence of accompanying clinical deterioration. Also, the decrease in C-reactive protein (CRP) was greater in Group 1 than Group 3 (p < 0.001). However, we found that early initiation of FPV treatment did not have a positive effect on the estimated survival time.

Conclusions: According to this retrospective study results, we believe that for better clinical outcomes, FPV treatment should be started promptly to enhance antiviral effects and improve clinical outcomes.
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http://dx.doi.org/10.1186/s12985-021-01577-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8148395PMC
May 2021

Femoral stem fractures after primary and revision hip replacements: A single-center experience.

Jt Dis Relat Surg 2020 ;31(3):557-563

İstanbul Metin Sabancı Baltalimanı Kemik Hastalıkları Eğitim ve Araştırma Hastanesi Ortopedi ve Travmatoloji Kliniği, 34335 Beşiktaş, İstanbul, Türkiye.

Objectives: This study aims to present our experience in the management of fractured femoral stems after primary and revision hip replacements by evaluating the clinical and radiographic characteristics and determining the effectiveness of the extraction methods.

Patients And Methods: A total of 15 patients (5 males, 10 females; mean age 65.9 years; range, 49 to 87 years) who underwent revision hip replacement due to a fractured femoral stem between January 2005 and December 2019 were included in this retrospective study. The mechanisms and risk factors for failure as well as methods applied to extract fractured stem were analyzed through clinical and radiographic data.

Results: Nine patients had fractured cemented femoral stems, while six patients had fractured fully porous coated cementless revision stems. Lack of proximal buttress in distally fixed femoral stems was detected in 11 patients and identified as the predominant mechanism resulting in fracture. The proximal extraction method with conventional revision instrumentation, the cortical window technique, and extended trochanteric osteotomy (ETO) were used in three, seven, and five cases, respectively.

Conclusion: Our results demonstrated that the lack of proximal buttress is the most common reason for femoral stem fracture. Moreover, the proximal extraction method was mostly ineffective in fully porous femoral stems. A step-by-step approach should be considered for the extraction of a broken stem. The cortical window method can be considered as the second step if proximal extraction methods fail, and ETO should be considered at the last step if all techniques fail.
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http://dx.doi.org/10.5606/ehc.2020.76162DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7607938PMC
February 2021

The effect of in vivo created vascularized neurotube on peripheric nerve regeneration.

Injury 2017 Jul 11;48(7):1486-1491. Epub 2017 May 11.

Gulhane Military Medical Academy, Dept. of Plastic Surgery, Ankara, Turkey.

Introduction: Creating vascularized nerve conduits for treatment of nerve gaps have been researched, however, these methods need microsurgical anastomosis thereby complicating the nerve repair process. Thus, the concept of vascularized nerve conduits has not popularized up till now. The aim of this study is to evaluate the effects of vascularized and non-vascularized biological conduits on peripheral nerve regeneration.

Material And Methods: Following ethical board approval, 15 Sprague-Dawley rats were used in the study. The rats were equally divided into three groups. In group I, a silicon rod was inserted next to the sciatic nerve of the rat and connective tissue generated around this rod was used as a vascularized biological conduit. In group II, a silicon rod was inserted into the dorsum of the rat and connective tissue generated around this rod was used as a non-vascularized biological conduit. In group III, autogenic nerve graft was used to repair the nerve gap. The contralateral sciatic nerve is used as a control in all rats. Macroscopic, electrophysiological and histomorphometric evaluations were performed to determine the nerve regeneration.

Results: There was no statistically significant difference between groups, in terms of latency. However, the mean amplitude of group I was found to be higher than other groups. The difference between group I and II was statistically significant. Myelinated axonal counts in group I was significantly higher than groups II and III.

Conclusion: Our results showed that vascularized biological conduits provided better nerve regeneration when compared to autografts and non-vascularized biological conduits. Creation and application of vascularized conduits by using the technique described here is easy. Although this method is not an alternative to autogenic nerve grafts, our results are promising and encouraging for further studies.
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http://dx.doi.org/10.1016/j.injury.2017.05.014DOI Listing
July 2017

Decreased cerebral vasomotor reactivity in patients with obstructive sleep apnea syndrome.

Sleep Med 2017 02 18;30:88-92. Epub 2016 Nov 18.

Department of Psychiatry, Gulhane Military Medical Academy, Ankara, Turkey.

Objective: In obstructive sleep apnea syndrome (OSAS), any of the activated neural, vascular, hemodynamic, metabolic, inflammatory, and thrombotic mechanisms may be related to increased cerebrovascular disease and risk of death; however, the possible pathophysiological process between obstructive sleep apnea syndrome and stroke has not been clearly explained. We hypothesize that alterations in vasomotor reactivity in patients may be responsible for their altered cerebral blood flow, and may contribute to the increased risk of ischemic stroke.

Methods: A total of 30 untreated patients with severe obstructive sleep apnea and 26 control subjects were included in the study. The mean blood flow velocity and breath holding index were measured in middle cerebral artery bilaterally in both patient and control groups by using transcranial Doppler ultrasound. We compared the values between two groups.

Results: The mean blood flow velocity and breath holding indexes were significantly decreased in the patient group when compared with the control group. There were no correlations between cerebral hemodynamic parameters and polysomnographic findings in patients.

Conclusion: Our findings suggest that there was a deteriorated vasodilator response to hypercapnia in patients with OSAS. This deterioration may stem from chemoreceptors or endothelial damages that lead to vascular relaxation and vasodilatation in cerebrovascular circulation. This impaired cerebral vascular regulation may contribute to the increased risk of stroke in patients with OSAS.
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http://dx.doi.org/10.1016/j.sleep.2016.09.020DOI Listing
February 2017

Visual and brainstem auditory evoked potentials in children with obesity.

Brain Dev 2016 Mar 14;38(3):310-6. Epub 2015 Oct 14.

Gülhane Military Medical Academy, Department of Pediatric Neurology, Ankara, Turkey.

Aims: The aim of our study is to investigate alterations in visual evoked potentials (VEP) and brainstem auditory evoked potentials (BAEP) in children with obesity.

Methods: A total of 96 children, with a mean age of 12.1±2.0 years (range 9-17 years, 63 obese and 33 age and sex-matched control subjects) were included in the study. Laboratory tests were performed to detect insulin resistance (IR) and dyslipidemia. The latencies and amplitudes of VEP and BAEP were measured in healthy and obese subjects.

Results: The VEP P100, BAEP interpeak latency (IPL) I-III and IPL I-V averages of obese children were significantly longer than the control subjects. When the obese group was divided into two subgroups, those with IR and without IR, BAEP wave I, wave III and P100 wave latencies were found to be longer in the group with IR. A statistically significant correlation was observed between BAEP wave I latency, IPL I-V, IPL I-III and the homeostatic model assessment insulin resistance (HOMA IR) index and fasting insulin level.

Conclusions: Our findings suggest that VEP and BAEP can be used to determine early subclinical on auditory and visual functions of obese children with insulin resistance.
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http://dx.doi.org/10.1016/j.braindev.2015.09.010DOI Listing
March 2016

MRI diagnosis of dural sinus - Cortical venous thrombosis: Immediate post-contrast 3D GRE T1-weighted imaging versus unenhanced MR venography and conventional MR sequences.

Clin Neurol Neurosurg 2015 Jul 22;134:44-54. Epub 2015 Apr 22.

Gulhane Military Medical School, Department of Radiology, Ankara, Turkey.

Objective: Primary aim is to compare the diagnostic value of contrast-enhanced 3D GRE T1-weighted sequences with unenhanced MR venography and conventional magnetic resonance imaging (MRI), in detection of dural venous sinus (DVS) and cortical venous thrombosis; secondary aim is to determine the relationship between DVS thrombosis/site and gender, age, infarction or hemorrhage.

Methods: We retrospectively reviewed conventional MR images, unenhanced MR venography and immediate post-contrast 3D GRE T1-weighted MR images in 30 patients (17 male and 13 female, 21-70 years old, mean age 40.1) with clinically suspected DVS thrombosis. MR examinations had been performed with 1.5T or 3T MR Scanners. DVSs were evaluated in 10 sub-segments, including cortical veins. Each set of MR images were examined separately, blinded to the final diagnosis. Associated findings were also noted and sensitivity, specificity and accuracy of each MRI technique were calculated.

Results: Final diagnosis of cortical venous and/or dural sinus thrombosis was established in 24 (80%) of 30 cases and 67 (22.3%) out of 300 segments. For detection of the thrombotic segment, sensitivity, specificity, and accuracy were 83.6%, 95.3%, and 92.7% by conventional MR sequences, 89.6%, 91.8%, and 91.3% by unenhanced MR venography, and 92.5%, 100%, and 98.3% by contrast-enhanced 3D GRE T1-weighted sequence, respectively. Infarction and hemorrhage were more frequent in cases with cortical venous thrombosis, while gender and age had no significant relation with DVS thrombosis or its site. Conventional MR sequences and unenhanced MR venography were helpful due to additional information they provided in some cases with isolated cortical venous thrombosis, with hyperintense thrombus material and with associated hemorrhage or infarction.

Conclusion: Contrast-enhanced 3D GRE T1-weighted MRI is the most accurate imaging method for the detection of DVS and/or cortical venous thrombosis. Infarction and hemorrhage were more frequent in cases with cortical venous thrombosis.
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http://dx.doi.org/10.1016/j.clineuro.2015.04.013DOI Listing
July 2015

Reduced breath holding index in patients with chronic migraine.

Acta Neurol Belg 2015 Sep 12;115(3):323-7. Epub 2014 Oct 12.

Neurology Service, Etimesgut Military Hospital, Etimesgut, Ankara, Turkey,

Migraine is a neurovascular disorder characterized by autonomic nervous system dysfunction and severe headache attacks. Studies have shown that changes in the intracranial vessels during migraine have an important role in the pathophysiology. Many studies have been conducted on the increased risk of stroke in patients with migraine, but insufficient data are available on the mechanism underlying the increase. This study aimed to evaluate basal cerebral blood flow velocity and vasomotor reactivity in patients with chronic migraine. We evaluated 38 patients with chronic migraine. Three of them were excluded because they had auras and four of them were excluded because of their use of medication that can affect cerebral blood flow velocity and breath holding index (beta or calcium channel blockers). Our study population consisted of 31 patients with chronic migraine without aura and 29 age- and gender-matched healthy individuals who were not taking any medication. The mean blood flow velocity and breath holding index were measured on both sides from the middle cerebral artery and posterior cerebral artery, with temporal window insonation. The breath holding index for middle cerebral artery and posterior cerebral artery was significantly lower in the migraine group compared to that of the control group (p < 0.05).The vasomotor reactivity indicates the dilatation potential of a vessel, and it is closely related to autoregulation. According to our results, the vasodilator response of cerebral arterioles to hypercapnia was lower in patients with chronic migraine. These findings showed the existence of impairments in the harmonic cerebral hemodynamic mechanisms in patients with chronic migraine. This finding also supports the existing idea of an increased risk of stroke in patients with chronic migraine due to impaired vasomotor reactivity.
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http://dx.doi.org/10.1007/s13760-014-0375-yDOI Listing
September 2015

Other Possible Methods in the Differential Diagnosis of Epileptic and Non-Epileptic Seizures.

Noro Psikiyatr Ars 2014 Sep 1;51(3):293. Epub 2014 Sep 1.

Gülhane Military Medical Academy, Department of Neurology, Ankara, Turkey.

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http://dx.doi.org/10.4274/npa.y7102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5353139PMC
September 2014

Validity of late-term electroneurography in Bell's palsy.

Otol Neurotol 2014 Apr;35(4):656-61

*Department of Otorhinolaryngology, Etimesgut Military Hospital; †Department of Otorhinolaryngology, Gulhane Military Medical Academy, Ankara; ‡Department of Otorhinolaryngology, Istanbul Training and Research Hospital, Istanbul; and §Department of Neurology, Etimesgut Military Hospital, Ankara, Turkey.

Objective: To evaluate the validity of early (within 3 wk) and late-term (after 3 wk) electroneurography (ENoG) findings in Bell's palsy (BP) to predict the prognosis.

Study Design: Retrospective case review.

Setting: Tertiary referral center.

Patients: Patients with peripheral facial paralysis with no identified cause. All patients were given the same treatment.

Intervention(s): House Brackmann (HB) grading and ENoG.

Main Outcome Measures: The records of 38 patients with BP were retrospectively analyzed. This study included only those patients who had been followed up for at least 4 months on a regular basis or until complete recovery. ENoG was performed for orbicularis oculi and orbicularis oris muscles and degeneration ratio was calculated separately. Correlation between HB grading and ENoG findings, relationship between duration for maximum recovery and ENoG findings, and also initial HB grading and recovery rate were investigated.

Results: Complete recovery rate was significantly higher in patients with HB grades I to III at initial examination. A significant correlation was found between HB grading and degree of ENoG degeneration at the 7th and 14th days of FP. Patients with degeneration less than 80% for orbicularis oculi and less than 65% for orbicularis oris had significantly better and faster recovery than those with higher level of degeneration (p < 0.05).

Conclusion: ENoG and HB grading during first to fourth weeks of BP are useful prognostic indicators. Serial ENoG examinations are recommended to predict the status of neural degeneration and the prognosis of the palsy. However, ENoG in late term may not be compatible with clinical facial function.
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http://dx.doi.org/10.1097/MAO.0000000000000233DOI Listing
April 2014

Cognitive Impairment in Patients with Multiple Sclerosis.

Noro Psikiyatr Ars 2014 Mar 1;51(1):90. Epub 2014 Mar 1.

Department of Neurology, Gülhane Military Medical Academy, Ankara, Turkey.

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http://dx.doi.org/10.4274/npa.y6943DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5370259PMC
March 2014

Differential diagnosis of carpal tunnel syndrome.

Turk Neurosurg 2014 ;24(1):150

Etimesgut Military Hospital, Department of Neurology, Ankara, Turkey.

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October 2014

Follicular lymphoma patient relapsing with paraneoplastic sensory neuronopathy (ganglioneuropathy).

Turk J Haematol 2013 Sep 5;30(3):333-5. Epub 2013 Sep 5.

Gülhane Military Medical Academy, Department of Gastroenterology, Ankara, Turkey.

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http://dx.doi.org/10.4274/TJH-2013.0125DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3878536PMC
September 2013

Migraine and restless leg syndrome co-morbidity may be due to iron deficiency.

Ann Indian Acad Neurol 2013 Jul;16(3):461

Department of Neurology, Kasımpaşa Military Hospital, Istanbul, Turkey.

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http://dx.doi.org/10.4103/0972-2327.116956DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3788318PMC
July 2013

Plexitis or radiculitis secondary to bee sting.

Ann Indian Acad Neurol 2013 Jul;16(3):457

Department of Neurology, Etimesgut Military Hospital, Ankara, Turkey.

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http://dx.doi.org/10.4103/0972-2327.116948DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3788314PMC
July 2013

Importance of cutaneous silent period in fibromyalgia and its relationship with disease characteristics, psychological disorders and quality of life of patients.

Rev Bras Reumatol 2013 May-Jun;53(3):288-95

Introduction: Cutaneous silent period (CSP) is an inhibitory spinal protective reflex and its afferents consist of A-delta nerve fibers. We aimed to evaluate patients with fibromyalgia (FM) and healthy controls to determine any differences between the groups in terms of CSP duration and latency, and if present, to determine whether there is any relationship with disease characteristics, psychological disorders and quality of life.

Materials And Methods: Thirty-two patients with FM and 32 healthy volunteers were included in the study. The patient and control groups were compared in terms of CSP latency and duration in both upper and lower extremities. Disease characteristics, psychological disorders and quality of life of patients were assessed using the Fibromyalgia Impact Questionnaire (FIQ) and Short Form-36 (SF-36). Patients with CSP measurements equal to or lower than those of the control group were compared with those with higher values than controls in terms of disease characteristics, psychological status and quality of life.

Results: Significantly prolonged CSP latencies in both upper and lower extremities were determined in patients compared to controls. We found that prolongation of CSP latency in the lower extremity is associated with disease severity and functional disability.

Conclusions: CSP latencies in both upper and lower extremities in patients with FM are longer than in healthy volunteers. Moreover, prolongation of CSP latency in the lower extremity is associated with disease severity and physical functional disability.
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August 2014

Normal anatomical features and variations of the vertebrobasilar circulation and its branches: an analysis with 64-detector row CT and 3T MR angiographies.

ScientificWorldJournal 2013 29;2013:620162. Epub 2013 Apr 29.

Gulhane Military Medical School, Department of Radiology, Etlik, 06018 Ankara, Turkey.

Purpose: To determine the normal anatomical features and variations of the vertebrobasilar circulation and its branches in patients who underwent multidetector computed tomography (CT) or magnetic resonance (MR) angiographies of the brain.

Methods: 135 patients (male, 83 and female, 52; mean age, 50.1 years) who underwent CT (n = 71) or MR (n = 64) angiographies of the vertebrobasilar vasculature for various reasons were analyzed retrospectively. The right and left distal vertebral arteries (VAs), posterior inferior cerebellar arteries (PICAs), anterior inferior cerebellar arteries (AICAs), superior cerebellar arteries (SCAs), posterior cerebral arteries (PCAs), and posterior communicating arteries (PCoAs) were analyzed individually.

Results: In 24.4% of the cases (33/135) right PICA, in 19.3% of the cases (26/135) left PICA, in 17.8% of the cases (24/135) right AICA, and in 18.5% of the cases (25/135) left AICA were absent. In cases without PICA or AICA, there was a statistically significant, moderately or well-developed AICA or PICA on the same side, respectively (P < 0.001). The most common variation was isolated absence of right PICA and was seen in 17.8% of the cases.

Conclusions: The anatomic features of the branches of the vertebrobasilar circulation may be different from well-known normal anatomy. CT and MR angiographies allow a precise and detailed evaluation of vertebrobasilar circulation.
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http://dx.doi.org/10.1155/2013/620162DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3759058PMC
April 2014

Two conjoined plaques or a flap?

Ann Indian Acad Neurol 2013 Apr;16(2):293

Department of Neurology, Etimesgut Military Hospital, Istanbul, Ankara, Turkey.

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http://dx.doi.org/10.4103/0972-2327.112504DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3724099PMC
April 2013

Differential diagnosis of the complex regional pain syndrome.

Oral Surg Oral Med Oral Pathol Oral Radiol 2013 Jul 1;116(1):122-3. Epub 2013 May 1.

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http://dx.doi.org/10.1016/j.oooo.2013.01.055DOI Listing
July 2013

Spatial tuning function of pattern visual evoked potentials in multiple sclerosis patients without optic neuritis history.

Med Glas (Zenica) 2013 Feb;10(1):99-105

Department of Ophthalmology, Gulhane Military Medical Academy, 2Department of Neurology, Etimesgut Military Hospital; Ankara, Turkey.

Aim: To explore amplitude and latency-check size function in multiple sclerosis (MS) patients without optic neuritis history.

Methods: Thirty-six MS patients and 21 control subjects were included. Pattern visual evoked responses to ive check sizes (2°, 1°, 30', 15', and 7') were recorded.

Results: P100 amplitudes were significantly reduced in 2°, 1° and 7' checks and, P100 latencies were significantly delayed in all checks in MS patients (p < 0.05). Inter-ocular amplitude/ latency differences were significantly higher in MS patients than control group (p < 0.05). The P100 amplitudes for 2° check was somewhat higher than amplitudes for 1° check in MS and control groups. However, MS patients had latter amplitude-check size function curve in large checks. In small checks, the slope of the amplitude-check size curves were similar for MS and control groups. The flattening of amplitude-check size function curve in large checks increased in MS patients with reduced P100 amplitudes. The P100 amplitudes for 2° check was lower than P100 amplitudes for 1° check in MS patients with reduced P100 amplitudes in contrast to normal subjects and MS patients with normal P100 amplitudes. Both groups had almost parallel P100 latency-check size curves in all checks. With respect to 95% confidence limit in control subjects in each check sizes, the number of eyes with delayed latency and reduced amplitude in MS patients were higher in large checks.

Conclusion: This study showed that P100 amplitudes are reduced in MS patients without optic neuritis history, and responses to large checks are affected more than small checks.
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February 2013

Effects of topiramate on peripheral nerve excitability.

J Clin Neurophysiol 2012 Jun;29(3):268-70

Department of Neurology, Pamukkale University Medical Faculty, Denizli, Turkey.

Purpose: Antiepileptic drugs are generally used to control the cortical hyperexcitable states. But some of them are also effective on the peripheral nervous system, so they may be used in some states like neuropathic pain. Several recent reports suggest the possible effects of antiepileptic drugs on peripheral nerve excitability. Strength duration time properties gives an indirect idea about the persistent, paranodal sodium (Na) channels and may indirectly reflect the peripheral nerve excitability. Topiramate suppresses the cortical hyperexcitability, but previous studies could not prove a significant effect of topiramate on peripheral nerves. The aim of this study is to investigate the probable nerve excitability changes caused by topiramate.

Methods: Forty migraine patients and 40 controls were included in the study. Median motor and sensory conduction parameters were recorded. Strength duration properties were also recorded from abductor pollicis longus muscle, with the stimulation of median nerve. The electrophysiological studies were repeated 4 weeks after the initiation of topiramate in the treatment group.

Results: Nerve conduction parameters were not significantly affected by 4-week topiramate treatment. But the strength duration time constant decreased significantly, reflecting a reduction in the excitability. This decrement seemed to be more obvious in those in whom topiramate was also clinically useful.

Conclusions: The method used demonstrated a probable effect of topiramate on the peripheral nerve excitability.
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http://dx.doi.org/10.1097/WNP.0b013e318257c0a0DOI Listing
June 2012

Demographic, clinical, and polysomnographic features in patients with narcolepsy: an experience of 181 patients with narcolepsy from a Turkish sleep center.

Acta Neurol Belg 2012 Jun 2;112(2):177-81. Epub 2012 Mar 2.

Department of Psychiatry, Gülhane Military Medical Academy, General Tevfik Sağlam Street No: 1, 06018 Etlik, Ankara, Turkey.

The present study was designed to describe the socio-demographic, clinical, and polysomnographic features of patients diagnosed with narcolepsy in our sleep center. This retrospective cross-sectional study was conducted on 181 patients diagnosed with narcolepsy based on the results of clinical evaluation, polysomnography (PSG), and multiple sleep latency test (MSLT) between 1993 and 2009. Approximately 70% of the patients had cataplexy, whereas 42% had hallucinations and 55.8% had sleep paralysis. Although sleep efficiency was higher (91.28 ± 5.89%) in patients with narcolepsy, they woke frequently during the night, and their percentages of deep sleep were low (stage 3, 5.12 ± 3.08%, stage 4, 9.60 ± 7.10%). Our study group was divided into two based on age: individuals aged <30 years (n = 152) and >30 years (n = 29). REM latency on PSG was shorter (t = 2.96, p = 0.004) and sleep onset REM (SOREM) on MSLT was higher (t = 2.56, p = 0.011) in the older group than in the younger group. Cataplexy is seen in most patients with narcolepsy. In older patients, REM latency on PSG is shorter and the number of SOREM on MSLT is higher.
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http://dx.doi.org/10.1007/s13760-012-0053-xDOI Listing
June 2012

Acute lymphoblastic leukemia presenting with oculomotor nerve palsy.

Acta Neurol Belg 2011 Dec;111(4):362-4

Department of Neurology, Gülhane Military Medical Academy, Ankara.

A 48-year-old man presented with left ptosis and double vision. Laboratory test findings indicated acute lymphoblastic leukemia (ALL). Lymphoblastic infiltration of both cavernous sinuses was observed on pituitary gland magnetic resonance imaging. Leukemias may present by many clinical conditions, but isolated cranial nerve palsy is very rare. To our knowledge, this is the first case of ALL presenting with oculomotor nerve palsy. Clinicians should consider oculomotor nerve palsy as the first ALL indication.
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December 2011

Cerebral venous thrombosis presenting with subarachnoid hemorrhage after spinal anesthesia.

Acta Neurol Belg 2011 Sep;111(3):237-40

Department of Neurology, Gülhane Military Medical Academy, Ankara, Turkey.

A 22-year-old male had a meniscopathy operation using spinal anesthesia. After the operation, the patient reported a throbbing headache. His brain computed tomography (CT) showed subarachnoid hemorrhage (SAH) and hyperdense dural venous sinuses suspicious for thrombosis. Filling defects were observed in the superior sagittal and right transverse sinuses on the contrast-enhanced magnetic resonance images. The patient was diagnosed with cerebral venous sinus thrombosis (CVST). On the tenth day of his admission, his clinical findings progressed and heparin therapy was initiated after resorption of hemorrhage was observed in a second non-contrast CT scan. The patient developed decreased consciousness the day after heparin administration. A subsequent brain CT revealed intraparenchymal hemorrhage in the right anteroinferior frontal region. Heparin therapy was discontinued, and anti-edema therapy was started. The presentation of CVST with SAH is a rare condition. Furthermore, development of CVST after spinal anesthesia is very rare. In this case, CVST developed after spinal anesthesia, and its first clinical presentation was SAH. To our knowledge, this is the first case CVST presenting with SAH after spinal anesthesia.
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September 2011

Effect of pramipexole on cutaneous-silent-period parameters in patients with restless legs syndrome.

Clin Neurophysiol 2012 Jan 14;123(1):154-9. Epub 2011 Jul 14.

Gülhane Military Medical Academy, Department of Neurology, Ankara, Turkey.

Objective: The aim of this study was to investigate cutaneous-silent-period (CSP) parameters in patients with restless legs syndrome (RLS) and examine the effects of treatment on CSP which, to our knowledge, have not been investigated till date.

Methods: A total of 25 patients with RLS and 25 healthy volunteers were studied. CSP latency and duration in the upper and lower extremities were examined in the two groups. In RLS patients, the variables were examined before and after pramipexole treatment.

Results: Lower-extremity CSP latency was longer (106.22±11.69 ms vs. 91.67±8.53 ms; p<0.001) and CSP duration was shorter (35.50±10.91 ms vs. 49.47±6.43 ms; p<0.001) in patients, compared with controls. In the patient group, CSP durations in the upper (40.88±7.95 ms vs. 46.84±10.22 ms; p=0.006) and lower extremities (35.50±10.91 ms vs. 44.91±6.43 ms; p=0.005) were prolonged after treatment, compared with pre-treatment values.

Conclusions: Small-fibre neuropathy may exist in RLS. In addition, we suggest that pramipexole may regulate cortical and spinal inhibitory mechanisms.

Significance: The use of CSP may aid in the diagnosis of RLS and may be used as a measure of treatment effectiveness.
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http://dx.doi.org/10.1016/j.clinph.2011.05.027DOI Listing
January 2012
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