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Öğe Cerebral infarction due to traumatic carotid artery dissection(Turkish Assoc Trauma Emergency Surgery, 2008) Kilincer, Cumhur; Tiryaki, Mehmet; Celik, Yahya; Turgut, Nilda; Balci, Kemal; Utku, Ufuk; Cobanglu, SebahattinWith the advent of improved neuroradiological methods, it has been determined that frequency of traumatic carotid artery dissections is higher than previously observed. Since delayed neurological deficits may develop in some asymptomatic undiagnosed cases, it is essential to consider the possibility of the carotid artery dissection and evaluate it properly in suspicious cases. In this article, a case of internal carotid artery dissection and subsequent cerebral infarction following a motor vehicle accident is presented. Pathogenesis, clinical features, diagnostic method choices and treatments in this rare but severe condition are discussed in light of the relevant literature in order to convey current knowledge.Öğe Clinical, pathological and endocrinological evaluationof patients with microscopic transsphenoidal pituitarysurgery(2021) Özçelik, Serhat; Gökkaya, Naile; Tiryaki, Mehmet; Aydoğmuş, Evren; Çelik, Mehmet; Yavuzer, Dilek; Aydin, KadriyeAim: Detailed evaluation of patients in preoperative stage is an important factor that reduces morbidity and mortality as well as theoperation itself. In our study, we aimed to examine clinically, pathologically and endocrinologically, the patients who were decided toundergo transsphenoidal surgery, in light of the literature. Materials and Methods: In this retrospective observational study, preoperative and pathological data of consecutive pituitaryadenoma patients who applied to our department from January 2019 to June 2020 and underwent transsphenoidal surgery withmicroscopic methods, were examined. Results: The study included a total of 31 patients. Distribution of patients in relation to pathological diagnoses was as follows:Functional pituitary adenoma (n: 15), non-functional adenoma (n: 11), apoplexy (n: 2), carcinoma metastasis (n: 2) andcraniopharyngioma (n: 1). No statistically significant difference was found between functional and non-functional adenomas, interms of tumor size, cavernous sinus invasion, Ki-67 index and p53 staining pattern (p> 0.05) whereas presence of suprasellarextension and visual field defect were significantly more in non-functional adenomas (p = 0.015, p = 0.045, respectively). Conclusion: Highly invasive character was detected in both functional and non-functional pituitary Ki-67 indexes were low in thestudy population, increased p53 expression was noticeable. We can state that the Ki-67 index may not be directly proportional tothe invasive behavior of the disease.Öğe Çocukluk çağı kafa travmaları: 280 olgunun retrospektif değerlendirilmesi(2005) Şimşek, Osman; Hiçdönmez, Tufan; Hamamcıoğlu, M. Kemal; Kılınçer, Cumhur; Parsak, Turgay; Tiryaki, Mehmet; Ömürlü, İmran KurtAMAÇ Çocukluk çağı kafa travmalarında etiyolojik nedenler, klinik özellikler, radyolojik bulgular ve iyileşme oranlan araştırıldı. GEREÇ VE YÖNTEM Ocak 1995 ile Ocak 2004 tarihleri arasında Trakya Üniversitesi Tıp Fakültesi Nöroşirurji Anabilim Dalma kafa travması tanısı ile yatırılan 0-16 yaş grubundaki 280 olgu istatistik yöntemler kullanılarak incelendi. BULGULAR Giriş Glasgow Koma Skoruna (GKS) göre olguların % 70,l'i hafif (GKS: 13-15), % 17,Ti orta (GKS: 9-12), % 6,8'i ağır (GKS: 3—8) kafa travması olarak değerlendirildi. En sık travma nedeni yüksekten düşme (% 34,3), eşlik eden en sık yaralanma ise uzun kemik kırıkları idi (% 12,9). 51 hastaya (% 18,2) nöroşirürjikal cerrahi girişim uygulandı. Glasgow Çıkış Skoruna (GÇS) göre yapılan değerlendirmede hastaların % 87,5'i tama yakın iyileşti, %12,5'i değişik derecelerde sekellerle taburcu edildi ya da kaybedildi. Hastanın giriş GKS ile GÇS arasında orta derecede güçlü bir korelasyon saptandı (r=0,53, p=0,01). SONUÇ Çocukluk çağı kafa travmalarının yarıya yakınının nedeni düşmeydi ve bu olguların prognozu iyi bulundu. Okul çağında ise ilk sırayı trafik kazaları aldı. Trafik kazaları gerek giriş GKS gerekse prognoz açısından en ağır travma tipiydi. Hastanın politravmalı oluşu, subdural hematom, serebral kontüzyon, subaraknoid kanama, intraserebral hematom, serebral ödem, diffüz aksonal yaralanmaya sahip olması ve ameliyat gerektiren bir kranyal hasar bulunması kötü prognozla ilişkili bulundu.Öğe Deneysel künt kafa travmasında N-asetilsisteinin sekonder beyin hasarı üzerine etkisi / The effect of N-acetylcysteine on secondary damage in experimental closed head injury(2006) Tiryaki, Mehmet; Hiçdönmez, TufanÖZET N-asetilsistein' in, glutatyon prekürsörü, antioksidan ve serebest radikal temizleyicisi olarak yararlı etkileri, santral sinir sistemi iskemi ve iskemi/reperfüzyon modelleriyle ortaya konmuştur. Ancak N-asetilsistein'in santral sinir sistemi travmasındaki etkileri daha az anlaşılmıştır. Bu çalışmada, ratlarda oluşturulan deneysel künt kafa travması modeliyle N- asetilsistein'in sekonder hasar üzerine tedavi edici etkisi incelenmeye çalışılmıştır. Otuz altı erkek Sprague-Dawley rat, her bir grupta 12 rat olacak şekilde rastgele üç gruba ayrıldı: Grup 1 (kontrol), Grup 2 (travma), ve Grup 3 (travma + N-asetilsistein tedavisi). Grup 2 ve 3' de, koronal sütürün hemen önünde ve sağ hemisferde bir noktaya gelecek şekilde kafatasına 7 cm yükseklikten bir travma uygulandı. Ratlar, travmadan sonra 2. saatte (Altgrup 1A, 2A ve 3A) ve 12. saatte (Altgrup 1B, 2B ve 3B) sakrifiye edildi. Beyin dokusu biyokimyasal ve histopatolojik inceleme için çıkarıldı. Künt kafa travması kontrollerle kıyaslandığında doku malonildialdehid düzeylerini önemli oranda yükseltti (p< 0.05).Travmadan sonra tek doz N-asetilsistein (150 mg/kg) uygulanması, atmış malonildialdehid düzeylerini önemli oranda düşürerek koruyucu etki gösterdi (p<0.05). Histopatolojik çalışma sonuçları sadece travmaya maruz kalan grupta, nöronların ileri derecede koyulaştığını ve piknotik nukleusta dejenerasyon geliştiğini gösterdi. N-asetilsistein ile tedavi edilen grupta nöronların morfolojisi oldukça iyi korundu. Sadece travmaya maruz kalan grupta nöron sayısı, hem kontrol grubundan hem de travma ile birlikte N-asetilsistein tedavisi uygulanan gruptan ciddi derecede daha düşük bulundu. Sonuçlar, N-asetilsistein tedavisinin travmaya bağlı oksidatif beyin dokusu hasarından korunma için faydalı olabileceğini ortaya koydu. Anahtar sözcükler: Beyin dokusu, malonildialdehid , caspase-3, kafa travması, rat, N-asetilsisteinÖğe A laboratory training model in fresh cadaveric sheep brain for microneurosurgical dissection of cranial nerves in posterior fossa(Taylor & Francis Ltd, 2008) Hamamcioglu, Mustafa Kemal; Hicdonmez, Tufan; Tiryaki, Mehmet; Cobanoglu, SebahattinA neurosurgical laboratory training model is designed for residents of neurosurgery to handle surgical microscopes and microneurosurgical instruments. The material consists of a one-year-old fresh cadaveric sheep cranium. A four-step approach was designed to simulate microneurosurgical dissection along the posterior fossa cisterns, and to dissect cranial nerves emerging from the brain stem. We conclude that this laboratory training model is useful to allow trainees to gain experience with the general use of an operating microscope, and familiarity with handling cranial nerves.Öğe Microneurosurgical training model in fresh cadaveric cow brain: a laboratory study simulating the approach to the circle of Willis(Elsevier Science Inc, 2006) Hicdonmez, Tufan; Hamamcioglu, M. Kemal; Tiryaki, Mehmet; Cukur, Ziya; Cobanoglu, SebahattinBackgrounds: Residents of neurosurgery need many years to develop microneurosurgical skills, and laboratory training models are essential for developing and refining surgical skills before clinical application of microneurosurgery. A simple simulation model is needed for young residents to learn how to handle microneurosurgical instruments, and to perform safe dissection of intracranial vessels and nerves. Methods: The material consists of a 2-year-old fresh cadaveric cow cranium. A 4-step approach was designed to dissect the internal carotid artery and its proximal branches, the optic nerve, the optic chiasm, and the pituitary stalk. Results: The model simulates standard microneurosurgery using a variety of approaches to vessels and neural structures in and around the circle of Willis of the human brain. Conclusion: The cadaveric cow brain, besides being cost-effective, represents a fairly useful method to accustom residents of neurosurgery, especially junior residents, to dissecting intracranial vessels and nerves, and it simulates intracranial microneurosurgical procedures performed in the human brain. (c) 2006 Elsevier Inc. All rights reserved.Öğe Neuroprotective effects of N-acetylcysteine on experimental closed head trauma in rats(Springer/Plenum Publishers, 2006) Hicdonmez, Tufan; Kanter, Mehmet; Tiryaki, Mehmet; Parsak, Turgay; Cobanoglu, SebahattinN-acetylcysteine (NAC) is a precursor of glutathione, a potent antioxidant, and a free radical scavenger. The beneficial effect of NAC on nervous system ischemia and ischemia/reperfusion models has been well documented. However, the effect of NAC on nervous system trauma remains less understood. Therefore, we aimed to investigate the therapeutic efficacy of NAC with an experimental closed head trauma model in rats. Thirty-six adult male Sprague-Dawley rats were randomly divided into three groups of 12 rats each: Group I (control), Group II (trauma-alone), and Group III (trauma+NAC treatment). In Groups II and III, a cranial impact was delivered to the skull from a height of 7 cm at a point just in front of the coronal suture and over the right hemisphere. Rats were sacrificed at 2 h (Subgroups I-A, II-A, and III-A) and 12 h (Subgroups I-B, II-B, and III-B) after the onset of injury. Brain tissues were removed for biochemical and histopathological investigation. The closed head trauma significantly increased tissue malondialdehyde (MDA) levels (P < 0.05), and significantly decreased tissue superoxide dismutase (SOD) and glutathione peroxidase (GPx) activities (P < 0.05), but not tissue catalase (CAT) activity, when compared with controls. The administration of a single dose of NAC (150 mg/kg) 15 min after the trauma has shown protective effect via decreasing significantly the elevated MDA levels (P < 0.05) and also significantly (P < 0.05) increasing the reduced antioxidant enzyme (SOD and GPx) activities, except CAT activity. In the trauma-alone group, the neurons became extensively dark and degenerated into picnotic nuclei. The morphology of neurons in the NAC treatment group was well protected. The number of neurons in the trauma-alone group was significantly less than that of both the control and trauma+NAC treatment groups. In conclusion, the NAC treatment might be beneficial in preventing trauma-induced oxidative brain tissue damage, thus showing potential for clinical implications.Öğe Nocardial brain abscess: Review of clinical management(Elsevier Sci Ltd, 2006) Kilincer, Cumhur; Hamamcioglu, M. Kemal; Simsek, Osman; Hicdonmez, Tufan; Aydoslu, Bayram; Tansel, Ozlem; Tiryaki, MehmetNocardiosis has become a significant opportunistic infection over the last two decades as the number of immunocompromised individuals has grown worldwide. We present two patients with nocardial brain abscess. The first patient was a 39-year-old woman with systemic lupus erythematosus. A left temporoparietal abscess was detected and aspirated through a burr-hole. Nocardia farcinica infection was diagnosed. The patient had an accompanying pulmonary infection and was thus treated with imipenem and amikacine for 3 weeks. She received oral minocycline for 1 year. The second patient was a 43-year-old man who was being treated with corticosteroids for glomerulonephritis. He was diagnosed with a ring-enhancing multiloculated abscess in the left cerebellar hemisphere, with an additional two small supratentorial lesions and triventricular hydrocephalus. Gross total excision of the cerebellar abscess was performed via a left suboccipital craniectomy. Culture revealed Nocardia asteroides, and the patient was successfully treated with intravenous ceftriaxone, then oral trimethoprime-sulfamethoxazole for 1 year. The clinical course, radiological findings, and management of nocardial brain abscess are discussed in light of the relevant literature, and current clinical management is reviewed through examination of the cases presented here. (C) 2006 Elsevier Ltd. All rights reserved.Öğe Travmatik karotis arter diseksiyonuna bağlı serebral enfarkt: Olgu sunumu ve güncel yaklaşımın gözden geçirilmesi(2008) Kılınçer, Cumhur; Tiryaki, Mehmet; Çelik, Yahya; Turgut, Nilda; Balcı, Kemal; Utku, Ufuk; Çobanoğlu, Sebahattinİlerleyen nöroradyolojik yöntemler sayesinde travmatik karotis diseksiyonlarının sanıldığı kadar seyrek olmadığı anlaşılmıştır. Asemptomatik olduğu için tanısı konulamayan bazı olgularda geç dönemde nörolojik defisit gelişebildiğinden şüpheli hasta grubunda karotis diseksiyonunun akla gelmesi ve uygun şekilde araştırılması gereklidir. Bu yazıda, geçirdiği trafik kazası sonrasında karotis interna arter diseksiyonu ve buna bağlı serebral enfarkt gelişen bir hasta sunuldu. Hastalığın patogenezi, klinik özellikleri ve uygulanan tanı ve tedavi yöntemlerinin seçimi literatür bilgisi ışığında tartışıldı, sık rastlanmayan ancak akılda tutulması gereken bu durum hakkında güncel bilginin aktarılması amaçlandı.