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Bolukbasi Y, Saglam Y, Selek U, Topkan E, Kataria A, Unal Z, Alpan V. Reproducible Deep-inspiration Breath-hold Irradiation with Forward Intensity-modulated Radiotherapy for Left-sided Breast Cancer Significantly Reduces Cardiac Radiation Exposure Compared to Inverse Intensity-modulated Radiotherapy. Tumori 2018; 100:169-78. [DOI: 10.1177/030089161410000209] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Aims and Background To investigate the objective utility of our clinical routine of reproducible deep-inspiration breath-hold irradiation for left-sided breast cancer patients on reducing cardiac exposure. Methods and Study Design Free-breathing and reproducible deep-inspiration breath-hold scans were evaluated for our 10 consecutive left-sided breast cancer patients treated with reproducible deep-inspiration breath-hold. The study was based on the adjuvant dose of 50 Gy in 25 fractions of 2 Gy/fraction. Both inverse and forward intensity-modulated radiotherapy plans were generated for each computed tomography dataset. Results Reproducible deep-inspiration breath-hold plans with forward intensity-modulated radiotherapy significantly spared the heart and left anterior descending artery compared to generated free-breathing plans based on mean doses – free-breathing vs reproducible deep-inspiration breath-hold, left ventricle (296.1 vs 94.5 cGy, P = 0.005), right ventricle (158.3 vs 59.2 cGy, P = 0.005), left anterior descending artery (171.1 vs 78.1 cGy, P = 0.005), and whole heart (173.9 vs 66 cGy, P = 0.005), heart V20 (2.2% vs 0%, P = 0.007) and heart V10 (4.2% vs 0.3%, P = 0.007) – whereas they revealed no additional burden on the ipsilateral lung. Reproducible deep-inspiration breath-hold and free-breathing plans with inverse intensity-modulated radiotherapy provided similar organ at risk sparing by reducing the mean doses to the left ventricle, left anterior descending artery, heart, V10-V20 of the heart and right ventricle. However, forward intensity-modulated radiotherapy showed significant reduction in doses to the left ventricle, left anterior descending artery, heart, right ventricle, and contralateral breast (mean dose, 248.9 to 12.3 cGy, P = 0.005). The mean doses for free-breathing vs reproducible deep-inspiration breath-hold of the proximal left anterior descending artery were 1.78 vs 1.08 Gy and of the distal left anterior descending artery were 8.11 vs 3.89 Gy, whereas mean distances to the 50 Gy isodose line of the proximal left anterior descending artery were 6.6 vs 3.3 cm and of the distal left anterior descending artery were 7.4 vs 4.1 cm, with forward intensity-modulated radiotherapy. Overall reduction in mean doses to proximal and distal left anterior descending artery with deep-inspiration breath-hold irradiation was 39% (P = 0.02) and 52% (P = 0.002), respectively. Conclusions We found a significant reduction of radiation exposure to the contralateral breast, left and right ventricles, as well as of proximal and especially distal left anterior descending artery with the deep-inspiration breath-hold technique with forward intensity-modulated radiotherapy planning.
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Affiliation(s)
- Yasemin Bolukbasi
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Radiation Oncology, American Hospital, MD Anderson Radiation Treatment Center, Istanbul, Turkey
| | - Yucel Saglam
- Department of Radiation Oncology, American Hospital, MD Anderson Radiation Treatment Center, Istanbul, Turkey
| | - Ugur Selek
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Radiation Oncology, American Hospital, MD Anderson Radiation Treatment Center, Istanbul, Turkey
- Department of Radiation Oncology, Koc University, School of Medicine, Istanbul, Turkey
| | - Erkan Topkan
- Department of Radiation Oncology, Baskent University, School of Medicine, Adana, Turkey
| | | | - Zeynep Unal
- Department of Radiology, American Hospital, Istanbul, Turkey
| | - Vildan Alpan
- Department of Radiation Oncology, American Hospital, MD Anderson Radiation Treatment Center, Istanbul, Turkey
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Koksoy C, Sevim Y, Unal Z, Demirel E. Effects of Venous Stent Placement on Cutaneous Microvascular Function in Iliocaval Venous Obstruction. J Vasc Surg Venous Lymphat Disord 2015; 3:129. [DOI: 10.1016/j.jvsv.2014.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Eosinophilic gastroenteritis is an uncommon disease characterized by eosinophilic infiltration of the gastrointestinal tract. The clinical manifestations are related to the layer(s) and extent of the bowel involved. In this paper, we present a case of intractable abdominal pain caused by jejunal submucosal eosinophilic infiltration without mucosal involvement, diagnosed by deep endoscopic biopsies. The patient was successfully treated with steroids without need for surgery for diagnosis or therapy.
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Affiliation(s)
- Zeynel Mungan
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Turkey ; Department of Gastroenterology, American Hospital, Istanbul, Turkey
| | - Tan Attila
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Turkey ; Department of Gastroenterology, American Hospital, Istanbul, Turkey
| | - Yersu Kapran
- Department of Pathology, American Hospital, Istanbul, Turkey
| | | | - Zeynep Unal
- Department of Diagnostic Radiology, American Hospital, Istanbul, Turkey
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Bolukbasi Y, Saglam Y, Selek U, Topkan E, Kataria A, Unal Z, Alpan V. Reproducible deep-inspiration breath-hold irradiation with forward intensity-modulated radiotherapy for left-sided breast cancer significantly reduces cardiac radiation exposure compared to inverse intensity-modulated radiotherapy. Tumori 2014. [PMID: 24852861 DOI: 10.1700/1491.16405] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS AND BACKGROUND To investigate the objective utility of our clinical routine of reproducible deep-inspiration breath-hold irradiation for left-sided breast cancer patients on reducing cardiac exposure. METHODS AND STUDY DESIGN Free-breathing and reproducible deep-inspiration breath-hold scans were evaluated for our 10 consecutive left-sided breast cancer patients treated with reproducible deep-inspiration breath-hold. The study was based on the adjuvant dose of 50 Gy in 25 fractions of 2 Gy/fraction. Both inverse and forward intensity-modulated radiotherapy plans were generated for each computed tomography dataset. RESULTS Reproducible deep-inspiration breath-hold plans with forward intensity-modulated radiotherapy significantly spared the heart and left anterior descending artery compared to generated free-breathing plans based on mean doses - free-breathing vs reproducible deep-inspiration breath-hold, left ventricle (296.1 vs 94.5 cGy, P = 0.005), right ventricle (158.3 vs 59.2 cGy, P = 0.005), left anterior descending artery (171.1 vs 78.1 cGy, P = 0.005), and whole heart (173.9 vs 66 cGy, P = 0.005), heart V20 (2.2% vs 0%, P = 0.007) and heart V10 (4.2% vs 0.3%, P = 0.007) - whereas they revealed no additional burden on the ipsilateral lung. Reproducible deep-inspiration breath-hold and free-breathing plans with inverse intensity-modulated radiotherapy provided similar organ at risk sparing by reducing the mean doses to the left ventricle, left anterior descending artery, heart, V10-V20 of the heart and right ventricle. However, forward intensity-modulated radiotherapy showed significant reduction in doses to the left ventricle, left anterior descending artery, heart, right ventricle, and contralateral breast (mean dose, 248.9 to 12.3 cGy, P = 0.005). The mean doses for free-breathing vs reproducible deep-inspiration breath-hold of the proximal left anterior descending artery were 1.78 vs 1.08 Gy and of the distal left anterior descending artery were 8.11 vs 3.89 Gy, whereas mean distances to the 50 Gy isodose line of the proximal left anterior descending artery were 6.6 vs 3.3 cm and of the distal left anterior descending artery were 7.4 vs 4.1 cm, with forward intensity-modulated radiotherapy. Overall reduction in mean doses to proximal and distal left anterior descending artery with deep-inspiration breath-hold irradiation was 39% (P = 0.02) and 52% (P = 0.002), respectively. CONCLUSIONS We found a significant reduction of radiation exposure to the contralateral breast, left and right ventricles, as well as of proximal and especially distal left anterior descending artery with the deep-inspiration breath-hold technique with forward intensity-modulated radiotherapy planning.
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Bolukbasi Y, Selek U, Saglam Y, Kataria A, Unal Z, Alpan V, Kirsner S, Ballo M. EP-1528 BREATH HOLD IRRADIATION TECHNIQUE FOR LEFT SIDED BREAST CANCER SIGNIFICANTLY REDUCES CARDIAC RADIATION EXPOSURE. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71861-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ozyiğit T, Unal Z, Ozben B. Successful intravenous immunoglobulin therapy in a case of acute fulminant myocarditis. Turk Kardiyol Dern Ars 2011; 39:59-63. [PMID: 21358234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Fulminant myocarditis is an inflammatory process that occurs in the myocardium and causes acute-onset heart failure. Its prognosis is poor unless patients are promptly and aggressively supported. Although an autoimmune mechanism has been postulated for myocarditis, immunomodulatory treatment strategies are still under investigation. We report on a 30-year-old woman with acute myocarditis, whose condition rapidly deteriorated despite standard medical therapy. High-dose intravenous immunoglobulin therapy (70 g/day for 2 days) was given and the patient showed dramatic improvement on the second day. Left ventricular ejection fraction increased from 32% to 40% and to 50% at 24 and 48 hours of treatment, respectively. She was discharged on the tenth day with normal ejection fraction. She was free of cardiac events during a two-year follow-up. High-dose intravenous immunoglobulin may be potentially useful in selected patients, especially if given early in acute fulminant myocarditis.
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Affiliation(s)
- Tolga Ozyiğit
- Department of Cardiology, American Hospital, İstanbul, Turkey
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Boylu E, Domaç FM, Koçer A, Unal Z, Tanridağ T, Us O. Visual evoked potential abnormalities in migraine patients. Electromyogr Clin Neurophysiol 2010; 50:303-308. [PMID: 21061777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Visual processing in migraine has been targeted indicating that the visual pathways are involved in the migraine pathophysiology. We aimed to assess the nature of visual evoked potential (VEP) changes in migraine patients and to evaluate the role of VEP in the diagnosis of migraine. MATERIALS AND METHODS We examined 31 female and 10 male patients with a migraine headache diagnosis according to the criteria of the International Headache Society. Control subjects had neither migraine and other types of primary headache nor familial history. VEP were elicited using a checkerboard by monocular and binocular pattern reversal stimulation. The latencies of N75, P100 and N145 and peak-to-peak amplitude of N75-P100 were measured. We compared VEP latencies and amplitudes of the monocular and binocular stimulation within each population. RESULTS The N75 and P100 latencies were found to be significantly longer in the study group than the control group (p = 0.014 and p = 0.034, respectively) while the amplitudes in the study group were lower (p = 0.014). N145 latency was found to be longer in patients with longer duration of disease (p < 0.05). P100 latency was found to be significantly longer in patients with aura than the patients without aura (p = 0.029). N75 latency, recorded by left monocular stimulation, was elongated and the amplitude was diminished with left hemicranial headache. CONCLUSION Measurement of VEP latency and amplitude is a valuable and reliable test for the diagnosis of migraine. Our results reflect a persisting dysfunction of precortical visual processing which might be relevant in the pathogenesis of migraine.
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Affiliation(s)
- E Boylu
- Division of Electrodiagnostic Neurology, Department of Neurology, Marmara University, Istanbul, Turkey
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Domaç FM, Koçer A, Boylu E, Unal Z, Tanridağ T, Us O. P178 Visual event related potentials in migraneous patients. Clin Neurophysiol 2008. [DOI: 10.1016/s1388-2457(08)60449-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Boylu E, Domaç FM, Koçer A, Unal Z, Tanridağ T, Us O. P177 Diagnostic value of visual evoked potentials in migraine. Clin Neurophysiol 2008. [DOI: 10.1016/s1388-2457(08)60448-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Unal Z, Domaç FM, Boylu E, Tanridağ T, Us O. MO26 Blink reflex studies in migraine and tension-type headache. Clin Neurophysiol 2008. [DOI: 10.1016/s1388-2457(08)60134-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Aydin K, Ucar A, Oguz KK, Okur OO, Agayev A, Unal Z, Yilmaz S, Ozturk C. Increased gray matter density in the parietal cortex of mathematicians: a voxel-based morphometry study. AJNR Am J Neuroradiol 2007; 28:1859-64. [PMID: 17921236 DOI: 10.3174/ajnr.a0696] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The training to acquire or practicing to perform a skill, which may lead to structural changes in the brain, is called experience-dependent structural plasticity. The main purpose of this cross-sectional study was to investigate the presence of experience-dependent structural plasticity in mathematicians' brains, which may develop after long-term practice of mathematic thinking. MATERIALS AND METHODS Twenty-six volunteer mathematicians, who have been working as academicians, were enrolled in the study. We applied an optimized method of voxel-based morphometry in the mathematicians and the age- and sex-matched control subjects. We assessed the gray and white matter density differences in mathematicians and the control subjects. Moreover, the correlation between the cortical density and the time spent as an academician was investigated. RESULTS We found that cortical gray matter density in the left inferior frontal and bilateral inferior parietal lobules of the mathematicians were significantly increased compared with the control subjects. Furthermore, increase in gray matter density in the right inferior parietal lobule of the mathematicians was strongly correlated with the time spent as an academician (r = 0.84; P < .01). Left-inferior frontal and bilateral parietal regions are involved in arithmetic processing. Inferior parietal regions are also involved in high-level mathematic thinking, which requires visuospatial imagery, such as mental creation and manipulation of 3D objects. CONCLUSION The voxel-based morphometric analysis of mathematicians' brains revealed increased gray matter density in the cortical regions related to mathematic thinking. The correlation between cortical density increase and the time spent as an academician suggests experience-dependent structural plasticity in mathematicians' brains.
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Affiliation(s)
- K Aydin
- Department of Neuroradiology Istanbul Medical School, Istanbul University, Capa, Istanbul, Turkey.
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Aydin K, Tatli B, Ozkan M, Ciftci K, Unal Z, Sani S, Ozmen M, Caliskan M, Aydinli N, Guven S. Quantification of neurometabolites in subacute sclerosing panencephalitis by 1H-MRS. Neurology 2006; 67:911-3. [PMID: 16966569 DOI: 10.1212/01.wnl.0000233836.16266.f5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The authors studied 20 patients with subacute sclerosing panencephalitis (SSPE) to investigate the correlations between MRI, magnetic resonance spectroscopy (MRS), and clinical status. MRI findings did not correlate with clinical status. By contrast, all patients had reductions in N-acetyl aspartate (NAA) and increase in myoinositol (mI) (p < 0.01), and NAA and mI concentrations correlated with clinical severity (p < 0.05). During follow-up, NAA continued to decline. (1)H-MRS may be a useful measure of disease severity and progression in SSPE.
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Affiliation(s)
- K Aydin
- Department of Neuroradiology, Istanbul Medical School, Istanbul University, Turkey.
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Affiliation(s)
- Cüneyt Türkmen
- Department of Nuclear Medicine, Istanbul University, Istanbul Medical Faculty, Turkey.
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Abstract
OBJECTIVE To investigate the frequency of cranial magnetic resonance imaging abnormalities in patients with migraine and their relationship to type, duration, and frequency of migraine attacks. METHODS Forty-five patients (43 women, 2 men) with migraine whose ages ranged between 19 and 53 years (mean, 40.91 [SD, 7.69]) were evaluated. Of the 45 patients, 20 had migraine with aura and 25 had migraine without aura, according to the diagnostic criteria of the International Headache Society. RESULTS In 13 (28.8%) of 45 patients, white matter foci were present on magnetic resonance imaging. Eight of these patients (61.5%) had migraine with aura, and 5 patients (38.4%) had migraine without aura. The presence of white matter foci was significantly higher in the patients with aura (8 [40%] of 20) than in those without aura (5 [20%] of 25). It was found that as the frequency of attacks per month increased, the number of patients with white matter foci also increased. Although the mean duration of migraine was longer in patients with white matter foci (149.5 months [SD, 87.9]) than in those without white matter foci (134.1 months [SD, 88.3]), there was no significant difference (P >.05). CONCLUSION Although there are no specific magnetic resonance imaging findings peculiar to migraine, detection of white matter foci should be taken into consideration in patients with migraine (especially migraine with aura). Frequency of attacks is an important indicator of existence of white matter foci.
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Affiliation(s)
- Eren Gozke
- Departments of Neurology, PTT Teaching and Research Hospital, Istanbul, Turkey
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