Ersin Hacıyakupoğlu

Effects of arginine vasopressin and v1 receptor antagonist on cerebral vasospasm secondary to subarachnoid hemorrhage: an experimental study

AIMnTo examine morphological, radiological and biochemical effects of arginine vasopressin (AV) and V1 receptor antagonist on cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH) in rabbits.nnnMATERIAL AND METHODSnForty male New Zealand white rabbits were randomly divided into four groups comprising 10 rabbits each. The groups were; 1) Control group, 2) SAH group, 3) SAH+AV group, 4) SAH+V1 antagonist group. Diameters of the basilar artery in all groups were measured on angiograms. All animals were sacrificed two days following basilar angiography and tissue samples of basilar artery were obtained under microscope immediate after craniectomy for ultrastructural and biochemical examinations.nnnRESULTSnThe artery diameters were found to be 50% and 50% at the 30th minute in the groups 2 and 3 respectively. In group 3, CVS was 13% more in comparison with the 2nd group. In group 4, vascular constriction was 34.5% at the 30th minute and about 30.9% at the 300th minute. Despite the increase in regional blood flow, AV did not provide morphological change. Histological appearance was related to vascular stenosis due to CVS. Histological outcome was the best in group 4 because of less CVS.nnnCONCLUSIONnArginine vasopressin plays an important role in CVS. We detected morphological and radiological recovery in basilar artery, besides moderate improvement due to AV receptor antagonist in CVS.

Metastatik Beyin Tümörleri

Metastatik tumor; orjinini Santral Sinir Sistemi (SSS) disindaki dokulardan alan primer sistemik kanserlerin sekonder olarak SSS ne yayilmasidir. Eriskinde SSS ne en sik metastaz sirasiyla akciger, meme, malign melanom, renal hucreli Ca, kolon ve tiroid kanserinden gelir. Akciger kanseri %30-60 oraninda beyine metastaz yapar. Cocukta beyin metastazi oldukca azdir. En sik losemi, lenfoma, osteogenik sarkom, rhabdamyosarkom ve germ hucreli tumorler beyne metastaz yaparlar. Malign melanom, akciger, meme ve kolon kanserleri %50 oraninda multipl metastaz yaparken renal tumorler tek metastaz yapmaya meyillidir. Akciger kanseri tani koyduktan 6-9 ay sonra beyne metastaz yaparken, renal kanser 1 yil, kolon kanseri 2 yil, meme kanseri ve malign melanom 3 yil sonra beyine metastaz yapabilir. %6 olguda primer tumore ait hicbir bulgu yokken beyine metastaz olmaktadir. Tedavide verilen ilk ilac kortikosteroiddir, daha sonra ameliyat, Radyoterapi (RT), Kemoterapi (KT) ve Stereotaktik Radyosurgery (SRS) yapilabilir. Kucuk hucreli akciger kanseri, lenfoma, germ hucreli tumorler RT ve KTye hassastirlar. Non small akciger kanserleri, renal, kolon, malign melanom radiorezistandir. Eger hastada 3-4 aydan uzun yasam suresi bekleniyorsa agresif tedavi uygulanir. RTde verilen dozun total miktari ve verilis suresi ile ilgili akut ve kronik komplikasyonlar meydana gelir. Metastatik tumorlerin ameliyatlarinda amac norolojik defisit olmadan tumorun total cikartilmasi, intrakranial basincin azaltilmasi ve eger postoperatuar RT yapilacaksa dozun mumkun oldugu kadar dusuk tutulmasidir. Onceleri multipl metastazlar opere edilmemekte idi ancak ne kadar cok metastaz alinirsa RT ve KT den o kadar cok cevap alindigindan gunumuzde ameliyat onemlidir. Anahtar Kelimeler: Metastatik beyin tumorleri, Stereotaktik radyosurgery, Malign melanom, Akciger kanserleri, Renal hucreli karsinom, Radyoterapi, Kemoterapi

Multiple intracranial tumors: Coexistence of a glioblastoma and null cell pituitary adenoma within the same patient

The coexistence of a glioblastoma multiforme and a null ell pituitary adenoma within the same patient is presented. lthough brain tumors are diagnosed in a slightly increasing umber of patients, due to a broader availability of computer omography andmagnetic resonance imaging (MRI), the estimated requency of primary brain tumors per year is as low as about 6–8 atients/100,000people.Moreover, simultaneousexistencesofpriary brain tumors with different pathologies were described in ot more than 0.9% of all primary brain tumors, but the majorty of those cases were seen after radiotherapy or are associated ith familial tumor syndromes [1,3]. Furthermore it is known that n phacomatosis syndromes, mesodermal and neuroectodermal umors can be seen together and occurrences of an ependymoma, hromophobe pituitary adenoma and an astrocytoma in those atients have been reported elsewhere [4]. But to our knowledge, his is the only case with two intracranial tumors of an essentially ifferent histopathological nature within the same patient, who oes not suffer from any known germ line mutation.

Serebral Anevrizma Cerrahi Komplikasyonları

Serebral anevrizmalarin kraniotomi ile klipaji yillardir kullanilagelen en onemli cerrahi tedavi seklidir. Cerrahi ekipmanlar ve intraoperatif monitorizasyon tekniklerindeki gelismeler bu cerrahiyi daha da guvenilir bir hale getirmistir. Anevrizmayi tamamen kapamaya yonelik cerrahi yeniden kanama riskini anlamli oranda azaltsa da, intraoperatif ve postoperatif komplikasyonlar hala cerrahi tedavinin faydalarini kisitlayan onemli faktorlerdir. Beyin cerrahi ekibi hastayi yakindan takip etmelidir. Hastalarin buyuk cogunlugunda en az bir norolojik veya cerrahi komplikasyon gelismektedir, bu nedenle tedavi sonuclarinin iyilestirilebilmesi bu komplikasyonlarin erkenden teshis ve tedavisi icin surekli tetikte olmayi gerektirmektedir.