Ertugrul Tatlisumak

The blood-brain barrier is continuously open for several weeks following transient focal cerebral ischemia.

The blood-brain barrier (BBB) is the principal regulator of blood-borne substance entry into the brain parenchyma. Therefore, BBB leakage, which leads to cerebral edema and influx of toxic substances, is common in pathological conditions such as cerebral ischemia, inflammation, trauma, and tumors. The leakage of BBB after ischemia-reperfusion injury has long been considered to be biphasic, although a considerable amount of discrepancies as for the timing of the second opening does exist among the studies. This led us to evaluate systematically and quantitatively the dynamics of BBB leakage in a rat model of 90-min ischemia-reperfusion, using gadolinium-enhanced (small molecule) magnetic resonance imaging and fluorescent dye Evans Blue (large molecule). BBB leakage was assessed at the following time points after reperfusion: 25 min, 2, 4, 6, 12, 18, 24, 36, 48, and 72 h, and 1, 2, 3, 4, and 5 weeks. We observed BBB leakage for both gadolinium and Evans Blue as early as 25 min after reperfusion. Thereafter, BBB remained open for up to 3 weeks for Evans Blue and up to 5 weeks for gadolinium. Our results show that BBB leakage after ischemia-reperfusion injury in the rat is continuous and long-lasting, without any closure up to several weeks. This is the first systematic and extensive study fully demonstrating BBB leakage dynamics following transient brain ischemia and the findings are of major clinical and experimental interest.

Post-ischemic leakiness of the blood-brain barrier: a quantitative and systematic assessment by Patlak plots.

The Patlak plot analysis of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) allows estimation of blood-brain barrier (BBB) leakage following temporary focal cerebral ischemia. Thus far, a systematic and quantitative in vivo evaluation of post-ischemic BBB leakage is lacking. Here, using DCE-MRI and the Patlak plot method, we quantitatively assessed BBB leakage in rats at the following time-points after reperfusion: 25 min, 2, 4, 6, 12, 18, 24, 36, 48, and 72 h, and 1, 2, 3, 4, and 5 weeks. Sham-operated animals served as controls. Data collected for each time-point were: the blood-to-brain transfer rate constant (K(i)) of the contrast agent gadolinium, distribution volume (V(p)), ischemic lesion volume, and apparent diffusion coefficient (ADC) values. Compared to controls, K(i), measured at all time-points, except for 5 weeks, appeared significantly different (p<0.001). At several time-points (25 min, 48 and 72 h, 4 and 5 weeks), V(p) was similar compared to that of controls, but for the remaining groups the difference was significant (p<0.001). Analyzing the relationship of K(i) values to time-points, we observed a trend towards a decrease over time (r=-0.61, p=0.014). Both ADC values (r=-0.58, p=0.02) and ischemic lesion volumes (r=0.75, p=0.0015) correlated with K(i) values. These results suggest that after ischemia-reperfusion in rats, BBB leakage is continuous during a 4-week period. Its magnitude diminishes over time and correlates with severity and extent of ischemic injury.

CT study on morphometry of frontal sinus

The aim of this study was to determine the prevalence and morphological characteristics of the frontal sinus in an adult population. This study was conducted retrospectively on paranasal CT scans in the axial and coronal planes of 300 cases (123 male and 177 female). The mean age was 40.74 ± 13.34 (range 20–83). Measurements of the width, height and anteroposterior length for each sinus and total width were obtained from CT scans. Measurements were compared statistically with relation to side and sex. The cases were divided into subgroups according to age for each sex and each measurement parameter was also compared among the subgroups. All measurements tended to be larger on the left side and were significantly larger in males than females. There was a significant difference in the anteroposterior lengths of right and left sides in both males and females and height for males and width for females. In both sexes, the highest values of measurements were usually observed at the 31–40 age group and there was a tendency to decrease with aging. The larger diameters of the left frontal sinus imply that it may be more possibly violated during surgical interventions. Morphometric features differed significantly in the two sexes at different ages and comparison with previous studies presented great regional variability. The size of the frontal sinus was seen to be related to age and sex. The knowledge provided in the present study is useful for some surgical procedures and widens the anthropometric knowledge of humanity. Clin. Anat. 21:287–293, 2008.

Nurses’ knowledge regarding patients with intravenous catheters and phlebitis interventions

This study was planned and applied in 2 stages. Stage I was applied to determine the knowledge of nurses working in the internal medicine, surgery, obstetrics and gynecology, pediatrics, and other services in Celal Bayar University Hospital about using intravenous catheter and intravenous fluid treatment, and the symptoms and treatment procedure for phlebitis. Stage II consisted of observation of all patients who had intravenous catheters for symptoms of phlebitis for 5 days and the interventions the nurses used for the patients who had phlebitis. In stage I, questionnaires were used to determine the knowledge of the nurses; in stage II, 2 investigators observed the patients. Results were evaluated using SPSS software with chi(2) statistical analysis. Nurses were found to have high knowledge levels, but their practices were not suitable to their knowledge levels. Of the patients who participated in the study, 67.24% showed symptoms of phlebitis. We found that there was a significant relationship (P <.05) between the selection of the vein and the occurrence of phlebitis in patients who had an intravenous catheter. We also found that the relationships between the age groups of the patients and phlebitis and the relationships between the diagnosis and phlebitis were statistically significant (P <.05).

Usability of CT Images of Frontal Sinus in Forensic Personal Identification

Forensic personal identification is a fundamental topic of forensic sciences and technologies to identify lived subjects, recently deceased bodies and human remains often at a crime scene by using several appropriate techniques. Throughout human history, many different methods were used for personal identification. The most commonly used method was relying on one’s memory to identify the distinguishing features and characteristics of other humans, such as their outward appearance or the sound of their voice before the introduction of computer technology (Michael & Michael, 2006). In Ancient Egypt and China, criminals and victims of several medico-legal events was often identified through visual characteristics such as sex, human height, body weight, deformation of the body, tattoos, old scars or caste marks and clothing, etc. In the forensic personal identification, progressions based on science accelerated in 19th century. Italian Cesare Lombroso (1835-1909) had studied on body structures of prison inmates and had claimed that criminals have particular physiognomic attributes or deformities. In 1823, known first documentation of fingerprints were defined in a thesis by Johannes Evangelists Purkinje (1787-1869), a Czech anatomist and physiologist. French Police Officer Alphonse Bertillon (1853-1914) created first anthropometric scientific system based on physical measurements for identifying criminals in 1880. Sir Francis Galton (18221911) was an English inventor, devised a method for classifying fingerprints that proved useful in forensic science and he wrote first book about fingerprints in 1892 (Soysal & Eke, 1999). In November 1895, the detection of electromagnetic radiation in a wavelength range today known as x-rays or Rontgen rays by Wilhelm Conrad Rontgen (1845-1923), a German physicist, marked an era in forensic science as well as in clinical diagnosis. The discovery of ABO blood group system by Karl Landsteiner (1868-1943), an Austrian biologist and physician, in 1901 and rhesus blood system by Landsteiner and Alexander Solomon Wiener (1907-1976), American Scientist, in 1937, and description of Coombs test by British immunologists Robin Coombs (1921-2006), et al., blood samples was used to be a unique profile that could be used for personal identification in legal and criminal areas. At 9:05 am on Monday 10 September 1984, Sir Alec John Jeffreys (1950-....), British geneticist, looked at the X-ray film image of a deoxyribonucleic acid (DNA), then he developed techniques for DNA fingerprinting and DNA profiling, which provided a significant contribution for forensic personal identification in all over the world (Soysal & Eke, 1999).

The effect of altitude and climate on the suicide rates in Turkey

Suicide is one of the most important public health problems. There was an association between suicide and several factors such as psychiatric diseases and psychological characteristics, somatic illness, cultural, socioeconomic, familial, occupational and individual risk factors. Also, high altitude and climatic factors including high temperature, cloudiness, more sunshine and low rainfalls were defined as some of these risk factors in the literature. In this study, we aimed to investigate correlation between suicide rates and altitudes of all cities in Turkey and between suicide rates and climatic factors including Rainfall Activity Index, Winter Mean Temperatures, Summer Mean Temperatures and Temperature Difference between January and July previously defined by several authors in the broad series in Turkey. In Turkey, 29865 suicidal deaths occurred in 10 years period between 2006 and 2015. Of them, 21020 (70.4%) were males and 8845 (29.6%) were females. In this study, we found that high altitude above 1500 m, winter median temperature lower than -10 °C and hard temperature changes above 25 °C between winter and summer of settlements were important factors that affected on female suicide rates appropriate to knowledge which defined in previous studies. In conclusion, we suggested that the associations among suicide rates with altitudes and climate should be studied in wider series obtained from different countries for reaching more reliable results.

The effects of gender and age on forensic personal identification from frontal sinus in a Turkish population.

Objectives: To define the dimensions of the frontal sinus in groups standardized for age and gender and to discuss the reasons and the effects of the variations. Methods: Frontal sinus measurements were obtained from paranasal CT scans of 180 males and 180 females in the Radiology Department of Dursun Odabas Medical Center of Yuzuncu Yil University, Van, which is located in Eastern Turkey, between February and March 2016. The width and height of sinuses were measured on a coronal plane, and the anteroposterior length was measured on an axial plane. Volumes were calculated using the Hospital Information Management Systems and Image Archiving and Management System program. The Statistical Package of the Social Science version 13 was used for statistical analyses. Results: We determined differences in the frontal sinus measurements of different age groups in a Turkish adult population. Frontal sinus dimensions were usually higher in females and lower in males after 40-49 years of age than their younger counterparts, but the measurements were lower in females and higher in males in 70≤ years of age group than 60-69 years of age. Left frontal sinus was dominant in young age groups but right frontal sinus was dominant in groups 40-49 years of age or older. Conclusion: We observed crossing of the measurements between the different age groups, which we could not find clear explanations. The results of such studies may affect forensic identification from frontal sinus measurements.

The Possible Effects of Altitude and Climate on the Development of the Frontal Sinus in Adults

Climatic and altitude features of living region may affect human body. Many changes in several tissues and organs and several health problems due to climatic and altitude effects were defined in the literature. However, there were limited nu mber of studies which evaluated correlation between development of frontal sinus and climatic/altitude effect. In this study, widths, h eights, AP lengths and volumes of frontal sinus were compared by Paranasal CT scans in populations living in Van which has colder climate and higher altitude and Manisa which has milder climate and lower altitude. It was found that widths, antero-posterior lengths and volumes of frontal sinus were higher in populations living in colder climate and higher altitude according to populations living in mil der cli ate and lower altitude. Heights of frontal sinuses were on the contrary of this. These results were found appropriate to increasing of ephalic index in cold climate according to Allen’s Rule. We suggest that larger population study should be made with peoples having the s me or similar race and genetic structure in different climate and altitude regions and the proportional comparison of frontal sinus m easurements with cephalic index should be considered in future studies.

True Retaining Ligaments of Face as Surgical Landmarks

La adherencia de los tejidos que recubren a las estructuras subyacentes en la cara se mantiene por los ligamentos de retencion. Los ligamentos de retencion verdaderos llamados ligamentos orbitales, cigomatico y mandibular son una serie de bandas fibrosas que se extienden desde el periostio a la dermis. El efecto de la inmovilizacion de los verdaderos ligamentos de retencion debe ser liberado para lograr un movimiento satisfactorio de la piel del rostro y del SMAS durante los procedimientos de estiramiento facial. El objetivo fue definir la ubicacion de los verdaderos ligamentos de retencion de la cara para discutir su utilidad como puntos de referencia quirurgicos. El estudio se realizo sobre diez hemi-caras de cadaveres, fijadas con formalina. Las disecciones se asemejaron a los procedimientos de estiramiento facial, se aplicaron y determinaron los ligamentos. Se midieron las distancias de los ligamentos al canto lateral, trago, comisura y a las lineas de trago a canto lateral y comisura. Las correlaciones fueron analizadas estadisticamente. Las distancias de los ligamentos cigomatico y mandibular desde el trago fueron 66,50±10,78 mm y 114,80±9,76 mm, respectivamente. Las distancias del ligamento cigomatico a la comisura y la linea de comisura al trago fueron 56,30±8,94 mm y 28,40±5,19 mm, respectivamente. Las distancias de los ligamentos cigomatico y mandibular desde el trago estaban correlacionadas de forma importante con una relacion de 3/5 y habia una fuerte correlacion entre las distancias del ligamento cigomatico desde la linea de comisura y el trago - con una relacion de 2. Los resultados de este estudio han dilucidado la posibilidad de la utilizacion de los verdaderos ligamentos de retencion como puntos de referencia quirurgicos para la cirugia facial.

Asymmetry, Handedness and Auricle Morphometry

El objetivo de este estudio fue determinar diversas mediciones morfometricas de la oreja, para investigar la asimetria y su relacion con el uso de las manos en ambos sexos. Se realizaron mediciones morfometricas de los pabellones auriculares y las manos de 400 estudiantes universitarios (200 hombres y 299 mujeres). Todas las medidas de las orejas fueron mayores en los hombres y todas las diferencias, excepto las correspondientes al ancho del lobulo auricular, fueron estadisticamente significativas. Todas las mediciones de los pabellones auriculares izquierdos y derechos presentaron diferencias estadisticamente significativas en ambos sexos, excepto en el caso de la longitud del lobulo auricular en los hombres, y la distancia desde el punto mas alto de la oreja a la parte inferior de la incisura intertragica en el lobulo auricular de las mujeres. La longitud de la oreja y la distancia desde el punto mas alto de la misma a la parte inferior de la escotadura intertragica tenian valores mas altos en el lado izquierdo y todas las demas mediciones fueron mas elevadas en el lado derecho. No hubo diferencia significativa entre las mediciones de las orejas correspondientes a los sujetos diestros y zurdos. Todas las mediciones fueron superiores en el lado derecho, excepto la longitud del pabellon auricular y la distancia desde el punto mas alto de la oreja a la parte inferior de la incisura intertragica en sujetos diestros y sujetos zurdos, y todas las diferencias, excepto la longitud del lobulo auricular, fueron significativamente diferentes en los sujetos diestros como en la poblacion total, pero en sujetos zurdos la diferencia de la anchura de la oreja no fue significativa. Se encontro una aparente asimetria en las orejas derecha e izquierda de los sujetos del presente estudio que debe tenerse en consideracion en las cirugias plasticas del oido externo, para el diseno de los dispositivos de audicion y para su aplicacion en estudios forenses de las huellas de la oreja.