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Öğe 3D modeling and comparative analysis of the double arcus aorta case(2022) Avnioğlu, Seda; Dikici, Rümeysa; Etli, MustafaWe analyzed the double arch of a 51-year-old male patient who applied to the outpatient clinic with chest pain and shortness of breath and compared this rare case with the studies in the literature. Double aortic arch (DAA) is defned as a type of vascular ring malformation. The incidence of congenital heart diseases is less than 1%. DAA makes up 46–76% of all rings. We aimed to contribute to cardiac surgery by examining and modeling the diameters in the 2D and 3D images of the patient. For 3D modeling, an open-source software program ITK-SNAP 3.8 was used, which converts 2D images from MRI, CT, and ultrasound to 3D medical image volumes. CT images of the case taken from the SECTRA system of our hospital were uploaded to ITK-SNAP and segmentation was performed. With 3D modeling, a better understanding of the stenosis in the trachea and the double arch was achieved. The ascending aorta diameter was 30 mm. There were atherosclerotic changes in the aorta and its branches. The diameter of the right aortic arch was 22.2 mm, and the diameter of the left aortic arch was 14.5 mm. Trachea diameter was found to be 17 mm/13.2 mm. Esophageal diameter was 9.8 mm. The patient had no specifc complaints and no medical or surgical treatment was recommended because his physical examination was normal. We think that a better understanding of such cases in 3D may contribute to cardiovascular surgeryÖğe Acute arterial occlusion of upper extremity in a patient with preoperative leriche syndrome(Alanya Alaaddin Keykubat Üniversitesi, 2019) Serhatlıoğlu, Faruk; Etli, MustafaLeriche syndrome is the obstruction of the infrarenal aorta or bilateral iliac artery bifurcation. It is a peripheral vascular disease and can affect both lower extremities. It is a rare disease with high mortality rates. The characteristic symptoms are claudication in the leg, decreased or absent femoral pulses and male erectile disorder. Leriche syndrome’s treatment is surgeryÖğe Analysis of routine blood markers for predicting amputation/re-amputation risk in diabetic foot(Wiley, 2020) Gülcü, Anıl; Etli, Mustafa; Karahan, Oğuz; Aslan, AhmetDiabetic foot is challenging progressive disease which requires multisystemic control. Neuropathy, arteriopathy, and cellular responses should treated collaboratively. Despite all medical advances, diabetic foot can highly resulted with amputation and also re-amputation can be required because of failed wound healing. In this study, we aimed to investigate the relation between blood parameters and amputation events. Diabetic 323 patients include to the study who referred to orthopaedic clinic for amputation. Amputation levels (amputation levels phalanx, metatarsal, lisfranc, syme, below knee, knee-disarticulation, above-knee amputation) and re-amputations recorded and compared with routine blood parameters. Re-amputation was observed at 69 patients. The significant difference detected between lower albumin, higher HbA1c, higher CRP levels (P < 0.05) in regards to gross amputation levels, and increased wound depth. Furthermore, lower albumin levels and higher levels of WBC, HbA1c, CRP, and Creatinine were detected in re-amputation levels. Especially, HbA1c, CRP, and Creatinine levels were found as upper bound of reference line for re-amputation. The statistically optimal HbA1c cutoff point for diabetes was >= 7.05%, with a sensitivity of 86% and a specificity of 59%. In according to our results, simple blood parameters can be useful for observing the progress of amputation in diabetic foot. Particularly, lower albumin, and higher HbA1c, CRP, and Creatinine levels detected as related with poor prognosis. Besides, screening of HbA1c level seems to be highly sensitive for detecting of re-amputation possibility.Öğe Analysis of the brain MR image of a patient with anosmia due to Covid-19 by voxel-based morphometry-Case report(Wiley, 2021) Avnioglu, Seda; Etli, Mustafa; Dikici, Rumeysa[Abstract Not Available]Öğe Can superficial veins be used as a drainage path in deep venous injuries?(2021) Etli, Mustafa; Gürsu, ÖzgürPeripheral vascular injuries are frequently encountered traumas that require emergency intervention. Rapid recognition of vascular injury, fluid replacement, blood transfusion, and early revascularization are very critical in the potential prevention of mortality, extremity loss, and functional defect. In the present report, we aimed to emphasize the importance of arterial and superficial venous and also deep venous revascularizations on the mortality and morbidity of a patient with burts vascular injuries.Öğe Common carotid artery bifurcation aneurysm mimicking glomus caroticum(2019) Etli, Mustafa; Şahin, Caner; Özen, ÖzkanPatients with extracranial carotid aneurysms may apply to Ear, Nose and Throat clinics with complaints of pulsatile mass in the neck, neurological symptoms or tinnitus. Glomus caroticum is one of the most common diagnoses of patients with a large mass of pulsatile neck. Herein, we present a case of common carotid artery aneurysm at the level of common carotid artery mimicking glomus caroticum. Glomus may coexist with an aneurysm in the carotid artery. Risk of complications during lesion excision may increase the presence of aneurysm. In patients admitted with a pulsatile mass lesion in the carotid bifurcation region, the diagnosis and treatment of aneurysm with glomus caroticum should be kept in mind.Öğe Evaluation of the predictive role of standard laboratory tests for disease severity in patients with deep venous thrombosis(2022) Etli, Mustafa; Karahan, Oğuz; Serhatlıoğlu, Faruk; Öntaş, HakanIntroduction: Deep venous thrombosis (DVT) can result in fatal outcomes if it is not timely diagnosed and sufficiently treated. Some laboratory markers were identified in previous reports for predicting the disease with low sensitivity or specificity. We aimed to evaluate the predictive value of serum albumin levels and compare them with conventional laboratory parameters. Material and methods: Fifty patients with acute lower-extremity DVT who has no previous history of malignancy or hematologic disorder were included in the study. The demographical variables and standard biomarkers of the DVT group were compared with the normal population (n:50). Thereafter patients were divided into two groups extensive DVT (thrombosis involves popliteal, femoral, and iliac veins together) and localized DVT (thrombosis involves popliteal vein and below) and biomarkers were compared in patient groups. Results: The demographical variables and white blood cell count (WBC) were found as similar between healthy groups and DVT groups. However, mean platelet volume (MPV), D-Dimer, neutrophil to lymphocyte ratio (NLR), and fibrinogen to albumin ratio (FAR) were found markedly higher in DVT patients. Moreover, statistically incremental FAR and NLR levels were detected (p < 0.05) in patients with extensive DVT (involved iliac and femoral veins). Conclusion: Serum NLR and FAR levels seem to be significant predictors for the extensive thrombotic event in patients with DVT.Öğe Hemodiyaliz amaçlı açılan arterio-venöz fistüllerde gelişen endotel disfonksiyonuna statinlerin etkisi(Alanya Alaaddin Keykubat Üniversitesi, 2019) Etli, Mustafa; Yavuz, Turhan; Kayan, Mustafa; Sezer, Mehmet TuğrulAmaç: Bu çalışmamızda; düzenli ve yeterli şekilde, en az 6 aydır, son dönem böbrek hastalığı nedeniyle hemodiyalize giren hastalarda Atorvastatin tedavisinin antihiperlipidemik etkilerinin yanında endotel disfonksiyonu(ED) üzerine etkisine akım aracılı dilatasyon (flow-mediated dilation, FMD) testi ile bakarak statinin arterio venöz fistül açıklığı üzerine etkilerini araştırdık. Hastalar ve Yöntem: Çalışmada 15 kontrol ve 15 atorvastatin alan hasta incelendi. ED’nun değerlendirilmesi daha önce tanımlandığı şekilde FMD Ölçümü yapılarak fistül olan kolda brakial arterdeki akım aracılı dilatasyonun değerlendirmesi ile yapıldı. Bulgular: LDL ilk ve son değer farkının statin verilen ve verilmeyen gruplara göre bağımsız T-testi ile karşılaştırlmasında; Statin verilen gurupta LDL değerleri istatistiksel olarak belirgin anlamlıydı (p=0,000, p<0,01). Ayrıca FMD ilk ve son değer farkının statin verilen ve verilmeyen gruplara göre göre bağımsız T-testi ile karşılaştırlmasında ise: Statin verilen gurupta FMD değerleri verilmeyenlere göre istatistiksel olarak anlamlıydı (p =0,001, p< 0,01). Sonuç: Yaptığımız çalışmada da endotel disfonksiyonunu göstermek için uyguladığımız FMD test sonuçları; i) statin gurubuyla, kontrol gurubu karşılaştırıldığında statin gurubu lehine istatiksel olarak anlamlı olduğu, ii) statin gurubunda ateroskleroz gelişimindeki azalmaya bağlı olarak fistül gelişimi ve açıklık oranının istatiksel olarak daha anlamlı olduğu şeklinde açıklanabilir. Bu bulgular doğrultusunda statin AVF hastalarında kısa dönem fistül açıklığının sağlanması ve diyalize giriş yolunun ek işleme gerek kalmadan korunması yönünden statin kullanımının gerekli olduğu düşüncesindeyiz.Öğe Investigation of routine blood parameters for predicting embolic risk in patients with nonvalvular atrial fibrillation(Wolters Kluwer Medknow Publications, 2022) Etli, MustafaIntroduction: Nonvalvular atrial fibrillation (NV-AF) is an important risk factor for cardiac thromboembolic disorders. However, there is not an exact biomarker for evaluating risk in these patients. In this study, we aimed to investigate the routine blood test and inflammatory markers in NV-AF patients with or without embolic complications. Materials and Methods: Routine complete blood count (CBC) and a clinical biochemistry analysis of 214 NV-AF patients (151 with embolic complication and 63 without embolic complication) were recorded retrospectively. Obtained results compared between NV-AF with embolic group and NV-AF without an embolic group. Results: The most of the CBC and biochemical markers were found as similar (P > 0.05) between groups except white blood cell count, lymphocyte ratio (Lym%), neutrophil ratio (Neu%), eosinophil ratio (Eus%), neutrophil count (Neu), mean corpuscular hemoglobin concentration, blood urea nitrogen, cholesterol, low-density lipid, sodium (Na), total bilirubin, direct bilirubin, plasma iron levels, and neutrophil to lymphocyte ratio (NLR) (P < 0.05). Conclusion: The inflammatory markers, especially NLR, seem to be useful for embolic risk stratification in NVAF patients.Öğe Investigation of Rupture Risk of Thoracic Aortic Aneurysms via Fluid-Structure Interaction and Artificial Intelligence Method(Springer Heidelberg, 2024) Koru, Murat; Canbolat, Gokhan; Daricik, Fatih; Karahan, Oguz; Etli, Mustafa; Korkmaz, ErgunPatient-specific studies on vascular flows have significantly increased for hemodynamics due to the need for different observation techniques in clinical practice. In this study, we investigate aortic aneurysms in terms of deformation, stress, and rupture risk. The effect of Ascending Aortic Diameter (AAD) was investigated in different aortic arches (19.81 mm, 42.94 mm, and 48.01 mm) via Computational Fluid Dynamics (CFD), Two-way coupling Fluid-Structure Interactions (FSI) and deep learning. The non-newtonian Carreau viscosity model was utilized with patient-specific velocity waveform. Deformations, Wall Shear Stresses (WSSs), von Mises stress, and rupture risk were presented by safety factors. Results show that the WSS distribution is distinctly higher in rigid cases than the elastic cases. Although WSS values rise with the increase in AAD, aneurysm regions indicate low WSS values in both rigid and elastic artery solutions. For the given AADs, the deformations are 2.75 mm, 6. 82 mm, and 8.48 mm and Equivalent von Mises stresses are 0.16 MPa, 0.46 MPa, and 0.53 MPa. When the rupture risk was evaluated for the arteries, the results showed that the aneurysm with AAD of 48.01 mm poses a risk up to three times more than AAD of 19.81 mm. In addition, an Artificial neural network (ANN) method was developed to predict the rupture risk with a 98.6% accurate prediction by numerical data. As a result, FSI could indicate more accurately the level of rupture risk than the rigid artery assumptions to guide the clinical assessments and deep learning methods could decrease the computational costs according to CFD and FSI.Öğe Investigation of serum ischemia-modified albumin levels in coronary artery disease patients(Springer India, 2020) Etli, MustafaObjective Ischemia-modified albumin (IMA) is a novel marker for the detection of ischemia. The value of this biomarker has been studied in patients with coronary artery disease (CAD). However, the relationship between the severity of coronary stenosis and serum IMA levels remains unknown. Therefore, we aimed to investigate the potential role of serum IMA levels in predicting the severity of coronary atherosclerosis. Materials and methods One hundred and forty-two individuals who underwent coronary angiography for coronary artery disease complaints were included in the study. Participants were divided into three groups based on their diagnosis as control (healthy subjects), group I (subjects with lower Gensini score), and group II (subjects with higher Gensini score). Global Registry of Acute Coronary Events (GRACE) risk score and Gensini scores were calculated after coronary angiogram in the patient groups. Then, venous blood samples were collected from each participant. Serum IMA levels and the levels of routine laboratory markers were measured. Results The serum lymphocyte, neutrophil, and high-density lipid (HDL) levels were statistically insignificant between the groups. The white blood cell (WBC) count and IMA levels were significantly higher in the patient groups (p < 0.05). The GRACE and Gensini scores were significantly different in the patient groups (p < 0.05). However, there was no significant correlation between the GRACE and Gensini scores and serum IMA levels. Conclusion Although IMA levels can be a significant predictor for ischemia according to previous reports, this biomarker seems to be insufficient for determining the severity of disease in patients with CAD.Öğe Investigation of the correlation between cardiac parameters and aortic diameter in patients with ascending aortic aneurysm(2022) Etli, Mustafa; Avnioğlu, Seda; Yılmaz, Halil; Karahan, OğuzBackground: Aortic aneurysms (AA) are enlargement of the aorta silently until diagnosing, not detectable on physical examination, and usually incidentally discovered during radiologic scanning for other reasons. It can get bigger sizes and can result in life-threatening outcomes if not detected early on. In this study, we aimed to determine the relationship between ascending aortic diameter and cardiac parameters that can be detected with tomography or/and echocardiography. Newly diagnosed (n: 85) ascending AA patients and healthy individuals (n: 86) who have not any thoracic pathology in computed tomography (CT) scans included to the study. Echocardiographically determined left atrial dimension (LAD), left ventricular end-diastolic diameter (LVDd), left ventricular end-systolic diameter (LVDs), left ventricular ejection fraction (LVEF) and the left ventricular posterior wall thickness (LVPWd) values of each patient were recorded. The thorax diameters, ascending aorta diameters and cardiac volume values recorded from CT scans. The obtained findings were statistically compared. Results: Positive correlation was found between aortic diameter and aging (p: 0.000). Increased thorax diameter and cardiac volume values were detected in ascending AA cases (p < 0.05). It was found to be ascending aortic diameter was positively correlated with thorax diameter and cardiac volume (0.50 < r ? 0.70) values and higher aortic diameter, cardiac volume, thorax diameter values were detected in male individuals when compared with the female gender. There was no significant correlation between LVEF, LVDd, and LVDs values and aortic diameter. Conclusions: Cardiac volume and thorax diameter were found as strongly correlated with the diameter of the ascending aorta. The clarifying of these parameters with larger cohorts might be beneficial for the estimation of the progression of ascending AA.Öğe INVESTIGATION OF VASCULAR FLOW IN A THORACIC AORTA IN TERMS OF FLOW MODELS AND BLOOD RHEOLOGY VIA COMPUTATIONAL FLUID DYNAMICS (CFD)(World Scientific Publ Co Pte Ltd, 2024) Canbolat, Gokhan; Etli, Mustafa; Karahan, Oguz; Koru, Murat; Korkmaz, ErgunThe studies on vascular flows have increased in the last decade. In this work; we have focused on the effects of flow model and blood rheology on hemodynamics for a real-subject scan using Computed Tomography Angiography (CTA) during numerical solutions. Various vascular flow studies using Newtonian or non-Newtonian blood models were presented in the literature with laminar or turbulent flow assumptions. In this study; six different turbulent models (Realizable k-epsilon, Standard k-epsilon, SST k-omega, Standard k-omega, Transition k-kl-omega, Transition SST) were compared to laminar flow to show whether turbulent flow solution is necessary. Blood rheology was investigated by using five different non-Newtonian models (Carreau, Herschel-Bulkley, Carreau-Yasuda, Casson, Power-Law) in addition to Newtonian model to indicate whether non-Newtonian blood assumptions is necessary. The In vivo boundary conditions were utilized by the UDF code which defines the real-patient cardiac cycle obtained by Echocardiography (ECHO) to present hemodynamics in the study. The results show that laminar flow well matched with the four turbulent models and two models shows by 4.8% and 19.5% differences in Wall Shear Stress (WSS) according to laminar flow. When the blood rheology was investigated, results revealed significant differences in WSS by 25.7%, 8.7%, 22.4%, 12.3%, and 32.5% for the non-Newtonian models in the given order, respectively, compared to Newtonian assumption. It concluded that laminar flow solution could be effective instead of solving turbulent flows in terms of computational cost, however, non-Newtonian blood effects could be considered to determine critical hemodynamics levels in a normal aortic arc.Öğe Numerical investigation of patient-specific thoracic aortic aneurysms and comparison with normal subject via computational fluid dynamics (CFD)(Springer Heidelberg, 2021) Etli, Mustafa; Canbolat, Gökhan; Karahan, Oğuz; Koru, MuratVascular hemodynamics play an important role in cardiovascular diseases. This work aimed to investigate the effects of an increase in ascending aortic diameter (AAD) on hemodynamics throughout a cardiac cycle for real patients. In this study, two scans of thoracic aortic aneurysm (TAA) subject with different AADs (42.94 mm and 48.01 mm) and a scan of a normal subject (19.81 mm) were analyzed to assess the effects of hemodynamics on the progression of TAA with the same flow rate. Real-patient aortic geometries were scanned by computed tomography angiography (CTA), and steady and pulsatile flow conditions were used to simulate real patient aortic geometries. Aortic arches were obtained from routine clinical scans. Computational fluid dynamics (CFD) simulations were performed with in vivo boundary conditions, and 3D Navier-Stokes equations were solved by a UDF (user-defined function) code defining a real cardiac cycle of one patient using Fourier series (FS). Wall shear stress (WSS) and pressure distributions were presented from normal subject to TAA cases. The results show that during the peak systolic phase pressure load increased by 18.56% from normal subject to TAA case 1 and by 23.8% from normal subject to TAA case 2 in the aneurysm region. It is concluded that although overall WSS increased in aneurysm cases but was low in dilatation areas. As a result, abnormal changes in WSS and higher pressure load may lead to rupture and risk of further dilatation. CFD simulations were highly effective to guide clinical predictions and assess the progress of aneurysm regions in case of early surgical intervention.Öğe Paraoxonase 1 activity as a new biochemical marker in the diagnosis of peripheral arterial disease(2021) Savaş, Hasan Basri; Etli, MustafaAim: Peripheral artery disease (PAD) is an atherosclerotic disease. It is seen in older ages. It causes cardiovascular morbidity and mortality. PAD may progress without any symptoms. Despite its high frequency, there is no laboratory parameter that directly indicates peripheral arterial disease in routine biochemical tests. The relationship between oxidative stress increase and PAD is known. In this study, it is aimed to show the possible usage of the activities of the antioxidant enzymes paraoxonase 1 and arylesterase as a new marker in the diagnosis of PAD. Material and Methods: A total of 70 individuals, including 35 in the control group and 35 peripheral artery patients, were included in this study. The collected blood serums were separated and stored at -80 °C. Paraoxonase 1 and arylesterase activities were measured using the spectrophotometric method in the serum which was dissolved at room temperature. The results were subjected to statistical analysis. P <0.05 was accepted as the level of significance. Results: In the peripheral arterial disease group, the paraoxonase 1 and arylesterase activities were found to be significantly lower than those in the control group (p <0.05). In peripheral arterial disease, paraoxonase 1 and arylesterase activities were shown to decrease. Conclusion: In peripheral arterial disease, paraoxonase 1 and arylesterase activities were found to decrease significantly. The results of similar studies related to atherosclerosis in the literature were in line with our findings. It would be beneficial to support the results of this study with new studies and evaluate paraoxonase 1 and arylesterase activities in routine biochemistry laboratories for the diagnosis and follow-up of peripheral arterial disease.Öğe Prevalence of Accessory Renal Artery In Aortic Aneurysms(2020) Etli, Mustafa; Avnioglu, Seda; Dikici, RumeysaIntroduction: Open surgical procedures and endovascular aortic procedures are the most fearedrenal injuries in abdominal aortic surgery. The presence of renal anomalies and clear localization during aneurysm repair brings surgical success. In this article, we aimed to show the importance of renal anomalies in terms of mortality and morbidity in aneurysm repair.Materials and Methods: Between January 2017 and January 2019, 250 patients with aortic aneurysm and CT angiography were included in the study.The files of the patients who underwent computerized contrast angiographyforaorticaneurysmin Trainingand Research Hospital were reviewed retrospectively. Results: Bilateral renal artery was detected in four male patients; and left accessory renal artery was detected in five male and three female patients. At the end of the study, 250 patients were screened; and bilateral renal arteries were detected in 1.6%, left accessory arteries were detected in 3.2% of the eight patients.Conclusions: Itisimportantthatsurgeonsand radiologists know the accessory arterial variations not only in abdominal aortic surgery, but also in recent years duetoincreased renaltransplantation reconstruction, urological and radiological surgical techniques.Öğe Unusual presentation of moyamoya disease with popliteal involvement: Case report and review of the literature(2021) Etli, Mustafa; Karahan, OğuzMoyamoya disease is a rare disorder that involves the cerebrovascular system. Usually, it leads to occlusion of the arteries of the cerebral system and causes cerebral circulatory complaints. A 48-year-old female patient was admitted to our clinic with intermittent claudication in both legs. Biphasic and monophasic waveform patterns were detected bilaterally in distal (trifurcation arteries) lower extremities with Doppler sonography. The patient therefore underwent systemic vascular examination. Computed tomography angiography revealed bilateral carotid occlusion at the level of supraclinoid segments, and opacifications were detected at the distal segments of the bilateral anterior cerebellar and middle cerebellar arteries. The patient was diagnosed with moyamoya disease, and anticoagulant treatment was started. In conclusion, most previous reports have presented the cerebrovascular involvement of moyamoya disease. However, this disease can involve different peripheral vascular systems and careful and systemic vascular examination is necessary for an exact diagnosis.
