Browsing by Author "Kaçar, Emre"
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Publication Efficacy of 0.1% tacrolimus ointment in chronic plaque psoriasis: A randomized double-blind placebo-controlled study(Deri Zuhrevi Hastaliklar Dernegi, 2015-01-01) Kaçar, Seval Dogruk; Kaçar, Emre; Baskan, Emel Bulbul; BÜLBÜL BAŞKAN, EMEL; Bolca, Naile; BOLCA TOPAL, NAİLE; Adım, Sadiman Balaban; BALABAN ADIM, ŞADUMAN; Tunalı, Şükran; Sarıcaoğlu, Hayriye; SARICAOĞLU, HAYRİYE; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Deri ve Zührevi Hastalıkları Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Patoloji Anabilim Dalı.; JLM-2426-2023; AAH-1388-2021Background and Design: Despite the development of effective systemic treatments and new biological agents for psoriasis nowadays, topical medications are still the mainstay of treatment. Topical calcineurin inhibitors are currently used in various skin diseases. We investigated the efficacy and safety of tacrolimus, which is an alternative in topical treatment, in comparison with the present medications in plaque psoriasis.Materials and Methods: This prospective double-blind placebo-controlled study was conducted in 24 patients with the diagnosis of plaque psoriasis who were seen in Uludag University Hospital dermatology outpatient clinic. 0.1% tacrolimus ointment, 0.1% mometasone furoate ointment, 0.005% calcipotriol ointment and placebo in encrypted bottles were randomly applied under occlusion to 27 psoriatic plaques in test chambers, every other day, for a period of 19 days. Clinic sum scores, side effects, and epidermal thickness measured by superficial ultrasound were noted before and after treatment in all microplaques. Besides, histopathologic scoring and epidermal thickness were measured in 9 patients at the end of the study.Results: The clinic sum scores and ultrasonographic epidermal thickness at the end were both significantly lower than the beginning values in all microplaques (p<0.05). The reduction in these two values with tacrolimus were significantly higher than that with placebo (p<0.001), but no difference was observed with calcipotriol (p=0.287, p=0.813, respectively). On the other hand, the reduction in these values with mometasone was significantly higher than with tacrolimus (p<0.05). Mometasone furoate was the most effective when the three ointments were compared with placebo in terms of total histopathological score and epidermal thickness.Conclusion: Tacrolimus ointment applied under occlusion is an alternative topical medication in the treatment of plaque psoriasis. Occlusion in practice requires patient compliance. Thus, studies to find a new formulation that will increase absorption of drug from thick psoriatic plaques are needed.Publication Intracraniat aneurysm rupture during flow diverter stent placement: Successful treatment with stent-in-stent combination(Elsevier, 2015-04-01) Kaçar, Emre; Nas, Ömer Fatih; Erdoğan, C.; Hakyemez, Bahattin; NAS, ÖMER FATİH; Erdoğan, C.; HAKYEMEZ, BAHATTİN; 0000-0002-3425-0740; Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı; AAI-2318-2021; AAG-8561-2021Intra-procedural aneurysm rupture (IPAR) is one of the most feared complications in the endovascular treatment of intracranial aneurysms. Most IPAR cases occur during microwire or microcatheter advancement or coil placement into the aneurysm [1]. Flow diverter stent (FDS) treatment may also result in early or late post-procedural aneurysm rupture. Although the definite cause is not known, changes in intra-aneurysmal hemodynamics after the stent are held responsible for the rupture [7]. We present a case where IPAR developed during FDS treatment and hemostasis was achieved with stent-in-stent combination.Item Kalp pili yerleştirilmesi sonrası gelişen kompleks venöz darlığın perkütan yolla geçilmesinde seeker crossing support kateterin nadir kullanımı(Uludağ Üniversitesi, 2015-10-12) Kaçar, Emre; Şanal, Bekir; Nas, Ömer Fatih; Hacıkurt, Kadir; Sağ, Saim; Erdoğan, Cüneyt; Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Kardiyoloji Anabilim Dalı.Kalp pilinin yerleştirilmesi sonrasında ortaya çıkan en yaygın komplikasyonlar venöz tromboz ve venöz darlıktır. Son yıllarda, perkütan yaklaşım santral venöz darlıkların tedavisinde etkili bir tedavi seçeneği olmaktadır. Perkütan yolla standart yöntemlerle vasküler kompleks darlıkların geçilemediği durumlarda Seeker crossing support kateter (SCSK) (Bard PV, Tempe), üstün uç yapısıyla alternatif iyi bir yöntem olabilir. Yazımızda; kalp pili implantasyonu sonrası sol subklavian ve brakiosefalik vende gelişen oklüzyonun standart perkütan yöntemlerle geçilememesi üzerine SCSK kateterle darlığın başarılı şekilde geçilmesi ve santral venöz sistemde rekanalizasyonun sağlanması sunulmaktadır.Item Lomber disk hernisi nedeniyle opere olan olgularda Manyetik Rezonans (MR) görüntüleme ile saptanan vertebra endplate değişikliklerinin önemi(Uludağ Üniversitesi, 2004) Kaçar, Emre; Parlak, Müfit; Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.Amaç: Lomber disk hernisi nedeniyle cerrahi tedavi uygulanan olguların, preoperatif MR incelemelerinde yaygın olarak saptanan ve dejeneratif disk değişikliğinin bir bulgusu olan end-plate değişikliklerinin, opetrasyon sonrası uzun dönemde tekrarlayan bel ağrısı yakınması ve rekürren disk hernisi gelişimi ile ilişkisinin araştırılması. Gereç ve Yöntem: Çalışmaya Ocak 1994 ve Haziran 2003 tarihleri arasında, lomber disk hernisi nedeniyle opere olan 748 olgu dahil edildi. Olguların preoperatif lumbosakral MR incelemelerinde saptanan end-plate değişikliklerinin düzeyi, tipi ve şiddeti ile operasyon sonrası uzun dönemdeki klinik iyileşme durumları arasındaki ilişki değerlendirildi. Ayrıca operasyon sonrası rekürren disk hernisi nedeniyle tekrar opere olan 38 olgunun preoperatif lumbosakral MR incelemelerinde saptanan end-plate değişikliklerinin düzeyi, tipi ve şiddeti ile rekürren disk hernisi gelişimi arasındaki ilişki incelendi. Bulgular: Cerrahi tedavi sonrası ortalama 12,6 aylık izlem süresinde tekrarlayan bel ağrısı yakınması olan olguların % 8,5'inde Tip 1 , % 57,7'sinde Tip 2, % 1,1'inde Tip 3 end-plate değişikliği saptandı ve istatistiksel olarak Tip 2 end-plate değişikliğinin operasyon sonrası uzun dönemde tekrarlayan bel ağrısı yakınması ile ilişkili olduğu görüldü (p=0,000). Rekürren disk hernisi nedeniyle tekrar opere olan 38 olgunun % 0,5'inde Tip 1, % 3,5'inde Tip 2 end-plate değişikliği olduğu görüldü, Tip 3 end-plate değişikliği saptanmadı. End-plate değişiklikleri ile rekürren disk gelişimi arasında, istatistiksel açıdan anlamlı ilişki bulunmadı (p˃0,05). Tartışma ve Sonuç: MR incelemede saptanan Tip 2end-plate değişiklikleri, lomber disk hernisi nedeniyle opere olan olgularda, uzun dönemde görülebilecek tekrarlayan bel ağrısı yakınmasının bir göstergesi olabilir. Ancak MR'da saptanan end-plate değişiklikleri, rekürren disk hernisi gelişimi ile ilişkili görülmemektedir.Publication Modified Y-configured stents with the waffle-cone technique by use of solitaire® stent for patients with wide-necked bifurcation aneurysms(Springer, 2015-08-01) Nas, Ömer Fatih; Kaçar, Emre; Kaya, Ahmet; Erdoğan, Cüneyt; Hakyemez, Bahattin; NAS, ÖMER FATİH; KAYA, AHMET TUFAN; Erdoğan, Cüneyt; HAKYEMEZ, BAHATTİN; 0000-0002-3425-0740; Uludağ Üniversitesi Tıp Fakültesi Radyoloji Anabilim Dalı; 0000-0002-8813-6513; AAS-5392-2021; AAI-2318-2021; AAG-8561-2021; COE-1124-2022Endovascular treatment of wide-necked bifurcation aneurysms can be challenging, despite improvements in endovascular techniques. Y stent-assisted coiling is one such technique, but this may not be technically feasible, especially in cases of acute angulation between the proximal and distal parent arteries, and may require use of "modified Y-configured stents with the waffle-cone technique". We report three cases of wide-necked bifurcation aneurysms that were successfully treated by use of the Solitaire (R) stent.Item Pattern, variability, and hemispheric differences of the subparietal sulcus on multiplanar reconstructed MR images(Springer, 2015-07-17) Kaçar, Emre; Nas, Ömer Fatih; Ökeer, Emre; Hakyemez, Bahattin; Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; 0000-0002-3425-0740; AAI-2318-2021; AAG-8561-2021; 51864050100; 56529606700; 6602527239Purpose The aim of this study was to analyze variations in the morphological features of the subparietal sulcus (SPS) and to investigate interhemispheric and gender differences in these variations using multiplanar reconstructed (MPR) magnetic resonance (MR) images. MethodsTwo hundred subjects with normal cranial MR imaging, including high-resolution T1-weighted volumetric data, were enrolled in the study. The sagittal or oblique sagittal MPR images created from high-resolution T1-weighted data were analyzed for the following morphological features: the SPS patterns, the continuity of the SPS with the cingulate sulcus and parieto-occipital sulcus (POS), and the presence of upwardly directed SPS branches reaching to the hemispheric surface. Interindividual variability of the morphologic features, hemispheric asymmetry, and gender differences were investigated. ResultsConsiderable variations were found in the morphological features of the SPS. The H-pattern, no connection with the cingulate sulcus or the POS, and one upwardly directed branch reaching the hemispheric surface were most commonly observed morphologic features of the SPS in 45.2, 41.8, and 48 % of the all hemispheres, respectively. Furthermore, the connection of the SPS only with the cingulate sulcus and the presence of two upwardly directed branches reaching the hemispheric surface showed the significant leftward asymmetry (P < 0.05). ConclusionsOur study demonstrated the extensive morphological variability of the SPS and the hemispheric asymmetry for some morphological features. Knowledge of these variations and their hemispheric asymmetry may be helpful for surgical approaches in neurosurgery and structure-function correlations in functional neuroimaging studies involving the posteromedial hemisphere.Publication Rare use of twin solitaire® stents in the double waffle-cone technique for endovascular treatment of a wide-necked bifurcation aneurysm(Sage, 2015-04-01) Nas, Ömer Fatih; Kaçar, Emre; Kaya, Ahmet; Erdoğan, Cüneyt; Hakyemez, Bahattin; NAS, ÖMER FATİH; KAYA, AHMET TUFAN; Erdoğan, Cüneyt; HAKYEMEZ, BAHATTİN; Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı; 0000-0002-8813-6513; 0000-0002-3425-0740; AAI-2318-2021; AAS-5392-2021; AAG-8561-2021; COE-1124-2022Endovascular treatment of wide-necked bifurcation aneurysms may be challenging. The waffle-cone technique can be used in these aneurysms in case of acute angulation between parent artery and distal artery of the aneurysm. Solitaire (R) stent (Ev3, Irvine, CA, USA) has the significant advantage of mitigating the potential complication risks. This study reports the second case in the literature in which endovascular treatment of a wide-necked bifurcation aneurysm with the double waffle-cone technique by using twin Solitaire (R) stents proved to be successful.Item Retrieval of a dislocated coil and stent-assisted coiling by Solitaire (R) stent during endovascutar treatment of an intracraniat aneurysm(Elsevier, 2016-03) Kaçar, Emre; Nas, Ömer Fatih; Kaya, Ahmet; Erdoğan, Cüneyt; Hakyemez, Bahattin; Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; 0000-0002-8813-6513; 0000-0002-3425-0740; 0000-0002-4467-3456; AAG-8561-2021; AAS-5392-2021; AAI-2318-2021; W-1759-2017; 51864050100; 56659105900; 8293835700; 6602527239Coil embolization is an effective and safe procedure for the treatment of intracranial aneurysms. It is known to produce good clinical outcomes and provide sufficient protec- tion against recurrent bleeding [1-4]. In a systematic review, Brilstra et al. retrieved 19 (1.4%) re-bleeding episodes, 36 (2.6%) aneurysmal ruptures, 124 (9%) ischemic and 55 (4%) permanent complications in 1383 patients with ruptured and unruptured aneurysms treated with coil embolization. Complications occurring during coil embolization include rupture of aneurysm, arterial dissection, bleeding and microembolic complications. Coil dislocation is another rare complication of coil embolization which occurs in 2-6% of the procedures [3,5-7]. Thromboembolic complications during endovascular treatment could be caused by coil dislocation or thrombus formation in parent vessel because of vasospasm [2]. Dislocation can be fixed by retrieval of the coil from the aneurysm or placement of the coil back in the aneurysm [3,8]. Retrieval of a dislocated coil can be achieved by snares and stent retrievers. We present herein a case where Solitaire® stent (Ev3, Irvine, CA, USA) was used for retrieval of a dislocated coil, which protruded into the proximal part of the internal carotid artery (ICA) during endovascular treatment and secondly for total aneurysm treatment by stent-assisted coiling technique in the same patient.Publication Single-stage endovascular treatment in patients with severe extracranial large vessel stenosis and concomitant ipsilateral unruptured intracranial aneurysm(Türk Radyoloji Derneği, 2015-11-01) Kaçar, Emre; Nas, Ömer Fatih; Erdoğan, Cüneyt; Hakyemez, Bahattin; NAS, ÖMER FATİH; Erdoğan, Cüneyt; HAKYEMEZ, BAHATTİN; Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; 0000-0002-3425-0740; COE-1124-2022; AAI-2318-2021; AAG-8561-2021PURPOSEWe aimed to evaluate the safety and effectiveness of single-stage endovascular treatment in patients with severe extracranial large vessel stenosis and concomitant ipsilateral unruptured intracranial aneurysm.METHODSHospital database was screened for patients who underwent single-stage endovascular treatment between February 2008 and June 2013 and seven patients were identified. The procedures included unilateral carotid artery stenting (CAS) (n=4), bilateral CAS (n=2), and proximal left subclavian artery stenting (n=1) along with ipsilateral intracranial aneurysm treatment (n=7). The mean internal carotid artery stenosis was 81.6% (range, 70%-95%), and the subclavian artery stenosis was 90%. All aneurysms were unruptured. The mean aneurysm diameter was 7.7 mm (range, 5-13 mm). The aneurysms were ipsilateral to the internal carotid artery stenosis (internal carotid artery aneurysm) in five patients, and in the anterior communicating artery in one patient. The patient with subclavian artery stenosis had a fenestration aneurysm in the proximal basilar artery. Stenting of the extracranial large vessel stenosis was performed before aneurysm treatment in all patients. In two patients who underwent bilateral CAS, the contralateral carotid artery stenosis, which had no aneurysm distally, was treated initially.RESULTSThere were no procedure-related complications or technical failure. The mean clinical follow-up period was 18 months (range, 9-34 months). One patient who underwent unilateral CAS experienced contralateral transient ischemic attack during the clinical follow-up. There was no restenosis on six-month follow-up angiograms, and all aneurysms were adequately occluded.CONCLUSIONA single-stage procedure appears to be feasible for treatment of patients with severe extracranial large vessel stenosis and concomitant ipsilateral intracranial aneurysm.Publication The gently pull-back technique for neck bypass in treatment of wide-necked internal carotid artery aneurysms: A report of three cases and review of the literature(Sage Publications Inc, 2015-12-01) Kaçar, Emre; Hakyemez, Bahattin; NAS, ÖMER FATİH; Nas, Ömer F.; KAYA, AHMET TUFAN; Kaya, Ahmet; Erdoğan, Cüneyt; Kocaeli, Hasan; KOCAELİ, HASAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; 0000-0002-8813-6513; AAG-8561-2021; AAS-5392-2021Neck bypass failure in endovascular treatment of wide-necked internal carotid artery (ICA) aneurysms may adversely affect the technical success of the procedure. We used the gently pull-back technique to bypass the aneurysm neck and access the distal parent artery during endovascular treatment in patients with wide-necked ICA aneurysms. In this technique, a loop was made in the aneurysm and the distal parent artery was reached by using a small diameter microguidewire and a microcatheter. After providing reliable distal access, the microguidewire was removed and the whole system which consists of the microcatheter was gently pulled back. Finally the microcatheter was straightened and the aneurysm neck was passed. After crossing the aneurysm neck, a flow-diverting stent treatment and stent-assisted coiling were performed in three cases with wide-necked ICA aneurysm. The gently pull-back technique is a simple and effective method which requires no extra intravascular device and helps to bypass the aneurysm neck through a small diameter microguidewire and a microcatheter. This technique may be useful for neck aneurysm bypass in endovascular treatment of wide-necked ICA aneurysms.Item Use of Solitaire (TM) retrievable stent-assisted coiling technique for endovascular treatment of post-traumatic direct carotid cavernous fistula(Elsevier, 2016-11) Büyükkaya, Ramazan; Kaçar, Emre; Nas, Ömer Fatih; Erdoğan, Cuneyt; Hakyemez, Bahattin; Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; 0000-0002-3425-0740; AAI-2318-2021; AAG-8561-2021; 51864050100; 8293835700; 6602527239Item Vertebrobaziler dolikoektaziye bağlı hemifasiyal spazm(Uludağ Üniversitesi, 2004-07-16) Şanal, Bekir; Gökalp, Gökhan; Kaçar, Emre; Parlak, Müfit; Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.Hemifasiyal spazm (HFS), 7. kranial sinirin innerve ettiği fasiyal kasların tek taraflı istemsiz ve ağrısız kontraksiyonudur. Sıklıkla 7. kranial sinirin bir komşu arter tarafından kök giriş bölgesinde vasküler dolikoektaziye bağlı kompresyonu ile oluşmaktadır. Fasiyal sinirin vasküler patolojiye bağlı kompresyonunu ve diğer kranial sinirleri değerlendirmede 3B CISS MR sekansı, konvansiyonel görüntülere ek olarak yapılması gerekli bir görüntüleme yöntemidir. Bu yazıda, 3B CISS MRG yöntemi ile vertebrobaziler dolikoektazi ve buna bağlı nörovasküler basının gösterildiği hemifasiyal spazmı olan bir olgunun klinik ve radyolojik bulgularını sunmayı ve tartışmayı amaçladık.