THE USAGE OF GELATIN AND POLYVINYL ALCOHOL AS A HARDENER İN THE CADAVERS THAT İS FİXED WITH FIXATION-PRESERVATION SOLUTION (SEFS) CONSISTING OF LIQUID FOAM SOAP, ALCOHOL, CITRIC ACID, AND ANTISEPTIC

Amaç: Bu çalışmanın amacı; sıvı köpük sabun, etanol, sitrik asit karışımı ve benzalkonyum klorür den oluşan fiksasyon-preservasyon solüsyonunu (SEFS) geliştirerek uzun süre bozulmadan saklanabilen, eğitim ve araştırma amacıyla çalışılabilen kadavralar hazırlamaya imkân veren pratik ve ekonomik bir kadavra hazırlama yöntemine ulaşmaktır. Gereç ve Yöntem: Bu amaç için 6 adet Yeni Zelanda tavşanı ve 4 adet Saanen oğlak kullanılmıştır. Hayvanlar iki gruba ayrılarak modifiye edilmiş SEFS kullanılarak tespit edilmiştir. Tespit işleminin ardından damar yolundan bir gruba çeşme suyu, sığır jelatini ve gliserin karışımı (jelatin-Gls); diğer gruba ise çeşme suyu, sığır jelatini ve polivinil alkol (jelatin-PVA) karışımı uygulanmıştır. Hazırlanan kadavralar klasik diseksiyon yöntemi ile diseke edilerek diseksiyona uygunluklarına ait bulgular alınmıştır. Kadavralardan alınan doku örneklerinde renk ve sertlik analizleri, ayrıca bazı eklemlerde eklem hareket aralığı ölçümleri yapılarak her iki grupta bulunan kadavralar 12 aylık sürede karşılaştırmalı olarak değerlendirilmiştir. Bulgular: Kadavralar tespit edildikten 3 ay sonra diseksiyonlarına başlandı. Kadavraların deri diseksiyonlarına başlamadan yapılan gözlemde dokunsal ve görsel özellikleri hem grup I (jelatin-Gls) de hem de grup II (jelatin-PVA) de in vivo görünüm ve kıvamda oldukları tespit edildi. Deri kası ve deri altı bağ dokusunun doğal renginde olduğu; deri altında hiçbir alanda hipostatik konjesyona benzer sıvı birikimleri tespit edilmedi. Kasların dokunsal ve görsel muayenelerinde doğal renklerine çok yakın, canlı bir renk tonuna sahip oldukları ve sübjektif olarak kıvamlarının formaldehitle tespit edilmiş kadavraya nazaran daha yumuşak ve esnek oldukları görüldü. Pleura, akciğerler ve kalbin doğal renklerinde olduğu görüldü Akciğerler kollabe olmamış; kalp sahip olduğu normal görüntü ve hacmindeydi. Kalp içi boşluklu yapısını korumuş atriumlar ve ventriküllerin duvarları içe doğru çökmemişti. Grup II (jelatin-PVA)’nin hem göğüs hem de karın organlarının hacimlerinin korunması konusunda özellikle, kalp, akciğer, karaciğer, dalak ve böbreklerde grup I’e göre daha iyi sonuç verdiği görüldü. Sonuç: Çalışma sonuçlarına göre bir tespit solüsyonu olarak SEFS ve jelatin-PVA karışımının kadavradan beklenen bazı özellikler açısından daha üstün olduğu tespit edilmiştir.KABUL VE ONAY .................................................................................................. i TEŞEKKÜR .............................................................................................................. ii İÇİNDEKİLER .......................................................................................................... iii SİMGELER VE KISALTMALAR DİZİNİ .............................................................. vi ŞEKİLLER DİZİNİ ................................................................................................... vii RESİMLER DİZİNİ .................................................................................................. ix TABLOLAR DİZİNİ .................................................................................................. xi ÖZET ......................................................................................................................... xiii ABSTRACT .............................................................................................................. xv 1. GİRİŞ ………………............................................................................................. 1 2. GENEL BİLGİLER ............................................................................................... 5 2.1. Kadavra ve Tespit ……………………………………………………………... 2.2. Kadavra ve Tespit İşleminin Kısa Tarihçesi …………………………………. 2.2.1. Sık Kullanılan Formaldehitli Tespit Solüsyonları ………………………….. 2.2.2. Formaldehit İçermeyen Tespit Solüsyonları ………………………………... 2.3. Tespit İşlemi ………………………………………………………………….. 2.3.1. Amino Asitler ……………………………………………………………….. 2.3.2. Proteinleri Oluşturan Bağlar ……………………………..………………….. 2.3.3. Proteinler ………………………………………………..………………….. 2.3.3.1. Birinci (Primer) Yapı ………………………………………………..…….. 2.3.3.2. İkincil (Sekonder) Yapı ……………………………………………..…….. 2.3.3.3. Üçüncül (Tersiyer) Yapı ……………………………………………..…….. 2.3.3.4. Dördüncül (Kuaterner) Yapı ………………………………………..…….. 2.4. Denaturasyon ……….......…….………………………………………………. 2.4.1. Aldehitler ve Ketonların Denaturasyon Etkisi .……………………….……. 2.4.2. Asit ve Bazları Denaturasyon Etkisi .............................................………….. 2.4.3. Organik Çözücüler, Nötral Tuzlar ve Deterjanların Denaturasyon Etkisi ….. 2.4.4. İndirgeyicilerin Denaturasyon Etkisi …………….………………………….. 2.5. Tespit Solüsyonlarının İçeriği ………………………………………………….. 2.5.1. Protein Sabitleyiciler ..……………………..………………………………… 2.5.2. Antiseptikler ...…………………….………………………………………….. 2.5.3. Renk Koruyucular - İyileştiriciler ….………………………………………… 2.5.4. Yüzey Aktif Maddeler ….………………………….………………………… 2.5.5. Nemlendiriciler (Yumuşatıcılar) ….……………………..…………………… 2.5.6. Antikoagulanlar ….……………………………….…………………………… 2.5.7. Tamponlar ….………………………………………….……………………… 2.6. İyonik Sıvılar ….………………………………………………………………… 3. GEREÇ VE YÖNTEM ….…………………………...…………………………… 3.1. Gereç ………………………………….………………………………………… 3.2. Yöntem ……………………………….………………………………………… 3.2.1. Tespit (Pefüzyon), Saklama (İmmersiyon) Solüsyonları ve Tespit İşlemi …… 3.2.2. Verilerin Toplanması ve Değerlendirilmesi …...……………………………… 4. BULGULAR ...………………………….………………………………………… 4.1. Kadavraların Dokunsal ve Görsel Değerlendirme Sonuçları …………………… 4.2. Renk ve Sertlik Analiz Sonuçları .…….………………………………………… 4.3. Gonyometrik Ölçüm Sonuçları ............................................................…….…… 5 5 7 8 11 11 13 15 15 16 17 17 17 19 20 20 21 21 21 22 23 24 24 25 25 25 27 27 27 27 31 34 34 47 55 5. TARTIŞMA ………………………………………………………………………. 61 6. SONUÇ VE ÖNERİLER …………………………………………………………. 68 KAYNAKLAR ………………………………………………………………………. 69 EKLER ………………………………………………………………………………. 80 Ek 1 (ADÜ HADYEK) ……………………………………………………………… 80 BİLİMSEL ETİK BEYANI ......................................................................................... 81 ÖZ GEÇMİŞ ................................................................................................................ 8

Epileptic seizures in cerebral venous sinus thrombosis: Subgroup analysis of VENOST study

Purpose: The aim of this study is to evaluate the presence and prognostic impact of early seizures in cerebral venous sinus thrombosis patients (CVST).Method: VENOST is a retrospective and prospective national multicenter observational study. CVST patients with or without epileptic seizures (ES) were analyzed and compared in terms of demographic and imaging data, causative factors, clinical variables, and prognosis in a total of 1126 patients.Results: The mean age of the patients in the ES group was 39.73 +/- 12.64 and 40.17 +/- 14.02 years in the non-ES group (p > 0.05). Epileptic seizures were more common (76.6 %) in females (p < 0.001). Early ES occurred in 269 of 1126 patients (23.9 %). Epileptic seizures mainly presented in the acute phase (71.4 %) of the disease (p < 0.001). Majority of these (60.5 %) were in the first 24 h of the CVST. The most common neurological signs were focal neurologic deficits (29.9 %) and altered consciousness (31.4 %) in the ES group. Superior sagittal sinus (SSS) and cortical veins (CV) involvement were the most common sites of thrombosis and the mostly related etiology were found puerperium in seizure group (30.3 % vs 13.9 %). Patients with seizures had worse outcome in the first month of the disease (p < 0.001) but these did not have any influence thereafter.Conclusions: In this largest CVST cohort (VENOST) reported female sex, presence of focal neurological deficits and altered consciousness, thrombosis of the SSS and CVs, hemorrhagic infarction were risk factors for ES occurrence in patients with CVST

Epileptic seizures in cerebral venous sinus thrombosis: Subgroup analysis of VENOST study

Purpose: The aim of this study is to evaluate the presence and prognostic impact of early seizures in cerebral venous sinus thrombosis patients (CVST). Method: VENOST is a retrospective and prospective national multicenter observational study. CVST patients with or without epileptic seizures (ES) were analyzed and compared in terms of demographic and imaging data, causative factors, clinical variables, and prognosis in a total of 1126 patients. Results: The mean age of the patients in the ES group was 39.73 +/- 12.64 and 40.17 +/- 14.02 years in the non-ES group (p > 0.05). Epileptic seizures were more common (76.6 %) in females (p < 0.001). Early ES occurred in 269 of 1126 patients (23.9 %). Epileptic seizures mainly presented in the acute phase (71.4 %) of the disease (p < 0.001). Majority of these (60.5 %) were in the first 24 h of the CVST. The most common neurological signs were focal neurologic deficits (29.9 %) and altered consciousness (31.4 %) in the ES group. Superior sagittal sinus (SSS) and cortical veins (CV) involvement were the most common sites of thrombosis and the mostly related etiology were found puerperium in seizure group (30.3 % vs 13.9 %). Patients with seizures had worse outcome in the first month of the disease (p < 0.001) but these did not have any influence thereafter. Conclusions: In this largest CVST cohort (VENOST) reported female sex, presence of focal neurological deficits and altered consciousness, thrombosis of the SSS and CVs, hemorrhagic infarction were risk factors for ES occurrence in patients with CVST.WOS:0005375741000192-s2.0-85083703251PubMed: 3235381

Assessment of Patients with Intracerebral Hemorrhage or Hemorrhagic Transformation in the VENOST Study

PubMed: 33130674Introduction: Cerebral venous and sinus thrombosis (CVST) may lead to cerebral edema and increased intracranial pressure; besides, ischemic or hemorrhagic lesions may develop. Intracerebral hemorrhages occur in approximately one-third of CVST patients. We assessed and compared the findings of the cerebral hemorrhage (CH) group and the CVST group. Materials and Methods: in the VENOST study, medical records of 1,193 patients with CVST, aged over 18 years, were obtained from 35 national stroke centers. Demographic characteristics, clinical symptoms, signs at the admission, radiological findings, etiologic factors, acute and maintenance treatment, and outcome results were reported. the number of involved sinuses or veins, localizations of thrombus, and lesions on CT and MRI scans were recorded. Results: CH was detected in the brain imaging of 241 (21.1%) patients, as hemorrhagic infarction in 198 patients and intracerebral hemorrhage in 43 patients. Gynecologic causes comprised the largest percentage (41.7%) of etiology and risk factors in the CVST group. in the CH group, headache associated with other neurological symptoms was more frequent. These neurological symptoms were epileptic seizures (46.9%), nausea and/or vomiting (36.5%), altered consciousness (36.5%), and focal neurological deficits (33.6%). mRS was ?3 in 23.1% of the patients in the CH group. Discussion and Conclusion: CVST, an important cause of stroke in the young, should be monitored closely if the patients have additional symptoms of headache, multiple sinus involvement, and CH. Older age and parenchymal lesion, either hemorrhagic infarction or intracerebral hemorrhage, imply poor outcome. © 2020 S. Karger AG, Basel. All rights reserved

Headache as the sole presenting symptom of cerebral venous sinuses thrombosis: Subgroup analysis of data from the VENOST study

Objectives: Headache is the most common complaint in cerebral venous sinus thrombosis (CVST) and it may sometimes be the only symptom in these patients. This retrospective and prospective study was an investigation of any differences in terms of clinical risk factors, radiological findings, or prognosis in patients with CVST who presented with isolated headache (IH) and cases with other concomitant findings (non-isolated headache [NIH]). Methods: A total of 1144 patients from a multicenter study of cerebral venous sinus thrombosis ( VENOST study) were enrolled in this research. The demographic, biochemical, clinical, and radiological aspects of 287 IH cases and 857 NIH cases were compared. Results: There were twice as many women as men in the study group. In the IH group, when gender distribution was evaluated by age group, no statistically significant difference was found. The onset of headache was frequently subacute and chronic in the IH group, but an acute onset was more common in the NIH group. Other neurological findings were observed in 29% of the IH group during follow-up. A previous history of deep, cerebral, or other venous thromboembolism was less common in the IH group than in the NIH group. Transverse sinus involvement was greater in the IH group, whereas sagittal sinus involvement was greater in the NIH group. The presence of a plasminogen activator inhibitor (PAI) mutation was significantly greater in the IH group. Conclusion: IH and CVST should be kept in mind if a patient has subacute or chronic headache. PAI, which has an important role in thrombolytic events, may be a risk factor in CVST. Detailed hematological investigations should be considered. Additional studies are needed