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    The effect of vertebral artery characteristics on cervical discogenic pain and disability
    (2021) San, Ayça Uran; Keles, Hakan
    Objective : Cervical discogenic pain, which is characterized by a stiffness or pain in neck movement, generally occurs as a result of disc degeneration. On the other hand; vascular pathologies of the cervical region, especially vertebrobasilar insufficiency, may give rise to similar findings in patients; it can also be detected simultaneously with cervical disc pathologies. In this study, it was aimed to investigate whether the circulatory properties of the vertebral arteries have an effect on the neck pain and functional status of the patients. Material and Method: Based on the participants’ medical history, physical examination and radiological examination, sixty five patients were diagnosed with cervical disc herniation. Twenty patients who met the inclusion criteria were completed the study. Vertebral artery and carotid artery doppler ultrasonography was performed in these patients, thus any stenosis or insufficiency in vascular systems of the neck was evaluated. Additionally; vertebral blood flow rate (ml/min),vessel diameter(mm), minimum blood flow velocity (Vmin) and maximum blood flow velocity (Vmax) was measured by doppler ultrasonography. The obtained findings compared with patients’ level of pain measured with the “VAS (Visual Analog Scale)” and the level of daily life activities measured by the “Neck Disability Index “. Results: It was detected a statistically significant negative correlation between the VAS score and right vertebral artery diameter (p=0.019, r=-0.518). A significant reverse correlation between VAS score and right vertebral arterial blood flow rate (p=0.011, r=-0.556) was also observed. No correlation was found between other vertebral artery parameters and VAS score or Neck Disability Index (p>0.05). Conclusion: The findings of this study revealed that there is a correlation between the vertebral artery flow rate and pain level. Clinicians must take into consideration vertebral pathologies in patients with neck pain because of this vital condition may accompany with various musculoskeletal pathologies such as cervical disc herniation.
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    Evaluation of the relationship between para-aortic adipose tissue and ascending aortic diameter using a new method
    (Taylor & Francis Ltd, 2022) Adar, Adem; Onalan, Orhan; Cakan, Fahri; Keles, Hakan; Akbay, Ertan; Akinci, Sinan; Coner, Ali
    Background Para-aortic adipose tissue (PAT) is the local adipose tissue that externally surrounds the aorta. It contributes significantly to aortic atherosclerosis and enlargement. Studies conducted with computed tomography and magnetic resonance have shown that individuals with aortic aneurysm had more PAT than healthy individuals. In this study, we measured PAT using transthoracic echocardiography (TTE). The aim of this study is to investigate the possible relationship of TTE measured PAT with ascending aortic width. Methods PAT was defined as the hypoechoic space in front of ascending aortic 2 cm above the sinotubular junction at the end of the systole. Patients were divided into 2 groups according to the presence of dilatation in the ascending aorta using Roman's classification (aortic size index, ASI). ASI of less than 21 was considered no aortic dilation and an ASI of 21 mm/m2 or greater was considered to have aortic dilation. Results A total of 321 unselected patients were divided into the ascending aortic dilatation (AAD) group (n = 96) and the normal ascending aorta diameter group (n = 225 patients). PAT was significantly higher in the AAD group compared with the non-ADD group (0.9 (0.48) vs. 0.7 (0.91) mm, p < 0.0001). Univariate and multivariate logistic regression analysis revealed that PAT (OR: 3.005, 95%CI (1.445-6.251)) were significantly associated with AAD. Conclusions This is the first study which evaluated PAT measured by TTE. We found a significant association between PAT measured by TTE and ascending aorta width.
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    Onychomycosis is associated with subclinical atherosclerosis in patients with diabetes
    (Verlag Hans Huber Hogrefe Ag, 2015) Onalan, Orhan; Adar, Adem; Keles, Hakan; Ertugrul, Goksen; Ozkan, Nurhayat; Aktas, Habibullah; Karakaya, Ekrem
    Background: We aimed to investigate the association of toenail onychomycosis with subclinical atherosclerosis in patients with diabetes mellitus. Patients and methods: Consecutive diabetic patients who were seen at our outpatient clinic were enrolled. The carotid intima-media thickness (CIMT) was assessed and toenail onychomycosis was diagnosed with microscopic evaluation. Results: We investigated 127 patients with diabetes melltus type 2. Overall, the prevalence of toenail onychomycosis was 37.8% (48 of 127). Of the 127 patients, 60 (47.2%) had subclinical atherosclerosis (CIMT >= 1 mm). Prevalence of male gender (43.3% vs. 22.4%, p = 0.012) and onychomycosis (53.3% vs. 23.9%, p = 0.001) was significantly higher in patients with subclinical atherosclerosis. Among biochemical parameters, low-density lipoprotein (122 +/- 38 mg/dL vs. 108 +/- 36 mg/dL, p = 0.039) and glycosylated hemoglobin levels (median 8.4%, IQR: 2.1% vs. median 7.5%, IQR: 1.6%, p = 0.002) were significantly higher in patients with subclinical atherosclerosis. Study groups were similar with respect to all other demographic, clinical, and laboratory parameters. After adjustment for all potential confounders, the presence of onychomycosis was independently associated with subclinical atherosclerosis (OR 2.77, 95 % CI 1.16 to 6.30) in multivariate logistic regression analysis. Conclusions: Presence of onychomycosis in patients with diabetes is associated with subclinical atherosclerosis. Onychomycosis may be a marker of atherosclerotic arterial involvement.
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    Relationship between Aortic Arch Calcification, Detected by Chest X-Ray, and Renal Resistive Index in Patients with Hypertension
    (Karger, 2019) Adar, Adem; Onalan, Orhan; Keles, Hakan; Cakan, Fahri; Kokturk, Ugur
    Objective: Aortic arch calcification (AAC) is a surrogate marker for arterial stiffness and hypertension-related vascular damage. Renal resistive index (RRI), a renal Doppler ultrasonography parameter, is used to assess renal hemodynamics. In this study, we aimed to evaluate the relationship between RRI and AAC in patients with hypertension. Methods: Patients with hypertension underwent a chest X-ray and renal Doppler ultrasonography. They were divided into two groups according to RRI (group 1: RRI >= 0.70; group 2: RRI <0.70). Two examiners, blinded to the findings of RRI, reviewed the AAC in these patients. The kappa value was detected to be 0.781 and a p value <0.001 was considered significant. Results: The study included 289 hypertensive patients (mean age 63.87 +/- 11.38 years). In 53.6% (n = 155) of the study subjects, RRI was observed to be >= 0.70. Patients with RRI = 70 were older and had more prevalent AAC as well as left ventricular hypertrophy. A multiple linear regression analysis was carried out to test whether presence of AAC significantly predicted RRI. The results of the regression analysis indicated that presence of AAC significantly predicted RRI (beta = 0.053; p < 0.001). Conclusions: A strong and independent relationship was found between AAC on chest X-ray and RRI in patients with hypertension. (C) 2018 The Author(s) Published by S. Karger AG, Basel