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Yang H.,American Hospital
Clinical Nuclear Medicine | Year: 2017

ABSTRACT: FDG PET/CT was performed in a 47-year-old man to evaluate possible malignancy of the spine revealed by MRI. The PET images revealed numerous focal FDG activity throughout the skeletal system. In addition, multiple foci of the increased activity in the mediastinal and hilar nodes were noted, suggestive of sarcoidosis, which was proven following biopsy. Therapy for sarcoidosis was initiated. In the subsequent 4 follow-up FDG PET/CT scans, the activity in both the bones and mediastinal/hilar regions fluctuated. However, anatomical abnormality in the bones on the CT images was never visualized during the entire clinical course. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.


Opondo D.,University of Amsterdam | Tefekli A.,American Hospital | Esen T.,American Hospital | Labate G.,Urosalud | And 4 more authors.
European Urology | Year: 2012

Background: Previous studies have demonstrated relationships between case volumes and outcomes in surgery. Little is known about the impact of case volumes on the outcomes of percutaneous nephrolithotomy (PCNL). Objective: To investigate the influence of case volumes on the efficacy and safety outcomes of PCNL. Design, setting, and participants: From November 2007 to December 2009, prospective data were collected by the Clinical Research Office of the Endourological Society from consecutive patients over a 1-yr period in 96 centers globally. Data of 3933 patients in the Global PCNL study database were included in this study. Outcome measurements and statistical analysis: Patients were divided into low- and high-volume groups based on the median annual case volume of their respective treatment center. Preoperative characteristics and outcomes were compared between the two groups. Case volume was treated as a continuous variable. The relationship between case volume and stone-free (SF) rate, complication rate, and duration of hospital stay was explored using multivariate regression analysis. Results and limitations: SF rates were higher in high-volume centers (82.5% vs 75.1%; p value <0.001). Complication rates were lower in high-volume centers (15.9% vs 21.7%; p value 0.002), whereas the mean (standard deviation [SD]) duration of stay was shorter in high-volume centers (3.4 [2.6] vs 4.9 [3.7] d; p value <0.001). SF rate increased with case volume, whereas complication rate and duration of stay diminished with increasing case volumes after adjusting for stone burden, urine culture status, American Society of Anesthesiologists score, and the presence of staghorn stones. The highest SF rates were observed in centers with >120 cases per year. Conclusions: Centers that perform high numbers of PCNLs per year achieve better results. Both the efficacy and safety outcomes of PCNL improve with the number of surgeries performed in a given center per year. © 2012 European Association of Urology.


Kul-Panza E.,Camlica Erdem Hospital | Berker N.,American Hospital
Minerva Medica | Year: 2010

Aim. The aim of this study was to investigate the effect of intra-articular hyaluronic acid (HA) injection on pain and function in knee osteoarthritis (OA). Methods. Fourty-eight patients with knee OA were included in this study. The patients were randomized into two groups: one group received HA injections (average molecular weight [MW] 1.5 million Da), and the other group received placebo containing 0.9% saline. Three injections of HA or placebo were given at weeks 1, 2 and 3. The evaluation instruments were: Visual Analog Scale (VAS); Likert Scale; Lequesne ndex; the Western Ontario and McMaster Universities (WOMAC) Index for Osteoarthritis pain, stiffness, and function, and WOMAC pain subgroups (pain on walking, climbing stairs, at night, on sitting and lying down, on standing); the number of analgesics taken; changes in knee flexion angle; and patient satisfaction. Assessment was performed at weeks 1, 3, 5, and 14 after the first injection. Results. Significant improvement for almost all parameters was noted in both groups (P <0.05). There was no statistically significant difference between change in outcome after HA or placebo treatment (P>0.05), except for WOMAC pain subscore on walking at final assessment (week 14) which showed greater improvement in the HA-treated group (35-2% versus 9.1%; P=0-01). Conclusion. HA treatment was effective in the management of knee OA and improved knee pain and functional outcome, but there was no statistically significant difference in functional and symptom improvement with respect to saline (placebo) injection.


Oreroglu A.R.,Okmeydani Research and Training Hospital | Dogan T.,American Hospital | Akan M.,Okmeydani Research and Training Hospital
Aesthetic Surgery Journal | Year: 2012

Background: A complete subperichondrial and subperiosteal dissection technique during rhinoplasty may minimize soft tissue disruption, resulting in less scar tissue formation and preservation of ligamentous structures. Objectives: The authors describe their results with subperichondrial dissection of the nasal framework and manipulation of the preserved nasal ligaments. Methods: The charts of 228 consecutive patients who underwent rhinoplasty with complete subperichondrial dissection via an open or closed approach between May 2008 and April 2011 with the senior author (BÇ) were retrospectively reviewed. Intraoperatively, the scroll ligament and Pitanguy's midline ligament were repaired to stabilize the internal valve and tip position, respectively. Results: Patients in this series (182 women, 46 men) ranged in age from 18 to 54 years (mean, 24.3 years). A total of 203 procedures were primary rhinoplasties; 14 were secondary, and 11 were revisions. The open approach was used in 92 patients, whereas a closed dome delivery was used in the remaining 136 patients. Follow-up ranged from 9 months to 3 years. A complete subperichondrial dissection technique resulted in relatively limited edema and more rapid patient recovery compared with the authors' previous experience with the sub-superficial musculoaponeurotic system (SMAS) approach. Repeat elevation in the subperichondrial plane was easier and less traumatic in revision cases compared with secondary rhinoplasty cases. Conclusions: Subperichondrial dissection of the nasal framework allows reshaping and redraping of the nasal tip and controlled manipulation and repair of ligaments without disturbing the overlying soft tissue. © 2012 The American Society for Aesthetic Plastic Surgery, Inc.


Kucukunal A.,Sisli Etfal Training and Research Hospital | Altunay I.K.,Sisli Etfal Training and Research Hospital | Mercan S.,American Hospital
Journal of Sexual Medicine | Year: 2013

Introduction: Human papillomavirus (HPV) infection can present clinically as genital warts (GWs) in both males and females. Much less is known about the psychosexual consequences of GW, and the studies on patients in this group are still quite limited. Aims: The aim of this study was to test two hypotheses: (i) sexual dysfunction (SD) is likely to occur in male patients suffering from GWs; (ii) if male SD exists, it may be associated with depression or anxiety. Methods: This was a pilot study with a prospective cross-sectional design. Male patients with GW (N for patient group=116) were compared with male control cases (N for control group=71) using the Arizona Sexual Experience Scale (ASEX), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). The participants were evaluated by a dermatologist and a psychiatrist, respectively. Main Outcome Measures: The associations between sexual dysfunction, depression, and anxiety among the participants were examined. Results: There was no difference between the groups in terms of sociodemographic changes. Sexual dysfunction was found to be significantly more common in the patients than controls (P=0.000<0.001). When the subscores of ASEX were evaluated, they were found to be statistically significant between the two groups (P=0.000<0.001). BDI and BAI scores were statistically higher in the patient group than in controls, and there was a positive correlation between BDI and BAI scores with ASEX total and subscores (P=0.000<0.001). Conclusions: Male patients with GW have higher rates of sexual dysfunction, depression, and anxiety when compared with the normal population. Men suffering from GW should be evaluated for possible sexual problems, besides depression and anxiety. © 2013 International Society for Sexual Medicine.


Tarabichi S.,American Hospital | Tarabichi Y.,American Hospital | Hawari M.,American Hospital
Journal of Arthroplasty | Year: 2010

Total knee arthroplasty patients often have difficulty performing activities involving flexion beyond 130°. The NexGen LPS Flex (Zimmer Inc, Warsaw, Ind) mobile bearing implant accommodates up to 155° of flexion. Two hundred eighteen total knee arthroplasties were performed using this implant on 125 patients over a 2-year period with a minimum of 5 years follow-up. All data were collected prospectively. Forty-four percent of preoperative cases had full flexion (ie, 140° active flexion and ability to kneel with thigh/calf contact for 1 minute). Five-year data showed an average flexion of 140° ± 11.5° and flexion greater than 140° in 103 knees (68%). There were no differences in patellofemoral pain levels, complications, or Knee Society scores despite our patients having, on average, an increase in flexion and function. © 2010 Elsevier Inc. All rights reserved.


MacGillivray R.G.,American Hospital | Tarabichi S.B.,American Hospital | Hawari M.F.,American Hospital | Raoof N.T.,American Hospital
Journal of Arthroplasty | Year: 2011

The effects of 2-dosage regimens of tranexamic acid (10 mg/kg and 15 mg/kg) on blood loss and transfusion requirement were compared to saline placebo in 60 patients undergoing concurrent bilateral total knee arthroplasty, with additional reinfusion autotransfusion from intraarticular drains. Mean blood loss was 462 mL in 15 mL/kg group, 678 mL in 10 mg/kg group, and 918 mL in controls (P<.01 vs 15 mg/kg). Blood available for autotransfusion was greatest in controls and least in 15 mg/kg group. Combined autologous and allogenic transfusion volumes were similar in the treatment groups and significantly less than controls (P<.01). With use of an autologous reinfusion strategy, the lower dose is sufficient to lead to a lesser allogenic transfusion requirement. © 2011 Elsevier Inc.


Horjeti B.,American Hospital | Goda A.,University of Tirana
Journal of Electrocardiology | Year: 2012

A patient with anginal chest pain and electrocardiographic changes suggesting ischemia was referred to our hospital. Coronary angiography revealed no significant stenosis or ectasia but only slow flow in all 3 coronary arteries. After infusion of unfractionated heparin for 24 hours, negative T waves became less deep, and repeated coronary angiography showed significant improvement of the coronary flow. The coronary slow flow phenomenon, together with the associated ischemic electrocardiographic changes, should be considered as a separate entity in the differential diagnosis of acute coronary syndromes. Additional clinical research is required to better understand the syndromes of chest pain with normal coronary arteries. © 2012 Elsevier Inc. All rights reserved.


Tarabichi S.,American Hospital | Tarabichi Y.,Cornell College
Journal of Arthroplasty | Year: 2010

We hypothesize that tethering adhesions of the quadriceps muscle are the major pathological structures responsible for a limited range of motion in the stiff arthritic knee. Forty-two modified quadriceps muscle releases were performed on 24 patients with advanced osteoarthritis scheduled for total knee arthroplasty. The ranges of motion were documented intraoperatively both before and immediately after the release. Passive flexion improved significantly in all patients (mean, 32.4° of improvement, P < .001) following a modified quadriceps release, despite any presence of osteophytes or severe deformities. These results strongly implicate adhesions of the quadriceps muscle to the underlying femur, which prevent the distal excursion of the quadriceps tendon, as the restrictive pathology preventing deep flexion in patients with osteoarthritis. © 2010 Elsevier Inc.


Urman B.,Koç University | Urman B.,American Hospital | Yakin K.,American Hospital
Current Opinion in Obstetrics and Gynecology | Year: 2012

Purpose of review: Androgens and particularly dehydroepiandrosterone (DHEA) have been advocated as adjuncts to ovarian stimulation in women with diminished ovarian reserve. Given the limited number of options in these women it is understandable that both physicians and patients resort to treatments that are not evidence based. Recent findings: DHEA is such an adjunct and has been recently used extensively in women responding poorly to gonadotropins and women of advanced age seeking treatment with assisted reproductive techniques. Although androgens may be biologically plausible, current evidence is not sufficient to prove their effectiveness. Summary: Until well designed studies show a beneficial effect of DHEA supplementation in women with a diminished ovarian reserve, its widespread use should be discouraged. The patients should be counseled regarding the experimental nature of such a treatment. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

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