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Duran M.,Ankara Research and Education Hospital | Uysal O.K.,Kayseri Education and Research Hospital | Gunebakmaz O.,Harran University | Yilmaz Y.,Kayseri Education and Research Hospital | And 7 more authors.
Herz | Year: 2014

Objective. We aimed to elucidate the relationship between mild-to-moderate renal impairment and the development of coronary collateral vessels (CCV) in patients with acute coronary syndrome (ACS). Methods. We enrolled 461 patients with ACS who underwent coronary angiography for the first time. The development of CCV was assessed with the Rentrop score. Kidney function was classified according to the estimated glomerular filtration rate (eGFR). The Gensini score was used to show the extent of atherosclerosis. Results. The mean eGFR value was 89.9±24.3 U/l for patients with no development of collaterals and 82.7±20.5 for patients who had CCV. The mean age was 59±11 years and 349 patients (75.7%) were male. Rentrop classifications 1-2-3 (presence of CCV) were determined in 222 (48.1%) patients. The presence of CCV was significantly associated with low levels of eGFR (p=0.001), increased serum creatinine levels (p=0.034), high levels of serum albumin (0.036), and the Gensini score (p<0.001). Multivariate analysis showed that the Gensini score was an independent predictor of the presence of CCV (OR=1.090, 95% CI: 1.032-1.151, p=0.002). Conclusion. We suggest that the association between mild-to-moderate renal impairment and the presence of CCV may be explained by increased myocardial ischemia and severe CAD. © 2013 Urban & Vogel.


Kutun S.,Ankara Oncology Research and Training Hospital | Ay A.A.,Ankara Oncology Research and Training Hospital | Ulucanlar H.,Ankara Oncology Research and Training Hospital | Tarcan O.,Ankara Oncology Research and Training Hospital | And 5 more authors.
South African Journal of Surgery | Year: 2010

Objective. We evaluated the efficacy of local nitroglycerin application in preventing and treating flap complications after modified radical mastectomy in a large patient cohort. Patients and methods. Between 1993 and 2008, 6 426 patients undergoing surgery for stage Il breast cancer were enrolled in this prospective study. Patients were randomised into treatment and control groups. In the treatment group a nitroglycerin preparation (Nitroderm) was applied to the flap area. Major complications, recovery periods, menopausal status, additional diseases (diabetes mellitus, hypertension, atherosclerotic heart disease) and adverse effects related to nitroglycerin use were recorded. Results. The recovery rate without major complications was statistically significantly higher in the nitroglycerin-treated group than in the controls (p<0.001). Conclusion. Our results indicate that topical nitroglycerin reduces flap complications after breast surgery.


Duran M.,Ankara Research and Education Hospital | Uysal O.K.,Kayseri Education and Research Hospital | Gunebakmaz O.,Harran University | Baran O.,Kayseri Education and Research Hospital | And 8 more authors.
Angiology | Year: 2014

We aimed to elucidate the relationship between mild to moderate renal impairements and burden of atherosclerosis in patients with acute coronary syndrome (ACS). A total of 380 patients with ACS were included in the study. Gensini and SYNTAX scores were also calculated. Kidney function was classified based on estimated glomerular filtration rate (eGFR) into stage 1: eGFR >90, stage 2: 60 to 89, and stage 3: 30 to 60 mL/min per 1.73 m2. Gensini and SYNTAX scores were higher in stages 2 and 3 than in stage 1. Also, the number of diseased vessels, number of critical lesions (>50 and 70%), left main disease, and number of total occlusion vessels were higher in stages 2 and 3 than in stage 1. Multivariate linear regression analysis demonstrated that a decreased eGFR was an independent risk factor for SYNTAX and Gensini scores together with age and male gender. © The Author(s) 2013.


Yazgan S.,Bülent Ecevit University | Celik U.,Istanbul Medeniyet University | Isk M.,Bülent Ecevit University | Yesil N.K.,Ankara Research and Education Hospital | And 4 more authors.
International Ophthalmology | Year: 2016

To evaluate the efficacy of golimumab on severe and frequent recurrent anterior uveitis in patients with HLA-B27-positive ankylosing spondylitis. In this study, 15 eyes of 12 HLA-B27-positive AS patients with resistant anterior uveitis who received 50 mg of subcutaneous golimumab (Gol) per month due to frequent uveitis recurrences were analyzed retrospectively between May 2013 and October 2015. Assessment criteria were uveitis activity, the number of recurrence of uveitis, visual acuity, systemic corticosteroid, or other drug requirement for maintenance of remission of AU. Twelve patients (15 eyes) with HLA-B27-positive ankylosing spondylitis and anterior uveitis have been treated with golimumab 50 mg/month. Remission of uveitis was observed in 12 eyes out of 15. Malign hypertension developed in one subject after the second dose of golimumab therefore the treatment was stopped and this subject was excluded from the study. Median follow-up time was 11 months (interquartile range: 8–18). No uveitic reaction was seen except in the patient who stopped treatment. No topical or systemic steroid necessity was needed except in two cases with oral 4 mg systemic maintenance. Visual acuity was significantly increased (p = 0.002). Golimumab may be a new and effective choice for maintaining remission and the prevention of recurrences of severe, resistant anterior uveitis in patients with HLA-B27-positive ankylosing spondylitis. © 2016 Springer Science+Business Media Dordrecht


Yildirim A.E.,Ankara Numune Research and Education Hospital | Sahinoglu M.,Ankara Numune Research and Education Hospital | Ekici I.,Ankara Numune Research and Education Hospital | Cagil E.,Ankara Numune Research and Education Hospital | And 4 more authors.
World Neurosurgery | Year: 2016

Background: Nonfunctioning pituitary adenomas are the most common pituitary adenomas in adults and cause significant morbidity unless adequately treated. Methods: This study retrospectively assessed the medical records of 160 patients operated via pure endonasal endoscopy. The presenting symptoms, results of neurologic and visual examinations, levels of pituitary hormones, results of radiologic examinations, size of the adenoma, rates of resection, results of postoperative visual examination, and pituitary hormone levels at follow-up were recorded to establish the appropriate approach, operative criteria, and outcomes of patients with nonfunctioning pituitary adenoma. Results: Headache was the presenting symptom in 87.5% of the patients. Thirty-three percent had visual loss, and visual examinations on the whole study population revealed a visual field defect in 47.5% of the patients. Only 16.25% of the patients presented with endocrinological symptoms; 52.5% had abnormal anterior pituitary hormone levels. Regarding adenoma size, 56 patients had macroadenoma (35%), 84 (52.5%) had mesoadenoma, and 20 patients had giant adenoma. Gross total resection was achieved in 90% of the patients; subtotal resection was achieved in the remainder. The rate of total resection was lower for giant adenomas and recurrences. Visual symptoms and anterior pituitary hormone levels improved in 27 and 42 patients, respectively, after the operation. Conclusions: Nonfunctioning pituitary adenomas present frequently as mesoademonas and giant adenomas. Patients with these tumors may have subclinical visual or hormonal deficits at the time of diagnosis. Early and effective surgical treatment is essential for rapid recovery of visual and/or hormonal deficits, particularly in symptomatic cases. © 2016 Elsevier Inc. All rights reserved.


PubMed | Ankara Research and Education Hospital and Ankara Numune Research and Education Hospital
Type: | Journal: World neurosurgery | Year: 2016

Nonfunctioning pituitary adenomas are the most common pituitary adenomas in adults and cause significant morbidity unless adequately treated.This study retrospectively assessed the medical records of 160 patients operated via pure endonasal endoscopy. The presenting symptoms, results of neurologic and visual examinations, levels of pituitary hormones, results of radiologic examinations, size of the adenoma, rates of resection, results of postoperative visual examination, and pituitary hormone levels at follow-up were recorded to establish the appropriate approach, operative criteria, and outcomes of patients with nonfunctioning pituitary adenoma.Headache was the presenting symptom in 87.5% of the patients. Thirty-three percent had visual loss, and visual examinations on the whole study population revealed a visual field defect in 47.5% of the patients. Only 16.25% of the patients presented with endocrinological symptoms; 52.5% had abnormal anterior pituitary hormone levels. Regarding adenoma size, 56 patients had macroadenoma (35%), 84 (52.5%) had mesoadenoma, and 20 patients had giant adenoma. Gross total resection was achieved in 90% of the patients; subtotal resection was achieved in the remainder. The rate of total resection was lower for giant adenomas and recurrences. Visual symptoms and anterior pituitary hormone levels improved in 27 and 42 patients, respectively, after the operation.Nonfunctioning pituitary adenomas present frequently as mesoademonas and giant adenomas. Patients with these tumors may have subclinical visual or hormonal deficits at the time of diagnosis. Early and effective surgical treatment is essential for rapid recovery of visual and/or hormonal deficits, particularly in symptomatic cases.


PubMed | Ankara Research and Education Hospital, Turkiye Yuksek Ihtisas Hospital and Corum State Hospital
Type: Journal Article | Journal: Asian cardiovascular & thoracic annals | Year: 2016

A median sternotomy is the most common approach for cardiac and great vessel surgery. After a median sternotomy, healing complications such as instability, nonunion, and infection, are rare but devastating. Predisposing factors for sternal complications are old age, diabetes, steroid treatment, postmenopause state, obesity, reoperation, and the use of bilateral internal mammary arteries. Patients with sternal dehiscence frequently require reoperation to maintain optimum sternal stability. The technique chosen for sternal closure must provide excellent sternal approximation. We describe a modified Robicsek procedure reinforced with figure-of-8 sternal wires. We named this technique double-check.


PubMed | Ankara Research and Education Hospital, Istanbul Medeniyet University, Bülent Ecevit University and Hitit University
Type: | Journal: International ophthalmology | Year: 2016

To evaluate the efficacy of golimumab on severe and frequent recurrent anterior uveitis in patients with HLA-B27-positive ankylosing spondylitis. In this study, 15 eyes of 12 HLA-B27-positive AS patients with resistant anterior uveitis who received 50mg of subcutaneous golimumab (Gol) per month due to frequent uveitis recurrences were analyzed retrospectively between May 2013 and October 2015. Assessment criteria were uveitis activity, the number of recurrence of uveitis, visual acuity, systemic corticosteroid, or other drug requirement for maintenance of remission of AU. Twelve patients (15 eyes) with HLA-B27-positive ankylosing spondylitis and anterior uveitis have been treated with golimumab 50mg/month. Remission of uveitis was observed in 12 eyes out of 15. Malign hypertension developed in one subject after the second dose of golimumab therefore the treatment was stopped and this subject was excluded from the study. Median follow-up time was 11months (interquartile range: 8-18). No uveitic reaction was seen except in the patient who stopped treatment. No topical or systemic steroid necessity was needed except in two cases with oral 4mg systemic maintenance. Visual acuity was significantly increased (p=0.002). Golimumab may be a new and effective choice for maintaining remission and the prevention of recurrences of severe, resistant anterior uveitis in patients with HLA-B27-positive ankylosing spondylitis.


Acar U.,Hacettepe University | Acar D.E.,Zekai Tahir Burak Womens Health Research And Education Hospital | Tanriverdi C.,Istanbul University | Acar M.,Dskap Yldrm Beyazt Research and Education Hospital | And 3 more authors.
Ocular Immunology and Inflammation | Year: 2016

Purpose: To compare the lowering effects of ketorolac 0.4% and nepafenac 0.1% on aqueous and vitreous humor prostaglandin E2 (PGE2) levels in rabbits. Methods: Ketorolac and nepafenac ophthalmic solutions were administered to the right eyes of 24 healthy rabbits after randomized division into two groups. The left eyes of these rabbits were considered as controls for the two groups. On the 4th day of the experiment, the samples were taken from the aqueous and vitreous humors of the rabbits bilaterally, and PGE2 levels were measured by an enzyme immune assay kit. Results: Ketorolac and nepafenac achieved a statistically significant decrease (p<0.001, for each) in PGE2 levels in the aqueous (11.75 ± 6.15 and 14.75 ± 7.60 pg/mL, respectively) and the vitreous humor (6.58 ± 4.62 and 9.83 ± 4.55 pg/mL, respectively). Conclusions: Both ketorolac and nepafenac inhibited PGE2 levels in both the aqueous and vitreous humors of rabbits. Although PGE2-lowering effects were similar in the aqueous humor, nepafenac seemed to be more potent than ketorolac in the vitreous humor. © 2016, Informa Healthcare. All rights reserved.


Tonuk S.B.,Abant Izzet Baysal University | Serin E.,Istanbul Research and Education Hospital | Ayhan F.F.,Ankara Research and Education Hospital | Yorgancioglu Z.R.,Ankara Research and Education Hospital
Medicine (United States) | Year: 2016

To investigate the effects of physical agents on the levels of stress hormones in patients with osteoarthritis (OA). Transcutaneous electrical nerve stimulation, hot packs, and therapeutic ultrasound were applied to the lumbar region and knees of patients with OA. Blood samples were taken for the measurement of the serum levels of glucose, insulin (INS), growth hormone (GH), prolactin (PRL), cortisol (COR), and plasma adrenocorticotropic hormone (ACTH) immediately before and after the 1st session, to investigate the acute effects of those physical agents on the endocrine system. The hormone levels were also measured every 5 sessions in a total of 10 sessions. The treatment response was also evaluated by using the visual analogue scale (VAS), Roland Morris Disability Questionnaire (RMDQ), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) throughout the therapy period. After the 1st session, there was a decrease in INS levels and a mild decrease in PRL levels (P=0.001 and P<0.05, respectively). Throughout the 10-session therapy period, the INS levels increased, whereas the ACTH and COR levels decreased (P<0.05 for all). The VAS-spine, RMDQ, VAS-knee, and WOMAC scores decreased (P=0.001 for VAS-spine and P<0.001 for all others). A positive correlation was detected between the changes in serum COR and WOMAC-pain score (P<0.05). Although the combination therapy caused changes in INS level accompanied with steady glucose levels, the application of physical agents did not adversely affect the hormone levels. The decrease in ACTH and COR levels may be attributed to the analgesic effect of agents and may be an indicator of patient comfort through a central action. Copyright © 2016 the Author(s). Published by Wolters Kluwer Health, Inc. All.

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