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Gur A.S.,Ataturk Teaching and Research Hospital | Unal B.,Inonu University | Ozbek U.,University of Pittsburgh | Ozmen V.,Istanbul University | And 8 more authors.
European Journal of Surgical Oncology | Year: 2010

Objective: In the study, our aim was to evaluate the predictability of four different nomograms on non-sentinel lymph node metastases (NSLNM) in breast cancer (BC) patients with positive sentinel lymph node (SLN) biopsy in a multi-center study. Methods: We identified 607 patients who had a positive SLN biopsy and completion axillary lymph node dissection (CALND) at seven different BC treatment centers in Turkey. The BC nomograms developed by the Memorial Sloan Kettering Cancer Center (MSKCC), Tenon Hospital, Cambridge University, and Stanford University were used to calculate the probability of NSLNM. Area under (AUC) Receiver Operating Characteristics Curve (ROC) was calculated for each nomogram and values greater than 0.70 were accepted as demonstrating good discrimination. Results: Two hundred and eighty-seven patients (287) of 607 patients (47.2%) had a positive axillary NSLNM. The AUC values were 0.705, 0.711, 0.730, and 0.582 for the MSKCC, Cambridge, Stanford, and Tenon models, respectively. On the multivariate analysis; overall metastasis size (OMS), lymphovascular invasion (LVI), and proportion of positive SLN to total SLN were found statistically significant. We created a formula to predict the NSLNM in our patient population and the AUC value of this formula was 0.8023. Conclusions: The MSKCC, Cambridge, and Stanford nomograms were good discriminators of NSLNM in SLN positive BC patients in this study. A newly created formula in this study needs to be validated in prospective studies in different patient populations. A nomogram to predict NSLNM in patients with positive SLN biopsy developed at one institution should be used with caution. © 2009 Elsevier Ltd. All rights reserved.


PubMed | Jagiellonian University, Medical University of Lublin, Laiko Hospital, Aristotle University of Thessaloniki and 6 more.
Type: Journal Article | Journal: JPEN. Journal of parenteral and enteral nutrition | Year: 2015

Disease-related malnutrition (DRM) represents a critical public health concern. Therefore, Fight Against Malnutrition (FAM) should be a state priority, but the degree to which this is true appears to differ considerably among European countries. The aim of this study was to put the problem into perspective by comparing the prevalence of malnutrition in countries from opposite parts of the continent.Six countries-Croatia, Estonia, Greece, Lithuania, Poland, and Turkey-participated in the study. A short questionnaire was used to assess DRM: its prevalence, the current situation in hospitals, regulations for reimbursement, and general healthcare circumstances. Data from ESPENs NutritionDay 2006 were used to broaden the perspective.At admission in October 2012, 4068 patients were assessed. The study was performed in 160 hospitals and 225 units with 9143 beds. The highest proportions of patients with 3 or more points on the Nutritional Risk Screening 2002 were observed in Estonia (80.4%) and Turkey (39.4%), whereas the lowest were in Lithuania (14.2%). The provision of nutrition support was best in Turkey (39.4% required intervention, 34.4% received intervention) and Poland (21.9% and 27.8%, respectively). Nutrition support teams (NSTs) are active in some countries, whereas in others they virtually do not exist.The prevalence of malnutrition was quite high in some countries, and the nutrition approach differed among them. It could be the result of the lack of reimbursement, inactive or nonexistent NSTs, and low nutrition awareness. Those facts confirmed that the continuation of FAM activities is necessary.


PubMed | Bigadic Public Hospital and Ataturk Teaching and Research Hospital
Type: | Journal: European journal of ophthalmology | Year: 2016

To evaluate the optic nerve head parameters and peripapillary retinal nerve fiber layer using spectral-domain optical coherence tomography (SD-OCT) in a systemic sclerosis (SSc) cohort and age-matched controls to determine whether SSc patients have an increased risk of normal-tension glaucoma (NTG).We examined 30 patients (3 male, 27 female) with SSc and 28 age- and sex-matched controls. Retinal nerve fiber and optic disc morphology were evaluated using Cirrus SD-OCT.Optic disc morphology measurements including disc area, rim area, average and vertical cup/disc (C/D) ratio, and cup volume were not significantly different between the study groups. The average and 4-quadrant retinal nerve fiber layer (RNFL) measurements of the C/D >0.3 subgroups were not significantly different in the patients and controls. These values were also similar for the C/D >0.5 subgroups except that the average inferior quadrant RNFL thickness of the right eyes in the patient subgroup was significantly thinner than in the control subgroup (p<0.05).Our SSc cohort had relatively shorter disease duration but increased prevalence of early glaucomatous damage signs. Our findings indicate that SSc is a risk factor for developing normal-tension glaucoma. Further studies combined with visual field evaluation are necessary to identify the long-term glaucomatous effects of SSc.


PubMed | Izmir Kâtip Celebi University, Bigadic Public Hospital and Ataturk Teaching and Research Hospital
Type: Journal Article | Journal: International ophthalmology | Year: 2016

To evaluate main numerical parameters of anterior segment and the effects of eyelid skin changes on these parameters in patients with systemic sclerosis (SSc). Thirty-four patients with SSc and 34 healthy individuals were enrolled. Besides full eye examination, anterior segment measurements including anterior chamber depth (ACD), anterior chamber volume, anterior chamber angle width, central corneal thickness, pupil size, corneal volume and keratometry were obtained using a Sirius Scheimpflug/Placido photography-based topography system. Eyelid thickness was evaluated using the scala of the modified Rodnan skin score and the patients were subgrouped with respect to these scores to evaluate the effect of eyelid thickening on the anterior segment parameters. Age and sex distributions of the groups were similar (p>0.05). SSc patients had steeper and thinner corneas, smaller corneal volumes, narrower, shallower and smaller anterior segments but only the mean ACD value of right eyes was found significantly less than those of the controls (p=0.047). The mean ACD values of SSc subgroup patients with moderate to severe eyelid thickening (50%) had lower ACD measurements compared to those of control group. (p=0.043 for the right eyes, p=0.070 for the left eyes). However, SSc subgroup patients with none to mild eyelid thickening (50%) had similar anterior segment parameters with control subjects (p>0.05). Anterior chamber parameters of the SSc patients could show significant differences. These differences occur parallel to the eyelid changes but not secondary to it.


Aldemir M.,Ataturk Teaching and Research Hospital | Ucgul Y.E.,Ataturk Teaching and Research Hospital | Kayigil O.,Ataturk Teaching and Research Hospital
International Urology and Nephrology | Year: 2011

Purpose: To compare the efficiency and spontaneous expulsion rates of tamsulosin and Rowatinex in patients with distal ureteral stones. Methods: Between March and July 2009, 90 patients with distal ureteral stones <10 mm in size were included in the study. Patients were randomized in 3 groups: Group 1 (n = 31, those received 0.4 mg tamsulosin once daily), Group 2 (n = 30, those received 100 mg Rowatinex capsules 3 times a day), and Group 3 (n = 29, those received diclofenac 100 mg once daily). All patients were followed up for 10 days. Results and conclusions: Mean age of the patients was 42.4 ± 16.1 (range, 22-75), 46.5 ± 16.5 (range, 22-76), and 43.5 ± 16.6 (range, 18-71) years in Groups 1-3, respectively. On admission, 37.8% had hematuria and 78.9% had lower urinary tract symptoms (LUTS). No statistically significant differences were detected between the three groups regarding patient age, gender, mean stone size, stone location, stone site, additional analgesic requirement, number of ureteral colics during the treatment, and upper urinary tract dilation. The mean stone expulsion time was 3.5 days in Group 1, 6 days in Group 2, and 7 days in Group 3 (P = 0.02). Stone expulsion rate was significantly high in Group 1 compared to Group 2 (P = 0.002). Similarly, stone expulsion rate was significantly high in Group 1 compared to Group 3 (P = 0.001). Medical treatment with tamsulosin seems to be effective in patients with distal ureteral stones <10 mm in size. However, use of Rowatinex does not seem to have any significant effect on clearance rate of distal ureteral calculi. © 2010 Springer Science+Business Media, B.V.


Kilic M.,Ataturk Teaching and Research Hospital | Serefoglu E.C.,Ataturk Teaching and Research Hospital | Ozdemir A.T.,Ataturk Teaching and Research Hospital | Balbay M.D.,Ataturk Teaching and Research Hospital
Andrologia | Year: 2010

Penile color Doppler sonography is a valuable method for evaluating erectile dysfunction. However, there are some concerns about the safety of this method due to the intracorporeal pharmacological injection, which may cause priapism as a complication, resulting in penile fibrosis. To evaluate the actual incidence of papaverine-induced priapism in patients with erectile dysfunction (ED) who underwent penile colour Doppler sonography and to determine the safety of this diagnostic tool, a retrospective study was conducted using the database of our institution. A total of 672 men with ED underwent penile color Doppler ultrasonography with the intracorporeal injection of 60 mg papaverine hydrochloride. The patient characteristics of priapism cases were retrospectively evaluatedriapism in 18 of the 672 patients (2.68%) was successfully treated with blood aspiration, irrigation and injection of an α-agonist medication, when neededatients with priapism were younger compared with those without priapism; mean age 45 ± 12.51 (20-68) versus 50.93 ± 12.04 (17-78) (P < 0.001)enile Doppler ultrasound is a safe procedure in evaluating erectile dysfunction. The incidence of priapism, which is the most important complication of this procedure, is low and can be managed successfully with conservative approaches. © 2009 Blackwell Publishing Ltd.


Ozdemir A.T.,Ataturk Teaching and Research Hospital | Altinova S.,Ataturk Teaching and Research Hospital | Serefoglu E.C.,Ataturk Teaching and Research Hospital
Journal of Clinical and Analytical Medicine | Year: 2012

Aim The initial therapy for superficial bladder carcinoma is the transurethral resection of the tumor. In spite of successful resections, there are 60-79% recurrence and 15% progression rates. Additional therapies are suggested for the treatment of superficial bladder carcinoma. We compared the efficacy of interferon alfa-2b monotherapy with interferon alfa-2b plus Bacillus Calmette Guerin (BCG) combination therapy with urine interleukin (IL) 2, 6 and 10 levels of patients with superficial bladder carcinoma. Material and Methods The patients who underwent TUR-BT for superficial bladder tumor (pathological staging Ta-T1) between 2004 and 2007 at our hospital included in this prospective study. Intravesical immunotherapy was administered once a week for 6 weeks and there after a month for 6 months, starting 4 weeks after TUR-BT. IL levels were measured. Results IL-2, IL-6 and IL-10 levels in urine samples were taken at 2nd and 4th hours of intravesical therapy. A statistically significant difference was observed between mean urine IL-2 levels of patients treated with IFNα-2b monotherapy and IFNα-2b plus BCG combination both at 2nd and 4th hours. (p=0.05) In IFNα-2b plus BCG combination group, there was a statistical significant difference between stages regarding IL-2 and IL-6 levels (p=0.05). Among patients with G3 tumors, IL-2 levels were higher at 2 and 4 hours (p=0.05) but there was no significant difference in IL-6 and IL-10 levels in this group of patients regardless of intravesical therapy received (p=0.05). Conclusions IFNα-2b and BCG combination therapy is a reliable and effective therapy in the management of superficial bladder tumors.


Sengul O.,Ataturk Teaching and Research Hospital | Dede S.,Etlik Zubeyde Hanm Womens Health Teaching And Research Hospitalankara
European Journal of General Medicine | Year: 2014

Fetal period is characterized by the rapid growth and maturation of tissues and organs. There are various alterations in carbohydrate, lipid and protein metabolisms in mother to provide nutrition to fetus. If something is wrong about these metabolisms in mother, this will indirectly affect fetus. So it is essential to elucidate the maternal and fetal carbohydrate, lipid and protein metabolisms in the management of a pregnant woman. Mild fasting hypoglycemia, postprandial hyperglycemia, hyperinsulinemia and increased peripheral insulin resistance are the characteristics of pregnancy. The fetus primarily depends on glucose as the energy source but can also use other substrates such as lactate, keto acids, amino acids, fatty acids and glycogen as energy sources. Proteins are needed as structural components. Alterations in lipid metabolism cause accumulation of maternal fat stores in the early pregnancy in order to enhance lipolysis in the late pregnancy providing glucose and amino acids for fetus while promoting usage of lipids as maternal energy source. Maternal energy metabolism affects fetal energy metabolism both in short and long terms. By the clarification of maternal and fetal energy metabolisms, it may be possible to predict and prevent some diseases of a newborn in the future. © 2014, TIP ARASTIRMALARI DERNEGI. All rights reserved.


Aldemir M.,Ataturk Teaching and Research Hospital | Okulu E.,Ataturk Teaching and Research Hospital | Neselioglu S.,Ataturk Teaching and Research Hospital | Erel O.,Ataturk Teaching and Research Hospital | Kayigil O.,Ataturk Teaching and Research Hospital
International Journal of Impotence Research | Year: 2011

We investigated the effects of Antep pistachio on International Index of Erectile Function (IIEF) scores, penile color Doppler ultrasound (PCDU) parameters and serum lipid levels in patients with ED. A total of 17 married male patients with ED for at least 12 months were included in this prospective study. Patients were put on a 100 g pistachio nuts diet for 3 weeks. IIEF and PCDU were evaluated before and after the pistachio diet. In addition, plasma total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglyceride were measured before and after dietary modifications from all subjects. Mean IIEF-15 score was 36±7.5 before the diet and 54.2±4.9 after the diet (P=0.001). Similarly, an increase in all five domains of IIEF was observed after the diet (P<0.05). Mean peak systolic velocity values before and after the pistachio diet were 35.5±15.2 and 43.3±12.4 cm s-1, respectively (P=0.018). After the pistachio diet, TC and LDL levels decreased significantly, whereas HDL level increased (P=0.008, 0.007 and 0.001, respectively). We demonstrated that a pistachio diet improved IIEF scores and PCDU parameters without any associated side effects in patients with ED. Furthermore, the lipid parameters showed statistically significant improvements after this diet. © 2011 Macmillan Publishers Limited. All rights reserved.


PubMed | Kartal Kosuyolu High Specialty Training and Research Hospital, Ataturk Teaching and Research Hospital, Turkiye Yuksek Ihtisas Teaching and Research Hospital, Ankara University and 3 more.
Type: Journal Article | Journal: European journal of radiology | Year: 2015

To investigate the efficacy of positron emission tomography/computed tomography (PET/CT) in detection and management of hepatic and extrahepatic metastases from gastrointestinal cancers.Between February 2008 and July 2010, patients histopathologically diagnosed with gastrointestinal cancer and showing suspected metastasis on CT screening were subsequently evaluated with PET/CT. All patients were subgrouped according to histopathological origin and localization of the primary tumor. Localization of gastrointestinal cancers was further specified as lower gastrointestinal system (GIS), upper GIS, or hepato-pancreato-biliary (HPB). Both accuracy and impact of CT and PET/CT on patient management were retrospectively evaluated.One hundred and thirteen patients diagnosed histopathologically with gastrointestinal cancers were retrospectively evaluated. Seventy-nine patients had adenocarcinoma and 34 patients other gastrointestinal tumors. Forty-one patients were in the upper GIS group, 30 patients in the HPB group, and 42 patients in the lower GIS group. Evaluation the diagnostic performance of PET/CT for suspected metastasis according to histopathological origin of the tumor, revealed that the sensitivity of PET/CT - although statistically not different - was higher in adenocarcinomas than in non-adenocarcinomas (90% (95% CI, 0.78-0.96) vs. 71.4% (95% CI, 0.45-0.88), P=0.86). The specificity was not significantly different (85.7% (95% CI, 0.70-0.93) vs. 85% (95% CI, 0.63-0.94), P=1.00). In the overall patient group; CT was significantly more sensitive than PET/CT for detection of hepatic metastases (94.7% vs. 78.9%, P=0.042), whereas PET/CT was significantly more specific than CT (48% vs. 98.7%, P<0.001). In subgroup analysis, sensitivity was not significantly different (P>0.05) but specificity was significantly higher in PET/CT than CT (P<0.05). The specificity of PET/CT was highest in upper GIS (100%) and HPB (100%) subgroups. In the overall patient group; for detection of extrahepatic metastasis, the sensitivity of CT (75%) and PET/CT (87.5%) showed no significant difference (P=0.437). However, PET/CT was significantly more specific than CT (88.7% vs. 70.4%, P=0.007). In subgroup analysis, no significant difference was found between CT and PET/CT either in sensitivity or in specificity (P>0.05). The specificity of PET/CT was highest in the lower GIS subgroup (93%). The management of 45 patients (39.8%) was revised after PET/CT evaluation.PET/CT has a higher specificity than CT in detecting suspected hepatic and extrahepatic metastases of gastrointestinal cancers, and has an impact of nearly 40% on changing patient management strategies.

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