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Tekirdağ, Turkey

Gozen A.S.,University of Heidelberg | Malkoc E.,Corlu Military Hospital | Al-Sudani I.,Al Sadder Teaching Hospital | Rassweiler J.,University of Heidelberg
Journal of Endourology | Year: 2012

Background and Purpose: The surgical approach and repair for urorectal fistula (URF) is a challenging task. A variety of techniques have been described to treat URFs, and the laparoscopic approach has been approved as an efficient tool for even some complex fistulas. We aimed to report our laparoscopic experience for complex URF repair with special emphasis on salvage prostatectomy. Patients and Methods: The study included four men (59-75 years), with laparoscopic repair for complex URFs. URF developed after transurethral resection of the prostate in patients 2 and 3 and after radical prostatectomy in patient 4. Patient 1 had received combined radiotherapy and chemotherapy for the rectal carcinoma; a prostatic abscess developed that resulted at the end in URF. Laparoscopic salvage prostatectomy was performed for patients 1 and 2. A transvesical laparoscopic approach was performed for patient 3, and a transperitoneal transvesical technique was performed for patient 4. A tunica vaginalis flap was used for patient 1, and peritoneal interposition flaps were developed in patients 2 and 4 mL, and no patients needed intraoperative blood transfusion. Postoperative hospital stay was 12 to 34 days. The urethral catheter was removed on postoperative day 11 to 32, and cystography showed no leakage of contrast except in patient 1. Conclusions: Laparoscopic URF repair is safe and efficacious in experienced hands even in complex cases, and salvage laparoscopic prostatectomy seems like a valuable operative option. The technique requires advanced experience, however, particularly with pelvic surgery and intracorporeal suturing. Copyright © 2012, Mary Ann Liebert, Inc. 2012. Source

Ozdemir M.T.,Corlu Military Hospital | Kir M.C.,Surgery Academy
Indian Journal of Orthopaedics | Year: 2011

Background: Repair of diaphyseal bone defects is a challenging problem for orthopedic surgeons. In large bone defects the quantity of harvested autogenous bone may not be sufficient to fill the gap and then the use of synthetic or allogenic grafts along with autogenous bone becomes mandatory to achieve compact filling. Finding the optimal graft mixture for treatment of large diaphyseal defects is an important goal in contemporary orthopedics and this was the main focus of this study. The aim of this study is to investigate the efficacy of demineralized bone matrix (DBM) and autogenous cancellous bone (ACB) graft composite in a rabbit bilateral ulna segmental defect model. Materials and Methods: Twenty-seven adult female rabbits were divided into five groups. A two-centimeter piece of long bone on the midshaft of the ulna was osteotomized and removed from the rabbits′ forearms. In group 1 (n=7) the defects were treated with ACB, in group 2 (n=7) with DBM, and in group 3 (n=7) with ACB and DBM in the ratio of 1:1. Groups 4 and 5, with three rabbits in each group, were the negative and positive controls, respectively. Twelve weeks after implantation the rabbits were sacrificed and union was evaluated with radiograph (Faxitron), dual-energy x-ray absorptiometry (DEXA), and histological methods (decalcified sectioning). Results: Union rates and the volume of new bone in the different groups were as follows: group 1 - 92.8% union and 78.6% new bone; group 2 - 72.2% union and 63.6% new bone; and group 3 - 100% union and 100% new bone. DEXA results (bone mineral density [BMD]) were as follows: group 1 - 0.164 g/cm 2 , group 2 - 0.138 g/cm 2 , and group 3 - 0.194 g/cm 2. Conclusions: DBM serves as a graft extender or enhancer for autogenous graft and decreases the need of autogenous bone graft in the treatment of bone defects. In this study, the DBM and ACB composite facilitated the healing process. The union rate was better with the combination than with the use of any one of these grafts alone. Source

Kir M.C.,Corlu Military Hospital | Ozdemir M.T.,Surgery Academy
Indian Journal of Orthopaedics | Year: 2011

The myositis ossificans around shoulder in military recruits are not reported yet. Three young male soldiers presented with complaints of palpable mass at the anterior aspect of shoulder; tenderness around the superior part of deltopectoral groove close to acromioclavicular joint; and restriction of shoulder motion. They also noticed ecchymosis and pain around the coracoid process and anterior shoulder region during regular firing exercises. Plain X-rays and computerized tomography showed extra-capsular, dense, irregular structure in the space between pectoralis and deltoid muscles which correlated with heterotopic bone. One patient refused surgical intervention because of the completion of his military serving period. Surgical excision was performed for the other two patients. During surgical exploration, both ossified masses were found in deltopectoral region and mostly in fibers of clavicular and acromial parts of deltoid muscle. Pathological reports confirmed the structure of masses as mature trabecular bone. Postoperatively indomethacin treatment and active shoulder exercises were started until the full range of motion was regained. Mini soft bag was used on the rifle contact area of the shoulder. No complications or recurrences were observed during the 24 months of followup period. Source

Boyraz O.,Corlu Military Hospital | Saracoglu M.,Gulhane Haydarpasa Training Hospital
Diabetes Research and Clinical Practice | Year: 2010

Objective: Nerve conduction studies (NCS) and Michigan Neuropathy Screening Instrument (MNSI) are commonly used to make the diagnosis of diabetic peripheral neuropathy. The objective of this study was to compare the diagnostic values of MNSI patient version test and physical test for the assessment of the diabetic peripheral neuropathy in obese vs. non-obese patients. Method: This study was conducted on 70 type 2 diabetic patients. We carried out the MNSI patient version test and MNSI physical assessment test. Nerve conduction studies were performed for the diagnosis of the diabetic peripheral neuropathy. Results: In diabetic peripheral neuropathy (DPN) determined by NCS, the independent prediction of peripheral neuropathy was the score of Michigan physical assessment (odds 2.0; CI: 1.3-3.0). In BMI (body mass index) ≥30 diabetic patients who have peripheral neuropathy, Michigan patient version test is not significant. But the score of Michigan physical assessment is significantly increased in these patients compared to patients without peripheral neuropathy. In BMI. < 30 diabetic patients who have peripheral neuropathy, scores of both Michigan patient version and physical assessment instruments are significantly increased. Conclusion: To screen diabetic peripheral neuropathy, Michigan physical assessment may be more useful instrument than Michigan patient version test in obese diabetic patients. © 2010. Source

Ak M.,Inonu University | Yavuz K.F.,Bakirkoy Research and Training Hospital for Psychiatry | Lapsekili N.,Corlu Military Hospital | Turkcapar M.H.,Diskapi Yildirim Beyazit Training and Research Hospital
Dusunen Adam | Year: 2012

Evaluation of burden in a group of patients with chronic psychiatric disorders and their caregivers Objective: Psychosocial, emotional and physical responses arising while giving care is considered as the burden of the caregiver. To be aware of the burden to the family members or caregivers and the severity of the burden provides important clues for family treatment. The aim of this study was to investigate the burden of the caregivers of bipolar disorder and schizophrenia patients, the relationship of the caregiving burden with sociodemographic and psychopathological variables, and whether there is any similarities between the two groups with respect to caregiving burden. Methodology: The caregivers of 40 chronic bipolar patients and 40 schizophrenia patients diagnosed according to DSM-IV participated in this study. Patients' symptoms were assessed with Clinical Global Impression Scale. Caregivers were evaluated using Zarit Burden Interview. Results: Caregiving burden was found high in the caregivers of bipolar disorder and schizophrenia patients, but there is no statistical difference between the groups. Educational status of the caregivers, the severity of the illness, caregiver's relationship to the patient, a history of psychiatric disorder in the family were found as important variables that increased the burden of the caregiver. Discussion: To uncover the factors that affect the burden of the caregivers is important for predicting relapses. Bipolar disorder and schizophrenia significantly affect not only patients but also their families (or caregivers). At this stage, the responsibility of the clinician is not restricted to clinical practice, but includes educating patients and their families as well as helping them to organise against psychological and social difficulties. Source

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