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İstanbul, Turkey

Guler N.,Nightingale | Dayangac M.,Nightingale | Yaprak O.,Nightingale | Akyildiz M.,Nightingale | And 8 more authors.
Transplant International | Year: 2013

In right lobe (RL) living donor liver transplantation (LDLT), portal vein (PV) variations are of immense clinical significance. In this study, we describe in detail our PV reconstruction techniques in RL grafts with variant PV anatomy and evaluate the impact of accompanying biliary variations on the recipient outcomes. In a total of 386 RL LDLTs performed between July 2004 and July 2012, the clinical data on 52 (13%) transplants using RL grafts with variant PV anatomy were retrospectively analyzed. Portal vein anatomy was classified as type 2 in 20 patients, type 3 in 24 patients, and type 4 in eight patients. The PV reconstruction techniques utilized included back-wall plasty (n = 21), back-wall plasty with saphenous vein graft interposition (n = 6), saphenous vein graft interposition (n = 5), cryopreserved iliac vein Y-graft interposition (n = 6), and quiltplasty (n = 3). There was no donor mortality. In a median follow-up of 29 months, none of the recipients had vascular complications. Anomalous PV anatomy was associated with a high (54%) incidence of biliary variations; however, these variations did not result in increased biliary complication rate. Overall, the 1- and 3-year patient survival rates of recipients were 91% and 81%, respectively. Vascular and biliary variations in RL grafts render LDLT technically more challenging. By employing appropriate reconstruction techniques, it is possible to successfully use RL grafts with PV variations without endangering recipient and donor safety. © 2013 Steunstichting ESOT. Published by John Wiley & Sons Ltd. Source

Karakoca Y.,Medical Park Goztepe Hospital | Yapicier O.,Bahcesehir University
Journal of Bronchology and Interventional Pulmonology | Year: 2015

Background: Inflammation of the small airways (bronchiolitis) contributes to airflow limitation by narrowing and obliterating the airway lumen in patients with chronic obstructive pulmonary disease (COPD). Although currently available treatments provide satisfactory disease control in most patients, a significant number of patients do not respond. This study presents the outcomes of Karakoca resector balloon desobstruction in patients with severe COPD who did not respond to medical treatment. Methods: Ten COPD patients classified as stage IV by the Global Initiative for Obstructive Lung Disease (GOLD) and unsuccessfully treated with high-dose bronchodilators and corticosteroids, oral corticosteroids, oxygen, and NIMV therapy underwent therapeutic bronchoscopy, including balloon desobstruction for segmental and subsegmental bronchi. Exercise capacity and SpO 2 levels were measured and lung function tests and bronchoscopic biopsies performed before and after the intervention. Results: After Karakoca resector balloon desobstruction, improvements were noted in the effort capacity, SpO 2 and forced expiratory volume in 1 second levels of all patients. None of the patients developed preoperative complications or complication or exacerbation within the postoperative 1 to 3 months of follow-up. Conclusion: Satisfactory results were achieved in all patients, warranting study of Karakoca resector balloon desobstruction in larger patient cohorts. © 2015 Wolters Kluwer Health, Inc. All rights reserved. Source

Akpinar P.,Istanbul Fatih Sultan Mehmet Training and Research Hospital | Icagasioglu A.,Istanbul Medeniyet University | Cihangiroglu M.,Medical Park Goztepe Hospital
Journal of Musculoskeletal Pain | Year: 2014

Background: Spinal tuberculosis is an uncommon disease but still occurs widely. Findings: We describe a 56-year-old woman presenting with a severe backache. She was diagnosed with osteoporosis and a lumbar disc herniation two months ago, but tuberculosis had not been diagnosed before. We reviewed the relevant literature and emphasized the impact of early diagnosis of spinal tuberculosis. Conclusions: The onset of tuberculous spondylitis is insidious in nature, with various clinical presentations. Lack of specific symptoms causes delays in diagnosis. Its diagnosis may be delayed because tuberculosis is not considered in the differential diagnosis. In cases with severe back pain, spinal tuberculosis must be included in the differential diagnosis. © 2014 Informa Healthcare USA, Inc. Source

Toygar B.,Bahcesehir University | Yabas Kiziloglu O.,Bahcesehir University | Toygar O.,Bahcesehir University | Hacimustafaoglu A.M.,Medical Park Goztepe Hospital
International Ophthalmology | Year: 2016

The purpose of this study was to evaluate the early visual and refractive outcomes of a new aspheric monofocal microincision intraocular lens (IOL). This retrospective case series included eyes of patients who underwent implantation of a microincision IOL following 1.8 mm manual coaxial microincision cataract surgery and who attended regular postoperative follow-up visits on the first week and first, third, and sixth months. The postoperative uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refraction and predictability, intraoperative and postoperative complications, posterior capsule opacification (PCO), IOL centration, and surgically induced astigmatism (SIA) were evaluated. Sixty-three eyes of 38 patients ranging in age from 51 to 86 were included in the study. The mean preoperative BCVA was 0.52 ± 0.42 logMAR. At the postoperative sixth month, the mean postoperative UCVA and BCVA were 0.12 ± 0.11 and 0.01 ± 0.03 logMAR, respectively. The mean postoperative spherical equivalent refraction (SER) was −0.30 ± 0.49 D. The SER was within ± 1.00 D of the attempted correction in 95.2 % of the eyes. The mean SIA measured with vector analysis was 0.45 ± 0.28 D. Mild PCO was observed in 9 eyes (14.7 %) with none requiring Nd:Yag laser capsulotomy. On centration analysis, the IOL was found to be 0.26 mm on average to the supero-nasal position. The aspheric microincision IOL was safely implanted and provided satisfactory visual and refractive outcomes in the early postoperative period. © 2016 Springer Science+Business Media Dordrecht Source

Oner S.Y.,Marmara University | Volkan O.,Fatih Sultan Mehmet Education and Research Hospital | Oner C.,Istanbul Science University | Mengi A.,Fatih Sultan Mehmet Education and Research Hospital | And 2 more authors.
Acta Reumatologica Portuguesa | Year: 2015

Objectives: Leptin is a fat tissue hormone, which effects energy expenditure, food intake, hematopoiesis, osteogenesis, angiogenesis, reproductive and immune systems. We aimed to determine serum leptin levels and investigate the association between disease activity and other in parameters in rheumatoid arthritis (RA) patients. Methods: Patients with RA (n=106), as the study group, healthy controls (n=52) and osteoarthritis (OA) patients (n=37), as a control group, were enrolled to the study. RA patients were categorized in four different groups according to DAS28 scores: remission, low (LDA), mode rate (MDA) or high (HDA) disease activity. Results: No significant difference was present between the body mass indices of the three groups. Mean leptin levels in RA patients, OA group and healthy indivi duals were 25.60±13.41, 23.03±11.51 and 23.81±12.85 ng/ml, respectively and no significant difference was present between the groups. Nine of (8.5%) RA patients were in remission, 16 (15.1%) were in LDA, 40 (37.7%) in MDA and 41 (38.7%) were in HDA. Leptin levels did not correlate with DAS28 scores of RA patients (r=-0.12, p=0.11). Mean leptin levels in RA patients in remission was 32.65±7.28; in LDA 23.94±10.94; in MDA 26.73±14.92 and in HDA 23.59±13.50 ng/ml (p=NS). No associations were obser ved between leptin levels and CRP, ESR, RF positivity and disease duration. Conclusions: Our study revealed no correlation of di - sease activity and serum leptin levels. Therefore leptin does not seem to be an appropriate biomarker to moni - torize inflammation in RA. Source

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