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Arici C.,Gulhane Military Medical Faculty
Journal of AAPOS | Year: 2012

Purpose: To compare the effectiveness of superior oblique tuck and inferior oblique weakening procedures on objective and subjective torsion in patients with superior oblique palsy. Methods: Patients with unilateral superior oblique palsy evaluated between September 2007 and October 2009 were treated with one of four surgical procedures on the basis of their preoperative findings: superior oblique tuck, anterior transposition of the inferior oblique muscle, inferior oblique recession, or inferior oblique myectomy. Subjective (double Maddox rods) and objective (fundus photography) torsion were measured pre- and postoperatively. Results: A total of 28 patients were evaluated (mean age, 16.4 ± 12.4 years; range, 6-51 years). In 15 (53.6%) the superior oblique palsy was congenital; in 13 (46.4%) it was acquired. The mean decrease in subjective extorsion was 6.2°± 2.3°after superior oblique tuck, 2.3°± 2.4°after anterior transposition of the inferior oblique, 1.3°± 2.7°after inferior oblique recession, and 2.6°± 4.7°after inferior oblique myectomy. Objective extorsion decreased by 5.8°± 0.8°, 4.4°± 1.7°, 3.1°± 3.2°, and 3.4°± 4.7°, respectively. Conclusions: Superior oblique tuck appears to correct extorsion more effectively than inferior oblique surgery, but this may be an artifact of performing tucks in patients with greater initial extorsion. The small amount of extorsion correction was similar for all inferior oblique procedures. © 2012 by the American Association for Pediatric Ophthalmology and Strabismus.


Esen A.,Medical Park Hospital | Dolanmaz D.,Selcuk University | Kalayci A.,Selcuk University | Gunhan O.,Gulhane Military Medical Faculty | Avunduk M.C.,Selcuk University
Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology | Year: 2010

Localized Langerhans cell histiocytosis (LLCH), formerly known as eosinophilic granuloma, mainly affects the skull, mandible, vertebrae, and ribs in children and the long bones of adults. Symptoms range from none to pain, swelling, and tenderness over the site of the lesion. General malaise and fever occasionally are present. Radiographically, lesions appear as radiolucent areas with well demarcated borders. LLCH may resolve spontaneously after biopsy in a period of months to years. However, if features include continuous pain, decrease of function, pathologic fractures, migration and resorption of teeth, or rapid progression, then active treatment needs to be considered. Treatment approaches include surgery, radiotherapy, chemotherapy, and intralesional injection of corticosteroids. In children with mandibular LLCH, 1 dose of methyprednisolone succinate injection has proven to be adequate. However, injections have not been performed in cases involving pathologic fracture. We report a new case of LLCH of the mandible that caused a pathologic fracture in an adult patient. Repeated intralesional corticosteroid injections resulted in fracture line disappearance within 14 months and lesion healing by the end of the 36-month follow-up. © 2010 Mosby, Inc. All rights reserved.


Hussein A.,Minia University | Ozgok Y.,Gulhane Military Medical Faculty | Ross L.,University of Illinois at Chicago | Rao P.,University of Illinois at Chicago | Niederberger C.,University of Illinois at Chicago
BJU International | Year: 2013

Study Type - Therapy (outcomes) Level of Evidence 2a What's known on the subject? and What does the study add? Clomiphene citrate, hCG and human menopausal gonadotropin (hMG) are widely used in treatment of oligospermia, because they increase FSH and testosterone which are essential for spermatogenesis. Finding a sperm in non-obstructive azoospermia for intracytoplasmic sperm injection is a challenge and much effort is required to reach the optimum method of sperm retrieval. The study shows that a new protocol of clomiphene citrate, hCG and hMG in the treatment of non-obstructive azoospermia achieves an increase in the levels of FSH, LH and total testosterone to the target levels that we set. Our target level of FSH was 1.5 times its initial level and for serum testosterone it was 600-800 ng/dL. Using our described medical treatment protocol in cases of non-obstructive azoospermia, sperm may be found in patients' ejaculate (∼11%) and if they remain azoospermic they will have a greater likelihood of sperms being obtained in testicular sperm extraction. Objective To evaluate the effect of optimizing serum level of follicle-stimulating hormone (FSH), luteinizing hormone (LH) and testosterone on sperm retrieval for intracytoplasmic sperm injection. Patients and methods A total of 612 patients with non-obstructive azoospermia were evaluated with routine history, physical examination and hormonal assessment. Of these, 116 patients underwent microsurgical (micro)-testicular sperm extraction (TESE) without any medical treatment and formed the control group and the remaining 496 patients were administered clomiphene citrate in a titrated dose. Patients were classified into four groups according to their response to clomiphene citrate. Group 1: patients with an obvious increase in FSH and total testosterone (n= 372). Group 2: patients showing an increase in FSH with no or little increase in LH and total testosterone (n= 62). For these patients we continued with clomiphene citrate and added human chorionic gonadotrophin (hCG). Group 3: patients with no increase in the levels of the three hormones (n= 46). Group 4: included patients with continuously decreasing serum testosterone levels in response to the increasing dose of clomiphene citrate (n= 16). Accordingly, patients in groups 3 and 4 discontinued clomiphene citrate and started hCG and human menopausal gonadotropin (hMG). Semen analyses were performed periodically and, in patients who remained azoospermic, micro-TESE was performed. RESULTS Sperm were noted in 54 patients (10.9%) in semen analysis after treatment in all groups (with no significant difference) at a mean (sd) concentration of 2.3 (4.1) million/mL. For the 442 patients who remained azoospermic after treatment, successful sperm retrieval was significantly higher (57%) compared with the control group (33.6%). Conclusion For patients with non-obstructive azoospermia, clomiphene citrate, hCG and hMG administration, leading to an increased level of FSH and total testosterone, results in an increased rate of sperm in the ejaculate and increased likelihood of successful micro-TESE. © 2012 THE AUTHORS. BJU INTERNATIONAL © 2012 BJU INTERNATIONAL.


Turk A.,Karadeniz Technical University | Ceylan O.M.,Gulhane Military Medical Faculty | Arici C.,Gulhane Military Medical Faculty | Keskin S.,Gulhane Military Medical Faculty | And 4 more authors.
American Journal of Ophthalmology | Year: 2012

• Purpose: To determine the normative values of the peripapillary retinal nerve fiber layer (RNFL), macular thickness, and macular volume in healthy children using spectral-domain optical coherence tomography (SD-OCT) and analyze the correlation of such values with age, refraction error, and biometric measurements. • Design: Observational case series. • Methods: This institutional study involved 107 eyes from 107 healthy pediatric patients (54 female, 53 male) with ages between 6 and 16 years. After the biometric measurements and refractive error values (in spherical equivalent) of the cases were obtained, the peripapillary RNFL, macular thickness, and macular volume values were calculated using the Spectralis OCT device. • Results: Among the study group, with an average age of 10.46 ± 2.94 years, the average axial length (AL) was 23.33 ± 0.89 mm; the average spherical equivalent (SE) value was -0.27 ± 0.99 diopter. The average peripapillary RNFL thickness was 106.45 ± 9.41 μm; the average macular thickness was 326.44 ± 14.17 μm; and the average macular volume was 0.257 ± 0.011 mm 3. The aforementioned OCT measurements were not significantly correlated with age, SE, or AL values (P >.05 for all). Conclusions: This study reports SD-OCT findings among healthy pediatric cases. SD-OCT can be reliably used for pediatric patients because of its short exposure time and high degree of image resolution. © 2012 Elsevier Inc. All rights reserved.


Korkmaz C.,Center for Assisted Reproduction Technologies and IVF | Cinar O.,Etlik Zubeyde Hanim Womens Health Teaching and Research Hospital | Akyol M.,Gulhane Military Medical Faculty
Gynecological Endocrinology | Year: 2011

Meiotic spindle analysis with a non-invasive technique, the PolScope, is used to protect the meiotic spindle from damage during microinjection. To evaluate the predictive feature of PolScope, we have designed a retrospective study to analyse the correlation between the meiotic spindle visualisation with regard to spindle location and outcomes of assisted reproductive technologies (ART), including patient age, previous cycles, the number of the collected oocytes, fertilisation rates (FR), pronuclear scoring (PNS) and embryo scoring of the days from two to five. All of the data belonging to 1496 oocytes from 190 patients were statistically analysed. We found that the oocytes having PolScope visualised spindle have higher FR, and also observed that when the spindle located at 0°30° according to the first polar body, gave the highest FR. PNS gave higher scores in the spindle visualised group, but spindle angle did not affect PNS outcomes. Although a correlation was found between spindle visualisation and developed embryo qualities, particularly at day 2 and 3, spindle angles did not affect embryo quality. We conclude that PolScope microscopy has an efficiency to estimate FR, and cleavage stage embryo development. © 2011 Informa UK, Ltd.


Ercan C.M.,Gulhane Military Medical Faculty | Sakinci M.,Gulhane Military Medical Faculty | Duru N.K.,Gulhane Military Medical Faculty | Alanbay B.,Gulhane Military Medical Faculty | And 2 more authors.
Gynecological Endocrinology | Year: 2010

Objective. To evaluate whether a change takes place in antimullerian hormone (AMH) levels reflecting the ovarian reserve after laparoscopic endometrioma stripping surgery and to demonstrate if there is any correlation between AMH levels and the sizes of endometriomas. Method. Fourty-seven women participated as the study group in this prospective controlled trial, 33 of whom (70.2%) had unilateral and 14 (29.7%) of whom had bilateral endometriomas. Pre-and post-operative serum AMH levels were measured and compared with 17 normo-ovulatory control cases and also correlated with endometrioma sizes. Result(s). Mean pre-operative AMH levels of the study group and the normo-ovulatory control cases did not reveal a statistically significant difference (1.62±1.09ng/ml and 2.06±0.51ng/ml, P>0.05). Mean level of post-operative serum AMH of the study group decreased from 1.62±1.09 to 1.39±1.16. However, this reduction was not statistically significant. (P>0.05). Pre-and post-operative AMH levels do not reveal a correlation with the size of endometrioma in both group of patients with either unilateral or bilateral endometrioma. Conclusion(s). The presence of the endometrioma does not impair the AMH levels. Laparoscopic endometrioma stripping surgery do not appear to cause a damage in the AMH secreting healthy ovarian tissue, in the short-term follow-up. Laparoscopic stripping surgery of endometriomas in experienced hands is currently a valid approach. © 2010 Informa UK Ltd.


Yorbik O.,Gulhane Military Medical Faculty | Kurt I.,Gulhane Military Medical Faculty | Hasimi A.,Gulhane Military Medical Faculty | Ozturk O.,Gulhane Military Medical Faculty
Biological Trace Element Research | Year: 2010

Although potentially harmful effects of heavy metals are well known, limited numbers of studies exist regarding their relationship with autism. The aim of this study was to investigate urine levels of some heavy metals such as of chromium (Cr), cadmium (Cd), and lead (Pb) in children with autism and healthy subjects. Urine levels of Cr, Cd, and Pb were measured by atomic absorption spectrometry in 30 children with autism and compared with 20 healthy controls. Urine Cd and Pb levels were found as significantly decreased in children with autism compared to healthy subjects (p<0.05). On the other hand, urine Cr levels were significantly higher in children with autism than healthy subjects (p<0.05). This study suggested that autism may be associated with significant decrease in excretion rate of Cd and Pb and a significant increase excretion rate in the levels of Cr in the urine. These results have indicated that further studies are warranted for investigation of possible roles of heavy metals in autism. © 2009 Humana Press Inc.


Sobac G.,Gulhane Military Medical Faculty | Erdem U.,Gulhane Military Medical Faculty | Durukan A.H.,Gulhane Military Medical Faculty | Erdurman C.,Gulhane Military Medical Faculty | And 4 more authors.
Ophthalmology | Year: 2010

Purpose: To evaluate the intermediate-term safety and effectiveness of interferon alpha-2a (IFNα2a) in patients with Behçets uveitis (BU) refractory to corticosteroids and immunosuppressive agents. Design: Open, nonrandomized, uncontrolled, interventional, prospective study. Participants: Fifty-three patients (106 eyes) with active, vision-threatening BU who failed to respond to conventional treatments. Intervention: In 53 patients, acute inflammation was suppressed with effective prednisolone dosage (12 mg/kg/day, tapered to 10 mg within 46 weeks). The patients were treated with IFNα2a 4.5 million international units (MIU) 3 times per week for the first 3 months followed by IFNα2a 3 MIU 3 times per week for the next 3 months. Observation or other treatment methods were performed according to the decision tree developed for this study. Main Outcome Measures: Remission and complete response (primary outcome measures), frequency of uveitis attacks, visual acuity (VA), and adverse effects (secondary outcome measures). Results: During 2 years of follow-up (median 65 months, range 12130 months), compliance with the therapy was excellent. At the end of 1-year follow-up, treatment response was obtained in 45 of 53 patients (84.9%). The mean attack rate of 3.6±1.1 per year (range, 28) decreased to 0.56±0.75 (range, 04) per year (P=0.001). Visual acuity improved (≥0.2 logarithm of the minimum angle of resolution units from initial VA) in 30 eyes (28.3%) and worsened in 12 eyes (11.3%). Five patients (9.4%) did not respond to the initial treatment, and 3 patients (5.6%) developed severe adverse effects, including psoriasis, epileptic seizure, and extreme tiredness. Fifteen patients (28.3%) were off treatment for all the medications and disease free for 28±13.1 months (range, 1250 months). Conclusions: These results suggest that IFNα2a may be a valuable treatment option in BU that is refractory to corticosteroids and conventional immunosuppressive agents. The possible role of IFNα2a as a first-line agent in BU should be validated in randomized controlled clinical trials against newly described biologic agents. © 2010 by the American Academy of Ophthalmology.


Ercan C.M.,Gulhane Military Medical Faculty | Duru N.K.,Gulhane Military Medical Faculty | Karasahin K.E.,Gulhane Military Medical Faculty | Coksuer H.,Gulhane Military Medical Faculty | And 2 more authors.
European Journal of Obstetrics Gynecology and Reproductive Biology | Year: 2011

Objective: To evaluate the ovarian reserve after laparoscopic stripping of unilateral endometriomas by comparing the operated and non-operated ovaries. Study design: Bilateral ovarian volumes, antral follicle counts, and stromal blood flows were assessed by ultrasonography and anti-mullerian hormone (AMH) levels were analysed in 36 patients who had undergone laparoscopic cystectomy for unilateral ovarian endometrioma. Results: Mean antral follicle counts (AFC) of the operated side ovaries were significantly lower on the second postoperative day (3.1 ± 2.4 vs 5.2 ± 3.7; p < 0.05) and in the third month (3.7 ± 2.1 vs 6.4 ± 2.7; p < 0.05). Pulsatility indices of the operated ovaries were significantly decreased on the second postoperative day (2.22 ± 0.46 vs 1.76 ± 0.51; p < 0.05) while resistance indices were increased (0.81 ± 0.06 vs 0.88 ± 0.13; p < 0.05). Doppler parameters had recovered and a non-significant decrease in AMH levels of the patients was recorded in the third month after surgery (2.03 ± 0.41 ng/mL vs 1.95 ± 0.62 ng/mL; p > 0.05). Conclusion: Although laparoscopic stripping of endometriomas seems to affect the ovarian reserve in terms of AFCs, it does not have a significant negative impact at the end of three months as assessed by ovarian volumes, Doppler indices and AMH levels. Endometrioma surgery techniques are important in preserving normal functioning ovaries and further studies are necessary for optimising these surgical approaches. © 2011 Elsevier Ireland Ltd.


To use the ultrashort time-to-echo magnetic resonance imaging (UTE MRI) technique to quantify short T2* properties (obtained through gradient echo) of a disc from the human temporomandibular joint (TMJ) and to corroborate regional T2* values with biomechanical properties and histologic appearance of the discal tissues. A cadaveric human TMJ was sliced sagittally and imaged by conventional and UTE MRI techniques. The slices were then subjected to either biomechanical indentation testing or histologic evaluation, and linear regression was used for comparison to T2* maps obtained from UTE MRI data. Feasibility of in vivo UTE MRI was assessed in two human volunteers. The UTE MRI technique of the specimens provided images of the TMJ disc with greater signal-to-noise ratio (~3 fold) and contrast against surrounding tissues than conventional techniques. Higher T2* values correlated with lower indentation stiffness (softer) and less collagen organization as indicated by polarized light microscopy. T2* values were also obtained from the volunteers. UTE MRI facilitates quantitative characterization of TMJ discs, which may reflect structural and functional properties related to TMJ dysfunction.

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