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Birkent H.,Gulhane Military Medical School | Sardesai M.,University of Washington | Hu A.,University of Washington | Merati A.L.,University of Washington
Laryngoscope | Year: 2013

Objectives/Hypothesis In-office percutaneous injection laryngoplasty is a common treatment for glottal insufficiency. Our objective was to prospectively study voice outcomes and patient tolerance of the procedure. Study Design Prospective case series. Methods Consecutive adult patients undergoing awake injection laryngoplasty were recruited. Voice Handicap Index (VHI)-30; Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V); and vocal Grade, Roughness, Breathiness, Asthenia and Strain (GRBAS) were evaluated prior to injection and 2 months postinjection. Visual analog scale (VAS) was completed by the patient before and after the procedure to quantify the amount of discomfort. Results Thirty-five subjects enrolled; 26 (15 male, 11 female; mean age 61.6±13.2 years) had complete data. All components of VHI improved significantly: functional (P=0.0006), emotional (P=0.0004), physical (P=0.009), and total (P=0.0006). CAPE-V also improved significantly (P=0.003). All components of GRBAS, except for roughness, improved significantly: grade (P=0.004), roughness (P=0.718), breathiness (P=0.023), asthenia (P=0.023), and strain (P=0.03). Patient expectations on the tolerance of the procedure was similar to what they reported immediately afterward (P=0.803). Conclusions Injection laryngoplasty is an effective method of treating glottal insufficiency, as measured by voice outcomes. Patients have realistic expectations on the procedure experience and find it tolerable. This is the first prospective study of injection laryngoplasty outcomes. Level of Evidence 4. Laryngoscope, 2013 Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Yetkin S.,Diyarbakir Military Hospital | Aydin H.,Sleep Diary Sleep Research Center | Ozgen F.,Gulhane Military Medical School
Psychiatry and Clinical Neurosciences | Year: 2010

Aims: The purpose of the present study was to investigate sleep structure in post-traumatic stress disorder (PTSD) patients with and without any psychiatric comorbidities. The relationship between sleep variables and measurements of clinical symptom severity were also investigated. Methods: Sleep patterns of 24 non-medicated male PTSD patients and 16 age- and sex-matched normal controls were investigated on polysomnography on two consecutive nights. Six PTSD-only patients and 15 PTSD patients with major depressive disorder (MDD) were also compared to normal controls. Sleep variables were correlated with PTSD symptoms. Results: Compared to the normal controls, the PTSD patients with MDD had difficulty initiating sleep, poor sleep efficiency, decreased total sleep time, decreased slow wave sleep (SWS), and a reduced rapid eye movement (REM) sleep latency. The PTSD patients without any comorbid psychiatric disorders had moderately significant disturbances of sleep continuity, and decreased SWS, but no abnormalities of REM sleep. REM sleep latency was inversely proportional to the severity of startle response. SWS was found to be inversely correlated with the severity of psychogenic amnesia. Conclusions: PTSD patients have disturbance of sleep continuity, and SWS deficit, without the impact of comorbid depression on sleep. The relationship between SWS and the inability to recall an important aspect of trauma may indicate the role of sleep in the consolidation of traumatic memories. The relationship between the severity of the startle response and REM latency may suggest that REM sleep physiology shares common substrates with the symptoms of PTSD. © 2010 Japanese Society of Psychiatry and Neurology.

Ertugrul S.,GATA Haydarpasa Training Hospital | Gun I.,GATA Haydarpasa Training Hospital | Mungen E.,GATA Haydarpasa Training Hospital | Muhcu M.,GATA Haydarpasa Training Hospital | And 2 more authors.
Journal of Obstetrics and Gynaecology Research | Year: 2013

Aim: Our aim is to evaluate the association between gestational age at delivery and neonatal outcomes in elective cesarean delivery. Material and Methods: A total of 1784 viable singleton pregnancies that were delivered by elective caesarean section at term were included in the study. All pregnancies were categorized according to the number of completed weeks of gestation (37+0-6, 38+0-6, 39+0-6 and ≥40+0 weeks). In this study, the patient groups compared in terms of demographic characteristics and neonatal outcomes. Results: The rates of the neonatal intensive care unit admission were 8.7%. When maternal and neonatal characteristics were statistically analyzed, the incidence of advanced maternal age and previous cesarean delivery increased as gestational age at delivery decreased; the incidence of nuchal cord and delivering a baby of ≥4000 g at birth increased as gestational age at delivery increased.As compared with deliveries at 39 weeks, cesarean delivery at 37 weeks of gestation had significantly higher risk, including that of neonatal intensive care unit admission, transient tachypnea of the newborn after delivery and O2 support. There was one perinatal death observed in the study. Conclusions: According to the results of our study, compared to elective cesarean delivery after 37 weeks of gestation, elective cesarean delivery at 37 weeks of gestation was associated with a statistically significant increase in neonatal mortality. Therefore, elective cesarean delivery should not be performed at 37 weeks of gestation and 39 weeks of gestation appears to be the ideal timing for elective cesarean delivery. © 2012 The Authors.

Battal B.,Gulhane Military Medical School | Akgun V.,Golcuk Military Hospital | Kocaoglu M.,Gulhane Military Medical School
Diagnostic and Interventional Radiology | Year: 2012

Diffusion-weighted imaging has recently been incorporated into extra-neurological pediatric imaging protocols because of its various clinical advantages. Because diffusion-weighted imaging does not require intravenous contrast media, it can be safely used in patients with reduced renal function. Furthermore, diffusion-weighted imaging can be performed within several minutes by using the echo planar imaging technique. Its clinical advantages include improved tissue characterization, as well as the ability to assess organ functionality, monitor the treatment response after chemotherapy or radiation therapy and predict patient outcomes. The aims of this pictorial essay were to explain the physical principles underlying diffusion-weighted imaging, to outline the interpretation of diffusion-weighted images and apparent diffusion coefficient maps, and to list the extra-neurological applications of diffusion- weighted imaging in children. © Turkish Society of Radiology 2012.

Battal B.,Gulhane Military Medical School | Kocaoglu M.,Gulhane Military Medical School | Bulakbasi N.,Gulhane Military Medical School | Husmen G.,Edremit Military Hospital | And 2 more authors.
British Journal of Radiology | Year: 2011

Cerebrospinal fluid (CSF) spaces include ventricles and cerebral and spinal subarachnoid spaces. CSF motion is a combined effect of CSF production rate and superimposed cardiac pulsations. Knowledge of CSF dynamics has benefited considerably from the development of phase-contrast (PC) MRI. There are several disorders such as communicating and non-communicating hydrocephalus, Chiari malformation, syringomyelic cyst and arachnoid cyst that can change the CSF dynamics. The aims of this pictorial review are to outline the PC MRI technique, CSF physiology and cerebrospinal space anatomy, to describe a group of congenital and acquired disorders that can alter the CSF dynamics, and to assess the use of PC MRI in the assessment of various central nervous system abnormalities. © 2011 The British Institute of Radiology.

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