Ankara, Turkey
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Bozbas S.S.,Baskent University | Bozbas H.,Guven Hospital
World Journal of Gastroenterology | Year: 2016

Pulmonary vascular disorders including portopulmonary hypertension (PoPHT) are among the common complications of liver disease and are prognostically significant. Survival is very low without medical treatment and liver transplantation. With advances in medical therapy for elevated pulmonary artery pressure (PAP) and liver transplant surgery, survival of patients with PoPHT and advanced liver disease is significantly improved. Because of the prognostic significance of PoPHT and the limited donor pool, a comprehensive preoperative cardio-pulmonary assessment is of great importance in cirrhotic patients prior to transplant surgery. Therefore, a detailed transthoracic Doppler echocardiographic examination must be an essential component of this evaluation. Patients with mild PoPHT can safely undergo liver transplant surgery. In cases of moderate to severe PoPHT, right heart catheterization (RHC) should be performed. In patients with moderate to severe PoPHT on RHC (mean PAP 35-45 mmHg), vasodilator therapy should be attempted. Liver transplantation should be encouraged in cases that demonstrate a positive response. Bridging therapy with specific pulmonary arterial hypertension treatment agents should be considered until the transplant surgery and should be continued during the peri-and post-operative periods as needed. © The Author(s) 2016.


Tuna V.,Nizip Government Hospital | Alkis I.,Medical Park Hospital | Safiye A.S.,Guven Hospital | Imamoglu N.,Hayat Hospital | And 2 more authors.
Australian and New Zealand Journal of Obstetrics and Gynaecology | Year: 2010

In this study, comparing four different parameters in women with surgical menopause because of ovariectomy in reproductive age and in women with natural menopause, the effect of withdrawal of ovarian hormones on both groups was investigated. The patient groups in this study were constituted of 100 women in reproductive age who had undergone total abdominal hysterectomy + bilateral salpingo-oophorectomy and 50 women with natural menopause referred to out-patient's clinic within the same period. The findings for four different parameters were recorded one day before the surgery and at 3rd month post-operatively in surgical menopause group and at the day of referral to outpatient clinic in natural menopause group. The parameters planned to be recorded were blood lipid profile, thrombotic system, arterial elasticity and psychosexual variations. Post-operative high-density lipoprotein level in surgical menopause group was found lower than that of natural menopause group (47.08 vs 52.44 mg/dL, P < 0.05). Post-operative very low density lipoprotein level in surgical menopause group was increased more than that in natural menopause group (27.74 vs 23.58 mg/dL, P < 0.05). An increase was observed in post-operative carotid artery Pulsality Index and Resistive Index levels of surgical menopause group compared with natural menopause group (1.44 vs 1.33, P < 0.001 and 0.73 vs 0.68, P < 0.001 respectively). In surgical menopause group, the differences between pre- and post-operative values of bleeding time (1.15 vs 1.24, P < 0.0001), clotting time (5.9 vs 6.08, P < 0.0001) and fibrinogen level (422 vs 395, P < 0.0001) were found statistically significant. While bleeding time and clotting time were increased post-operatively, fibrinogen level was decreased. A significant increase was observed in post-operative mean Kupperman Index levels of surgical menopause group compared with that of natural menopause group (23.89 vs 9.94, P < 0.001). It was concluded that the ovaries should be considered as important organs impacting women's quality of life with their hormones produced also in the period of menopause; that disadvantages of oophorectomy during hysterectomy should be considered and that an attempt to conserve ovaries during surgery except pre-cancerous events would benefit women. © 2010 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.


Arpaci E.,Sakarya University | Tokluoglu S.,Guven Hospital | Yetigyigit T.,Namik Kemal University | Alkis N.,Ankara Oncology Training and Research Hospital
Asian Pacific Journal of Cancer Prevention | Year: 2013

Background: A literature review on 1,104,269 cancer patients concluded that the prevalence of multiple primary malignancies (MPM) is between 0.73% and 11.7%. MPMs seem to have higher incidence than that influenced by hazard only. The purpose of this study was to investigate clinically useful information for effective screening for synchronous and metachronous second primary cancers and to identify a potential surveillance protocol. Materials and Methods: Using statistical and epidemiological indicators we evaluated the patients with MPMs (double locations) admitted to Dr. Abdurrahman Yurtarslan Ankara Oncology Education and Research Hospital between 1981 and 2010. Results: Out of the 130 cases, 24 (18.4%) were synchronous while 106 cases (81.6%) were metachronous tumours. Mean interval time from first to second primary cancers was 4.65 years (0-27 years). The most frequent malignant associations were breast-breast, breast-endometrium and breast-ovary. Both primary and secondary tumors tended to be in an advanced stage explained by the low compliance of the patients to follow-up. Conclusions: The possibility that MPMs exist must always be considered during pretreatment evaluation. Screening procedures are especially useful for the early detection of associated tumors, whereas careful monitoring of patients treated for primary cancer and a good communication between patients and medical care teams should ensure early detection of secondary tumors, and subsequent appropriate management.


Ertek S.,Ufuk University | Cicero A.F.,University of Bologna | Cesur M.,Guven Hospital | Akcil M.,Baskent University | And 3 more authors.
Acta Diabetologica | Year: 2011

Our aim in this study was to evaluate the relationship between metabolic syndrome (MS) as defined by different criteria and the severity of coronary lesions in a sample of diabetic and non-diabetic patients undergoing elective coronary angiography. All patients had blood and urine tests, physical examinations were performed before angiography, and finally they were classified based on three criteria (World Health Organisation-WHO, Adult Treatment Panel-ATP III and International Diabetes Federation-IDF). Eighty-eight patients were diabetic, and 96 patients were non-diabetic. Among all patients, diabetics had significantly higher Gensini scores (P < 0.001). According to WHO criteria (P = 0.005) and IDF criteria (P = 0.015) metabolic syndrome patients had higher Gensini scores, but for ATP III criteria difference was not significant. When we evaluated diabetics and non-diabetics separately, non-diabetic patients with MS had significantly higher scores with WHO definition (P = 0.015) and mildly higher but not significant values with other MS criteria (P = 0.057 for both IDF and ATP III). Neither any one of MS components nor gender revealed significant relationship with coronary disease severity. In our study with a cohort of Turkish patients undergoing elective coronary angiography; we concluded that MS should be taken into consideration, especially in non-diabetic patients. © 2010 Springer-Verlag.


Randall J.,Patient and Health Professional Services | Keven K.,Ankara University | Atli T.,Guven Hospital | Ustun C.,University of Minnesota
Bone Marrow Transplantation | Year: 2016

Allogeneic hematopoietic cell transplantation (alloHCT) may be the only curative option for some older adults with hematologic malignancies, and its associated risks of significant morbidity and mortality warrant a clear, informed decision-making process. As older adults have not been transplanted routinely until recent years, younger people have been the prototypical group around whom the current process has developed. Yet, this process is applied to older adults who have different considerations than younger patients when making their transplant decision. Older adults do not have the open-ended lives of younger patients and are entitled to consider how to spend their remaining time. They also possess maturity and experience, and with proper knowledge, they can make informed choices rather than moving forward in the transplant process unaware. Notably, older patients face similar problems with the informed decision-making process in nephrology. Strategies such as providing education about alloHCT gradually and repeatedly during induction, presenting recent knowledge from the literature in plain language, and utilizing a team approach to patient education may help older adults make the best decision about transplant in light of their situation and values. Understanding when and how older adults decide on alloHCT is an important first step to further exploring this problem. © 2016 Macmillan Publishers Limited.


Uzun M.,Cag Medical Center | Akkan K.,Cag Medical Center | Coskun B.,Guven Hospital
Diagnostic and Interventional Radiology | Year: 2010

Round ligament varicosities are easily misdiagnosed as an obstructed hernia in a gravid patient. When this condition is diagnosed correctly, unnecessary intervention may be prevented. We aimed to determine the significance of round ligament varicosities in pregnancy and to describe their clinical presentation and sonographic appearance. © Turkish Society of Radiology 2010.


Cekin A.H.,Antalya Training and Research Hospital | GuR G.,Medicana International Ankara Hospital | Turkoglu S.,Ankara University | Aldemir D.,Ankara University | And 4 more authors.
Turkish Journal of Gastroenterology | Year: 2013

Background/aims: Ischemia-reperfusion injury may occur during liver transplantation and remains a serious concern in clinical practice. This study was designed to study the potential benefit of L-carnitine on experimental warm hepatic ischemia-reperfusion injury in rats. Materials and Methods: Forty-five male Wistar Albino rats were divided into three groups; Group 1 sham-operation without ischemia-reperfusion (n=15); Group 2, ischemia-reperfusion (n=15); and Group 3, which was administered L-carnitine (200 mg/kg, intraperitoneal, for 4 days) prior to ischemia-reperfusion (n=15). The study animals were then sacrificed to obtain hepatic tissue and serum samples. Tissue levels of malondialdehyde and reduced glutathione and serum levels for aspartate aminotransferase, alanine aminotransferase and lactate dehydrogenase were assessed. Results: Mean aspartate aminotransferase levels were significantly higher in Group 2 (405.2 U/L) when compared to Groups 1 (137.1 U/L) and 3 (267.6 U/L). Mean alanine aminotransferase levels were significantly higher in Group 2 (257.1 U/L) when compared to Groups 1 (37.2 U/L), and 3 (118.1 U/L) (p<0.001 for each). Mean lactate dehydrogenase levels were significantly higher in Group 2 (2943.8 U/L) when compared to Groups 1 (1496.5 U/L), and 3 (2185.3U/L) (p<0.001 for each). Mean malondialdehyde levels were significantly higher in Group 2 (54.3 nmol/g) compared to Groups 1 (41.0 nmol/g) and 3 (42.1 nmol/g) (p<0.001 for each). Mean reduced glutathione levels were significantly lower in Group 2 (5.9 nmol/mg) and Group 3 (7.4 nmol/mg) compared to Group 1 (9.1 nmol/mg) (p<0.001 for each). Conclusions: In conclusion, our data supports a protective effect of L-carnitine against oxidative damage in hepatic ischemia-reperfusion injury in rats. This is evidenced by improvement of the antioxidant defense system and lipid peroxidation levels.


Han S.,Guven Hospital
Chirurgia | Year: 2010

Various pathologies leading to dyspnea have been described. There is limited information on dyspnea associated with pathology of the xiphoid process. In this pathology, malposition or chondritis may develop due to trauma or abdominal obesity. All of these may lead to sensitivity and/or pain in the xiphoid area of the patient, which results in difficulty in breathing deeply and discomfort in breathing. Dyspnea is more pronounced during physical activity. Four patients with dyspnea associated with xiphoid pathologies were evaluated in our clinic. In these patients, xiphoid resection was performed. In early postoperative period and afterwards, the conditions of the patients significantly improved. Here, the patients with dyspnea associated with xiphoid pathologies whose conditions improved after surgery have been presented.


Sari T.,Ankara Nuclear Research And Training Center | Tulek N.,Ankara Nuclear Research And Training Center | Bulut C.,Ankara Nuclear Research And Training Center | Oral B.,Guven Hospital | Tuncer Ertem G.,Ankara Nuclear Research And Training Center
Travel Medicine and Infectious Disease | Year: 2014

Objective Due to lack of effective treatment for rabies, post-exposure prophylaxis becomes very important. In this study, we investigated side effects developed in patients following administration of rabies post-exposure prophylaxis.Methods A total of 1685 patients were vaccinated. 265 patients (15.7%) administered the Essen regimen with equine rabies immunoglobulin and 1420 patients (84.2%) administered Zagreb regimen. 761 (45.2%) patients were vaccinated with a verocell vaccine; Verorab and 924 patients (54.8%) were vaccinated with Abhayrab.Results All side effects were higher in female patients than those of males. The patients with chronic illness also had significantly, increased side effects; headache (12.4%), pain at site of administration (11.3%), and arthralgia (10.5%) compared to the patients without chronic illness. We grouped the patients in three as; 0-15years, 15-60 years, and 60 years and above. In the first group; fever (21.2%), vomiting (2.4%) and coughing (2.1%); in the second group (15-60 years), headache (8.8%), arthralgia (6.7%) were significantly increased compared to the other groups. Side effects are significantly higher with schema of 2-1-1 and Abhayrab trade mark vaccine, particularly following the first doses. Discussion Second generation rabies vaccines are safe, effective and cheaper than HDCV. When fatality of rabies disease is considered, occurring side effects can be tolerated. © 2014 Elsevier Ltd.


Cekmen N.,Guven Hospital | Aydimathn A.,Guven Hospital | Erdemli O.,Guven Hospital
e-SPEN | Year: 2011

Background & aims: Glutamine supplementation has beneficial effects on morbidity and mortality in critically ill patients. We investigated the effect of L-alanyl-L-glutamine dipeptide supplemented TPN on biochemical parameters, length of stay (LOS) and mortality in 30 critically patients. Methods: Randomized, prospective, controlled, double-blind study in general intensive care ünit (ICU) in Guven hospital, Turkey. 30 patients admitted to the ICU and requiring TPN for more than 5 days. The patients were randomized and analyzed in two groups; Patients received either Gln-supplemented TPN (containing L-alanyl-L-glutamine dipeptide; 0.5 g/kg per day; n = 15) or standart Gln-free TPN (control group n = 15). Demographics, time of TPN, APACHE II score, type of diagnosis, biochemistry, nutritional, immune parameters, ICU LOS, ICU mortality, and in-hospital mortality were analyzed and compared. Results: There were no difference between groups according to the demographics, APACHE II score, the duration of TPN, diagnosis, the biochemistry except albumin, nutritional and inflammatory parameters, ICU LOS, ICU mortality, and in-hospital mortality. After 2 weeks of treatment, in Gln-supplemented TPN group exhibited significant increases in serum albumin levels (P = 0.006). Conclusion: We found no biochemical and clinical difference between the two groups. Much trials will be necessary to identify a difference in our patient population. © 2011.

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