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Stavileci B.,Istanbul University | Cimci M.,Istanbul University | Ikitimur B.,Istanbul University | Barman H.A.,Istanbul University | And 3 more authors.
Annals of Noninvasive Electrocardiology | Year: 2014

Background The presence of notched R or S waves without accompanying typical bundle branch blocks, or the existence of an additional wave like RSR' pattern in the original QRS complex (with a duration of <120 ms) has been defined as narrow QRS fragmentation. Persistence of the fQRS found on the admission electrocardiogram (ECG) in patients with acute ST segment elevation myocardial infarction (STEMI) will have prognostic significance in the short term. Methods The study was carried out using retrospectively collected data of 296 consecutive patients diagnosed as acute STEMI.fQRS group had fQRS both in admission and latest ECGs (n = 80, 27%), and non-fQRS group had no fQRS in last ECG (n = 216, 73%). Primary end points were in-hospital cardiovascular mortality, hemodynamic instability, and electrical instability. Results MI localization, symptom duration, reperfusion therapy (RPT) rate, RPT modality, rate of successful reperfusion did not differ. Mean ejection fraction was lower and all end points were more frequent in the fQRS group. Irrespective of the RPT modality and success of RPT, mortality rate was higher in patients with persistent fQRS. GRACE score >120 points (OR = 4.765), age >70 years (OR = 4.041), anterior MI localization (OR = 3.148), and presence of fQRS (OR = 2.484) were significant predictors of primary end points. fQRS increased the predictive ability of GRACE score >120 about two folds (OR = 7.305, P < 0.001). Conclusion Persistent fQRS on ECG is associated with poor prognosis and there is a lack of expected mortality benefit of RPT, particularly that of fibrinolytic therapy, in STEMI patients with fQRS. © 2014 Wiley Periodicals, Inc.

Asim K.,Recep Tayyip Erdogan University | Gokhan E.,Recep Tayyip Erdogan University | Ozlem B.,Recep Tayyip Erdogan University | Ozcan Y.,Recep Tayyip Erdogan University | And 4 more authors.
American Journal of Emergency Medicine | Year: 2014

Aim We assessed out-of-hospital cardiac arrest patients' cerebral oxygenation during cardiopulmonary resuscitation (CPR) using near infrared spectrophotometry (NIRS). We evaluated the relation between a rise in patients' cerebral saturation values between the start and end of CPR and return of spontaneous circulation. Materials and methods Twenty-three patients with unwitnessed out-of-hospital cardiac arrest and brought to our emergency department by emergency ambulance were evaluated. Cerebral saturations from time of start of CPR were measured using NIRS. CPR was performed for a maximum of 30 min. The relation between cerebral saturations in patients with or without return of spontaneous circulation was then evaluated. Results Twenty-three patients, 12 (52.2%) female and 11 (47.8%) male, with a mean age of 64.09 ± 13.66 were included. A correlation was determined between a rise in cerebral saturation measured throughout CPR and the return of spontaneous circulation (P <.001). Conclusion Patients whose cerebral saturation values measured with NIRS rise during CPR have a higher post-resuscitation survival rate. Monitoring of patients during CPR with this non-invasive technique may be a good method for predicting return of spontaneous circulation. © 2013 Elsevier Inc.

Doventas A.,Istanbul Education and Research Hospital | Bilici A.,Dr Lutfi Kirdar Kartal Education And Research Hospital | Demirelli F.,Istanbul University | Ersoy G.,Istanbul University | And 2 more authors.
Hepato-Gastroenterology | Year: 2012

Background/Aims: The aim of the study is to evaluate the correlation between c-erb-B2 and CD44 overexpression and survival of patients with gastric cancer. Methodology: The paraffin blocks of 48 patients with gastric carcinoma were retrospectively analyzed. The pathological specimens were stained with CD44 and c-erb-B2 by immunohistochemical methods. Results: The positivity of c-erb-B2 was detected in 9 patients. In six of them, predominantly strong cytoplasmic staining was observed. The remaining three tumors were predominantly membranous stained. No correlation was found between the c-erb-B2 positivity and overall survival (OS). Seventeen specimens (35.4%) were CD44 positive, all localized in cell membrane. The median OS time of CD44 positive patients was worse than that of patients with CD44 negative (11 vs. 17 months, respectively). This difference was statistically significant 0=0.03). In 5 patients both CD44 and c-erb-B2 were detected as positive. However, there were 23 patients with both CD44 negative and c-erb-B2 negative. The median OS time for patients with both CD44 and c-erb-B2 negative was better than those of patients with both CD44 and c-erb-B2 positive (37 vs. 11 months, respectively, p=0.03). The relationship between CD44 and c-erb-B2 positivities and clinicopathological factors (p>0.05). Conclusions: Our results showed that there was no correlation between c-erb-B2 positivity and OS, except for CD44. In addition, we found significant association of simultaneous positivities of c-erb-B2 and CD44 with OS of patients with gastric cancer. CD44 alone can be taken as a prognostic factor and also simultaneous overexpression of CD44 and c-erb-B2 may be used as a marker of poor prognosis. © H.G.E. Update Medical Publishing S.A.

Arikan S.,Istanbul Education and Research Hospital | Kocakusak A.,Haseki Education and Research Hospital
Acta Medica Portuguesa | Year: 2015

Introduction and Aim: Retained intracorporeal textile products (gossypiboma-textiloma) are undesired and accidental surgical results for both patients and surgeons, which are underreported because of medicolegal remifications. Fourteen textiloma cases, who had been treated or whose treatment procedures had been followed-up personally by two general surgeons in a period of 27 years almost during their whole professional lives were presented to describe and define the clinical and pathological characteristics. Material and Methods: Patient characteristics including gender and age, areas of location within the body, time intervals until diagnosis, clinical presentations and complaints, treatment modalities, complications, causative surgical interventions, and diagnostic approaches were retrospectively evaluated. Results: Nine female and five male patients with a mean age of 43.07 ± 15.23 (median: 45) years at diagnosis were enrolled in the study. Cesarean section in three, inguinal hernioraphy in four, explorative laparotomy because of acute abdomen in one, sigmoid colon resection in one, appendectomy and right salpingoophorectomy in one, etrangulated incisional hernia after a previous surgical intervention because of an ovarian mass in one, thyroidectomy in one, epigastric hernioraphy in one, and bilateral segmental mastectomy with bilateral axillary sentinal lymph node dissection in one were the causative surgical interventions. Locations of textilomas were the abdominal cavity in seven, inguinal surgical wound in four, epigastric surgical wound in one, thyroidectomy lodge in one, and bilateral axillary cavities in one patient. The mean time interval until diagnosis was 14.48 (median: 5.5) months. Dıscussıon: Earlier recognition of foreign bodies can provide a better outcome. Conclusion: Gossypibomas are preventable iatrogenic faults which create severe problems. Strict adherence to the rules of the operation room is a must to keep the tip of the iceberg shut in the Pandora’s box. © Ordem dos Médicos 2015.

Api M.,Haseki Education and Research Hospital | Api O.,Dr Lutfi Kirdar Kartal Education And Research Hospital
Gynecological Endocrinology | Year: 2010

Objective. To report the successful treatment of an advanced interstitial ectopic pregnancy via laparoscopic cornuotomy following treatment failure with methotrexate (MTX). Case. A 28-year-old, gravida 3, para 0 woman with a history of successfully treated tubal pregnancy with medical therapy 2 years ago, presented with spotting bleeding and lower abdominal pain. Her initial beta-hCG level was 11706 mIU/ml and the transvaginal ultrasound examination showed an empty uterine cavity with a gestational sac 8×10×9 mm in diameter having no fetal pole or yolk sac, located just adjacent to the left uterine cornual region. She was introduced 50 mg of systemic MTX with the presumed diagnosis of interstitial pregnancy. Because the serum beta-hCG level raised to 18654 mIU/ml and a fetal pole with cardiac activity emerged on the ultrasound on the fourth day after MTX injection, laparoscopy was planned. The interstitial pregnancy was successfully treated via laparoscopic cornuotomy with the preservation of the uterus. Conclusion. In advanced interstitial pregnancies with high hCG levels, systemic MTX therapy is expected to be ineffective. Laparoscopic cornuotomy is a minimally invasive and effective method of treatment with the advantage of preserving future fertility. © 2010 Informa UK Ltd.

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