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Cakir E.,Bezmialem Foundation University | Buyukpinarbasili N.,Bezmialem Foundation University | Ziyade S.,Bezmialem Foundation University | Selcuk-Duru H.N.,Haseki Educational and Research Hospital | And 2 more authors.
Pediatric Pulmonology | Year: 2013

Pulmonary nocardiosis is a rare infection and overwhelmingly limited to immunocompromised individuals. Endobronchial nocardiosis is even more rare. Nocardiosis is rarely seen in immunocompetent hosts mostly as cutaneous infection. Here we report an immunocompetent child with endobronchial nocardiosis presenting as nonresolving pneumonia and lung abscess. To our knowledge, this is the first case reported in the literature of endobronchial nocardiosis in a child. Pediatr Pulmonol. 2013; 48:1144-1147. © 2012 Wiley Periodicals, Inc. © 2012 Wiley Periodicals, Inc.


Kotil K.,Istanbul Educational and Research Hospital | Akcetin M.A.,Haseki Educational and Research Hospital | Savas Y.,Istanbul Educational and Research Hospital
Journal of Clinical Neuroscience | Year: 2012

We rarely use the cervical transpedicular fixation (CPF) technique in the neurosurgery departments of the authors' institutions because the pedicle is thin and there is a risk of neurovascular damage. In this study we investigated postoperative neurovascular injury caused by the transpedicular screws of 210 pedicles in 45 patients on whom we performed CPF for various cervical pathologies. Fixation was performed between C3 and C7, and the iliac crest and lamina were used as autografts for fusion. In 205 of 210 pedicles (97.6%), the screws were in the correct position, while a non-critical lateral orientation was detected in three pedicles (1.4%). Two screws (one in each of two patients) were positioned inappropriately (0.9%, Grade 3), unilaterally and directly in the vertebral foramen, as shown on postoperative CT scans; blood circulation was normal on angiography. The fusion rate was 100%. The average screw length used for C3 to C7 was 32 mm. The patients were followed up for an average of 35.7 months (range: 17-60 months). There was no morbidity or mortality in our study. We concluded that CPF provides very strong cervical spine fixation but also carries a risk of pedicle perforation without neurovascular injury. However, a free-hand technique performed by an experienced surgeon is acceptable for CPF for various cervical pathologies. © 2011 Elsevier Ltd. All rights reserved.


Kotil K.,Istanbul Educational and Research Hospital | Savas Y.,Haseki Educational and Research Hospital
Journal of Spinal Disorders and Techniques | Year: 2013

STUDY DESIGN:: Prospective cohort data by merging data from comparative studies. OBJECTIVE:: This study aimed to compare clinical and radiologic outcomes of the transforaminal lumbar interbody fusion (TLIF) procedure with or without pedicle screw support in stable patients with a degenerative disease. SUMMARY OF BACKGROUND DATA:: The unilateral lumbar interbody fusion technique has gained popularity in the management of many lumbar degenerative conditions requiring fusion. TLIF is routinely performed with the support of pedicle screws. The use of the TLIF procedure without pedicle screw support has not yet been reported. METHODS:: Between February 2006 and May 2009, surgical decompression and fusion was performed in patients with lumbar degenerative conditions using the TLIF technique either with (n=30, group A) or without pedicle screw support (n=30, group B). The 2 groups had similar age, sex distribution, pain level, and pain history. In this prospective study, patients were followed for a mean period of 31 months (range, 22 to 38 mo). The mean age was 45.5 years (range, 29 to 78 y), and all patients had a disease involving a single intervertebral space. RESULTS:: The female to male ratio was 19:11 and 18:12 in groups A and B, respectively. Pain and function were evaluated by the Oswestry disability index and visual analog scale. Pseudoarthrosis developed in 2 patients from group A and in 3 patients from group B. Although these 5 patients had insufficient fusion, they did show a clinical improvement. The mean duration of the operation was 110 and 73 minutes in groups A and B, respectively. The mean total amount of bleeding was 410 and 220 mL in groups A and B, respectively. Cage loosening did not occur in group A, but 1 patient in group B developed asymptomatic cage loosening limited to the endplates. Four patients in group A suffered sciatic pain because of the malposition of the screw, and 1 patient in group B had contralateral sciatic pain lasting for 2 months. The visual analog scale and Oswestry disability index scores were higher in group A than in group B 1 month after the operation (P<0.005), but the groups did not significantly differ at 3 months (P<0.89). The cost of the procedure was 3-fold higher in group A compared with group B. CONCLUSIONS:: This study showed that the TLIF procedure without pedicle screw support would be sufficient in the management of preoperatively stable patients with lumbar degenerative spinal disease requiring fusion after single-level decompression. This technique is minimally invasive, requires only unilateral intervention, allows magnetic resonance imaging during the postoperative period and is associated with less costs and complications when compared with pedicle screwing. This study represents the first prospective comparative report on this technique showing several of its advantages. © 2012 Lippincott Williams and Wilkins.


Civilibal M.,Haseki Educational and Research Hospital | Selcuk Duru N.,Haseki Educational and Research Hospital | Elevli M.,Haseki Educational and Research Hospital | Civilibal N.,Istanbul University
Journal of Pediatric Urology | Year: 2014

Objective The aim of this study was to measure the 24 h urinary calcium content in children with monosymptomatic nocturnal enuresis (MNE) and compare with those in healthy children to investigate whether there is any relation with enuresis and hypercalciuria. Material and methods This study included 120 children and adolescents with MNE aged between 7 and 14 years. Eighty age- and sex-matched healthy children served as a control group. To determine urinary calcium excretion, 24 h urine samples were collected. The children with enuresis were divided into two sub-groups as hypercalciuric and normocalciuric groups according to the amount of urinary calcium excretion. Results Hypercalciuria was found in 27 (23%) of the MNE patients compared with two (4%) of continent children (p < 0.001). In addition, the mean 24 h urine calcium/body weight ratio was higher in the enuresis group than in the control group, 2.94 ± 2.42 versus 1.59 ± 1.72, respectively (p = 0.002). When the children with enuresis were divided into two groups as normokalsiuric and hypercalciuric, the hypercalciuric children were younger and the majority of this group were boys. Conclusions Our study showed that hypercalciuria is common in children with MNE, so we suggested measuring urine calcium levels in NE patients. However, further studies are needed to clarify the relationship between hypercalciuria and NE in larger series. © 2014 Journal of Pediatric Urology Company.


Verim A.,Haydarpasa Numune Educational and Research Hospital | Duymus R.,SisliEtfal Educational and Research Hospital | Karaca C.T.,Haydarpasa Numune Educational and Research Hospital | Ozkul M.H.,Haseki Educational and Research Hospital | And 3 more authors.
Otolaryngology - Head and Neck Surgery (United States) | Year: 2013

Objectives. To investigate the causes of columellar scar formation in a Turkish population in relation to nasal skin thickness, texture, and type and discuss possible solutions for better results. Study Design. Prospective, clinical study. Setting. Otorhinolaryngology department of a tertiary hospital. Methods. The preoperative dermal thickness of 50 consecutive patients undergoing "external approach" septorhinoplasty was measured (using a 14 MHz ultrasound probe) at the midportion of the right and left nostril, tip, supratip, and columella. Surgery was performed using a middle columellar gullwing incision. All patients had a minimum follow-up of 6 months after surgery. Assessment of the columellar scar was performed according to the Stony Brook Scar Evaluation Scale modified for columellar scars. The mean values of skin thickness measurements, skin type (according to the Fitzpatrick skin classification scale), skin texture (oily, combination, normal, dry, and sensitive types), smoking habit, and patient gender were recorded and compared with the columellar incision scar scores. Results. There was no statistically significant difference in healing between the skin thickness of the tip, supratip, left nostril, right nostril, columella and mean skin thickness values, skin types (Fitzpatrick 2, 3, 4, 5), skin textures, and smoking with regard to columellar scar formation (P >.05). However, men healed significantly better than women (P<.05). Conclusions. The columellar incision heals independently of the influence of skin thickness; texture; Fitzpatrick skin types 2, 3, 4, and 5; and smoking. Male gender seems to be a significant factor in healing. © 2013 American Academy of Otolaryngology - Head and Neck Surgery Foundation.

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