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Apuhan T.,Abant Izzet Baysal University | Yildirim Y.S.,Haseki Research and Training Hospital | Aksoy F.,Bezmialem Foundation University | Borcin O.,Haseki Research and Training Hospital | Ozturan O.,Bezmialem Foundation University
International Journal of Pediatric Otorhinolaryngology | Year: 2011

Objective: To compare the effects of, volatile anesthetics, desflurane and sevoflurane on intra-operative and postoperative bleeding in patients who underwent tonsillectomy and adenoidectomy. Material and method: Totally 40 children (14 girl and 26 boys) aged between 2 and 16. years were included in this prospective randomized double-blind clinical trial. The patients underwent conventional cold tonsillectomy and curettage adenoidectomy under general anesthesia. For the maintenance of anesthesia, the patients were randomized into two groups; desflurane group and sevoflurane group, each including 20 subjects. Desflurane concentration was set between 4% and 6% (0.7-0.9 MAC), whereas sevoflurane concentration was set between 2% and 2.5% (0.7-0.9 MAC). The amount of perioperative bleeding in milliliters was measured by using separate aspirator bags for each patient. Results: Desflurane caused significantly lower amount of perioperative bleeding compared to sevoflurane (p= 0.03). No significant difference was observed between the two groups in terms of age, body mass index and operation duration, respectively (p= 0.20, p= 0.49, p= 0.07). Conclusion: Desflurane, which is one of the volatile anesthetics, leads to a lower amount of intraoperative bleeding than sevoflurane during tonsillectomy and adenoidectomy operations. © 2011 Elsevier Ireland Ltd.


Apuhan T.,Abant Izzet Baysal University | Yildirim Y.S.,Haseki Research and Training Hospital | Ozaslan H.,Hisar Intercontinental Hospital
International Journal of Pediatric Otorhinolaryngology | Year: 2011

Objective: The aim of this study was to investigate the developmental relationship between adenoid tissue volume and mastoid air cell volume, using a 3D reconstruction technique. Study design: Cross-sectional retrospective study. Subjects and methods: Multislice computed tomography (MSCT) images were obtained using three-dimensional (3D) reconstruction and volume-rendering techniques (VRT). The subjects were 63 boys and 37 girls, 3-16 years of age. The volumes of bilateral mastoid air cells and adenoids marked in axial-coronal-sagittal planes were calculated. The patients were grouped into three categories according to adenoid tissue volume, total mastoid volume (TMV), and age. Results: No significant difference was noted between the right mastoid volume (RMV) and the left mastoid volume (LMV) or between age and sex (p= 0.368; p= 0.549; p= 0.454). The incremental increase in adenoid tissue volume did not correlate with TMV (r= -0.161, r= -0.279, r= 0.015). The incremental increase in TMV did not correlate with the volume of adenoid tissue (r= 0.024, r= 0.148, r= 0.017). Conclusions: No significant correlation was obtained between the incremental increase in adenoid tissue volume and TMV or the incremental increase in TMV and adenoid tissue volume. There does not seem to be a developmental relationship between adenoid tissue volume and TMV. © 2010 Elsevier Ireland Ltd.


Hariri A.G.,Maltepe University | Gulec M.Y.,Erenkoy Psychiatry and Neurological Disorders Research and Training Hospital | Orengul F.F.C.,Haseki Research and Training Hospital | Sumbul E.A.,Erenkoy Psychiatry and Neurological Disorders Research and Training Hospital | And 2 more authors.
Journal of Affective Disorders | Year: 2015

Abstract Objective The dissociative experiences of patients with bipolar disorder (BD) differ from those of patients with other psychiatric disorders with regard to certain features. The primary goal of this study was to evaluate the relationship between the clinical variables of BD and childhood trauma using the factor structure, psychometric features, and potential subdimensions of the Dissociative Experience Scale (DES). Method This study included 200 BD patients who were in a remission period and 50 healthy volunteers. The BD patients were recruited from two psychiatry clinic departments in Turkey. The sociodemographic data of the two groups and their scores on the DES and Childhood Trauma Questionnaire (CTQ)-28 were compared. Results The overall DES scores and the scores for each DES item accurately and reliably measured dissociation in the BD patients (item-total correlation r scores: >0.20, Cronbach's alpha: 0.95), and a factor analysis revealed two subdimensions of the DES for BD: identity confusion/alteration (SubDES-1) and amnesia and depersonalization/derealization (SubDES-2). Although age at onset of BD was significantly correlated with both subdimensions, illness duration was significantly correlated only with the SubDES-2. Of all the subjects, 19.5% (39/200 patients) were identified as having dissociative experiences by the DES-Taxon (DES-T), and subjects in this subscale (DES-T-positive) had significantly higher total scores on the CTQ-28 as well as higher scores on each subgroup of this scale. The highest CTQ-28 subgroup score was emotional neglect, which was followed by emotional abuse and physical neglect and then sexual abuse and physical abuse. There was a significant correlation between total scores on the CTQ-28 and SubDES-2 but none of the CTQ-28 subscale scores was significantly correlated with either SubDES-1 or SubDES-2. Conclusion The DES sufficiently and reliably identified the experience of dissociative symptoms on the part of BD patients, and a factor analysis revealed two subdimensions of BD on this scale. In particular, DES-T-positive subjects experienced a greater amount of childhood trauma and, as a result, had an earlier age at onset of BD. Additionally, SubDES-2, which was associated with amnesia and depersonalization/derealization, was closely related to illness duration. © 2015 Elsevier B.V.


Veyseller B.,Bezmialem Foundation University | Aksoy F.,Bezmialem Foundation University | Yildirim Y.S.,Elbistan State Hospital | Karatas A.,Haseki Research and Training Hospital | Ozturan O.,Bezmialem Foundation University
Archives of Otolaryngology - Head and Neck Surgery | Year: 2011

Objective: To investigate whether the recurrent laryngeal nerve (RLN) identification technique use dinthyroidectomy affects RLN paralysis and hypoparathyroidism. Design: Patients were allocated into 2 groups according to the thyroidectomy technique used to identify the RLN: (1) superior-inferior direction, exploring the nerve where it enters the larynx, followed by superior pedicle ligation; and (2) inferior-superior direction, following the inferior pedicle ligation and identifying the nerve in the tracheoesophageal groove. The first and second groups included 67 and 128 patients, respectively. In the first group, 19 patients underwent loboisthmectomy, and 48 underwent total thyroidectomy. In the second group, 42 patients underwent lobo-isthmectomy, and 86 underwent total thyroidectomy. We performed 115 and 214 RLN dissections in the first and second groups, respectively. Setting: Academic tertiary hospital. Patients: The study included 195 consecutive patients, 161 female (82.5%), and 34 male (17.5%), who underwent thyroidectomy for goiter between January 2006 and August 2009. Their mean age was 44.7 years (range, 14-79 years). The mean follow-up was 26 months (range, 12-42 months). Interventions: Unilateral or bilateral total thyroidectomies performed using extracapsular dissection with 2 different RLN identification techniques. Main Outcome Measures: Incidence of hypocalcemia, vocal cord paralysis, hemorrhage, and wound infection. Results: NoRLN paralysis was observed in the first group. In the second group, unilateral RLN paralysis was seen in 2 of 128 patients (1.5%). Groups 1 and 2 included 48 and 86 total thyroidectomies, respectively. Temporary hypoparathyroidismwasobserved in4patients in the first group (8.3%). In the second group, permanent hypoparathyroidism was observed only in 4 patients (4.6%), and temporary hypoparathyroidism was observed in 14 patients (16.2%). Conclusions: Comparing the 2 groups based on the frequencies of RLN paralysis and hypoparathyroidism, we found that complications were significantly lowerin the firstgroup (P<.05) in terms of hypoparathyroidism. The rate of hypoparathyroidism was significantly lower in the thyroidectomies that located the RLN using the superior-inferior approach. In our hands, the superior-inferior approach was a safer technique, in terms of avoiding complications. ©2011 American Medical Association. All rights reserved.


Simsek A.,Haseki Research and Training Hospital | Kirecci S.L.,Sisli Etfal Research and Training Hospital | Kucuktopcu O.,Haseki Research and Training Hospital | Ozgor F.,Haseki Research and Training Hospital | And 4 more authors.
Asian Journal of Andrology | Year: 2014

Dapoxetine hydrochloride is a selective serotonin reuptake inhibitor and the first drug approved for the on-demand treatment of premature ejaculation (PE). Our objective in this study was to characterize the efficacy of on-demand dapoxetine (30 and 60 mg) and daily paroxetine (20 mg) usage in treating PE. We conducted a 1 month study involving a total of 150 patients. Patients were divided into three groups of 50. Group 1 were treated with on-demand dapoxetine (30 mg), Group 2 with on-demand dapoxetine (60 mg) and Group 3 with daily paroxetine (20 mg). Our outcome measurement was increased from baseline intravaginal ejaculatory latency time (IELT) after treatment. The IELT increased from baseline to posttreatment by 117%, 117% and 170% in the paroxetine group (P < 0.01), 30 mg dapoxetine group (P < 0.01) and 60 mg dapoxetine group (P < 0.01), respectively. The increase from baseline IELT were similar for the 30 mg dapoxetine and paroxetine groups (P > 0.05), while the 60 mg dapoxetine group had a larger posttreatment IELT increase compared with the 30 mg dapoxetine (P < 0.05) and paroxetine (P < 0.01) groups. Dapoxetine (60 mg) 1-3 h before planned intercourse is a very effective treatment modality for PE. However, an on-demand dose of 30 mg dapoxetine is no more effective than the currently prescribed paroxetine treatment.


Sevketoglu E.,Bakirkoy Dr Sadi Konuk Research And Training Hospital | Yildizdas D.,Cukurova University | Horoz O.O.,Cukurova University | Kihtir H.S.,Bakirkoy Dr Sadi Konuk Research And Training Hospital | And 3 more authors.
Pediatric Critical Care Medicine | Year: 2014

Objective: Thrombocytopenia-associated multiple organ failure can lead to high mortality in critically ill children, possibly related to consequences of thrombotic microangiopathy. Plasma exchange therapy may improve thrombotic microangiopathy. The purpose of this observational cohort study is to describe whether there is an association between use of plasma exchange therapy and outcome in the Turkish thrombocytopenia-associated multiple organ failure network.Setting-Interventions: We performed a retrospective cohort analysis in patients with thrombocytopenia-associated multiple organ failure at three different PICUs comparing those who received plasma exchange (+) plus standard therapies with those who did not receive plasma exchange (-) and only received standard therapies.Results: Among 42 of the enrolled patients with thrombocytopenia- associated multiple organ failure, all had a primary or secondary sepsis diagnosis. Fifteen received plasma exchange therapy (PE [+] group) and 27 received standard medical treatment without plasma exchange (PE [-] group). The mean age was 17.69 months (8.24-54.22) in the PE (+) group and 13.46 months (6.47-20.55) in the PE (-) group. Age (p = 0.232), gender (p = 0.206), thrombocyte count (p = 0.09), Organ Failure Index score (p = 0.111), and pediatric logistic organ dysfunction score (p = 0.177) at admission were not statistically different between groups. The overall 28-day mortality was higher in the PE (-) group (70.37%) compared with the PE (+) group (26.67%) (univariate p = 0.006; multivariate controlling for pediatric logistic organ dysfunction, Organ Failure Index, Pediatric Risk of Mortality scores, and neurological failure p = 0.048). Length of stay was increased in the PE (+) group (p = 0.004).Conclusions: The positive association found between use of plasma exchange therapy and improved survival supports the potential of this therapy in Turkish children with thrombocytopeniaassociated multiple organ failure. The positive, although less so, associated treatment effect observed after controlling for illness severity provides further rationale for performing a randomized controlled trial in the pediatric Turkish thrombocytopenia-associated multiple organ failure network. Sample size calculations call for a 100-patient trial with a pre hoc interim analysis after enrollment of 50 patients with thrombocytopenia-associated multiple organ failure. (Pediatr Crit Care Med 2014; 15:e354-e359). Copyright © 2014 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.


Kirecci S.L.,Sisli Etfal Research and Training Hospital | Simsek A.,Haseki Research and Training Hospital | Gurbuz Z.G.,Haseki Research and Training Hospital | Mimaroglu S.,Haseki Research and Training Hospital | And 3 more authors.
International Journal of Urology | Year: 2014

Objectives: To examine the relationship between premature ejaculation and plasma melatonin levels, and assess the efficacy of selective serotonin reuptake inhibitors in treating premature ejaculation. Methods: A total of 60 men with lifelong premature ejaculation and 40 healthy male controls were included in the present study. For each participant, a medical history was obtained, a physical examination was carried out, and intravaginal ejaculation latency time and melatonin levels were measured. Premature ejaculation patients were randomly categorized into three treatment groups: group1 received fluoxetine (20mg/day), group2 received paroxetine (20mg/day) and group3 received sertraline (50mg/day). Results: The mean baseline plasma melatonin levels in men with premature ejaculation were significantly lower than in the healthy controls (5.34 vs 14.84pg/mL). After 4weeks of treatment, the mean intravaginal ejaculation latency time scores for all of the premature ejaculation treatment groups showed a significant improvement from the baseline values. The plasma melatonin levels were also significantly increased (P<0.05) from baseline (5.34pg/mL) to 9.50pg/mL, 10.24pg/mL or 13.30pg/mL for groups1, 2 and 3, respectively. Conclusions: Our findings show that premature ejaculation is associated with decreased plasma melatonin levels. After treatment with selective serotonin reuptake inhibitors, an increased plasma melatonin level can retard ejaculation, presumably by both central and peripheral mechanisms. This is the first study to evaluate the possible role of serotoninergic interactions on the melatoninergic system in premature ejaculation. © 2014 The Japanese Urological Association.


Apuhan T.,Abant Izzet Baysal University | Apuhan T.,Hisar Intercontinental Hospital | Yildirim Y.S.,Haseki Research and Training Hospital | Ozaslan H.,Hisar Intercontinental Hospital
Otolaryngology - Head and Neck Surgery | Year: 2011

Objective. The aim of this study was to evaluate the developmental relationship between the volumes of paranasal sinuses and adenoid tissue by using a 3-dimensional (3D) reconstruction technique. Study Design. Cross-sectional study. Setting. Tertiary referral center. Subjects and Methods. Multislice computed tomography (MSCT) images were obtained using 3D reconstructions and a volume-rendering technique (VRT) in 69 boys and 35 girls aged 3 to 16 years, and bilateral maxillary, frontal, and sphenoid sinus volumes, as well as adenoid tissue volume marked in axial-coronal-sagittal planes, were calculated. The patients were grouped in 3 categories according to adenoid tissue volumes, and comparisons were made. Results. There was no significant difference between the right maxillary volume and left maxillary volume (P = .93). No significant difference was noted between the groups in terms of age and gender. There was no significant correlation between frontal, sphenoid, right and left maxillary, or total maxillary sinus volumes in all 3 groups of patients. Conclusion. When classified according to adenoid tissue size, it was observed that increasing adenoid tissue volumes did not significantly affect the development of paranasal sinuses. Developmentally, there are no statistically significant correlations between the volumes of paranasal sinuses and adenoid tissues. © American Academy of Otolaryngology - Head and Neck Surgery Foundation 2011.


Aksoy F.,Haseki Research and Training Hospital | Yildirim Y.S.,Haseki Research and Training Hospital | Veyseller B.,Haseki Research and Training Hospital | Ozturan O.,Haseki Research and Training Hospital | Demirhan H.,Haseki Research and Training Hospital
Otolaryngology - Head and Neck Surgery | Year: 2010

OBJECTIVE: A variety of medical and surgical treatment alternatives exists for the management of inferior turbinate hypertrophy, indicating a lack of consensus on the optimal technique. The purpose of the present study was to evaluate the inferior turbinate objectively by means of radiologic methodology during the early and late periods in patients treated with inferior turbinate outfracture. STUDY DESIGN: Case series with planned data collection. SETTING: Tertiary referral center. SUBJECTS AND METHODS: Eighty inferior turbinates of 40 patients (28 males, 12 females) who underwent surgery because of septum deviation and inferior turbinate hypertrophy were included in this prospective clinical study. All patients were evaluated by paranasal sinus computed tomography preoperatively and at one and six months postsurgery. The angle and the distance between the inferior turbinate and the lateral wall of the nasal fossa and the area lateral to the inferior turbinate bone were measured on the coronal plane anterior posteriorly at five different anatomic levels. RESULTS: Statistically significant reductions were noted in the angle and distances in all sections one and six months postoperatively when compared with the preoperative measurements (P < 0.005). CONCLUSION: Compared with the preoperative status, those patients who underwent turbinate outfracture procedures displayed a reduction in the angle and the distance between the inferior turbinate bone and the lateral wall of the nasal fossa and the area lateral to the inferior turbinate bone one month following surgery. Ongoing outcomes of this treatment method have been objectively shown. © 2010 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.


Aksoy F.,Haseki Research and Training Hospital | Veyseller B.,Haseki Research and Training Hospital | Yildirim Y.S.,Haseki Research and Training Hospital | Acar H.,Haseki Research and Training Hospital | And 2 more authors.
Otolaryngology - Head and Neck Surgery | Year: 2010

Objective: This study was performed to determine the role of nasal muscle function in patients with dynamic or static nasal valve collapse by comparing the electromyographic activities of nasal muscles in healthy individuals. Study Design: Cross-sectional clinical study. Setting: Tertiary referral center. Subjects and Methods: Twenty adult patients with dynamic nasal valve collapse, 18 patients with unilateral static nasal valve stenosis (septum deviation), and 20 healthy adults were included in the study. The activity of their nasal muscles was measured by surface electromyography (EMG), and the results were compared for the patient and control groups. Results: No abnormal finding was found in any of the nasal muscles of the control group. In the majority of patients with dynamic nasal valve pathology, statistically significant functional disorders were detected in the m dilator naris anterior and m nasalis transversalis muscles compared with the controls. During inspiration and expiration in patients with static nasal valve pathology, some revealed muscular abnormities during inspiration. Normal muscle activation was observed in all of the patients during expiration. Conclusion: Determination of agents involved in pathologies of the nasal valve region is necessary for planning appropriate treatment. The role of nasal muscles in dynamic nasal valve pathologies, which has not been previously recognized, should be considered. A more effective and adequate solution for the nasal sidewalls than static pathologies should be considered in these patients by taking into account the muscular activity disorders detected by EMG at the stage of surgical treatment. © 2010 American Academy of Otolaryngology-Head and Neck Surgery Foundation.

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