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Server E.A.,Istanbul Training and Research Hospital
Kulak burun bogaz ihtisas dergisi : KBB = Journal of ear, nose, and throat | Year: 2016

OBJECTIVES: This study aims to investigate the long-term efficiency and reliability of the Pillar Implant (PI) procedure.PATIENTS AND METHODS: Between January 2008 and January 2010, a total of 27 patients (16 males, 11 females; mean age 45.8±7.2 years; range 31 to 58 years) who were diagnosed with low obstructive sleep apnea syndrome and simple snoring underwent the PI procedure in this retrospective, nonrandomized study. The patients were evaluated preoperatively with visual analog scale (VAS) scores in terms of snoring, dysphagia, mouth dryness, foreign body sensation, and pain at the first month, third month, and sixth year intervals.RESULTS: Based on the snoring scale, VAS scores were statistically significantly lower in the first month, third month and sixth year compared to preoperative scores (p=0.001, p=0.008, p=0.017, respectively). There was no pain in any patients beyond the third day. The VAS score averages in all evaluations were higher by statistical significance relative to the preoperative averages (p=0.018, p=0.027, p=0.025, respectively). Mouth dryness was encountered in seven patients. It persisted in seven patients at the third month and in five patients at the sixth year interval. The VAS score averages were statistically significantly higher in all evaluations compared to the preoperative scores (p=0.017, p=0.018, p=0.042, respectively).CONCLUSION: Pillar implant is an efficient, reliable method in the long-term; however, it should be considered that it could cause complaints such as dysphagia, foreign body sensation, and mouth dryness.


Salman S.,Istanbul Training and Research Hospital | Akpinar M.E.,Istanbul Training and Research Hospital | Yigit O.,Istanbul Training and Research Hospital | Gormus U.,Istanbul Science University
American Journal of Rhinology and Allergy | Year: 2012

Background: Corticosteroids are a mainstay of treatment for chronic rhinosinusitis with nasal polyposis (CRSwNP). Data related to the effect of systemic methylprednisolone on surfactant protein (SP) expression in CRSwNP is limited. This study aimed to reveal the consequences of systemic methylprednisolone treatment on levels of SP-A and SP-D, which play a role in innate immunity, in patients with CRSwNP. Methods: Twenty-one patients with CRSwNP were included in the study, along with 15 control patients scheduled for dacryocystorhinostomy. A polypoid tissue biopsy was taken under local anesthesia, and 15 CRSwNP patients were scheduled for endoscopic sinus surgery after 3 weeks of oral methylprednisolone. Posttreatment biopsies were performed perioperatively. Pre- and posttreatment endoscopic polyp grades were determined, as were symptom scores regarding nasal obstruction, headache, and nasal discharge using a visual analog scale (VAS). SP-A and SP-D levels were measured using enzyme-linked immunosorbent assay and the results were compared. Results: All patients reported relief from clinical symptoms through VAS after methylprednisolone treatment. The posttreatment polyp grade was reduced (p = 0.0001). SP-A and SP-D levels did not yield a significant difference between CRSwNP patients and controls (p = 0.25 and p = 0.13, respectively). Statistically significant up-regulation was detected in SP-A and SP-D levels after oral methylprednisolone (p = 0.0002 and p = 0.0004, respectively). Conclusion: In this study, significant up-regulation of SP-A and SP-D was revealed in patients with CRSwNP after systemic steroid treatment. The role of SP-A and SP-D up-regulation in CRSwNP pathogenesis and therapeutic outcomes of corticosteroids have potential importance for the introduction of new therapeutic modalities that are more effective and produce fewer adverse effects. Copyright © 2012, OceanSide Publications, Inc.


Karaguzel E.,Karadeniz Technical University | Kadihasanoglu M.,Istanbul Training and Research Hospital | Kutlu O.,Karadeniz Technical University
Nature Reviews Urology | Year: 2014

Testicular torsion is a urological emergency most commonly seen in adolescence, involving a decrease in blood flow in the testis resulting from torsion of the spermatic cord that can result in gonad injury or even loss if not treated in time. Testicular ischaemia-reperfusion injury represents the principle pathophysiology of testicular torsion, with ischaemia caused by twisting of the spermatic cord, and reperfusion on its subsequent release. Many cellular and molecular mechanisms are involved in ischaemia-reperfusion injury following testicular torsion. Studies have investigated the use of pharmacological agents as supportive therapy to surgical repair in order to prevent the adverse effects of testicular torsion. Numerous substances have been proposed as important in the prevention of post-ischaemia-reperfusion testicular injury. A range of chemicals and drugs has been successfully tested in animal models for the purpose of mitigating the dangerous effects of ischaemia-reperfusion in testis torsion. © 2014 Macmillan Publishers Limited. All rights reserved.


Aren A.,Istanbul Training and Research Hospital | Gokce A.H.,Istanbul Training and Research Hospital | Gokce F.S.,Balikli Rum Hospital | Dursun N.,Istanbul Training and Research Hospital
Hernia | Year: 2011

Introduction: The fascia transversalis is accepted as one of the anatomical structures that can prevent hernia formation. Degradation of collagen within the fascia transversalis is one of the known reasons for the development of inguinal hernia. In the present study, we investigated the roles of matrix metalloproteinases (MMPs), specifically MMP-1, MMP-2, and MMP-9 in the etiology of inguinal hernia. Materials and methods: This prospective study included 60 inguinal hernia patients: 30 patients had indirect inguinal hernia and 30 patients had direct inguinal hernia. An additional 30 patients operated for reasons other than hernia in the inguinal canal were included as a control group. All patients underwent operations at Istanbul Training and Research Hospital between 1 June 2009 and 1 December 2009. Tissue specimens were taken from the fascia transversalis from patient and control groups during the operation, and MMP-1, MMP-2, MMP-9 values were investigated using immunohistochemical methods. Results: Significantly higher values of MMP-1, MMP-2, MMP-9, were found in inguinal hernia cases than in the control group (P = 0.0001, P = 0.007, P = 0.021, respectively). Conclusion: Increased MMP-1, MMP-2, MMP-9 values play a role in the etiology of inguinal hernia. Since weakening may also occur in other tissues in addition to the floor of inguinal canal in inguinal hernia patients, the association of arterial aneurisms and connective tissue diseases should also be investigated in these patients. © 2011 Springer-Verlag.


Sahin S.,Istanbul Training and Research Hospital
The West Indian medical journal | Year: 2013

A 60-year old female patient was found comatosed at home and taken to the hospital's Emergency Department by her relatives. It was learnt that she wrapped her knees with spirit-impregnated cotton pad for pain for one week. On physical examination, only a colour change of purple violet on her knees was noted. Metabolic acidosis with increased anion gap was detected by arterial blood analysis. The patient underwent haemodialysis. She was discharged from the hospital with no complaints, alert and rational following five days of follow-up treatment, with the diagnosis of methyl alcohol poisoning.


Bilici S.,Istanbul Training and Research Hospital
Kulak burun boǧaz ihtisas dergisi : KBB = Journal of ear, nose, and throat | Year: 2011

A 45-year-old male patient had left sided submucosal swelling extending backwards from the tip of the tongue disturbing articulation and swallowing. Submucosally located lesion was 3 x 2 x 1.5 cm in size and totally excised under local anesthesia. In this article, we present a case of ancient schwannoma of tongue. Although a very rare entity, ancient schwannoma should be considered in differential diagnosis of tongue lesions.


Ozdemir N.G.,Istanbul Training and Research Hospital
Turkish Neurosurgery | Year: 2015

Aim: The connections of posterior commissure are defined. Its fibers mediate the consensual light reflex by interconnecting the pretectal nuclei. The fiber connections from the thalamic, pretectal, superior colliculus and the habenular nuclei are known, but they have not been shown anatomically. The present study is a fiber dissection study to define the anatomy of the posterior commissure. Material and Methods: Twenty formalin-fixed sheep heads were used in the study. The specimens were fixed in 10% formalin solution for 3 weeks. The arachnoidal and vascular structures were removed by using a surgical microscope magnification (x6-x40) and brains were again fixed for 4 weeks at -20°C. The fiber dissections were performed at Marmara University, Rhoton Laboratory. Also, a radiological tractographic study was carried on five healthy volunteers to see the posterior commissure cortical connections. Results: In fifteen sheep brains, the dimensions of the posterior commissure were measured as 1.36 mm (range 0.5-2.5 mm) width, and as 4.6 mm (range 3-6 mm) length. In the dissection study, a frontotemporooccipital fascicle was observed to connect with the fibers of the posterior commissure. Diffusion tensor imaging scans showed the frontotemporooccipital tract to extend to posterior commissural region. Conclusion: To our knowledge, this is the first anatomical and tractographic study regarding the posterior commissure. However, further human cadaveric studies are necessary.


Nuhoglu F.,Istanbul Training and Research Hospital | Gurbuz B.,Istanbul Training and Research Hospital | Eltutar K.,Istanbul Training and Research Hospital
Acta Otorhinolaryngologica Italica | Year: 2012

The main objective of the present study was to prospectively evaluate long-term surgical success and safety in patients with nasolacrimal duct obstruction treated with a multidiode transcanalicular laser and bicanalicular silicone intubation stenting. 42 patients treated with transcanalicular laser dacryocystorhinostomy for nasolacrimal duct obstruction were prospectively enrolled. In all cases, silicone stents were inserted. Subjective outcome measure was resolution or improvement of epiphora. Objective outcome measures were patency of the lacrimal system tested with fluorescein and persistence of the nasolacrimal window visualized by nasal endoscopy. The lacrimal system was functional in 95.2% of the patients. The endocanalicular laser DCR failed in two of the 42 (4.8%) cases. External dacryocystorhinostomy was performed successfully on the failed cases. Lacrimal pump syndrome was not seen in any patient. In conclusion, endocanalicular laser dacryocystorhinostomy using a multidiode laser appears to be an effective technique in patients unresponsive to medical therapy.


Sengoz A.,Istanbul Training and Research Hospital | Kotil K.,Istanbul Training and Research Hospital | Demiroglu E.,Kafkas University
Journal of Neurosurgery: Spine | Year: 2011

Object. Posterior epidural migration of a free disc fragment in the lumbar region is a very rare condition that has only been reported in isolated cases to date. Patients with this condition present with radiculopathy or major neurological deficits. Difficulties in diagnosis and the choice and timing of surgical treatment are important in these cases. In this clinical case series, features of cases with posterior epidural migration of free lumbar disc fragments accompanied by cauda equina syndrome are discussed. Methods. Eight cases (0.27%) of posterior epidural migration of disc fragments were detected among 2880 patients surgically treated for lumbar disc herniation between 1995 and 2008. Seven of these patients had cauda equina syndrome. The mean duration of symptoms in the 8 cases was 4.2 days (range 1-10 days). The group included 6 men and 2 women, with a mean age of 48 years (range 34-72 years). The sequestered disc fragments were at the L3-4 level in 6 patients (75%) and the L4-5 level in 2 (25%). Magnetic resonance imaging showed tumor-like ring contrast enhancement around sequestered fragments in 5 patients. The patients' motor, sensory, sexual, and urological functions were evaluated postoperatively, and modified Odom criteria and a visual analog scale were used in the assessment of postoperative outcomes. Results. A microsurgical approach was used in all cases. Sequestrectomy with minimal hemilaminotomy and removal of the free segments were performed. The patients were followed up for a mean period of 28.5 months. Three patients (37.5%) had excellent results, 3 (37.5%) had good results, 1 patient (12.5%) had fair results, and only 1 patient had poor results according to the Odom criteria. The main factors affecting the long-term outcomes were the presence of cauda equina syndrome and the time period between onset of symptoms and surgery. Conclusions. Patients with posterior migration of a disc fragment present with severe neurological deficits such as cauda equina syndrome. Because the radiological images of disc fragments may mimic those of other more common posterior epidural space-occupying lesions, definite diagnosis of posteriorly located disc fragments is difficult. All of these lesions can be completely removed with hemilaminotomy and sequestrectomy, and early surgical treatment is important as a first choice to prevent severe neurological deficits.


Toktas G.,Istanbul Training and Research Hospital
Asian journal of endoscopic surgery | Year: 2013

We evaluated a minimally invasive surgical technique involving a single percutaneous access with a laparoscopic trocar under video-cystoscopic vision for managing large bladder stones. All patients were candidates for open surgery. Fourteen patients with bladder stones larger than 3 cm in diameter or multiple stones were treated with this technique. The procedure involved the percutaneous placement of a laparoscopic trocar under cystoscopic control and the introduction of a rigid nephroscope into the bladder. Stones were cleansed via fragmentation or direct removal. The technique was successful in all cases, resulting in controlled, stone-free bladders; there were no surgical complications. The mean operation time was comparable to that of standard management. All patients discharged uneventfully. None reported urethral stricture during the 24-month follow-up period. Percutaneous cystolithotripsy under endoscopic control is easy to perform and should be considered as an alternative for large or multiple bladder stones as it decreases the risk of urethral stricture. © 2013 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.

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