Ergunes K.,Izmir Ataturk Training and Research Hospital
Asian cardiovascular & thoracic annals | Year: 2013
The aim of this study was to investigate the effect of preoperative low ejection fraction (≤30%) on postoperative morbidity and mortality in patients undergoing isolated on-pump coronary artery bypass grafting. We also investigated the effect of pre- and perioperative factors on survival. Between January 2002 and December 2009, 103 (6.2%) patients with an ejection fraction ≤30% and 1554 (93.8%) with an ejection fraction >30% underwent coronary artery bypass grafting. In multivariate logistic regression analysis, cardiopulmonary bypass time, operation time, prolonged inotropic support, and intensive care unit stay were independent predictors of mortality in patients with low ejection fraction. Intensive care unit and hospital stays were significantly longer in these patients, and the postoperative mortality rate was significantly higher. Advanced age (≥70 years) influenced mortality during the follow-up of patients with low ejection fraction. Midterm survival was significantly reduced in patients with ejection fraction ≤30%. Smoking, prolonged inotropic support, and prolonged ventilatory support were independent predictors of midterm survival in patients with ejection fraction ≤30%. On-pump coronary artery bypass grafting can be performed in patients with ejection fraction ≤30%, with reasonable mortality and morbidity rates.
Arkun R.,Ege University |
Mete B.D.,Izmir Ataturk Training and Research Hospital
Seminars in Musculoskeletal Radiology | Year: 2011
Brucellosis is a zoonosis of worldwide distribution caused by small gram-negative nonencapsulated coccobacilli of the genus Brucella. It is characterized by a granulomatous reaction in the reticuloendothelial system. Because it affects several organs and tissues, it may have various clinical manifestations. Musculoskeletal involvement is one of the most common locations, and the frequency of bone and joint (osteoarticular) involvement of brucellosis varies between 10% and 85%. Osteoarticular involvement includes spondylitis, sacroiliitis, osteomyelitis, peripheral arthritis, bursitis, and tenosynovitis. The most common osteoarticular finding in children is monoarticular arthritis, mostly located in the knees and hips; whereas in adults, sacroiliitis is the most frequent. Imaging studies, including radiography, computed tomography (CT), magnetic resonance (MR) imaging, and bone scintigraphy, have been used for diagnosis. Radiography is limited to evaluating the focal form of spinal brucellosis and advanced disease at the joints. CT and bone scintigraphy have limited value because of their inadequate soft tissue resolution. MR imaging is the method of choice to assess the extent of disease and follow up the treatment response. However, MR imaging has a low specificity to predict the exact cause of an osteoarticular lesion, and in case of arthralgia or symptoms of osteomyelitis or spondylodiscitis, the index of suspicion should be high in regions where the disease is endemic. © 2011 Thieme Medical Publishers, Inc.
Arkun R.,Ege University |
Mete B.D.,Izmir Ataturk Training and Research Hospital
Seminars in Musculoskeletal Radiology | Year: 2011
Hydatid disease is an infectious disease caused by the larval stage of the parasitic tapeworm Echinococcosis granulosus. Its distribution is worldwide. Although hydatid disease can develop in almost any part of the body, it is most commonly found in the liver and lung. Musculoskeletal involvement is rare. The radiological appearance of the hydatid disease of musculoskeletal system mimics tumors and other inflammatory conditions. Therefore preoperative diagnosis of musculoskeletal hydatid disease is sometimes difficult clinically and radiologically. On radiography, different radiographic changes may occur. In cases of osteolytic and inflammatory changes, it may mimic any variant of nonspecific or specific osteomyelitis. Bone erosion and destruction may lead to almost complete osteolysis, bone may distort, and on occasion, its radiologic appearances may be confused with those of a malignant bone tumor. Computed tomography (CT) is more accurate in delineating the area of destruction. The primary role of CT and magnetic resonance imaging is in the recognition of extraosseous spread of the hydatid disease within the soft tissues. This article reviews the pathological basis and the clinical and imaging features of musculoskeletal hydatid disease. © 2011 Thieme Medical Publishers, Inc.
Akyildiz Z.I.,Izmir Ataturk Training and Research Hospital |
Ergene O.,Dokuz Eylül University
Acta Cardiologica | Year: 2014
Objective Cardiologists' approach to angina in outpatients with stable coronary artery disease (CAD) is unclear. Therefore, we analysed data from the national multicentre, observational PULSE study to evaluate the frequency of angina, clinical variables aff ecting angina frequency and the impact of frequent angina on quality of life (QoL) in outpatients with stable CAD managed by cardiologists in secondary and tertiary health-care centres in Turkey. Methods and results Adult outpatients with stable CAD in sinus rhythm were included. Data were collected at a single study visit from 83 centres. Patients were divided into fi ve categories according to angina attack frequency. QoL was measured by the MacNew heart disease health-related QoL Questionnaire. The mean (standard deviation; SD) age of all patients (n = 2661) was 61.2 (10.2) years. Of 2,661 patients, 48.7% had no anginal attacks while 16.5% had minimal, 14.5% occasional, 12.2% regular and 8.1% frequent attacks. Angina attack frequency correlated positively with female sex, heart rate, the severity of angina. Emotional, physical, social, and global scores of QoL tended to decrease across angina attack frequency categories. Short- and long-acting nitrates, ivabradine were signifi cantly more preferred in patients with higher frequency of angina attacks rather than beta blockers and calcium channel blockers. Conclusions Insuffi cient angina control in outpatients with stable CAD requires reassessment of medical approach since it has a negative impact on QoL. The social and economic consequences of this burden should be sought on a national basis.
Sari A.,Izmir Ataturk Training and Research Hospital
Indian journal of pathology & microbiology | Year: 2010
Papillary renal cell carcinoma (PRCC) is the second most common carcinoma of the kidney, which is classified into two types. Type 1 displays single layer of cells with scanty pale cytoplasm and type 2 has pseudostratified high-grade nuclei with eosinophilic cytoplasm. Recently, apart from these two types, oncocytic PRCC and clear-cell PRCC have been described. To the best of our knowledge, lipocyte-like cells have not yet been reported to accompany any subtypes of renal cell carcinoma. Herein, we report a case of PRCC with lipocyte-like cells and sarcomatoid features. Lipocyte-like cells might represent a special type of PRCC or this feature may be an indication of poor prognosis regarding its association with sarcomatoid change.
Limon O.,Izmir Ataturk Training and Research Hospital
The American journal of emergency medicine | Year: 2012
Spontaneous urinary bladder perforation is a rare and life-threatening condition similar to traumatic and iatrogenic perforation. The connection with the underlying bladder damage due to previous radiotherapy, inflammation, malignancy, obstruction, or other causes can be found in almost all cases. The symptoms are often nonspecific, and misdiagnosis is common. Here, we present a case of spontaneous urinary bladder perforation due to bladder necrosis in a diabetic woman. She presented to the emergency department with abdominal pain. Exploratory laparotomy was performed by surgeons and revealed necrosis of the anterior and lateral walls of the urinary bladder. Microscopic examination revealed necrotic changes throughout the bladder wall. Ghost-like cellular outlines were compatible with coagulative necrosis. Clusters of bacteria were also present in some necrobiotic tissues. Malignant cells were not present. It appears probable that the infection was due to local interference with the blood supply (arterial, capillary, or venous) combined with the systemic metabolic upset that led to the bladder condition. In our case, we observed partial necrosis of the bladder rather than distortion of the entire blood supply to the bladder as consequences of the microvascular effects of diabetes. Urinary bladder perforation must be considered in the differential diagnosis of patients presenting with free fluid in the abdomen/peritonitis, decreased urine output, and hematuria, and in whom increased levels of urea/creatinine are detected in serum and/ or peritoneal fluid aspirate.
Yetimalar H.,Izmir Ataturk Training and Research Hospital
Akusherstvo i ginekologiia | Year: 2011
Our aim was to compare the effectivenesses and influences on life quality rates of patients who underwent Burch Colposuspension or Colporaphy Anterior-Kelly Plication for the surgical treatment of stress urinary incontinence (SUI). 81 patients who applied to Izmir Ataturk Training and Research Hospital 3rd Obstetrics and Gynecology Department between the dates of January 2006 and June 2007 with complaints of urinary leakage and were diagnosed as SUI were included to our study. 41 patients (50.6%) underwent Burch colposuspension and ColporaphyAnterior-Kelly Plication were applied to 40 patients (49.4%). Patients were reexamined after 6 months following discharge in terms of complications, stress test, patient complaints and life quality scores. The mean age of patients as well as the number of postmenauposal ones who underwent Colporaphy Anterior-Kelly Plication was significantly higher (p < 0.05). The difference of hospitalization was statistically insignificant between two groups (p = 0.413, p > 0.05). Also the differences for the 6th month postoperative stres test results were statistically insignificant (p > 0.05). Life Quality Inqury results differences were statistically insignificant (p > 0.05). Preoperative and postoperative scores of the patients were compared and convalescence was detected. This convalescence was statistically significant for each three tests (p < 0.05). In this study the success rates were 87.8% for the Burch procedure and 75% for Colporaphy Anterior-Kelly Plication. all of the patients had benefited from both operations according to life quality inquries. Besides the fact that the Burch procedure is the gold standart for SUI Colporaphy Anterior-Kelly plication might be chosen for the older patients with pelvic organ prolapse (POP). There were no significant differences in terms of complications. The results of our study were consistent with those of other publications. Currently Burch operation is the gold standard treatment modality for SUI. Use of life quality inquries proved to be useful in patients' convalescence follow-up.
Ozgur A.,Izmir Ataturk Training and Research Hospital
The Journal of laryngology and otology | Year: 2011
To evaluate symptom scores and nasal smear cytology findings in seasonal allergic rhinitis patients, before and after treatment. Twenty-nine consecutive adult patients with seasonal allergic rhinitis were evaluated prospectively. They received mometasone furoate nasal spray and cetirizine for 21 days. Nasal and ocular symptom scores were recorded before and after treatment. Nasal cytology was also assessed as a means of determining treatment. The combined use of an intranasal corticosteroid and an oral antihistamine caused a significant improvement in nasal and ocular symptom scores. Cytological evaluation revealed significant reduction in nasal eosinophil, neutrophil and goblet cell counts after three weeks' treatment. Symptom scoring systems are widely used for the evaluation of drug efficacy in allergic rhinitis treatment. When investigating the disease and evaluating treatment efficacy, objective as well as subjective methods are needed. Nasal cytological assessment is a simple, objective method which provides valuable information about the nasal mucosa.
[Comparison of proportion method in Löwenstein-Jensen medium with the BACTEC 460 TB system for antimycobacterial susceptibility testing of Mycobacterium tuberculosis isolates]. [Mycobacterium tuberculosis İzolatlarinin Antitüberküloz İlaçlara Duyarliliǧinin Saptanmasinda Antibiyotikli Löwenstein-Jensen Besiyerinde Proporsiyon Yönteminin BACTEC 460 TB Sistemi ile Karşilaştirilmasi]
Gul Yurtsever S.,Izmir Ataturk Training and Research Hospital
Mikrobiyoloji bülteni | Year: 2011
This study was conducted to compare BACTEC 460 TB system and the proportion method in commercially available and ready to use antibiotic added Löweinstein-Jensen (LJ) medium for susceptibility testing of first line drugs in Mycobacterium tuberculosis complex isolates. A total 238 M.tuberculosis strains isolated from clinical samples in our laboratory between 2006-2010 period were included in the study. Susceptibility testing for streptomycin, isoniazid, rifampicin and ethambutol in commercially provided LJ medium (Salubris Inc., Istanbul) was performed by the proportion method as recommended by the manufacturer, and the results were compared with the results of BACTEC 460 TB (Becton Dickinson, USA) system. Resistance rates of M.tuberculosis strains against streptomycin, isoniasid, rifampicin and ethambutol obtained by BACTEC 460 TB system were 19.7%, 42%, 40.8% and 18%, respectively. Those rates were 22.7%, 38.7%, 37% and 15.5%, respectively, by antibiotic added LJ proportion method. There was no statistically significant difference between the two methods in terms of resistance rates (p> 0.05). The rates of consistency between proportion method in LJ medium and BACTEC 460 TB system for streptomycin, isoniasid, rifampicin and ethambutol susceptibility were found as 85.3%, 92.4%, 95.4% and 92.4%, respectively. When comparing the reporting time (interval between beginning of the process to reporting of the results) of the methods, minimal, maximal and average reporting spans for BACTEC 460 TB system were 5, 12 and 8.08 ± 2.65 days, and 15, 42 and 23.89 ± 6.02 days for the proportion method in LJ medium, respectively, being statistically significant (p= 0.001). It was determined that the sensitivity test results of major antimycobacterial drugs in commercial LJ medium were compatible with the BACTEC 460 TB system. Nonetheless, the rate of incompatible results was higher for STR than the other drugs. Although there has been some disadvantages such as longer reporting time, need for experience in manual processing and visual evaluation, standardized LJ media approved for quality can be used for susceptibility testing of M.tuberculosis in the laboratories which do not have eligible conditions for the establishment of automated systems.
Gunes H.F.,Izmir Ataturk Training and Research Hospital |
Ozdemir N.,Izmir Ataturk Training and Research Hospital
Turkish Neurosurgery | Year: 2012
Intramedullary tumors affecting the entire cord from the cervicomedullary junction to the conus are termed "holocord tumors". Ependymomas are the most frequent intramedullary tumor in adults. Holocord ependymoma is an exceedingly rare condition. An extensive review of the literature revealed that only five other cases have been reported. We report the sixth case of holocord ependymoma. In this article, we present a case of holocord ependymoma in a 19-year-old girl which was totally resected in a two-stage approach. A two-staged operation is recommended for the aim of total resection for this disease. Besides, cysts are common feature of all spinal ependymomas. There was a solid mass not accompanied by a cyst a any level in our patient's tumor. To the authors' best knowledge, a pure solid mass not accompanied by a cyst has not been previously reported with holocord ependymoma cases.