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Bakkaloglu S.A.,Gazi University | Borzych D.,Medical University of Gdańsk | Borzych D.,Center for Pediatric and Adolescent Medicine | Borzych D.,Dr Behcet Uz Children Research And Education Hospital | And 15 more authors.
Clinical Journal of the American Society of Nephrology | Year: 2011

Background and objectives Left ventricular hypertrophy (LVH) is an independent risk factor and an intermediate end point of dialysis-associated cardiovascular comorbidity. We utilized a global pediatric registry to assess the prevalence, incidence, and predictors of LVH as well as its evolution in the longitudinal follow- up in dialyzed children. Design, setting, participants, & measurements Cross-sectional echocardiographic, clinical, and biochemical data were evaluated in 507 children on peritoneal dialysis (PD), and longitudinal data were evaluated in 128 patients. The 95th percentile of LV mass index relative to height age was used to define LVH. Results The overall LVH prevalence was 48.1%. In the prospective analysis, the incidence of LVH developing de novo in patients with normal baseline LV mass was 29%, and the incidence of regression from LVH to normal LV mass 40% per year on PD. Transformation to and regression from concentric LV geometry occurred in 36% and 28% of the patients, respectively. Hypertension, high body mass index, use of continuous ambulatory peritoneal dialysis, renal disease other than hypo/dysplasia, and hyperparathyroidism were identified as independent predictors of LVH. The use of renin-angiotensin system (RAS) antagonists and high total fluid output (sum of urine and ultrafiltration) were protective from concentric geometry. The risk of LVH at 1 year was increased by higher systolic BP standard deviation score and reduced in children with renal hypo/dysplasia. Conclusions Using height-adjusted left ventricular mass index reference data, LVH is highly prevalent but less common than previously diagnosed in children on PD. Renal hypo/dysplasia is protective from LVH, likely because of lower BP and polyuria. Hypertension, fluid overload, and hyperparathyroidism are modifiable determinants of LVH. © 2011 by the American Society of Nephrology.


Karaman K.,Sakarya University | Tanoglu A.,GATA Haydarpasa Training Hospital | Beyazit Y.,Canakkale State Hospital | Han I.,Izmir Tepecik Teaching and Research Hospital
BMJ Case Reports | Year: 2015

Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie's syndrome, is a clinical syndrome characterised by gross dilation of the caecum and right hemicolon, which sometimes extends to the sigmoid colon and rectum in the absence of an anatomic lesion in the intestinal lumen. It is characterised by impaired propulsion of contents of the gastrointestinal tract, which results in a clinical picture of intestinal obstruction. A careful examination of the markedly distended colon can exclude several colonic pathologies, including mechanical obstruction and other causes of toxic megacolon. ACPO can sometimes predispose or mimic colonic volvulus, especially in geriatric patients. Copyright © 2015 BMJ Publishing Group.


PubMed | GATA Haydarpasa Training Hospital, Canakkale State Hospital, Izmir Tepecik Teaching and Research Hospital and Sakarya University
Type: | Journal: BMJ case reports | Year: 2015

Acute colonic pseudo-obstruction (ACPO), also known as Ogilvies syndrome, is a clinical syndrome characterised by gross dilation of the caecum and right hemicolon, which sometimes extends to the sigmoid colon and rectum in the absence of an anatomic lesion in the intestinal lumen. It is characterised by impaired propulsion of contents of the gastrointestinal tract, which results in a clinical picture of intestinal obstruction. A careful examination of the markedly distended colon can exclude several colonic pathologies, including mechanical obstruction and other causes of toxic megacolon. ACPO can sometimes predispose or mimic colonic volvulus, especially in geriatric patients.


Toz E.,Izmir Tepecik Teaching and Research Hospital | Ozcan A.,Izmir Tepecik Teaching and Research Hospital | Balsak D.,Halic University | Avci M.E.,Kanuni Sultan Suleyman Training and Research Hospital | And 2 more authors.
Menopause | Year: 2016

Objective: This study aimed to assess the effects of hysterectomy and bilateral salpingo-oophorectomy (BSO) - compared with the effects of hysterectomy alone - on skin aging in premenopausal women undergoing hysterectomy for benign conditions. Methods: One hundred thirty-five premenopausal women who underwent hysterectomy with BSO were compared with a control group of women who underwent hysterectomy alone based on skin parameters (including wrinkling, laxity/sagging, and texture/dryness) and Skindex-29 questionnaire scores. The inclusion criteria were as follows: aged between 40 and 50 years, follicle-stimulating hormone level lower than 40mIU/mL, undergoing hysterectomy with or without BSO for benign conditions, and not receiving estrogen or progesterone treatment. The exclusion criteria were as follows: adrenocortical hyperplasia or Cushing's syndrome; use of corticosteroids for autoimmune diseases; malignancy, connective tissue diseases (eg, Ehlers-Danlos syndrome), or dermatological diseases (eg, lichen sclerosus); or regular use of medications known to interfere with the condition of the skin. Results: All skin parameters in the hysterectomy group and the hysterectomy with BSO group worsened on weeks 24 and 48. Laxity/sagging and texture/dryness scores on weeks 24 and 48 were significantly worse in the BSO group; laxity/sagging and texture/dryness scores continued to worsen between 24 and 48 weeks. Scores for the Skindex-29 questionnaire emotion and symptom subscales were significantly higher in the BSO group compared with the non-BSO group. Conclusions: Prophylactic BSO during hysterectomy is a significant independent risk factor for worsening skin laxity/sagging and texture/dryness in premenopausal women undergoing hysterectomy for benign conditions. Prophylactic BSO in the presence of dermatological conditions is also associated with reduced quality of life. © 2015 by The North American Menopause Society.


PubMed | Ege University, Dr Sadi Konuk Teaching and Research Hospital, Manisa State Hospital and Izmir Tepecik Teaching and Research Hospital
Type: Journal Article | Journal: Transplantation proceedings | Year: 2015

Double-J (DJ) stents play an important role in modern urology to prevent undesirable side effects after surgery. We aimed to investigate the relationship of DJ stents with the demographic characteristics, surgical complications, urinary tract infection (UTI), and hematuria in the patients who underwent renal transplantation (Tx).Data of 354 patients who underwent renal Tx between 2008 and 2011 at Ege University were evaluated retrospectively; 331 patients were included in this study. The term DJ (-) represents patients in whom a DJ stent was not placed. Primary DJ term represents patients in whom the DJ stent was placed during the first Tx. Secondary DJ term represents the patients who had DJ after Tx for any complication.Two hundred fifty-four (76.7%) patients were in the DJ (-) group, 52 (15.7%) were in the primary DJ group, and 25 (7.6%) were in the secondary DJ group. There were significant differences between the groups in terms of anastomosis type (P = .000), stay-in-hospital time (P = .000), surgical complication (P = .000), re-operation (P = .000), percutaneous nephrostomy (P = .000), UTI (P = .000), first-time UTI (P = .000), recurrent UTI (P = .000), positive hemoculture (P = .000), hematuria (P = .000), duration of dialysis before Tx (P = .000), live/deceased donor (P = .000), and delayed graft function (P = .009).Our choice is to use the DJ stent in selected high-risk patients and to keep the indications for DJ stent wider in deceased donor transplants by considering possible surgical complications. The use of the stent only in selected cases will decrease surgical complications due to stent placement.


Halicioglu O.,Izmir Tepecik Teaching and Research Hospital | Aksit S.,Ege University | Koc F.,Ege University | Akman S.A.,Izmir Tepecik Teaching and Research Hospital | And 6 more authors.
Paediatric and Perinatal Epidemiology | Year: 2012

Halicioglu O, Aksit S, Koc F, Akman SA, Albudak E, Yaprak I, Coker I, Colak A, Ozturk C, Gulec ES. Vitamin D deficiency in pregnant women and their neonates in spring time in western Turkey. Paediatric and Perinatal Epidemiology 2012; 26: 53-60. Although Turkey is located in a sunny region, vitamin D deficiency is still a serious health problem in pregnant women and their infants, especially among the low socio-economic status Turkish population. This study was carried out in order to measure serum 25-hydroxyvitamin D3 [25(OH)D] concentrations of the pregnant women in the last trimester and in their neonates at delivery and to determine the factors associated with maternal serum 25(OH)D concentrations. Among the patients visiting the Ege Obstetrics and Gynecology Hospital in the period March to May 2008, 258 healthy pregnant women <37 weeks of gestation were included in this study. The information on different characteristics such as the number of pregnancies and births, nutritional status, vitamin and mineral support during gestation, educational status, clothing style and the economic level of the family was collected from women. Blood samples from the mothers and umbilical cord of the newborns were taken to measure 25(OH)D. The mean 25(OH)D concentrations of the mothers and their infants were 11.5 ± 5.4 ng/mL and 11.5 ± 6.8 ng/mL, respectively. We found a strong positive correlation between maternal serum and umbilical cord blood 25(OH)D concentrations (r = 0.651, P < 0.001). The concentration of 25(OH)D was 20 ng/mL in 233 mothers (90.3%) and a;circ10 ng/mL in 130 mothers (50.4%). Maternal serum 25(OH)D concentrations related strongly to factors such as uncovered dressing style, sufficient consumption of dairy products and multivitamin use during gestation (P < 0.05). About half (52.7%) of these women had a covered dressing style. 25(OH)D concentrations of these covered dressing mothers and their infants were 9.7 ± 5.1 ng/mL and 9.7 ± 5.6 ng/mL, respectively, which were significantly lower compared with those of uncovered mothers and their babies (P < 0.001). This study showed that, despite a sunny environment, vitamin D deficiency and insufficiency are highly prevalent among the mothers and their neonates. This is generally due to the life style and nutritional status of the mothers. These findings suggest that much more effective vitamin D prophylaxis programmes should be implemented for pregnant women as well as for their babies. © 2011 Blackwell Publishing Ltd.


Mir S.,Ege University | Yavascan O.,Izmir Tepecik Teaching and Research Hospital | Berdeli A.,Ege University | Sozeri B.,Ege University
Nephrology Dialysis Transplantation | Year: 2012

Background.In steroid-resistant nephrotic syndrome (SRNS), a considerable number of patient progress to end-stage renal disease (ESRD), despite aggressive therapy. The latest advance in familial focal segmental glomerulosclerosis (FSGS) has been the discovery of a mutant form of canonical transient receptor potential channel 6 (TRPC6) leading to FSGS through unclear mechanisms. The aim of this study is to screen for TRPC6 mutations in familial and sporadic SRNS patients. Methods.Twenty-five children with SRNS originating from Turkey were included in this study. Nine patients had familial and 16 patients had sporadic SRNS. Mutation analysis was performed in all 13 coding exons of the TRPC6 gene with the direct DNA sequencing method. The control group consisted of 50 normal healthy children originating from Turkey. Results.No mutation was detected in nine children (four familial, five sporadic). A variant (L395A) in one patient, intronic nucleotide substitution (c.171 + 16 A>G and c.171 + 86 G>C) in six patients and previously described missense (A404V; rs36111323) and synonymous (N561N; rs12366144) aminoacid variants in nine patients were found. Among patients with intronic, missense and synonymous aminoacid variants, 5 patients had familial and 11 patients had sporadic SRNS. Their mean age at onset of proteinuria was 2.6 ± 1.7 years. Seven cases (three familial, four sporadic) progressed to ESRD with a mean time of 10.2 ± 2.9 years. Conclusions.In conclusion, analysis of TRPC6 gene mutations in FSGS will provide new insights into the pathogenesis of nephrotic syndrome. Previous works have emphasized that the patients with only hereditary familial FSGS carried a missense mutation in the TRPC6 gene. Our findings suggest that TRPC6 mutations may also have an important role in the pathogenesis of sporadic SRNS. © 2011 The Author.


Toz E.,Izmir Tepecik Teaching and Research Hospital | Sanci M.,Izmir Tepecik Teaching and Research Hospital | Ozcan A.,Izmir Tepecik Teaching and Research Hospital | Beyan E.,Izmir Tepecik Teaching and Research Hospital | Inan A.H.,Izmir Tepecik Teaching and Research Hospital
International Journal of Gynecology and Obstetrics | Year: 2016

Objective To compare classic terminology and the PALM-COEIN (polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory disorders, endometrium, iatrogenic, and not classified) classification system among women who underwent surgery for abnormal uterine bleeding (AUB), and to subclassify the components of the PALM group for future studies. Methods In a retrospective study, data were obtained for nonpregnant women aged 18-55 years who underwent hysterectomy, myomectomy, or polypectomy for AUB at a center in Turkey in 2014. The patients were retrospectively classified according to the PALM-COEIN system, and the two terminologies were compared. Results: A total of 471 women were included. The term "hypermenorrhea" covered 15 different pathology combinations, "menorrhagia" nine, "metrorrhagia" 14, and "menometrorrhagia" 18. Of 92 patients with polyp, 5 (5.4%) had two polyps and 1 (1.1%) had three. Of 146 patients with adenomyosis, 131 (89.7%) had diffuse adenomyosis and 12 (8.2%) had adenomyoma. Of 309 patients with myoma uteri, 108 (34.9%) had submucous myoma and 201 (65.1%) had other types of myoma. Conclusion Classic terminology for AUB is insufficient and confusing with respect to etiologic pathologies among nonpregnant women of reproductive age. Widespread adoption of the PALM-COEIN system for AUB classification will facilitate more meaningful communication among both clinicians and investigators, and clarify the populations that should be evaluated in clinical trials, thereby enhancing communication with patients. © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.


Yavascan O.,Izmir Tepecik Teaching and Research Hospital
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia | Year: 2011

Peritonitis and catheter exit- site infections (ESI) are important causes of hospitalization and catheter loss in patients undergoing chronic peritoneal dialysis (CPD). The frequency of infection can be reduced by scrupulous exit- site care with or without topical antiseptics. There are no studies showing any benefit in the use of povidone-iodine or normal saline for care of exit- sites in long- term CPD patients. In this study, we aimed to determine the potential effectiveness of the application of povidone-iodine or normal saline at the catheter exit- site in preventing ESI and peritonitis in children on CPD. A total of 98 patients treated with either povidone-iodine or normal saline were included in this study. Group I (34 patients) used povidone-iodine and group II (64 patients) simply cleansed the exit- site with normal saline (0.9% NaCl). Dressings were changed 2 to 3 times in a week. The total cumulative follow- up time was 3233 patient- months. ESIs occurred in 10 (29.4%) of 34 patients using povidone-iodine and in 10 (15.6%) of 64 patients using normal saline. The frequency of ESI was significantly high in group I (povidone-iodine) patients. The mean rate of ESI was 1 episode/60.8 patient- months for group I versus 1 episode/144 patient- months for group II (P < 0.05). The rate of peritonitis was similar in each group (1 episode/21.3 patient- months for group I versus 1 episode/20.17 patient- months for group II) (P > 0.05). In conclusion, exit- site care with normal saline is an effective strategy in reducing the incidence of ESI in children on CPD. It can thus significantly reduce morbidity, catheter loss, and the need to transfer patients on peritoneal dialysis to hemodialysis.


PubMed | Izmir Tepecik Teaching and Research Hospital
Type: Journal Article | Journal: International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics | Year: 2016

To compare classic terminology and the PALM-COEIN (polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory disorders, endometrium, iatrogenic, and not classified) classification system among women who underwent surgery for abnormal uterine bleeding (AUB), and to subclassify the components of the PALM group for future studies.In a retrospective study, data were obtained for nonpregnant women aged 18-55years who underwent hysterectomy, myomectomy, or polypectomy for AUB at a center in Turkey in 2014. The patients were retrospectively classified according to the PALM-COEIN system, and the two terminologies were compared.A total of 471 women were included. The term hypermenorrhea covered 15 different pathology combinations, menorrhagia nine, metrorrhagia 14, and menometrorrhagia 18. Of 92 patients with polyp, 5 (5.4%) had two polyps and 1 (1.1%) had three. Of 146 patients with adenomyosis, 131 (89.7%) had diffuse adenomyosis and 12 (8.2%) had adenomyoma. Of 309 patients with myoma uteri, 108 (34.9%) had submucous myoma and 201 (65.1%) had other types of myoma.Classic terminology for AUB is insufficient and confusing with respect to etiologic pathologies among nonpregnant women of reproductive age. Widespread adoption of the PALM-COEIN system for AUB classification will facilitate more meaningful communication among both clinicians and investigators, and clarify the populations that should be evaluated in clinical trials, thereby enhancing communication with patients.

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