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Tamer G.,Goztepe Education and Research Hospital | Arik S.,Goztepe Education and Research Hospital | Tamer I.,Kartal Education and Research Hospital | Coksert D.,Goztepe Education and Research Hospital
Thyroid | Year: 2011

Background: Vitamin D insufficiency, defined as serum levels of 25-hydroxyvitamin D [25(OH)D3] lower than 30 ng/mL, has been reported to be prevalent in several autoimmune diseases such as multiple sclerosis and type 1 diabetes mellitus. The goal of the present study was to assess whether vitamin D insufficiency is also a feature of Hashimoto's thyroiditis (HT). Methods: We performed a prevalence case-control study that included 161 cases with HT and 162 healthy controls. Serum levels of 25(OH)D3, calcium, phosphorus, and parathyroid hormone were measured in all 323 subjects. Results: The prevalence of vitamin D insufficiency in HT cases (148 of 161, 92%) was significantly higher than that observed in healthy controls (102 of 162, 63%, p < 0.0001). Among HT cases, the prevalence rate of vitamin D insufficiency showed a trend to be higher in patients with overt hypothyroidism (47 of 50, 94%) or subclinical hypothyroidism (44 of 45, 98%) than in those with euthyroidism (57 of 66, 86%), but the differences were not significant (p = 0.083). Conclusion: Vitamin D insufficiency is associated with HT. Further studies are needed to determine whether vitamin D insufficiency is a casual factor in the pathogenesis of HT or rather a consequence of the disease. © Copyright 2011, Mary Ann Liebert, Inc.


Sanli A.,Kartal Education and Research Hospital | Aydin S.,Kartal Education and Research Hospital | Sarisoy Z.A.,Giresun Governmet Hospital | Paksoy M.,Kartal Education and Research Hospital | And 2 more authors.
Turkish Journal of Medical Sciences | Year: 2011

Aim: To compare the protective Effect of dexamethasone and lactate against cisplatin-induced ototoxicity. Materials and methods: Thirty Wistar rats were randomly divided into 4 groups. After the rats were sedated with intraperitoneal (IP) ketamine hydrochloride (50 mg/kg) and xylazine (7.5 mg/kg), baseline ABRs (auditory brainstem evoked responses) were measured in response to clicks and tone pips of 4, 8, 12, and 16 kHz. After auditory thresholds were determined, the animals received drug administration as follows: Group 1 (n: 6) received intratympanic (IT) saline (0.9% NaCl) solution, Group 2 (n: 8) IP cisplatin (20 mg/kg) alone, Group 3 (n: 8) IT dexamethasone (0.1-0.3 mL), and Group 4 (n: 8) IT lactated Ringer's (LR) solution (0.1-0.3 mL) followed aft er 30 min by 20 mg/kg cisplatin. Dexamethasone, LR solution, and saline application were continued for 3 days. At the end of the study, ABR testing was performed and threshold changes were recorded. Results: Group 2 animals showed marked hearing loss with average threshold shift s of 39,6 dB for clicks, 7.2 dB at 4 kHz, 8.4 dB at 8 kHz, 71.1 dB at 12 kHz and 71.8 dB at 16 kHz. No significant loss was observed in Group 3 with average threshold shift s of 1.6 dB, 4.7 dB, 8.7 dB, and 4.2 dB for clicks and tone pips at 4, 8, 12, and 16 kHz, respectively. Similar findings were observed in Group 4 with shift s of 3.5 dB, 6.8 dB, 11.3 dB, and 15.2 dB for clicks and tone pips at 4, 8, 12, and 16 kHz, respectively. Significant protection was seen in Group 3 and 4 animals compared with Group 2 animals. There was no side Effect in IT administration of LR solution and dexamethasone for hearing functions. Both of these appear to be easier and safer to apply and have a usable protective Effect against cisplatin ototoxicity. Conclusion: IT administration of LR solution and dexamethasone appear to be easy and safe to apply and have a useful protective Effect. Clinical applications including these agents could be considered for use in order to reduce the side Effect s of ototoxic chemotherapy protocols. © Tübitak.


Kuru T.,Marmara University | Yeldan I.,Istanbul University | Dereli E.E.,Istanbul Bilgi University | Ozdincler A.R.,Istanbul University | And 2 more authors.
Clinical Rehabilitation | Year: 2016

Objective: To compare the efficacy of three-dimensional (3D) Schroth exercises in patients with adolescent idiopathic scoliosis. Design: A randomised-controlled study. Setting: An outpatient exercise-unit and in a home setting. Subjects: Fifty-one patients with adolescent idiopathic scoliosis. Interventions: Forty-five patients with adolescent idiopathic scoliosis meeting the inclusion criteria were divided into three groups. Schroth's 3D exercises were applied to the first group in the clinic and were given as a home program for the second group; the third group was the control. Main Measures: Scoliosis angle (Cobb method), angle of rotation (scoliometer), waist asymmetry (waist - elbow distance), maximum hump height of the patients and quality of life (QoL) (SRS-23) were assessed pre-treatment and, at the 6th, 12th and 24th weeks. Results: The Cobb (-2.53°; P=0.003) and rotation angles (-4.23°; P=0.000) significantly decreased, which indicated an improvement in the clinic exercise group compared to the other groups. The gibbosity (-68.66mm; P=0.000) and waist asymmetry improved only in the clinic exercise group, whereas the results of the other groups worsened. QoL did not change significantly in either group. Conclusion: According to the results of this study the Schroth exercise program applied in the clinic under physiotherapist supervision was superior to the home exercise and control groups; additionally, we observed that scoliosis progressed in the control group, which received no treatment. © The Author(s) 2015.


Gezen C.,Kartal Education and Research Hospital | Kement M.,Kartal Education and Research Hospital | Altuntas Y.E.,Kartal Education and Research Hospital | Okkabaz N.,Kartal Education and Research Hospital | And 5 more authors.
World Journal of Surgical Oncology | Year: 2012

Background: Locally advanced colorectal cancers are best treated with multivisceral resections. The aim of this study is to evaluate early and late results after multivisceral resections.Methods: All patients operated for primary colorectal cancer between 2001 and 2010 were -reviewed. These were compared within the patients underwent single organ and multivisceral resections: demographics, tumor and procedure related parameters, perioperative results, early oncological outcomes and 5-year survival.Results: A total of 354 patients (59.6 ± 13.8 years old, 210 [59.3%] males) were abstracted. Ninety (25.4%) patients underwent multivisceral resections for clinical T4 tumors and en-bloc R0 resection was achieved in 82 (91.1%). Only 31 (34.4% and 8.8% of clinical T4 and all cancers, respectively) cases had actual adjacent organ invasions (pT4). Males (20%) had lower risk for locally advanced tumors than females (33.3%) (p < 0.05). PT4 cancers were more common, if the clinical T4 tumor is located in the colon (48.8% vs 21.3%; p < 0.01). Laparoscopy was seldom initiated and the risk of conversion was higher in clinical T4 tumors (p < 0.05). The rates of sphincter-saving procedures were not different. Operation time, bleeding and transfusion requirements increased when multivisceral resections were necessitated (p < 0.05), but hospital stay, complications and 30-day mortality rates were similar. The 5-year survival rates were identical (p > 0.05).Conclusions: Clinical T4 tumors are not rare and more common in women. An actual invasion (pT4) may be observed in one third of all clinical T4 tumors, and more frequent in colon cancers. An en-bloc, R0, multivisceral resection may be achieved in most cases. Multivisceral resections do not alter the rates of sphincter-saving procedures, morbidity and 30-day mortality; do not worsen survival but increase operation time, intraoperative bleeding and perioperative transfusion requirements. © 2012 Gezen et al; licensee BioMed Central Ltd.


Kement M.,Samsun Education and Research Hospital | Ozlem N.,Samsun Education and Research Hospital | Colak E.,Samsun Education and Research Hospital | Kesmer S.,Samsun Education and Research Hospital | And 2 more authors.
World Journal of Gastroenterology | Year: 2012

AIM: To describe the clinical characteristics of patients with gastric or intestinal bezoars recently treated in our hospital. METHODS: In this study, a retrospective chart review of consecutive patients with gastrointestinal bezoars, who were treated at the Samsun Education and Research Hospital between January 2006 and March 2011, was conducted. Data on demographic characteristics, clinical presentation, history of risk factors, diagnostic procedures, localization of bezoars, treatment interventions, and postoperative morbidity and mortality rates were collected and evaluated. RESULTS: Forty-two patients [26 (61.9%) males and 16 (31.1%) females] with a mean ± SD (range) age of 55.8 ± 10.5 (37-74) years were enrolled in this study. Thirty-six patients (85.7%) had one or more predisposing risk factors for gastrointestinal bezoars. The most common predisposing risk factor was a history of previous gastric surgery which was identified in 18 patients (42.8%). Twenty three patients (54.8%) had multiple predisposing risk factors. Phytobezoars were identified in all patients except one who had a trichobezoar in the stomach. Non-operative endoscopic fragmentation was performed either initially or after unsuccessful medical treatment in 14 patients with gastric bezoars and was completely successful in 10 patients (71.5%). Surgery was the most frequent treatment method in our study, which was required in 28 patients (66.7%). Intestinal obstruction secondary to bezoars was the most common complication (n = 18, 42.8%) in our study. CONCLUSION: The presence of multiple predisposing factors may create a synergistic effect in the development of bezoars. © 2012 Baishideng. All rights reserved.


Gezen C.,Kartal Education and Research Hospital | Altuntas Y.E.,Kartal Education and Research Hospital | Kement M.,Kartal Education and Research Hospital | Aksakal N.,Kartal Education and Research Hospital | And 4 more authors.
Journal of Laparoendoscopic and Advanced Surgical Techniques | Year: 2012

Background: This study aims to compare the results of laparoscopic and conventional techniques in patients with low rectal cancers. Subjects and Methods: A retrospective data analysis was initiated in patients underwent laparoscopic or conventional surgery for cancers located in the low (<6 cm) rectum. Patient and tumor-related information, outcomes of operations, and survival were compared between the groups. Results: Among 142 patietns (91 men [64.1%]; mean±standard deviation age, 57.7±14.6 years) who had tumors located <6 cm from the dentate line, 92 (64.8%) were operated on with the laparoscopic technique. Demographics, tumor stage, and localization (2.9±2.0 versus 2.9±2.1 cm from the dentate line in laparoscopic and conventional arms, respectively; P=.968) were similar. However, there were more patients in the laparoscopic group who received neoadjuvant chemoradiation therapy (92.4% versus 80.0%; P=.03), since there were significantly fewer cases with stage I tumors in this group (3.3% versus 14%; P=.33). The conversion rate was 14.1% (n=13). The amount of bleeding and the requirement for transfusion decreased (P<.05 for both), and the possibility of sphincter-saving procedures (66.3% versus 34.0%; P<.001) increased, in the laparoscopy group. Other parameters were identical. In the laparoscopy group, the number of harvested lymph nodes (10.2±5.4 versus 12.4±6.0; P=.025) and the rate of vascular invasion (27.5% versus 47.8%; P=.021) were less, and Kaplan-Meier analysis revealed an improved survival (P=.042), although the follow-up period was significantly shorter in this group (P<.001). Conclusions: Laparoscopic surgery for low rectal cancers may be technically feasible and oncologically safe. Laparoscopy may increase the possibility of sphincter preservation. © Copyright 2012, Mary Ann Liebert, Inc. 2012.


Karadas O.,Erzincan Military Hospital | Gul H.L.,Kartal Education and Research Hospital | Inan L.E.,Ankara Education and Research Hospital
Journal of Headache and Pain | Year: 2013

Background: The present study aimed to evaluate the efficacy of local lidocaine injections into the myofascial trigger points (TPs) located at the pericranial muscles in patients with episodic tension-type headache (ETTH). Methods: The study included 108 patients with frequent ETTH that were randomized into 4 groups. One injection of saline (NaCl 0.9%) was administered to group 1 (n = 27), 1 injection of lidocaine (0.5%) was administered to group 2 (n = 27), group 3 (n = 27) received 5 injections of saline (NaCl 0.9%), and group 4 (n = 27) received 5 injections of lidocaine (0.5%); on alternate days 2 mL for each muscle was injected into the frontal, temporal, masseter, sternocleidomastoid, semispinalis capitis, trapezius and splenius capitis muscles bilaterally. The frequency of painful days per month (FPD) and the patients' visual analogue scales (VAS) were evaluated before treatment, and 2, 4 and 6 months after treatment. Results: Mean age of the patients was 36.28 ± 9.41 years (range: 18-54 years). FPD scores improved significantly in group 2, 3 and 4 at 2 months posttreatment compared to pre- treatment (all P < 0.05), and also VAS scores improved significantly in group 2 and 4 at 2 months posttreatment (P < 0.05) but this improvement insisted at the 6 month only in group 4. Group 2 had better VAS and FPD than group 1 only at 2. and 4. months after treatment (for VAS P < 0.0121, P = 0.0232; for FPD P = 0.0003, P = 0.0004, respectively). Group 4 had better scores than group 3 at the 2., 4. and 6. months after treatment in both parameters (all P < 0.05). Group 2 had better scores than group 1 in FPD at the 2. and 4. months posttreatment (P = 0.0003, P = 0.0004, respectively), but not at the 6. month. Conclusion: Local lidocaine injections into the myofascial TPs located in the pericranial muscles could be considered as an effective alternative treatment for ETTH. © 2013 Karadaş et al.; licensee Springer.


PubMed | Istanbul University and Kartal Education and Research Hospital
Type: | Journal: International journal of surgery (London, England) | Year: 2015

Current study aims to analyze the impact of previous vertical laparotomy on safety and feasibility of laparoscopic sigmoid colon and rectal cancer operations.All consecutive patients who underwent a laparoscopic resection for sigmoid colon or rectal cancer were included. These aspects were abstracted and compared within no laparotomy and previous vertical laparotomy groups: demographics, perioperative aspects, pathological features and survival.There were 252 patients in no laparotomy group, and 25 cases with previous vertical incisions including lower (n = 12, 48%), upper (n = 7, 28%), and lower&upper (n = 2, 8%) midline and paramedian (n = 4, 16%) laparotomies. Veress insufflation and open technique were used in 19 (76%) and 6 (24%) cases, respectively, during the insertion of the first trocar in previous laparotomy group. Patients in previous laparotomy group were significantly older (59.2 13.4 vs. 66.2 10.1, p = 0.01), but gender, ASA scores, tumor and technique related factors were similar within the groups, including operation time (200 [70-600] vs. 200 [130-390] min, p = 0.353), blood loss (250 [100-1500] vs. 250 [0-2200] ml, p = 0.46), additional trocar insertion (10 [4%] vs. 3 [12%], p = 0.101), conversion (20 [7.9%] vs. 4 [16%], p = 0.25), postoperative complication (59 [23.4%] vs. 4 [16%], p = 0.06) and 30-day mortality (7 [2.8%] vs. 1 [4%], p = 0.536) rates. Oncological outcomes regarding pathological features and 5-year survival rates (65% vs. 73.2%, p = 0.678) were not different.The presence of a previous laparotomy does not worsen the outcomes in patients undergoing laparoscopic removal of sigmoid or rectal cancer, thus laparoscopy may be considered to be safe and feasible in these cases.


PubMed | Istanbul University, Istanbul Bilgi University, Marmara University and Kartal Education and Research Hospital
Type: Journal Article | Journal: Clinical rehabilitation | Year: 2015

To compare the efficacy of three-dimensional (3D) Schroth exercises in patients with adolescent idiopathic scoliosis.A randomised-controlled study.An outpatient exercise-unit and in a home setting.Fifty-one patients with adolescent idiopathic scoliosis.Forty-five patients with adolescent idiopathic scoliosis meeting the inclusion criteria were divided into three groups. Schroths 3D exercises were applied to the first group in the clinic and were given as a home program for the second group; the third group was the control.Scoliosis angle (Cobb method), angle of rotation (scoliometer), waist asymmetry (waist - elbow distance), maximum hump height of the patients and quality of life (QoL) (SRS-23) were assessed pre-treatment and, at the 6(th), 12(th) and 24(th) weeks.The Cobb (-2.53; P=0.003) and rotation angles (-4.23; P=0.000) significantly decreased, which indicated an improvement in the clinic exercise group compared to the other groups. The gibbosity (-68.66mm; P=0.000) and waist asymmetry improved only in the clinic exercise group, whereas the results of the other groups worsened. QoL did not change significantly in either group.According to the results of this study the Schroth exercise program applied in the clinic under physiotherapist supervision was superior to the home exercise and control groups; additionally, we observed that scoliosis progressed in the control group, which received no treatment.


PubMed | Istanbul University and Kartal Education and Research Hospital
Type: Journal Article | Journal: The Indian journal of surgery | Year: 2015

The bipolar radiofrequency device (Habib) has been recently introduced in order to reduce intraoperative bleeding for a safe hepatic resection as an alternative to the conventional tools. However, indications, perioperative findings, and outcome of the device for hepatic resections remain and deserve to be analyzed. The current study aims to analyze the feasibility of the bipolar radiofrequency device (Habib) for hepatic resections. Information of the patients that underwent hepatic resection using with the Habib device between 2007 and 2011 was abstracted. Patient, disease, and operation-related findings and perioperative data were investigated. A total of 71 cases (38 [53.5%] males, mean age was 56.811.9) were analyzed. Metastatic disease (n=55; 77.5%) was the leading indication followed by primary liver and biliary malignancies (n=7; 9.9%), hemangioma (n=5; 7%), hydatid disease (n=3; 2.8%), and hepatic gunshot trauma (n=1; 1.4%). Metastasectomy was the most commonly performed procedure (n=31; 56.3%), but in 24 (77.4%) cases, it was performed in addition to extended resections. Other procedures in the study patients include segmentectomy in 17, bisegmentectomy in 19, trisegmentectomy in 17, right or left hepatectomy in 8, and extended right/left hepatectomy in 3. The mean (SD) operation time was 241.778.2min. The median amount of bleeding was 300cc (range 25-2500), and 23 (32.4%) cases required perioperative transfusion. The median hospitalization period was 5days (range 1-47). Lengthened drainage (n=9, 12.7%) and intraabdominal abscess (n=8, 11.23%) were the most common problems. Hepatic resections using the Habib device seem to be feasible in cases with primary and metastatic hepatic lesions and benign liver masses and even those with hepatic trauma. It may lessen the amount of intraoperative hemorrhage, although lengthened drainage and intraabdominal abscess were the major postoperative problems in these cases.

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