Kartal Training and Research Hospital

İstanbul, Turkey

Kartal Training and Research Hospital

İstanbul, Turkey
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Sogutlu Sari E.,Balikesir University | Kubaloglu A.,Kartal Training and Research Hospital | Unal M.,Akdeniz University | Pinero D.,University of Alicante | And 3 more authors.
American Journal of Ophthalmology | Year: 2013

Purpose: To compare outcomes of big-bubble deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) for macular corneal dystrophy. Design: Prospective, randomized, interventional case series. Methods: setting: Single hospital. patients: Eighty-two eyes of 54 patients requiring keratoplasty for the treatment of macular corneal dystrophy without endothelial involvement were included. main outcome measures: Operative complications, uncorrected visual acuity, best-corrected visual acuity, contrast sensitivity function, higher-order aberrations, and endothelial cell density were evaluated. Results: The DALK and PK group consisted of 35 and 41 eyes, respectively. Best-corrected visual acuity after surgery was 20/40 or better 68.5% and 70.7% of the eyes in the DALK and PK groups, respectively (P >.05). No statistically significant differences between groups were found in contrast sensitivity function with and without glare for any spatial frequency (P >.05). Significantly higher levels of higher-order aberrations were found in the DALK group (P <.01). In both groups, a progressive and statistically significant reduction in endothelial cell density was found (P <.01). At the last follow-up, the mean endothelial cell loss was 18.1% and 26.9% in DALK and PK groups, respectively (P =.03). Graft rejection episodes were seen in 5 eyes (12.1%) in the PK group, and regrafting was necessary in 3 eyes (7.3%). Recurrence of the disease was documented in 5.7% and 4.8% of the eyes in the DALK and PK groups, respectively. Conclusions: Deep anterior lamellar keratoplasty with the big-bubble technique provided comparable visual and optical results as PK and resulted in less endothelial damage, as well as eliminating endothelial rejection in macular corneal dystrophy. Deep anterior lamellar keratoplasty surgery is a viable option for macular corneal dystrophy without endothelial involvement. © 2013 Elsevier Inc. All rights reserved.

Sari E.S.,Kartal Training and Research Hospital | Kubaloglu A.,Kartal Training and Research Hospital | Unal M.,Akdeniz University | Llorens D.P.,University of Alicante | And 4 more authors.
British Journal of Ophthalmology | Year: 2012

Purpose: To evaluate and compare visual and optical performance outcomes by means of analysis of the contrast sensitivity function (CSF) and ocular higher order aberrations (HOA) in patients with keratoconus who had deep anterior lamellar keratoplasty (DALK) or penetrating keratoplasty (PK). Methods: In this prospective, randomised case series, 174 eyes of 140 consecutive patients with moderate to advanced keratoconus were included. The big-bubble technique was attempted to perform DALK. Intraoperative and postoperative complications, uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), refraction, topographic astigmatism, CSF and ocular HOA were evaluated. Results: The DALK and PK groups consisted of 99 and 75 eyes, respectively. Postoperative BSCVA was 20/40 or better in 64 eyes (85%) in the PK group and and 82 eyes (83%) in the DALK group (p>0.05). The mean spherical equivalent and maximum keratometry were -1.50 (-6.25 to +4.75) and 46.85 (40.60 to 56.00) in the PK group and -2.25 (-8.75 to +4.00) and 46.90 (40.60 to 53.60) in the DALK group, respectively. The differences were not statistically significant (p=0.08 and p=0.66, respectively). No significant differences in photopic contrast sensitivity were found for each of the spatial frequencies (p>0.05 for all). However, mesopic contrast sensitivity for three cycles/degree was significantly higher in the DALK group (p=0.01). No significant differences between groups were detected for any of the aberrometric parameters (p>0.05). Conclusions: DALK is an alternative treatment option in eyes with moderate to advanced keratoconus, providing comparable results to PK in terms of visual acuity, refraction, CSF and HOA.

Paksoy M.,Kartal Training and Research Hospital | Hardal U.,Kartal Training and Research Hospital | Caglar C.,Kartal Training and Research Hospital
Journal of Cancer Research and Clinical Oncology | Year: 2011

Objective: The aim of this study was to investigate the relation between Cathepsin D (Cath-D) and E-Cadherin (E-Cad) expression levels in tumor tissue and neck lymph node metastasis. This attempt should be made to identify new factors that one could be useful in predicting clinical behavior. Study design: In this study, we investigated rates of dying for E-Cad and Cath-D in paraphin blocks of larynx and neck dissection specimens taken from 56 selected patients. Laryngeal specimens dyed by ECad and Cath-D immunohistochemically. Immunoreactivity classified for E-Cad as positive (75% and above), reduced (25-75%) and negative (below 25%). Immunoreactivity classified for Cath-D:dye absorption rates higher than 50% evaluated positive and absorption rates lower than 50% evaluated negative. We compared the rates of dying for E-Cad and Cath-D groups to with or without neck lymph node metastasis in specimens. Results: Neck metastasis were found in 41% of patients, in 55.6% of patients, if the E-Cad was negative, 40.6% if it was reduced, 33.3% if it was positive in specimens. The neck metastasis was found in 35.4% of patients with Cath-D expression negative, while 75% of patients was found with Cath-D expression positive. Conclusion: Neck metastasis was found higher in E-Cad reduced group than positive group. Neck node metastasis was significantly higher in Cath-D positive group than Cath-D negative group. Cath-D and E-Cad essays may useful in identifying neck lymph node involvement. Cath-D expression levels are more in this predictive factor than E-Cad levels for possibility of neck lymph node metastasis in LSCC. © The Author(s) 2011.

Canguven O.,Kartal Training and Research Hospital
Turk Uroloji Dergisi | Year: 2013

In the field of urology, many new ideas and skills are developed by surgeons and researchers. To share this knowledge or these skills with others, we should publish our findings in journal articles. This article is an attempt to lucidly convey how to go about submitting a scientific article for publication in an appropriate journal. © 2013 by Turkish Association of Urology.

Canguven O.,Kartal Training and Research Hospital | Albayrak S.,Kartal Training and Research Hospital
Medical Hypotheses | Year: 2011

Asthma is a chronic inflammatory airway disorder that causes respiratory hypersensitivity and intermittent obstruction. Airway hyperresponsiveness to both specific and nonspecific stimuli is the hallmark of asthma. Although genetic susceptibility and airway inflammation are believed to play fundamental roles, etiology of asthma is unknown. In most cases, the treatment of asthma focuses on control of factors contributing to asthma severity and pharmacologic therapy including bronchodilator and anti-inflammatory agents.The prevalence of reported asthma is greater in prepubertal boys, with a change to a female predominance after puberty. Many epidemiological studies also suggest that women are at increased risk of developing adult-onset asthma and also suffer from more severe disease than men. This strongly suggests an important role for sex hormones in asthma. Previous articles provided us that, testosterone and/or its metabolites maintain the physiological balance of autoimmunity and protective immunity by preserving the number of regulatory cells. Testosterone is an immunosuppressant and is likely to be protective against immunological and inflammatory processes that trigger asthma.We hypothesized that the testosterone or selective androgen receptor modulators would have beneficial effects on asthma and could decrease the risk of asthmatic attacks. © 2011 Elsevier Ltd.

Goktas C.,Kartal Training and Research Hospital | Akca O.,Kartal Training and Research Hospital | Horuz R.,Kartal Training and Research Hospital | Gokhan O.,Biosan Center | And 2 more authors.
Urology | Year: 2011

Objective: To evaluate the treatment parameters of shockwave lithotripsy (SWL) in lower calyceal calculi in adults and children in a comparative manner. Material and Methods: Between 2006 and 2011, SWL was performed for lower calyceal calculi in 282 adults (mean age 48.5 years, range 28-64) and 54 children (mean age 48 months, range 5-141). The Wolf Piezolith 3000 lithotriptor has been used for SWL. Success rates, auxiliary procedures, additional interventions, and complications were evaluated in detail in a comparative manner. Results: Mean stone size was 7.7 mm (range 5-25) and 8.1 mm (range 5-23) in children and in adults, respectively. Mean SWL sessions were 1.5 (range 1-5) in children and 2.4 (range 1-6) in adults. Although 66.6% of children were stone-free after the first session, 28% of adult patients were stone-free after the first SWL session, showing a statistically significant difference (P =.0001). After the treatments, although a complete stone-free status was obtained in 85% of children, 31.5% of adults were stone-free at 3-month follow-up after SWL (P =.0001). Although no auxiliary procedures were needed in children, 8.2% of adults required them. Likewise, the percentage of additional procedures were higher in adults than children (20.2%). Conclusion: SWL for lower calyceal calculi has been found to be highly successful in pediatric patients. These results demonstrate that, irrespective of stone size, SWL should be the first treatment alternative in the management of lower calyx stones in children. © 2011 Elsevier Inc.

Basaran N.F.,Kartal Training and Research Hospital | Akici A.,Marmara University
Patient Preference and Adherence | Year: 2012

Aim: Physicians' inappropriate prescribing habits affect patients' lives both medically and financially. To avoid these unwanted situations, the World Health Organization defined the rational use of drugs (RUD) in 1985. This study aimed to investigate whether patients were as informed about their diagnosis and medication as anticipated and their knowledge about the RUD in general. Methods: A questionnaire was given to 260 patients being treated at the Kartal Training and Research Hospital between February and March 2012. Results: Most of the patients declared that they were not informed enough about their diagnosis and not all of the physicians evaluated their therapies. These undesirable conditions were due to high daily examined patient numbers. A total of 68.6% of patients stated that time allotted per patient was 0-10 minutes, 33.1% found the information given sufficient, and 11.3% were told to repeat back narratives about their treatments. Instructions and warnings given by physicians about prescribed drugs did not fully meet the RUD criteria. The majority of referred patients were willing to be educated about the subject. Conclusion: These results showed that heavy patient load seriously affects the RUD process. Improvement of the current health system should be given serious consideration. After sufficient arrangements have been made in this field, patients will be able to be informed properly about medicines prescribed by their physicians. Also, public education programs will be helpful to raise awareness of the subject on a larger scale. © 2012 Basaran and Akici, publisher and licensee Dove Medical Press Ltd.

Koytak A.,Kartal Training and Research Hospital | Erol K.,Kartal Training and Research Hospital | Coskun E.,Kartal Training and Research Hospital | Asik N.,Kartal Training and Research Hospital | And 2 more authors.
Retina | Year: 2010

Purpose: The purpose of this study was to evaluate the results of fluorescein angiog-raphy-guided photodynamic therapy with half-dose verteporfin in the treatment of chronic central serous chorioretinopathy with focal leakage areas. Methods: Eight cases with a history of central serous chorioretinopathy of ≥6 months were included. All eyes had one or more focal areas of active retinal pigment epithelial leak. Photodynamic therapy was applied with half-dose verteporfin (3 mg/m), and the spot size was set limited to the area of active leakage shown on fluorescein angiography. Results: The mean duration of the last central serous chorioretinopathy episode was 12.50 months. The mean best-corrected visual acuity improved from 20/122 to 20/60 the first month (P = 0.017) and to 20/55 the first year after treatment (P = 0.018). Seven eyes (87.5%) had improved vision 1 year after treatment, and 1 eye (12.5%) had stable vision with a mean number of 3.61 gained lines. The mean central macular thickness was reduced from 366 ± 95 μm to 217 ± 32 μm the first month (P = 0.006). Conclusion: Fluorescein angiography-guided photodynamic therapy with half-dose verteporfin seems to be a rational and effective alternative to other methods in the treatment of chronic central serous chorioretinopathy with focal leakage on fluorescein angiography. Copyright © 2010 Lippincott Williams & Wilkins. All rights reserved.

Koyuncu H.H.,Yeditepe University | Yencilek F.,Yeditepe University | Eryildirim B.,Kartal Training and Research Hospital | Sarica K.,Yeditepe University
Urological Research | Year: 2010

The aim of this study was to evaluate the possible effect of a positive family history on the age at the onset of urinary stone disease and the frequency of subsequent symptomatic episodes relating to the disease. Between March 2006 and April 2009, patients with either a newly diagnosed or a previously documented stone disease were included in the study program. They were required to fill in a questionnaire and divided into two groups according to the positive family history of stone disease; group I comprised patients with a family history for urinary calculi and group II those without. Depending on the data obtained from questionnaires, all patients were evaluated in detail with respect to the age at the onset of the stone disease, stone passage and interventions over time, time to first recurrence (time interval between the onset of the disease and the first recurrence), number of total stone episodes and recurrence intervals. 1,595 patients suffering from urolithiasis with the mean age of 41.7 (14-69 years) were evaluated with respect to their past history of the disease. There were 437 patients in group I and 1,158 in group II. There was no statistically significant difierence between the mean age value of two groups (P = 0.09). When both genders in group I were analyzed separately, female patients tended to have higher rate of family history positivity than males. Comparative evaluation of the age at the onset of the disease between the two groups did reveal that stone formation occured at younger ages in patients with positive family history [P = 0.01 (males), P = 0.01 (females)] and the mean age of onset of the disease was lower in males than females in group I (P = 0.01). Patients in group I had relatively more stone episodes from the onset of the disease [P < 0.01 (2-4 episodes), P < 0.01 (≥5 episodes)]. Male patients were associated with higher number of stone episodes (P = 0.01). Mean time interval between recurrences was noted to be significantly shorter in group I patients when compared with patients in group II [P < 0.01 (males), P = 0.02 (females)]. In conclusion, our results showed that urinary stone formation may occur at younger ages and that the frequency of symptom episodes may be higher in patients with a positive family history. We believe that the positive family history for urinary stone disease could give us valuable information concerning the onset as well as the severity of the disease. © The Author(s) 2009.

Filiz Basaran N.,Kartal Training and Research Hospital | Akici A.,Marmara University
European Journal of Clinical Pharmacology | Year: 2013

Purpose: The rational use of drugs (RUD) is primarily the responsibility of physicians. The aim of this study was to investigate whether physicians are aware of RUD principles and how they apply them in daily medical practice. Methods: A total 136 physicians working at the Kartal Training and Research Hospital in Istanbul were enrolled in the study between February and March 2012. A face-to-face interview was conducted with physicians to assess their knowledge and attitude regarding RUD. Results: A large majority of the physicians declared that consultation time was insufficient (84 %). The data obtained from the survey indicate that 54 % of the enrolled physicians monitored the therapeutic outcome and that 27 % found the information given to the patient to be sufficient. Participating physicians stated that the less known characteristics of the drugs they prescribed were drug interactions, traceability in market, and price. The most preferred reference source was Vademecum (a drug guideline prepared by the private sector). Two major factors contributing to prescribing patterns were "self study" and "observation of teachers" at clinical training. There was a significant difference between internists-surgeons and residents-specialists in the number of prescribed drugs per prescription (p < 0.001) and in the information provided to the patient on the prescribed drugs (name, effect, dose, instructions, possible side effect) (p < 0.05), respectively. Conclusions: Our findings overall show that the principles of RUD were not fully applied in daily medical practice by the participating physicians. One important reason for this is a heavy patient load, which requires a change in managerial practices within the healthcare system. The other, more essential explanation is education; consequently, serious consideration should be given to including effective clinical pharmacotherapy training and RUD courses in the medical education curriculum. © 2013 Springer-Verlag Berlin Heidelberg.

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