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Zehir R.,Kartal Kosuyolu Heart and Research Hospital | Karabay C.Y.,Kartal Kosuyolu Heart and Research Hospital | Kocabay G.,University of Padua | Kalayci A.,Kartal Kosuyolu Heart and Research Hospital | And 4 more authors.
Journal of Interventional Cardiac Electrophysiology | Year: 2014

Conclusion: This study shows that atrial electromechanical delay is prolonged in PCOS patients. Atrial electromechanical delay prolongation is related to low-grade inflammation, insulin resistance, and LV diastolic dysfunction in PCOS.Results: PWD was higher in PCOS women (50.45 ± 3.7 vs 34.73 ± 6.7 ms, p = 0.008). Interatrial and intraatrial electromechanical delay were found longer in patients with PCOS compared to controls (41.9 ± 9.0 vs 22.2 ± 6.6 ms, p < 0.001; 22.6 ± 5.8 vs 5.9 ± 4.7 ms, p < 0.001, respectively). Left atrial (LA) volume index and LV diastolic parameters were significantly different between the groups. PWD was correlated with interatrial electromechanical delay (r = 0.54, p < 0.01). Interatrial electromechanical delay was strongly correlated with homeostatic model assessment insulin resistance index and high-sensitivity C-reactive protein levels (r = 0.68, p < 0.001; r = 0.53, p < 0.001, respectively). Interatrial electromechanical delay was positively correlated with LA volume index and deceleration time (r = 0.31, p = 0.04; r = 0.37, p = 0.021, respectively) and negatively correlated with flow propagation velocity (r = −0.38, p = 0.014).Background: Polycystic ovary syndrome (PCOS) is closely related to increased cardiovascular risk in women of reproductive age. Atrial conduction abnormalities in these patients have not been investigated in terms of atrial electromechanical delay measured by tissue Doppler imaging (TDI) as an early predictor of atrial fibrillation development. The aim of this study was to evaluate whether TDI-derived atrial conduction time is prolonged in PCOS.Methods: The study included 51 patients with PCOS and 48 age-matched healthy controls. P-wave dispersion (PWD) was calculated on the 12-lead surface electrocardiogram. Systolic and diastolic left ventricular (LV) functions, atrial electromechanical coupling, intraatrial and interatrial electromechanical delays were measured with conventional echocardiography and TDI. © 2014, Springer Science+Business Media New York.


Hasbahceci M.,Bezmialem Foundation University | Basak F.,Umraniye Education and Research Hospital | Acar A.,Lutfi Kirdar Kartal Education and Research Hospital | Alimoglu O.,Istanbul Medeniyet University
Minimally Invasive Surgery | Year: 2014

Background. The exact nature of learning curve of totally extraperitoneal inguinal hernia and the number required to master this technique remain controversial. Patients and Methods. We present a retrospective review of a single surgeon experience on patients who underwent totally extraperitoneal inguinal hernia repair. Results. There were 42 hernias (22 left- and 20 right-sided) in 39 patients with a mean age of 48.8±15.1 years. Indirect, direct, and combined hernias were present in 18, 12, and 12 cases, respectively. The mean operative time was 55.1±22.8 minutes. Peritoneal injury occurred in 9 cases (21.4%). Conversion to open surgery was necessitated in 7 cases (16.7%). After grouping of all patients into two groups as cases between 1-21 and 22-42, it was seen that the majority of peritoneal injuries (7 out of 9, 77.8%, P=0.130) and all conversions (P=0.001) occurred in the first 21 cases. Conclusions. Learning curve of totally extraperitoneal inguinal hernia repair can be divided into two consequent steps: immediate and late. At least 20 operations are required for gaining anatomical knowledge and surgical pitfalls based on the ability to perform this operation without conversion during immediate phase. © 2014 Mustafa Hasbahceci et al.


Baykul T.,Suleyman Demirel University of Turkey | Basak K.,Lutfi Kirdar Kartal Education and Research Hospital | Kocer G.,Suleyman Demirel University of Turkey
Journal of Craniofacial Surgery | Year: 2013

Objective: The objective of this study was to determine whether smoking causes pathological changes, comparing intensity of epidermal growth factor receptor (EGFR) expression in smokers' and non-smokers' pericoronal follicles located around asymptomatic impacted lower third molars. Study Design: Eighty-two dental follicles were collected from asymptomatic mandibular third molars of 41 smoker and 41 nonsmoker patients. Specimens were examined immunohistochemically using antibody against EGFR. Results: The expression of EGFR in smokers' pericoronal follicles was higher as compared with nonsmokers (P = 0.036). Also, high EGFR expression was detected in female smokers than in female nonsmokers (P = 0.01). There was a statistically significant correlation between pack-years and EGFR expression intensity in male patients. Conclusions: The risk of pathological differentiation in pericoronal tissues of smoking patients is higher than in the nonsmoking patients. This factor may be taken into account when deciding whether to remove an asymptomatic impacted lower third molar. Copyright © 2013 by Mutaz B. Habal, MD.


Korkmaz A.A.,Sema Hospital | Onan B.,Lutfi Kirdar Kartal Education and Research Hospital | Demir A.S.,Sema Hospital | Tarakci S.I.,Sema Hospital | And 3 more authors.
Anadolu Kardiyoloji Dergisi | Year: 2011

Objective: Mitral valve repair has become the procedure of choice for almost every type of mitral regurgitation (MR) in the current surgical era. We assessed clinical outcomes of mitral valve repair in severe MR. Methods: In this prospective cohort study, 103 patients (61 male, 42 female, mean age 53.2±14.8 years), who were planned to undergo valve repair were included. Mitral valve pathology was regurgitant in 86% and mixed in 14% of patients. The intention to perform mitral repair was successful in 100 (97.1%) of patients. Concomitant procedures were performed in 57 (57%) patients including 31 coronary artery bypass grafting and 13 tricuspid valve repairs. After surgery, early (<30 days) and late (>30 days) complications were recorded. Postoperative echocardiography was performed in all patients at discharge and during clinical follow-up. Late survival and freedom from adverse events including thromboembolism, endocarditis, reoperation, and residual severe MR were estimated by using the Kaplan-Meier survival analysis. Results: There was no early mortality. Echocardiographic assessment of patients at discharge revealed no/trivial regurgitation in 89% and mild (1+) MR in 11% of all patients. Late mortality occurred in only one patient at 14 months because of renal failure. The mean follow-up period of patients was 21.2±10.3 months. Echocardiographic examination during follow-up revealed that mitral insufficiency was none or mild in 96% of patients. Three (3%) patients had moderate (2+) MR and were treated medically. Mitral insufficiency recurrence with severe (3+) regurgitation occurred in one (1%) patient undergoing coronary artery revascularization and concomitant left ventricular aneurysmectomy. Re-operation was needed in only one (1%) case because of infective endocarditis that was treated with mechanical valve replacement. Kaplan-Meier estimates were 99±2.7% for late survival and 98±2.2%, 99±2.7%, 99±2.7% and 99±0.9% for freedom from thromboembolism, endocarditis, reoperation, and residual severe MR, respectively. Conclusion: This study showed that mitral valve repair provides excellent surgical outcomes. Repair procedures are safe, and highly effective, but operations require a considerable surgical experience. © 2011 by AVES Yayi{dotless}nci{dotless}li{dotless}k Ltd.


Bozbuga M.,Lutfi Kirdar Kartal Education and Research Hospital | Gulec I.,Lutfi Kirdar Kartal Education and Research Hospital | Suslu H.T.,Lutfi Kirdar Kartal Education and Research Hospital | Bayindir C.,Istanbul University
Neurology India | Year: 2010

Lhermitte-Duclos disease (LDD) is a pathologic entity with progrediating, diffuse hypertrophy chiefly of the stratum granulosum of the cerebellum. Typically LDD is a unilateral lesion of the cerebellum or in vermis. Here we report a case of LDD with bilateral lesions of cerebellar hemispheres managed surgically. A 28-year-old woman presented with one-year history of progressive headache, nausea, vomiting, and blurred vision. Neurologic examination revealed a bilateral mild papilledema, mild dysmetria, and dysdiadochokinesia. The cerebellar lesions caused moderate mass effect in posterior fossa with hydrocephalus, and Chiari type I malformation. We performed the suboccipital-retrosigmoid approach, and removed completely the left intracerebellar mass. Symptoms related to elevated intracranial pressure disappeared in a short period postoperatively.


Arslan F.,Lutfi Kirdar Kartal Education and Research Hospital | Batirel A.,Lutfi Kirdar Kartal Education and Research Hospital | Samasti M.,Istanbul University | Tabak F.,Istanbul University | And 2 more authors.
Turkish Journal of Gastroenterology | Year: 2012

Fascioliasis, which is a zoonotic infestation caused by the trematode Fasciola hepatica (liver fluke), is primarily a disease of herbivorous animals such as sheep and cattle. Humans become accidental hosts through ingesting uncooked aquatic plants such as watercress. It presents a wide spectrum of clinical pictures ranging from fever, eosinophilia and vague gastrointestinal symptoms in the acute phase to cholangitis, cholecystitis, biliary obstruction, extrahepatic infestation, or asymptomatic eosinophilia in the chronic phase. However, it may often be overlooked, especially in the acute phase, because of vague symptoms. As a result of newly introduced serological assays facilitating the diagnosis, there has been an increase in the number of reported cases. Here, we report the clinical and laboratory assessment and therapeutic approach of a series of three cases diagnosed (in order of) one week, three months and one and a half years after presentation of the first symptoms of the disease.


Suslu H.T.,Lutfi Kirdar Kartal Education and Research Hospital | Tatarli N.,Lutfi Kirdar Kartal Education and Research Hospital | Karaaslan A.,Lutfi Kirdar Kartal Education and Research Hospital | Demirel N.,Lutfi Kirdar Kartal Education and Research Hospital
Journal of Neurological Surgery, Part A: Central European Neurosurgery | Year: 2014

Laboratory training models are essential for developing and refining surgical skills prior to clinical application of spinal surgery. A simple simulation model is needed for young residents to learn how to handle instruments and to perform safe lumbar approaches. Our aim is to present a practical laboratory model using a fresh sheep lumbar spine that allows to simulate lumbar microdiscectomy in humans. The material consists of a fresh cadaveric spine from a 2-year-old sheep. The surgical steps for lumbar microdiscectomy were conducted under the magnification of the operating microscope. The cadaveric sheep spine represents a useful model to train posterior lumbar microdiscectomy. © 2014 Georg Thieme Verlag KG.


Turan Suslu H.,Lutfi Kirdar Kartal Education and Research Hospital | Tatarli N.,Lutfi Kirdar Kartal Education and Research Hospital | Hicdonmez T.,Lutfi Kirdar Kartal Education and Research Hospital | Borekci A.,Lutfi Kirdar Kartal Education and Research Hospital
British Journal of Neurosurgery | Year: 2012

Background. Laboratory training models are essential for developing and refining surgical skills prior to clinical application of spinal surgery. A simple simulation model is needed for young residents to learn how to handle instruments and to perform safe posterior lumbar approaches. Our aim is to present a practical laboratory model using a fresh sheep lumbar spine that simulates the pedicular screw fixation in spine surgery. Methods. The material consists of a fresh cadaveric spine from a 2-year-old sheep. A two-step approach was designed for posterior lumbar approaches including placement of lumbar pedicular screws. Results. The model simulates standard posterior lumbar pedicular screw fixation of the human spine. Conclusions. The cadaveric sheep spine represents a useful method to accustom trainees of neurosurgery and spine surgery residents and simulates posterior lumbar pedicular screw fixation performed in the human spine. © 2012 The Neurosurgical Foundation.


Turan Suslu H.,Lutfi Kirdar Kartal Education and Research Hospital | Bozbuga M.,Trakya University | Bayindir C.,Istanbul University
Turkish Neurosurgery | Year: 2011

Tuberculosis has been an important public health problem in both developing and develop nations. Tuberculosis of the central nervous system is rare. Tuberculosis meningitis and tuberculoma are the two most important manifestations of tuberculosis of the CNS. Intracranial tuberculomas may be solitary or multiple. Solitary tuberculomas may be indistinguishable from cranial abscess or primary brain tumor. It is necessary to rule out tuberculoma in patients with intracranial mass lesions. We present a case of tuberculoma mimicking a high grade glial tumor on magnetic resonance imaging and clinical presentation. A 30-year-old woman presented with one-month history of epilepsy. Cranial magnetic resonance imaging showed a left occipital peripheral ring-enhanced lesion with central necrosis. There was a strong suspicion of glial tumor. The lesion was totally excised with left occipital craniotomy. Histological examination of mass revealed a tuberculoma. The patient was treated with antituberculous chemotherapy.


PubMed | Lutfi Kirdar Kartal Education and Research Hospital
Type: Journal Article | Journal: Journal of B.U.ON. : official journal of the Balkan Union of Oncology | Year: 2012

To observe the outcome of maximal transurethral resection of bladder tumor (TURBT) followed by induction chemotherapy and concurrent chemoradiotherapy in medically inoperable patients with bladder cancer.This study included 30 patients with stage T 2-4 bladder cancer. The patients were first treated with TURBT, and then received 2 cycles of induction chemotherapy with gemcitabine and cisplatin, followed by concurrent chemoradiotherapy with gemcitabine.Median follow up was 28.9 months. Radiologically, complete and partial response rates were 60 and 36.7%, while cystoscopically they were 40 and 30%, respectively. Local progression (4 cases) and distant metastasis (11 cases) were noted. Median overall survival and progressionfree survival were 32 and 21 months, respectively. One -and 2-year overall survival and progression-free survival rates were 97.60% and 83.49%, respectively.The multimodal treatment performed in this study was well tolerated and achieved a high rate of bladder preservation in selected patients with bladder cancer.

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