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Gedik H.,Ministry of Health Bakirkoy Sadi Konuk Training and Research Hospital | Yokus O.,Ministry of Health Istanbul Training and Research Hospital
Asian Pacific Journal of Tropical Disease | Year: 2015

Hepatosplenic candidiasis (HSC) is a disseminated invasive fungal infection that commonly occurs in patients with acute leukemia. Persistent fever in patients who recovered from prolonged neutropenia subsequent to chemotherapy is the main symptom. A case is presented of a 26 year-old man, who was admitted to Hematology Ward with acute T-cell lymphoblastic leukemia. Febrile neutropenia developed after two cycles of hyper CVAD 1 and two cycles of hyper CVAD 2 chemotherapy. HSC was diagnosed and confirmed by computed axial tomography and hepatic biopsy. A persistent fever under antibiotic therapy should prompt investigation of HSC or other invasive fungal infection in immunocompromised patients. © 2015 Asian Pacific Tropical Medicine Press.

Bozkurt A.K.,Istanbul University | Tabak O.,Ministry of Health Istanbul Training and Research Hospital | Gumus M.,Avcilar Anadolu Hospital | Kaplan Y.,Sanofi S.A.
BMC Cardiovascular Disorders | Year: 2011

Background: To investigate the presence of peripheral artery disease (PAD) via the ankle brachial index (ABI) in patients with known cardiovascular and/or cerebrovascular diseases or with at least one risk factor for atherothrombosis.Methods: Patients with a history of atherothrombotic events, or aged 50-69 years with at least one cardiovascular risk factor, or > = 70 years of age were included in this multicenter, cross-sectional, non-interventional study (DIREGL04074). Demographics, medical history, physical examination findings, and physician awareness of PAD were analyzed. The number of patients with low ABI (< = 0.90) was analyzed.Results: A total of 530 patients (mean age, 63.4 ± 8.7 years; 50.2% female) were enrolled. Hypertension and dyslipidemia were present in 88.7% and 65.5% of patients, respectively. PAD-related symptoms were evident in about one-third of the patients, and at least one of the pedal pulses was negative in 6.5% of patients. The frequency of low ABI was 20.0% in the whole study population and 30% for patients older than 70 years. Older age, greater number of total risk factors, and presence of PAD-related physical findings were associated with increased likelihood of low ABI (p < 0.001). There was no gender difference in the prevalence of low ABI, PAD symptoms, or total number of risk factors. Exercise (33.6%) was the most common non-pharmacological option recommended by physicians, and acetylsalicylic acid (ASA) (45.4%) was the most frequently prescribed medication for PAD.Conclusion: Our results indicate that advanced age, greater number of total risk factors and presence of PAD-related physical findings were associated with increased likelihood of low ABI. These findings are similar to those reported in similar studies of different populations, and document a fairly high prevalence of PAD in a Mediterranean country. © 2011 Bozkurt et al; licensee BioMed Central Ltd.

Akpinar M.E.,Ministry of Health Istanbul Training and Research Hospital | Yigit O.,Ministry of Health Istanbul Training and Research Hospital | Kocak I.,Yeditepe University | Altundag A.,Research Hospital
Laryngoscope | Year: 2011

Objectives/Hypothesis: To evaluate the impact of the uvular length on the efficacy of palatal implants in primary snoring. Study Design: Prospective case series, tertiary hospital, snoring and respiratory sleep disorders center. Methods: Forty subjects with inserted palatal implants and diagnoses of primary snoring were included. All met the inclusion criteria of age >18 years, body mass index <30, apnea-hypopnea index <5, tonsil grade <3, soft-palate length >25 mm, and Friedman tongue position <3 following clinical, endoscopic, and polysomnographic evaluation. Epworth sleepiness scale (ESS) and the snoring-intensity visual analogue scale (VAS) were recorded before and 9 months after the implant. Four subjects with extruded implants were excluded; the remaining 36 subjects were divided into two groups, Group I and Group II, with uvular lengths of ≤15 mm and >amp;15 mm, respectively. The study assessed and compared subjective outcome measures including the partner's satisfaction (PS), partner's reported improvement (PRI), 50% VAS and ESS reduction, and subjective success (SS) defined as 50% VAS reduction. The Student t test, I;umlbsupesup& test, and logistic regression models were used for statistical evaluation. Results: SS (50% VAS reduction), PS, PRI, and 50% ESS reduction were significantly higher in Group I (P <.001, P =.0257, P =.027, P <.001). The overall SS, PRI, PS, and 50% ESS reduction were 33%, 78%, 50%, and 50%, respectively. The uvular length was found to be the determinant factor of SS (P =.005; odds ratio = 0.75), PRI (P =.039; odds ratio = 0.83), and 50% ESS reduction (P =.038; odds ratio: 0.84) following implant insertion through stepwise logistic regression analysis. Conclusions: Excess uvular length (>15 mm) is an important anatomic feature decreasing the efficacy of palatal implants in snoring, and additional measures, such as uvulectomy, should be considered simultaneously for better outcomes (level 4). © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

Ozturkmen Y.,Ministry of Health Istanbul Training and Research Hospital | Karamehmetoglu M.,Ministry of Health Istanbul Training and Research Hospital
Acta Orthopaedica et Traumatologica Turcica | Year: 2011

Ribbing disease (RD) is a rare bone dysplasia characterized by benign endosteal and periosteal new bone formation confined to the diaphysis of the long bones of the lower extremities in young adults. The etiology and optimal treatment for the disease are unknown. It is often initially diagnosed as a low-grade osteomyelitis or a bone-forming neoplasia. It may also be confused with other causes of increased bone density. The onset is usually after puberty and the most common presenting symptom is pain that does not resolve with medical treatment and sometimes is intolerable. We report the case of a 22-year old woman with clinical and radiological manifestations of RD. In spite of different medical treatment modalities, pain did not resolve and the patient consulted multiple physicians. Intramedullary reaming of the tibia was performed to relieve the severe pain. To the authors' knowledge, in this report we present a case of RD for the third time in the orthopaedic literature and also she is the second case in the English literature to undergo a definite surgical treatment modality as intramedullary reaming for the solution of her pain. Owing to the rarity of the disease we aimed to report the complete findings of our encounter with the disease and to emphasize the role of an orthopaedic surgeon in consultation and intervention for the treatment of intolerable pain which is the most important symptom of this disease. © 2011 Turkish Association of Orthopaedics and Traumatology.

Ozturkmen Y.,Ministry of Health Istanbul Training and Research Hospital | Canikliolu M.,Ministry of Health Istanbul Training and Research Hospital | Karamehmetolu M.,Ministry of Health Istanbul Training and Research Hospital | Fiukur E.,Ministry of Health Istanbul Training and Research Hospital
Acta Orthopaedica et Traumatologica Turcica | Year: 2010

Objectives: We aimed to evaluate the clinical and radiological outcomes of open reduction and internal fixation augmented with calcium phosphate cement (CPC) in the treatment of depressed tibial plateau fractures. Methods: Twenty-eight knees of 28 patients [19 males and 9 females; mean age, 41.2 years (range 22-72 years)] who had open reduction and internal fixation combined with CPC augmentation were included in this study. Seventeen fractures were Schatzker type II, 5 were type III, 3 were type IV, 2 were type V, and 1 was type VI. CPC was used to fill the subchondral bone defects in all knees. Fixation of the fragments was done with screws in 3 knees (10%). Standard proximal tibial plates or buttress plates were used in 25 knees (90%) with an additional split fragment extending distally to achieve internal fixation. Full weight-bearing was allowed in 6.4 weeks (range 6-12 weeks) after surgery. Resorption of CPC granules was defined as the decrease in the size and density of grafting material on radiographs. Rasmussen's radiological and clinical scores were determined postoperatively. Functionality was assessed with Lysholm knee scoring system. Activity was graded with Tegner's activity scale. Results: Union was achieved in all patients with a mean follow-up of 22.2 months (range 6-36 months). There were no intraoperative complications. At the latest follow-up radiographs, resorption of the graft was observed in 25 knees (89%). Rasmussen's radiologic score was excellent in 17 patients (61%), good in 9 patients (32%), and fair in 2 patients (7%). Rasmussen's clinical score was excellent in 9 patients (32%), good in 18 patients (64%), and fair in 1 patient (4%). According to the Lysholm knee score, functional results were excellent in 16 patients (57%), good in 8 patients (29%), and fair in 4 patients (14%). Twenty-two patients (78%) achieved the preoperative activity level after surgery, and there was no significant difference between the mean preoperative and postoperative Tegner scores (4.11±0.68 and 4.04±0.64, respectively, p=0.161). Conclusion: CPC is a safe biomaterial with many advantages in augmenting the open reduction and internal fixation of depressed tibial plateau fractures, including elimination of morbidity associated with bone graft harvesting, the unlimited supply of bone substitute, the optimum filling of irregular bone defects, and shortening of the postoperative full weight-bearing time. © 2010 Turkish Association of Orthopaedics and Traumatology.

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