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Ozaslan E.,Numune Education and Research Hospital | Purnak T.,Numune Education and Research Hospital | Yildiz A.,Numune Education and Research Hospital
Saudi Journal of Gastroenterology | Year: 2011

Variceal bleeding is the most challenging emergent situation among the causes of upper gastrointestinal bleeding. Despite substantial improvement, a need remains for therapeutic armamentarium of such cases, which is easy, effective and without side-effect. Ankaferd blood stopper (ABS) is a standardized herbal extract acting as a hemostatic agent on the bleeding or injured areas. In this observational study, a total of four patients with variceal bleeding were treated with endoscopic ABS application. The lesions were bleeding gastric varices (n:3) and bleeding duodenal varix (n:1). ABS was selected as a bridge to definitive therapies due to unavailability or inappropriateness of bleeding lesions to conventional measures. ABS was instilled or flushed onto the bleeding areas by sclerotherotherapy needle or heater probe catheter. Periprocedural control of the bleeding was achieved in all instances. Thereafter, on an elective basis, two patients with gastric varices underwent cyanoacrylate injection, while third underwent Transjugular intrahepatic portosystemic shunt and embolization. The patient with duodenal varix refused further therapy, after a few hours after admission and was discharged. He again presented the same day with rebleeding, but died before any attempt could be made to control his bleeding. ABS seems to be effective in cases of variceal bleeding as a bridge to therapy. Its major advantages are the ease of use and lack of side-effects.


Asik M.,Canakkale Onsekiz Mart University | Sahin S.,Numune Education and Research Hospital | Ozkul F.,Numune Education and Research Hospital | Anaforoglu I.,Numune Education and Research Hospital | And 4 more authors.
Clinical Endocrinology | Year: 2013

Summary Objective Hypothyroidism, whether overt or subclinical, has multiple effects on the cardiovascular system. Epicardial fat tissue (EFT) is closely related to cardiovascular disorders and atherosclerosis. Our study aimed to assess EFT thickness and carotid artery intima-media thickness (CIMT) in patients with Hashimoto's thyroiditis (HT) displaying overt and subclinical hypothyroidism (SCH). Design and patients The study included 33 patients with SCH and 24 patients with overt hypothyroidism (OH) with HT as well as 32 healthy controls. EFT thickness, CIMT, thyroid hormone levels and lipid parameters were measured in all subjects. Correlation analysis and linear regression analysis were performed for EFT thickness. Results Mean EFT thickness was 2·89 ± 0·38, 3·53 ± 0·92 and 4·56 ± 1·61 mm in control, SCH and OH groups, respectively (P < 0·001). EFT thickness of OH patients was high compared with SCH and control subjects (P < 0·01 and <0·001, respectively). CIMT of OH patients was high compared with SCH and control subjects (P < 0·01 and <0·001, respectively). In addition, EFT was significantly thicker in SCH patients than in controls (P < 0·05). Correlation analysis showed that EFT thickness was significantly positively correlated with CIMT, age, body mass index, systolic blood pressure, thyroid-stimulating hormone, total and LDL cholesterol and triglyceride and negatively correlated with free T4. In the regression analysis, EFT thickness retained its independent and positive association with CIMT, patient group (particularly OH) and systolic blood pressure. Conclusions Epicardial fat tissue thickness may be a useful indicator of early atherosclerosis in SCH and OH patients with HT. © 2013 John Wiley & Sons Ltd.


Kelekci K.H.,Numune Education and Research Hospital | Kelekci S.,Numune Education and Research Hospital | Yengel I.,Numune Education and Research Hospital | Gul S.,Numune Education and Research Hospital | Yilmaz B.,Numune Education and Research Hospital
Journal of Dermatological Treatment | Year: 2012

Objective: To compare the effectiveness of three different combinations of combined oral contraceptives (COCs) and anti-androgens in the treatment of hirsutism. Methods: A total of 134 women with moderate and severe hirsutism were randomly assigned to three treatment regimens: Group I received 30 μg of ethinyl estradiol (EE)/3 mg of drospirenone (DRSP) plus 100 mg of cyproterone acetate (CPA) (n 45); group II received 30 μg of EE/3 mg of DRSP plus 100 mg of spironolactone (n 44); and group III received 35 μg of EE/2 mg of CPA plus 100 mg of CPA (n 45), daily for 6 months. The decrease in the modified FerrimanGallwey hirsutism score (mFGS) was the main outcome measure. Results: The mean decrease in mFGS after 3 and 6 months of the treatment course was 26% and 49% in group I (both p < 0.01), 27% and 49% in group II (both p < 0.01), and 25% and 45% in group III (both p < 0.01), respectively, when compared with baseline. Although the mFGS was significantly decreased in all groups, there was no significant difference between groups. Conclusion: CPA or DRSP containing COCs in combination with CPA or spironolactone have similar effects for the treatment of hirsutism. © 2012 Informa Healthcare USA on behalf of Informa UK Ltd.


Cay S.,Yuksek Ihtisas Heart Education and Research Hospital | Cagirci G.,DIskapI YIldIrIm BeyazIt Research and Educational Hospital | Sen N.,Mustafa Kemal University | Balbay Y.,Yuksek Ihtisas Heart Education and Research Hospital | And 3 more authors.
Cardiovascular Drugs and Therapy | Year: 2010

Background: Extensively used lipid-lowering statins have also non-lipid-lowering, pleiotropic effects. Previous studies have demonstrated that a pre-procedural single dose of atorvastatin is associated with reduced peri-procedural myocardial injury. Aim: The aim of the present study was to demonstrate the effect of a single high loading dose (40 mg) of rosuvastatin on peri-procedural myocardial injury. Methods: Two hundred ninety nine statin-naive patients with stable angina and de novo lesions eligible for PCI were randomized to a rosuvastatin-treatment (n=153) and to a no-treatment (n=146) group. A 40 mg loading dose of rosuvastatin was administrated 24 h before the PCI. CK-MB and cTnI levels were measured before and 12 h after the procedure. Results: Baseline characteristics were fairly similar between the two arms. The incidence of a CK-MB and cTnI elevation >3× ULN in the rosuvastatin group was significantly lower compared to the control group (0.7% vs. 11.0%, p<0.001 and 10.5% vs. 39.0%, p<0.001, respectively). Similarly, the incidence of any CK-MB and cTnI elevation>ULN in the rosuvastatin group was significantly lower compared to the control group (10.5% vs. 34.2%, p<0.001 and 20.9% vs. 61.6%, p<0.001, respectively). In addition, CK-MB and cTnI values 12 h after the PCI were significantly lower in the rosuvastatin group compared to the control group (20.13±7.24 U/L vs. 27.02±18.64 U/L, p<0.001 and 0.14±0.34 ng/ml vs. 0.35±0.40 ng/ml, p<0.001, respectively). Conclusion: A single high loading dose of rosuvastatin reduces the incidence of peri-procedural myocardial necrosis and infarction effectively. © 2010 Springer Science+Business Media, LLC.


Bozkurt B.,Selcuk University | Ozkan F.,Numune Education and Research Hospital | Yilmaz M.,Selcuk University | Okudan S.,Selcuk University
Optometry and Vision Science | Year: 2015

Purpose. The aim was to evaluate the anterior and posterior corneal topographic characteristics of three patients with posterior polymorphous corneal dystrophy (PPCD) using a rotating Scheimpflug camera combined with a Placido disc system (Sirius, CSO, Italy). Case Reports. Two children with unilateral PPCD and a 53-year-old woman with bilateral PPCD were diagnosed by the presence of vesicles and railroad track lesions at the level of the Descemet membrane with slitlamp biomicroscopy and in vivo confocal microscopy. Anisometropic and/or meridional amblyopia was detected in both children. In the 16-year-old child, there was unilateral anterior corneal steepening with high astigmatism (plano -7.00 ×170) in the eye with PPCD. The 5-year-old boy had unilateral axial myopia and against-the-rule corneal astigmatism (-12.00 -2.00 ×90). Corneal topography of the woman revealed with-the-rule astigmatism and thin corneas (464 μm OD and 445 μm OS) in both eyes. Posterior corneal steepening greater than 25 μm either in a vertical or in a horizontal pattern changing with the orientation of the railroad track band lesions was detected in all subjects. Conclusions. Besides anterior corneal changes, PPCD seems to cause posterior corneal elevation, which necessitates corneal tomographic evaluation. In unilateral or highly asymmetric cases, children with PPCD should be screened for amblyopia. Copyright © 2015 American Academy of Optometry.


Ozaslan E.,Numune Education and Research Hospital
Hepato-Gastroenterology | Year: 2010

Occult HBV infection (OBI) is an increasingly reported form of hepatitis B virus (HBV) infection. With the current knowledge, in immunocompetent individuals, OBI is mainly a diagnostic challenge and has a very low probability of transfusion risk, controversial risk of liver disease or hepatocellular carcinoma, etc. In immunosuppressed individuals, however, reactivation of OBI is a real concern even today. There are many controversies about the management of such cases, including anti-HBc and/or alanine aminotransferase monitoring, HBV DNA monitoring, vaccination or pre-emptive nucleoside analogs. We present here four OBI cases which reveal the difficulties in the diagnosis and management of OBI and include a discussion upon current literature. © H.G.E. Update Medical Publishing S.A.


Kurtul A.,Ankara Education and Research Hospital | Yarlioglues M.,Ankara Education and Research Hospital | Murat S.N.,Ankara Education and Research Hospital | Demircelik M.B.,Ankara University | And 5 more authors.
Angiology | Year: 2015

We investigated the relationship between red cell distribution width (RDW) and contrast-induced nephropathy (CIN) in patients (aged 61 ± 12, 69% men) with acute coronary syndrome (ACS). Consecutive patients diagnosed with ACS (n = 662) who underwent percutaneous coronary intervention (PCI) were included in the study. Patients were divided into 2 groups: CIN and no CIN. Contrast-induced nephropathy was defined as an increase in serum creatinine level of ≥0.5 mg/dL or ≥25% above baseline within 72 hours after PCI. Contrast-induced nephropathy occurred in 81 (12.2%) patients. Red cell distribution width, creatinine, and high-sensitivity C-reactive protein levels were significantly higher in the CIN group than in the no-CIN group. Multivariate regression analysis revealed that baseline RDW level (odds ratio 1.379, 95% confidence interval 1.084-1.753, P =.009), age (P =.025), creatinine (P =.004), and left ventricular ejection fraction (P =.011) were independent risk factors for the development of CIN. In conclusion, increased RDW levels are independently associated with a greater risk of CIN in patients undergoing PCI for ACS. © The Author(s) 2014.


Ozcan K.M.,Numune Education and Research Hospital | Ozdas T.,Yenimahalle State Hospital | Baran H.,Ardahan State Hospital | Ozdogan F.,Silvan State Hospital | Dere H.,Numune Education and Research Hospital
International Journal of Pediatric Otorhinolaryngology | Year: 2013

Hemolacria is a very rare entity which literally means "bloody tears". Conjunctivitis, capillary hemangioma, conjunctival telangiectasia, trauma, retrograde epistaxis and nasal and paranasal neoplasms may play a role in its etiology. In our case report, a 11-year-old female patient who presented with the complaint of bilateral epistaxis accompanied by bloody tears that had been present for 2 years and whose endoscopic examination revealed hyperemia and increased vascularity in the nasal cavity mucosa was discussed together with a review of the literature. © 2012 Elsevier Ireland Ltd.


Yilmaz Y.,Marmara University | Ones T.,Marmara University | Purnak T.,Numune Education and Research Hospital | Ozguven S.,Marmara University | And 4 more authors.
Alimentary Pharmacology and Therapeutics | Year: 2011

Background The presence of active brown adipose tissue (BAT) has been associated with a reduced risk of obesity in adult humans. Aim To examine whether the presence and activity of BAT in patients undergoing PET-CT examinations is related to the presence of fatty liver. Method We retrospectively analysed 3666 consecutive PET-CT whole-body scans performed on a total of 1832 patients who were referred for suspected malignancies. BAT-positive subjects (BAT+) were defined as subjects who showed substantial amounts of brown adipose tissue on PET-CT scans. In areas where uptake of [ 18F]FDG was identified by CT for BAT, the maximal standardised uptake values (SUVmax), defined as the maximum activity per millilitre within the region of interest divided by the injected dose in megabecquerels per gram of body weight, were determined. A ratio of mean liver attenuation to spleen attenuation <0.8 on CT scans was considered to indicate NAFLD. Results Thirty patients of the 1832 screened individuals (2%) demonstrated brown fat uptake (BAT+ subjects). Ninety matched individuals without evidence of BAT on PET scans (BAT- subjects) were enrolled for comparison purposes. After adjustment for potential confounders, the odds ratio for having NAFLD was significantly higher for BAT- subjects (3.12, 95% confidence interval = 1.03-9.88, P < 0.05). The SUVmax for brown fat tissue was significantly correlated with the ratio of mean liver attenuation to spleen attenuation (P < 0.05). Conclusion The presence of brown adipose tissue in adulthood is independently associated with a lower likelihood of NAFLD diagnosed by CT findings. © 2011 Blackwell Publishing Ltd.


Keskek S.O.,Numune Education and Research Hospital | Kirim S.,Numune Education and Research Hospital | Turhan A.,Numune Education and Research Hospital | Turhan F.G.,Numune Education and Research Hospital
Annals of Hematology | Year: 2013

Beta-thalassemia minor is a common genetic blood disorder in Mediterranean countries such as Turkey. Additionally, depression is one of the most widespread mental disorders that affect people worldwide, and its prevalence is increasing with co-occurring medical conditions. The aim of this study was to determine whether the frequency of depression is elevated in subjects with beta-thalassemia minor. A total of 106 subjects were included in this study, of which 53 participants were diagnosed with beta-thalassemia minor. The other 53 participants were otherwise healthy. Hemoglobin electrophoresis and a complete blood count were performed in all subjects, and all participants were evaluated using the Hamilton Depression Rating Scale (HDRS). The HDRS scores of the subjects with beta-thalassemia minor were higher than those in the healthy subjects (p < 0.001). Additionally, the hemoglobin A2 levels were positively associated with the HDRS scores (p < 0.0001, r = 0.482). This study suggests a possible association between depression and beta-thalassemia minor, in which the risk of depression may be increased in subjects with this condition. © 2013 Springer-Verlag Berlin Heidelberg.

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