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Cabuk H.,Okmeydan Training and Research Hospital | Kusku Cabuk F.,Okmeydan Training and Research Hospital | Kusku Cabuk F.,Istanbul Science University
Clinical Anatomy | Year: 2016

Proprioceptive inputs from the joints and limbs arise from mechanoreceptors in the muscles, ligaments and tendons. The knee joint has a wide range of movements, and proper neuroanatomical organization is critical for knee stability. Four ligaments (the anterior (ACL) and posterior (PCL) cruciate ligaments and the medial (MCL) and lateral (LCL) collateral ligaments) and four tendons (the semitendinosus (STT), gracilis (GT), popliteal (PoT), and patellar (PaT) tendons) from eight fresh frozen cadavers were harvested. Each harvested tissue was divided into its bone insertion side and its tendinous part for immunohistochemical examination using S100 staining. Freeman–Wyke's classification was used to identify the mechanoreceptors. The mechanoreceptors were usually located close to the bone insertion. Free nerve endings followed by Ruffini endings were the most common mechanoreceptors overall. No Pacini corpuscles were observed; free nerve endings and Golgi-like endings were most frequent in the PCL (PCL-PaT: P = 0.0.1, PCL-STT: P = 0.00), and Ruffini endings in the popliteal tendon (PoT-PaT: P = 0.00, Pot-STT: P = 0.00, PoT-LCL: P = 0.00, PoT-GT: P = 0.00, PoT-ACL: P = 0.09). The cruciate ligaments had more mechanoreceptors than the medial structures (MS) or the patellar tendon (CR-Pat: P = 0.000, CR-MS: P = 0.01). The differences in mechanoreceptor distributions between the ligaments and tendons could reflect the different roles of these structures in the dynamic coordination of knee motion. Clin. Anat. 29:789–795, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.


Ozkaya O.,Okmeydan Training and Research Hospital | Egemen O.,Okmeydan Training and Research Hospital | Yesilada A.,Sisli Etfal Training and Research Hospital | Sakz D.,Sisli Etfal Training and Research Hospital | Ugurlu K.,Sisli Etfal Training and Research Hospital
Journal of Plastic, Reconstructive and Aesthetic Surgery | Year: 2012

Objective: Random-pattern skin flaps are used widely in plastic surgery, but necrosis resulting from ischaemia in the distal sections of the flap is a serious problem. Free oxygen radicals and the accumulation of increased neutrophil granulocytes play important roles in tissue injury and may lead to partial or complete necrosis of the flap. Amniotic membrane is a biomaterial used widely in clinical settings to prevent the infiltration and activation of leucocytes. The aim of this study was to test the effects of amniotic membrane on the survival of ischaemic skin flaps in rats. Methods: A total of 32 male rats were divided randomly into four groups of eight, according to the procedure to be tested: flap-only (F), flap-amniotic membrane (FA), flap-Tegaderm ® (FT) and flap-amniotic membrane-Tegaderm® (FAT). Rectangular, random-pattern, caudally based modified McFarlane skin flaps were elevated at the dorsum of the rats in all four groups. The flap-only group was also the control group; in this group, the flaps were elevated and sutured to their native position. In the FA group, after the flaps were elevated, the amniotic membrane was inserted underneath the undersurface of the flap. In the FT group, after the flaps were elevated, a piece of Tegaderm was inserted underneath the undersurface of the flap. In the FAT group, the amniotic membrane was inserted underneath the undersurface of the flap and the Tegaderm ® was inserted in the flap donor area. The survival rate of the skin flaps was measured on day 7, and histologic assessments were performed. Results: The survival rate of the skin flaps was significantly improved in the FA and FAT groups (67-69%, p < 0.05) compared with the F and FT groups (46-48%, p < 0.05). Histologic analysis showed many more blood vessels and fewer neutrophils in the FA and FAT groups than in the F and FT groups. Conclusion: This study showed that amniotic membrane could improve the survival rate of ischaemic skin flaps. © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.


PubMed | Charité - Medical University of Berlin, Okmeydan Training and Research Hospital and Guys Hospital
Type: | Journal: Clinical and translational allergy | Year: 2017

The introduction of omalizumab to the management of chronic spontaneous urticaria (CSU) has markedly improved the therapeutic possibilities for both, patients and physicians dealing with this disabling disease. But there is still a hard core of patients who do not tolerate or benefit from existing therapies and who require effective treatment. Novel approaches include the use of currently available drugs off-licence, investigational drugs currently undergoing clinical trials and exploring the potential for therapies directed at pathophysiological targets in CSU. Off-licence uses of currently available drugs include rituximab and tumour necrosis factor inhibitors. Ligelizumab (anti-IgE), canakinumab (anti-IL-1), AZD1981 (a PGD2 receptor antagonist) and GSK 2646264 (a selective Syk inhibitor) are currently in clinical trials for CSU. Examples of drugs that could target potential pathophysiological targets in CSU include substance P antagonists, designed ankyrin repeat proteins, C5a/C5a receptor inhibitors, anti-IL-4, anti-IL-5 and anti-IL-13 and drugs that target inhibitory mast cell receptors. Other mediators and receptors of likely pathogenic relevance should be explored in skin profiling and functional proof of concept studies. The exploration of novel therapeutic targets for their role and relevance in CSU should help to achieve a better understanding of its etiopathogenesis.


Belen E.,Okmeydan Training and Research Hospital | Ozal E.,Pendik State Hospital | Pusuroglu H.,Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
Heart and Vessels | Year: 2015

Mitral valve stenosis is a common manifestation of chronic rheumatic heart disease. In rheumatic mitral valve stenosis (RMVS) patients, left atrial spontaneous echo contrast (LASEC) is an independent predictor of thromboembolism risk. While the anticoagulant therapy algorithm for atrial fibrillation patients is clear, the clinical tools determining high-risk patients in sinus rhythm are insufficient. Our aim is to examine the relationship between CHA2DS2-VASc score in RMVS patients in sinus rhythm and the presence of LASEC. The patients with RMVS upon presentation to the cardiology polyclinic were included in this cross-sectional study consecutively, and CHA2DS2-VASc scores were calculated. All patients were evaluated with transthoracic and transesophageal echocardiography and were divided into two groups as those with and without LASEC. The total number of patients was 265, with LASEC determined in 97 (36.6 %) and not determined in 168 (63.4 %). No significant differences in terms of age, gender, and body mass index were found between the groups. Patients with LASEC had higher mean CHA2DS2-VASc score than patients without LASEC (2.10 ± 1.21 vs. 1.11 ± 0.7, respectively; p < 0.001). In the multivariate logistic regression analysis, it has been determined that there is an independent association between the existence of LASEC and CHA2DS2-VASc score (OR 3.176, CI 1.937–5.206; p < 0.001). The ROC analysis revealed that CHA2DS2-VASc score 2 or more predicted presence of LASEC with a sensitivity of 71 % and a specificity of 82 % (AUC 0.746, 95 % CI 0.682–0.810). The CHA2DS2-VASc score could be useful marker to detect prothrombotic state in patients with RMVS in sinus rhythm. © 2015 Springer Japan


Crac Y.,Karadeniz Technical University | Nural N.,Karadeniz Technical University | Salturk Z.,Okmeydan Training and Research Hospital
Supportive Care in Cancer | Year: 2016

Background: Terminal stage cancer patients experience anxiety about death and pessimism about the future. They usually fear that as they approach death, their pain will increase, they will lose their reputation, and they will be alone. However, few studies have evaluated the loneliness that these cancer patients feel. This was a cross-sectional and definitive study that evaluated the feeling of loneliness in terminal cancer patients. Methods: In total, 55 cancer patients with terminal cancer who were hospitalised for palliative therapy between 14 November 2014 and 14 January 2015 in the Okmeydanı Training and Research Hospital were included in the study. The patients were given a questionnaire form that included sociodemographic properties and University of California Los Angeles Loneliness Scale to collect data. Results: Loneliness was detected as 53.61 ± 9.29. There was no relationship between sociodemographic data and loneliness (p > 0.05). Regression analysis revealed that family support and sharing of emotional stress were related to the level of loneliness (p < 0.05). More than half of the patients needed psychological support because they could not handle the situation. Conclusions: Terminal stage cancer patients felt lonely in general, and patients with a lack of visitors and family support experienced a higher level of loneliness. © 2016, Springer-Verlag Berlin Heidelberg.


Egemen O.,Okmeydan Training and Research Hospital
Journal of Craniofacial Surgery | Year: 2014

ABSTRACT: Lip carcinoma is one of the most common cancers of the head and neck region. Lower lips are more frequently affected. Squamous cell carcinoma accounts for more than 95% of the cases. The aim of treatment is to achieve the highest cure rates with adequate excision with clear surgical margins while leaving the smallest defect sizes behind for reconstruction. Excised tissue is known to shrink when removed, in relation with its retractile properties. In this study, the evaluation of the amount of shrinkage in excised lip cancer specimens and determination of the relation between surgical and histopathologic margins were aimed.The study included 21 consecutive excised lip specimens for the treatment of squamous cell carcinoma of the lip. The volume of the specimen, tumor length, and margin distance measurements were measured and recorded step by step from before surgical excision to histopathologic evaluation. Specimens were evaluated in a standardized fashion by the same pathologist after 48 hours of fixation. For data analysis, Number Cruncher Statistical System 2007 and Power Analysis and Sample Size 2008 Statistical Software (Kaysville, UT) were used.The surgical margins of the excised lip specimen shrink up to 41% to 47.5% from before excision to histopathologic evaluation. The most significant step was the excision step, followed by the formalin fixation step. The histopathologic process itself and the duration of formalin fixation did not result a significant change in surgical margins. The tumor tissue itself did not show a significant shrinkage. © 2014 by Mutaz B. Habal, MD.


Belen E.,Okmeydan Training and Research Hospital | Karaman O.,Kanuni Sultan Suleyman Training and Research Hospital | Caliskan G.,Kanuni Sultan Suleyman Training and Research Hospital | Atamaner O.,Kanuni Sultan Suleyman Training and Research Hospital | Aslan O.,Kanuni Sultan Suleyman Training and Research Hospital
Vascular | Year: 2016

Osteoarthritis is one of the most common chronic diseases and associated with increased cardiovascular comorbidity and deaths. Elastic properties of aorta are closely associated with cardiovascular mortality and morbidity. In our study, we aimed to evaluate aortic stiffness in primary osteoarthritis patients. A total of 160 patients including 80 patients with primary knee osteoarthritis and 80 controls without osteoarthritis were included in the study. Additionally, osteoarthritis patients were divided into four subgroups according to the severity of the disease. Aortic parameters were evaluated by using transthoracic echocardiography method. While measurements of aortic stiffness of osteoarthritis group were higher compared to the control group (p<0.01), aortic strain and aortic distensibility measurements of osteoarthritis group are lower than the control group (p< 0.01). Additionally, it was determined that as the severity of osteoarthritis increased also aortic stiffness increased highly significantly (p = 0.001). Presence and severity of osteoarthritis are closely associated with elastic properties of aorta, which are correlated with cardiovascular mortality and morbidity. © 2015, The Author(s) 2015.


Gungor S.,Okmeydan Training and Research Hospital | Sayilgan T.,Okmeydan Training and Research Hospital | Gokdemir G.,Okmeydan Training and Research Hospital | Ozcan D.,Okmeydan Training and Research Hospital
Indian Journal of Dermatology, Venereology and Leprology | Year: 2014

Background: Striae distensae or stretch marks are atrophic linear dermal scars with epidermal atrophy. There are many therapeutic options for management, but no consistently effective modality is available yet. Objective: We compared the efficacy of 1064 nm long pulse (LP) Nd: YAG laser and 2940 nm variable square pulse (VSP) erbium: YAG laser in the treatment of striae distensae. Methods: Twenty female volunteers (Fitzpatrick skin types II-V) aged between 20 and 40 years with striae (3 patients with the rubra type and 17 with the alba type) were enrolled in the study. The duration of striae ranged from 4 months to 12 years. Lesions were located on the abdomen in all patients except one patient who had striae on the arms and two patients with striae in the lumbar region. Treatments were randomly allocated to both sides of the body in each patient, one side being treated with VSP erbium: YAG laser and the opposite side with LP Nd: YAG laser. All subjects were treated monthly for a total of three treatments. Two 3-mm punch biopsies were obtained from six subjects, both of the same striae, one before the first treatment and one 4 weeks after the last session. Results: Response was evaluated clinically by photographic comparison and was found to be poor in 17 subjects, both on the LP Nd: YAG laser treated side and VSP erbium YAG laser treated side. All these patients had mature lesions (striae distensae alba). Three subjects had a moderate response on both sides; these patients' striae were immature (striae distensae rubra). Histologically, elastic fibers were slightly increased in post-treatment samples compared with pretreatment skin biopsies. Conclusion: We observed no satisfactory clinical improvement in striae distensae alba lesions although histopathological changes were seen. We suggest that variable square pulse Er: YAG and long pulse Nd: YAG lasers are not useful in the treatment of striae distensae alba.


PubMed | Istanbul University, Okmeydan Training and Research Hospital and Alfagoz Medical Center
Type: Journal Article | Journal: Turkish journal of ophthalmology | Year: 2017

A 25-year-old man suffered an isolated lens anterior capsular tear and mature cataract formation following blunt injury to his right eye. One week after the trauma, best-corrected visual acuity (BCVA) in the right eye was hand motion. B-scan ultrasonography showed that the lens posterior capsule was intact; no vitreous foreign body or retinal pathology were observed. Orbital computed tomography revealed narrowed anterior chamber and increased lens material volume and lens reflectivity in the injured right eye. The globe was intact and no bone fractures were observed. The cataractous lens material was removed by phacoemulsification and a foldable, acrylic, posterior chamber intraocular lens was implanted in the bag. Postoperative BCVA in the right eye was 20/20.


PubMed | Istanbul University and Okmeydan Training and Research Hospital
Type: | Journal: International ophthalmology | Year: 2017

To evaluate the frequency of high-risk histopathologic factors in Turkish children enucleated for retinoblastoma and to analyze the association between growth pattern, rosetta formation, tumor thickness, presence of necrosis, calcification, neovascularization, rate of mitosis, and high-risk histopathologic factors.Pathology reports of 59 eyes who had received enucleation for retinoblastoma were reviewed retrospectively. The histopathologic data included presence of choroidal invasion, optic nerve invasion, scleral extension, tumor thickness, presence of necrosis, calcification, neovascularization, rosetta formation and lymphocyte infiltration, rate of mitosis, and growth pattern.This study included 59 eyes from 30 (50.8%) male and 29 (49.2%) female patients. The mean age was 22.8718.99months. There were 30 (50.8%) eyes with choroidal invasion, 30 (50.8%) eyes with optic nerve invasion, and 5 (8.5%) eyes with scleral invasion. Endophytic growth pattern was seen in 27 (45.8%) eyes, exophytic growth pattern was seen in 2 (3.4%) eyes, and combined growth pattern was seen in 30 (50.8%) eyes. Exophytic growth pattern was found statistically related to choroidal invasion (p=0.00). Although tumor with greater thickness tended to have more choroidal invasion (p=0.02), there was no relation between tumor thickness and optic nerve invasion (p=0.09).Incidences of choroidal and optic nerve invasion showed similarity with other developing countries. Because of higher incidence of high-risk factors, intra-arterial chemotherapy with its targeted effect should be preferred carefully.

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