Okmeydani Education and Research Hospital

Şişli, Turkey

Okmeydani Education and Research Hospital

Şişli, Turkey
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Demirayak G.,Okmeydani Education and Research Hospital
Journal of Obstetrics and Gynaecology | Year: 2017

The aim of this study was to show a different technique for a gasless laparoendoscopic single-site (LESS) hysterectomy and to present advantages and limitations of this technique. Women undergoing gasless LESS hysterectomy with a different technique were evaluated. A total of 14 LESS hysterectomies were performed using this gasless technique and rigid laparoscopic instruments by one surgeon. The mean age of the patients was 48.6 (±4.6). The average blood loss was 80 ± 35 ml. The average time between an umbilical incision and starting hysterectomy was 5 (±2,1) min. The time between starting hysterectomy and umbilical incision closure was 120 (±24) min in the laparoscopic suture group and 88 (±16) min in the vaginal suture group. The mean uterus weight was 188 (±95) g. In conclusion, this different technique is feasible and low cost, especially in non-obese patients. But further studies with large participants are needed to elucidate the safety.Impact statementConventional CO2 pneumoperitoneum has many adverse effects on cardiopulmonary function, haemodynamic, metabolic and neurologic systems due to high-intraperitoneal pressure. The usage of gasless technique eliminates these adverse effects and postoperative shoulder pain. The satisfaction of patients is higher in laparoendoscopic single-site (LESS) hysterectomy due to improved cosmesis and reduced postoperative analgesic requirements.In the literature, there are a few studies showing techniques combining LESS and gasless laparoscopy for hysterectomy. In this study, a different approach for creating operational space in gasless laparoscopy is described. Creation of intraabdominal operational space is convenient and takes a short time in this technique. The average time between an umbilical incision and starting a hysterectomy is five minutes. Additional training is not needed for experienced surgeons in LESS. Also, cost-effectiveness is one of important advantages. It is quite safe, no possibility of vascular injury, including inferior epigastric or superficial epigastric vessels. Also suturing the vaginal cuff and knot tying is easier in this technique.This technique can be used safely in patients with poor cardiopulmonary reserve. Also, by means of its cost effectiveness, it can be preferred in developing countries. As a result, it may be a good alternative to conventional LESS hysterectomy. © 2017 Informa UK Limited, trading as Taylor & Francis Group

Yildirim G.,Okmeydani Education and Research Hospital | Cingi C.,Eskiehir Osmangazi University | Kaya E.,Eskiehir Osmangazi University
European Archives of Oto-Rhino-Laryngology | Year: 2013

Although discussions regarding nasal packing are still ongoing, to eliminate any possible complications, surgeons have used nasal packing for many years. Septoplasty is one of the most frequently performed operations by head and neck surgeons. Any methods to diminish the surgical time or bring comfort to the surgeon will be well appreciated. In this study, we attempted to demonstrate the usefulness of the stapler method by comparing preoperative and postoperative results from the visual analog scale (VAS), nasal obstruction symptom evaluation (NOSE), rhinosinusitis quality of life questionnaire (RQLQ), and acoustic rhinomanometry values. In addition, we evaluated pain scores, postoperative complications, and breathing after nasal packing, stapling, and trans-septal suturing techniques. Patients were divided into three groups. In the first group, deviated cartilage was removed or repositioned and mucoperichondrial flaps were closed with a bioresorbable stapler after septoplasty. Four or five staples were placed on the septum. In the second group, the septum was sutured continuously with 4/0 Pegelak (Doǧsan TR). In the third group, Merocel packs were used without any sutures and were kept for 48 h. Nasal packing leads to patient discomfort after septal surgery; however, there is no difference in patient comfort between closing the mucoperichondrial flaps by suturing the septum or using a stapler. After surgery, there were no differences between the groups in terms of successful breathing. This situation was assessed by endoscopic examination and acoustic rhinomanometry. Thus, there was no objective or subjective difference. Stapling increases the doctor's comfort level and surgical time is optimized. Although experienced surgeons can easily suture the septum, less experienced ones have some difficulty; therefore, stapling may provide more benefit to the latter. Further, four staples are sufficient to close the septum. © 2012 Springer-Verlag.

Adas G.,Okmeydani Education and Research Hospital | Arikan S.,Istanbul Education and Research Hospital | Karatepe O.,Okmeydani Education and Research Hospital | Kemik O.,Okmeydani Education and Research Hospital | And 4 more authors.
Langenbeck's Archives of Surgery | Year: 2011

Objective: The goal of this study is to examine if allogenic mesenchymal stem cell (MSC) transplantation is a useful therapy for left ischemic colon anastomosis in rats. Summary and background data: Problems with anastomosis healing may lead to serious postoperative complications. Bone marrow-derived mesenchymal stem cells (BM-MSCs), which are also referred to as stromal progenitor cells, are self-renewing and expandable stem cells. Recent studies have suggested that BM-MSCs play a crucial role in the processes of intestinal repair and accelerate angiogenesis. Methods: MSCs were isolated from rats before analysis by light and scanning electron microscopy. Forty male Wistar albino rats weighing 250-280 g were divided into four equal groups (n=10) as follows: group 1: control, ischemic left colonic anastomoses (fourth day); group 2: control, ischemic left colonic anastomoses (seventh day); group 3: ischemic left colonic anastomoses + locally transplanted BM-MSCs (fourth day); group 4: ischemic left colonic anastomoses + locally transplanted BM-MSCs (seventh day). Histopathological features and anastomotic strength were evaluated. Results: BM-MSCs therapy significantly accelerated all of the healing parameters for ischemic colonic anastomosis except for inflammation on the fourth day. On the seventh day, BM-MSCs augmented the levels of the hydroxyproline and bursting pressure. Histological parameters, especially angiogenesis, were also found to be important for healing of ischemic colonic anastomoses. Conclusions: This is the first study to use locally transplanted cell therapy for the healing of ischemic colonic anastomosis. BM-MSCs therapy significantly accelerated all of the healing parameters for ischemic colonic anastomosis. © 2010 Springer-Verlag.

Atalay N.S.,Pamukkale University | Ercidogan O.,Okmeydani Education and Research Hospital | Akkaya N.,Pamukkale University | Sahin F.,Pamukkale University
Pain Physician | Year: 2014

Background: Although there are several studies of systemic corticosteroid therapies in various doses and various durations in complex regional pain syndrome (CRPS), the outcome measurement parameters are limited to the range of motion measurements, edema, and symptoms of CRPS. Objective: To investigate the effects of prednisolone on clinical symptoms, pain, hand grip strength, range of motion, as well as on functional ability and quality of life in patients who developed CRPS after traumatic upper extremity injury. Study Design: Retrospective evaluation. Methods: Forty-five patients who used prednisolone for CRPS of the upper extremity were retrospectively studied. Prednisolone was started with a dose of 30 mg and tapered by 5 mg every 3 days until discontinuation after 3 weeks. Clinical symptoms (morning stiffness, cold intolerance, shoulder pain, numbness of fingers, hyperesthesia, abnormal sweating, and cyanosis that is exacerbated by exposure to cold temperature), pain (Visual Analogue Scale-Rest [VAS-R] and VASActivity [VAS-A]) were reviewed. The muscle strength with grip strength (GS) (kg), lateral pinch (LP) (pound), tip-to-tip pinch (TP) (pound), and chuck pinch (CP) (pound) measurements; the joint range of motion with using third finger tip-distal crease distance (FT-DC) (cm); functional ability with Quick-Disabilities of the Arm, Shoulder and Hand (Q-DASH) score; and quality of life with Short Form-36 (SF-36) score were evaluated. Results: Mean age was 43.53 ± 11.43 years. After 3 weeks of therapy, patients showed significant improvements in clinical symptoms compared to the basal assessments (P < 0.05). The comparison of pre- and post-treatment results revealed that VAS-R, VAS-A, GS, LP, TP, CP, FT-DC, Q-DASH scores, and all SF-36 subscores were significantly improved (P < 0.05). Limitations: The retrospective design and data collection procedure was limited to the medical records of patients. Conclusion: A short-term oral prednisolone therapy significantly reduced the symptoms and signs of CRPS, and improved the functional abilities and quality of life.

Dilli D.,Dr Sami Ulus Maternity and Children Research and Training Hospital | Aydin B.,Dr Sami Ulus Maternity and Children Research and Training Hospital | Fettah N.D.,Dr Sami Ulus Maternity and Children Research and Training Hospital | Ozyazici E.,Dr Sami Ulus Maternity and Children Research and Training Hospital | And 8 more authors.
Journal of Pediatrics | Year: 2015

Objective To test the efficacy of probiotic and prebiotic, alone or combined (synbiotic), on the prevention of necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants. Study design A prospective, randomized, controlled trial was conducted at 5 neonatal intensive care units in Turkey. VLBW infants (n = 400) were assigned to a control group and 3 study groups that were given probiotic (Bifidobacterium lactis), prebiotic (inulin), or synbiotic (Bifidobacterium lactis plus inulin) added to breastmilk or formula for a maximum of 8 weeks before discharge or death. The primary outcome was NEC (Bell stage 2). Results The rate of NEC was lower in probiotic (2.0%) and synbiotic (4.0%) groups compared with prebiotic (12.0%) and placebo (18.0%) groups (P <.001). The times to reach full enteral feeding were faster (P <.001), the rates of clinical nosocomial sepsis were lower (P =.004), stays in the neonatal intensive care unit were shorter, (P =.002), and mortality rates were lower (P =.003) for infants receiving probiotics, prebiotics, or synbiotic than controls. The use of antenatal steroid (OR 0.5, 95% CI 0.3-0.9) and postnatal probiotic (alone or in synbiotic) (OR 0.5, 95% CI 0.2-0.8) decreased the risk of NEC, and maternal antibiotic exposure increased this risk (OR 1.9, 95% CI 1.1-3.6). Conclusions In VLBW infants, probiotic (Bifidobacterium lactis) and synbiotic (Bifidobacterium lactis plus inulin) but not prebiotic (inulin) alone decrease NEC. © 2015 Elsevier Inc.

Varol A.,Marmara University | Basa S.,Marmara University | Ozturk S.,Okmeydani Education and Research Hospital
Journal of Cranio-Maxillofacial Surgery | Year: 2010

Introduction: To evaluate the role of induced hypotension during maxillary downfracture osteotomy on the requirement for blood transfusion, duration of operation and induced anaemia in bimaxillary surgery. Material and methods: 45 young orthognathic patients were operated under hypotensive anaesthesia between 2004 and 2006. Operations were LeFort I osteotomies (n = 45), bilateral sagittal split osteotomies (BSSO) (n = 42), segmental osteotomies (n = 3), tongue reduction (n = 1), genioplasties (n = 15), digastric myotomies (n = 2), and bone grafts were the supplementary procedures. Pre-postoperative haemograms, intraoperative blood loss, and duration of operations were the studied parameters. Statistical analysis was performed using SPSS 11.5 for Windows. Results: None of the patients received a blood transfusion. Mean blood loss was 377 ± 111.2 mL with the range of 180 mL to the maximum of 625 mL. Mean duration was 267.1 ± 61.2 min with minimum of 180 min and maximum of 400 min. Mean preop Hb level was 14 ± 1.9 g/dL with the range from 10.3 g/dL to a maximum of 17.2 g/dL. Mean postop Hb level was 11.8 ± 2 g/dL with a range of 8.2-16.2 g/dL levels. Preop erythrocyte counts were 435.3 ± 18.2 and 416.4 ± 16.1 (×104/mcL) on the first postop day. Conclusion: Transfusion in bimaxillary orthognathic surgery could be prevented by induction of hypotension during maxillary downfracture. © 2009 European Association for Cranio-Maxillo-Facial Surgery.

Egemen O.,Okmeydani Education and Research Hospital | Ozkaya O.,Okmeydani Education and Research Hospital | Uscetin I.,Okmeydani Education and Research Hospital | Akan M.,Okmeydani Education and Research Hospital
British Journal of Oral and Maxillofacial Surgery | Year: 2012

Loading the eyelid with a gold weight is a popular technique for improving closure of the eyelid in patients with facial palsy. Despite it being both safe and simple, placement of the weight into a submuscular pocket is not always successful. Ulceration of the skin, and extrusion and visibility of the implant, are quite common short or long-term complications. We have developed a technical refinement of lid-loading. After the implant has been sutured in the appropriate place, we cover the implant with a fascia lata graft. We have used this technique in 8 patients who had had excision of an acoustic neuroma. No implant ulcerated or migrated, and none of the patients complained that the implant was visible during follow up of between 3 months and 4 years. Tendinous grafts act as a strong barrier to the gold weight because they are durable and thick. Fascia lata is easily harvested and leaves an inconspicuous scar at the donor site. We therefore recommend the technique to avoid complications. © 2011 The British Association of Oral and Maxillofacial Surgeons.

Egemen O.,Okmeydani Education and Research Hospital | Ozkaya O.,Okmeydani Education and Research Hospital | Ozturk M.B.,Okmeydani Education and Research Hospital | Aksan T.,Okmeydani Education and Research Hospital | And 2 more authors.
International Wound Journal | Year: 2012

Venous ulcers are characterised by longstanding and recurrent loss of skin integrity. Once occurred, healing is slow and recurrence is high because of inappropriate conditions of the wound bed. This study involves 20 patients with chronic venous ulcers at least 6 weeks of duration treated with negative pressure wound therapy (NPWT). Patients underwent a radical debridement of all devitalised tissues in the first operation. After adequate haemostasis, silver-impregnated polyurethane foam was applied. Once the wounds were determined to be clean and adequate granulation tissue formation was achieved, split-thickness skin grafts were applied. Black polyurethane foam was applied over them. All wounds completely healed without the need for further debridement or regrafting. The mean number of silver-impregnated foam dressing changes prior to grafting was 2·9 (one to eight changes). The mean number of NPWT foam changes was 2·6 after skin grafting (two to five changes). Two patients who did not use conservative treatments for chronic venous insufficiency (CVI) after discharge from the hospital had recurrence of venous ulcers in the follow-up period. Application of NPWT provides quick wound-bed preparation and complete graft take in venous ulcer treatment. © 2011 The Authors. © 2011 Blackwell Publishing Ltd and Medicalhelplines.com Inc.

Hanci D.,Okmeydani Education and Research Hospital | Altun H.,Yunus Emre Hospital
International Journal of Pediatric Otorhinolaryngology | Year: 2015

Objectives: To find the effectiveness of hyaluronic acid in post-tonsillectomy pain relief and wound healing. Methods: Fifty patients were included in this prospective, double-blind, controlled clinical study (20 males, 30 females mean age of 13.56 years). Hyaluronic acid was applied to one side and the other side was used as a control during tonsillectomy. Therefore, the same patient evaluated and scored the post-tonsillectomy pain, excluding individual bias. Results: Results indicated that patients had significantly lower pain scores for hyaluronic acid treated side (p< 0.001). At the end of two weeks follow-up period, the wound in the hyaluronic acid side was almost completely healed, indicating that the healing was faster with hyaluronic acid compared to control side (p< 0.001). Conclusion: Hyaluronic acid could be recommended as an effective treatment for the management of post-tonsillectomy pain and wound healing. © 2015.

Asfuroglu Barutca S.,Okmeydani Education and Research Hospital | Rza Oreroglu A.,Okmeydani Education and Research Hospital | Uscetin I.,Okmeydani Education and Research Hospital | Kutlu N.,Medicana International Hospital
Annals of Plastic Surgery | Year: 2011

Isolated congenital nasal anomalies are rare; the isolated absence of any specific nasal structure is even rarer. In this report, we present a patient with congenital isolated partial absence of the left lower lateral cartilage including only the lateral crura. © 2011 by Lippincott Williams & Wilkins.

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