Training and Research Hospital

Ankara, Turkey

Training and Research Hospital

Ankara, Turkey
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Goktas A.,Training and Research Hospital | Goktas S.,Tekden Hospital
International Ophthalmology | Year: 2011

Acute depigmentation of the iris is a new condition characterized by pigment dispersion in the anterior chamber, depigmentation of the iris stroma, and pigment deposition in the anterior chamber angle. A 33-year-old woman using a topical corticosteroid every 2 h for the treatment of acute iridocyclitis was referred to our clinic to seek another opinion because her symptoms had not improved. An ocular evaluation of the patient revealed pigment precipitates on the corneal endothelium, pigment dispersion in the anterior chamber, symmetrical diffuse depigmentation, granularity of the iris stroma, and pigment deposition in the trabecular meshwork. These findings suggested a diagnosis of bilateral acute depigmentation of the iris (BADI) instead of iridocyclitis. Clinicians should be careful in the differential diagnosis of iris depigmentation from iridocyclitis to avoid the unnecessary use of high-dose topical corticosteroids. © 2011 Springer Science+Business Media B.V.

Kocer D.,Training and Research Hospital | Bayram F.,Erciyes University | Diri H.,Erciyes University
Gynecological Endocrinology | Year: 2014

Polycystic ovary syndrome (PCOS) is a heterogeneous disorder, which is considered not only a reproductive disease but also a metabolic disorder associated with long-term health risks. The aim of this study was to assess the effects of metformin on insulin resistance, oxidant-antioxidant status, endothelial dysfunction, lipid metabolism and their contribution to the risks of cardiovascular disease in women with PCOS. Fifteen women with PCOS and 17 healthy women were included in this case-control study. Nitric oxide (NO), endothelin-1 (ET-1), malondialdehyde (MDA), Apo A1, Apo B, small, dense LDL cholesterol (sdLDL-C), lipid levels and paraoxonase 1 (PON1) activity were measured in serum/plasma obtained from study groups. Insulin resistance (HOMA index-Homeostasis Model Assessment) and serum sex hormone profiles were also evaluated. Significantly decreased NO levels and PON1 activities, but increased MDA, ET-1 and sdLDL-C were found in PCOS patients compared to those of controls. Serum MDA, ET-1, HOMA and sdLDL-C levels decreased and PON1 activity and NO levels increased significantly after the metformin treatment. There was a positive correlation between MDA and free testosterone (fT), ET-1 and fT; and a negative correlation between PON1 activity and fT. Insulin resistance, dyslipidemia, endothelial dysfunction and oxidative stress might contribute to the excess risk of cardiovascular disease reported in PCOS. Metformin seemed to decrease oxidative stress and improve insulin resistance, dyslipidemia and endothelial dysfunction in PCOS patients. © 2014 Informa UK Ltd. All rights reserved: reproduction in whole or part not permitted.

OBJECTIVES: Galectin-3 is a marker associated with myocardial fibrosis and left ventricular myocardial index (LVMI). Myocardial fibrosis and LVMI have been reported in many studies to be associated with microvolt T-wave alternans (MTWA) positivity. In this study, galectin-3 levels of normotensive individuals and sustained systodiastolic hypertensive patients were compared and the association between galectin-3 levels and ambulatory ECG-based MTWA was investigated. METHODS: A total of 184 individuals were included in the study, among whom, 43 were normotensive and 141 had sustained systodiastolic hypertension without cardiovascular or chronic renal failure. Galectin-3, MTWA, and LVMI were evaluated in all participants. Galectin-3 levels of hypertensive and normotensive participants were compared. The association between galectin-3, MTWA, LVMI, and estimated glomerular filtration rate (eGFR) was investigated in hypertensive patients. RESULTS: LVMI and galectin-3 levels were higher among hypertensive patients compared with normotensives (94.9±26.8 vs. 76.4±22.9 g/m, 7.325±2.123 vs. 5.233±1.506 ng/ml; P<0.001, P<0.001). Correlation analysis carried out among the hypertensive patients showed that the galectin-3 level was correlated positively to LVMI, age, and MTWA positivity (r=0.396, P<0.001; r=0.358, P<0.001; r=0.361, P<0.001, respectively), whereas it was correlated negatively to eGFR and male sex (r=−0.364, P<0.001; r=−0.280, P=0.001, respectively). Multiple logistic regression analysis indicated that LVMI and galectin-3 showed an independent association with MTWA positivity in hypertensive patients (P=0.003 and 0.005, respectively). CONCLUSION: Increased galectin-3 levels are associated with ambulatory ECG-based MTWA positivity, decreased eGFR, and increased LVMI in hypertensive patients. This association may be used for risk classification in this patient group. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

Consecutive patients (n = 235) with coronary ischemia were studied; 69 patients (29%) had diabetes. An oral glucose tolerance test (OGTT) was administered to the 166 patients without diabetes; 76 (46%) had normal glucose tolerance (group I = NGT), 68 (41%) had impaired glucose tolerance ([IGT] group II = IGT), and 22 (13%) had diabetic glucose tolerance (DGT). The DGT patients were added to the known diabetics forming (Group III; n = 91). Multivessel disease was significantly more prevalent in group III; 30 patients (43%) in group I, 32 patients (51%) in group II, and 57 patients (69%) in group III (P = .002). Gensini scores were 43.20 ± 24.92 in group I, 54.22 ± 42.61 in group II, and 60.59 ± 38.21 in group III. (P = .037) The severity of coronary artery disease is related to abnormal glucose tolerance. Patients with IGT could be neglected in terms of interventions focused to improve risk factors.

Karakus R.,Training and Research Hospital
Ultrasound Quarterly | Year: 2014

ABSTRACT: We aimed to evaluate the association of fetal aortic isthmus (AoI) Doppler flow measurements in intrauterine growth-restricted (IUGR) fetuses with fetal outcome. The data presented in this prospective cohort study were obtained from 74 IUGR and 71 appropriate-for-gestational-age (AGA) fetuses of singleton pregnancies with normal medical and obstetric histories that were between 26 and 40 weeks of gestation. All AoI Doppler scans were performed by the same observer. There were no statistical differences in maternal characteristics and gestational age or between AGA and IUGR fetuses at the inclusion time. No cases of reversed flow during diastole were detected. Aortic isthmus flow index was increased in growth-restricted fetuses. Absolute end-diastolic (EDV) and time-averaged maximum velocities were decreased in the IUGR fetuses. There was an association between AoI Doppler EDV measurements and prediction of neonatal intensive care unit requirement as well as AoI Doppler isthmic flow index and resistance index measurements and low 5-minute Apgar values. Aortic isthmus EDV was found to be independently associated with IUGR status. Because the AoI Doppler flow measurements of the IUGR fetuses were different from the AGA fetuses and predicted neonatal adverse outcome, Doppler imaging of the AoI could be used as a screening tool in the clinical surveillance of fetuses with IUGR after confirmation in larger prospective studies. © 2014 by Lippincott Williams & Wilkins

Although there have been a number of studies on the pathogenesis of Crimean-Congo hemorrhagic fever (CCHF) recently, knowledge on this topic is still insufficient. This study aims to reveal the kinetics of serum CCHF virus (CCHFV) titers, serum levels of anti-CCHFV immunoglobulin (Ig)G, tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10, and interferon (IFN)-γ in CCHF patients. In total, 31 CCHF cases (11 fatal) were studied. Serum samples were obtained daily from all patients from the time of admission and continued for a 7-day hospitalization period for serologic (ELISA), virologic (real-time PCR), and cytokine (ELISA) analysis. The mean serum CCHFV titer at admission was 5.5E + 09 copies/mL in fatal cases and 5.7E + 08 copies/mL in survivors (p < 0.001). Compared to survivors, both the mean serum levels of IL-6 and TNF-α at admission were found to be significantly increased in fatal cases. The serum levels of IL-6, TNF-α and serum CCHFV titer at admission were significantly and positively correlated with disseminated intravascular coagulation (DIC) scores (r = 0.626, p = 0.0002; r = 0.461, p = 0.009; and r = 0.625, p = 0.003, respectively). When the data obtained from the sequential determination of CCHFV titer and levels of anti-CCHFV IgG, IL-6, TNF-α, IL-10 and IFN-γ were grouped according to the days of illness, the initial serum CCHFV titer of a fatal patient was 5.5E + 09 (copies/mL) and it was 6.1E + 09 (copies/mL) in a survivor on the 2 day of illness. While significant alterations were observed in all cytokines during the monitoring period, IL-6 levels remained consistently higher in fatal cases and TNF-α levels increased in both in fatal and non-fatal CCHF cases. The increased CCHFV load and higher concentrations of IL-6 and TNF-α, the presence of DIC, and the absence of CCHFV specific immunity are strongly associated with death in CCHF.

Yekeler E.,Training and Research Hospital
Annals of Thoracic Surgery | Year: 2012

Swyer-James Macleod syndrome is a radiologic entity characterized by hyperlucency of one or more lobes or of the entire lung, decreased number and diameter of ipsilateral peripheral pulmonary vessels, and difficult visibility of the arterial network and unobstructed bronchial system. A 21-year-old male was admitted to our clinic on the observation of left hemithoracic hyperinflation on chest radiography. Preoperative evaluation revealed an increase of ventilation to the left lower lobe and the deletion of peripheral vascular structures. Scintigraphy revealed a perfusion defect in the left lower lobe. In this patient with congenital left upper lobe hypoplasia and Swyer-James Macleod syndrome in the lower half of the lower lobe, I present the coexistence of these two rare clinical entities and "acquired lobar emphysema." © 2012 The Society of Thoracic Surgeons.

Purpose To evaluate the correlation of subretinal fluid volume with choroidal thickness and macular volume in acute central serous chorioretinopathy (CSC). Methods Twenty patients with acute unilateral treatment-naive idiopathic CSC and 20 age-matched normal eyes were included in this prospective cross-sectional study. Subretinal fluid volume (SRFV) of study eyes was estimated using a built-in segmentation-modifying tool of Spectralis spectral-domain optic coherence tomography (SD-OCT). Subfoveal choroidal thickness (SCT) (measured with enhanced depth imaging-OCT) and macular volume (MV) were also determined. The correlation of SRFV with SCT and MV was analyzed statistically. Results There was no significant correlation of SRFV with SCT and MV in the study eyes (r=0.062, P=0.796 and r= -0.061, P=0.798, respectively). The mean SCT of the study eyes, the fellow eyes and the control eyes were 461.4±101.4, 375.3±103.7, 287.6±62.5 μm, respectively (P<0.001). The mean modified MV (determined excluding SRF volume) of the study eyes, the macular volume of the fellow and the control eyes was 8.57±0.59 mm 3, 8.75±0.4 mm 3 and 8.73±0.38 mm 3, respectively (P>0.05). Conclusion sThe current study shows that subretinal fluid volume does not correlate with subfoveal choroidal thickness. This novel finding suggests that formation of subretinal fluid is not solely associated with choroidal vasculature in acute CSC. © 2014 Macmillan Publishers Limited All rights reserved.

Emsen I.M.,Training and Research Hospital
Journal of Craniofacial Surgery | Year: 2015

There are many methods on skin defects and their reconstructions. The basic rule for reconstruction of these defects is to perform with the most easy and simple method. Local flaps are one of the most convenient for skin defects. Free flaps, interpolation flaps are usually can not preferred because of no time saving, and need the second operation to delay. For this reason, local flap methods have been always popular methods for the reconstruction of small to large skin defects. 10 patients were included to this study. All patients were operated by one senior author. Average follow-up was 10.9 months (1-26 months). Four of patients were female, and others were male. There was no seen any flap ischeamia at follow up. Histopathologic rewiev of removed masses was reported as malignant skin tumor for 7 patients, and as benign skin tumor for 3 patients. Even at the early postoperative period, no distal flap ischeamia was observed. Additionally, no any wound infection, dehiscence and other problems related to wound healing process were seen. In conclusion, our proposed technique that named ''bi-unilobed cutaneous flap '' has more superior properties than the other local flap methods including: easy planning, no need wide dissection, and has more less donor area morbidity. This suggested method is a different and a good alternative for small to large skin defectaccording to the standard local flaps such as banner, VY, advancement, transposition, Limberg, and other modified local flaps. Copyright ©2015 by Mutaz B. Habal, MD.

Emsen I.M.,Training and Research Hospital
The Journal of craniofacial surgery | Year: 2016

PURPOSE: Nasal tip reconstruction is an important component in aesthetic rhinoplasty. Different congenital deformities or acquired disorders (trauma, infection, operations) may affect the nasal tip structure. Additionally, the natural appearance of the nasal tip projection can be lost after rhinoplasty. The lower lateral cartilages are the main structural component of the nasal alae and tip support. Any distortion or failure on the alar cartilages may lead to both functional and aesthetic problems. In this article, the author presents a different method for nasal tip support.PATIENTS AND METHODS: Between 2010 and 2014, a chart review was performed of 64 consecutive primary rhinoplasty patients (29 women, 35 men). Postoperative follow-up period was at least 12 months. None of the patients were secondary patients or no nasal tip surgery was done previously. The patients with secondary rhinoplasty, saddle deformity, revision rhinoplasty, cleft lip nose, and crooked nose were excluded from the study.RESULTS: The three-dimensional pyramid cartilage technique was used in all the patients with the open rhinoplasty approach to ensure the nasal tip projection. Average time was between 4 and 7 minutes for graft harvesting and suturing to the nasal tip in this technique. The follow-up period was between 12 and 48 months. There was a revision procedure in 4 patients because of the distortion of the tip graft and tearing of the graft material. The revision procedure was done for these patients.DISCUSSION: In this article, the author presents "three-dimensional pyramid cartilage technique' as a new and alternative technique for better projection of the nasal tip. This technique also provided the support to nasal tip using only 1 graft material with minimal manipulation, with no donor area morbidity or another cartilage resection except the nasal septum.

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