Sakarya Education and Research Hospital

Adapazarı, Turkey

Sakarya Education and Research Hospital

Adapazarı, Turkey
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Gungen A.C.,Istanbul University | Coban H.,Sakarya Education and Research Hospital
Biomedical Research (India) | Year: 2017

Background and objective: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a safe and minimally invasive procedure that yields accurate results in the evaluation of mediastinal lymphadenopathies. The aim of our study was to retrospectively evaluate EBUS-TBNA procedures performed in our clinic and to reveal the value of EBUS-TBNA in terms of mediastinal lymph node diagnoses. Methods: A total of 52 patients with mediastinal lymph node enlargement (short axis >1 cm) who underwent thoracic computed tomography and EBUS-TBNA were retrospectively included in this study. Results: The mean age of the patients was 51.3 ± 15.5 (range: 18-74) years and there were 23 (44.2%) females and 29 (55.8%) males. The sizes of the sampled lymph nodes ranged from 10 mm to 30 mm. Of the 52 patients who underwent EBUS-TBNA, 43 (82.7%) had a final diagnosis. Mediastinoscopy was performed in nine (17.3%) patients who reached a negative cytological outcome. As a final diagnosis, sarcoidosis was found in 23 patients, tuberculosis in 3 patients, squamous cell lung cancer in 6 patients, small cell lung cancer in 9 patients, lung adenocarcinoma in 1 patient and a benign diagnosis in 10 cases. No complications were observed in any of the cases. Conclusion: TBNA is a safe interventional procedure under EBUS guidance that provides a high adequacy and diagnostic rate for mediastinal lymph nodes and reduces the need for invasive surgery. © 2017, Scientific Publishers of India. All rights reserved.


Senates E.,Haydarpasa Numune Education and Research Hospital | Colak Y.,Mardin State Hospital | Erdem E.D.,Haydarpasa Numune Education and Research Hospital | Yesil A.,Haydarpasa Numune Education and Research Hospital | And 5 more authors.
Journal of Crohn's and Colitis | Year: 2013

Background and aim: Crohn's disease (CD) decreases fertility both directly, by inducing inflammation in the fallopian tubes and ovaries, and indirectly, through the surgical interventions and tubal adhesions associated with disease treatment. Anti-müllerian hormone (AMH) is a reliable indicator of ovarian reserve in women. We aimed to compare serum AMH levels between reproductive-age women with CD and healthy controls. Methods: Serum AMH levels were measured by ELISA in 35 women with CD and 35 age-matched healthy women controls. Results: CD patients and controls were similar in terms of age, height, weight and BMI. Mean CD duration was 60 months. CRP, ESR and leukocyte counts were significantly higher in CD patients compared to the controls (p < 0.001, p = 0.004 and p = 0.04, respectively). AMH levels in CD patients (1.02 ± 0.72) were significantly lower compared to the controls (1.89 ± 1.80) (p = 0.009). Serum AMH levels in CD patients with active disease (0.33 ± 0.25) were significantly lower compared to CD patients who were in remission (1.53 ± 0.49) (p = 0.001). Serum AMH levels were similar in CD patients with a disease duration of less than 5 years (17 patients) and CD patients with a disease duration of greater than 5 years (18 patients) (p = 0.8). In CD patients, a negative correlation between CDAI and serum AMH levels was found (r = -0.718, p < 0.001). Serum AMH levels were similar in CD patients who had (6 patients) and had not undergone (29 patients) surgical treatment (p = 0.2). Conclusion: Serum AMH levels of reproductive-age women with CD were significantly lower compared to the controls. CDAI and AMH are inversely correlated. © 2012 European Crohn's and Colitis Organisation.


PubMed | Van Education and Research Hospital, Sakarya Education and Research Hospital, Gazi University, Gaziosmanpaşa University and Ankara Numune Education and Research Hospital
Type: Journal Article | Journal: Wiener klinische Wochenschrift | Year: 2016

In this retrospective study, we aimed to evaluate the clinicopathological characteristics of the patients presenting with liver metastases from unknown primary site besides survival rates, treatment outcomes, and prognostic factors.In all, 68 patients followed-up at our center with adenocarcinoma of unknown primary (ACUP) metastatic to the liver between 2005 and 2013 were enrolled. All of the liver metastases were proven by liver biopsy and all yielded diagnosis of adenocarcinoma.Median age was 61 years (29-90) and most of the patients were male (male/female: 43/25). The liver was the only metastatic site in 2 (3%) patients whilst 66 patients (97%) had extrahepatic metastases. The most common extrahepatic metastatic sites were lymph nodes (89.7%), lungs (32.4%), bones (25%), peritoneum (11.8%), brain (4.4%), and adrenal glands (2.9%). Of all 68 patients, 39 (57.4%) were treated with chemotherapy. Median overall survival (OS) was significantly higher in ACUP patients treated with chemotherapy [12.5 months (95% CI 8.3-16.7) vs. 4 months (95% CI 1.2-6.8), (p=0.026), respectively]. In multivariate analysis, ECOG (Eastern Cooperative Oncology Group) performance status (p=0.009), chemotherapy (p=0.024), serum albumin (p=0.012), and serum CA 19-9 level (p=0.026) at initial diagnosis were identified as independent prognostic factors influencing survival for the patients with liver metastases from ACUP.Patients with liver metastases from ACUP have poor prognosis and chemotherapy improves survival. Decreased serum albumin level, increased CA 19-9 level and poor performance status are independent poor prognostic factors.


Bes C.,Bakirkoy Dr Sadi Konuk Education And Research Hospital | Yazici A.,Sakarya Education and Research Hospital | Soy M.,Hisar Intercontinental Hospital
Rheumatology International | Year: 2013

Anemia is one of the extra-articular findings of ankylosing spondylitis (AS), and anti-TNF therapy has been shown benefit in patients with anemia associated AS. In this study, we aimed to evaluate and compare the effects of biological and non-biological agents on hemoglobin levels in AS patients. One hundred consecutive patients who fulfilled ASAS criteria for AS were included in the study. Fifty-four of the patients treated with anti-TNF agents (20 patients treated with infliximab, 20 patients with adalimumab, and 14 patients with etanercept), and 46 patients treated with non-steroidal anti-inflammatory drugs and/or other disease modifying anti-rheumatic drugs. The C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), hemoglobin (HGB), hematocrit (HCT) counts, and BASDAI scores were compared before starting therapy and at 52 weeks. There was no statistically significant difference between patients about demographical data (age, sex) and disease age (p > 0.05 for all). Significant difference was determined between HGB, HCT, CRP, ESR, and BASDAI values before and after therapy (for infliximab p: 0.001; 0.000; 0.000; 0.000; 0.000, respectively, and for adalimumab p: 0.017; 0.03; 0.001; 0.002; 0.000, respectively). In etanercept group, there was no significant difference in HGB values, when compared with before starting therapy and at 52 weeks (p > 0.05). In the group of treated with non-biological agents, ESR values and BASDAI scores showed distinctive improvement after 52 weeks of therapy, but was not a significant difference in hemoglobin and hematocrit values. Conclusion: Anti-TNF-alpha therapy with monoclonal antibodies (adalimumab and infliximab) did not only suppress disease activity but also provided a significant improvement in HGB levels. In the groups of treated with a TNF-alpha receptor antagonist (ETA) and non-biological agents, disease activity was suppressed, but there was not founded significant improvement in HGB levels after 52 weeks. Different outcomes of anti-TNF agents may be associated with their different effect mechanisms. © 2012 Springer-Verlag Berlin Heidelberg.


Altunoz M.E.,Haydarpasa Numune Education and Research Hospital | Altunoz M.E.,Sakarya Education and Research Hospital | Senates E.,Haydarpasa Numune Education and Research Hospital | Yesil A.,Haydarpasa Numune Education and Research Hospital | And 2 more authors.
Digestive Diseases and Sciences | Year: 2012

Background Hepatitis B (HBV) is a vaccine-preventable infection that may cause severe infections, particularly in patients who are being treated with immunosuppressive therapy [(i.e., inflammatory bowel disease (IBD)]. Limited data are available about IBD patients' response rate to HBV vaccine. Aim To assess the efficacy of HBV vaccine in IBD patients and healthy controls. Methods Serological markers of HBV were assessed in IBD patients, and HBV vaccine was administered to seronegative patients. The subsequent determination of anti-HBs antibody was recorded. An adequate immune response (AIR) and an effective immune response (EIR) to HBV were defined as more than 10 and 100 mIU/ml, respectively. The single dose vaccine was administered at 0, 1 and 6 months. Results A total of 102 patients with IBD (39 Crohn's disease, 63 ulcerative colitis; 54 female, 48 male) and 52 (25 female, 27 male) healthy controls were included. Mean age for patients and controls were 38 ± 12 and 31 ± 8, respectively (P\0.001). Both AIR and EIR were significantly lower in patients than in controls (P\0.001), but they were similar between patients with CD and UC (P = 0.302). Forty-four (43%) patients were on immunosuppressive therapy before vaccination. After vaccination, 76 and 53% of the patients had AIRs and EIRs, respectively, whereas 100 and 87% of the controls had AIRs and EIRs, respectively (P\0.001 and P\0.001, respectively). Conclusions The response rate of IBD patients receiving HBV vaccinations were significantly lower compared to controls. The response rate of those receiving immunosuppressive therapy and with active disease was much too low. Vaccination should be given during remission and at immunosuppression-free times. © Springer Science+Business Media, LLC 2012.


Okuyan H.,Sakarya Education and Research Hospital | Altin C.,Yenimahalle State Hospital
Indian Journal of Pharmacology | Year: 2013

Itraconazole is a broad-spectrum antifungal agent. It rarely leads to adverse the cardiovascular effects, especially heart failure. We present here a case of a 60-year-old female patient with itraconazole induced heart failure.


Yilmaz M.S.,Sakarya Education and Research Hospital | Guven M.,Sakarya Education and Research Hospital | Buyukarslan D.G.,Sakarya Education and Research Hospital | Kaymaz R.,Sakarya Education and Research Hospital | Erkorkmaz U.,Gaziosmanpaşa University
Otolaryngology - Head and Neck Surgery | Year: 2012

Objective. This study aims to compare the effects of Merocel nasal packs and silicone nasal septal splints with integral airway on the ventilation and pressure of the middle ear when applied intranasally after septoplasty for isolated septal deviation. Study Design. A prospective, randomized trial. Setting. A tertiary referral center. Subjects and Methods. Fifty-one patients who underwent septoplasty for nasal respiratory impairment caused by septal deviation were randomized into 2 groups. After septoplasty, bilateral anterior Merocel nasal packs were applied in one group, while silicone nasal septal splints with integral airway were applied in the other group. Middle ear pressures were compared using preoperative and postoperative tympanometry. Results. Pathological decrease in the middle ear pressure in at least 1 ear was determined in 17 patients (73.9%) in the Merocel group compared with only 6 patients (21.4%) in the silicone nasal septal splint group at the 48th postoperative hour. In the first 24 hours following surgery, decreases in tympanometric pressures were seen in both groups, but more in the Merocel group. After 24 hours, middle ear pressures continued to decrease in the Merocel group but started to increase in the silicone nasal septal splint group. Conclusion. Because they allow inhalation through the nose and cause less Eustachian tube dysfunction than Merocel, using silicone nasal septal splints with integral airway instead of packing after septoplasty seems a more reasonable option. © American Academy of Otolaryngology - Head and Neck Surgery Foundation 2012.


Cakar M.A.,Sakarya Education and Research Hospital
Vascular health and risk management | Year: 2010

Anomalous origin of the left main coronary artery from the right sinus of Valsalva is extremely rare when not associated with other congenital cardiac anomalies. In this report we present a patient with a single coronary ostium, with both the left and right coronary artery systems arising from it. The right coronary artery was found to contain a significant flow-limiting lesion that was successfully treated with percutaneous coronary intervention.


Cakar M.A.,Sakarya Education and Research Hospital
Journal of cardiovascular medicine (Hagerstown, Md.) | Year: 2012

The incidence of dual left anterior descending coronary artery (LAD) in normal hearts has been reported to range from 0.13 to 1%. Type IV dual LAD differs from the other three types in the origination of the long LAD from the right coronary sinus. We present a case of type IV dual LAD in a patient with anterior myocardial infarction related to the short LAD.


PubMed | Sakarya Education and Research Hospital
Type: Journal Article | Journal: Saudi medical journal | Year: 2017

To examine the anesthesiologists choice for anesthesia techniques and drugs in circumcision and determine the preoperative examination, intraoperative monitoring techniques, postoperative analgesia methods, and common complications among anesthesiologists working in Turkey.Methods: This cross-sectional study was conducted at Bulent Ecevit University Hospital, Zonguldak, Turkey, between May and July 2012. Survey data were obtained via survey forms through electronic data over the web. The questionnaire consists of 20 questions. These questions included demographic data, methods of anesthesia for circumcision, postoperative analgesia methods, and monitoring methods.Results: The data were obtained from 206 anesthesiologists who agreed to participate in the survey. Circumcision was performed most frequently in the age group of 3-6 years old. It was found that 47% of routine preoperative laboratory tests were coagulation parameters and complete blood count tests. The most common method of anesthesia was laryngeal mask. The frequency of administration of regional anesthesia was 37.4%, and caudal block was more preferable. Bupivacaine as a local anesthetic in regional anesthesia and midazolam and ketamine were the most preferred agents in sedoanalgesia. During regional anesthesia, ultrasound was most often used by anesthesiologists (31.6%).Conclusion: Ambulatory anesthesia protocols, which are also needed in circumcision, can be improved with international recommendation, and these protocols could be conformed as sociocultural structure in societies. This study should be regarded as a preliminary study to attract attention on anesthesia techniques in circumcision.

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