Sisli Etfal Teaching and Research Hospital

İstanbul, Turkey

Sisli Etfal Teaching and Research Hospital

İstanbul, Turkey
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Cingi C.,Eskiehir Osmangazi University | Sayin I.,Bakirkoy Dr Sadi Konuk Teaching and Research Hospital | Civelek S.,Sisli Etfal Teaching and Research Hospital
Expert Review of Medical Devices | Year: 2010

Powered instruments have been introduced into otorhinolaryngology practice over the last decade. These instruments were accepted immediately by many institutions, and continuing development has led to the current use of microdebriders in a variety of surgical procedures in otorhinolaryngology. In clinical rhinology, they were first used in endoscopic sinus surgery to facilitate working on deep planes, but have subsequently been adopted in various conditions. This article presents an evaluation of the use of microdebriders in common rhinological disorders. © 2010 Expert Reviews Ltd.

Dalgard F.J.,Innlandet Hospital Trust | Gieler U.,Justus Liebig University | Tomas-Aragones L.,University of Zaragoza | Lien L.,Hedmark University College | And 16 more authors.
Journal of Investigative Dermatology | Year: 2015

The contribution of psychological disorders to the burden of skin disease has been poorly explored, and this is a large-scale study to ascertain the association between depression, anxiety, and suicidal ideation with various dermatological diagnoses. This international multicenter observational cross-sectional study was conducted in 13 European countries. In each dermatology clinic, 250 consecutive adult out-patients were recruited to complete a questionnaire, reporting socio-demographic information, negative life events, and suicidal ideation; depression and anxiety were assessed with the Hospital Anxiety and Depression Scale. A clinical examination was performed. A control group was recruited among hospital employees. There were 4,994 participants - 3,635 patients and 1,359 controls. Clinical depression was present in 10.1% patients (controls 4.3%, odds ratio (OR) 2.40 (1.67-3.47)). Clinical anxiety was present in 17.2% (controls 11.1%, OR 2.18 (1.68-2.82)). Suicidal ideation was reported by 12.7% of all patients (controls 8.3%, OR 1.94 (1.33-2.82)). For individual diagnoses, only patients with psoriasis had significant association with suicidal ideation. The association with depression and anxiety was highest for patients with psoriasis, atopic dermatitis, hand eczema, and leg ulcers. These results identify a major additional burden of skin disease and have important clinical implications. © 2015 The Society for Investigative Dermatology.

Nelson J.C.,University of California at San Francisco | Zhang Q.,Eli Lilly and Company | Deberdt W.,Eli Lilly and Company | Marangell L.B.,Eli Lilly and Company | And 2 more authors.
Current Medical Research and Opinion | Year: 2012

Objective: To identify predictors of remission with placebo treatment in double-blind randomized controlled trials (RCTs) in major depressive disorder (MDD). Method: A total of 1017 placebo-treated patients with baseline Hamilton Depression rating scale (HAMD) total ≥15 from eight duloxetine RCTs were included. Remission was defined as endpoint (7-8 weeks) HAMD total ≤7. Data were randomly split into training data (N=813, 80%) for model selection and test data (N=204, 20%) for validation. Logistic regression and classification and regression tree (CART) methods were used to identify predictors of remission. Predictive accuracy of models was assessed by Receiver Operator Characteristic (ROC) curves. Results: Baseline predictors for remission with placebo consistently identified with the logistic regression and CART analysis were less severe depressive symptoms (based on HAMD core symptoms), younger age, less anxiety (based on HAMD anxiety/somatization), and shorter current MDD episode duration. Associated cut-off values from the CART method characterized patient groups according to their remission likelihood. However, the predictive accuracy was modest for both methods with areas under the ROC curve of 0.6-0.65 based on test data. Conclusion: The derived models, although of limited value for predicting remission in individual patients, may be useful for adjusting for placebo effects in clinical trials. © 2012 Informa UK Ltd All rights reserved.

Kocak-Uzel E.,University of Houston | Kocak-Uzel E.,Sisli Etfal Teaching and Research Hospital | Gunn G.B.,University of Houston | Colen R.R.,University of Houston | And 12 more authors.
Radiotherapy and Oncology | Year: 2014

Background To investigate potential dose-response relationship between radiation-associated nausea and vomiting (RANV) reported during radiotherapy and candidate nausea/vomiting-associated regions of interest (CNV-ROIs) in head and neck (HNC) squamous cell carcinomas. Methods and material A total of 130 patients treated with IMRT with squamous cell carcinomas of head and neck were evaluated. For each patient, CNV-ROIs were segmented manually on planning CT images. Clinical on-treatment RANV data were reconstructed by a review of the records for all patients. Dosimetric data parameters were recorded from dose-volume histograms. Nausea and vomiting reports were concatenated as a single binary "Any N/V" variable, and as a "CTC-V2+" variable. Results The mean dose to CNV-ROIs was higher for patients experiencing RANV events. For patients receiving IMRT alone, a dose-response effect was observed with varying degrees of magnitude, at a statistically significant level for the area postrema, brainstem, dorsal vagal complex, medulla oblongata, solitary nucleus, oropharyngeal mucosa and whole brain CNV-ROIs. Conclusion RANV is a common therapy-related morbidity facing patients receiving HNC radiotherapy, and, for those receiving radiotherapy-alone, is associated with modifiable dose to specific CNS structures. © 2014 Elsevier Ireland Ltd. All rights reserved.

Karadag B.,Sisli Etfal Teaching and Research Hospital | Ozyigit T.,American Hospital | Ozben B.,Marmara University | Kayaoglu S.,Sisli Etfal Teaching and Research Hospital | Altuntas Y.,Sisli Etfal Teaching and Research Hospital
Journal of Clinical Neuroscience | Year: 2013

Left atrial (LA) enlargement is a predictor of cardiovascular outcomes such as atrial fibrillation (AF), stroke, and death. The aim of this study was to explore the relationship between LA size and cognitive function in elderly patients without any signs of clinical dementia, AF or previous stroke. We assessed the cognitive status and LA volume (LAV) of 108 consecutive patients (27 males; mean age, 74.8 ± 6.9 years) with sinus rhythm. Cognitive status was assessed by the Mini Mental State Examination (MMSE). Patients with a MMSE score of ≤25 were considered to have cognitive impairment. LAV was measured with two-dimensional echocardiography. LAV index (LAVI) was obtained by indexing LAV to body surface area. Thirty-five patients (32.4%) had cognitive impairment. The patients with cognitive impairment had significantly larger left atria than the patients with normal cognitive function. Receiver operating characteristic analysis revealed a cut-off point of ≥34 mL/m2 for LAVI to predict patients with cognitive impairment (sensitivity, 97.1%; specificity, 52.1%; positive predictive value, 49.3%; negative predictive value, 97.4%). LAVI ≥ 34 mL/m2 was significantly associated with cognitive impairment (p = 0.001, odds ratio = 36.91, 95% confidence interval = 4.8-284.2). Logistic regression analysis revealed that LAVI ≥ 34 mL/m 2 and age were independently associated with cognitive impairment. Increased LAVI is associated with cognitive impairment. Assessment of cognitive function may be recommended in elderly patients with enlarged left atria. © 2013 Elsevier Ltd. All rights reserved.

Uzel E.K.,Sisli Etfal Teaching and Research Hospital | Karacam S.,Istanbul University | Elicin O.,Istanbul University | Uzel O.O.,Istanbul University
Strahlentherapie und Onkologie | Year: 2013

Purpose: To compare the effect of two different intensity-modulated radiation therapy (IMRT) planning techniques on parotid gland doses in patients with nasopharyngeal carcinoma (NPC). Patients and methods: Radiotherapy for 10 NPC patients referred to the University of Istanbul Cerrahpasa Medical School was planned with arc- and static seven-field IMRT. The simultaneous integrated boost (SIB) technique was used to deliver 70 Gy (2.12 Gy per fraction) to the primary tumor and involved nodes; 60 Gy (1.81 Gy per fraction) to the entire nasopharynx and 54 Gy (1.63 Gy per fraction) to elective lymph nodes in 33 fractions. Plans also aimed to keep the mean parotid dose below 26 Gy and limit the maximum doses to the spinal cord and brain stem to 45 and 54 Gy, respectively. Mean parotid gland doses for the two planning techniques were compared using a paired t-test. Target coverage and dose inhomogeneity were evaluated by calculating conformity- (CI) and homogeneity index (HI) values. Results: Target coverage and dose homogeneity were identical and good for both planning techniques: CI = 1.05 ± 0.08 and 1.05 ± 0.08; HI = 1.08 ± 0.02 and 1.07 ± 0.01 for arc- and static field IMRT, respectively. Mean doses to contralateral parotid glands were 25.73 ± 4.27 and 27.73 ± 3.5 Gy(p = 0.008) for arc- and static field IMRT plans, respectively, whereas mean ipsilateral parotid doses were 30.65 ± 6.25 and 32.55 ± 5.93 Gy (non-significant p-value), respectively. Mean monitor units (MU) per fraction for the 10 patients were considerably lower for arc- than for static field treatments - 540.5 ± 130.39 versus 1288.4 ± 197.28 (p < 0.001). Conclusion: Normal tissues - particularly the parotid glands - are better spared with the arc technique in patients with NPC. MU and treatment times are considerably reduced in arc IMRT plans. © 2013 Urban & Vogel.

Civelek S.,Sisli Etfal Teaching and Research Hospital | Sayin I.,Bakirkoy Teaching and Research Hospital | Ercan I.,Sisli Etfal Teaching and Research Hospital | Cakir B.O.,Sisli Etfal Teaching and Research Hospital | Turgut S.,Sisli Etfal Teaching and Research Hospital
Ear, Nose and Throat Journal | Year: 2012

We report our assessment of the effectiveness of bipolar radiofrequency-induced interstitial thermoablation (BRIT) for the treatment of certain oral cavity vascular malformations in 5 children. Two of these patients had lymphangiomatous macroglossia (LM), 1 had lymphangioma circumscriptum (LC), and 2 had a venous malformation (VM). Each patient underwent BRIT at least twice; treatment was delivered at 4- to 8-week intervals according to each patient's circumstances. The 2 patients with LM required three treatment sessions; although their tongue volume decreased after each session, both still required a partial glossectomy to achieve a satisfactory reduction in volume. The patient with LC underwent two BRIT treatments, which reduced the size of the lesion by half; the remainder was excised. The 2 patients with a VM (1 buccal and 1 lingual) responded well to BRIT, and their malformations almost completely disappeared. Our early results with BRIT suggest that it is an effective treatment for oral cavity vascular malformations-more so for patients with venous rather than lymphangiomatous lesions. © 2012 Vendome Group, LLC.

Uzel E.K.,Sisli Etfal Teaching and Research Hospital | Ekmekcioglu O.,Nuclear Medicine | Elicin O.,Radiation Oncology | Halac M.,Nuclear Medicine | Uzel O.E.,Radiation Oncology
Asian Pacific Journal of Cancer Prevention | Year: 2013

Objectives: To evaluate accuracy of FDG-PET CT in prediction of persistent disease in head and neck cancer cases and to determine prognostic value of metabolic tumor response. Materials and Methods: Between 2009 and 2011, 46 patients with squamous cell carcinoma of head and neck receiving PET-CT were treated with definitive radiotherapy, with or without chemotherapy. There were 29 nasopharyngeal, 11 hypopharyngeal, 3 oropharyngeal and 3 laryngeal cancer patients, with a median age of 50.5 years (range 16-84), 32 males and 14 females. All patients were evaluated with PET-CT median 3-5 months (2.4-9.4) after completion of radiotherapy. Results: After a median 20 months of follow up, complete metabolic response was observed in 63% of patients. Suspicious residual uptake was present in 10.9% and residual metabolic uptake in 26.0% of patients. The overall sensitivity, specificity, positive predictive value and negative predictive value of FDG-PET-CT for detection of residual disease was 91% and 81%, 64% and 96% respectively. Two year LRC was 95% in complete responders while it was 34% in non-complete responders. Conclusions: FDG PET CT is a valuable tool for assessment of treatment response, especially in patients at high risk of local recurrence, and also as an indicator of prognosis. Definitely more precise criteria are required for assessment of response, there being no clear cut uptake value indicating residual disease. Futhermore, repair processes of normal tissue may consume glucose which appear as increased uptake in control FDG PET CT.

Karamustafalioglu O.,Sisli Etfal Teaching and Research Hospital
The Journal of clinical psychiatry | Year: 2010

A large gap exists between the number of people needing treatment and the number of people receiving treatment for depression in the Middle East. Barriers to mental health care in the region have included the lack of education for primary health care providers about mental illnesses, the scarcity of trained mental health care specialists, the lack of resources in developing countries, and the stigmatization of mental illness in Middle Eastern cultures. Guidelines for the treatment of depression have not been developed in most countries of the region. Guidelines have been published for both general practitioners and for psychiatrists in Turkey, and they are similar to guidelines published in the West. These guidelines are assessed using the AGREE instrument. Although guidelines recommend antidepressants as a first-line treatment for depression, many physicians in Middle Eastern countries prescribe benzodiazepines. One reason for this treatment gap may be that patients with depression often seek treatment from primary care providers and report somatic symptoms. Primary care providers may not be as knowledgeable about the diagnosis of depression or its treatment as psychiatrists and may not have access to certain classes of medications. More education for both physicians and patients in the Middle East is needed to decrease the stigma associated with depression.

Cetinkaya F.,Maltepe University | Incioglu A.,Maltepe University | Birinci S.,Health Directorate of Istanbul | Karaman B.E.,Maltepe University | And 2 more authors.
Allergy: European Journal of Allergy and Clinical Immunology | Year: 2013

Background There are very limited data characterizing the epidemiology of anaphylaxis from low- and middle-income country settings. We aimed to estimate the frequency of anaphylaxis admissions to hospitals in Istanbul. Methods We obtained data from all 45 hospitals in Istanbul over a 12-month period and used ICD-10 codes to extract data on those admitted with a recorded primary diagnosis of anaphylaxis. Because of concerns about possible under-coding, we undertook an additional analysis to identify patients admitted with two or more clinical codes for symptoms and/or signs suggestive of, but not coded as having, anaphylaxis. Results A total of 114 cases (79 people with anaphylaxis codes and 35 with symptoms and signs suggestive of anaphylaxis) were identified, giving an overall estimate of 1.95 cases per 100 000 person-years. Conclusion The novel two-stage identification approach employed suggests significant under-recording of anaphylaxis in those admitted to hospitals in Istanbul. © 2012 John Wiley & Sons A/S.

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