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Omeroglu H.,Eskiehir Osmangazi University | Agus H.,Tepecik Teaching and Research Hospital | Bicimoglu A.,Kent Hospital | Tumer Y.,Ankara Numune Teaching and Research Hospital
Journal of Pediatric Orthopaedics | Year: 2012

Background: We aimed to evaluate experienced surgeons' decisions regarding the need for secondary surgery in developmental dysplasia of the hip (DDH) at 5 to 7 years of age. Methods: We selected 21 hips from 17 patients who had mid-term and skeletally mature radiographs and who had neither had complications nor secondary surgery until skeletal maturity after having an initial soft tissue surgery for DDH before the age of 18 months. Twenty experienced orthopaedic surgeons evaluated the mid-term follow-up radiographs of these hips in terms of their need for secondary surgery. Results: On the basis of management grading of the observers at mid-term follow-up, the risk of unnecessary surgical management was 12% in hips that would eventually be normal at skeletal maturity. The risk of not performing needed surgery was 40% in hips that would eventually become dysplastic at skeletal maturity. Experience of the surgeons in terms of years had no significant effect on the management decisions. The center-edge angle, the acetabular index angle (AIA), percentage of femoral head coverage, Shenton line, and the acetabular angle of Sharp were the 5 most commonly used radiographic parameters at mid-term follow-up to assess whether a secondary surgery would be needed. Center-edge angle, AIA, femoral head coverage, and Shenton line correlated, whereas the acetabular angle did not significantly correlate with surgeons' quantitative management decisions on the basis of mid-term radiographs. Conclusions: Experienced surgeons are more likely to opt for nonoperative management in hips that show no ischemic changes or instability at 5 to 7 years of age even in the presence of slightly abnormal radiographic measurements. AIA is considered the best radiographic parameter for making decisions regarding the need for secondary surgery in DDH at 5 to 7 years of age. Level of Evidence: Level II prognostic study. © 2012 by Lippincott Williams & Wilkins.


Hasdemir C.,Ege University | Payzin S.,Ege University | Kocabas U.,Ege University | Sahin H.,Ege University | And 7 more authors.
Heart Rhythm | Year: 2015

Background Atrioventricular nodal reentrant tachycardia (AVNRT) may coexist with Brugada syndrome (BrS). Objectives The present study was designed to determine the prevalence of drug-induced type 1 Brugada ECG pattern (concealed BrS) in patients presenting with clinical spontaneous AVNRT and to investigate their electrocardiographic, electrophysiological, and genetic characteristics. Methods Ninety-six consecutive patients without any sign of BrS on baseline electrocardiogram undergoing electrophysiological study and ablation for symptomatic, drug-resistant AVNRT and 66 control subjects underwent an ajmaline challenge to unmask BrS. Genetic screening was performed in 17 patients displaying both AVNRT and BrS. Results A concealed BrS electrocardiogram was uncovered in 26 of 96 patients with AVNRT (27.1%) and in 3 of 66 control subjects (4.5%) (P ≤.001). Patients with concealed BrS were predominantly female patients (n=23 [88.5%] vs n=44 [62.9%], P =.015), had higher prevalence of chest pain (n=10 [38.5%] vs n=13 [18.6%], p=0.042), migraine headaches (n=10 [38.5%] vs n=10 [14.2%], p=0.008), and drug-induced initiation and/or worsening of duration and/or frequency of AVNRT (n=4 [15.4%] vs n=1 [1.4%], p=0.006) as compared to patients with AVNRT without BrS. Genetic screening identified 19 mutations or rare variants in 13 genes in 13 of 17 patients with both AVNRT and BrS (yield = 76.5%). Ten of these 13 genotype-positive patients (76.9%) harbored genetic variants known or suspected to cause a loss of function of cardiac sodium channel current (SCN5A, SCN10A, SCN1B, GPD1L, PKP2, and HEY2). Conclusion Our results suggest that spontaneous AVNRT and concealed BrS co-occur, particularly in female patients, and that genetic variants that reduce sodium channel current may provide a mechanistic link between AVNRT and BrS and predispose to expression of both phenotypes. © 2015 Heart Rhythm Society.


Koc G.,Tepecik Teaching and Research Hospital | Wang X.,Tianjin Medical University | Luo Y.,University of Iowa
Canadian Journal of Urology | Year: 2011

Introduction: Renal cell carcinoma (RCC) is the most common type of kidney cancer in adults, responsible for approximately 90% of all kidney cancers. Prior to 2005, treatment options for patients with locally advanced and metastatic disease were limited. After the approval of sorafenib by the US Food and Drug Administration (FDA), other tyrosine kinase inhibitors (TKI) have been successively used for treating patients with advanced RCC. Pazopanib is the newest, orally bioavailable, and multi-targeted TKI, and is considered a first-line treatment option for certain patients. This review summarizes updated clinical studies, mechanism of action, and pharmacokinetics of pazopanib. Materials and methods: Published English language literatures and data information on pazopanib for treating advanced RCC available as of March 2011 were identified and summarized. Results: In phase II and III randomized clinical trials, pazopanib treatment resulted in considerably longer progression-free survival in patients with advanced RCC compared to placebo, with an acceptable side-effect profile. In addition, there are a few ongoing pazopanib studies including comparison to other TKIs, use for patients who have failed prior cytokine therapy, and combination with other therapeutic agents. Conclusions: Pazopanib has been used in the United States, Europe and Canada for treating patients with advanced RCC. Currently, it is being used in good or intermediate risk RCC and shows survival benefit with acceptable adverse effects. Pazopanib is a new treatment option and needs further evaluation, particularly on its effect relative to other TKIs as well as its use in combination with other agents. © The Canadian Journal of Urology™.


Hasdemir C.,Ege University | Ulucan C.,Ege University | Yavuzgil O.,Ege University | Yuksel A.,Kent Hospital | And 8 more authors.
Journal of Cardiovascular Electrophysiology | Year: 2011

Idiopathic Ventricular Arrhythmias and Cardiomyopathy. Introduction: Idiopathic ventricular arrhythmias in the form of monomorphic premature ventricular contractions (PVC) and/or ventricular tachycardia (VT) can cause tachycardia-induced cardiomyopathy (TICMP). The aim of this study was to determine the incidence, clinical and electrophysiologic characteristics, and the predictors of TICMP in patients with idiopathic ventricular arrhythmias. Methods: Study population consisted of 249 consecutive patients (148 F/101 M, 45 ± 20 y/o) with frequent PVCs and/or VT. All patients underwent transthoracic echocardiography and 24-hour Holter monitoring. TICMP was defined as left ventricular ejection fraction (LVEF) of ≤50% in the absence of any detectable underlying heart disease and improvement of LVEF a ̂ 15% following effective treatment of index ventricular arrhythmia. Results: Seventeen (6.8%) patients had TICMP. Patients with TICMP compared to patients with preserved LVEF were more likely to be male (65% vs 39%, P = 0.043) and asymptomatic (29% vs 9%, P = 0.018), and were more likely to have higher PVC burden (29.4 ± 9.2 vs 8.1 ± 7.4, P < 0.001), persistence of PVCs throughout the day (65% vs 22%, P = 0.001), and repetitive monomorphic VT (24% vs 0.9%, P < 0.001). PVC burden of 16% by ROC curve analysis best separated the patients with TICMP compared to patients with preserved LVEF (sensitivity 100%, specificity 87%, area under curve 0.96). Conclusions: TICMP was relatively common (∼1 in every 15 patients) in our study population. The predictors of TICMP were male gender, absence of symptoms, PVC burden of ≥16%, persistence of PVCs throughout the day, and the presence of repetitive monomorphic VT. (J Cardiovasc Electrophysiol, Vol. 22, pp. 663-668, June 2011) © 2011 Wiley Periodicals, Inc.


Halicioglu O.,Izmir Tepecik Teaching and Research Hospital | Aksit S.,Ege University | Koc F.,Ege University | Akman S.A.,Izmir Tepecik Teaching and Research Hospital | And 6 more authors.
Paediatric and Perinatal Epidemiology | Year: 2012

Halicioglu O, Aksit S, Koc F, Akman SA, Albudak E, Yaprak I, Coker I, Colak A, Ozturk C, Gulec ES. Vitamin D deficiency in pregnant women and their neonates in spring time in western Turkey. Paediatric and Perinatal Epidemiology 2012; 26: 53-60. Although Turkey is located in a sunny region, vitamin D deficiency is still a serious health problem in pregnant women and their infants, especially among the low socio-economic status Turkish population. This study was carried out in order to measure serum 25-hydroxyvitamin D3 [25(OH)D] concentrations of the pregnant women in the last trimester and in their neonates at delivery and to determine the factors associated with maternal serum 25(OH)D concentrations. Among the patients visiting the Ege Obstetrics and Gynecology Hospital in the period March to May 2008, 258 healthy pregnant women <37 weeks of gestation were included in this study. The information on different characteristics such as the number of pregnancies and births, nutritional status, vitamin and mineral support during gestation, educational status, clothing style and the economic level of the family was collected from women. Blood samples from the mothers and umbilical cord of the newborns were taken to measure 25(OH)D. The mean 25(OH)D concentrations of the mothers and their infants were 11.5 ± 5.4 ng/mL and 11.5 ± 6.8 ng/mL, respectively. We found a strong positive correlation between maternal serum and umbilical cord blood 25(OH)D concentrations (r = 0.651, P < 0.001). The concentration of 25(OH)D was 20 ng/mL in 233 mothers (90.3%) and a;circ10 ng/mL in 130 mothers (50.4%). Maternal serum 25(OH)D concentrations related strongly to factors such as uncovered dressing style, sufficient consumption of dairy products and multivitamin use during gestation (P < 0.05). About half (52.7%) of these women had a covered dressing style. 25(OH)D concentrations of these covered dressing mothers and their infants were 9.7 ± 5.1 ng/mL and 9.7 ± 5.6 ng/mL, respectively, which were significantly lower compared with those of uncovered mothers and their babies (P < 0.001). This study showed that, despite a sunny environment, vitamin D deficiency and insufficiency are highly prevalent among the mothers and their neonates. This is generally due to the life style and nutritional status of the mothers. These findings suggest that much more effective vitamin D prophylaxis programmes should be implemented for pregnant women as well as for their babies. © 2011 Blackwell Publishing Ltd.


Yakar Tuluce S.,Ataturk Training and Research Hospital | Kayikcioglu M.,Ege University | Tuluce K.,Ege University | Yilmaz M.G.,Ege University | And 3 more authors.
Journal of the American Society of Echocardiography | Year: 2010

Background: The incidence of systemic thromboembolism is high in patients with hypertrophic cardiomyopathy (HCM). The authors hypothesized that vulnerability to such vascular events could be caused by depressed left atrial appendage (LAA) function during normal sinus rhythm (SR). The aim of this cross-sectional study was to investigate LAA contractile function during SR in patients with HCM. Methods: LAA function was assessed in 62 patients with HCM in SR and compared with that in 53 age-matched and sex-matched controls. Patients with histories of atrial fibrillation and documented episodes of paroxysmal atrial fibrillation on 24-hour Holter monitoring and depressed left ventricular ejection fractions (<50%) were excluded. Multiplane transesophageal echocardiography was performed for determination of the morphology and function of the LAA. Results: LAA thrombi were present in five patients (8%) with HCM. LAA emptying and filling Doppler velocities were significantly depressed in the HCM group. LAA emptying and filling velocities were negatively correlated with age in controls (r = -0.4, P = .005), but these velocities were not associated with age in the HCM group. Moreover, LAA velocities were not associated with left ventricular mass index, left ventricular outflow tract gradient, or the degree of diastolic dysfunction in the HCM group. All Doppler tissue imaging velocities obtained from LAA walls were also significantly depressed in the HCM group. Conclusions: LAA thrombus formation was not rare in this patient population. The significantly depressed LAA filling and emptying velocities in SR may predispose patients with HCM to thromboembolic events. The depressed Doppler tissue imaging LAA parameters in patients with HCM may indicate the presence of a possible intrinsic atrial myopathy. Thromboembolic risk should be taken into account, and the evaluation of LAA morphology and function by transesophageal echocardiography might become a component of routine workup in patients with HCM in the future. © 2010 by the American Society of Echocardiography.


Hasdemir C.,Ege University | Kartal Y.,Ege University | Simsek E.,Ege University | Yavuzgil O.,Ege University | And 2 more authors.
PACE - Pacing and Clinical Electrophysiology | Year: 2013

Background Idiopathic ventricular arrhythmias in the form of frequent, monomorphic premature ventricular contractions (PVC) can cause PVC-induced cardiomyopathy (PICMP). The aim of this study was to determine the baseline echocardiographic characteristics and the time course and degree of recovery of left ventricular (LV) systolic dysfunction in patients with PICMP. Methods Study population consisted of 348 consecutive patients (205F/143M, 44 ± 19 y/o) with frequent PVCs and/or ventricular tachycardia. PICMP was defined as LV ejection fraction (LVEF) of <55% in the absence of any detectable underlying heart disease and improvement of LVEF ≥ 15% following treatment of ventricular arrhythmia. Patients with PCIMP underwent transthoracic echocardiography for LV size and function at 1 week and at 1-3 to 6-12 months of follow-up. Results Twenty-four patients (8F/16M, 47 ± 18 y/o) with PICMP with complete echocardiographic data were included in the study. Average baseline LV end-diastolic diameter, LV end-systolic volume, LV mass index, and LVEF were 55.4 ± 6.8 mm, 69.6 ± 23.3 mL, 110.2 ± 28.3 g/m2, and 41 ± 8.4%, respectively. Mild-to-moderate mitral regurgitation (MR) was present in 13 (54%) patients. Early improvement (≥25% increase in LVEF at 1-week follow-up compared to baseline) was observed in 13 (54%) patients. Patients with early improvement had higher LVEF at 12 months of follow-up compared to patients without early improvement (58.8 ± 5.0% vs 52.5 ± 6.7%, P = 0.019). Conclusions PCIMP is characterized by mild-to-moderate global LV systolic dysfunction with slightly increased LV mass and mild-to-moderate MR. Greatest improvement in LV systolic dysfunction was observed at 1-week follow-up in our study population. Early improvement in LVEF may potentially predict the complete reversibility of LV systolic dysfunction. ©2013, The Authors. Journal compilation ©2013 Wiley Periodicals, Inc.


Oktay B.,Uludag University | Koc G.,Tepecik Teaching and Research Hospital | Vuruskan H.,Uludag University | Danisoglu M.E.,Uludag University | Kordan Y.,Uludag University
Urology Journal | Year: 2011

Purpose: To evaluate the feasibility of laparoscopic simple prostatectomy for large volume prostates. Materials and Methods: Between October 2007 and July 2009, laparoscopic simple prostatectomy was performed on 16 patients with the prostates over 80 mL. All the patients were operated with transvesical method. Peri-operative and 3rd postoperative month data were recorded and evaluated. Results: The mean prostate volume was 147 mL (range, 80 to 200 mL). The mean operation time, blood loss, duration of hospitalization, and duration of drain placement was 133 minutes (range, 75 to 210 minutes), 134 cc (range, 50 to 300 cc), 3.9 days (range, 2 to 7 days), and 2.1 days (range, 2 to 3 days), respectively. Only one patient required blood transfusion due to postoperative bleeding and clot obstruction in the catheter lumen. Postoperative infection was not seen and recatheterization was not needed in any of the patients. All the patients' pathology reports were noted as benign. Pre-operative and postoperative International Prostate Symptom Score were 9.2 and 25.4, respectively. Maximum urinary flow rate was 4.0 mL/sec pre-operatively, but 24.7 mL/sec postoperatively. Conclusion: Laparoscopic simple prostatectomy is a feasible method with low morbidity and improved postoperative outcomes.


Halicioglu O.,Tepecik Teaching and Research Hospital | Akman S.A.,Tepecik Teaching and Research Hospital | Tatar B.,Tepecik Teaching and Research Hospital | Atesli R.,Tepecik Teaching and Research Hospital | Kose S.,Tepecik Teaching and Research Hospital
Travel Medicine and Infectious Disease | Year: 2012

The age-specific prevalence of hepatitis A virus (HAV) infection and risk factors were evaluated in a low socioeconomic population in Izmir. Children and adolescents 1-18 years of age admitted to the outpatient clinics for follow-up visits, or healthy children between April-December 2009 were investigated for anti-HAV antibodies by a cross-sectional study. A questionnaire on sociodemographic and hygiene information was obtained from the parents. All unvaccinated children against HAV were grouped according to their age. Seven hundred and twenty-nine children were enrolled in the study. Total HAV IgG seropositivity was 29.5% while age related values were as follows: 1-2 years, 21.4%; 2.1-5 years, 15.1%; 5.1-8 years, 20.1%; 8.1-11 years, 32.6%; 11.1-14 years, 44.3% and 14.1-18 years, 52.4%. The presence of anti-HAV IgG was associated significantly with low family income and lack of education of parents and living in a crowded family. HAV infection was endemic in a population of children living in Izmir. Anti-HAV vaccination should be considered for preschool children because teenagers are at risk of infection in this region. © 2011 Elsevier Ltd. All rights reserved.


Ekin R.G.,Tepecik Teaching and Research Hospital | Celik O.,Tepecik Teaching and Research Hospital | Ilbey Y.O.,Tepecik Teaching and Research Hospital
Central European Journal of Urology | Year: 2015

Introduction Over the last two decades, minimally invasive treatment options for ureteropelvic junction obstruction have been developed and are bcoming more popular. Multiple series of laparoscopic pyelo­plasty have demonstrated high success rates and low perioperative morbidity in pediatric and adult popu­lations, for both the transperitoneal and retroperitoneal approaches. In this review, we aimed to analyze the current status of minimally invasive therapy of ureteropelvic junction obstruction. Material and methods A PubMed database search was conducted to examine minimally invasive treat­ments of ureteropelvic junction obstruction. Results A large number of cases have been reported for adult patients, confirming that robotic pyeloplasty represents a viable option for either primary or secondary repair. Comparative studies demonstrate similar success and complication rates between minimally invasive and open pyeloplasty in both the adult and pediatric populations. A clear advantage, in terms of hospital stay, of minimally invasive over open pyelo­plasty was observed only in the adult population. Conclusions Studies have shown that minimally invasive pyeloplasty techniques are a safe, effective, and feasible in adult and pediatric populations. © 2015 Polish Urological Association. All Rights Reserved.

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