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Oncel G.,Izmir University | Oncel D.,Tepecik Training and Research Hospital
Heart Surgery Forum | Year: 2013

Purpose: Coronary artery calcium (CAC) is a specific indicator of and an independent risk factor for atherosclerosis; however, calcium scoring may miss noncalcified plaques, which may have clinical importance. The aim of this study was both to identify the presence and extent of coronary plaques during computed tomography coronary angiography (CTCA) in patients with a zero CAC score and to evaluate the effect of risk factors and symptom status on the presence of noncalcified plaques. Materials and Methods: In this retrospective study, we analyzed the cases of 842 consecutive patients between October 2006 and November 2011. Of these patients, we included 357 with a zero calcium score in the study. Information regarding patient age, sex, coronary risk factors, and symptom status were recorded. Coronary calcium-scoring scans were followed by CTCA. The calcium scores were calculated, and the presence of noncalcified plaques and significant stenoses (>50% of vessel diameter) was evaluated. Results: Of the 357 patients with a zero calcium score, 37 (10.36%) had atherosclerotic plaques; 9 patients (2.52%) had significant coronary stenosis. Among coronary risk factors, only diabetes mellitus was significantly correlated with any risk factors (presence of atherosclerosis and obstructive coronary artery disease; P = .030 and .013, respectively). Conclusion: Although CAC scoring is a safe and a reliable test to exclude obstructive coronary artery disease, the absence of CAC does not definitively exclude the presence of atherosclerosis. CTCA is a more appropriate method for determining the atheroma burden. © 2013 Forum Multimedia Publishing, LLC.

Tekgul N.,Tepecik Training and Research Hospital | Saltik D.,No 8 Osmangazi Seher Sukru Ergil Family Health Center | Vatansever K.,Ege University
Turkish Journal of Pediatrics | Year: 2014

The purpose of this study was to investigate the secular trend of menarche age within the last 35 years in an immigrant urban city in Turkey-İzmir. We found the mean age at menarche as 13.10±1.18 years for 121,257 women. The reported mean age at menarche showed a decreasing trend over time. For women born before 1963 (≥40 years of age), the mean age at menarche was 13.08±1.21 years. For women born from 1964-1973 (30-39 years of age), the mean age at menarche was 13.12±1.19 years. For women born from 1974-1983 (20-29 years of age), the mean age at menarche was 13.11±1.18 years, and for those born after 1984 (15-19 years of age), the mean age at menarche was 13.06±1.16 years (p=0.000). When divided according to socioeconomic status, the mean age at menarche was 13.11±1.11 in the high socioeconomic group, 13.22±1.25 in the middle socioeconomic group, and 12.75±1.02 in the low socioeconomic group (p=0.000). In conclusion, in the Turkish population, the mean age at menarche has decreased from 13.12 to 13.06 over the past 30 years, and the mean age at menarche was lower in the low socioeconomic group.

Varol Y.,Dr Suat Seren Chest Diseases Training And Research Hospital | Ozacar R.,Dr Suat Seren Chest Diseases Training And Research Hospital | Balci G.,Dr Suat Seren Chest Diseases Training And Research Hospital | Usta L.,Tepecik Training and Research Hospital | Taymaz Z.,Dr Suat Seren Chest Diseases Training And Research Hospital
COPD: Journal of Chronic Obstructive Pulmonary Disease | Year: 2014

Aims: The CAT is a short, simple eight-item questionnaire for assessing and monitoring COPD. It is not known how reliable the CAT scores are for COPD patients who are frequently exacerbated. The effectiveness of the CAT for assessing COPD severity and exacerbation rates was evaluated. Methods: This study enrolled 165 stable COPD patients who completed the CAT between April 2011 and February 2012. Results: Patients had a mean forced expiratory volume in one second (FEV1) equal to 43.7% of the predicted value and a mean CAT score of 21.2 (± 7.56) units. There was a good association between the FEV1 (percentage of predicted value) and CAT scores (p < 0.0001). Frequent exacerbators had significantly higher CAT scores than infrequent exacerbators (24.8 ± 6.7 versus 17.5 ± 6.5, p < 0.0001). Also, as the frequency of the COPD exacerbations increased, CAT scores (p < 0.0001) significantly increased. There was a significant association between the frequency of hospitalization and the CAT scores (p = 0.001). Conclusions: We observed a good relation between the CAT, FEV 1, and disease severity in patients with COPD. We found that the baseline CAT scores are elevated in frequent exacerbators. © 2013 Informa Healthcare USA, Inc.

Duman Atilla O.,Tepecik Training and Research Hospital
Hong Kong Journal of Emergency Medicine | Year: 2013

Boerhaave's syndrome is a very rare disease characterised by spontaneous rupture of the oesophagus. Clinical presentation is varied and may depend on the cause, location, size, degree of contamination, and site of injur y. Patient s may present with abdominal pain, pneumothorax, hydropneumothorax, and pneumomediastinum. Tension pneumothorax after esophageal perforation has been rarely reported in the medical literature. In our report, a case of tension pneumothorax secondary to Boerhaave's syndrome in a 44-year-old male is presented here.

Sahin H.,Tepecik Training and Research Hospital | Pekcevik Y.,Tepecik Training and Research Hospital
Surgical and Radiologic Anatomy | Year: 2016

Developmental venous variations (DVVs) are anatomic variations of normal transmedullary veins which are often discovered incidentally. Although they are accepted as benign compensatory venous drainage systems, they may become symptomatic or clinically significant due to flow-related causes. The fragile venous drainage systems increase vulnerability to in–out flow alterations. Increased inflow or decreased outflow causes rise in venous pressure, which may subsequently produce ischemic symptoms. Obstruction or stenosis of the collector vein is the most common cause of decreased outflow of a DVV. However, in the absence of collecting vein stenosis, venous hypertension may still exist due to volume overload. In case of multiple DVVs with single combined drainage pathway, functional outflow restriction may occur due to diminished capability of the vessel to adapt to pressure changes. In this report, we present a case with bilateral thalamic DVVs, which cause parenchymal amorphous calcification and drain into the left internal cerebral vein. A review of the literature on DVVs with outflow restriction including pathophysiological mechanisms is also discussed. © 2016, Springer-Verlag France.

OBJECTIVE: The aim of the present study was to compare the pediatric appendicitis score (PAS), the Alvarado score (AS), white blood cell count (WBC), absolute neutrophil count (ANC), C-reactive protein (CRP) level, procalcitonin level, and ultrasound (US) data, with the appendectomy decisions of pediatric surgeons diagnosing acute appendicitis (AA) in a real-life setting; this was a top-level, high-volume pediatric emergency department (PED) in a developing country. METHODS: The study was conducted prospectively between January 2012 and June 2013 in the PED of the Tepecik Teaching and Research Hospital in Izmir, Turkey. The study was observational in nature; no attempt was made to influence indications for exploration or the timing thereof. Children aged 4 to 18 years presenting to the PED on suspicion of AA were included. The WBC, ANC, CRP level, and procalcitonin level were measured, and US was performed on all patients on admission. The PAS and AS were calculated. An operative decision was made by each pediatric surgeon who had the results of laboratory and radiological tests. The criterion standard for AA was histopathological assessment. RESULTS: Upon receiver operating curve (ROC) analysis, the areas under the ROCs (AUROCs) of the WBC, ANC, CRP level, procalcitonin level, US positivity, PAS, AS, and decisions of pediatric surgeons supported by laboratory and US data were 0.734, 0.741, 0.671, 0.675, 0.670, 0.831, 0.794, and 0.910, respectively. When US data were employed only in cases with PASs 4 to 7, the sensitivity increased but specificity decreased. The sensitivity and specificity of pediatric surgical decisions were 100% and 82.50%, respectively. The difference between the PAS AUROC and the pediatric surgeon decision-making AUROC was significant (P = 0.0393; 95% confidence interval, 0.0470–0.226). CONCLUSIONS: Good pediatric surgical decision making supported by laboratory and US data for those suspected of AA may be the most effective diagnostic tool in a high-volume PED in a developing country. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

Kurt S.,Tepecik Training and Research Hospital | Toz E.,Tepecik Training and Research Hospital | Canda M.T.,Kent Hospital | Sahin C.,Tepecik Training and Research Hospital | Tasyurt A.,Tepecik Training and Research Hospital
European Journal of Obstetrics Gynecology and Reproductive Biology | Year: 2015

Objective: To investigate the relationship between two connective tissue pathologies: striae and pelvic organ prolapse (POP). Study design: Four hundred and eighty-eight women who had undergone gynaecological surgery were divided into two groups. The study group (n = 244) consisted of symptomatic patients with POP, and the control group (n = 244) consisted of cases who underwent surgery for benign gynaecological conditions without evidence of POP. The groups were compared in terms of the presence, intensity and severity of striae, as well as their general characteristics. Results: The presence of striae (p = 0.001), number of striae (p = 0.001) and Davey score (p = 0.00001) were significantly higher in the study group, and the absence of striae was more common in the control group (p = 0.00001). According to multivariate analysis, the presence of striae, an increased number of striae (>15) and a Davey score >2 increased the risk of POP 1.29 fold (p = 0.03, 95% confidence interval [CI] 1.14-1.35), 1.19 fold (p = 0.04, 95% CI 1.14-1.25) and 2.51 fold (p = 0.01, 95% CI 1.66-3.78), respectively. Conclusion: Striae may serve as a promising marker for POP. In particular, women who develop striae should be cautious about their risk for developing POP in the future, and should be informed about preventive methods for POP. © 2014 Elsevier Ireland Ltd. All rights reserved.

Akinci B.,Tepecik Training and Research Hospital
Recent Patents on Endocrine, Metabolic and Immune Drug Discovery | Year: 2012

Thrombin activatable fibrinolysis inhibitor (TAFI) is a zymogene that potently inhibits fibrinolysis through the removal of the carboxy-terminal lysine and arginine residues from partially degraded fibrin polymers. In addition, TAFI has a suppressor effect on conversion of inactive plasminogen to plasmin. Since impaired fibrinolysis is a very well established risk factor for cardiovascular morbidity and mortality, understanding the role of TAFI in cardiovascular disorders, insulin resistance, diabetes and other endocrine problems may hold promise for improving management of these diseases. This paper includes a review of current evidence on TAFI pathway and its alteration in endocrine and cardiovascular disorders and relevant patents. © 2012 Bentham Science Publishers.

Colak A.,Tepecik Training and Research Hospital | Toprak B.,Tepecik Training and Research Hospital | Dogan N.,Tepecik Training and Research Hospital | Ustuner F.,Tepecik Training and Research Hospital
Biochemia Medica | Year: 2013

Introduction: Studies about vitamin D [25(OH)D] stability in plasma are limited and preanalytical variables such as tube type may affect results. We aimed to evaluate effect of storage conditions, sample type and some preanalytical variables on vitamin D concentration. Materials and methods: Blood samples from 15 healthy subjects were centrifuged at different temperatures and stored under different conditions. Serum and plasma 25(OH)D difference, effect of centrifugation temperature and common storage conditions were investigated. Results: There was no difference between serum and plasma vitamin D concentration. Centrifugation temperature had no impact on vitamin D concentration. 25(OH)D is stable under common storage conditions: 4 hours at room temperature, 24 hours at 2-8 °C, 7 days at -20 °C, 3 months t -80 °C. Conclusion: Vitamin D does not require any special storage conditions and refrigeration. Both serum and plasma can be used for measurement. © Croatian Society of Medical Biochemistry and Laboratory Medicine.

Engin O.,Tepecik Training and Research Hospital
Chirurgia (Bucharest, Romania : 1990) | Year: 2012

Fecaliths, lymphoid hyperplasia, parasites, undigested plant residues and foreign bodies are considered as part of the aetiology of acute appendicitis. In our article we discussed about fecaliths, fecalith formation, and its aetiological value. Patients which have been operated on for acute appendicitis between 2009-2010 are analysed retrospectively. The average age was 29,3. The number of cases with fecalith was 261 (36,1%). Out of these, 19 acute appendicites, 95 phlegmons, and 30 perforations were detected. Intraluminal pathologies probably play a major role in the development of acute appendicitis. Intraluminal pathological findings may also be seen in healthy persons without necessarily pointing to acute appendicitis. Disease progresses from intraluminal fecalith with no inflammation to perforation from the beginning. There are many explanations regarding the formation of fecaliths. Diagnosis of the fecalith may be decided with ultrasonography, computed tomography and magnetic resonance imaging techniques. In case of preoperatively demonstrated intraluminal fecalith through ultrasonographic examination with clinical symptoms of acute appendicitis, early appendectomy must be performed in our opinion. Early appendectomy lowers morbidity and mortality rates. Celsius.

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