Turkiye Yuksek Ihtisas Education and Research Hospital

Ankara, Turkey

Turkiye Yuksek Ihtisas Education and Research Hospital

Ankara, Turkey
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Demir A.,Turkiye Yuksek Ihtisas Education and Research Hospital | Erdemli O.,Acibadem University | Unal U.,Turkiye Yuksek Ihtisas Education and Research Hospital | Tasoglu I.,Turkiye Yuksek Ihtisas Education and Research Hospital
Journal of Cardiac Surgery | Year: 2013

Near-infrared spectroscopy (NIRS) is a noninvasive continuous monitoring method for measuring the oxyhemoglobin saturation of the brain tissue. NIRS monitoring can suggest neuronal hypoxia in the frontal-brain before irreversible impairment of cellular metabolism. We report two cases of Type B aortic dissection surgery in which spinal regional perfusion monitoring was performed by placing two NIRS sensors on the back-skin through T6-T8 and T9-T11 vertebraes. © 2013 Wiley Periodicals, Inc.

Mendi M.A.,Turkiye Yuksek Ihtisas Education and Research Hospital | Afsar B.,Konya Numune Hospital | Oksuz F.,Turkiye Yuksek Ihtisas Education and Research Hospital | Turak O.,Turkiye Yuksek Ihtisas Education and Research Hospital | And 4 more authors.
Angiology | Year: 2017

Developing contrast-induced nephropathy (CIN) after primary percutaneous coronary intervention (pPCI) has a negative impact on survival and morbidity. We assessed the predictive value of serum uric acid (SUA) for the development of CIN in patients with ST-segment elevation myocardial infarction (STEMI) who underwent pPCI. Contrast-induced nephropathy was defined an increase of ≥25% or ≥0.5 mg/dL in creatinine concentrations within 72 hours after pPCI. Patients were divided into 2 groups according to admission median SUA level. Serum uric acid level was <5.4 mg/dL (group 1; n = 222) and ≥5.4 mg/dL (group 2; n = 228). Compared to group 1, development of CIN (12% vs 20%, P <.001) was significantly greater in group 2. Using a cut point of >5.45 mg/dL, the SUA level predicted development of CIN with a sensitivity of 70% and specificity of 67%. In multiple logistic regression analysis, SUA level, diabetes mellitus, left ventricular ejection fraction <50%, contrast volume, estimated glomerular filtration rate, and C-reactive protein level emerged as independent predictors of CIN. In conclusion, elevated SUA is an independent risk factor for the development of CIN after pPCI in patients with STEMI. © The Author(s) 2016.

Berberoglu Z.,Turkiye Yuksek Ihtisas Education and Research Hospital | Yazici A.C.,Baskent University | Demirag N.G.,Baskent University
Clinical Endocrinology | Year: 2010

Objective To evaluate the effect of rosiglitazone on bone metabolism and bone density. Design An open-label, randomized, controlled trial of 24-month duration. Patients and measurements Obese, postmenopausal women with newly diagnosed diabetes were studied. Before and after the intervention, metabolic bone markers and bone density were assessed. Results Twenty-six patients received rosiglitazone (4 mg/day), and 23 remained on diet alone. Serum bone-specific alkaline phosphatase and osteocalcin levels decreased by 17% (P < 0·001 vs control group) and 26% (P < 0·01 vs control group), respectively, in the rosiglitazone group. There were no significant changes in the deoxypyridinoline levels between the two groups. Annual bone loss at the trochanter and at the lumbar spine associated with each year of rosiglitazone use was 2·56% (P = 0·01 vs control group) and 2·18% (P < 0·01 vs control group), respectively. Femoral neck and total hip bone density declined significantly in both groups (P < 0·01, and P = 0·01, respectively) but was not significantly different between the two groups. Conclusions Rosiglitazone treatment adversely affects bone formation over a 2-year period. It increases bone loss at the lumbar spine and trochanter in postmenopausal, type 2 diabetic women. However, bone loss at the total hip did not differ with use of this agent. © 2010 Blackwell Publishing Ltd.

Acikgoz S.K.,Turkiye Yuksek Ihtisas Education and Research Hospital | Acikgoz E.,Gazi University
Drug Metabolism and Drug Interactions | Year: 2013

Artemisia absinthium, also known as wormwood, is used widely as an herbal medicine. In this report, we introduce an 82-year-old Turkish woman who was treated with warfarin for atrial fibrillation and was hospitalized for gastrointestinal bleeding as a result of extremely elevated international normalized ratio (INR) after consumption of A. absinthium . Naranjo adverse drug reaction probability scale score was 6, which indicated a probable relationship between the patient's elevated INR and her concomitant use of wormwood and warfarin. Clinicians should be vigilant about potential dangers of herbal medicines taken with conventional drugs, and patients taking drugs with a narrow therapeutic index, such as warfarin, should be educated about avoiding consumption of herbal medicines.

Akboga M.K.,Turkiye Yuksek Ihtisas Education and Research Hospital | Canpolat U.,Turkiye Yuksek Ihtisas Education and Research Hospital | Sahinarslan A.,Gazi University | Alsancak Y.,Gazi University | And 4 more authors.
Atherosclerosis | Year: 2015

Objective: Although cardiovascular protective action of bilirubin has been attributed to its antioxidant effect, there was scarce data regarding the anti-inflammatory properties. Herein, we aimed to assess the relationship between serum total bilirubin level and severity of coronary artery disease (CAD) in association with the direct inflammatory marker such as C-reactive protein (CRP), the other indirect markers included in inflammation process such as neutrophil to lymphocyte ratio (NLR) and red cell distribution width (RDW) in patients with stable CAD. Methods: Angiographic data of 1501 patients were analyzed in this retrospective cross-sectional study. Patients were categorized according to Gensini scores as control, mild CAD and severe CAD groups. The association of clinical and laboratory parameters with the severity of CAD were determined by multivariable linear regression analysis. Results: Total bilirubin level in the control group was significantly higher than those of the other groups. After multivariable linear regression analysis total bilirubin [β=-3.131 (-4.481,-1.782), p<0.001] was significantly associated with the severity of CAD. Futhermore, there was a moderate and significant inverse correlation between serum total bilirubin level and the severity of CAD (r=-0.173, p<0.001), CRP (r=-0.112, p<0.001), NLR (r=-0.070, p=0.026) and RDW (r=-0.074, p=0.027). Conclusion: Serum total bilirubin level was independently and inversely associated with the severity of coronary atherosclerosis in patients with stable CAD. In addition, total bilirubin level was inversely correlated with CRP, NLR and RDW. These results suggest that besides its already known effect on the oxidative stress, higher serum total bilirubin level may exhibit an anti-inflammatory effect in the coronary atherosclerotic process. © 2015 Elsevier Ireland Ltd.

Acikgoz E.,Gazi University | Yaman B.,Gazi University | Acikgoz S.K.,Turkiye Yuksek Ihtisas Education and Research Hospital | Topal S.,Gazi University | And 2 more authors.
Annals of Noninvasive Electrocardiology | Year: 2015

Background: Fragmented QRS (fQRS) is an indicator of nonhomogeneous ventricular activity caused by myocardial fibrosis. Aortic stenosis (AS) is known to be a cause of myocardial fibrosis. We aimed to investigate the relationship of fQRS with severity of AS, echocardiographic, and electrocardiographic findings, and development of atrial fibrillation and manifest heart failure in AS patients. Methods: One hundred four patients with moderate and severe AS were recruited for the study. Patients with mitral or tricuspid stenosis, previous myocardial infarction, segmental wall motion abnormality or left ventricular ejection fraction (LVEF) below 50% and patients with complete-incomplete BBB and pacemaker rhythm were excluded. Results: Mean age of the patients was 69 ± 14.8 and 73.1% had fQRS. Patients with fQRS had lower LVEF, higher mean QRS duration, intrinsic deflection, Cornell voltage, Romhilt-Estes Score, systolic pulmonary artery pressure, mean and peak systolic transaortic gradients and left atrium diameter. Manifest heart failure was more frequent in patients with fQRS. In stepwise multivariate logistic regression analyze, manifest heart failure, peak systolic transaortic gradient, LVEF, intrinsic deflection, strain pattern and Cornell voltage were independently associated with fQRS. Strain pattern and fQRS were found as independent predictors of severe AS. Conclusions: fQRS is independently associated with the severity of AS while traditional LVH criteria, except strain pattern, are not. fQRS may be better than traditional ECG criteria of LVH and echocardiographic LVH as an indicator of myocardial fibrosis in AS. Thus, fQRS may have a role in determining the severity and prognosis of AS. © 2014 Wiley Periodicals, Inc.

Lafci G.,Turkiye Yuksek Ihtisas Education and Research Hospital | Budak A.B.,Ankara Numune Education and Research Hospital | Yener A.U.,Canakkale Onsekiz Mart University | Cicek O.F.,Turkiye Yuksek Ihtisas Education and Research Hospital
Heart Lung and Circulation | Year: 2014

Since the first successful application of the heart-lung machine in 1953 by John Gibbon [1], great efforts have been made to modify the bypass techniques and devices in order to allow prolonged extracorporeal circulation in the intensive care unit (ICU), commonly referred to as extracorporeal membrane oxygenation (ECMO). ECMO uses classic cardiopulmonary bypass technology to support circulation. It provides continuous, non-pulsatile cardiac output and extracorporeal oxygenation [2]. Veno-venous ECMO (VV ECMO) provides respiratory support, while veno-arterial ECMO (VA ECMO) provides cardio-respiratory support to patients with severe but potentially reversible cardiac or respiratory deterioration refractory to standard therapeutic modalities. ECMO is a temporary form of life support providing a prolonged biventricular circulatory and pulmonary support for patients experiencing both pulmonary and cardiac failure unresponsive to conventional therapy. Despite the advent of newer ventricular assist devices that are more suitable for long term support, ECMO is simple to establish, cost-effective to operate. © 2013 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).

Disibeyaz S.,Turkiye Yuksek Ihtisas Education and Research Hospital
Surgical Laparoscopy, Endoscopy and Percutaneous Techniques | Year: 2016

Most ingested foreign bodies are best treated with endoscopically. If the sharp-pointed objects embedded in the esophageal wall, it may not be able to be removed by conventional endoscopic devices and surgery is required. Herein, we described a new technique for the extraction of both ends embedded sharp-pointed objects in the esophageal wall. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

Gomceli I.,Turkiye Yuksek Ihtisas Education and Research Hospital
Acta medica (Hradec Králové) / Universitas Carolina, Facultas Medica Hradec Králové | Year: 2012

To evaluate the clinical usefulness of serum levels of soluble form of endoglin in stage III colorectal adenocarcinomas (CRC) patients for detection of recurrence. The case-control study consisted of 80 stage III CRC patients who underwent surgery with curative intent and 70 age-and sex-matched healthy volunteers. Serum levels of soluble form of endoglin (sol-end) were measured in both groups. Also, predictive factors of recurrence were evaluated using multivariate analyses. Serum levels of sol-end in stage III CRC patients were significantly higher than those in controls. There was not a significant association between serum levels of sol-end and clinicopathological features in CRC patients. Multivariate regression analysis showed the LNR (hazard ratio, 2.54; 95% CI, 1.46-4.34; p < 0.001), to be significant independent factors to estimate local recurrence in stage III CRC patients. Preoperative serum levels of sol-end do not seem useful as a marker for detection of recurrence in stage III CRC patients.

Arslan U.,Samsun Education and Research Hospital | Kocaoglu T.,Turkiye Yuksek Ihtisas Education and Research Hospital | Balci M.,Turkiye Yuksek Ihtisas Education and Research Hospital | Duyuler S.,Turkiye Yuksek Ihtisas Education and Research Hospital | Korkmaz A.,Turkiye Yuksek Ihtisas Education and Research Hospital
Journal of Cardiology | Year: 2012

Background and purpose: Coronary collateral circulation (CCC) has been demonstrated to be impaired in patients with type 2 diabetes mellitus which is characterized by insulin resistance. In this study, our purpose was to find out a possible relationship between CCC and non-alcoholic fatty liver disease (NAFLD), which is also characterized by insulin resistance, in non-diabetic patients with severe coronary artery disease. Methods: One hundred and fifty-one consecutive non-diabetic patients with stable angina pectoris who were found to have >95% stenosis of at least one major coronary artery were enrolled. Abdominal ultrasonography (USG) was performed after coronary angiography to determine the presence or absence of NAFLD. Results: According to Cohen-Rentrop method, 81 (53.7%) patients had good and 70 (46.3%) patients had poor collateral development. NAFLD was present in 98 patients (64.9% of study population) and more prevalent in patients with poor collateral development [58 of 70 patients (82.9%) vs. 40 of 81 patients (49.4%), p< 0.001]. Mean Rentrop collateral score was significantly lower in patients with NAFLD (1.2. ± 1.2 vs. 2.1. ± 0.9, p< 0.001). Shorter angina time, metabolic syndrome, presence of insulin resistance, less severe coronary artery disease, and female sex were also associated with poor collateral development. When the logistic regression analysis was performed using these factors, NAFLD was still significantly related to poor collateral development. Conclusions: Presence of NAFLD is associated with poor coronary collateral development in non-diabetic patients with severe coronary artery disease independent from other variables, especially metabolic syndrome and insulin resistance. Which mechanisms play role in this association is needed to be cleared with further studies. © 2012 Japanese College of Cardiology.

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