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Celebi I.,Sisli Etfal Training and Research Hospital | Oz A.,Sisli Etfal Training and Research Hospital | Yildirim H.,VKV American Hospital | Bankeroglu H.,VKV American Hospital | Basak M.,Sisli Etfal Training and Research Hospital
Surgical and Radiologic Anatomy | Year: 2012

Congenital vascular variants involving the temporal bones are rare. Awareness of these variants is important as they may mimic glomus tumors or complicate middle ear surgery. We present a case of a persistent stapedial artery associated with an aberrant carotid artery in the left temporal bone, which is highlighted in computed tomography imaging Wndings. We further discuss a possible relationship between hypoplasia of the A1 segment of the anterior cerebral artery and this congenital variant.© Springer-Verlag 2011.


Ozbalak M.,Istanbul University | Cetiner M.,VKV American Hospital | Bekoz H.,Memorial Hospital | Atesoglu E.B.,Kocaeli University | And 4 more authors.
Hematological Oncology | Year: 2012

Myelodysplastic syndrome (MDS) represents a heterogeneous group of potentially malignant diseases of bone-marrow stem cells. Acute myelogenous leukaemia (AML) is an inevitable outcome for many patients with MDS. Azacitidine has been reported to result in comparably higher response rates and improved survival than other treatment strategies. In this retrospective study, we report the results on 25 'real life' patients with MDS, CMML or AML treated with azacitidine between 2005 and 2009. All patients fulfilled the World Health Organization criteria for MDS and AML. No eligibility criteria other than diagnosis were considered. Complete response (CR) rate was observed in three of the 25 'real life' patients (12%) with a median duration of CR of 5 months (4-6 months). Seven patients (28%) had mono- or bi-lineage haematologic improvement and 15 patients (60%) showed neither morphologic nor haematologic response. Among 17 non-AML patients, the median time from onset of Aza-C treatment to AML transformation was 10 months (4-15 months). Overall death rate was 72%. All of the eight AML patients died. The death rate under Aza-C among non-AML patients was 59%. Unlike the results of the clinical trials, our data show that Aza-C has a limited activity in 'real-life' patients with MDS and AML. It is obvious that Aza-C can induce complete or partial responses in a considerable number of MDS patients but responses are usually not durable as we observed in our patients. © 2011 John Wiley & Sons, Ltd.


Yildirim D.,Kasimpasa Military Hospital | Gurses B.,Yeditepe University | Gurpinar B.,Kasimpasa Military Hospital | Ekci B.,Yeditepe University | And 2 more authors.
Journal of International Medical Research | Year: 2011

Fine needle aspiration biopsy (FNAB) is the gold standard for the diagnosis of lymphoma in Hashimoto's thyroiditis and is able to differentiate between benign, inflammatory or malignant nodules, classifying them as either true nodules or pseudonodules. This technique is, however, invasive. The present study aimed to differentiate pseudonodules from true nodules by sonoelastography, a non- invasive technique, in 54 patients with Hashimoto's thyroiditis. The accuracy of sonoelastography to differentiate between true or pseudonodules was compared with the gold standard FNAB and with grey scale ultrasonography. The nodules were categorized into three groups: non- demarcated hypoechogenic, demarcated hyperechogenic, and demarcated hypoechogenic. Sonoelastography findings were concordant with the cytopathological results and demonstrated that sono- elastography was able to detect true thyroid nodules often misdiagnosed by conventional grey scale ultrasonography. Sonoelastography was found to have increased sensitivity for true nodule diagnosis compared with conventional grey scale ultrasonography and may eliminate unnecessary FNABs being carried out. © 2011 Field House Publishing LLP.


Sunde A.,Norwegian University of Science and Technology | Balaban B.,VKV American Hospital
Fertility and Sterility | Year: 2013

In the past decades, the efficiency of human assisted reproductive technologies (ART) has improved. We have witnessed important new developments such as intracytoplasmic sperm injection, blastocyst culture, vitrification, and methods for genetic analysis of human embryos. Despite these improvements, current ART laboratories are to a large extent composed of general laboratory equipment that is not designed and manufactured especially for human ART. Human reproductive cells have different physiochemical requirements than somatic cells. We encourage the development of laboratory equipment, utensils, and consumables that are designed specifically for human ART. In addition, the quality and consistency of commercially available culture media have improved, but the composition of commercially available ART culture media varies considerably. It is difficult to see the scientific rationale for this variation. Currently it is not known which of these formulations gives the best clinical results. Finally, selection of embryos in routine ART should be done with the use of variables that have been shown to have statistically independent selection power. With the advent of automatic and objective methods for recording morphology and growth kinetics of human embryos, there is a possibility to pool data sets from many different clinics. This may enable the construction of selection algorithms based on objectively recorded embryo parameters. New methods for the genetic analysis of chromosomal status of embryos may prove to be useful, but they should be tested in controlled randomized trials before being introduced for routine use in ART. Copyright © 2013 American Society for Reproductive Medicine, Published by Elsevier Inc.


Hizarcioglu-Gulsen H.,Hacettepe University | Saltik-Temizel I.N.,Hacettepe University | Demir H.,Hacettepe University | Gurakan F.,VKV American Hospital | And 2 more authors.
Journal of Pediatric Gastroenterology and Nutrition | Year: 2014

Objectives: Intractable diarrhea of infancy (IDI), a group of prolonged diarrheal disorders, is difficult to diagnose and manage. We documented general features of patients and the causes of IDI.Methods: The present retrospective study included 60 hospitalized patients with IDI ages 0 to 24 months during January 2000 to December 2010. Detailed history, laboratory and endoscopic findings, diagnoses, and clinical courses were reviewed. Descriptive analyses were used for statistical evaluation.Results: The male/female ratio was 1.4. The median age at onset of diarrhea was 12 days. A total of 70% and 11% of patients were severely and moderately malnourished, respectively. Carbohydrate malabsorption (CM) and food allergies (n= 11, 18% for both) were the most frequent causes. A total of 16 of the patients (27%) did not have a specific diagnosis. The other diagnoses were infections (n = 5), immune-mediated disorders (IMD) (n = 6), congenital enterocyte defects (CED) (n = 3, 5%), short bowel syndrome (n = 2), cystic fibrosis (n = 2), intestinal pseudoobstruction (n= 1), congenital disorder of glycosylation (n= 1), abetalipoproteinemia (n=1), and proprotein convertase (PC) 1 deficiency (n = 1). Stool calprotectin level was high in 10 of 19 patients with Crohn disease (n = 3, mean 1116±851mg/L), food allergy (n = 4, mean 516±288mg/L), and undefined etiology (n = 3, mean 616 ± 780 mg/L). The mean duration of hospitalization was 76 days.Conclusions: IDI is a heterogenous group of diarrheal disorders. The most frequent causes were CM and food allergies in our study. Because high levels of calprotectin support inflammation, calprotectin levels may help to discriminate CED and inflammatory causes of IDI. Copyright © 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.


Gulgonen A.,VKV American Hospital | Ozer K.,University of Michigan
Journal of Hand Surgery: European Volume | Year: 2012

We analyzed the long-term functional outcome in patients with major upper extremity replantations. Two patients had amputations proximal to the elbow joint, two had elbow disarticulations and five patients had amputations at the forearm. The mean age was 24 and the mean follow-up time was 18 years. Six patients have undergone secondary operations. The mean grip strength was restored to 34% of the contralateral extremity. Protective sensation was restored in all patients. According to Chen's functional recovery scale, five patients had excellent, two had good, and two had fair results. Grip strength, two-point discrimination, ranges of motion and Chen's scale did not improve after 5 years. However, Semmes-Weinstein monofilament testing and cold intolerance continued to improve up to 10 and 12 years, respectively. Replantation of an upper extremity proximal to the wrist joint satisfactorily restored the upper extremity function. © 2011 The British Society for Surgery of the Hand.


Aydin S.,VKV American Hospital | Yildirim H.,VKV American Hospital | Bozkus H.,VKV American Hospital | Vural M.,VKV American Hospital
European Spine Journal | Year: 2010

Discal cysts are rare causes of low back pain and radiculopathy. Only few reports in the literature describe these pathologies. In this article, the authors report five cases (3 males and 2 females) of lumbar discal cysts treated surgically by microdiscectomy. These patients were admitted with a history of back pain and/or sciatalgia. Magnetic resonance imaging of the lumbar spine of all patients revealed lumbar discal cysts, causing compression to the spinal dura and roots. All patients were treated by partial hemilaminectomy and microscopic cyst resection. Postoperatively, the complaints showed improvement, and the patients were discharged with no complications. The cases of lumbar discal cysts are described in the literature as individual case reports, therefore; the authors performed a wide systemic review of all these cases published in PubMed and MedLine, including the patients in the present report. The data of all patients were analyzed to obtain statistically based estimated information about the incidence, the epidemiology, the natural history and the optimum management of these lesions. © 2010 Springer-Verlag.


Dogan T.,VKV American Hospital
Annals of Plastic Surgery | Year: 2010

Various techniques have been suggested in the literature for umbilicoplasty. These techniques result in a reconstructed umbilicus with a deep cavity shape, and visible suture line. Furthermore, these techniques have in common the difficult step of suturing the umbilicus to the base of the abdominal fascia to create a periumbilical concavity.The new technique described in this article results in a noticeably smaller and shallower cavity while the scar is hidden inside the natural umbilical scar. This new technique's procedural simplicity gives it an important additional advantage.The umbilicus is incised within a very large skin island on its tip which is subsequently exteriorized out of a 2-cm vertical incision. The stalk is then opened by 4 clamps in the 12, 3, 6, and 9 o'clock positions. The skin between the clamps is incised up to the umbilical base, fixed, and the excess skin flaps are resected.The technique was successfully implemented in 62 consecutive cases. Copyright © 2010 by Lippincott Williams & Wilkins.


Sar V.,Vkv American Hospital
Clinical Psychopharmacology and Neuroscience | Year: 2014

It has been claimed that the progress of psychiatry has lagged behind that of other medical disciplines over the last few decades. This may suggest the need for innovative thinking and research in psychiatry, which should consider neglected areas as topics of interest in light of the potential progress which might be made in this regard. This review is concerned with one such field of psychiatry: dissociation and dissociative disorders. Dissociation is the ultimate form of human response to chronic developmental stress, because patients with dissociative disorders report the highest frequency of childhood abuse and/or neglect among all psychiatric disorders. The cardinal feature of dissociation is a disruption in one or more mental functions. Dissociative amnesia, depersonalization, derealization, identity confusion, and identity alterations are core phenomena of dissociative psychopathology which constitute a single dimension characterized by a spectrum of severity. While dissociative identity disorder (DID) is the most pervasive condition of all dissociative disorders, partial representations of this spectrum may be diagnosed as dissociative amnesia (with or without fugue), depersonalization disorder, and other specified dissociative disorders such as subthreshold DID, dissociative trance disorder, acute dissociative disorders, and identity disturbances due to exposure to oppression. In addition to constituting disorders in their own right, dissociation may accompany almost every psychiatric disorder and operate as a confounding factor in general psychiatry, including neurobiological and psycho-pharmacological research. While an anti-dissociative drug does not yet exist, appropriate psychotherapy leads to considerable improvement for many patients with dissociative disorders. Copyright© 2014, Korean College of Neuropsychopharmacology


Balaban B.,VKV American Hospital | Yakin K.,VKV American Hospital | Alatas C.,VKV American Hospital | Oktem O.,VKV American Hospital | And 2 more authors.
Reproductive BioMedicine Online | Year: 2011

Recent evidence shows that the selection of spermatozoa based on the analysis of morphology under high magnification (6000) may have a positive impact on embryo development in cases with severe male factor infertility and/or previous implantation failures. The objective of this prospective randomized study was to compare the clinical outcome of 87 intracytoplasmic morphologically selected sperm injection (IMSI) cycles with 81 conventional intracytoplasmic sperm injection (ICSI) cycles in an unselected infertile population. IMSI did not provide a significant improvement in the clinical outcome compared with ICSI although there were trends for higher implantation (28.9% versus 19.5%), clinical pregnancy (54.0% versus 44.4%) and live birth rates (43.7% versus 38.3%) in the IMSI group. However, severe male factor patients benefited from the IMSI procedure as shown by significantly higher implantation rates compared with their counterparts in the ICSI group (29.6% versus 15.2%, P = 0.01). These results suggest that IMSI may improve IVF success rates in a selected group of patients with male factor infertility. © 2011, Reproductive Healthcare Ltd. All rights reserved.

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