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İstanbul, Turkey

Yildirim D.,Kasimpasa Military Hospital | Tamam C.,Kasimpasa Military Hospital | Gumus T.,VKV American Hospital
Clinics | Year: 2010

OBJECTIVE: The aim of this study was to compare the efficiency of multiplanar reformatted images and three-dimensional images created after multidetector computed tomography examination in detecting acute posttraumatic osseous pathology of the skeletal system. METHOD: Between October 2006 and December 2008, 105 patients with a history of acute trauma were referred to our service. Patients were evaluated with multidetector computed tomography using multiplanary reconstructed images initially (R-I), and six months after this initial evaluation, three-dimensional images were assessed of each patient (R-II). Axial images were used for guiding as a reference Data obtained was recorded and graded according to importance levels of the pathologies. RESULTS: The R-II score was higher in the non-articular and highest in periartricular fractures of the extremities, and thoracic and pelvic cage injuries. For the spinal column, while R-I data was more significant In patients referred with polytrauma, R-II data, was more statistically significant, for short processing and adaptation time to acquiring immediate critical information. For all cases it was seen that three dimensional scans were more efficient in providing the orientation, within a short time. CONCLUSION: By dual source multidedector tomography systems trauma patients may be evaluated by multiplanary and three dimensionally reconstructed images. When used correctly, three dimensional imaging is advantageous and can help determine the exact nature and extension and also importance of osseous injuries. © 2010 CLINICS.


Findikcioglu K.,Gazi University | Findikcioglu F.,TDV 29 Mayis Hospital | Sezgin B.,Gazi University | Demirtas Y.,19 Mayis University | Yavuzer R.,VKV American Hospital
Journal of Plastic, Reconstructive and Aesthetic Surgery | Year: 2012

Background: Hormonal changes that take place during the menstrual cycle may have an effect on perioperative bleeding. Previous studies have confirmed a relationship between the menstrual cycle and surgical bleeding in rhinoplasty and breast reduction surgery; yet both surgical sites display changes in accordance with sex hormone levels during the menstrual phase. Aim: The aim of this study was to determine the effect of the menstrual cycle on perioperative bleeding when undergoing surgeries of sites not directly related to menstrual hormonal changes. Materials and methods: Forty-one patients undergoing abdominoplasty were grouped as group A - perimenstrual (0-7, 21-28 days), group B - periovulatory (8-20 days) and group C - postmenopausal. Intra-operative blood loss was calculated during surgery while postoperative blood loss was determined by measuring the amount of drainage. All menstrual data were recorded. Age, body mass index and weight of the resected tissue were also considered as factors that can affect the amount of bleeding and therefore were also evaluated in terms of significance. Results: There was no significant difference between groups regarding intra-operative and postoperative blood loss. Body mass index and weight of the resected tissue had a strong influence on the time of drain removal and the amount of intra-operative and postoperative blood loss. Conclusion: This study strongly suggests that the menstrual period does not affect perioperative blood loss for operations on areas less sensitive to sex hormone levels such as the abdomen. In light of the results, we can conclude that the patient's menstrual date is not of vital importance regarding perioperative blood loss when planning surgery for areas with less sensitivity to menstrual hormonal changes. © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.


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.


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.


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

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