Yalova State Hospital

Yalova, Turkey

Yalova State Hospital

Yalova, Turkey

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Cetiner H.,Elazig Education and Research Hospital | Cavusoglu I.,Yalova State Hospital | Duzer S.,Elazig Education and Research Hospital
American Journal of Rhinology and Allergy | Year: 2017

Background: The relationship between septal perforation and smoking (of cigarettes) was not previously studied in patients who underwent septoplasty. Objectives: To evaluate the effect of smoking on nasal septal perforation development and the postoperative healing process in patients who underwent septoplasty. Methods: Medical records of patients who underwent septoplasty procedures between January 2010 and December 2014 were retrospectively reviewed. Any candidates with chronic systemic disease, were >40 years of age, were prone to complications (i.e., excessive septal deviation), or had previous nasal surgery were excluded from study. The subjects were grouped by smoking habits, and septal effects of smoking were evaluated clinically. Results: Of 281 patients, 88 qualified as smokers (group 1) and 193 were considered nonsmokers (group 2). Septal perforation was observed in eight patients in group 1 and in one patient in group 2 (p < 0.05). In groups 1 and 2, the average healing times were 8.8 ± 2.04 days and 7.51 ± 1.75 days, respectively (p < 0.05). Conclusion: Both nasal recovery time and development of septal perforation proved significantly greater in patients who smoked after septoplasty. © Copyright 2017, Ocean Side Publications, Inc., U.S.A.


Cavdar F.,Yalova State Hospital | Yildar M.,Balikesir University | Tellioglu G.,Gaziosmanpasa Private Hospital | Kara M.,Haydarpasa Training and Research Hospital | And 2 more authors.
Pancreatology | Year: 2014

Objectives: The majority of bile duct stones (BDS) that cause acute biliary pancreatitis (ABP) pass spontaneously into the duodenum. If not passed, they worsen the prognosis or cause recurrence. Therefore, they must be treated. The purpose of this study was to assess the number and timing of spontaneous passage of BDS using magnetic resonance cholangiopancreatography (MRCP) and to determine the effect of this approach on endoscopic retrograde cholangiopancreatography (ERCP). Methods: Sixty patients diagnosed with ABP were evaluated prospectively. MRCP was performed between the 1st and 4th days of an acute attack in all the patients. A control MRCP was performed after 7 days in patients with MRCP-identified choledocholithiasis. Patients in whom BDS were visible on imaging or who showed no decrease in bilirubin or cholestasis enzymes underwent ERCP. Results: MRCP revealed choledocholithiasis in 20 (33%) of the 60 patients. In the control MRCP imaging, choledocholithiasis was detected in 16 of 20 (80% of those who had stone initially) patients. ERCP was performed in these patients and in 2 patients who did not have BDS on the control MRCP but whose bilirubin values and cholestatic enzyme levels had not decreased. ERCP verified choledocholithiasis in 16 of the 18 patients. The positive predictive value of MRCP was 93.7% (15/16). Conclusions: MRCP performed in the second week in ABP patients with a nonworsening prognosis and a suspicion of choledocholithiasis will give more specific results. This will avoid unnecessary ERCP and the potential morbidity and mortality that can develop with this invasive procedure. © 2014 IAP and EPC.


Purpose: This study was performed to compare the use of a bilateral gluteus maximus advancing flap (BGMAF) following oblique incision, which was recently described for the surgical treatment of sacrococcygeal pilonidal sinus (SPS) disease, with the widely used Limberg flap (LF) technique following a rhomboid incision. Methods: A total of 105 patients treated for SPS were evaluated retrospectively. The patients were evaluated in terms of their age, body mass index, symptoms, length of the operation, complications, postoperative hospital stay, time to return to work, postoperative cosmetic satisfaction and recurrence rate. Results: Fifty-six of the patients were treated with BGMAF, while 49 were treated with LF. The mean follow-up was 20.5 ± 5.4 months. The mean length of the operation, hospital stay and time to return to work were shorter, while the cosmetic satisfaction score was higher in the BGMAF group compared to the LF group. There was no statistically significant difference between the groups for the other criteria. Conclusion: The BGMAF appears to be superior to the LF in terms of the length of the operation, time to return to work and degree of cosmetic satisfaction. It is preferable for sinuses not to require wide excision, while the LF is more appropriate for sinuses with a large post-excision defect. © 2013 Springer Japan.


PubMed | Yalova State Hospital, Kars State Hospital, Atatürk University and Kosuyolu Kartal Heart Training and Research Hospital
Type: Journal Article | Journal: Postepy w kardiologii interwencyjnej = Advances in interventional cardiology | Year: 2016

Coronary fractional flow reserve (FFR) is recommended as the gold standard method in evaluating intermediate coronary stenoses. However, there are significant debates concerning the agents and the timing of the measurement.To compare the contrast medium induced Pd/Pa ratio (CMR) with the FFR.We enrolled 28 consecutive patients with 34 intermediate lesions who underwent coronary FFR measurement by intracoronary (i.c.) adenosine. After baseline Pd/Pa was calculated, a single contrast medium (Iomeron) injection of 6 ml (3 ml/s) was performed manually. Within 10 s after the contrast medium injection, the CMR was calculated. Bolus injection of i.c. adenosine was performed to induce maximal hyperemia (from 60 g to 600 g), and when it was 0.80, the intermediate lesion was considered as significant.After bolus i.c. adenosine, 12 lesions of 34 (35.3%) were identified as significant. The CMR value was 0.86 0.06 (range: 0.71-0.97). There were no significant differences between FFR and CMR values (p = 0.108). A substantial positive correlation between adenosine and contrast values was detected (0.886 and p < 0.001). Good agreement in Bland-Altman analysis was revealed (mean bias was 0.027, 95% confidence interval 0.038-0.092). Receiver operating characteristics curve analysis showed 90.9% sensitivity and 91.7% specificity for a cut-off value of 0.85 for the CMR compared to FFR ( 0.80).Our study showed that measuring the CMR is a feasible method compared to FFR. The CMR may be used in situations where adenosine cannot be administered.


Zorlu A.,Cumhuriyet University | Bektasoglu G.,Cumhuriyet University | Kukul Guven F.M.,Cumhuriyet University | Dogan O.T.,Cumhuriyet University | And 6 more authors.
American Journal of Cardiology | Year: 2012

Red cell distribution width (RDW) is strongly associated with prognosis in cardiopulmonary disorders such as coronary artery disease, acute myocardial infarction, acute and chronic heart failure, and pulmonary hypertension. However, its prognostic significance in acute pulmonary embolism (PE) is unknown. The aim of this study was to investigate the relation between admission RDW and early mortality in patients with acute PE. One hundred sixty-five patients with confirmed acute PE were included. Patients with previous treatment for anemia, malignancy, or chronic liver disease, those with dialysis treatment for chronic renal failure, and those who received erythrocyte suspension for any reason were excluded. A total of 136 consecutive patients with acute PE were evaluated prospectively. According to receiver-operating characteristic curve analysis, the optimal cut-off value of RDW to predict early mortality was >14.6%, with 95.2% sensitivity and 53% specificity. Patients were categorized prospectively as having unchanged (group 1) or increased (group 2) RDW on the basis of a cut-off value of 14.6%. The mean age of patients was 63 ± 15 years. The mean follow-up duration was 11 ± 7 days, and 21 patients died. Among these 21 patients, 1 (1.6%) was in group 1 and 20 (27%) were in group 2 (p <0.001). Increased RDW >14.6% on admission, age, presence of shock, heart rate, oxygen saturation, and creatinine level were found to have prognostic significance in univariate Cox proportional-hazards analysis. Only increased RDW >14.6% on admission (hazard ratio 15.465, p = 0.012) and the presence of shock (hazard ratio 9.354, p <0.001) remained associated with increased risk for acute PE-related early mortality in a multivariate Cox proportional-hazards model. In conclusion, high RDW was associated with worse hemodynamic parameters, and RDW seems to aid in the risk stratification of patients with acute PE. © 2012 Elsevier Inc. All rights reserved.


PubMed | Yalova State Hospital, Bursa Yuksek Ihtisas Education and Research Hospital, Namik Kemal University and Bahcesehir University
Type: Journal Article | Journal: Northern clinics of Istanbul | Year: 2017

In this study, the effect of neutrophil-lymphocyte ratio (NLR), which is a recently developed inflammatory parameter, as an early stage mortality predictive marker on coronary artery bypass (CABG) patients of various age groups was examined.Seventy eight patients under the age of 45 (Group 1) and 80 patients who were older than 45 (Group 2) randomly chosen from the patients who underwent isolated CABG surgery, were examined. The preoperative characteristics and NLRs were noted. The primary end point of the study was determined as all-cause in- hospital mortality.Mortality was observed in 2 patients in Group 1 and 11 patients in Group 2. The threshold value of NLR was 2,47 in the Receiver Operating Characteristic (ROC) curve in Group 1 and there wasnt any significant correlation between preoperative NLR and mortality rates in the patients whose NLRs were above this curve. The threshold value was determined as 4.07 in Group 2 and there was a significant relation between preoperative NLR and mortality (p<0,01). No relation was found between NLR and mortality when all the examined patients were considered (p>0.05).NLR that can be easily calculated, can be used as a mortality predictor in the patients of advanced age who will undergo isolated CABG procedure.


PubMed | Yalova State Hospital, Kosuyolu Heart Hospital, Atatürk University and Bahcesehir University
Type: Review | Journal: Clinical cardiology | Year: 2016

Recent trials reported that risk of atrial fibrillation (AF) is increased in patients using ivabradine compared with controls. We performed this meta-analysis to investigate the risk of AF association with ivabradine treatment on the basis of data obtained from randomized controlled trials (RCTs). We searched PubMed, EMBASE, Scopus, and the Cochrane Library for RCTs that comprised >100 patients. The incidence of AF was assessed. We obtained data from European Medicines Agency (EMA) scientific reports for the RCTs in which the incidence of AF was not reported. We used trial sequential analysis (TSA) to provide information on when we had reached firm evidence of new AF based on a 15% relative risk increase (RRI) in ivabradine treatment. Three RCTs and 1 EMA overall oral safety set (OOSS) pooled analysis (included 5 RCTs) were included in the meta-analysis (N=40437). The incidence of AF was 5.34% in patients using ivabradine and 4.56% in placebo. There was significantly higher incidence of AF (24% RRI) in the ivabradine group when compared with placebo before (RR: 1.24, 95% confidence interval: 1.08-1.42, P = 0.003, I 1980 = 53%) and after excluding OOSS (RR: 1.24, 95% confidence interval: 1.06-1.44, P = 0.008). In the TSA, the cumulative z-curve crossed both the traditional boundary (P = 0.05) and the trial sequential monitoring boundary, indicating firm evidence for 15% increase in ivabradine treatment when compared with placebo. Study results indicate that AF is more common in the ivabradine group (24% RRI) than in controls.


Zorlu A.,Cumhuriyet University | Yilmaz M.B.,Cumhuriyet University | Yucel H.,Cumhuriyet University | Bektasoglu G.,Cumhuriyet University | And 2 more authors.
Journal of Thrombosis and Thrombolysis | Year: 2012

D-dimer is a fibrin degradation product, and is implicated in pathologies of cardiovascular system. Thrombosis within the vascular system in relation with inflammation and stasis might be associated with poor prognosis in patients with systolic heart failure (HF). In this study we aimed to investigate for relationship between d-dimer levels and cardiovascular mortality in patients with systolic HF. A total of 174 consecutive patients with hospitalized systolic HF were evaluated. All hospitalized patients were obtained d-dimer levels within the first 24 h following admission after obtaining informed consent. Patients were followed up for cardiovascular mortality and 40 (23%) patients died. d-dimer levels were higher among those who died compared to those who survived (2727 ± 2569 (710-4438) versus. 1029 ± 1319 (303-1061) ng/ml, P<0.001). Optimal cut-off level of d-dimer to predict cardiovascular mortality was found to be >1435 ng/ml. D-dimer levels were negatively correlated with ejection fraction, positively correlated with left atrium size and left ventricular diastolic diameter. D-dimer>1435 ng/ml, age, diabetes mellitus, presence of atrial fibrillation, and creatinine level were found to have prognostic significance in univariate analyses. In multivariate Cox proportional-hazards model, d-dimer>1435 ng/ml (HR = 3.250, 95% CI 1.647-6.414, P = 0.001), creatinine level (HR = 1.269, 95% CI 1.008-1.599, P = 0.043), and presence of atrial fibrillation (HR = 2.159, 95% CI 1.047-4.452, P = 0.037) remained associated with an increased risk of death after adjustment for variables found to be statistically significant in univariate analysis and correlated with d-dimer level. In conclusion, d-dimer measurement could help risk stratification in patients with systolic HF. © Springer Science+Business Media, LLC 2012.


PubMed | Yalova State Hospital, Medical Park Bursa Hospital, Bursa Yuksek Ihtisas Education and Research Hospital and Bahcesehir University
Type: Journal Article | Journal: Cardiovascular journal of Africa | Year: 2016

The objective of this study was to investigate the effect of anatomical characteristics on mortality rates after endovascular aneurysm repair (EVAR).We investigated 56 EVAR procedures for infrarenal aortic aneurysms performed between January 2010 and December 2013, and the data were supplemented with a prospective review. The patients were divided into two groups according to the diameter of the aneurysm. Group I (n = 30): patients with aneurysm diameters less than 6 cm, group II (n = 26): patients with aneurysm diameters larger than 6 cm. The pre-operative anatomical data of the aneurysms were noted and the groups were compared with regard to postoperative results.There were no correlations between diameter of aneurysm (p > 0.05), aneurysm neck angle (p > 0.05) and mortality rate. The long-term mortality rate was found to be high in patients in whom an endoleak occurred.We found that aneurysm diameter did not have an effect on postoperative mortality rates. An increased EuroSCORE value and the development of endoleaks had an effect on long-term mortality rates.


Kayabasi H.,Yalova State Hospital | Yilmaz Z.,Dicle University | Sit D.,Bagcilar Training and Research Hospital | Kadiroglu A.K.,Dicle University | Yilmaz E.,Dicle University
European Review for Medical and Pharmacological Sciences | Year: 2013

INTRODUCTION: We aimed to evaluate the effects of Losartan, an angiotensin receptor blocker, on serum inflammatory markers, plasma thiol groups, and oxidative stres indexes among patients undergoing hemodialysis (HD) treatment. PATIENTS AND METHODS: Fiftytwo end-stage renal disease (ESRD) patients undergoing chronic HD programme for at least 12 months, and thirty age and gender matched healthy volunteers were enrolled into this prospective clinical trial. Plasma levels of thiol groups (SH), total antioxidant capacitiy (TAC), and total oxidant status (TOS) were studied. Oxidative stress index (OSI) was calculated by TOS/TAC. Firstly results of patients were compared with healthy subjects and then patients were treated by Losartan 50-100 mg and followed up for three months. RESULTS: Among patients, SH Groups, TAC, TOS, and OSI were statistically higher than controls. Also the inflammatory markers were significantly higher in patients than controls and albumin was lower among patients. At the end of the 3 months among all patients the mean value of TAC was increased to 1.7±0.4 micromol Trolox Eqv./L. from 1.4±0.2, and SH groups to 0.33±0.02 mmol/L from 0.22±0.01, (p < 0.001) while TOS decreased to 7.2±1.1 micromol H2O2 Eqv./L from 9.5±4.5, and OSI decreased to 5.0±0.8 from 7.1±3.2 (p < 0.001). CONCLUSIONS: Losartan was effective in controlling blood pressure, and decreasing OSI, a marker of elevated oxidative stress, and increasing plasma levels of SH groups, an antioxidant, in ESRD patients undergoing hemodialysis. So, it may not be only a hypotensive drug, but also improves OS, particularly in patients with ESRD.

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