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İsmail E, Kutlu B, Acar Hİ, Yörübulut M, Akkoca M, Kocaay AF, Elhan A, Kuzu MA. Lateral Lymph Node Dissection for Locally Advanced Rectal Carcinoma: A Step-by-Step Description of Surgical Anatomical Planes During Cadaveric Dissection and Minimally Invasive Surgery. Surg Laparosc Endosc Percutan Tech 2024; 34:101-107. [PMID: 38134383 DOI: 10.1097/sle.0000000000001241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/15/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE Total mesorectal excision (TME) is accepted as gold standard method in rectal cancer globally. But there is no standard for lateral lymph nodes. Combination of neoadjuvant treatment plus lateral lymph node dissection (LLND) in select patients might be a promising method. Our purpose is to describe the anatomic landmarks of LLND on cadavers and minimally invasive surgery. MATERIALS AND METHODS Local advanced rectal cancer and lateral lymph node (LLN) metastasis are accepted as an indication of neoadjuvant treatment. LLND was performed according to preoperative imaging after radiochemotherapy. RESULTS Twenty-eight (10.5%) of 267 patients with rectal cancer who had suspected lateral lymph node metastasis (LLNM) with magnetic resonance imaging (MRI) underwent LLND in addition to TME after neoadjuvant chemoradiotherapy. Eight of them had LLNM. Three patients had bilateral LLND and only 1 had LLNM. The median number of harvested lymph nodes was 6. The rates of LLNM increased with the presence of poor prognosis markers. One regional and 1 distant recurrence were detected in patients who had no LLN metastasis compared with2 regional and 4 distant recurrences in the LLN-positive group. CONCLUSIONS Local advanced rectal cancer cases may benefit from LLND, but it does not appear to have an effect on overall survival. There is no consensus whether size and/or morphologic criteria in MRI are the ideal guide for LLND.
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Affiliation(s)
- Erkin İsmail
- Acibadem Hospital; Departments of General Surgery and Anatomy, Faculty of Medicine, Ankara University; SBU Etlik City Hospital, Ankara, Turkey
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Özdemir H, Ekin Dağ N, Çakmak Taşkın E, Konca HK, Arga G, Nar Ötgün S, Güriz H, Elhan A, Çiftçi E, İnce E. [Burden of Pneumococcal Meningitis and Bacteremia, Serotype Distribution and Antibiotic Resistance in Healthy Children After Conjugated Pneumococcal Vaccine Implementation: Single Center Experience]. MIKROBIYOL BUL 2021; 55:492-506. [PMID: 34666651 DOI: 10.5578/mb.20219703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In Turkey, the seven-valent pneumococcal conjugated vaccine (PCV7) was included in the childhood national immunization programme in April 2008 and was replaced by the 13-valent pneumococcal conjugated vaccine (PCV13) in April 2011. In this retrospective, single-center study, it was aimed to determine the serotype distribution and antimicrobial resistance in Streptococcus pneumoniae isolates of pediatric patients with invasive pneumococcal disease (IPD) after the introduction of PVC7 and PVC13. Fifty pediatric patients diagnosed with meningitis and sepsis/bacteremia between October 2009 and October 2019 were included in the study. The pediatric patient group consisted of previously healthy patients diagnosed with meningitis and sepsis/bacteremia with S.pneumoniae isolated in their blood or cerebrospinal fluids. Patients with pneumonia-associated bacteremia and empyema were not included in the study. Serotyping of the isolates was performed by Quellung reaction using specific antisera (Statens Serum Institute, Denmark) and antibiotic (penicillin and ceftriaxone) susceptibility was determined by antibiotic gradient method based on Clinical Laboratory Standards Institute (CLSI) criteria. Of the children, 29 (58%) were boys and 21 (42%) were girls. The median age of the patients was 19 months (1 month-18 year). When the children under the age of five were evaluated, it was found that 30 (79%) patients were diagnosed with occult bacteremia/sepsis and 8 (21%) with meningitis. The overall annual incidence rate of IPD among the healthy children aged <5 years decreased significantly from 9.35/100000 to 0.83/100000 (p< 0.001). Serotype identification was determined for 44 of 50 pneumococcal isolates . However, since six patients with underlying disease were not included in the evaluation, the remaining 38 isolates were found to be one of the serotypes included in PCV7 and PCV13 at a rate of 28.9% (n= 11) and 44.7% (n= 17), respectively. While the rate of PCV13 serotypes seen in the PCV7 period was 81.8%, this rate decreased to 29.6% within eight years after PCV13 administration. The rate of non-vaccine serotypes was determined as 54.5% in PCV7 period and 70.3% in PCV13 period. The rate of non-vaccine serotypes in patients under 5 years was 60% in the period of PCV7 and 75% in the period of PCV13. The proportion of non-vaccine serotypes has increased over time. However, this difference was not statistically significant (p> 0.05). The most common serotypes detected in isolates were 19F, 23F, 7F, 31 and 24B. According to the minimum inhibitory concentration values of the isolates recovered from patients with meningitis, penicillin and ceftriaxone resistance rates were found as 43.9% and 9.8%, respectively. In conclusion, our study showed that there was a 91.1% decrease in the incidence of IPD in healthy children aged under five years after the implementation of PCV7 and PCV13. It was determined that while the rate of serotypes in vaccine content decreased, there was an increase in non-vaccine serotypes. In addition no significant change was observed in antibiotic resistance rates over the years.
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Affiliation(s)
- Halil Özdemir
- Ankara University Faculty of Medicine, Division of Pediatric Infectious Diseases, Ankara, Turkey
| | - Nihal Ekin Dağ
- Ankara University Faculty of Medicine, Department of Pediatrics, Ankara, Turkey
| | - Esra Çakmak Taşkın
- Ankara University Faculty of Medicine, Division of Pediatric Infectious Diseases, Ankara, Turkey
| | - Hatice Kübra Konca
- Ankara University Faculty of Medicine, Division of Pediatric Infectious Diseases, Ankara, Turkey
| | - Gül Arga
- Ankara University Faculty of Medicine, Division of Pediatric Infectious Diseases, Ankara, Turkey
| | - Selin Nar Ötgün
- Republic of Turkey Ministry of Health, General Directorate of Public Health, National Respiratory Pathogens Reference Laboratory, Ankara, Turkey
| | - Haluk Güriz
- Ankara University Faculty of Medicine, Cebeci Hospital Microbiology Laboratory, Ankara, Turkey
| | - Atilla Elhan
- Ankara University Faculty of Medicine, Department of Biostatistics, Ankara, Turkey
| | - Ergin Çiftçi
- Ankara University Faculty of Medicine, Division of Pediatric Infectious Diseases, Ankara, Turkey
| | - Erdal İnce
- Ankara University Faculty of Medicine, Division of Pediatric Infectious Diseases, Ankara, Turkey
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Tokatli Z, Ferhat M, Ibis MA, Turkmen Sariyildiz G, Elhan A, Sarica K. Does the power of the laser devices matter for a successful HoLEP procedure? A prospective comparative study. Int J Clin Pract 2021; 75:e14531. [PMID: 34130360 DOI: 10.1111/ijcp.14531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/14/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The objectives of this prospective study were to evaluate the efficiency, safety and applicability of medium-power (MP) holmium laser devices in the endoscopic enucleation of the enlarged prostate (HoLEP) compared with high-power (HP) laser devices. METHODS From October 2019 to July 2020, a total of 120 consecutive patients planned for HoLEP were divided randomly into two groups formed in terms of the power of the device used. While patients in group 1 were treated with a MP device (50 W) at 39.6 W (2.2 J/18 Hz), patients in group 2 were treated with HP (100 W) device at 42 W (1.2 J/35 Hz). Preoperative patient characteristics, perioperative measures and 3-month functional outcomes were evaluated in both groups with an emphasis on enucleation efficiency (EE) and haemoglobin decrease in a comparative manner. RESULTS All patients underwent successful HoLEP surgery with no severe perioperative and postoperative complications. No statistically significant differences were observed in terms of preoperative patient characteristics and perioperative measures in the two groups. The median EE values in groups 1 and 2 were 1.15 (interquartile range [IQR]: 0.33-2.2) and 1.11 (IQR: 0.4-2.8), respectively (P = .775). Haemoglobin decrease values in groups 1 and 2 were 1.3 (IQR: 0.1-4) and 1.4 (IQR: 0.4-3.1), respectively (P = .736). There was no difference in terms of either catheterisation time or hospital stay in the groups. In the model created to predict haemoglobin decrease, only biopsy was detected to be the independent predictive factor among the data from laser device, biopsy and antithrombotic use. Functional outcomes markedly improved in all patients without any statistically significant difference between the groups in the 3-month follow-up. CONCLUSION Our comparative study indicated that HoLEP can be performed safely and effectively with MP laser devices without any technical difficulties and with comparable results achieved in HP laser devices.
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Affiliation(s)
- Zafer Tokatli
- Department of Urology, Medicana International Ankara Hospital, Ankara, Turkey
| | - Mehmet Ferhat
- Department of Urology, Medicana Bahçelievler Hospital, Istanbul, Turkey
| | - Muhammed Arif Ibis
- Department of Urology, University of Health Sciences, Kecioren Training and Research Hospital, Ankara, Turkey
| | | | - Atilla Elhan
- Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey
| | - Kemal Sarica
- Department of Urology, Biruni University School of Medicine, Istanbul, Turkey
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Gürsoy Çoruh A, Yenigün B, Uzun Ç, Kahya Y, Büyükceran EU, Elhan A, Orhan K, Kayı Cangır A. A comparison of the fusion model of deep learning neural networks with human observation for lung nodule detection and classification. Br J Radiol 2021; 94:20210222. [PMID: 34111976 DOI: 10.1259/bjr.20210222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To compare the diagnostic performance of a newly developed artificial intelligence (AI) algorithm derived from the fusion of convolution neural networks (CNN) versus human observers in the estimation of malignancy risk in pulmonary nodules. METHODS The study population consists of 158 nodules from 158 patients. All nodules (81 benign and 77 malignant) were determined to be malignant or benign by a radiologist based on pathologic assessment and/or follow-up imaging. Two radiologists and an AI platform analyzed the nodules based on the Lung-RADS classification. The two observers also noted the size, location, and morphologic features of the nodules. An intraclass correlation coefficient was calculated for both observers and the AI; ROC curve analysis was performed to determine diagnostic performances. RESULTS Nodule size, presence of spiculation, and presence of fat were significantly different between the malignant and benign nodules (p < 0.001, for all three). Eighteen (11.3%) nodules were not detected and analyzed by the AI. Observer 1, observer 2, and the AI had an AUC of 0.917 ± 0.023, 0.870 ± 0.033, and 0.790 ± 0.037 in the ROC analysis of malignity probability, respectively. The observers were in almost perfect agreement for localization, nodule size, and lung-RADS classification [κ (95% CI)=0.984 (0.961-1.000), 0.978 (0.970-0.984), and 0.924 (0.878-0.970), respectively]. CONCLUSION The performance of the fusion AI algorithm in estimating the risk of malignancy was slightly lower than the performance of the observers. Fusion AI algorithms might be applied in an assisting role, especially for inexperienced radiologists. ADVANCES IN KNOWLEDGE In this study, we proposed a fusion model using four state-of-art object detectors for lung nodule detection and discrimination. The use of fusion of deep learning neural networks might be used in a supportive role for radiologists when interpreting lung nodule discrimination.
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Affiliation(s)
| | - Bülent Yenigün
- Department of Thoracic Surgery, School of Medicine, Ankara University, Ankara, Turkey
| | - Çağlar Uzun
- Department of Radiology, School of Medicine, Ankara University, Ankara, Turkey
| | - Yusuf Kahya
- Department of Thoracic Surgery, School of Medicine, Ankara University, Ankara, Turkey
| | | | - Atilla Elhan
- Department of Biostatistics, School of Medicine, Ankara University, Ankara, Turkey
| | - Kaan Orhan
- Dentomaxillofacial Radiology, Ankara University, Faculty of Dentistry and Ankara University Medical Design Application and Research Center, Ankara, Turkey
| | - Ayten Kayı Cangır
- Department of Thoracic Surgery, School of Medicine, Ankara University, Ankara, Turkey
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Seval GC, Kabacam G, Yakut M, Seven G, Savas B, Elhan A, Cinar K, Idilman R. The natural course of non-alcoholic fatty liver disease. Hepatol Forum 2020; 1:20-24. [PMID: 35949661 PMCID: PMC9344371 DOI: 10.14744/hf.2020.0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/16/2020] [Indexed: 05/08/2023]
Abstract
BACKGROUND AND AIM The present study aims to describe the characteristics and long-term clinical outcomes of patients with non-alcoholic fatty liver disease (NAFLD). MATERIAL AND METHODS A total of 1308 individuals with NAFLD were seen in the Liver Diseases Outpatient Clinic. Diagnosis of NAFLD in each case was based on biochemical, radiological and histological criteria, when available. After diagnosis, all NAFLD patients were administered a conventional diet and exercise program. The median follow-up period was 55.3 months. RESULTS At the time of the diagnosis, the mean age was 50.8±11.3 years, and female gender was slightly predominant (51.4%). The median body mass index was 29.2±4.7 kg/m2: 39% were obese. Seventeen percent of the patients had diabetes mellitus, 53% insulin resistance, 60% hyperlipidemia, and 32% hypertension. Median serum aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma-glutamyl transpeptidase levels were 31 U/L (range: 10-248 U/L), 45 U/L (range: 10-285 U/L) and 41 (range: 8-1200 U/L), respectively. Liver biopsy was performed in 293 individuals. The median NAFLD activity score was 5.0, median hepatic steatosis 2, ballooning 1, lobular inflammation 1, portal inflammation 0, and fibrosis 0. Of note, 41.3% of the samples (121/293) revealed the presence of fibrosis and 31% of the samples (37/121) showed significant fibrosis. With multivariate analysis, diabetes and obesity were associated with the presence of significant fibrosis. Among them, 765 patients (M/F: 353/412, mean age: 51.0±10.9) had at least six months of follow-up. In this group, from baseline to the end of the follow-up period, a significant improvement in the serum AST and ALT levels was observed. CONCLUSION NAFLD is a potentially progressive disease. Diabetes and obesity were associated with the presence of advanced fibrosis.
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Affiliation(s)
- Guldane Cengiz Seval
- Department of Internal Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Gokhan Kabacam
- Department of Gastroenterology, Ankara UniversitySchool of Medicine, Ankara, Turkey
| | - Mustafa Yakut
- Department of Gastroenterology, Ankara UniversitySchool of Medicine, Ankara, Turkey
| | - Gulseren Seven
- Department of Gastroenterology, Ankara UniversitySchool of Medicine, Ankara, Turkey
| | - Berna Savas
- Department of Pathology, Ankara University School of Medicine, Ankara, Turkey
| | - Atilla Elhan
- Department of Biostatistics , Ankara University School of Medicine, Ankara, Turkey
| | - Kubilay Cinar
- Department of Internal Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara UniversitySchool of Medicine, Ankara, Turkey
- Corresponding author: Ramazan Idilman; Ankara Universitesi Tip Fakultesi, Gastroenteroloji Bolumu, 06100 Cebeci, Ankara, Turkey Phone: +90 312 438 66 76; e-mail:
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Gursoy Coruh A, Peker E, Elhan A, Erden I, Erden A. Evaluation of Extramural Venous Invasion by Diffusion-Weighted Magnetic Resonance Imaging and Computed Tomography in Rectal Adenocarcinoma. Can Assoc Radiol J 2019; 70:457-465. [PMID: 31582328 DOI: 10.1016/j.carj.2019.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/30/2019] [Accepted: 06/09/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The aim of this study is to evaluate the diagnostic contribution of diffusion-weighted magnetic resonance imaging (MRI) and computed tomography (CT) to distinguish extramural venous invasion (EMVI) in rectal adenocarcinoma. MATERIALS AND METHODS Fifty-eight patients who had been diagnosed with rectal adenocarcinoma (30 patients with EMVI and 28 patients without EMVI) were enrolled in the study. Apparent diffusion coefficient (ADC) values of the tumour and the EMVI (+) vein, the lengths of the tumours were measured on MRI. The diameters of the superior rectal vein (SRV)-inferior mesenteric vein (IMV) and distant metastatic spread were evaluated on CT. The ability of these findings to detect EMVI was assessed using receiver operating characteristic (ROC) analysis. Pathology was accepted as the reference test for EMVI. RESULTS Mean diameters of the SRV (4.9 ± 0.9 mm vs 3.7 ± 0.8 mm) and IMV (6.9 ± 0.8 mm vs 5.4 ± 0.9 mm) were significantly larger (P < .001) and tumour ADC values were significantly lower (0.926 ± 0.281 × 10-3 mm2/s vs 1.026 ± 0.246 × 10-3 mm2/s; P = .032) in EMVI (+) patients. Diameters of 3.95 mm for the SRV (area under the curve [AUC] ± standard error [SE]: 0.851 ± 0.051, P < .001, sensitivity: 93.3%, specificity: 67.9%) and 5.95 mm for the IMV (AUC ± SE: 0.893 ± 0.040, P < .001, sensitivity: 93.3%, specificity: 71.4%) and an ADC value of 0.929 × 10-3 mm2/s (AUC ± SE: 0.664 ± 0.072, P = .032 sensitivity: 76.7%, specificity: 57.1%) were found to be cutoff values, determined by ROC analysis, for detection of EMVI. Distant metastases were significantly more prevalent in EMVI (+) patients (P < .001). CONCLUSION The measurement of ADC values and SRV-IMV diameters seems to have contribution for diagnosis of EMVI in rectal adenocarcinoma. EMVI (+) patients appear to have higher risks of distant metastases at diagnosis.
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Affiliation(s)
| | - Elif Peker
- Department of Radiology, School of Medicine, Ankara University, Ankara, Turkey
| | - Atilla Elhan
- Department of Biostatistics, School of Medicine, Ankara University, Ankara, Turkey
| | - Ilhan Erden
- Department of Radiology, School of Medicine, Ankara University, Ankara, Turkey
| | - Ayse Erden
- Department of Radiology, School of Medicine, Ankara University, Ankara, Turkey
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Coruh AG, Uzun C, Akkaya Z, Gulpinar B, Elhan A, Tuzuner A. Is There a Correlation with Pre-donation Kidney Volume and Renal Function in the Renal Transplant Recipient?: A Volumetric Computed Tomography Study. Transplant Proc 2019; 51:2312-2317. [DOI: 10.1016/j.transproceed.2019.02.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 02/01/2019] [Accepted: 02/17/2019] [Indexed: 01/28/2023]
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Yılmaz G, Coşkun B, Elhan A, Azap A, Akan H. D-index: A New Scoring System in Febrile Neutropenic Patients for Predicting Invasive Fungal Infections. Turk J Haematol 2016; 33:102-6. [PMID: 26376689 PMCID: PMC5100719 DOI: 10.4274/tjh.2014.0070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 05/21/2014] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Neutropenia is a critical risk factor for invasive fungal infections (IFIs). We retrospectively performed this study to assess the performance of the D-index, a new test that combines both the duration and the severity of neutropenia, in predicting IFIs among patients with acute myelogenous leukemia.
MATERIALS AND METHODS Fifteen patients with IFIs and 28 patients who did not develop IFIs were enrolled in the study. The D-index was defined as the area over the neutrophil curve, whereas the cumulative-D-index (c-D-index) was the area over the neutrophil curve from the start of neutropenia until the first clinical manifestation of IFI.
RESULTS The D-index and the c-D-index tended to be significantly higher in patients with IFIs, with medians of 10,150 (range: 4000-22,000) and 5300 (range: 2300-22,200), respectively (p=0.037 and p=0.003, respectively). The receiver operating characteristic analyses showed that there was a cutoff point of 3875 for the D-index in predicting IFI; the sensitivity, specificity, and positive and negative predictive values were 100%, 67.9%, 35.4%, and 100%, respectively. There was also a cutoff point of 4225 for the c-D-index in predicting IFI; the sensitivity, specificity, and positive and negative predictive values for the c-D-index were 93.3%, 71.4%, 36.6%, and 98.4%.
CONCLUSION The D-index and especially the c-D-index could be useful tools with high negative predictive value to exclude as well as to predict IFIs in the management of neutropenic patients.
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Affiliation(s)
- Gülden Yılmaz
- Ankara University Faculty of Medicine, Department of Clinical Microbiology and Infectious Diseases, Ankara, Turkey, Phone : +90 312 508 27 15, E-mail :
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Ugurlu O, Baltaci S, Aslan G, Can C, Cal C, Elhan A, Turkeri L, Mungan A. Does skip metastasis or other lymph node parameters have additional effects on survival of patients undergoing radical cystectomy for bladder cancer? Korean J Urol 2015; 56:357-64. [PMID: 25964836 PMCID: PMC4426507 DOI: 10.4111/kju.2015.56.5.357] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 04/01/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate the effects of lymph node metastasis, skip metastasis, and other factors related to lymph node status on survival in patients who underwent radical cystectomy (RC) and extended lymph node dissection (eLND). Materials and Methods RC and eLND were performed in 85 patients with a diagnosis of bladder cancer. Disease-free survival (DFS) and overall survival (OS) were determined by using a Cox proportional hazards model that included the number of excised lymph nodes, the presence of pathological lymph node metastasis, the anatomical level of positive nodes, the number of positive lymph nodes, lymph node density, and the presence of skip metastasis. Results The mean number of lymph nodes removed per patient was 29.4±9.3. Lymph node positivity was detected in 85 patients (34.1%). The mean follow-up duration was 44.9±27.4 months (2-93 months). Five-year estimated OS and DFS for the 85 patients were 62.6% and 57%, respectively. Three of 29 lymph node-positive patients (10.3%) had skip metastasis. Only lymph node positivity had a significant effect on 5-year OS and DFS (p<0.001). No difference in OS and DFS was found between the three patients with skip metastasis and other lymph node-positive patients. Other factors related to lymph node status had no significant effect on 5-year OS and DFS. Conclusions No factors related to lymph node status predict DFS and OS, except for lymph node positivity. OS and DFS were comparable between patients with skip metastasis and other lymph node-positive patients.
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Affiliation(s)
- Ozgur Ugurlu
- Department of Urology, Private Akay Hospital, Ankara, Turkey
| | - Sumer Baltaci
- Department of Urology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Guven Aslan
- Department of Urology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Cavit Can
- Department of Urology, Eskişehir Osmangazi University Medical Faculty, Eskişehir, Turkey
| | - Cag Cal
- Department of Urology, Ege University Medical Faculty, Izmir, Turkey
| | - Atilla Elhan
- Department of Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Levent Turkeri
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Aydin Mungan
- Department of Urology, Karaelmas University, School of Medicine, Zonguldak, Turkey
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Özdel S, Özçakar ZB, Sahin S, Ekim M, Elhan A, Yalcinkaya F. The role of genotype in Familial Mediterranean Fever. Pediatr Rheumatol Online J 2014. [PMCID: PMC4191456 DOI: 10.1186/1546-0096-12-s1-p261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Özdel S, Özçakar ZB, Sahin S, Ekim M, Elhan A, Yalcinkaya F. Familial Mediterranean Fever in older children. Pediatr Rheumatol Online J 2014. [PMCID: PMC4191433 DOI: 10.1186/1546-0096-12-s1-p254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Tirali RE, Gulsahi K, Cehreli SB, Karahan ZC, Uzunoğlu E, Elhan A. Antimicrobial efficacy of octenidine hydrochloride, MTAD and chlorhexidine gluconate mixed with calcium hydroxide. J Contemp Dent Pract 2013; 14:456-60. [PMID: 24171989 DOI: 10.5005/jp-journals-10024-1344] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this in vitro study was to investigate whether mixing with calcium hydroxide [Ca(OH)2] affects the antimicrobial action of Octenidine hydrochloride (Octenisept), MTAD and chlorhexidine against Enterococcus faecalis and Candida albicans. MATERIALS AND METHODS Freshly grown cultures of Enterococcus faecalis, Candida albicans and a mixture of both strains were incubated in agar plates containing brain-heart infusion broth (BHIB). Zones of inhibition were measured at 24 and 48 hours. Statistical analysis was performed using Mann-Whitney U test and Kruskal-Wallis one-way analysis of variance (ANOVA, both p=0.05). RESULTS Mixing with Ca(OH)2 significantly increased the antibacterial effect of Octenisept (p<0.05), but did not alter its antifungal activity. Only chlorhexidine showed more antibacterial and antifungal efficiency compared to its Ca(OH)2-mixed version (both p<0.05). Mixing with Ca(OH)2 decreased the antibacterial efficacy of MTAD, but increased its antifungal effect (both p<0.05). CONCLUSION These results demonstrate the differential effects of Ca(OH)2 addition on the antimicrobial action of the tested endodontic medicaments in vitro. Ca(OH)2 was as effective as its combination with all of the tested medicaments.
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Affiliation(s)
- Resmiye Ebru Tirali
- Assistant Professor, Department of Pediatric Dentistry, Baskent University, Ankara, Turkey, e-mail:
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Idilman IS, Aniktar H, Idilman R, Kabacam G, Savas B, Elhan A, Celik A, Bahar K, Karcaaltincaba M. Hepatic steatosis: quantification by proton density fat fraction with MR imaging versus liver biopsy. Radiology 2013; 267:767-75. [PMID: 23382293 DOI: 10.1148/radiol.13121360] [Citation(s) in RCA: 272] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To determine utility of proton density fat fraction (PDFF) measurements for quantifying the liver fat content in patients with nonalcoholic fatty liver disease (NAFLD), and compare these results with liver biopsy findings. MATERIALS AND METHODS This retrospective study was approved by the institutional review board with waivers of informed consent. Between June 2010 and April 2011, 86 patients received a diagnosis of NAFLD. Ten patients did not accept liver biopsy and six patients had contraindications for magnetic resonance (MR) imaging. Seventy patients were included in this study. Seventy patients with NAFLD (40 men, 30 women; mean age, 44.7 years; range, 16-69 years) underwent T1-independent volumetric multiecho gradient-echo imaging with T2* correction and spectral fat modeling. Median time interval between MR imaging and liver biopsy was 14.5 days (range, 0-259 days). MR examinations were performed with a 1.5-T MR imaging system. Complex-based PDFF measurements were performed by placing regions of interest in Couinaud system segments V-VI and all liver segments from I to VIII. All liver biopsy specimens were retrieved from archives and evaluated by one pathologist for hepatic steatosis according to criteria from a previous study. Pearson correlation coefficient, receiver operating characteristics, and linear regression analyses were used for statistical analyses. RESULTS Mean PDFF calculated with MR imaging was 18.1% ± 9.5 (standard deviation). Close correlation for quantification of hepatic steatosis was observed between PDFF and liver biopsy (r = 0.82). PDFF was effective in discriminating moderate or severe hepatic steatosis from mild or no hepatic steatosis, with area under the curve of 0.95. The correlation between biopsy and PDFF-determined steatosis was less pronounced when fibrosis was present (r = 0.60) than when fibrosis was absent (r = 0.86; P = .02). CONCLUSION PDFF measurement by MR imaging provided a noninvasive, accurate estimation of the presence and grading of hepatic steatosis in patients with NAFLD. Hepatic fibrosis reduced the correlation between biopsy results and PDFF.
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Affiliation(s)
- Ilkay S Idilman
- Department of Radiology, Liver Imaging Team, Hacettepe University, School of Medicine, Sihhiye, Ankara, Turkey
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Abstract
Chronic pain after inguinal hernia repair with prosthetic meshes is recorded in some patients. Although the exact etiology of the pain is not fully understood, it can be related to the trauma to the regional nerves. It is possible to involve these nerves by injuring, suturing, stapling, tacking or compressing them during the operation. Therefore, a delicate surgical approach to the inguinal floor with correct identification of three nerves is necessary for patient comfort at early and late postoperative period. We herein report a surgical view of an inguinal floor which are very rich of neural structures in a patient undergo an elective inguinal hernia repair. The number of the main nerve bundles was excessive, and they were thicker than generally met. This kind of anatomic variations may create a difficulty for repair with prosthetic material. The identification of the nerve structures was hard at first sight and the correct identification was only made by consulting the surgical picture with a senior anatomist.
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Affiliation(s)
- H. Kulacoglu
- Department of Surgery Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey
- Department of Surgery Ankara Hernia Center, Ankara, Turkey
| | - T. Sen
- Department of Surgery Ankara University School of Medicine, Department of Anatomy, Ankara, Turkey
| | - I. Ozyaylali
- Department of Surgery Ankara Hernia Center, Ankara, Turkey
| | - A. Elhan
- Department of Surgery Ankara University School of Medicine, Department of Anatomy, Ankara, Turkey
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15
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Ozen H, Ugurlu O, Baltaci S, Adsan O, Aslan G, Can C, Gunaydin G, Elhan A, Beduk Y. Extended pelvic lymph node dissection: before or after radical cystectomy? A multicenter study of the Turkish society of urooncology. Korean J Urol 2012; 53:451-6. [PMID: 22866214 PMCID: PMC3406189 DOI: 10.4111/kju.2012.53.7.451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 12/26/2011] [Indexed: 12/03/2022] Open
Abstract
Purpose We aimed to ascertain the effects of performing extended pelvic lymph node dissection (PLND) on the duration of surgery, morbidity, and the number of lymph nodes removed when the dissection was performed before or after radical cystectomy (RC). Materials and Methods We used the database of our previous prospective multicenter study. A total of 118 patients underwent RC and extended PLND. Of the 118 patients, 48 (40.7%) underwent extended PLND before RC (group 1) and 70 (59.3%) underwent extended PLND after RC (group 2). The two groups were compared for extended PLND time, RC time, and total operation times, per operative morbidity, and the total numbers of lymph nodes removed. Results Clinical and pathologic characteristics were comparable in the two groups (p>0.05). The mean RC time and mean total operation times were significantly shorter in group 1 than in group 2 (p<0.001). The mean number of lymph nodes removed was 27.31±10.36 in group 1 and 30.87±8.3 in group 2 (p=0.041). Only at the presacral region was the mean number of lymph nodes removed significantly fewer in group 1 than in group 2 (p=0.001). Intraoperative and postoperative complications and drain withdrawal time were similar in both groups (p=0.058, p=0.391, p=0.613, respectively). Conclusions When extended PLND was performed before RC, the duration of RC and consequently the total duration of the operation were significantly shorter than when extended PLND was performed after RC. Practitioners may consider performing extended PLND before RC and rechecking the presacral area for additional lymph nodes after RC, particularly in elderly patients with high co-morbidity for whom the duration of surgery matters.
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Affiliation(s)
- Haluk Ozen
- Department of Urology, Hacettepe University Medical Faculty, Ankara, Turkey
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16
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Idilman R, Cinar K, Seven G, Bozkus Y, Elhan A, Bozdayi M, Yurdaydin C, Bahar K. Hepatitis B surface antigen seroconversion is associated with favourable long-term clinical outcomes during lamivudine treatment in HBeAg-negative chronic hepatitis B patients. J Viral Hepat 2012; 19:220-6. [PMID: 22329377 DOI: 10.1111/j.1365-2893.2011.01542.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The aims of this study were to assess hepatitis B surface antigen (HBsAg) seroconversion and to determine its impact on the natural course of the disease in patients with HBeAg-negative chronic hepatitis B (CHB) during lamivudine (LMV) treatment. A total of 183 consecutive patients with HBeAg-negative CHB who were treated with LMV were included in the study. Data were retrospectively collected from outpatient visit charts. The primary endpoint was HBsAg seroconversion to anti-HBs. The secondary endpoint was to determine the development of cirrhosis. Loss of HBsAg was confirmed in 10 patients and seroconversion to anti-HBs in nine patients during LMV treatment or after its discontinuation. HBsAg seroconversion was achieved on-treatment in four patients after a median treatment duration of 30 months and off-treatment in the remaining five patients in a median 61 months after LMV discontinuation. The cumulative probability of HBsAg seroconversion increased from 0.6% at 1 year and 1.9% at 5 years to 21.5% at 10 years of LMV during and after LMV treatment. HBsAg clearance was preceded by undetectable serum hepatitis B virus (HBV) DNA. The majority of the patients responding to treatment had undetectable HBV DNA levels at 24 weeks of treatment. The cumulative probability of LMV resistance increased from 2.2% at 1 year to 37.3% at 5 years. No baseline parameter predicting either HBsAg seroconversion or the emergence of LMV resistance was identified. None of the patients with HBsAg seroconversion experienced virological breakthrough or disease progression during the follow-up period. These results indicate that HBsAg seroclearance can occur in patients with HBeAg-negative CHB under LMV therapy and predicts better clinical outcome.
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Affiliation(s)
- R Idilman
- Department of Gastroenterology, Ankara University, Ankara, Turkey.
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17
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Ergül Z, Kulaçoğlu H, Sen T, Esmer AF, Güller M, Güneri G, Elhan A. A short postgraduate anatomy course may improve the junior surgical residents' anatomy knowledge for the nerves of the inguinal region. Chirurgia (Bucur) 2011; 106:599-603. [PMID: 22165058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND AND AIM Inguinal hernia repair is one of the most common operations in a junior surgical resident's postgraduate training. Short recall courses can improve junior residents' anatomy knowledge and results in better surgical outcomes. We aimed to investigate the effect of a short course on anatomical competency during inguinal hernia repairs. METHODS During the first 25 inguinal hernia repairs, two junior residents were asked to identify iliohypogastric, ilioinguinal, and genital branch of genitofemoral nerves. Then, the residents were given a short recall course by anatomists. Afterwards, the participants were taken into an in-vivo anatomy test again. The same parameters were recorded in another 25 inguinal hernia repairs. In addition to the nerve identification records, case characteristics [body mass index (BMI < or = 25 vs. >25), hernia type (indirect vs. direct), and anesthesia used (general or regional vs. local)] were recorded. RESULTS Anatomy education had a clear impact on the correct identification rates for the iliohypogastric and ilioinguinal nerves. The rates increased from 70% to 90% and above. Correct identification rate for the three nerves together significantly increased from 16 to 52% following anatomy education (P = 0.006). All three nerves were identified with significantly higher success rates after anatomy education. The increase in the success rate for identification of the genital branch of genitofemoral nerve was 4-fold. CONCLUSIONS Short anatomy courses in specific subjects for junior surgical residents given by formal anatomists may be effective during postgraduate education. The benefit obtained in the present study for the inguinal region nerves may be expanded to more important anatomical structures, such as the recurrent laryngeal nerve in a thyroidectomy, or more complex subjects.
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Affiliation(s)
- Z Ergül
- Department of Surgery, Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey
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18
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Idil A, Ozen M, Atak N, Elhan A, Pehlivan S. Validity and reliability study of Turkish version on low vision with quality of life questionnaire. Int J Ophthalmol 2011; 4:546-51. [PMID: 22553719 DOI: 10.3980/j.issn.2222-3959.2011.05.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 08/16/2011] [Indexed: 12/14/2022] Open
Abstract
AIM To adapt the low vision-related quality of life (LVQOL) instrument into Turkish language and to assess its validity and reliability. METHODS The study was conducted in 387 patients attending the Centre of Low Vision Rehabilitation, Faculty of Medicine, Ankara University. For statistical analyses, the Spearman's correlation coefficient, Cronbach's alpha coefficient and Confirmatory Factor Analysis (CFA) were used. RESULTS According to results of CFA, the item in the "Adjustment" subscale because of having the factor loading below 0.40, was excluded from the questionnaire. The reliability of the questionnaire was assessed according to Cronbach's alpha coefficients. The reliability of the "Distance Vision, Mobility, and Lighting" subscale was α=0.863; of the "Adjustment" subscale wasα=0.694; "Reading and Fine Work" wasα=0.791, and "Activities of Daily Living" was α=0.770. So these results indicate that the questionnaire is reliable to measure the vision related quality of life of low-vision patients. The correlations between the subscales were also analyzed, and the correlation between "Adjustment" and "Reading and Fine Work" was found to be the lowest (r(s)=0.336, P<0.001), whereas the strongest correlation was found between the "Reading and Fine Work", and "Activities of Daily Living". Additionally, the "Adjustment" dimension showed the strongest correlation with only "Distance Vision, Mobility, and Lighting" dimension. CONCLUSION After removing the last item in the second dimension, the Turkish adaptation of all dimensions of the LVQOL has been shown to be reliable, valid and suitable for use in patients with low vision in Turkey.
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Affiliation(s)
- Aysun Idil
- Department of Public Health, Centre of Low Vision Rehabilitation, Faculty of Medicine, Ankara University, Ankara, Turkey
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19
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Tecder Ünal M, Karabulut HG, Gümüş-Akay G, Dölen Y, Elhan A, Tükün A, Ünal AE. Endothelial nitric oxide synthase gene polymorphism in gastric cancer. Turk J Gastroenterol 2010; 21:338-344. [PMID: 21331985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND/AIMS Nitric oxide, a labile compound synthesized by nitric oxide synthase, is a major regulator not only of physiological vascular tonus but also of the abnormal vascularity associated with tumors. Endothelial production of nitric oxide regulates blood flow and angiogenesis and reduces tumor cell adhesion to the endothelium. A high concentration of nitric oxide and its metabolites causes DNA damage during nitration, nitrosation and deamination. Both positive and negative effects on carcinogenesis and tumor growth, apoptosis, and cytotoxic mechanisms may be explained by differential susceptibility of tumor cells to nitric oxide-mediated reactions. METHODS In this study, three major polymorphisms (786T>C, the 27 base pair variable number of tandem repeats in intron 4, and 894G>T) of the endothelial nitric oxide synthase gene were investigated in gastric cancer and normal tissues of 50 patients with gastric cancer and in the peripheral blood of 98 healthy subjects. RESULTS We found no significant differences in intron 4a/b and 894G>T (Glu298Asp) allele and genotype frequencies between control and patient specimens. Nevertheless, the genotype and allele frequencies of 786T>C polymorphism were found to be significantly different between the healthy controls and tumor tissues. CONCLUSIONS The results suggest that endothelial nitric oxide synthase 786T>C polymorphism may play a role in the development of gastric cancer.
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Affiliation(s)
- Müge Tecder Ünal
- Department of Pharmacology, Başkent University, School of Medicine, Ankara.
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20
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Kutlay Ş, Küçükdeveci AA, Yanık B, Elhan A, Öztuna D, Tennant A. The interval scaling properties of the London Handicap Scale: an example from the adaptation of the scale for use in Turkey. Clin Rehabil 2010; 25:248-55. [DOI: 10.1177/0269215510380829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: To adapt the London Handicap Scale into the Turkish language, and to investigate the scaling properties of this version in a sample of people who have experienced a stroke. Design: After the translation process, the internal construct validity was tested by Rasch analysis and the reliability by internal consistency and intraclass correlation coefficient. The interval scaling properties were assessed by contrasting the raw and weighted London Handicap Scale scores with the Rasch latent estimates. Setting: An outpatient rehabilitation unit of a university hospital. Subjects: One hundred and eighty-eight community-dwelling post-stroke patients (mean age 63 (SD 12) years, 54% male) were assessed by the Turkish version of the London Handicap Scale. Results: After adjustment for local dependency, the data showed good fit to Rasch model expectations with a mean item fit −0.240 (SD 1.868), person fit −0.403 (SD 0.893) and chi-square interaction 8.55 (df 10, P = 0.575). The reliability was good with a Cronbach’s α and intraclass correlation coefficient of 0.845. Analysis of the scaling properties showed that either the raw London Handicap Scale score or its weighted score were non-linear with respect to the Rasch latent estimate. Conclusions: The London Handicap Scale is a valid and reliable scale for use in stroke in Turkey. Its unweighted raw scores and weighted scores are equivalent and ordinal, but a linear transformation is possible through Rasch analysis.
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Affiliation(s)
- Şehim Kutlay
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Ankara
| | - Ayşe A Küçükdeveci
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Ankara
| | - Burcu Yanık
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Fatih
| | - Atilla Elhan
- Department of Biostatistics, Faculty of Medicine, University of Ankara, Turkey
| | - Derya Öztuna
- Department of Biostatistics, Faculty of Medicine, University of Ankara, Turkey
| | - Alan Tennant
- Department of Rehabilitation Medicine, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, UK
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21
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Yüksek M, Ikincioğullari A, Doğu F, Elhan A, Yüksek N, Reisli I, Babacan E. Primary immune deficiency disease awareness among a group of Turkish physicians. Turk J Pediatr 2010; 52:372-377. [PMID: 21043382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Primary immunodeficiencies (PIDs) are a relatively common occurrence in countries where consanguineous marriages are widespread. A principal factor leading to misdiagnosis and ensuing complications can be the lack of knowledge and proper evaluation. The aim of this study was to assess PID awareness and the identification of diagnostic criteria leading to correct diagnosis. Seven hundred eighty-six questionnaires with 71 items were distributed to physicians attending the 41st National Congress of Pediatrics (2005) and to pediatric residents of two university hospitals from different cities in Turkey. The 217 completed questionnaires revealed that family history (91.2%), consanguineous marriages (87.1%), infant deaths (70.0%), persistent thrush (90.3%), hospitalization for recurrent cellulitis (70.5%), chronic diarrhea due to giardiasis (62.2%), recurrent oral aphthous lesions (58.5%), telangiectasia (82.0%), failure to thrive (78.8%), absence of tonsil tissue (74.7%), oculocutaneous albinism (73.7%), and resistant sinusitis (71.0%) were cited among important indicators of PID. However, neonatal tetany (77.9%), liver abscess (61.3%) and poliomyelitis following oral polio vaccination (51.2%) were not considered as related to PID. Although white blood cell (WBC) and differential were chosen as the preferred initial tests, leukocytosis and lymphopenia were also not judged as related to PID. More comprehensive pre/postgraduate education in PID appears to be necessary for physicians in Turkey.
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Affiliation(s)
- Mutlu Yüksek
- Department of Pediatric Immunology, Ankara University Faculty of Medicine, Ankara, Turkey
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22
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Dogan S, Demirer S, Kepenekci I, Erkek B, Kiziltay A, Hasirci N, Müftüoglu S, Nazikoglu A, Renda N, Dincer UD, Elhan A, Kuterdem E. Epidermal growth factor-containing wound closure enhances wound healing in non-diabetic and diabetic rats. Int Wound J 2009; 6:107-15. [PMID: 19432660 DOI: 10.1111/j.1742-481x.2009.00584.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND This study was designed to elucidate the in vivo efficacy of epidermal growth factor (EGF) on wound healing in non diabetic and diabetic rats. METHODS Ninety-six male Wistar-Albino rats were randomly divided into six groups. Saline-moistened gauze, pure gelatin or EGF in gelatin-microsphere dressings were used in a dermal excision model in both normal and streptomycin-induced diabetic rats. Wound healing was evaluated on day 7 and 14. Reduction in wound area, hydroxypyroline content and tensile strength of the wound were evaluated in each rat. Tissue samples taken from the wounds were examined histopathologically for reepithelialisation, cellular infiltration, number of fibroblasts, granulation and neovascularisation. RESULTS On day 7, the use of EGF-containing dressing was observed to reduce the wound area better when compared with the other dressings tested. This effect was significant in normal rats rather than diabetic rats. The difference in reduction of wound area did not persist on day 14. No significant effect on hydroxyproline content of the wound was found with EGF-containing dressing in either normal or diabetic rats. There was a statistically significant increase in tensile strength values of EGF-applied non diabetic rats over the 14 day period. An increase in tensile strength was prominent in also EGF-applied diabetic rats on day 14. Histological examination revealed higher histopathologic scores in EGF-applied diabetic and non diabetic rats. CONCLUSION These findings implicate that use of EGF in gelatin-microsphere dressings improves wound healing both in normal and diabetic rats.
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Affiliation(s)
- S Dogan
- Ankara University School of Medicine, Department of General Surgery, Ankara, Turkey
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Abstract
Endoscopic endonasal transsphenoidal approach to the sellar region yields an alternative to classical microsurgical approaches. Endoscopes provide images that differ from microscopic view. This study aimed to highlight surgical landmarks and their anatomical relationships for pituitary surgery through endoscopic perspective. Ten sides of five adult cadaveric heads with red-colored latex injected arteries were evaluated. Endoscopic dissections were performed and measurements were done in the sphenoid sinuses before and after the removal of bony structures in all the aspects. Endoscopic vision of the sellar region enabled a wide panoramic perspective and detailed inspection. The measurements, in general, indicated the variations in the bony structures and soft tissues. The width of the pituitary, which is the distance between the medial margins of the carotid prominences, was measured as 21 +/- 2.5 mm and the distance between the medial margin of the carotid prominences at the lower margin of the pituitary was 18 +/- 3.1 mm. After the bony structures were removed, further measurements were done. The width of the pituitary, which is the distance between the medial margins of the anterior curvature of the ICA, was measured as 23.2 +/- 3 mm, while the distance between the posterior curvature of the ICA was 19.7 +/- 4.9 mm. Endoscopic view provided superior detailed visualization of the close relationships between pituitary gland, internal carotid arteries, and optic nerves. This facilitated exact evaluation for variations, which could result in more effective and safe surgery. However, these variations again emphasize the necessity of preoperative radiological evaluation in each case.
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Affiliation(s)
- A Unlu
- Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey.
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Kurtaiş Y, Küçükdeveci A, Elhan A, Yılmaz A, Kalli T, Sonel Tur B, Tennant A. Psychometric properties of the Rivermead Motor Assessment: Its utility in stroke. J Rehabil Med 2009; 41:1055-61. [DOI: 10.2340/16501977-0463] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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25
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Sadeghi F, Yurur-Kutlay N, Berberoglu M, Cetinkaya E, Aycan Z, Kara C, Ilgin Ruhi H, Ocal G, Siklar Z, Elhan A, Tukun A. Identification of frequency and distribution of the nine most frequent mutations among patients with 21-hydroxylase deficiency in Turkey. J Pediatr Endocrinol Metab 2008; 21:781-7. [PMID: 18825878 DOI: 10.1515/jpem.2008.21.8.781] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders mainly due to defects in the steroid 21-hydroxylase (CYP21A2) gene. METHODS To determine the mutational spectrum in the Turkish population, the CYP21A2 active gene was analyzed in 100 unrelated patients with the classical form of 21-hydroxylase deficiency using PCR and RFLP. RESULTS Mutations were detected in 78 patients: 64 patients were homozygous for one mutation, seven patients were compound heterozygous with different mutations on each chromosome, two patients were homozygous for two different mutations, five patients were heterozygous, and 22 patients harbored none of the tested mutations. The most frequent mutation was IVS2-13A/C (28.5%), followed by large gene deletion (17%), Q318X (11.5%), I172N (4%), V281L (3.5%), R356W (3.5%), 8-bp (3%), complex alleles (2%), P30L (1%) and E6 cluster (1%). CONCLUSION The distribution of mutation frequencies in our study was slightly different from those previously reported in Turkey and in other parts of the world.
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Affiliation(s)
- F Sadeghi
- Medical Genetics Department, Ankara University Faculty of Medicine, Ankara, Turkey.
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Kahilogullari G, Comert A, Arslan M, Esmer AF, Tuccar E, Elhan A, Tubbs RS, Ugur HC. Callosal branches of the anterior cerebral artery: an anatomical report. Clin Anat 2008; 21:383-8. [PMID: 18521950 DOI: 10.1002/ca.20647] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although the morphology of the corpus callosum is well defined, the arterial supply of this structure has not been comprehensively studied. To elucidate this further, 40 cerebral hemispheres from 30 adult cadaveric brains were obtained. The anterior cerebral arteries were cannulated and injected with red latex. The following were observed and documented: (1) the number, diameter, and course of the arteries supplying the corpus callosum; (2) the territories vascularized by these arteries; (3) any variations of the callosal arteries. Short callosal arteries were present in 58 hemispheres (96.6%) and supplied the superficial surface of the corpus callosum along its midline and were a primary arterial source to this structure. Long callosal arteries were found in 28 hemispheres (46.6%) and contributed to the pial plexus. The cingulocallosal arteries were present in all hemispheres and supplied the corpus callosum, cingulate gyrus, and also contributed to the pericallosal pial plexus. The recurrent cingulocallosal arteries were present in 17 hemispheres (28.3%) and also contributed to the pericallosal pial plexus. The median callosal artery, an anatomical variation, was present in 10 brains (33.3%). This vessel supplied the corpus callosum and the cingulate gyrus. The aim of the present study was to provide a detailed description of the arteries supplying the corpus callosum for those who encounter these vessels radiologically or surgically.
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Affiliation(s)
- G Kahilogullari
- Department of Neurosurgery, Ankara University, Faculty of Medicine, Ankara, Turkey
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Abstract
The infragluteal fold is one of the major concerns in reshaping of the gluteal region. This study reevaluated the fold both histologically and anatomically. Five fixed cadavers were used. The infragluteal fold on the right side was explored by dissection, whereas the infragluteal fold of the contralateral side was removed en bloc. Tissue samples (6 cm long x 2 mm thick) were taken at three points from each fold bloc: the most medial point, the middle point, and the most lateral end of the sulcus. Anatomic dissections and histologic examinations showed that the infragluteal fold consists of strong fibrous bands extending from the dermis of the medial one-third of the fold to the ramus of the ischium and sacrum, forming the letter J. The infragluteal fold, which attaches to both the ischium and the sacrum in a continuous fashion, is an anatomic structure in its medial part and only a crease laterally.
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Affiliation(s)
- O Babuccu
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Zonguldak Karaelmas University, Faculty of Medicine, 67200 Kozlu, Zonguldak, Turkey.
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28
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Akkaya T, Comert A, Kendir S, Acar HI, Gumus H, Tekdemir I, Elhan A. Detailed anatomy of accessory obturator nerve blockade. Minerva Anestesiol 2008; 74:119-122. [PMID: 18354367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND The accessory obturator nerve (AON) often innervates the hip joint and adductor longus. The AON is present in 10-30% of patients, and thus it is clinically important that it is also considered during obturator nerve (ON) blockade. METHODS The study was performed on 12 cadavers (24 body-sides) and the AON beginning from the lumbar plexus was observed. The needle was classically penetrated into the ON to gain access to the AON and upon definition of detailed AON anatomy, morphometric measurements were conducted. In addition, novel maneuvers used in the study were described. RESULTS Throughout the dissections, the AON was detected on three sides (12.5%) and the mean AON- pubic tubercle distance was measured as 4.0 cm. The needle was withdrawn and positioned medially and almost parallel to the skin. It was then advanced through the superior pubic ramus to reach the AON. CONCLUSION Owing to its anatomical structure, the AON can be easily accessed during classical ON blockade using the maneuvers described here. Further clinical studies are needed to investigate if supplementing ON blockade with AON blockade might improve the clinical efficiency and quality of the blockade.
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Affiliation(s)
- T Akkaya
- Department of Anaesthesia and Pain Unit, Ankara Diskapi Training and Research Hospital, Ankara, Turkey.
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Abstract
Head and neck cancer (HNC) is a serious health problem worldwide and tobacco smoke is a main causative factor for this malignancy. Interindividual genetic differences in enzymes involved in the metabolism of tobacco smoke carcinogens are one of the most important risk factors in the development of HNC. GSTM1 and GSTT1 enzymes participate in detoxifying of tobacco smoke carcinogens and have deletion polymorphisms. We performed a case control study to investigate a possible association between GSTM1 and GSTT1 variants and HNC risk. A total of 98 HNC cases, all of which were squamous cell carcinoma, and 120 healthy controls were investigated. GSTM1 and GSTT1 polymorphisms were genotyped using PCR. There was a significant association between HNC and GSTM1-null genotype (adjusted OR: 2.36, 95% CI: 1.303-4.26, p = 0.005). The frequency overall of GSTT1-null genotypes was not significant in HNC patients compared with that of GSTT1-positive genotypes (adjusted OR: 1.16, 95% CI: 0.563-2.397, p = 0.686). No combined effect was observed for GSTM1 and GSTT1 genotypes. When data were stratified by smoking status, cases having GSTM1-null genotype who were smokers conferred the highest risk (adjusted OR: 4.06, 95% CI: 1.3-12.63). Thus, our results suggest that GSTM1 polymorphism may significantly increase the risk of HNC and there is an additive interaction between GSTM1-null genotype and smoking on HNC risk.
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Affiliation(s)
- Halit Sinan Suzen
- Faculty of Pharmacy, Department of Toxicology, Ankara University, Tandogan-06100, Ankara, Turkey.
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Yavuzer G, Oken O, Elhan A, Stam HJ. Repeatability of lower limb three-dimensional kinematics in patients with stroke. Gait Posture 2008; 27:31-5. [PMID: 17257845 DOI: 10.1016/j.gaitpost.2006.12.016] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2006] [Revised: 12/25/2006] [Accepted: 12/26/2006] [Indexed: 02/02/2023]
Abstract
The within- and between-session repeatability of time-distance and sagittal plane kinematic gait parameters were evaluated in 20 hemiparetic patients with sub-acute stroke. A test-retest design was used in which the patients were tested during two sessions within a 2h period. Each session comprised three consecutive trials. The intraclass correlation coefficients (ICCs) for time-distance parameters ranged from 0.82 to 0.99. The within- and between-session repeatability of pelvis, hip, knee and ankle kinematic waveforms were high: the mean coefficient of multiple correlations (CMCs) ranged from 0.85 to 0.95. The within-session coefficient of variation (CV%) for time-distance parameters ranged from 3.9 to 14.1, whereas, between-session CV% ranged from 6.1 to 17.2, showing similar but higher variability. The within- and between-session CV% for sagittal plane kinematics of the paretic lower limb ranged from 3.6 to 32.4. The results indicate that time-distance parameters and sagittal plane gait kinematics of the paretic lower limb, measured by the Vicon 370 gait analysis system, are repeatable and can be used to assess treatment effects after stroke.
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Affiliation(s)
- Gunes Yavuzer
- Department of Physical Medicine & Rehabilitation, Ankara University Faculty of Medicine, Ankara, Turkey.
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Adsan O, Baltaci S, Cal C, Büyükalpelli R, Uğurlu O, Bozlu M, Türkölmez K, Sahin H, Elhan A. Reliability of Frozen Section Examination of External Iliac, Hypogastric, and Obturator Lymph Nodes During Radical Cystectomy: A Multicenter Study. Urology 2007; 69:83-6. [PMID: 17270622 DOI: 10.1016/j.urology.2006.09.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Revised: 07/03/2006] [Accepted: 09/21/2006] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To evaluate the accuracy of frozen section examination (FSE) for detecting lymph node (LN) metastasis in patients with bladder cancer undergoing radical cystectomy and pelvic LN dissection. To our knowledge, the accuracy of FSE to identify LN metastases in patients with bladder cancer is still undetermined. METHODS The clinical data of 360 patients who had undergone radical cystectomy with pelvic lymphadenectomy for bladder cancer in six urologic institutions were retrospectively analyzed. The nodal regions included were the external iliac, hypogastric, and obturator LNs. The FSE results of the right and left LN regions were compared with the final histopathologic results of the respective LN regions. RESULTS The final pathologic examination revealed nodal metastases in 65 patients (18.1%). Of the 720 right and left LN regions in 360 patients, 88 (12.2%) were metastatic at the final pathologic examination. Although the FSE findings were negative, the final pathologic examination revealed LN metastases in 26 patients and in 29 pelvic LN regions. All LN regions with positive FSE findings were positive at the final pathologic examination. When we considered the 720 LN regions, the sensitivity, specificity, and positive and negative predictive values for FSE were 67%, 100%, 100%, and 95.6%, respectively. CONCLUSIONS Until innovations in imaging methods improve nodal staging in patients with bladder cancer, performing FSE of the external iliac, hypogastric, and obturator LNs seems to be a reliable procedure for the evaluation of the LNs. The information obtained with FSE of the LNs can be used to determine intraoperatively the extent of LN dissection.
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Affiliation(s)
- Oztuğ Adsan
- Department of II Urology, Ankara Numune Education and Research Hospital, Ankara, Turkey.
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Akkaya T, Comert A, Kendir S, Acar H, Gumus H, Tekdemir I, Elhan A. 361 DOES THE PRESENCE OF ACCESORY OBTURATOR NERVE EFFECT THE SUCCESS OF OBTURATOR NERVE BLOCKADE? Eur J Pain 2006. [DOI: 10.1016/s1090-3801(06)60364-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ozçakar ZB, Yalçinkaya F, Tutar E, Cakar N, Uçar T, Elhan A, Acar B, Yüksel S, Uncu N, Kara N, Atalay S, Ekim M. Hypertension and Left Ventricular Hypertrophy in Pediatric Peritoneal Dialysis Patients: Ambulatory Blood Pressure Monitoring and Echocardiographic Evaluation. ACTA ACUST UNITED AC 2006; 104:c101-6. [PMID: 16785736 DOI: 10.1159/000093997] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2005] [Accepted: 04/23/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hypertension is a frequent complication of end-stage renal disease and left ventricular hypertrophy (LVH) is common in patients with poorly controlled hypertension. The aim of this study was to evaluate hypertension in pediatric peritoneal dialysis (PD) patients, to compare casual and ambulatory blood pressure (BP) measurements and to evaluate the impact of BP parameters on LVH. METHODS The study comprised 25 PD patients (9 M, 16 F; mean age 14.14 +/- 3.32 years) that have been followed in outpatient clinics. Medical records were reviewed for demographic features; casual BP measurements, ambulatory blood pressure monitoring (ABPM) and echocardiographic evaluation were applied to all patients. RESULTS The mean 24-hour and daytime systolic blood pressure (SBP) values were found to be higher than casual SBP (p < 0.001). Significant difference was present in the frequency of hypertension between casual SBP (32%) and the mean daytime SBP (56%) (p < 0.05). Nighttime systolic hypertension was detected in 14 (56%) and diastolic hypertension in 16 (64%) patients. Elevated daytime SBP load and DBP load were detected in 64 and 76% of the patients, respectively. Elevated nighttime SBP load and DBP load were detected in 72% of the patients. Seventeen (68%) patients had attenuated dipping for SBP. The mean left ventricular mass index (LVMI) was 52.65 +/- 18.17 g/m(2.7) and 13 (52%) patients had LVH. LVMI was significantly correlated with casual BP measurements and the majority of ABPM parameters. CONCLUSION The majority of pediatric PD patients had BP abnormalities in which severity was most accurately assessed with ABPM. Casual BP and majority of ABPM parameters were found to be significantly correlated with LVMI. Ambulatory blood pressure monitoring should be performed in all pediatric PD patients.
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Affiliation(s)
- Z Birsin Ozçakar
- Department of Pediatric Nephrology, Ankara University School of Medicine, Ankara, Turkey.
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Baykara M, Demirkazik A, Elhan A, Yalcin B, Buyukcelik A, Dogan M, Utkan G, Tek I, Doruk H, Akan H, Icli F. Lymphopenia and monocytopenia versus MASCC score system in patients with febrile neutropenia. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.18622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
18622 Background: The purpose of this study was determine the clinical significance of lymphopenia and monocytopenia in terms of its duration and depth in patients with febrile neutropenia (FEN) and MASCC scores parametres. Methods: Sixty-six patients with FEN were prospectively analysed. Recurrent FEN episodes were excluded in this trial. Twenty-four patients had solid tumors, 42 patients had lymphoma-leukemia. Patients with MASCC-scores ≥21 evaluated as low-risk (LR) and the ones with their scores <21 were high-risk (HR). Results: Thirty-six patients had HR and the rest had LR. Lymphocyte count <700/mm3 and monocyte count <100/mm3 were found as 91.6% and 86.6% in HR and in LR groups, respectively.The rate of refractory fever(RF) in HR patients was clearly high.Patients with protracted neutropenia (PN) had higher rate of RF (p = 0.007). Patients with longer duration of neutropenia and monocytopenia tended to have RF (p = 0.052, p = 0.018). The rate of administered AFT was significantly high in HR patients (p = 0.005). AFT was administered to one third of HR patients, but no patient received AFT in LR-group (p < 0.001). In group with neutropenia duration (ND) <10 days, one patient received AFP (p < 0.001). AFT was given to most of the patients who had longer duration of lymphopenia or monocytopenia (respectively; p = 0.002, p = 0.001), and who had leukemia (p = 0.001). The most important parameters effecting the duration of antibiotic therapy (DAT) was found to be ND. DAT >14 days was found more than fourfold in patients PN (p = 0.007). Fifty-five percent out of patients with solid tumor or lymphoma were given <14 days antibiotic therapy. But, most of patients with leukemia had antibiotics >14 days (p = 0.002).The rate of antibiotic therapy >14 days was higher in patients with longer duration of lymphopenia and monocytopenia (respectively; p = 0.073, p = 0.062). The most important parameter that influences on antibiotic modification (AM) was severity of monocytopenia on the first day of FEN. The rate of AM was found in aproximately nine-fold in patients that had monocyte counts ≤100/ mm3 as compared to monocyte ≥100/ mm3 (p = 0.01). Conclusions: The depth of monocytopenia and durations of lymphopenia and monocytopenia were the important parameter influencing antibiotic modification in FEN. No significant financial relationships to disclose.
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Affiliation(s)
| | | | - A. Elhan
- Ankara University, Ankara, Turkey
| | | | | | - M. Dogan
- Ankara University, Ankara, Turkey
| | - G. Utkan
- Ankara University, Ankara, Turkey
| | - I. Tek
- Ankara University, Ankara, Turkey
| | - H. Doruk
- Ankara University, Ankara, Turkey
| | - H. Akan
- Ankara University, Ankara, Turkey
| | - F. Icli
- Ankara University, Ankara, Turkey
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Duparc F, Noyon M, Ozeel J, Gerometta A, Michot C, Tadjalli M, Moslemy H, Safaei S, Heiman A, Wish-Baratz S, Melnikov T, Smoliar E, Hakan AY, Yucel F, Kachlík DK, Pešl MP, Báča VB, Stingl JS, Kachlík KD, Čech ČP, Báča BV, Mompeó B, Marrero-Rodriguez A, Zeybek A, Sağlam B, Çikler E, Çetinel Ş, Ercan F, Şener G, Kawawa Y, Kohda E, Tatsuya T, Moroi M, Kunimasa T, Nagamoto M, Terada H, Labuschagne BCJ, van der Krieke TJ, Hoogland PV, Muller CJF, Lyners R, Vorster W, Matusz P, Zaboi DE, Xu SC, Tu LL, Wang Q, Zhang M, Han H, Tao W, Jiao Y, Pang G, Aydin ME, Kopuz C, Demir MT, Yildirim M, Kale A, Ince Y, Khamanarong K, Jeeravipoolvarn P, Chaijaroonkhanarak W, Gawgleun W, Fujino T, Uz A, Apaydin N, Bozkurt M, Elhan A, Sheibani MT, Adibmoradi M, Jahovic N, Alican I, Erkanli G, Arbak S, Karakaş S, Taşer F, Güneş H, Yildiz Y, Yazici Y, Aland RC, Kippers V, Song WC, Park SH, Shin C, Koh KS, Russo G, Pomara F, Veca M, Cacciola F, Martorana U, Gravante G, Tobenas-Dujardin AC, Laquerrière A, Muller JM, Fréger P, López-Serna N, Álvarez-González E, Torres-Gonzàlez V, Laredo-López G, Esparza-González GV, Álvarez-Cantú R, Garza-González CE, Guzmán-López S, Aldur MM, Çelik HH, Sürücü S, Denk C, Yang HJ, Gil YC, Kim TJ, Lee HY, Lee WJ, Lee H, Hu KS, Akita K, Kim HJ, Jung HS, Gurbuz H, Balik S, Wavreille G, Chantelot C, Demondion X, Fontaine C, Çavdar S, Yalin A, Saka E, Özdoǧmuş Ö, Çakmak Ö, Elevli L, Saǧlam B, Coquerel-Beghin D, Milliez PY, Lemierre G, Oktem G, Vatansever S, Ayla S, Uysal A, Aktas S, Karabulut B, Bilir A, Uslu S, Aktug H, Yurtseven ME, Celik HH, Tatar I, Surucu S, Karaduman A, Tunali S, Neuhüttler S, Kröll A, Moriggl B, Brenner E, Loukas M, Arora S, Louis RG, Fogg QA, Wagner T, Tedman RA, Ching HY, Eze N, Bottrill ID, Blyth P, Faull RLM, Vuletic J, Elizondo-Omaña RE, Rodríguez MAG, López SG, de la Garza OT, Liu YH, Zhang KL, Lu DH, Kwak HH, Park HD, Youn KH, Kang HJ, Kang HC, Han SH, Ikiz ZAA, Ucerler H, Uygur M, Kutoglu T, Dina C, Iliescu D, Şapte E, Bordei P, Lekšan I, Marcikić M, Radić R, Nikolić V, Kurbel S, Selthofer R, Báča V, Doubková A, Kachlík D, Stingl J, Džupa V, Grill R, Nam YS, Paik DJ, Shin CS, Kim SJ, Kim DG, Jin CS, Kim DI, Lee UY, Kwak DS, Lee JH, Han CH, Carpino A, Rago V, Romeo F, Carani C, Andò S, Arican RY, Coskun N, Sarikcioglu L, Sindel M, Arican YR, Altun U, Ozsoy U, Oguz N, Yildirim FB, Nakajima K, Duygulu E, Aydin H, Gurer EI, Ozkan O, Tuzuner S, Özsoy U, Çubukçu S, Demirel BM, Akkin SM, Marur T, Weiglein AH, Maghiar TT, Borza C, Bumbu A, Bumbu G, Polle G, Auquit-Auckbur I, Dujardin F, Biga N, Olivier E, Defives T, Ghazali S, Anastasi G, Rizzo G, Favaloro A, Miliardi D, Giacobbe O, Santoro G, Trimarchi F, Cutroneo G, Govsa F, Bilge O, Ozer MA, Erdogmus S, Grizzi F, Pelillo F, Mori M, Franceschini B, Portinaro N, Godlewski G, Viala M, Rouanet JP, Prat D, Rahmé ZS, Prudhomme M, Eken E, Kwiatkowska M, Liegmann J, Chmielewski R, Grimmond J, Kwiatkowski M, Schintler MV, Windisch G, Wittgruber G, Prandl EC, Prodinger P, Anderhuber F, Scharnagl E, Gerbino A, Buscemi M, Leone A, Mandracchia R, Peri G, Lipari D, Farina-Lipari E, Valentino B, D’Arpa S, Cordova A, Bucchieri F, Ribbene A, David S, Palma A, Davies DE, Haitchi HM, Holgate ST, La Rocca G, Anzalone R, Campanella C, Rappa F, Bartolotta T, Cappello F, Bellafiore M, Sivverini G, Palumbo D, Macaluso F, Farina F, Di Felice V, Montalbano A, Ardizzone N, Marcianò V, Zummo G, Tanyeli E, Üzel M, Carini F, Scardina GA, Varia P, Valenza V, Messina P, Meiring JH, Schumann C, Whitmore I, Greyling LM, Hamel O, Hamel A, Robert R, Garçon M, Lagier S, Blin Y, Armstrong O, Rogez JM, Le Borgne J, Ifrim CF, Maghiar A, Botea M, Ifrim M, Pop O, Sandor M, Behdadipour Z, Saberi M, Esfandiary E, Gentile C, Marconi A, Livrea MA, Uzan G, D’Alessio P, Ridola CG, Grassi N, Pantuso G, Bottino A, Cacace E, Li Petri S, Di Gaudio F, Guercio G, Latteri MA, Nobile D, Cipolla C, Caruso G, Salvaggio G, Lo Cascio A, Fatta G, Lagalla R, Campisi A, Verderame F, Martegani A, Cardinale AE, Luedinghausen MV. Poster presentation. Surg Radiol Anat 2005. [DOI: 10.1007/bf03371476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Feigl G, Rosmarin W, Weninger B, Likar R, Hoogland PV, Groen RJM, Vorster W, Grobbelaar M, Muller CJF, du Toit DF, Moriggl B, Greher M, Klauser A, Eichenberger U, Prades JM, Timoshenko A, Faye M, Martin CH, Baroncini M, Baiz H, Ben Henda A, Fontaine C, Baksa G, Toth M, Patonay L, Gonçalves-Ferreira A, Gonçalves C, Neto L, Fonseca T, Gaspar H, Rino J, Fernandes M, Fernandes P, Cardoso H, Miranda B, Rego J, Hamel A, Guillouche P, Hamel O, Garçon M, Lager S, Blin Y, Armstrong O, Robert R, Rogez JM, Le Borgne J, Kahilogulları G, Comert A, Esmer AF, Tuccar E, Tekdemir I, Ozdemir M, Odabasi AB, Elhan A, Anand MK, Singh PR, Verma M, Raibagkar CJ, Kim HJ, Kwak HH, Hu KS, Francke JP, Macchi V, Porzionato A, Parenti A, Metalli P, Zanon GF, De Caro R, Bernardes A, Dionísio J, Messias P, Patrício J, Apaydin N, Uz A, Evirgen O, Shim KS, Park HD, Youn KH, Cajozzo M, Bartolotta T, Cappello F, Sunseri A, Romeo M, Altieri G, Modica G, La Barbera G, La Marca G, Valentino F, Valentino B, Martino A, Dees G, Kleintjes WA, Williams R, Herpe B, Leborgne J, Lagier S, Cordova A, Pirrello R, Moschella F, Mahajan MV, Bhat UB, Abhayankar SV, Ambiye MV, Kachlík DK, Stingl JS, Sosna BS, Fára PF, Lametschwandtner AL, Minnich BM, Straka ZS, Ifrim M, Ifrim CF, Botea M, Latorre R, Sun F, Henry R, Crisóstomo V, Cano FG, Usón J, Mtez-Gomaríz F, Climent S, Hurmusiadis V, Barrick S, Barrow J, Clifford N, Morgan F, Wilson R, Wiseman L, Fogg OA, Loukas M, Tedman RA, Capaccioli N, Capaccioli L, Mannini A, Guazzi G, Mangoni M, Paternostro F, Vagnoli PT, Gulisano M, Pacini S, Grignon B, Jankowski R, Hennion D, Zhu X, Roland J, Mutiu G, Tessitore V, Uzzo ML, Bonaventura G, Milio G, Spatola GF, Ilkan T, Selcuk T, Mustafa AM, Hamdi CH, Emel TC, Faruk U, Hamdi CH, Bulent G, Báča V, Doubková A, Kachlík D, Stingl J, Saylam C, Kitiş Ö, Üçerler H, Manisahı E, Gönül AS, Dashti GHR, Nematbaksh M, Mardani M, Hami J, Rezaian M, Radmehr B, Akbari M, Paryani MR, Gilanpour H, Zamfir C, Zamfir M, Lupusoru C, Raileanu C, Lupusoru R, Bordei P, Iliescu D, Şapte E, Adam S, Baker C, Sergi C, Barberini F, Ripani M, Di Nitto V, Zani A, Magnosi F, Heyn R, Familiari G, Elgin U, Demiryurek D, Berker N, Ilhan B, Simsek T, Batman A, Bayramoglu A, Fogg QA, Bartczak A, Kamionek M, Kiedrowski M, Fudalej M, Wagner T, Artibani W, Tiengo C, Taglialavoro G, Mazzoleni F, Scapinelli R, Ardizzone E, Cannella V, Peri D, Pirrone R, Peri G. Platform session. Surg Radiol Anat 2005. [DOI: 10.1007/bf03371475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Petri E, Niemeyer R, Petri E, Niemeyer R, Sivaslioglu AA, Haberal A, Dölen I, Dede H, Akkök E, Deveci S, Demir B, Aksakal O, Ugur M, Yilmaz B, Yesilyurt H, Mollamahmutoglu L, Sivaslioglu AA, Elhan A, Sakul U, Dölen I, Tunc E, Ercan F, Haberal A, Aksakal O, Tuncay G, Aytan H, Tapisiz OL, Bilge U, Mollamahmutoglu L, Aksakal O, Tuncay G, Bal S, Bilge U, Tapisiz OL, Mollamahmutoglu L, Unlu S, Aksakal O, Tapisiz OL, Tuncay G, Aytan H, Ugur M, Bilge U, Mollamahmutoglu L, Yasar L, Yazicioglu F, Efe C, Sönmez S, Zebitay AG, Süt N, Sensoy Y, Cebi Z, Bayrak O, Cimentepe E, Gümüs II, Dede H, Sivaslioglu A, Dolen I, Dede FS, Seckin L, Haberal A, Sivaslioglu AA, Dolen I, Dede H, Dilbaz S, Demir B, Sümer C, Gelisen O, Unlubilgin E, Deveci S, Dede S, Seckin L, Haberal A, Dönmez MD, Atis A, Aydin Y, Tandogan T, Ozpak D, Oruc O, Aksakal OS, Doganay M, Aytan H, Gungor T, Bal S, Bilge U, Mollamahmutoglu L, Ozdegirmenci O, Dede FS, Haberal A, Karslioglu Y, Karadeniz S, Gunhan O. Urogynecology. Arch Gynecol Obstet 2005. [DOI: 10.1007/bf02954774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Karatas A, Caglar S, Savas A, Elhan A, Erdogan A. Microsurgical anatomy of the dorsal cervical rootlets and dorsal root entry zones. Acta Neurochir (Wien) 2005; 147:195-9; discussion 199. [PMID: 15565478 DOI: 10.1007/s00701-004-0425-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Detailed anatomical knowledge of the dorsal cervical rootlets and dorsal root entry zones (DREZ) is important for the diagnosis and treatment of cervical myeloradiculopathy and surgical management of pain. There are far fewer micro-anatomical studies of this area than gross anatomical studies. This study presents several anatomical points regarding the dorsal cervical rootlets and dorsal root entry zones. METHOD Fifteen adult formalin-fixed cadaveric spines from C1 to T1 were used to observe the posterior structures. They were studied under the surgical microscope following en bloc laminectomy and foraminotomy. The morphological features of the dorsal root entry zones and dorsal rootlets were determined. The distance from the midline to the DREZ, the longitudinal length of the DREZ in the spinal canal, the length of the dorsal rootlets, the number of dorsal rootlets and the intersegmental anastomoses between the dorsal rootlets were measured. FINDINGS The distance from the midline to the DREZ ranged from 1.1 to 4.7 mm. Longitudinal length of the dorsal rootlets ranged 4.3-17.7 mm. The shortest length of the dorsal rootlets ranged between 5-28 mm, and longest lengths of the dorsal rootlets ranged 6.8-30.3 mm. The number of dorsal rootlets ranged from 2-13. Between the C2-T1 dorsal rootlets, 142 connections out of 30 intersegments were noted. CONCLUSIONS The distance from the midline to the DREZ decreased in the lower cervical spine. The longest longitudinal length of the DREZ was at the C5 level. The length of the dorsal rootlets was increased in the lower cervical spine. The average number of dorsal rootlets tended to increase in the lower cervical spine. Anastomoses were most often found between C6-7 and C5-6 dorsal rootlets. Knowledge of the anatomical features of dorsal cervical rootlets and dorsal root entry zones is essential for a surgeon to avoid injuring the neural structures. This knowledge is a must not only to avoid complications but also for the success, safety and effectiveness of microsurgical operations of the pathological conditions like posterior myeloradiculopathy and pain treatment such as DREZ operations.
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Affiliation(s)
- A Karatas
- Department of Neurosurgery, Fatih University School of Medicine, Ankara, Turkey.
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Dolapci I, Tekeli A, Ozsan M, Yaman O, Ergin S, Elhan A. Detecting of Mycoplasma genitalium in male patients with urethritis symptoms in Turkey by polymerase chain reaction. Saudi Med J 2005; 26:64-8. [PMID: 15756355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
OBJECTIVE The aim of this study was to investigate the incidence of Mycoplasma genitalium in the urine samples of 63 male patients who had urethritis symptoms. Along with Neisseria gonorrhoeae (N. gonorrhoeae) and Chlamydia trachomatis (C. trachomatis). We also investigated Mycoplasma hominis (M. hominis) and Ureaplasma urealyticum (U. urealyticum), both of which are known to cause urethritis. METHODS Microorganisms were investigated in urine samples of the patients with polymerase chain reaction. The study was conducted between September 2003 - February 2004 at the Department of Microbiology and Clinical Microbiology Ankara University School of Medicine, Ankara, Turkey. RESULTS A total of 63 urine samples were analyzed and 6 (9.52%) patients had N. gonorrhoeae, 4 (6.34%) had C. trachomatis, while 4 (6.34%) urines were positive in terms of M. genitalium. Nevertheless, 3 (4.76%) patients had U. urealyticum and 2 (3.17%) patients had M. hominis. One urine sample was positive in terms of both N. gonorrhoeae and U. urealyticum, and another urine sample was positive in terms of both M. hominis and U. urealyticum. The results were compared with the control group and found no statistically significant difference. CONCLUSION Mycoplasma species are found in normal flora of urogenital system and also as an agent of urogenital infection. In our study, we found low microorganism rates when compared with Europe and America. This difference may be due to the conservative sexual behavior in Turkey.
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Affiliation(s)
- Istar Dolapci
- Department of Microbiology and Clinical Microbiology, Ankara University School of Medicine, Sihhiye 06100, Ankara, Turkey.
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Abstract
Both the course and localization of the transverse facial artery are described, based upon the bilateral dissection of heads from 20 human cadavers. Its anatomical relationships with the mandibular fossa, the articular tubercle, the zygomatic arch, the parotid duct and the maxillary artery are studied and morphometric features are calculated. Furthermore, the transverse facial territory was examined. This territory was supplied by a single perforating branch in 28 cases, by two perforating branches in 10 and by three perforating branches in 2. Knowledge of the course and relationships of the transverse facial artery should help to protect this artery from the risk for transection. However, the variable course of the transverse facial artery must always be taken into consideration by the clinicians during surgical procedures.
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Affiliation(s)
- R Başar
- Department of Anatomy, Hacettepe University, Faculty of Medicine, 06100 Ankara, Turkey
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Cankal F, Apaydin N, Acar HI, Elhan A, Tekdemir I, Yurdakul M, Kaya M, Esmer AF. Evaluation of the anterior and posterior ethmoidal canal by computed tomography. Clin Radiol 2004; 59:1034-40. [PMID: 15488853 DOI: 10.1016/j.crad.2004.04.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2003] [Revised: 03/30/2004] [Accepted: 04/16/2004] [Indexed: 11/29/2022]
Abstract
AIM To examine the anatomy, length and angulation of the anterior and posterior ethmoidal canals (AECs and PECs) using computed tomography (CT), and to determine the anatomical landmarks in which the canals are expected to be seen in transverse and coronal planes. MATERIALS AND METHODS CT images of 150 patients were analysed. One, 2, and 3 mm thick sections were obtained separately in axial and coronal images. The frequency of visualization of the AECs and PECs, and if present, a third canal, was noted. The course and the angulation of the AEC and the PEC in transverse and coronal planes were recorded. On axial sections the distance between the AEC and PEC and the previously defined landmarks were measured. On coronal images, the distances were calculated from the thickness of the cross-section and the number of sections between the various structures. RESULTS The AEC was identified as a separate canal in 84% of patients, and was embedded in the ethmoid roof in 16%. The PEC was seen as a separate canal in 8% and was present in the ethmoid roof in 92%. On the 1 mm thick coronal and transverse sections, a third canal was identified at the junction of the middle and posterior third of the AEC-PEC distance in both of the images. The average lengths of these canals were 4-12 mm (mean 8.2 mm) for the AEC, and 2-13 mm (mean 7.6 mm) for the PEC. CONCLUSIONS To avoid the complications that can develop during endoscopic sinus surgery; the course, length and the angulations of the anterior and posterior ethmoidal arteries and their canals can be identified by CT in standard positions if a sufficiently thin section thickness is used. The present study has shown the exact CT localization of the AECs and PECS, which are frequently overlooked when evaluating para-nasal sinuses.
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Affiliation(s)
- F Cankal
- Department of Radiology, T. Yuksek Ihtisas Hospital, Ankara, Turkey
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Top�u �, Karakayali F, Kuzu M, �zdemir S, Erverdi N, Elhan A, Aras N. The authors reply. Surg Endosc 2004. [DOI: 10.1007/s00464-003-9262-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Göğüş C, Baltaci S, Filiz E, Elhan A, Bedük Y. Significance of thrombocytosis for determining prognosis in patients with localized renal cell carcinoma. Urology 2004; 63:447-50. [PMID: 15028435 DOI: 10.1016/j.urology.2003.10.039] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2003] [Accepted: 10/09/2003] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the significance of thrombocytosis for determining survival in patients with localized renal cell carcinoma (RCC) who underwent radical nephrectomy with curative intent. METHODS The study population comprised 151 patients who underwent radical nephrectomy with a diagnosis of localized RCC. The inclusion criteria were at least one preoperative platelet count and a tissue diagnosis of RCC. Thrombocytosis was defined as a platelet count greater than 400,000/mm3. The charts of these patients were retrospectively reviewed and the relationship between the preoperative platelet counts and survival was evaluated according to the histologic variants. RESULTS The mean follow-up was 37.1 +/- 24.1 months (median 34, range 3 to 91). Of these 151 patients, 21 had a preoperative platelet count greater than 400,000/mm3. The thrombocytosis rate was significantly greater in those with advanced T stage (P = 0.045). Lymph node positivity also correlated with thrombocytosis (P = 0.028). However, no statistically significant correlation was found between grade and histologic subtypes and thrombocytosis (P = 0.053 and P = 0.354, respectively). Ten (47.6%) of 21 patients with thrombocytosis and 21 (16.2%) of the remaining 130 patients died of disease progression (P = 0.002). The Kaplan-Meier cause-specific survival curves showed that patients who had thrombocytosis had a mean survival of 45.2 months compared with 76.6 months in patients without thrombocytosis (P = 0.0002). CONCLUSIONS Preoperative thrombocytosis is a significant predictor for determining prognosis in patients with localized RCC. Thrombocytosis was found more frequently in patients with advanced stage RCC, and patients with preoperative thrombocytosis had a worse survival compared with those with normal platelet counts.
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Affiliation(s)
- Cağatay Göğüş
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
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Abstract
The fossa navicularis is a relatively rare anatomic variation of the skull base. Awareness of its existence will avoid misinterpretations of radiological images and unnecessary investigations. This study describes the appearance of the fossa navicularis, and investigates its incidence and whether it is related to pathology at the basiocciput. We studied 492 dry human skulls and 525 computer tomography (CT) images of patients. Dry skulls showing a fossa navicularis were investigated by CT scan, whereas patients identified as having a fossa navicularis were further examined with magnetic resonance imaging (MRI). To document the position of the fossa more precisely, measurements were made between the fossa navicularis and certain anatomic landmarks such as the foramen ovale, the pharyngeal tubercle, the posterior border of the vomer, the foramen lacerum, the carotid canal, and the occipital condyle. Upon examination, 26 of 492 skulls (5.3%) were found to have a fossa navicularis. Twelve were <2 mm in depth and the other 14 had a depth of >/=2 mm. Of the 525 patients, 16 (3.0%) were identified as having a fossa navicularis in CT images. Evaluation of MRIs showed no soft tissue lesions in any of these patients. Comprehensive anatomic details of the fossa navicularis have not been reported in the literature. The results of this study may be useful to radiologists, anatomists, and surgeons interested in the skull base.
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Affiliation(s)
- F Cankal
- Department of Anatomy, Ankara University Medical School, Ankara, Turkey
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Ozer H, Tekdemir I, Elhan A, Turanli S, Engebretsen L. A clinical case and anatomical study of the innervation supply of the vastus medialis muscle. Knee Surg Sports Traumatol Arthrosc 2004; 12:119-22. [PMID: 12756522 DOI: 10.1007/s00167-003-0382-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2002] [Accepted: 03/06/2003] [Indexed: 11/28/2022]
Abstract
The innervation supply to the vastus medialis (VM) muscle, a component of quadriceps femoris (QF), is provided by a branch of the femoral nerve (FN) running along the muscle. The course of the nerve from lumbar roots to the muscle has been described by many researchers. It is known to ride along the femoral vein, artery and saphenous nerve and enter the adductor canal (Hunter's canal), and then to divide into branches that supply vastus medialis and the knee joint. Femoral mononeuropathy is uncommon, and is usually due to compression in the spinal level. Hematoma in the psoas and iliacus muscles, drug abuse, lithotomy position and limb lengthening are the other associated reasons for a mononeuropathy of the femoral nerve. Isolated vastus lateralis (VL) atrophies have been reported by a few authors, suggesting that compression of the nerve and direct violation of the nerve with injections might be the reason for mononeuropathy. Isolated VM atrophy has not been previously reported. The purpose of the study was to identify the anatomical structures around the FN branch which innervates the VM muscle.
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Affiliation(s)
- H Ozer
- 2nd Department of Orthopaedics and Traumatology, Dr. Muhittin Ulker Emergency Care and Traumatology Hospital, Ankara, Turkey.
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Bengisun U, Tagil SM, Elhan A. Accessibility of calf perforating veins from the superficial posterior compartment: an anatomic dissection study. Eur J Vasc Endovasc Surg 2003; 25:552-5. [PMID: 12787698 DOI: 10.1053/ejvs.2002.1878] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES to determine the anatomic location of medial perforating veins (PVs) and their course within the compartments of the leg. MATERIALS AND METHODS the lower extremity veins of 15 cadavers were filled with coloured latex solution. Medial PVs between the ankle and the knee were dissected out. RESULTS in total 95 direct PVs (mean 6.3 per extremity, range 3-9) were identified and classifed as Cockett I, II, or III, proximal and distal paratibial and Boyd. Cockett PVs were present in more than half of the cases, of which the majority (except Cockett I) were located in the superficial posterior compartment. Whereas the vast majority of Cockett PVs originate from the posterior arch vein, the other perforators originate from the greater saphenous vein. CONCLUSIONS only 62% of all PVs pass through the superficial posterior compartment. As a result, during subfascial endoscopic perforating vein surgery (SEPS), at least one third of patients require a paratibial fasciotomy in order to reach and ligate the PVs.
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Affiliation(s)
- U Bengisun
- Department of General Surgery, Ankara University, Ankara, Turkey
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Topçu O, Karakayali F, Kuzu MA, Ozdemir S, Erverdi N, Elhan A, Aras N. Comparison of long-term quality of life after laparoscopic and open cholecystectomy. Surg Endosc 2003; 17:291-5. [PMID: 12364987 DOI: 10.1007/s00464-001-9231-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2001] [Accepted: 05/06/2002] [Indexed: 10/27/2022]
Abstract
BACKGROUND Although many studies have compared open and laparoscopic procedures, showing many advantages in favor of the laparoscopic technique during the early postoperative period, only a limited number of reports in the literature compare the two techniques during the later follow-up period with regard to quality of life. This study aimed to compare the effects of these two cholecystectomy techniques on the quality of life and clinical outcome of the patients during long-term follow-up evaluation. METHODS This study evaluated 200 patients who underwent cholecystectomy operations with either technique between 1993 and 1999 in our department. There were 100 patients in each group. Both groups were similar with respect to age, gender, body mass indexes, American Society of Anesthesiology (ASA) scores, and indications for surgery. The Medical Outcome Study Short Form 36 Health survey (SF-36), which includes 36 items, was used for evaluating the quality-of-life index. In addition to this, a system-specific instrument for gastrointestinal diseases was used to investigate clinical outcome. RESULTS The mean administration time for the questionnaire was 46.8 +/- 18.7 months in the laparoscopic cholecystectomy (LC) group and 41.5 +/- 16 months in the open cholecystectomy (OC) group. Statistically significant differences were noted in the scores for all eight SF = 36 health status domains in favor of laparospopic surgery. No statistically significant difference was found for abdominal pain, location of the pain, referral to a doctor for the pain, accompanying symptoms, relieving factors for the pain, distention, and dyspeptic complaints, usage of antacid therapy, weight changes, changes in bowel habit, need for a special diet, or sexual functions between the two groups. CONCLUSIONS The gastrointestinal clinical symptoms were similar in the two groups during the long-term follow-up evaluation, but laparoscopic cholecystectomy was found to be significantly superior to the open technique with respect to the quality of life over the long term.
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Affiliation(s)
- O Topçu
- Department of Surgery, University of Ankara, Ankara, Turkey
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Abstract
The anatomy of the internal anal sphincter and surrounding structures was investigated in 24 cadavers using a surgical microscope (6-25 x magnification). An understanding of the anatomy of the internal anal sphincter is helpful in avoiding complications during surgical procedures in the anorectal region. The external anal sphincter was composed of three ellipsoid rings of skeletal muscle (subcutaneous, superficial, and deep) that encircle the anal canal; in contrast, we found that the internal anal sphincter was composed of flat rings of smooth muscle bundles stacked one on top of the other, like the slats of a Venetian blind. In each anal canal, the average number of ring-like slats observed was 26.33 +/- 2.93 (range = 20-30) and each was covered by its own fascia. The smooth muscle fibers and fascia coalesced at three equidistant points around the anal canal to form three columns that extended distally into the lumen and differed in form from the other anal columns. When viewed from an anterior position, the columns were located anteriorly at the observer's right (5 o'clock position), posteriorly at the right (1 o'clock position), and laterally at the left (9 o'clock position). This heretofore unreported anatomy of the internal anal sphincter may play an important role in closing off the lumen of the anal canal and maintaining bowel continence.
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Affiliation(s)
- A Uz
- Ankara University, Faculty of Medicine, Department of Anatomy, Ankara, Turkey.
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Kuzu MA, Topçu O, Uçar K, Ulukent S, Unal E, Erverdi N, Elhan A, Demirci S. Effect of sphincter-sacrificing surgery for rectal carcinoma on quality of life in Muslim patients. Dis Colon Rectum 2002; 45:1359-66. [PMID: 12394435 DOI: 10.1007/s10350-004-6425-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Living with a permanent colostomy significantly diminishes a patient's quality of life. However, little is known about its influence on worship patterns in Muslims. Therefore, the aim of this study was to assess the quality of life in Muslim patients after surgery for rectal carcinoma, especially with respect to religious worship. METHODS We studied 178 patients who had undergone curative surgery for colorectal carcinoma. The patients fell into three groups based on the type of surgery they underwent: abdominoperineal resection (n = 75), sphincter-saving resection (n = 51), and anterior resection including sigmoid colectomy (n = 52). Quality of life was measured with the Medical Outcomes Study Short Form 36 Health Survey and a questionnaire that asked participants about their work responsibilities, sexual life, and religious worship. RESULTS The scores for all eight subscales of the Short Form 36 in the abdominoperineal resection group were significantly poorer than those in the sphincter-saving resection and anterior resection groups ( P< 0.001). In addition, social life and work responsibilities were significantly more affected in the abdominoperineal resection group than in the other two groups ( P< 0.001). A significantly ( P< 0.001) greater number of patients in the abdominoperineal resection group stopped praying daily (either alone or in a mosque) and fasting during Ramadan. CONCLUSION Two aspects of religious worship (praying and fasting) were significantly impaired in the Muslim patients who had a stoma as a result of sphincter-sacrificing surgery. To improve quality of life in these patients, religious issues as they relate to the presence of a stoma should be discussed during preoperative counseling, the informed consent process, and counseling with local religious authorities.
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Abstract
This cadaver study investigated the innervation patterns of the abductor digiti minimi in Guyon's canal. There was only one branch to the abductor digiti minimi in 22 of the 30 specimens. Two branches were found in three hands, and three branches in two. Three other variations were documented.
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Affiliation(s)
- E Gudemez
- Department of Surgery and Traumatology, Kirkkdale University Faculty of Medicine, Turkey.
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