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Yavuz O, Kurt S, Ozmen S, Bilen E, Akdöner A. Prediction of Intraperitoneal Adhesions in Repeated Cesarean Deliveries with Stria Gravidarum Scoring System: A Cross-sectional Study. Niger J Clin Pract 2024; 27:489-495. [PMID: 38679772 DOI: 10.4103/njcp.njcp_767_23] [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: 11/01/2023] [Accepted: 03/01/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND The preoperative prediction of intraperitoneal adhesion (IPA) before repeated cesarean deliveries (CD), which are becoming more prevalent, is crucial for maternal health. AIM The aim of the study was to preoperatively predict IPA in repeated CD with the stria gravidarum (SG) scoring system. METHODS A total of 167 patients with at least one previous CD at or beyond 37 weeks of gestation were analyzed. Preoperative SG was calculated according to the Davey scoring system: 0-2 score were defined as mild SG (Group 1; n: 94, 56.2%), and 3-8 score were defined as severe SG (Group 2; n = 73, 43.8%). Preoperative previous cesarean incision features were evaluated according to the Vancouver scar scale. IPA was evaluated according to the Nair's and modified Nair's scoring systems. RESULTS Parity, younger age at first pregnancy, higher body mass index, number of previous CDs, rate of scar symptoms, Nair's and the modified Nair's scores were statistically significant in Group 2 (P = 0.01; P = 0.04; P = 0.007; P = 0.004; P < 0.001; P = 0.007; P = 0.02, respectively). Davey score ≥3 and Vancouver score ≥4.5 were determined as the cut-off value to predict IPA (P = 0.1 and 0.07, respectively). According to multivariate analysis, both Davey and Vancouver scores are independent factors in predicting IPA (P = 0.02 and 0.04, respectively). CONCLUSION Evaluating the SG score through the Davey score in women with a history of previous CD may assist in predicting IPA status before the planning of a subsequent surgery.
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Affiliation(s)
- O Yavuz
- Department of Gynecology and Obstetrics, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - S Kurt
- Department of Gynecology and Obstetrics, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - S Ozmen
- Department of Gynecology and Obstetrics, T.C. Sağlık Bakanlığı Karacabey Devlet Hastanesi, Bursa, Turkey
| | - E Bilen
- Department of Gynecology and Obstetrics, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - A Akdöner
- Department of Gynecology and Obstetrics, Dokuz Eylul University School of Medicine, Izmir, Turkey
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Ozmen S, Tabur S, Oney-Birol S. Alleviation role of exogenous cadaverine on cell cycle, endogenous polyamines amounts and biochemical enzyme changes in barley seedlings under drought stress. Sci Rep 2023; 13:17488. [PMID: 37840053 PMCID: PMC10577135 DOI: 10.1038/s41598-023-44795-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/12/2023] [Indexed: 10/17/2023] Open
Abstract
Cadaverine (Cad), which has an independent synthesis pathway compared to other polyamine (PA) types, contributes to the health of plants by regulating plant growth and development, abiotic stress tolerance and antioxidant defense mechanisms. In this work, experiments were carried out to understand the effects of exogenous Cad (10 µM) application under drought stress (%22 PEG 6000) and without stress on cell cycle, total protein content, endogenous PA levels, and biochemical enzyme activities in barley (Hordeum vulgare cv. Burakbey) considering the potential of Cad to stimulate the drought-related tolerance system. Cad application in a stress-free environment showed an effect almost like low-impact drought stress, causing changes in all parameters examined compared to samples grown in distilled water environment (Control). The results clearly show that Cad applied against the negative effects of drought stress on all parameters creates a drought resistance mechanism of the plant. Accordingly, Cad applied together with drought stress increased the density of cells in the cell cycle (G1-S and S-G2 phases) and the amount of endogenous (spermidine 10% and spermine 40%) PAs. In addition, while superoxide dismutase (SOD) (5%), (CAT) (55%) and ascorbate peroxidase (APX) (18%) enzyme levels increased, a stress response mechanism occurred due to the decrease in total protein content (20%) and malondialdehyde (MDA) (80%). As a result, exogenous application of 10 µM Cad showed that it reduced the negative effects of drought stress on endogenous PA amounts, cell division and biochemical activities in barley.
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Affiliation(s)
- Serkan Ozmen
- Department of Biology, Faculty of Arts and Sciences, Süleyman Demirel University, 32260, Isparta, Turkey
| | - Selma Tabur
- Department of Biology, Faculty of Arts and Sciences, Süleyman Demirel University, 32260, Isparta, Turkey
| | - Signem Oney-Birol
- Department of Moleculer Biology and Genetics, Faculty of Arts and Sciences, Burdur Mehmet Akif Ersoy University, 15030, Burdur, Turkey.
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Mutluer T, Gorker I, Akdemir D, Ozdemir DF, Ozel OO, Vural P, Tufan AE, Karacetin G, Arman AR, Fis NP, Demirci E, Ozmen S, Hesapcioglu ST, Oztop D, Tural U, Aktepe E, Aksu H, Ardic UA, Basgul S, Bilac O, Coskun M, Celik GG, Demirkaya SK, Dursun OB, Durukan I, Fidan T, Gokcen C, Gormez V, Gundogdu OY, Herguner S, Kandemir H, Kilic BG, Kilincaslan A, Nasiroglu S, Sapmaz SY, Sahin N, Tahiroglu AY, Toros F, Unal F, Yazici IP, Yazici KU, Isik U, Ercan ES. Prevalence, comorbidities and mediators of childhood anxiety disorders in urban Turkey: a national representative epidemiological study. Soc Psychiatry Psychiatr Epidemiol 2022:10.1007/s00127-022-02396-7. [PMID: 36526939 PMCID: PMC9758023 DOI: 10.1007/s00127-022-02396-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE The aim of this study is to evaluate the prevalence of anxiety disorders, its correlation with sociodemographic characteristics, its comorbidities with other psychiatric disorders and its predictors in school-aged children. METHODS This study is part of a representative, multi-centered national study that is planned by the Turkish Association of Child and Adolescent Mental Health to evaluate the prevalence of psychopathology among elementary school students in Turkey between the years 2014-2015. Children are screened via Kiddie Schedule for Affective Disorders and Schizophrenia for School Age Children Present and Lifetime Version. Impairment is assessed by a 3-point Likert type scale independently by the parent and the teacher. The final sample included 5842 children with the mean age of 8.7 years. RESULTS The prevalence of any anxiety disorder without considering impairment is 16.7% and considering impairment is 5.2% in children according to our study. We found significant differences for comorbid Attention Deficit Hyperactivity Disorder, Disruptive Behavior Disorder, Mood Disorders, Tic Disorders, Obsessive Compulsive Disorder, Enuresis Nocturna, Encopresis, and Intellectual Disability. Having a history of paternal physical disorder, living in the regions of Marmara, Mediterranean and Black Sea were found to be the main predictors of having childhood anxiety disorders according to the logistic regression analysis. CONCLUSION Better understanding of childhood anxiety disorders, comorbid conditions and predictors will result in earlier diagnosis and more appropriate treatment.
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Affiliation(s)
- T. Mutluer
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Koç University School of Medicine, Istanbul, Turkey
| | - I. Gorker
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Trakya University, Edirne, Turkey
| | - D. Akdemir
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Hacettepe University, Ankara, Turkey
| | - D. Foto Ozdemir
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Hacettepe University, Ankara, Turkey
| | - O. Ozcan Ozel
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Inonu University, Malatya, Turkey
| | - P. Vural
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Uludag University, Bursa, Turkey
| | - A. E. Tufan
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Abant Izzet Baysal University, Bolu, Turkey
| | - G. Karacetin
- Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | - A. Rodopman Arman
- Department of Child and Adolescent Psychiatry, Marmara University, Pendik Training and Research Hospital, Istanbul, Turkey
| | - N. Perdahli Fis
- Department of Child and Adolescent Psychiatry, Marmara University, Pendik Training and Research Hospital, Istanbul, Turkey
| | - E. Demirci
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Erciyes University, Kayseri, Turkey
| | - S. Ozmen
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Erciyes University, Kayseri, Turkey
| | - S. Tural Hesapcioglu
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Karadeniz Technical University, Trabzon, Turkey
| | - D. Oztop
- Faculty of Medicine, Child and Adolescent Psychiatry Department, Ankara University, Ankara, Turkey
| | - U. Tural
- Faculty of Medicine, Department of Psychiatry, Kocaeli University, Kocaeli, Turkey
| | - E. Aktepe
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Suleyman Demirel University, Isparta, Turkey
| | - H. Aksu
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Adnan Menderes University, Aydin, Turkey
| | - U. Akyol Ardic
- Child and Adolescent Psychiatry, Denizli State Hospital, Denizli, Turkey
| | - S. Basgul
- Department of Psychology, Hasan Kalyoncu University, Istanbul, Turkey
| | - O. Bilac
- Department of Child and Adolescent Psychiatry, Manisa Celal Bayar University, Manisa, Turkey
| | - M. Coskun
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul University, Istanbul, Turkey
| | - G. G. Celik
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Cukurova University, Adana, Turkey
| | | | - O. B. Dursun
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ataturk University, Erzurum, Turkey
| | - I. Durukan
- Gulhane Faculty of Medicine, Department of Child and Adolescent Psychiatry, University of Health Sciences, Ankara, Turkey
| | - T. Fidan
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Osmangazi University, Eskisehir, Turkey
| | - C. Gokcen
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Gaziantep University, Gaziantep, Turkey
| | - V. Gormez
- Department of Child and Adolescent Psychiatry, Bezmi Alem University, Istanbul, Turkey
| | - O. Yildiz Gundogdu
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kocaeli University, Kocaeli, Turkey
| | - S. Herguner
- Meram Faculty of Medicine, Department of Child and Adolescent Psychiatry, Necmettin Erbakan University, Konya, Turkey
| | - H. Kandemir
- Medical School, Department of Child and Adolescent Psychiatry, Harran University, Sanliurfa, Turkey
| | - B. Gunay Kilic
- Faculty of Medicine, Child and Adolescent Psychiatry Department, Ankara University, Ankara, Turkey
| | - A. Kilincaslan
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul University, Istanbul, Turkey
| | - S. Nasiroglu
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Akdeniz University, Antalya, Turkey
| | - S. Yalin Sapmaz
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Celal Bayar University, Manisa, Turkey
| | - N. Sahin
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Mugla Sitki Kocman University, Mugla, Turkey
| | - A. Y. Tahiroglu
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Cukurova University, Adana, Turkey
| | - F. Toros
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Mersin University, Mersin, Turkey
| | - F. Unal
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Hacettepe University, Ankara, Turkey
| | - I. Percinel Yazici
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Firat University, Elazig, Turkey
| | - K. U. Yazici
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Firat University, Elazig, Turkey
| | - U. Isik
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Suleyman Demirel University, Isparta, Turkey
| | - E. S. Ercan
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ege University, Izmir, Turkey
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Ercan N, Ozmen S, Bostanci I. A rare case of localized aquagenic urticaria in a preschool child, including a literature review. Revue Française d'Allergologie 2019. [DOI: 10.1016/j.reval.2019.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sezgin B, Sibar S, Findikcioglu K, Sencan A, Emmez H, Baykaner K, Ozmen S. Use of an epidermal growth factor-infused foam dressing in a complicated case of Adams-Oliver syndrome. J Wound Care 2019; 26:342-345. [PMID: 28598754 DOI: 10.12968/jowc.2017.26.6.342] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Adams-Oliver syndrome is a rare disorder with varying degrees of scalp and cranial bone defects as well as limb anomalies, which can range from mild to more pronounced manifestations. In mild cases, closure of these defects can be achieved with a conservative approach. However, surgical closure is recommended in cases where the defect is extensive and includes cranial involvement. Several complicated cases of Adams-Oliver syndrome have been reported, in which flap failures were encountered and other alternatives had to be used to close critical scalp defects. Here, the case of a 4-year-old child with Adams-Oliver syndrome and a complex cranial defect with exposed titanium mesh is described. The patient was successfully treated with epidermal growth factor (EGF) infused foam dressings and subsequent split-thickness skin grafting. The EGF has been highlighted for its essential role in dermal wound repair through the stimulation of the proliferation and migration of keratinocytes, and showed accelerated wound healing when used in partial or full-thickness skin wounds.
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Affiliation(s)
- B Sezgin
- Koç University School of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul, Turkey
| | - S Sibar
- Gazi University Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara, Turkey
| | - K Findikcioglu
- Gazi University Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara, Turkey
| | - A Sencan
- Bagcilar Training and Research Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul, Turkey
| | - H Emmez
- Gazi University Hospital, Department of Neurosurgery, Ankara, Turkey
| | - K Baykaner
- Gazi University Hospital, Department of Neurosurgery, Ankara, Turkey
| | - S Ozmen
- Koç University School of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul, Turkey
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Ozmen S, Timur O, Calik I, Altinkaynak K, Simsek E, Gozcu H, Arslan A, Carlioglu A. Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) may be superior to C-reactive protein (CRP) for predicting the occurrence of differentiated thyroid cancer. Endocr Regul 2019; 51:131-136. [PMID: 28858848 DOI: 10.1515/enr-2017-0013] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES NLR (neutrophil-lymphocyte ratio) and PLR (platelet-lymphocyte ratio) are prognostic markers of differentiated thyroid cancers. In our study, we evaluated NLR, PLR and C-reactive protein (CRP) for predicting the occurence of differentiated thyroid cancer. This is the first study that compares NLR and PLR to C-reactive protein indifferantiated thyroid cancer not only papillary cancer but also folliculer cancer. METHODS This study includes 51 papillary carcinoma, 42 papillary microcarcinoma and 31 folliculer carcinoma patients attending to our outpatient Endocrinology Clinic at Erzurum Region Training and Research Hospital between 2009 and 2014. The control group include 50 age, sex and body mass index matched healty subjects. Blood counts and CRP were measured at the day before surgery. Thyroglobulin was measured after 6 months of operation. RESULTS There were positive correlations between tumor diameter, age, white blood cell (WBC) and thyroglobulin levels. There were also positive correlation between NLR, PLR and CRP levels. CONCLUSION In our study, we found out that higher NLR and PLR was associated with higher levels of thyroglobulin which indicates worse survival. CRP levels were also associated with poorer tumor profile but the determining rate was lower according to ROC analysis.
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Yirmibesoglu Erkal E, Celik D, Ozmen S, Aksu G, Erkal H. EP-1423: the evaluation of sleep quality in cancer patients following the diagnosis of a metastatic site. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31858-3] [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: 11/25/2022]
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Abstract
BACKGROUND AND OBJECTIVE Although potato is greatly consumed all over the world, adverse reactions to potato are uncommon. Our aim is to describe the clinical features of potato sensitivity in allergic children. MATERIALS AND METHODS Forty children with sensitivity to potato were followed up in the Pediatric Immunology and Allergy Clinic of our hospital were included in the study. These patients were retrospectively evaluated from January 2012 to December 2013. RESULTS Forty children aged between 6 months and 10 years (mean 2.9±3.2, median:1.5 years) were enrolled of whom 26 were male (65%). Thirty three of these children had presented eczema, nine wheezing, seven urticaria and/or angioedema, six rhinitis, four subjects had experienced anaphylaxis, and two vomiting or other gastrointestinal complaints. In 38 (95%) patients, skin prick tests detected sensitivity to other allergens besides potato. The most frequently identified sensitivities were to food sensitivities (82.5%). In addition sensitivity to house dust mite, cat dander, pollens, A. Alternata and cockroaches in skin prick tests were documented in nine, six, five, four and four patients, respectively. Latex sensitivity was not detected in any patient. Five (38.5%) out of 13 patients over the age of three showed sensitivity to pollen. CONCLUSIONS Potatoes sensitivity is mostly seen in children with atopic dermatitis. In children with atopic eczema should be asked whether the increase in complaints with potatoes. Mostly potato sensitivity is combined with other food allergies. Therefore potato should be included in the test in patients with atopic eczema and food allergy.
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Affiliation(s)
- M Dogru
- Department of Pediatric Allergy-Immunology. Dr. Sami Ulus Woman's Health and Children Education and Research Hospital, Ankara, Turkey
| | - S Ozmen
- Department of Pediatric Allergy-Immunology. Dr. Sami Ulus Woman's Health and Children Education and Research Hospital, Ankara, Turkey
| | - I Bostanci
- Department of Pediatric Allergy-Immunology. Dr. Sami Ulus Woman's Health and Children Education and Research Hospital, Ankara, Turkey
| | - S Keles
- Department of Pediatric Allergy-Immunology. Dr. Sami Ulus Woman's Health and Children Education and Research Hospital, Ankara, Turkey
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Bayram AK, Kardas F, Demirci EO, Gokahmetoglu S, Ozmen S, Canpolat M, Oztop DB, Kumandas S, Gumus H, Per H. Lack of serum antineuronal antibodies in children with autism. BRATISL MED J 2016; 117:77-9. [PMID: 26830036 DOI: 10.4149/bll_2016_015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Autism spectrum disorders (ASDs) are a severe group of neurodevelopmental disorders that are characterized by impairment in social communication, and imagination and social interaction. The aetiology of autism is complex, but some studies suggest autoimmunity to the central nervous system in the pathogenesis. The aim of this study is to investigate the positivity of antineuronal antibodies including anti-glutamic acid decarboxylase antibodies (anti-GAD), anti-glutamate receptor (anti-GluR) antibodies and seven types of anti-ganglioside antibodies, in children with autism. METHODS We conducted the study over a period of one year from May 2012 to December 2013. Human anti-GAD in serum were investigated with ELISA; human autoantibodies against the N-methyl-D-aspartate subtype of GluR were investigated with indirect immunofluorescence test; class IgG antibodies against the seven gangliosides were investigated with immunoblot assay. RESULTS Serum antineuronal antibodies were measured in 42 children (24 male, 18 female) with autism in comparison to 21 (13 male, 8 female) healthy-matched children aged between 2-12 years. There was no seropositivity of antineuronal antibodies in either of the groups. CONCLUSION There is no evidence to support an association between autism and antibodies positivity of anti-GAD, anti-GluR and anti-gangliosides (Ref. 26).
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Bilgic A, Yilmaz S, Ozcan O, Tufan A, Ozmen S, Oztop D, Akça O, Turkoglu S, Yar A. Impact of Parental ADHD Dimensions On Disruptive Behavioral Disorders Symptomatology in Children with ADHD. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)30447-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Bilgic A, Yilmaz S, Ozcan O, Tufan A, Ozmen S, Oztop D, Akça O, Turkoglu S, Yar A. The Role of Parental Temperament Traits in Disruptive Behavioral Disorders of Children with ADHD. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)30332-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Bantis C, Heering P, Kouri NM, Siekierka-Harreis M, Stangou M, Schwandt C, Efstratiadis G, Rump LC, Ivens K, Haddiya I, Houssaini Squalli T, Laouad I, Ramdani B, Bayahia R, Dimas GG, Tegos TJ, Spiroglou SG, Pitsalidis CG, Sioulis AS, Karamouzis IM, Savopoulos CG, Karamouzis MI, Orologas AG, Hatzitolios AI, Grekas DM, Maixnerova D, Jancova E, Rychlik I, Rysava R, Merta M, Reiterova J, Kolsky A, Honsova E, Skibova J, Tesar V, Kendi Celebi Z, Calayoglu R, Keven K, Kurultak I, Mescigil P, Erbay B, Karatan O, Duman N, Erturk S, Nergizoglu G, Kutlay S, Sengul S, Ates K, Marino F, Martorano C, Bellantoni M, Tripepi R, Zoccali C, Ishizuka K, Harita Y, Kajiho Y, Tsurumi H, Asano T, Nishiyama K, Sugawara N, Chikamoto H, Akioka Y, Yamaguchi Y, Igarashi T, Hattori M, Bantis C, Heering PJ, Kouri NM, Stangou M, Siekierka-Harreis M, Efstratiadis G, Rump LC, Ivens K, Sahay M, Monova DV, Monov SV, Wang YY, Cheng H, Wang GQ, Dong HR, Chen YP, Wang CJ, Tang YL, Buti E, Dervishi E, Bergesio F, Ghiandai G, Mjeshtri A, Paudice N, Caldini AL, Nozzoli C, Minetti EE, Sun L, Feng J, Yao L, Fan Q, Ma J, Wang L, Kirsanova T, Merkusheva L, Ruinihina N, Kozlovskaya N, Elenshleger G, Turgutalp K, Karabulut U, Ozcan T, Helvaci I, Kiykim A, Kaul A, Bhadhuaria D, sharma R, Prasad N, Gupta A, Clajus C, Schmidt J, Haller H, Kumpers P, David S, Sevillano AM, Molina M, Gutierrez E, Morales E, Gonzalez E, Hernandez E, Praga M, Conde Olasagasti JL, Vozmediano Poyatos C, Illescas ML, Tallon S, Uson Carrasco JJ, Roca Munoz A, Rivera Hernandez F, Ismail G, Jurubita R, Andronesi A, Bobeica R, Zilisteanu D, Rusu E, Achim C, Sevillano AM, Molina M, Gutierrez E, Morales E, Huerta A, Hernandez E, Caro J, Gutierrez-Solis E, Praga M, Pasquariello A, Pasquariello G, Innocenti M, Grassi G, Egidi MF, Ozturk O, Yildiz A, Gul CB, Dilek K, Monov SV, Monova DV, Tylicki L, Jakubowska A, Weber E, Lizakowski S, Swietlik D, Rutkowski B, Postorino A, Costa S, Cristadoro S, Magazzu G, Bellinghieri G, Savica V, Buemi M, Santoro D, Lu Y, Shen P, Li X, Xu Y, Pan X, Wang W, Chen X, Zhang W, Ren H, Chen N, Mitic BP, Cvetkovic T, Vlahovic P, Velickovic Radovanovic R, Stefanovic V, Kostic S, Djordjevic V, Ao Q, Ma Q, Cheng Q, Wang X, Liu S, Zhang R, Ozturk S, Ozmen S, Akin D, Danis R, Yilmaz M, Hajri S, Barbouche S, Okpa H, Oviasu E, Ojogwu L, Fotouhi N, Ghaffari A, Hamzavi F, Nasri H, Ardalan M, Stott A, Ullah A, Anijeet H, Ahmed S, Kohli HS, Rajachandran R, Rathi M, Jha V, Sakhuja V, Yenigun E, Dede F, Turgut D, Koc E, Akoglu H, Piskinpasa S, Ozturk R, Odabas A, Bajcsi D, Abraham G, Kemeny E, Sonkodi S, Legrady P, Letoha A, Constantinou K, Ondrik Z, Ivanyi B, Lucisano G, Comi N, Cianfrone P, Summaria C, Piraina V, Talarico R, Camastra C, Fuiano G, Proletov I, Saganova E, Galkina O, Bogdanova E, Zubina I, Sipovskii V, Smirnov A, Bailly E, Pierre D, Kerdraon R, Grezard O, Gnappi E, Delsante M, Galetti M, Maggiore U, Manenti L, Hasan MJ, Muqueet MA, Mostafi M, Chowdhury I, Haque W, Khan T, Kang YJ, Bae EJ, Cho HS, Chang SH, Park DJ, Li X, Xu G, Lin H, Hu Z, Yu X, Xing C, Mei C, Zuo L, Ni Z, Ding X, Li D, Chen N, Ren H, Shen P, Li X, Pan X, Zhang Q, Feng X, Lin L, Zhang W, Chen N. Clinical nephrology - miscellaneous. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ozmen S, Demirceken F, Barut Y, Dibek Misirlioglu E. Role of laryngoscopy in children with respiratory complaints and suspected reflux. Allergol Immunopathol (Madr) 2012; 40:204-9. [PMID: 21978888 DOI: 10.1016/j.aller.2011.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 06/04/2011] [Accepted: 06/14/2011] [Indexed: 01/21/2023]
Abstract
BACKGROUND In recent years, laryngopharyngeal reflux (LPR) in children has been taken into consideration. OBJECTIVE The aim of this study was to assess the laryngoscopic findings in children diagnosed LPR and/or gastro-oesophageal reflux (GERD). METHODS The findings of 49 patients with at least one or more respiratory complaint such as chronic cough, wheezing, hoarseness, recurrent laryngitis, and throat clearing/postnasal discharge suggesting LPR were evaluated retrospectively. The diagnosis of LPR+GERD or GERD was done by the clinical history and 24 h double-probe pH monitoring and/or scintigraphy. RESULTS Thirty eight out of 49 patients examined by laryngoscopy underwent 24 h double-probe pH monitoring and/or scintigraphy. Thirty of them were diagnosed as LPR+GERD or GERD by any test positivity. Twelve of 30 patients diagnosed with LPR+GERD or GERD had a positive laryngeal finding on the examination of fibre optic laryngoscopy. The most common finding with eight cases was arytenoid erythema A sensitivity of 40% and specificity of 50% for the laryngoscopy in the diagnosis of LPR/GERD were found. CONCLUSION In children with unexplained respiratory symptoms, laryngopharyngeal reflux should be suspected. Therefore, until enough data on this issue in the literature accumulates, the history and the laboratory findings of the patients obtained from various techniques to document paediatric LPR should be evaluated together.
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Duman H, Dogru M, Misirlioglu F, Ozmen S, Bostanci I. Anaphylaxis during skin test with vecuronium. Allergol Immunopathol (Madr) 2012; 40:61-2. [PMID: 21429653 DOI: 10.1016/j.aller.2010.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2010] [Revised: 11/28/2010] [Accepted: 12/07/2010] [Indexed: 11/20/2022]
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Arik Yilmaz E, Ozmen S, Bostanci I, Misirlioglu ED, Ertan U. Erythrocyte zinc levels in children with bronchial asthma. Pediatr Pulmonol 2011; 46:1189-93. [PMID: 21815275 DOI: 10.1002/ppul.21501] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [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] [Received: 02/20/2011] [Accepted: 05/25/2011] [Indexed: 11/08/2022]
Abstract
Zinc deficiency may be suspected to play a role in the pathogenesis, control, and severity of asthma because of its antioxidant, antiapoptotic, and anti-inflammatory effects. We aimed to investigate whether there was any relationship between erythrocyte zinc levels and childhood asthma. The erythrocyte zinc levels of 67 asthmatic and 45 healthy children were analyzed in this case-control study. The mean concentrations of erythrocyte zinc were 1215.8 ± 145.1 µg/dl in asthma patients and 1206.9 ± 119.5 µg/dl in controls with no significant difference (P = 0.472). The erythrocyte zinc level was below 1,000 µg/dl in 6 asthmatic patients (8.9%) and 2 control group patients (4.4%). There was no relationship between erythrocyte zinc levels and duration of follow-up, severity, and control of the asthma (P > 0.05). On the other hand, patients hospitalized for an asthma attack had significantly lower erythrocyte zinc levels compared with nonhospitalized patients and the control group (P = 0.000 and P = 0.004 respectively). This study's findings indicate that asthmatic children are not a risk group for zinc deficiency. We emphasize that checking zinc levels in children who are hospitalized for an asthma attack may be useful.
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Affiliation(s)
- E Arik Yilmaz
- Department of Pediatrics, Dr. Sami Ulus Research and Training Hospital of Women's and Children's Health and Diseases, Ankara, Turkey.
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Sekerel BE, Soyer OU, Keskin O, Uzuner N, Yazicioglu M, Kiliç M, Artaç H, Ozmen S, Can D, Zeyrek D, Cokugras H, Canitez Y, Aydogan M, Kuyucu S, Inal A, Gurkan F, Orhan F, Yilmaz O, Boz AB, Tahan F, Cevit O. The reliability and validity of Turkish version of Childhood Asthma Control Test. Qual Life Res 2011; 21:685-90. [PMID: 21792732 DOI: 10.1007/s11136-011-9970-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2011] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The reliability and validity of Turkish version of Childhood Asthma Control Test (C-ACT). PURPOSE The management of asthma is an important as well as difficult issue of physician's daily practice particularly in busy clinical settings. C-ACT was created to identify asthma control levels in children aged 4-11 years. Our aim was to evaluate the reliability, validity and responsiveness of C-ACT in a Turkish sample of children with asthma. METHOD In this multicenter study, 368 children were enrolled. C-ACT was completed every month by parents and patients who were evaluated in 3 visits within 2 month intervals. At each visit, physicians interpret the control level and decided for the treatment step as established in GINA guidelines. RESULTS The internal consistency reliability of the Turkish version of C-ACT (C-ACT1 to C-ACT5) was found to be 0.82, 0.83, 0.82, 0.82 and 0.80, respectively (reliability statistics, Cronbach's alpha). Test-retest reliability was 0.71. There was significant correlation between C-ACT and physician's assessment of asthma control at visit 1 (r = 0.65, P < 0.001). CONCLUSIONS Turkish version of C-ACT is an accurate and reliable tool to evaluate asthma control in children aged 4-11 years. Its widespread use may facilitate appropriate assessment of asthma control and may lead to decrease the number of uncontrolled patients.
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Affiliation(s)
- B E Sekerel
- Faculty of Medicine, Pediatric Allergy and Asthma Unit, Hacettepe University, 06100, Ankara, Turkey.
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Sahiner U, Cetinkaya S, Ozmen S, Arslan Z. Evaluation of adrenocortical function in 3-7 aged asthmatic children treated with moderate doses of fluticasone propionate: reliability of dehydroepiandrosterone sulphate (dhea-s) as a screening test. Allergol Immunopathol (Madr) 2011; 39:154-8. [PMID: 21257254 DOI: 10.1016/j.aller.2010.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2010] [Revised: 06/20/2010] [Accepted: 06/24/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Inhaled corticosteroids (ICS) are the first-line therapy in the treatment of persistent asthma. At medium to high doses and prolonged usage, ICS can supresss the hypothalamic-pituitary-adrenal axis. Dehydroepiandrosterone sulphate (DHEA-S) is a corticotropin-dependent adrenal androgen precursor that is supressible in patients treated with ICS. OBJECTIVES To evaluate the adrenal axis in asthmatic children treated with moderate doses of fluticasone propionate and to evaluate the DHEA-S as a possible marker for adrenal axis ın preadrenarchal children. METHODS Twenty-eight children with persistent asthma with a mean age of 4.4 years (median 4.2; range 2.5-7.1) on long term treatment (mean 6.16; median 6; range 4.5-9 months) with moderate doses (mean 250; median 253; range 158-347 (g/m(2)/day) of inhaled fluticasone propionate were evaluated with low-dose ACTH stimulation test to assess adrenal function, and DHEA-S levels were compared with the results. RESULTS One out of 28 patients (3.57%) demonstrated an abnormal cortisol response to low-dose ACTH test. There was no correlation between DHEA-S and peak cortisol, morning cortisol and fasting blood glucose levels. However, mean inhaled corticosteroid dosages were inversely correlated with the DHEA-S. CONCLUSIONS In most of the children with persistent asthma, mild to moderate fluticazone propionate doses supress the hypothalamic-pituitary-adrenal axis rarely. Chronic moderate doses of ICS may suppress adrenal androgen levels without supression of cortisol production. DHEA-S levels may be used as a practical method to follow adrenal functions and may be an earlier indicator of adrenal dysfunction in children.
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Dibek Misirlioglu E, Ozmen S, Bostanci I. An infant with chickpea and egg allergy. Allergol Immunopathol (Madr) 2011; 39:186-7. [PMID: 21208713 DOI: 10.1016/j.aller.2010.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 06/04/2010] [Accepted: 06/07/2010] [Indexed: 11/24/2022]
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Bostanci I, Misirlioglu ED, Ozmen S, Ginis T. Two adolescent patients with high IgE levels and hypereosinophilia are associated with cockroach allergen. Allergol Immunopathol (Madr) 2011; 39:114-5. [PMID: 21208711 DOI: 10.1016/j.aller.2010.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 05/07/2010] [Accepted: 05/13/2010] [Indexed: 11/17/2022]
Affiliation(s)
- I Bostanci
- Dr. Sami Ulus Woman's Health and Children Education and Research Hospital, Department of Pediatric Allergy and Asthma, Ankara, Turkey
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Affiliation(s)
- S Ozmen
- Department of Pediatric Allergy and Asthma, Dr. Sami Ulus Woman's Health and Children, Education and Research Hospital, 63/23 Basin Cad. Basinevler, Ankara, Turkey
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Sekerel B, Keskin O, Uzuner N, Yazicioglu M, Kilic M, Artac H, Ozmen S, Can D, Zeyrek D, Cokugras H, Soyer O, Sapan N, Aydogan M, Kuyucu S, Inal A, Gurkan F, Orhan F, Yilmaz O, Bingol Boz A, Tahan F, Cevit O. The Utility of Childhood Asthma Control Test and its Relationship with Control Measures and with the Decisions Made by Asthma Specialist. J Allergy Clin Immunol 2010. [DOI: 10.1016/j.jaci.2009.12.537] [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: 11/25/2022]
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Ozmen AO, Aksoy S, Ozmen S, Saraç S, Sennaroğlu L, Gürsel B. Balance after stapedotomy: analysis of balance with computerized dynamic posturography. Clin Otolaryngol 2009; 34:212-7. [PMID: 19531169 DOI: 10.1111/j.1749-4486.2009.01915.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of this study was to investigate vestibular symptoms and their effect on the balance in otosclerosis patients undergoing stapedotomy operations. DESIGN & SETTING Prospective study at an academic tertiary referral centre. PARTICIPANTS Thirty-three patients undergoing stapedotomy were included in the study. MAIN OUTCOME MEASURES Sensory organisation test (SOT) protocol of computerized dynamic posturography was used to analyse the balance in patients preoperatively, in the first postoperative week and the first postoperative month. Postoperative vestibular symptoms were analysed with a grading system. Audiograms were obtained preoperatively and 1 month after the operation. RESULTS Preoperatively, all patients were asymptomatic when considering the vestibular system; however, eight of them got low SOT scores on vestibular examination. Postoperatively 82% of the patients had vestibular complaints in variable severity. In the first week, all but one patient become asymptomatic. This patient recovered by the end of postoperative second week. However, a significant drop in SOT scores was encountered at the first week testing (Student's T-test, P = 0.001). One month after the operation, all patients were asymptomatic and SOT scores recovered at least to preoperative level. Neither patient characteristics, nor audiological findings were found to be correlated with vestibular changes. CONCLUSION Stapedotomy causes a temporary balance loss in a high percentage of patients which then recover to their former levels in the first postoperative month.
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Affiliation(s)
- A O Ozmen
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Uludağ University, Bursa, Turkey.
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Ozmen S, Danis R, Akin D, Batun S. Anticardiolipin antibodies in hemodialysis patients with hepatitis C and their role in fistula failure. Clin Nephrol 2009; 72:193-198. [PMID: 19761724] [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: 05/28/2023] Open
Abstract
BACKGROUND/AIMS Several conflicting results are presently reported regarding raised IgG and IgM-anticardiolipin antibodies (ACA) titers in hemodialysis (HD) patients and their role in vascular access dysfunction. We aimed to determine the prevalence of both IgM and IgG-ACA titers and to analyze retrospectively their role in primary and secondary arteriovenous fistula (AVF) failure in a homogeneous group of HD patients with chronic hepatitis C. METHODS This study included 103 adults on maintenance hemodialysis with chronic hepatitis C infection. All participants had blood samples drawn predialysis and after an overnight fast. Analysis included biochemistry, IgG and IgM ACA, Anti-HCV, HBsAg, serum HCV RNA and HCV genotyping. RESULTS The prevalence of IgG-ACA was 14.6% (15/103). No patient had a positive value of the IgM-ACA test. HCV replication was detected in 52 of 76 patients. The most common HCV genotype was genotype 1 (90%). The percentage of females was higher in ACA(+) group (p = 0.038). There were no significant differences between subjects with and without ACA-IgG regarding other parameters studied. No difference in regard to AVF survival was detected between ACA(+) and ACA(-) groups (p > 0.05). CONCLUSION We found no significant differences in primary or secondary AVF failure between patients with elevated and normal ACA. Therefore, we conclude that AVFF may be caused by factors other than ACA in these patients. More prospective studies are needed to confirm this observation.
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Affiliation(s)
- S Ozmen
- Department of Nephrology, Dicle University School of Medicine, Diyarbakir, Turkey.
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Abstract
It is often difficult to distinguish acute renal failure clinically from chronic renal failure, especially in patients who do not have records of their medical history. We investigated the magnitude of iPTH increase in ARF and the potential role of iPTH as a marker for differential diagnosis of ARF and CRF in new patients referred to our renal unit. We prospectively analyzed 122 (ARF n = 64, CRF n = 58) patients referred to our renal unit with serum creatinine higher than 2 mg/dL. ROC curve analysis was performed to investigate role of iPTH for differentiating ARF from CRF. The sensitivity, specificity, and positive predictive value of iPTH in discrimination of ARF and CRF were calculated. There was no statistically significant difference regarding the means of age, sex distribution, and serum chemistry between patients with ARF or CRF. But serum iPTH (p < 0.0001) levels were lower in patients with ARF than in those with CRF. A cutoff, set at 170 pg/mL for iPTH to discriminate patients with CRF, yielded a sensitivity of 88% and a specificity of 89%. This study confirms that the iPTH measurement is of clinical value in differentiating acute from chronic renal failure.
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Affiliation(s)
- S Ozmen
- Department of Nephrology, Dicle University School of Medicine, Diyarbakir, Turkey.
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Kirdemir P, Ozmen S, Peker TT, Karaaslan D, Ozorak O, Sari S. 31. Comparison of Intrathecal Levobupivacaine and Levobupivacaine-Morphine for Caesarean Delivery (Randomized Stdy). Reg Anesth Pain Med 2008. [DOI: 10.1136/rapm-00115550-200809001-00259] [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: 11/04/2022]
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Yilmaz S, Bayan K, Tüzün Y, Dursun M, Kaplan A, Ozmen S, Canoruç F, Akkuş Z. Replacement of hystological findings: serum hyaluronic acid for fibrosis, high-sensitive C-reactive protein for necroinflamation in chronic viral hepatitis. Int J Clin Pract 2007; 61:438-43. [PMID: 17313611 DOI: 10.1111/j.1742-1241.2006.00912.x] [Citation(s) in RCA: 12] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Because of limitations in biopsy procedure, several non-invasive tests have been developed for predicting the histological findings in chronic hepatitis. A fibrosis (F) score 1 or above and necroinflammation [histological activity index (HAI)] score 4 or above are required to initiate the treatment in chronic viral hepatitis. Literature includes many studies on hyaluronic acid (HA) as a non-invasive procedure in predicting histological findings but lacks on high-sensitive-C-reactive protein (hsCRP). We evaluated the diagnostic value of HA and hsCRP in patients with chronic viral hepatitis. Ninety-eight subjects (42 chronic viral hepatitis, 28 cirrhosis and 28 healthy controls) were included in the study. Liver biopsies were performed on 42 chronic hepatitis patients and assessed by Ishak scoring system. All sera were stored at -70 degrees C until assay. Many laboratory parameters related to viral hepatitis, HA and hsCRP were studied following the instructions. We tried to determine a cut-off value for HA to represent > or =F1 score and that for hsCRP to represent > or =4 HAI score. Hepatitis B virus was the predominant aetiology of chronic hepatitis in our study. Mean HA levels were 113, 754 and 24 ng/ml in patients with chronic hepatitis, cirrhosis and controls, respectively (anova, p < 0.001). A HA level >64.7 ng/ml had a 100% specificity for diagnosing chronic hepatitis. A value > or =154 ng/ml had a 100% specificity, 100% positive predictive value and 90% negative predictive value for diagnosing liver cirrhosis (Area 1.00; p < 0.0001). A cut-off value of 63 ng/ml for HA had a 100% specificity for diagnosing fibrosis score > or =1 in chronic hepatitis (Area 0.86; p < 0.001). An hsCRP level >0.56 mg/dl had a 100% specificity and 12% sensitivity for diagnosing chronic hepatitis (Area 0.71; p = 0.002), while cut-off of 0.53 mg/dl had 75% specificity for diagnosing HAI > or = 4 in chronic hepatitis (Area 0.32; p = 0.132). This study supported the HA level in predicting fibrosis score > or =1 with a cut-off value of 63 ng/ml. Cut-off of 154 ng/ml had a strong worth for cirrhosis. A cut-off of hsCRP for predicting HAI score > or =4 warrants further evaluation in wider study populations. We concluded that we are a bit closer to the strategy for guiding therapy in patients with chronic hepatitis, without a liver biopsy.
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Affiliation(s)
- S Yilmaz
- Dicle University, Faculty of Medicine, Department of Gastroenterology, 21280 Diyarbakýr, Turkey.
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Ozmen S, Cil T, Atay AE, Tuzcu AK, Bahceci M. A simple way to estimate mean plasma glucose and to identify Type 2 diabetic subjects with poor glycaemic control when a standardized HbA1c assay is not available. Diabet Med 2006; 23:1151-4. [PMID: 16978383 DOI: 10.1111/j.1464-5491.2006.01927.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 11/27/2022]
Abstract
AIMS To evaluate the relationship between HbA(1c) and fasting plasma glucose (FPG) and postprandial plasma glucose (PPG) levels, and to estimate the mean plasma glucose (mPG) derived from FPG and PPG that would predict Type 2 diabetic subjects with poor glycaemic control. METHODS FPG, PPG and HbA(1c) values from 565 Type 2 diabetic patients (247 men and 318 women) were recorded. Linear regression analysis and Pearson's correlation was used to determine the relationship between HbA(1c), FPG and PPG. FPG and PPG were included as explanatory variables of HbA(1c) in linear regression analysis. RESULTS The American Diabetes Association's objective of achieving an HbA(1c) level < 7.0% was obtained in 26.2% of the patients. The coefficients of FPG and PPG which determined HbA(1c) were similar. Therefore, mPG was calculated using the equation (FPG + PPG)/2. Pearson's correlation coefficient for HbA(1c) and FPG, PPG and mPG were 0.723 (P < 0.0001), 0.734 and 0.761 (P < 0.0001), respectively. A mPG cut-off value of 10 mmol/l predicted an HbA(1c) > 7% in the whole population, with a sensitivity of 84.2% and specificity of 80.4%. The area was high (0.90) in receiver-operating characteristic (ROC) curve analysis performed to examine the performance of mPG to predict HbA(1c) > 7%. CONCLUSIONS The mPG derived from FPG and PPG correlates strongly with HbA(1c). We therefore suggest that using a cut-off of 10 mmol/l for mPG may be appropriate in diabetes management in the primary-care setting, where most management of Type 2 diabetes occurs.
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Affiliation(s)
- S Ozmen
- Department of Internal Medicine and Department of Endocrinology, Dicle University School of Medicine, Diyarbakir, Turkey.
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Tuzcu A, Bahceci M, Celen MK, Kilinc N, Ozmen S. NECROTIZING (MALIGNANT) OTITIS EXTERNA: AN UNUSUAL LOCALIZATION OF MUCORMYCOSIS. Indian J Med Microbiol 2006. [DOI: 10.1016/s0255-0857(21)02292-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Ozmen S, Ulusal BG, Ulusal AE, Izycki D, Yoder B, Siemionow M. Trafficking of Donor-Derived Bone Marrow Correlates With Chimerism and Extension of Composite Allograft Survival Across MHC Barrier. Transplant Proc 2006; 38:1625-33. [PMID: 16797371 DOI: 10.1016/j.transproceed.2006.02.154] [Citation(s) in RCA: 9] [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: 09/21/2005] [Indexed: 11/28/2022]
Abstract
We proposed to evaluate differences between recipient's immune response to vascularized skin and combined vascularized skin/bone allografts, under a 7-day alphabeta-TCR plus cyclosporine (CsA) treatment protocol. Thirty-six transplantations were performed in six groups: group I (isograft control-vascularized skin graft; n=6); group II (isograft control-combined vascularized skin/bone graft; n=6); group III (allograft rejection control group-vascularized skin graft; n=6); group IV (allograft rejection control-combined vascularized skin/bone graft; n=6); group V (allograft treatment-vascularized skin graft; n=6); and group VI (allograft treatment-combined vascularized skin/bone graft; n=6). Isograft transplantations were performed between Lewis rats and allografts were transplanted across the MHC barrier from Brown Norway to Lewis rats. In the allograft treatment group, a combined alphabeta-TCR+CsA protocol was applied for 7 days. All groups were compared clinically, immunologically and histologically. Statistical significance was determined with two-tailed Student's t test. Indefinite graft survival was achieved in the isograft control group (>300 days). Allograft rejection controls rejected within 5 to 9 days posttransplant; chimerism levels were undetectable (<.5%). Allografts under the alphabeta-TCR+CsA protocol had significantly extended survival when skin was combined with bone (61-125 days) compared to vascularized skin allografts (43-61 days). Lymphoid macrochimerism was significantly higher in group VI than group V. Histology confirmed skin and bone viability. Combined vascularized skin/bone allografts had higher and sustained levels of donor-specific chimerism and extended allograft survival.
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Affiliation(s)
- S Ozmen
- Department of Plastic Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Abstract
Malignant otitis externa (MOE) is a severe infection of external auditory canal and skull base. A 17-year-old diabetic girl was admitted with diabetic ketoacidosis. Cellulitis of her right ear occurred on the second day of hospitalization and a black necrotic scar in the same region appeared on the next day. The lesion rapidly invaded to right side of neck and surrounding tissue of the patient. Therefore, antimycotic therapy was started. Unfortunately the patient died on seventh day of hospitalization because of probably extensive fungal invasion. Physicians should suspect MOE connected to mucormycosis especially in patients with cutaneous lesions of ear unresponsive to antibiotic therapy.
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Affiliation(s)
- A Tuzcu
- Department of Infectious Diseases, Diyarbakir, Turkey
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Siemionow M, Zielinski M, Ozmen S, Izycki D. Intraosseus Transplantation of Donor-Derived Hematopoietic Stem and Progenitor Cells Induces Donor-Specific Chimerism and Extends Composite Tissue Allograft Survival. Transplant Proc 2005; 37:2303-8. [PMID: 15964405 DOI: 10.1016/j.transproceed.2005.03.127] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [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: 03/11/2005] [Indexed: 11/24/2022]
Abstract
We investigated the effect of the intraosseous allotransplantation of the donor-derived hematopoietic stem cells (HSC) CD90+ on chimerism induction and survival of rat hind limb transplants. Eighteen rat hind limb transplantations were performed between Lewis-Brown-Norway and Lewis rats in three groups. Isograft and allograft rejection controls received no treatment. In the experimental group, 0.8 to 1.2 x 10(6) of separated and purified CD90+ HSC cells were transplanted intramedullary into the bone marrow cavity of the recipient's tibia during opposite hind limb transplantation, without immunosuppressive therapy. Transplants from isograft group survived indefinitely. Allograft controls rejected transplants on day 7 posttransplant. The injection of separated and purified CD90+ cells of the donor origin extended survival of the transplanted limbs up to 15 days in group III. We introduced a novel method of transplantation of the CD90+ cells of the donor origin into the recipient's bone marrow cavity. This technique resulted in extended allograft survival, without immunosuppressive therapy.
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Affiliation(s)
- M Siemionow
- Department of Plastic Surgery A-60, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Affiliation(s)
- N Tomac
- Zonguldak Karaelmas, Universitesi Hastanesi, Cocuk Sagligi Bolumu, Kozlu, Zonguldak, Turkey.
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Cihan A, Mentes BB, Tatlicioglu E, Ozmen S, Leventoglu S, Ucan BH. Modified Limberg flap reconstruction compares favourably with primary repair for pilonidal sinus surgery. ANZ J Surg 2004; 74:238-42. [PMID: 15043735 DOI: 10.1111/j.1445-2197.2004.02951.x] [Citation(s) in RCA: 56] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The present study analyses the results of wide excision with primary closure (PC), wide excision with classical Limberg flap reconstruction (LF) and wide excision with modified Limberg flap reconstruction (MLF) in the surgical treatment of sacrococcygeal pilonidal disease. METHODS One hundred and sixty-two well-documented patients who were operated on for pilonidal disease and followed for more than 1 year were analysed retrospectively. Group 1 was composed of patients with excision plus PC (n = 78) while group 2 included those with excision plus a LF reconstruction (n = 40), and group 3 included those with excision plus a MLF reconstruction (n = 44). RESULTS There were no significant differences among the three groups with respect to age, sex distribution, frequency of recurrent disease, or follow-up periods (P > 0.05 for all comparisons). Significant disadvantages regarding postoperative infection rate, mobilization time, discharge from hospital, and time off work were noted for primary closure, compared with both LF and MLF reconstructions. Following a median follow-up period of 4.2 years, 14 recurrences (17.9%) developed in the PC group, three (7.5%) in the LF group, and none (0%) in the MLF group. The zero recurrence rate in the MLF group was significantly lower than that in the PC group (P = 0.003). On the other hand, the recurrence rate in the LF was not found to differ significantly from that in the PC group (P = 0.126). Comparing the LF and MLF groups, none of the surgical end points reached a statistically significant difference (P > 0.05 for all comparisons). CONCLUSIONS For the surgical treatment of sacrococcygeal pilonidal disease, excision plus a classical or modified Limberg flap reconstruction proved to be superior to excision plus primary closure in terms of infection, mobilization time, discharge from hospital and time off work. Additionally, MLF reconstruction resulted in a statistically lower recurrence rate when compared with PC.
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Affiliation(s)
- Alper Cihan
- Department of Surgery, Zonguldak Karaelmas University Medical School, Ankara, Turkey.
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Altuntas I, Delibas N, Doguc DK, Ozmen S, Gultekin F. Role of reactive oxygen species in organophosphate insecticide phosalone toxicity in erythrocytes in vitro. Toxicol In Vitro 2003; 17:153-7. [PMID: 12650668 DOI: 10.1016/s0887-2333(02)00133-9] [Citation(s) in RCA: 58] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Reactive oxygen species (ROS) caused by organophosphates may be involved in the toxicity of various pesticides. Therefore, in this study we aimed to investigate how an organophosphate insecticide, phosalone, affects lipid peroxidation (LPO) and the antioxidant defence system in vitro. For this purpose, the effects of various doses of phosalone on LPO and the activities of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and catalase (CAT) in erythrocytes were studied. Each phosalone dose was incubated with a previously prepared erythrocyte sample at +4 degrees C for 0, 60 and 180 min. After incubation, the levels of malondialdehyde (MDA) and the activities of SOD, GSH-Px and CAT were determined. Phosalone caused an increase in MDA formation and a decrease in the activities of SOD, GSH-Px and CAT. However, these effects were seen only at extremely high concentrations of phosalone and these concentrations were in the lethal range. Therefore, we suggest that ROS may not involve in the toxic effects of the pesticidal use of phosalone in low concentrations.
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Affiliation(s)
- I Altuntas
- Suleyman Demirel University, School of Medicine, Department of Biochemistry and Clinical Biochemistry, Isparta, Turkey.
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lżycki D, Osawa T, Ozer K, Ozmen S, Mackiewicz J, Siemionow M. 217. Thymic dependence of tolerance in vascularized composite tissue allografts under Cyclosporine A and ab-T Cell Receptor monoclonal antibody protocol. Rep Pract Oncol Radiother 2003. [DOI: 10.1016/s1507-1367(03)70701-9] [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: 10/18/2022] Open
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Ozmen S, Koşar A, Soyupek S, Armağan A, Hoşcan MB, Aydin C. The selection of the regional anaesthesia in the transurethral resection of the prostate (TURP) operation. Int Urol Nephrol 2003; 35:507-12. [PMID: 15198156 DOI: 10.1023/b:urol.0000025616.21293.6c] [Citation(s) in RCA: 14] [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] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of our study was to compare the three different regional anaesthesia methods in patients who underwent transurethral resection of the prostate (TURP) and to determine the ideal anaesthesia method for TURP operation. METHODS Totally 77 ASA II-III patients were preloaded with 500 ml 0.9% NaCl solution before regional anaesthesia. In group E (n:27) epidural anaesthesia were achieved by applying 75 mg bupivacaine heavy + 50 microg fentanyl in the L3-L4 intervertebral space. In group SP (n:28) 15 mg bupivacaine heavy + 50 microg fentanyl were used for spinal anaesthesia (L3-L4 intervertebral space) while in group SA (n:30) 10 mg bupivacaine heavy + 50 microg fentanyl were used with saddle blockade. Systolic arterial pressure (SAP), heart rate (HR), peripheral oxygen saturation (SpO2), serum sodium measurement was recorded before and after hydration and during operation. The motor block and sensory level have been measured. RESULTS Intraoperative SAP values were more stable than the other groups in group SA. The decrease in HR values were significant 15 minutes after prehydration in three groups (p < 0.05). SpO2 values of the groups were stable during the operation. The time to reach the maximum block was very short in patients in Group SA (p < 0.0001). There was a statistically significant difference between the groups in terms of motor block values (p < 0.0001). No fully paralysed sample was seen in Group SA even though there was a sufficient surgical anaesthesia. CONCLUSIONS Saddle block has some advantages compared to spinal and epidural anaesthesia methods such as achieving adequate anaesthesia, stable haemodynami, the lower degree of motor blockage and no full blockage in patients. Saddle block is an the most optimal anaesthesia method for TURP operation.
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Affiliation(s)
- S Ozmen
- Department of Urology, Süleyman Demirel University Faculty of Medicine, Isparta, Turkey
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Iżycki D, Osawa T, Ozmen S, Gozel Ulusal B, Engine Ulusal A, Mackiewicz A, Siemionow M. 215. Vascularized bone marrow transplantation extends survival of vascularized skin allografts. Rep Pract Oncol Radiother 2003. [DOI: 10.1016/s1507-1367(03)70699-3] [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] Open
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Abstract
BACKGROUND The prevalence of allergic disorders has been increasing over the last 30 years, especially in developed countries. One factor associated with this rise may be the decline of many childhood infections. We investigated tuberculin responses in allergic children in order to see the development of delayed-type hypersensitivity reactions to tubercule bacillus infection. METHODS The study sample was composed of 106 allergic and 100 nonallergic children vaccinated with bacille Calmette-Guerin (BCG). The standard Mantoux test was applied to all children. The reactions were read after 72 h by measuring the diameter of the wheal. RESULTS The wheal size was 6.29 +/- 5.09 mm (mean +/- SD) in allergic children, and 2.79 +/- 2.96 mm in nonallergic children. The difference between the two groups was significant (P < 0.001). In children with a single BCG scar, the mean purified protein derivative (PPD) wheal size for allergic children was 4.77 +/- 4.79 mm, and for nonallergic children it was 2.48 +/- 3.19 mm. The mean PPD wheal sizes in allergic and nonallergic children who had been vaccinated twice were 8.35 +/- 4.80 mm and 3.33 +/- 2.44 mm, respectively. This difference was statistically significant (P < 0.05). In 27.35% of the allergic children and 6% of the nonallergic children, the positive tuberculin responses (PPD > or = 10 mm) were recorded. The difference was significant (P < 0.05). CONCLUSIONS Our results showed that response to tuberculin in BCG-immunized allergic children is higher than in BCG-immunized nonallergic children.
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Affiliation(s)
- S Ozmen
- Dr Sami Ulus Children's Hospital, 06080 Telsizler, Ankara, Turkey
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Ozmen S, Yavuz L, Ceylan BG, Tarhan O, Aydin C. Comparison of granisetron with granisetron plus droperidol combination prophylaxis in post-operative nausea and vomiting after laparoscopic cholecystectomy. J Int Med Res 2002; 30:520-4. [PMID: 12449522 DOI: 10.1177/147323000203000508] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 11/16/2022] Open
Abstract
The aim of this study was to evaluate the effects of granisetron and granisetron plus droperidol combination therapy on post-operative nausea and vomiting (PONV) in 60 patients who had undergone elective laparoscopic cholecystectomy. Induction of anaesthesia was achieved using 5 mg/kg thiopentone, 2 micrograms/kg fentanyl and 0.5 mg/kg atracurium, and anaesthesia was maintained with 2-2.5% sevoflurane. The patients were randomly assigned to two groups: group G (granisetron) (n = 30) patients received 3 mg granisetron and group GD (granisetron plus droperidol) (n = 30) patients received 3 mg granisetron and 1.25 mg droperidol shortly before the induction of anaesthesia. PONV incidence was recorded post-operatively at 15 min, 30 min, 60 min, 2 h, 4 h, 12 h and 24 h. While PONV prophylaxis provided almost complete emetic control in patients who received the granisetron plus droperidol combination, patients who received granisetron prophylaxis alone experienced PONV more frequently at 30 min and 60 min post-operatively. We conclude that addition of a low dose of droperidol to granisetron prophylaxis is more effective than granisetron prophylaxis alone for successful control of PONV.
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Affiliation(s)
- S Ozmen
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey.
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Ozmen S, Yavuzer R, Latifoğlu O, Ayhan S, Tuncer S, Yazici I, Atabay K. Specimen radiography: an assessment method for reduction mammaplasty materials. Aesthetic Plast Surg 2001; 25:432-5. [PMID: 11731849 DOI: 10.1007/s00266-001-0011-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Although, one out of every eight women has a risk of developing breast cancer, the reported incidence of breast carcinoma detection in reduction mammaplasty materials is rather low. To our knowledge, specimen radiography, which is used for breast biopsies has not been used for the assessment of breast reduction materials. We investigated the applicability of specimen radiography and its potential benefits in detection of the breast pathologies, especially malignancies in reduction mammaplasty materials. Forty patients scheduled for reduction mammaplasty operation were included. In all cases an inferior pedicle reduction technique was preferred and the radiographs of the resected breast tissues were taken immediately. The radiographs were evaluated for any possible pathologic appearance and all abnormal findings were marked. For the histopathologic evaluation, in addition to the random sampling of the pathologist, any marked areas were also microscopically examined. In two cases fibrocystic changes were found in radiographs and the same results were obtained in the histological examination. No false negative mammogram was seen. Specimen radiography, which is applicable for breast reduction materials is an easy and cheap method and does not cause any patient discomfort. It seems that the radiographs of reduction mammaplasty materials are useful to provide guidance to the pathologist during tissue sampling for microscopic examination especially when large amounts of breast tissue is excised.
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Abstract
Even with excellent operative techniques, prolonged ischemic periods may cause unwanted results because of a complex mechanism called reperfusion injury. Various pharmacological and immunological agents have been used to prevent this type of injury. Another known way to diminish reperfusion injury is the gradual reperfusion of the ischemic tissues. In this study, the effect of a gradual increase in blood flow on ischemia-reperfusion injury of the skeletal muscle was investigated. The right hind limbs of 15 rats were partially amputated, leaving the femoral vessels intact. Preischemic femoral arterial blood flow was measured by using a transonic small-animal blood flowmeter (T106) in all animals. The rats were divided into three groups: Group I consisted of control rats; no ischemia was induced. Group II was the conventional clamp release group. Clamps were applied to the femoral vessels to induce 150 minutes of ischemia. The clamps were then released immediately and postischemic blood flow was measured. Group III was the gradual clamp release group. After 150 minutes of ischemia, clamps were released gradually at a rate so that the blood flow velocity would reach one fourth the mean preischemic value at 30 seconds, one half at 60 seconds, three fourths at 90 seconds, and would reach its preischemic value at 120 seconds. Total clamp release was allowed when blood flow was less than 1.5 fold of the preischemic values. Postoperatively the soleus muscles were evaluated histopathologically, and malonyldialdehyde and myeloperoxidase levels were measured. The mean preischemic blood flow was 13.6 +/- 2.24 ml per kilogram per minute in all groups. In the conventional release group, postischemic flow reached four to five fold its preischemic values (61.06 ml per kilogram per minute). Histopathology revealed more tissue damage in the conventional release group. Malondialdehyde and myeloperoxidase levels were also significantly lower in the gradual release group. Depending on histological and biochemical findings, a gradual increase in blood flow was demonstrated to reduce the intensity of ischemia-reperfusion injury in the soleus muscle of this animal model.
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Affiliation(s)
- S Unal
- Department of Plastic and Reconstructive Surgery, Gazi University Medical Faculty, Ankara, Turkey
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Affiliation(s)
- K Atabay
- Department of Plastic and Reconstructive Surgery, Gazi University, Medical Faculty, Ankara, Turkey
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Yavuzer R, Ozmen S, Cavuşoğlu T, Poyraz A, Süer O. Elastofibroma dorsi. Ann Plast Surg 2000; 45:340-1. [PMID: 10987543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Akyürek N, Ataoğlu O, Cenetoğlu S, Ozmen S, Cavuşoğlu T, Yavuzer R. Pacinian corpuscle hyperplasia coexisting with Dupuytren's contracture. Ann Plast Surg 2000; 45:220-2. [PMID: 10949364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Cenetoğlu S, Ozmen S, Tuncer S, Latifoğlu O, Yavuzer R. Topical lignocaine gel for split-thickness skin graft donor-site pain management. Plast Reconstr Surg 2000; 105:2633. [PMID: 10845334 DOI: 10.1097/00006534-200006000-00075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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