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Open Access
Rotator manşet yırtığı tedavisinde tam artroskopik ve artroskopi yardımlı mini açık teknikle yapılan tamir sonuçlarımız ve bu iki tekniğin karşılaştırılması / Results of all arthroscopic vs arthroscopic assisted mini open rotator cuff tear repair and comparison of these two techniques
(Bezmialem Vakıf University, 2010) DEDEOĞLU, Süleyman Semih; PROF. DR. CEM ZEKİ ESENYEL
Purpose: In our study; In the treatment of rotator cuff tears, we aimed to evaluate the results of repair of arthroscopic and arthroscopic assisted mini open technique, which are the two most commonly used methods in the world and our country, in terms of patient health and country economics. Material and methods: Forty-two patients who were admitted to our outpatient clinic between 2008 and 2010 with shoulder complaints and who were found to have rotator cuffs ruptured at various degrees after the examinations were included in the study. Patients were routinely evaluated by preoperative and postoperative magnetic resonance imaging, supraspinatus outlet x-rays and Constant shoulder scoring system. Results: The Constant Scores averaged 57.35 before surgery and 71.5 after surgery were found in 20 patients who underwent arthroscopic treatment. In this group, the mean duration of operation was 102.6 minutes and the duration of discharge from hospital was 1.27 days. The preoperative mean Constant score was 54.86 and the postoperative Constant Score was 77.181 for 22 patients operated with arthroscopic mini open technique. The average duration of operation was 82.68 minutes while the discharge time from hospital was 1.94 days. Conclusions: We found the clinical and functional results of repair with mini open technique satisfactory. There was no significant difference in terms of deltoid muscle dysfunction when compared with arthroscopic technique. The development of arthroscopic technique facilitating equipment, the progress of surgeons' training curriculum, and the availability of cheaper financials over time will further increase the weight of the arthroscopic surgical treatment in the treatment of rotator cuff tear in the future.
Open Access
Aplanasyon, dinamik kontür ve havalı tonometrelerle göziçi basıncı ölçülmesi: normal ve primer açık açılı glokomlu olgularda karşılaştırmalı çalışma / Intraocular pressure measurement by applanation, dynamic contour and air puff tonometers, comparative study in with POAG and normal cases
(Bezmialem Vakıf University, 2010) ÖZBİLEN, Kemal Turgay; PROF. DR. MEHMET SELİM KOCABORA
Purpose: by the Goldmann applanation (GAT), Dynamic contour (DCT) and Non-contact (NCT) tonometers, healthy and primary open-angle glaucoma (POAG) in patients with intraocular pressure (IOP) and ocular pulse amplitude (OPA) by making measurements of these three methods and among themselves and between the two groups by comparing credibility among their influences parameters and to investigate the clinical significance. Materials and Methods: A prospective and controlled in this study the 32 men(%50), 32 women, 64 patients received the left eye. 33 POAG patients who are under-diagnosed and treated and 31 control. IOP measurement, respectively, NCT, DCT, and GAT do with whether after (CCT) were measured by ultrasonic pachymeter. OPA and All values were recorded. Results: The mean age was 53.36 ± 10 years (31-80), CCT was 561 ± 45 μ, IOP values average 16.39 ± 3.75 mmHg by GAT, 17.89 ± 3.55 mmHg by DCT, 15.76 ±3.49 mmHg by NCT was found and no differences between two groups. The difference of means between DCT and GAT with NCT, while statistically significant, between GAT and NCT was not significant. With all three methods no correlation between age, gender, and the presence of POAG.Positive correlation all three methods between the CCT. In all three methods with each other very well be correlated, the most powerful one was between DCT and GAT. All three methods revealed a correlation between the CCT, it is determined that affected at least DCT seen. Difference in all three methods of thick cornea was created on. At all corneal thickness DCT measurements tend to produce higher GAT and NCT measurements. when corneal thickness increased, the reduction of this difference was seen. DCT on average, 1.51 ± 1.57 mmHg than GAT and 2.14 ± 2.02 mmHg than NCT, GAT 0.63 ± 1.55 mmHg than NCT higher is measured. This difference did not change in the control and POAG patients have seen.OPA found an average of 2.56 ± 1.04 mmHg, did not detect a difference in two groups. While no correlation between OPA and age, and CCT was correlated with IOP values measured by DCT we saw the strongest correlation. OPA in women (2.81 ± 1.16 mmHg) than men (2.30 ± 0.84 mmHg) is higher and this is found to be statistically significant. Conclusion: The DCT is by minimally affected corneal and other factors (age, gender) in direction of 'diagnosis and treatment of glaucoma' important tonometer. in this regard, we can complete lack of GAT and NCT, Compliant patients are easy to use. Provided such data to OPA and diastolic IOP. In practice the IOP threshold values determined by GAT using, DCT is considered if the new threshold determination regarding whether the necessary with a larger population and prospective studies are required have been concluded.
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Parsiyel nefrektomi yapılan böbrek tümörlü olgularda pedikül klempajı ile parenkimal klempajın post-operatif sonuçlarının karşılaştırılması / Comparison of the post-operati̇ve results of pedicular clamping and parenchymal clamping in renal tumors with partial nephrectomy
(Bezmialem Vakıf University, 2010) ARSLAN, Burak
OBJECTİVE: Although partial nephrectomy is the gold standart for <4cm and peripheral tumors, today between 4-7cm in the tumor successfully implemented. Vascular or parenchymal clamping techniques can be performed to decrease bleeding during partial nephrectomy. Our aim is to evaluate the postoperative results of both clamping techniques. MATERIAL AND METHODS : 64 patients with 2-6cm renal mass underwent partial nephrectomy at our institution. Thoracoabdominal incision was made over the 9, 10, 11 or 12. ribs according to the localization of the mass and than rib was removed to get into retroperitoneal space. After Gerota's fascia was opened kidney freed from surrounding tissues. Selective renal parenchymal clamping was performed around the tumor, 1 to 2 cm proximal to the line of resection, using a large bowel clamp. In the other group, a bulldog clamp was placed to renal arteries to control intraoperative bleeding. The prominent intrarenal vessels within the transected parenchyma were suture ligated and when it was entered, the collecting system was closed with continuous sutures. The renal defect was closed on itself using absorbable sutures. All data concerning ischemia time, operative time, estimated blood loss, postoperative serum creatinine and GFR levels were recorded and compared. RESULTS: The study included 64 patients 36 (56.3%) males and 28 (43.8%) were women. The average age of all patients was 55,78 (25-78), the average BMI is 22,44±2,16 (19-27) kg/m² and the mean tumor diameter is 4.1±0.9cm. The median time of selective clamping was 18,42 ±4,06 (8-27)minutes and vascular clamping was 17,94±3,89minutes (8-27). The median operating time and intraoperative blood loss were 87,73±13,56minutes and 377,7±65,5ml (180-510) in parenchymal clamping group, 84,65±12,43minutes and 243,2±80,6ml (100-420) in vascular clamping group. The median pre-op/post-op creatinine and GFR values were 0,80±0,06mg/dl (0,70-0,97), 0,83±0,05mg/dl (0,75-0,98), 95,7±13,7ml/dk/1.73m2 (70-117), 91,8±13,2ml/dk/1.73 m2 (66-116) in parenchymal clamping group and 0,80±0,06mg/dl (0,69-0,98), 0,83±0,05mg/dl (0,70-0,99), 92,9±14,8ml/dk/1.73 m2 (72-116) , 88,7±14,3ml/dk/1.73m2 (68-116) in vascular clamping group. In the long term follow up of patients with lokal recurrence or systemic metastases were not observed. CONCLUSİON: There were no statistically significant differences between the two groups regarding age, BMI, tumor size, surgical margin, postoperative creatinine and GFR, ischemia time and operation time. There was a significantly higher mean blood loss in patients without vascular occlusion.
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Klavikula kırıklarında uygulanan tedavi yöntemlerinin klavikula uzunluğuna ve fonksiyonuna etkisi / The effects of various clavicle fracture treatments on length and functionality
(Bezmialem Vakıf University, 2010) BARIŞ, Alican; DOÇ. DR. TOLGA TÜZÜNER
ABSTRACT Objectives: We evaluated the results of different treatment modalities in the treatment of clavicle fractures in adults. Methods: Forty patients (mean age 37 y) with closed clavicle fractures (30 midshaft, 9 distal and 1 proksimal) were identified. Twenty-seven patients were treated nonoperatively with a sling or figure of eight brace. Thirteen patients (11 midshaft and 2 distal) were treated operatively. The mean follow-up was 22 months( range, 6-48 months). Outcome measurement was complications, clavicular shortening, Constant shoulder score and Disability of the Arm, shoulder and Hand score (DASH). Clavicle length was measured on a computed tomography scan from the lateral end of the clavicle to the sternoclavicular joint. Clavicular shortening was calculated. Results: The avarage amount of clavicular shortening was measured 9,1±5,6 mm in nonoperative group and 3,2±3,7 mm in operative group in comparison to the uninjured side. The mean Constant score was 85±11,8 in nonoperative group and 87,5±7,8 in operative group. The mean DASH skore was calculated 6,3±7,1 in nonoperative group and 5±5,2 in operative group. In 30 patiensts, union was achieved. Malunion occured in six patients and nonunions occured in four patients ( 3 distal and 1 midshaft). There were no nonunions and malunions in operative group. Three patiens had a complication resulting from the surgical procedure. One patient had signs of brachial plexus lesion before surgery. Conclusion: Most midshaft clavicle fractures are effectively treated nonoperatively. the treatment protocol, therefore, is based more on patient comfort and need for return to activities than it is on rates of healing. Type 1 or 3 distal clavicle fractures are usually treated non-operatively by a simple sling. Type 2 fractures require surgery due to the high rate of non-union if conservative treatment is chosen.
Open Access
Torakolomber transpediküler vida ile posterior stabilizasyon uygulanan hastalarda cerrahi alan enfeksiyonu gelişiminin prospektif takibi / Prospective follow-up of surgical site infection in patients undergoing posterior stabilization with thoracolumbar transpedicular screw
(Bezmialem Vakıf University, 2010) EREN, Burak; PROF. DR. FEYZA KARAGÖZ GÜZEY
OBJECTIVE: To determine the rate of surgical site infection in patients who underwent posterior stabilization with thoracolumbar transpedicular screws, to determine the risk factors in the development of surgical site infection, to investigate the effectiveness of bathing the instruments with antibiotic solution in preventing the development of infection. GENERAL INFORMATION: Surgical site infection prolongs the patient's hospital stay and increases morbidity and mortality. When hospital expenses are calculated, a patient who develops osteomyelitis costs at least 4 times more than a patient who is only stabilized. The increase in the use of metal implants in spine surgery in the last 15 years has brought along an increase in postoperative infection rates. In the literature, the frequency of spinal infections after surgery is around 1%, while it has been reported between 1-13% when a metal is used. This reveals that there is a serious relationship between the use of instruments and the development of infection. Staphylococcus aureus is the most common (60%) isolated bacterium in postoperative spinal infections. However, in most cases there is an infection with more than one organism. Bacteria are transported and adhered when implanted on the surface of instruments or during a temporary bacteremia. Microorganisms in biofilm layers cause resistance to both antimicrobial therapy and host defense. Some risk factors have been reported in the literature, such as diabetes mellitus, cardiovascular diseases, advanced age, malignant disease, obesity, trauma, revision surgery, excessive blood loss, use of allografts, and excessive operating room traffic. Laboratory tests used in the follow-up of surgical site infection; leukocyte count, erythrocyte sedimentation rate and C-reactive protein. The incidence of surgical site infection has decreased with the use of prophylactic antibiotics. MATERIAL and METHOD: In this study; 239 patients who underwent posterior stabilization with transpedicular screws between March 2006 and June 2009 in our clinic were prospectively studied for at least 21 days and at most 2 years in terms of infection. Various risk factors were evaluated for each patient. Instruments were applied to 104 selected cases by washing them with Vancomycin HCl - Ceftriaxone disodium hemiheptahydrate dissolved in 200 cc isotonic serum and the effectiveness of this procedure in preventing infection development was investigated. RESULTS and DISCUSSION: The rate of surgical site infection in 239 patients was 12.6% (n: 30). Superficial infection (8.4%) was detected in 20 patients, and deep infection (4.2%) was detected in 10 patients. Patients with a diagnosis of vertebral fracture, patients with a blood sugar of 140 mg / dL and above, patients with first degree diabetic relatives, patients with an additional disease, patients without paraplegic and sphincter control, patients whose surgery lasted longer than 4 hours, patients who used allograft bone chips, patients with more than 1200 cc of instrumentation, patients with dural injury, patients with preoperative hemoglobin value below 12.2 g / dL, patients with urinary catheter for more than 2 days, patients with additional intervention and surgery patients followed up in the intensive care unit; the surgical area was found to be risky for the development of infection. C-reactive protein was found to be elevated in patients with surgical site infections. More than one microorganism was isolated in 12 patients with culture growth. Staphylococcus aureus was observed in 10 patients (45.4%). Wound debridement was performed in 8 (26.7%) of 30 patients with infection. In 4 patients (13.3%), the instrumentation system was removed due to deep infection. One of the 239 cases was lost due to sepsis due to surgical site infection. CONCLUSION: One of the most common and important complications after spine surgery is infections. The goal should be to prevent infection before it occurs. For this, risk factors should be determined and minimized and prophylactic methods should be developed. Today, both clinical and experimental studies are ongoing to prevent infections after spine surgery. In the coming years, the goal should be to develop instruments with better biocompatibility and lower infection rates. In our study, bathing the instruments with antibiotics and applying them to the patient was found to be statistically significant in preventing deep infections.
Open Access
Pterjiyum tedavisinde intraoperatif anti-vegf kullanımı: Bevacizumab ile mitomisin-c uygulamasının karşılaştırmalı çalışması / Pterji̇yum tedavi̇si̇nde i̇ntraoperati̇f anti̇-vegf kullanimi: Bevaci̇zumab i̇le mi̇tomi̇si̇n-c uygulamasinin karşilaştirmali çalişmasi
(Bezmialem Vakıf University, 2010) FAZIL, Korhan; PROF. DR. MEHMET SELİM KOCABORA ; PROF. DR. OSMAN ÇEKİÇ
In this study, it was aimed to compare the effects on the recurrence rates of primary excision surgery together with Mitomisin-C or Anti-VEGF usage on patients that were diagnosed primary pterygium at our clinic. 30 eyes of 30 patients that came and were diagnosed primary pterygium between July 2007 and April 2008 at our clinic were included to the study. Patients that have been diagnosed any ocular disease like glaucoma, vitreoretinal disease or dry eye syndrome and using any ocular medications were excluded from the study. The cases were randomly divided into two equal groups, 15 eyes of 15 patients that were included in the first group were undergone primary excision surgery with intraoperative 0,2 mg/ml Mitomycin-C usage and the other 15 eyes of 15 patients that were included in the second group were undergone primary excision surgery with subconjunctival 2,5mg/0,1ml Bevacizumab (Avastin®, Altuzan®) injection. The patients were examined 1.day, 1.week, 1.month, 3.month, 6.month and 1.year after the surgery. During these examinations, the cases with recurrence and time of recurrence were recorded. The recurrence rates were calculated and statistically compared according to the demographic and clinical properties and the type of surgery that was performed. Statistically homogeneity of two groups was established for age, sexuality and side of the affected eyes (p=0,967-1,00-0,439). The average of follow-up time was 13,9±4,3 months. Any complications were not seen in MMC group, but in BVCZMB group; contraction of wound was seen in 2 patients and suture reaction was seen in 1 patient. Recurrence was seen in 4 patients (%26,7) in MMC group while it was seen in 10 patients (%66,7) in BVCZMB group. The average age of the patients that were seen recurrence in the BVCZMB group was statistically low (p=0,007). When the groups were evaluated separately, there was not seen any statistically meaningful difference between the sexuality and the recurrence rates (p=0,235-0,58). The average time of recurrence was 2,5±0,9 months in MMC group while it was 3,6±1,2 months in BVCZMB group. As a result; primary excision + subconjunctival bevacizumab (PE+BVCZMB) injection does not supply any advantage for recurrence in a longtime period, however it should not be forgetten that PE + BVCZMB can be a preferred method for older patients to clear off the serious complications of PE + MMC method.
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Çok düşük doğum ağırlıklı prematüre bebeklerde farklı tanı yötemleri kullanılarak, maternal D vitamini eksikliğinin prematüre osteopenisi gelişimindeki etkisinin değerlendirilmesi
(Bezmialem Vakıf University, 2010) DURSUN, Mesut
GEREÇ ve YÖNTEM:Çalısmaya, Haziran 2009 ? Ocak 2010 tarihleri arasında Sağlık Bakanlığı?stanbul Bakırköy Kadın Doğum ve Çocuk Hastalıkları Eğitim ve Arastırma Hastanesi2. ve 3. düzey Neonatoloji Servislerinde yatan, 32. GH'ndan önce doğup, doğumağırlıkları < 1500 gr. olan prematüre bebekler dahil edildi. Çalısmaya alınan bebeklerinannelerinin 25-OHD vitamini ile Ca, P ve ALP düzeyleri ölçüldü. Annelerinde 25?OHD vitamini düzeyi <40 nmol/L olan bebekler çalısma grubunu (Grup 1), 25-OHDvitamini düzeyi ?40 nmol/L olan bebekler ise kontrol grubunu (Grup 2) olusturdu. Tümolguların annelerinin perinatal takip bilgileri; bebeklerin doğum sekli, cinsiyet, gebelikhaftası, hastanede yattıkları süre, beslenme sekilleri, aldıkları ilaçlar, geçirdiklerihastalıklar, yoğun bakım ünitesinde kalıs süreleri, mekanik ventilasyon ihtiyaçları ,TPN alım süreleri vb. bilgiler olusturulmus olan çalısma formuna kaydedildi.Bebeklerden doğum sonrası ilk günde serum Ca, P, ALP; 40 GH'ını tamamladıklarındaise serum üre, kreatinin, Ca, P, ALP, GGT, idrar P ve idrar kreatinin düzeyleri çalısıldı,TRP yüzdeleri hesaplandı ve femur grafileri çekilerek bebeklerin kemikmineralizasyonu değerlendirildi.BULGULAR:Çalısmamızda; 1. Grupta, gebelik haftası 24-32 GH arasında, ortalama(30.3±1.23) hafta olan 30 prematüre bebek; 2. Grupta ise gebelik haftası 25?32 GHarasında, ortalama (29,73±1,56) hafta olarak saptanan 30 prematüre bebek yeraldı.Grup-1'deki bebeklerin 16'sı kız, 14'ü erkek cinsiyette olup; 6'sı NSD, 24'ü sezaryen60doğum ile; Grup-2'deki bebeklerin ise 14'ü kız, 16'sı erkek cinsiyette olup; 5'i NSD,25'i sezaryen doğum ile dünyaya geldi. Hastalarımızın doğum sonrası ilk günkü serumCa, P ve ALP değerleri karsılastırıldığında, gruplar arasında Ca ve P düzeyleri açısındanfarklılık saptanmadı. Grup-1'in ALP değerleri, 2. Gruptaki prematürelere göre dahayüksek saptanmakla birlikte bu farklılık istatistiksel olarak anlamlı bulunmadı.Olgularımızın hastanede yattıkları süre içindeki en düsük serum Ca, P konsantrasyonlarıile, en yüksek ALP düzeyleri karsılastırıldığında; iki grubun Ca ve P düzeyleri arasındafarklılık bulunmadığı ancak istatistiksel olarak anlamlı bulunmasa da, 1. gruptakihastaların ALP düzeylerinin 2. gruptaki hastalara göre daha yüksek olduğu saptandı.Prematürelerin 40. gebelik haftasındaki serum Ca, P ve ALP düzeylerikarsılastırıldığında, 1. gruptakilerin P değerlerinin 2. Gruptakilere göre istatistikselolarak daha düsük olduğu görüldü (p: 0,04). Buna karsılık gruplar arasında serum Ca veALP değerleri açısından farklılık saptanmadı. Kırkıncı gebelik haftası TRP değeri >%95saptanan hastaların %71,4'ü Grup-1'de, %28,6'sı Grup-2'de saptandı. Grupların TRPdeğerleri genel olarak karsılastırıldığında ise istatistiksel olarak farklılık bulunmadı.Tubuler fosfat reabsorbsiyonu >%95 olan hastaların uzun süre hastanede kaldıkları(Grup-1'de ort. 44,8 gün, Grup-2'de ort. 49,5 gün), tamamının yoğun bakım ünitesindeyatıp mekanik ventilasyon desteği aldığı öğrenildi. Ayrıca TRP >%95 olan hastaların40. GH serum P değerinin ort. 4,78 mg/dl, ALP düzeyinin ise ort. 694 U/L olduğu;ortalama serum P değerinin TRPsi normal olan hastalara göre daha düsük ve özellikleortalama ALP değerinin ise anlamlı sekilde yüksek olduğu saptandı.SOnUÇ: Osteopeni etiyolojisinde birçok faktör etkendir. Tanıda sık kullanılanCa, P, ALP, vitamin D düzeyi ve radyolojik testlerin güvenirliliği konusunda halatartısmalar olsa da, ALP ve P önemli biyokimyasal parametrelerdendir.Bu çalısmada maternal D vitamini eksikliği olan prematürelerde, osteopenivarlığında alkalen fosfataz yüksekliğinin ve serum fosfor düzeyi düsüklüğünün önemliolduğunu gördük. Tubuler fosfat reabsorbsiyonunun osteopeni tanısında önemli bir tanıyöntemi olduğunu gösterdik. Daha büyük olgu içeren çalısmalarla TRP'nin osteopenigelismesindeki rolü, tanıda önemi, sensivite ve spesifitesi arastırılmalıdır.
Open Access
Hemodiyaliz ve sürekli ayaktan periton diyalizi hastalarında depresyon ve anksiyete bozuklukları, yaşam kaliteleri, cinsel hayatları ve stresle başa çıkma tutumları
(2010) BAYKAN, Hayriye
The aim of this study is to evaluate depression, anxiety disorders, quality of life, sexual life and coping strategies with stress in chronic renal disease patients treated with hemodialysis, continuous ambulatory peritoneal dialysis(CAPD) and healthy control groups . The study sample was composed of patients who were undergoing hemodialysis (n=42) and CAPD (n=41) in Istanbul University, Istanbul Faculty of Medicine Hospital , Istanbul Education and Research Hospital and two private dialysis center. However, 41 healthy person having similar sociodemographic properties with the patient groups were chosen. Firstly we identified psychiatric disorders by using a structured clinical interview for DSM-IV Axis I Diagnosis (SCID-I). Additionally, Hospital Anxiety and Depression Scale (HADS), Short Form-36, Coping Strategies with Stress Inventory, Arizona Sexuel Experiences Scale(ASEX) and Questionnaire for Sociodemographic Information were applied. In this study; according to SCID-I; 59,5% of dialysis patients, 53,7% of CAPD patients and % 26,8 of controls were diagnosed with a psychiatric disorder. The most common disorder was depressiv disorders all of the groups. Although this disorders were mostly seen in hemodialysis patients, there was no statistically significant difference between hemodialysis and CAPD groups in depressive disorders, sexual disfunction and anxiety disorders. According to ASEX; 78,6% of hemodiyalysis and 65,9% of CAPD patients have sexual function disorders. The disfunctional coping strategies that used by hemodialysis patients were significantly higher than CAPD patients. As we assessed the quality of life, physical component scores of CAPD patients were significantly higher than the score of hemodialysis patients. Psychological component scores of CAPD patients were also higher than hemodialysis patients but the difference between the two groups were not statistically significant. Finally, we suggest that psychiatric assesment of these patients is essential to diminish pscyhiciatric morbidity and to enhance of quality of life.
Open Access
Subklinik hipotiroidi nedeni ile ilaç kullanmakta olan hastalarda levotiroksin tedavisinin lipid profili ve vücut kitle indeksi üzerine olan
(Bezmialem Vakıf University, 2011) YETMİŞ, Mikail; PROF. DR. RÜMEYZA KAZANCIOĞLU
Objectives: Subclinical hypothyroidism is defined as a mild elevation in serum thyroid stimulating hormone ( TSH ) level while serum free T4 ( FT4 ) and free T3 ( FT3 ) levels are in reference range. Main problem with these patients is whether they will receive therapy or not. In many studies, positive effects of levothyroxine treatment on serum lipid levels and cardiac functions are shown. In this prospective clinical study, we aimed to evaluate the metabolic changes in the newly diagnosed subclinical hypothyroidism patients who were administred thyroxine.Material and Methods: Sixty-three newly diagnosed patients with subclinical hypothyroidism were included in the study group. Randomly chosen 36 patients receiving therapy constituted the study group while the remaining 27 patients formed the control group and followed without any treatment. Patients were questioned for symptoms and examined thoroughly at the beginning of the study and at the end of thrird month. Thyroid function tests, lipid parameters and bady mass index of the patients were determined both at the beginning and end of the study.Results: There were 32 ( 88.8% ) female, 4 ( 11.2% ) male patients; mean values of age and BMI were 44.66±13.34 years and 29.96±5.99 kg/m², respectively the control group had 23 (85.2%) female, 4 ( 14.8% ) male patients; Their mean values of age and BMI were 42.51±11.66 years and 30.68±5.61 kg/m², respectively.Mean TSH levels and mean fT3 levels were significantly decreased in the third month with respect to the beginning in patients receiving treatment when compared to the control group. In the beginning mean levels of serum LDL cholesterol were 127.55±44.69 mg/dl, and 112.37±30.43 mg/dl in the study and control groups. Mean LDL cholesterol level showed a significant increase in the control group during three months ( p=0.041 ).Conclusions: In this study, we found that the symptoms of clinical hypothyroidism mostly existed in patients with subclinical hypothyroidism, and clinical and metabolic parameters improved with levothyroxine therapy.
Open Access
Radikal prostatektomi operasyonunda rabdoid sfinkterden geçilen sütürün inkontinans üzerine olan etkisi / The effect of suture which crossed the rhabdoid sphicter during radical prostatectomy on the patient's continency
(Bezmialem Vakıf University, 2011) TOPAKTAŞ, Ramazan; Prof. Dr. Şinasi Yavuz ÖNOL
Objective: The success of radical retropubic prostatectomy (RRP) depends on effective control of the deep venous complex, preservation of neurovascular bundles when necessary and water-tight and wide urethrovesical anastomosis. Including rhabdosphincter in the vesicourethral anastomosis, where striated sphincter is fixed to the bladder neck, not only prevents caudal retraction of the urethra but also provides more anatomically position. The aim of this study was to define the continence status in patients where rhabdosphincter was included in the vesicourethral anastomosis.Materials and Methods: Between November 2004 and September 2010, 90 cases who underwent RRP by the same surgeon in our clinic were taken into the study. The mean age of patients was 64.3 years (range 51-78). In all cases, during RRP vesicourethral anastomosis was performed include the rhabdosphincter. The anastomosis was performed with mean 2,9 (0-7) interrupted no.2-0 vicryl sutures, depending on the angulation of symphisis pubis and pelvic cavity. All patients preoperatively had total prostatic specific antigen level (tPSA), prostate biopsy accompanied by transrectal ultrasound (TRUS-Bx) and bone scintigraphy. Intraoperative and postoperative parameters were considered blood loss, operation time, hospitalization,time to drain removal and pathological examination. Pad test was performed to all patients at 1, 3, 6 and 12 months postoperatively. We defined patients as `continent? when they no need pad, as `mild incontinence? when they use only one pad daily, as `moderate incontinence? when they use two or three pads daily and as `severe incontinence? when they use more than three pads daily.Results: Preoperative total PSA value was 12,2 ng/ml ( range: 2,7- 84 ng/ml ). Preoperative TRUS-Bx results were found that Gleason scores were 5, 6, 7 and 8 in 7, 53, 21, 9 patients, respectively. Intraoperative mean blood loss was 780 ml. (150-3500). Mean operation time was 103 minutes (60-200). Mean hospital stay was 4,6 days(2-20) and mean urethral catheter removal time was 14,6 days (9-28). Postoperative pathology results were found that Gleason scores were 5, 6, 7 and 8 in 5, 43, 32, 10 patients, respectively. According to results of postoperative pad tests, 38, 48, 55 and 75 patients were defined as continent in first, third, sixth and twelfth months, respectively.Conclusion: We think that, our novel technique of vesicourethral anastomosis in standard RRP provides more optimal urethral position during fixation of pelvic floor and urethra, protect caudal retraction, preserve functional urethral lenght. Also strong fullthickness stitch on urethra provides better urinary continence by hanging urethra in our patients. Although our early continence rate is better, our long term continence rate is similar to literature.
Open Access
Resveratrolün sıçan random deri fleplerinin yaşayabilirliği üzerine etkisi: Deneysel çalışma
(2011) Akpınar, Ali Cem
Random paternli cilt flepleri doku defektlerinin kapatılması amacıyla plastik cerrahide sık kullanılır. Flep boyu uzadıkça, flep vaskülaritesini etkileyecek bir travma varlığında ve/veya flep planlamasının hatalı yapıldığı durumlarda flebin kan akımı kritik düzeylere düşebilir. Flep yaşayabilirliğini arttırmak için sempatolitik, direkt vazodilatatör, antitrombotik ve antikoagülan ajan kullanımı, kanın reolojik özelliklerini değiştirme, antioksidan ilaçlar kullanılması gibi yaklaşımlar mevcuttur. İskemiye maruz kalan bölgede serbest oksijen radikalleri ve nötrofil birikimi doku hasarına neden olur. Oluşan toksisiteyi önlemek için bir çok çalışma yapılmıştır. Resveratrol, bitkiler tarafından travmatik zedelenme veya fungal saldırılara karşı sentezlenir. Yapılan çalışmalarda resveratrolün anti-agregan, anti-oksidan, anti-enflammatuar ve vazodilatasyon etkileri olduğu bildirilmiştir. Bu etkileri göz önüne alınarak resveratrolün flep yaşayabilirliğini arttıracağı düşünülerek çalışma planlandı. Resveratrolün flep yaşayabilirliğini olumlu yönde etkilediğinin gösterilmesi ile ilacın insana uygulanması mümkün olacaktır.Bu çalışma İstanbul Üniversitesi Deneysel Tıp Araştırma Enstitüsü'nde yapıldı. Deney hayvanı olarak 24 adet Sprague-Dawley cinsi erişkin dişi sıçan kullanıldı. Sıçanlar 8'er adetten oluşan üç gruba ayrıldı. Sıçanlara flep kaldırma işlemi uygulandı. İlk dozu cerrahi işlemden 1 saat önce olmak üzere toplam 7 gün boyunca intraperitoneal yoldan günde 1 kez verilmek üzere 1.gruba izotonik NaCl, 2.gruba Dimetilsülfoksit(DMSO), 3.gruba DMSO'da çözdürülmüş 1 mg/kg resveratrol enjekte edildi. Postoperatif 7. günde sıçanların sırt bölgesindeki flepler dijital fotoğraf makinesi ile fotoğraflandı. Nekroz alanının flep boyutuna oranı Adobe Photoshop CS2 programı ile hesaplandı. Postoperatif 7. günde doku örnekleri alındı ve bütün hayvanlara ötenazi uygulandı. Histopatolojik incelemede birim alandaki kapiller ve enflamatuar hücre sayımı yapıldı. Sonuçlar Mann Whitney U testi ve ANOVA Varyans analizi ile değerlendirildi.Bütün sıçanlar deney sonuna kadar canlı kaldı. Operasyon sonrası 7. günde bütün fleplerde nekroz hattı belirgin şekilde oluştu. Flep canlı alanı pembe-beyaz renkte ve normal tonusta iken nekroz bölgesi siyah renkte ve sert idi. Postoperatif 7. gün yapılan yaşayabilirlik değerlendirmesinde resveratrol grubunun yaşayan flep oranının kontrol gruplarına göre istatistiksel olarak anlamlı şekilde yüksek olduğu görüldü. Histopatolojik olarak da resveratrol grubunda kontrol gruplarına göre istatistiksel olarak anlamlı derecede birim alanda daha fazla kapiller, daha az enflammatuar hücre olduğu bulundu.Çalışmamızda preoperatif başlanan ve postoperatif 7 gün boyunca devam edilen 1 mg/kg sistemik resveratrol uygulamasının flep yaşayabilirliğini arttırdığı gösterilmiştir. Flep cerrahisi planlanan hastalara operasyon öncesi ve sonrası sistemik resveratrol uygulaması ile komplikasyonların, hastanede yatış süresinin, ek cerrahi girişimlerin azalacağı düşünülmektedir.
Open Access
Kasık fıtığı onarımında kullanılan total ekstra peritoneal (TEP) onarım tekniğinde preperitoneal alanın disseksiyonunda balonlu ve balonsuz diseksiyon yöntemlerinin karşılaştırılması
(2011) BİROL, Selim
BAKGROUND AND PURPOSE: Despite being costly use of dissection balon inTotal Ekstra Peritoneal (TEP) inguinal hernia operation is widely accepted and is believed to ease the operation. In this prospective randomized trial we aimed to define ,if any, the superiorities of balon dissection of preperitoneal space against non-baloon blunt endıcamera dissection.PATIENTS AND METHODS: Totally 40 patients, 20 of whom were randomized in Baloon Dissection group , and the rest in Camera Dissection grup undervent unilateral TEP inguinal hernia repair. Demographic data like age, sex, height, weight, BMI, distance between SIASs, and distance between pubic bne and umilicus were recorded. All the TEP operations were videorecorded from beginning to end. Early and late postoperative pain assessement were carried out through VAS. Intraoperative complications like bleeding,peritoneal laceration, conversion to open surgery, and objective surgical difficulty scale points were recorded.The timing of seeing the epigastric vessesls, pubic bone, peritoneal dissection time, peritonel reduction time and mesh placement time were recording according to the video records. Postoperative complications like hematoma,seroma,chronic groin pain,reccurence,infection and total postoperative control number were recorded. Lastly the total cost per patient between two groups was analysed.RESULT: No statistical difference was recorded between the parameters mentioned above but cost. Cost was statistically low in the Camera Dissection group (p<0,0001).CONCLUSION: Looking trough all the parametres mentioned before, it is understood that baloon dissection adds no benefit over Camera dissection except increasing the cost significantly. Morever Balon dissection did not add any extra peroperative or postoperative risk nor complication comparing to Baloon dissection. The objective surgical difficulty scale for tep points were also very close that enforces our thougt that both methods are identical excluding the hight cost of the dissection baloon. Considering all the results we advocate camera dissection comparing the baloon method.
Open Access
Rotavirus gastroenteriti olan çocuklarda iki farklı probiyotiğin etkinliklerinin karşılaştırılması / The comparision of the efficiency of two different probiotics in rotavirus gastroenteritis in children
(Bezmialem Vakıf University, 2011) ERDOĞAN, Özlem; YRD. DOÇ. DR. BİLGE TANYERİ
PURPOSE: The aim of the study is to compare the clinical efficiency of most frequently usedprobiotics Saccharomyces boulardii and Bifidobacterium lactis in children between 6 monthsand 5 years of age with a diagnosis of rotavirus gastroenteritis.MATERIALS AND METHODS: The children, between 6 months-5 years of age, were admitted to pediatric emergency unit with a diagnosis of rotavirus gastroenteritis, were included in the study. The study was conducted between 01.09.2009- 01.05.2010. The patients' demographics, medical history, the symptoms associated with gastroenteritis (frequency of diarrhea, stool characteristics consistency and vomitting), nutritional status, degree of dehydration, oral tolerance were recorded.Patients were divided into 3 groups: Group I, age-appropriate diarrhea diet and Saccharomyces boulardii were given (n:25); Group II, age-appropriate diarrhea diet and Bifidobacterium lactis were given (n:25); and Group III, age-appropriate diarrhea diet were given (n:25).RESULTSeventy five patients, who had rotavirus gastroenteritis were included in the study. The median age of patients was 20.9 ± 2.9 months. The gender distributation was males 49.3% (n:37). The rotavirus gastroenteritis were frequently seen in winter months.(62.7 %, n: 47).Ninety three percent (n:70) of the patients were not vaccinated with rotavirus vaccineThe duration of diarrhea was shorter in the group I (p<0.05). Hospitalization rates and vomitting were higher in the group II (p<0.05). CONCLUSION: In this study the authors compared frequently used probiotics, Saccharomyces boulardii and Bifidobacterium lactis, which are widely used in rotavirus gastroenteritis. The authors found that the durations of diarrhea were shorter in the group treated with Bifidobacterium lactis, and the hospitalization rates and vomiting were higher in the group treated with Saccharomyces boulardii.As a conclusion, although some type of probiotics frequently used in the treatment of rotavirus gastroenteritis may have a complemental role and some type of probiotics may not have a beneficial effect. Further studies shoud be done to detect which probiotics may be used as a complemantary treatment in rotavirus gastroenteritis.
Open Access
Altmış yaş üstü hastalarda kronik hastalıkların malnutrisyona etkisi / The effect of chronic ilnesses on malnutrition in elderly patients over sixty age
(Bezmialem Vakıf University, 2011) UĞUR, Aycan; DOÇ. DR. AHMET TURAN IŞIK
Aim: The aim of this study is to evaluate the nutritional status of the elder patients with chronic diseases, their tendency to malnutrition and the association between chronic illnessess and malnutrition.Materials and Methods: Elderly (60 years and older) patients (125 male, 187 female, total 312) hospitalized between April to September 2011 for different chronic diseases included this cross-sectional study. The nutritional status of the each patient was graded with Mini Nutritional Assessment Short Form (MNA-SF). Biological measurements included serum albumin, glucose, sodium, potassium, calcium, blood urea nitrogen, creatinine, lipid profile, thyroid functio tests. Weigth, heigth, waist and hip circumference were measured and body mass index was calculated. The age, gender, marital status, and living region of the patients were also recorded.Results: Patients with MNA?10 were older, had lower waist circumference, waist to hip ratio, and BMI; decreased serum albumin, sodium, potassium, calcium, free T3 levels and higher vitamin B12 and BUN (p<0.001). Also serum total cholesterol (p=0.029) and triglyceride (p=0.032) levels were decreased in these patients. Patients with chronic renal insufficiency and congestive heart failure (CHF) had lower MNA-SF scores. In multivariate logistic regression analysis with 24 independent variables, age, dementia, CHF, vitamine B12 and albumin levels were significantly related with MNA-SF score.Conclusion: The short form of MNA is a feasible, cost effective and practical method to assess nutritional status. Especially in patients with dementia and CHF, close monitorisation of nutrition and energy balance is crucial.
Open Access
Yerleşmiş romatoid artrit hastalarında kardiyovasküler risk ile fonksiyonel yetersizlik ve hastalık aktivitesi arasındaki ilişki
(Bezmialem Vakıf University, 2011) YAZGAN UMUT, Saadet; PROF. DR. MUSTAFA GÜLER
Rheumatoid arthritis (RA) is a systemic autoimmune disease which results in functional insufficiency and disability. Stabile angina, coroner arter diseases, myocardial infarction, congestive hearth failure and stroke are the mostly seen causes of mortality and morbidity in RA. The cause of death in %40-50 of RA patients is cardiovascular disease. It was shown that because of the chronic inflammation and immunological abnormalities, the cardiovascular disease prevalance is higher in chronic RA compaired to early and moderate RA. Using the Framingham score, the primary aim of this study was to determine the cardiovascular risk in patients with RA and its correlation with disease activity and functional ability. The secondary aim of the study was to compare the Ra patients with the control group by the meaning of Framingham risk score and cardiovascular risk.A total of 74 patients participated in this cross-sectional study. All of the RA patients were recruited from the rheumatoid arthritis outpatient clinic of Bezmialem Vakif University Hospital who were regularly followed-up. All of them fullfilled the American College of Rheumatology criteria for the classification of rheumatoid arthritis. A total of 39 subjects without inflammatory athritis were included to our study as Control grup. Framingam score was calculated by evaluating the the age, smoking, diabetes, cholesterol and blood pressure measurements. DAS-28 (Diseae Activity Score-28) was used for evaluating disease activity and HAQ (Health Assesment Quastionnaire) for evaluating the functional ability in our patients.We couldn?t find any significant difference between the case and control groups by meaning of Framingham score. The mean of ESR (erythrocyte sedimentation rate) and blood pressure of participants in study group was significiantly higher than those of control group.There was not any significant difference by the meaning of CRP (C-Reactive Protein) and cholesterol level between th groups. The mean DAS-28 was 3,855 ± 1,224 and the mean HAQ was 0,642 ± 0,705 in case group. DAS-28, HAQ, CRP, ESR and disease duration were not significantly correlated with Framingham score.For the patients who have inflammatory arthritis, besides to traditional risk factors, new risk score calculation that consists of other disease spesific risk factors are needed. By extending the sample size and by designing the prospective studies, statistically more significant results will be achieved.
Open Access
Ağrıyla ilişkili sakatlık indeksinin Türkçe sürümünün geçerlilik ve güveniirliği / Validation and reliability of the Turkish version of the Pain disability index
(Bezmialem Vakıf University, 2011) ASLANBAŞ, Çağlayan; DOÇ. DR. TEOMAN AYDIN
The purpose of the present study was to adapt the Pain Disability Index (PDI) to Turkish population and assess the reliability and validity of the adapted Turkish version. In this regard, 151 patients who were admitted to our outpatient clinic with symptomatic knee OA was included in our study. The diagnosis of OA was based on the American College of Rheumatology (ACR) criteria. The sociodemographic features of the patients have been determined. Detailed physical examinations of the all patients were done by the same Physical Medicine and Rehabilitation doctor. The knee x-ray?s of the patients were evaluated with the Kellgren- Lawrence grading system. The pain severity at rest, in motion and at physical examination was determined by using visual analogue scale. All the participants have read and filled out the PDI, the WOMAC, and the SF-36 under the same doctor supervision. To show test-retest reliability, 103 of the participants were tested again with the adapted Turkish version of the PDI, 5 days later. The reliability of the adapted version was excellent with high internal consistency and test-retest reliability. In the analysis for validity, a high correlation between the similar sub-scales of both the SF-36 and the WOMAC to the PDI was found. In conclusion, the present study indicates that Turkish version of the PDI is highly reliable and valid.
Open Access
0-6 yaş grubu çocuklarda el yaralanmalarının retrospektif analizi: Klinik çalışma / Retrospective analysis of hand injuries in children aged between 0 and 6 years: Clinical study
(Bezmialem Vakıf University, 2011) ÖZDEMİR, Azimet; PROF. DR. ETHEM GÜNEREN
Hand injuries occur with a yearly increasing rate in the modern century and constituteapproximately 1/5 of the patients referring to emergency departments. There are only a few studiesin the literature regarding the analysis of hand injuries, risk of injury, possible precautions andtreatment approaches in the group of 0-6 years of age.507 children within the group of 0-6 years of age, who were treated for hand injuries in ourclinic from January 2006 to January 2011 were retrospectively investigated in our study. Cases wereevaluated with regards to the type of injury, the underlying reason, location, treatment approachand the outcomes. The reasons were crush and compression (55%), sharp objects (31,5%), burn(6,4%), falling (3,1%), foreign body (1,8%), forearm injuries (1,3%) and infections (0,8%).368 cases (72,6%) were domestic and 139 (27,4%) were outdoor injuries. Injuries were morefrequent (76%) in spring and summer. More injuries (80%) had occured between 14:00-20:00compared to other times of the day. Incidence of affected right/left hand was 2/1.321 of the cases (63,5%) were simple injuries while 185 (36,5%) were complex.14% of the cases received in-hospital treatment. 88.5% underwent surgery under emergencyconditions and 11,5% had elective surgery. Fingertip injuries were observed in 75,3% (382 cases) ofthe cases. The most common reason of these injuries was the finger being caught in a door.Among these, 32,3% (164 cases) were restored with primary suture, 43% (218 cases) hadnail-bed repair, 1,3% (7 cases) had foreign body extraction, 4,6% (23 cases) received composite graft,18,6% (94) were restored with local flap.It is known that there are only a few studies in the literature on hand injuries within thegroup of 0-6 years of age. Our study aimed to not only provide an analysis of the injuries in this agegroup but also aimed to constitute a database for the possible risk factors and the related protectionmethods.Accidents have been demonstrated as one of the major reasons of disability and death in thegroup of 0-6 years of age. Despite the variations among geographic groups and age groups, indooraccidents constitute 25% of all accidents. In a study conducted in our country, this rate was found tobe 18-25%. In another study including the group of 1-7 years of age, one third of the children werereported to have had a domestic accident within the recent year.Key Words: 0-6 Years of Age, Hand Injuries, Retrospective Study.
Open Access
Benign prostat hiperplazisi nedeniyle yapılan transvezikal prostatektomi ve transüretral prostatektomi' nin hastaların preoperatif ve postoperatif prostat spesifik antijen düzeylerine bakılarak cerrahi etkinliklerinin karşılaştırılması / Comparison of surgical efficiency by assesing preoperative and postoperative prostate specific antigen levels in whom transurethral and transvesical prostatectomy were performed due to benign prostatic hyperplasia
(Bezmialem Vakıf University, 2011) POLAT, Emre Can; Prof. Dr. Şinasi Yavuz ÖNOL
Objective: To investigate the correlation between extracted tissue amount and prostate specific antigen (PSA) decline in benign prostatic hyperplasia (BPH) patients treated with transvesical prostatectomy (TVP) and transurethral resection of prostate (TURP) and also to determine baseline PSA levels for prostate cancer screening whom underwent these procedures for benign diseases.Materials and methods: Between May 2008 and April 2011, a total of 214 patients who underwent TVP (n:79) and TURP (n:135) with histopathologically, diagnosis of BPH was confirmed were enrolled to the study. The mean age of patients was 68.2 years (50-86) in TVP group and 65.7 years (50-79) in TURP group. All patients had rectal examination, serum total and free PSA levels measurement, transrectal ultrasonography (TRUS), uroflowmeter, and International Prostate Symptom Scoring before the operation. In the postoperative3rd month, the PSA measurement was repeated, and the correlation between the decrease in total and free PSA levels and the amount of tissue resected during the procedure was investigated.Resuts: Before the procedure the prostate weight measured with TRUS was 86.3 ± 50.7 g in TVP group and 44.8 ± 15.4 g in TURP group (p < 0.001). The mean total PSA was 7,3 ± 6,1 ng/ml, free PSA was 1.4 ± 1,3 ng/ml in TVP group and the mean total PSA was 2,9 ± 2,1 ng/ml, free PSA was 0,7 ± 0,4 ng/ml in TURP group. The mean weight of prostate enucleated with TVP was 70.6 ± 33.3 g and the mean weight of prostate resected with TURP was 23.2 ± 8.8 g (p < 0.001). In the postoperative 3rd month, the mean total PSA level was 1.6 ± 1.4 ng/ml, the free PSA level was 0.4 ± 0.3 ng/ml in TVP group and the mean total PSA level was 1.4 ± 1.1 ng/ml, the free PSA level was 0,3 ± 0,2 ng/ml in TURP group. In both TVP and TURP group a positive correlation between the amount of tissue extracted and the total-free PSA levels before and after the procedure was detected. In TVP group mean enucleated prostate volume was 81.4%. The decrease in total and free PSA levels was 79% and 58%, respectively. In TURP group mean resected prostate volume was 52%. The decrease in total and free PSA levels was 47% and 42%, respectively. For 1 g of prostate mass enucleated in TVP group, the total and free PSA levels decreased 0,145 ng/ml and 0,03 ng/ml, respectively. In TURP group for 1 g of prostate mass resected, the total and free PSA levels decreased 0,103 ng/ml and 0,013 ng/ml, respectively.Conclusion: Total-free PSA levels decrease with the amount of tissue extracted during TVP and TURP in BPH patients. More adenoma tissue was significantly extracted in TVP groupand the decrease of PSA per gram of tissue after TVP was more than TURP group. This is the indication of that radical resection concept is not realistic and transitional zone can only be enucleated completely in TVP group.In line with the literature in terms of post-TURP prostate adenocarcinoma PSA cut-off value of 2 ng /ml might be taken and we should be careful at the much lower levels of PSA after TVP.
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Üniversal titanyum protez ile ossiküler rekonstrüksiyonda erken dönem sonuçlarımız / Our early results of ossicular reconstruction by universal titanium prostheses
(Bezmialem Vakıf University, 2011) ÇALIM, Ömer Faruk
Our aim is to evaluate effects of operation procedures, scheduling, ossicular chain damages, presence of cholesteatoma and preoperative Middle Ear Risk Index (MERI) scores on postoperative hearing results. This paper is based on twenty-two patients, all of whom had ossiculoplasty at Vakif Gureba Training and Research Hospital Department of Otorhinolaryngology between September 2008 and October 2010. Three patients were excluded from the study, due to prosthesis extrusion and cholesteatoma recurrence. As a result, the evaluations were performed on the remaining nineteen patients. The time interval of patients follow-up was between six to twenty-five months with a mean of 16.26. The mean age of the patients was 32,21±8,75 years, ages varying from 17 to 51 years. Seven of the patients had cholesteatoma. Canal wall down (CWD) technique was performed to three patients, while canal wall up (CWU) technique was performed to sixteen. Eleven patients had CWU with mastoidectomy; remaining five patients had CWU without mastoidectomy. Total ossicular reconstruction was performed to 13 patients and partial ossicular reconstruction was performed to six patients. Universal titanium total ossicular reconstruction prosthesis (TORP) and partial ossicular reconstruction prosthesis (PORP) were used as ossiculoplasty materials. The mean air-bone gap of the patients were calculated at 0.5., 1., 2., and 4. kHz frequencies. Postoperative air-bone gap (ABG) of 20 dB or below was used as functional success criteria. Also in the study, hearing gains and ABG gains were calculated. In statistical analysis; variance was used in evaluating continuous variables. Kruskal Wallis and Mann Whitney U tests were used in evaluating the differences between variables among non-normal groups. On the other hand, the chi-square test was used in categorical comparisons. In addition, a P value of less than 0.05 was considered significant. In this study, ABG ≤20 dB was found in four (21.1%) cases, ABG 21-30 dB in seven (36.8%) cases and ABG ≥ 31 dB in eight (47.1%) cases in the postoperative sixth month. In the PORP group, ABG ≤20 dB was found in one (16.7%) cases, and ABG ≤30 dB in six (100%) cases. In the TORP group, ABG ≤20 dB was found in three (23.1%) cases, ABG ≤30 dB in five (38.5%) cases, and ABG ≥31 dB in eight (61.5%) cases. ABG gains and hearing gains were significant high in the patients, who had PORP as compared to TORP in the postoperative sixth month. On the other hand, ABG values did not have significant differences between the prosthesis. ABG gains were significant high in the patients, who had CWU with and without mastoidectomy when compared to the patients, who had CWD mastoidectomy in the postoperative sixth month. Also, the patients who had malleus handle had better ABG, ABG gain and hearing gain results. The postoperative sixth and twelve month ABG gains were significantly higher in stapes suprastructure group than the stapes suprastructure-missing group. In addition, postoperative ABG had better results in revision surgery than in the staged surgery. Statistically significant difference was not found between the operation scheduling groups, due to small number of the patients. However; the results were close to the level of significance. In the the postoperative sixth month ABG and air-conduction results were better in chronic otitis with cholesteatoma group as compared to chronic otitis without cholesteatoma group. ABG<30 dB ratio was 100% in the patients with mild MERI scores (1-3), 87.5% in the patients with moderate MERI scores (4-6) and 12.5% in the patients with severe MERI scores (7-12). It was found a correlation between postoperative sixth month ABG and the grade of preoperative MERI. Postoperative ABG values marked a rise with increasing of the MERI scores. Two patients had an extrusion of the prostheses (9%) because of recurrent middle ear disease. Cholesteatoma recurrence was observed in one patient (4.5%), as a result open cavity procedure was performed and the prosthesis was taken out. Revision surgery was performed for four (%18) cases, because of prosthesis dislocation. Retraction was determined in three (13.5%) cases. Eight cases with severe MERI risk scores had complications. Two cases with moderate MERI risk scores developed retraction. None of the cases had sensorineural hearing loss. When compared to the preoperative evaluations, significant decreases was observed in bone conduction response at 1., 2., and 4. kHz. in the postoperative 12th months of the study. As a result, it was seen that according to the success rates in ossiculoplasty interventions; CWU technique was more successful than CWD technique and so was partial ossicular reconstruction than total ossicular reconstruction. The postoperative hearing success rates were affected by; preoperative MERI scores, presence of cholesteatoma, malleus handle and stapes suprastructure. The results between the operations scheduling were close to the level of significance. Success of hearing reconstruction is affected by preoperative middle ear factors. Preoperative MERI scores may lead surgery and may lead to case-specific strategy for each patient. In conclusion; persistent and recurrent abnormalities within the middle ear should be considered as the most important reason for failure. In addition, staged surgery should be preferred, and ossicular chain reconstruction should be planned after decreasing MERI risk scores.
Open Access
Sıçanlarda silikon implant etrafında kapsül oluşumuna otojen yağ dokudan elde edilen mezenkimal kök hücrelerin etkisinin araştırılması: Sıçan modelinde deneysel çalışma / An experimental study in a rat model: The research of the effect of mesenchymal stem cells derived from autogenous fat tissue to the capsule formation around silicone implants
(Bezmialem Vakıf University, 2011) YOĞUN, Fatma Nilay; YRD. DOÇ. DR. MEHMET VELİ KARAALTIN
In this study, the effect of mesenchymal stem cells that derived from autogenous fat tissue to the capsule formation around silicone implants has been searched.16 Wistar Albino rats, weight of 270-310 gr, were used for the study. The subjects are divided into equal groups as experiment group (Group II) and control group (Group I). Subcutaneous silicone implants was placed in the pectoral area of all rats in both groups by opening a pouch for implant. While it was not used an additional therapy for Group I, it was injected a suspension containing 40 million cells / cc to the pouch where the silicone implant placed in Group II. All implants excised at the postoperative 8th week from both groups. Capsule formation removed totally and took histopathological examination.Samples were examined by histology specialist: Morphometric evaluation with volumetric measurement of capsules thickness, evaluation of the amount of collagen-procollagen, light microscopy with Masson Trichrome dyeing. In morphometric evaluation of capsule thickness there was a significant difference between Group I and Group II (p<0,032). In Group II the amount of procollagen- collagen was lower than Group I. In light microscopy neoangiogenesis in Group II higher than Group I.In this study it is founded that the use of 40 million cells/cc mesenchymal stem cells reduce the capsule formation around the silicone implant and the silicone implant does not form foreign body reaction.

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