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Biomedical subjects

S Unal

Publications and source records attributed to S Unal.

At least 55 records · Page 3Linked to original sources
PubMed2000

Prevention of meatal stenosis with W-flap glanuloplasty in hypospadias surgery: a long-term follow-up.

Meatal stenosis is a complication that can occur after hypospadias surgery. Although there are many different surgical techniques that can solve this problem, once it has occurred, meatal stenosis can be difficult to treat. To decrease meatal stenosis risk and to achieve an anatomically placed, aesthetically pleasing meatal opening, a new W flap was designed for glanuloplasty. The authors describe the technique in detail along with long-term results. A total of 356 hypospadias cases were operated using various urethroplasty methods. Independent from the preferred urethroplasty method, the W-flap was used for glanuloplasty in all patients. Patients were followed for 1 to 10 years. Meatal stenosis incidence was 0.8%, and good cosmetic results with a natural-looking, anatomically placed meatus and a well-directed urinary stream during urination were achieved. W-flap glanuloplasty, an addition to reconstructive surgeons' armamentarium, is applicable to most patients. It places the meatus in its appropriate anatomic location, increases the meatal diameter by insetting two flaps, avoids a circular anastomosis, reduces the risk of late contraction, helps to achieve good aesthetic results with good urinary stream, eliminates the need for stents, and reduces meatal stenosis risk overall. It is a good glanuloplasty alternative that can be applied with most hypospadias repair techniques.

Adolescent↗
PubMed2000

Analysis of a mini-outbreak of methicillin-resistant Staphylococcus aureus in a surgical ward by using arbitrarily primed-polymerase chain reaction.

In November 1995, an increase was noticed in the number of methicillin-resistant Staphylococcus aureus (MRSA) isolates from a surgical ward at Hacettepe University Hospital. All MRSA isolates obtained from clinical specimens in this ward (14 MRSA isolates from wound cultures of 10 patients) were collected prospectively for 10 weeks. Surveillance cultures were taken from ward personnel (nose cultures from 4 physicians, 7 nurses, 1 secretary, 1 waiter), 2 surgical dressing containers and 1 nebulizer. MRSA was isolated from one of the surgical dressing containers, the nebulizer and nose cultures of 3 physicians, 3 nurses and the ward secretary. Arbitrarily primed polymerase chain reaction (AP-PCR) analysis showed that most MRSA isolates belonged to 2 major clones (pattern A, pattern B). Pattern A was the most frequent one and was present in 4 clinical isolates, surgical dressing container-1. Pattern B was identified in 3 clinical isolates and nose culture of physician-3. AP-PCR analysis revealed that this mini-MRSA outbreak was caused by contamination of surgical dressing container with MRSA and nasal MRSA carriage in ward staff. AP-PCR seems to be a valuable typing method for analysis of nosocomial MRSA outbreaks because of its simplicity and rapidity.

Adolescent↗
PubMed2000

Antimicrobial resistance of gram-negative isolates from intensive care units in Turkey: comparison to previous three years.

Resistance rates to selected antibiotics of gram-negative bacteria isolated from intensive care units (ICU) of 16 Turkish hospitals during 1998 were evaluated and compared to data from the previous 3 years. Antibiotic susceptibilities to imipenem, ceftazidime, ceftazidime-clavulanate, cefoperazone-sulbactam, ceftriaxone, cefepime, cefodizime, cefuroxime, piperacillin-tazobactam, ticarcillin-clavulanate, gentamicin, amikacin and ciprofloxacin were determined by Etest. A total of 1,404 isolates from 1,060 patients were collected, mainly from urinary and respiratory tracts. As in the previous 3 years, Pseudomonas spp. was the most frequently isolated gram-negative species (29.7%), followed by Escherichia coli, Acinetobacter and Klebsiella spp. Imipenem was the most active in vitro agent (73.4% susceptible), followed by ciprofloxacin (60.6%), cefoperazone-sulbactam (58.7%), cefepime (56.7%), piperacillin-tazobactam (55.0%) and amikacin (54.7%). In 1996, a decline in susceptibility rates of all antibiotics was evident. With the exception of imipenem, resistance to which remained stable, rates somewhat increased in 1997. In 1998, susceptibility to imipenem and cefepime remained stable, amikacin resistance tended to increase and susceptibility rates to other antibacterials showed a favorable increase. These results may in part be due to the implementation of a surveillance program and increased understanding of the magnitude of the resistance problem.

Anti-Bacterial Agents↗
PubMed2000

Bone mineral density in childhood obesity.

There are several metabolic and hormonal disturbances in childhood obesity. The purpose of this study was to determine the relationship between childhood obesity and bone mineral density (BMD). We studied BMD in 37 obese children and in 37 non-obese children. BMD was measured at L2-L4 level by using dual energy X-ray absorptiometry. BMD was significantly related to age, height and weight. The mean BMD in the obese children and control group was 0.655 +/- 0.175 and 0.626 +/- 0.159 g/cm2, respectively, without any statistically significant difference (p>0.05). There was no correlation between BMD values and osteocalcin or calcitonin levels. According to Tanner's pubertal staging, the mean BMD of pubertal obese children was higher than that of prepubertal obese children. BMD of the pubertal obese children was significantly higher than that of the pubertal control group (p<0.05). Girls had higher mean BMD values than boys. In conclusion, our results show that BMD is not influenced by obesity in children but higher values in puberty were observed in obese children which may due to hormonal changes.

Absorptiometry, Photon↗
PubMed1999

Effect of diabetes mellitus on formation of coronary collateral vessels.

BACKGROUND: Although myocardial ischemia is known to be significantly related to the development of coronary collateral vessels (CCVs), there is considerable variation between patients with ischemic heart disease in the presence of collateral development. The nature of this variability is not well known. Likewise, it remains unclear whether diabetes mellitus (DM) has any effect on CCVs. The aim of this study was to evaluate the effect of DM on CCVs. METHODS AND RESULTS: Of the patients who underwent coronary angiography during the interval between March 1, 1993, and June 20, 1998, in our institution, 306 were diabetic. Those patients in whom coronary angiography is normal or severity of coronary artery stenosis is thought not to be sufficient for the development of CCVs (<75%) were excluded from the study. A total of 205 patients (mean age, 59+/-8 years) met the criteria for the DM group. For case-control matching, 205 consecutive nondiabetic patients (mean age, 58+/-9 years) who had >/=1 diseased vessel with >75% stenosis were included in the control group. The CCVs were graded according to the Rentrop scoring system, and the collateral score was calculated by summing the Rentrop numbers of every patient. There was no statistical difference between patients with and without DM in clinical baseline characteristics. The mean number of diseased vessels in the DM group (1.58+/-0.68) was higher than that in the nondiabetic group (1.42+/-0.65, P=0.005). The mean collateral score was 2.41+/-2.20 in the DM group and 2.60+/-2.39 in the control group. After confounding variables were controlled for, the collateral score in the diabetic group was significantly different from that in the nondiabetic group (P=0.034). CONCLUSIONS: Our findings suggest that CCV development is poorer in patients with than in patients without DM. Thus, we can speculate that DM is an important factor affecting CCV development.

Aged↗
PubMed1999

Familial Mediterranean fever. No role of Mycobacterium tuberculosis in ten patients.

BACKGROUND: Tuberculosis (TB) and Familial mediterranean fever (FMF) are two common diseases in our region, Turkey. Both share some properties in common: Both cause AA type amyloidosis and have association with some immunological abnormalities. Upon incidentally observing Mycobacterium tuberculosis in bone marrow biopsies of three patients with FMF in a previous study, we intended to elucidate this association prospectively. MATERIAL AND METHODS: In this study, we examined prospectively 10 FMF patients, 5 male and 5 female, with a median duration of 31 years disease activity. All were under colchicine therapy. They had no sign of renal involvement. The bone marrow biopsies of these patients were examined for the presence of M. tuberculosis by Polymerase chain reaction (PCR), BACTEC culture and pathological stains. Pathological examination was performed for the existence of granuloma and amyloid deposition by hematoxylin-eosin, Crystal Violet and Congo red stains. RESULTS: The examination of all bone marrow specimens by the mentioned methods suggest that Mycobacterium tuberculosis has no role in the ethiopathogenesis of FMF. Although the patients had a positive family history of 60% for tuberculosis and in 80% of them with positive tuberculin skin test. CONCLUSIONS: We concluded that although there seemed to be a kind of association between both diseases, this relationship is not via the direct existence of bacteria itself. Considering high family history and skin test positivity, one should look for the presence of autoimmune mechanisms under this suspicious relationship between tuberculosis and FMF. Also, this is the first study examined the state of amyloidosis in the bone marrow at an earlier stage of FMF without overt renal findings.

Adult↗
PubMed1999

Pharmacological profile of survivors of acute myocardial infarction at Turkish academic hospitals.

AIM: The purpose of this study was to document treatment profiles in 850 patients surviving acute myocardial infarction at 17 academic hospitals in Turkey. METHODS AND RESULTS: Pharmacological management data of acute myocardial infarction survivors were collected and divided into three categories: drugs which patients received before hospitalization, during the hospitalization, and at hospital discharge. Data regarding medical history, complications during hospitalization, MI extent (Q wave or non-Q wave), infarct location and diagnostic and revascularization procedures were also recorded. This study is based on the 850 patients who met the diagnostic criteria for initial acute MI in the period examined. Among 850 patients with myocardial infarction enrolled 408 (48%) received thrombolytic therapy. The median time interval from symptom onset to initiation of thrombolytic therapy was 196 min. The most commonly used thrombolytic agent was streptokinase (93%). Thrombolytic recipients were younger, and presented sooner after onset of symptoms. Among patients receiving thrombolytic therapy, concomitant pharmacotherapy included aspirin (95%), intravenous heparin (93%), intravenous nitroglycerin (91%), oral beta-blockers (44%), calcium channel antagonists (13%), and angiotensin converting enzyme inhibitors (41%). The lipid lowering therapy was only used in 4% of all patients, and was given to 18% of patients with hyperlipidemia. CONCLUSION: Current usage rates of thrombolytic therapy in Turkey are lower than expected, but when compared with previous reports it increased. Although adjunctive treatment with intravenous heparin and intravenous nitroglycerin is usually used, beta-blockers appear to be underused and calcium channel blockers appear to be overused. The lipid reducing therapies were infrequently prescribed.

Adrenergic beta-Antagonists↗
PubMed1999

The prevalence and identification of risk factors for type 2 diabetes mellitus and impaired glucose tolerance in Kayseri, central Anatolia, Turkey.

Type 2 diabetes mellitus is a chronic disease which causes neurologic, cardiac, vascular, ocular and renal complications. The present study documented the prevalence of diabetes and associated risk factors in 1774 adults who were older than 30 years. An oral glucose tolerance test (OGTT) was conducted according to the World Health Organization (WHO) criteria. Of the 1452 subjects, 58 (4%) had diagnosed diabetes, 41 (2.9%) undiagnosed diabetes and 130 (9%) had impaired glucose tolerance. The total glucose intolerance was 15. 9%. The prevalences of type 2 diabetes mellitus (9.7%-4.1%) were significantly different in low occupational and high occupational activity groups, respectively (P<0.0001). The prevalence of type 2 diabetes mellitus was 17.9% among the hypertensive group (P<0.0001). The prevalence of type 2 diabetes mellitus was higher in smokers (P<0.05). Patients with diagnosed diabetes, undiagnosed diabetes and IGT were older, more obese and have higher blood glucose values, triglyceride values, systolic and diastolic blood pressures than healthy subjects (P<0.001). We conclude that type 2 diabetes mellitus and IGT prevalences are quite high in the urban area of Kayseri, central Anatolia and multivariate analysis indicated that low occupational activity, low leisure activity, family history for diabetes, hypertension and obesity were significant independent risk factors for diabetes mellitus.

Adult↗
PubMed1999

Comparison of meropenem with amikacin plus ceftazidime in the empirical treatment of febrile neutropenia: a prospective randomised multicentre trial in patients without previous prophylactic antibiotics. Meropenem Study Group of Turkey.

Eighty three patients with neutropenia and cancer were randomised to receive either 1 g meropenem tds or amikacin 15 mg/kg single dose daily plus ceftazidime 2 g tds. No prophylactic antibiotics were allowed before entry to the trial. Seventy seven patients were available for analysis. Infection was microbiologically or clinically documented in 53 episodes (69%). The overall success rate without adjustment was 49% in monotherapy, 37.5% in the combination group. These rates were increased to 65% and 56%, respectively when secondary infection episodes requiring a different class of chemotherapy were taken into account. Median duration for defervescence was 3 days in successfully treated patients in both groups. Only minor reversible side effects were noted in both treatment arms. Meropenem monotherapy seemed as effective and safe as amikacin plus ceftazidime for the empirical treatment of neutropenic cancer patients with fever.

Adult↗
PubMed1999

A surveillance study of antimicrobial resistance of gram-negative bacteria isolated from intensive care units in eight hospitals in Turkey.

This study was carried out with the participation of eight hospitals in Turkey to determine the frequency of gram-negative bacteria isolated in intensive care units (ICU) and to compare their resistance rates to selected antibiotics. Aerobic gram-negative bacteria isolated from ICUs during 1996 were studied. Antibiotic susceptibilities to imipenem, ceftazidime, ceftazidime-clavulanate, ceftriaxone, cefotaxime, cefepime, cefodizime, cefuroxime, piperacillin/tazobactam, amoxycillin-clavulanate, gentamicin, amikacin and ciprofloxacin were determined by Etest. A total of 748 isolates were obtained from 547 patients. The majority of organisms were isolated from the respiratory (38.8%) and urinary tracts (30.9%). Pseudomonas spp. were the most frequently isolated gram-negative species (26.8%), followed by Klebsiella spp. (26.2%). Escherichia coli, Acinetobacter spp. and Enterobacter spp. were the other commonly isolated organisms. High resistance rates were observed for all antibiotics studied. Imipenem appeared to be the most active agent against the majority of isolates. Although resistance rates exceeded 50%, ciprofloxacin, cefepime and amikacin were found to be relatively effective. Extended-spectrum beta-lactamase (ESBL) production appeared to be a major mechanism of resistance to beta-lactam antibiotics. In contrast to ceftazidime-clavulanate, piperacillin/tazobactam showed poor activity against organisms thought to produce ESBL, suggesting the presence of an enzyme resistant to tazobactam action. This study has yielded high rates of resistance in aerobic gram-negative isolates from ICUs in Turkey. High resistance rates to all the other antibacterials studied leave imipenem as the only reliable agent for the empirical treatment of ICU infections in Turkey.

Drug Resistance, Microbial↗
PubMed1999

Disappointing results with Tc-99m tetrofosmin for detecting medullary thyroid carcinoma metastases comparison with Tc-99m VDMSA and TI-201.

PURPOSE: This prospective study assessed the detectability of metastatic lesions by Tc-99m tetrofosmin in medullary thyroid carcinoma and to compare the results with Tc-99m penta dimercapto succinic acid (VDMSA) and TI-201. METHODS: A prospective study was performed on 24 patients (10 men, 14 women; ages 23 to 76 years) with medullary thyroid carcinoma after total thyroidectomy. Five cases were sporadic and 19 were familial. After the injection of 740 MBq (20 mCi) tetrofosmin, 740 MBq (20 mCi) VDMSA and 74 MBq (20 mCi) TI-201, whole-body scans and 5-minute static images of the head, neck, chest, abdomen and pelvis were obtained. All scintigraphic studies were compared with calcitonin levels, radiologic findings, histopathologic results, and clinical follow-up. RESULTS: Thirty-four metastatic sites were detected in 12 patients on the basis clinical, radiologic, and histopathologic findings. Patients were divided into three groups according to the calcitonin levels and scintigraphic findings. Group 1 consisted of patients with elevated calcitonin levels and positive scintigraphic findings. Among 34 metastatic sites, 30 could be detected with VDMSA. Only 21 and 20 metastatic sites could be visualized with TI-201 and tetrofosmin, respectively. All 30 lesions showed intense VDMSA uptake but only faint or no uptake with TI-201 and tetrofosmin. Patients in group 2 were accepted to have micrometastases. In this group, calcitonin was minimally elevated, and the results of all three scintigraphs were negative. Group 3 included patients with true-negative results. All patients had normal calcitonin levels and negative results of scintigraphic studies. CONCLUSIONS: Tetrofosmin has no role in the detection of medullary thyroid carcinoma metastases. These results show that VDMSA is clearly superior to TI-201 and tetrofosmin in the follow-up of patients with medullary thyroid carcinoma.

Adult↗
PubMed1998

Vesicouterine fistula (Youssef's syndrome): case report.

Vesicouterine fistula (Youssef's syndrome), a rare complication of cesarean section is presented. A 33-year-old female had vesicouterine fistula with symptoms of amenorrhoea and cyclic haematuria following cesarean section. The patient was treated by hysterectomy and the fistula tract was repaired.

Adult↗
PubMed1998

Prospective randomized comparison of intravesical BCG therapy with standard dose versus low doses in superficial bladder cancer.

In this study, we evaluated low dose intravesical bacillus Calmette-Guerin (BCG) therapy following transurethral resection (TUR) in 80 patients with superficial bladder cancer. The patients were divided into two groups. Of the Connaught BCG strain 81 mg was given to 40 patients in Group 1 and 54 mg to the remainder of 40 patients in Group 2. BCG was introduced once a week for 6 weeks. Tumour recurrence was seen in 6 patients in Group 1 and in 10 patients in Group 2. Recurrence rates per month were 0.71 and 1.49, respectively. There was no significant difference in complication rates. These data suggest that while the standard dose (81 mg) intravesical therapy of BCG is more effective than the low dose, there was no significant difference in side effects between the two groups.

Adjuvants, Immunologic↗
PubMed1998

Gastroesophageal reflux and a comparison of the different antireflux procedures following esophagomyotomy: an experimental study in rabbits.

The surgical options for achalasia remain controversial regarding the surgical access route, whether it be transthoracic or transabdominal, the need of, and the type of an added antireflux procedure following an esophagomyotomy. These questions were investigated in an experimental study that used 30 albino rabbits divided into six groups, as follows: transabdominal Heller's esophagomyotomy (TAHE), transthoracic Heller's esophagomyotomy (TTHE), TAHE and Nissen total fundoplication (NF), TAHE and partial fundoplication (PF), TAHE and modified fundoplication (MF), and a control group. Esophageal transit time (ETT) and gastroesophageal reflux (GER) were evaluated by scintigraphy on the seventh postoperative day. When an esophagomyotomy was performed either with a transabdominal or transthoracic approach, a significantly increased GER rate was found in comparison to the controls. All types of antireflux procedures performed prevented GER effectively. Although NF and PF groups showed a significant delay in ETT when compared to the control group (P < 0.001), no such finding was observed in the MF group. In conclusion, an antireflux procedure following an esophagomyotomy is recommended. A modified fundoplication was thus found to be as effective as the other techniques in preventing GER, and was even a safer method when obstructive findings following a total or partial fundoplication were considered.

Animals↗
PubMed1998

Comparison of cytochemical staining, immunofluorescence and PCR for diagnosis of pneumocystis carinii on sputum samples.

Detection of P. carinii has increased with the use of polymerase chain reaction (PCR), particularly in sputum samples. In this study, sputum samples obtained from 30 immunosuppressed patients with respiratory symptoms (12 HIV-infected) were tested by standard cytochemical staining (Giemsa and methenamine silver), immunofluorescence (IF) staining and PCR for detection of P. carinii and the results were compared. Pneumocystis carinii was detected in 4, 8 and 13 sputum samples by cytological staining, IF test and PCR, respectively. Specific amplification bands were obtained in all sputum samples that were positive by both other tests. All tests gave negative results in sputum samples obtained from 5 HIV-infected asymptomatic patients and 22 non-immunosuppressed tuberculosis patients. Our observations suggest that PCR results were well correlated with P. carinii pneumonia (PCP), especially in non-HIV-infected patients. However, PCR positivity obtained in HIV-infected patients could be misleading in the diagnosis of PCP without careful clinical evaluation. Positive results obtained by Giemsa staining or IF test confirm diagnosis of PCP authoritatively. As a result, we suggest testing sputum samples by both PCR and IF techniques for detection of P. carinii.

AIDS-Related Opportunistic Infections↗
PubMed1998

Correlation of in vitro fluconazole susceptibility with clinical outcome for severely ill patients with oropharyngeal candidiasis.

We investigated the correlation between in vitro susceptibility to fluconazole and clinical response in severely ill patients with oropharyngeal candidiasis treated with fluconazole. The study included 48 adult patients, of whom 23 were neutropenic (absolute neutrophil count, < 500/mm3). Forty-eight isolates (20 Candida albicans, 12 Candida krusei, 10 Candida kefyr, 3 Torulopsis glabrata, and 3 Candida tropicalis) were tested for susceptibility to fluconazole with use of the macrodilution method of the National Committee for Clinical Laboratory Standards. A strain was considered to be susceptible to fluconazole if the MIC was < or = 8 micrograms/mL and resistant if the value was > or = 64 micrograms/mL. All but one of the resistant strains were C. krusei isolates. Species of causative Candida, persistent neutropenia, and susceptibility to fluconazole were significant predictors of clinical response by univariate analysis. Logistic regression analysis indicated that the only significant factor was the species of Candida isolates, validating the recently recommended MIC breakpoint and the correlation between clinical outcome and in vitro antifungal susceptibility.

Adult↗