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Öğe Evaluation of the effects of bile on the arterial tonus in a rabbit model(Lippincott Williams and Wilkins, 2015) Temiz G.; Mezili C.; Tiftikçioglu Y.Ö.; Şirinoglu H.; Çinar M.; Kismali E.; Nart D.; Gürler T.; Alper M.Background: Hepatic artery anastomosis is an essential part of live-donor liver transplantation, and during this anastomosis, an unusual contact between bile and vessel ends is observed. In this study, the effects of this nonphysiological contact in a rabbit model were evaluated. Methods: The study was designed in 2 steps - in vitro and in vivo. Three groups were established for the in vitro study. In the first group, vessels were incubated in Krebs solution with 5% bile for 1 minute. In the second group, vessels were kept in Krebs solution with 5% bile for 5 minutes. Vessels in the control group were kept in Krebs solution without bile. All groups were examined for responses to vasodilator and vasoconstrictor agents in organ bath system. The specimens were evaluated immunohistochemically and histopathologically. In the in vivo step, microvascular anastomosis was performed bilaterally. Right carotid artery was anastomosed during bile contamination as study group, and left carotid artery was anastomosed without bile contamination as control group. Blood flow indexes were measured. Results: The results of the in vitro study revealed decreased responses to contractile and relaxing agents in the first study group compared with that of the control group (P < 0.0001). There was no response obtained in the second study group. The Doppler ultrasound results revealed no difference between preoperative and postoperative flow indexes (P > 0.05). There was no postoperative spasm in the study group. However, there was significant vasospasm in the control group (P < 0.05). Conclusions: Vessels exposed to bile have decreased contractile and relaxing responses, and this effect increases with exposure duration. Copyright © 2015 The Authors.Öğe Is it possible to predict sepsis, the most serious complication in prostate biopsy?(S. Karger AG, 2010) Simsir A.; Kismali E.; Mammadov R.; Gunaydin G.; Cal C.Objective: Prostate biopsy for the diagnosis of prostate cancer by transrectal ultrasonography (TRUS) is a common procedure used in daily urology practice with a low complication rate and easy applicability. In this study, the precipitating factors and prophylaxis for sepsis, the worst complication of the procedure, were assessed. Patients and Methods: 2,023 patients with suspected prostate cancer who underwent biopsy by TRUS in one center were assessed retrospectively. The relationship between sepsis and age, serum total prostate-specific antigen (PSA) level, PSA density, prostate volume, number of biopsies, number of repeated biopsies, accompanying diagnosis of prostatitis, presence of urethral catheter, and presence of diabetes mellitus was assessed. Data were analyzed using the t test and logistic regression analysis. Results: Of the 2,023 patients, 62 (3.06%) developed sepsis within 5 days after biopsy. There was no significant relationship between the biopsy and the above parameters using the logistic regression analysis. Using the t test, it was found that the number of biopsy cores (p < 0.001), presence of urethral catheter (p < 0.0001), and presence of diabetes mellitus (p < 0.0001) were predictive factors for sepsis. Conclusion: Sepsis is a rare but life-threatening complication after prostate biopsy by TRUS. Although preoperative prophylactic oral antibiotics and enema before biopsy have proven to be effective in decreasing urinary tract infection rates, patients with urethral catheter, diabetes mellitus or those to undergo biopsy from more sites than ten cores should be closely monitored after biopsy. © 2010 S. Karger AG, Basel.Öğe Long-term follow-up in patients with homozygous familial hypercholesterolemia; 13-year experience of a university hospital lipid clinic [Homozigot ailevi hiperkolesterolemili hastalarin uzun dönem izlemi: Bir üniversite hastanesi lipit poliklini?inin 13 yillik deneyimi](Turkish Society of Cardiology, 2014) Kayikçio?lu M.; Kismali E.; Can L.; Payzin S.Objectives: Familiar hypercholesterolemia (FH) is a genetic disease characterized with extremely high levels of cholesterol leading to premature atherosclerosis. In homozygous individuals (HoFH) cardiovascular events could develop in childhood. In this article, long-term clinical experience with adult HoFH patients who are followed in Department of Cardiology, Ege University Faculty of Medicine is presented. Study design: Seventeen HoFH patients (11 females, 6 males) who are being followed between the years 2000-2013 were included. All data including clinical characteristics, family history, lipid levels, treatment, lipid-apheresis, cardiovascular events, complications were obtained retrospectively from patient chart records. Results: Mean age was 31 ±10 years at admission to our clinic. First diagnosis age was 25±14. At diagnosis, mean cholesterol level was 625±136 mg/dl. Admission complaints were dermatologic (41 %) and ischemic symptoms (41 %). Atotal of 3 patients (18%) were diagnosed during family screening. 65% of the patients' parents had consanguineous marriage. Xantomas was present in 59%, aortic valve pathology in 59%, and carotid artery plaques in 47%. Coronary artery disease was documented in 59%. Though all patients had indication for apheresis, 10 patients received apheresis due to high refusal rate. Age at the first apheresis was 27±12 (minimum 10-maximum 42) and adherence to apheresis was 60%. With 2 years regular apheresis skin depositions were vanished, however carotid atherosclerosis and aortic pathology progressed. During the 43±42 months follow-up, 4 patients died (mean age: 25±5). Conclusion: Diagnosis is late in HoAH. Due to the delayed treatment of lipid apheresis, atherosclerosis and aortic stenosis progress in these patients. The awareness of the physicians and knowledge of the public is warranted. © 2014 Turkish Society of Cardiology.Öğe Management strategies in childhood lymphangiomas [Çocukluk çagl lenfanjiomalarinda tedavi yaklaşlmlarl](2009) Divarci E.; Çeli§k A.; Kismali E.; Ergün O.The aim of this study is to investigate the optimal treatment strategy for lymphangioma by analyzing the results of primary excision and sclerotherapy with bleomycin. Retrospective analysis of patients with lymphangiomas treated at our institution between 2000-2010 was performed. Data related to age, and gender of the patients, localization, and radiological type of lymphomas, treatment methods and their outcomes were reviewed. Twenty-nine invasive attempts (16 excisions, 13 sclerotherapies) were performed on 22 patients (17M, 5F). Mean age of the patients was 2,1±2,9 years. Lesions were localized on head-neck (9), axillary (6), trunk (6) and retroperitoneal regions (1). Lymphangiomas were classified as macrocystic, microcystic and cavernous types.. Treatment success was evaluated based on decrease in mass size as "poor response" (<75 %), and "good response" (75-100 %). Fourteen patients treated with primary surgical excision had achieved good (9) (64 %) and poor (5) responses. Additional sclerotherapy procedures were required in 5 patients after excision and treated successfully. Eight patients treated with primary sclerotherapy had good (6) (75 %) and poor (2) response rates, and 2 additional surgical excisions were necessitated. Patients who needed additional therapy after sclerotherapy had microcystic lesions. No major complications were seen in both groups. Mean follow-up period was 5 years (3 months-10 years). "Good" surgical success was proved at all patients Sclerotherapy and/or primary excision could be performed in the treatment of lymphangioma Achievement of surgical success is depended on appropriate patient choice. As a general approach, sclerotherapy must be preferred primarily for macrocystic lesions and excision for microcystic lesions.Öğe A new insight for evaluation of the inferior turbinate with ultrasound elastography(American Institute of Ultrasound in Medicine, 2015) Kismali E.; Göde S.; Turhal G.; Öztürk K.; Midilli R.Objectives - There are diseases that affect the stroma of the inferior turbinate and many surgical interventions that alter it. However, an objective method that can evaluate the turbinate's stromal structure in detail has not been defined yet. The primary aim of this study was to investigate the effectiveness and reliability of ultrasound elastography for objective evaluation of the inferior turbinate stroma and define the most suitable elastographic technique. Methods - Twenty inferior turbinates in 10 healthy participants were included. Five of the participants (50%) were male, and 5 (50%) were female, with a mean age ± SD of 28.3 ± 3.2 years (range, 26-35) years. To obtain reliable and reproducible results, elastography was performed twice, 3 days apart, with and without a topical decongestant to evaluate the effects of the nasal cycle and mucosal edema. Two previously described valid elastographic outcome measures were reevaluated for the inferior turbinate. The tissue strain ratio and sound wave propagation speed were calculated for each measurement. Results - Median propagation speeds without and with the decongestant for the first and second measurements were 2.125 (interquartile range [IQR], 0.85), 2.175 (IQR, 0.53), 2.520 (IQR, 0.79), and 2.555 (IQR, 0.53) m/s, respectively. Median turbinate stroma-to-subcutaneous tissue strain ratios without and with the decongestant for the first and second measurements were 1.402 (IQR, 0.96), 0.942 (IQR, 0.24), 1.035 (IQR, 0.98), and 1.427 (IQR, 1.68). Conclusions - We suggest that elastography is a reliable and reproducible method that is not substantially affected by mucosal edema. It is a novel technique that can evaluate the inferior turbinate stroma and might be used in concordance with other objective functional techniques such as acoustic rhinometry. Therefore, it can be used in further studies regarding diagnosis of turbinate diseases and objective evaluation of previous surgical treatments. © 2015 by the American Institute of Ultrasound in Medicine.Öğe Propranolol as the first-line therapy for infantile hemangiomas: Preliminary results of two centers(2012) Celik A.; Tiryaki S.; Musayev A.; Kismali E.; Levent E.; Ergun O.Aim: Despite a mostly self-limiting course, infantile hemangiomas can cause severe functional and/or cosmetic problems. The aim of this study was to determine the efficiency of propranolol treatment on infantile hemangiomas. Methods: Sixty-seven infantile hemangioma patients were included in propranolol protocol in two institutions from 2009 to 2011. Participants included 36 boys and 31 girls. An associate protocol with radiology and pediatric cardiology was constructed for appropriate patient selection. Patients received a dose of 2 mg/kg/day, and all were admitted for the first 24 hours of therapy. Results: Sixty-seven patients were included in the study. Mean age at the initiation of therapy was 7 months (1 to 24 months), and eleven patients were older than 12 months of age when propranolol was started. All patients showed improvement with varying responses. No side effects were detected during the treatment. Conclusion: Previously defined treatments for hemangiomas were efficient, yet had a limited usage because of side effects. Propranolol, with a high efficacy (not as total involution but stabilization and regression) and feasibility deserves to be the first line therapy for infantile hemangiomas even after the proliferation phase. Copyright © 2012 Journal of Drugs in Dermatology.Öğe Prostate biopsies and controversies(W.B. Saunders, 2013) Turgut A.T.; Kismali E.; Dogra V.Transrectal ultrasound (TRUS)-guided biopsy of the prostate, the gold standard for the diagnosis of prostate cancer, plays a crucial role in the management of the disease. The absolute indications for performing a TRUS-guided prostate biopsy are abnormal digital rectal examination, elevated serum total prostate-specific antigen levels, and/or suspicious finding on TRUS examination. The procedure has several inherent shortcomings, including the risk of inadequate sampling of the gland. There are controversies about various aspects of the procedure, such as indications, preprocedural evalution, sampling technique, that are explored throughout the article in light of the literature data. © 2013 Elsevier Inc.Öğe Should complete and incomplete spinal cord injury patients receive the same attention in urodynamic evaluations and ultrasonography examinations of the upper urinary tract?(2012) Akkoc Y.; Cinar Y.; Kismali E.The aim of the study was to compare urodynamic findings and upper urinary tract (UUT) abnormalities detected by ultrasonography in complete and incomplete suprasacral spinal cord injury (SCI) patients with neurogenic detrusor overactivity. Thirty-eight suprasacral SCI patients who underwent ultrasonography evaluation of the UUT and urodynamic investigation were evaluated retrospectively. The mean maximum detrusor pressure was 51.08+28.71 cmH 2O for the American Spinal Injury Association (ASIA)-A group and 61.42+30.93 cmH 2O for the ASIA-B-E group (P>0.05). The mean cystometric capacity was 269.38+139.98 for the ASIA-A group and 223.36+135.59 ml for the ASIA-B-E group (P>0.05). Abnormalities in the UUT were found in 15.4% of the complete SCI patients and 16% of the incomplete SCI patients (P>0.05). No differences were found in urodynamic parameters and UUT abnormalities between the complete and the incomplete suprasacral SCI patients. Therefore, incomplete SCI patients should be observed with the same caution as complete SCI patients. Copyright © 2012 Lippincott Williams &Wilkins.Öğe Ultrasonography of the prostate: Update on current techniques(W.B. Saunders, 2010) Turgut A.T.; Kismali E.; Dogra V.S.[No abstract available]
