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ABSTRACT: To create a better scoring system for outcome prediction for patients with Fournier's gangrene in order to design more appropriate and feasible management strategies.
Using logistic regression, the medical records of 80 patients who underwent surgery for Fournier's gangrene in the last 10 years were reviewed using a prospectively maintained database, and a novel scoring system was adopted combining this data with the Fournier's gangrene severity index (FGSI). The new system consists of a physiological score, an age score, and an extent of gangrene score.
The mortality rate of the 80 patients was 21%. Using the new scoring system (UFGSI), at a threshold value of 9, there was a 94% probability of death with a score greater than 9 and an 81% probability of survival with a score of 9 or less (P < 0.001). The receiver operating characteristics (ROC) analysis concluded that the new scoring system was more powerful than the FGSI (P = 0.002).
The power of the novel scoring system introduced in this study proves that in patients with Fournier's gangrene, the extent of the gangrene as well as the patient's age and physiological status have a significant effect on the outcome.
Techniques in Coloproctology 09/2010; 14(3):217-23. · 1.29 Impact Factor
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ABSTRACT: We aimed to examine p16 protein expression in ovarian serous neoplasms along with normal ovarian tissues.
P16 expression was immunhistochemically evaluated in 86 ovarian serous neoplasms (21 cystadenomas, 20 borderline tumors and 45 carcinomas) and 21 non-neoplastic ovarian tissue. The results were also compared with histopathological grade in serous adenocarcinomas.
P16 expression rates for benign, borderline ovarian tumors and ovarian cancer were 14.2%, 85% and 86.6%, respectively. It was significantly higher in carcinomas (p < 0.001) and borderline tumors (p < 0.001) compared to cystadenomas. No immunoreactivity was found in the non-neoplastic ovarian surface epithelial cells. The percentage of p16 expression did not change significantly with histological grade in carcinomas.
P16 expression is strong and widespread involving most tumor cells in serous papillary ovarian carcinomas, and is probably an early event.
European journal of gynaecological oncology 01/2010; 31(3):312-4. · 0.47 Impact Factor
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ABSTRACT: Combinations of insulin and oral antidiabetic drugs (OAD) are often prescribed instead of insulin alone. In this study, the effects of insulin glargine (IG) in combination with repaglinide or acarbose on glycemic parameters were investigated. Obese Type 2 diabetic patients with fasting blood glucose (FBG) levels >or= 7.7 mmol/l [corrected] and hemoglobin glycated (A1C) >or=9% under maximal OAD combination therapy were enrolled. Previous therapies were discontinued, and patients were randomized into 2 groups. The combinations of IG and repaglinide were administered to group 1, and of IG and acarbose to group 2 for 13 weeks. Twenty patients in group 1 and 18 patients in group 2 completed the study. A1C levels were significantly decreased from 10.9+/-1.4% to 7.7+/-1.1% in group 1 and 11.0+/-1.4% to 8.1+/-1.4% in group 2. FBG levels were significantly decreased from 11.9+/-2.7 to 7.1+/-2.3 mmol/l in group 1 and 11.1+/-2.5 to 6.8+/-1.4 mmol/l in group 2. Post-prandial glucose levels were significantly decreased from 15.3+/-3.8 to 10.3+/-3.0 mmol/l in group 1 and 14.0+/-3.1 to 8.9+/-2.2 mmol/l in group 2. Intergroup comparisons indicated no significant differences. More weight gain was detected in group 1, compared to the baseline. Symptomatic hypoglycemia incidence was similar in both groups. Severe hypoglycemic attacks were seen in two patients in group 1. Flatulence incidence was higher in acarbose group. Conclusively, repaglinide and acarbose were equally effective when combined with IG for obese Type 2 diabetic patients controlled inadequately with OAD alone. Furthermore, acarbose seems to have advantages over repaglinide concerning weight gain and severe hypoglycemic attacks.
Journal of endocrinological investigation 01/2009; 32(1):69-73. · 1.57 Impact Factor
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C Duran,
D Ediger,
C Ersoy,
N F Coskun,
H Selimoglu, I Ercan,
S Kiyici,
M Guclu,
D A Saglam,
E Erturk,
E Tuncel,
S Imamoglu
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ABSTRACT: Autoimmune disorders are considered to be associated with a Th1 immune response whereas allergic diseases with a Th2 response. Studies mainly performed on children revealed conflicting results regarding the association of atopy/allergic disease and autoimmune disorders. Therefore, we aimed to investigate the prevalence of allergic diseases in adult Type 1 diabetic patients.
Eighty-nine Type 1 diabetic patients and 64 controls were enrolled into the study. Skin-prick test and European Community Respiratory Health Survey questionnaire were performed on all cases. Patients who gave at least one positive answer to questions about asthma in the questionnaire underwent pulmonary function test and methacholine challenge test.
Patients' mean age were similar in diabetic patients and controls (28.2+/-8.9 and 28.1+/-5.2 yr; respectively). In skin-prick test, the rate of positive response to at least one allergen was not significantly different in diabetes (29.2%) and in the control group (31.3%). In European Community Respiratory Health Survey questionnaire, diabetic patients waked up by an attack of cough more than controls did. The rate of physician-diagnosed asthma was similar in both groups. There was no difference between the 2 groups based on the answers of other questions about asthma and other allergic diseases such as allergic rhinitis, eczema, and drug allergy.
We found that atopy frequencies were similar in an adult population of Type 1 diabetic patients and controls. Although asthmatic symptom prevalence is increased in diabetic patients, the incidence of current asthma was similar in both groups.
Journal of endocrinological investigation 04/2008; 31(3):211-5. · 1.57 Impact Factor
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ABSTRACT: There is disagreement in the current evidence for viral aetiologies in the pathogenesis of Behçet's disease (BD).
To investigate the presence of B19 DNA in skin lesions of patients with BD, compare with the skin of healthy controls and evaluate its role in the pathogenesis.
In total, 40 patients diagnosed with BD according to the criteria proposed by the International Study Group for Behçet's Disease and routinely followed up at our centre were enrolled into the study. All the patients selected were in the active phase of disease. Skin and blood samples of patients with BD and of the healthy volunteers were examined for B19 serology, histopathology and genome expression.
The quantity of B19 DNA in nonulcerative BD lesions of was significantly different from ulcerative lesions in the study group and from the skin of the healthy controls (P < 0.01). For the nonulcerative lesions, real-time PCR analysis for B19 DNA was found to be 64% sensitive (95% CI 42.5-82.0) and 85% specific (95% CI 62.1-96.6) with a cut-off value of > 154 IU/mL (P < 0.001).
To the best of our knowledge, this is the first study that provides evidence for a possible causal link between BD and parvovirus B19, and our data suggest the presence of the virus, particularly in intact, nonulcerative skin lesions of BD. Limitations to this study include the limited number of participants, and the fact that the exact source of B19 DNA was undetected.
Clinical and Experimental Dermatology 04/2007; 32(2):186-90. · 1.20 Impact Factor
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ABSTRACT: To examine the relationships between the expression of protein Nm23 and surgical stage, histologic grade, histopathologic findings, and survival in women with endometrial carcinoma.
19 patients with lymph node involvement were matched with 24 patients without lymph node involvement and the best paraffin-embedded blocks were selected for Nm23 immunohistochemical staining. The slides were evaluated semiquantitatively according to their degree of cytoplasmic staining. Statistical analysis was performed to determine whether there was a relationship between Nm23 expression and surgical stage, histologic grade, depth of myometrial invasion, lymph node metastasis, and/or lymphovascular space involvement. Survival analysis was also performed.
Slides from 15 patients (79%) with lymph node involvement and 22 patients (88%) without lymph node involvement were found to be positive for Nm23 (P=0.01). No significant relations were observed between Nm23 expression and surgical stage, histologic grade, depth of myometrial invasion, or lymphovascular space involvement. Nm23 expression was found to be significantly related to lower rates of lymph node metastasis and longer survival (P=0.02).
Elevated Nm23 expression is related to lower rates of lymph node metastasis and longer survival.
International Journal of Gynecology & Obstetrics 11/2006; 95(1):35-9. · 2.05 Impact Factor
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ABSTRACT: In this study, we aimed to evaluate the ocular findings in vitiligo patients and reveal any clinical feature that might suggest an association or a risk factor.
Very few reports in the literature are available about the ocular findings in vitiligo and the possible associations of the ocular findings in vitiligo patients have not been studied so far.
A total of 45 patients with previously documented cutaneous vitiligo were examined for ocular findings. Demographic features including age, gender, duration of vitiligo, presence of associated autoimmune diseases, type of vitiligo and the anatomical distributions of vitiligo were recorded to evaluate a possible relationship with the ocular findings. Univariate and multivariate analyses as well as cluster analysis were performed. After description of the clusters, the Mann-Whitney U-test and Fisher's exact test were used to determine the variables. Concordance among the variables in each group was evaluated with the McNemar test.
Ten patients had ocular findings that included anterior segment (iris) involvement, ring-like peripapillary atrophy around the optic nerve, atrophy of pigment epithelium, focal hypopigmented spots and diffuse hypopigmentation. The presence of periorbital vitiligo was significantly related to the ocular findings. Cluster analysis revealed concordances between periorbital and genitalial localizations of vitiligo and ocular findings.
The number of patients and the range of ocular findings in our study are insufficient to make definite conclusions but anatomical localizations, primarily periorbital and to a lesser extent genitalial vitiligo, seem to be the most probably alerting features for ocular findings.
Journal of the European Academy of Dermatology and Venereology 09/2006; 20(7):829-33. · 2.98 Impact Factor
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E Kurt,
C Sezgin,
T Evrensel,
U Yalcinkaya,
O Kanat,
A Veral,
M Demiray,
M Arslan,
B Karabulut, I Ercan,
E Goker,
O Manavoglu
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ABSTRACT: In this study, we aimed to investigate the clinicopathological characteristics with special emphasis on c-kit expression and the treatment results of patients with extrapulmonary small cell carcinoma (EPSCC). The medical records of the patients with EPSCC were reviewed, and the data regarding patient and tumour characteristics, treatment and clinical outcome were retrieved and analysed. A total of 28 patients with the diagnosis of EPSCC were identified. There were 19 males and 9 females, with a mean age of 56.5 years. Patients with limited disease (LD) (n = 13) were treated with surgery, chemotherapy (CT) and radiotherapy with different sequences. Patients with extensive disease (ED) (n = 15) were mainly treated with combination CT. The median overall survival was 14.5 months in patients with LD compared to 11 months in those with ED (p = 0.029). Ten patients (36%) showed c-kit overexpression. There was no significant difference between the survival of c-kit-positive and c-kit-negative patients (p = 0.367). In conclusion, our study demonstrates that the prognosis of EPSCC is poor despite currently available treatments. C-kit may be considered as a potential target for novel therapeutical approaches.
International Journal of Clinical Practice 06/2005; 59(5):537-43. · 2.41 Impact Factor
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ABSTRACT: There are conflicting data about the effects of cisplatin on erythropoietin (EPO) response to anemia. Aim of our study was to investigate whether endogenous EPO response to anemia in cisplatin treated patients was insufficient in comparison to the anemic chemotherapy-naive cancer patients and non cancer patients with iron deficiency anemia. Patients who had hemoglobin (Hb) levels of less than 110 g/l were included in the study. Fifteen chemotherapy- naive cancer patients were enrolled in Group A. Group B consisted of 15 patients who had been treated with three cycles of cisplatin chemotherapy and then became anemic and in Group C were included 15 patients who had iron deficiency anemia, without any malignancy. The mean Hb values were not different between all groups (102.8+/-39.8 g/l, 103.1+/-2.5 g/l and 99.3+/-3.6 g/l in Group A, Group B and Group C, respectively). However, EPO levels were found to be significantly lower in Group A and Group B than Group C (29.63+/-9.09 mU/ml, 20.87+/-2.43 mU/ml and 85.38+/-25.72 mU/ml, respectively; p=0.017 Group A vs. Group C, p=0.005 Group B vs. Group C). No significant difference was found between Group A and B (p=0.917). Opposite the iron deficiency anemia, cancer anemia is associated with an inadequate EPO response to anemia and administration of cisplatin does not lead to it further deterioration.
Neoplasma 02/2005; 52(1):43-5. · 1.44 Impact Factor
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ABSTRACT: AIM: Clinical features and outcome of 36 patients with necrotizing pneumonia (NP) as well as 36 children with parapneumonic effusions (PPE) and 36 with severe control pneumonia (CP) were investigated. The mean age of the patients in the NP, PPE and CP groups were similar (3.8 +/- 3.3 (mean +/- SD), 4.2 +/- 3.0 and 4.2 +/- 3.0 y, respectively (p > 0.05)). The duration of symptoms at presentation were 11.9 +/- 8.5, 9.2 +/- 7.2 and 6 +/- 3.6 d, respectively (p < 0.01). The diagnosis of NP was established by computerized tomography. The mean (mean +/- SD) laboratory results in patients with NP revealed a white blood cell (WBC) count of 19,300 +/- 8700/mm3, erythrocyte sedimentation rate (ESR) of 71 +/- 22 mm/h, C-reactive protein (CRP) of 13.6 +/- 11.7 mg/dl and aspartate aminotransferase (AST) of 66 +/- 132 U/L. The values of WBC, ESR, CRP and AST in the NP group were significantly higher than those of the other groups (p < 0.001). The duration of hospitalization in the NP, PPE and CP groups was 26 +/- 9, 16 +/- 6 and 10 +/- 5 d, respectively (p < 0.001). The number of febrile days was 8 +/- 4, 4 +/- 3 and 3 +/- 3 (p < 0.001), and the duration of normalization of CRP was 14 +/- 4, 11 +/- 4 and 7 +/- 3 d (p < 0.001), respectively. The average cost of treatment was 3476 US dollars, 1646 US dollars and 844 US dollars, respectively (p < 0.001). CONCLUSION: All NP patients except two (94%) were complicated with PPE. The effusion in patients with NP and PPE was complicated with bronchopleural fistula (55% and 0%, respectively, p < 0.001). Surgical treatment was required in 66%, 8% and 0% in patients with NP, PPE and CP, respectively (p < 0.001). The mortality rate was 5.5%, 2.7% and 0% (p > 0.05).
Acta Paediatrica 10/2004; 93(9):1172-7. · 2.07 Impact Factor
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ABSTRACT: The concentrations of maternal anti-RSV IgG antibodies were followed in 49 healthy newborns over the first six months of life. At birth, 41 mothers (83%) tested positive for anti-RSV IgG and all of their babies carried maternal anti-RSV IgG. Anti-RSV IgG positivity dropped to 73% at 1 month, 6% at 3 months, and 2% at 6 months. Between 3 and 6 months, 8% did acquire RSV infection, half of them as acute bronchiolitis and half as non-specific respiratory infection. All of the patients who acquired clinical RSV disease had an antibody concentration of <20 RU/ml which may be the cut off value for protection.
Archives of Disease in Childhood 02/2004; 89(1):52-3. · 2.88 Impact Factor
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ABSTRACT: We reviewed medical records of dialyzed patients admitted to our hospital after the Marmara earthquake and evaluated the factors affecting mortality in survivors and non-survivors according to the survival times.
Crush syndrome (CS) was diagnosed in 110 patients. Dialysis treatment was initiated in 60 patients; 21 of all died. The patients were divided into 2 groups which consisted of 39 survivors (Group A, 25 male, 14 female, mean age: 31 +/- 2.2 years) and 21 non-survivors (Group B, 9 male, 12 female, mean age: 27 +/- 3.0 years). Victims treated by any form of renal replacement therapy, including daily or intermittant hemodialysis and/or continuous venovenous hemodiafiltration. Clinical and laboratory findings were recorded regularly. Statistical analysis was performed with Kaplan-Meier method, log rank test and Cox regression analysis for the survival functions.
APACHE II scores were 13.5 +/- 0.5 for Group A and 13 +/- 0.9 for Group B. Dialysis support was started to patients in Group A in a mean period of 2.8 +/- 0.2 days and in Group B in a mean period of 3.7 +/- 0.6 days after the earthquake (p > 0.05). The most frequent site of trauma was lower extremity (61.5%) and upper + lower extremities (23%) in Group A, and lower extremity (38.1%) and trunk + lower extremity (23.8%) in Group B. The frequencies of abdominal trauma, pelvic fracture and thoracic trauma in Group B were 23.8%, 19% and 14.2%, respectively. Multiple trauma was more frequent in Group B than in Group A (42.8% vs 2.5%). The rates of fasciotomy, amputation and surgery were similar in both groups. The frequency of sepsis was higher in non-survivors. In our center, the overall mortality rate was 8%, mortality rate in CS was 21% and in dialyzed patients it was 35%. Mortality was mainly associated with sepsis. Survival periods (52.3 +/- 4.0 days) in Group A were longer than in Group B (17.3 +/- 2.5 days). With Cox regression analysis, the parameters such as systolic hypotension on admission, female gender, high serum peak creatine kinase (> 20,000 U/l) and multiple trauma including thoracic and abdominal regions, were factors increasing risk of mortality.
As a result, sepsis, multiple trauma and severe crush injury were the main factors increasing mortality risk in dialyzed injuries after the earthquake.
Clinical nephrology 05/2003; 59(5):334-40. · 1.17 Impact Factor
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ABSTRACT: The relationship between hemoglobin A1c (HbA1c) and iron status in type 1 diabetes mellitus (DM) has not been adequately studied. In this prospective investigation, we aimed to determine the effect of iron deficiency on HbA1c in diabetic patients who also had insufficient iron stores.
Thirty-seven patients with type 1 DM were included in the study. Eleven of them were also iron deficient (ID) and the remaining 26 were iron-sufficient (IS). Two non-diabetic control groups were selected for the ID and IS groups. All patients with ID were treated with iron at 6 mg/kg per day for 3 months. Glycemia in diabetic patients was monitored at home before breakfast and supper by a glycometer. Hemoglobin A1c was measured in all subjects at the beginning and the end of the study.
Patients with ID DM had higher levels of HbA1c than those in the control group (P < 0.001). There were no significant differences in the weekly average glucose concentration of the patients with ID DM before and after iron supplementation. In contrast, HbA1c decreased from a mean of 10.1 +/- 2.7% to a mean of 8.2 +/- 3.1% (P < 0.05). Additionally, HbA1c in ID non-diabetic patients decreased from a mean of 7.6 +/- 2.6% to 6.2 +/- 1.4% after iron therapy (P < 0.05).
We conclude that among type 1 DM patients with similar level of glycemia, iron deficiency anemia is associated with higher concentrations of HbA1c. In addition, iron replacement therapy leads to a drop in HbA1c in both diabetic and non-diabetic patients. The iron status of the patient must be considered during the interpretation of HbA1c concentrations in type 1 DM.
Pediatrics International 09/1999; 41(4):357-62. · 0.63 Impact Factor
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ABSTRACT: The role of age, gender and smoking on both the genotoxic effects of Helicobacter pylori and the efficacy of eradication therapy in a group of patients with gastritis was investigated. Gastritis was confirmed by endoscopy and biopsy, and the presence of H. pylori by urease testing. Pre- and post-treatment peripheral blood lymphocyte cultures were prepared from 17 patients and 25 metaphases per patients were analysed for sister chromatid exchange (SCE), a well-established technique for the evaluation of human exposure to toxic agents. Treatment with omeprazole, clarithromycin and amoxycillin triple therapy eradicated H. pylori in 94% of patients and significantly reduced the SCE frequency. Pre-treatment SCE frequency was found to be positively correlated with age. Female smokers tended to have higher post-treatment SCE frequencies than male smokers, and pre- and post-treatment SCE frequencies were higher in older males than in older females. Eradication therapy decreased the genotoxicity of H. pylori, but age in males and smoking in females may decrease treatment efficacy.
The Journal of international medical research 30(4):380-5. · 0.90 Impact Factor
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ABSTRACT: To compare the amount of ultrasound (US) energy and balanced solution (BS) required for burst mode and pulse mode during bimanual phacoemulsification surgery.
One hundred cases were divided into two groups (the pulse mode Group 1 [50 eyes], the burst mode Group 2 [50 eyes]). One surgeon (M.B.) performed phaco notemulsification procedures using topical anesthesia with the AMO Sovereign in all patients. The technique was based on the nuclear hardness and surgeon's criteria and performed bimanually. The surgery time, total ultrasound time (UST) and effective US power (USP), and used balanced solution (BS) were retrospectively compared.
The mean surgery time, mean UST, and mean used BS volume were not statistically different in both groups (p>0.05). The mean EPT was statistically highly different in both groups (p>0.001). There was a slight tendency toward more surgery time in Group 2 than in Group 1, although the difference was not significant (p=0.146). Statistically significant higher results (Group 1: r=0,889, p<0.001, and Group 2: r=0,834, p<0.001) were seen in Group 1 when both groups were evaluated for the surgery time and used BS volume. When UST and used BS volume were evaluated in Groups 1 and 2, significant relation was seen in both but the correlation is statistically higher in Group 1 (Group 1: r=0,765, p<0.001, and Group 2: r=0,544, p<0.001).
The very low energy modes with the WhiteStar technology are suitable for bimanual cataract surgery.
European journal of ophthalmology 16(6):804-8. · 0.96 Impact Factor
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ABSTRACT: This randomized phase 2 study aimed to assess and compare the toxicity and response rates in patients with unresectable non-small cell lung cancer treated with radiotherapy (1.8-2 Gray [Gy] daily, five fractions a week, total 63 Gy) or radiotherapy + paclitaxel administered weekly (1.8 Gy daily, five fractions a week, total 59.4 Gy). Twelve patients in the latter arm received 30 mg/m2 paclitaxel (median six cycles) over a 3-h infusion once weekly. After assessing toxicity, the remaining nine patients received 60 mg/m2 paclitaxel weekly (median six cycles). Response was evaluated radiologically 1 month after treatment. Grade 3 toxicity was 20% and 38% in the radiotherapy and chemoradiotherapy groups, respectively. Overall survival rates in complete and objective (complete plus partial) responders and progression-free survival rate of the objective responders were significantly better in the chemoradiotherapy arm. We believe that using paclitaxel in concurrent chemoradiotherapy regimens may be effective in patients with unresectable, locoregionally advanced non-small cell lung cancer.
The Journal of international medical research 32(4):375-83. · 0.90 Impact Factor
