Showing papers by "Başkent University published in 1997"
TL;DR: It is illustrated that less than ten percent of Turkish acute general hospitals operate efficiently compared to their counterparts, and that the validity of DEA is illustrated by comparing it to the ratio analysis method; no discernible differences are found.
Abstract: This study uses Data Envelopment Analysis to examine the technical efficiencies of 573 Turkish acute general hospitals. Inputs of number of beds, number of primary care physicians, and number of specialists, and how they are used to produce outputs of inpatient discharges, outpatient visits, and surgical operations, are examined. Results illustrate that less than ten percent of Turkish acute general hospitals operate efficiently compared to their counterparts. Inefficient, compared to efficient hospitals, on average utilize 32% more specialists, 47% more primary care physicians, and have 119% more staffed bed capacity. They also produce on average less output. Particularly, 13% less outpatient visits, 16% inpatient hospitalization, and 57% less surgical procedures. Additionally, the validity of DEA is illustrated by comparing it to the ratio analysis methods no discernible differences in the results are found.
126 citations
TL;DR: Four patients with chronic nonunion of the scaphoid were treated by a vascularized bone graft based on first dorsal metacarpal artery with minimal morbidity and predictable good results, and this technique is recommended for the treatment of established scaphoids pseudoarthrosis with avascular necrosis.
Abstract: Four patients with chronic nonunion of the scaphoid were treated by a vascularized bone graft based on first dorsal metacarpal artery. The mean duration of the nonunion was 28.5 months (range 12-48 months). There was avascular necrosis in all patients confirmed by magnetic resonance imaging (MRI). None of the patients had previous attempts at surgical reconstruction. Two fractures were localized at the waist one in the distal part and one at the proximal pole. Osseous union of the scaphoid was confirmed by X-ray in all patients in an average of 2.1 months. We recommend this technique for the treatment of established scaphoid pseudoarthrosis with avascular necrosis since it is associated with minimal morbidity and predictable good results.
79 citations
TL;DR: It is suggested that haemodialysis patients are not protected against Hp infection as the Hp prevalences are as high as that for the non-renal disease group.
Abstract: Methods. Two hundred and one patients with dys- from Germany, the prevalence of Hp was significantly peptic complaints were included in the study. The lower in chronic uraemia patients than in nongroups consisted of 47 HD, 54 renal transplant recipi- uraemics. The authors concluded that uraemic patients ents, and 100 non-renal disease patients. Upper gastro- seemed to be protected against Hp [5 ]. In other studies, intestinal endoscopies were performed and gastric however, the Hp prevalence was found to be higher antral biopsies were obtained for urease test in all (50‐58%) [6,7]. Kashiwaga et al. found that Hppatients. positive subjects accounted for inuremic HD patients, Results. Twenty-eight (60%) of the 47 HD and 38 but only 23.5% of the RTR were Hp positive [7]. ( 70%) of the 54 RTR were positive for Hp. Sixty-four The aim of the present study was to evaluate the ( 64%) of the 100 patients with various gastrointestinal prevalence of Hp positivity in HD patients and in complaints and known to have no renal dysfunction RTR to evaluate its possible role in upper gastrointestiwere positive for Hp. The Hp prevalences among the nal complaints in these special groups of patients. three groups were not significantly different (P>0.05). The prevalence of Hp infection did not correlate with the haemodialysis duration nor the post-transplan- Subjects and methods tation duration (P>0.05). There was no correlation Two hundred and one patients with upper gastrointestinal between the prevalence of Hp infection and duration complaints were included in this study. Patients who had of haemodialysis therapy or time post-transplantation. taken antibiotics within 4 weeks were excluded from the Conclusion. These findings suggest that HD patients study. The patients were grouped as follows: group 1, 47 are not protected against Hp infection as the Hp HD patients; group 2, 54 RTR; and group 3, 100 non-renal disease (NRD) patients. Mean age and male/female ratios prevalences are as high as that for the non-renal disease are shown in Table 1. Mean HD duration time for group 1 group. The increased dyspeptic complaints may be was 28.87±28.92 months and mean post-transplantation partly related to Hp infection.
48 citations
TL;DR: Extramedullary plasmacytoma of the liver is a rare tumour, only two cases of which have been reported so far as mentioned in this paper, and a third case arising in a 22 year old woman, who presented with abdominal pain and enlargement of liver, is described.
Abstract: Extramedullary plasmacytoma of the liver is a rare tumour, only two cases of which have been reported so far. A third case arising in a 22 year old woman, who presented with abdominal pain and enlargement of the liver, is described. Ultrasound and a computed tomography scan showed a solitary hepatic mass, 12 cm diameter, involving both lobes of the liver. Serum immunoelectrophoresis revealed an IgG kappa monoclonal gammopathy. Histologically, the tumour was composed of mature plasma cells with mild atypia. The plasma cells infiltrated the liver parenchyma and showed kappa light chain restriction. The monoclonal nature of the tumour was also demonstrated by PCR amplification of the immunoglobulin heavy chain genes. There was no evidence of bone involvement and repeated bone marrow aspirates and biopsy specimens were normal. The patient was treated with eight courses of chemotherapy. One year after diagnosis, the patient is well, the size of the tumour has decreased and the paraproteinaemia has disappeared.
28 citations
23 citations
TL;DR: The case of a patient who had sciatic neuropathy caused by intrapelvic migration of the acetabular cup is reported, and the clinical importance of differentiating this condition from coexisting conditions of the lumbar spine is described.
Abstract: Symptomatic or clinically detectable peripheral neuropathy after a total hip arthroplasty is rare, with a prevalence of 0.3 to 1.0 per cent according to one report; however, the total number of hip replacements performed during the period of the study was not provided9. Injury to the obturator, sciatic, or femoral nerve can occur during or after the procedure. In a prospective study of thirty hip arthroplasties in twenty-eight patients, some degree of nerve damage was detectable electromyographically in twenty-one patients (75 per cent)10.
The principal risk factors for neural injury include revision total hip arthroplasty, limb-lengthening, anticoagulation, female gender, and vascular insufficiency4,10. Delayed palsies of the sciatic nerve are usually due to protruded cement or fragments of broken wire1,3,5. However, to our knowledge, delayed sciatica secondary to protrusion of a cemented acetabular cup that had migrated superiorly has not been reported previously.
We report the case of a patient who had sciatic neuropathy caused by intrapelvic migration of the acetabular cup, and we describe the clinical importance of differentiating this condition from coexisting conditions of the lumbar spine.
A sixty-nine-year-old woman sustained a fracture of the left femoral neck in 1979. Treatment with open reduction and internal fixation was complicated by aseptic failure of fixation and avascular necrosis. A left total hip arthroplasty, also performed in 1979, failed without infection as well. In 1990, a revision was done with insertion of a cup with cement and titanium wire mesh. After the revision the pain in the hip persisted, and at twelve months the patient began to have …
21 citations
TL;DR: The microemulsion formulation of cyclosporin (CyE) was found to be more beneficial and cost-effective as induction and maintenance immunosuppression than the conventional formulation (CyA).
Abstract: We compared the mean trough level/dose (L/D) ratio, mean coefficient of variation (CV) of individual patients, and graft, patient, and rejection-free survival rates of 40 renal transplant recipients receiving Neoral (CyE) with 103 consecutive renal transplant recipients receiving Sandimmun (CyA). The mean L/D ratio on the 3rd post-transplant day (16.2 vs 11.8, P < 0.04), in the 1st week (24.6 vs 16.1; P < 0.03), and 1st month (39.1 vs 28.7; P < 0.05) were higher in the CyE group. In both groups the L/D ratio improved in proportion to the duration of time post-transplant and reached a maximum in the 3rd post-transplant month. In the early post-transplant period in particular, the number of patients achieving target levels was significantly higher, and the mean dose needed to achieve target levels lower, in the CyE group. The variation in trough levels, demonstrated by the CV, was lower in the CyE group (0.41 ± 0.14) than in the CyA group (0.62 ± 0.21; P < 0.005). Actuarial 1-year patient and graft survival rates in the CyE group were 100 % and 96 %, respectively; these were similar to the 100 % and 95 % in the CyA group. The 1-year rejection-free survival rate in the CyE group was 61 % compared to 43 % in the CyA group (P < 0.02). We conclude that it is possible to obtain higher blood trough levels at lower doses by administering CyE, particularly in the early post-transplant period. The lower variability of trough levels and the higher L/D ratio in the CyE group, which are related to improved bioavailability of CyE, may explain the lower rejection rate among these patients. In this study, the microemulsion formulation of cyclosporin (CyE) was found to be more beneficial and cost-effective as induction and maintenance immunosuppression than the conventional formulation (CyA).
15 citations
TL;DR: Six spontaneous reports of glossitis, stomatitis, and/or black tongue as adverse drug reactions (ADRs) due to a combination of lansoprazole with antibiotics for treating Helicobacter pylori infections in peptic ulcer disease are described.
Abstract: TO THE EDITOR: From July 1995 to March 1996, the Sicilian Regional Pharmacovigilance Centre received six spontaneous reports of glossitis, stomatitis, and/or black tongue as adverse drug reactions (ADRs) due to a combination of lansoprazole with antibiotics for treating Helicobacter pylori infections in peptic ulcer disease. Hatlebakk et al.' have reported stomatitis in nine patients treated with lansoprazole and amoxicillin for peptic ulcer disease. These adverse events were not observed when lansoprazole was used alone. None of the ADRs experienced by our patients is reported by the manufacturer. In the light of this, we describe six cases. Case Reports. The following reports were made by four general practitioners and by one gastroenterologist. Our Centre has not received any spontaneous reports regarding omeprazole, describing such adverse effects. During the first week of therapy in all six patients, lansoprazole 60 mgld was administered with clarithromycin I gld. In three cases both drugs were also administered with metronidazole I gld and in the others with amoxicillin 2 gld. After the first week of therapy, antibiotic administration was stopped and treatment was continued with only a reduced dosage of lansoprazole 30 mgld, which lasted for I, 2, and 3 weeks, in one, two, and one cases, respectively. In the remaining two cases, the therapy with lansoprazole alone at the lower dose was discontinued after 4 and 12 days because of adverse effects. Glossitis was diagnosed in each of the six patients treated with lansoprazole. Glossitis alone was the adverse effect in one case (man, aged 57 y), it was associated with black tongue in three cases (2 men, aged 75 and 34 y; I woman, aged 51 y), and with stomatitis in the last two cases (2 men, aged 58 and 54 y). ADRs occurred in five cases within the first 7 days after the beginning of the treatment (antibiotics plus lansoprazole): on days 2. 4, 5, 6, and 7. In the last case. the onset of the reaction was on day 19, 12 days after discontinuation of the antibiotic treatment and with a reduced dosage of lansoprazole. In the first five cases, the patients made a complete recovery during week 2. In the sixth case (ADR occurred after 12 d of lansoprazole monotherapy), the symptoms of the adverse event were improved 4 days after discontinuation of the drug. None of the patients was treated with any drugs other than those mentioned above, nor had the patients any concurrent diseases to cause the ADRs reported. Discussion. Glossitis has been reported to occur when amoxicillin is combined with lansoprazole.' Metronidazole may also cause glossitis when administered with lansoprazole. Our data do not enable us to know whether clarithromycin-Iansoprazole combinations may also induce glossitis/stomatitis with any other antibiotic combinations. The cause of tongue discoloration is unknown to us. Physicians treating H. pylori infections by using lansoprazole in different combination regimens with antibiotics should check patients for black tongue. glossitis, and stomatitis. They should also report these ADRs to their pharmacovigilance center. :::::
15 citations
TL;DR: An allotransplanted fascia as a vascular source proved in this model its capability to improve the survival of a random skin flap and to accept a free bone or muscle graft with temporary immunosuppression and hold promise for possible use of an allogeneic vascular source in flap fabrication.
Abstract: The purpose of this study was to explore the possible use of an allogeneic vascular source for flap fabrication. Epigastric fascia with its superficial epigastric vessel pedicle was harvested from the donor rat and microsurgically revascularized in the recipient rat across a major histocompatibility barrier. ACI rats (Rtl-a) served as donors, and Lewis rats (Rtl-1) served as recipients. The recipient rat was immunosuppressed with a daily dose of 2 mg/kg cyclosporin A plus 5 mg/kg prednisone for 4 weeks. Three experiments were performed for skin, muscle, and bone studies. In experiment 1 (20 Lewis rats), placement of the allotransplanted fascia underneath the epigastric skin significantly improved the survival of a random epigastric skin flap raised 3 weeks later (7.35 ± 0.65 cm 2 versus 6.09 ± 0.90 cm 2 , p < 0.05). Immunosuppression was discontinued 10 days after flap elevation with no observable additional skin necrosis. In experiment 2 (13 Lewis rats) and experiment 3 (14 Lewis rats), segments of isogeneic muscle and bone were grafted successfully on the allotransplanted fascia, respectively. The survival of these grafts was confirmed by metabolic bone activity, bone labeling, microangiography, and histologic studies and further confirmed 2 weeks after cessation of immunosuppression. An allotransplanted fascia as a vascular source proved in this model its capability to improve the survival of a random skin flap and to accept a free bone or muscle graft with temporary immunosuppression. These findings hold promise for possible use of an allogeneic vascular source in flap fabrication.
13 citations
TL;DR: The hybrid approach is shown to optimize the initial cost and the coverage efficiency, and can be applied to similar networking problems.
Abstract: A method for designing a terrestrial digital audio broadcasting single frequency network (T-DAB SFN) for a mountainous region is proposed. A computer database and the digital terrain elevation data are used in designing the network. Two fundamental approaches are compared; first, utilization of the existing transmitter sites is maximized by applying the initial cost constraint; then, the coverage percent of the service is forced to approach to 100% by applying the coverage efficiency constraint. Finally, a T-DAB SFN hybrid design procedure optimizing both constraints is proposed. The three design approaches are illustrated on the coverage of the mountainous Istanbul-Ankara highway. The results are compared using a reference cost look up table. The hybrid approach is shown to optimize the initial cost and the coverage efficiency, and can be applied to similar networking problems.
11 citations
TL;DR: The coded excitation imaging improves the signal-to-noise ratio and minimizes the signal firings, and hence provides increased penetration depth and frame rates.
TL;DR: This study demonstrated that the use of oral misoprostol is a simple, inexpensive and easy procedure for termination of second trimester complicated pregnancy.
Abstract: To define the mean effective dose of oral misoprostol, a PGE2 methylanalogue, for terminating midtrimester complicated pregnancy without producing significant side-effects and complications, forty-two patients with intrauterine complicated pregnancies of 14-28 weeks were treated with oral misoprostol.
TL;DR: Tear calcium level has no diagnostic importance for the development of ocular calcification in chronic renal failure.
Abstract: BACKGROUND In patients with chronic renal failure (CRF) on regular dialysis treatment, limboconjunctival degeneration and calcifications are common. The mechanisms of ectopic conjunctival and corneal calcification remain largely speculative. The aim of the present work was to study tear calcium levels in patients with chronic renal failure, which could alter calcium excretion patterns, and to examine whether the calcium level in tear fluid is of more diagnostic importance than static calcium levels in blood. METHODS Tear calcium levels were measured in 25 patients with chronic renal failure, compared with 14 normal subjects. Conjunctival and corneal calcium deposits were graded by the Porter and Crombie classification. RESULTS While 11 of the 25 patients had no clinically apparent calcium deposits, six had Grade 1 or 2, and eight had Grade 3 and over limboconjunctival calcification. Mean tear calcium levels were 1.436 +/- 0.165 mg/dl in the patients and 1.307 +/- 0.155 mg/dl in the normal group. The difference was not significant (P = 0.572). No correlation was found between the grade of the calcium deposits and tear calcium levels. CONCLUSIONS Tear calcium level has no diagnostic importance for the development of ocular calcification in chronic renal failure.
TL;DR: A closed-form expression for the field produced by a plane wave incident on an infinitely long conducting cylinder, coated with a lossy dielectric of nonuniform thickness, was obtained using perturbation theory as mentioned in this paper.
Abstract: A closed-form expression for the field produced by a plane wave incident on an infinitely long conducting cylinder, coated with a lossy dielectric of nonuniform thickness, is obtained using perturbation theory. This approximate series solution is later evaluated asymptotically for electrically large cylinder sizes. The scattered fields are interpreted using geometric optics and creeping waves. The fields are calculated using the exact series, the approximate perturbation series, and the high-frequency asymptotic solutions, and compared for different angles of incidence.
Journal Article•
TL;DR: A case of an epidural cavernous hemangioma which was originating from the left C8 nerve root and extending anteriorly to the apex of the left lung is reported.
Abstract: Cavernous hemangiomas are vascular malformations of the central nervous system that may rarely affect the epidural space of the spine. We report a case of an epidural cavernous hemangioma which was originating from the left C8 nerve root and extending anteriorly to the apex of the left lung.
TL;DR: Two unusual cases, a lymphangioma of the thoracic wall in a 42-year-old man and an aneurysmal bone cyst of the scapula in an 8- year-old boy, are presented.
Abstract: Scapular clicking with shoulder motion has been described for a variety of conditions. Two unusual cases, a lymphangioma of the thoracic wall in a 42-year-old man and an aneurysmal bone cyst of the scapula in an 8-year-old boy, are presented. The lymphangioma was treated by marginal excision of the lesion and the aneurysmal bone cyst, by excision of the infraspinal portion of the scapula with resolution of symptoms.
TL;DR: Occluding the non-tested eye with a translucent patch increased retinal sensitivity and improved global perimetric indexes by eliminating the ‘Ganzfeld blankout phenomenon’.
Abstract: The effect of translucent occluders on the results of automated static perimetry in 28 eyes of 14 normal volunteers was studied. The subjects were tested with automated perimetry with both an opaque and a translucent occluder. Occluding the non-tested eye with a translucent patch increased retinal sensitivity and improved global perimetric indexes by eliminating the ‘Ganzfeld blankout phenomenon’.
TL;DR: The order-recursive solutions of the least-squares problem, in particular the QR decomposition, are used to obtain the order recursive URLS algorithms, which provide the flexibility to alter the order of the URLS algorithm without adding extra variables.
Journal Article•
TL;DR: Primary extragenital malignant mixed mesodermal tumors prove to be rare but highly malignant neoplasms.
Abstract: Malignant mixed mesodermal tumors rarely occur in extragenital sites. An 80-year-old patient presented with a malignant mixed mesodermal tumor, consisting of papillary serous adenocarcinoma and chondrosarcomatous components. The patient refused further treatment following surgery and died of disease 2.5 months later. Based on the present case and a review of the literature, primary extragenital malignant mixed mesodermal tumors prove to be rare but highly malignant neoplasms. Further data is yet to be gathered in order to determine the exact origin and behavior of these tumors.
TL;DR: A case with bilateral Duane's retraction syndrome type I accompanied by renal agenesis, vesico-ureteral reflux, patent ductus arteriosus, and external ear malpositioning is reported.
Abstract: Duane's retraction syndrome is associated with various ocular and systemic abnormalities. We report a case with bilateral Duane's retraction syndrome type I accompanied by renal agenesis, vesico-ureteral reflux, patent ductus arteriosus, and external ear malpositioning. Because of disabling consequences, we recommend a thorough physical examination and screening for renal and cardiac abnormalities in all patients presenting with Duane's reaction syndrome.
01 Jan 1997
TL;DR: A retrospective single-center study to determine the relevance of serologic HLA matching on 1, 3, and 5-year kidney graft and patient survivals in live-related and cadaveric kidney transplant patients treated with cyclosporine (CyA).
Abstract: In kidney transplantation, graft and patient survival is affected by various factors related to donors and recipients. Human leukocyte antigen (HLA) complex is the important one among them [1]. Recipient characteristics such as race, sex, age, original disease, and pretransplant sensitization, and donor characteristics such as age, age disparity between donor and recipient [1], and cold ischemic time of graft are the other factors well known to influence short-and long-term graft success. HLA complex encodes four classes of genes, the first two of which provide the major antigenic stimulus in allograft rejection. ClassI products (HLA-A,-B, and -C) are constitutively expressed in humans by most tissue and cells except erythrocytes. Class II products (HLA-DR, -DP, -DQ) are much more limited in distribution and are normally expressed on B lymphocytes, dentritic cells, monocytes and macrophages. The first kidney transplantation in was Turkey performed on November 3, 1975 by our team. Among 1071 kidney transplantations performed in our centers from November 3, 1975 to April 1,1996, the last 750 were performed in our new center, Baskent University Hospital. We have made a retrospective single-center study to determine the relevance of serologic HLA matching on 1-, 3-, and 5-year kidney graft and patient survivals in our live-related and cadaveric kidney transplant patients treated with cyclosporine (CyA).
01 Jan 1997
TL;DR: The linearized risk per patient-year for all embolic events (major and minor) was 0.27, 0.69, 1.11, and 0.97% for double valve replacement as mentioned in this paper.
Abstract: From February 1992 to October 1995, 504 patients aged 3 to 69 years (median, 36 years) received 663 Ultracor prostheses (103 aortic, 259 mitral, 12 tricuspid, and 130 multiple). Early mortality was 2.77% with a rate of 3.88% for aortic valve replacement, 3.47% for mitral, 0% for tricuspid, and 0.99% for double valve replacement. Follow-up was 100% (719.5 patient-years) and the overall mortality (early and late deaths) was 3.76% with a rate of 4.85% after aortic valve replacement, 3.85% after mitral valve replacement, 8.33% after tricuspid valve replacement, and 2.97% after double valve replacement. There were no deaths among 29 patients who had triple valve replacement. All patients including 33 children (3.5 to 18 years of age) received sodium warfarin. The linearized risk per patient-year for all embolic events (major and minor) was 0.69%, 1.11%, and 0.69% for aortic, mitral, and multiple valve replacement respectively. When only major events were considered, the linearized risks were 0.27%, 0.13%, and ...