Showing papers by "Başkent University published in 2008"

Detection of aneurysms by 64-section multidetector CT angiography in patients acutely suspected of having an intracranial aneurysm and comparison with digital subtraction and 3D rotational angiography.

Abstract: BACKGROUND AND PURPOSE: Four-section multisection CT angiography (MSCTA) accurately detects aneurysms at or more than 4 mm but is less accurate for those less than 4 mm. Our purpose was to determine the accuracy of 64-section MSCTA (64MSCTA) in aneurysm detection versus combined digital subtraction angiography (DSA) and 3D rotational angiography (3DRA). MATERIALS AND METHODS: In a retrospective review of patients studied because of acute symptoms suspicious for arising from an intracranial aneurysm, 63 subjects were included who had undergone CT angiography (CTA). Of these, 36 underwent catheter DSA; all but 4 were also studied with 3DRA. The most common indication was subarachnoid hemorrhage (SAH; n = 43). Two neuroradiologists independently reviewed each CTA, DSA, and 3DRA. RESULTS: A total of 41 aneurysms were found in 28 patients. The mean size was 6.09 mm on DSA/3DRA and 5.98 mm on 64MSCTA. κ was excellent (0.97) between the aneurysm size on 64MSCTA and DSA/3DRA. Ultimately, 37 aneurysms were detected by DSA/3DRA in 25 of the 36 patients who underwent conventional angiography. The reviewers noted four 1- to 1.5-mm sessile outpouchings only on 3DRA; none were considered a source of SAH. One 64MSCTA was false positive, whereas one 2-mm aneurysm was missed by CTA. The sensitivity of CTA for aneurysms less than 4 mm was 92.3%, whereas it was 100% for those 4–10 mm and more than 10 mm, excluding the indeterminate, sessile lesions. CONCLUSIONS: In comparison with the available literature, 64MSCTA may have improved the detection of less than 4-mm aneurysms compared with 4- or 16-section CTA. However, the combination of DSA with 3DRA is currently the most sensitive technique to detect untreated aneurysms and should be considered in suspicious cases of SAH where the aneurysm is not depicted by 64MSCTA, because 64MSCTA may occasionally miss aneurysms less than 3–4 mm size.

Radial tears in the root of the posterior horn of the medial meniscus

Abstract: The purpose of this study is to define the clinical features and characteristics of radial tears in the root of the posterior horn of the medial meniscus and to report the outcome of arthroscopic treatment. Arthroscopic meniscus surgery was performed on 7,148 knees. Of those, 722 (10.1%) were radial tear in the root of the posterior horn of the medial meniscus. We reviewed the medical records from a random sample of 67 subjects studied (mean age 55.8 years, range 38–72, mean follow-up period 56.7 months, range, 8–123), which included surgical notes and detailed arthroscopic photographs of 70 knees. All patients were treated with arthroscopic partial meniscectomy. The age distribution, preoperative physical signs, results of magnetic resonance imaging , body mass index, and surgical findings of the study subjects were analyzed and the clinical results were graded with the Lysholm knee scoring scale and a questionnaire. Radiologic evaluation consisted of preoperative and at the latest follow-up radiographs. Eighty percent of the patients were older than 50 years, and 80.6% were either obese or morbidly obese. The mean Lysholm score improved from a preoperative value of 53 to a value of 67. The average preoperative Kellgren–Lawrence radiograph grade was 2 (range 0–3 points), a value that increased to 3 (range 2–4) at the latest follow-up, which showed a significant worsening. The preoperative MRI was reevaluated after the arthroscopic confirmation of a medial meniscal root tear. A tear could be demonstrated in only 72.9% of the patients, the rest of whom demonstrated degeneration and/or fluid accumulation at the posterior horn without a visible meniscal tear. Radial tears in the root of the medial meniscal posterior horn, which may not be visible in about one-third of the preoperative MRI scans, are common. That type of meniscal tear is strongly associated with obesity and older age and is morphologically different from the degenerative tears that often occur in the posterior horn. Partial meniscectomy provides symptomatic relief in most cases but does not arrest the progression of radiographically revealed osteoarthritis.

Central vertigo and dizziness: epidemiology, differential diagnosis, and common causes.

Abstract: Background:Dizziness is a common complaint among patients seen by primary care physicians, neurologists, and otolaryngologists. The most common causes of dizziness are peripheral vestibular disorders, but central nervous system disorders must be excluded. This article provides an overview of the epi

Demographic and clinical properties of juvenile-onset Behçet's disease: A controlled multicenter study

Abstract: Background Behcet's disease (BD) is a multisystemic inflammatory disorder of unknown origin. The disease usually occurs between the second and the fourth decades, whereas it is uncommon in children. Objective In this multicenter study, we aimed to describe the demographic and clinical features along with severity in juvenile- versus adult-onset BD. Methods Patients with initial symptoms at age 16 years or younger were considered as having juvenile-onset BD. In all, 83 patients with juvenile-onset BD (38 male and 45 female; mean age 19.6 ± 7.6 years) and 536 with adult-onset (>16 years) BD (293 male and 243 female; mean age 39.2 ± 10.1 years) who fulfilled the classification criteria of the International Study Group for BD were involved in the study. Results Familial cases were more frequent in juvenile-onset compared with adult-onset BD (19% vs 10.3%; P = .017). The mean age of disease onset was 12.29 ± 3.54 years in juvenile-onset BD and 31.66 ± 8.71 years in adult-onset BD. Mucocutaneous lesions and articular symptoms were the most commonly observed manifestations in both groups. The frequency of disease manifestations was not different between juvenile- and adult-onset BD, except neurologic and gastrointestinal involvement, which were higher in juvenile-onset BD than adult-onset BD ( P = .027 and P = .024, respectively). Oral ulcer was the most common onset manifestation of both juvenile-onset (86.74%) and adult-onset (89.55%) BD. The frequencies of onset manifestations of BD were similar, except genital ulcer, which was higher in adult-onset BD ( P = .025). Limitations Our study consisted of patients with BD mainly applying to dermatology and venerology departments. Therefore, it can be speculated that this study includes rather a milder spectrum of the disease. Conclusions Although the clinical spectrum of juvenile-onset BD seems to be similar to adult-onset BD, the frequency of severe organ involvement was higher. Because of the higher prevalence of familial cases in juvenile-onset BD, it can be speculated that genetic factors may favor early expression of the disease with severe organ involvement.

Demographic and Clinical Features of Uveitis in Tertiary Centers in Turkey

Abstract: Purpose: To analyze the referral patterns and clinical features of uveitis in tertiary eye care centers in Turkey. Methods: Uveitis services of eight university clinics collected data on uveitis patients who presented during 2004. Data were collected on a form including a questionnaire on socio-demographic and clinical features which were documented at presentation. Results: A total of 761 patients (1187 eyes) with a mean age of 35.5 years were included in the study. Male to female ratio was 1.04:1. The majority of patients (89.6%) were from an urban population, 53% were referrals and 43% had had uveitis for more than one year. The most common type of uveitis was anterior uveitis (52.5%) followed by panuveitis (28.1%), posterior uveitis (12.7%) and intermediate uveitis (6.7%). In 56.8% of patients an etiological classification was established. The most common etiology was Behcet's disease (32.1%), followed by Fuchs' heterochromic iridocyclitis (5.1%) and ocular toxoplasmosis (4.7%). Among 48 pediatric pat...

Comparing hot pack, short-wave diathermy, ultrasound, and TENS on isokinetic strength, pain, and functional status of women with osteoarthritic knees: a single-blind, randomized, controlled trial.

Abstract: Cetin N, Aytar A, Atalay A, Akman MN: Comparing hot pack, short-wave diathermy, ultrasound, and TENS on isokinetic strength, pain, and functional status of women with osteoarthritic knees: a single-blind, randomized, controlled trial. Am J Phys Med Rehabil 2008;87:443–451.Objective:To invest

Preoperative evaluation of hyperparathyroidism: the role of dual-phase parathyroid scintigraphy and ultrasound imaging.

Abstract: Objective The aim of this study was to evaluate the efficacy of dual-phase 99mTc-methoxyisobutylnitrile (MIBI) parathyroid scintigraphy (PS) and ultrasound (US) in primary (pHPT) and secondary (sHPT) hyperparathyroidism.

Ict usage in higher education: a case study on preservice teachers and instructors

Abstract: This study explored the level of usage of preservice teachers’ and instructors’ utilization of information and communication technologies (ICT). Thus, the main purpose of this study was to examine factors that contribute to preservice teachers’ utilization of technology and suggest recommendations regarding to the effective utilization of technology. This case study used data from a school of education in a private university. Results of this study indicated that teacher education programs fail to provide appropriate instructional technologies and computer facilities for both in and out of class activities. Furthermore, three factors that appear to have a significant influence on the effective use of technology were found to be: (1) the quantity and quality of the lessons addressing technology in the curriculum, (2) incompetent teachers/lack of in-service training, and (3) insufficient technological infrastructure.

Fibrin glue versus sutures for conjunctival autografting in Pterygium surgery: A Prospective Comparative Study

Abstract: Aim : To compare the use of fibrin glue versus sutures for fixating conjunctival autografts in patients undergoing pterygium excision. Methods : Fifty patients (50 eyes) with primary pterygium were randomized to undergo pterygium surgery using either fibrin glue (25 eyes) or 8-0 Vicryl sutures (25 eyes) to attach the conjunctival autograft. The patients were followed-up for 12 months. Outcome measures were postoperative patient comfort, duration of surgery, and recurrence of pterygium. Results : In the fibrin glue group, the mean operation time was 15.7±2.4 minutes (range, 12-18 minutes); it was 32.5±6.7 minutes (range, 25-40 minutes) in the suture group (P<.001). The intensity of the postoperative pain, foreign body sensation, irritation and epiphora were significantly lower in the fibrin glue group than in the suture group (P<.001). Intense itchy sensation at the first 2 postoperative visits was lesser among patients in the fibrin glue group (5 patients, 20%) than in the suture group (12 patients, 48%) (P < .05). Two patients in the fibrin glue group had partial graft dehiscence, these grafts were successfully reattached with fibrin glue. At the end of follow-up, pterygium recurrence was observed in 1 eye (4%) in the fibrin glue group and in 3 eyes (12%) in the suture group (P<.05). Conclusion : Using fibrin glue in pterygium surgery with conjunctival autografting significantly reduces surgery time, improves postoperative patient comfort, and results in a lower recurrence rate compared with suturing.

The Influence of One-step Polishing Systems on the Surface Roughness and Microhardness of Nanocomposites

Abstract: Clinical Relevance One-step polishing systems exhibited similar or better surface roughness values when compared to multi-step polishing systems. In all groups, mylar-strip created surfaces showed lower microhardness values than polished surfaces. Different polishing procedures did not effect the microhardness of nanocomposites. One-step polishing systems may be a good choice for polishing nanocomposites, resulting in reduced chair time.

Clinicopathological significance of PTEN loss and the phosphoinositide 3-kinase/Akt pathway in sporadic colorectal neoplasms: is PTEN loss predictor of local recurrence?

Abstract: Background PTEN is a tumor-suppressor gene located on chromosome 10. Deficient PTEN expression leads to activation of the phosphoinositide 3-kinase (PI3K)/Akt (pAkt) signaling pathway, which may contribute to multiple human cancers. The relation between PTEN expression and Akt activation is still unclear in colorectal cancers and adenomatous polyps. Moreover, PTEN and pAkt expression in relation to demographic, tumoral, and outcome variables remains to be elucidated. Methods PTEN and pAkt expression were evaluated in 76 primary colorectal cancers and 25 adenomatous colorectal polyp tissues using immunohistochemical staining on paraffin-embedded sections. PTEN and pAkt expression were compared with clinicopathologic features of colorectal cancers. The relationship between PTEN and pAkt expression was also investigated. Results In colorectal cancers, pAkt expression was found to be significantly higher than polyps ( P = .007). On the other hand, PTEN expression was significantly lower in polyps ( P PTEN expression showed a negative correlation with young age, female sex, and left-sided (distal) tumors. On multivariate analysis, low PTEN expression ( PTEN loss) was noted as an independent parameter for local recurrence ( P = .024). There was significant association between pAkt expression and stage ( P = .008), and preoperative serum carcinoembryonic antigen (CEA) levels ( P = .017) in colorectal cancers. A negative correlation between PTEN and pAkt expression was found in colon cancer patients ( P = .010), whereas no significiant association was found in adenomatous polyps ( P = .403). No correlation of PTEN expression or pAkt expression was observed in Kaplan-Meier survival statistics and multivariate analyses for disease-free and overall survival. Conclusions The current study suggests that the PTEN loss–PI3K/pAkt pathway may play an important role in sporadic colon carcinogenesis and that reduced PTEN expression may predict relapse in colorectal cancer patients.

Assessment of panoramic radiomorphometric indices in Turkish patients of different age groups, gender and dental status.

Abstract: Objectives: The aim of the study was to determine the distribution of the appearance of the inferior mandibular cortex (Mandibular Cortical Index (MCI)) in a large Turkish population group and to assess a range of values for cortical width at the mental foramen region (Mental Index (MI)) and the ratio of the thickness of the mandibular cortex to the distance between the inferior margin of the mental foramen and the inferior mandibular cortex (Panoramic Mandibular Index (PMI)) according to the MCI. In addition, we assess how age, sex and dental status affected the MCI. Methods: Panoramic radiographs of 1863 patients, 698 (37.5%) men and 1165 (62.5%) women over 20 years old, were assessed during 2005–2006 from the files of Baskent University. Gender, age and dental status were recorded for each patient. MCI classifications, MI and PMI values in the MCI groups were evaluated and comparisons were made using logistic regression analysis. Results: Compared with patients aged 20–49 years, the likelihood of MCI C...

The value of Tzanck smear test in diagnosis of erosive, vesicular, bullous, and pustular skin lesions.

Abstract: Background Tzanck smear is generally used for the diagnosis of the pemphigus group of autoimmune bullous diseases and mucocutaneous herpesvirus infections. There are only a few studies in the literature investigating its diagnostic value. Objectives We aimed to investigate Tzanck smear findings and to determine the diagnostic value of this test in moist (erosive, vesicular, bullous, and pustular) skin lesions. We also aimed to develop an algorithmic approach for the diagnosis of these types of skin lesions according to the Tzanck smear findings. Methods Samples were stained with May-Grunwald-Giemsa and evaluated by the same dermatologist. In some patients, methylene blue and Gram staining or direct immunofluorescence examinations were additionally performed. In all of the study cases, after the evaluation of clinical and laboratory findings (including, when appropriate, potassium hydroxide examination; viral serology; bacterial and fungal cultures; histopathology; direct and indirect immunofluorescence; patch testing), the definite diagnosis was established. We also determined the sensitivity and the specificity of certain Tzanck smear findings. Results Tzanck smear was performed in a total of 400 patients with moist skin lesions. The sensitivities of multinucleated giant cells and acantholytic cells in herpetic infections, dyskeratotic acantholytic cells and cocci in bullous impetigo, pseudohyphae in candidiasis, acantholytic cells in pemphigus and more than 10 tadpole cells (magnification ×100) in spongiotic dermatitis were 84.7%, 92%, 100%, 100%, and 81.5%, respectively. Limitations Because Tzanck smears were evaluated by the same dermatologist, no comment could be made regarding the interobserver reliability of this test and how the level of experience with this technique might affect the results. Also, the sensitivity and the specificity of Tzanck smear test findings for certain diseases could not be calculated because of an insufficient number of patients. Conclusion The Tzanck smear test is an inexpensive, useful, and an easy diagnostic tool for certain skin diseases.

Helicobacter pylori prevalence in diabetes mellitus patients with dyspeptic symptoms and its relationship to glycemic control and late complications.

Abstract: Background There are contradictory reports on Helicobacter pylori prevalence and its relationship to late complications of diabetes mellitus (DM). The aim of this study was to determine the prevalence of H. pylori infection in type 2 DM patients and to evaluate the relationship between H. pylori infection and the glycemic control, late complications. Material and Method A total of 141 type 2 DM patients and 142 nondiabetic subjects with upper gastrointestinal symptoms were enrolled in the study. All patients underwent upper gastrointestinal endoscopy with biopsy specimens obtained from gastric antrum and corpus. H. pylori status was evaluated in each patient by both the rapid urease test and histopathological examination. Plasma glucose, HbA1c, microalbuminuria in 24 h collected urine, electroneuromyography, and fundoscopic examinations were performed in all subjects. Results The prevalence of H. pylori infection was 61.7% and 58.5%, respectively, among type 2 diabetic patients and nondiabetic controls and was not statistically significant (P = 0.577). The duration of diabetes, fasting blood glucose and haemoglobin A1c levels, nephropathy and retinopathy prevalence did not differ significantly between the two groups (diabetics versus nondiabetics). There was no late complication in 60.3% of the type 2 diabetic patients as compared to at least one late complication in the remainders. A statistically significant correlation was found between H. pylori infection and the presence of neuropathy (P = 0.021). Conclusions The prevalence of H. pylori infection did not differ significantly between the diabetic patients and nondiabetic controls. Interestingly, diabetics with H. pylori infection had a higher incidence of neuropathy, although there was no association between the duration and regulation of diabetes, retinopathy, nephropathy and H. pylori status.

A Guide for Monitoring Child Development in Low- and Middle-Income Countries

Abstract: OBJECTIVE. In low- and middle-income countries, methods for clinicians to address difficulties in language, social-emotional, cognitive, behavioral, or neuromotor development during early childhood are lacking. To fill this gap, we designed, in Turkey, the Guide for Monitoring Child Development, which aims to aid clinicians in monitoring and supporting child development and the early detection and management of developmental difficulties. The Guide for Monitoring Child Development monitoring component is a practical, open-ended interview that catalyzes communication between clinicians and caregivers and obtains a portrayal of the child9s development. We report on the development and psychometric properties of the Guide for Monitoring Child Development monitoring component for children aged 0 to 24 months. METHODS. We examined the ages of attainment of Guide for Monitoring Child Development milestones and internal consistency in a cross-sectional study of healthy children receiving well-child care (study 1). In 2 clinical samples, we studied the interrater reliability between medical students and a child development specialist administering the guide (study 2), as well as the concurrent validity of the guide administered during a health visit and a comprehensive developmental assessment (study 3). RESULTS. In study 1 (N = 510), item-total scale correlations ranged from 0.28 to 0.91. An age-dependent attainment pattern was seen in all of the milestones. In study 2 (N = 92), interrater reliability between medical-student pairs and between the child development specialist and students was high (kappa scores were 0.83–0.88). In study 3 (N = 79), the sensitivity, specificity, and positive and negative predictive values were 0.88, 0.93, 0.84, and 0.94, respectively. CONCLUSIONS. The Guide for Monitoring Child Development is an innovative method for monitoring child development that is designed specifically for use by health care providers in low- and middle-income countries. Studies in Turkey provide preliminary evidence for its reliability and validity.

Building-based damage detection due to earthquake using the watershed segmentation of the post-event aerial images

Abstract: This paper presents an approach for detecting the damaged buildings due to earthquake using the watershed segmentation of the post-event aerial images. The approach utilizes the relationship between the buildings and their cast shadows. It is based on an idea that if a building is damaged, it will not produce shadows. The cast shadows of the buildings are detected through an immersion-based watershed segmentation. The boundaries of the buildings are available and stored in a GIS as vector polygons. The vector-building boundaries are used to match the shadow casting edges of the buildings with their corresponding shadows and to perform assessments on a building-specific manner. For each building, a final decision on the damage condition is taken, based on the assessments carried out for that building only. The approach was implemented in Golcuk, one of the urban areas most strongly hit by the 1999 Izmit, Turkey earthquake. To implement the approach, a system called the Building-Based Earthquake Damage Assessment System was developed in MATLAB. Of the 284 buildings processed and analysed, 229 were correctly labelled as damaged and undamaged, providing an overall accuracy of 80.63%.

Preliminary report on surgical mask induced deoxygenation during major surgery

Abstract: Objetivos. Este estudio se realizo para determinar si la saturacion de oxigeno del cirujano se afectaba por el uso de la mascarilla, durante intervenciones de larga duracion. Metodos. Se hizo un estudio longitudinal y prospectivo en 53 cirujanos con medidas de la hemoglogina realizadas con un oximetro para medir la saturacion del pulso arterial. Se hicieron estudios antes y despues de la operacion. Resultados. Nuestro estudio puso de manifiesto una disminucion de la saturacion de oxigeno de las pulsaciones arteriales (SpO2) y un ligero aumento de las pulsaciones en comparacion con el estado preoperatorio en todos los grupos de cirujanos. La disminucion era mayor en el grupo de edad superior a los 35 anos. Conclusiones. Segun nuestros hallazgos, el ritmo del pulso aumenta y la concentracion de SpO2 disminuye despues de la primera hora de la operacion. Este cambio temprano de SpO2 puede deberse a la mascarilla o al estres de la intervencion. Puesto que un ligero descenso en la saturacion a este nivel refleja una mayor disminucion de la PaO2, nuestros datos pueden tener un valor clinico para la salud del personal sanitario y para los cirujanos.

Factors affecting fever following percutaneous nephrolithotomy: a prospective clinical study.

Abstract: Aim: To evaluate the preoperative and intraoperative factors that might affect development of fever following percutaneous nephrolithotomy (PCNL) and to investigate the clinical significance of int...

The role of expectations in patients' hospital assessments: A Turkish university hospital example

Abstract: Purpose – This paper aims to conduct a preliminary assessment of patient attitudes regarding important aspects of service dimensions using SERVQUAL. Design/methodology/approach – The SERVQUAL scale is routinely used at the Baskent University Hospitals Network, Turkey. The study consisted of 550 randomly chosen patients who presented to any member of the hospital network during January and February 2006 and received treatment as inpatients or outpatients at those healthcare facilities.Findings – The patients' perceived scores were higher than expected for an ordinary hospital but lower than expected for a high‐quality hospital. Young patients had a high‐expected service score gap and a low adequate service score difference. Highly educated patients had a high‐expected service score difference. Uninsured patients had a low adequate service score difference. Originality/value – Baskent University multidisciplinary healthcare teams have performed periodic patient satisfaction surveys in order to identify stre...

Long-term complications of open carpal tunnel release.

Abstract: Fifty patients who underwent open carpal tunnel release (OCTR) surgery at least 12 months earlier for carpal tunnel syndrome were reviewed, focusing on scar tenderness, pillar pain, and symptoms of neuroma. A total of 55 hands were studied. At an average of 20.2 months of follow-up, 5.5% had Tinel's sign, 7.3% had scar tenderness, 12.7% had pillar pain, and 18% had burning discomfort. Pillar pain was elicited in a much higher fraction of patients by using the "table test" (provocation of pillar pain by having the patient lean with his/her weight on the hands placed on the edge of a table), even when traditional tests were negative. Symptoms and signs are present in a substantial number of patients after OCTR, even after almost 2 years of follow-up. Patients should be informed of the incidence of long-term symptoms and signs after OCTR surgery.

Effects of Mouth Rinses on Color Stability of Resin Composites

Abstract: Objectives The aim of this study was to evaluate the effects of 3 commercially available mouth rinses on the color stability of 4 different resin-based composite restorative materials.