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Allen TJ, Henze Bancroft LC, Unal O, Estkowski LD, Cashen TA, Korosec F, Strigel RM, Kelcz F, Fowler AM, Gegios A, Thai J, Lebel RM, Holmes JH. Evaluation of a Deep Learning Reconstruction for High-Quality T2-Weighted Breast Magnetic Resonance Imaging. Tomography 2023; 9:1949-1964. [PMID: 37888744 PMCID: PMC10611328 DOI: 10.3390/tomography9050152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
Deep learning (DL) reconstruction techniques to improve MR image quality are becoming commercially available with the hope that they will be applicable to multiple imaging application sites and acquisition protocols. However, before clinical implementation, these methods must be validated for specific use cases. In this work, the quality of standard-of-care (SOC) T2w and a high-spatial-resolution (HR) imaging of the breast were assessed both with and without prototype DL reconstruction. Studies were performed using data collected from phantoms, 20 retrospectively collected SOC patient exams, and 56 prospectively acquired SOC and HR patient exams. Image quality was quantitatively assessed via signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and edge sharpness. Qualitatively, all in vivo images were scored by either two or four radiologist readers using 5-point Likert scales in the following categories: artifacts, perceived sharpness, perceived SNR, and overall quality. Differences in reader scores were tested for significance. Reader preference and perception of signal intensity changes were also assessed. Application of the DL resulted in higher average SNR (1.2-2.8 times), CNR (1.0-1.8 times), and image sharpness (1.2-1.7 times). Qualitatively, the SOC acquisition with DL resulted in significantly improved image quality scores in all categories compared to non-DL images. HR acquisition with DL significantly increased SNR, sharpness, and overall quality compared to both the non-DL SOC and the non-DL HR images. The acquisition time for the HR data only required a 20% increase compared to the SOC acquisition and readers typically preferred DL images over non-DL counterparts. Overall, the DL reconstruction demonstrated improved T2w image quality in clinical breast MRI.
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Affiliation(s)
- Timothy J. Allen
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, USA
| | - Leah C. Henze Bancroft
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
| | - Orhan Unal
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, USA
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
| | | | - Ty A. Cashen
- GE Healthcare, 3000 N Grandview Blvd, Waukesha, WI 53188, USA (R.M.L.)
| | - Frank Korosec
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
| | - Roberta M. Strigel
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, USA
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
- Carbone Cancer Center, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
| | - Frederick Kelcz
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
| | - Amy M. Fowler
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, USA
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
- Carbone Cancer Center, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
| | - Alison Gegios
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
| | - Janice Thai
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
| | - R. Marc Lebel
- GE Healthcare, 3000 N Grandview Blvd, Waukesha, WI 53188, USA (R.M.L.)
| | - James H. Holmes
- Department of Radiology, University of Iowa, 169 Newton Road, Iowa City, IA 52242, USA
- Department of Biomedical Engineering, University of Iowa, 3100 Seamans Center, Iowa City, IA 52242, USA
- Holden Comprehensive Cancer Center, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
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Allen TJ, Henze Bancroft LC, Wang K, Wang PN, Unal O, Estkowski LD, Cashen TA, Bayram E, Strigel RM, Holmes JH. Automated Placement of Scan and Pre-Scan Volumes for Breast MRI Using a Convolutional Neural Network. Tomography 2023; 9:967-980. [PMID: 37218939 PMCID: PMC10204486 DOI: 10.3390/tomography9030079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 05/24/2023] Open
Abstract
Graphically prescribed patient-specific imaging volumes and local pre-scan volumes are routinely placed by MRI technologists to optimize image quality. However, manual placement of these volumes by MR technologists is time-consuming, tedious, and subject to intra- and inter-operator variability. Resolving these bottlenecks is critical with the rise in abbreviated breast MRI exams for screening purposes. This work proposes an automated approach for the placement of scan and pre-scan volumes for breast MRI. Anatomic 3-plane scout image series and associated scan volumes were retrospectively collected from 333 clinical breast exams acquired on 10 individual MRI scanners. Bilateral pre-scan volumes were also generated and reviewed in consensus by three MR physicists. A deep convolutional neural network was trained to predict both the scan and pre-scan volumes from the 3-plane scout images. The agreement between the network-predicted volumes and the clinical scan volumes or physicist-placed pre-scan volumes was evaluated using the intersection over union, the absolute distance between volume centers, and the difference in volume sizes. The scan volume model achieved a median 3D intersection over union of 0.69. The median error in scan volume location was 2.7 cm and the median size error was 2%. The median 3D intersection over union for the pre-scan placement was 0.68 with no significant difference in mean value between the left and right pre-scan volumes. The median error in the pre-scan volume location was 1.3 cm and the median size error was -2%. The average estimated uncertainty in positioning or volume size for both models ranged from 0.2 to 3.4 cm. Overall, this work demonstrates the feasibility of an automated approach for the placement of scan and pre-scan volumes based on a neural network model.
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Affiliation(s)
- Timothy J. Allen
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, USA
| | - Leah C. Henze Bancroft
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
| | - Kang Wang
- GE Healthcare, 3000 N Grandview Blvd, Waukesha, WI 53188, USA
| | - Ping Ni Wang
- GE Healthcare, 3000 N Grandview Blvd, Waukesha, WI 53188, USA
| | - Orhan Unal
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, USA
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
| | | | - Ty A. Cashen
- GE Healthcare, 3000 N Grandview Blvd, Waukesha, WI 53188, USA
| | - Ersin Bayram
- GE Healthcare, 3000 N Grandview Blvd, Waukesha, WI 53188, USA
| | - Roberta M. Strigel
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, USA
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
- Carbone Cancer Center, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
| | - James H. Holmes
- Department of Radiology, University of Iowa, 169 Newton Road, Iowa City, IA 52242, USA
- Department of Biomedical Engineering, University of Iowa, 3100 Seamans Center, Iowa City, IA 52242, USA
- Holden Comprehensive Cancer Center, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
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Akgun-Unal N, Ozyildirim S, Unal O, Baltaci SB, Mogulkoc R, Baltaci AK. The effects of resveratrol and melatonin on cardiac dysfunction in diabetic elderly female rats. Physiol Res 2023; 72:187-198. [PMID: 37159853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
We aimed to investigate the effects of melatonin and resveratrol on diabetes-related papillary muscle dysfunction and structural heart disorders. The protective effect of resveratrol and melatonin supplementation on cardiac functions was investigated in a diabetic elderly female rat model. 16-month-old rats (n=48) were allocated into 8 groups. Group1: Control, Group2: Resveratrol Control, Group3: Melatonin Control, Group4: Resveratrol and Melatonin Control, Group5: Diabetes, Group6: Diabetes Resveratrol, Group7: Diabetes Melatonin, Group8: Diabetes Resveratrol and Melatonin. Streptozotocin was injected intraperitoneally to the rats for experimental diabetes induction. Thereafter, resveratrol (intraperitoneal) and melatonin (subcutaneous) were administered for 4 weeks. Resveratrol and melatonin had a protective effect on the contractile parameters and structural properties of the papillary muscle, which was impaired by diabetes. it has been presented that diabetes impairs the contractile function of the papillary muscle for each stimulus frequency tested and the responses obtained as a result of Ca+2 uptake and release mechanisms from the Sarcoplasmic reticulum, and it has been observed that these effects are improved with resveratrol and melatonin injection. The decrease in myocardial papillary muscle strength in the diabetic elderly female rat can be reversed with the combination of resveratrol, melatonin and resveratrol+melatonin. Melatonin+resveratrol supplementation is no different from melatonin and/or resveratrol supplementation. Resveratrol and melatonin supplementation may have a protective effect on cardiac functions in a diabetic elderly female rat model.
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Affiliation(s)
- N Akgun-Unal
- Department of Biophysics, Medicine Faculty, Ondokuz Mayis University, Samsun, Turkey.
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Buhur A, Unal O. Management of ectopic pregnancy in a tertiary hospital: a retrospective cohort study. Eur Rev Med Pharmacol Sci 2023; 27:3500-3507. [PMID: 37140299 DOI: 10.26355/eurrev_202304_32122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE The goal of this study was to manage the treatment modalities of ectopic pregnancy. PATIENTS AND METHODS This retrospective study included 1,103 women diagnosed and treated for ectopic pregnancy at Kanuni Sultan Suleyman Training and Research Hospital between January 1, 2017, and December 31, 2020. Serial beta-human chorionic gonadotropin (β-Hcg) measurements and transvaginal ultrasound (TV USG) findings were used to establish the diagnosis of an ectopic pregnancy. They were divided into four groups: expectant treatment, single-dose methotrexate, multidose methotrexate, and surgical treatment. All data analyses were performed using SPSS version 24.0. A receiver operating characteristic (ROC) analysis was used to determine the cut-off for change in beta-human chorionic gonadotropin (β-hCG) levels between the first and fourth day. RESULTS There were significant differences between groups in terms of gestational age and β-hCG changes (p < 0.001). In patients receiving expectant treatment, the decrease in β-hCG values on the fourth day was 35.19%, while patients receiving single-dose methotrexate treatment showed a decrease of 24%. The most common risk factor for ectopic pregnancy was the absence of risk factors. Comparison of the surgical treatment group with the other groups revealed significant differences in terms of the presence of free fluid in the abdomen, the average diameter of the ectopic pregnancy mass, and the presence of fetal cardiac activity. A single dose of methotrexate was effective in patients with β-hCG levels lower than 1,227.5 mIU/ml, with a 68.5% sensitivity and 69.1% specificity. CONCLUSIONS An increase in gestational age also leads to an increase in β-hCG values and the diameter of the ectopic focus. As the diagnosis period progresses, the need for surgical intervention increases.
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Affiliation(s)
- A Buhur
- Department of Gynecology and Obstetrics, Istanbul Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey.
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Rodoplu O, Yildiz C, Oztas D, Beyaz M, Ulukan M, Unal O. The efficacy of rotational pharmaco-mechanical thrombectomy in patients with acute iliofemoral deep vein thrombosis: is the standard treatment of deep vein thrombosis changing? J Vasc Surg Venous Lymphat Disord 2021. [DOI: 10.1016/j.jvsv.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Erley J, Zieschang V, Lapinskas T, Demir A, Wiesemann S, Haass M, Osman NF, Simonetti OP, Liu Y, Patel AR, Mor-Avi V, Unal O, Johnson KM, Pieske B, Hansmann J, Schulz-Menger J, Kelle S. A multi-vendor, multi-center study on reproducibility and comparability of fast strain-encoded cardiovascular magnetic resonance imaging. Int J Cardiovasc Imaging 2020; 36:899-911. [PMID: 32056087 PMCID: PMC7174273 DOI: 10.1007/s10554-020-01775-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/11/2020] [Indexed: 01/23/2023]
Abstract
Myocardial strain is a convenient parameter to quantify left ventricular (LV) function. Fast strain-encoding (fSENC) enables the acquisition of cardiovascular magnetic resonance images for strain-measurement within a few heartbeats during free-breathing. It is necessary to analyze inter-vendor agreement of techniques to determine strain, such as fSENC, in order to compare existing studies and plan multi-center studies. Therefore, the aim of this study was to investigate inter-vendor agreement and test-retest reproducibility of fSENC for three major MRI-vendors. fSENC-images were acquired three times in the same group of 15 healthy volunteers using 3 Tesla scanners from three different vendors: at the German Heart Institute Berlin, the Charité University Medicine Berlin-Campus Buch and the Theresien-Hospital Mannheim. Volunteers were scanned using the same imaging protocol composed of two fSENC-acquisitions, a 15-min break and another two fSENC-acquisitions. LV global longitudinal and circumferential strain (GLS, GCS) were analyzed by a trained observer (Myostrain 5.0, Myocardial Solutions) and for nine volunteers repeatedly by another observer. Inter-vendor agreement was determined using Bland-Altman analysis. Test-retest reproducibility and intra- and inter-observer reproducibility were analyzed using intraclass correlation coefficient (ICC) and coefficients of variation (CoV). Inter-vendor agreement between all three sites was good for GLS and GCS, with biases of 0.01–1.88%. Test-retest reproducibility of scans before and after the break was high, shown by ICC- and CoV values of 0.63–0.97 and 3–9% for GLS and 0.69–0.82 and 4–7% for GCS, respectively. Intra- and inter-observer reproducibility were excellent for both parameters (ICC of 0.77–0.99, CoV of 2–5%). This trial demonstrates good inter-vendor agreement and test–retest reproducibility of GLS and GCS measurements, acquired at three different scanners from three different vendors using fSENC. The results indicate that it is necessary to account for a possible bias (< 2%) when comparing strain measurements of different scanners. Technical differences between scanners, which impact inter-vendor agreement, should be further analyzed and minimized. DRKS Registration Number: 00013253. Universal Trial Number (UTN): U1111-1207-5874.
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Affiliation(s)
- Jennifer Erley
- Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Victoria Zieschang
- Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Tomas Lapinskas
- Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Aylin Demir
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Max-Delbrueck Center for Molecular Medicine, Department of Cardiology and Nephrology, Charité Medical Faculty, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Stephanie Wiesemann
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Max-Delbrueck Center for Molecular Medicine, Department of Cardiology and Nephrology, Charité Medical Faculty, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Markus Haass
- Department of Internal Medicine/Cardiology/Angiology, Theresienkrankenhaus Und St. Hedwig-Klinik, Mannheim, Germany
| | - Nael F Osman
- Department of Radiology and Radiological Science, School of Medicine, John Hopkins University, Baltimore, MD, USA.,Myocardial Solutions, Inc, Morrisville, NC, USA
| | - Orlando P Simonetti
- Departments of Internal Medicine and Radiology, The Ohio State University, Columbus, OH, USA
| | - Yingmin Liu
- Dorothy M. Davis Heart and Lung Research Institute, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Amit R Patel
- Department of Cardiology, University of Chicago Medicine, Chicago, IL, USA
| | - Victor Mor-Avi
- Department of Cardiology, University of Chicago Medicine, Chicago, IL, USA
| | - Orhan Unal
- Departments of Radiology and Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Kevin M Johnson
- Departments of Radiology and Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Burkert Pieske
- Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,Department of Internal Medicine/Cardiology, Charité Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Jochen Hansmann
- Department of Radiology, Theresienkrankenhaus Und St. Hedwig-Klinik, Mannheim, Germany
| | - Jeanette Schulz-Menger
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Max-Delbrueck Center for Molecular Medicine, Department of Cardiology and Nephrology, Charité Medical Faculty, HELIOS Klinikum Berlin Buch, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. .,Department of Internal Medicine/Cardiology, Charité Campus Virchow Klinikum, Berlin, Germany. .,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
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Kaya B, Damarer Z, Daglar K, Unal O, Soliman A, Guralp O. Is there yet a role for internal iliac artery ligation in obstetric hemorrhage with the current gain in popularity of other uterus sparing techniques? J Matern Fetal Neonatal Med 2016; 30:1325-1332. [DOI: 10.1080/14767058.2016.1212333] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Karatepe O, Eken I, Acet E, Unal O, Mert M, Koc B, Karahan S, Filizcan U, Ugurlucan M, Aksoy M. Vacuum Assisted Closure Improves the Quality of Life in Patients with Diabetic Foot. Acta Chir Belg 2016. [DOI: 10.1080/00015458.2011.11680757] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- O. Karatepe
- Department of General Surgery, Istanbul University, Faculty of Medicine
| | - I. Eken
- Department of General Surgery, Istanbul University, Faculty of Medicine
| | - E. Acet
- Department of General Surgery, Istanbul University, Faculty of Medicine
| | - O. Unal
- Department of Vascular Surgery, Istanbul University, Faculty of Medicine
| | - M. Mert
- Department of Endocrinology, Istanbul University, Faculty of Medicine
| | - B. Koc
- Department of General Surgery, Istanbul University, Faculty of Medicine
| | - S. Karahan
- Department of General Surgery, Istanbul University, Faculty of Medicine
| | - U. Filizcan
- Okmeydani Training and Research Hospital; Department of Cardiovascular Surgery, Istanbul University, Faculty of Medicine
| | - M. Ugurlucan
- Maltepe University Medical Faculty; Department of Cardiovascular Surgery, Istanbul University, Faculty of Medicine
| | - M. Aksoy
- Duzce Ataturk State Hospital; Department of General Surgery, Istanbul University, Faculty of Medicine
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Venkateswaran M, Unal O, Hurley S, Samsonov A, Wang P, Fain SB, Kurpad KN. Modeling Endovascular MRI Coil Coupling With Transmit RF Excitation. IEEE Trans Biomed Eng 2016; 64:70-77. [PMID: 26960218 DOI: 10.1109/tbme.2016.2538279] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To model inductive coupling of endovascular coils with transmit RF excitation for selecting coils for MRI-guided interventions. METHODS Independent and computationally efficient FEM models are developed for the endovascular coil, cable, transmit excitation, and imaging domain. Electromagnetic and circuit solvers are coupled to simulate net B1 + fields and induced currents and voltages. Our models are validated using the Bloch-Siegert B1 + mapping sequence for a series-tuned multimode coil, capable of tracking, wireless visualization, and high-resolution endovascular imaging. RESULTS Validation shows good agreement at 24-, 28-, and 34-μT background RF excitation within experimental limitations. Quantitative coil performance metrics agree with simulation. A parametric study demonstrates tradeoff in coil performance metrics when varying number of coil turns. Tracking, imaging, and wireless marker multimode coil features and their integration is demonstrated in a pig study. CONCLUSION Developed models for the multimode coil were successfully validated. Modeling for geometric optimization and coil selection serves as a precursor to time consuming and expensive experiments. Specific applications demonstrated include parametric optimization, coil selection for a cardiac intervention, and an animal imaging experiment. SIGNIFICANCE Our modular, adaptable, and computationally efficient modeling approach enables rapid comparison, selection, and optimization of inductively coupled coils for MRI-guided interventions.
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Abstract
OBJECTIVE To determine whether preeclampsia causes fetal cardiac cell damage by assessing umbilical artery NT-proBNP, cardiac troponin I and homocysteine. METHODS A cross-sectional study with 73 fetuses between 26 and 40 weeks of gestation was performed. Thirty-three healthy mothers' fetuses were control group (Group I). While 12 mildly pre-eclamptic mothers' fetuses constituted Group II, 28 fetuses of severe pre-eclamptic mothers were Group III. RESULTS Umbilical cord mean NT-proBNP levels of Group I, II and III are 520.8 ± 404.5 pg/ml; 664.2 ± 215.9 pg/ml; and 1932.8 ± 2979.5 pg/ml, respectively (p = 0.0001). The number of neonates with NT-proBNP > 500 pg/mL that indicates severe cardiac damage is higher in Group III (p = 0.001). The mean homocysteine levels are also statistically significantly higher in Group III. Cardiac troponin I levels are not different between the groups (p = 0.46). CONCLUSION Increased NT-proBNP and homocysteine might not only indicate some degree of in-utero cardiac cell damage but also feto-placental endothelial injury in the fetuses of severe pre-eclamptic mothers. Our finding that shows no evidence of correlation between cardiac troponin I levels with cell damage and endothelial injury requires further research.
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Affiliation(s)
- Aybala Akil
- a Department of Gynecology and Obstetrics , Acibadem Bodrum Hospital , Mugla , Turkey
| | - Olus Api
- b Faculty of Medicine, Department of Gynecology and Obstetrics , Yeditepe University , Istanbul , Turkey
| | - Esra Oten Can
- c Department of Gynecology and Obstetrics , Kanuni Sultan Suleyman Education and Research Hospital , Istanbul , Turkey
| | - Sadullah Ozkan
- d Department of Gynecology and Obstetrics , Cekerek State Hospital , Yozgat , Turkey
| | - Serif Ercan
- e Department of Biochemistry , Luleburgaz State Hospital , Kirklareli , Turkey
| | - Asuman Orcun
- f Department of Biochemistry , Kartal Dr Lutfi Kirdar Education and Research Hospital , Istanbul , Turkey , and
| | - Orhan Unal
- g Faculty of Medicine, Department of Gynecology and Obstetrics , Sakarya University , Sakarya , Turkey
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Kaya B, Tuten A, Daglar K, Misirlioglu M, Polat M, Yildirim Y, Unal O, Kilic GS, Guralp O. Balloon tamponade for the management of postpartum uterine hemorrhage. J Perinat Med 2014; 42:745-53. [PMID: 24663227 DOI: 10.1515/jpm-2013-0336] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 02/27/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the use of the Bakri balloon in postpartum hemorrhage (PPH) resistant to medical treatment. METHODS The Bakri balloon was applied to 45 women with PPH after failure of initial management. Bilateral internal iliac artery ligation (BIIAL) and hysterectomy were performed if necessary. RESULTS The Bakri balloon was applied in 45 women; an additional BIIAL was required in nine women. The mean inflation volume of the Bakri balloon was 571±264 mL (range: 240-1300 mL). Hemostasis was achieved in 34 (75.5%) women with the Bakri balloon alone, and in six women with an additional BIIAL. The Bakri balloon was effective with additional procedures overall in 40 of 45 (88.8%) women. In 34 women with uterine atony, the Bakri balloon was successful alone in 27 (79.4%) and with an additional BIIAL in 30 (88.2%) women. An inflation volume of >500 mL was necessary in 18 women with uterine atony. CONCLUSION The Bakri balloon may be performed as a first line of treatment for PPH resistant to uterotonic agents, and can be used not only in tertiary centers but also in limited-resource centers. The inflation volume of the Bakri balloon should be adjusted according to the type of PPH; a volume exceeding 500 mL may be necessary in uterine atony.
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Akil A, Api O, Bektas Y, Yilmaz AO, Yalti S, Unal O. Paracetamol vs dexketoprofen for perineal pain relief after episiotomy or perineal tear. J OBSTET GYNAECOL 2014; 34:25-8. [PMID: 24359044 DOI: 10.3109/01443615.2013.828026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A randomised controlled trial was conducted to investigate efficacy of paracetamol and dexketoprofen trometamol for perineal pain relief after perineal repair. Subjects were randomly assigned to receive two doses of either 50 mg of intravenous dexketoprofen trometamol via slow i.v. infusion (Group I, n = 49) or 1,000 mg of paracetamol via intravenous infusion (Group II, n = 46). The main outcome measure was a VAS (visual analogue scale) for pain recorded at 1 h (VAS 1). A total of 82 patients were included in the final analysis (Group I, n = 41; Group II, n = 41). There was no difference among groups in terms of pain scores at the beginning (VAS 0). The pain was decreased in 70% of the patients in Group I and in 62% of the patients in Group II (p = 0.502). Both paracetamol and dexketoprofen are effective in perineal pain relief after episiotomy or perineal tear repair.
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Affiliation(s)
- A Akil
- Bodrum Acıbadem Hospital , Bodrum , Mugla
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Ipek A, Cay N, Unal O, Idilman İ, Balaban M. PP-245 Atrioventricular Septal Defect Diagnosed By Fetal Ultrasonography. Am J Cardiol 2014. [DOI: 10.1016/j.amjcard.2014.01.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Wang P, Unal O. Motion-compensated real-time MR thermometry augmented by tracking coils. J Magn Reson Imaging 2014; 41:851-7. [PMID: 24478147 DOI: 10.1002/jmri.24574] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 01/07/2014] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To develop and evaluate a real-time proton resonant frequency (PRF) based MR thermometry method with a novel motion compensation technique, using linear phase model and active tracking coils. MATERIALS AND METHODS A 6F catheter with multiple tracking coils and radiofrequency (RF) ablation tip was built for ex vivo experiments using excised bovine liver on a 1.5 Tesla scanner. A real-time MR acquisition scheme with interleaved active catheter tracking and multislice imaging was implemented. To evaluate the proposed method, in-plane periodic linear motion and through-plane irregular motion were induced by the rocker capability of the scanner and hand, respectively. Real-time temperature maps of the tissue undergoing a 2-min RF ablation cycle were obtained and used to compare the performance of the proposed method with that of the multi-baseline method. RESULTS The temporal window achieved per acquisition of one slice and catheter tracking is ∼380 ms. The standard deviations of tracking errors are less than 1 mm for both irregular and periodic motions in x-y plane. The measurements at the heated and unheated regions demonstrate that the proposed thermometry method perform equally well for both in-plane and through-plane motion while maintaining a similar accuracy (σ = 1.10 versus 1.04°C) compared with the conventional multi-baseline method. CONCLUSION The new MR thermometry method using catheter-based tracking coils and linear phase model for motion compensation and phase correction is promising and may offer reliable MR thermometry for real-time MRI-guided thermal therapies.
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Affiliation(s)
- Peng Wang
- Medical Physics, University of Wisconsin - Madison, Wisconsin, USA
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Affiliation(s)
- O. Unal
- Department of Mechanical EngineeringFaculty of Engineering, Bartin University 74100, Bartin, Turkey
| | - R. Varol
- Department of Mechanical EngineeringFaculty of Engineering, Suleyman Demirel University 32260, Isparta, Turkey
| | - A. Erdogan
- Department of Metallurgical and Materials Engineering, Bartin University, 74100, Bartin, Turkey
| | - M. S. Gok
- Department of Metallurgical and Materials Engineering, Bartin University, 74100, Bartin, Turkey
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Kecskemeti S, Johnson K, François CJ, Schiebler ML, Unal O. Volumetric late gadolinium-enhanced myocardial imaging with retrospective inversion time selection. J Magn Reson Imaging 2013; 38:1276-82. [PMID: 23389851 DOI: 10.1002/jmri.24037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 12/12/2012] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To develop and validate a novel free-breathing 3D radial late gadolinium-enhanced magnetic resonance imaging technique (3D LGE-MRI) with isotropic resolution and retrospective inversion time (TI) selection for myocardial viability imaging. MATERIALS AND METHODS The 3D radial LGE-MRI method featuring an interleaved and bit-reversed radial k-space trajectory was evaluated in 12 subjects that also had clinical breath-hold Cartesian 2D LGE-MRI. The 3D LGE-MRI acquisition requires a predicted TI and a user-controlled data acquisition window that determines the sampling width around the predicted TI. Sliding window reconstructions with update rates of 1× the repetition time (TR) allow for a user selectable TI to obtain the maximum nulling of the myocardium. The retrospective nature of the acquisition allows the user to choose from a range of possible TI times centered on the expected TI. Those projections most corrupted by respiratory motion, as determined by a respiratory bellows signal, were resampled according to the diminishing variance algorithm. The quality of the left ventricular myocardial nulling on the 3D LGE-MRI and 2D LGE-MRI was assessed using a 4-point Likert scale by two experienced radiologists. Comparison of image quality scores for the two methods was performed using generalized estimating equations. RESULTS All 3D LGE-MRI cases produced similar nulling of myocardial signal as the 2D LGE-MRI. The image quality of myocardial nulling was not significantly different between the two acquisitions (mean nulling of 3.4 for 2D vs. 3.1 for 3D, and P = 0.0645). The average absolute deviation from mean scores was also not determined to be statistically significant (1.8 for 2D and 0.4 for 3D and P = 0.1673). Total acquisition time was ∼9 minutes for 3D LGE-MRI with voxel sizes ranging from 1.6(3) to 2.0(3) mm(3) . Conversely, the total imaging time was twice as long for the 2D DCE-MRI (>17 minutes) with an eight times larger voxel size of 1.4 × 2.2 × 7.0 mm. CONCLUSION The 3D LGE-MRI technique demonstrated in this study is a promising alternative for the assessment of myocardial viability in patients who have difficulty sustaining breath-holds for the clinical standard 2D LGE-MRI.
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Affiliation(s)
- Steve Kecskemeti
- Department of Physics, University of Wisconsin, Madison, Wisconsin, USA; Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, USA
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Unal O, Citgez B, Cipe G, Toydemir T, Karatepe O. Conservative treatment of arterial pseudoaneurism in patients with behcet disease. Georgian Med News 2013:28-32. [PMID: 23482359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Behcet's Disease (BD) is a rare disease, of unknown origin that generally causes an inflammation in the subcutaneous tissue, eyes and brain vessels, and related with the immune system, predominantly seen in male patients and the mean age at onset is mainly in the third decade. The aim of the study was to present our experiences with the cases of arterial pseudoaneurysms that we treated conservatively without surgical or radiological intervention. Eleven patients with Behcet's disease who developed arterial pseudoaneuryms and responsed to the medical treatment are included in the study. The operation requirement, the complication rates, and factors that influence morbidity and mortality are evaluated. The mean age of the patients was 29,5 (18-35) years. Nine of the patients were male and 2 were female. The mean period of hospitalization was 18 (11-34) days. Six patients redeveloped aneurysm during their follow-up. Three of these patients were treated with surgery. Five patients had no complication during an average of 20 months of follow-up period. Arterial pseudoaneurysm is a rare complication of Behcet's disease. Despite the good response to conservative treatment at the beginning period, the patients should be closely followed up and redevelopment of the aneurysm should be kept in mind.
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Affiliation(s)
- O Unal
- Bakirkoy research Hospital, Department of Vasculary Surgery, Istanbul, Turkey
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18
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Gokce M, Unal O, Hismi B, Gumruk F, Coskun T, Balta G, Unal S, Cetin M, Kalkanoglu-Sivri HS, Dursun A, Tokatlı A. Secondary hemophagocytosis in 3 patients with organic acidemia involving propionate metabolism. Pediatr Hematol Oncol 2012; 29:92-8. [PMID: 21970506 DOI: 10.3109/08880018.2011.601402] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hemophagocytic lymphohistiocytosis (HLH) may develop secondary to infections, malignancies, immune deficiency syndromes, and rheumatologic and metabolic disorders. Associations between HLH and inborn errors of metabolism, including lysinuric protein intolerance, multiple sulfatase deficiency, galactosemia, Gaucher disease, Pearson syndrome, and galactosialidosis, have previously been reported in the literature. In this report the authors present 3 children with disorders of propionate metabolism--1 with methylmalonic acidemia and 2 with propionic acidemia--who developed secondary HLH during their metabolic attacks. All patients fulfilled the 5 HLH criteria of the Histiocyte Society. Familial HLH was ruled out by molecular analysis. Plasma exchange was performed for 2 of them. Unfortunately 1 died of multiorgan failure despite intensive therapy. This is the first report of such an association.
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Affiliation(s)
- M Gokce
- Department of Pediatric Hematology, Hacettepe Medical Faculty, Ankara, Turkey.
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Karatepe O, Eken I, Acet E, Unal O, Mert M, Koc B, Karahan S, Filizcan U, Ugurlucan M, Aksoy M. Vacuum assisted closure improves the quality of life in patients with diabetic foot. Acta Chir Belg 2011; 111:298-302. [PMID: 22191131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Diabetes Mellitus (DM) is the most common endocrine disease worldwide. One of the most important chronic complications of this disease is the development of diabetic foot. The management of diabetic foot wounds is quite important with respect to public health. AIMS To determine the effect of Vacuum Assisted Closure (VAC) therapy on the quality of life in the treatment of diabetic foot ulcers and compare it with standart wound care. METHODS Between May 2007 to December 2008, 67 consecutive patients with diabetic foot ulcers were randomly assigned to VAC therapy (Group 1, n : 30) or standart wound care (Group 2, n : 37). The SF-36 questionnaire was administered the day before and in the month following wound healing. Global analyses of the 8 domains and 2 comprehensive indexes of SF-36, Physical Component Summary (PCS) and Mental Component Summary (MCS) were performed. Clinical measures included standard antidiabetic treatment, daily wound care including antiseptic bath, debridement, toe removal for gangrene when necessary, and wound care with conventional methods or VAC. Healing time was calculated as the time from hospital admission to the time of re-epithelization. RESULTS There were no differences in the mean age, ulcer size and pulse status of the patients in both groups. Healing time in the VAC group was significantly reduced (p < 0.05). All 8 domains of SF-36 and MCS and PCS scores improved remarkably after VAC therapy. CONCLUSION Vacuum Assisted Closure therapy was found to be effective in the treatment of chronic diabetic ulcers. The improvement of quality of life demonstrates a clear-cut indication in this particular group of patients.
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Affiliation(s)
- O Karatepe
- Department of General Surgery, Okmeydani Training and Research Hospital, Istanbul, Turkey
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20
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Kars B, Buyukbayrak EE, Karsidag AYK, Pirimoglu M, Unal O, Turan C. Comparison of success rates of 'transvaginal aspiration and tetracycline sclerotherapy' versus 'only aspiration' in the management of non-neoplastic ovarian cysts. J Obstet Gynaecol Res 2011; 38:65-9. [PMID: 21827579 DOI: 10.1111/j.1447-0756.2011.01627.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To investigate the value of tetracycline sclerotherapy for management of recurrent or persisting non-neoplastic ovarian cysts in comparison to the aspiration without sclerotherapy. MATERIAL AND METHODS Ninety-six patients with proven non-neoplastic ovarian cysts were randomized into two groups. Group 1 patients underwent cyst aspiration together with tetracycline sclerotherapy (n=48). Group 2 patients underwent only cyst aspiration without tetracycline sclerotherapy (n=48). Then, all patients were followed up monthly with ultrasonography for 12months. The procedure was considered to have failed if the recurring cyst, detected by ultrasound, was 4cm in size or greater. RESULTS There were no differences between the two groups regarding demographic data, initial cyst volume and tumor markers. Recurrence rates within 12months were 14.6% in group 1 and 50% in group 2 (P<0.001). CONCLUSION Based on the recurrence rates, we suggest transvaginal aspiration together with tetracycline sclerotherapy rather than only simple transvaginal aspiration in the management of non-neoplastic ovarian cysts.
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Affiliation(s)
- Bulent Kars
- Dr Lutfi Kirdar Kartal Education and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
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Abstract
PURPOSE To demonstrate the feasibility of using a single intravascular radiofrequency (RF) probe connected to the external magnetic resonance imaging (MRI) system via a single coaxial cable to perform active tip tracking and catheter visualization and high signal-to-noise ratio (SNR) intravascular imaging. MATERIALS AND METHODS A multimode intravascular RF coil was constructed on a 6F balloon catheter and interfaced to a 1.5T MRI scanner via a decoupling circuit. Bench measurements of coil impedances were followed by imaging experiments in saline and phantoms. RESULTS The multimode coil behaves as an inductively coupled transmit coil. The forward-looking capability of 6 mm was measured. A greater than 3-fold increase in SNR compared to conventional imaging using optimized external coil was demonstrated. Simultaneous active tip tracking and catheter visualization was demonstrated. CONCLUSION It is feasible to perform 1) active tip tracking, 2) catheter visualization, and 3) high SNR imaging using a single multimode intravascular RF coil that is connected to the external system via a single coaxial cable.
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Affiliation(s)
- Krishna N Kurpad
- Department of Radiology, University of Wisconsin, Madison, WI, USA.
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Besiroglu L, Sozen M, Ozbebit O, Avcu S, Selvi Y, Bora A, Atli A, Unal O, Bulut MD. The involvement of distinct neural systems in patients with obsessive-compulsive disorder with autogenous and reactive obsessions. Acta Psychiatr Scand 2011; 124:141-51. [PMID: 21627621 DOI: 10.1111/j.1600-0447.2011.01726.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the regional metabolite abnormalities and changes after treatment in patients with OCD with autogenous and reactive obsessions. METHOD We assessed right anterior cingulate cortex (ACC) and amygdala-hippocampal region (Am + Hpp) N-acetyl-aspartate (NAA), choline (Cho) and creatine (Cr) concentrations and NAA/Cr and Cho/Cr ratios using single-voxel proton magnetic resonance spectroscopy in 15 patients with autogenous obsessions (OCD-A), 15 patients with reactive obsessions (OCD-R) and 15 healthy controls (HC). Measurements were repeated after 16 weeks of fluoxetine treatment. RESULTS Baseline ACC NAA/Cr ratios of both OCD groups were significantly lower than HC. OCD-A group had significantly lower baseline NAA/Cr ratios in the Am + Hpp than other groups. These differences were more likely to be explained by higher Cr levels in ACC. We found no significant differences and changes for Cho levels and Cho/Cr ratios between groups and within groups. Significant increase in NAA/Cr ratios of OCD-A group found in the Am + Hpp was more likely to be explained by increased NAA levels. No significant changes were found in ACC NAA/Cr ratios. CONCLUSION While disturbed energy metabolism in ACC might reflect a common pathology in patients with OCD regardless of symptom dimension, alterations in mesiotemporal lobe are more likely for autogenous obsessions.
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Affiliation(s)
- L Besiroglu
- Department of Psychiatry, Yuzuncu Yil University, Van, Turkey.
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Pirimoglu ZM, Ozyapi AG, Kars B, Buyukbayrak EE, Solak Y, Karsidag AYK, Unal O, Turan MC. Comparing the effects of intrauterine progestin system and oral progestin on health-related quality of life and Kupperman index in hormone replacement therapy. J Obstet Gynaecol Res 2011; 37:1376-81. [DOI: 10.1111/j.1447-0756.2011.01541.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Unal O, Kars B, Buyukbayrak EE, Karsidag AYK, Turan C. The effectiveness of bilateral hypogastric artery ligation for obstetric hemorrhage in three different underlying conditions and its impact on future fertility. J Matern Fetal Neonatal Med 2011; 24:1273-6. [DOI: 10.3109/14767058.2011.574751] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Oven Ustaalioglu BB, Bilici A, Kefeli U, Seker M, Salepci T, Unal O, Gumus M. A retrospective analysis of women's chances to become pregnant after completion of chemotherapy: a single center experience. J BUON 2011; 16:349-352. [PMID: 21766510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE With the improvement in anticancer therapies, the survival of women with malignancies has increased and infertility may affect the quality of life of premenopausal women, who experience temporary or permanent amenorrhea due to chemotherapy. The aim of this study was to review the rate of pregnancies among women with malignancy previously treated with chemotherapy. METHODS We retrospectively recorded 317 women younger than 40 years of age who were treated with chemotherapy (and a number of them with additional radiotherapy/RT) due to several malignancies between 2007-2010. The patients who got pregnant after stopping chemotherapy and during followup were analyzed. RESULTS Among women with breast cancer (n=116), malignant lymphoma (n=85), ovarian cancer (n=26) and colon cancer (n=90), 20 got pregnant after a median 22.9 months (range 10.7-96.5) from the end of chemotherapy. Childbearing was uneventful and newborns were healthy. CONCLUSION Women who had previously received chemotherapy for malignancy can get pregnant and deliver healthy newborns.
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Affiliation(s)
- B B Oven Ustaalioglu
- Department of Medical Oncology, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey.
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Pirimoglu ZM, Arslan C, Buyukbayrak EE, Kars B, Karsidag YK, Unal O, Turan MC. Glucose tolerance of premenopausal women after menopause due to surgical removal of ovaries. Climacteric 2011; 14:453-7. [PMID: 21271939 DOI: 10.3109/13697137.2010.539723] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the influence of the abrupt withdrawal of ovarian function on glucose tolerance by studying premenopausal women before and after oophorectomy. METHODS Thirty premenopausal women who needed hysterectomy for benign reasons volunteered for the study in our hospital in Istanbul, Turkey. An oral glucose tolerance test (OGTT) was performed before surgery and 3, 6 and 12 months after surgery. Fasting glucose, fasting insulin levels and insulin/glucose indexes, HOMA indexes, insulin and glucose levels were measured during OGTT. RESULTS The mean fasting and 2-h glucose levels of the women did not change significantly during the 12 months of follow-up. However, the glucose levels during the glucose tolerance tests changed significantly after surgery (p<0.05). Insulin responses to the glucose tolerance test also increased significantly (p<0.005). Insulin/glucose indexes were significantly higher after surgery (p<0.005). Type 2 diabetes mellitus was detected in five women and impaired glucose tolerance was detected in 12 of the 30 patients after surgery in the 12-month period. CONCLUSION The impairment of carbohydrate metabolism due to an abrupt decrease in natural estrogen levels should be considered before removing the ovaries during hysterectomy in premenopausal patients.
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Affiliation(s)
- Z M Pirimoglu
- Obstetrics and Gynecology Department of Dr. Lutfi Kirdar Kartal Education and Research Hospital, Kartal, Istanbul, Turkey
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Avcu S, Koseoglu MN, Ceylan K, Bulut MD, Dbulutand M, Unal O. The value of diffusion-weighted MRI in the diagnosis of malignant and benign urinary bladder lesions. Br J Radiol 2011; 84:875-82. [PMID: 21224296 DOI: 10.1259/bjr/30591350] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To investigate the role of diffusion-weighted MRI (DWI) in the diagnosis of urinary bladder (UB) tumours by means of measuring apparent diffusion coefficient (ADC) values. METHODS A total of 83 people aged between 18 and 86 years were included in the study: 63 patients with UB pathology (46 malignant, 17 benign) constituted the case group; 20 individuals without any UB pathology constituted the control group. DWI was applied to all individuals. The ADC values were measured based on the tissue of the UB mass entities and normal UB wall in the control group. RESULTS The mean ADC value in the UB carcinoma group was significantly lower than that in the control group: 1.0684 ± 0.26 × 10(-3) mm(2) s(-1) and 2.010 ± 0.11 × 10(-3) mm(2) s(-1), respectively (p<0.01). There was a significant difference among the mean ADC values of different grades of malignant tumours, corresponding to 0.9185 ± 0.20 mm(2) s(-1) and 1.281 ± 0.18 mm(2) s(-1) in high-grade and low-grade malignant UB carcinomas, respectively (p<0.01). The ADC value in the carcinoma group was significantly lower than that in the benign lesion group: 1.0684 ± 0.26 × 10(-3) mm(2) s(-1) and 1.803 ± 0.19 × 10(-3) mm(2) s(-1), respectively (p<0.01). All 46 malignant lesions displayed a restriction in diffusion; 4 of the 17 benign lesions displayed a mild restriction in diffusion. The sensitivity, specificity and accuracy of DWI in the diagnosis of malignant UB lesions was 100%, 76.5% and 93.65%, respectively. CONCLUSION DWI can be beneficial in the differentiation of benign and malignant UB lesions, as well as of high-grade and low-grade UB carcinomas, using quantitative ADC measurements.
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Affiliation(s)
- S Avcu
- Department of Radiology, School of Medicine, Yuzuncu Yil University, Van, Turkey.
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Naki M, Api O, Acioglu HC, Uzun MG, Kars B, Unal O. Analgesic Efficacy of Forced Coughing versus Local Anesthesia during Cervical Punch Biopsy. Gynecol Obstet Invest 2011; 72:5-9. [DOI: 10.1159/000320842] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 09/01/2010] [Indexed: 11/19/2022]
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Kars B, Karsidag AYK, Buyukbayrak EE, Telatar B, Turan C, Unal O. Evaluation of fetal lung maturity by turbidity testing and tap test. Turk J Obstet Gynecol 2011. [DOI: 10.5505/tjod.2011.97752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Karageyim Karsidag AY, Alkan N, Esim Buyukbayrak E, Kars B, Pirimoglu M, Unal O, Turan MC. The effects of low dose hormone therapy on serum lipid profile, glisemic control, thyroid hormones and androgen levels in postmenopausal women. Turk J Obstet Gynecol 2011. [DOI: 10.5505/tjod.2011.81488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Api O, Akil A, Uzun MG, Acioglu HC, Yalcin O, Api M, Unal O. Fetal retroperitoneal lipoblastoma: ultrasonographic appearance of a rare embryonal soft tissue tumor. J Matern Fetal Neonatal Med 2010; 23:1069-71. [PMID: 20718582 DOI: 10.3109/14767050903301025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Karsidag AYK, Karsidag C, Buyukbayrak EE, Kars B, Pirimoglu M, Unal O, Turan MC. Raloxifene: is it really effective on mood changes in postmenopausal osteopenic women? J Psychosom Obstet Gynaecol 2010; 31:273-8. [PMID: 20961269 DOI: 10.3109/0167482x.2010.524718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate the effect of raloxifene therapy on menopausal symptoms, depression and anxiety scores using Kupperman's Scale, Hamilton Depression Rating Scale (HDRS) and Beck Anxiety Rating Scale (BARS) in osteopenic postmenopausal women. METHODS This was a prospective, randomised, parallel and open labeled clinical study. One-hundred thirty-two postmenopausal osteopenic women with natural menopause enrolled into the study. One-hundred twenty-four of them completed the study. Group I patients were treated with oral raloxifene (60 mg/day), Group II patients were treated with oral calcium supplementation (1000 mg/day) for 3 months. The patient's menopausal, depressive and anxiety symptoms were assessed by using Kupperman's Scale, HDRS and BARS, before and at the end of treatment. For statistical analysis unpaired t, ANOVA, RM-ANOVA, MANCOVA, Pearson correlation tests were used. Statistical significance level was established at p < 0.05. RESULTS Baseline Kupperman's Scale, HDRS and BARS scores were not different among two groups. At the end of 3 months of therapy, there was improvement in menopausal symptoms, depression and anxiety scores within both groups. When we compared change of scores before and after the treatment; group I scores were better than group II scores. CONCLUSION Our results suggest that raloxifene may have a positive effect on mood in osteopenic postmenopausal women.
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Affiliation(s)
- A Yasemin Karageyim Karsidag
- Department of Obstetrics and Gynecology, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey.
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Naki MM, Api O, Acioglu HC, Ozkan S, Kars B, Unal O. Comparative study of a barbed suture, poliglecaprone and stapler in Pfannenstiel incisions performed for benign gynecological procedures: a randomized trial. Acta Obstet Gynecol Scand 2010; 89:1473-7. [PMID: 20919804 DOI: 10.3109/00016349.2010.516815] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare a novel barbed suture, poliglecaprone-25 suture and stapler in Pfannenstiel incisions performed for benign gynecological procedures. DESIGN A randomized controlled non-inferiority trial with randomization in a 1:1:1 ratio. SETTING Istanbul Dr. Lutfi Kirdar Kartal Research and Training Hospital, Department of Obstetrics and Gynecology. POPULATION Patients between 18 and 45 years of age without prior lower abdominal incision and undergoing Pfannenstiel incisions for benign gynecological procedures. METHODS A total of 117 female patients randomized into barbed (n = 39), poliglecaprone-25 (n = 39) and stapler (n = 39) groups according to suture type. Skin closure techniques were compared in terms of length of incision (cm), adverse events (wound dehiscence, incisional infection, seroma and hematoma), subjective pain scores, patient satisfaction and postoperative scar cosmesis. MAIN OUTCOME MEASURES. The difference between three suture materials in terms of postoperative incision pain, patient satisfaction and scar cosmesis. RESULTS Skin closure techniques were similar in terms of length of incision (cm), adverse events and pain scores and Modified Hollander Cosmesis Score. Barbed (p < 0.001) and poliglecaprone-25 (p < 0.01) sutures were significantly better than staplers in terms of patient satisfaction. CONCLUSION The three different methods of skin closure revealed comparable outcome except for a significant superiority of sutures to the stapler method in terms of patient satisfaction scores.
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Affiliation(s)
- Mehmet Murat Naki
- Department of Obstetrics and Gynecology, Dr. Lutfi Kirdar Kartal Research and Training Hospital, Istanbul, Turkey.
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Naki MM, Api O, Celik H, Kars B, Yaşar E, Unal O. Comparative study of Misgav-Ladach and Pfannenstiel-Kerr cesarean techniques: a randomized controlled trial. J Matern Fetal Neonatal Med 2010; 24:239-44. [PMID: 20712425 DOI: 10.3109/14767058.2010.482612] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM To compare Pfannenstiel-Kerr (PKM) and Misgav-Ladach (MLM) methods in terms of operation-related features and neonatal outcome in primary cesarean deliveries. METHODS A total of 180 pregnant women randomized into PKM (n = 90) or MLM (n = 90) groups were included in this study. Primary outcome measures were total operative and extraction times, Apgar score, blood loss, wound complications, and the suture use. Secondary outcome measures were wound seroma and infection incidence, time of bowel restitution, and the perceived pain. RESULTS Total operation and extraction times were significantly shorter and less suture material was used in the MLM group than the PKM group (p < 0.001). Initially, higher scores obtained for 6 h-VAS in the MLM group (p < 0.05) were normalized after 24 h of the operation. PKM and MLM were similar in terms of preoperative and postoperative levels of hemoglobin and hematocrit, wound complication, bowel restitution, fever, seroma, infection, wound dehiscence and the need for transfusion, antibiotic, and analgesics. CONCLUSION The operation-related morbidity of the MLM and PKM for primary C/S seem to be comparable; however, the MLM seems to be superior in terms of operation time and the amount of suture usage but inferior in pain scores in the early postoperative period.
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Affiliation(s)
- Mehmet Murat Naki
- Department of Obstetrics and Gynecology, Dr Lutfi Kirdar Kartal Research and Training Hospital, Kartal, Istanbul, Turkey
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Buyukbayrak EE, Karageyim Karsidag AY, Kars B, Balcik O, Pirimoglu M, Unal O, Turan C. Effectiveness of short-term maintenance treatment with cabergoline in microadenoma-related and idiopathic hyperprolactinemia. Arch Gynecol Obstet 2010; 282:561-6. [PMID: 20571820 DOI: 10.1007/s00404-010-1562-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Accepted: 06/09/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study aimed to determine the effectiveness of short-term maintenance treatment with cabergoline and to find out minimum effective dosage of cabergoline during maintenance treatment for patients with microadenoma-related and idiopathic hyperprolactinemia. STUDY DESIGN Cabergoline was administered orally at a dose of 0.5 mg twice per week to 164 de novo hyperprolactinemic patients until serum prolactin level normalized. After this initial treatment phase, patients started on maintenance phase for which they were previously randomized. No maintenance treatment (Group I, n = 36) or cabergoline 0.5 mg (Group II, n = 46), 0.25 mg (Group III, n = 39), 0.125 mg (Group IV, n = 43) was administered twice per week for 8 weeks as maintenance treatment. Then, maintenance phase was finalized and patients were followed up for 6 months. Mean serum prolactin levels through maintenance treatment phase and follow-up period were assessed between groups and within groups. RESULTS Except for group I, all the groups showed a similar pattern with fast decrease of serum prolactine level during maintenance phase and slower increase during the follow-up period. Notably, the average prolactin level was significantly lower at the last follow-up visit than at the diagnosis time in all of the groups. Stable normoprolactinemia of the groups at the end of follow-up period were 47.2, 37, 48.7, and 34.9%, respectively. CONCLUSIONS The results indicate that short maintenance treatment in idiopathic and microadenoma-related hyperprolactinemia seems as effective as long maintenance treatment in the present study. But, further studies with larger study population and longer follow-up period are needed to make a decision about early treatment withdrawal. Also, during the maintenance treatment administration of medicine to patients should be tapered down to the lowest dose that will maintain prolactin levels normal.
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Affiliation(s)
- Esra Esim Buyukbayrak
- Department of Gynecology, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey.
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Mustafa Can M, Kaymaz C, Can E, Tanboğa İH, Apı O, Kars B, Ceren Tokgoz H, Turkyılmaz E, Akgun T, Sonmez K, Saglam M, Turan C, Unal O, Serebruany V. Whole blood platelet aggregation failed to detect differences between preeclampsia and normal pregnancy. Platelets 2010; 21:496-7. [DOI: 10.3109/09537101003797275] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Esim Buyukbayrak E, Kars B, Karsidag AYK, Karadeniz BI, Kaymaz O, Gencer S, Pirimoglu ZM, Unal O, Turan MC. Diagnosis of vulvovaginitis: comparison of clinical and microbiological diagnosis. Arch Gynecol Obstet 2010; 282:515-9. [PMID: 20461391 DOI: 10.1007/s00404-010-1498-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Accepted: 04/23/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of the present study was to compare the current diagnostic clinical and laboratory approaches to women with vulvovaginal discharge complaint. The secondary outcomes were to determine the prevalence of infections in our setting and to look for the relation between vulvovaginal infections and predisposing factors if present. METHOD Premenopausal women applying to our gynecology outpatient clinic with vaginal discharge complaint were enrolled prospectively into the study. Each patient evaluated clinically with direct observation of vaginal secretions, wet mount examination, whiff test, vaginal pH testing and chlamydia rapid antigen test. Each patient also evaluated microbiologically with vaginal discharge culture and gram staining. Clinical diagnosis was compared with the microbiological diagnosis (the gold standard). Diagnostic accuracy was measured with sensitivity, specificity, positive (ppv) and negative predictive values (npv). RESULTS 460 patients were included in the study. 89.8% of patients received a clinical diagnosis whereas only 36% of them had microbiological diagnosis. The sensitivity, specificity, ppv, npv of clinical diagnosis over microbiological culture results were 95, 13, 38, 82%, respectively. The most commonly encountered microorganisms by culture were Candida species (17.4%) and Gardnerella vaginalis (10.2%). Clinically, the most commonly made diagnoses were mixed infection (34.1%), bacterial vaginosis (32.4%) and fungal infection (14.1%). Symptoms did not predict laboratory results. Predisposing factors (DM, vaginal douching practice, presence of IUD and usage of oral contraceptive pills) were not found to be statistically important influencing factors for vaginal infections. CONCLUSION Clinical diagnosis based on combining symptoms with office-based testing improves diagnostic accuracy but is insufficient. The most effective approach also incorporates laboratory testing as an adjunct when a diagnosis is in question or treatment is failing.
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Affiliation(s)
- Esra Esim Buyukbayrak
- Department of Gynecology, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Kartal, Istanbul, Turkey.
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Karsidag AYK, Buyukbayrak EE, Kars B, Suyugul U, Unal O, Turan MC. The relationship between unexplained elevated serum markers in triple test, uterine artery Doppler measurements and adverse pregnancy outcome. J PAK MED ASSOC 2010; 60:181-186. [PMID: 20225773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To investigate the relationship between adverse pregnancy outcomes and unexplained elevations of second trimester maternal serum human chorionic gonadotropin (hCG), alpha fetoprotein (AFP) levels and uterine artery Doppler measurements. METHODS A total of 144 women between 16-20 weeks of gestation that applied to our clinic for triple test were enrolled into the study. Study group consisted of 84 pregnant women with hCG and/or AFP levels > or =2 MoM. Control group comprised of 60 pregnant women with hCG and AFP levels <2 MoM. Study group was further subdivided into 3 subgroups: Subgroup I; only AFP> or =2 MoM (n=30), subgroup II; only hCG > or =2 MoM (n=64) and subgroup III; both AFP and hCG > or =2 MoM (n=10). RESULT Operative delivery rate (p = 0.0017), overall complication rate (p=0.0002), bilateral early diastolic notch presence rate (p = 0.015) were high and mean birth weight was low (p=0.045) in the study group. In subgroup I patients, low birth weight [LBW] (p = 0.0008), preterm delivery (p = 0.0001), preeclampsia (p = 0.003) and preterm premature rupture of membranes [PPROM] (p = 0.012) rates were high. In subgroup II patients, only small for gestational age baby [SGA] (p = 0.016) rate was high. In subgroup III patients LBW (p = 0.009), preterm delivery (p = 0.0001) and PPROM (p = 0.01) rates were high. According to Doppler velocimetry studies, bilateral early diastolic notch presence rate was high (p = 0.015) in the study group. CONCLUSION Patients with high AFP levels and bilateral uterine artery diastolic notch presence, are candidates for pregnancy complications and these groups of patients should be followed up more intensively.
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Buyukbayrak EE, Kaymaz O, Kars B, Karsidag AYK, Bektas E, Unal O, Turan C. Caesarean delivery or vaginal birth: Preference of Turkish pregnant women and influencing factors. J OBSTET GYNAECOL 2010; 30:155-8. [DOI: 10.3109/01443610903461436] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pirimoglu ZM, Guzelmeric K, Alpay B, Balcik O, Unal O, Turan MC. Psychological factors of hyperemesis gravidarum by using the SCL-90-R questionnaire. CLIN EXP OBSTET GYN 2010; 37:56-59. [PMID: 20420284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Hyperemesis gravidarum is known as a complex disease with interaction of biological, psychological and sociocultural factors. Our study was an attempt to understand the psychological effects on hyperemesis gravidarum by using an objective scale. METHODS Thirty-four pregnant women with hyperemesis gravidarum who were hospitalized in the Obstetrics and Gynecology Department of Dr. Lutfi Kirdar Kartal Education and Research Hospital in Istanbul, Turkey comprised the patient group and asymptomatic pregnant women who came for routine antenatal visits to our clinic were enrolled in this study as the control group between March 1, 2007 and October 15, 2008. Women in both groups filled in the Symptom Check List (SCL-90-R) questionnaire. The data collected from both groups were analyzed by using the Student's t-test (SPSS 13.00). Frequencies of high SCL scores between groups were analyzed by chi-square tests. RESULTS The patients with hyperemesis gravidarum had higher distress scores than those in the control group. The mean value of global severity index (GSI) was 1.03 in the patient group and 0.64 in the control group. The difference was statistically significant (p < 0.005). The most significant difference between the two groups was in somatization subscales (p < 0.0001). CONCLUSION Hyperemesis gravidarum is a complex disorder with psychological aspects. Considering this fact can help us deal with the disorder.
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Affiliation(s)
- Z M Pirimoglu
- Obstetrics and Gynecology Department, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Kartal, Istanbul, Turkey.
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Avcu S, Unal O, Turan A, Kiriş M, Yuca K. Retropharyngeal abscess presenting with acute respiratory distress in a case of cervical spondylodiscitis. B-ENT 2010; 6:63-65. [PMID: 20420084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
We treated a 41-year-old man who presented with dysphagia, fever and respiratory distress. Magnetic resonance imaging (MRI) showed a large retropharyngeal abscess (RPA) extending to the C5-6 level, C5-6 spondylodiscitis and a spinal epidural abscess. The RPA was drained surgically under emergency conditions. Because the tuberculin skin test was positive, the patient underwent a triple anti-tuberculous drugs regimen. After six months of drug therapy, the epidural abscess was completely resolved. One of the most important aetiologies of RPA is thought to be tuberculous spondylodiscitis, and cervical vertebrae should be scanned thoroughly with pre-operative MRI.
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Affiliation(s)
- S Avcu
- Department of Radiology, Yüzüncü Yil University Medical Faculty Van, Turkey.
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Turan C, Koc N, Dansuk R, Cengizoglu B, Mericeli DS, Unal O. Misoprostol administration in first-trimester pregnancies with embryonic demise reduces uterine arterial blood flow. J Matern Fetal Neonatal Med 2009; 14:226-8. [PMID: 14738166 DOI: 10.1080/jmf.14.4.226.228] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study was designed to evaluate the effect of misoprostol on the blood flow in uterine arteries of pregnant women with first-trimester embryonic demise. METHODS Transvaginal ultrasonographic Doppler examinations (resistance index, pulsatility index, systolic/diastolic ratio) of the uterine arteries in 61 pregnant women were performed before misoprostol administration and 90 min later. Following baseline Doppler measurements, each woman received 200 microg misoprostol intravaginally and 200 microg misoprostol orally. RESULTS AND CONCLUSION All Doppler indices increased significantly after misoprostol administration (p < 0.0001), suggesting an increase in flow resistance.
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Affiliation(s)
- C Turan
- Department of Obstetrics and Gynecology, Kartal Education and Research Hospital, Istanbul, Turkey
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Karsidag AYK, Buyukbayrak EE, Kars B, Dansuk R, Unal O, Turan MC. Vaginal versus sublingual misoprostol for second-trimester pregnancy termination and effect on Doppler measurements. Int J Gynaecol Obstet 2009; 106:250-3. [DOI: 10.1016/j.ijgo.2009.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 03/17/2009] [Accepted: 04/01/2009] [Indexed: 11/29/2022]
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Api O, Unal O, Api M, Dogance U, Balcik O, Kara O, Turan C. Do asymptomatic patients require routine hemoglobin testing following uneventful, unplanned cesarean sections? Arch Gynecol Obstet 2009; 281:195-9. [PMID: 19404659 DOI: 10.1007/s00404-009-1093-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Accepted: 04/14/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine the clinical usefulness of routine postoperative hemoglobin testing after unplanned, uneventful cesarean sections in low-risk women without any signs or symptoms of anemia and to identify possible risk factors for hemorrhage. MATERIALS AND METHODS Retrospective analysis of the charts of all women who underwent non-elective and uneventful cesarean section over 12 months was performed and demographic data, estimated blood loss at surgery, pre- and post-operative hemoglobin values, postoperative symptoms suggesting anemia, and incidence of transfusion were tabulated. Statistical analysis was done with Student t test and Mann-Whitney U test. RESULTS A total of 2,450 women were delivered during the study period among whom 743 of them (30.3%) underwent cesarean section. Among the cesarean sections, 421 (56.6%) were found to be unplanned and uneventful operations performed in low-risk women with no postoperative signs or symptoms for anemia. The mean preoperative hemoglobin of the low-risk asymptomatic women was 11.7+/-1.99 g/dl, whereas it was 11.24+/-1.99 g/dl, postoperatively (P<0.001). In 72% of the patients, there was a drop in hemoglobin concentrations, whereas 24.5% experienced an increase and 3.5% showed no change, postoperatively. Only one woman experienced a drop of greater than 30% in hemoglobin concentration. Since the woman did not show any signs of hemodynamic instability or symptoms of anemia, she was not transfused. CONCLUSION Our findings suggest that routine hemoglobin testing following uneventful, unplanned cesarean section neither change postoperative management nor determine the patients requiring blood transfusion.
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Affiliation(s)
- Olus Api
- Department of Obstetrics and Gynecology, Dr. Lutfi Kirdar Kartal Teaching and Research Hospital, Istanbul, Turkey.
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Api O, Demır HN, Api M, Tamer I, Orbay E, Unal O. Anxiety scores before and after genetic sonogram. Arch Gynecol Obstet 2009; 280:553-8. [DOI: 10.1007/s00404-009-0959-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Accepted: 01/20/2009] [Indexed: 11/30/2022]
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Avcu S, Akgun C, Temel H, Arslan S, Akbayram S, Unal O. Report of a girl with vacterl syndrome and right pulmonary agenesis. Genet Couns 2009; 20:379-383. [PMID: 20162874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Report of a girl with VACTERL syndrome and right pulmonary agenesis: VACTERL syndrome is a combination of vertebral anomalies (V), anal atresia (A), congenital heart defects (C), tracheo-esophageal fistula (T), esophageal atresia (E), abnormalities of kidneys (renal anomalies, R) and limbs (L). In the present patient right pulmonary agenesis is co-occurring with VACTERL syndrome. We report on this case because the association of right pulmonary agenesis and VACTERL syndrome is rare.
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Affiliation(s)
- S Avcu
- Department of Radiology, University of Yuziancl Yil, School of Medicine, Van, Turkey
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Api O, Emeksiz Balcin M, Ugurel V, Api M, Turan C, Unal O. The effect of uterine fundal pressure on the duration of the second stage of labor: A randomized controlled trial. Acta Obstet Gynecol Scand 2009; 88:320-4. [PMID: 19172441 DOI: 10.1080/00016340902730326] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
OBJECTIVE To determine the efficacy of intravenous (i.v.) paracetamol for decreasing pain associated with fractional curettage. MATERIALS AND METHODS This double-blind, randomised, placebo-controlled trial included 70 women who underwent fractional curettage. Patients were randomly assigned to receive i.v. infusion of either 1000 mg paracetamol (n = 36) or 0.9% normal saline as placebo (n = 34) prior to the procedure. The main outcome measure was the intensity of pain assessed by a 10-cm visual analogue scale. Pain scoring was performed at t(1) = prior to the procedure, t(2) = during the procedure and t(3) = 30 min after the procedure. Statistical analysis was performed using the Student's t-test, chi-squared and Pearson's correlation analysis. RESULTS The pain scores at t(2) and t(3) were significantly higher than the score at t(1) in both groups. There was no statistically significant difference between the pain scores at t(1), t(2) and t(3) among the two groups. Menopausal status had no effect on the pain scores and on the treatment outcome. The pain scores prior to the procedure were significantly higher in women with a history of endometrial curettage when compared with women who have no history. CONCLUSIONS Fractional curettage is associated with mild pain. We were unable to detect a significant difference in pain scores in patients undergoing fractional curettage when comparing the use of i.v. paracetamol with placebo. History of prior endometrial curettage seems to be a predictor of the basal pain scores at admission although it does not affect the pain intensity related to the procedure.
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Affiliation(s)
- O Api
- Department of Obstetrics & Gynecology, Dr Lutfi Kirdar Kartal Teaching and Research Hospital, Istanbul, Turkey.
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Api O, Emeksiz MB, Api M, Ugurel V, Unal O. Modified myocardial performance index for evaluation of fetal cardiac function in pre-eclampsia. Ultrasound Obstet Gynecol 2009; 33:51-57. [PMID: 19086000 DOI: 10.1002/uog.6272] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To assess cardiac function by means of the modified myocardial performance index (Mod-MPI) in fetuses of pre-eclamptic mothers without intrauterine growth restriction and to compare this with values from normal controls. METHODS A cross-sectional study was conducted including a total of 72 fetuses at between 26 and 40 weeks' gestation. Forty fetuses of healthy mothers were assigned as the control group (Group I) while 15 fetuses of mildly pre-eclamptic mothers constituted Group II and 17 fetuses of severely pre-eclamptic mothers constituted Group III. Two-dimensional gray-scale and Doppler fetal echocardiography was used to exclude cardiac anomalies and calculate the Mod-MPI. RESULTS The mean+/-SD Mod-MPI values of Groups I, II and III were 0.43+/-0.045, 0.44+/-0.064 and 0.44+/-0.064, respectively (P=0.680). The mean aortic peak systolic velocity (PSV), the mean mitral valve early ventricular filling (E-wave) and active atrial filling (A-wave) peak velocities were significantly lower in fetuses of severely pre-eclamptic mothers than in fetuses of mildly pre-eclamptic mothers and control fetuses. CONCLUSION The fetal global myocardial function assessed by Mod-MPI does not seem to change in mild or severe pre-eclampsia. The lower mitral E-wave and A-wave peak velocities and the lower aortic PSV seem to reflect the increased cardiac afterload against which the fetal heart has to work, rather than systolic or diastolic cardiac dysfunction, in the fetuses of severely pre-eclamptic mothers.
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Affiliation(s)
- O Api
- Department of Obstetrics & Gynecology, Dr Lutfi Kirdar Kartal Teaching and Research Hospital Istanbul, Turkey.
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Karagoz T, Pazarli P, Mocin OY, Duman D, Duman G, Salturk C, Unal O. Evaluation of drug resistance in pulmonary tuberculosis patients at Sureyyapasa Chest Diseases Hospital, Istanbul, Turkey. Int J Tuberc Lung Dis 2008; 12:631-635. [PMID: 18492329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
SETTING Sureyyapasa Chest Diseases and Thoracic Surgery Training Hospital, Istanbul, Turkey. OBJECTIVE To determine levels of Mycobacterium tuberculosis resistance to first-line drugs in patients with pulmonary tuberculosis (PTB). DESIGN Between 1 January and 31 December 2005, all hospitalised PTB patients with culture-positive M. tuberculosis specimens and corresponding drug susceptibility tests (DST) for isoniazid (INH), rifampicin (RMP), streptomycin (SM) and ethambutol, routinely performed for every tuberculosis (TB) case at our centre, were included. RESULTS Of a total of 1513 cases, 1277 (84.4%) were new and 236 (15.6%) were previously treated cases. Of the 1513 isolates, 290 (19%) isolates were resistant to at least one of the drugs tested. Resistance among new and previously treated cases was respectively 16.3% (209 of 1277) and 34.3% (81/236). Any SM resistance and any INH resistance were the most common drug resistance in new cases, while any RMP resistance was the most common drug resistance in previously treated cases. Multidrug resistance was detected in 3.2% (n = 41) of new cases and in 13.5% (n = 32) of previously treated cases. CONCLUSION Planning for TB control requires an assessment of the number and distribution of drug-resistant cases, with laboratories providing accurate and reliable results.
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Affiliation(s)
- T Karagoz
- Pulmonary Diseases Clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Training Hospital, Istanbul, Turkey
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