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PERCUTANEOUS TREATMENT OF BILE LEAKAGE AFTER LIVING DONOR LIVER TRANSPLANTATION
No full textGuven, Koray/0000-0001-8572-1998WOS: 000492145900003Objective: Biliary leakage (BL) is one of the most frequent complications following living donor liver transplantation (LDLT). Radiological methods are important in diagnosis and treatment. Although endoscopic approaches are considered as the first-line treatment option in BL, nowadays, increasing experience is strengthening the role of interventional radiological approaches. in our article, we aim to analyze our experience in the diagnosis and treatment of BLs developed after LDLT. Material and methods: Between January 2015 and December 2018, 361 LDLT cases performed consecutive at our center were analyzed retrospectively. the leakage diagnosis and location was demonstrated by magnetic resonance cholangiopancreatography (MRCP) with hepatobiliary excreted contrast agent gadoxetate disodium in patients with suspected leakage. BLs were treated by endoscopic, interventional radiological, surgical or conservative approaches. Results: of the total 361 cases, 27 (7.4%) had BL. Twenty six (96%) of the BL were anastomotic and 1 (3,7%) was incision surface leakage. One patient (3.7%) was treated by endoscopic sphincterotomy methods, 23 (85,1%) patients by interventional radiological approaches, two patients (7.4%) by surgery and 1 patient (3,7%) by conservative approaches. There were no minor and major complications during interventional radiological procedures. After the procedure, minor complications (mild cholangitic attack) in 4 (17.4%), mild edematous pancreatitis in 2 (8,6%) developed in 6 (26%) patients. Conclusion: Endoscopic treatment approaches may be complicated in patients with multiple anastomosis of biliary tract after LDLT. Although interventional radiological approaches require experience, they can be performed as an alternative treatment method
Nutrition Principles in Bariatric Surgery
No full textHer geçen gün giderek artan obezite önemli bir halk sağlığı sorunu haline gelmiştir. Obezite tedavisinde, tıbbi beslenme tedavisi, egzersiz, farmokolojik tedavi ve davranış değişikliği tedavisi gibi geleneksel yöntemlerin yanı sıra yeni tekniklerin kullanıldığı cerrahi yöntemler de ülkemizde ve dünyada giderek yaygınlaşmaktadır. Ameliyat öncesi hastanın beslenme durumunun saptanması ve ameliyat sonrası beslenme takibi, olası beslenme komplikasyonlarının önlenmesi için son derece önemlidir. Bu derlemede amaç, bariatrik cerrahi ameliyatı öncesi ve sonrası beslenme ilkelerini irdelemektir.Obesity, which is increasing day by day, has become a major public health problem. With regard to its treatment, both conventional methods-such as medical nutrition therapy, exercise, pharmacological treatment, behavior change therapy- and surgical methods applied with new techniques are becoming increasingly widespread in our country and in the world. To determine the pre-operative nutritional status of the patient and the postoperative nutritional follow-up are extremely important in order to prevent possible nutritional complications. The purpose of this review is to examine the preoperative and postoperative principles of bariatric surgical procedure
Radiological and functional outcomes of ultrasound-guided PRP injections in intrasubstance meniscal degenerations
No full textPubMed: 31204581Aim: This retrospective study is aimed to analyze the effect of ultrasound-guided platelet-rich plasma (PRP) injections on grade 2 intrasubstance meniscal degenerations (IMDs). Materials and Methods: Fifteen patients who underwent PRP injections for symptomatic grade 2 meniscal lesions were included in the study. All injections were performed with ultrasound in the degenerated menisci. Patients were evaluated with Lysholm score and magnetic resonance imaging (MRI) before the injection and after a mean of 32-month follow-up. T2-weighted MRI images were evaluated on sagittal by two authors as double-blind. Results: Lysholm score was found to be statistically significantly increased, and in 67% of the patients, grade 2 degenerations were improved to grade 1. Conclusion: Intra-meniscal PRP injection under ultrasonography guidance provides good functional scores and radiological improvement in the patients with IMD. © the Author(s) 2019
The Effect of the Teachers’ Value Orientation on Interpersonel Self-Efficacy Perceptions
No full textBu araştırmanın amacı; öğretmenlerinin kişilerarası öz-yeterlik algılarını tespit etmek ve öğretmenlerin değer yönelimlerinin, kişilerarası öz-yeterlik algıları üzerine etkisini belirlemektir. Araştırma ilişkisel tarama desende tasarlanmıştır. Araştırma evrenini, 2014-2015 eğitim öğretim yılında Sarıyer ilçesinde görev yapan ortaokul ve ilkokul öğretmenleri oluşturmaktadır. Araştırmanın örneklemi, basit tesadüfi örnekleme yöntemi kullanılarak belirlenen 64 okulda görev yapan 493 öğretmendir. Verilerin toplanmasında, “Öğretmen Kişilerarası Öz-Yeterlik Ölçeği”(KÖYÖ); “Portre Değerler Ölçeği” (PDÖ) ile araştırmacı tarafından hazırlanan “Kişisel Bilgi Formu” kullanılmıştır. Araştırmada elde edilen verilerin analizinde, bağımsız grup t-testi, tek yönlü varyans analizi (Anova), Kruskal-Wallis H testi, Mann-Whitney U testi, Spearman korelasyon analizi, Pearson Ki Kare testi, Lineer regresyon analizi kullanılmıştır. Sonuç olarak öğretmenlerin değer yönelimlerinin öz-yeterlik algıları üzerine evrenselcilik, güvenlik ve öz-yönelim değerleri etkili olmuştur. Bu aynı zamanda araştırmaya katılan tüm öğretmenlerin en çok önem verdikleri ilk üç değerdir. Bu iki sonuç, evrenselcilik, güvenlik ve öz-yönelim değerlerinin, hem öğretmenlerin öz-yeterliklerini etkileyen değerler olduğunu, hem de öğretmenlerin tercih ettikleri ilk üç değer olduğunu göstermektedir.The aim of this study is to determine teachers’ perceived interpersonel self-efficacy and the effect teachers’ value orientations on interpersonel self-efficacy perception. The correlational design was used in the research. The population of the research was teachers working at the primary schools and secondary schools in the Sarıyer in the 2014-2015 education year. The sample of this study consisted of 493 teachers working at the 64 schools, which was determined by the use of the random sampling method. During the data collection process, “The Teacher Interpersonal Self-efficacy Scale” , “Portrait Values Questionnaire” and “Personal Informatin Form” developed by the researcher were used. Data analysis was done using the independent group t- test, single – sided variance analysis ( Anova ), Kruskal-Wallis H test, Mann-Whitney U test, Spearman correlation analysis, Pearson chi square test, Linear regression analysis. When the findings were evaluated it was discovered that; Universalism, security and self-direction are the major values effecting teacher’s perceived interpersonel self-efficacy. These findings shows that these three values are most important values for all teachers. These are universalism, security and self-direction. These three values also interact with self-efficacy perceptions
Three-Dimensional Reconstruction of the Semicircular Canals with a Two-Hands Model
No full textObjective: To help understand the anatomy and the diseases of the semicircular canals (SCCs) by defining the three-dimensional reconstruction of the SCCs in a model reconstructed using the two hands (two-hands model) and to determine the three-dimensional configuration of the two hands by measuring the angle between the SCCs and the sagittal plane. Methods: Patients older than 18 years of age with computed tomography (CT) scans of the temporal bones taken between 2017 and 2018 at the Yeditepe University Hospital were included in the study. CT images were evaluated by a radiologist. The angles between every SCC and the sagittal plane were measured with the MIMICS 12.1 program. Mean angles between the SCCs and the sagittal plane were measured. These angles were demonstrated on the twohands model of the SCCs by means of a goniometer and photographed. Results: Thirty patients and 60 temporal bones were included in the study. Mean angles between the superior, the posterior, and the horizontal SCCs and the sagittal plane were found as 37.1±3.3°, 50.4±4.1°, and 89.5±4.7°, respectively. Conclusion: This is the first study to define the three-dimensional representation of the SCCs with a two-hands model. This may allow for a better understanding and the better teaching of the anatomy and diseases of SCCs
The effect of a 12 week prehabilitation program on pain and function for patients undergoing total knee arthroplasty: A prospective controlled study
No full textBackground: The concept of preparing the body before a stressful event, such as surgery, has been termed “prehabilitation” (preoperative physiotherapy and exercise programs). Prehabilitation programs for people awaiting total knee arthroplasty (TKA) have positive effects on patients health status and may also lead to better postoperative outcomes. Aim: The purpose of this study was to examine effect of a prehabilitation program on knee pain, functional ability among patients with knee osteoarthritis after TKA surgery. Study Design: A Prospective Controlled Study. Patients and Methods: Subjects enrolled in this prospective controlled study who referred to our Orthopedics and Traumatology outpatient clinic between 2014 April–2015 May, had severe OA with pain not responsive to conservative treatment and scheduled for unilateral TKA. Subjects were assigned to a control or prehabilitation group. Patients of prehabilitation group were recruited from the orthopaedic waiting lists for primary unilateral TKA. Partipicants in the prehabilitation group were prescribed a training program that consisted of education and home-based exercise 12 weeks before the operation. After the TKA, all subjects partipicated in the same postoperative rehabilitation protocol. Evaluations were made before the surgery, with follow-up assessments at 3 and 6 months after surgery. Knee pain was assessed by the use of a 10-cm Visual Analog Scale (VAS) and function assesed by Knee injury and Osteoarthritis Outcome Score (KOOS) scale. Results: A statistically significant improvement was observed in the values of VAS and all subsclaes of KOOS in both groups at third and sixth month compared to baseline. The intergroup comparison of the improvement (pre-post scores at sixth month) did not show any statistically significant diffeferences in VAS and KOOS scores. Conclusion: Our results show that prehabilitation before TKA is not superior to surgical treatment alone but about 20% of the patients changed their operation decision. So it is important to be able to postpone this process especially in the early period. © 201
Determination of preanesthetic high-risk using fuzzy risk evaluation for surgical operations [Cerrahi ameliyatlardaki preanestezik yüksek riskin bulanık risk değerlendirmesi ıle belirlenmesi]
No full textObjective: Determination of preanesthetic high risk during surgical procedures using fuzzy risk evaluation. Material and Methods: In this study for the high risk patient classification, five major criteria comprising cardiac, pulmonary, renal or liver diseases and diabetes mellitus and three minor criteria comprising patients’ age, body mass index and cigarette smoking were chosen to define the high-risk group. Since the fuzzy logic gives the ability to use linguistic expressions, that include the intuition of human operators or experts during the decision making process, it this study by using fuzzy logic modelling, rules for high risks were developed. To reach this aim a new fuzzy logic decision system is proposed that uses four input variables to calculate the risk as a percentage that is the output of the fuzzy system. Results: Using Fuzzy risk evaluation; By taking into account the number of inputs and number of their corresponding membership functions, it is deduced that 270 fuzzy rules will be enough. Conclusion: In this study, a risk classification model was developed by combining the risk criteria defined by previous medical studies and clinical experience with a fuzzy logic model in the preoperative period. This developed fuzzy logic model needs to be investigated by selecting specific groups of patients and specific operations. © 2019 by Türkiye Klinikleri
Role of Preoperative Viral Load and Presence of Hepatocellular Carcinoma in the Biliary Complications After Liver Transplantation Due to Hepatitis C Virus
No full textBackground: Chronic hepatitis C virus (HCV) infection is a global health problem, and the need for liver transplants is ever-growing. For optimal surgical success, risk factors must be identified and HCV viral load must be reduced to a minimum to avoid complications. In this study, we aimed to investigate the role of HCV viral load on the post-transplant biliary complications. Method: Between 2004 and 2018, the cases of 114 liver transplant recipients with HCV infection were retrospectively reviewed. Data collection included demographic variables, preoperative and postoperative amount of serum HCV RNA copies, preoperative diagnosis of hepatocellular carcinoma (HCC), and postoperative biliary complications in the early and late period. After missing values were excluded, the remaining 97 patients were divided into 2 groups according to preoperative HCV RNA status (Group A: HCV RNA [+] and Group B: HCV RNA [-]). Results: Demographic parameters were similar among both groups. There were 67 patients in Group A and 30 patients in Group B. The overall rate of biliary complications was higher in Group A without statistical significance (20% [n = 14] vs 13% [n = 4], respectively, P = .573). Biliary stricture occurrence in the late period was also higher in Group A. In HCC (+) patients (n = 26), biliary complications were significantly higher compared to HCC (-) patients (34% vs 12%, P = .018). However, in patients with biliary complications, the rate of multiple duct anastomoses was higher with no statistical significance (45% vs 26%, respectively, P = .14). Conclusion: The biliary complications on patient survival has been previously established, and this is mostly evident in those patients with viral etiology and hepatocellular carcinoma. As was also suggested in our study, hepatocellular carcinoma and positive viral status should be considered as predisposing factors for postoperative biliary complications after liver transplantation. However, the rate of multiple duct anastomoses should also be taken into consideration. New standards of antiviral medications and bridge therapy for HCC may improve transplant outcomes. © 2019 Elsevier Inc
Breast and cervical cancer screening for women with physical disabilities: A qualitative study of experiences and barriers
No full textAim: To determine the experiences of women with physical disabilities regarding the barriers to their participation in breast and cervical cancer screening. Design: Qualitative descriptive study. Method: Sixteen women who use wheelchairs were recruited. Data were collected via semi-structured face-to-face interviews between January - March 2017. Interviews were transcribed and data were analysed thematically. Results: Three main themes were uncovered: (a) Personal factors; such as lack of knowledge, fear and embarrassment, feeling anxious about the examination process and dependency on others; (b) Environmental and structural factors; and (c) expectations and suggestions of women with disabilities to enable their participation in screening. Conclusion: The participation rate of women with physical disabilities in screening is low. The participation of women with disabilities in breast and cervical cancer screening may increase if physical barriers to accessing healthcare services are removed, appropriate and less time-consuming examination conditions are met, and healthcare personnel are informed about the needs of persons with disabilities. Impact: Knowing the barriers for women with physical disabilities to participate in cancer screening can help health professionals develop new procedures to increase their participation to cancer screening. Women with physical disabilities encountered various barriers such as; lack of knowledge, fear and embarrassment, feeling anxious about the examination process and dependency on others, access to the healthcare services, environmental, physical limitations, and inadequate knowledge of healthcare professional about their disability. This study will guide healthcare professionals in developing strategies to increase the participation of women with physical disabilities in screening. © 2019 John Wiley & Sons Lt
Are flexible bronchoscopic cryoextraction practices an alternative to rigid bronchoscopy?
No full textWOS: 000465324100003PubMed ID: 31130131Introduction: We aimed to evaluate the efficacy of flexible bronchoscopic cryoextraction in the treatment of airw ay obstruction arise from mucus plugs and blood clots and present our experience. Materials and Methods: The present study evaluated patients who previously underwent unsuccessful flexible bronchoscopy for the removal of secretions and blood clots in the central airway and who underwent flexible bronchoscopic cryoextraction between January 2013-November 2017. Results: The study included seven patients with a mean age of 58.29 +/- 18.56 years (28-76). Three patients underwent bedside intervention in the intensive care unit, and four patients underwent an intervention in the bronchoscopy unit. Seven patients underwent a total of nine sessions of cryoextraction. Severe complications or mortality did not occur during the cryoextraction sessions. Conclusion: Flexible bronchoscopic cryoextraction offers a safe treatment strategy as an alternative to rigid bronchoscopy in patients in whom airway patency cannot be achieved using other flexible bronchoscopic interventions. and accuracy of PET was higher compared to CT with this cut-off value