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Öğe Are spontaneous peak flow rates predictors of weaning?(AVES, 2015) Bahar, Ilhan; Baldane, Suleyman; Elay, Gulseren; Coskun, Ramazan; Gundogan, Kursat; Guven, Muhammet; Sungur, MuratObjective: Numerous parameters have been suggested for the prediction of weaning from mechanical ventilation; however, these parameters have limited success in the prediction of weaning outcome. This study aims to assess the success of peak flow rates [spontaneous peak inspiratory flow rate (SPIF) and spontaneous peak expiratory flow rate (SPEF)] that were measured during a spontaneous breathing trial (SBT) for the prediction of weaning outcome. Material and Methods: Patients who were managed and who received mechanical ventilation support for at least 24 h in the Internal Medicine and General Surgery Intensive Care Units of Erciyes University, School of Medicine between March, 2011 and May, 2012 were included in this study. Over 30 min, SPIF and SPEF values were measured during SBT in patients who were spontaneously breathing through a T-tube. Patients who tolerated the 30-min SBT were extubated. Patients who did not require reintubation for 48 h after extubation were considered as successful weaning, whereas those who required re-intubation were considered as weaning failure. Results: The study was completed with a total of 36 patients with 11 patients in the failure group and 25 in the success group. In both the groups, the area under curve (AUC) was calculated for each minute via ROC analysis using minute SPIF and SPEF values that were measured during SBT. The maximum AUC was calculated at 23 min for SPIF (0.564; 95% CI: 0.363-0.764) and at 9 min for SPEF (0.542; 95% CI: 0.316-0.3769). When the cut-off value for SPIF was accepted as >26.7 l/min at 23 min, sensitivity and specificity were calculated as 72.0% and 48.0%, respectively. When the cut-off value for SPEF was accepted as >24.7 l/min at 9 min, sensitivity and specificity were calculated as 63.6% and 48.0%, respectively. Conclusion: We believe that minute SPIF measurement, which has better sensitivity, and minute SPEF measurement, which has better specificity, compared with the available traditional predictors may be used as potential bedside weaning predictors when evaluated in comprehensive studies.Öğe A CASE OF PAGET'S DISEASE OF THE BONE PRESENTED WITH HEARING LOSS AS THE FIRST SYMPTOM(GUNES KITABEVI LTD STI, 2014) Baldane, Suleyman; Ipekci, Suleyman H.; Bulut, Serap; Baldane, Emine Gul; Gedik, Gonca Kara; Kebapcilar, LeventA 67-year-old woman presented to the audiology clinic with a complaint of bilateral hearing loss over the past two years. Routine biochemical screening showed an alkaline phosphatase level of 381 U/L, and she was referred to our endocrinology unit. Her vitamin D and parathyroid hormone levels, as well as thyroid, liver and kidney function test results, were within normal ranges. Cranial x-ray radiography showed an increase in the diploe distance and a sclerotic pattern in the calvarium; while whole body bone scintigraphy demonstrated a diffuse increase in radioactive substance involvement of the calvarium. Serum osteocalcin and spot urinary deoxypyridinoline levels were increased. The patient was diagnosed with Paget's disease with hearing loss as the first symptom, and she was started taking zoledronic acid treatment. Three months later, her alkaline phosphatase level had returned to the normal range, and audiologic examination showed a mild improvement in hearing.Öğe Cornea in PCOS patients as a possible target of IGF-1 action and insulin resistance(SPRINGER HEIDELBERG, 2014) Kebapcilar, Ayse Gul; Tatar, Mehmet Gurkan; Ipekci, Suleyman Hilmi; Gonulalan, Gulsum; Korkmaz, Huseyin; Baldane, Suleyman; Celik, CetinPrevious studies suggest that serum IGF-1 is higher in women with polycystic ovary syndrome (PCOS). The ophthalmologic effects of IGF-1 excess have not yet been investigated in women with PCOS. The aim of the current study is to compare the corneal thickness of patients with PCOS and those of healthy subjects. Forty three patients with PCOS and 30 age-matched and gender-matched healthy individuals were enrolled in this cross-sectional study. Central corneal thickness (CCT) was measured in patients with PCOS and in healthy individuals with an ultrasound pachymeter. IGF-1 values were also determined in the study group. Women with PCOS had significantly higher levels of IGF-1 and homeostasis model assessment (HOMA-IR) levels than the control group. Right and left CCT measurements were higher in the PCOS group than in the control group. A positive correlation between IGF-1 and right and left CCT was identified in both groups. In multiple linear stepwise regression analyses, IGF-1 independently and positively associated with HOMA-IR in women with PCOS. A correlation between total testosterone and CCT was identified in the whole group. In multiple stepwise regression analyses, total testosterone independently and positively associated with left central corneal thickness in the whole group. These findings indicate that PCOS has target organ effects on the eye. Consequently, it can change central corneal thickness. Higher IGF-1 levels seem to be the main causes of increased corneal thickness. Insulin resistance in PCOS is one of the underlying causes and promotes increase in IGF-1. We suggest a careful and detailed corneal evaluation in PCOS patients to prevent the potential risk of increased CCT, in addition to the already-known complications.Öğe Efficacy comparison of oral rosuvastatin versus oral progesterone and bevacizumab on regression of surgically endometriotic implants in rats(TAYLOR & FRANCIS LTD, 2017) Kebapcilar, Ayse G.; Ilhan, Tolgay T.; Dursunoglu, Duygu; Kebapcilar, Levent; Ipekci, Suleyman H.; Baldane, Suleyman; Ucar, Mustafa G.This study hypothesizes that oral rosuvastatin, oral dienogest and intraperitoneal bevacizumab might improve endometriosis in randomly selected female Wistar albino rats with surgically endometriotic implants. Thirty female Wistar albino rats with surgically endometriotic implants were randomized into three treatment groups: oral rosuvastatin (20mg kg/day; oral rosuvastatin group 1; n=10), oral progesterone (dienogest group 2; n=10) and intraperitoneal bevacizumab (2.5mg/kg of single intraperitoneal injection of bevacizumab; bevacizumab group 3; n=10), for 10 days. Post-treatment variables were compared. The oral rosuvastatin group showed higher reduction for the glandular epithelium and uterine vessels of histopathological scores values than the oral progesterone group (both, p<0.017, respectively). The median glandular epithelium and uterine vessels and histopathological scores values did not show a statistically significant difference between group 1 and group 3 (p>0.017). Endometrial thickness values and uterine volume values were more significantly reduced in the oral rosuvastatin group than the oral progesterone group (both, p<0.017, respectively). Moreover, endometrial thickness and uterine volume values were not different in groups wecompared with group 3 (p>0.017). In conclusion, oral rosuvastatin and intraperitoneal injection of bevacizumab may cause more significant regression of surgically endometriotic implants in rats than oral progesterone medications.Öğe Is the Mean Platelet Volume a Predictive Marker of a Low Apgar Score and Insulin Resistance in Gestational Diabetes Mellitus? A Retrospective Case-Control Study(PREMCHAND SHANTIDEVI RESEARCH FOUNDATION, 2016) Kebapcilar, Levent; Kebapcilar, Ayse Gul; Ilhan, Tolgay Tuyan; Ipekci, Suleyman Hilmi; Baldane, Suleyman; Pekin, Aybike; Kulaksizoglu, MustafaIntroduction: Gestational diabetes is defined as various degrees of glucose intolerance diagnosed or detected for the first time during pregnancy and is the most common metabolic complication of pregnancy. Early diagnosis and adequate treatment are important to prevent complications. Preeclampsia, polyhydramnios, fetalmacrosomia, and operative delivery are some of the complications seen in pregnant women diagnosed with Gestational Diabetes Mellitus (GDM). Aim: The present study was designed to determine whether there was an association between Mean Platelet Volume (MPV) in predicting poor fetal outcome, insulin resistance, neonatal Apgar scores and gestational age for women with GDM. Materials and Methods: In this retrospective study, we enrolled 101 pregnant women with GDM together with a group of 138 healthy controls. MPV, insulin and homeostatic model assessment (HOMA-IR) values were measured at 24-28 weeks of the pregnancy. An independent samples t-test was used to compare MPV values. Multivariate linear regression models were used to establish relations between MPV values, HOMAIR, insulin levels and Apgar score. Results: There was a significant positive correlation between MPV values, HOMA-IR and Insulin levels and a negative correlation with Apgar score at 1 min and 5 min in the GDM group (r=0.227, p=0.02; r=0.206, p=0.03; r=-0.485, p<0.001; and r=-0.399, p<0.001, respectively). In the multivariate logistic regression analysis, a high MPV value was most consistently associated with a low Apgar 1 min score (beta=-0.387, p=0.003) in the GDM group. An MPV of >8.0 fL had a sensitivity of 82% and a specificity of 75% for the prediction of GDM. Conclusion: We investigated the potential of MPV values in predicting low Apgar scores and insulin resistance in women with GDM.Öğe Primary Pleomorphic Rhabdomyosarcoma of Thyroid Gland in an Adult Patient: A Case Report(AVES, 2016) Ozaslan, Ersin; Berk, Veli; Baldane, Suleyman; Eker, Baki; Bozkurt, Oktay; Senol, Serkan; Duran, Ayse OcakThyroid sarcoma is a very rare entity, accounting for less than 1% of all malignant thyroid tumours. Rhabdomyosarcoma (RMS) is a sarcoma subtype, which is more common in children and adolescents. In this case, a 68-year old man, presented with hoarseness and diagnosed with pleomorphic RMS, was explored. No study of primary thyroid pure RMS has been reported in the literature, with the exception of the case reports of differentiated RMS.Öğe Pulmonary Extramedullary Hematopoiesis Mimicking Plasmacytoma in a Patient with Multiple Myeloma(DE GRUYTER OPEN LTD, 2015) Baldane, Suleyman; Sivgin, Serdar; Kaynar, Leylagul; Ozaslan, Ersin; Yildirim, Afra; Canoz, Ozlem; Eser, BulentA 42-year-old male patient was admitted to our hospital for planning autologous hematopoietic stem cell transplantation (auto-HSCT). He was diagnosed as multiple myeloma (IgG type Kappa) in 2003. His physical examination was normal with no important abnormality on laboratory evaluation. Chest radiography performed for routine evaluation prior to transplantation revealed a large, welldefined mass, that had obtuse angles with the chest wall consistent with extraparenchymal lesion superposed on second and third ribs. Also, there were multiple bony structures demonstrating changes of destructive effects of multiple myeloma. Computed tomography (CT)-guided biopsy was obtained from the mass by transthoracic fine-needle aspiration (FNAB) method. Biopsy was reported as extramedullary hematopoiesis (EMH) contrary to our expectation of multiple myeloma.Öğe Subclinical Celiac Disease Presented with Postpartum Low Back Pain Case Report(BAYCINAR MEDICAL PUBL-BAYCINAR TIBBI YAYINCILIK, 2015) Baldane, Suleyman; Ipekci, Suleyman; Sahin, Fatih; Gul Baldane, Emine; Karabagli, Pinar; Kebapcilar, LeventA 35-year-old woman was admitted with severe low back pain. The patient, who gave birth 5 months ago, was then breastfeeding and presented with postpartum low back pain with increasing severity. Her laboratory results revealed anemia, hypocalcemia, severe vitamin D deficiency, and increase in alkaline phosphatase (ALP) and parathyroid hormone (PTH) levels. Dual energy X-ray absorptiometry (DXA) scan demonstrated lumbar vertebral T and Z scores of -5.1 and -4.4, respectively. The serologic tests for celiac disease (CD) to search underlying malabsorption were positive. Histological analysis of the duodenal biopsy specimen revealed results consistent with the diagnosis of CD. However, because of an absence of gastrointestinal complaints, the diagnosis of subclinical CD could have been made when malabsorption resulted in osteoporosis associated with severe vitamin D deficiency. The initiation of vitamin D therapy showed a significant increase after 6 months at the lumbar vertebra T and Z scores of -0.7 and -0.2, respectively.Öğe Successful preoperative treatment by plasmapheresis of hyperthyroidism with hydatidiform mole(AVES, 2018) Kirac, Cem Onur; Baldane, Suleyman; Kebapcilar, Ayse Gul; Ipekci, Suleyman Hilmi; Ucar, Mustafa Gazi; Celik, Cetin; Kebapcilar, LeventWe recently encountered the case of an 18-year-old female complaining of abdominal pain, fatigue, nausea, vomiting, tremor of the hands, and vaginal bleeding. Her blood test revealed highly elevated human chorionic gonadotropin (hCG) levels, suppressed thyroid-stimulating hormone (TSH) levels, and increased free thyroid hormone levels. Molar pregnancy and hyperthyroidism were suspected based on highly elevated hCG levels and suppressed TSH levels with the co-existence of ultrasono-graphic findings of the uterus and thyroid Doppler images. Her symptoms and thyroid hormone levels responded well to plasmapheresis. Subsequently, the patient underwent dilatation and curettage for hydatidiform mole. Histopathology of the products verified the diagnosis of complete hydatidiform mole with no invasion. The patient is currently stable, and her hCG and thyroid hormone levels are within normal reference ranges.Öğe An uncommon presentation of Sjogren's syndrome and brucellosis(PERGAMON-ELSEVIER SCIENCE LTD, 2014) Celik, Gulperi; Ozturk, Ercument; Ipekci, Suleyman Hilmi; Yilmaz, Sema; Colkesen, Fatih; Baldane, Suleyman; Kebapcilar, LeventWe describe herein a case of hypokalemia due to proximal renal tubular acidosis (RTA) and Fanconi's syndrome (FS) and nephrogenic diabetes insipidus with DIC - a rare complication of Sjogren's syndrome (SS) and brucellosis. The interesting feature of this case was the presentation with severe hypokalemia, causing acute flaccid quadriparesis with cardiac arrest which is extremely rare. The patient was a 48-year-old woman who suffered cardiopulmonary arrest an hour after hospitalization. Analysis of a blood sample obtained before her cardiopulmonary arrest yielded surprising results: laboratory investigations showed profound hypokalemia (1.1 mEq/L) with renal K wasting, hyperchloremic metabolic acidosis with normal anion gap, hypophosphatemia with hypouricemia, glucosuria, and proteinuria. A diagnosis of RTA and FS were made. On the seventh day, she looked acutely ill, temperature 38.8 C and pale, and her physical examination revealed purpuric skin lesions on both legs. The serum antibrucella titration agglutination test was found to be 1 of 160 positive with a nosocomial infection. The clinical and laboratory findings were consistent with disseminated intravascular coagulation (DIC). She was unable to concentrate her urine and so a diagnosis of nephrogenic diabetes insipidus (NDI) was reached. A thorough survey for the cause of FS, RTA and NDI revealed that she had xerophthalmia and xerostomia accompanied by high anti-Ro antibody, positive Schirmer test, confirming the diagnosis of SS. (C) 2014 Elsevier Ltd. All rights reserved.
