Kartal Training Research Articles

İŞE BAĞLILIĞIN TÜKENMİŞLİK VE DEPRESYON DÜZEYLERİ ÜZERİNDEKİ ETKİLERİ: SAĞLIK ÇALIŞANLARI ÜZERİNDE BİR ARAŞTIRMA

Bu çalışmanın temel amacı, sağlık çalışanlarının işe bağlılık düzeylerinin tükenmişlik ve depresyon düzeyleri üzerindeki etkileri incelemektir. Amaç doğrultusunda kişisel bilgiler formu, işe bağlılık ölçeği, tükenmişlik ölçeği ve depresyon ölçeklerinden oluşan anket formu; 2013 Yılı Mayıs ayında İstanbul Kartal Eğitim Araştırma Hastanesi’nde görev yapan 266 sağlık çalışanına uygulanmıştır. Anketlerden elde edilen veriler bilgisayar ortamında SPSS 17.0 istatistik programı aracılığıyla analiz edilmiştir. sağlık çalışanlarının işe bağlılık, tükenmişlik ve depresyon düzeyleri arasındaki ilişkilerin belirlenmesinde korelasyon analizinden, sağlık çalışanlarının işe bağlılık düzeylerinin tükenmişlik ve depresyon düzeyleri üzerindeki etkilerinin belirlenmesinde ise regresyon analizinden faydalanılmıştır. Analiz sonucunda, sağlık çalışanlarının işe bağlılık, tükenmişlik ve depresyon düzeyleri arasında istatistiksel açıdan anlamlı ilişkilerin olduğu belirlenmiştir. Sağlık çalışanlarının işe bağlılık düzeyleri arttıkça depresyon ve tükenmişlik düzeylerinin azaldığı sonucuna ulaşılmıştır.

Aspects of physicians’ attitudes towards the rational use of drugs at a training and research hospital: a survey study

The rational use of drugs (RUD) is primarily the responsibility of physicians. The aim of this study was to investigate whether physicians are aware of RUD principles and how they apply them in daily medical practice. A total 136 physicians working at the Kartal Training and Research Hospital in Istanbul were enrolled in the study between February and March 2012. A face-to-face interview was conducted with physicians to assess their knowledge and attitude regarding RUD. A large majority of the physicians declared that consultation time was insufficient (84%). The data obtained from the survey indicate that 54% of the enrolled physicians monitored the therapeutic outcome and that 27% found the information given to the patient to be sufficient. Participating physicians stated that the less known characteristics of the drugs they prescribed were drug interactions, traceability in market, and price. The most preferred reference source was Vademecum (a drug guideline prepared by the private sector). Two major factors contributing to prescribing patterns were "self study" and "observation of teachers" at clinical training. There was a significant difference between internists-surgeons and residents-specialists in the number of prescribed drugs per prescription (p < 0.001) and in the information provided to the patient on the prescribed drugs (name, effect, dose, instructions, possible side effect) (p < 0.05), respectively. Our findings overall show that the principles of RUD were not fully applied in daily medical practice by the participating physicians. One important reason for this is a heavy patient load, which requires a change in managerial practices within the healthcare system. The other, more essential explanation is education; consequently, serious consideration should be given to including effective clinical pharmacotherapy training and RUD courses in the medical education curriculum.

Quality of life assessment of patients with metastatic lung cancer receiving plantinium-based chemotheraphy

ABSTRACT AIM: The aims of the study were to investigate, possible changes in quality of life (QOL) during chemotherapy, which factors might affect QOL and the relationship between QOL and performance status. MATERIAL AND METHODS: The study was conducted at the oncology clinics of Dr. Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey. Patients diagnosed with advanced small-cell lung cancer or stage IV non-small cell lung cancer were enrolled in the study. They were given platinum-based chemotherapy. The QOL EORTC core questionnaire QLQ–C30 (version 3.0) and the lung cancer module QLQ-LC13 were conducted on four separate occasions. Data related to the patients’ clincal and performance status (Karnofsky Performance Status Scale (KPS) and ECOG) were recorded throughout the study. RESULTS: With treatment, significant increases in chemotherapy related side-effects and in symptom scales related both to adverse drug reactions and disease progression were recorded. A strong, significant, negative correlation (r = -0.71, p< 0.05) between ECOG performance and all domains of EORTC QLQ-C30 was observed, similar to that between KPS and EORTC QLQ-C30 (r = -0.74, p< 0.05). CONCLUSION: This research indicates a lack of benefit in terms of QOL from platinumbased chemotherapy in patients with metastatic lung cancer. Routine QOL assessment in this patient population may encourage the development of treatment programs which minimize chemotherapy side-effects, while maximizing patients’ well being. KEYWORDS: Small-Cell-Lung-Carcinoma, Non-Small-Cell-Lung-Carcinoma, Quality of Life, Karnofsky Performance Status Scale, Chemotherapy

Comparison of Outcomes of Posterior Chamber and Iris-Claw Anterior Chamber Phakic Intraocular Lens Implantation for Moderate to High Myopia

Purpose: To compare visual acuity and contrast sensitivity between Posterior Chamber Phakic Intraocular Lens (ICL) and Iris-Claw Anterior Chamber Phakic Intraocular Lens (Artiflex) implantation for moderate to high myopia. Setting: Dr. Lutfi Kirdar Kartal Training and Research Hospital, Eye Clinic, Istanbul, Turkey. Participants: Sixty eyes of 30 myopic patients were included in the study. Thirty eyes of 15 patients underwent implantation of ICL (24)/ toric ICL (6) and 30 eyes of 15 patients underwent implantation of Artiflex. Methods: Preoperative and postoperative 1, 6 and 12 months, logarithm of the minimum angle of resolution (log MAR) uncorrected visual acuity (UCVA), log MAR best spectacle-corrected visual acuity (BSCVA), manifest refraction, intraocular pressure (IOP), endothelial cell density (ECD) and complications were evaluated. Contrast sensitivity (CS) was also evaluated at 1.5, 2.52, 4.23, 7.10 and 11.91 cycles per degree spatial frequencies by CC-100 Topcon LCD preoperative and postoperative 1-year. Main outcome measures: Improvement in visual acuity (VA) and CS, percentage change in ECD and IOP. Results: Preoperatively, there was no significant difference in the mean UCVA, BSCVA and CS between the ICL and Artiflex groups (p=0.798; 0.672; 0.510) and the mean spherical equivalent (SE) was significantly better in the ICL group than the Artiflex group (p=0.003). One year postoperatively, the mean UCVA and BSCVA were significantly better in the ICL group than the Artiflex group (p=0.002; 0.0001). We found no significant difference in the mean SE between the ICL and Artiflex groups (p=0.809). The mean photopic CS increased considerably at all spatial frequencies compared with preoperative levels in the ICL and Artiflex groups (p=0.0001) Conclusion: After 1-year follow-up, the phakic IOLs performed well in correcting moderate to high myopia. Preoperatively and 1-year postoperatively, there was no significant difference in the mean photopic CS between the ICL and Artiflex group at all spatial frequencies. No vision-threatening complications occurred during the observation period.

Patients&amp;rsquo; experience and perspectives on the rational use of drugs in Turkey: a survey study

AimPhysicians’ inappropriate prescribing habits affect patients’ lives both medically and financially. To avoid these unwanted situations, the World Health Organization defined the rational use of drugs (RUD) in 1985. This study aimed to investigate whether patients were as informed about their diagnosis and medication as anticipated and their knowledge about the RUD in general.MethodsA questionnaire was given to 260 patients being treated at the Kartal Training and Research Hospital between February and March 2012.ResultsMost of the patients declared that they were not informed enough about their diagnosis and not all of the physicians evaluated their therapies. These undesirable conditions were due to high daily examined patient numbers. A total of 68.6% of patients stated that time allotted per patient was 0–10 minutes, 33.1% found the information given sufficient, and 11.3% were told to repeat back narratives about their treatments. Instructions and warnings given by physicians about prescribed drugs did not fully meet the RUD criteria. The majority of referred patients were willing to be educated about the subject.ConclusionThese results showed that heavy patient load seriously affects the RUD process. Improvement of the current health system should be given serious consideration. After sufficient arrangements have been made in this field, patients will be able to be informed properly about medicines prescribed by their physicians. Also, public education programs will be helpful to raise awareness of the subject on a larger scale.

Elevation Changes of Central Posterior Corneal Surface After Intracorneal Ring Segment Implantation in Keratoconus

To compare changes that occur at the posterior corneal surface after the implantation of intracorneal ring segments (ICRSs) using either mechanical or femtosecond laser-assisted procedures and to correlate these changes with the visual outcome achieved. Retrospective, nonrandomized, and interventional case series including 223 consecutive eyes of 186 patients with keratoconus ranging in age from 16 to 39 years that were implanted with ring segments (KeraRing; Mediphacos) at Kartal Training and Research Hospital, Istanbul, Turkey. Two groups were created according to the surgical technique used: mechanical group (168 eyes) and femtosecond group (55 eyes). Visual and refractive outcomes and corneal elevation changes were evaluated during a 24-month follow-up. Correlations between visual and posterior elevation changes were evaluated. The posterior corneal surface could not be analyzed with accuracy for diameters larger than the diameter of the ICRS implant. A statistically significant reduction of maximum elevation for both the corneal surfaces was observed at 1 month after the surgery (P < 0.01), with additional reductions at 3 and 6 months (P ≤ 0.03). In addition, the posterior best-fit sphere was flattened significantly at 1 month after the surgery in both the groups, with additional flattening at 3 months (P ≤ 0.03). No significant differences between groups in posterior corneal elevation parameters were found at any time point of the follow-up (P ≥ 0.14). Moderate and significant correlations of the postoperative visual outcome with the change in posterior best-fit sphere were found only in the femtosecond group. A central corneal flattening of the posterior corneal surface occurs after ring segment implantation in keratoconus.

Phakic anterior chamber lenses in very high myopia: an 18-month follow up

To evaluate the efficacy and tolerance of two different foldable anterior chamber phakic intraocular lenses for high myopia. A prospective interventional case series at the Eye Clinic, Kartal Training and Research Hospital, Istanbul, Turkey. Sixty-two eyes of 31 patients received iris-claw lens (group 1) (Artiflex AC 401, Ophtec), and 43 eyes of 22 patients received angle-supported lens (group 2) (I-Care, Corneal). The mean preoperative spherical equivalents for group 1 and group 2 were -12.13 D and -18.95 D, respectively. Endothelial cell density was measured at day 1 and at 1, 3, 6, 12 and 18 months for follow ups. Percentage change in endothelial cell density and improvement in visual acuity. At the 18-months follow up, uncorrected visual acuity improved to logMAR 0.37 ± 0.23 from 1.60 ± 0.10 in group 1, and logMAR 0.47 ± 0.14 from 0.70 ± 0.20 in group 2; best spectacle corrected visual acuity improved to logMAR 0.23 ± 0.22 from logMAR 0.36 ± 0.14) in group 1, and logMAR 0.29 ± 0.18 from logMAR 0.50 ± 0.20) in group 2 (P<0.001, in both groups). Mean decreased endothelial cell density was 241 cells/mm(2) (8.61%) and 223 cells/mm(2) (8.42%) at 18 months follow up in group 1 and 2, respectively (P=0.17) but significant in comparison to preoperative values for both groups (P<0.001). Although both iris-claw and angle-supported lenses offer good refractive outcomes significant endothelial cell density was observed at 18 months follow up.

Could Cellular Proliferation Be a Predictive Index for the Relapse of Nasal Polyposis and Down-Regulated by Nasal Steroid Treatment?

The aim of this article is to identify the cellular mitotic activity using Ki-67 monoclonal antibody for predicting relapses of nasal polyposis after surgery. A prospective study was conducted at Kartal Training and Research Hospital Otolaryngology Department between January 2006 and September 2008. Nasal polyps were obtained from all patients and pathological materials were analyzed for the Ki-67 staining using immunohistochemistry. Patients were followed after surgery for 12months for relapse. There was no statistically significant difference between recurrent and nonrecurrent polyps. Polyp recurrence has a multifactorial origin. Ki-67 index alone does not provide sufficient information about polyp recurrence before the operation.

Comparison of deep anterior lamellar keratoplasty and intrastromal corneal ring segment implantation in advanced keratoconus

To compare the visual and refractive results in eyes with advanced keratoconus having deep anterior lamellar keratoplasty (DALK) with those having intrastromal corneal ring segment (ICRS) implantation. Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey. Comparative case series. Records of advanced keratoconus patients with a clear central cornea and contact lens intolerance who had DALK or ICRS implantation were reviewed. Preoperatively and after 24 months, the uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, and Orbscan II keratometry (K) readings in the 2 groups were comparable. The DALK group comprised 36 eyes and the ICRS group, 30 eyes. Both groups had a statistically significant increase in UDVA and CDVA from preoperatively to 24 months postoperatively (P<.001). The DALK group had a statistically significantly greater improvement in UDVA and CDVA than the ICRS group 24 months postoperatively (P<.001). The improvement in spherical equivalent (SE) refractive error, manifest sphere, and manifest cylinder was statistically significant in both groups (P<.001). The mean reduction in SE and manifest cylinder were significantly greater in the DALK group (P<.05). The postoperative reduction in the maximum and minimum K values was statistically significant in both groups (P<.001); the mean reduction in K values was significantly greater in the DALK group (P<.001). Although DALK provided greater improvement in visual acuity and refractive errors in advanced keratoconus cases, ICRS implantation may be an alternative treatment with satisfactory outcomes and less visual impact.

Psychometric properties of the Turkish version of the Patient Health Questionnaire–Somatic, Anxiety, and Depressive Symptoms

ObjectiveIn this study, we examined the psychometric properties of the Turkish version of the Patient Health Questionnaire–Somatic, Anxiety, and Depressive Symptoms (PHQ-SADS) developed by Kroenke, Spitzer, and Williams. MethodThis study sample consisted of 200 outpatients admitted to Erenköy Mental Health Training and Research Hospital, Erenköy Physiotherapy and Rehabilitation Hospital, and Kartal Training and Research Hospital and 240 graduate students in Karadeniz Technical University. Participants were administered the 90-item Symptoms Checklist (SCL-90R) and the 7-item Whiteley Index, along with the PHQ-SADS. A month later, the PHQ-SADS was readministered to 60 of the students. To investigate the internal consistency of the scale and its subscales, corrected item-total correlations were examined to establish the effect on the Cronbach coefficients and internal consistency of each item of the subscales. Test-retest correlations were also analyzed for reliability. Factorial structure was investigated using principal component analysis. The validity of distinguishing congruent and specific groups was also investigated for validity. ResultsTotal scores on the scale showed an adequate test-retest consistency (r = 0.54, 0.52, and 0.76, respectively). All items showed adequate correlations (r > 0.26) in the test-retest analysis. Cronbach α values were 0.86 (control), 0.93 (patient), and 0.92 (total) on the test of internal consistency. When the questions were analyzed individually, the item-total correlation for item 7 of the PHQ somatization subscale was found to be inadequate in the control group. Exploratory factorial analysis and varimax rotation results showed that the scale provided a 4-factor structure. In the validity analysis, a significant difference between the patient and the control group mean values was determined. The SCL-90R, 7-item Whiteley Index, and SCL-90R somatization subscales were found to be sufficiently related to the number of symptoms to establish criterion-related validity. ConclusionFindings with respect to internal consistency, test-retest consistency, item-total correlation, factorial structure, distinguishing validity for specific groups, and criterion-related validity for the PHQ-SADS show that the scale is acceptable in terms of validity and reliability for the Turkish population.

Randomized Trial of Oral Misoprostol Treatment for Cervical Ripening Before Tandem Application in Cervix Cancer

To investigate the efficacy of oral misoprostol administered to facilitate tandem application to the cervix as a part of brachytherapy in patients with cervical cancer. Eighty patients with cervical cancer who had been planned to undergo brachytherapy at Dr. Lütfi Kırdar Kartal Training and Research Hospital were evaluated in a double-blind, prospective, randomized trial. Patients were divided randomly into two groups of 40 patients. The first and second groups received 400 μg of misoprostol orally and placebo, respectively, 3 h before tandem application. The two groups were compared in terms of age, diameter of tumor, parity, age at first intercourse, amount of bleeding and pain at first tandem application, length of endometrial cavity measured by hysterometer, and size of Hegar dilators used for cervical dilatation. Of all cases, 63.6%, 16.3%, 10%, 6.3%, 2.5%, and 1.3% were Stage IIB, IIIB, IIIA, IVA, IIA and IIC, respectively. Mean (±SD) age (range) was 49.3 ± 13.1 (25-83) years and 56.6 ± 13.2 (30-78) years in the study and control groups, respectively (p = 0.015). Age at first intercourse, diameter of tumor, parity, amount of bleeding at first tandem application, and length of endometrial cavity measured by hysterometer were not significantly different between the two groups. Pain score was significantly higher in the control group (p < 0.001). Application was significantly easier in the study group compared with controls (p < 0.001). Average size of initial Hegar dilators used for cervical dilatation was significantly higher in the study group compared with controls (p = 0.017). Administration of misoprostol 400 μg orally for cervical ripening before tandem application facilitates the procedure, increases patient tolerability and comfort, and may decrease complication rates.

Reviewer indeks of Journal of Kartal Training and Research Hospital, Volume XXII of 2011

Reviewer indeks of Journal of Kartal Training and Research Hospital, Volume XXII of 2011

Comparison of mechanical and femtosecond laser tunnel creation for intrastromal corneal ring segment implantation in keratoconus: Prospective randomized clinical trial

To compare the outcomes of mechanical and femtosecond laser-assisted tunnel creation for intrastromal corneal ring segment (ICRS) implantation in eyes with keratoconus. Kartal Training and Research Hospital, Istanbul, Turkey. In this prospective study, consecutive eyes with keratoconus were randomly assigned to have ICRS tunnel creation with a mechanical device or a femtosecond laser. Keraring ICRS with a 5.0 mm diameter and 160-degree arc length were implanted in all cases. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, and keratometry (K) readings were measured preoperatively and 1 year postoperatively, and the data in the mechanical group and the femtosecond group were compared statistically. One year postoperatively, there was significant improvement in UDVA, CDVA, K readings, spherical equivalent (SE), and manifest sphere and cylinder in both groups (P<.05). The UDVA improved by 2.4 lines in the mechanical group and 2.0 lines in the femtosecond group and the CDVA by 3.3 lines and 2.7 lines, respectively; the mean reduction in maximum keratometry was 4.50 diopters (D) and 4.70 D, respectively, and the mean reduction in SE, 3.18 D and 3.09 D, respectively. There were no statistically significant differences between the 2 groups in visual or refractive results (P>.05). Anterior corneal perforation, superficial segment placement, and segment extrusion occurred in 1 eye each in the mechanical group. Segment migration occurred in 1 eye in the femtosecond group. Despite intraoperative complications in the mechanical group, the visual and refractive outcomes were similar to those in the femtosecond group.

Human papillomavirus is not associated with breast carcinoma

Breast cancer is the most common cancer in women, accounting for 23% of all female cancers around the world. Research on its etiology has focused primarily on genetic and environmental factors [1]. Infectious etiology in carcinogenesis has long been suggested by epidemiological and experimental studies. Current estimates suggest that approximately 15–20% of all cancers worldwide appear to be associated with viral infections, and several human DNA viruses are now accepted as causative agent of specific malignancies [2]. Human papillomavirus (HPV) is one of the viruses and is responsible for causing virtually all cases of cervical cancer in women [2]. A number of studies have reported HPV DNA detection in extragenital cancers, although the etiological involvement of HPV in those malignancies is still controversial [3]. The aim of the present study was to investigate a possible presence of HPV DNA in breast cancer tissue in a population of Turkish women and discuss the results in the light of literature. In this study, 84 patients with invasive breast carcinoma as a study group and 49 patients with invasive cervical carcinoma and CIN lesions as a control group were selected from our pathology department’s archives. All of the cases were screened by nested MY/GP polymerase chain reaction (PCR) for HPV DNA in paraffin-embedded archival tissue samples. In the study group, all tested samples (84 breast carcinoma) were negative for HPV DNA (Fig. 1). In the control group (21 with invasive cervical carcinoma, 12 with CIN III, 7 with CIN II, and 9 with CIN I) 34 out of 49 (69.4%) cervical tissues were positive for the HPV DNA. Di Lonardo et al. were first to report the relationship between HPV and breast cancer in 1992. They investigated the presence of HPV DNA on paraffin-embedded tissue sections using PCR and in situ hybridization techniques. By PCR, they detected HPV 16 DNA in breast carcinomas, with a frequency of 29.4% positive cases. However, they were unable to identify any HPV DNA sequences by in situ hybridization [4]. Since then, some other studies which looked for HPV DNA in breast carcinoma by PCR were published and the prevalence of HPV DNA in breast carcinomas was found to be varied between 4 and 86% [5–7]. To date, the mechanism by which the virus reaches the breast has not been clearly identified. However, there are two proposed mechanisms that HPVs are transmitted to the breast, mechanical and systemic pathways [5, 7]. de Villiers et al. detected the viruses in both the nipple and the areolar tissue in patients with breast carcinoma. Their study is consistent with the mechanical pathway involving transfer of the virus in a retrograde fashion via the nipple, areola, lactiferous ducts, and sinuses [6]. On the other hand, Widschwendter et al. found the same type of HPV DNA positivity in breast carcinomas, as well as in regional lymph node metastases of the patients with invasive cervical cancer, and they suggested oncogenic HPV DNA might be transported from an original site of infection to the breast tissue by the blood or lymphatic system in a systemic pathway [8]. However, some other studies from different countries were failed to demonstrate the presence of HPV DNA in D. Yavuzer (&) N. Karadayi Department of Pathology, Dr. Lutfi Kirdar Kartal Training and Research Hospital, Cevizli, 34865 Istanbul, Turkey e-mail: dilekyavuzer@yahoo.com

Incidence of and Risk Factors for Increased Intraocular Pressure After Penetrating Keratoplasty

To identify the incidence of and risk factors associated with the development of glaucoma after penetrating keratoplasty. A retrospective study was carried out between September 1996 and January 2007 with 729 patients' 749 eyes, which underwent penetrating keratoplasty at the 1st Eye Clinic at Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul. Six attending surgeons performed all the surgeries at the same center. Age, sex, preoperative diagnosis, the presence of preoperative glaucoma, the status of the lenses, and additional surgery performed during keratoplasty, which may affect the postoperative intraocular pressure, were evaluated. The patients' ages ranged from 5 to 86 years (with a mean of 40.9 +/- 20.4 years). Two hundred seventy-seven (61.9%) of the patients were female and 452 (38.1%) were male. Intraocular pressure increases in the early postoperative period occurred in 41 (5.5%) eyes and chronically elevated intraocular pressure was found in 124 (16.6%) eyes. Preoperative diagnosis of inflammatory diseases such as graft thinning (relative risk [RR] = 4.96), traumatic scar formation (RR = 2.66), graft abscess (RR = 2.62), graft rejection (RR = 2.61), bullous keratopathy (RR = 2.59), and corneal abscess (RR = 1.52) were found to be risk factors for the development of glaucoma. Also, the following were significantly associated with an increased risk of glaucoma: peripheral anterior synechia (P = 0.019), preoperative glaucoma (P = 0.0001), and additional surgery combined with penetrating keratoplasty (P = 0.0001). The average period between surgery and the first intraocular pressure elevation was 5.0 +/- 6.5 months for all eyes. The mean intraocular pressure value of eyes that developed glaucoma after penetrating keratoplasty was 27.9 +/- 5.8 mmHg. Increased intraocular pressure after penetrating keratoplasty is a common clinical problem, and the risk factors are preoperative diagnosis of inflammatory diseases, peripheral anterior synechia, preoperative glaucoma, and additional surgery combined with penetrating keratoplasty.

Enucleating the large and median geniohyoid dermoid cysts of the floor of the mouth with intraoral inferior based U‐shaped flap technique: how we do it

Clinical OtolaryngologyVolume 34, Issue 5 p. 479-481 Enucleating the large and median geniohyoid dermoid cysts of the floor of the mouth with intraoral inferior based U-shaped flap technique: how we do it M. Eken, M. Eken Second ENT, Kartal training and research hospital, Istanbul, TurkeySearch for more papers by this authorZ.A. Oktay, Z.A. Oktay Second ENT, Kartal training and research hospital, Istanbul, TurkeySearch for more papers by this authorE. Ayduran, E. Ayduran Second ENT, Kartal training and research hospital, Istanbul, TurkeySearch for more papers by this authorE.E. Eken, E.E. Eken ENT clinic, Sultanbeyli state hospital, Istanbul, TurkeySearch for more papers by this authorA. Sanli, A. Sanli Second ENT, Kartal training and research hospital, Istanbul, TurkeySearch for more papers by this author M. Eken, M. Eken Second ENT, Kartal training and research hospital, Istanbul, TurkeySearch for more papers by this authorZ.A. Oktay, Z.A. Oktay Second ENT, Kartal training and research hospital, Istanbul, TurkeySearch for more papers by this authorE. Ayduran, E. Ayduran Second ENT, Kartal training and research hospital, Istanbul, TurkeySearch for more papers by this authorE.E. Eken, E.E. Eken ENT clinic, Sultanbeyli state hospital, Istanbul, TurkeySearch for more papers by this authorA. Sanli, A. Sanli Second ENT, Kartal training and research hospital, Istanbul, TurkeySearch for more papers by this author First published: 24 September 2009 https://doi.org/10.1111/j.1749-4486.2009.01956.xCitations: 3 Dr Mehmet Eken, Kartal Dr. Lutfi Kirdar, Training and Research Hospital 2nd ENT Clinic, Uskudar street, Konak Apartment number: 39/11, Kartal Istanbul, Turkey. Tel.: +90 505 234 45 96; fax: +90216 330 95 02; e-mail: memedken@yahoo.com Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume34, Issue5October 2009Pages 479-481 RelatedInformation

Intubating laryngeal mask airway vs laryngoscopy in normotensive patients: Which path to take?

Anesthesiology and Intensive Care, Dr. Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey

Monitoring of neuromuscular block after administration of rocuronium in patients with diabetes mellitus

Anesthesiology and Intensive Care, Dr. Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey

Astigmatism after superonasal and superotemporal clear corneal incisions in phacoemulsification

To determine the astigmatism outcomes after cataract surgery performed using superonasal and superotemporal clear corneal incisions. Department of Ophthalmology, Kartal Training and Research Hospital, Istanbul, Turkey. This prospective study includes consecutive 45 eyes of 34 patients having phacoemulsification with implantation of foldable acrylic intraocular lens through a corneal tunnel incision between January and April 2004. The right eye always had a superotemporal incision while the left eye a superonasal incision. Astigmatism was measured by keratometry readings before surgery and 3rd, 15th, and 45th days postoperatively. The surgically induced astigmatism (SIA) was calculated by the vector analysis using the Holladay-Cravy-Koch method at 3rd day, 2nd and 6th weeks postoperatively. The mean preoperative astigmatism was 0.74 +/- 0.45 diopter (D) in the temporal incision group and 0.69 +/- 0.39 D in the nasal incision group. Fifty-eight percent of eyes had against-the-rule (ATR) astigmatism, 26% had with-the-rule (WTR) astigmatism, and 16% were astigmatically neutral. At 6 weeks, 46% of eyes had ATR astigmatism and 35% had WTR astigmatism. The mean total astigmatism was lower in the temporal incision group than in the nasal incision group at all successive examinations postoperatively. Although the total astigmatism decreased at 6 weeks in both groups, temporal incisions yielded less total and surgically induced astigmatism (P < .05). Cataract surgery using superotemporal incision induced significantly less SIA in the early postoperative period.

Determination of factors affecting the success rate of spinal anaesthesia

Department of II. Anesthesiology and Intensive Care, Dr. Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey