Publications by authors named "Hatice Yılmaz"

30 Publications

  • Page 1 of 1

Sigmoid Sinus Thrombosis Followed by Splenic Infarction Due to Imatinib Therapy in a Patient with Gastrointestinal Stromal Tumor; Hematological Side Effects of Imatinib.

J Pharm Pharm Sci 2021 ;24:148-152

Department of Medical Oncology, Atatürk University Faculty of Medicine, Erzurum, Turkey.

Imatinib has an important place as an adjuvant therapy as well as in the treatment of metastatic disease caused by gastrointestinal stromal tumor (GIST), which is one of the common mesenchymal tumors of the gastrointestinal tract. Imatinib is a tyrosine kinase inhibitor and is generally well tolerated. However, it can cause some serious adverse effects. The most common of these are edema on the face and legs, headache, fatigue, nausea, vomiting, and rash on the skin. The most serious side effects, albeit less common, are gastrointestinal or intraabdominal bleeding. However, thrombotic events such as sigmoid sinus thrombosis and splenic infarction are extremely rare. The current report presents a patient with GIST who is treated with imatinib 400 mg/day. The patient presented with edema on the face and headache in the second month of imatinib therapy, after which she was diagnosed with sigmoid sinus thrombosis. The patient who presented with abdominal pain approximately three months later developed splenic infarction. She was administered acetylsalicylic acid, supplemental oxygen (O2) in the first episode of thrombosis, and imatinib therapy was discontinued. The patient's complaints and thrombus regressed, after which imatinib therapy was resumed. She was administered intravenous hydration, supplemental oxygen, analgesics, and imatinib therapy was discontinued after the patient sustained splenic infarction. After resolution of sigmoid sinus thrombosis and the regression of splenic infarction area, the patient was switched to sunitinib therapy. She is attending routine control visits. Sigmoid sinus thrombosis and splenic infarction should be kept in mind as a rare cause of headache and abdominal pain in patients treated with imatinib, and detailed neurological and gastrointestinal evaluation should be performed.
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http://dx.doi.org/10.18433/jpps31425DOI Listing
January 2021

Clinical significance of postoperatif controlling nutritional status (CONUT) score in glioblastoma multiforme.

J Clin Neurosci 2021 Apr 19;86:260-266. Epub 2021 Feb 19.

Department of Medical Oncology, Adnan Menders University Faculty of Medicine, Aydın, Turkey.

Purpose: The Controlling Nutritional Status (CONUT) Score, a new parameter that reflects the immuno-nutritional status, has been closely associated with prognosis in many cancer types. However, the prognostic significance of the CONUT score in Glioblastoma Multiforme (GBM) is not known. In this study, we aimed to show the prognostic significance of the CONUT score in the postoperative period in patients with GBM.

Methods: 120 patients followed up with GBM were included in the study, retrospectively. According to the receiver operating characteristic (ROC) curve analysis, the optimal cut-off values were determined for the CONUT score, and the patients were divided into low (<2.5) and high (≥2.5) CONUT groups. Systemic immune inflammation index (SII), prognostic nutritional index (PNI), and neutrophil-lymphocyte ratio (NLR) were grouped according to the cut-off point of 1111, 46.5, and 4.48, respectively. Cox regression analyzes were used to assess their prognostic significance for progression-free survival (PFS) and overall survival (OS).

Results: The high CONUT score group was found to have worse PFS and OS than the low CONUT score group (p < 0.001, p < 0.001). In univariate analysis, age, gender, comorbidity, CONUT score, SII, PNI, NLR were found to be significant for both PFS and OS. In multivariate analysis, only age and CONUT score were found as independent prognostic factors for both PFS (p: 0.040, p < 0,001) and OS (p: 0,041, p < 0,001).

Conclusion: The CONUT score in the postoperative period in patients with GBM is an independent prognostic parameter that predicts progression and survival.
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http://dx.doi.org/10.1016/j.jocn.2021.01.036DOI Listing
April 2021

The Diagnostic Value of Superb Microvascular Imaging in Prediction of Uterine Artery Embolization Treatment Response in Uterine Leiomyomas.

J Ultrasound Med 2021 Feb 18. Epub 2021 Feb 18.

Cerrahpasa Medical Faculty, Radiology Department, Istanbul University, Istanbul, Turkey.

Objectives: We aimed to determine if superb microvascular imaging (SMI) can predict response to uterine artery embolization (UAE) as compared with power Doppler ultrasound.

Methods: The blood flow and the volume of the dominant leiomyoma was evaluated by power Doppler ultrasonography (PDUS) and SMI 1 day before and 3 months after the UAE procedure. SMI and PDUS blood flow were classified to 4 grades of vascularity. The change in fibroid volume in Grades 0-2 (hypovascular group) was compared to the hypervascular Grade 3 group.

Results: Twenty-eight women (mean age, 40.9 years; range, 33-53 years) were examined with PDUS and SMI before and 3 months after UAE. The volume reduction was statistically significantly higher hypervascular group (P < .05). When we accept 30% or more volume reduction as a good response to UAE, the positive predictive value, negative predictive value, sensitivity, specificity, and accuracy of SMI were 100, 64, 73.6, 100, and 82.1%, respectively. There was excellent agreement between the two blinded observers in SMI measurements.

Conclusions: SMI, with its high reproducibility, provides further microvessel information than PDUS in uterine fibroids. It may be a useful tool in prediction of response to UAE treatment and improve counseling and patient selection for UAE versus medical or surgical treatment options.
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http://dx.doi.org/10.1002/jum.15647DOI Listing
February 2021

Peri-operative blood transfusion in elective major surgery: incidence, indications and outcome - an observational multicentre study.

Blood Transfus 2020 07;18(4):261-279

Department of Anaesthesiology and Reanimation, Ankara Ataturk Teaching Hospital, Ankara, Turkey.

Background: Patients' demographic and epidemiological characteristics, local variations in clinicians' knowledge and experience and types of surgery can influence peri-operative transfusion practices. Sharing data on transfusion practices and recipients may improve patients' care and implementation of Patient Blood Management (PBM).

Materials And Methods: This was a multicentre, prospective, observational, cross-sectional study that included 61 centres. Clinical and transfusion data of patients undergoing major elective surgery were collected; transfusion predictors and patients' outcomes were analysed.

Results: Of 6,121 patients, 1,579 (25.8%) received a peri-operative transfusion. A total of 5,812 blood components were transfused: red blood cells (RBC), fresh-frozen plasma and platelets in 1,425 (23.3%), 762 (12.4%) and 88 (1.4%) cases, respectively). Pre-operative anaemia was identified in 2,019 (33%) patients. Half of the RBC units were used by patients in the age group 45-69 years. Specific procedures with the highest RBC use were coronary artery bypass grafting (16.9% of all units) and hip arthroplasty (14.9%). Low haemoglobin concentration was the most common indication for intra-operative RBC transfusion (57%) and plasma and platelet transfusions were mostly initiated for acute bleeding (61.3% and 61.1%, respectively). The RBC transfusion rate in study centres varied from 2% to 72%. RBC transfusion was inappropriate in 99% (n=150/151) of pre-operative, 23% (n=211/926) of intra-operative and 43% (n=308/716) of post-operative RBC transfusion episodes. Pre-operative haemoglobin, increased blood loss, open surgery and duration of surgery were the main independent predictors of intra-operative RBC transfusion. Low pre-operative haemoglobin concentration was independently associated with post-operative pulmonary complications.

Conclusions: These findings identified areas for improvement in peri-operative transfusion practice and PBM implementation in Turkey.
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http://dx.doi.org/10.2450/2020.0011-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7375885PMC
July 2020

The prognostic significance of hemoglobin-to-red cell distribution width ratio in muscle-invasive bladder cancer.

Biomark Med 2020 06 10;14(9):727-738. Epub 2020 Jul 10.

Department of Medical Oncology, Faculty of Medicine, Ataturk University, Yakutiye, Erzurum, Turkey.

To investigate the prognostic significance of pretreatment hemoglobin (HB)-to-red cell distribution width (RDW) ratio (HRR) in patients with muscle-invasive bladder cancer (MIBC). The neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), prognostic nutritional index, HRR, HB and RDW were analyzed to assess their prognostic value using the Kaplan-Meier curves and Cox-regression analysis in 152 patients with MIBC. Univariate analysis showed that the progression-free survival (PFS) was associated with NLR, SII, HRR, RDW, whereas overall survival (OS) was associated with NLR, SII, prognostic nutritional index, HRR, HB, RDW. In multivariate analysis, HRR was found to be an independent prognostic factor for both PFS and OS. HRR is a new prognostic factor that can be used to predict PFS/OS in MIBC.
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http://dx.doi.org/10.2217/bmm-2020-0045DOI Listing
June 2020

Evaluation of Subclinical Atherosclerosis with Carotid Intima-Media and Epicardial Fat Thickness in Patients with Sarcoidosis.

Turk Thorac J 2020 May;21(3):174-179

Department of Pulmonary Medicine, Baskent University School of Medicine, Ankara, Turkey.

Objectives: Since many similar mechanisms may play a role in the pathophysiology of sarcoidosis and atherosclerosis, the risk of subclinical atherosclerosis may be increased in patients with sarcoidosis. The aim of this study was to evaluate known markers of subclinical atherosclerosis, namely epicardial fat thickness (EFT) and carotid intima-media thickness (CIMT) in patients with sarcoidosis.

Materials And Methods: This cross-sectional study included a total of 183 subjects, including 94 patients with sarcoidosis (patient group) and a control group of 89 healthy individuals. Measurements of EFT and CIMT were taken from all subjects and recorded. The groups were compared, and differences were analyzed statistically.

Results: EFT was higher in patients than in control subjects (6.42±1.12 mm vs 7.13±1.41 mm, p<0.001). CIMT was higher in patients than in control subjects (0.51±0.02 mm vs 0.52±0.02 mm, p=0.003).

Conclusion: EFT and CIMT were found to be higher in patients with sarcoidosis than in healthy people. These results indicate that the risk of subclinical atherosclerosis might be increased in these patients.
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http://dx.doi.org/10.5152/TurkThoracJ.2019.19017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7311145PMC
May 2020

The Significance of Controlling Nutritional Status (CONUT) Score as a Novel Prognostic Parameter in Small Cell Lung Cancer.

Lung 2020 08 19;198(4):695-704. Epub 2020 May 19.

Department Of Medical Oncology, Adnan Menderes University Faculty of Medicine, Aydın, Turkey.

Purpose: The immuno-nutritional status is closely related to the prognosis in many cancers. Controlling nutritional status (CONUT) score is a new parameter that reflects the immuno-nutritional status and is prognostic in some cancers. However, the prognostic significance of the CONUT score in small cell lung cancer (SCLC) is unknown. We aimed to demonstrate the prognostic significance of the CONUT score in patients with SCLC.

Methods: Two hundred sixteen patients who were followed up with SCLC were included in the study retrospectively. According to the receiver operating characteristic (ROC) curve analysis, the optimal cutoff values were determined for the CONUT score, and the patients were divided into low (< 2) and high (≥ 2) CONUT groups. Neutrophil-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and prognostic nutritional index (PNI) were grouped based on a cutoff point 2.84, 626, and 46.1, respectively. Cox regression analyses were used to assess their prognostic values for progression-free survival (PFS) and overall survival (OS).

Results: The high CONUT group had significantly worse PFS and OS than the low CONUT group (p < 0.001, p < 0.001). In univariate analysis, stage, prophylactic cranial irradiation, extrapulmonary lesion, PNI, body mass index, CONUT score were found to be significant for both PFS and OS. In multivariate analysis, only CONUT score and stage were found as independent prognostic factors for both PFS (p: 0.018, p: 0.046) and OS (p: 0.038, p: 0.006).

Conclusion: The CONUT score at the time of diagnosis is an independent prognostic parameter that predicts recurrence and survival times in SCLC.
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http://dx.doi.org/10.1007/s00408-020-00361-2DOI Listing
August 2020

Predicting Pulmonary Complications Following Upper and Lower Abdominal Surgery: ASA vs. ARISCAT Risk Index.

Turk J Anaesthesiol Reanim 2020 Apr 8;48(2):96-101. Epub 2019 Oct 8.

Department of General Surgery, Başkent University Adana Teaching and Research Center, Adana, Turkey.

Objective: Postoperative pulmonary complications (POPC) account for a substantial proportion of risk related to surgery and anaesthesia. The American Society of Anesthesiologists (ASA) classification and the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) risk index correlate well with POPC. Here, we compared their accuracy in predicting pulmonary complications following upper and lower abdominal surgery.

Methods: We retrospectively reviewed the medical records of patients undergoing upper and lower abdominal surgery. We collected patients' demographic data, comorbidities, preoperative pulmonary risk score, laboratory results, surgical data, respiratory tract infection history within one month before surgery, surgical urgency, ASA scores and pulmonary complications within one month after the surgery.

Results: We evaluated 241 patients [upper abdominal surgery (UAS) n=121; lower abdominal surgery (LAS) n=120; mean age 55.7±3.1 years]. In the UAS, 55.8% of the patients were male. In LAS, all patients were female. In both groups, the most common POPC was pleural effusion with compressive atelectasis (CA). Regarding risk score, in both groups, patients with high-risk developed a higher rate of pulmonary complications [UAS (50%), LAS (40%)]. In patients with low-risk scores, the rate of pulmonary complications was significantly lower than the intermediate and high-risk groups (p<0.001). A positive correlation was observed between preoperative risk score and complications (UAS r=0.34; LAS r=0.35 p<0.05). No association was observed between the ASA scores and POPC (p=0.8).

Conclusion: The ASA classification was found to be a weaker modality than ARİSCAT risk index to predict pulmonary complications after the upper and lower abdominal surgeries.
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http://dx.doi.org/10.5152/TJAR.2019.28158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7101190PMC
April 2020

Investigation of the Relationship between Asthma and Visceral Obesity by Epicardial Fat Thickness Measurement.

Turk Thorac J 2019 Jan 1;20(1):1-5. Epub 2019 Jan 1.

Department of Pulmonary Medicine, Başkent University School of Medicine, Ankara, Turkey.

Objectives: Obesity is a risk factor defined in recent years for asthma. It is associated not only with asthma but also with many cardiovascular diseases. Visceral obesity is a more significant risk factor than general obesity in cardiovascular diseases. Although the association of visceral obesity with cardiovascular diseases is well known, the relationship in patients with asthma is not fully understood. The aim of the present study was to investigate whether there is a relationship between asthma and visceral fat by using epicardial fat thickness (EFT) measurement.

Materials And Methods: A total of 401 subjects (229 patients with persistent asthma and 172 controls) were enrolled in the study. In our study, EFT was measured, recorded by echocardiography, and was evaluated whether there was a statistical significant difference between the two groups.

Results: The mean EFT was 5.84±0.79 mm in the patient group and 5.71±0.93 mm in the control group. There was no statistically significant difference between the groups (p=0.145). Similarly, when we compared control and asthma severity subgroups, we did not find statistically significant differences (control group mean 5.71±0.93 mm, mild group mean 5.86±0.81 mm, moderate group mean 5.8±0.84 mm, and severe group mean 5.83±0.67 mm, p=0.505).

Conclusion: In the present study, we observed that the EFT did not increase in patients with asthma compared with the normal population. Based on our results, we suggest that visceral obesity may not be a significant risk factor for asthma.
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http://dx.doi.org/10.5152/TurkThoracJ.2018.18028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340690PMC
January 2019

Effects of Virtual Reality and External Cold and Vibration on Pain in 7- to 12-Year-Old Children During Phlebotomy: A Randomized Controlled Trial.

J Perianesth Nurs 2018 Dec 17;33(6):981-989. Epub 2018 Mar 17.

Purpose: The aim of this study was to evaluate the effects of the virtual reality (VR) and external cold and vibration methods on pain scores in children aged 7 to 12 years during phlebotomy.

Design: A randomized controlled study.

Methods: The sample of children (n = 121) was allocated to the groups (group 1, VR; group 2, external cold and vibration; group 3, control) by blocked randomization. Pain scores were assessed after the phlebotomy using self-report, parent's reports, report from the nurse who attempted the phlebotomy, and researchers' report with the Wong-Baker FACES scale.

Findings: Pain scores were determined to be lower in groups 1 and 2. Although there was no difference between the groups 1 and 2, a statistically significant difference was found between groups 1 or 2 and group 3 based on all pain scores.

Conclusions: Results suggest that VR and external cold and vibration are effective in reducing the pain in 7- to 12-year-old children during phlebotomy. VR can be used safely for the pain management of children who are growing up in the age of technology.
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http://dx.doi.org/10.1016/j.jopan.2017.12.010DOI Listing
December 2018

Can tree species diversity be assessed with Landsat data in a temperate forest?

Environ Monit Assess 2017 Oct 28;189(11):586. Epub 2017 Oct 28.

Department of Forest Engineering, Faculty of Forestry, Istanbul University, 34473 Bahçeköy, Istanbul, Turkey.

The diversity of forest trees as an indicator of ecosystem health can be assessed using the spectral characteristics of plant communities through remote sensing data. The objectives of this study were to investigate alpha and beta tree diversity using Landsat data for six dates in the Gönen dam watershed of Turkey. We used richness and the Shannon and Simpson diversity indices to calculate tree alpha diversity. We also represented the relationship between beta diversity and remotely sensed data using species composition similarity and spectral distance similarity of sampling plots via quantile regression. A total of 99 sampling units, each 20 m × 20 m, were selected using geographically stratified random sampling method. Within each plot, the tree species were identified, and all of the trees with a diameter at breast height (dbh) larger than 7 cm were measured. Presence/absence and abundance data (tree species number and tree species basal area) of tree species were used to determine the relationship between richness and the Shannon and Simpson diversity indices, which were computed with ground field data, and spectral variables derived (2 × 2 pixels and 3 × 3 pixels) from Landsat 8 OLI data. The Shannon-Weiner index had the highest correlation. For all six dates, NDVI (normalized difference vegetation index) was the spectral variable most strongly correlated with the Shannon index and the tree diversity variables. The Ratio of green to red (VI) was the spectral variable least correlated with the tree diversity variables and the Shannon basal area. In both beta diversity curves, the slope of the OLS regression was low, while in the upper quantile, it was approximately twice the lower quantiles. The Jaccard index is closed to one with little difference in both two beta diversity approaches. This result is due to increasing the similarity between the sampling plots when they are located close to each other. The intercept differences between two investigated beta diversity were strongly related to the development stage of a number of sampling plots in the tree species basal area method. To obtain beta diversity, the tree basal area method indicates better result than the tree species number method at representing similarity of regions which are located close together. In conclusion, NDVI is helpful for estimating the alpha diversity of trees over large areas when the vegetation is at the maximum growing season. Beta diversity could be obtained with the spectral heterogeneity of Landsat data. Future tree diversity studies using remote sensing data should select data sets when vegetation is at the maximum growing season. Also, forest tree diversity investigations can be identified by using higher-resolution remote sensing data such as ESA Sentinel 2 data which is freely available since June 2015.
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http://dx.doi.org/10.1007/s10661-017-6295-6DOI Listing
October 2017

Determining the factors affecting the distribution of , an endemic plant of Turkey, and a mapping species distribution model.

Ecol Evol 2017 Feb 23;7(4):1112-1124. Epub 2017 Jan 23.

Department of Forest Engineering Faculty of Forestry Istanbul University Istanbul Turkey.

Species distribution modeling was used to determine factors among the large predictor candidate data set that affect the distribution of , an endemic bulbous plant species of Turkey, to quantify the relative importance of each factor and make a potential spatial distribution map of . Models were built using the Boosted Regression Trees method based on 35 presence and 70 absence records obtained through field sampling in the Gönen Dam watershed area of the Kazdağı Mountains in West Anatolia. Large candidate variables of monthly and seasonal climate, fine-scale land surface, and geologic and biotic variables were simplified using a BRT simplifying procedure. Analyses performed on these resources, direct and indirect variables showed that there were 14 main factors that influence the species' distribution. Five of the 14 most important variables influencing the distribution of the species are bedrock type, density, precipitation during the wettest month, density, and northness. These variables account for approximately 60% of the relative importance for determining the distribution of the species. Prediction performance was assessed by 10 random subsample data sets and gave a maximum the area under a receiver operating characteristic curve (AUC) value of 0.93 and an average AUC value of 0.8. This study provides a significant contribution to the knowledge of the habitat requirements and ecological characteristics of this species. The distribution of this species is explained by a combination of biotic and abiotic factors. Hence, using biotic interaction and fine-scale land surface variables in species distribution models improved the accuracy and precision of the model. The knowledge of the relationships between distribution patterns and environmental factors and biotic interaction of can help develop a management and conservation strategy for this species.
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http://dx.doi.org/10.1002/ece3.2766DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5306017PMC
February 2017

Evaluating the cancer related fatigue by children, mothers, and nurses in Turkish pediatric oncology patients.

Eur J Oncol Nurs 2016 Aug 15;23:66-71. Epub 2016 May 15.

Muğla Sıtkı Koçman University, Fethiye Health School, Pediatric Nursing Department, Fethiye, Muğla, Turkey. Electronic address:

Purpose: The aims of this study were to evaluate cancer related fatigue by children', mothers', and nurses' perspectives in recently diagnosed pediatric oncology patients, to evaluate levels of agreement between the fatigue scales, and to evaluate the relationships between fatigue and sample characteristics.

Method: The sample of this cohort, descriptive, correlational study consisted of 26 recently cancer diagnosed children between the ages of 7 and 12, receiving inpatient treatment in pediatric oncology/hematology units, their mothers and their nurses. The data about children's fatigue were collected using the Child Fatigue Scale-24 h, Parent Fatigue Scale-24 h and Staff Fatigue Scale-24 h, for two consecutive days in the second and third weeks of the patient's first chemotherapy treatment cycle.

Results: The mean scores of the Child Fatigue Scale-24 h showed the children's fatigue to be at a moderate level, a statistically significant difference was found between the CFS-24 h and PFS-24 h mean scores in the first and second measurement (p < 0.05). The Intraclass correlation showed a good agreement between scales and repeated measurements for these scales.

Conclusion: Fatigue in recently diagnosed cancer patients is an important symptom which is of particular concern to the children, their parents and nurses. The study showed that these three scales can be used alone an also used simultaneously, and also proved that these scales are reliable for repeated measurements.
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http://dx.doi.org/10.1016/j.ejon.2016.05.002DOI Listing
August 2016

Evaluation of bronchoscopic lung volume reduction coil treatment results in patients with severe emphysema.

Clin Respir J 2017 Sep 2;11(5):585-592. Epub 2015 Oct 2.

Department of İnternal Medicine, Sifa University Medical Faculty, Izmir, Turkey.

Introduction: Bronchoscopic lung volume reduction coil (BLVR-C) implantation is an alternative therapeutic approach that can be applied together with medical treatment for patients with severe emphysema. BLVR-C is both easier and safer in terms of complications than volume reduction surgery. This study aimed to evaluate medium-term outcomes following BLVR-C treatment.

Methods: Forty patients who underwent BLVR-C between September 2013 and March 2014 were reviewed retrospectively. We compared changes between the baseline and 6-month post-procedural results with respect to pulmonary function tests, a 6-min walk test (6MWT), chronic obstructive pulmonary disease (COPD) assessment test (CAT), St. George's Respiratory Questionnaire (SGRQ), and pulmonary artery pressure (PAP) and arterial blood gas analyses. Secondary outcomes included procedure-related and follow-up complications.

Results: An average of 9.5 (range: 5-11) coils were placed per lung in an average procedural duration of 20.8 ± 7.0 min (range: 9-45) min. Six months after BLVR-C treatment, significant improvements were observed in patients' pulmonary function tests and quality of life. Changes were observed in the forced exhalation volume in 1 s (+150 mL), residual volume (-14.5%), 6MWT (+48 m), SGRQ (-10.5) and CAT Score (-7.5). Changes in the PAP and partial pressure of carbon dioxide values were not significant, and pneumothorax did not occur. In a 6-month follow-up, 11 cases of COPD exacerbation (41.4%), 7 cases of pneumonia (16.9%) and 1 death (2%) occurred. Treatment in 1 case was postponed because of hypotension and bradycardia during the process.

Conclusion: BLVR-C treatment appears to be effective over the medium-term and safe for patients with severe emphysema.
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http://dx.doi.org/10.1111/crj.12387DOI Listing
September 2017

Demographic, clinical, and laboratory features of Turkish patients with late onset ankylosing spondylitis.

Bosn J Basic Med Sci 2015 Jul 22;15(3):64-7. Epub 2015 Jul 22.

Sifa University Faculty of Medicine Department of Ortopedics.

Ankylosing spondylitis (AS) is a chronic inflammatory disease, which typically begins in early decades of life with primarily axial joints involvement. This disease rarely affects patients older than 50 years of age. The aim of this study was to compare and evaluate the demographic, clinical, and laboratory features of late onset and early onset AS patients who were followed up in a single rheumatology center. A total of 339 patients who have been diagnosed with AS according to modified New York criteria were included in the study. The patients whose initial symptoms were observed after 50 years of age were accepted as late onset AS. Out of 339 patients, 27 (7.9%) were diagnosed as late onset AS and 312 (92.3%) patients were evaluated as early onset AS. Of 27 late onset patients, 10 were male and 17 were female. Delay in the diagnosis was 5.8 years for early onset AS, while it was 3.8 years for late onset AS (p = 0.001). Higher levels of acute phase reactants and more methotrexate (MTX) use were detected in early onset AS patients compared to late onset AS (p = 0.001, p = 0.007, respectively). Statistically, there was no difference between these two groups, with regard to disease clinical activity indexes, anthropometric measurement parameters, uveitis and peripheral joint involvement. In this study, we showed that early and late onset AS patients may present with different clinical, genetic, and laboratory features. Late onset AS patients are characterized with lower human leukocyte antigen-B27 sequence, less inflammatory sign, delayed diagnosis, and less MTX and anti-tumor necrosis factor alpha drug usage.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4594328PMC
http://dx.doi.org/10.17305/bjbms.2015.511DOI Listing
July 2015

Co-occurrence of rheumatoid arthritis and sarcoidosis.

BMJ Case Rep 2015 Jul 6;2015. Epub 2015 Jul 6.

Department of Rheumatology, Sifa University, Izmir, Turkey.

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterised by erosive arthritis. Sarcoidosis is a chronic disease characterised by formation of non-calcified granulomas. Our case, a 35-year-old woman, presented with metacarpophalangeal, proximal interphalangeal (PİP) joints and arthritis of both ankles, of 6-month duration. She had morning stiffness lasting 1 h, restriction of range of motion and erythaema nodosum. Laboratory tests showed elevated acute phase responses and serum ACE levels, and anti-cyclic citrullinated peptide antibody positivity. There was periarticular osteoporosis on her hand and wrist on direct X-rays and hilar lymphadenopathy on her thorax CT. The pathological result of endobronchial ultrasound biopsy showed non-calcified granuloma congruent with sarcoidosis. According to clinical, laboratory and histopathological evaluation, the patient was diagnosed with RA and sarcoidosis. Corticosteroids and methotrexate were started, and on her sixth month of follow-up, her clinical and laboratory findings and lymphadenopathies on CT had regressed. The clinical follow-up continues; the patient appears to be in clinical remission.
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http://dx.doi.org/10.1136/bcr-2014-208803DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4493228PMC
July 2015

Determination of methods used by the neonatal care unit nurses for management of procedural pain in Turkey.

J Pak Med Assoc 2015 May;65(5):526-31

Nurse, RTS Diyaliz Merkezi, Izmir, Turkey.

Objective: To determine the pharmacological and non-pharmacological methods used by neonatal intensive care unit nurses to reduce procedural pain.

Methods: The cross-sectional study was conducted from September 2011 to June 2012 and comprised nurses employed in the paediatric departments, consisting of neonatal intensive care units and newborn units, of 15 hospitals in various cities of Turkey: 8 in Istanbul, 3 in Izmir and two each in Antalya and Edirne. Data was collected using a questionnaire and analysed using SPSS 15.

Results: The mean age of the 486 nurses was 28.19±5.14 years; 316(65%) had bachelor's degrees; 278(57.2%) had nursing experience greater than 6 years; and 322(72.5%) had newborn nursing experience greater than 6 years. Overall, 364(74.9%) nurses used non-pharmacological methods, and 145(29.8%) used pharmacological methods for pain relief. The most commonly used non-pharmacological methods were skin touch 364(75%) and giving a pacifier 269(55.3%). The most commonly used pharmacological methods were paracetamol and ibuprofen by 145(29.8%) nurses. A statistically significant difference was found between the level of education and use of pharmacological and non-pharmacological methods for pain relief (p< 0.05).

Conclusions: Among the nurses in both groups, very little pain management was used for invasive procedures. Educational programmes for pain management in newborns should be arranged to develop an institutional culture. Guidelines for these patients' pain management should also be established.
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May 2015

The prevalence of antinuclear antibodies in patients with sarcoidosis.

Autoimmune Dis 2014 17;2014:351852. Epub 2014 Dec 17.

Department of Orthopedics, Faculty of Medicine, Sifa University, Izmir, Turkey.

Introduction. Sarcoidosis, which is a chronic inflammatory granulomatous disease, can mimic different rheumatologic diseases including connective tissue diseases. Antinuclear antibodies are the markers used for connective tissue diseases. Aim. To determine antinuclear antibody frequency and any possible correlation with clinical and laboratory data in sarcoidosis patients. Material and Method. Forty-two sarcoidosis patients, 45 rheumatoid arthritis patients, and 45 healthy volunteers who were followed up in rheumatology outpatient clinic were included in this study. Demographic, clinical, serological, and radiological data of all patients were recorded. Antinuclear antibodies were determined with indirect immunofluorescent method and 1/100 titration was accepted as positive. The cases that were ANA positive were evaluated with immunoblot method. Results. Average age of the 42 patients (10 males) with sarcoidosis was 45.2 (20-70 years), and average disease duration was 3.5 years. ANA positivity was detected in 12 (28.5%) patients with sarcoidosis (1/100 in 10 patients, 1/320 in two patients), in 19 of RA patients (42.2%), and in two of healthy volunteers in low titer (P < 0.001). In the subgroup analysis made by immunblot test, one patient had anticentromere antibody, one had anti-Ro antibody, one had anti-Scl-70 antibody, one had anti-dsDNA antibody, and eight patients were negative. The two patients who had anticentromere and anti-Scl-70 antibodies had also Sjögren's syndrome and scleroderma diagnosis, respectively. Discussion. The prevalence of ANA in patients with sarcoidosis was found to be significantly higher than healthy control group and lower than RA patients. This result shows that ANA may have an important role in the pathogenesis of sarcoidosis and also could be important in revealing the overlap syndromes of sarcoidosis-connective tissue diseases. Further studies with larger series are necessary in this subject.
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http://dx.doi.org/10.1155/2014/351852DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4281448PMC
January 2015

Severe candida laryngitis in a patient with rheumatoid arthritis treated with adalimumab.

Eur J Rheumatol 2014 Dec 1;1(4):167-169. Epub 2014 Dec 1.

Department of Dermatology, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale, Turkey.

Rheumatoid arthritis is a chronic erosive rheumatic disease that can present with polyarticular involvement. Anti-TNF-alpha drugs are used in cases that are resistant to traditional disease-modifying antirheumatic drugs (DMARDs). Anti-TNF-alpha drugs are groundbreaking drugs, the efficacy of which has been proven in the treatment of rheumatoid arthritis. However, the data concerning safety remain limited and contradictory. The risk of tuberculosis reactivation, various infections, as well as lymphoproliferative disease and/or secondary malignancy is a matter of discussion. In this report, we report a 52-year-old male patient using adalimumab for active rheumatoid arthritis who presented to our polyclinic with generalized mouth and throat sores, hoarseness, and swallowing difficulty. Candida laryngitis was detected in the laryngoscopy and culture samples. Adalimumab was discontinued, and the infection was controlled with anti-fungal treatment.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5042250PMC
http://dx.doi.org/10.5152/eurjrheumatol.2014.140001DOI Listing
December 2014

Digital vasculitis in a patient with rheumatoid arthritis responded well to adalimumab.

Case Rep Rheumatol 2014 15;2014:416825. Epub 2014 Jul 15.

Department of Orthopedics, Faculty of Medicine, Sifa University, Turkey.

42-year-old old female patient, followed up with diagnosis of rheumatoid arthritis for 15 years, was admitted with necrotising ulcer of left hand 1st and 2nd fingertips and pain, swelling, limitation of movement, and morning stiffness at bilateral wrist, and metacarpophalangeal and proximal interphalangeal joints. Laboratory tests revealed elevated acute phase reactants. Radial and ulnar arteries were clear in upper extremity Doppler ultrasound. The patient was diagnosed as RA activation and digital ulcer and administered iloprost infusion for five days and 1 mg/kg corticosteroid and 20 mg/week methotrexate (MTX). After one month, a partial regression of clinical and laboratory findings was observed. However, 6 months later, due to relapsed and increased complaints and findings, adalimumab 40 mg was administered. Two months later, clinical and laboratory findings apparently decreased.
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http://dx.doi.org/10.1155/2014/416825DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4123564PMC
August 2014

Leukocytoclastic vasculitis in a patient with ankylosing spondylitis.

Case Rep Rheumatol 2014 5;2014:653837. Epub 2014 Feb 5.

Department of Rheumatology, Faculty of Medicine, Sifa University, Bornova, 35100 Izmir, Turkey.

A 26-year-old male patient presented to our rheumatology clinic with pain, swelling and limitation of movement in his right ankle, and also purpuric skin lesions in the lower extremity pretibial region. He was asked questions, and he said that he had been having chronic low back pain and morning stiffness for the last few years. His physical examination revealed that he had arthritis in his right ankle, purpuric skin lesions in pretibial regions of both legs, and bilateral FABERE/FADIR positivity. The sacroiliac joint imaging and MRI revealed bilateral sacroiliitis findings, and the lateral heel imaging revealed enthesitis. HLA-B27 was positive. Skin biopsy from lower skin lesions was reported to be consistent with leukocytoclastic vasculitis. Based on clinical, laboratory, radiological, and pathological examinations, the patient was diagnosed with ankylosing spondylitis and leukocytoclastic vasculitis. Administration of corticosteroid, salazopyrin, and nonsteroid anti-inflammatory medications was started. Notable clinical and laboratory regression was observed during his checks 3 months later.
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http://dx.doi.org/10.1155/2014/653837DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3933523PMC
March 2014

Ghrelin and adipokines as circulating markers of disease activity in patients with Takayasu arteritis.

Arthritis Res Ther 2012 Dec 21;14(6):R272. Epub 2012 Dec 21.

Introduction: The current markers of disease activity in Takayasu arteritis (TA) are insufficient for proper assessment. We investigated circulating levels of unacylated and acylated ghrelin, leptin and adiponectin and their relationships with disease activity in patients with TA.

Methods: This study included 31 patients with TA and 32 sex-, age- and body mass index-matched healthy controls. Disease activity was assessed in TA patients using various tools, including Kerr's criteria, disease extent index-Takayasu, physician's global assessment, radiological parameters, and laboratory markers. Plasma unacylated and acylated ghrelin, and serum leptin and adiponectin levels were measured using an enzyme-linked immunosorbent assay.

Results: Unacylated and acylated ghrelin levels were found to be significantly lower in TA patients than that in healthy controls. Patients with active disease had lower unacylated ghrelin levels than those with inactive disease and had lower acylated ghrelin levels than healthy controls. Ghrelin levels were negatively correlated with various parameters of disease activity. The leptin/ghrelin ratio was significantly higher in TA patients than controls. It was positively correlated with disease activity. There was a positive correlation between unacylated and acylated ghrelin and a negative correlation between leptin and ghrelin. There was no statistical difference in adiponectin levels between TA patients and controls. The radiological activity markers were positively correlated with other parameters of disease activity.

Conclusions: This study suggests that plasma unacylated and acylated ghrelin levels may be useful in monitoring disease activity and planning treatment strategies for patients with TA. The serum leptin level and leptin/ghrelin ratio may also be used to help assess the disease activity.
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http://dx.doi.org/10.1186/ar4120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674588PMC
December 2012

Reliability and validity of Turkish versions of the child, parent and staff cancer fatigue scales.

Asian Pac J Cancer Prev 2012 ;13(7):3135-41

Pediatric Nursing Department, Ege University Faculty of Nursing, Bornova, Izmir, Turkey.

This study was designed to adapt the Turkish versions of scales to evaluate fatigue in children with cancer from the perspectives of the children, parents and staff. The objective of this study was to validate "Child Fatigue Scale-24 hours" (CFS-24 hours), "Parent Fatigue Scale-24 hours" (PFS-24 hours) and "Staff Fatigue Scale-24 hours" (SFS-24 hours) for use in Turkish clinical research settings. Translation of the scales into Turkish and validity and reliability tests were performed. The validity of the translated scales was assessed with language validity and content validity. The reliability of the translated scales was assessed with internal consistency. The scales were evaluated by considering the following: calculation of the Cronbach alpha coefficient for parallel form reliability with 52 pediatric cancer patients, 86 parents and 43 nurses. The internal consistency was estimated as 0.88 for the Child Fatigue Scale-24 hours, 0.77 for the Parent Fatigue Scale-24 hours, and 0.72 for the Staff Fatigue Scale-24 hours (Cronbach's α). The Turkish version of the Child Fatigue Scale-24 hours, the Parent Fatigue Scale-24 hours and the Staff Fatigue Scale-24 hours were judged reliable and valid instruments to assess fatigue in children and showed good psychometric properties. These scales should assist in understanding to what extent initiatives can minimize or eliminate fatigue. Our scales are recommended for further studies and use in pediatric oncology clinics as routine measurements and nursing initiatives should be planned accordingly.
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June 2013

Health professionals' estimation of cancer-related fatigue in children.

J Pediatr Oncol Nurs 2010 Nov-Dec;27(6):330-7

Pediatric Oncology Department and Pediatric BMT Center, Ege University School of Medicine, Bornova, Izmir, Turkey.

Many studies show that cancer-related fatigue is one of the most common symptoms experienced by children as a side effect of cancer therapy. This problem has grown considerably in recent years; the exact mechanisms underlying fatigue remain unclear. Therefore, assessing and managing this symptom can be problematic. This article describes the findings from a survey evaluating how health professionals (n = 56) at the Pediatric Oncology Centers in Izmir currently define and assess cancer-related fatigue. The results demonstrate that while the problems associated with fatigue are acknowledged, assessment tools are not widely used, and the majority of health professionals report that they would benefit from further education on the subject to assist in the care of patients.
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http://dx.doi.org/10.1177/1043454210377176DOI Listing
February 2011

Sexual activity, knowledge and contraceptive usage by gender among university students in Turkey.

Eur J Contracept Reprod Health Care 2010 Dec 27;15(6):433-40. Epub 2010 Sep 27.

Department of Paediatric Nursing, Ege University School of Nursing, Bornova, Izmir, Turkey.

Objective: To assess sexual activity and contraceptive knowledge and practice by gender among university students.

Methods: Descriptive and cross-sectional study conducted at Ege University, Turkey, with 1000 volunteering students. Data collection was stopped when 500 students of each gender had participated.

Results: Of the surveyed students, 50.3% (27.4% female, 73.2% male) reported having had sexual intercourse; the mean age at first sexual intercourse was 18.4 years for girls and 16.9 years for boys. We found that 44.5% of female and 30.6% of male students failed to use contraception at their first coitus, whereas 2.2% of female and 13.7% of male students failed to do so at their most recent intercourse. The rate of condom usage for students' first sexual encounter was 50.1% (35.8% female, 55.5% male) and was 67.8% (70.1% female, 66.9% male) at their most recent intercourse. Abortion was mentioned by 43.9% of female and 39.2% of male students as a method of preventing pregnancy after unprotected coitus.

Conclusion: Male Turkish students had started sexual relations at a younger age but had less often unprotected first sex than female students.
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http://dx.doi.org/10.3109/13625187.2010.515045DOI Listing
December 2010

[Intussusception in adults].

Ulus Travma Acil Cerrahi Derg 2009 Mar;15(2):154-8

Department of General Surgery, Dicle University Faculty of Medicine, Diyarbakir, Turkey.

Background: Adult intussusception is an unusual entity, and its etiology differs from that in pediatric patients. The purpose of this study was to determine the causes and management of intussusception in adults.

Methods: A retrospective review of patients with a diagnosis of gastrointestinal intussusception between 1986 and 2006 was conducted. All patients under the age of 18 and cases with rectal, ostomy, or gastroenterostomy prolapse were excluded.

Results: There were 28 cases of adult intussusception. Mean age was 38.6+/-16.7 years. A preoperative diagnosis of intussusception was made in 53.5% of the cases. There were 23 enteric, three colonic and two ileocolic intussusceptions. A lead point was identified in 25 patients (89.3%). Invagination was due to benign causes in 19 patients, malignant causes in six patients and idiopathic in three patients. Complication was seen in three (10.3%) cases.

Conclusion: In this series, the mean age of the patients was younger than in the literature. Since intussusception was due to small bowel pathologies, the proportion of benign/malignant lesions favored benign lesions. Although it is encountered rarely in adults, physicians should be aware of invagination and consider it in each case of acute abdomen because of the wide spectrum of the clinical settings.
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March 2009

Acute appendicitis in pregnancy--risk factors associated with principal outcomes: a case control study.

Int J Surg 2007 Jun 21;5(3):192-7. Epub 2006 Jun 21.

Department of Surgery, Faculty of Medicine, University of Dicle, Diyarbakir, Turkey.

Background: The aim of this study was to determine the risk factors associated with the principal outcomes in acute appendicitis during pregnancy: appendix-perforation, and maternal and fetal mortality and maternal morbidity.

Methods: Fifty-two pregnant women who were diagnosed and operated upon acute appendicitis in Dicle University Hospital, Diyarbakir, Turkey were presented.

Results: The frequency of appendicitis was higher in second trimester. On laparotomy 21 patients had perforated, 29 patients had non-perforated and 2 patients had normal appendix. Interval between symptom onset and operation was found as the only predictive variable, which was independently associated with the presence of appendiceal perforation. There was a significant difference between perforated and non-perforated patients about the rate of complications (52% vs. 17%). Gestational age (p=0.036), interval between symptom onset and operation (p=0.018) and white blood cell count (p=0.025) were the variables related with preterm labor. Tocolytic treatment after the onset of contractions could not prevent preterm labor. The rate of fetal mortality was 8%.

Conclusions: Presence of perforation is the only predictive factor for maternal morbidity. The aim of the surgeon should be operating the patient before perforation. An observation period may be essential in equivocal patients, but should be individualized according to duration of symptoms and findings of physical examination. The interval between the symptom onset and operation should never exceed 20 hours. Tocolytics should be ordered for the patients with delayed presentation and advanced gestational age in order to prevent preterm labor and fetal loss.
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http://dx.doi.org/10.1016/j.ijsu.2006.05.005DOI Listing
June 2007

Micronized purified flavonoid fraction may prevent formation of intraperitoneal adhesions in rats.

Fertil Steril 2005 Oct;84 Suppl 2:1083-8

Department of General Surgery, Faculty of Medicine, University of Dicle, Diyarbakir, Turkey.

Objective: To evaluate the efficacy of an anti-inflammatory and capillary regulator drug, micronized purified flavonoid fraction (MPFF), in the prevention of postoperative formation of adhesions.

Design: A double-blind, controlled study evaluated the efficacy of MPFF in reducing postoperative adhesion formation in a rat model.

Setting: Animal care facility of an academic research setting.

Animal(s): Thirty Sprague-Dawley female rats randomly divided into three groups.

Intervention(s): Starting on day of surgery, group 2 rats received oral MPFF (100 mg/kg per day for 7 days). Group 3 rats were intraperitoneally injected with 5 mL of saline (containing 200 mg/kg per day of MPFF for 3 days). Control rats received no medication. A standardized surgical trauma was applied in all animals. Three weeks after surgery, the rats were killed, and the adhesions were scored according to macroscopic and microscopic scales.

Main Outcome Measure(s): Postoperative adhesions.

Result(s): Both oral and intraperitoneal administration of MPFF reduced the scores of adhesions according to macroscopic and microscopic scales. There was no difference between the routes of administration.

Conclusion(s): A statistically significant reduction in postoperative formation of adhesions was observed after oral and intraperitoneal administration of MPFF in our experimental animal model. However, further studies are required to reveal its mechanism of action.
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http://dx.doi.org/10.1016/j.fertnstert.2005.03.076DOI Listing
October 2005

The nature and origin of intraocular metallic foreign bodies appearing after phacoemulsification.

Ophthalmologica 2003 May-Jun;217(3):212-4

Ophthalmology Department, Ege University School of Medicine, Bornova Izmir, Turkey.

In order to evaluate the nature and origin of metallic foreign bodies embedded in the iris after uneventful phacoemulsification, we aimed to produce metallic fragments by applying ultrasound power with the same phaco machine and handpiece in an experimental model in vitro. In a glass bottle, we used linear phaco power of 100% continuously for 5 min first with a new phaco tip and then with a used tip. Afterwards, the fluid in the bottle was filtered through a Millipore filter. The remains on the filter were studied by scanning electron microscopy (SEM) and microprobe. Small particles remained on the filter which was used for the new tip. Microprobe microanalysis showed that these particles were mainly titanium, the same as the phaco tip. SEM of both the new and the used tips showed small fragments on the exterior surface and lumen. Intraocular metallic foreign bodies after phacoemulsification are likely to be shaken loose from the phaco tip. Although it is mostly agreed that these fragments are well tolerated, their overall effect remains to be evaluated in the long term.
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http://dx.doi.org/10.1159/000068979DOI Listing
May 2003