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Öğe Does AHI Value Enough for Evaluating the Obstructive Sleep Apnea Severity?(Springer India, 2015) Dundar, Yusuf; Saylam, Guleser; Tatar, Emel Cadalh; Ozdek, Ali; Korkmaz, Hakan; Firat, Hikmet; Ardic, SadikObstructive sleep apnea/hypopnea syndrome (OSAHS) is an important and more common public health problem with increasing incidence. Polysomonography (PSG) is the gold standard test in OSAHS diagnosis. Apnea-hypopnea index (AHI) is the main parameter of PSG, which is correlated with OSAHS severity. The main complaint of OSAHS patients is daytime sleepiness and the Epworth Sleepiness Scale (ESS) used for evaluation of disease severity. The correlation of AHI with daytime sleepiness and ESS is well known. But there are many patients, which have uncorrelated daytime sleepiness with AHI. This data calls this hypothesis; Are there any other parameters which may affect daytime sleepiness. 648 patients with complaining of snoring and apnea were evaluated by polysomnography and anthropometric measurements. The cut-off value of ESS was accepted 10 as an indicator of severe daytime sleepiness. Patients were divided to groups with the aim of homogenization, according to AHI values. The patients with similar AHI values were analyzed according to their ESS scores. BMI and neck circumference were elevated in daytime sleepiness patients. The nocturnal hypoxemia markers; apnea number/index, maximum duration of apnea, at least SO2 concentration, duration of SO2 less than 90 % were much effected in the group of daytime sleepiness. Beside the fact that our research, AHI is not enough for predicting the daytime sleepiness; anthropometric measurements and the nocturnal hypoxemia markers should be evaluated.Öğe Does Diffusion-Weighted MR Imaging Change the Follow-Up Strategy in Cases with Residual Cholesteatoma?(Aves, 2015) Dundar, Yusuf; Akcan, Fatih Alper; Dilli, Alper; Tatar, Emel; Korkmaz, Hakan; Ozdek, AliOBJECTIVE: To analyze the effectiveness of diffusion-weighted magnetic resonance imaging (DW-MRI) in the evaluation of recurrent cholesteatomas. MATERIALS and METHODS: Twenty-three patients undergoing second-look surgery were included in our study. There were 14 men and 9 women with ages ranging from 10 to 50. All patients underwent DW-MRI prior to second-look surgery. All magnetic resonance imaging (MRI) examinations were performed with a 1.5-T MRI unit using a standard 8-channel neurovascular coil. DW-MRI and apparent diffusion coefficient maps were included in the examination. Cholesteatoma was diagnosed on the DW-MRI as a marked hyperintense signal in comparison with brain tissue. All cases were classified as positive or negative. RESULTS: The sensitivity and specificity of DW-MRI were 86% and 87%, respectively. The positive predictive value of DW-MRI was 92%, while the negative predictive value was 77%. CONCLUSION: The DW-MRI technique is an important and effective technique in the evaluation of residual cholesteatoma. It can be an alternative method to second-look surgery, which can spare patients repeat operations.Öğe The evaluation of inflammatory process, endothelial dysfunction and oxidative stress in sleep apnea(Deomed Publ, Istanbul, 2014) Dundar, Yusuf; Tatar, Emel Cadalli; Saylam, Guleser; Korkmaz, Hakan; Selcuk, Omer Tarik; Ozdek, Ali; Ardic, SadikObjective: To investigate the correlation of inflammatory process, endothelial dysfunction and oxidative stress with obstructive sleep apnea (OSA). Methods: In our prospective cross-sectional clinical study in a tertiary referral hospital, we evaluated 63 patients with newly diagnosed OSA and 9 simple snorers. Each patient was evaluated in terms of additional systemic diseases and laboratory tests. In addition to routine blood analysis; oxidative stress markers (leptine, RBP), vascular endothelial markers (ICAM-I, VCAM-I) and inflammatory markers (Crp, IL-6, TNF-alpha, isoprostane) were analyzed. Polysomnography test was performed and study population was divided into four groups depending on their AHI values. The levels of markers were analyzed and compared between the four groups. Results: There was a weak correlation between the isoprostane levels and mean apnea duration and also a mild correlation to the maximum apnea duration. A weak correlation was detected between leptine and VCAM levels to age and also a weak negative correlation was detected between CRP levels to age. The leptin levels were found to be mildly correlated to BMI and abdominal circumference. The ICAM levels were found to have a weak correlation to BMI and abdominal circumference. Conclusion: Our results indicate a correlation between sleep apnea and oxidative stress. These results may help to explain the association of comorbid diseases with OSAS. Further investigators should aim to explain key steps of inflammatory response in sleep apnea.Öğe A life-saving approach to trachea-innominate artery fistula: endovascular stent(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2014) Korkmaz, Hakan; Yildirim, Utku Mahir; Dundar, Yusuf; Tatar, Emel Cadalli; Saylam, Guleser; Ozdek, AliTracheo-innominate artery fistula is a devastating complication of tracheal operations. It is most commonly seen after tracheotomy and mostly in the postoperative 7th to 14th days. Despite all radical therapeutic interventions, survival rate of this emergency condition is very poor. In this article, we report a 24-year-old male case with trachea-innominate artery fistula after endotracheal titanium stent removal. This complication was successfully managed with an endovascular stent. Sternotomy and innominate artery ligation is the main emergency procedure, however, endovascular stent deployment can be an alternative procedure in hemodynamically stable patients with better results.
