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Battery-Operated Solution for Low-Back Pain

Battery-Operated Solution for Low-Back Pain

04 July 2014

Most of people complain about low-back and neck pain troubles. Especially one group of them could not be recovered from the pain although they had many herniated disk surgery. Assoc. Prof. Dr. Kader Keskinbora, Liv Hospital Algologist, who explains that battery for back bone pain could be a remedy, says, “ Some patients are not be recovered from the pain although they had many low-back and neck surgery. If treatments intended the pain, physiotherapy, some therapeutic approaches like medication etc. don’t help these patients; the therapeutic approach needed to be applied, is spinal cord stimulation, in other words battery-operated for backbone pain. In this approach, an electrode is implanted to spinal canal of the patient and its end is connected to a generator (pain battery) produces flow. Transmission of the pain to the brain is blocked by transmitting the flow, produced by the battery, to spinal cord with electrode. Patients can control their low-back and neck pain by activating the battery.

 

Depression could be the reason to low-back and neck pain

The pain originating from backbone is felt in mostly lumbar region, and also in the neck and back region. This pain can last in the level of medium intensity over the years according as it can begin in the level of sudden intensity (it can be felt within the last six weeks). The pain in the low-back and neck can be result of mostly muscle spasm in these regions, calcification of various joints (facet joint) and herniation of the disk. This pain could arise without any reason according as it starts after any activity or trauma. Especially the people, who have weak low-back and stomach muscles due to the spiritual and emotional tension, inactive work and life-style, have more risk for the low-back and neck pain. If the the stubborn low-back and neck pain, which was started suddenly or lasted for long time, doesn’t recover although physiotherapy was applied, or if surgical intervention wasn’t found necessary, interventional pain treatment options become the main topic of conversation. Injection (cortisone) and radiofrequency treatment can be applied to facet joint causing the pain in the low-back and neck region or to the nerve root affected by herniation. Recently, radiofrequency treatment (application of pulsed radiofrequency flow) applied to nerve root in the low-back and neck is accepted most effective than injection treatment, and it enables outlasting (minimum 2 years) pain cure and it is preferred with the reason of not causing tissue damage.

 

The pain is brought under control with battery

Other important patient group is the patients that had many low-back and neck surgery but still suffering from the pain. After the surgery of herniated disk and cervical disc hernia, in some patient leg and low-back pain is felt intensively depending on some bonds on spinal canal. These patients have to have surgery over and over again after herniated disk surgery upon their pain didn’t recover. Every herniated disk surgery could cause new bond and afterwards the pain. If treatments intended the pain, physiotherapy, some therapeutic approaches like medication etc. don’t help these patients; the therapeutic approach needed to be applied, is spinal cord stimulation. In this approach also named as spinal pain battery, an electrode is implanted to spinal canal of the patient and its end is connected to a generator (pain battery) produces flow. Transmission of the pain to the brain is blocked by transmitting the flow, produced by the battery, to spinal cord with electrode. Patients can control their low-back and neck pain with this impelling approach by activating the battery.

Brain Surgery Not Scaring Anymore!

Brain Surgery Not Scaring Anymore!

03 June 2016

Brain surgeries are performed more easily at Liv Hospital where the experience and technology meet. By use of Fluorescence Guided Method, the tumors difficult to be accessed can easily be removed.

Fluorescence guided surgery is the brain tumour surgery performed with the guidance of fluorescent. Normally tumours developped in brain tissue, some metastases and tumours like lymphoma may not exactly be distinguished from the brain tissue during the surgery.  Prof. Dr. Talat Kırış,  the Brain and Nerve Surgeon of Liv Hospital Istanbul emphasizes that if the tumour is in depth, we need cover a distance to access it and there is a risk of harming the normal brain tissue if the direction to be followed in this course deviates. But Fluorescence Guided Surgery and Navigation eliminates this problem.

 

IT GUIDES THE OPERATION

This method used in treating malign brain tumours and lymphoma can also be used in metastatic tumours.

“In the Fluorescence guided surgery, a drug is administered after the skull is opened during the operation. This is a drug used by the ophthalmologists in ophthalmic angiography for years. With this drug retained by the tumor, you can see the entire tumour tissue which is different from the health brain tissue in yollow colour. These tissues which are normally off-white is seen in different colour when we attach a yellow filter to our microscope. Brain tissue get pinker and tumour tissue yellower", says Prof.Dr. Talat Kırış.

 

HOW DEEP THE TUMOUR IS LOCATED IS NOT A PROBLEM ANYMORE

The advantage of the fluorescence guided method is that the tumour can easily be accessed no matter how deep it is located. Once the tumour is accessed in the brain, the yellow-coloured parts are removed. When these parts are cleared away, the urruounding brain tissue can be seen. This method allows for the complete removal of the tumour and the damage to the healthy brain tissue can be minimized.  

Bypass or Stent?

Bypass or Stent?

24 December 2014

A major reason for cardiac diseases is the occlusions in the coronary arteries. The advantages and disadvantages of the soluble stent and coronary bypass methods, both used in the treatment of occlusions in the coronary arteries should be known.

A major reason for cardiac diseases is the narrowing occurred in the coronary arteries. When this narrowing in the artery becomes an occlusion, heart attack occurs. There are two methods currently used to eliminate these occlusions in the arteries and to treat the arteries before having myocardial infarction. One of them is to insert stent into the coronary arteries while the other is coronary bypass surgery.

Ass. Prof. Dr. Oğuz Taşdemir, Cardiovascular Surgeon of Liv Hospital Ankara gives information on the stent and bypass methods indicating that about five million people died of heart diseases in Turkey last year.

 

 

 

Avoid heart attack and associated death

 

It is estimated that mortality from the heart diseases will increase above 15 million by 2030. The heart's pumping function becomes disrupted as a result of narrowing of the coronary arteries of the heart. When applied to the right patient by the right hands, the stent and bypass methods used in treating the coronary bypass diseases are the treatment options avoiding heart attack and related mortality.

 

Coronary Bypass

 

Coronary bypass is the procedure of diverting the flow of blood around a section of a blocked artery in your heart. In the coronary bypass surgery, the vein in the leg called saphena or the arteries located under the arteries or arteries taken from arm. Through these vessels, blood is sent to the parts of the heart which cannot receive sufficient blood. Coronary bypass surgery has been applied throughout the world for years. Crucial developments have been experienced in this surgical method. Today, diseases groups including some other heart diseases along with the coronary artery disease and very old patients can be successfully treated.  

 

Case-specific operation

 

The studies have found out that the comparisons made between the patients treated with stent and those treated with bypass showed that the surgical operation gives better results in terms of the life expectancy and complications of the risky patients having multiple diseased arteries of risky multiple. Every passing day, stent is applied to increasing number of patients before coronary bypass operation. The surgical operation, which is mostly performed in a safer manner, may be risky after a stent applied. In many patient having coronary artery disease, who had a stent, the surgical operation is considered when the chest pan recurs. The chance of success of the coronary bypass operation is lower after a stent has been applied. It is suggested that the heart underperforms when the surgical operation is applied on the patients in the group of patients to whom stent has been applied previously and who have pumping function weakened. It is asserted that stent application is a risk factor for this type of patient.  

Sometimes, stents cause deformation in the vessel wall. Stents may also obstruct small auxiliary vessels. Now, in the light of all this information, should we employ stent or surgical operation method? Will we give up stent? No. The procedure a patient will undergo should be discussed and decided best by the heart surgeon, cardiologist and patient together. Thus, the healthiest decision can be made.

 

Changing Life-Style in the Chemotherapy Minimizes the Side Effects

Changing Life-Style in the Chemotherapy Minimizes the Side Effects

01 April 2015

The side of chemotherapy can minimized thanks to the modern chemotherapy technique and physician recommendations. Eliminating the side effects caused by this therapy and maintaining high quality of life during the treatment increases the success of the treatment improving the compliance of the patient to the therapy. Ass. Prof. Dr. Gökhan Erdem, the Medical Oncologist of Liv Hospital Ankara, points out that the patients and patient relatives should be informed the side effects associated with the disease and its treatment. “In chemotherapy, lack of information causes more negative effects than thought and reduces the compliance to the therapy. Information should not be one off but considered an integral part of the process during the entire treatment. Furthermore, this is very important for not only the patient but also patient relatives particularly those taking part in the care of the patient. If the patient is well informed about what he/she is faced with and how to fight with it, everyone's work will be simplified," says Ass. Prof. Dr. Gökhan Erdem. Ass. Prof. Dr. Gökhan Erdem gave tips for minimising the side effects of chemotherapy.

  • Frequently wash your hands with anti-bacterial soap.

 

  • Try to keep away from infectious diseases.

 

  • Eat well and balanced.

 

  • Move on your social life.

 

  • Quit smoking and drinking alcohol.

 

  • Comply with the exercise program advised by your physician to avoid loss of muscle.

 

  • Start the day with a light breakfast on the days when you will receive chemotherapy.

 

  • Drink plenty of water.

 

  • A good communication with your physician responsible for your treatment will ensure a comfortable process of therapy. 

End to Fear of Endoscopy by taking a capsule

End to Fear of Endoscopy by taking a capsule

12 April 2013
What is video capsule endoscopy?

Our digestive system is in the form of long tube starting in the mouth and ending in anus. We can examine the oesophagus, stomach and the first part of small intestine by "upper digestive system endoscopy" and the large intestines by lower digestive system endoscopy called colonoscopy. However, the part of small intestine in between the upper and lower digestive system has diseases specific to it and there are methods for the direct examination of this part (double balloon enteroscopy). However, this type of endoscopic examinations is technically quite difficult methods, which is difficult to be adapted by the patient having a limited area of application. Video Capsule Endoscopy is the name given to the examination carried out by an pill-size electronic device (of 1.2 cm) having an front optic camera capable of taking 2 to 3 photos per second of the middle and lower parts of the small intestine, which are unable to be examined by the existing standard endoscopic methods, in the digestive system . About 60 thousand photos taken for an average period of 8 to 12 hours depending on the specifications of the device used are recorded by a data recorder being hanged on the waist of the patient by a hanger in the form of a belt. Upon the careful examination of the recorded photos in electronic environment for a period of 1 to 2 hours, a report is prepared.

For the diagnosis of which diseases is VCE used?

It is used for detecting the bleeding of unknown origin in digestive system, the inflammatory and tumoral diseases affecting the small intestines, polyps, celiac diseases and other small intestine diseases having a course with malabsorption.

For which conditions is it unsuitable?

The primary conditions for which VCE is not suitable are the diseases having course with intestinal obstruction (obstructive or restrictive tumors and inflammatory conditions). This is because the capsule swallow is stuck in this area and cannot be eliminated from digestive system.

What are the advantages and disadvantages of VCE?

The major advantage of it is that it is a method well -tolerable by patient. Besides, it has high sensitivity in diagnosing and the undesired side effects are little if any in the patient selected as eligible for this procedure. The only disadvantage is that it is just a diagnostic but not therapeutic method.

How is VCE applied?

Liquid food should be shifted to and a low dose of cathartical drug taken on the day before when the capsule endoscopy will be performed to improve the image quality. Patient comes to the clinic after a fasting period of 12 hours. The recording electrodes of the capsule endoscopy system are adhered to the abdominal area and the capsule is given to the patient to be swallowed by him/her. Patient can take liquid clear food 2 hours later and then a light meal 4 hours later. Following a recording of about 12 hours, the patient brings the device system on him/her back to the hospital and the records taken are examined by the physician, who will, in turn, prepare a report. The patient can move on with the capsule system on him but she/he should not avoid from heavy exercise and keep away from magnetic environments in order not to affect the recording system (i.e, she/he may not have a MRI and she/he is advised nıt to pass through the security scanners).

False Facts Known to be True About Herniated Disk In Lower Back

False Facts Known to be True About Herniated Disk In Lower Back

25 August 2014

Eight out of 10 person has herniated Disk In Lower Back, which is a frequent health problem in society. Dr. Hilal Yıldız, the Physical Therapy and Rehabilitation Specialist from Liv Hospital, points out that not every pain in lower back is herniated disc-related, saying "the strain in lower back muscles is caused by the damage to the ligaments connecting the spinal disc and the slipped discs. Therefore everybody has the risk of having herniated disc in the lower back." Spec. Dr. Hilal Yıldız underlines the false facts know not be true about the herniated disc in the lower back.

  • HERNIATED DISC IS DEVELOPED IN THOSE LIFTING HEAVY OBJECTS FALSE  

 

Lifting heavy objects is a risk factor. This is because increased pressure occurs in the certain parts of the lumbar spine in your uncontrolled lift of heavy objects. This leads to displacement and prolapse of the nucleus, which cannot stand the pressure. But herniated disc may be seen in the individuals remaining seated.

 

  • THOSE HAVING HERNIATED DISC SHOULD LIE ON FIRM SURFACE FALSE

In fact, very hard firm surface may be uncomfortable for spine. A half-firm orthopedic mattress is ideal for those who have herniated disc. However, during the painful period, attention should be paid to lying position.
 

  • CONSTANT USE OF CORSET IS NECESSARY AFTER THE HERNIATED DISC SURGERY. FALSE
     

Corset weakens the lumbar muscles since it undertakes the functions of such muscles. What is ideal is that the lumbar muscles are strong. However during the periods of heavy pain in muscles such as standing for long hours, travelling etc, corset may be used for not more than two weeks


 

  • IT NEEDS A COMPLETE BED REST WITHOUT STANDING UP EXCEPT FOR GOING TO BATHROOM. FALSE

The patient may stand up even immediately after the surgery. Within month of the surgery, it is advised to avoid the movements excessively straining the lower back, bending forward and backward, turning or sitting down for prolonged periods of time. Movements and exercises are gradually moved on. The patient may get back to his/her daily life in a short period of time. 
 

  • THE RISK OF REMAINING PARALYSED IS HIGH IN HERNIATED DISC SURGERY. FALSE

Today, there are many different methods of surgery. We rarely witness the case of remaining paralysed.   It is advised that anyone whose disease is advanced to a level requiring surgery undergo the surgery with mind at peace. What is important is to assess if the patient really needs to have an operation. 
 

  • EXERCISING AVOIDS HERNIATED DISC FALSE

 

A reason for herniated disc is to sit down for prolonged periods of time and stay inactive. The body weight loads on the lower parts and the disc is loaded more than it can carry. Exercise is essential to have strong muscles. Doing regular exercises such as swimming, pilates and yoga strengthen all muscles uniformly. And this significantly avoids the herniated disc.

 
Fluorescein Guided Neurosurgery

Fluorescein Guided Neurosurgery

04 February 2016

Brain operations can be carried out more easily at Liv Hospital Istanbul, where experience and technology come into being.

 

BRAIN SURGERIES ARE NO MORE FRIGHTENING! 

Fluorescein-guided surgery implies brain tumor surgery that is carried out with guidance of fluorescein imaging. Tumors originating from brain tissue, some metastases and tumors, such as lymphoma, may not be clearly distinguished from intact brain tissue during operation. Prof. Talat Kırış, M.D., Neurosurgeon of Liv Hospital Istanbul, emphasizes that intact brain tissue can be damaged if access route deviates, as a particular distance should be covered to expose tumor at deep localization. However, fluorescein-guided surgery and navigation helps coping with this problem. 

IT GUIDES THE OPERATION

This method is not only used in treatment of malignant brain tumors and lymphoma, but also in management of metastatic tumors. 
"In fluorescein-guided surgery, a drug is administered after skull is intraoperatively opened" says Prof. Talat Kırış. “This drug has been long used by ophthalmologists for eye angiography. Tumor tissue is stained yellow with this drug and thus, healthy brain tissue can be distinguished from tumor. Although both tissues appear whitish with naked eye, they appear in different color when we look through a yellow-color filter, which is integrated to the microscope. Brain tissue appears pinker, while tumor tissue turns into a yellow formation" he added. 

DEPTH OF TUMOR IS NO MORE A PROBLEM.

When we talk about advantage of Fluorescein-guided method, surgeon can easily expose tumor no matter how deep it is located. After tumor is exposed in brain tissue, yellow parts are excised. After such tissues are totally excised, healthy brain tissue is seen. This method not only enables total excision of tumor, but it also minimizes injury to brain tissue. 

Fundamentals of Hair Transplantation in 10 Questions

Fundamentals of Hair Transplantation in 10 Questions

20 November 2013

Hair loss is a condition which is caused by genetic inheritance, hormonal changes, infection, fungus diseases, old age or occurs idiopathically, in other words due to an unknown reason, and cause physical and therefore psychological problems in both women and men. Hair loss may also result from various dermatological diseases, burns and traumatic reasons. Human beings normally loss 80 to 100 strands daily. Loss exceeding such amount is abnormal and needs to be treated. In the cases where the hair loss persists in spite of all treatment applied, the only and exact solution is hair transplantation, which is a surgical method. Dr. Reşat Arpacı, from Liv Hospital, told the fundamental sof hair transplantation.

  1. What is hair transplantation?

It is the surgical procedure that moves the hair follicles from the donor site which is located between two ears and right above the ears and coded not to lose hair, the 'recipient site' which lose hair, by use of suitable techniques.

  1. What are the hair transplantation methods?

Follicular Unit Transplantation (FUT)

In this method, the hairy skin removed from the healthy and non-hair losing site on the back of the neck is divided into follicular units containing 1 to 4 hairs in their natural groupings by use of very small micro blades under the microscope by means of suitable techniques and transplanted in the thinning or balded areas. The site from which the follicles are removed on the back of the head is suitably sutured. At the stage of transplantation of the follicular units prepared, the pattern, hair line to be applied, compliance with the growing direction of the existing hairs can only be designed by an specialist having an experience of long years. This method has gradually been left after the introduction of FUE method in 2004.

Follicular Unit Extraction (FUT)

This method is based on the removal of individual hairs together with their follicles without incision. Therefore, there is no need for suture. With this technique which is easier and more comfortable, today it has become possible to transplant 4000 grafts which means 9000 to 10000 hairs in a single session in a recognized hospitals and clinics.

  1. How long does this procedure takes?

Hair transplantation is a procedure taking about 4 to 6 hours depending upon the size of the recipient site, hair and skin structure, and the technique to be used.

  1. Is it a painful procedure?

Hair transplantation is a procedure in which you feel no pain since it is performed under local anaesthesia.

  1. Do the transplanted hairs really grow?  If yes, when?

Yes, they really grow. Preparation of grafts (groupings of hair), the conditions under which they are kept waiting and the use of right technique are the factors affecting the results directly, and the procedure has a success rate of 100 percent provided the aforementioned conditions are met. The hair starts growing visibly 3 months after the day of operation. Within 6 months, more than half of the hair has started growing. The completion of the process takes about 1 year.

 

  1. When can I go into public?

There is nothing which make you preclude from going into public after the operation. For the first 2 to 3 days, there will be tiny pink dots seen and then these will gradually become pale and restore within a week. Hair transplantation is not a procedure which restrain one from their daily life.

  1. When can I have a bath? What are the points that I should consider after the operation?

You will be advised of such information in preliminary meeting so as not to leave a question mark, even tiny, over minds. In addition, you will get the answers of many question which do not come to your mind both orally and in writing in a file.

  1. Will the transplanted hair be lost again?

No, it will not. This is because the hairs are removed from a site which is coded not to be lost and carry on this nature in the recipient site.

  1. Is it noticed that I have got a hair transplantation?

The natural appearance of the hair transplantation depends on the re-formation of the original hair line of the person, the right angling of the channels in which the hairs will be transplanted, determination of the density by the site of transplantation and the correct calculation of the growing direction of the hair strands. These condition can be met only by a very experienced physician specialized in hair transplantation.

  1. By whom will this procedure performed? What are their related experiences?

Hair transplantation is performed by medical aestheticians, dermatologists and plastic surgeons in hospitals or surgical medicine centres. However, it should be noted that the healthcare staff other than the physician should also be very experienced.  

 
Get Rid of Haemorrhoids with the Most Recent Treatment

Get Rid of Haemorrhoids with the Most Recent Treatment

23 January 2015

In this day and time, haemorrhoids can be treated quickly and easily in short period of time.   The treatment varies depending upon at which phase this condition is. At early phase, diet and medication may be sufficient. At the middle phase, nonoperative methods such as needle and tying methods are commonly used. At the advanced phase, operation is inevitable.   Haemorrhoid which is called 'piles' in colloquial language is caused by the rich vascular cushions in the anal canal when sagging, swollen or bleeding. Haemorrhoid, which has become a taboo in society and reduces quality of life, is commonly used among women and men. Prof. Dr. Bülent Menteş, General Surgeon of Liv Hospital, Ankara, points out that it is usually too late when the medical care is sought for this condition underlining that one does not have to live with it. Here is the Prof. Dr. Bülent Menteş's answers what is wondered about haemorrhoid.

 

Haemorrhoids are grouped under two categories: internal and external.

The common sign of the internal haemorrhoids is rectal bleeding during bowel movement. No specific pain. If the rectal bleeding is accompanied by a severe pain, another disease apart from or accompanied by haemorrhoid (e.g. anal fissure) should be suspected. In advanced cases, prolapsing masses (piles) and anal mucous discharge or uncomfortable feeling may occur. The external haemorrhoids suddenly swell and cause severe pain by forming blood clot, that'd being thrombosed.

Haemorrhoid is prevalent between the ages of 20 and 40.

It can be seen in every group of age including childhood while it centres around the group of young adults at the age of 20 to 40. The possible causes of it are that the changes in eating and bowel movement habits due to the events such as military service, marriage, relocation etc. occurs in this range of age and that the pregnancy and delivery events which may provoke the haemorrhoidal diseases coincide with this age range.

Foods rich in fibre should be preferred.

Haemorrhoid is known to be associated with wrong, irregular bowel movement and straining. And this condition is basically related to nutrition.  Certain studies shows food rich in fibres is effective in the treatment of haemorrhoid. For a healthy bowel function, it is important to eat for example fruit salad, olive oil and whole-wheat bread for the breakfast , vegetable dish and yogurt for lunch, and a large bowl of lettuce salad seasoned with olive oil for dinner and a small bowl of pumpkin seeds at night and to drink plenty of water. The key here is a daily intake of fibre of 15 to 20 gr. If it is necessary to be increased in some cases, it can be done by adding 1 to 2 tablespoon of bran in soup or yogurt. But a sudden intake of too much fibre does more harm than good. It may cause some problems such as stomach-ache and excessive flatulency.

Surgery becomes inevitable at the advanced phase.

Haemorrhoid treatment should be determined by the type and phase of the haemorrhoid. External haemorrhoids are is easier and simpler to diagnose and treat than internal ones. The external haemorrhoids are not treated unless they pose a problem but when they cause problems (such as formation of blood clot, swelling, pain etc) they may have to simply be excised. The internal haemorrhoids, which are more common, may appear with the vascular cushions in the anal canal when relapsing, swollen or bleeding. Therefore, the treatment should be based on the prevention or elimination of this prolapsed and bleeding. In the early phase of internal haemorrhoids, a comfortable bowel movement by use of a diet rich in fibres, hot water baths and oral medication in the inflammatory periods are usually adequate. In the haemorrhoids of grade 2 or 3, rubber band ligation, laser and sclerotheraphy are the other methods used in addition to the above-mentioned measures. When applied properly, these methods are very short, painless outpatient procedures and aims to re-place the relapsing piles of haemorrhoid. At Grace 4, the most advanced phase, haemorrhoids usually have to be surgically excised.

Do not underestimate haemorrhoids!

The tissue types and mechanisms of development of haemorrhoid and intestinal cancers are totally different and therefore it is not possible that a haemorrhoid becomes cancerous. Particularly, it should always be remembered that there may be an underlying tumour in those who suffer from haemorrhoids. Therefore, if haemorrhoid develops at old ages, one should be more alert on another pathology underlying. The most important thing that should be remembered is that the haemorrhoid may be the tip of the iceberg, which means that more important underlying diseases such as enterocele, intestinal cancer etc should not be missed or haemorrhoid should not be underestimated.

Get Rid of Joint Pains with Your Own Blood

Get Rid of Joint Pains with Your Own Blood

02 March 2017

in in the joints like knees, hips etc, which are curable at the early stages, may become big problems as they advance. Treatment of joint diseases becomes difficult due to the reasons such as the load on the body, deformations cartilage, meniscus and connective tissues and range up to surgical operation and prosthesis. Emphasizing that pain and loss function seriously affect the life comfort, Prof. Dr. Rıdvan Alaca, the Physiotherapist from Liv Hospital Ankara, says that joint pains can be cured by injecting the plasma exracted from the patient's own blood by use of PRP method into the joint.

 The body repairs itself with PRP

The medical studies on the body's repairing itself has significantly increased recently. The healing capability of the damaged joint is limited since it has no blood and lymphatic circulation. PRP both speeds up the process and reduces the pain.  PRP which is abbreviation of "Platelet Rich Plasma” means plasma rich in thrombcytes. Nonsurgical PRP method ensures a quicker healing of tissues and less feeling of pain in all joint problems including knee arthritis, and musculoskeletal system diseases. The fluid used in the treatment is a natural cure since it is prepared from the patient's own blood.

How is it performed?

About 10 ml blood is intravenously taken from the patient into specially-prepared tubes. The blood collected is specially centrifuged in the tube and this process takes 15 minutes. Following centrifugation, the cells of the blood other than thrombocytes settle down to the bottom of the tube. A yellow coloured plasma rich in thrombocytes remains in the surface. Üstte kalan sıvının dip kısmında trombositlerin daha da yoğun olduğu bir bölüme özel sistem sayesinde her milimetre küpünde yaklaşık 1-2  milyon trombosit hücresi olan 3-4 ml plazma enjeksiyonunun uygulanacağı enjektöre çekiliyor. After all these stages, PRP is administered to the desired area by use of appropriate techniques without delay.

It speeds up healing and restoration of the cartilage

PRP increases the release of the repairing and growth factors called cytokins. This increase stimulates the cells in the worn cartilage and thus the synthesis of the substances playing an important role in healing such as proteoglican and collagen and process of restoration of the cartilage speeds up. In PRP method, the yellow coloured plasma fluid rich in throbocytes obtained from blood is administered into the knee joint in the amount of 2 to 4 ml three times with the intervals of 10 to 30 days. Healing starts within a few weeks after the injection and the healing process goes on for 3 to 12 months depending on the degree of wear and tear of the tissue. Unlike the cortisone injections, there is no quick relief of pain after PRP injections. In PRP applications, pain ends wearing off over months. In contrary to cortisone applications, no recurrent complaints are observed after PRP application. PRP is not a pian killer but a treatment method for the damaged joints.

 

 

Head -Neck Cancers

Head -Neck Cancers


Head-neck cancers are the cancers which occur in the most remarkable part of the human body. Even though they are not as frequent as a lung or breast cancer, the distress caused by them in terms of patient and society shows the significance of these cancers. The distress mainly results from the fact that the head and neck area is the most uncontainable part of the human body. For example, it is not likely when in community (e.g, when in the subway, on the bus, street or in the movie etc) to notice that a woman who has lost a breast due to breast cancer or a person who has to live with colostomy (defecation through the opening which is formed by drawing the healthy end of large intestine through an incision in the anterior abdominal wall and suturing it into place) have lost their organs due to cancer. Even though the patient is diseased, they can move on a normal person in community. However, a patient who has lost entire of his throat due to a cancer occurred in head-neck area (e.g., an advanced throat cancer) might have to live with a permanent hole (tracheostomy) in the lower part of his/her neck or problems like inability to speak or make himself/herself understood in the rest of his/her life.   The sputum spilling out of the lungs whenever the patient coughs and inability to speak may cause the patient to excluded or detach himself/herself from the society and thus sink into a great depression.

Throat cancer is not the only condition occurring in head-neck area and resulting such a distress in the patient and community. In addition to throat cancer, a patient who had to lose almost all of his/her jaw due to intraoral cancer developed in the jawbone (mandibula), a patient who had to lose his/her nose or half of his/her face due to paranasal sinus cancer, or a patient who had to lose his/her entire tongue and thus is unable to speak and swallow due to tongue cancer may become alone with problems and difficulties difficult to overcome both in community and his/her inner world.   Examples can be reproduced.   A patient who is unable to swallow and speak and has to live with feeding tube due to pharyngeal cancer, and a patient who is unable to speak and has food reflux into nose upon swallowing due to soft palatal cancer are other examples.

The major reason for people to fear of head-neck cancers and abstain from referring to a physician upon noticing that they have head/neck cancer is this deep organic and mental distress in the patient and community, which is likely to be caused by head-neck cancers due to possible loss of organ. However, this is totally a groundless fear. The Otolaryngology and Head & Neck Surgery and Radiation Oncology Disciplines, which have been developped in parallel to today's technological advances make it possible to cure head-neck cancer through a rational treatment without making the patient distressed. For example, 83 percent of the throat cancer patients has the chance to get rid of the disease with no permanent hole (tracheostomy) opened in their neck no matter what phase the disease is. Likewise, the advances in the otolaryngology and Head & Neck Surgery discipline make it possible to make a new jawbone for a patient who has lost almost all of his/her lower jaw for intramouth cancer by transplanting bone from leg or to make a new tongue for a patient who has lost almost all of his/her tongue for tongue cancer by using forearm skin.  Therefore, it is a groundless fear that people having head/neck cancer delay their treatment because of such kind of concerns.  

Invisible Dental Braces Make You Free

Invisible Dental Braces Make You Free

23 January 2013

Many people feel awful for their dental deformities or diastema and, for this very reason, cover their teeth while smiling. Those who suffer from this do not receive treatment since they are not willing to wear dental braces. Dt. Fırat Dağcıoğlu, from Liv HOSPITAL Orthodontics Department, says that people of all ages from childhood to adulthood can be treated by use of the alternative treatments used today indicating that you can have beautiful teeth without wearing dental braces with the help of the treatment methods called 'Invasilign and Lingual' employed for adults.

Straight teeth and a beautiful smile is the most effective way for people to express themselves in the right way. For dental health, which has an important place in your quality of life from your general state of health to how you look, alternative treatments can be employed for people of all ages. Orthodontic treatments, which are better to get in childhood, (including dental brace treatment) are neglected for a variety of reasons or teeth may have become deformed at increased age for many reasons.

What is the difference between the orthodontic treatment of adults and children?

It is all but impossible to form the jawbone skeletally in adulthood. They may have lost a part of the teeth and supporting bone. Orthodontic treatment may be only a part of a more comprehensive treatment plan. Treatment is conducted in a combined way by a team formed by a family dentist, oral surgeon, orthodontist, periodontist, and endodontist. The major factor which is effective in differing the treatment in adulthood from that in the childhood is that the jaw development has been completed. Jawbone size incompatibility may be fixed with surgical intervention in adulthood. For example, in the cases where the jaw bone is receding, very serious closing problems arises while the lower jaw tries to catch the upper jaw. Only moving the teeth orthodontically does not solve this problem. The neck needs to be elongated to ensure that lower jaw can catch the upper jaw.

Does the orthodontic treatment help when there is pain in jaw joints and muscles?

The most important factors leading to the jaw joint problems is grinding and clenching of the teeth. This is usually a night habit. It damages teeth and create a traumatic effect in the jaw joint. It may cause chronic or acute pain. An orthodontist may diagnose the problem. Joint surgery may be needed for more sophisticated disorders.

 

How the Invasilign method is applied?

It is a known fact that adults keep away from this treatment due to aesthetic concerns about dental braces. This problem is possible to eliminate by use of 'Invasilign' method without using brace and bracket.

With the 'Invasilign' method, the new technology used in the treatment of dental diseases, a proper and healthy treatment of teeth is ensured by use of ergonomic transparent plates that are not clearly visible in the mouth without using brace and brackets. Crooked teeth, which are usually caused by genetic factors and can be fixed in early ages, can also be fixed in the advancing age but the treatment lasts longer. Invisalign method is a system ensuring to straighten the teeth by using a series of removable transparent plaque that are not clearly visible in the mouth, which are placed to straighten the crooked teeth, without using brackets or braces. Each transparent straightening plaque, which is modelled exactly according to the tooth structure of the patient by means of dedicated 3D computer systems, is worn for about 2 weeks and is replaced by another one after 2 weeks. There are small differences between this replacement straightener and the previous one, which makes the teeth straighter. This proceeds step by step. With certain intervals, the duration of the treatment varies from 9 to 15 months depending on how much the teeth are crooked. In this period, the number of transparent straightening plaques used are about 18 to 30. As for the conventional orthodontic treatment using braces and brackets, the duration is 18 to 24 months.

How does the lingual method differs?

Another method of treatment, that's 'Lingual' orthodontic treatment known as invisible or hidden dental brace is a type of orthodontic treatment in which the brackets and braces used to straighten the crooked teeth are placed not in the front face but in the back face of the teeth. Orthodontists specialized after the study of dentistry attend to the lingual orthodontics programs of various universities to study this technique for additional 2 years. Likewise, World Society of Lingual Orthodontics (WSLO) and European Society of Lingual Orthodontics (ESLO) hold an exam for clinical proficiency in lingual technique. However, the orthodontists having passed this exam can apply this treatment. With lingual orthodontic treatment to be applied by the orthodontists specialized in this technique and having adequate knowledge and clinical experience, any case can be treated as in labial technique (with outer dental braces).

 
Liv Hospital Has Been Awarded The Well-Known Center of Excellence Accreditation In 3 Branches

Liv Hospital Has Been Awarded The Well-Known Center of Excellence Accreditation In 3 Branches

10 December 2015

Liv Hospital, entered the sector 3years ago to be a leader in the international arena in the healthcare as a new brand, has been awarded the well-known Center of Excellence Accreditation in 3 branches.

Liv Hospital was co-authorized after completing the “Center of Excellence Accreditation” in the branches of robotic surgery, colorectal surgery and obesity surgery by succeeding the stringent audit conducted by the Surgical Review Corporation (SRC) which is an impartial international commission. The Center of Excellence Accreditation which can be achieved by very few companies in the world was granted to an organization outside the Unites States for the first time by the concerning authority. Liv Hospital succeeded the 2-day stringent audit completely and accurately in the branches of robotic surgery, colorectal surgery and obesity surgery and scored a great success. Liv Hospital has been co-authorized by awarding the title of the Center of Excellence in the branches of robotic surgery, colorectal surgery and obesity surgery, and has proven that it provides the equivalent service with the reputable organizations of the world in these branches.

Why Center of Excellence?

First of all, it must be proven to the auditor delegation that the qualification of the physician in the related fields, specific studies, to treat patients equivalent to the world-class criteria and in certain number, complications, readmission, and analysis and functional results of the clinical data are equivalent to the organizations accredited before. In addition, it must be proven during the audit that the patient treatment protocols are determined by making decisions through joint meetings conducted with other disciplines, that the healthcare services and their results are integrated, and that they are created by planning from past to the future. Also, achieving a certain quality in institutionalization and treatment outcomes is among the basic application criteria.
Liv Hospital, after fulfilled all criteria required for application, has been audited for 2 days by the commission members who came from U.S. for audit purpose. Many fields including the number of cases performed by the Liv Hospital surgeons and complications rates, readmission, reoperation, complication rates, their educational backgrounds and qualifications, the symposiums and trainings they attended in regular manner, assessment of tasks, competencies and responsibilities of the persons from physicians to nurses, from janitors to allied health personnel, proper consultation and equipment, safety of the anesthesia and surgery processes, infection control, safe use of drugs, patient rooms, emergency unit, examination rooms, protocols of the clinical care standard, informant consent forms, from institutional commitment and support groups to building safety were scrutinized and went through a stringent audit.

“Being a Center of Excellence is a matter of culture”

Meri Istiroti, Liv Hospital Group Coordinator, who pointed out that being a center of excellence is a matter of culture, said that "We, as Liv Hospital, offer to our guests an integrated diagnostic and treatment service with a 360-degree approach. However, experiencing our quality healthcare service by our patients and individual satisfaction are very important to us, but not enough. Companies without vision cannot move, and companies without the target cannot grow. Achieving altogether is a completely different feeling. Our efforts will never end. We will take it more and more forward every day making a difference in patient care. As a center of excellence registered in global level, we will sustain the quality, efficient and effective healthcare without stopping. Being a center of excellence does not stop getting certified; we will sustain this permanently".

The winner will be public health

Prof. Dr. Oktar Asoglu, Liv Hospital's Medical Director, points out that having certified with a Center of Excellence award is a great team success. Prof. Dr. Oktar Asoglu says “medicine is changing rapidly, the half-life of knowledge is rapidly getting shorter. Quality health care must be measurable. In situations based on performance, being able to assess the treatment outputs is very difficult in the structures where everyone does everything. In this context, supervision of the international independent audit firms in the relevant areas will support to increase the quality of health care. And the winner will be public health. Just like the accreditation of the prestigious institutions in education, the accreditation processes in the health care will also open a new page for our country for the aspect of public health".

Audit from past to future

Qualification of the concerning physicians in the relevant branches and the number of operations performed by documentation, complication rates, survival rates, infections rates in the robotic, colorectal and obesity surgeries have to be provided in the international standards or better. 

Fully reflection of the accuracy of the patient records
Appointing a program director separately for each clinic and ensuring and proving a consensus by holding case-based meetings in a multi-disciplinary working format with all other departments.
Participating of not only the physicians but also all relevant health staff (nurse, anesthesia technician, etc.) in the multidisciplinary meetings.

Being available of all required consultant physicians in the hospital and managing the complications in a fastest way possible for 7/24 when needed.

Making available the devices and equipment and infrastructure that are well-designed for obese patients. These are, for example, chairs, beds, MRI device, blood pressure devices, and suitable WCs, etc. for obese patients.
For the physicians leading the relevant branches, having an educational background-certification recognized by many organizations both national and international, having a strong academic background.
Making available the workflow diagrams and maps every required places indicating what the patient should do every day. Thus, error rate depending on the human factor is minimized.
Adopting a holistic approach to patients. For example, always providing support to the patients admitted for obesity by not only physicians and nurses but also psychologists, dieticians, etc.
Using the strong training methods. Making available the detailed patient training images, effective presentation techniques and informed consent forms; experienced trainer staff, correct and systematic data management and transparency in data sharing.

After the Center of Excellence Accreditation based on the SRC’s corporate data analysis awarded the Center Of Excellence Accreditation:

Complications were reduced by 65%
Costs were lowered by 35%
Productivity improved by 47%
Patient safety raised by 71%
Coordination between teams was increased by 59%
Awareness increased by 59%
Patient satisfaction increased by 53%
Patient volume increased by 53%
References increased by 35%

Non-surgical Face Lifting with Spiderweb Aesthetic

Non-surgical Face Lifting with Spiderweb Aesthetic

03 March 2014

The face is the part of our body in which the first signs of aging are seen.  If the effects of time have been occurred in your face or any other part of your body, there is no need for hoping for help from surgical methods for a young and healthy face anymore. Spiderweb and thread treatment makes it possible to lift the face and low neck area with no use of surgical methods and to have a young and lively look. Prof. Dr. Başak Kandi, the Dermatologist and Veneral Diseases Specialist from Liv Hospital Ankara, pointed out that the sagging and wrinkles of those do not prefer the surgical methods are eliminated by spiderweb and thread treatment. "Spiderweb and thread treatment ensures that the face can be placed into its original position. Besides, this treatment is a method used for build up sagging in the face and neck," says Prof. Dr. Başak Kandi.

It is possible to restore the face.

 

What is key in rejuvenating the face or body is to be able not to impair the natural structure and expression of the area. The spiderweb and thread treatment aims to treat the sagging caused by aging without changing the look and expression in the face. With the increasing age, skin loses its tightness due to effects of gravity and sun damage. But it is possible to reverse it. The purpose here is to re-achieve the oval shape of the face, re-form the triangle of chin, to tighten the sagging in the neck, re-define the cheekbones and lip contour, to remove the lines above and below the lips, to lift the eyebrows in the patients who are not willing to have botox done, wipe out the sagging underarm and inside the legs and the lines in the elbows and knee caps with the increasing age.

 

Get rid of your problematic areas in 30 minutes

 In this method called spiderweb and thread treatment, sagging and lines can be eliminated by using dedicated threads. The skin is tightened and rejuvenated with no surgical operation. Application of spiderweb and thread technique takes about 30 minutes. The application is performed on a target group of age between 35 and 70 by use of local anaesthetic creams with no need for general anaesthesia. However, this technique is applicable to those who are about 25 years old. This is because the thread technique makes it possible to narrow wide faces. If one has a very wide facial shape and is not comfortable with this, a more triangle-like shape of face can be achieved. Apart from that, anyone who has facial sagging can benefit from this technique. No incision is made during the application of spiderweb and thread technique. In addition, the person on which this technique is applied can get back to their daily life soon after the application. The thread used in the application is highly reliable material not harmful for the patient and having no side effects, since it is a material known for long years. Even though some bruises may occur during the application depending on the patient's degree of sensitivity, these will disappear in a few days.

 
Over-weight: the Enemy of the Waist

Over-weight: the Enemy of the Waist

25 February 2015

Do you frequently feel pain in your legs, do you tend to stop and rest while walking, do you have complaints such as numbed, painful and burning legs? These may be caused by spondylolisthesis, colloquially spine slippage. Weight control has a significant role in avoiding spine slippage, which occurs as a result of the displacement of one lumbar vertebra on another compressing the spinal cord.  "Overweight and sudden weight gaining should be avoided, inactive life style should be kept away and abdomen and back strengthening exercises should be done," says Prof. Dr. Ethem Beşkonaklı, the Brain and Nerve Surgeon of Liv Hospital Ankara, pointing out that carrying excessive and imbalanced load should be avoided to protect from spine slippage.

 

It is seen mostly in elderly people.  
 

There are many types of spine slippage. The most common ones of them include slippages associated with natural wear and tear in bones and ligaments in the body, the slippages after any serious trauma affecting the structure of spine and vertebra slippage developed associated with the congenital problems in childhood. In the spine slippage, the first complaint of the patients is back pain. Symptoms sometimes may include leg pain down to heels, numbed legs, electrification while moving, burning as well as stiffness in calf muscles, difficulty in walking and increase in the back slope.

 

Postoperative use of lumbar corset is essential


In the mild spine slippages, pain killers, temporary lumbar corset, rest and physiotherapy methods may be tried individually or in combination. The patients having mild spine slippage, not comforted or partially comforted by these treatments, or suffering from painful and numbed leg may be injected with pain killers at the suitable sites. Advanced spine slippages, spine slippages in which the pain complaints were not relieved in spite of the medical treatment methods, and those which cause urinary incontinence, weakness and numbness of feet and sexual dysfunction are treated by surgery. The method of surgical treatment is decided by the general condition of the patient, location and degree of the slippage. Generally, the slipped vertebrae are fused to each other, vertebrae is supported and arranged by certain metal devices and compression of nerves is eliminated. The patient can start walking wearing lumbar corset and is kept under medical follow up accompanied by the back and leg exercises after the operation.

 

Points to be considered to avoid spine slippage

 

  • Avoid from overweight and sudden gain of weight

  • Do not carry excessive and imbalanced loads.

  • Do not bend over but bend your legs to pick something up floor.

  • Use orthopaedic bed, lie on side or back.

  • Avoid heavy and competitive sports.

  • Wear shoes with soft sole.

  • Avoid an inactive style of life.

  • Do abdomen and back muscle strengthening exercises.

Put an End to Your Migraine Headache with Botox

Put an End to Your Migraine Headache with Botox

02 March 2017

Almost everybody suffers from headache throughout their life. Headache becomes chronic and reduces the quality of life in some people while it is temporary in some others. “If you have severe headache at least half of a month and this headache is migrainous, you may have "chronic migraine," says Dr. Akçay Övünç Özön, the Neurologist from Liv Hospital Ankara, pointing out that every one out of two people suffering from migraine headaches is "chronic migraine patient". Özün also adds that botox is effective in treating chronic migraine, saying "we aim to decrease the activity of the muscles injecting botox into them. When the activity of the muscle is minimized, the pain is also minimized. The patients' quality of life is improved and they get rid of the headaches," says Dr. Akçay Övünç Özön, the Neurologist from Liv Hospital Ankara.

 

 

Botox treatment for chronic migraine

 

Patients having chronic migraine are alone with risks of taking painkillers continuously and excessively and the negative psychological mood created by the fact that they have to live with pain. In the light of scientific data, botox is a new option in protective treatment for chronic migraine. In chronic migraine, botox should be applied by specialists experienced in this area with true diagnosis. Today, migraine and chronic migraine is diagnosed and treated by neurologists and headache centres.


Aim is to minimize the activity of muscles.

 

In treating chronic migraine, the muscles are injected with botox toxin to minimize their activity. When the muscle activity is minimized, the pain is also minimized. In this treatment, the stretched groups of muscles are injected with toxin at 31 points in 7 different areas. The treatment is applied by injecting more toxin into the stretched groups of muscles while injecting less into the less stretched groups of muscles. Treatment is applied at the intervals of 3 months. It is applied in 3 to 5 courses of treatment.

 

Not very migraine headache is chronic

 

Chronic migraine is not a simple headache or a headache lasting for years. Every chronic headache is not a chronic migraine while every migraine is not chronic migraine. Chronic migraine is a mild or more severe condition often one-sided but sometimes both-sided sensitive to light, sound, movement and smell often accompanied by vomiting. However, in some chronic migraine cases, the symptoms like nausea and vomiting is less but the headache is still to a disturbing extent.

 

 It reduces the quality of life

Chronic migraine patients may experience financial problems due to loss of work force and a reduced quality of life. This has negative psychological effects. In our country, one out of 6 to 7 people have migraine and each one out of 10 migraine patient suffers from this disease chronically. The prevalence of chronic migraine is 1.7 percent in Turkey. Migraine, which is ranked by World Health Organization as 19th among causes for years lived with disability, ranks higher than diabetes.  

 
Rejuvenate with Your Own Cells

Rejuvenate with Your Own Cells

05 November 2014

Our body is formed by millions of cells. Most of the cells are integrated into our organs such as liver, kidney and brain and enable such organs to function. "The stem cell which enables our organs to carry on their function and is the key cell of human being has been produced in laboratory setting to be used for personalized treatments for the las 10 to 15 years. Stem cell which today is used for cartilage lesion in orthopaedics, in aesthetic and cosmetic surgery, nonhealing burnts, nonhealing wounds, diabetic feet, cardiological problems, gives very successful results of treatment," said Prof. Dr. Erdal Karaöz, (Histlogy - Embryology, Root Cell, Gene Therapy and Tissue / Organ Engineering Specialist) the Head of Regenerative Medicine Research and Production Centre of Liv Hospital.   We talked with Prof. Dr. Erdal Karaöz about what is wondered about stem cell.  

For what purposes is stem cell used today?

The areas of use of stem cell can be divided into two groups. It is used in cosmetic and aesthetic surgery, orthopaedics, dermatology and treatment of blood diseases. However, there are also incurable disorders hoping for help from stem cell therapy. These include central nervous system related disorders such as neuro-degenerative diseases including spinal cord injury, ALS etc, muscle diseases, organ failures, autoimmune diseases and loss and lack of vision. All of these patients are waiting for approved stem cell-based treatment protocols.

Does stem cell cause cancer?

Stem cell is obtained from various resources. It is known that in theory, the stem cells obtained from human body does not cause cancer. But if stem cell is obtained from human embryo (that is embryonic stem cell) and even a one of them is transplanted as undifferentiated to human body, non-malign tumours called "teratoma" may present. But today, there is no report that the cells used in the stem cell-based treatment protocols approved and awaiting for approval called mature stem cells cause cancer in the recipient.

How is stem cell is applied?

The first of the applications is the method in which the relevant tissue - which is mostly lipoaspirate (abdominal fat tissue) - is removed from the patient, undergone certain treatments under the operating room or laboratory conditions and then re-transplanted in the patients in the same session. This application is not of pure stem cell. The transplanted cell suspensions contain stem cell by 5%. It largely contains vascular cells which are rich in fat tissue after the procedure which we call vascular fraction. This method is used mainly in plastic surgery and orthopaedics. The second application is based on the proliferation of the stem cell extracted from a tissue (which may be a fat tissue or bone marrow) by use of special methods in laboratory until it reaches the necessary number for transplantation. The cells obtained by this method are purely stem cell. This is because they necessarily undergo many tests that we call characterization and as a result of such tests, they are approved as stem cell and can be used for clinical applications if they meet the criteria to be eligible for being stem cell.   The patients are subjected to quality control tests including endotoxicity, microbial and virological tests before transplantation. The cells having been able to pass all these tests are re-transplanted to the patients. For example, for the spinal cord damage which is under research, it is injected into heart to revive the dead cardiac tissue. Or it is used in approved treatment protocols. As in tendon injuries, healing of burn injuries etc.

Is the stem cell applied to whom it is harvested from?

It is usually applied to whom it is harvested from. But in some cases, the stem cells harvested from the bone marrow or fat tissue of another person can be used for particularly the immune system-related problems. This is because when transplanted to another person, these cells are by their nature not perceived as foreign by the person's immune system cells. Thus, the stem cells transplanted from another person can function as your own stem cell. This is called allogeneic transplantation.

Can the cell harvested be used after 20 years?

It is theoretically possible. Once the cells are proliferated in sufficient amount, a part of them can be used for transplantation to the patient. Another part of them are transplanted as the second and third dose to the patient after the pathology results or when the desired results have not been able to get. For this purpose, a part of the cells are cryopreserved in tanks containing liquid nitrogen at -196OC by use of suitable methods. It is a known fact that the cells preserved up to 20 years keeps viability and functions.  

Robotic-Assisted Coronary Bypass through a 4 cm Incision without chest opening

Robotic-Assisted Coronary Bypass through a 4 cm Incision without chest opening

18 February 2015

Cardiovascular diseases are the leading most frequent chronic diseases prevalent in Turkey. In the treatment of the cardiovascular diseases, the bypass surgery, which is performed robotic-assisted in recent years, is a very important advantage in terms of patient comfort and speed of recovery. It is possible to perform bypass robotically with no use of scalpel to cut chest and no heartbeat stopped through 3 tiny incisions made under the armpit and a 4-cm incision on the site where the rib is located. Ass. Prof. Dr. Ahmet Özkara, the Cardiovascular Surgeon from Liv Hospital, says that they perform robotic-assisted bypass on the patient by use of thoracic artery, which is the major vessel on the heart and that they perform this operation without opening the chest area as in the conventional coronary bypass and without stopping the heartbeat. Op. Dr. Cenk İndelen from Liv Hospital says that with robotic-assisted bypass, the patient can get back to their everyday life much earlier and this method results in far less rate of infection and bleeding and adds: "It is much more superior than the conventional coronary bypass from a cosmetic point of view. Patient gets back to their work within two weeks. They restore their normal physical condition.

 

This is performed with no use of scalpel. Thanks to the new technological advance experienced in the field of heart surgery in the last 15 years, the number of the minimally invasive methods as alternatives for conventional methods of surgery is gradually increasing. The number of the robotic-assisted heart surgeries performed in the USA and European countries has increased by about 20 percent in the recent years. This number is also increasing in Turkey. In the robotic-assisted surgery, the operation is performed without cutting the sternum, or colloquially breastbone. Robotic arms are inserted through the small incisions of 4 cm made on the right or left side of the rib cage without no use of scalpel to cut the chest and without stopping the heartbeat. The robotic camera inserted through this incision provides 8- to10-fold magnified and clear 3D imaging. A surgeon attaches surgical instruments on the robotic arms while another surgeon uses these instruments through the console with the camera.

 

It is comfortable for both patient and surgeon. Unlike the conventional or thoracoscopic surgery, the reliability of the instruments used is higher. The surgical instruments being manipulated by the finger movements of the surgeon controlling the console can make the moves difficult to be performed by the wrist. No hand tremor or fatigue is in question and it is easier to work on the sites difficult to access. This provides comfort for both the surgeon and patient.

 

Less pain, lower rate of infection.

On the patients eligible for robotic-assisted surgery, coronary artery bypass surgery, mitral valve surgery, congenital cardiac surgery and arrhythmia surgery are possible to perform by robotic-assisted surgery. Coronary artery bypass surgery can be performed with (bu use of cardiopulmonary devices) or without the heartbeat stopped. Mitral valve operations are performed by stopping the heartbeat. With the robotic-assisted coronary surgery, the time of recovery of the patients significantly shortens and the patients can usually get back to work after 15 days. Bleeding, infection, pain and use of blood is less probable.

Advantages of robotic-assisted coronary surgery

  • Better results:  The problemssuch as pain and postoperative disorders of certain body functions are less likely and the patient satisfaction is higher.

  • Less damage: Performing the operation through tiny incisions by use of a camera provides, contrary to popular belief, a clearer and more detailed view than the open surgery and ensures that the operation can be completed with far less tissue trauma.

  • Quicker Recovery: Postoperative recovery is quicker than that in open surgery. This also means shorter hospitalization and quicker recovery of the patient.

  • Less pain: The patients feel less postoperative pain since the operation is performed through the small incisions.

  • Lower risk of infection: The smaller the site of incision is, the lower the risk of postoperative infection in surgical site is.

  • Better cosmetic results: Since the operation is performed through the incisions of 1 to 1.5 cm, it gives better cosmetic results than the open surgery.

  • Clearer are of view: Performance of the operation through tiny incisions by use of optic cal system provides a much clearer and more detailed are of view.

  • Less bleeding:  Tissue damage is less, so bleeding is at minimum level.

Scoliosis Rather Hits Young Girls

Scoliosis Rather Hits Young Girls

25 May 2015

The strongest theory for scoliosis (curvature of the spine) the reason of which is not known accurately is that it is inherited. It is 10-fold prevalent among girls than boys. Ass. Prof. Dr. Çağatay Öztürk, the Spinal Surgeon of Liv Hospital Istanbul points out that scoliosis is more frequently seen in the adolescent girls saying “In the beginning, it just cause discomfort cosmetically but in the advanced period may press onto the lungs and intestines. Therefore, early diagnosis is very important." Ass. Prof Dr. told about what is wondered about scoliosis.

It is prevalent among those having orthodontic problems.

In order for the scoliosis to be noticed, the curvature of spine should be more than a specific degree. Otherwise, it is difficult to notice it. Scoliosis in the lower back area may not be noticed until the curvature reaches up to 30 to 35 degrees. If the child is overweight, he/she may have reached a level requiring surgery once it is noticed. If the child is thin and scoliosis is on the back, it may be noticed earlier. In addition, it can be said that scoliosis is more prevalent in the patients having orthodontic problems.

It may advance in spite of use of corset.

In the scoliosis of 0 to 25 degrees, the patient is particularly followed up in a period in which it has an increased potential of advancing like adolescence etc. In the scoliosis up to 35 degrees, corset treatment is available. Corset is worn for 23 hours a day in the beginning and it may be needed to use it for a long period depending on the age at which scoliosis is discovered. However, scoliosis has an advancing potential of 60 percent only in spite of the use of corset.

It is not a chronic disease

Thanks to the available methods of treatment, it is not a chronic disease anymore. If a curvature of the spine of a patient having scoliosis has an angle of more than 40 degrees, the patient can be operated. With the surgery performed in timely manner on the eligible patients selected suitably, the spine of the patient become straight and experience no aesthetic problem and can do any type of sports done by their peers except for those done professionally, get married and have children in future.

Surgery should be performed in summer holiday

The patient can get back to school after a month of the surgery. An they can do sports after the sixth month. Therefore, we schedule the scoliosis surgery to summer holiday. We advise no sportive activity within the first three months of the surgery while advising swimming thereafter. And after the sixth month of the surgery the patients has already got back to his/her healthy life.  

Stem Cell Applications In Rheumatic Diseases

Stem Cell Applications In Rheumatic Diseases

09 February 2017

Mesenchymal stem cells (MSC) have been used in animal models and in many in vitro studies for various diseases, including rheumatic diseases, for the past decade. The first successful outcome after MSCs were started being used for therapeutic purposes was achieved 15 years ago in support of the efficacy of bone marrow transplant. However, the actual boom in this field has been observed following the publication of the achievements of these cells in cases of acute graft versus host disease since 2004.

Recently, a better understanding of the MCS functions showed that these cells also have strong immunosuppressive and inflammatory suppressive effects. Mesenchymal stem cells have been proposed as a promising alternative in the treatment of many rheumatic diseases, especially rheumatoid arthritis (RA), thanks to their immunoregulatory functions.

Rheumatoid arthritis 

The first publication about the use of MSC in rheumatoid arthritis belonged to the transplantation and negative results of MSC of allogenic bone marrow in four patients. 172 patients participated in the second major study on patients with rheumatoid arthritis, and 136 patients were given 40x106 allogenic umbilical cord-derived MSC, while 36 patients were given cell-free culture fluid as placebo. There were two treatment options in this study: One of the options was to give cell-free culture fluid with non-steroidal anti-inflammatory drugs that modify the disease (control group) and the other one was to give umbilical cord MSC in addition to the other drugs. At the end of the study, the researchers concluded that the fluid given had no benefit in control group patients and the umbilical cord MSC therapy, which was given in addition to non-steroidal anti-inflammatory drugs for patients with rheumatoid arthritis, was clinically reliable, significant, and permanent. In addition to these studies, positive outcomes were notified in three patients, who received autologous adipose-derived MSC in 2011.

Dermatomyositis / Polymyositis (DM/PM) 

Some of the 10 patients with therapy-resistant DM / PM or severe systemic involvement were infused intravenous allogenic bone marrow-derived MSC and some were infused umbilical cord-derived MSC 106 cells/kg. Partial clinical improvement and decrease in creatinine kinase level were seen in all cases. Patients who developed a relapse received a second infusion. A 35-year old female with significant improvement received 4 infusions of adipose tissue-derived MSCs that were reproduced in a culture environment.

Systemic Sclerosis 

The first report on the use of MSC in the treatment of a rheumatic disease belonged to a 41-year old female in 2008. Following single dose infusion of intravenous allogenic MSC (106 cell/kg), a significant improvement is noted on skin and in ulcers of this patient who was diagnosed with complicated diffuse cutaneous systemic sclerosis 4 years ago and has extremity (acral) ulcers. However, the ulcers relapsed and there was response to Bosentan therapy. A similar outcome was also seen at the end of the treatment periods of 4 patients from the same group. Experts concluded that MSCs are successful in improving acral ulcer and second-degree skin thickening, but further studies are needed to achieve a conclusion in heterogenic clinical symptoms.  Later, minor studies have also shown that local injection of adipose tissue-derived MSC into the face and fingers showed positive outcomes in the treatment of systemic sclerosis patients with autologous blood and bone marrow-derived mononuclear blood cells and autologous bone marrow-derived MSC applications. No remarkable toxic affect is noted in any of these studies. 

Primary Sjögren's Syndrome 

Significant results were obtained in the umbilical cord-derived MSC treatment performed on 24 patients with severe Sjögren’s syndrome by a center. Improvement is noted in SICCA symptoms, severe systemic involvements, autoantibody levels and saliva flow in most of the patients. Moreover, no toxic affect is noted. Considering these positive results, an increase in the number of prospective and controlled clinical studies can be expected in order to obtain new information on Sjögren's syndrome treatment with MSC.

Systemic Lupus Erythematosus (SLE) 

Since 2010, changes in the course of the diseases of more than 300 treatment-resistant SLE patients (most of them from a single center) after MSC treatments have been published. MSCs obtained from different sources, including autologous or allogenic bone marrow and allogenic umbilical cord-derived, were used in most of these treatments. Positive results were obtained in most of the patients, while some of them showed increase in circulation-regulatory T cell count, despite no improvement was seen in the symptoms. Considering all these studies, experts conclude that MSCs are safe and applicable for treatment-resistant SLE patients; however, the results of randomized, controlled, prospective studies from more centers should also be evaluated to prove these inferences

Stretta: Non-Surgical Treatment of Reflux

Stretta: Non-Surgical Treatment of Reflux

28 November 2014

Reflux, which is a disease frequently seen in the world, is also prevalent in Turkey due to stress, overweight and malnutrition. According to the studies, one out of five person has reflux. Prof. Dr. Cengiz Pata, the Gastroenterologist from the Liv Hospital, gave information about stretta, the non-surgical treatment of reflux, which solves the reflux problem by 90 percent. ‘’If the patient is younger and the opening in the stomach valve is less than 3 cm, the reflux can be treated by applying a special electric current (radiofrequency) to the lower end of the oesophagus in a short period as 30 minutes with no need for surgical intervention. By this method, the patient is outpatiently treated and get back to his/her daily life with no use of drug. Stretta method provides the painless and long term results. The radiofrequency current used in stretta method is also used for treatment of various diseases such as cardiac arrhythmia, liver cysts etc," says Prof. Dr. Cengiz Pata.  

 

 

Reflux is experienced by every person in the certain periods of his/her life.

 

A functional, valve-like formation has occurred by the specialization of the muscle structure in the junction where the stomach and oesophagus meet. Under normal condition, the gastric acid, bile juice, and the other fluids in the stomach as well as the foods eaten do not come up thanks to this valve. Coming of the stomach content up to the oesophagus is called reflux and the disease associated with the reflux Gastrooesophageal Reflux Disease (GERD). In fact, reflux is a physiological phenomenon and experienced by every person in the certain parts of the day. Actualy reflux is the whole of the tissue changes caused by the gastric acid coming up in oesophagus, throat, lungs, mouth and teeth and the associated disease.

 

Be alert against the following symptoms:

Burning in the stomach and feeling this burning in the upper parts of the chest, known as heartburn, water brash, feeling of the foods re-filling into the mouth, difficulty in swallowing, coughing, hoarseness, earache etc. often indicates to the reflux. The complaints such as hoarseness, chest pain etc may need patient to be examined by ear, nose and throat and cardiology disciplines.

 

Take the heartburn seriously

 

Heartburn is very important in diagnosing the disease. The first diagnostic examination needs to be made is gastroscopy. In the rare patients difficult to diagnose, the level of acid in oesophagus is measured for 24 hours.

 

Tips for those suffering from reflux

 

Avoid eating 2 hours before bed

Fill your stomach less at the meals

Use higher pillows while sleeping at nights

Do not wear too tight clothes.

Those overweight should restore their ideal weight.

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