Medical Unit's

A

Andrology is a field of science that deals with male reproductive system and all disorders affecting male or female sexual health as well as age-dependent alterations in male subjects. Andrological disorders are diagnosed and treated in a division of the Urology clinic and cutting-edge methods and technology are used for the treatment.

Diagnosis and treatment of infertility are addressed in a multidisciplinary approach in cooperation with the In Vitro Fertilization Center. All infertility treatments are based on teamwork and the cutting-edge treatment modalities, such as microsurgical varicocelectomy and micro-TESE (microsurgical sperm retrieval from testes), are used.

Disorders diagnosed and treated in the field of Andrology

  • Infertility
  • Varicocele
  • Microsurgical Varicoselectomy
  • Sexually Transmitted Diseases
  • Diseases of Penis And Foreskin, Hemospermia
  • Premature Ejaculation
  • Disorders of Orgasm and Ejaculation (excluding premature ejaculation)
  • Sexual Dysfunctions
  • Vasectomy
  • Gender Uncertainty (Intersex)
  • Penile Prosthesis Implantation
  • Testicular Diseases
  • Hydrocele
  • Spermatocele
  • Testicular and Epididymal Infection

Gender Uncertainty (Intersex)

“Intersex” refers to ambiguous external genitalia of the newborn or in other words, absence of clear differentiation between male and female sex and presence of characteristics of the opposite sex. Underlying causes of such disorders may be chromosomal disorders, hormone deficiency or excessive secretion of hormone and exposure to medications that are contraindicated during pregnancy.  Such patients should be evaluated by a team of newborn specialist, pediatric endocrinologist, pediatric urologist, Pediatric psychiatrist and genetic specialist within possible shortest time. As a result of this evaluation, the more consistent gender should be determined and a decision should be made about the gender assignment. After this decision is made, certain type of treatments and surgeries should be employed to correct the gender of the baby or the infant. Such treatments should be completed before sexual identity develops. Otherwise, psychological side effects will be inevitable for the child.

In the Department of Emergency Medicine, services are rendered round the clock based on patient care in the light of actual and scientific facts with an experienced dynamic physicians and related healthcare personnel.

Our emergency medicine department, which approaches the patient’s and their relatives’ needs sensitively, works in coordination with the other medical departments and maintains the patient’s care and follow-up processes jointly.

After patients are examined by Emergency Medicine specialists, they are referred to the related medical department, when necessary, after relevant tests and treatments.

In the Emergency Medicine Department, where services are provided using all resources that modern medicine offers, the most suitable and efficient treatment is timely offered in CRP room, observation unit, trauma room and all support units.

The Department of Anesthesiology and Reanimation is responsible for the pre-operative medical evaluation, intra- and post-operative pain management and anesthesia administrations for all surgical procedures in all age groups within all patient care and treatment services of the hospital.

Anesthesia services include pre-operative medical assessment, intra- and post-operative pain management and monitoring of all vital functions performed by experienced anesthesiologists. It also includes anesthesia administrations in all surgical branches, anesthesia in infants and pediatrics, pain-free births, day case surgery anesthesia and analgesics and sedation in all diagnostic and therapeutic procedures.

Our experienced team with high scientific qualifications administers anesthesia for procedures carried out by departments of Cardiac Surgery, Neurosurgery, Pediatric Surgery, Gynecology, Orthopedics, Thoracic Surgery, Vascular Surgery, Otorhinolaryngology, Urology and Ophthalmology with its world-class technological infrastructure. Our services rendered by specialists of our hospital include general anesthesia, regional anesthesia (epidural anesthesia, spinal anesthesia, combined spinal and epidural anesthesia), peripheral nerve blocks for upper and lower limb surgeries (anesthesia that numbs only the surgical site), and patient-controlled pain management, where pain pumps are used in order to avoid postoperative pain.

In Oral and Dental Health Clinics of Kolan Hospital Group and medical centers, services are rendered for diagnosis and treatment of diseases regarding oral, dental and jaw health for both pediatric and adult patients.

Aesthetic Dentistry

Various solutions are also generated for oral and dental cosmetic; we are able to provide a new smile (Hollywood Smile) with laminate, porcelain veneer, gum contouring and tooth bleaching.

Zirconia Porcelains

It is the highest quality product of all the time regarding aesthetics, solidity, tissue compatibility and natural appearance which are the main necessities of dentistry. This system meets all your needs, such as biocompatibility, natural appearance, aesthetic and mechanical resistance, and zirconium, a white allow, is used for the frame of this system rather than a metallic frame. Zirconia-based porcelains are preferred trustfully in our clinics, since they are cosmetic enough to be used for anterior teeth and solid enough to be used for posterior teeth.

Porcelain Laminate Veneers

Porcelain laminate veneer is a successful method that supports the treatment to modify color, size and shape of teeth. They are attached to the surface of anterior tooth to mask bad discoloration or to change the shape of tooth and they are resistant to recurrent discoloration.  They are preferred mostly for their superiority for opacity and requirement of minimal dental substance to be removed. This type of porcelains react photo-flashes and neon lights like natural teeth and they cannot be distinguished from real teeth, similar to full porcelain crowns.

Tooth Whitening

Tooth whitening (bleaching) is a good option for discolorations that cannot be eliminated by brushing or superficial cleaning procedures (physical removal of tartar and stains) and that are caused by tooth structure and lead to poor appearance. It ensures permanent whitening without damaging teeth.

There are two types of bleaching method. These are home bleaching and clinical bleaching (tooth whitening) methods. Satisfying whitening and beautiful smile are ensured with tooth whitening procedure. Bleaching procedure should necessarily be under professional control.

Pedodontics

Health of deciduous teeth in childhood directly affects the future dental health. The set of deciduous teeth and following set of combined teeth develop in the period when growth of child is at the most active phase. The first deciduous tooth starts to erupt in the sixth month. Different groups of deciduous teeth are missed occasionally and leave their place to permanent deciduous teeth. This condition lasts until 12 years of age. During this period, early miss of deciduous teeth may affect the jaw development and cause cosmetic and speech disorders. All treatments that focus on permanent teeth apply to the deciduous teeth.

Treatment of pediatric dental problems (Pedodontics) is a separate field of dentistry that requires a professional approach. Moreover, skeletal jaw development should be kept under control by orthodontists during growth of the child. In our clinic, measures are taken to ensure that the children at growth age have a healthy dental and oral structure and treatments are applied by specialists dentists.

Halitosis (bad breath)

Today, halitosis is a very common condition also faced by civilized societies. And it is a reason of social offense. It brings along socio-psychological problems. Since 90% of halitosis is caused by oral problems, a full oral examination, elimination of dental and gingival problems, oral hygiene, cleaning surface of tongue and eliminating infectious sources are necessary for the treatment.

Implant

Implants are artificial titanium roots that are placed to jaw bone to replace the teeth missed for various reasons. Implant is the best alternative to the natural teeth in terms of function and aesthetic. Implants provide better speech and chewing function comparing to conventional crown and prostheses. Implant is a comfortable and reliable application. Following dental implants that are recently used very commonly, many patients can engage in the social life in the same day. For prosthesis to be placed on implant – the second stage of implant therapy-, it is necessary to wait for 2 to 4 months in order to ensure fusion between the implant and the jaw bone after the operation.

Local anesthesia can be administered to make patients feel no pain and discomfort. General anesthesia can also be administered, if and whenever necessary.

Resting, bandage and splinting, non-steroidal pain killers and edema-relieving drugs (NSAIDs), regional cortisone injections and physical therapy are at the forefront in minor injuries. Platelet rich plasma injections, which are also very popular in recent days and used in the treatment of professional athletes, are also effective in tissue healing. If the injury is severe, surgical approach is needed. Open and closed (arthroscopic) techniques are used for surgical procedures. Closed (arthroscopic) methods enable clear visualization of intra-articular structures and intervention. Healthy tissues are damaged less and the healing period is shorter.

Successful outcomes are obtained in management of sports injuries after arthroscopic surgery, since the procedure is maintained with physiotherapy and rehabilitation.

How Should Emergency Approach Be If There Is Sports Injury, How Should a Final Diagnosis Be Made?

The sport must be terminated immediately and the athlete must move out of the playing area. Cold (ice) compress should be applied on the injured body part; however, cold should not be applied on bare skin. Cold compression should be paused for 1.5 to 2 hours following 20- to 30-minute compression. Compression should be performed with an elastic bandage to prevent swelling and the arm and leg should be elevated to the level of heart. Then, a doctor who is specialized in sports injuries should determine the severity of injury by careful examination. The final diagnosis is made with the help of imaging modalities at the hospital. Direct x-rays and computed tomography (CT) are used for the diagnosis of fractures and dislocations in the bones and joints; ultrasound (USG) and magnetic resonance imaging (MRI) are used for the diagnosis of soft tissue injuries.

How is the treatment done?

Resting, bandage and splinting, non-steroidal pain killers and edema-relieving drugs (NSAIDs), regional cortisone injections and physical therapy are at the forefront in minor injuries. Platelet rich plasma injections, which are also very popular in recent days and used in the treatment of professional athletes, are also effective in tissue healing. If the injury is severe, surgical approach is needed. Open and closed (arthroscopic) techniques are used for surgical procedures. Closed (arthroscopic) methods enable clear visualization of intra-articular structures and intervention. Healthy tissues are damaged less and the healing period is shorter.

Orthopedic and Open Surgical Treatments of Sports Injuries

Resting, bandage and splinting, non-steroidal pain killers and edema-relieving drugs (NSAIDs), regional cortisone injections and physical therapy are at the forefront in minor injuries. Platelet rich plasma injections, which are also very popular in recent days and used in the treatment of professional athletes, are also effective in tissue healing. If the injury is severe, surgical approach is needed. Open and closed (arthroscopic) techniques are used for surgical procedures. Closed (arthroscopic) methods enable clear visualization of intra-articular structures and intervention. Healthy tissues are damaged less and the healing period is shorter.

Successful outcomes are obtained in management of sports injuries after arthroscopic surgery, since the procedure is maintained with physiotherapy and rehabilitation.

Andrology is a field of science that deals with male reproductive system and all disorders affecting male or female sexual health as well as age-dependent alterations in male subjects. Andrological disorders are diagnosed and treated in a division of the Urology clinic and cutting-edge methods and technology are used for the treatment.

Diagnosis and treatment of infertility are addressed in a multidisciplinary approach in cooperation with the In Vitro Fertilization Center. All infertility treatments are based on teamwork and the cutting-edge treatment modalities, such as microsurgical varicocelectomy and micro-TESE (microsurgical sperm retrieval from testes), are used.

Disorders diagnosed and treated in the field of Andrology

  • Infertility
  • Varicocele
  • Microsurgical Varicoselectomy
  • Sexually Transmitted Diseases
  • Diseases of Penis And Foreskin, Hemospermia
  • Premature Ejaculation
  • Disorders of Orgasm and Ejaculation (excluding premature ejaculation)
  • Sexual Dysfunctions
  • Vasectomy
  • Gender Uncertainty (Intersex)
  • Penile Prosthesis Implantation
  • Testicular Diseases
  • Hydrocele
  • Spermatocele
  • Testicular and Epididymal Infection

Gender Uncertainty (Intersex)

“Intersex” refers to ambiguous external genitalia of the newborn or in other words, absence of clear differentiation between male and female sex and presence of characteristics of the opposite sex. Underlying causes of such disorders may be chromosomal disorders, hormone deficiency or excessive secretion of hormone and exposure to medications that are contraindicated during pregnancy.  Such patients should be evaluated by a team of newborn specialist, pediatric endocrinologist, pediatric urologist, Pediatric psychiatrist and genetic specialist within possible shortest time. As a result of this evaluation, the more consistent gender should be determined and a decision should be made about the gender assignment. After this decision is made, certain type of treatments and surgeries should be employed to correct the gender of the baby or the infant. Such treatments should be completed before sexual identity develops. Otherwise, psychological side effects will be inevitable for the child.

C

Check-Up, also referred to as “Personal Medical Screening”, aims to diagnose potential diseases at early stages in order to take precautions and keep the individual healthy. A Check-Up is a sequence of examinations and tests performed in order to diagnose diseases at early stages, which develop insidiously, even if the patient has no remarkable complaint.

In the Check-Up Center; symptoms of diseases that involve internal organs are identified; pre-diabetes, abnormal cholesterol levels, heart diseases, alcohol and hepatitis B and common cancers like breast, uterine and colorectal cancers are diagnosed and potential gender- and lifestyle-related risks are determined as well as risk analyses are made for early diagnosis.

In the Check-Up program where personalized analyses are carried out, overweight patients are also supervised for a healthier life.

If you say “I Care About Myself, I Care About My Health”; Your Personalized Check-Up packages are available at all our branches.

"Plastic" means formable in etymology. The term “Reconstructive” means rebuilding and it is a division of medicine that aims to correct congenital or acquired deformities and dysfunctions using surgical techniques. Plastic Surgery deals with all kinds of surgical problems on the outer surface of the body, while Cosmetic Surgery is a division of Plastic Surgery. The intention is to make the body appear more beautiful and improved. Cosmetic surgery is the area where the surgical and artistic skills are combined.

Following conditions and surgeries within the field of Plastic Surgery are as follows:

Facial trauma and lacerations (treatment of fractured facial bones)

Congenital anomalies: Harelip, cleft palate, hypospadias, polydactyly, syndactyly (fused digits), hemogron etc.

Malignant skin tumors and healing

Hand surgery and microsurgery

Burns, chronic wounds (bed sores, diabetic wounds)

Cosmetic Surgery

Examples of operations carried out at our hospital;

Blepharoplasty (Eyelid Aesthetics)

The term implies correction of the droopy eyelids (ptosis) and under-eye bags.

Rhinoplasty (Nose Job)

Cartilaginous and bony roof of the nose is re-shaped with surgical methods. It is combined with septorhinoplasty, if cosmetic concerns are accompanied by shortness of breath.

 

Ear Deformities

These operations aim correction deformities of ear(s), such as prominent ears, or reconstruction of an ear in case of microtia.

Mammoplasty

Breast Augmentation

Breast Reduction or Breast lift (mastopexy)

Breast Reconstruction

Excessive engorgement of breasts may lead to particular complaints such as weight gain, shoulder pain; irritation of skin beneath the underwear straps, moisture and resultant fungal infections. Engorged breasts are reduced, while small breasts are augmented. Breast lift is an option for sagging. Breast(s) can be reconstructed for patients who underwent mastectomy due to cancer.

Abdominoplasty-Liposuction

Excessive fat deposition in the tummy and other body parts secondary to weight gain and pregnancy and sagging tummy secondary to weakened abdominal muscles can be corrected with abdominoplasty and liposuction.

Gynecomastia (Enlargement of the male breast)

It is a female type enlargement of the male breast. It can be corrected with surgical treatment.

Correction of sagging skin of the arms and legs.

Removal of scars and tattoos on the face and other parts of the body.

All cardiovascular conditions of adults and pediatric patients can be successfully operated on in the Department of Cardiovascular Surgery. Specialized healthcare personnel renders high-order services in bypass surgeries, heart valve operations and aortic surgery. While the experienced cardiac anesthesia team and fully equipped intensive care unit are major contributors to the success rates of surgeries, the comfort of postoperative patient rooms allow the patients and their relatives to go through this process in the most comfortable way.

Surgical Treatment of Heart Diseases

Coronary Artery By-pass Surgeries: Arteries that supply oxygen and nutrients to the heart muscle are referred to as coronary arteries. Smoking, diabetes, excessive weight, stress and genetic factors influence the functioning of the cardiac muscle negative by hardening the arteries (atheroscleroris), resulting in stenosis of coronary arteries. The initial symptom of this clinical picture, also known as Coronary Artery Disease, is chest pain. While this pain is initially provoked by exercise (walking, running, ascending stairs and going up hills), it is also manifested at rest at the advanced stages.  When the coronary artery is totally occluded, heart attack (myocardial infarction) develops which threatens the life. As a result of the heart attack, a part of the heart muscle dies. The patient may have to continue the rest of life with complaints such as shortness of breath and fatigue, as the heart cannot pump efficiently. Therefore, individuals with complaint of exercise-induced chest pain who are at risk of atherosclerosis (hardened artery) should timely present to a cardiologist in order to prevent potential occurrence of a heart attack and to live long and healthy.

In our clinic, heart–lung machine is used or off-pump surgeries (the heart beats while the surgery is performed) are carried out for coronary artery disease and complications of myocardial infarction that requires surgical management.

Heart Valve Surgeries: The four valves of the heart may impair due to congenital or acquired reasons, resulting in structural and functional damage of the heart. The damage may transform into an irreversible form, if left untreated. The most common causes of acquired heart valve diseases are rheumatic fever in childhood, degeneration of valves secondary to aging and functional and structural alterations of the heart secondary to coronary artery disease / myocardial infarction. Heart valve diseases that are manifested by symptoms, such as shortness of breath, low exercise capacity and palpitation (heart rhythm disorders), are among the conditions that can affect all age groups.

 

In our clinic, success rates of all heart valve replacements and repairs are comparable to the global success rates. Moreover, two or more valves are operated on in combination with coronary artery bypass graft surgery in the same session.

Surgical Management of Diseases of Aorta: Aorta is the great artery that originates from the heart. Primary diseases of this artery are dissection and aneurysms (dilatation).  When a tear occurs in the innermost layer of the artery, the blood surges through the tear, but not extends to the outermost layer of the aortic wall, resulting in separation of the layers. Separation of the layers within the aortic wall, also referred to as dissection, originates at the outlet of the heart and may extend to the legs. The most significant complaint of those patients is a sudden-onset sharp pain which refers to the chest and/or back.  The outermost layer of aorta is torn in a very short time, as this weak layer cannot stand the pressure of the blood surging the dissection. Death is inevitable, if patients are not operated on within 48 hours.

All urgent surgeries of aortic diseases are performed successfully by our specialized cardiac surgeons.

Adult Congenital Heart Diseases: Congenital Heart Diseases, namely ASD (a hole between atria) and VSD (a hole between ventricles), are typically diagnosed and treated in childhood. Occasionally, these two diseases may not be diagnosed until adulthood. ASD and VSD cause irreversible damage of lungs after the age 45-50, as they cause excessive blood supply to lungs. Diagnosis and treatment before this stage are very important. For the patients with irreversible lung damage, surgery is not an option and unfortunately, they pass away at 50-60 years of age.

Surgeries of these diseases that are diagnosed by experienced cardiologists can be successfully performed in our cardiovascular surgery clinic.

Minimally Invasive Heart Surgery: Today, performing a heart surgery with well-known outcomes using special equipment through a small incision or without using heart-lung machine provides patients quick recovery, less pain and earlier engagement in daily life activities. In our clinic, valve surgeries are carried out and ASD can be closed successfully through an approximately 10-cm incision made in arm or beneath the breast.

Atrial Fibrillation Surgery: Atrial Fibrillation (AF) is a common arrhythmia that affects 0.4% of the general population and this rate increases up to 10% in those above 65 years of age. 60% of patients who will undergo mitral valve surgery and 5% of patients who will undergo coronary bypass surgery have AF rhythm. Treatment of atrial fibrillation during heart surgery can remarkably improve the outcome of the surgery and the postoperative functional capacity. For AF surgery, both Radiofrequency Ablation (heat application) and Cryo-Ablation (Cold application) can be successfully performed in our clinic.

Cardiology Clinic of Kolan Hospital Group renders healthcare services with its cutting edge technological equipment that meet international standards and top level infrastructure in accordance with the purpose of protecting cardiac health and diagnosing and managing diseases and disorders of heart and blood vessels.

Contribution of Pediatric Cardiology Clinic offers the opportunity of diagnosing and treating all patients with heart diseases, ranging from newborns to elderly patients.

Cardiology Clinic diagnose, treat and rehabilitate patients with heart diseases in addition to coronary intensive care.

Arrhythmia and Cardiac Electrophysiology

Diagnosis and treatment of cardiac rhythm disorders are planned at this division. Instant ECG recording is required for diagnosis of rhythm disorder. For this purpose, event recording devices, also referred to as Rhythm Holter, are used. Tilt table test that is used to investigate etiology of syncope is also available in rhythm disorder outpatient clinic. Patients with cardiac pacemaker are followed up and batteries of pacemakers are checked here.

There are various types of rhythm disorders that cause tachycardia. Such disorders originate from electrical anomalies at various parts of the heart. A tissue that is not found in the heart under normal circumstance is responsible for abnormal electrical discharges. Similar to the coronary angiography, a catheter is inserted into femoral artery and advanced to the heart; the tissue is identified and destroyed. This procedure is referred to as catheter ablation. Radiofrequency ablation or cryoablation is used to destroy the abnormal tissue. Electrophysiology device is necessary for catheter ablation. Patients stay at the hospital for one night for follow-up. The procedure is carried out under local anesthesia. Success rate is almost 100% for many rhythm disorders.

Invasive Cardiology

Cardiac Catheterization and Coronary Angiography

Coronary artery is the vessel that supplies blood to the cardiac tissues. If patient specifies complaints that are suggestive of stenosis of coronary arteries or if first-line tests (cardiac stress, stress echocardiography, thallium test etc.) point to a disorder, cardiac catheterization and coronary angiography is done to determine location and severity of the stenosis. If a critical stenosis (narrowing) is found, treatment options are balloon angioplasty – stent implantation or bypass surgery. Coronary angiography is safely done through the puncture of femoral artery and radial artery at our hospital. Moreover, if femoral artery is punctured for the procedure, the artery is sealed with a substantially safe and pain-free novel method and the patient can be mobilized earlier.

Balloon Angioplasty – Stent Implantation

Stenotic segments of coronary arteries are dilated by placing a balloon into the lumen of the artery and/or implanting a stent in the catheter laboratory. Patients are discharged after they are monitored and followed up for a night, if no complication is observed; patients can engage daily routines within shortest time.

 

Urgent Coronary Balloon Dilatation and Stent Implantation During Heart Attack (Acute Myocardial Infarction)

It occurs due to sudden occlusion of coronary arteries that supply blood to the cardiac tissues. The event that suddenly occludes the coronary artery is clot formation on a plaque secondary to the tear of the plaque. Cardiac muscle tissue gets damaged when the coronary artery obstructs. Thrombolytic medicines should be urgently started or balloon dilatation and stent implantation are urgently done to minimize the damage. When patients with myocardial infarction present to or are brought to our hospital, blood flow is restored in obstructed or almost obstructed coronary arteries with balloon angioplasty and stent implantation round the clock. Those patients are monitored at coronary intensive care unit until they are stabilized.

Moreover, catheter method is used to close some congenital heart holes in adults.

Patent Foramen Ovale Closure with Catheter Method

It is a hole in configuration of valve secondary to insufficient closure of a membrane located between right and left atria of the heart that should spontaneously close after the birth. The valve opens when intrathoracic pressure increases (cough, sneezing, spraining) and blood flows bidirectionally between two atria. When the blood flows from the right atrium to the left atrium without being filtered in the lung, small particles and clots found in blood migrate to brain and other organs and cause stroke and infarction of organs. If such holes cause stroke or if it is not possible to start anticoagulant treatment (blood thinners), they are closed by qualified physicians of our hospital with a method similar to the angiography.

Temporary Pacemaker

Heart beats are transiently blocked or seriously slow down temporarily in some conditions. Such conditions may spontaneously disappear. Similar to the angiography, an artery located in groin or neck is punctured and a cardiac pacemaker is temporarily implanted to maintain rhythm and survive the patient until the condition disappears.

Non-invasive Cardiology

Transthoracic Echocardiography: The patient is placed left flank position and examination is made over thoracic wall using a gel. The procedure is very similar to an ultrasound scan. Cardiac walls, heart valves and greater arteries are visualized and evaluated. Procedure is carried out by cardiologist. There is no exposure to X-ray. It can be performed in all age ranges with no side effect. This procedure enables evaluating cardiac valve functions, determining etiology of shortness of breath, syncope, rhythm disorders and identifying severe myometrial infarction (death of cardiac muscle) and stenotic coronary arteries (without direct visualization of vessel), if any.

Transesophageal Echocardiography

 

The procedure is similar to gastroscopy. The probe of the Echocardiography device is inserted through the mouth and advanced to esophagus for the ultrasound scan of the heart. With this approach, cardiac chambers and heart valves are fat better evaluated as the lungs do not superimpose. In some cases, it is also required when transthoracic echocardiography generates unclear images.

Cardiac Stress Test

The test is used to diagnose coronary artery diseases, determine exercise capacity and routine health examinations of patients with coronary artery disease.

The test is performed under supervision of an experienced nurse and cardiologist.

Patients are prepared according to particular rules and walk on treadmill while the inclination is gradually increased; ECG traces and blood pressure are continuously recorded.

Stress Echocardiography

Stress echocardiography is a type of echocardiography with the use of exercise methods or medicines that accelerate heart beats. In stress echocardiography, echocardiographic images are recorded immediately before and after the exercise protocol if treadmill is used or at all stages of the exercise if bicycle exercise is used. If exercise test cannot be done, medicines that increase heart rate and contraction of the heart are intravenously administered at particular intervals in pharmaceutical stress echocardiography.

Electrocardiography (ECG), Rhythm Holter Monitoring, Event Recorder, Loop Recorder and Tilt Table Test are used to diagnose and follow-up rhythm disorders in Cardiology Clinic.

Coronary Intensive Care Unit admits not only patients who have had a heart attack or at risk of a potential heart attack and who develops shock secondary to heart disease and need life support due to cardiac rhythm disorder or who have rhythm disorder that should be treated, but also patients who need close cardiac monitoring during treatment of extra-cardiac diseases. Moreover, patients who underwent cardiac operation are generally admitted to the Coronary Intensive Care Unit to improve and recover, before they are transferred to the inpatient room.

Services;

Any and all cardiac procedures can be performed at our Coronary Intensive Care Unit.

  • Thrombolytic treatment (fibrinolysis)
  • Coronary angiography
  • Stent implantation
  • Balloon angioplasty
  • Implantation of temporary and permanent pacemaker
  • Treatment of unstable angina pectoris
  • Follow-up and treatment of myocardial infarction
  • Follow-up and treatment of heart failure
  • Follow-up and treatment of rhythm disorders
  • Right and left cardiac catheterization

D

Dermatology is a science dealing with dermal and mucosal diseases, sexually transmitted diseases (STDs), and hair and nail diseases.

At our hospital where allergic skin diseases are diagnosed and managed, physical examination is followed by laboratory tests and Prick Test as well as Patch test in order to identify etiology of skin diseases such as eczema, contact eczema and urticaria (rash). The treatment is planned in accordance with the results.

Skin Patch Test

Patch Testing helps to identify the substances causing a reaction in patients who developed a reaction in case of a contact, and as to whether or not the substances are allergic.

The active substance of a drug is impregnated in a patch for medicines that are characterized with late-onset allergic reactions; the patch is attached to the back of the patient and detached 48 hours later. Skin findings are observed up to 96 hours.  The Patch test applied by our dermatologists reveals a small, red skin rash on the application area in case of an allergy.

Allergy Skin Test (Prick Test)

Prick Test is an allergy test mainly used to identify etiological factors such as house dust, grass pollens, and pet fur that result in allergic flu and asthma.

Test solutions are prepared using many allergens such as dust mite proteins, tree pollens, grain pollens, flower pollens, animal fur, molds and many other substances that are suspected to cause or has the potential of causing allergy; small aliquots of these solutions are dropped on skin of medial side of the arm or the back and the skin is slightly scratched with the aid of a plastic rod or a similar object. If an allergic reaction occurs, a skin reaction, ranging from a mild redness to remarkable stiffness and swelling depending on the severity of the allergic reaction, is observed on the skin, where the test solution is dropped. The size of the allergic reaction is measured by the physician in order to determine whether there is an allergy and which substances cause allergy, if there is an allergic reaction.

 

Our dermatology outpatient clinic diagnoses and manages following diseases.

  • Fungal Infections
  • Eczema
  • Chemical Peeling
  • Hair Loss
  • Nail Diseases and Ingrown Nails
  • Psoriasis
  • Urticaria (Rash)
  • Drug Reactions
  • Sunburns
  • Insect Stings
  • Warts
  • Skin Cancer
  • Acne and Skin Spots
  • All Allergy Tests

E

In the Department of Emergency Medicine, services are rendered round the clock based on patient care in the light of actual and scientific facts with an experienced dynamic physicians and related healthcare personnel.

Our emergency medicine department, which approaches the patient’s and their relatives’ needs sensitively, works in coordination with the other medical departments and maintains the patient’s care and follow-up processes jointly.

After patients are examined by Emergency Medicine specialists, they are referred to the related medical department, when necessary, after relevant tests and treatments.

In the Emergency Medicine Department, where services are provided using all resources that modern medicine offers, the most suitable and efficient treatment is timely offered in CRP room, observation unit, trauma room and all support units.

The fields of specialty of the Department of Endocrinology and Metabolic Diseases are Diabetes Mellitus (type 1 diabetes, type 2 diabetes mellitus, gestational diabetes), obesity (overweight), thyroid diseases, parathyroid diseases, pituitary diseases, adrenal gland diseases, hirsutism (excessive body hair), hormone-related testicular and ovarian diseases, osteoporosis and other metabolic bone diseases, lipid metabolism diseases and rare metabolic diseases.

What is Diabetes?

Most of the ingested nutrition is metabolized to glucose in order to be used as energy. This glucose is found in blood circulation and the body uses it as energy. Insulin is the hormone that ensures that the glucose in circulation enters the body cells and it is secreted from the organ named pancreas. Glucose is transported from foods into blood circulation and insulin ensures the intra-cellular transportation of it. Cells use glucose as fuel.

Diabetes is a condition that develops in cases where inadequate insulin hormones are secreted from the pancreas or where the insulin hormone cannot be used effectively, and it lasts a lifetime. In this case, glucose of the ingested nutrition cannot be used and the level of blood glucose raises. This condition is called Diabetes Mellitus.

How Many Kinds of Diabetes Is There?

Diabetes has two types:

Type 1 Diabetes: In these cases, insulin production of the pancreas is either stopped or reduced severely. There is no insulin in blood in this situation. Insulin injections are required to balance the blood glucose level. It usually develops in children and young adults, in the early life.

Type 2 Diabetes: In these cases, the pancreas keeps producing insulin nearly at normal level up to elder ages. In fact, the insulin production can even exceed normal level from time to time. However, the insulin cannot have a sufficient effect. Obesity and malnutrition will hinder insulin to show the desired effects and elevate blood glucose. Most of the patients are above the age of 40 and obese, and have familial histories of diabetes.

What Are Symptoms The Of Diabetes?

The following symptoms are occasionally seen in diabetic patients;

  • Excessive thirst and dry mouth
  • Drinking excessive water
  • Frequent micturition
  • Weight loss
  • Appetent and excessive eating
  • Blurred vision
  • Fatigue, tiredness
  • Skin infections
  • Non-healing wounds

Who Has A Higher Risk Of Developing Diabetes?

Diabetes can occur in everybody, however;

  • Individuals with familial history of diabetes (parents of children)
  • Obese (BMI > 27 kg/m²)
  • Lack of habitual physical activity
  • Individuals with known impaired glucose tolerance
  • Females with history of gestational diabetes or who deliver infants heavier than 4 kg
  • Individuals with hypertension (>140/90 mmHg)
  • Individuals with HDL cholesterol level of 250 mg/dl (blood lipid)
  • Individuals with polycystic ovary syndrome have a higher risk.

Which Conditions Are Results Of Diabetes?

Inability to control blood glucose forms short- and long-term health problems. Diabetes can cause several damages in small and large vessels and nerves. These damages are called complications.

What Are Acute Complications Of Diabetes?

There are life-threatening conditions that develop quickly in diabetes. These can cause death if not treated quickly and appropriately.

Low glucose level (hypoglycemia): An individual cannot conduct normal functions when blood glucose reduces excessively (due to redundant medications, excessive sports and insufficient energy ingestion). Hypoglycemia can be recovered quickly with the intake of a sugary fruit juice, cube sugar or granulated sugar.

Ketoacidosis: Ketoacidosis, also called diabetic coma, is an extreme condition associated with the absence of insulin. It is frequently seen in people with type 1 diabetes.

Nonketotic hyperosmolar coma: It occurs following excessive glucose accumulation in the body. It especially affects elder type 2 diabetic patients that cannot receive sufficient fluid.

What Are Chronic Complications Of Diabetes?

Prolonged elevated blood glucose causes damage in large and small vessels and problems can be seen in the organs where that damage is.

Cardiovascular diseases: Diabetes is one of the most critical risk factors of cardiovascular diseases. Risk of heart failure, heart attack and sudden death increased by 5 times in diabetic patients. Moreover, it can cause nutritional deficiencies in vein occlusions especially in leg veins.

 

Eye involvement (retinopathy): The basic cause of blindness in adults aged 20-74 is diabetes. The cause of this problem is that the possibility of becoming blind is 25 times more in diabetic patients compared to normal people. A regular and detailed ophthalmologic examination of diabetic patients is just as important as a blood glucose control.

Kidney involvement (nephropathy): It is a huge threat for diabetic patients. Severe renal diseases that may require dialysis and/or a kidney transplant can develop in 40% of patients with a poor glucose regulation.

Nerve involvement (neuropathy): It develops in about 50% of diabetic patients. Causing loss of sensation in hands and feet, it can cause vein occlusions and foot wounds and leg cuts. Diabetes is unfortunately the main cause of hand-foot losses following accidents. Nerve involvement can also cause sexual impotency in diabetic patients.

How And Why Should Diabetes Be Screened?

It is recommended to especially use fasting blood glucose in screening type 2 diabetes. Because many individuals that carry the criteria of diagnosis of diabetes are unaware of their conditions. (awareness rate is 50%). Community studies show that type 2 diabetes may exist as from 10 years before the diagnosis. In about 50% of patients with diagnosis of type II diabetes, one or more diabetic complication occurs during the diagnosis. Early diagnosis and treatment of diabetes can reduce the course of the disease and the complication development. Therefore, it is recommended that patients above the age of 45 are screened once in three years and individuals with additional risk factors are screened every year in younger ages.

How Should Diabetes Be Treated?

There is no treatment method that eliminates diabetes totally. If a good support can be obtained from the diabetes team consisting of the doctor, dietician and diabetes nurse and advices are strictly followed, a healthy and active life can be experienced. The aim of the treatment is to keep blood glucose at levels near to normal and to prevent excessive elevations and decreases. Treatment of diabetes has 3 main components; nutrition, exercises and medication.

Can Development Of Diabetes Be Prevented?

A good treatment and treatment compliance can have very good outcomes in diabetes. After the diagnosis of diabetes is made, the most important event is to prevent the complications of diabetes to develop. However, what actually matters is finding risky persons and preventing the development of diabetes by making changes in the lifestyle.

G

Gastroenterology department renders diagnostic and therapeutic services by physicians, who are specialized in internal medicine and digestive system problems, and by other relevant healthcare personnel using all possible means of cutting-edge devices.

In Gastroenterology department, all hepatic diseases, including complications of cirrhosis, but excluding liver transplant surgery, are treated with advanced innovative approach and comprehensive therapies are performed.

In addition, scans are intermittently required to follow up chronic liver diseases, especially regarding development of tumor, and necessary treatments are provided in cooperation with the radiology department for this issue.

If surgical management is required, the department cooperates with General Surgery and Radiology clinics for diagnosis and treatment of all liver diseases. Basic symptoms of gastroenterological diseases are heartburn, reflux, abdominal pain, sensation of burn at the central zone of the chest wall, nausea, vomiting, persistent tickly cough, irritation caused by particular foods, diarrhea, constipation, hemoptysis, rectal bleeding, spraining in defecation, changed bowel habits, yellowing of skin and eyes, itching and sometimes fatigue and weight loss.

Endoscopic procedures are used in diagnosis and treatment of those diseases. The procedures are carried out under sedation (intravenous sedatives), if the patient request, and thus, the patient feels no pain during the procedures.

Clinical Practices in Gastroenterology Department

  • Upper Gastrointestinal Endoscopy (GASTROSCOPY)
  • Lower Gastrointestinal Endoscopy (COLONOSCOPY)
  • ERCP (Diagnostic and Therapeutic)
  • Sclerotherapy
  • Esophageal balloon and bougie dilatation
  • Endoscopic intra-gastric balloon placement (treatment of obesity)
  • Endoscopic Mucosal Resection (EMR)
  • Stent placement to gastrointestinal tract
  • Biopsy and treatments for liver diseases
  • Inflammatory Bowel Diseases (Crohn and ulcerative colitis) Outpatient Clinic)

ERCP

Biliary tract and pancreatic diseases are diagnosed and treated using ERCP in Gastroenterology clinic.

ERCP is a special endoscopic procedure used to diagnose and treat biliary tract and pancreatic diseases with a special endoscopy device called duodenoscope.

In our gastroenterology clinic, ERCP ensures surgery-free treatment of gallstones in a short time.

Duodenoscope is inserted through the mouth and the orifice of the biliary tract is identified in the small intestine and next, the endoscope is advanced into biliary tract and pancreatic canal, if required, to visualize those anatomic structures. ERCP can also be used for therapeutic purposes, such as removal of gallstones, placement of stent (plastic or metal catheter) to manage obstructions and taking biopsy specimens.

For inoperable patients or for patients who are not medically stable to undergo surgery, bile flow is restored using tiny tubes, also referred to as stent. This procedure prevents dysfunctions of organs, such as liver and kidney, secondary to obstructive jaundice.

We intend to cure patients with gall stones and other bile duct diseases within shortest time possible based on diagnostic and treatment services rendered by our experienced gastroenterology and hepatopancreatobiliary surgery team.

Indications of ERCP

  • Choledochal (common bile duct) stones
  • Dysfunctions of Sphincter of Oddi
  • Cholangitis (inflammations of biliary tract)
  • Biliary pancreatitis
  • Injuries of biliary tract
  • Liver cysts draining to the bile duct
  • Periampullar tumors (pancreatic head-ampulla of Vater-lower end of choledochus)
  • Common bile duct (choledochus) and intrahepatic bile duct tumors
  • Chronic pancreatitis

In our hospital, ERCP procedure is performed under anesthesia following necessary workup and assessment.

Department of General Surgery provides services with its patient-oriented, qualified staff who can apply all techniques used in modern surgery.

In the department, all kinds of urgent surgical operations, gastrointestinal system surgery, endocrine surgery, oncologic (cancer) surgery, colorectal and colorectal operations are successfully performed with laparoscopic or conventional techniques.

Diagnosis and Treatment Areas of General Surgery

  • Esophageal diseases,
  • Diagnosis and treatment of gastroesophageal reflux disease,
  • Gastric diseases,
  • Morbid obesity surgery,
  • Intestinal and Colonic diseases (laparoscopic colon resection),
  • Anal diseases (hemorrhoid, fistula, fissure, anal botox injection),
  • Pilonidal sinus (ingrown hair),
  • Hepatobiliary diseases,
  • Pancreatic and spleenic diseases,
  • Inguinal and abdominal anterior wall hernia (laparoscopic and open surgeries),
  • Breast diseases,
  • Endocrine system diseases (Thyroid gland and adrenal glands),

Laparoscopic Surgery (Abdominal & Inguinal Hernia)

Abdominal and İnguinal hernias are a surgical disease characterized with bulging and spontaneously disappearing protrusion of abdominal organs through the weak spots on the anterior abdominal wall. Abdominal-inguinal hernias are important conditions as they present a clinical picture called 'herniation' that is caused by the circulatory impairment of the intra-abdominal organs in the hernia sac causing pain and swelling requiring urgent surgical operation.

Recently, the innovations in modern tissue repair and augmentation materials for the treatment of this disease group have been noticed. These innovations and laparoscopic surgery lead to more effective and less painful treatments.

When medical or medication treatment does not help abdominal-inguinal hernia, open and laparoscopic surgery can be successfully performed by the experienced laparoscopic surgery team using state-of-the-art facilities of our hospital.

Reflux Surgery

Recently, we use advantages of laparoscopic surgery, namely less pain and shorter recovery period, also in treatment of the reflux disease. Laparoscopic fundoplication is commonly used worldwide to reconstruct the impaired valve between the stomach and the esophagus and to prevent the leakage of gastric contents into the esophagus. Procedure lasts approximately 1 to 1.5 hours and patient can be started on oral nutrition the day after surgery, discharged in same day or the day after and can resume working within 7 days. All advantages of laparoscopic surgeries are utilized (less pain, shorter hospital stay and absence of postoperative risks). Thus, quality of life is undoubtedly enhanced, since patient does not need to take pills every day for years, esophageal inflammation regresses and risk of cancer is eliminated that is secondary to chronic inflammation.

Surgical Oncology

Gastrointestinal diseases may require resection of an organ of the digestive system partially or completely: Such as resecting stomach due to gastric ulcer, resecting a part of the colon due to colonic diverticular disease. In these diseases, it is sufficient to resect the relevant organ partially or completely. However, if the surgery is indicated due to cancer, even the total resection of the organ may not be adequate. In addition, all lymph nodes with the risk of involvement should be removed. Therefore, the lymph nodes should be resected by DII lymphadenectomy in gastric cancer, and total mesorectal excision should be performed in the cancers of the distal colon. If these principles are strictly followed, the prognosis is often better. A multidisciplinary treatment approach is adopted when the cancer is treated surgically. For this purpose, individual treatment plans can be identified in the multidisciplinary Tumor Councils for cancer patients by discussing the choice of the open or closed (laparoscopic) methods.

Endocrine System Surgery (Thyroid, breast surgery)

Hormonal or endocrine system; has a vital importance for the integrated and harmonized functioning of body parts or organs.

The diseases of the endocrine organs or glands have been known for a long time and constitute a group of common diseases. The thyroid, parathyroid and adrenal glands are components of the hormonal system that fall into practice field of the general surgery.

Thyroid gland diseases are very common in the population, and they require long-term, even life-long follow-up and treatment in several cases. Thyroid nodules; are one of the most common diseases, and their cancerous potential and the treatment options are the most important problem of the disease. Current surgical methods, vascular closure devices, intraoperative identification of nerves that innervate the vocal cords allow safer operations of the thyroid gland in our hospital.

The parathyroid glands are the endocrine glands that are frequently located adjacent to the thyroid glands and they have very important hormonal functions. Early diagnosis and treatment of hormonal diseases associated with parathyroid glands are also important because these diseases may cause permanent damage.

Adrenal glands located on the top of both kidneys are another organ with vital importance in our hormonal system. Recently, the incidence of adrenal gland diseases is significantly increased due to the advanced diagnostic methods such as CT and MRI. As a result of increased incidence, laparoscopic surgery, a less invasive method, has been successfully performed in the surgical treatment of the adrenal tumors, especially the benign tumors.

Treatment of Hemorrhoidal Disease, Anal Fistula and Anal Fissure

 

Treatment will vary depending on the grade of hemorrhoid. For Grade1 hemorrhoid, medications, regulation of bowel habits, avoidance from hot pepper and spices and prevention of constipation will usually be sufficient.

For Grade 2 hemorrhoid, medical treatment, infrared coagulation and rubber band ligation are possible options. Rubber band ligation is a very effective method for internal hemorrhoids which do not meet indication of surgery. This pain-free procedure lasts within short time (5-10 minutes). Patient may immediately engage in routine daily life activities.

For Grade 3 hemorrhoids, rubber band ligation and surgery should be considered, while the only option is surgery for Grade 4 hemorrhoid. Hemorrhoid plies are completely extirpated and thus, the disease is completely and immediately eliminated. Among all treatment modalities, the only method with highest efficiency and lowest recurrence rate is surgery.

Recently, less invasive (less painful) or non-surgical treatment modalities are employed in the treatment of common anal canal diseases that affect the quality of life such as hemorrhoidal disease, anal fissure or anal and perianal fistula. Longo surgery which we carry out for hemorrhoidal disease is an example of less invasive (minimally invasive) treatment; and perianal Botox injection is an example of non-surgical treatment reserved for anal fissure, a very painful disease.

Colorectal cancer

Diagnostic methods such as anoscopy, sigmoidoscopy and colonoscopy used for direct visualization of colon and anal canal allow early diagnosis as well as the treatment of certain diseases such as colonic polyps. In addition, CT and MR play an important role in the early diagnosis of diseases.

Recently, surgical treatment of colonic diseases has advanced significantly and laparoscopic colon surgeries have been frequently performed in advanced care centers just like our hospital. The patients experience less pain in the postoperative period thanks to laparoscopic colonic surgeries and the hospitalization period is significantly shortened.

Obesity Surgery

Obesity surgery consists of several surgical techniques to treat overweight. These operations principally make some modifications in the digestive system. Today, all of them are laparoscopically performed, i.e. closed methods.

The most important cause of obesity is excessive food consumption, leading to excessive calorie intake. If significant amount of fat accumulates in the body, the metabolism is totally disturbed and the satiety level gradually increases.

In the obesity surgery, basically two operations are performed. One of them is to reduce the gastric volume. If you decrease the capacity of stomach from 1 to 1.5 liters to 100 ml, the patient feels full even with very small quantities of food. This feeling of satiety is the superiority of obesity surgery over other methods. Because, all other methods recommended to the patient whether called diet or healthy nutrition, are condemned to fail due to the feeling of hunger and insatiate.

The other operation performed in our hospital is to shorten the length of the intestine, where the food is digested, by creating a new passage between the stomach and the small intestine. In this operation, no bowel is resected; just the food absorption is reduced by tying 1.5 to 2 meters of the small intestines.

The most common operation in the first group is laparoscopic sleeve gastrectomy. It is widely known as “tube stomach”. In this operation, no apparatus or tube is placed into the stomach. A large part of the stomach (85%) is excised. Since the remaining stomach resembles a thin tube, the operation is called as tube stomach.

The most common operation in the other group (i.e. reduced absorption group) is gastric bypass. In this surgery, the stomach is reduced. The small stomach pouch is attached to the distal end of the small intestine. The aim is to eliminate absorption of a part of fat and caloric content of foods.

This group is the most potent modality in obesity-related metabolic diseases including diabetes, hypertension and hypercholesterolemia. Without waiting weight loss as in others, blood sugar levels are restored to normal ranges, blood pressure is regulated and blood lipids decrease to physiological ranges. We frequently observe that our patients with blood glucose readings about 450 mg/dl, diabetic foot and  renal problems discontinue insulin and antihypertensive agents following the surgery.

Today, all these surgeries can be performed with only 4 to 5 small incisions (the largest one measuring 1.5 cm), without opening the abdomen thanks to the technological developments. Thus, the post-operative comfort of the patients has improved drastically. Therefore, our patients may engage in daily activities mostly within 5-7 days.

Gastrointestinal Cancer Surgery

Gastric cancer is the 4th most common cancer. In our country, approximately twenty thousand people are diagnosed with gastric cancer every year. The risk of gastric cancer is higher for men. In the elderly, gastric cancer is more common.

The large intestine, also referred to as colon, is about 2 meters long and comes after the small intestines in the digestive system. Colon cancer is an important disease which is common especially in western countries. The incidence is about 5/10.000 in the general population. Colon cancer is equally prevalent in men and women and it is the third most common cancer.

 

Laparoscopy, Endoscopy, Minimally Invasive Surgery

Laparoscopic or minimally invasive technique, or better known as closed method surgery in public, is a special field of surgical practices. Although laparoscopy was first used in surgical management of gynecological diseases, it has started to be used in gall bladder, pancreas, liver, stomach and intestine surgeries with advanced technology and became increasingly widespread all over the world. In the open or conventional surgery, a longitudinal abdominal incision had been required to reach the abdominal cavity. However, laparoscopic surgery requires only several small incisions, measuring 0.5 to 1 cm in length. Trocar implies cannulas inserted into the abdominal cavity through the port sites.

A camera used for intra-abdominal imaging through trocars and many instruments specially designed for these techniques are inserted into the abdomen, and surgeries are completed. The abdominal cavity is inflated and enlarged with carbon dioxide gas to facilitate visualization. Thus, intra-abdominal organs are pulled away from each other and a cavity is created for the surgery.

 

The images taken by the camera are transferred to the video monitors found in the operating theater. The surgeon views these intra-abdominal images on the monitor during the surgery. This system allows the surgeon to perform several surgeries with traditional methods through smaller incisions. The endoscopic examination of stomach is called as ‘gastroscopy’. If the procedure focuses on colon, the procedure will be “colonoscopy”. Gastroscopy focuses esophagus, esophagogastric junction, stomach, pylorus and duodenum.

 

Breast Cancer Surgery

Benign breast diseases range from abnormal breast development and breast infections to circulatory disorders of the breast and benign masses.

The malignant diseases of breast with certain frequencies include malignant masses located in the breast and malignant diseases that are first manifested by the involvement of the nipple and progress to skin disorders.

Today, surgical and medical approaches for breast diseases continue to advance, and our success rates increase with more promising outcomes as compared to the past.

Especially, the breast conserving treatments, as compared to the past approaches to the breast cancer, improve patient health with more cosmetic outcomes by performing optimal surgical methods individually for each patient in the light of our experience.

In intensive care units, critical patients are treated when they need life support. Contrary to other departments, intensive care units have more advanced technology devices. They are very special units, where patients are monitored by specialist physicians and nurses and life support is maintained continuously. Cutting edge devices are used at diagnosis, follow-up, treatment and support phases in Intensive Care Unit, and all medical conditions can be managed and patients are supervised by physicians round the clock.

 

Intensive Care for Cerebral Hemorrhages

 

Cerebrovascular diseases (such as stroke, paralysis) may cause disabilities and even death. Cerebral hemorrhage should be particularly diagnosed early, and these patients need to be managed in intensive care unit and even operation may be necessary. In our hospital, patients with cerebral hemorrhage are managed and supervised by experienced physicians. Patients admitted to intensive care unit are started on care and follow-up plan by nurses starting in the first day. For patients who cannot swallow or who should not swallow, foods are transferred into the stomach using a fine tube that is placed through the nasal cavity. Gastrointestinal route is used for nutrition of the patients as far as possible.

 

Sepsis and Intensive Care

 

Sepsis is a serious disease which implies an extraordinarily severe reaction of the body against an infection. The reaction of the body against an infection is accurately targeted to the infection site under normal circumstances. In sepsis, immune system begins a chain reaction to fight against the infection. The reaction of the body causes generalized symptoms rather than localizing them at the infection site. This condition is also referred to as systemic response. As a result of this systemic response, patients with sepsis generally develop fever, tachycardia, and hyperventilation. For some patients, the reaction against the infection gets out of control, impairs the biological harmony of the body or damages one or more than one vital organ. This systemic reactions is more hazardous than the infection itself. Medical approach to sepsis patients is very important. Patients should necessarily be followed up and treated in Intensive Care Unit.

 

COPD, Pneumonia and Intensive Care

 

Acute COPD attack is defined as an exacerbation that can be associated by progressed shortness of breath, poor daily performance, changes in amount and color of sputum, increasing severity of cough, fever and/or impaired mental condition for a stable patient. Acute attack implies persistence of one or more than one symptom mentioned above for at least 24 hours. Symptoms of attack may also be accompanied by complaints such as fatigue, tiredness, sleeplessness, depression and confusion. COPD cases develop 1 to 4 acute attacks every year. A great majority of mild acute attacks can be treated at home without need of hospitalization. However, moderate and severe attacks should necessarily be managed in Intensive Care Units of hospitals.

In Gynecology and Obstetrics, advanced diagnostic and therapeutic services are rendered by specialist physicians using modern medical methods for managing gynecologic and pregnancy-related problems.

FEMALE HEALTH

Kolan International Hospital provides services regarding all processes of general female health, ranging from menopause, osteoporosis, supervision of pregnancy and supervision of high risk pregnancies to reproductive health center (IVF-Test Tube Baby).

ADOLESCENCE PERIOD

Adolescent gynecology is one of the most important issues dealt by Gynecology Clinic. Complaints of this period vary from that of adult period and gynecologic examination has unique features for this age group. In addition to routine protocols, such as supervision of adolescence development of girls and vaccination programs that aim prevention of cervix cancer, diagnostic and therapeutic services are also available for other health problems, such as menstrual disorders and abnormal hair growth.

 

SUPERVISION OF HIGH-RISK PREGNANCY

Conditions posing risk for maternal and fetal health are timely identified to make the pregnancy healthy and problem-free to the maximum extent; awareness of expectant mothers are raised and the pregnancy is supervised for high risk pregnancies. Mother and baby are supported to overcome this process in a healthy state.

BIRTH

Kolan International Hospital ensures the comfort to make expectant mothers feel themselves in a peaceful and trustworthy environment, while the perfect moment waited for 9 months is getting close.

 

Delivery method is decided according to the initial assessment made after delivery starts and the pre-partum findings.

In the Department of Gynecology and Obstetrics, delivery methods include spontaneous (vaginal) delivery, caesarean section (general anesthesia), delivery under epidural anesthesia and delivery under spinal anesthesia.

“Gynecology and Obstetrics Clinic targets high rates of pregnancy and live birth in the light of recent developments."

H

All disorders of hands and arms are diagnosed and surgically managed with elective or urgent surgeries in the division of hand surgery.

All fractures and dislocations as well as resultant complications, such as malunion, non-union and articular discordance, are treated in the division of hand surgery.

Following conditions of hands and arms are treated using microsurgical methods.

  • Tumors
  • Open wounds
  • Vessel, Nerve and Tendon Injuries
  • Tissue losse
  • Day surgeries are preferred for conditions such as nerve entrapments, tendinitis and arthritis secondary to excessive use. Arthroscopic surgery can be performed for wrist problems.

Hematology is a field of science that primarily studies diseases, such as lymphoma, multiple myeloma and acute and chronic leukemia as well as diseases related to bone marrow, lymph system and blood. A major part of blood diseases includes conditions that have vital importance. Treatment of those diseases requires a good team work and experience. Hematology is one of the fields of science, which important developments have recently occurred, treatment options have increased and clinical studies are intensively conducted. Hematologic cancers can be ever increasingly treated.

 

The experienced hematology team carries out successful transplantations in our Bone Marrow Transplant Center. Any and all bone marrow transplantations (unrelated, related, haploidentical) are performed.

 

Department of Hematology is one of the rare centers, where experienced physicians and healthcare personnel work in coordination with other sub-specialty departments, such as Endocrinology, Nephrology, Rheumatology and Gastroenterology in order to meet high chemotherapy standards and ensure implementation of multidisciplinary approach.

Recently, the term “bone marrow transplantation” is used like an idiom.  Actually, it means the transplantation of stem cells located in the bone marrow to produce new blood cells. Those stem cells are called blood stem cells. Blood stem cells are transplanted either from another person (allogeneic blood stem cell transplant) or from the patient (autologous blood stem cell transplant).

Allogeneic Stem Cell Transplantation

Some molecules (human leukocyte antigens: HLA) on tissue cells of patient and the donor should match in the allogeneic stem cell transplant. The donor that matches the patient’s HLA (tissue type) is first searched in the family. If no matched related (sibling and other relatives) donor can be found, an unrelated donor is searched in bone marrow banks, where voluntary donors are registered. In the allogeneic stem cell transplant, the reaction developed by blood cells that produce new blood cells against the body of the recipient despite full match is useful, as the reaction is somewhat a biological treatment (Graft Versus Leukemia Effect) targeted to malignant cells of the patient. However, if the reaction occurs in an exaggerated form, organ damage can develop (GRAFT VERSUS HOST DISEASE). All patients and donor candidates are assessed regarding this risk, before allogeneic stem cell is transplanted; if there is option of selection, the best candidate is selected.

Autologous Stem Cell Transplantation

In autologous stem cell transplantation, high-dose chemotherapy is administered that destroys the blood production system completely and patient’s own stem cells that were harvested and stored previously are transfused back to the patient to restore blood production process. In contrast to the allogeneic stem cell transplantation, diseased cells can be transfused back to the patient, as patient’s own bone marrow is used. Moreover, the biological treatment (GRAFT VERSUS LEUKOMIA EFFECT) is not the case that can be developed by foreign blood cells. Therefore, the risk of recurrence is higher after autologous stem cell transplantation comparing to the allogeneic stem cell transplantation. However, this type of transplantation is characterized with less adverse effects, as a biological reaction will not be caused by foreign blood cells.

How Are Stem Cells Obtained?

Blood stem cells are either directly harvested from the bone marrow or stem cells are forced to migrate from the bone marrow to the blood circulation and they are harvested from the peripheral blood using cell separation devices (apheresis); or blood stem cells are obtained from the maternal part of the umbilical cord that is disposed after the birth.

How is Blood Stem Cell Transplanted?

Blood stem cells are transplanted by intravenously transfusing the stem cells to the blood circulation. This is not a surgery.  Transplanted blood stem cells use indicators to identify the bone marrow, where they settle and start producing new blood cells. As it may take approximately two weeks to start production, the count of blood cells gradually decreases and the patient requires medical treatment (blood transfusion, antibiotics in case of fever, chemotherapy or medications for diarrhea and abdominal pain related to the transplantation). This medical treatment period is accompanied by the risk of death. Therefore, blood stem cell transplantation can be performed by physicians and healthcare team that have knowledge and experience in this field.

Who are eligible for Blood Stem Cell Transplantation?

Blood stem cell transplantation, colloquially referred to as bone marrow transplantation, is a part of the treatment that aims restoration of the blood production system. Today, it forms a part of treatment for especially some malignant blood diseases.

Blood stem cell transplantation is a treatment method that is reserved for some diseases like defective production of blood, metabolic diseases, immune system disorder etc. in the background.

Why Is Health Screen Made After Blood Stem Cell Transplantation is Decided?

Blood stem cell transplantation is generally performed following a heavy chemotherapy, radiotherapy or chemoradiotherapy. Patients receive a health screening to foresee, albeit partly, side effects of the treatment and the risk of organ damage caused by biological reaction, if allogeneic transplantation is performed. The infections (sinusitis, dental problems) are treated, as they pose risk when the blood counts decrease after chemotherapy is started. If patient is hypertensive, it is regulated with medications. Type of disease, response to the preparation regimen, accompanying diseases (comorbidities) like hypertension, heart disease, renal disease and so on, advanced age of the patient and the donor and history of pregnancy (for women) are the factors that affect the success of the transplantation negatively.

 

Where is Blood Stem Cell Transplantation Performed?

If the primary physician who diagnoses the blood disease decides blood stem cell transplantation for the patient, the patient is referred to the transplantation center of the facility or transplantation center of another facility, if there is no transplantation center at the hospital, where the disease is diagnosed, and next, the decision should be approved by a scientific council. After it is clarified by the council that the transplantation helps the disease, the patient is started on the transplantation program. Serious assessment, evaluation and observation of the patient before and after the transplantation are important.

Bone marrow transplantation center, patient rooms and corridors of the unit are equipped with HEPA filter than eliminates particles and minimizes the risk of infection. Our hematology clinic that is founded by Assist. Prof. Şebnem İzmir Güner, M.D., who is well-known for her knowledge and experience in this field, cooperates with Internal Medicine and Blood Diseases clinic in order to serve local and international patients based on versatile specializations and healthcare services.

How Can You Apply to our Bone Marrow Transplantation Center?

Phone: Call the Bone Marrow Transplantation Council at 0 (212) 222 0 888 or 444 1 443 to schedule an appointment.  If you wish, you may meet our physicians in person.

Hair transplant is the procedure of transferring healthy and strong hair follicles from the donor site, generally at the posterior part of the head, to the bald or almost bald areas of the scalp. Modern surgical technologies enable highly natural appearance in the hair transplant. Thus, psychological traumas and isolation from social life due to hair loss are eliminated and individuals feel stronger.

I

Internal Medicine is a discipline which forms a basis for all clinical branches. It is aimed to provide the patients with the most appropriate and effective healthcare service through the advanced diagnostic and therapeutic methods and the opportunities offered by the advanced medical technology in addition to the physicians and healthcare professionals who are specialists in all fields related to the Department of Internal Medicine.

The General Internal Medicine service has been provided through an innovative sense at a center including ambulatory outpatient examinations, treatments of inpatients, preoperative preparations and necessary interventions, emergency service, and check-up.

Check-up programs that are designed according to all age ranges, genders and complaints are available in Kolan Hospital Group. Within the scope of check-up programs, a quality service has been provided through physical examinations and detailed laboratory (blood, urine and stool tests), radiological and cardiologic examinations made by the specialist physicians with all opportunities provided by the advanced technology products.

Department of Internal Medicine aims to be an international center, where medical technological procedures of the diagnosis and treatment unit are performed.

Internal Medicine is a discipline which consists of six major divisions.

  • Endocrinology (Hormone Diseases)
  • Gastroenterology (Digestive System Diseases)
  • Rheumatology (Rheumatic Diseases)
  • Nephrology (Kidney Diseases and Hypertension)
  • Hematology (Blood Diseases)
  • Oncology (Benign Tumors and Cancers)

Moreover, the Internal Medicine Unit applies a ‘’Comprehensive Geriatric Assessment Program’’ for older adults. Whenever required, patients are consulted with other specialized departments, such as Neurology, Psychiatry, Orthopedics, Ophthalmology, Otorhinolaryngology, and Physical Medicine and Rehabilitation.

Diabetes

Diabetes mellitus is a metabolic disorder that is usually caused by a combination of hereditary and environmental factors and results in high blood glucose levels (hyperglycemia).

Diabetes develops either due to a deficiency or total lack of insulin production (Type 1 diabetes) or insulin resistance (Type 2 diabetes) or during pregnancy (gestational diabetes). Other symptoms of diabetes are impaired vision, loss or gain of weight with no clear reason, fatigue, and changes in energy metabolism. Injection of insulin by syringe, insulin pump or insulin pens is the most basic treatment method of Type 1 diabetes. However, Type 2 diabetes is regulated through exercises, life style modifications, diet, antihyperglycemic drugs, and insulin supplement or a combination of them.

Diabetes and treatment methods used in diabetes may lead to many complications. If the disease is not well-controlled and followed up, emergency complications such as hyperglycemia, ketoacidosis or non-ketotic hyperosmolar coma (diabetic coma) may develop. Major chronic (long-term) complications are circulatory (heart and cardiovascular) diseases such as hypertension, congestive cardiac failure and atherosclerosis (vascular occlusion), chronic renal failure (nephropathy), retinal damage that may lead to blindness (retinopathy), various types of nerve injuries (peripheral neuropathy), and microvascular diseases that lead to impotence (sexual problems, loss of sexual drive etc.) and delay in wound healing. Particularly, the poor wound in feet secondary to circulatory problems may result in amputation.

Endocrine

There are many hormones regulating the healthy functioning of our body, and many organs secreting such hormones. Endocrinology deals with diseases caused by insufficient or excessive production of these hormones.

Major examples of those diseases are as follows:

  • Diabetes (Diabetes Mellitus)
  • Hypertension
  • Thyroid Diseases (Goiter etc.)
  • Adrenal Diseases
  • Obesity
  • Osteoporosis (bone loss)
  • High Cholesterol, High Triglyceride
  • Abnormal hair growth
  • General Internal Medicine

When necessary, internists work in cooperation with subspecialties, such as Endocrinology, Nephrology, Hematology, Gastroenterology, Rheumatology, and other departments such as Cardiology, Chest Diseases, Infection Diseases, Neurology, and Psychiatry in accordance with the diagnosis made in the Department of General Internal Medicine, and thus, patient’s all health problems are solved by consulting with the relevant departments.

Services rendered by the Department of General Internal Medicine include check-up programs in addition to outpatient examination, inpatient treatment and follow-up. Check-up is a comprehensive healthcare screening made periodically in accordance with the patient’s gender, age, and risk factors, even if the person has no complaint. Check-up programs enable early diagnosis of many fatal diseases, and the success rate of the treatment is maximized, if the condition is diagnosed early.

Gastrointestinal Diseases

  • Reflux Disease
  • Gastritis
  • Gastric Ulcer and Gastrointestinal Bleeding
  • Indigestion,
  • Diarrhea
  • Colitis (Ulcerative Colitis, Crohn’s Disease)
  • Constipation, Hemorrhoid
  • Liver Diseases (Hepatitis A, B and C, Cirrhosis, Fatty Liver Syndrome, Jaundice)
  • Gallbladder Stones and Inflammations
  • Familial Mediterranean Fever
  • Pancreatic Inflammations
  • Cancers (Esophagus, Stomach, Bowel, Liver, Pancreas)

Gastroesophageal reflux disease (GERD), which is colloquially abbreviated as reflux, is a condition in which the gastric contents (gastric acid, bile) leak backwards from stomach into esophagus. However, when reflux recurs frequently during the day or persists for a long time and especially occurs during sleep, it is termed as pathological reflux. The condition causes the typical symptoms, such as heartburn and esophageal damages (erosion and ulcers) varying in severity. In this case, it is diagnosed as ‘’gastroesophageal reflux disease’’ (GERD)’’, or ‘’reflux disease’’ in colloquial terms. If the reflux disease persists for a long time and is not treated adequately, it may cause the esophageal stricture (narrowing of the esophageal lumen), which is seen in approximately 10% of patients with reflux. The major symptom is difficulty swallowing.

Other probable complications of reflux disease are more severe problems which may be caused by chronic laryngitis, asthma and aspiration of gastric contents into the respiratory tract. A severe and silent complication of gastroesophageal reflux disease is Barrett’s esophagus. Incidence of esophageal cancer in patients with Barrett’s esophagus is 50 times higher than the general population. A person with these symptoms should necessarily visit a doctor and be followed up and treated.

Gastritis

Gastritis is somewhat an inflammation of gastric mucosa. It may be acute or chronic in nature. The most common reason of chronic gastritis is a microbe called as Helicobacter pylori (HP).

Ulcer

If gastritis progresses and is left untreated, it may first cause erosion followed by ulcer on gastric mucosa due to deepening of the erosion.

Gluten-Sensitive Enteropathy (Celiac Disease)

Small intestine is an important organ where food is digested and absorbed. Celiac disease, which is also known as gluten-sensitive enteropathy, is a disease that impairs digestion and absorption of nutrients in bowels. The patients with celiac disease are sensitive to ‘’gluten’’, a protein contained in wheat, barley, rye and to some extent, oat. Impairment of digestion and absorption first leads to diarrhea followed by deficiency of nutrients in body over the time. It may lead to some symptoms such as anemia, iron deficiency, diarrhea, swelling or weight loss. When celiac patients are on a gluten-free diet, the damage in their small intestines heals. However, if they start to consume the food that contains gluten again, symptoms of the disease reappear.

Irritable Bowel Syndrome (Spastic Colitis)

Irritable bowel syndrome (IBS) is a functional bowel disease accompanied by changes in bowel habits, abdominal distension and gas and abdominal pains.

Causes of Nausea and Vomiting

Gastroenteritis: If nausea and vomiting are followed by diarrhea, one of the probable causes may be viral gastroenteritis (inflammation of digestive system). It can be accompanied by headache and fever. Viral gastroenteritis is the most common reason of nausea and vomiting in children. This problem generally recovers within 24 – 48 hours. The principal treatment of viral gastroenteritis is fluid replacement. Thus, the patients are recommended to drink plenty of ‘’clean’’ water. If required, the lost fluid and electrolytes are replaced intravenously.

  • Food poisoning
  • Pregnancy
  • Ulcers, strictures and occlusions in digestive tract, inflammations in pancreas, inflammations and occlusions related to gallbladder and bile tracts, inflammation of peritoneum, appendicitis etc.)
  • Infections
  • Myocardial infarction (heart attack)
  • Renal and adrenal gland diseases
  • Radiotherapy
  • Eye diseases
  • Malignant diseases
  • Conditions causing an increased intracranial pressure (Hypertension, cerebral hemorrhage, cerebral edema or tumor)

If the condition is not treated, the electrolyte loss (potassium, chloride etc.) may cause severe fluid loss, electrolyte disorders, weight loss and blackout.

Inflammatory Bowel Disease

The term inflammatory bowel disease (IBD) covers ulcerative colitis and Crohn’s disease. Ulcerative colitis is a chronic and inflammatory disease which affects the inner surface of the large intestine. While Crohn’s disease can involve any part of the gastrointestinal system from the mouth to anus, it is more commonly found at the end of the small intestine (the ileum) where it joins the beginning of the large intestine. In comparison with ulcerative colitis, it causes an inflammation which affects all layers of the gastrointestinal wall. At active inflammation stages, the inner surface of the intestine is red, swollen, ulcerative and bleeding.

Ulcerative Colitis: The most common symptoms of ulcerative colitis are diarrhea, feeling of urgency to defecate, abdominal pain, and rectal bleeding (blood in the stool) with/without defecation. Some patients may feel loss of appetite, tiredness and weakness. Though the bleeding is usually minor, it may sometimes be serious, and anemia may develop. Arthralgia (joint pain), swelling and red eyes, and problems related to the liver are other symptoms of the disease. These problems may be solved after recovery of colitis.

Rheumatic Diseases

Rheumatology deals with rheumatic inflammatory diseases and other musculoskeletal system diseases which generally develop as a result of dysfunction of the immune system.

Major Diseases

  • Rheumatoid arthritis
  • Spondyloarthropathies and ankylosing spondylitis
  • Behçet’s disease
  • Connective tissues diseases: Systemic lupus erythematosus, scleroderma, mixed connective tissue disease, Sjögren’s syndrome and dermatomyositis, polymyositis
  • Familial Mediterranean Fever
  • Acute rheumatic fever
  • Crystal arthritis (Gout)
  • Infectious arthritis
  • Amyloidosis
  • Metabolic and degenerative diseases: Osteoarthritis, osteoporosis, osteomalacia, Paget’s disease etc. are the most common rheumatic diseases.

Arthritis: In addition to arthralgia, existence of swelling, warmth redness or limited motion of the joint points to the inflammation of the joint.

Hypertension

Hypertension means blood pressure above physiological ranges. Though normal blood pressure varies from person to person, it should be respectively maximum 130 mmHg for systolic pressure and maximum 85 mmHg for diastolic pressure.

In our day, accepted blood pressure for a normal adult at rest is 120/80 mmHg (millimeter mercury).

Blood pressure is usually low, while a person is sleeping; on the other hand, it elevates during temper or excitement. The upper limit of the normal range is 140/90 mmHg (millimeter mercury).

Hypertension is a major risk factor for heart diseases. If it is not treated, it drastically increases risk of severe disease and mortality in severe cerebral, cardiovascular and renal diseases.

Hypercholesterolemia

 

Hypercholesteremia is blood level of cholesterol above normal ranges. If blood contains a high level of cholesterol, it accumulates in blood vessels and causes hardening and narrowing of the blood vessels (arteriosclerosis).

Metabolic Syndrome

Metabolic syndrome is a modern life disease. Metabolic syndrome threatens the individuals with sedentary work, and the incidence is increasing not only in our country but also worldwide.

Patients with desk work, unhealthy nutrition and intensive stress are at highest risk for this syndrome.

Metabolic syndrome increases the risk of heart disease and diabetes, as the age advances. Before the disease occurs, it is necessary to eliminate the risk factors which cause the disease. Enlarged waist circumference, hypertension, high cholesterol, and borderline hyperglycemia are the symptoms of metabolic syndrome. If it is not treated timely, it may lead to heart attack, diabetes mellitus, stroke, and obesity.

Risk Factors

Female Male

 

Abdominal Obesity (Waist Circumference)          > 88 cm                       > 102 cm

 

Triglyceride                                                  > 150 mg / dL    > 150 mg / dL

 

HDL-C                                                           < 50 mg / dL                  < 40 mg / dL

 

Blood Pressure                                           130/85 mm / Hg            130 / 85 mm Hg

 

Fasting Blood Glucose                                110 mg / dL                  110 mg / dL

Thyroid Diseases

The thyroid is a gland, which stands as two symmetrical parts in front and at the back of throat and controls body secretions by secreting T3 and T4 hormones to blood.

Symptoms of hyperthyroidism are tremor in hands, nervousness, restlessness, intolerance to hot weather, tachycardia, muscle weakness, poor exercise capacity, increased bowel movements and sometimes diarrhea, loss of weight without diet, hair loss, skin thinning, and nail injuries.

Hypothyroidism is generally manifested by tiredness, fatigue, depression, and enlargement and dryness of tongue. In general, weight gain is one of the most important problems of patients. Menstrual irregularity constitutes an important problem in female patients. In addition, hypertension may develop. It may cause slowdown in movements and reduction in perception. It also leads to bowel disorders and frequently constipation.

Viruses, bacteria, fungi or parasites that cause diseases are identified, diagnosed and treated in Department of Infectious Diseases of Kolan Hospital Group.

Infectious Diseases are a group of diseases which are commonly seen and may cause fatalities in all world countries in spite of advancements and developments in medical technologies.

Contagious diseases, ranging from influenza to meningitis, from urinary tract infections to hepatitis, diarrhea, food intoxications and parasite diseases and systemic fungal infections, are diagnosed and treated at inpatient and outpatient settings in Infectious Diseases Clinics of Kolan Hospital Group. Moreover, febrile diseases are assessed, followed up and treated.

 

Microbiology Laboratory

In microbiology laboratory, infection agents are identified using culture methods, serological tests or direct examinations. The latest bacterial identification and antibiogram methods used in Microbiology Laboratories of our hospital enable identification of all aerobic and anaerobic bacteria. Both culture and direct diagnostic methods are available for fungal and parasitic infections, while advanced antigenic diagnostic methods are actively and routinely used to identify viral agents.

The Infection Control Center is established in this end to prevent inappropriate use of antibiotics and to ensure hygienic conditions at hospital by continuously educating our employees and managing waste and the center is headed by Infectious Diseases Specialist.

Interventional Radiology is a division of the Radiology Department. Invasive procedures are carried out for many body parts using imaging modalities, such as ultrasound, computed tomography and scopy methods. Those procedures are performed under local anesthesia or sedation in order to cause minimal discomfort for the patient.

Most Common Procedures

  • Taking biopsy specimens of organs or tumors
  • Temporary (biliary drainage) or permanent (biliary stent placement) elimination of obstruction in biliary tract.
  • Temporary or permanent catheterization of the urinary tract to maintain viability of kidneys in case of obstructions that hinder urine flow from kidneys; nephrostomy
  • Drainage of fluid collection in lung; pleural drainage
  • Drainage of intraabdominal fluid collection; drainage of ascites
  • Drainage of inflammatory collection in any part of the body; percutaneous drainage of abscess

In Interventional Radiology division, state-of-the-art digital devices are used to diagnose medical conditions, while many diseases can be managed with no need to surgery.

Department of Radiology renders interventional radiology services using state-of-the-art devices.

Medical Imaging Devices

  • 5 Tesla MRI, Siemens Magnetom Avanto
  • 16-slice Multi Slice CT, Siemens Somatom Emotion
  • Fluoroscopy
  • Digital X-ray
  • Ultrasound (Doppler)
  • Digital Mamography, stereotactic breast biopsy
  • C arm
  • Portable X-ray
  • PET-CT
  • Bone Densitometry

In Department of Radiology, all images are processes in digital environment and saved in a common center. After images are reviewed, images and reports are digitally archived and transferred to all units of the hospital.

Interventional Radiology is a division of the Radiology Department. Invasive procedures are carried out for many body parts using imaging modalities, such as ultrasound, computed tomography, X-ray and even magnetic resonance imaging. Those procedures are performed under regional anesthesia or general sedation in order to cause minimal discomfort for the patient.

Most Common Procedures

  • Taking biopsy specimens of organs or tumors
  • Temporary (biliary drainage) or permanent (biliary stent placement) elimination of obstruction in biliary tract.
  • Temporary or permanent catheterization of the urinary tract to maintain viability of kidneys in case of obstructions that hinder urine flow from kidneys; nephrostomy
  • Drainage of fluid collection in lung; pleural drainage
  • Drainage of intraabdominal fluid collection; drainage of ascites
  • Drainage of inflammatory collection in any part of the body; percutaneous drainage of abscess

In Interventional Radiology division, state-of-the-art digital devices are used to diagnose medical conditions, while many diseases can be managed with no need to surgery.

The most important two steps of In Vitro Fertilization (IVF) therapies are experience and trust. Experience is vitally important in both clinical and laboratory practices for accurately diagnosing the underlying cause(s) of the infertility (female, male or both) and for planning the patient-specific treatment approaches. Inaccurate treatment plans, especially for women, may cause severe health problems and even death (such as the risk of OHSS in ovulation induction or postoperative complications) beyond the waste of money, time and hopes. Therefore, it is important that you should consider some important factors when you choose the clinic; you also need to take into account the experience of the laboratory team.

In our In Vitro Fertilization Units, your expectations will be met by our team with experience of thousands of cases.

Trust problems are common in in vitro fertilization therapies, because most patients are not sufficiently informed before and after the treatment; concrete verbal, written or visual information is not provided enough to  make them trust. If a facility wants to build trust, it will need an experienced team that closely follows the scientific novelties, cutting edge devices/equipment and laboratory conditions that comply with international quality standards; in other words, the facility should be first self-confident. In our facility that meets all those prerequisites, you will be clearly and honestly informed at every stage of your treatment and scientifically satisfactory answers will be given to your questions. Comparing to other medical treatments, psychological condition is much more important for in vitro fertilization therapies and therefore, the confidence in the facility is the most remarkable contribution of the patient to the success of the treatment; we will do our best to make you help us, as you have confidence in us.

M

Parkinson’s disease is a chronic neurological disorder that is secondary to deficiency of “dopamine” in brain. Aging damages and decreases number of cells that secrete dopamine in brain, resulting in movements disorders and involuntary movements. The condition is manifested by tremor in hands and feet, slowing down of movements, stiffness of muscles and difficulty walking.

How is Parkinson’s Disease Diagnosed?

Diagnosis of Parkinson’s disease is based on clinical symptoms. Especially for elderly patients, “money-counting” tremor in hands, more remarkable at one side of the body, slowing down of movements, loss of swinging arms while walking, glassy gazes, decreased mimics and accompanying “mask face” state as well as gait pattern characterized by short steps and body bended forward suggest early stage of the disease. If you notice such symptoms, it is necessary to seek help from a neurologist.

Who are more commonly affected?

Parkinson’s disease is an old age condition and mean age of onset is 62 to 65 years. Prevalence and symptoms increases relatively by aging. Considering age of onset, if symptoms appear at younger ages, dopamine synthesis further decreases in the future and the young-onset conditions may be somewhat more progressive. Unfortunately, there is no study that demonstrates number of patients with Parkison’s disease in detail. It is only estimated that there are approximately 120 thousand patients with Parkinson’s disease.

What Are Social Problems Experienced by Patients with Parkinson’s Disease?

Parkinson’s disease slows down movements, resulting in inability to do work and subsequently daily activities independently.  Therefore, patients detach from social and work lives at early and mid stages of the disease; however, patients need assistance of other persons in advanced stage. Those problems pose negative psychological effects on patients, who are already suffering from slowing down of movements and tremor, and accordingly, most patients become introverted and develop depression.

How Is The Surgery Carried Out?

In “Microelectrode Recording and Stimulation Technique” which enables us to monitor electrical activity of single brain cell, we aim identify location of cells that are responsible for the disease and of anatomic formations around those cells. Therefore, we speak with the patient during the surgery or in other words, the patient is not anaesthetized. Thus, reactions of the patient are observed to facilitate access to the diseased locus. Patient is alert in first two to three hours of the surgery and we help each other. “Microelectrode Recording and Stimulation Technique” makes our aim realized. Thanks to this procedure, we can identify location of cells that are responsible for the disease and of anatomic formations around those cells with an error margin below eighty microns; thus, we can place the neurostimulator to the correct location with zero error margin.

How Is Neurostimulator Therapy Applied?

For neurostimulator surgeries, two electrodes are placed in regions that are determined in brain. Similar to implantation of cardiac pacemaker, the battery is placed into subcutaneous tissue of chest wall; connection lines are extended through the subcutaneous tissue and electrode are connected to the battery. Since the system is completely closed, it cannot be recognized. Only a small lump is observed and palpated or felt on subcutaneous tissue of the chest wall. Next, computer assistance is used to determine best frequencies and stimulation parameters. Patients need to visit the clinic frequent for postoperative 2 to 3 weeks. Patients start engaging in routine daily life, after optimum adjustments are made.

What Kind Of Change Does a Neurostimulator Cause in Patient’s Lives?

Patients experience striking recovery and resume ordinary daily life in postoperative period. In other words, patients cling to life again with neurostimulator.  Neurostimular generates successful outcomes for patients with Parkinson’s disease, who have poor response to medication therapy, suffers from severe tremor attacks or cannot properly benefit from medications anymore due to severe side effects. It is very important to select patients who are operable and benefit from surgery. Thus, patients who cannot hold even fork, cannot thread a needle and cannot write may resume past healthy days after battery settings are completed in the postoperative period.

The Battery Turns the Clock Back

Patients with Parkinson’s disease may turn the clock back to the first years of the disease and resume healthy days after neurostimulator is implanted. In other words, the neurostimulator rolls back the clock.  The patient who cannot hold even spoon enjoys the freedom or independency in the postoperative period.  Patients who cannot tie shoelaces, button up shirts, cannot live without assistance and detach from social life gain the opportunity of independent life, resuming social life and even doing work again.

Department of Medical Oncology deals with management and systemic treatment of cancer patients. Before a treatment is planned and started, all cancer patients are assessed in Department of Medical Oncology with a multidisciplinary approach in coordination with departments of Pathology, Radiology, Nuclear Medicine, Radiation Oncology, Surgical Oncology and Interventional Radiology.

In addition, Medical Oncology arranges systemic treatment of cancer patients before, after or during local treatments. Those therapies include hormone therapies, chemotherapies, smart molecules (targeted therapies) and immunotherapy.

Outpatient and day therapies are available in Medical Oncology clinic. Patients are admitted to inpatient clinics, if required.

In microbiology laboratory, infection agents are identified using culture methods, serological tests or direct examinations. The latest bacterial identification and antibiogram methods used in Microbiology Laboratories of our hospital enable identification of all aerobic and anaerobic bacteria. Both culture and direct diagnostic methods are available for fungal and parasitic infections, while advanced antigenic diagnostic methods are actively and routinely used to identify viral agents.

The Infection Control Center is established in this end to prevent inappropriate use of antibiotics and to ensure hygienic conditions at hospital by continuously educating our employees and managing waste and the center is headed by Infectious Diseases Specialist.

N

Objective of Nutrition and Diet Division is to create awareness about healthy eating in society and render nutrition and diet services that support recovery period of patients.

Healthy eating is one of the important components of the preventive and therapeutic healthcare services. Dietitian and Nutritionist supports to improve quality of life by educating patients on how the diet can be planned according to life style of the patient, nutritional factors in development of diseases, necessary dietary modifications in the time of disease, rules of food preparation and cooking and scientific ways to make accurate practices.

Specialists obtain detailed information regarding nutritional problems (weight, disease), review nutritional habits and identify metabolic age, body fat, body water and muscle ratio and their segmental distribution with body analysis devices. Next, a specific nutrition plan is made considering age, height, gender, physical activity and blood test results, and compliance to the plan is regularly checked. Nutrition and Diet Division plans nutritional therapy that is appropriate for the disease and assesses nutrition for babies, children, adults, elderly subjects and pregnant women as well as breastfeeding mothers.

  • Medical Nutrition in Obesity
  • Medical Nutrition in Diabetes Mellitus
  • Healthy Eating in Pregnancy and Breastfeeding
  • Medical Nutrition Therapy in Eating Disorders (Night eating syndrome, bulimia nervosa, anorexia nervosa)
  • Medical Nutrition Therapy in Gastric Diseases
  • Diet Therapy to Gain Weight
  • Polycystic ovary and nutrition
  • Medical Nutrition in Liver Diseases
  • Medical Nutrition in Kidney Diseases
  • Medical Nutrition in Hypertension and Cardiovascular Diseases
  • Medical Nutrition in Rheumatism and Gout Disease
  • Medical Nutrition for Oncology Patients
  • Malnutrition (Extremely lean body and insufficient nutrition)
  • Nutrition for the patients with food allergy and food intolerance
  • Healthy Eating in infancy – childhood- adolescence
  • Nutrition for Athletes

Nutrition and Diet Division offers personalized diagnosis and management along with applications by providing our society quality service approach at most cost effective conditions.

A wide array of diseases that involves the brain and the nervous system are successfully treated with a multidisciplinary approach in the Neurosurgery Clinic.

Primary operations carried out in the department are as follows;

  • Neurovascular Surgery
    • Cerebrovascular Diseases (Vascular Diseases of Brain)
    • Arteriovenous malformations
    • Cavernomas
  • Neuro-Oncologic Surgery
  • Brain Tumors
  • Glial tumors
  • Meningiomas, Pituitary Gland Tumors
  • Metastatic brain tumors
  • Skull base tumors
  • Cerebellopontine angle tumors
  • Pineal tumors
  • Intra-ventricular tumors.
  • Spine Surgery
  • Herniated Cervical, Thoracic and Lumbar Disc Surgery (micro-surgery)
  • Fractures of Cervical, Thoracic and Lumbar Spine
  • Spine and Spinal Cord tumors
  • Degenerative Spine Diseases
  • Surgical Treatment of Peripheral Nervous Diseases
  • Peripheral Nerve Tumors
  • Entrapment Neuropathies
    • Carpal Tunnel Syndrome
    • Ulnar Nerve Entrapment
    • Tarsal Tunnel Syndrome
    • Peroneal Nerve Entrapment Neuropathy
  • Hydrocephalus Surgery
  • Endoscopic Third Ventriculostomy, Septostomy, Aquaductoplasty
  • VP Shunt Surgeries
  • LP Shunt Surgeries
  • Congenital and Acquired Anomalies
  • Spina Bifida (Meningocele, Meningomyelocele, Lipomeningocele)
  • Tethered Cord Syndrome
  • Craniosynostosis Surgeries
  • Chiari Malformations
  • Head Traumas
  • Micro-vascular decompression

Healthcare services are rendered round the clock for babies, who need intensive care, by experienced nurses under supervision of neonatologists. Neonatal intensive care unit provides advanced care starting at the gestational age of 24 weeks for high-risk babies, such as preterm delivery, multiple pregnancies and pediatric surgery cases. Neonatal Intensive Care Unit admits not only babies given birth in our hospitals but also all babies who need intensive care.

1.2.3. 1st, 2nd and 3rd Level Neonatal and Premature Intensive Care

All newborns with risk factors and severe diseases are provided with necessary support at the Neonatal Intensive Care Unit. Services are rendered by neonatologists and pediatricians along with nurses who received special training in the field.

In the Neonatal Unit, newborns who were born at other hospitals, but transferred to our hospitals are admitted along with babies who are already monitored.

Neonatal ICU is arranged in compliance with international standards and criteria mandated by Ministry of Health such that one nurse provides care for 3 patients in every hour of day under supervision of Neonatologist.

In Neonatal Unit, available technological products are 31 incubators, 15 ventilators, 1 transport incubator, 31 monitors (used for monitoring vital signs of babies), 10 phototherapy devices (treatment of  jaundice) and injectomat and infusion pumps used for administering drug and serum.

In Neonatal Intensive Care Unit, advanced care is provided for newborns with high risks such as preterm delivery, multiple pregnancies, maternal diabetes, meconium aspiration syndrome, damage of brain and other organs due to difficult delivery, starting at gestational age of 24 weeks.

Eye examinations (Retinopathy of Prematurity - ROP), obstruction or stenosis of esophagus and intestine (atresia), pediatric surgery for congenital surgical problems of lung and neurosurgical operations like meningomyelocele and hydrocephalia are performed and specialized neonatal follow-up and treatments are provided.

Moreover, babies with heart problems are examined and Echocardiography is studied in the incubator and thus, treatment is planned. Cranial and renal ultrasounds of neonatal patients are scanned in incubator by our specialist radiologist.

Ventilator Treatment of Babies

Since lungs of newborns, especially premature babies, are not sufficiently developed, the babies with respiratory distress are mechanically ventilated with respiratory device. Cutting edge ventilators are available in our hospital and they are used by experienced neonatologist and nurses.

Follow-up of Perinatal Infections

Infection rate is never zero in intensive care units. However, this rate can be reduced by strict measures. Along with controls in entries and exits of our unit, babies are not touched unless necessary, hands are cleaned and hand disinfectants are used if contact is needed and cleaning materials are used under directives and recommendations of Hospital Infection Committee. Therefore, nosocomial infection is very rare.

Nutrition of Premature Infant

Feeding premature babies with breast milk is the most important and lifesaving approach. In severely premature babies, nutritional problems may occur along with many other problems. For those babies, nutritional problems are primarily caused by insufficient development of gastrointestinal system, while many other reasons play role such as low amount of digestive enzymes and insufficient bowel activity.

Term baby can suck and swallow immediately after birth. However, suck reflex does not start before 23 weeks of the gestation in premature babies and it develop in coordination with swallowing in 34 weeks of the pregnancy. Swallowing develops earlier than sucking. However, coordination of suck reflex and swallowing will be achieved later. A full sucking and swallowing function develops in 34 weeks of the pregnancy and sometimes in 32 weeks.

Therefore, we feed babies, especially ones who were born before gestational age of 34 weeks, through a tube that is inserted by mouth. Nutrition is started as soon as possible and the breast milk is prioritized.

Treatment of Neonatal Jaundice

Jaundice can be hazardous for every newborn. In newborn clinics, the risk of jaundice is investigated in each newborn and necessary treatments are performed. Jaundice implies yellowing of the skin and sclera (white part) of eyes secondary to increased amount of a yellow substance, referred to as bilirubin, in the body. If bilirubin level increases in blood, yellowing starts and gradually extends from head to feet. In severe cases of jaundice, bilirubin accumulates in the brain and causes irreversible injuries that are called kernicterus (like cerebral palsy, deafness).

Severity of jaundice may vary among babies. The time (hours) after birth, weeks after delivery, weight and nutritional status are taken into account. To prevent exacerbation of jaundice, the baby should be fed well and pass urine and stool frequently. Another important factor is the blood incompatibility between the mother and the baby.

All newborns should breastfed as soon as possible. Babies should be frequently breastfed to prevent exacerbation of jaundice. Baby should not be allowed to sleep longer than 4 hours; sugared water should not be used, if supplement is required, and only the formula advised by the doctor should be given.

Treatment of jaundice is easy and possible. Phototherapy is the most common treatment modality. A tape is attached on the eye of the baby to avoid damage by light. Jaundice is rarely managed by blood exchange, especially when there is blood incompatibility between the mother and the baby.

Department of Neurology uses technological advancements for the diagnosis and the treatment of diseases that involve brain, spine, peripheral nerve and muscles in adults.

  • In the department of Neurology, general neurology, epilepsy, headache, low back ache, vascular tension,
  • Sleep disorders, dizziness and balance disorders, Parkinson’s disease and movement disorders,
  • Peripheral nerve and muscles diseases, Alzheimer’s disease and dementia and Multiple Sclerosis are diagnosed and treated.
  • The Neurology Unit works in collaboration with Departments of Radiology and Neurosurgery.
  • In the diagnosis and treatment of epilepsy, long-term video EEG, MRI, PET-CT and SPECT tests are used to assess the condition.
  • EMG (electromyoneurography) is used in the evaluation of neuropathies that are manifested by complaints like numbness in hands and feet and painful conditions like lumbar and cervical hernias.
  • Computed tomography or magnetic resonance imaging (MRI), Echocardiography and extracranial Doppler contribute to the treatment and follow-up of patients.
  • The patients with life threatening conditions, such as coma, progressive stroke and frequently relapsing seizures are followed up and treated at intensive care units.

Headaches

Headache covers a wide spectrum ranging from the most common tension type headache on the psychological background to migraine and headache caused by aneurysm and tumor. Headaches are thoroughly examined, evaluated and treated.

Epilepsy

This is a condition that an individual can encounter any time through the lifespan from neonatal period to elder ages. If the underlying cause is known, treatment is planned, while etiology is investigated if the condition is idiopathic.

Cerebrovascular Diseases (Stroke)

Transient ischemic attack or permanent “strokes” that develop secondary to the obstruction of cerebral vessels on the background of diabetes mellitus, hypertension, hardening of arteries (atherosclerosis) and heart diseases are vascular diseases that are one of the main cause of death. Medical treatment, physiotherapy and effective monitoring at both intensive care units and inpatient rooms are available at our hospitals.

Dementia (Alzheimer's Disease, Vascular Dementia)

Memory impairment, one of the major problems of our age, is a condition with a risk that doubles in every 10 years after the age of 50. Here, the most important approach is to discriminate treatable memory impairments from others. Alzheimer’s disease, Prick Hant Vascular dementias and Lewy body dementias are assessed with regards to unique characteristics and patients with such diseases are followed up and treated at our hospital. Moreover, these clinical pictures are not limited to the memory impairment and they are also associated with behavioral disorders. In this case, our qualified psychiatrists find solutions for problems faced by patients and families.

Peripheral Neuropathies

Peripheral Neuropathy (PN) implies a damaged peripheral nerve. The primary intention of the treatment is to eliminate the cause and to alleviate symptoms. Depending on the cause, the treatment may slow down, stop or reverse the neuropathy. For example, if the etiology is vitamin deficiency, progression of the condition can be stopped by oral or intravenous supplements. Infections can be treated with antibiotics or antiviral medicines.

EEG

It refers a procedure which records electrical activity of brain. The electrical signals of cerebral nervous cells are transmitted to the scalp. The signals are recorded and saved by a computer using electrodes, which are placed at particular location of scalp. The signal are assessed by an experienced Neurologist.

EMG

EMG implies recording electrical signals of nerves and muscles. EMG is a method which is used for diagnosing nervous diseases, verifying diagnosis, determining extent of functional disorders or structural damages, monitoring course of disease and evaluating efficiency of treatment. Different tests can be applied within scope of EMG. Most common tests are “nerve conduction studies” and “needle EMG”.

EEG Monitoring

It implies concomitant video recording during an EEG. Here, the aim is to make a comparison and a decision relative to the concomitant EEG changes in suspicious movement disorders or seizure-like conditions. Moreover, it can be useful in clarifying the relations of some unexpected motions with EEG.

Nuclear Medicine is a discipline that diagnose and treats diseases using radioactive substances. Imaging modalities of Nuclear Medicine enables assessment of functioning in organs.

Department of Nuclear Medicine and Molecular Imaging in Kolan Hospital covers positron emission tomography / computed tomography (PET-CT) division, Gamma camera division, where all nuclear medicine workups are performed, and exercise-pharmacological stress test and bone density measurement divisions. Technical equipment include Siemens Biograph mCT, Siemens Gamma cameras assisted with E-soft computer systems, computed exercise test device, Lunar DPX bone densitometry and other auxiliary devices of nuclear medicine laboratory.

Labeled leukocyte scintigraphy

In our department, labeled leukocyte scintigraphy, which can be performed in limited number of facilities in Turkey, is routinely performed by our experienced team. With this technique, it is possible to find focus of infection in idiopathic fever cases and prosthesis, bone and soft tissue infections.

Renal Scintigraphy.

  • Dynamic Kidney Scintigraphy
  • Static Kidney Scintigraphy

Dynamic Kidney Scintigraphy: It is performed by using DTPA, MAG3 or EC. Blood supply, filtration function and relative-splint renal functions are determined with this test. It is necessary that older children and adults drink 1 to 1.5 liter of water starting 2 hours prior to the workup. There is no need to be fasting. It is necessary that newborns and infants are given milk, formula or water –as much as they can drink- prior to workup. The procedure lasts 30-40 minutes on average.

Static Kidney Scintigraphy: This method is preferred for patients with frequent urinary tract infection, pyelonephritis, reflux (Vesicoureteral reflux) or abnormally located kidney(s). This workup determines whether there is a loss in functional renal units and relative-split renal functions. Preliminary preparation is not required. Nutritional status does not influence the examination. Imaging is done approximately 1 to 3 hours after drug is intravenously administered. Scanning time is approximately 15 to 20 minutes.

Bone scintigraphy:

Bone scintigraphy is frequently used in evaluation of orthopedic injuries, fractures, tumors or idiopathic pains. All body bones can be scanned with a single injection in bone scintigraphy. Radioactive substance is excreted to the soft tissue, after it is injected into vein, and it is taken up by skeletal system in time. Depending on why this test is performed, images are obtained immediately after drug is injected and in first 5 minutes to evaluate blood flow and soft tissue phases in the area. In order to visualize osseous tissue, it is necessary to wait for 2 to 3 hours after injection. After waiting time is completed, total body is scanned. Preliminary preparation is not required. However, it is necessary to drink fluids (all kind of drinks) as much as possible at the interval when imaging is performed. This ensures that radioactive substance is excreted from the soft tissue and bones are more clearly visualized. Urinary bladder should be emptied immediately prior to the imaging.

Thyroid Scintigraphy (Tc-99m):

Thyroid scintigraphy provides information about size, location, structure and function of the thyroid gland. Scanning is started 15 to 20 minutes after technetium pertechnetate (Tc-99m), a radioactive substance, is infused into the vein. Scanning lasts approximately 15 to 20 minutes.

Myocardial Perfusion Scintigraphy

It is a two-phase test, where images are recorded at rest and post-exercise period in order to investigate if there is an occlusion in coronary arteries which supply blood to the left cardiac muscle. Treadmill is used for exercise or pharmaceuticals are used in patients, who cannot do exercise, in order to increase the heart rate. Radioactive substance, which can be taken up by cardiac muscles, is intravenously injected in order to evaluate blood flow in heart at rest. After approximately 45 to 60 minutes elapse, cardiac stress test is performed. When the target heart rate is reached in treadmill exercise (it may vary depending on age), radioactive substance is intravenously injected. Second scanning is done 30 minutes after the exercise part of the test is completed. Scanning lasts approximately 20 minutes. Findings of two scans are compared. Workup should be done while fasting. It might be necessary to stop infusion of the medicine or modify the dose, as instructed by physician.

PET/CT Imaging Technology

PET (Positron Emission Tomography) is a functional imaging method, which provides physiological information necessary for clinical diagnosis based on alterations in tissue metabolism. Usage of biologic radioisotopes that imitates native components of body and spreads positron (Carbon-11, Oxygen-15, Nitrogen-13, Fluorine-18 etc.) is one of widely recognized advantages offered by PET. In our country, flourodeoxyglucose (FDG) labeled with Fluorine-18 is the radioactive substance that is most commonly used in PET-CT.

PET shows bio-distribution of a tracer molecule, which is marked with a special radiopharmaceutical agent (generally F-18-FDG which is a component of glucose), in every organ. Radioactive tracers accumulate in areas where it is most heavily metabolized, or in other words, at periphery of tumors.  F-18 is decomposed in glucose metabolism and positrons are emitted that are detected by PET unit. At the same time, ring-like CT unit produces high-resolution three dimensional X-ray images of the body part examined. As a result, a consolidated ‘anatomo-molecular’ image is obtained, which visualizes localization, size, metabolism and distribution of tumor. Anatomic and functional details are obtained in a single image. Although PET/CT is most commonly used in the field of oncology, it facilitates early diagnosis of neurological diseases (dementia, epilepsy, Alzheimer’s disease etc.) and cardiac disorders.

Oncologic PET-CT

 

PET-CT is used for following purposes in lung cancer, mesothelioma, lymphoma, melanoma, cancers of head & neck, small intestine, colon, rectum, esophagus, breast, thyroid gland and other endocrine glands as well as tumors of pancreas, liver, kidney, urinary bladder, ureter, testis, penis and other male genital organs, female genital organs, brain and musculoskeletal system.

  • Diagnosis,
  • Determining dissemination of the disease before the treatment (staging)
  • Identifying the tumor tissue in patients who will receive radiotherapy; treatment planning; delivery of correct dose to the correct region,
  • Evaluating response to the treatment (investigating response of tumor to chemotherapy or radiotherapy)
  • Evaluating efficacy of chemotherapy (chemosensitivity) in patients who are given chemotherapy alone, but eligible for alternative chemotherapy protocols,
  • Post-treatment staging and evaluating efficacy of the treatment,
  • Re-staging the patients with relapse,
  • Investigating the primary focus in metastatic cancers with undiagnosed tumor focus.

Issues Requiring Attention in PET-CT Scan

  • Patients should rest and avoid strenuous physical activity one day before the scan.
  • Patients should not eat and drink sugared foods and beverages (fruit, fruit juice). A fasting period (minimum 6-hours) is required before workup. Patient should not get cold especially at winter while presenting to the hospital.
  • Blood glucose is analyzed after primary preparations are completed in the day of scan.
  • Patient is intravenously injected FDG molecule (radioactive substance) labeled with Fluoride-18, which is a glucose derivative and emits positrons.
  • It is necessary to wait for 49 to 60 minutes to have drug widely distributed to the body. Patient should definitely rest and avoid moving or even talking, unless necessary.
  • Once waiting time is over, patient is transferred to the imaging room.
  • Both 3D CT and PET images are obtained in the same session within 12 to 20 minutes in total.

Tests Available in Department of Nuclear Medicine;

INFECTION IMAGING

  • Labeled leukocyte scintigraphy

TUMOR IMAGING:

  • F18 FDG Oncologic PET/CT
  • F-18 NAF total body bone scan PET/CT
  • I-131 total body scan

CARDIOLOGY

  • Exercise myocardial perfusion SPECT (with Tc-99m complexes)
  • Pharmacological stress myocardial perfusion SPECT (Tc-99m complexes)

SKELETAL SYSTEM

  • Total body bone scan
  • Tri-phase bone scintigraphy

GENITOURINARY SYSTEM

  • Dynamic Scintigraphy of Kidneys Using a Diuretic (Tc-99m MAG3)
  • Dynamic Scintigraphy of Kidneys Using a Diuretic (Tc-99m DTPA)
  • Renal cortical (parenchyma) scintigraphy (static scintigraphy of kidneys, Tc99m DMSA)
  • Captopril Renal Scintigraphy (MAG3-DTPA)
  • Indirect cystoscintigraphy
  • Direct cystoscintigraphy
  • Testis scintigraphy

GASTROINTESTINAL SYSTEM

  • Gastroesophageal reflux scintigraphy
  • Ectopic gastric mucosa (Meckel’s diverticulum) study
  • Gastrointestinal bleeding study (Tc-99m RBC)
  • Gastric Emptying Study (Tc-99m complexes)
  • Hepatic Blood Pool SPECT (Tc99m RBC)
  • Salivary gland scintigraphy

PULMONARY SYSTEM

  • Lung perfusion scintigraphy
  • Quantitative lung perfusion scintigraphy

CENTRAL NERVOUS SYSTEM

  • Brain perfusion SPECT
  • F18 FDG Brain PET/CT

HEMATOLOGY

  • Lymphoscintigraphy
  • Selective Spleen Scintigraphy (Tc-99mm-labeled denaturated erythrocyte)

 

RADIONUCLIDE TREATMENT

  • Treatment of hyperthyroidism

OTHER STUDIES

  • Dacryoscintigraphy
  • Bone Density Test

What is radioactive iodine treatment and how is it applied in treatment of diffuse toxic goiter?

Radioactive iodine therapy, colloquially referred to as “atomic treatment”, is a treatment modality with proven efficiency and safety that has been used worldwide for longer than 60 years. The radioactive iodine in capsule or liquid form is ingested by mouth; after it is absorbed by the digestive system, they are taken up by thyroid cells and the radiation emitted by the substance destroys the abnormally functioning thyroid cells.

Following rules apply to preparation for radioactive iodine therapy:

  • You need to be fasting for 4 to 6 hours before the treatment. However, you can drink water.
  • Efficiency of your treatment will increase, if you do not take some medicines that contain iodine or influence metabolism of the thyroid gland for below mentioned periods.
  • Medicines used for treatment of goiter (propycil, tiramozol) (3-5 days)
  • Amiodarone (12-24 weeks)

How is radioactive iodine ingested and what should be taken into account when it is ingested?

The patient swallows the capsule form or ingests the liquid form of radioactive iodine in one glass of water under supervision of Nuclear Medicine doctor.

What needs to be taken into consideration after radioactive iodine is ingested?

Patients can eat meal two hours after the drug is taken. Patients should suck lemon or sugar, chew gum and drink plenty of water or fruit juice after the first 24 hours in order to prevent damage of salivary glands by the radioactive iodine. Patients need to void frequently and the toilet should be flushed abundantly. Hands should be washed with plenty of water every time the patient goes to the bathroom; patients should take shower every day and all clothes, including underwear, socks and head scarf, should be changed after every shower.

What are the side effects of the radioactive iodine therapy?

There is risk of hypothyroidism (underactive thyroid gland) after the treatment. Neck pain, tension and transient exacerbation of hyperthyroidism can be faced after the treatment, albeit rare. There is also risk of ophthalmopathy (bulge of eye globes) or exacerbation of existing ophthalmopathy after the treatment.

How is radioactive iodine excreted by the body?

Radioactive iodine is excreted mostly in urine, but also in saliva, sweat and stool, albeit at lower concentrations. The ingested iodine is largely absorbed by the thyroid gland. The iodine uptake by other body cells is ignorable and no tissue damage is reported to date.

O

In Oral and Dental Health Clinics of Kolan Hospital Group and medical centers, services are rendered for diagnosis and treatment of diseases regarding oral, dental and jaw health for both pediatric and adult patients.

Aesthetic Dentistry

Various solutions are also generated for oral and dental cosmetic; we are able to provide a new smile (Hollywood Smile) with laminate, porcelain veneer, gum contouring and tooth bleaching.

Zirconia Porcelains

It is the highest quality product of all the time regarding aesthetics, solidity, tissue compatibility and natural appearance which are the main necessities of dentistry. This system meets all your needs, such as biocompatibility, natural appearance, aesthetic and mechanical resistance, and zirconium, a white allow, is used for the frame of this system rather than a metallic frame. Zirconia-based porcelains are preferred trustfully in our clinics, since they are cosmetic enough to be used for anterior teeth and solid enough to be used for posterior teeth.

Porcelain Laminate Veneers

Porcelain laminate veneer is a successful method that supports the treatment to modify color, size and shape of teeth. They are attached to the surface of anterior tooth to mask bad discoloration or to change the shape of tooth and they are resistant to recurrent discoloration.  They are preferred mostly for their superiority for opacity and requirement of minimal dental substance to be removed. This type of porcelains react photo-flashes and neon lights like natural teeth and they cannot be distinguished from real teeth, similar to full porcelain crowns.

Tooth Whitening

Tooth whitening (bleaching) is a good option for discolorations that cannot be eliminated by brushing or superficial cleaning procedures (physical removal of tartar and stains) and that are caused by tooth structure and lead to poor appearance. It ensures permanent whitening without damaging teeth.

There are two types of bleaching method. These are home bleaching and clinical bleaching (tooth whitening) methods. Satisfying whitening and beautiful smile are ensured with tooth whitening procedure. Bleaching procedure should necessarily be under professional control.

Pedodontics

Health of deciduous teeth in childhood directly affects the future dental health. The set of deciduous teeth and following set of combined teeth develop in the period when growth of child is at the most active phase. The first deciduous tooth starts to erupt in the sixth month. Different groups of deciduous teeth are missed occasionally and leave their place to permanent deciduous teeth. This condition lasts until 12 years of age. During this period, early miss of deciduous teeth may affect the jaw development and cause cosmetic and speech disorders. All treatments that focus on permanent teeth apply to the deciduous teeth.

Treatment of pediatric dental problems (Pedodontics) is a separate field of dentistry that requires a professional approach. Moreover, skeletal jaw development should be kept under control by orthodontists during growth of the child. In our clinic, measures are taken to ensure that the children at growth age have a healthy dental and oral structure and treatments are applied by specialists dentists.

Halitosis (bad breath)

Today, halitosis is a very common condition also faced by civilized societies. And it is a reason of social offense. It brings along socio-psychological problems. Since 90% of halitosis is caused by oral problems, a full oral examination, elimination of dental and gingival problems, oral hygiene, cleaning surface of tongue and eliminating infectious sources are necessary for the treatment.

Implant

Implants are artificial titanium roots that are placed to jaw bone to replace the teeth missed for various reasons. Implant is the best alternative to the natural teeth in terms of function and aesthetic. Implants provide better speech and chewing function comparing to conventional crown and prostheses. Implant is a comfortable and reliable application. Following dental implants that are recently used very commonly, many patients can engage in the social life in the same day. For prosthesis to be placed on implant – the second stage of implant therapy-, it is necessary to wait for 2 to 4 months in order to ensure fusion between the implant and the jaw bone after the operation.

Local anesthesia can be administered to make patients feel no pain and discomfort. General anesthesia can also be administered, if and whenever necessary.

Healthcare services are rendered using cutting-edge products in our Ophthalmology clinic.

In the first step of the eye examination, complaints of the patient are obtained and eyebrow, eyelids and gaze position of eyes are assessed in the light of complaints.

Computed ORM (autorefractometer) and retinoscope are used to measure the refractive error and corrected and uncorrected acuities are determined for both eyes. In biomicroscopic examination, eyelashes, conjunctiva, cornea and other anterior segment components of the eye are carefully examined. Next, intraocular pressure is measured.

Following activities are carried out in the department.

Cataract surgeries: Suture-free cataract surgery and intra-ocular lens implantation under drop anesthesia with phacoemulsification method

Refractive errors: Determination of refractive errors; prescription of eye glasses and contact lenses. Diagnoses facilitated by corneal topography, wavefront, ocular response analyzer and OCT of anterior segment and PRK, LASIK, LASEK, EPI-LASIK, LASIK with INTRALASE and CK (Conductive Keratoplasty) surgeries.

Diagnosis and Treatment of Corneal Diseases: Verification of diagnoses by confocal microscopy, OCT of anterior segment and corneal topography; full-thickness and lamellar corneal transplantation and artificial cornea (Boston-type keratoprosthesis) surgeries.

Contact lens and keratoconus unit: Soft, rigid and hybrid keratoconus contact lens, cross-linking, intra-corneal ring implantation, full-thickness and lamellar corneal transplantation.

Strabismus and Pediatric Eye Health Unit: Treatment of Lazy Eye, Hess curtain, orthopic treatment, neurovision.

Diagnosis and treatments of Glaucoma: Visual Field, Ocular Response Analyzer (ORA), evaluation of head of the optic nerve with OCT and HRA, filtration and seton (tube) surgeries, SLT, endoscopic cyclophotocoagulation.

Oculoplastic Surgery and Orbital Surgery: Surgical management of eyelids, lacrimal canals and orbital diseases as well as periorbital cosmetic surgeries and botox for strabismus, spasm of eyelid and cosmetic concerns.

Diagnosis and Treatment of Retinal Diseases: Diagnosis and treatment of retinal diseases, including macular diseases and diabetic retinopathy, with FFA, ICG and OCT and anti-VEGF injection and vitreoretinal surgery.

Neurophthalmology: Diagnosis and treatment of common diseases of eye and central nervous system, neurovision.

Ocular oncology: Diagnosis and treatment of eye, periocular and eyelid tumors.

Optic, refractive and visual rehabilitation: Visual aid for visually disabled persons, telescopic eye glasses.

Uvea – Bahçet’s Disease unit: Treatment and follow-up of intraocular inflammations and related systemic diseases in coordination with specialists.

Ocular trauma unit: Correction of functional and cosmetic damages caused by periorbital trauma.

Ocular infection unit: Diagnosis and treatment of eye and periocular infections.

In Otorhinolaryngology department, modern and high technology methods are practiced for diagnosis and surgical treatments of diseases that involve ears, nose and sinus cavities, lips and oral cavity, epipharynx, pharynx and larynx as well as thyroid and parathyroid glands and all parotid glands and head & neck anomalies. Endoscopic and microscopic examination methods are used in Otorhinolaryngology outpatient clinic; workups regarding diagnosis of hearing and balance system are practiced in the audiology laboratory of the department.

Diseases Diagnosed and Treated in Otorhinolaryngology Clinic

Otology / Neurotology: Medical and surgical treatment of ear diseases, including congenital anomalies, infectious and traumatic diseases and cancers of external, middle and internal ear, disorders related to neural pathways of hearing and balance:

  • Surgical treatment of chronic middle ear diseases (repair of perforated tympanic membranes, repair of ear ossicles, cholesteatoma surgery),
  • Medical and surgical treatment of facial nerve paralysis
  • Medical and surgical treatment of Meniere's disease
  • Surgical treatment of otosclerosis (calcified ossicles)
  • Surgical treatment of tumors in auricle, external acoustic canal and middle ear
  • Surgical placement of bone anchored hearing implant
  • Cochlear implant (bionic ear).

Pediatric Otolaryngology: Medical and surgical treatment of otorhinolaryngologic diseases in children:

  • Hypertrophy of tonsils and adenoid tissue,
  • Placement of ventilation tube
  • Surgical treatment of congenital cervical lesions.

Head & Neck Region: Medical and surgical treatment of head and neck tumors (cancerous and non-cancerous) and thyroid and parathyroic surgery:

  • Surgical treatment of lip cancers,
  • Surgery of oral cavity, tongue and tonsil tumors,
  • Surgical treatment of epipharyngeal, pharyngeal and laryngeal cancers,
  • Surgery of submandibular and parotid glands,
  • Surgical treatment of facial skin and bones, sinus cancers,
  • Repair of fractured facial bones (nose and jaw fractures),
  • Dissection surgeries for removal of cervical lymph nodes.

Facial plastic and reconstructive surgery: Cosmetic and functional anomalies of face and neck that require treatment:

 

  • Rhinoplasty (nose job)
  • Otoplasty (correction of prominent ear anomalies),

Rhinology: Medical and surgical treatment of nasal and sinus cavities

  • Deviated septum (septoplasty) surgeries,
  • Reduction of nasal turbinate (conchae) with radiofrequency,
  • Surgical treatment of nasal polyps, Functional Endoscopic Sinus Surgery (FESS)

Laryngology: Medical and surgical treatment of voice disorders:

  • Surgical treatment of nodules and polyps in vocal cords,
  • Medical and surgical treatment of disorders secondary to vocal cord paralysis:

Allergy: Diagnosis (allergy tests) and treatment of allergic diseases of upper respiratory tracts:

Audiology: Pure tone audiometry, tympanometry, stapes reflex test, otoacoustic emission, neonatal hearing test and BERA tests are performed in the audiology unit of our department.

Facial Cosmetic

Rhinoplasty

Rhinoplasty is a surgery performed for reshaping and reconstructing the nose.  The aim is to form a new nose with better functioning and appearance. Moreover, the deviated septum that makes breathing difficult can be corrected with rhinoplasty surgery.

The nose job aims to reshape the nose with reference to facial characteristics. Since this surgery is carried out on nose, patient’s nose also affects the success of the surgery. In other words; thickness of skin, thin cartilages and the native form of the nose as well as the wound healing process and your history of nose surgery determine the success rate. The aim is not forming a nose that does not match the facial appearance. Therefore, forming the best nose alone will not solve the problems. The best outcome is regarded as a nose that fits the face best. Accordingly, requesting to mimic nose of another person is also wrong. If a beautiful nose is formed that does not look as if operated and a better breathing is achieved comparing to preoperative course, this means that your surgery is successful.

Nose jobs are the most common aesthetic surgeries worldwide. The surgery lasts two to five hours depending on the extent of the procedure. If nasal bone is operated on, bruising and swellings may occur in postoperative period. However they are far less severe comparing to former surgical methods. Generally, silicone pads are placed in the nasal cavity to let you breathe easier after the surgery and small casting and plasters are applied outside of the nose.

Postoperative pain is not a matter of concern. Only simple pain killers are needed to alleviate the pain. Intra-nasal silicone pads are removed two days later and breathing returns to normal pattern.  This pad removal procedure is far less painful than removal of classical gauze pads and it takes a very short time.

Otoplasty

Otoplasty is the surgery carried out to correct the appearance of the earlap. With otoplasty surgery, it is possible to correct the severely prominent ear, also called cauliflower ears colloquially, as well as the congenital or acquired ear and ear lobe deformities. Prominent ears cause social and psychological problems especially in childhood. As children grow up, they can be exposed to ruthless reactions and criticisms due to the appearance of ears in social environments like kindergarten, nursery school or schools. This can cause to become an object of derision, being alienated, problems in the development of personality and lead to communication disorders, school failures, and decreased self-confidence. Therefore, it is generally accepted that the best time for otoplasty is pre-school period. Adults may also require an otoplasty surgery in order to eliminate this appearance, which can also be perceived as a disadvantage in social environments among adults, and to be able to tie their hair up above their ears or cut their hair short comfortably.

No severe pain is generally experienced after the surgery; a mild pain can be expected that can be managed with painkillers. A head bandage is worn at day time and in the evening for one week; patients are asked to wear the bandage only in the evening in several subsequent weeks. While children can start the school a week later, adults may engage in work earlier.

Endoscopic Sinus Surgery

Sinus implies air spaces located around the nose, forehead, behind the eye globe and in the upper jaw bone (maxilla). About half a liter of fluid is secreted by sinuses. If air inlet and outlet to/from the sinus is distorted (cold, flu, nasal bone deviations, polyps, adenoid tissue, etc.), the microbes begin to grow. Thus, mucosa of sinus gets inflamed. This condition is called as “acute sinusitis”. If the cause disappears, aeration of the sinus starts again and it becomes healthy. Otherwise, the condition will continue and if this process lasts up to 3 months, "chronic sinusitis" will occur. The treatment of acute sinusitis is a short and easy process, while the treatment of chronic sinusitis is hard and a surgical method is needed to be applied mostly.

What are Symptoms of Sinusitis?

Nasal congestion, runny nose, fatigue, mild fever and pain and tenderness in the forehead, behind the eye and in upper jaw may develop. Acute sinusitis should be suspected if runny nose turns into a cold with yellow-green nasal discharge. Diagnosis of sinusitis can be made with the health history and endoscopic examination. However, the final diagnosis is made with radiology studies. Since direct X-ray images do not contribute substantially to the diagnosis, computed tomography is the best diagnostic method, whenever needed. Sinus tomography should not be ordered frequently, excluding chronic sinusitis.

How is Sinusitis Treated?

 

Acute sinusitis usually responds to antibiotherapy. Chronic sinusitis usually requires a surgery. Functional Endoscopic Sinus Surgery (FESS) is the most efficient method in the treatment of sinusitis. Outcomes of this surgical method that is carried out by experienced surgeons are pretty successful. The decision of surgery in chronic sinusitis is generally done after a 2-3-week antibiotherapy followed by a tomography scan. The surgical procedure is preferably done under general anesthesia. It is very important to clean the nasal cavity and follow the physician’s advices in the postoperative period.

Nasal Polyps

Nasal polyps are mucosa balloons that develop due to chronic inflammatory diseases of the mucosa that lines the nose and sinuses. They are soft in consistency and have a tendency to form structures like a bunch of grapes due to confluence. Sometimes, they can grow enough to protrude from nostrils. The condition is more common in men. The most frequent complaint is nasal congestion. Sneezing, itching, runny nose and postnasal drip may occur. Snoring and sleep apnea can be seen. It can lead to disturbances of smell and taste. The diagnosis can be made with direct or endoscopic examination. It is easy to visualize the polyps in the sinuses on a tomography scan. Cortisone is the most efficient medicine for nasal polyps. If cortisone does not relieve complaints, a surgical treatment is planned. Recently, when nasal polyps are excised using “shavers”, less bleeding occurs and the duration of surgery shortens.

Middle and Inner Ear Surgery

Serous Otitis Media (Serous Otitis, Otitis Media With Effusion)

The middle ear cavity is connected to the most posterior part of the nasal passage through a canal called as Eustachian tube. Some muscles, which are the extensions of the swallowing and chewing muscles, open the inlet of the Eustachian tube that opens to the nasal passage in every 3-4 swallows, and the accumulated secretions and air with reduced oxygen in the middle ear drain to the nasal passage and the fresh air that comes from the nose enters the middle ear. After this air and fluid exchange, the Eustachian tube spontaneously closes. This tube is underdeveloped in children. Therefore, middle ear infections are more common in children. In addition, flow of fresh air from the most posterior part of the nasal cavity is obstructed when an adenoid hypertrophy obstructs the orifice of the Eustachian tube. If no air is supplied to the middle ear for a long time, the middle ear cavity can be completely filled in by fluids secreted by tissues at this locus. The replacement of air by fluid in the middle ear cavity is referred to as “serous otitis”. Serous otitis is often asymptomatic, excluding a mild hearing loss.

The appearance of the ear drum (tympanic membrane) in the physical examination provides the first cue for the diagnosis. The diagnosis is verified by tympanometry that measures the hearing and pressure of the middle ear cavity. For adult patients, the underlying cause should be eliminated prior to a surgical procedure for the ear. If the cause is adenoid hypertrophy in a pediatric patient, serous otitis is an indication for excision of the adenoid hypertrophy. After tympanogram is obtained in a child with serous otitis media, antibiotic treatment should be continued for 20 days (repeated twice or thrice, if required); next, the ear is examined and findings are compared to tympanogram data and placement of a ventilation tube into the ear drum can be decided if the medication treatment does not help.

Chronic otitis media

 

Chronic otitis media is operatively treated; the hole on he ear drum is closed and damaged ossicles, if any, are corrected and repaired to eliminate the chronic condition that involves the middle ear. Several techniques are used for this surgery.

Myringoplasty: Only the perforation of the ear drum is repaired.

Ossiculoplasty: Tympanic membrane is intact. The damaged ossicles are repaired to restore hearing.

Mastoidectomy: The cells (mastoid cells) of the bone located behind the ear are removed.

In patients with chronic middle ear disease, “cholesteatoma”, bright white growth, develops that is comprised of dead skin of external acoustic meatus and outer cells of the ear drum in the middle ear or air cavities located in the ear bone.   Those growths are typical for spiral expansion, similar to skin of onion, and they compress and destruct the bone segments. Cholesteatoma is the most common cause of complications in chronic middle ear inflammations and they can destruct all tissues encountered. It damages the facial nerve by destructing the facial nerve canal. The inflammation in the middle ear spreads to brain and cerebellum, resulting in meningitis and cerebral abscess. Therefore, a chronic middle ear disease with cholesteatoma is an absolute indication for mastoidectomy.

Otosclerosis (Calcium Deposits in Middle Ear Ossicles)

Otosclerosis implies uncontrolled patchy calcium deposition on the bone capsule that encloses the inner ear. Since this calcification focus often develops in the bone capsule at the location where the stapes is nearby the inner ear, stapes is the most commonly involved ossicle. Motions of the stapes impair or are completely lost. Sound waves cannot be conducted to fluids located in the inner ear. Thus, the sound cannot be conducted to the inner ear. Tinnitus and gradual onset of hearing loss develop in the involved ear. Most patients are 20 to 40 years old women. Family history is usually notable for hearing loss (genetic transition).  In addition, hearing threshold test, tympanogram and reflex test, among audiological tests, support the diagnosis. The final diagnosis is made during the surgery. In other words, the final diagnosis and treatment of the otosclerosis are based on surgery. When the ear drum is elevated, immobile stapes and the calcification focus verify the diagnosis. Stapedectomy is the most common surgical method, where the stapes that is immobile due to calcification is removed and replaced by a prosthetic bone.

Meniere’s disease

The inner ear is one of the most complex, sensitive and perfect organs of the body. It is comprised of a bone capsule where ear fluid and balance organs, also known as cochlea and semi-circular canals, are located. Hearing organ and cells are found in the cochlea, while the balance organ and cells are located in semicircular canals. Two fluids with varying characteristics – cerebrospinal fluid and fluid derived from blood vessels – are drained into the cochlea and semicircular canals. Those fluids are retained apart from each other by bones and membranes. Production and drainage of those fluids are finely regulated. In Menier’s disease, the fluid deriving from blood vessels is overproduced and/or drained insufficiently. In a Meniere’s attack, volume of the fluid increases in the compartment of balance and hearing organ and the membranous septum swells. Therefore, feeling of pressure and fullness, a symptom of Meniere’s attack, is secondary to the swelling. The membranous septum perforates and two fluids are mixed. Those fluids that are vary in character are toxic to each other and they cause vertigo and hearing loss. Tinnitus, nausea and vomiting are accompanying symptoms.

Is there surgical treatment of Meniere’s disease?

For Meniere’s diseases, surgeries vary depending on hearing level. Drainage surgeries that conserve hearing can be performed for patients without poor hearing who suffer from vertigo. Surgeries that damage and deactivate functions of the inner ear can be performed for the patients with total loss of hearing who suffer from severe vertigo.

Intratympanic Injection

Intratympanic injections (passing tympanic membrane and directly reaching the middle ear) have gradually become popular in recent years. The major advantage of intratympanic injection is the absence of systemic side effects since therapeutic drug is given only to the middle air. Especially cortisone which is used in treatment of sudden-onset hearing loss can cause side effects such as gastric complaints, weight gain and even life threatening ones like gastric bleeding when it is used via oral route in tablet form. Since intratympanic therapy has local effects, those side-effects are not observed.

Intratympanic injection can be used in following conditions:

Sudden-onset hearing loss:  Those are hearing losses which can be associated with tinnitus, balance disorder and vertigo and develop suddenly (shorter than 3 days). The only known effective therapy is cortisone. Studies proved that intratympanic administration is as effective as oral use. Early treatment (the first 72 hours) is very important for sudden-onset hearing losses. The earlier therapy starts, the better outcomes are gained. Outcomes can be obtained with intratympanic injection even if treatment delays (more than 1 month).

Meniere’s disease: Gentamicin can be given through intratympanic route for vertigo that cannot be controlled with drugs.

Tinnitus: Intratympanic injections can be applied for tinnitus that cannot be controlled with drugs.

How is Intratympanic Injection Practiced?

First, tympanic membrane is numbed with lidocaine spray. Drug passes through tympanic membrane and administered to the middle ear using syringes with dental ends thin as hair. No pain is felt as tympanic membrane is numbed. Feeling taste of drug in epipharynx is normal due to Eustachian tube.  Since a tiny hole is opened in tympanic membrane, tympanic membrane immediately repairs itself and no permanent hole develops.

Head & Neck Cancer Surgery

 

Thyroid cancers

Thyroid gland surgery falls into the practice field of head and neck surgery, the basic training of otorhinolaryngology discipline. For thyroid gland cancers, thyroid gland is totally excised, if necessary, and the patient needs to use thyroid hormone lifelong.

Pharyngeal Cancers

Satisfying outcomes can be achieved when cancers of pharynx at the inlet of the esophagus are diagnosed early. Endoscopic examination is a must for everybody that feels an obstruction while swallowing.

Mouth Cavity Cancers

For intraoral cancers originating from tongue, tonsil, soft or hard palate, successful outcomes can be obtained with surgical treatment at the early stage.

Salivary Gland Cancers

There are large submandibular and parotid salivary glands. Since facial nerve passes through the parotid gland, temporary or permanent facial paralysis is likely in the surgical treatment of the salivary gland.  Although facial paralysis is not very likely if the surgery is performed by experienced surgeons, the risk should be taken into consideration in surgical treatment of the cancers of the salivary glands.

Laryngeal Cancer

Larynx is the second door of the airway, following mouth and nose, where the voice is produced. Therefore, it is the first connection point of damaging and harmful substances in the inspired air. Smoking is the most important etiological factor of the laryngeal cancer. Accompanying consumption of alcohol, genetic factors, air pollution and diseases like reflux increase the risk.

The most common symptom of laryngeal cancer is persistent hoarseness. It is necessary to be examined by an otorhinolaryngologist if hoarseness persists longer than 10 to 15 days.

Laryngeal cancer can certainly be treated if it is diagnosed early. Grade 1 tumors, involving the vocal cord, can be completely cured with radiation therapy or a simple intraoral procedure. In moderate grades, partial laryngeal surgeries can be performed by opening a temporary hole in the throat. In more advanced grades, it may be necessary to totally remove the larynx and open a permanent tracheotomy. However, outcomes and survival are very promising even at advanced stage. Cervical lymph nodes can be surgically removed or radiotherapy is started. To restore voice production in total laryngectomized patients, esophageal speech, placement of internal device or usage of external device are the treatment options.

What Is Neck Dissection? Why Is It Done?

 

There are membranes (fascia) in the neck that cover organs like the muscles, veins, esophagus, pharynx and thyroid. Lymph ducts and lymph nodes are present in the spaces below and above these fascias. Lymph nodes fight against foreign cells and microbes. All internal and external organs in the head and neck have lymphatic vessel network that drain to and from these lymph nodes. Thereby, a facial acne or tonsillitis may inflame lymph nodes or tumor cells may win the war against the lymph nodes and cause development of cancer and expansion of lymph nodes.

Cervical dissection implies surgical removal of cervical lymph nodes and lymphatic ducts when head and neck tumors spread to lymph nodes.

Surgical Treatment of Snoring and Sleep Apnea

Sleep covers the night part of the diurnal rhythm, characterized by slowing down of all bodily activities. When the body gets tried in late afternoon, bodily functions slow down and the body becomes ready to fall asleep several hours later. Tired and worn tissues are renewed and repaired during sleep. Therefore, sufficient breathing and oxygen are needed.

Sleep apnea is a condition that is characterized by cessation of breathing for 10 seconds in minimum for five or more times during sleep. This is followed by a short arousal period that cannot be recognized by the patient. Waking up and falling asleep at frequent intervals results in waking up tired.

Since oxygen supply ceases during the apnea period, all the organism, especially brain, is affected. Patient wakes up tired and concentration impairs as respiratory muscles overwork. Daily life quality decreases. Patient takes a nap whenever possible. Decision making and cognitive skills weaken and loss of concentration results in failure, unhappiness, weariness and tendency to accidents. It lays a ground for cardiovascular diseases, hypertension and lung diseases or worsens them, if they already exist.

Snoring is noisy breathing during sleep. It is usually accompanied by apnea. The underlying cause of both snoring and apnea is an obstruction or narrowing in the airway, where the air flows. Nose is the most common reason of the obstruction. The most common etiology of the nasal obstruction is the deviation of the osseocartilaginous structure (septum) that divides the nasal cavity into two compartments. Conditions that involve throat and palate (such as swollen uvula) may also lead to apnea and snoring. Thickening in neck and tongue secondary to overweight may also cause snoring.

How is Snoring and Apnea Examined?

The first step is a otorhinolaryngologic examination. Polysomnography (sleep testing) is the most important diagnostic method; the patient sleeps at the clinic settings for one night, while respiratory, cardiovascular and cerebral functions are evaluated and mean apnea episodes per hour are determined.

 

Treatment of apnea and snoring involves eliminating the factor that causes the obstruction. Medical or surgical methods are available. Weight loss and quitting smoke and alcohol are first-line measures that should be tried before a surgery is decided or other devices that assist breathing are used.

Surgical methods used by ENT surgeons to treat snoring and apnea include septoplasty, radiofrequency or surgical reduction of nasal turbinate, surgical removal of nasal turbinate, removal of intranasal adhesions, correction of nasal wings, adenoid hypertrophy surgeries, surgical removal of benign or malignant tumors, radiofrequency or surgical reduction of soft palate, tonsillectomy and procedures that aim reduction of the tongue base.

Cochlear implant (bionic ear)

Cochlear implant is an electronic device that is used for patients with advanced stage hearing loss. Cochlear implant is frequently referred to as bionic ear.

Cochlear implant is an electronic device that is placed in the inner to restore hearing in patients with advanced hearing loss secondary to damaged hearing cells in the cochlea. Cochlear implant restores hearing to almost physiological hearing.

How is Cochlear Implant Placed?

Cochlear implant consists of 2 parts. The internal piece or part is operatively placed. The receiver is placed on the scalp behind the ear and the internal electrode is inserted into the cochlea. The surgery is performed under general anesthesia and lasts approximately 1 hour. Estimated hospital stay is 2 days. Wound care is required every other day for one week. Since absorbable sutures are used, there is no need to remove stitches. The surgical wound heals completely within a week.  The external piece is adapted approximately 3 weeks after the surgery. The external piece is placed behind the ear, similar to an ordinary hearing aid device, with no need to a surgical procedure and it is matched to the subcutaneous part of the device by a magnet.

How does cochlear implant work?

The microphone on the external part of the device conducts the sound to the internal piece. Next, the sound processor equipped in the internal part of the device transforms the sounds into electric stimuli that are directly transmitted to nervous cells of the inner ear. The electrical stimuli are transmitted by nervous cells to the hearing center of the brain to enable hearing.

Outcomes of Cochlear Implant

After cochlear implant is placed, patients are maintained on special education. The earlier the cochlear implant is placed, the more promising outcomes are obtained. If the cochlear implant is placed while the child learns to talk (age range = 1-3 years), best outcomes are obtained. Hearing and speech are almost identical to healthy children.

Bone Anchored Hearing Device

Bone Anchored Hearing Device

The transcutaneous technology used in cochlear implants and middle ear implants is now also available for stimulating the bone conduction. An implant with a vibration transmitter is placed to the subcutaneous tissue.  The implant directly stimulates the inner ear without need to conduct signals over the outer and middle ears. Since the direct stimulation enables the bone conduction, hearing is also restored in the other ear and perfect audiological outcomes are obtained.

It is also an attractive solution from cosmetic perspective. Since implant is placed in the subcutaneous tissue, it cannot be seen. The sound processor is remarkably small and hidden under scalp hair.

How is it placed?

The bone anchored implants are placed under general anesthesia and the procedure lasts approximately 45 minutes. Patients usually need to stay at the hospital for one night. Wound care is required every other day for one week. The surgical wound heals completely at the end of the one week.

Results

Since the direct stimulation enables the bone conduction also in the other ear, fat better outcomes are obtained comparing to the conventional hearing aids.

Medical and Surgical Treatment of Voice Disorders

Benign Tumors of Vocal Cords

Polyp of Vocal Cord

This lesion develops secondary to bleeding into the epithelia of the vocal cord following an acute voice trauma (such as shouting). It is almost always unilateral. It is more common in middle aged men. The complaint is hoarseness. The treatment is surgical excision.

Nodule of Vocal Cord

The condition is characterized by bilateral thickening at the junction of one third anterior and two third posterior parts of the vocal cords, where the friction of vocal cords is most potent, secondary to long-term wrong use of the voice. It is also referred to as Singer’s nodule. It is more likely in professions that require professional use of the voice (teacher, singers, politician, stallholder etc.). The complaint is hoarseness. The first-line treatment is speech therapy. The patient is educated on correct use of vocal cords and breathing in the speech therapy. Surgery is the option for advanced stage nodules that do not respond to the speech therapy.

Contact Granuloma and Intubation Granuloma

Contact granuloma is commonly seen in middle aged men. It is usually secondary to long-term overuse of vocal cords and accordingly, it corresponds to nodule of vocal cord in women. The intubation granuloma develops several weeks after a tube is placed into trachea before general anesthesia is administered. The complaint is hoarseness. The first-line treatment is speech therapy. Surgical excision is considered for fibrotic nodules that do not respond to the speech therapy.

Cysts of Vocal Cord

Almost all cysts characterized with serous or mucous content and thin wall develop beneath the mucosa of the vocal cord; they are infrequently seen deep in the muscles of the vocal cord. The occluded orifice of microscopic endocrine glands located on the surface of vocal cords is considered as the primary etiological factor. The complaint is hoarseness. Treatment is surgical excision of cysts.

Papilloma of Vocal Cord and Juvenile Papilloma (Papillomatosis)

It is considered that Human Papilloma Virus type 6 and 11 play a role in the development of papillomas. It is more common in middle aged men. It transforms into laryngeal cancer by up to 20 percent. It causes hoarseness. Surgical procedures aim correcting the quality of voice and restoring patency of the airway.  The most effective treatment is the removal of papilloma by using CO2 laser under general anesthesia. Moreover, it is reported that systemic interferon has curative effects.

Dysplasia

Leucoplakia (whitish thickened mucosal areas) and hyperkeratosis (mucosal eruption and thickening appearing gray to red in color) are more common in smokers and chronic laryngitis. In physical examination, they cannot be differentiated from cancers due to the appearance; therefore, they should be operatively removed and examined in pathology laboratory. Even if cancer is not reported for pathology examination, patients should be closely followed up due to the high risk of laryngeal cancer.

Obesity surgery consists of several surgical techniques to treat overweight. These operations principally make some modifications in the digestive system. Today, all of them are laparoscopically performed, i.e. closed methods.

The most important cause of obesity is excessive food consumption, leading to excessive calorie intake. If significant amount of fat accumulates in the body, the metabolism is totally disturbed and the satiety level gradually increases.

In the obesity surgery, basically two operations are performed. One of them is to reduce the gastric volume. If you decrease the capacity of stomach from 1 to 1.5 liters to 100 ml, the patient feels full even with very small quantities of food. This feeling of satiety is the superiority of obesity surgery over other methods. Because, all other methods recommended to the patient whether called diet or healthy nutrition, are condemned to fail due to the feeling of hunger and insatiate.

The other operation performed in our hospital is to shorten the length of the intestine, where the food is digested, by creating a new passage between the stomach and the small intestine. In this operation, no bowel is resected; just the food absorption is reduced by tying 1.5 to 2 meters of the small intestines.

The most common operation in the first group is laparoscopic sleeve gastrectomy. It is widely known as “tube stomach”. In this operation, no apparatus or tube is placed into the stomach. A large part of the stomach (85%) is excised. Since the remaining stomach resembles a thin tube, the operation is called as tube stomach.

The most common operation in the other group (i.e. reduced absorption group) is gastric bypass. In this surgery, the stomach is reduced. The small stomach pouch is attached to the distal end of the small intestine. The aim is to eliminate absorption of a part of fat and caloric content of foods.

This group is the most potent modality in obesity-related metabolic diseases including diabetes, hypertension and hypercholesterolemia. Without waiting weight loss as in others, blood sugar levels are restored to normal ranges, blood pressure is regulated and blood lipids decrease to physiological ranges. We frequently observe that our patients with blood glucose readings about 450 mg/dl, diabetic foot and  renal problems discontinue insulin and antihypertensive agents following the surgery.

Today, all these surgeries can be performed with only 4 to 5 small incisions (the largest one measuring 1 cm), without opening the abdomen thanks to the technological developments. Thus, the post-operative comfort of the patients has improved drastically. Therefore, our patients may engage in daily activities mostly within 5-7 days.

In the Cancer Center, high-risk patients are assessed by qualified physicians, who are expert on multidisciplinary approach, using high-tech medical devices. All those workup is very important for early diagnosis of cancer. Other relevant services include screening programs for early diagnosis of cancer, determining healthy people, who are at risk of cancer, and informing such individuals about cancer prevention measures.

Radiation Oncology

Radiotherapy is one of the most common modalities used in treatment of cancer, and here, aim is treating cancerous tissue or some benign tumors. X-ray beams are used to prevent growth of cancerous cells or to kill them at the locus of treatment. Treatment is planned for each patient, considering personal needs, and it is combined with chemotherapy in pre- and post-operative periods. In Department of Radiation Oncology, successful results are achieved with modern techniques and cutting-edge technology devices – all used in line with multidisciplinary approach.

Tumor Councils

A multidisciplinary approach is adopted for cancer cases. A council of specialist from relevant departments discusses patients, who are started on a treatment that is decided by the council.

Cancer Surgery

Surgical removal of tumor is still the only fully curative treatment and one of most efficient options to prolong survival. Successful outcomes are obtained for all cases without sacrificing principles of cancer surgery.

In our Department of Oncologic Surgery; conventional surgeries and minimally invasive procedures, which play an important role in the treatment of cancer, are performed in the field of cancer surgery. A multidisciplinary treatment approach is also adopted in the surgical treatment of cancer and accordingly, patient-specific treatment plans are made following the multidisciplinary patient assessment performed for cancer patients.

Orthopedics and Traumatology centers treat all kinds of injuries, such as fractures and dislocations, and operatively correct congenital (clubfoot, hip dislocations) or acquired deformities.

Arthroscopic (closed method) surgeries are performed for the treatment of knee and ankle diseases. Prosthetic surgery (Arthroplasty) is performed for disorders of the hip, knee, shoulder and elbow joints secondary to arthritis.

Knee and hip prosthesis

Knees are our joints, where orthopedic problems are most common. The reasons are; the longest two bones of our body make joints, the range of motion is too large and there are shallow bone structures, the strength is only provided by soft tissue, and our knees are exposed to more load than other joints. In sports activities, too much force is loaded. Damage to cartilage tissue, a meniscus tear and ruptured ligaments destroy the health of the knee and results in pain, swelling, laxity and locking. A healthy knee does not ache, lock, or swell.

Prosthesis is a good choice for patients who are not considered to benefit from knee arthroscopy and guidance surgery in limbs that do not respond to medication treatment, intra-articular injection and physical therapy, or who have complaints after they have previously undergone such operations. If there is no response to the above alternatives and knee problems decreases quality of life, it is possible to speculate that a knee prosthesis is required. Given the fact that prosthesis can be left in the body up to 20 to 25 years, the concept of life quality is more important than the age of the patient at the surgery. However, for people younger than 55, other treatment modalities should be tried until the end. Other treatment modalities may be advantageous for people at 55 to 65 years of age. It can be easily applied for people older than 65.

The hip joint and the pelvic bone, where the hip join exists, play the key role in standing, walking and running. Along the birth, with a timely and healthy development of the hip joint and the surrounding bones and soft tissues, the quality of life is improved by the hip joints that are pain free and intact range of motion. Patients with congenital unhealthy development of the hip joint or acquired fractures and dislocations often encounter problems like infections, bone erosion, inguinal pain referring to the medial thigh in the presence of tumors, swelling, irregular walking and limited joint motion. Postural disorders, limping, unequal length of legs, limited joint motion, thigh pain, tenderness and swelling are the conditions that should be examined. Patients with such complaints can be cured with early diagnosis and treatment.

Treatment of Childhood Orthopedic Diseases

Developmental Dislocation of the Hip

Dislocation and insufficiency of hip is a neonatal and childhood problem. If the diagnosis delays, children are brought to doctor with complaint of limping. Dislocation of hip in children can be treated, if the condition is diagnosed early. Appropriate treatment implies: The gentle reduction of the hip joint into the cavity without damaging vessels that feed the hip bone. This problem, which will occur after the treatment, leads to late serious disabilities. We should remember the saying "you can lead a horse to water but you cannot make it drink” in this treatment. Even if these patients are late in the treatment, successful results are obtained in unilateral dislocations up to 10-11 years of age and in bilateral dislocations up to 6-7 years of age. However, previous unsuccessful attempts will have negative consequences.

Developmental Dysplasia of Hip (coverage insufficiency)

This condition is not associated with limping that is encountered in the dislocation of the hip. Therefore, it may not be noticed for a long time. They often present with pain referring to the knee. Therefore, it is an insidious disease. Sometimes, the first manifestation is lumbar hernia. The dysplasic hip plays an important role in early-onset arthritis. Early recognition of these patients and treatment before the age of 30-35 prevents early arthritis. This treatment corrects the coverage insufficiency and delays the need to hip prosthesis.

Perthes Disease

The disease is characterized by limping that starts at 2 to 12 years of age secondary to insufficient blood supply to the hip joint. Perthes disease should be considered in a child who limps longer than 7 days with no pain and fever. Severity of the disease varies largely, similar to an earthquake. In some cases, no surgery is required, while the intended recovery may also fail despite operative treatment. There is no consensus on definite treatment of this disease. However, these patients need at least two years of regular follow-up during the recovery period.

Pes Equinovarus (Clubfoot)

A congenital clubfoot can be unilateral or bilateral. Some cases are not true clubfoot and simple massages can correct the deformity. For true clubfoot, after primary health problems of the mother and the infant are solved, casting is repeated at weekly intervals for 6 to 7 times. A minor procedure, also referred to as tenotomy, is 90% of patients. (Ponseti Method)

The success of treatment depends on the harmony of family, child and doctor.

Cerebral palsy

The disease occurs secondary to no or insufficient oxygen supply to brain. This phenomenon may occur when the mother is pregnant or during and after birth for various reasons. This case is not progressive in the brain. However, involuntary contractions that develop in the muscles sometimes lead to disorders of the bones and joints. This can lead to difficulties in meeting the child's basic needs. Cooperation of Physical Medicine and Rehabilitation and Orthopedics plays an important role in the treatment.

Spina Bifida (Myelomeningocele)

The disease can be diagnosed during pregnancy. Patients present to doctor with urinary and/or fecal incontinence and varying loss of strength in lower limbs depending on the involved level of the spinal cord. The orthopedic approach is to treat the spinal cord and spinal problems as well as to remedy the deformities in the lower limbs and to adapt to the device. Fractures occur easily. It can be confused with inflammation. Sometimes, wounds that heal hardly develop in soles. These problems can be corrected with appropriate orthopedic treatments.

Pes Planus (Flat-foot)

Physiological Pes Planus:

It is also known as flat foot or collapse of arch. Families start worrying about the child who starts walking. Reinforcements and insoles do not work for these children; self-confidence of children is also compromised. The physician should differentiate pain from pathological foot. The operation requires a limited number of patients.

Pathological Pes Planus:

It is associated with stroke, muscle and nerve diseases or congenital bone abnormalities. These patients often require surgery.

Intoeing and out-toeing in children

It is seen in children who start walking. Their parents worry. Family history is usually remarkable. It originates from hip, legs and feet. Children may have a tendency to W-type sitting position or sit cross-legged. Some of these problems will improve over time. Some of the unresolved problems can be corrected surgically. Sports tendency of these children can be addressed in an examination at 3 to 6 years of age.

Soft tissues such as muscles, tendons, joint capsules and cartilage are injured due to abnormal loading. Besides, bone injuries and visceral organ injuries are also seen during severe trauma. There are 639 muscles in our body and they account for approximately 40% of the body weight. There are around 300 bones at birth and 206 bones in adults (some of them fuse over time).

How Should Emergency Approach Be If There Is Sports Injury, How Should a Final Diagnosis Be Made?

The sport must be terminated immediately and the athlete must move out of the playing area. Cold (ice) compress should be applied on the injured body part; however, cold should not be applied on bare skin. Cold compression should be paused for 1.5 to 2 hours following 20- to 30-minute compression. Compression should be performed with an elastic bandage to prevent swelling and the arm and leg should be elevated to the level of heart. Then, a doctor who is specialized in sports injuries should determine the severity of injury by careful examination. The final diagnosis is made with the help of imaging modalities at the hospital. Direct x-rays and computed tomography (CT) are used for the diagnosis of fractures and dislocations in the bones and joints; ultrasound (USG) and magnetic resonance imaging (MRI) are used for the diagnosis of soft tissue injuries.

 

How is the treatment done?

Resting, bandage and splinting, non-steroidal pain killers and edema-relieving drugs (NSAIDs), regional cortisone injections and physical therapy are at the forefront in minor injuries. Platelet rich plasma injections, which are also very popular in recent days and used in the treatment of professional athletes, are also effective in tissue healing. If the injury is severe, surgical approach is needed. Open and closed (arthroscopic) techniques are used for surgical procedures. Closed (arthroscopic) methods enable clear visualization of intra-articular structures and intervention. Healthy tissues are damaged less and the healing period is shorter.

 

Orthopedic and Open Surgical Treatments of Sports Injuries

Resting, bandage and splinting, non-steroidal pain killers and edema-relieving drugs (NSAIDs), regional cortisone injections and physical therapy are at the forefront in minor injuries. Platelet rich plasma injections, which are also very popular in recent days and used in the treatment of professional athletes, are also effective in tissue healing. If the injury is severe, surgical approach is needed. Open and closed (arthroscopic) techniques are used for surgical procedures. Closed (arthroscopic) methods enable clear visualization of intra-articular structures and intervention. Healthy tissues are damaged less and the healing period is shorter.

Successful outcomes are obtained in management of sports injuries after arthroscopic surgery, since the procedure is maintained with physiotherapy and rehabilitation.

P

In the Pediatric Outpatient Clinic of Kolan Hospital Group, pediatric healthcare services are available for all patients, ranging from newborns to adolescents, round the clock.

In the Pediatrics outpatient clinic, necessary laboratory and radiological examinations are performed by using all scientific and technological opportunities and innovations.

In the Pediatric Outpatient Clinic of Kolan Hospital Group, growth and development of children are monitored and routine vaccines mandated by the Ministry of Health and all other special vaccines are administered in accordance with the vaccination schedule. Childhood diseases and all infectious diseases are diagnosed and treated, and necessary services on childhood nutrition are provided.

Routine Health Examination of Children at Age 0-16

An infant should be monitored at certain intervals starting from fetal life till the end of adolescence when the development is completed.

The child is systematically assessed in each examination, and the child’s growth, development and vaccination are evaluated. Hearing, vision and teeth problems are investigated. Behavioral problems are examined through observation of the child and discussions with the family.

The most important aim is prevention and support; the intention is to prevent the preventable diseases and to diagnose and treat unpreventable diseases at early stage.

How often should routine child examination be made?

One should always remember that routine child health examination varies for each child. The pediatrician welcomes the newborn infant by being available during the delivery. Examination and screening tests are made, and nutritional education is also initiated throughout the hospital stay.

The discharged newborns should be brought for examination within the first week and in Day 15. The babies should be followed up monthly till the end of the first year.

Follow-up interval is quarterly after the age 1. The children should be routinely examined by the pediatrician every six months till the preschool period and then at least once a year.

The preschool period, which is also called as middle childhood period, involves the children aged 5 to 6. Health examinations of these children aim to prevent health problems and learning disabilities that the children may encounter during the school years.

Social, mental and physical health including vision and hearing are as important as chronological age of the child in order to be ready for school and a successful school life.

Administration of Vaccines Mandated by the Ministry of Health and Special Vaccines

 

Vaccines are very effective methods for the prevention of infectious diseases.

Vaccines administered during childhood and adolescence and vaccination schedule used in Turkey are largely conforming to international standards. In our hospital, in addition to all vaccines mandated by the Ministry of Health, we also recommend and administer the ‘special’ vaccines, which are not on the list yet, for the children. The vaccination schedule may be frequently updated and amended due to new vaccines that are licensed following long-term investigations.

Recommendations on Updated Childhood Vaccines are as follows:

Vaccines on the Vaccination List of the Ministry of Health:

Hepatitis B vaccine: The first dose of hepatitis B vaccine should be administered to all newborns immediately after the birth or not later than discharge. The second dose of hepatitis B should be administered when the baby is one month old, and the third dose should be administered when the baby is sixth months old.

BCG Vaccine: In our country, BCG Vaccine is administered to all babies at 2 months of age.

Combination Vaccine (Diphtheria, Tetanus, Cellular Pertussis, Haemophilus Influenza, and Inactive Polio Vaccine): The vaccine can be administered to 6 weeks old babies at the earliest. Four doses are administered at 2 months, 4 months, 6 months and 18 months of age. The booster dose is administered to children at 4 to 6 years of age.

Oral Polio (Infantile Paralysis) Vaccine: In our country, it is recommended to be administered to children at 6 to 18 months of age and 4 to 6 years of age.

Pneumococcal Vaccine: Conjugated pneumococcal vaccine cannot administered earlier than 6 weeks of age. In our country, it is administered in 4 doses at 2 months, 4 months, 6 months and 12 months of age.

MMR (Measles, Mumps, and Rubella Vaccine): The first dose should be administered at 12 months of age followed by the second dose at 4 to 6 years of age.

Chickenpox Vaccine: The first dose is administered when the child is 12 months old. The second dose should be repeated at age 4 to 6 years.

Hepatitis A Vaccine: The first dose should be administered at 18 months of age followed by the second dose at 24 months of age.

Special Vaccines

Rotavirus Vaccine: The first dose of vaccine should be administered to 6 to 12 weeks old babies, and the final dose should not be given later than 32 weeks.

Meningococcal Vaccine: Tetravalent meningococcal conjugate vaccine can be administered to children at or above 9 months of age.

Influenza (Flu) Vaccine: Inactive flu vaccine can be administered at 6 months of age at earliest. Flu vaccine is primarily recommended for risk groups. However, it can be administered to all adults and children upon request of the families.

Tetanus – Adult Type Diphtheria - Acellular Pertussis Vaccine: This type of combination vaccine should be administered to children aged 11-12 years or adults, who were given last dose of diphtheria-tetanus vaccine minimum 5 years ago. Vaccination is especially recommended for parents of newborns and premature babies.

Human Papillomavirus (Cervical Cancer) Vaccine: The first dose of this vaccine, which cannot be administered before 9 years of age, is usually administered to girls at 11 or 12 years of age and three doses in total are required 2 months and 6 months after the first dose.

Breast Milk and Breastfeeding

Breast milk is the most natural and healthy nutrient for the baby. The milk of every living being has the appropriate composition to meet infant’s requirements.

Unless there is a medical problem, babies should only be fed with breast milk in the first 6 months of life without any additional food including water.

World Health Organization recommends minimum one year of breastfeeding.

Benefits of Breast Milk:

  • Breast milk consists of all necessary protein, fat, sugar, minerals, and growth factors and preservatives against some diseases and infections.
  • Breast milk is easily digested.
  • Breast milk is practical and affordable, and it does not require any preparation.
  • Breastfeeding allows physical contact and intimacy, and babies are more peaceful.
  • Breastfeeding mothers return to their pre-pregnancy state more quickly with the effect of hormones related to breastfeeding.
  • Less number of diseases such as infection, allergy, obesity, diabetes is observed in breastfed babies.
  • Breastfeeding women face lower risk of osteoporosis and breast and ovarian cancers.
  • The thickened, high-energy colostrums is produced in the first days followed by transitional milk on 3 to 6 days and finally the more watery ripe milk.
  • Breast milk of mothers of preterm babies varies from that of full term infant; accordingly, breast milk is naturally made up to meet requirements of each baby.
  • Milk content differs at the beginning and end of breastfeeding. Initially, glucose-rich milk is secreted while fat-rich milk, resulting in a feeling of fullness, is secreted at the end of breastfeeding.

For a successful breastfeeding:

  • Although breastfeeding seems like a natural and simple event, mothers need to be informed, confident and be supported by the family and others.
  • Abundant milk can be produced by starting breastfeeding as early as possible after birth, breastfeeding as often and long as the baby wants (including at nights) and holding the baby against the breast in an appropriate position to let the baby take sufficient breast tissue into the mouth.

In an efficient breastfeeding:

  • The whole body of the baby is turned towards the mother and stays very close.
  • Baby’s mouth is widely open with the lips facing outwards, and she grips a part of areola (brown circle around the nipple) along with the nipple.
  • It is observed that the baby sucks the milk deeply and slowly at intervals.
  • No pacifier or feeding bottle should be given to prevent nipple confusion.

Pumping Breast Milk:

  • In conditions where the mother cannot breastfeed the baby, the breast must be milked by hand or by using a device to prevent drying up and tightness in breasts.

Storage of Breast Milk:

  • Breast milk can be stored at room temperature for 3 hours, in a refrigerator for 3 days, and in a deep-freezer for 3 months.

Vision Screening for Children

Newborns and all children, who are presented to routine child health examination, should be assessed for eye and visual problems through the age-specific physical examination, tests and the health history.

Prior to starting school, all children should be examined at around the age of 3 by an ophthalmologist for strabismus, visual acuity, and other conditions which may lead to lazy eye.

Hearing Screening Tests in Children

Hearing tests of newborns have become more common as preventive medicine practices are recently attached ever increasing importance.

Hearing Screening:

Hearing loss leads to speaking and language problems in moderate to severe cases, and school and behavioral problems even in mild cases. Detection of hearing loss by neonatal screening tests and assessment of hearing during examination of each child is important to prevent or minimize negative results.

Optimally, congenital hearing losses should be diagnosed within the first 3 months and treated within the first 6 months.

Risk factors for hearing loss:

The risk for hearing loss is higher in some cases. A special care should be taken in the cases listed below:

In the first month:

  • Family history notable for congenital sensorial hearing loss
  • Infections of mother during pregnancy (TORCH group)
  • Head, face and ear abnormalities, cleft lip-palate
  • Syndromes in which hearing loss is expected (i.e., Down syndrome)
  • Jaundice requiring blood transfusion
  • Birth weight under 1500 grams
  • The five-minute Apgar score 0-3 and the ten-minute Apgar Score 0-6
  • Respiratory problems (i.e., meconium aspiration)
  • Mechanical ventilation more than 10 days
  • Use of ototoxic drug (for example, gentamicin) more than 5 days or in combination with diuretics
  • Meningitis

1 to 24 months:

  • Family or babysitter believes that there is a delay in child’s hearing, speaking or development
  • Serous otitis relapsing frequently or persisting longer than 3 months.
  • Head trauma associated by fractured temporal bone
  • Childhood diseases that may lead to hearing loss (meningitis, mumps, measles)
  • Diseases that involve the nervous system

However, it is known that only 50% of children with significant hearing loss can be diagnosed by hearing screening only in the high-risk group.

Therefore, OAE hearing test should be made for every newborn.

Newborn Screening Tests

When should the test be made?

To avoid false negative results, blood should be drawn minimum 24 hours after starting to feed the baby with nutrients including protein. Blood sampling is usually preferred at 48 to 72 hours after the birth. This period should not exceed 7 days. If sampling is required within the first 24 hours, repetition of the test should be recommended within the 1st or 2nd week.

The test should be made at 7 days of age in premature babies regardless of the treatment history.

It is recommended to repeat the test after a while for babies, who take antibiotics, corticosteroids, dopamine, and in babies with iodine contamination.

How to learn test results?

If the results of metabolic disease screening are within physiological ranges, families are not informed in general. If the test results are suspicious, families are called and informed about advanced tests, and the tests necessary for final diagnosis are initiated.

Inpatient Follow-up and Treatment

A special care is taken to let inpatient children stay with their parents. Services and rooms used for the treatment of children have been designed by prioritizing all security measures. A pediatrician is on duty for 24 hours at inpatient floors. Families are informed and consent is obtained for all procedures. All consultations required for the treatment can be provided.

24-Hour Emergency Pediatric Outpatient Clinic

A Pediatrician is on duty for 24 hours. For immediate diagnosis and treatment procedures of children, all kinds of examinations, consultations and hospitalization procedures, if required, are carried out in the quickest way. Our patients examined in the emergency service and to be treated on an outpatient basis are referred to our outpatient specialists for the follow-up visits.

Pediatric Surgery Clinic deals with outpatient follow-up and treatment of all surgical problems of the entire digestive system, urinary tract and thoracic cavity, excluding the heart, in children. All necessary procedures are planned considering metabolism of baby and child and physiological and psychological developments.

Some Common Diseases Treated at Pediatric Surgery Clinic

Surgical Diseases of Digestive System

  • Constipation and all anomalies of defecation, fecal incontinence, nutritional disorders, anal fistula, avoiding pooping, fistula
  • Stricture of esophagus, diseases secondary to caustic and corrosive materials (corrosive esophagitis)
  • Gastric stricture, obstruction and ulcer disease
  • Gastro-esophageal reflux disease (GER) and complications
  • Obstructed small intestine, polyp disease, inflammatory bowel diseases
  • Appendicitis
  • Mega-colon secondary to congenital developmental disorders of intestinal nerves (Hirschprung's Disease)
  • Inguinal hernia, umbilical hernia
  • Cysts, abscess and tumors of liver
  • Congenital atresia, cystic dilatation or bile stone of bile ducts
  • Pancreatic cysts and tumors
  • Splenic diseases and splenectomy in blood diseases.

Surgical Diseases of Respiratory System

  • Congenital lung diseases, cysts
  • Treatment of abscess and empyema secondary to pulmonary infections
  • Foreign body aspiration and bronchoscopic interventions
  • Deformities of chest wall (pectus excavatum, pectus carinatum)

Surgical Diseases of Genitourinary System

  • Renal cysts, tumors and stones
  • Stricture of ureteropelvic junction (UPJ)
  • Stricture of ureterovesical junction (UVJ)
  • Enlargement of ureter, stones
  • Vesicoureteral reflux (VUR)
  • Urinary bladder infections, stones
  • Omphalocele and gastroschisis (extra-abdominal location of bowel secondary to atresia of abdominal wall).
  • Hypospadias (a defect of urethra in male in which the opening of the tube that carries urine from the body (urethra) develops abnormally, usually on the underside of the penis)
  • Undescended testis, hydrocele, spermatic cord cyst
  • Infections including but not limited to epidydimorchitis (inflammation of testis), balanitis and postitis and prostatitis
  • Circumcision
  • Ovarian cyst, torsion in girls
  • Imperforate hymen, labial adhesions

Surgical Diseases of Newborn

  • Esophageal Atresia: Congenital esophageal atresia, developmental defects and relation with trachea
  • Gastroduodenal atresia: Obstructed duodenum, atresia of small intestine and colon
  • Congenital diaphragmatic hernia (colon is located in thoracic cavity secondary to atresia of diaphragm)
  • Congenital stricture or atresia of anus (anorectal malformations)

Endoscopic Interventions

  • Esophagoscopy, gastroscopy, duodenoscopy
  • Colonoscopy, rectoscopy, anoscopy
  • Cystoscopy, ureteroscopy, bronchoscopy

Cancer in Childhood and Surgical Treatments

  • Kidney and adrenal gland tumors
  • Liver tumors
  • Ovarian and testicular tumors
  • Tumors of other organs

Surgical Treatment of Hormonal Diseases

  • Thyroid gland diseases (goiter)
  • Pancreatic diseases

Pediatric Head & Neck Surgery

  • Cervical masses, reactive lymph nodes
  • Congenital neck cysts and sinuses
  • Torticollis

Department of Pediatric Cardiology of Kolan Hospital Group aims to render advanced services for the follow-up and treatment of congenital or acquired structural disorders of the heart.

In Pediatric Cardiology clinic, state-of-the-art Echocardiography device, catheter laboratory, cardiac stress test and rhythm holter – diagnostic and therapeutic devices appropriate for pediatric age group – and the tilt table that is available in rare healthcare facilities in Istanbul are used to diagnose and treat pediatric diseases.

In addition to advanced therapeutic and diagnostic services available at units of Kolan Hospital Group, high-tech products are also used.

Cardiac Stress Test

This method is useful to identify the etiology of a health problem in patients with exercise-related complaints.

Rhythm Holter: This is a diagnostic method used especially for complaints of palpitation attacks in children with normal heart rhythm in the physical examination; the heart rate is recorded for 24 hours in order to clarify yhe causative factor. It enables to determine the treatment method based on the type of the palpitation. Rhythm holter and cardiac stress test hold an important position to determine future life risks of children who have undergone an open heart surgery.

ECG

This device enables ultrasound imaging of the heart and it is used to assess the structural impairments in the heart (holes, stenoses, contraction strength). It especially allows the treatment of infants who require an urgent cardiac intervention without wasting time in our hospital’s neonatal intensive care unit.

Cardiac Catheterization Laboratory: It enables necessary additional measurements and imaging in congenital heart diseases, where cardiographic exams fall short. Cutting-edge echocardiography and angiography devices are used in our hospital since imaging is very important in the treatments that use “Cardiac Catheter” method.

Catheter Method: It is ensured that newborns with certain congenital heart diseases hold on to life with non-operative interventions that are carried out to open a hole between the atria or ensure that the hole between the carotid and pulmonary arteries remains patent.

A treatment can be provided by implanting a balloon or a device through a non-operative catheter method at the atria, ventricles or stenoses between the veins (valves or veins).

Echocardiography (Transthoracic and Transesophageal)

This device enables ultrasound imaging of the heart and it is used to assess the structural impairments in the heart (holes, stenoses, contraction strength). It especially allows the treatment of infants who require an urgent cardiac intervention without wasting time in our hospital’s neonatal intensive care unit.

Tilt Table Test (Diagnosis and Treatment of Syncope)

“Tilt Table Test” is one of important tests that intends investigating etiology of syncope in children and the test is available in only a few healthcare facilities. If syncope occurs in children during the test, the child is managed with the correct method.

Physical Medicine and Rehabilitation is a medical department that diagnoses and treats musculoskeletal diseases, provides patients with the opportunity of pain-free movement using technological devices and exercises and offers superior service quality to boost the quality of life.

Physiatrists (physical medicine and rehabilitation specialists) and physiotherapists adopt a holistic approach for acute and chronic conditions such as disability secondary to musculoskeletal problems, neurological diseases, chronic pain and cancer. In addition, healthcare services are rendered to prevent, diagnose, treat and rehabilitate medical conditions that cause disability in all age groups.

Conditions Treated by Physical Medicine and Rehabilitation

  • Herniated lumbar and cervical discs.
  • Painful conditions of neck, shoulder, elbow, lumbar region, hip, knee, foot, ankle and heel (i.e. meniscus, heel spur and arthritis)
  • Rheumatic diseases that cause arthralgia – joint pain - and limited motion (arthrosis, rheumatoid arthritis, Ankylosing spondylitis), fibromyalgia, myalgia, trigger finger, tennis elbow, carpal tunnel syndrome, cellulitis, soft tissue diseases, nerve entrapments
  • Back pain (dorsalgia), neck pain (cervicalgia) and low-back pains (lumbalgia) secondary to posture disorders
  • Osteoporosis, commonly referred to as loss of bone
  • Limited range of motion secondary to fractures and other orthopedic reasons, pre-and post-operative periods of hand surgeries and prosthesis surgery
  • Hemiparalysis (stroke secondary to intracranial hemorrhage or occlusion of cerebral vessels)
  • Facial paralysis
  • Spinal cord injuries secondary to occupational accidents or traffic accidents or congenital or acquired paralysis and spasticity in children
  • Limited motion and arthralgia that may develop secondary to fracture
  • Scoliosis, kyphosis (abnormal curvature of the spine), spinal conditions secondary to aging
  • Sports injuries (anterior-posterior cruciate ligament tears, meniscus injuries etc.)

Examples of most common physiotherapy methods used in our Physical Medicine and Rehabilitation Unit are as follows:

  • Hot therapies: Infrared, hot pack, paraffin
  • Cold therapies: Cold pack,
  • Electric current treatments: TENS, interference,
  • Electrical stimulation, Compex
  • Ultrasound, shortwave therapy
  • Vacuum therapy methods: Classical vacuum
  • Laser therapies: HIL therapy (High intensity laser)
  • Shock Wave Therapy (ESWT)
  • Specific exercise therapies (exercises w/wo equipment)
  • Traction
  • Pneumatic compression- Lympha Press (for lymphatic drainage)

Various methods are applied in sessions that take 1 to 1.5 hours at Physiotherapy Unit and average number of sessions is between 15 and 20. Rehabilitation requires longer time periods, even years.

Physical Medicine and Rehabilitation Units work to harmonize knowledge and modern technology to ensure pain-free movement in the shortest possible time and make persons with disability or disease independent in the social life.

Pathology is a field of science that examines structural and functional impairments of tissues and cells caused by diseases and investigates etiology/underlying reasons of diseases. In this end, body fluids and tissues sampled at outpatient settings and operating theaters are examined at the Department of Pathology. Pathology units that work in cooperation with central laboratories are available in all hospitals.

Level 2 (detailed) ultrasound examinations at the high - risk pregnancy outpatient clinic are performed by means of ultrasound devices which can produce images at high quality, perform doppler test, color doppler test, and have 3 and 4 dimensional imaging capabilities. Samples of placenta, fluid or blood can be collected from the fetus in the mother's womb for tests. (Cvs, Amniocentesis, Cordocentesis)

The term "high - risk pregnancy" is used to refer to the presence of a special condition which threatens the health of the pregnant woman or of the unborn baby. In fact, there is no "zero risk pregnancy". A problem which does not exist during the initial months may later appear in the course of pregnancy.

Detailed ultrasound examinations

Potential fetal problems are mostly examined via ultrasound devices. A detailed screening of the baby’s body structure and internal organs performed via an advanced ultrasound device is commonly known as "Color Ultrasound", "Color Doppler", "Detailed Ultrasound", "3 Dimensional - 4 Dimensional Ultrasound" and "Documented Ultrasound". Physicians mainly use the term "Level 2 Ultrasound", or "Detailed Ultrasound". Doppler, Color Doppler, 3 and 4 Dimensional Imaging methods are used during the screening when required; however, the most important information is obtained from the high - quality black - gray - white images which can be produced by advanced ultrasound devices. Detailed ultrasound examinations differ from the ultrasound examinations performed while tracking a routine pregnancy from the following aspects: An advanced ultrasound device with a high image quality and Doppler test, Color Doppler test and 3 and 4 dimensional imaging capabilities is used; The examination requires longer time to examine the organs of the fetus at the smallest possible level of detail; The examination is performed by a physician (Perinatologist) who is specialized on high - risk pregnancies, congenital disabilities and diseases. Following the screening, a report containing details and recommendations in writing will be issued.

Are detailed ultrasound examinations harmful to the fetus?

Ultrasound is an extremely high pitch which is inaudible to human ear. It does not emit radiation. Ultrasound has been in use nearly for 60 years for the examination of fetuses. There has been no reported case of damage on fetal health due to ultrasound scanning for medical purposes. However, it is still advisable to complete the ultrasound examination within the shortest time possible and patients are recommended to avoid going for ultrasound examination when it is unnecessary.

Which problems can be diagnosed by detailed ultrasound examination?

Detailed ultrasound screening allows examination of the body and organ structures as well as the growth and development of the fetus in terms of disorders (anomalies) or symptoms (markers) leading to suspicion of congenital disease. Disorders (anomalies) are abnormal formations in the baby's body and organ structures. Detailed ultrasound screening which is conducted at 12 - 14 weeks of gestation (First Trimester Screening) allows diagnosis of 80 - 90% of anomalies that will lead to permanent disability or short life expectancy, and enables parents the right to make a decision on early termination of pregnancy. Detailed ultrasound screening which is conducted at 20 - 22 weeks of gestation (Second Trimester Screening) allows diagnosis of nearly all anomalies that will lead to permanent disability or short life expectancy. The markers are the physical characteristics which may as well be observed in normal fetuses, but are more frequently observed in those with genetic or infectious diseases. For instance, symptoms such as mild enlargement of the ventricles, absent or short nasal bone, increase in nuchal fold thickness, absent middle phalanges in the little finger, deviation of the first metatarsal may also be observed in normal fetuses; however, such symptoms are also more commonly observed in babies with congenital mental retardation known as Down Syndrome.

Which problems cannot be diagnosed by detailed ultrasound screening?

The possibility of diagnosis of disabilities depends on the size and location of the disability - a majority of very small structural problems cannot be detected by ultrasound ; anal atresia, choanal atresia, cleft soft palate, intestinal obstruction, small holes in the heart, deformities in reproductive organs can be given as examples to anomalies which cannot be detected by ultrasound. Moreover, factors such as unsuitable week of gestation for screening, being overweight during pregnancy, position of the baby in the womb, low amniotic fluid, etc. may affect ultrasound examination and prevent diagnosis of potential problems. Congenital diseases that do not affect the baby's body and organ structures cannot be diagnosed by ultrasound screening. Congenital mental retardation, vision or hearing impairment, blood diseases, infectious diseases, metabolic diseases (tissue or physicochemical diseases) are problems which cannot be diagnosed by ultrasound screening. It is not possible to diagnose most of these diseases by any examination during pregnancy. Some of them can be diagnosed by conducting tests on samples collected from the placenta, amniotic fluid or umbilical cord blood. Such tests are not recommended for all pregnancies since they are costly and have a risk of miscarriage, though small; however, such tests are performed in case of increased risk of Down Syndrome (an incurable congenital mental retardation due to chromosome abnormality) or of any other genetic or infectious disease.

In which period of pregnancy is detailed ultrasound screening performed?

For detailed ultrasound screening, the pregnant is usually guided by the physician tracking the pregnancy. In case of suspicion of deformation, decrease or increase of amniotic fluid, or suspicion of retarded development, such screening may be required in any week of gestation. If a detailed ultrasound examination is to be conducted in any case without an existing suspicion of any special problem, the first examination will be performed between 12 - 14 weeks of gestation (First Trimester Screening), and second examination will be performed between 20 - 22 weeks of gestation (Second Trimester Screening).

First Trimester Screening (Detailed Ultrasound and Double Test in the first 3 months of pregnancy)

This examination is performed between 12 - 14 weeks of gestation and it involves ultrasound screening and blood tests (double test). The purpose of this examination is to diagnose as early as possible any congenital defects which may cause unwanted pregnancy, and the risk of Down Syndrome, which is a common cause of mental retardation. The earlier the pregnancy is terminated in case of severe fetal disability diagnosed, the less psychological trauma and distress it will cause in families. Although the body structure of 3 - month fetuses cannot be viewed as detailed as that of 5 - month fetuses, many major deformities such as cranium deformities, severe spinal deformities, abdominal wall defects, absence of hand - arm - leg - foot or shortened bone, ectopic organs, defects in formation of cardiac cavities or major blood vessels entering and leaving the heart can be diagnosed early. The other purpose of this examination is to perform an estimation of the risk of Down Syndrome, which is a common cause of mental retardation, by measuring the nuchal fold thickness, monitoring the nasal bone, and examining by ultrasound any abnormal blood flow in the valve between the small and large right ventricles of the heart (tricuspid valve) and in the vein connecting the umbilical vein with the right atrium of the heart (Ductus Venosus). 90% of babies with Down Syndrome can be diagnosed if findings of the ultrasound screening are accompanied by the Double Test (Combined Test) on the pregnant’s blood sample and amniocentesis is applied to high risk fetuses. This ratio is higher than that of the Triple Test performed as a single test between 1 - 20 weeks of gestation (60% diagnostic power) and of the Quadruple Test (80% diagnostic power). In case of multiple pregnancies (twins, triplets, quadruplets), tests on samples collected from the pregnant's blood are not reliable; therefore, the risk is estimated solely on basis of findings of the ultrasound screening and the pregnant’s age.

Second Trimester Screening

This is the most common examination performed by perinatologists. It is the most detailed fetal examination performed during pregnancy. Unless there is any specific reason, it is usually advised that it should be performed between 20 - 22 weeks of gestation. During these weeks, fetal structures can be viewed at the smallest possible level of detail by ultrasound, and nearly all of anomalies which may lead to short life expectancy or permanent disability can be detected. Such examination may be performed earlier or later than the mentioned weeks in circumstances such as suspicion of disability or subsequently formed damage, retarded development, decrease or increase in the amniotic fluid.

Third Trimester Doppler

This refers to assessment of blood flow in the umbilical cord and brain vessels of fetuses with a detected developmental problem in the last trimester of gestation and in the uterine vessels of the pregnant patient.

Invasive Procedures

“Invasive Procedure" refers to the procedures such as sampling of the placental tissue in a transabdominal manner (Chorionic Villus Sampling or CVS), sampling of the amniotic fluid (amniocentesis), and sampling of blood from the fetal umbilical cord (cordocentesis). Invasive procedures are used in checks of congenital diseases that cannot be diagnosed by ultrasound but may be detected by laboratory tests. Tissues or cells of the fetus which are sampled by invasive procedure may be examined for the disease which is scanned by laboratory tests. Invasive procedures are not advised for every pregnant patient, but are recommended for patients with increased risk of congenital fetal disease which can be detected by laboratory tests. Amniocentesis is the most common invasive procedure applied, and it is usually performed in pregnancies with increased risk for Down Syndrome.

Suggestions for patients who want to visit HRPC for examination

The High - Risk Pregnancy Clinic provides service by appointment. Appointments for Detailed Ultrasound can be made via phone. Appointments for invasive procedures (CVS, amniocentesis, cordocentesis) are not scheduled via phone; pregnant patients must attend in person and be accompanied by their partner, and the fetus must go through a detailed ultrasound examination, and the parents must be informed verbally and in writing about the purpose of the intervention intended and its potential risks.

Examinations involving ultrasound screening take 30 minutes on average (45 - 60 minutes for multiple pregnancies). If the baby's position is not suitable for examination, the physician may suggest waiting and this may increase the time spent at the hospital up to one or one and a half hours. Examination may be delayed if the ultrasound image quality is poor in patients with abdominal subcutaneous fat tissue or when it is earlier than 20 weeks of gestation. Patients may be admitted to the examination later than the appointment time scheduled, though not frequently, due to reasons such as admission of an emergency patient or extension of the examination period of a pregnant patient who has been diagnosed with a medical problem. If an invasive procedure (e.g. amniocentesis) is required, the time to be spent at the hospital may take longer than 2 hours.

You are recommended to attend the examination with your partner. If your partner cannot accompany you, you are recommended to attend with one relative who is capable of understanding the explanations to be made by the physician.

You should not bring children or multiple companions with you with the excuse that they want to see the baby. The long duration of examination, possible requirement of vaginal examination and explanations to be made in case of diagnosis of any problem may be boring or inappropriate for children. Upon your request, the ultrasound images will be recorded on a DVD concurrently with the examination and any 3 dimensional images of the baby captured will be given to you.

You must arrive 15 minutes before your appointment time to have necessary registration procedures performed. You are recommended to bring the documented results of examinations performed and ultrasound screening images captured - reports produced during gestation. It is preferable that you eat your meal before the examination.

PET (Positron Emission Tomography) is a functional imaging method, which provides physiological information necessary for clinical diagnosis based on alterations in tissue metabolism. Usage of biologic radioisotopes that imitates native components of body and spreads positron (Carbon-11, Oxygen-15, Nitrogen-13, Fluorine-18 etc.) is one of widely recognized advantages offered by PET. In our country, flourodeoxyglucose (FDG) labeled with Fluorine-18 is the radioactive substance that is most commonly used in PET-CT.

PET shows bio-distribution of a tracer molecule, which is marked with a special radiopharmaceutical agent (generally F-18-FDG which is a component of glucose), in every organ. Radioactive tracers accumulate in areas where it is most heavily metabolized, or in other words, at periphery of tumors.  F-18 is decomposed in glucose metabolism and positrons are emitted that are detected by PET unit. At the same time, ring-like CT unit produces high-resolution three dimensional X-ray images of the body part examined. As a result, a consolidated ‘anatomo-molecular’ image is obtained, which visualizes localization, size, metabolism and distribution of tumor. Anatomic and functional details are obtained in a single image. Although PET/CT is most commonly used in the field of oncology, it facilitates early diagnosis of neurological diseases (dementia, epilepsy, Alzheimer’s disease etc.) and cardiac disorders.

Oncologic PET-CT

PET-CT is used for following purposes in lung cancer, mesothelioma, lymphoma, melanoma, cancers of head & neck, small intestine, colon, rectum, esophagus, breast, thyroid gland and other endocrine glands as well as tumors of pancreas, liver, kidney, urinary bladder, ureter, testis, penis and other male genital organs, female genital organs, brain and musculoskeletal system.

Diagnosis,

  • Determining dissemination of the disease before the treatment (staging)
  • Identifying the tumor tissue in patients who will receive radiotherapy; treatment planning; delivery of correct dose to the correct region,
  • Evaluating response to the treatment (investigating response of tumor to chemotherapy or radiotherapy)
  • Evaluating efficacy of chemotherapy (chemosensitivity) in patients who are given chemotherapy alone, but eligible for alternative chemotherapy protocols,
  • Post-treatment staging and evaluating efficacy of the treatment,
  • Re-staging the patients with relapse,
  • Investigating the primary focus in metastatic cancers with undiagnosed tumor focus.

Issues Requiring Attention in PET-CT Scan

  • Patients should rest and avoid strenuous physical activity one day before the scan.
  • Patients should not eat and drink sugared foods and beverages (fruit, fruit juice). A fasting period (minimum 6-hours) is required before workup. Patient should not get cold especially at winter while presenting to the hospital.
  • Blood glucose is analyzed after primary preparations are completed in the day of scan.
  • Patient is intravenously injected FDG molecule (radioactive substance) labeled with Fluoride-18, which is a glucose derivative and emits positrons.
  • It is necessary to wait for 49 to 60 minutes to have drug widely distributed to the body. Patient should definitely rest and avoid moving or even talking, unless necessary.
  • Once waiting time is over, patient is transferred to the imaging room.
  • Both 3D CT and PET images are obtained in the same session within 12 to 20 minutes in total.

Plastic Surgery is a specialized department that deals with the correction of tissue defects secondary to various causes or organ and body deformities related to skin, subcutaneous tissue, muscle, tendon and skeletal system. Basic function of plastic surgery is to restore acceptable appearance and functioning in a deformed or partially or totally dysfunctional organ. The term, plastic, comes from Greek word “plasticos” and Latin word “plasticus”. It means “to mold” and “give form”. The word, reconstructive, derives from “reconstruction”. It means “rebuilding” and “repair”. In plastic surgery, although patient’s own tissues are typically used, artificial materials are also utilized, such as artificial bone and silicone. Plastic and Reconstructive Surgery refers to reshaping the tissues depending on relevant deformity, either developmental or acquired, and regaining functional anatomic and aesthetic appearance.

In the field of Plastic Surgery, the most common conditions that are addressed surgically are burns and its complications. In our country, treatments focusing on burn and post-burn scars/sequels account for 25% of all plastic surgery operations.

Excluding corrective operations based on aesthetic concern, emergency operations for injuries take an important place in the field of plastic and reconstructive surgery. Such surgeries mostly include attachment of a severed hand or finger and treatment of injured nerves and tendons.

Head and Neck Tumors

Tumors of salivary glands, sinuses and mandibular and maxillary bones and all malignant and benign skin tumors are addressed surgically.

Congenital Anomalies

Cleft lips, also referred to as harelip, cleft palate – a deeper anomaly- and ear anomalies are common defects. Genital organ anomalies are also common, which most individuals refrain for expressing due to pervasive sense of shame. Such congenital anomalies are treated by plastic surgeons.

Facial Bone Surgery

Congenital deformities may be present in facial bones. Moreover, facial deformities and contour impairments may also occur secondary to accident. Such deformities are successfully managed and corrected by Plastic Surgery.

Reconstruction of Severed Limbs

Some organs that are congenitally absent or that are lost due to diseases or accidents can be reconstructed in Plastic and Reconstruction Clinic. Among them are reconstruction of ear in a patient with congenital atresia of ear, breast reconstruction for those who underwent mastectomy due to cancer, and nasal reconstruction for severed or removed nose.

Cosmetic Surgery

Advancements in medicine bring highly efficient opportunities in surgery just as the medical treatment of many diseases. By utilizing those opportunities, free tissue transfers can be done using microsurgical methods. Free tissue is transferred using microsurgical techniques to repair defects caused by poorly healing wounds and cancers.

“Cosmetic Surgery” is one the most popular fields of the Plastic and Reconstructive Surgery. Nose jobs, elimination of periorbital and abdominal wrinkles and removal of excessive fat tissue are considered in this context. Liposuction and facial rejuvenation with laser are also carried out at this unit.

Mental health can be identified as a concordant, satisfying and balanced life of an individual that is in harmony with the society, the culture and the family, but especially with him/herself. In the rapidly changing world, one's ability to love in close relationships and to use own capacity effectively can occasionally be interrupted by stressful life events. Mental disorders usually underlie the unhappiness in relationships, loss of life energy and interrupted productivity and creative activities.

Most of them are easily treated at our hospital using psychotherapy and/or pharmacotherapy (medication treatment). Department of Psychiatry identifies physical, social and psychological conditions that cause mental disorders and treats them in the light of actual scientific data based on a good communication between the patient and the physician.

Common Psychiatric Disorders That Require Treatment

  • Depression
  • Bipolar Disorder (Manic-Depressive Disorder)
  • Panic Disorder (Panic Attack)
  • Generalized Anxiety Disorder
  • Obsessive Compulsive Disorder (Obsession Disorder)
  • Social Phobia
  • Phobias
  • Psychosomatic Diseases (Associated with physical manifestations)
  • Impulse Control Disorders
  • Dissociative Disorders
  • Internet Addiction
  • Post-Traumatic Stress Disorder
  • Schizophrenia and Psychotic Disorders
  • Sexual Dysfunctions
  • Marriage and Relationship Problems
  • Personality Disorders
  • Eating Disorders
  • Sleep Disorders

In Psychology divisions, all psychotherapy programs are available at weekly sessions by psychologists. The patient is informed about the relevant program in detail subject to confidentiality and limit principles. If necessary, the case is managed in cooperation with the psychiatry clinic.

 

Personal psychotherapy services are available in psychology divisions.

R

Radiotherapy

Radiotherapy is a treatment modality that aims to destroy tumor cells by delivering radiation to the target area using advanced technological devices. Treatments are scheduled in sessions and performed within several days to weeks. Duration and type of treatment are decided by Radiation Oncologist.

For cancer, radiotherapy (irradiation) is applied alone or in combination with surgery / chemotherapy. Success rates are pretty high, when radiotherapy is accurately planned and applied by Radiation Oncologist. Therefore, advanced technology plays a very important role in radiotherapy. When this synergy is appropriately used, success rate increases.

Recently, radiotherapy is used approximately in half of the cancer patients.

Radiotherapy is efficacious in treatment of cancer, when advanced radiotherapy techniques, namely three dimensional radiography planning and IMRT, are used.

Advanced radiotherapy with advanced technological support:

Radiotherapy is continuously updated in line with technological advancements. Tumors are treated with procedures under supervision of the radiation oncologist using treatment planning systems (TPS) without damaging the healthy organs in close proximity to the tumor. Human factor and technological advancements are coordinated to help the treatment of patients.

A clear differentiation is made between the diseased area and the healthy tissues, as the target zone is examined in detail using the advanced technology. Thus, side effects are minimized by accurately focusing the radiotherapy to the tumor.

Personalized treatment for each patient:

 

After reports and X-rays are reviewed by your doctor and detailed evaluation is made, a patient-specific treatment plan is created.  Very remarkable gains are achieved, as this detailed treatment is planned and checked at daily intervals by the radiotherapy team.

Rheumatology is the medical discipline that deals with rheumatic inflammatory diseases and other diseases of the muscoskeletal system. Rheumatism is the broad term for conditions that cause pain and limited motion as well as swelling and deformity in components of the locomotor system – muscles, bones, joints and ligaments.

There is no single type of rheumatic disease; approximately 200 disorders are included in this group.

The most common diseases are Ankylosing spondylitis, Rheumatoid arthritis, Behçet’s disease and Psoriatic arthritis.

Rheumatoid diseases are manifested by many complaints depending on the actual disease. Rheumatic diseases involve visceral organs, such as HEART, LUNG and KIDNEY, along with the joints. It may also influence the skin and the eyes.  Therefore, those complains are not limited to joints.

S

For sleep disorders, up-to-date diagnostic and therapeutic procedures are performed with a multidisciplinary approach in cooperation with Departments of Neurology, Chest Diseases and Otorhinolaryngology.

T

In our thoracic surgery clinics, it is underlined that surgical treatment and follow-up of lung cancer are as important as early diagnosis. All surgical techniques are available for cancer surgeries in our operating theatres equipped with the latest technology. However, surgical treatment options are also offered for mediastinal tumors, non-cancerous pulmonary problems, chest wall abnormalities, sweating problems (hand, armpit, face etc.) and esophageal diseases.

Lung Cancer Surgery

Treatments of small-cell and non-small-cell lung cancers vary. Surgery is preferred mostly in non-small-cell lung cancer. Besides, surgery/chemotherapy/radiotherapy or dual or triple combination thereof may be administered by the stage of the disease.

If the disease is diagnosed in early period and there is no contraindication for operation, surgery is the MOST EFFECTIVE TREATMENT in lung cancer. Especially the cases with early stage lung cancer would constitute the patient group having the highest survival rate if the cancerous tissue is completely excised. Therefore, the patients elected for surgery should take advantage of these opportunities; otherwise, same chance of success is very low with other treatments.

The "Lung Cancer Council" decides the treatment method to be used in lung cancer. This council consists of pulmonologist, thoracic surgeon, medical and radiation oncologists, nuclear medicine doctor, radiologist and pathologist.

In surgical treatment, cancerous tissue is excised by conventional "thoracotomy" (open surgery) or thoracoscopic surgery, also known as closed surgery. A single pulmonary lobe (lobectomy) or entire lung (pneumonectomy) may be excised depending on the extent the cancer spread. The amount of lung to be resected is planned before the surgery. When a part of the lung is resected, the remaining lung tissue should be sufficient for the patient. Therefore, the pulmonary and cardiac functions of the patient are evaluated extensively before the surgery. If the overall health, age, and organ functions of the patient do not allow the surgery, the operation is contraindicated, even if the cancer is technically resectable.

On the other hand, even if the cancer is determined as "not resectable" in the initial examination, cancer tissue can be debulked by neoadjuvant chemotherapy and/or radiotherapy at optimal pre-operative doses followed by surgical excision. Extensive and detailed examination is required before a patient is considered as "inoperable".

Congenital Chest Deformities

Chest deformities (abnormalities in the shape) are congenital abnormalities in the osseous and muscular structure of the chest wall. Most of these disorders, ranging from a slight protrusion of a rib to total protrusion of the heart (which is fatal), are not life-threatening; they do not cause any symptoms or complaints are secondary to dysfunctions. There are various types of chest deformity, and the most common ones are Pectus Excavatum (shoemaker breast) and Pectus Carinatum (pigeon breast).

 

Pectus Excavatum:  It is also known as shoemaker breast. Anterior chest wall is collapsed inward. It usually presents at birth or within the first years of the life. It becomes more apparent during rapid growth period at 14-15 years of age. It is the most common chest wall deformity. It is four times more likely in males as compared to females. There is also familial predisposition.

The most common complaints

  • Negative psychological effects due to physical deformities
  • "Poor exercise capacity" and resultant "difficulties during sports activities" as compared to peers due to the cardiac and pulmonary dysfunction.

Treatment

Treatment is usually a surgical operation. The ideal age of patient for surgery is 10-12 years, although it varies depending on sex, patient and the deformity. A vacuum bell may be used in mild cases or severe cases to facilitate operation. The necessary pre-operative measurements are made to determine the appropriate pectus bar (steel rod) for the patient and it is operatively inserted. Most patients return to school in 2-3 weeks, although exercise (physical training, weight lifting, etc.) should be limited for six weeks. Pectus bar is removed 2 to 4 years after placement. The bar is removed under general analgesia. No major complications have been reported to date during the removal of the bars. The patients may be discharged one or two hours after the bar is removed. Given the long-term outcomes of NUSS surgeries, the risk of recurrence is below 5% and patient satisfaction is very high.

NUSS Surgery

NUSS surgery is used to correct Pectus Excavatum (shoemaker breast) and the surgery is accompanied by some advantages such as fewer incisions, fewer procedures, shorter operation time, faster recovery after surgery, and positive long-term outcomes. By video-assisted thoracoscopy, the posterior side of the chest bone (sternum) is supported by a steel bar and lifted forward. Since there is no need to cut or divide the ribs and cartilage, large incisions on the chest wall are not required. If possible, shoemaker breast should be corrected before puberty, so that the chest wall easily gets its normal shape at the end of the rapid growth period. However, thanks to Nuss technique, very promising outcomes are obtained even for 30 to 40 years old patients.

Pectus Carinatum:  It is also known as pigeon breast. Anterior chest wall is pushed outward. The symptoms are similar to that of pectus excavatum. Pectus carinatum deformity can be corrected with ABRAMSON technique, a closed surgery method similar to NUSS surgery.

 

Abramson surgery: No access into the thoracic cavity is required in this technique. After appropriate shape is given to steel bar, it is inserted through a tunnel prepared subcutaneously at the level where the chest protrudes most. Both ends of the bar are screwed to the fixers, called stabilizers, that are secured on ribs by steel wires. The steel bar and stabilizers are removed under general anesthesia 2-4 years after placement.

Mediastenoscopy and Bronchoscopy

Mediastinoscopy is a method frequently used to stage lung cancer, to diagnose other lung diseases that involve lymph nodes (such as sarcoidosis, tuberculosis). In addition to methods such as computed tomography and nuclear medicine, it is a reliable and accurate method.

 

Application methods

  • Standard cervical mediastinoscopy: is the most common form of mediastinoscopy, and a special device is inserted into the cavity, called as mediastinum, located between the heart and lungs through a small incision made in patient’s neck under general anesthesia. If video assistance will be used, the images taken are reflected on a monitor. The device is advanced anterolateral to the trachea and lymph nodes or tumors are biopsied.
  • Anterior mediastinoscopy: The device is inserted into the left anterior side of the chest, rather than the neck, approximately between the 2nd and 3rd The other steps are same as above.
  • Extended cervical mediastinoscopy: The incision is same as standard cervical mediastinoscopy, but the route of the device is different. The device is advanced anterior to aorta and peri-aortic lymph nodes are biopsied.
  • Subxyphoidal Mediastinoscopy: The incision is made below the chest bone (sternum).

Implementation

The most common indication is preoperative staging of lung cancer. If a cancerous cell is observed in the lymph node biopsy, surgery is not recommended. Although there is no great risk, adverse events may occur since the operation is performed close to high vascularized vital organs. Morbidity rate is near-zero for this operation (0.08%).

Endoscopic Surgery

The endoscopic intervention in the chest region is called "thoracoscopy". Thoracoscopy is usually performed with a video assisted system. This is called "Video Assisted Thoracoscopic Surgery (VATS)".

Video Assisted Thoracoscopic Surgery (VATS)

Video Assisted Thoracoscopic Surgery is performed under general anesthesia to visualize the chest cavity by a video camera and to view images on a monitor. Following the visualization of the ribcage, almost all operative procedures, including biopsy and surgical resection, can be performed with the aid of several surgical devices through holes (ports) opened on the chest.

As compared to standard thoracotomy (open surgery), after VATS the patients:

  • have less pain,
  • Stay shorter in the hospital,
  • Engage in daily life activities quicker,
  • Resume daily activities more easily.

Besides, since the incision is smaller, bleeding is less likely, and this closed method is more tolerable for older patients with respiratory distress. However, patient selection is important in thoracoscopy, as this operation is not an option for all patients and all size of lesions. It is recommended to follow your doctor's advices.

Endoscopic Transthoracic Sympathectomy

This method is another area, where thoracoscopic intervention can be used, and is indicated in the treatment of extreme hand-armpit sweating. As compared to the open sympathectomy, the endoscopic technique is a much safer method. A small incision is made under the armpit under general anesthesia. The sympathetic nerve is displayed in the chest cavity by a camera. The sympathetic nerve is clipped, cut or cauterized at the level causing sweating, and is disconnected from the sweat glands.

Mediastinal Surgery

The mediastinum is a cavity between the two lungs, the heart and the trachea within the thoracic cavity. Surgical conditions of the mediastinum can mainly be divided into:

Mediastinitis: Mediastinitis is the inflammation of mediastinum. Typically, it manifests with abscess. The infection in mediastinum may develop due to the conditions harming the esophagus, an oral infection spreading distally or post-operative complications. As a result, the overall health of the patient impairs. Urgent surgery is required. The abscess in the mediastinum is operatively drained through the chest cavity above the sternum, i.e. chest bone.

Cysts: It is a term used for fluid-filled, thick-walled formations. Most mediastinal cysts are congenital in nature and they expand gradually. Typically, they are not malignant, but they should be excised because they compress the surrounding tissues. All cysts should be excised by sternotomy (chest bone incision) or thoracic cavity incision (thoracotomy or VATS). Typically, the cure is obtained when the cyst is totally excised.

Mediastinal tumors: Benign or malignant tumors originating from mediastinal structures may be observed. Surgery, radiotherapy and chemotherapy may be applied according to the features of the tumor.

Thymic surgery: The thymus is an H-shaped gland located in the anterior side of the mediastinum; it extends over the pericardium, the membrane of the heart and trachea. Benign or malignant tumors (thymoma and thymic carcinoma) of this gland are the most common tumors of the anterior mediastinum. These tumors are staged as other regional tumors. The first-line treatment is surgery for the early stage. Radiotherapy or chemotherapy is also available as a supportive treatment. The operation is usually carried out through a "sternotomy". The chest bone, known as sternum, is cut vertically under general anesthesia using special saws and split into two parts. Next, anterior mediastinum is exposed. The thymus is excised together with the tumoral tissue and the invasion site. It is important to excise the tumor entirely. If it cannot be excised, radiotherapy and/or chemotherapy is/are given as adjuvant treatment in the optimal settings after the operation.

Besides, even though no tumoral formation is found, it may be necessary to excise the thymus gland in the "Miyastenia Gravis", a neurological disorder characterized by fatigue and weakness in the muscles. The recovery rate is 30-80% after thymus is excised. Thymus can be excised by sternotomy or by closed surgery known as VATS.

Bronchoplasty

Bronchoplasty consists of a group of procedures to cut airways (known as bronchi) and to reconstruct them by end-to-end anastomoses. The purpose is to protect the remaining intact lung tissue during the resection. In other words, the purpose is to excise centrally located bronchial lesion, and thus to avoid the excision of the entire lung (pneumonectomy).

Bronchoplasty has mainly two indications:

  • Bronchial obstruction (irreversible obstructions caused by trauma or infection)
  • Bronchial tumor (benign or malign)

Bronchoplastic surgeries are more difficult than conventional ones and require experience. Patient selection is very important in this technique. The lesion should be localized adjacent to the central area and the remaining pulmonary tissue should be benign. It is very important to determine the length of intrabronchial lesion by bronchoscopy before the operation.

The diseases bronchial segment is circumferentially resected by bronchoplasty during thoracotomy performed under general anesthesia. Two ends of bronchi are reconstructed by end-to-end anastomosis. Several release (liberation) techniques are used when these ends need to be closed up to each other for anastomosis.

When bronchoplastic surgeries are compared with standard pneumonectomy, there is no risk in morbidity and pulmonary functions and quality of life are maintained because more active lung tissue is left.

The blood bank (station) of Kolan Hospital is a unit that meets blood and blood product needs of inpatients in a safe and rapid manner by using the state-of-the-art equipment round the clock.

When blood is needed for our patient, voluntary blood donors with compatible blood type are identified, including family members of the patient and other donors who meet prerequisites, and asked to present to our blood station.

After the initial interview with the blood donors, they are asked to read and sign a "Donor Survey Form”. Blood pressure, pulse, height and weight are measured and if no contraindication is determined, blood samples are drawn from the donor to do necessary blood tests. Those tests intend preventing any adverse event that may affect health of the donor negatively and eliminating risks valid for the recipient (infection, blood incompatibility reactions, etc.).

Following tests are analyzed in the blood of the donor:

  • Blood type
  • Complete blood count
  • Anti HBC total
  • Anti-HCV
  • Anti-HIV
  • HbsAg
  • VDRL
  • Cross-Match (to verify that the blood type of the donor matches the blood type of the recipient)

If blood tests do not point to a negative result, the blood is immediately drawn from the donor or an appointment is scheduled for the date of surgery.

U

Urology Department of Urology renders high-quality urological assessment, examination and treatment services by physicians, who closely monitor all scientific and technological advancements, for adults and children.

Urology Clinic is a discipline of medicine that examines male and female urine production and voiding (kidneys, internal urinary tracts, bladder, prostate gland and external urinary tracts), along with male reproductive and sexual health problems; and it deals with diagnosis and medical and surgical treatments of disorders in those systems.

Diagnostic and Therapeutic Services Available in the Department of Urology

Stones of Kidney and Urinary Tract

All endoscopic methods used in treatment of stones in kidney and urinary tract (Flexible / Semi-rigid Ureterorenoscopy, Percutaneous Nephrolothotomy (PNL), ESWL) are successfully performed at Kolan International Hospital.

Benign Prostate Hyperplasia (BPH)

Benign prostate hyperplasia is one of the most common diseases in the aging men. Half of men older than fifty either takes medications or undergoes surgery for this reason.

Laser prostatectomy: “GreenLight” method, a recently developed very efficient alternative to surgical treatment of benign prostatic hyperplasia, is successfully used.

TUR-prostatectomy: In this endoscopic (closed) method, endoscopic device is inserted through urethra and prostatic region is reached; next, prostate gland is cut into small fragments with electrocautery and fragments are removed. Bipolar-Plasmakinetic TUR is also available along with conventional TUR-P at our hospital.

Open Prostatectomy: It is preferred in advanced stage prostatic hyperplasias where TUR-P is not an option due to stenosis of urethra or presence of large stones in the urinary bladder.

V

A varix implies dilatation and/or tortuous appearance of superficial veins due to valve insufficiency. Prolonged standing leads to pain and increased pressure in the leg with varicose veins. Such complaints relieve when the leg is elevated. Other symptoms of the disease include heavy feeling, itching, cramps and edema (swelling) around ankles. If the disease is left untreated or if valve insufficiency is at advanced stage, discolorations and ulcer (open wound) may develop around the ankle.

Women are three times more likely to develop varicose veins. Risk factors include advanced age, pregnancy, prolonged standing, overweight and obesity and family history.

In the Varicose Vein Clinic, Conventional surgery, Endovenous Laser Ablation (EVLA), Endovenous Radiofrequency (RF) Ablation and Mechanical Ablation are performed when it is medically indicated to treat the condition and Foam Sclerotherapy, Transdermal Laser and Transdermal Radiofrequency are reserved for cosmetic concerns.