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Diseases

Varicocele

<h2>What is Varicocele?</h2> <p>Varicocele is the varicose of veins that drain blood of the testicles, which is encountered in 30-40% of the patients who are presented to the doctor with the problem of infertility. Varicocele is the clinical name given to the enlargement of testicle veins like varicose in the legs. Disruption of testicular temperature affects testicular function and impairs sperm and testosterone production, with toxic substances in dirty blood accumulating in the testicle and disrupting testicular blood flow.</p> <h2>What are the symptoms of varicocele?</h2> <p>Varicocele symptoms are very important for the diagnosis and treatment of the disease. Swelling on the testicle</p> <ul> <li>and pain in the testicle</li> <li>may be the symptoms of varicocele.</li> <li>Testicle pain may be a symptom.</li> </ul> <p>The dilatation of the veins may become evident enough to be seen from outside after a while and may take on an varicose-like shape on the legs. Symptoms of varicocele include swelling in the testicles, as well as sweating and a feeling of warmth. The shrinkage of the testicles, which is one of the symptoms of varicocele, can be seen in some patients, although rare.</p> <h2>Why Does Varicocele Occur?</h2> <p>The cause of varicocele is unclear. It is observed in individuals with children in the society at a rate of 15-20% even in adult ages. It is observed in 30-40% of men applying for infertility. In secondary infertility, who have had a child before and who apply again with a child request, it can be up to 60%.</p> <p>While varicocele is seen 90% in left testicle, 8-9% observed in bilateral. Its rate of being seen only on the right is 1-2%. The appearance of varicocele mostly on the left side depends on a number of anatomical factors.</p> <ul> <li>The left side testicle is slightly lower than the right side.</li> <li>The vein on the left side of the testicle is longer than the right side.</li> <li>Anatomical relationship of the left side testicle vein with other neighboring organs in the abdomen.</li> <li>Among the features such as the anatomical structure of the left side testicle vein emptying, varicocele is among the reasons why it is seen on the left side.</li> </ul> <h2>How to Understand Varicocele?</h2> <p>Careful individuals can identify the varicocele from irregularity, swelling or pain on the testicle when self-examining. Varicoceles are mostly diagnosed during the doctor&#39;s examination in applications made with infertility complaints. Also; Pain in conditions requiring effort such as long standing, sports or sexual activity may indicate varicocele. Varicocele examination is performed as part of the genital examination. The patient should be examined in a standing position at a room temperature of 21 -22 degrees. The testicles and genital area are observed while the patient is standing and standing upright. The patient is examined both in the normal position and by straining maneuvers by observation and hand. It should be determined whether there is an expansion in the vascular structure with normal and strain maneuvers. With these procedures, the presence of varicocele is clinically determined. The golden standard is physical examination in diagnosis. In addition, Scrotal Doppler ultrasonography is performed to support clinical diagnosis, to determine the degree of varicocele and to decide on surgery.</p> <h2>How is Varicocele Treatment?</h2> <p>After the diagnosis of varicocele, firstly, whether there is a difference between the testicle sizes and the consistency of the testicle should be checked. Performing semen analysis in which sperm parameters are evaluated is decisive in the treatment. If the patient&#39;s sperm parameters do not have a problem, it is controversial whether they should be operated or not.</p> <p>The factors can disrupt sperm parameters in this kind of patients;</p> <ul> <li>Eating habits</li> <li>Smoking and alcohol</li> <li>Exposure to toxic substances</li> </ul> <p>Antioxidant drugs and nutritional methods can be recommended to correct sperm parameters and the environment in which sperm are located. After the diagnosis, the question arises as to which varicocele patients will be operated. It is not a correct approach to make an operation decision by looking at the varicocele grade, that is, the grade value. In some cases, even a 1st degree (Grade 1) varicocele can be operated, while in some cases, surgery may not be decided for 3rd degree (Grade 3) varicocele. Operation decision is a situation that varies according to the patient. &nbsp;</p> <p>Supportive therapies may be recommended in the patient group who have been diagnosed with varicocele but have no infertility problem or whose impairment in sperm parameters is limited.Antioxidant agents can be given for patients who have not experienced severe sperm loss, whose sperm motion has not completely disappeared, and sperm deformity is minimal. However, surgery can be recommended in patients who have been diagnosed with varicocele and whose sperm parameters are impaired and who are infertile. In such patients, changes in exercise, diet and lifestyle are not beneficial for the elimination of the disease.&nbsp;</p> <p><strong>As a result;</strong></p> <ul> <li>The patients with normal sperm parameters, only radiological varicocele, no reflux or below normal vascular diameter are not required to be operated.</li> <li>Patients with impaired sperm parameters benefit more from surgery.</li> <li>It is important to perform clinical follow-up by evaluating testicular sizes and consistency in varicoceles in adulthood.</li> <li>Varicocele surgery only due to pain is not a right approach.</li> <li>After the surgery, 60-70% sperm parameters improve.</li> <li>It is important to perform the postoperative evaluation at the 6th month and to determine the change in sperm parameters.</li> <li>The accepted approach in the treatment is interventions made from the groin area by microsurgery.</li> </ul> <h2>FREQUENTLY ASKED QUESTIONS ABOUT VARICOCELE</h2> <p><strong>How is varicocele pain?</strong></p> <p>Varicocele pain is an uncomfortable blunt, distinctive pain in the testicle. This pain can be felt in the groin area and the testicle, as well as from time to time in the leg. Varicocele pain can go away with painkillers. The pain experienced can be confused with different ailments. Besides the presence of varicocele in a patient who applied for testicular pain;</p> <ul> <li>Hernia</li> <li>Urinary tract calculus (kidney calculus) that fall into the urinary tract or bladder</li> <li>Orchitis, testicular infection</li> <li>It should be evaluated whether the vascular structure of the testicle rotates around itself and causes bleeding.</li> </ul> <p>Pain caused by such ailments can be confused with varicocele pain. Some inquiries such as whether the person has a complaint in urination, whether the swelling in the testicle has increased, whether the pain begins suddenly or not, and laboratory methods can provide the differential diagnosis. Not all pain must be varicocele.</p> <p>Pain can be felt more pronounced after standing for a long time, walking, exercise, sexual activity.</p> <p><strong>How does the testicle look in the varicocele?</strong></p> <p>The varicocele does not cause any changes in the testicle. However, in advanced varicocele patients, the veins cab be seen as superficial in testicles, such as varicose veins in the legs. Varicose enlarged veins can be palpable through the skin and can be observed.</p> <p><strong>Who has varicocele mostly?</strong></p> <p>The reason for the occurrence of varicocele is unknown. However, there are some risk groups:</p> <ul> <li>Mostly overweight people</li> <li>People doing high-weight sports that increase intra-abdominal pressure</li> <li>People suffering from chronic asthma and chronic cough attacks</li> <li>People who experience chronic constipation that increases intra-abdominal pressure</li> <li>It can be considered as occupational disease as in varicose disease. Occupational groups such as teachers and police, which standing up are more common.</li> </ul> <p>Varicocele is common in people with varicose veins in the legs because it is a vein disease. Inverse of this situation, varicose disease can also be seen in people with varicocele. Since both diseases are related to veins, insufficiency of the valves in these vessels may occur due to factors such as problems in the transmission of blood.</p> <p><strong>What is Bilateral Varicocele?</strong></p> <p>While varicocele is 90% seen in the left testicle, 8-9% can be seen on both sides. The occurrence of varicocele in both sides is named as bilateral.</p> <p><strong>Are there any foods good for varicocele?</strong></p> <p>Nutrition has nothing to do with varicocele formation or treatment. Only people with chronic constipation can be evaluated in this group. Fiber or olive oil nutrition which helps eliminate constipation may benefit indirectly.</p> <p><strong>Does varicocele cause infertility?</strong></p> <p>Varicocele ranks first among the treatable infertility causes. If the varicocele causes male infertility, then an operation decision can be made. However, it should be noted that not every varicocele is the cause of infertility and there may be no improvement in sperm values in each patient after surgery.</p> <p><strong>Does varicocele prevent erection?</strong></p> <p>The testicle has two basic functions. Varicocele may cause impairment in the functions of testicles that produce sperm and hormones. Chronic varicocele may lead to a decrease in the production of the male hormone called testosterone, as well as sperm production, by causing a decrease in testicle size in the later periods. If chronic varicocele is not treated, it can cause erection and sexual desire loss along with low testosterone.</p> <p><strong>What are the varicocele grades?&nbsp;&nbsp;</strong></p> <p>According to the examination in the clinical environment, varicocele is evaluated as 3 stages, namely Grade.</p> <ol> <li>Grade (Grade 1): This is a situation in which the patient who is examined as standing up does not have any symptoms, however, the varicocele is detected by palpation when the patient strains.</li> <li>Grade (Grade 2): Varicocele can be slightly observed when the patient is standing up. This is a situation in which the veins become visible and palpable after the patient strains.</li> <li>Grade (Grade 3): This is a situation in which the vessels are visible without straining on the patient who is examined as standing up and this image becomes more evident at the end of the straining maneuver. &nbsp;</li> </ol> <p><strong>For which patients, varicocele surgery decision is made?</strong></p> <p>In order to decide on varicocele surgery, it is necessary to reveal the presence of varicocele and have infertility in the patient. In patients with this condition, surgery can be decided with the support of the following criteria:</p> <ul> <li>Shrinkage in testicle size, softening in testicular consistency</li> <li>More than 3 mm vascular dilation with Doppler ultrasonography</li> <li>Determination of blood backflow in Doppler examination</li> <li>Impaired sperm parameters in semen analysis</li> </ul> <p>In addition, in the patients who has varicocele and who have previously undergone assisted reproductive methods but failed, treatment of varicocele may be recommended as a risk factor before a new application if the failure is known to be caused by sperm factor.</p> <p>It is not correct to make an operation decision in people only with testicular pain.</p> <p><strong>How is varicocele surgery performed?</strong></p> <p>Varicocele surgery is performed by microsurgery. The testicle veins are reached by entering through a 2 cm incision in the groin area. Under the microscope, the enlarged veins are separated from other vessels and connected.</p> <p><strong>How long does varicocele surgery take?</strong></p> <p>Since varicocele surgery is performed with microsurgery methods, all the vessels in that area must be connected. Depending on whether the operation is unilateral or bilateral and the number of vessels connected, the duration may vary between 1-2.5 hours.</p> <p><strong>Are there any risks of varicocele surgery?</strong></p> <p>Since varicocele surgery is performed by microsurgery method, the complication rate is extremely low. The most important risk is the attachment of the testicular artery and associated post-operative testicular shrinkage and impaired blood supply. However, since the surgery is performed by microsurgery, the arterial and vein distinction can be made very clearly. The probability of experiencing such a complication is extremely low today. The likelihood of fluid accumulation around the testicle, namely hydrocele, is also extremely reduced. Apart from this, risks such as postoperative infection development and bleeding formation that may occur in all surgeries should not be ignored. With precautions such as attention to sterilization and hemostasis, possible problems are minimized.</p> <p><strong>Are there different treatment methods for varicocele?</strong></p> <p>Treatment of varicocele is performed by using different surgical and radiological methods.</p> <p><strong>Varicocele embolization;</strong> Interventional radiology methods can be used for entering through the groin and an occlusive substance injection can be made into the enlarged veins. However, in this method, side effects such as mobilization of the occlusive substance, that is, going to other places, loss of effectiveness of the substance over time, pain and allergic reaction can be experienced. This treatment approach is not highly recommended in international guidelines.</p> <p>There are also surgical methods applied other than microsurgery.There are approaches from the groin area, high groin area or laparoscopic. However, surgery under the microscope from the lower groin area is considered as the golden standard.</p> <p><strong>Does varicocele reoccur?</strong></p> <p>There are different treatment methods of varicocele, but the probability of recurrence is almost zero in surgeries performed with microsurgery.</p> <p><strong>How long is the healing time of varicocele?</strong></p> <p>After the surgery performed with the microsurgery method, the patient can return to his normal activity within 2-3 days and to routine business life within 1 week and 10 days. It may take 4-6 weeks to perform activities that require heavy effort and exercise.</p> <p><strong>When do sperm improve after varicocele surgery?</strong></p> <p>To evaluate the effect of varicocele surgery on sperm, sperm production time should be considered. The time from the main germ cell to the production of mature sperm in the testicle is considered to be an average of 90 days. So sperm parameters are checked every 3 months after surgery. The best recovery in terms of sperm production after varicocele occurs at the 6th month. If there is an improvement in sperm parameters at the 6th month, the 9th and 12th months should be expected when the increase becomes more evident. However, if there is no change in sperm parameters 6 months after the operation, an additional improvement due to the operation should not be expected in the patient. It is necessary to direct the patient to other treatment alternatives. After the operation, an improvement in the sperm parameters of the patient is observed in 60-70%. While 30 - 40% of the patients do not see any improvement, less than 1% of patients may experience worsening after varicocele surgery. This very rare condition occurs mostly in patients experiencing bilateral varicocele.</p> <p><strong>What are the conditions that patients should pay attention to after the operation?</strong></p> <p>After varicocele surgery, it is necessary to stay away from sportive activity, heavy exercise and sexual activity by following the doctor&#39;s recommendation in the early period. It is appropriate to wait 15-20 days for sexual activity and 4-6 weeks for exercises that require effort ans sports. Apart from these, it is necessary to follow the treatment methods recommended by the doctor.</p> <p><strong>Is there pain in the testicles after surgery?</strong></p> <p>In varicocele surgery, which is a surgical procedure, there may be some kind of neuralgia pain, especially due to damage to the nervous tissues in the testicle area. In addition, it is not the right approach to operate patients suffering from only testicular pain. There may be many underlying causes of pain in such patients. Pain continues after surgery in such patients. The most important reason for failed surgery is patients who do not have infertility, but experience pain alone.</p> <p><strong>Does swelling occur after varicocele surgery?</strong></p> <p>Post-operative testicular connective tissue release may result in testicular sagging on the operated side. However, swelling is the increase of fluid that is normal around the testicle, that is, the development of Hydrocele. It is a more experienced situation in the methods applied outside the microsurgery method. It is a problem seen less than 1% in operations performed with microsurgery method. Since the lymphatic vessels are clearly demonstrated and no operations such as connection or burning are performed, the lymphatic circulation is not affected, so there is no swelling and swelling around the testicle after surgery.</p> <p><strong>Can those who have varicocele surgery have children?</strong></p> <p>After the operation, sperm parameters improve in 60-70% of the patients. If there is no improvement in sperm parameters in the 6th month, it is useful to direct the patient to methods such as vaccination or in vitro fertilization according to the sperm parameters of the patient, taking into account the conditions such as age factor and female factor. If a young patient who comes to the doctor to evaluate the general condition and has a diagnosis of varicocele with impaired sperm parameters and wants to have children in normal ways, varicocele surgery may be recommended. However, in the older patients with the same diagnosis, instead of wasting time with varicocele surgery, it is more appropriate to refer them with to treatments such as IVF or vaccination. Here, the clinical condition and age of the patients are taken into consideration. Infertility should be evaluated bilaterally not only as the condition of the individual but also as the condition of the couple.</p> <p><strong>What happens if varicocele is not treated?</strong></p> <p>Varicocele is a chronic condition and does not heal on its own. If left untreated, it can progressively cause decrease in testicle size, enlargement in varicocele size, further decrease in sperm parameters, and hormonal disruption in the testicle in the future. Also, none of these may happen and the patient can have it as standard for life. There is no such thing as the operation of every varicocele.</p> <p><strong>Does varicocele occur in young people and children?</strong></p> <p>An important problem of varicocele is its observed in young people. Varicocele, which is less than 1% in the child age group, is observed by 15% in the 13-15 age group. It is very difficult to evaluate the effect of varicocele on the testicle in the 16-17 age group. Since sperm production has not started completely in this age group, it is not very healthy to evaluate sperm function. In addition, it is not ethically correct to perform semen analysis in young people in this age range. In young people whose surgery decision is difficult to make; when evaluating testicle sizes and testicular consistency, it is necessary to determine the degree of varicocele radiologically. Surgery may be considered if the varicocele causes differences and shrinkage in the size of the testicles. However, in young people who do not have a difference in testicle size and consistency, it is more appropriate to decide on surgery by evaluating sperm parameters by semen analysis when the patient at least reaches the age of adolescence.</p>

POLYCYSTIC OVARY SYNDROME

<p>Polycystic ovary syndrome (PCOS), which is very common in women of reproductive age, is among the most important causes of infertility, as it reveals the problem of not being able to ovulate. Benign cysts that form in the ovaries cause hairiness, excess weight gain and acne along with menstrual irregularity. This disease can be combated with diet and exercise under the control of a dietitian, and appropriate drug treatment.</p> <h2>What is polycystic ovary syndrome?</h2> <p>Polycystic ovary syndrome, which is an important ovulation problem in women, is seen in one of every 10 women. This problem, which is common in women of reproductive age, manifests itself as benign cysts that occur in the ovaries. Polycystic ovarian syndrome, which is diagnosed with the appearance of more than 10 cysts smaller than 1 centimeter in ultrasonography, which is a imaging technique, can lead to infertility, diabetes, coronary artery diseases and blood pressure disorders if not treated in women of reproductive age.</p> <h2>How does polycystic ovary syndrome develop?</h2> <p>Two ovaries, which are for reproduction in the female body, develop a mature egg suitable for fertilization in one menstrual period. The egg develops and matures in a vesicle filled with fluid called follicle. A follicle is selected every month in women, it grows and ovulates. In women with polycystic ovarian syndrome, this follicle cannot be selected and therefore there is no ovulation every month. In the ultrasound examination, the ovaries are seen as many vesicles with undeveloped eggs, that is, many cysts.</p> <h2>Which situations should be suspected?</h2> <p>It turns out that about 20% of women who apply to IVF centers have a problem of ovulation. Polycystic ovarian syndrome is the leading problem of ovulation in women who are examined by specialist physicians to have children. Women who have menstrual irregularities, overweight and hairiness problems should be diagnosed after physical examination and ultrasound to be performed. During adolescence, sometimes menstrual irregularity occurs as a normal condition. However, the presence of this disease in adolescent girls with menstrual irregularities can be&nbsp;revealed thanks to laboratory tests as well as imaging techniques.</p> <h2>What are the symptoms?</h2> <p>In adolescence, after one or two periods no menstruation, irregular menstruation (menstruation less rare than 35 days), unusual bleeding.</p> <p>Excessive pimples on the face and back, visible changes in skin tissue, maculation on the hand. Polycystic ovary syndrome is mostly the cause of recurrent acne, especially in the 20s.</p> <p>As a result of this disease, excessive hair growth and deepening of the voice in the body are thought to be due to the male hormone (androgens). The hormone testosterone, which is present in a certain proportion in every woman, increases during this period, causing hairiness and thickening of the voice.</p> <p>Male hormone, the level of which increases in the body due to polycystic ovary syndrome, can adhere to the receptors in the hair follicles (receptor) and cause male pattern hair loss.</p> <p>Especially as a result of decreasing female hormones and increasing male hormone, breast sizes may reduce over time.</p> <p>Difficulty or infertility in getting pregnant is an important symptom. This problem, which is seen in 10% of young women, is one of the most important causes of infertility.</p> <p>Excessive weight gain. Half of the women with polycystic ovaries were found to be obese.</p> <h2>What causes polycystic ovary syndrome?</h2> <p>Despite numerous clinical and experimental studies, it is not known exactly what caused the disease. However, the disease is thought to be caused by the &#39;insulin&#39; hormone that regulates carbohydrate metabolism. It is thought that excess weight causes insulin resistance and insulin resistance triggers polycystic ovary syndrome. Insulin, the main hormone that enables sugar, the main food source in the body, to enter the body cells (muscle, fat and liver cells) from the blood to provide energy, is secreted from beta cells in the pancreas. Secretion of high levels of insulin that occur in the body with insulin resistance increase the production of male hormone (androgens) in the ovaries.</p> <h2>How is the treatment of the disease?</h2> <p>When planning treatment, these patients should be reduced to ideal weight under the supervision of a dietician. If necessary, &#39;metformin&#39; drug treatment used in diabetics to break the insulin resistance is used in this period. As a result of medical treatment and weight loss, there may be a significant improvement in the number, and sometimes the pregnancy may occur spontaneously when the ovulation problem disappears. However, if menstrual irregularity persists after these procedures, ovulation stimulating drugs and hormone needles can be applied. Pregnancy is tried to be created by suggesting a normal intercourse from the eggs that develop as a result of these follow-ups or by vaccination method. If pregnancy could not be achieved with 3-4 times follow-up and vaccination, it is recommended to switch to IVF.</p> <h2>What should be recommended to women?</h2> <p>It is absolutely important for women with polycystic ovary syndrome skip gynecological follow-ups after pregnancy and to continue annual examinations. In these patients, some diseases, especially diabetes, may occur in older ages. To prevent this, excess weight gain should be prevented, regular exercise should be recommended and if necessary, regular menstruation should be provided with medications.</p> <h2>FREQUENTLY ASKED QUESTIONS ON POLYCYSTIC OVARY SYNDROME</h2> <p><strong>I use a drug used in diabetics, is there any harm to the body?</strong></p> <p>The drug called metformin used in diabetes is given to many women diagnosed with polycystic ovary syndrome to provide ovulation. In addition, studies have shown that this drug reduces the risk of miscarriage in pregnant women.</p> <p><strong>Is there a cure for the disease?</strong></p> <p>There is no definitive cure for polycystic ovary syndrome. In the disease that occurs due to many parameters, complaints are reduced by weight control to be achieved with drug therapy and diet.</p> <p><strong>Besides infertility, does this disease have other negative consequences?</strong></p> <p>One of the most important consequences of polycystic ovarian syndrome is that the body develops resistance to insulin. Due to the long duration of insulin resistance, many women become diabetics in the long term. It has been determined that the risk of high blood pressure and heart diseases arises due to the disease.</p> <p><strong>Is there any harm in irregular or absent menstruation?</strong></p> <p>The body is exposed to high estrogen effects for a long time because ovulation is rare or absent in women with rare menstruation due to this disease. Progesterone secreted after ovulation will suppress the effects of estrogen, resulting in the possibility of uterine cancer.</p> <p><strong>Is there a good side of this disease?</strong></p> <p>In the studies conducted, it was determined that the number of ovaries in women with PCOS is better (AMH values are higher) and that these patients maintain their egg count better than other women and menopause age is advanced even in the later ages.</p>

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Technologies

PET/CT

<p>Contact Us</p> <p>Add to Favorites</p> <p>PET / CT, which is a method that increases success in the fight against cancer in order to identify cancerous tissues, treatment planning and evaluation of the process, is considered as one of the most important technologies for many patients to have a healthy life.</p> <p>&nbsp;</p> <p>Contents</p> <p>What is PET / CT?</p> <p>What are the application areas of PET / CT?</p> <p>What are the features of PET / CT that make the difference?</p> <p>How is PET / CT operation performed?</p> <p>Frequently asked questions</p> <p>What is PET / CT?</p> <p>Positron emission tomography (PET-CT) technology, combined with computed tomography (CT), is an important technology medical imaging method that enables the diagnosis of many diseases. PET / CT is widely used in the diagnosis and staging of cancer. In addition, its effectiveness is utilized in the diagnosis of &quot;undiagnosable diseases&quot; such as fever of unknown cause, detection of infection foci, detection of living tissue in cardiac patients, and differentiation of Alzheimer&#39;s and dementia. In particular, all stages are carried out with a PET / CT device for the initial diagnosis, staging, determination of the prevalence and the correct treatment plan of the cancer. A road map of cancer treatment with PET / CT makes a significant contribution to the fight against the disease.</p> <p>&nbsp;</p> <p>It is used in Memorial Şişli Hospital, Memorial Bah&ccedil;elievler Hospital, Memorial Ankara Hospital, Memorial Diyarbakır Hospital and Memorial Health Group Medstar Antalya Hospital.</p> <p>&nbsp;</p> <p>What are the application areas of PET / CT?</p> <p>PET / CT, which guides cancer treatment, is used in the following stages of diagnosis and treatment;</p> <p>&nbsp;</p> <p>It determines the metabolism of the tissue with cancer suspicion.</p> <p>It reveals whether the masses detected by various imaging methods show cancer metabolism. If the mass is PET / CT positive, this mass consumes too much glucose and the probability of cancer is high.</p> <p>It is directive in taking biopsy from the correct and least disturbing area of the tissue with cancer suspicion. Cancerous tissue can also damage its own structure due to uncontrolled proliferation. Sufficient cells may not be obtained for diagnosis from tissue fragments taken from the damaged area, PET / CT shows the areas where living cells are concentrated and guides biopsy.</p> <p>It is a guide in reaching the diagnosis in the fastest way.</p> <p>What are the features of PET / CT that make the difference?</p> <p>Evaluation of cancer prevalence: PET / CT technology is successfully used in many types of cancer for the purpose of evaluating (staging) the disease prevalence at the first stage after cancer diagnosis. It is a guide for regional treatments in patients with disease that has spread (metastasis) to the body.</p> <p>Determination of the treatment approach: On average, after this examination, the treatment approach changes in one out of three patients. Sometimes drug treatment can be performed instead of a heavy surgical application and/or operation may not be required. In some cases, PET / CT shows that there is no spread in the patient who is thought to have distant spread, allowing the decision to remove the cancerous tissue by surgery instead of the drug treatment decision.</p> <p>Early detection of the benefit of cancer drugs: Cancer drugs are drugs whose side effects should be considered. Using the appropriate medication can prevent the side effects and prevent the disease with the right medication and early intervention to the cancerous tissue. The evaluation to be made with PET / CT after the 1st or 2nd course of treatment gives information about how useful the drug can be in the early period. Thus, the drug can be changed early and a new drug treatment can be started.</p> <p>Determination of treatment response: With PET / CT, response to cancer drugs can be evaluated by measuring both structural changes and the intensity of cellular activity numerically. After the treatment is completed, the effectiveness of the treatment can be determined by investigating the presence of live cancer cells. PET / CT is the imaging system that shows the earliest response to treatment.</p> <p>Making beam treatment plan: By mapping the areas of living tumor cells to be given radiation in radiotherapy or radiation therapy with PET / CT, the chance of correct and effective treatment increases. In addition, irradiation to healthy tissues is prevented.</p> <p>Early detection of recurrent disease: After treatment cures are completed, patients are followed up with methods such as ultrasound and tomography and blood tests. In these methods, in case of doubt, whether living cancer cells reappear or not and their prevalence are determined by PET / CT method.</p> <p>HOW IS PET / CT PROCEDURE PERFORMED?</p> <p>For PET / CT procedure, the patient needs at least 6 hours of fasting. First, the patient&#39;s blood glucose is measured. If the blood sugar is within the desired limits, radioactive material is injected into the vein. Although there are various radioactive materials, the most used one is F-18 Fluorodeoxyglucose. This substance is a sugar molecule bound to a radioactive substance called Flor-18. Following the injection, the patient is kept waiting for an hour to keep the drug in the cancerous tissue in sufficient amount. It is then captured in the PET / CT device. Other materials used in PET / CT are F-18 NaF to visualize bones, Ga-68 PSMA in the investigation of the spread of prostate cancers, and Ga-68 DOTA-TATE used in the investigation of neuroendocrine tumors. Apart from these, there are many radiopharmaceuticals that are not used routinely.</p> <p>&nbsp;</p> <p>PET / CT can increase the success in the fight against cancer in many stages from the detection of cancerous tissue to the treatment plan, from the evaluation of the treatment success to the planning of the radiation therapy.</p> <p>&nbsp;</p> <p>FREQUENTLY ASKED QUESTIONS</p> <p>What does PET / CT mean?</p> <p>The most important difference of cancer cells from normal cells is their rapid and uncontrolled proliferation. The energy needs of highly active cells are also higher than normal. When substances such as sugar, protein and some special building blocks used by cancer cells in this process are radioactively labeled and displayed, the location of cancerous tissues can be determined. The PET / CT device operates on the basis of this logic.</p> <p>&nbsp;</p> <p>What is PET / CT for?</p> <p>It is the most advanced medical imaging method in the diagnosis and staging of cancer to a great extent.</p> <p>&nbsp;</p> <p>How long does a PET / CT procedure take?</p> <p>It takes an average of 20-25 minutes, although it varies according to the area to be shot.</p>

O-Arm

<p><strong>What is O-Arm?</strong></p> <p>It is possible to get detailed information before the patient leaves the operating room by using the O Arm. Previously, it was performed in the operating room with a C-arm and 2-dimensional x-ray device called Scopy. O-Arm&#39;s high technology provides the opportunity to be a 3D image in the operating room environment. Since the O Arm is mobile, there is no need to move the patient for imaging.</p> <p>&nbsp;</p> <p><strong>In Which Diseases Is O Arm Used?</strong></p> <p>O-Arm is mostly used in brain, nerve and spinal cord surgery operations. In brain tumor surgeries, in addition to instant display of the risky area during surgery, it can be frequently used in spine instrumentation, ie spine screwing operations. Spine screwing operations;</p> <ul> <li>Spinal fractures</li> <li>Slipped Low Back</li> <li>Spinal Tumor</li> <li>Spinal curvatures, namely scoliosis</li> <li>Spinal collapse due to infection</li> <li>Situations where excessive bone is surgically removed due to narrow canal</li> <li>Spine screwing surgery can be applied in cases such as spinal deformities due to aging.</li> <li>O Arm advantages (distinctive features)</li> </ul> <p>Spine screwing operations are usually performed with a 3-armed X-ray device called a scopy. Images obtained with scopy are 2-dimensional, while images obtained with O Arm are 3-dimensional.</p> <p>&nbsp;</p> <ul> <li>The margin of error is minimized in screwing operations performed with the arm.</li> <li>It provides critical information to the surgeon at every stage of the surgery.</li> <li>The risk of recurrence is reduced</li> <li>Due to the short exposure time, the patient is exposed to very little radiation.</li> <li>The O-Arm imaging system provides rapid recovery to the patient with a small incision.</li> <li>This system minimizes the great risks of complex surgeries.</li> <li>It reduces the risk of infection.</li> <li>The risk of stroke due to the screw is eliminated.</li> </ul>

Neuronavigation

<p>Neuronavigation is an advanced technology application that is generally used in brain nerve and spinal cord surgery department surgeries.</p> <p><strong>What is neuronavigation?</strong></p> <p>It can be compared to the navigation systems used in automobiles and mobile phones. Neuronavigation provides guidance to the surgeon during surgery and helps to plan a sensitive surgical approach to the targeted lesion by defining the surrounding nerve and vascular structures. The neuronavigation system, which significantly increases the success of brain, nerve and spinal cord surgery, also allows surgeries to be safer.</p> <p>&nbsp;</p> <p><strong>IN WHICH DISEASES IS NEURONAVIGATION USED?</strong></p> <p>Neuronavigation system is mostly used in the operations of brain, nerve and spinal cord surgery.</p> <p>&nbsp;</p> <ul> <li>Brain tumor surgeries</li> <li>Cerebral hemorrhage</li> <li>AVM (Arteriovenous Malformation) in the surgery of cerebrovascular diseases</li> <li>In cases of Parkinson&#39;s or similar diseases with tremor, in surgeries requiring battery insertion</li> <li>Spine surgeries and determination of the direction of the screws placed in the spine</li> <li>In addition, neuronavigation system can be used in some orthopedic surgeries.</li> </ul> <p>&nbsp;</p> <p><strong>Benefits of Neuronavigation System (Features that make the difference)</strong></p> <p>It shows the surgeon the shortest and safest route to the area where the lesion is located with the help of previously taken MRI and CT images in brain and spine surgeries known as sensitive area surgeries. Since the surgeon reaches the area to be operated on with the help of neuronavigation, the targeted area is approached with almost zero error and the healthy tissue is damaged at the least level. Risky brain and spine surgeries, where even millimetric errors can lead to negative consequences, become safer with the use of neuronavigation technology.</p> <p>&nbsp;</p> <p>The advantages of using the neuronavigation system in operations can be listed as follows;</p> <ul> <li>Deep brain lesions can be defined more accurately.</li> <li>The tumor is removed more precisely.</li> <li>The surgery is performed with a smaller incision than the skin and bone.</li> <li>Less blood is used.</li> <li>Operation time is shortened</li> <li>Surgery wound heals faster</li> <li>The length of stay in the hospital is shortened and the patient can return to social life more quickly.</li> <li>Frequently Asked Questions About Neuronavigation</li> </ul> <p>&nbsp;</p> <p><strong>How Is The Patient Prepared For Neuronavigation?</strong></p> <p>There is no different preparation for patients who will use neuronavigation in their surgery, except for the preparations made in standard surgeries.</p> <p>Advanced Magnetic Resonance (MR) or Computed Tomography (CT) images of the area to be operated before surgery are taken.</p> <p>The 3-dimensional images obtained are placed on top of each other and uploaded to the &quot;Neuronavigation&quot; device used in the surgery. After the patient is taken into the operating room, the surgical area is designated at the computer in 3D with the help of a probe that is passed over the skin surface.</p> <p>In this way, the shortest and safest road map to reach the area where the surgery will be performed is prepared for the surgical team.</p> <p>The neuronavigation device, which defines the patient&#39;s 3D radiological examinations, allows the surgeon to work only in the problematic area and stay away from the surrounding normal tissues by showing various risk areas in the brain or spinal cord.</p>

Neuromonitoring

<p>Even the smallest mistake made in the operations performed on the brain and spine can cause paralysis. Neuromonitoring technology is one of the high technologies used in such surgeries.</p> <p>Benefits of Neuromonitoring System (Features that make the difference)</p> <p><strong>Frequently Asked Questions About Neuromonitoring</strong></p> <p><strong>What is neuromonitoring?</strong></p> <p>Neuromonitoring system is used to minimize the risks in brain and spine surgeries. With the intraoperative neuromonitoring method, the surgeon is warned by the detection of the damage that may occur in the nerves during surgery.</p> <p>&nbsp;</p> <p><strong>In Which Diseases Is Neuromonitoring Used?</strong></p> <p>The neuromonitoring system can be used mostly in the operations of the brain, nerve and spinal cord surgery department, and in some operations of the ear, nose and throat diseases and general surgery department.</p> <p>Aneurysms</p> <p>Brain tumors</p> <p>Stimulation of Spinal Screws</p> <p>Trigeminus Neuralgia</p> <p>Cerebrovascular diseases such as AVM (Arteriovenous malformation), Hemifacial Spasm</p> <p>Spinal cord tumors and spinal diseases</p> <p>Scoliosis surgeries</p> <p>In some surgeries of ear and nose diseases such as laryngeal cancer, salivary gland cancer surgeries</p> <p>Neuromonitoring can be used in thyroid surgeries.</p> <p><strong>BENEFITS OF NEUROMONITORING SYSTEM (DIFFERENTIAL FEATURES)</strong></p> <p>Tumors located in sensitive areas of the brain or removal of spinal cord tumors always pose a risk of stroke. After brain tumor surgery, patients may experience problems in functions such as motor function, such as nutrition, walking, and speech. In such risky surgeries, the neuromonitoring system warns the surgeon during surgery, making the operations much safer. Complications experienced after surgery are minimized.</p> <p>&nbsp;</p> <p>One of the most vital problems in sensitive spine surgeries such as scoliosis and removal of spinal cord tumors is the risk of paralysis during the operation. The effects of the intervention performed in previous operations on the spinal cord could not be understood, before. The patients were awakened towards the end of the surgery and the effects of the intervention on the spinal cord were controlled. This procedure was not only troublesome for the patient, but it would be too late for a second intervention. By using the neuromonitoring device that constantly shows the condition of the nerves in these operations, the possible nerve injuries are prevented.</p> <p>&nbsp;</p> <p><strong>Frequently Asked Questions About Neuromonitoring</strong></p> <p><strong>How to Prepare the Patient for Neuromonitoring Application?</strong></p> <p>Electrodes are placed on the face, arms and legs of the patient who is brought to the operating room and put to sleep. The signals received from these electrodes during the operation are followed by the surgeon.</p> <p>&nbsp;</p> <p>When there is a decrease in the signal received from the muscles, the neuromonitoring device informs the surgeon that it is in the sensitive area.</p> <p>&nbsp;</p> <p>In surgeries using neuromonitoring, the system must be in coordination with anesthesia. It is important that the anesthesia that paralyzes the muscles is not too deep in such surgeries. The return of the electricity given to the muscles is important in terms of the signals to be received from the neuromonitoring device.</p>

All Technology Content

Treatment Methods

Robotic Kidney Transplantation

<h2><strong>ROBOTIC KIDNEY TRANSPLANT</strong></h2> <p>Kidney transplantation is the most effective treatment of chronic kidney failure which is the result of permanent loss of kidney function. The patients with chronic kidney failure can return to their lives as healthy individuals in a short time upon a successful transplant and post-operation follow-up process. The &quot;Da Vinci Robotic Surgery&quot; method applied in Memorial Bah&ccedil;elievler Kidney Transplant Center offers opportunities to reduce many risks during surgery as well as to improve the quality of life of the patient after surgery.</p> <p>[doctor-box]1221[/doctor-box]&nbsp;</p> <h2><strong>KIDNEY IS TRANSPLANTED WITH ROBOTIC METHOD</strong></h2> <p>Kidney transplant is a versatile process that requires proper pre-operation preparations, an experienced team using advanced technology during transplant process, a professional team to manage the post-transplant care and treatments.&nbsp; Good and proper management of this process is important for the patient&#39;s future quality of life and reducing the risk of possible complications. The &quot;Da Vinci Robotic Surgery&quot; method applied in Memorial Bah&ccedil;elievler Kidney Transplant Center provides important privileges to the physician as well as the patient during and after the kidney transplant process. Thanks to the image zooming system that increases the vision quality of the surgeon 15 times during the surgery, even the thinnest veins can be seen in all details. In addition, it does not cause tiredness and loss of concentration since the surgeon can sit for the long period of surgery. In case of possible hand tremor of the surgeon, the risk of developing complications is also minimized by the anti-tremor system in the device. In addition, in these operations in which the kidney is completely attached to the recipient by the robotic method, the risk of developing post-operative infections is much lower compared to the open method by providing a quick healing of the scar thanks to the only 4 cm incision opened in the patient. In addition, immunosuppressive drugs that suppress the immune system administrated to the patient after open surgery can delay the healing of the large scar area in open surgery. The small incision in the robotic surgery method greatly reduces this risk.</p> <p>&nbsp;</p> <h3>There are 3 parts in the Da Vinci System in which the surgeon moves the arms of the robot as his/her hands with 3D image:</h3> <p>&nbsp;</p> <p><strong>Surgical console section</strong> where the surgeon sits during operation,</p> <p><strong>Patient console section</strong> next to the patient and including robotic arms prepared under sterile conditions,</p> <p><strong>Camera system unit providing advanced imaging system</strong>.</p> <p>In the Da Vinci Robotic System, the camera and the accompanying three robotic arms are proceeded into the abdomen through tunnels with a diameter of 0.8 cm or 1 cm placed on the wall of the abdomen from certain points. Thanks to the thin and gentle surgical robotic arms, the joining (anostomosis) of the veins of the kidney which is placed into the abdomen through a small incision, is performed. In order to increase safety, the incision in the lower part of the abdomen from where the kidney will be removed, is performed at the beginning of the surgery. Since the surgeon&#39;s hand can enter through this incision during the surgery, there is the advantage of feeling and the chance to intervene in an emergency.</p> <p>&nbsp;</p> <h2><strong>THINGS TO KNOW ABOUT &quot;DA VINCI ROBOTIC SURGERY&quot; METHOD</strong></h2> <p>Robotic kidney transplant surgery requires high surgical experience and advanced technology. Surgery for the kidney donor is now performed as standard with the laparoscopic method. Robotic surgery provides additional benefits in terms of kidney recipient&#39;s quality of life and reduction of complications.</p> <p>&nbsp;</p> <p>Robotic kidney transplant surgery has important advantages for both surgeon and patient. One of the most important of these concerns the surgeon&#39;s quality of vision during the operation. Laparoscopic kidney transplantation methods with standard camera provide only two-dimensional images. In the Da Vinci Robotic Surgery system, 3D images can be obtained thanks to high resolution cameras that transmit seperate images to each eye. In addition, since these cameras can zoom in 15 times, surgery can be performed with an ideal view.</p> <p>&nbsp;</p> <p>The ends of the surgical instruments at the tip of the robot&#39;s arms rotate around their axes at total of 540 degrees in all planes. This technology enables the surgery to be performed even in the deepest parts of the body, beyond the mobility capacity of the human wrist.</p> <p>The &quot;tremor scaling&quot; feature in the Da Vinci Robotic Surgery system prevents the surgeon from transmitting possible hand tremors to the devices during the surgery.</p> <p>&nbsp;</p> <p>In classical surgeries, surgeons perform the surgeries by standing up and this may cause difficulties due to tiredness in prolonged surgical interventions. In robotic surgery, since the surgeon works by sitting, his/her concentration is higher and the risk of stress due to tiredness decreases.</p> <p>&nbsp;</p> <p>The operation continues meticulously, as the robot moves according to the surgeon&#39;s wrist movements. Especially in suturing and suturing tissues, a much greater advantage is provided compared to the laparoscopic system.</p> <p>&nbsp;</p> <p>After the operations performed with robotic surgery, the patient can recover in a much shorter time and the length of hospital stay is also shortened.</p> <p>&nbsp;</p> <p>&nbsp;</p>

Botox

<h2>What is Botox?</h2> <p>Botox (Botulinum toxin) is a toxin obtained from bacteria called Clostridium botulinum. It acts by preventing the release of substances that provide conduction at the nerve endings and stopping the transmission between the nerves and the organs reached by the nerves. Stopping nerve conduction causes the functions of the organ that the nerve reaches to decrease or disappear completely. It can be used for aesthetic and cosmetic purposes, to reduce the wrinkles on the face, to prevent its formation and to reduce sweating in the areas of excessive sweating and in the treatment of chronic migraine.</p> <h2>For what areas is botox used?</h2> <p><strong>Wrinkle treatment</strong></p> <p>The working of the mimic muscles over the years makes the folds on the skin that cover them prominent, resulting in dynamic streaks on the face. The most common dynamic lines appear on the forehead, between the eyebrows, around the eyes and around the lips. The lines on the forehead and eye edges give the person an older look, while the lines between the eyebrows give the person a frowned and angry look. By applying Botox to the mimic muscles, the movements of these muscles can be weakened, and the decrease in muscle movements also reduces the folding of the skin on it with muscle movements and streaking due to folding. In this way, a significant improvement is gained in the facial expression that appears old and angry.</p> <p><strong>Face contouring</strong></p> <p>With Botox injection, it can be provided to lift the eyebrows from the tail part and to decrease the height in the middle part of the eyebrow which makes a confused facial appearance.</p> <p>Be seen clearly of upper gum while smiling causes an non aesthetic appearance while laughing. With Botox injection this can be easily corrected.</p> <p>Masetter (chewing muscle) Hypertrophy: Unlike other region applications, Botox applications to the massetter muscle are performed not for wrinkles, but especially to soften the square face appearance of the patients with prominent hypertrophy of the massetter muscle and to obtain an oval face. Thus, a thinner and feminine facial appearance is obtained.</p> <p><strong>Excessive sweating treatment</strong></p> <p>When Botox is applied to the sweat glands, the connection between the sweat glands and nerve endings can also be stopped by reducing the activity of the sweat glands.</p> <p>The most sweating areas of the body are palms and armpits. With applying botox to sweating areas of people who suffer from excessive sweating and smell, improvement in complaints is provided.</p> <p>After determining the excessive sweating zones with the pre-application tests, the effect of the procedure lasts up to 6 months.</p> <p><strong>Migraine treatment</strong></p> <p>Botox procedure is made with needle tips thinner than 31 injection points to 7 regions of head and neck. The treatment is planned individually and there are at least 2 treatment periods with an interval of 12 weeks. In some patients, the injection should be repeated for the efficiency while in others the efficiency continues for several years. With the decision of a specialist neurologist, additional doses in botox injections according to the pain location can be applied to the required areas and migraine can be taken under control by obtaining successful results.</p> <h2>How is Botox applied?</h2> <p>Botox is applied as an injection and is not a painful procedure, a slight pain may be felt at the time of injection. If a decrease in the movements of the mimic muscles is desired, injection is made into the mimic muscles and If the complaint of sweating is desired to be reduced, injection is made inside the skin.</p> <p>The effect of Botox starts 3-4 days after the injection and completed totally in the first week and the duration of efficiency is 4-6 months. When Botox loses its efficiency, the procedure can be repeated.</p> <p>Botox has no serious side effects on health. After procedure, a temporary swelling, bruising, and rarely temporarily lower eyelid can happen.</p> <p>Immediately after the procedure, daily life can be easily continued. However, it should be avoided from movements that require bending for a long time and to active the facial muscles. In addition, after Botox injection, the head should be kept high for about four hours, bending forward should be avoided and should not be lying down. About eight hours after the Botox injection, a shower can be taken with warm water and without causing any damage to the face, i.e. without sac or pressure. While washing the face, pay attention to using cold water.</p> <h2>FREQUENTLY ASKED QUESTIONS ABOUT BOTOKS</h2> <p><strong>Is Botox snake poison?</strong></p> <p>No, Botox is a natural, protein-based drug made from a special bacterium.</p> <p><strong>Who should perform Botox?</strong></p> <p>Botox procedure, which is an effective method for facial rejuvenation, should be perforemed by specialist physicians who know the facial anatomy well and in order to avoid possible complications and achieve the desired result.</p> <p><strong>Is Botox a reliable treatment method?</strong></p> <p>It is a drug with over 2000 studies approved by the Ministry of Health in our country and by more than 70 countries around the world. It has been used for 20 years and millions of people prefer these procedures safely every year.</p> <p><strong>How long does the effect of Botox last for?</strong></p> <p>Approximately 3 months after the application, the movement begins to return in strong muscles. The movement of weak muscles also begins after 4 months. The effect disappears completely after 6 months. It is recomended to repeat it between 4-6 months.</p> <p><strong>Does Botox cause any expression loss in face?</strong></p> <p>The main purpose of Botox procedure is not to neutralize the expression on the face, but to soften the facial expressions and give the face a natural aesthetic appearance. Confused and expressionless images are caused by the procedure being done by wrong hands. Botox must be done by experts.</p> <p><strong>How many times can a person get botox throughout his life?</strong></p> <p>As long as it is done in specialist and right hands, it can be done under the control of a doctor during all life.</p> <p><strong>Can pregnant women get botox?</strong></p> <p>It is not yet known exactly whether Botox has a harmful effect during pregnancy and breastfeeding. For this reason, botox procedures are not recommended during pregnancy and breastfeeding, and botox should not be applied in people with diseases of the nervous-muscular system.</p>

POEM

<h2>What is POEM?</h2> <p>Peroral Endoscopic Myotomy (POEM) procedure is an advanced endoscopic treatment method used in achalasia or some esophagus diseases. With the Peroral Endoscopic Myotomy (POEM) method applied in a few centers in the world, the problematical muscles are cut by entering through the mouth as if normal endoscopy is performed.</p> <h2>In which diseases is POEM used?</h2> <p>It is a treatment method for achalasia disease, which has symptoms such as difficulty in swallowing after eating, a feeling of food stuck and congestion in the chest, discomfort in the chest, food coming back from the mouth, lung infections due to food getting into the lungs, bad breath and chest pain.</p> <h2>How is POEM performed? How is POEM applied?</h2> <p>The problematic muscles in the esophagus are cut by entering through the mouth as if classical endoscopy is performed with the POEM method applied in a few centers in the world. After the diagnosis of achalasia disease, with some endoscopic methods, the muscles in the esophagus are intervened endoscopically, allowing the patient to eat again.</p> <h2>What are the distinctive features of the POEM method?</h2> <p>The most advanced endoscopic treatment methods in the world are now successfully applied in our country. Since the procedure is done endoscopically, there are no incisions on the body and the patient is discharged in a short time. Patients start eating 1 day after POEM procedure, which takes approximately 1-1.5 hours, and continue their lives on the 2nd day in a healthy way. The success rates in long term are quite high. In our center, achalasia disease can be treated by using advanced endoscopic systems.</p> <h2>Frequently asked questions</h2> <ol> <li>What does POEM mean?<br /> Peroral Endoscopic Myotomy (POEM) procedure is an advanced endoscopic treatment method used in achalasia or some esophagus diseases. With the Peroral Endoscopic Myotomy (POEM) method applied in a few centers in the world, the problematical muscles are cut by entering through the mouth as if normal endoscopy is performed. The muscles in the esophagus affected by the achalasia disease are intervened endoscopically and the patient is provided to eat easily again.</li> <li>What is esophageal manometry?<br /> The working order of the esophagus and contraction movements during swallowing are examined by manometry. In endoscopic evaluations in patients presented to the doctor with swallowing disorder, if a tumoral condition is not detected and there is no reflux symptom, the diagnosis of achalasia is confirmed by manometric methods. These manometric examinations can be successfully performed in the Motility Center in the newly opened Advanced Endoscopy Center of Memorial Bah&ccedil;elievler Hospital.</li> <li>What is the success rate of POEM method, which is the treatment of achalasia disease?<br /> The biggest advantage of POEM method is that the success rate of achalasia disease is high when compared to other endoscopic methods. Considering the 5-year results, it is known that the success rates are over 90 percent.</li> <li>Is POEM, a treatment for achalasia disease, a risky procedure?<br /> In addition, since the complication rates are low, it is currently the first preferred treatment method in the primary treatment of achalasia disease in the world.</li> <li>Can patients with previous botox, balloon or surgical treatment for achalasia disease also be treated with the POEM method?<br /> POEM method can be applied safely in patients who have been treated for achalasia disease but whose complaints have not regressed or recurred.POEM</li> </ol>

ILIZAROV METHOD

<p>Treatment of Short Stature and Leg Curvatures</p> <h2>What is the Ilizarov method?</h2> <p>This method is used in the treatment of many different deformities, from short stature to bone loss. Successful results are obtained in both pediatric and adult patients. Ilizarov method can also be used in achondroplasia, that is, short stature (dwarfism). People whose height is under 135 cm can go over 150 cm in 2-3 sessions.The difference in length on the legs; shortness compensation can be equalized by shortening the long leg and lengthening the short leg, the limping condition in patients disappears. In addition, deformities in the legs called X or Y legs can be eliminated.Treatment of arm shortness can also be done with Ilizarov.With this method, both arms and legs can be extended in children in about two years.&nbsp;</p> <p>In adults, if some of the bone is lost due to a traffic accident or firearm injury, if the bone is not to be brought to the area by microsurgery, the bone can be made with the Ilizarov device. For example, bone loss of 10 cm is completely filled in 100 days by extending 1 mm per day. The bone lost by the patient, whose treatment was completed within six months, can be created in the same quality and volume.In this way, the lives of people who have surgery change.&nbsp;</p> <p>Ilizarov is a system that can give controlled movement to the bone parts with the help of hinges and rods, where the bones are fixed with thin wires and circles.This method basically relies on the practice of completing the part of a bone that is destroyed by lengthening it with a piece cut from the bone again. With this method, which is applied without placing a new bone on the corrected area, the existing bone can be extended by 1 mm per day and 30% of the short bone length can be achieved in congenital shortness.Surgical interventions can be applied to child or adult patients with arm and leg inequality developing after congenital diseases, bone loss and traumas (such as early closure of growth cartilage). In this process, a low-energy fracture is created in the bone and it is extended (1mm / day). Elongation up to 80% of the original length of the bone can be achieved. In parallel with the developing implant technology in appropriate cases, the use of new techniques and technology alternative to the Ilizarov technique are also carried out.</p> <h2>In which diseases Ilizarov method is used as a treatment?</h2> <ul> <li>Closed and open fractures</li> <li>Non-union fractures</li> <li>Bone lengthening treatment (lengthening, polio sequel, post-traumatic, post-infection growth shortenings due to early closure of cartilage and leg length inequalities)</li> <li>Correction of arm and leg curvatures</li> <li>Bone loss (usually occurs after tumor, after trauma or after infection)</li> <li>Treatment of untreated developmental hip dislocation</li> <li>In foot diseases</li> <li>Bone infections</li> <li>Joint movement restrictions</li> <li>In metabolic diseases</li> <li>It is applied in bone structural disorders.</li> </ul> <p>Application areas of Ilizarov method</p> <p>Length inequality in the legs: Shortness of the legs can develop due to many reasons. It should be addressed under 3 subtopics:</p> <ol> <li>Congenital,</li> <li>Developmental</li> <li>Shortening that cause shortening of bone ends</li> <li>There are three ways to equalize the length difference:</li> <li>Shortness compensation (with lifters added under the shoes)</li> <li>Shortening the long leg</li> <li>Elongnation of the short leg</li> </ol> <p>Most congenital leg shortness patients can be treated with lengthening and reconstruction. In many cases, it is preferable to start lengthening and reconstruction surgery before the age of 4, often before the age of 2.</p> <p>Developmental leg shortness cases can be treated with one or two lengthening operations. Most of the post-traumatic leg shortness (malunion) cases occur in adults and are resolved only by an lengthening operation. Most of these patients can be treated with lengthening over screw or a full implanted screw.</p> <h2>How is it applied?</h2> <p>Dwarfism Treatment with Ilizarov Method</p> <p><strong>Consultation and initial evaluation:</strong> Detailed history of the patient applying for treatment and information of previous surgical interventions are obtained.</p> <p>Following a detailed clinical examination, radiological and sometimes laboratory examinations are performed at appropriate positions and evaluated. If the patient is decided to undergo surgical treatment, this situation is shared with the patient and relatives. Details of the surgical treatment to be applied are explained.</p> <p><strong>Surgical treatment:</strong> Generally, the device to be used before the surgery is prepared in accordance on the patient in order to save time. The device is fixed to the bone with the help of wires and screws in surgery. It is made with small skin incisions, the purpose of which is to minimize damage to the surrounding soft tissues while bone cutting.</p> <p><strong>Post-operative treatment and rehabilitation:</strong> Lengthening the bone usually begins 7-10 days later. Although it varies according to the patient and pathology, it is usually divided into 1 mm 4 equal intervals per day and applied as 0.25 mm every 6 hours. However, during this period, the team of physiotherapy specialists lifts the patient on his/her feet, teaches walking with support and exercises to the necessary muscles. The purpose here is:</p> <ul> <li>To prevent the disadvantages of being dependent to the bed by lifting the patient immediately,</li> <li>Ensuring the patient&#39;s participation in active treatment,</li> <li>To maintain joint range of motion,</li> <li>To keep the muscles tight.</li> </ul> <p>Patients usually stay in the hospital for 3-7 days. However, in complicated cases, they may need to stay longer. During this period, the maintenance of the wires and screws at certain times is carried out by the support staff and the patient is given the necessary training for his/her own application at home.</p> <p>Physical therapy should be applied after the patient is discharged. The doctor&#39;s recommended exercises can be done by the patient or he/she can get help. However, professional physiotherapist support may be required in patients who are found to have insufficient mobility in subsequent controls. After the surgery, patients are encouraged to participate in daily activities as much as possible in school and work environments.</p> <p><strong>Lengthening:</strong> In the Caucasian race, the lower limit of normal height for males is 166 cm and 153 cm for females. Patients with a height below the normal limit are not treated until their elongation is complete. To shorten the period of the lengthening, lengthening over screw or self-lengthening screw techniques are preferred. The aim is to achieve 5-7.5 cm elongation in patients with a height below the normal limit. It can be assumed that each 2.5 cm lengthening takes 1 month. The lengthening procedure does not start until one week or 10 days after the operation. Therefore, a lengthening of 5 to 7.5 cm takes place in a period of 2-3 months. In the lengthening technique over screws, after the lengthening is finished, a second operation is performed and locking is done through the screw holes.At the end of the extension, giving weight on the body is not allowed, except for the transition from bed to chair or toilet. This means using a wheelchair for 4 - 5 months during the lengthening period. The total wheelchair duration of 5 - 7.5 cm extension reaches 4 - 5 months. Physical therapy is performed especially to restore ankle movements and ankle thrust.</p> <p>This requires a few more months. Removing screws is not a critical situation. This can be done safely after the bone heals. It is generally preferred 1 year after the lengthening is over.</p> <p><strong>Leg curvatures:</strong> The curvatures seen on the legs generally occur in two forms with the appearance of &ldquo;X&rdquo; or &ldquo;parenthesis&rdquo;. The curvature of the X leg is outward, and inward on parenthesis&nbsp;the leg. Due to the curvature, the loading axes of the hip, knee and foot joints in the body change. Thanks to these operations, the walking axis is changed and the person is walks in a healthy way.</p> <h2>What are the advantages of the Ilizarov system?</h2> <ul> <li>Stimulates bone construction.</li> <li>Increases vascularization. This increases the blood supply, so the rate of bone union increases.</li> <li>Increased blood supply also speeds up the healing of inflammation (osteomyelitis) that may occur or exist.</li> <li>Curvatures that may occur at any stage of treatment or that already exist can be corrected without the need for anesthesia.</li> <li>After the operation (if there is no obstacle), the patient can walk immediately. Therefore, it does not cause serious disruption in the patient&#39;s economic and social life.</li> </ul> <h2>FREQUENTLY ASKED QUESTIONS ABOUT ILIZAROV METHOD</h2> <p><strong>When is the Ilizarov method applied?</strong></p> <p>For the treatment of dwarfism with the Ilizarov method, the child&#39;s development must be completed. This period is stated as 16 for girls and 17-18 for boys.</p> <p><strong>Is leg lengthening treatment more effective in children?</strong></p> <p>Although this treatment is thought to be beneficial for children, the same results can be achieved for adults. However, the fact that children recover much faster and their bones form much faster causes this kind of perception. While the 6cm defect in adults can be closed in eight months, this period can be completed in five months in children. Pediatric patients can adapt to the device much more quickly. They can run, fall and play games by acting as if there are no devices in their bodies. Families experience the biggest concern in this regard because they think that children will be uncomfortable with this. However, treatment can be started in children who have reached the age of three and it can be seen that they adapt very easily.</p> <p><strong>What are the points that the patient should pay attention to after the procedure?</strong></p> <ul> <li>First of all, it is very important for the patient to carry out daily wire medical dressing as described, to pay attention to the cleanliness of the device and, if possible, to protect the system from the external environment with a special garment.</li> <li>The patient should perform the movements described by the doctor regularly in order not to encounter joint movement limitation.</li> <li>Unless stated otherwise, should be walked with as much weight given as possible to speed up the treatment process and prevent problems that may develop.</li> <li>To complete the treatment successfully, smoking should be avoided and smoking environments should be avoided.</li> <li>Medicines containing vitamins and calcium recommended by the doctor should be used regularly.</li> <li>It is important to consume plenty of milk and dairy products (yogurt, cheese, etc.).</li> </ul>

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