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Orthopedics And TraumatologyEnez HealthNo Comments

Young Women are More Affected by Scoliosis

Although the cause of scoliosis (curvature of the spine) is not fully understood, the strongest theory suggests genetics. It is 10 times more prevalent in young women than men. Highlighting that scoliosis is more common in adolescent girls, Liv Hospital Istanbul Spinal Surger Specialist Prof. Dr. Cagatay Ozturk said “Initially, scoliosis causes aesthetic concern, however, it can compress lungs and intestines in the latter stages. Therefore, early diagnosis is of crucial importance for necessary precautions.” Prof. Dr. Cagatay Ozturk answered questions about scoliosis.

Scoliosis is also seen in people with orthodontic problems

The curvature of the spine must exceed a certain angle in order for scoliosis to be noticed. Otherwise, it might be difficult to observe. Scoliosis of the lower back may not be noticed until 30-35 degrees of curvature. If the child is overweight, by the time scoliosis is initially noticed, the condition could have reached to a surgical stage. If the child is thin and scoliosis is in back region, then the condition can be recognized at an earlier age. Additionally, it is possible to say that scoliosis is more prevalent in patients with orthodontic problems.

Scoliosis can progress despite the bracing

In scoliosis cases up to 25 degrees, patients are more closely monitored during adolescence, where the progression potential of the disease increases. Bracing (corset) treatment can be performed for scoliosis cases up to 35 degrees. Initially, the bracing is used for 23 hours a day and it might be necessary to use bracing for a longer period of time depending on the scoliosis onset age. However, scoliosis has a 60% progression potential despite the bracing.

Scoliosis is not a chronic disease

With the current treatment methods, scoliosis is no longer a chronic disease. Surgical procedures can be performed for scoliosis patients who have more 40 degrees of curvature. Surgery, with timely diagnosis and suitable patient selection, can provide a straight spine without any aesthetic problems and patients can take part in all sports activities (except for professional level) as with their peers and can have children in the future.

Pediatric HematologyEnez HealthNo Comments

Do not Fear Leukemia

Leukemia is a disease that occurs one in every 25,000 children, caused by genetic defects in the blood cell nucleus and manifested by cell immortality and proliferation. However, leukemia is no longer a terrifying disease. It is possible to completely recover from leukemia with early diagnosis and treatment. Liv Hospital Pediatric Hematology-Oncology Specialist Prof. Dr. Hilmi Apak warns parents about sudden and ongoing symptoms, and longer 10 days of fever in their children. Prof. Dr. Hilmi Apak: “Weakness, fatigue, anemia, gingival and nasal bleeding, causeless bruises on the skin without any trauma, excess menstrual bleeding and persistent fever must be noted. These symptoms may indicate leukemia”.

Body cannot defend itself

Generally, leukemia occurs after an infection, as a disease of the immune system. The body becomes unable to defend itself after uncontrolled growth of leukocytes and the disease disturbs the functions of other blood cells like red cells and thrombocytes. When leukemia develops in the patient, red blood cell production in the bone marrow decreases, leading to anemia. Reduced bone marrow causes thrombocytes to decrease. When platelets, which are plate-like cells that protect our body against bleeding, decrease, symptoms such as easy bleeding, bruising and fever may occur.

Beware of the symptoms

Complaints similar to leukemia symptoms can easily be seen in children of any age, so families should observe the symptoms carefully instead of panicking. Every children can have a bleeding nose or bruises on their legs. The important thing to observe is the duration of the complaints. For example, when a child has flu, they may have nasal bleeding for a few days. However, if the bleeding persists, then a doctor must be consulted. In addition, in case a child has persistent fever for more than 10 days, persistent and increased number of bruises, then a doctor should consulted. If an abnormal condition detected, if the liver is enlarged, there is gland formation in the arm pits, neck and groin area, growth in sweat glands and suspicious findings in blood count, then hematology department must be consulted.

Diagnosis and treatment

If there is leukemia suspicion, blood count and microscopic analysis must be performed. In case of a suspicion, then further examination would be performed by taking a bone marrow sample. If leukemia is detected based on the examination in a pathology laboratory, bone marrow will be subject to additional tests to determine the type of leukemia. Cortisone drugs are the main components of the treatment. If an acute leukemia responds well to cortisone treatment, then there is increased chance of high response rate for chemotherapy drugs. In leukemia, patients need to be constantly monitored and supervised by a physician, as their immune system is weakened and blood transfusion need is present. Treatment may last two years, including ambulatory treatment. Patients are closely followed up against recurrence. In case of recurrence, intense chemotherapy is applied and bone marrow transplantation is planned if necessary.

Bone marrow transplantation not a primary preference

Bone marrow transplantation is not a primary preference in leukemia. Bone marrow transplantation is decided based on the cell type in the patient, the response to the treatment and the possibility of recurrence. Initially, chemotherapy is a more effective method than bone marrow transplantation. However, if chemotherapy becomes ineffective later on, then bone marrow transplantation is considered. In bone marrow transplantation, very high doses of chemotherapy, to a point where patient’s bone marrow is completely disappeared, is applied. Then, healthy bone marrow collected from a suitable donor is transplanted to the patient under appropriate conditions. While bone marrow transplants from relatives are generally successful, similar results can also be achieved with bone marrow of other individual outside the familiy.

Obesity SurgeryEnez HealthNo Comments

Rebirth with Obesity Surgery

Upon deciding for the obesity surgery; the heart and circulatory system, lungs, hormones are tested and other general assays are performed. In addition, the patient undergoes psychological evaluation.

When a person loses most of their excess weight after obesity surgery, they don’t just recover physically, but socially as well. They regain their confidence, living the joy of a rebirth. Liv Hospital Obesity Surgery Specialist Prof. Dr. Hasan Altun explained the obesity surgery.

Who are overweight, obese and morbid obese people?

Body mass index is used to decide whether a person is overweight or obese. Body mass index is calculated by dividing the weight by the square of the height. Let’s consider a 100kg and 170cm person; their body mass index would be approximately 35. People with body mass index between 20-35 are defined as overweight, if BMI is over 30 than it is called obese. And a BMI value over 40 is defined as morbid (fatal) obesity.

Is it impossible for morbid obese people to lose weight with sports and diet?

The main goal of the obesity treatment is to enable the person to lose weight by making lifestyle changes. Non-surgical methods (diet, acupuncture, medication, sports etc.) must be the priority.

However, the success rate of these methods in morbid obesity is 10%, at most. There are people who managed to lose weight with these methods, however, generally the problem is weight maintenance.

What is the admission reason of obesity patients; aesthetics or health?

Generally, patients refer to surgery as a last resort. Majority of the patient admitting to the clinic are the ones who tried and failed with many methods. There are patients who come for aesthetic reasons, but they are very few. Most of the time, their concern is health. Unsuccessful drug treatment of the diseases caused by obesity, such as diabetes, hypertension, sleep apnea, high cholesterol is another reason for patients to opt for surgery.

What is the current status of obesity in Turkey?

Based on body mass index numbers published by Turkish Statistical Institute; 25% of women are obese, 29% are overweight, while 15% of men are obese and 38% are overweight. These numbers are close to that of those developed countries.

What other diseases does obesity cause?

There are many common and obesity-related accompanying diseases that significantly reduce quality of life. Diabetes, obesity, sleep apnea, high cholesterol, hypertension, reflux, asthma, joint problems, vascular problems in the legs are some of them.

Can everybody undergo surgery? Who are eligible for obesity surgery?

Not every patient who apply for obesity surgery can be operated. Patients are required to meet certain criteria. They must have tried non-surgical methods for a period of time. Patients must be 18-65 years of age and be able to go under anesthesia. Body mass index must be over 40; or there must be an additional obesity-related disease if BMI is between 35-40, and diabetes or metabolic syndrome if BMI is between 30-35. In addition, there must be no untreated psychiatric disorder and no substance or alcohol addiction.

Do you decide for surgery on your own?

Surgery decision is made by a committee. This committee is consisted of obesity surgeon, endocrinologist, cardiologist, pulmonologist, psychologist or psychiatrist and a dietitian. The surgery decision is made by the evaluation of these experts.

How is surgery performed?

Today, these surgeries are performed with high technology means. Laparoscopic or robotic methods are used to perform the operation through one or multiple holes, instead of opening the abdomen area. Surgeries gradually take less time with the advanced technology. The sleeve gastrectomy, one of the most common obesity surgery, can be completed in 45 minutes.

When do patient return their normal life?

Thanks to technology, these surgeries are performed without opening the abdomen; therefore, patients can return their daily lives within 1 week.

When does weight loss start?

Patients start losing weight right after the surgery; they can lose up to 3-4 kilograms during their 2-3 days hospital stay. The weight loss happens rapidly in the first months and lasts for 1-1.5 years. Patients lose 75-80% of the excess weight. 


Is 100% success possible after the surgery?

Compared to diet and other methods, success rate of these surgeries is very high. Success rate varies between 80-95% depending on the method.

Do patients have difficulty after the surgery? Can they adapt quickly?

The patient adaptation after the surgery is high. Especially the rapid weight loss in the first months increases the adaptation rate. In order to enhance the adaptation, patients are followed up after the surgery. The patient is closely monitored by the surgery team,dietitian and psychologist and necessary actions are taken for patients that have difficulty with adaptation. And periodic group therapies are performed to increase compliance and success.

Is there a risk of failure to lose weight or regain?

If the patients are monitored well, the risk of weight loss failure or weight regain is very low. Depending on the method, this rate is 5-10%, at most.

What is required from the patients after the surgery?

After the surgery, liquid diet is required for 1 month and then the process of transitioning to solid food. Compliance is very important in this period. The patients are required to comply with certain limitations after the surgery and support the weight loss by increasing their physical activity.

What is improved after the surgery? What sort of comfort can patients have?

With weight loss, the patients can get rid of many accompanying diseases caused by obesity. Additionally, they can perform their physical activities more comfortably and become free from many restrictions caused by obesity in their life. Efficiency and success in the business life also increases with weight loss.

People regain their confidence and their psychological problems decrease.

What are the surgical methods performed for obese patients?

Sleeve gastrectomy is the most common obesity surgery. Previously, the most frequent method was vertical banded gastroplasty, also known as stomach stapling. However, it became less common due to low success rates and associated complications. Other methods include gastric bypass that restricts absorption and duodenal switch surgeries.

Why sleeve gastrectomy is the most common method?

Sleeve gastrectomy surgeries are shorter and simpler. They do not restrict or disrupt absorption; there is no intestinal intervention. Therefore, there is no risk of future intestinal problem and no need for lifelong vitamin and mineral supplement. It is the most preferred method for its highly successful outcomes and simple method.

How about gastric bypass?

Gastric bypass is an older method. It has been used for a long time. In addition to restricted food intake, it also disrupts absorption as intestines are shortened. In comparison to sleeve gastrectomy, bypass method provides better weight loss, and higher recovery from obesity-related accompanying diseases. However, surgery duration is longer, more complicated and required lifelong vitamin and mineral supplement. Therefore, gastric bypass is used for a limited patient group.

Cardiovascular SurgeryEnez HealthNo Comments

Robotic Bypass Through a 4 cm Incision Without Opening the Thorax

Cardiovascular diseases are among the most common chronic diseases in our country. Bypass operations with robotic surgery for the treatment of cardiovascular diseases offer many advantages in terms of patient comfort and rapid recovery. Robotic bypass is possible by using 3 cuts in the armpit and a 4 cm incision on the rib cage without touching a scalpel to the heart or stopping it. Liv Hospital Cardiovascular Surgery Specialist Prof. Dr. Ahmet Ozkara: “We perform robotic bypass by using the most important vessel on the heart; thoracic aorta. Unlike conventional bypass surgeries, we complete the operation without opening the thorax and stopping the heart”. Highlighting that patients can return their normal life sooner with robotic bypass, Liv Hospital Cardiovascular Surgery Specialist Prof.
Dr. Ahmet Ozkara told that infection rates and bleeding is significantly decreased with this method, and said: “It is superior to conventional bypass surgery in terms of cosmetics as well. The patient can return to work within a few weeks. They reach normal physical conditioning.

No scalpel is used.

With the technological developments of the last 15 years, the number of minimally invasive methods is increasing as an alternative to classical surgery methods in cardiac surgery. In the US and European countries, the number of robotic heart surgeries increased by 20 percent in recent years. And there is a similar trend in our country as well. In robotic cardiac surgery, the operation is performed without cutting the breastbone, the sternum. The robotic arm inserted through small cuts on right or left side of the rib cage. The 3-dimensional image obtained by the camera inserted through an incision provides a 8-10 times larger and clearer image. One surgeon attached the surgical instruments to the robotic arm, while another surgeon operates these instruments from a console with the camera display.

Comfortable for both patient and the surgeon

The instruments used in robotic surgery provide greater safety than the conventional or thoracoscopic surgery. The surgical instruments are operated by the finger movements of the surgeon at the console and these robotic arms are capable of movements that are difficult for wrist. There is no hand shake or fatigue, and intervention to anatomical regions with difficult access become easier. This provides comfort for both the surgeon and the patient.

Less pain, less infection

Coronary artery bypass surgery, mitral valve surgery, congenital heart surgery and arrhythmia surgery are performed by robotic surgery in eligible patients. Coronary artery bypass surgery is performed without stopping the heart or by stopping the heart (using a cardiopulmonary pump). Mitral valve operations are performed by stopping the heart with a special fluid. With robotic heart surgery, the recovery period is significantly shortened, and patients can usually return to work after 7-10 days. Bleeding, infection, pain and blood transfusion are less frequent. And it provides cosmetically superior results. 

Advantages of robotic surgery:

Better results:

  • Pain and some post-operative physical function disorders are less common, and better results are obtained in terms of patient satisfaction.
  • Less damage: The operation is performed through small incisions and with camera assistance; on the contrary to general belief, robotic surgery provides clearer and more detailed view than the open surgery, and this allows the operation to be completed with significantly less tissue trauma.
  • Faster recovery: The post-operative recovery is much more faster than open surgery. And this also translates into shorter hospital stay and faster return to normal life.
  • Less pain: As the surgery is performed through small cuts, patients feel less pain after the operation.
  • Less infection risk: Post-operative surgical site infection is less likely as the incisions are very small.
  • Better cosmetic outcome: Since the operation is performed with 1-1,5 cm cuts, better cosmetic outcomes are obtained in comparison to open surgery.
  • Better field of view: As the surgery is performed with the assistance of optical systems, more detailed and clear field of view is provided compared to open surgery.
  • Less blood loss: Blood loss is minimum thanks to less tissue damage.
Eye DıseasesEnez HealthNo Comments

Diplopia in Children

Normally, both eyes look at the same spot and vision axis are parallel to each other. The loss of this parallelism and two eyes looking at different directions is called diplopia (cross-eyed). The ability to track object-light with eyes and focusing the eyes on a target generally develops at third month. During this period, transient and small misalignments can be considered as normal. However, if there is a suspected misalignment after three months, then an ophthalmologist must visited. Liv Hospital Ulus Ophthalmologist Prof. Dr. Umit Beden explained diplopia.

Children and adults can have diplopia

Diplopia can be seen in both children and adults. Misalignment observed in childhood may not be related with another cause or can be accompanied by other conditions (cataract, eye tumors or neurological diseases) that disrupt vision. Therefore, eye examination is required immediately after diplopia is noticed. In childhood and infancy, diplopia can manifest with each eye focusing on different spots or closing one eye in dark and sunny environments or tilting the head to one side in daily life. And double vision is the most important symptom in adulthood.

Underdevelopment of the nasal bridge might give the appearance of diplopia in many babies. Therefore, it is wrong to assume that diplopia during infancy would recover in time. In case of such suspicion, the baby must be examined by an ophthalmologist as soon as possible. If there is diplopia indeed, it is unlikely to recover in time. Additionally, healthy visionary development of both eyes would be hindered in babies with diplopia and it is important to start treatment early to prevent this. Otherwise, lazy eye condition that can develop in one or both eyes will become permanent.

Normally, it is recommended that every healthy child should have their first eye examination between 6 months and 1 year. In addition to this, eye examination to be performed at the age of 3 is very important in terms of the treatment of any potential lazy eye condition. When diplopia is diagnosed, the goal of the treatment is to enable the healthy completion of the visionary development of the child. Therefore, eyeglass prescription, covering treatment and surgery can be planned. Instant treatment is not possible for childhood diplopia, a long-term follow up will be required. In case surgery is planned, it will not be an alternative to eyeglass prescription or covering treatment; eyeglass use and covering treatment may continue after the opeation.

RadiologyEnez HealthNo Comments

360′ Overview of the Heart with Cardiac MRI

The heart is one of the most difficult areas to visualize due to its location inside the rib cage and behind the bone structures, and constant motion. Therefore, centers with state-of-the-art technology and experienced specialists are required for the detailed examination of heart-related functions and diseases. Stating that Cardiac MRI is an advanced imaging technique that enables a detailed examination of the heart without any interventional procedure, Liv Hospital Ulus Radiology Specialist Assoc. Prof. Dr. Ayse Gormeli explained the advantages of the method.

Cardiac MRI can be used for children

As no radiation is involved with Cardiac MRI, it can be safely used both for children and adults. And the drug (contrast agent) that can be used if necessary during the procedure is also significantly safer than the tomographic methods. This examination method provides the best possible calculation of the cardiac functions. The structures of the heart can be examined on every plane without any angle restriction. Pathologies in the heart can be clearly revealed.

For which conditions can it be used?

  • Cardiac MRI provides detailed information about the damage on the cardiac muscle in patients with vascular occlusion (vitality test). The extent of such damage is of crucial importance to determine whether the patient can benefit from a heart surgery.
  • In congenital heart diseases, Cardiac MRI offers significant contribution for pre-operative planning and risk classification by providing a detailed evaluation of the heart and large vessels. Additionally, it also allows for the acquisition of most reliable and accurate data in lifelong follow-ups after the surgery.
  • In cases of valvular insufficiency or obstruction, Cardiac MRI is used for the determination of the disease severity. The back flow rate of the blood through the valves can be calculated with a great accuracy.
  • It enables the discovery of underlying cause in cardiac arrhythmias.
  • In patients with suspected mass in the heart, it can be used to distinguish the mass and clot and to determine the malign tumors, if any.
  • Cardiac MRI also allows for the monitorization of the extent to which the heart is affected by evaluating the cardiac muscle in detail in case of diseases like mediterranean anemia (thalassemia), sarcoidosis, Anderson-Fabry disease, amiloidosis.

For which conditions it cannot be used?

Individuals with cardiac pacemaker or other non-MRI safe medical materials (prosthesis, cochlear implant etc.) are not eligible for MR imaging. In addition, it should not be used for claustrophobic individuals without proper medical assistance.

How does Cardiac MRI work?

A vascular access is opened on the arm before the examination. After the patient is taken into the MRI device, ECG leads are attached to the chest to see the cardiac motion. Breath holding exercises are performed as the patients are required to hold their breaths for short periods of time during the examination, and then the MRI acquisition is initiated. In cases where necessary, a drug called contrast agent can be administered from the vascular access. The examination is completed within 30-45 minutes on average.

General SurgeryEnez HealthNo Comments

Keep Your Intestines Happy and Cancer-Free with Mediterranean Diet

Colon cancer is one of the most common cancer both in the world and our country. Scientific studies have shown that Mediterranean diet, rich in vegetables, fruits, fish, olive oil, and nuts, significantly reduces cancer and vascular occlusion related deaths. Liv Hospital General Surgery Specialist Prof. Dr.
Hakan Yanar explained prevention, screening and treatment methods of colon cancer and the importance of nutrition.

What are the causes of colon cancer? Who are at risk?

More than 90% of colon cancers are caused by previously developed polyps. While the incidence of polyps is rare before the age 50, cancer rates increase thereafter due to higher polyp incidence. Nutritional habits that are rich in fat and low in fibers, colon cancer history in immediate family, inflammatory intestinal diseases like ulcerative colitis and Chron’s disease lead to increased colon cancer risk.

Is colon cancer dangerous?

Early diagnosis is very important in colon cancer, which is an asymptomatic and slow-progression cancer. This type of cancer is especially prevalent in people older than 50 and it can be treated with early diagnosis. Colon cancer is second or third most frequent cancer type in the world.

What are the symptoms of colon cancer?

  • Anemia
  • Constipation
  • Palpable mass
  • Rectal bleeding
  • Blood in the stool
  • Decreased stool diameter
  • Changed defecation routine
  • Inability to relief the urge to defecate
  • Abdominal pain for more than 15 days

How to diagnose early?

 Although occult blood in stool and immunohistochemical tests can be used for colorectal cancer screening, the most effective method is colonoscopy. The goal must be the removal of polyps, before they develop into cancerous tissues, during colonoscopy. Therefore, first colonoscopy screening must be performed at the age of 50 for people without colon cancer history in their family and, if the results are normal, it must be repeated every ten years. And for people with colon cancer in their family, first colonoscopy must be performed 10 years before the cancer onset age of the affected family member.

What is the treatment of colon cancer?

Standard treatment method is surgery. However, the removal of some healthy colon tissue and surrounding lymph nodes together with the tumors is of crucial importance. The surgical procedure affects long-term survival, relapse of the tumor or metastasis; therefore it must be performed by experienced surgeons. Today, these surgeries are performed with high success rates by using laparoscopy and robotic surgery methods, without any incision on the abdomen. Less post-operative pain, shorter hospital stay and very little scar around the surgical site are among the advantages of laparoscopic and robotic surgeries. In case of tumors close to the anus, colostomy (attaching the colon to the outer wall of the belly) can be prevented with chemotherapy and radiotherapy methods to be applied prior to the operation.

Follow the Recommendations

  • Have regular screening tests.
  • Consult your doctor in case of long-term constipation and rectal bleeding complaints
  • Do moderate intensity exercises for 4-5 days a week instead of an inactive life.
  • Apply a nutritional schedule that is rich in fibers, low in fats with balanced protein.
  • Avoid smoking and alcohol.
  • Maintain your ideal weight.
  • Scientific studies have shown that Mediterranean diet, rich in vegetables, fruits, fish, olive oil, and nuts, significantly reduces cancer and vascular occlusion related deaths.
Radiotion OncologyEnez HealthNo Comments

Target-Oriented Irradiation In Prostate Cancer Treatment: 4-Dimensional Brachytherapy

Brachytherapy, one of the most important tools in radiation oncology, can be used for the treatment of prostate cancer. Brachytherapy addition can increase the efficiency of radiotherapy for patients who are not eligible for surgery in the organ-restricted stages of the prostate cancer. Similar to external irradiation, tumor is effectively destroyed with minimal side effects in brachytherapy. Liv Hospital Radiation Oncology Specialist Prof. Dr. Merdan Fayda explained 4-dimensional prostate brachytherapy.

Prostate brachytherapy allows irradiation of the cancerous tissue in the prostate from within, instead of external application. Therefore, very successful results can be obtained by targeting the tumor up close with high dose and without damaging the surrounding tissue.

4-Dimensional prostate brachytherapy

Liv Hospital Radiation Oncology Clinic offer real-time imaging guided high dose rapid prostate brachytherapy. HDR (high dose) prostate brachytherapy is performed with real-time transrectal ultrasonography for prostate cancer patients. Brachytherapy can be performed as an addition to external irradiation method IG-IMRT for suitable select patients.

What is the 4-dimensional high dose rapid prostate brachytherapy with real-time imaging guide?

The 4-dimensional prostate brachytherapy method is performed via plastic needles palced into prostate tissue under the guidance of transrectal ultrasonography. As the whole procedure is performed with real-time high-resolution ultrasonography guidance, it offers an extremely effective treatment planning and high accuracy application. The most effective treatment plan with least side effects is scheduled and delivered based on the real-time images of the prostate and other normal tissues. The procedure takes approximately 2 hours under general or spinal anesthesia and is completed after the removal of the needles. Then the patient is invited for external radiation or second prostate brachytherapy to be initiated one week later.

What are the advantages of prostate brachytherapy?

  • Total radiotherapy duration is shortened.
  • Treatment efficiency is increased.
  • The duration of hormone therapy can be shortened.
  • The damage of surrounding tissues and organs is reduced.
  • Less side effects.
  • Urinary incontinence/urinary tract stenosis incidences are significantly low.
  • It is usually performed in a single session and there is almost no risk of bleeding.

Who are eligible for prostate brachytherapy?

  • As an addition to the external treatment (IG-IMRT) of moderate and high-risk prostate cancer patients,
  • As focal radiotherapy in patients who previously received radiotherapy and had relapse,
  • As a single therapy for low-risk patients who are not eligible for selected operation.

What are the advantages of 4-dimensional high dose prostate brachytherapy over permanent seed brachytherapy?

  • The patient can return their normal daily life as there will be no radioactive source inside.
  • Real-time imaging guidance performed throughout the entire procedure increases the accuracy.
  • Since no radioactive source will be placed inside the patient, there is no displacement risk of such materials.
CardiologyEnez HealthNo Comments

Protect the Rhythm of Your Heart

Although heart rhythm disorders are more common in the elderly, it is a heart condition that can occur at any age. This disease may have no vital risks, or lead to sudden death. Liv HOSPİTAL Cardiologist Prof. Dr. Enis Oguz explained what should be done to protect the rhythm of our heart.

What are the causes of cardiac arrhythmia?

Electrical stimulation is required for heart muscle to contract. The right atrium of the heart has cells that regularly outputs electrical stimuli. This electrical stimulus must spread all over the heart. The heart has lines consisted of sequentially located cells that the electricity flows through, as in an electrical grid. And the cardiac muscle responds to this electrical stimulus. Any abnormality in these structures results in the disruption of heart rhythm.
Arrhythmia exhibits itself in the form acceleration (tachycardia), irregular beat (premature beat) or decelaration (bradycardia).

What are the symptoms?

The most common symptom is the feeling of palpitation. Patients describe this feeling with statements like “My heart is like fluttering like a bird”, “As if my heart will dart out of my chest”, “My heart beats are visible from outside”, “I feel my heart beating in my mouth”. The palpitation usually starts suddenly and sometimes lasts for seconds, sometimes minutes and even hours, then stops. Other symptoms may include dizziness and fainting. Arrhythmia-related faints often indicate life-threatening types of arrhythmias.

Which age range is affected?

Arrhythmia can be seen in any age group. Arrhythmias are more common in older ages and are associated with other heart diseases. Taking all age groups into account, 2% of the general population and 10% of the population over 80 years of age is known to have atrial fibrillation (atrium-related arrhythmia of the heart). These numbers show the importance of cardiac arrhythmias for public health.

What tests are used for arrhythmia?
The most important method used for the diagnosis of arrhythmias is ECG, the recording of the electrical activity of the heart. However, in order for ECG to have diagnostic value, electrical activity must be recorded at the moment of arrhythmia. For example, if a patient suffers from an arrhythmia episode and goes to the nearest health institute while the tachycardia is ongoing to receive ECG, the type of the arrhythmia can be determined. However, some arrhythmias are short; therefore they cannot be recorded. For such cases, there are portable recording devices with the size of a cell phone, so patients can carry it with them. The purpose is to allow the patient to record their arrhythmia at the time it occurs.

3 years of cardiac rhythm recording

There are surgically placed subcutaneous recording devices, and they are used to record rare arrhythmias. This technique allows continuous arrhythmia record for 3 years. If these methods fail to identify the arrhythmia, then electrophysiological study, an interventional method, can be used. Some cases require diagnostic methods like echocardiography, cardiac MRI, coronary angiography. In addition, a special test is performed to identify the cause of fainting, called vasovagal syncope. In this disease, reflexive declaration of the heart rhythm and even temporary halt can occur. Differential diagnosis can be made with this simple method for many patients who are confused with epilepsy and who are under examination for diagnosis in neurology clinics.

Are patients with arrhythmia required to use specific diet?

Nutrition is important for patients with arrhythmia. Some substances posses stimulating properties for the electrical system of the heart. These may trigger arrhythmia. Effects of tea, coffee and smoking can be given as examples. In addition, many drug can also cause arrhythmia. Sometimes, heart and blood pressure drugs can cause bradycardia (deceleration). For example, drugs used for eye pressure can include substances that slows down the heart rate. Sometimes, a drug prescribed to treat an arrhythmia can cause another arrhythmia. General recommendations for cardiac health also apply for arrhythmia prevention. These include stress management, ideal body weight, regular exercise, nutrition without lard and trans fatty acid, reduced salt intake, quitting smoking, zero or reduced alcohol consumption.

Radiotion OncologyEnez HealthNo Comments

What is Brachytherapy?

Brachytherapy is a type of radiotherapy where radioactive sources/radiation source is placed next to the tumor. It is being successfully used for the treatment of gynecological cancers (uterine, cervix, vagina), lung cancer, skin cancer. Today, brachytherapy can be applied as 3-dimensional with the use of imaging methods that are based on cross sectional anatomy like computed tomography and magnetic resonance imaging. As 3-dimensional brachytherapy is more frequently used, success rates increase and side effects decrease. Liv Hospital Radiation Oncology Specialist Prof. Dr. Merdan Fayda explained the brachytherapy method.

Brachytherapy has three fundamental application methods:

  1. Intracavitary brachytherapy: (Inside the cavities) performed by using applicators placed inside the natural cavities of the patient (uterine, cervix, bronchi etc).
  2. Interstitial brachytherapy: (Inside the tissue) performed by placing applicators inside the related tissues or by using radioactive sources delivered through a needle, as well as permanent placement of radioactive sources (permanent prostate uLDR brachytherapy).
  3. Contact brachytherapy: Radioactive source/radiation source is applied to external tissues such as kin or is applied at the time of removal of other organs during operation like in superficial intraoperative radiotherapy (IORT).

3 dimensional brachytherapy in gynecological tumors

In the treatment of gynecological tumors performed by physicians from different disciplines, brachytherapy has an important function and is applied by bringing radioactive sources near the area to be irradiated.

The most frequent area of use for brachytherapy is gynecological cancers. For uterus cancers (endometrium), cervical cancers and vagina cancers brachytherapy is applied after the operation, and in case of patients not fit for the operation, it is applied as single therapy method along with external irradiation.

Especially in the recent years, brachytherapy applications developed from 2-dimensional methods to 3-dimensional methods. Based on data acquired from computerized tomography and MR devices, 3-dimensional brachytheraphy applications contributes to the successful treatment of gynecological cancers and provides suitable protection for the surrounding tissues (bladder, rectum, sigmoid etc). This allows the treatment to be completed with less side effects.

Skin brachytherapy (with Leipzig applicator)

Brachytheraphy is successfully used for the treatment of early phase of skin squamous and basal cell cancers with a suitable depth and surface. Cosmetic damages arising from operation during the treatment of the tumors especially developing around the face are seen less with brachytherapy. Patients suffering from early stage skin cancer localized on the face may be treated with brachytheraphy if deemed eligible by the plastic surgeon.

3-dimensional brachytheraphy in lung (bronchi) cancers

In case of patients for whom external irradiation methods cannot be used in the radiotherapy of lung cancer, brachytheraphy can be performed through tubes to be placed inside the main airways with the assistance of pulmonology team.

In order to bring the radioactive source near the target area of the patient, certain assistant instruments such as applicators may be used. Although these applicators are mostly placed without any pain, sometimes anesthesia may be necessary.

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