Person: ŞİMŞEK, FERRUH
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ŞİMŞEK
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FERRUH
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Publication Metadata only The effect of intradetrusor botulinum neurotoxin type A on urinary NGF, TGF BETA-1, TIMP-2 levels in children with neurogenic detrusor overactivity due to myelodysplasia(WILEY, 2017) ŞEKERCİ, ÇAĞRI AKIN; Top, Tuncay; Sekerci, Cagri Akin; Isbilen-Basok, Banu; Tanidir, Yiloren; Tinay, Ilker; Isman, Ferruh Kemal; Akbal, Cem; Simsek, Ferruh; Tarcan, TufanAimsThe aim of this study was to determine the value of urine nerve growth factor (NGF), transforming growth factor beta 1 (TGF-Beta-1), tissue inhibitor of matrix metalloproteinase 2 (TIMP-2) levels to predict the urodynamic profile before and after botulinum neurotoxin type A (BoNT-A) treatment in children with myelodysplasia. MethodsThis prospective study included 15 children with myelodysplasia who underwent intradetrusor BoNT-A injections due to neurogenic detrusor overactivity (NDOA). Urine samples of each child were collected before and after BoNT-A injections, specifically at the first and third postoperative months. Urine samples were analyzed with ELISA method and NGF, TGF-Beta-1, and TIMP-2 levels were measured. Urine marker levels and clinical findings were assessed for statistical significance with Wilcoxon Signed Ranks Test and Friedman Test. ResultsA total of 15 children (5 boys and 10 girls) were assigned as the study group. Mean age of the patients was 7.12.5 years (range 2.5-11). A statistically significantly decline was observed in urinary TGF-Beta-1 and NGF levels following BoNT-A injections, compared to the preoperative levels (P<0.05). TIMP-2 levels also tend to decrease following BoNT-A injections but this was not statistically significant compared to the preoperative levels. ConclusionThis preliminary study, suggests urinary TGF-Beta-1 and NGF as a potent marker in children with NDOA, as they decline following BoNT-A injection. Further studies are needed in identifying their special role in assessing treatment success after invasive interventions.Publication Metadata only Durability of a single successful endoscopic polytetrafluoroethylene injection for primary vesicoureteral reflux: 14-year followup results(ELSEVIER SCIENCE INC, 2007) ŞİMŞEK, FERRUH; Yucel, Selcuk; Tarcan, Tufan; Simsek, FerruhPurpose: We reviewed our 14-year experience with successful single endoscopic subureteral polytetrafluoroethylene injection for the treatment of primary vesicoureteral reflux in children. Materials and Methods: We retrospectively reviewed the charts of 42 patients with primary vesicoureteral reflux who were treated with a single successful subureteral polytetrafluoroethylene injection between 1989 and 1993 and followed with routine 1, 3 and 10-year voiding cystourethrography. Results: The study included 30 girls and 12 boys 2 to 14 years old (median age 6 years). Four patients were lost to followup. Of the 38 remaining patients 28 had unilateral and 10 had bilateral primary vesicoureteral reflux. Endoscopic treatment with subureteral. polytetrafluoroethylene injection was performed in 48 ureters. Followup ranged from 10 to 14 years (mean 12.5 +/- 2.1). Voiding cystourethrography in 38 patients and 48 ureters revealed that 35 ureters (73%) remained free of reflux, whereas reflux recurred in 13 (27%) at a median of 2 years. Of these 13 ureters recurring reflux was grade I to II in 5 and grade III to V in 8. Reflux recurred in 11 of 24 ureters with grade IV to V reflux. Of the 13 recurrences 10 presented as febrile urinary tract infections and only 3 grade I recurrences were detected on voiding cystourethrography alone. No untoward effects were seen in any of these patients with injection of polytetrafluoroethylene. Conclusions: Long-term followup may be warranted after a single successful endoscopic injection for vesicoureteral reflux, particularly high grade reflux. However, followup voiding cystourethrography is unnecessary in patients presenting with febrile urinary tract infection.Publication Metadata only Miyelomeningoselli hastalarda nörojenik detrusor aşırı aktivitesine bağlı vezikoüreteral reflünün tedavisinde İntravezikal onabotulinum toksin a enjeksiyonunun etkinliğI(2013-10-06) TARCAN, TUFAN; ŞAHİN, BAHADIR; ALPAY, HARİKA; ŞİMŞEK, FERRUH; TARCAN T., AKBAL C., Top T., ŞAHİN B., Asutay M. K., ALPAY H., ŞİMŞEK F.Publication Metadata only Cic-associated asymptomatic bacteriuria in children with myelodysplasia: should esbl-producing bacteria change our management?(2018-08-30) TARCAN, TUFAN; ŞAHİN, BAHADIR; ŞİMŞEK, FERRUH; TARCAN T., AKBAL C., Top T., Talibzade F., ŞAHİN B., Soysal A., ŞİMŞEK F.Publication Metadata only Efficacy of intravesical onabotulinum toxin-a injection on the treatment of vesicoureteral reflux associated with neurogenic detrusor overactivity in children with myelomeningocele(2013-08-30) TARCAN, TUFAN; ŞAHİN, BAHADIR; ALPAY, HARİKA; ŞİMŞEK, FERRUH; TARCAN T., AKBAL C., Top T., ŞAHİN B., Asutay M. K., ALPAY H., ŞİMŞEK F.Publication Metadata only Aşırı akti̇f mesanesi̇ olan çocuklarda pedi̇atri̇k alt üri̇ner si̇stem semptom skorunun tanısal değeri̇(2013-11-24) ŞENER, TARIK EMRE; ŞAHİN, BAHADIR; TİNAY, İLKER; TARCAN, TUFAN; ŞİMŞEK, FERRUH; AKBAL C., Sahan A., ŞENER T. E., ŞAHİN B., TİNAY İ., TARCAN T., ŞİMŞEK F.Publication Metadata only Diagnostic value of the pediatric lower urinary tract symptom score in children with overactive bladder(SPRINGER, 2014) ŞİMŞEK, FERRUH; Akbal, Cem; Sahan, Ahmet; Sener, T. Emre; Sahin, Bahadir; Tinay, Ilker; Tarcan, Tufan; Simsek, FerruhThe aims were (1) to assess the pediatric lower urinary tract symptom score (SS) prior to treatment as a means of determining severity of overactive bladder (OAB) and (2) to investigate relationships between SS results and those of standard diagnostic modalities. Symptom scores were recorded pre- and 6 months SS for 294 children with OAB unrelated to neurological disorder. Uroflowmetry-electromyography data, total bladder capacity, and a 2-day bladder diary were also recorded, and upper urinary tract deterioration was investigated as indicated. Overactive bladder was treated with standard approaches. No response to treatment was defined as 0-49 % reduction in OAB-related symptoms based on SS results. Non-responders underwent additional evaluations as indicated. Two hundred forty-one patients (97 %; mean age 9.8 +/- A 2.8 years; mean follow-up 11 months; range 6-18 months) completed the study. One hundred thirteen (47 %) required ultrasonography (USG), and those with abnormal USG had a significantly higher pre- and 6 months SS (p = 0.016). All non-responders (n = 38; 16 %) underwent urodynamics evaluation, 34 underwent spinal magnetic resonance imaging (MRI), 34 underwent voiding cystourethrography (VCUG), and 34 underwent dimercaptosuccinic acid scanning (DMSA). Non-responders with terminal detrusor hyperactivity had significantly lower SS after therapy (p = 0.09). Non-responders with abnormal MRI had higher pre- and 6 months SS than those with normal MRI. Thirteen (38 %) of the non-responders who required VCUG had vesicoureteral reflux (VUR), and this subgroup had higher pre-treatment SS (p = 0.030). Seven (21 %) of the non-responders who required DMSA had scarring, and all 7 had VUR. The subgroup with scarring had higher pre-treatment SS (p = 0.030). Pediatric OAB patients with high 6 months SS have a higher incidence of additional upper urinary tract pathology. Those with low pre-treatment SS require fewer laboratory tests and other assessments. The SS tool can reduce the number of urodynamics evaluations, and other tests required to diagnose renal damage in children with OAB.Publication Metadata only Mesenchymal stem cell therapy in treatment of erectile dysfunction: Autologous or allogeneic cell sources?(WILEY, 2014) ŞİMŞEK, FERRUH; Mangir, Naside; Akbal, Cem; Tarcan, Tufan; Simsek, Ferruh; Turkeri, LeventObjectiveTo compare the efficacy of intracavernosal injection of autologous and allogeneic mesenchymal stem cells as potential treatment of erectile dysfunction in an experimental rat model. MethodsMesenchymal stem cells were isolated from rat paratesticular fat tissue. Bilateral cavernous nerve injury was carried out followed by immediate intracavernosal injection of either autologous or allogeneic mesenchymal stem cells or mesenchymal stem cell lysates. One month after injection, erectile function was evaluated by means of intracavernosal pressure measurement. All rats were eventually killed, and penile tissues were taken for immunhistochemical and molecular investigation. ResultsA total of 36 Sprague-Dawley rats were used. The mean maximum intracavernosal pressure in the sham-operated, autologous and allogeneic mesenchymal stem cell injection groups were significantly better compared with the vehicle injection group (80.5 [3.56], 71.1 [2.9] and 69.2 [3.2] vs 40.33 [4.4], respectively). Mean maximum intracavernosal pressure to mean arterial pressure ratios in the autologous and allogeneic mesenchymal stem cell and mesenchymal stem cell lysate injection groups were not significantly different. ConclusionsIntracavernosal injection of both autologous or allogeneic mesenchymal stem cells improve erectile functions in a rat model of cavernous nerve injury. Allogeneic mesenchymal stem cells might provide clinicians with ready to use, standardized and, in certain cases, more effective products. More studies focusing on long-term immunological aspects of allogeneic mesenchymal stem cells are required.Publication Metadata only Urinary NGF, TGF-beta 1, TIMP-2 and Bladder Wall Thickness Predict Neurourological Findings in Children with Myelodysplasia(ELSEVIER SCIENCE INC, 2014) ŞEKERCİ, ÇAĞRI AKIN; Sekerci, Cagri Akin; Isbilen, Banu; Isman, Ferruh; Akbal, Cem; Simsek, Ferruh; Tarcan, TufanPurpose: Dimercapto-succinic acid scintigraphy and urodynamic studies are gold standards to evaluate renal scarring and neurogenic bladder dysfunction, respectively. We sought to establish the value of bladder wall thickness together with urine NGF, TGF-beta 1 and TIMP-2 to predict the urodynamic profile and upper urinary tract damage in children with myelodysplasia. Materials and Methods: A total of 80 children with myelodysplasia underwent urodynamic investigation, bladder wall thickness measurement and dimercaptosuccinic acid scintigraphy with basic neurourological evaluation. Two study and 2 control groups were created according to presence or absence of renal scarring on dimercapto-succinic acid scan (study and control groups 1) and according to detrusor leak point pressure greater or less than 40 cm H2O (study and control groups 2). Urine samples were analyzed with ELISA. Results: The study population consisted of 44 girls and 36 boys with a median +/- SD age of 7.2 +/- 3.6 years (range 2 to 17). Study and control groups 1 consisted of 35 and 45 children with abnormal and normal dimercapto-succinic acid scan findings, respectively. Study and control groups 2 included 30 and 50 children with detrusor leak point pressure greater and less than 40 cm H2O, respectively. Bladder wall thickness and urinary levels of TGF-beta 1, NGF and TIMP-2 were significantly increased in both study groups compared to controls. Conclusions: Urine markers and bladder wall thickness measurement may predict urinary tract impairment in children with myelodysplasia. Such markers may differentiate at risk patients with either renal scarring or high detrusor leak point pressure, and decrease the need for urodynamics and renal scintigraphy.Publication Metadata only The timing of primary neurosurgical repair significantly affects neurogenic bladder prognosis in children with myelomeningocele(ELSEVIER SCIENCE INC, 2006) ŞİMŞEK, FERRUH; Tarcan, Tufan; Onol, Fikret Fatih; Ilker, Yalcin; Alpay, Harika; Simsek, Ferruh; Ozek, MemetPurpose: The correlation between timing of the primary neurosurgical repair and urological prognosis in infants with open spinal dysraphism remains unknown. We investigated the impact of primary repair timing on neurogenic bladder prognosis in children with myelomeningocele. Materials and Methods: We retrospectively reviewed the records of 401 children with myelomeningocele followed at our multidisciplinary clinic between 1996 and 2005. Among these patients 129 were included in the study based on the availability of urological followup data at age 3 years, which was chosen as an ideal point for the standardization of urological findings. Children were assigned to 1 of 2 groups-those who underwent primary neurosurgical repair within 72 hours of delivery (group 1) and those undergoing repair after 72 hours (group 2). We compared the incidence of febrile urinary tract infections, hydronephrosis, vesicoureteral reflux and secondary tethering of the spinal cord at age 3 years, as well as cystometric bladder capacity and detrusor leak point pressure between the 2 groups. Results: Urological followup data at age 3 years revealed significantly increased incidence of febrile urinary tract infections, vesicoureteral reflux, hydronephrosis and secondary tethering of the spinal cord in children in group 2 compared to group 1 (chi-square, p <= 0.05 for all comparisons). Urodynamic assessment also showed a significantly lower bladder capacity and a substantially higher detrusor leak point pressure in children who received primary repair at later than 72 hours (t test, p < 0.05). A subgroup analysis of group 1 comparing children who underwent repair before and after 24 hours following delivery failed to demonstrate any significant difference in terms of febrile urinary tract infections, vesicoureteral reflux, hydronephrosis and secondary tethering (chi-square, p > 0.05 for all comparisons), whereas mean bladder capacity was significantly higher (t test, P < 0.05) and mean detrusor leak point pressure was lower (t test, p = 0.08) in children undergoing repair within 24 hours of delivery. Conclusions: The timing of primary neurosurgical repair has a significant impact on neurogenic bladder prognosis in children with myelomeningocele. Closure of the spinal lesion on the first day of life seems to provide the best chance for favorable lower urinary tract function.
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