EFFECTING FACTORS OF CUSTOMER SATISFACTION

To be successful in global competitive markets, many firms have responded to rapid technological change, heightened competition and shortened product life cycles by focusing customer satisfaction. It is very difficult to ensure customer satisfaction. In spite of the increasing offer, customers are more conscious, and they make purchasing decisions by evaluating multiple choices and selecting among these choices. In this paper, supplier performance was evaluated by their customers and then, effects of performance criteria factors on customer satisfaction were analyzed. To examine the role of supplier performance in customer satisfaction, a survey was conducted of 182 manufacturing companies in Turkey. Factor analysis yielded seven factors: technical capability, innovation, conformance quality, pricing, delivery, flexibility and service. Correlation analysis indicated that innovation, delivery, flexibility and service factors significantly correlated with customer satisfaction. Hierarchical multiple regression analysis suggested that delivery, flexibility, service and innovation significantly contributed to the customer satisfaction

A simple heart valve replacement technique which improves surgical time

Aim of the study: Different heart valve replacement techniques have been described in the literature. In the present study, a simple and very fast heart valve replacement technique is presented. Material and methods: In a two-year period, 87 patients with the diagnosis of mitral valve disease, aortic valve disease or combined valve disease underwent valve replacement performed by the same surgeon. In this technique, the valve was implanted with the valve clamped to the surgical dressing without the assistant holding it. Patients with coexisting surgical pathologies were excluded from the study. A control group was created among the patients who were operated on during the same time period by different surgeons with the assistant holding the prosthesis. Control group operations were done by conventional valve holding and suturing techniques. Results: Mean age of the patients was 61.6 ± 3.2 years. Mitral valve replacement (MVR) was done to 51 patients, aortic valve replacement (AVR) to 12 patients and both aortic and MVR to 24 patients. Aortic cross clamp duration was 30.7 ± 3.3 min for MVR, 34.8 ± 6.2 min for AVR and 69.1 ± 6.1 min for both valve replacements. Aortic clamping durations were significantly higher in the conventional implantation technique. Discussion: The described technique has many advantages such as short myocardial ischemia duration, better exposure of the surgical field and facilitation of assistance. © 2014 Termedia Sp. z o.o. All rights reserved

Efficacy of Optic Nerve Sheath Fenestration in Patients with Increased Intracranial Pressure

Objectives:To evaluate the effectiveness of optic nerve sheath fenestration (ONSF) on visual functions in patients with increased intracranial pressure (İİP).Materials and Methods:The medical records of 24 eyes of 17 patients who had İİP due to idiopathic intracranial hypertension, cerebral venous sinus thrombosis, or intracranial cyst and underwent ONSF surgery to prevent visual loss were evaluated. Pre- and postoperative visual acuity, optic disc images, and visual field findings were reviewed.Results:The mean age of the patients was 30.4±8.5 years, and 88.2% were female. The patients’ mean body mass index was 28.67±6.1 kg/m2. The mean follow-up time was 24±12.1 months (range: 3-44). At postoperative 3 months, the mean best-corrected distance visual acuity had improved in 20 eyes (83.3%) and stabilized in 4 eyes (16.7%) compared to preoperative values. In visual field mean deviation, an improvement was observed in 10 eyes (90.9%), while 1 eye (9.1%) eye remained stable. Optic disc edema decreased in all patients.Conclusion:This study indicates that ONSF has beneficial effects on visual function in patients with rapidly progressive visual loss caused by increased intracranial pressure

Bilateral intracerebral hemorrhage of basal ganglion: a case report

Serebral kanamanın en sık gözlendigi bölgeler putamen, temporal lob, parietal lob veya frontal lobların santral maddesi, thalamus, serebllar hemisfer ve beyin sapında ponstur. Bazal ganglionlar hipertansiyona baglı intraserebral hemorajinin (ISH) en yaygın gözlendigi bölgedir. Etyolojisinde hipertansiyon, vasküler anomaliler, vaskülopatiler, hematolojik bozukluklar, tümörler, antikoagülanlar, ilaçlar rol oynar. Bilateral intraserebral hemoraji (BIH) gelisiminde hipertansiyondan baska metanol intoksikasyonu, etilen glikol intoksikasyonu, neonatal asfiksi, migren ve hiperglisemik hiperosmolar koma ile iliskili vakalar da bildirilmistir. Hipertansiyona baglı olarak bilateral bazal ganglion kanaması az rastlanılan bir tablodur. Bu olgu sunumunda, sol hemiparezisi olan, risk faktörü olarak hipertansiyon ve diabeti bulunan ve hipertansiyona baglı bilateral intraserebral hemoraji gelisen bir hastadan bahsedecegiz.Cerebral hemorrhages are mainly seen in the area of the central matter of putamen, temporal lobe, parietal lobe or frontal lobe, thalamus, cerebellar hemisphere and pons in the brainstem. Hypertension related intracranial hemorrhages are most commonly seen in basal ganglia. The etiology of the hemorrhages are hypertension, vascular anomalies, vasculopaties, hematological disease, tumors, anticoagulant drugs. Besides hypertension, methanol or ethylene glycol intoxication, neonatal asphyxia, migraine and hyperglycemic hyperosmolar coma are also related with this condition. In this case report we discuss a patient with hypertension and diabetes mellitus who developed bilateral intracerebral hemorrhages of the basal ganglia

Stereotactic body radioablation therapy as an immediate and early term antiarrhythmic palliative therapeutic choice in patients with refractory ventricular tachycardia

Background: Stereotactic body radioablation therapy (SBRT) has recently been introduced with the ability to provide ablative energy noninvasively to arrhythmogenic substrate while reducing damage to normal cardiac tissue nearby and minimizing patients’ procedural risk. There is still debate regarding whether SBRT has a predominant effect in the early or late period after the procedure. We sought to assess the time course of SBRT’s efficacy as well as the value of using a blanking period following a SBRT session. Methods: Eight patients (mean age 58 ± 14 years) underwent eight SBRT sessions for refractory ventricular tachycardia (VT). SBRT was given using a linear accelerator device with a total dose of 25 Gy to the targeted area. Results: During a median follow-up of 8 months, all patients demonstrated VT recurrences; however, implantable cardioverter-defibrillator (ICD) and anti-tachycardia pacing therapies were significantly reduced with SBRT (8.46 to 0.83/per month, p = 0.047; 18.50 to 3.29/per month, p = 0.036, respectively). While analyzing the temporal SBRT outcomes, the 2 weeks to 3 months period demonstrated the most favorable outcomes. After 6 months, one patient was ICD therapy-free and the remaining patients demonstrated VT episodes. Conclusions: Our findings showed that the SBRT was associated with a marked reduction in the burden of VT and ICD interventions especially during first 3 months. Although SBRT does not seem to succeed complete termination of VT in long-term period, our findings support the strategy that SBRT can be utilized for immediate antiarrhythmic palliation in critically ill patients with otherwise untreatable refractory VT and electrical storm

The mapping of photographer’s studio in Izmir 1900-1950: From Frank Street to Kemeraltı

The purpose of this study is to discuss the link between the photographer and the city based on a close reading of the historical dislocation and the transformation of urban space. Therefore, it is possible to say that both in the past and today, migrations are changing urban spaces by influencing the social, cultural, and economic structures in cities. In this context, the study focuses on the mappings produced in photographer's studios in Izmir between 1900 and 1950. Mapping is a creative method that accommodates various representation possibilities and that consequently propounds unpredictable relationships. In this framework, in order to show both the experiences of the exile and their reflection in urban spaces, the network of photographers in the city have been visually analyzed. Before 1922, 62 photographers were active in İzmir. Around half of them were from Levantine or Armenian origin who settled in Izmir, and their studios were situated on the Frank and the Rose Streets of the city. After 1922, Turkish-Muslim photographers replaced them. Most of these Turkish-Muslim immigrant photographers preferred to open their studios around Kemeraltı as a significant commercial zone. Habits of urban space use and the Kemeraltı region were reshaped and defined together with the existence of these immigrants

Retrospective Comparison of Moderate and Severe Diaphragmatic Eventration in Children: Efficiency of Radiological Classification

Aim:Diaphragmatic eventration (DE) is a congenital or acquired elevation of the hemi-diaphragm. The indications for surgery may be challenging because clinical symptoms do not always correlate with radiological severity. We aim to identify the factors for the necessity and the efficiency of thoracoscopic diaphragmatic plication (TDP) in children with DE.Materials and Methods:A retrospective cross-sectional analysis of patients treated for DE (April 2006-August 2017) was performed. Demographics, type of DE, laterality, associated malformations and clinical symptoms were evaluated. Patients were grouped in two groups (moderate and severe) according to their diaphragmatic elevation levels on X-ray at admission. The severe DE group (SDE, n=14) had a DE of more than 2 vertebral bodies whereas the DE was 2 vertebral bodies or less in the moderate DE group (MDE, n=16). The groups were then compared regarding the necessity of TDP. The efficiency of TDP was analyzed by comparison of the outcome of patients who underwent TDP with that of conservative management.Results:There were 30 DE cases with a median age of 13.75 months. DE was acquired in 5 patients. The right side was the dominant side (21/30). The most common clinical symptoms were pneumonia (21) and respiratory distress (7) while 6 cases were asymptomatic. Acquired DE and respiratory distress were significantly higher in the SDE group. Four patients (25%) in the MDE group and 13 patients (92.9%) in the SDE group required TDP (p=0.000). The total number of cases of pneumonia was significantly higher in the conservatively treated patients in the follow-up (p=0.023).Conclusion:Two vertebral bodies may be an efficient cut-off level to discriminate between MDE and SDE. Absolute indications for TDP are SDE, acquired DE and respiratory distress at admission. Patients that are conservatively treated are more prone to pneumonia

Analysis of the Nutrient Foramen in Human Dry Ulnae of Turkish Population: An Anatomical Study and Current Literature Review

Objective: The nutrient artery which enters through the nutrient foramen (NF) provides blood circulation and nutrition in long bones. This supply is essential during the growing period, the early phases of ossification, and in some surgical procedures. This study aimed to investigate NF in adult human ulnas in the Turkish population. Methods: For this study, 155 (70 right and 85 left) Turkish dry adult human ulnas were used. The presence, number, and patency of NF were recorded as well as its topography and direction. The vertical distance between the most proximal point of the olecranon and the proximal edge of the NF (DONF), and the longitudinal distance between the most ventral point of the coronoid process on the sagittal plane and the proximal edge of the NF (DCpNF) was calculated. Additionally, the foraminal index (FI) was assessed. Results: Single and double NFs were in 139 ulnas (89.67%), and 3 ulnas (1.94%), respectively. NFs were not observed in 13 ulnas (8.39%). The majority of NFs (93.12%) were situated on the anterior surface of the ulna. The direction of all NFs was towards the elbow. The mean DONF and DCpNF were 9.48 ± 1.57 cm, and 6.68 ± 1.44 cm, respectively. The FI was 37.45% in ulnas with a single NF, while it was 41.46% in ulnas with a double NF. Conclusion: Our study has presented additional information such as the FI of ulnas with 2 NFs, and the distance between the coronoid process and NF in the Turkish population

Retospective analysis of risk factors, etiological factors and treatment options in patients with cerebral venous thrombosis

PURPOSE: Cerebral venous thrombosis (CVT) is not a common disease. It is known to have a varied clinical spectrum. There is too much cause of the etiology of disease. In this manuscript we discussed our patients initial symptoms, cause of CVT and our patients' prognosis. MATERIALS and METHODS: This study was a retrospective database analysis of 29 patients who had CVT followed from 2004 to 2010. All of the patients had cranial magnetic resonans imaging (MR) and Mr /Computarized Tomography (CT) venography. RESULTS: There were 27 female, 2 male in this study. Mean age of the patients was 34.97 ±12.79 years old. Only eight patients had abnormal neurological examination (4 patients papilloedema, 2 patients confusion, 1 patient cerebellar dysfunction, 1 patient homonymous hemianopsia). Initial symptoms of patients were headache(n=19), epileptic seizures (n=6), blurred vision (n=1), diplopia (n=2) and one of the patient had vertigo. Ten patients had only one sinus thrombosis however 19 patients had more than one sinus thrombosis. Thrombotic risk factors were found in 21 patients. Most important risc factor were pregnancy, postpartum condition, oral contraceptive usage and acquired hypercoagulable disease. CONCLUSION: CVT is rare but important condition. Sometimes non specific headache is a herald of this condition. Especially pregnancy and postpartum period are susceptibility of this condition