Thursday, May 30, 2019

Attention to Periodic Fever Syndrome in Children!

PFAPA (periodic fevers with aphthous stomatitis, pharyngitis, and adenitis)

Image source: Everyday Health
Periodic fever syndrome, which usually gives symptoms with a fever of 41 degrees and worries the families very frequently, is common in children aged 2-5 years. Periodic high fever syndrome is the most common symptom with aphthae in the mouth, neck swelling and pharyngitis.

PFAPA Syndrome definition

PFAPA syndrome is an autoinflammatory disease that occurs in childhood with recurrent fever, aphthous stomatitis, pharyngitis and cervical adenitis. The disease occurs mostly under five years of age. The fever episodes of the disease recur at irregular intervals and lasts for 3-4 days on average. Fever is usually above 39 ° C in children and is unresponsive to all antibiotic and antipyretic treatments. All clinical symptoms disappear immediately with single dose of corticosteroids. Permanent treatment option is tonsillo-adenoidectomy in children.

Basic information about PFAPA

• It usually disappears spontaneously in the second decade of life. However, they can continue to adulthood and the attacks become less frequent in this period.
• Steroids given at the beginning of the seizure usually terminate it, but more frequent seizures may occur.
• Removal of tonsils in children can treat the disease.
• Seizures may affect the quality of life of children and their families and may not go to school. No harm to the health of the child in the long term.

In PFAPA syndrome, apart from periodic fever, membranous pharyngitis, aphthous stomatitis, cervical lymphadenopathy are seen. Neutropenia or increased IgD levels are not observed during the attack.

Pay attention to these symptoms!

• If your child's fever lasts for 3-7 days (average 5 days) and suddenly falls,

• In addition to fever, abdominal pain, nausea, vomiting, sweating, tremors, muscle-bone and joint pain,

• Two-sided swelling of the neck glands,

• If there is growth in the liver and spleen,

• If aphthae have formed in the mouth (These aphthous lesions are usually painless and quickly heal.)

• If the fever is in a sudden tendency and the general condition of the fever is recovering rapidly and is completely normal between the attacks; your child may have PFAPA syndrome. Although there is frequent attack in PFAPA syndrome, the development and growth of the child is not affected. In blood tests, there is an increase in the findings suggestive of severe inflammation. However, microbes cannot be detected in throat cultures or other materials.

The most important feature of PFAPA syndrome is; As the age grows, the interval between the attacks is opened and spontaneous recovery is seen within 4-8 years. The diagnosis of the disease is made by the presence of the above findings after the other causes of recurrent fever, especially the Familial Mediterranean Fever, have been eliminated.

Patients diagnosed with PFAPA syndrome are treated with cortisone therapy at the onset of an episode and the disease is rapidly controlled. With this treatment, most of the time the inter-episode is opened.

In cases of pfapa syndrome, which cannot be controlled by cortisone treatment, adenoidecomy and tonsil operations are also recommended. In cases where the fever rhythmically repeats, it is necessary to carry out the necessary research and to think about the recurrent fever syndromes.

High fever of unknown origin in infants and children!

High fever with unknown etiology is common in infants and children. However, recurrent fever is also frequently seen. The clinical entity characterized by aphthous stomatitis, pharyngitis, cervical adenitis and periodic fever, which were abbreviated as PFAPA syndrome, were first described in 1985 by Marshall et al. The etiology and treatment of PFAPA syndrome is still unknown. However, glucocorticoids are highly effective in controlling symptoms. Cimetidine and steroids are known to reduce disease duration. There are many reports that the symptoms disappeared completely after tonsillectomy. It was observed that the syndrome complex lasted for 4-6 days, and the symptoms completely resolved with corticosteroid use.

Suddenly start attention to the rise of fever!

Many diseases can be seen in children, especially until the age of primary school. Children can have an upper respiratory tract infection on average 9 times a year, and the majority of them are viral. In addition, periodic fever syndromes should be considered in children with frequent febrile diseases, especially if the fever is cyclic. PFAPA syndrome, which is one of the most common syndromes in children with real fever, is; periodic fever, aphthous stomatitis, pharyngitis and adenitis.

The most prominent feature of this syndrome is cyclic fever attacks. In the child, the fever starts suddenly, it is between 38.9-41 degrees, and the fever between 3-6 days usually does not last longer than 7 days and sometimes heals suddenly. The fever cycle ranges from 26 to 30 days, with an average of 28 days, with an average of 11-12 fever episodes per year. In this picture, the child looks healthy and maintains normal growth and development. Aphthous ulcers in the mouth can be seen in children with fever. Although there is no definitive laboratory diagnosis, it is clinically diagnosed and at least three fever attacks must be documented.

Attacks can last for 4-8 years on average

The response of the fever to steroid treatment is considered as a diagnostic criterion. These patients do not usually have beta-hemolytic streptococcal germ production in throat cultures, but reproduction should not mean that this syndrome is not present. At least 3 fever attacks (shorter than 7 days, regular and periodic), pharyngitis and painful throat swelling or aphthous ulcer in the mouth, normal growth and development, presence of healthy looking children between fever episodes, PFAPA should be considered in the presence of. While the fever episodes last for 4-8 years, their frequency decreases as the child gets older and then heals spontaneously.

The attacks are not easy to control!

There is no definitive treatment for the disease. Steroids are used in the treatment of attacks. Although single dose steroid administration improves fever and pharyngitis findings, it does not prevent the next fever. Other drugs used in the treatment are colchicine and cimetidine. In some cases, removal of tonsils can prevent attacks.

Can be mixed with familial mediterranean fever

This disorder can be confused with Familial Mediterranean Fever (FMF), which is considered to be a periodic fever syndrome in children. FMF usually occurs at older ages and attacks occur at irregular intervals. Although the fever varies between 38-40 degrees, it continues for 12-36 hours and falls spontaneously. Chest pain and joint pain can also be seen, especially with abdominal pain. The child seems healthy among the attacks. Because there is a genetic transition, there may be people with similar complaints in the family. The familial Mediterranean fever should be treated as distinct from this disorder. Otherwise, depending on the accumulation of amyloid in the body, especially in the kidney, other internal organs may be damaged.

How is PFAPA diagnosed?

Laboratory tests for PFAPA diagnosis are not available. The disease is diagnosed by symptoms and physical examination. During seizures, things such as white blood cell counts, signs of inflammation, which can be measured by blood tests, increase. Before approving the diagnosis, it is necessary to eliminate other diseases that may have similar symptoms. The response to treatment with steroids may also provide a diagnosis of PFAPA. In cases other than a classical appearance, it is necessary to exclude other causes of recurrent fever, especially if the symptoms started during the first year of life and signs of inflammation increased during seizures.

How is PFAPA treated?

The goal of treatment is to control symptoms during fever bouts, to shorten the duration of seizures and to prevent them from repeating. Fever does not respond very well to acetaminophen and nonsteroidal anti-inflammatory drugs. If a single dose of steroid is given when the symptoms begin, it may significantly shorten and even terminate the duration of the seizure. However, the time between seizures and this treatment may be shortened and the next seizure may come early than expected.

Drugs such as cimetidine and colchicine can prevent seizures from half to one-third of children if used regularly. In many studies, it has been observed that the removal of tonsils permanently treats PFAPA in 80% of patients, but the role and timing of surgery during this treatment is not yet clear. Generally, if the steroid response is seen to be good, tonsillectomy and adenoidectomy can be planned in the following period.

You can find details about "Periodic Fever Syndrome" and before and after photos at >> PFAPA Syndrome - Symptoms, Causes, Diagnosis, Treatment

Source links >> Outcome of Tonsillectomy in Selected Patients With PFAPA Syndrome ...Periodic fever, aphthous stomatitis, pharyngitis and adenitis

Bosphorus - Istanbul - Turkey - ENT Doctor Istanbul - ENT Specialist Istanbul - Nose Job Istanbul - Rhinoplasty Istanbul - ENT Office Istanbul - Dr.Murat Enoz - ENT Clinic Istanbul - ENT Doctor in Istanbul - Nose Job in Turkey
Bosphorus - Istanbul - Turkey - ENT Doctor Istanbul - ENT Specialist Istanbul - Nose Job Istanbul - Rhinoplasty Istanbul - ENT Office Istanbul - Dr.Murat Enoz - ENT Clinic Istanbul - ENT Doctor in Istanbul - Nose Job in Turkey

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul
Private Office:
Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
Appointment Phone: +90 212 561 00 52
Mobile phone: +90 533 6550199
Fax: +90 212 542 74 47

Thursday, May 16, 2019

Frequently Asked Questions For Rhinoplasty in Istanbul

Nose Aesthetic Operation - FAQ - Dr.Murat Enöz

Rhinoplasty in Istanbul
Rhinoplasty Operation - Nose Job - Turkey - Istanbul

You Can Read Before Coming to Istanbul for Aesthetic Nose Surgery

How to Choose a Doctor For Nose Aesthetics?

Nose aesthetic operations are personal. No rhinoplasty surgery can be considered "standard" and is not the same as the other. Before meeting with your doctor for rhinoplasty in Istanbul, try to understand the features you do not please in your nose and the features you want to change. Ask your physician to show patients with similar characteristics to these problems. Ask your doctor about his views. You should not forget that medical sciences are open to interpretation. Different physicians may have different opinions on the same subject. Therefore, you can reach the happy ending with the physician who understands you best. Also note that sometimes the situations you request may not be realistic or interchangeable. Your physician's views on this subject are also very important.

Rhinoplasty in Istanbul - Frequently Asked Questions (FAQ) - Dr.Murat Enöz

One of the most important gains of nasal aesthetic surgery is to provide natural breathing through the nose. This surgery should not be considered as a cosmetic procedure but its important contribution to health should be evaluated.

Preoperative Detailed Examination of The Nasal Anatomy

Rhinoplasty is the reshaping of the nose after the thorough examination of the nasal anatomy, taking into account the expectations and demands of the person. There are many nasal shapes. Large nose, small nose, upturned, curved and hooked nose etc. People who do not like the shape of the nose and therefore have social or psychological distress, have a nose surgery. A detailed examination of the nose is made and the patient is prepared for surgery. As a result of these examinations, the most appropriate nasal shape is determined for the patient. The shape of the nose that fits the character of the person, which will look elegant and aesthetical from the outside is determined.
Sometimes your physician may refuse your surgery for justified reasons and can take you away from your nose surgery decision!...
The nose is one of the important aesthetic organs. In addition to aesthetics, he also undertook various tasks. It is where breathing begins, the nose is effective in creating a special sound. The body is one of the doors opening to the outside. It is a whole with its functions and aesthetic appearance. Therefore, the nose should be handled both internally and externally. The aesthetic problems in the nose and functional problems should be solved together. If the nose aesthetics are bad, the nose functions too badly. Similarly, if there is a problem such as curvature which affects the breathing negatively, an aesthetic nose structure can not be obtained.

Rhinoplasty in Istanbul - Frequently Asked Questions (FAQ) - Dr.Murat Enöz

Correct listening of the patients, understanding the anatomy correctly, evaluating the possible outcomes with patient expectations is very important. Rhinoplasty surgery may not be performed in the presence of different situations such as the expectation of non-realistic operation results, the thought of having a very important psychological effect (such as body dysmorphic disorder - this may be present in one third of patients who are planning to undergo rhinoplasty surgery, such as body dysmorphic disorder, source: One-Third of Rhinoplasty Patients Have Body Dysmorphic Symptoms). In particular, patients with thick skin need a very thin and naric nose, patients with asymmetric traumatic nose deformities, such as patients wanting a full symmetric nose is close to the impossible results should be informed about the process. You can read the new guideline about rhinoplasty that published by American Academy of Otolaryngology-Head and Neck Surgery at >> Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty

Evaluation of patients before the rhinoplasty in Istanbul

During the first meeting, I listen to patients who came for rhinoplasty in Istanbul. I took photos and I give detailed information about the nose aesthetic operation. I talk to the patients about their noses, the changes that can and will not be, the risks and the special problems that can be experienced. It is often the right option to speak face to face on the digital rhinoplasty animation program.

Rhinoplasty in Istanbul - Frequently Asked Questions (FAQ) - Dr.Murat Enöz

How is Rhinoplasty Operation Performed?

I know that this is very detailed question. It is done by general anesthesia and is completed in about 2 hours. Nasal aesthetics can be applied as open and closed with 2 different techniques. Since I usually perform complicated revision nose surgery, I prefer open technique rhinoplasty in Istanbul.

Open and Closed Nose Aesthetic Surgery

The main difference between the two techniques is the cutting of the skin at the bottom of the nose. This part is called open nose surgery when the operation is cut. In the closed technique, it would not be right to think that there is no nose incision. In both techniques, the aim is to make the anatomical structures in the nose visible and to shape the nose in the direction of the previous planning.

Concerns About Rhinoplasty Operation in Istanbul

Why is nose aesthetic done?

It is the process of reforming the nose for different reasons. These reasons include the desire to have an aesthetic nose, nasal volume reduction, nasal enlargement, nasal hump removal and nasal bone reshaping, nose tip lifting or reshaping.

Frequently Asked Questions For Rhinoplasty in Istanbul

Do you feel pain or pain during surgery?

Since surgery is performed under general anesthesia, there is no pain during the operation. The new generation of silicone supports, which are applied at the moment, do not cause pain in order to provide comfortable breathing instead of previously used nasal buffers.

Rhinoplasty in Istanbul - Frequently Asked Questions (FAQ) - Dr.Murat Enöz

Can rhinoplasty operation be performed under local anesthesia?

Local anesthesia can be used for many plastic surgery as well as for nose surgery. With the numbness of the nose and its surroundings, aesthetics can be realized without the transactions in the region being felt. For all procedures such as nasal bone curvature, nasal bone filing, nasal tip removal, local anesthesia may be preferred instead of general.

How should an ideal nose aesthetic surgery be?

It is not possible to talk about the ideal shape of the nose, but rather an ideal nose shape for every facial shape. For this reason, a nose design is performed by taking into consideration the face, size and characteristic of the person during nose surgery operations. Generally, to ensure that the nose shape is ideal, one should pay attention to the alignment of the upper lip and the chin tip.

Which season is the best for rhinoplasty in Istanbul?

In general, there is no season of plastic surgery such as nasal bone surgery and nasal correction, it can be done anytime, but summer is the season that needs special attention due to the negative effects of excessive heat.

Do rhinoplasty operation cause the loss of smell after surgery?

Temporary odor problems may occur in nasal surgeries. However, loss of odor occurs mostly in patients performing nasal bone-related procedures. Since the nerve tissues are suppressed, the problem may persist until short-term mucosal edema is achieved. After the aesthetic surgery, the sense of smell becomes regressed due to the swelling.

Is massage should be done after rhinoplasty?

Nose massage practice is usually recommended to increase blood circulation in the nose area. Massage which supports the faster healing of the wound should be applied regularly and without suppression by correct techniques. One-way mild massage from the nasal neck to the nasal wings should be performed if recommended.

How to choose a doctor?

You should know the physician you are going to undertake the operation of rhinoplasty in Istanbul. It is very important to test whether you understand the result of your dialogue with your doctor. You should review your doctor's past achievements. You can ask her to show her previous surgeries. There must be a mutual trust with your physician.

Is incision scar remains after the operation at the tip of the nose?

In the open technique, a small incision is made at the junction of the nose and lip part, so a slight scar can be left after the surgery. In the closed technique, there is no incision due to the incision in this section.

What should be done if you do not like the operation result?

There are two reasons for this. The first one is that his nose hasn't been beautiful and the patient doesn't just love his nose and he's not happy. Second, the nose alone can be beautiful in itself. But it may not be compatible with the face. Therefore, it is a very good example that the beautification of the nose alone does not make the patient very happy. What needs to be done here is to perceive the face of the patient and to perceive that the face and beauty are a whole.

How long is the surgery?

It takes about 1.5-2.5 hours. However, in some cases, the operation time may be longer as it requires the removal of cartilage from the ear or ribs (revision rhinoplasties, curved nose deformities ...).

Does bruising occur after the operation?

According to the operation techniques may be bruises and swelling can be seen after rhinoplasty. These bruises vary from person to person. Some people do not have any bruises. Some people may experience more or less bruising. This is due to the preferred solutions in surgery.

How much is the recovery process?

The post-operative recovery process may differ from the technique used in the operation, the technique of the intervention, and the personal characteristics of the patient. The mean recovery time after rhinoplasty in Istanbul varies between 7 and 10 days. Many patients can easily return to their work or school within a week or less. Although it changes according to your profession, you should set yourself a minimum of 7 days of annual leave. Many physicians, outside the nose and used the splint in the 7th day, but a further 5 days would like to apply a patch. In other words, if you can increase the time to stay away from work for 12 days, you will get back to work when you have recovered perfectly and your edema is very low. Your new nose will begin to look very nice in 2 weeks and will sit out in 6 weeks. However, the process of reduction of edema at the micro level and its proper fit will last for up to 2-3 years.

What is narrow nose?

The inside of our nose is the size of a matchbox. It is not a very spacious place. And there is a compartment that separates the two holes. Most surgeries are made as if they were caused by the curvature. Why do we have two holes in our bouquet? 3 hours one 3 hours and the other works.

Will you show your nasal shape after surgery with postoperative rhinoplasty animation program?

If you review these programs, you will be a master user in a few days. Therefore, you can work in your home on the photo taken before the surgery and you can put a very nice nose. The real question starts here! How realistic are these computer programs. Nasal aesthetic surgery is performed on live and changing (healing) tissue. That is the change of living tissue. After this process, the healing characteristics of the patient, post-operative care of the patient, asymmetric tissue traumas during the operation (asymmetric nodes asymmetric tissue dissection and graft applications are required) are determined as a result.

Who does rhinoplasty operation?

Many people want to make the areas that are not satisfied with their appearance in the body, with a variety of aesthetic operations. Thanks to these operations, people who are unhappy because of one or more points in their body can live more peacefully and happier with their bodies.

When can I start work?

The answer to this question is different for everyone. If you are in general health, if you are doing sports, if you do not smoke, after your post-operative care by your doctor, you can start working within 7-10 days after the surgery.  After rhinoplasty in Istanbul, usually the bruise on the face in the second week will be mostly gone.

What should be considered after surgery?

It is absolutely necessary to take care to take the amount of fluid recommended by the doctor. Also, the lips should not remain dry. It should be wetted with a continuous cloth. The bumpers placed on the nose should be very careful and should not be moved. Do not take the medication given by the doctor should take attention to what your doctor says and should not take extra medication.

How long do I have to stay in the hospital?

You can get out of hospital one day after surgery.

Do I have breathing problems?

One of the most important reasons you have difficulty breathing through your nose is the curvature of your cartilage and bones. Therefore, you must have an Otolaryngology specialist before your operation. Because you may not breathe because it may not be so simple. A detailed intranasal endoscopic examination will provide important information. In addition, it is very important to evaluate the condition of your nose, the presence of allergic disease, the presence of other problems such as sinusitis and polyp. Otherwise, it is not possible to get good air from your nose. This is why the noses we encounter often, but not functional. Your breath may not improve only by correcting the nasal cartilage-bones after rhinoplasty. Treatment of turbinate hypertrophy and nasal valve problems is also important.

Can I swim in the sea?

You can swim and sunbathe 2 weeks after you have left the plastic guard on your nose.

Will bruising and swelling be seen on the face?

At the end of the first week, the plaster cast is removed from the nose. There are still bulges in the nose and cheeks in the detention pouches. These swelling is only within 15 days. The bruises are gone.

Should I use medication after surgery?

You can also use the appropriate medications doctor control gold

May I smoke after rhinoplasty?

Smoking or alcohol should not be used before and after the operation or postoperative use should be limited considerably.

When will my nose take shape after surgery?

In patients with thick skin characteristics, complete recovery time may be 2-3 years after rhinoplasty operation; This period is about 1 year in patients with thin skin and simple nose surgery.

Could rhinoplasty be done under 18 years of age?

Although there is no written rule in aesthetic surgery, experts do not recommend applications under the age of 18 years. As the nasal development continues, it is best to expect and not expect a surgical trauma to cause nasal deformity. Children under the age of 15 are legally required to sign the family. The lower limit for these operations is 16 years for girls and 18 years for boys. However, we can rarely perform this surgery even in younger children with severe difficulty in nasal airway obstruction. However, when we have to do so, it is possible to perform this operation without touching the cartilage and bone growth points in these childhood nose surgery operations. In advanced ages, there is no upper limit for performing this surgery.

Does the nose tip droop?

As a result of the operations performed properly and correctly, there is no nose drop problem. The problems to be experienced after years are indicative of the physiological state of the skin as a result of aging.

When can I wear glasses?

A question open to discussion. You can wear glasses from the 3rd week if there is no procedure about the bones. After the rhinoplasty operation where the classic nasal bone is broken, glasses should not be used for 6 months.

Is nasal buffer used in surgery?

In the operations performed by placing the tampon, the tampon is taken after 7 days although it varies according to the operation.

What is revision nose surgery?

Aesthetic nose operations are the most difficult plastic surgery. The patient's preoperative problems make the operation more difficult. In addition, the period of wound healing, which medical science still cannot clarify, and the problems that may arise, affect the results of nasal surgeries. Still, you don't have to be pessimistic about it. Experienced physician in the hands of a well-planned and applied surgery after the desired nose can be achieved. Studies have shown that revision nose rates are below 5 percent. I think the most important thing you should know as a surgical candidate for revision surgery is the extent, ie the size of the second operation. You can give your revision surgery as a result of very small millimetric asymmetries or superficial roughness in your nose, which can be corrected with very short local procedures. Or your nose will have collapses, asymmetries, breathing problems, and the second operation may require cartilage from your ear or rib. In other words, you may need a thorough nose surgery. It is necessary to clearly distinguish these two operations from each other. I describe the second as a revision nose surgery.

What are the causes of breathing complaints?

The structure separating the nasal cavity into two separate compartments in the vertical axis is called "nasal septum". The curvature in the septum can sometimes be corrected without surgery with a simple surgical procedure, and sometimes it can be corrected with an aesthetic configuration using cartilages from the ear or rib. At the point where the nasal tip meets the nasal back, there is a transition problem that occurs when the airflow is not visible, but deep breathing at the transition point where a natural turbulence occurs. Strong breathing while the nose wings inward to breathe makes it difficult to breathe. Normally, breathing, while breathing in the nose wings occur if the noses occur. In most cases, there is no physical problem in the examination. The problem is in the function. Apart from these, turbinate hypertrophy, nasal polyps, intranasal masses, allergy can cause breathing problems.

What are the risks associated with rhinoplasty?

As in every surgical procedure; rhinoplasty operation may have several complications and risks. What is important is that you should have a doctor who knows these risks well and tries to take precautions against them. In particular, asymmetric areas may not be corrected after revision nasal surgeries, especially for curved nose deformities. Complications requiring severe tissue losses and large surgeries are very rare.

Cost of Nose Aesthetic in Istanbul

Nasal aesthetics prices in Istanbul vary according to the clinic where the surgery is performed and the preferred physician. Factors such as how to intervene in the area of the nose can be decisive in the price point for rhinoplasty in Istanbul. Depending on the hospital to be operated, depending on whether the person has insurance and insurance coverage. The most important thing in an operation is to satisfy the patient. Generally in luxury hospitals total surgical cost is can rise up to $ 4500; it can be reduced to 300 us dollars in cheap hospitals. Treatment fees may be higher in patients who require grafting, such as additional rib cartilage, ear cartilage, especially with long processing time.

Similar link >> Brief Information About Rhinoplasty (Nose Aesthetic Surgery) in Istanbul

You can find details about "Rhinoplasty in Istanbul" and before and after photos at >> Rhinoplasty in Istanbul / Natural Rhinoplasty in Istanbul, Turkey

Bosphorus - Istanbul - Turkey - ENT Doctor Istanbul - ENT Specialist Istanbul - Nose Job Istanbul - Rhinoplasty Istanbul - ENT Office Istanbul - Dr.Murat Enoz - ENT Clinic Istanbul - ENT Doctor in Istanbul - Nose Job in Turkey
Bosphorus - Istanbul - Turkey - ENT Doctor Istanbul - ENT Specialist Istanbul - Nose Job Istanbul - Rhinoplasty Istanbul - ENT Office Istanbul - Dr.Murat Enoz - ENT Clinic Istanbul - ENT Doctor in Istanbul - Nose Job in Turkey
Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul
Private Office:
Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
Appointment Phone: +90 212 561 00 52
Mobile phone: +90 533 6550199
Fax: +90 212 542 74 47