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Öğe A comparison of the vasodilatory effects of verapamil, papaverine and nitroglycerin on isolated rat aorta(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2013) Ege, Turan; Halıcı, Umit; Gür, Özcan; Gürkan, Selami; Özkaramanlı Gür, Demet; Duran, EnverBackground: This study aims to compare the vasodilatory effects of verapamil, papaverine and nitroglycerin on rat aortic preparations in in vitro isolated tissue bath system and to evaluate the role of vascular endothelium on vasodilatory responses of the isolated rat aorta samples. Methods: The thoracic aorta segments collected from 30 male Wistar rats (20 endothelialized and 20 de-endothelialized vascular rings for each drug in 2 mm wide strips, total number of 120 vascular rings) were suspended into the Krebs solution of the isolated tissue bath system. Phenylephrine was used to induce isometric contraction and tissue samples were treated with verapamil, papaverine and nitroglycerin separately to draw concentration-response curves of isometric vasodilatory responses. This procedure was repeated for de-endothelialized aorta samples. Results: Papaverine and verapamil induced vasodilatatory responses starting from the concentration of 10(-8) M and reached its maximum at concentration of 10(-3) M, while nitroglycerin induced vasodilation at lower concentrations starting from a concentration of 10(-12) M, reaching its maximum at 10(-6) M. Nitroglycerin was the most potent agent, followed by verapamil and papaverine. Efficacy analysis revealed that the most efficient agents were papaverine (140 +/- 6.7%), nitroglycerin (110.8 +/- 1.35%) and verapamil (99 +/- 4.14%), respectively. The results were similar in aorta samples without endothelium (p >= 0.05, F test). Conclusion: In this study examining isolated rat aorta, nitroglycerin was the most potent agent, while papaverine was the most efficient agent. Our study results showed that endothelium played no role in vasodilatation responses of these drugs.Öğe A new center: First six months analysis of adult cardiac surgery(2012) Gürkan, Selami; Gür, Özcan; Arar, Makbule Cavidan; Ege, TuranObjective: Cardiac surgery centers are developing and growing in recent years. We aimed to evaluate the first six months results of cardiac surgery operations that performed in our clinic which built new. Material and Methods: One hundred seven (73 men, 34 women; mean age 58.35±11.15 years) consecutive patient operated between October 2011 and March 2012 were analyzed retrospectively. While hypertension (43.9%) was the most common disease followed by diyabetes (39.2%), hyperlipidemia (35.5%) and chronic obstructive pulmonary disease (21.4%). Coronary artrey bypass graft operation was applied to 86 (80.3%) patients. The other procedures were; valve operation, atrial septal defect repair and Benthall. Results: Hospital mortality was 2.8% with 3 cases. Two of the patients were acute myocardial infarction, the other one was with left ventricular aneurysm. One of these patients diagnosed with acute myocardial infarction was taken to operation accompanied by cardiopulmonary resuscitation because of cardiopulmonary arrest. Postoperative wound infection was seen in 5 patiens. Saphenous vein wound infection in 3 and sternal wound infection in 2 patients was seen. Postoperative atrial fibrillation was seen in 28% of patients. Sinusal rhythm restored in all postoperative atrial fibrillations by medikal treatment. Revision operation for bleeding in 3 and for resistant ventricular fibrillation in 1 patient were performed. Conclusion: We thought that cardiac surgery operations that started at October 2011 in our clinic could be performed with acceptable mortality and morbidity rates. Copyright © 2012 by Türkiye Klinikleri.Öğe Body mass index as a determinant of postoperative morbidity(Cardiology Academic Press, 2013) Gürkan, Selami; Gür, Özcan; Özkaramanlı Gür, Demet; Ege, Turan; Canbaz, Suat; İşcan, ŞahinBACKGROUND: The impact of obesity on postoperative mortality and morbidity in coronary artery bypass grafting (CABG) operations is a widely studied but poorly defined topic. OBJECTIVE: To investigate the effect of body mass index (BMI) on in-hospital mortality and morbidity after isolated CABG surgery. METHODS: Prospectively collected data of a series of 1057 consecutive patients who underwent on-pump isolated CABG surgery were retrospectively analyzed. Patients were divided into five groups according to WHO BMI categorization (defined as underweight [BMI <20 kg/m(2)]; normal weight [BMI >= 20 kg/m(2) to <25 kg/m(2)]; overweight [BMI >= 25 kg/m(2) to <30 kg/m(2)]; obese, [BMI >= 30 kg/m(2) to <35 kg/m(2)]; and morbidly obese, [BMI >= 35 kg/m(2)]). RESULTS: Of 1057 patients, 13 patients (1.2%) were underweight, 298 (28.2%) were normal weight, 462 (43.7%) were overweight, 218 (20.6%) were obese and 66 (6.2%) were morbidly obese. The mean age was significantly lower in underweight patients, who were also more likely to be male. In contrast, obese and morbidly obese patients were older, and more likely to have comorbidities such as diabetes and hypertension. The incidence of postoperative bronchodilator use (P<0.001), leg wound infection (P=0.038), sternal dehiscence (P=0.039) and development of new-onset atrial fibrillation (P<0.001) was significantly higher in obese and morbidly obese groups. In contrast, postoperative prolonged ventilation (P<0.001), need for blood transfusions (P<0.001) and revision for bleeding (P=0.041), as well as gastrointestinal complications (P<0.001), were significantly higher in underweight patients. Multivariate logistic regression analysis showed that not BMI but female sex, older age and diabetes mellitis were independent risk factors for early mortality after CABG surgery. CONCLUSION: No effect of BMI on early postoperative mortality after CABG surgery could be demonstrated. However, in terms of morbidity, postoperative bleeding and revision for bleeding were increased in underweight patients while sternal dehiscence, wound infections and occurrence of atrial fibrillation were increased in obese and morbidly obese patients.Öğe Büyük safen ven yetmezliğinde manuel 980 nm lazer çıplak-uçlu fiber ile otomatik geri çekme sistemli 1470 nm radial fiber lazerin karşılaştırılması: Erken dönem etkinlik ve komplikasyonlarin analizi(2013) Gürkan, Selami; Gür, Özcan; Arar, Makbule Cavidan; Donbaloğlu, Mehmet Okan; Ege, TuranAmaç: Endovenöz lazer ablasyon, variköz ven tedavisinde en çok kabul gören tedavi seçeneklerinden biridir. Bu retrospektif çalışmanın amacı manuel 980 nm çıplak fiber lazer ile otomatik geri çekme sistemli 1470 nm radial fiber lazerin erken dönem etkinliklerinin karşılaştırılması. Gereç ve Yöntemler: Ekim 2011 ile Ocak 2013 arasında büyük safen ven yetmezliği sebebiyle endovenöz lazer ablasyon ile tedavi edilen 78 hasta ve 89 ekstremite incelendi. 980 nm lazer ve çıplak fiber ile tedavi edilen 40 hasta ve 45 ekstremite Grup 1 olarak tanımlandı. 1470 nm lazer radial fiber ve otomatik geri çekme sistemi ile tedavi edilen 38 hasta ve 44 ekstremite Grup 2 olarak tanımlandı. Ağrı, ekimoz, endurasyon, parestezi gibi lokal komplikasyonlar postoperatif 3, 7 ve 30. günlerde klinik olarak ve Doppler ultrasonografi ile değerlendirildi. Bulgular: Grup 1 ve grup 2de erken kapanma oranları sırasıyla %91 (n=41) ve %93 (n=41) idi. Bir aylık takipler sonunda her iki grupta da venöz klinik şiddet skorlarında belirgin derecede azalma oldu. Postoperatif ekimoz, endurasyon parestezi ve analjezik ihtiyacı grup 1de anlamlı derecede yüksek olmasına rağmen, major komplikasyonlar her iki grupta da görülmedi. Sonuç: Her iki tip lazer ile yapılan endovenöz lazer ablasyon işleminin erken dönem sonuçları tatmin ediciydi. Otomatik geri çekme sistemli 1470 nm dalga boyunda radial fiber kullanılarak yapılan büyük safen venin endovenöz lazer ablasyonunun etkili ve güvenli bir tedavi seçeneği olduğu söylenebilir.Öğe Comparison of the efficacy of the cardiac hypothermia and normothermia to myocardial damage in coronary artery bypass graft surgery with systemic normothermic cardiopulmonary bypass(Edizioni Minerva Medica, 2013) Çakır, Habib; Gür, Özcan; Ege, Turan; Kunduracilar, H.; Ketenciler, S.; Duran, E.Aim. The aim of our research is to investigate the cardiac damage formed by either local cardiac hypothermia or cardiac normothermia technique in patients who undergone isolated coronary artery bypass graft (CABG) surgery. Methods. The total of 40 patients who underwent isolated CABG operation under normothermic cardiopulmonary bypass (CPB) were studied. Patients were randomly divided into two groups as cardiac hypothermia and cardiac normothermia. Myocardial temperature was measured from the interventricular septum before aortic cross-clamp (ACC) (baseline), the ACC 20th minutes (ischemia) and after 20 minutes removal of the ACC (reperfusion). The coronary sinus blood samples were simultaneously obtained from the retrograde cardioplegia cannula while myocardial temperature was being measured. Complement component 3 (C3), complement component 4 (C4), troponin I and tumor necrosis factor-alpha (TNF-alpha) was measured from the coronary sinus blood samples. Results. Myocardial temperature was between 18-28 degrees C (deep hypothermia) during ACC in group 1. Myocardial temperature was over 34 degrees C (normothermia) during ACC in group 2. TNF-alpha values of group 1 for ischemia and reperfusion were higher than group 2, and it was found statistically significant (P<0.05). Conclusion. Myocardial damage was less than in normothermia group according to hypothermia group. The results show that ice-cold blood cardioplegia and local ice treatment of the heart during CPB seems to harm the heart more than warm blood cardioplegia.Öğe Comparison of vasospasm and vasodilatation response of saphenous vein grafts harvested by conventional and no-touch techniques(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2012) Gür, Özcan; Gürkan, Selami; Özkaramanlı Gür, Demet; Karadağ, Hakan; Ege, TuranBackground: In this study, we aimed to compare vasoconstriction and vasodilatation responses of saphenous vein grafts (SVG) harvested by conventional and no touch techniques in tissue bath system. Methods: Between February 2007 and September 2007, 12 patients (10 males, 2 females; mean age 55.6 +/- 5.8 years; range 38 to 75 years) who underwent coronary artery bypass graft (CABG) surgery in our clinic with signed informed consents were included. Based on the techniques used during harvesting, the grafts were divided into two groups, including group 1 (n=16) with SVGs harvested by conventional technique and group 2 by no-touch technique. In group 1, SVG was removed completely from adjacent adipose tissues. In group 2, SVG was removed with adjacent adipose tissues, preserving saphenous nerves. Results: The vasodilatation response of SVGs was significantly higher with the no touch technique, while the vasoconstriction response of SVGs was significantly higher with the conventional technique at lower doses. Conclusion: We belive that no-touch harvesting technique of SVGs may decrease early graft failure and reduce also postoperative morbidity and mortality rate, contributing to improve graft patency rate in the long-term.Öğe Derin ven trombozu bulunan hastalarda tedavi etkinliğinin değerlendirilmesi(2012) Gür, Özcan; Gürkan, Selami; Çakır, Habib; Özkaramanlı Gür, Demet; Donbaloğlu, Mehmet Okan; Ege, TuranAmaç: Derin venöz sistemde trombüs oluşumu ve venöz akımın kesilmesi derin ven trombozu (DVT) olarak adlandırılmaktadır. Çalışmada DVT tanısı alan hastalarda tedavi sonuçlarını değerlendirmeyi amaçladık. Yöntem: Kliniğimizde kasım 2010 mayıs 2012 tarihleri arasında doppler ultrasonografi ile derin ven trombozu tanısı almış toplam 73 hasta çalışmaya alındı. Hastaların yaş ortalaması 55.205 ± 18.12 (Min: 22, Max: 84) idi. Hastalara standart DVT tedavisi uygulandı. Olgular tarafımızdan 6. ay'da doppler ultrasonografi ile venöz sistemleri tekrar değerlendirildi. Hastalar etyolojik faktörlere göre incelendi. Bulgular: Otuz hasta cerrahi sonrası yetersiz profilaksi, 9 hasta malignite, 34 hasta ise idiyopatik idi. 39 olguda sol alt ekstremite, 21 olguda sağ alt ekstremite ve 13 olguda ise her iki alt ekstremitede derin ven trombozu mevcuttu. 6 ay sonunda doppler ultrasonografi ile tüm hastaların tromboze ven segmenti değerlerdirildi. 54 olguda (%73) tromboza ait radyolojik bulgu kalmamış olup, 12 olguda (%16.4) rekanalize tromboze segment, 7 olguda (%8.5) ise trombozun devam ettiği görülmüştür. Sonuç: Derin ven trombozu tedavisi ve profilaksisinin yeterli yapılması rekürrensi azaltırken rekanalizasyon ve tromboz lizisini arttırmaktadır. Olguların mortalite ve morbiditesinin azalmasını sağlamaktadır.Öğe Early results of monopolar versus bipolar radiofrequency ablation for atrial fibrillation during open heart surgery(Cardiology Academic Press, 2013) Gür, Özcan; Gürkan, Selami; Özkaramanlı Gür, Demet; Çakır, Habib; Yüksel, Volkan; Hüseyin, Serhat; Ege, TuranBACKROUND: In patients with atrial fibrillation (AF) for whom open heart surgery is scheduled, it is suggested to treat AF by ablation. OBJECTIVE: To compare the efficacy of monopolar and bipolar surgical radiofrequency ablation systems in patients undergoing concomitant open heart surgery and reveal the factors affecting the conversion to sinus rhythm. METHODS: Forty-three patients (19 male and 24 female) who underwent irrigated monopolar or bipolar radiofrequency ablation for persistent AF at concomitant cardiac surgery between 2007 and 2012 were included in the study. RESULTS: Monopolar ablation was performed in 24 and bipolar ablation was performed in 19 patients. Twenty of the 24 patients who underwent monopolar radiofrequency ablation and 15 of the 19 patients in the bipolar ablation group were in sinus rhythm at the three-month follow-up. There was no statistically significant difference between the two ablation procedures on the conversion of AF to sinus rhythm. When the effect of left atrial diameter on conversion to sinus rhythm was compared, left atrial diameter >60 mm was found to have pronounced negative influence on procedural success, while left atrial diameter <60 mm had no effect. CONCLUSION: A concomitant monopolar or bipolar modified Cox maze procedure during open heart surgery is equally effective technique for AF ablation at three months of follow up. Left atrial diameters >60 mm significantly reduced the rate of conversion to sinus rhythm.Öğe Endovasküler abdominal aortik anevrizma tamirlerinde erken dönem sonuçları (6 aylık takip)(2013) Gür, Özcan; Gürkan, Selami; Özkaramanlı Gür, Demet; Arar, Makbule Cavidan; Ege, TuranAmaç: Abdominal aort anevrizması, açık cerrahi teknikler ile tedavi edilebildiği gibi endovasküler olarak da tamir edilebilmektedir. Çalışmamızda, endovasküler aort tamiri yapılan olguların 6 aylık erken dönem sonuçlarını sunmayı amaçladık. Gereç ve Yöntemler: Kliniğimizde 2010-2012 mayıs tarihleri arasında endovasküler aort anevrizma tamiri yapılan 18 hasta çalışmaya alındı. Olgular işlem sonrası 1. ve 6. ay kontrollerine çağrılarak endoleak açısından değerlendirildi. Olguların komorbidite sebeplerine bakıldığında %38,9u diyabetik (n:7), %77,8 hipertansif (n:14), %55.6 kronik obstruktif akciğer hastalığı (n:10), %16,7 malignite (n:3), %22,2si koroner arter hastalığı (n:4), 1 olguda ise peritonit sebebiyle geçirilmiş batın cerrahisi mevcuttu. Bulgular: Olguların 4ü kadın, 14ü erkek toplam 18 hastaya endovasküler aort tamiri (EVAR) işlemi uygulandı. Hastaların yaş ortalaması 72,77±6,54 (min:62, max:82) olarak saptandı. Olguların 6 aylık takibinde mortalite gözlenmezken 1 olguda endoleak saptandı. Sonuç: EVAR işlemi açık cerrahi için yüksek riskli olgularda (ileri yaş, komorbidite varlığı, geçirilmiş batın cerrahisi) düşük mortalite ve morbidite oranları ile güvenli bir biçimde uygulanabilir. Daha kesin sonuçlar için uzun dönem takiplere ihtiyaç duyulmaktadır.Öğe Evaluation of Treatment Activity in Patients With Deep Venous Thrombosis(Cukurova Univ, Fac Medicine, 2012) Gür, Özcan; Gürkan, Selami; Çakır, Habib; Özkaramanlı Gür, Demet; Donbaloğlu, Mehmet Okan; Ege, TuranPurpose: Deep vein thrombosis (DVT) refers to thrombi formation and blood stasis in the deep veins of the extremities. This study was to determine the effectiveness of DVT treatment in our clinic. Method: All of 73 patients who diagnosed Deep Venous Thromboses with dupplex ultrasoun between december 2010 and may 2012, at our institution were enrolled in this study. The mean age of the patients was 55.205 +/- 18.12 (Min: 22, Max: 84). Standart DVT treatment was applied. We re-evaluated the change in deep venous system using follow-up Dupplex ultrasonography after 6 months. The patients were observed according to etiology. Results: Etiologic factors were insufficient prophylaxis after surgery (30 patients), malignancy (9 patients) and idiopathic (34 patients). Deep venous thrombosis existed left lower extremity (n=39), right lower extremity (n=21) and bilateral lower extremity (n=13). Thrombosis vein segment of all patients were evaluated with duplex ultrasonography after 6 months. Radiologic findings of thrombosis disappeared in 54 patients (73%). Thrombosis segment were recanalization in 12 patients (16.4%). Thrombosis was not recovery in 7 patients (8.5%). Conclusion: If treatment and prophylaxis of deep venous thrombosis perform enough, recurrence decreases and recanalization and lysis of thrombosis increase. Eventually mortality and morbidity of cases decrease.Öğe In vitro effects of amiodarone on coronary artery bypass grafts(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2015) Karaca, Okay Güven; Ege, Turan; Canbaz, Suat; Gür, Özcan; Karadağ, Çetin Hakan; Ecevit, Ata Niyazi; Kalender, MehmetBackground: This study aims to investigate the effects of amiodarone on the most commonly used grafts, internal thoracic artery (ITA), saphenous vein (SV), and radial artery (RA) in organ bath. Methods: Twenty patients (16 males, 4 females; mean ages 58.4 +/- 9.9 years; range 38 to 80 years) who underwent isolated coronary artery bypass graft (CABG) surgery between May 2008 and October 2008 were included in this study. Internal thoracic artery, saphenous vein, and radial artery grafts were harvested. Specimens were taken to laboratory in +4 degrees C Krebs solution. Specimens were suspended in 10 ml organ bath containing Krebs solution. Results: Amiodarone caused relaxation in all grafts (ITA, RA, SV) between 10(-9)-10(-3,5) M concentration in a dose dependent manner (p<0.01). Maximum relaxation rates (mean) induced by amiodarone were 78.9%, 74.9% and 66.5% for ITA, RA and SV, respectively. Conclusion: Although we did not evaluate the endothelium-independent relaxation response in this study, higher rates of relaxation response were observed with ITA grafts comparing to other grafts, and these results were compatible with literature. According to the results of this study, amiodarone-class III antiarrhythmic agent- caused vasodilation in all three grafts in vitro. Vasodilator effect of amiodarone on grafts may help to increase patency rates.Öğe In vitro effects of lidocaine hydrochloride on coronary artery bypass grafts(Edizioni Minerva Medica, 2012) Gür, Özcan; Ege, Turan; Gürkan, Selami; Özkaramanlı Gür, Demet; Karadağ, Hakan; Çakır, Habib; Duran, E.Aim. Coronary artery bypass grafting (CABG) is one of the most common procedures performed to improve blood supply to myocardium. The characteristics of grafts, mechanical stress and pharmacological agents have substantial influence on the short and long term graft patency. Lidocaine is among the most frequently used antiarrhytlunic agents perioperatively. The aim of this study was to evaluate the in vitro effects of lidocaine on internal mammarian artery (IMA), radial artery (RA) and saphenous vein (SV) grafts. Methods. Using standard tissue bath techniques, responses to increasing concentrations of lidocaine hydrochloride were obtained, in segments of IMA, RA and SV grafts. Twenty patients were enrolled in the study with a total number of 48 grafts (16 for IMA, RA and SV grafts each). In vitro lidocaine concentrations between 10(-9)M and 10(-3.5)M were studied to represent therapeutic plasma concentration of 1.5-5 mcg/mL. Results. In IMA and RA grafts, lidocaine hydrochloride caused vasodilatation (40.5 +/- 1.9% and 39.1 +/- 2.6 % respectively) at concentrations between 10(-9) to 10(-7.5) M while causing a dose dependent vasoconstriction response at concentrations above 10(-7.5)M. In SV graft samples, lidocain hydrochloride caused vasodilatation (24.4 +/- 1.9 %) at concentrations between 10(-9) to 10(-7.5) M while causing dose dependent vasoconstriction at concentrations above 10(-7) M. For vasoconstriction effect, mean +/- SD values for E-max were calculated as: 120.1 +/- 6.6% in IMA, 83.35 +/- 5.06% in RA, and 154.0 +/- 13.8% in SV. The vasoconstriction in the SV samples was higher than in the RA and IMA. The mean SD LogEC(50) values were -5.15 +/- 0.27, -5.76 +/- 0.11 and -5.56 +/- 0.19 for SV, IMA and RA grafts respectively.) There was a statiscally significant differences in the Log EC50 values between SV, IMA and RA (P<0.005) Conclusion. Based on the results of our study, we conclude that, increasing doses of lidocaine in the perioperative period may cause vasospasm in IMA, RA and SV grafts. Thus, avoiding high doses may have a role in improving perioperative and long term mortality.Öğe Kronik böbrek yetmezlikli hastalarda hemodiyaliz amaçlı kateter uygulamalarında hasta memnuniyeti(2012) Gür, Özcan; Gürkan, Selami; Çakır, Habib; Özkaramanlı Gür, Demet; Ege, TuranAmaç: Kronik böbrek yetmezliği bulunan, renal transplant yapılamayan hastalar hemodiyaliz bağımlı olarak yaşamaktadır. Hemodiyalize giriş yolu olarak arteriovenöz şant (AV) altın standart yöntemlerdir. AV şant açılamayan ya da AV şant mevcut olup henüz olgunlaşmamış hastalarda hemodiyaliz'e girebilmek için hemodiyaliz kateterleri kullanılmaktadır. Hemodiyaliz kateterleri sıklıkla femoral, subklaviyan ve juguler venlere uygulanmakla beraber nadir olarak torakolomber yaklaşımla inferior vena kavaya da takılmaktadır. Çalışmamızda hemodiyaliz amacıyla kullanılan kateterlerin hasta memnuniyeti ve yaşam kalitesine etkilerini incelemeyi amaçladık. Yöntem: Kliniğimizde ocak 2011- mayıs 2012 yılları arasında hemodiyaliz amacıyla arteriyovenöz şant açılan ve katater takılan topla 139 hasta çalışmaya alındı. Hastalardan 91 erkek 48 kadın, yaş ortalaması 60,85 ±14,6 (min: 54, max:83) idi. Hastalar arasında demografik olarak anlamlı fark yoktu. Bu hastalar ile tek tek görülerek takılan kateter ve bölgelere göre menuniyet durumları araştırıldı. Bulgular: Takılan kataterlere bağlı olarak olguların %69.06'da herhangi bir şikayet gözlenmedi. En sık gözlenen şikayet ağrı olup olguların %17.9'da bu şikayet mevcut idi. Diğer şikayetler sırası ile %9.3 olguda görünümünden rahatsız olma ve %3.5 olguda yaşam kalitesinin olumsuz etkilenme olarak belirlendi. Komplikasyon olarak %10.7 oranında katater yeri enfeksiyonu ve %9.3 oranında katater oklüzyonu tespit edildi. Femoral bölgeye takılan kataterlerin enfeksiyon oranı %85 oranında tespit edildi. Sonuç: Kronik böbrek yetmezliği bulunan olgularda hemodiyaliz amacıyla katater takılacağı durumlarda öncelikli olarak juguler bölgenin tercih edilmesi gerektiği, juguler bölgenin uygun olmadığı durumlarda yüksek enfeksiyon oranları sebebiyle subklaviyan bölgenin ve en son seçenek olarak femoral bölgenin tercih edilmesi gerektiğini düşünüyoruz. Katater takılacak bölge ve oluşabilecek şikayetler hakkında hastaların bilgilendirilmesinin hasta memnuniyetini arttıracağı kanaatindeyizÖğe Patient Satisfaction with Hemodialysis Catheter in Patients with Chronic Renal Failure(Cukurova Univ, Fac Medicine, 2012) Gür, Özcan; Gürkan, Selami; Çakır, Habib; Özkaramanlı Gür, Demet; Ege, TuranPurpose: Patients with chronic renal failure, for whom renal transplantation is not an option, depend on hemodialysis for life. An Arteriovenous shunt is the gold standart access site for hemodialysis. In patients without an AV shunt or with an immature shunt, a hemodialysis catheter is used. Subclavian, femoral and juguler veins are common sites for hemodiaylsis catheter. Patients may have different complaints with the catheter according to the insertion site. In our study, we aimed to investigate the impact of the site of the catheter on patients' comfort and social lives. Method: Between January 2011 and May 2012, 48 women and 91 men (139 patients) who underwent AV shunt operation in our clinic. The mean age of the patients was 60.85 +/- 14.6(min:54, max:83) years. Every patient was interviewed individually about his comfort and satisfaction with the catheter. There were no statistically significant demographic differences among patients. Results: When insertion of a hemodialysis catheter is planned in patients with chronic renal failure, internal juguler vein is the optimum site and should be preferred in the first line. In cases which juguler vein is not available, subclavian vein is the next preferred site and he femoral vein, due to its high rates of infection, is the last place to choose for the insertion of a hemodialysis catheter. Conclusion: We believe that informing patients about the site of the catheter and the possible disadvantages will improve the patient satisfaction.Öğe Successful Replacement of Mitral Valve in a Patient with Antiphospholipid Syndrome(2016) Gürkan, Selami; Gür, Özcan; Gür Özkaramanlı, Demet; Arar, Makbule Cavidan; Ege, TuranElli bir yaşında mitral yetmezlik tanısı ile cerrahi tedavi için yatırılan bir hastayı sunduk. Dört yıl önce primer antifosfolipid tanısı almış ve trombositopeni hikayesi mevcut. Postoperatif titiz antikoagülan tedavi ile mitral kapak başarılı bir şekilde replase edildi ve postoperatif dönem olaysız geçti. Antifosfolipid sendromlu hastalarda kardiyak cerrahide yüksek mortalite ve morbidite oranları bildirilmiştir. Postoperatif dönemde hemen antikoagülan tedavinin başlanması trombozun önlenmesi açısından çok önemlidir.Öğe Surgical catheterization of ınferoir vena cava for emergent hemodialysis(2014) Ege, Turan; Gür, Özcan; Gürkan, Selami; Özkaramanlı Gür, DemetKronik böbrek yetersizliği olgularında, önemli tedavi seçeneği olan hemodiyaliz için arteriyovenöz fistül veya santral venöz kateterizasyon hayati önem taşır. Yeterli debi sağlayan arteriyovenöz fistülü olmayan olgularda acil hemodiyaliz için santral venöz katetere ihtiyaç vardır. Arteriyel veya venöz oklüzyonlar nedeniyle yaşanan terminal access problemlerinde son seçenek olarak vena cava inferiorun veya kalbin kateterizasyonu yapılabilir. Bu yazımızda, terminal acces problemi yaşadığımız ve cerrahi olarak vena cava inferiorun kateterizasyonunu yaparak yaşam sürelerini uzattığımız iki olguyu sunmayı amaçladık.Öğe The impact of body mass index on mortality and morbidity in patients undergoing isolated valve surgery(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2013) Gür, Özcan; Gürkan, Selami; Özkaramanlı Gür, Demet; Yüksel, Volkan; Hüseyin, Serhat; İşcan, Şahin; Ege, TuranBackground: This study aims to investigate the impact of body mass index (BMI) on early mortality and morbidity in patients undergoing isolated valve surgery. Methods: Between January 2004 and December 2012, medical records of 196 patients (115 males, 81 females; mean age 62.0 years; range 28 to 81 years) who underwent isolated valve surgery in our clinic with prospective follow-up data were retrospectively analyzed. The patients were divided into three groups according to their BMI values. Group 1 consisted of patients with a BMI <25 kg/m(2), group 2 consisted of patients with a BMI of >= 25 kg/m(2) to <30 kg/m(2) and group 3 consisted of patients with a BMI of >= 30 kg/m(2). Obesity was defined as a BMI of >= 30 kg/m(2). Groups were compared in terms of morbidity parameters including bleeding, respiratory, renal, neurological and sternal complications and in-hospital mortality. Results: Increased BMI was associated with increased diabetes prevalence and use of bronchodilator. According to postoperative data, there was no significant difference in duration of extubation, postoperative renal functions, neurological complications such as stroke and transient ischemic attack, length of intensive care unit or hospital stay among three groups. Obese patients in group 3 had significantly higher rates of respiratory complications including re-intubation (p=0.011) and postoperative bronchodilator need (p=0.034), sternal dehiscence and sternal infections (p=0.023) and in-hospital mortality (p=0.021). The bleeding complications were significantly higher in group 1 (p=0.004). Conclusion: Our study results suggest that obesity results in increased 30-day mortality and several morbidity parameters such as respiratory and sternal complications in patients undergoing isolated valve surgery.Öğe Unexpected etiology in pericardial effusion: Malignant fibrous histiocytoma: Case report(2013) Hüseyin, Serhat; Yüksel, V.; Gürkan, Selami; Gür, Özcan; Ege, TuranAlthough malignant fibrous histiocytoma is the most widely seen malignant soft tis sue tumor in adults, mediastinal localizations are uncommon. In this report, we aimed to present a patient admitted to hospital with complaints of hypotension, vertigo, arrhythmia and operated under emergency conditions for severe paericardial effusion leading to right atrial collapse and di agnosed as malignant fibrous histiocytoma. Copyright © 2013 by Türkiye Klinik leri.Öğe Vasodilation Responses to Non-Selective alpha-Adrenergic Blockage of Coronary Bypass Grafts in Diabetic and Non-Diabetic Patients: in Vitro Study(Medical Tribune Inc, 2015) Gürkan, Selami; Gür, Özcan; Özkaramanlı Gür, Demet; Göçmez, Semil Selcen; Ege, TuranBackground: Adrenergic tonus is increased in atherosclerotic coronary arteries. In this study, we aimed to demonstrate in vitro effects of phentolamine, a reversible nonselective alpha (a) adrenergic blocker, on coronary artery bypass grafts (CABG) and compare its effects in diabetic and nondiabetic patients. Methods: A total number of 30 patients (15 diabetic and 15 nondiabetic) who were assigned to elective CABG surgery were enrolled into the study. For both groups of patients, 16 internal mammarian artery (IMA) samples, 16 saphenous vein (SV) samples and 16 radial artery (RA) samples were collected and studied in the tissue bath system. The vasodilatation responses to increasing doses of phentolamine were recorded. Results: When grafts were compared in terms of amount of vasodilatation to phentolamine, IMA had the most prominent vasodilatation followed by RA and SV respectively. Although the vasodilatation responses in nondiabetic patients were numerically higher than diabetic patients, there was no statistically difference between the groups. Conclusion: Phentolamine, a nonselective a adrenergic blocker, is proven to have equal vasodilatory effects in diabetic and nondiabetic CABG grafts and can safely be used both intravenously and topically in the perioperative period.
