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Öğe Impact of a supervised pulmonary rehabilitation program on postoperative dyspnea in patients undergoing cardiac surgery(BAYRAKOL MEDICAL PUBLISHER, 2022) Esen, Osman; Özcanoğlu, Hatice DilekAim: This prospective study aimed to analyze the impact of postoperative in-hospital pulmonary rehabilitation on pulmonary outcomes in patients who underwent cardiovascular surgery. Material and Methods: This study was carried out on subjects who underwent cardiovascular surgery and were scheduled for a supervised pulmonary rehabilitation program following the cardiac surgery in our institute. The BORG scale of perceived exertion, a 100 points VAS scale for the severity of perceived dyspnea, and Respiratory Distress Assessment Instrument (RDAI) score were applied before and after completion of pulmonary rehabilitation program. Dyspnea, orthopnea, tachypnea, anxiety, cough and presence of sputum were also recorded prior to and subsequent to pulmonary rehabilitation. Blood gas analysis was also carried out before and after pulmonary rehabilitation. Results: BORG scale score (1.89 +/- 0.07 vs. 1.21 +/- 0.05, p=0.001), VAS scale scores for dyspnea (5.7:0.4 vs. 8.5:0.8, p<0.001), and RDAI scores (4.2 +/- 0.5 vs. 7.8 +/- 1.2, p<0.001) improved significantly following pulmonary rehabilitation. The prevalence of dyspnea and tachypnea also reduced following pulmonary rehabilitation. No significant change was observed in blood gas analysis results. Discussion: Application of a supervised pulmonary rehabilitation program including removal of bronchial secretions, postural drainage, percussion, vibration and aspiration and patients positioning improves self-reported dyspnea in patients who underwent cardiac surgery.Öğe Comparison of tap block and epidural block in gynecologic oncology surgeries(BAYRAKOL MEDICAL PUBLISHER, 2022) Aydın, Nevin; Esen, Osman; Ateş, HaticeAim: Transversus abdominis plane (TAP) block and epidural analgesia may be helpful in relieving pain after surgical procedures in gynecological malignancies. In this retrospective cohort study, it was aimed to compare the analgesic efficacy of TAP block and epidural block in patients operated for gynecological malignancy. Material and Methods: Medical files of 74 patients who underwent surgery for gynecological malignancy were retrospectively reviewed. All patients underwent gynecologic surgeries. Group I (n=25) received epidural analgesia, Group II (n=25) TAP block, and Group III (n=24) received no additional analgesic procedures. Baseline descriptors, visual analog scale for pain, Ramsay sedation score, operation and ICU length of stay, need for additional medication, and gastrointestinal symptoms were compared between groups. Results: The level of pain relief, hemodynamic and respiratory parameters in the 3 operated groups were mostly similar. In patients <55 years of age, the Ramsay sedation scale was significantly higher 12 hours after surgery. In these patients (<55 years), additional drug use was needed more at the 12th hour. VAS scores at theist (p=0.024) and 2nd (p=0.004) hours were also higher in patients with a body mass index of >25. Discussion: Our results showed that TAP block and epidural analgesia provide safe and effective methods for postoperative analgesia in gynecological malignancies.Öğe Impact of leg wrapping in combination with leg elevation on postspinal hypotension in subjects undergoing elective cesarean section under spinal anesthesia(BAYRAKOL MEDICAL PUBLISHER, 2021) Esen, Osman; Balcı, Canan; Sargın, Mehmet Akif; Erdivanlı, BaşarAim: This study aimed to compare the efficacy of lower extremity wrapping with elastic bandages in conjunction with leg elevation to leg elevation alone in terms of maternal systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, and SaO2 in term mothers undergoing elective cesarean section (CS) with spinal anesthesia. Material and Methods: A series of 62 term mothers aged between 20 and 45 years who were scheduled for elective CS under spinal anesthesia were enrolled in the study. Using sealed envelopes, participants were allocated to one of two study groups: the wrapping group (n=30) or the control group (n=32). All subjects received volume administration of lactated Ringer's solution of 10 mL/kg over the 15 min prior to the administration of the spinal block. Subjects allocated to the wrapping group received lower extremity wrapping with 10-cm Esmarch elastic bandages applied from the ankle to the mid-thigh immediately before the administration of the subarachnoid block. Following intrathecal injection, lower limbs were elevated 20 degrees in subjects allocated to the wrapping group by tilting the foot-end of the operating table. Systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, and SaO2 were monitored intraoperatively. Results: Systolic, diastolic, and mean blood pressures were significantly higher in the wrapping group compared to the control subjects beginning from the 2nd minute of the intrathecal injection to the 20th-30th minute of the intrathecal injection. The median ephedrine dose was significantly higher in the control group than the wrapping group [15 (0-40) mg vs. 5 (0-30) mg, p=0.007]. Vomiting was also more frequent in control subjects compared to those receiving lower extremity wrapping and leg elevation (18% vs. 0%, p=0.024). Discussion: Lower extremity wrapping in combination with leg elevation provides a better hemodynamic profile than volume administration alone in subjects undergoing elective CS under spinal anesthesia. Subjects receiving lower extremity wrapping and leg elevation require less vasopressors and experience less vomiting compared to subjects receiving only volume administration.Öğe Ultrasonographic evaluation of flap thickness in patients with pilonidal sinus-original article(2018) Dikicier, Enis; Altıntoprak, Fatih; Uzunoğlu, Mustafa Yener; Arslan, Yusuf; Asil, Kıyasettin; Zengin, İsmailAim Various risk factors have been defi ned for recurrence in pilonidal disease. This study was designed to investigate the local subcutaneous tissue thickness in patients who were operated on for sacrococcygeal pilonidal disease. ( Sakarya Med J 2018, 8(3):505-510) Methods Ninety-eight patients who had been operated in General Surgery Clinics of Sakarya University Research and Educational Hospital on with the diagnosis of pilonidal sinus were retrospectively evaluated between January 2008 and January 2014. In evaluation of the fl ap thickness, the nearest and farthest margins were measured by ultrasonography between the skin and sacrum.This is a cross-sectional and descriptive study and local ethics approval was obtained from Sakarya University Medical School Results Resection and primary closure and Limberg fl ap transposition were performed in 46 (46.9%) and 52 (53.1%) patients, respectively. Mean fl ap thickness was found to be 17.2 mm (range: 3.9 - 36.4) and 20.5 mm (range: 4.0 - 42.3) in the primary repair group and the Limberg group, respectively. The recurrence rate was 10.8% in the primary repair group, 3.8% in the Limberg group at a mean of 27.1 months (range: 12-54 months) of follow-up. Conclusion Subcutaneous tissue thickness in the place of surgery was greater in patients with the Limberg fl ap procedure compared to the patients with primary closure in pilonidal sinus disease. Flap thickness may be a parameter that can be used to predict the possibilty of recurrenceÖğe Nanoteknoloji ve nanonöroşirürji(2018) Kiraz, Murat; Çevik, Serdar; Demirel, Altan; Gergin, Yusuf Emrah; Ozdemir, OmerNanoteknoloji atomların farklı dizilişleriyle; üretim tekniklerinde yenilik yapmak ve ihtiyaca uygun üstün özellikli yeni ürünler geliştirmektir. Nanonöroşirürji ise nanoteknoloji ile kombine hücresel ve moleküler biyoloji kullanılarak, merkezi ve periferik sinir sisteminin, hücre ve mikrohücre düzeyinde nano ölçekli manipülasyonu olarak tanımlanır. Nanoteknoloji, mevcut görüntüleme modalitelerinin çözünürlüğünün ve duyarlılığının artırılmasında, beyin tümörlerinin tedavi planlamasında, özellikle de glioblastoma gibi malign neoplazmlar ile ilgili mevcut yaklaşımın değiştirilmesinde, omurga hastalıklarının tedavisinde yeni yapısal destek ve enfeksiyon oranlarının azaltılmasını amaçlayarak gelişmeye devam etmektedir. Ayrıca nöral doku mühendisliği açısından, nano malzemeler nörorejenerasyon sürecini yönlendirebilecek niteliktedir. Nanoteknoloji, hücresel ve moleküler düzeye müdahaleyi kolaylaştırarak nöroşirürjiyi değiştirme gücüne sahiptir. Bu derleme yazısında, gelişmekte olan nanoteknoloji tekniklerinin nöroşirürji ile ilgili potansiyel önemi değerlendirildi.Öğe Evaluation of videodermoscopic features of chemotherapy induced alopecias(Ortadogu Reklam Tanitim Yayincilik Turizm Egitim Insaat Sanayi ve Ticaret A.S., 2020) Karadağ Köse, Özlem; Akosman, Cengiz; Borlu, Murat M.Amaç: Kemoterapiyle indüklenen alopesi, onkoloji hastalarında psikososyal açıdan kanser tedavisinin en yıkıcı bulgularından bir tanesidir. Bu çalışmada, kemoterapiyle indüklenen alopesilerin değerlendirilmesinde videodermoskopik incelemenin yerinin belirlenmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya, kemoterapi alan ve klinik inceleme sonrası kemoterapiyle indüklenen alopesi tanısı konan ardışık 41 hasta dâhil edildi. Hastaların yaş, cinsiyet, deri fototipi, malignite tanısı, tedavi protokolündeki kemoterapi ajanları ve alopesinin yaygınlığı kaydedildi. Trikoskopik fotoğraflar X30-X50’lik büyütmeler ile elde edildi. Literatürdeki yayınlar ile oluşturulan kontrol listesine göre trikoskopik bulgular incelendi. Bulgular: Foliküler bulgulardan olan saç çapı değişkenliği hastaların tümünde saptandı. Siyah nokta %78, sarı nokta %75,6, kırık saç %51,2, Pohl-Pinkus %46,3, ünlem işareti saçlar ve alev figürleri %26,8 oranında izlendi. İki renkli, kısa vellus ve moniletrix-benzeri saçlar %22, domuz kuyruğu ve incelen saç %19,5, lale saç %14,6 ve zig zag saç ise %9,8 oranında görüldü. Daha nadir izlenen diğer bulgular V saç %7,3, virgül saç, peripilar bulgu ve boş folikül ise %4,9 oranında idi. Nötrofil benzeri saç (%7,3) ilk kez tanımlandı. Sonuç: Kemoterapi ile indüklenen alopesilerde zig zag saç, lale saç ve V saç yeni trikoskopik bulgulardı. Nötrofil benzeri saçlar ise ilk kez bu çalışmada tanımlandı. Kemoterapiyle indüklenen alopesilerin dermoskopisi, alopesi areata ve trikotillomani ile bazı benzer bulgular göstermektedir.Öğe Tension pneumocephalus after endoscopic paranasal sinus surgery(Aves Press Ltd, 2017) Çevik, Serdar; Yuksel, Ulas; Hanimoglu, HakanTension pneumocephalus (TP) which produces increased intracranial pressure and leads to neurological deterioration is a rare but life-threatening complication. A 59-year-old male patient who had undergone endoscopic sinus surgery was admitted to the emergency room with severe headache, nausea, and vomiting. Cranial computed tomography revealed pneumocephalus. Endoscopic surgery under general anesthesia was performed again, and a dural tear at the crista galli was identified and repaired using an autograft and fibrin glue. In same session, burr-hole drainage was also performed. He recovered after few days and was discharged. Therefore, following endoscopic sinus surgery, surgeons should be aware of the development of pneumocephalus, a rare but life-threatening complication.Öğe Traumatic isolated brain stem hematoma: a case report presenting with hemiparesis(Aves Press Ltd, 2018) Çevik, Serdar; Yuksel, Ulas; Ogul, Hayri; Şengül, GoksinIsolated brain stem hemorrhages are rare but have a high mortality rate after blunt head trauma. 56-year-old male admitted to the emergency room with weakness on the right side of his body, one day after the blunt head trauma. Right hemiparesis which is near to plegia (lower extremity motor weakness level was higher than upper extremity) was found on his neurological examination. T2-weighted images and susceptibility weighted images (SWI) of the magnetic resonance revealed heterogenous hyperintense lesion with hemorrhage at the left side of the pons. The patient was managed with conservative treatment; at three-month follow-up, near total recovery was observed on his neurological examination. As a conclusion, it could be said that brain stem contusion with hemorrhage could be kept in mind in patient with hemiparesis if the neurological deficit of the patient cannot be explained by supratentorial or spinal cord lesions.Öğe Analysis of denver neurodevelopmental screening test results of myelomeningocele, hydrocephalus, and microcephaly patients(Medknow Publications & Media Pvt Ltd, 2018) Alataş, İbrahim; Canaz, Gökhan; Arslan, Gülseren; Çevik, Serdar; Kaçmaz, Belgü; Kara, Nursu; Canaz, HuseyinContext: Spina bifida, hydrocephalus, and similar congenital central nervous system (CNS) anomalies take origin from embryologic stages weeks before birth, but assessment and follow-up of these patients are important to figure and predict the effects of these anomalies on child's neurodevelopment. Aims: To evaluate of multiple groups of congenital CNS anomalies in the neurodevelopment level. Settings and Design: The study was conducted at a research and treatment center for spina bifida patients. Materials and Methods: The study group included 348 patients with a mean age of 15.4 (+/- 15.1) months, who had spina bifida aperta, hydrocephalus, and microcephaly. Patients with other known intracranial conditions were excluded. The subjects were evaluated into five groups: Group 1, 88 patients with congenital hydrocephalus; Group 2, 48 patients with congenital hydrocephalus and ventriculoperitoneal shunt; Group 3, 148 patients with microcephaly; Group 4, 30 patients who were operated for spina bifida aperta; and Group 5, 39 patients who were operated for spina bifida aperta and also had ventriculoperitoneal shunt implantation. Denver Developmental Screening Test II was used to assess patients' neurodevelopment levels. Statistical Analysis Used: Pearson's chi-square and Fisher's exact tests were used for data analysis. Group comparisons were also made in pairs with chi-square test according to Bonferroni corrections. Frequency of abnormal findings was significantly correlated with age (P = 0.014). Results: Total score differences of five groups appeared to be statistically significant according to Pearson's chi-square test (P = 0.000). When we compared groups in pairs, abnormal results were significantly frequent in shunted groups (P < 0.01). Conclusions: Our results suggested that shunt-dependent hydrocephalus caused serious neurodevelopmental impairments in patients.Öğe The relationship of erythropoietin receptor expression and prognosis in glioblastoma multiforme patients(Wolters Kluwer Medknow Publications, 2018) Çevik, Serdar; Kitis, S.; Evran, S.; Akkaya, E.; Tosuner, Z.; Hanimoglu, H.Background: Glioblastoma multiforme (GBM) is the most common primary brain tumor characterized with poor prognosis and short survival. In addition to the standard treatment protocols, targeted molecular treatment options are under trial. In the recent trials, erythropoietin and erythropoietin receptor were found to be linked with the progression of GBM cells. Aim: In this study, we compared the expression of EPOR with survival in GBM patients with mortality. Materials and Methods: Twenty-six patients operated for GBM in 2012u2014 were enrolled in this study. Tumor tissues were stained with EPOR, epidermal growth factor receptor, vascular endothelial growth factor, and assigned as (1+), (2+), and (3+) according to their immunohistochemical staining levels. The average postoperative follow-up time was 9.3 months. KaplanuMeier's survival test and Spearman's correlation test were used in statistical analysis. Results: EPOR 1(+) stained group showed a median survival of 8 months (95% confidence interval [CI]: 0.954u15.046). EPOR 2(+) stained group showed a median survival of 6 months (95% CI: 2.901u9.090) EPOR 3(+) stained group showed a median survival of 2 months (95% CI: 0.400u3.600). (KaplanuMeier P = 0.002). Conclusion: These results portrayed that EPOR staining levels were inversely proportional with average survival time. In the future, specific inhibitors of this molecule could be used to form a novel treatment option for GBM.Öğe Stump appendicitis: a retrospective review of 3130 consecutive appendectomy cases(Biomed Central Ltd, 2018) Dikicier, Enis; Altıntoprak, Fatih; Özdemir, Kayhan; Gündoğdu, Kemal; Uzunoğlu, Mustafa Yener; Çakmak, Güner; Onuray, Feyyaz; Çapoğlu, RecaiBackground: Stump appendicitis is inflammation of remnant appendix tissue due to incomplete removal of the appendix. Due to appendectomy history, stump appendicitis diagnosis is usually delay and that can cause increase morbidity. Methods: Medical records of patients who had surgery for acute appendicitis at a single center from 2008 to 2017 were retrospectively reviewed. During the evaluation of medical records, patients that had a previous operation for acute appendicitis or had "stump appendicitis" as an exploratory finding in operation notes were included. Results: Appendectomy was performed in 3130 patients (2630 open surgeries and 380 laparoscopic surgeries). Stump appendicitis was diagnosed in five patients (0.15%). The appendectomies had been performed 4, 5, 7, 7, and 11 years previously. Mean time taken for surgery was 36 h after symptoms began. Open surgery was performed in three patients, laparoscopic procedures in others. Conclusion: Awareness of stump appendicitis before radiological examinations may facilitate accurate diagnosis and decrease the duration of the decision-making process, leading to decreased morbidity.Öğe Treatment results of small bowel perforations due to unusual causes(Professional Medical Publications, 2018) Uzunoğlu, Mustafa Yener; Altıntoprak, Fatih; Dikicier, Enis; Zengin, İsmailObjectives: Although non-traumatic Small Bowel Perforations (SBPs) are rare, they have high rates of morbidity and mortality in case of late presentation. Aetiological factors vary across different geographical regions. In this paper, SBPs caused by anything other than trauma and other well-known causes are presented and the current literature is reviewed. Methods: The study was conducted at General Surgery Clinics of two different tertiary university hospitals between January 2008 and September 2016. The authors directly involved in managing the patients. This study was approved by the ethical institutional board and was performed at the Department of General Surgery, School of Medicine, Sakarya University. The medical records of patients retained in both hospitals are electronic. Medical records of subjects who had undergone emergency operations with a prediagnosis of acute abdomen in single center, and were determined to have SBPs due to unusual causes, were investigated retrospectively. Patients with aetiological factors such as trauma, mesenteric vascular disease, internal and external hernias, intra abdominal adhesions, inflammatory bowel diseases, and iatrogenic causes were excluded. Results: In total, 35 patients were evaluated, 20 (57.1%) males and 15 (42.9%) females. The mean age of the cases was 51.6 (18-88) years. Mean time until admission at the hospital was 1.4 days (range 0.25-7 days). The most frequent aetiological factors were various malignancies (10 cases, 28.5%) and perforation of Meckel's diverticulum (8 cases, 22.8%). It was surprising to detect a considerable rate of perforation due to bezoars (6 patients, 17.1%). Conclusions: Post-operative consequences of SBPs due to unusual causes are similar with those related to common, known causes. Factors affecting the clinical course are presentation time and patients' clinical status in admission, not aetiology.Öğe Multiple gastritis cystica profunda in a patient without gastric surgery history(Acad Medical Sciences I R Iran, 2018) Dikicier, Enis; Altıntoprak, FatihGastritis cystica profunda (GCP) is a rare condition characterized by polypoid cystic ectasia of the submucosal layer with cystic dilatation of the glandular structures of the stomach. The probable pathogenesis refers to degradation of the integrity of the muscularis mucosa and migration of epithelial cells to the submucosal layer. The most common cause known in the literature for this occurrence is previous stomach surgery. A case presented with two GCP lesions in different locations in the stomach without any history of previous surgery.Öğe Torakolomber bileşke disk herniasyonlarının cerrahi tedavisinde posterolateral transkambin yaklaşım(Istanbul Univ, Fac Medicine, Publ Off, 2020) Can, Halil; Diren, FurkanAmaç: Torakolomber bileşke disk herniasyonlarının (TLBDH) tedavisi için optimal cerrahi yaklaşım biçimi halen tartışmalıdır. TLBDH’nın güncel cerrahi tedavisinde anterolateral retroperitoneal, anterior transtorasik, posterolateral, lateral ve transforaminal endoskopik yaklaşımlar uygulanmaktadır. Posterolateral transkambin yaklaşımda, pars interartikülaris ve faset ekleminden minimal kemik alınarak, instabiliteye yol açmadan diskektomi ile dekompresyon sağlanmaktadır. Transkambin yaklaşımın, ileri düzeyde nöral doku retraksiyonu olmaksızın diskektomi yapılabilmesi, iyileşme süresinin kısa olması ve postoperatif komplikasyonların daha az görülmesi gibi avantajları vardır. Yöntemler: Kliniğimizde 2016-2018 tarihleri arasında posterolateral transkambin yaklaşım ile ameliyat edilen 3’ü T12-L1 ve 5’i L1-2 TLBDH’lı 8 hasta retrospektif olarak sunuldu. Çalışmamıza far lateral, foraminal ve paramedian uzanım gösteren, klinik olarak kauda ekuina sendromu, konus medüllaris sendromu ve radikülopatiye neden olmuş, ekstrüde veya sekestre disk hernili hastalar dahil edildi. Hastalarda cilt insizyonu ve fasyanın açılışı orta hattan yapıldı. Paravertebral adeleler subperiostal sıyrılarak pars lateralinde çıkan kök açığa konulup sekestre veya ekstrüde disk fragmanlarının alınması hedeflendi. Bulgular: Hastaların 3’ü erkek, 5’i kadın ve ortalama yaşı 45,1 (32- 66) olarak saptandı. Ortalama operasyon süresi 57,8 dakikaydı. Preoperatif VAS değerleri 8,75±0,51, postoperatif VAS değerleri 1,25±0,65 saptandı. MacNab klasifikasyonuna göre postoperatif 6 ay sonraki sonuçları; %62,5‘i mükemmel, %25’i iyi, %12,5’i vasat olarak bulundu. Hastalarda nörolojik hasar, beyin omurilik sıvısı (BOS) fistülü, pnömotoraks ve operasyon lojunda hematom gelişmedi.Öğe Massive primary intraventricular hemorrhage due to idiopathic lateral posterior choroidal artery aneurysm: case illustration(Elsevier Inc., 2018) Bozkurt, Gökhan; Yaman M.E.; Çevik, Serdar; Kırbaş İ.; Yağmurlu B.Peripheral aneurysms of the lateral posterior choroidal artery are rare and mostly in association with vascular and occlusive pathologies such as moyamoya disease. To the best of our knowledge, pure lateral posterior choroidal artery aneurysms without association of any other vascular diseases are unique and only 3 cases have been reported in the literature. © 2017 Elsevier Inc.Öğe Effects of modic type 1 changes in the vertebrae on low back pain(Elsevier Inc., 2019) Hanımoğlu H.; Çevik, Serdar; Yılmaz H.; Kaplan A.; Çalış F.; Katar S.; Evran, Ş.; Akkaya, E.; Karaca O.Objective: The present study examined the physical extent of Modic type 1 (MT1) changes and other phenotypic magnetic resonance imaging (MRI) findings in the vertebrae of patients with low back pain (LBP) and MT1 changes. We also identified any correlations of these findings with the severity of pain and the Oswestry Disability Index (ODI). The relationship between the presence of pain and MT1 changes has been examined in several studies. However, to the best of our knowledge, no study has assessed the relationships between pain severity and ODI and the total vertebral area of MT1 involvement. Methods: After excluding any patient with MT2 or MT3 changes, 49 patients with a diagnosis of LBP and MT1 changes demonstrated on MRI were included. MT1 involvement area, disc height, number of Schmorl's nodes, disc degeneration (Pfirrmann grade), and cross-sectional area of the lumbar muscles were obtained via MRI. Additionally, patient demographic data, body mass index, physical activity level, and disability (ODI) scores were assessed. Results: The total vertebral area of MT1 involvement correlated significantly and positively with the ODI (P = 0.001). In the multivariate linear regression model, with ODI as the dependent variable and age, mean Pfirrmann grade, total vertebral area of MT1 involvement, and sex as independent variables, only the total vertebral area of MT1 involvement was significantly associated with the ODI. Conclusions: A significant positive correlation was noted between the vertebral MT1 involvement extent and changes in the ODI. Other MRI features of patients with LBP were not related to pain severity or ODI. © 2018 Elsevier Inc.
