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Öğe Acute thrombosis of inferior vena cava in a pregnant woman presenting with sciatica: A case report(SPRINGER, 2005) Gormus, N; Ustun, ME; Paksoy, Y; Ogun, TC; Solak, HA 20-year-old pregnant woman was admitted to our department with symptoms of deep venous thrombosis in the left lower extremity and excessive lumbar pain. Low-molecular-weight heparin was administered. She recovered with this treatement, however, severe lumbar pain continued. A lumbar magnetic resonance imageg showed dilated epidural veins compressing the roots and acute thrombosis of the inferior vena cava extending to renal veins. During the same period she had acute deep venous thrombosis in her right leg. An urgent venous thrombectomy was performed. Sciatica and deep venous thrombosis resolved after the operation. Low-molecular-weight heparin was administered until the end of her pregnancy.Öğe The cerebroprotective effects of pentoxifylline and aprotinin during cardiopulmonary bypass in dogs(ARNOLD, HODDER HEADLINE PLC, 2004) Durgut, K; Hosgor, K; Gormus, N; Ozergin, U; Solak, HObjective: The purpose of this study was to investigate the cerebroprotective effects of pentoxifylline (PNX) and aprotinin in dogs using cardiopulmonary bypass (CPB). Materials and methods: Eighteen clinically healthy dogs were divided into three groups: Group 1 ( control, n = 6), Group 2 (PNX, n = 6), and Group 3 (aprotinin, n = 6). PNX was administered at a dose of 300 mg/day in Group 2 three days before the operation and during the operation. Half a million IU aprotinin were added to the prime solution and 500 000 IU were transfused via a central venous jugular catheter preoperatively in Group 3. Blood samples were taken from the central jugular vein before and after CPB and interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), and S100beta protein were measured. Gliosis was investigated histopathologically in cerebral cortex biopsy samples under light microscopy. Results: The preoperative results of IL-6, TNF-alpha, and S100beta protein values were found to be significantly higher (p < 0.001) when compared with postoperative values. This significant difference was observed in the same parameters between Groups 1 and 2, and 1 and 3 (p < 0.001). There was no significant difference between Groups 2 and 3. Comparison between pre- and postoperative levels of IL-6 and TNF-alpha for Group 2 and Group 3 revealed statistically significant differences (p < 0.001), whereas S100β protein levels did not. Histopathological examinations showed significant differences between the control group and PNX and aprotinin, and between aprotinin and PNX groups (p < 0.001). Conclusion: PNX and aprotinin might be useful in order to reduce postoperative cerebral damage in patients undergoing cardiac surgery with CPB.Öğe Circulating leptin, zinc, and copper levels after extracorporeal circulation(MAGHIRA & MAAS PUBLICATIONS, 2005) Gormus, ZI; Gormus, N; Baltaci, AK; Halifeoglu, I; Mogulkoc, ROBJECTIVE: The role of leptin in the acute stress response to extracorporeal circulation has been well documented, however, the relationship between leptin and zinc has not been investigated previously. We aimed to research the circulating leptin, zinc, and copper levels before, during, and after the extracorporeal circulation, and effect of preoperative zinc administration to these. METHODS: Twenty patients who were taken to elective coronary artery bypass grafting operations using extracorporeal circulation were taken to this research and divided into two equal groups (n(1), n(2)). In both groups blood samples were taken just before the operation (T0), at the end of operation (T1), and at the first postoperative day (T2). In the second group (n(2)) oral zinc (50 mg, once a day) was administered to patients for 5 days, preoperatively. The serum leptin, zinc, and copper levels were studied. RESULTS: In group n(1) circulating leptin levels were significantly increased at T2 when compared to T0 and T1 (p < 0.05); zinc levels were decreased at T2 when compared to T0 and T1 (p < 0.05); copper levels were decreased at T2 when compared to T0 (p < 0.05), and decreased at T1 when compared to T0 (p < 0.05). In group n(2) circulating leptin levels were significantly increased at T2 when compared to T0 and T1 (p < 0.05); zinc levels were decreased at T2 when compared to T0 and T1 (p < 0.05); copper levels were increased at T2 when compared to T1 (p < 0.05). CONCLUSIONS: These results indicate that circulating leptin levels increase after the extracorporeal circulation as an acute response, while zinc and copper levels decrease at the same period. Preoperative zinc administration does not prevent the leptin response after extracorporeal circulation.Öğe The clinical and surgical features of right-sided intracardiac masses due to echinococcosis(SPRINGER-VERLAG, 2004) Gormus, N; Yeniterzi, M; Telli, HH; Solak, HRight-sided cardiac echinococcosis shows special clinical and surgical features beyond the rareness of echinococcosis in this position, leading to serious and life-threatening complications. We examined our cardiac hydatid cyst patients, retrospectively, and report our experience of the surgical treatment of right-sided cardiac hydatid cysts. Between 1985 and 2000, seven patients were transferred to our department from the cardiology department with a diagnosis of cystic cardiac masses which were highly suspected of being hydatid cysts. Two were males and 5 were females. In 3 patients the hydatid cyst was located in the right ventricle, and one was in the right atrium. The mean age of the patients was 37 years (ranging from 12 to 60 years). One patient had preoperative pulmonary emboli. In all right-sided cardiac echinococcosis patients, cardiopulmonary bypass was used. All cysts were cleaned after quilting the cystic cavities, and daughter cysts were removed carefully. The cavities were closed with purse-string sutures. Postoperatively, one patient had pulmonary emboli. In all patients, mebendazole was administered postoperatively. When a right-sided cardiac hydatid cyst is diagnosed, early surgical treatment should be performed under open-heart surgery conditions. During the operation, a single cannula in the superior vena cava should be used until fibrillation, and after clamping, the cannula for the pulmonary artery inferior vena cava should be inserted.Öğe Effect of off-pump and on-pump coronary artery bypass grafting on renal function(TAYLOR & FRANCIS LTD, 2005) Celik, JB; Gormus, N; Topal, A; Okesli, S; Solak, HBackground. Coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) has the risk of renal dysfunction. The cause of renal dysfunction after CPB is multifactorial, such as nonpulsatile flow, renal hypoperfusion, hypothermia, and duration of CPB. This study compared off-pump technique with on-pump technique on renal function in patients who underwent CABG. Methods. Sixty patients with normal preoperative renal functions undergoing CABG were randomly assigned to conventional revascularization with CPB (on-pump) or beating heart revascularization (off-pump). Renal functions were assessed up to 10 days postoperatively. Results. Creatinine clearance was found to be significantly higher in the off-pump group than in the on-pump group (p <.05). The off-pump group had significantly less increase in creatinine levels when compared with the on-pump group (p <.05). The free water clearance values decreased similarly in both groups; however, the recovery was more prompt in the off-pump group (p <.05). No significant differences were found in the prevalence of postoperative hemodialysis. Conclusion. The off-pump technique may provide a positive contribution and sufficient protection on postoperative renal functions in patients undergoing CABG.Öğe Epidural venous plexus enlargements presenting with radiculopathy and back pain in patients with inferior vena cava obstruction or occlusion(LIPPINCOTT WILLIAMS & WILKINS, 2004) Paksoy, Y; Gormus, NStudy Design. In the last 2 years, we have examined 9640 patients experiencing back pain or sciatica, using MRI. There were 13 (0.13%) patients who had radicular symptoms that clinically mimicked lumbar disc herniation or spinal stenosis. All of these patients had inferior vena caval obstruction or occlusion that caused engorgement in the epidural and paravertebral venous system, causing nerve root compression. Objective. To illustrate the imaging characteristics of 13 patients with epidural engorged veins due to inferior vena cava obstruction or occlusion causing sciatica and low back pain. Summary of the Background Data. Abnormalities or pathological changes of epidural venous network may give rise to symptoms similar to or mimicking lumbar disc herniation or spinal stenosis. Multiple lumbar epidural varices can cause nerve root and thecal sac compression. Lumbar epidural varices have been infrequently described in the literature. To date, the cause of anterior epidural venous enlargement has been poorly understood, and both congenital and acquired causes have been proposed. This report describes enlarged epidural veins in patients with inferior vena caval thrombosis or obstruction presenting with radicular syndromes. Methods. The authors have seen 13 patients with radicular symptoms. All of the patients had inferior vena caval obstruction or occlusion that caused engorgement in the epidural veins, causing nerve root compression. The ages of these patients ranged from 20 to 53 ( mean, 30) years. All of the patients were examined with color Doppler ultrasonography and magnetic resonance scanner. Results. Ten of 13 patients had inferior vena cava thrombosis located just under the renal vein orifices. In two patients, there was compression to inferior vena cava due to parity. In the remaining patient, a huge intra-abdominal mass was observed, and this mass was causing inferior vena cava obstruction and invasion. Enlargements of epidural venous plexus were demonstrated in all of these cases. All of the patients presented with the acute onset of low back pain followed shortly thereafter by acute radicular symptoms. The compression to inferior vena cava could not be treated in one patient because of intra-abdominal malignancy. The remaining 12 patients with inferior vena cava obstruction or occlusion experienced complete resolution of symptoms after treatment or delivery. Conclusion. The authors believe that epidural venous engorgement should be considered when the symptoms of patients with deep venous and inferior vena cava thrombosis are accompanied by radicular and/or back pain, because pathologic processes compressing a nerve root can cause pain.Öğe Lemierre's syndrome associated with septic pulmonary embolism: A case report(SPRINGER-VERLAG, 2004) Gormus, N; Durgut, K; Ozergin, U; Odev, K; Solak, HAn 18-year-old female patient suffering from a painful right-sided neck mass was admitted to our emergency service. Computed tomography of the neck revealed thrombosis of the right internal jugular vein. Computed tomography of the chest indicated septic pulmonary emboli in both lungs. Blood and oropharyngeal cultures showed proteus that was sensitive to cefepime and amicasin. Chemotherapy was administered for 12 days, however, her complaints continued with fulminant progression. An urgent decompression and excessive debridement were performed. Although Lemierre syndrome is a well-known cause of internal jugular vein thrombosis, association with proteus culture is very rare.Öğe Methylprednisolone prevents inflammatory reaction occurring during cardiopulmonary bypass: effects on TNF-alpha, IL-6, IL-8, IL-10(SAGE PUBLICATIONS LTD, 2004) Celik, JB; Gormus, N; Okesli, S; Gormus, ZI; Solak, HObjective: This study examined the correlation between tumour necrosis factor-alfa (TNF-alpha), interleukin (IL)-6 and IL-8, IL-10 and methylprednisolone pretreatment. Methods: This is a prospective, randomized and double-blinded study. Sixty patients undergoing coronary artery bypass grafting (CABG) were randomized to receive either intravenous methylprednisolone (n = 30, Group M) or intravenous placebo (n = 30, Group S). The patients received intravenously either 30 mg/kg methylprednisolone ( Group M) or placebo (Group S) 10 min before and after cardiopulmonary bypass (CPB). In an intensive care unit (ICU), four additional doses were given at 6-hourly intervals. Blood samples for the measurements of TNF-alpha, IL-6, IL-8 and IL-10 were obtained before induction of anaesthesia (T0 = control value), after induction (T1), before starting CPB (T2), after aortic declamping (T3), at the end of CPB (T4) and 6 hours (T5), 12 hours (T6) and 24 hours (T7) after skin closure. Creatine kinase (CK) and creatine kinase isoenzyme MB (CK-MB) were evaluated at the following intervals: T0, T5, T6 and T7. Results: When compared with the control value, TNF-alpha, IL-6 and IL-8 significantly increased in Group S and Group M (p < 0.05), but these values were significantly greater in Group S than in Group M (p < 0.05). In comparison with the control value, IL-10 increased in both groups (p < 0.05), but was significantly greater in Group M than in Group S (p < 0.05). CK and CK-MB were increased in both groups in postoperative values compared to control values. In Group S, CK and CK-MB levels were significantly lower than in Group M (p < 0.05). Conclusion: In this study, we have found that pre-operative administration of methylprednisolone has decreased TNF-alpha, IL-6 and IL-8 release, and increased the perfusing IL-10 levels after CPB. Thus, methylprednisolone may decrease the inflammatory response during the CPB procedure.Öğe Preoperative analgesia management with rofecoxib in thoracotomy patients(W B SAUNDERS CO, 2005) Celik, JB; Gormus, N; Gormus, ZI; Okesli, S; Solak, HObjective: Pain management after thoracotomy is significant because pain reduces the postoperative respiratory performance. In this study, the analgesic efficacy and safety of rofecoxib in thoracotomy patients were evaluated. Design: A prospective, randomized, double-blind, and placebo-controlled study. Setting: This study was performed in the Meram Medical School of Selcuk University Departments of Cardiovascular Surgery and Anesthesiology. Participants: Sixty patients undergoing elective thoracic surgery via thoracotomy were randomized to receive either oral placebo or rofecoxib, 50 mg, 1 hour before surgery. Interventions: All patients received a standard anesthetic. Pain scores, sedation scores, heart rate, mean arterial pressure, respiratory rate, analgesic requirements, and side effects were noted 2, 4, 8,12, 18, 24, 32, 40, and 48 hours after operation. Measurements and Main Results:There were no significant differences between the 2 study groups with respect to demographics, sedation score, intraoperative blood loss, and postoperative drainage. Compared with placebo, morphine consumption and pain scores at rest and during coughing were significantly lower with rofecoxib. Conclusions: The preoperative administration of rofecoxib, 50 mg, provides significant analgesia for postoperative pain relief and decreases additional opioid requirements after thoracotomy. (C) 2005 Elsevier Inc. All rights reserved.Öğe Suppurated mediastinal and cardiac echinococcosis: Report of a case(SPRINGER, 2005) Gormus, N; Durgut, K; Ozergin, U; Solak, HWe herein report the case of a suppurated mediastinal and cardiac hydatid cyst which occurred after the initial treatment of the patient for a primary mediastinal hydatid cyst in a radiology department. Both extracorporeal circulation and total circulatory arrest were used during the operation. We believe that surgery is the only feasible treatment for hydatid cysts located in the mediastinum, and surgery should be urgently performed whenever a possible rupture is suspected in order to avoid a possible anaphylactic reaction, mediastinal suppurations leading to serious complications, and growth into the pleural cavity.Öğe Three-dimensional contrast-enhanced magnetic resonance angiography (3-D CE-MRA) in the evaluation of hemodialysis access complications, and the condition of central veins in patients who are candidates for hemodialysis access(WICHTIG EDITORE, 2004) Paksoy, Y; Gormus, N; Tercan, MABackground: Arteriovenous (AV) fistulas are crucial in Patients requiring long-term hemodialysis (HD). Dysfunctions of these fistulas are the most common causes of recurrent hospitalizations. This study aimed to evaluate the feasibility, safety and usefulness of contrast-enhanced magnetic resonance angiography (CE-MRA) in the evaluation of HD fistulas complications, and the condition of the central veins before HD access. Methods: This study comprised 30 consecutive patients (15 females, 15 males; age range 25-66 yrs, mean +/- SD 51.2 +/- 9.9 yrs). Of 30 patients, 26 had native AV fistulas and the remaining four patients, who had a history of previous subclavian vein catheterization, were candidates for HD fistulas. Nine patients had a radiocephalic fistula, 15 had a brachiobasilic fistula, one had a saphenous vein graft, and one had brachiobasilic vein transposition. To observe the fistula complications in these cases, three-dimensional (3-D) CE-MRA using gadolinium was performed. Results: The results were considered normal in three patients (10%), who were candidates for AV fistula construction; one patient had central vein occlusion due to previous catheterization. Thirteen patients (43.3%) had venous stenosis or occlusion; three of them (10%) had low CE arteries distal to fistula region, leading to ischemic complications, and six (20%) had stenosis at the fistula region. Seven patients (23.3%) had venous pseudoaneurysms, whereas two of them had both pseudoaneurysms and fistula region stenosis, and one had both venous stenosis and pseudoaneurysm. There were no adverse or allergic-like reactions or heat and taste sensations observed in our series. Conclusions: 3-D CE-MRA is a useful, safe and a practical imaging modality in complicated fistula diagnosis with fewer complications and side-effects in comparison to fistulography.Öğe Vena cubiti media for creation of a loop-shaped arteriovenous fistula at the elbow region(SPRINGER, 2004) Gormus, N; Ozergin, U; Ozpinar, C; Solak, HHemodialysis access is one of the major routes, for patients who need long-term hemodialysis. In this report, we tried a new secondary arteriovenous fistula technique. Between January 2000 and June 2003, hemodialysis access was created in more than 650 patients with end-stage renal failure at our institution. In 15 cases a loop-shaped hemodialysis access was created between the brachial artery and vena cubiti media as a second choice. The youngest patient was 12 years old, whereas the oldest was 75. The mean follow-up period (+/-SD) for these patients was 10.4+/-2.53 months. Twelve patients are still using these fistulas successfully for hemodialysis (86.6%), whereas one patient died 7 months after the operation (6.7%). In one patient, the arteriovenous fistula failed 6 months after the operation (6.7%). Thrombosis due to hypotension occured in two cases (13.3%) and this was resolved by simple thrombectomy. One patient had an aneurysm over the vena cubiti media (6.6%). None of the patients had an infection. These results suggest that an end-to-side anastomosis between the brachial artery and, vena cubiti media can be used as a second choice for hemodialysis access in patients with end-stage renal disease.
