Kalp ve Damar Cerrahisi/Makale Koleksiyonu

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https://hdl.handle.net/20.500.12395/15619

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Postoperative Outcomes of Mitral Valve Repair in Patients with Bileaflet Prolapse
(Selçuk Üniversitesi, 2023 Nisan) Çiçek, Ömer Faruk; Mola, Serkan; Kadiroğulları, Ersin; Yalçınkaya, Adnan; Diken, Adem İlkay; Yaşar, Emre; Altıntaş, Garip; Ulaş, Mahmut; Lafçı, Gökhan; Çağlı, Kerim; Günertem, Orhan Eren; Erkengel, İbrahim
Background: Today, repair techniques almost completely take place of the mitral valve replacement, especially in patients with degenerative disease. Majority of the surgeons hesitate to prefer repair in patients with bileaflet prolapse. In this study we aimed to investigate postoperative results of our patients with mitral valve insufficiency due to bileaflet prolapse and treated with repair techniques. Methods: 89 patients who underwent mitral valve repair by the same surgical team due to bileaflet prolapse, between January 2006 and January 2016 in …………….. Hospital were included to this study. Preoperative, operative and postoperative data such as mortality, recurrent mitral insufficiency, echocardiographic chages and reoperation rates were investigated. Results: Mean follow up duration was 25.3±17.7 months. Mean age was 46.6±17.4. According to transthoracic echocardiographic evaluations, 8 (%9) patients had moderate and 81 (%91) patients had severe mitral insufficiency. When preoperative and postoperative values were compared, there was statistically significant improvement in functional capacity of patients according to NYHA classification. (2.1±0.5;1, p=0.001) Improvements in left ventricular end diastolic diameter(5.5±0.7 ; 5±0.6, p=0.001), left ventricular end sistolic diamete(3.8±0.6; 3.6±0.6, p=0.004 )r, left atrium diameter(4.8±0.9; 4.3±0.6, p=0.001) and pulmonary artery pressure (44.3±13.4; 32.1±5.4, p=0.001) were statistically significant. Conclusions: In the lights of findings about good postoperative results and durability rates, mitral valve repair can be safely used in patients with mitral valve insufficiency due to bileaflet prolapse especially with chordae replacement technique which can be feasible after improvements in suture technologies.
Koyunlarda Ventral Trunkal Vagotominin Ön Mideler ve Abomasum Fonksiyonları Üzerine Etkileri
(Selçuk Üniversitesi, 1990 Ocak) Turgut, Kürşat; Başoğlu, Abdullah; Koç, Yılmaz; Çiftçi, Kemal; Tıpırdamaz, Saadettin; Aslan, Veysi; Gürbilek, Mehmet; Ok, Mahmut; Özkan, Cevat
In this study, a total of 12 sheep was used. 6 of which were used as a control group on which only paramedian laparatomy was performed. 6 of which were used as an experimental group on wihch ventral truncal vagotomy was performed via paramedian laparatoy. All the clinical, heamotological, biochemical and electrocardiographic examinations were performed for a month during the experiment. During the study clinical symptoms of vagus indigestion which has been described by Hoflund were not observed. There was significant decreaments in the respiration rate of experimental group at the 4 ^ (th), 10 ^ (th) and 20th day of the experiment. Plasma BE values were significantly increased at the 10 ^ (th) 20 ^ (th) and 30 ^ (th) day of axperiment in the experimental group. Rumen Cl concentration was significantly increased only at the 15 ^ (th) day of the experiment in the experimental group. Plasma gastrin concentration was decreased only at the sceond day of the experiment in the experimental group. Sinus arret was recorded during the electrocardiographic examination of the two groups of sheep at the diferent time. Theresult of the study showed that functional disorders of the nervus vagus did not play a role of the pathogenesis of vagus indigestion.
Evaluation of the Patients Developing Severe Pleural Effusion After Isolated Coronary Artery Bypass Operation
(Selçuk Üniversitesi, 2022) Tekümit, Hayrettin; Akbayrak, Hakan
Objective: In this study, we aimed to determine the causal relationship between isolated coronary bypass surgery development of severe pleural effusion in the early postoperative period. Methods: In this study, 7862 isolated coronary artery bypass surgery cases conducted in our hospital between February 2001 and July 2013 were analyzed retrospectively. 175 (2.2%) patients developed early-severe pleural effusion were included in the study. The findings of 175 cases with early severe postoperative pleural effusion (Group A) were compared with the data of 180 cases (Group B) who had similar demographic findings and did not develop early-serious pleural effusion in the postoperative period. Results: The mean age of these pleural effusion cases was 66.3±9.5 (55-76). 149 (85.1%) of the cases were operated under elective conditions and 26 (14.9%) of them were operated under emergency conditions. The mean cardiopulmonary bypass time of the cases was 70±28 (40-100) minutes. Left internal thoracic artery (LITA) and saphenous vein graft (SVG) were used together in 161 (92%) cases. Patients discharged after operation uneventfully. However, of the cases, 126 (72%) had shortness of breath, 115 (65.7%) dry cough, 28 (16%) productive cough, 50 (28.6%) tachypnea, 22 (12.5%) chest pain. Early severe pleural effusion developed in the left hemithorax in 154 (88%) of the cases. LITA+SVG was used in 148 (96.1%) of these cases, and only SVG was used in 6 (3.9%) cases. Early severe pleural effusion developed in the right hemithorax in 14 (8%) of the cases. LITA+SVG was used in 10 (71.4%) of these cases, and only SVG was used in 4 (28.6%) cases. The cases with bilateral early severe pleural effusion were 7 (4%). LITA+SVG was used in 3 (42.9%) of these cases, and only SVG was used in 4 (57.1%) cases. When the two groups were compared, Group A had significantly higher rates of low EF and atrial fibrillation than Group B. Conclusion: It is known that coronary artery bypass surgery causes deterioration of postoperative pulmonary function. One of the most common complications of coronary artery bypass surgery is pleural effusion. It is known that this postoperative picture is associated with increased hospital readmission, rehospitalization and high postoperative morbidity. It is important to determine preoperative risks in terms of postoperative patient management and morbidity assessment.
Thyroid Dysfunction Coexistence in Patients with Acute and Subacute Deep Vein Thrombosis
(Selçuk Üniversitesi, 2022) Altınay, Levent; Büyükateş, Mustafa; Aktunç, Erol; Sungur, Elif Coşkun
Objective: Coagulation anomalies in patients with thyroid dysfunction may vary from subclinical disorders in laboratory tests to life threatening thrombotic events or bleeding. We aimed to determine the effect of thyroid dysfunction on thrombophilia in patients with acute and subacute deep vein thrombosis (DVT). Materials and Methods: A number of 30 patients with the diagnosis of DVT between November 2015 and June 2016 included in this case - control study. The patients divided into two groups as provoked (with known ethiology, n = 13) and unprovoked (with un-known ethiology, n = 17) patients. Provoked patients group divided as the patients with acquired risk factors (predisposition) and/or the patients with genetic risk factors. Results: The difference of the rate of the thyroid dysfunction between the provoked and unprovoked groups was not significant (p=0.844). The PAI – 1 gene mutation was detected in 70% of the study cohort and none of the patients had prothrombin gene mutation. The most provocative factors for DVT were male gender and undergoing a major surgery in the last three months. Conclusions: There was no correlation between acute – subacute DVT and thyroid dysfunction in this study. Therefore, we think that the ‘provocative factors’ may support the relation of thyroid dysfunction and venous thromboembolism (VTE). We think that more studies with larger cohorts and prospective should be conducted about this subject.
Concomitant Heart Surgery with Pulmonary Hamartoma Resection: A Case Report
(Selçuk Üniversitesi, 2022) Tanyeli, Ömer; Görmüş, Niyazi; Orhan, Atilla
Concomitant lesions of the heart and lung are rare, but when present, they pose a therapeutic challenge to surgeons. A combined procedure clears the need for a second major procedure, improving outcomes and providing economic benefits. However, cardiopulmonary bypass may adversely affect the natural history of pulmonary masses when malignancy is suspected. To avoid these suspects, off-pump techniques may be preferred in suitable patients. This article presents a case of simultaneous off-pump coronary artery bypass grafting and pulmonary hamartoma resection in a 53-year-old man who detected a lung mass during preoperative preparation.
Two-stage surgery for extra pelvic intravenous leiomyomatosis: Report of a case
(TAYLOR & FRANCIS INC, 2019) Bayramoglu, Denizhan.; Orhan, Atilla.; Gul, Ayhan.; Sahin, Gozde.; Celik, Zeliha Esin.; Koplay, Mustafa.; Celik, Cetin.
Intravenous leiomyomatosis (IVL) is a variant of leiomyoma characterised by intravascular proliferation and originates from the uterine mesoderm. The main pathogenesis of IVL has not been exactly assessed, yet (Xu et al. 2013; Li et al. 2014). There are two main theories; the first one is: a tumour arises from the walls of venous structures and the second one is: a primary tumour (e.g. myoma) directly spreads into adjacent small venouses (Moniaga and Randall 2012). The early studies have reported an incidence of 0.25–0.41% of IVL in patients with uterine fibroid tumours (Ma et al. 2016; Low et al. 2017). Here, we presented a case suspected of IVL during the operation; although it was reported as uterine sarcoma and vena cava inferior thrombus on radiological imaging methods, pre-operation.
Transposition of basilic vein in forearm for arteriovenous fistula creation: Our mid-term results
(BAYCINAR MEDICAL PUBL-BAYCINAR TIBBI YAYINCILIK, 2019) Uzun, Hacı Alper; Çiçek, Ömer Faruk; Seren, Mustafa
Background: In this study, we aimed to present our mid-term results of basilic vein transposition in the forearm to create an arteriovenous fistula. Methods: Between January 2015 and October 2017, a total of 21 patients (13 males, 8 females; mean age 54.2 +/- 11.3 years; range, 32 to 74 years) with an adequate basilic vein and radial arterial systems who underwent basilic vein transposition in the forearm were retrospectively analyzed. All operations were performed under local anesthesia and mild sedation. The basilic vein was harvested using a single incision from elbow joint to wrist as an in situ vein graft. If the harvested basilic vein did not extend easily to the radial artery in the wrist region, the saphenous vein was harvested to extend arteriovenous fistula tract. Results: The mean follow-up was 25.3 +/- 9.8 (range, 2 to 32) months. All patients underwent arteriovenous access surgery using transposed basilic vein in the forearm. In all patients, except for two, transposed basilic vein in the forearm stayed patent during follow-up with a patency rate of 90.5%. The mean fistula maturation time was 45.2 +/- 10.7 (range, 28 to 59) days. Conclusion: If cephalic vein diameters are too small for arteriovenous fistula creation, basilic vein system in the medial surface of the forearm may be considered a favorable option.
The effects of dexmedetomidine on human internal mammary artery and saphenous vein grafts under hypothermia and normothermia
(COMENIUS UNIV, 2019) Oc, B.; Arun, O.; Taylan, S. B.; Oc, M.; Bariskaner, H.; Duman, A.
OBJECTIVES: The purpose of this study was to determine the effects of hypothermia and normothermia on the isolated human saphenous vein (SV) and internal mammary artery (IMA) responses to dexmedetomidine. METHODS: The response of human IMA and SV strips with (E+) and without (E-) endothelium subjected to cumulative concentrations of (10(-9), 0(-6) M) dexmedetomidine were recorded at 37 degrees C and at 28 degrees C. OnE-way ANOVA was used for analysis. A p < 0.05 was considered significant. RESULTS: At 37 degrees C dexmedetomidine resulted in similar signifi cant concentration-dependent contractions in both E+ and E-SV strips (p < 0.05). At 37 degrees C dexmedetomidine resulted in signifi cant concentration-dependent contractions in E+ IMA strips, these contractions were significantly lower at all concentrations of dexmedetomidine in E-compared to E+ IMA strips (p < 0.05). When results between similar groups of SV and IMA strips were compared, the contractions were significantly higher in the IMA strips in E+ and E-at 37 degrees C and also E-28 degrees C groups compared to SV (p < 0.05). CONCLUSION: In conclusion, dexmedetomidine causes in vitro vasoconstriction in human IMA and SV grafts. These contractions are greater in IMA compared to SV grafts. Endothelium-derived pathways are possibly involved in the contractile responses of IMA. Moderate hypothermia augments vasoconstriction in SV grafts
Pulmonary thromboendarterectomy in a combined thrombophilia patient
(CLINICS CARDIVE PUBL PTY LTD, 2019) Akbayrak, Hakan; Tekumit, Hayrettin
Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially correctable cause of secondary pulmonary hypertension. Surgical treatment remains the primary treatment for patients with CTEPH. Pulmonary thromboendarterectomy (PEA) with deep hypothermic circulatory arrest is the standard and recommended surgical technique for the treatment of these patients. The prevalence of CTEPH after an acute pulmonary thromboembolism (PTE) has been found in various studies to be between 0.6 and 8.8%. Mortality rates in elective PEA cases with CTEPH are reported to be between 1.9 and 4.5%. We report on a 50-year-old female patient with combined inherited thrombophilia, including protein C and protein S deficiencies, who was diagnosed with CTEPH and was successfully treated with pulmonary thromboendarterectomy.
Iliac artery ınjury during lumbar disc hernia surgery
(ELSEVIER SCIENCE INC, 2019) Şahinoğlu, Mert; Arun, Oğuzhan; Orhan, Atilla; Nayman, Alaaddin; Çalışır, Akın; Bocu, Yasin; Cebeci, Yasemin; Duman, Ateş; Yılmaz, Hüseyin; Köktekir, Ender; Karabağlı, Hakan
BACKGROUND: Vascular injury complications during lumbar discectomy are rare but potentially life-threatening. Therefore, an early diagnosis and effective treatment management is required for these complications. CASE DESCRIPTION: A 50-year-old female patient was admitted to our outpatient clinic with severe back and right leg pain. She underwent surgery for right L4-5 extruded disc herniation with general anesthesia. Sudden arterial hemorrhage occurred during discectomy performed with straight disc forceps and was controlled using hemostatic materials, with no significant decrease in blood pressure. However, the patient became hypotensive near the end of the operation. The incision was quickly closed, and she was turned to supine position. Emergency abdominal ultrasound, computed tomography, and computed tomography angiography revealed an injury of the left main iliac artery, which was repaired by endovascular stenting. Laparotomy and Bogota bag were applied because of increased intrabdominal pressure at 3 hours postoperative. In addition, a retroperitoneal catheter was placed into the area of the right retroperitoneal hematoma on the first postoperative day. Tissue plasminogen activator was administered through the catheter. On postoperative day 3, the Bogota bag was removed, and the abdomen was closed. The patient was discharged without neurodeficit on day 27. Her abdominal fascial defect was closed with a synthetic graft after 5 months. CONCLUSIONS: Although lumbar discectomy is one of the most commonly performed neurosurgical procedures, the routine rules of discectomy should not be neglected. Early detection and a multidisciplinary approach can help prevent mortality in the event of vascular injury.
Effect of fenofibrate on serum nitric oxide levels in patients with hypertriglyceridemia
(WROCLAW MEDICAL UNIV, 2019) Esenboga, Kerim.; Çiçek, Ömer Faruk.; Oktay, Ahmet Afşin.; Ayral, Pelin Aribal.; Gürlek, Adalet.
Background. Fenofibrate, a peroxisome proliferator-activated receptor-alpha (PPAR alpha) agonist, is used to treat patients with hypercholesterolemia and hypertriglyceridemia in order to reduce the risk of development of the atherosclerotic cardiovascular disease. However, it exerts pleiotropic effects beyond correcting atherogenic dyslipidemia to treat hypercholesterolemia. Objectives. The aim of this study was to investigate the potential effects of fenofibrate on endothelial function by analyzing the serum nitric oxide (NO) levels in patients with hypertriglyceridemia. Material and methods. Lipid profiles and serum NO levels were assessed in 56 healthy adults aged 29 to 84 years, before and after 12 weeks of fenofibrate (250 mg/d; n = 30) or placebo (n = 26). Appropriate dietary suggestions for hypertriglyceridemia were made for all patients. This study was randomized, double-blind and placebo-controlled in design. Results. Total cholesterol, low-density lipoprotein (LDL), very low-density lipoprotein (VLDL) and triglyceride levels significantly decreased; high-density lipoprotein (HDL) and NO levels significantly increased after 12 weeks of fenofibrate therapy. We observed a statistically significant correlation between the increase in serum NO levels and decrease in serum triglyceride levels (r = -0.42, p = 0.02) in the fenofibrate group. Conclusions. The positive effect of short-term fenofibrate treatments on vascular endothelial functions in patients with hypertriglyceridemia has been demonstrated by increasing the serum NO levels. Agents such as fenofibrate targeting PPAR alpha-associated signaling pathways show promise as an alternative treatment of vascular dysfunction related to advanced age and hyperlipidemia.
Comparison of anterior mitral leaflet repair techniques with and without the use of chordal replacement in patients with degenerative mitral valve insufficiency
(FORUM MULTIMEDIA PUBLISHING, LLC, 2019) Kadiroğulları, Ersin; Çiçek, Ömer Faruk; Mola, Serkan; Yaşar, Emre; Erkengel, İbrahim; Yalçınkaya, Adnan; Günertem, Eren; İkbaliafşar, Ferhat; Diken, Adem; Kocabeyoğlu, Sabit; Lafçı, Gökhan; Çağlı, Kerim
Background: The aim of our study was to compare the outcome of patients who underwent mitral valve anterior leaflet repair with and without chordal replacement for degenerative mitral valve insufficiency. Methods: This study was conducted at our center between May 2006 and May 2013. The study included 125 patients with degenerative mitral valve insufficiency (64 males, 61 females; mean age 47 years, age range 16-78 years) who underwent mitral valve repair with anterior leaflet procedures. The patients were divided into 2 groups. Group A consisted of 56 patients with chordal replacement, and group B consisted of 69 patients with other repair techniques performed. Results: No significant difference was determined between the 2 groups in mortality, recurrence, and reoperation rates. The mortality rate was 3.6% in group A and 1.4% in group B. During the follow-up period, 3 patients were reoperated on (mitral valve replacement) because of severe mitral valve insufficiency. Two of these patients were from group A (3.6%), and the other was from group B (1.4%). One patient in group A underwent intraoperative mitral valve replacement after unsuccessful chordal replacement. Fifty patients (89.3%) in group A and 65 patients (94.2%) in group B exhibited no or mild recurrence of mitral valve insufficiency. Conclusion: Mitral valve repair in patients with degenerative mitral valve insufficiency resulting from anterior leaflet pathology is a safe procedure because of its durability and good long-term results. Despite the difficulty of the chordal replacement procedure, it may be used as an alternative technique for anterior mitral valve leaflet repair.
A Huge True Axillobrachial Aneurysm Following Arteriovenous Fistula Ligation
(2019) Orhan, Atilla; Özergin, Ufuk
Aneurysmal degeneration of the upper limb arteriesis a rare entity. We discuss the clinical characteristics,surgical options for a huge true axillobrachial arteryaneurysm following arteriovenous fistula closure afterrenal transplantation. The underlying pathogenesis of thetrue axillobrachial artery aneurysm remains unclear. Thecurrent theory is that the adaptive arterial wall enlargementis secondary to the increased flow in the inflow artery.Immunosuppressive therapy and corticosteroids contributeto the aneurysmal formation. Surgical treatment includinganeurysmal excision, bypass with autogenous or prostheticgrafts are the primary therapeutic options.We believe that this case will be inspiring and helpful to thecardiovascular surgeons during their daily practice.
Comparative effects of atorvastatin 80 mg versus rosuvastatin 40 mg on the neutrophil to lymphocyte ratio, platelet to lymphocyte ratio and monocyte to hdl-cholesterol ratio in patients with acute myocardial infarction
(2019) Tuncez, Abdullah
Background: Previous studies have shown the association between the elevated levels of hematological markers like Neutrophilto Lymphocyte ratio (NLR), Platelet to lymphocyte ratio (PLR) and Monocyte to High density lipoprotein cholesterol (HDL-C) ratio(MHR) and increased risk of the existence of cardiovascular disease, increased risk of acute coronary syndromes and severity ofcardiovascular disease. One of the most commonly used drugs in atherosclerotic cardiovascular diseases are statins and we knowthat statins have beneficial effects in addition to LDL-lowering effects known as pleiotropic effects. However the effects of statinson the hematological markers are unclear. We performed this investigation to clarify and compare the effects of maximum-dose ofatorvastatin and rosuvastatin on hematological biomarkers in patients with acute myocardial infarction.Methods: Statin or other anti-lipid drugs naive patients with either ST-segment elevation myocardial infarction or Non-ST elevationmyocardial infarction were enrolled to our study. Biochemistry parameters, lipid parameters, blood-count parameters and NLR, PLRand MHR levels were measured at baseline and 30 days after discharge. Baseline characteristics and results of 2 groups after onemonthtreatment were compared.Results: Among the 128 statin-naive patients included, 65 patients received atorvastatin (80 mg/day) and 63 patients recievedrosuvastatin (40 mg/day). Baseline clinical characteristics of groups were similar. Atorvastatin 80 mg significantly decreased thelevels of NLR (p0.001) and MHR (p0.024) at the end of one-month therapy. Rosuvastatin 40 mg also significantly decreased thelevels of NLR (p0.001) and MHR (p0.006) at the end of one-month therapy. Both statins were ineffective on the levels of PLR.Percent and absolute changes of NLR, MHR and PLR were similar and there were no statistically significant differences between bothgroups. The percent and absolute changes of lipid parameters were also similar among both treatment arms.Conclusion: Our results showed that atorvastatin 80 mg and rosuvastatin 40 mg decreased the NLR and MHR levels significantly atthe end of one-month therapy. However, both statins have no effects on PLR levels.
Emergent surgical treatment of lethal valve dysfunction during pregnancy in a last-trimester patient
(SAUDI MED J, 2018) Akbayrak, Hakan; Çiçek, Ömer Faruk; Orhan, Atilla
A mechanical heart valve thrombosis during pregnancy is one of the most lethal conditions to experience due to its detrimental effects on both mother and fetus. Cardiac surgery during pregnancy is reserved for cases where medical treatment fails due to harmful maternal and fetal effects. A 24-year-old female in the 38th week of pregnancy was admitted to the emergency room with aggravated dyspnea, tachypnea, and palpitations. She had 2 previous cardiac operations in her medical history. A stuck mechanical valve was diagnosed in the mitral position via transthoracic echocardiography, which had resulted from her decision to cease taking warfarin when planning to become pregnant. In pregnant patients who have prosthetic mechanical valve thrombosis, surgical approach should be considered depending on the conditions of the mother and the baby. When emergency delivery of the baby is feasible, emergent surgical treatment should be utilized for patients who are in critical condition.
Complete Absence of The Left Pericardium in On-Pump Coronary Artery Bypass Operation
(2018) Orhan, Atilla
The complete absence of the left pericardium is a rarecondition, which is found incidentally during surgicalprocedures. Preoperative computerized tomographyimaging is not a routine practice in open heart surgery, andthe diagnosis of these cases is often overlooked. In a patientundergoing on-pump coronary artery bypass surgery, wepresent a rare case of a left pericardium after sternotomy.
Assessment of Left Ventricular Systolic and Diastolic Function With Conventional and Tissue Doppler Echocardiography Imaging Techniques in Patients Administered Tyrosine Kinase Inhibitor
(2012) Alihanoğlu, Yusuf İzzettin; Kaya, Zeynettin; Arı, Hatem; Karaarslan, Şükrü; Yıldız, Bekir Serhat; Karanfil, Mustafa; Yazıcı, Mehmet; Börüban, Melih Cem; Özdemir, Kurtuluş; Ülgen, Mustafa Sıddık
Objectives: The aim of this study was to use echocardiographic techniques to determine the possible cardiotoxic effects of low molecular weight tyrosine-kinase inhibitors (TKI) in patients receiving the therapy for the first time. Study design: Thirty patients (17 females; 13 males; mean age 49±16; range 22 to 76 years) who met the exclusion criteria and were diagnosed as having malignancy were enrolled. All patients underwent conventional echocardiography and tissue Doppler imaging (TDI) prior to the treatment. The conventional echocardiogram was repeated 2 months later as the patients were concurrently receiving therapy. Myocardial Performance Index was obtained by conventional echocardiography and by TDI techniques to evaluate left ventricular systolic and diastolic function. Results: Statistically significant increase occurred in mean left ventricle (LV) end-systolic volume. However, there was significant decrease in both mean LV ejection fraction and LV stroke volume values (64±3, 62±4, p=0.000 and 67±13, 61±13, p=0.000, respectively). Anterior wall Em/Am ratio measured by using the TDI technique was significantly decreased at the end of two months (0.99±0.49, 0.90±0.41, p=0.03). In addition, decreases were determined in Sm values obtained from all of four LV walls and also in mean Sm value, but this decrease was significant only for the lateral wall Sm measurement (12.8±2.9, 11.6±2.3, p=0.004). Conclusion: Tyrosine-kinase inhibitors therapy can be administered safely to patients without predisposing factors for cardiotoxicity in short treatment intervals, and low molecular TKIs may cause subtle or clinically significant cardiotoxicity following the treatment period even in patients without predisposing factors for cardiotoxicity, so clinicians should consider this possibility.
Appropriateness of the Current Guidelines on Reperfusion Treatment for Patients Applying to Our Hospital With St-Segment Elevation Acute Myocardial Infarction
(2012) Karaarslan, Şükrü; Alihanoğlu, Yusuf İzzettin; Yıldız, Bekir Serhat; Sönmez, Osman; Soylu, Ahmet; Bacaksız, Ahmet; Alur, İhsan; Özdemir, Kurtuluş; Düzenli, Akif
Objectives: This study investigated the appropriateness of treatment for patients admitted with ST-segment elevation myocardial infarction (STEMI) according to the current guidelines. We also aimed to determine in-patient and out-patient factors affecting optimal re perfusion therapy. Study design: The reperfusion therapy of 176 patients with STEMI was determined. The time period from first contact with a healthcare provider to the time of balloon inflation (door to balloon time), and from the time period of first contact with a healthcare provider to the time of initiation of a thrombolytic (door to needle time) were calculated. Similarly, the time from admission at the emergency service (ES) of our hospital after referral to the moment of balloon inflation (ES to balloon time) and the period from admission to ES at our hospital to the moment of initiation of a thrombolytic (ES to needle time) were calculated. In order to determine the amount of in-hospital delay, the time from ES admission to the call to the cardiology department and the time for the cardiologist to evaluate the patient and transfer time were recorded. Whether the referring physician was a cardiologist and the effect of work hours on the reperfusion period was also recorded. Results: The door to balloon time in the referred patient group was calculated as an average of 228 minutes, while the time for patients directly admitted to ES was calculated as an average of 98 minutes. Patients referred for the mechanical reperfusion period compared to American Heart Association (AHA) guidelines consisted of only 6% of the eligible patients, while according to the European Society of Cardiology (ESC) guidelines 13% of patients were appropriate. Patients who were directly admitted to ES, experienced rates according to AHA guidelines and 73% experienced these rates according to ESC guidelines. We also found no significant effect of working hours or referring physician's specialty (cardiologist or other) on reperfusion time. Conclusion: Compliance rates of reperfusion therapy for patients presenting with STEMI was very low. We realized, when taking into consideration the reasons for delay in terms of both health community and the policy of the country, it is obvious that we have to take strict measures. © 2012 Turkish Society of Cardiology.
The Problems and Cost-Effectiveness Analysis of Diabetic Foot Infections
(Turkiye Klinikleri, 2012) Gönen, Mehmet Sait; Çakır, Mehtap; Gönülalan, Gülsüm; Öztürk, Mine; İpekçi, Süleyman Hilmi; Köşker, Ali; Karalezli, Mustafa Nazım; Erayman, İbrahim; Durgul, Kadir; Keskin, Mustafa; Seyhan, Nevra
Objective: Hospitalization in patients with diabetic foot infection usually increases costs due to required long-term medical treatments and surgical managements. We aimed to investigate the ethiological factors of diabetic foot infections, frequency of osteomyelitis and amputation and the cost of diabetic foot infection treatments. Materials and Method: Patients with DM and diabetic foot infections that was admitted to our Endocrinology clinic between January 2009 and January 2010 was reviewed retrospectively. Demographic properties, phisical examinations, laboratuary tests, treatments, hospitalization time and cost informations of patients were investigated. Results: The mean age of 80 patients with 59 males and 21 females was 62±11 years. All patients were diagnosed as Type 2 DM except four patients (5%) with Type 1 DM. The mean duration of DM in our study group was 15.6 years, the mean hospitalization time was 22.1 days and mean cost per patient was 2573 $. Discussion: Diabetic foot infection is an important complication of DM due to impaired quality of life, loss of work, developement of psychosocial trauma, increased frequency and duration of hospitalization, increased cost of treatment recently. Daily foot care and examination by patients seem an important factor to reduce cost of diabetic foot infections.
Tracheobronchial Aspiration of Foreign Bodies and Rigid Bronchoscopy in Children
(WILEY-BLACKWELL, 2012) Öncel, Murat; Sunam, Güven Sadi; Ceran, Sami
Background: A significant proportion of cases of tracheobronchial foreign body aspiration due to life-threatening condition is observed during childhood. The aim of the present study was to describe our experience with the diagnosis and treatment of foreign body aspirations during childhood and review published literature. Methods: One hundred and eighty-four patients under 16 years of age with a tentative diagnosis of foreign body aspiration were retrospectively evaluated according to age, sex, patient delay symptoms at presentation, foreign body type, localization and the diagnostic and therapeutic methods used. Results: The most frequently aspirated objects were shelled nuts and seeds such as sunflower seeds, pistachio and hazelnuts. The chief symptom was cough. On physical examination, the most frequent findings were unilateral decrease of respiratory sound on the affected side with coarsening and bronchi. While 51% of cases presented a radiological finding, chest X-ray was normal in the other. All patients underwent rigid bronchoscopy under general anesthesia and a foreign body was identified in 137 (74.3%). The rigid bronchoscopy intervention was used in some cases, especially in the presence of tracheal foreign bodies of organic origin. Conclusions: Tracheobronchial foreign body aspiration is a significant cause of childhood morbidity and mortality. Early diagnosis and treatment is of utmost importance. Rigid bronchoscopy under general anesthesia should be performed in all patients suspected of foreign body aspiration, which could minimize mortality and morbidity if performed by experienced personnel with safe methods.

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