Browsing by Author "Eker, Esra"

Now showing 1 - 11 of 11

Comparison of Blood Cardioplegia and Del Nido Cardioplegia Use in Isolated Vsd Patients
(Discovery Publication, 2018) Ozbek, Baburhan; Gur, Ali Kemal; Aykac, Mehmet Coskun; Eker, Esra
Objective: Ventricular septal defect (VSD) is the most common pathology among congenital heart diseases. Surgical closure, transcatheter closure or medical follow-up are among the treatment strategies. Surgical closure of VSD can now be safely performed with low morbidity and mortality. In this study, we aimed to compare the efficacy of blood cardioplegia and del Nido cardioplegia during VSD operation. Material and Method: In our Pediatric Cardiovascular Surgery Clinic, we retrospectively evaluated 186 patients, between 6 weeks and 18 years of age, who underwent operation due to isolated VSD between September 2013 and December 2017. Patients were divided into two groups as Group 1 (n = 108 using blood cardioplegia) and Group 2 (n = 78 using del Nido cardioplegia). Pre-operative data, peri-operative data and postoperative data of patients were retrospectively recorded and reviewed in detail. Findings: 153 patients (82.2%) were under 5 years old, 24 (12.9%) were between 5 and 10 years old, and 9 (4.8%) were between 10 and 20 years of age. 112 (60.2%) of the patients were male and 74 (39.8%) were female. The mean age of the patients was 3.8 +/- 2.08 in Group 1 and 4.2 +/- 2.13 in Group 2. There was no statistically significant difference in preoperative demographic data between Group 1 and Group 2 patients (p> 0.05). The duration of cardiopulmonary bypass (CPB), duration of intubation, intensive care unit stay and discharge time were found to be statistically significant when compared with Group 1 (p < 0.05). Result: Congenital heart disease cases can have a long operation time. In the light of our findings, we recommend the use of del Nido cardioplegia, which is administered a single-time and reduces inotropic need and duration of operation as well as significantly reduce extubation and discharge times, instead of blood cardioplegia which is given every twenty minutes. It can be said that del Nido cardioplegia can be safely used in the cases of congenital heart surgery, although it is difficult to give a definitive judgment due to the inadequacy of our case count.
Comparison of Milligan Morgan Hemorrhoidectomy and Direct Current Electrotherapy for the Treatment of Hemorrhoidal Disease
(Discovery Publication, 2018) Bartin, Mehmet Kadir; Tekeli, Arzu Esen; Eker, Esra; Oner, Muzaffer Onder
Background: It is aimed to compare Milligan Morgan hemorrhoidectomy and direct current electrotherapy for the treatment of grade 2 and grade 3 internal hemorrhoids. Material and Methods: Patients with symptomatic grade 2 or 3 internal hemorrhoids which is refractory to medical treatment were enrolled in this retrospective study. In the galvanization group, hemorrhoidal columns were coagulated using electrotherapy by a 2mA to 16mA current probe. And the Milligan Morgan hemorrhoidectomy was applied routinely as an open surgical procedure. Operative time, postoperative pain, hospitalization duration, clinical stage was measured. Patients were followed up for 3 months for healing, late complications and the recurrence. Results: The operative time and the hospitalization duration were significantly more in Milligan Morgan group (p<0.05). The relapse occurred in 3 patients in Milligan Morgan group and in 1 patient in galvanization group. The relaps rate was statistically less in galvanization group (p<0.05). Postoperative pain scores were similar in two groups at seventh day of the surgery (p=0.326). But at the first and third day of surgery the VAS values were higher in Milligan Morgan group (p=0.032). Conclusion: Hemorrhoidal coagulation with galvanic electrotherapy reduces the operation time and hospitalization duration. Also the relaps rate and the postoperative pain which is scored by the VAS values are less in this procedure according to the Milligan Morgan open surgery. However the late complications and late postoperative pain violence may be equivalent between these two surgery types.
Complications Associated With Carotid Body Tumor Excision
(Baycinar Medical Publ-baycinar Tibbi Yayincilik, 2018) Gur, Ali Kemal; Aykac, Mehmet Cokun; Yargi, Mahmut; Eker, Esra
Background: This study aims to evaluate associated complications of carotid tumor excisions and outcomes. Methods: Between January 2013 and April 2016, a total of 29 patients (2 males, 27 females; mean age 55.2 +/- 4.4 years; range, 17 to 76 years) were operated with the preliminary diagnosis of a carotid body tumor. According to the Shamblin classification of carotid body tumors, 12 patients were type 1, 13 patients were type 2, and four patients were type 3. Results: Main symptoms were dizziness, pain in the neck area, tinnitus, and headache. Headache was the most common symptom among them. Neurological and surgical complications developed in 10 patients (34.4%). Of operated patients, dysphagia developed in three (8.7%), facial hemiparesis in two (6.8%), hemorrhage in two (6.8%), hematoma-related respiratory distress in one (3.4%), left hemiparesis in one (3.4%), and transient bradycardia in one (3.4%). The patient who had respiratory distress associated with bleeding following extubation was reoperated. In the patients with facial and left hemiparesis, paresis was transient. Dysphagia also resolved in the subsequent follow-up outpatient visits. None of the patients experienced a permanent complication. Conclusion: Surgical excision is the most appropriate choice of treatment in carotid body tumors, and postoperative complications can be minimized through careful dissections and retractions. A special attention should be paid to nerve-preserving surgery.
Doğum Sonrası Erken Dönem Gelişen Aort Diseksiyonu
(2018) Tekeli, Arzu Esen; Eker, Esra; Gür, Ali Kemal
İntima ve media tabakasının ayrılması sonucu gelişenaort diseksiyonu tedavi edilmediği takdirde mortal seyredenbir hastalıktır. Tedavisi acil cerrahi müdahaleolan aort diseksiyonu genellikle hipertansif ve bağ dokuhastalığı olan hastalarda görülmektedir. Gebeliğe bağlıhipervolemi, taşikardi, kardiyak output artışı ve özelliklegebeliğin son dönemlerinde aortaya ve iliac arterlerebası sonrası asendan ve torakal aortada meydanagelen basınç gebelikteki aort diseksiyonları için riskfaktörleridir. Bu makalemizde 29 yaşında herhangi birkardiyak öyküsü olmayan 35 haftalık gebelik sonrasıüçüncü çocuğunu doğuran ve postpartum 1. günde anibaşlayan sırt ağrısı ile yapılan tetkikler sonrasındaaort diseksiyonu tanısı konan bir kadın hastayı sunmakistedik.
Effect of Preoperative Hba1c Levels on Postoperative Acute Renal Failure in Diabetic Patients Undergoing Coronary Bypass Surgery
(Discovery Publication, 2020) Gur, Ali Kemal; Sahinalp, Sahin; Eker, Esra; Unal, Harun
Introduction: Open heart surgery in patients with diabetes mellitus (DM) is associated with a higher mortality and morbidity than other patients. Diabetes mellitus (DM) is present in 30 to 40% of patients undergoing coronary bypass surgery (CABG). In this study, we aimed to clarify the relationship between preoperative glycohemoglobin (HbA1C) levels and postoperative acute renal failure (ARF) in patients with DM undergoing isolated coronary bypass surgery. Methods: We retrospectively enrolled a total of 295 patients who underwent elective, isolated CABG between January 2014 and February 2017 in our clinic and whose information was recorded. DM was detected in 118 of 295 patients. These patients were divided into two groups as Group 1 (HbA1c levels <7%, n = 72) and Group 2 (HbA1c levels >7%, n = 46). All patients were treated with standard insulin therapy after consulting the internal medicine department before the operation. Results: Of the 118 patients included in the study, 82 were males and 36 were females. There were 72 patients (51 M, 21 F) in Group 1 and 46 patients (31 M, 15 F) in Group 2. The mean age was 62.4 +/- 3.2 years in Group 1 and 61.5 +/- 4.5 years in Group 2. The mean duration of DM diagnosis was 10.2 +/- 3.3 years in Group 1 and 11.7 +/- 2.6 years in Group 2. The mean duration of hospitalization in intensive care unit was 6.10 +/- 2.3 days in Group 1 and 9.1 +/- 2.5 days in Group 2, which was found to be statistically significant (p=0.008). Discussion and conclusion: Hemodialysis (HD) may be required after coronary bypass surgery in diabetic patients. Although there is no direct correlation between high HbA1c levels and postoperative HD, we believe that these patients should be more closely monitored with more frequent measurements of urea, creatinine, blood gas and electrolyte levels.
The Effects of the Usage of Blood and Blood Products in Open Heart Surgery Patients and the Risk of Postoperative Atrial Fibrillation Development
(Discovery Publication, 2018) Gur, Ali Kemal; Tekeli, Arzu Esen; Eker, Esra; Aykac, Mehmet Coskun
Background: The current study explains the relationship between blood and blood-products that are used during surgery and AF. Material and Methods: A total of 260 patients who underwent elective isolated coronary artery bypass grafting (CABG) between January 2015 and March 2017 were included in the study, retrospectively. The study subjects were divided into two groups; patients whom we used blood products during surgery (Group I) and patients whom we didn't use blood products during surgery (Group II). In Group I there were 140 patients (54 female, 86 male), in Group 2 there were 120 patients (45 female, 75 male). AF rates, perioperative and postoperative blood usage rates and preoperative demographic characteristics were recorded and studied in both groups. Results: AF developed in 95 (36%) of 260 patients who underwent isolated coronary bypass surgery. AF developed in 64 (45%) patients in group I and 31 (25%) in group II. The incidence of AF was found to be statistically significantly lower in the group which we the blood products weren't used (p> 0,05). There was no significant difference between the groups in terms of smoking habits, chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM) and hypertension (HT). The mean age was 63.2 +/- 9.2 years in Group I and 60.5 +/- 8.3 years in Group II. Aortic cross clamping (ACK) duration in patients with cardiopulmonary bypass was 65.2 +/- 33.1 minutes in Group I, In the Group 2 mean duration was 59.7 +/- 25.4 minutes (p < 0,05). The mean number of distal anastomoses was 3.1 +/- 2.3 in Group I and 3.5 +/- 2.7 in Group II (p < 0,05). 1 bag of blood and blood products were given to 75 patients (53.5%), 2 bags to 38 patients (27.1%) and 3 bags were given to 27 patients (19.2%). The mean duration of hospitalization in intensive care unit was 3.2 +/- 1.6 days in Group I and 2.1 +/- 1.1 days in Group II. No mortal cases within the first month were included in the study. Conclusion: The incidence of AF was significantly lower in coronary bypass operations without the usage of blood and blood products during and after the operation. We conclude that limiting the usage of blood and blood products will result in a significant reduction in the incidence of AF.
The Effects of Thyroid Gland Volume and Weight on Surgical Approach Selection and Anesthesia Management in Retrosternal Goiter
(Zamensalamati Publ Co, 2022) Bartm, Mehmet Kadir; Tekeli, Arzu Esen; Okut, Gokalp; Eker, Esra; Oner, Muzaffer Onder
Background: Retrosternal goiter surgery is a technically challenging procedure. Selecting the appropriate surgical approach is critical in preventing surgical and anesthesia complications. Objectives: This retrospective clinical study aimed to investigate the role of thyroid volume and weight in the development of retrosternal goiter and the importance of special anesthesia management in patients with retrosternal goiter, which is a potentially difficult airway candidate. Methods: Retrosternal goiter was detected in 125 patients through ultrasonography. Patients were divided into cervical surgery (CA) and sternotomy (ECA) groups. Volumetric measurements were performed ultrasonographically. Patients' demographics, preoperative thyroid ultrasonography features, American Society of Anesthesiologists (ASA) classifications, Mallampati classifications, intubation characteristics, perioperative and postoperative patient data, and postoperative thyroid specimen weights were recorded. Results: A total of 106 patients (32 male and 74 female) were operated on for bilateral total thyroidectomy. Total thyroidectomy was performed with CA in 98 (92.5%) patients and with ECA in 8 (7.5%) patients. Malignancy was detected in 4 (3%) of 106 operated cases. All of the malignant cases were seen in patients with a cervical approach. When the volumetric measurements of both groups were compared, the volume values were significantly higher in the ECA group (P=0.032). 67 patients were ASA I and 39 patients were ASA II. 64 patients were defined as Mallampati Class I, 36 patients as Mallampati Class II, and 6 patients as Mallampati Class III. Intubation was performed on the third attempt for 5 patients and 8 patients with Mallampati I and Mallampati II, respectively. The rate of difficult intubation was statistically significant in the ECA group (P=0.019). Conclusion: Predicting ECA requirement in the preoperative period is closely related to the preoperative volumetric analysis of the thyroid gland with three-dimensional ultrasonography. In addition, since anesthesia management is difficult in patients who need ECA, volumetric analysis has become even more critical.
The Efficacy of Transversus Abdominis Plane Block for Postoperative Analgesia in Laparoscopic Cholecystectomy Cases: a Retrospective Evaluation of 515 Patients
(Sage Publications Ltd, 2020) Tekeli, Arzu Esen; Eker, Esra; Bartin, Mehmet Kadir; Oner, Muzaffer Onder
Objective To compare patients that received intravenous (i.v.) analgesics with those that received transversus abdominis plane (TAP) block for pain relief after laparoscopic cholecystectomy. Methods This retrospective study enrolled patients that had undergone laparoscopic cholecystectomy and divided them into two groups: the i.v. analgesic group (controls; group A) and the TAP block group (group T). Data retrieved from the medical records included postoperative visual analogue scale (VAS) pain scores, duration of intensive care unit (ICU) stay, total hospital stay, additional analgesic requirements and the occurrence of nausea and vomiting. Results A total of 515 patients were included (group A,n = 247; group T,n = 268). Postoperative VAS pain scores at 0, 2, 4 and 6 h and the need for additional analgesics were significantly lower in group T than in group A. Postoperative VAS pain scores at 12 and 24 h were significantly higher in group T than in group A. Postoperative nausea and vomiting were significantly lower in group T than in group A. The rate of ICU admission in group T was significantly lower than in group A. Conclusions Effective postoperative analgesia can be achieved with TAP block and undesirable effects can be reduced.
Karotis Cisim Tümörü Eksizyonu ile İlişkili Komplikasyonlar
(2018) Eker, Esra; Gür, Ali Kemal; Yargı, Mahmut; Aykaç, Mehmet Coşkun
Amaç: Bu çalışmada karotis cisim tümörü eksizyonları ile ilişkili komplikasyonlar ve sonuçları değerlendirildi. Çalışma planı: Ocak 2013 - Nisan 2016 tarihleri arasında karotis cisim tümörü ön tanısı ile toplam 29 hasta (2 erkek, 27 kadın; ort. yaş 55.2±4.4 yıl; dağılım 17-76 yıl) ameliyat edildi. Shamblin karotis cisim tümörü sınıflamasına göre, 12 hasta tip 1, 13 hasta tip 2 ve dört hasta tip 3 idi. Bulgular: Başlıca semptomlar baş dönmesi, boyun bölgesinde ağrı, kulak çınlaması ve baş ağrısı idi. Bu semptomların en sık görüleni baş ağrısı idi. On hastada (%34.4) nörolojik ve cerrahi komplikasyonlar gelişti. Ameliyat edilen hastaların üçünde (%8.7) yutma güçlüğü, ikisinde (%6.8) fasiyal hemiparezi, ikisinde (%6.8) kanama, birinde (%3.4) hematom ile ilişkili solunum sıkıntısı, birinde (%3.4) sol hemiparezi ve birinde (%3.4) geçici bradikardi gelişti. Ekstübasyon sonrası kanama nedeniyle solunum sıkıntısı olan bir hasta tekrar ameliyata alındı. Fasiyal ve sol hemiparezili hastaların parezi durumları geçici idi. Yutma güçlüğü de, takip eden poliklinik kontrollerinde düzeldi. Hiçbir hastada kalıcı komplikasyon görülmedi. Sonuç: Cerrahi eksizyonun en uygun tedavi seçeneği olduğu karotis cisim tümörlerinde ameliyat sonrası komplikasyonlar, dikkatli diseksiyonlar ve ekartasyonlar ile en aza indirgenebilir. Özellikle sinir koruyucu cerrahiye dikkat edilmelidir
Türkiye’de Ameliyathane Çalışanlarının Anestezi Tercihleri
(2020) Demirkiran, Hilmi; Eker, Esra; Demir, Canan; Bartın, Mehmet Kadir; Tekeli, Arzu Esen
Amaç: Anestezi uygulamaları ile her gün karşı karşıya olanameliyathane çalışanlarının kendileri ya da yakınları ile ilgili bircerrahi gerektiğinde hangi anestezi yöntemini tercih ettiklerinive nedenlerini ortaya koymak.Gereç ve Yöntem: Yarı yapılandırılmış sorulardan oluşan biranket, teknolojik iletişim yöntemleri ile (internet üzerindenGoogle forms, messenger, whatsapp gibi) Türkiye’nin farklıbölgelerinde ve farklı hastanelerinde görev yapan 1000ameliyathane çalışanına ulaştırıldı. Yaş, cinsiyet, meslek vesüresi, kendilerine anestezi uygulanıp uygulanmadığı,uygulandı ise yöntemi, hangi anestezi yöntemini neden tercihedecekleri ya da etmeyecekleri ve hangi anestezi yönteminineden önereceklerini kapsayan sorular soruldu.Bulgular: Yaşları 20 ila 60 arasında değişen katılımcıların%51.2’sini (n=327) erkekler, %48.8’ni (n=312) kadınlaroluşturuyordu. Katılımcıların % 69’u (n=440) herhangi birnedenle kendilerine anestezi uygulandığını belirtirken %31’i(n=199) anestezi uygulanmadığını ifade etti. Katılımcılar içingenel anestezi, rejyonal anestezi, periferik sinir bloğuyöntemlerinin üçünün de uygun olduğu cerrahi işlemlerdetercihin % 47 ile rejyonal anestezi (spinal, epidural, kombinespinal epidural anestezi) yönünde olduğu anlaşıldı.Yakınlarınıza ve hastalarınıza hangi anestezi yöntemini tavsiyeedersiniz sorusuna ameliyathane çalışanlarının cevabı rejyonalanestezi ağırlıklı olmuştur.Sonuç: Bu çalışmada Türkiye’de ameliyathane çalışanlarınındaha çok rejyonal anestezi tercih ettiğini saptadık. Daha genişkatılımlı çalışmalar ile anestezi tercihlerinin ne yöndeolacağının öğrenilebileceği ve bu durumun iş gücü ve maliyetplanlaması açısından da önemli olabileceği kanısındayız.
When To Remove Drains After Coronary Bypass Surgery
(Discovery Publication, 2018) Gur, Ali Kemal; Eker, Esra; Tekeli, Arzu Esen; Aykac, Mehmet Coskun
Background: Mediastinal and thoracic drains after open heart surgery are a vital preventive measure against postoperative cardiac tamponade. In this study, we investigated when to remove mediastinal and thoracal drains in patients who underwent isolated coronary bypass surgery. Material and Methods: A total of 446 patients who underwent elective isolated coronary artery bypass grafting (CABG) in our clinic between January 2015 and March 2017 were enrolled prospectively. Patients were divided into two groups: Group I (the last 24-hour drainage follow-up was under 150 ml) and Group II (last 24 hours drainage follow-up was under 50 ml). There were 210 patients (95 female, 115 male) in Group I and 236 patients (112 female, 124 male) in Group II. Postoperative Tamponade and pleural effusion rates, perioperative and postoperative blood usage rates, and preoperative demographic characteristics were recorded evaluated statistically. Results: The average age of the patients included in the study was 59,5 +/- 6,2, consisting of 239 male and 207 female patients. There were 210 patients (95 F, 115 M) in group I, 236 patients (112 F, 124 M) in group II. The mean amount of drainage; in Group I: 582 +/- 123 ml, in Group II: 614 +/- 205 ml. The average time of drain removal; Group I: 2.3 +/- 0.5 days, Group II: 4.1 +/- 0.3 days. Development rate of cardiac tamponade that required surgery on the first postoperative day; Group I: 5 (2.3%) and Group II: 3 (1.2%) respectively (p<0.05). Thoracentesis was required due to pleural effusion in 11 (5.2%) patients in group I and 6 (2.5%) patients in group II (p<0.05). The overall average age of the patients was 59.5 +/- 6.2 and consisted of 239 male and 207 female patients. Conclusion: It can be suggested that drains should not be removed until the drainage amount of the mediastinal and thoracal drains is reduced to 50 ml / day to further reduce the morbidity after isolated coronary bypass surgery.