Browsing by Author "Ekim, H."

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Arterio-Venous Fistula Management With Saphenous Vein Graft Interposition in Hemodialysis Patients; Clinical Study; Mid-Term Results
(Elsevier Ireland Ltd, 2011) Odabasi, D.; Basel, H.; Ekim, H.
Arteriovenous Fistula Aneuryms Seen More Frequently at Brachial Region in End Stage Renal Failure Patients
(2011) Odabaşi, D.; Ari, E.; Ekim, H.
Objective: The aim of this study is to evaluate the aneursysm developing in arteriovenous fistula's (AVF) in end stage renal failure (ESRF) patients and to emphasize the importance of using the distal portions of extremities for AVF operations as possible. Material and Methods: Between January 2006 and January 2011 200 patients who have ESRF disease had 232 AVF operations. AVF operation conducted 113 (56%) of the patients were male and 87 (44%) were female. 17 (62%) of the patients were male and 10 (38%) of the patients were female who had anuerysm developed. Patients evaluated according to their sex, age, ESRF duration, AVF localizations. Results: The mean age of male patients was 41.50 ± 16.53, and female patients was 43.37 ±17.65 who had aneurysm in AVF's. The mean duration ESRF of male patients was 53±26 months and female patients was 56 ± 24 months. AVF localizations of 27 patients who had aneurysms are; right radial AVF 2 (7%), right high AVF 2 (7%), right brachial AVF 8 (29%), left radial AVF 1 (3%), left high radial AVF 5 (18%), left brachial AVF 9 (33%). The mean fistula flow of the male patients was 1332 ± 411 mL/min and female patients was 1117 ± 326 mL/min. Aneurysm developed 17 (15%) in 113 male patients, 10 (11%) in 87 female patients. High output cardiac failure developed 2 (11%) in 17 aneurysm developed male patients, 1 (10%) in 10 aneurysm developed female patients. Conclusion: Aneurysm developed significantly more in brachial region compared to forearm. It is the forearm if feasible vessels recieved to be preferred for AVF operation having regard the risk of aneursym development. Copyright © 2011 by Türkiye Klinikleri.
Cardiac Tamponade Surgery, Which Method To Choose
(2011) Odabaşi, D.; Gümrükçüog̈lu, H.A.; Kiymaz, A.; Ekim, H.
Objective: Cardiac tamponade (CT) represents a life-threatening condition and different methods are applied in the surgical treatment. We have reviewed the results of 100 patients who had subxiphoid pericardial drainage, pericardio-peritoneal window and thoracotomy after the diagnosis of CT. Material and Methods: The study group consisted of 100 patients diagnosed with CT from January 2005 to January 2011 at our institution. Subxiphoid pericardial drainage was performed in 35 (35%) patients (group A). Pericardio-peritoneal window performed in 20 (20%) patients (group B). Thoracotomy was performed in 45 (45%) patients (group C). Data on medical history, characteristics of the pericardial fluid, treatment strategy and follow-up data were collected. Results: Malignant diseases, tuberculosis and idiopathic were primary cause of tamponade (57%, 17% and 15% respectively). Major and minor complications were as fallows; group A: 5%, 5%; group B: 5%, 10%; group C: 4%, 13% respectively. Recurrance ≤ 90 day were as fallows; group A: 20%; group B: 15%; group C: 6%. Thirty day morbidity; group A: 11%, group B: 15%, group C: 20%. Mortality; grup A: 20%, group B: 25%, group C: 22%. Conclusion: Major complication rates of these methods are close to each other, but more invasive method of thoracotomy, which has the lowest recurrence rates and requires the operating room environment. Implementation in intensive care unit and under local anesthesia and are the most importanat advantages of subxiphoid pericardial drainage and pericardio-peritoneal window methods. Copyright © 2011 by Türkiye Klinikleri.
Effects of Giant Left Atrium on Thromboembolism After Mitral Valve Replacement
(Asia Publishing Exchange Pte Ltd, 2005) Kutay, V.; Kirali, K.; Ekim, H.; Yakut, C.
The aim of this study was to evaluate the incidence of thromboembolic events in patients with giant left atrium ( > 6.5 cm) after mitral valve replacement. From January 2000 to September 2002, a total of 126 patients who had undergone mitral valve replacement were divided into two groups according to the presence or absence of giant left atrium. Group A comprised 34 patients with left atrium over 6.5 cm without compression symptoms and Group B comprised 92 patients. The preoperative variables did not distinguish the patients in each group, except for atrial fibrillation; Group A 85.2% and Group B 61.9% ( p < 0.01). After mitral valve replacement, left atrium mean diameter was significantly decreased in Group A from 8.1 ± 1.3 mm to 6.2 ± 1.6 mm ( p < 0.01). There were no significant differences in thrombosis, hemorrhage and thromboembolism rates in both groups. Postoperative clinical and hemodynamic parameters demonstrated a positive clinical response to mitral valve replacement in patients with giant left atrium. During follow-up no direct relationship between thromboembolism and giant left atrium was evident.
Management of Esophageal Foreign Bodies: a Report on 26 Patients and Literature Review
(2010) Ekim, H.
The purpose of this study is to present our experience of the removal of esophageal foreign bodies in children and adults using rigid esophagoscope under general anesthesia. A total of 26 patients with a history of ingested foreign body in the esophagus were admitted and treated in our hospital between July 2005 and August 2007, of whom 20 children and 6 adults. There were 14 male and 12 female patients between 6 months and 70 years of age. All patients except one had a clear history and symptoms of foreign body ingestion. The main symptoms were difficulty in swallowing, acute onset of pain, dysphagia, choking and excessive salivation. A lateral neck plain radiograph and a posteroanterior view that included the oropharynx, neck, chest, and abdomen were made routinely before esophagoscopic examination. Foreign bodies were most commonly identified in the cervical esophagus, usually immediately below the cricopharyngeus (16 children). Remaining foreign bodies were as follows: 6 (4 children, 2 adults) foreign bodies were lodged in the midesophagus and 4 (all adults) in the distal esophagus. All foreign bodies were removed under general anesthesia. A rigid esophagoscope was used to remove them. Coins were the most common foreign body removed from the esophagus, occurring in 14 patients, all children. Other foreign bodies were bones mixed with pieces of meat, button battery, staples, safety pins, chicken bones, and fish bone. There were no deaths, no perforations, no cases of mediastinitis, and actually no complications secondary to insertion of the esophagoscope and removal of the foreign body. Rigid esophagoscopy remains as safe method of esophageal foreign body removal. The timely diagnosis and endoscopic removal should be performed to prevent serious life-threatening complications.
Management of Prosthetic Mitral Valve Thrombosis
(2005) Ekim, H.; Akbayrak, H.; Başel, H.; Hazar, A.; Karadaǧ, M.; Kutay, V.; Yakut, C.
Prosthetic mitral valve thrombosis is a lifethreatening complication. Data on complications and outcome are limited. The purpose of this study was to review the clinical experience with the thrombolytic therapy and surgical management of prosthetic mitral valve obstruction in our hospital. Between the January 2001 and April 2005, twelve patients with obstructed prosthetic mitral valve were admitted to our hospital. There were 8 female and 4 male patients ranging in age from14 to 60 years, with a mean age of 34±12 years. In all patients, the diagnosis of prosthetic valve thrombosis was confirmed by echocardiography including transesophageal echocardiography. All patients showed absence or muffering of prosthetic valve sounds. Two of 12 patients received thrombolytic therapy by using streptokinase. In the remaining 10 patients, operations were performed on an emergency basis with median sternotomy and cardiopulmonary bypass techniques using antegrade-retrograde combinated isothermic blood cardioplegia and moderate hypothermia. The principal risk factors of prosthetic valve thrombosis are inadequate anticoagulation or fluctuation in anticoagulation levels. Its treatment is either surgical or with thrombolytics. Although both treatment methods are effective, the latter is gaining favor. However, surgery is often required due to large thrombi and a presence of pannus formation.
Management of the Lower Extremity Arterial Injuries
(2004) Ekim, H.; Kutay, V.; Demirbaǧ, R.; Hazar, A.; Karadaǧ, M.
Objective: The incidence of vascular injuries has increased considerably during the past 40 years. However, although they represent less than 1% of all injuries, they deserve special attention because of their severe complications. Method: From May 1999 to March 2003, 30 patients with lower limp vascular injury were surgically treated in our clinic. Diagnosis was made by physical examination alone, or in combination with angiography. Primer vascular repairwas carried out where possible; if not possible the interposition graft was used. When an interposition graft was necessary either polytetrafluoroethylene(PTFE) or saphenous vein was used for vascular reconstruction. Results: The study group consisted of 24 males and 6 females, ranging in age from 14 years to 39 years with a mean age of 26.2±8.1 years. Penetrating trauma was the cause of a high proportion of cases. There were 31 arterial injuries. Only one patient had bilateral arterial injuries (right and left tibial arteries). Arterial injuries were most common in the femoral artery area, followed by the tibial and popliteal arteries. Surgical procedures performed were primary repair in 12 arterial injuries, saphenous vein interposition graft in 15, and PTFE interposition graft in 4. There were 18 patients with associated venous injury, of which 11 cases had primary repair, and 7 had vein graft interposition. There were concomitant femur fracture in 3 patients, and fibula fracture in 1. Conclusion: Patients who suffer lower extremity arterial injury should be transferred to vascular surgery centers as soon as possible. Anticoagulant treatment should be started as soon as possible to prevent the propagation of the thrombosis. Early fasciotomy is warranted if there is any suspicion of occurrence of compartment syndrome.
Movable Thrombus Attached on Mitral Anterior Leaflet
(Elsevier Ireland Ltd, 2011) Gumrukcuoglu, H. A.; Odabasi, D.; Ekim, H.; Akdag, S.; Ozdemir, M.
Penetrating Cardiac Injury: Report of Three Cases and Review of the Literature
(2007) Ekim, H.; Tuncer, M.
Background: Penetrating wound of the heart should be suspected in any patient with penetrating wound of the chest, upper abdomen or neck and particularly of the anterior aspect of the left chest wall in proximity to the heart. Case Report: In this paper, we present 3 cases of penetrating heart injury associated with pulmonary injury, which were successfully operated on. All patients were young males. Postoperatively, 2 patients requiring cardiopulmonary bypass (CPB) underwent revision operation due to bleeding. Early recognition of cardiac injury is the precondition of success. Hemodynamically unstable patients with penetrating cardiac wound should be taken to the operating room immediately without performing time-consuming procedures. Because of their small size and protected location, selective penetrating injuries to the coronary arteries are uncommon. Conclusions: The present cases of severe left ventricular injury associated with pulmonary injury, which might have had a disastrous outcome if delayed, underline the value of emergent surgery in unstable penetrating thoracic injury. Additionally, coronary revascularization may provide a safe alternative therapy to primary ligation for management of proximal left anterior descending artery (LAD) injuries.
Primary Aneurysm of the Greater Saphenous Vein: Case Report and Literature Review
(2010) Ekim, H.; Başel, H.; Odabaşi, D.; Özen, S.
Primary venous aneurysm is a rare vascular abnormality that can occur throughout the venous system. We report a proximal greater saphenous vein aneurysm in a twenty one-year old male. A venous duplex ultrasonographic examination showed a fusiform venous aneurysm (5 cm in diameter) of the proximal greater saphenous vein containing occluding thrombus adherent to its wall and extending to saphenofemoral junction. Operation was performed due to apparent symptoms and the potential risk for thromboembolic complications. Aneurysm was exposed through a vertical left femoral incision. It was totally filled with thrombi. Histopathological examination of the aneurysmal wall demonstrated fibrocellular thickening with irregular vascular proliferation with multiple reduplications of internal elastic lamina. Because of the risk of thromboembolism, saphenous vein aneurysm containing occluding thrombus extending to saphenofemoral junction should be treated surgically.
Primary Venous Aneurysm of the External Jugular Vein
(2002) Ekim, H.; Özen, S.
Repair of Ventricle Free Wall Rupture After Acute Myocardial Infarction: a Case Report
(2009) Ekim, H.; Tuncer, M.; Basel, H.
Introduction: Acute myocardial infarction (AMI) may culminate in sudden death by ventricular fibrillation, cardiogenic shock, and cardiac rupture. We present a case of postinfarction rupture treated by direct closure and coronary artery bypass grafting after thrombolytic therapy. Case report: A 67-year-old woman with cardiac risk factors of hypertension, diabetes mellitus, and being post-menopausal was admitted complaining of chest pain and sweating. Thrombolytic therapy with streptokinase was started due to acute myocardial infarction. But, reperfusion criteria were not achieved. Echocardiography revealed a moderate pericardial effusion with mild right chamber collapse and pericardial thrombus. Cardiac catheterization revealed totally occluded left anterior descending (LAD) and circumflex coronary arteries. She was taken to the operating-room immediately. The pericardium was opened and a large amount of blood with thrombus was removed. Her hemodynamic indices improved immediately. There was active bleeding from multiple sites with a 4 mm rupture. Cardiopulmonary bypass was established. Direct closure of rupture was carried out. Reversed autogenous saphenous vein bypass grafts were placed to the LAD and second obtuse margin coronary arteries. Postoperative recovery was uneventful and she was discharged from hospital in good condition. She remained asymptomatic during first year following the surgery. Conclusion: This case demonstrates that left ventricular free wall rupture is not always fatal and that early diagnosis and emergency surgical therapy may be successful. The combination of surgical repair with revascularization should be considered, because 80% of patients who experience LVFWR have multivessel coronary artery disease. © 2009 Ekim et al; licensee BioMed Central Ltd.
Should We Use Basilic Vein Transposition Instead of Prosthetic Graft for Creation of Secondary Arterio-Venous Fistula in Hemodialysis Dependent End Stage Renal Failure Patients
(2011) Odabaşi, D.; Ekim, H.; Ari, E.
Objective: Every end stage renal failure (ESRF) patient needs vascular access for hemodialysis (HD). Secondary arterio-venous fistula (AVF) constitution with prosthetic graft (PG) or basilic vein transposition (BVT) are good alternatives for patients who lost the chance of radio-cephalic arterio-venous fistula (RCAVF) or brachio-cephalic arterio-venous fistula (BCAVF). To evaluate the patency and complication rates after AVF formation a concurrent series of patients were reviewed. Material and Methods: From January 2006 to January 2010, 40 secondary HD access procedures were performed in 40 consecutive patients. All access procedures were planned on the basis of preoperative duplex ultrasonography (USG) scans of arm and forearm. Functional patency was defined as ability to cannulate for HD patient successfully. Primary and secondary cumulative functional patency of PG's and BVT's were determined with Kaplan Meier test, differences were analyzed with Log Rank test, differences in revision rates including thrombolysis, thrombectomies and operative revisions were analyzed with the Z test and the Fisher exact t-test. Results: Mean follow up was 48 (43-54 months) months. Risk factors were similar between the two groups. BVT group has the better patency ratings. Steal syndrome and odema were higher in BVT group. Conclusion: As long as the patient is a candidate for an upper arm secondary AVF creation based on anatomical criteria BVT is always be considered before a PG. Copyright © 2011 by Türkiye Klinikleri.
Tension Viscerothorax Due To Traumatic Diaphragmatic Rupture
(King Faisal Specialist Hospital and Research Centre, 2008) Ekim, H.; Tuncer, M.; Özbay, B.