Browsing by Author "Goktas, Ugur"

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A Case Report of a Patient With Cleft Palate Carrying the Risk of Tetraplegia
(Alliance Communications Group Division Allen Press, 2011) Isik, Daghan; Guner, Savas; Avcu, Serhat; Goktas, Ugur; Atik, Bekir
Spondyloepiphyseal dysplasia congenita (SEDC) is an inherited disorder of bone growth that results in short-trunk dwarfism, skeletal abnormalities, disorders in vision and hearing, atlanto-axial instability, and cleft palate. This important anomaly of the cervical vertebrae carries the risk of tetraplegia during cleft palate operations. In this case report, we discuss a case of spondyloepiphyseal dysplasia congenita, the perioperative and postoperative measures, and the risk of tetraplegia.
Clinical Outcomes of Suture Delay in Forehead Flap
(Lippincott Williams & Wilkins, 2012) Isik, Daghan; Kiroglu, Faruk; Isik, Yasemin; Goktas, Ugur; Atik, Bekir
The delay phenomenon is a surgical procedure performed to raise a wider skin flap and to improve the survival of skin flaps. Surgery, chemicals, sutures, and lasers can be used for the delay procedure. In this study, delayed forehead flaps created by suturing were used for coverage of nasal skin defects in eleven patients. In 7 patients, the cross-paramedian forehead flap was used to increase the extent of flap lengthening. In the first session, suture delay was performed on both sides of the forehead flap margin. In the second session, the flap was elevated and sutured to its new position, 7 to 10 days after the initial surgery. All flaps were completely viable, and patient satisfaction was optimal in all cases. The positive effect of surgical delay on flap survival has been shown in experimental and clinical studies. However, experimentally, suture delay or chemical delay procedures have been shown to be beneficial in flap survival only. Suture delay seems to be an inexpensive, effective, easily performed, a traumatic, and safe technique, especially among patients with systemic diseases such as diabetes or cardiovascular diseases, smoking patients who may lose the flap, or patients who need very wide and long flaps.
Comparing Effects of Low and High-Flow Anesthesia on Hemorheology and Coagulation Factors
(Professional Medical Publications, 2015) Binici, Orhan; Kati, Ismail; Goktas, Ugur; Soyaral, Lokman; Aytekin, Osman Cagatay
Objectives: In the current study, we compared the effects of low- and high-flow anesthesia techniques on hemorheology and coagulation parameters in patients who received sevofluran. Methods: Forty patients classified as Risk Group I-II according to American Society of Anesthesiologists' (ASA) guidelines who were scheduled to undergo general anesthesia were randomly assigned to one of two groups. Low-flow anesthesia was administered to the first group, and high-flow anesthesia was used in the second group. Blood samples were obtained in the preoperative and peroperative periods (at 60 and 120 min) for determination of blood and plasma viscosity, plasma oncotic pressure, international normalized ratio (INR), phorotrombin time (PT), activated partial phorotrombin time (aPTT) and fibrinogen. Blood was also drawn for analysis of factor VIII (FVIII) activity, which was measured in the preoperative period and at postoperative six hour. Results: The peroperative plasma viscosity was significantly low in Group 1 relative to Group 2. aPTT was significantly elevated at 60 minutes in Group 1 relative to Group 2, but the increase at 120 minutes was not significant. Conclusion: The effects of low-flow anesthesia on hemorheology were greater than those of high-flow anesthesia.
Comparison of Remifentanil, Alfentanil, and Fentanil Co-Administered With Propofol To Facilitate Laryngeal Mask Insertion
(Tubitak Scientific & Technological Research Council Turkey, 2010) Sizlan, Ali; Goktas, Ugur; Ozhan, Ceyda; Ozhan, Mehmet Ozguer; Orhan, Mehmet Emin; Kurt, Ercan
Aim: To compare the efficacy of different doses of fentanil, remifentanil, and alfentanil co-administered with propofol in patients undergoing minor surgery. Materials and methods: This double-blind, multi-centered, placebo-controlled study was conducted in 2 medical centers. One hundred forty-one ASA class I and II adult patients aged 18-65 years were included in the study. Patients received iv. 1 mu g kg(-1) fentanil (group F, n = 33), 10 mu g kg(-1) alfentanil (group A, n = 33), 0.5 mu g kg(-1) remifentanil (group R, n = 36), or saline (control group, n = 39) co-administered with propofol 2.5 mg kg(-1) without additives over 30 s. An LMA was inserted 90 s later. Conditions for the LMA insertion were assessed. The number of attempts, airway quality, and hemodynamic changes were recorded. Results: There were no significant differences in the demographic data among the groups. The LMA was more easily placed in the remifentanil group compared with the other groups. All first attempts for the LMA insertion were successful in the remifentanil group. When the opiates groups were compared with the control group, easier insertion rates were detected in all the opiate groups. LMA insertion was easiest in the remifentanil group, followed by the alfentanil, fentanil, and control groups, in that order. Heart rates and blood pressures were reduced in all groups, but no treatment was required. Conclusion: Opiates co-administered with propofol improved the LMA insertion conditions compared to propofol alone. Out of the opiates, remifentanil had the highest success rate.
Comparison of Two Different Right-Sided Double-Lumen Tubes With Different Designs
(Tubitak Scientific & Technological Research Council Turkey, 2012) Sazak, Hilal; Goktas, Ugur; Alagoz, Ali; Demirbas, Cilsem Sevgen; Guven, Ozlem; Savkilioglu, Eser
Aim: To compare usage of 2 right-sided double-lumen tubes (RDLTs) with different designs in thoracic anesthesia. Although the left-sided double-lumen tube (DLT) is preferred, the RDLT is necessary in some circumstances. Materials and methods: A total of 40 patients undergoing left thoracotomy were divided into 2 groups receiving a Rusch or Sheridan RDLT. The position of the RDLT was verified by clinical evaluation. It was also checked by fiberoptic bronchoscope (FOB). When malposition was detected, it was corrected using the FOB. The correct installation time of the RDLT, frequency of bronchoscopy, and left lung collapse time were recorded. Results: According to the bronchoscopic assessment, the rates of patients with a misplaced RDLT in the supine (40% vs. 50%) and lateral decubitis position (35% vs. 30%) were similar between the groups (P > 0.05). Ratios of total malpositions to total bronchoscopies were similar. The most frequent malposition types were displacement of RDLTs proximally or distally. Correct RDLT installation time (262 vs. 291 s) and collapse time of the left lung (215 vs. 234 s) were comparable between the groups (P > 0.05). Conclusion: With the aid of bronchoscopic evaluation, our data suggest that Rusch and Sheridan RDLTs are not superior to each other in one-lung ventilation. They were similar in terms of malpositions.
Cylothorax Developing Due To Thrombosis in the Subclavian Vein
(Modestum Ltd, 2013) Isik, Yasemin; Goktas, Ugur; Binici, Orhan; Kati, Ismail
Chylothorax, which is a rare complication of central venous catheterization, is an accumulation of lymphatic fluid in the pleural space as a result of impairment of the integrity of ductus thoracicus. In this case report, we will look over chylothorax related to thrombus developing following subclavian vein catheterization.
Cytomegalovirus Pneumonia and Pulmonary Haemorrhage in a Patient With Polyarteritis Nodosa
(Pakistan Medical Assoc, 2016) Sunnetcioglu, Aysel; Sunnetcioglu, Mahmut; Emre, Habib; Soyoral, Lokman; Goktas, Ugur
Cytomegaloviruses are opportunistic pathogens that cause lung infection in immunocompromised individuals. A 24-year-old male was admitted to the hospital with complaints of cough, fever and dyspnoea. He was receiving immunosuppressive therapy for polyarteritis nodosa. A chest X-ray showed heterogeneous right-sided opacity in the middle and lower lung zones. The diagnosis of cytomegalovirus pneumonia was confirmed by positive test for serum cytomegalovirus IgM antibodies. One day after admission, haemoptysis developed and patient with hemoptysis who had shortness of breath was intubated. Computed tomography (CT) showed bilateral alveolar opacity.
Delayed Diagnosed Subclinic Von Willebrand Disease Case Report
(derman Medical Publ, 2013) Ceylan, Mehmet Fethi; Guner, Savap; Turktas, Ugur; Goktas, Ugur; Demir, Cengiz
The evaluation of the patients who will be operated in terms of preoperative bleeding diathesis is an obligation. This evaluation contains history, physical examination and tests of haemostasis. That are as a routin used among these tests are the number of platelet, PT, aPTT and the values of INR. Despite these assessments, all of the bleeding-clotting disorders have not been able to be determined. Therefore, due to omitted diagnosis of bleeding diathesis, in orthopedic procedures, hemartroz hemarthrosis, intramuscular hematoma, and abandoned bleeding may develop in the postoperative period. These complications are the causes of morbidity and mortality. In one of our cases, who had osteochondroma in his femur diaphysis and also whose preoperative history, examination and mentioned tests were normal, developed recurrent bleeding and hematoma in the operative area in the postoperative period. Von Willebrand disease was determined in the examination which was carried out by being considered bleeding diathesis. As a result, seen at the rate of 1% in community screening and the most common inherited bleeding diathesis, in the cases of Von Willebrand disease's subclinical a good patient history should be taken in order to be able to be early dianosed diagnosed and to be able to be prevent the complications and also the necessary tests for diagnosis should be performed.
The Differences in Cerebral Oxygenation Among Patients Undergoing Thyroidectomy in Different Positions and Comparison of Their Effects on Nausea-Vomiting
(Drunpp-sarajevo, 2012) Gunes, Haci Yusuf; Goktas, Ugur; Kati, Ismail; Yuce, Hasan Husnu; Bartin, Serap
Background: Hyperextension of the patient's neck associated with distortion and vasospasm of the vertebral and internal carotid arteries intra-operatively. In this study we aimed to investigation of whether there is effects of supine, slight neck hyperextension and semi-seated and neck hyperextension positions of patients on postoperative nausea and vomiting (PONV) via regional cerebral oxygen saturation (rSO(2)). Methods: ASA I-II group of 40 adult patients for whom elective thyroid operations under general anesthesia (GA) were planned, were divided into 2 randomized groups. The patients in the Group 1 were positioned in the hyperextension of the neck at 45 degrees semi-seated position and in the Group 2 patients were positioned in the supine position. Results: The heart rate (HR), and mean arterial pressure (MAP) values were found to be statistically significantly higher in the first group than the second group in a few values (p<0.05). There were no significant differences between the groups when they were compared for left and right cerebral oxygen saturation (p>0.05). No correlation was determined between the cerebral arterial desaturation and rates of PONV. Conclusions: It was concluded that cardiovascular changes due to hyperextension of the neck in a semi-seated position during surgery under general anesthesia, despite a cerebral desaturation in rSO(2) that remained within the cerebral auto-regulation range and there is no correlation of PONV with either neck hyperextension in the semi-seated position or desaturation conditions with less than a 20% decrease in rSO(2).
Difficult Airway Management in Lymphangiomatos Macroglossia
(Blackwell Publishing, 2008) Goktas, Ugur; Tekin, Murat; Kati, Ismail; Toprak, Kemal; Yuece, Hasan Huesnue
The Effect of Gsm Mobile Phone Electromagnetic Field on Femur Fracture Healing in a Rat Model
(derman Medical Publ, 2012) Kalender, Ali Murat; Goktas, Ugur; Ozbag, Davut; Erturkr, Cemil; Okumus, Mehmet; Guner, Savas; Un, Ahmet
Aim: Biological effects of electromagnetic field (EMF) and their consequences on human health have been the subject of much interest and research in recent years. The aim of this study was to investigate the effects of 900 MHz EMF on femur fracture healing in a rat model. Material and Method: After sixty male Sprague-Dawley rats were exposed to a closed right femur fracture under anesthesia, the reduction and fixation were done with a 21 g needle. Then, 900 MHz radiation (2 W peak output power and 1.04 mW/cm2 power density) was applied to EM group for one hour/day for seven days. The healing was assessed using radiological (Lane and Sandhu classification), histological (Huo scale for callus evaluation), and biomechanical (3-point bending) measures at 2nd, 4th and 6th weeks after fracture. Results: Fracture healing, as assessed radiologically and histopathologically, in Group EM and control animals was similar at 2nd, 4th and 6th weeks. Fracture healing, as assessed biomechanically, was significantly better in Group EM compared to controls in those sacrificed at 2nd week post-procedure (p <0.05). Biomechanical strength was not different between the groups at 4th and 6th weeks. Discussion: 900 MHz EMF from a mobile phone in this rat femur fracture model resulted in no significant difference in healing from controls not exposed to EM radiation.
The Effect of Magnesium Sulfate on Uncontrollable Contractions in a Tetanus Case
(Lippincott Williams & Wilkins, 2012) Kati, Ismail; Goktas, Ugur; Cagan, Eren; Guzel, Abdulmenap; Bartin, Serap
Tetanus is a rare disease caused by the exotoxins of Clostridium tetani. Higher mortality rates have been reported among the elderly and in the newborn. In this report of a tetanus case, the treatment and prognosis of contractions resistant to diazepam, midazolam, and atracurium infusion has been evaluated.
Effectivity of One Session Charcoal Hemoperfusion Treatment in Severe Carbamazepine Poisoning
(Kowsar Publ, 2013) Isik, Yasemin; Soyoral, Lokman; Karadas, Sevdegul; Emre, Habib; Cegin, Muhammed Bilal; Goktas, Ugur
A carbamazepine intoxication with suicide attempt is a relatively common clinical problem that presenting with coma, respiratory depression, arrhythmia, hemodynamic instability and even death. We report a case of severe carbamazepine poisoning that was successfully treated with one session charcoal hemoperfusion. On admission, the patient was comatose and required ventilator support. Hemoperfusion with coated activated charcoal successfully decreased the serum carbamazepine concentration from 45 mu g mL(-1) to 21 mu g mL(-1) within 2 h, with subsequent clinical improvement.
Effects of Fentanyl With Levobupivacaine on Cognitive Functions and Cerebral Oxygenation
(Modestum Ltd, 2013) Cegin, Muhammet B.; Goktas, Ugur; Kati, Ismail; Guzel, Abdulmenap; Binici, Orhan
Preoperative risk assessment may fail in most patients who may be exposed to postoperative neurological sequelae. The aim of this study was to assess the effects of Fentanyl added to epidural levobupivacaine on cerebral oxygenation and cognitive functions. There was a negative correlation between age and MMT, and a positive correlation between SpO(2) and MMT. MMT scores of Group 2 at postoperative first hour and fifth hours were lower than those of Group 1. It was concluded that while fentanyl added to epidural local anesthetic had no effect on hemodynamic parameters, SpO(2), and right-left cerebral oxygen saturation, and although it may have caused a decrease in MMT scores in the early postoperative period, it did not cause impairment in cognitive functions.
Effects of Lidocaine Infiltration on Cost of Rhinoplasty Made Under General Anesthesia
(Lippincott Williams & Wilkins, 2011) Goktas, Ugur; Isik, Daghan; Kati, Ismail; Atik, Bekir; Soyoral, Lokman
This study aimed to compare the effects of combined and noncombined lidocaine with adrenaline infiltration in general anesthesia (GA) procedures, in which the standard anesthesia depth is monitored by Bispectral Index monitoring, on minimum alveolar concentration (MAC) levels and the costs. Following approval by the local ethics committee, an American Society of Anesthesiologists physical status I-II group of 40 adult patients for whom elective rhinoplasties under GA were planned was divided into 2 double-blind randomized groups. In group 1, GA and lidocaine + adrenaline were administered, whereas in group 2, only GA and adrenaline were administered. All the patients who had been taken to the operation room underwent electrocardiography and measurements of the peripheral oxygen saturation, end-tidal carbon dioxide, heart rate, mean blood pressure, and Bispectral Index monitoring. Using the operation time and the MAC% values, the total consumed inhalation agent amounts were calculated, and the cost difference was determined. The mean blood pressure values were lower in group 1 (P < 0.05). In group 1, the MAC% was 20.83% lower than that of group 2; the consumed desflurane amount was 20.29%, and the cost was 20.29% lower than that of group 2 (P G 0.05). In rhinoplasties under GA, the lidocaine + adrenaline combination infiltration not only decreased inhaled anesthetic requirement and cost but also supported the hemodynamic stability. In addition, surgical satisfaction increased in the lidocaine + adrenaline group because of small number of agitated patients during the recovery period.
Effects of Sugammadex and Neostigmine on Renal Biomarkers
(int Scientific information, inc, 2016) Isik, Yasemin; Palabiyik, Onur; Cegin, Bilal Muhammed; Goktas, Ugur; Kati, Ismail
Background: Neostigmine, the currently commonly used agent for reversal of neuromuscular blockade. Sugammadex is a novel and unique compound designed as an antagonist of steroidal neuromuscular blockers. In this study, we evaluated the effects of sugammadex or neostigmine on kidney functions in patients scheduled for elective surgery. Material/Methods: Patients scheduled for a surgical procedure under desflurane/opioid anesthesia received an intubating dose rocuronium. Patients were divided into 2 groups receiving either sugammadex or neostigmine atropine to reverse neuromuscular blockade. Cystatin C, creatinine, urea, blood urea nitrogen, sodium, potassium, and calcium levels in the blood and alpha(1)microglobulin, beta(2)microglobulin, and microalbumin levels in the urine were measured. Results: There was no significant difference between the groups with regard to the demographic data. In the Neostigmine Group, although beta(2)microglobulin and microalbumin were similar, a significant increase was found in the postoperative alpha(1)microglobulin and cystatin C values. In the Sugammadex Group, although beta(2)-microglobulin and cystatin C were similar, a significant increase was found in the postoperative alpha(1)-microglobulin and microalbumin values. The only significant difference was cystatin C value variation in the Neostigmine Group compared to the Sugammadex Group. Conclusions: We believe that the use of more specific and sensitive new-generation markers like cystatin C to evaluate kidney function will provide a better understanding and interpretation of our results. Sugammadex has more tolerable effects on kidney function in patients than does neostigmine. However, when compared to preoperative values, there is a negative alteration of postoperative values. Neostigmine and sugammadex do not cause renal failure but they may affect kidney function.
Effects of Theophylline With Methylprednisolone Combination Therapy on Biomechanics and Histopathology in Diaphragm Muscles of Rats
(Springer/plenum Publishers, 2016) Yuzkat, Nureddin; Kati, Ismail; Isik, Yasemin; Kavak, Servet; Goktas, Ugur; Cengiz, Nurettin
The purpose of this study was to investigate the effects of theophylline and methylprednisolone on the mechanical response and histopathology of hemidiaphragm muscle in rats. In the current study, we aimed to investigate the effects of theophylline and methylprednisolone, which are frequently used in clinics and which have different effects on the respiratory system and on the biomechanics and histopathology of the diaphragm muscle. The study included four groups of rats. Group T received 1 mg/kg of intraperitoneal theophylline, group M received 2 mg/kg of intraperitoneal methylprednisolone, group TM received 1 mg/kg of intraperitoneal theophylline plus 2 mg/kg of intraperitoneal methylprednisolone, and group K received of 1 mL intraperitoneal isotonic solution (of 0.9 % NaCl). The medications were continued for 7 days in each group. The rats underwent cervical dislocation under anesthesia on the eighth day, and their diaphragm samples were extracted. The left hemidiaphragm was used for the investigation of biomechanical parameters, and the right hemidiaphragm was used for the histopathological evaluation. It was observed that the medication administered in group T increased the contraction strength and duration compared with that in group M. Additionally, the duration of semi-relaxation was prolonged in group T compared with group M. The highest contraction strength and the longest contraction period among all of the groups were observed in group TM. It was concluded that the combined use of theophylline and methylprednisolone had positive effects on the contraction strength and the durations of contraction and semi-relaxation of the diaphragm muscle. In addition, both drugs had synergistic effects on each other.
Efficiency of Hematocrit, Lymphocyte, C-Reactive Protein and Transferrin Levels in Predicting Mortality in Intensive Care Unit Patients
(Modestum Ltd, 2015) Palabiyik, Onur; Isik, Yasemin; Cegin, Muhammed Bilal; Goktas, Ugur; Kati, Ismail
The effectiveness of many physiological parameters and laboratory tests was investigated in predicting mortality. In this study, we investigated hematocrit, C-reactive protein, transferrin and total lymphocyte count along with Acute Physiology and Chronic Health Evaluation II and Glasgow Coma Scores of patients who were hospitalized in the intensive care unit. The data were retrospectively analyzed from hospital information management system, doctors' records and nurse observing forms. The mortality rate was 42.6%. The Acute Physiology and Chronic Health Evaluation II scores were significantly higher in cases with mortality compared to those without mortality. The admission and discharge Glasgow Coma Scores were significantly lower in patients who showed mortality compared with patients without mortality. Admission and discharge hematocrit and transferrin values were significantly lower in cases with mortality compared to those without mortality. Discharge C-reactive protein values were significantly higher in cases with mortality compared to those without mortality. Discharge total lymphocyte count values were significantly lower in cases with mortality compared to those without mortality. Consequently, we believe that hematocrit and transferrin values at the time of admission to the intensive care unit and total lymphocyte count and C-reactive protein at the time of discharge from the intensive care unit can be effective in predicting mortality.
Evaluation of Nosocomial Infections.and Antibiotic Resistance Profiles in the Anesthesiology Intensive Care Unit
(Galenos Yayincilik, 2010) Goktas, Ugur; Yaman, Gorkem; Karahocagil, Mustafa Kasim; Bilici, Adnan; Kati, Ismail; Berktas, Mustafa; Akdeniz, Hayrettin
Objective: We aimed to determine the etiological agents of nosocomial infections and susceptibility patterns in our intensive care unit (ICU). Materials and methods: The study included 341 patients (mean age 47.8-122.7 years) who were admitted to our ICU longer than 72 hours between May 2007 and July 2008. All the patients were followed-up daily together with infectious disease specialists. Nosocomial infections were defined according to the CDC criteria (Centers for Disease Control and Prevention). Blood cultures and cultures from infectious foci were taken from patients who were thought to have a nosocomial infection. Results: A total of 141 episodes of nosocomial infection developed in 57 patients (16.7%), including ventilator-associated pneumonia (74 episodes, 52.5%), primary bacteremia (n=49, 34.8%), urinary system infections (n=15, 10.6%), and surgical site infections (n=3, 2.1%). Isolated bacteria were as follows: S. aureus (22%), P. aeruginosa (15.6%), Acinetobacter spp. (14.2%), E. coli (14.2%), Klebsiella spp (11.4%), coagulase-negative staphylococcus (CNS) (7.8%), Enterococcus spp. (5%), Enterobacter spp. (4.3%), S. pneumoniae (2.8%), and S. maltophilia (2.1%). Resistance rates to oxacillin were 90.3% in S. aureus and 81.8% in CNS isolates. In Enterococcus spp., resistance to ampicillin was 71.4%, high-level aminoglycoside resistance was 85.7%, with no resistance to vancomycin. Extended-spectrum beta-lactamase-positive strains accounted for 70% for E. coil and 93.7% for Klebsiella species. Conclusion: Monitoring of nosocomial infections and infectious agents together with resistance rates in the ICU has great importance in both the prevention of infections and rational antibiotic use.
Hungry Bone Syndrome as a Cause of Recurrent Laryngospasm After Parathyroidectomy
(Lippincott Williams & Wilkins, 2011) Isik, Yasemin; Goktas, Ugur; Yuzkat, Nureddin; Kati, Ismail