Browsing by Author "Gur, Ali Kemal"

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Adipose Tissue Derived Stem Cell Therapy for Diabetic Foot
(Excerpta Medica inc-elsevier Science inc, 2014) Odabasi, Dolunay; Gur, Ali Kemal; Kunt, Aysegul; Kunt, Alper Sami
The Association of Aneurysms Related To Arteriovenous Fistulas and Chronic Hepatitis C Virus Infection in Maintenance Hemodialysis
(Baycinar Medical Publ-baycinar Tibbi Yayincilik, 2014) Odabasi, Dolunay; Gur, Ali Kemal
Background: This study aims to investigate a possible association of aneurysm of arteriovenous fistulas (AVFs) and chronic hepatitis C virus (HCV) infection in maintenance hemodialysis (HD) patients. Methods: In this cross-sectional study, 179 HD patients with AVFs who were referred to Van Yuzuncu Yil University Hospital between January 2010 and December 2010 were evaluated. Data including age, sex, duration of renal failure, number of operated fistulas, number of patients with aneurysmal fistulas and chronic HCV infection were recorded. Doppler ultrasonography was performed to determine AVF patency and aneurysm flow. Results: Thirthy-three patients (group A) had aneurysm and 21 (group A1) of these patients had chronic HCV infection, while 12 (group A2) had no chronic HCV infection. Hundred and forty-six patients (group B) had no aneurysm. Of these patients, 15 (group B1) had chronic HCV infection, while 131 (group B2) had no chronic HCV infection. There were no statistical differences in age, sex, and duration of renal failure between the groups. The mean AVF flow was higher in group A1 (856 +/- 123 ml/min) compared to group A2 (560 +/- 98 ml/min) (p<0.05). The mean AVF flow was also higher in group B1 (536 +/- 54 ml/min) compared to group B2 (373 +/- 47 ml/min) (p<0.05). Criyoglobulinemia positivity was statistically significant in aneurysmal AVFs (group A1 and A2) than nonaneurysmal AVFs (group B1 and B2) (p<0.001). Conclusion: Our results demonstrated that aneurysm of AVFs in maintenance HD patients was associated with chronic HCV infection.
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 One- and Two-Stage Basilic Vein Transposition for Arterio-Venous Fistula Formation in Haemodialysis Patients: Preliminary Results
(Clinics Cardive Publ Pty Ltd, 2013) Ozcan, Sedat; Gur, Ali Kemal; Yener, Ali Umit; Odabasi, Dolunay
Objective: This study aimed to compare the results of one-and two-stage basilic vein transposition (BVT) in haemodialysis patients. Methods: This was a non-randomised, retrospective study between January 2007 and January 2012 on 96 patients who were diagnosed with end-stage renal failure (ESRF) (54 males, 42 females; mean age 43.6 +/- 14 years) and underwent one- or two-stage BVT in our clinic. All patients who were not eligible for a native radio-cephalic or brachio-cephalic arterio-venous fistula (AVF) were scheduled for one-or two-stage BVT after arterial (brachial, radial and ulnar) and venous (basilic and cephalic) Doppler ultrasonography. Patients were retrospectively divided into two groups: group 1, basilic vein diameter > 3 mm and patients who underwent one-stage BVT; and group 2, basilic vein diameter < 3 mm and patients who underwent two-stage BVT. In group 1, the basilic vein with a single incision was anastomosed to the brachial artery, followed by superficialisation. In group 2, the basilic vein was anastomosed to the brachial artery and they underwent the superficialisation procedure one month postoperatively. Fistula maturation and postoperative complications were assessed. Results: The mean diameter of the basilic vein was statistically significantly higher in group 1 (3.46 +/- 0.2 mm) than in group 2 (2.79 +/- 0.1 mm) (p < 0.05). In terms of postoperative complications, thrombosis, haemorrhage and haematoma were significantly higher in group 1 (34, 36 and 17%, respectively) than in group 2 (23, 14 and 6%, respectively) (p < 0.05). The rate of fistula maturation was significantly lower in group 1 (66%), compared to group 2 (77%) (p < 0.05). Time to fistula maturation was significantly shorter in group 1 (mean 41 +/- 14 days), compared to group 2 (mean 64 +/- 28 days) (p < 0.05). Conclusion: Two-stage BVT was superior to one-stage BVT due to its lower rate of postoperative complications and higher fistula maturation, despite its disadvantage of late fistula use. Although the diameter of the basilic vein was larger in patients who underwent one-stage BVT, we observed that one-stage BVT was disadvantageous in terms of postoperative complications and fistula maturation.
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.
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.
Impact of Elevated Serum Estradiol/Free Testosterone Ratio on Male Varicose Veins in a Prospective Study
(Springer Wien, 2015) Ozcan, Sedat; Odabasi, Dolunay; Kurt, Tolga; Gur, Ali Kemal; Kunt, Aysegul; Balaharoglu, Yavuz; Kunt, Alper Sami
Although some studies indicate an association between increased levels of estradiol and varicose veins in women, the role of sex hormones on varicose veins have a question mark in men. We investigated estradiol-2/free testosterone (E2/fT) ratio relationship on varicosity in 100 male patients dividing them into two groups. Group A (n = 46) had varicose veins with endocrinological problems, especially infertility, whereas group B (n = 54) also had varicose veins but no endocrinological problems. Venous blood samples were drawn from both groups in the morning to detect the levels of serum estradiol (E2), androstenedione, dehydroepiandrostenedione sulphate and free testosterone (fT). Patient history, physical examination, colour duplex ultrasound of both limbs and classification of CEAP were performed in both groups. Serum E2/fT ratio was calculated in correspondence with CEAP classification. CEAP classification is the varicosity classification, and it is concerned about the clinical class (C), etiology (E), anatomical distribution (A) and underlying pathophysiology (P). E2/fT ratio was significantly higher in group A (4.18 +/- A 0.54) compared with group B (2.98 +/- A 0.36). Moreover, there is a high correlation between serum E2/fT ratio and CEAP clinical classification in group A (4) compared with group B (2). Serum E2/fT ratio is associated with varicose veins in male patients.
Isolated Tricuspid Valve Repair for Libman-Sacks Endocarditis
(Wiley-blackwell, 2014) Gur, Ali Kemal; Odabasi, Dolunay; Kunt, Ayse Gul; Kunt, Alper Sami
Cardiac involvement is a well-known complication of systemic lupus erythematosus (SLE), which can involve most cardiac components, including pericardium, conduction system, myocardium, heart valves, and coronary arteries. Libman-Sacks (verrucous) endocarditis is the characteristic cardiac valvular manifestation. Although isolated tricuspid valve involvement is quite rare, we report a patient with SLE who had tricuspid stenosis caused by Libman-Sacks endocarditis. The patient underwent successful commisurotomy and Kay annuloplasty on the tricuspid valve under cardiopulmonary bypass.
Penetration of Arcus Aorta by Tunneled Cuffed Catheter: Should Fluoroscopic Guidance Be Preferred
(Wichtig Publishing, 2014) Yavuz, Alpaslan; Yuksel, Enver; Gur, Ali Kemal; Bora, Aydin; Bulut, Mehmet Deniz; Emre, Habib
Should Plication or Graft Be Used in Pulmonary Artery Aneurysm Operations
(Discovery Publication, 2018) Ozbek, Baburhan; Gur, Ali Kemal; Aykac, Mehmet Coskun; Yargi, Mahmut
Objective: Pulmonary artery aneurysms (PAA) are rare diseases generally diagnosed coincidentally. Although most of the PAA patients are asymptomatic, they can be symptomatic due to complications such as rupture, pulmonary valve leakage, thromboemboli, dissection and pressure on coronary arteries and pulmonary valve. Our aim in this study was to compare plication and graft usage techniques in PAA operations. Material and Method: A total of 11 patients who had elective PAA operation between January 1, 2010 and December 31, 2018 in our clinic and had registered demographical information were retrospectively examined. Patients included in the study were separated into two groups as those who had plication in PAA (Group 1) and those who had tube graft change in PAA (Group 2). There were six patients in Group 1 (2 F, 4 M) and five patients (2 F, 3 M) in Group 2. Preoperative and postoperative data of the patients in both groups were registered and examined in detail. Findings: Among the 11 patients who had surgical repair due to PAA, seven were male and four were female. Although the ages of the patients changed between 38 and 65, the average age was 53.4 years. There was no significant difference in diabetes mellitus, hypertension, coronary artery disease among the groups. Chronic obstructive pulmonary disease (COPD) was observed more in Group 1. Operations were made under cardiopulmonary bypass. Aortic cross clamp duration (ACC) was 96 +/- 18 minutes in Group 1 and 105 +/- 22 minutes in Group 2 (p>0.05). Average intensive care unit hospitalization duration of the patients was 2.5 +/- 1.5days in Group 1 and 3.4 +/- 1.5 days in Group 2 (p<0.05) but no statistically significant difference was found among the average hospitalization durations of the patients (p>0,05). Result: Although observed frequently, PAA can cause mortality especially due to causes such as rupture and dissection. Surgical intervention is required in patients with PAA over 5,5 cm. Although different views are available in literature, in our study, we detected tube graft usage to be more effective in surgical treatment. As there is a change of aneurysm reformation in postoperative followups of the patients who had plication especially, we suggest graft usage in PAA surgical treatment.
Spontaneous Rupture of the Right Ventricle on Cardiopulmonary Bypass
(Baycinar Medical Publ-baycinar Tibbi Yayincilik, 2015) Ozcan, Sedat; Gur, Ali Kemal; Odabasi, Dolunay
Wall ruptures after myocardial infarction are rare. Early diagnosis and treatment decrease mortality significantly. In this article, we present a 68-year-old female patient who admitted to our cardiology clinic due to inferior myocardial infarction one month ago and was placed a stent to right coronary artery with primary percutaneous transluminal coronary angioplasty. Patient was operated under elective conditions. Coronary artery bypass graft operation was performed to the left coronary arterial system. Right coronary artery distal bed was not operated due to ungraftable conditions. Right ventricular wall spontaneously ruptured during venous decannulation. Recannulation was performed and the ruptured area was repaired using pericardial mesh. Patient was discharged at seventh postoperative day without any problem.
Successful Retrieval of the Detached Porous Metallic Tip of a Mechanical Aspiration Catheter During Thrombectomy in a Case With May-Thurner Syndrome: a Case Report
(Thieme Medical Publ inc, 2016) Yavuz, Alpaslan; Andic, Cagatay; Gur, Ali Kemal; Goya, Cemil; Bora, Aydin; Beyazal, Mehmet
Modern, minimally invasive techniques used to treat deep venous thrombosis, such as percutaneous mechanical thrombectomy (PMT) and catheter-directed thrombolysis, have gained worldwide acceptance. PMT has the advantage of speed and is also associated with improved outcomes, shortened hospital stays, and low complication rates. The main complications associated with PMT have been primarily due to iatrogenic vascular damage resulting in perforation, embolic occlusion, and arteriovenous fistula formation; to date, there has been no publication in the literature describing complications resulting from device failure. We present an unusual complication of PMT resulting from detachment of the catheter tip during thrombectomy and bailout technique employed.
Surgical Treatment of Cardiac Myxomas: a 23-Case Experience
(Forum Multimedia Publishing, Llc, 2018) Gur, Ali Kemal; Aykac, Mehmet Coskun
Objective: Although seen rarely compared to all tumors, cardiac tumors are tumors which may have a mortal course with possible complications. The most common cardiac tumor in adults is myxoma with its benign character. The results of cardiac tumors resected with open cardiac surgery in our center are reported in this study. Materials and Methods: Twenty-three cardiac tumor patients electively operated on in our clinic between January 2010 and August 2017 were retrospectively included in the study. Information of the patients participating in the study were registered. The patients were between 25 and 67 years of age, and 18 were female (72.3%), and 5 were male (21.7%). The average age of the patients was 42.1 +/- 8.9 years. Echocardiography was used for diagnosis in all patients. There was no common complaint for the patients, with the complaints changing according to tumor location. All patients were operated on by means of cardiopulmonary bypass with aortic cross-clamp and bicaval cannulation. Preoperative demographical characteristics and perioperative and postoperative data were registered for the patients and were evaluated statistically. Results: Nineteen of the tumors (82.6%) were in the left atrium, and 4 were (17.4%) in the right atrium. Diameter of the tumors changed between 2.5 x 1.5 and 8.5 x 6.5 cm. The tumoral structure was resected together with the solid tissue located in its root in all patients operated on. Pericardial patch was used for 11 (47.8%), and primary closure was used for 12 (51.2%) of the defects. Early and late mortality was not observed in any patient. Conclusion: To prevent possible complications of cardiac myxomas, they need to be resected together with the surrounding healthy tissue as soon as possible after the diagnosis. Cardiac myxomas can be operated on with a tolerable operation risk. Echocardiography should be made annually for any possible relapse after operation.
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.