Publications by authors named "Sinan Yılmaz"

22 Publications

  • Page 1 of 1

The Efficacy of Intraoperative Freehand Erector Spinae Plane Block in Lumbar Spondylolisthesis: A Randomized Controlled Study.

Spine (Phila Pa 1976) 2021 Jan 25. Epub 2021 Jan 25.

Department of Anesthesiology and Reanimation, Bezmialem Vakif University, 34093 Istanbul, Turkey Department of Neurosurgery, Special Aile Hospital, 34590 Istanbul, Turkey Department of Biostatistics, Bezmialem Vakif University, 34093 Istanbul, Turkey.

Study Design: Prospective randomized comparative (controlled) study.

Objective: Management of the severe postoperative back pain followed the major spinal surgeries remains a challenge. The search is going on to find simple, efficient, and reliable perioperative analgesia with low side effects. We aimed to investigate the efficacy of intraoperative freehand erector spinae plane block (ESBP) after spinal surgeries.

Summary Of Background Data: A few case reports and randomized controlled studies demonstrated the analgesic efficacy of ESPB in spinal surgeries. Up-to-date, no randomized controlled studies investigated the effectiveness of ESPB on spinal instrumentation surgeries.

Methods: We randomly divided fifty-six consecutive adult patients who underwent posterior spinal instrumentation and fusion for spondylolisthesis into two groups. The study (ESPB) group (n = 28) received intraoperative freehand bilateral ESPB with a 20 ml mixture solution of 0.25% bupivacaine and 1.0% lidocaine equally divided into all operating levels. In the control group (n = 28), 20 ml physiological saline was injected. Postoperatively, we ordered 1 gr Paracetamol thrice/day, besides patient-controlled analgesia pumps with morphine. We performed a postoperative evaluation with a visual analog scale (VAS), morphine consumption, ESPB-related adverse effects, and postoperative length of hospital stay (PLOS).

Results: Morphine consumption was significantly higher in the controls within the first postoperative 24-hour 44.75 ± 12.3 mg versus 33.75 ± 6.81 mg in the ESPB participants (p < 0.001). Except for postoperative 24th-hour VAS (p = 0.127), all postoperative VAS scores recorded at all time-points were significantly higher in the controls (p < 0.05). In control individuals, the first analgesic demand time was shorter, and PLOS was longer (p < 0.001). Patient satisfaction was significantly higher in the ESPB group. We observed no significant difference regarding postoperative complications.

Conclusions: Intraoperative ESPB as a part of multimodal analgesia was effective. For posterior instrumented patients with spondylolisthesis, it can relieve postoperative backache and reduce opioid consumption.Level of Evidence: 1.
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http://dx.doi.org/10.1097/BRS.0000000000003966DOI Listing
January 2021

Questionnaire-guided evaluation of the effectiveness of long-term intravesical 0.2% chondroitin sulfate therapy in interstitial cystitis.

Int Urogynecol J 2020 Feb 11. Epub 2020 Feb 11.

Department of Public Health, Atatürk University Faculty of Medicine, Erzurum, Turkey.

Introduction And Hypothesis: To investigate the long-term feasibility, safety and effectiveness of intravesical chondroitin sulfate therapy in patients with one or more forms of chronic cystitis.

Methods: The study included 62 female patients with interstitial cystitis/painful bladder syndrome (IC/PBS) who received intravesical chondroitin sulfate (40 ml/80 mg) therapy between 2014 and 2018. A total of 15 doses of intravesical treatment were applied, once weekly in the first month and once monthly from the second month onward. A 3-day voiding diary, a visual analog scale (VAS), the O'Leary Sant Indexes (ICSI/ICPI), the Pelvic Pain and Urgency/Frequency Symptom (PPUFS) Scale and PPUF Bother scores were recorded and evaluated through prospective comparison before treatment and at the first month and first year. Patients were also assessed using the Global Response Assessment (GRA) at the end of the first month and first year to assess the effectiveness of responses to treatment.

Results: In the first month of treatment, 0.2% chondroitin sulfate was ineffective in 22.5% of patients, with mild improvement observed in 40.0% and moderate-good improvement in 37.0%. Evaluation at the end of the first year revealed mild improvement in 21.0% of patients and moderate-good improvement in 79.0%. Statistically significant improvements were observed in all scoring systems at 1 and 12 months compared with pre-treatment values (p < 0.001).

Conclusion: Long-term intravesical chondroitin sulfate therapy is a safe and highly successful therapeutic modality that produces significant improvement in patients' quality of life and symptoms in the treatment of IC/PBS.
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http://dx.doi.org/10.1007/s00192-020-04245-0DOI Listing
February 2020

Comparison of ultrasound-guided transversus abdominis plane block, quadratus lumborum block, and caudal epidural block for perioperative analgesia in pediatric lower abdominal surgery

Turk J Med Sci 2019 Oct 24;49(5):1395-1402. Epub 2019 Oct 24.

Department of Anesthesiology and Reanimation, Faculty of Medicine, Bezmialem Vakıf University, İstanbul, Turkey

Background/aim: Despite different regional anesthesia techniques used to provide intraoperative and postoperative analgesia in pediatric patients, the analgesic effectiveness of peripheral nerve blockades with minimal side effect profiles have not yet been fully determined. We aimed to compare the efficacy of ultrasound-guided transversus abdominis plane (TAP) block, quadratus lumborum (QL) block, and caudal epidural block on perioperative analgesia in pediatric patients aged between 6 months and 14 years who underwent elective unilateral lower abdominal wall surgery.

Materials And Methods: Ninety-four patients classified under the American Society of Anesthesiologists physical status classification system as ASA I or ASA II were randomly divided into 3 equal groups to perform TAP, QL or Caudal epidural block using 0.25% of bupivacaine solution (0.5 ml kg−1).

Results: Postoperative analgesic consumption was highest in the TAP block group (P < 0.05). In the QL block group, Pediatric Objective Pain Scale (POAS) scores were statistically significantly lower after 2 and 4 h (P < 0.05). The length of hospital stay was significantly longer in the caudal block group than the QL block group (P < 0.05).

Conclusion: We suggest that analgesia with ultrasound-guided QL block should be considered as an option for perioperative analgesia in pediatric patients undergoing lower abdominal surgery if the expertise and equipment are available.
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http://dx.doi.org/10.3906/sag-1812-59DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7018333PMC
October 2019

Assessing the Impact of Early Childhood Caries on the Development of First Permanent Molar Decays.

Front Public Health 2019 9;7:186. Epub 2019 Jul 9.

Department of Public Health, Faculty of Medicine, Atatürk University, Erzurum, Turkey.

The aim of this study was to evaluate whether the treated and untreated severe early childhood caries (ECC) in children would make any impact on the Permanent First Molar (PFM) decays. Our descriptive epidemiological study was conducted in Ataturk University, Faculty of Dentistry, Department of Pediatric Dentistry/Erzurum-Turkey, between 2011 and 2017. We included a total of 90 children (44 girls, 46 boys), and divided them into 3 equal groups. They were 6-9 years old with a mean age of 7.38 ± 0.89. Group 1 consisted of the patients who had previously been treated under GA, Group 2 included the patients with untreated ECC and with no previous dental treatment, and Group 3 consisted of the patients who had been periodically treated in normal clinical settings. Each patient was processed through; dmft scoring and PFM caries evaluation process in accordance with International Caries Detection and Assessment System (ICDAS), respectively. The obtained data was analyzed with SPSS v20.0. And also, we used tests. In accordance with ICDAS, we found that Group 3 had the highest mean number of PFMs (2 ± 1.43) and Group 2 had the lowest (1.43 ± 1.45). In Group 2, the number of ICDAS-determined carious PFMs were significantly lower than the other groups ( < 0.05). However, ICDAS score 6 was 0 in Group 1, while it was determined higher as 4.2% in Group 2. In respect to our research outcomes, which revealed that regardless of treated or not severe ECC had a significant impact on the PFMs, we strongly recommend that the parent of the children experiencing ECC should be informed about the risk of future caries in PFMs.
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http://dx.doi.org/10.3389/fpubh.2019.00186DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6629786PMC
July 2019

The relationship with clinical course and prognosis of serum endothelin-1, angiopoietin-2, and tie-2 levels in Crimean-Congo hemorrhagic fever

Turk J Med Sci 2019 08 8;49(4):1192-1197. Epub 2019 Aug 8.

Department of Public Health, Atatürk University, School of Medicine, Erzurum, Turkey

Background/aim: Crimean-Congo hemorrhagic fever (CCHF) is a serious illness characterized by fever and hemorrhage. Endothelin-1 (ET-1), angiopoietin-2 (Ang-2), and endothelial cell-specific receptor tyrosine kinase (Tie-2) are believed to be important markers of the pathogenesis, clinical course, and prognosis of the disease. The aim of this study was to determine ET-1, Ang-2, and Tie-2 levels in adults with CCHF and investigate the associations between these markers and pathogenesis and disease course.

Materials And Methods: Sixty CCHF patients were included in the study. The patients were classified according to disease severity criteria and Ang-2, Tie-2, and ET-1 levels were compared.

Results: Mean serum ET-1 level was 36.62 ± 27.99 pg/mL in the patient group and 3.70 ± 4.71 pg/mL in the control group (P = 0.001). Mean serum Ang-2 levels were 2511.18 ± 1018.64 pg/mL in the patient group and 3570.76 ± 209.52 pg/mL in the control group (P = 0.001). Mean serum Tie-2 levels were 7.35 ± 7.75 ng/mL in the patient group and 0.67 ± 1.26 ng/mL in the control group (P = 0.001).

Conclusion: Elevated ET-1 and Tie-2 levels were associated with more severe disease course, while Ang-2 level was negatively correlated with severity in adult CCHF patients. ET-1, Tie-2, and Ang-2 levels are important prognostic parameters in CCHF and may contribute significantly to treatment and follow-up.
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http://dx.doi.org/10.3906/sag-1812-10DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7018223PMC
August 2019

Evaluation of the Burden of Care and the Quality of Life in the Parents of Turkish Children with Familial Mediterranean Fever.

J Pediatr Nurs 2019 Sep - Oct;48:e21-e26. Epub 2019 Jun 5.

Department of Public Health, Ataturk University Medical Faculty, Turkey.

Purpose: This study aimed to determine the burden of care and the quality of life in caregivers of children with FMF.

Design And Methods: A cross-sectional study was conducted. Caregivers of the 109 children with FMF followed by a pediatric nephrology department were invited to join the study. Besides demographic information, the Zarit Care Burden Scale (ZCBS) and the World Health Organization Quality of Life Questionnaire-Short Form (WHOQOL-BREF) were used to collect data. Results for 90 patients were analyzed.

Results: The mean (±SD) ZCBS score of the caregivers was 44.78 ± 13.55. Care burden of the caregivers according to the ZCBS was categorized as; 61.1% (n = 55) mild, 25.6% (n = 23) moderate, and 13.3% (n = 12) severe. Although single caregivers were perceived as having a relatively higher burden than those who were married (80% and 36%), this difference was not significant. There were no statistically significant differences between ZCBS categories concerning caregivers' gender, educational status, and having comorbidities (p > 0.05). Also, there were no significant correlations between ZCBS and the WHOQOL-BREF domains (p > 0.05).

Conclusion: This study showed that the quality of life of the caregivers of children with FMF was not adversely affected, but a significant number of caregivers perceived care burden in moderate severity. Attention should be paid to the needs of caregivers, and they should be provided with adequate social, economic, physical, and psychological support.

Practice Implication: Responsive strategies to support caregivers' should be taken as means of social, economic, physical, and psychological needs.
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http://dx.doi.org/10.1016/j.pedn.2019.05.017DOI Listing
May 2020

Comparison of two different bone anchored hearing instruments: Baha-5 vs Ponto-plus.

Acta Otolaryngol 2019 Jun 7;139(6):517-521. Epub 2019 Apr 7.

c Department of Otorhinolaryngology , Kocaeli Medical Park Hospital , Kocaeli , Turkey.

Background: To our knowledge, there is no study comparing Ponto Plus (Oticon Medical AB, Askim, Sweden) and Baha 5 (Cochlear Bone Anchored Solutions AG, Mölnlycke, Sweden) available in the literature.

Aims/objectives: The primary aim was to compare the performance of the Baha 5 with the Ponto Plus device in terms of speech understanding in quiet and in noise. In addition, to determine statistically whether or not the difference between the abutment systems created any variation in terms of skin reaction.

Materials And Methods: Twenty bone-anchored hearing instrument users, ten in each group, were evaluated for speech understanding in quiet and several signal-to-noise ratios using the Turkish Matrix Test in a two-speaker setup. The Holger classifications were also reviewed to determine adverse skin reactions.

Results: It was revealed that the hearing results of both devices were similar and, when the skin reactions were compared, there was no statistically significant difference between the two-implant systems.

Conclusions And Significance: Because of the similar results of the groups, it can be interpreted as the key different device features such as the size, weight, colour alternatives, and the ease of use of the devices might be important in terms of device preference.
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http://dx.doi.org/10.1080/00016489.2019.1590637DOI Listing
June 2019

Survival after cardiopulmonary arrest in a tertiary care hospital in Turkey.

Ann Saudi Med 2019 Mar-Apr;39(2):92-99

From the Department of Biostatistics, Adnan Menderes Universitesi Tip Fakultesi, Aydin, Turkey.

Background: Despite significant improvements in the field of cardiopulmonary resuscitation (CPR) over the past 40 years, disparate survival rates are reported after in-hospital cardiac arrest (IHCA). Few studies have addressed the effect of comorbid conditions on survival after IHCA.

Objective: Examine IHCAs over a two-year period, determine survival rates, and assess the effects of comorbid diseases on survival after IHCA.

Design: Retrospective, cross-sectional study.

Setting: Tertiary care hospital in Turkey.

Patients And Methods: Patients who had an IHCA recorded in the data management system between 1 January 2016 and 31 December 2017 were evaluated using Utstein-style records for data collection. The Charlson Comorbidity Index (CCI) was scored retrospectively.

Main Outcome Measures: Return of spontaneous circulation (ROSC), survival in the first 24 hours, survival longer than 24 hours, and survival up to 6 months after discharge, CCI score, gender, age, location of IHCA, and first documented heart rhythm.

Sample Size: 370 IHCA cases.

Results: Of 502 patient, 370 met inclusion criteria. The presence of shockable rhythm was low (15.7%). The CCI was ≤3 in 10% (n=37) of all patients. A CPR duration of ≥20 minutes was the most important risk factor for ROSC. CCI ≥6 reduced ROSC-achieved cases by 2.8-fold ( P=.036) and increased the mortality rate by 2.8 fold ( P=.041). IHCA was most frequent in intensive care units (60.3%, n=223).

Conclusion: Assessing patients at risk in the hospital for comorbid conditions by CCI would be beneficial to prevent deaths related to IHCA. Close monitoring of patients with high CCI scores is advisable, as is making IHCA calls on time.

Limitations: Retrospective, small sample size, and no evaluation of the neurological condition of the discharged patients.

Conflict Of Interest: None.
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http://dx.doi.org/10.5144/0256-4947.2019.07.03.1400DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6464664PMC
January 2020

Fertility Preferences of Women in a Province Center.

Eurasian J Med 2018 Oct;50(3):187-192

Department of Public Health, Atatürk University, Erzurum, Turkey.

Objective: Fertility preferences and status are important parameters involved in reproductive health. The aim of the present study was to define some characteristics of the fertility preferences of women aged 15-49 years in our region.

Materials And Methods: This cross-sectional study was conducted between 2013 and 2015. The study population consisted of 627 married women aged 15-49 years living in a city center. A questionnaire about socio-demographic characteristics, pregnancy and birth traits, and fertility preferences was applied. Chi-square, Mann-Whitney U, and Spearman correlation tests were analyzed using Statistical Package for Social Sciences (SPSS) version 20.00 (IBM, SPSS Corp.; Armonk, NY, USA) software for statistical analyses. A p<0.05 was considered statistically significant.

Results: The mean age of the women participating in the survey was 33.03±7.1 years. Median age at marriage was 20 years, mean age at first pregnancy was 21 years, and mean number of pregnancies was 3.07 years, with 14.6% having had more than five pregnancies and 34.6% having experienced previous miscarriages. The mean number of live births was 2.2, and 21.5% of women had waited 24 months between pregnancies. Additionally, 77.7% reported using family planning of any kind, with 62.1% using the modern method. Women's ages at first marriage varied significantly depending on education (p<0.001) and working status (p<0.001), whereas ages at first pregnancy varied significantly depending on educational status (p<0.001). The total number of pregnancies varied significantly depending on level of education, working status, and family income (p<0.001). Times between two pregnancies among women with histories of more than two pregnancies differed significantly depending on educational status (p<0.05).

Conclusion: The most important factors in women's fertility preferences are education, work, and income. Increasing women's educational levels can lead to safe and healthy pregnancies and births.
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http://dx.doi.org/10.5152/eurasianjmed.2018.17236DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6263224PMC
October 2018

Preoperative Serum Thyroglobulin Level as a Useful Predictive Marker to Differentiate Thyroid Cancer.

ORL J Otorhinolaryngol Relat Spec 2018;80(5-6):290-295. Epub 2018 Sep 25.

Department of Biostatistics, Faculty of Medicine, Ataturk University, Erzurum, Turkey.

Introduction: Thyroid cancer is the most common endocrine system cancer. Although fine-needle aspiration biopsy is the most commonly used method for diagnosis, it is not always sufficient. The aim of this study was to investigate the influence of preoperative serum thyroglobulin (Tg) concentration on differentiated thyroid cancer risk.

Material And Methods: A total of 133 patients who underwent total thyroidectomy due to various indications at the Ear-Nose-Throat Department, Ataturk University Medical School, between April 2015 and December 2015, were included in this prospective study. Histopathological diagnosis and preoperative Tg levels were compared. Receiver operating characteristic (ROC) analysis was used for detection of the cut-off to discriminate malignant from benign thyroid masses using preoperative Tg as a variable.

Results: Malignant pathology (differentiated thyroid carcinoma) was detected in 59 out of 133 patients (44.4%) and benign pathology in 74 (55.6%). A statistically significant difference in preoperative Tg value was detected between malignant and benign cases (p < 0.05).

Conclusion: The prevalence of differentiated thyroid carcinoma was higher among patients with a preoperative serum Tg value > 188.5 ng/mL, and this may thus be used as a marker for the diagnosis of this malignancy.
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http://dx.doi.org/10.1159/000491932DOI Listing
October 2019

Use of Family Planning Methods and Influencing Factors Among Women in Erzurum.

Med Sci Monit 2018 Jul 19;24:5027-5034. Epub 2018 Jul 19.

Department of Public Health, Ataturk University, Erzurum, Turkey.

BACKGROUND Our study aimed to determine the prevalence of family planning methods, socio-demographic characteristics and the relationship between pregnancy histories and usage of family planning methods among women aged 15-49 years old living in the Erzurum provincial center. MATERIAL AND METHODS This is a descriptive, cross-sectional study. From the total 106 669 women aged 15-49 years old living in the Erzurum provincial center, a sample of 627 individuals was selected. A questionnaire consisting of items inquiring into women's socio-demographic characteristics, birth and pregnancy history, and the use of family planning methods was administered using face-to-face interviews. Statistical analysis was performed using the SPSS 20.00 software. Descriptive statistics were expressed as mean, median, n, percentage, and standard deviation. The chi square, chi square trend, Mann-Whitney U tests, and logistic regression analysis were used for data analysis. RESULTS The mean age of the women in the study was 33.03 years (SD=7.1 years). The mean total number of pregnancies was 3.07 (SD=1.7). Of the women in the study, 77.7% (n=487) used some kind of FP, with 48.2% (n=302) using modern methods and 29.5% (n=185) using traditional techniques. The most commonly used modern methods were intra-uterine devices (IUDs) and condoms, and the most common traditional method used was withdrawal. The use of modern methods was higher among women working outside of the house. It was positively associated with higher education and income and negatively associated with the total number of pregnancies. CONCLUSIONS Appropriate use of family planning services rises in line with improvements in women's education, prosperity, and employment status.
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http://dx.doi.org/10.12659/MSM.908388DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6063134PMC
July 2018

The evaluation of the effect of venous diameter measurement by ultrasonography on pain and withdrawal response.

J Anesth 2018 06 23;32(3):375-380. Epub 2018 Mar 23.

Department of Anaesthesiology and Reanimation, Adnan Menderes University School of Medicine, Aydin, 09100, Turkey.

Purpose: Rocuronium and propofol are used in the induction of anesthesia give discomfort to the patients. We aimed to investigate the relationship between venous diameter measured using ultrasonography, and pain and withdrawal movements after propofol and rocuronium applied with intravenous (IV).

Methods: This prospective-observational study was performed on 142 voluntary patients undergoing surgical operation under general anesthesia. An ultrasonography was used to measure the vein transverse diameter. Patients with a venous transverse diameter of ≤2 mm were classified as group 1 (n = 50), while patients with a diameter of > 2 mm were classified as group 2 (n = 92). The propofol pain was assessed according to the verbal rating scale (VRS). In addition, the withdrawal movements of the rocuronium injection were evaluated using the four-point scale.

Results: There was no difference between the two groups in terms of the demographic data. The patients have pain after propofol 38.2% and withdrawal movements after rocuronium 42.4% were detected. The maximum number of patients without pain after propofol injection (78.2%) and without withdrawal movements after rocuronium (76%) was found to be higher in group 2 (p = 0.001).

Conclusion: In this study, we found a reduction in the incidence and severity of pain and withdrawal movements in intravenous propofol and rocuronium administration through peripheral venous vessels of large diameter. We believe that the clinical drug injection through vessels with large venous diameter with the help of USG may be a non-invasive, simple, and reliable method to reduce pain and withdrawal movements in propofol and rocuronium injections.
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http://dx.doi.org/10.1007/s00540-018-2489-5DOI Listing
June 2018

Demonstration of analgesic effect of intranasal ketamine and intranasal fentanyl for postoperative pain after pediatric tonsillectomy.

Int J Pediatr Otorhinolaryngol 2018 Jan 23;104:182-185. Epub 2017 Nov 23.

Bezmialem Vakif University, Faculty of Medicine, Department of Otorhinolaryngology, Fatih, Istanbul, Turkey.

Objective: Tonsillectomy is one of the oldest and most commonly performed surgical procedure in otolaryngology. Postoperative pain management is still an unsolved problem. In this study, our aim is to demonstrate the efficacy of intranasal ketamine and intranasal fentanyl for postoperative pain relief after tonsillectomy in children.

Material And Method: This randomized-controlled study was conducted to evaluate the effects of intranasal ketamine and intranasal fentanyl in children undergoing tonsillectomy. Tonsillectomy performed in 63 children were randomized into three groups. Group I received: Intravenous paracetamol (10 mg/kg), Group II received intranasal ketamine (1.5 mg/kg ketamine), Group III received intranasal fentanyl (1.5 mcg/kg). The Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and Wilson sedation scale scores were recorded at 15, 30, 60 min, 2 h, 6hr, 12 h and 24 h postoperatively. Patients were interviewed on the day after surgery to assess the postoperative pain, nightmares, hallucinations, nausea, vomiting and bleeding.

Results: Intranasal ketamine and intranasal fentanyl provided significantly stronger analgesic affects compared to intravenous paracetamol administration at postoperative 15, 30, 60 min and at 2, 6, 12 and 24 h in CHEOPS (p < 0.05). Sedative effects were observed in three patients in the intranasal ketamine administration group. No such sedative effect was seen in the groups that received intranasal fentanyl and intravenous paracetamol in Wilson Sedation Scale (p < 0.05). Cognitive impairment, constipation, nausea, vomiting and bleeding were not observed in any of the groups.

Conclusion: This study showed that either intranasal ketamine and intranasal fentanyl were more effective than paracetamol for postoperative analgesia after pediatric tonsillectomy. Sedative effects were observed in three patients with the group of intranasal ketamine. There was no significant difference in the efficacy of IN Ketamine and IN Fentanyl for post-tonsillectomy pain.
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http://dx.doi.org/10.1016/j.ijporl.2017.11.018DOI Listing
January 2018

Comparison of EtView™ tracheoscopic ventilation tube and video-assisted fiberoptic bronchoscopy during percutaneous dilatational tracheostomy.

J Clin Monit Comput 2017 Jun 29;31(3):507-512. Epub 2016 Apr 29.

Department of Anesthesiology and Reanimation, Faculty of Medicine, Bezmialem Vakif University, Vatan caddesi, Fatih, 34093, Istanbul, Turkey.

Fiberoptic bronchoscopy (FOB) via endotracheal tube (ETT) is the most frequent utilized technique for monitoring of percutaneous dilatational tracheostomy (PDT) procedure while maintaining mechanical ventilation. Endoscopic guidance has increased the safety of this procedure; nevertheless, the use of a bronchoscope via ETT potentially may deteriorate ventilation and lead to hypercarbia and/or hypoxia. EtView tracheoscopic ventilation tube (EtView TVT) is a standard endotracheal tube with a camera and light source embedded at the tip. The objectives of this study are to introduce EtView TVT as a monitoring tool during PDT and to compare it with video assisted FOB via ETT. We hypothesized that using EtView TVT during PDT may obtain similar visualization; also may have advantages regarding better mechanical ventilation conditions when compared with video-assisted FOB via ETT. Patients, 18-75 years of age requiring mechanical ventilation scheduled for PDT were randomly allocated into two groups for airway monitorization to guide PDT procedure either with FOB via ETT (Group FOB, n = 12) or EtView TVT (Group EtView, n = 12). After standard anesthesia protocol, alveolar recruitment maneuver was applied and all patients were mechanically ventilated at pressure-controlled ventilation mode with same pressure levels. The primary outcome variable was the reduction in arterial oxygen partial pressure (PaO) values during the procedure. Other respiratory variables and the effectiveness (the visualization and identification of relevant airway structures) of two techniques were the secondary outcome variables. Patients in both groups were comparable with respect to demographic characteristics and initial respiratory variables. Visualization and identification of relevant airway structures in any steps of the PDT procedure were also comparable. The decrease in minute ventilation in Group FOB was higher when compared with Group EtView (51 ± 4 % vs. 12 ± 7.3 %, p < 0.05). The decrease in PaO from initial levels during (34 ± 21 % vs. 5 ± 7 % decrease) and after (26 ± 27 % vs. 2.8 ± 16 % decrease) the procedure was higher in Group FOB when compared with Group EtView (p < 0.05). Considering comparable features in monitorization and advantageous features over mechanical ventilation when compared with video bronchoscopy; EtView TVT would be a good alternative for airway monitorization during PDT especially for patients with poor pulmonary reserve.
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http://dx.doi.org/10.1007/s10877-016-9885-xDOI Listing
June 2017

Comparison of different methods for measurement of electrolytes in patients admitted to the intensive care unit.

Saudi Med J 2016 Mar;37(3):262-7

Department of Anesthesiology and Reanimation, Adnan Menderes University School of Medicine, Aydin, Turkey. E-mail.

Objectives: To investigate whether electrolyte levels measured by using blood gas analyzers (ABG) and auto-analyzers (AA) are equivalent and can be used interchangeably.

Methods: This observational prospective study was conducted in 100 patients admitted to the Intensive Care Unit, Adnan Menderes University School of Medicine, Aydin, Turkey, between March and August 2014. Samples for both AA and ABG analyzers were collected simultaneously from invasive arterial catheters of patients. The electrolyte levels were measured by using 2 methods.

Results: The mean sodium level measured by ABG was 136.1 ± 6.3 mmol/L and 137.8 ± 5.4 mmol/L for AA (p=0.001). The Pearson's correlation coefficient was 0.561 (p less than 0.001). The Bland-Altman 95% limits of agreement were -9.4 to 12.6 mmol/L. The mean potassium levels measured by ABG was 3.4 ± 0.7 mmol/L and AA was 3.8 ± 0.7 mmol/L (p=0.001). The Bland-Altman comparison limits were -0.58 to 1.24 and the associated Pearson's correlation coefficient was 0.812 (p less than 0.001).

Conclusion: The results of the 2 analyzing methods, in terms of sodium, were not equivalent and could not be used interchangeably. However, according to the statistical analyses results, by including, but not blindly trusting these findings, urgent and vital decisions could be made by the potassium levels obtained from the BGA, but a simultaneous follow-up sample had to be sent to the central laboratory for confirmation.
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http://dx.doi.org/10.15537/smj.2016.3.13539DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4800889PMC
March 2016

The auditory brainstem responses in patients with unilateral cochlear hearing loss.

Indian J Otolaryngol Head Neck Surg 2013 Jul 4;65(3):203-9. Epub 2011 Dec 4.

Department of ORL, Ministry of Health Ankara Training and Research Hospital, Ankara, Turkey.

The aim of our study is to analyze changes occurring in the auditory brainstem response (ABR) according to stimulus parameters in unilateral cochlear hearing loss cases. Twenty-nine cases (14 male, 15 female) with unilateral sensorineural hearing loss (SNHL) were investigated. All cases had cochlear SNHL on one side whereas normal hearing on the other side. All cases underwent ABR testing with varying stimulus intensity levels and stimulus repetition rates (SRRs). Results were compared and their correlation with audiogram shapes investigated. As stimulus intensity levels decreased on both ears, latencies expanded and amplitudes decreased in all traces of ABR. Latencies of ears with cochlear hearing loss were observed to be longer than those in normal ears. Responses to SRR increases were similar on both ears. Audiogram shapes should be taken into consideration while performing ABR in order to address asymmetric SNHL. The interpretation of ABR changes with various stimulus levels may provide a better understanding of cochlear pathologies associated with hearing loss in the future.
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http://dx.doi.org/10.1007/s12070-011-0402-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3696157PMC
July 2013

Non-invasive detection of biliary leaks using Gd-EOB-DTPA-enhanced MR cholangiography: comparison with T2-weighted MR cholangiography.

Eur Radiol 2013 Oct 22;23(10):2713-22. Epub 2013 May 22.

School of Medicine, Department of Radiology, Atatürk University, Erzurum, Turkey,

Objective: To evaluate the added role of T1-weighted (T1w) gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance cholangiography (MRC) compared with T2-weighted MRC (T2w-MRC) in the detection of biliary leaks.

Methods: Ninety-nine patients with suspected biliary complications underwent routine T2w-MRC and T1w contrast-enhanced (CE) MRC using Gd-EOB-DTPA to identify biliary leaks. Two observers reviewed the image sets separately and together. MRC findings were compared with those of surgery and percutaneous transhepatic cholangiopancreatography. The sensitivity, specificity and accuracy of the techniques in identifying biliary leaks were calculated.

Results: Accuracy of locating biliary leaks was superior with the combination of Gd-EOB-DTPA-enhanced MRC and T2w-MRC (P < 0.05).The mean sensitivities were 79 % vs 59 %, and the mean accuracy rates were 84 % vs 58 % for combined CE-MRC and T2w-MRC vs sole T2w-MRC. Nineteen out of 21 patients with biliary-cyst communication, 90.4 %, and 12/15 patients with post-traumatic biliary extravasations, 80 %, were detected by the combination of Gd-EOB-DTPA-enhanced MRC and T2w-MRC images, P < 0.05.

Conclusions: Gd-EOB-DTPA-enhanced MRC yields information that complements T2w-MRC findings and improves the identification and localisation of the bile extravasations (84 % accuracy, 100 % specificity, P < 0.05). We recommend Gd-EOB-DTPA-enhanced MRC in addition to T2w-MRC to increase the preoperative accuracy of identifying and locating extravasations of bile.

Key Points: • Magnetic resonance cholangiography (MRC) does not always detect bile leakage and cysto-biliary communications. • Gd-EOB-DTPA-enhanced MRC helps by demonstrating extravasation of contrast material into fluid collections. • Gd-EOB-DTPA-enhanced MRC also demonstrates the leakage site and bile duct injury type. • Combined Gd-EOB-DTPA-enhanced and T2w-MRC can provide comprehensive information about biliary system. • Gd-EOB-DTPA-enhanced MRC is non-invasive and does not use ionising radiation.
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http://dx.doi.org/10.1007/s00330-013-2880-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3769590PMC
October 2013

Diagnosis and management of necrotizing fasciitis of the head and neck.

Curr Infect Dis Rep 2012 Apr;14(2):161-5

Department of Otolaryngology, Ministry of Health, Ankara Training & Research Hospital, Ankara, Turkiye,

Necrotizing fasciitis is a rapidly progressing and life-threatening soft tissue infection that often affects the abdominal wall, perineum, or extremities following surgery or trauma. It predominantly occurs in elderly and immunocompromised patients. It is rarely seen in the head and neck region. Necrotizing fasciitis of the head and neck carries high rates of morbidity and mortality. Symptoms usually develop quickly and well-timed diagnosis is critical to optimizing outcome. Diagnosis is based on a combination of clinical history, Gram staining and culture, imaging and surgical exploration. Early and aggressive surgical management and urgent parenteral antibiotic therapy are critical to optimizing outcome.
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http://dx.doi.org/10.1007/s11908-012-0240-1DOI Listing
April 2012

Do silicone nasal septal splints with integral airway reduce postoperative eustachian tube dysfunction?

Otolaryngol Head Neck Surg 2012 Jan 7;146(1):141-5. Epub 2011 Sep 7.

Ministry of Health, Sakarya Education and Research Hospital, Department of Otorhinolaryngology, Sakarya, Turkey.

Objective: This study aims to compare the effects of Merocel nasal packs and silicone nasal septal splints with integral airway on the ventilation and pressure of the middle ear when applied intranasally after septoplasty for isolated septal deviation.

Study Design: A prospective, randomized trial.

Setting: A tertiary referral center.

Subjects And Methods: Fifty-one patients who underwent septoplasty for nasal respiratory impairment caused by septal deviation were randomized into 2 groups. After septoplasty, bilateral anterior Merocel nasal packs were applied in one group, while silicone nasal septal splints with integral airway were applied in the other group. Middle ear pressures were compared using preoperative and post-operative tympanometry.

Results: Pathological decrease in the middle ear pressure in at least 1 ear was determined in 17 patients (73.9%) in the Merocel group compared with only 6 patients (21.4%) in the silicone nasal septal splint group at the 48th postoperative hour. In the first 24 hours following surgery, decreases in tympanometric pressures were seen in both groups, but more in the Merocel group. After 24 hours, middle ear pressures continued to decrease in the Merocel group but started to increase in the silicone nasal septal splint group.

Conclusion: Because they allow inhalation through the nose and cause less Eustachian tube dysfunction than Merocel, using silicone nasal septal splints with integral airway instead of packing after septoplasty seems a more reasonable option.
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http://dx.doi.org/10.1177/0194599811421595DOI Listing
January 2012

Segmental vitiligo in a patient with thoracic outlet syndrome.

Rheumatol Int 2012 Sep 29;32(9):2941-3. Epub 2011 Jul 29.

Department of Physical Medicine and Rehabilitation, İskenderun Military Hospital, Hatay, Turkey.

Reported here is a 35-year-old man with findings of thoracic outlet syndrome and bilateral segmental vitiligo on C8-T1 dermatomes. The possible causal relationship between the two disorders under the common denominator of cervical sympathetic involvement is discussed for the first time in the literature.
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http://dx.doi.org/10.1007/s00296-011-2024-6DOI Listing
September 2012

Equilibrium, thermodynamic and kinetic studies for the biosorption of aqueous lead(II), cadmium(II) and nickel(II) ions on Spirulina platensis.

J Hazard Mater 2008 Jun 9;154(1-3):973-80. Epub 2007 Nov 9.

Department of Chemistry, Izmir Institute of Technology, Urla 35430, Izmir, Turkey.

The biosorption of lead(II), cadmium(II) and nickel(II) ions from aqueous solution by Spirulina platensis was studied as a function of time, concentration, temperature, repetitive reactivity, and ionic competition. The kinetic results obeyed well the pseudo second-order model. Freundlich, Dubinin Radushkevich and Temkin isotherm models were applied in describing the equilibrium partition of the ions. Freundlich isotherm was applied to describe the design of a single-stage batch sorption system. According to the thermodynamic parameters such as DeltaG degrees, DeltaH degrees and DeltaS degrees calculated, the sorption process was endothermic and largely driven towards the products. Sorption activities in a three metal ion system were studied which indicated that there is a relative selectivity of the biosorbent towards Pb2+ ions. The measurements of the repetitive reusability of S. platensis indicated a large capacity towards the three metal ions.
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http://dx.doi.org/10.1016/j.jhazmat.2007.11.007DOI Listing
June 2008

Histochemical and immunohistochemical features of a case showing association of meningioma and prolactinoma containing amyloid.

Brain Tumor Pathol 2002 ;19(1):1-3

Dokuz Eylül University, Faculty of Medicine, Department of Pathology, 35340 Inciralti-Izmir, Turkey.

We report the rare case of a 43-year-old woman with a simultaneous meningioma of the sphenoid wing and an amyloid-containing prolactinoma. The patient, who presented with a 17-year history of amenorrhea, and galactorrhea, was found to have a 10-mm mass in the pituitary gland. During excision of this lesion, another mass was noticed, which was located in the sphenoid wing. Both lesions were completely excised. Histopathological examination revealed that the pituitary tumor was a prolactinoma with diffuse amyloid deposition and that the second tumor was a typical meningioma. The coexistence of a prolactinoma containing amyloid and a meningioma is very rare in the literature, so this case is presented here with its histochemical and immunohistochemical features. We discuss the significance of prolactinoma containing amyloid and the simultaneous presentation of these two tumors.
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http://dx.doi.org/10.1007/BF02482448DOI Listing
December 2002