Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Analysis of Bleeding Following Carotid Endarterectomy(2022) Hafez, Izzet; Diken, Adem, I; Ozyalcin, Sertan; Alemdaroglu, Utku; Tunel, Huseyin A.; https://orcid.org/0000-0002-8782-7603; ABE-8722-2020BACKGROUND: Carotid artery stenosis is one of the main causes of cerebral stroke. Carotid endarterectomy is still the most important technique for treatment. We aimed to reveal the factors which cause major bleeding and need for reoperation in patients treated with carotid endarterectomy and the primary closure technique. METHODS: Data of 97 patients who received conventional carotid endarterectomy and primary closure at our clinic between 2015 and 2020 were retrospectively analyzed. In line with these data, situations that could lead to major bleeding after surgery such as preoperative blood thinner drug use history, preoperative and postoperative complete blood counts, bleeding times and comorbid diseases were examined. RESULTS: Four of 97 patients included in the study (4.1%) were reoperated. Among these patients, 2 (50%) were receiving only anticoagulant treatment, while the other 2 (3.1%) were receiving only antiplatelet treatment. The difference between two groups was statistically significant. When the postoperative first day and total drain amounts of the patients in reoperated and nonreoperated group the difference was found significant (P<0.001). CONCLUSIONS: In our study, while no significant relationship could be found between antiplatelet use in the preoperative period and the prevalence of major bleeding, it was revealed that use of anticoagulant drugs for any reason in the preoperative period may lead to postoperative major bleeding even though the treatment has been stopped before surgery. History of preoperative anticoagulant drug used in patients taken in for reoperation is an issue that needs to be examined and paid attention to.Item Effects of Two Different Treatment Techniques on the Recovery Parameters of Moderate Carpal Tunnel Syndrome: A Six-Month Follow-up Study(2016) Celik, Guner; Ilik, Mustafa Kemal; 26657237Purpose: The optimal therapy for moderately severe carpal tunnel syndrome (CTS) remains unclear. In this study, the authors aimed at comparing the clinical and electrophysiologic recovery of CTS after local steroid injection and operation. Methods: This is a clinical prospective study consisting of 100 patients with moderate CTS. The patients were diagnosed electrophysiologically with isolated median nerve neuropathy and had CTS symptoms for at least 3 months. While the patients undergoing local steroid injection were defined as injection group (42 women, 8 men and n = 50), other participants undergoing surgery were defined as operation group (47 women, 3 men and n = 50). The severity of the symptoms and electrophysiologic findings were evaluated before and at the first, third, and sixth months after the treatment. Results: The authors found that all parameters were improved at the end of the first month in both groups. However, the recovery of all parameters increased at the third month and was statistically higher in operation group, compared with injection group. Furthermore, the recovery rate of distal sensory latencies and the visual analog scale scores was decreased in injection group at the third month. The authors observed that the recovery continued in both groups in the sixth month, and the rates of recovery were markedly lower in injection group than in operation group, compared with those obtained at the first month. Conclusions: The clinical recovery was more pronounced than the electrophysiologic recovery. And surgery is more effective technique than steroid injection for the treatment of the moderate CTS in the long term.Item Morbidity and Mortality of Colorectal Cancer Surgery in Octogenarians(2016) Torer, NurkanObjectives The aim of this study was to determine common problems, preoperative assessment criteria, and postoperative morbidity and mortality of octogenarians with colorectal cancer. Materials and method We screened the medical records of patients aged 80 years or older (study group) and that of patients of 50-59 years of age (control group) who were operated for colon cancer. Demographic features, comorbidities, American Society of Anaesthesiologists (ASA) score, urgency of operation, tumor localization, presence of colostomy, duration of hospital stay, admission to and duration of stay in the intensive care unit (ICU), TNM (Tumor, Node, Metastasis) stage, postoperative morbidity, and mortality rates were recorded. Results The medical records of 23 patients aged above 80 years and 39 patients aged between 50-59 years were screened retrospectively. The two groups did not differ significantly with respect to the morbidity rate but the mortality rate was significantly higher in the study group (p = 0.583 and p = 0.016, respectively). The study group patients needed significantly more ostomy creation procedures. In the analysis of the octogenarian groups, the ASA score or the presence of comorbidities had no discernible effect on the morbidity and mortality rates. Conclusion Specific preoperative evaluations are needed for prediction of mortality risk in geriatric patients. Rational criteria for performing protective ostomy should also be determined in octogenarians.Item Decision Analysis in Quest of the Ideal Treatment in Adult Spinal Deformity Adjusted for Minimum Clinically Important Difference(2020) Acaroglu, Emre; Yuksel, Selcen; Ates, Can; Ayhan, Selim; Bahadir, Sinan; Nabi, Vugar; Vila-Casademunt, Alba; Perez-Grueso, Francisco Javier Sanchez; Obeid, Ibrahim; 0000-0003-0153-3012; 32622065; U-5409-2018BACKGROUND: Surgery appears to yield better results in adult spinal deformity treatment when fixed minimum clinically important difference values are used to define success. Our objective was to analyze utilities and improvement provided by surgical versus nonsurgical treatment at 2 years using Oswestry Disability Index with treatment-specific minimum clinically important difference values. METHODS: From a multicenter database including 1452 patients, 698 with 2 years of follow-up were analyzed. Mean age of patients was 50.95 +/- 19.44 years; 580 patients were women, and 118 were men. The surgical group comprised 369 patients, and the nonsurgical group comprised 329 patients. The surgical group was subcategorized into no complications (192 patients), minor complications (97 patients) and major complications (80 patients) groups to analyze the effect of complications on results. Minimum clinically important differences using Oswestry Disability Index were 14.31, 14.96, and 2.48 for overall, surgical, and nonsurgical groups. Utilities were calculated by visual analog scale mapping. RESULTS: Surgical treatment provided higher utility (0.583) than nonsurgical treatment (0.549) that was sensitive to complications, being 0.634, 0.564, and 0.497 in no, minor, and major complications. Probabilities of improvement, unchanged, and deterioration were 38.3%, 39.2%, and 22.5% for surgical treatment and 39.4%, 10.5%, and 50.1% for nonsurgical treatment. Improvement in the surgical group was also sensitive to complications with rates of 40.1%, 39.3%, and 33.3%. CONCLUSIONS: Our results suggest that surgical treatment has less disease burden and less chance of deterioration, but equal chances for improvement at 2 years of follow-up. As it appears to be a better modality in the absence of complications, future efforts need be directed to decreasing the complication rates.