Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Management and Outcomes of Major Pelvic Hemorrhage in Complex Abdomino-Pelvic Surgery(2023) Aytac, Erman; Sokmen, Selman; Ozturk, Ersin; Rencuzogullari, Ahmet; Sungurtekin, Ugur; Akyol, Cihangir; Demirbas, Sezai; Leventoglu, Sezai; Karakayali, Feza; Korkut, Mustafa Ali; Oncel, Mustafa; Gulcu, Baris; Canda, Aras Emre; Eray, Ismail Cem; Ozgen, Utku; Ersoz, Siyar; Ozer, Tahir; Ozerhan, Ismail Hakki; Bozbiyik, Osman; Haksal, Mustafa; Oral, Berke Mustafa; 0000-0002-6481-1473; 37816336; HKO-5077-2023Introduction: Hemorrhage is a challenging complication of pelvic surgery. This study aimed to analyze the causes, management and factors associated with morbidity in patients experiencing major pelvic hemorrhage during complex abdomino-pelvic surgery.Methods: Patients who had major intraoperative pelvic hemorrhage during complex abdomino-pelvic surgery at 11 tertiary referral centers between 1997-2017 were included. Patient characteristics, management strategies to control bleeding, short and long term postoperative outcomes were evaluated retrospectively.Results: There were 120 patients with a mean age of 56.6 +/- 2.4 years and a mean BMI of 28.3 +/- 1 kg/m(2). While 104 (95%) of the patients were operated for malignancy, 16(5%) of the patients had surgery for a benign disease. The most common bleeding site was the presacral venous plexus 90(75%). Major pelvic hemorrhage was managed simultaneously in 114(95 %) patients. Electrocauterization 27(23%), pelvic packing 26(22%), suturing 7(6%), thumbtacks application 7(6%), muscle welding 4(4%), use of energy devices 2(2%) and topical hemostatic agents 2(2%) were the management tools. Combined techniques were used in 43(36%) patients. Short-term morbidity and mortality rates were 48(40%) and 2(2%), respectively. High preoperative CRP levels(p=0.04), history of preoperative radiotherapy (p=0.04), longer bleeding time (p=0.006) and increased blood transfusion (p=0.005) were the factors associated with postoperative morbidity.Discussion/Conclusion: Postoperative morbidity related to major pelvic hemorrhage can be reduced by optimizing the risk factors. Prehabilitation prior to surgery to moderate inflammatory status and prompt action with proper technique to control major pelvic hemorrhage can prevent excessive blood loss in complex abdomino-pelvic surgery.Item THE OUTCOMES OF USING FIXED-DOSE NOMOGRAM-GUIDED UNFRACTIONATED HEPARIN THERAPY IN ELDERLY PATIENTS IN COMPARISON WITH YOUNGER PATIENTS(2020) Acibuca, Aynur; Muderrisoglu, Ibrahim Haldun; 0000-0002-3444-8845; ABG-4047-2020Introduction: In elderly patients, the dosing of unfractionated heparin is difficult because of changing metabolism, which affects the determination of a therapeutic level. The aim of this study was to evaluate the effects of unfractionated heparin therapy in an older population and to determine whether there was any difference from a younger population in terms of the activated partial thromboplastin time results and complication rates when using a standard nomogram. Materials and Methods: A total of 120 patients aged <80 years (Group 1) and 120 patients aged >= 80 years (Group 2), all of whom had been given unfractionated heparin therapy for selected indications in the coronary care unit, were randomly selected and retrospectively enrolled in the study. Infusion time up to a maximum of 48 hours was included, and activated partial thromboplastin time results in that period were categorised as subtherapeutic, therapeutic, or supratherapeutic. The rates of the patients' subtherapeutic, therapeutic, and supratherapeutic results were compared between groups. Results: The peak activated partial thromboplastin time level was higher in patients aged >= 80 years (58.85 [51.28] vs 76.50 [57.45], p<0.001). The supratherapeutic activated partial thromboplastin time percentage (0 [0.25] vs 0.20 [0.43], p<0.001) and numbers of first activated partial thromboplastin time in the supratherapeutic range (10% vs 24.2%, p=0.004) were significantly higher in the older group. Conclusion: Over-anticoagulation may be a problem in the elderly population when using standard nomograms. It was concluded that improvements should be made for a nomogram specific to an older population.Item Cerebrovascular events in hemodialysis patients; a retrospective observational study(2019) Ozelsancak, Ruya; Micozkadioglu, Hasan; Torun, Dilek; Tekkarismaz, Nihan; 0000-0002-0788-8319; 31830923Background This study reports findings in subjects who underwent brain imaging for any reason, and examined factors influencing cerebrovascular events (CVEs) in hemodialysis (HD) patients. Methods We reviewed the files of patients on HD between January 2015 and January 2018. A total of 432 patients who underwent HD for at least 5 months by the January 2015 and who were older than 18 years were included in the study; 264 had been examined by cerebral computed tomography or magnetic resonance imaging examination within the 3 years. Cerebrovascular pathology was detected in 139 of 264 patients. Results Of the 139 patients, 65 (24.62%) had ischemic lesions, 25 (9.47%) had hemorrhagic lesions, and 49 (18.56%) had cerebral small vessel disease (CSVD). We compared recorded data and later clinical findings between patients with and those without CVEs. The cause of end-stage renal disease was diabetes in 58.5% of patients with ischemic lesions, 52% in those with hemorrhagic lesions, and 55% in those with CSVD (P < 0.05). Patients with cerebrovascular ischemia were older (P = 0.0001) and had lower serum creatinine (sCr) (P = 0.0001) and higher serum C-reactive protein (CRP) (P = 0.002) levels than normal subjects. Hemorrhagic patients were older (P = 0.003) and had lower sCr (P = 0.003) and serum predialysis potassium (P = 0.003) and parathyroid hormone (PTH) (P = 0.004) levels than normal subjects. Patients with CSVD were older (P < 0.0001) and had lower sCr (P < 0.0001), phosphorus (P < 0.007), and PTH (P < 0.013) and higher CRP (P < 0.002) levels than normal subjects. Conclusions HD patients with CVEs are older and typically have diabetes mellitus and lower sCr levels.Item Endovascular Management of Surgically Uncontrolled Hemorrhage Following Post-Radical Nephrectomy: A Case Report(2018) Dirim, Ayhan; Ozyer, Umut; 0000-0002-4300-009X; AAK-9071-2021We present an isolated right lumbar arterial hemorrhage following right radical nephrectomy. Surgical re-exploration was unsuccessful therefore active bleeding was diagnosed and treated with endovascular approach.