PubMed İndeksli Yayınlar Koleksiyonu
Permanent URI for this collectionhttps://hdl.handle.net/11727/4810
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Item The effect of pneumoperitoneum on the cross-sectional areas of internal jugular vein and subclavian vein in laparoscopic cholecystectomy operation(2016) Pinar, Huseyin Ulas; Dogan, Rafi; Konuk, Ummu Mine; Cifci, Egemen; Duman, Enes; Karagulle, Erdal; Turk, Emin; Karaca, Omer; 27515323Background: Increased central venous pressure secondary to an increase in intraabdominal pressure has been reported during laparoscopic surgery. However, no study has yet determined the effect of pneumoperitoneum on cross-sectional area (CSA) of central veins by ultrasonography during laparoscopic cholecystectomy. Herein, we aimed to quantify changes in CSAs of internal jugular (IJV) and subclavian veins (SCV) by ultrasonography during this surgery. Methods: This study included 60 ASA I-II patients scheduled for laparoscopic cholecystectomy surgery under general anesthesia. Pneumoperitoneum was performed with CO2 at 12 mmHg. The CSAs of right IJV and right SCV were measured using a 6 Mhz ultrasonography transducer in supine and neutral positions before anesthesia induction (T1), 5 min after connecting to mechanical ventilator (T2), 5 min after creation of pneumoperitoneum (T3), at the end of pneumoperitoneum (T4), and 5 min after desufflation and before extubation (T5) both at end-expiration and end-inspiration. Results: The comparison of IJV CSA at inspiration showed significant increase in T3 value compared to T2 value (p < 0.001). Similarly the expiratory measurements of IJV CSA demonstrated significant increase in T3 value compared to T2 value (p < 0.001). The comparison of inspiratory CSA measurements of SCV showed significantly increased in T3 (p = 0.009) than T2 value. In expiratory measurements there was a significant increase in T3 (p = 0.032) value compared to T2. All measurements of IJV and SCV SCAs both end-inspiration and end-expiration T5 values significantly decreased compared to T4 values (p < 0.001). Conclusions: Pneumoperitoneum with an intraabdominal pressure of 12 mmHg produces significant increases in IJV and SCV CSAs during laparoscopic cholecystectomy procedure. We believe that this finding may enhance our understanding of pneumoperitoneum-induced hemodynamic changes and facilitate catheterization attempts.Item Percutaneous Placement of Pancreatico-biliary Drainage Catheter for the Treatment of Complicated Pancreatic Anastomotic Leakage: an Alternative Treatment Option(2016) Duman, Enes; Yildirim, Erkan; 0000-0002-9057-722X; 27994344; ABI-3856-2020A 58-year-old female patient who had anastomotic leakage after a Whipple operation was treated with a percutaneously placed pancreatico-biliary drainage catheter. Complete secondary healing of the anastomotic defect and leakage was seen on control cholangiography examination on the 35th postoperative day, and the pancreatico-biliary drainage catheter was removed. She was discharged on the 39th postoperative day uneventfully. Percutaneous pancreatico-biliary drainage should be kept in mind as an alternative treatment option of complicated pancreatic anastomotic leakage after a Whipple operation.Item Endovascular Treatment of Wide Necked Ruptured Saccular Aneurysms with Flow-Diverter Stent(2017) Duman, Enes; Coven, Ilker; Yildirim, Erkan; Yilmaz, Cem; Pinar, H.Ulas; 0000-0002-2353-8044; 0000-0003-0473-6763; 0000-0002-9057-722X; 27593785; AAK-2948-2021; Q-2420-2015; ABI-3856-2020AIM: Flow diverter (FD) stents have been used in the treatment of unruptured intracranial aneurysms. There are a few studies that report the use of these devices in ruptured blister-like aneurysms. We present 5 consecutive patients, who had ruptured intracranial wide necked or side branch close to the neck of saccular aneurysms, with no other treatment options, treated with FD stents and coil embolization. MATERIAL and METHODS: Between September 2012 and April 2015, 139 ruptured aneurysms of 133 consequent patients were treated. Of these, 48 were surgically treated aneurysms. Five of the remaining 85 aneurysms treated with FD stents. Three aneurysms were in the posterior communicating artery, and 2 were in the supraclinoid internal carotid artery (ICA). Partial coil embolization was performed in addition to FD stents in three patients. All patients were treated in the first 3 days after bleeding. RESULTS: Technical success was 100%. Inappropriate deployment of silk stent and partial thrombus formation occurred in one patient due to the jailed micro-catheter. Inappropriate apposition of stent was corrected with a balloon, and the thrombus resolved with tirofiban, tissue plasminogen activator (t-PA) injections. No other complication or death occurred related to the procedure. One patient who had a giant ICA aneurysm and Fisher grade 4 bleeding died due to vasospasm, cerebral edema and sepsis on the postoperative 13th day. The other patients were followed-up uneventfully with computed tomography angiography (CTA) at 6th month and digital subtraction angiography (DSA) at 12th month. CONCLUSION: FD stents can be used in the treatment of ruptured large wide necked or side branch close to the neck of saccular aneurysms when other treatment options can not be used.Item IS THERE A REAL CORRELATION BETWEEN RED CELL DISTRIBUTION WIDTH AND PERIPHERAL ARTERIAL DISEASE?(2017) Duman, Enes; Kulaksizoglu, Sevsen; Cifci, Egemen; Ozulku, Mehmet; 0000-0002-7613-2240; 30581327; AAI-8932-2021Background: Few data is available concerning the association between peripheral arterial disease (PAD) and red cell distribution width (RDW). In this study, we analyzed the relationship between RDW and atherosclerosis of the vessels other than coronary arteries in patients who had undergone digital substraction angiography (DSA). Methods: This study included 730 patients who had undergone DSA. Patients were divided into two groups according to their angiographic images. The association between RDW and atherosclerosis of peripheral arteries was analyzed. The relationship between atherosclerosis and smoking, hypertension (HT), diabetes mellitus (DM), hs-CRP, hemoglobin, white blood cell (WBC), triglyceride, total cholesterol, HDL and LDL cholesterol levels was assessed. Results: Atherosclerosis was observed more common in male and patients with older age, HT, DM and smoking (p< 0.001). hs-CRP and WBC levels were both in significantly positive association with atherosclerosis (p< 0.05). However, there were no significant differences in the RDW levels, hemoglobin, triglyceride, total cholesterol, LDL and HDL cholesterol levels in the groups (p> 0.05). Conclusions: Our results seem to demonstrate that older age, male gender, HT, DM and smoking are powerful risk factors for PAD. In contrast to the previous reports, RDW levels are found not to be associated with atherosclerosis of peripheral arteries.Item Association Between Brain Venous Drainage, Cerebral Aneurysm Formation and Aneurysm Rupture(2017) Duman, Enes; Coven, Ilker; Yildirim, Erkan; Yilmaz, Cem; Pinar, H.Ulas; Ozdemir, Ozgur; 0000-0003-0473-6763; 0000-0002-9057-722X; 0000-0002-2353-8044; 27593813; Q-2420-2015; ABI-3856-2020; AAK-2948-2021AIM: The brain venous drainage dominance is generally divided into three groups; right or left dominance and co-dominance. There is no study in the literature examining the link between brain venous drainage and aneurysm formation or rupture. Our aim was to evaluate the association between venous dominancy, aneurysm formation and rupture. MATERIAL and METHODS: Eighty-six patients, who underwent cerebral digital subtraction angiography and who had cerebral aneurysms, were included in the study. The angiographic images, patient charts, and tomography images were scanned retrospectively. We recorded the aneurysm's location, size, dome to neck ratio (D/N); the patient's gender, age, whether there was a ruptured aneurysm, smoking history, and/or hypertension; dominance of venous drainage, aneurysm side, Fisher scores and the World Federation of Neurosurgical Societies (WFNS) Grading System for Subarachnoid Hemorrhage scores for patients who had a ruptured aneurysm. We assessed whether or not venous drainage was associated with rupture of the aneurysm and if venous dominance was a predisposing factor for aneurysm formation like location, size, and hypertension. RESULTS: There was a statistically significant association between venous dominance and side of aneurysm; and also a statistically significant association between venous dominance and rupture. There was a positive correlation between hypertension and rupture. The most common aneurysm location was the anterior communicating artery, followed by the middle cerebral artery. CONCLUSION: Brain venous drainage dominance may be a predisposing factor for aneurysm formation and it can be predictive for rupture.Item High Prolactin Level as a Predictor of Vasospasm in Aneurysmal Subarachnoidal Hemorrhage(2017) Kircelli, Atilla; Coven, Ilker; Duman, Enes; Pinar, Huseyin Ulas; Basaran, Betul; 0000-0003-0473-6763; 0000-0003-2109-1274; 28784938; Q-2420-2015; AAK-5299-2021Background: Aneurysmal subarachnoid hemorrhage (aSAH) is a destructive syndrome with a mortality rate of 50%. Recent studies have also suggested a high pervasiveness of hypothalamic-pituitary insufficiency in up to 45% of patients after aSAH. Prolactin has been associated with the pathogenesis of hypertensive irregularities that are linked to pregnancy. Material/Methods: We identified a group of 141 patients with spontaneous SAH due to a ruptured cerebral aneurysm; these patients were operated on at our institution's Neurosurgery and Interventional Radiology Department between 2011 and June 2015. All of the data were obtained retrospectively from medical records. Results: The hormonal abnormalities observed in the initial 24 h after ictus in subjects with subarachnoid SAH were caused by stressful stimulation aggravated by intracranial bleeding. Conclusions: The elevated prolactin levels that occur in patients with aSAH can be used in conjunction with other auxiliary factors that we believe may be beneficial to vasospasm.Item Laparoscopic gastrostomy under awake thoracic epidural anesthesia: A successful experience(2018) Pinar, Huseyin Ulas; Karaca, Omer; Duman, Enes; Dogan, Rafi; 30028480General anesthesia is the first choice as an anesthesia method particularly for abdominal operations. However, because neuromuscular blockade induced during general anesthesia will increase atelectasis in a patient with pulmonary disease, it will also increase postoperative ventilator dependence, which will be even more apparent in cases of chronic obstructive pulmonary disease (COPD) that pose a risk, particularly for postoperative complications. Herein, thoracic epidural anesthesia (TEA) was found to be a better option for our patient with severe COPD and stage IV lung cancer, as it provided sufficient anesthesia and better postoperative care for laparoscopic gastrostomy.