Fakülteler / Faculties
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Item Reversal of Rocuronium Induced Neuromuscular Block with Sugammadex in Patients Under 2 Years of Age. A Series of 280 Cases(2023) Ozmete, Ozlem; Dardag, Emre; Civi, Soner; 38131376AIM: Neuromuscular muscle relaxants are still indispensable for surgical procedures requiring general anesthesia, and the use of these agents may result in postoperative residual curarization. Sugammadex may offer a distinct advantage to pediatric patients where residual neuromuscular blockade may be poorly tolerated. Sugammadex is approved for use in adults and children over two years. This is the main reason why large-scale studies could not be conducted in the group of patients younger than two years old. This study aimed to evaluate the efficacy and safety of sugammadex for reversing deep rocuronium-induced neuromuscular blockade in children under two years of age. METHODS: Pediatric patients younger than two years of age who underwent neurosurgery under sevoflurane anesthesia were included in the study. Neuromuscular block was achieved by the administration of rocuronium. It was antagonized by the administration of 5 mg/kg sugammadex and evaluated using train-of-four (TOF). Primary outcome measure was the time from sugammadex administration to return of the TOF ratio to 0,9. Postoperative adverse events were also recorded. RESULTS: Two hundred eighty patients (10 day-24 months of age; 3-18 kg) were included in this study. Reversal of deep rocuronium-induced neuromuscular block with sugammadex was rapid in all patients. No residual curarization or recurarization was observed. No adverse events or hypersensitivity reactions were observed after administration of sugammadex. CONCLUSION: Reversal of rocuronium-induced deep neuromuscular block in infants was rapid and safe. Sugammadex provided safe extubation in patients younger than two years of age who had undergone neurosurgery. Research Fund.Item Does The Dominant Hand Factor Have an Effect on Postoperative Recovery in The Surgical Treatment of Carpal Tunnel Syndrome?(2018) Civi, Soner; Tanburoglu, Anil; Suner, Halil Ibrahim; Kardes, Ozgur; Durdag, Emre; Tufan, Kadir; https://orcid.org/0000-0002-1055-5152; https://orcid.org/0000-0001-9627-3502; https://orcid.org/0000-0002-5957-8611; https://orcid.org/0000-0003-2854-941X; https://orcid.org/0000-0001-6939-5491; https://orcid.org/0000-0003-1509-4575; U-2400-2018; AAK-1876-2021; AAJ-5381-2021; P-5895-2018; AAK-1734-2021; AAK-1686-2021Objective: Carpal Tunnel Syndrome (CTS) is the most frequently encountered entrapment neuropathy. Surgical treatment is usually suggested to patients with severe symptoms. In this study, we aimed to examine the effect of the dominant hand on the clinical results of CTS decompression surgery. Methods: Fifty (5M, 45F) patients were included in the study. The Edinburgh Handedness Inventory was used to identify the dominant hand of patients included in the study. Visual analogue scale (VAS) values were evaluated pre- and postoperatively. Results: Twenty-eight patients underwent surgery on the dominant hand and 22 patients had surgery to their non-dominant hand. The VAS values of patients who underwent non-dominant hand surgery were lower than those who underwent surgery on the dominant hand. Conclusion: In our study, it was determined that patient complacency after surgical procedures performed on dominant hands was less when compared with the non-dominant side. We believe that suitable exercise and protection programs for dominant hands in the postoperative period of carpal tunnel surgery, in addition to a good and careful surgical technique, positively affects the results of surgical treatment.Item Effects of Quercetin on Chronic Constriction Nerve Injury in an Experimental Rat Model(2016) Civi, Soner; Emmez, Gokcen; Dere, Umit Akin; Borcek, Alp Ozgun; Emmez, Hakan; https://orcid.org/0000-0002-1055-5152; 26960544; U-2400-2018Flavonoids are popular substances in the literature, with proven effects on cardiovascular, neoplastic and neurodegenerative diseases. Antioxidant effect is the most pronounced and studied one. Among thousands of flavonoids, quercetin (QUE) is a prototype with significant antioxidant effects. This study aims to demonstrate the effects of QUE in an experimental rat model of chronic constriction injury (CCI). A two-level study was designed with 42 adult Wistar rats that were randomly assigned to different groups. In the first part, animals in sham, control, quercetin, morphine and gabapentine groups received chronic constriction injury to their sciatic nerves and received a single dose of QUE, morphine and gabapentine. In the second part, different dose regimens of QUE were administered to different groups of animals. Pre-injury and post-injury assessments for mechanical hypersensitivity, thermal sensitivity, locomotor activity and anxiety were recorded and statistical comparisons were performed between different groups. Comparison of QUE with morphine and gabapentine has revealed significant effects of this agent in the current chronic constriction injury model. QUE was significantly superior to Gabapentine and morphine in terms of alleviating mechanical and thermal hypersensitivity. Additionally, pre-injury administration of QUE for 4 days demonstrated long-term effectiveness on mechanical hypersensitivity. This preliminary report the on effects of QUE in a chronic constriction injury model proved significant effects of the agent, which should be supplemented with different studies using different dose regimens.Item Sugammadex Given for Rocuronium-Induced Neuromuscular Blockade in Infants: A Retrospective Study(2016) Ozmete, Ozlem; Bali, Cagla; Cok, Oya Yalcin; Turk, Hatice Evren Eker; Ozyilkan, Nesrin Bozdogan; Civi, Soner; Aribogan, Anis; 0000-0002-1055-5152; 0000-0003-3004-2626; 0000-0002-7901-0185; 0000-0002-4973-8132; 0000-0003-2615-1918; 0000-0002-4419-5693; 0000-0001-5845-699X; 27871583; AAI-7779-2021; U-2400-2018; AAI-7998-2021; AAI-8790-2021; AAI-8769-2021; S-8336-2019; AAI-7880-2021Study Objective: To evaluate the efficacy and safety of sugammadex in reversing profound neuromuscular block induced by rocuronium in infant patients. Design: Retrospective observational study. Setting: University teaching hospital. Patients: Twenty-six infants (2-12 months of age; 3-11 kg) with an American Society of Anesthesiologists classification I, II, or III who were scheduled to undergo neurosurgical procedures were included in the study. Interventions: Anesthesia was induced with 5 mg/kg thiopental, 1 mu g/kg fentanyl and 0.6 mg/kg rocuronium. Sevoflurane was administered to all patients after intubation. Methods: The neuromuscular block was monitored with acceleromyography using train-of-four (TOF) stimuli. Patients received additional doses of rocuronium to maintain a deep block during surgery. If profound neuromuscular block (TOF, 0) persisted at the end of the surgery, 3 mg/kg sugammadex was administered. Measurements: The demographic data, surgeries, and anesthetic agents were recorded. The time from sugammadex administration to recovery of neuromuscular function (TOF ratio, >0.9) and complications during and after extubation were also recorded. Main results: Twenty-six infants who had a deep neuromuscular block (TOF, 0) at the end of surgery received 3 mg/kg sugammadex. The mean recovery time of the T4/T1 ratio of 0.9 was 112 seconds. No clinical evidence of recurarization or residual curarization was observed. Conclusions: The efficacy and safety of sugammadex were confirmed in infant surgical patients for reversal of deep neuromuscular block induced by rocuronium. (C) 2016 Elsevier Inc. All rights reserved.Item Brain Metastasis of Penile Angiosarcoma(2018) Kardes, Ozgur; Aydemir, Fatih; Suner, Halil Ibrahim; Durdag, Emre; Civi, Soner; Tufan, Kadir; Kayaselcuk, Fazilet; https://orcid.org/0000-0003-2854-941X; https://orcid.org/0000-0002-5957-8611; https://orcid.org/0000-0001-6939-5491; https://orcid.org/0000-0002-1055-5152; https://orcid.org/0000-0003-1509-4575; https://orcid.org/0000-0002-1180-3840; 29150829; P-5895-2018; AAJ-5381-2021; AAK-1734-2021; U-2400-2018; AAK-1686-2021; AAE-2550-2021Angiosarcoma is a rare malignancy originating from vascular endothelial cells. Brain metastasis of aniosarcomas are uncommon up to the literature. Penile angiosarcomas are also seldom among all anjiosarcomas. A case with penile angiosarcoma with confirmed brain metastasis is aimed to be reported and contribute to the literature for similar cases.Item The Effects of Infusion of Perineural Pregabalin in the Experimentally Created Sciatic Nerve Anastomosis in Rats(2018) Civi, Soner; Bulduk, Erkut Baha; Kocer, Nazim Emrah; Kardes, Ozgur; Suner, Halil Ibrahim; Durdag, Emre; Tufan, Kadir; 0000-0002-5943-9283; 0000-0003-2854-941X; 0000-0002-5957-8611; 0000-0001-6939-5491; 0000-0003-1509-4575; 30569903; AAM-5436-2021; P-5895-2018; AAJ-5381-2021; AAK-1734-2021; AAK-1686-2021INTRODUCTION AND OBJECT: The aim of our study was to assess the effect of perineural pregabalin administration on the success of coaptation in experimental rat sciatic nerve anastomosis by measuring the expression of anti-inflammatory cytokine TGF-beta. It is thus to provide alternative solutions to this problem which we often see in clinical practice and whose results are not satisfactory. METHODS: In our study, 40 adult, male, Sprague-Dawley rats; 5 groups were randomly assigned Group 1: This group's sciatic nerves were dissected and the surgical site was sutured. Group 2: Rats whose sciatic nerves are sectioned transversely through the fill-thickness and end-to-end anastomosis is performed and no additional procedure is performed. Group 3: Intraperitoneal administration of 30 mg / kg pregabalin for 7 days with anastomosis. Group 4: 30 mg/kg pregabalin given orally for 7 days with anastomosis. Group 5: Given 10 microliters / h pregabalin subcutaneous perineural infusion for 7 days with anastomosis. After 60 days of surgery, the experiment was terminated with high dose thiopental (50 mg/kg). The right sciatic nerves of all animals were taken and sections obtained were examined immunohistopathologically. RESULTS: Inflammation was significantly less in the 5th group than in the other groups. TGF-beta expression in Groups 3, 4, and 5 is significantly higher than Groups 1 and 2, which also supports this situation. Although the expression in group 5 was not statistically significant, the number of TGF-beta expression was higher than Groups 3 and 4. In terms of immunohistochemical properties; 1 to 3, 1 to 4, 1 to 5, 2 to 5 groups were statistically significant (p<0,05). CONCLUSIONS: In conclusion, perinural infusion of pregabalin into the anastomotic region has not been previously tried in the literature and it has been found that immunohistochemistry provides positive contributions to healing of anastomosis. More research is needed to demonstrate that this effect is superior to other methods of administration of the drug.Item Effect of decompressive hemicraniectomy in patients with acute middle cerebral artery infarction 2050(2021) Suner, Halil İbrahim; Tanburoglu, Anil; Durdag, Emre; Civi, Soner; Gunesli Yetisken, Aylin; Kardes, Ozgur; Andic, Cagatay; Tufan, Kadir; 0000-0002-5957-8611; 0000-0003-2854-941X; 0000-0001-9627-3502; 0000-0001-8581-8685; 33890450; AAJ-5381-2021; P-5895-2018; AAK-1876-2021; AAM-1671-2021Background/aim: We aimed to determine in which cases this procedure may be more effective based on the data of patients who underwent decompressive hemicraniectomy (DHC). Material and methods: Overall, 47 patients who underwent DHC due to acute middle cerebral artery (MCA) infarction between January 2014 and january 2019 were retrospectively investigated. These patients were divided into two groups: those who died after DHC (Group A) and those who survived DHC (Group B). The groups were compared in terms of various parameters. We investigated whether the patient's modified Rankin scale (mRS) status changed depending on age (> 60 and < 60 years). Results: The median age of all patients was 65 (37-80) years; groups A and B had median ages of 66.5 (37-80) and 61 (44-79) years (p = 0.111), respectively; 55.3% patients were male. The elapsed times until hospitalization after the onset of symptoms were 4.5 and 3 h in groups A and B, respectively (p = 0.014). The median GCS score at the time of admission was 7 (5-12) and 10 (8-14) in groups A and B, respectively (p = 0.0001). At the time of admission, 63.3% patients in group A had anisocoria, whereas no patient in group B had anisocoria (p = 0.0001). In postoperative period, 40% patients in group A and all patients in group B received AC/AA treatment. The survival of patients aged < 60 and > 60 years who underwent DHC for MCA infraction was 61.5% and 26.5%, respectively (p = 0,041). The median mRS of patients < 60 and > 60 years were 4 (1-6) and 6 (1-6), respectively (p = 0.018). Conclusion: Age, DHC timing, and elapsed time until hospitalization or access to treatment directly affect the functional outcome and survival in MCA-infarcted patients who underwent DHC. In patients in whom the medical treatment fails, early DHC administration will increase survival without waiting for neurological worsening once herniation is detected radiologically.Item Spine Tango in Turkish: Development of a Local Registry System(2017) Civi, Soner; Borcek, Alp Ozgun; Bulduk, Erkut B.; Emmez, Hakan; Kaymaz, Memduh; 0000-0002-1055-5152; 27593753; U-2400-2018AIM: Successfully established registry systems, rather than personal efforts to collect data, are required to record, analyze, compare and secure patient related data. Unfortunately, our country does not have such patient registry systems for spinal pathologies and surgeries at this time. In order to fill this gap in patient management in Turkey, the authors adopted already established Spine Tango registry system in a unique way answering the requirements of our health system. This article aims to present the adaptation process of Spine Tango forms for use in Turkish and describe the first implementation with 50 patients treated for spinal pathologies in a tertiary referral center. MATERIAL and METHODS: In 2011, an effort was initiated by the first author to translate the original Spine Tango forms into Turkish. Funding for this project was provided by authors themselves. With the assistance of a Spine Tango team, the translation process was completed. The Turkish forms were then used in an academic institution with a high spinal workload. A local solution was developed by the authors using commercially available software and mobile instruments. This system was tested with 50 spine patients from June 2012 to January 2013. RESULTS: The analysis of the data gathered using the new Turkey Spine Tango registry system was successful. CONCLUSION: In an environment of exponentially increasing medical data, successfully established registry systems have the potential to facilitate patient management. The authors recommend the use of Turkish Spine Tango forms for clinics performing spinal interventions.Item Effects of Atorvastatin on Experimental Spinal Cord lschemia-Reperfusion Injury in Rabbits(2017) Kardes, Ozgur; Civi, Soner; Tufan, Kadir; Oz Oyar, Eser; Omeroglu, Suna; Aykol, Sukru; 0000-0003-2854-941X; 27593815; P-5895-2018AIM: Extent of secondary injury is the determinant of tissue destruction and functional worsening after primary spinal cord injury (SCI). Data have accumulated on alleviation of secondary injury in SCI from many studies on the subject. Besides its cholesterol lowering effects, statins are known to have anti-inflammatory and anti-oxidant effects which are the main targets of spinal cord research. This study aims to evaluate the effects of atorvastatin on experimental spinal cord ischemia-reperfusion injury. MATERIAL and METHODS: Thirty adult male New Zealand rabbits were allocated into control, ischemia-reperfusion (I/R) and treatment groups. Treatment group received 5 mg/kg of atorvastatin via lavage for the preceding 14 days. Other groups received placebo during the same time period. After two weeks, animals in the I/R and treatment groups underwent abdominal temporary aorta occlusion for 30 minutes. Neurological condition of the animals was recorded during the 48 hours of observation. Afterwards, animals were sacrificed and levels of malondialdehyde, glutathione and nitric oxide in spinal cord tissue and plasma and the histopathological tissue changes were determined. RESULTS: Animals in the treatment groups demonstrated significantly better results than the I/R group regarding biochemical markers. Neurological evaluation using the Tarlov scale demonstrated significantly better results at the 48th hour in treatment group. Histopathological results were also better in the treatment groups. CONCLUSION: Results of this study demonstrate the neuroprotective effects of atorvastatin. Atorvastatin has favorable effects on biochemical markers of oxidative stress in SCI. Further studies with larger cohorts and different time periods are also needed.Item Usefulness of End-to-Side Bridging Anastomosis of Sural Nerve to Tibial Nerve : An Experimental Research(2017) Civi, Soner; Durdag, Emre; Aytar, Murat Hamit; Kardes, Ozgur; Kaymaz, Figen; Aykol, Sukru; 0000-0003-2854-941X; 0000-0001-6939-5491; 0000-0002-1055-5152; 28689390; P-5895-2018; AAK-1734-2021; U-2400-2018Objective : Repair of sensorial nerve defect is an important issue on peripheric nerve surgery. The aim of the present study was to determine the effects of sensory-motor nerve bridging on the denervated dermatomal area, in rats with sensory nerve defects, using a neural cell adhesion molecule (NCAM). Methods : We compared the efficacy of end-to-side (ETS) coaptation of the tibial nerve for sural nerve defect repair, in 32 Sprague-Dawley rats. Rats were assigned to 1 of 4 groups : group A was the sham operated group, group B rats had sural nerves sectioned and buried in neighboring muscles, group C experienced nerve sectioning and end-to-end (ETE) anastomosis, and group D had sural nerves sectioned and ETS anastomosis was performed using atibial nerve bridge. Neurological evaluation included the skin pinch test and histological evaluation was performed by assessing NCAM expression in nerve terminals. Results : Rats in the denervated group yielded negative results for the skin pinch tests, while animals in the surgical intervention groups (group C and D) demonstrated positive results. As predicted, there were no positively stained skin specimens in the denervated group (group B); however, the surgery groups demonstrated significant staining. NCAM expression was also significantly higher in the surgery groups. However, the mean NCAM values were not significantly different between group C and group D. Conclusion : Previous research indicates that ETE nerve repair is the gold standard for peripheral nerve defect repair. However, ETS repair is an effective alternative method in cases of sensorial nerve defect when ETE repair is not possible.