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    Absence of infrarenal inferior vena cava is not a congenital abnormality
    (Comenius Univ, 2009) Alicioglu, Banu; Kaplan, Mustafa; Ege, Turan
    The absence of inferior vena cava (IVC) is one among infrequent subtypes of IVC abnormalities that are rarely seen in general population. The absence of IVC involves either that of entire IVC or that of infrarenal segment. These two entities are relatively similar but their etiopathogeneses are still controversial. The absence of the entire IVC is thought to be a result of an embryologic disorder, whereas perinatal thrombosis is hypothesised to lead to the development of absent infrarenal IVC, thus the latter is a developmental disorder and the former occurs due to embryologic disorder. We report an adult man with renal-infrarenal absence of IVC, as well as missing common iliac veins. He clinically presented with extensive varicose collateral circulation on the thoracoabdominal wall, right varicocele and severe varices on lower limbs. Calcifications of adrenal glands indicate a hematologic disorder during perinatal period. The etiopathogenesis of this unusual abnormality is emphasized in this case report (Fig. 5, Ref. 10). Full Text (Free, PDF) www.bmj.sk.
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    Açık kalp cerrahisinde farklı iki heparin nötralizasyon yönteminin postoperatif drenaja etkisi
    (2002) Ege, Turan; Çıkırıkçıoğlu, Mustafa; Arar, Cavidan; Acıpayam, Mehmet; Duran, Enver
    Giriş ve Amaç: Koroner arter bypass cerrahisi uygulanan hastalarda farklı iki yöntemle heparinin nötralizasyonu sonucu postoperatif dönemde aktive edilmiş pıhtılaşma zamanında (ACT) ve drenaj miktarlarında oluşan değişiklikleri araştırmak. Materyal ve Metotlar: Trakya Üniversitesi Tıp Fakültesi Kalp Damar Cerrahisi Kliniğinde 1 Ocak-31 Temmuz 2002 tarihleri arasında koroner bypass operasyonu uygulanan 53 olgu çalışmaya alındı. Hastalar rastlantısal olarak iki gruba ayrıldı. Operasyon sırasında uygulanan toplam heparin miktarının 1.3 katı oranında protamin verilenler Grup=1(n=29)'i ve kardiyopulmoner bypass sonunda protamin dozu bir grafikle hesaplanarak heparin nötralizasyonu uygulananlar Grup=2(n=24)'yi oluşturdu, iki grubun postoperatif ACT ve drenaj miktarları karşılaştırıldı. Bulgular: iki grup arasında yaş, cins, vücut kitle oranı (BMI), gren sayısı, kardiyopulmoner bypas zamanı (KPBZ), kros klemp zamanı (KKZ), ejeksiyon fraksiyonu (EF) ve sol internal mammarian arter (LlMA) kullanımı bakımından farklılık yoktu. Protamin verildikten 5 dakika sonraki ACT değerlerinde 2 grup arasında farklılık yoktu (Grup 1=129.8±12.6, Grup 2=128.5±14.1 saniye). Protamin sonrası 2-4 ve 6.saatlerde ACT değeri grup 1'de (131.9±19.2, 129.2±11.5, 127.0±9.2 saniye) grup 2'ye göre (118.5±13.5, 114.4±9.6, 111.9±10.3 saniye) belirgin derecede yüksekti. Grup 1 'de toplam protamin dozu (318.0±45.2 mg), grup 2'ye (287.7±42.3 mg) göre anlamlı derecede fazla bulundu. Postoperatif 0-2, 2-4, 4-6, 6-12.saat ve toplam drenaj miktarları karşılaştırıldığında grup 1'de (172.4±91.9, 107.4±64.9, 92.1±42.1, 118.8+81.8 ve 876.6±112.5 mililitre) grup 2'ye göre (91.7$pm$55.0, 74.2$pm$63.7, 67.7±51.9, 71.6±40.5 ve 706.2±98.3 mililitre) anlamlı derecede fazla olduğu görüldü.Sonuçlar: KPB sonunda heparinin yeterince nötralize edilememesi postoperatif dönemde kanama, kardiyak tamponad ve tranfüzyon reaksiyonları gibi komplikasyonlara yol açmaktadır. Bu komplikasyonları azaltmak için heparin nötralizasyonunda, hastada o anda mevcut olan miktarının bilinmesi ve bunun protaminle nötralizasyonu büyük önem taşımaktadır. Bu nedenle protamin dozu hesaplanırken hastanın bazal, heparin sonrası ve kardiyopulmoner bypas (KPB) sonundaki ACT değerleriyle elde edilen grafiğin kullanılması büyük avantajlar sağlamaktadır.
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    Analysis of C-reactive protein and biochemical parameters in pericardial fluid
    (Yonsei Univ College Medicine, 2006) Ege, Turan; Us, Melih Hulusi; Cikirikcioglu, Mustafa; Arar, Cavidan; Duran, Enver
    This study was designed to examine the relationship between pericardial fluid and plasma CRP levels, and to alterations in other biochemical parameters in patients undergoing Coronary Artery Bypass Grafting (CABG). The study group consisted of 96 Coronary Artery Disease (CAD) patients who were referred to our clinic for a CABG procedure and from whom sufficient amount of pericardial fluid could be collected. The patients were classified into 3 groups: Stable Angina Pectoris (SAP) (n = 27), Unstable Angina Pectoris (USAP) (n = 36), and Post-Myocardial Infarction (PMI) (n = 33). Levels of CRP, glucose, albumin, total protein, Creatine Kinase (CK), Creatine Kinase-MB (CK-MB), and Lactate Dehydrogenase (LDH) were determined in pericardial fluid samples and in simultaneously collected blood samples from radial artery. The pericardial CRP and LDH levels in the PMI group were higher than in the SAP (p = 0.015 and p = 0.000, respectively) and USAP (p = 0.011, p = 0.047) groups. Serum CRP levels in USAP (p = 0.014) and PMI (p = 0.000) groups were higher than those in the SAP group. Pericardial albumin levels in the PMI group were higher than in the USAP group (p = 0.038). In all groups, the pericardial fluid/serum protein ratio was > 0.5, the LDL ratio was > 0.6, and pericardial fluid LDH concentrations were > 300 mg/dl. CRP level of pericardial fluid was significantly higher in the PMI group than in other groups. However, pericardial fluid LDH levels were higher than blood LDH levels in this group and were also higher than pericardial fluid LDH levels of other groups.
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    Arteriyovenöz fistül operasyonlarında venöz transpozisyon uygulamalarına ait sonuçlarımız
    (2002) Çıkırıkçıoğlu, Mustafa; Ege, Turan; Süt, Necdet; Duran, Enver
    Amaç: Son evre böbrek yetmezliği tedavisinde hemodiyaliz uygulaması olguların büyük çoğunluğunda arteriyovenöz fistül(AVF)'ler aracılığı ile yapılmaktadır. Bu çalışma, AVF operasyonlarında uyguladığımız üç farklı tekniğe ait sonuçların karşılaştırılmalı olarak değerlendirilmesi amacıyla planlanmıştır.Materyal-metod: Kliniğimizde Ocak 2000- Nisan 2001 tarihleri arasında AVF operasyonu uygulanan 112 olgu çalışmaya alındı. Olgular operasyon tipine göre üç gruba ayrıldı. 1. Grup: Klasik AVF operasyonu uygulananlar(n: 95), 2. Grup: Venöz transpozisyon ile AVF açılanlar(n: 14), 3. Grup: Sentetik greft kullanılarak AVF oluşturulanlar(n: 3). Olgulara ait özellikler dosya kayıtlarından retrospektif olarak sağlandı. Açık kalma oranları telefon görüşmeleri ve poliklinik kontrolleri ile elde edildi. Sonuçlar SPSS istatistik programında Kruskall-Wallis varyans analizi ve Tukey/Tam-hane çoklu karşılaştırma testleri kullanılarak karşılaştırıldı.Bulgular: Üç grup arasında kronik böbrek yetmezliği süresi (p= 0.000) ve daha'önce geçirilen operasyon sayıları açı-sından anlamlı fark olduğu saptandı (p= 0.000). Operasyon maliyetleri Grup 1 ve 2'de, Grup 3'e göre önemli ölçüde düşük olarak bulundu (p= 0.000). Otojen doku kullanılan olgularda 6 aylık açık kalım oranları birbirine yakındı (Grup 1 : % 77.8, Grup 2: % 85.7, p=0.730). Greft kullanılan olgularda 6 aylık açık kalım elde edilemediği görüldü.Sonuç: Venöz transpozisyon işlemleri ile elde edilen açık kalım sonuçları, klasik AVF operasyonları ile benzerdir. Bu çalışmanın sonucunda AVF operasyonu uygulanacak olgularda otojen ven kullanımının mümkün olduğunca zorlanmasının açık kalım, komplikasyonların önlenmesi ve operasyon maliyeti açısından faydalı olduğu saptanmıştır.
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    Basilic vein superficialization for hemodialysis vascular access
    (Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2013) Yuksel, Volkan; Halici, Umit; Huseyin, Serhat; Guclu, Orkut; Canbaz, Suat; Ege, Turan; Sunar, Hasan
    Background: This study aims to discuss the outcomes of superficialization of basilic vein technique in brachiobasilic arteriovenous fistula formation and to present our experience. Methods: Between January 2006 and January 2012, 170 patients (74 males, 96 females; mean age 60.7 +/- 9.1 years; range 31 to 83 years) who underwent basilic vein superficialization surgery in our clinic were included. All patients were examined under Doppler ultrasonography preoperatively. Demographic data of the patients, maturation time and complications were recorded. The mean follow-up was 12 months. Results: Non-dominant upper limb was preferred for surgery. Of the 170 patients who were operated, 166(97.6%) underwent hemodialysis. The mean maturation time was 61 days. Massive bleeding in the postoperative period occurred in two patients (1.2%). Wound infection was observed in eight patients (4.7%) in the early postoperative period. The most common reason for primary failure was thrombosis, which was observed in 48 patients (28.2%). The primary and secondary patency rates of the fistulas were 77% and 82%, respectively at one-year. Conclusion: Arteriovenous fistula formation through superficialization of the basilic vein offers satisfactory results in chronic hemodialysis patients with reasonable postoperative complication rate.
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    Body mass index as a determinant of postoperative morbidity
    (Cardiology Academic Press, 2013) Gurkan, Selami; Gur, Ozcan; Gur, Demet Ozkaramanli; Ege, Turan; Canbaz, Suat; Iscan, Sahin
    BACKGROUND: The impact of obesity on postoperative mortality and morbidity in coronary artery bypass grafting (CABG) operations is a widely studied but poorly defined topic. OBJECTIVE: To investigate the effect of body mass index (BMI) on in-hospital mortality and morbidity after isolated CABG surgery. METHODS: Prospectively collected data of a series of 1057 consecutive patients who underwent on-pump isolated CABG surgery were retrospectively analyzed. Patients were divided into five groups according to WHO BMI categorization (defined as underweight [BMI <20 kg/m(2)]; normal weight [BMI >= 20 kg/m(2) to <25 kg/m(2)]; overweight [BMI >= 25 kg/m(2) to <30 kg/m(2)]; obese, [BMI >= 30 kg/m(2) to <35 kg/m(2)]; and morbidly obese, [BMI >= 35 kg/m(2)]). RESULTS: Of 1057 patients, 13 patients (1.2%) were underweight, 298 (28.2%) were normal weight, 462 (43.7%) were overweight, 218 (20.6%) were obese and 66 (6.2%) were morbidly obese. The mean age was significantly lower in underweight patients, who were also more likely to be male. In contrast, obese and morbidly obese patients were older, and more likely to have comorbidities such as diabetes and hypertension. The incidence of postoperative bronchodilator use (P<0.001), leg wound infection (P=0.038), sternal dehiscence (P=0.039) and development of new-onset atrial fibrillation (P<0.001) was significantly higher in obese and morbidly obese groups. In contrast, postoperative prolonged ventilation (P<0.001), need for blood transfusions (P<0.001) and revision for bleeding (P=0.041), as well as gastrointestinal complications (P<0.001), were significantly higher in underweight patients. Multivariate logistic regression analysis showed that not BMI but female sex, older age and diabetes mellitis were independent risk factors for early mortality after CABG surgery. CONCLUSION: No effect of BMI on early postoperative mortality after CABG surgery could be demonstrated. However, in terms of morbidity, postoperative bleeding and revision for bleeding were increased in underweight patients while sternal dehiscence, wound infections and occurrence of atrial fibrillation were increased in obese and morbidly obese patients.
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    Büyük safen ven yetmezliğinde manuel 980 nm lazer çıplak-uçlu fiber ile otomatik geri çekme sistemli 1470 nm radial fiber lazerin karşılaştırılması: Erken dönem etkinlik ve komplikasyonlarin analizi
    (2013) Gürkan, Selami; Gür, Özcan; Arar, Cavidan; Donbaloğlu, Mehmet Okan; Ege, Turan
    Amaç: Endovenöz lazer ablasyon, variköz ven tedavisinde en çok kabul gören tedavi seçeneklerinden biridir. Bu retrospektif çalışmanın amacı manuel 980 nm çıplak fiber lazer ile otomatik geri çekme sistemli 1470 nm radial fiber lazerin erken dönem etkinliklerinin karşılaştırılması.Gereç ve Yöntemler: Ekim 2011 ile Ocak 2013 arasında büyük safen ven yetmezliği sebebiyle endovenöz lazer ablasyon ile tedavi edilen 78 hasta ve 89 ekstremite incelendi. 980 nm lazer ve çıplak fiber ile tedavi edilen 40 hasta ve 45 ekstremite Grup 1 olarak tanımlandı. 1470 nm lazer radial fiber ve otomatik geri çekme sistemi ile tedavi edilen 38 hasta ve 44 ekstremite Grup 2 olarak tanımlandı. Ağrı, ekimoz, endurasyon, parestezi gibi lokal komplikasyonlar postoperatif 3, 7 ve 30. günlerde klinik olarak ve Doppler ultrasonografi ile değerlendirildi.Bulgular: Grup 1 ve grup 2de erken kapanma oranları sırasıyla %91 (n=41) ve %93 (n=41) idi. Bir aylık takipler sonunda her iki grupta da venöz klinik şiddet skorlarında belirgin derecede azalma oldu. Postoperatif ekimoz, endurasyon parestezi ve analjezik ihtiyacı grup 1de anlamlı derecede yüksek olmasına rağmen, major komplikasyonlar her iki grupta da görülmedi. Sonuç: Her iki tip lazer ile yapılan endovenöz lazer ablasyon işleminin erken dönem sonuçları tatmin ediciydi. Otomatik geri çekme sistemli 1470 nm dalga boyunda radial fiber kullanılarak yapılan büyük safen venin endovenöz lazer ablasyonunun etkili ve güvenli bir tedavi seçeneği olduğu söylenebilir.
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    Cardiac metastasis of hepatocellular carcinoma in a young non-cirrhotic patient, to the left ventricle
    (Elsevier Espana, 2012) Tastekin, Ebru; Usta, Ufuk; Ege, Turan; Kazindir, Gokhan; Kutlu, Ali Kemal
    Hepatocellular carcinoma (HCC) is the most common primary tumor of the liver.(1,2) The most common extrahepatic metastatic sites are lung, abdominal lymph nodes and bone, while its cardiac metastasis is rare.(2,3) Metastasis of HCC into the cardiac cavity is mostly caused by direct tumor invasion of vena cava inferior with continuous extension into the right cardiac cavity.(4,5) Right heart metastasis without invasion of inferior vena cava, which may be caused by hematogenous spread of cancer cells, is rarely reported.(6,7) This paper announces an unusual case of isolated involvement of left ventricle (LV) together with myocardial invasion of HCC. Our patient is known to be the first case with isolated HCC metastasis to the left ventricle. Strikingly, the patient was young and non-cirrhotic with negative serum HBsAg, and anti-HCV results.
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    Cardiac rhabdomyoma in an adult patient presenting with right ventricular outflow tract obstruction
    (Elsevier Ireland Ltd, 2008) Aktoz, Meryem; Tatli, Ersan; Ege, Turan; Yalcin, Omer; Buyuklu, Mutlu; Aksu, Feza; Gul, Cetin
    We present a 24 year old woman with cardiac rhabdomyoma. Cardiac rhabdomyoma is the most common benign cardiac tumor in infants, but in adults, cardiac rhabdomyoma is very rare. These tumors are often spontaneously reversible because they are associated to the right or left ventricular outflow tract obstruction, tachyarrhythmias and heart failure where surgery is necessary. (C) 2007 Elsevier Ireland Ltd. All rights reserved.
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    Combined cardiac surgery and substernal thyroidectomy
    (Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2012) Gurkan, Selami; Huseyin, Serhat; Sarac, Atilla; Ege, Turan; Duran, Enver
    Excessive growth of the thyroid gland is frequently associated with multinodular goiter. Shifting of mediastinal structures and large airway obstruction via extrinsic compression by a mass effect can lead to additional surgical problems. In November 2008, a 65-year-old male patient with unstable angina pectoris was admitted to our clinic for coronary artery bypass grafting. A retrosternal mass lying over the ascending aorta precluded cannulation. After the resection of retrosternal goiter, cardiopulmonary bypass was performed with single right atrial and ascending aortic cannulation. Combined cardiac surgery and thyroidectomy can be safely performed if the preoperative thyroid hormone levels are maintained in the euthyroid state.
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    Comparison of early period results of blood use in open heart surgery
    (Medknow Publications & Media Pvt Ltd, 2016) Huseyin, Serhat; Yuksel, Volkan; Guclu, Orkut; Turan, Fatma Nesrin; Canbaz, Suat; Ege, Turan; Sunar, Hasan
    Background: Various adverse effects of homologous blood transfusion detected particularly in open heart surgery, in which it is frequently used, lead researchers to study on autologous blood use and to evaluate the patient's blood better. Due to the complications of homologous blood transfusion, development of techniques that utilize less transfusion has become inevitable. We aimed to evaluate the effects of acute normovolemic hemodilution (ANH) in patients undergoing open heart surgery. Materials and Methods: In this study, 120 patients who underwent open heart surgery were included. Patients were grouped into three: Autologous transfusion group (Group 1), homologous transfusion group (Group 2), and those received autologous blood and homologous blood products (Group 3). Patient data regarding preoperative characteristics, biochemical parameters, drainage, extubation time, duration of stay at intensive care, atrial fibrillation (AF) development, and hospital stay were recorded. Results: A statistically significant difference (P < 0.005) was found in favor of autologous group (Group 1) with respect to gender, body surface area, European System for Cardiac Operative Risk Evaluation, smoking, hematocrit levels, platelet counts, urea, C-reactive protein levels, protamine use, postoperative drainage, frequency of AF development, intubation period, stay at intensive care and hospital stay, and amount of used blood products. Conclusion: The use of autologous blood rather than homologous transfusion is not only attenuates side effects and complications of transfusion but also positively affects postoperative recovery process. Therefore, ANH can be considered as an easy, effective, and cheap technique during open heart surgery.
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    A comparison of the vasodilatory effects of verapamil, papaverine and nitroglycerin on isolated rat aorta
    (Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2013) Ege, Turan; Halici, Umit; Gur, Ozcan; Gurkan, Selami; Gur, Demet Ozkaramanli; Duran, Enver
    Background: This study aims to compare the vasodilatory effects of verapamil, papaverine and nitroglycerin on rat aortic preparations in in vitro isolated tissue bath system and to evaluate the role of vascular endothelium on vasodilatory responses of the isolated rat aorta samples. Methods: The thoracic aorta segments collected from 30 male Wistar rats (20 endothelialized and 20 de-endothelialized vascular rings for each drug in 2 mm wide strips, total number of 120 vascular rings) were suspended into the Krebs solution of the isolated tissue bath system. Phenylephrine was used to induce isometric contraction and tissue samples were treated with verapamil, papaverine and nitroglycerin separately to draw concentration-response curves of isometric vasodilatory responses. This procedure was repeated for de-endothelialized aorta samples. Results: Papaverine and verapamil induced vasodilatatory responses starting from the concentration of 10(-8) M and reached its maximum at concentration of 10(-3) M, while nitroglycerin induced vasodilation at lower concentrations starting from a concentration of 10(-12) M, reaching its maximum at 10(-6) M. Nitroglycerin was the most potent agent, followed by verapamil and papaverine. Efficacy analysis revealed that the most efficient agents were papaverine (140 +/- 6.7%), nitroglycerin (110.8 +/- 1.35%) and verapamil (99 +/- 4.14%), respectively. The results were similar in aorta samples without endothelium (p >= 0.05, F test). Conclusion: In this study examining isolated rat aorta, nitroglycerin was the most potent agent, while papaverine was the most efficient agent. Our study results showed that endothelium played no role in vasodilatation responses of these drugs.
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    Comparison of vasospasm and vasodilatation response of saphenous vein grafts harvested by conventional and no-touch techniques
    (Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2012) Gur, Ozcan; Gurkan, Selami; Ozkaramanli, Demet Gur; Karadag, Hakan; Ege, Turan
    Background: In this study, we aimed to compare vasoconstriction and vasodilatation responses of saphenous vein grafts (SVG) harvested by conventional and no touch techniques in tissue bath system. Methods: Between February 2007 and September 2007, 12 patients (10 males, 2 females; mean age 55.6 +/- 5.8 years; range 38 to 75 years) who underwent coronary artery bypass graft (CABG) surgery in our clinic with signed informed consents were included. Based on the techniques used during harvesting, the grafts were divided into two groups, including group 1 (n=16) with SVGs harvested by conventional technique and group 2 by no-touch technique. In group 1, SVG was removed completely from adjacent adipose tissues. In group 2, SVG was removed with adjacent adipose tissues, preserving saphenous nerves. Results: The vasodilatation response of SVGs was significantly higher with the no touch technique, while the vasoconstriction response of SVGs was significantly higher with the conventional technique at lower doses. Conclusion: We belive that no-touch harvesting technique of SVGs may decrease early graft failure and reduce also postoperative morbidity and mortality rate, contributing to improve graft patency rate in the long-term.
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    Derin ven trombozu etiyolojisinde önemli bir etken: Malignite
    (2003) Ege, Turan; Duran, Enver; Yüksel, Volkan; Çakır, Habib
    Amaç: Derin ven trombozu (DVT) tanısı konulan olgular arasında, malignite görülme sıklığını saptamak ve saptanan maligniteleri retrospektif olarak incelemek amaçlanmıştır. Materyal Metot: Kliniğimizde Ocak 2001-Mart 2003 tarihleri arasında alt ekstremitede akut DVT saptanan 212 hasta bu çalışmaya alındı. Bu olgulardan, malignite saptananların dosyaları analiz edildi ve sonuçlar tartışıldı. Bulgular: Malignite saptanan 21 olguda (%9.9) ortalama yaşı 57.7 ± 9.9 (35-72) ve E/K oranı 10/11 olarak bulundu. En sık jinekolojik (n=7, %33.3) ve akciğer (n-6, %28.5) maligniteleri saptanırken, gastrointestinal (n-3, %14.3) ve ürolojik maligniteler (n-3, %14.3) ise daha az oranda saptandı. Jinekolojik maligniteler, uterus (n= 4), över (n= 2) ve vulva (n=1) lokalizasyonluydu. Akciğer maligniteleri ise, küçük hücreli akciğer kanseri (n=4) ve epider-moid kanser (n=2) olarak saptandı. Gastrointestinal malignitelerin tümü kalın barsakta lokalize, ürolojik malignitelerden 2'si renal (hipernef-roma) 1'i prostat orijinliydi. Venöz trombozlar en sık femoral vende (%85.7) lokalizeydi. Hemoglobin, trombosit ve albumin değerleri, malignité grubunda diğer gruba göre belirgin olarak azalmış olarak bulundu (p < 0.05). Sonuç: DVT gelişen hastalarda malignite halen oldukça yüksek oranda görülmektedir. Etiyolojide risk faktörü saptanamayan olgular arasında özellikle, jinekolojik Ve akciğer malignitelerinin detaylı olarak araştırılması gerektiğini düşünüyoruz.
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    Emergency reoperation after open heart surgery: ten years of experience
    (Termedia Publishing House Ltd, 2013) Yuksel, Volkan; Huseyin, Serhat; Canbaz, Suat; Ege, Turan; Sunar, Hasan
    Background: Postoperative bleeding is an important corn plication after open heart surgery. Resternotomy for bleeding is an important source of mortality and morbidity. Aim of the study: We aimed to identify the common sites of bleeding after open heart surgery and to present our results. Material and methods: We performed 2286 open heart operations from January 2003 to January 2013. Reoperation for bleeding was performed in the case of bleeding that exceeded 3 ml/kg/h in the first 3 hours, continued bleeding of more than 200 ml/h that did not cease, and in the event of clinical signs of tamponade. All patients were reoperated in the operating theatre. Patient data and bleeding sites were recorded. Results: 98 patients (4.3%) underwent reoperation for bleeding or tamponade. Non-surgical causes of bleeding were found in 44 patients (44.9%). The major sites of bleeding were the left side branch of the internal thoracic artery (17.4%) and the side branch of the saphenous vein graft (13.3%). Mortality occurred in 13 patients (13.3%). Conclusions: Emergency reoperation for bleeding or tamponade after open heart surgery is an important problem. A high percentage of reoperated cases were due to technical errors during graft harvesting. We cannot always avoid the hematologic factors causing bleeding, but we can reduce the number of correctable causes that are usually surgeon-related. This should also contribute to reducing mortality and morbidity after open heart surgery.
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    Endovasküler abdominal aortik anevrizma tamirlerinde erken dönem sonuçları (6 aylık takip)
    (2013) Gür, Özcan; Gürkan, Selami; Gür, Demet Özkaramanlı; Arar, Cavidan; Ege, Turan
    Amaç: Abdominal aort anevrizması, açık cerrahi teknikler ile tedavi edilebildiği gibi endovasküler olarak da tamir edilebilmektedir. Çalışmamızda, endovasküler aort tamiri yapılan olguların 6 aylık erken dönem sonuçlarını sunmayı amaçladık. Gereç ve Yöntemler: Kliniğimizde 2010-2012 mayıs tarihleri arasında endovasküler aort anevrizma tamiri yapılan 18 hasta çalışmaya alındı. Olgular işlem sonrası 1. ve 6. ay kontrollerine çağrılarak endoleak açısından değerlendirildi. Olguların komorbidite sebeplerine bakıldığında %38,9u diyabetik (n:7), %77,8 hipertansif (n:14), %55.6 kronik obstruktif akciğer hastalığı (n:10), %16,7 malignite (n:3), %22,2si koroner arter hastalığı (n:4), 1 olguda ise peritonit sebebiyle geçirilmiş batın cerrahisi mevcuttu. Bulgular: Olguların 4ü kadın, 14ü erkek toplam 18 hastaya endovasküler aort tamiri (EVAR) işlemi uygulandı. Hastaların yaş ortalaması 72,77±6,54 (min:62, max:82) olarak saptandı. Olguların 6 aylık takibinde mortalite gözlenmezken 1 olguda endoleak saptandı. Sonuç: EVAR işlemi açık cerrahi için yüksek riskli olgularda (ileri yaş, komorbidite varlığı, geçirilmiş batın cerrahisi) düşük mortalite ve morbidite oranları ile güvenli bir biçimde uygulanabilir. Daha kesin sonuçlar için uzun dönem takiplere ihtiyaç duyulmaktadır.
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    The Evaluation of In Vitro Effects of Dipyridamole on Coronary Artery Bypass Grafts
    (Galenos Publ House, 2011) Ege, Turan; Karaca, Okay Guven; Gur, Ozcan; Karadag, Hakan; Gurkan, Selami; Duran, Enver
    Objective: The aim of this study is to evaluate the efficacy of dipyridamole in relieving the vasospasm of coronary artery bypass grafts. Material and Methods: Twenty two patients who underwent elective coronary artery bypass grafting (CABG) were admitted to the study (Men/Women:14/8, mean age: 62.4 +/- 8.8 years). Ten samples from left internal mammary(LIMA), radial arterial (RA) and saphenous vein (SV) grafts were collected for each. The samples were transported to the vascular laboratory in 4 C Krebs solution. Submaximal smooth muscle contraction was achieved first by 10-7M of phenylephrine solution. Dipyridamole was then added, starting from a concentration of 10-9M to a concentration of 10-3.5M in two minutes intervals and half logarithmic dose increments. The concentration-response curves were obtained of the vasodilatation response relative to the begining. Results: In the LIMA graft samples, the vasodilation response to dipyridamole was 43.2 +/- 1.6% and 97.6 +/- 4.1% at concentrations of 10-6M and 10-3.5M respectively. In RA graft samples, the vasodilation response to dipyridamole was 36.3 +/- 1.8% and 95.3 +/- 2.7% at concentrations of 10-6M and 10-3.5M respectively. In SV graft samples, however, the vasodilation response to dipyridamole was 43.2 +/- 1.4% and 96.6 +/- 2.2% at concentrations of 10-6M and 10-3.5M respectively. Conclusions: The amplitude of relaxation response to dipyridamole of all grafts samples were similar, without statistically significant difference among the IMA, RA and SV grafts in the in vitro tissue bath system. These results prove that dipyridamole has a potential use as a vasodilatatory drug in all graft types.
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    Evaluation of R-R interval variability with electromyography following coronary artery bypass grafting
    (2005) Turgut, Nilda; Canbaz, Suat; Balcı, Kemal; Ege, Turan; Halıcı, Ümit; Duran, Enver; Yavuz, Ebru
    Amaç: R-R interval değişkenliği (RRİD) analizi kalbin otonomik fonksiyonu hakkında bilgi verir. Koroner arter bypass cerrahisi sonrasında RRİD belirgin olarak azalmaktadır. Çalışmamızda, koroner arter bypass cerrahisi uygulanan hastalarda alternatif bir yöntem olarak elektromiyografi (EMG) ile RRİD değerlendirildi. Çalışma planı: Çalışmaya koroner arter bypass cerrahisi yapılan 19 hasta (6 kadın, 13 erkek; ort. yaş 57.8±10.2) alındı. Tüm hastalarda istirahat ve hiperventilasyon sırasında olmak üzere, ameliyat öncesinde ve ameliyattan bir ve iki ay sonrasında EMG ile RRİD analizi yapıldı. Bulgular: Ameliyat öncesiyle karşılaştırıldığında, ameliyattan bir ay (R-R, istirahat, p=0.001; R-R, hiperventilasyon, p=0.009) ve iki ay (R-R, istirahat, p=0.001; R-R, hiperventilasyon, p=0.006) sonra istirahat ve hiperventilasyon sırasında elde edilen ortalama RRİD değerleri anlamlı derecede düşük bulundu. Ameliyattan bir ay sonraki ortalama RRİD değerleri, ikinci ay sonundaki değerlerden anlamlı derecede düşük idi (R-R, istirahat, p=0.01; R-R, hiperventilasyon, p=0.001). R-R interval değişkenliği ile yaş, cinsiyet, hipertansiyon, sigara içme, total kolesterol ve trigliserid düzeyleri, beden kütle indeksi; cerrahi, kardiyopulmoner bypass, kros klemp, mekanik ventilasyon ve yoğun bakımda kalma süreleri arasında ilişki görülmedi. Sonuç: Bulgularımız, koroner arter bypass ameliyatından sonraki ilk iki ayda RRİD değerlerinin anlamlı derecede düştüğünü, ikinci aydaki değerlerde kısmi düzelme meydana geldiğini gösterdi. R-R interval değişkenliğinin EMG ile analizi, koroner arter bypass ameliyatı uygulanan hastalarda zaman kaybına yol açmayan, EMG laboratuvarında kolaylıkla yapılabilen ve kalbin otonomik fonksiyonunu yansıtan bir seçenektir.
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    An experimental model of aortic surgery and the effect of Iloprost on lung injury
    (Informa Healthcare, 2013) Iscan, Sahin; Huseyin, Serhat; Ozdemir, A. Coskun; Yalta, Tulin; Yuksel, Volkan; Aksu, Volkan; Ege, Turan
    Objectives. Ischemia/reperfusion (I/R) damage of the lung is a frequently encountered complication following aortic surgery. The aim of the present study is to investigate the histopathological effects of Iloprost on pulmonary damage developed after I/R. Design. Twenty-four Sprague-Dawley rats were randomly divided into 3 groups. In the control group, aortas were not clamped. In the I/R group, aortas were occluded, and after 1 h of ischemia, clamps were removed. After 2 h of reperfusion period, lungs of the rats were extracted. In the I/R + Iloprost group after 1 h of ischemia, Iloprost infusion was initiated, and maintained for the duration of 2 h reperfusion period. For histopathological scoring, density of polymorphonuclear leucocytes, congestion, interstitial edema, and bleeding were semiquantitatively evaluated, and histopathological changes were scored. Results. In the I/R group, multifocal-marked histopathological changes in 5 (62.5%), and multifocal-moderate histopathological changes in 3 (37.5%) rats were detected. In the I/R + Iloprost group, multifocal-moderate histopathological changes in 4 (50%), and multifocal-mild changes in 4 (50%) rats were detected. Conclusions. In the experimental rat model, administration of Iloprost has been shown to have preventive effects for pulmonary damage occurring after I/R generated by infrarenal aortic occlusion.
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    Factor V Leiden Mutation Accompanying Recurrent Massive Pulmonary Thromboembolism
    (Aves, 2012) Perincek, Gokhan; Hatipoglu, Osman Nuri; Ege, Turan; Kara, Ibrahim; Kul, Seref
    A 46-year-old female patient was admitted to the emergency department with the complaints of dyspnea, swelling of the right leg and and feeling of unwell. Deep venous thrombosis was detected at the lower extremity venous Doppler ultrasound and thrombi was detected at the left main pulmonary artery and at the segmental pulmonary arteries bilaterally with the computed tomography of thorax. As hypotension was developed, she was diagnosed with pulmonary thromboembolism and treated with streptokinase infusion. The patient's complaint of dyspnea decreased and her haemodynamic parameters improved after thrombolytic therapy, and subsequently she underwent anticoagulant therapy. On the fifth day of monotorization, while still under the anticoagulant therapy, the patient suddenly developed dyspnea, cyanosis and hypotension. The rt-PA therapy was adminestered with the pre-diagnosis of recurrent massive pulmonary thromboembolism. After the rt-PA therapy, the patient's haemodynamics improved, her cyanosis and complaints of dyspnea regressed. Heterozygote Factor V Leiden mutation was detected with examinations. Inferior vena cava filter was placed together with the anticoagulant therapy. The patient has been under our monitoring for 3 months.