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Öğe The analgesic effects of gabapentin after total abdominal hysterectomy(Lippincott Williams & Wilkins, 2004) Turan, A; Karamanlioglu, B; Memis, D; Usar, P; Pamukçu, Z; Türe, MWe investigated, in a randomized, placebo-controlled, double-blind study, the efficacy and safety of gabapentin on pain after abdominal hysterectomy and on tramadol consumption in patients. The 50 patients were randomized to receive either oral placebo or gabapentin 1200 mg 1 h before surgery. Anesthesia was induced with propofol and maintained with sevoflurane in 50% N2O/O-2 with a fresh gas flow of 2 L/min (50% N2O in O-2) and fentanyl (2 mug/kg). All patients received patient-controlled analgesia with tramadol with a 50 mg initial loading dose, 20 mg incremental dose, 10-min lockout interval, and 4-h limit of 300 mg. The incremental dose was increased to 30 mg if analgesia was inadequate after 1 h. Patients were studied at 4,8,12,16, 20, and 24 h for visual analog (VAS) pain scores, heart rate, peripheral oxygen saturation, mean arterial blood pressure, respiratory rate, sedation, and tramadol consumption. The VAS scores in the sitting and supine position at 1, 4, 8, 12,16, and 20 h were significantly lower in the gabapentin group when compared with the placebo group up to 20 h after surgery. The tramadol consumption at 12, 16, 20, and 24 h and total tramadol consumption were significantly less in the gabapentin group when compared with placebo group. Sedation scores were similar at all the measured times. There were no differences between groups in adverse effects. Preoperative oral gabapentin decreased pain scores and postoperative tramadol consumption in patients after abdominal hysterectomy.Öğe Differentiating the infarct-related artery on initial electrocardiogram in single or multi-vessel disease in acute inferior myocardial infarction and evaluating involvement of vessels using correspondence analysis(Westminster Publ Inc, 2005) Kürüm, T; Birsin, A; Özbay, G; Türe, MInitial electrocardiography changes were compared prospectively with the findings of coronary angiography to predict the infarct-related artery (IRA) in cases of single- and multi-vessel disease and to demonstrate the relationship between other coexisting coronary involvements and IRA in patients who presented with acute inferior myocardial infarction (AMI). ST elevations or depressions of at least 1 mm (0.1 mV) were evaluated in the leads 1, aVL, and V-1-V-6. Of the 160 patients hospitalized due to inferior AMI, 153 (96%) underwent coronary angiography using standard methods. The angiograms were screened for stenotic lesions using quantitative coronary angiography to confirm significance, which was considered > 50% vessel lumen diameter reduction. Among single-vessel involvements, the IRA was either the circumflex artery (Cx) or right coronary artery (RCA). In conditions in which IRA was detected as either Cx or RCA, 1-, 2-, and 3-vessel involvements were also detected. Correspondence analysis was performed to show the vessel involvements accompanying IRA. Compared with patients with IRA as RCA, the presence of ST depressions in the leads V-1 or V-2 and aVL were more frequently seen in patients with IRA as Cx (p = 0.000, p = 0.015, respectively). Among all vessel involvements in which IRA was either Cx or RCA, a ST-segment depression in leads V-1 or V-2 (P = 0-000) and aVL (p = 0.000) and a ST-segment elevation in lead 1 (p = 0.005) were considered to be significant for Cx, and a ST-segment depression in lead I for RCA involvement (p=0.010). According to correspondence analysis, the most frequent single-vessel involvement seen in inferior AM] was RCA; when IRA was RCA, a multi-vessel involvement included RCA and Cx; and when IRA was Cx, a single-vessel involvement included the left anterior descending (LAD) artery most frequently, and RCA+LAD less frequently (p = 0.000). In inferior AMI, RCA was the most common IRA; however, the possibility of multi-vessel disease is increased when Cx is found to be the IRA. In patients presenting with inferior AM], the presence of ST-depression in the leads aVL and V1-2 is a sensitive finding that indicates Cx stenosis rather than RCA stenosis and is not affected by coexisting other coronary artery involvements.Öğe The effect of intravenous pantoprazole and ranitidine for improving preoperative gastric fluid properties in adults undergoing elective surgery(Lippincott Williams & Wilkins, 2003) Memis, D; Turan, A; Karamanlioglu, B; Saral, P; Türe, M; Pamukçu, ZWe studied pantoprazole, a new potent and fast-acting proton pump inhibitor. Its effects on preoperative gastric fluid volume and pH have not yet been determined. In this randomized, controlled trial, we examined the effects of preoperative IV pantoprazole or ranitidine on gastric pH and volume. Ninety patients (ASA status I and II, scheduled for elective surgery) were studied. One hour before surgery, patients in Group I (n = 30) were given IV saline 5 mL, those in Group II (n = 30) were given 40 mg of pantoprazole IV, and those in Group III (n = 30) were given 50 mg of ranitidine IV. A nasogastric tube was inserted immediately after anesthesia induction. Gastric contents were aspirated, and volume and pH were recorded. The pH values determined in Group I were 3.73 +/- 0.82; in Group II, they were 5.30 +/- 1.84; and in Group III, they were 4.80 +/- 1.40. There was no statistical difference between Groups 2 and 3, but there was a significant difference between Group I and Groups 2 and 3 (P < 0.0005). The volume of the gastric contents was 28.67 +/- 10.98 mL in Group I, 15.20 +/- 15.52 mL in Group II, and 7.77 +/- 11.17 mL in Group III. There was no statistical difference between Groups 2 and 3, but there was a statistically significant difference between Group I and Groups 2 and 3 (P < 0.0005). The proportion of patients considered at risk of significant lung injury should aspiration occur was 20% of Group I, 10% of Group II, and 3.3% of Group III. When statistically evaluated, there was no difference among groups. We concluded that the administration of IV pantoprazole and ranitidine 1 h before surgery is effective in reducing gastric pH and volume.Öğe The epidemiology of hepatitis a virus infection in children, in Edirne, Turkey(Springer, 2004) Erdogan, MS; Otkun, M; Tatman-Otkun, M; Akata, F; Türe, MTurkey is a middle endemic area with respect to Hepatitis A virus (HAV) infection. However, the frequency of this infection varies due to socioeconomic differences in various regions. The aim of this study was to detect the most likely age of exposure to HAV and factors affecting infection rates among children living in Edirne. A sample of 645 children between the ages of 0-19 living in Edirne were tested for total anti-HAV levels using ELISA method. A questionnaire on socio-economic status (SES), possible risk factors, and place of residence was completed for each child. Anti-HAV seropositivity was found to be 4.4, 25, 37.3 and 43.2%, in 2-5, 6-10, 11-14 and 15-19 age groups, respectively. Seropositivity was found to be increasing with age (p < 0.05). According to logistic regression analysis results; mother's education, SES of family, history of hepatitis in primary family members and the number of brothers or sisters were determined as factors increasing the seropositivity of HAV. Furthermore, HAV infection risk was found to be a decreasing function of income that is higher the income less likely the infection. These results showed that HAV infection rate in Edirne is in middle endemicity and the most likely way of exposure is transmission from family members. Although it requires further cost-effectiveness studies, our results indicate that applying the HAV vaccination in early childhood would be beneficial to decrease the prevalence of the infection and prevent HAV epidemics.Öğe Maternal serum tumor necrosis factor-? in patients with preterm labor(Sci Printers & Publ Inc, 2001) Gücer, F; Balkanli-Kaplan, P; Yüksel, M; Yüce, MA; Türe, M; Yardim, TOBJECTIVE: To evaluate maternal serum tumor necrosis factor-alpha (TNF alpha) levels in patients with preterm labor without clinical signs of chorioamnionitis and to compare these with levels in nonlaboring controls. STUDY DESIGN: The study group consisted of 44 patients with a singleton pregnancy admitted to our department with the diagnosis of preterm labor between 26 and 36 weeks' gestation. The control group consisted of 25 healthy consecutive patients with a singleton pregnancy without preterm contractions who were seen for routine antenatal visits. Maternal serum TNF alpha was measured using a solid-phase, two-site chemiluminescent enzyme immunometric assay method, and levels were compared in patients with preterm labor and nonlaboring controls. RESULTS: The median maternal serum TNF alpha level for patients with preterm labor was 29.4 pg/mL (range, 12.3-173) as compared with 23 pg/mL (range, 11.9-62.7) in the control group (P = .031). Among 44 patients with preterm labor, 14 (32%) delivered within one week of admission. The median maternal serum TNF alpha level was significantly higher in patients who delivered within one week than in those who delivered after one week and controls (71.3 pg/mL [range, 28-173]) versus 22 pg/mL (range, 12.3-86) versus 23 pg/mL (range, 11.9-62.7) (P < .0001). CONCLUSION: TNF was elevated in patients with preterm labor, suggesting a role for maternal serum TNF alpha in its initiation.Öğe Predictive value of admission electrocardiogram for multivessel disease in acute anterior and anterior-inferior myocardial infarction(Futura Publ Co, 2002) Kürüm, T; Öztekin, E; Özçelik, F; Eker, H; Türe, M; Özbay, GBackground: Our aim was to investigate the correlation between admission ECG and coronary angiography findings in terms of predicting the culprit vessel responsible for the infarct or multivessel disease in acute anterior or anterior-inferior myocardial infarction (AMI). Methods: We investigated 101 patients with a diagnosis of anterior AMI with or without ST-segment elevation or ST-segment depression in at least two leads in DII, III, aVF. The patients were classified as those with vessel involvement in the left anterior descending (LAD) coronary artery and patients with multivessel disease. Vessel involvement in LAD + circumflex artery (Cx) or LAD + right coronary artery (RCA) or LAD + Cx + RCA were considered as multivessel disease. Thus, (a) anterior AMI patients with reciprocal changes in inferior leads, (b) anterior AMI patients with inferior elevations, (c) all anterior AMI patients according to the ST-segment changes in the inferior region were analyzed according to the presence of LAD or multivesssel involvement. Results: Presence of ST-segment depression in aVL and V6 was significantly correlated with the presence of multivessel disease in anterior AMI patients with reciprocal changes in the inferior leads (P = 0.005 and P = 0.003, respectively). No statistically significant difference between the leads were detected in terms of ST-segment elevation in predicting vessel involvement in the two groups of anterior AMI patients with inferior elevations, When all the patients with anterior AMI were analyzed, the presence of ST-segment depression in leads aVL, V4, V5 and V6 were significantly associated with the presence of multivessel disease (P = 0.035, P = 0.010, P = 0.011, P = 0.001, respectively). Conclusions: The presence of ST-segmert depression in anterolateral leads in the admission ECG of anterior AMI patients with reciprocal changes in inferior leads was associated with multivessel disease.Öğe Predictive value of thyroid hormones on the first day in adult respiratory distress syndrome patients admitted to ICU(K Faisal Spec Hosp Res Centre, 2005) Türe, M; Memis, D; Kurt, I; Pamukçu, ZBACKGROUND: Thyroid hormone dysfunction could affect outcome and increase mortality in critical illness. Therefore, in a prospective, observational study we analyzed and compared the prognostic accuracy of free tri-iodothyronine (M), free thyroxine (M), thyroid-stimulating hormone (TSH), along with the APACHE II and SOFA scoring systems in predicting intensive care unit (ICU) mortality in critically ill patients. PATIENTS AND METHODS: Physiology scores were calculated for the first 24 hours after ICU admission in 206 patients with acute respiratory distress syndrome. APACHE 11 and SOFA scores were employed to determine the initial severity of illness. Thyroid hormones were measured within the first 24 hours. Logistic regression models were created for APACHE 11 scores, SOFA scores, and thyroid hormone levels. The models predicted high- and low-risk subgroups. Models that showed a good fit were stratified by Kaplan-Meier survival curves. RESULTS:There were 98 (47.6%) survivors and 108 (52.4%) non-survivors. The survivors had a lower APACHE 11 score (11.50 vs 15.82, P < 0.0005), a lower SOFA score (6.06 vs 9.42, P < 0.0005), a younger age (57 vs 70 years, P=4.008), a shorter ICU stay (13 vs 16 days, P=4.012), and a higher fT3 level (2.18 vs 1.72 pg/mL, P=4.002) than non-survivors. ICU survival was most closely predicted by a model that included age and fT3 and a model that included APACHE 11 and APACHE II*sex. CONCLUSION: In critically ill patients, serum fT3 concentrations markedly decreased after ICU admission among non-survivors. According to our findings, fT3 levels might have additive discriminatory power to age, SOFA and APACHE 11 scores in predicting short-term mortality in ARDS patients admitted to ICU.Öğe Predictors of short-term outcome of spontaneous bacterial peritonitis in turkish cirrhotic patients(Blackwell Publishing Asia, 2005) Soylu, AR; Dökmeci, G; Tezel, A; Ümit, H; Amuca, H; Akova, M; Türe, M[Abstract Not Available]Öğe Preoperative oral rofecoxib reduces postoperative pain and tramadol consumption in patients after abdominal hysterectomy(Lippincott Williams & Wilkins, 2004) Karamanlioglu, B; Turan, A; Memis, D; Türe, MWe designed this study to determine whether the administration of a preoperative dose of rofecoxib to patients undergoing abdominal hysterectomy would decrease patient-controlled analgesia (PCA) tramadol use or enhance analgesia. Sixty patients were randomized to receive either oral placebo or rofecoxib 50 mg 1 h before surgery. All patients received a standard anesthetic protocol. Intraoperative blood loss was determined. At the end of surgery, all patients received tramadol IV via a PCA-device. Pain scores, sedation scores, mean arterial blood pressure, heart rate, and peripheral oxygen saturation were assessed at 1, 2, 4, 6, 8, 12, and 24 h after surgery. Total and incremental tramadol consumption at the same times was recorded from the PCA-device. Antiemetic requirements and adverse effects were noted during the first postoperative 24 h. Duration of hospital stay was also recorded. The pain scores were significantly lower in the rofecoxib group compared with the placebo group at 6 times during the first 12 postoperative h (P < 0.05). The total consumption of tramadol (627 +/- 69 mg versus 535 +/- 45 mg; P < 0.05) and the incremental doses at 1, 2, 4, 6, 8, and 12 h after surgery were significantly more in the placebo group than in the rofecoxib group. There were no differences between groups in intraoperative blood loss, sedation scores, hemodynamic variables, peripheral oxygen saturation, antiemetic requirements, or adverse effects after surgery. The length of hospital stay was also similar in the groups. We conclude that the preoperative administration of oral rofecoxib provided a significant analgesic benefit and decreased the opioid requirements in patients undergoing abdominal hysterectomy.Öğe The relationship between 99mTc-HMPAO brain SPECT and the scores of real life rating scale in autistic children(Elsevier Science Bv, 2002) Kaya, M; Karasalihoglu, S; Üstün, F; Gültekin, A; Çermik, TF; Fazlioglu, Y; Türe, MChildhood autism is a developmental disability of unknown origin with probable multiple etiologies. The purpose of this study was to compare the changes of regional cerebral blood flow (rCBF) in autistic and non-autistic controls, and to determine the relationship between rCBF on Tc-99m-hexamethylpropylene amine oxime (HMPAO) brain SPECT and the scores of the Ritvo-Freeman Real Life Rating Scale (RLRS), IQ levels, and age of autistic children. Eighteen autistic children (four girls, 14 boys: mean age: 6.13 +/- 1.99 years) and I I non-autistic controls (five girls, six boys, mean age: 6.5 +/- 3.39 years) were examined using Tc-99m-HMPAO brain SPECT. All the children satisfying DSM-IV criteria for autistic disorder were taken into evaluation, and scored by the Ritvo-Freeman RLRS, IQ levels of these children were determined by Goodenough IQ test. Six cortical regions of interest (ROIs; frontal (F), parietal (P), frontotemporal (FT), temporal (T), temporo-occipital (TO), and occipital (0)) were obtained on transaxial slices for count data acquisition. The ratio of average counts in each ROI to whole-slice Counts for the autistic children was correlated with the scores of Ritvo-Freeman RLRS. Hypoperfusion in rCBF in autistic children compared with the control group were identified in bilateral F. FT, T, and TO regions. We found no relationship between rCBF on Tc-99m-HMPAO brain SPECT and the scores of the Ritvo-Freeman RLRS. There was a relationship between bilateral F regions perfusion on Tc-99m-HMPAO brain SPECT and the age of autistic children. There was also a negative correlation between IQ levels and the scores of sensory responses, social relationship to people, and sensory-motor responses. Our results suggest that Tc-99m-HMPAO brain SPECT is helpful to locate the perfusion abnormalities but no correlation is found between rCBF on Tc-99m-HMPAO brain SPECT and the scores of Ritvo-Freeman RLRS. (C) 2002 Elsevier Science B.V. All rights reserved.Öğe Relationship with plasma neurohormones and dyssynchrony detected by Doppler echocardiography in patients undergoing permanent pacemaker implantation(Taylor & Francis Ltd, 2003) Kürüm, T; Yüksel, M; Özbay, G; Söyük, S; Türe, MObjective - To determine whether isovolumic relaxation flow (IRF) and isovolumic contraction flow (ICF) resulted from asynchrony and asynergy due to VVI and DDD pacemakers modulated neurohormones, we measured neurohormone levels in plasma and investigated the characteristics of IRF and ICF using Doppler echocardiography. Methods and results - We studied 11 patients with dual-chamber pacemakers (DDD) and 11 patients, with ventricular inhibiting mode (VVI). All patients underwent Doppler echocardiography of the left ventricle. Atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), renin and aldosteron were measured. The LV was scanned for the presence of intracavitary flow during the isovolumic relaxation and isovolumic contraction period. The plasma levels of BNP and ANP were significantly lower in DDD mode than in VVI mode (56+/-32 pg/ml vs. 94+/-32 pg/ml, p=0.022 and 98+/-20 pg/ml vs. 134+/-17 pg/ml, p=0.042, respectively). There were no significant differences in the plasma level of renin or aldosteron. VVI mode versus DDD mode increased isovolumic relaxation flow time (129+/-41 vs. 111+/-36 sec, p = 0.020) and isovolumic relaxation flow velocity (50+/-4 vs. 37+/-2 cm/s, p=0.018). A strong relationship between blood ANP and BNP levels and IRF velocity was found in patients with a VVI pacemaker (r: 0.632, p: 0.028; r: 0.528, p: 0.024, respectively). Conclusion - VVI mode has a longer isovolumic relaxation time, isovolumic relaxation flow velocity and has higher ANP and BNP plasma levels than DDD mode. IRF resulting from asynergy and asynchrony in VVI mode pacemakers versus DDD mode pacemakers affects the plasma levels of ANP and BNP compared to renin and alclosteron.Öğe Thallium-201 SPECT in advanced non-small cell lung cancer(Japanese Society Nuclear Medicine, 2003) Çermik, TF; Yüksel, M; Karlikaya, C; Doganay, L; Türe, M; Berkarda, SPurpose: The aim of this study was to evaluate the relationship between Tl-201 tumor uptake, chemotherapeutic response, metastasis, p53 status and survival in non-small cell lung cancer (NSCLC). Methods: A total of 23 patients underwent Tl-201 SPECT. In 9 patients, 2nd Tl-201 SPECT study were performed 1 week after the 3rd cycle of chemotherapy (ChT), and early (ER) and delayed (DR) tumor/normal lung ratios and retention indices (RI) were obtained. In 15 patients p53 status was assayed with immuno-histochemical staining. The patients were divided into subgroups after the 3rd cycle of ChT; responders [R(+) (n = 10)] and non-responders [R(-) (n = 13)], distant metastasis [(M-1) n =11] and [(M-0) n = 12], and mutant p53 status [p(+) n = 7, p53(-) n = 8]. Results: The differences for ER, DR and RI values between all of the subgroups were not statistically significant. ER and DR of responders decreased significantly after ChT; from to 2.46 to 1.36 (p = 0.04) and 2.29 to 1.53 (p = 0.04), respectively. In the non-responder group, both ER and DR slightly increased after ChT (p > 0.05). Conclusion: Our results suggest that in NSCLC, there was a weak correlation between higher Tl-201 ratios and positive response to chemotherapy, absence of distant metastasis, and p53(-) status. Significant Tl-201 uptake decrease after chemotherapy indicates that delayed Tl-201 uptake can be used in evaluating the chemotherapeutic response.
