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Öğe Acute stress disorder and post-traumatic stress disorder following traumatic amputation(Acta Medica Belgica, 2010) Copuroglu, Cem; Ozcan, Mert; Yilmaz, Baris; Gorgulu, Yasemin; Abay, Ercan; Yalniz, ErolTraumatic amputations are important causes of acute stress disorder and post-traumatic stress disorder. In this study, we aimed to rind out the occurrence rate of symptoms of acute and post-traumatic stress disorder after traumatic amputations and according to this, to assess the psychiatric status of the patients in the postoperative period. Twenty-two patients with traumatic limb amputation who were treated in our institution were retrospectively evaluated. During the early post-traumatic period, the patients were observed to determine whether they needed any psychiatric supportive treatment. During the follow-up period, after the sixth month from the trauma, the patients were referred to the psychiatry department and they were evaluated to determine whether they needed any psychiatric supportive treatment, by clinical psychiatric examination and use of the 'post-traumatic stress disorder scale' (Clinician Administered Post traumatic Scale, or CAPS). Twenty-one (95.5%) of 22 patients were male, one (4.5%.) female. Mean age of the patients was 40.8 years (range : 15 to 69). During the early post-traumatic period, 8 (36.3%) of these patients consulted the psychiatry clinic following the orthopaedists' observations. Five (%22.7) of these patients needed psychiatric supportive treatment for acute stress disorder. After the 6th month (6 months to 5 years), 17 (77.2%) had chronic and delayed post-traumatic stress disorder and needed psychiatric supportive treatment. Patients who have sustained a traumatic amputation may need psychiatric supportive treatment in the late period after the trauma. As we orthopaedic surgeons treat these patients surgically we should be aware of their psychiatric status.Öğe Ankle arthroplasty in a patient with bleeding diathesis and the mid-term clinical outcome of the case(Elsevier Sci Ltd, 2015) Yilmaz, Baris; Komur, Baran; Ozdemir, Guzelali; Heybeli, NurettinPurpose: The purpose of this report was to present the case of a patient with bleeding diathesis on whom we performed ankle arthroplasty for the first time. Materials and methods: A 29-year old male patient with bleeding diathesis, who had been treated and followed up over a long period, underwent ankle arthroplasty because of osteoarthritis of the ankle. The patient was prepared for surgery by the haematology department in accordance with the guidelines for surgical preparation, diagnosis and management of haemophilia. After ankle arthroplasty was performed, the preoperative and two-year postoperative clinical outcomes were evaluated using a subjective foot score and Maryland foot score. Results: Preoperative factor VIII levels were raised to the target level of haemostasis prior to the surgical procedure. The factor VIII levels were maintained within the normal range up to postoperative day 14. The subjective foot score of the patient was 40 preoperatively and 85 postoperatively, whereas their Maryland foot scores were 33 preoperatively and 90 postoperatively. Both scoring systems indicate an excellent clinical outcome. Conclusion: As observed, the early and mid-term functional outcomes are promising for patients with bleeding diathesis who undergo ankle arthroplasty. (C) 2015 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Limited.Öğe Comparison of Different Anesthetic Techniques on Postoperative Outcomes in Elderly Patients with Hip Fracture(Ortadogu Ad Pres & Publ Co, 2012) Sahin, Sevtap Hekimoglu; Heybeli, Nurettin; Colak, Alkin; Arar, Cavidan; Alan, Kudret; Copuroglu, Cem; Yilmaz, BarisObjective: Determining the type of anesthesia is a complex medical decision that depends on many factors including co-morbidity, age, type of surgery performed, and the risk of the anesthetic techniques. This study evaluated the effects of anesthesia type on postoperative mortality and morbidity in hip fractures. Material and Methods: One hundred eighty-five patients older than 60 years who were operated for hip fracture between 2005-2009 were retrospectively analyzed. Patients received general anesthesia (n=67), spinal anesthesia (n=67), or epidural anesthesia (n=51). The clinical features of the patients were obtained from the hospital records. Morbidity outcomes were assessed on postoperative day 7. Mortality rates were calculated on postoperative day 7 and postoperative day 30. Results: There were no significant differences between the three groups with regard to intraoperative blood loss, intraoperative blood transfusion, smoking status, length of stay in hospital, American Society of Anesthesiology (ASA) physical status, and Charlson Comorbidity Index (CCI) (p=0.393, p=0.088, p=0.369, p=0.228, p=0.491, p=0.371 respectively). Similarly, no difference was detected between the three groups regarding patient mortality rates for day 7 and 30 (p=0.738, p=0.805 respectively). Conclusion: No technique was superior to the others. Due to the similar mortality rates among the groups, we suggest that the proper anesthetic technique selected according to the clinical features of the patient combined with adequate monitorization would yield successful results with all three techniques.Öğe Distal Oblique Metatarsal Osteotomy for Hallux Valgus Deformity: A Clinical Analysis(Elsevier Science Inc, 2017) Guler, Olcay; Yilmaz, Baris; Mutlu, Serhat; Cerci, Mehmet Halis; Heybeli, NurettinWe compared the outcomes of the distal oblique metatarsal (DOM) osteotomy, which is parallel to the articulation surface of the proximal phalanx, with those of the chevron osteotomy and evaluated whether displacement and shortening of the first metatarsal have any effect on the incidence of metatarsalgia and patient satisfaction. Patients treated with the DOM osteotomy (n = 30) or distal chevron osteotomy (n = 31) were evaluated retrospectively. The chevron and DOM osteotomies both provided significant improvement in the first intermetatarsal angle (p <.001), hallux valgus angle (p <.001), distal metatarsal articular angle (p <.001), range of first metatarsophalangeal joint motion (p <.001), American Orthopaedic Foot and Ankle Society score (p <.001), and sesamoid position (p <.001), without any significant differences between the 2 groups. Patient satisfaction and metatarsalgia also were not different between the study groups. The DOM osteotomy group had higher plantar displacement (0.1 +/- 0.1 mm versus 1.0 +/- 0.1 mm; p <.001) and absolute shortening of the first metatarsal (1.0 +/- 0.4 mm versus 6.8 +/- 1.0 mm; p <.001). In conclusion, the DOM osteotomy is an alternative treatment method for mild and moderate hallux valgus. (C) 2017 by the American College of Foot and Ankle Surgeons. All rights reserved.Öğe An Evaluation of the Effect of the Biological Dose of Fluoroscopic Radiation Exposure in the Operating Room(Aves, 2018) Yilmaz, Baris; Copuroglu, Cem; Tabakcioglu, Kiymet; Pala, Funda Sibel; Ozcan, Mert; Ciftdemir, MertObjective: Through an evaluation of the biological dose, we aimed to evaluate the risks of ionizing radiation to which physicians and auxiliary healthcare personnel working in orthopedic operating rooms are exposed to via diagnostic use of fluoroscopy. Methods: Blood samples were collected from physicians and auxiliary healthcare personnel working in the orthopedic operating room. The biological dose was evaluated using micronucleus and dicentric analysis. To assess the effects of physical and chemical agents together, a total of 31,000 binucleate cells were evaluated using the micronucleus method and 16,500 metaphase plaques were evaluated using dicentric analysis, which is accepted as the most important indicator in determining the effects of radiation. Results: The study participants comprised 18 males and 5 females (16 physicians, 4 nurses, and 3 patient carers) with a mean age of 34.1 years (range, 22-58 years) who were thought to have been exposed to ionizing radiation in the working environment. The mean duration of working under ionizing radiation was 73.6 months (range, 1.5-420 months). In the blood samples, the total micronucleus frequency was determined as 8.8 +/- 1.4. In the evaluation of the 16,500 metaphysis plaques, radiation-specific dicentric was observed in 5 subjects (normal frequency: 5/10,000). As a result of the analysis made use both methods, the dose was determined to be slightly above background level, and below risk level in 6 subjects. The dose was related with medical applications in 4 of these subjects. Conclusion: Fluoroscopy should be attempted in the operating room within a restricted time as far as possible and at measurements of high kV and low mA. kV-mA values are of utmost importance for providing the best results according to the nature of the operation; the tube outlet is predefined away from the patient's skin.Öğe Injuries associated with motorcycle accidents(Turkish Assoc Orthopaedics Traumatology, 2008) Alicioglu, Banu; Yalniz, Erol; Eskin, Deniz; Yilmaz, BarisObjectives: In recent years, there has been a significant increase in motorcycle accidents in parallel with the increasing number of motorcyclists. Data on motorcycle accidents/injuries are relatively limited in Turkey. This study sought to determine the injury profile of patients involved in motorcycle accidents. Methods: This retrospective study included 212 patients (204 males, 8 females; mean age 36 16 years; range 2 to 79 years) who were hospitalized for injuries caused by motorcycle accidents. Data on age and sex, injury patterns, length of hospitalization were recorded. Injuries were grouped according to localization. Results: The frequencies of injuries in descending order were as follows: musculoskeletal system injuries (n=106, 50% skull injuries (n=103, 48.6%), maxillofacial injuries (n=38, 17.9%), thoracic (n=15, 7.1% vertebral (n=10, 4.7%), and abdominal (n=6, 2.8%) injuries. Multiple fractures in upper and lower extremities were seen in 17 (8%) and 43 (20.3%) patients, respectively. The most frequent extremity injuries were tibia-fibula fractures (17.9%) followed by shoulder injuries (11.3%). Both extremity and skull injuries were seen in 23 patients (10.9%). The mean hospital stay was 12.2 +/- 16.8 days (range 1 to 150 days). Eight patients required intensive care for a mean of seven days. As a complication, one patient (0.5%) with olecranon and tibial plateau fractures developed pulmonary embolism. Motorcycle accidents resulted in mortality in nine patients (4.3%). Conclusion: Since motorcycle accidents are preventable or associated risks for injuries are reducible, risk factors for our country should be determined, necessary laws and restrictive regulations should be put into practice, and educational programs should be implemented.Öğe Is olecranon osteotomy necessary fort he surgical treatment of distal humerus fractures located close to intra-articular area?(Yerkure Tanitim & Yayincilik Hizmetleri A S, 2017) Yilmaz, Baris; Copuroglu, Cem; Ciftdemir, Mert; Ozcan, Mert; Imge, Erdi; Saridogan, KenanObjective: The aim of this study is to evaluate the clinical results and necessary of olecranon osteotomy by open reduction and internal fixation by parallel plating of distal humerus located close to intra-articular surface of distal humerus. Materials and Methods: 43 patients were evaluated in this study separated into two groups. In group 1 olecranon osteotomy was performed and in group 2 paratricipital approach was performed to all patients. All patients were evaluated by hospital stay time, follow-up, surgical time, range of motion (ROM), complications and Mayo elbow performance scoring system functions. Results: Mean age was 44.35 +/- 11.61 (19-62) years. There was no statistically significant difference by age, sex, side distribution, hospital stay, follow-up time and ROM. Operation time was 133.04 +/- 18.14 minutes in Group 1 and 171 +/- 15.1 minutes in Group 2. There was statistically significant decrease in surgical time in Group 1 compared to group 2 (p:0.001; p<0.05). There was not any postoperative complication and union was achieved clinically and radiologically in both groups. Mayo elbow score was 85.65 +/- 4.34 while 90.25 +/- 4.13 in group 2 (p:0.001; p<0.05). Conclusion: There was better ROM and functional scores in paratrisipital approach group while only surgical time increased in this group. In conclusion, olecranon osteotomy should not be performed in intra-articular fractures of distal humerus whom treated by open reduction and parallel plating if it is not necessary to protect congruity of joint.Öğe Is success objective or subjective in knee prosthesis?(Yerkure Tanitim & Yayincilik Hizmetleri A S, 2009) Copuroglu, Cem; Ozcan, Mert; Aykac, Bilal; Yilmaz, Baris; Yalniz, ErolObjective: To analyze the relation between the radiological and functional results and satisfaction of the knee prosthesis. Material and Methods: In this study, knee prosthesis applied to 43 patients' 76 knees were retrospectively evaluated. As a radiologic parameter; anatomical alignment, and as a functional measurement; range of motion was evaluated. Visual analogue scale (VAS) was measured as a pain score. The relation of functional and radiological measurements with VAS scores was analyzed. All the patients were re-evaluated with Oxford knee score. Results: Study group included 37 women and 6 men with a mean age of 63 (26-76). A total number of 76 knees (33 bilateral, 10 unilateral) were evaluated. Mean follow up time was 16.25 months (2-29 months). In the last evaluation; according to the preoperative evaluation, varus deformity improved, functional improvement could not be gained and VAS decreased, in 23 knees. In 21 knees, no radiological and functional improvement could be gained, VAS decreased. In 13 knees, no radiological difference was obtained, functions got worse, VAS decreased. In 3 knees, no radiological difference was obtained, functions were better, VAS decreased. Three knees were radiologically worse, without any change in functions, VAS decreased. In 2 knees, radiological and functional results improved, VAS decreased. In 2 knees, although there was postoperative infection, VAS decreased. In only 3 knees, radiological and functional results were worse and VAS score did not change. Mean Oxford knee score was 9.7. Conclusions: Although radiological and functional results are not so good, application of the knee prosthesis decreases the patients' pain and increases the patients' satisfaction.Öğe Magnetic resonance imaging predictors of surgical outcome in degenerative lumbar spinal stenosis(Springer, 2012) Alicioglu, Banu; Yilmaz, Baris; Bulakbasi, Nail; Copuroglu, Cem; Yalniz, Erol; Aykac, Bilal; Urut, Devrim UlasTo identify any MRI predictors for surgical outcomes of patients with degenerative lumbar spinal stenosis (DLSS) having instrumented posterior decompression (IPD) surgery. Seventy patients with DLSS who underwent IPD were reviewed retrospectively. The clinical score of each patient was assessed using the JOAS (Japanese Orthopedics Association Scoring) system, which is mainly based on the subjective symptoms and physical signs of the patients before (JOAS-I) and after (JOAS-II) surgery. Healing rate (HR) was calculated as: [(JOAS-II) - (JOAS-I)] x 100/[15 - (JOAS-I)]. HR > 50 % was considered clinical improvement. Radiological stenosis was assessed on MRI and was graded from 0 to 3 at the laminectomy level in terms of thecal sac-nerve root compression, foraminal stenosis, and facet degeneration. Mean HR of the improved patients (n = 39) was 81.94; HR of the unimproved patients (n = 31) was 34.75 (p < 0.05). There was no statistical difference in radiological stenosis parameters between the two groups (p > 0.05). HR was worse in patients with severe facet degeneration. Surgical outcomes of DLSS depend on multiple variables. It is not possible to predict the outcomes by assessing only one parameter. The possible outcomes should be analyzed by considering all the factors individually.Öğe A magnetic resonance imaging study of abnormalities of the patella and patellar tendon that predispose children to acute patellofemoral dislocation(Elsevier Science Inc, 2017) Yilmaz, Baris; Cicek, Esin Derin; Sirin, Evrim; Ozdemir, Guzelali; Karakus, Ozgun; Muratli, Hasan HilmiThis study compared 20 children hospitalised with acute patellofemoral dislocation with an age-matched healthy control group with no history of knee problems or patellar dislocation. The following morphological parameters were significantly different between the groups: the mean patellar width and length, mean sulcus depth, mean patellar tendon width and total patellar volume. The magnetic resonance imaging findings of this study suggested that structurally smaller than normal patella and patellar tendon volumes are predisposing factors for acute patellofemoral dislocation. (C) 2016 Elsevier Inc. All rights reserved.Öğe Major Extremity Injuries Associated with Farmyard Accidents(Hindawi Ltd, 2012) Copuroglu, Cem; Heybeli, Nurettin; Ozcan, Mert; Yilmaz, Baris; Ciftdemir, Mert; Copuroglu, ElifBackground. The aim of the study is to analyze the major agricultural injuries related to the extremities. Patients. We evaluated a 3-year period including 41 patients. Data on age, sex, injury patterns, anatomical localizations, injury season, length of stay in the hospital, and infections were evaluated, and the patients were examined with SF-36 in the follow-up period. Results. Hand was the most commonly injured part (n: 9) followed by the distal part of the lower limb (cruris) (n: 7) and foot (n: 7). Mean time between trauma and emergency-department arrival was 115 minutes (60-360). Mean length of stay was 24 days (4-150), and mean number of operations during hospitalization was 2.4 (1-30). Deep wound infection was seen in 8 patients. Seasonal distribution for accidents was even for spring and fall (27% each), high for summer (36%), and less for winter (10%). Conclusions. Distal parts of the elbow and knee were affected more frequently. Due to the high microbiological load and high incidence of crush-type injuries, repetitive debridements and long duration of hospital stay were needed. Attention should be paid in the harvesting times to the farmyard injuries. Due to the seasonal variation, more resources should be allocated to treat the increasing incidence of injury over the period from spring to fall.Öğe A Retrospective Trial Comparing the Effects of Different Anesthetic Techniques on Phantom Pain After Lower Limb Amputation(Elsevier Science Inc, 2011) Sahin, Sevtap Hekimoglu; Colak, Alkin; Arar, Cavidan; Tutunculer, Ebru; Sut, Necdet; Yilmaz, Baris; Birtane, MuratBACKGROUND: Pain and other sensations from an amputated or absent limb, called phantom pain and phantom sensations, are well-known phenomena. OBJECTIVE: The aim of this retrospective study was to evaluate the effects of anesthetic techniques on phantom pain, phantom sensations, and stump pain after lower limb amputation. METHODS: Ninety-two patients with American Society of Anesthesiologists physical status I to III were analyzed for 1 to 24 months after lower limb amputation in this retrospective study. Patients received general, spinal, or epidural anesthesia or peripheral nerve block for their amputations. Standardized questions were used to assess phantom limb pain, phantom sensation, and stump pain postoperatively. Pain intensity was assessed on a numeric rating scale (NRS) of 0 to 10. Patients' medical histories were determined from hospital records. RESULTS: Patients who received epidural anesthesia and peripheral nerve block perceived significantly less pain in the week after surgery compared with patients who received general anesthesia and spinal anesthesia (NRS [SD] values, 2.68 [1.0] and 2.70 [1.0] respectively). After approximately 14 to 17 months, there was no difference in phantom limb pain, phantom sensation, or stump pain among the anesthetic techniques for amputation. CONCLUSIONS: In patients undergoing lower limb amputation, performing epidural anesthesia or peripheral nerve block, instead of general anesthesia or spinal anesthesia, might attenuate phantom and stump pain in the first week after operation. Anesthetic technique might not have an effect on phantom limb pain, phantom sensation, or stump pain at 14 to 17 months after lower limb amputation. (Curr Tiler Res Clin Exp. 2011;72:127-137) (C) 2011 Elsevier HS Journals, Inc. All rights reserved.Öğe Vaccination status of COVID-19 patients followed up in the ICU in a country with heterologous vaccination policy: A multicenter national study in Turkey(Elsevier, 2023) Yildirim, Suleyman; Erkoyun, Erdem; Alpdog, Ozcan; Yilmaz, Huseyin Oguz; Yilmaz, Baris; Donmez, Gul Erdal; Saritas, AykutObjective: Vaccination against severe acute respiratory syndrome coronavirus-2 (SARS-2) prevents the development of serious diseases has been shown in many studies. However, the effect of vaccination on outcomes in COVID-19 patients requiring intensive care is not clear.Methods: This is a retrospective multicenter study conducted in 17 intensive care unit (ICU) in Turkey between January 1, 2021, and December 31, 2021. Patients aged 18 years and older who were diagnosed with COVID-19 and followed in ICU were included in the study. Patients who have never been vaccinated and patients who have been vaccinated with a single dose were considered unvaccinated. Logistic regression models were fit for the two outcomes (28-day mortality and in-hospital mortality).Results: A total of 2968 patients were included final analysis. The most of patients followed in the ICU during the study period were unvaccinated (58.5%). Vaccinated patients were older, had higher Charlson comorbidity index (CCI), and had higher APACHE-2 scores than unvaccinated patients. Risk for 28-day mortality and in-hospital mortality was similar in across the year both vaccinated and unvaccinated patients. However, risk for in-hospital mortality and 28-day mortality was higher in the unvaccinated patients in quarter 4 adjusted for gender and CCI (OR: 1.45, 95% CI: 1.06-1.99 and OR: 1.42, 95% CI: 1.03-1.96, respectively) compared to the vaccinated group.Conclusion: Despite effective vaccination, fully vaccinated patients may be admitted to ICU because of disease severity. Unvaccinated patients were younger and had fewer comorbid conditions. Unvaccinated patients have an increased risk of 28-day mortality when adjusted for gender and CCI.
