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- ArticleYalnız künye2017Comparison of the effects of propofol plus fentanyl with midazolam plus fentanyl on pr, qtc interval and qt dispersion in patients undergoing coronary artery surgery; [Koroner arter cerrahisi planlanan hastalarda propofol-fentanil ile midazolam-fentanil’in pr, qtc aralığı ve qt dispersiyonu üzerindeki etkilerinin karşılaştırılması]
Onk, Didem; Onk, Oruç Alper; Değirmenci, Hüsnü; Küçüksu, Zafer; Bedir, Zehra; Kuyrukluyıldız, Ufuk; Ayazoğlu, Tülin Akarsu
Aim: To compare the effects of propofol and midazolam on markers of myocardial homogeneity when used during anesthesia induction in patients undergoing coronary artery bypass grafting. Material and Method: A total of 50 patients with normal left ventricular systolic function and normal electrocardiogram were randomized into two groups as to receive propofol Group 1 (n=25, mean age: 68.28±10.44) or midazolam (n=25, mean age: 67.88±8.90) during induction of anesthesia. Standard 12-lead electrocardiograms were obtained just before induction of anesthesia to ensure baseline compara-bility of two groups. Patients were monitored with an ambulatory electrocardiogram before and after surgery, and individual average QT duration, QTc duration, P dispersion and QT dispersion were calculated. Results: Dis-tribution of baseline characteristics were similar between two groups. Two groups were also similar regarding preoperative QT duration, QTc duration, QT dispersion and p-wave dispersion. Mean of individual average QT duration, QTc duration, and P dispersion did not differ significantly between two groups whereas mean of individual average QT dispersion was significantly higher in propofol group than that in midazolam group in the postoperative period (32.80±13.07 vs. 24.60±9.34, in Group 1 and 2, respectively, p=0.01). Discussion: Midazolam seems to have minimal effect on the electrical stabil-ity of the myocardium, whereas propofol is likely to limit recovery of myocardial homogeneity after CABG to some extent when used during induction of anesthesia.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2017Use of inflammatory cytokines and blood PAPP-A levels as the laboratory evidence of preconditioning in cardiac surgery; [Kardiyak cerrahide önkoşullamanın laboratuvar kanıtları olarak olarak inflamatuvar sitokinlerin ve kan PAPP-A düzeylerinin kullanımı]
Onk, Didem; Özçelik, Fatih; Onk, Oruç Alper; Günay, Murat; Akarsu Ayazoğlu, Tülin; Çoban, Abdulkadir
Cardioprotective management has increasingly become a standard of care for preservation of myocardial reserve during cardiac surgery. This study investigates the usefulness of inflammatory cytokines and PAPP-A levels in predicting the appropriate preconditioning method. Ninety ASA III patients scheduled for CABG surgery were included and allocated into three groups. Group 1 (n=30) received propofol (2-3 mg.kg-1.h-1) and fentanyl (3-5 mcg.kg-1.h-1) infusions with 5% desflurane inhalation. Group 2 (n=30) received propofol (5-6 mg.kg-1.h-1) and fentanyl (3-5 mcg.kg-1.h-1) infusions with 5% desflurane inhalation. Group 3 (n=30) received midazolam (0.04-0.06 mg.kg-1.h-1) and fentanyl (3-5 mcg.kg-1.h-1) infusions with 5% desflurane inhalation. TNF-α, PAPP-A and us-CRP levels were measured one day preo-peratively (S1), immediately prior to the cardiopulmonary bypass (S2), after completion of the cardiopulmonary bypass (S3) and 48 hours postoperatively (S4). In all groups, TNF-α increased at S2 and S3 and decreased at S4 (P<0.05), with the most prominent increase observed in Group 2. The highest increase in PAPP-A levels at S2 and S3 stages was observed in Group 2 whereas the lowest decrease at S4 stage was observed in Groups 1 and 3. In Group 1, us-CRP levels showed a significant increase at S3 compared to S1 and S2 (p<0.05) and decreased to levels close to S1 and S2. PAPP-A can be used with us-CRP and TNF-α to determine the optimal preconditioning method in the anaesthetic management of CABG surgery. Using these markers, we observed that midazolam-desflurane and low-dose propofol-desflurane were effective in anaesthetic preconditioning during CABG surgery.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2016Ankaferd® Kanama Durdurucunun Rat Abdominal Aort Kanama Modelinde Kanama Zamanına Etkisi
Onk, Oruç Alper; Erol, Huseyin Serkan; Onk, Didem; Özçelik, Fatih; Yiğiner, Ömer; Aksüt, Mehmet; Kahraman, Ümit; Sertoglu, Erdim; Tuncer, Osman Nuri; Erkut, Bilgehan
The use of topical haemostatic agents has been popularised in recent years in many areas of surgery. We aimed to determine whether Ankaferd blood stopper® (ABS) can shorten the bleeding time and decrease the amount of bleeding in a rat abdominal aortic bleeding modelPatients and Methods: A total of 40 rats were randomly divided into four groups (n= 10 in each group). Saline- and ABS-soaked gauzes were applied to rats that had not received any pre-treatment in Groups 1 and 2, while saline- and ABS-soaked gauzes were applied to rats that had received acetylsalicylic acid plus oral clopidrogel for 5 days in Groups 3 and 4. An incision of about 1 mm was made over the aorta just proximal to the iliac bifurcation. Mean bleeding time (MBT) and mean bleeding amount (MBA) were determined and compared. Results: There were no signifi cant differences in the age, weight and blood sample laboratory results of rats. Shorter MBT and less MBA were determined in ABS-soaked groups and the differences were statistically signifi cant. Conclusion: Ankaferd blood stopper® has the potential to reduce the bleeding time and post-operative blood loss after a major aortic surgery.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2016Apoptosis, autophagy & endoplasmic reticulum stress in diabetes mellitus
Demirtas, Levent; Guclu, Aydin; Erdur, Fatih Mehmet; Akbas, Emin Murat; Ozcicek, Adalet; Onk, Didem; Turkmen, Kultigin
The prevalence of diabetes mellitus (DM) is increasing secondary to increased consumption of food and decreased physical activity worldwide. Hyperglycaemia, insulin resistance and hypertrophy of pancreatic beta cells occur in the early phase of diabetes. However, with the progression of diabetes, dysfunction and loss of beta cells occur in both types 1 and 2 DM. Programmed cell death also named apoptosis is found to be associated with diabetes, and apoptosis of beta cells might be the main mechanism of relative insulin deficiency in DM. Autophagic cell death and apoptosis are not entirely distinct programmed cell death mechanisms and share many of the regulator proteins. These processes can occur in both physiologic and pathologic conditions including DM. Besides these two important pathways, endoplasmic reticulum (ER) also acts as a cell sensor to monitor and maintain cellular homeostasis. ER stress has been found to be associated with autophagy and apoptosis. This review was aimed to describe the interactions between apoptosis, autophagy and ER stress pathways in DM.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2016Melatonin Attenuates Contrast-Induced Nephropathy in Diabetic Rats: The Role of Interleukin-33 and Oxidative Stress
Onk, Didem; Onk, Oruc Alper; Turkmen, Kultigin; Erol, Huseyin Serkan; Ayazoglu, Tulin Akarsu; Keles, Osman Nuri; Halici, Mesut; Topal, Ergun
Background. Inflammation and oxidative stress (OxS) contribute to the pathogenesis of diabetic kidney disease (DKD) and contrast-induced nephropathy (CIN). Patients with DKD were found to be more prone to CIN. Interleukin-33 (IL-33) is a proinflammatory cytokine, but its role in DKD and CIN is unknown. Methods. Thirty male Sprague-Dawley rats were enrolled. The first group was comprised of healthy rats (HRs), whereas the other four groups were made up of diabetic rats (DRs), diabetic rats with contrast-induced nephropathy (CIN + DRs), melatonin-treated diabetic rats (MTDRs), and melatonin-treated CIN + DRs (MTCIN + DRs). All groups except the HRs received 50 mg/kg/day streptozotocin (STZ). CIN + DRs were constituted by administrating 1.5 mg/kg of intravenous radiocontrast dye on the 35th day. MTDRs and MTCIN + DRs were given 20 mg/kg/day of intraperitoneal injection of melatonin (MT) from the 28th day for the constitutive seven days. Results. We observed increased IL-33 in the kidney tissue following induction of CIN in DRs. To determine whether MT is effective in preventing CIN, we administered MT in CIN + DRs and demonstrated that kidney tissue levels of OxS markers, inflammatory cytokines, and IL-33 were significantly diminished in MTCIN + DRs compared with other groups without MT treatment (p<0.05). Conclusion. Inhibition of IL-33 with MT provides therapeutic potential in DKD with CIN.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2016Effects of fentanyl and morphine on shivering during spinal anesthesia in patients undergoing endovenous ablation of varicose veins
Onk, Didem; Ayazoğlu, Tülin Akarsu; Kuyrukluyıldız, Ufuk; Aksüt, Mehmet; Bedir, Zehra; Küpeli, İlke; Onk, Oruç Alper; Alagöl, Ayşin
Background: We sought to investigate the effect of morphine and fentanyl on shivering when used adjunctively with bupivacaine during spinal anesthesia in patients undergoing varicose vein surgery on an outpatient basis. Material/Methods: The study included a total of 90 patients, aged 25-45 years, ASA I-II, scheduled to undergo endovenous laser ablation under spinal anesthesia for lower extremity venous insufficiency/varicose vein disease. Patients were randomly allocated into 3 groups: Group M (morphine group) received 5 mg 0.5% hyperbaric bupivacaine + 0.1 mg morphine, Group F (fentanyl group) received 5 mg 0.5% hyperbaric bupivacaine + 25 μg fentanyl, and Group C (control group) received 5 mg 0.5% hyperbaric bupivacaine + physiologic saline. The level of sensory blockade was assessed with pin-prick test and the level of motor blockade was assessed with Bromage scale at 5-min intervals. Shivering grade and time to first postoperative analgesic requirement was recorded. Results: Level and time of sensory block showed a slight but insignificant increase in the Morphine Group and Fentanyl Group. Time of postoperative analgesic requirement was significantly longer in patients who received morphine (p<0.05). Shivering was significantly less common in patients who received morphine and fentanyl than in patients who are in the Control Group (p<0.02). Conclusions: Morphine or fentanyl may be used as adjunctives to spinal anesthesia to prevent shivering in patients undergoing venous surgery.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2016Management of anesthesia during lung transplantations in a single Turkish center
Akarsu Ayazoğlu, Tulin; Ozensoy, Aynur; Dedemoğlu, Mehmet; Baysal, Ayse; Gul, Yasar G.; Onk, Didem; Onk, Alper
Aim: The aim of this study is to present our institutional experience during the management of anesthesia in lung transplantation (LT) surgeries as a definitive surgical treatment option in end-stage lung diseases. Methods: From a total of 15 patients, lung transplantation was performed as single LT (SLT) in 4 patients (n = 4) and as sequential bilateral LT (BLT) in 11 patients (n = 11). The anesthetic management included; for induction; intravenous ketamine, midazolam at doses of 2 mg/kg, 0.05 mg/kg, respectively or propofol, fentanyl at doses of 1 mg/kg, 3 mcg/kg, respectively. For maintenance, all patients received; 100% O2 and total intravenous infusion of propofol and remifentanil at doses of 0.02 mcg/kg/min and 0.1-0.25 μg/kg/min, respectively. All patients received intravenous rocuronium bromide for induction and maintenance. Hemodynamic stability was maintained with appropriate and adequate administration of vasodilators (intravenous Prostaglandin (PGI2) (0.5-1 ng/kg/min), inhaled nitric oxide (10-40 ppm), dopamine (2 mcg/kg/min) and vasopressors (intravenous dobutamine (5-15 mcg/kg/min), norepinephrine (0.05-1 mcg/kg/min),ephedrine (5 to 10 mg bolus doses) to keep mean arterial blood pressure above 50 mmHg. Results: Cardiopulmonary bypass (CPB) was performed in five patients who underwent sequential BLT and one SLT case. Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) was used in four cases of sequential BLT and in two cases of SLT. Neither ECMO nor CPB was performed in two BLT and in one SLT patient. One SLT patient who underwent CPB was admitted to the intensive care unit with support of intra-aortic balloon pump (IABP) and ECMO. Intraoperative death did not occur. Conclusion: During SLT or BLT, management of anesthesia with propofol and remifentanil provides a stable hemodynamic and medical support. Although our experience with VA ECMO was limited, our experience shows that this support system is a valuable tool to provide hemodynamic stability for patients undergoing LT.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2016What Is the Best Pulmonary Physiotherapy Method in ICU?
Kuyrukluyildiz, Ufuk; Binici, Orhan; Kupeli, Ilke; Erturk, Nurel; Gulhan, Bariş; Akyol, Fethi; Ozcicek, Adalet; Onk, Didem; Karabakan, Guldane
Objective. Effects of high frequency chest wall oscillation technique were investigated on intubated ICU patients. Background. Thirty intubated patients were included in the study. The control group (n=15) received routine pulmonary rehabilitation technique. In addition to the pulmonary rehabilitation technique, the study group (n=15) was given high frequency chest wall oscillation (HFCWO). APACHE II, dry sputum weight, lung collapse index, and blood gas values were measured at 24th, 48th, and 72nd hours and endotracheal aspirate culture was studied at initial and 72nd hour. The days of ventilation and days in ICU were evaluated. Results. There is no significant difference between APACHE II scores of groups. The dry sputum weights increased in the study group at 72nd hour (p=0.001). The lung collapse index decreased in study group at 48th (p=0.003) and 72nd hours (p<0.001). The PO2 levels increased in the study group at 72nd hour (p=0.015). The culture positivity at 72nd hour was decreased to 20%. The days of ventilation and staying in ICU did not differ between the groups. Conclusions. Although HFCWO is very expensive equipment, combined technique may prevent the development of lung atelectasis or hospital-acquired pneumonia more than routine pulmonary rehabilitation. It does not change intubated period and length of stay in ICU. However, more further controlled clinical studies are needed to use it in ICU.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2016Comparison of TIVA and desflurane added to a subanaesthetic dose of propofol in patients undergoing coronary artery bypass surgery: Evaluation of haemodynamic and stress hormone changes
Onk, Didem; Ayazoglu, Tölin Akarsu; Onk, Oruç Alper; Aksöt, Mehmet; Gönay, Murat; Turkmen, Kultigin; Özensoy, Aynur; Ersoy, Çigdem Yazici; Çoban, Abdulkadir
Introduction. Increased levels of stress hormones are associated with mortality in patients undergoing coronary artery bypass grafting (CABG). Aim. To compare total intravenous anaesthesia (TIVA) and desflurane added to a subanaesthetic dose of propofol. Material and Methods. Fifty patients were enrolled in this study. Fentanyl (3-5mcg/kg/h) was started in both groups. Patients were divided into two groups. The PD group (n = 25) received 1 minimum alveolar concentration (MAC) desflurane anaesthesia in addition to propofol infusion (2-3mg/kg/h), while P group (n = 25) received propofol infusion (5-6mg/kg/h) only. Biochemical data, cortisol, and insulin levels were measured preoperatively (T0), after initiation of CPB but before cross-clamping the aorta (T1), after removal of the cross-clamp (T2), and at the 24th postoperative hour (T3). Results. Systolic, diastolic, and mean arterial pressure levels were significantly higher in PD group than those in P group in T1 and T2 measurements (p ≤ 0.05). CK-MB showed a significant decrease in group P (p ≤ 0.05).When we compared both groups, cortisol levels were significantly higher in PD group than P group (p ≤ 0.05). Conclusion. Stress and haemodynamic responses were better controlled using TIVA than desflurane inhalation added to a subanaesthetic dose of propofol in patients undergoing CABG.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2016Liv-52; prophylactic or therapeutic agent against desflurane-induced hepatotoxicity in rats
Kuyrukluyildiz, Ufuk; Binici, Orhan; Cetin, Nihal; Balci, Mecdi G.; Onk, Didem; Cankaya, Murat; Kafa, A. Humeyra Taskin; Altuner, Durdu; Yilmaz, Adnan
Liv-52 has hepatoprotective effect and may be beneficial for desflurane hepatotoxicity. We aimed to investigate the prophylactic or therapeutic effects of Liv-52 on hepatotoxicity induced desflurane. The study was designed into seven groups as healthy group (HG), desflurane control groups (DCG-1, DCG-2, and DCG-3), Liv-52 treatment after desflurane (DLG), Liv-52 treatment before desflurane group (LDG), and Liv-52 treatment before and after desflurane group (LDLG). Desflurane was adjusted as to 6% concentration for two hours. Liv-52 was given 20 mg/kg. Alanine transaminase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), malondialdehyde (MDA), and total glutathione (tGSH) levels were measured. MDA, tGSH, ALT, AST, and LDH levels of DLG, LDG, and LDLG were found statistically significant compared to controls and healthy groups (p < 0.05). But the differences between HG and LDLG for both MDA, tGSH, ALT, AST, and LDH parameters were found statistically insignificant (p > 0.05). Pathological findings such as sinusoidal dilatation congestion and inflammation areas were observed in control groups but not in LDLG. Both prophylactic and therapeutic uses of Liv-52 may be the most appropriate methods to be minimized desflurane-induced hepatotoxicity.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2016The Effects of Diabetes Mellitus on Ovarian Injury and Reserve: An Experimental Study
Nayki, Umit; Onk, Didem; Balci, Gurhan; Nayki, Cenk; Onk, Alper; Gunay, Murat
Objective: The study aims to investigate the effects of diabetes mellitus (DM) on ovarian injury and reserve in a rat model. Study Design: In this prospective experimental study, 16 female Sprague-Dawley albino rats (12 weeks, 220-240 g) were randomly divided into 2 groups. Group 1 included 8 normal healthy rats as controls. No drug was administered to the controls. Group 2 included the other 8 rats in which diabetes was induced by intraperitoneal injections of streptozotocin (STZ). After overt DM occurred (blood glucose >250 mg/dl), all the animals were euthanized and blood samples were collected by cardiac puncture for biochemical analysis. Bilateral oophorectomy was performed for histopathological examination. Immunoexpressions of nuclear factor-kappa B (NF-kB) and caspase-3 as well as anti-Müllerian hormone (AMH) levels were assessed. Values were analyzed by t test. Results: Immunoexpressions of NF-kB and caspase-3 were significantly higher in non-treated diabetic rats than in the control group (p = 0.011 and p = 0.010, respectively). In healthy control group, AMH levels (3.22 ± 0.58 ng/ml) were significantly higher than in the non-treated diabetic group (1.41 ± 0.25 ng/dl; p = 0.024). Conclusion: Hyperglycemia causes severe ovarian injury via NF-kB pathway and caspase-3 apoptotic pathway, leading to the decrease in ovarian reserve in STZ-induced diabetic rats.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2016The effect of melatonin on oxidative stress and apoptosis in experimental diabetes mellitus-related ovarian injury
Nayki, Umit; Onk, Didem; Balci, Gurhan; Nayki, Cenk; Onk, Alper; Çankaya, Murat; Taskin Kafa, Ayse Humeyra; Kuzucu, Mehmet
We aimed to evaluate the effect of melatonin on oxidative stress and ovarian injury in rats. Twenty-four Sprague-Dawley albino rats were divided into three groups: Group 1 as nondiabetic healthy controls (n = 8), group 2 as nontreated diabetic rats (n = 8) and group 3 as melatonin-treated diabetic rats (n = 8). After overt diabetes was produced by intraperitoneal injection of streptozosin, 20 mg/kg/day of melatonin was given intraperitoneally to group 3 for a week. NF-kB and caspase-3 immunoexpressions, lipid peroxidation, the activities of antioxidative enzymes, total oxidant capacity and total antioxidant capacity were assessed. Immunoexpressions of NF-kB and caspase-3 were significantly lower in group 3 than group 2. There was a significant decrease in superoxide dismutase activity in group 2 than group 1 and a significant increase in group 3 compared with group 2. We observed a nonsignificant decrease in catalase activity between group 1 and group 2 and a nonsignificant increase between group 2 and group 3. There was a nonsignificant increase in the plasma level of total oxidant status in group 2 than group 1, but a significant decrease was observed in group 3 compared to group 2. Total antioxidant status was significantly lower in group 2 compared with group 1 and group 3. In conclusion, melatonin ameliorates the negative effects of oxidative stress on DM-related ovarian injury.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2016The effect of anakinra on paclitaxel-induced peripheral neuropathic pain in rats
Kuyrukluyıldız, Ufuk; Küpeli, İlke; Bedir, Zehra; Özmen, Özgür; Onk, Didem; Süleyman, Bahadır; Mammadov, Renad; Süleyman, Halis
Objective: Paclitaxel is used in the treatment of cancer, and it may cause interleukin-1 beta (IL-1β)-related peripheral neuropathic pain. While our primary aim was to investigate the analgesic efficacy of an IL-1β antagonist, a secondary outcome was to assess whether a correlation exists between analgesic effects and antioxidant activity. Methods: A total of 24 albino Wistar male rats were divided into the following groups: paclitaxel-control, paclitaxel+50 mg kg−1 anakinra, paclitaxel+100 mg kg−1 anakinra and healthy group (HG). After the normal paw pain threshold in all animal groups was measured using a Basile algesimeter, a single dose of 2 mg kg−1 paclitaxel was intraperitoneally administered on the 1st, 3rd, 5th and 7th days. Anakinra was intraperitoneally administered following the final paclitaxel administration. The paw pain thresholds in the groups were measured before and seven days after paclitaxel administration and at the 1st and 3rd hours after anakinra administration. After the third hour of measurement, the rats were killed with high doses of ketamine, and the paw tissues were removed. Malondialdehyde, myeloperoxidase and total glutathione levels were measured in claw tissues, and IL-1β gene expression was determined. The biochemical results were compared with the results of the HG; in the meanwhile the claw pain threshold results were compared with the results obtained after the last paclitaxel and the results obtained from the 1st and 3rd hours after the anakinra application. Results: The claw paw pain threshold of the rats decreased one and three hours after anakinra administration. Further, 100 mg kg−1 anakinra had greater analgesic activity than 50 mg kg−1 anakinra. A correlation was found between the antioxidant and analgesic activities of 100 mg kg−1 anakinra. Conclusion: Anakinra may be useful to reduce paclitaxel-induced neuropathic pain; further, 100 mg kg−1 anakinra may have greater analgesic and antioxidant activities.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2016Risk factors for acute kidney injury after coronary artery bypass surgery and its detection using neutrophil gelatinase-associated lipocalin
Onk, Oruç Alper; Onk, Didem; Ozcelik, Fatih; Gunay, Murat; Turkmen, Kultigin
Introduction: Acute kidney injury (AKI) is an important complication of cardiac surgery due to its high mortality. The aim of the present study was to detect the factors leading to AKI in patients who underwent coronary artery bypass surgery (CABS) and also to determine the optimal timing for detecting AKI using the biomarker neutrophil gelatinase-associated lipocalin (NGAL). Materials and Methods: The records of 375 patients who underwent CABS were reviewed in this case-control study. Ejection fraction (EF), common carotid artery intima-media thickness (CCA-IMT) and cross-clamp (C-C) time of the patients were recorded. Blood samples were taken from all patients on preoperative day 1 as well as 6, 12, 24, 36, 48 h and 7 days after operation. Biochemical parameters were studied in patients with and without AKI. Results: According to the Risk Injury Failure Loss End Stage criteria, 24 patients had renal risk, 17 had injury and 4 had failure. Postoperative 24-hour serum creatinine levels indicated the risk of renal dysfunction for only 4 patients in the AKI group. CCA-IMT, C-C time, haematocrit (HCT) and preoperative interleukin-6 levels were significantly higher in the AKI group than in the non-AKI group. Postoperative 6- and 12-hour NGAL levels in the AKI group correlated with postoperative 36-hour serum creatinine levels. The optimal cut-off values for postoperative 6- and 12-hour NGAL test were 310 and 283 ng/ml, respectively. The area under the curve was higher in the 12-hour NGAL test (p < 0.0086). Conclusion: The number of stenotic coronary arteries, EF, CCA-IMT and HCT are all important risk factors. Early postoperative NGAL results were highly specific for the early recognition of AKI.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2015Sol atriyal kalsifiye amorf tümör
Onk, Oruç Alper; Sayar, Ilyas; Onk, Didem; Erentuğ, Vedat; Aksüt, Mehmet; Değirmenci, Hüsnü
In this article, we present a 82-year-old female casewithout any previous history of heart disease diagnosedwith a hyperdense mass originating in left atrial side of theinteratrial septum on echocardiography. The patient wasscheduled for surgery. Left atrium was entered through theinteratrial groove. The tumor was found attached to theinteratrial septum. It was macroscopically creamish-yellowcolored, 20x10 mm in size and solid in texture. It wastotally resected from its attachments to the interatrialseptum. Light microscopy showed polypoid formationswith prominent papillary structures including scatteredhyalinized areas and large areas of calcification. Themass was pathologically diagnosed as cardiac calcifiedamorphous tumor. She was discharged under medicaltreatment on seventh day after surgery.
RDL Kalıcı Kaydıİncele - Review ArticleYalnız künye2015Erişkin Akut Solunum Sıkıntısı Sendromu Olan Hastalarda Ekstrakorporeal Yaşam Desteği: Derleme
Onk, Didem; Ayazoğlu Akarsu, Tülin
Şiddetli acute respiratory distresssyndrome (akut solunum yetmezliğisendromu) (ARDS) artan pulmoner vaskülergeçirgenliğin artması sonucunda, hipoksemive bilateral radyolojik opasiteler ile giden,azalmış akciğer komplians ile ilişkili akutdiffüz, enflamatuvar akciğer hasarıdır.Extracorporeal membrane oxygenation(ekstrakorporeal membran oksijenasyonu)(ECMO) yenidoğan, çocuk ve yetişkinlerdegörülen birincil veya ikincil solunum veya kal hastalıklarının neden olduğu yetmezliklerdedestek tedavisi olarak kullanılmaktadır.Şiddetli ARDS hastaları ECMO tedavisi içinadaydırlar. Birincil geri dönüşümlü hastalıkları olan hastalarda uygulanan ECMO bir tedaviyöntemi değil, bir destek yöntemidir. ECMOtedavisi ile ilişkili olarak-mortalite, morbiditede artış, uzun süreli sakatlık ve yaşamkalitesinin düşmesi-cerrahi alan ve organkanamaları, böbrek ve çoklu organ yetmezliğ ve santral sinir sistemi problemleri görülebilir Bu derlemede şiddetli ARDS olan hastalarda ECMO kullanımına ilişkin genel bir bakışsağlamak amaçlanmıştır. Anahtar Kelimeler: Akut solunum sıkıntısısendromu, ekstrakorporeal membranoksijenasyonu, ekstrakorporeal yaşamdesteği
RDL Kalıcı Kaydıİncele - Review ArticleAçık Erişim2015Extracorporeal Life Support for Patients with Acute Respiratory Distress Syndrome: Review
Ayazoglu, Tulin Akarsu; Onk, Didem
Patients with severe acute respiratory distress syndrome (ARDS) is an acute diffuse, inflammatory lung injury, leading to increased pulmonary vascular permeability with hypoxemia and bilateral radiographic opacities, associated with decreased lung compliance. Extracorporeal membrane oxygenation (ECMO) has been used to support primary or secondary diseases causing respiratory or cardiac failures in newborns, children and adults. Patients with severe ARDS are candidates for ECMO therapy. ECMO is a support modality, not a treatment; it is only beneficial in patients whose primary disease is reversible. ECMO complications-which can lead to mortality, morbidity, long-term disability and reduced quality of life-include surgical and organ bleeding, renal and multiorgan failure and central nervous system problems. The aim of this article was to provide a general overview of ECMO use and outcomes patients with severe acute respiratory distress syndrom.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2015A left atrial calcified amorphous tumor
Aksüt, Mehmet; Onk, Oruç Alper; Sayar, Ilyas; Değirmenci, Hüsnü; Onk, Didem; Erentuğ, Vedat
In this article, we present a 82-year-old female case without any previous history of heart disease diagnosed with a hyperdense mass originating in left atrial side of the interatrial septum on echocardiography. The patient was scheduled for surgery. Left atrium was entered through the interatrial groove. The tumor was found attached to the interatrial septum. It was macroscopically creamish-yellow colored, 20×10 mm in size and solid in texture. It was totally resected from its attachments to the interatrial septum. Light microscopy showed polypoid formations with prominent papillary structures including scattered hyalinized areas and large areas of calcification. The mass was pathologically diagnosed as cardiac calcified amorphous tumor. She was discharged under medical treatment on seventh day after surgery.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2015Thoracic epidural analgesia in a patient with multiple comorbidities for subxiphoid incisional hernia repair
Onk, Didem; Eken, Huseyin; Ayazoglu, Tulin Akarsu; Kupeli, Ilke; Kucuksu, Zafer; Alagol, Aysin
Anesthetic preparation before non-cardiac surgery deserves particular attention in patients with cardiac disease as these are prone to develop hemodynamic instability and myocardial ischemia. Risk of complications is not only related to individual patient characteristics, but also to surgery related factors. In this report we present our experience regarding anesthetic management of a patient with multiple comorbidities including advanced chronic obstructive pulmonary disease, severely impaired left ventricular systolic function and occluded bypass grafts. We chose thoracic epidural analgesia for his sub-xiphoid incisional hernia repair. The operative and postoperative course was uneventful.
RDL Kalıcı Kaydıİncele - ArticleYayıncıda açık erişim2015Comparison of dexmedetomidine and propofol used for drug-induced sleep endoscopy in patients with obstructive sleep apnea syndrome
Kuyrukluyıldız, Ufuk; Binici, Orhan; Onk, Didem; Celik, Serap Ayhan; Torun, Mumtaz Taner; Unver, Edhem; Ozcicek, Adalet; Alagol, Aysin
Backround: Surgical operations are alternative treatments in persons with Obstructive Sleep Apnea Syndrome who cannot tolerate continuous positive airway pressure therapy. Drug-Induced Sleep Endoscopy is a method with which somnolence is pharmacologically induced and collapse is evaluated through nasal endoscopy in patients with Obstructive Sleep Apnea Syndrome. Aims: We aimed to evaluate efficiency of dexmedetomidine or propofol used for sedation in patients undergoing drug-induced sleep endoscopy. Methods: A total of 40 patients aged between 18 and 65 years old in the ASA STATUS I-II group were included in the study. After premedicatıon wıth midazolam 0.05 mg/kg intravenously, patients were randomly divided into two groups and administered intravenous (iv) propofol with the loading dose of 0.7 mg/kg for 10 minutes, followed 0.5 mg/kg/h infusion (Group P); or dexmedetomidine with the loading dose of 1 mcg/kg for 10 minutes, followed by 0.3 mcg/kg/h infusion (Group D). Haemodynamic and respiratuary parameters, Bispectral index score, Ramsey sedation score, time to achieve sufficient sedation, surgeon’s and patients’ satisfaction, postoperative Aldrete score and side effects were recorded. Results: Time to achieve sufficient sedation, Bispectral index scores at 5, 10 and 15th. minutes intraoperatively, first Aldrete score in the recovery room, SpO2 values and respiratory rates all over the surgical procedure and in the recovery room were found lower in Group P (P<0.05). Bispectral index scores, mean arterial pressure and heart rate in the recovery room were significantly lower in Group D (P<0.05). Conclusion: Dexmedetomidine may be preferred as a safer agent with respecting to respiratory function compared with propofol in obstructive sleep apnea patients who known to be susceptible to hypoxia and hypercarbia.
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