Browsing by Author "Çivi M."
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Item Femoral nerve paralysis caused by traumatic retroperitoneal hematoma: Case report; [Travmatik retroperitoneal hematoma baǧli femoral sinir paralizisi](2010) Şencan A.; Keleş G.; Ertan P.; Aşçi A.; Çivi M.Retroperitoneal hematoma is a kind of life-threatening injury which commonly develops after blunt trauma in childhood. Femoral nerve paralysis that occurs after retroperitoneal hematoma is a rare complication. It occurs as the result of femoral nerve being compressed while passing through psoas muscle or due to the compression of hematoma on femoral nerve after proceeding down towards femoral canal and causing ischemic femoral nerve injury. Whether this femoral nerve paralysis is permenant or temporary seems to be related with the drainage of the hematoma. However, it differs from patient to patient related with the size of the hematoma and the degree of compression. In this study, a 13-years-old boy who developed retroperitoneal hematoma after falling down the stairs and who after wards developed femoral nerve paralysis that regressed on follow-up is reported as a rare complication. Copyright © 2009 by Türkiye Klinikleri.Item Evaluation of hemostatic changes using thromboelastography after crystalloid or colloid fluid administration during major orthopedic surgery(Associacao Brasileira de Divulgacao Cientifica, 2012) Topçu I.; Çivi M.; Öztürk T.; Keleş G.T.; Çoban S.; Yentür E.A.; Okçu G.The effects of Ringer lactate, 6% hydroxyethyl starch (130/0.4) or 4% succinylated gelatin solutions on perioperative coagulability were measured by thromboelastography (TEG). Seventy-five patients (ASA I-III) who were to undergo major orthopedic procedures performed under epidural anesthesia were included in the study. Patients were randomly divided into three groups of 25 each for the administration of maintenance fluids: group RL (Ringer lactate), group HES (6% hydroxyethyl starch 130/0.4), and group JEL (4% gelofusine solution). Blood samples were obtained during the perioperative period before epidural anesthesia (t1, baseline), at the end of the surgery (t2), and 24 h after the operation (t3). TEG data, reaction time (R), coagulation time (K), angle value (α), and maximum amplitude (MA) were recorded. TEG parameters changed from normal values in all patients. In group RL, R and K times decreased compared to perioperative values while the α angle and MA increased (P < 0.05). In group HES, R and K times increased, however, the α angle and MA decreased (P < 0.05). In group JEL, R time increased (P < 0.05), but K time, α angle and MA did not change significantly. In the present study, RL, 6% HES (130/0.4) and 4% JEL solutions caused changes in the coagulation system of all patients as measured by TEG, but these changes remained within normal limits.Item The effects of lornoxicam on brain edema and blood brain barrier following diffuse traumatic brain injury in rats; [Lornoksikamin siçanlarda diffüz travmatik beyin hasarinda beyin ödemi ve kan beyin bariyeri üzerine etkileri](Turkish Association of Trauma and Emergency Surgery, 2013) Topçu I.; Gümüşer G.; Bayram E.; Aras F.; Çetin I.; Temiz C.; Çivi M.BACKGROUND In this experiment, the effects of lornoxicam on brain edema and the blood brain barrier (BBB) following diffuse traumatic brain injury (TBI) were studied. METHODS Twenty adult male Wistar albino rats were anesthetized, and experimental closed head trauma was induced by the Marmarou method. After head injury, the rats were randomly divided into two groups: Group I was the control group, to which 2 ml saline was administered intraperitoneally, and Group II was the lornoxicam group, to which 2 ml 1.3 mg kg-1 lornoxicam was administered intraperitoneally. Twenty-four hours after head trauma, 99 mTc pentetate (DTPA) was injected at a dose of 37 MBq, and posterior planar images of each rat were obtained using an Infinia gamma camera. After imaging of BBB permeability, brain tissues were dissected from the cranium. The brain water content (BWC) of each sample was calculated using the wet-dry method. RESULTS The lesion/background (L/b) ratio of Group I was 3.76±0.46 and 3.02±0.66 for early (5th min) and late (60th min) imaging, respectively. In Group II, the L/b ratios were 3.52±0.96 and 2.63±0.63 for early and late imaging, respectively (p>0.05). BWC was 79.6±2.5% and 77.5±1.1% for Groups I and II, respectively (p<0.05). CONCLUSION In this rat model of TBI, lornoxicam reduced brain edema but did not affect BBB permeability.Item Fentanyl reaction in a parkinsonian patient receiving monoamine oxidase inhibitor while undergoing cardiac surgery; [Kardiyak cerrahi geçiren ve monoamin oksidaz inhibitörü kullanan parkinson hastasinda fentanil reaksiyonu](Turkish Anaesthesiology and Intensive Care Society, 2014) Öztürk T.; Çikrikci C.; Yildirim F.; Kurdal A.T.; Çivi M.Use of fentanyl is a controversial issue because of possible adverse drug interactions in patients using monoamine oxidase inhibitors during cardiac surgery. In this case report we described a drug interaction with fentanyl in a parkinsonian patient who was 57 years old, 45 kg weigh and required mitral valve replacement surgery while he was taking a selective monoamine oxidase inhibitor type B (Rasajilin) with selective serotonin reuptake inhibitor (paroxetin). Despite anesthesia and surgery were maintained normally, supraventricular tachycardia, hypertension, sweating, flushing and hypertermia were observed during warming of the heart and the weaning period of cardiopulmonary bypass. Tachycardias were treated by cardioversion and beta-blocker therapy. Patient's body temparature was controlled at 37°C by using pump perfusion. Fentanyl infusion was discontinued. After hemodynamic stability was achieved, cardiopulmonary bypass was terminated. Total fentanyl consumption was 2.8 mg. Parkinson's therapy was resumed at the first day postoperatively. Patient was discharged at the 7th day.Item Tromboelastography in the evaluation of coagulation disorders in patients with sepsis(2014) Kiliç Y.; Topçu I.; Bambal H.; Çivi M.Aim: Unbalanced hemostasis and disseminated intravenous coagulopathy serve as key participants in organ dysfunction and disability. In this study we evaluated the coagulation profiles of patients diagnosed with systemic inflammatory syndrome (SIRS)-sepsis and multiple organ dysfunction syndrome. We also researched coagulation in sepsis by comparing thromboelastography (TEG) data with those of nonsepsis patients to determine the usefulness of the TEG device. Materials and methods: Data were collected from 55 anesthesiology and surgery intensive care unit (ICU) patients: 21 with SIRS-sepsis (Group S) and 34 patients without SIRS-sepsis (Group C). Blood samples were taken upon admission to the ICU (t1) and on day 3 of the ICU stay (t2). TEG data (R = reaction time, K = coagulation time, α = alpha angle, and MA = maximum amplitude) were recorded. TEG parameters were compared with routine coagulation and hemogram studies. Results: Te mean R value in Group C was higher than that of Group S at both t1 and t2. Group S had a significantly lower K value and higher alpha angle at t1 compared to Group C (P < 0.05). Conclusion: Hypercoagulability was observed in SIRS-sepsis patients in the ICU, as measured with TEG. We believe that TEG will be a useful tool in the evaluation of coagulation disorders developing in septic critically ill patients. © TÜBİTAK.Item Percutaneous endoscopic gastrostomy in intensive care unit; [Yoğun bakım ünitesinde perkutan endoskopik gastrostomi](Logos Medical Publishing, 2015) Gürsoy C.; Uğur Y.L.; Çivi M.Introduction: It is known that enteral nutrition (EN) affects clinical course favourably, and decreases length of stay in hospital and incidence of infection by decreasing malnutrition of the patients in the intensive care unit. Oral route is firstly preferred for EN. When long-term EN (>4-6 weeks) is anticipated, ostomy is planned for patients in whom oral intake is not possible and tube feding is used in intensive care unit. In this article we aim to assess 20 patients, and their outcomes who underwent PEG in intensive care unit. Material and Method: We retrospectively reviewed medical records of 20 patients in whom PEG was succesfully employed between January 2011, and September 2014. Results: Five of 20 patients were women (20%), and fifteen were men (75%). The mean age of the patients was 43.4±2.8 years, mean length of hospital stay was 77.6±39.8 days. The mean time from admission until application of PEG was 37.8±21.9 days. There were no complications during the PEG procedure. The wound infection was occured on 3 (15%) patients. Before PEG placement, pulmonary infection that need to be treated with antibiotics was detected in 18 (90%) patients and it was determined that mean positive results of sample of endotracheal aspirate culture was 2.6±1.2. After PEG placement, pulmonary infection requiring antibiotherapy was seen in 11 (55%) patients, Within an average of 2.3±.1.3 days bacterial growth was detected was detected in endotharcheal aspirates (p:0,18). Conclusion: PEG insertion in patients who cannot receive adequate oral intake is an established route for providing long-term enteral nutrition. Our experience suggests that the PEG is a safe and a simple method which decreases incidence of pulmonary infection with a low complication rate. © 2015, Logos Medical Publishing. All rights reserved.Item Diagnostic and prognostic value of procalcitonin and sTREM-1 levels in sepsis(Turkiye Klinikleri Journal of Medical Sciences, 2015) Bayram H.; Tünger Ö.; Çivi M.; Yüceyar M.H.; Ulman C.; Dinç Horasan G.; Çetin Ç.B.Background/aim: Sepsis is still a major cause of morbidity and mortality despite the improvements in diagnosis and treatment. The aim of this study was to investigate the values of procalcitonin and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in the diferential diagnosis of patients with sepsis and noninfectious systemic infammatory response syndrome (NI-SIRS) and measure their importance in the prognosis of patients with sepsis. Materials and methods: This prospective study included 41 NI-SIRS and 33 sepsis patients hospitalized in Celal Bayar University Hospital, Manisa, Turkey. Blood samples were taken from NI-SIRS patients on days 0 and 3 and from sepsis patients on days 0, 3, 4, 7, and 14. Clinical status of the patients was determined with the SOFA scoring system. Results: The SOFA scoring system and procalcitonin and sTREM-1 measurements were significant in the differential diagnosis of sepsis and NI-SIRS patients. The SOFA scoring system was considered the most important indicator in determining the prognosis of sepsis patients. Procalcitonin and sTREM-1 levels increased progressively in nonsurvivors and decreased in survivors, but changes were statistically in significant. Conclusion: In the differentiation of sepsis and NI-SIRS, and evaluation of the prognosis of sepsis, combined measurements of procalcitonin and sTREM-1 levels are important. © TÜBİTAK.Item Immune and inflammatory role of hydroxyethyl starch 130/0.4 and fluid gelatin in patients undergoing coronary surgery(Academic Press, 2015) Öztürk T.; Onur E.; Cerrahoğlu M.; Çalgan M.; Nizamoglu F.; Çivi M.Objectives: Compare the effects on inflammatory (TNF-α, IL-6, IL-8 and IL-10) and immunologic (CD3+, CD4+, CD8+, CD11b+, CD16+/56+ T cells and total lymphocyte concentration) variables of hydroxyethyl starch 130/0.4, 4% modified fluid gelatin, or crystalloid when used as volume replacement fluids for acute normovolemic hemodilution (a blood conservation technique) in coronary artery bypass graft patients. Methods: Thirty patients undergoing coronary artery bypass graft surgery were randomized to receive Isolyte S® (Group ISO), 6% hydroxyethyl starch 130/0.4 (Group HES) or 4% modified gelatin solution (Group GEL) for acute normovolemic hemodilution. Blood samples were taken immediately after induction of anaesthesia (T0), and 2h (T1), 12h (T2), 24h (T3), and 48h (T4) after separation from cardiopulmonary bypass. TNF-α, IL-6, IL-8 and IL-10 levels were determined with commercially available ELISA kits. CD3+ (mature T cells), CD4+ (T helper cells), CD8+ (suppressor cytotoxic T cells), CD16+/56+ (natural killer lymphocytes), and CD11b+ (Mac-1, adhesion receptor) levels were measured using flow-cytometry reagents. The CD4+:CD8+ ratio was calculated. Results: Between-group comparisons showed significantly higher levels of TNF-α at T1 (2h after weaning from cardiopulmonary bypass) in Group HES compared to Group ISO (p=0.003). IL-8 was significantly lower in Group HES than Group GEL at T1 (p=0.0005). IL-10 was significantly higher in Group HES than in Group GEL at T1 (p=0.0001). The CD4+:CD8+ ratio in Group ISO was significantly lower than that in Group HES at T2 (p=0.003). CD11b+ levels in Group HES were also higher than those in Group GEL and group ISO at T2, but not significantly. CD16/56+ levels in Group HES were higher than those in Group GEL at T2 (p<0.003). No excessive hemorrhage occurred in any patient. Mediastinal drainage during the first 24h after surgery in Group HES (347±207mL) was not significantly different from that of Group GEL (272±177mL) or Group ISO (247±109) (p>0.05). Conclusion: Hydroxyethyl starch 130/0.4 reduced pro-inflammatory responses and increased anti-inflammatory responses to a greater degree than gelatin solution and isolyte S®. The use of hydroxyethyl starch, compared to gelatin solution and isolyte S®, resulted in less decrease in the CD4+:CD8+ ratio, suggesting less immunosuppression. © 2014 Elsevier Ltd.Item Impact of Secondary Insults in Brain Death After Traumatic Brain Injury(Elsevier USA, 2019) Heppekcan D.; Ekin S.; Çivi M.; Aydın Tok D.In addition to primary injury in severe head trauma, secondary systemic insults that aggravate the brain injury may result in fatal neurologic outcome. We aim to evaluate the correlation between brain death and secondary systemic insults in 100 patients with severe traumatic brain injury (TBI) admitted to the intensive care unit. We collected data on hypotension and hypoxemia at the time of admission to intensive care unit and data on hypotension, hypoxemia, hypocarbia, hypercarbia, shock, anemia, hyperglycemia, and hyperthermia within the first 24 hours. In addition, we recorded the category of TBI according to computed tomography findings. Twenty-six patients (26%) who developed brain death were significantly younger than survivors. Early hypotension (odds ratio [OR], 10.24; 95% confidence interval [CI], 3.64–28.78; P = .000) and early shock (OR, 8.31; 95% CI, 2.65–26.01; P = .000) were significantly more frequent among brain-death patients. The most featured factor that independently predicted the development of brain death in patients with severe TBI was the existence of hypotension (B–2.74; 95% CI, 0.016–0.252; P = .000). The most common type of injury among brain death patients was a surgically evacuated mass lesion. Although all critical care principles are applied to prevent secondary systemic brain insults, when brain death occurs, the prevention of hypotension will become significant in preserving organs in better condition for procurement. © 2019 Elsevier Inc.Item Effects of Nutritional Support on the Quality of Life of Cancer Patients(Turkiye Klinikleri, 2022) Karadaş G.; Erdoğan A.P.; Ekinci F.; Çivi M.; Göksel G.Objective: In this study, we investigated the effects of nutritional support on the quality of life of cancer patients, determined nutritional deficiencies, eliminated it at the earliest, and established a built-in system to prolong patient survival. Material and Methods: We included 459 patients admitted to the medical oncology outpatient clinic, diagnosed with cancer and receiving chemotherapy; 59 of 459 patients were diagnosed with malnutrition in the study using the Nutritional Risk Screening (NRS) 2002 nutritional status scale. Appropriate enteral nutrition support was provided to the patients, and control evaluations were made four times at intervals of 28 days. In these controls, information on the height, weight, and the right and left middle arm circumference of the patients was recorded. Along with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-30 (EORTC QLQ-30) Quality of Life Scale, the Hospital Anxiety and Depression Scale was also used. Results: A statistically significant difference was found in the NRS 2002 scores of the patients regarding the adequacy of intake, protein and calorie requirement, functional status, and the symptom scale. The anxiety and depression scores of the patients decreased in all the controls, and the most noticeable decrease occurred at the end of the third control. Conclusion: Evaluating malnutrition and providing adequate nutritional support to cancer patients improves body composition and the quality of life by reducing anxiety and depression. © 2022 by Turkish Society of Medical Oncology.