Browsing by Author "Topçu, I"
Now showing 1 - 20 of 20
Results Per Page
Sort Options
Item Ultrasound guided posterior femoral cutaneous nerve blockTopçu, I; Aysel, IThe posterior femoral cutaneous nerve (PFCN) is a branch of the sacral plexus. It needs to be implemented as a complementary block for anesthesia or in the surgeries necessitating tourniquet in the suitable cases. We consider target oriented block concept within the PFCN block in the anesthesia implementations with the emergence of ultrasonic regional anesthesia in the practice and with the better understanding of sonoanatomy.Item Effects of low-dose propofol vs ketamine on emergence cough in children undergoing flexible bronchoscopy with sevoflurane-remifentanil anesthesia: a randomized, double-blind, placebo-controlled trialOzturk, T; Acikel, A; Yilmaz, O; Topçu, I; Çevikkalp, E; Yuksel, HStudy Objective: To determine the effects of low-dose ketamine and propofol on cough during emergence and the recovery period when administered at emergence in children undergoing fiberoptic bronchoscopy for bronchoalveolar lavage (FOBL) with sevoflurane-remifentanil anesthesia. Design: Randomized, double-blind, placebo-controlled trial. Setting: Operating room, postoperative recovery area. Patients: Sixty-eight children aged 1 to 8 years old undergoing elective diagnostic FOBL. Interventions: After discontinuation of anesthetics at the end of FOBL, patients were randomly divided into 3 groups: in group K, children were administered 0.5 mg/kg of ketamine; in group P, 0.5 mg/kg of propofol; and in group C, 0.1 mL/kg of normal saline. Measurements: Anesthesia time, procedure time, emergence time, and recovery time were recorded. Coughing and delirium scores were recorded as the patient fully emerged from anesthesia (time 0) and 5, 10, 15, and 20 minutes later. Main Results: The percentage of children with moderate or severe cough during emergence was similar in all groups. Mean delirium scores at emergence (TO) were significantly lower in group K than those in group P and in group C (P = .0001 and P = .02). Mean delirium score at 5 minutes in group K (6 [5-10]) was significantly lower than that of group C (P = .02) and similar to that of group P. The recovery time of group K was significantly longer than that of group C and group P (P = .01 and P = .03, respectively). Conclusions: Ketamine or propofol given at the end of sevoflurane-remifentanil general anesthesia in children undergoing FOBL did not decrease cough more than normal saline during the emergence period. Ketamine and propofol, compared to normal saline, had a beneficial effect on decreasing the incidence of emergence delirium. Ketamine lengthened recovery time. (C) 2016 Elsevier Inc. All rights reserved.Item Relationship between nutrition and ASA-classification in the elderlySakarya, M; Karadag, F; Lüleci, N; Keles, GT; Topçu, I; Erinçler, TObjective: Old age and bad nourishment are risk factors for the postoperative period. In this study, the mini nutritional assessment (MNA) of elderly patients was evaluated before the operation and compared with their ASA-classification. Methods: 215 outpatients (age > 60 years) were included. MNA-score was fixed as follows: MNA 24 - 30 = normal (MNA I); MNA 17-23.5 = risk of malnutrition (MNA II) MNA < 17 = undernourished (MNA III). In addition, the ASA-score of all patients was registered. chi(2)-, Mann-Whitney-U- and correlation analysis were used for statistical analysis. A cut off-value of 24 was fixed for MNA and correlated with the ASA-score. Results: 34,9% of all patients were allocated to MNA II or III, but only 19.9% to ASA III or IV. The sensivity of the ASA-classification for evaluation of the nutritional status was 0.33, selectivity was 0.87, positive predictive value was 0.58 and negative predictive value was 0.70. Conclusion: ASA evaluation is not suitable for assessment of the nutritional status. With regard to typical postoperative complications, the nutritional status of patients should be assessed separately.Item Isolation and in vitro cultivation of human urine-derived cells: an alternative stem cell sourceTayhan, SE; Keles, GT; Topçu, I; Mir, E; Gürhan, SIDObjective: For in vitro tissue engineering in urology, stem cells are commonly isolated from tissue specimens obtained during open or endoscopic surgery. Within the context of the present study our aim was to isolate cells from human urine by an alternative and safe technique rather than using the indicated method. Material and methods: After human urine samples had been collected from young and healthy donors via urethral catheterization, cells were precipitated by centrifugation and cultured. Following this isolation procedure, cells were characterized by immunocytochemical method using specific antibodies. Results: When these cells were characterized by immunocytochemical methods using specific antibodies some of them were positive for mesenchymal stem cell marker CD90 while the others were labelled with urothelial marker cytokeratin 7. When all these results were taken into consideration, urothelial cells together with stem cells were observed in the urine-derived cell population. Conclusion: According to the results obtained from this study human urine may be preferred as an alternative stem cell and urothelial cell source in that this method is and easily reproducible non-invasive method.Item A comparison of the effects of thoracolumbar interfascial plane (TLIP) block and erector spinae plane (ESP) block in postoperative acute pain in spinal surgeryDilsiz, P; Sari, S; Tan, KB; Demircioglu, M; Topçu, I; Erel, VK; Aydin, ON; Turgut, MPurpose: Spinal surgeries are a very painful procedure. New regional techniques for postoperative pain management are being considered. The present study aimed to evaluate the hypothesis that the ultrasound-guided erector spinae plane (ESP) block would lead to lower opioid consumption compared to the thoracolumbar interfascial plane (TLIP) block after lumbar disk surgery. The study's primary objective was to compare postoperative total opioid consumption, and the secondary objective was to assess postoperative pain scores.Methods: Sixty-eight patients who underwent elective lumbar disk surgery were randomly assigned to either the ESP block group or the TLIP block group. The current pain status of the patients in both the ESP and TLIP block groups was assessed using the Numerical Rating Scale (NRS) at specific time intervals (30 min, 1, 6, 12 and 24 h) during the postoperative period. The number of times patients administered a bolus dose of patient-controlled analgesia, (PCA) within the first 24 h was recorded.Results: In the ESP group, the total opioid consumption in terms of morphine equivalents was found to be significantly lower (ESP group: 7.7 +/- 7.0; TLIP group: 13.0 +/- 10.1; p < 0.05). The NRS scores were similar between the groups at 30 min, 1, 6, and 12 h, but at 24 h, they were significantly lower in the ESP group. Moreover, the groups had no significant difference regarding observed side effects.Conclusion: This study demonstrated the analgesic efficacy of both techniques, revealing that the ESP block provides more effective analgesia in patients undergoing lumbar disk surgery.Item Comparison of clinical effectiveness of thoracic epidural and intravenous patient-controlled analgesia for the treatment of rib fractures pain in intensive care unitTopçu, I; Ekici, Z; Sakarya, MBACKGROUND The results of thoracic epidural and systemic patient controlled analgesia practice were evaluated retrospectively in patients with thoracic trauma. METHODS Patients who were admitted to the intensive care unit between 1997 and 2003, with a diagnosis of multiple rib fractures related to thoracic trauma were evaluated retrospectively. Data were recorded from 49 patients who met the following criteria; three or more rib fractures, initiation of PCA with I.V. phentanyl or thoracic epidural analgesia with phentanyl and bupivacaine. RESULTS There were no significant differences between the groups concerning injury severity score. APACHE II score (8.1 +/- 1.6 and 9.2 +/- 1.7) and the number of rib fractures (4 +/- 1.1 and 6.8 +/- 2.7) were higher in thoracic epidural analgesia group (p<0.05). Pain scores of patients who received thoracic epidural analgesia were significantly lower as from 6th hour during whole therapy (p<0.05). Length of intensive care unit stay (15.6 +/- 5.9 and 12.1 +/- 4.4 day) was found to be shorter in thoracic epidural analgesia group (p<0.05). There were no differences between the groups regarding mechanical ventilation requirement, pulmonary and cardiac complications. CONCLUSION We suggest that the use of thoracic epidural analgesia with infusion of local anesthetics and opioids are more appropriate as they provide more effective analgesia and shorten length of intensive care unit stay in chest trauma patients with more than three rib fractures who require intensive care.Item Underestimated role of alcohol at skin disinfection: lipid dissolving property when used in association with conventional antiseptic agentsYentur, A; Topçu, I; Isik, R; Degerli, K; Surucuoglu, SAim: After conventional aqueous disinfectant solutions, it was shown that microorganisms were still protected in hair follicles We hypothesized that those aqueous disinfectant solutions when used in combination with alcohol may be more effective on the inhibition of recolonization of skin and therefore catheter tip colonization Materials and methods: Skin surface samples were taken from epidural catheter insertion sites prior to catheterization, and before and after disinfection with different combinations of povidone-iodine, chlorhexidine, and alcohol Before catheter removal, cultures were taken once more and tips of the catheters were cultured Results: Catheter tip colonization and skin culture results of 10% povidone-iodine + 70% alcohol group were significantly lower than those of other groups after disinfection. Conclusion: Sequential use of alcohol and povidone-iodine is the most effective combination for limiting re-colonization of skin flora Contamination of catheters appears to take place at removal or via the spread of these re-colonized bacteria along the catheter tract.Item Effects of esmolol on hemodynamic responses to laryngoscopy and tracheal intubation in diabetic versus non-diabetic patientsTasyüz, T; Topçu, I; Özaslan, S; Sakarya, MAim: We aimed to investigate the efficiency of esmolol, a short-acting 8-blocker, in preventing the hemodynamic response to laryngoscopy and endotracheal intubation in diabetic patients. Materials and Methods: Eighty diabetic or non-diabetic patients with ASA physical status I-II scheduled for noncardiac surgery were included in this study. They were divided randomly into 4 groups (Non-diabetic control: NDC, Non-diabetic esmolol: NDE, Diabetic control: DC, Diabetic esmolol: DE). Blood glucose analyses were measured in the preoperative period and at the 10(th) min of the study. Prior to anesthetic induction, 1 mg/kg esmolol to Groups NDE and DE and saline to Groups NDC and DC were administered in 1 min by slow infusion. After 2 mins, systolic and diastolic arterial blood pressures (SBP, DBP), heart rate (HR), bispectral index (BIS) and peripheral oxygen saturation (SPO2) were recorded in all groups. Laryngoscopy and endotracheal intubation were performed after induction. SBP, DBP, HR, SPO2 and BIS values were recorded every minute during 10 mins after intubation. Results: In Groups NDE and DE, SBP, DBP and HR values were significantly lower after drug administration than the values obtained before drug administration (p < 0.05). In Groups NDC, NDE and DC, SBP, DBP and HR values were significantly higher in the first minute of the intubation compared to before drug administration (p < 0.05), but were significantly low in subsequent measurements (p < 0.05). Blood glucose analyses were found significantly higher in Group NDE than Group NDC (p < 0.05). Conclusions: We propose that esmolol might be used effectively to control hemodynamic response to tracheal intubation in diabetic patients. We also determined that esmolol causes no difference in blood glucose levels.Item Evaluation of hemostatic changes using thromboelastography after crystalloid or colloid fluid administration during major orthopedic surgeryTopçu, I; Çivi, M; Öztürk, T; Keles, GT; Çoban, S; Yentür, EA; Okçu, GThe 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 (alpha), 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 alpha angle and MA increased (P < 0.05). In group HES, R and K times increased, however, the alpha angle and MA decreased (P < 0.05). In group JEL, R time increased (P < 0.05), but K time, alpha 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 Thromboelastography in the evaluation of coagulation disorders in patients with sepsisKiliç, Y; Topçu, I; Bambal, H; Çivi, MAim: 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, a = alpha angle, and MA = maximum amplitude) were recorded. TEG parameters were compared with routine coagulation and hemogram studies. Results: The 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.Item The effects of lornoxicam on brain edema and blood brain barrier following diffuse traumatic brain injury in ratsTopçu, I; Gümüser, G; Bayram, E; Aras, F; Çetin, I; Temiz, C; Çivi, MBACKGROUND 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 Evaluation of piroxicam-β-cyclodextrin as a preemptive analgesic in functional endoscopic sinus surgeryKeles, GT; Topçu, I; Ekici, Z; Yentür, AThe preemptive analgesic efficacy and adverse effects of preoperatively administered piroxicam-beta-cyclodextrin for post-endoscopic sinus surgery pain was determined in a prospective, double-blind, randomized, clinical study. Seventy-five American Society of Anesthesiologists status I-II patients, aged 18-65 years, were divided into three groups with similar demographic characteristics: group 1 received 20 mg piroxicam-beta-cyclodextrin, group 2 received 40 mg piroxicam-beta-cyclodextrin and group 3 received placebo orally before induction of general anesthesia. A blinded observer recorded the incidence and severity of pain at admission to the post-anesthesia care unit (PACU), at 15, 30, and 45 min in the PACU, and 1, 2, 4, 6, and 24 h postoperatively. All patients received patient-controlled morphine analgesia during the postoperative period and consumption was recorded for 24 h. During the PACU period, mean visual analogue scale values were significantly lower in groups 1 and 2 compared to group 3 (P < 0.05). During the postoperative period, morphine consumption was 3.03 +/- 2.54, 2.7 +/- 2.8, and 5.56 +/- 3.12 mg for each group, respectively (P < 0.05). As a side effect, bleeding was observed in groups 1 and 3, nausea and vomiting in all groups, and edema only in group 3. However, no significant differences were detected in any of the parameters analyzed, which also included epigastric pain, constipation/diarrhea and headache. Similar hematological test results were obtained for all groups. Preemptive administration of piroxicam-beta-cyclodextrin effectively reduced analgesic consumption, and 40 mg of the drug was more effective than 20 mg piroxicam-beta-cyclodextrin without side effects during the postoperative period.Item The Effect of Intravitreal Bevacizumab on Apoptosis of Rat Retina CellsKayikçioglu, Ö; Vatansever, S; Topçu, I; Aydemir, I; Bilecenoglu, T; Kahvecioglu, F; Emre, SPurpose: To investigate the apoptotic effects of intravitreal bevacizumab on rat retinal cells. Material and Method: Thirty-six male adult Swiss albino rats were randomly divided into two groups. The first group was applied 0.25 mg bevacizumab in 0.01 ml saline, and the second group received the same amount of saline intravitreally. Each group was divided into 3 subgroups. The animals were sacrificed and their globes were enucleated at the 3rd, 24th, and 72nd hours of the experiment. Enucleated eyes were preserved for histological analysis, immunohistochemical analysis of caspase-3, caspase-8, caspase-9, Fas/Fas L, VEGF and VEGF receptors (Flt-1, Flk-1), and TUNEL staining. Results: Histological evaluation showed no sign of retinal toxicity in both groups. In TUNEL staining, TUNEL(+) cells were detected in all subgroups, but the number of positive cells was relatively lower in bevacizumab treatment group that reached statistically significant level at 24 and 72 hours of treatment (p<0.001). Immunohistochemical analysis revealed that in saline-treated subgroups, immunoreactivity was more pronounced for all apoptosis-inducing proteins compared to bevacizumab-treated group. Also immunoreactivity of VEGF was prominent in saline treated group. For VEGF receptors, staining was only positive for Flt-1 at the 3rd hour in the control group. Discussion: Bevacizumab did not have apoptosis-inducing potential compared to saline solution in short term, which was documented with TUNEL and immunohistochemical staining.Item Two different methods of lidocaine inhalation before diagnostic flexible bronchoscopy: effects on post-bronchoscopy respiratory symptomsYüksel, H; Yasar, A; Açikel, A; Topçu, I; Yilmaz, ÖBackground/aim: Use of topical anesthesia before flexible bronchoscopy for the evaluation of the upper airways prevents cough and stridor during and after the procedure while reducing the need for sedation. In practice, lidocaine is the medication of choice before bronchoscopy. There various types of nebulizers used for inhalation treatments. In this study, we compared the respiratory tract symptoms after flexible bronchoscopy between children who received pre-procedure topical lidocaine with mesh or jet nebulizers. Materials and methods: We enrolled 4-18 years old subjects that underwent flexible bronchoscopy due to treatment-resistant asthma in this retrospective case-control study. Twenty subjects received topical lidocaine with jet nebulizers while 20 received it with mesh nebulizers. Age, sex, duration of bronchoscopy, duration of anesthesia, time to awaken, and time to recovery were recorded as well as cough and laryngospasm scores after flexible bronchoscopy. Results: Severe cough after flexible bronchoscopy was not encountered in the mesh nebulizers group but was seen in 10% of the jet nebulizers group (p = 0.027). On the other hand, age, sex, duration of bronchoscopy, duration of anesthesia, time to awaken, and time to recovery were not significantly different between the mesh and jet nebulizer groups (p = 0.44, 0.34, 0.51, 0.88, 0.88, and 0.22, respectively). Moreover, croup and laryngospasm scores between the two groups were similar (p = 0.62, 0.50 respectively). Cough score was significantly worse jet nebulizers group (p = 0.03). Conclusion: Topical lidocaine application with mesh nebulizers decreases the most common complication, cough, after flexible bronchoscopy in children more effectively compare to jet nebulizers. Thus, mesh nebulizers may be a faster way of nebulization before flexible bronchoscopy as an alternative to jet nebulizers.Item Infant who Developed Noncardiac Pulmonary Edema after Flexible Fiberoptic BronchoscopyYüksel, H; Topçu, I; Ikizoglu, HT; Yilmaz, Ö; Sögüt, A; Keles, GPulmonary edema may be secondary to cardiac or noncardiac etiologies. Noncardiac pulmonary edema develops as a result of increased vasopermeability, leading to water and protein leak into the interstitium. Negative pressure at the level of the alveoli during flexible fiberoptic bronchoscopy (FFB) may lead to the development of pulmonary edema. This is a rare complication in infants undergoing FFB. Dignostic FFB was performed on a four month old female patient with hypoxic ischemic encephalopathy due to persistent upper respiratory findings. Additional respiratory tract anomalies were not observed in this case who was diagnosed as having laryngomalacia. She developed bronchospastic findings following FFB which improved with nebulized salbutamol treatment. Although her bronchospasm regressed two hours after the procedure, oxygen requirement continued and fine rales became prominent on pulmonary auscultation. Findings of pulmonary edema were observed in the chest X-ray. Mannitol at a dose of 0.5 mg/kg was administered with the diagnosis of pulmonary edema. Physical findings and vital signs normalized with treatment and oxygen requirement ceased. This case was discussed because pulmonary edema after FFB is a rare complication and this is the first experience with mannitol in the treatment.Item May the first-line treatment for foreign body aspiration in childhood be flexible bronchoscopy?Yüksel, H; Yasar, A; Açikel, A; Topçu, I; Yilmaz, ÖINTRODUCTION: Rigid bronchoscopy (RB) is the traditional treatment in foreign body (FB) aspiration in childhood but is a traumatic and invasive procedure. However, flexible optic bronchoscopy (FoB) is a noninvasive and nontraumatic respiratory intervention. The aim of this study was to evaluate FoB as a first-line treatment modality in pediatric cases presenting with a preliminary diagnosis of FB aspiration. METHODS: Subjects who underwent FoB under general anesthesia with the preliminary diagnosis of FB aspiration were enrolled in this cross-sectional study. Two cases were inherited from pediatric surgery because they were not removed with FoB. The demographic, clinical, and radiological findings at the presentation were recorded. Results of success rate and complications were recorded. RESULTS: Among the FB aspiration cases age range of 7 months to 16 years. FoB demonstrated a FB in the airways of 31 (62.2%) subjects. The duration of the symptoms in the subjects was 9.1 +/- 8.8 days. Three of the cases were taken over from pediatric surgery because they were not removed with RB. Most commonly encountered FB's were organic materials (n = 20, 64%). FoB was successful in removing the FB from the proximal and also distal airways in 93% of the subjects. No significant complications and side effects were observed except post-FoB cough. CONCLUSION: This result has shown that FoB for the treatment of FB aspiration is successful in removing FB aspiration from both the proximal and distal airway that the RB cannot remove. Furthermore, FoB did not have any significant airway complication. FoB may be used as the first-line treatment modality for FB aspiration instead of RB in childhood the fact that noninvasive and nontraumatic respiratory intervention.Item Flexible Fiberoptic Bronchoscopy Experience in Childhood: Evaluation of 96 CasesYüksel, H; Sögüt, A; Topçu, I; Yilmaz, Ö; Okkali, Z; Keles, GThis study is presented to evaluate the results of flexible fiberoptic bronchoscopy performed at our Department of Pediatric Allergy and Pulmonology Unit. Data of the 96 pediatric patients who had undergone flexible fiberoptic bronchoscopy in our clinic between January 2003 and February 2007 were evaluated retrospectively. Forty six patients (47.9%) were female and fifty patients (52.1%) were male. The mean age was 73.8 +/- 49.7 months, with a range of 2 and180 months. The most common indications for bronchoscopy were: persistent and/or recurrent pneumonia (24%), atelectasis (22%), suspected foreign bodies (10%), pulmonary tuberculosis (9%) tracheoesophageal fistula (5%), stridor (4%), and others (pulmonary hypoplasia, bronchial hypoplasia, gastroesophageal reflux, bronchiectasis, pulmonary hemosiderosis, hydatid cyst). Bronchoscopy findings of 19 (20%) patients were normal, while those of 77 (80%) patients produced findings which aided diagnosis and therapy. Moreover, rare pulmonary diseases such as tracheal bronchus in two cases and bronchial mucoepidermoid carcinoma in one case with recurrent pneumonia were encountered. Complications were pulmonary edema in one case, laryngospasm in two cases, bronchospasm in one case, and fever in three cases. In conclusion pediatric FFB is an advanced diagnostic tool with high diagnostic value and a low and insignificant complication rate in experienced hands and technically advanced settings.Item Effects of sevofluran on cell division and levels of sister chromatid exchangeLüleci, N; Sakarya, M; Topçu, I; Lüleci, E; Erinçler, T; Solak, MObjective: Purpose of the study was to investigate the mitotic index (MI) and sister chromatid exchange (SCE) levels to identify the mutagenic and carcinogenic effects of sevoflurane (sevoflurane). Methods: 42 non-smoking male and female turkish patients of ASA-risk I and II were included. The patients received an anaesthesia induction with 8% sevoflurane in 100% oxygen ('' tidal volume methode '') and 0,1 mg/kg BW vecuronium for neuromuscular block and endotracheal intubation. Anaesthesia was maintained with 2.0-2.5 sevoflurane in 60% N2O and 40% O-2. Four 5 ml venous blood samples werde taken: before induction (control), 60 minutes, 24 hours and 5 days after sevoflurane anesthesia. Samples were prepared according to the periferic blood culture assay, modified by Morhead and co-workers, and levels of MI and SCE were examined. Results: 60 minutes after sevoflurane-anaesthesia a significant decrease of MI was found compared to controls (p < 0.01). This depression was lower after 24 hours (p < 0.05) and reversible after 5 days. SCE increased significantly during 60 minutes of anaesthesia (p < 0.001), was also lower after 24 hours (5.6 +/- 2.4 vs. 4.4 +/- 1.7) and returned to normal levels after 5 days (p > 0.05). Conclusion: The application of sevoflurane for anaesthesia may influence the cell division in humans and may have a mutagenic effect on DNA at the cell level, which is reversible.Item The Effect of Flexible Bronchoscopy on Anxiety in ChildrenTürkeli, A; Yilmaz, Ö; Topçu, I; Yüksel, HOBJECTIVES: Flexible bronchoscopy (FB) is a semi-invasive diagnostic tool that allows direct visualization of the airways. The use for diagnostic and therapeutic purposes in children is incrasing with the developments in modern anesthesia. Irrespective of the type of the invasive diagnostic procedure, these interventions are known to cause anxiety in patients. The aim of our study was to evaluate the anxiety and depression status in children hospitalized for bronchoscopy and to investigate the effects of FB. MATERIAL AND METHODS: Thirty children hospitalized for FB and 30 controls, aged 7 to 16 years, were enrolled in this study. Anxiety was evaluated with the Hospital anxiety and depression scale (HADS) besides other parameters recorded. RESULTS: The mean HADS anxiety scores in the patient and control groups were respectively 10.1 (3.5) and 2.7 (1.3) (p=0.001). The mean HADS depression scores were respectively 8.8 (3.7) and 2.2 (1.1) (p=0.001). Among the patients, 50% had anxiety and 53.3% had findings while none in the control group showed signs of anxiety and depression. A positive correlation was found between the age and, anxiety and depression scores in patients' groups (respectively r(1) = 0.257; p=0.05 and r(2) = 0.288; p=0.02). CONCLUSION: Anxiety was demonstrated in nearly half of the children hospitalized for bronchoscopy. It has been observed that behavioral and physical problems may be encountered in approximately 40-60% of children who feel generalized anxiety before anesthesia, during the preoperative, postoperative period, and subsequent periods. These results suggest that the detection of children with increased anxiety and indicate the individual requirements can be assisted pharmacological and psychological supports.