Browsing by Author "Topcu, I"
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Item Which Implant Is Better for Treating Reverse Obliquity Fractures of the Proximal Femur: A Standard or Long Nail?Okcu, G; Ozkayin, N; Okta, C; Topcu, I; Aktuglu, KReverse obliquity fractures of the proximal femur have biomechanical characteristics distinct from other intertrochanteric fractures and high implant failure rate when treated with sliding hip screws. Intramedullary hip nailing for these fractures reportedly has less potential for cut-out of the lag screw because of their loadbearing capacity when compared with extramedullary implants. However, it is unclear whether nail length influences healing. We compared standard and long types of intramedullary hip nails in terms of (1) reoperation (fixation failure), (2) 1-year mortality rate, (3) function and mobility, and (4) union rate. We conducted a pilot prospective randomized controlled trial comparing standard versus long (a parts per thousand yen 34 cm) intramedullary hip nails for reverse obliquity fractures of the proximal femur from January 2009 to December 2009. There were 15 patients with standard nails and 18 with long nails. Mean age was 79 years (range, 67-95 years). We determined 1-year mortality rates, reoperation rates, Parker-Palmer mobility and Harris hip scores, and radiographic findings (fracture union, blade cut-out, tip-apex distance, implant failure). Minimum followup was 12 months (mean, 14 months; range, 12-20 months). We found no difference in reoperation rates between groups. Two patients (both from the long-nail group) underwent revision surgery because of implant failure in one and deep infection in the other. There was no difference between the standard- and long-nail groups in mortality rate (17% versus 18%), Parker-Palmer mobility score (five versus six), Harris hip score (74 versus 79), union rate (100% in both groups), blade cut-out (zero versus one), and tip-apex distance (22 versus 24 mm). Our preliminary data suggest reverse obliquity fractures of the trochanteric region of the femur can be treated with either standard or long intramedullary nails.Item Effectiveness of clonidine and fentanyl addition to bupivacaine in postoperative patient controlled epidural analgesiaTopcu, I; Luleci, N; Tekin, S; Kefi, A; Erincler, TBackground and Objectives: The aim of this prospective randomized double-blinded study was to compare the analgesic and side-effects of bupivacaine in combination with clonidine or fentanyl during patient-controlled-epidural analgesia (PCEA) in the postoperative period after abdominal hysterectomy. Methods: 75 patients from 18 to 65 years of age with ASA status I - II were investigated. After preoperative epidural catheterization, the patients were operated in general anesthesia. After surgery, the patients were randomly allocated to 3 PCEA-groups: Group B 0.125% bupivacaine, Group F 0.125% bupivacaine plus 1 mu g x ml(-1) fentanyl, Group C 0.125% bupivacaine plus 0.75 mu g x ml(-1) clonidine (10 ml loading dose, 5 ml repetitive bolus dose, 10 min lockout time, 30 ml limit within 4h). During the following 24 hours, hemodynamic parameters, pain score using visual analog scale (VAS), total analgesic consumption, additional analgesic requirements, sedation, satisfaction, nausea scores and probable side-effects were evaluated. Results: Total analgesic consumption was not different between Group F and Group C, but lower than in Group B (p < 0.05). Additional analgesic use was not different between the groups. Group F and Group C had lower VAS-scores in 24 hours than Group B (p < 0.05). Hemodynamic and sedation scores of patients were not different. In Group C, incidence of nausea was lower and satisfaction of patients was higher (p < 0.05). Conclusions: Addition of clonidine or fentanyl to local anesthetics for PCEA can reduce the analgetic demand. Epidural clonidine can reduce postoperative nausea and is connected with higher patients' satisfaction.Item The Effects of Lornoxicam on Neuroprotection Following Diffuse Traumatic Brain Injury in RatsTopcu, I; Vatansever, S; Bayram, E; Var, A; Cetin, I; Civi, MAIM: In this study, the effects of lornoxicam on the prevention of secondary brain injury via the apoptotic pathway were studied in a rat model of head injury. MATERIAL and METHODS: Thirty adult male Wistar albino rats were anesthetized, and experimental closed head trauma was induced by allowing a 450 g weight to fall two meters onto a metallic disk fixed to the intact skull. After head injury, the rats were randomly divided into two groups: Group I (n=15) rats were administered 2 mL saline intraperitoneally (controls); Group II (n=15) rats were administered 2 mL 1.3 mg kg(-1) lornoxicam intraperitoneally. Brain tissue samples were divided into two pieces by interhemispheric incision for biochemical and histological analysis. RESULTS: TUNEL positivity was seen in neuroglia cells of the brain cortex in both groups. While the immunoreactivities of caspase 8,9 and Fast Fas ligand were similar in both groups, the immunoreactivity of caspase 3 was greater in Group I than Group II. MDA was significantly lower in Group II than in Group I (p<0.05).The decrease in SOD level was higher in Group I than Group II. CONCLUSION: Lornoxicam did not prevent apoptosis in this rat model of brain trauma but causes a decrease.Item The effect of regional and general anaesthesia on cerebral oxygenation in shoulder arthroscopyAcikel, A; Topcu, I; Ozturk, T; Keles, GT; Ozalp, TAim: Shoulder arthroscopy in the beach-chair position can negatively affect cerebral perfusion and oxygenation, and thus, neurocognitive function. In this study, we aimed to compare the effects of general and regional anaesthesia (GA and RA, respectively) on cerebral oxygenation in patients undergoing shoulder arthroscopy in the beach-chair position. Material and Methods: This prospective, randomized study included 60 patients who underwent shoulder arthroscopy in the beach-chair position. Patients were divided into two groups: (1) GA (n = 30), and (2) RA using an interscalene brachial plexus block (ISB; n = 30). All patients were laid supine prior to GA or ISB (T0), and after induction of GA or ISB (T1). Next, patients were placed in the beach-chair position. The right and left cerebral oxygen saturation (NIRS-R, NIRS-L, respectively), peripheral oxygen saturation (SpO2), heart rate (HR), and mean arterial pressure (MAP) values were recorded at T0 and T1, as well as 5 (T2), 10 (T3), 20 (T4), and 30 minutes (T5) after patients were placed in the beach-chair position. Results: Patient's clinical characteristics, initial laboratory findings, and perioperative data were similar in both groups. Compared to T0, MAP was significantly lower at T1, T2, T3, and T4 in the GA group. Tukey's HSD test indicated p<0.05, p<0.0001, p<0.0001, and p<0.001, respectively. Although NIRS-R and NIRS-L values fluctuated substantially, there were no differences between groups at any of the pre-defined time points. Discussion: ISB in the beach-chair position may better preserve cerebral oxygenation compared to GA.Item Comparison of analgesic activity of the addition to neostigmine and fentanyl to bupivacaine in postoperative epidural analgesiaTekin, S; Topcu, I; Ekici, NZ; Caglar, H; Erincler, TObjectives: To compare the analgesic and side effects of bupivacaine in combinations with neostigmine and fentanyl using patient-controlled-epidural analgesia (PCEA) methods in the postoperative period after abdominal hysterectomy. Methods: Seventy-five adult American Society of Anesthesiologists physical status I-II patients, aged 18-65 years were included in the study. The study took place in Celal Bayar University Hospital, Turkey between 20032004 years. After preoperative epidural catheterization, the patients were operated under general anesthesia. After surgery, the patients were randomly allocated in a double-blinded manner to receive PCEA and divided into 3 groups: Group B: 0.125% bupivacaine, Group N: 0.125% bupivacaine plus neostigmine 4 mu g kg(-1) and Group F: 0.125% bupivacaine plus 1 mu g kg(-1) fentanyl solutions (10 mL loading dose, 5 mL bolus dose, 10 min lockout time, 30 mL in 4 hour limit). During the following 24 hours, hemodynamic parameters, pain score using visual analog scale, total analgesic consumption, additional analgesic requirements, sedation, satisfaction, nausea scores and probable side-effects were evaluated. Results: Total analgesic consumption was 143.7 +/- 7.2 mL in Group B, 123.4 +/- 6.2 mL in Group N and 106 +/- 8.3 mL in Groups F. The mean value in Group F was significantly lower than Group N and Group B (p < 0.05), and was lower in Group N than Group B. Visual analog scale scores were lower in Group F than other groups (p < 0.05). There were no differences in side effects between all groups. Conclusions: Fentanyl and neostigmine by the PCEA method can be used safely for postoperative analgesia after gynecologic surgery. They increase analgesia quality and satisfaction without an increase in side effects.Item Seizures, metabolic acidosis and coma resulting from acute isoniazid intoxicationTopcu, I; Yentur, EA; Kefi, A; Ekici, NZ; Sakarya, MIsoniazid is an anti-tuberculosis drug, used commonly for treatment and prophylaxis of tuberculosis. Acute isoniazid intoxication is characterized by a clinical triad consisting of metabolic acidosis resistant to treatment with sodium bicarbonate, seizures which may be fatal and refractory to standard anticonvulsant therapy, and coma. Treatment requires admission to the intensive care unit for ventilatory support, management of seizures and metabolic acidosis. Pyridoxine, in a dose equivalent to the amount of isoniazid ingested, is the only effective antidote. We report the successful treatment of two isoniazid intoxication cases: the case of a child developing an accidental acute isoniazid intoxication and an adult case of isoniazid intoxication with the intent of suicide.Item The effect of epidural and general anesthesia on newborn rectal temperature at elective cesarean sectionYentur, EA; Topcu, I; Ekici, Z; Ozturk, T; Keles, GT; Civi, MBoth epidural and general anesthesia can impair thermoregulatory mechanisms during surgery. However, there is lack of information about the effects of different methods of anesthesia on newborn temperature. The purpose of this study was to determine whether there are differences in newborn rectal temperature related to type of anesthesia. Sixty-three pregnant women were randomly assigned to receive general or epidural anesthesia. Maternal core temperature was measured three times with a rectal probe just before anesthesia, at the beginning of surgery and at delivery. In addition, umbilical vein blood was sampled for pH. The rectal temperatures of the babies were recorded immediately after delivery, and Apgar scores were determined 1, 5, and 10 min after birth. The duration of anesthesia and the volume of intravenous fluid given during the procedure (833 +/- 144 vs 420 +/- 215 mL) were significantly higher in the epidural group than in the general anesthesia group (P < 0.0001). Maternal rectal temperatures were not different in both groups at all measurements. In contrast, newborn rectal temperatures were lower in the epidural anesthesia group than in the general anesthesia group (37.4 +/- 0.3 vs 37.6 +/- 0.3 degrees C; P < 0.05) immediately after birth. Furthermore, the umbilical vein pH value (7.31 +/- 0.05 vs 7.33 +/- 0.01; P < 0.05) and Apgar scores at the 1st-min measurement (8.0 +/- 0.9 vs 8.5 +/- 0.7; P < 0.05) were lower in the epidural anesthesia group than in the general anesthesia group. Since epidural anesthesia requires more iv fluid infusion and a longer time for cesarean section, it involves a risk of a mild temperature reduction for the baby which, however, did not reach the limits of hypothermia.Item Assessment of in-hospital cardiopulmonary resuscitation using Utstein template in a university hospitalTok, D; Keles, GT; Toprak, V; Topcu, IThe aim of this study was to evaluate the effectiveness of in-hospital cardiopulmonary resuscitation (CPR) strategies and identify key predictors of post-CPR survival in a university hospital setting. Using a form recommended by the European Resuscitation Council, data regarding in-hospital CPR attempts from January 2001 to December 2002 were recorded and analyzed. The main outcomes of interest were immediate survival after CPR and survival to hospital discharge. Of 307 patients who suffered cardiac arrest in the study period, 103 (33.5%) were resuscitated. Of these 103 patients, 28 (27.2%) survived immediately and 12 (11.7%) survived to hospital discharge. The key predictors of immediate survival were CPR duration and initial cardiac rhythm as monitored by ventricular fibrillation/pulseless ventricular tachycardia (VF/VT). The key predictors of survival to hospital discharge were CPR duration, immediate defibrillation, Glasgow Coma Scale score, and Early Prediction Score. Together, our results suggest that in-hospital CPR strategies require improvement. They also underscore the importance of data collection and analysis in evaluating the effectiveness of inhospital CPR strategies.Item Is skin disinfection with 10% povidone iodine sufficient to prevent epidural needle and catheter contamination?Yentur, EA; Luleci, N; Topcu, I; Degerli, K; Surucuoglu, SBackground and Objectives: Epidural space infection is a potential complication of epidural catheter placement. in this study, we investigated the incidence of epidural needle and catheter contamination after skin surface disinfection with 10% povidone-iodine (PI). Methods: Sixty seven patients having surgery under epidural anesthesia were enrolled in this prospective study. After preparation with 10% PI, skin swab cultures were taken from the site of catheter insertion. Epidural needles were cultured immediately after epidural catheters were placed. Catheters were removed at 48 hours and 2 to 3 cm of the distal tips were cultured as well. Results: Fifty-six skin swabs, 52 epidural needles, and 48 catheters were cultured. Although only 3.5% (2) colonization was observed on skin surface cultures, 34.6% (18) of the epidural needles and 45.8% (22) of the catheters were colonized. No systemic or local infection was observed. Conclusion: Our results suggest that despite skin surface disinfection with PI, there is still significant risk for contamination of needles and catheters during epidural catheterization.Item Comparison of thoracic epidural and paravertebral analgesia for postoperative pain control after thoracotomyÖztürk, T; Topcu, I; Yaldiz, S; Özbakkaloglu, A; Asik, K; Yentür, AObjectives: In the present randomized, controlled, and blinded study, the effects of thoracic paravertebral analgesia were compared to those of epidural analgesia on postoperative pain, hemodynamics, and respiration rate following thoracotomy. Methods: Patients scheduled for elective open-lung surgery were included. One hour prior to surgery, thoracic epidural catheters were used in 18 patients (ED group), and ultrasound-guided paravertebral catheters were used in 17 patients (PV group). Standard general anesthesia was administered to all. Following anesthesia, postoperative analgesia of levobupivacaine 0.1% and morphine 0.1 mg mL(-1) was administered via catheter. Patient-controlled analgesia (PCA) regime with tramadol was initiated, and amounts of local anesthetics and tramadol demanded and delivered within the first 24 hours were recorded. Visual analog scale (VAS) pain score, sedation score, side effects, and vital signs (blood pressure, heart rate, and respiratory rate) were assessed by an observer blinded to patient data at 1, 2, 3, 4, 6, 12, and 24 hours. Results: Differences in PCA bolus demands and deliveries were not statistically significant between the PV group (26.8 +/- 1.3 and 33.1 +/- 4.5) and the ED group (25.1 +/- 3.5 and 32.5 +/- 4.3). Neither were differences in VAS scores statistically significant (p = 0.3). Rates of sedation among the PV group were lower than those of the ED group at 1 hour (p = 0.001). Five patients in the ED (% 28) group experienced hypotension (p = 0.02). Conclusion: Paravertebral block with levobupivacaine 0.1% and morphine 0.1 mg mL(-1) may be an alternative form of pain relief following thoracotomy.Item The Efficacy of Femoral Block and Unilateral Spinal Anaesthesia on Analgesia, Haemodynamics and Mobilization in Patients undergoing Endovenous Ablation in the Lower ExtremityÖztürk, T; Çevikkalp, E; Nizamoglu, F; Özbakkaloglu, A; Topcu, IObjective: This study aimed to investigate the efficacy of femoral block and unilateral spinal anaesthesia on analgesia, haemodynamics and mobilization during endovenous ablation in patients with lower extremity venous insufficiency. Methods: Forty patients of ASA physical status I and II, with ages ranging between 30 and 45 years, and who were scheduled for endovenous laser ablation for varicose veins were prospectively enrolled in this study. Patients were randomized into a unilateral spinal anaesthesia group (group HS, n=20) or a femoral block group (group F, n=20). Group HS received 7.5-10 mg of heavy bupivacaine for unilateral spinal anaesthesia, while group F received 100 mg prilocaine for femoral block with ultrasound guidance. The level of motor blockage (Bromage score), visual pain score, mean heart rate and mean arterial pressures were recorded at postoperative 0, 1, 2, 3d and 6 h, respectively. Results: Perioperative visual pain score values in both groups were <4. None of the groups required an additional analgesic agent. Bromage scores were significantly lower in group F than in group HS during the postoperative period (p<0.01). Motor function returned to normal in all patients at 3 h in group F and at 6 h in group HS. Postoperative mean heart rate and arterial pressure did not differ between the groups (p>0.05). Conclusion: In patients with lower extremity venous insufficiency who were undergoing endovenous laser ablation, an ultrasound-guided femoral block provided similar analgesia with that of unilateral spinal anaesthesia. In group F, the duration of anaesthesia and mobilization time was shorter.Item The effect of Misoprostol, a prostaglandin E1 analog, on apoptosis in ischemia-reperfusion-induced intestinal injuryTopcu, I; Vatansever, S; Var, A; Cavus, Z; Cilaker, S; Sakarya, MThe aim of this study was to investigate whether Misoprostol, a synthetic prostaglandin (PG) E1 analog, has any effect on the prevention of apoptosis in ischemia-reperfusion (I/R)-induced intestinal injury. Thirty adult mate Wistar albino rats were divided into three groups: group I = sham operated+satine; group II = I/R+saline; and group III = I/R+Misoprostol. Misoprostol. (50 mu g/kg/d) was administered as an intragastric meat for 3 days. The terminal ileum was collected for histological and biochemical. investigations. Apoptotic cells were detected by terminal deoxynucteotidyl transferase-mediated dUTP nick end-labetted (TUNEL) reaction. Immunohistochemical. analysis was performed to determine the distribution of inducible nitric oxide synthase (iNOS) and endothelial NOS (eNOS). Samples were also analyzed for matondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px). The number of TUNEL-positive cells was higher in group II when compared to the other two groups (p < 0.05). In group III this value was higher when compared to group I, but lower than group II (p<0.05). iNOS immunoreactivity was not detected in ileum sections of group I animals, but moderate immunoreactivity was seen in group II and mild immunoreactivity in group III. The immunoreactivity of eNOS was moderate in ileum sections of all three groups. In ileum tissue, MDA was found to be higher in group II compared to group I (p<0.05), but there was no difference in group III. SOD was not different between groups I and III, but was significantly higher in group II (p<0.05). In our experimental model of I/R-induced intestinal injury, apoptosis is induced in enterocytes, whereas Misoprostol decreases enterocyte apoptosis in this experimental model. Our results indicate that Misoprostol may play a key rote in the pathophysiologic events leading to failure of the intrinsic gut barrier defense mechanisms of intestinal epithelium. (c) 2007 Elsevier GmbH. All rights reserved.Item FIRST LINE TREATMENT FOR FOREIGN BODY ASPIRATION IN CHILDREN: FLEXIBLE BRONCHOSCOPYYuksel, H; Yilmaz, O; Acikel, A; Basbay, Y; Yasar, A; Topcu, IItem Effect of low dose propofol and ketamin on emergence in children undergoing flexible bronchoscopy with sevoflurane-remifentanil anaesthesiaOzturk, T; Kefi, A; Yilmaz, O; Topcu, I; Cevikkalp, E; Yuksel, HItem The effects of tramadol and fentanyl on gastrointestinal motility in septic ratsTopcu, I; Ekici, NZ; Isik, R; Sakarya, MIn this study, we investigated the effects of tramadol and fentanyl on gastrointestinal transit (GIT) during acute systemic inflammation in an experimental model of cecal ligation and perforation (CLP). One-hundred-twenty male Swiss-Albino rats were divided randomly into 6 groups: Group I = sham-operated + saline; Group II = sham-operated + fentanyl; Group III = sham-operated + tramadol; Group IV = CLP + saline; Group V = CLP + fentanyl; Group VI CLP + tramadol. Suspension of charcoal was administered as an intragastric meal to measure the GIT. GIT% (mean +/- SD) were 46.1% +/- 9.8%, 43.2% +/- 9.8%, 45.9% +/- 10.2%, 33.2% +/- 9.2%, 24.9% +/- 4.1%, and 31.8% +/- 8.4% in Groups I, II, III, IV, V, and VI, respectively. GIT% was significantly less in Group V than in Groups 1, 11, 111, and IV (P < 0.05). The Group VI mean value was significantly lower than those of Groups I, II, and III (P < 0.05) but not different from those of Groups W and V (P > 0.05). The antitransit effect of fentanyl was shown to have increased in the experimental sepsis model, but no decrease in GIT was obtained with tramadol. This was thought to be the result of an associated endogenic opioid system activation and receptor upregulation in sepsis.