Browsing by Author "Yercan H."

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    The Effect of Hyperventilation on the Increase of Cerebral Blood Flow Velocity Secondary to Deflation of the Tourniquet in Lower Extremity Surgery; [Alt Ekstremite Cerrahisinde Turnike Açilmasina Sekonder Beyin Kan Akim Hizi Artişina Hiperventilasyonun Etkisi]
    (2003) Sakarya M.; Topçu I.; Özkol M.; Yentür A.; Yercan H.; Okçu G.
    We aimed to investigate the effects of hyperventilation on cerebral blood flow (CBF) in order to maintain normocapnia following the deflation of the tourniquet in patients undergoing elective lower extremity operation during intravenous general anesthesia (TIVA). In all cases(n=15), anaesthesia was induced by 2 mg kg-1 propofol, 1 μg kg-1 remifentanyl and 1 mg kg-1 vecuronium, and was maintained with the mixture of 50 % air-O2, 6-8 mg kg-1 dk-1 propofol and 0.5 μg kg-1 dk-1 remifentanyl infusions. Patients were randomized into two groups. Group I (n=7) was ventilated by f=10/min and V T=8 mL kg-1. Patients in group II (n=8) were ventilated similarly as group I until the deflation of tourniquet, and following deflation by increasing respiratory frequency adjusted to maintain end-tidal CO 2 (PETCO2) between 30-35 mmHg. Middle cerebral artery (MCA) flow velocity was measured by transcranial Doppler ultrasonography as mean (m-MCA) and peak (p-MCA) values. Data were recorded 5 minutes before tourniquet deflation (control), and every minute in the first 10 minutes following deflation While there has been no difference for p-MCA, m-MCA and PaCO2 in group II, significant increases (p<0.05) in mean MCA flow velocity were obtained in 2nd, 3rd and 4th minutes in group I. Maximum increase was obtained in 3rd minute and determined as 52±7 cm/sec. The increases of PaCO2 were obtained in 2 to 6 minutes (p<0.05) and maximum level was 41±1 mmHg (25 %±3 %) in 3rd minute. We concluded that, the increase of MCA flow velocity and CBF related to the increase of PaCO2 after deflation of the pneumatic tourniquet may be prevented by maintaining normocapnia provided by increasing minute ventilation.
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    Giant-cell tumors of the tendon sheath involving the hand or the wrist: an analysis of 141 patients; [El ve el bileginde tendon kilifinin dev hücreli tümörü: 141 hastanin degerlendirilmesi.]
    (2004) Ozalp T.; Yercan H.; Kurt C.; Ozdemir O.; Coşkunol E.
    OBJECTIVES: Giant-cell tumors of the tendon sheath localized in the hand or wrist were retrospectively reviewed with respect to diagnosis, surgical treatment, and postoperative complications. METHODS: During a 21-year period, a total of 141 patients (83 females, 58 males; mean age 37.5 years; range 6 to 77 years) underwent surgery for 146 lesions that developed in the hand (n=134) or the wrist (n=12). Involvement was on the right side in 77 patients, and on the left side in 64 patients. The mean follow-up period was 3.5 years (range 6 months to 11 years). RESULTS: On presentation, the most common symptom was the presence of a painless soft tissue mass. The most frequent localization was the volar part (76%) of the second (27%) and the third (24) fingers, or the proximal phalanx (57%). Forty per cent of tumors were encountered at ages between 30 and 50 years. The duration of symptoms ranged from one month to five years and the highest number of presentations fell within the first six months. In eighteen patients, radiologic studies showed osseous involvement, being cortical sclerosis in 12 patients, and erosion in eight patients. Postoperative complications included digital nerve injuries in four patients, superficial infection in three patients, and joint stiffness in 12 patients. Twenty-three patients (16%) developed recurrences within a mean of 3.7 years (range 2 months to 7 years). CONCLUSION: Taking high rates of recurrences into consideration, surgery for giant-cell tumors of the tendon sheath requires wide surgical exposure, attentive skills, and the use of magnification.
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    Long-term results of autograft and allograft applications in hand enchondromas; [El yerleşimli enkondromlarin tedavisinde otogreft veya allogreft uygulamalarinin geç dönem sonuçlari.]
    (2004) Yercan H.; Ozalp T.; Coşkunol E.; Ozdemir O.
    OBJECTIVES: We evaluated the long-term results of treatment with curettage followed by an autograft or allograft application in patients with enchondroma of the hand. METHODS: Within a 15-year period, 76 patients (41 males, 35 females; mean age 32 years; range 14 to 47 years) were operated on for enchondroma of the hand. Following curettage of the lesion, reconstruction of the defect was made either by an autograft obtained from the iliac crest (n=76) or by a dehydrated cancellous allograft (n=15). The diagnosis was histologically confirmed in all the cases. Functional and radiographic results were assessed according to the Enneking scoring system and the Tordai classification system, respectively. The mean follow-up periods were 13.5 years (10-22 years) and 7.4 years (6-11 years) in autograft and allograft applications, respectively. RESULTS: Consolidation of the autografts took a mean of 38 days and maximum grasp force was obtained in a mean of 46 days. These periods were 51 and 55 days, respectively, for the allografts. Functional results were excellent/very good in 64%, good in 23%, and poor in 13.1% with autografts; radiographically, 78.7% of the patients were in group I, 18% were in group II, and 3.3% were in group III. Of the allograft group, the results were excellent/very good in 66.7%, good in 26.7%, and poor in 6.7%. Radiographically, 80%, 13.3%, and 6.7% of the patients were classified in group I, II, and III, respectively. There were two recurrences in the autograft group, while one patient, in the allograft group, who had multiple enchondromatosis required a ray amputation because of malignant transformation. CONCLUSION: Autograft and allograft applications seem to yield similar success rates in the treatment of enchondroma of the hand.
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    Giant cell tumor at the wrist: a review of 23 cases; [El bileginde dev hücreli tümör: yirmi üç olgunun incelenmesi.]
    (2006) Ozalp T.; Yercan H.; Okçu G.; Ozdemir O.; Coşkunol E.
    OBJECTIVES: We evaluated patients who underwent surgical treatment for giant cell tumor of the wrist with regard to recurrence rates, factors influencing tumor recurrence, complications, and postoperative functional and emotional status of the patients. METHODS: The study included 23 patients (6 males, 17 females; mean age 31.6 years; range 12 to 74 years) who were treated surgically for giant cell tumor of the wrist. Grading, assessment of surgical margins, and functional evaluation were performed according to the Enneking's criteria. The effects of tumor volume, soft tissue extension, and selected surgical therapy on recurrence were investigated. Joint movements and stability, postoperative pain, presence of deformity, muscle strength, limitations in functional activities, and patient satisfaction were evaluated. The mean follow-up period was 6.7 years. RESULTS: Of all the patients, 69% had stage 2 and 23% had stage 3 tumors. There was no significant correlation between tumor volume and recurrence (p=0.22). Recurrences were observed in three (33%) of nine patients with soft tissue extension and in four (28.6%) of 14 patients without soft tissue extension. Recurrence rates were 33.3% in those who were treated by curettage alone (n=3), 50% with curettage and grafting (n=6), 50% with curettage and bone cement (n=2), and 16% in those who underwent wide excision (n=12). CONCLUSION: The most important factor influencing recurrence rate in giant cell tumors is the extent of surgical resection. At least marginal resection must be considered in patients with stage 2 and 3 lesions especially in cases with soft tissue extension. Adjunctive therapy should be added if curettage is considered.
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    The modifed Eden-Lange procedure for paralysis of the trapezius muscle; [Trapezius felcinde modifiye Eden-Lange prosedürü: Olgu sunumu.]
    (2007) Ozalp T.; Yercan H.; Okçu G.; Erkan S.
    Trapezius muscle paralysis results from injury to the spinal accessory nerve. Impairment in the trapezius muscle function may destabilize the muscle resulting in winged scapula. A 25-year-old university student who was active in sports had complaints of shoulder drop and pain on abduction. He had a three-year history of fall resulting in a scapular fracture for which he received conservative treatment. Physical examination showed asymmetry and drop of the right shoulder. Lateral scapular winging was apparent particularly above 90 degrees of abduction. Electromyography revealed isolated paralysis of the trapezius muscle. The patient underwent reconstruction with the modified Eden-Lange procedure. After a two-year follow-up, asymmetry in the shoulder decreased, there was no pain on active abduction, and the patient returned to active sports and was fully satisfied with the outcome.
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    Giant-cell tumor of the hand: Midterm results in five patients; [Tumeur à cellules géantes de la main: Résultats du traitement: 5 Cas au recul moyen de 7,8 ans]
    (Elsevier Masson SAS, 2007) Ozalp T.; Yercan H.; Okçu G.; Ozdemir O.; Coskunol E.; Bégué T.; Calli I.
    Purpose of the study: Giant-cell bone tumors are benign but have great potential for recurrence. Frequently observed in epiphyseal areas of tubular bones, these tumors are rarely found in hand localizations. We examined the characteristic features of giant-cell tumors of the hand and analyzed the pertinence of surgical treatment. We noted complications, consequences of recurrence and later operations on the same tumor site in five cases. Case reports: Five patients treated between 1973 and 2000 for giant-cell tumors involving the hand bones were reviewed retrospectively. Mean age was 41.6 years and mean follow-up was 7.8 years. The surgical procedure was curettage for two, curettage with bone graft for two and amputation for one. The Enneking score was noted. Results: Pain was the main symptom, with local swelling in several cases. At 7.8 years follow-up recurrence was noted for four of the five tumors. Two patients were treated for a second recurrence. Amputation of the forearm was required for one recurrence affecting soft tissue. Mean time between two consecutive recurrences was three months. In all six episodes of recurrent tumor were treated. These five patients had a total of ten operations. There were no cases of metastasis nor multicentric foci. Discussion: Treatment of giant-cell tumors involving the hand bones is designed to eradicate the tumor and also protect hand function while keeping in mind the aggressive nature of these benign tumors. Surgical alternatives for radical treatment can include wide resection, resection of the ray and amputation. © 2007. Elsevier Masson SAS.
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    Osteotomies in the treatment of osteochondral lesions of the knee joint; [Diz ekleminin osteokondral lezyonlarinin tedavisinde osteotomiler.]
    (2007) Yercan H.; Aydoǧdu S.; Sur H.
    Excellent results of total knee arthroplasty have outweighed high tibial osteotomy applications in the treatment of osteoarthritis of the knee joint, but there is a growing interest in osteotomies as an adjunct in the treatment of full-thickness chondral and osteochondral lesions of the knee. Abnormal biomechanics in both tibiofemoral and patellofemoral articulations resulting from instability and malalignment should be corrected and osteotomy should be regarded as the first step in the treatment of these lesions. A simultaneous or staged osteotomy may contribute to the success of current techniques used for cartilage and osteochondral repair. Clinical, radiographic, and experimental studies have shown beneficial effects of osteotomies on cartilage regeneration. The aim of the osteotomy is simple: cartilage needs proper biomechanical environment for healing.
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    The analysis of functional and radiographic outcomes of conservative treatment in patients with low lumbar burst fractures
    (Elsevier Ltd, 2015) Erkan S.; Tosyali K.; Özalp T.; Yercan H.; Okcu G.
    Introduction Burst fractures of the low lumbar spine constitute approximately one percent of all lumbar fractures. There is still no consensus on the optimal treatment of low lumbar burst factures. We aimed to evaluate the functional and radiographic outcomes of conservative treatment in patients with low lumbar burst fracture. Methods 15 patients (11 males, 4 females; mean age 32 ± 8) who had low lumbar spine burst fracture treated with a custom-moulded thoracolumbosacral orthosis (TLSO) with a thigh extension were enrolled. The mean follow-up period was 22 ± 6 months. 14 patients were neurologically intact and one had isolated nerve root injury. There were 24% type A fractures and 76% type B fractures according to the Denis classification system. Functional outcomes were evaluated by using Oswestry Disability Index (ODI), Short-Form 36 (SF-36) and Visual Analogue Scale (VAS). Radiographic outcome was analyzed by measuring anterior vertebral height loss, kyphosis angle, amount of canal retropulsion. Functional and radiographic outcomes were reviewed initially and at 1, 3, 6, 12 months, and at the latest follow-up. Functional and radiographic improvements were analyzed statistically. Results The mean bracing period was 11.9 ± 1.7 weeks. The mean initial ODI, SF-36, and VAS score of the patients was 78.3 ± 9.6, 23.7 ± 8.9, and 8.7 ± 0.7, respectively. The mean ODI, SF-36, and VAS score of the patients at the final follow-up was 26.4 ± 6.5, 68.1 ± 11.2, and 2.8 ± 1.7, respectively. The improvement in functional outcomes was measured to be significant (p < 0.05 for ODI, SF-36 and VAS). The mean initial anterior vertebral height loss, kyphosis angle, amount of canal retropulsion was found to be 27.2% ± 9.6%, -6.8° ± 3.2°, 37.4% ± 10.2%, respectively. The mean anterior vertebral height loss, kyphosis angle, and amount of canal retropulsion at the final follow-up was 23.1% ±.6.7%, -4.2° ± 2.4°, 19.6% ± 7.7%, respectively. Among the radiographic outcomes, only the amount of canal retropulsion improved statistically (p = 0.042). Conclusion Conservative treatment using a custom-moulded thoracolumbosacral orthosis with a thigh extension is a safe and effective method in patients with low lumbar spine burst fractures and can improve functional and radiographic outcomes. © 2015 Elsevier Ltd. All rights reserved.