In this study, we aimed to determine the causal relationship between isolated coronary bypass sur... more In this study, we aimed to determine the causal relationship between isolated coronary bypass surgery development of severe pleural effusion in the early postoperative period. Methods: In this study, 7862 isolated coronary artery bypass surgery cases conducted in our hospital between February 2001 and July 2013 were analyzed retrospectively. 175 (2.2%) patients developed early-severe pleural effusion were included in the study. The findings of 175 cases with early severe postoperative pleural effusion (Group A) were compared with the data of 180 cases (Group B) who had similar demographic findings and did not develop early-serious pleural effusion in the postoperative period. Results: The mean age of these pleural effusion cases was 66.3±9.5 (55-76). 149 (85.1%) of the cases were operated under elective conditions and 26 (14.9%) of them were operated under emergency conditions. The mean cardiopulmonary bypass time of the cases was 70±28 (40-100) minutes. Left internal thoracic artery (LITA) and saphenous vein graft (SVG) were used together in 161 (92%) cases. Patients discharged after operation uneventfully. However, of the cases, 126 (72%) had shortness of breath, 115 (65.7%) dry cough, 28 (16%) productive cough, 50 (28.6%) tachypnea, 22 (12.5%) chest pain. Early severe pleural effusion developed in the left hemithorax in 154 (88%) of the cases. LITA+SVG was used in 148 (96.1%) of these cases, and only SVG was used in 6 (3.9%) cases. Early severe pleural effusion developed in the right hemithorax in 14 (8%) of the cases. LITA+SVG was used in 10 (71.4%) of these cases, and only SVG was used in 4 (28.6%) cases. The cases with bilateral early severe pleural effusion were 7 (4%). LITA+SVG was used in 3 (42.9%) of these cases, and only SVG was used in 4 (57.1%) cases. When the two groups were compared, Group A had significantly higher rates of low EF and atrial fibrillation than Group B. Conclusion: It is known that coronary artery bypass surgery causes deterioration of postoperative pulmonary function. One of the most common complications of coronary artery bypass surgery is pleural effusion. It is known that this postoperative picture is associated with increased hospital readmission, rehospitalization and high postoperative morbidity. It is important to determine preoperative risks in terms of postoperative patient management and morbidity assessment.
... Cardiac pacing following surgery for acquired heart disease. J Card Surg 1996;11:332-40. 8) C... more ... Cardiac pacing following surgery for acquired heart disease. J Card Surg 1996;11:332-40. 8) Ceviz M, Kocak H, Basoglu A, Sahin M, Cerrahoglu M, Ates A, et al. Post-CABG conduction disturbances. Ann Thorac Surg 1995;59:546-7. ...
... Ancak kötü olan vakalarda “patch plasty'' u... more ... Ancak kötü olan vakalarda “patch plasty'' uygulandı. Yirmibeş olguda embolektomiyle beraber femoral artere endarterektomi ve safen “patch plasty'' yapıldı. ... Damar Cer Derg 1995;4:91-6. 21) Türkçapar AG, Erverdi N, Tüzüner A, Erdem E. Üst ekstremite tromboembolileri. ...
Objective: Oral anticoagulation therapy with warfarin may cause injury to the skin. Warfarin-indu... more Objective: Oral anticoagulation therapy with warfarin may cause injury to the skin. Warfarin-induced skin necrosis (WISN) is a rare complication with prevelance of 0.01-0.1%. WISN has been postulated to be associated with deficiencies of protein C, protein S, factor VII, and antithrombin III. It is more common among middle-aged, perimenopausal, obese women being treated for deep venous trombosis or pulmonary emboli. Cutaneous injury from warfarin begins as localized paresthesias with an erythematous flush, progresses to petechiae and hemorrhagic bullae, and may eventually result in full-thickness skin necrosis. Patients typically experience pain in affected areas. The onset of disease is usually between the third and sixth day of therapy. Early recognition and treatment are important to avoid substantial morbidity. Methods: A 62 years old man was operated for coronary artery disease. Coronary endarterectomy was made for two vessels. That's why, warfarin was given 5 mg per day after the operation. In patients right hip, erythematous and hemorrhagic bullous skin lesions were seen around saphenous incision line at postoperative third days. We thought these lesions could be due to warfarin. The patient has deficiencies of protein C and protein S. Drugs were stopped. Vitamin K and fresh frosen plasma were given to the patient. The lesions were absent after a few days when drugs were stopped. Results: The patient was discharged at postoperative nineth days. The patient was examined after one month. Some skin hyperpigmentation were examined. There was no other skin signs. Conclusions: WISN is a rare complication of anticoagulant therapy characterized by skin and subcutaneous tissue necrosis that typically begins 3-6 days after initiating warfarin treatment. Warfarin-induced skin necrosis occurred in our patient despite our following literature recommended precautions for the administration of warfarin. Physicians should consider this reaction when suspicious skin lesions appear, regardless of the manner in which warfarin treatment was initiated.
Aim. Peripheral arterial aneurysms are frequently encountered due to increased incidence of arter... more Aim. Peripheral arterial aneurysms are frequently encountered due to increased incidence of arteriosclerosis and common use of invasive methods for the diagnostic and therapeutic purposes. The aim of this report is to evaluate preoperative features of peripheral arterial aneurisms operated at our clinic and their surgical results retrospectively. Methods. 35 peripheral arterial aneurysm cases diagnosed and operated at our clinic between the years of 1999-2008 and they were retrospectively evaluated. Results. Acute and chronic ischemia of the extremities were determined in 12 cases (34.3%). True aneurysms were seen in 12 (34.3%) cases (more than one aneurysm in one case). Pseudo-aneurysms were seen in 23 (65.7%) cases. Frequent causes for true and pseudoaneurysms were arteriosclerosis and iatrogenic factors. Frequent localization of the 26 (74.2%) aneurysms were the femoral and popliteal arteries. It was noted that, aneurysmectomy combined with interposition of sapheneous vein or syn...
Ozet Amac. Son yillarda tani ve tedavi amacli invaziv metotlarin yaygin kullanimi nedeniyle pseud... more Ozet Amac. Son yillarda tani ve tedavi amacli invaziv metotlarin yaygin kullanimi nedeniyle pseudo anevrizma olgulari artmistir. Bu calismamizin amaci, klinigimizde opere edilen periferik arter gercek ve pseudo anevrizma olgularinin preoperatif ozelliklerinin, cerrahi tedavi sonuclarinin retrospektif olarak degerlendirilmesidir. Yontem . Klinigimizde 1999-2008 yillari arasinda periferik arter anevrizmasi saptanan 35 olgu retrospektif olarak incelendi. Bulgular. Akut ve kronik olmak uzere toplam 12 (%34,3) olguda ekstremite iskemisi mevcuttu. Gercek anevrizma 12 (%34,3) (1 olguda birden fazla anevrizma), psodoanevrizma ise 23 (%65,7) olguda tespit edildi. Etiyolojide gercek anevrizmalarda en sik ateroskleroz, psodoanevrizmalarda ise iyatrojenik nedenler saptandi. 26 (%74,2) olguda anevrizmanin en sik yerlestigi bolge femoral ve popliteal arterler olup en sik uygulanan cerrahi yontemin psodo anevrizmada primer tamir, gercek anevrizmada ise anevrizmektomi ile birlikte safen ven veya se...
Amac: Hemodiyaliz amaciyla acilan arteriyovenoz fistullerde distal iskemi ender gorulen ciddi bir... more Amac: Hemodiyaliz amaciyla acilan arteriyovenoz fistullerde distal iskemi ender gorulen ciddi bir komplikasyondur. Amacimiz arteriyovenoz fistul komplikasyonu olarak gelisen ust ekstremite iskemilerinde cerrahi tedavinin sonuclarini degerlendirmektir. Yontem: Mayis 1999 ile Nisan 2005 tarihleri arasinda 412 hastada arteriyovenoz fistul nedeniyle cerrahi girisim uyguladik. Bunlardan sekiz hastada arteriyovenoz fistul komplikasyonu olarak distal iskemi gelismistir. Hastalarin yaslari 26 ile 56 arasinda degismekte (ortalama 39±1,2 yil) idi. Bulgular: Distal iskemi gelismesine neden olan tum arteriyovenoz fistuller brakiyal arterle sefalik veya bazilik ven arasinda acilmisti. Hastalardan dordunde sadece fistul ligature edildi. Uc hastada fistul ligature edildikten sonra brakiyal arterde gelisen anevrizmalar rezeke edildi ve arteriyel devamlilik bir hastada brakiyal arterin uc uca anastomozu ile, bir hastada araya konulan safen ven grefti ile ve diger hasta da ise PTFE interpozisyon gref...
62-year-old man with 4-vessel coronary artery disease and a history of deep vein thrombosis under... more 62-year-old man with 4-vessel coronary artery disease and a history of deep vein thrombosis underwent coronary artery bypass grafting (CABG) with coronary endarterectomy of the left circumflex coronary artery. After surgery, he was placed on oral anticoagulant therapy with warfarin (5 mg/d). On postoperative day (POD) 3, erythematous and hemorrhagic bullous skin lesions appeared around the saphenous artery incision on the patient's right leg (Fig. 1). Thinking that these lesions might be due to the warfarin therapy, we immediately stopped it and started enoxaparin sodium (60 mg/d). We also administered vitamin K and fresh frozen plasma. Blood samples were drawn and sent for laboratory analysis. The lesions disappeared 5 days later, on POD 8. The patient was discharged from the hospital on POD 9. Ten days later, laboratory test results for the previously drawn blood samples revealed protein C and protein S deficiencies in our patient. At a follow-up visit one month after discharge, the only lesions seen on the patient's right leg were a few areas of hyperpigmented skin (Fig. 2). Comment Warfarin-induced skin necrosis (WISN) is a rare but dangerous complication of anticoagulation therapy. At a prevalence of ≤0.1%, 1 WISN is associated with high rates of morbidity and mortality. 2,3 It predominantly affects middle-aged, perimenopausal, obese women being treated for deep vein thrombosis or pulmonary emboli. 3 The skin and subcutaneous tissue necrosis characteristic of WISN typically begins 3 to 6 days after warfarin therapy starts. 2 Initial signs include localized paresthesia with an
Vascular anomaly is a general term that includes all vascular malformations, vascular tumors and ... more Vascular anomaly is a general term that includes all vascular malformations, vascular tumors and other congenital vascular defects. Vascular malformation is the most common term, and it describes blood vessels that are abnormally formed at birth. Vascular malformations can develop in any part of the body. The most common location is in the lower extremities. Vascular malformations involve arteries, veins or lymphatic vessels or a combination of these. Our patient was a 22 years old man with an arteriovenous malformation in his left forearm. He was admitted due to increased pain and swelling on his left forearm over the previous nine months. He had one arterial feeder derived from the ulnar artery and two venous drainage systems at the magnetic resonance angiography. We used indocyanine green fluorescence angiography to assess the arteriovenous malformation during surgery. We thought (found) that it was a very useful and unique technique for assessing the anomalies of the vascular anatomy and eradicating the nidus of the arteriovenous malformation. It could prove to be very helpful in avoiding significant blood loss during surgery.
Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially correctable cause of secon... more Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially correctable cause of secondary pulmonary hypertension. Surgical treatment remains the primary treatment for patients with CTEPH. Pulmonary thromboendarterectomy (PEA) with deep hypothermic circulatory arrest is the standard and recommended surgical technique for the treatment of these patients. The prevalence of CTEPH after an acute pulmonary thromboembolism (PTE) has been found in various studies to be between 0.6 and 8.8%. Mortality rates in elective PEA cases with CTEPH are reported to be between 1.9 and 4.5%. We report on a 50-year-old female patient with combined inherited thrombophilia, including protein C and protein S deficiencies, who was diagnosed with CTEPH and was successfully treated with pulmonary thromboendarterectomy.
Pericardial cysts are rare benign lesions of the thoracic cavity and are mostly congenital anomal... more Pericardial cysts are rare benign lesions of the thoracic cavity and are mostly congenital anomalies. They are induced by an incomplete coalescence of foetal lacunae during the development of the pericardium. Pericardial cysts are usually unilocular, well marginated spherical or teardrop shaped and may be attached to the pericardium directly or by a pedicle. Of all pericardial cysts, 70 to 75% are located at the right cardiophrenic angle. We report a case that was incidentally diagnosed with only chest magnetic resonance imaging because of a paracardiac mass. In order to prevent complications, the giant pericardial cyst was excised outside of the pericardium with median sternotomy.
Objective The aim of the study was to evaluate the diagnostic accuracy and effective radiation do... more Objective The aim of the study was to evaluate the diagnostic accuracy and effective radiation dose (ERD) of high pitch dual source multidetector computed tomography (MDCT) for coronary artery bypass graft (CABG) patency. Materials and methods Fourty-five patients who underwent 128 × 2-slice MDCT angiography with a prospective electrocardiogram-triggering, low-dose, high pitch, dual source, flash spiral acquisition mode after CABG surgery were included in the study. The interobserver agreement of the image quality was evaluated with Cohen κ value. The image quality was compared to the heart rates (HRs) using Mann-Whitney U test and to the graft segments using χ 2 test. The findings for the CABG patency on MDCT were compared to those determined on catheter coronary angiography. Dose-length product (DLP) and ERD were compared to the gender, HRs, and body mass index (BMI) of the patients using Kruskall Wallis and Mann-Whitney U tests. Results A total of 110 grafts and 330 vessel segments were evaluated with a good interobserver agreement
Abstract. Prosthetic mitral valve thrombosis is a lifethreatening complication. Data on complicat... more Abstract. Prosthetic mitral valve thrombosis is a lifethreatening complication. Data on complications and outcome are limited. The purpose of this study was to review the clinical experience with the thrombolytic therapy and surgical management of prosthetic mitral valve obstruction in our hospital. Between the January 2001 and April 2005, twelve patients with obstructed prosthetic mitral valve were admitted to our hospital. There were 8 female and 4 male patients ranging in age from14 to 60 years, with a mean age of 34±12 years. In all patients, the diagnosis of prosthetic valve thrombosis was confirmed by echocardiography including transesophageal echocardiography. All patients showed absence or muffering of prosthetic valve sounds. Two of 12 patients received thrombolytic therapy by using streptokinase. In the remaining 10 patients, operations were performed on an emergency basis with median sternotomy and cardiopulmonary bypass techniques using antegrade-retrograde combinated isothermic blood cardioplegia and moderate hypothermia. The principal risk factors of prosthetic valve thrombosis are inadequate anticoagulation or fluctuation in anticoagulation levels. Its treatment is either surgical or with thrombolytics. Although both treatment methods are effective, the latter is gaining favor. However, surgery is often required due to large thrombi and a presence of pannus formation. Keywords: Prosthetic mitral valve thrombosis, pannus, thrombolysis
Summary Spontaneous dissection of the main iliac artery is a rare condition with obvious treatmen... more Summary Spontaneous dissection of the main iliac artery is a rare condition with obvious treatment modalities. A 25-year-old male patient presented with exercise induced left leg pain. Magnetic resonance angiography demonstrated a spontaneous left main iliac artery dissection. The patient is followed-up conservatively for 4 months with anticoagulant therapy and exercise limitation. (Turkish J Vasc Surg 2003;12(2): 29-31) Key Words: Spontaneous dissection, common iliac artery, athletic injuries, anticoagulant therapy
The increased reporting of cases of drug-induced liver injuries reflects the growing number of ne... more The increased reporting of cases of drug-induced liver injuries reflects the growing number of new agents introduced into clinical practice in the last decade. The aim of this study was to determine the most common causes of drug-induced liver injury in our surroundings. We analyzed 52 patients with a diagnosis of hepatotoxic liver injury (medical history, detailed clinical evaluation of patients, histopathologic analysis of the liver, abdominal ultrasound, and laboratory determination of standard liver function tests) and followed up for 12 months. Liver functional test results and morphologic findings were monitored. We used biologic markers relevant for the differential diagnosis, monitoring of disease progression, and response to therapy. The causes of toxic liver damage in our study included the following agents, classified into groups: industrial toxins (8 patients), food and beverages (9 patients), anti-rheumatic agents and analgesics (6 patients), antiarrhythmic drugs (4 patients), antilipemic agents (4 patients), antibiotics (4 patients), vitamins (3 patients), antihypertensive drugs (3 patients), antiplatelet drugs (2 patients), anticonvulsants (2 patients), drugs for osteoporosis (2 patients), antihypertensive drugs (1 patient), oral antidiabetic agents (1 patient), oral contraceptives (1 patient), glucocorticoids (1 patient), and antidepressants (1 patient). We obtained the results of HLA typing for 29 of the 52 patients with hepatotoxic liver injury and for 22 of 52 patients with chronic viral hepatitis. The paper points to hepatotoxicity, which is not rare in our population. Structure of xenobiotic agents causing liver toxicity in our environment is mainly industrial toxins, as well as food and beverages, more than drugs.
Medical science monitor : international medical journal of experimental and clinical research, 2006
The aim of this prospective, randomized study was to assess the efficacy of posterior pericardiot... more The aim of this prospective, randomized study was to assess the efficacy of posterior pericardiotomy in decreasing the prevalence of pericardial effusion and postoperative atrial fibrillation (AF). The study was performed in 100 patients who underwent elective coronary artery bypass grafting surgery (CABG) between October 2003 and July 2005. They were randomized to receive posterior pericardiotomy (Group A) or no posterior pericardiotomy (Group B). A 4-cm longitudinal incision was made parallel and posterior to the left phrenic nerve, extending from the left inferior pulmonary vein to the diaphragm in group A patients. Posterior pericardiotomy was not performed in group B patients. Early pericardial effusion developed in 6 patients (12%) of group A and 21 patients (42%) of group B; no late pericardial effusion developed in group A, but did in 3 patients (6%) of group B. The number of patients who developed postoperative AF was significantly lower in the fenestration group compared w...
In this study, we aimed to determine the causal relationship between isolated coronary bypass sur... more In this study, we aimed to determine the causal relationship between isolated coronary bypass surgery development of severe pleural effusion in the early postoperative period. Methods: In this study, 7862 isolated coronary artery bypass surgery cases conducted in our hospital between February 2001 and July 2013 were analyzed retrospectively. 175 (2.2%) patients developed early-severe pleural effusion were included in the study. The findings of 175 cases with early severe postoperative pleural effusion (Group A) were compared with the data of 180 cases (Group B) who had similar demographic findings and did not develop early-serious pleural effusion in the postoperative period. Results: The mean age of these pleural effusion cases was 66.3±9.5 (55-76). 149 (85.1%) of the cases were operated under elective conditions and 26 (14.9%) of them were operated under emergency conditions. The mean cardiopulmonary bypass time of the cases was 70±28 (40-100) minutes. Left internal thoracic artery (LITA) and saphenous vein graft (SVG) were used together in 161 (92%) cases. Patients discharged after operation uneventfully. However, of the cases, 126 (72%) had shortness of breath, 115 (65.7%) dry cough, 28 (16%) productive cough, 50 (28.6%) tachypnea, 22 (12.5%) chest pain. Early severe pleural effusion developed in the left hemithorax in 154 (88%) of the cases. LITA+SVG was used in 148 (96.1%) of these cases, and only SVG was used in 6 (3.9%) cases. Early severe pleural effusion developed in the right hemithorax in 14 (8%) of the cases. LITA+SVG was used in 10 (71.4%) of these cases, and only SVG was used in 4 (28.6%) cases. The cases with bilateral early severe pleural effusion were 7 (4%). LITA+SVG was used in 3 (42.9%) of these cases, and only SVG was used in 4 (57.1%) cases. When the two groups were compared, Group A had significantly higher rates of low EF and atrial fibrillation than Group B. Conclusion: It is known that coronary artery bypass surgery causes deterioration of postoperative pulmonary function. One of the most common complications of coronary artery bypass surgery is pleural effusion. It is known that this postoperative picture is associated with increased hospital readmission, rehospitalization and high postoperative morbidity. It is important to determine preoperative risks in terms of postoperative patient management and morbidity assessment.
... Cardiac pacing following surgery for acquired heart disease. J Card Surg 1996;11:332-40. 8) C... more ... Cardiac pacing following surgery for acquired heart disease. J Card Surg 1996;11:332-40. 8) Ceviz M, Kocak H, Basoglu A, Sahin M, Cerrahoglu M, Ates A, et al. Post-CABG conduction disturbances. Ann Thorac Surg 1995;59:546-7. ...
... Ancak kötü olan vakalarda “patch plasty'' u... more ... Ancak kötü olan vakalarda “patch plasty'' uygulandı. Yirmibeş olguda embolektomiyle beraber femoral artere endarterektomi ve safen “patch plasty'' yapıldı. ... Damar Cer Derg 1995;4:91-6. 21) Türkçapar AG, Erverdi N, Tüzüner A, Erdem E. Üst ekstremite tromboembolileri. ...
Objective: Oral anticoagulation therapy with warfarin may cause injury to the skin. Warfarin-indu... more Objective: Oral anticoagulation therapy with warfarin may cause injury to the skin. Warfarin-induced skin necrosis (WISN) is a rare complication with prevelance of 0.01-0.1%. WISN has been postulated to be associated with deficiencies of protein C, protein S, factor VII, and antithrombin III. It is more common among middle-aged, perimenopausal, obese women being treated for deep venous trombosis or pulmonary emboli. Cutaneous injury from warfarin begins as localized paresthesias with an erythematous flush, progresses to petechiae and hemorrhagic bullae, and may eventually result in full-thickness skin necrosis. Patients typically experience pain in affected areas. The onset of disease is usually between the third and sixth day of therapy. Early recognition and treatment are important to avoid substantial morbidity. Methods: A 62 years old man was operated for coronary artery disease. Coronary endarterectomy was made for two vessels. That's why, warfarin was given 5 mg per day after the operation. In patients right hip, erythematous and hemorrhagic bullous skin lesions were seen around saphenous incision line at postoperative third days. We thought these lesions could be due to warfarin. The patient has deficiencies of protein C and protein S. Drugs were stopped. Vitamin K and fresh frosen plasma were given to the patient. The lesions were absent after a few days when drugs were stopped. Results: The patient was discharged at postoperative nineth days. The patient was examined after one month. Some skin hyperpigmentation were examined. There was no other skin signs. Conclusions: WISN is a rare complication of anticoagulant therapy characterized by skin and subcutaneous tissue necrosis that typically begins 3-6 days after initiating warfarin treatment. Warfarin-induced skin necrosis occurred in our patient despite our following literature recommended precautions for the administration of warfarin. Physicians should consider this reaction when suspicious skin lesions appear, regardless of the manner in which warfarin treatment was initiated.
Aim. Peripheral arterial aneurysms are frequently encountered due to increased incidence of arter... more Aim. Peripheral arterial aneurysms are frequently encountered due to increased incidence of arteriosclerosis and common use of invasive methods for the diagnostic and therapeutic purposes. The aim of this report is to evaluate preoperative features of peripheral arterial aneurisms operated at our clinic and their surgical results retrospectively. Methods. 35 peripheral arterial aneurysm cases diagnosed and operated at our clinic between the years of 1999-2008 and they were retrospectively evaluated. Results. Acute and chronic ischemia of the extremities were determined in 12 cases (34.3%). True aneurysms were seen in 12 (34.3%) cases (more than one aneurysm in one case). Pseudo-aneurysms were seen in 23 (65.7%) cases. Frequent causes for true and pseudoaneurysms were arteriosclerosis and iatrogenic factors. Frequent localization of the 26 (74.2%) aneurysms were the femoral and popliteal arteries. It was noted that, aneurysmectomy combined with interposition of sapheneous vein or syn...
Ozet Amac. Son yillarda tani ve tedavi amacli invaziv metotlarin yaygin kullanimi nedeniyle pseud... more Ozet Amac. Son yillarda tani ve tedavi amacli invaziv metotlarin yaygin kullanimi nedeniyle pseudo anevrizma olgulari artmistir. Bu calismamizin amaci, klinigimizde opere edilen periferik arter gercek ve pseudo anevrizma olgularinin preoperatif ozelliklerinin, cerrahi tedavi sonuclarinin retrospektif olarak degerlendirilmesidir. Yontem . Klinigimizde 1999-2008 yillari arasinda periferik arter anevrizmasi saptanan 35 olgu retrospektif olarak incelendi. Bulgular. Akut ve kronik olmak uzere toplam 12 (%34,3) olguda ekstremite iskemisi mevcuttu. Gercek anevrizma 12 (%34,3) (1 olguda birden fazla anevrizma), psodoanevrizma ise 23 (%65,7) olguda tespit edildi. Etiyolojide gercek anevrizmalarda en sik ateroskleroz, psodoanevrizmalarda ise iyatrojenik nedenler saptandi. 26 (%74,2) olguda anevrizmanin en sik yerlestigi bolge femoral ve popliteal arterler olup en sik uygulanan cerrahi yontemin psodo anevrizmada primer tamir, gercek anevrizmada ise anevrizmektomi ile birlikte safen ven veya se...
Amac: Hemodiyaliz amaciyla acilan arteriyovenoz fistullerde distal iskemi ender gorulen ciddi bir... more Amac: Hemodiyaliz amaciyla acilan arteriyovenoz fistullerde distal iskemi ender gorulen ciddi bir komplikasyondur. Amacimiz arteriyovenoz fistul komplikasyonu olarak gelisen ust ekstremite iskemilerinde cerrahi tedavinin sonuclarini degerlendirmektir. Yontem: Mayis 1999 ile Nisan 2005 tarihleri arasinda 412 hastada arteriyovenoz fistul nedeniyle cerrahi girisim uyguladik. Bunlardan sekiz hastada arteriyovenoz fistul komplikasyonu olarak distal iskemi gelismistir. Hastalarin yaslari 26 ile 56 arasinda degismekte (ortalama 39±1,2 yil) idi. Bulgular: Distal iskemi gelismesine neden olan tum arteriyovenoz fistuller brakiyal arterle sefalik veya bazilik ven arasinda acilmisti. Hastalardan dordunde sadece fistul ligature edildi. Uc hastada fistul ligature edildikten sonra brakiyal arterde gelisen anevrizmalar rezeke edildi ve arteriyel devamlilik bir hastada brakiyal arterin uc uca anastomozu ile, bir hastada araya konulan safen ven grefti ile ve diger hasta da ise PTFE interpozisyon gref...
62-year-old man with 4-vessel coronary artery disease and a history of deep vein thrombosis under... more 62-year-old man with 4-vessel coronary artery disease and a history of deep vein thrombosis underwent coronary artery bypass grafting (CABG) with coronary endarterectomy of the left circumflex coronary artery. After surgery, he was placed on oral anticoagulant therapy with warfarin (5 mg/d). On postoperative day (POD) 3, erythematous and hemorrhagic bullous skin lesions appeared around the saphenous artery incision on the patient's right leg (Fig. 1). Thinking that these lesions might be due to the warfarin therapy, we immediately stopped it and started enoxaparin sodium (60 mg/d). We also administered vitamin K and fresh frozen plasma. Blood samples were drawn and sent for laboratory analysis. The lesions disappeared 5 days later, on POD 8. The patient was discharged from the hospital on POD 9. Ten days later, laboratory test results for the previously drawn blood samples revealed protein C and protein S deficiencies in our patient. At a follow-up visit one month after discharge, the only lesions seen on the patient's right leg were a few areas of hyperpigmented skin (Fig. 2). Comment Warfarin-induced skin necrosis (WISN) is a rare but dangerous complication of anticoagulation therapy. At a prevalence of ≤0.1%, 1 WISN is associated with high rates of morbidity and mortality. 2,3 It predominantly affects middle-aged, perimenopausal, obese women being treated for deep vein thrombosis or pulmonary emboli. 3 The skin and subcutaneous tissue necrosis characteristic of WISN typically begins 3 to 6 days after warfarin therapy starts. 2 Initial signs include localized paresthesia with an
Vascular anomaly is a general term that includes all vascular malformations, vascular tumors and ... more Vascular anomaly is a general term that includes all vascular malformations, vascular tumors and other congenital vascular defects. Vascular malformation is the most common term, and it describes blood vessels that are abnormally formed at birth. Vascular malformations can develop in any part of the body. The most common location is in the lower extremities. Vascular malformations involve arteries, veins or lymphatic vessels or a combination of these. Our patient was a 22 years old man with an arteriovenous malformation in his left forearm. He was admitted due to increased pain and swelling on his left forearm over the previous nine months. He had one arterial feeder derived from the ulnar artery and two venous drainage systems at the magnetic resonance angiography. We used indocyanine green fluorescence angiography to assess the arteriovenous malformation during surgery. We thought (found) that it was a very useful and unique technique for assessing the anomalies of the vascular anatomy and eradicating the nidus of the arteriovenous malformation. It could prove to be very helpful in avoiding significant blood loss during surgery.
Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially correctable cause of secon... more Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially correctable cause of secondary pulmonary hypertension. Surgical treatment remains the primary treatment for patients with CTEPH. Pulmonary thromboendarterectomy (PEA) with deep hypothermic circulatory arrest is the standard and recommended surgical technique for the treatment of these patients. The prevalence of CTEPH after an acute pulmonary thromboembolism (PTE) has been found in various studies to be between 0.6 and 8.8%. Mortality rates in elective PEA cases with CTEPH are reported to be between 1.9 and 4.5%. We report on a 50-year-old female patient with combined inherited thrombophilia, including protein C and protein S deficiencies, who was diagnosed with CTEPH and was successfully treated with pulmonary thromboendarterectomy.
Pericardial cysts are rare benign lesions of the thoracic cavity and are mostly congenital anomal... more Pericardial cysts are rare benign lesions of the thoracic cavity and are mostly congenital anomalies. They are induced by an incomplete coalescence of foetal lacunae during the development of the pericardium. Pericardial cysts are usually unilocular, well marginated spherical or teardrop shaped and may be attached to the pericardium directly or by a pedicle. Of all pericardial cysts, 70 to 75% are located at the right cardiophrenic angle. We report a case that was incidentally diagnosed with only chest magnetic resonance imaging because of a paracardiac mass. In order to prevent complications, the giant pericardial cyst was excised outside of the pericardium with median sternotomy.
Objective The aim of the study was to evaluate the diagnostic accuracy and effective radiation do... more Objective The aim of the study was to evaluate the diagnostic accuracy and effective radiation dose (ERD) of high pitch dual source multidetector computed tomography (MDCT) for coronary artery bypass graft (CABG) patency. Materials and methods Fourty-five patients who underwent 128 × 2-slice MDCT angiography with a prospective electrocardiogram-triggering, low-dose, high pitch, dual source, flash spiral acquisition mode after CABG surgery were included in the study. The interobserver agreement of the image quality was evaluated with Cohen κ value. The image quality was compared to the heart rates (HRs) using Mann-Whitney U test and to the graft segments using χ 2 test. The findings for the CABG patency on MDCT were compared to those determined on catheter coronary angiography. Dose-length product (DLP) and ERD were compared to the gender, HRs, and body mass index (BMI) of the patients using Kruskall Wallis and Mann-Whitney U tests. Results A total of 110 grafts and 330 vessel segments were evaluated with a good interobserver agreement
Abstract. Prosthetic mitral valve thrombosis is a lifethreatening complication. Data on complicat... more Abstract. Prosthetic mitral valve thrombosis is a lifethreatening complication. Data on complications and outcome are limited. The purpose of this study was to review the clinical experience with the thrombolytic therapy and surgical management of prosthetic mitral valve obstruction in our hospital. Between the January 2001 and April 2005, twelve patients with obstructed prosthetic mitral valve were admitted to our hospital. There were 8 female and 4 male patients ranging in age from14 to 60 years, with a mean age of 34±12 years. In all patients, the diagnosis of prosthetic valve thrombosis was confirmed by echocardiography including transesophageal echocardiography. All patients showed absence or muffering of prosthetic valve sounds. Two of 12 patients received thrombolytic therapy by using streptokinase. In the remaining 10 patients, operations were performed on an emergency basis with median sternotomy and cardiopulmonary bypass techniques using antegrade-retrograde combinated isothermic blood cardioplegia and moderate hypothermia. The principal risk factors of prosthetic valve thrombosis are inadequate anticoagulation or fluctuation in anticoagulation levels. Its treatment is either surgical or with thrombolytics. Although both treatment methods are effective, the latter is gaining favor. However, surgery is often required due to large thrombi and a presence of pannus formation. Keywords: Prosthetic mitral valve thrombosis, pannus, thrombolysis
Summary Spontaneous dissection of the main iliac artery is a rare condition with obvious treatmen... more Summary Spontaneous dissection of the main iliac artery is a rare condition with obvious treatment modalities. A 25-year-old male patient presented with exercise induced left leg pain. Magnetic resonance angiography demonstrated a spontaneous left main iliac artery dissection. The patient is followed-up conservatively for 4 months with anticoagulant therapy and exercise limitation. (Turkish J Vasc Surg 2003;12(2): 29-31) Key Words: Spontaneous dissection, common iliac artery, athletic injuries, anticoagulant therapy
The increased reporting of cases of drug-induced liver injuries reflects the growing number of ne... more The increased reporting of cases of drug-induced liver injuries reflects the growing number of new agents introduced into clinical practice in the last decade. The aim of this study was to determine the most common causes of drug-induced liver injury in our surroundings. We analyzed 52 patients with a diagnosis of hepatotoxic liver injury (medical history, detailed clinical evaluation of patients, histopathologic analysis of the liver, abdominal ultrasound, and laboratory determination of standard liver function tests) and followed up for 12 months. Liver functional test results and morphologic findings were monitored. We used biologic markers relevant for the differential diagnosis, monitoring of disease progression, and response to therapy. The causes of toxic liver damage in our study included the following agents, classified into groups: industrial toxins (8 patients), food and beverages (9 patients), anti-rheumatic agents and analgesics (6 patients), antiarrhythmic drugs (4 patients), antilipemic agents (4 patients), antibiotics (4 patients), vitamins (3 patients), antihypertensive drugs (3 patients), antiplatelet drugs (2 patients), anticonvulsants (2 patients), drugs for osteoporosis (2 patients), antihypertensive drugs (1 patient), oral antidiabetic agents (1 patient), oral contraceptives (1 patient), glucocorticoids (1 patient), and antidepressants (1 patient). We obtained the results of HLA typing for 29 of the 52 patients with hepatotoxic liver injury and for 22 of 52 patients with chronic viral hepatitis. The paper points to hepatotoxicity, which is not rare in our population. Structure of xenobiotic agents causing liver toxicity in our environment is mainly industrial toxins, as well as food and beverages, more than drugs.
Medical science monitor : international medical journal of experimental and clinical research, 2006
The aim of this prospective, randomized study was to assess the efficacy of posterior pericardiot... more The aim of this prospective, randomized study was to assess the efficacy of posterior pericardiotomy in decreasing the prevalence of pericardial effusion and postoperative atrial fibrillation (AF). The study was performed in 100 patients who underwent elective coronary artery bypass grafting surgery (CABG) between October 2003 and July 2005. They were randomized to receive posterior pericardiotomy (Group A) or no posterior pericardiotomy (Group B). A 4-cm longitudinal incision was made parallel and posterior to the left phrenic nerve, extending from the left inferior pulmonary vein to the diaphragm in group A patients. Posterior pericardiotomy was not performed in group B patients. Early pericardial effusion developed in 6 patients (12%) of group A and 21 patients (42%) of group B; no late pericardial effusion developed in group A, but did in 3 patients (6%) of group B. The number of patients who developed postoperative AF was significantly lower in the fenestration group compared w...
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Papers by Hakan Akbayrak