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Öğe A comparison of four different endovenous ablation techniques(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2017) Korkmaz, Kemal; Yener, Ali Umit; Genc, Serhat Bahadir; Gedik, Hikmet Selcuk; Budak, Ali Baran; Cagli, KerimBackground: This study aims to investigate the efficacy of radiofrequency ablation and endovenous laser ablation techniques and the impact on the quality of life of patients. Methods: Between October 2011 and October 2012, 472 extremities of a total of 368 patients (258 females, 110 males; mean age 41.2 years; range 24 to 62 years) who were admitted to our Cardiovascular clinic and underwent endovenous ablation for symptomatic varicose veins were included in the study. Of the patients, 1470 nm wavelength diode laser in 34.1% (n=161), 980 nm wavelength diode laser in 20.1% (n=95), radiofrequency ablation in 26.3% (n=124), and 1470 nm wavelength radial fiber laser in 26.3% (n=124) was applied. These techniques were compared in terms of the postoperative complications, complete occlusion, recanalization rates, and patient comfort. Results: Any major complication such as deep venous thrombosis, pulmonary embolism, and skin burn was observed in none of the patients. Postoperative pain and paresthesias were similar in the endovenous laser ablation groups. Radiofrequency ablation group had lesser postoperative pain and ecchymosis (n=9; n=2; p<0.05). Ecchymosis were mostly seen in 1470 nm wavelength radial diode laser group (n=12; p<0.05) and 980 nm wavelength diode laser group (n=15; p<0.05). At six months, recanalization was observed in the 1470 nm wavelength diode laser group (n=2) and in the 980 nm wavelength diode laser group (n=2). At one year, we observed recanalization in four patients in the radiofrequency ablation group, which did not statistical significance. Conclusion: Considering the same recanalization rates with endovenous laser ablation, lower need for tumescent anesthesia, effective use of thermal energy, and low complication rates, we recommend radiofrequency ablation technique in the treatment of superficial venous insufficiency.Öğe Application of radiofrequency ablation procedure on a morbidly obese patient with a venous ulcer and large saphenous vein(Clinics Cardive Publ Pty Ltd, 2015) Yener, Ali Umit; Yener, Ozlem; Gedik, Hikmet Selcuk; Korkmaz, Kemal; Ozkan, Turgut; Lafci, Ayse; Cagli, KerimVenous ulcers that occur due to chronic venous insufficiency are seen on the upper medial malleol of the ankle. Treatment of venous ulcers is protracted and generally the success rate is low. Co-morbid factors play an important role in the success of treatment of venous ulcers. In this case report, we demonstrate successful venous ulcer treatment in a morbidly obese patient with co-morbid conditions.Öğe DOES A BASIC BLOOD TEST TELL THE LOCATION OF PERIPHERAL ARTERIAL LESIONS?(Carbone Editore, 2015) Yener, Ali Umit; Cicek, Omer Faruk; Cicek, Mustafa Cuneyt; Ozkan, Turgut; Korkmaz, Kemal; Yener, Ozlem; Genc, BahadirAim: In this retrospective study, We investigated if neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) can suggest at hospital admission the location of lesion according to TASC 2 classification, in patients with peripheral arterial disease(PAD). Methods: In patients who underwent peripheral angiography, the routine blood tests performed before the procedure were collected. 241 patients between January 2010 and March 2013 were included in the study. The relationship between blood parameters and the location of peripheral arterial lesions was investigated. The patients were divided into 4 groups according to their TASC 2 (Trans-Atlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease)classification; group A,B,C and D. Results: According to blood tests of patients, NLR and PLR were 3.47 +/- 2.69 and 154.1 +/- 71.2, respectively. When NLR and PLR values were evaluated separately in each group, in patients of Group D according to TASC 2. median NLR and PLR values were significantly higher compared to other groups. In high PLR group, concomitant coronary artery disease was observed in 30.9% of patients, and this difference was statistically significant compared to the low PLR group. Conclusion: Widespread of the PAD may be predicted with the help of a simple blood test at the limited conditions of outpatient clinics and time will be saved in terms of prevention of PAD.Öğe Does a basic blood test tell the location of peripheral arterial lesions?(Acta Medica Mediterranea, 2015) Yener, Ali Umit; Cicek, Omer Faruk; Cicek, Mustafa Cuneyt; Ozkan, Turgut; Korkmaz, Kemal; Yener, Ozlem; Genc, BahadirAim: In this retrospective study, we investigated if neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) can suggest at hospital admission the location of lesion according to TASC 2 classification, in patients with peripheral arterial disease(PAD). Methods: In patients who underwent peripheral angiography, the routine blood tests performed before the procedure were collected. 241 patients between January 2010 and March 2013 were included in the study. The relationship between blood parameters and the location of peripheral arterial lesions was investigated. The patients were divided into 4 groups according to their TASC 2 (Trans-Atlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease )classification; group A,B,C and D. Results: According to blood tests of patients, NLR and PLR were 3.47 ± 2.69 and 154.1 ± 71.2 , respectively. When NLR and PLR values were evaluated separately in each group, in patients of Group D according to TASC 2 , median NLR and PLR values were significantly higher compared to other groups. In high PLR group, concomitant coronary artery disease was observed in 30.9% of patients, and this difference was statistically significant compared to the low PLR group. Conclusion: Widespread of the PAD may be predicted with the help of a simple blood test at the limited conditions of outpatient clinics and time will be saved in terms of prevention of PAD.Öğe Koroner arter baypas greftleme sırasında koroner arter endarterektominin mortalite ve morbidite üzerindeki etkisi(2014) Yener, Ali Ümit; Kervan, Ümit; Korkmaz, Kemal; Gedik, Hikmet Selçuk; Budak, Ali Baran; Genç, Serhat Bahadır; Taşoğlu, İrfanAmaç: Bu çalışmada, koroner endarterektominin (KE) eşzamanlı koroner arter baypas greftleme (KABG) geçiren hastalarda morbidite ve mortalite üzerindeki etkisi araştırıldı.Çalışma planı: Mart 2000 ve Nisan 2010 tarihleri arasında KABG cerrahisi ile beraber eşzamanlı KE ve yama plasti geçiren 587 hasta (KABG+KE grup) retrospektif olarak inceledi. Hastalar randomize bir şekilde seçilmiş ve aynı dönemde KE olmadan KABG cerrahisi geçirmiş 600 hasta (KABG grup) ile karşılaştırıldı. Hasta dosyalarından edinilen büyük parametre serileri ve alt grup analizi ile grupların kapsamlı bir değerlendirmesi yapıldı.Bul gu lar: KABG+KE grubundaki hastalar, KABG grubundakilerden daha yaşlıydı (59.6±10.3'e kıyasla 61.3±7.3; p<0.001). Aterosklerotik risk faktörleri insidansı, üç damar hastalığı ve kararsız angina pektoris şikayetleri KABG+KE grubunda biraz daha yüksekti (p<0.05). Eşzamanlı KE, kros klemp ve kardiyopulmoner baypas süresini uzattı. Ayrıca, ameliyat sonrası toplam entübasyon süresi (12±10.3'e kıyasla 12±7.4 saat; p<0.05) anlamlı şekilde daha uzundu (p<0.05). Miyokard enfarktüsü (p=0.006) ve intraaortik balon pompası gerekliliği (p<0.001) oranları KABG+KE grubunda anlamlı olarak daha yüksekti. Mortalite oranı iki grup arasında farklı değildi.So nuç: Endarterektomi endikasyonu sınırlayıcı bir şekilde ele alınmaya devam edilmelidir. Endarterektomi, anastomozun teknik olarak mümkün görünmediği, sadece tıkanmış, yarı tıkanmış veya ciddi bir şekilde kalsifiye olmuş damarlarda uzun süreli stenoz ile uygulanmalıdır. Endarterektomi, KABG'nin yerine kullanılmamalı ve deneyimli bir cerrahi ekibi tarafından uygulanmalıdır. Öte yandan, konvansiyonel koroner baypas cerrahisine kıyasla KE ek mortalite ile ilişkilendirilemeyebilir.Öğe Open Heart Surgery in a Newly Established Cardiovascular Department: The first 300 cases(Derman Medical Publ, 2015) Korkmaz, Kemal; Gedik, Hikmet Selcuk; Budak, Ali Baran; Genc, Serhat Bahadir; Lafui, Ayse; Yener, Ali Umit; Cagli, KerimAim: Evaluation of the results of open heart surgery in a newly established cardiovascular clinic: Ankara Numune Education and Research Hospital. Material and Method: Between June 2012 and January 2014, 300 open heart surgeries were performed. Urgent operation was performed in 22 patients (7.3%) because of ST-elevation myocardial infarction and in 1 patient because of left ventricular aneurysm rupture. Coronary artery bypass grafting was performed in 211 (70.3%) patients. The other patients underwent various complex operations such as valve repair, Tirone-David procedure and repair of atrioventricular canal defect. Results: In 3 patients (1%) hospital mortality was seen. Reoperation was performed in 8 patients (2.6%) because of pericardial tamponade and in 9 patients (3%) because of bleeding. Atrial fibrillation was developed in 28 patients (9.3%) in the postoperative period and normal sinus rhythm was established with medical cardioversion. Intraaortic balloon pump(IABP) was used in 4 patients preoperatively and in 11 patients postoperatively, including 15 patients(%5). Discussion: In the current era, the patients who are consulted to cardiovascular surgery clinics become more chronic, high risk and patients with additional co-morbid diseases because of the developments in interventional cardiology. Our newly established center aims to be a nationally and internationally successful clinic which was proved by low mortality and morbidity rates with a team who follows the developments and constantly educate and trained.Öğe Radiofrequency ablation of the great saphenous vein in an elderly patient with co-morbid disease(Clinics Cardive Publ Pty Ltd, 2013) Yener, Ali Umit; Yener, Ozlem; Gedik, Hikmet Selcuk; Korkmaz, Kemal; Ozkan, Turgut; Lafci, Ayse; Cagli, KerimAn 86-year-old male patient with hypertension, Parkinsonisrn, benign prostatic hyperplasia, cataract and chronic obstructive pulmonary disease had a history of coronary bypass surgery in two veins due to anterior myocardial infarction one year earlier. He presented with pain and feelings of paresthesia below the knee of his left leg, and had fallen twice. He had used compressions and venoprotective medication for two years and had also received physiotherapy but it had not alleviated the symptoms. He had varicose dilatations in the left leg and pigmentation and a recovered venous ulcer scar were present on the medial malleolus. The patient was classed as grade 4 according to the CEAP classification. Because there was no deficiency in the superficial femoral and popliteal Veins, the patient was taken for endovenous ablation. He had no pain or sensation of heaviness in the legs on postoperative day 10, and the first, third and sixth months of check up. Endovenous ablation is a procedure that increases the quality of life and comfort in elderly patients, with minimal pain. Radiofrequency catheter procedures have proven to be more successful in patients of all age groups than procedures such as standard surgery and foam therapy.Öğe Steroids and impact on cardiac surgical approach: A review of the literature(Anatolian Journal of Clinical Investigation, 2014) Özkan, Muhammed Turgut Alper; Yener, Ali Ümit; Korkmaz, Kemal; Çİçek, Ömer FarukBecause of their anti-inflammatory, anti-allergic and immunosuppressive properties, corticosteroids are one of the most widely used drugs since 1940. Corticosteroids ward off adverse effects of cardiopulmonary bypass and detrimental alterations associated with activation of the systemic inflammatory response in patients undergoing cardiac surgery with cardiopulmonary bypass. In addition, it is shown that preoperative use of steroids are associated with shorter duration of ventilation, diminished blood loss and transfusion, less use of inotropic agents, lower occurrence of atrial fibrillation, shorter ICU and hospital length of stay. Corticosteroid use in open heart surgery is discussed in this review. © 2014, Anatolian Journal of Clinical Investigation. All rights reserved.Öğe The impact of coronary artery endarterectomy on mortality and morbidity during coronary artery bypass grafting(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2014) Yener, Ali Umit; Kervan, Umit; Korkmaz, Kemal; Gedik, Hikmet Selcuk; Budak, Ali Baran; Genc, Serhat Bahadir; Ozkan, M. Turgut AlperBackground: This study aims to investigate the effect of coronary endarterectomy (CE) on morbidity and mortality in patients undergoing concomitant coronary artery bypass grafting (CABG). Methods: We retrospectively reviewed 587 patients who underwent CABG surgery with concomitant CE (CABG+CE group) and patch plasty between March 2000 and April 2010. We compared these patients with randomly selected 600 patients who had undergone CABG surgery without CE (CABG only group) in the same period. A comprehensive evaluation of the groups was achieved by subgroup analysis with large series of parameters from patient files. Results: The patients in the CABG+CE group were older than the patients in the CABG only group (59.6 +/- 10.3 vs. 61.3 +/- 7.3; p<0.001). The incidence of atherosclerotic risk factors, triple-vessel disease, and complaints of unstable angina pectoris were slightly higher in CABG+CE group (p<0.05). Concomitant CE prolonged cross-clamp and cardiopulmonary bypass time. Also, postoperative total entubation time (12 +/- 10.3 vs. 12 +/- 7.4 hours; p<0.05) was significantly longer (p<0.05). The rates of myocardial infarction (p=0.006) and intra-aortic balloon pump requirement (p<0.001) were significantly higher in the CABG+CE group. The mortality rate did not differ between the two groups. Conclusion: Indication for CE must still be handled restrictively. Endarterectomy should be performed only on occluded, nearly occluded, and/or severely calcified vessels with long-range stenosis if regular anastomoses to these vessels seem to be technically impossible. Endarterectomy should not be considered as a substitute for CABG, and should be performed by an experienced surgical team. However, CE might not be associated with additional mortality compared to conventional coronary bypass surgery.