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    Detection of fetal keratin with high molecular weight cytokeratin immunostaining in lung biopsy material from a patient with amniotic fluid embolism
    (2013) Hacivelioglu, Servet; Oguzalp, Huseyin; Muratli, Asli; Asgun, Fatih; Kirilmaz, Bahadir; Omur, Dilek
    Amniotic fluid embolism (AFE) is a rare and fatal disorder in which the diagnosis can be challenging for clinicians and pathologists. A healthy 36-year-old woman (gravida 4, para 2) was admitted for delivery in the 40th week of gestation. At the fifth minute following birth, during expulsion of the placenta, the patient suddenly collapsed with bradycardia, shallow respiration, and loss of consciousness. After evaluation, an emergent pulmonary embolectomy for acute thrombo-embolism was performed, however the patient could not be weaned from cardiopulmonary bypass, and died of severe right ventricular dysfunction following the operation. Microscopic examination of the biopsy material detected clearly visible fetal epithelial squames inside pulmonary vessels, both with routine hematoxylin-eosin (HE) staining and immunostaining for high molecular weight cytokeratin (HMW-CK). The diagnosis of amniotic fluid embolism (AFE) was made, which was confirmed as the cause of death. We show that HMW-CK staining can be a useful means of detecting amniotic fluid-derived fetal keratin within alveolar tissue. We suggest that this technique, used in addition to HE staining and in combination with sudden-onset clinical findings, may increase the accuracy of diagnosis in AFE.
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    The analgesic efficacy of ultrasound-guided transversus abdominis plane block on postoperative pain and morphine consumption in varicocelectomy
    (Saudi Med J, 2016) Omur, Dilek; Oguzalp, Huseyin; Kiraz, Hasan A.; Ekin, Serpil; Alan, Cabir; Ersay, Ahmet R.; Hanci, Volkan
    Objectives: To evaluate the analgesic effect of transversus abdominis plane (TAP) block administered before varicocele surgery. Methods: This study was completed at the Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey, between January 2011 and April 2013. In a prospective, double blind, randomized, placebo controlled clinical study, 40 male patients scheduled for elective varicocele operations were randomized to group T (treatment group) or group C (controls). After receiving general anesthesia, group T received a TAP block using 20 mL 0.25% bupivacaine on the operation side, whereas group C received a control block using 20 mL 0.9% Sodium chloride. During the first 24 hours after surgery, the patient pain was evaluated using the visual analogue scale (VAS) at rest and while coughing. Postoperative patient controlled analgesia morphine consumption, VAS scores, and side effects were recorded. Results: Of 34 patients, Group T (n=18) had significantly lower VAS pain scores than Group C (n=16) both at rest and while coughing. The total morphine consumed was lower (7.7 +/- 4.0) versus 21.6 +/- 12.4 mg, p<0.001) in the 24 hours after surgery. Conclusion: As part of a multimodal analgesic regime after varicocelectomy surgery, morphine consumption and VAS pain scores were significantly lower among those receiving 20 mL 0.25% bupivacaine administered for a TAP block than among controls.
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    The effect of anaesthesia technique on maternal and cord blood ischaemia-modified albumin levels during caesarean section: A randomized controlled study
    (Sage Publications Ltd, 2013) Omur, Dilek; Hacivelioglu, Servet Ozden; Oguzalp, Huseyin; Uyan, Berna; Kiraz, Hasan Ali; Duman, Can; Tutunculer, Funda Kirtay
    Objective: Ischaemia-modified albumin (IMA) is an early marker for various ischaemic events, including cardiac ischaemia. This study determined variations in IMA levels during caesarean section, performed under general anaesthesia or with combined spinal epidural anaesthesia. Methods: Full-term, healthy pregnant women were allocated to undergo caesarean section, using either general anaesthesia or combined spinal epidural anaesthesia. IMA and albumin levels were measured in maternal serum samples taken immediately prior to caesarean section and 30min into the procedure, as well as from serum taken from cord blood after double clamping. Results: At total of 51 healthy pregnant women underwent either general anaesthesia (n=28) or combined spinal epidural anaesthesia (n=23). Within-group analysis of the general anaesthesia group showed that both IMA levels and IMA/albumin ratios were significantly higher at 30min of surgery compared with the immediate preoperative period. Conclusions: Lower IMA levels in the combined spinal epidural anaesthesia group may have been due to improved balancing of oxidative stress during caesarean section. Further research on IMA levels during caesarean section should take into account the method of anaesthesia used.