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Öğe A new technique to simplify the minimally invasive parathyroidectomy: Ultrasound-assisted guided wire localization for solitary parathyroid adenomas(Pakistan Medical Assoc, 2016) Ozkul, Faruk; Arik, Muhammed Kasim; Eroglu, Mustafa; Faydaci, Umut; Toman, Huseyin; Tas, Sukru; Ukinc, KubilayObjective: To investigate the benefits of ultrasound-assisted guided wire localization in MIP for selected cases. Methods: In this prospective, nonrandomised study, we included 36 patients with solitary parathyroid adenomas diagnosed preoperatively by 99m Tc sesta MIBI scintigraphy and/or neck ultrasonography. An ultrasound-guided wire was placed in the solitary parathyroid adenoma preoperatively. MIPs were performed under local anaesthesia plus sedation. After the excision, the parathyroidectomy was confirmed with postoperative ultrasonography. Results: There were 36 patients included in our study. The mean age was 54.89 +/- 11.28 years, and 30 patients were females (83.3%). Preoperative PTH and calcium (Ca) levels were 269.5 pg/mL (83.5-5,000 pg/mL) and 12.2 mg/dL (11.1-20 mg/dL), respectively. Postoperative serum PTH and Ca levels were 42.04 +/- 26.65 pg/mL and 8.95 +/- 0.74 mg/dL, respectively. The mean operation time was 21.69 +/- 6.4 minutes and the average hospitalisation time was 18 hours (range: 10-72 hours). Conclusions: Ultrasound-assisted guided wire localization may be useful in selected MIP cases. The MIP advantages include higher success rates and being easy to learn and practise.Öğe A practical approach in difficult intubation: use of gum elastic bougie on 10 cases(Yerkure Tanitim & Yayincilik Hizmetleri A S, 2016) Altinisik, Ugur; Erbas, Mesut; Kiraz, Hasan Ali; Simsek, Tuncer; Altinisik, Hatice Betul; Turk, Fatos Ipek; Toman, HuseyinObjective: When faced with unexpected difficult intubation, despite all the technological advances, there is still a need of equipments that are easy to use and very reachable. In this study, we offer our experiences in use of gum elastic bougie in 10 cases with unexpected difficult intubation in our operation rooms. Material and Methods: In Canakkale 18 March University Medical Faculty's Operating Rooms and between the years 2013-2014, all the encountered unexpected difficult intubation cases are classified and the patients who has Mallampati score I-II and having any airway pathology evaluated for the use of Gum elastic bougie (GEB). Auxiliary equipments used in intubation, number of intubation attempts, number of anesthesiologists who tried for intubation, the number of trials with GEB and the complications due to the use of GEB were recorded. Results: A total of 10 cases with unexpected difficult intubation were included in the study. All of the cases were male and intubation was attempted with size 4 blades. Stylet in 6 cases, fast trach laryngeal mask in 1 case were used after unsuccessful intubation attempts. However the use of this equipments patients couldn't be intubated and after at least 3 three attempts GEB used this time for intubation. An experienced anesthesiologist with the help of GEB intubated all the patients at once. There were no complications related to the use of GEB. Conclusion: GEB is widely used in European countries for unexpected difficult intubation. In our patients, despite the absence of any complications, due to the blind insertion of bougie trauma cases have been reported. GEB when performed by an experienced anesthesiologist is a good alternative airway equipment in unexpected difficult airway management, because it's inexpensive, easy to use and portable.Öğe Agenesis of Isthmus of the Thyroid Gland in a Patient with Graves-Basedow Disease and a Solitary Nodule(Hindawi Ltd, 2013) Ozkan, Omer Faruk; Asik, Mehmet; Toman, Huseyin; Ozkul, Faruk; Cikman, Oztekin; Karaayvaz, MuammerThe thyroid is a vascular endocrine gland with two lateral lobes connected by a narrow, median isthmus. Although a wide range of congenital anomalies of the thyroid gland has been reported in the literature, agenesis of the thyroid isthmus is a very rare congenital anomaly Thyroid isthmus agenesis does not manifest clinical symptoms, and it can be confused with other thyroid pathologies. We describe a patient with no isthmus of the thyroid, associated with Graves-Basedow disease. Thyroid isthmus agenesis should be kept in mind in order for surgical procedures involving thyroid pathologies to be carried out safely.Öğe Anesthetic management for super-super morbidly obese patient(Anaesthesia Pain & Intensive Care, 2014) Erbas, Mesut; Toman, Huseyin; Kiraz, Hasan Ali; Simsek, Tuncer; Arik, M. Kasim; Uyan, Berna; Sahin, HasanObesity leads to several changes in both airway and drug metabolism. The problems are compounded in cases of super super morbid obesity. Gastric banding surgery for weight loss was planned for a 47 year old, super-super morbidly obese female patient (164 kg and 151 cm, BMI: 72 kg/m(2)). On pre-operative examination, patient had a short thick neck and grade 4 Mallampatti class. Induction of anesthesia was done in the sitting / semi-sitting position Maintenance was provided with 6% desflurane and O-2/air mixture. Remifentanil infusion of 0.05 mu g/kg was administered during surgery. Patient had an uneventful recovery. The use of short acting drugs and appropriate monitoring provided hemodynamic stability and a fast and smooth recoveryÖğe Blood gas analyzer utility in evaluating oxygen kinetics of the aqueous humor(Consel Brasil Oftalmologia, 2015) Ersan, Ismail; Arikan, Sedat; Toman, Huseyin; Kara, Selcuk; Gencer, Baran; Erbas, Mesut; Tufan, Hasan AliPurpose: To measure the partial pressure of oxygen (PO2) and carbon dioxide (PCO2) and the pH of aqueous humor (AH) and arterial blood samples from rabbits using a blood gas analyzer. Methods: Twenty New Zealand rabbits were anesthetized intramuscularly with ketamine and xylazine and were then allowed to breathe room air. Using a gas blood analyzer, arterial blood and AH samples were analyzed for PO2, PCO2, and pH. Results: The mean arterial blood pressure was 87.14 +/- 15.0 mmHg. The mean blood and AH PO2 were 95.18 +/- 11.76 mmHg and 88.83 +/- 9.92 mmHg, the mean blood and AH PCO2 were 25.86 +/- 5.46 mmHg and 29.50 +/- 5.36 mmHg, and the mean blood and AH pH were 7.38 +/- 0.06 and 7.33 +/- 0.09, respectively. Conclusions: The blood gas analyzer was easily employed to evaluate the aqueous humor in rabbits. When comparing the results of studies evaluating aqueous PO2, care should be taken to determine the methods used in these studies.Öğe Co-occurrence of Papillary and Follicular Thyroid Carcinoma in a Patient with Hodgkin's Disease(Galenos Yayincilik, 2013) Asik, Mehmet; Ozkul, Faruk; Toman, Huseyin; Durmus, Ahmet; Anaforoglu, Inan; Gunes, Fahri; Akbal, Erdem[Anstract Not Available]Öğe Comparison of effects of sugammadex and neostigmine on QTc prolongation in rabbits under general anesthesia(Acta Cirurgica Brasileira, 2014) Erbas, Mesut; Toman, Huseyin; Sahin, Hasan; Kiraz, Hasan Ali; Barutcu, Ahmet; Simsek, Tuncer; Yener, Ali UmitPURPOSE: To compare the effects of sugammadex and neostigmine, used to antagonize the effects of rocuronium, on the QT(c) interval. METHODS: This study used 10 adult New Zealand white rabbits of 2.5-3.5 kg randomly divided into two groups: sugammadex group (Group S, n: 5) and neostigmine group (Group N, n: 5). For general anesthesia administering 2 mg/kg iv propofol and 1 mcg/kg iv fentanyl, 0.6 mg/kg iv rocuronium was given. Later to provide reliable airway for all experimental animals V-Gel Rabbit was inserted. The rabbits were manually ventilated by the same anesthetist. After the V-Gel Rabbit was inserted at 2, 5, 10, 20, 25, 27, 30 and 40 minutes measurements were repeated and recorded. At 25 minutes after induction Group N rabbits were given 0.05 mg/kg iv neostigmine + 0.01 mg/kg iv atropine. Group S were administered 2 mg/kg iv sugammadex. RESULTS: Comparing the QT(c) interval in the rabbits in Group S and Group N, in the 25th, 27th and 30th minute after muscle relaxant antagonist was administered the QT(c) interval in the neostigmine group rabbits was significantly increased (p < 0.05). CONCLUSION: While sugammadex, administered to antagonize the effect of rocuronium, did not significantly affect the QTc interval, neostigmine+atropine proloned the QT(c) interval.Öğe Comparison of the effectivity of oral and intra-articular administration of tenoxicam in patients with knee osteoarthritis(Elsevier Science Inc, 2015) Erbas, Mesut; Simsek, Tuncer; Kiraz, Hasan Ali; Sahin, Hasan; Toman, HuseyinBackground and objectives: Tenoxicam is widely used in osteoarthritis treatment and we aimed to compare the effectivity of oral and intra-articular administration of tenoxicam in osteoarthritis treatment. Methods: This study was performed between 2011 and 2012 by retrospectively analyzing and comparing the findings of 60 patients who were clinically and radiologically diagnosed with knee degenerative osteoarthritis in Bunyan state hospital pain policlinic. 60 patients included in the study were divided into two groups. The first group (tenoxicam IA, n=30) included patient findings of those subjected to intra-articular injection of 20 mg tenoxicam to the knee once a week for three weeks and the second group (oral tenoxicam, n=30) included patients who were administered 20 mg oral tenoxicam once a day for three weeks. All patients were clinically evaluated pre-treatment and in the 1st week, 1st month and 3rd month post-treatment according to specified criteria. Results and conclusions: Twenty two of 60 patients included in the study were male and 38 were female. In both groups significant improvements were detected in all of the observed parameters: visual analog scale, Western Ontario McMaster Osteoarthritis Index (pain, physical activity, knee stiffness) and Lequesne index scores and in the evaluations performed in 1st week, 1st month and 3rd month with respect to pre-treatment values. Besides, a better compliance to treatment and gastrointestinal system tolerability in tenoxicam IA group was also observed. Intra-articular tenoxicam administration could be thought as an alternative treatment method in patients with knee osteoarthritis who cannot use oral tenoxicam especially due to systemic gastrointestinal system side effects and those who have difficulties in adapting to treatment. (c) 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.Öğe Comparison of the effects of various airway devices on hemodynamic response and QTc interval in rabbits under general anesthesia(Springer Heidelberg, 2015) Toman, Huseyin; Erbas, Mesut; Sahin, Hasan; Kiraz, Hasan Ali; Uzun, Metehan; Ovali, Mehmet AkifIn this study, we aimed to compare the effects of various airway devices on QTc interval in rabbits under general anesthesia. The subjects were randomly separated into four groups: Group ETT, Group LMA, Group PLA, Group V-gel. Baseline values and hearth rate, mean arterial pressure and ECG was obtained at the 1st, 5th and 30th minutes after administration of anesthesia and placement of airway device and, QTc interval was evaluated. Difference was observed between ET group and V-gel group in the 5th minute mean arterial pressure values (p < 0.05). It was observed that QTc intervals at the 1st and 5th minute in the ET group significantly increased when compared with the other groups (p < 0.05). Again, it was observed that QTc interval of ET group at the 15th and 30th minute was longer when compared with PLA and V-gel groups (p < 0.05). It was also observed that QTc interval of LMA Group at the 5th minute after intubation significantly increased when compared with V-gel group (p < 0.05). It was observed that HR values of ETT group at the 1st, 5th and 15th minutes after intubation increased with regards to PLA and V-gel groups (p < 0.05). It was determined that the 30th minute hearth rate of ETT group was higher when compared to V-gel group (p < 0.05). Conclusion: In our study we observed that V-gel Rabbit affected both hemodynamic response and QT interval less than other airway devices.Öğe Effects of Prophylactic Ozone Therapy on General Anesthesia and Surgical Stress Response: Neutrophil/Lymphocyte Ratio and Ischemia-Modified Albumin(Int College Of Surgeons, 2019) Toman, Huseyin; Sahin, Hasan; Erbas, Mesut; Turkon, Hakan; Simsek, Tuncer; Kiraz, Hasan Ali; Ozkan, Muhammed Turgut AlperGeneral anesthesia and surgical stress cause an acute endocrine, metabolic, and immunologic inflammatory response in organisms and an increase in neutrophil lymphocyte ratio (NLR) and ischemia-modified albumin (IMA) levels. Ozone, other than inhalation administration, reduces the release of antioxidants and some proinflammatory cytokines and has been shown to have an anti-inflammatory effect. Our aim is to research how the NLR and IMA response is affected in rabbits undergoing surgical intervention with general anesthesia given prophylactic with ozone therapy. We divided 12 New Zealand rabbits into 2 groups: group O was given 70 lg/mL 10 mL ozone by the rectal route in 6 sessions on alternate days, and group C was given air by the rectal route. The rabbits underwent surgical intervention under general anesthesia. Blood samples were taken at basal, preoperation, 30 minutes postanesthesia, and 24 hours postoperation and were examined for hemogram and IMA. At 24 hours postoperation, an increase in NLR was observed in both groups, more clearly in group C (P < 0.05). In both groups, comparisons within the groups showed a significant increase in NLR only at 24 hours postoperation compared to other times (P < 0.05).When IMA values were compared, differences between the groups were observed between preoperative values and those at the 30 minutes postanesthesia and 24 hours postoperation (P < 0.05). When general anesthesia and surgical stress response were evaluated using inflammatory parameters of both NLR and IMA, there was significantly less of an increase in levels in rabbits given ozone compared to the control group.Öğe Effects of sugammadex on the prevention of postoperative peritoneal adhesions(Wiley, 2015) Sahin, Hasan; Toman, Huseyin; Kiraz, Hasan Ali; Simsek, Tuncer; Erbas, Mesut; Ozkul, Faruk; Arik, Muhammet KasimMany materials and techniques have been used to prevent and repair intra-abdominal adhesions, but an effective solution has not been found. The aim of this study is to research the effect of sugammadex on intra-abdominal adhesions in an experimentally induced intraabdominal adhesion model. Twenty-four female Wistar albino rats were included in the study. The experimental animals were randomly divided into three groups: the sugammadex group (Group SX, n=8), the control group (Group C, n=8), and the shamgroup (Group S, n=8). After starvation for 1 night, the rats were injected with a 50 mg/kg intramuscular dose of ketamine and a 5 mg/kg intramuscular dose of xylazine for anesthesia. The rats in the SX group were given 3 mL sugammadex into the peritoneal cavity, while rats in the control group were given 3 mL 0.9% sodium chloride. In the sham group, the peritoneal cavity was opened, but no chemicals were administered. All rats were sacrificed on the 10th postoperative day. The adhesions were staged as 0, 1, 2, and 3 according to Evans et al.'s model. Our evaluation of macroscopic adhesion intensity found statistically significant differences between the groups. The sugammadex group was observed to have fewer adhesions in a statistically significant manner compared with the control group (p < 0.05). In our experimental intra-abdominal adhesion model in rats, we observed that sugammadex prevented postoperative intra-abdominal adhesions. Copyright (C) 2015, Kaohsiung Medical University. Published by Elsevier Taiwan LLC. All rights reserved.Öğe Evaluation of Precipitation Characteristics of Commonly Used Non-Steroidal Anti-Inflammatory Analgesic Drugs(Colegio Farmaceuticos Provincia De Buenos Aires, 2015) Kiraz, Hasan Ali; Omur, Dilek; Ekin, Serpil; Toman, Huseyin; Uyan, Berna; Yurtlu, Bulent Serhan; Hanci, VolkanPostoperative pain is a major problem in clinical practice. Non-steroidal anti-inflammatory drugs have traditionally been used to relieve postoperative pain. Administration of intravenous products together can result incompatibility problems and this is clinically hazardous. Reference texts, published reports can provide information about drugs' incompatibility characteristics but there have been limited data for new drugs such as lornoxicam, tenoxicam and dexketoprofen, commonly used non-steroidal anti-inflammatory drugs. In this study, it was aimed to investigate whether there is precipitation between lornoxicam, tenoxicam and dexketoprofen with other commonly used drugs in anesthesiology practice.Öğe Evaluation of the Approaches of the Anaesthesiologists on Maintenance of Anaesthesia Machines(Aves, 2016) Altinisik, Ugur; Altinisik, Hatice Betul; Simsek, Tuncer; Kiraz, Hasan Ali; Dogu, Tugba; Toman, Huseyin; Sahin, HasanObjective: In this study, we aimed to discuss the level of knowledge and approach on 'maintenance, calibration and cleaning of anaesthesia devices' among anaesthesiologists in Turkey. Methods: A questionnaire was prepared with 21 questions based on the Google document system, and these questionnaires were sent to the anaesthesiologists via e-mail. Results: Overall, 226 anaesthesiologists answered our survey. With respect to the maintenance and calibration, anaesthesiologists had sufficient information about the vaporizer and the carbon dioxide canister devices; however, information about the vital components, such as disassembly of the anaesthesia machine, flow sensor, oxygen sensor, battery and exhaust system, was insufficient. The cleaning and sterilization procedures were performed when the devices became dirty, and the bacteria filter was used only for the protection of the anaesthesia system. There was a lack of knowledge about how and which part of the anaesthesia device should be disinfected. In total, 85% of the survey participants were thinking of the need of additional education on anaesthesia machine maintenance. Conclusion: It is observed that education about anaesthesia device maintenance, calibration and cleaning issues is obviously necessary for the anaesthesiology specialists in our country. We believe that it would be useful to highlight this issue to anaesthesia educational institutions and anaesthesia associations.Öğe Experimental Esophagitis Model Preventing Tracheal Aspiration(Wroclaw Medical Univ, 2015) Kiraz, Hasan A.; Erbas, Mesut; Kucuk, Adem; Topaloglu, Naci; Erdem, Havva; Sahin, Hasan; Toman, HuseyinBackground. Corrosive esophagitis injuries are a serious clinical problem with many agents used for diagnosis and treatment. Experimental esophagus burn models use a method described mainly in studies by Gehanno and Guedon, and modified by Liu and Richardson. Objectives. The aim of this study was to describe a new esophagitis model that prevents tracheal aspiration. Material and Methods. In this study we used 16 Wistar albino rats weighing between 220-240 g. The experimental animals were randomly divided into two groups: the model group (group M, n: 8) and control group (group C, n: 8). The necessary anesthesia was administered. Passing through a median laparotomy incision, the abdomen was entered and in group M and C the esophagus was freed and held by a suture at the gastroesophageal junction. After this procedure, about 1 cm proximal to the gastroesophageal junction, the esophagus was suspended by a suture. The esophagus segment between the two sutures was exposed to 0.1 mL 10% NaOH in group M and 0.1 mL saline in group C for 20 s. Ten days later all experimental animals were sacrificed and their esophagus removed. After dying with hematoxylin and eosine trichrome, the histopathological evaluation results for the rats in all groups were investigated with a light microscope. Results. Histopathological examination indicated submucosal collagen increase, damage to muscularis mucosa and tunica muscularis and collagen deposition. In the model group, the rats had high neutrophils and tissue damage accompanied by necrosis. In the control group, the rats had minimal or no tissue damage and fibrosis was not observed. Conclusions. Our procedure is relatively less invasive and easy to apply with corrosive esophagitis only in the required region, and at the same time treatment medications can be easily administered.Öğe Is hyperbaric oxygen or ozone effective in experimental endocarditis?(Academic Press Inc Elsevier Science, 2016) Ozkan, Muhammed Turgut Alper; Vural, Ahmet; Cicek, Omer Faruk; Yener, Ali Umit; Ozcan, Sedat; Toman, Huseyin; Unver, AhmetBackground: Infective endocarditis, a disease with high mortality and morbidity, is most commonly caused by Staphylococcus aureus; mortality and morbidity further increase in the presence of methicillin-resistant strains of S. aureus. Linezolid is the first of the oxazolidinones, a new antibiotic group that has been approved for the treatment of infections caused by gram-positive cocci. Linezolid reduces the quantity of microorganisms in vegetation to some extent; in addition, the use of hyperbaric oxygen (HBO) and ozone (O-3) therapies is likely to improve targeted antibacterial effect. Materials and methods: Fifty-six adult male Wistar rats weighing 300-350 g were used. The subjects were divided into groups as follows: Group 1 (n = 8): control group that was not inoculated with microorganisms and was untreated; Group 2 (n = 8): control group that was inoculated with microorganisms but was untreated; Group 3 (n = 8): linezolid treatment group; Group 4 (n = 8): O-3 therapy group; Group 5 (n = 8): HBO therapy group; Group 6 (n = 8): linezolid + O-3 therapy group; Group 7 (n = 8): linezolid + HBO therapy group. Results: In terms of reducing the number of colonies in the aortic valve, linezolid + HBO therapy was found to be the most effective treatment. Then, respectively linezolid + O-3, linezolid, HBO, and O-3 were found to be effective. Conclusions: We found that linezolid significantly reduced the number of bacteria in the vegetation in the experimental endocarditis model, and HBO therapy increases the effectiveness of linezolid and makes this better than O-3. (C) 2016 Elsevier Inc. All rights reserved.Öğe Major Ozonated Autohemotherapy Preconditioning Ameliorates Kidney Ischemia-Reperfusion Injury(Springer/Plenum Publishers, 2016) Sancak, Eyup Burak; Turkon, Hakan; Cukur, Selma; Erimsah, Sevilay; Akbas, Alpaslan; Gulpinar, Murat Tolga; Toman, HuseyinMedical ozone has therapeutic properties as an antimicrobial, anti-inflammatory, modulator of antioxidant defense system. Major ozonated autohemotherapy (MOA) is a new therapeutic approach that is widely used in the treatment of many diseases. The objective of the present study was to determine whether preischemic application of MOA would attenuate renal ischemia-reperfusion injury (IRI) in rabbits. Twenty-four male New Zealand white rabbits were divided into four groups, each including six animals: (1) Sham-operated group, (2) Ozone group (the MOA group without IRI), (3) IR group (60 min ischemia followed by 24 h reperfusion), and (4) IR + MOA group (MOA group). The effects of MOA were examined by use of hematologic and biochemical parameters consisting of neutrophil to lymphocyte ratio (NLR), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), ischemia-modified albumin (IMA), total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI). In addition, the histopathological changes including the tubular brush border loss (TBBL), tubular cast (TC), tubular necrosis (TN), intertubular hemorrhage and congestion (IHC), dilatation of bowman space (DBS), and interstitial inflammatory cells infiltration (IECI) were evaluated. In the IR group, compared to the Sham group, biochemical parameters indicating oxidative stress, NLR, IL-6, TNF-alpha, IMA, TOS, and OSI have increased. MOA reduced inflammation and oxidative stress parameters. Although TAS values have decreased in the IR group and increased in the MOA-pretreated group, no significant changes in TAS values were detected between the IR and MOA groups. The total score was obtained by summing all the scores from morphological kidney damage markers. The total score has increased with IR damage when compared with the Sham group (13.83 +/- 4.30 vs 1.51 +/- 1.71; p = 0.002). But, the total score has decreased significantly after application of MOA (5.01 +/- 1.49; p = 0.002; compared with the IR group). MOA preconditioning is effective in reducing tissue damage induced in kidney ischemia-reperfusion injury. The protective effect of MOA is mediated via reducing inflammatory response and regulating of reactive oxygen species (ROS). Renal histology also showed convincing evidence regarding MOA's protective nature against kidney injury induced renal ischemia-reperfusion. Consequently, MOA might be helpful in protecting the kidneys from IR-induced damage in humans, probably through the anti-inflammatory effect and reducing the total oxidant status.Öğe PERCUTANEOUS TREATMENT OF LUMBAR SYNOVIAL CYST: A CASE REPORT(Carbone Editore, 2014) Erbas, Mesut; Ozdemir, Ugur; Toman, Huseyin; Sahin, Hasan; Savluk, Omer Faruk; Luleci, NurettinIntroduction and aims: Synovial cysts are benign cystic lesions that form when the joint capsule is worn during joint movement and synovial fluid leaks out. Intraspinal synovial cysts in the lumbar region are generally diagnosed when investigating patients who complaints of back pain or other symptoms which could be attributed to radiculopathy. The aim of this paper is to present the use of the percutaneous needle aspiration method with tomography guidance to treat an L4-L5 synovial cyst causing radicular symptoms. Case report: A 40-year old female, with a 5-year complaint of back pain, applied to our clinic with recent increase in existing complaints and the addition of left leg pain. Lumbar computed tomography and magnetic resonance imaging examinations showed at L4 vertebra corpus level in the spinal canal right posterolateral recess, neighboring the right L5 nerve root, a 9x7x4 mm T2 hyperintense, T1 hypointense nodular appearance. A percutaneous cyst aspiration was planned and after aseptic conditions were ensured, a 22 G spinal needle was used to aspire the fluid in the synovial cyst between L4-L5 guided by tomography images and 80 mg methyl prednisone with 6 ml 0.25% bupivacaine were injected into cyst and the procedure was completed. Discussion and conclusion: In symptomatic lumbar synovial cyst cases percutaneous cyst aspiration, steroid injection or surgical resection may be chosen. However as percutaneous cyst aspiration has a lower rate of complications such as infection, bleeding, nerve damage and dural puncture compared to surgical treatment, it should be first choice.Öğe Percutaneous treatment of lumbar synovial cyst: A case report(Acta Medica Mediterranea, 2014) Erbas, Mesut; Ozdemir, Ugur; Toman, Huseyin; Sahin, Hasan; Savluk, Omer Faruk; Luleci, NurettinIntroduction and aims: Synovial cysts are benign cystic lesions that form when the joint capsule is worn during joint movement and synovial fluid leaks out. Intraspinal synovial cysts in the lumbar region are generally diagnosed when investigating patients who complaints of back pain or other symptoms which could be attributed to radiculopathy. The aim of this paper is to present the use of the percutaneous needle aspiration method with tomography guidance to treat an L4-L5 synovial cyst causing radicular symptoms. Case report: A 40-year old female, with a 5-year complaint of back pain, applied to our clinic with recent increase in existing complaints and the addition of left leg pain. Lumbar computed tomography and magnetic resonance imaging examinations showed at L4 vertebra corpus level in the spinal canal right posterolateral recess, neighboring the right L5 nerve root, a 9x7x4 mm T2 hyperintense, T1 hypointense nodular appearance. A percutaneous cyst aspiration was planned and after aseptic conditions were ensured, a 22 G spinal needle was used to aspire the fluid in the synovial cyst between L4-L5 guided by tomography images and 80 mg methyl prednisone with 6 ml 0.25% bupivacaine were injected into cyst and the procedure was completed. Discussion and conclusion: In symptomatic lumbar synovial cyst cases percutaneous cyst aspiration, steroid injection or surgical resection may be chosen. However as percutaneous cyst aspiration has a lower rate of complications such as infection, bleeding, nerve damage and dural puncture compared to surgical treatment, it should be first choice.Öğe Sedation for transesophageal echocardiography: Comparison of propofol, midazolam and midazolam-alfentanil combination(Medical Association of Zenica-Doboj Canton, 2016) Toman, Huseyin; Erkılınc, Atakan; Kocak, Tuncer; Guzelmeric, Fusun; Savluk, Omer Faruk; Dogukan, Mevlut; Acar, GokselAim The administration of trans esophageal echocardiography (TEE) may cause nausea, shortness of breath, agitation, emotional distress and pain in patients due to pharyngo-esophageal intubation, which may be partially relieved by sedoanalgesia. The aim of this study was to compare clinical effects of midazolam, midazolam-alfentanil combination and propofol sedation given for sedation and sedoanalgesia to patients with planned diagnostic TEE interventions. Methods This study was prospectively completed with 90 randomized adult patients in ASA risk groups I-II-III. Group M were given 2.5 mg midazolam, group MA were given 1 mg midazolam and 5 ?g/kg alfentanil and group P were given 0.5 mg/kg propofol intravenous bolus. If necessary, additional doses were administered. Patients administered with TEE were evaluated in terms of additional dose requirements, Ramsey Sedation Scale (RSS), modified Aldrete Scoring (MAS), recovery time and duration of stay in the hospital. Results In the group P additional dose requirements were greater (p<0.05), as well as the duration of stay in the recovery unit and hospital were shorter (p<0.05). On insertion of the TEE probe, the RSS in the group P was clearly higher than in other groups M and MA (p<0.05). Conclusion During the TEE intervention, the use of propofol, contrary to requirements for additional dose and observation of apnea, appears to be advantageous due to providing more rapid and effective sedation depth without a need of expensive antagonist agents, and allowing early discharge of patients. Additionally, it seems that the use of midazolam combined with alfentanil, is more advantageous comparing to midazolam alone. © 2016, Medical Association of Zenica-Doboj Canton. All rights reserved.Öğe Severe headache following ozone therapy: Pneumocephalus(Kare Publ, 2017) Toman, Huseyin; Ozdemir, Ugur; Kiraz, Hasan Ali; Luleci, NurettinPneumocephalus is defined as air in the cranial cavity. Pneumocephalus can result from inadvertent dural puncture during lumbar epidural anesthesia or epidural steroid injection. Presently described is case of 41-year-old woman who had undergone lumbar disc hernia operation but due to ongoing complaints, was diagnosed as having failed back surgery syndrome. Percutaneous epidural neuroplasty was performed. In the operating room, under sterile conditions and under sedoanalgesia, Racz catheter was inserted in caudal area and guided to epidural area with scope. In accordance with Madrid Declaration, 20 ug/mL concentration and 5 mL volume oxygen-ozone mixture was injected. After waiting 5 minutes, 0.25% bupivacaine + 80 mg triamcinolone + 1500 units hyaluronidase was administered through the catheter. After epidural neuroplasty procedure, when patient was taken to gurney, she complained of severe headache and nausea. Computed tomography scans of head were done immediately, and consistent with pneumocephalus, air was observed in right lateral ventricle frontal horn, interhemispheric fissure, and superior cerebellar cistern. Patient was placed in Trendelenburg position and intravenous fluid was replaced. Analgesics and bed rest were recommended as treatment. Patient was discharged from hospital on the second day. Within a week, headache pain and other complaints had resolved. In this article, the case of a failed back surgery patient who was postoperatively treated with medical ozone and experienced complication of pneumocephalus is discussed in context of literature data.
