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    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, Kerim
    Background: 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.
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    Adjunctive Hyperbaric Oxygen Therapy or Alone Antibiotherapy? Methicillin Resistant Staphylococcus aureus Mediastinitis in a Rat Model
    (Soc Brasil Cirurgia Cardiovasc, 2015) Kurt, Tolga; Vural, Ahmet; Temiz, Ahmet; Ozbudak, Ersan; Yener, Ali Umit; Sacar, Suzan; Sacar, Mustafa
    Objective: In the post-sternotomy mediastinitis patients, Staphylococcus aureus is the pathogenic microorganism encountered most often. In our study, we aimed to determine the efficacy of antibiotic treatment with vancomycin and tigecycline, alone or in combination with hyperbaric oxygen treatment, on bacterial elimination in experimental S. aureus mediastinitis. Methods: Forty-nine adult female Wistar rats were used. They were randomly divided into seven groups, as follows: non-contaminated, contaminated control, vancomycin, tigecycline, hyperbaric oxygen, hyperbaric oxygen + vancomycin and hyperbaric oxygen + tigecycline. The vancomycin rat group received 10 mg/kg/day of vancomycin twice a day through intramuscular injection. The tigecycline group rats received 7 mg/kg/day of tigecycline twice a day through intraperitoneal injection. The hyperbaric oxygen group underwent 90 min sessions of 100% oxygen at 2.5 atm pressure. Treatment continued for 7 days. Twelve hours after the end of treatment, tissue samples were obtained from the upper part of the sternum for bacterial count assessment. Results: When the quantitative bacterial counts of the untreated contaminated group were compared with those of the treated groups, a significant decrease was observed. However, comparing the antibiotic groups with the same antibiotic combined with hyperbaric oxygen, there was a significant reduction in microorganisms identified (P<0.05). Comparing hyperbaric oxygen used alone with the vancomycin and tigecycline groups, it was seen that the effect was not significant (P<0.05). Conclusion: We believe that the combination of hyperbaric oxygen with antibiotics had a significant effect on mediastinitis resulting from methicillin-resistant Staphylococcus aureus. Methicillin-resistant Staphylococcus aureus mediastinitis can be treated without requiring a multidrug combination, thereby reducing the medication dose and concomitantly decreasing the side effects.
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    An effective treatment for prevention and impediment of atrial fibrillation after cardiac surgery
    (Pulsus Group Inc., 2014) Yener, Ali Umit; Ozkan, Turgut; Cicek, Mustafa Cuneyt; Cicek, Tugba; Baysal, Erkan; Genc, Bahadir; Dogan, Emre
    Atrial fibrillation is a common rhythm disorders after open heart surgery and associated with increased morbidity and mortality. Advanced age, hypertension, COPD are known to be the causes of postoperative atrial fibrillation. However, reactive oxygen radicals formed after open heart surgery have been shown to be involved in the etiology of AF. Besides its expectorant feature, NAC is a molecule known to be an antioxidant. In this retrospective study, we compared the incidence of postoperative AF and onset time of AF in patients who used preoperatively NAC because of COPD and who did not use NAC. In this study, the incidence of atrial fibrillation was significantly lower in patients using NAC preoperatively. Also onset time of AF was significantly longer in patients who used NAC.
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    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, Kerim
    Venous 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.
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    Are patients, who were previously diagnosed with coronary artery disease by coronary angiography, on optimal medical treatment?
    (Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2015) Temiz, Ahmet; Yener, Ali Umit; Barutcu, Ahmet; Gazi, Emine; Altun, Burak; Bekler, Adem; Vural, Ahmet
    Background: This study aims to detect the drug usage rate of patients who had coronary artery disease (CAD) diagnosis by coronary angiogram (CAG). Methods: Reports of 1,549 patients (993 males, 556 females; mean age 62.9 +/- 10.9 years; range 20 to 87 years) (184 normal CAG, 1,365 CAD) who were performed CAG between October 2009 and February 2012 were retrospectively analyzed. Medication data were collected between August 2013 and November 2013 from patients' pharmacy refill data. Usage of aspirin, tienopiridine, statin, angiotensin converting enzyme inhibitor, beta blocker (BB), warfarin, angiotensinogen receptor blocker, nitrate, trimetazidine, calcium channel blocker, and diuretic were recorded. Results: Usage rates of angiotensinogen receptor blocker, trimetazidine, calcium channel blocker, warfarin, diuretic, and fibrate were not statistically different between patients with CAD and normal CAG. Rates of using aspirin (50.3% vs. 39.1%, p=0.005), tienopiridine (25.6% vs. 9.8%, p<0.001), angiotensin converting enzyme inhibitor (38.0% vs. 21.7%, p<0.001), statin (48.5% vs. 30.6%, p<0.001), BB (56.8% vs. 40.2%, p<0.001) and nitrate (15.1% vs. 6.0%, p<0.001) were higher in patients with CAD. Rate of patients using all four drugs, antiplatelet agent, statin, angiotensin converting enzyme inhibitor, and BB was only 13.1% in CAD group. Only 25.8% of patients with CAD used all three of antiplatelet agent, statin, and BB. Conclusion: Patients with CAD are not on optimal medical treatment. These patients should be questioned in every visit in terms of the status of their treatment to administer the optimum medications to reduce cardiovascular mortality and morbidity.
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    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 Umit
    PURPOSE: 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.
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    Comparison of one- and two-stage basilic vein transposition for arterio-venous fistula formation in haemodialysis patients: preliminary results
    (Clinics Cardive Publ Pty Ltd, 2013) Ozcan, Sedat; Gur, Ali Kemal; Yener, Ali Umit; Odabasi, Dolunay
    Objective: This study aimed to compare the results of one-and two-stage basilic vein transposition (BVT) in haemodialysis patients. Methods: This was a non-randomised, retrospective study between January 2007 and January 2012 on 96 patients who were diagnosed with end-stage renal failure (ESRF) (54 males, 42 females; mean age 43.6 +/- 14 years) and underwent one- or two-stage BVT in our clinic. All patients who were not eligible for a native radio-cephalic or brachio-cephalic arterio-venous fistula (AVF) were scheduled for one-or two-stage BVT after arterial (brachial, radial and ulnar) and venous (basilic and cephalic) Doppler ultrasonography. Patients were retrospectively divided into two groups: group 1, basilic vein diameter > 3 mm and patients who underwent one-stage BVT; and group 2, basilic vein diameter < 3 mm and patients who underwent two-stage BVT. In group 1, the basilic vein with a single incision was anastomosed to the brachial artery, followed by superficialisation. In group 2, the basilic vein was anastomosed to the brachial artery and they underwent the superficialisation procedure one month postoperatively. Fistula maturation and postoperative complications were assessed. Results: The mean diameter of the basilic vein was statistically significantly higher in group 1 (3.46 +/- 0.2 mm) than in group 2 (2.79 +/- 0.1 mm) (p < 0.05). In terms of postoperative complications, thrombosis, haemorrhage and haematoma were significantly higher in group 1 (34, 36 and 17%, respectively) than in group 2 (23, 14 and 6%, respectively) (p < 0.05). The rate of fistula maturation was significantly lower in group 1 (66%), compared to group 2 (77%) (p < 0.05). Time to fistula maturation was significantly shorter in group 1 (mean 41 +/- 14 days), compared to group 2 (mean 64 +/- 28 days) (p < 0.05). Conclusion: Two-stage BVT was superior to one-stage BVT due to its lower rate of postoperative complications and higher fistula maturation, despite its disadvantage of late fistula use. Although the diameter of the basilic vein was larger in patients who underwent one-stage BVT, we observed that one-stage BVT was disadvantageous in terms of postoperative complications and fistula maturation.
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    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, Bahadir
    Aim: 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.
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    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, Bahadir
    Aim: 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.
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    Effect of acetyl salicylic acid resistance on saphenous vein graft occlusion in patients with metabolic syndrome who had coronary bypass surgery
    (Pulsus Group Inc., 2014) Baysal, Erkan; Yener, Ali Umit; Ozkan, Turgut; Karan, Adnan; Astan, Ramazan; Keskin, Gokhan; Yener, Ozlem
    PURPOSE: The goal of this study was to investigate the effect of acetyl salicylic acid (ASA) resistance on saphenous vein graft occlusion in saphenous vein graft used patients with metabolic syndrome who had CABG. ASA resistance may be higher in patients with metabolic syndrome and saphenous vein graft occlusion and this may result in adverse coronary events. MATERIAL-METHOD: 41 patients with metabolic syndrome who had previously CABG operation for whom saphenous vein graft was used and who currently used 100-300 mg/day ASA, who had postoperative angina pectoris, whose ischemia was determined by noninvasive tests and to whom coronary angiography were performed, were included in our study. The patients were divided into two groups as patients with saphenous vein graft occlusion (n:18) and the patients without saphenous vein graft occlusion (n:23). FINDINGS: In both groups with similar demographic characteristics while ASA resistance was determined in 10 patients with saphenous vein graft occlusion, 7 patients without saphenous vein graft occlusion had ASA resistance. This statistics showed us that in the patients with metabolic syndrome and who had ASA resistance, saphenous vein graft occlusion developed more. CONCLUSION: Although it is important to check ASA resistance in patients with metabolic syndrome, to whom CABG are intended, it is not checked routinely. In patients with metabolic syndrome who have ASA resistance, if CABG is planned high dose ASA treatment can be applied in early period, additional antithrombocyte treatment may be added or arterial graft may be used.
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    Ergotamine-induced vasospastic ischemia mimicking arterial embolism: unusual case
    (Turkish Assoc Trauma Emergency Surgery, 2014) Adam, Gurhan; Kurt, Tolga; Cinar, Celal; Sariyildirim, Abdullah; Resorlu, Mustafa; Uysal, Fatma; Yener, Ali Umit
    Ergotamine toxicity is an important and rare condition, including tachycardia, arterial spasm which occurring as a result of accidental overdosing or drug interactions. We assessed the consequences of delayed diagnosis of peripheral arterial vasoconstriction occurring after simultaneous macrolide use by a 35-year-old woman using an ergot-derived drug for migraine. Diagnosis of ergotamine intoxication begins with suspicion. Interventional radiologists and surgeons should be aware of this acute dangerous condition.
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    Increased Platelet Distribution Width Is Associated With Severity of Coronary Artery Disease in Patients With Acute Coronary Syndrome
    (Sage Publications Inc, 2015) Bekler, Adem; Ozkan, Muhammed Turgut Alper; Tenekecioglu, Erhan; Gazi, Emine; Yener, Ali Umit; Temiz, Ahmet; Altun, Burak
    Platelet activation plays a pivotal role in acute coronary syndrome (ACS). We investigated the relationship between platelet distribution width (PDW) and severity of coronary artery disease (CAD) in patients with ACS. A total of 502 patients with ACS were enrolled. High (n = 151) and low PDW (n = 351) groups were defined as patients having values in the third tertile (>17%) and lower 2 tertiles (17%). There were significantly higher Gensini score (44 [10-168] vs 36 [2-132], P < .001), and neutrophil-lymphocyte ratio (3.1 [0.8-12.4] vs 2.5 [0.3-13], P = .012) and baseline platelet counts were significantly lower (220 [61-623] vs 233 [79-644] 10(3)/mm(3), P = .022) in the high PDW group. The variables PDW >17%, diabetes mellitus, and myocardial infarction were found to be associated with high Gensini score (odds ratio [OR]: 1.91, 95% confidence interval [CI]: 1.27-2.88, P = .002; OR: 2.85, 95%CI: 1.91-4.25, P < .001; OR: 2.67, 95% CI:1.74-4.1, P < .001, respectively). An increased PDW (>17%) is associated with severity of CAD in patients with ACS.
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    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, Ahmet
    Background: 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.
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    Magnesium; the electrolyte that delays the formation of atrial fibrillation
    (Pulsus Group Inc., 2014) Yener, Ali Umit; Ozkan, Turgut; Cicek, Mustafa Cuneyt; Baysal, Erkan; Dogan, Emre; Cicek, Omer Faruk; Genc, Bahadir
    Atrial fibrillation is one of the most common undesirable situation seen after open-heart surgery because of increasing the length of hospital stay, morbidity and mortality. It is revealed that atrial fibrillation may occur as a result of various electrolyte deficiencies such as magnesium. In this retrospective study, we aimed to compare the rhythm outputs of different cardiopulmonary bypass protocols,magnesium included in study group and without magnesium used patients was inserted in control group. The incidence of atrial fibrillation between 2 groups was not statistically significant. Furthermore magnesium treatment delayed the onset of atrial fibrillation in patients after coronary bypass graft surgery.
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    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, Kerim
    Aim: 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.
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    Protective effect of gel form of gastric gavage applicated aloe vera on ischemia reperfusion injury in renal and lung tissue
    (C M B Assoc, 2017) Sahin, Hasan; Yener, Ali Umit; Karaboga, Ihsan; Sehitoglu, Muserref Hilal; Dogu, Tugba; Altinisik, Hatice Betul; Altinisik, Ugur
    The aloe vera plant has become increasingly popular in recent years. This study aimed to research the effect of aloe vera to prevent renal and lung tissue damage in an experimental ischemia-reperfusion (I/R) injury model. The study included 21 male Wistar Albino rats, which were categorized into control group, n = 7 (no procedures), Sham group n = 7 (I/R); and aloe vera therapy group, n = 7 (aloe vera and I/R). Superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and malondialdehyde (MDA) were evaluated from lung and kidney tissues for biochemical investigations. As histopathological, hematoxylin and eosin and anti-iNOS were also examined. In biochemical investigations, SOD, CAT, and GPx levels of the Sham group were found to be lower compared with the other groups (P < 0.05). The aloe vera therapy group was not statistically different from control groups but significantly different compared with the Sham group. In the same way, the MDA levels of kidney and lung tissues were statistically significant in the aloe vera therapy group, compared to the Sham group. In the Sham group, the peribronchial and perialveolar edema were observed in lung parenchyma. Also, excess interstitial hemorrhage, leukocyte infiltration, and alveolar wall thickening were identified in ischemic groups. The histopathological changes were much lighter than in the aloe vera therapy group. In renal tissues, excess epithelial cell deterioration, tubular desqumination, and glomerular atrophy were observed in the Sham group. The histopathological changes were markedly reduced in the aloe vera therapy group. In the kidney and lung tissue, the level of iNOS activity in the Sham group was significantly higher than in the control and aloe vera therapy group. This study indicated that aloe vera is protective against oxidative damage formed by I/R in distant organs like the lungs and kidneys.
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    Protective role of heparin in the injury of the liver and kidney on the experimental model of ischemia/reperfusion
    (BMC, 2014) Yener, Ali Umit; Cicek, Mustafa Cuneyt; Genc, Serhat Bahadir; Ozkan, Turgut; Dogan, Emre; Bilgin, Bulent Caglar; Akin, Tezcan
    Background: Surgery of thoracoabdominal aortic aneurysms (TAAA) is associated with high incidence of serious complications. Ischemia/reperfusion (I/R) injury may be responsible for these complications. We investigated the effect of degree of anticoagulation on remote organ I/R injuries and whether heparin is protective against I/R injury in addition to its anticoagulant properties. Methods: Spraque Dawley rats were used to determine both liver and kidney concentrations of HSP-70, IL-6, MPO in four groups: ischemic control (operation with cross-clamping and intraperitoneal administration of 0.9% saline, n = 7), sham (operation without cross-clamping, n = 7), heparin (ACT level about 200), and high dose heparin (ACT level up to 600). Histological analyses of the organs were performed. Results: Histopathological evaluation of kidney presented significant differences between groups with regards to the cytoplasmic vacuole formation, hemorrhage, tubular cell degeneration and tubular dilatation while heparinized group had best results. The kidney MPO and HSP-70 levels significantly decreased (p < 0.05), but IL-6 level was not significant (p > 0.05) in heparinized group when compared to ischemic control group. No statistically significant intergroup differences were detected in the tissue samples of liver. Immunohistochemical markers of the liver were compared and no statistically significant difference was found among the groups. Conclusion: Heparin is an important anticoagulation agent in TAAA surgical procedures but the use of higher levels of heparin in the present study revealed no beneficial effects. Bleeding complications is much less when heparin is used in the real-world clinical practice as ACT levels of 200.
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    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, Kerim
    An 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.
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    Relationship between fragmented QRS and paradoxical septal motion in coronary artery bypass graft patients
    (Springer, 2015) Barutcu, Ahmet; Ozdemir, Semra; Tan, Yusuf Ziya; Yener, Ali Umit; Ozcan, Sedat; Gazi, Emine
    Paradoxical septal motion (PSM) can cause confusion in the assessment of ventricular function with scintigraphy even in the absence of ventricular septal damage and ischemia. Fragmented QRS (fQRS) is associated with various cardiac disorders. In this study, we aimed to determine the correlation between paradoxical septal motion and fQRS after coronary artery bypass grafting (CABG). We retrospectively reviewed the hospital records showing scintigraphic images and electrocardiograms (ECG) of the patients who had undergone CABG. The patients were classified based on the evaluation of motion and thickening of the septal wall. The patients with regular thickening of the septal wall and abnormal motion were classified as PSM (+) group. The patients with normal motion and thickening of the septal wall were classified as PSM (-) group. fQRS complexes are defined as various RSR patterns either with or without Q-waves on a 12-lead resting ECG. PSM was found to be more common in fQRS patients (p < 0.001). PSM was seen in 91.4 % of cases with fQRS and in 79.8 % of cases without fQRS. No significant differences were found in the phase analysis parameters. A correlation was found between septal wall motion values and the presence of fQRS (r = 0.197, p = 0.012). fQRS was associated with PSM. fQRS may cause PSM in patients with CABG without left bundle branch block due to a conduction defect. PSM and fQRS are predictive of cardiac mortality. Patients diagnosed with PSM and fQRS, should be monitored closely.
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    The assessment of septal wall motion in patients undergoing CABG by myocardial perfusion-gated SPECT
    (Lippincott Williams & Wilkins, 2015) Ozdemir, Semra; Yener, Ali Umit; Barutcu, Ahmet; Tan, Yusuf Z.; Celik, Fatmanur
    PurposeIn this study, we aimed to assess the presence and prevalence of paradoxical septal motion (PSM) by myocardial perfusion-gated single-photon emission computed tomography (SPECT) imaging in patients undergoing coronary artery bypass grafting (CABG).MethodsA total of 172 patients (145 men and 27 women, with a mean age of 64.818.93 years) undergoing CABG surgery were included in the study. All selected scintigraphic studies of the patients undergoing CABG were reprocessed. Semiquantitative interpretation of septal perfusion, wall motion, and wall thickening was performed with QPS and QGS programs. Phase analysis parameters were also obtained using the Emory Cardiac Toolbox. According to myocardial perfusion-gated SPECT results, the patients were trichotomized as follows: group 1 (nonischemic PSM): regular perfusion and thickening of the septal wall and abnormal motion of the septal wall; group 2 (ischemic PSM): abnormal perfusion, motion, and thickening of the septal wall; group 3 (non-PSM): normal perfusion, motion, and thickening of the septal wall. The data in each of the three groups were compared using Student's t-test and one-way analysis of variance.ResultsNo PSM (normal perfusion, motion, and thickening of the septal wall) was observed in 19.2% of patients undergoing CABG, whereas nonischemic PSM (regular perfusion and thickening of the septal wall and abnormal motion of the septal wall) was observed in 60.5% of patients and ischemic PSM (abnormal perfusion, motion and thickening of the septal wall) was seen in 20.3% of patients.ConclusionAccording to our study results, PSM is fairly common in patients undergoing CABG. It will be beneficial to use myocardial perfusion scintigraphy-gated SPECT, which is a noninvasive examination method, to identify the presence of PSM and investigate whether it is accompanied by ischemia or infarction.