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Aslaner MA, Helvacı Ö, Haycock K, Kılıçaslan İ, Yaşar E, Cerit MN, Şendur HN, Güz G, Demircan A. Diagnostic accuracy of venous system ultrasound for subtypes of acute kidney injury. Emerg Med J 2024; 41:304-310. [PMID: 38355289 DOI: 10.1136/emermed-2023-213241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 02/03/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Management of acute kidney injury (AKI) in the ED can be difficult due to uncertainty regarding the aetiology. This study investigated the diagnostic value of venous system ultrasound for determining the aetiological subtypes of AKI in the ED. METHODS This multidisciplinary prospective cohort study was conducted in a single academic ED over the course of a year. Adult patients with AKI were evaluated using the venous excess ultrasound (VExUS) score, which is a four-step ultrasound protocol. The protocol begins with the inferior vena cava (IVC) measurement and examines organ flow patterns, including portal, hepatic and renal veins in the presence of dilated IVC. The AKI subtypes (hypovolaemia, cardiorenal, systemic vasodilatation and renal) were adjudicated by nephrologists and emergency physicians, considering data that became available during the hospitalisation. We determined the diagnostic test characteristics of VExUS for identifying each of the four AKI aetiological subtypes. RESULTS 150 patients with AKI were included in the study. Hypovolaemia was the most frequent finally adjudicated cause of AKI (66%), followed by cardiorenal (18%), systemic vasodilatation (8.7%) and renal (7.3%). In diagnosing the cardiorenal subtype, the area under the curve (AUC) for VExUS grade >0 was 0.819, with 77.8% sensitivity and 80.5% specificity, and the AUC for IVC maximum diameter >20.4 mm was 0.865, with 74.1% sensitivity and 86.2% specificity. For the hypovolaemia subtype, the AUC for VExUS grade ≤0 was 0.711, with 83.8% sensitivity and 56.9% specificity, and the AUC for IVC maximum diameter ≤16.8 mm was 0.736, with 73.7% sensitivity and 68.6% specificity. None of the parameters achieved adequate test characteristics for renal and systemic vasodilatation subtypes. CONCLUSION The VExUS score has good diagnostic accuracy for cardiorenal AKI and fair accuracy for hypovolaemic AKI but cannot identify renal and systemic vasodilatation subtypes. It should not therefore be used in isolation to determine the cause of AKI in the ED. TRIAL REGISTRATION NUMBER NCT04948710.
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Affiliation(s)
- Mehmet Ali Aslaner
- Department of Emergency Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Özant Helvacı
- Department of Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Korbin Haycock
- Department of Emergency Medicine, Loma Linda University, Loma Linda, California, USA
- Emergency Medicine, Riverside University Health System, Moreno Valley, California, USA
| | - İsa Kılıçaslan
- Department of Emergency Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Emre Yaşar
- Department of Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Mahi Nur Cerit
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Halit Nahit Şendur
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Galip Güz
- Department of Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Demircan
- Department of Emergency Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
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Yaşar E. Coronary Involvement of Behçet's Disease: Saccular Coronary Artery Aneurysm. Kardiologiia 2023; 63:95-96. [PMID: 37970862 DOI: 10.18087/cardio.2023.10.n1931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 12/24/2021] [Indexed: 11/19/2023]
Abstract
Coronary artery aneurysms (CAAs) are rarely reported in large angiographic series. The majority are atherosclerotic in origin. Other causes are connective tissue disorders, trauma, vasculitis, congenital, mycotic, and idiopathic. We herein present the case of an symptomatic patient with a giant left anterior descending artery aneurysm. The CAA was successfully treated by surgical resection and a mammary artery bypass graft.
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Affiliation(s)
- E Yaşar
- Malatya Training and Research Hospital
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Duman ZM, Kadiroğulları E, Kaplan MC, Timur B, Başgöze A, Yaşar E, Bayram M, Aydın Ü, Onan B. Central vs. Peripheral Cannulation During Reoperations: A Propensity Score Matching Analysis. Braz J Cardiovasc Surg 2023; 38:e20220463. [PMID: 37801428 PMCID: PMC10550105 DOI: 10.21470/1678-9741-2022-0463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/10/2023] [Indexed: 10/08/2023] Open
Abstract
INTRODUCTION The aim of this study is to compare the postoperative outcomes and early mortality of peripheral and central cannulation techniques in cardiac reoperations using propensity score matching analysis. METHODS In this retrospective cohort, patients who underwent cardiac reoperations with median resternotomy were analyzed in terms of propensity score matching. Between November 2010 and September 2020, 257 patients underwent cardiac reoperations via central (Group 1) or peripheral (Group 2) cannulation. A 1:1 propensity score matching was performed to balance the influence of potential confounding factors to compare postoperative data and mortality rate. RESULTS There were no significant differences when comparing the matched groups regarding early mortality (P=0.51), major cardiac injury (P=0.99), prolonged ventilation (P=0.16), and postoperative stroke (P=0.99). The development of acute renal failure (P=0.02) was statistically less frequent in Group 1. CONCLUSIONS Performing cardiopulmonary bypass via peripheral cannulation increases acute renal failure in cardiac reoperations. In contrast, peripheral or central cannulation have similar early mortality rate in cardiac reoperations.
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Affiliation(s)
- Zihni Mert Duman
- Department of Cardiovascular Surgery, Cizre State Hospital, Sirnak,
Turkey
| | - Ersin Kadiroğulları
- Department of Cardiovascular Surgery, İstanbul Mehmet Akif Ersoy
Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Can Kaplan
- Department of Cardiovascular Surgery, İstanbul Mehmet Akif Ersoy
Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Barış Timur
- Department of Cardiovascular Surgery, İstanbul Mehmet Akif Ersoy
Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Aylin Başgöze
- Department of Cardiovascular Surgery, İstanbul Mehmet Akif Ersoy
Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Emre Yaşar
- Department of Cardiovascular Surgery, İstanbul Mehmet Akif Ersoy
Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Muhammed Bayram
- Department of Cardiovascular Surgery, İstanbul Mehmet Akif Ersoy
Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ünal Aydın
- Department of Cardiovascular Surgery, İstanbul Mehmet Akif Ersoy
Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Burak Onan
- Department of Cardiovascular Surgery, İstanbul Mehmet Akif Ersoy
Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Yaşar E, Duman ZM, Timur B, Bayram M, Kaplan MC, Kadiroğulları E. Fate of the Patent False Lumen of the Descending Aorta After Surgical Treatment for Acute Type 1 Aortic Dissection. Braz J Cardiovasc Surg 2023; 38:e20220257. [PMID: 37801681 PMCID: PMC10552773 DOI: 10.21470/1678-9741-2022-0257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 05/15/2023] [Indexed: 10/08/2023] Open
Abstract
INTRODUCTION This study aimed to investigate the factors affecting false lumen patency in the descending thoracic aorta among patients who underwent surgery for acute type 1 aortic dissection. METHODS A total of 112 patients with acute type 1 aortic dissection, with the flap below the diaphragm level, underwent surgery between January 2010 and September 2019. Of these, 60 patients who were followed up for ≥ 12 months and whose computed tomography scans were available were included in this study. The patients were divided into two groups: group I, consists of patent false lumen (n=36), and group II, consists of thrombosed false lumen (n=24). Demographic data, operative techniques, postoperative descending aortic diameters, reintervention, and late mortality were compared between the two groups. RESULTS The mean follow-up period of all patients was 37.6±26.1 months (range: 12-104). The diameter increase in the proximal and distal descending aorta was significantly higher in the patent false lumen group (5.3±3.7 mm vs. 3.25±2.34 mm; P=0.015; 3.1±2.52 mm vs. 1.9±1.55 mm; P=0.038, respectively). No significant difference in terms of hypertension was found between the two groups during the follow-up period (21 patients, 58.3% vs. 8 patients, 33.3%; P=0.058). A total of 29 patients (48.3%) were found to be hypertensive in the postoperative period. CONCLUSION After surgical treatment for acute type 1 aortic dissection, patients should be monitored closely, regardless of whether the false lumen is patent or thrombosed. Mortality and reintervention can be seen in patients with patent false lumen during follow-up.
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Affiliation(s)
- Emre Yaşar
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy
Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Zihni Mert Duman
- Department of Cardiovascular Surgery, Cizre State Hospital,
Şırnak, Turkey
| | - Barış Timur
- Department of Cardiovascular Surgery, Istanbul Dr. Siyami Ersek
Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Muhammed Bayram
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy
Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Can Kaplan
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy
Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ersin Kadiroğulları
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy
Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Gursoy M, Yaşar E, Guler S, Yalcin L, Muradli T, Kadirogullari E, Kutluk E, Aydin U. Impact of Indexed Effective Orifice Area on the Quality of Life of Patients after Aortic Valve Replacement. Heart Surg Forum 2023; 26:E249-E254. [PMID: 37401426 DOI: 10.1532/hsf.5621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/11/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Improving health related quality of life is an important goal of aortic valve replacement. Inadequate effective orifice area of prosthesis according to the patient's body surface area may be associated with poor outcomes. In this study, we aimed to analyze impact of indexed effective orifice area (iEOA) on patients' quality of life after aortic valve replacement. METHODS A total of 138 patients who underwent isolated aortic valve replacement were included to the study. Quality of life assessment was performed with EuroQol Group EQ-5D-5L questionnaire. Patients were divided into three groups based on iEOA (Group 1 had an iEOA of <0.65 cm2/m2 (19 patients), Group 2 had an iEOA between 0.65-0.85 cm2/m2 (71 patients), and Group 3 had an iEOA of >0.85 cm2/m2). Mean EQ-5D-5L scores were compared among the groups statistically. RESULTS Mean EQ-5D-5L scores were lower in Group 1 than in Groups 2 and 3 (Group 1: 0.72 ± 0.18, Group 2: 0.83 ± 0.20, and Group 3: 0.86 ± 0.9, p = 0.044 and p = 0.014). The EQ-5D-5L score was significantly lower in patients with a ≥20 mmHg transvalvular gradient than those with a <20 mmHg (0.74 ± 0.25 vs. 0.84 ± 0.18, p = 0.014). CONCLUSIONS Our results show that an iEOA <0.65 cm2/m2 is significantly associated with impaired postoperative health-related quality of life. Newer generation prostheses, transcatheter valve implantation, and root enlargement techniques should be kept in mind in preoperative planning.
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Affiliation(s)
- Mete Gursoy
- Department of Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, 34303 Istanbul, Turkey.
| | - Emre Yaşar
- Department of Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, 34303 Istanbul, Turkey.
| | - Salih Guler
- Department of Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, 34303 Istanbul, Turkey.
| | - Lokman Yalcin
- Department of Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, 34303 Istanbul, Turkey.
| | - Tural Muradli
- Department of Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, 34303 Istanbul, Turkey.
| | - Ersin Kadirogullari
- Department of Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, 34303 Istanbul, Turkey.
| | - Erhan Kutluk
- Department of Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, 34303 Istanbul, Turkey.
| | - Unal Aydin
- Department of Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, 34303 Istanbul, Turkey.
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Çakmak T, Çakmak E, Balgetir F, Yaşar E, Karakuş Y. Do novel oral anticoagulant drugs used in patients with nonvalvular atrial fibrillation act only as anticoagulants? Eur Rev Med Pharmacol Sci 2023; 27:2946-2952. [PMID: 37070895 DOI: 10.26355/eurrev_202304_31926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVE Although inflammation has an important role in the pathogenesis of atrial fibrillation (AF), the effect of novel oral anticoagulants (NOAC) used to reduce the risk of ischemic stroke and embolism on inflammation remains unknown. In this study, we aimed to investigate the effects of NOAC, which have been shown to have anticoagulant properties, on inflammation and platelet reactivation, which have an important role in the pathogenesis of AF. PATIENTS AND METHODS A total of 530 patients, including 380 patients with nonvalvular AF using NOAC and 150 patients with nonvalvular AF who did not use any NOAC were included in the study. Neutrophil-to-lymphocyte ratio (NLR) was calculated as the ratio of absolute neutrophil count to absolute lymphocyte count. Mean platelet volume (MPV), red cell distribution width (RDW), and neutrophil-to-lymphocyte ratio (NLR) values of both groups were assessed both on admission and at three-month follow-up. RESULTS When the complete blood count (CBC) changes of the groups included in the study were compared, the RDW, MPV, and NLR values showed a greater decrease in the NOAC group compared to the non-NOAC group (p=0.000 for all). CONCLUSIONS The results indicated that the NOAC used in anticoagulation treatment do not only act as anticoagulants but also reduce inflammation and platelet reactivation, which have an important role in the pathogenesis of AF and thromboembolism.
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Affiliation(s)
- T Çakmak
- Department of Cardiology, Balıkesir Atatürk City Hospital, Balıkesir, Turkey.
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Yaşar E, Duman ZM, Bayram M, Kahraman MZ, Köseoğlu M, Kadiroğulları E, Aydın Ü, Onan B. Predictors and outcomes of conversion to sternotomy in minimally invasive coronary artery bypass grafting. Turk Gogus Kalp Damar Cerrahisi Derg 2023; 31:161-168. [PMID: 37484640 PMCID: PMC10357860 DOI: 10.5606/tgkdc.dergisi.2023.24552] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/07/2023] [Indexed: 07/25/2023]
Abstract
Background This study aims to investigate the risk factors and surgical outcomes of conversion to median sternotomy in minimally invasive direct coronary artery bypass grafting. Methods Between January 2017 and July 2022, a total of 274 patients (246 males, 28 females; mean age: 57.0±9.6 years; range, 33 to 81 years) who underwent conventional (n=116) or robot-assisted (n=158) minimally invasive direct coronary artery bypass grafting were retrospectively analyzed. The primary outcome measure of the study was conversion to median sternotomy, and the secondary outcome measures were operative mortality, length of intensive care unit and hospital stay. Results Conversion to median sternotomy was required in 26 (9.5%) patients. The most common cause of conversion was intramyocardial left anterior descending artery (27.0%). Among preoperative and operative characteristics, only age was statistically significant risk factor for conversion to sternotomy (odds ratio=1.06, p=0.01). Operative mortality occurred in one patient (0.36%) patient in the entire cohort. The length of intensive care unit and hospital stay was significantly longer in patients requiring conversion to median sternotomy (p=0.002 and p<0.001, respectively). There was no significant difference in other postoperative outcomes between the two groups (p>0.05). Conclusion Intramyocardial left anterior descending artery is the most common reason for conversion to sternotomy, and older age increases the risk of conversion. Minimally invasive coronary artery bypass grafting can be performed with satisfactory results, even if it requires conversion to sternotomy.
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Affiliation(s)
- Emre Yaşar
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye
| | - Zihni Mert Duman
- Department of Cardiovascular Surgery, Cizre State Hospital, Şırnak, Türkiye
| | - Muhammed Bayram
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye
| | - Meliha Zeynep Kahraman
- Department of Anesthesiology and Reanimation, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye
| | - Mehmet Köseoğlu
- Department of Anesthesiology and Reanimation, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye
| | - Ersin Kadiroğulları
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye
| | - Ünal Aydın
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye
| | - Burak Onan
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye
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Bayram M, Duman ZM, Timur B, Yaşar E, Üstünışık ÇT, Kaplan MC, Kadiroğulları E. Predictive value of age, creatinine, and ejection fraction (ACEF) scoring system for operative mortality in patients with Stanford type A aortic dissection. Indian J Thorac Cardiovasc Surg 2023; 39:6-13. [PMID: 36590040 PMCID: PMC9794663 DOI: 10.1007/s12055-022-01431-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/15/2022] [Accepted: 10/18/2022] [Indexed: 11/27/2022] Open
Abstract
Purpose Stanford type A aortic dissection (TAAD) is the most common and fatal type of dissection. An easier-to-use risk stratification may help eliminate bias in patients at high risk of dissection. The age, serum creatinine, and ejection fraction (ACEF) score is a simple risk model developed to predict the mortality risk of elective coronary artery bypass graft surgery. This study aimed to evaluate the relationship between preoperative ACEF score and operative mortality in patients with TAAD undergoing emergency surgery. Methods In this retrospective cohort study, 113 patients diagnosed with TAAD between January 2017 and September 2021 were evaluated. The primary endpoint was operative mortality. Receiver operating characteristic analysis was performed for the ACEF score, ACEF II score, and European System for Cardiac Operative Risk Evaluation II. Univariate and multivariate analyses of operative mortality were performed using the logistic regression model. Results Operative mortality occurred in 23 (20.4%) patients. The cutoff ACEF score was calculated as 1.1 for predicting operative mortality (area under the curve = 0.712, P value = 0.002, sensitivity = 74.0%, specificity = 67.8%, likelihood ratio = 2.3). Based on the cutoff value, 46 (40.7%) patients had a high ACEF score (ACEF ≥ 1.1) and 67 (59.3%) patients had a low ACEF score (ACEF < 1.1). The high ACEF score was associated with an increased incidence of operative mortality compared with the low ACEF score (37.0% vs. 9.0%; P = 0.001). Conclusions The ACEF score can be used as a useful and relatively simple tool for risk stratification before TAAD surgery. However, the ACEF score is only indicated for risk assessment and should not affect treatment.
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Affiliation(s)
- Muhammed Bayram
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, 34303 Turkey
| | - Zihni Mert Duman
- Department of Cardiovascular Surgery, Cizre State Hospital, Şırnak, 72200 Turkey
| | - Barış Timur
- Department of Cardiovascular Surgery, Istanbul Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, 34668 Turkey
| | - Emre Yaşar
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, 34303 Turkey
| | - Çiğdem Tel Üstünışık
- Department of Cardiovascular Surgery, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Mustafa Can Kaplan
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, 34303 Turkey
| | - Ersin Kadiroğulları
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, 34303 Turkey
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Demir M, Demir ŞŞ, Yaşar E. Big data and innovative organizational performance: Evidence from a moderated‐mediated model. Creat Innov Manage 2022. [DOI: 10.1111/caim.12525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mahmut Demir
- Department of Tourism Management, Faculty of Tourism Isparta University of Applied Sciences Isparta Türkiye
| | - Şirvan Şen Demir
- Department of Tourism Management, Faculty of Economic and Administrative Sciences Suleyman Demirel University Isparta Türkiye
| | - Emre Yaşar
- Department of Tourism Guidance, Faculty of Tourism Isparta University of Applied Sciences Isparta Türkiye
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Aslaner MA, Yaşar E, Kılıçaslan İ, Cerit MN, Emren SV, Yüksek B, Karakök B, Baykuş BA, Bildik F, Güz G, Keleş A, Demircan A. Accuracy of Multi-organ Point-of-Care Ultrasound for Acute Kidney Injury Etiologies. Ultrasound Med Biol 2022; 48:2009-2018. [PMID: 35914991 DOI: 10.1016/j.ultrasmedbio.2022.05.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/15/2022] [Accepted: 05/18/2022] [Indexed: 06/15/2023]
Abstract
This study investigated the diagnostic performance of point-of-care ultrasound (POCUS) for acute kidney injury (AKI) etiological subgroups in emergency department (ED) patients. Multi-organ POCUS including kidney, bladder, inferior vena cava (IVC), lung and cardiac examinations were used to identify five AKI subgroups: hypovolemia, reduced cardiac output, systemic vasodilatation and renal vasomodulation, renal and post-renal. One hundred sixty-five AKI patients were included in the study. The most diagnostic parameter in the post-renal group was the presence of any hydronephrosis, with a sensitivity of 93.3% (95% confidence interval [CI]: 68.1-99.8) and specificity of 85.9% (95% CI: 79.3-91.1). For the reduced cardiac output group, the most diagnostic parameter was IVC maximum diameter >17 mm with a sensitivity of 100% (95% CI: 83.2-100) and specificity of 70.2% (95% CI: 61.6-77.7). For the hypovolemia group, the most diagnostic parameter was IVC maximum diameter ≤17.9 mm with a sensitivity of 81.2% (95% CI: 71.2-88.8) and specificity of 56.5% (95% CI: 44-68.4). For the systemic vasodilatation and renal vasomodulation group, the most diagnostic parameter was diffuse ascites with a sensitivity of 56.3% (95% CI: 29.9-80.2) and specificity of 89.9% (95% CI: 83.8-94.2). None of the parameters were significant for the renal group. We concluded that multi-organ POCUS is of diagnostic value for AKI subgroups.
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Affiliation(s)
- Mehmet Ali Aslaner
- Department of Emergency Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey.
| | - Emre Yaşar
- Department of Nephrology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - İsa Kılıçaslan
- Department of Emergency Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mahi Nur Cerit
- Department of Radiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Sadık Volkan Emren
- Department of Cardiology, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Başak Yüksek
- Department of Emergency Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Busegül Karakök
- Department of Emergency Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Bekir Alperen Baykuş
- Department of Emergency Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Fikret Bildik
- Department of Emergency Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Galip Güz
- Department of Nephrology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ayfer Keleş
- Department of Emergency Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ahmet Demircan
- Department of Emergency Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
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Yaşar E, Çakmak T, Bayramoğlu A, Karakuş Y, Tekin S, Şekerci G, Türkoğlu C. MOTS-c as a predictor of coronary lesions and complexity in patients with stable coronary artery disease. Eur Rev Med Pharmacol Sci 2022; 26:5676-5682. [PMID: 36066139 DOI: 10.26355/eurrev_202208_29501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Atherosclerosis plays a major role in the development of coronary artery disease (CAD). It has been shown that mitochondrial open-reading-frame of the twelve S rRNA-c (MOTS-c), a mitochondrial-derived peptide, has preventive effects on atherosclerosis. The aim of this study was to determine the relationship between MOTS-c levels and CAD presence and severity using SYNTAX score (SS) in patients with stable angina pectoris. PATIENTS AND METHODS Ninety-two consecutive patients with stable coronary artery disease (CAD+) and ninety-two consecutive patients with normal coronary artery (CAD-) were included. Presence and severity of coronary artery disease were determined using the SS. RESULTS We observed that the MOTS-c levels was lower in the CAD group (111±13 vs. 161±23, p<0.001). The MOTS-c levels were also found to be significant independent predictors for CAD in multiple regression analysis (p<0.001). A MOTS-c levels ≥130.9 had 80.3% sensitivity and 73.2% specificity (area under the curve [AUC]: 0.858, 95% CI: 0.895-0.999, p<0.001) for predicting CAD. CONCLUSIONS The authors revealed that there is a strong correlation between MOTS-c levels and CAD. Therefore, MOTS-c may help identify patients with CAD, thus allowing for early preventive treatment.
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Affiliation(s)
- E Yaşar
- Department of Cardiology, Malatya Training and Research Hospital, Malatya, Turkey.
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12
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Bayram M, Duman ZM, Timur B, Aksu T, Yaşar E, Güneysu E, Buğra AK, Yalçın L, Polat M, Coşkun H, Gürsoy M, Aydın Ü. Prognostic values of the C-reactive protein to albumin ratio and prognostic nutritional index in carotid endarterectomy patients. Vascular 2022:17085381221111015. [PMID: 35739066 DOI: 10.1177/17085381221111015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES C-reactive protein to albumin ratio (CAR) and prognostic nutritional index (PNI) are novel parameters with proven prognostic importance in the postoperative outcomes of coronary and peripheral vascular diseases. In this study, we aimed to evaluate the ability of CAR and PNI to predict major cardiac and cerebrovascular events (MACCE) during the postoperative period of Carotid artery endarterectomy (CEA). METHODS A total of 505 carotid endarterectomy patients were retrospectively evaluated. Of 505 patients, 23 patients who died and who experienced myocardial infarction or major neurologic complication in the first 30 days after the operation were included in MACCE group (Group 1). The remaining 482 patients were included in Group 2. Receiver operating characteristics (ROC) curve analysis was used to evaluate preoperative serum albumin value, lymphocytes count, PNI, and CAR to predict the MACCE. The DeLong test was used to compare the area below the curve (AUC) with each of these parameters. RESULTS CAR (2.48 ± 1.82 and 1.64 ± 1.37) and CRP (9.98 ± 7.42 and 6.81 ± 5.70) values are statistically higher in Group 1 than in Group 2. PNI (41.59 ± 3.11 and 43.54 ± 4.20) and albumin (40.43 ± 3.15 and 42.35 ± 4.15) values were significantly lower in Group 1 than in Group 2. The accuracy of albumin (AUC: 0.669) in the prediction of MACCE was found to be the highest among CAR (AUC: 0.631), PNI (AUC:0.667), and CRP (AUC:0.631). CONCLUSION Preoperative nutritional and inflammatory status is significantly associated with post-operative outcomes. PNI and CAR can be used for preoperative evaluation, as CEA is recommended for patients who have low possibility of having postoperative major adverse events.
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Affiliation(s)
- Muhammed Bayram
- Department of Cardiovascular Surgery, 111319Cizre State Hospital, Şırnak, Turkey
| | - Zihni M Duman
- Department of Cardiovascular Surgery, 111319Cizre State Hospital, Şırnak, Turkey
| | - Barış Timur
- Department of Cardiovascular Surgery, 187456Istanbul DR. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Timuçin Aksu
- Department of Cardiovascular Surgery, 111319Cizre State Hospital, Şırnak, Turkey
| | - Emre Yaşar
- Department of Cardiovascular Surgery, 111319Cizre State Hospital, Şırnak, Turkey
| | - Elif Güneysu
- Department of Cardiovascular Surgery, 111319Cizre State Hospital, Şırnak, Turkey
| | - Abdül Kerim Buğra
- Department of Cardiovascular Surgery, 111319Cizre State Hospital, Şırnak, Turkey
| | - Lokman Yalçın
- Department of Cardiovascular Surgery, 111319Cizre State Hospital, Şırnak, Turkey
| | - Mücahit Polat
- Department of Cardiovascular Surgery, 111319Cizre State Hospital, Şırnak, Turkey
| | - Hasan Coşkun
- Department of Cardiovascular Surgery, 111319Cizre State Hospital, Şırnak, Turkey
| | - Mete Gürsoy
- Department of Cardiovascular Surgery, 111319Cizre State Hospital, Şırnak, Turkey
| | - Ünal Aydın
- Department of Cardiovascular Surgery, 111319Cizre State Hospital, Şırnak, Turkey
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Candemir B, Yıldırım F, Yaşar E, Erten Y, Göker B. Relationship between Health Literacy and Frailty in Older Adults with Chronic Kidney Disease. Exp Aging Res 2022; 49:201-213. [PMID: 35467490 DOI: 10.1080/0361073x.2022.2068326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with an increased risk of frailty, morbidity, and mortality in older adults. Limited health literacy (HL) is a condition that can cause frailty in CKD. Frailty leads to a decreased resistance to stress situations caused by activities of daily living and increased morbidity and mortality. The aim of this study was to investigate the relationship between HL and frailty in older adults with stage 4-5 CKD. METHODS A total of 109 patients with stage 4-5CKD were included. All patients underwent a comprehensive geriatric assessment. Health literacy was assessed by the Turkish version of the European Health Literacy Questionnaire. Frailty status was measured using the Fried Frailty Index. RESULTS The median age was 72 (68-80) years and 72 patients (66.1%) had lowHL. Forty-six patients (42.2%) were frail, and frailty was more common in the low HL group. CONCLUSION The present study demonstrated that low HL level was common in geriatric patients with stage 4-5 CKD and was associated with frailty, as well as a decrease in daily and instrumental life activities, decrease in acceptance of illness scale, and compliance with medical treatment.
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Affiliation(s)
- Burcu Candemir
- Department of Geriatrics, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Funda Yıldırım
- Department of Geriatrics, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Emre Yaşar
- Department of Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Yasemin Erten
- Department of Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Berna Göker
- Department of Geriatrics, Gazi University Faculty of Medicine, Ankara, Turkey
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Kadiroğulları E, Çiçek ÖF, Mola S, Yaşar E, Erkengel İ, Yalçınkaya A, Günertem E, İkbaliafşar F, Diken A, Kocabeyoğlu S, Lafçı G, Çağlı K. Comparison of Anterior Mitral Leaflet Repair Techniques with and without the Use of Chordal Replacement in Patients with Degenerative Mitral Valve Insufficiency. Heart Surg Forum 2019; 22:E234-E240. [PMID: 31237550 DOI: 10.1532/hsf.2317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 02/14/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of our study was to compare the outcome of patients who underwent mitral valve anterior leaflet repair with and without chordal replacement for degenerative mitral valve insufficiency. METHODS This study was conducted at our center between May 2006 and May 2013. The study included 125 patients with degenerative mitral valve insufficiency (64 males, 61 females; mean age 47 years, age range 16-78 years) who underwent mitral valve repair with anterior leaflet procedures. The patients were divided into 2 groups. Group A consisted of 56 patients with chordal replacement, and group B consisted of 69 patients with other repair techniques performed. RESULTS No significant difference was determined between the 2 groups in mortality, recurrence, and reoperation rates. The mortality rate was 3.6% in group A and 1.4% in group B. During the follow-up period, 3 patients were reoperated on (mitral valve replacement) because of severe mitral valve insufficiency. Two of these patients were from group A (3.6%), and the other was from group B (1.4%). One patient in group A underwent intraoperative mitral valve replacement after unsuccessful chordal replacement. Fifty patients (89.3%) in group A and 65 patients (94.2%) in group B exhibited no or mild recurrence of mitral valve insufficiency. CONCLUSION Mitral valve repair in patients with degenerative mitral valve insufficiency resulting from anterior leaflet pathology is a safe procedure because of its durability and good long-term results. Despite the difficulty of the chordal replacement procedure, it may be used as an alternative technique for anterior mitral valve leaflet repair.
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Affiliation(s)
- Ersin Kadiroğulları
- Department of Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ömer Faruk Çiçek
- Department of Cardiovascular Surgery, Selçuk University School of Medicine, Konya, Turkey
| | - Serkan Mola
- Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Emre Yaşar
- Department of Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - İbrahim Erkengel
- Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Adnan Yalçınkaya
- Department of Cardiovascular Surgery, Hitit University School of Medicine, Çorum, Turkey
| | - Eren Günertem
- Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Ferhat İkbaliafşar
- Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Adem Diken
- Department of Cardiovascular Surgery, Hitit University School of Medicine, Çorum, Turkey
| | - Sabit Kocabeyoğlu
- Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Gökhan Lafçı
- Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Kerim Çağlı
- Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
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Yilmaz B, Göktepe S, Yaşar E, Kesikburun S, Adıgüzel E. The effect of autonomic nervous system dysfunction on oxygen consumption during daily living activities in patients with spinal cord injury. Spinal Cord 2016; 55:300-303. [PMID: 27431660 DOI: 10.1038/sc.2016.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 05/17/2016] [Accepted: 05/28/2016] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Case-control study. OBJECTIVES To investigate the level of autonomic nervous system dysfunction in patients with spinal cord injury and to determine its effect on the basal metabolic rate and oxygen consumption during daily living activities. SETTING Turkish Armed Forces Rehabilitation Center, Ankara, Turkey. METHODS Thirty-six patients with chronic spinal cord injury (SCI) were allocated into two groups according to the presence of autonomic nervous system dysfunction. Autonomic nervous system dysfunction was investigated with the measurements of blood pressure and heart rate during urodynamic examination and several provocative maneuvers (standing at tilt table, forcing deep respiration and Valsalva). Groups were compared in terms of the basal metabolic rate and oxygen consumption during daily living activities. Measurement of the basal metabolic rate was determined by indirect calorimetry under standardized conditions. Total body fat mass and lean tissue mass were measured in all participants using dual-energy X-ray absorptiometry by standard methods. Telemetric intrapulmonary gas exchange analyzer was used to measure oxygen consumption during daily living activities. RESULTS There was no statistically significant difference between the groups in age, time since injury, body mass lean and fat rates, or sensory and motor scores (P>0.05). Basal metabolic rates and oxygen consumption during daily living activities were not different between the groups (P>0.05). CONCLUSIONS These results suggest that the presence of autonomic dysfunction does not change oxygen consumption at rest and during daily living activities.
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Affiliation(s)
- B Yilmaz
- Department of Physical Medicine and Rehabilitation, Gülhane Military Medical Academy, Turkish Armed Forces Rehabilitation Center, Ankara, Turkey
| | - S Göktepe
- Department of Physical Medicine and Rehabilitation, Gülhane Military Medical Academy, Turkish Armed Forces Rehabilitation Center, Ankara, Turkey
| | - E Yaşar
- Department of Physical Medicine and Rehabilitation, Gülhane Military Medical Academy, Turkish Armed Forces Rehabilitation Center, Ankara, Turkey
| | - S Kesikburun
- Department of Physical Medicine and Rehabilitation, Gülhane Military Medical Academy, Turkish Armed Forces Rehabilitation Center, Ankara, Turkey
| | - E Adıgüzel
- Department of Physical Medicine and Rehabilitation, Gülhane Military Medical Academy, Turkish Armed Forces Rehabilitation Center, Ankara, Turkey
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Yaşar E, Yılmaz B, Göktepe S, Kesikburun S. The effect of functional electrical stimulation cycling on late functional improvement in patients with chronic incomplete spinal cord injury. Spinal Cord 2015; 53:866-9. [PMID: 25687513 DOI: 10.1038/sc.2015.19] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 01/09/2015] [Accepted: 01/14/2015] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Prospective single-arm study. OBJECTIVES To investigate the effect of functional electrical stimulation (FES) cycling on late functional recovery, spasticity, gait parameters and oxygen consumption during walking in patients with chronic incomplete spinal cord injury (SCI). SETTING Turkish Armed Forces Rehabilitation Center, Ankara, Turkey. METHODS Ten patients with chronic (duration of more than 2 years) incomplete SCI who could ambulate at least 10 m independently or with the assistance of a cane or walker, but no hip-knee-ankle-foot orthosis. The subjects underwent 1-h FES cycling sessions three times a week for 16 weeks. Outcome measures including the total motor score, the Functional Independence Measure (FIM) score, the Modified Ashworth Scale for knee spasticity, temporal spatial gait parameters and oxygen consumption rate during walking were assessed at baseline, 3 and 6 months after the baseline. RESULTS There were statistically significant improvements in total motor scores, the FIM scores and spasticity level at the 6-month follow-up (P<0.01). The changes in gait parameters reached no significant level (P>0.05). Oxygen consumption rate of the patients showed significant reduction at only 6 months compared with baseline (P<0.01). CONCLUSION The results suggest that FES cycling may provide some functional improvements in the late period of SCI. SPONSORSHIP The study was supported by The Scientific and Technological Research Council of Turkey (TUBITAK).
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Affiliation(s)
- E Yaşar
- Gülhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, Turkish Armed Forces Rehabilitation Center, Ankara, Turkey
| | - B Yılmaz
- Gülhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, Turkish Armed Forces Rehabilitation Center, Ankara, Turkey
| | - S Göktepe
- Gülhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, Turkish Armed Forces Rehabilitation Center, Ankara, Turkey
| | - S Kesikburun
- Gülhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, Turkish Armed Forces Rehabilitation Center, Ankara, Turkey
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Güzelküçük Ü, Demir Y, Kesikburun S, Aras B, Yaşar E, Tan AK. Ultrasound findings of the urinary tract in patients with spinal cord injury: a study of 1005 cases. Spinal Cord 2014; 53:139-44. [DOI: 10.1038/sc.2014.201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 10/08/2014] [Accepted: 10/12/2014] [Indexed: 11/10/2022]
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Kesikburun S, Köroğlu Omaç Ö, Yaşar E, Yilmaz B, Kenan Tan A. Ultrasound guided block of the saphenous neuroma following use of an AFO in a patient with paraplegia. A case report. Eur J Phys Rehabil Med 2014; 50:197-198. [PMID: 24398411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The saphenous nerve is the terminal branch of the femoral nerve and a pure sensory nerve that provide sensation to medial leg. Injury to saphanous nerve following trauma or surgery of the knee can result in formation of a painful neuroma along its distribution. We present a case of saphenous neuroma following use of an ankle-foot orthosis (AFO) in a patient with paraplegia. A 36-year-old patient with paraplegia who was capable of walking independently with his AFO presented to our department with a 3-month history of pain in his left calf. Examination revealed tenderness, paresthesias and positive Tinel sign over the anteromedial aspect of the calf. Ultrasonographic examination of the painful area showed a mass with heterogenous echogenity which was consistent with a saphenous neuroma at the site where fastener band of AFO compressed to skin. We performed a nerve block with steroid and local anesthetic injection under ultrasound guidance to the neuroma. The patient reported pain relief following injection. The use of the AFO may cause a painful saphenous neuroma which is an unusual cause of extremity pain in patients with paraplegia. Ultrasound may be a beneficial diagnostic tool and a guidance for the therapeutic interventions in this condition.
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Affiliation(s)
- S Kesikburun
- Department of Physical Medicine and Rehabilitation Gülhane Military Medical Academy Turkish Armed Forces Rehabilitation Center, Ankara, Turkey -
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Yaşar E, Tok F, Taşkaynatan MA, Yilmaz B, Balaban B, Alaca R. The effects of phenol neurolysis of the obturator nerve on the distribution of buttock-seat interface pressure in spinal cord injury patients with hip adductor spasticity. Spinal Cord 2010; 48:828-31. [PMID: 20386553 DOI: 10.1038/sc.2010.34] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Hip adductor spasticity may adversely effect shear-force and pressure distribution on the buttocks, where ulcerations most frequently appear in patients with spinal cord injury (SCI). Phenol neurolysis of the obturator nerve (ON) is commonly used to manage hip adductor spasticity. This study aimed to determine the effects on the distribution of buttock-seat interface pressure (BSIP) in a group of SCI patients with adductor spasticity that underwent ON blockade with phenol. METHODS We reviewed the records of SCI patients that were admitted to our clinic between January 2009 and December 2009. BSIP values (obtained with an X-sensor 48) and hip adductor spasticity levels of SCI patients with hip adductor spasticity that underwent ON blockade with phenol were collected. BSIP distributions of the patients were divided into two portions: first one is the BSIP distribution at the pressure ≤37 mm Hg, and the second one is at the pressure >37 mm Hg. RESULTS The study included 20 SCI patients (19 males and 1 female), with a mean age of 42.85±13.24 years. Although the percentage of BSIP distribution at ≤37 mm Hg range increased significantly (P<0.001), after ON neurolysis, BSIP distribution at >37 mm Hg range decreased significantly (P<0.001). In addition, mean hip adductor spasticity decreased significantly after ON neurolysis (P<0.001). CONCLUSION Phenol neurolysis of the ON is a promising treatment for the management of hip adductor spasticity in SCI patients and also has positive effects on BSIP, which has a crucial function in the development of pressure ulcers.
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Affiliation(s)
- E Yaşar
- Department of Physical Medicine and Rehabilitation, Gulhane Military Medical Academy, GMMA TAF Rehabilitation Center, Ankara, Turkey.
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