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Öğe Autogenous arterial radial-basilic forearm looped transposition(Mosby, Inc, 2003) Sunar, H; Cikirikcioglu, M; Halici, Ü; Duran, EWe describe the use of radial artery as a conduit for arteriovenous hemodialysis access in the forearm. The advantages of this type of fistula are use of autogenous material and its localization because forearm fistula is easily cannulated and is more convenient for the patient. This fistula may be an alternative solution in selected hemodialysis patients for the difficult access in whom superficial arm veins are exhausted and lower extremity access is unsuitable.Öğe The effects of cardiopulmonary bypass on androgen hormones in coronary artery bypass surgery(Cambridge Med Publ, 2002) Canbaz, S; Ege, T; Sunar, H; Cikirikcioglu, M; Acipayam, M; Duran, EThe effects of testosterone on coronary vasomotor regulation have been described by several recent reports. Here we investigated changes in serum androgen levels during and after cardiopulmonary bypass (CPB) in patients who had undergone coronary artery bypass surgery. Serum luteinizing hormone, free testosterone and dihydroepiandrestenedione sulphate (DHEA sulphate) levels were evaluated in 38 male coronary artery bypass surgery patients using a chemical immunoassay technique. All hormone levels were corrected to account for haemodilution. Serum-free testosterone level decreased significantly during weaning from CPB (from 15.7 +/- 4.2 nmol/l to 6.2 +/- 2.8 nmol/l), and an even greater decrease was observed in the first post-operative day (5.4 +/- 3.1 nmol/l). On the seventh post-operative day, free testosterone levels reached a normal value (11.8 +/- 5.5 nmol/l), although they were still significantly lower compared with the pre-operative value. There were slight alterations in serum DHEA sulphate levels, although the only significant decrease occurred from the first to the seventh day post-operation (from 4.7 +/- 2.2 pmol/l to 3.7 +/- 1.8 pmol/l, respectively). Serum luteinizing hormone levels were decreased during weaning from CPB (from 4.8 +/- 2.1 mIU/ml to 3.9 +/- 1.8 mIU/mI), but increased rapidly to the pre-operative value (5.5 +/- 2.5 mIU/ml) at the first post-operative day. These results show that CPB affects serum luteinizing hormone, free testosterone and dihydroepiandrestenedione sulphate levels. The free testosterone level decreases significantly both during and after CPB surgery.Öğe The effects of intracoronary administration of vitamin E on myocardial ischemia-reperfusion injury during coronary artery surgery(Georg Thieme Verlag Kg, 2003) Canbaz, S; Duran, E; Ege, T; Sunar, H; Cikirikcioglu, M; Acipayam, MBackground: Vitamin E has a strong antioxidant capacity, and has been used in several ischemia-reperfusion studies. The aim of this study was to investigate the effects of water-soluble vitamin E (alpha-tocopherol) on myocardial protection during coronary artery surgery. Methods: Water soluble vitamin E (100mg) in tepid saline (n = 14) or tepid saline alone (n = 16) was administered into the coronary arteries at the end of aortic cross-clamping. Cardiac troponin-1 (cTn-1), MB-isoenzyme of creatine kinase (CK-MB), myoglobin, blood gas, and lactate levels in systemic and coronary sinus blood and hemodynamic variables were assessed during and after the operation. Results: Eight hours after reperfusion, cTn-1 levels increased to 3.06 +/- 1.8 ng/ml and 6.97 +/- 3.9 ng/ml in the vitamin E group and control group, respectively (p = 0.01). Coronary sinus lactate concentration was 2.68 +/- 0.5 mmol/l in the vitamin E group and 4.01 +/- 1.5 mmol/l in the control group 60 minutes after reperfusion (p = 0.027). Conclusions: Administration of vitamin E into the coronary arteries before removal of the aortic cross-clamp can reduce myocardial cell injury and protect the myocardium from ischemia-reperfusion injury.Öğe The importance of aprotinin and pentoxifylline in preventing leukocyte sequestration and lung injury caused by protamine at the end of cardiopulmonary bypass surgery(Georg Thieme Verlag Kg, 2004) Ege, T; Arar, C; Canbaz, S; Cikirikcioglu, M; Sunar, H; Yuksel, V; Duran, EBackground: Protamine has adverse effects on pulmonary gas exchange during the postoperative period. The objective of this study was to investigate the importance of aprotinin and pentoxifylline in preventing the leukocyte sequestration and lung injury caused by protamine administered after the termination of cardiopulmonary bypass (CPB). Methods: Participants (n = 39) were allocated into three groups at the termination of CPB: Group 1, (control group, n = 16); Group 2 (aprotinin group, n = 12), who received protamine + aprotinin (15 000 IU/kg); and Group 3 (Pentoxifylline group, n = 11), who received protamine + pentoxifylline (10 mg/kg). Leukocyte counts in pulmonary and radial arteries were determined after the termination of CPB and before any drug was given (t(1)), and 5 minutes (t(2)), 2 hours (t(3)), 6 hours (t(4)) and 12 hours (t(s)) after the administration of protamine. Alveolar-arterial O-2 gradient (A-aO(2)) and dynamic pulmonary compliance were measured at t(1), t(2) and t(3). Results: In the control group, an increase in pulmonary leukocyte sequestration was observed 5 minutes and 2 hours after protamine administration, after which this difference disappeared. No significant degree of pulmonary sequestration was detected in any measurements after protamine was administered in the aprotinin and pentoxifylline (PTX) groups. Dynamic lung compliance was 50.1, 45.2 and 47.2 ml/cm H2O in the control group, 49.2, 61.1 and 56.3 ml/ cm H2O in the aprotinin group, and 49.5, 54.5 and 50.4 ml/cm H2O in the PTX group. The A-aO(2) gradient was 212.2, 263.3 and 254.3 mmHg in the control group, 209.4, 257.1 and 217.3 mmHg in the aprotinin group, and 211.3, 260.8 and 219.2 mmHg in the PTX group. Conclusion: Aprotinin and PTX treatments have favourable effects on lung function by reducing protamine-induced leukocyte sequestration into lungs at the end of CPB.Öğe The importance of intrapericardial drain selection in cardiac surgery(Elsevier, 2004) Ege, T; Tatli, E; Canbaz, S; Cikirikcioglu, M; Sunar, H; Ozalp, B; Duran, EIntroduction: To explore the impact of intrapericardial and infracardiac drains on pericardial effusions in cardiac surgery. Materials and methods: Patients undergoing coronary artery bypass grafting were randomized into two groups. At the end of the intervention, an intrapericardial and infracardiac Blake drain was placed in patients in group 1 (n = 97), and an intrapericardial and infracardiac semirigid drain was placed in patients in group 2 (n = 105). In addition, a semirigid drain was placed into mediastinum in all cases. The amount of drainage was calculated at six different time points postoperatively: postoperative 0 to 2 h, postoperative 2 to 4 h, postoperative 4 to 6 h, postoperative 6 to 12 h, postoperative 12 to 24 h, and postoperative 24 to 48 h. The amount of pericardial effusion was estimated by transthoracic echocardiography after the drains were removed. Results: In all measurements, the amount of drainage from intrapericardial Blake drains was higher, the total amount of drainage being equal to 330.7 +/- 29.4 mL and 193.2 +/- 19.6 mL in the Blake drain and semirigid drain groups, respectively (p = 0.000) [mean +/- SD]. When the drains were removed, the volume of pericardial effusion was 3.86 +/- 0.76 mm in Blake drain group and 7.59 +/- 1.16 mm in semirigid drain group (p = 0.000). The incidence of postoperative atrial fibrillation was 11.3% in the group with Blake drains, and 23.8% in the group with semirigid drains (p = 0.016). Conclusion: The more effective drainage obtained with infracardiac Blake drains compared to semirigid drains helps to reduce the amount of postoperative pericardial effusion and the risk of atrial fibrillation.Öğe The importance of pulmonary artery circulation during cardiopulmonary bypass(Cambridge Med Publ, 2003) Ege, T; Canbaz, S; Cikirikcioglu, M; Arar, C; Edis, M; Duran, EThis study sought to determine changes in transpulmonary difference in blood cells and alveolar-arterial oxygen (A-aO(2)) gradient when pulmonary artery circulation was obstructed in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). Eighteen patients were divided into group A (control group; X-clamp placed on aorta, n = 9) and group B (pulmonary ischaemia group; X-clamp placed on aorta and pulmonary artery, n = 9). Haematological parameters were compared before CPB and up to 90 min after declamping. A-aO(2) gradient differences were compared before and 2 h and 6 h after declamping. A transpulmonary increase in leucocyte levels normalized after 60 min in group A but remained higher in group B. A transpulmonary increase in neutrophils normalized after 60 min in group A and 90 min in group B. Increased lymphocyte levels normalized after 30 min in group A and 90 min in group B. A-aO(2), gradient was determined as: group A (294.8 +/- 74.3) and group B (321.2 +/- 73.3) before X-clamping; group A (132.7 +/- 22.7) and group B (236.6 +/- 41.5) 2 h after declamping; and group A (72.2 +/- 22.7) and group B (189.4 +/- 88.9) 6 h after declamping. When pulmonary artery circulation was obstructed during the X-clamping period, leucocyte, neutrophil and lymphocyte sequestration within both lungs increased, and an increased A-aO(2) gradient was observed because of tissue damage. To prevent post-operative complications, precautions to maintain normal pulmonary artery circulation are recommended.Öğe Regarding Vein transposition in the forearm for autogenous hemodialysis access and Basilic vein transposition: An underused autologous alternative to prosthetic dialysis angioaccess(Mosby, Inc, 2002) Cikirikcioglu, M; Duran, E[Abstract Not Available]Öğe Surgical masks in the operating theatre: They are really necessary in cardiovascular procedures(Australian Soc Anaesthetists, 2002) Cikirikcioglu, M; Duran, E[Abstract Not Available]