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Öğe Adding dexmedetomidine to lidocaine for intravenous regional anesthesia(Lippincott Williams & Wilkins, 2004) Memis, D; Turan, A; Karamanlioglu, B; Pamukçu, Z; Kurt, IDexmedetomidine is approximately 8 times more selective toward the alpha-2-adrenoceptors than clonidine. It decreases anesthetic requirements by up to 90% and induces analgesia in patients. We designed this study to evaluate the effect of dexmedetomidine when added to lidocaine in IV regional anesthesia (IVRA). We investigated onset and duration of sensory and motor blocks, the quality of the anesthesia, intraoperative-postoperative hemodynamic variables, and intraoperative-postoperative pain and sedation. Thirty patients undergoing hand surgery were randomly assigned to 2 groups to receive IVRA. They received 40 mL of 0.5% lidocaine and either 1 mL of isotonic saline (group L, n = 15) or 0.5 mug/kg dexmedetomidine (group LD, n = 15). Sensory and motor block onset and recovery times and anesthesia quality were noted. Before and after the tourniquet application at 5, 10, 15, 20, and 40 min, hemodynamic variables, tourniquet pain and sedation, and analgesic use were recorded. After the tourniquet deflation, at 30 min, and 2, 4, 6, 12, and 24 h, hemodynamic variables, pain and sedation values, time to first analgesic requirement, analgesic use, and side effects were noted. Shortened sensory and motor block onset times, prolonged sensory and motor block recovery times, prolonged tolerance for the tourniquet, and improved quality of anesthesia were found in group LD. Visual analog scale scores were significantly less in group LD in the intraoperative period and 30 min, and 2, 4, and 6 h after tourniquet release. Intra-postoperative analgesic requirements were significantly less in group LD. Time to first analgesic requirements was significantly longer in group LD in the postoperative period. We conclude that the addition of 0.5 mug/kg dexmedetomidine to lidocaine for IVRA improves quality of anesthesia and perioperative analgesia without causing side effects.Öğe Analgesic effects of gabapentin after spinal surgery(Lippincott Williams & Wilkins, 2004) Turan, A; Karamanlioglu, B; Memis, D; Hamamcioglu, MK; Tükenmez, B; Pamukçu, Z; Kurt, IBackground: A combination of opioid and nonopioid analgesic drugs may improve the quality of postoperative analgesia as well as reduce opioid requirements and their associated side effects. Studies have shown synergism between gabapentin and morphine in animal and human experiments and in the treatment of incisional pain. Therefore, the authors investigated, in a randomized, placebo-controlled, double-blind study, the effects of gabapentin on acute postoperative pain and morphine consumption in patients undergoing spinal surgery. Methods: After standard premedication, 25 patients in the control group received oral placebo, and 25 patients in the gabapentin group received 1,200 mg of gabapentin, 1 h before surgery in a randomized fashion. Anesthesia was induced with propofol and cisatracurium. and was maintained with sevoflurane and remifentanil. The total intraoperative remifentanil consumption by each patient was noted. All patients postoperatively received patient-controlled analgesia with morphine (1 mg/ml) with an incremental dose of 2 mg, a lockout interval of 10 min, and a 4-h limit of 40 mg. The incremental dose was increased to 3 mg, and the 4-h limit to 50 mg, if analgesia was inadequate after I h. Patients were questioned for the first 1 h in the PACU and were later evaluated in the ward at 1, 2, 4, 6, 12, and 24 h. Pain scores, heart rate, oxygen saturation measured by pulse oximetry, mean blood pressure, respiratory rate, sedation, morphine use, and total dose of morphine were recorded. Results: Overall, pain scores at 1, 2, and 4 It were significantly lower in the gabapentin group when compared with the placebo group. Total morphine consumption in the gabapentin group was 16.3 +/- 8.9 mg (mean +/- SD) versus 42.8 +/- 10.9 mg in the placebo patients. The incidence of vomiting and urinary retention was significantly (P < 0.05) higher in the placebo group, but there was no difference in incidence of other adverse effects between the groups. Conclusions: Preoperative oral gabapentin decreased pain scores in the early postoperative period and postoperative morphine consumption in spinal surgery patients while decreasing some morphine-associated side effects.Öğe Comparing classification techniques for predicting essential hypertension(Pergamon-Elsevier Science Ltd, 2005) Ture, M; Kurt, I; Kurum, AT; Ozdamar, KHypertension is a leading cause of heart disease and stroke. In this study, performance of classification techniques is compared in order to predict the risk of essential hypertension disease. A retrospective analysis was performed in 694 subjects (452 patients and 242 controls). We compared performances of three decision trees, four statistical algorithms, and two neural networks. Predictor variables were age, sex, family history of hypertension, smoking habits, lipoprotein (a), triglyceride, uric acid, total cholesterol, and body mass index (BMI). Classification techniques were grouped using hierarchical cluster analysis (HCA). The data points appeared to cluster in three groups. The first cluster included MLP and RBF. Furthermore CART which was more similar than other techniques linked this cluster. The second cluster included FDA/MARS (degree= 1), LR and QUEST, but FDA/MARS (degree= 1) and LR was more similar than QUEST. The third cluster included FDA/MARS (degree =2), CHAID and FDA, but FDA/MARS (degree =2) and CHAID was more similar than FDA. MLP and RBF which are one each of neural networks procedures, performed better than other techniques in predicting hypertension. QUEST had a lesser performance than other techniques. (c) 2005 Elsevier Ltd. All rights reserved.Öğe Comparison of four different time series methods to forecast hepatitis A virus infection(Pergamon-Elsevier Science Ltd, 2006) Ture, M; Kurt, IHepatitis A virus (HAV) infection is not a problem of only developing countries, but also of developed countries. In this study, we compared time series prediction capabilities of three artificial neural networks (ANN) algorithms (multi-layer perceptron (MLP). radial basis function (RBF), and time delay neural networks (TDNN)), and auto-regressive integrated moving average (ARIMA) model to HAV forecasting. To assess the effectiveness of these methods, we used in forecasting 13 years of time series (January 1992-June 2004) monthly records for HAV data, in Turkey. Results show that MLP is more accurate and performs better than RBF, TDNN and ARIMA model. (c) 2005 Elsevier Ltd. All rights reserved.Öğe Predictive value of thyroid hormones on the first day in adult respiratory distress syndrome patients admitted to ICU(K Faisal Spec Hosp Res Centre, 2005) Türe, M; Memis, D; Kurt, I; Pamukçu, ZBACKGROUND: Thyroid hormone dysfunction could affect outcome and increase mortality in critical illness. Therefore, in a prospective, observational study we analyzed and compared the prognostic accuracy of free tri-iodothyronine (M), free thyroxine (M), thyroid-stimulating hormone (TSH), along with the APACHE II and SOFA scoring systems in predicting intensive care unit (ICU) mortality in critically ill patients. PATIENTS AND METHODS: Physiology scores were calculated for the first 24 hours after ICU admission in 206 patients with acute respiratory distress syndrome. APACHE 11 and SOFA scores were employed to determine the initial severity of illness. Thyroid hormones were measured within the first 24 hours. Logistic regression models were created for APACHE 11 scores, SOFA scores, and thyroid hormone levels. The models predicted high- and low-risk subgroups. Models that showed a good fit were stratified by Kaplan-Meier survival curves. RESULTS:There were 98 (47.6%) survivors and 108 (52.4%) non-survivors. The survivors had a lower APACHE 11 score (11.50 vs 15.82, P < 0.0005), a lower SOFA score (6.06 vs 9.42, P < 0.0005), a younger age (57 vs 70 years, P=4.008), a shorter ICU stay (13 vs 16 days, P=4.012), and a higher fT3 level (2.18 vs 1.72 pg/mL, P=4.002) than non-survivors. ICU survival was most closely predicted by a model that included age and fT3 and a model that included APACHE 11 and APACHE II*sex. CONCLUSION: In critically ill patients, serum fT3 concentrations markedly decreased after ICU admission among non-survivors. According to our findings, fT3 levels might have additive discriminatory power to age, SOFA and APACHE 11 scores in predicting short-term mortality in ARDS patients admitted to ICU.
