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Öğe BİR ÜNİVERSİTE HASTANESİ KLİNİĞİNDE YAPILAN İLK 200 AÇIK KALP AMELİYATI SONUÇLARI: KIRIKKALE ÜNİVERSİTESİ, TIP FAKÜLTESİ, KALP-DAMAR CERRAHİSİ(2020) Gültekin, Yıldırım; Bolat, AliAmaç: Çalışmanın amacı, kliniğimizde yapılan ilk 200 açıkkalp ameliyatının sonuçlarını değerlendirmektir.Gereç ve Yöntemler: Yapılan 200 kalp ameliyatı hastanekayıt sistemi taranarak geriye dönük olarak incelendi.Hastaların yaş, cinsiyet, komorbiditeleri, ameliyat tipleri,hastane ve yoğun bakımda yatış süreleri, morbidite vemortalite oranları değerlendirildi.Bulgular: Hastaların 128’i kadın,72’si erkekti. Yaşları 38-90yıl arasında olup, ortalama 68±5 yıldı. Komorbit faktörleriolarak, kronik obstrüktif akciğer hastalığı, hipertansiyon,diabetes mellitus, hiperlipidemi, serebro-vasküler hastalık,periferik arter hastalığı ve kronik böbrek yetmezliği vemiyokart enfarktüsü görüldü.Toplam 162 koroner arter bypass grefti (KABG) yapıldı.Bunlardan 24 tanesi çalışan kalpte gerçekleştirildi. Eşzamanlı olarak 5 karotis endarterektomi ve 15 koronerendarterektomi yapıldı. Dört KABG ve mitral kapakreplasmanı (MVR), 2 KABG ve aort kapak replasmanı(AVR), 6 AVR, 12 MVR, 4 AVR ve MVR, 3 MVR vetricuspit anuloplasti yapıldı. İki hastaya aort diseksiyonunedeniyle asenden aort replasmanı ve 3 hastanın asendenaort anevrizmasına supra koroner aort replasmanı yapıldı. İkihastaya kardiyak yaralanma nedeniyle sağ ventrikül tamiriyapıldı.Düşük kardiyak debi nedeniyle 10 hastaya intra-aortik balonpompası takıldı. Komplikasyon olarak 38 hastada atrialfibrilasyon, 4 hastada akut böbrek yetmezliği, 3 hastadaserebrovaskuler olay gelişti. Hastaların 4’ünde postoperatifkanama ve 3’ünde sternal dehisens nedeniyle revizyonyapıldı. Bir hastada mediastinit görüldü. Yoğun bakımdakalış süresi ortalama 2,2±1,7 gün olup, hastanede kalış süresi7,5±4 gündü. Hastane mortalitesi 8 hastada (%4) görüldü.Sonuç: Kırıkkale Üniversitesi Tıp Fakültesi Araştırma veUygulama Hastanesi kalp ve damar cerrahisi kliniği, açıkkalp ameliyatlarının literatüre uygun morbidite ve mortaliteoranları ile yapıldığı bir merkez olmuştur.Öğe Clinical Manifestations in Patients with Segmental Hypoplasia of Great Saphenous Vein(Kuwait Medical Assoc, 2017) Sipahi, Mesut; Bolat, Ali; Serin, Halil Ibrahim; Erkoc, Mustafa Fatih; Acikgoz, Burak; Kulah, BahadirObjectives: Segmental hypoplasia of the great saphenous vein (GSV) is a common condition which may cause chronic venous insufficiency. Despite the high incidence thereof, few studies have investigated GSV hypoplasia. We evaluated the presentations of patients with GSV segmental hypoplasia. Design: Prospective study Setting: Bozok Universty, School of Medicine, Yozgat, Turkey Subjects and methods: Demographic and clinical data, duplex ultrasound findings, length and location of the narrowing segments, and coexisting chronic venous insufficiency (CVI) and deep vein thrombosis (DVT), were retrospectively reviewed. Patients with segmental hypoplasia of the GSV were grouped according to the length and midpoint location of the narrow segment. The SPSS version 18.0 was used to conduct statistical tests. P-values < 0.05 were deemed to indicate statistical significance. Intervention: Ultrasound Main outcome measure: Hypoplastic GSV segments evaluation with ultrasonography Results: The study included 163 patients, 20% of whom were of an advanced age. We observed 257 extremities of the 163 patients. Varicose findings were observed in 62% of all patients. Comorbid CVI was significantly more common in the elderly than in the younger patients (P = 0.008). Skin changes occurred more frequently in male than in female (P = 0.016) and in elderly than in younger (P = 0.019) patients. The most common site of narrowing segments was below the knee. Conclusion: Segmental hypoplasia of the GSV commonly occurs in females. Male sex and advanced age are risk factors for skin changes, varicose findings, and DVT. DVT is more common in patients with hypoplastic segments longer than 5 cm.Öğe Comparison of sympathectomy and cilostazol treatment results in non-revascularized critical leg ischemia(2021) Gültekin, Yıldırım; Bolat, Ali; Gemalmaz, HüseyinObjective: The aim of this retrospective study is to compare the efficacy of sympathectomy and cilostazol therapy in critical limb ischemia that cannot be revascularized. Material and Method: This study was retrospectively conducted on 30 patients who underwent lumbar sympathectomy (Group 1) and received cilotazol treatment (Group 2) between January 2017 and August 2020. Demographic data, comorbidity, complications, wound healing, walking distance and pain scale records of the patients were determined by examining the hospital registry system and statistical analysis was performed. Results: In the study, no significant difference was found between the two groups in terms of walking distance and ischemic pain in the statistical analysis of the data before treatment, at the 3rd, 6th, 12th and 24th months (p>0.05). However, a statistically significant difference was found between the pre-treatment data and the data at the 3rd, 6th, 12th and 24th months in both Group 1 and Group 2 in terms of walking distance and ischemic pain (p<0.001 ). In the time periods followed in both groups, it was observed that there was an increase in walking distance and a decrease in ischemic pain. Conclusion: Cilostazol treatment may be preferred as a good alternative treatment method compared to lumbar sympathectomy in critical leg ischemia.Öğe Does Aspartate Aminotransferase to Alanine Aminotransferase Ratio Predict Acute Kidney Injury After Cardiac Surgery?(Forum Multimedia Publishing, Llc, 2021) Gultekin, Yildirim; Bolat, Ali; Hatice, Keles; Kunt, Atike TekeliBackground: Aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AST/ALT) frequently is used in the diagnosis and prognosis of liver diseases, however it is also used in the diagnosis and prognosis of many other diseases, such as myocardial infarction, acute ischemic stroke, and peripheral artery disease. Acute kidney injury (AKI) is one of the most important complications after cardiac surgery and is one of the main causes of morbidity and mortality. The purpose of the study was to analyze the relationship between AST to ALT and AKI after isolated coronary artery bypass graft surgery (CABG). Methods: We retrospectively reviewed the prospectively collected data of 253 adult patients, who underwent isolated CABG surgery with normal renal function (baseline serum creatinine value <1.4 mg/dL). Preoperative (T0) and postoperative day 1 and day 3 (T1 and T2) serum AST and ALT levels were analyzed, and AST/ALT was calculated. A preoperative AST/ALT of 1.22 was found to be the best cutoff point for predicting postoperative AKI. Kidney injury was interpreted, according to RIFLE classification. The effect of AST to ALT ratio on AM after CABG was determined using logistic regression analysis, and the results were expressed as odds ratio (OR) with a 95% confidence interval (CI). A P value < .05 was considered statistically significant. Results: Postoperative AKI occurred in 40 patients (15.8%). On logistic regression analysis, higher AST/ALT both preoperatively and postoperatively were associated with an increased incidence of postoperative AKI (T0: OR, 3.983; 95% CI, 1.940-8.180, P < .001, T1: OR, 2.760; 95% CI, 1.381-5.515, P = .004, T2: OR, 2.515; 95% CI, 1.195-5.294, P = .015). Conclusion: Preoperative and postoperative elevated AST to ALT ratio seems to be associated with an increased incidence of AKI after elective isolated CABG surgery.Öğe Editöre Mektup(2017) Alpcan, Ayşegül; Bolat, Ali; Tursun, Serkan; Kabalcı, MehmetR. Comparison of Bruker Biotyper matrix-assisted laser desorption ionization-time of flight mass spectrometer to BD Phoenix automa- ted microbiology system for identification of gram-negative bacilli. J Clin Microbiol 2011;49:887-9Öğe Effectiveness of internal compression therapy in primary safen vein failure(2022) Bolat, Ali; Gültekin, YıldırımAim: The aim of this study is to evaluate the effectiveness of internal compression therapy (ICT), a new technique used in the treatment of chronic venous insufficiency (CVI), and to share the early results. Material and Method: Between September 2018 and June 2019, 27 patients with superficial venous insufficiency due to saphenofemoral junction (SFJ) insufficiency and who underwent ICT were included in the study. Demographic data, venous color doppler ultrasonography (RDUS) results, CEAP (clinical etiology, anatomy, pathophysiology) classification, venous clinical severity score (VCSS) and visual analog scale (VAS) results were retrospectively analyzed from the files of the patients. Results: It was determined that 14 of the 27 patients were female and 13 were male in the study. While the mean CEAP classification scores were 3.9±0.5 before the procedure, it was 2.3±0.7 at the 3rd month after the procedure (p<0.001). While the mean duration of venous reflux before the procedure was 4.7±0.3 seconds, pathological reflux was detected in 2 patients at the 3rd month after the procedure (p<0.001). While the mean VCSS score was 11.2±3.3 before the procedure, it was 5.4±1.2 at 3 months (p<0.001). While the mean VAS score was 6.5±1.3 preoperatively, the mean VAS score was 2.7±1.4 at 3 months after the procedure (p<0.001). No complications were observed in any of the patients. Conclusion: We think that ICT can be used as an alternative treatment method in the treatment of superficial venous insufficiency due to valve dysfunction in SFJ.Öğe Investigation of the contribution of concentrated growth factor (CGF) and processed lipoaspirate (PLA) to wound healing in diabetic rats(2021) Bolat, Ali; Gültekin, YıldırımAim: The aim of the study is to show the effectiveness of concentrated growth factor (CGF) and processed lipoaspirate (PLA)in wound healing in diabetic rats.Materyal and Method: A total of 30 rats were used in the study. It was divided into 3 groups as concentrated growth factor,processed lipoaspirate and control group. The rats were made diabetic using Sreptozotocin IP. A 5mm diameter wound wascreated on one of the hind legs of all rats by using a punch. Concentrated growth factor and processed lipoaspirate were appliedto the lesions. Daily wound size and wound condition were recorded on days 3, 5 and 10. At the end of the study, blood sampleswere taken for TNF-?, TGF-?, IL-1, PDGF, FGF and VEGF measurements before the rats were sacrificed.Results: The mean wound diameters measured on the 3rd day in the study were 4.6±0.06 mm in the control group, 4.1±0.05mm in the concentrated growth factor group, and 4.4±0.07 mm in the processed lipoaspirate group. The wound diametersmeasured on the 5th day were 3.1±0.04 mm in the control group, 1.6±0.05 mm in the concentrated growth factor groupand 2.7±0.06 mm in the processed lipoaspirate group (p<0.01). The mean closure time of wounds was 5.3±1.1 days in theconcentrated growth factor group, 7.1±1.4 days in the processed lipoaspirate group, and 9.4±0.5 days in the control group. Allof the wounds were healed in all groups on the 10th day. This improvement rate in the concentrated growth factor group wasstatistically significant compared to the other two groups (p<0.01). Concentrated growth factor and PLA increased the speedof wound healing in diabetic rats. Inflammatory marker levels (TNF-?, TGF-?, IL-1, PDGF, FGF, VEGF) obtained from bloodsamples were higher than normal in all rats and there was no significant difference between the groups (p>0.05).Conclusion: In this study, it was shown that concentrated growth factor application was more effective than processedlipoaspirate application in wound healing in diabetic rats.Öğe Krill Oil Prevents Atherosclerosis in an Experimental Model(2021) Gültekin, Yıldırım; Bolat, Ali; Kunt, Atike TekeliObjectives: The major aim of coronary artery disease management is to reduce the formation and progression of atherosclerotic plaque. Omega-3 fatty acid supplementation that is obtained from fish has been shown to reduce cardiovascular events. Krill (Euphasia superba) are small crustaceans that live in cold seas like the Antarctic Ocean. Recently, due to its high content, and form of the eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), krill oil has become popular in researches dealing with the prevention of cardiac disorders and cancer. This study aims to analyze the effect of krill oil supplements on atherosclerosis in rats treated with high-fat diet and streptozotocin-induced diabetes mellitus. Materials and Methods: Twenty Sprague-Dawley male rats were split into two groups: the control group (C group) and the krill oil group (KO group). Each group was fed with a high-fat diet for six months and streptozotocin was injected subcutaneously to obtain an experimental model of atherosclerosis. The KO group received a 50 mg daily supplement of krill oil orally. Rats were sacrificed after six months for biochemical and histopathological examinations of the aorta and coronary arteries. Results: The atherosclerosis model was confirmed by elevated levels of low-density lipoprotein (LDL), triglyceride (TG), total cholesterol (TC), and glucose, also decreased insulin and high-density lipoprotein (HDL). The atherosclerosis index (TC/HDL) was lower in the C group compared to the KO group (p=0.012). Serum native thiol and total thiol levels were higher; however, the disulfide level was lower in the KO group. This result was statistically significant (p<0.001).In the KO group, there was a significant decrease in the number of foam cells discovered in the tissue examined from the aorta and coronary arteries with hematoxylin and eosin staining. Conclusions: The present study indicates that krill oil supplements attenuate the number of foam cells in the aorta and coronary arteries, indicating the preventive effect of krill oil on atherosclerosis.Öğe The effect of phosphorylcoline-coated cardiopulmonary by-pass circuits on morbidity and mortality in patients with congenital open cardiac surgery(2021) Bolat, Ali; Sürer, Süleyman; Gülbahar, Özlem; Bolat, Esef; Gültekin, Yıldırım; Kutsal, AliObjective: Our aim in this study is to investigate the relationship between mortality and morbidity of phosphorylcholinecoated oxygenator circuit used in heart-lung machine in congenital open-heart surgery operations.Material and Method: The study was conducted in Dr. Sami Ulus Child Diseases Training and Research Hospital CardiovascularSurgery Clinic between 2008-2009. 30 congenital heart patients were included. The patients were divided into 2 groups of 15people. In one of the groups, a phosphorylcholine coated oxygenator circuit was used in the heart lung machine (GroupP). In the other group, a standard oxygenator circuit was used (Group C).Congenital heart surgery was performed for 19ventricular septal defects (VSD), 5 secundum atrial septal defects (ASD), 3 primum ASD, 2 mitral insufficiency and 1 discretsubaortic membrane. Extubation times, intensive care and discharge times, 24-hour drainage follow-up, inotropic drug use,blood and fresh frozen plasma (FFP) transfusion amount, aspartate aminotransferase, alanine aminotransferase, creatinephosphokinase-MB, urea, blood urea nitrogen, creatinine, white cell number of platelets, lactate dehydrogenase, albumin, totalprotein, C-reactive protein, prothrombin time, partial thromboplastin time, fibrinogen, D-dimer, C5a and elastase levels werecompared perioperatively.Results: In the study, it was determined that the discharge time was shorter in Group P. It was found that the increase ind-dimer values with fibrinogen was less in Group P. These were found to be statistically significant (p<0.05). There was nosignificant difference between groups in other parameters (p>0.05). There was no mortality in either group.Conclusion: In this study, phosphorylcholine-coated oxygenator did not significantly reduce the inflammatory responseduring cardiopulmonary by-pass (CPB). There was no difference between the two groups in terms of morbitidity and mortality.However, the fact that fibrinogen values, which are the acute phase reactants, are lower than the control group and the increasein d-dimer values remain limited may be important in terms of hemocompatibility of the phosphorylcholine coated circuit.Öğe The effect of postoperative administration of low-molecular-weight-heparin (tinzaparin) on arterial thrombosis in an experimental rat model(2024) Gültekin, Yıldırım; Bolat, Ali; Özbayburtlu, Merih; Keleş, Hatice; Kunt, Atike TekeliIntroduction: Low molecular weight heparins are licensed in the prophylaxis of venous thromboembolism but not of arterial thrombosis. This study aimed to evaluate the effect of postoperative administration of low molecular weight heparin, tinzaparin, on the rate of arterial thrombosis in a rat model. Methods: The right femoral arteries of sixteen male Wistar Albino rats were incised transversely and then were repaired with a continuous suture. Eight rats were given 175 IU/kg/day tinzaparin postoperatively for three days, while the remaining eight rats were kept free of tinzaparin. All rats were controlled daily for vascular circulation, bleeding, and hematoma until the reoperation on the fourth postoperative day. Reoperation was performed to explore vascular patency and excise a sample of vascular tissue from the repaired femoral artery for histopathological examination. A blood sample was also withdrawn for the detection of anti-factor Xa activity to show the efficacy of tinzaparin. Results: During the postoperative three-day follow-up period, while vascular circulation disorder was detected in none of the tinzaparin- treated rats, it was detected in two rats not treated with tinzaparin (25%). None of the rats in either group developed bleeding or hematoma at the surgical site. Anti-factor Xa activity in the rats treated with tinzaparin postoperatively was found to be significantly higher than in the rats not treated with tinzaparin (p<0.001). Histopathological examination revealed thrombus and fibrin formation at the femoral artery incision line in only one rat (12.5%) treated with tinzaparin, and in seven rats (87.5%) not treated with tinzaparin (p?0.001). Intimal hyperplasia was not detected in any group, but mixed-type inflammatory cell infiltration and endothelial and fibroblastic activity around the sutures were noted in both. Conclusion: The postoperative subcutaneous administration of 175 IU/kg/day tinzaparin effectively attenuates the rate of arterial thrombosis in arterial surgical interventions in a rat model.Öğe VENA SAFENA MAGNANIN ANATOMİK VARYASYONU DERİN VEN TROMBOZU İÇİN BİR RİSK FAKTÖRÜ MÜDÜR?(Kırıkkale Üniversitesi, 2021) Bolat, Ali; Gültekin, YıldırımAmaç: Bu retrospektif çalışmanın amacı, vena safena magnanın, anatomik varyasyonunun femoral ven trombozuna olan etkisini araştırmaktır.Gereç ve Yöntemler: Bu çalışma Kırıkkale Üniversitesi Tıp Fakültesi Hastanesi Kalp ve Damar Cerrahisi Kliniğinde Ocak 2017 ve Ağustos 2019 tarihleri arasında takip ve tedavi edilen femoral ven trombozu tanısı olan hastalarda yapıldı. Hastaların demografik özellikleri, venöz renkli Doppler ultrasonografi raporları ve eşlik eden hastalıklar retrospektif olarak incelendi. Vena safena magnanın tipleri, uyluk seviyesinde safen kompartmanındaki yerleşimlerine göre belirlendi.Bulgular: Çalışma ana ve superfisiyal femoral vende derin ven trombozu tanısı konulan 130 hasta üzerinde yapılmıştır. Hastaların 62’si kadın ve 68’i erkekti ve yaşları 16 ile 89 yıl arasında değişmekteydi. Ortalama yaşları ise 55.8±17.3 yıldı. Derin ven trombozu risk faktörlerinden, en sık ileri yaş (%37), en az oral kontraseptif kullanımı (%1.5) gözlendi. On hastada predispozan faktör saptanamadı. Ana ve superfisiyal femoral derin ven trombozu olan hastalarda vena safena magna tiplerinin görülme yüzdeleri normal popülasyona göre aynı bulunmuştur.Sonuç: Çalışmada ana ve superfisiyal femoral derin ven trombozu olan hastalarda vena safena magna varyasyonlarının görülme oranının normal popülasyona göre benzer olduğu saptandı.Öğe VENA SAFENA MAGNANIN ANATOMİK VARYASYONU DERİN VEN TROMBOZU İÇİN BİR RİSK FAKTÖRÜ MÜDÜR?(2021) Bolat, Ali; Gültekin, YıldırımAmaç: Bu retrospektif çalışmanın amacı, vena safenamagnanın, anatomik varyasyonunun femoral ven trombozunaolan etkisini araştırmaktır.Gereç ve Yöntemler: Bu çalışma Kırıkkale Üniversitesi TıpFakültesi Hastanesi Kalp ve Damar Cerrahisi Kliniğinde Ocak2017 ve Ağustos 2019 tarihleri arasında takip ve tedavi edilenfemoral ven trombozu tanısı olan hastalarda yapıldı.Hastaların demografik özellikleri, venöz renkli Dopplerultrasonografi raporları ve eşlik eden hastalıklar retrospektifolarak incelendi. Vena safena magnanın tipleri, uylukseviyesinde safen kompartmanındaki yerleşimlerine görebelirlendi.Bulgular: Çalışma ana ve superfisiyal femoral vende derinven trombozu tanısı konulan 130 hasta üzerinde yapılmıştır.Hastaların 62’si kadın ve 68’i erkekti ve yaşları 16 ile 89 yılarasında değişmekteydi. Ortalama yaşları ise 55.8±17.3 yıldı.Derin ven trombozu risk faktörlerinden, en sık ileri yaş (%37),en az oral kontraseptif kullanımı (%1.5) gözlendi. On hastadapredispozan faktör saptanamadı. Ana ve superfisiyal femoralderin ven trombozu olan hastalarda vena safena magnatiplerinin görülme yüzdeleri normal popülasyona göre aynıbulunmuştur.Sonuç: Çalışmada ana ve superfisiyal femoral derin ventrombozu olan hastalarda vena safena magna varyasyonlarınıngörülme oranının normal popülasyona göre benzer olduğusaptandı.Öğe YÜZEYEL VARİSLERDE N-BUTİL SİYANOAKRİLAT İLE SKLEROTERAPİ SONUÇLARIMIZ(2021) Bolat, Ali; Gültekin, Yıldırım; Gemalmaz, HüseyinAmaç: Varis, kronik venöz yetmezlik sonrası daha çok alt eksremitede ortaya çıkan ve toplumda yaygın olarak görülen; tromboflebit ve derin ven trombozu gibi ciddi komplikasyonlara neden olabildiği gibi, kozmetik sorunlara da neden olan bir patolojidir. Bu çalışmanın amacı küçük çaplı varikoz venlerin (1-3 mm) n-butil-siyanoakrilatla yapılan skleroterapi sonuçlarını paylaşmaktır.Gereç ve Yöntemler: Ocak 2017 ve Ağustos 2019 yılları arasında varis nedeniyle n-butil-siyanoakrilat kullanılarak skleroterapi yapılan 90 hastanın dosyaları geriye dönük incelendi. Hastaların demografik özellikleri, şikayetleri, venöz renkli Doppler ultrasonografi raporları, işlem sonrası komplikasyonlar ve hasta memnuniyet sonuçları retrospektif olarak incelendi.Bulgular: Hastaların yaş aralığı 20 ile 60 yıl arasında değişmekteydi. Bunlardan 70’i kadın, 20’si erkekti. İşlem yapılan 90 hastanın 85’inde tam oklüzyon sağlandı. 5 hastada geriye kalan telenjektazik varisler ekzovenöz lazer uygulamasıyla tedavi edildi. Hiçbir hastada cilt nekrozu görülmedi. Üç hastada tromboflebit ve 4 hastada hiperpigmentasyon geliştiği görüldü. Derin ven trombozu ve anafilaktik reaksiyon gelişmedi. Takipte uygulama yerinde nüks görülmedi. Hasta memnuniyeti %94.4 olarak yüksek düzeyde saptandı. Varislerin kapatılması için ortalama 1-3 seans tedavi uygulandı.Sonuç: N-butil-siyanoakrilat, varis lümenini hızlı bir şekilde kapatması, nüks ve komplikasyonların az olması ve hasta memnuniyetinin yüksek olması nedeniyle varis tedavisinde skleroterapi uygulamasında iyi bir alternatif ajan olarak kullanılabilir.
