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  • Küçük Resim
    Öğe
    Akciğer kanserinde prognostik faktörler
    (2016) Günala, Nesimi; Gülbahar, Gültekin; Öztürk, Erman Bağatur; Sakıncı, Ünal; Dural, Koray
    Amaç: Akciğer kanseri tüm dünyada kansere bağlı ölümlerde kadınlarda ve erkeklerde birinci sırada yer almaktadır. Cerrahi rezeksiyon küçük hücreli dışı akciğer kanserli (KHDAK) hastalarda en önemli tedavi şeklidir. Ancak rezeksiyon uygulanan erken evre hastalarda bile sağkalım istenilen seviyelere ulaşamamaktadır. Bu çalışmanın amacı cerrahi rezeksiyon uygulanan KHDAK hastalarında sağ kalım üzerinde etkili olabilecek faktörlerin araştırılmasıdır.Gereç ve Yöntemler: 2003 ile 2006 yılları arasında KHDAK nedeniyle cerrahi rezeksiyon uygulanan 71 hastada çalışmaya dahil edildi. Hastalar, bir yıllık takip sonunda hayatta olanlar (Grup I, n 37) ile bir yıllık takip sonunda exitus olanlar veya nüks gelişenler (Grup II, n 34) olmak üzere iki gruba ayrıldı. Bu gruplar arasında hastaların, şikayet, laboratuar bulguları, tümör yerleşim yeri, çapı, lenf nodu durumu, evre ve tedavi şekli açısından farklılıklar araştırıldı.Bulgular: En büyük tümör çapı grup I'de ortalama 40,2 mm, grup II'de ise 51,0 mm idi (P 0,05). Otuzdört hastada N0, 17 hastada N1, 20 hastada da N2 vardı ve lenf nodu evresi grup I'de anlamlı olarak düşük saptandı (P 0,05). Her iki grup evre yönünden evre I, II ve III olarak karşılaştırıldı ve evre grup I'de anlamlı olarak düşük saptandı (P 0,05). Grup I ve grup II için ortalama CEA değerleri sırasıyla 3,26 ile 7,67 ng/mL'ydi (P 0,05). Grup I ve grup II için ortalama CA 19-9 değerleri sırasıyla 13,35 ve 30,04 ng/mL'ydi (P 0,05). Her iki grup arasında balgam çıkarma dışında anlamlı fark saptanmadı (P 0,05).Sonuçlar: Akciğer kanseri için tanımlanan prognostik faktörler farklılıklar göstermektedir. TNM evreleme sistemi KHDAK'li hastalarda prognozu en doğru yansıtan faktör olarak görünmekle birlikte aynı grup içinde serum CEA seviyesi benzeri faktörler de prognoza etki edebilmektedir. Ancak klinik heterojeniteden dolayı KHDAK'li tek bir hastanın prognozunu belirlemek zordur
  • Küçük Resim
    Öğe
    An analysis of clinical features of pulmonary giant hydatid cyst in adult population
    (Excerpta Medica Inc-Elsevier Science Inc, 2009) Koçer, Bülent; Gülbahar, Gültekin; Han, Serdar; Durukan, Elif; Dural, Koray; Sakıncı, Ünal
    BACKGROUND: We performed an analysis of giant hydatid cysts (GCHs) detected in the adult Population by comparison with the features of other simple hydatid cysts (CHs) in the light of the relevant literature. METHODS: The records of 74 adult patients who were operated on in our clinic for pulmonary CHs between 2001 and 2005 were retrospectively evaluated. Cysts that were 10 cm or larger in diameter on any plane were considered GCHs. The cysts were classified into 2 groups as GCHs (group A) and other (group 13). The groups were then compared for age, sex, symptom, cyst location, preoperative complications, Surgical procedure performed, operative morbidity, and mortality. RESULTS: Of 74 patients, 10 (13.5%) were in group A and 64 were in group B. No differences were detected between the clinical presentation, gender distribution, surgical procedure performed, and postoperative morbidity and mortality rates of GCHs and other cysts in adults. In both groups, there were no significant differences between the rates of involvement of 2 lungs (P = .527). However, both groups had lower lobe involvement, more markedly in group A (81.8% and 45.5% respectively; P = .023). Two patients in group A (20%) and 19 patients in group B (28.1%) had complicated cysts. CONCLUSIONS: The tendency of GCH to involve the lower lobe of the lung compared to smaller cysts suggests underlying mechanisms other than lung elasticity in the late onset of the symptoms parallel to cyst growth. (C) 2009 Elsevier Inc, All rights reserved.
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    Ankara Numune Hastanesi acil servisi’ne 2002-2004 yılları arasında başvuran kesici-delici alet yaralarının retrospektif değerlendirilmesi
    (2006) Tümer, Ali Rıza; Koçer, Bülent; Han, Serdar; Dural, Koray
    Yakın zamanlarda, saldırgan eğilimler ve şiddet gittikçe daha sık görülmekte, sorun çözme yöntemi olarak karşılıklı konuşma ve diyalogun yerini, ateşli silah ve bıçağa dayalı şiddet almaktadır. Sonuçta, özellikle acil servislerde çalışan hekimlerin sıklıkla aeşli silahlar ve bıçak gibi kesici ve delici alet yaraları ile karşılaştıkları bilinmektedir. Bu çalışmamızda Ankara Numune Hastanesi Acil Servisi'ne 2002 - 2004 yılları arasında yaralanma yakınması ile başvuran adli olgular, geriye dönük olarak incelenmiş, bu süre içinde 3055 olgunun adli olarak değerlendirildiği, bunların içinden 829 olguda şiddete bağlı insizyon yarası bulunduğu saptanmıştır. Olguların yaralanma biçimleri, cinsiyeti, yaşı, alkollü olup olmadığı, yara sayısı, yaranın şiddeti ve tedavisi, yaralanan lezyon bölgesi ve lezyon bölgelerine göre tedavi yaklaşımları araştırılmıştır. Bıçakların yasal boşluktan yararlanarak artan bir eğilimle yaralamalarda kullanılmasına dikkat çekilmek istenmiştir.
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    Blood Patch Pleurodesis In The Treatment Of Persistant Air Leakage In Langerhans Cell Histiocytosis: A Case Report
    (Amer Thoracic Soc, 2015) Baççıoğlu, Ayşe; Günal, Nesimi; Kalpaklioglu, Ayşe Füsun; Dural, Koray; Özpolat, Berkant
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  • Küçük Resim
    Öğe
    Blood Patch Pleurodesis in the Treatment of Persistant Air Leakage in Langerhans Cell Histiocytosis; A Case Report
    (Derman Medical Publ, 2013) Baççıoğlu, Ayşe; Günal, Nesimi; Kalpaklıoğlu, Füsun; Dural, Koray; Özpolat, Berkant
    Pulmonary langerhans cell histiocytosis is a rare reactive disorder with unclear pathogenesis. 16-year-old male patient complained about shortness of breath induced with exercise, non-productive cough, and intermittent chest pain for one year. Pulmonary function tests were in restrictive nature. There were multiple air cysts in lung parenchyma smaller than one cm and minimal pneumothorax on the left hemithorax in high resolution computed tomography of thorax. There was no hypoxemia in arterial blood gas analysis, and no pulmonary hypertension in echocardiography. Pulmonary langerhans cell histiocytosis was diagnosed with clinical features and typical radiographic appearance. Existence of multisystem langerhans cell histiocytosis was excluded thorough a detailed history, comprehensive physical examination, and baseline radiographic, blood and urine tests. He was recommended to quit smoking and close follow-up was planned. A tube thoracostomy was performed for left sided total pneumothorax one month later, and blood patch pleurodesis was done due to persistent air leakage with a successful outcome. As far as we know this is the first case report of pulmonary langerhans cell histiocytosis who was treated with autologous blood pleurodesis in the literature.
  • Küçük Resim
    Öğe
    A comparative analysis of giant and smaller hydatid cysts of lung treated surgically
    (2017) Özpolat, Berkant; Yazkan, Rasih; Günal, Nesimi; Dural, Koray
    Amaç: Bu çalışmanın amacı akciğerin dev kist hidatiklerinin daha küçük boydaki hidatik kistlerle karşılaştırılmasıdır.Gereç ve Yöntem: Akciğer kist hidatiği nedeniyle ameliyat edilen 62 hasta geriye dünük olarak değerlendirildi. Hastalar dev kist hidatik (Grup A, n=23) ve daha küçük çapta olanlar (Grup B, n=39) olmak üzere iki gruba ayrıldı. Gruplar yaş, cinsiyet, semptomlar, kist yerleşimi ve sayısı, preoperative komplikasyonlar, uygulanan cerrahi girişim şekli, postoperative uzamış hava kaçağı, göğüs tüpü alınma günü, postoperative komplikasyonlar, hastanede kalış süresi, morbidite ve mortalite açısından karşılaştırıldı.Bulgular: Yaş, cinsiyet, kist yerleşim yeri açısından anlamlı fark saptanmadı ((P = 0.925, P = 0.293, P = 0.179). Grup A'da 21 (%91) vakada kistler tek , Grup B'de vakaların yaklaşık 1/3'ünde birden fazla kist saptandı. Kistleri tek olması anlamlı bulundu (P = 0.005). Grup A'da 13 (%56) vakada kistotomi + kapitonaj yapılırken, Grup B'de 8 (%20) vakada yapılmıştı. Kistotomi + kapitonaj yöntemi Grup B'de Grup A'ya göre anlamlı olarak yüksekti. Uzamış hava kaçağı Grup A'da 8 (%20), Grup B'de 2 (%5) vakada gözlendi. Ortalama göğüs tüpü çekilme günü Grup A'da 4.57 ± 2.48 gün, Grup B'de 2.49 ± 1.63 gün ve hastanede kalış süresi Grup A'da 8.48 ± 3.39 gün ve Grup B'de 5.69 ± 1.80 gün olup her iki parametre istatistiksel olarak anlamlıydı (P < 0.001 ve P < 0.001). Postoperatif komplikasyonlar Grup A'da iki, Grup B'de üç vakada gözlendi. Her iki grupta da mortalite yoktu. Sonuçlar: Dev akciğer kistlerinin soliter görülme ihtimali fazla, ortalama göğüs tüpü çekilme ve hastanede kalış süresi uygulanan operasyondan bağımsız olarak uzamıştır. Kapitonajlı veya kapitonajsız yöntemlerin uygulandığı her iki grupta küratif cerrahi girişimlerin sonuçları mükemmeldir
  • Küçük Resim
    Öğe
    Comparison of the postoperative first and fifth year outcomes in patients who had undergone thymectomy for Myastenia Gravis
    (2015) Dural, Koray; Günal, Nesimi; Koçer, Bülent; Gülbahar, Gültekin; Koçer, Bilge
    Amaç: Myastenia gravis hastalarının tedavisinde timektominin etkinliği tartışmalıdır. Bu çalışmada myastenia graviste uzun dönem takip sonuçlarına göre timektomi etkinliğinin araştırılması amaçlandı.Gereç ve Yöntemler: Ocak 1995 ile Ocak 2004 arasında myastenia gravis nedeniyle sternotomi ve ekstended timektomi uygulanan 27 hastanın birinci ve beşinci yıllardaki klinik sonuçları istatistiksel olarak karşılaştırıldı.Bulgular: Hastaların postoperatif birinci ve beşinci yıllardaki klinik sonuçları arasında istatistiksel fark saptanmadı.Sonuçlar: Uzun dönem sonuçlarının iyi olması nedeniyle timektomi myastenia gravis tedavisinde güvenilir bir yöntemdir. Timektomi sonrası birinci ve beşinci yıllar sonunda elde edilen sonuçlar arasında farklılık yoktur
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    Diaphragmatic eventration
    (Akademisyen Yayinevi Kitabevi, 2021) Dural, Koray
    Diaphragmatic eventration is a clinical condition that often presents without symptoms. In this condition, all or certain parts of the diaphragm are located higher than normal. True diaphragmatic eventration occurs due to a congenital progressive disorder of the diaphragm muscle, and no pathology is observed in the sternum, ribs, and lumbar spine parts of the diaphragm. Diaphragmatic eventration is rare and is more commonly seen in males. The left hemi-diaphragm is more commonly affected. According to the embryological theory, abnormal or delayed migration of the myoblasts of the upper cervical somites leads to structural deficiency of the diaphragm muscle. In contrast to true diaphragmatic eventration, diaphragmatic paralysis is an acquired condition that usually occurs due to phrenic nerve damage caused by tumors or trauma.Diaphragmatic eventration can be bilateral, unilateral, total, or localized. The microscopic appearance of the affected section in eventration shows widespread fibroelastic changes and some muscle fibers. In children and infants, diaphragmatic eventration presents with prominent clinical findings, while most adult patients are asymptomatic and are usually diagnosed incidentally with a chest X-ray. It can become symptomatic in conditions that cause changes in weight gain, lung or chest wall compliance, especially in the elderly. Dyspnea (due to displacement of the affected hemi-diaphragm while lying in bed) and orthopnea are the main symptoms of a high hemi-diaphragm. Normal diaphragm movement during inspiration increases thoracic volume and provides the necessary space for proper lung inspiration. In patients with diaphragmatic eventration, there may be decreased, absent, or paradoxical diaphragm movement, as there is no normal diaphragm movement required for inspiration. As a result, ventilation and perfusion of the basal lung on the same side as the diaphragmatic eventration are impaired. Ventilation/perfusion mismatch and loss of chest wall compliance are among the factors contributing to dyspnea. Some patients may experience mild hypoxemia, which is compensated for by hyperventilation leading to mild respiratory alkalosis. Specifically, patients with left hemi-diaphragm eventration may experience nonspecific gastrointestinal symptoms such as epigastric pain, bloating, heartburn, belching, nausea, constipation, and growth retardation. Therefore, patients try to maintain an upright position to alleviate symptoms and may even prefer to sleep sitting up.The evaluation of symptomatic patients with diaphragmatic eventration should include assessment of dyspnea, physical examination, pulmonary function tests, and objective evaluation of imaging studies. The diagnosis of symptomatic hemi-diaphragmatic eventration is mainly based on clinical findings and is often dependent on the patient's history, chest X-ray, and the clinician's clinical attention. Conditions that may cause dyspnea, such as morbid obesity, heart failure, and chronic lung diseases, should be carefully examined and excluded through history taking. Physical examination provides a small contribution to the diagnosis of diaphragmatic eventration. However, two characteristic findings may be present: (1) paradoxical inward movement (also known as Hoover's sign), (2) abdominal paradox (thorax and abdomen move in an incongruous manner during inspiration). Pulmonary consolidation, decreased breath sounds, and frequent lung infections can occur together on the side with diaphragmatic eventration.Pulmonary function tests (PFTs) can provide useful objective information for the evaluation of dyspnea and patients with a high hemi-diaphragm, as forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) are generally decreased due to diaphragm dysfunction. Since the diaphragm plays a significant role in respiratory capacity, the evaluation of inspiratory PFT parameters is important. PFT evaluation should also be performed separately in the upright and supine positions. In patients with diaphragmatic eventration, lung volumes in the supine position are usually reduced by 20% to 50%. © 2021 Akademisyen Kitabevi A.Ş. All rights reserved.
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    İleri yaşta saptanan fibröz displazi: olgu sunumu
    (2018) Dural, Koray; Günal, Nesimi; Zorlu, Ekin; Kür, Salih; Atasoy, Pınar; Özpolat, Berkant
    Fibröz Displazi fibroosseöz dokunun medüller kemiğin yerini aldığı, özellikle kraniyofasiyal kemikler, uzun tübüler kemikler ve kosta tutulumu gösteren benign karakterde bir lezyondur. Bu olgu sunumunda 64 yaşında asemptomatik hastada malign dönüşüm ihtimali, kotta destrüksiyona ve patolojik kırıklara yol açabilme potansiyeli nedeniyle en bloc rezeksiyon uygulanan bir hastayı literatür eşliğinde sunduk.
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    Intrapericardial Gossypiboma in an Elderly Patient
    (Derman Medical Publ, 2013) Ozpolat, Berkant; Gunal, Nesimi; Yazkan, Rasih; Dural, Koray
    We report a case of surgically retained pericardial sponge in an 82-year-old man who underwent sternotomy for coronary artery bypass operation four years ago. After the operation the chest x-ray showed a radiopaque filament at the retrocardiac region. This case report shows the serial radiological examinations by computed tomographic scans over 4 years demonstrating a well-defined mass adjacent to left ventricle with a radiopaque filament inside with pseudocystic changes in time. As far as we know this case is the first one in the literature showing the changes in a case of gossypiboma, as the patient refused surgery.
  • Küçük Resim
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    Meteorological Conditions Related to the Onset of Spontaneous Pneumothorax
    (Tohoku Univ Medical Press, 2009) Özpolat, Berkant; Gözübüyük, Alper; Koçer, Bülent; Yazkan, Rasih; Dural, Koray; Genç, Onur
    Spontaneous pneumothorax is defined as the rupture of bleb or emphysematous bullae that develop just beneath the pulmonary pleura. Weather changes may influence the incidence of spontaneous pneumothorax. The aim of this study was to examine the influence of rainfall, temperature and atmospheric pressure changes on the onset of spontaneous pneumothorax. The study involved 669 spontaneous pneumothorax admissions to three reference hospitals in Ankara, Turkey between 1996 and 2006 (612 males and 57 females with the mean age of 34.0 +/- 15.5 years). The meteorological data were obtained from Turkish State Meteorological Services for temperature, atmospheric pressure, and rainfall. The correlation between these values and spontaneous pneumothorax clusters, which was defined as the admission of at least two patients with pneumothorax within three days of each other, was evaluated. Among 669 episodes of spontaneous pneumothorax, 472 (70.5%) occurred in 188 clusters. When compared to days without spontaneous pneumothorax, the amount of average rainfall on the day of admission with spontaneous pneumothorax, one day before and two days before the admission was significantly high. Similarly, the atmospheric pressure on one day and two days before the admission of spontaneous pneumothorax patients was significantly low. In addition, maximum temperature level was significantly lower on admission day of spontaneous pneumothorax patients compared to those on the days without spontaneous pneumothorax. This largest series of the literature shows that spontaneous pneumothorax occurs in clusters and suggests that rainfall, temperature and falls in atmospheric pressure might play a role in the pathophysiology of spontaneous pneumothorax.
  • Küçük Resim
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    A Rarely Seen Scapular Tumor: Chondrosarcoma
    (Derman Medical Publ, 2015) Gunal, Nesimi; Kaplan, Tevfik; Zorlu, Ekin; Ozpolat, Berkant; Dural, Koray
    Chondrosarcoma originating from scapula is a rare occurrence accounting 5-7% of all bone chondrosarcomas. They generally originate from new cartilaginous tissue and radiologically the lesion shows cortical destruction with lytic or expansile features. Although the mainstay of the treatment is surgery, the efficacy of chemotherapy and adjuvant therapy in case of residual tumour is still contradictory due to its rare occurrence. Here we present a 56-year-old woman with a swelling on her lump who was diagnosed as scapular chondrosarcoma. Here, the diagnosis and treatment and the approach to the microscopic residual tumour after surgical intervention was presented with the review of relevant literature.
  • Küçük Resim
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    Rib fracture posing risk for aortic rupture
    (Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2016) Gunal, Nesimi; Zorlu, Ekin; Kaplan, Tevfik; Dural, Koray; Ozpolat, Berkant
    A 50-year-old female patient was referred to emergency department with findings of shortness of breath and flail chest after a traffic accident. Her chest and abdomen computed tomography scan showed left hemopneumothorax, suspicious splenic bleeding, and multiple rib fractures. The fractured edge of the left sixth rib was posing a laceration threat against the descending aorta. After diagnostic laparotomy, left thoracotomy was performed, the fractured rib edge was resected before occurrence of any aortic injury, and the flail chest was stabilized. This article aims to draw attention to the importance of early intervention in posterior rib fractures posing injury threat against aorta and explain the possible mechanism.
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    Right Axillary Sweating After Left Thoracoscopic Sypathectomy in Two-Stage Surgery
    (Derman Medical Publ, 2013) Ozpolat, Berkant; Gunal, Nesimi; Dural, Koray
    One stage bilateral or two stage unilateral video assisted thoracoscopic sympathectomy could be performed in the treatment of primary focal hyperhidrosis. Here we present a case with compensatory sweating of contralateral side after a two stage operation.
  • Küçük Resim
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    Single port thoracoscopic sympathectomy for primary palmar hyperhidrosis in adolescence
    (Tubitak Scientific & Technical Research Council Turkey, 2014) Gunal, Nesimi; Ozpolat, Berkant; Gunal, Yasemin Dere; Dural, Koray
    Aim: Hyperhidrosis is defined as excessive sweating beyond the physiologic needs of a person. Palmar hyperhidrosis in the adolescent period may have an impact on school work and may cause psychological problems. In this study we aim to increase awareness of this disregarded problem. Materials and methods: We explicated the early outcomes of 7 consecutive adolescents, where single port video-assisted thoracoscopic sympathectomy was performed for primary palmar hyperhidrosis. Patients were evaluated for symptom resolution, which was defined as complete dryness, patient satisfaction, operative complications, and compensatory sweating. Results: In total 13 thoracoscopic procedures were done in 7 adolescents, consisting of 4 girls and 3 boys (median age = 16 years). Thoracoscopic sympathectomy achieved immediate complete dryness and all were very satisfied with the outcome of the procedure. Compensatory sweating was defined as mild by 4 (57%) patients. Conclusion: Thoracoscopic sympathectomy is safe and effective for the treatment of primary palmar hyperhidrosis in the adolescent period without any major side effects.
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    The comparison of pleurodesis effects of iodopovidone at different concentrations and magnesium silicate: An experimental study
    (Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2021) Zorlu, Ekin; Kur, Salih; Pekcan, Zeynep; Atasoy, Pinar; Gunal, Nesimi; Dural, Koray; Ozpolat, Berkant
    Background: This experimental study aims to investigate the pleurodesis effects of iodopovidone at different concentrations (2% and 4%) and sterile talc in a rat model. Methods: Forty male Wistar Albino rats were randomly divided into four equal groups including 10 rats in each group. Groups 1, 2, and 3 were designed as the study, and Group 4 as the control group. In Group 1, 4 g sterile talc was given in the slurry form at 20 mL 0.9% saline solution, in Group 2 and Group 3 10% iodopovidone solution were given at 4% and 2% concentrations, respectively, and in Group 4, 0.9% saline was only administrated as 3 mL into the pleural space. All rats were sacrificed on Day 30 and evaluated for macroscopic and microscopic examination. Microscopic evaluation was performed for alveolar collapse, alveolar hemorrhage, alveolar infiltration and fibrosis. Brain, liver, and kidney tissues were also examined. Results: Iodopovidone macroscopically caused a significant adhesion similar to sterile talc at a concentration of 4%. The pleurodesis effect of iodopovidone at a concentration of 4% was significantly similar to talc, when microscopic parameters were evaluated. Granulomas due to sterile talc were observed in the opposite hemithorax. Brain, liver, and kidney examinations revealed no systemic distribution for both agents. Conclusion: Iodopovidone is a powerful alternative to sterile talc with its easy accessibility and low cost. In this study, 4% iodopovidone was found to provide effective and safe pleurodesis in rats. We believe that the use of this concentration in clinical studies would provide more effective results.
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    TORAKAL SEMPATEKTOMİ ETKİNLİĞİNİN AVUÇ İÇİ ISI ÖLÇME YÖNTEMİYLE İLİŞKİSİ
    (2020) Dural, Koray; Özpolat, Berkant; Günal, Nesimi; Zorlu, Ekin; Kür, Salih
    Amaç: Hiperhidroz kişinin sosyal yaşam kalitesinde ciddibozulmaya ve psikolojik sorunlar oluşmasına yol açan, özellikleyüz, aksilla, palmar ve plantar bölgelerde yoğunlaşmış, normalfizyolojik ihtiyaçtan ve termoregülasyon için gerekenden dahafazla miktarda ter salgılanması olarak tanımlanmaktadır.Hiperhidroz tedavisinde topikal tedaviler, sistemik ilaçlar,iyontoforez, botulinum toksini enjeksiyonu, radyofrekansuygulamaları, psikoterapi veya cerrahi gibi çeşitli tedaviyöntemleri yer almaktadır. Her bir yöntemin kendine özgü farklıavantajları, dezavantajları, yan etkileri veya komplikasyonlarıbulunmaktadır. Tedavide günümüzde altın standart olarak kabuledilen ve kalıcı etki elde edilen tedavi şekli torakoskopik olarakyapılan sempatik blokajdır. Torakal sempatektominin sempatiksisteminin periferik vazodilatatör etkisiyle avuç içindeki ısıyı daartıracağı öngörüsüyle araştırmasını yapacağımız bu yöntemlesempatektomi seviyesini ve alanını sınırlı tutarak yan etkileriazaltabileceğimizi öngördük.Gereç ve Yöntemler: Çalışmamızda Endoskopik TorakalSempatektomi (ETS) uyguladığımız 21 hastada sempatik zincirbütünlüğünün kaybedilmesinin hemen öncesinde ve sonrasındaavuç içi ısı değerleri ölçülerek istatistiki karşılaştırmaları yapıldı.Bulgular: Torakal sempatik zincir bütünlüğünün bozulmasısonrası ölçülen avuç içi ısılarında müdahale öncesine göreistatistiksel olarak anlamlı artış bulundu.Sonuç: Operasyon esnasında avuç içi ısı takibi ETS’ninlokalizasyonun doğruluğunu takipte ve yan etkilerininazaltılmasında kullanılabilir.
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    Which Is More Effective for Minimally Invasive Pectus Repair: Epidural or Paravertebral Block?
    (MARY ANN LIEBERT, INC, 2020) Aydın, Gülçin; Şahin, Ahmet Tugrul; Gencay, Işın; Akçabay, Zeynep Nur; Günal, Nesimi; Dural, Koray; Özpolat, Berkant
    Objective: The aim of this study was to compare the effectiveness of epidural block (EDB) and paravertebral block (PVB) for minimally invasive pectus repair with the conventional method in terms of pain control during and after pectus operations, patient comfort, and length of stay in hospital. Materials and Methods: A retrospective review was made of patients who underwent minimally invasive pectus repair. The patients were allocated into three groups as follows: PVB group (Pre-emptive ultrasound-guided bilateral thoracic single injection PVB, n=15); EDB group (Pre-emptive landmark-guided single injection thoracic EDB, n=8); and Control group (Neither PVB nor EPB, n=9). The intraoperative analgesic requirement was recorded, and a visual analog scale (VAS) for pain evaluation and the Postoperative Patient Satisfaction Scale were applied to all patients. Results: The intraoperative analgesic requirement, VAS scores, postoperative satisfaction level, and time to first requirement for postoperative analgesia were different between the control and PVB groups (P<.001) and between the control and EDB groups (P<.001), but not different between the PVB and EDB groups. Although the length of stay in hospital was shorter in the PVB and EDB groups compared to the control group, the difference was not statistically significant (P=.422). Conclusion: Epidural and bilateral paravertebral blockades performed in conjunction with general anesthesia decrease the intraoperative and postoperative need for analgesics, and might be beneficial for pain management and contribute to a shorter length of hospital stay for patients undergoing minimally invasive pectus repair operations. Both blockades also significantly improved the patient satisfaction.