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G Arslan

Publications and source records attributed to G Arslan.

At least 19 recordsLinked to original sources
PubMed2006

A comparison of pre-emptive analgesic efficacy of diflunisal and lornoxicam for postoperative pain management: a prospective, randomized, single-blind, crossover study.

Diflunisal and lornoxicam are currently available non-steroidal anti-inflammatory drugs (NSAIDs) that have been shown to be effective to various degrees in pain relief when administered either pre-emptively or postoperatively. The pre-emptive analgesic efficacy of diflunisal 1000 mg was compared with that of lornoxicam 16 mg in 40 ASA I patients undergoing surgical removal of bilateral impacted third molars. The impacted third molar teeth on one side were removed at the first surgical appointment using one of the two drug regimens being assessed and the teeth on the contralateral side were removed at a second appointment using the alternate drug regimen; all operations were performed by the same surgeon. Acetaminophen up to 2000 mg daily was provided as rescue medication. The postoperative rescue analgesic consumption was recorded and pain scores were evaluated with a visual analogue scale at 2, 4, 6, 12 and 24h postoperatively. No statistically significant differences were found between groups with respect to rescue analgesic consumption and postoperative pain scores. Pre-emptive administration of both NSAIDs proved to be effective in the management of pain following the surgical removal of impacted third molar teeth.

Adolescent↗
PubMed2006

Comparison of adsorption capacity of young brown coals and humic acids prepared from different coal mines in Anatolia.

Binding of Zn2+ and Cd2+ cations to relatively young brown coals YBC (lignite), humic acids (HAs) and commercial humic acid (CHA) were studied in aqueous media at pH 2.7-6 by polarographic method. This study was conducted to evaluate the removal of heavy metals in an aquatic system without prior treatment. The general principles of cation binding to YBC and humic materials are discussed. Sorption of heavy metal ions (Zn2+ and Cd2+) on samples of YBCs from three areas (Ilgin, Beysehir, and Ermenek) in the vicinity of the city of Konya in Anatolia (Turkey) were compared with sorption of these metal ions on HAs, prepared from these YBCs. The ability of both types of sorbent to remove metals from aqueous solutions was studied as a function of pH and concentration of initial metal solutions. Sorption depends strongly on pH, the origin of the YBC and on the nature of the metal ion. Whereas, for YBCs the main ligand groups seem to be carboxylate ions, this is not the case for the HA polymers, prepared from three YBCs, which differ substantially from properties of commercial samples of "HA". The process is very efficient especially in the case of low concentrations of pollutants in water, where common methods are either economically unfavorable or technically complicated. Of the two metal ions examined, Cd2+ was found to form the most stable HA complexes, followed by Zn. Effective removal of metals was demonstrated at pH-values of 5-5.7. The adsorption isotherm was measured at 25 degrees C, using adsorptive solutions at the optimum pH-value to determine the adsorption capacity. An important aspect of the proposed method was that the removal was performed on several metals at a pH-range in which a given metal undergoes an adsorption process making the method useful for wastewater treatment.

Adsorption↗
PubMed2006

A corner-saving ureteral reimplantation technique without stenting.

In this study we present our new technique, which will simplify reconstruction of even a small-caliber ureter. Our transplantation team has performed 1523 renal transplantation since 1975. From 1975 to 1983, we performed 300 ureteroneocystostomies using the modified Politano-Leadbetter technique. Since 1983, the extravesical Lich-Gregoir technique was used in combination with temporary ureteral stenting in 1141 patients. After September 2003, we began a corner-saving technique. Eighty-two (62 living related, 20 cadaver) renal transplantations have been performed since September 2003. The mean recipient age was 32.2 +/- 10.9 years (range, 7 to 63). Mean donor age was 38.9 +/- 13.1 years. For ureteral reimplantation, a running suture is started from 3 mm ahead from the middle of the posterior wall and finished 3 mm afterward. After the last stitch, both ends of the suture material are pulled and the posterior wall of the ureter and bladder are approximated tightly. The anterior wall is sewn either with the same suture or another running suture. Since using this technique, we have not employed a double J or any other stent to prevent ureteral complications at the anastomosis side. We have seen only two (2.4%) ureteral complications. In conclusion, due to the low complication rate, we believe that our new technique is the safest way to perform a ureteroneocyctostomy.

Adolescent↗
PubMed2006

Renal transplantation in children.

INTRODUCTION: Various immunological, metabolic, and technical factors render pediatric recipients with end-stage renal disease unique from their adult counterparts. In addition, the potential for complications after renal transplantation is far greater in children than in adults. In this study, we retrospectively analyzed 83 pediatric recipients who underwent kidney transplantation at our institution from 1975 to 2004. MATERIALS AND METHODS: From November 1975 to December 2004, 1523 renal transplantations were performed at our institution with 56 procedures in 83 pediatric patients (44 boys and 39 girls; age range, 7 to 17 years; mean age, 14.9 +/- 2.2 years). RESULTS: Long-term follow-up revealed the following morbidities in 14 (16.3%) recipients: lymphocele in 7 (8.1%) patients, perirenal hematoma in 2 (2.3%), graft renal artery stenosis in 2 (2.3%), ureteral stenosis in 2 (2.3%), and ureteral anastomotic leak in 1 (1.2%). Six (7.2%) recipients with a functioning graft died during follow-up (five deaths were infection related, and the cause of one death was unknown). Five grafts failed (four for immunological reasons and one as a result of recurrent disease). The 1-, 3-, 5-year patient and graft survival rates were 98%, 93%, 92% and 91%, 78%, 67% for living related transplantations versus 98%, 91%, 90% and 92%, 76%, 65% for cadaveric transplantations, respectively. DISCUSSION: Better outcomes for renal transplantation in children may be obtained by strict adherence to precise surgical techniques, better immunosuppressive management, and early diagnosis/effective treatment of complications.

Adolescent↗
PubMed2006

Respiratory problems in renal transplant recipients admitted to intensive care during long-term follow-up.

Cardiovascular disease, malignancies, and infectious complications are major causes of morbidity and mortality of renal transplant recipients. Mortality rates vary between 16% and 40% in an intensive care unit (ICU). The aims of this study were to identify the types incidences of respiratory problems that affected renal transplant recipients admitted to the ICU during long-term follow-up thereby determining the impact of respiratory problems on mortality. We reviewed the data for 34 recipients who had 39 ICU admissions from January 2000 through December 2003. Twenty-four admissions (61.5%) had at least one respiratory problem at admission or developed at least one during the ICU stay. The most frequent problem was pneumonia (n=18, 46.2% of the 39 readmissions), followed by acute respiratory failure (n=10, 25.6%), atelectasis (n=9, 23.1%), pleural effusion (n=8, 20.5%), and pulmonary edema (n=2, 5.1%). The patients who had respiratory problems showed a significantly higher mortality rate than those who did not have respiratory problems (66.6% versus 26.6%, respectively; P<.05). The overall mortality rate was 58.8% (20 patients). Thus, infectious and respiratory problems are the most frequent indications for admission and the most common problems during an ICU stay. The prognosis for patients who either have a respiratory problem upon admission to the ICU or develop one during the ICU stay is poor.

Adult↗
PubMed2006

Results of biliary reconstructions in liver transplantation at our center.

Biliary complications are some of the most critical problems in liver transplantation. Despite various refinements in surgical technique, different types of liver transplantations are associated with significant numbers of biliary problems. In this study, we analyzed the results of biliary reconstructions in 127 liver transplant recipients at our center from April 2001 to May 2006. Through November 2004, we used different techniques for biliary reconstruction in 66 of these patients, including duct-to-duct (DD) anastomoses, Roux-en-Y hepaticojejunostomy (RYHJ), anastomoses over T tubes or stents, and anastomoses without stenting. During the first period, we used a DD anastomosis in 15 cadaveric whole liver grafts and in 25 right lobe and 12 left lobe or left lateral segment grafts from living-related donors. RYHJ was preferred in 2 cadaveric and 12 left lateral segment grafts. Beginning in November 2004, we employed intraoperative transhepatic biliary catheter insertion in 61 patients (29 children, 32 adults). In the most recent 61 cases of 13 liver grafts from cadavers and 48 from living-related donors, 14 patients (2 children and 12 adults) received whole-liver grafts, 22 (all adults) a right lobe, and 26 (all children) a left lateral or left lobe. Intraoperative transhepatic biliary catheter insertion was performed with DD anastomosis in 55 cases and with RYHJ in 6 cases. The mean complication rate decreased from 24% to 8.1% during the period using a new biliary reconstruction technique. Five biliary complications occurred in four patients. The new technique of biliary reconstruction using intraoperative biliary catheter insertion has significantly reduced the biliary complication rate. Transhepatic biliary stenting prevents biliary complications and maintains percutaneous access when problems arise. Intraoperative transhepatic biliary catheter insertion at the back table is a safe way to provide good biliary drainage after liver transplantation.

Adolescent↗
PubMed2006

Liver transplantation in children weighing less than 10 kilograms.

Orthotopic liver transplantation (OLT) remains a major medical and surgical challenge in small pediatric patients. From April 2003 through October 2005, 17 infants (each of whom weighed less than 10 kg) underwent the procedure. Four were girls and 13 were boys (mean age, 15.7 +/- 9.3 months [range, 2-36 months]; mean weight at the time of transplantation, 7.4 +/- 2.6 kg [range, 6-10 kg]). All transplants were obtained from living-related donors. Sixteen left lateral segments and 1 left lobe were transplanted. The median graft-to-recipient weight ratio was 3.5% +/- 1.2% (range, 1.5%-6.1%). During the early postoperative period, hepatic arterial thrombosis was identified in 2 infants, and a biliary leak in 1. Hepatic arterial thrombosis was treated by reanastomosis with polytetrafluoroethylene grafting in the first patient and by surgical embolectomy in the second. The biliary leak was treated with percutaneous drainage. In 1 infant, portal vein stenosis, which was identified during the late postoperative period, was treated by percutaneous balloon dilatation. At this time, 14 (82.3%) infants were alive, exhibiting good graft function at a median follow-up of 11 months (range, 2-36 months). Three infants died: 1 on postoperative day 47 from adult respiratory distress syndrome, 1 on postoperative day 12 from sepsis, and 1 on postoperative day 65 from sepsis associated with EBV infection. Episodes of acute rejection, which occurred in 5 patients, were treated with pulse steroid therapy. On follow-up, histologic examination revealed hepatocellular carcinoma in 2 infants and Burkitt's lymphoma in 1 infant. Our data confirm that extensive use of living-related donors in liver transplantation can result in an excellent outcome for small pediatric patients.

Anastomosis, Surgical↗
PubMed2005

The effect of anesthetic technique on early postoperative renal function after donor nephrectomy: a preliminary report.

General and regional anesthesia may both be used successfully in donor nephrectomy although the use of regional anesthesia is rare. We compared the remaining kidney function during general (n = 10) versus combined spinal-epidural (n = 10) anesthesia for donor surgery. Blood biochemistry data were collected preoperatively and postoperatively, while renal function was assessed by scintigraphy and urine levels of microalbumin, creatinine, Na, K, Ca and creatinine clearance rate were measured/calculated in 24-hour urine samples collected preoperatively and on postoperative day 2. There were no differences preoperatively and on postoperative day 2 with respect to glomerular filtration rate, microalbuminuria, or creatinine clearance rate (P > .05 for all). There were also no differences between the groups with respect to other scintigraphic findings preoperatively and on postoperative day 2 (P > .05 for all). The results suggest that general or combined spinal-epidural anesthesia for donor nephrectomy have similar effects on the remaining donor kidney function.

Anesthesia, Epidural↗
PubMed2005

Living-related liver transplantation in pediatric patients.

INTRODUCTION: Many developments in surgical technique, immunosuppression, and patient selection criteria have led to improved long-term patient and graft survival in pediatric patients receiving liver transplants. In this study, we examined the early results of 26 pediatric recipients who underwent 26 liver transplantations between January 2003 and December 2004 at our institution. MATERIALS AND METHODS: The most common indications for liver transplantation were cholestasis in 10 patients (38.5%) and Wilson's disease in 8 (30.8%). Other indications were fulminant hepatic failure (4 patients, 15.4%), tyrosinemia (2 patients, 7.7%), Caroli disease (1 patient, 3.8%), and cryptogenic cirrhosis (1 patient, 3.8%). One recipient with Byler disease and two with tyrosinemia also had incidental hepatocellular carcinoma. RESULTS: Of 26 patients, 24 (92.3%) underwent living-related liver transplantation and 2 (7.7%) underwent cadaveric transplantation. The medical records of all patients were retrospectively reviewed. Twenty-two of 26 survived with excellent graft function, showing 91.2%, 86.4%, and 81.6% at 3, 12, and 24 months graft and patient survival rates, respectively. Sixteen patients (61.5%) developed various morbidities with biliary and vascular complications being the most common. Four patients (15.3%) developed bile leaks. Four patients (15.3%) developed hepatic artery thromboses. Five patients (19.2%) developed life-threatening infections. Four patients (15.4%) died during the study period, three owing to infectious complications. The other patient died due to acute respiratory distress syndrome. CONCLUSION: Despite technical difficulties and a donor organ shortage, the results of liver transplantation in pediatric patients with end-stage liver disease have demonstrated promising results at our institution.

Adolescent↗
PubMed2005

Pulse contour cardiac output system use in pediatric orthotopic liver transplantation: preliminary report of nine patients.

Anesthetic management of orthotopic liver transplantation (OLT) in pediatric patients is challenging in terms of intraoperative bleeding, fluid management, and hemodynamic monitoring. The pulse contour cardiac output (PiCCO) system, a relatively new device based on the single-indicator transaortic thermodilution technique, may be useful for intraoperative hemodynamic monitoring in pediatric patients. This is a preliminary report of PiCCO use in nine children (aged 9.8 +/- 4.7 years) undergoing OLT. Hemodynamic volumetric parameters monitored by the PiCCO system were mean arterial pressure (MAP), cardiac index (CI), intrathoracic blood volume index (ITBVI), extravascular lung water index (EVLWI), systemic vascular resistance index (SVRI), and stroke volume variability (SVV). All parameters were recorded at anesthesia induction (T0), at the end of the anhepatic phase (Tanhepatic), and at the end of operation (Tend). The PiCCO system revealed similar MAP, CI, EVLWI, SVV, and SVRI values at all measurement intervals. Despite similar central venous pressure measurements, ITBVI values indicated significantly lower values at Tanhepatic than at T0 (627 +/- 160 mL/m2 and 751 +/- 151 mL/m2, respectively, P = .013). There were no PiCCO catheter-related complications in any patient. These findings demonstrate that the PiCCO system is a safe, continuous, multiparameter invasive monitoring device for use in pediatric patients undergoing OLT. This system may provide valuable data during pediatric OLT and appears to be a promising monitoring tool in these patients.

Adolescent↗
PubMed2005

Internal jugular versus subclavian vein catheterization for central venous catheterization in orthotopic liver transplantation.

The aim of this study was to compare incidence rates of mechanical and infectious complications associated with central venous catheterization via the internal jugular vein (IJV) versus the subclavian vein (SV) among 45 consecutive patients undergoing orthotopic liver transplantation (OLT) between January 2000 and June 2004. The subjects were divided into two groups according to the site of central venous catheterization (IJV or SV). We recorded each patient's physical characteristics, international normalized ratio (INR), partial thromboplastin time, platelet levels, number of puncture attempts, success/failure of central venous catheterization, duration of catheter placement, occurrence of catheter tip misplacement, arterial puncture, incidence of hematoma or pneumothorax, catheter-related infection, or bacterial colonization of the catheter. Senior staff anesthesiologists performed 22 SV and 23 IJV catheterizations for the 45 OLT procedures. The SV and IVJ groups both had minor coagulation abnormalities with slightly increased INR values at the time of catheterization. There were no significant differences between the groups with respect to success of central venous catheterization (100% for both), numbers of attempted punctures, duration of catheter placement, and incidence rates of mechanical and infectious complications. Both groups showed high frequencies of catheter tip misplacement, with right atrium as the site of misplacement in all cases. Two patients in the IJV group (8.7%) developed hematomas after accidental carotid artery puncture. The results suggest that, when performed by experienced anesthesiologists, central venous catheterization via the SV is an acceptable alternative to IJV catheterization for patients undergoing OLT.

Adult↗
PubMed2005

Intra- and postoperative complications of donor nephrectomies.

INTRODUCTION: Living-donor renal transplantation has become common worldwide. However, living-donor nephrectomy is not a complication-free procedure. This retrospective study reviews the intra-and postoperative risks and complications of donor nephrectomies at our institution between 1994 and 2002. METHOD: Two hundred fifty-seven consecutive donor nephrectomy patients were evaluated using medical records and anesthetic charts. RESULTS: The mean age of living donors was 42 +/- 12 years: 19 were older than 61 years, and 143 (55.6%) were women. Anesthesia for donor nephrectomy included general anesthesia, combined spinal-epidural anesthesia (CSE), general + CSE, and general + epidural anesthesia. We observed 51 intra- and postoperative complications in 26 patients. The minor complication rate was 10.1%. The duration of surgery was 3.56 +/- 0.26 hours (range, 2 to 5 hours). Serum creatinine levels were increased significantly (P < .05) on postoperative days 1, 3, and 5 compared with the preoperative levels (P < .05). There was no mortality. CONCLUSIONS: Like other surgical operations, living-donor nephrectomy is associated with intra- and postoperative complications. Although these complications are minor, maximal efforts must be applied in the anesthetic approach to minimize donor complications, and donors should be informed about potential risks.

Adult↗
PubMed2005

Severe angioedema caused by banana allergy under tacrolimus immunosuppression.

Occurrences of allergic reactions induced by various foods have been reported in pediatric liver graft recipients receiving tacrolimus immunosuppression. We describe herein a female infant, who was admitted to our hospital with life-threatening angioedema because of banana hypersensitivity, 8 months after orthotopic liver transplantation. Food allergies should be screened in all tacrolimus-immunosuppressed pediatric liver recipients who show suggestive clinical symptoms. Banana must be added to allergen batteries during etiologic investigations. Cyclosporine represents an option for drug conversion to prevent organ rejection.

Biliary Atresia↗