Biomedical subjects

H Bingöl

Publications and source records attributed to H Bingöl.

6 recordsLinked to original sources

PubMed2001

[Therapeutic approach in vascular injuries of the lower extremity: Amputation or limb salvage].

The management of lower extremity trauma with vasculary involvement should be directed toward to the salvage of the extremity or to the primary amputation according to the additional pathologies, parameters of the patient and the extremity. We investigated the efficiency of Mangled Extremity Severity Score (MESS) system which is proposed as an grading system to evaluate the change to extremity salvage or the risk for onset of systemic complications. 81 patients with lower extremity trauma were analyzed according to MESS criteria. 79 of the patients were men and mean age was 23 +/- 4. Fourteen patients had higher MESS score. (MESS > 7). Seven of them were older than 50 years. Primary amputation was performed in four of these 7 patients. Vascular repair was performed in three of patients. Multiorgan failure was developed in two of them and both patients died. Secondary amputation was performed to another patients underwent vasculary repair who had MESS > 7 score. Primary amputation was not performed directly in young patients who had MESS > 7. Secondary amputation was required in two of these patients. MESS scoring system can easily predict amputation in older patients but may cause unnecessary amputation in young patients.

Adolescent↗

PubMed1997

Long-term prevention of atrial fibrillation after coronary artery surgery.

UNLABELLED: We researched the necessity of quinidine fumarate or acebutolol prophylaxis in patients in whom atrial fibrillation occurred in the postdischarge period and returned to sinus rhythm after coronary artery surgery. DESIGN: Prospective review. PATIENTS: Since 1992, 60 patients were chosen in whom atrial fibrillation occurred in early postoperative period. There were no significant differences between them and they were separated into 3 groups. In group I (20 patients) we did not give any drug, in group II (20 patients) quinidine fumarate was given and in group III (20 patients) acebutolol was given and patients were controlled for 90 days. RESULT: Atrial fibrillation occurred in one patient in group I, (5%), two in group II (10%) and two in group III (10%), (p < 0.05). Different from the other groups, atrial fibrillation was asymptomatic with low ventricular response in group III. CONCLUSIONS: There were no significant differences among three groups statistically, so we suggested that long-term prevention of atrial fibrillation with quinidine fumarate or acebutolol was not necessary after coronary artery surgery.

Acebutolol↗

PubMed1996

Gastrointestinal complications after cardiac surgery.

OBJECTIVE: Gastrointestinal (GI) complications after cardiac surgery with cardiopulmonary bypass (CPB) are uncommon complications with significant morbidity and mortality rates. METHODS: From 1988 to 1995, 36 GI complications were identified in 3158 patients who underwent cardiac surgery (1.14% incidence). The mortality rate was 13.9%. Complications included hemorrhage in the GI tract in 22, perforated ulcer in 3, acute cholecystitis in 3, pancreatitis in 2, mesenteric ischemia in 3, diverticulitis in 1 and liver failure in 2 patients. RESULTS: Clinical risk factors included advanced age, combined coronary artery bypass grafting (CABG)-valve operation, postoperative low cardiac output (LCO), prolonged ventilation time, re-exploration of the chest, sternal infection and a positive history of peptic ulcer. Patients with a prolonged pump time had an increased risk of GI complications (P < 0.001). CONCLUSIONS: Gastrointestinal complications, although of low incidence, carry a significantly high mortality, and the clinician must be alert to institute early appropriate treatment.

Adolescent↗

PubMed1996

Late posterior cardiac tamponade after open heart surgery.

OBJECTIVE: Late cardiac tamponade after open heart surgery is a relatively uncommon, but potentially serious complication. We retrospectively analyzed 14 patients who had posterior cardiac tamponade 13 to 210 days after open heart surgery. PATIENTS: Between May 1988 and July 1995, 3150 adult patients underwent open heart surgery at the Gülhane Military Medical Academy. In 35 of 3150 patients (1.11%) late pericardial effusions developed, and in 14 (0.44% of 3150 consecutive open heart surgery performed on adult patients in our center) of these patients had posterior tamponade. There were moderate symptoms including fatigue, malaise, and dyspnea on exertion in all patients. The diagnosis was made by echocardiography in 13 patients, and by tomographic scanning in 1 patient. Analysis of these 14 patients revealed that all of them had hemodynamic criteria consistent with tamponade physiology on right heart catheterization with Swan-Ganz catheters. RESULTS: Echocardiography guid pericardiocentesis through the left anterior axillary line was effective in decompressing of posterior cardiac tamponade in 10 of 14 patients. Three patients required operative surgical drainage after unsuccessful pericardiocentesis through subxiphoid area. Two patients who underwent surgical drainage died, and in one patient surgical pericardiotomy had complete evacuation of posterior pericardial fluid with major complication. CONCLUSIONS: 2-D echocardiography guid pericardiocentesis through left anterior axillary line was found to be a useful, safe, and simple technique. It can be used as an alternative treatment to surgical pericardiotomy for posterior cardiac tamponade after open heart surgery.

Adult↗

PubMedDate not supplied

Discrete subaortic stenosis: assessing adequacy of myectomy by transesophageal echocardiography.

BACKGROUND: Membranectomy and myectomy are standard therapy for discrete subaortic stenosis (DS) and are associated with low rates of endocarditis, recurrence, and aortic insufficiency. Extensive myectomy increases risk of complications such as conduction tissue damage and iatrogenic ventricular septal defect (VSD). MATERIALS AND METHODS: Forty-five adult patients with DS underwent operations in Gulhane Military Medical Academy. Exertional dyspnea was the principal symptom in 29 (64.4%) patients. Transesophageal echocardiography (TEE) was performed routinely in all patients to assess the length and depth of needed myectomy during the perioperative period. Aortic insufficiency (AI) was also noted preoperatively in 31 (68.9%) and a history of aortic valve endocarditis was present in 4 (8.9%) patients. RESULTS: Myectomy was performed according to TEE measurements. An average of 10 mm in width, 10 mm in depth, and 2.3 mm in length of septal tissue was resected. The mean left ventricle-aorta peak systolic gradient decreased from 70.2+/-9.7 to 17.2+/-2.7 mmHg (p < 0.001). Aortic valve repair was performed in 8 (7.8%) patients and aortic valve replacement in 11 (24.4%) patients at the initial operation. Iatrogenic VSD did not occur in any of the patients. Average postoperative left ventricular outflow tract diameter was 21+/-1.5 mm. Temporary complete heart block occurred in three patients. There was an early residual gradient (36+/-8 mmHg) resulting from temporary hypercontraction that decreased (18+/-5 mmHg) in the first postoperative day. CONCLUSIONS: Myectomy under perioperative TEE measurement is safe and effective in the treatment of DS. TEE-guided myectomy reduces complications such as complete heart block and iatrogenic VSD.

Adolescent↗

PubMedDate not supplied

Left ventricular endoaneurysmorrhaphy: effect on left ventricular size, shape and function.

Left ventricular (LV) endoaneurysmorrhaphy is a relatively new surgical procedure with excellent results. Forty-five patients underwent surgical repair of LV aneurysm with LV endoaneurysmorrhaphy from 1991 to 1995. The main indication for operation was angina pectoris (71%). Concomitant myocardial revascularization was performed in 97% of the patients. The operative mortality rate was 2.2%. Pharmacologic inotropic support was required in 31% and mechanical support in 15%. Mean echocardiographic ejection fraction improved from 29.6% preoperatively to 48.3% postoperatively (p <0.001). LV end-diastolic volumes were 195 +/- 63 and 118 +/- 44 ml before and after surgery (p <0.01). Intraoperative transesophageal echocardiography revealed normal or near-normal LV shape in all cases. The mean follow-up was 34.0 +/- 9.2 months (16-50 months) and 1 patient died 9 months postoperatively. We conclude that endoaneurysmorrhaphy improves LV geometry and function in patients with LV aneurysms and can be performed with low surgical risk even in patients with large aneurysms and severely depressed LV function. ........

Adolescent↗