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Biomedical subjects

Ismail Gögenur

Publications and source records attributed to Ismail Gögenur.

9 recordsLinked to original sources
PubMed2007

Disturbances in melatonin, cortisol and core body temperature rhythms after major surgery.

BACKGROUND: It has been suggested that circadian rhythm disturbances are present after major surgery and that this may play a role in the development of postoperative sleep disturbances, fatigue, cognitive dysfunction and cardiovascular morbidity. The objective of this study was to examine the profile of melatonin, cortisol and core body temperature rhythms before and after major surgery. METHODS: Blood samples (melatonin and cortisol) and core body temperature readings were collected every hour in the 24-h period prior to surgery and the 48 h after surgery from 11 patients undergoing major abdominal surgery. All patients had private rooms. Light exposure was controlled and monitored. Phase markers [50% dim light melatonin onset (DLMO 50%) and offset (DLMOff 50%), cortisol and core body temperature acrophase] for the three circadian rhythm profiles were calculated before and after surgery. The correlation between the melatonin rhythm and time of surgery, duration of surgery and opioid use was examined. RESULTS: A median delay in the onset of melatonin was seen on the first postoperative day [median DLMO 50% 22:46 hours (range: 21:15-01:08 hours) on the preoperative day compared with 23:54 hours (range: 19:09-02:46 hours) on the first postoperative day; P </= 0.05] . A significant positive correlation existed between the duration of surgery and the time of melatonin onset (r = 0.67, P </= 0.05) . There was a significantly reduced basal secretion of melatonin immediately after surgery, with a subsequent significant increase in maximum melatonin values on the second postoperative night. A median delay of up to 4 h was seen in the timing of the peak of the temperature rhythm on the second postoperative day. Both cortisol secretion and core body temperature were increased after surgery and did not return to preoperative values in the 48 h of the postoperative study period. No significant correlation between opioid dose and the basal or maximum melatonin levels or the time of melatonin onset was found. CONCLUSION: We found disturbances in three circadian markers after major surgery. The clinical consequences of postoperative circadian disturbances should be investigated further in the future.

Abdomen↗
PubMed2006

[More paper--less research?].

Since the implementation of EU directive 2001/20/EF in May 2004, clinical research has become increasingly complicated to perform. The legal requirements are extensive with the result that clinical researchers find themselves spending more and more time on administrative procedures. The consequences will probably be that the amount of research will decline as a result of the new laws. We describe what the basic requirements for clinical researchers are today.

Biomedical Research↗
PubMed2006

Prevention of parastomal hernia by placement of a polypropylene mesh at the primary operation.

INTRODUCTION: Parastomal hernias occur frequently after placement of a permanent colostomy. Preliminary reports have shown a beneficial effect of placing a mesh at the primary operation to prevent the formation of a parastomal hernia. We studied the safety and prophylactic effect of placing a newly designed polypropylene mesh in an onlay position at the primary operation. METHODS: This was a prospective study that included 25 patients scheduled for elective colorectal surgery. Risk factors for development of parastomal hernia were recorded before surgery. A prepared lasercut polypropylene mesh with six "arms" was placed in an onlay position. Immediate and long-term complications were evaluated by an experienced stoma nurse and a surgeon. Abdominal ultrasound was performed at 6 and 12 months follow-up. Parastomal hernia was defined as both clinical and ultrasonographic signs of protrusion in the vicinity of the stoma. RESULTS: The median follow-up time was 12 (range, 2-26) months. One patient died eight days after surgery. Of the 24 patients included, none had infections or immediate complications after surgery. Two patients had minor complications necessitating a local revision of one of the mesh arms. No other long-term complication was found. Two patients had signs of parastomal hernia at 6 and 12 months follow-up, respectively. CONCLUSIONS: Placement of a polypropylene mesh in an onlay position at the primary operation is a safe procedure and probably results in a low risk of parastomal hernia occurrence.

Adult↗
PubMed2005

[Complications after treatment of colorectal cancer, with special focus on stomas, urological conditions and sexual dysfunction].

In spite of improved surgical principles in colorectal surgery, patients undergoing this operation still suffer from long-term postoperative complications. Many patients have permanent stomas, and up to 60% have problems related to their stomas, the most frequent of these being parastomal hernia. In this context, the use of primary prophylaxis with mesh insertion is encouraging. Before the introduction of total mesorectal excision (TME), there was a very high rate of bladder problems and sexual dysfunction with impotence and retrograde ejaculation. The rate has been reduced dramatically since the introduction of TME, but up to 5% of patients still suffer from permanent bladder dysfunction and complete impotence.

Colorectal Neoplasms↗
PubMed2005

[A simple model for training basic laparoscopic skills].

We have designed a new kind of black box for training laparoscopic skills. The model is simple and cheap, which makes the opportunities for training much more available. The design is based on the use of a webcam. The model is not a closed box but a table with the camera placed underneath, transmitting the image of the task being performed up onto a computer placed where the surgeon can see it. The open model makes lights and optics unnecessary. We recommend this model for basic laparoscopic training.

Animals↗
PubMed2005

[Endoscopic treatment of gastroesophageal reflux disease].

Gastroesophageal reflux disease (GERD) is highly prevalent in the general population, and the treatment is mostly medical. However, lifelong therapy with proton pump inhibitors is expensive, and some patients with GERD have surgery because of unsatisfying symptom control, poor compliance or lack of acceptance of lifelong medical therapy. In the last couple of years, four endoscopic treatment options for GERD have evolved. These are endoscopic suturing, gastroplication, local radiofrequency treatment and injection of biopolymer into the gastroesophageal junction. The results so far have been promising regarding symptomatic control and patient satisfaction. The lack of normalized pH in the lower esophagus, however, and the lack of a physiological background for the impressing symptomatic effect, plus the fact that there has been only one sham-controlled randomized clinical trial, suggest that carefulness should be exercised in utilizing the procedures until more solid evidence is available. The methods in themselves are promising, though, and will probably have a natural position in the future treatment of GERD.

Catheter Ablation↗
PubMed2005

[Laparoscopic cholecystectomy as an outpatient procedure].

INTRODUCTION: The aim of this study was to describe our experience with laparoscopic cholecystectomy as an outpatient procedure in terms of complications, same-day discharge, and a registration of patient' postoperative pain, convalescence and contact with general practitioners. MATERIALS AND METHODS: A prospective evaluation was done of the first 231 patients undergoing laparoscopic cholecystectomy in an outpatient clinic. RESULTS: Ninety per cent of the patients were discharged directly from the outpatient clinic, and a total of 93% of the patients were discharged within 24 hours of the operation. The readmission rate was 1%. Leakage from the cystic duct occurred in one case (0.4%), and no other injuries to the bile ducts were observed. The conversion rate was 1%. Within a week 54% of the patients had no pain and 55% of the patients had resumed normal activity. Postoperatively, 25% of the patients had contact with a general practitioner due to wound and other complaints that required no intervention. DISCUSSION: Laparoscopic cholecystectomy is very suitable as an outpatient procedure due to its high same-day discharge rate and high patient satisfaction combined with low readmission and complication rates. Our study did expose, however, a high number of postoperative contacts with general practitioners due to non-surgical problems, which emphasizes the need for better patient information and cooperation with general practitioners to optimize the outpatient procedure further.

Adolescent↗
PubMed2002

Lack of circadian variation in the activity of the autonomic nervous system after major abdominal operations.

OBJECTIVE: Most sudden postoperative deaths occur during the night and we conjectured that this was associated with circadian variations in the autonomic nervous tone, reflected in heart rate variability. DESIGN: Prospective clinical study. SETTINGS: University hospital, Denmark. SUBJECTS: 44 patients who had had major abdominal operations. INTERVENTIONS: Patients were monitored with 24-hour Holter ECG on the second postoperative day-evening-night. We calculated heart rate variability from the standard deviation of all normal R-R intervals (excluding ectopics-NN intervals) around the mean NN interval for the period of measurement (SDNN), the root mean square of the standard deviation of the differences between NN intervals (RMSSD), the percentage of NN intervals differing by more than 50 msec from adjacent NN intervals (pNN50) and the coefficient of component variance (meanNN/SDNN). MAIN OUTCOME MEASURES: Heart rate and heart rate variability. RESULTS: Circadian variation calculated from the SDNN (p = 0.43) the pNN50 (p = 0.11), the RMSSD (p = 0.47), and mean NN:SDNN ratio (p = 0.13) was absent postoperatively. Circadian variation in the heart rate was present but was set on a higher level compared with reference values. CONCLUSION: After major abdominal operations there was a lack of circadian variation in the autonomic nervous tone.

Adult↗