PubMed Health⌕ Search

Biomedical subjects

U Demirkiliç

Publications and source records attributed to U Demirkiliç.

17 recordsLinked to original sources
PubMed2006

A randomized trial of intravenous iloprost (a stable prostacyclin analogue) versus lumbar sympathectomy in the management of Buerger's disease.

AIM: The aim of this study was to compare the effects of iloprost and lumbar sympathectomy (LS) in the treatment of Buerger's disease. METHODS: Two hundred patients with rest pain and/or ischemic ulcers were randomized to undergo LS or 28-day intravenous treatment of iloprost. The primary endpoint was complete healing without pain or major amputation at 4 and 24 weeks. The secondary endpoints were analgesic requirement, reduction in the ulcer size, 50% reduction of the ulcer, and shift in the modified SVS/ISCVS clinical status grading scale. RESULTS: The comparison was carried out in 162 patients (iloprost: n=84; LS: n=78). Complete healing rate was 61.9% in the iloprost group, but 41% in the LS group at the 4th week (P=0.012); respective values for the 24th week were 85.3%, 52.3%, P<0.001. Analgesic requirement was lower in the iloprost group at the 4th and 24th weeks (P=0.01, and P=0.098, respectively). The size of the ulcers decreased more in the iloprost group than the LS group (P=0.044 and P=0.035 at 4th and 24th weeks); 50% reduction in the ulcer size in the iloprost group was greater than in the LS group (P=0.001 and P=0.009 at 4th and 24th weeks). SVS/ISCVS grading scale demonstrated a better clinical benefit in patients treated with iloprost (P<0.001 at 4th week, and P<0.001 and at 24th week). CONCLUSIONS: The results of this independent study indicate that using iloprost relieves ischemic symptoms better than LS. In the era of stable prostacyclin analogues, there is no reliable evidence to support the use of LS in Buerger's disease.

Adult↗
PubMed2001

Simple de-airing technique for aortic valve replacement with upper ministernotomy.

Upper ministernotomy for aortic valve replacement is intimidating for many surgeons, not only for limited surgical exposure but also for the inability to complete de-airing the apex of the heart. Conversion to full sternotomy had been reported for this inability to de-air the apex of the heart in a limited number of cases. We describe a simple de-airing method by introducing a 16 GA catheter into the apex of the left ventricle through the aorta and prosthetic valve.

Aortic Valve↗
PubMed2000

The role of prothrombotic mutations in patients with Buerger's disease.

Thromboangiitis obliterans (TAO), or Buerger's disease, is a segmental occlusive inflammatory disorder of the arteries and veins, and etiopathogenesis is still obscure. In the present study we investigated the prevalence of prothrombin 20210 G-->A, factor V 1691 G-->A (Factor V Leiden), and factor V 4070 A-->G (His 1299 Arg) mutations, found to be associated with increased risk for vascular thrombosis, in 36 patients with TAO. We performed a case-control study of these mutations. The odds ratio for prothrombin 20210 A allele compared with G allele was 7.98 (95% confidence intervals 2. 45-25.93). Only this prothrombotic genetic factor was associated with the risk of TAO (p=0.032). In conclusion, carrying the prothrombin 20210 G-->A may be an important prothrombotic risk factor of TAO. This genetic predisposition must be screened in these patients routinely, and clinical importance must be supported by further investigations.

Adolescent↗
PubMed1999

Left atrioventricular valve repair technique in partial atrioventricular septal defects.

BACKGROUND: The aim of our study was to evaluate the effect of chordal transfer around the cleft on left atrioventricular valve competence in the late postoperative period. METHODS: Forty-four adult patients underwent surgical correction of partial atrioventricular septal defect between 1983 and 1997. Fenestration was found in 8 patients (18.2%) and cleft, in 35 (79.5%). There was no chordal support of the free edges of the left superior and left inferior leaflets around the cleft in 18 patients. Two chordae were mobilized from the left lateral leaflet and reimplanted into the tip of the left superior and left inferior leaflets around the cleft. RESULTS: At 5 years postoperatively, left atrioventricular valve insufficiency was severe in 5 patients and moderate in 11 patients who had had cleft closure alone. In contrast, severe valvular insufficiency was present in only 1 patient in the group with chordal transfer (p < 0.05). Reoperation was done in 5 patients with isolated cleft closure. Left AV valve replacement was performed in 1 patient. CONCLUSIONS: Chordal transfer plus cleft closure with interrupted sutures significantly reduces early and late left atrioventricular valve incompetence and also decreases the rate of reoperation.

Adolescent↗
PubMed1998

Surgical approach to military vascular injuries.

PURPOSE OF THIS STUDY: Vascular injuries caused by high-velocity military missiles are associated with bone fracture, soft-tissue, nerve and tendon injuries. In this study we will discuss the surgical strategy and results of vascular injuries, which require a different approach from primary and elective surgical procedure. BASIC METHODS: Surgical interventions were performed in 116 patients. Vascular lesions were localized on the lower extremity in 53, upper extremity in 55, and nine were in other regions. Vascular injuries were concomitant with bone fracture in 46 and nerve injuries in 36 patients. Vascular repair was performed after orthopedic stabilization in vessels with an ischemic period of less than 4 hours. PRINCIPAL FINDINGS: Fasciotomy was performed after vascular repair in the 22 cases that had arrived after 8 hours. Amputation was required in two cases. There was one mortality. CONCLUSIONS: The best results are obtained when a multidisciplinary and emergency approach are used by the team of vascular, orthopedic, plastic and neurosurgeons who are experienced in military injuries.

Adolescent↗
PubMed1997

Missed arterial injuries in military patients.

BACKGROUND: Military vascular injuries frequently result from fragment wounds while civilian vascular injuries usually are caused by gunshot wounds. The natural history of untreated major injuries by small low velocity fragments is not well known. This study evaluated the nature of these wounds. METHODS: From 1990 to 1995, 40 patients with a delayed diagnosis of an arterial injury in the extremity, abdomen, or neck were treated. The median delay between injury and diagnosis was 60 days. All patients had been seen at other military hospitals immediately after trauma. RESULTS: During initial hospitalization, immediate exploration had been performed in 23 patients and arteriogram in 3 patients. According to analysis of the records of patients, none of them had hard signs of vascular injury at the time of initial evaluation after trauma. Complications of missed arterial injuries included the following: false aneurysm, 21 (52.5%); arteriovenous fistula, 14 (35%); and occlusion, 5 (12.5%). The superficial femoral artery (n = 11) was the most commonly injured vessel. The remaining arteries included the following: carotid, 2; vertebral, 1; subclavian, 5; axillary, 2; brachial, 3; radial or ulnar, 2; internal iliac, 2; common femoral, 1; profunda femoris, 2; popliteal, 1; tibioperoneal, 8. Thirty-eight patients had penetrating wounds (21 fragments, 9 gunshot, 3 shotgun, 5 stab wounds), and only 2 patients had blunt trauma. All patients underwent surgery. There were no deaths and no loss of extremity, but 10 patients had fair results and only 4 patients required later reoperation. CONCLUSION: Traumatic arterial injuries that particularly are caused by low-velocity small fragment wounds can result in serious delayed complications months or even years after the injury. Patients with penetrating injuries must be closely monitored, and arteriography is recommended to evaluate the conditions of patients with potential vascular injury even when overt clinical signs or symptoms of vascular injury are absent.

Abdominal Injuries↗
PubMed1997

Aneurysms of the sinus of Valsalva.

OBJECTIVE: To evaluate the properties of the coexistent cardiac anomalies associated with the aneurysm of sinus of Valsalva (ASV) and examine the long-term surgical results after operation. PATIENTS: From 1980 to 1994, nine patients (median age 22 years) underwent surgical correction of ASV. Aneurysms originated from the right (n = 5), noncoronary (n = 3) and left coronary sinus (n = 1) and entered into right ventricle (n = 5), right atrium (n = 3). In one patient, ASV originated from the left coronary sinus and unruptured. Coexistent cardiac lesions were aortic valve insufficiency (n = 4), ventricular septal defect (n = 5), patent foramen ovale (n = 1), right ventricular outflow tract obstruction (n = 1) and coronary artery anomaly (n = 2). All patients were symptomatic (sudden onset of symptoms in 3, gradual onset in 6). INTERVENTIONS: Ruptured ASVs were repaired by double approach in which both the involved chamber and the aortic root. Concomitant aortic surgery was performed in four patients (2 replacement, 2 valvuloplasty). VSDs were closed by patch in 4 and by direct suture in 1. RESULTS: The incidence of coexisting coronary artery anomaly was 22.2%. There was no hospital and late mortality. The mean follow-up period was 6.8 years (range 1 to 14 years). There were no reoperation for leaks of VSD, recurrence of aneurysm and aortic regurgitation. Eight patients were found to be in New York Heart Association class I, one patient in class II. CONCLUSION: The risk of the recurrent fistula or VSD is prevented by double approach technique, and also this approach reduces the incidence of late aortic insufficiency. Routinely preoperative coronary angiography must be performed for determine of coronary anomaly.

Adult↗
PubMed1996

Postoperative aprotinin: effect on blood loss and transfusion requirements in cardiac operations.

BACKGROUND: Aprotinin has been used increasingly to reduce postoperative blood loss in open heart operations. Although it was reported as safe in earlier studies, the overall safety of prophylactic use has been questioned recently. Because of the potential for complications and the high cost, it will be reasonable to use aprotinin more selectively in the postoperative period. METHODS: We prospectively studied the effect of postoperative low-dose aprotinin (2 million kallikrein inactivator units [280 mg]) on blood loss and transfusion requirements in patients undergoing cardiopulmonary bypass. Seventy-five patients were randomly assigned to three groups: prophylactic high-dose aprotinin (group 1), postoperative aprotinin (group 2), or a nonmedicated control group (group 3). RESULTS: The three groups were comparable in all demographic and operative variables. Postoperative chest tube drainage was significantly decreased in both aprotinin groups compared with that in the control group (295 mL in group 1 and 325 mL in group 2 versus 411 mL in group 3; p < 0.05). No significant difference was seen between the two aprotinin groups. The use of homologous blood products was significantly less in group 1 and group 2 than in group 3 (1.15 +/- 1.13 U and 1.35 +/- 1.30 U versus 2.55 +/- 1.09 U; p < 0.05). CONCLUSIONS: Our results suggest that postoperative aprotinin reduces blood loss and transfusion requirements comparably with prophylactic high-dose aprotinin. Thus, one can restrict its use to patients with excessive postoperative bleeding.

Adult↗
PubMed1996

Hypertension increases the contractions to sumatriptan in the human internal mammary artery.

BACKGROUND: The internal mammary artery is the graft of choice for myocardial revascularization. The tendency to spasm increases toward the distal end of the internal mammary artery, which is the portion generally used for anastomosis. The distal internal mammary artery is more pharmacologically responsive to 5-hydroxytryptamine and several other vasoconstrictor agents than its midsection. METHODS: We examined the effects of 5-hydroxytryptamine and a 5-hydroxytryptamine1-like receptor agonist sumatriptan on internal mammary artery segments (length, 3-4 mm) obtained from patients undergoing coronary artery bypass grafting. To unmask a 5-hydroxytryptamine1-like receptor-mediated contractile response, threshold concentrations of potassium chloride were used. RESULTS: 5-Hydroxytryptamine induced concentration-dependent contractions in all, quiescent and potassium chloride precontracted, preparations. Sumatriptan induced marked contraction in some of the quiescent internal mammary artery rings, whereas it elicited marked and concentration-dependent contractions in all of the preparations given a moderate tone by a threshold concentration of potassium chloride. The sensitivity to sumatriptan was higher in potassium chloride-precontracted distal arteries than it was for the quiescent distal segments. Additionally, the sensitivity to and the efficacy of sumatriptan were much more markedly potentiated by precontraction in the preparations taken from hypertensive patients. CONCLUSIONS: The more marked potentiation of the responses in arteries from hypertensive patients may be one of the factors influencing the patency rates.

Aged↗
PubMed1996

Postoperative use of aprotinin in cardiac operations: an alternative to its prophylactic use.

BACKGROUND: Aprotinin reduces blood loss after cardiopulmonary bypass. Although there can be little doubt about the efficacy of aprotinin, its safety has been questioned recently and is still under investigation. Because of the potential for complications and the high cost, a selective strategy limiting drug delivery to patients with established postoperative bleeding will be more reasonable. METHODS: In a prospective, randomized, double-blind trial we studied the effect of postoperative low-dose (2 million kallikrein inactivator units) aprotinin on blood loss and transfusion requirements in patients undergoing cardiopulmonary bypass. Fifty-seven patients were randomly assigned to two groups: aprotinin or placebo. RESULTS: The two groups were comparable in all demographic and surgical variables. Postoperative chest tube drainage was significantly less in the aprotinin group than in the placebo group (410 ml vs 696 ml, p < 0.01). The use of homologous blood products was significantly less in the aprotinin group than in the placebo group (0.4 +/- 0.5 unit vs 1.7 +/- 0.9 unit for packed red blood cells and 0.8 +/- 1.3 unit vs 2.3 +/- 1.6 unit for fresh frozen plasma). CONCLUSIONS: Our results suggest that postoperative aprotinin reduces blood loss and transfusion requirements and provides the opportunity to restrict its use selectively to patients with excessive postoperative bleeding.

Adult↗
PubMed1996

Partially unroofed coronary sinus syndrome with persistent left superior vena cava, absent right superior vena cava and right-sided pericardial defect.

Partially unroofed coronary sinus syndrome with persistent left superior vena cava is a rare congenital anomaly. It frequently produces a right-to-left shunt. We report a case in which a large left-to-right shunt was present, because of the obstruction to left ventricular inflow as a result of the dilated coronary sinus. This abnormality was associated with absent right superior vena cava and a partial pericardial defect on the right side.

Adult↗
PubMed1995

Cor triatriatum: report of an unusual variant--triatrial heart. A case report.

Cor triatriatum is a rare cardiac malformation presenting with symptoms and signs of pulmonary venous obstruction. Although diagnosis of this defect has been facilitated by diagnostic procedures such as echocardiography and angiocardiography, it could be missed preoperatively. The authors report a case of cor triatriatum that is unique in having two separate atrial septal defects in each side of the fibromuscular membrane and that was undiagnosed preoperatively with transthoracic echocardiography and cardiac catheterization.

Child, Preschool↗
PubMed1993

Topical use of aprotinin in open heart operations.

Among various pharmacological agents used to reduce bleeding after open-heart operations, high-dose aprotinin therapy seems most promising. However, its long-term effects are still obscure; there is almost always possibility of bypass graft occlusions produced by the hypercoagulable state induced by aprotinin in coronary bypass operations. Topical application of aprotinin into the pericardial cavity could prevent the adverse effects. Fifty patients were prospectively studied to evaluate the effects of topical aprotinin. One million KIU of aprotinin was poured into the pericardial cavity before closure of the sternotomy in group 1 (n = 25). Patients in group 2 (n = 25) served as controls. Total postoperative bleeding was significantly reduced in group 1 when compared with that of group 2 (722.7 +/- 230.8 versus 1,282.6 +/- 225.7 mL; p < 0.01). The use of banked donor blood products was significantly less in group 1 than in group 2 (0.33 +/- 0.67 versus 1.36 +/- 0.86 units; p < 0.01). These results show that topical use of aprotinin reduces post-operative blood loss and need for transfusion. It seems promising and warrants further studies to be done.

Administration, Topical↗
PubMed1993

Exact positioning of intra-aortic balloon catheter.

The positioning of the intra-aortic balloon catheter in the descending aorta is vital for successful balloon pumping. With transesophageal echocardiography, the catheter could be properly and rapidly positioned in the descending aorta.

Catheters, Indwelling↗
PubMed1993

Intraoperative echocardiography: techniques and current applications.

Intraoperative echocardiography has opened new dimensions in the evaluation of cardiac surgical patients, and has contributed significantly to the improved surgical results. The use of intraoperative echocardiography has enabled the surgeon to image the working heart, to define the operative anatomy and physiology, and to evaluate the results immediately before the patients leave the operating room. This review summarizes the current status and applications of intraoperative echocardiography in the practice of cardiac surgery.

Echocardiography↗
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↗