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Öğe Acute kidney injury in burns in the intensive care unit: A retrospective research(Turkish Association of Trauma and Emergency Surgery, 2023) Kuvvet, Yoldaş, T.; Atalay, A.; Balcı, C.; Demirağ, K.; Uyar, M.; Çankayalı, İ.BACKGROUND: Acute kidney injury (AKI) is one of the common complications, associated with high mortality and morbidity in patients with burn injuries. This study aimed to determine the frequency of AKI development, its affective factors, and mortality rates according to kidney disease improving global outcomes (KDIGO) criteria in the burn patients. METHODS: The study included patients who are hospitalized for at least 48 h and aged >18 years, whereas patients with a renal transplant, chronic renal failure, undergoing hemodialysis, <18 years of age, with a glomerular filtration rate of <15 on admission, and toxic epidermal necrolysis was excluded from the study. KDIGO criteria were used to evaluate the occurrence of AKI. Burn mech-anism, total body surface area, inhalation injury respiratory tract burn, fluid replacement at 72 h with Parkland Formula, mechanical ventilator support, inotrope/vasopressor support, intensive care unit, lenght of stay, mortality, abbreviated burn severity index (ABSI), acute physiology, and chronic health evaluation II (APACHE II) ve Sequential organ failure assessment (SOFA) were recorded. RESULTS: A total of 48 patients were included in our study, of which 26 (54.2%) developed AKI (+), whereas 22 (45.8%) did not (?). The mean total burn surface area was 47.30% in the AKI (+) group and 19.88% in the AKI (?) group. Mean scores of ABSI, II (APACHE II), and SOFA, the mechanical ventilation and inotrope/vasopressor support and the presence of sepsis were significantly higher in the AKI (+). No mortality was determined in the AKI (?) group, whereas 34.6% in the AKI (+) group which was significantly high. CONCLUSION: AKI was related to high morbidity and mortality in patients with burns. Using KDIGOs, classification in daily fol-low-up is useful in early diagnosis. © 2023, Turkish Association of Trauma and Emergency Surgery. All rights reserved.Öğe Antinociceptive effect of tramadol-venlafaxine combination in neuropathic pain model(Wiley-Blackwell, 2004) Parlar, A.; Onal, A.; Uyar, M.; Uyar, M.; Dogru, A.; Soykan, N.Öğe Complex regional pain syndrome in a patient with spinal cord injury: management with pulsed radiofrequency lumbar sympatholysis(Nature Publishing Group, 2008) Akkoc, Y.; Uyar, M.; Oncu, J.; Ozcan, Z.; Durmaz, B.Study design: Short communication. Objectives: To report a case with bilateral lower extremity complex regional pain syndrome (CRPS) in a patient with paraplegia occurring following spinal disc herniation surgery, who was treated successfully with pulse radiofrequency (PRF) lumbar sympatholysis. Setting: Departments of Physical Medicine and Rehabilitation, Algology Department of Anaesthesiology and Nuclear Medicine, Medical Faculty of Ege University, Izmir, Turkey. Methods: A 55-year-old woman had neuropathic pain in her lower extremities after T12-L1 disc herniation surgery. The pain decreased to a tolerable level with conservative treatment and her condition remained stable for the following 6 months; then she developed swelling, redness and severe burning pain in both feet. Physical examination showed edema and redness in the feet. On the basis of clinical findings and Tc-99m methylene diphosphonate (MDP) three-phase bone scintigraphy, she was diagnosed to have CRPS. Results: The patient underwent a diagnostic sympathetic ganglion blockade with bupivacaine, which resulted in a marked decrease in the pain and edema of the feet. Consequently, PRF lumbar sympatholysis was performed with a successful outcome in pain, edema and color changes in the feet. Conclusion: When treatment of CRPS fails with conventional modalities, PRF sympatholysis may be used for control of pain and other symptoms in such patients.Öğe Does the tumor localization in advanced pancreatic cancer have an influence on the management of symptoms and pain?(Imprimatur Publications, 2010) Eyigor, C.; Karaca, B.; Kuzeyli-Yildirim, Y.; Uslu, R.; Uyar, M.; Coker, A.Purpose: The symptoms and survival of patients with advanced pancreatic cancer show great variability according to tumor localization. The main purpose of this study was to see for any differences between the intensity of symptoms, mainly pain, and the need for analgesic treatment in advanced pancreatic cancer patients with different (head vs. body-tail) tumor localizations. Methods: Ninety-six patients with histologically confirmed pancreatic cancer were enrolled in the study. The patients were divided into 2 subgroups according to tumor localization: group 1 (n=50) with head tumors and group 2 (n=46) with body and tail tumors. The demographic features of the patients as well as disease stages, onset of symptoms and necessity and consumption of analgesics were recorded. Patients were followed-up until death, and survival data was also analysed. Results: At the time of diagnosis, patients with body and tail tumors had more advanced disease stages compared to head tumors (p=0.006). While jaundice was the most common initial symptom in head tumors (p<0.0001), it was pain in body and tail tumors (p<0.001). Patients with body and tail tumors had more analgesics consumption as compared to those with head tumors (p=0.009). No statistically significant difference in survival was detected between the 2 groups (p>0.05). Conclusion: We believe that pancreatic cancer should be accepted as two diverse disease types according to tumor localization, and pain and symptom management should be organized based on this fact.Öğe The effect of oropharyngeal aspiration before position change on reducing the incidence of ventilator- associated pneumonia(Springer Science and Business Media Deutschland GmbH, 2020) Akbiyik, A.; Hepçivici, Z.; Eşer, I.; Uyar, M.; Çetin, P.The aim of this study was to investigate the effect of oropharyngeal aspiration on ventilator-associated pneumonia (VAP) incidence just prior to changing patient position. This randomized controlled experimental study was conducted between July 2015 and April 2019 in anesthesiology and reanimation of intensive care unit (ICU). The patients of experimental group underwent oropharyngeal aspiration under surgical aseptic conditions before each position change. Patients of the control group received oropharyngeal aspiration only as needed. The mean age of the patients was 62.87 ± 17.33 years. The mean and median duration of stay in the ICU were 27.28 ± 30.69 and 18.00 days respectively. The mean and median of duration of the mechanical ventilation support were 26.72 ± 30.65 and 18.00 (min 4; max 168) days respectively. Thirty percent of the patients were VAP. The mean duration of VAP development was 7.50 ± 5.07 days. The rate of VAP development was 11.23/1000 mechanical ventilator days. Only 8.3% of the experimental group patients developed VAP; 91.7% of the control group patients developed VAP. The VAP rate in the control group was 16.82/1000 mechanical ventilator days and the VAP rate in the experimental group was 2.41/1000 mechanical ventilator days. Most VAP agents were multidrug resistant. Distribution of isolated microorganisms was as Acinetobacter baumannii, Pseudomonas aeruginosa, Corynebacterium striatum, Staphylococcus aureus, Providencia stuartii, Serratia marcescens, Stenotrophomonas maltophilia, and Aspergillus flavus. In our study, it was concluded that oropharyngeal aspiration performed prior to patient position change prevented the development of VAP. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature.Öğe EFFECT OF OZONE PRECONDITIONING ON LIVER, KIDNEY AND LUNG HISTOPATHOLOGY AND SOD, THIOLS AND AIDA LEVELS EN EXPERIMENTAL SEPSIS(Springer, 2011) Boyacilar, O.; Uyar, M.; Eyigor, C.; Uyanikgil, Y.; Sezer, E.; Ates, U.; Moral, A. R.Öğe The Effects of Compliance with Nutritional Counselling on Body Composition Parameters in Head and Neck Cancer Patients under Radiotherapy(Hindawi Publishing Corp, 2017) Bicakli, D. Hopanci; Akagunduz, O. Ozkaya; Dalak, R. Meseri; Esassolak, M.; Uslu, R.; Uyar, M.Background. Radiotherapy (RT) has been associated with increased risk of malnutrition in cancer patients, particularly in those with head and neck cancer (HNC). The aim of this prospective study was to evaluate the effects of compliance of patients with individual dietary counselling on body composition parameters in HNC patients under RT. Material and Methods. Sixty-nine consecutive patients (mean age: 61.0 +/- 13.8) were prospectively followed. Bioelectrical impedance analysis (BIA) was performed to determine body composition parameters before, in the middle of, and at the end of RT. All patients received nutritional counselling and majority of them (94.6%) received oral nutritional supplement (ONS) during RT or chemoradiotherapy. If a patient consumed >= 75% of the recommended energy and protein intake via ONS and regular food, he/she was considered to be "compliant" (n = 18), while those who failed to meet this criteria were considered to be "noncompliant" (n = 30). Results. Body mass index, weight, fat percentage, fat mass, fat free mass, and muscle mass did not decrease significantly over time in compliant patients, but in noncompliant patients, all of these indices decreased significantly from baseline compared to the end of treatment (p < 0.001). Hand grip strength did not differ significantly between the two groups at baseline and over time in each group. When retrospectively evaluated, heavy mucositis was less commonly observed in compliant than noncompliant patients (11.1% versus 88.9%, resp.) (p < 0.009). Conclusion. We conclude that body composition parameters were better in head and neck cancer patients considered as compliant with nutritional counselling than noncompliant ones during RT period.Öğe The efficacy of intrathecal morphine in post-thoracotomy pain management(Cambridge Med Publ, 2007) Askar, F. Z.; Kocabas, S.; Yucel, S.; Samancilar, O.; Cetin, H. Y.; Uyar, M.This study compared the analgesic efficacy of intrathecal (IT) morphine plus IV patient-controlled analgesia (PCA) morphine with IV PCA morphine alone in 33 patients undergoing thoracotomy randomized to two groups: the IT morphine group (n = 17) received 10 mu g/kg morphine 1 h before the end of surgery, while the control group (n = 16) did not. All patients had access to an IV PCA pump post-operatively that delivered 2 mg morphine boluses. Post-operative pain and sedation scores, respiratory and haemodynamic parameters, and morphine demand and delivery were assessed up to 48 h. Post-operative pain scores and morphine consumption were significantly reduced, while peak expiratory flow rates were significantly increased in the IT morphine group compared with controls. We concluded that IT morphine in addition to IV PCA established superior analgesia and maintained better respiratory function compared with IV PCA alone in post-thoracotomy patients.Öğe EVALUATION OF SERUM CRP VALUES IN DIFFERENT STAGES OF SEPSIS(Springer, 2012) Ece, C.; Cankayali, I.; Bor, C.; Demirag, K.; Uyar, M.; Moral, A. R.Öğe The frequency of fibromyalgia syndrome and quality of life in hospitalized cancer patients(Wiley-Blackwell Publishing, Inc, 2009) Eyigor, S.; Karapolat, H.; Korkmaz, O. K.; Eyigor, C.; Durmaz, B.; Uslu, R.; Uyar, M.To explore the frequency of fibromyalgia syndrome (FMS) among hospitalized cancer patients and address the relationships between pain, fatigue and quality of life with regard to the extent of pain, a cross-sectional and descriptive study was carried out in the Oncology Supportive Care Unit on 122 hospitalized cancer patients. Pain, sleep, disease impact (Fibromyalgia Impact Questionnaire), fatigue (Brief Fatigue Inventory), quality of life (Short Form 36 and European Organization for Research on Treatment of Cancer questionnaires Quality of Life-C30) were gathered using standardized measures. Thirteen of the hospitalized cancer patients (10.7%) included in the study were diagnosed with FMS. There were no statistically significant differences among three pain groups with respect to demographic characteristics (P > 0.05). There were significant differences among groups with regard to the presence of metastasis, fatigue, sleep disorder, pain, Brief Fatigue Inventory, Fibromyalgia Impact Questionnaire, most of subscores of Short Form 36 and European Organization for Research on Treatment of Cancer questionnaires Quality of Life-C30 scores (P < 0.05). In the present study, we have calculated the frequency of FMS among patients admitted to the oncology hospital in addition to establishing the relationships between pain, fatigue and quality of life with regard to the extent of pain. We believe that the descriptive data presented in this study would be helpful in future studies and therapeutic approaches.Öğe Hopelessness in Turkish cancer inpatients: The relation of hopelessness with psychological and medical outcomes(Wiley, 2006) Oenen Sertoez, Oe; Kuzeyli, Y.; Yasemin, M.; Cicek, L.; Uyar, M.Öğe Implementation of the ESPEN guideline on clinical nutrition in the intensive care unit (ICU): It is time to move forward!: A position paper from the ‘nutrition in the ICU’ ESPEN special interest group(Elsevier Ltd, 2023) Thibault, R.; Bear, D.E.; Fischer, A.; Montejo-González, J.C.; Hiesmayr, M.; Tamási, P.; Uyar, M.Nutritional assessment and provision of nutritional therapy are a core part of intensive care unit (ICU) patient treatment. The ESPEN guideline on clinical nutrition in the ICU was published in 2019. However, uncertainty and difficulties remain regarding its full implementation in daily practice. This position paper is intended to help ICU healthcare professionals facilitate the implementation of ESPEN nutrition guidelines to ensure the best care for their patients. We have aimed to emphasize the guideline recommendations that need to be implemented in the ICU, are advised, or are optional, and to give practical directives to improve the guideline recommendations in daily practice. These statements were written by the members of the ICU nutrition ESPEN special interest group (SIG), based on a survey aimed at identifying current practices relating to key issues in ICU nutrition. The ultimate goal is to improve the ICU patients quality of care. © 2023Öğe Our clinical experiences in the earthquake victims who came to our university after the 2020 Aegean Sea earthquake during the COVID-19 pandemic(Turkish Association of Trauma and Emergency Surgery, 2023) Çağıran, Z.; Sertöz, N.; Karaman, S.; Özen, D.; Demirkoparan, M.; Uyar, M.; Aktuglu, K.BACKGROUND: Earthquakes are natural disasters that threaten human life and cause loss of life and property in a very short time. In our study, we aim to carry out the medical analysis of the earthquake victims who came to our hospital after the Earthquake in the Aegean Sea and to share our clinical experiences. METHODS: We retrospectively analyzed patients the medical data records of earthquake victims brought to our hospital or the injured who applied due to the Aegean Sea earthquake. Patients demographic data, their complaints and diagnoses, hour of admission, their clinical courses, hospital arrangements (admission, discharge, and transfer), time spent until the operation, anesthesia methods, surgical intervantions, intensive care needs, crush syndrome, presence of acute renal failure, number of dialysis, mortality, and morbidity were reviewed. RESULTS: A total of 152 patients were brought to our hospital due to the earthquake. The most intense period of admission to the emergency department was the 1st 24–36 h. Mortality rate was found to be higher depending on the increase of age. While the most common cause of admission for the mortal earthquake survivors was to be trapped in the wreckage, the survivors applied for other reasons as well such as falling down. The most common type of fracture observed in survivors was the lower extremity fractures. CONCLUSION: Epidemiological studies can make an important contribution to the management and organization of the future earthquake-related injuries by healthcare institutions. © 2023, Turkish Association of Trauma and Emergency Surgery. All rights reserved.Öğe Postoperative chronic pain after breast surgery with or without cancer: follow up 6 months(Lippincott Williams & Wilkins, 2014) Turan, M.; Karaman, Y.; Karaman, S.; Uyar, M.; Gonullu, M.Öğe THE PREDICTIVE VALUE OF BRAIN ARREST NEUROLOGICAL OUTCOME SCALE ON MORTALITY AFTER CARDIAC ARREST(Springer, 2010) Sahutoglu, C.; Uyar, M.; Demirag, K.; Isayev, H.; Moral, A. R.Öğe A rare cause of headache; case report of trigeminal neuralgia concomitant with idiopathic intracranial hypertension(2023) Özalp, Horsanalı, B.; Yılmaz, H.; Uyar, M.; Eyigör, C.Trigeminal neuralgia (TN) is the condition of sudden, usually unilateral, very short-lasting, stinging, and recurrent pain in the distribution area of one or more branches of the trigeminal nerve. Idiopathic intracranial hypertension (IIH) is an increase in intracranial pressure associated with normal cerebrospinal fluid composition that is not due to a secondary cause. Although not frequent, the association of IIH and TN has also been reported. We aimed to present a rare case report in which TN is concomitant with IIH. A 56-year-old female patient was admitted to our clinic with the complaint of jabbing pain that may feel like an electrical shock on the right side of her face. In the patient's history, she was diagnosed with TN 8 years ago. She had a lightning-flashing pain in the area corresponding to the right mandibular nerve dermatome. Her pain attacks lasted 1-2 min, and recurring 15-20 times during the day. In the CISS sequence cranial MRI, bilateral perioptic CSF distance showed mild prominence, prominence in Meckel caves, and empty sella appearance features. These findings were found to be compatible with intracranial hypertension. As a result,based on these findings, the patient was diagnosed with TN or trigeminal neuropathy accompanying IIH. While patients diagnosed with TN may be associated with IIH, also trigeminal nerve may be affected, although not as much as other cranial nerves in patients with a diagnosis of IIH. The use of cranial MRI may prevent an additional pathology to be missed.Öğe Scintigraphic Methods in the Evaluation of Brain Death and Their Correlation with Clinical Examination and Apnea Test(Springer, 2011) Yararbas, U.; Argon, M.; Cankayali, I.; Uyar, M.; Moral, A. R.Öğe Should interventional pain management in patients with pancreatic cancer be guided by tumor localization?(Zerbinis Medical Publ, 2010) Eyigor, C.; Pirim, A.; Uyar, M.Purpose: To investigate the impact of pancreatic cancer localization in relation to the response to different interventional pain management methods and determine the method most suitable for satisfactory pain control. Methods: Interventional pain management was carried out by sympathetic block or spinal analgesia. Patients were allocated into 2 groups according to the tumor localization, namely group 1 (n=61; patients with pancreatic cancer confined to the head of pancreas), and group 2 (n=55; patients with pancreatic cancer confined to the body or tail of pancreas). Results: Among the patients who had interventional pain management, sufficient analgesia was achieved by sympathetic block in 9 of the 14 (64.3%) of them in group 1 and only in 3 of the 11 (27.3%) patients in group 2. Spinal analgesia was used in 5 of the 14 (35.7%) patients who required interventional pain management in group 1 and in 8 of the 11 (72.7%) patients in group 2 (p> 0.05). Conclusion: Pain palliation could be achieved by sympathetic block in patients with cancer localized in the head of pancreas while patients with tumor localized in the body and tail experienced sufficient pain palliation by spinal analgesia rather than sympathetic block.Öğe Spinal tüberkülozda (Pott Hastalığı) multimodal analjezi(2011) Eyigör, C.; Pirim, A; Çağıran, E; Uyar, M.Spinal tüberküloz (Pott Hastalığı) bel ağrısının nadir fakat morbidite oranı yüksek nedenlerinden biridir. Hastalarda hem somatik hem de nöropatik nitelikte siddetli ağrı olusabilir. 70 yasında, kadın hasta, 4 yıl önce Pott Hastalığı tanısı konulmus ve opere edilmis, siddetli ağrı sikayeti (VAS=10/10) ile kliniğimize basvurdu. MRG’de T7-T8 omurlarında siddetli yıkım, çökme ve sinir basısı mevcuttu. Hasta aynı nedenle 2 kez opere edilmisti. 100 mgr TTS fentanil, 400 mg/gün tramadol ve 4 gr/gün parasetamol kullanımına rağmen yeterli ağrı kontrolü sağlanamayan hastaya, 2x75 mg/gün pregabalin baslandı ve etkin doz olan 2x150 mg/gün’e çıkıldı. Hastanın 18. ay kontrolünde, 300 mg/gün pregabalin, 25 mgr fentanil TTS, 200 mg/gün tramadol, 2 gr parasetamol tedavisiyle hafif ağrısının (VAS: 2/10) olduğu, yürüteç yardımıyla yürüyebildiği ve günlük islerini kısmen yapabildiği saptandı. Olgumuz, Pott Hastalığı’nda multimodal analjezide pregabalinin kullanıldığı ilk olgu özelliğindedir.Öğe Weaning uygulanan yoğun bakım hastalarında PSV ile MRV modlarının metabolik parametreler üzerine etkisi(2013) Demir, H.F.; Demirağ, K.; Bor, C.; Uyar, M.; Eriş, F.O.Amaç: YB hastalarının yaklaşık %90’ı mekanik ventilasyon desteğine ihtiyaç duyar. Uzamış mekanik ventilasyon morbidite ve mortaliteyi arttırmaktadır. Mekanik ventilasyondan ayrılma (weaning) bu nedenle çok önemlidirÇalışmamızın hipotezi; weaning döneminde mandatory rate ventilation (MRV)’nin, pressure support ventilation (PSV)’ye göre, metabolik parametreler üzerinde daha olumlu etkisi olacağıdır. Bu amaçla metabolik parametrelerden oksijen tüketimi (VO2), karbondioksit üretimi (VCO2) ve enerji tüketimi (EE) ölçülerek karşılaştırıldı. Gereç ve Yöntem: Çalışmamızda 18 hasta dahil edildi. Hastalar kontrole modda iken indirekt kalorimetri cihazı ile bazal metabolik ölçüm yapıldı. Sonra hastalar randomize olarak PSV veya MRV modlarından birine ayrıldı. Hastalar toplam 60 dakika süresince izlendi. Solunum sayısı (SS), solunum mekanikleri, VO2, VCO2 ve EE değerlerkaydedildi. Bulgular: Tüm metabolik parametreler her iki grupta bazal ölçümden sonra anlamlı artış gösterdi, fakat % değişim açısından gruplar arasında farklılık gözlenmedi. İstatistiksel anlamlılık olmamakla birlikte, 30. dakikadan sonra metabolik parametrelerin PSV grubunda yükselmeye devam ederken MRV grubunda stabil olduğu belirlendi. Sonuç: İstatistiksel anlamlılık olmamakla birlikte klinik olarak MRV’nin weaning uygulanan hastalarda PSV’ye göre metabolik açıdan daha stabil koşullar sağladığı kanaatine varıldı.
