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Öğe Complications of percutaneous cordotomy(wiley, 2022) Yegül I.Percutaneous cordotomy is a procedure in which the spinal anterolateral ascending system for the transmission of nociception, known as the spinothalamic tract, is interrupted to relieve pain. Under computed tomography guidance, the needle is positioned so that its tip is directed to the anterior portion of the spinal cord. The major permanent complications of percutaneous cordotomy include loss of temperature sensation, mirror pain, headache, urinary complications, respiratory complications, Horner syndrome, epidural hematoma and post-cordotomy dysesthetic syndromes. Paresis may occur ipsilateral to the lesion, due to the effect of cord edema on the corticospinal tracts. Practitioners who perform cordotomy should be aware of patients' history of anticoagulation. Emergency decompression of epidural hematoma has to be performed in patients who are neurologically deteriorating. Transient hypotension can be seen following cordotomy. This is generally resolved by normal saline infusion. © 2022 John Wiley & Sons Ltd. All rights reserved.Öğe CT-guided percutaneous cordotomy for cancer pain relief [Kanser agrisi tedavisinde BT eşliginde perkütan kordotomi](2002) Yegül I.; Erhan E.CT-guided percutaneous cordotomy is one of the most useful procedures for patients with unilateral cancer pain. We evaluated the effectiveness and complications of CT-guided percutaneous cordotomy in this study. 234 patients who suffered from unilateral cancer pain underwent CT-guided percutaneous cordotomy. The procedure was repeated in 22 patients. Patients age (49 female/185 male) ranged from 17 to 83 years. Considering 256 procedures, complete pain relief was reported in 48.8 % of the patients where as satisfactory pain relief was reported in 40.2 % of the patients. The procedure was inadequate in the remaining 11.0 % of the patients. The most common complications were ipsilateral neck pain (164 %), nausea-vomiting (11.3 %), headache (6.6 %), transient motor deficit (6.6 %), and postcordotomy dysesthesia (3.1 %). The mortality rate of the procedure was 0.8 % (2 patients) and it was related to respiratory problems. In conclusion, CT-guided percutaneous cordotomy is a valuable procedure for the treatment of severe cancer pain syndromes with its low complication rate.Öğe Electrophysiological monitoring during CT-guided percutaneous cordotomy.(1995) Zileli M.; Coşkun E.; Yegül I.; Uyar M.During percutaneous cordotomy, impedance monitoring and electric stimulation have been widely used to enable a precise localization of the lesion electrode. The purpose of this study was to examine the possibility that the usage of additional electrophysiological techniques could help in improving the precision of the placement of the lesion electrode. Fourteen patients were monitored with 4 different techniques during CT-guided percutaneous cordotomy: 1) Median nerve somatosensory evoked potentials (mSEP): median nerve stimulation with recording from the scalp. 2) Spinal cord evoked potentials (SCEP): median nerve stimulation with recording via the cordotomy electrode. 3) Spinothalamic evoked potentials (SthEP): stimulation via the cordotomy electrode and recording from the scalp. Ipsilateral and contralateral mSEPs and SCEPs did not change after the lesion. SthEPs showed a significant decrease in 10 of 12 patients provided the stimulus intensity was kept below that producing a motor response (approx 0.5-1 mA). There was no obvious relationship between changes of the evoked potentials and the clinical outcome of the cordotomy. Our results suggest that there may be a relationship between the extent of the lesion and the decrease of the spinothalamic evoked potentials.Öğe Low-back pain algorithms [Bel agrilarinda algoritma](2003) Yegül I.Almost everyone experiences low-back pain at least once in the life-time. It is the most common morbidity cause under 45 years of age, and as a result of lost manpower and health expenses, it is a very, significant public health problem. The diagnostic and therapeutic approaches to the low-back pain has changed a lot during the last decades. It should always kept in mind that low-back pain is a multidisciplinary subject. The algorithms presented in this review will be the roadmaps for the clinicians to guide them during the treatment of low-back pain patient.Öğe Percutaneous invasive techniques in cervical pain [Servikal bölgeden kaynaklanan baş, boyun ve sirt agrilarinda perkutan tedavi girişimleri](2002) Yegül I.Cervical pain is one of the most common problems of the human beings. Most people suffer a period of cervical pain in their lives, which may be due to various etiological reasons. Cervical pain may originate from the facetal joints or the intervertebral discs. This may or may not be caused by degenerative changes. Muscular spasms, sympathetic involvement, neuropathy, and psychosocial factors may cause cervical pain. This review implies the invasive techniques of the cervical pain management. The invasive techniques, should be recognized when conservative therapy is insufficient and applied with right indications by experienced physicians in well equipped centers.Öğe The pharmacodynamic effects of rocuronium in morbidly obese patients [Morbid Obez Hastalarda Rokuronyumun Farmakodinamik Etkileri](2009) Ankan N.; Alper I.; Ulukaya S.; Balcioglu S.T.; Yegül I.Aim: In this study, we aimed to investigate the pharmacodynamic effects of rocuronium when dosed according to real or ideal body weights of morbidly obese patients and compare the results with normal body weight patients. Material and Methods: Sixteen morbidly obese patients (body mass index [BMI] >40 kg/m- 2) and 8 patients with normal body weights (BMI <30 kg/m- 2, control group) were given rocuronium (0.6 mg/kg iv) during application of anaesthesia The dose of rocuronium was based on the real (RBW, n=8) or ideal body weights (IBW, n=8) in morbidly obese patients. The neuromuscular blockade properties of three groups were compared. Results: The median onset time of rocuronium in the IBW group was significantly longer than that in the RBW and control group (210 versus 80 and 105 sec, respectively; p<0.05), while the duration of action was significantly shorter (28 versus 66 and 42 min, p<0.05). Any statistically significant difference in the recovery index were found between the groups (3.5 vs 4.5 and 2.5 min, p>0.05). Conclusion: Dosing rocuronium according to the ideal body weights in morbidly obese patients resulted in delayed onset time and shorter clinical duration when compared to the patients with normal body weights or morbidly obese patients who received rocuronium based on their real body weights. In addition to the type and duration of the operation, individually adjusted dosing may be required in morbidly obese patients when more rapid induction is necessary.Öğe Postherpetic neuralgia [Postherpetik nevralji](2002) Yegül I.Postherpetic neuralgia (PHN), which is one of the most intractable pain syndromes, is still missing a single treatment protocole. This is because of several peripheral and central mechanisms instead of a single mechanism that play role in PHN etiology. The description of PHN is made, its physiopathology is summarized and several prevention and treatment alternatives are explained in this review. The clinician should diagnose the PHN carefully, define the characteristics of the patient and establish a treatment plan with a multidisciplinary approach.
