Tıpta Uzmanlık Tezleri
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Publication Acil serviste troponin yükselmesini tahmin etmede lökosit, trombosit sayıları ve nötrofil/lenfosit oranının yararı / The benefit of leukocyte and platelet counts and neutrophil/lymphocyte ratio for predicting elevated troponin levels in emergency department(Bezmialem Vakıf University, 2015) Uğurlu, Yusuf; SÖNMEZ, ErtanObjective: We aimed to find out whether the number of leukocyte, platelet and neutrophil / lymphocyte ratio of the patients, who were admitted to the emergency department with the complaints suggestive of acute coronary syndrome (ACS) and who requires troponin monitorization, at admission had positive predictive value in identifying the patients in whom troponin value becomes positive and who are considered as non-st-segment elevation myocardial infarction (NSTEMI). Materials And Methods: Three hundred twenty-eight patients who were admitted to the emergency department with chest pain and the complaints suggestive of ACS and whose electrocardiograms (EKG) did not reveal ST elevation were examined retrospectively. A total of 163 patients whose troponin values were elevated and who were diagnosed with NSTEMI were included as the study group while 165 patients in whom ACS was excluded according to the American Heart Association (AHA) 2014 Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS) management guideline and who were discharged from the emergency department with the diagnosis of non-cardiac chest pain were included as the control group. The leukocyte count, platelet count, neutrophil / lymphocyte ratio and routine tests were compared among groups by the Statistical Package for Social Sciences (SPSS) for Windows 22.0 program. Results: When the patients of the study and control groups were compared in terms of cardiovascular risk factors, the parameters of age, gender distribution, family history, and history of coronary artery disease (CAD) did not show statistical difference between the two groups (p ˃ 0.05) whereas diabetes mellitus, hypertension, hyperlipidemia and smoking rates were found to be significantly higher in the study group compared to the control group (p = 0.006, p = 0.0.009, p = 0.011, p = 0.009). The leukocyte value and neutrophil / lymphocyte ratio were found to be significantly higher in the study group compared to the control group (p <0.001) while the platelet count was found to be significantly lower in the study group compared to the control group (p <0.001). In the Receiver operating curve (ROC) curve analyses, the cutoff value, sensitivity and specificity were determined to be 9.10 * 3 / uL, 74%, 70.8% for leukocyte, 235.10 * 3 / uL, 71.3%, 72% for platelet and 2.5, 84.8%, 71.9% for the neutrophil / lymphocyte ratio, respectively. Conclusion: Having leukocyte value over 9.10 * 3 / uL and neutrophil / lymphocyte ratio over 2.5 and having platelet value below 235.10 * 3 / uL in the initial blood samples of the patients, who were admitted to the emergency department with the complaints suggestive of ACS, predict the patients with troponin increase during monitorization. We suggest that these parameters may be used in conjunction with other cardiac parameters for the diagnosis of NSTEMI in the patients who are admitted to the emergency department with chest pain or the complaints suggestive of ACS and who require troponin monitorization. Keywords: Emergency Room, Acute Coronary Syndrome, Leukocyte, Neutrophil / Lymphocyte ratio, Platelet, TroponinPublication Açık açılı glokom olgularında minimal invaziv cerrahi tekniği olarak jel stent implantasyonunun etkinlik ve güvenilirliğinin değerlendirilmesi / Evaluation of efficiency and safety of gel stent implantation as minimal invasive surgery technique in open angle glaucoma(Bezmialem Vakıf University, 2018) HAMZAYEV, Igbal; UMURHAN AKKAN, Jülide CananPurpose : To evaluate the performance and safety of an ab interno gel stent, a minimally invasive glaucoma surgery device, in open angle glaucoma Materials and Methods : Medical records of 18 eyes of 15 patients undergone gel implantation with the same surgeon and same technique between June 2016 and April 2017 in the glaucoma unit of our clinic were evaluated retrospectively. Complete success was defined as intraocular pressure (IOP) reduction ≥20% from preoperative baseline without any glaucoma medications while partial success as IOP reduction of ≥20% with medications. Failure was defined as vision loss of light perception or worse, need for additional glaucoma surgery, or <20% reduction of IOP from baseline. Results : Mean intraocular pressure dropped from 20.4±4.1 (15-30) mmHg pre-op to 11±4.1(5-18), 12.6±3.9 (7-20), 13.3±2.7 (8-18), 13.5±3.1 (8-19), and 14.2±3.2 (8-21), 14.2±2.3 (11-17) mmHg at 1 week, 1, 3, 6, and 12 months (p < 0.001, Wilcoxon signed ranks) consecutively. Mean number of medications dropped from 2.2±0.7 preoperatively to 0.5±0.6 (p <0.001) at 1-year follow-up. 46.6% of eyes achieved complete success and 86.6% qualified success. Complications included hyphema in 2 eyes, and implant extrusion in 1 eye, and 1 eyes underwent trabeculectomy. Conclusion : Gel implant was an effective surgical treatment for open-angle glaucoma and a significant reduction in intraocular pressure and glaucoma medication was observed at with an average follow-up of 10.7 ± 2.4 months . Key Words : Ab interno implantation; Gel implant; Minimally invasive glaucoma surgery; Open-angle glaucomaPublication Asbest ile ilişkili hastalıkların gelişiminde çevresel ve mesleki asbest maruziyetinin değerlendirilmesi / Evaluation the enviromental and occupational asbetos exposures in the development of asbestos related diseas(Bezmialem Vakıf University, 2017) ÖZKAN, Didem; BAYRAM, MehmetAim: While there are many studies related to environmental asbestos exposure in our country, there is no information about occupational exposure. In this study we aimed to determine the environmental and occupational exposures and occupations with high risk in disease development in patients with asbestos related diseases. Materials and Method: 139 patients older than 18 years of age who had thorax computerized tomography and diagnosed for asbestos related diseases (pleural plaque, pleural calcification, mesothelioma etc.) in the registry of radiology or pathology departments between 01.01.2006-01.07.2016 at Bezmialem Vakıf University Medical Faculty Hospital were included to the study. All subjects were questioned for age, gender, birth place, living environment and period, occupations and periods. Occupations were classified according to Work-Related Lung Disease Surveillance Report 2002 as high, intermediate and low risk. Birth places of the subjects were marked at the geological maps showing ophiolitic units and the distance were measured as kilometers. Results: The distribution of the subjects according to the occupation was 31(22.3%), 29 (20.9%), and 79 (56.8%) in the high, intermediate and low risk groups, respectively. Although all female subjects were in the low risk group; 31%, 29% and 41% of the male subjects were in high, intermediate and low risk groups, respectively. While 90 subjects (71.2%) were close (<10 km) to ophiolites, 40 subjects (28.8%) were far (>10 km) from ophiolites. Mean age of the male subjects was 65.05±11.9 and female subjects was 63.03±13.1. Age distribution and distance to environmental asbestos exposure were significantly different in the high risk group than the rest of the subjects. However, there was no significant difference between low and intermediate risk groups. Optimal safety distance for environmental asbestos exposure was identified as 13-14,5 km. We have identified risky occupations and generated a map of Turkey for risk groups. Also, we have determined 10, 9, 6, 1 and 1 cases from Kastamonu-Taşköprü, Adıyaman-Gerger, Erzurum-Oltu, Niğde-Ulukışla and Sinop-Boyabat, respectively which were never reported at the literature. Conclusion: In our study, we determined that at least 20% of the asbestos related disease were related to occupational exposures. Also, we have identified new areas for environmental exposure. During the evaluation of the asbestos related diseases, occupational exposure should be questioned in accordance environmental exposures assessment.Publication Asemptomatik sağlıklı gönüllülerde kardiyak MRG ile sağ ventrikül myokardiyal yağ araştırılması: Cinsiyet, yaş ve vücut-kitle indeksi ile ilişkisi / Right ventricular fat imaging with cardiac MRİ in asymptomatic healthy volunteers: Relationship with age, gender and bmi(Bezmialem Vakıf University, 2018) TOKDEMİR ŞİŞMAN, Sevil; ÖZDEMİR, HüseyinPurpose: To demonstrate the relationship between right ventricular myocardial fat and gender, BMI and age in healthy and asymtomatic individuals. Materials and Methods: 107 healthy and asymptomatic subjects evaluated for right ventricular intramyocardiyal fat infiltration. ECG triggered cardiac MRI performed with Siemens Avanto 1,5 T in all subjects. Intramyocardial T1W hyperintense fat foci confirmed with fat saturated T1W images. Each subject evaluated for myocardial fat, number of involved segments, most frequent involved segments, associated wall motion abnormalities. Right ventricular and RVOT end diastolic diameters and right ventricle ejection fraction measured to assesment of right ventricular dysfunction. Relationship between all obtained data and gender, age and BMI was investigated. Results: Intramyocardial fat was detected in 65 of 107 subjects. 49 of subjects with fat were female. Fat was detected %45,7 of male and %68,1 of female subjects. There is statiscally significant positive relationship between rihgt ventricular myocardial fat deposition and female gender. BMI <30 was in 34, >30 was in 73 subjects. %38.2 of BMI<30 group and %71.2 of BMI>30 group has fat in myocardium. There is statiscally significant positive relationship between right ventricular myocardial fat deposition and obesity. Fat was observed most frequently in midventricular lateral, apicoanterior, midventricular anterior segments, and less frequently seen in RVOT. There is statiscally significant positive correlation between number of infiltrated segments and BMI. There was no difference in EF, RV ED and RVOT ED diameters between subjects with and without fat. Also RV ED and RVOT ED diameters were normal in both groups. Conclusion: Compared to CT assesment for myocardial fat content, MRI is more consistent with histopathologic results of autopsy series. Thus, MRI is more sensitive to fat content than CT. BMI and female gender have significant positive relationship with right ventricular myocardial fat. However, right ventricular functional measurements were normal. Therefore, in subjects with right ventricular myocardial fat, diagnosis of ARVD or other pathologic fat infiltration causes should be avoided unless accompanied by wall motion abnormalities or functional impairment.Publication Bariatrik cerrahinin obezite ile ilişkilendirilmişmikrorna düzeylerine etkisi / Bariatric surgery effect on associated with obesity microrna levels(Bezmialem Vakıf University, 2020) YIĞMAN, Samet; YARDIMCI, ErkanObjective: In this study, it was aimed to evaluate the relationship between miRNA expression levels associated with obesity and weight loss, to predict how much weight patients can lose postoperatively and to get maximum benefit from planned surgery. Materials and Methods: Between May 2017-July 2018, 17 patients who were indicated for bariatric surgery and planned laparoscopic sleeve gastrectomy at Bezmialem Vakıf University, Faculty of Medicine, Department of General Surgery, Obesity and Metabolic Surgery Polyclinic were included in this study. The study was approved by Bezmialem Vakıf University Faculty of Medicine Ethics Committee. Preoperative and postoperative 6th month blood samples and intraoperative adipose tissue samples were obtained. The expression levels of miRNA (miR27b-3p, miR122-5p, miR223-3p) associated with obesity were examined. The miRNAs were isolated from blood and adipose tissue and quantitated and analyzed by real-time polymerase chain reaction (RT-PCR) method. Postoperative 6th month excess weight loss rates (%EWL) were evaluated in three groups as %0-50 (group-1), %50-70 (group-2), %70-90 (group-3) respectively. The differences of miRNA expressions between blood and adipose tissues, gender, excess weight loss rates, and relationship with diabetes mellitus were examined. Results: 4 of the patients were male (%23.5), 13 were female (%76.4), male/female ratio 0.3, average age 41±11,6, average body mass index 49,1±7,6 kg/m2. Diabetes mellitus was present in 6 patients (35.2%) and their mean glucose and HbA1c values were 133 ± 59.4 mg / dl and 6.4 ± 1.3 %, respectively. The sixth month EWL rate was an average of %62.7±17. There were 4, 7 and 6 patients in groups 1, 2 and 3, respectively. The expression of miR223-3p was found significantly higher among all preoperative groups (p = 0.0046 for group-1; p <0.0001 for group-2; p = 0.0017 for group-3). MiR223-3p gene expression levels evaluated in preoperative and postoperative blood samples in group-2 and group-3 were found to be statistically significantly higher than miR27b-3p and miR122-5p gene expressions (p values for group-2 are p = 0.0335 and p = 0.0328 respectively, p values for group-3 are p=0.0446 and p = 0.0441 respectively). In addition, miR122-5p gene expression in fatty tissue was found to be less expressed than other miRNAs in patients with diabetes mellitus (p = 0.0062). Conclusion: Expression of miR223-3p has been shown to correlate with morbidly obese patients, particularly with patients with an EWL of 50% and above. For this reason, miR223-3p gene can be used as a possible biomarker in predicting weight loss after bariatric surgery. Thus, the group of patients who will benefit more from surgery can be determined in advance and the effectiveness of surgery can be increased. In addition, groups that will not benefit from surgery can be identified and combined (restrictive + malabsorbtive) or malabsorbtive surgical procedures may be preferred instead of restrictive bariatric surgery procedures in these patients. However, further studies with high number of cases, more types of miRNA and applied different bariatric surgery procedures are needed.Publication Baş ağrısıyla gelen çocuklarda demografik özellikler ve PEDMIDAS, MIDAS ölçeklerinin kullanımı / Demographic characteristics and use of PEDMIDAS, MIDAS scales in children with headache(Bezmialem Vakıf University, 2018) Kırmacı, Çiğdem; İÇAĞASIOĞLU, Dilara FüsunPediatric headache is one of the most common causes of pediatric outpatient clinics. It is important to recognize the classification and treatment of headache by the physician because of the high incidence, high quality of life and high economic burden. The World Health Organization has realized this situation and has initiated a global campaign to reduce the headache burden in the world. Considering the negative effects of headache on the social and school life of children, detailed history should be taken, differential diagnosis should be made and appropriate treatment should be determined in order to reach the correct diagnosis. The headache classification in adults was made in accordance with the diagnostic criteria published by the International Headache Society (IHS) in 2005. These criteria, which were not suitable for pediatric patients, have been adapted to children and adolescents in later years. Headaches affect daily activity and may impair the work or school performance of the patients and cause decrease in quality of life, family and social activities. This situation was evaluated by the WHO as disability. Various scales have been developed to measure the quality of life and disability related to headache in order to plan the treatment and evaluate the response to treatment. One of the most commonly used scales to measure disability in adult migraine patients is the Migraine Disability Assesment Scale (MIDAS). The MIDAS scale was adapted to the children and the PedMIDAS scale was prepared. In our retrospective and prospective study; we aimed to determine the demographic characteristics of the children with headache, the frequency of headaches and the type of IHS according to the criteria, by using the MIDAS and PedMIDAS scales, we focused on planning the treatment and evaluating the response to treatment. The study include 680 children aged 6-18 years, who were admitted to Bezmiâlem Vakıf University Hospital general pediatrics, pediatric emergency and pediatric neurology outpatient clinics with a headache between August 2017 and January 2017. Demographic findings and headache characteristics of the patients were noted. Prospective study was started in December 2017. MIDAS and PedMIDAS scales were applied to these patients. PedMIDAS scale was reapplied to patients who were called for control in February 2018 and their responses to treatment were evaluated. Nearly fifty five percent of the patients were female and nearly 45% were male. The most common presentation with headache was the pediatric neurology outpatient clinic. The most common type of headache in all diagnoses was tension-type headache. Nearly thirty of the patients in the prospective study felt pain 2 or 3 times a month and 40% of the patients had pain for 1-4 hours. Suppressive, compressive character pain was the most common type of pain. The most common localization was in the frontal region. Stress was the most common triggering factor for pain. It was observed that 50% of the patients provided relaxation with sleep and rest. Forty-four point three percent primary headaches were diagnosed with 25.2% tension headache and 18.6% migraine. Forty-one point six percent of the patients were diagnosed with secondary headache. MIDAS and PedMIDAS scales were applied to the patients and no statistically significant difference was found between the stages. The response to treatment was observed as a result of the PedMIDAS scale applied to patients diagnosed with migraine. These results have demostrated that the PedMIDAS scale can be used in children and adolescents with headache. The importance of preventive medicine in pediatric medicine is well-known in the light of this, in addition to reducing the concerns of the family and the child, the ways of coping with pain should be explained to family and the child.Publication Behçet tanılı olgularda kognitif fonksiyonlar ile beyin difüzyon tensor görüntüleme bulguları arasındaki ilişkinin değerlendirilmesi(Bezmialem Vakıf University, 2018) ATASOY BADUR, Bahar; TOPRAK, HüseyinObjective: To investigate the relationship between the DTG parameters obtained from the different brain localizations and the neurocognitive function test results. Material and Method: 35 adults with Behcet's disease and 21 healthy controls were participated in this study. Neurocognitive functions of the patients and the controls were evaluated with the Brief Battery Test which comprises the PASAT, Selective reminding test. Spatial recall test, Symbol digit modalities test and Word list generation test. In both of the patients and the controls, FA, ADC, MR and RD values were calculated at the 19 different localizations in the brain and the obtained values were compared with each other. Also, the correlation between the DTI parameters and the neurocognitive function test results were investigated. In addition, the effect of the presence of neurological symptoms and Neurobehcet diagnosis on the DTG parameters and neurocognitive functions were evaluated. Results: In Behcet's disease, at the cingulum and the splenium of the corpus callosum, the measured FA values were significantly lower compared with the controls. The ADC values of the corona radiata were significantly higher than the controls. Significant differences were found at the different brain localizations in patients with or without neurological symptoms and Neurobehcet. Also, between the neurocognitive functon test results and the DTI parameters, significant correlations were detected. Conclusion: Our results suggested that these findings could be an early indication of the detriment to the myelinated fibers, existence of the axonal dejeneration and the local cellular damage due to Behcet's disease and the secondary impairment of the neurocognitive functions. In addition to that, these DTI findings could be an early sign of the microstrucrural changes before the appearance of the neurologic symptoms and the conventional brain MRI findings. Our results suggested that in this patients, brain injury have been started at the cellular level due to the disease and the secondary impairment of the neurocognitive functions could be developed.Publication Beta talasemi minörde serum ürotensin II düzeyi incelenmesi(Bezmialem Vakıf University, 2017) BURHAN, Şebnem; KISKAÇ, MuharremIntroduction and Purpose: Beta Thalassemia Minor (BTM) is a chronic hemolytic anemia due to impaired hemoglobin structure due to poor production of beta globulin chain in hemoglobin structure. Cerebrovascular and cardiovascular events in BTM have been shown in studies performed less frequently. Mechanism has not been fully elucidated. Urotensin is the most potent known vasoconstrictor. Studies have shown that Urotensin II is elevated in essential hypertension, congestive heart failure, metabolic syndrome, and carotid artery stenosis. We also thought that the possible low UII levels in BTM might be a minor effect of cerebrovascular and cardiovascular pathologies in our study and we aimed to investigate serum urotensin II level in BTM patients. Material and Methods: The subjects included in the study were divided into two groups, the BTM group (Group 1-n: 45) and the healthy controls (Group 2-n: 46). Comorbidities and drug use that are known to affect the level of urotensin II and drug use have been identified as exclusion criteria for the study. Urotensin II measurements were performed using ELISA kits. Results: In the BTM group (Group 1), 46 people were included in the study group (Group 2). There was no difference between the two groups in terms of gender, age, and BMI (p: 0.69, p: 0,166, p: 0,145). Plasma UII level averages were 352.65 ± 130.46 ng / L in Group 1 and 222.88 ± 80.44 ng / L in Group 2. Group 1 was statistically significantly higher (p <0.001). UII levels were significantly correlated with HbA2 in the positive direction (p: <0.001, r: 0.482). There was no relationship between UII levels, age, sex, and BMI. Conclusion: In our study, we had the opposite result of our hypothesis. We expected to find the UII molecule low in Group 1. We think that high UII levels in the BTM group are highly detected as hemolysis and anemia secondary to ineffective erythropoiesis in BTM. The correlation of UII level with HbA2 supports this. We think that more comprehensive studies on the effect of other protective factors should be made in less frequent ischemic vascular pathologies in BTM.Publication Birinci trimester uterin arter doppler ölçümlerinin hiperemezis gravidarum hastalarında klinik önemi / Clinical importance of the first trimester uterine artery doppler measurements in patients wi̇th hyperemesis gravidarum(Bezmialem Vakıf University, 2017) MARAŞLI, Mustafa; KILIÇOĞLU DANE, Pakizer Banu; ADANIR, İlknurAim: To compare the first trimester uterine artery doppler measurements, biochemical markers of the first trimester antenatal screening test and severity of hyperemesis gravidarum according to PUQE score. . Material and methods: A prospective study was carried out in Bezmialem Vakif University Hospital, between 17 December 2016 and 17 March 2017, after ethics committee approval. A total of 207 consecutive patients were evaluated, all singular pregnancy with positive fetal heart rate, at 11th to 14th week of gestations. The demographic data of the patients such as age, gravida, parity and body analyses such as body mass index (BMI), height, weight were recorded. Ketonuria and urine analyses results were recorded as laboratory parameters. The diagnosis of hyperemesis gravidarum was based on the score of PUQE test. According to PUQE test score, the patients divided into two groups. The control group (Group I) included those with PUQE score < 6 and the study group (Group II) included those PUQE score ≥7. First trimester antenatal screening test and uterine artery doppler measurements were performed for the all patients. A total of 207 cases consisting of 131 Group I cases and 76 Group II cases were evaluated. We compared the first trimester uterine artery doppler measurements and biochemical markers of the first trimester antenatal screening tests between two groups. Statistical analysis were performed using SPSS v21 (Statistical Package for Social Sciences Chicago, USA); student-t, Anova, Mann-Whitney U and chi-square tests were used. And the level of significance was set at p<0,05. Results: A total of 207 cases consisting of 131 Group I cases and 76 Group II cases were evaluated. Right and left uterine artery PI, RI, mean PI, mean RI, presence of bilateral notch were found similar between two groups (p>0.05). No significant relationship was found between PAPP-A (p=0,9), B-HCG (p=0,5), NT mom (p=0,9) and PUQE scores of the patients in two groups. There was no significant difference between the groups in terms of age, gravida, parity, BMI, (P>0.05). There was also no significant differnce in terms of presence of leucocytes in urine analysis (p>0,4). But, there was a significant difference between the groups in terms of ketonüria (p=0,01). We see ketonüria more frequently in Group II (17,2 % vs 2,4% respectively). Conclusions: We didn't found any correlation between the first trimester uterine artery doppler parameters, biochemical markers of the first trimester antenatal screening test and severity of hyperemesis gravidarum according to PUQE score, in our study.Publication Botulinum toksininin kas hacmi üzerine etkisi: Deneysel çalışma / The effect of botulinum toxin on muscle volume: An experimental study(Bezmialem Vakıf University, 2018) GÜLEŞ, Mustafa Ekrem; GÜNEREN, EthemBotulinum Toxin A (BTx-A) has been used in clinical cosmetic practise worldwide, especially for improving facial rhytids. Earlier studies demonstrated that the repeated doses of BTx-A cause muscle atrophy. The development of muscle atrophy following chronic exposure serves to treat masseter hypertrophy. Reduction in masseter size is apparent only after continued inhibition of muscular contraction The injected muscle displays a reduction in volume temporarily. Despite its widespread use, there is no volumetric (quantitative) study focusing on the muscle volume alterations following the repeated injections of BTx-A with gradually increased doses. The gastrocnemius muscle has been found to be an ideal site for assesing the BTx-A effects on rats. We evaluated the effects of BTx-A injection in the right posterior gastrocnemius muscle of rats and aimed to determine the volume alterations in gastrocnemius muscle after repeated and gradually increased BTx-A injections followed by MRI assessment. Forty-eight male Sprague–Dawley rats with ranging weights of 300 to 350 grams have been used for the study. The rats were divided into 8 experimental groups. For 6 animals per group, the alterations in gastrocnemius volume were evaluated at regular intervals before and after the BTx-A injections using MRI. A vertical insicion was made in the right posterior leg of all rats for access to the gastrocnemius muscle. Groups 1 and 5 were injected sterile saline while the other groups were injected BTx-A into the muscular plane. The muscle volumes have been evaluated by MRI scanning for 5 times; on day 0 before the injection, on day 36 when the BTx-A has the maximum affect, on day 60 when the effect ends, on day 96 when the second injection has the maximum effect (on those injected) and on day 120 when the duration response of the second BTx-A injection ends. The 2nd, 3rd and 4th groups had statistically significant mean volume loss rates on day 36 compared to the day 0 values. When comparing the mean alterations of muscle volume preoperatively and on day 120 postoperatively, there was no statistically significant loss of muscle volume of the 2nd group, while groups 3 and 4 demonstrated statistically significant loss in gastrocnemius muscle volume on day 120. The percent amount of muscle volume changes were evaluated in groups 6,7 and 8 before (Day 0) and 36 days after the first injection. The percent amount of volume decrease was highest in group 8 and lowest in group 6, which demonstrated a similar pattern to the groups 2,3 and 4. The decrease in the percent amount of muscle volume was compared among groups 6 and 8 which demonstrated a statistically significant effect of the dose. We administrated the second injection 60 days after the first injection and assessed the percent amount of muscle volume change on the 96th day; the reductions were significantly more substantial in groups 6,7 and 8 than saline controls. The associated reductions in percent amount of muscle volume were significantly more substantial when BTx-A was administrated at higher doses. The reduction rate in percent amount of muscle was higher in group 8 compared to group 7, and also higher in group 7 compared to group 6. Comparing group 7 to group 8 and group 6 to group 8 respectively demonstrated an incremental decrease in percent amount of muscle at higher doses of injection which was statistically significant.Publication Bronşiolitis obliteranslı çocuklarda serum total oksidan ve antioksidan durumun değerlendirilmesi / Evaluation of serum total oxidants and antioxidant stability in children with bronchiolithis obliterans(Bezmialem Vakıf University, 2017) Güzel, Gülsüm; ÇAKIR, ErkanIntroduction Bronchiolitis obliterans (BO) is a rare chronic lung disease characterized by obstruction of the distal airways and an intense inflammatory reaction, usually following acute lower respiratory tract injury in children [1-3]. BO is divided into three categories; Post-infectious BO (PIBO), BO after hematopoietic stem cell transplantation (BMT) and BO after lung transplantation (LT). In the studies conducted, chronic inflammation and fibrosis were found to be common pathologic findings in variable degrees in the pathogenesis of PIBO. At the same time, recent publications have shown that children with PIPO have a significant increase in neutrophil count and interleukin-8 in bronchoalveolar lavage (BAL) [1]. The cytoplasm of the neutrophil cell contains granules containing various enzymes. These structures are classified as azurophilic and specific granules. The enzymes found in azurophilic granules are grouped into acid hydrolase, lysozyme and myeloperoxidase (MPO) bactericidal enzymes. Paraoxonase 1 (PON1) and arylesterase (ARES) are enzymes that act as antioxidants. Serum or plasma levels of many oxidant and antioxidant molecules can be measured separately by various analytical methods. However, in recent years more practical methods have been developed that totally measure oxidants and antioxidants in serum or plasma. These measurements, expressed as "Total oxidative state (TOS)" and "Total antioxidant state (TAS)", are easier and cheaper than the measurement of oxidants and antioxidants separately [2, 3]. Thiol is an organic compound containing a sulfhydryl group that plays a critical role in preventing the formation of any oxidative stress state in cells. Cysteine, one of the defensive protein mechanisms of the body, plays an important role in the prevention of oxidative damage by the functional thiol group it contains [4]. Goal In children with BO, the infection caused by pulmonary damage is shown in the etiology, but the mechanisms causing the disease are not fully explained. In our study, it was aimed to investigate whether oxidative stress and antioxidant status play a role in disease etiology. Materials and Methods This multicenter, cross-sectional study includes 63 post-infectious BO children diagnosed in Bezmialem Foundation University, Marmara University and Kocaeli University Children's Chest Diseases Departments. Sick children with PIBO; A standardized data extraction form was used to obtain demographic characteristics such as date of birth, sex, age of diagnosis, weight and length Z scores, parental smoking, breast milk intake, and respiratory symptoms in medical records. In all patients, complete blood count, total eosinophil count, serum total IgE, total protein, transferrin, prealbumin, vitamin D levels, sweat test, chest X-ray, microbiological examinations in sputum, immunologic examinations and bronchoscopy, lung biopsy and gastroesophageal reflux done. For the control group, a total of 57 patients were applied, whose ages 1 to 16 without malnutrition, no chronic disease, no anemia such as anemia, no immunocompromised, and no drug use history to cause immunosuppression, similar to the age and sex ratios enrolled to the Bezmialem Foundation University Child Health and Disease Policlinic. Results The study was carried out in Bezmialem Foundation University, Marmara University and Kocaeli University Hospital between September 2012 and December 2013 with a total of 120 cases in 38.3% (n = 46) girls and 61.7% (n = 74) boys. The ages of the subjects participating in the study ranged from 8 months to 16 years, with an average of 6.68 ± 3.87 years. The TAS measurement value of the patients in the patient group was found to be statistically significantly higher than those in the control group (p = 0,005, p <0,01). The TOS measurement value of the patients in the patient group was not statistically significant compared to the cases in the control group (p = 0,073, p> 0,05). There was no statistically significant difference between the measurements of Thiol according to the groups (p> 0,05). The ARES measurement value of the patients in the patient group was found to be significantly higher than the control group (p = 0,001, p <0,01). The MPO measurement value of the patients in the patient group was statistically significantly lower than the control group (p = 0,001, p <0,01). The PON measurement value of the patients in the patient group was found to be significantly higher than the control group (p = 0,001, p <0,01). Discussion and Conclusion In our study, serum PON1 and ARES enzyme levels were significantly higher in patients with postinfectious BO than in the control group. Normally, it can be thought that this enzyme should be produced by the liver at high rates to remove the effect of harmful oxidants in chronic inflammation, then to be released into the blood to be used at tissue level or systemically to break free radicals. Another parameter that we evaluate in this study is the MPO enzyme which plays an important role in the defense system of the body. In our study, we found that the MPO level was significantly lower in the PIBO-diagnosed group of patients than in the control group. Studies in the literature suggest that high levels of serum MPO may be used as a marker of inflammation and in evaluating the degree of inflammation in these patients. TOS levels in our study were not different between the two groups. Normally, high levels of oxidative stress can be explained as tissue destruction effects during acute periods of disease, while in later stages these levels may be normalized by antioxidant system. Our study is the first study in the literature regarding the status of oxidative stress and antioxidant system in post infectious BO and is a work that can inspire the future studies.Publication Deneysel spinal kord yaralanmasının patofizyolojisinde mikroRNA21'in rolü ve metilprednizolone tedavisinin patofizyolojiye ve mikroRNA21'e etkisi / The role of microRNA21 in the pathophysiology of experimental spinal cord injury and the effect of methylprednisolone treatment on pathophysiology and microRNA21(Bezmialem Vakıf University, 2019) Tekin, Abdurrahim; SEYİTHANOĞLU, Mehmet HakanSpinal cord injury has become a serious health problem especially in young people with increasing population. In our study, six experimental groups (n = 6) were created in order to investigate the effect of miRNA21 expression on the 1st and 7th days after spinal cord injury and miRNA21 level of methylprednisolone treatment. Spinal trauma model was applied to all animal groups except the first and fourth groups by aneurysm clip method. Methylprednisolone was given to the treatment groups (third and sixth group) after SCI. After the treatment, the first three groups were reoperated in the first three groups on the 7th day and the spinal cord tissue in the laminectomy area was removed for real-time PCR. Levels of miRNA21 and astrogliosis, apoptosis and inflammation were measured with Real-Time PCR and GFAP, VIM, STAT3, FASLG, PTEN, BAX, BCL2, COX-2, IL6 levels were measured. After all; It was observed that miRNA21 level increased after trauma and methylpredinisolone treatment decreased miRNA21 level in early period. Methylprednisolone treatment did not have a significant effect on astrogliosis, apoptosis and inflammation parameters. Further studies are needed to clarify the role of miRNA21 in SCI. Keywords: Spinal cord injury, miRNA21, Methylprednisolone, real-time PCRPublication Eczane eczacılarının diyabet hastalarının tedavisi, izlemi ve eğitimindeki rollerinin incelenmesi: İstanbul Zeytinburnu örneği / Evaluation of the role of community pharmacists in the treatment, follow-up and education of diabetic patients: İstanbul Zeytinburnu case(Bezmialem Vakıf University, 2018) MERCAN, Sümeyye; TORUN, PerihanBackground and Objective: In many countries, it becomes increasingly common to extend the practice role of community pharmacists towards public health activities. In order to inform policy makers, this study aimed to examine the role of pharmacists in the tertiary prevention of diabetic patients contactingı their pharmacies. Materials and Methods: In this mixed methods research, concurrent triangulation and concurrent transformative designs were combined. Data were collected face-to-face through a questionnaire in the descriptive quantitative study and through semi-structured interviews in the qualitative study. The data were blended during the interpretation stage and triangulation was used in the discussion of the findings. Results: The majority of the pharmacists (98.7%) believe that they should undertake roles in preventive health and health promotion. Although not systematically, the pharmacists have undertaken a number preventive services for diabetics, limited with their own knowledge, concerns and facilities. The main motivators for offering such services were the needs of patients and perceiving the task as pharmacist's own responsibility; the main barriers were lack of time, excessive workload and absence of a particular system for the implementation such activities. Professional development training, establisment of a system, allocation of resources and collaboration with other health professionals were suggested as the preconditions for pharmacists be involved in preventive activities. Conclusions: The research indicates that many pharmacists undertake roles in public health for diabetic patients and that these roles could be developed further with appropriate support. The findings provide a wide-scale evaluation of the subject through mixed research methodology and also offer important clues for future policies. Keywords: Community pharmacist; diabetes mellitus; mixed research methodology; preventive care; health promotionPublication Endokan ve ateroskleroz risk faktörleri arasındaki ilişki / Relationship between endocan and atherosclerotic risk factors(Bezmialem Vakıf University, 2017) AİLİA DAE, Shute; ÇAKIRCA, MustafaBackground: Endothelial dysfunction plays an important role in the pathophysiology of atherosclerosis and coronary artery disease (CAD). Previous studies suggested that human endothelial cell-specific molecule-1 (endocan) may be a novel endothelial dysfunction marker. This study aims to investigate the relationship between serum endocan concentration and atherosclerosis and relationship between serum endocan level and individual factors used to calculate 10 year risk of heart disease using ASCVD(Atherosclerotic Cardiovascular Disease) estimator. Methods: A total of 205 eligible patients were enrolled in this study. Serum endocan level was measured by enzyme-linked immunosorbent assay. Ten year risk of atherosclerotic heart disease were calculated for induvidual patients online using ASCVD risk estimator. Results: Backward linear regression analysis showed no correlation between serum endocan level and individual factors(age, gender, sytolic and diastolic blood pressure, smoking status, use of antihypertensive drugs) used to calculate ten year risk for coronary artery disease in ASCVD estimator. There was also no raltionship between serum endocan level and atherosclerosis. Conclusions: There was no significant realtionship between serum endocan concentration and atherosclerosis. We also found no correlation between serum endocan level and individal risk factors for atherosclerotic heart diseases used in ASCVD risk estimator.Publication Fasya iliaka kompartman bloğu için en uygun lokal anestezik volümü: Üç farklı volümün karşılaştırılması(Bezmialem Vakıf University, 2019) Dağlı Aslan, Hazan; ESEN, AsımOBJECTIVE: Fascia iliaca compartment block (FICB) is a recently preferred block to reduce postoperative pain in lower extremity surgeries. In our study, we aimed to find the most effective pain-reducing volume of FICB with USG in patients with total hip arthroplasty. MATERIALS AND METHODS: After the approval of the ethics committee, 45 ASA I-II-III patients with total hip arthroplasty were included in the study. All patients underwent general anesthesia and were maintained with inhalation anesthesia. The patients were divided into three groups with closed envelope extraction method. LA solution was prepared in 30 ml in Group 1, 40 ml in Group 2 and 50 ml in Group 3. FICB was performed with suprainguinal approach with USG in supine position at the end of the operation. In the recovery room, tramadoll iv-PCA device was connected to the patients. VAS≤5 until the recovery room, patients were made to patients requiring additional analgesics were followed. The compilation of input patient rooms, 1, 6, 12, 18, 24 hours VAS, satisfaction surveys and tramadol consumption values were recorded. RESULTS: Our study was carried out on a total of 45 patients, ranging from 18 to 85 years, 10 (22.2%) males and 35 (77.8%) females. The mean age of the patients was 60.7 ± 11.30 years. Cases were examined under three groups of 15 persons. There was no statistically significant difference between age, weight, height, BMI and gender distributions and duration of anesthesia and mean duration of surgery according to the groups (p> 0.05). VAS values, total tramadol consumption levels, bolus numbers, and bolus numbers of the patients in Group 2 at the 1., 6., 12., 18. and 24. hours were found to be significantly higher than the group 3 (p<0.05). No complication was observed in all three groups. CONCLUSION: FICB is an effective compartment block providing postoperative analgesia in total hip arthroplasty. In this study, the lowest pain scores and analgesic requirement were obtained in the group using 40 ml LA containing 2 mg/kg bupivacaine.Publication Febril konvülsiyon geçiren çocukların demografik ve klinik özelliklerinin incelenmesi / The investigation of the demographic and clinical characteristics of children with febrile convulsion(Bezmialem Vakıf University, 2017) ABDİLLAHİ, FATOUMA KHALİF; İŞCAN, AkınFebrile convulsion is characterized by a convulsion during a febrile disease of children between 1 months to 6 years without a history of afebrile convulsion, excluding CNS infection or any other possible etiology such as electrolyte imbalance, metabolic disturbance, intoxication or trauma. Febrile convulsions (FC) are the most common type of convulsions in childhood. Recurrences are frequent in FC. The children who experience a 2nd FC episode constitute 30-40%. In this study; 310 children with FC admitted to Bezmialem Vakif University, Pediatrics neurology clinic between 2013-2016 were included. The demographic features, recurrence and epilepsy risks and efficacy of different type of therapies were evaluated. It is aimed to retrospectively analyze the demographic and clinical characteristics of children between 6 months and 5 years of age and to analyze factors that may be related to febrile convulsion. The Male/female ratio was 1.3/1. An eleven (3,4%) of 310 had history of prematurity, 4 (1,4%) of 310 perinatal asfixia. The age of first FC was between 6-72 months (average age 25 months). FC was most frequent below 2 years of age (53%).Upper respiratory tract infection was the most frequent etiology (85%). Family history of febrile convulsions in 61 cases (19.6%) in father-mother and febrile convulsions in 42 cases in sister-brother (13.6%).Simple type first FC constitute 90,3%, whereas complex 9,7%. In 94,4% of patiens FC were of generalized-tonic-clonic type. Two hundred and fourteen patiens (65,8%) had reccurence. Epileptiforms disorders was not detected in cases who underwent electroencephalogram. One hundred and eleven cases (35.8%) underwent profilatic treatement. Of these, 55 cases (17.8%) receveid valproic acid and 15 cases (4,8%) long term oral phenobarbital. İntermitent rectal diazepam was given in 40 cases (%13,2). Recurence was seen in 1 out of 15 cases (6,6 %) after the onset of phenobarbital treatement, and in 13 out of 55 cases (23,63%) after valproic treatement. As a result, it was concluded that is very important to follow up patients with FC, which has good clinical course, because of high recurrence. Our study has been shown to be in accordance with literatüre.Publication Fonksiyonel manyetik rezonans görüntüleme yapılan olgularda dil lateralizasyonu ile korpus kallosum bütünlüğünün araştırılması / Relationships between language lateralization and CC dti metrics, tumor grade and tumors distance to language-eloquent-areas in glial neoplasms(Bezmialem Vakıf University, 2018) TİMOÇİN, Gizem; ARALAŞMAK, AyşePURPOSE: To search relationships between language lateralization and CC DTI metrics, tumor grade and tumors distance to language-eloquent-areas in glial neoplasms. MATERIALS AND METHODS: Total 42 patients with glial neoplasm were enrolled. Their fmri performed for language lateralization and DTI with 64-direction were retrospectively evaluated. Fiber tracking method was used for tractography of CC. Three groups were formed based on language lateralization (left, right and bilateral). We investigatedrelationships between these 3 groups and CC DTI metrics, grade of glial masses and tumors distance to language-eloquent-areas (nearby or remote) and relationship between grade of glial masses and CC DTI metrics.Kruskal Wallis, Mann-Whitney-U and Chi-square tests were used (p ≤ 0, 05). 26 of 42 patients had left hemispheric mass. All above tests were repeated for left hemispheric masses. RESULTS: Patients with left lateralized had highest CC tract number. In glial masses, language bilaterality was more common than normal population. Bilaterality in low grade tumors was found to be higher than high grade. In tumors nearby the language-eloquent-areas, bilaterality was more common.No relationship between tumor grades and CC DTI metrics was found. Similar distributions were observed for left hemispheric masses. CONCLUSION: Higher bilaterality in language dominancyin glial masses comparing the normal population and in tumors nearby language eloquent areassupport interhemispheric reorganization and plasticity. In low grade tumors with a longer life-span, bilaterality was higher than high grade, explaining interhemispheric reorganization and plasticity. Highest CC tract number in left lateralized group suggest intact CC integrity with limited hemispheric destruction.Publication Hemiplejik hastalarda solunum fonksiyon testi ve ultrasonografik diyafram ölçümlerinin korelasyonu ile solunum egzersizlerinin bu parametrelere etkilerinin araştırılması / Investigate the correlation of diaphragm ultrasound with pulmonary function test and the effects of pulmonaty rehabilitation on these parameters in hemiplegic patients(Bezmialem Vakıf University, 2020) KILIÇOĞLU, Mehmet Serkan; YURDAKUL, Ozan VolkanObjective: The aim of this study was to investigate the correlation of diaphragm ultrasound with pulmonary function test, and the effects of pulmonary rehabilitation on these parameters in hemiplegic patients. For this purpose, the correlation between diaphragm ultrasound (DUS) measurements and pulmonary function test (PFT) and the effects of pulmonary rehabilitation on these parameters were investigated in hemiplegic patients. Materials and Methods: The approval for the study was obtained from the Non-Interventional Clinical Research Ethics Committee of Bezmialem Vakif University. Our single-blind, randomized, prospective study reviewed 59 patients between the ages of 18-80 years who were admitted to the outpatient clinics of our clinic, developed hemiplegia due to the first stroke, had no cardiac and/or pulmonary diseases and had a mini mental score (MMT) above 24 and a Brunnstrom lower extremity value above stage 3. Of these patients, 9 were excluded from the study since they did not meet the study inclusion criteria and 5 were excluded because of refusing to participate in the study, so a total of 45 patients were randomized for the study. All patients included in the study were informed about the purpose of the study in detail and written consent was obtained. In the clinical evaluation, the Brunnstrom staging, mini-mental state examination (MMSE) for cognitive evaluation, Functional Ambulation Scale (FAS), and Functional Independence Measure (FIM) were used. All patients underwent DUS measurements. The affected side and the non-affected side were measured 3 times at end inspiration and at end expiration, and these measurements were averaged. After DUS measurement, PFT measurement was performed on the same day. Neurological rehabilitation and pulmonary rehabilitation programs were administered to the treatment group. Whereas, only neurological rehabilitation program was administered to the control group. The rehabilitation program was administered in 30 sessions, 5 days a week for 6 weeks. During the follow-ups, 4 patients left the study, 1 patient in the treatment group left the study voluntarily and 1 patient left the study because of the requirement for intensive care. In the control group, 1 patient left the study voluntarily and 1 patient left due to the development of hip fracture after a fall. After six weeks of follow-up, 41 patients completed the study. FVC, FEV1, diaphragm thickness measurement at end inspiration, diaphragm thickness measurement at end expiration, diaphragm thickening fraction were used as the measurement parameters. All patients were evaluated before and after treatment. Results: The results were compared both within and between groups. The affected side at end inspiration (p <0.01), the non-affected side at end inspiration (p=0.01), the affected side at end expiration (p=0.01), the non-affected side at end expiration (p=0.01), the affected side diaphragm thickening fraction (ΔKdi) (p=0.01), the non-affected side ΔKdi value (p = 0.01), which were measured with DUS in our study, were better in the treatment group than in the control group after treatment compared to the pre-treatment period (p=0.05). Similarly, the PFT parameters of FVC (p<0.01), FVC(%) (p<0.01), FEV1 (p=0.03), FEV1 (%) (p=0.02), FEV1/FVC (p=0.04) were better in the treatment group than in the control group after treatment compared to the pre-treatment period (p=0.05). In addition, the DUS measurement of the affected side diaphragm at end inspiration was positively correlated with the PFT parameter of FVC before treatment (r=0.38, p=0.03) and after treatment (r=0.460, p=0.02). (p<0.05). The DUS measurement of the affected side diaphragm at end inspiration was positively correlated with the PFT parameter of FEV1 before treatment (r=0.35, p=0.02) and after treatment (r=0.39, p=0.03). The DUS measurement of the affected side ΔKdi value was positively correlated with the PFT parameter of FVC before treatment (r=0.448, p=0.01) and after treatment (r=0.32, p=0.04). The DUS measurement of the affected side ΔKdi value was positively correlated with the PFT parameter of FVC before treatment (r=0.448, p=0.01) and after treatment (r=0.32, p=0.04). Conclusion: It is thought that DUS measurements can be used to evaluate respiratory problems in stroke patients. In addition, it was demonstrated that pulmonary rehabilitation improved these parameters in stroke patients, and this could be followed up with DUS. Keywords: Hemiplegia, Diaphragm Ultrasound, Pulmonary Function Test, Pulmonary Rehabilitation.Publication Hepatosteatoz ve omentin-1 ilişkisi / Relationship between hepatosteatosis and omentin-1(Bezmialem Vakıf University, 2020) Nursoy, Hatice; ÖZGEN, İlker TolgaBackground: Childhood obesity is an increasing problem in Turkey and all over the world and is associated with several comorbidities. Hepatosteatosis (NAFLD) is the most common liver disease in children and is closely associated with obesity. Omentin-1 is an adipokine which has been found to be negatively corralated with body mass index and insulin sensitizing effect. The relationship between insulin resistance and hepatosteatosis is well documented, because of that it may be assumed that the omentin-1 may have a role in the pathogenesis of hepatosteatosis. Omentin-1 levels have been studied in obese children, but there are not enough studies in the literature regarding omentin-1 levels in obese children with hepatosteatosis. In this study, we aimed to reveal the possible relationship between omentin-1 and hepatosteatosis in childhood by examining omentin-1 levels in obese children with and without hepatosteatosis and to contribute to elucidating the pathogenesis of hepatosteatosis. Material and methods: Between October 2017 and April 2018, 134 patients aged 12-18 years with puberty (puberty stage ≥ 3) and obesity (body mass index standard deviation score (BMI SDS) ≥ 95%) admitted to our pediatric endocrinology and general pediatric outpatient clinic. Anthropometric measurements and routine blood tests of the patients were performed, blood pressure values were recorded. Two mililiters blood collected into serum gel tube for human omentin-1 ELISA kit. Upper abdominal ultrasonography (USG) was performed in all patients for detection and staging of hepatosteatosis (grade 1, 2 and 3). Patients with chronic disease or syndromic obesity, patient who using antidiabetic drugs and who were unable to allocate blood for omentin-1 during blood collection were excluded from the study. Results: There was no significant difference between the groups with and without hepatosteatosis in terms of age and sex. The median omentin-1 levels were 11.02 ng/ml in patients without hepatosteatosis (n = 44) and the mean omentin-1 levels were 10.50 ng/ml in patients with hepatosteatosis (n = 38). There was no statistically significant difference between the two groups ((p=0.823). The median omentin-1 levels in patients with severe hepatosteatosis (stage 2-3) were 9.45 ng/ml, and the median omentin-1 levels in patients with mild hepatosteatosis (stage 1) were 9.75 ng/ml (p=0.953). Conclusion: In our study, no significant relationship was found between hepatosteatosis and omentin-1 levels in obese children. However, there is a need for studies with larger sample size in which patients grade 2-3 hepatosteatosis will be compared with healthy controls and obese patients without hepatosteatosis. Clarifying the role of Omentin-1 in hepatitis-forming conditions may also contribute to understanding its role in the pathogenesis of NAFLD.Publication Hipotansif anestezinin serebral perfüzyon ve kandaki antioksidan düzeyleri ile HIF1a düzeyi üzerine etkisinin değerlendirilmesi / Effect of hypotensive anesthesia on cerebral perfusion and bloodantioxidant levels and HIF 1a(Bezmialem Vakıf University, 2020) Şencan Özden, Ayşe; DAŞKAYA, HayrettinBackround and Aim: Controlled hypotension is the voluntary reversible reduction of arterial blood pressure. Hypotensive anstehesia is a method of anesthesia in which blood pressure is reduced in a controlled manner, especially in certain surgeries. İt reduces intraoperative bleeding and need for blood transfusion and provides a clean surgical vision in narrow-field surgeries or with high bleeding potential. Hypotensive anesthesia can be performed according to mean blood pressure (MBP) or systolic blood pressure (SBP). Near İnfrared Spectroscopy (NIRS) allows continuous and non-invasive monitoring of cerebral oxygenation. HIF 1a, TAS and TOS are laboratory markers that predict tissue oxygenation and perfusion. The aim of this study to evaluate the patients who underwent controlled hypotensive anesthesia under standardized depth of anesthesia; preoperative and postoperative blood HIF 1a, TAS, TOS measurement and serebral perfusion evaluation with NIRS and to investigate tissue hypoxia secondary to hypotensive anesthesia and the cahanges of the mediators at the tissue level and which blood pressure parameters are related. Materials and Methods: A total of 60 ASA 1-2 patients aged between 18-75 who underwent elective rhinoplasty and ortognatic surgery were included the study. Standard anesthesia induction and propofol and remifentanil infusion were applied to all patients with TIVA technique. The patients were divided into two groups. One group received hypotensive anesthesia according to MBP an done group received SBP. Continuous regionel cerebral oxygen saturation was monitored by NIRS in both groups. Blood samples were taken from all patients before anesthesia induction and at the and of the operation and stored for TAS, TOS, HIF 1a. At the and of the operation patients were fallowed in the post anesthesia care unit for 30 minutes and pain and nause vomiting scores were evaluated. İn addition, surgical satisfaction and bleeding scores and anesthetic consumption of both groups were recorded. Results: In our study, no statistically significant difference was found between the RsO2 values of the two groups. However, the number of patients with cerebral desaturation was higher in SBP group. There was no statistically significant difference between input and output TAS, TOS, HIF 1a values in MBP and SBP group. Output TOS of SBP group; output HIF 1a levels of MBP group werw significantly lower than those of input levels. The surgical satisfaction score of the MBP group was significantly higher and the bleeding score was significantly lower. Conclusion: Hypotensive anesthesia can be performed according to both MBP and SBP. However, in our study that follow-up MBP is more adventageous/protective, although it is not supported by very strong data. We recommend hypotensive anesthesia compared to MBP; but further studies are needed.
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