Meslek Yüksekokulları
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- ItemBilateral locked posterior shoulder dislocation overlooked for 15 months treated with the modified McLaughlin procedure: A case report(Bayçınar Tıbbi Yayıncılık, 2023) Saylık, Murat; Gökkuş, KemalNeglected bilateral posterior shoulder dislocation is a rare injury caused primarily by an epileptic seizure. The injury is usually associated with a reverse Hill-Sachs lesion in the anteromedial aspect of the humeral head. The modified McLaughlin technique may avoid instability and osteoarthritis when 20 to 40% of the articular surface is affected by reverse Hill-Sachs. In this article, we present the clinical results of a case overlooked in the literature for the longest time, i.e., for 15 months. A 46-year-old male patient was receiving treatment for epilepsy for five years. There was no fall or trauma in the four seizures he had during this time. The last seizure was 15 months ago. When the patient presented to our clinic, both shoulders were symmetrically deformed, the anterior shoulder contour disappeared (empty socket sign), and there was a loss of upper contour. The computed tomography (CT) scan revealed a posteriorly locked dislocation with a reverse Hill-Sachs lesion in 32% of the left shoulder and 36% of the right shoulder. We applied the modified McLaughlin procedure to the dominant right shoulder and, two months later, we used it to the left shoulder (with a graft taken from the anterior superior iliac spine). At one-year of follow-up, both shoulders were moderately functional: forward elevation left 70° and right 50°, abduction left 40° and right 60°, and internal rotation: the back of the hand could touch the fifth lumbar vertebra. Meanwhile, the patient did not suffer from recurrent dislocation. The pre- and postoperative Constant-Murley Scores for the right and left shoulder were 30/52 and 11/48, respectively. Although the operational outcomes using the modified McLaughlin technique were not ideal, with no recurrence, the patient seemed to be satisfied with this outcome. In conclusion, in neglected locked shoulder fracture-dislocations, the modified McLaughlin technique is a method that can respond to the pathophysiology by eliminating reverse Hill–Sachs lesion.
- ItemInterventional therapy of acute coronary syndromes in very old patient population and results of 2 years follow‑up(Springer, 2023) Boyraz, Bedrettin; Peker, Tezcan; Akgümüş, Alkame; Balun, Ahmet; 313898Background Research on cardiovascular treatment options and prognosis in very old age groups of patients is warranted. In our study, we evaluated and followed up on clinical conditions on admission and comorbidities of patients older than 80 years who were admitted to our hospital with acute myocardial infarction and shared our findings. Results A total of 144 patients were included in the study, with a mean age of 84.56 ± 5.01 years. No complications resulting in death or requiring surgery were observed in the patients. All-cause mortality was found to be related to heart failure, chronic pulmonary disease shock, and C-reactive protein levels. Cardiovascular mortality was correlated to heart failure, shock on admission, and C-reactive protein levels. No significant difference in mortality was observed between Non-ST elevated myocardial infarction and ST-elevation myocardial infarction. Conclusions Percutaneous coronary intervention is a safe treatment option with low complication and mortality rates in very old patients with acute coronary syndromes.
- ItemOpen and arthroscopic excision of the distal clavicle for osteoarthritis of the acromioclavicular joint--results over 5 years(TMMOB Makina Mühendisleri Odası, 2022) Saylık, MuratObjective: Initially performed as open surgery, arthroscopic applications of distal clavicle excision (DCE) have gained prevalence in recent years. Literature reviews about the long-term results give no clear indication that one method is superior to the other. This study aims to compare the follow-up results of patients treated with arthroscopic and open DCE for more than five years and to detect the superiority of each method. Material and Method: The study involved 328 patients treated with DCE between February 2008 and April 2017. One hundred and fourteen patients (66 male and 48 female; 81 arthroscopic and 33 open surgery), who had their records available and under went no other surgery than DCE, were included in the study. The Disability of the Arm, Shoulder, and Hand (DASH) score and Visual Analogue Scale (VAS) were used to assess post-DCE shoulder functions and pain, respectively. Within the study's scope, surgery duration, excision extent, complications (frozen shoulder, hematoma, surgical site infection, and instability), and revisions were compared. Results: In the >5-year follow-up process, no statistically significant difference was observed between pre-DCE DASH and VAS values or between post-DCE DASH and VAS values of the two groups, one involving 32 patients who underwent open surgery and the other involving 82 patients treated with arthroscopic surgery. However, there was a statistically significant difference between the pre- and post-DCE DASH and VAS scores of both groups, and it was observed that both surgical methods were effective. No statistically significant difference was observed between the two groups regarding the surgery duration. Arthroscopic DCE was measured to be 4.70 mm on average, while the average measure for open surgery was 5.53 mm, which indicated a statistically significant difference between the two groups. However, no significant association was observed between the excision extent and the DASH and VAS scores. Furthermore, no significant difference was observed between complication and revision rates. Conclusion: In the >5-year follow-up of patients who underwent arthroscopic or open DCE due to their acromioclavicular joint osteoarthritis, which could not be treated with conservative treatment, no statistically significant difference was observed in the two groups' post-DCE DASH scores, VAS scores, complication rates, and revision rates. There was, however, a statistically significant difference between both groups' pre- and post-DCE VAS and DASH scores, and both methods were effective.
- ItemPrognostic value of the leuko-glycemic index in coronary chronic total occlusion patients(Prusa Medikal Yayıncılık, 2023) Peker, Tezcan; Özbek, Mehmet; Boyraz, Bedrettin; Aslan, Selen Filiz; Demir, Muhammed; Aslan, Burhan; 313898Objectives: Inflammation parameters are related to the prevalence and mortality of coronary artery disease (CAD). We aimed to evaluate the prognostic value of the leuko-glycemic index (LGI) and determine mortality in patients with chronic coronary total occlusion (CTO). Methods: A total of 546 patients were evaluated in the study. All-cause death was the primary endpoint. The leuko-glycemic index was calculated from the blood samples at admission and patients were divided into 3 groups according to their LGI levels. Kaplan-Meier survival curves were performed and logistic regression analyses was used for all multivariable analysis. Results: The mean age of the study population was 63.1 ± 11.1 years and 70.3% were male. Median follow-up time 58.2 ± 22.4 months. The mortality rate was 33.6% in the high LGI group and significantly higher compared to the other group. In multivariable analysis, LGI (OR: 1.05, 95% CI: 1,0-1.2; p = 0.02) and age (OR: 1.07, 95% CI: 1.04-1.11; p = 0.001) were found as predictors of all-cause death. Conclusions: The study revealed that high LGI is associated with all-cause death in CTO patients and LGI was a predictor of all-cause death.
- ItemShort-term prognostic value of the culprit-SYNTAX score in patients with acute myocardial infarction(MDPI, 2023) Peker, Tezcan; Boyraz, Bedrettin; 313898Background: The SYNergy between Percutaneous Coronary Intervention with TAXus and Cardiac Surgery (SYNTAX) score is a scoring system that helps to decide on surgery or percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (MI), and studies are showing the prognostic value of this scoring system in both MI and coronary artery disease patients undergoing PCI. In acute coronary syndrome (ACS) patients, the infarct-related artery and the complexity of the lesions are also important in terms of mortality and morbidity. Our study aimed to determine the prognostic value of the culprit vessel’s SYNTAX score (cul-SS) in patients presenting with MI. Methods: In our study, 1284 patients presenting with MI were analyzed retrospectively. The SYNTAX scores and cul-SS of the patients were calculated. In-hospital and 30-day deaths and major complications were accepted as primary outcomes. The SYNTAX scores and cul-SS were compared in terms of predicting primary outcomes. Conclusions: Major complications were observed in 36 (2.8%) patients, death in 42 (3.3%) patients, and stent thrombosis in 24 (1.9%) patients. The area under the curves for SYNTAX and cul-SS for predicting primary outcomes is 0.64 and 0.68 (p = 0.026), respectively. Cul-SS was as successful as the SYNTAX score in predicting stent thrombosis and was superior in predicting short-term death and major complications.
- ItemThe effect of being married on heart rate variability, an indicator of autonomic dysfunction: A retrospective study(Lippincott Williams & Wilkins, 2023) Akgümüş, Alkame; Balun, Ahmet; Peker, Tezcan; Boyraz, Bedrettin; 313898Heart rate variability (HRV) is a noninvasive assessment that reflects the autonomic functions of the heart and is known to be impaired in many diseases. In our study, we aimed to investigate the relationship between HRV and being married. The study included 104 patients, between the aged 20 to 40 years were included in the study. The patients were divided into 2 groups as 53 healthy married (group 1) and 51 healthy unmarried (group 2). 24-hour rhythm Holter recordings were performed on all married and unmarried patients. Group 1 had a mean age of 32 ± 5 years and 47.2% men, and group 2 had a mean age of 30 ± 5 years and 54.9% men. Standard deviation of normal to normal (SDNN) was 150 ± 40 versus 128 ± 30 (P = .003), SDNN index was 66 ± 20 versus 56 ± 12 (P = .004), the square root of the mean of the squares of the differences of the adjacent root mean square of successive differences (RMSSD) was 37 ± 10 versus 30 ± 10 (P < .001), percentage of successive R-R intervals that differ by more than 50 milliseconds (PNN50) was 13.5 ± 7 versus 8.5 ± 7 (P = .001), HF was 450 ± 270 versus 225 ± 130 (P < .001) found to be significantly less in the group 2. LF/HF ratio was 1.68 ± 0.65 versus 3.31 ± 1.56 (P < .001) found to be significantly higher in the group 2. In our study, it is possible to say that the sympathetic system effect on the heart was more dominant and the HRV was lower in the unmarried group.
- ItemThe effect of different bed head angles on the hemodynamic parameters of intensive care patients lying in the supine position: a quasi-experimental study(Wiley, 2024-02) Yiğit Avcı, Şenay; Yılmaz, Dilek; 397256Aims: The aim of this study was to research the effect of different bed head angles on the hemodynamic parameters of intensive care patients lying in the supine position. Methods: This study was a non-randomized and non-controlled, quasiexperimental repeated measures study. The study was conducted with 50 intensive care patients aged 18 and over in a general surgery intensive care unit in Turkey. With each patient in the supine position, the bed head was raised to an angle of 0°, 20°, 30°, and 45° without a pillow, and the hemodynamic parameters of central venous pressure, systolic and diastolic blood pressure, heart rate, breathing rate, and peripheral oxygen saturation were recorded after 0 and 10 min. Results: It was found that the mean central venous pressure value measured at min 0 and 10 was higher when the intensive care patients' bed head angle was raised to 45° than when the bed head was at an angle of 0° or 20° (p < .05). It was found that the patients' other hemodynamic parameters were not affected by different bed head angles. Conclusions: It was concluded as a result of this research that in intensive care patients in the supine position, only central venous pressure was affected by bed head angle, and that central venous pressure measurement can be reliably made at a bed head angle of 30°.
- ItemThe role of advanced glycation end-product levels measured by skin autofluorescence in the development of mitral annular calcification(MDPI, 2023) Boyraz, Bedrettin; Peker, Tezcan; 313898As a person ages, mitral annular calcification develops in the mitral annulus with increasing frequency. Lipid deposition, inflammation, and aging-related degeneration have been cited as potential causes of this pathophysiology, though there is currently no conclusive evidence to support this. AGEs accumulate in tissues due to the glycation of proteins and lipids, increasing the release of proinflammatory cytokines secondary to oxidative stress through the AGE receptor. The AGE levels increase in diabetic microvascular complications and degenerative aortic valve disease. Our study was planned prospectively as a case–control study involving 94 MAC-positive patients and 94 MAC-negative patients. The demographics, echocardiographic data and AGE levels of the patients were measured and recorded using the skin autofluorescence method. AGE levels were significantly higher in the MAC-positive patient group (3.2 vs. 2.7; p < 0.001). The AGE levels were observed as an independent predictor of MAC development in a regression analysis (OR: 8.05, 95% CI: 3.74–17.33, p < 0.001). In a ROC-curve analysis, the AUC was 0.79 (95% CI: 0.72–0.85). At a cut-off value of 2.7, 79.7% sensitivity and 69.1% specificity were observed. AGE levels can be used to cheaply, easily and non-invasively identify patients at risk of developing MAC.
