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Öğe A rare cause of dysphagia and weight loss in a nonagenarian with hypertension: Dysphagia aortica(Blackwell Publishing Inc., 2015) Karavelioğlu, Yusuf; Kalçık, Macit; Yetim, Mücahit; Sarak, Taner; Bekar, Lütfü; Doğan, TolgaTo the Editor: Dysphagia is a subjective awareness of difficulty in swallowing caused by impaired progression of food from the oropharynx to the stomach. An unusual mechanical cause of dysphagia occurs from extrinsic compression of the esophagus by the aorta. This was first described in 1932 as dysphagia aortica, which develops primarily in women and is associated with short stature, old age, hypertension, and kyphosis.1 A 98?year?old woman with dysphagia aortica caused by a dilated archus aorta and uncontrolled hypertension is reported.Öğe Anafilaktik Reaksiyonda Epinefrin Aşırı Dozuna Bağlı Miyokard Enfarktüsü(2016) Bekar, Lütfü; Sarak, Taner; Yetim, Mücahit; Doğan, Tolga; Çelik, Oğuzhan; Çamkıran, Volkan; Karavelioğlu, YusufEpinefrin anafilaktik reaksiyonun tedavisinde sıklıkla kullanılan bir ajandır. Anafilaktik reaksiyonlarda epinefrin kullanımına bağlı göğüs ağrısı, miyokardiyal enfarktüs ve aritmi olabileceği bildirilmiştir. Biz bu makalede ciddi anafilaksisi olan bir hastada, subkutan olarak order edilen ancak yanlışlıkla intravenöz olarak uygulalan epinefrinin neden olduğu miyokardiyal enfarktüsü sunduk.Öğe Coronary embolism in a patient with massive left atrial thrombus and mechanical valve thrombus: Hybrid treatment with surgery and percutaneous intervention(Turkish Anaesthesiology and Intensive Care Society, 2013) Karavelioğlu, Yusuf; Yanartaş, Mehmet; Sarak, Taner; Bakal, Ruken Bengi; Özkan, Mehmet[No abstract available]Öğe Dunbar syndrome as an unusual cause of exercise-induced retrosternal pain(Turkish Society of Cardiology, 2015) Karavelioğlu, Yusuf; Kalçık, Macit; Sarak, TanerThe median arcuate ligament is a fibrous band connecting the left and right diaphragmatic crura across the aortic hiatus at the level of the T12/L1 vertebral bodies. The low insertion point of this ligament causes significant stenosis of the proximal portion of the coeliac artery in a small group of patients, and contributes to ischemic symptoms known as coeliac artery compression syndrome (CACS). It is also referred to as median arcuate ligament syndrome or Dunbar syndrome. Symptoms include especially postprandial epigastric or retrosternal pain, weight loss, nausea, vomiting, diarrhea and reduced appetite. In severe cases, exercise related abdominal pain may be caused by steal phenomenon, whereby blood is shunted to the skin and relevant muscles during exercise. Computed tomographic angiography and mesenteric angiography are the gold standard diagnostic modalities to confirm diagnosis of CACS. Surgical therapy with release of the median arcuate ligament usually is the primary treatment of choice. Here, we present a 46-year-old male CACS patient with postprandial and especially exercise-induced retrosternal pain radiating to the epigastric region, which may be misperceived as a coronary symptom. © 2015 Turkish Society of Cardiology.Öğe Early surgery is feasible in patients with hip fractures who are on clopidogrel therapy(Ekin Medical Publishing, 2015) Zehir, Sinan; Zehir, Regayip; Sarak, TanerObjective: Timing of surgery in hip fracture patients using antiplatelet agents is a controversial issue. Clopidogrel is an antiplatelet drug widely used in the treatment of many diseases. In this study, we aimed to investigate the outcomes of early surgery in hip fracture patients using clopidogrel. Methods: Elderly patients with femoral neck fractures who underwent open surgery between 2009 and 2014 were evaluated. Two hundred and eleven patients were included in the study. Patients were separated into 3 groups. Group 1 was constituted of patients using clopidogrel who had been operated on within 48 h after admission (n=74), Group 2 was constituted of patients using clopidogrel who had been operated on after the fifth day of admission (n=55), and Group 3 was constituted of patients not using clopidogrel who had been operated on within 48 h after admission (n=83). Length of hospital stay, amount of blood transfusion, rate of complication, and mortality rate were assessed for comparison of groups. Results: Age, sex, preoperative hemoglobin values, and ASA scores were not different between the groups. Amount of blood transfusions was higher in Group 1 (p=0.023). Duration of hospital stay was longer in Group 2 (p<0.01), as was complication rate (25.4%) (p<0.01). Mortality within 30 days and within the first 3 months post-surgery was significantly higher in Group 2 (p=0.031, p<0.01; respectively). Conclusion: Surgery should not be postponed in hip fracture patients using clopidogrel. © 2015 Turkish Association of Orthopaedics and Traumatology.Öğe Elektrik yaralanmalarında elektrokardiyografi bulgularının klinik gidişte önemi(Turkish Association of Trauma and Emergency Surgery, 2015) Vural, Aslı; Sarak, Taner; Vural, Selahattin; Yastı, Ahmet ÇınarAMAÇ: Bu çalışmada, elektrik yaralanması nedeniyle başvuran hastaların demografik ve klinik özellikleri, elektrik akımı türleri ve hastaların elektrokardiyografi bulgularının klinik gidişte öneminin incelenmesi amaçlandı. GEREÇ VE YÖNTEM: Hastanemiz yanık tedavi merkezinde 2011-2012 yılları arasında elektrik yaralanması nedeniyle yatarak tedavi edilen 53 hasta (50 erkek [%94.3], 3 kadın [%5.7]; ortalama yaş 34.5±9.6; dağılım 19-61 yaş) geriye dönük olarak incelendi. Hastaların demografik ve klinik özellikleri, elektrokardiografi (EKG) bulguları ve klinik sonuçları değerlendirildi. BULGULAR: Hastaların beşi yüksek gerilimli akımla, 48’i düşük gerilimli akımla yaralanmıştı. Geliş elektrokardiyografilerinde 27’si normal iken 12’sinde sinüs taşikardisi, üçünde atriyal fibrilasyon, yedisinde sağ dal bloğu, dördünde ventriküler erken atım saptandı. Geliş EKG’si normal sinüs ritmi, sağ dal bloğu ve ventriküler erken atımı olan hastalarda ölüm görülmedi. Sinüs taşikardisi olan dört hasta, atriyal fibrilasyonu olan bir hasta hayatını kaybetti (p=0.007). Elektrik akımı türünün elektrokardiyografiye etkisine bakıldığında, yüksek gerilime maruz kalan iki hastada normal sinüs ritmi, iki hastada sinüs taşikardisi, bir hastada atriyal fibrilasyon izlendi. SONUÇ: Elektrik yaralanmalarında, hastaların geliş elektrokardiyografisinde sinüs taşikardisi ve atriyal fibrilasyonu olan hastalarda ölüm oranlarının fazla olduğu saptandı. Yüksek gerilimle olan elektrik yaralanmalarında bu elektrokardiyografi bulguları daha sık görüldü. Bu nedenle, elektrokardiyografi bulguları ve gerilim tipi hastaların klinik gidişinde prognostik değer taşıyabilirÖğe Myocardial infarction related with epinephrine overdose in anaphylaxis(MEDİTAGEM Ltd. Şti., 2016) Bekar, Lütfü; Sarak, Taner; Yetim, Mücahit; Doğan, Tolga; Çelik, Oğuzhan; Çamkıran, Volkan; Karaarslan, Osman; Erçen Diken, Özlem; Karavelioğlu, YusufEpinephrine is an agent which is often used in the treatment of anaphylactic reaction. It has been reported that chest pain, myocardial infarction and arrhythmia may occur secondary to epinephrine use in anaphylactic reactions. In this report, we presented a case with anaphylaxis who developed myocardial infarction secondary to epinephrine, which was ordered to be administered subcutaneously but administered intravenously by mistake.Öğe Neutrophil to lymphocyte ratio is predictor of atrial fibrillation recurrence after cardioversion with amiodarone(SAGE Publications Inc., 2015) Karavelioğlu, Yusuf; Karapınar, Hekim; Yüksel, Murat; Memiç, Kadriye; Sarak, Taner; Kurt, Recep; Yılmaz, AhmetBackground: In this study, our aim is to examine the role of the neutrophil to lymphocyte ratio (NLR) in the predictions of recurrence under long-term follow-up in patients whose sinus rhythms (SRs) were restored with amiodarone in acute atrial fibrillation (AF).Methods: Retrospectively, patients with acute AF, which successfully converted to the SR with amiodarone treatment, were recruited into the study. Patients experiencing the first AF attack were enrolled to the study and followed up for 5 years (median 23 months, 25-75 percentiles 12-24 months). Neutrophil to lymphocyte ratio was computed as absolute neutrophil count divided by lymphocyte count.Results: A total of 218 patients were recruited into the study and followed up for 21.6 ± 13.9 months; 87 (40%) patients had ?1 recurrent AF attack within this period. The follow-up of 131 (60%) patients resulted in persisted SR without any other AF attack. Groups were similar in terms of age nd gender. Left atrium (LA) diameter and NLR were increased, and platelet count and lymphocyte count were decreased in patients with AF recurrence in univariate analysis (P < .05 for all). Only LA diameter (for per mm, 1.077 [1.021-1.136], P .006) and NLR (1.584 [1.197-2.095], P .001) were independent predictors of AF recurrence in the multivariate analysis.Conclusion: Increased NLR is a marker of increased inflammation and may serve as simple, cheap, and readily available predictors of recurrence in the long-term follow-up of patients admitted with acute AF and successfully converted to SR with amiodarone. © The Author(s) 2014.Öğe Penetran Ekstremite Travmalı Hastalarda Vasküler Yaralanmalar ve Sonuçları(2015) Yılmaz, Seyhan; Nazlı, Yasemin Ece; Zehir, Sinan; Sarak, Taner; Yılmaz, CeyhanAmaç: Derin penetran ekstremite travmaları için geçmişte rutin olarak, gereksiz yere acil eksplorasyon yapılmaktaydı. Bu tip travmaların Batı Avrupa'daki düşük insidansı travma cerrahlarının deneyim kazanmalarını zorlaştırmaktadır. Değişik merkezler, sivil hastaların vasküler travmalarının farklı operatif teknik ve klinik sonuçlarına yönelik sonuçlar bildirmişlerdir. Bölgemizdeki penetran ekstremite travmalarında vasküler yaralanma sıklığı ve sonuçlarının değerlendirilmesini amaçladık. Gereç ve Yöntemler: Hastanemiz acil servis departmanına 2013 yılı içinde başvuran 11 568 hasta incelendi ve penetran ekstremite travması nedeniyle başvuran 408 hasta çalışmaya dahil edildi. Bulgular: Penetran ekstremite travmalı 408 hastadan 52 tanesinde (43 erkek, %83) major vasküler yaralanma olduğu anlaşıldı. Hastaların yaş ortalaması 36,32±20,57 yıl (6-76 yıl) idi. Toplam 27 hastaya damar bütünlüğünü değerlendirmek için bilgisayarlı tomografik anjiografi tetkiki yaptırıldı. Sonuç: Bulgularımız, bölgemizdeki penetran ekstremite travmalı vasküler yaralanmalarda en sık nedenin ateşli silah yaralanması olduğunu göstermiştir. Periferik vasküler yaralanmalarda özellikle tüm major arterler olmak üzere travmatize major vasküler yapılar, mümkünse, en kısa sürede tamir edilmelidir.Öğe Platelet-to-lymphocyte ratio predicts contrast-induced nephropathy in acute myocardial infarction(DNT Ortadoğu Yayıncılık A.Ş., 2017) Zehir, Regayip; Sarak, Taner; Zehir, SinanAim: Contrast-induced nephropathy (CIN) is responsible for an increased mortality rate and correlates with increases in hospital stays and the risk of cardiovascular complications. The platelet to lymphocyte ratio (PLR) was introduced as a potential marker to determine the balance between thrombosis and inflammation and was associated with increased cardiovascular morbidity and mortality. We investigated whether PLR on admission is an independent risk factor that predicts the development of CIN in patients with ST-segment elevation myocardial infarction (STEMI) underwent primary percutaneous coronary intervention (pPCI). Material and Methods: 1348 consecutive patients with acute STMI who were admitted to our institution and underwent pPCI were retrospectively evaluated. Data obtained from hospital files and computer records. CIN development was accepted as the endpoint. Results: A total of 127 (9.4%) patients experienced CIN. 16 patients underwent renal replacement theraphy. In-hospital mortality rate was found 2.7% (n = 37). Patients were divided into two groups based on development of CIN. Age (P = 0.001), baseline GFR (P < 0.001), grade 3 and more chronic kidney disease (P < 0.001), baseline creatinin (P < 0.001), EF (P < 0.001), presence of DM (P < 0.001) were different between groups. In multivariate analyses, PLR (odds ratio [OR] 1.012, 95% confidence interval [CI] 1.006-1.017, P < 0.001) was independently predicted CIN development. Conclusion: PLR is easily available, widely used, and relatively cheap biomarker, and is an independent predictor of CIN development in patients with STEMI undergoing pPCI.Öğe Prevalence, presentation and occupational risk factors of chronic venous disease in nurses(SAGE Publications Ltd, 2016) Diken, Adem İlkay; Yalçınkaya, Adnan; Aksoy, Eray; Yılmaz, Seyhan; Özşen, Kelime; Sarak, Taner; Çağlı, KerimObjective: In this study involving a group of nurses employed in a number of different medical services with relatively well-defined working conditions, the presence and symptoms of chronic venous insufficiency were screened and their association with work burden and physical working conditions was explored. Methods: Of the 294 actively employed nurses during the study period, 232 (79%) were recruited on the basis of their willingness for participation and fulfilment of the inclusion criteria. Results: Among the study subjects, 62.9% had at least one symptom of chronic venous insufficiency, and 50.4% were found to have chronic venous insufficiency according to Clinical–Etiology–Anatomy–Pathophysiology classification criteria. A significant association was found between the diurnal ankle circumference difference in the left–right ankles and the mean duration of hospital stay. Conclusions: Our results have shown that the average duration of hospital stay, which is among the variables used to estimate the work burden of nurses, is associated with an increased frequency of the signs and symptoms of chronic venous insufficiency. © 2015, © The Author(s) 2015.Öğe The reliability of magnetic resonance imaging in patients undergoing cardiologic and cardiovascular surgical interventions(Bayçınar Medical Publishing, 2016) Diken, Adem İlkay; Yalçınkaya, Adnan; Çamkıran, Volkan; Yılmaz, Seyhan; Sarak, Taner; Çağlı, KerimMagnetic resonance imaging is an invaluable diagnostic tool which is increasingly more frequently used in clinical practice. However, the utility of this imaging technique may be limited in patients with metallic implants placed during previous cardiologic or cardiovascular surgical interventions due to increased complication rates. Despite increased rates of compatibility between such devices and magnetic resonance imaging thanks to technological advances, the risk of interaction with untoward consequences is still high in many cases. Herein, we describe a practical source of information and guidance on the reliability of magnetic resonance imaging in this patient population in the clinical practice in the light of evidence-based data.Öğe Tirofibanın ST elevasyonsuz miyokard infarktüslü hastalarda qt dispersiyonu ve aritmi üzerine etkisi(MEDİTAGEM Ltd. Şti., 2015) Sarak, Taner; Diken, Adem İlkay; Bekar, LütfüAmaç: Çalışmanın amacı NSTEMİ ‘li hastalarda standart tedaviye ek olarak verilen tirofibanın QT dispersiyonu ve aritmi sıklığı üzerindeki etkisini ortaya koymaktır. Giriş: QT dispersiyonu ventrikül repolarizasyon heterojenitesini yansıtan noninvaziv bir göstergedir. NSTEMİ’nde tirofibanın mortaliteyi azaltmadaki etkisinin aritmi ile ilgisi açıklığa kavuşmuş değildir. Bu etkinin trombüsün eri- mesine mi bağlı olduğu, yoksa aritmiye bağlı komplikasyonların engellenerek mi oluştuğunu açıklayabilmek üzere iki ayrı grup karşılaştırılmıştır. Yöntem ve Gereçler: Altmış altı NSTEMİ tanılı hasta, tirofiban ve standart tedavi verilen 32 hasta Grup 1, sadece standart tedaviyi alan 34 hasta Grup 2 olmak üzere ikiye ayrılmıştır. Tüm hastalardan hastaneye kabul edildikleri 1.gün ve 7. günde 50 mm/sn hız ve 20 mm/mV amplitüdünde EKG kaydı alındı. Yoğun bakım takibi süresince tele- metri ile aritmi takibi uygulandı. Sonuçlar: Her iki grupta da major yada minor kanamaya rastlanmadı. Grup 1 ile grup 2 arasında 1. gün (tedavi öncesi) QT, QTc, QTd ve QTcd değerleri arasında anlamlı fark saptanmadı. 1. ve 7. gündeki QT, QTc, QTd değerle- rindeki değişim miktarlarında anlamlı fark saptanmazken ortalama QTcd değerindeki azalma Grup 1’de istatistiksel olarak anlamlı idi (p=0,001) Grup 1 ve grup 2’deki parametreler birbirileriyle karşılaştırıldığında QT, QTc değerleri arasında anlamlı fark saptanmazken, QTd ve QTcd değerleri Grup 1’de anlamlı olarak daha düşük bulundu (sırasıy- la p<0.001 ve p=0.001) ). Sürekli VT, süreksiz VT ve ventriktiler fibrilasyon atağı birlikte değerlendirildiğinde grup 1’de ciddi ventriküler aritmi oranı grup 2’ye göre anlamlı olarak düşük tespit edildi (p=0,04). Tartışma: ST elevasyonsuz miyokard infarktüsünün medikal tedavisinde tirofiban kullanımının QT dispersiyonu ve hastane içi ciddi ventriküler aritmi gelişimi üzerine olumlu etkisi olduğu gözlendi.
