Mehmet Erdem Memetoğlu

Combination technique of tumescent anesthesia during endovenous laser therapy of saphenous vein insufficiency

OBJECTIVE This study aimed at evaluating the efficiency of applying tumescent anesthesia before an ablation procedure and continuously during endovenous laser treatment (EVLT) (combined tumescent technique) of saphenous vein insufficiency to reduce the patients pain and discomfort. METHODS Twenty-five patients with 31 duplex-confirmed great saphenous vein insufficiency underwent endovenous laser (940 nm) varicose vein treatment between December 2009 and April 2010. The patients were randomized in two groups. In group A (15 patients) tumescent anesthesia was used before the ablation procedure and in group B (10 patients) tumescent anesthesia was used before and continuously during the procedure. Patients were scheduled for a three-day examination after EVLT to assess the level of pain experienced. RESULTS According to the statistic analysis we observed that the mean level of pain score for the patients given classical tumescent anesthesia showed a higher level (P=0.003) compared with the patients given tumescent anesthesia in the combined procedure. CONCLUSION Combination technique of administering tumescent anesthesia before ablation and continuously during the EVLT procedure may be an alternative way to reduce the patients peroperative pain and discomfort.

Behçet's disease with aneurysm of internal iliac artery and percutaneous treatment

Behçets disease (BD), described in 1937 by Hulusi Behçet, is a multisystemic inflammatory disorder. In this paper, we report a large pseudoaneurysm of the internal iliac artery in a patient who had BD, and was admitted to emergency service complaining of leg pain and the percutaneous treatment of the pathology which followed.

Abdominal oxygen saturation for monitoring return of spontaneous circulation in out-of-hospital cardiac arrest using near infrared spectrophometry.

AIM We used near-infrared spectrophotometry to assess the initial and final abdominal and cerebral saturations during cardiopulmonary resuscitation (CPR) of patients with out-of-hospital cardiac arrest to determine if there is a correlation between increase in these saturation values and return of spontaneous circulation. MATERIALS AND METHODS We evaluated 34 patients with out-of-hospital cardiac arrest without witnesses brought to our emergency department. Abdominal and cerebral saturations were measured using near-infrared spectrophotometry from the start of CPR. Cardiopulmonary resuscitation was performed for a maximum of 30 minutes. The effect of abdominal saturations in patients with or without spontaneous circulation restored through CPR was then assessed. RESULTS Thirty-four patients (17 males + females) with a mean age of 63.06 ± 11.66 years were included in the study. A significant correlation was determined between increase in abdominal saturations measured at the start and end of CPR and the return of spontaneous circulation (P < .001). A good positive correlation was also identified between abdominal saturation and return of spontaneous circulation. CONCLUSION Patients with increased abdominal and cerebral saturation values have a higher survival rate after appropriate CPR. This noninvasive measurement system and monitoring of patients during CPR may be a good method of predicting return of spontaneous circulation and assessing abdominal perfusion.

An unusual clinical state: atrial fibrillation due to mad-honey intoxication.

The honey which is produced in the Karadeniz Region of Turkey and known as the ``mad honey`` contains Rhododendron ponticum nectar. Grayanotoxin is only produced by Ericaceae plants and thought to be responsible for toxicity. The typical symptoms are gastrointestinal and may sometimes cause cardiac complications, such as severe bradycardia and hypotension. In our case, we report a patient with unusual cardiac toxicity symptom such as atrial fibrillation, following ``mad honey`` ingestion and give a review of clinical presentation and treatment of grayanotoxin poisoning.

Is Increased Mean Platelet Volume a Risk Factor in Patients with Acute Deep Vein Thrombosis

1Department of Emergency Medicine, Recep Tayyip Erdogan University Faculty of Medicine, Rize; Departments of 2Cardiovascular Surgery, 3Cardiology, Gumushane State Hospital, Gumushane; 4Department of Thoracic Medicine, Erciyes Univercity Faculty of Medicine, Kayseri, Turkey. Asim KALKAN,1 Mehmet Erdem MEMETOĞLU,2 Ozlem BILIR,1 Gokhan ERSUNAN,1 Rasim KUTLU,3 Nuri TUTAR4 Is Increased Mean Platelet Volume a Risk Factor in Patients with Acute Deep Vein Thrombosis?

An unusual clinical state: true ulnar artery aneurysm in a five-year old girl

We report the case of a 5-year old girl, who presented with a true ulnar artery aneurysm, and the aetiology, clinical presentation and treatment of the disease.

Autologous bone marrow stem cell implantation in treatment of thromboangiitis obliterans

1Kayseri Educating and Training Hospital, Department of Cardiovascular Surgery, Kayseri, Turkey 2Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Hospital, Department of Cardiovascular Surgery, İstanbul, Turkey 3Giresun University of Medical School, Department of Cardiology, Giresun, Turkey 4Erzurum State Educating and Training Hospital, Department of Cardiovascular Surgery, Erzurum, Turkey 5Akdeniz University of Medical School, Department of Cardiovascular Surgery, Antalya, Turkey Our research was carried out in Akdeniz University of Medical School, Department of Cardiovascular Surgery, Antalya, Turkey

Comparison of Transcatheter Aortic Valve Implantation versus Surgical Aortic Valve Replacement to Improve Quality of Life in Patients >70 Years of Age with Severe Aortic Stenosis

Objective: Transcatheter aortic valve implantation has recently been used in the treatment of severe aortic valve stenosis, particularly in patients with high mortality and morbidity rates for open surgery. The purpose of this study was to compare quality of life in patients over 70 years of age undergoing surgical or transcatheter aortic valve implantation, before the procedure and in the early post-procedural period. Methods: Seventy-nine patients were included in the study, 38 (48.1%) male and 41 (51.9%) female. Mean age of patients was 74.3±5.2 (70-91) years. The surgical aortic valve replacement group consisted of 51 (64.6%) patients and the transcatheter aortic valve replacement group of 28 (35.4%). Quality of life data before the procedure and at the 3rd month postoperatively in patients aged 70 years and older undergoing surgical or transcatheter aortic valve implantation were assessed using the 36-item Short Form Health Survey form. Results: Positive increases in physical task difficulty (13.2±9.8 vs. 5.1±7.3) (P=0.001), emotional task difficulty (14.4±11.9 vs. 8.5±6.4) (P=0.035), and mental health (0.4±10.4 vs. 9.6±15.1) (P=0.001; P<0.01) scores in patients undergoing transcatheter aortic valve replacement were significantly higher compared to the surgical aortic valve replacement group. No statistically significant difference was determined between the groups in terms of pain, vitality, social function, physical function or general health scores in the preoperative and postoperative periods. Conclusion: The positive increase in quality of life parameters in the transcatheter aortic valve implantation group at the 3rd month postoperatively was significantly higher compared to the surgical aortic valve replacement group.

Management of coronary artery disease in Kyrgyzstan: a comparison with Turkey and europe according to European Action on Primary and Secondary Prevention by Intervention to Reduce Events III results

OBJECTIVES The European Action on Primary and Secondary Prevention by Intervention to Reduce Events (EUROASPIRE III) Study in coronary artery disease had been undertaken between the years of 2006 and 2007, with the participation of 22 countries in Europe including Turkey (76 centers). In this study, the situation in the management of coronary artery disease in Kyrgyzstan was compared with EUROASPIRE III findings of Turkey and Europe. STUDY DESIGN The results of 1067 patients with stable coronary artery disease admitted to 22 centers in Kyrgyzstan were studied retrospectively and compared with the European and Turkish findings in EUROASPIRE III. During the study, the patients were interviewed and examined in the first year after the initial coronary event and/or intervention. RESULTS The gender distribution of the 1067 patients in the study was 658 female (61.7%) and 409 male (38.3%), and the average age was 68 ± 14 years. The ratio of young patients (<50 years) in Kyrgyzstan and Turkey were higher compared with the other European countries (Kyrgyzstan 28.2%, Turkey 20% and Europe 12.7%). The number of patients followed after the coronary event in Kyrgyzstan was 524 (49.1%). Although there was not a big difference of the classical risk factors between Turkey and Europe, in Kyrgyzstan, smoking (75%), hypertension (84%), dyslipidemia (86.5%), and diabetes (74.4%) were much higher when compared to the other countries. The biggest difference between Kyrgyzstan and the other countries in EUROASPIRE III study including Turkey, was the infrequency of medical (78% vs. 95%) and interventional treatment (1.9% vs. 57%). Also, smoking cessation (27.4% vs.70.8% in Europe), physical activity (17.5% vs. 59.1% in Europe), and weight loss (37.2% vs. 58.2% in Europe) ratios after the coronary event were found to be much lower in Kyrgyzstan than in EUROASPIRE III study. CONCLUSION When compared to the results of EUROASPIRE III study of Turkey and Europe; the Kyrgyzstan results were found to be behind for the prevention, follow-up and treatment goals set by the guidelines.

En az bir yıl takipleriyle birlikte lazer safen ablasyon sonuçlarımız

Objectives: This retrospective study aimed to evaluate the efficacy and durability of endovenous laser ablation with 940 nanometer wavelength with at least one-year follow-up. Materials and methods: Between December 2009 and February 2012, a total of 68 incompetent great saphenous veins and 4 small saphenous veins were treated by endovenous laser ablation, using 940 nanometer wavelengths. Patients underwent standard clinical and duplex follow-up examinations with a mean of 18 months (range 12 to 26 months) after endovenous laser ablation. Patient satisfaction regarding the procedure was assessed with the use of a visual analog scale (range 1 to 100). Results: Post-procedural duplex scans showed total occlusion of the treated great saphenous veins in 56 patients (97%) and sub-total occlusion in 2 (3%) patients. For small saphenous veins, post-procedural duplex scans showed total occlusion in 4 (100%) patients. The average pre-procedure modified clinical picture, eti ology, anatomic distribution and pathophysiology clinical score improved significantly after 12 months. Complica tions from our series included swelling and induration in 3 patients (5%), skin pigmentation in 3 patients (5%). Patient satisfaction with the surgical outcome was 83.17 % (±11.79, n=58). Conclusions: Our results have been satisfying, and this study has reaffirmed the effectiveness and durability of endovenous laser ablation with 940 wavelength in the treatment of great saphenous vein insufficiency.