Mehmet Umit Ergenoglu

Effects of Single-Dose Gabapentin on Postoperative Pain and Morphine Consumption After Cardiac Surgery

OBJECTIVE The purpose of this study was to evaluate the analgesic effect of single-dose preoperative gabapentin on postoperative pain and morphine consumption after cardiac surgery. DESIGN A randomized, double-blind, placebo-controlled, clinical study. SETTING A single university hospital. PARTICIPANTS Sixty patients undergoing coronary artery bypass graft surgery. INTERVENTIONS Patients were randomly allocated into 2 groups preoperatively either to receive 600 mg of oral gabapentin (GABA) or placebo (PLA) 2 hours before the operation. After extubation, an anesthesiologist blinded to the groups recorded pain scores both at rest and with cough with a 10-point verbal rating scale and sedation scores at 2, 6, 12, 18, 24, and 48 hours. Cumulative morphine consumption and the incidence of side effects were recorded during the study period. MEASUREMENTS AND MAIN RESULTS The total morphine consumption was lower in the GABA group (6.7 ± 2.5 mg) than in the PLA group (15.5 ± 4.6 mg, p < 0.01). Pain scores at rest were significantly lower in the GABA group than in the PLA group throughout the study period (p < 0.05 in all measurement times). Pain scores at 2, 6, and 12 hours during coughing were significantly lower in the GABA group (p < 0.05). The number of oversedated patients was significantly higher in the GABA group at 2, 6, and 12 hours of study compared with PLA (p < 0.001 at 2 and 6 hours and p < 0.02 at 12 hours). The postoperative mechanical ventilation period was significantly prolonged in the GABA group (6.6 ± 1.2 hours) compared with the PLA group (5.5 ± 1 hours, p < 0.01). Nausea incidence was significantly lower in the GABA group (n = 9) than in the PLA group (n = 18, p = 0.02). CONCLUSIONS Oral GABA at a dose of 600 mg given before cardiac surgery significantly reduced postoperative morphine consumption and postoperative pain both at rest and with cough.

The Evaluation of Saphenofemoral Insufficiency in Primary Adult Varicocele

The aim of this study was to evaluate the possible relationship between varicocele and saphenofemoral insufficiency in patients diagnosed with primary varicocele. A total of 70 patients with the primary diagnosis of varicocele were included into the study. A total of 30 age-matched healthy adults were also included in the study as a control group. Varicocele was diagnosed by palpation and observation of each spermatic cord in standing position before and during a valsalva maneuver. Additionally, scrotal Doppler and lower extremity venous Doppler ultrasonography were performed. Patients who were with spermatic varicose vein larger than 3.0 mm were included in the study group as a varicocele patient. At the lower extremity venous Doppler ultrasonography, a retrograde flow lasting longer than 0.5 seconds during normal breathing or at the valsalva maneuver was considered to be meaningful for saphenofemoral junction insufficiency. Thirty-six (51.35%) patients had insufficiency in saphenofemoral junction in the study group (6 [8.5%] bilateral, 30 [42.85%] unilateral) whereas 8 (26.6%) had insufficiency in the control group (2 [6.6%] bilateral, 6 [20%] unilateral insufficiency). The patients with primary varicocele had a statistically significant (P = .02) higher rate of venous insufficiency in their saphenofemoral junctions when compared with the control group. In the present study, the rate of saphenofemoral insufficiency has been found to be statistically higher in patients with primary varicocele compared with healthy men. Depending on the common presence of valvular insufficiency, we believe that the presence of varicocele should be investigated in the young population suffering from saphenofemoral junction insufficiency.

Giant hydatid cyst of the interventricular septum mimicking acute myocardial infarction on ECG: an unusual cause of ST segment elevation

Hydatid disease is a parasitic infection caused by larvae of Echinococcus granulosus, which is still endemic in many cattle-raising areas. Cardiac involvement is a rare, but potentially a very serious complication of the hydatid disease. The diagnosis of cardiac cyst hydatid may be difficult due to the nonspecific symptoms and varying clinical presentations. With this report, we describe a case of giant hydatic cyst of the interventricular septum that caused ischemic changes on ECG, mimicking acute myocardial infarction. The final diagnosis was made by combining echocardiography, MRI, and serological tests. Surgical resection of the cyst, followed by albendezol treatment yielded a favorable outcome.

Fate of vena saphena magna stump after endovenous laser ablation with 980-nm diode laser: 12-month follow-up.

OBJECTIVE The aim of this study was to investigate the fate of VSM stump and its relation to the incidence of thrombosis during a-12 mo follow-up. BACKGROUND DATA Varicose veins are a common problem. There are several treatment alternatives available. Conventional surgical treatment is associated with high recurrence and complications. However, with the recent development of minimal invasive surgery, various techniques have been developed. Endovenous laser ablation (EVLA) is one of these techniques, which has proven to be safe and effective. Since EVLA is safe and has minor adverse reactions, residual VSM stump and its association with thrombosis after EVLA has not been well studied in literature. MATERIALS AND METHODS Sixty-nine patients underwent EVLA with a 980-nm diode laser (Ceralas D, Biolitec AG, Jena, Germany), and retrospectively obtained data were analyzed over a 12-mo period. Twenty-six patients were excluded due to the lack of follow-up. All EVLA procedures were performed by the same surgeon, who has experience of EVLA. Laser power was set at 10-15 W depending on the size of targeted vein. The saphenous vein was percutaneously punctured with an 18-gauge needle under ultrasonography guidance. Patients were reassessed at 1 wk, and at 3, 6, and 12 mo after the procedure. RESULTS Technical success was accomplished in all patients. One patient had flow signals with patent segment of the VSM visualized by venous duplex ultrasonography at 1 mo, which persisted until the 12-mo follow-up. None of the patients developed acute deep-venous thrombosis. CONCLUSIONS The present study shows that residual VSM stump-length measurement differences at 7 d and 12 mo were statistically significant. In future, large-scale studies are needed, focusing on the proper position of the catheter tip to the saphenofemoral junction and timing the intervals of follow-up after EVLA.

Grafting the Restenosed Coronary Artery, Dealing With Full Metal Jacket

2. Habib RH, Schwann TA, Engoren M. Late effects of radial artery versus saphenous vein grafting in patients aged 70 years or older. Ann Thorac Surg 2012;94:1478–84. 3. Deb S, Cohen EA, Singh SK, Une D, Laupacis A, Fremes SE. Radial artery and saphenous vein patency more than 5 years after coronary artery bypass surgery: results from RAPS (Radial Artery Patency Study). J Am Coll Cardiol 2012;60:28–35. 4. Tatoulis J, Buxton BF, Fuller JA, et al. Long-term patency of 1108 radial arterial-coronary angiograms over 10 years. Ann Thorac Surg 2009;88:23–30. 5. Lytle BW, Blackstone EH, Sabik JF, Houghtaling P, Loop FD, Cosgrove DM. The effect of bilateral internal thoracic artery grafting on survival during 20 postoperative years. Ann Thorac Surg 2004;78:2005–12. 6. Zacharias A, Habib RH, Schwann TA, Riordan CJ, Durham SJ, Shah A. Improved survival with radial artery versus vein conduits in coronary bypass surgery with left internal thoracic artery to left anterior descending artery grafting. Circulation 2004;109:1489–96. 7. Wu C, Camacho FT, Zhao S, et al. Long-term mortality of coronary artery bypass graft surgery and stenting with drug-eluting stents. Ann Thorac Surg 2013;95:1297–305.

Endovenous laser ablation with 980-nm diode laser: early and midterm results.

OBJECTIVE Endovenous laser ablation (EVLA) is an efficient method to treat incompetent great saphenous veins (GSV) with high occlusion rates. The aim of this prospective study is to demonstrate the treatment outcomes of EVLA of incompetent GSV with a 980-nm diode laser in an ambulatory setting. BACKGROUND DATA EVLA of the incompetent GSV with a 980-nm diode laser appears to be an extremely safe technique. There are several treatment alternatives available. Among the emerging techniques, EVLA is one of the most promising. METHODS Ninety eight patients (103 limbs) with symptomatic varicose veins secondary to GSV insufficiency treated with 980-nm EVLA were prospectively studied. In all patients, laser energy was administered with constant pullback of fiberoptic laser catheter under tumescent anesthesia. The patients were assessed and followed by clinical examination and venous duplex ultrasonography. Pain scores of the patients from discharge to their first follow-up visit (7 days) were recorded by using visual analog scale (VAS). Patient satisfaction was assessed and recorded at 6 month follow-up. RESULTS All patients tolerated EVLA procedure well, and were discharged from hospital on the same day with ablation procedure. The overall success rate was 97.5% in 98 patients. Mean length of measured treated vein segment was 29.93±6.36 cm. Mean applied total energy was 2006.24±480.16 J. Major complications such as deep vein thrombosis and skin burns were not seen. Most of the complications were minor and improved quickly. All patients returned to daily activities within 2 days. CONCLUSIONS EVLA of the GSV insufficiency using 980-nm diode laser is an effective and safe technique with a high patient satisfaction rate. The advantages of the procedure are that it is performed as an outpatient procedure, provides early mobilization, causes minimal cessation of daily activities, and avoids classic surgical complications.

Comparison of 980-nm and 1070-nm in endovenous laser treatment

The use of endovenous laser treatment for varicose veins has been increasing in recent years. It is a safer technique than surgical vein stripping. Its complications (e.g. bruising, pain) are less than the complications of surgical vein stripping. But best parameters such as optimum wavelength, power, and application duration are still under investigation to clarify uncertainties about this technique. To prevent its complications and improve its clinical outcomes, the exact mechanism of it has to be known. The aim of this study is to investigate the effect of different laser wavelengths on endovenous laser therapy. In this study 980-nm diode laser and 1070-nm fiber laser were used. Human veins were irradiated with 980-nm and 1070-nm lasers at 8 W and 10 W to find the optimal power and wavelength. After laser application, remarkable shrinkage was observed. Inner and outer diameters of the veins also narrowed for both of the laser types. 10 W of 980-nm laser application led to better shrinkage results.

Comparison of 980-nm and 1070-nm in endovenous laser treatment (EVLT)

The use of endovenous laser treatment for varicose veins has been increasing in recent years. It is a safer technique than surgical vein stripping. Its complications (e.g. bruising, pain) are less than the complications of surgical vein stripping. But best parameters such as optimum wavelength, power, and application duration are still under investigation to clarify uncertainties about this technique. To prevent its complications and improve its clinical outcomes, the exact mechanism of it has to be known. The aim of this study is to investigate the effect of different laser wavelengths on endovenous laser therapy. In this study 980-nm diode laser and 1070-nm fiber laser were used. Human veins were irradiated with 980-nm and 1070-nm lasers at 8 W and 10 W to find the optimal power and wavelength. After laser application, remarkable shrinkage was observed. Inner and outer diameters of the veins also narrowed for both of the laser types. 10 W of 980-nm laser application led to better shrinkage results.

Pinball-Like Free-Floating Left Atrial Ball Thrombus Presenting with Hemiplegia: A Challenging Treatment Decision.

We describe a case of a patient with a history of chronic atrial fibrillation who presented with sudden onset of left hemiplegia. Nine months earlier the longstanding warfarin therapy had been suspended due to a hemorrhagic stroke. Transthoracic echocardiography revealed a large free-floating highly mobile mass in the left atrium and severe mitral valve regurgitation. Due to the potential risk of an embolic event or a hemodynamic collapse, a decision to carry out an emergency operation was made irrespective of the neurological condition of the patient. Unfortunately, the patient died on the 18th postoperative day after a freshly occurring hemorrhagic stroke.

Endovascular Treatment of Abdominal Aortic Aneurysm in a 26-Year-Old Man. A Case Report and 10-Year Follow-up

We present endovascular treatment of abdominal aortic aneurysm in a 26-year-old man with a 10-year follow-up. A young patient presenting with an abdominal aortic aneurysm is extremely rare, and data describing this population are limited. Open aneurysm repair (OAR) is the treatment of choice in these patients. However, since its introduction, endovascular aneurysm repair (EVAR) has revolutionized the treatment of abdominal aortic aneurysms. The long-term durability and late complications after EVAR may have more significance when considering the optimal treatment for young patients with a longer life expectancy. Our good long-term outcome will help to support the use of EVAR as a reasonable alternative to OAR in young patients with suitable anatomic findings.