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Postoperative fluid management

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World Journal of Critical Care Medicine 2015年第3期4卷 192-201页

作者： Selami Ilgaz kayilioglu tolga Dinc Isa Sozen Akin Bostanoglu Mukerrem Cete Faruk Coskun Ankara Numune Training and Research Hospital Department of General Surgery

Postoperative care units are run by an anesthesiologist or a surgeon, or a team formed of both. Management of postoperative fluid therapy should be done considering both patients' status and intraoperative events. Types of the fluids, amount of the fluid given and timing of the administration are the main topics that determine the fluid management strategy. The main goal of fluid resuscitation is to provide adequate tissue perfusion without harming the patient. The endothelial glycocalyx dysfunction and fluid shift to extracellular compartment should be considered wisely. Fluid management must be done based on patient's body fluid status. Patients who are responsive to fluids can benefit from fluid resuscitation, whereas patients who are not fluid responsive are more likely to suffer complications of overhydration. Therefore, common use of central venous pressure measurement, which is proved to be inefficient to predict fluid responsiveness, should be avoided. Goal directed strategy is the most rational approach to assess the patient and maintain optimum fluid balance. However, accessible and applicable monitoring tools for determining patient's actual fluid need should be further studied and universalized. The debate around colloids and crystalloids should also be considered with goal directed therapies. Advantages and disadvantages of each solution must be evaluated with the patient's specific condition.

关键词： Body fluids Body fluid compartments Fluid therapy Intensive care Postoperative care

The diagnostic significance and the assessment of the value of vascular endothelial growth factor as a marker for success of chemical pleurodesis in malignant pleural effusion

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Journal of Biomedical Science and Engineering 2011年第3期4卷 214-218页

作者： Dalokay kilic Alper Findikcioglu Goknur Alver tolga Tatar Hakan Akbulut Ahmet Hatipoglu 不详

Differential diagnosis of pleural effusion is an important issue, since the treatment modalities and prognosis strictly depend on early and correct diagnosis of the underlying etiology. We assessed the efficacy of vascular endothelial growth factor (VEGF) in the differential diagnosis of patients with malignant and non-malignant pleural diseases. And also is assessed of the VEGF as a marker for success of chemical pleurodesis in malignant pleural effusion. Pleural effusions of 40 patients with a mean age of 55 (range, 26 to 78 years) were examined. A total of 20 patients had malignant pleural effusion;malignant mesothelioma (n=7), lung cancer (n=5) and metastatic malignancies (n=8). Twenty patients had benign pleural effusion;fibrinous pleuritis (n=6), tuberculosis (n=3) empyema (n=5), congestive heart failure (n=3), and acute pancreatitis (n=3). Definitive diagnosis was obtained in all cases with blind or open pleural biopsy, and cytological examination. VEGF levels were determined by enzyme-linked immunosorbent assay. The VEGF level of pleural effusion was comparably higher in the malignant group. The mean level of VEGF in patients with malignant pleural effusions (21.7 ± 1.8 ng/ml) was significantly (P rognostic marker for effective treatment of the patients who had malignant pleural effusions with pleurodesis. It is important issue in here whether VEGF could be useful in prognostication of outcome of chemical pleurodesis or not.

关键词： Malignant pleural effusion pleural effusion chemical pleurodesis vascular endothelial growth factor

The Use of Neuronavigation with Vasular Microdoppler in Transsphenoidal Pituitary Surgery

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Open Journal of Modern Neurosurgery 2016年第1期6卷 45-50页

作者： Mehmet Hakan Seyithanoglu Serkan kitis Meliha Gundag Papaker Fatih Calis tolga Turan Dundar Serdar Cevik Department of Neurosurgery Bezmialem Vakif University Faculty of Medicine Istanbul Turkey Department of Neurosurgery Agri State Hospital Agri Turkey

Object: To evaluate the use of neuronavigation with vascular micro-doppler in transsphenoidal pituitary surgery. Methods: 141 cases having done transsphenoidal pituitary surgery are evaluated from 2005 to 2014. Fluoroscopy was used in 69 cases and vascular micro-doppler with neuronavigation were used in 72 cases. Results: Transsphenoidal surgery has a lot of risks due to sella’s deep location, and position of the carotid artery and the optic nerve. Clasically the fluoroscopy and microscopic anatomical markers were used in order to minimize the risk of carotid artery and optic nerve damage. Additional devices such as neuronavigation and vascular micro-doppler are needed to decrease the morbidity and mortality arising from these injuries. Conclusion: Neurovascular complications such as carotid artery and optic nerve injuries owing to disorientation in transsphenoidal surgery will reduce the use of neuronavigation with vascular micro-doppler.

关键词： Transsphenoidal Surgery Vascular Micro-Doppler Neuronavigation Pituitary Adenomas

Self-medication with nutritional supplements and herbal over-the-counter products

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Natural Products and Bioprospecting 2011年第2期1卷 62-70页

作者： tolga EICHHORN Henry Johannes GRETEN Thomas EFFERTH Department of Pharmaceutical Biology Institute of Pharmacy and BiochemistryJohannes Gutenberg UniversityStaudinger Weg 555128 MainzGermany Heidelberg School of Chinese Medicine Karlsruher Straße 1269126 HeidelbergGermanyand Biomedical Sciences Institute Abel SalazarUniversity of PortoPortugal

In recent years,the popularity increased for nutritional supplements and herbal *** drugs,but not herbal therapies are paid by health *** are sold over-the-counter(OTC)on the patients’own ***,there are potential risks of self-medication,*** self-diagnosis,severe adverse reactions,dangerous drug interactions,risk of addiction *** are often used by patients at their own discretion without knowledge of and control by their *** users are at risk of *** medications taken by older patients increase the risk for adverse drug reactions,drug-drug interactions,and compliance problems for this age group(polypharmacy).Herbals should be discontinued prior to operations to avoid interactions with anesthetics or *** preparations may also be carcinogenic or interfere with cancer *** women use various OTC ***,in many cases,it is unclear whether their use is safe for mother or ***-medication with herbals is also largely distributed among anxious and depressive patients,and patients with other conditions and *** popularity of herbal products has also brought concerns on quality,efficacy and *** of botanical misidentification,contaminations with heavy metals,pesticides,radioactivity,organic solvents,microbials as well as adulteration with chemical drugs necessitate the establishment of international quality control *** effects have been reported for more than 300 plant species,and some commonly used herbs have been demonstrated to interact with Western *** care professionals have a critical responsibility assessing the self-care ability of their *** are available for pharmacists with information on action,side effects and toxicities as well as herbdrug *** is a need for established guidelines regarding the correct use of nutritional supplements and herbal OTC pre

关键词： botanicals contamination complementary and alternative medicine drug interactions geriatric gynecology insomnia hepatotoxicity menopause nephrotoxicity over-the-counter pain phase I/II enzymes pharmacognosy pharmacovigilance phyto-chemicals phytotherapy phytovigilance quality control

Development of a Six Sigma Infrastructure for Trabeculectomy Process

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American Journal of Operations Research 2014年第4期4卷 246-254页

作者： Can Ozturker Ibrahim Sahbaz Zeynep karaarasi Ozturker Mehmet tolga Taner Sukru Bayraktar Gamze kagan Beyoglu Eye Clinic IstanbulTurkey Department of Opticianry Uskudar UniversityIstanbulTurkey Eye Clinic Istanbul Education and Research HospitalIstanbulTurkey Department of Healthcare Management Uskudar UniversityIstanbulTurkey Eye Clinic Istanbul Surgery HospitalTurkey Department of Occupational Health and Safety Uskudar UniversityIstanbulTurkey

The aim of this article is to show how an eye clinic of a Turkish public hospital initiated Six Sigma principles to reduce the number of complications encountered during and after trabeculectomy surgeries. Data were collected for ten years. To analyse the process, main tools of Six Sigma’s Define-Measure-Analyze-Improve-Control (DMAIC) improvement cycle such as SIPOC Table, Failure, Mode and Effect Analysis were implemented. Sources and root causes of ten types of complications were identified and reported. Patient’s eye anatomy, experience of ophthalmic surgeon, quality of surgical equipment, quality and type of suture, and experience of staff were identified to be Critical-to-Quality (CTQ) factors for a successful surgery. The most frequently occurring complication was found to be hypotony. The process sigma level of the process was measured to be 3.1391. The surgical team concluded that ten complications (out of twelve) should be significantly reduced by taking the necessary preventative measures.

关键词： Six Sigma Ophthalmology Trabeculectomy Complications

Endoscopic submucosal dissection for premalignant lesions and noninvasive early gastrointestinal cancers

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World Journal of Gastroenterology 2011年第13期17卷 1701-1709页

作者： Sadettin Hulagu Omer Senturk Cem Aygun Orhan kocaman Altay Celebi tolga konduk Deniz koc Goktug Sirin Ugur korkmaz Ali Erkan Duman Neslihan Bozkurt Gokhan Dindar Tan Attila Yesim Gurbuz Orhan TarcinDivision of Gastroenterology Derince State Hospital kocaeli 41900 Turkey Cem kalayci Division of Gastroenterology Kocaeli University Medical School Kocaeli 41000 Turkey Division of Gastroenterology American HospitalIstanbul 34365 Turkey Department of Pathology Kocaeli UniversityMedical School Kocaeli 41000 Turkey Division of Gastroenterology Marmara University School of Medicine Altunizade Istanbul 34662 Turkey

AIM: To investigate the indication, feasibility, safety, and clinical utility of endoscopic submucosal dissection (ESD) in the management of various gastrointestinal pathologies. METHODS: The medical records of 60 consecutive patients (34 female, 26 male) who underwent ESD at the gastroenterology department of kocaeli University from 2006-2010 were examined. Patients selected for ESDhad premalignant lesions or non-invasive early cancers of the gastrointestinal tract and had endoscopic and histological diagnoses. Early cancers were considered to be confined to the submucosa, with no lymph node involvement by means of computed tomography and endosonography. RESULTS: Sixty ESD procedures were performed. The indications were epithelial lesions (n = 39) (33/39 adenoma with high grade dysplasia, 6/39 adenoma with low grade dysplasia), neuroendocrine tumor (n = 7), cancer (n = 7) (5/7 early colorectal cancer, 2/7 early gastric cancer), granular cell tumor (n = 3), gastrointestinal stromal tumor (n = 2), and leiomyoma (n = 2). En bloc and piecemeal resection rates were 91.6% (55/60) and 8.3% (5/60), respectively. Complete and incomplete resection rates were 96.6% (58/60) and 3.3% (2/60), respectively. Complications were major bleeding [n = 3 (5%)] and perforations [n = 5 (8.3%)] (4 colon, 1 stomach). Two patients with colonic perforations and two patients with submucosal lymphatic and microvasculature invasion (1 gastric carcinoid tumor, 1 colonic adenocarcinoma) were referred to surgery. During a mean follow-up of 12 mo, 1 patient with adenoma with high grade dysplasia underwent a second ESD procedure to resect a local recurrence. CONCluSION: ESD is a feasible and safe method for treatment of premalignant lesions and early malignant gastrointestinal epithelial and subepithelial lesions. Successful en bloc and complete resection of lesions yield high cure rates with low recurrence.

关键词： Endoscopic submucosal dissection Premalignant gastrointestinal lesion Noninvasive early gastrointestinal cancer Neuroendocrine tumor Gastrointestinal stromal tumor

Congenital Frontal Mature Dermoid Cyst: A Case Report

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Open Journal of Modern Neurosurgery 2014年第4期4卷 186-189页

作者： Mehmet Hakan Seyithanoglu kazim Dogan Meliha Gundag Serdar Cevik Seref Ozturk tolga Turan Dundar Department of Neurosurgery Faculty of Medicine Bezmialem Vakif University Istanbul Turkey Department of Neurosurgery Ardahan State Hospital Ardahan Turkey

Dermoid cysts are uncommon congenital or acquired developmental cystic malformations that were usually seen in the midline of frontal region and the anterior fontanel. Congenital forms develop from the remnants of the epithelium or ectodermal membranous bone growth line. We report here a case of a congenital frontal dermoid cyst that should be considered in the differential diagnosis of lipoma and neurofibroma. Dermoid cysts should be considered in the differential diagnosis of all nodular cyst-like lesions in the head and neck region. Early recognition and accurate diagnosis by means of Computerized Tomography scan or Magnetic Resonance Imaging facilitate successful treatment.

关键词： Dermoid Cyst Congenital Surgical Procedure Operative

Retrograde intrarenal surgery in pediatric patients

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World Journal of Nephrology 2014年第4期3卷 193-197页

作者： Berkan Resorlu Eyup Burak Sancak Mustafa Resorlu Murat tolga Gulpinar Gurhan Adam Alpaslan Akbas Huseyin Ozdemir Department of Urology Canakkale Onsekiz Mart UniversityFaculty of Medicine Department of Radiology Canakkale Onsekiz Mart UniversityFaculty of Medicine

Urinary tract stone disease is seen at a level of 1%-2% in childhood(< 18 years).In recent years,however,there has been a marked increased in pediatric stone disease,particularly in adolescence.A carbohydrateand salt-... 详细信息

Urinary tract stone disease is seen at a level of 1%-2% in childhood(ked increased in pediatric stone disease,particularly in adolescence.A carbohydrateand salt-heavy diet and a more sedentary lifestyle are implicated in this *** stone disease is rare in childhood,its presence is frequently associated with metabolic or anatomical disorders or infectious conditions,for which reason there is a high possibility of post-therapeutic *** such as a high possibility of recurrence and increasing incidence further enhance the importance of minimally invasive therapeutic options in children,with their expectations of a long *** children in whom active stone removal is decided on,the way to achieve the highest level of success with the least morbidity is to select the most appropriate treatment *** to today's advanced technology,renal stones that were once treated only by surgery can now be treated with minimally in-vasive techniques,from invasion of the urinary system in an antegrade(percutaneous nephrolithotomy) or retrograde(retrograde intrarenal surgery) manner or shock wave lithotripsy to laparoscopic stone *** compilation study examined studies involving the RIRS procedure,the latest minimally invasive technique,in children and compared the results of those studies with those from other techniques.

关键词： Percutaneous nephrolithotomy Pediatric Renal stone Retrograde intrarenal surgery Shockwave lithotripsy

A modified Rendezvous ERCP technique in duodenal diverticulum

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World Journal of Gastrointestinal Endoscopy 2013年第11期5卷 568-573页

作者： Mehmet Odabasi Mehmet kamil Yildiz Haci Hasan Abuoglu Cengiz Eris Erkan Ozkan Emre Gunay Ali Aktekin MA tolga Mu Department of Surgery Haydarpasa Education and Research Hospital

AIM: To postoperative endoscopic retrograde cholangiopancreatography(ERCP) failure, we describe a modified Rendezvous technique for an ERCP in patients operated on for common bile duct stone(CBDS) having a T-tube with retained CBDSs. METHODS: Five cases operated on for CBDSs and having retained stones with a T-tube were referred from other hospitals located in or around Istanbul city to the ERCP unit at the Haydarpasa Numune Education and Research Hospital. Under sedation anesthesia, a sterile guide-wire was inserted via the T-tube into the common bile duct(CBD) then to the papilla. A guide-wire was held by a loop snare and removed through the mouth. The guide-wire was inserted into the sphincterotome via the duodenoscope from the tip to the handle. The duodenoscope was inserted down to the duodenum with a sphincterotome and a guidewire in the working channel. With the guidance of a guide-wire, the ERCP and sphincterotomy were suc-cessfully performed, the guide-wire was removed from the T-tube, the stones were removed and the CBD was reexamined for retained stones by contrast. RESULTS: An ERCP can be used either preoperatively or postoperatively. Although the success rate in an isolated ERCP treatment ranges from up to 87%-97%, 5%-10% of the patients require two or more ERCP treatments. If a secondary ERCP fails, the clinicians must be ready for a laparoscopic or open exploration. A duodenal diverticulum is one of the most common failures in an ERCP, especially in patients with an intradiverticular papilla. For this small group of patients, an antegrade cannulation via a T-tube can improve the success rate up to nearly 100%. CONCluSION: The modified Rendezvous technique is a very easy method and increases the success of postoperative ERCP, especially in patients with large duodenal diverticula and with intradiverticular papilla.

关键词： Endoscopic retrograde cholangiopancreatography Retained stones Antegrade cannulation Intradiverticular papilla T-tube