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Öğe An unusual complication of anesthesia: Unilateral spinal myoclonus(Kare Publ, 2017) Kosem, Bahadir; Kilinc, Hatice[Abstract Not Available]Öğe Appendix mucinous cystadenoma mimicking a right adnexal mass(Cukurova Univ, Fac Medicine, 2016) Kafadar, Mehmet Tolga; Kosem, Bahadir; Kirtis, Emine; Kosus, Nermin; Kosus, AydinAppendix mucocele is a mass formed by the dilatation of appendix lumen due to abnormal mucinous secretions. It develops as a result of epithelial proliferation, mucinous secretion, and luminal dilatation on the background of mucosal hyperplasia, mucinous cystadenoma, or mucinous cystadenocarcinoma. Appendix mucinous cystadenoma is the most common type that may have different clinical presentations. The preoperative diagnosis remains difficult and the pathology is usually detected during laparotomy. Despite concerns about the rupture risk of appendix mucoceles, laparoscopic surgery has been increasingly used for its treatment. Perforation of a lesion and spread of its contents into abdominal cavity produces a condition known as pseudomyxoma peritonei. In this paper we report a case of 75-year-old woman who was taken to the operating room to be operated for a right adnexial mass and but ultimately underwent laparoscopic appendectomy after detecting an appendix mucocele in laparoscopic exploration.Öğe Effects of lornoxicam and intravenous ibuprofen on erythrocyte deformability and hepatic and renal blood flow in rats(Dove Medical Press Ltd, 2016) Arpaci, Hande; Comu, Faruk Metin; Kucuk, Aysegul; Kosem, Bahadir; Kartal, Seyfi; Sivgin, Volkan; Turgut, Huseyin CihadBackground: Change in blood supply is held responsible for anesthesia-related abnormal tissue and organ perfusion. Decreased erythrocyte deformability and increased aggregation may be detected after surgery performed under general anesthesia. It was shown that nonsteroidal anti-inflammatory drugs decrease erythrocyte deformability. Lornoxicam and/or intravenous (iv) ibuprofen are commonly preferred analgesic agents for postoperative pain management. In this study, we aimed to investigate the effects of lornoxicam (2 mg/kg, iv) and ibuprofen (30 mg/kg, iv) on erythrocyte deformability, as well as hepatic and renal blood flows, in male rats. Methods: Eighteen male Wistar albino rats were randomly divided into three groups as follows: iv lornoxicam-treated group (Group L), iv ibuprofen-treated group (Group I), and control group (Group C). Drug administration was carried out by the iv route in all groups except Group C. Hepatic and renal blood flows were studied by laser Doppler, and euthanasia was performed via intra-abdominal blood uptake. Erythrocyte deformability was measured using a constant-flow filtrometry system. Results: Lornoxicam and ibuprofen increased the relative resistance, which is an indicator of erythrocyte deformability, of rats (P=0.016). Comparison of the results from Group L and Group I revealed no statistically significant differences (P=0.694), although the erythrocyte deformability levels in Group L and Group I were statistically higher than the results observed in Group C (P=0.018 and P=0.008, respectively). Hepatic and renal blood flows were significantly lower than the same in Group C. Conclusion: We believe that lornoxicam and ibuprofen may lead to functional disorders related to renal and liver tissue perfusion secondary to both decreased blood flow and erythrocyte deformability. Further studies regarding these issues are thought to be essential.Öğe Effects of remifentanil, nitroglycerin, and sevoflurane on the corrected QT and Tp-e intervals during controlled hypotensive anesthesia(Elsevier Science Inc, 2016) Cimen, Nuran Kavun; Kosem, Bahadir; Cimen, Tolga; Kartal, Seyfi; Muslu, Bunyamin; Karabayirli, Safinaz; Gozdemir, MuhammetStudy objective: Controlled hypotension is a preferred method in various surgical operations, but limited data are available for the effects of drug combinations that are used to ensure the desired level of hypotension on cardiac repolarization. Design: Randomized, prospective, double-blinded study. Patients: The study comprised 65 patients undergoing septorhinoplasty surgery under general anesthesia. Interventions: Group S received sevoflurane inhalation alone, group R received sevoflurane and remifentant and group N received sevoflurane and nitroglycerine in a way that a mean arterial pressure of 60 +/- 5 mm Hg was achieved. Measurements: Electrocardiogram was performed before induction (T1), 30 minutes after induction (T2), and 5 minutes after extubation (T3). Corrected QT (QTc), QT dispersion (QTd), and corrected Tp-e (Tp-ec) intervals and Tp-e/corrected QT (Tp-e/QTc) ratio were calculated. Main results: QTc prolongation was observed at T2 and T3 in all groups, but only QTc prolongation at T2 was statistically significant in group S (P> .05). Significant prolongation of QTd interval at T2 and T3 was observed in group S (P< .05). In all groups, Tp-ec decreased at T2. However Tp-ec decrease was not statistically significant in group S (P= .103) and group R (P= .058). Tp-e/QTc was significantly decreased on T2 in all 3 groups, and it was returned to baseline at T3 (P< .05). Conclusion: The present study demonstrated that none of the 3 hypotensive anesthesia methods has an overall negative effect on Tp-e and Tp-e/QTc. Therefore, we conclude that all 3 methods can be used safely in terms of proarrhythmic risk, but increased sevoflurane consumption may require more attention due to significant prolongation of QTc and QTd. (C) 2016 Elsevier Inc. All rights reserved.Öğe Melatonin protects kidney against apoptosis induced by acute unilateral ureteral obstruction in rats(Polish Urological Assoc, 2016) Yildirim, Mehmet Erol; Badem, Huseyin; Cakmak, Muzaffer; Yilmaz, Hakki; Kosem, Bahadir; Karatas, Omer Faruk; Bayrak, ReyhanIntroduction To investigate whether there was a protective effect of melatonin on apoptotic mechanisms after an acute unilateral obstruction of the kidney. Material and methods A total of 25 rats consisting of five groups were used in the study, designated as follows: Group 1: control, Group 2: sham, Group 3: unilateral ureteral obstruction treated with only saline, Group 4: unilateral ureteral obstruction treated with melatonin immediately, and Group 5: unilateral obstruction treated with melatonin one day after obstruction. Melatonin was administered as a 10 mg/kg dose intraperitoneally. The kidneys were evaluated according to the apoptotic index and Ki-67 scores. Results Comparison of all obstruction groups (Group 3, 4, and 5), revealed that the apoptotic index was significantly higher in Groups 1 and 2. Despite melatonin reduced apoptotic mechanisms in Groups 4 and 5, there was no significant difference between Groups 4 and 5 in terms of the reduction of apoptosis. However, the reduction of apoptosis in the melatonin treated group did not decrease to the level of Groups 1 and 2. Conclusions Despite melatonin administration, which significantly reduces the apoptotic index occurring after acute unilateral ureteral obstruction, the present study did not observe a return to normal renal histology in the obstruction groups.Öğe Successful Anaesthetic Management of Elderly Patients with Leprosy(Aves, 2016) Kosem, Bahadir[Abstract Not Available]Öğe The effectiveness of local steroid injection after internal urethrotomy to avoid recurrence(Pagepress Publ, 2015) Yildirim, Mehmet Erol; Kaynar, Mehmet; Ozyuvali, Ekrem; Badem, Huseyin; Cakmak, Muzaffer; Kosem, Bahadir; Cimentepe, ErsinObjective: Local steroid injection to the stricture region after internal urethrotomy (IU) is a promising technique to avoid the recurrence, although the effectiveness and safety of this technique is still controversial. We aimed to determine the efficacy and safety of local steroids as applied with the IU procedure. Material-Method: A total of 83 patients data with urethral stricture in men were examined retrospectively. Patients classified in two groups who had steroid injection with internal urethrotomy or not. Metil prednisolone 40 mg was injected with transurethral injection needle in the stricture region at the 5, 7 and 12 o'clock sites at the same session with internal urethrotomy. Procedure was considered successful if patient did not report any voiding difficulty and maximum flow rate > 15 mL/second for a voided volume of at least 150 mL after removal of the catheter. Patient's age, time to recurrence, previous recurrences were evaluated. Results: The mean age was 56.4 (18-83) years. Of those patients 33/83 had recurrent stenosis. Nineteen out of these 33 recurrent stenosis patients were treated with local steroid injection and 14/33 had no injection. Only two patients of the steroid treated group had recurrence. Despite that 12 patients had recurrence in the steroid non-treated group. Also the primary stenosis patients showed no recurrence at the steroid+ IU group. Conclusions: The use of local steroids with IU seems to decrease the high stricture recurrence rate following IU. When local steroids were administered with complementary intention, the disease control outcomes are encouraging. Further robust comparative effectiveness studies are now required.Öğe Urethral Caruncle Causing Bilateral Bladder Diverticula: A Case Report(Aves, 2016) Ozyuvali, Ekrem; Yildirim, Mehmet Erol; Kosem, Bahadir; Cimentepe, ErsinAn urethral caruncle is a benign vascular tumor usually originating from the rear lip of the external urethral meatus and is usually observed in postmenopausal women. It is not included within the list of causes of bladder overdistension in women. We present a case of a urethral caruncle as a rare cause of acute urinary obstruction in a 71-year-old woman. The 71-year-old woman had occasional bleeding from a mass in the urethral meatus for 3 years. A reddish mass, measuring 3 cm in diameter, was noted at the posterior lip of the urethral meatus. The mass was diagnosed to be a urethral caruncle and was removed. Microscopically, the squamous epithelium, which covered the urethral caruncle, was found to be keratinized, with the proliferation of atypical cells with swollen nuclei in the entire mucosal layer. The patient could urinate better after the indwelling urethral catheter was taken out.
