Cerrahi Tıp Bilimleri Bölümü / Department of Surgical Sciences
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Article Acute Clouding of a Trifocal Intraocular Lens During Implantation: a Case Report(Elsevier Inc., 2022) Özülken, Kemal; Gokce S.E.; Tekin K.Purpose: In this paper, we present a case of acute clouding of a trifocal intraocular lens (IOL) that resolved spontaneously by the day after surgery. Observations: A 68-year-old woman with a nuclear cataract in the right eye was scheduled for cataract surgery with +21.00 diopter trifocal IOL (AT LISA tri 839MP, Carl Zeiss Meditec AG, Germany) implantation. Phacoemulsification was uneventful until the implantation of the IOL. Although the IOL was initially transparent, we observed acute clouding of the IOL optic immediately upon implantation into the eye, and the IOL remained cloudy at the end of the surgery. On the day after surgery, we observed that the clouding was completely resolved. Conclusions and Importance: We think that the sudden temperature change of the IOL upon implantation into the anterior chamber may have caused acute clouding. If a similar situation is encountered, clinicians should avoid explantation or replacement of the Zeiss AT LISA trifocal IOL, as the clouding resolves spontaneously. © 2022Article Additive Effect of Topical Nepafenac on Mydriasis in Patients With Diabetes Mellitus(Eye and Contact Lens Association (ECLA), 2020-08) Kızıltoprak, Hasan; Koç, Mustafa; Yetkin, Esat; Tekin, Kemal; İnanç, Merve; Özülken, KemalOBJECTIVES: To evaluate the additive effect of topical nepafenac on pupil diameter (PD) in patients with diabetes mellitus (DM) and cataract. METHODS: This prospective comparative study included the patients having cataract surgery with and without DM. Two consecutive PD measurements were taken using an automatic quantitative pupillometry system (MonPack One, Metrovision). A baseline measurement was taken, then one drop of nepafenac % 0.1 (Nevanac; Alcon, Fort Worth, TX) was instilled only to the eye that will be operated on (study eye). Cyclopentolate 1.0% (Sikloplejin; Abdi İbrahim, İstanbul, Turkey) was instilled to both eyes (study eye/fellow eye) 5 minutes later. The second measurement was taken at 1 hour after this application. RESULTS: The DM group consisted of 43 patients, and the control group consisted of 39 participants. The baseline PDs of both eyes were similar in the DM group (P=0.070) and the control group (P=0.345). The change in pupil size from baseline to mydriasis was statistically significantly greater in the study eyes (2.69±0.53) than fellow eyes (2.54±0.61) in the DM group (P=0.009), but there was no statistically significant difference in the control group (2.94±0.63 vs. 2.86±0.58). When the groups were compared, the PD changes were similar in the study eyes between groups (P=0.065), while the PD changes in the fellow eyes were lower in the DM group (P=0.017). CONCLUSIONS: Nepafenac has been shown additive effect on pupil dilation in diabetic patients before cataract surgery.Article Citation - WoS: 13Citation - Scopus: 15Adherence To Glaucoma Medication, Illness Perceptions, and Beliefs About Glaucoma: Attitudinal Perspectives Among Turkish Population(Sage Publications Ltd, 2021) Güven, Soner; Koylu, Mehmet Talay; Mumcuoğlu, TarkanPurpose: To evaluate the topical glaucoma eye drops adherence prevalence and its association with beliefs and illness perceptions about glaucoma in Turkey. We also aimed to explore the factors linked to patients' total, voluntary, and involuntary non-adherence to medication in different patient attitudes. Material and Methods: A prospective study with cross-sectional design which included a total of 317 glaucoma patients who completed questionnaires. We assessed the adherence to medication, illness perceptions, and the beliefs about the glaucoma treatment by the "Reported Adherence to Medication scale," "the Brief Illness Perception Questionnaire," and "the Beliefs about Medicine-Specific Questionnaire," respectively. According to the RAM scale, voluntary and involuntary non-adherence scores were also distinguished. Different adherence categories in RAM scale were compared with perception and belief measures. Patient attitudes were assessed from the BMQ. We also performed attitudinal type comparisons with different adherence groups. Results: The full adherence prevelance to glaucoma medication was 40%. The proportion of voluntary and involuntary non-adherence was 26% and 57%, respectively. The adherence groups were similar in terms of belief measures but statistically different according to illness perceptions (consequences (p = 0.002), timeline (p = 0.008), personal control (p = 0.001), identity (p = 0.019), concerns (p = 0.003)), and attitude types (ambivalent (p = 0.030) and accepting (p = 0.029)). Conclusion: New strategies are required to improve patient adherence to glaucoma medication in Turkey. The beliefs about the glaucoma treatment and illness perceptions are also needed to be enhanced.Review Ağız Mukozası Epitelinde Psödoepitelyomatöz Hiperplazi(Duzce University Faculty of Medicine, 2019) Kahraman, Devrim; Günhan, ÖmerSquamous epithelium covering the oral mucosa is open to a variety of irritations and may show aberrant reactive proliferations. These changes may create an abnormal clinical mass and histologically mimic neoplastic lesions. These reactions are called pseudoepitheliomatous hyperplasia or pseudocarcinomatous change. Exaggerated abnormal reactive changes may cause misdiagnosis of oral cancer in the mouth by inexperienced persons in oral pathology. On the other hand, due to histological similarities, also oral cancers may underdiagnosed wrongly as reactive lesions and lead to delays in cancer diagnosis and treatment. In this article, the causes of pseudoepitheliomatous hyperplasia and related specific diseases will be discussed. Additionally, the differential diagnosis of oral cancers from reactive lesions will be covered. The well knowing of the clinical features and a careful histological evaluation will prevent undesirable problems in the future. The information of the article is more useful for the pathologists; however, it will be helpful for the clinicians to know the problems and difficulties in the accurate diagnostic process.Article Aktif Hastalarda Diz Medial Kondil Sınırlı Kıkırdak Defektlerinde Yüzey Kaplama Artroplastisi Tedavi Sonuçlarımız(Kanuni Sultan Süleyman Training and Research Hospital, 2020) Karahan, Nazım; Yılmaz, Barış; Kaya, Murat; Kömür, Baran; Aktaş, Erdem; Heybeli, NurettinINTRODUCTION: In this study, we aimed to present the clinical results of articular resurfacing prosthesis cases applied to cartilage problems of active patients who cannot be treated conservative and biological surgical methods. METHODS: From April 2007 to March 2014, 32 patients were treated with femoral resurfacing using the HemiCAP implant. Indication for treatment with HemiCAP implant was symptomatic cartilage lesion at the medial femoral condyle demonstrated by MRI or arthroscopy, which was ICRS grade 3–4 and size less than 4 cm2. Patients were evaluated according to VAS score, American Knee Society Score, clinical improvement. RESULTS: 32 patients ( 8 males, 24 females) evaluated in this study. Mean age was 53.1 ± 3.2 years. 18 ( %56.3 ) patients were operated from right knee while 14 ( %43.7) of patients from left. Follow-up time was between 24 and 30 months ( 26.6 ±1.9 ). The decrease in postoperative VAS compared to preoperative VAS was statistically significant ( p<0.01 ). A statistically significant increase was observed in postoperative American Knee Society Score compared to preoperative knee scores ( p<0.01 ). Preoperative function score was 46.5 ± 9.1, postoperative function score was 77.3 ± 7.7. A statistically significant increase was observed in postoperative knee function scores compared to preoperative knee function scores ( p<0.01 ). DISCUSSION AND CONCLUSION: The femoral resurfacing treatment in active patients with local cartilage damage clinically reduces symptoms and improves knee function in the early period.Book Part Alcon marka cihazlar ile Refraktif cerrahi(Anadolu Kitabevi, 2024) Özkoyuncu Kocabaş, Dilara; Özülken, Kemal[No Abstract Available]Article Citation - WoS: 5Citation - Scopus: 6Alterations in the Choroidal Thickness and Retinal Vascular Caliber in Keratoconus(Springer, 2023) Aksoy Aydemir, Gozde; Ozkoyuncu Kocabas, Dilara; Aydemir, Emre; Bayat, Alper Halil; Cinar, Serife Sule; Karadag, Ayse SevgiPurpose To compare the choroidal thickness (CT) and retinal vascular caliber in the differentiation of patients who have keratoconus (KC) from those of astigmatic and normal patients. Methods This was a prospective, cross-sectional study. A total of 72 patients who had KC, 70 who had astigmatism, and 83 healthy control subjects were enrolled in this study. All the patients were examined using the Sirius topography system and spectral domain optical coherence tomography with enhanced depth imaging. Using the digital fundus photographs, the retinal vascular calibers were calculated. The measurements were also analyzed between the KC stages according to the Amsler-Krumeich classification. Results The CT measurements were significantly higher in the KC group, when compared with the other 2 groups, in each location (P < 0.05). No statistically significant difference was observed with regards to the central retinal artery equivalent (CRAE) values (P = 0.959), while significant differences were noted in the central retinal vein equivalent (CRVE) among the groups (P = 0.011). Significant increases were noted in the CT as the stage of KC progressed, except at temporal 3000 mu m (P = 0.603). No statistically significant difference was observed with regards to the CRAE among the stages (P = 0.901). However, the CRVE changes increased remarkably as the stages advanced (P < 0.001). Conclusion The patients who had KC seemed to have a thicker CT and higher CRVE values than the healthy individuals, and these differences were progressively increased as the stages of KC advanced. Reflecting the vascular effects of inflammation, the high CRVE supported theories based on the inflammatory component of KC.Article Citation - WoS: 16Citation - Scopus: 18Anestezistin Uyanik Kraniyotomi Uygulamalarındaki Yaklaşımı(Turkish Society of Anaesthesiology and Reanimation, 2018) Özlü, OnurAwake craniotomy, which was initially used for the surgical treatment of epilepsy, is performed for the resection of tumours in the vicinity of some eloquent areas of the cerebral cortex which is essential for language and motor functions. It is also performed for stereotactic brain biopsy, ventriculostomy, and supratentorial tumour resections. In some institutions, avoiding risks of general anaesthesia, shortened hospitalization and reduced use of hospital resources may be the other indications for awake craniotomy. Anaesthesiologists aim to provide safe and effective surgical status, maintaining a comfortable and pain-free condition for the patient during surgical procedure and prolonged stationary position and maintaining patient cooperation during intradural interventions. Providing anaesthesia for awake craniotomy require scalp blockage, specific sedation protocols and airway management. Long-acting local anaesthetic agents like bupivacaine or levobupivacaine are preferred. More commonly, propofol, dexmedetomidine and remifentanyl are used as sedative agents. A successful anaesthesia for awake craniotomy depends on the personal experience and detailed planning of the anaesthetic procedure. The aim of this review was to present an anaesthetic technique for awake craniotomy under the light of the literature.Review Anesthesia Management for Craniosynostosis Surgery(Anestezi Dergisi, 2022) Özlü, O.Craniosynostosis is premature fusion of one or more cranial sutures. In isolated craniosynostosis, surgical procedures are applied to ensure normal brain development and normal cognitive functions, to correct cosmetic deformities in order to prevent psychosocial negative consequences. The fact that they are mostly infants, combined with significant blood loss in the perioperative period, makes these cases challenging for the anesthetist. Ensuring airway safety, coping with metabolic complications related to blood transfusions and infusion of electrolyte fluids, preventing hypothermia, postoperative pain management, treatment of nausea and vomiting are the main subjects of anesthesia management. Excellent results can be obtained with proper preoperative planning, monitoring and timely blood and fluid infusion. © 2022 Anestezi Dergisi. All rights reserved.Article Citation - WoS: 11Citation - Scopus: 5Assessment of Corneal Endothelial Cell Morphology and Anterior Segment Parameters in Covid-19(Sage Publications Ltd, 2022) Oren, Burak; Özkoyuncu Kocabaş, DilaraBackground: The ocular manifestations of the 2019 novel coronavirus disease (COVID-19) vary from acute follicular, pseudomembranous, and hemorrhagic conjunctivitis to keratoconjunctivitis with subepithelial infiltrates and dendritic lesions. Similar to other respiratory viruses, such as adenoviruses, it is thought that COVID-19 may impact the cornea. However, its impact on the cornea and anterior segment parameters are currently poorly understood. Objective: This study aims to assess the corneal endothelial cell morphology and anterior segment parameters in patients who have recovered from COVID-19. Methods: In this cross-sectional study, the COVID-19 group comprised 34 patients who had been diagnosed with and recovered from COVID-19, while the control group comprised age- and sex-matched individuals without any systemic or ocular diseases. The endothelial cell density (ECD), coefficient of variation (CV) of cell area, hexagonal cell percentage (HEX), anterior chamber depth (ACD), central corneal thickness (CCT), horizontal anterior chamber diameter (HACD), iridocorneal angle (ICA), horizontal visible iris diameter (HVID), pupillary diameter (PD), and keratometry values (K1 and K2) were analyzed for each participant. The differences in each of these between the groups were analyzed using either an independent samples t test or a Mann-Whitney U test based on the normality of the data. Results: Regarding corneal endothelial cell morphology, the ECDs for the COVID-19 and control groups were 2278.50 +/- 186.78 cells/mm(2) and 2420.15 +/- 222.25 cells/mm(2), respectively (p = 0.002). A significant increase was noted in CV values in the COVID-19 group compared with the control group (p <0.001). The HEX values for the COVID-19 and control groups were 56.26 +/- 5.75 and 61.50 +/- 3.63, respectively (p < 0.001). Regarding the anterior segment parameters, no significant differences were observed between the groups (p> 0.05). Conclusions: It was hypothesized that individuals who had recovered from COVID-19 would demonstrate a reduction in their endothelial functional preserves. A decrease in ECD and HEX and an increase in CV were observed in the individuals during their early post-recovery period from COVID-19.Article Citation - WoS: 2Citation - Scopus: 2Assessment of Tear Meniscus Dimensions Using Anterior Segment Optical Coherence Tomography in Vitamin D Deficiency in a Pediatric Population(Georg Thieme Verlag Kg, 2023) Ören, Burak; Erboğa, Çağlar; Kocaay, Funda; Öztürk, Yücel; Bilak, Şemsettin; Özkoyuncu Kocabaş, Dilara; Ballı, HacıBackground To investigate of the effect of vitamin D (Vit-D) deficiency on the tear film in children and compare it with that of healthy subjects.Methods This prospective and cross-sectional study comprised 75 eyes of children who had Vit-D deficiency (Group 1) and 85 eyes of age- and gender-matched healthy children (Group 2). The tear-film break-up time (TF-BUT) and Schirmer test values, as well as the Ocular Surface Disease Index (OSDI) scores, were recorded for the participants in all groups. Measurement of the tear meniscus area (TMA) and tear meniscus height (TMH) was performed 2 times in the same day via the use of anterior segment-optical coherence tomography (AS-OCT).Results The mean age of the participants in Group 1 was 12.42 +/- 3.40 years, while in Group 2, it was 12.59 +/- 2.32 years (p = 0.758). Group 1 comprised 43 females and 32 males, while Group 2 comprised 44 females and 41 males (p = 0.250). The mean TMH, TMA, and Schirmer test values were found to be significantly lower in children with Vit-D deficiency (Group 1) than in healthy children (Group 2), with p < 0.05 for all the values. It was concluded that there was no significant difference in the values for the mean TF-BUT and OSDI scores (p = 0.029 and p = 0.596, respectively).Conclusion The children with Vit-D deficiency exhibited lower TMH, TMA, and Schirmer test values. The alterations that were observed in these parameters were more prominent in the participants who had lower Vit-D levels.Article Citation - WoS: 33Citation - Scopus: 33Associations Between Risk Factors and Developmental Dysplasia of the Hip and Ultrasonographic Hip Type: a Retrospective Case Control Study(2019) Ömeroğlu, H.; Akceylan, A.; Köse, N.Purpose We aimed to revisit the correlation between the previously defined risk factors and the occurrence of developmental dysplasia of the hip (DDH) and to assess the influence of these factors on the ultrasonographic type of hip dysplasia according to the Graf’s classification in patients with DDH. Methods Data of healthy infants (mean age 33 days) who had bilateral mature (normal) hips (Graf type I) were compared with the data of infants (mean age 105 days) who were treated by abduction brace due to unilateral or bilateral DDH (Graf type IIa- and worse hips). Results Infants with at least one risk factor had a significantly higher rate of DDH than those with no risk factors (p < 0.001). Likewise, infants with more than one risk factor had a significantly higher rate of DDH than those with only one risk factor (p = 0.008). Family history, breech presentation and swaddling were found to be the three significant risk factors related to the development of DDH. Family history, swaddling and oligohydramnios were found to be the three significant risk factors correlated with a higher rate of unstable/decentred hip(s) (Graf types D/III/IV) in patients with DDH. Conclusion The risk of DDH significantly increases in infants who have more than one risk factor for DDH. Positive family history and postnatal traditional swaddling are the two main factors both in the aetiology of DDH and in development of a more severe hip dysplasia in patients with DDH. Besides, breech presentation increases the risk of development of DDH and oligohydramnios leads to development of a more severe hip dysplasia in patients with DDH. By introducing these four variables as ‘absolute risk factors for DDH’ to the selective newborn hip screening programmes, the sensitivity and specificity of these programmes may be optimized and the risk of delayed diagnosis may be lessened.Article Citation - Scopus: 1Asymmetric Z-Plasty for Telephone Deformity in Prominent Ear Correction(Lippincott Williams & Wilkins, 2014) Uysal, Afşin; Uysal, Çağrı A.; Çöloğlu, Harun; Borman, HüseyinThere have been plenty of surgical techniques for the correction of prominent ears. "Telephone deformity" or "reverse telephone ear" has been described as the undesired result of the inappropriate correction of the prominent ear, mainly the deficient correction of the lobule. We have performed an asymmetric Z-plasty to the lobule to overcome this deformity not only by excision of the excess skin but also by transposition of the soft tissue. Between 2005 and 2011, the technique currently described was performed in 19 patients. Preoperative, intraoperative, and postoperative standardized photographs were taken, and measurements were done on postoperative first week, first month, and first year. The measurements include ear height at 3 different horizontal planes as follows: (1) the most cranial point of the ear, (2) the middle point of the ear, and (3) the most caudal point of the ear. The angle between the vertical plane of the head and the ear was measured at these previously defined 3 points. These measurements were used for indication and preoperative planning. There were statistically significant differences between preoperative and postoperative values (P < 0.05). The postoperative first year results indicated the effectiveness of this alternative technique for the long-term maintenance of the position of the lobule.Conference Object Az Gören Çocuğun Habilitasyon ve Rehabilitasyonu(Türk Oftalmoloji Derneği, 2024) Tunay, Zühal[No Abstract Available]Conference Object Az gören çocukta görmenin değerlendirilmesi(Türk Oftalmoloji Derneği, 2024) Özen Tunay, Zühal[No Abstract Available]Conference Object Az Görme Rehabilitasyonunda İleri Yöntemler(Türk Oftalmoloji Derneği, 2024) İdil, Aysun; Özen Tunay, Zühal; Şahlı, Esra; Altınbay, Deniz[No Abstract Available]Book “az Görü-yorum” : Az Görenlere Medikososyal Yaklaşım(TOBB ETÜ Yayınları, 2024) Özen Tunay, ZühalBook Part Baş-boyun Patolojisinde Tuzaklar(Kongre Tıp Kitabevi, 2022) Kahraman, Devrim; Günhan, Ömer; Sarıoğlu, Sülen; Olgaç, Vakur[No Abstract Available]Article Citation - WoS: 27Citation - Scopus: 32Basic Principles of Fracture Treatment in Children(2018) Ömeroğlu, HakanThis review aims to summarize the basic treatment principles of fractures according to their types and general management principles of special conditions including physeal fractures, multiple fractures, open fractures, and pathologic fractures in children. Definition of the fracture is needed for better understanding the injury mechanism, planning a proper treatment strategy, and estimating the prognosis. As the healing process is less complicated, remodeling capacity is higher and non-union is rare, the fractures in children are commonly treated by non-surgical methods. Surgical treatment is preferred in children with multiple injuries, in open fractures, in some pathologic fractures, in fractures with coexisting vascular injuries, in fractures which have a history of failed initial conservative treatment and in fractures in which the conservative treatment has no/little value such as femur neck fractures, some physeal fractures, displaced extension and flexion type humerus supracondylar fractures, displaced humerus lateral condyle fractures, femur, tibia and forearm shaft fractures in older children and adolescents and unstable pelvis and acetabulum fractures. Most of the fractures in children can successfully be treated by non-surgical methods.Article Benzer Kırma Kusuru İçin Uygulanan Farklı Keratorefraktif Cerrahi Yöntemlerinin Keratometrik Değerler Üzerine Etkileri(2021) Özülken, Kemal; İlhan, Çağrı; Tekin, Kemal; Mumcuoğlu, Tarkan; Kaya, MahmutAmaç: Fotorefraktif keratektomi (PRK) ve laser in-situ keratomileusis (LASIK) gibi farklıkeratorefraktif yöntemlerle düzeltilen benzer büyüklükteki miyopik ve birleşik miyop astigmatik kırmakusurunun, korneal keratometrik güç üzerindeki etkilerinin benzer olup olmadığının araştırılmasıdır.Gereç ve Yöntemler: Bu geriye dönük, randomize olmayan, karşılaştırmalı klinik araştırmaOcak 2018 ve Haziran 2019 tarihleri arasında gerçekleştirilmiştir. Uygulanan cerrahiye göre olgularPRK (n=100) ve LASIK (n=76) olarak 2 gruba ayrılmıştır ve her bir hastanın sağ gözü çalışmayadahil edilmiştir. Olguların cerrahi öncesi ve cerrahi sonrası 6. aydaki klinik verileri göz önündebulundurularak sferik eşdeğerindeki (SE) azalma ile SEfark ve ortalama keratometrideki (Km) değişim ileKfark değerleri hesaplanmıştır. Kfark/SEfark hesaplaması ile birim SE değişiminin Km üzerindeki etkileriaraştırılmış ve gruplar arasında karşılaştırma yapılmıştır.Bulgular: PRK ve LASIK grupları arasında cinsiyet (p=0,348) ve yaş (p=0,768) bakımından anlamlıfark yoktu. SEfark değeri PRK grubunda -3,36 ± 1,46 D (-0,88 ile -6,50 D) iken LASIK grubunda -3,26± 1,41 D (-1 ile -6,13 D) idi ve gruplar arasında anlamlı fark yoktu (p=0,206). Kfark/SEfark parametresiPRK grubunda -0,87 ± 0,23 (-0,23 ile -1,53) iken LASIK grubunda -0,94 ± 0,46 (-0,32 ile -1,29) idive gruplar arasında anlamlı fark yoktu (p=0,169).Sonuç: Benzer büyüklükteki miyopik veya birleşik miyop astigmatik kırma kusuru düzeltmesindeuygulanan PRK ve LASIK cerrahilerinin Km değerindeki cerrahi ile elde edilen değişim üzerine olanetkileri benzerdir.

