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Öğe Early postoperative candida colonization in alimentary canal in patients undergoing open heart surgery(Edizioni Minerva Medica, 2005) Alat, I; Kuzucu, Ç; Akpinar, MB; Egri, M; Battaloglu, B; Cihan, HBAim To examine the frequency and factors predisposing to candidiasis in the digestive tract in the early postoperative period after open heart surgery. Methods. One hundred patients undergoing open heart surgery were enrolled in this study. Patients were divided into 2 groups in regard to Candida spp. colonization. Group A means increased Candida spp. colonization after open heart surgery (31/100). Group B indicates unchanged Candida spp. colonization after open heart surgery (69/100). Samples were obtained from both oral and anal inucosa in 3 different periods of operation: 1) preoperatively (stage 1), 2) at the end of the first hour in the intensive care unit (stage 2), 3) 24 hours after operation (stage 3). Findings were compared with both preoperative and intraoperative parameters. For fungal isolation Sabourauds dextrose agar and blood agar were used. Results. In Group A (31), there was a significant relationship between the samples in stage 1 and 2 (p=0.031), and also a significance between stage 1 and 3 (p=0.048). Comparison between Candida positive and negative groups (Group A and B) did not reflect any statistical significance (P>0.05). Conclusion. Candida colonization in the alimentary canal in the early postoperative period after open heart surgery is due to individual preoperative features. However, early postoperative Candida colonization in the digestive tract is not a risk factor for sepsis unless the patient has an additional risk factor leading to prolongation of length of stay in the intensive care unit.Öğe Induced angiogenesis with intramedullary direct current: experimental research(Amer Physiological Soc, 2005) Inan, M; Alat, I; Gurses, I; Kekilli, E; Kutlu, R; Eskin, A; Aydin, OMThe purpose of this study was to evaluate angiogenesis after the use of intramedullary direct electrical current in rabbit tibia. Thirty-two New Zealand rabbits were divided into four groups: group 1, false electrode group; group 2, hole group; group 3, control group; and group 4, intramedullary electrical stimulation group. One-half of the rabbits in each group were evaluated angiographically, pathologically, and scintigraphically on day 7, and the rest were evaluated on day 21. Results proved that electrical stimulation was not capable of the induction of angiogenesis in the subjects killed on day 7 and day 21. Furthermore, we found some fibrotic changes secondary to electrical stimulation on day 7 ( P = 0.04) and day 21 ( P = 0.01). However, an increase in new capillary vessels occurred in the false electrode group ( P = 0.02). We found no useful effect of electrical stimulation in our study, a finding that is possibly due to our use of a method previously undocumented in the literature. We believe that this study can be the new baseline for further studies into the stimulation or inhibition of angiogenesis using intramedullary wire with or without electrical stimulation.Öğe The mechanical or electrical induction of medullary angiogenesis - Will it improve sternal wound healing?(Texas Heart Inst, 2004) Alat, I; Inan, M; Gurses, I; Kekilli, E; Germen, B; Harma, A; Eskin, AWe induced angiogenesis in the tibial medulla and cortex of rabbits by electrical and mechanical stimulation, with the aim of future application to ischemic disease. Sixteen New Zealand rabbits were divided into 4 groups: in Group 1, a wire was inserted into the medullary channel; in Group 2 a hole was drilled into the tibia; in Group 3, electrical stimulation was applied to the medullary channel; and in Group 4 (the control group), nothing was done. The interventions were applied during a 21-day period, after which all animals were evaluated scintigraphically and histopathologically. All 3 interventional groups were significantly superior to the control group in regard to medullary and cortical vascularity: the P values were 0.021 in all comparisons to control. However the most fibrotic changes in the medulla occurred in the group that had been treated with electricity (P=0.008). Slight fibrotic changes occurred in the hole group (P=0.040), and none occurred in the K-wire group. In sum, all 3 interventions are capable of inducing medullary angiogenesis, but electricity is inferior in regard to fibrotic change. We believe that this present study can establish a baseline for further work that explores clinical applications to problematic ischemic conditions, including delayed sternal wound healing after cardiac surgery.Öğe The role of brain natriuretic peptide in the prediction of cardiac performance in coronary artery bypass grafting(Texas Heart Inst, 2003) Saribulbul, O; Alat, I; Coskun, S; Apaydin, AZ; Yagdi, T; Kiliccioglu, M; Alayunt, EAThe relationship between brain natriuretic peptide and cardiopulmonary bypass has not been examined sufficiently In this study, we prospectively examined brain natriuretic peptide levels in the plasma of 26 patients undergoing coronary artery bypass grafting. Brain natriuretic peptide measurements were carried out at 4 times: preoperatively, 3 hours after institution of cross-clamping, 24 hours after institution of cross-clamping, and on the 5th postoperative day. In addition, we measured individual variables and compared them to brain natriuretic peptide levels. Mean preoperative brain natriuretic peptide levels were significantly higher in patients with histories of myocardial infarction (P = 0.0047) and heart failure (ejection fraction less than or equal to0.40) (P = 0.0001). There was a significant correlation between preoperative brain natriuretic peptide levels and cross-clamp times (P = 0.028), and an inverse correlation between those levels and preoperative cardiac indices (P = 0.001). The preoperative brain natriuretic peptide level also correlated inversely with left ventricular ejection fraction before (P = 0.001) and 5 days after (P = 0.01) operation. When the Clinical Severity Scoring System was applied, preoperative brain natriuretic peptide plasma concentrations in 19 patients with risk scores of 0-2 were significantly lower than in the 7 patients whose risk scores were 3-6 (P = 0.006). There was also a significant relationship between preoperative brain natriuretic peptide plasma concentrations and the postoperative requirement for inotropic agents (P = 0.027). This study suggests that plasma brain natriuretic peptide concentration could be one of the predictors of risk in patients undergoing coronary artery bypass grafting.Öğe Successful treatment of Buerger's disease with intramedullary K-wire: The results of the first 11 extremities(W B Saunders Co Ltd, 2005) Inan, M; Alat, I; Kutlu, R; Harma, A; Germen, BObjective. This study describes a new technique for treatment of Buerger's disease, developed to stimulate angiogenesis, using a Kirschner wire placed in the medullary canal of the tibia. The aim of the study was to evaluate clinical and radiological effects of this technique in patients where medical and surgical therapy had failed. Material and methods. Eleven extremities (six patients) with Buerger's disease were treated with the intramedullary Kirschner wire technique. Inclusion criteria were chronic critical ischemia, Rutherford Grade II or III, with major arterial occlusion shown by Doppler examination and angiography; failure to respond to non-surgical and surgical treatment; and the need for strong analgesics. Results. The mean follow-up time was 19 months (range, 13-25 months). Satisfactory remission in each patient was obtained within 6 weeks of intervention. A significant improvement in clinical manifestations including reduced rest pain and increased claudication distance was observed. Foot ulcers completely healed after Kirschner wire intervention. Conclusion. Despite short-term follow-up and small patient series, the intramedullary Kirschner wire technique can be expected to achieve relief of pain and a decrease in major amputations in patients with Buerger's disease in whom medical and surgical therapy had failed. However, comparative studies with longer follow-up should be done to confirm the benefits of this new treatment.
