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    Corneal endothelial changes in long-term cannabinoid users
    (Taylor & Francis Ltd, 2018) Polat, Nihat; Cumurcu, Birgul; Cumurcu, Tongabay; Tuncer, Ilknur
    Purpose: The aim of this study was at evaluating the effects of long-term cannabis use on the corneal endothelial cells with the specular microscopy.Methods: The study enrolled 28 eyes of 28 patients diagnosed with cannabinoid use disorder. The cannabinoid group was selected among patients who had been using the substance for three days or more per week over the past one year. Thirty-two eyes of 32 age- and sex-matched healthy individuals enrolled as control group in the study. Corneal endothelial cell density (CD), coefficient of variation (CV) and hexagonal cell ratio (HEX) values were analyzed by specular microscopy.Results: The mean CD was 2900211 cells/mm(2) in the cannabinoid group and 3097 +/- 214 cells/mm(2) in the control group (p<0.01). There was a significant decrease in cannabinoid group. The mean CV was 29 +/- 7 and 27 +/- 4 in the cannabinoid and control groups, respectively (p>0.05). No significant difference was present between the cannabinoid and the control groups in terms of mean CV value. The mean HEX was 52 +/- 5% in the cannabinoid group and 53 +/- 10% in the control group (p>0.05). There was not a significant difference between the cannabinoid and the control groups in terms of mean HEX value.Conclusion: A significant decrease in CD was found in cannabinoid users compared the control group.
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    Effect of the Addition of Ketamine to Sevoflurane Anesthesia on Seizure Duration in Electroconvulsive Therapy
    (Lippincott Williams & Wilkins, 2015) Erdil, Feray; Ozgul, Ulku; Colak, Cemil; Cumurcu, Birgul; Durmus, Mahmut
    Objectives We evaluated the effects of a subanesthetic dose of ketamine, which was administered as an adjunct to sevoflurane, on duration of seizure activity, hemodynamic profile, and recovery times during electroconvulsive therapy in patients with major depression. Methods Patients were randomly allocated to a group receiving either sevoflurane-ketamine (group SK) or sevoflurane-saline (group SS). Sevoflurane was initiated in both groups at 8% for anesthesia induction until loss of consciousness was achieved, at which point it was discontinued. After loss of consciousness, ketamine was administered to the group SK in the form of a 0.5-mg/kg intravenous bolus. Patients in the group SS received saline in the same manner. Mean arterial pressure (MAP) and heart rate were recorded before anesthetic induction (T1); after anesthetic induction (T2); as well as 0, 1, 3, and 10 minutes after the seizure had ended (T3, T4, T5, and T6, respectively). Motor and electroencephalogram seizure durations were recorded. Results Motor and electroencephalogram seizure durations in the group SS were similar to those observed for the group SK. The heart rate increased significantly during T2 to T6 in both group SS and group SK compared with the baseline. The MAP increased in the group SS during the period between T3 and T6 as well as in the group SK during the same period compared with the baseline. The MAP increased more in the group SK, in comparison with the group SS, during T2 (P < 0.05). Conclusions The addition of ketamine at subanesthetic doses, for the purposes of anesthetic induction with sevoflurane, yielded results similar to those in the control group in terms of both seizure duration and hemodynamic stability.
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    Toxic epidermal necrolysis due to concomitant use of valproic asid and lamotrigine
    (Deri Zuhrevi Hastaliklar Dernegi, 2015) Ozcan, Hamdi; Cenk, Hulya; Cumurcu, Birgul
    Toxic epidermal necrolysis (TEN) is a rare but life-threatening acute mucacutaneous hypersensitivity reaction, usually related to medications. Concomitant use of lamotrigine and valproic acid can cause this serious reaction. A 36-year-old male was admitted to the emergency department with the complaints of high fever, burning sensation at eyes, oral and genital mucous erosions, generalized rush and weakness. He had been taking valproic asid, olanzapine, and sertraline for bipolar affective disorder. Lamotrigine 25 mg/day treatment was added to his treatment protocol 15 days before the rush and lamotgine dose was increased 50 mg/day 10 days later. The patient was diagnosed with TEN caused by concomitant use of valproic acid and lamotrigine. The patient was followed up and treated at the burn unit with intravenous immunoglobulin, corticosteroid and antibiotics. Concomitant use of valproic acid and lamotrigine increases the frequency of adverse reaction. TEN may cause serious complications and death. Patients with TEN should be followed by a multi-disciplinary team. Early determination of complications and suitable management can increase the odds for survival.