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Öğe Açık Rinoplasti ile Nazal Dermoid Kist Tedavisi(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2013) Bilen, Bilge Türk; Erbatur, Serkan; Aytekin, Ahmet HamdiNazal dermoid kistler nadir görülen konjenital anomalilerden olmakla birlikte, orta hat nazal lezyonlarının en sık görülen tiplerini teşkil etmektedir. Bu lezyonlar genellikle doğumda veya erken çocukluk döneminde fark edilmektedir. Nazal dermoid kistler intrakranyal uzanım gösterebilmekte olup, tanıda intrakranyal devamlılık şüphesini ekarte etmek amaçlı MR görüntülemeden yararlanılmalı ve operasyon buna göre planlanmalıdır. Bu kistlerin tedavisinde tam eksizyonun yanı sıra kozmetik kaygı da tedavinin başarısını etkileyen faktörler olmaktadır. Bu çalışmada, çocukluk çağından beri burun sırtında kitle şikayeti ile başvuran 16 yaşındaki erkek hastanın açık rinoplasti tekniği ile dermoid kist eksizyonu yaparak, kozmetik ve fonksiyonel açıdan tatmin edici sonuç aldığımız bir olguyu sunuyoruz.Öğe Aesthetic reconstruction of congenital cerebriform intradermal nevus by sequential tissue expansion at an early age: Ten-year follow-up(2012) Fırat, Cemal; Gürlek, Ali; Aytekin, Ahmet Hamdi; Erbatur, SerkanÖz: Serebriform intradermal nevus skalpte görülen konjenital tümoral bir anomalidir. Malign melanoma gelişme insidansı %10’a kadar ulaşabilmektedir. Bu lezyon için cerrahi eksizyon tek tedavi seçeneğidir. Bu vakada, 45 günlük bir bebeğin kafa derisinin %75’ini kaplayan konjenital serebriform intradermal nevusün ardışık doku genişletme metodu ile tedavisinin 10 yıllık takip sonuçlarını sunmaktayız. Ardışık doku genişletme işlemi sırasıyla 450, 400, 250 ml’lik dikdörtgen şekilli doku genişleticilerle sekiz aylık bir sürede uygulandı. Sözkonusu bu üç doku genişletme işlemi arasındaki bekleme süresi 2 hafta idi. Doku genişletme tekniği saçlı deri rekonstrüksiyonunda oldukça etkin bir seçenektir. Bu teknik ardışık veya aşamalı olarak uygulanabilir. Homojen saç folikülü dağılımı elde etmek amacıyla, kalan saçlı deri elverdiği ölçüde genişletilebilir. Geniş defektlerin rekonstrüksiyonunda dikkatli planlama, komplikasyonların önlenmesinde yardımcıdır. Bu vakada, 45 günlük çocuk hastaya ardışık doku genişletme işlemini sekiz ay boyunca uyguladık. Bu vaka, literatürdeki diğer vakalarla kıyaslandığında bu kadar erken yaşta doku genişletici uygulanan tek vakadır. Diğer taraftan, rekonstrüksiyon metodundan ziyade on yıllık estetik sonucu vurgulamak istemekteyiz. Geniş defektlerin rekonstrüksiyonunda ardışık doku genişletme işlemi ve genişleticinin ikinci doku genişletme işlemi başlayıncaya kadar flebin altında tutulması, flep kontraktürünü azaltarak ameliyat sayısını düşürmekte ve daha iyi estetik sonuçlar sağlamaktadır.Öğe Ardışık Doku Genişletme İşlemi ile Konjenital Serebriform İntradermal Nevüsün Erken Yaşta Estetik Rekonstrüksiyonu: 0n Yıllık Takip(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2012) Fırat, Cemal; Gürlek, Ali; Aytekin, Ahmet Hamdi; Erbatur, SerkanSerebriform intradermal nevus skalpte görülen konjenital tümoral bir anomalidir. Malign melanoma gelişme insidansı %10’a kadar ulaşabilmektedir. Bu lezyon için cerrahi eksizyon tek tedavi seçeneğidir. Bu vakada, 45 günlük bir bebeğin kafa derisinin %75’ini kaplayan konjenital serebriform intradermal nevusün ardışık doku genişletme metodu ile tedavisinin 10 yıllık takip sonuçlarını sunmaktayız. Ardışık doku genişletme işlemi sırasıyla 450, 400, 250 ml’lik dikdörtgen şekilli doku genişleticilerle sekiz aylık bir sürede uygulandı. Sözkonusu bu üç doku genişletme işlemi arasındaki bekleme süresi 2 hafta idi. Doku genişletme tekniği saçlı deri rekonstrüksiyonunda oldukça etkin bir seçenektir. Bu teknik ardışık veya aşamalı olarak uygulanabilir. Homojen saç folikülü dağılımı elde etmek amacıyla, kalan saçlı deri elverdiği ölçüde genişletilebilir. Geniş defektlerin rekonstrüksiyonunda dikkatli planlama, komplikasyonların önlenmesinde yardımcıdır. Bu vakada, 45 günlük çocuk hastaya ardışık doku genişletme işlemini sekiz ay boyunca uyguladık. Bu vaka, literatürdeki diğer vakalarla kıyaslandığında bu kadar erken yaşta doku genişletici uygulanan tek vakadır. Diğer taraftan, rekonstrüksiyon metodundan ziyade on yıllık estetik sonucu vurgulamak istemekteyiz. Geniş defektlerin rekonstrüksiyonunda ardışık doku genişletme işlemi ve genişleticinin ikinci doku genişletme işlemi başlayıncaya kadar flebin altında tutulması, flep kontraktürünü azaltarak ameliyat sayısını düşürmekte ve daha iyi estetik sonuçlar sağlamaktadır.Öğe Atypical Presentation of Skull Metastasis from Rectal Adenocarcinoma as an Initial Symptom of Recurrence(Hindawi Ltd, 2012) Firat, Cemal; Aytekin, Ahmet Hamdi; Erbatur, Serkan; Aydin, Nasuhi Engin; Selcuk, Engin BurakMost malignant rectal tumors are histopathologically characterized as adenocarcinoma and generally metastasize to distant organs such as the lungs or the liver. Metastasis of rectal carcinomas to the skull is extremely rare. This study reports the initial diagnosis of rectal adenocarcinoma recurrence in a 65-year-old female with scalp metastasis. The patient's history indicated a colorectal adenocarcinoma that was resected five years earlier. A skull metastasis from a rectal adenocarcinoma has not yet been reported in the literature as an initial symptom for recurrence. This paper suggests that skull metastasis from any part of the body must be considered in the differential diagnosis of soft tissue tumors in the skull even in the absence of intestinal symptoms.Öğe An Autoprosthesis Technique for Better Breast Projection in Free Nipple Graft Reduction Mammaplasty(Springer, 2012) Firat, Cemal; Gurlek, Ali; Erbatur, Serkan; Aytekin, Ahmet HamdiReduction mammaplasty for macromastia provides relief from uncomfortable symptoms and improves self-confidence and the ability to participate in sports activities. Reduction mammaplasty using the free nipple graft technique may result in bottoming-out deformity and a lack of upper-pole projection. We describe a modified breast reduction technique that combines the Graf and Thorek methods. We operated on 26 patients with gigantomastia using this novel technique. Preoperative markings were planned according to the classic Thorek amputation technique using a Wise pattern. A 10-cm x 14-cm pyramidal inferior-based dermoglandular flap was prepared, passed under a transverse pectoral muscle loop, and then back-folded over the pectoral loop, thereby establishing an autoprosthesis to increase upper-pole fullness and prevent bottoming-out deformity. The average weight of the removed breast tissue was 1,634 g (range = 1,120-2,140 g) for the right breast and 1,630 g (range = 1,110-2,120 g) for the left breast. The average follow-up period was 22 months (range = 11-37 months). All samples were pathologically assessed. Minor complications included wound breakdown at the T-junction, fat necrosis, hypertrophic scarring, and partial necrosis of the nipple-areola complex (NAC). Loss of nipple projection and partial hypopigmentation of the NAC occurred in most patients. Mild glandular ptosis was observed in two patients, with no flattening or deflation, but no severe bottoming-out deformity was observed during long-term follow-up. All patients were happy with their new bra size, breast projection, and breast weight. Our combined autoprosthesis technique resulted in satisfactory long-term breast projection and upper-pole fullness. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.Öğe Başarılı bir replantasyonda beklenmedik bir yenilgi: sigara?(İnönü Üniversitesi Sağlık Bilimleri, 2012) Fırat, Cemal; Erbatur, Serkan; Elmas, Ömer; Geyik, Yılmaz; Aytekin, Ahmet HamdiBu çalışmada, başarılı bir başparmak replantasyonunun 9. gününde sigaraya bağlı başarısızlık görülen bir olgumuzu sunmayı amaçladık. Kırk altı yaşında erkek hasta sağ el başparmağının proksimal falanks seviyesinden 3 saat önce spiralle kesilmesi nedeniyle kliniğimize başvurdu. Başarılı bir replantasyon gerçekleştirildi. Sekiz gün boyunca heparin ve antikoagülan tedavi uygulandı. Dokuzuncu günde parmak dolaşımının belirgin olarak bozulduğu ve giderek morarmaya başladığı görüldü. Hastanın o gün bir saatte 6 adet sigara içtiği öğrenildi. Arteryel yetmezliğin venöz yetmezlikle ilişkili olma ihtimali düşünülerek tırnak yatağı açılıp bir süre sülük uyguladı. Ancak yaklaşık 10 saat sonra dolaşım tamamen kayboldu. İki gün sonra nekroz tamamen oturdu ve parmak alınarak güdük onarımı yapıldı. Sigara hem trombosit agregasyonunu hem de katekolamin salınımını artırarak vazospazma yol açmaktadır. Heparinin hasarlanmış damarlarda iyileşmeyi dramatik olarak artırdığı ve endotelial rejenerasyonun 14 günde gerçekleştiği gösterilmiştir. Bu vakamızda sigaranın tetiklediği vazospazmın yanı sıra antikoagülan ajanları erken kestiğimizi düşünmekteyiz. Bu tür olgularda sigara tüketiminin kısıtlanmasının ve iki hafta boyunca heparin uygulanmasının faydalı olacağı kanaatindeyiz.Öğe Çocuklarda Zon 2 seviyesindeki replantasyon deneyimlerimiz(2012) Fırat, Cemal; Aytekin, Ahmet Hamdi; Erbatur, Serkan; Geyik, Yılmaz; Elmas, ÖmerÖz: Amaç: Zon 2 bölgesinde görülen ampütasyonlar çocuklarda oldukça sık görülmekte olup, bu bölgede yapılacak replantasyonlar sonuçları itibariyle daha zordur. Bu çalışmamızda 2010-2012 yılları arasında zon 2’de olan ampütasyonları nedeniyle kliniğimizde replantasyon ve revaskülarizasyon operasyonları gerçekleştirilen 8 çocuğun geriye dönük analizinin yapılması amaçlanmıştır. Gereç ve yöntem: Haziran 2010 ile Şubat 2012 tarihleri arasında kliniğimizde amputasyon seviyesi zon 2 olan ve yaşları 3 ila 15 arasında değişen 8 çocuk hasta ameliyat edildi. 4 hastada ezilme tipi ve 4 hastada giyotin tipi düzgün kesi ile oluşmuş total ampütasyon mevcuttu. Ortalama iskemi süresi 3,5 saatti (1,5-8 saat). 5 hastada replantasyon başarılı bir şekilde sağlanırken 3 hastada mükerrer anastomozlara rağmen dolaşım sağlanamadı. Tüm vakalarda replantasyon aşamasında papaverin kullanıldı. Takip süresi ortalama 9 ay (2-16 ay) idi. Bulgular: Lokal papaverin uygulanması replantasyonu belirgin olarak kolaylaştırmaktadır. Ayrıca bütün hastalara per-operatif olarak kullanılan lidokain, heparin, ılık yıkama solüsyonları (ortalama 28°C %0,9 NaCl) ve post-operatif olarak uygulanan, düşük molekül ağırlıklı dekstran (500cc/24 saat), düşük molekül ağırlıklı heparin, asetil salisilik asit ve pentoksifilinin replantasyon başarısında oldukça etkili olmaktadır. İskemi süresi (soğuk veya sıcak) kısa olan vakalarda başarı önemli ölçüde artmaktadır. Sonuç: Çocuk hastalarda zon 2’deki replantasyonlarda başarılı sonuçlar için iyi bir büyütme sağlayan mikroskop, 10/0 ve 11/0 sütürler, kaliteli ve hassas mikrocerrahi aletler, iyi bir vasodilatasyon, yeterli kemik kısaltma ve cerrahi eksplorasyon ile postoperatif yakın takip ve tedavi gereklidir. Ameliyat sonrası uygulanacak iyi bir fizik tedavi replantasyonların başarısı için şarttır.Öğe Comparision of clinical and histopathological results of hyalomatrix usage in adult patients(E-Century Publishing Corp, 2012) Erbatur, Serkan; Coban, Yusuf Kenan; Aydin, Engin NasuhiClinical and histopathological results of the hyaluronic acid skin substitute treatment of the patients who admitted to Inonu University Medical Faculty Plastic Reconstructive and Aesthetic Surgery clinic between january 2011 and march 2012 were evaluated. The patients were divided into two groups. HA were used for treatment of Hypertrophic scar (HS) or Keloid (K) in 10 patients of the first group. Skin biopsies obtained at peroperative and postoperative 3rd month were subjected to histopathologic examination in this group. In the second group, 10 patients with full thickness soft tissue loss secondary to burns, trauma or excisional reasons were also treated with HA application. Vancouver scar scale were used to determine the scar quality in both groups. Mean age was 25. 2 +/- 10.2 and mean follow-up duration was 6.3 +/- 3.6 months in group 1. Preoperative and postoperative VSS scores in group 1 were 10.7 +/- 1.16 and 6.2 +/- 0.91, respectively. This difference was statistically significant (p<0,005). No HS or K development was seen in any patient in group 2 during the following period. Collagenisation scores of preoperative skin biopsies were significantly higher than postoperative scores (p<0,0001). Vascularisation scores of preoperative skin biopsies were significantly lower than postoperative scores (p<0,00001). The use of HA skin substitute in adults for treatment of HS or K provided the desired clinical healing in the 6 months' follow-up periods. At the same time, HA application as an alternative to other treatment modalities led to a durable skin coverage in full thickness tissue loss in adult patients.Öğe Comparison of the effects of PRP and hyaluronic acid in promoting peripheral nerve regeneration An experimental study with vascular conduit model in rats'(Edizioni Luigi Pozzi, 2016) Firat, Cemal; Aytekin, Ahmet Hamdi; Durak, Mehmet Akif; Geyik, Yilmaz; Erbatur, Serkan; Dogan, Metin; Elmas, OmerAIM: Peripheral nerve defects generally occur due to mechanical, chemical, thermal and pathologic causes and the reconstruction is still a challenging problem. In the present study, we aimed to compare the effects of platelet rich plasma (PRP) that has high levels of growth factors and hyaluronic acid (HA) that is known to have positive effects on nerve regeneration by decreasing scar formation in a rat model where they were injected through allogeneic aorta graft in peripheral nerve defects using histopathologic and functional methods. MATERIAL AND METHODS: The study involved 20 Wistar Albino male rats that weighed 200 to 250 grams and aged about 1 year old. Of the rats, two were used as donor for PRP and aorta graft harvest. Three random groups of 6 rats were composed. In all of the groups, the left sciatic nerves were used and 1 cm of defects were created. The right sciatic nerves were used as control groups. Group I was the group repaired with autograft, Group 2 was the group repaired with HA injected through aorta graft and Group 3 was the group repaired with PRP injected through aorta graft. The findings were evaluated in terms of functional (electromyography and walk test analysis) and histopathologic parameters at 12 weeks. RESULTS: In all of the groups varying degrees of axonal regeneration was observed. Group I was the closest group to the control group showing highest rate of nerve regeneration followed by Group 3 where PRP was injected through aorta graft and group 2 where ha was used respectively. CONCLUSION: The study demonstrates that PRP enhances peripheral nerve regeneration more than HA when used in a vascular conduit model.Öğe Correction of True Hanging Columella Using Medial Crural Tuck-Up Technique(Springer, 2013) Bilen, Bilge Turk; Aytekin, Ahmet Hamdi; Erbatur, Serkan; Geyik, YilmazThe nasal tip and columella are the two main key components that affect the results of a successful and aesthetically satisfactory rhinoplasty. A true hanging columella is a deformity in which the caudal border of the columella has a downward bowing appearance due to disproportion between the ala nasi and the columella, which is usually congenital. In the management of this challenging deformity, a thorough understanding and consideration of tip dynamics and the anatomical causes address the proper technique to be used. In this study we present our clinical experience with the medial crural tuck-up technique used on 53 consecutive patients with a true hanging columella. A total of 1,421 patients underwent rhinoplasty between January 2005 and September 2011; 53 of those patients (age range = 20-37 years; mean = 27.3 years), who underwent this technique, were involved in the study. Thirty-eight patients were followed up for more than 1 year. The results were evaluated by comparing postoperative photos with preoperative photographic documentation. The appearance of the nasal tip and columella remained fine and stable over the 1 year of follow-up. Despite its limitation of applicability in secondary cases, the advantages of this technique are that it does not require conchal or costal cartilage and the desired tip rotation and projection can be done with ease.Öğe Depressive and Anxious Temperaments in Patients with Complex Regional Pain Syndrome Secondary to Tendon Injury(Taylor & Francis Ltd, 2014) Batmaz, Ibrahim; Dilek, Banu; Sariyildiz, Mustafa Akif; Erbatur, Serkan; Bez, Yasin; Yazmalar, Levent; Bozkurt, MehtapObjective: To determine the affective temperaments and somatoform amplification of the symptoms and its relation with the complex regional pain syndrome [CRPS] in patients who had tendon injuries of the forearm and hand. Methods: Sixty-seven patients [60 males, 7 females] with a forearm or hand tendon injury were enrolled in the present study. The patients were divided into two groups: CRPS and non-CRPS. The patients' pain levels within the last 48 hours were assessed using the visual analog scale [VAS]. The temperament of the patients was evaluated using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto questionnaire [TEMPS-A]. Their anxiety levels were evaluated with the help of the State-Trait Anxiety Inventory [STAI]. The depression assessment was performed using the Beck Depression Inventory [BDI]. The Somato sensory Amplification Scale [SSAS] was employed for the evaluation of the somatoform disorders. Results: The mean age of the patients was 26.21 +/- 8.01 years [age range: 18 to 57 years]. Among the patients 24 [35.8%] had developed CRPS. When the patients with and without CRPS were compared in terms of their psychological scores, the STAI-II and BDI scores were observed to be significantly deteriorated in the CRPS group in comparison to the non-CRPS group [p<0.05]. Among the TEMPS-A subtypes, anxious [16.7%] and depressive [41.7%] temperaments were more dominant in the CRPS group and the ratio was significantly more deteriorated than the non-CRPS group [p<0.05]. No significant difference was observed between the groups regarding the SSAS scores [p>0.05]. Conclusion: The present study is the first one evaluating the affective temperaments of CRPS patients with tendon injury, and the main findings point out that depressive and anxious temperaments are the most common dominant affective temperaments among our patients.Öğe Diabetik Ayak Sağaltımında Vakum Destekli Kapama (VAC) Metodu ve Debridmanın Birlikte Etkinliği(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2012) Fırat, Cemal; Aytekin, Ahmet Hamdi; Erbatur, SerkanDiabetik ayak ülserleri periferik nöropati, vasküler yetmezlik ve immün sistem bozukluklarından oluşan kısır döngünün sonucu olup enfeksiyon ve doku kayıplarına neden olmaktadır. Bu yıkıcı süreç cerrahi onarım seçeneklerini oldukça kısıtlamakta ve greftle onarım seçeneğini öne çıkarmaktadır. Greftlerin başarısı enfeksiyondan arındırılmış yeterli granülasyon dokusunun varlığına bağlıdır. Vakum yardımlı yara kapama sistemi (VAC) tedavisi bu iki etkiyi aynı anda sağlamada oldukça etkili ve başarılıdır. Bu çalışmamızda debritmanlarla birlikte VAC tedavisi uygulamalarının etkinliğini, 20 diabetik ayak ülserli olguda, geriye dönük olarak inceledik. Gereç ve Yöntem: VAC tedavisi mükerrer debridmanlarla birlikte ortalama 7 seans uygulandı. 36 saat 125-150 mm Hg intermittan basınç altında uygulandı. Seanslar arasında 12 saat bekleme süresi vardı. VAC tedavi uygulamasının ikinci seansından itibaren yaralarda belirgin granülasyon dokusu artışı ve kontraksiyonla yara boyutlarında küçülme gözlendi. Bulgular: Yeterli kalınlıkta granülasyon dokusu oluşturulduktan sonra yaralar kısmi kalınlıkta deri grefti ile onarıldı. Ayak topuğuna lokalize yarası olan 2 hasta dışında nüks görülmedi. 3 hastaya 6 ay sonra distal seviye transmetatarsal reamputasyon yapıldı. Sonuç: VAC tedavisi, yara enfeksiyonunun drenajında, yaranın kontraksiyonunda ve granülasyon dokusunun artmasında oldukça güvenli ve etkili bir yöntemdir. VAC tedavisinin bu etkinliğinde belirleyici olan uygun zaman aralıklarında yapılan etkili debridmanlardır.Öğe Effectiveness of early fasciotomy in the management of snakebites(Turkish Assoc Trauma Emergency Surgery, 2012) Firat, Cemal; Erbatur, Serkan; Aytekin, Ahmet Hamdi; Kilinc, HidirBACKGROUND The purpose of this study was to emphasize that early fasciotomy performed in the treatment of snakebites in the absence of the classic compartment syndrome criteria accelerates the clinical recovery and reduces the progressive tissue damage. METHODS Fourteen patients with snakebite were examined retrospectively. Five of them healed with routine treatments. Six patients who did not respond to the treatment underwent early fasciotomy procedure in 48 hours. All of the patients had edema, pain, ecchymosis, bulla formation, and progressive skin necrosis over the extremity. Fasciotomy was performed in three patients who were referred in the late period with compartment syndrome. Fasciotomy incisions were closed after 4-6 days. RESULTS After the early fasciotomy, edema diminished rapidly, the skin became more viable and local necrosis did not progress. Further, the toxic symptoms like local temperature increase and fever also diminished. The healing process in the three patients who underwent late fasciotomy was much slower compared with the early fasciotomy group. In particular, necrosis on the muscle and skin had deteriorated. CONCLUSION Fasciotomy has a special place in snakebites. In cases of compartment syndrome, all necessary treatments including early fasciotomy should be performed before the full clinical symptoms develop or the compartment pressure reaches the threshold value.Öğe Effects of montelukast on burn wound healing in a rat model(CLINICAL AND INVESTIGATIVE MEDICINE, 2008) Turtay, Muhammet Gökhan; Fırat, Cemal; Şamdancı, Emine; Oğuztürk, Hakan; Erbatur, Serkan; Çolak, CemilPURPOSE: Montelukast, a selective cysteinyl leukotriene D4-receptor antagonist, is used in the treatment of asthma. In a rat model, our aim was to investigate the effects of montelukast, alone or in combination with topical antibiotics, on local burn wound healing. METHODS: Rats were randomly allocated to four groups after local burn development: Group 1; rats were left to secondary healing without treatment, Group 2; a dose of 10 mg/kg montelukast was given by gastric gavage once a day for 10 days, Group 3; rats were treated with topical pomade (bacitracin neomycin sulphate), and Group 4; rats were treat with a combination of topical antibiotic and montelukast (10 mg/kg were given by gastric gavage once a day for 10 days). Skin biopsies were taken on days 3, 10, 14, and 20 relative to burn induction. RESULTS: Reepithelialization in the pomade and montelukast+pomade groups on the 10th day was significantly greater, in comparison with control and montelukast groups (p < 0.05). For the montelukast group, edema (on the 14th day) and angiogenesis, fibroblast proliferation, edema and macrophage infiltration (on the 20th day) were statistically improved in comparison with the control group (p < 0.05). For the montelukast+pomade group, angiogenesis, fibroblast proliferation and macrophage infiltration (on the 10th day), and angiogenesis, fibroblast proliferation, edema and macrophage infiltration (on the 14th and 20th days) were statistically improved in comparison with the control group (p < 0.05). CONCLUSION: In conclusion, montelukast was effective on burn wound healing. Moreover, the effect was amplified when combined with topical antibiotics applied in the early stage of burn wound healing.Öğe Effects of montelukast on burn wound healing in a rat model(Clinical and investigative medicine, 2008) Turtay, Muhammet Gökhan; Fırat, Cemal; Şamdancı, Emine; Oğuztürk, Hakan; Erbatur, Serkan; Çolak, CemilPurpose: Montelukast, a selective cysteinyl leukotriene D4-receptor antagonist, is used in the treatment of asthma. In a rat model, our aim was to investigate the e!ects of montelukast, alone or in combination with topical antibiotics, on local burn wound healing. Methods: Rats were randomly allocated to four groups a"er local burn development: Group 1; rats were le" to secondary healing without treatment, Group 2; a dose of 10 mg/ kg montelukast was given by gastric gavage once a day for 10 days, Group 3; rats were treated with topical pomade (bacitracin neomycin sulphate), and Group 4; rats were treat with a combination of topical antibiotic and montelukast (10 mg/kg were given by gastric gavage once a day for 10 days). Skin biopsies were taken on days 3, 10, 14, and 20 relative to burn induction. Results: Reepithelialization in the pomade and montelukast+pomade groups on the 10th day was signi$cantly greater, in comparison with control and montelukast groups (p<0.05). For the montelukast group, edema (on the 14th day) and angiogenesis, $broblast proliferation, edema and macrophage in$ltration (on the 20th day) were statistically improved in comparison with the control group (p<0.05). For the montelukast+pomade group, angiogenesis, $broblast proliferation and macrophage in$ltration (on the 10th day), and angiogenesis, $broblast proliferation, edema and macrophage in$ltration (on the 14th and 20th days) were statistically improved in comparison with the control group (p<0.05). Conclusion: In conclusion, montelukast was e!ective on burn wound healing. Moreover, the e!ect was ampli$ed when combined with topical antibiotics applied in the early stage of burn wound healing.Öğe Effects of montelukast on burn wound healing in a rat model(Canadian Soc Clinical Investigation, 2010) Turtay, Muhammet G.; Firat, Cemal; Samdanci, Emine; Oguzturk, Hakan; Erbatur, Serkan; Colak, CemilPurpose: Montelukast, a selective cysteinyl leukotriene D(4)-receptor antagonist, is used in the treatment of asthma. In a rat model, our aim was to investigate the effects of montelukast, alone or in combination with topical antibiotics, on local burn wound healing. Methods: Rats were randomly allocated to four groups after local burn development: Group 1; rats were left to secondary healing without treatment, Group 2; a dose of 10 mg/ kg montelukast was given by gastric gavage once a day for 10 days, Group 3; rats were treated with topical pomade (bacitracin neomycin sulphate), and Group 4; rats were treat with a combination of topical antibiotic and montelukast (10 mg/kg were given by gastric gavage once a day for 10 days). Skin biopsies were taken on days 3, 10, 14, and 20 relative to burn induction. Results: Reepithelialization in the pomade and montelukast+pomade groups on the 10(th) day was significantly greater, in comparison with control and montelukast groups (p<0.05). For the montelukast group, edema (on the 14(th) day) and angiogenesis, fibroblast proliferation, edema and macrophage infiltration (on the 20(th) day) were statistically improved in comparison with the control group (p<0.05). For the montelukast+pomade group, angiogenesis, fibroblast proliferation and macrophage infiltration (on the 10th day), and angiogenesis, fibroblast proliferation, edema and macrophage infiltration (on the 14th and 20th days) were statistically improved in comparison with the control group (p<0.05). Conclusion: In conclusion, montelukast was effective on burn wound healing. Moreover, the effect was amplified when combined with topical antibiotics applied in the early stage of burn wound healing.Öğe Erken fasyotominin yılan ısırıkları tedavisindeki etkinliği(Ulusal Travma ve Acil Cerrahi Dergisi, 2012) Fırat, Cemal; Erbatur, Serkan; Aytekin, Ahmet Hamdi; Kılınç, HıdırAMAÇ Bu çalışmamızda amacımız, yılan sokmalarına bağlı gelişen kompartman sendromlarının tedavisinde, klasik kompartman sendromu kriterlerinden uzaklaşarak yapılan erken fasyotominin hem klinik iyileşmeyi hızlandırdığı hem de ilerleyici doku hasarını azalttığını vurgulamaktır. GEREÇ VE YÖNTEM Yılan ısırması nedeniyle başvuran 14 hasta geriye dönük olarak incelendi. Hastaların 5’i rutin tedavi ile takip edilerek iyileştirildi. Tedaviye yanıt vermeyen 6 hastaya ekstremitede artan ödem, ağrı, peteşi-ekimoz, bül formasyonu, ilerleyici deri nekrozu ve gerilemeyen klinik ve laboratuvar bozukluklar nedeniyle ilk 48 saat içerisinde erken fasyotomi yapıldı. Geç dönemde kompartman tanısı ile kliniğimize sevk edilen 3 hastaya ise başvurduklarında fasyotomi yapıldı. Fasyotomi insizyonları 4 ila 6 gün sonra kapatıldı. BULGULAR Erken fasyotomi uygulanan 6 hastada ödemin hızla azaldığı, ekstremite derisindeki lokal nekrozların ilerlemediği gözlendi. Ayrıca bu hastalarda lokal ısı artışı veya ateş gibi toksik belirtiler hızla geriledi. Geç fasyotomi yapılan 3 hastada ise iyileşme hızı erken cerrahi yapılanlarla kıyaslandığında oldukça yavaştı ve kas ve derideki nekrotik ilerleme kısmen geriledi. SONUÇ Fasyotomi yılan ısırıklarında özel bir yere sahip olup kompartman sendromu olgularında gerekli tüm tedaviler uygulanmalı kliniğin tam olarak oturmasını veya kompartman basıncının eşik değere ulaşmasını beklemeden erken fasyotomi yapılmalıdır.Öğe ?-Glucan treatment prevents progressive burn ischaemia in the zone of stasis and improves burn healing: An experimental study in rats(Elsevier Sci Ltd, 2013) Firat, Cemal; Samdanci, Emine; Erbatur, Serkan; Aytekin, Ahmet Hamdi; Ak, Muharrem; Turtay, Muhammed Gokhan; Coban, Yusuf KenanSaving the zone of stasis is one of the major goals of burn specialists. Increasing the tissue tolerance to ischaemia and inhibiting inflammation have been proposed to enable salvage of this zone. After a burn, excessive inflammation, including increased vascular permeability, local tissue oedema and neutrophil activation, causes local tissue damage by triggering vascular thrombosis and blocking capillaries, resulting in tissue ischaemia and necrosis. Oxygen radicals also contribute to tissue damage after a burn. However, macrophages play a pivotal role in the response to burn. We studied beta-glucan because of its many positive systemic effects that are beneficial to burn healing, including immunomodulatory effects, antioxidant effects (free-radical scavenging activity) and effects associated with the reduction of the inflammatory response. There were four test groups in this study with eight rats in each group. Group 1 was the control group, group 2 was administered a local pomade (bacitracin + neomycin sulphate), group 3 received beta-glucan (50 mg kg(-1), orally) + the local pomade and group 4 received beta-glucan. Burns were created using a brass comb model. Macroscopic, histopathological and statistical assessments were performed. Samples were harvested on the 3rd, 7th and 21 days for analysis. The neutrophilic infiltration into the zone of stasis was analysed on day 3. Macrophage infiltration, fibroblast proliferation, angiogenesis and re-epithelialisation ratios in the zone of stasis were analysed on days 7 and 21. The beta-glucan groups (groups 3 and 4) exhibited lower neutrophil counts on the 3rd day, and macrophage infiltration, fibroblast proliferation, angiogenesis and re-epithelialisation were very high in these groups on the 7th day. In particular, re-epithelialisation on the 21st day was significantly better in the beta-glucan groups. This study demonstrated that beta-glucan may prevent neutrophil-dependent tissue damage and burn-induced oxidative injury through its anti-inflammatory and antioxidant properties. We speculate that the inhibition of neutrophil activation preserves vascular patency by preventing capillary blockage. beta-Glucan is also a powerful macrophage stimulator, and is therefore very effective in saving the zone of stasis. (C) 2012 Elsevier Ltd and ISBI. All rights reserved.Öğe The influence of reduction mammaplasty on dermato-psychiatric disorders(Eurasian Journal of Medicine, 2012) Fırat, Cemal; Erbatur, Serkan; Aytekin, Ahmet HamdiÖz: Fasiyal sinir paralizileri birçok farklı nedene bağlı olarak görülebilir. Bu nedenler arasında; genetik faktörler, viral infeksiyona bağlı gelişen vasküler iskemi ve inflamasyon, otoimmun hastalıklar, temporal kemik fraktürleri, baş-boyun tümörleri, santral sinir sistemi lezyonları yer almaktadır. Ancak tüm bu bilinen nedenlere karşın fasiyal paralizilerin büyük çoğunluğu “idiopatik” ya da “Bell paralizisi” olarak karşımıza çıkmaktadır. Bell paralizisinde hastaların yaklaşık %80-85'inde ilk üç ay içerisinde spontan ve tam iyileşme görülür. Ancak prognozu olumsuz etkileyen faktörlerde göz önüne alındığında bu hastalara erken dönemde tedavi başlanması gerektiği kabul edilmektedir. Tedavide kortikosteroidlerin erken dönemde kullanılmaya başladığında etkili olduğu bilinmektedir. Kortikosteroid tedavisi ile birlikte ya da tek başına antiviral ajanların da tedavide rutin olarak kullanılması ile ilgili, kesin ve yeterli klinik kanıtlar ise henüz elde edilememiştir. Ayrıca Bell paralizili hastaların az bir kısmında erken dönemde yapılacak dekompresyon cerrahisini destekleyen yayınlar olmakla birlikte, tedavideki yeri hala tartışmalıdır ve ileri çalışmalarla desteklenmesi gerekmektedir. Biz de bu derleme ile Bell paralizinin tanı ve tedavisini mevcut literatürler ışığında tartışmayı amaçladık. Başlık (İngilizce): Diagnosis and management of bell palsy Öz (İngilizce): A variety of disorders can affect the function of the facial nerve, such as genetic factors, vascular iskemia and inflammation according to viral infections, otoimmune diseases, temporal bone fractures, head and neck tumours, central nervous system tumours. Despite all of these known conditions the most common presentation of facial paralysis is still “idiopathic”, or “Bell paralysis”. Spontaneous and complete recovery in first three months expected in 80-85% of all patients with Bell paralysis. But early treatment should be considered if recognized the factors effecting prognosis negatively. It has been known that the early administration of corticosteroids improves the chance of full recovery. But there remains insufficient clinical evidences supporting the routine use of antiviral medications with or without corticosteroid therapy. In addition, in a few group of patients, early phase facial nerve decompression surgery techniques are supported by literatures, whereas it remains still highly controversial issue and necessary to support by further studies. In this review we aimed to discuss the diagnosis and treatment procedures of Bell's palsy in the lights of literature.Öğe The Influence of Reduction Mammaplasty on Dermato-Psychiatric Disorders(Aves, 2012) Firat, Cemal; Erbatur, Serkan; Aytekin, Ahmet HamdiObjective: Macromastia can cause psychiatric disorders, such as anxiety and depression, and decreases in self-esteem and self-confidence. These problems often externalize themselves on the skin, causing lesions characterized by various degrees of excoriations and lichenified plaques. Mammaplasty operations are very effective in the treatment of neurotic excoriations and similar skin lesions as well as any underlying psychiatric disorders. Materials and Methods: This study included 17 patients with macromastia and neurotic excoriation lesions who underwent psychiatric treatment for various reasons. Follow ups were performed using routine photographs used in breast surgeries. Results: During the postoperative follow ups, the excoriations for nearly every patient healed within 2 weeks. Some lesions healed with atrophic scars and some with permanent hyperpigmentation. Patients' physical complaints, such as backache, shoulder ache and submammary pruritic dermatitis, were also observed to heal. In addition, the patients stated that they felt better psychologically, and most also reported stopping psychiatric treatment. Conclusion: The psychological problems caused by macromastia include neurotic excoriation and similar skin problems, and aesthetic reduction mammaplasty surgeries are very effective in the treatment of these lesions. Body image perception comprises an important part of self-respect and self-esteem, and psychological-status cosmetic surgery can be evaluated as an alternative to psychological treatment.
