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    Comparison of the effects of nicardipine and remifentanil on surgical visual field and hemodynamic parameters in tympanomastoidectomy cases
    (2024) Karaaslan, Erol; Tan, Mehmet; Ozkan, Ahmet Selim; Gülçek, İlham; Sarıtoy, Celal
    In this study; We aimed to compare the surgical visual field and hemodynamic effects of Nicardipine and Remifentanil in microscopic tympanomastoidectomy patients. The study was planned as a prospective, double-blind, and randomized clinical trial. A total of 64 patients aged between 18 and 65 were included in the study and the patients were randomized into 2 groups: Group N (Nicardipine=32) and Group R (Remifentanil=32). The input data were measured at pre-induction (T0), 5 minutes post-incision (T1), 20 minutes post-incision (T2), mastoidectomy during the tour (T3), cholesteatoma clearance (T4), grafting (T5), extubation (T6), 10 minutes post-extubation (T7), at the time of admission to the post-anesthesia care unit (PACU) (T8) and the 15th minute (T9) in PACU along with hemodynamic parameters values. In the evaluation of the visibility of the surgical field, the Boezaart Scale was used. There was no significant difference in demographic data in both groups. Considering the hemodynamic parameters between the groups, HR values were higher in Group N during the whole period (T1-T9) (p<0.05). T1, T6, T7, and T8, while DAB and MAP were lower in Group N. No difference was observed between the groups in terms of Boezaart Scoring, nausea-vomiting and pain scoring. Remifentanil and Nicardipine provided similar surgical field visual quality in CH application in tympanomastoidectomy cases. We think that nicardipine may be preferred in cases with sensitivity to the pathological effects of bradycardia because it does not have a bradycardia-producing effect.
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    The first uniportal VATS sleeve lobectomy in Türkiye: A case report
    (2024) Ulutaş, Hakkı; Gülçek, İlham; Kalkan, Muhammed
    In recent years, video-assisted thoracic surgery (VATS) has become the gold standard approach in the surgical treatment of early-stage non-small cell lung cancer. Especially in cases of central tumors, sleeve lobectomies that preserve parenchyma and respiratory reserves are performed instead of pneumonectomies by experienced clinics. Here, we present the first case of uniportal VATS right bronchial sleeve upper lobectomy for right main bronchial invasion in Turkey, which was successfully performed in August 2022. A patient diagnosed with laryngeal carcinoma who had been in remission for 5 years complained of a cough. Computed thoracic tomography showed hilar peribronchial thickening and an endobronchial lesion (EBL) extending from the right upper lobe bronchus to the main bronchus, almost completely obstructing the upper lobe bronchus. Bronchoscopy revealed that the right upper lobe entrance was obstructed with EBL, and its distance to the carina was 1.6 cm. Bronchoscopic biopsy revealed squamous cell carcinoma. The thorax was entered through an incision of approximately 3 cm in the right fifth intercostal space. First, the right upper lobe pulmonary arteries and superior pulmonary vein were dissected and cut. The main bronchus was divided until the intermediate bronchus. With the help of an endoscissor, the main and intermediate bronchus were incised with appropriate surgical margins, and the lobectomy material was removed. Both macroscopic appearance and frozen and microscopic main and intermediate bronchus surgical margin tumor negativity were confirmed. One suture was passed through the lateral cartilage from the inside out, and the needle was fixed to the posterior pleura. Membranous and cartilage parts were continuously anastomosed with a double-needle 3/0 prolene suture at 2–3 mm intervals. Pathological evaluation confirmed squamous cell carcinoma with a tumor diameter of 1.7 cm, hilar 1/11 lymph node metastasis, and negative surgical margin. Adhering to oncologic principles, sleeve resections, which are difficult even with the currently known open techniques, can be performed effectively and safely with uniportal VATS in experienced centers.
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    Kolonoskopi Sonrası Nadir Görülen Pnömoretroperitoneum, Pnömomediastinum, Pnömotoraks ve Subkutan Amfizem Olgusu
    (2024) Ağar, Mehmet; Gülçek, İlham; Kalkan, Muhammed
    Kolonoskopi sonrası pnömoretroperitoneum, pnömomediastinum,pnömotoraks ve subkutan amfizem birlikteliği nadir görülen bir durumdur. Kolonoskopi sonrası görülen bu nadir klinik durumu literatüre katkı sağlaması amaçlı sunduk. Akut batın nedeniyle iki yıl önce opere olan hasta kolon darlığı nedeniyle kolonoskopi yapılan 62 yaşındaki erkek hasta işlem sonrası boynunda şişlik, göğsünde ve karnında cilt altı şişlik şikayeti ile başvurdu. Hastada pnömoretroperitoneum, pnömomediastinum ve subkutan amfizem tespit edildi. Kolonoskopi sonrası görülecek cilt altı amfizem durumunda akla pnömomediastinum ve pnömotoraks olma ihtimalide gelmelidir.