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Öğe 6-Month Results of Transdiscal Biacuplasty on Patients with Discogenic Low Back Pain: Preliminary Findings(Ivyspring Int Publ, 2011) Karaman, Haktan; Tufek, Adnan; Kavak, Gonul Olmez; Kaya, Sedat; Yildirim, Zeynep Baysal; Uysal, Ersin; Celik, FeyziStudy Design: Prospective observational study. Objective: Our aim is to investigate the efficacy and safety of TransDiscal Biacuplasty. Summary of Background Data: Chronic discogenic pain is one of the leading causes of low back pain; however, the condition is not helped by most non-invasive methods. The results of major surgical operations for these patients are unsatisfactory. Recently, attention has shifted to disk heating methods for treatment. TransDiscal Biacuplasty is one of the minimally invasive treatment methods. The method was developed as an alternative to spinal surgical practices and Intradiscal Electrothermal Therapy for treatment of patients with chronic discogenic pain. Methods: The candidates for this study were patients with chronic discogenic pain that did not res pond to conservative treatment. The main criteria for inclusion were: the existence of axial low back pain present for 6 months; disc degeneration or internal disc disruption at a minimum of one level, and maximum of two levels, in MR imaging; and positive discography. Physical function was assessed using the Oswestry Disability Index when measuring the pain with VAS. Patient satisfaction was evaluated using a 4-grade scale. Follow-ups were made 1, 3, and 6 months after treatment. Results: 15 patients were treated at one or two levels. The mean patient age was 43.1 +/- 9.2 years. We found the mean symptom duration to be 40.5 +/- 45.7 months. At the sixth month, 57.1% of patients reported a 50% or more reduction in pain, while 78.6% of patients reported a reduction of at least two points in their VAS values. In the final check, 78.6% of patients reported a 10-point improvement in their Oswestry Disability scores compared to the initial values. No complications were observed in any of the patients. Conclusions: TransDiscal Biacuplasty is an effective and safe method.Öğe Comparison of the effectiveness of intrathecal bupivacaine and Levobupivacaine in hip surgery(Slovene Medical Soc, 2013) Celik, Feyzi; Karaman, Haktan; Tufek, Adnan; Kavak, Gonul Olmez; Yildirim, Zeynep Baysal; Tokgoz, Orhan; Guzel, AbdulmenapPurpose: We aimed to compare the anesthetic and hemodynamic effects of intrathecally administered levobupivacaine and bupivacaine in combination with fentanyl in hip surgery. Subjects and methods: Sixty patients categorized as class 1 or 2 according to the American Society of Anesthesiologists (ASA) Physical Status classification, aged between 18 and 65 years and scheduled for hip surgery were randomly assigned to two groups. Patients in Group I received spinal anesthesia with 0.5 % bupivacaine 12.5 mg + fentanyl 10 mu g (total 2.6 ml), and patients in Group II received 0.5 % levobupivacaine 12.5 mg + fentanyl 10 mu g (total 2.6 ml) intrathecally. The level of sensory block and motor block was evaluated, and hemodynamic data were recorded. Results: The onset of sensory block and the time to two-segment regression were similar between the two groups. In the levobupivacaine group, the time to motor block onset was longer and the motor block regression time was shorter than that of bupivacaine group. The groups were similar with respect to hemodynamic data. Conclusion: We consider that levobupivacaine may be a good alternative to bupivacaine, particularly in surgical procedures where less motor block development is desired.Öğe The Complications of Transforaminal Lumbar Epidural Steroid Injections(Lippincott Williams & Wilkins, 2011) Karaman, Haktan; Kavak, Gonul Olmez; Tufek, Adnan; Yildirim, Zeynep BaysalStudy Design. A prospective observational study. Objective. In this study, we aimed to investigate the major and minor complications of transforaminal lumbar epidural steroid injections guided by fluoroscopy and the incidence of vascular penetration encountered during this procedure. Summary of Background Data. Epidural steroid administration is one of the treatment options for lumbar disc hernia accompanied by radiculopathy. This method, initially applied by blind interlaminar technique, has generally been performed by fluoroscopically guided transforaminal method now. The complications of this method cause to a serious concern. The complications of this intervention have been reported by either mostly retrospective studies or case reports until now. Prospective studies with large patient series are needed to determine the types and incidences of the complications. Methods. In this study carried out for more than 5 years, major and minor complications of transforaminal lumbar epidural steroid injections were investigated prospectively. All of the interventions were performed under fluoroscopic guidance by the same physician using a standardized method. A follow-up was made once in the third week. The complications encountered during the procedure and in the third week were prospectively recorded. In addition, the incidence of vascular penetration that is potentially hazardous is included in the study. Results. A total of 562 patients were performed 1305 times transforaminal lumbar epidural steroid. The overall incidence of vascular penetration encountered was 7.4%. Although major complications were not seen, the total rate of all minor complications was 11.5%. Whereas all of the minor complications were transient, the most frequent minor complication was vasovagal reaction (8.7%). Conclusion. On the basis of the results of this study in which only minor complications were encountered, it can be said that the frequency of major complications is pretty rare in transforaminal lumbar epidural steroid injections in expert hands and in the conditions in which safety precautions are taken.Öğe Cooled radiofrequency application for treatment of sacroiliac joint pain(Springer Wien, 2011) Karaman, Haktan; Kavak, Gonul Olmez; Tufek, Adnan; Celik, Feyzi; Yildirim, Zeynep Baysal; Akdemir, Mehmet Salim; Tokgoz, OrhanBackground The unavailability of an effective and long-lasting treatment for sacroiliac-based pain has led researchers to study the efficacy of radiofrequency in denervation. In this study, we aimed to investigate the efficacy and safety of novel cooled radiofrequency application for sacral lateral-branch denervation. Methods Patients experiencing chronic sacroiliac pain were selected for our observational study. Fluoroscopy guidance cooled radiofrequency denervation was applied on the L5 dorsal ramus and the S1-3 lateral branches on patients who had twice undergone consecutive joint blockages to confirm the diagnosis and obtained at least 75% pain relief. At the 1st, 3rd and 6th month postoperatively, the patients' pain was evaluated using a visual analog scale (VAS), and their physical function was evaluated with the Oswestry Disability Index (ODI). Results Cooled radiofrequency was applied on a total of 15 patients. Prior to the procedures, the median VAS score (interquartile range) was 8 (7-9), but at the 1st, 3rd and 6th month, this had fallen to 3 (1-4), 2 (1-3) and 3 (2-4). The baseline median ODI score (interquartile range) was 36 (32-38), while at the 1st, 3rd and 6th month, it was 16 (820), 12 (9-18) and 14 (10-20), respectively. At the final control, while 80% of the patients reported at least a 50% decline in pain scores, 86.7% of those reported at least a ten-point reduction in ODI scores. Conclusion It was seen that the cooled radiofrequency used for sacroiliac denervation was an effective and safe method in the short to intermediate term.Öğe Effectiveness of nucleoplasty applied for chronic radicular pain(Int Scientific Information, Inc, 2011) Karaman, Haktan; Tufek, Adnan; Kavak, Gonul Olmez; Yildirim, Zeynep Baysal; Temel, Vildan; Celik, Feyzi; Akdemir, Mehmet SalimBackground: Over the last several decades there has been a general trend toward reduction and minimalization in surgical treatment of chronic back pain, since open surgery brings complications in small and contained disc herniations instead of achieving expected success. Attention has been focussed on percutaneous nucleoplasty due to the limited success of other minimally invasive methods, as well due to their associated complications. However, there have been few studies in the English literature with a follow-up period of more than I year. Material/Methods: Patients with chronic disc herniations having more significant radicular leg pain, who did not respond to non-invasive treatment methods and for whom open surgery was not an option were selected for percutaneous nucleoplasty application. Upon intervention, patients were prospectively questioned by an independent physician regarding pain, physical improvement, and operation satisfaction at 1, 6, 12 and 24 months. Pain was evaluated with VAS, and physical improvement was evaluated based on the Oswestry Disability Index. Results: Mean VAS that was 8.7 +/- 1.1 before the procedure was determined to be 3.4 +/- 1.9 at 24 months follow-up. At the latest follow-up, 87.5% of the patients reported a 30% or higher decrease in their pain. While Oswestry scores were 76.1 +/- 10.2 in the beginning, they went down to 33.9 +/- 14.9 at the end of 2 years. The percent of those stating good and excellent satisfaction was 66% (23 persons) on the last follow-up. Conclusions: While it is once more shown that nucleoplasty is a safe method, it is also shown that its effectiveness continues at the end of 2 years.Öğe Efficacy of transforaminal lumbar epidural steroid injections in patients with lumbar radiculopathy(Kare Publ, 2012) Cetin, Mehmet Fatih; Karaman, Haktan; Kavak, Gonul Olmez; Tufek, Adnan; Yildirim, Zeynep BaysalObjectives: This study looks into the efficacy and safety of the transforaminal lumbar epidural steroid injection (TLESI) applied to patients with radiculopathy due to lumbar disk herniation. Methods: The patients' files which were applied TLESI, were retrospectively scanned. Patients who did not respond to one-month conservative treatment and who were detected to have bulging or protruding lumbar disk herniation as a result of imaging methods were included in the study. All applications were performed with C-arm fluoroscopy under local anesthesia by outpatient method. In all cases, a mix of 80 mg triamsinolone and 0.25% bupivacaine, was transforaminally injected to the anterior epidural area. Initial VAS pain scores were compared with the values of the 1, 3 and 6th months after the application. Patient satisfaction was determined through scoring. Furthermore, early and late term complications were collected for evaluation. Results: A total of 222 patients were administered TLESI 460 times (average: 2.1, repeat interval: 1-6 times). The applications were carried out most frequently at the levels of L4-L5 and L5-S1. While the initial VAS score average was 8.2 +/- 0.7, after TLESI, it was 5.0 +/- 1.6, 4.8 +/- 1.5 and 5.1 +/- 1.5 in the 1, 3 and 6th months, respectively. 63.9% of the patients (n=142) defined the treatment as 'good and excellent'. No major complications were experienced and the overall minor complication rate was 11.1%. Conclusion: It was seen that TLESI was an efficient and safe method in the short and medium term.Öğe Factors Affecting ICU Stay and Length of Stay in the ICU in Patients with HELLP Syndrome in a Tertiary Referral Hospital(Hindawi Ltd, 2022) Agacayak, Elif; Bugday, Rezan; Peker, Nurullah; Deger, Ugur; Kavak, Gonul Olmez; Evsen, Mehmet Siddik; Gul, TalipObjective. The study aimed to compare patients with HELLP syndrome who require intensive care and who do not require intensive care and evaluate the factors affecting the length of stay in the intensive care unit. Methods. Patients were divided into two groups as follows: requiring intensive care (group 1) and not requiring intensive care (group 2). The data of both groups were compared in terms of demographic characteristics, transfusion amounts, length of stay in the intensive care unit, maternal complications, and mortality. Results. 14032 births in a tertiary center between 2011 and 2018 were evaluated in this study. During the study period, 342 patients were diagnosed with HELLP, and 32 (9.4%) of these were followed up in the intensive care unit. The length of stay in the intensive care unit was determined as 8.1 (7.2) days on average. Fresh frozen plasma, erythrocyte suspension, apheresis, and random thrombocyte transfusion were observed to be significantly more in group 1 patients. In the regression analysis, the most effective factor was found to be erythrocyte suspension and the length of stay in the intensive care unit was significantly longer in patients who had erythrocyte suspension transfusion. The receiver operating characteristic curve showed that the area under the curve value for erythrocyte transfusion was 70.6%. When the cutoff value of erythrocyte suspension was 450 (95% CI: 365-681) ml, the sensitivity was 43.8% and the specificity was 91.6%. Conclusion. We think that physicians should be careful that maternal morbidity and mortality may increase as the need for erythrocyte suspension transfusion increases in patients with HELLP syndrome. Minimum transfusion to hemodynamically stable patients can be more suitable in terms of morbidity and mortality in managing patients with HELLP syndrome requiring erythrocyte suspension transfusion. Precautions and measures should be taken in this regard.Öğe Foot drop following spinal anaesthesia(Elsevier Science Inc, 2015) Aycan, Ilker Onguc; Turgut, Huseyin; Guzel, Abdulmenap; Dogan, Erdal; Kavak, Gonul Olmez[Abstract Not Available]Öğe Intra-articularly applied pulsed radiofrequency can reduce chronic knee pain in patients with osteoarthritis(Lippincott Williams & Wilkins, 2011) Karaman, Haktan; Tufek, Adnan; Kavak, Gonul Olmez; Yildirim, Zeynep Baysal; Uysal, Ersin; Celik, Feyzi; Kaya, SedatBackground: Osteoarthritis (OA) is the most widespread chronic joint disease worldwide. Symptomatic knee OA is observed in approximately 12% of individuals more than 60 years of age. Conservative treatments models may not be effective always, and that some of them have serious adverse effects that prompted the researchers to research different treatment methods. In this study, we investigated short- and mid-term effectiveness of intra-articular pulsed radiofrequency (PRF) applied in patients with chronic knee pain due to OA. Methods: This study was carried out in the pain management center of a university hospital between January 2009 and June 2009. The patient record files of 31 patients who received intra-articular PRF were retrospectively reviewed. The antero-lateral area of the knee, where the intervention would be applied, was anesthetized with 1% lidocaine. An introducer needle was placed intra-articularly. PRF was started as 42 degrees C at 2 Hz for 15 minutes. The pain of the patients was evaluated by 10 cm Visual Analog Scale (VAS). Furthermore, the ages, the gender, the symptom duration of the patients, the side of the knee on which the intervention was applied, and the complications were collected for statistical evaluation. Results: Although the mean initial VAS scores of the patients were 6.1 +/- 0.9 cm, it was found, respectively, to be 3.9 +/- 1.9 cm and 4.1 +/- 1.9 cm at the first- and sixth-month follow-ups. In general, a decrease of 32.8% in mean in the VAS scores was achieved in the last follow-up; whereas the rate of patients reporting a minimum decrease of 2 points in the VAS scores was 64.5% and the rate of patients reporting a decrease of >= 50% in their pain was calculated as 35.5%. Conclusion: PRF applied to the knee joint appears to be an effective and safe method. Copyright (C) 2011 Elsevier Taiwan LLC and the Chinese Medical Association. All rights reserved.Öğe OUR APPLICATIONS OF PERCUTANEOUS VERTEBROPLASTY IN VERTEBRA PLANA TYPE COMPRESSION FRACTURES ASSOCIATED WITH OSTEOPOROSIS(Gunes Kitabevi Ltd Sti, 2011) Karaman, Haktan; Akay, Hatice Ozturkmen; Taze, Hatice Aslanhan; Kaya, Sedat; Kavak, Gonul Olmez; Balkan, BedihT he indication area of percutaneous vertebroplasty, which was first applied successfully for the management of aggressive vertebral hemangioma in 1987 in France, has grown in the years. One of these indications is osteoporotic vertebral compression fractures. Osteoporosis, common amongst elderly patients causes significant compression fractures. Most of the fractures that do not cause pressure on the spinal canal are successfully treated with percutaneous vertebroplasty. However most authors, claiming that in cases of severe vertebral compression fracture ( vertebra plana) associated with osteoporosis, cement leakage developing due to technical difficulties may cause dangerous complications such as emboli, death and disability, asserted that the application of percutaneous vertebroplasty is contraindicated. This study, presenting successful percutaneous vertebroplasty in two patients with the vertebra plana type compression fracture associated with osteoporosis, underlines that as long as it is performed meticulously, the complication risk in percutaneous vertebroplasty is very low.Öğe Reexpansive Pulmonary Edema Following Cardiac Tamponade(Duzce Univ, 2012) Celik, Feyzi; Tufek, Adnan; Dogan, Erdal; Temel, Vildan; Yildirim, Zeynep Baysal; Kavak, Gonul OlmezPulmonary edema may occur secondary to increased left ventricular load and systemic vascular resistance following a sudden drainage of cardiac tamponade fluid. In present case, a 65-year-old male patient who underwent heart surgery three months ago, was operated due to respiratory distress symptoms and developed reexpansion pulmonary edema, was reported.Öğe Thymoquinone treatment against acetaminophen-induced hepatotoxicity in rats(Elsevier Science Bv, 2014) Aycan, Ilker Onguc; Tufek, Adnan; Tokgoz, Orhan; Evliyaoglu, Osman; Firat, Ugur; Kavak, Gonul Olmez; Turgut, HuseyinAim: In this study, we aimed to examine the efficacy of thymoquinone (TQ) treatment in acetaminophen-induced liver toxicity in rats. Methods: Forty Wistar Albino rats were used for the study (four groups, with 10 rats for each group). Animals in the control group were not given any medication. In the thymoquinone (TQ) group, animals were given three times 5 mg/kg oral thymoquinone for every six hours, which equals to a total dose of 15 mg/kg. In the acetaminophen (APAP) group, animals were given APAP at a single dose of 500 mg/kg orally. In the APAP + TQ group, animals were given 500 mg/kg APAP orally followed by three doses of TQ at a 15 mg/kg total dose in an 18-h time interval. All animals were sacrificed at the 24th hour. Alanine amino transferase (ALT), aspartat amino transferase (AST), superoxide dismutase (SOD), oxidized glutathione (GSSG), glutathione peroxides (GSH-Px), and malondialdehyde (MDA) activities were measured in rat blood. Histopathological examination was also performed. Results: Serum ALT, AST levels, GSSG, and SOD activity as well as the serum and tissue MDA levels were found to be higher in the APAP group than in the control group (p <= 0.001). Likewise, serum GSH-Px activity was found to be lower in the APAP group (p <= 0.001). In contrast, in the APAP + TQ group, serum ALT, AST levels, GSSG, SOD activity and the serum and tissue MDA levels were found to be lower compared to that of the APAP group. This difference was statistically significant (p <= 0.001). In the APAP + TQ group, the GSH-Px activity was found to be significantly higher compared to the APAP group (p < 0.05). In contrast to this finding, the GSH-Px activity in the APAP + TQ group was found to be lower than that of the control group (p <= 0.001). Histopathological analysis revealed significant liver necrosis and toxicity with a high dose of APAP where TQ treatment was related with significantly lower liver injury scores. Conclusion: TQ treatment may have an important therapeuthic effect via the upregulation of antioxidant systems in the APAP-induced liver hepatotoxicity in rats. (C) 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.Öğe Would Pulsed Radiofrequency applied to different anatomical regions have effective results for chronic pain treatment?(Pakistan Medical Assoc, 2011) Karaman, Haktan; Tufek, Adnan; Kavak, Gonul Olmez; Yildirim, Zeynep Baysal; Celik, FeyziObjective: To observe the effect of Pulsed radiofrequency on patients presenting with complaints of chronic pain. Methods: It was a retrospective cross sectional study which included patients with chronic pain who did not respond to conventional treatment.The study was conducted at the Pain Management Centre, Dicle University, Diyarbakir, Turkey from October 2008 to September 2010. The applications of Pulsed radiofrequency (PRF) were made under the guidance of C-arm fluoroscopy, local anaesthesia, and sedoanalgesia. The intervention types applied consisted of sacroiliac intraarticular, heel, sciatic nerve and impar ganglion Pulsed radiofrequency. Visual Analogue Scale (VAS) was used for pain assessment.Sacroiliac intraarticular PRF was applied to nine patients, impar ganglion PRF to eight patients, heel PRF to four patients and sciatic nerve PRF was applied to three patients. Results: The mean age of the patients was 41.3 +/- 16.9 (range 15-77) years, 15 (62.5%) were females. The mean follow-up period was 8.5 +/- 5.4 months. A minimum 50% decrease was determined in the VAS scores of 16 (66.7%) patients compared to the initial values. The patients who had >= 50% decrease in their VAS scores in the sacroiliac group was 55.6. This value was 75.0, 75.0 and 66.7 in the impar, heel and sciatic nerve groups respectively. No early- or late-term complications were observed in any of the patients. Conclusions: P Pulsed Radiofrequency implementation was found to be an effective and safe method for chronic pain treatment in our centre.
