Browsing by Author "Tokyay, Rifat"

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Acil serviste yatak başı idrar tripsinojen-2 ölçümü akut pankreatitin ayırıcı tanısı için kullanılabilir mi?
(Uludağ Üniversitesi, 2003) Güler, Veli; Tokyay, Rifat; Uludağ Üniversitesi/Tıp Fakültesi/İlk ve Acil Yardım Anabilim Dalı.
Akut pankreatit, pankreatik enzimler ile bezin kendi kendini yıkıma uğratması sonucu meydana gelen inflamatuar bir süreçtir. Akut pankreatitin kliniği, kendi kendini sınırlayan hafif türünden ani ölümcül sonuçlar doğurabilecek şiddetli türüne kadar değişik bir spektrum gösterir. Özellikle atipik kliniği olan hastalarda, akut pankreatitin tanısını koymak zor olabilir. Klinisyen, genel durumu çok bozuk olup semptom ve bulguları tam belirlenemediği, erken post operatif dönemde fizik muayene bulgularının tam değerlendirilemediği ya da semptomların başlangıcından sonra uzun zaman geçmiş olan hastalarda, tanıya gitmekte zorlanabilir, ölümcül akut pankreatit olgularının %42'sinde tanının ancak otopsiyle konabildiği bildirilmiştir. Akut pankreatit tanısında hala en sık kullanılan serum amilaz düzeyi ölçümü, böyle durumlarda yeterli derecede duyarlı ve özgül değildir. Son zamanlarda, akut pankreatit tanısının konmasında, idrarda tripsinojen-2 tayininin serum amilaz düzeyi ölçümüne göre daha avantajlı olabileceği yönünde literatürde birçok yayın vardır. Bu yayınlara göre idrarda tripsinojen-2 tayininin başlıca avantajları -duyarlılığının daha yüksek olması, -3 dakika gibi kısa bir sürede sonuç alınması, -uygulamak için bir laboratuara ve laboratuar personeline ihtiyaç olmaması, -serumda 30 güne kadar yüksek düzeyde kalabildiği için geç başvuran olguları da saptayabilmesi, -kronik alkolik pankreatitin akut ataklarının tanısı ile -akut pankreatitin komplikasyonlarının tanısında da duyarlı olması sayılabilir. Bu çalışmada, acil servise başvuran akut pankreatitli hastaların tanısını hızlı ve doğru bir şekilde koyabilmek için idrarda tripsinojen-2 ölçümünün güvenilir bir tanı yöntemi olup olmadığını araştırdık. Bunun için de tanısının akut pankreatit olduğu ve tanısının akut pankreatit olmadığı kesin olarak bilinen iki grup hasta çalışmaya alınarak idrarda tripsinojen-2 tayininin akut pankreatit tanısındaki özgüllüğünü ve duyarlılığını araştırdık. Toplam 53 hasta çalışmaya alındı. Bunlardan 15'i kesin akut apandisit tanısı konan, 38'i ise kesin akut pankreatit tanısı konan olgulardı. Akut pankreatit grubundaki ve akut apandisit grubundaki tüm hastaların serum amilaz düzeyleri ile idrarda tripsinojen-2 düzeyleri ölçüldü. İdrarda kalitatif tripsinojen-2 ölçümü, çalışmamıza aldığımız 38 akut pankreatitli hastanın 32 tanesinde pozitif, 6 tanesinde negatif olarak saptanırken, 15 akut apandisitti hastanın tamamında negatif olarak bulundu (duyarlılık %84, özgüllük %100). Serum amilaz düzeyi, 38 akut pankreatitli hastanın 24 tanesinde 900 IU/L'nin üzerinde ve 15 akut apandisitli hastanın tamamında normal sınırlardaydı (duyarlılık %63, özgüllük %100). Sonuç olarak, acil serviste idrarda tripsinojen-2 ölçümünün, serum amilazma göre, istatistiksel olarak daha kuvvetli olması, kısa sürede sonuç almması ve laboratuar ekipmanına gereksinim göstermemesi nedeniyle akut pankreatiti diğer akut karın nedenlerinden ayırmada başvurulabilecek bir tarama testi olarak kullanılabileceği kanısına varıldı.
Compliance with protocols in transferring emergency patients to a tertiary care centre
(Elsevier, 2004-09) Armağan, Erol; Gültekin, Murat Al; Engindeniz, Zülfi; Tokyay, Rifat; Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Genel Cerrahi Anabilim Dalı.; 0000-0003-1874-5097; AAH-8846-2021; AAN-2617-2021; 6506464232; 6504053848; 6507354145; 7003296847
Study objectives: We evaluated compliance with standard patient transfer protocols in a pre- and post-interventional, study among patients transferred from other hospitals to our tertiary care university hospital. Methods: In the first phase, transfer information was recorded on the arrival in 174 consecutive patients transferred to our emergency department (ED) over a 2-month period in 1999. Emergency caregivers throughout the province then received education about proper transfer procedures. This training was provided through monthly citywide co-ordination and co-operation meetings among the physicians of the emergency medical services (EMS) and the emergency departments of the hospitals in the city and the nearby counties. Fifteen months after the beginning of these educational efforts, the second observational phase was implemented. Over a period of 2 months in early 2001, information was recorded from 180 consecutive patients transferred to our ED. Presence of patient medical records, Laboratory results, and X-rays; clearly delineated reason for transfer; prior notification of transfer; and appropriate care during transport from the initial facility were the parameters compared in the pre- and post-intervention periods. Results: Patients in phase-II were found to have had more appropriate care in some respects, such as presence of cervical collar and proper airway management, during transport from the initial facility than patients in phased (P < 0.05). However, other parameters were not significantly different between the two phases. Conclusion: We have concluded that our monthly meetings and conferences have made a positive impact on compliance with some of the standard transfer protocols. We must however, continue our efforts to increase compliance with other aspects of standard patient transfer guidelines.
Hypertonic saline dextran alleviates hepatic injury in hypovolemic rats undergoing porta hepatis occlusion
(Lippincott Williams and Wilkins, 2003-04) Özgüç, Halil; Tokyay, Rifat; Kahveci, Nevzat; Serdar, Zehra; Gür, Esma Sürmen; Uludağ Üniversitesi/Tıp Fakültesi/Genel Cerrahi Anabilim Dalı.; 0000-0003-0841-8201; 0000-0001-7377-9682; AAG-7070-2021; AAG-7327-2021; 6603867989; 7003296847; 6602597846; 57222002284; 7801407302
To monitor the ischemic and/or reperfusion injury after porta hepatis occlusion (Pringle maneuver) in livers subjected to hypotension, serum alanine amino transferase (ALT), liver malondialdehyde, (MIDA), and liver glutathione (GSH) levels were measured. MDA is a by-product of oxidant-induced lipid peroxidation, and GSH is an endogenous antioxidant. The effects of lactated Ringer's (LR) and hypertonic saline (7.5%)/Dextran (6%; HSD) resuscitation on liver injury, if any, was investigated. Rats in sham (S, n = 8) and five other groups (n = 8) underwent femoral artery and vein catheterization and laparotomy. The hemorrhage and ischemia (HI) group was bled 30% of their blood volume and had their porta hepatis occluded for 30 min. The HI, LR, and HSD groups underwent both hemorrhage and occlusion. Thirty minutes after hemorrhage, the LR and HSD groups received either LR (equivalent to three times the shed blood) or HSD (10 mL/kg) resuscitation over 30 min. Both LR and HSD resuscitation lowered the increased ALT and liver tissue MDA seen in the HI group. ALT was decreased from 348 +/- 93 IU/L in the HI group to 200 +/- 98 IU/L in the LR and 139 +/- 74 IU/L in the HSD groups. Liver tissue MDA was 353 +/- 22 nmol/g/tissue in the HI group and LR decreased it to 261 +/- 17 nmol/g/tissue, whereas HSD decreased it to 273 +/- 20 nmol/g/tissue. The decrease in ALT and the increase in liver GSH were more pronounced with HSD resuscitation (P < 0.05). HSD seems to be more effective than LR in decreasing the liver tissue damage produced by total hepatic inflow occlusion under hypovolemic conditions.
Medical experience of a university hospital in Turkey after the 1999 Marmara earthquake
(BMJ Publishing Group, 2005-07-01) Tokyay, Rifat; Bulut, Mehtap; Fedakar, Recep; Akköse, Şule; Akgöz, Semra; Özgüç, Halil; Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Adli Tıp Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Genel Cerrahi Anabilim Dalı.; AAH-6287-2021
Objectives: This study aimed to provide an overview of morbidity and mortality among patients admitted to the Hospital of the Medicine Faculty of Uludag University, Bursa, Turkey, after the 1999 Marmara earthquake. Methods: Retrospective analysis of the medical records of 645 earthquake victims. Patients' demographic data, diagnosis, dispositions, and prognosis were reviewed. Results: A total of 330 patients with earthquake related injuries and illness admitted to our hospital were included and divided into three main groups: crush syndrome (n=110), vital organ injuries (n=57), and non-traumatic but earthquake related illness (n=55). Seventy seven per cent of patients were hospitalised during the first three days after the earthquake. The rate of mortality associated with the crush syndrome, vital organ injury, and non-traumatic medical problems was 21% (23/110), 17.5% (10/57), and 9% (5/55), respectively. The overall mortality rate was 8% (50/645). Conclusions: In the first 24-48 hours after a major earthquake, hospital emergency departments are flooded with large numbers of patients. Among this patient load, those patients with crush syndrome or vital organ injuries are particularly at risk. Proper triage and prompt treatment of these seriously injured earthquake victims may decrease morbidity and mortality. It is hoped that this review of the challenges met after the Marmara earthquake and the lessons learned will be of use to emergency department physicians as well as hospital emergency planners in preparing for future natural disasters.
Oxothiazolidine carboxylate provides protection against hepatocellular injury seen after porta hepatis occlusion (pringle maneuver) under hypovolemic conditions
(Springer, 2003-04) Özgüç, Halil; Tokyay, Rifat; Kahveci, Nevzat; Serdar, Zehra; Sürmen Gür, Esma; Korfalı, Ender; Uludağ Üniversitesi/Tıp Fakültesi/Genel Cerrahi Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Fizyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Biyokimya Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Beyin ve Sinir Cerrahisi Anabilim Dalı.; 0000-0001-7377-9682; 0000-0003-0841-8201; AAG-7070-2021; AAG-7327-2021; 6603867989; 7003296847; 6602597846; 57222002284; 7801407302; 7004641343
The sensitivity of liver to warm ischemia has always been a concern for surgeons. To monitor the ischemia and/or reperfusion injury after the Pringle maneuver (occlusion of porta hepatis) in livers subjected to hemorrhage, blood pressure, blood pH, base deficit (BE), serum alanine aminotransferase (ALT), serum and liver malondialdehyde (MDA), and liver glutathione (GSH) levels were measured. MDA is a by-product of oxidant induced lipid peroxidation, and GSH is an endogenous antioxidant. The effect of lactated Ringer's (LR) resuscitation with or without the addition of 2-oxothiazolidine-4-carboxylate (OTC), a cysteine prodrug (enhancing glutathione production) on liver injury, if any, were investigated. Rats in the sham group (n = 8) and five other groups (n = 8) underwent femoral artery and vein catheterization and laparotomy. The hemorrhage group was bled 30% of their blood volume and the ischemia group underwent occlusion of the porta hepatis 30 minutes. The hemorrhage-ischemia (HI), LR, and OTC groups underwent both hemorrhage and occlusion. The LR and OTC groups, 30 minutes after hemorrhage, received either LR resuscitation (equivalent to three times the shed blood) or LR resuscitation plus IV OTC (100 mg/kg before clamping and 100 mg/kg after declamping). Porta hepatis occlusion in the presence of hypovolemia (HI group) caused an increase in serum ALT, plasma MDA, liver NIDA, and base deficit and a decrease in blood pH levels. LR resuscitation lowered only MDA (plasma and liver) and base deficit but did not reduce ALT and increase blood pH. Although liver GSH did not change, OTC kept all parameters at control levels. OTC prevents the deleterious effects of total hepatic inflow occlusion under hypovolemic conditions, but this does not occur through enhancement liver glutathione production. OTC may protect the liver by accelerating hepatic glutathione turnover, but further studies are needed to explain its mechanism of action.
Randomized controlled trial of appendicectomy versus antibiotic therapy for acute appendicitis
(Blackwell Science, 1995) Eriksson, Staffan A. V.; Granström, Lars; Özgüç, Halil; İrgil, Ceyhun; Kaya, Ekrem; Tokyay, Rifat; Uludağ Üniversitesi/Tıp Fakültesi/Acil Servis ve Travma Merkezi.
I was interested to read the article on surgical technique by Dr Di Saverio and colleagues (Br J Surg 1993; 80: 873) concerning the use of an adjustable sliding knot for securing subcuticular running sutures. This article suggested several applications for such a knot, and I would like to suggest another possible use. The technique involves using the spare length of suture to tie a sliding knot by means of two half hitches on to the end of the subcuticular suture protruding from the skin. The knot is slid to acquire the correct tension and then secured by a further knot to the protruding length. I have found this knot to be particularly useful in securing the subcuticular suture involved in Bascom’s repair for pilonidal sinus. I found acquiring the correct tension for closing the wound after ‘picking out the pits’ to be difficult with other knots. Beads and sliding buttons are to be avoided in the natal cleft.