Prof. Dr. Zeliha Özer | TC. Maltepe University (original) (raw)

Papers by Prof. Dr. Zeliha Özer

Journal of Clinical Anesthesia, 2019

European Journal of Anaesthesiology, 2006

Background and objective: Levosimendan has a cardioprotective action by inducing coronary vasodil... more Background and objective: Levosimendan has a cardioprotective action by inducing coronary vasodilatation and preconditioning by opening K ATP channels. The aim of this study was to determine whether levosimendan enhances myocardial damage during hypothermic ischaemia and reperfusion in isolated rat hearts. Methods: Twenty-one male Wistar rats were divided into three groups. After surgical preparation, coronary circulation was started by retrograde aortic perfusion using Krebs-Henseleit buffer solution and lasted 15 min. After perfusion Group 1 (control; n 5 7) received no further treatment. In Group 2 (non-treated; n 5 7), hearts were arrested with cold cardioplegic solution after perfusion and subjected to 60 min of hypothermic global ischaemia followed by 30 min reperfusion. In Group 3 (levosimendan treated; n 5 7), levosimendan was added to the buffer solution during perfusion and the hearts were arrested with cold cardioplegic solution and subjected to 60 min of hypothermic global ischaemia followed by 30 min reperfusion. At the end of the reperfusion period, the hearts were prepared for biochemical assays and for histological analysis. Results: Tissue malondialdehyde levels were significantly lower in the levosimendan-treated group than in the non-treated group (P 5 0.019). The tissue Na 1 -K 1 ATPase activity was significantly decreased in the non-treated group than in the levosimendan-treated group (P 5 0.027). Tissue myeloperoxidase (MPO) enzyme activity was significantly higher in the non-treated group than in the levosimendan-treated group (P 5 0.004). Electron microscopic examination of the hearts showed cardiomyocytic degeneration at the myofibril, mitochondria and sarcoplasmic reticulum in both non-treated and levosimendan-treated groups. The severity of these findings was more extensive in the non-treated group. Conclusions: Treatment with levosimendan provided better cardioprotection with cold cardioplegic arrest followed by global hypothermic ischaemia in isolated rat hearts.

European Journal of Anaesthesiology, 2008

Background and objective: Levosimendan has a cardioprotective action by inducing coronary vasodil... more Background and objective: Levosimendan has a cardioprotective action by inducing coronary vasodilatation and preconditioning by opening K ATP channels. The aim of this study was to determine whether levosimendan enhances myocardial damage during hypothermic ischaemia and reperfusion in isolated rat hearts. Methods: Twenty-one male Wistar rats were divided into three groups. After surgical preparation, coronary circulation was started by retrograde aortic perfusion using Krebs-Henseleit buffer solution and lasted 15 min. After perfusion Group 1 (control; n 5 7) received no further treatment. In Group 2 (non-treated; n 5 7), hearts were arrested with cold cardioplegic solution after perfusion and subjected to 60 min of hypothermic global ischaemia followed by 30 min reperfusion. In Group 3 (levosimendan treated; n 5 7), levosimendan was added to the buffer solution during perfusion and the hearts were arrested with cold cardioplegic solution and subjected to 60 min of hypothermic global ischaemia followed by 30 min reperfusion. At the end of the reperfusion period, the hearts were prepared for biochemical assays and for histological analysis. Results: Tissue malondialdehyde levels were significantly lower in the levosimendan-treated group than in the non-treated group (P 5 0.019). The tissue Na 1 -K 1 ATPase activity was significantly decreased in the non-treated group than in the levosimendan-treated group (P 5 0.027). Tissue myeloperoxidase (MPO) enzyme activity was significantly higher in the non-treated group than in the levosimendan-treated group (P 5 0.004). Electron microscopic examination of the hearts showed cardiomyocytic degeneration at the myofibril, mitochondria and sarcoplasmic reticulum in both non-treated and levosimendan-treated groups. The severity of these findings was more extensive in the non-treated group. Conclusions: Treatment with levosimendan provided better cardioprotection with cold cardioplegic arrest followed by global hypothermic ischaemia in isolated rat hearts.

European Journal of Anaesthesiology, 2005

European Journal of Anaesthesiology, 2006

European Journal of Anaesthesiology, 2005

Intrathecal morphine has been used in hopes of providing long-lasting postoperative analgesia in ... more Intrathecal morphine has been used in hopes of providing long-lasting postoperative analgesia in patients after cardiac surgery. The aim of this study was to evaluate the effects of 7 micro/kg intrathecal morphine administration in coronary bypass surgery in the postoperative period. We conducted a prospective, randomized, blinded, and controlled study. Twenty-three patients, who underwent primary elective coronary bypass surgery, were randomly allocated to receive morphine 7 micro/kg intrathecally, before the induction of general anesthesia (Group M, n = 12) or no intrathecal injection (Group C, n = 11). Pain scores, determined by visual analogue scale (VAS), were recorded immediately after extubation upon admission to the intensive care unit (ICU), at the 2nd, 4th, 6th, and 18th hour after extubation. Pethidine was administered if the patient's VAS > or = 4 and consumption was recorded. Extubation time and ICU length of stay were also recorded. VAS scores were lower in the Group M at each measured time than the control group (p = 0.016, 0.023, 0.004, 0.0001, and 0.001, respectively). According to the VAS scores, pethidine requirement was lower in the Group M than the control (p = 0.001). Extubation time (3.58 +/- 1.57 vs. 4.86 +/- 1.38 hours, p = 0.045) and ICU length of stay (16.25 +/- 2.70 vs. 19.30 +/- 2.45 hours, p = 0.014) were also significantly shorter in the Group M than the control group. No significant complications were seen in this group of patients. Intrathecal morphine provided effective analgesia, earlier tracheal extubation and less ICU length stay after on-pump coronary bypass surgery. The influence on ICU length of stay requires further evaluations.

Clinical Intensive Care, 2005

ABSTRACT Introduction and Objective. Paradoxical embolism through a patent foramen ovale (PFO) is... more ABSTRACT Introduction and Objective. Paradoxical embolism through a patent foramen ovale (PFO) is a frequent cause of cerebral embolim on young patients. In this report, we describe a young woman who presented with postpartum tonic clonic seizures after an uncomplicated labor. Case. A 28 years old woman who suffered unexplained neurological symptoms on 10th day of the postpartum period was admitted to the neurology clinic. Investigations demonstrated a previously unknown patent foramen ovale and paradoxical embolism was diagnosed as the cause of symptoms. The diagnosis was based on established criteria and the failure to identify an arterial or cardiac embolic source. Discussion and Conclusion. Paradoxical cerebral embolisation only occurs in patients with a shunt and it is a severe complication that causes high morbidity and mortality.

Clinical Intensive Care, 2005

ABSTRACT Introduction and Objective. Paradoxical embolism through a patent foramen ovale (PFO) is... more ABSTRACT Introduction and Objective. Paradoxical embolism through a patent foramen ovale (PFO) is a frequent cause of cerebral embolim on young patients. In this report, we describe a young woman who presented with postpartum tonic clonic seizures after an uncomplicated labor. Case. A 28 years old woman who suffered unexplained neurological symptoms on 10th day of the postpartum period was admitted to the neurology clinic. Investigations demonstrated a previously unknown patent foramen ovale and paradoxical embolism was diagnosed as the cause of symptoms. The diagnosis was based on established criteria and the failure to identify an arterial or cardiac embolic source. Discussion and Conclusion. Paradoxical cerebral embolisation only occurs in patients with a shunt and it is a severe complication that causes high morbidity and mortality.

Journal of Cardiac Surgery, 2008

Background: Intrathecal morphine has been used in hopes of providing long-lasting postoperative a... more Background: Intrathecal morphine has been used in hopes of providing long-lasting postoperative analgesia in patients after cardiac surgery. The aim of this study was to evaluate the effects of 7 µ/kg intrathecal morphine administration in coronary bypass surgery in the postoperative period. Methods: We conducted a prospective, randomized, blinded, and controlled study. Twenty-three patients, who underwent primary elective coronary bypass surgery, were randomly allocated to receive morphine 7 µ/kg intrathecally, before the induction of general anesthesia (Group M, n = 12) or no intrathecal injection (Group C, n = 11). Pain scores, determined by visual analogue scale (VAS), were recorded immediately after extubation upon admission to the intensive care unit (ICU), at the 2nd, 4th, 6th, and 18th hour after extubation. Pethidine was administered if the patient's VAS ≥ 4 and consumption was recorded. Extubation time and ICU length of stay were also recorded. Results: VAS scores were lower in the Group M at each measured time than the control . According to the VAS scores, pethidine requirement was lower in the Group M than the control (p = 0.001). Extubation time (3.58 ± 1.57 vs. 4.86 ± 1.38 hours, p = 0.045) and ICU length of stay (16.25 ± 2.70 vs. 19.30 ± 2.45 hours, p = 0.014) were also significantly shorter in the Group M than the control group. No significant complications were seen in this group of patients. Conclusions: Intrathecal morphine provided effective analgesia, earlier tracheal extubation and less ICU length stay after on-pump coronary bypass surgery. The influence on ICU length of stay requires further evaluations.

Neurosurgery Quarterly, 2005

Glutamate neurotoxicity has been implicated in the pathophysiology of cerebral ischemia-reperfusi... more Glutamate neurotoxicity has been implicated in the pathophysiology of cerebral ischemia-reperfusion injury. Therefore, we investigated the effect of glutamate receptor antagonist riluzole in a rabbit model of warm cerebral ischemia-reperfusion. A total of 16 New Zealand rabbits were randomly assigned to one of three groups: Riluzole group (n = 6), which received riluzole (8 mg/kg), control group (n = 5), which received only vehicle before ischemic period, and sham group (n = 5), which had the same operation but did not undergo clamping. To induce warm cerebral ischemia the left carotid artery was occluded for 15 minutes and then reperfusion was allowed. The rabbits were killed after 4 hours of reperfusion. The brain slices were harvested for immunohistochemical examination of platelet endothelial cell adhesion molecule (PECAM) expression and blood samples were taken for measurement of serum superoxide dismutase (SOD), catalase, myeloperoxidase (MPO) and malondialdehyde (MDA) levels. The results indicated that riluzole treatment reduced the relative levels of malondialdehyde and myeloperoxidase and increased SOD levels (P , 0.001). No statistically important difference was determined between riluzole and sham group with respect to these results. We did not find any significant difference in catalase levels among three groups. Immunohistochemical examination showed significant decrease of PECAM expression in riluzole treated animals (P , 0.05). Our findings suggested that riluzole may protect brain in a setting of severe ischemia-reperfusion injury and therefore, be considered for clinical usage.

Objective To examine the effects of short-term cyclic stretch on apoptosis in alveolar type II ce... more Objective To examine the effects of short-term cyclic stretch on apoptosis in alveolar type II cells (A549). To study in vitro the direct influence of alveolar type II cells on mechanical stretch. Methods A549 were treated with different doses of lipopolysaccharide (LPS), 0 ng/ml, 1 ng/ml, 10 ng/ml, 100 ng/ml, 1000 ng/ml, and then A549 were lengthened 5%, 15%, 30% using a FLEXCELL tension unit 4000, a vacuum-driven device that applies strain to cells, which were cultured in six-well plates coated with collagen-I, and 12 cycles/min for 4 hours. Apoptosis was measured using the flow cytometry method that measures annexin V and propidium iodide (PI) staining. The morphological changes of apoptotic cells were observed by transmission electron microscope. Results Apoptosis could be induced in alveolar type II cells (A549) by mechanical stretch. The percentage of annexin V + PI cells increased after being treated with cyclic stretch for 4 hours by 5%, 15%, 30% in all groups. The morphological features of apoptotic cells demonstrated by transmission electron microscope were as follows: shrinkage of the cell, chromatin condensation and aggregation under the nuclear membrane as a crescent or lump, membrane-encapsulated nuclear fragment or cell organ formed by invagination of the cell membrane, and apoptotic body formation followed by vacuolization. Conclusion Apoptosis induced by mechanical stretch and LPS is dose dependent. Mechanical stretch aggravates apoptosis especially in cells treated with LPS. Annexin V and PI double staining is a specific, sensitive, and quantitative method for analyzing apoptotic cells. It is also helpful to clarify the protective mechanism of low-volume ventilation in ARDS. PaO 2 /FiO 2 430 [421; 440] # 380 [349; 397] 165 [68; 289] # C (ml/cmH 2 O) 28 [24; 32]* 18 [16; 21]* 12 [8; 17]* R i (cmH 2 O/l/s) 4.1 [3.9; 4.5] 4.5 [4.3; 5.1] 5.1 [3.7; 7.9] # P < 0.05 control vs 24-hour peritonitis, *P < 0.05 control vs 12-hour and 24-hour peritonitis.

Toxicology and Industrial Health, 2005

The purpose of this study was to evaluate the impact of the Glasgow Coma Scale (GCS), Acute Physi... more The purpose of this study was to evaluate the impact of the Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation (APACHE) II and Simplified Acute Physiology Score (SAPS) II scoring systems for organophosphate poisoning (OPP) in an intensive care unit (ICU). The following data were collected on all consecutive patients who were admitted to the ICU between June 1999 and December 2004. Demographic data, GCS, APACHE II and SAPS II scoring systems were recorded. Predicted mortality was calculated using original regression formulas. Standardized mortality ratio (SMR) was computed with 95% confidence intervals (CI). The sensitivity and specificity for each scoring system were evaluated by calculating the Area Under the Receiver Operating Characteristic Curves. The actual mortality in OPP was 21.9%. Predicted mortality by all systems was not significantly different from actual mortality [SMR and 95% CI for GCS: 1.00 (0.65 Á/ 1.35), APACHE II: 0.87 (0.54Á/1.03), SAPS II: 1.40 (0.98 Á/1.82)]. The area under the ROC curve for APACHE II is largest, but there is no statistically significant difference when compared with SAPS II and GCS (GCS 0.9009/0.059, APACHE II 0.9299/0.045 and SAPS II 0.8919/0.057). In our ICU group of patients, in predicting the mortality rates in OPP, the three scoring systems, which are GCS, APACHE II and SAPS II, had similar impacts; however, GCS system has superiority over the other systems in being easy to perform, and not requiring complex physiologic parameters and laboratory methods. Toxicology and Industrial Health 2005; 21: 141Á/146.

Clinical Intensive Care, 2005

ABSTRACT Introduction and Objective. Paradoxical embolism through a patent foramen ovale (PFO) is... more ABSTRACT Introduction and Objective. Paradoxical embolism through a patent foramen ovale (PFO) is a frequent cause of cerebral embolim on young patients. In this report, we describe a young woman who presented with postpartum tonic clonic seizures after an uncomplicated labor. Case. A 28 years old woman who suffered unexplained neurological symptoms on 10th day of the postpartum period was admitted to the neurology clinic. Investigations demonstrated a previously unknown patent foramen ovale and paradoxical embolism was diagnosed as the cause of symptoms. The diagnosis was based on established criteria and the failure to identify an arterial or cardiac embolic source. Discussion and Conclusion. Paradoxical cerebral embolisation only occurs in patients with a shunt and it is a severe complication that causes high morbidity and mortality.

European Journal of Anaesthesiology, 2006

Toxicology and Industrial Health, 2005

The purpose of this study was to evaluate the impact of the Glasgow Coma Scale (GCS), Acute Physi... more The purpose of this study was to evaluate the impact of the Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation (APACHE) II and Simplified Acute Physiology Score (SAPS) II scoring systems for organophosphate poisoning (OPP) in an intensive care unit (ICU). The following data were collected on all consecutive patients who were admitted to the ICU between June 1999 and December 2004. Demographic data, GCS, APACHE II and SAPS II scoring systems were recorded. Predicted mortality was calculated using original regression formulas. Standardized mortality ratio (SMR) was computed with 95% confidence intervals (CI). The sensitivity and specificity for each scoring system were evaluated by calculating the Area Under the Receiver Operating Characteristic Curves. The actual mortality in OPP was 21.9%. Predicted mortality by all systems was not significantly different from actual mortality [SMR and 95% CI for GCS: 1.00 (0.65 Á/ 1.35), APACHE II: 0.87 (0.54Á/1.03), SAPS II: 1.40 (0.98 Á/1.82)]. The area under the ROC curve for APACHE II is largest, but there is no statistically significant difference when compared with SAPS II and GCS (GCS 0.9009/0.059, APACHE II 0.9299/0.045 and SAPS II 0.8919/0.057). In our ICU group of patients, in predicting the mortality rates in OPP, the three scoring systems, which are GCS, APACHE II and SAPS II, had similar impacts; however, GCS system has superiority over the other systems in being easy to perform, and not requiring complex physiologic parameters and laboratory methods. Toxicology and Industrial Health 2005; 21: 141Á/146.

European Journal of Anaesthesiology, 2006

European Journal of Anaesthesiology, 2006

Background and objective: Levosimendan has a cardioprotective action by inducing coronary vasodil... more Background and objective: Levosimendan has a cardioprotective action by inducing coronary vasodilatation and preconditioning by opening K ATP channels. The aim of this study was to determine whether levosimendan enhances myocardial damage during hypothermic ischaemia and reperfusion in isolated rat hearts. Methods: Twenty-one male Wistar rats were divided into three groups. After surgical preparation, coronary circulation was started by retrograde aortic perfusion using Krebs-Henseleit buffer solution and lasted 15 min. After perfusion Group 1 (control; n 5 7) received no further treatment. In Group 2 (non-treated; n 5 7), hearts were arrested with cold cardioplegic solution after perfusion and subjected to 60 min of hypothermic global ischaemia followed by 30 min reperfusion. In Group 3 (levosimendan treated; n 5 7), levosimendan was added to the buffer solution during perfusion and the hearts were arrested with cold cardioplegic solution and subjected to 60 min of hypothermic global ischaemia followed by 30 min reperfusion. At the end of the reperfusion period, the hearts were prepared for biochemical assays and for histological analysis. Results: Tissue malondialdehyde levels were significantly lower in the levosimendan-treated group than in the non-treated group (P 5 0.019). The tissue Na 1 -K 1 ATPase activity was significantly decreased in the non-treated group than in the levosimendan-treated group (P 5 0.027). Tissue myeloperoxidase (MPO) enzyme activity was significantly higher in the non-treated group than in the levosimendan-treated group (P 5 0.004). Electron microscopic examination of the hearts showed cardiomyocytic degeneration at the myofibril, mitochondria and sarcoplasmic reticulum in both non-treated and levosimendan-treated groups. The severity of these findings was more extensive in the non-treated group. Conclusions: Treatment with levosimendan provided better cardioprotection with cold cardioplegic arrest followed by global hypothermic ischaemia in isolated rat hearts.

Journal of Clinical Anesthesia, 2019

European Journal of Anaesthesiology, 2006

Background and objective: Levosimendan has a cardioprotective action by inducing coronary vasodil... more Background and objective: Levosimendan has a cardioprotective action by inducing coronary vasodilatation and preconditioning by opening K ATP channels. The aim of this study was to determine whether levosimendan enhances myocardial damage during hypothermic ischaemia and reperfusion in isolated rat hearts. Methods: Twenty-one male Wistar rats were divided into three groups. After surgical preparation, coronary circulation was started by retrograde aortic perfusion using Krebs-Henseleit buffer solution and lasted 15 min. After perfusion Group 1 (control; n 5 7) received no further treatment. In Group 2 (non-treated; n 5 7), hearts were arrested with cold cardioplegic solution after perfusion and subjected to 60 min of hypothermic global ischaemia followed by 30 min reperfusion. In Group 3 (levosimendan treated; n 5 7), levosimendan was added to the buffer solution during perfusion and the hearts were arrested with cold cardioplegic solution and subjected to 60 min of hypothermic global ischaemia followed by 30 min reperfusion. At the end of the reperfusion period, the hearts were prepared for biochemical assays and for histological analysis. Results: Tissue malondialdehyde levels were significantly lower in the levosimendan-treated group than in the non-treated group (P 5 0.019). The tissue Na 1 -K 1 ATPase activity was significantly decreased in the non-treated group than in the levosimendan-treated group (P 5 0.027). Tissue myeloperoxidase (MPO) enzyme activity was significantly higher in the non-treated group than in the levosimendan-treated group (P 5 0.004). Electron microscopic examination of the hearts showed cardiomyocytic degeneration at the myofibril, mitochondria and sarcoplasmic reticulum in both non-treated and levosimendan-treated groups. The severity of these findings was more extensive in the non-treated group. Conclusions: Treatment with levosimendan provided better cardioprotection with cold cardioplegic arrest followed by global hypothermic ischaemia in isolated rat hearts.

European Journal of Anaesthesiology, 2008

Background and objective: Levosimendan has a cardioprotective action by inducing coronary vasodil... more Background and objective: Levosimendan has a cardioprotective action by inducing coronary vasodilatation and preconditioning by opening K ATP channels. The aim of this study was to determine whether levosimendan enhances myocardial damage during hypothermic ischaemia and reperfusion in isolated rat hearts. Methods: Twenty-one male Wistar rats were divided into three groups. After surgical preparation, coronary circulation was started by retrograde aortic perfusion using Krebs-Henseleit buffer solution and lasted 15 min. After perfusion Group 1 (control; n 5 7) received no further treatment. In Group 2 (non-treated; n 5 7), hearts were arrested with cold cardioplegic solution after perfusion and subjected to 60 min of hypothermic global ischaemia followed by 30 min reperfusion. In Group 3 (levosimendan treated; n 5 7), levosimendan was added to the buffer solution during perfusion and the hearts were arrested with cold cardioplegic solution and subjected to 60 min of hypothermic global ischaemia followed by 30 min reperfusion. At the end of the reperfusion period, the hearts were prepared for biochemical assays and for histological analysis. Results: Tissue malondialdehyde levels were significantly lower in the levosimendan-treated group than in the non-treated group (P 5 0.019). The tissue Na 1 -K 1 ATPase activity was significantly decreased in the non-treated group than in the levosimendan-treated group (P 5 0.027). Tissue myeloperoxidase (MPO) enzyme activity was significantly higher in the non-treated group than in the levosimendan-treated group (P 5 0.004). Electron microscopic examination of the hearts showed cardiomyocytic degeneration at the myofibril, mitochondria and sarcoplasmic reticulum in both non-treated and levosimendan-treated groups. The severity of these findings was more extensive in the non-treated group. Conclusions: Treatment with levosimendan provided better cardioprotection with cold cardioplegic arrest followed by global hypothermic ischaemia in isolated rat hearts.

European Journal of Anaesthesiology, 2005

European Journal of Anaesthesiology, 2006

European Journal of Anaesthesiology, 2005

Intrathecal morphine has been used in hopes of providing long-lasting postoperative analgesia in ... more Intrathecal morphine has been used in hopes of providing long-lasting postoperative analgesia in patients after cardiac surgery. The aim of this study was to evaluate the effects of 7 micro/kg intrathecal morphine administration in coronary bypass surgery in the postoperative period. We conducted a prospective, randomized, blinded, and controlled study. Twenty-three patients, who underwent primary elective coronary bypass surgery, were randomly allocated to receive morphine 7 micro/kg intrathecally, before the induction of general anesthesia (Group M, n = 12) or no intrathecal injection (Group C, n = 11). Pain scores, determined by visual analogue scale (VAS), were recorded immediately after extubation upon admission to the intensive care unit (ICU), at the 2nd, 4th, 6th, and 18th hour after extubation. Pethidine was administered if the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s VAS &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 4 and consumption was recorded. Extubation time and ICU length of stay were also recorded. VAS scores were lower in the Group M at each measured time than the control group (p = 0.016, 0.023, 0.004, 0.0001, and 0.001, respectively). According to the VAS scores, pethidine requirement was lower in the Group M than the control (p = 0.001). Extubation time (3.58 +/- 1.57 vs. 4.86 +/- 1.38 hours, p = 0.045) and ICU length of stay (16.25 +/- 2.70 vs. 19.30 +/- 2.45 hours, p = 0.014) were also significantly shorter in the Group M than the control group. No significant complications were seen in this group of patients. Intrathecal morphine provided effective analgesia, earlier tracheal extubation and less ICU length stay after on-pump coronary bypass surgery. The influence on ICU length of stay requires further evaluations.

Clinical Intensive Care, 2005

ABSTRACT Introduction and Objective. Paradoxical embolism through a patent foramen ovale (PFO) is... more ABSTRACT Introduction and Objective. Paradoxical embolism through a patent foramen ovale (PFO) is a frequent cause of cerebral embolim on young patients. In this report, we describe a young woman who presented with postpartum tonic clonic seizures after an uncomplicated labor. Case. A 28 years old woman who suffered unexplained neurological symptoms on 10th day of the postpartum period was admitted to the neurology clinic. Investigations demonstrated a previously unknown patent foramen ovale and paradoxical embolism was diagnosed as the cause of symptoms. The diagnosis was based on established criteria and the failure to identify an arterial or cardiac embolic source. Discussion and Conclusion. Paradoxical cerebral embolisation only occurs in patients with a shunt and it is a severe complication that causes high morbidity and mortality.

Clinical Intensive Care, 2005

ABSTRACT Introduction and Objective. Paradoxical embolism through a patent foramen ovale (PFO) is... more ABSTRACT Introduction and Objective. Paradoxical embolism through a patent foramen ovale (PFO) is a frequent cause of cerebral embolim on young patients. In this report, we describe a young woman who presented with postpartum tonic clonic seizures after an uncomplicated labor. Case. A 28 years old woman who suffered unexplained neurological symptoms on 10th day of the postpartum period was admitted to the neurology clinic. Investigations demonstrated a previously unknown patent foramen ovale and paradoxical embolism was diagnosed as the cause of symptoms. The diagnosis was based on established criteria and the failure to identify an arterial or cardiac embolic source. Discussion and Conclusion. Paradoxical cerebral embolisation only occurs in patients with a shunt and it is a severe complication that causes high morbidity and mortality.

Journal of Cardiac Surgery, 2008

Background: Intrathecal morphine has been used in hopes of providing long-lasting postoperative a... more Background: Intrathecal morphine has been used in hopes of providing long-lasting postoperative analgesia in patients after cardiac surgery. The aim of this study was to evaluate the effects of 7 µ/kg intrathecal morphine administration in coronary bypass surgery in the postoperative period. Methods: We conducted a prospective, randomized, blinded, and controlled study. Twenty-three patients, who underwent primary elective coronary bypass surgery, were randomly allocated to receive morphine 7 µ/kg intrathecally, before the induction of general anesthesia (Group M, n = 12) or no intrathecal injection (Group C, n = 11). Pain scores, determined by visual analogue scale (VAS), were recorded immediately after extubation upon admission to the intensive care unit (ICU), at the 2nd, 4th, 6th, and 18th hour after extubation. Pethidine was administered if the patient's VAS ≥ 4 and consumption was recorded. Extubation time and ICU length of stay were also recorded. Results: VAS scores were lower in the Group M at each measured time than the control . According to the VAS scores, pethidine requirement was lower in the Group M than the control (p = 0.001). Extubation time (3.58 ± 1.57 vs. 4.86 ± 1.38 hours, p = 0.045) and ICU length of stay (16.25 ± 2.70 vs. 19.30 ± 2.45 hours, p = 0.014) were also significantly shorter in the Group M than the control group. No significant complications were seen in this group of patients. Conclusions: Intrathecal morphine provided effective analgesia, earlier tracheal extubation and less ICU length stay after on-pump coronary bypass surgery. The influence on ICU length of stay requires further evaluations.

Neurosurgery Quarterly, 2005

Glutamate neurotoxicity has been implicated in the pathophysiology of cerebral ischemia-reperfusi... more Glutamate neurotoxicity has been implicated in the pathophysiology of cerebral ischemia-reperfusion injury. Therefore, we investigated the effect of glutamate receptor antagonist riluzole in a rabbit model of warm cerebral ischemia-reperfusion. A total of 16 New Zealand rabbits were randomly assigned to one of three groups: Riluzole group (n = 6), which received riluzole (8 mg/kg), control group (n = 5), which received only vehicle before ischemic period, and sham group (n = 5), which had the same operation but did not undergo clamping. To induce warm cerebral ischemia the left carotid artery was occluded for 15 minutes and then reperfusion was allowed. The rabbits were killed after 4 hours of reperfusion. The brain slices were harvested for immunohistochemical examination of platelet endothelial cell adhesion molecule (PECAM) expression and blood samples were taken for measurement of serum superoxide dismutase (SOD), catalase, myeloperoxidase (MPO) and malondialdehyde (MDA) levels. The results indicated that riluzole treatment reduced the relative levels of malondialdehyde and myeloperoxidase and increased SOD levels (P , 0.001). No statistically important difference was determined between riluzole and sham group with respect to these results. We did not find any significant difference in catalase levels among three groups. Immunohistochemical examination showed significant decrease of PECAM expression in riluzole treated animals (P , 0.05). Our findings suggested that riluzole may protect brain in a setting of severe ischemia-reperfusion injury and therefore, be considered for clinical usage.

Objective To examine the effects of short-term cyclic stretch on apoptosis in alveolar type II ce... more Objective To examine the effects of short-term cyclic stretch on apoptosis in alveolar type II cells (A549). To study in vitro the direct influence of alveolar type II cells on mechanical stretch. Methods A549 were treated with different doses of lipopolysaccharide (LPS), 0 ng/ml, 1 ng/ml, 10 ng/ml, 100 ng/ml, 1000 ng/ml, and then A549 were lengthened 5%, 15%, 30% using a FLEXCELL tension unit 4000, a vacuum-driven device that applies strain to cells, which were cultured in six-well plates coated with collagen-I, and 12 cycles/min for 4 hours. Apoptosis was measured using the flow cytometry method that measures annexin V and propidium iodide (PI) staining. The morphological changes of apoptotic cells were observed by transmission electron microscope. Results Apoptosis could be induced in alveolar type II cells (A549) by mechanical stretch. The percentage of annexin V + PI cells increased after being treated with cyclic stretch for 4 hours by 5%, 15%, 30% in all groups. The morphological features of apoptotic cells demonstrated by transmission electron microscope were as follows: shrinkage of the cell, chromatin condensation and aggregation under the nuclear membrane as a crescent or lump, membrane-encapsulated nuclear fragment or cell organ formed by invagination of the cell membrane, and apoptotic body formation followed by vacuolization. Conclusion Apoptosis induced by mechanical stretch and LPS is dose dependent. Mechanical stretch aggravates apoptosis especially in cells treated with LPS. Annexin V and PI double staining is a specific, sensitive, and quantitative method for analyzing apoptotic cells. It is also helpful to clarify the protective mechanism of low-volume ventilation in ARDS. PaO 2 /FiO 2 430 [421; 440] # 380 [349; 397] 165 [68; 289] # C (ml/cmH 2 O) 28 [24; 32]* 18 [16; 21]* 12 [8; 17]* R i (cmH 2 O/l/s) 4.1 [3.9; 4.5] 4.5 [4.3; 5.1] 5.1 [3.7; 7.9] # P < 0.05 control vs 24-hour peritonitis, *P < 0.05 control vs 12-hour and 24-hour peritonitis.

Toxicology and Industrial Health, 2005

The purpose of this study was to evaluate the impact of the Glasgow Coma Scale (GCS), Acute Physi... more The purpose of this study was to evaluate the impact of the Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation (APACHE) II and Simplified Acute Physiology Score (SAPS) II scoring systems for organophosphate poisoning (OPP) in an intensive care unit (ICU). The following data were collected on all consecutive patients who were admitted to the ICU between June 1999 and December 2004. Demographic data, GCS, APACHE II and SAPS II scoring systems were recorded. Predicted mortality was calculated using original regression formulas. Standardized mortality ratio (SMR) was computed with 95% confidence intervals (CI). The sensitivity and specificity for each scoring system were evaluated by calculating the Area Under the Receiver Operating Characteristic Curves. The actual mortality in OPP was 21.9%. Predicted mortality by all systems was not significantly different from actual mortality [SMR and 95% CI for GCS: 1.00 (0.65 Á/ 1.35), APACHE II: 0.87 (0.54Á/1.03), SAPS II: 1.40 (0.98 Á/1.82)]. The area under the ROC curve for APACHE II is largest, but there is no statistically significant difference when compared with SAPS II and GCS (GCS 0.9009/0.059, APACHE II 0.9299/0.045 and SAPS II 0.8919/0.057). In our ICU group of patients, in predicting the mortality rates in OPP, the three scoring systems, which are GCS, APACHE II and SAPS II, had similar impacts; however, GCS system has superiority over the other systems in being easy to perform, and not requiring complex physiologic parameters and laboratory methods. Toxicology and Industrial Health 2005; 21: 141Á/146.

Clinical Intensive Care, 2005

ABSTRACT Introduction and Objective. Paradoxical embolism through a patent foramen ovale (PFO) is... more ABSTRACT Introduction and Objective. Paradoxical embolism through a patent foramen ovale (PFO) is a frequent cause of cerebral embolim on young patients. In this report, we describe a young woman who presented with postpartum tonic clonic seizures after an uncomplicated labor. Case. A 28 years old woman who suffered unexplained neurological symptoms on 10th day of the postpartum period was admitted to the neurology clinic. Investigations demonstrated a previously unknown patent foramen ovale and paradoxical embolism was diagnosed as the cause of symptoms. The diagnosis was based on established criteria and the failure to identify an arterial or cardiac embolic source. Discussion and Conclusion. Paradoxical cerebral embolisation only occurs in patients with a shunt and it is a severe complication that causes high morbidity and mortality.

European Journal of Anaesthesiology, 2006

Toxicology and Industrial Health, 2005

The purpose of this study was to evaluate the impact of the Glasgow Coma Scale (GCS), Acute Physi... more The purpose of this study was to evaluate the impact of the Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation (APACHE) II and Simplified Acute Physiology Score (SAPS) II scoring systems for organophosphate poisoning (OPP) in an intensive care unit (ICU). The following data were collected on all consecutive patients who were admitted to the ICU between June 1999 and December 2004. Demographic data, GCS, APACHE II and SAPS II scoring systems were recorded. Predicted mortality was calculated using original regression formulas. Standardized mortality ratio (SMR) was computed with 95% confidence intervals (CI). The sensitivity and specificity for each scoring system were evaluated by calculating the Area Under the Receiver Operating Characteristic Curves. The actual mortality in OPP was 21.9%. Predicted mortality by all systems was not significantly different from actual mortality [SMR and 95% CI for GCS: 1.00 (0.65 Á/ 1.35), APACHE II: 0.87 (0.54Á/1.03), SAPS II: 1.40 (0.98 Á/1.82)]. The area under the ROC curve for APACHE II is largest, but there is no statistically significant difference when compared with SAPS II and GCS (GCS 0.9009/0.059, APACHE II 0.9299/0.045 and SAPS II 0.8919/0.057). In our ICU group of patients, in predicting the mortality rates in OPP, the three scoring systems, which are GCS, APACHE II and SAPS II, had similar impacts; however, GCS system has superiority over the other systems in being easy to perform, and not requiring complex physiologic parameters and laboratory methods. Toxicology and Industrial Health 2005; 21: 141Á/146.

European Journal of Anaesthesiology, 2006

European Journal of Anaesthesiology, 2006

Background and objective: Levosimendan has a cardioprotective action by inducing coronary vasodil... more Background and objective: Levosimendan has a cardioprotective action by inducing coronary vasodilatation and preconditioning by opening K ATP channels. The aim of this study was to determine whether levosimendan enhances myocardial damage during hypothermic ischaemia and reperfusion in isolated rat hearts. Methods: Twenty-one male Wistar rats were divided into three groups. After surgical preparation, coronary circulation was started by retrograde aortic perfusion using Krebs-Henseleit buffer solution and lasted 15 min. After perfusion Group 1 (control; n 5 7) received no further treatment. In Group 2 (non-treated; n 5 7), hearts were arrested with cold cardioplegic solution after perfusion and subjected to 60 min of hypothermic global ischaemia followed by 30 min reperfusion. In Group 3 (levosimendan treated; n 5 7), levosimendan was added to the buffer solution during perfusion and the hearts were arrested with cold cardioplegic solution and subjected to 60 min of hypothermic global ischaemia followed by 30 min reperfusion. At the end of the reperfusion period, the hearts were prepared for biochemical assays and for histological analysis. Results: Tissue malondialdehyde levels were significantly lower in the levosimendan-treated group than in the non-treated group (P 5 0.019). The tissue Na 1 -K 1 ATPase activity was significantly decreased in the non-treated group than in the levosimendan-treated group (P 5 0.027). Tissue myeloperoxidase (MPO) enzyme activity was significantly higher in the non-treated group than in the levosimendan-treated group (P 5 0.004). Electron microscopic examination of the hearts showed cardiomyocytic degeneration at the myofibril, mitochondria and sarcoplasmic reticulum in both non-treated and levosimendan-treated groups. The severity of these findings was more extensive in the non-treated group. Conclusions: Treatment with levosimendan provided better cardioprotection with cold cardioplegic arrest followed by global hypothermic ischaemia in isolated rat hearts.