Arzu Gercek | Istanbul Medipol University (original) (raw)

Papers by Arzu Gercek

Journal of neurosurgical anesthesiology, 2005

Obstructive hydrocephalus remains a problem, and improvements in fiberoptic technology have promo... more Obstructive hydrocephalus remains a problem, and improvements in fiberoptic technology have promoted interest in neuroendoscopic ventriculostomy (NTV) as an alternative to standard cerebrospinal fluid shunts. The present study assessed 210 pediatric NTVs performed between 1994 and 2004 in patients aged 2 months to 10 years. Five children needed same-session ventriculoperitoneal shunting due to insufficient bypass of the obstruction. The other 205 procedures were technically successful, but 7 patients needed early-postoperative shunting and 10 required late shunting. During NTV, 86 (40.1%) of the patients developed arrhythmia. One patient arrested during balloon dilatation, but normal rhythm returned after deflation and epinephrine/atropine therapy, with no resultant morbidity. Twenty-six (10.2%) patients developed tachycardia (without hypertension) followed by bradycardia, and 6 children (2.8%) developed hypertension. In 1 case (0.5%), a branch of the basilar artery ruptured during ...

Journal of Neurosurgical Anesthesiology, 2004

Journal of Clinical Neuroscience, 2009

In children with spasticity, deep tendon reflexes are hyperactive and even stimulation of normal ... more In children with spasticity, deep tendon reflexes are hyperactive and even stimulation of normal dorsal rootlets can produce exaggerated full-strength, single-twitch responses in the muscles they innervate. This phenomenon is called the brisk hyperactive response (BHR). The aim of this study was to compare the efficacy of 2 volatile anesthetics, isoflurane and sevoflurane, for suppressing the confounding effect of BHR during selective dorsal rhizotomy (SDR) in children with spasticity. The subjects were 54 consecutive children of American Society of Anesthesiology physical status III who were scheduled for SDR. After tracheal intubation, each child was randomly assigned to Group I (isoflurane; n = 27) or Group S (sevoflurane; n = 27). There was no significant difference between the mean operation times in Groups I and S (200 ± 40 vs. 220 ± 35 minutes, respectively; p = 0.0559). Thirteen patients in Group I (48.1%) and 5 in Group S (18.5%) exhibited BHR during stimulation of the dorsal rootlets (odds ratio 4.086; p = 0.0418). Three of these 18 patients (2 in Group I and 1 in Group S) experienced hypertension and tachycardia simultaneously with BHR (odds ratio 4.086; p = 1.0). The results suggest that sevoflurane is more effective at preventing BHR and might be a better choice for anesthetic management of children with spasticity undergoing SDR.

A 37-year-old man was admitted to our clinic with sudden onset of severe headache and vomiting. F... more A 37-year-old man was admitted to our clinic with sudden onset of severe headache and vomiting. Fundoscopic ophthalmic examination revealed papiledema as a sign of increased intracranial pressure. Cranial magnetic resonance imaging revealed homogenous gadolinium, enhanced cystic lesion in the third ventricle and agenesis of the septum pellucidum. Transcallosal interhemispheric approach was performed and the cystic lesion was excised totally. Pathological diagnosis was a colloid cyst. After one-day in intensive care, the patient was discharged on postoperative day 4. His neurological examination was normal after a six-month follow-up. This report represents the second report of colloid cyst and septal agenesis, and a first report of treatment of the colloid cyst with this syndrome.

Marmara Medical Journal, 2003

Lymphatic complications are uncommon after spinal surgery. Thoracic duct injury is a rare complic... more Lymphatic complications are uncommon after spinal surgery. Thoracic duct injury is a rare complication of scoliosis surgery. Intensive care staff must be alert about complications, because early diagnosis is essential for treatment. To increase awareness of the surgeon and the intensive care staff about such a rare postoperative complication, we report a 5-year- old girl patient who developed a thoracic duct injury after correction of scoliosis. Key Words: Scoliosis, Complication; Lymphatic, Chylothorax.

Marmara Medical Journal, 2015

37 yasinda erkek hasta ani baslayan siddetli basagrisi ve kusma sikayetleri ile klinigimize basvu... more 37 yasinda erkek hasta ani baslayan siddetli basagrisi ve kusma sikayetleri ile klinigimize basvurdu. Gozdibi muayenesinde intrakraniyal basinc artisinin bir bulgusu olarak papilodem saptandi. Kraniyal magnetik rezonans goruntulemede 3. ventrikulde, gadolinyum tutan kistik lezyon ve septum agenezi saptandi. Transkollazal interhemisferik yaklasimla kist tamamen cikarildi. Patoloji olarak kolloid kist tanisi kondu. Yogun bakimda bir gun takip edilen hasta, postoperatif 4 gunde taburcu edildi. Altinci ayda yapilan kontrolunde norolojik muayenesi normal sinirlarda bulundu. Bu vaka literaturdeki 2. kolloid kist ve septal agenezis vakasi ve ilk intrakraniyal basinc artisi ile bulgu veren vaka sunumudur.

Marmara Medical Journal, 2006

Amac: Pituiter cerrahi adenomlarin tiplerine gore, farklilik gosteren morbiditeler nedeniyle ane... more Amac: Pituiter cerrahi adenomlarin tiplerine gore, farklilik gosteren morbiditeler nedeniyle anestezi doktoru icin yogun ugras gerektiren girisimlerdir. Bu calismanin amaci, transsfenoidal cerrahi sirasinda ortaya cikan komplikasyonlari anestezi doktorunun bakis acisiyla degerlendirmektir. Yontem: 1 Ocak 2002-1 Ocak 2006 tarihleri arasinda transsfenoidal hipofiz cerrahisi geciren ve ASA skoru I-II olan 82 hasta retrospektif olarak calismaya alindi. Her hasta icin; demografik ozellikler, havayolu saglanmasi, cerrahi sure, kardiyovaskuler ve elektrokardiyografik anormallikler, patolojik tani ve perioperatif donemde ortaya cikan komplikasyonlar kaydedildi. Bulgular: Anestezi induksiyonunu takiben 4 hastada medikal tedaviye cevap vermeyen agir bradikardi ve genis QRS kompleksin eslik ettigi ventrikuler premature atimlar goruldu. Uc hasta entubasyon sirasinda problem yasadi. Oniki hastada ise submukozal enjeksiyon sonrasinda hipertansif yanit gozlendi. Erken postoperatif donemde 2 has...

4 Acibadem Universitesi Tip Fakultesi, Norosirurji Anabilim Dali, Istanbul 4 Benign intracranial ... more 4 Acibadem Universitesi Tip Fakultesi, Norosirurji Anabilim Dali, Istanbul 4 Benign intracranial hypertension may occasionally be associated with cranial nerve palsies. Abducens nerve palsies occur in 10 % to 20 % patients with benign intracranial hypertension, other cranial nerve palsies occur much less frequently. We reported a 25-year-old woman benign intrac- ranial hypertension with bilateral seventh nerve palsy. Complete improvement of her cranial nerve palsy was achieved with lumboperitoneal shunting within 14 days.

Objective: Pituitary surgery presents unique challenges for the anesthesiologist due to the disti... more Objective: Pituitary surgery presents unique challenges for the anesthesiologist due to the distinct medical co-morbidities associated with various adenomas. The aim of this study was to investigate the perioperative complications throughout the transsphenoidal pituitary surgery from the anesthesiologist’s perspective. Methods: Retrospectively, 82 ASA physical status I-II patients, who underwent transsphenoidal surgery between 1 Jan 2002-1 Jan 2006, were included in the study. The following general information was recorded for each patient: demographic data, airway management, cardiovascular and electrocardiographic abnormalities, duration of procedures, pituitary pathology, and any complications during the perioperative period. Results: After induction, four patients developed severe bradycardia and ventricular premature beats with bizarre QRS complex with hypotension, non-responsive to atropine and ephedrine. Three patients experienced intubation problems.In 12 patients, following...

Marmara Medical Journal, 2003

Objective: Hypokalemia, a frequent electrolyte imbalance encountered In the Intensive Care Unit (... more Objective: Hypokalemia, a frequent electrolyte imbalance encountered In the Intensive Care Unit (ICU), is an important cause of morbidity and mortality in critically ill patients. In this study the etiology and incidence of hypokalemia in critically ill patients was investigated retrospectively. Methods: The ICU records of 440 patients, followed up more than 2 days in surgical intensive care and reanimation unit between 01.01.1999 and 31.12.2000 were analysed retrospectively. When hypokalemia was first observed (K<3.5 meq/L) in patients, the coexisting pathologies such as hypothermia (axillary body temperature <36°C), dialysis, presence of diarrhea, vomiting and ketoacidosis, arterial pH values, type of nutrition, use of insulin, diuretics and beta adrenergic agents, presence of blood transfusions were recorded. The relationship between these data, age, type of surgery and hypokalemia was recorded. The data obtained were compared statistically with ANOVA, Fisher’s exact and Ch...

Kortikal stimulasyon sirasinda beynin hassas alanlarini haritalandirabilmek icin hasta bilincli v... more Kortikal stimulasyon sirasinda beynin hassas alanlarini haritalandirabilmek icin hasta bilincli ve konusur durumda olmalidir. Lokal anestezi altinda kraniyotomi yapilabilirse de, kemik flebin genel anestezi altinda kaldirilmasi hasta tarafindan daha iyi tolere edilir. Biz, dominant hemisfer- temporal veya pariyeto-oksipital lob cerrahisi geciren 4 yetiskin hastadaki tecrubelerimizi bildiriyoruz. Uyanik kortikal beyin haritalandirilmasi islemi sirasinda propofol-alfentanil infuzyonu ile laringeal maske kullanimi alternatif bir anestezik tekniktir. Anahtar Kelimeler: Kortikal haritalandirma stimulasyonu, kraniyotomi, laringeal maske, bilincli-sedasyon anestezisi

European Journal of Anaesthesiology, 2008

Here, we report a case of deep venous thrombosis in a 45-years-old female patient that had become... more Here, we report a case of deep venous thrombosis in a 45-years-old female patient that had become clinically symptomatic in the very early postoperative period of major spine surgery, at the postoperative hour 12. In addition, the factors that promote the formation of DVT so quickly have been discussed.

Journal of …, 2008

Aim of this study is to evaluate the passage of irrigation fluid during irrigation with (Pulsavac... more Aim of this study is to evaluate the passage of irrigation fluid during irrigation with (Pulsavac tm plus) and its effect on whole blood count and blood electrolytes level. After propofol, remifentanil and vecuronium induction lungs were intubated and prone position was given to the ...

Marmara Med J, 2003

The aim of this study was to evaluate the correlation of sex, age, bedside scoring systems and bo... more The aim of this study was to evaluate the correlation of sex, age, bedside scoring systems and body mass index with laryngoscopic view in patients with clinically difficult intubation. Methods: Five hundred patients, aged 20-70 years, were included in the study. The age, sex, weight and height of the patients were recorded preoperatively and body mass index was calculated. The patients were examined for Mallampati classification, thyromental distance, mouth opening, neck mobility and structure of maxillary teeth, and scored according to airway difficulty score. The body mass index was scored as an additional parameter. During laryngoscopy, Cormack-Lehane grading was done according to the view of the glottis. Three or more attempts required for intubation and / or more than 10 minutes time spent was accepted as difficult airway. For statistical analysis; oneway of ANOVA with post-hoc Tukey and Chi-square test were used and p<0.05 was accepted as statistically significant. Results: Thirty-three of 500 patients (6.6%) had difficult intubation. A significant correlation was found between clinically difficult intubation and thyromental distance (p<0.05), Mallampati classification (p<0.01) and mouth opening (p<0.01). Also, Cormack-Lehane grading was found to be correlated with thyromental distance (p<0.05), Mallampati classification (p<0.05) and mouth opening (p<0.05). Conclusion: The difficult intubation was found to be correlated with Mallampati classification, thyromental distance and mouth opening.

The Internet Journal of …, 2004

A 29-year-old primipara woman in the 36th week of pregnancy was admitted to our Emergency Clinic ... more A 29-year-old primipara woman in the 36th week of pregnancy was admitted to our Emergency Clinic with a complaint of severe headache for 3 months and nausea / vomiting since since last week. A large frontoparietal intracranial tumour with peripheral edema was found at magnetic resonance imaging. Due to the high risk of herniation, she underwent an emergent craniotomy and cesarean section at the same session. Here, we presented the management of the patient throughout the perioperative period.

Marmara Medical Journal

ABSTRACT In order to determine the eloquent cortical areas responsible for speech, motor, primary... more ABSTRACT In order to determine the eloquent cortical areas responsible for speech, motor, primary sensory, or visual cortex the patient must be conscious and able to talk during cortical stimulation. The challenge for the anesthetist is to find a technique which provides adequate sedation, analgesia, and respiratory and hemodynamic control, but also an awake and cooperative patient for neurological testing. Although a craniotomy can be performed under local anesthesia, the patient will better tolerate the procedure if removal of the bone flap is performed under general anesthesia. We reported our experience with four adult patients who underwent cranial surgery concerning the dominant hemisphere. These patients had an asleep–awake–asleep technique. During asleep phase, lungs were ventilated with 50 % N2 O in O2 via laryngeal mask airway and infusion of propofol and alfentanil was done. During awake cortical mapping, alfentanil infusion was continued and oxygenation was maintained vi...

Turkish neurosurgery, 2008

In routine surgical practice, anterior approaches are not often used to treat upper cervical path... more In routine surgical practice, anterior approaches are not often used to treat upper cervical pathologies. Such lesions can be difficult to access surgically. This article describes 2 cases in which the transmandibular approach was used to address anterior upper cervical pathology. One case was a chordoma invading the C2-C3 vertebrae and the other case was atlanto-axial instability. Neurological examination revealed myelopathy in both cases. Each patient had already undergone occipito-cervical fusion at a different center and, thus, had limited neck extension and mouth-opening ability. In the first case, the tumor was totally excised. In the second, the dens was removed. We believe that the transmandibular approach is the best option for patients with limited neck mobility and restricted mouth-opening ability.

International journal of fertility and women's medicine

The frequency and the intensity of chronic pain, as well as the related factors, were assessed in... more The frequency and the intensity of chronic pain, as well as the related factors, were assessed in a cohort of breast cancer patients. The life functions were also questioned in patients who have post-treatment chronic pain. The scope of this retrospective study was a cohort of surgically-treated breast cancer patients with unilateral early stage disease who were under regular follow-up. Patients were eligible if they completed their treatments at least 6 months before and were free of disease. Patients who had a previous history of chronic pain syndrome, chronic debilitating disease, psychiatric diagnosis, and other cancers were excluded. All data regarding their demographics and treatments were recorded. Chronic pain was defined as the pain at treatment-related regions for a duration of at least three months after completion of treatment. Turkish version of "Brief Pain Inventory (Short Form)" was given to the patients with chronic pain in order to assess their pain intens...

Journal of neurosurgical anesthesiology, 2005

Journal of Neurosurgical Anesthesiology, 2004

Journal of Clinical Neuroscience, 2009

Marmara Medical Journal, 2003

Marmara Medical Journal, 2015

Marmara Medical Journal, 2006

Marmara Medical Journal, 2003

European Journal of Anaesthesiology, 2008

Journal of …, 2008

Marmara Med J, 2003

The Internet Journal of …, 2004

Marmara Medical Journal

Turkish neurosurgery, 2008

International journal of fertility and women's medicine