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Öğe Anestezik ölçümleme, değerlendirme ve kayıtlamanın strasbourg delil sistemi ile yaşam hakkı bağlamında değerlendirilmesi ve delillerin kabul edilebilirliği sorunu(2014) Şeker, İlknur Suidiye; Şeker, Hilmi; Boran, ErtayAvrupa İnsan Hakları Mahkemesi (AİHM) kararlarının iç hukuktaki yargılama- ların tekrarı nedeni olması, oradaki delil sisteminin iç hukuk üzerindeki takdir marjı ile sistemlerin uyumu için yapılması gerekenlerin belirlenmesini gerekli kılar. Devletin ölümün meydana gelmemesi için alması gereken önlemlerin derinliği ile genişliği onunla ameliyathane, anestezi uzmanı, anestezik ölçümleme ve kayıtlama arasındaki ilişkinin büyüteç altına alınmasını gerektirir. Anestezik girişimlerden neşet eden ölümlerin yaşam hakkına yönelik risk olarak tanımlanması, yerel yargı otoriteleriyle yargılananların bu davaların referans aldığı dayanak ve argümanlar hakkında bilgi edinmelerini zorunlu kılar. Strasbourg Delil Sistemi hakkında malumat edinmenin olası bir yargılamada anestezi uzmanı ve devlete suçlama karşısında etkin ve verimli bir savunma olanak ve kolaylığı tanıyacağı tartışmasızdır. Devletin, egemenliği altında meydana gelen ölümün hangi koşullarda ve neden gerçekleştiğini ispatla ödevli olması, ölümün sebeplerini açık, yalın ve ikna edici şekilde açıklama yükümlülüğü, gözleri bu ispatın yararlanacağı vasıtaların taşıması gereken özelliklere odaklar. AİHS birçok deneyimiyle olası bir ölüm kuşkusunun tıbbi delillerin değerlendiril- mesiyle aşılacağını ima etmektedir. Tıbbi delillerin, kanıt sıralamasının doruğuna oturması, kanıtların gözdesi haline gelmesi gözleri tıbbi delillerle türevlerine çevirdi. Tıbbi delillerin oldukça geniş bir portföye sahip olması, araştırmanın kapsamının daraltılmasını zorunlu kıldı. Çalışmamız kendisini iyice büzerek, ilgisini tıbbi kanıtların önemli bir türevi olan anestezik kayıtlarla sınırlamakla yetindi. Uzmana anestezik girişim öncesi sırası ve sonrasında yaptığı ölçümleme değer- lendirme ve kayıtlamanın muhtemel bir yargılamada hatırı sayılır bir argüman olduğunu anımsatmayı, anestezik kayıtların tutulmasındaki özensizliğin yaratacağı etki ve sonuçların altını çizmeyi hedefledi. İdareye de anestezik kayıtların ispat külfeti açısından taşıdığı değeri, kayıtların zamanında ve olgularla uyumlu olarak tutulmaması halinde devleti ispat sahasında bekleyen akıbet hakkında bilgilendirerek gerekli ve optimum önlemler almasını amaçladı.Öğe Doppler ultrasound findings in kidney transplant recipients with and without of new onset diabetes mellitus beyond 5 years after transplantation(E-Century Publishing Corp, 2015) Boran, Mediha; Tola, Muharrem; Boran, Ertay; Boran, MertayObjective: Renal Doppler Ultrasound (RDU) indices: resistive index (RI) and pulsatility index (PI) are frequently applied as a noninvasive method that measured possible causes of allograft dysfunction in kidney transplant patients. We aimed to compare long-term prognosis and associated risk factors including the RDU markers in recipients with and without new-onset diabetes after transplantation (NODAT) beyond 5 years after kidney transplantation. Methods: A prospectively maintained database of 137 kidney allograft recipients, transplanted in a single center, maintained on reduced tacrolimus-based immunosuppressive regimen and angiotensin receptor blocker (ARB) was retrospectively analyzed. The assessment including incidence of NODAT and associated risk factors including RI and PI was compared between 12 recipients with and 125 recipients without NODAT median 77.5 months and 74 months, respectively, after kidney transplantation. Results: NODAT was detected in 12 (9.6%) of the 137 kidney transplant recipients, without gender predilection. In univariate regression analysis recipient age (P < 0.001), recipients weight at the time of NODAT >= 65 kg (P < 0.001), as well as proteinuria (P = 0.026), tacrolimus trough levels (P = 0.005), PI (P = 0.023) were associated with the long-term risk of NODAT and multivariate regression analysis also revealed that recipients weight at the time of NODAT = 65 kg (P = 0.004) was independent long-term risk factor for NODAT. Conclusions: Our study demonstrated that beyond 5 years after kidney transplantation the RDU indices: RI and PI are not long-term risk factors for NODAT and the correction of recipient's body weight, the treatment with ARB and maintained reduced TAC doses lowered the incidence of NODAT.Öğe ECG Evaluation in Patients with Pneumothorax Admitted to the Emergency Department: A Three years Analysis(Duzce Univ, Fac Medicine, 2021) Karakoyun, Salih; Boran, Mertay; Saritas, Ayhan; Boran, ErtayObjective: Pneumothorax is one of the life-threatening differential diagnoses of patients presenting to emergency department (ED) with shortness of breath and chest pain. The place of dynamic electrocardiography (ECG) changes in diagnosis of pneumothorax was not well defined. The aim of our study was to reveal the clinical importance of ECG in pneumothorax. Methods: Between 01.04.2014 and 01.04.2017, 147 patients who applied to our ED and take a diagnosis of pneumothorax were retrospectively examined. The patients were divided as Group 1 (with pneumothorax volume <20%), and group 2 (with pneumothorax volume >= 20%). Patient demographics, mechanism of pneumothorax formation (traumatic or spontaneous), X-ray and tomographic findings, ECG findings, hospitalization-follow-up periods, treatment methods; were derived from the hospital's data recording system and compared between groups. Results: 109 (74.1 %) of 147 patients had a traumatic pneumothorax, and 38 (25.8%) had a spontaneous pneumothorax (p <0.001). 21 (55.2%) of the spontaneous pneumothorax cases are primary spontaneous pneumothorax. 64.6% (n=95) of the patients had chest pain. The two groups were similar in terms of age, hemoglobin level, GCS, number of days followed, gender and smoking status, (p> 0.05). When the ECG data was analyzed, a difference was found between the two groups. While 52.8% of the patients in group 1 had ECG changes, all of the patients in group-2 (100%) had unusual ECG findings (p = 0.004). Conclusions: Pneumothorax is a condition that should not be overlooked at ED. Pneumothorax especially with large volume size (size >= 20%) should be remembered in cases with abnormal findings in their ECG.Öğe HLA-Identical Sibling Renal Transplantation: Influence of Donor and Recipient Gender Mismatch on Long-term Outcomes(Elsevier Science Inc, 2014) Boran, Mediha; Boran, Mertay; Boran, ErtayBackground. Long-term function of living-related kidney allograft depends on multiple variables. The aim of the present study was to assess the influence of donor and recipient gender mismatch on the short and long-term outcomes in human leukocyte antigen (HLA)-identical sibling renal transplants (SRTs) receiving induction therapy and different immunosuppressive regimens. Material and Methods. Twenty-nine recipients who were grafted from their HLA-identical siblings between 1994 and 2008 were divided into 2 groups (same and mismatched) according to gender of donor and recipient. The analyzed variables were age, gender, cholesterol, triglyceride, proteinuria, estimated glomerular filtration rate, weight, body mass index, and serum creatinine at 6, 12, 24, 36, 48, and 60 months, and median follow-up. Univariate and multivariate logistic regression models (when appropriate) were used to evaluate the effects of variables on allograft survival. Results. The number of male donors (P = .001) and recipient age (P = .019) was significantly higher in the same gender group than in mismatched gender group; there were no relationships between remainder analyzed parameters. Multivariate regression analysis revealed that after median follow-up period of 84 months (range, 60-232) the most important potential factors to significantly influence long-term outcomes were male donor (P = .002), recipient age (P < .001), and donor age (P = .021). Conclusion. Our study demonstrated that male donor, and donor and recipient age affected long-term survival of HLA-identical SRTs, supported with antibody induction therapy and lifetime immunosuppression.Öğe Is the ABO Blood Group a Predictor of Renal Allograft Survival in ABO Identical Donor Recipients?(2021) Boran, Ertay; Boran, MedihaObjective: The effect of the ABO blood group on renal allograft survival (AS) is unclear. We assessed the influence of theABO blood group on AS and performed a comparative analysis of AS in kidney transplant recipients with different ABOblood groups.Methods: The 239 renal transplant recipients who underwent transplantation in a single center were stratified into the3 groups: blood group O (84, 35.14%), blood group A (104, 43.51%), and due to the low number of blood group AB patients,blood groups B and AB were classified as blood group B (51, 21.3%). Clinical outcomes and patient demographics wereinvestigated and compared between groups.Results: The AS of blood group O recipients was significantly longer than that of blood group B recipients (P = .001).Correlation analyses revealed that recipient age (P = .002), donor age (P = .013), creatinine level (P = .022), estimated glomerular filtration rate (eGFR) (P = .005), human leukocyte antigen (HLA) mismatches (P = .001), blood group O (P < .0001),blood group B (P < .0001), cyclosporine A (P < .0001), and sirolimus treatment (P = .032) were predictors of AS. Multivariateregression analyses indicated that blood group B (? = ?0.618, P < .0001) and cyclosporine A-based immunosuppression (?= ?0.924, P < .0001) were negative predictors of AS.Conclusion: The data presented here showed that eGFR, low recipient age, low donor age, patient gender (male), and3 HLA mismatches were correlated with long-term AS. In contrast, shorter AS was associated with the blood group B andcyclosporine A treatment.Öğe Laparoskopik Kolesistektomilerde Preemptif ve İntraoperatif Tramadol ve Fentanil Kullanımının Karşılaştırılması(2022) Boran, Ertay; Demirbağ, Ali Eba; Okyay, Rahşan Dilek; Uluer, Pınar Gamze Durak; Erdemli, Özcan; Muslu, SeldaAmaç: Bu çalışmada preemptif ve intraoperatif analjezi amaçlı tramadol ve fentanil uygulamalarının hemodinami, analjezik ve nöromüsküler bloke edici ajan tüketimi, uyanma süresi ve postoperatif ağrı üzerine etkilerinin karşılaştırılması amaçlanmıştır. Gereç ve Yöntemler: Genel anestezi altında laparoskopik kolesistektomi planlanan 120 hasta dört gruba ayrıldı. Fentanil bolus (Grup FB) ve fentanil infüzyon (Grup Fİ) gruplarına; 2 ?gkg-1 fentanil, tramadol bolus (Grup TB) ve tramadol infüzyon (Grup Tİ) gruplarına; 2 mgkg-1 tramadol intravenöz (iv) uygulanmasını takiben, tüm gruplarda propofol ve rokuronium indüksiyonu yapıldı. Entübasyon sonrası, Grup Fİ’ye 0.5?gkg-1saat-1 fentanil, Grup Tİ’ye 0.5 mgkg-1saat-1 tramadol uygulandı. İntraoperatif ek analjezi ihtiyacında Grup FB ve Grup Fİ’ye; 0.5?gkg-1 fentanil, Grup Tİ ve Grup TB’ye 0.5 mg kg-1 tramadol yapıldı. Postoperatif vizüel analog skala (VAS) >5 olduğunda meperidin ve gerektiğinde diklofenak uygulandı. Hemodinamik veriler, fentanil, tramadol tüketimleri, uyanma süresi, VAS değerleri, analjezik ihtiyaçlar kaydedildi. Bulgular: İndüksiyondan sonra ortalama arter basıncı (OAB) fentanil gruplarında daha düşük bulundu (p<0.05) Entübasyon sonrası kalp atım hızı ve OAB tramadol gruplarında daha fazla yükseldi (p<0.05). İntraoperatif analjezik tüketimleri infüzyon gruplarında bolus uygulananlara oranla fazlaydı (p<0.05). Nöromüsküler ajan tüketimi tramadol gruplarında fazlaydı (p<0.05). Postoperatif 5. ve 60.dk’da Grup FB’de; VAS değerleri ile ek analjezik ihtiyacı daha fazla iken OAB düşük seyretti (p<0.05). Sonuç: Entübasyona hemodinamik yanıtların fentanil uygulananlarda daha iyi önlendiği, preemptif ve intraoperatif fentanil bolus uygulamalarının postoperatif analjezi sağlamada yetersiz olduğu kanısına varıldı.Öğe Late-Onset BK Viruria in Renal Transplant Recipients(Elsevier Science Inc, 2015) Boran, Mediha; Yıldırım, Tuğçe; Boran, Ertay; Boran, Mertay; Kılıç, H.Background. Most cases of BK virus (BKV) infections emerge within the 1st years of kidney transplantation. We aimed to determine the prevalence of late-onset BKV infection and whether there are any differences between risk factors in early and late BKV infections. Methods. In this single-center retrospective study, we reviewed 300 kidney transplant recipients that were under regular follow-up and selected recipients with BKV infection and recorded associated risk factors, connection with immunosuppression, and responses to modification of treatment. Results. BKV was detected within the 1st 5 years after transplantation in 20 patients (6.6%, group 1) and after 5 years in 15 patients (5.0%, group 2). There were no significant differences between the 2 groups regarding age, sex, sex mismatches, donor type, BKV elimination time, serum creatinine, and estimated glomerular filtration rate at the times of BKV detection and last follow-up visit. In group 1, 2 recipients had biopsy-proven BKV-associated nephropathy (BKVAN), 3 recipients had BK viruria and viremia without BKVAN (biopsy proven), and 15 recipients (75%) had only BK viruria. In group 2, all of the patients had only BK viruria. In this group, on detection of BK viruria and immediate modification of immunosuppressive regimens prevented BK viremia. Conclusions. Routine screening of renal transplant recipients for BKV was indicated not only during the 1st 5 years, but also for the full follow-up period after transplantation.Öğe Late-onset BK viruria in renal transplant recipients [conferenceObject](Lippincott Williams & Wilkins, 2016) Boran, Mediha; Yıldırım, Tolga; Boran, Ertay; Boran, Mertay…Öğe Noninvasive Ventilation in Renal Transplant. Perioperative and Postoperative(Nova Science Publishers, Inc., 2022) Boran, Ertay; Boran, MertayLife expectancy after kidney transplantation has improved over the past decade. Elderly patients with comorbid diseases not previously considered for kidney transplant are now seen as potential recipients. Besides, kidney transplantation is now performed with kidneys donated by living, unrelated donors. This potentially requires stronger immunosuppression and leads to a higher risk of complications. Respiratory failure (RF) in the postoperative period has a high risk of mortality and morbidity. It extends the length of stay in the hospital and in the intensive care unit (ICU). Early application of NIV in renal transplant recipients with RF was well tolerated and associated with a rapid and sustained improvement. © 2022 by Nova Science Publishers, Inc.Öğe Pons Bleeding: Physical Treatment Time and Amantadin Sulfate in Intensive Care: Miracle?(Lippincott Williams & Wilkins, 2021) Boran, Ertay; Boran, Mertay[Bastract Not Available]Öğe Renal Doppler Resistance Indices in Kidney Transplant Recipients With Proteinuria(Elsevier Science Inc, 2018) Boran, Mediha; Boran, Ertay; Tola, MuharremBackground. The onset of proteinuria in renal transplant recipients may be associated with an increased risk of allograft failure. Little is known about the relationships between factors influencing proteinuria and the Doppler ultrasound (DU) intrarenal resistive index (RI) and pulsatility index (PI) among donor recipients with proteinuria <1000 mg/24 h. Methods. We assessed correlations between the DU RI and PI and protein content in 93 selected renal transplant recipients: 62 patients with proteinuria 100 to 299 mg/24 h, 16 patients with proteinuria 300 to 499 mg/24 h, and 15 patients with proteinuria 500 to 999 mg/24 h. All patients underwent transplantation in a single center and were monitored by DU for at least 28 months post-transplantation. Results. The DU RI values of the proteinuria 100 to 299 mg/24 h, 300 to 499 mg/24 h, and 500 to 999 mg/24 h groups were 0.67 +/- 0.05; 0.65 +/- 0.04, and 0.64 +/- 0.07, respectively, and the P1 values were 1.21 +/- 0.20, 1.10 + 0.14, and 1.15 +/- 0.22, respectively. Multivariate logistic regression analysis revealed a correlation between group 100 to 299 mg/24 h and RI values, serum creatinine, living donor (R-2 = 19.6%, P = .05); group 300 to 499 mg/24 h and the RI, PI values, cadaver donor (R-2 = 17.5%, P = .001); and group 500 to 999 mg/24 h and the RI, PI values, serum creatinine, graft survival (R-2 = 15.4%, P = .005). Conclusions. Among donor recipients with proteinuria <1000 mg/24 h, DU RI values were <0.72 and PI values were <1.41 and correlations were revealed between the incidence of proteinuria and factors such as the RI, PI, and serum creatinine level.Öğe Renal Resistance Indices After Kidney Transplantation(Wiley-Blackwell, 2014) Boran, Mediha; Tola, Muharrem; Boran, Mertay; Boran, Ertay…Öğe Renal Resistance Indices After Kidney Transplantation.(Lippincott Williams & Wilkins, 2014) Boran, Mediha; Tola, Muharrem; Boran, Mertay; Boran, Ertay…
