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    Clinical Outcomes of Uniportal Versus Multiportal Endoscopic Thoracic Sympathectomy in Patients With Severe Palmar and Axillary Hyperhidrosis
    (2022) Aslaner, Oktay
    Aim: Palmar and axillary hyperhidrosis is caused by overstimulation of the sympathetic nervous system that control the sweat glands. This study compares the clinical consequences of uniportal and multiportal thoracic endoscopic thoracic sympathectomy (ETS), in cases of severe palmar and axillary hyperhidrosis. Methods: In this retrospective study, forty-one patients who were diagnosed as severe palmar and axillary primary hyperhidrosis were analyzed. These underwent multiportal ETS between 2015 and 2020 at our thoracic surgery clinic. They were divided into two groups, 24 as uniportal (58.5%) and 17 as multiportal (41.5%). They were compared in terms of the length of hospital stay, the initial complications and possible recurrences after three months. Descriptive statistics were used to evaluate stratified and continuous variables. Results: There was no significant difference in moderate pain between the two groups. There was a significant difference between the two groups in terms of 3 days or more hospitalization. There were no significant difference related to the rate of complications such as ptosis, Horner syndrome, increased duration of surgery and recurrence rate of hyperhidrosis 3 months after surgery. Some mild to moderate side effects disappeared spontaneously at 6-month follow-up. Conclusion: The results showed that uniportal and multiportal endoscopic thoracoscopic sympathectomy (EST) are very effective, safe and minimally invasive methods for the treatment of palmar and axillary hyperhidrosis. Compared to the multiportal approach, uniportal EST causes less postoperative pain and less surgical duration.
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    Comparison of Oxidative Effects of Electronic Cigarette and Tobacco Smoke Exposure Performed Experimentally
    (2022) Aslaner, Oktay
    Objective: Cigarette smoking is a life-threatening habit that has rapidly spread in every socioeconomic part of the public worldwide. There exist mechanisms of nicotine delivery available to use in the hope of halting cigarette smoking, and the electronic cigarette (EC) is one of the common methods used for tobacco smoking replacement. This study aimed to investigate experimentally the oxidative effects of tobacco smoke and EC smoke which contain nicotine. Method: We constructed smoke circuit rooms for exposing the rats to EC or tobacco smoke. Three groups were created, the control group (N = 8); the electronic cigarette group (N = 8), exposure to electronic cigarette smoke for 2 h per day; and the tobacco group (N = 8), exposure to traditional cigarette smoke for 2 h per day. After the first and second week of exposure, blood samples were obtained, and serum oxidative stress index (OSI), paraoxonase 1 (PON1) activity, and prolidase levels were evaluated. Results: Higher values of OSI and prolidase levels were detected in the first week of EC or tobacco smoke exposure in both study groups (p < 0.001) when compared with the control group, and partial decrements were observed in the second week. By contrast, elevated PON1 levels were observed in the second week after EC or tobacco smoke exposure. The highest OSI levels were observed in the tobacco smoke group (p < 0.001). The lowest values of PON1 levels were detected in the first week of the electronic cigarette smoke group, and this decremental value was statistically different than normal, the second week of the electronic cigarette smoke group, the first week of the traditional cigarette smoke exposure group, and the second week of the traditional cigarette smoke exposure group values (p < 0.000). Conclusion: Our results indicate that EC smoke induced oxidative stress. Therefore, ECs are potentially risky for human health and can lead to important health problems.
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    Dramatical recovery of thoracic outlet syndrome after surgery: Case report
    (Alanya Alaaddin Keykubat Üniversitesi, 2019) Aslaner, Oktay
    Thoracic Outlet Syndrome (TOS) is a complex of clinical symptoms characterized by the compression of vascular and neurogenic structures which are localized within the thoracic outlet region. There is no gold standard diagnostic criterion for TOS and the anamnesis and physical examination are important tools for the diagnosis. Supportive and differential examinations are often electromyography (EMG), direct cervical radiography, and neck MRI. Priority in treatment is conservative treatment consisting of medical treatment and physical therapy. Last surgical option is the surgical treatment consisting of the resection of the first costa and cervical costa, and the incision of the scalenus anterior and scalenus medius muscles. It has been reported that TOS resulting from the compression of vascular structures, improved in a very short period of time after surgery, while in TOS resulting from the compression of neurogenic structures the improvement occurs between 6 months and 1 year on average. We performed 1st costa resection on a TOS case with the compression of neurogenic structures . Contrary to the literature, complaints of our case disappeared completely within 1 week. One month after the operation, EMG findings returned to normal.
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    Is atherosklerosi?s developing risk in patients with asthma?
    (2022) Aslaner, Oktay
    Asthma is an inflammatory disease of the airways and is characterized by attacks of bronchospasm. Atherosclerosis develops as a result of a series of systemic inflammatory processes that begin with arterial endothelial dysfunction. Arteries tend to dilate in hypoxemic conditions Flow-Mediated Dilation (FMD) is a non-invasive, low-cost, straightforward and effective method that was described some 20 years ago, showing endothelial function and therefore a predisposition to atherosclerosis, according to the reflex vasodilation response of the artery after occlusion. In this study, we aimed to evaluate the susceptibility of these patients to atherosclerosis by performing the FMD test in controlled and uncontrolled asthma groups. We included 61 asthma patients in this study and 30 healthy people enrolled thi study as control group. Thirty-two of the patients were uncontrolled, did not receive regular treatment and were not followed up regularly, whereas 29 patients were full symptom control. Pulmonary function tests were performed on all subjects who met the inclusion criteria of the study and gave informed consent. After the pulmonary function test, the right brachial artery diameters of all cases were measured from intima to intima by Doppler USG. FEV1 values were 67.28±9.89% in in patients with uncontrolled astma, and 79±7 in symptom free group of astma patients. The initial brachial artery diameter was 4.40±0.33 and The measurement made after 5 minutes was 4.69±0.296 (p<0.001) in patients with uncontrolled astmatic patents. The difference between these two measurements was 0.29±0.16. FMD tet results in Symptom free patients values were 4.45±03 and 4.81±0.4 respectively (p<0.001). Initial and after measurements difference between symptom free and uncontrolled patients were 0.36±0.16 and 0.29±0.11 p<0.01. There was not statistically significant difference between symptom free patients and healthy group. We have shown that vascular disfunction in symptomatic astma patients with FMD test. Atherosclerosis developing might be higher in asthma patients and this patients should be encourage to regular medicine usage.
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    Penetrating heart injuries in hospitals with few facilities: Not a moment to waste
    (2021) Aslaner, Oktay
    Background: Penetrating heart injury is a genuine emergency that needs to be diagnosed and treated as soon as possible. Transport to a tertiary center with facilities such as a heart-lung pump and sternotomy can lead to loss of time. This study aimed to share the author's experiences in a private hospital with limited facilities. Methods: A retrospective study was conducted at a private hospital. Eleven penetrating cardiac injuries, which were treated surgically by the at two small hospitals from 2005 to 2015, were evaluated retrospectively. Patients' age and sex, type of injury, damage site at the heart, duration between injury and surgery, presence of additional damage, and patient survival were all recorded. Results: The most common form of injury was sharp object injury, while the most common site was the right ventricle. The period from injury to surgery, the additional injuries were found to be statistically significant in terms of survival ratios. The probability of patients' survival at intervention times 30, 60, and 120 minutes was 90.9, 54.5, and 27.3%, respectively. Conclusion: Mortality in cardiac injuries can be reduced with early intervention. The risks of being transported to an advanced hospital and the risk of emergency surgery performed in a small less equips facility should be well weighed. Successful surgeries may be performed even in a small, well-organized hospital.
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    Surgi?cal treatment of li?fe-threateni?ng hemoptysi?s: 15 years of experi?ence
    (2021) Aslaner, Oktay
    Hemoptysis is the name of the finding that the bleeding originating from any part of the respiratory system passing through the bronchial system and out through the mouth. While it can often disappear with medical treatment or spontaneously, the term “life-threatening hemoptysis” (LTH) has started to be used when it results in a serious event, such as airway obstruction, impaired gas exchange or hemodynamic instability. In this article, we aimed to share our surgical experiences with LTH, that has developed and changed in the literature in the past 15 years. In the same time we aimed to show the efficiency of surgery in LTH. This study includes a retrospective analysis of 129 patients who applied to our clinic with the complaint of hemoptysis, between 2005 and 2020. We included all patients who applied to our outpatient clinic with hemoptysis complaints and for whom we could access retrospective file information. We considered our patients with sudden onset or airway obstruction, deterioration in oxygenation and hemoptysis of 100 cc or more in 24 hours as life-threatening hemoptysis (LTH), and our other patients as minor hemoptysis. 74 (57.36%) of the patients were female and 55 (42.74%) were male. Those with LTH were 39% (30.23), and those without LTH were 9 (69.77%). Bronchiectasis seen in 35 patients (27.1%) was found to be the most common etiological disease. Lung cancer (26 cases, 20.15%) and tuberculosis (16 cases, 12.4%) were other common etiologies. The approach to hemoptysis should be made by considering every patient to return to the LTH form and should be treated by rapid diagnosis and treatment, with correct history and physical examination methods. Correct treatment, surgical timing in particular, can be lifesaving.
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    Thoracic Outlet syndrom: Efficiency of surgery
    (Alanya Alaaddin Keykubat Üniversitesi, 2020) Aslaner, Oktay
    Aim: In this study, we aimed to evaluate the effectiveness of surgical treatment in patients diagnosed with thoracic outlet syndrome.Patients and Methods: This study was conducted by analyzing the age, sex, occupational distribution, anamnesis and physical examination findings, symptoms, preoperative examinations, operation findings, postoperative complications, postoperative hospital stay and operation results of thirty seven patients who were diagnosed with Thoracic Outlet Syndrome, and were operated on between 1991 and 2004.Results: Most of the patients were in the 15-35 age group (72.97%) and female (91.9%). Most of these cases were housewives (51.4%). The most common symptoms were pain (94.6%) and numbness (78.4%). The most commonly used test in physical examination was the Adson test, which provided an 86% positive rate. The most common pathology encountered in radiological tests was cervical rib anomaly (37.8%). It was found that EMG of upper extremity supported TOS with a rate of 48.6% and arterial doppler of upper extremity supported TOS with a rate of 13,5%. We applied first rib and cervical rib resection scalenectomy and cutting of fibromuscular bands as a surgery by transaxillary approach. A 78.4% complete recovery was observed in the early period after surgery and there was no mortality in any of the cases.Conclusion: In this study, the results were satisfactory in TOS patients on suitable cases and with good surgical technique. Surgical success rate can reach up to 97%.