The relationship between conservation-revitalization projects and site management plan: A case study for sÜLeymaniye mosque and its environs

The aim of this paper is to examine the relationship between site management plans and the conservation-revitalization projects in context of the spatial-functional plan decisions and institutional authority-responsibility. These examinations have been handled with a method which depends on comparative-assessment of three basic data sources: conservation plans, conservation-revitalization projects and site management plan. The case study is The Süleymaniye Mosque and its environs which had been declared “historic-urban protected site” in 1977 and was inscribed on UNESCO World Heritage List within the scope of “Historic Areas of Istanbul” in 1985.However; socio-spatial and functional strategies for the Süleymaniye Mosque and its environs have been determined by Historical Peninsula Site Management Plan dated 2009. We believe that this study will present alternative perspectives to the problems arising in the context of coordination among stakeholders in the process of conservation-revitalization of historical urban environments through the re-evaluation of the institutional and managerial scope and content of the site management models through the case of Turkey. © 2017 WIT Press

The effects of combination of verapamil and MK-801 on rat neuropathic pain model

N-Metil-D-Aspartat reseptörü kalsiyum ile aktif hale gelmektedir. Kalsiyum antagonisti verapamil ve N-metil-D-aspartat antagonisti MK-801'in sıçanlarda kronik sinir hasarı modelinde termal nosisepsiyona olan etkileri bilinmektedir. Bu çalışmada her iki ilacın birlikte uygulanmasının analjezik etkinliğinin araştırılması amaçlandı. Çalışma, ağırlıkları 180-220 g arasında değişen Sprague Dawley cinsi 30 erkek sıçanda gerçekleştirildi. Barbitürat anestezisi altında sağ siyatik sinirleri bulunarak 4/0 kromik katgüt ile gevşek şekilde bağlandı. İlaçlara ameliyatı takiben başlandı ve beş gün süre ile uygulandı. Tedavi protokolünde: ilk dört gün intraperitoneal 10 mg kg-1 verapamil uygulandı; beşinci gün ise 20 dakikalık ara ile verapamil 1 mg kg-1 MK-801 ile kombine edildi. Nosiseptif testler 46.5°C'de Hot Plate Test ile 120 dakika boyunca her 30 dakikada bir ölçüm yapılarak gerçekleştirildi. Opere bacağın çekilme zamanı reaksiyon süresi olarak belirlenerek kaydedildi. Nöropatik ağrı modelinde kronik verapamil veya tek başına MK-801 uygulaması nosisepsiyonu belirgin ölçüde azalttı. İki ilacın kombinasyonu ile tek başına gözlenen antinosiseptif etkinin altında değerler elde edildi. Kalsiyum antagonisti ön tedavisi nöropatik ağrı mode-linde N-metil-D-aspartat reseptörüne olan duyarlılığı azaltmaktadır. N-metil-D-aspartat reseptöründe kalsiyum antagonistleri ve MK-801'in bağlanma bölgeleri birbirine yakın olabilir. Bu nedenle, birlikte uygulandıklarında reseptör duyarlılığını azaltarak ve/veya bağlanma düzeyinde etkileşerek antagonist etkinin görülmesine neden olduklarını düşünmekteyiz.N-methly-D-aspartate receptor is activated by calcium. The effects of a calcium antagonist verapamil and N-methly-D-aspartae receptor antagonist MK-801 on thermal nociception in rat model of chronic nerve injury was well known. We aimed to study the analgesic effects of combination of two drugs using the same model. The present study was constituted on 30 male Sprague Dawley rat weighing 180-220 g. The right common sciatic nerve was exposed and ligated loosely with 4/0 chromic gut under anaesthesia with a barbiturate. The administration of drugs were started after the operation and continued through five days. According to the treatment protocol, verapamil 10 mg kg-1 was administered for four days and on the fifth day MK-801 1 mg kg-1 was combined. The drugs were given with 20 mi-nutes' intervals through intraperitoneal route. Nociceptive tests were performed by Hot Plate Test at 46.5°C throughout a 120 minutes' period at every 30 minutes. The time of withdrawal of the operated limb was accepted as reaction time. Chronic administration of verapamil or MK-801 admi-nistration as a sole drug was substantially reduced nociception on neuropathic pain model. The antinociceptive effects of the combination of drugs was found to be lower than values obtained from each drug individually. Pretreatment with a calcium antagonist reduced the sensitivity to N-methyl-D-aspartate receptor on neuropthic pain model. It was concluded that, the binding sites of calcium antagonists and MK-801 on N-methyl-D-aspartate receptors can be close to each other, therefore antagonism may be seen by reducing receptor sensitivity or a reaction during binding

Weill marchesani sendromunda uzamış postoperatif apne

Weill Marchesani Sendromu (WMS), nadir, görülen bir sistemik konnektif doku hastalığıdır. Sendrom karakteristik olarak mikroseferofaki, ektopik lens, glokom, brakiodaktili ve brakiomorfı içermektedir. Bu olgu sunumunda, glokom cerrahisi geçiren, belirgin rezidüel blok ve postoperatif apne gelişen 17 ve 18 yaşlarında iki kız kardeş bildirilmektedir. Her iki hastamnda bir sonraki anestezi uygulamaları farklı anestezîk ajanlar kullanılarak sorunsuz tamamlanmıştır. Bu yazıda, uygulanan ilaçlar arasındaki muhtemel reaksiyonlar, konjenital sendrom ve uzamış apne nedenleri araştırılarak, tartışılmıştır.Weill Marchesani Syndrome (WMS) is an unusual systemic connective tissue disorder. This case report describes two sisters, 17 and 18 years old, with WMS. Both patients underwent glaucoma surgery and had prolonged postoperative recovery times because of apnea and an apparent residual neuromuscular block. Additional anesthetic exposures with different anesthetic drugs in both patients were uneventful. In this report, the possible interactions among the applied drugs, the hereditary syndrome and prolonged apnea were discussed

Is there a difference between Parkinson disease patients and a control group in terms of urinary symptoms and quality of life?

WOS: 000393331000009PubMed ID: 28081354Background/aim: The aim of this study is to research whether urinary symptoms and disruption of quality of life observed in Parkinson disease patients are different than those of their healthy peers. Additionally, whether these complaints were affected by characteristics such as age at onset of Parkinson disease, sex, disease duration, and severity was investigated. Materials and methods: This study comprised a total of 79 individuals, 39 Parkinson patients and a control group of 40 individuals. Parkinson diagnosis was provided by a neurology expert according to the UK Parkinson's Disease Society Brain Bank Criteria. All patients were evaluated by a urologist with the International Prostate Symptom Score (IPSS) and an overactive bladder (OAB) questionnaire. Results: Compared with the control group, the Parkinson patient group had statistically significantly higher rates of urological complaints (P < 0.001), irritative symptoms (P < 0.001), voiding symptoms (P < 0.001), OAB score (P < 0.001), IPSS total score (P = 0.007), and treatment requirements (P < 0.001). Conclusion: Urologic complaints were observed more frequently in the Parkinson patient group compared to the control group. Another important result of this study is that in the Parkinson patient group there was no difference found between urologic complaints in terms of sex

The comparison of preemptive analgesic effectiveneas of epidural and intravenous fentanil

Bu çalışmada, total abdominal histerektomilerde epidural ve intravenöz olarak uygulanan fentanilin preemptif analjezik etkinliğinin karşılaştırılması amaçlandı. ASA I-II grubu, total abdominal histerektomi yapılacak 54 hasta çalışmaya alındı ve randomize olarak üç gruba ayrıldı. Bütün hastalara standart genel anestezi uygulandı. Kontrol grubuna (Grup K, n18), sadece genel anestezi verildi. Epidural analjezi grubuna (Grup E, n18), preoperatif olarak L2-3 veya L3-4 aralıklarından yerleştirilen epidural kateterden 10 mL % 0.9 NaCl içinde 4 µg kg-1 fentanil, insizyondan 30 dakika önce uygulandı. İntravenöz analjezi grubuna (Grup İ, n18), insizyondan 5 dakika önce 4 µg kg-1 İV fentanil uygulandı. Postoperatif ağrı, 1.,2., 4., 6., 12. ve 24. saatlerde VAS ağrı skalası ile değerlendirildi. İlk analjezik istem zamanları ve 24 saatlik toplam analjezik tüketimleri kaydedildi. Ayrıca insizyon öncesi ve postoperatif 4. saatteki kan glukoz ve kortizol düzeylerine bakıldı. Postoperatif bütün evrelerdeki VAS skorları ve toplam analjezik gereksinimi Grup E'de diğer iki gruba göre anlamlı derecede düşük bulundu (p0.05). İlk analjezik istem zamanı da Grup E'de belirgin olarak uzundu (p0.05). Preinsizyonel kan glukoz ve kortizol değerlerinde gruplar arasında farklılık yok iken, postoperatif 4. saatte Grup E'de diğer iki gruba göre anlamlı derecede düşük bulundu (p0.05). Ancak bütün grupların postoperatif 4. saatteki değerleri preinsizyonel değerlerle karşılaştırıldığında, anlamlı bir artış tespit edildi (p0.05). Sonuç olarak total abdominal histerektomi ameliyatlarında preemptif epidural fentanilin akut postoperatif ağrı ve cerrahi stres yanıtın kontrolünde intravenöz fentanilden daha etkili olduğunu düşünmekteyiz.In this study, we aimed to compare the preemptive analgesic effect of fentanyl, which is used by intravenous or epidural route, in total abdominal hysterectomy (TAH). Fifty-four ASA I-II patients who admitted for total abdominal hysterectomy were included to this study and patients were randomly separated into three groups. All patients were given standard general anesthesia. General anesthesia alone was given in control group (Group K). In epidural analgesia group (Group E), epidural catheter was inserted preoperatively through L2-3 interspace and 4 µg kg-1 fentanyl in 10 mL0.9 % NaCl was administered 30 min. before incision. In intravenous analgesia group (Group I), fentanyl 4 µg kg-1 was administered intravenously 5 min. before skin incision. Pain scores were assessed with visual analogue scale (VAS) at 1st, 2nd, 4th, 6th, 12th and 24th hours postoperatively. First analgesic requirement time and total analgesic consumption were also recorded. Surgical stress response was evaluated with the blood glucose and plasma cortisol levels of patients whom were obtained before the incision and postoperative 4th hour. Compared to the other two groups, we observed that remarkable lower VAS pain scores and total analgesic consumption was provided in Group E (p<0.05). First analgesic requirement time was also significantly prolonged in Group E (p<0.05). The blood glucose and plasma cortisol levels at 4th hour postoperatively were significantly lower in Group E when compared to the other two groups (p<0.05). As a result we suggested that preemptive epidural fentanyl administration was more effective than preemptive intravenous fentanyl in postoperative acute pain and surgical stress response control at total abdominal hysterectomy

Different intravenous sedation techniques during sinonasal surgery with local anaesthesia

Amaç: Lokal anestezi altında uygulanan sinonazal cerrahide, intravenöz sedasyon için kullanılan dört farklı anestezik medikasyonun hemodinamiye etkileri ve yan etkileri karşılaştırıldı. Gereç ve Yöntem: Septoplasti veya fonksiyonel endoskopik sinüs cerrahisi geçiren seksen hasta, rastgele dört gruba ayrıldı. Birinci gruptaki hastalara midazolam (0,07 mg/kg) ve fentanyl (1 µg/kg/dk), intravenöz (İV), ikinci gruptaki hastalara fentanyl (1 µg/kg), İV ve propofol infüzyonu (2 mg/kg/sa), üçüncü gruptaki hastalara midazolam (0,07 mg/kg), İV ve remifentanil infüzyonu (0.05 µg/kg/dk), dördüncü gruptaki hastalara ise propofol (2 mg/kg/sa) ve remifentanil (0.05 µg/kg/dk) infüzyonu uygulandı. Bütün hastalarda elektrokardiyografi, kan basıncı ve satürasyon şeklinde standart monitörizasyon yapıldı. Sekiz ölçüm periyodunda alınan veriler istatiksel olarak analiz edildi: 1: ameliyat öncesi (bazal), 2: intravenöz medikasyon sonrası, 3: lokal anestezi sonrası, 4: ameliyat başlangıcından hemen sonra, 5, 6, 7: ameliyat süresince ve 8: ameliyat bitiminde. Bulgular: Kalp hızı ve kan basıncı seyrinde gruplar arasında anlamlı fark gözlenmedi. Sedasyon sonrası satürasyon değerleri gruplar arasında farklı bulundu (p0.01). Hemodinamik parametreler, midazolam ve remifentanil alan hasta grubunda stabil seyretti. Propofol ve remifentanil alan hastalarda ameliyatın ikinci yarısında görülen hipoventilasyon dışında yan etki gözlenmedi. Sonuç: Sinonazal cerrahide lokal anestezi ile birlikte uygulanan sedasyon tekniklerinden, midazolam-remifentanil kombinasyonu oldukça stabil hemodinami sağlamaktadır. Yan etkilerinin azlığı bakımından propofol-remifentanil kombinasyonu midazolam-remifentanile alternatif olabilir.Objectives: To compare the haemodynamic and adverse effects of different intravenous sedation techniques during sinonasal surgery with local anaesthesia. Materials and Methods: Eighty patients undergoing septoplasty or functional endoscopic sinus surgery were studied. Patients were randomly assigned into one of four groups (n20/group). Group I received midazolam (0.07 mg/kg) and fentanyl (1 µg/kg), group II received fentanyl (1 µg/kg) and propofol (2 mg/kg/h), group III received midazolam (0.07 mg/kg) and remifentanil (0.05 µg/kg/min), and group IV received propofol (2mg/kg/h) and remifentanil (0.05 µg/kg/min). Cardiovascular monitoring including electrocardiography, mean arterial pressure and oxygen saturation was applied to all patients. The readings; baseline (1), after intravenous medication (2), after local anesthesia (3), at the beginning of the operation (4), during the operation (5, 6, 7) and at the end of the operation (8), were analyzed. Results: There were statistically significant differences among the groups in saturation after sedation (p<0.01). Haemodynamic parameters remained more stable in group-I. In group-IV, no side effect occurred, except a decrease in saturation, at the second part of the operation. Conclusion: The combination of midazolam and remifentanil provided more stable haemodynamic parameters during sinonasal surgery. Propofol and remifentanil may be an alternative technique in respect to less side effects except hypoventilation

The effects of repeated sevoflurane anesthesia on renal tubular enzymes in rabbits

Yeni inhalasyon ajanlarından birisi olan sevofluran, organik ve inorganik florür metabolitlerine metabolize olmaktadır. Açığa çıkan serbest florid iyonu, nefrotoksisiteden sorumlu tutulmaktadır. Bu çalışmada; deneysel olarak tekrarlayan uygulamalarda farklı konsantrasyonlarda sevofluran kullanımının renal etkileri, önemli üriner indikatörlerden n-asetil-d- glukozaminidaz (NAG), alkalen fosfataz (ALP), ve gamma glutamil transferaz (GGT) atılımı incelenerek araştırıldı. Çalışmada 14 adet Yeni Zellanda tipi erkek tavşan kullanıldı. Tavşanlar rastgele 2 gruba ayrıldı (n=7). Grup I'deki tavşanlara % l, Grup H'deki tavşanlara % 3 sevofluran, 4 Ldk-1 O2+N2O karışımı içinde 3 gün ardarda, 3 saat süreyle uygulandı. Her iki grubun 24 saatlik idrarları özel bir düzenek ile preoperatif dönemde ve her anestezi uygulamasından sonra toplandı. Son anesteziden 5 gün sonra 24 saatlik idrarları toplandı. İdrar örneklerinden NAG, ALP ve GGT çalışıldı. Ayrıca, preoperatif dönemde ve anestezi uygulamalarını takiben tavşanların kulak yenlerinden kan örnekleri alınarak, kan üre azotu (BUN) ve kreatinin (Kr) çalışıldı. Sonuçlarda, üriner NAG seviyesinde Grup II de 3. günde preoperatif değerlere göre belirgin artış, üriner GGT seviyesinde de, 2. ve 3. günlerde anlamlı artış izlendi. Her iki grupta da, BUN, kreatinin ve idrar ALP değerlerinde fark saptanmadı. NAG ve GGT düzeyleri 9. günde preoperatif değerlere döndü. Sonuç olarak, tekrarlayan sevofluran uygulamalarının, renal sistem üzerinde oluşturduğu değişikliklerin geçici olduğu kanaatine varıldı.Sevoflurane, one of new inhalation agents, is metabolized to organic and inorganic fluoride metabolites. Nephrotoxicity is due to free fluoride. In this study; we investigated the renal effects of repeated and different concentrations of sevoflurane anesthesia, experimentally. Sensitive urinary indicators n-asetil-d- glukozaminidaz (NAG), alkalen phosfatase (ALP), and gamma glutamil transferase (GGT) were assessed. This study was performed in 14, male New Zelland rabbits. Rabbits were divided into two groups (n=7). Group I (n=7) received sevoflurane 1 % and Group II (n=7) 3 % sevoflurane with O2+N2O ( 4 Lmin') 3 hours a day for 3 days Urine samples were collected via a special apparatus for 24 hours preoperative and after anesthesia. Urine samples were taken five days after the last administration of anesthesia and NAG, ALP and GGT levels in urine were determined. Blood samples taken from ear veins were obtained to determine BUN and Creatine. In Group II, urinary NAG levels increased significantly on the third day and a significant increase in GGT was observed on second and third days. There was no significant change in BUN, Cre and urinary ALP. NAG and GGT levels returned to normal on the 9th day. We concluded that, the effects of repeated sevoflurane administration on renal system are temporary

Effect of bladder dysfunction on development of depression and anxiety in Parkinson's disease

Objectives: Parkinson's disease (PD) often presents with movement disorder. However, besides motor complaints, there are many complaints such as anxiety, depression, urinary complaints and constipation. The aim of this study was to investigate whether neurogenic lower urinary dysfunction (NLUD), which is frequently seen in PD, has an effect on the development of anxiety and depression in these patients. Materials and methods: The study included 32 males (66.6%) and 16 females (33.3%); in total 48 subjects were registered. For the diagnosis and severity of PD, the UK Parkinson's Disease Society Brain Bank Criteria, Unified Parkinson's Disease Rating Scale (UPDRS) and the Hoehn-Yahr scale were used. Urological evaluation was performed using history, physical examination, laboratory tests and standard forms such as IPSS and OAB-V8. Results: There was no difference between the genders in terms of duration, severity and NLUD (p > 0.05). The incidence of anxiety and depression in PD patients was 62.8% and 72.1%, respectively. The prevalence of NLUD was 67.4% and depression and anxiety was found to increase (1.06 and 1.28 times, respectively) in relation to NLUD. In particular, there was a relationship between storage lower urinary tract symptoms and anxiety and depression development (p < 0.05). Conclusions: As expected, it was found that the incidence of NLUD, anxiety and depression was increased in PD. In addition, NLUD was found to be a risk factor for the development of anxiety and depression. Therefore, it is concluded that NLUD, which can potentially cause important complications, as well as motor complaints, should be closely monitored and treated in PD patients

CNS toxicity after combined sciatic and femoral nerve block with lidocaine

Sağ ayak lateral malleolünde lezyonu nedeni ile opere olacak 48 yaşındaki kadın hastaya kombine siyatik-femoral sinir blokajı uygulandı. Bloktan 12 dakika sonra bilinç kaybı meydana geldi. Ancak vital parametrelerin stabil olması ve ilave komplikasyon görülmemesi nedeni ile operasyona izin verildi. Bloğun 95. dakikasında hasta ağrılı uyaranlara cevap vermeye başladı ve bloktan 135 dakika sonra bilinci tamamen geri döndü. Hastanın semptomları klasik santral sinir sistemi bulguları ile uyumlu olmamakla birlikte; göreceli olarak yüksek doz lidokain kullanılmış olması, aneminin varlığı, nöbet aktivitesi olarak değerlendirilen kas seğirmelerinin olması ve bu kas seğirmelerinin düşük doz midazolam ile ortadan kalkması lokal anestezik toksisitesini düşündürdü.Combined sciatic-femoral nerve block was performed in a 48-year-old woman for the removal of a right lateral malleolar lesion. The patient became unconscious at the 12th minute of the block. As vital signs were stable and no additional complication was seen, the operation was carried out and completed. The patient began to respond to painful stimulus, and was conscious and fully oriented. 95 and 135 minutes after the block respectively. Although the patient's symptoms were not consistent with classical central nervous system toxicity, relatively high dose of lidocaine used, and coexistence of anemia, occurrence of muscular twitching which could be related to seizure activity, and the treatment of this twitching with a small dose of midazolam were thought to indicate toxicit