Turkish journal of trauma & emergency surgery, 1997
Bu çalışmada 1990-1995 yılları arasındaki 5 yıllık periyod içinde Ankara Numune Hastanesi Acil Ce... more Bu çalışmada 1990-1995 yılları arasındaki 5 yıllık periyod içinde Ankara Numune Hastanesi Acil Cerrahi Servisinde tedavi edilen 57 travmatik kolon yaralanmak hasta retrospektif olarak incelendi. 57 hastanın 23'ü (%40) ateşli silah yaralanması (ASY), 22'si (%39) delici kesici ...
Glutathione peroxidase activities and malondialdehyde levels were measured in the homogenated ant... more Glutathione peroxidase activities and malondialdehyde levels were measured in the homogenated anterior segment of rat eyes with endotoxin induced acute anterior uveitis in euthyroid, hyperthyroid and hypothyroid rats. Malondialdehyde concentrations were found to be significantly increased (p < 0.0005) and glutathione peroxidase activities significantly decreased (p < 0.01) in the hyperthyroid group when compared with controls. Malondialdehyde concentrations of the hypothyroid rat eyes were higher than the control group (p < 0.05), but glutathione peroxidase activities of the same group showed no difference with controls (p>0.05). These results suggest that excess or deficiency of the thyroid hormones cause alterations in the malondialdehyde levels and glutathione peroxidase activities of the rat eyes in endotoxin induced uveitis, and hyperthyroidism may increase the oxidative stress in endotoxin induced acute anterior uveitis. Key words: endotoxin induced uveitis (EIU)-hyperthyroidismhypothyroidismmalondialdehyde (MDA)glutathione peroxidase (GPx).
Hydatid cyst A case of inferior vena caval thrombosis is presented. Thrombosis was caused Inferio... more Hydatid cyst A case of inferior vena caval thrombosis is presented. Thrombosis was caused Inferior vena cava by compression through a hydatid cyst. The patient died because of pulmo-Thrombosis nary embolism.
... The role of nitric oxide on neutrophil chemostaxis and bacterial translocation in a sepsis mo... more ... The role of nitric oxide on neutrophil chemostaxis and bacterial translocation in a sepsis model: An experimental study. Nuri A. KAMA, Mete DOLAPÇI, Mutlu DOGANAY, Erhan REIS, Yunus N. YUKSEK, Gul DAĞLAR. ... Kaplan et al. ...
Carcinoid tumors which arise from enterochromaffin cells are usually found in the appendix, ileum... more Carcinoid tumors which arise from enterochromaffin cells are usually found in the appendix, ileum, bronchus and rectum. Biliary duct carcinoids are exceedingly rare. Pre-operative diagnosis is very difficult because they mimic the signs and symptoms of choledocholithiasis. We report a case of biliary duct carcinoid. A 38-year-old woman admitted with signs and symptoms of obstructive jaundice. ERCP demonstrated an obstruction in the common bile duct. A choledochotomy T drainage was performed. Histopathologically the mass which was removed from the common bile duct was a carcinoid tumor. There are only nine cases of biliary duct carcinoid in the literature to date. These cases are reviewed.
Background: Hernia repair is one of the most frequent procedures in surgery. The aim of this stud... more Background: Hernia repair is one of the most frequent procedures in surgery. The aim of this study is to compare Lichtenstein procedure and non-mesh suture repair of primary inguinal hernias with respect to quality of life. Methods: Between August 2000 and December 2003, 70 patients scheduled for repair of a unilateral primary inguinal hernia were prospectively evaluated by Short Form 36 (SF-36) to assess quality of life after 6 months of operation. Registrars under supervision of consultants did all operations. Results: Among 70 patients, 24 patients (34.2%) had undergone non-mesh suture repair and 46 patients (65.8%) had undergone Lichtenstein procedure. SF-36 questionnaire showed a significant diff erence in physical function, pain and global health parameters of the test in favour of the Lichtenstein procedure 6 months postoperatively. Conclusion: We conclude that long-term quality of life following Lichtenstein procedure is superior to non-mesh suture repair in primary inguinal hernias.
Journal of Gastroenterology and Hepatology, Apr 1, 2007
Background and Aim: With the introduction of H2 receptor antagonists and proton pump inhibitors,... more Background and Aim: With the introduction of H2 receptor antagonists and proton pump inhibitors, the incidence of elective surgery for peptic ulcer (PU) diseases has decreased, although complications of PU such as perforation and bleeding have remained fairly constant. The purpose of this study was to identify the risk factors that predict morbidity and mortality in patients with perforated PU.Methods: The records of 269 patients who were operated on for perforated PU were reviewed retrospectively. The following factors were analyzed in terms of morbidity and mortality: age &gt;65 years; gender; associated medical illness; chronic ingestion of non‐steroidal anti‐inflammatory drugs, aspirin, corticosteroids or immunosuppressants; alcohol ingestion and smoking habits; American Society of Anesthesiologist (ASA) status; season; delayed operation; site of ulcer perforation; and shock on admission and type of operation.Results: There were 30 female (11.16%) and 239 male (88.84%) patients. Seventy‐one (26.4%) patients had associated diseases. Simple closure was performed in 257 (95.5%) patients; 12 patients (4.5%) underwent definitive operations. A total of 108 postoperative complications were present in 65 (24.2%) patients. Twenty‐three patients died (8.55%). Multivariate analysis showed that only age, ASA score, treatment delay, presence of shock and definitive operation were independent predictors of mortality. Significant risk factors that led to morbidity were ASA status, time of surgery, season, presence of shock and type of surgery. There was a significant difference concerning morbidity and mortality between simple closure of the perforation and definitive surgery.Conclusions: Age, delayed surgery, presence of shock, ASA risk and definitive surgery are factors significantly associated with fatal outcomes in patients undergoing emergency surgery for perforated PU. Therefore, proper resuscitation from shock, improving ASA grade, decreasing delay and reserving definitive surgery for selected patients is needed to improve overall results.
Tiroid hastalıklarında sık kullanılan ameliyat öncesi tanı yöntemi olan İİAB' nin histopatolojik ... more Tiroid hastalıklarında sık kullanılan ameliyat öncesi tanı yöntemi olan İİAB' nin histopatolojik inceleme ile korelasyonunu yaparak kendi klinik deneyimimiz eşliğinde bu yöntemin duyarlılığını ortaya koymayı amaçladık. Gereç ve yöntem: Ankara Numune Eğitim ve Araştırma Hastanesi 2. Cerrahi Kliniği'nde Ocak 2006-Aralık 2010 tarihleri arasında total tiroidektomi ameliyatı uygulanan 355 hasta malignite oranı ve ince iğne aspirasyon biyopsinin tiroidektomi öncesi maligniteyi saptamadaki özgüllüğü ve duyarlılığı yönünden geriye dönük olarak incelendi. Hastaların preoperatif dönemde yapılan laboratuar incelemeleri, tiroidin fonksiyonel durumu, ultrasonografi, sintigrafi ve tiroid İİAB gibi tanı yöntemleri ile postoperatif histopatolojik inceleme sonuçları korele edildi. Bulgular: İİAB uygulanan 167 hastanın patolojik inceleme sonucunda, benign sonuç % 58 (n=97), şüpheli sonuç % 29,9 (n=50), yetersiz materyal oranı % 6,6 (n=11) ve malign sonuç % 5,4 (n=9)'unda raporlandı. Çalışmamızdaki İİAB nin duyarlılığı %83, özgüllüğü %100 olarak saptandı. Sonuç: Bu çalışmada sunulan veriler, operasyon gerekliliğinin belirlenmesi ve malignitenin doğrulanmasında İİAB nin kullanımını desteklemektedir. Negatif İİAB sonucu diğer klinik faktörlerle gerekliliği gösterilen operasyonu engellememelidir. Rezeksiyonun büyüklüğüne, oluşmuş risk faktörlerinin ve boyun eksplorasyonundaki bulgularına bakılarak karar verilmelidir.
Objective: To investigate the factors associated with patients with Fournier's gangrene, and to c... more Objective: To investigate the factors associated with patients with Fournier's gangrene, and to clarify the effect of diabetes mellitus (DM) as a comorbid disease on morbidity and mortality of patients with Fournier's gangrene. Methods: Twenty-six Fournier's gangrene patients who were admitted to the Emergency Department of Ankara Numune Teaching and Research Hospital, Ankara, Turkey from 1997 to 2003 were examined retrospectively. Results: The mean age of the patients was 52.8 years. There were 8 female (30.8%) and 18 male (69.2%) patients. The etiological causes were as follows: diseases of the perianal region, history of operations, trauma and injections. Major comorbid disease states were diabetes mellitus (DM) and hypertension. The lesions in Fournier's gangrene were most commonly located in the perineum and genital region. Female patients with diabetes mellitus had significantly unusual extensive involvement, especially abdominal wall involvement. The most frequently isolated pathogen was Escherichia coli, while staphylococcal infection was most commonly seen in the presence of DM. Colostomy was performed on 53.8% of the patients, and cystostomy on 7.6% of the patients. Average time of staying at the hospital was 25 days with a mortality rate of 34.6%. Patients with DM had high mortality rates and stayed longer at the hospital than the non-diabetic patients. Conclusion: In addition to early diagnosis, early and aggressive debridement and administration of multiple wide spectrum antibiotics chosen for the causative agent are the golden standard for decreasing the mortality and morbidity. Diabetes mellitus has been found to be an important factor to increase mortality rates of patients with Fournier's gangrene.
Objective: To examine respiratory functions of patients after open and laparoscopic cholecystecto... more Objective: To examine respiratory functions of patients after open and laparoscopic cholecystectomy and to compare the advantages. Methods: Fifty five cases with cholelithiasis subjected to elective cholescystectomy were studied. The patients were divided into two groups. Open Cholecystectomy (OC) was performed on 27 cases (Group I), and Laparoscopic Cholecystectomy (LC) in 28 cases (Group II). Respiratory function tests were performed 24 hours before the operation and on the 1st and 6th day after surgery. Blood gas values and anaesthesia periods were recorded. Forced expiratuary volume in the 1st second (FEV1), forced vital capacity (FVC) and FEV1/FVC values were also noted. Results: FEV1, FVC and FEV1/FVC values on first post-operative day in all cases were statistically lower than the preoperative values (p = 0.0001). Percentage changes of respiratory function test was calculated preoperatively and 1st postoperative day. The changes in both groups showed a significant decrease in FEV1, FVC and FEVI/FVC in Group I compared to Group II (p = 0.0001 in FEV1, p = 0.007 in FVC and p = 0.004 in FEV1/FVC). There was no significant difference in respiratory function tests evaluated on the 6th postoperative day and they had returned to normal values. There was no difference among preoperative and postoperative PaCO2, pH values in arteriel blood gas values in all cases (p = 0.355 p = 0,215). These parameters did not differ in both groups (p = 0.527, p = 0.591), There was a significant decrease in PaO2 and O2 saturation in all cases (p = 0.0001), but there was no significant difference when both groups were compared (p = 0.166, p = 0.678). Conclusion: The better results of pulmonary function tests in patients subjected to LC proves the advantage of the procedure over OC.
Introduction: Haemostasis is very important in thyroid surgery. In conventional surgery, electroc... more Introduction: Haemostasis is very important in thyroid surgery. In conventional surgery, electrocoagulation and suture ligation are used for haemostasis; newer techniques include vessel clips, ultrasonic instruments and lasers. The aim of this prospective study was to compare the usage of the ultrasonic harmonic scalpel (UHS) with conventional procedures, in total thyroidectomies, for operation time, blood loss, usage of drain, cost, length of hospitalisation and complications. Methods: We examined 104 patients who underwent bilateral total thyroidectomy. They were divided randomly into two groups. Patients in Group I (n=54) underwent operations using conventional techniques (electrocautery and suture ligation) while patients in Group II (n=50) underwent operations using the UHS. Operation time, number of ligatures used, blood loss, intra-operative complications, weight of the specimen, necessity of drain, postoperative seroma, bleeding, infection, transient or permanent hypocalcaemia, permanent recurrent laryngeal nerve palsy and length of hospitalisation were recorded. Results: The operation time was significantly longer in Group I (conventional) (105±16 minutes; mean±standard deviation) than Group II (UHS) (77.9±12.5 minutes; P<0.001). The mean blood loss was less in patients who were operated on with the UHS (25.3±10.2 g) than in patients operated on with conventional methods (59.5±33.9 g; P<0.
OBJECTIVE This study aimed to investigate the presence of indoleamine-2,3-dioxygenase and bacteri... more OBJECTIVE This study aimed to investigate the presence of indoleamine-2,3-dioxygenase and bacterial translocation after the administration of 3-aminobenzamide and infliximab in the TNBS model of rat colitis. METHODS The study group was divided into five categories as follows: group 1: (control), group 2: colitis+saline, group 3: colitis+3-aminobenzamide, group 4: colitis+infliximab, and group 5: colitis+3-aminobenzamide+infliximab. Intestinal mesenteric cultures were incubated on specific agar media plates under aerobic and anaerobic conditions, bacterial translocation was evaluated and assessed as colony-forming units per gram of tissue. Colonic tissue samples were evaluated by Western blotting method to detect the presence of indoleamine-2,3-dioxygenase. RESULTS The results obtained were as follows: group 1: normal gut flora; group 2: eight of nine samples had bacterial translocation, of which six of them had positive indoleamine-2,3-dioxygenase protein; group 3: five of nine samp...
Ethyl pyruvate is a simple derivative in Ca+2- and K+-containing balanced salt solution of pyruva... more Ethyl pyruvate is a simple derivative in Ca+2- and K+-containing balanced salt solution of pyruvate to avoid the problems associated with the instability of pyruvate in solution. It has been shown to ameliorate the effects of ischemia-reperfusion (I/R) injury in many organs. It has also been shown that I/R injury delays the healing of colonic anastomosis. In this study, the effect of ethyl pyruvate on the healing of colon anastomosis and anastomotic strength after I/R injury was investigated. Anastomosis of the colon was performed in 32 adult male Wistar albino rats divided into 4 groups of 8 individuals: (1) sham-operated control group (group 1); (2) 30 minutes of intestinal I/R by superior mesenteric artery occlusion (group 2); (3) I/R+ ethyl pyruvate (group 3), ethyl pyruvate was administered as a 50-mg/kg/d single dose; and (4) I/R+ ethyl pyruvate (group 4), ethyl pyruvate administration was repeatedly (every 6 hours) at the same dose (50 mg/kg). On the fifth postoperative day, animals were killed. Perianastomotic tissue hydroxyproline contents and anastomotic bursting pressures were measured in all groups. When the anastomotic bursting pressures and tissue hydroxyproline contents were compared, it was found that they were decreased in group 2 when compared with groups 1, 3, and 4 ( P &lt; .05). Both anastomotic bursting pressure ( P = .005) and hydroxyproline content ( P &lt; .001) levels were found to be significantly increased with ethyl pyruvate administration when compared with group 2. When ethyl pyruvate administration doses were compared, a significant difference was not observed ( P &gt; .05). Ethyl pyruvate significantly prevents the delaying effect of I/R injury on anastomotic strength and healing independent from doses of administration.
ABSTRACT Objective: Pilonidal sinus disease (PSD) is a benign disease caused by hair follicles in... more ABSTRACT Objective: Pilonidal sinus disease (PSD) is a benign disease caused by hair follicles in sacrococcygeal region. Despite the use of different methods in treatment, there is no consensus reached for treatment modalities. In this study we compared the primary repair and limberg flap method. Material and Methods: In this study, 376 PSD patients who underwent surgery in our clinic between 2005 -2012 were analyzed retrospectively.184 of these patients managed with primary repair and 192 with limberg flap. Patients who have acute enflamation symptoms and abcess were excluded. Patients evaluated rertospectively. All data examined for statistical analysis. Results: Surgery time and hospital stay were significantly higher in patients who underwent Limberg flap repair (p0,05). But cosmetic care, surgical site paresthesia were found higher in limberg flap group(p
Purpose Splenectomy is associated with increased risk of overwhelming post-splenectomy infections... more Purpose Splenectomy is associated with increased risk of overwhelming post-splenectomy infections despite proper anti-pneumococcal vaccination. As most studies concentrated on vaccination-induced humoral immunity, the cellular immune responses triggered in splenectomized patients are not yet well studied. The present study aims to investigate this area as it can contribute to the development of more effective vaccination strategies. Methods Five healthy and 14 splenectomized patients were vaccinated with pneumococcal conjugate polysaccharide vaccine (PCV) followed by pneumococcal polysaccharide vaccine according to the guidelines established by Advisory Committee on Immunization Practices. PBMC samples collected 0, 8, and 12 weeks after PCV immunization were in vitro stimulated with PCV. Levels of lymphoproliferation, T H cell differentiation, and cytokine release were assessed by carboxyfluorescein succinimidyl ester labeling, intracellular cytokine staining, and ELISA, respectively. Results While T H 1-dominated immune response was detected in both groups, asplenic individuals generated significantly lower levels of T H 1 cells following in vitro stimulation. Similarly, levels of IFN-γ, IL-4, and IL-17 release and lymphoproliferation were significantly lower in asplenic patients. Conclusions According to our data, splenectomy negatively influences the levels of PCV-induced lymphoproliferation, T H 1 differentiation, and cytokine release. Besides, PCV failed to induce T H 17-dominant immune response which is crucial for protection against extracellular pathogens.
Departmental sources Background: Pilonidal sinus (PS) is a common disease of the sacrococcygeal-n... more Departmental sources Background: Pilonidal sinus (PS) is a common disease of the sacrococcygeal-natal region. There are many treatment options, but there is still no consensus on the ideal treatment. We compared the results of our PS patients who were treated with primary midline closure (PMC), Limberg flap repair (LFR), and Karydakis flap (KF). Material/Methods: The data for 924 PS patients from 2013 to 2017 were retrospectively examined. Demographic data, surgical procedures, schedules, and recurrence rates were examined. Results: The mean age was 28.4 years (14-77 years), 82.5% were male (n=762), and 17.5% were female (n=162). PMC was performed on 53.7% (n=496) of the patients, 32.5% (n=300) received LFR, and 13.9% (n=128) underwent KF. PMC was the first choice among females but LFR was the first choice in recurrent patients. The recurrence rate was 10.8% in the PMC group, 8% in the LFR group, and 3.1% in the KF group. In Short Form Survey-36 (SF-36) scores, the best cosmetic outcomes were observed in cases of PMC (p<0.05). Overall, wound dehiscence (WD) was observed in 7.5%, surgical site infection (SSI) in 2.4%, and seroma in 8.5% of all patients. The KF group had the lowest complication rates (p<0.01). Conclusions: According to the results of this study, the reason for preferring PMC among women is cosmetic concerns. PMC still remains important for treatment, but it should be noted that the recurrence rates due to inadequate excision are mostly observed in cases of PMC. Considering their low recurrence rates, LFR or KF should be considered first. When low recurrence rates, patient comfort, and cosmetic results are evaluated together, KF in particular emerges as a method preferred by physicians and patients.
Turkish journal of trauma & emergency surgery, 1997
Bu çalışmada 1990-1995 yılları arasındaki 5 yıllık periyod içinde Ankara Numune Hastanesi Acil Ce... more Bu çalışmada 1990-1995 yılları arasındaki 5 yıllık periyod içinde Ankara Numune Hastanesi Acil Cerrahi Servisinde tedavi edilen 57 travmatik kolon yaralanmak hasta retrospektif olarak incelendi. 57 hastanın 23'ü (%40) ateşli silah yaralanması (ASY), 22'si (%39) delici kesici ...
Glutathione peroxidase activities and malondialdehyde levels were measured in the homogenated ant... more Glutathione peroxidase activities and malondialdehyde levels were measured in the homogenated anterior segment of rat eyes with endotoxin induced acute anterior uveitis in euthyroid, hyperthyroid and hypothyroid rats. Malondialdehyde concentrations were found to be significantly increased (p < 0.0005) and glutathione peroxidase activities significantly decreased (p < 0.01) in the hyperthyroid group when compared with controls. Malondialdehyde concentrations of the hypothyroid rat eyes were higher than the control group (p < 0.05), but glutathione peroxidase activities of the same group showed no difference with controls (p>0.05). These results suggest that excess or deficiency of the thyroid hormones cause alterations in the malondialdehyde levels and glutathione peroxidase activities of the rat eyes in endotoxin induced uveitis, and hyperthyroidism may increase the oxidative stress in endotoxin induced acute anterior uveitis. Key words: endotoxin induced uveitis (EIU)-hyperthyroidismhypothyroidismmalondialdehyde (MDA)glutathione peroxidase (GPx).
Hydatid cyst A case of inferior vena caval thrombosis is presented. Thrombosis was caused Inferio... more Hydatid cyst A case of inferior vena caval thrombosis is presented. Thrombosis was caused Inferior vena cava by compression through a hydatid cyst. The patient died because of pulmo-Thrombosis nary embolism.
... The role of nitric oxide on neutrophil chemostaxis and bacterial translocation in a sepsis mo... more ... The role of nitric oxide on neutrophil chemostaxis and bacterial translocation in a sepsis model: An experimental study. Nuri A. KAMA, Mete DOLAPÇI, Mutlu DOGANAY, Erhan REIS, Yunus N. YUKSEK, Gul DAĞLAR. ... Kaplan et al. ...
Carcinoid tumors which arise from enterochromaffin cells are usually found in the appendix, ileum... more Carcinoid tumors which arise from enterochromaffin cells are usually found in the appendix, ileum, bronchus and rectum. Biliary duct carcinoids are exceedingly rare. Pre-operative diagnosis is very difficult because they mimic the signs and symptoms of choledocholithiasis. We report a case of biliary duct carcinoid. A 38-year-old woman admitted with signs and symptoms of obstructive jaundice. ERCP demonstrated an obstruction in the common bile duct. A choledochotomy T drainage was performed. Histopathologically the mass which was removed from the common bile duct was a carcinoid tumor. There are only nine cases of biliary duct carcinoid in the literature to date. These cases are reviewed.
Background: Hernia repair is one of the most frequent procedures in surgery. The aim of this stud... more Background: Hernia repair is one of the most frequent procedures in surgery. The aim of this study is to compare Lichtenstein procedure and non-mesh suture repair of primary inguinal hernias with respect to quality of life. Methods: Between August 2000 and December 2003, 70 patients scheduled for repair of a unilateral primary inguinal hernia were prospectively evaluated by Short Form 36 (SF-36) to assess quality of life after 6 months of operation. Registrars under supervision of consultants did all operations. Results: Among 70 patients, 24 patients (34.2%) had undergone non-mesh suture repair and 46 patients (65.8%) had undergone Lichtenstein procedure. SF-36 questionnaire showed a significant diff erence in physical function, pain and global health parameters of the test in favour of the Lichtenstein procedure 6 months postoperatively. Conclusion: We conclude that long-term quality of life following Lichtenstein procedure is superior to non-mesh suture repair in primary inguinal hernias.
Journal of Gastroenterology and Hepatology, Apr 1, 2007
Background and Aim: With the introduction of H2 receptor antagonists and proton pump inhibitors,... more Background and Aim: With the introduction of H2 receptor antagonists and proton pump inhibitors, the incidence of elective surgery for peptic ulcer (PU) diseases has decreased, although complications of PU such as perforation and bleeding have remained fairly constant. The purpose of this study was to identify the risk factors that predict morbidity and mortality in patients with perforated PU.Methods: The records of 269 patients who were operated on for perforated PU were reviewed retrospectively. The following factors were analyzed in terms of morbidity and mortality: age &gt;65 years; gender; associated medical illness; chronic ingestion of non‐steroidal anti‐inflammatory drugs, aspirin, corticosteroids or immunosuppressants; alcohol ingestion and smoking habits; American Society of Anesthesiologist (ASA) status; season; delayed operation; site of ulcer perforation; and shock on admission and type of operation.Results: There were 30 female (11.16%) and 239 male (88.84%) patients. Seventy‐one (26.4%) patients had associated diseases. Simple closure was performed in 257 (95.5%) patients; 12 patients (4.5%) underwent definitive operations. A total of 108 postoperative complications were present in 65 (24.2%) patients. Twenty‐three patients died (8.55%). Multivariate analysis showed that only age, ASA score, treatment delay, presence of shock and definitive operation were independent predictors of mortality. Significant risk factors that led to morbidity were ASA status, time of surgery, season, presence of shock and type of surgery. There was a significant difference concerning morbidity and mortality between simple closure of the perforation and definitive surgery.Conclusions: Age, delayed surgery, presence of shock, ASA risk and definitive surgery are factors significantly associated with fatal outcomes in patients undergoing emergency surgery for perforated PU. Therefore, proper resuscitation from shock, improving ASA grade, decreasing delay and reserving definitive surgery for selected patients is needed to improve overall results.
Tiroid hastalıklarında sık kullanılan ameliyat öncesi tanı yöntemi olan İİAB' nin histopatolojik ... more Tiroid hastalıklarında sık kullanılan ameliyat öncesi tanı yöntemi olan İİAB' nin histopatolojik inceleme ile korelasyonunu yaparak kendi klinik deneyimimiz eşliğinde bu yöntemin duyarlılığını ortaya koymayı amaçladık. Gereç ve yöntem: Ankara Numune Eğitim ve Araştırma Hastanesi 2. Cerrahi Kliniği'nde Ocak 2006-Aralık 2010 tarihleri arasında total tiroidektomi ameliyatı uygulanan 355 hasta malignite oranı ve ince iğne aspirasyon biyopsinin tiroidektomi öncesi maligniteyi saptamadaki özgüllüğü ve duyarlılığı yönünden geriye dönük olarak incelendi. Hastaların preoperatif dönemde yapılan laboratuar incelemeleri, tiroidin fonksiyonel durumu, ultrasonografi, sintigrafi ve tiroid İİAB gibi tanı yöntemleri ile postoperatif histopatolojik inceleme sonuçları korele edildi. Bulgular: İİAB uygulanan 167 hastanın patolojik inceleme sonucunda, benign sonuç % 58 (n=97), şüpheli sonuç % 29,9 (n=50), yetersiz materyal oranı % 6,6 (n=11) ve malign sonuç % 5,4 (n=9)'unda raporlandı. Çalışmamızdaki İİAB nin duyarlılığı %83, özgüllüğü %100 olarak saptandı. Sonuç: Bu çalışmada sunulan veriler, operasyon gerekliliğinin belirlenmesi ve malignitenin doğrulanmasında İİAB nin kullanımını desteklemektedir. Negatif İİAB sonucu diğer klinik faktörlerle gerekliliği gösterilen operasyonu engellememelidir. Rezeksiyonun büyüklüğüne, oluşmuş risk faktörlerinin ve boyun eksplorasyonundaki bulgularına bakılarak karar verilmelidir.
Objective: To investigate the factors associated with patients with Fournier's gangrene, and to c... more Objective: To investigate the factors associated with patients with Fournier's gangrene, and to clarify the effect of diabetes mellitus (DM) as a comorbid disease on morbidity and mortality of patients with Fournier's gangrene. Methods: Twenty-six Fournier's gangrene patients who were admitted to the Emergency Department of Ankara Numune Teaching and Research Hospital, Ankara, Turkey from 1997 to 2003 were examined retrospectively. Results: The mean age of the patients was 52.8 years. There were 8 female (30.8%) and 18 male (69.2%) patients. The etiological causes were as follows: diseases of the perianal region, history of operations, trauma and injections. Major comorbid disease states were diabetes mellitus (DM) and hypertension. The lesions in Fournier's gangrene were most commonly located in the perineum and genital region. Female patients with diabetes mellitus had significantly unusual extensive involvement, especially abdominal wall involvement. The most frequently isolated pathogen was Escherichia coli, while staphylococcal infection was most commonly seen in the presence of DM. Colostomy was performed on 53.8% of the patients, and cystostomy on 7.6% of the patients. Average time of staying at the hospital was 25 days with a mortality rate of 34.6%. Patients with DM had high mortality rates and stayed longer at the hospital than the non-diabetic patients. Conclusion: In addition to early diagnosis, early and aggressive debridement and administration of multiple wide spectrum antibiotics chosen for the causative agent are the golden standard for decreasing the mortality and morbidity. Diabetes mellitus has been found to be an important factor to increase mortality rates of patients with Fournier's gangrene.
Objective: To examine respiratory functions of patients after open and laparoscopic cholecystecto... more Objective: To examine respiratory functions of patients after open and laparoscopic cholecystectomy and to compare the advantages. Methods: Fifty five cases with cholelithiasis subjected to elective cholescystectomy were studied. The patients were divided into two groups. Open Cholecystectomy (OC) was performed on 27 cases (Group I), and Laparoscopic Cholecystectomy (LC) in 28 cases (Group II). Respiratory function tests were performed 24 hours before the operation and on the 1st and 6th day after surgery. Blood gas values and anaesthesia periods were recorded. Forced expiratuary volume in the 1st second (FEV1), forced vital capacity (FVC) and FEV1/FVC values were also noted. Results: FEV1, FVC and FEV1/FVC values on first post-operative day in all cases were statistically lower than the preoperative values (p = 0.0001). Percentage changes of respiratory function test was calculated preoperatively and 1st postoperative day. The changes in both groups showed a significant decrease in FEV1, FVC and FEVI/FVC in Group I compared to Group II (p = 0.0001 in FEV1, p = 0.007 in FVC and p = 0.004 in FEV1/FVC). There was no significant difference in respiratory function tests evaluated on the 6th postoperative day and they had returned to normal values. There was no difference among preoperative and postoperative PaCO2, pH values in arteriel blood gas values in all cases (p = 0.355 p = 0,215). These parameters did not differ in both groups (p = 0.527, p = 0.591), There was a significant decrease in PaO2 and O2 saturation in all cases (p = 0.0001), but there was no significant difference when both groups were compared (p = 0.166, p = 0.678). Conclusion: The better results of pulmonary function tests in patients subjected to LC proves the advantage of the procedure over OC.
Introduction: Haemostasis is very important in thyroid surgery. In conventional surgery, electroc... more Introduction: Haemostasis is very important in thyroid surgery. In conventional surgery, electrocoagulation and suture ligation are used for haemostasis; newer techniques include vessel clips, ultrasonic instruments and lasers. The aim of this prospective study was to compare the usage of the ultrasonic harmonic scalpel (UHS) with conventional procedures, in total thyroidectomies, for operation time, blood loss, usage of drain, cost, length of hospitalisation and complications. Methods: We examined 104 patients who underwent bilateral total thyroidectomy. They were divided randomly into two groups. Patients in Group I (n=54) underwent operations using conventional techniques (electrocautery and suture ligation) while patients in Group II (n=50) underwent operations using the UHS. Operation time, number of ligatures used, blood loss, intra-operative complications, weight of the specimen, necessity of drain, postoperative seroma, bleeding, infection, transient or permanent hypocalcaemia, permanent recurrent laryngeal nerve palsy and length of hospitalisation were recorded. Results: The operation time was significantly longer in Group I (conventional) (105±16 minutes; mean±standard deviation) than Group II (UHS) (77.9±12.5 minutes; P<0.001). The mean blood loss was less in patients who were operated on with the UHS (25.3±10.2 g) than in patients operated on with conventional methods (59.5±33.9 g; P<0.
OBJECTIVE This study aimed to investigate the presence of indoleamine-2,3-dioxygenase and bacteri... more OBJECTIVE This study aimed to investigate the presence of indoleamine-2,3-dioxygenase and bacterial translocation after the administration of 3-aminobenzamide and infliximab in the TNBS model of rat colitis. METHODS The study group was divided into five categories as follows: group 1: (control), group 2: colitis+saline, group 3: colitis+3-aminobenzamide, group 4: colitis+infliximab, and group 5: colitis+3-aminobenzamide+infliximab. Intestinal mesenteric cultures were incubated on specific agar media plates under aerobic and anaerobic conditions, bacterial translocation was evaluated and assessed as colony-forming units per gram of tissue. Colonic tissue samples were evaluated by Western blotting method to detect the presence of indoleamine-2,3-dioxygenase. RESULTS The results obtained were as follows: group 1: normal gut flora; group 2: eight of nine samples had bacterial translocation, of which six of them had positive indoleamine-2,3-dioxygenase protein; group 3: five of nine samp...
Ethyl pyruvate is a simple derivative in Ca+2- and K+-containing balanced salt solution of pyruva... more Ethyl pyruvate is a simple derivative in Ca+2- and K+-containing balanced salt solution of pyruvate to avoid the problems associated with the instability of pyruvate in solution. It has been shown to ameliorate the effects of ischemia-reperfusion (I/R) injury in many organs. It has also been shown that I/R injury delays the healing of colonic anastomosis. In this study, the effect of ethyl pyruvate on the healing of colon anastomosis and anastomotic strength after I/R injury was investigated. Anastomosis of the colon was performed in 32 adult male Wistar albino rats divided into 4 groups of 8 individuals: (1) sham-operated control group (group 1); (2) 30 minutes of intestinal I/R by superior mesenteric artery occlusion (group 2); (3) I/R+ ethyl pyruvate (group 3), ethyl pyruvate was administered as a 50-mg/kg/d single dose; and (4) I/R+ ethyl pyruvate (group 4), ethyl pyruvate administration was repeatedly (every 6 hours) at the same dose (50 mg/kg). On the fifth postoperative day, animals were killed. Perianastomotic tissue hydroxyproline contents and anastomotic bursting pressures were measured in all groups. When the anastomotic bursting pressures and tissue hydroxyproline contents were compared, it was found that they were decreased in group 2 when compared with groups 1, 3, and 4 ( P &lt; .05). Both anastomotic bursting pressure ( P = .005) and hydroxyproline content ( P &lt; .001) levels were found to be significantly increased with ethyl pyruvate administration when compared with group 2. When ethyl pyruvate administration doses were compared, a significant difference was not observed ( P &gt; .05). Ethyl pyruvate significantly prevents the delaying effect of I/R injury on anastomotic strength and healing independent from doses of administration.
ABSTRACT Objective: Pilonidal sinus disease (PSD) is a benign disease caused by hair follicles in... more ABSTRACT Objective: Pilonidal sinus disease (PSD) is a benign disease caused by hair follicles in sacrococcygeal region. Despite the use of different methods in treatment, there is no consensus reached for treatment modalities. In this study we compared the primary repair and limberg flap method. Material and Methods: In this study, 376 PSD patients who underwent surgery in our clinic between 2005 -2012 were analyzed retrospectively.184 of these patients managed with primary repair and 192 with limberg flap. Patients who have acute enflamation symptoms and abcess were excluded. Patients evaluated rertospectively. All data examined for statistical analysis. Results: Surgery time and hospital stay were significantly higher in patients who underwent Limberg flap repair (p0,05). But cosmetic care, surgical site paresthesia were found higher in limberg flap group(p
Purpose Splenectomy is associated with increased risk of overwhelming post-splenectomy infections... more Purpose Splenectomy is associated with increased risk of overwhelming post-splenectomy infections despite proper anti-pneumococcal vaccination. As most studies concentrated on vaccination-induced humoral immunity, the cellular immune responses triggered in splenectomized patients are not yet well studied. The present study aims to investigate this area as it can contribute to the development of more effective vaccination strategies. Methods Five healthy and 14 splenectomized patients were vaccinated with pneumococcal conjugate polysaccharide vaccine (PCV) followed by pneumococcal polysaccharide vaccine according to the guidelines established by Advisory Committee on Immunization Practices. PBMC samples collected 0, 8, and 12 weeks after PCV immunization were in vitro stimulated with PCV. Levels of lymphoproliferation, T H cell differentiation, and cytokine release were assessed by carboxyfluorescein succinimidyl ester labeling, intracellular cytokine staining, and ELISA, respectively. Results While T H 1-dominated immune response was detected in both groups, asplenic individuals generated significantly lower levels of T H 1 cells following in vitro stimulation. Similarly, levels of IFN-γ, IL-4, and IL-17 release and lymphoproliferation were significantly lower in asplenic patients. Conclusions According to our data, splenectomy negatively influences the levels of PCV-induced lymphoproliferation, T H 1 differentiation, and cytokine release. Besides, PCV failed to induce T H 17-dominant immune response which is crucial for protection against extracellular pathogens.
Departmental sources Background: Pilonidal sinus (PS) is a common disease of the sacrococcygeal-n... more Departmental sources Background: Pilonidal sinus (PS) is a common disease of the sacrococcygeal-natal region. There are many treatment options, but there is still no consensus on the ideal treatment. We compared the results of our PS patients who were treated with primary midline closure (PMC), Limberg flap repair (LFR), and Karydakis flap (KF). Material/Methods: The data for 924 PS patients from 2013 to 2017 were retrospectively examined. Demographic data, surgical procedures, schedules, and recurrence rates were examined. Results: The mean age was 28.4 years (14-77 years), 82.5% were male (n=762), and 17.5% were female (n=162). PMC was performed on 53.7% (n=496) of the patients, 32.5% (n=300) received LFR, and 13.9% (n=128) underwent KF. PMC was the first choice among females but LFR was the first choice in recurrent patients. The recurrence rate was 10.8% in the PMC group, 8% in the LFR group, and 3.1% in the KF group. In Short Form Survey-36 (SF-36) scores, the best cosmetic outcomes were observed in cases of PMC (p<0.05). Overall, wound dehiscence (WD) was observed in 7.5%, surgical site infection (SSI) in 2.4%, and seroma in 8.5% of all patients. The KF group had the lowest complication rates (p<0.01). Conclusions: According to the results of this study, the reason for preferring PMC among women is cosmetic concerns. PMC still remains important for treatment, but it should be noted that the recurrence rates due to inadequate excision are mostly observed in cases of PMC. Considering their low recurrence rates, LFR or KF should be considered first. When low recurrence rates, patient comfort, and cosmetic results are evaluated together, KF in particular emerges as a method preferred by physicians and patients.
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Papers by Mete Dolapci