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Öğe A New Preoperative Categorization and Potential Preoperative Indicator for Cysto-Biliary Fistula in Hydatid Hepatic Disease(Int College Of Surgeons, 2016) Menekse, Ebru; Turan, Umit; Özyazıcı, Sefa; Karateke, Faruk; Aziret, Mehmet; Bali, İlhan; Özdoğan, MehmetThe objective of this study was to determine the risk for cysto-biliary fistula (CBF) and preoperative predictive factors in patients with hepatic hydatid disease (HHD) with high levels of hepatobiliary enzymes (HLE) alone. The risk of CBF and predictive factors in patients with HHD whose only sign of fistula was HLE is unknown. A total of 116 patients without clinical and radiologic signs who were operated for HHD were categorized into 2 groups: patients with and without HLE. The patients with HLE were defined as usual suspicious.'' The potential preoperatively predictive factors for CBF were retrospectively analyzed in this group. Our data included 18.1% of patients (n = 21) with CBF and 69.2% of patients (n = 81) with HLE. The usual suspicious group contained 24.7% of patients (n = 20) with CBF. The risk of CBF was 11-fold higher in the usual suspicious group (95% confidence interval, 1.4-86.7). The red cell distribution width (RDW) was higher in patients with CBF than in patients without CBF in the usual suspicious group (P = 0.006). The performance of the RDW, with a cutoff value of 13.75%, was found to be suboptimal for predicting CBF for patients in the usual suspicious group (area under the curve, 0.661; 95% confidence interval, 0.525-0.798). We defined a new preoperatively high-risk group with HLE alone; this definition can help to identify patients at risk for preoperatively undetectable CBF. The RDW was not found to be sufficient for the discrimination of usual suspicious group with CBF.Öğe A Rare Cause of Intestinal Obstruction: Paraduodenal Hernia(Namık Kemal Üniversitesi, Tıp Fakültesi, 2014) Aziret, Mehmet; Reyhan, Enver; Erdem, Hasan; Sözen, SelimInternal abdominal hernias may rarely be the cause of intestinal obstruction with an incidence of less than 1% and paraduodenal hernias constitute approximately 50% of them. Those hernias emerge as a result of abnormalities in gut rotation at the embryonic stage. The clinical spectrum of a symptomatic internal hernia may range from abdominal pain to frank intestinal obstruction. Delay in the diagnosis and treatment should be avoided, since the content of paraduodenal hernia may quickly progress to strangulation and necrosis because of vascular compromise. Here, we report a case of successfully diagnosed and treated with cause of paraduodenal hernia.Öğe Basal Cell Carcinoma Appearing As a Suture Reaction Along The Incision Line(Namık Kemal Üniversitesi, Tıp Fakültesi, 2014) Aziret, Mehmet; Erdem, Hasan; Çetinkünar, Süleyman; Yaycıoğlu, İsmail Bülent; İrkörücü, Oktay; Emir, SeyfiThe most frequently occurring malignant neoplasm of the skin is basal cell carcinoma (BCC). It is seen most often around the head and neck area. Predisposing factors include exposure to ultraviolet radiation (UV) and inorganic arsenic, trauma, chronic wounds, immune dysfunction and plaques, such as sebaceous nevus.While squamous cell carcinoma is frequently encountered as a result of chronic wounds, silk fistulas and scar formation, cases of BCC are very rare. In incidences of BCC developing along the incision line, the treatment involves making a large surgical excision. Problems related to the incision site are most often observed in operations conducted at surgical clinics, with the most common cause being suture reactions. In cases of chronic ulceration and discharge, a diagnosis of BCC should be considered and a biopsy should be conducted.Öğe Can isolated pancreaticojejunostomy reduce pancreas fistula after pancreaticoduodenectomy with Roux-en-Y reconstruction?(2016) Erdem, Hasan; Çetinkünar, Süleyman; Aziret, Mehmet; Reyhan, Enver; Sözütek, Alper; Sözen, Selim; İrkörücü, OktayAmaç: Pankreatikoduodenektomi ampulla Vateri, pankreas başı, distal koledok tümörleri ve bazı kronik pankreatit olgularında yaygın kabul gören cerrahi prosedürdür. Rekonstrüksiyon sonrası pankreatik fistül halen ciddi bir problemdir. Rekonstrüksiyon yöntemleri hususunda üzerinde fikir birliği sağlanmış bir yöntem henüz yoktur.Gereç ve Yöntemler: Pankreas tümörü nedeniyle pankreatikoduodenektomi uygulanan hastalarda yapılan rekonstrüksiyon yöntemleri ve sonuçları retrospektif olarak araştırılmıştır. Tüm hastalardaki anastomoz Roux-en-Y şeklinde yapılmış olup birbirinden farkları ise şöyledir; Tip 1: Y bacağı ile sadece pankreatik anastomoz, Tip 2: Y bacağı ile pankreas ve hepatik kanal anastomozu birlikte yapılmıştır.Bulgular: Çalışmaya 31 hasta dahil edilmiştir. Hastaların 21'i erkek, 10'u kadındı. Çalışmamızda pankreatik fistül, kanama, abse, yara yeri enfeksiyonu ve akciğer enfeksiyonu postoperatif dönemde gözlenen komplikasyonlardı. Her ne kadar grup 2'de komplikasyonların sayısı grup 1'e kıyasla daha fazla gözlense de istatistiksel olarak anlamlı fark tespit edilmedi. Mortalite her iki grupta da birer hastada gelişti.Sonuç: Kaçağın sebeplerinden birinin aynı ans üzerine yapılan pankreas ve safra kanalı anastomozlarının birlikte debiyi yükseltmesi ve anastomoz basıncını arttırarak fistül oluşumuna neden olması olduğunu düşünüyoruz. Çalışmamızın dezavantajı ise hasta sayısının az olmasıdır. Pankreatik sıvı ile safranın ayrı anastomozlarla rekonstüksiyonu kronik pankreatik fistülleri azaltabilir.Öğe Comparison of Drainage, Delayed Pits Excision, and Closure With Excision and Secondary Healing in Pilonidal Sinus Abscess Cases(Int College Of Surgeons, 2016) Sözen, Selim; Aziret, Mehmet; Bali, İlhan; Yıldırım, Ali CihatA pilonidal abscess is an emergency situation which requires immediate drainage and is usually seen in young men. We aimed to compare incision and draining (I&D) of acute pilonidal abscess (PSA) and healing by secondary intention with I&D and subsequent delayed pits excision and closure (PE/PC). A total of 62 patients admitted with PSA were randomized to undergo either I&D and healing by secondary intention (group 1, n = 33) or I&D and PE/PC (group 2, n = 29). Demographic characteristics of the patients, abscess depth and location, duration and healing times of the symptoms, time required to return to work, and ratio of chronic pilonidal sinus (PNS) development were recorded, and the two methods were compared. No statistically significant differences were found between the groups in relation to sex, age, and preoperative findings, including discharge, infection, pain, and length and depth of abscess. There was no difference in length of hospital stay between the groups, and no statistically significant difference was found between the groups in terms of complication rate (P = 0.298). A statistically significant difference (P = 0.033) was, however, found between the two groups in the recurrence rate of a pilonidal abscess (9.09% in group 1 versus 3.44% in group 2). A statistically significant difference was also observed between the groups in terms of development of chronic PNS (P = 0.020). According to the results of our study, I&D and PE/PC should be the primary procedure used, as opposed to skin incision, curettage, and secondary healing for the treatment of PSA.Öğe Effectiveness of Limberg and Karydakis flap in recurrent pilonidal sinus disease(Hospital Clinicas, Univ Sao Paulo, 2015) Bali, İlhan; Aziret, Mehmet; Sözen, Selim; Emir, Seyfi; Erdem, Hasan; Çetinkunar, Süleyman; Irkorucu, OktayOBJECTIVE: Sacrococcygeal pilonidal sinus is common in young men and may recur over time after surgery. We investigated whether a factor exists that can aid in the determination of the preferred technique between the early Limberg flap and Karydakis flap techniques for treating recurrent pilonidal sinus. MATERIALS AND METHODS: This prospective and randomized study enrolled 71 patients with recurrent pilonidal sinus in whom the Limberg flap or Karydakis flap techniques were applied for reconstruction after excision. Patients were divided into two groups as follows: 37 patients were treated with the Limberg flap technique and 34 patients were treated with the Karydakis flap technique. Fluid collection, wound infection, flap edema, hematoma, partial wound separation, return to daily activities, pain score, complete healing time, painless seating and patient satisfaction were compared between the groups. ClinicalTrial.gov: NCT02287935. RESULTS: The development rates of total fluid collection, wound infection, flap edema, hematoma, and partial wound separation were 9.8%, 16%, 7%, 15% and 4.2%, respectively; total flap necrosis was not observed in any patient (p<0.001). During the average follow-up of 28 months, no patients (0%) developed recurrent disease. The two groups differed with respect to early surgical complications (p<0.001). CONCLUSION: In this study, use of the Limberg flap was associated with lower complication rates, shorter length of hospital stay, early return to work, low pain score, high patient satisfaction and better complete healing duration. Therefore, we recommend the Limberg flap for treatment of recurrent pilonidal sinus.Öğe IMPORTANCE OF TOGETHER USE OF ENDOSCOPIC AND INTRAOPERATIVE ULTRASONOGRAPHY IN THE DIAGNOSIS AND TREATMENT OF INSULINOMA(Namık Kemal Üniversitesi, Tıp Fakültesi, 2016) Arslan, Ersoy; Aziret, Mehmet; Akgündüz, Fatih; İrkörücü, Oktay; Reyhan, Enver; Adamhasan, Fulya; Bali, İlhan; Emir, SeyfiIntroduction: Insulinoma is a usually benign tumor of pancreas. It is seen rarely and incidence of insulinoma is 1 in 250,000 patient-years. We present a rare case with insulinoma which well diagnosed and treated with aid of endoscopic and intraoperative ultrasonography. Case Report: A patient involving a 39-year-old woman with complaints of cold sweats, weakness, syncope attacks, palpitations was evaluated in polyclinic. She was hospitalized with the diagnosis of pancreatic insulinoma after abdominal computer tomography(CT), magnetic resonance imaging(MRI) endoscopic ultrasonography(EUS), and biochemical parameters. The patient was well treated with enucleation and after imaging aid of endoscopic and intraoperative ultrasound(IOUS). Discussion: In patients with insulinoma, preoperative localization of tumor is most important for diagnosis and treatment. Therefore; CT scanning, MRI, EUS and SPECT / CT are used for diagnosis of insulinoma. Together use of endoscopic and intraoperatively ultrasonography are increasing recently. Enucleation is a curative treatment approach in insulinoma. Conclusion: Together using of preoperative endoscopic and intraoperative ultrasound is quite helpful in the diagnosis and treatment of insulinoma.Öğe MASSIVE PELVIC CELLULITIS MIMICKİNG FOURNIER'S GANGRENE: A CASE REPORT AND REVIEW OF THE LITERATURE(Namık Kemal Üniversitesi, Tıp Fakültesi, 2016) Aziret, Mehmet; Dülger, Mahmut; Şahin, Mutlu; Karasatı, Seval Boyraz; Bali, İlhanIntroduction: Fournier’s gangrene (FG), a localized form of necrotizing fasciitis (NF), is a rapidly progressive infectious disease that particularly affects the genital area. Cellulitis, however, is a mild disease that affects the skin and extremities. Case Report: We report a case involving a 71-year-old woman with a rash, extending from her thigh to her breast, which had begun two days prior to her visit to the ER. She was referred to our clinic with an initial diagnosis of extensive pelvic cellulitis mimicking Fournier's gangrene. Following the first assessment (blood glucose >500 mg/dL, pyrexia of 38.3 °C), she was admitted to the intensive care unit, where she received antibiotics and dressings and was monitored. Showing a good recovery, she was discharged in two weeks. Discussion: In the diagnosis and treatment of Fournier's gangrene, significant advancements have been made since it was first described by Jean-Alfred Fournier in 1883. The disease’s morbidity and mortality, however, is still between 25% and 35%. Conclusion: In patients with FG, early diagnosis and aggressive treatment are highly recommended.Öğe Pancreatic Gastrointestinal Stromal Tumor after Upper Gastrointestinal Hemorrhage and Performance of Whipple Procedure: A Case Report and Literature Review(Int Scientific Literature, Inc, 2015) Aziret, Mehmet; Çetinkunar, Süleyman; Aktaş, Elife; Irkorucu, Oktay; Bali, İlhan; Erdem, HasanObjective: Rare disease Background: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the gastrointestinal system. These types of tumors originate from any part of the tract as well as from the intestine, colon, omentum, mesentery or retroperitoneum. GIST is a rare tumor compared to other types of tumors, accounting for less than 1% of all gastrointestinal tumors. Case Report: A 56-year-old male patient was hospitalized due to an upper gastrointestinal hemorrhage and the start of abdominal pain on the same day. In the upper gastrointestinal endoscopy that was performed, a solitary mass was found in the second section of the duodenum and a blood vessel (Forrest type 2a) was seen. The extent and location of the mass was detected by abdominal tomography. After hemodynamic recovery, a Whipple procedure was performed without any complications. A subsequent histopathological examination detected a c-kit-positive (CD117) pancreatic GIST with high mitotic index. Conclusions: The most effective treatment method for GISTs is surgical resection. In patients with a head of pancreatic GIST, the Whipple procedure can be used more safely and effectively.Öğe Protective Effect of Nigella Sativa in an Animal Model of Colon Anastomosis With Ischemia/Reperfusion Injury(Int College Of Surgeons, 2018) Bali, İlhan; Polat, Fatin Rüştü; Aziret, Mehmet; Sözen, Selim; Oruc, Cem; Coskunkan, Ufuk; Koç, Ahmet; Bilir, Bülent; Emir, SeyfiObjective: Anastomotic leaks are one of the chief complications after gastrointestinal surgery. The aim of this study was to evaluate whether Nigella sativa administration protects against ischemia/reperfusion injury on healing of colonic anastomosis in rats. Method: Thirty male Wistar albino rats, weighing between 200 and 240 g, were used in the study. They were randomly divided into three groups (n = 10 for each group): Anastomosis (group 1), anastomosis and ischemia/reperfusion injury (group 2), and treatment group of anastomosis, ischemia/reperfusion injury, and Nigella sativa (group 3). After 7 days, serum, plasma, and colonic tissue were obtained and then all rats were sacrificed. Tissue and serum level of total oxidant status, total antioxidant status, total thiol levels, hydroxyproline, interleukin-6, and TNF-alpha were determined and specimens were histopathologically evaluated. Results: In the Nigella sativa treated rats, serum hydroxyproline levels were significantly higher, while tissue levels were significantly lower than those seen in group 1 and group 2 (P = 0.007, P = 0.01, respectively). In the Nigella sativa group, the serum levels of TNF-alpha were significantly lower than those seen in group 1 and 2 (P = 0.001). Also, in group 3, the tissue IL-6 level was significantly higher than that seen in group 1 and group 2 (P = 0.009). The histopathologic analysis showed less edema and inflammatory cell infiltration in the Nigella sativa treated group, as well as a statistically significant difference according to the Chiu classification (P < 0.05). Conclusion: The results of this study indicate that Nigella sativa has a protective and therapeutic effect against ischemia/reperfusion injury on the healing of colonic anastomosis in rats.Öğe The appearance of free-air in the abdomen with related pneumatosis cystoides intestinalis: Three case reports and review of the literature(Elsevier Sci Ltd, 2014) Aziret, Mehmet; Erdem, Hasan; Ülgen, Yiğit; Kahramanca, Sahin; Çetinktinar, Stileyman; Bozkurt, Hilmi; Irkorucu, Oktay; Bali, İlhanINTRODUCTION: Pneumatosis sistoides intestinalis (PSI) is a rare condition with unknown origin, defined as the appearance of gas-filled cysts in the intestinal wall. It usually occurs due to respiratory infections, tumor or collagen disease, traumas, immunosuppression. PRESENTATION OF CASE: Three patients with PSI were examined that followed up and treated in our clinic. The first patient was hospitalized for emergency treatment of previously diagnosed free-air under the diaphragm. He had a defense on physical examination and free-air was detected in X-ray and abdomen CT. We decided to laparatomy and peroperatively, stenotic pylorus with an abnormally increased stomach and gas-filled cysts were seen in the terminal ileum. Antrectomy and gastrojejunostomy with partial ileum and cecum resection and end ileostomy were performed. The second patient underwent laparatomy because of intraperitoneal free-air and acute abdomen. Partial ileum and cecum resection and ileotransversostomy were performed. The third patient with intraperitoneal free-air was treated with antibiotics, oxygen treatment and bowel rest. DISCUSSION: PSI is usually asymptomatic. Plain radiographs, USG, CT, upper gastrointestinal endoscopy, colonoscopy can use for diagnosis. Treatment of PSI depends on the underlying cause; include elemental diet, antibiotics, steroids, hyperbaric oxygen therapy and surgery. CONCLUSION: In patients with asymptomatic and symptomatic PSI are different treat. Symptomatic PSI can be safely treated antrectomy and gastrojejunostomy with partial ileum and cecum resection. (C) 2014 The Authors. Published by Elsevier Ltd. on behalf of Surgical Associates Ltd. This is an open access article under the CC BY-NC-SA license.Öğe The Effect of Curcumin on an Animal Intestinal Ischemia/Reperfusion Model for Bacterial Translocation and Inflammatory Response(Int College Of Surgeons, 2015) Sözen, Selim; Aziret, Mehmet; Bali, İlhan; Emir, Seyfi; Ülgen, Yiğit; Binnetoğlu, Kenan; Çetinkunar, SüleymanIschemia/reperfusion (IR) injury of the intestine is a major problem in abdominal pathological condition and is associated with a high morbidity and mortality. The purpose of the study is to investigate the effects of curcumin on the bacterial translocation incidence and inflammatory response in rats submitted to bowel ischemia reperfusion injury. Thirty-two Wistar albino rats with a weight of 200 to 250 g were used in the study. They were randomly divided into 3 groups (n = 10 for each group): sham only operated group(group I); IR group (group II); and IR + curcumin treatment group (group III). Curcumin (curcumin from Curcuma longa) 20 mg/kg/day was given orally to the curcumin group. All animals were given 109 E. Coli by orogastric intubation 12 hours before sampling. Seventy-two hours after the first operation, mesenteric lymph node and blood samples were obtained and cultured. Blood samples of 2 mL were obtained for a polymerase chain reaction study. A piece of terminal ileum was also sampled for histopathologic examination. Mesenteric lymph node and blood cultures of all control animals were positive for microbiological growth, and polymerase chain reaction results were positive in seven of the eight rats. Histopathologically, edema, vasodilatation and inflammatory cell infiltration were found to be less in the other groups in comparison to the control group. Curcumin reduced bacterial translocation in blood, hepatocellular damage, and plasma cytokine levels. Curcumin reduced the incidence of bacterial translocation in intestinal I/R. rats. These results suggest that Curcumin would be clinically useful in the treatment of intestinal I/R injury.Öğe The effects of vardenafil and pentoxifylline administration in an animal model of ischemic colitis(Hospital Clinicas, Univ Sao Paulo, 2014) Aziret, Mehmet; Irkorucu, Oktay; Reyhan, Enver; Erdem, Hasan; Das, Koray; Özkara, Selvinaz; Deger, Kamuran Cumhur; Sözen, Selim; Bali, İlhanOBJECTIVES: Vardenafil enhances dilatation of vascular smooth muscle and inhibits platelet aggregation. The purpose of this study was to evaluate the clinical effects of vardenafil and pentoxifylline administration in an experimental model of ischemic colitis. METHODS: Forty female Wistar albino rats weighing 250-300 g were randomized into five experimental groups (each with n = 8) as follows: 1) a sham group subjected to a sham surgical procedure and administered only tap water; 2) a control group subjected to a standardized surgical procedure to induce ischemic colitis and administered only tap water; 3) and 4) treatment groups subjected to surgical induction of ischemic colitis followed by the postoperative administration of 5 mg/kg or 10 mg/kg vardenafil, respectively; and 5) a treatment group subjected to surgical induction of ischemic colitis followed by postoperative administration of pentoxifylline at 50 mg/kg/day per day as a single dose for a 3-day period. All animals were sacrificed at 72 h post-surgery and subjected to relaparotomy. We scored the macroscopically visible damage, measured the ischemic area and scored histopathology to determine the severity of ischemia. Tissue malondialdehyde levels were also quantified. RESULTS: The mean Gomella ischemic areas were 63.3 mm(2) in the control group; 3.4 and 9.6 mm(2) in the vardenafil 5 and vardenafil 10 groups, respectively; and 3.4 mm(2) in the pentoxifylline group (p = 0.0001). The mean malondialdehyde values were 63.7 nmol/g in the control group; 25.3 and 25.6 nmol/g in the vardenafil 5 and vardenafil 10 groups, respectively; and 22.8 nmol/g in the pentoxifylline group (p = 0.0001). CONCLUSION: Our findings indicate that vardenafil and pentoxifylline are effective treatment options in an animal model of ischemic colitis. The positive clinical effects produced by these drugs are likely due to their influence on the hemodynamics associated with vascular smooth muscle and platelet functions.Öğe The Protective Effect of Silymarin on Cholestatic Liver Injury(Carbone Editore, 2015) Bilgin, Bülent Çağlar; Tokgöz, Serhat; Çetinkunar, Süleyman; Aziret, Mehmet; Erdem, Hasan; Aktimur, Recep; Sözen, SelimIntroduction: Medical and surgical problems caused by obstructive jaundice is an important problem for surgeons and gastroenterologists. Silymarin prevents liver damage by maintaining the integrity of the plasma membrane. Purpose: The aim of this study was to evaluate whether silymarin administration would protect against cholestatic liver injury in rats with bile duct ligation. Methods: Thirty male Sprague-Dawley rats with a weight of 200-240 g were used in the study. They were randomly divided into three groups (n = 10 for each group): sham group only operated (Group I), control group was bile duct ligation (BDL) (Group II), and treatment group was IR+ BDL+silymarin (Group III) Silymarin 200 mg/kg/day was given by orally to the Silymarin group for 10 days. After 10 days, all rats were sacrificed, plasma and liver samples were obtained. Blood parameters were measured and tissue level of Glutathione (GSH), malondialdehyde (MDA) and copper/zinc superoxide dismutase (Cu / Zn SOD) were determined. The degree of portal inflammation, necrosis, vacuolar degeneration, sinusoidal dilatation, vascular congestion and fibrosis were evaluated histopathologically. Results: In the silymarin treated rats, MDA levels and liver tissue Cu-Zn SOD levels were significantly lower, while GSH levels were significantly higher than that of the BDL group (p = 0.001, p = 0.05, p = 0.001, respectively). In the BDL+silymarin group, the levels of LDH were significantly lower than that of the BDL group (p = 0.01). Conclusions: Our results supported indicate that silymarin exerts a protective and therapeutic effect on cholestatic liver injury in bile duct ligated rats.
