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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 A Rare Complication of Incisional Hernia Repair: Gastric Obstruction Due to Mesh Migration on Gastroenterostomy Line(Namık Kemal Üniversitesi, Tıp Fakültesi, 2014) Erdem, Hasan; Sözen, Selim; Çetinkünar, Süleyman; Bali, İlhan; İrkörücü, OktayHernia repair is one of the most common elective procedures in general surgery. Agreement has been achieved that tension-free hernia repair using prostheses reducesrecurrence rates significantly. Approximately 60% of prosthetic repairs of the inguinal flor are believed to use a flat mesh of some type, and 90% of incisional and ventral herniarepairs incorporate the use of a synthetic prosthesis. However, the use of prosthetic mesh for hernia repair can cause serious complicationssuch as infection, seroma formation, fistulae formation, adhesion, biomaterial-related intestinal obstructions, and other miscellaneous complications. Mesh migration is dangerous and rare complication after hernia repair. Hereby, reporting a rare case of intra-peritoneal migration of polypropylene mesh and its adhesion to stomach wall following onlay mesh repair of incisional hernia.Öğe Adrenal insidentalomalarda cerrahi yaklaşım: On üç olgu sunumu ve literatür derlemesi(2016) Erdem, Hasan; Çetinkünar, Süleyman; Kuyucu, Faruk; Erçil, Hakan; Görür, Mustafa; Sözen, SelimAmaç: Adrenal insidentalomalar rutin görüntüleme tekniklerinde yaklaşık %4-7 oranında tespit edilirler. Çoğunlukla benign olmakla birlikte dikkatli klinik ve laboratuvar incelemeleri sonrasında karsinom veya fonksiyonel adenomlar belirlenebilir.Gereç ve Yöntemler: Ocak 2010-Haziran 2014 tarihleri arasında adrenal kitle tespit edilerek cerrahi tedavi uygulanan 13 hastanın bulguları retrospektif olarak incelendi.Bulgular: Olgulardan 7'si (%54) erkek, 6'sı (%46) kadın, ortalama yaş 38,2 idi. Klinik tanılarda 5 hastada (%38,4) feokromasitoma, 5 hastada (%38,4) nonfonksiyone adenom, 1 hastada (%7,6) metastatik lezyon, 1 hastada (%7,6) Cushing sendromu, 1 hastada (%7,6) sürrenal karsinom tespit edilmiştir. Cerrahi tedavi uygulanan hastaların 8'ine laparotomi ile, 52'sine de laparoskopik adrenalektomi uygulanmıştır.Sonuç: Adrenal insidentaloma saptanan olgular asemptomatik olsa dahi hormonal yönden detaylı olarak incelenmeli, non-fonksiyone kitlelere ise malignite kuşkulu lezyonlar olarak bakılmalıdır. Kitle boyutu 6 cm'den küçük ve komşu organ infiltrasyonu bulunmayan hastalarda laparoskopik adrenalektomi altın standart haline gelmektedir.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 Effect of bariatric surgery on humoral control of metabolic derangements in obese patients with type 2 diabetes mellitus: How it works(Baishideng Publishing Group Inc, 2015) Çetinkunar, Süleyman; Erdem, Hasan; Aktimur, Recep; Sözen, SelimObesity and diabetes is a co-pandemic and a major health concern that is expanding. It has many psychosocial and economic consequences due to morbidity and mortality of this disease combination. The pathophysiology of obesity and related diabetes is complex and multifactorial. One arm of this disease process is the genetic susceptibility. Other arm is dependent on the intricate neuro-humoral factors that converge in the central nerve system. Gut hormones and the adipose tissue derived factors plays an important role in this delicate network. Bariatric surgery provides the only durable option for treatment of obesity and furthermore it provides a remission in the concomitant diseases that accompany obesity. This review provides a brief insight to all these mechanisms and tries to deduce the possible reasons of remission of type 2 diabetes after bariatric surgery.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 Evaluation of mean platelet volume as a diagnostic biomarker in acute appendicitis(E-Century Publishing Corp, 2015) Erdem, Hasan; Aktimur, Recep; Çetinkunar, Süleyman; Reyhan, Enver; Gökler, Cihan; Irkorucu, Oktay; Sözen, SelimBackground: Diagnosis of acute appendicitis remains to be challenging with up to 30% negative exploration rates. In addition to careful clinical history and physical examination, we still need easily applicable, cheap and effective biomarker. Patients and methods: A retrospective case-controlled study was designed in two groups, both containing 100 patients, acute appendicitis and control. Leukocyte count, neutrophil percentage, platelet count and meal platelet volume (MPV) were compared. Results: MPV values for acute appendicitis and control groups were 7.4 +/- 0.9 fL (5.6-10.6) and 9.1 +/- 1.6 fL (5.1-13.1). For the diagnosis of acute appendicitis, ROC analysis revealed 74% sensitivity and 75% specificity for a cut-off value of 7.95 fL of MPV, however, the diagnostic value of leukocyte count and/or neutrophil ratio was superior. Conclusion: Our results suggest that, MPV value is an important parameter in the diagnosis of acute appendicitis, but in terms of sensitivity and specificity, leukocyte count and/or neutrophil percentage is superior.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 Primary Thyroid Lymphoma Causing Progressive Respiratory Distress: A Case Report(Namık Kemal Üniversitesi, Tıp Fakültesi, 2014) Erdem, Hasan; Çetinkunar, Süleyman; Bali, İlhan; Demirtürk, Pelin; Gökler, Cihan; Sözen, Selim; İrkörücü, OktayPrimary thyroid lymphoma (PTL) is a rare malignancy of the thyroid gland. It usually presents itself as a very rapidly growing mass, and respiratory distress is commonly the first finding. Ultrasound guided fine needle aspiration biopsy and surgical biopsy can help with its diagnosis. The treatment is radiotherapy and chemotherapy. Surgical treatment is only indicated in cases which tracheal compression is severe. In this report, we present a primary thyroid lymphoma case, which presented with progressive respiratory distress, and dramatically went into remission with medical therapy, along with a literature review.Öğe Surgical approach in adrenal incidentalomas: Report of thirteen cases and review of the literature(Aves, 2016) Erdem, Hasan; Çetinkunar, Süleyman; Kuyucu, Faruk; Ercil, Hakan; Gorur, Mustafa; Sözen, SelimObjective: The rate of adrenal incidentalomas detected in routine diagnostic imaging techniques is approximately 4-7%. Although the lesions are generally benign, carcinoma and functional adenomas can be diagnosed with careful clinic and laboratory evaluation. Material and Methods: Data of 13 patients who underwent surgery for an adrenal mass between January 2010-June 2014 were analyzed retrospectively. Results: Seven (54%) patients were male, 6 (46%) were female, and the mean age was 38.2. The clinical diagnosis was pheochromacytoma in 5 patients (38.4%), non-functional adenoma in 5 (38.4), and metastatic lesion, Cushing syndrome, and adrenal carcinoma each in one patient (7.6%). Conventional open adrenalectomy was performed in 8 patients, while 5 patients underwent laparoscopic adrenalectomy. Conclusion: Adrenal incidentalomas should be carefully evaluated for hormonal activity even if asymptomatic, and non-functional lesions should be considered as suspicious-for-malignancy. Laparoscopic adrenalectomy has become the gold standard for patients with a mass less than 6 cm, and without infiltration to adjacent organs.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 silymarin on hepatic regeneration after partial hepatectomy: is silymarin effective in hepatic regeneration?(E-Century Publishing Corp, 2015) Çetinkunar, Süleyman; Tokgöz, Serhat; Bilgin, Bülent Çağlar; Erdem, Hasan; Aktimur, Recep; Can, Serpil; Polat, Yılmaz; Sözen, SelimAim: Silymarin from Silybum marianum was found to reduce liver injury. The aim of the present study was to investigate the effects of silymarin on hepatic regeneration in partially hepatectomized rats. Methods: Thirty Wistar-Albino rats were divided into 3 groups of 10 animals as sham, control and experimental groups. In the sham group (n= 10) abdominal incision was closed after laparotomy. In the control group (n= 10), the rats underwent 70% hepatectomy after laparotomy. In the experimental group (n= 10) after partial 70% hepatectomy, silymarin (200 mg/kg/d) were given to rats for 10 days. Rats in three groups were sacrificed on 10 days. Aspartate (AST) and alanine transaminase (ALT), gamma glutamyl transferase (GGT), ALP, LDH and total bilirubin levels were measured using intracardiac blood samples. Tissue malondialdehyde (MDA) and tissue glutathion (GSH) and Superoxide dismutase (SOD) levels were measured. To reveal the increase in the mass of the remnant liver tissue in the control and experimental groups relative weight of the liver was calculated. Histopathological analysis of the liver was performed using a semi-quantitative scoring system. Results: A statistically significant difference among three groups was not shown for AST and ALT levels. A statistically significant difference was found between the groups as for total bilirubin and gamma glutamyl transferase levels. Increases in relative liver weights were seen with time in Groups 2 and 3. A statistically significant difference was not found for tissue malondialdehyde, Glutathion and Superoxide dismutase levels between hepatectomy and hepatectomy + silymarin groups. On liver tissue sections of the rats in the hepatectomy + silymarin group, increased regeneration and lipid peroxidation were observed accompanied by decreased antioxidant response. Conclusion: It has been observed that silymarin with many established functions such as antiproliferative, anti-inflammatory and energy antioxidant effects, does not contributed to proliferative regeneration of the liver-which has very important metabolic functions -after partial hepatectomy; instead it will decrease serum levels of transaminases.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.
