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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 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 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 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 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.
