Publications by authors named "Cemil Caliskan"

33 Publications

Prognostic factors in acute mesenteric ischemia and evaluation with multiple logistic regression analysis effecting morbidity and mortality.

Pol Przegl Chir 2020 Dec;93(1):25-33

Ege University Faculty of Medicine, Department of General Surgery, Izmir, Turkey.

<b>Background:</b> Acute mesenteric ischaemia (AMI) is a catastrophic abdominal emergency characterized by sudden critical interruption to the intestinal blood flow which commonly leads to bowel infarction and death. AMI still has a poor prognosis with an in-hospital mortality rate of 50-69 %. This high mortality rate is related to the delay in diagnosis which is often diffucult and overlooked. Early intervention is crucial and the potential for intestinal viability. <br><b>Methods:</b> The charts of 140 patients who were hospitalazed with AMI between May 1997 and August 2013 in Ege University Faculty of Medicine, department of general surgery were retrospectively reviewed. Demographical and clinical features of patients determining the best predictors which effect on morbidity and mortality were evaluated by Multiple Logistic Regression analysis by Enter method after adjustment for all possible confounding factors. <br><b>Results:</b> After Multiple LR analysis by Enter method after adjustment for all possible confounding factors affecting morbidity; shock, exploration and stay in hospital were statistically significant. Age, cardiac comorbidities, ASA scores, the time delay between onset of acute abdominal pain to surgery, the presence of acidosis and shock, the involved organs (small bowel and both), type of surgery and medical treatment and small bowel length under 100 cm were statistically significant on mortality. <br><b>Conclusion:</b> Risk factors related to mortality and morbidity have been poorly analyzed due to lack of prospective studies and smaller number of patients. Early diagnosis generally depends on clinical awareness and suspicion. Age and time of delay between onset of acute abdominal pain to surgery longer than 24 hours are the most important parameters that predict the mortality for patients presenting with shock and acidosis.
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http://dx.doi.org/10.5604/01.3001.0014.5824DOI Listing
December 2020

The effects of chemoradiotherapy on recurrence and survival in locally advanced rectal cancers with curative total mesorectal excision: a prospective, nonrandomized study.

World J Surg Oncol 2017 Nov 22;15(1):205. Epub 2017 Nov 22.

Department of Gastroenterology, Ege University School of Medicine, Izmir, Turkey.

Background: There are only two prospective, randomized studies comparing preoperative long-term chemoradiotherapy and postoperative chemoradiotherapy in locally advanced rectal cancer (LARC); however, conflicting results in terms of locoregional recurrence (LR) and survival rates have been reported. This prospective study aims to compare the effects of preoperative versus postoperative chemoradiotherapy on recurrence and survival rates in LARC patients.

Methods: From January 2003 to January 2016, a total of 336 eligible patients who were clinically diagnosed with LARC (T-T tm or node-positive disease) were prospectively assigned into preoperative chemoradiotherapy (n = 177) and postoperative chemoradiotherapy (n = 159) groups. The preoperative treatment consisted of 50.4 Gy total dose of radiotherapy (delivered in fractions of 1.8 Gy) and concomitant two cycles chemotherapy of 5-fluorouracil and leucovorin. The patients in the preoperative group underwent curative total mesorectal excision (TME) following long-term chemoradiotherapy. Surgery was performed 8 (range 4-12) median weeks after the completion of the chemoradiotherapy. Similar protocol was administered to the postoperative group 4 weeks after the operation. Four cycles of adjuvant chemotherapy were added to the groups. The primary end points were locoregional recurrences and 5-year cancer-specific, overall, and disease-free survivals.

Results: The mean follow-up period was 60.4 (range 12 to 168) months. Five-year cumulative incidence of locoregional recurrence (LR) was 7.4% in the preoperative group and 13.4% in the postoperative group (p = 0.021). Five-year cancer-specific survival (CSS) was 87.5% in the preoperative group and 80% in the postoperative group (p = 0.022). Overall survival (OS) was 79.8 versus 74.7% (p = 0.064), disease-free survival (DFS) was 75.2 versus 64.8% (p = 0.062), and severe late toxicity was 7.4 versus 13.2% (p = 0.002), respectively. The rate of patient compliance was higher in the preoperative group (p < 0.001).

Conclusions: Preoperative chemoradiotherapy, as compared with postoperative chemoradiotherapy, significantly improved local control, patient compliance, CSS, and late toxicity and suggested a trend toward improved overall and disease-free survival.
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http://dx.doi.org/10.1186/s12957-017-1275-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5700528PMC
November 2017

Morgagni Hernia: Is It Just a Congenital Hernia or a Cause of Emergency Surgery?

Am Surg 2016 Nov;82(11):317-319

Ege University School of Medicine, General Surgery Department, Izmir, Turkey.

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November 2016

Unexpected Benefit of the Positron Emission Tomography/Computed Tomography Using F-Fluorodeoxyglucose: Report of a Case.

Indian J Surg 2016 Oct 6;78(5):348-350. Epub 2016 Apr 6.

Department of General Surgery, Division of Proctology, Ege University School of Medicine, 35100 Bornova, Izmir, Turkey.

The positron emission tomography/computed tomography (PET/CT) has been a new tool utilized in the diagnosis and staging of various cancers. However, common worldwide utilization of the PET/CT includes some economic, legal, and ethic controversies. Although PET/CT scanning can detect colorectal premalignant lesions in an early treatable stage, most governments' health care system does not pay for it as a screening test because of its economic burden. Thus, people are forced to make vital decisions about their health because of health policies of their governments. Here, we present an unusual case and discuss the utilization of PET/CT for detection of incidental neoplasms.
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http://dx.doi.org/10.1007/s12262-016-1477-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5127980PMC
October 2016

Totally Curative Surgical Resection of Retrorectal Tumors.

Hepatogastroenterology 2015 May;62(139):606-11

Background/aims: Retrorectal (also known as presacral) tumor (RT) is a rare disease of retrorectal space. There is no large numbered case series in the literature. Well documented small numbered case series will help to establish meta-analysis and surgical decision making.

Methodology: Between 2000 and 2014 medical records of patients with diagnosis of RT at two institutions were reviewed. Clinical features, diagnostic studies, type of surgery, surgical findings, surgical technique, and histopathology of the tumor, morbidity and survival are examined based on data registry.

Results: During 14 years period of time, total of 12 patients operated with diagnosis of RT were retrieved to this study. There were five men and seven women. The median age at the time of diagnosis was 43 (27-56) years. The most frequent findings were pain and palpable mass. There were five anterior, four posterior and three anteroposterior approaches for surgery. There is no recurrence or disease related mortality observed after median of 7 years (1-14).

Conclusion: The primary and only satisfactory treatment is surgery for RTs. Prognosis is directly related primary local control with complete excision, which is often difficult to achieve for malignant lesions.
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May 2015

A rare cause of colonic obstruction "colonic intussusception": report of two cases.

Case Rep Surg 2015 10;2015:465374. Epub 2015 Mar 10.

Department of General Surgery, Ege University Faculty of Medicine, Izmir, Turkey.

Colocolic intussusceptions are rare clinical entities in adults and almost always caused by a leading lesion which often warrants resection. Mostly being malignant, the leading lesions are rarely benign lesions where intraluminal lipomas are the most frequent among them. Most adult intussusceptions require surgical resection owing to two major reasons: common presence of a leading lesion and significantly high risk of malignancy-reaching as high as 65% regardless of the anatomic site-of the leading lesion. Resection of the affected segment is usually the treatment of choice, since preoperative diagnosis of the lesion is usually ineffective and most leading lesions are malignant. This paper represents two cases of adult colocolic intussusception caused by intraluminal lipomas with a brief review of the literature.
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http://dx.doi.org/10.1155/2015/465374DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4377455PMC
April 2015

Our 'ligation of intersphincteric fistula tract' experience for complex anorectal fistulas: is it a preferable method?

Am Surg 2014 Nov;80(11):E307-8

Department of General Surgery, Ege University, School of Medicine, Izmir, Turkey.

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November 2014

Superior mesenteric artery syndrome: a rare cause of intestinal obstruction. Diagnosis and surgical management.

Indian J Surg 2013 Apr 15;75(2):106-10. Epub 2012 Mar 15.

Department of Surgery, Ege University Faculty of Medicine, Izmir, Turkey.

Superior mesenteric artery syndrome is a rare but well-known clinical entity characterized by compression of the third or transverse portion of the duodenum against the aorta by the superior mesenteric artery, resulting in chronic, intermittent, or acute, complete or partial, duodenal obstruction. The treatment for this arteriomesenteric compression includes conservative measures and surgical intervention. The aim of the study was to evaluate our surgical management and outcomes of the patients with superior mesenteric artery syndrome. The cases with superior mesenteric artery syndrome admitted between January 2000 and January 2010 were retrospectively investigated from the patients' records. All six patients had a history of chronic abdominal pain, nausea, postprandial early satiety, vomiting, and weight loss. Diagnostic methods included barium esophagogastroduodenography, upper gastrointestinal endoscopy, and computed tomography. Medical management was the first step of treatment in all cases before surgery. Of those, four underwent Roux-en-Y duodenojejunostomy and two underwent gastroenterostomy. Postoperative periods were uneventful and mean duration of hospitalization after the operations was 7 days. Conservative initial treatment is usually followed by surgical intervention for the main problem that is the narrowing of the aortomesenteric angle in patients with superior mesenteric artery syndrome. This syndrome should be considered in the differential diagnosis in patients with chronic upper abdominal pain. Duodenojejunostomy is the most frequently used procedure with a high success rate.
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http://dx.doi.org/10.1007/s12262-012-0423-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3644149PMC
April 2013

Recurrent pilonidal sinus: lay open or flap closure, does it differ?

Int Surg 2013 Oct-Dec;98(4):319-23

Ege University Faculty of Medicine, General Surgery Department, Izmir, Turkiye.

Treatment options of pilonidal sinus, which has high recurrence rates, is still controversial. In this study, we aimed to analyze for possible factors affecting recurrence. Forty-one patients with recurrent pilonidal sinus were included in this study. Of them, 33 were male and 9 were female (mean age, 24.9 years; age range, 16-42). Factors (i.e., risk factors) were detected in 32 patients. Excision-secondary healing and lay open was performed on 30 of the patients admitted with recurrence. Excision and flap closure was applied on 11 patients. Our recurrence rate was 9.7%. The recurrence rate of our study is compatible with the literature. Comparative studies are needed to determine the appropriate method to decrease recurrence rate.
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http://dx.doi.org/10.9738/INTSURG-D-13-00081.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3829057PMC
February 2015

Spontaneous intestinal intramural hematoma: What to do and not to do.

Ulus Cerrahi Derg 2013 1;29(2):72-5. Epub 2013 Jun 1.

Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey.

Objective: Spontaneous intestinal intramural hematoma is a rare complication of anticoagulant treatment. In this study, we retrospectively evaluated 14 patients with the diagnosis of intramural hematoma of the small intestine who were followed-up and treated in our clinic, and we aimed to determine current approaches in the diagnosis and treatment of intramural hematoma.

Material And Methods: Between February 2010-October 2012, 14 patients diagnosed with small intestinal intramural hematoma were retrospectively analyzed. Nine patients were followed due to clinical findings and 5 patients underwent operation with a histopathological diagnosis of intramural hematoma.

Results: Abdominal computed tomography demonstrated ileal and jejunal wall thickening in 10 patients, while findings were consistent with mesenteric vascular disease in four. Five patients were operated due to mechanical bowel obstruction and acute abdomen. The other 9 patients were followed up with medical treatment and 8 of these patients were already using warfarin due to cardiac bypass and valve replacement.

Conclusion: Spontaneous intestinal intramural hematoma is a rare cause of small bowel obstruction due to intramural hematoma, which is encountered even more rarely. An intramural hematoma should be considered among differential diagnosis of patients who present with abdominal pain and symptoms of obstruction with a history of anticoagulant drug use and elevated International Normalized Ratio (INR) levels. Early diagnosis and medical follow-up can provide a good response to treatment in the majority of patients without requiring surgery.
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http://dx.doi.org/10.5152/UCD.2013.41DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4379831PMC
May 2015

Complicated Meckel's diverticulum and therapeutic management.

Ulus Cerrahi Derg 2013 1;29(2):63-6. Epub 2013 Jun 1.

Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey.

Objective: This study aimed to investigate the treatment options and compare patient management with the literature for patients operated on for an acute abdomen who had complications due to inflammation of the Meckel's diverticulum at our clinics.

Material And Methods: This study retrospectively evaluated 14 patients who had been operated on for acute abdomen and had been diagnosed with Meckel's diverticulitis (MD) in Ege University Medical Faculty Department of General Surgery, between October 2007 and October 2012.

Results: Fourteen patients with a diagnosis of Meckel's diverticulitis (MD) were retrospectively analyzed. Radiologically, the abdominal computer tomography showed pathologies compatible with mechanical intestinal obstruction, Meckel's diverticulitis and peridiverticular abscess, as well as detection of free air within the abdomen on direct abdominal X-ray. Among patients diagnosed with complicated Meckel's diverticuli (obstruction, diverticulitis, perforation) 10 patients had partial small bowel resection and end-to-end anastomosis (71.5%), three patients underwent diverticulum excision (21.4%), and one patient underwent right hemicolectomy+ileotransversostomy (7.1%).

Conclusion: Meckel's diverticulum is a vestigial remnant of an omphalomesenteric channel in the small bowel. It is a real congenital diverticular abnormality that contains all three layers of the small bowel. Surgical excision should be performed if Meckel's diverticulum is detected in order to avoid incidental complications such as ulceration, bleeding, bowel obstruction, diverticulitis or perforation. Meckel's diverticulitis does not have specific clinical and radiological findings. Delayed diagnosis can lead to lethal septic complications. Complications associated with Meckel's diverticulitis, especially if a definite diagnosis is not made during the preoperative period, should be considered in the differential diagnosis. In the presence of a complicated diverticulum the appropriate treatment should be emergent surgical intervention.
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http://dx.doi.org/10.5152/UCD.2013.36DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4379835PMC
May 2015

Mesenteric fibromatosis of the ileocolic area: a case report.

Indian J Surg 2011 Apr 16;73(2):149-51. Epub 2010 Nov 16.

Ege University, Izmir, Turkey.

Fibromatosis is a kind of spindle cell tumor which is characterized by the remarkable proliferation and invasive growth of fibrous tissue. It often arises from the abdominal wall or the extremities and rarely from the mesentery and abdominal organs. The patient was 35 year old female whose major complaints were an abdominal mass and pain. She underwent a right hemicolectomy after the tumor was confirmed by abdominal ultrasonography and computerized tomography. Hereby the pathophysiology, diagnosis and the treatment of the disease is discussed.
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http://dx.doi.org/10.1007/s12262-010-0202-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3077151PMC
April 2011

Abdominal cocoon syndrome as a rare cause of mechanical bowel obstruction: report of two cases.

Ulus Travma Acil Cerrahi Derg 2011 Nov;17(6):557-60

Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey.

An abdominal cocoon is an extremely rare condition, and has been reported mainly in young adolescent women as a cause of small bowel obstruction. In these patients, the small bowel is encased in a fibrous sac called an abdominal cocoon. We hereby present two cases who were diagnosed only by laparotomy and their correlation with the literature. They both received early intervention, thus preventing the need for bowel resection. The pathology of both membranes showed inflammation.
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http://dx.doi.org/10.5505/tjtes.2011.39018DOI Listing
November 2011

ω-3 Fatty acids have no impact on serum lactate levels after major gastric cancer surgery.

JPEN J Parenter Enteral Nutr 2011 Jul;35(4):488-92

Department of General Surgery, Ege University, School of Medicine, Bornova-Izmir, Turkey.

Background: Preoperative and intraoperative nutrition support in patients undergoing major surgery results in decreased incidence of morbidity and mortality. Studies investigating the role of ω-3 fatty acids in these patients are increasing. Some are focused on perfusion at the cellular level. This study was undertaken to address the effect of postoperative administration of ω-3 fatty acids on cellular hypoperfusion associated with major gastric surgery.

Methods: Twenty-six patients undergoing gastric cancer surgery were randomly assigned to receive parenteral nutrition (PN) supplemented with a combination of ω-6 and ω-3 fatty acids (Omegaven, 0.2 g/kg/d; Lipovenoes 10%, 0.6 g/kg/d) or with ω-6 fatty acid (Lipovenoes 10%, 0.8 g/kg/d) for 5 days. Blood samples were taken preoperatively, postoperative day 1, and on the last day of PN therapy (day 5).

Results: Patients receiving ω-3 and ω-6 fatty acids showed neither lower serum lactate levels nor lower rates of complications compared with patients receiving ω-6 only. There were no statistically significant differences between the groups in other biochemical parameters, complications, or length of hospital stay or mortality.

Conclusion: PN with ω-3 fatty acid supplementation does not have a significant impact on cellular hypoperfusion and lactate clearance after major gastric surgery.
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http://dx.doi.org/10.1177/0148607110386611DOI Listing
July 2011

Foreign bodies in the rectum: an analysis of 30 patients.

Surg Today 2011 Jun 28;41(6):795-800. Epub 2011 May 28.

Division of Proctology, Department of General Surgery, Ege University School of Medicine, 35100, Bornova, Izmir, Turkey.

Purpose: A foreign body in the rectum is a rare clinical entity. These foreign bodies can be classified under two major groups: the ones that are inserted from the anus and the ones that are swallowed and thereafter become stuck in the rectum.

Methods: Data of patients admitted with a foreign body in the rectum between 1988 and 2008 were retrospectively analyzed. A total of 30 patients were reviewed.

Results: The most common reason for a foreign body in the rectum was insertion for erotic purposes, which was seen in 19 of the 30 patients. All these patients were male. The remaining 11 patients reported nonerotic causes. The most efficient and implemented therapeutic method was simple extraction during the first examination.

Conclusions: The most common reason for a foreign body in the rectum is insertion for erotic purposes. The first target of therapy should be extraction of the foreign body using the simplest method possible. Meanwhile, protecting the integrity of the intestine is of the utmost importance. The care for maintaining the integrity of the rectum should include an evaluation of the patient's psychological status.
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http://dx.doi.org/10.1007/s00595-009-4362-5DOI Listing
June 2011

Postoperative radiotherapy in rectal cancer: long-term results of 290 patients.

Hepatogastroenterology 2010 Sep-Oct;57(102-103):1099-105

Ege University School of Medicine, Department of Radiation Oncology, Izmir, Turkey.

Background/aims: To evaluate treatment results and to identify prognostic factors affecting local-relapse-free (LRFS), disease-free (DFS) and overall survival (OS) in patients treated with postoperative radiotherapy (RT) for rectal cancer.

Methodology: A retrospective review was performed in 290 patients treated between January 1990 and December 2005. Median RT dose was 54 Gy. A total of 220 (75.8%) patients also received 5-fluorouracil based chemotherapy.

Results: During a median follow-up of 56 months (range 9-216 months), 68 patients (23.4%) developed local recurrence and 96 patients (33.1%) developed distant metastases. Five-year LRFS, DFS, and OS rates were 74.6%, 52.6%, and 53.7%, respectively. On multivariate analysis, significant prognostic factors for LRFS were age, pathologic T stage (pT), and distance from anal verge; for DFS were pT stage, and positive surgical margin; for OS were pT and pathologic N (pN) stages. One hundred and fifty-two node-positive patients whose number of retrieved and metastatic nodes are known were evaluated according to the lymph node ratio (LNR). OS and DFS rates significantly decreased with increasing LNR (p = 0.005, and p = 0.023 respectively). RT related Grade 3-4 late morbidity rate was 3.1%. A second primary malignancy developed in 4.8% of patients.

Conclusion: Among several prognostic factors, pT stage significantly predicted for LRFS, DFS and OS on multivariate analysis, while pN stage was significant for all three only on univariate analysis. LNR which affected DFS and OS could be an important tool for prognostic prediction for node-positive patients.
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April 2011

Coexistence of gastric cancer and gastrointestinal stromal tumor: report of two cases.

Turk J Gastroenterol 2010 Sep;21(3):302-4

Department of General Surgery, Ege University School of Medicine, İzmir.

Gastrointestinal stromal tumors and adenocancers are distinct neoplasms originating from different cell layers. Though adenocancers constitute the most common type of gastric tumors, synchronous development of a gastrointestinal stromal tumor is extremely rare. Case 1: A 63-year-old male patient underwent a radical total gastrectomy with D2 lymphadenectomy and Rouxen-Y reconstruction. Histopathologic and immunohistochemical examination of the specimen disclosed an advanced stage, intestinal type adenocancer intermixing with a distinct lesion of gastrointestinal stromal tumor. The early postoperative course was uneventful; however, recurrence was seen and he survived only 13 months. Case 2: A 60-year-old male patient underwent a distal subtotal gastrectomy with D2 lymphadenectomy, and reconstruction was provided with Billroth 2 procedure. Intraoperatively, a 0.5 cm vegetating lesion was detected on the gastric body and resected. Histopathologic and immunohistochemical examination disclosed an intestinal type adenocancer, and the incidental lesion was reported as gastrointestinal stromal tumor. His postoperative course was uneventful, and the patient is free of disease after one year. The conditions under which the synchronous tumors develop away from each other or collide are vague. Currently, the stage of the adenocancer and the size and mitotic manner of the gastrointestinal stromal tumors are the leading prognostic factors.
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http://dx.doi.org/10.4318/tjg.2010.0105DOI Listing
September 2010

Colonic malignant melanoma, primary or metastatic? Case report.

Turk J Gastroenterol 2010 Mar;21(1):45-9

Department of Pathology, Ege University School of Medicine, Izmir, Turkey.

Gastrointestinal malignant melanomas, either primary or metastatic, are rare and overlooked tumors. There is also controversy regarding the actual existence of primary melanoma in the gastrointestinal tract apart from the esophagus and anorectal regions, where melanocytes normally exist. A case of malignant melanoma in the cecum is presented. The patient was a 30- year-old male who presented to the hospital for abdominal pain and diarrhea. The tumor was located mainly in the submucosa and measured 14x11x4.5 cm. The cut surface was solid, gray-white and fleshy. Histologically, tumor cells were arranged in compact nests or wide cords surrounded by fibrous stroma. The tumor cells had pleomorphic nuclei and quite rich cytoplasm; multinucleated, giant tumor cells were intermingled. Although no tumor cells contained apparent brown pigment, most were found to be positive for S-100 protein, HMB-45, Melan-A, and vimentin. The possibility of a metastatic lesion was considered. While the patient had a history of a pathologically examined dorsal nevus excision two years before, there was no evidence of either cutaneous or ocular primary melanoma at the time of diagnosis. Moreover, a thorough postoperative investigation did not reveal any other lesion in any other site favoring a metastatic spread. There was also no evidence of recurrent disease or metastasis one year after the surgery. This case is presented in view of its rare occurrence in the cecum. The difficulties in the diagnostic course are discussed, together with a literature review on distinguishing a primary mucosal melanoma from a metastatic one from an unknown or regressed cutaneous primary tumor.
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http://dx.doi.org/10.4318/tjg.2010.0048DOI Listing
March 2010

Negative prognostic factors in colorectal carcinoma: An analysis of 448 patients.

Indian J Surg 2010 Jun 26;72(3):243-8. Epub 2010 Aug 26.

Department of General Surgery/Division of Proctology, School of Medicine, Ege University, Turkey Izmir.

Background And Aims: Colorectal carcinoma (CRC) is the most frequent malignancy of the gastrointestinal tract. Prognostic researches are carried out for choosing the optimum therapy, evaluating therapy results and comparing multicentre results for better qualification in the therapy of the disease.

Patients And Methods: In this study, 448 patients, whose surgery and follow-up was performed by the same correspondent surgeon between the years 1995 and 2003, were retrospectively analyzed.

Results: Age, presence of comorbidity, weight loss, emergency admission, high serum CEA and CA 19-9 levels, neighboring organ invasion, operation type, major morbidity, tumor size and type, lymph node metastases, venous and perineural invasion, Dukes' classification and local recurrence and distant metastasis during follow-up are found to be significant negative factors affecting prognosis of the CRC patient.

Conclusion: Therapy results of the CRC are evaluated by survival times regardless of the therapy method selected for each individual. In our study we tried to find out negative prognostic factors by researching possible factors affecting disease free survival time for CRC. Since our understanding of factors that have an impact on prognosis increases, we are hoping to improve survival.
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http://dx.doi.org/10.1007/s12262-010-0052-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3452660PMC
June 2010

A new extraction technique for rectal foreign bodies with a rubber band ligation device.

Surg Today 2010 Jun 23;40(6):583-5. Epub 2010 May 23.

Division of Proctology, Department of General Surgery, Ege University School of Medicine, 35100, Bornova, Izmir, Turkey.

Foreign bodies in the rectum are a rare clinical condition that should be noted. The most frequently encountered cause is erotic activity. The first goal of the therapy is extraction of the foreign body using the simplest method possible while protecting the integrity of the intestine. Many instruments and methods have been suggested for this purpose. This report discusses a new management strategy for these patients along with a review of the literature.
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http://dx.doi.org/10.1007/s00595-009-4095-5DOI Listing
June 2010

Massive gastrointestinal bleeding caused by stromal tumour of the jejunum.

Can J Surg 2009 Oct;52(5):E185-7

Department of General Surgery, Ege University School of Medicine, Izmir, Turkey.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769133PMC
October 2009

Experimental comparison of meshes for rectal prolapse surgery.

Eur Surg Res 2009 13;43(3):310-4. Epub 2009 Aug 13.

Division of Proctology, Department of General Surgery, Ege University School of Medicine, Bornova, Izmir, Turkey.

Aim: The aim of this experimental study is to investigate the foreign body tissue created by the meshes that are used for rectopexy.

Method: Sixty rats were divided equally into 5 groups. Four mesh types (Surgipro, Ivalon, Gore-Tex and Vypro) were implanted into the retroperitoneal area except for the sham group. After a 5-week follow-up period, all animals were sacrificed. Specimens were evaluated macroscopically by using scoring systems and biochemically by determining tissue hydroxyproline and nitric oxide levels.

Results: The most evident foreign body reaction was observed in the Ivalon group, which showed higher 'macroscopic adhesion' scores (p < 0.005), although there were no significant differences in tissue hydroxyproline and nitric oxide levels between the groups (p > 0.05).

Conclusion: In rectal prolapse surgery, selecting the ideal mesh type is unclear, depending on evidence-based results. In the present study, we could not prove which mesh was definitely superior to the other, macroscopically, histologically and biochemically. The findings of this experimental rat model suggest that implantation of all 4 types of meshes are suitable for posterior rectopexy.
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http://dx.doi.org/10.1159/000235157DOI Listing
January 2010

Steroid utilization in eosinophilic jejunitis: beneficial or harmful?

Langenbecks Arch Surg 2010 Jan 6;395(1):99-101. Epub 2009 May 6.

Department of General Surgery, Division of Proctology, Ege University School of Medicine, Bornova, 35100, Izmir, Turkey.

Purpose: Eosinophilic jejunitis is a rare disorder of undetermined origin, which is characterized by infiltration of eosinophils in the intestine. The aim of this study is to evaluate steroid therapy effect in patient treated for eosinophilic jejunitis to share our experience with other colleagues.

Methods: We report a patient with symptoms of small bowel obstruction whose diagnosis was confirmed by previous operation owing to a well-known pathology due to an unusual reason, perforation, which was masqueraded by therapeutic drugs.

Result: This clinical entity is usually encountered between the third and fifth decades. Stomach and small intestine are the most affected organs; however, it can affect any part of the gastrointestinal system. Abdominal pain and obstructive symptoms concomitant with weight loss are the common presenting complaints. According to current knowledge, avoiding unnecessary resection unless it is inevitable is an acceptable option for the management of eosinophilic jejunitis disease.

Conclusion: Recent data suggest that eosinophils may directly damage the gastrointestinal tract wall in eosinophilic gastroenteritis. A few limited literatures about this disease strongly recommends steroid therapy for treatment. Furthermore, beneficial or harmful effects of steroids in eosinophilic jejunitis and its treatment details are discussed and reviewed.
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http://dx.doi.org/10.1007/s00423-009-0501-0DOI Listing
January 2010

Intussusception in adults: clinical characteristics, diagnosis and operative strategies.

World J Gastroenterol 2009 Apr;15(16):1985-9

Department of Surgery, Izmir Education and Research Hospital, Izmir, Turkey.

Aim: To evaluate 20 adults with intussusception and to clarify the cause, clinical features, diagnosis, and management of this uncommon entity.

Methods: A retrospective review of patients aged > 18 years with a diagnosis of intestinal intussusception between 2000 and 2008. Patients with rectal prolapse, prolapse of or around an ostomy and gastroenterostomy intussusception were excluded.

Results: There were 20 cases of adult intussusception. Mean age was 47.7 years. Abdominal pain, nausea, and vomiting were the most common symptoms. The majority of intussusceptions were in the small intestine (85%). There were three (15%) cases of colonic intussusception. Enteric intussusception consisted of five jejunojejunal cases, nine ileoileal, and four cases of ileocecal invagination. Among enteric intussusceptions, 14 were secondary to a benign process, and in one of these, the malignant cause was secondary to metastatic lung adenocarcinoma. All colonic lesions were malignant. All cases were treated surgically.

Conclusion: Adult intussusception is an unusual and challenging condition and is a preoperative diagnostic problem. Treatment usually requires resection of the involved bowel segment. Reduction can be attempted in small-bowel intussusception if the segment involved is viable or malignancy is not suspected; however, a more careful approach is recommended in colonic intussusception because of a significantly higher coexistence of malignancy.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2675089PMC
http://dx.doi.org/10.3748/wjg.15.1985DOI Listing
April 2009

Can hyperbaric oxygenation decrease doxorubicin hepatotoxicity and improve regeneration in the injured liver?

J Hepatobiliary Pancreat Surg 2009 17;16(3):346-52. Epub 2009 Mar 17.

Department of General Surgery, Ege University Hospital, 3rd Floor, Bornova, 35100, Izmir, Turkey.

Background/purpose: Portal vein embolization is used in the treatment of hepatocellular cancer, with the purpose of enhancing resectability. However, regeneration is restricted due to hepatocellular injury following chemotherapeutics (e.g. doxorubicin). The aim of this study was to investigate whether hyperbaric oxygenation (HBO) can alleviate the hepatotoxicity of chemotherapy and improve regeneration in the injured liver.

Methods: Rats were allocated to four experimental groups. Group I rats were subjected to right portal vein ligation (RPVL); rats in groups II and III were administered doxorubicin prior to RPVL, with group III rats being additionally exposed to HBO sessions postoperatively; group IV rats was sham-operated. All rats were sacrificed on postoperative day 7, and liver injury was assessed by measuring alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Protein synthetic ability was determined based albumin levels and liver regeneration by the mitotic index (MI).

Results: The AST and ALT values of group II rats were significantly higher than those of group I, but not those of group III. Rats treated with doxorubicin and HBO (groups II and III) showed slightly but not significant differences in albumin levels than those subjected to only RPVL or sham-operated. The MI was significantly increased in groups I, II, and III, with the MI of group III rats significantly higher than those of group I rats.

Conclusions: Based on our results, we conclude that HBO treatment has the potential to diminish doxorubicin-related hepatotoxicity and improve regeneration in the injured liver.
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http://dx.doi.org/10.1007/s00534-009-0059-9DOI Listing
August 2009

Rectosigmoid endometriosis.

Turk J Gastroenterol 2008 Dec;19(4):294-6

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December 2008

Dieulafoy's lesion of the anal canal: report of a case.

Turk J Gastroenterol 2007 Dec;18(4):265-7

Department of General Surgery, Ege University, Faculty of Medicine, Izmir, Turkey.

Background/aims: Dieulafoy's lesion of the anal canal is a very rare clinical case. Although it was first described in the stomach, there has been an increasing frequency, especially in the last decade, of reports of the lesion in the colorectal region.

Methods: Herein, we report one case presenting with massive hematochezia requiring multiple blood transfusions due to a Dieulafoy's lesion in the anal canal. To our knowledge, this is the fourth case in Medline. Surgical oversewing was attempted twice but rebleeding occurred, and local excision through the anal canal was performed.

Results: The patient was treated successfully with mucosectomy including the lesion.

Conclusions: Sclerotherapy, alcohol and epinephrine injection, thermocoagulation and selective arterial embolization are the options of therapeutic endoscopy and interventional radiology. As for surgical management, oversewing is an alternative technique. However, in our opinion, because of the recurrent and life-threatening manner of this arterial bleeding pattern, local excision, if possible, is the most reliable management of the disease.
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December 2007
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