Publications by authors named "Ebubekir Gündeş"

34 Publications

Endoscopic and histopathological features of the upper gastrointestinal system polyps: evaluation of 12.563 procedures.

Turk J Surg 2019 Jun 13;35(2):98-104. Epub 2019 Jun 13.

Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Merkezi, Gastroenteroloji Cerrahi Kliniği, İstanbul, Türkiye.

Objectives: With the widespread use of esophagogastroduodenoscopy (EGD) in recent years, upper gastrointestinal system polyps have started to be encountered more often. Although most patients with gastric polyps are asymptomatic, these are important due to their malign potential, and gastric cancer may develop if left untreated.

Material And Methods: Records of 12.563 patients who underwent EGD at Kartal Kosuyolu High Specialization Health Application and Research Center for any reason between January 2013 and June 2016 were reviewed retrospectively. Patients with at least 1 histopathologically proven polyp were included in this study.

Results: A total of 12.563 endoscopic procedures of the upper gastrointestinal system were investigated and 353 (2.8%) polypoid lesions were detected. Mean age of these patients was 56.3 years and 241 (68.3%) of the patients were female. Gastric polyps were found most commonly in the antrum (50.1%) and of all gastric polyps, 245 (69.5%) were less than 1 cm. Histopathological evaluation showed that hyperplastic polyp (HP) (n= 151, 42.8%) was the most common polyp type, followed by fundic gastric polyp (FGP) (n= 51, 14.4%). Non-polyp gastric mucosa evaluation of 298 patients revealed that 34.9% of the cases were Helicobacter pylori positive, 19.4% had intestinal metaplasia, and 11.4% had atrophic gastritis.

Conclusion: Polyps of the upper gastrointestinal system are generally detected coincidentally as they have no specific symptoms. Polypectomy is required for gastric polyps because of their potential for malign transformation according to medical evidence.
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http://dx.doi.org/10.5578/turkjsurg.4155DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6796076PMC
June 2019

The effects of rectal cancer surgery on the anatomical localisation of ureters - a prospective observational study.

Contemp Oncol (Pozn) 2019 31;23(3):164-168. Epub 2019 Oct 31.

Department of Gastroenterological Surgery, Kartal Koşuyolu Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.

Introduction: Anatomical changes after surgery and fibrotic adhesions increase the organ laceration risk, including that of the ureter, in recurrent cases and secondary operations. The aim of this study was to investigate the changes in the anatomical localisations of the ureters via computed tomography urography in patients undergoing rectal cancer surgery.

Material And Methods: The study involved prospectively collected data on the changes of ureteral location preoperatively and postoperatively in patients with operated rectal cancer. Distances (mm) of ureters determined midline in the computed tomography urogram phase.

Results: A total of 18 patients were included. The mean distances between the right ( ) and left ( ) ureters and the mid-vertebral line before the surgery were 30.9 ±5.4 mm and 34.5 ±9.9 mm, respectively. The postoperative distances between them ( and ) were 26.4 ±9.1 mm and 29.5 ±9.9 mm, respectively. The measurement showed that 83.3% (15/18) of the right ureters had deviated medially, whereas 16.7% (3/18) of them had deviated laterally. The measurements showed that 88.8% (16/18) of the left ureters had deviated medially, whereas 11.2% (2/18) of them had deviated laterally. The differences between the preoperative and postoperative measurements of the right and left ureter positions were 4.5 ±9.2 mm and 4.9 ±4.6 mm, respectively, with the displacement in the left ureter being statistically significant ( ≤ 0.001).

Conclusions: Rectal cancer surgery causes medially deviated changes in the positions of the ureters.
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http://dx.doi.org/10.5114/wo.2019.89244DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883969PMC
October 2019

Spontaneous splenic rupture related to anticoagulant and antiaggregant treatment.

Prz Gastroenterol 2019 5;14(2):152-156. Epub 2019 Jul 5.

Gastroenterological Surgery Department, Kartal Koşuyolu High Speciality and Training Hospital, Istanbul, Turkey.

Introduction: Trauma is the most frequent cause of splenic rupture. In contrast to traumatic rupture of the spleen, spontaneous splenic rupture (SSR) is a rare and life-threatening condition.

Aim: To present the cases of patients with SSR, who had no history of trauma, and who had been receiving anticoagulant and/or antiaggregant treatment while hospitalised for cardiac reasons.

Material And Methods: The cases of 6 patients with SSR at Gastroenterological Surgery Department, Kartal Koşuyolu High Speciality and Training Hospital were retrospectively evaluated. The clinicodemographic factors and the diagnostic and therapeutic methods utilised for these patients with SSR while hospitalised were investigated as well.

Results: Five (83.3%) of the patients were male and 1 (16.6%) was female. The median age of the patients was 71 (61-73) years. Three of the patients had only been receiving antiaggregant treatment, while 2 had only been receiving anticoagulant treatment; only 1 patient had been receiving both anticoagulant and antiaggregant treatments. The decrease in haematocrit (HCT) levels ascertained on the day of SSR diagnosis and the HCT levels ascertained on the day of hospitalisation were statistically significant. All the patients received a blood transfusion. While 5 (83.33%) of the 6 patients had splenectomy, 1 (16.66%) patient received conservative treatment. Mortality was seen in 4 (66.6%) patients.

Conclusions: Spontaneous splenic rupture is a condition that should be taken into consideration in the differential diagnosis of patients hospitalised for cardiac reasons, who are receiving anticoagulant and/or antiaggregant treatment in cases of newly developed abdominal pain and low HCT levels.
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http://dx.doi.org/10.5114/pg.2019.85900DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6791140PMC
July 2019

Ischemic colitis following infrarenal abdominal aortic aneurysm treatment: Results from a tertiary medical center.

North Clin Istanb 2018 Sep;5(3):221-226

Department of Gastroenterological Surgery, Kartal Kosuyolu High Speciality and Training Hospital, Istanbul, Turkey.

Objective: The aim of this study was to investigate the effects of ruptured aneurysm on morbidity and mortality in patients with ischemic colitis (IC) and resection following infrarenal abdominal aortic aneurysms (AAA) surgery.

Methods: Between January 2012 and December 2016, patients who underwent resection for ischemic colitis in our clinic were retrospectively reviewed. Data on the ruptured condition of the aneurysm, the emergency or elective form of aneurysm surgery, treatment method for the aneurysm (EVAR-open) were obtained. The patients were compared and divided into two groups as those with ruptured aneurysm and those without.

Results: A total of 275 infrarenal AAA cases were treated by the cardiovascular surgery clinic between January 2012 and December 2016. Fourteen patients (5%) developed ischemic colitis requiring resection. Four (1.8%) patients with EVAR and 10 (17.5%) patients with open surgery were operated because of IC. No statistically significant difference was observed between the two groups in terms of demographic data and surgical procedures. The intergroup comparison did not reveal any statistically significant difference among gastrointestinal (GIS) symptoms, the time period until surgery, the involved colon segment, and the surgical procedures performed. The mortality rate in ruptured AAA group was 83.3%, while it was 62.5% in the non-ruptured AAA group. In spite of the fact that the mortality rate was high in the ruptured group, it was not statistically significant (p=0.393).

Conclusion: IC is a complication of AAA surgery with a high mortality rate. Rupture in abdominal aortic aneurysm increasing mortality in IC patients. This complication with a high mortality rate following open AAA surgery should be noted by surgeons and we believe that the liberal utilization of laparotomy and early intervention in suspected cases will decrease mortality rates.
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http://dx.doi.org/10.14744/nci.2017.80774DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6323563PMC
September 2018

Risk factors and laboratory markers used to predict leakage in esophagojejunal anastomotic leakage after total gastrectomy.

Turk J Surg 2018 Nov 20:1-6. Epub 2018 Nov 20.

Department of Gastroenterological Surgery, Kartal Koşuyolu High Speciality Training and Research Hospital, İstanbul, Turkey.

Objective: Esophagojejunal anastomotic leakages, which occur in the reconstruction procedures performed after total or proximal gastrectomy, still account for one of the most significant causes of morbidity and mortality in spite of the developments seen in the perioperative management and surgical techniques in gastric cancer surgery. The aim of the presentstudy was to ascertain the risk factors for Esophagojejunal anastomotic leakages.

Materialand Methods: A total of 80 patients with gastric cancer, who had total gastrectomy + D2 lymph node dissection and Esophagojejunal anastomotic between January 2013 and December 2016, were retrospectively evaluated. Patients who did not have anastomotic leakages during their clinical follow-ups were allocated to Group 1, whereasthose who had anastomotic leakages were allocated to Group 2.

Results: A total of 58 (72.5%) out of 80 patients were males, whereas 22 (27.5%) were females.The mean age of the patients was 61.2±11.2 years. There were no demographic differences between the groups. Postoperative recurrent fever (p=0.001), C-reactive protein values on postoperative days 3 and 5 (p=0.01), and neutrophil-to-lymphocyte ratio on postoperative day 5 (p=0.022) were found to be statistically significant with regardto Esophagojejunal anastomotic leakages and other postoperative complications. The duration of operation (p=0.032) and combined organ resection (p=0.008) were ascertained as risk factors for Esophagojejunal anastomotic leakages.

Conclusion: Surgeons should be careful about Esophagojejunal anastomotic leakages thatare significant postoperative complications seen especially in cases where the duration of operation is prolonged, and additional organ resections are performed. Recurrent fever, high C-reactive protein levels, and neutrophil-to-lymphocyte ratio may serve as warnings for complications in postoperative follow-ups.
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http://dx.doi.org/10.5152/turkjsurg.2018.4117DOI Listing
November 2018

Risk factors and laboratory markers used to predict leakage in esophagojejunal anastomotic leakage after total gastrectomy.

Turk J Surg 2019 Mar 20;35(1):6-12. Epub 2018 Nov 20.

Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Gastroenteroloji Cerrahi Kliniği, İstanbul Türkiye.

Objectives: Esophagojejunal anastomotic leakages, which occur in the reconstruction procedures performed after total or proximal gastrectomy, still account for one of the most significant causes of morbidity and mortality in spite of the developments seen in perioperative management and surgical techniques in gastric cancer surgery. The aim of the present study was to ascertain the risk factors for Esophagojejunal anastomotic leakages.

Material And Methods: A total of 80 patients with gastric cancer, who had total gastrectomy +D2 lymph node dissection and Esophagojejunal anastomotic between January 2013 and December 2016, were retrospectively evaluated. Patients who did not have anastomotic leakages during their clinical follow-ups were allocated to Group 1, whereas those who had anastomotic leakages were allocated to Group 2.

Results: A total of 58 (72.5%) out of 80 patients were males, whereas 22 (27.5%) were females. Mean age of the patients was 61.2 ± 11.2 years. There were no demographic differences between the groups. Postoperative recurrent fever (p= 0.001), C-reactive protein values on postoperative days 3 and 5 (p= 0.01), and neutrophil-to-lymphocyte ratio on postoperative day 5 (p= 0.022) were found to be statistically significant with regard to Esophagojejunal anastomotic leakages and other postoperative complications. The duration of operation (p= 0.032) and combined organ resection (p= 0.008) were ascertained as risk factors for Esophagojejunal anastomotic leakages.

Conclusion: Surgeons should be careful about Esophagojejunal anastomotic leakages which are significant postoperative complications seen especially in cases where the duration of operation is prolonged, and additional organ resections are performed. Recurrent fever, high C-reactive protein levels, and neutrophil-to-lymphocyte ratio may serve as warnings for complications in postoperative follow-ups.
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http://dx.doi.org/10.5578/turkjsurg.4117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6791678PMC
March 2019

Gastric cancer with situs inversus totalis: does it really create difficulties for surgeons?

Prz Gastroenterol 2018 26;13(1):47-51. Epub 2018 Mar 26.

Gastroenterological Surgery Department, Kartal Koşuyolu High Speciality and Training Hospital, Istanbul, Turkey.

Introduction: Situs inversus totalis (SIT) is a very rare condition that is seen at a rate of one in about 6000-8000 births.

Aim: To offer a general view on the coexistence of SIT and gastric cancer, accompanied by a literature review.

Material And Methods: Within the scope of this study, the case of a patient with gastric adenocarcinoma and SIT has been presented. Previous research on gastric cancer cases with SIT was reviewed through a comprehensive search of the PubMed, Medline, and Google Scholar databases. The keywords used to conduct this research were "situs inversus totalis and gastric cancer," "situs inversus totalis and gastric malignant," and "situs inversus totalis and gastric resection." The database search covered English studies published between 2000 and 2016.

Results: The results of our literature review revealed 20 studies of patients with gastric cancer and SIT, and 21 related cases. Overall, 12 of the patients were male, 9 were female, and their mean age was 61.8 ±10.97 years. The vascular assessment data showed that three out of the 13 mentioned cases had vascular anomalies. Eleven of the patients had laparoscopic resections, and one of the patients that had a surgical procedure exhibiting a postoperative mechanical obstruction.

Conclusions: The coexistence of SIT and gastric cancer is a very rare condition, and a careful preoperative radiological assessment should be conducted because there can be accompanying vascular anomalies. Laparoscopies and robotic surgeries can be performed for suitable patients at experienced centres, consistent with oncological principles.
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http://dx.doi.org/10.5114/pg.2018.74563DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5894452PMC
March 2018

Emergency abdominal surgery in patients with left ventricular assist device: short- and long-term results.

Postepy Kardiol Interwencyjnej 2017 29;13(4):313-319. Epub 2017 Nov 29.

Cardiovascular Surgery Department, Kartal Koşuyolu High Speciality and Training Hospital, Istanbul, Turkey.

Introduction: Emergency abdominal surgery (EAS) in patients with long-term mechanical circulatory support and strong anticoagulation is very difficult.

Aim: To present our experiences regarding the short- and long-term results of patients with a left ventricular assist device (LVAD) who underwent emergency abdominal surgery under general anesthesia at a large tertiary healthcare center.

Material And Methods: The electronic medical records of 7 patients with LVAD who underwent EAS between January 1, 2010 and December 31, 2016 were retrospectively investigated in order to evaluate perioperative management and outcomes. The patients were divided into two groups based on the need for EAS procedures.

Results: Seven (9.2%) of 76 patients with LVAD underwent EAS an average of 79.1 ±79.4 days after implantation. No statistically significant differences were found between the groups with and without EAS with regard to demographic characteristics, type of device, and rate of perioperative mortality ( > 0.05). The indications for surgery, retroperitoneal hematoma in 2 patients and in 5 other patients; ileus, iatrogenic splenic injury associated with thoracentesis, splenic abscess, acute abdominal pain and rectal cancer surgery was a pelvic abscess in a patient who is connected to the stump. In all cases laparotomy was performed with median incision. The perioperative mortality rate was 28.6% ( = 2). Two patients underwent orthotopic heart transplant during long-term follow-up.

Conclusions: The EAS is not rare during LVAD treatment but is a rather complex procedure. General surgeons will be increasingly likely to encounter such patients as their numbers rise and their life expectancies are prolonged.
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http://dx.doi.org/10.5114/aic.2017.71613DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5770862PMC
November 2017

Giant paraesophageal hernia-related chronic gastric volvulus case to the emergent surgery.

Prz Gastroenterol 2017 14;12(4):315-317. Epub 2017 Dec 14.

Intensive Care Unit, Haydarpasa Education And Research Hospital, Istanbul, Turkey.

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http://dx.doi.org/10.5114/pg.2017.72111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5771459PMC
December 2017

Emergency cases following elective colonoscopy: Iatrogenic colonic perforation.

Turk J Surg 2017 1;33(4):248-252. Epub 2017 Dec 1.

Department of Gastroenterology Surgery, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital, İstanbul, Turkey.

Objective: Our aim in this study was to present the cases of our patients who contracted colonic perforation during elective colonoscopy and became emergency cases; we also discuss treatment modalities along with literature reports on the subject.

Material And Methods: Cases of patients who contracted iatrogenic colonic perforation following endoscopy of the colorectal system between January 2009 and December 2015 at Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital's Endoscopy Unit were reviewed retrospectively.

Results: Within the duration of the study, 5.586 patients underwent colonoscopies at our hospital; 7 (0.12%) of these patients contracted iatrogenic colonic perforation. Three (42.8%) of these patients were male, four (57.2%) were female, and their mean age was 69 years (46 to 84). Six (85.7%) patients were diagnosed intraoperationally, while one (14.3%) patient was diagnosed 12 hours after the procedure. The perforation area was the sigmoid colon in six patients and the ascending colon in one patient; all patients underwent surgery. Four patients were discharged with no complications. One of the remaining three patients had enterocutaneous fistula, one had acute renal failure, and one died of sepsis.

Conclusion: The progress of perforation due to colonoscopy varies according to the underlying diseases, the mechanism of perforation formation, the treatment modality used, and the experience of the physicians treating the patient. Special attention should be paid to senior and comorbid patients receiving therapeutic procedures during colonoscopy.
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http://dx.doi.org/10.5152/UCD.2016.3572DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5731559PMC
December 2017

Unexpected diagnosis in a patient with a left ventricular assist device: rectal cancer.

Arch Med Sci Atheroscler Dis 2017 5;2:e31-e33. Epub 2017 Oct 5.

Department of Gastroenterological Surgery, Kartal Koşuyolu High Specialized Training and Research Hospital, Kartal, Istanbul, Turkey.

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http://dx.doi.org/10.5114/amsad.2017.70497DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5728079PMC
October 2017

A New Laparoscopic Manoeuvre in Median Arcuate Ligament Syndrome.

Balkan Med J 2017 12;34(6):590-592

Department of Gastroenterological Surgery, University of Health Sciences, Kartal Koşuyolu High Specialized Training and Research Hospital, İstanbul, Turkey.

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http://dx.doi.org/10.4274/balkanmedj.2017.0596DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5785670PMC
December 2017

Examination of anastomotic leak with aqueous contrast swallow after total gastrectomy: Should it be carried out routinely?

Contemp Oncol (Pozn) 2017 29;21(3):224-227. Epub 2017 Sep 29.

Department of Gastroenterological Surgery, Kartal Kosuyolu High Speciality Education and Training Hospital, İstanbul,Turkey.

Aim Of The Study: Examination of esophagojejunal (EJ) anastomosis with aqueous contrast swallow after total gastrectomy is still routinely conducted by many centres. The present study aimed to answer the question: Is it necessary to evaluate EJ anastomosis in terms of leakage by having every patient drink oral contrast agent before initiation of oral food intake after total gastrectomy (TG) performed due to gastric cancer?

Material And Methods: Clinical and radiological results of patients on whom total gastrectomy was performed due to gastric cancer between January 2013 and December 2016 were retrospectively reviewed. Diagnostic method used for patients in whom leak developed and therapeutic interventions were assessed. Evaluation results from aqueous contrast agent and clinical, laboratory, and tomographic findings were studied.

Results: Sixty of the 69 patients who underwent total gastrectomy with a diagnosis of gastric adenocarcinoma swallowed aqueous contrast agent on postoperative day 7 ±2 days and were evaluated in terms of anastomotic leak. Leak developed in 14 patients (20.2 %), 10 of whom ingested contrast agent. Leak was identified in 6 of those patients; however, diagnosis was made with multislice computed tomography (CT) in four patients (40%). The sensitivity of the examination with aqueous contrast agent was 60%.

Conclusions: Evaluating anastomotic leak with aqueous contrast agent after TG has low sensitivity, and it would be wise to resort to this procedure in cases with clinical suspicion, rather than routinely performing it in every patient.
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http://dx.doi.org/10.5114/wo.2017.70112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5701583PMC
September 2017

Long-term evolution of squamous-cell cancer in Plummer-Vinson syndrome.

Prz Gastroenterol 2017 30;12(3):226-228. Epub 2017 Sep 30.

Gastroenterological Surgery Department, Kartal Koşuyolu High Speciality and Training Hospital, Istanbul, Turkey.

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http://dx.doi.org/10.5114/pg.2017.70477DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5672712PMC
September 2017

Cause of mortality in aortoesophageal fistula: oesophageal sepsis. A case report.

Prz Gastroenterol 2017 30;12(3):222-225. Epub 2017 Sep 30.

Department of Gastroenterological Surgery, Kartal Kosuyolu High Speciality Education and Training Hospital, Istanbul, Turkey.

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http://dx.doi.org/10.5114/pg.2017.70476DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5672711PMC
September 2017

Spontaneous rectus sheath hematoma in cardiac in patients: a single-center experience.

Ulus Travma Acil Cerrahi Derg 2017 Nov;23(6):483-488

Department of Gastroenterological Surgery, Kartal Koşuyolu High Speciality Training and Research Hospital, İstanbul-Turkey.

Background: This study presents the relationship between mortality and spontaneous rectus sheath hematoma (RSH) in inpatients receiving anticoagulant and antiaggregant treatment for cardiac pathology at cardiology and cardiovascular surgery clinics.

Methods: Within the scope of our study, the cases of 27 patients who were diagnosed with spontaneous RSH between January 2010 and December 2015 at Kartal Kosuyolu High Speciality Training and Research Hospital were retrospectively evaluated.

Results: Of the 27 patients, 19 (70.4%) were female and 8 (29.6%) were male. The mean age was 63±12 (32-84) years. All the patients had at least one comorbidity that necessitated follow-up. Fourteen patients received only anticoagulant treatment, 8 received only antiaggregant treatment, and the remaining 5 received both types of treatment. Physical examination of all patients revealed painful palpable masses in the lower quadrants of the abdomen. According to the results of computed tomography (CT) scans, which showed the size and localization of the masses, 7 of the cases were classified as Type I, 6 as Type II, and 14 as Type III. Although 23 of the cases received medical treatment, the remaining 4 patients received surgical treatment. Eight (29.6%) patients suffered mortality.

Conclusion: RSH is rare, but its prevalence is increased among patients receiving anticoagulant and antiaggregant treatment for cardiac reasons. The mortality rate markedly increased among patients who contracted RSH during hospitalization for cardiac reasons, had comorbidities, and experienced additional complications due to extended hospitalization.
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http://dx.doi.org/10.5505/tjtes.2017.67672DOI Listing
November 2017

Factors affecting treatment, management and mortality in cases of retroperitoneal hematoma after cardiac catheterization: a single-center experience.

Postepy Kardiol Interwencyjnej 2017 25;13(3):218-224. Epub 2017 Sep 25.

Gastroenterological Surgery Department, Kartal Koşuyolu High Speciality and Training Hospital, Istanbul, Turkey.

Introduction: There is little information available on the clinical aspects, results, treatment and management of cardiac catheterization-related retroperitoneal hematoma. Data on the subject are rather limited, and current publications are based on a limited number of retrospective cohort studies and case reports.

Aim: To perform a retrospective analysis of the demographic, clinical, and in-hospital results of patients who developed retroperitoneal hematoma (RPH) after cardiac catheterization (CC).

Material And Methods: The cases of 124,064 patients who had CCs between January 2010 and October 2016 were retrospectively analyzed. Patients diagnosed with RPH were classified into three groups depending on the method of treatment: conservative (group 1), endovascular stenting (group 2), and surgery (group 3). The independent risk factors, based on RPH-related mortality, were determined by logistic regression analysis.

Results: Of the 68 (0.054%) patients with RPH, 75% received conservative treatment, 13.2% underwent angiographic stent placement, and 11.7% had surgical treatment. Red blood cell packets (RBCPs) ( = 0.043), duration of hospitalization ( = 0.007), and mortality rates ( = 0.006) were statistically significantly higher in group 3 in comparison to the other groups. Multivariate subgroup analysis was conducted to determine mortality rates, with post-procedural highest creatinine ≥ 2 mg/dl and RBCPs ≥ 10 established as independent risk factors.

Conclusions: Hemodynamically stable patients with no active hemorrhaging are shown to have good results with conservative treatment. We believe that endovascular methods should be used initially for hemodynamically unstable patients, while surgical treatment should be employed in cases where endovascular methods fail or abdominal compartment syndrome develops.
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http://dx.doi.org/10.5114/aic.2017.70189DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644040PMC
September 2017

Does antiaggregant administration lead to early diagnosis in proximal colon cancer?

North Clin Istanb 2017 26;4(2):173-179. Epub 2017 Aug 26.

Department of Gastroenterology Surgery, Kosuyolu High Speciality Training and Research Hospital, Kartal, Istanbul, Turkey.

Objective: Cancers of the proximal colon are often diagnosed in advanced stages with iron deficiency anemia and nonspecific symptoms. Aspirin and clopidogrel are commonly used antiaggregant agents for various clinical conditions. The aim of this study was to investigate the effects of antiaggregant medication on the early diagnosis of proximal colon cancer.

Methods: Cases of colon cancer patients who had received curative surgical procedures between January 1, 2013 and July 31, 2016 were retrospectively reviewed. The clinical and pathological results of patients who had used antiaggregant drugs were compared to those who had not.

Results: During the studied period, 246 colorectal cancer patients underwent curative surgical procedures. Of the 67 patients with proximal colon cancer who were included in the study, 27 (40.3%) had taken antiaggregant medication. The mean age of the antiaggregant group was 67.1 years (range: 34-88 years), while it was 58.3 years (range: 34-83 years) for the non-antiaggregant group; the difference between the 2 groups was statistically significant (p=0.03). A pathological evaluation revealed that 74.1% of the antiaggregant group was in the early stages (Stage I/II: 7/13), while 42.5% of the non-antiaggregant group was in the early stages (Stage I/II: 2/15); the difference was statistically significant (p=0.011).

Conclusion: Antiaggregant medication has a positive effect on diagnosing proximal colon cancer at early stages. Patients using aspirin or clopidogrel should undergo a complete colonoscopic evaluation in the presence of gastrointestinal tract bleeding or newly developed anemia.
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http://dx.doi.org/10.14744/nci.2017.80148DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5613266PMC
August 2017

Postrenal acute kidney injury and abdominal compartment syndrome associated with bladder pressure: type III rectus sheath hematoma.

Arch Med Sci Atheroscler Dis 2017 13;2(1):e1-e2. Epub 2017 Mar 13.

Gastroenterological Surgery Department, Kartal Koşuyolu High Speciality and Training Hospital, Istanbul, Turkey.

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http://dx.doi.org/10.5114/amsad.2017.66479DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5596111PMC
March 2017

Acute abdomen in a mentally retarded patient: cecal volvulus.

Prz Gastroenterol 2017 30;12(2):159-161. Epub 2017 May 30.

Gastroenterological Surgery Department, Kartal Koşuyolu High Speciality and Training Hospital, Istanbul, Turkey.

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http://dx.doi.org/10.5114/pg.2017.68053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5497133PMC
May 2017

A rare cause of ileus: late jejunal stricture following blunt abdominal trauma.

Ulus Travma Acil Cerrahi Derg 2017 Jan;23(1):74-76

Department of Gastrointestinal Surgery, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital, İstanbul-Turkey.

Small intestinal stricture forming in the late phase following nonpenetrating abdominal trauma is rare cause of ileus. It has often been suggested that it is result of localized feeding deficiency on the intestinal wall related to minor trauma in the mesentery. Laparoscopy has been increasingly used for diagnosis and treatment. Diagnosis should be supported by pathological analyses in case of intestinal stenosis related to blunt abdominal traumas.
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http://dx.doi.org/10.5505/tjtes.2016.06981DOI Listing
January 2017

Anticoagulant-induced breast hematoma.

Ulus Travma Acil Cerrahi Derg 2017 Jan;23(1):72-73

Department of Gastroenterology Surgery, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital, İstanbul-Turkey.

Warfarin is the most commonly used oral anticoagulant and is widely prescribed to prevent thromboembolic events. Warfarin-dependent spontaneous breast hematoma is a very rare complication. Presently described is rare case of warfarin-induced breast hematoma.
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http://dx.doi.org/10.5505/tjtes.2016.01657DOI Listing
January 2017

Spleen-Preserving Surgery in Splenic Artery Aneurysm.

Case Rep Surg 2017 17;2017:8716962. Epub 2017 Dec 17.

Department of Gastroenterological Surgery, Kartal Koşuyolu High Speciality and Training Hospital, Kartal, Istanbul, Turkey.

Endovascular interventions are increasingly used in the treatment of a splenic artery aneurysm (SAA), which is a rare and life-threatening clinical disorder. However, in cases of SAA rupture, minimally invasive interventions are unsuitable, and open surgery remains the gold standard method. In open surgery, care should be taken to preserve the spleen and its immune function in cases where an arterial segment of sufficient length allows for reconstruction. An SAA was detected in a 51-year-old woman who presented to our polyclinic with left upper quadrant pain. An endovascular intervention was unsuccessful, and open surgery was performed. Approximately 5 cm of aneurysm in the middle segment of the splenic artery was treated by arterial anastomosis, and the spleen was preserved. The patient experienced no postoperative complications and remained asymptomatic at the seventh month of follow-up. The aim of this case report is to emphasize the importance of splenic sparing surgery in cases of SAAs.
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http://dx.doi.org/10.1155/2017/8716962DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5748087PMC
December 2017

Magnetic Resonance Imaging Features of Idiopathic Granulomatous Mastitis: A Retrospective Analysis.

Iran J Radiol 2016 Jul 23;13(3):e20873. Epub 2016 May 23.

Department of Radiology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey.

Background: Granulomatous mastitis is a rare and benign inflammatory breast disease that may clinically and radiologically mimic breast cancer.

Objectives: The aim of this study was to evaluate the features of idiopathic granulomatous mastitis (IGM) on breast magnetic resonance imaging (MRI) with mammographic and sonographic findings.

Patients And Methods: A retrospective analysis was conducted on 20 patients with IGM who had been diagnosed by needle core or excisional biopsy at a single institution between 2006 and 2012. All of the patients underwent MRI for suspicious breast findings prior to biopsy. MRI examinations were performed on a 1.5 T scanner. The MRI findings were evaluated in accordance with the breast imaging-reporting and data system (BI-RADS) MRI lexicon established by the American College of Radiology.

Results: MRI detected a total of 29 lesions in the 20 patients. Fourteen of these lesions were seen as mass enhancements, with the remaining 15 identified as non-mass enhancements (NMEs). The median size of all lesions was 3.6 cm (range, 0.7 - 6.7 cm). The most frequently observed features were masses with a round shape (9 out of 14, 64%), smooth contour (11 out of 14, 78%), and a rim enhancement pattern (10 out of 14, 71%). The most common features of the 15 NME lesions were segmental distribution (6 out of 15, 40%) and heterogeneous enhancement patterns (8 out of 15, 53%). The time-intensity curves of the dynamic studies showed benign type one signal intensity (persistent enhancement pattern) in the majority of lesions (10 out of 20, 50%).

Conclusion: Our study suggests that breast MRI findings of IGM have a wide spectrum. Rim enhancement patterns are frequently seen on contrast enhanced images, but the imaging findings are nonspecific and cannot be used definitively to distinguish between benign and malignant lesions.
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http://dx.doi.org/10.5812/iranjradiol.20873DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5106557PMC
July 2016

Surgical management of a splenic artery aneurysm.

Clin Case Rep 2016 May 29;4(5):524-5. Epub 2016 Mar 29.

Cardiovascular Surgery Department Kartal Koşuyolu High Speciality and Training Hospital Istanbul Turkey.

Aneurisms of the splenic artery are rare clinical findings. Surgeons and interventional radiologists should co-operate in the management of this challenging disease; we describe here a surgical option.
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http://dx.doi.org/10.1002/ccr3.550DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4856251PMC
May 2016

Relationship of preoperative neutrophil lymphocyte ratio with prognosis in gastrointestinal stromal tumors.

Ulus Cerrahi Derg 2015 1;31(2):61-4. Epub 2015 Jun 1.

Department of General Surgery, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey.

Objective: Gastrointestinal stromal tumors are believed to play a role in immunosuppression with their local effect. In some cancers with associated inflammation, an increased pretreatment neutrophil lymphocyte ratio is considered as an indicator of poor prognosis. The aim of our study was to assess the relationship of increased blood neutrophil lymphocyte ratio with disease prognosis in patients with gastrointestinal stromal tumors.

Material And Methods: The data of 78 patients who underwent surgery with the diagnosis of primary gastrointestinal stromal tumor in our clinic were evaluated retrospectively. The preoperative neutrophil lymphocyte ratio in the peripheral blood was determined. The neutrophil lymphocyte ratio and its relationship with tumor risk and prognosis were compared. The data were evaluated by Pearson's correlation analysis and the Welch ANOVA test.

Results: The preoperative neutrophil lymphocyte ratio was significantly increased in the high-risk groups (p<0.05). An increased preoperative neutrophil lymphocyte ratio was associated with shorter survival (r=-0.32, p=0.009). In addition, an increase in the neutrophil lymphocyte ratio was associated with an increase in the mitotic activity of the tumor (r=-0.364, p=0.025).

Conclusion: The preoperative neutrophil lymphocyte ratio in gastrointestinal stromal tumors can be used as an indicator of high-risk tumors and poor prognosis.
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http://dx.doi.org/10.5152/UCD.2015.2840DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4485812PMC
July 2015

[Primary retroperitoneal hydatid cyst].

Turkiye Parazitol Derg 2014 ;38(1):68-70

Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, Konya, Türkiye.

Hydatid cysts cause diseases most frequently by localizing in the liver and the lungs. Hydatid cysts with retroperitoneal localization are very rare. A 45-year-old female patient presented to our hospital with complaints of back pain, weight loss, and fatigue. The computerized tomography (CT) revealed that the patient had a septated cystic lesion of about 8x7x6 cm localized in the posterior of the left kidney, in the paravertebral site causing destruction of the neighboring costa. During laparotomy, the wall of the cyst with retroperitoneal localization was partially excised and the remaining cavity was drained. The drain was removed on post-op day 5. The histopathological diagnosis was reported to be a hydatid cyst. No problems were seen during the follow-ups of the patient who was administered post-op albendazole. Hydatid cysts are an endemic disease in our country and it should be kept in mind that they also have atypical localizations.
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http://dx.doi.org/10.5152/tpd..2014.2897DOI Listing
November 2014

Bilateral Breast Abscess Caused by in a Non-lactating Woman: A Rare Case.

J Breast Health 2014 Jul 1;10(3):174-176. Epub 2014 Jul 1.

Department of General Surgery, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey.

Breast abscess usually occurs during lactation and the responsible organism is often . Breast abscess in non-lactating women is extremely rare and limited data is available in the literature regarding this entity. In our study, a 36-year-old non-lactating female patient who developed bilateral breast abscess due to infection without any predisposing factors has been discussed in light of the literature.
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http://dx.doi.org/10.5152/tjbh.2014.1602DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5351543PMC
July 2014

Primary Neuroendocrine Carcinoma of the Breast: A Report of Three Cases.

J Breast Health 2014 Apr 1;10(2):125-128. Epub 2014 Apr 1.

Departement of Radiology, Necmettin Erbakan University Faculty of Medicicine, Konya, Turkey.

Primary neuroendocrine carcinoma of the breast is extremely rare. More than 97% of neuroendocrine tumors occur in the gastrointestinal and respiratory tracts. Three cases that have been operated in our clinic and had a diagnosis of primary neuroendocrine carcinoma of the breast were assessed, along with literature data. Histopathological diagnoses were obtained by preoperative core needle biopsy. Breast-conserving surgery was performed in two cases, and modified radical mastectomy in one. In all cases, immunohistochemical studies were positive for neuron-specific enolase and synaptophysin. All patients received adjuvant chemotherapy (CT) and one patient received additional radiotherapy (RT). Recurrence or distant metastasis was not detected during long-term follow-up after surgery.
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http://dx.doi.org/10.5152/tjbh.2014.1557DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5351471PMC
April 2014