Publications by authors named "Kamuran Cumhur Değer"

26 Publications

  • Page 1 of 1

Pancreatic cystic echinococcosis causing acute pancreatitis.

Ulus Travma Acil Cerrahi Derg 2020 11;26(6):951-954

Department of General Surgery, Bezmialem Vakıf University Faculty of Medicine, İstanbul-Turkey.

Echinococcosis is a zoonotic infestation, most commonly arises from Echinococcus granulosus helminth. The definitive hosts are carnivora, such as dogs and cats, and the intermediate hosts are herbivores, including cattle, sheep and goats. Humans are intermediate hosts, causing cystic echinococcosis. In our country, the incidence of echinococcos is 14%. The disease is localized in the liver by 70%. Cyst hydatid localized in the pancreas is unusual, with an incidence of 0.2-0.6%, and rarely causes acute pancreatitis. In this report, we present a 45-year-old male patient with cyst hydatid, which manifested by an acute pancreatitis attack. In the examination, there was a CE2 type according to WHO classification stage III cyst hydatid of 97 mm diameter with septa associated with Wirsung duct, acute pancreatitis and splenomegaly. The indirect hemagglutination test was >1: 2560. The patient underwent pancreatectomy and splenectomy following medical therapy with Albendazole tablet for four weeks. IHA of the patient was found as 1/32 in the third month. Cyst hydatid should be considered in the differential diagnosis of all cystic masses, especially in the regions where the disease is endemic. In addition, it should be remembered that although rarely seen, pancreatic cyst hydatid may cause acute pancreatitis.
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http://dx.doi.org/10.14744/tjtes.2019.85069DOI Listing
November 2020

Predictive and prognostic value of L-lactate, D-dimer, leukocyte, C-reactive protein and neutrophil/lymphocyte ratio in patients with acute mesenteric ischemia.

Ulus Travma Acil Cerrahi Derg 2020 Jan;26(1):86-94

Department of General Surgery, Bezmialem Foundation University Faculty of Medicine, İstanbul-Turkey.

Background: Acute mesenteric ischemia (AMI) is a disease that causes an ischemia in the intestines due to the obstruction of the mesenteric vessels feeding the intestines, with a mortality rate reaching up to 80%. The overall incidence of AMI is 0.63 per 100,000 people. Early diagnosis and treatment are very important for survival. There is no ideal biomarker that can reflect different types and stages of AMI. This study investigated the predictive and prognostic value of L-lactate, D-dimer, leukocyte, C reactive protein (CRP) and neutrophil/lymphocyte ratio (NLR) in the preoperative period were investigated in patients operated for AMI.

Methods: A total of 44 patients operated for AMI between 2015 and 2019 were evaluated in this study. Demographic, clinical, radiological, laboratory and surgical findings of the patients included in this study were recorded. The patients were divided into groups according to the etiological type of AMI. L-lactate, D-dimer, CRP, leukocyte, and NLR levels of these patients were determined. Statistical analysis was performed according to AMI groups.

Results: The mean age of the 44 patients included in this study was 67.7 years and the female to male ratio was 0.76. According to tomography results, 31.8% (n=14) of the patients had mesenteric artery embolism, 29.5% (n=13) had mesenteric artery thrombus, 25% (n=11) had mesenteric vein thrombus and 13.6% (n=6) had non-occlusive mesenteric ischemia. When AMI types were compared, D-dimer and CRP levels were found to be significantly different from other markers. The total length of stay in the hospital was found to be significantly correlated with the L-lactate (p=0.047) and CRP (p=0.045) levels. In the analyses, CRP was determined to be the common biomarker that could be used in the diagnosis of mesenteric ischemia in all AMI types.

Conclusion: Particularly, the CRP level can be used effectively in the preoperative period to diagnose AMI and to determine its subtype and clinical course. However, L-lactate, D-dimer, leukocyte and NLR are markers that have no predictive value in the diagnosis of all AMI subtypes.
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http://dx.doi.org/10.14744/tjtes.2019.61580DOI Listing
January 2020

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

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

Closure of non-healing perianal Crohn's disease with surgery and vacuum-assisted closure (VAC) system.

Turk J Gastroenterol 2018 05;29(3):367-369

Department of Gastrointestinal Surgey, Kartal Koşuyolu High Speciality Training and Research Hospital, İstanbul, Turkey.

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http://dx.doi.org/10.5152/tjg.2018.17138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6284670PMC
May 2018

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 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

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

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

Comment: Leiomyosarcoma of the retrohepatic vena cava: Report of a case treated with resection and reconstruction with polytetrafluoroethylene vascular graft.

Ulus Cerrahi Derg 2016 29;32(3):231-2. Epub 2016 Feb 29.

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

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http://dx.doi.org/10.5152/UCD.2015.3344DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4970789PMC
August 2016

Laparoscopic treatment of a mesenteric cyst.

Prz Gastroenterol 2016 8;11(2):143-4. Epub 2016 Feb 8.

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

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http://dx.doi.org/10.5114/pg.2015.55187DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4916233PMC
June 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

Gastric bezoars.

Prz Gastroenterol 2016 2;11(1):60-1. Epub 2016 Feb 2.

Department of Gastroenterology Surgery, Kartal Koşuyolu High Specialty Education and Research Hospital, Istanbul, Turkey.

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http://dx.doi.org/10.5114/pg.2015.55188DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4814539PMC
April 2016

Performance of venous port catheter insertion by a general surgeon: a prospective study.

Int Surg 2015 May;100(5):827-35

1 Adana Numune Training and Research Hospital, Department of General Surgery, Adana and Kars State Hospital General Surgery, Kars, Turkey.

As part of the vascular access procedures, venous ports, commonly referred to as catheters, are placed under the skin to enable safe and easy vascular access for administration of repeated drug treatments. 122 patients who had received a venous port catheter insertion procedure in the general surgery department between January 1012 and January 2014 were involved in this study. Patients were divided into two groups: those who had undergone a fluoroscopy (group 1) and those who had not undergone a fluoroscopy (group 2). Complications that emerged during and after the port catheter insertion procedure and successful insertion rates were recorded in the database. Data of these patients were presented in a prospective manner. There were 92 to 30 patients in groups 1 and 2, respectively. In group 1, the mean age was approximately 56.8, total catheter stay time was 20,631 days, and mean time of port use was 224.2 days. In group 2, the mean age was approximately 61.2, total catheter stay time was 13,575 days, and mean time of port use was 452.5 days. Successful insertion rate was 100% and 90% in groups 1 and 2, respectively (P < 0.05). The proper insertion of the port catheter accompanied by monitoring methods can decrease procedure-related complications. Statistical comparisons between the two groups in terms of malposition and successful insertion rates also support this view (P < 0.05). The findings support the view that in cancer patients, a venous port catheter insertion accompanied by a fluoroscopy can be safely performed by general surgeons.
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http://dx.doi.org/10.9738/INTSURG-D-14-00214.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4452970PMC
May 2015

The effects of vardenafil and pentoxifylline administration in an animal model of ischemic colitis.

Clinics (Sao Paulo) 2014 Nov;69(11):763-9

Department of General Surgery, Adana Adana Numune Training and Research Hospital, Adana, Turkey.

Objectives: 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 mm2 in the control group; 3.4 and 9.6 mm2 in the vardenafil 5 and vardenafil 10 groups, respectively; and 3.4 mm2 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.
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http://dx.doi.org/10.6061/clinics/2014(11)10DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4255201PMC
November 2014

Efficacy of pentoxifylline and tadalafil in rat model of ischemic colitis.

J Invest Surg 2014 Dec;27(6):349-53

1Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey.

Objective: The aim of this study is to investigate the efficacy of tadalafil against pentoxifylline in rat model of ischemic colitis (IC).

Material-methods: Thirty-two Wistar albino rats were subjected to laparotomy and left colon devascularization to create an IC model and then randomly placed into four groups. Group-1 (sham group) was administered 0.9% NaCl following laparotomy, group 2 (control group) was administered 0.9% NaCl following induced IC, group 3 was given pentoxifylline (n = 8), and group 4 was given tadalafil. On the third day; macroscopic findings, Gomella's ischemic area and Wallace scoring, histopathological analysis, and Chiu scoring were performed, and malondialdehyde (MDA) measurement in ischemic colon tissue was carried out through chemical analysis.

Results: Significant differences were observed in acidic fluid, bowel dilatation, and serosal change (p < .05). The ischemic area measured 63.3 mm(2) in the control group, 2.8 mm(2) in the pentoxifylline group (p = .0001), and 2.4 mm(2) (p = .0001) in the tadalafil group. A significant difference was seen between the sham group and the control and pentoxifylline groups (p < .01), in terms of Wallace score and Chiu classification. Similarly, a significant difference was determined between the control group and pentoxifylline and tadalafil groups (p < .01), but no significant difference was established between the pentoxifylline group and tadalafil group (p = .33). MDA measurement was found on an average to be 63.7 in the control group, 22.7 in group 3 and 22.8 in group 4 (p = 001).

Conclusion: Although tadalafil is superior to pentoxifylline, both drugs are considered to have positive effects.
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http://dx.doi.org/10.3109/08941939.2014.971204DOI Listing
December 2014

Abolition of anti-adhesiogenic effect of heparin by protamine sulfate.

Int J Surg 2014 29;12(7):729-33. Epub 2014 May 29.

Department of Surgery, Adana Numune Training and Research Hospital, Adana, Turkey.

Objective: Intraabdominal adhesion is a frequently encountered condition after surgery and can end up in important complications. The objective of this study is to test whether the antiadhesiogenic effect of heparin could be antagonized by administration of protamine in a rat model.

Material And Methods: A laparotomy with caecal abrasion model was used in 40 Wistar rats. Single dose of 1 cc saline was injected subcutaneously (SC) in one group (control); 50 IU/kg heparin was injected SC in Group 2; 50 IU/kg protamine SC given to Group 3; 50 IU/kg heparin and 50 IU/kg protamine was given SC to Group 4 for 3 consecutive days. Each group consisted of 10 rats. All rats were sacrificed one week later for macroscopic and microscopic examination and they were scored for adhesion using Mazuji adhesion scale.

Results: There was significant difference in the heparin group with respect to Mazuji adhesion score, histopathological score (fibrosis, inflammation and vascular proliferation) and S-100 staining (P < 0.05). Additionally, the inflammation was more severe in the mucosa and submucosa compared to serosa in the heparin group (P < 0.01). With respect to fibrosis and vascular proliferation, apart from submucosal fibrosis, heparin group was statistically superior to the control group by means of each layer (P < 0.01).

Conclusion: It seems that heparin is effective preventing adhesion in this rat model. Abolition of heparin's antiadhesiogenic effect by protamine administration is likely exerted via its antithrombine activity. Clinical application of our findings in intraabdominal surgery warrants further investigation.
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http://dx.doi.org/10.1016/j.ijsu.2014.05.061DOI Listing
December 2014

Effects of β-glucan on colon anastomotic healing in rats given preoperative irradiation.

J Invest Surg 2014 Jun 19;27(3):155-62. Epub 2013 Dec 19.

1Department of General Surgery, Faculty of Medicine, Harran University , Sanlıurfa , Turkey.

Background: Radiation therapy is an essential therapeutic modality in the management of a wide variety of tumors. We aimed to investigate the short-term effects of pelvic irradiation on the healing of colon anastomoses and to determine the potential protective effects of β-glucan in this situation.

Material And Methods: Sixty Wistar albino rats were randomized into three experimental groups: a control group (n = 20), an irradiation (IR) group (n = 20), and an irradiation+β-glucan (IR+β-glucan) group (n = 20). Only segmental colonic resection and anastomosis were performed on the control group. The IR group underwent the same surgical procedure as the control group 5 days after pelvic irradiation. In the IR+β-glucan group, the same procedure was applied as in the IR group after β-glucan administration. The groups were subdivided into subgroups according to the date of euthanasia (third [n = 10] or seventh [n = 10] postoperative [PO] day), and anastomotic colonic segments were resected to evaluate bursting pressures and biochemical and histopathological parameters.

Results: Bursting pressure values were significantly lower in the IR group (p < .001). Malondialdehyde (MDA) levels were significantly higher in the IR group, whereas β-glucan significantly decreased MDA levels on the third PO day (p < .001). Granulation tissue formation scores were significantly lower in the IR+β-glucan group compared with the control group and the IR group (p < .001).

Conclusions: The results of this study indicate that irradiation has negative effects on the early healing of colon anastomoses. The administration of β-glucan ameliorates these unfavorable effects by altering bursting pressures and biochemical parameters.
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http://dx.doi.org/10.3109/08941939.2013.865820DOI Listing
June 2014

Open mini-incision parathyroidectomy for solitary parathyroid adenoma: surgical limitations.

Eur Arch Otorhinolaryngol 2014 Mar 28;271(3):625. Epub 2013 Jun 28.

Department of General Surgery, Adana Numune Research and Training Hospital, Yüregir, Adana, Turkey,

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http://dx.doi.org/10.1007/s00405-013-2599-5DOI Listing
March 2014

Accuracy of surgeon-performed gallbladder ultrasound in identification of acute cholecystitis.

J Invest Surg 2013 Apr 28;26(2):85-8. Epub 2012 Dec 28.

Department of Surgery, Adana Numune Training and Research Hospital, Adana, Turkey.

Background: Acute cholecystitis is a common cause of emergency hospital admission. Ultrasonography (US) plays a significant role in the prompt diagnosis of this medical condition. However, it is difficult to find a radiologist in attendance for performing gallbladder US "beyond daytime and on weekends." With this standpoint, we decided to assess prospectively the accuracy of surgeon-performed gallbladder US for identifying acute cholecystitis in patients with cholelithiasis.

Materials And Methods: Seventy-one consecutive patients awaiting elective or acute gallbladder surgery were included in this study. The US findings of surgeons and radiologists are compared with the histopathology reports. The sensitivity, specificity, accuracy, PPV (positive predictive value), and NPV (negative predictive value) for acute cholecystitis by both surgeon-performed ultrasound (SPUS) and radiologist-performed ultrasound (RPUS) were evaluated.

Results: Both radiologists and surgeons visualized the gallstones of each patient in all cases. The sensitivity, specificity, accuracy, and NPV for acute cholecystitis by SPUS were 84.2%, 92.1%, 90%, and 94%, respectively, whereas the sensitivity, specificity, accuracy, and NPV for acute cholecystitis by RPUS were 92.3%, 85.9%, 87.1%, and 98%, respectively.

Conclusions: Both SPUS and RPUS had a high accuracy rate in electing the acute cholecystitis. Our data support the fact that the use of US by general surgeons is effective in the diagnosis of acute cholecystitis.
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http://dx.doi.org/10.3109/08941939.2012.697977DOI Listing
April 2013