Mesut Gül

Risk Factors Effecting Mortality in Acute Mesenteric Ischemia and Mortality Rates: A Single Center Experience

The objective of this study is to discuss the effective factors on morbidity and mortality in patients who were operated on for acute mesenteric ischemia. Between 2006 and 2011, 95 patients, who underwent emergent surgery for acute mesenteric ischemia, were analyzed retrospectively. The study group consisted of 56 men (58.9%) and 39 women (41.1%), with an average age of 68.4 ± 14.4 years. Elapsed time between the onset of the symptoms and the surgical operation was less than 24 hours in 47 (49.5%) cases, and more than 24 hours in 48 cases (50.5%) (P < 0.001). Although all of the patients had intestinal necroses, colon involvement was seen in 38 patients, and mortality was higher in this group of patients (P < 0.001). Mortality rate was 42.1%. This was higher in older patients, those with increased leukocyte levels, increased elapsed time to laparotomy, and when the colon was involved.

Effect of erythropoietin on liver regeneration in an experimental model of partial hepatectomy

BACKGROUND AND AIM The liver shows remarkable regeneration ability after damage or resection. The main stimulant for hepatic regeneration is resection. Erythropoietin (EPO), which was initially used for anemia therapy, is today known as a general tissue protector owing to its anti-inflammatory, anti-oxidant, anti-apoptotic, and angiogenic properties. This study aims to investigate the effect of systemically administered EPO on liver regeneration after partial hepatectomy. METHODS Forty-eight male Wistar albino rats were randomly split in two groups A and B consisting of 24 rats each. Standard 70% hepatectomy was performed on the rats in group A. The same surgical procedure was performed on the rats in group B, and they were additionally administered 3000 U/kg/subcutaneous EPO. The rats were sacrificed 24, 48, and 72 h after resection. The groups were compared in terms of biochemical, morphological, and histopathological parameters. RESULTS The biochemical results showed that the administration of EPO decreased aspartate aminotransferase levels significantly (p < 0.05) at 24 h after hepatectomy. A comparison of the groups in terms of relative liver weight showed that EPO-treated groups exhibited a statistically significant increase (p < 0.05) for all three time periods. Histopathology results showed that in the EPO-treated groups, the mitosis index at 48 and 72 h, double nuclei cell number at 72 h, and proliferating cell nuclear antigen ratio at 48 h showed a significant increase (p < 0.05). CONCLUSION Our study showed that systemically administering high-dose EPO increases regeneration by affecting the biochemical, morphological, and histopathological parameters after liver resection.

Percutaneous Cholecystostomy in High-Risk Elderly Patients With Acute Cholecystitis: A Lifesaving Option

Purpose: To analyze the results of percutaneous cholecystostomy in in high-risk elderly patients with acute cholecystitis. Materials and Methods: Between June 2010 and May 2011, 11 patients aged over 60 who had at least 1 systemic disease and underwent percutaneous cholecystostomy were reviewed retrospectively. Results: The procedure was technically successful in 10 (90.9%) patients. Clinical improvement was achieved in 81.8% of patients within 72 hours. Two patients received emergency surgery while elective cholecystostomy was performed in 5 patients. Percutaneous cholecystostomy was performed singly in 4 (36.4%) patients. Early complication rate was 18.2%. Two (18.2%) patients died. Conclusion: Percutaneous cholecystostomy can be performed with low mortality and morbidity. Cholecystectomy should be performed in all patients with suitable general conditions due to the high recurrence rates of percutaneous cholecystostomy.

Can mean platelet volume be a new risk factor in portal venous thrombosis

Background: The aim of this study was to discuss the possibility of mean platelet volume (MPV) being a new risk factor in the etiology of portal venous thrombosis (PVT). Methods: Study participants were categorized into 2 different groups: group I, control group (n = 35) and group II, PVT group (n = 34). Demographic data and MPV values were recorded retrospectively. Results: No differences were determined between the 2 groups regarding hypertension, diabetes mellitus, and smoking (P > .05). The average hemoglobin levels were 10.8 ± 2.1 in group II and 14.0 ± 1.7 in group I (P < .001). Although the MPV levels of group II patients were 8.2 ± 0.52, the average level in group I was determined as 7.8 ± 0.62 (P = .012). In the performed receiver–operating characteristic (ROC) analysis, the cutoff value for patients with PVT for MPV was determined as 7.9 (area under curve: 0.674), sensitivity as 70.6%, and specificity as 65.7% (P = .013). Conclusion: The current study shows that MPV is significantly higher in patients with PVT than in the control group.

Spontaneous intraperitoneal rupture of a hepatic hydatid cyst.

Hydatid cysts, which are endemic to certain areas, typically are found in the liver. Spontaneous intraperitoneal rupture, which can be life threatening, is rare. This article presents a case of spontaneous rupture of a hydatid cyst in a 69-year-old woman who was admitted to the emergency department. The patient had no history of trauma. Abdominal ultrasonography and computed tomography suggested rupture of a hydatid cyst. The patient underwent a partial cystectomy, and the cystic area was washed with hypertonic saline and the peritoneal cavity was washed with isotonic saline and drained. Postoperatively, the patient was treated with albendazole for 3 months. No additional pathology was observed at the 3-, 6-, and 9-month follow-ups. Although rare, a ruptured hydatid cyst should be considered in the differential diagnosis of the acute abdomen in a patient residing in an endemic area.

The Protective Effect of Ellagic Acid on Lung Damage Caused by Experimental Obstructive Jaundice Model

Abstract Aim : This study aimed to investigate protective effects of ellagic acid on lungs in an experimental obstructive jaundice model. Methods : Four groups were established, each consisting of ten randomly selected rats: Group 1: sham, Group 2: ellagic acid, Group 3: obstructive jaundice, and Group 4: obstructive jaundice + ellagic acid. Ellagic acid was administered orally at a dose of 60 mg/kg/day to group 2 and 4. The animals were sacrificed eight days later. The total oxidative status and the total antioxidant capacity in their lung tissue were determined, and malondialdehyde levels in their blood were measured. Histopathological changes in the lungs were examined. Results : In the obstructive jaundice group treated with ellagic acid, there was a decrease in malondialdehyde levels and a reduction in the total oxidative status and the oxidative stress index, whereas the total antioxidant capacity increased (p < 0.001). The histopathological examination showed that neutrophil leukocyte infiltration and edema formation decreased and destruction of lung parenchyma disappeared following the treatment with the ellagic acid (p < 0.05). Conclusion : This study shows that ellagic acid has a protective effect against oxidative damage in lung tissue in obstructive jaundice.

Factors Affecting Morbidity and Mortality in Patients Who Underwent Emergency Operation for Incarcerated Abdominal Wall Hernia

Patients with incarcerated abdominal wall hernias (AWHs) are often encountered in emergency care units. Despite advances in anesthesia, antisepsis, antibiotic therapy, and fluid therapy, the morbidity and mortality rates for these patients remain high. Between 2006 and 2011, we retrospectively analyzed the cases of 131 patients who underwent emergency surgery for incarcerated abdominal wall hernias. Of these, there were 70 women (53.4%) and 61 men (46.6%) with an average age of 63.3 ± 17.4 years (range, 17-91 years). Morbidity was observed in 28 patients (21.4%), and the mortality rate was 2.3%. Intestinal resection, presence of concomitant disease, and general anesthesia were the independent variants that affected morbidity of patients with incarcerated abdominal wall hernias.

Mean Platelet Volume: Is It a Predictive Parameter in Diagnosis of Acute Mesenteric Ischemia?

Our objective for this study was to discuss the usability of mean platelet volume, which is associated with numerous vascular pathologies, in the early diagnosis of acute mesenteric ischemia. Acute mesenteric ischemia is an uncommon, life-threatening clinical condition mostly seen in the elderly. Early diagnosis of acute mesenteric ischemia and correction of blood circulation before necrosis occurs are important factors affecting prognosis. A total of 95 patients who underwent emergency surgery for acute mesenteric ischemia and 90 healthy volunteers as control group were included in this study. Age, gender, hemoglobin values, white blood cell counts, mean platelet volume, and platelet counts are recorded for evaluation. The mean platelet volume values were significantly higher in patients with acute mesenteric ischemia than in the controls (9.4 ± 1.1 fL and 7.4 ± 1.4 fL, respectively; P < 0.001). Receiver-operating characteristic analysis demonstrated a cutoff value of mean platelet volume as 8.1 fL (area under the curve, 0.862), a sensitivity of 83.2%, and a specificity of 80%. As a result, in the patients who are admitted to the hospital with acute nonspecific abdominal pain and suspected of having acute mesenteric ischemia, high mean platelet volume values in routine hemograms support the diagnosis of acute mesenteric ischemia.

The Effects of Erythropoietin on Bacterial Translocation and Inflammatory Response in an Experimental Intestinal Obstruction Model in Rats / Uticaj Eritropoetina Na Bakterijsku Translokaciju I Inflamatorni Odgovor U Eksperimentalnom Modelu Intestinalne Opstrukcije Kod Pacova

Summary Background: Intestinal obstruction results in distortion of balance of antiinflammatory cytokines and release of oxidants, and also leads to bacterial translocation, sepsis and multiple organ failure. Asymmetric dimethylarginine is related to multiple organ failure as a new prognostic marker. Erythropoietin reduces the inflammatory response by decreasing the levels of proinflammatory cytokines and cytokine-induced apoptosis. In this study, we aimed to investigate the effectiveness of erythropoietin in reducing the severity of bacterial translocation and inflammatory response after intestinal obstruction and the relation between asymmetric dimethylarginine and inflammatory markers. Methods: Forty Wistar albino rats (200-250 g) were divided into 4 groups as follows: Group 1 (Sham), only ileocaecal junction dissection; Group 2 (Erythropoietin), ileocaecal junction dissection and 3000 lU/kg erythropoietin subcutaneously; Group 3 (Intestinal Obstruction), complete ileal ligation; Group 4 (Intestinal Obstruction + Erythropoietin), complete ileal ligation and 3000 IU/kg erythropoietin subcutaneously. After 24 hours, the rats were sacrificed by taking blood from the heart for biochemical analyses. Peritoneal swab culture, liver, mesenteric lymph nodes, spleen and ileum were collected for microbiological and histopathological examinations. Results: Erythropoietin reduced the secretion of inflammatory cytokines, oxidative damage and bacterial translocation, prevented the formation of inflammatory changes in the intestine, liver, spleen and mesenteric lymph nodes,and also significantly prevented the formation of intestinal damage after intestinal obstruction (p<0.05). Conclusions: Asymmetric dimethylarginine levels did not differ between the groups. Erythropoietin may be useful to preserve from intestinal injury and related sepsis in patients with intestinal obstruction. Asymmetric dimethylarginine is not a suitable prognostic marker. Kratak sadržaj Uvod Kao posledica intestinalne opstrukcije javlja se poremećaj ravnoteže antiinflamatornih citokina i oslobađanje oksida nata, a dolazi i do bakterijske translokacije, sepse i višestrukog otkazivanja organa. Asimetrični dimetilarginin dovodi se u vezu sa višestrukim otkazivanjem organa kao novi prognostički marker. Eritropoetin ublažava inflamatorni odgovor smanjivanjem nivoa proinflamatornih citokina i apoptoze izazvane citokinima. U ovoj studiji cilj je bio da istražimo efikasnost eritropoetina u pogledu smanjenja obima bakterijske translokacije i inflamatornog odgovora posle intestinalne opstrukcije, kao i odnos između asimetričnog dimetilarginina i inflamatornih markera. Metode: Četrdeset albino pacova soja Wistar (200-250 g) podeljeno je u sledeće četiri grupe: Grupa 1, samo disekcija ileocekalnog spoja; Grupa 2 (Eritropoetin), disekcija ileocekalnog spoja i 3000 IU/kg eritropoetina supkutano; Grupa 3 (Intestinalna opstrukcija), kompletna ilealna ligacija; Grupa 4 (Intestinalna opstrukcija + eritropoetin), kompletna ilealna ligacija i 3000 IU/kg eritropoetina supkutano. Posle 24 časa, pacovi su žrtvovani uzimanjem krvi iz srca za biohemijske analize. Kulture peritonealnog brisa, jetre, mezenteričnih limfnih čvorova, slezine i ileuma uzete su za mikrobiološka i histopatološka ispitivanja. Rezultati: Eritropoetin je smanjio lučenje inflamatornih citokina, oksidativno oštećenje i bakterijsku translokaciju, sprečio nastanak inflamatornih promena u crevima, jetri, slezini i mezenteričnim limfnim čvorovima i u značajnoj meri takođe sprečio nastanak intestinalnih oštećenja posle intestinalne opstrukcije (p<0,05). Zaključak: Nivoi asimetričnog dimetilarginina nisu se razlikovali između grupa. Eritropoetin može biti koristan za sprečavanje intestinalnih oštećenja i sepse kod pacijenata sa intestinalnom opstrukcijom, dok asimetrični dimetilarginin nije odgovarajući prognostički marker.

Is Ostomy Still Mandatory in Rectal Injuries

The aim of this study was to compare the outcomes of the treatment methods of ostomy and primary repair in rectal injuries. A total of 63 patients with rectal injury who had been treated at Dicle University Hospital between 2000 and 2011 were retrospectively reviewed. To determine the outcomes of the treatment methods, the patients were divided into 2 groups (ostomy group: patients who underwent ostomy plus primary repair; repair group: patients who only underwent primary repair) and compared. The patients included 51 men and 12 women. A total of 44 patients underwent ostomy, whereas 19 patients underwent primary repair. No morbidity was detected in either group with grade II intraperitoneal rectal injury. The outcomes of the patients with grade II intraperitoneal and extraperitoneal rectal injury were similar. In the treatment of patients with low-grade rectal injuries, primary repair can be preferred to ostomy.