Zübeyir Bozdağ

Fournier's Gangrene: A Summary of 10 Years of Clinical Experience.

We aimed to present our clinical experience with FG treatment. Fourniers gangrene (FG) is a rare but serious disease characterized by progressive necrosis in the genitourinary and perineal region. The retrospective study included 43 patients. Patients were divided into 2 groups as survivors and nonsurvivors. Included in the analysis were data pertaining to demographics, predisposing factors, comorbidities, results of bacteriologic analyses, number of debridements, duration of treatment, FG Severity Index (FGSI) score, fecal diversion methods (trephine ostomy or Flexi-Seal Fecal Management System-FMS), and dressing methods (wet or negative aspiration system). In the nonsurvivor group, urea, WBC, and age were significantly higher, whereas albumin, hematocrit, platelet count, and length of hospital stay (LOHS) were significantly lower compared to the survivor group. Mean FGSI was lower in survivors in comparison with nonsurvivors (5.00 ± 1.86 and 10.00 ± 1.27, respectively; P < 0.001). We conclude that FGSI is an important predictor in the prognosis of FG. Vacuum-assisted closure (VAC) should be performed in compliant patients in order to enhance patient comfort by reducing pain and the number of dressings. Fecal diversion should be performed as needed, preferably by using FMS. The trephine ostomy should be the method of choice in cases where an ostomy is necessary.

Peptik ülser perforasyonunda morbidite ve mortaliteye etkili risk faktörleri

OBJECTIVE Peptic ulcer perforation continues to be a major surgical problem. In this study, risk factors that influence morbidity and mortality in perforated peptic ulcer disease were examined. MATERIAL AND METHODS Files of 148 patients who were included in the study due to peptic ulcer perforation between January 2006 and December 2010 were retrospectively analyzed. Data regarding age, gender, complaints, time elapsed between onset of symptoms and hospital admission, physical examination findings, co-morbid diseases, laboratory and imaging findings, length of hospital stay, morbidity and mortality were recorded. RESULTS The study group included 129 (87.2%) male and 19 (12.8%) female patients. The mean age was 51.7±20 (15-88) years. Forty five patients (30.4%) had at least one co-morbid disease. In the postoperative period, 30 patients (20.3%) had complications. The most common complication was wound infection. Mortality was observed in 27 patients (18.2%). The most common cause of mortality was sepsis. Multivariate analysis revealed age over 60 years, presence of co-morbidities and Mannheim peritonitis index as independent risk factors for morbidity. Age over 60 years, time to admission and Mannheim peritonitis index were detected as independent risk factors for mortality. CONCLUSION Early diagnosis and proper treatment are important in patients presenting with peptic ulcer perforation.Results: The study group included 129 (87.2%) male and 19 (12.8%) female patients. The mean age was 51.7±20 (15-88) years. Forty five patients (30.4%) had at least one co-morbid disease. In the postoperative period, 30 patients (20.3%) had complications. The most common complication was wound infection. Mortality was observed in 27 patients (18.2%). The most common cause of mortality was sepsis. Multivariate analysis revealed age over 60 years, presence of co-morbidities and Mannheim peritonitis index as independent risk factors for morbidity. Age over 60 years, time to admission and Mannheim peritonitis index were detected as independent risk factors for mortality. Conclusion: Early diagnosis and proper treatment are important in patients presenting with peptic ulcer perforation.

Fasciola hepatica infection at a University Clinic in Turkey

INTRODUCTION We aimed to analyze the approaches to the diagnosis and treatment of patients with fascioliasis in light of current literature. METHODOLOGY Thirty-nine patients with fascioliasis admitted to the Surgery Clinic of Dicle Medical Faculty (Turkey) were included in this study. The demographic, clinical, diagnostic, treatment and outcome data were analyzed retrospectively. RESULTS Abdominal pain (n = 37; 95%) and eosinophilia (n = 31; 79%) were the most common findings. Twenty-seven patients were diagnosed by clinical and radiological findings. Patients were treated with triclabendazole. Thirty-six (92.4%) of the patients improved after medical treatment. CONCLUSIONS The presence of typical clinical, laboratory and radiological findings is sufficient for diagnosis. Triclabendazole administration is often an effective treatment, with improvements occurring over the course of a few months.

Therapeutic effects of ellagic acid on L-arginin ınduced acute pancreatitis

PURPOSE To investigate the therapeutic effects of ellagic acid on L-arginin ınduced acute pancreatitis in rats. METHODS Thirty-two were split into four groups. Group 1 (control) rats were performed only laparotomy, no drugs were administered. Group 2 (control+EA) rats were administered 85mg/kg EA orally. Rats were sacrificed by cardiac puncture 24 hours after the administration. Group3 (AP) 24 hours after intraperitoneal L-arginine administration, rats were sacrificed by cardiac puncture. Group 4 (EA)-(AP): 85mg/kg EA was administered orally after the L-arginine administration. 24 hours later, rats were sacrificed by cardiac puncture. Serum TNF-α, IL-1β, IL-6, total oxidative status (TOS), total antioxidant capacity (TAC), amylase levels were determined in all groups. RESULTS Group 3 (AP) rats showed significantly raised TOS level as compared to Group1 (control) rats (p<0.001). Following the EA therapy, a decrease in TOS was observed in Group 4 (AP+EA). TAC levels were significantly raised in the Group 4 (AP+EA) compared to the Group 3 (AP) (p=0.003). Group 3 (AP) showed significantly increased TNF-α, IL-1β and IL-6 serum levels as compared to Group 4 (AP+EA). Histopathological changes were supported our result. CONCLUSION The healing effects of ellagic acid on inflammatory and oxidative stress were confirmed by histopathological and biochemical evaluations of the pancreatic tissue.

Effect of Intraperitoneal Thymoquinone on Postoperative Peritoneal Adhesions.

Abstract Background: To determine the effect of thymoquinone on adhesion formation in a rat caecotomy/suture model. Materials and Methods : Thirty wistar rats were randomized into three groups: The control group received saline and the thymoquinone group received 10 mg/kg thymoquinone after cecal caecotomy/suture model. In the sham group the abdominal wall was closed without any abrasion to the cecum. On day 15, adhesions were classified, and histopathological samples were taken. Results : There were no incisional hernias or wound dehiscences. In comparing adhesion scores, a significant difference was found between the thymoquinone and the control groups (p < 0.05). The grade of inflammation for the thymoquinone and the sham groups were significantly lower than that of the control group (p < 0.01 and p < 0.001, respectively). Hydroxyproline levels were significantly lower in the sham and thymoquinone groups compared to the control group (p < 0.05). Conclusions : Based on the results of this study in a rat peritoneal adhesion model, intraperitoneal administered thymo-quinone has a strong anti-adhesive effect.

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.

Superior Mesenteric Artery (Wilkie’s) Syndrome: A Rare Cause of Upper Gastrointestinal System Obstruction

Abstract Background Superior mesenteric artery syndrome (SMAS) results from the compression of the third part of the duodenum between the aorta and the proximal part of the superior mesenteric artery (SMA). Clinical presentation of SMAS is characterized by the dilatation of the proximal part of the third part of the duodenum. SMAS is a rare cause of the upper gastrointestinal system (UGS) obstruction. In this study, we aimed to present our clinical experience in the treatment of five patients with SMAS, which is a rare clinical condition requiring surgery. Patients and methods The retrospective study included five patients who were treated due to SMAS at our clinic between January 2010 and January 2014. Results All the patients were underweight, with a mean BMI of 15.73 (14–16). The clinical symptoms included epigastric pain after food intake, large volume bilious emesis, early satiety, failure to gain weight, indigestion, esophageal reflux, sense of fullness, and persistent weight loss. SMAS was diagnosed using barium meal studies, upper gastrointestinal endoscopy, abdominal ultrasonography, and CT angiography. Four patients underwent duodenojejunostomy and one patient was managed with gastrojejunostomy. No complication was observed during the postoperative period, and all the patients achieved significant improvement in symptoms. Conclusion SMAS is a rare cause of UGS obstruction, and the diagnosis of SMAS is often delayed. SMAS should be suspected in the differential diagnosis of the patients with unsubstantiated symptoms of persistent nausea, emesis, and significant weight loss.

Improvement of minimally invasive parathyroidectomy outcomes by real time ultrasonography performed by a surgeon and radiologist team.

AIMS Minimally invasive parathyroidectomy (MIP) has become the first line of treatment for primary hyperparathyroidism caused by solitary parathyroid adenoma. In order to increase the sensitivity of high-resolution ultrasonography (hUS), surgeon performed ultrasonography (SUS) has been increasingly used preoperatively. However, a radiologist and surgeon performing ultrasonography (RSUS) has not been a usual practice. In this study, we aimed to evaluate the clinical contribution of RSUS on MIP. MATERIAL AND METHODS From 2012 to 2014, a total of 30 consecutive patients (4 male, 26 female, mean age 48.87+/-14.52 years) with solitary parathyroid adenoma, were included in the study. All patients underwent preoperative hUS and Technetium-99m sestamibi scintigraphy. In patients, demographic characteristics, diagnostic tools used, levels of biochemical parameters, duration of operation, and length of hospital stay were recorded. RESULTS Adenomas were successfully localized by US in all patients and the surgical approach was determined according to this localization. Parathyroidectomy with MIP was successfully performed under local anesthesia in all patients. Mean operation time was 19.87+/-3.35 min. Postoperative PTH and calcium values were significantly decreased. All patients were discharged from the hospital in the same day. None of the patients had complications such as recurrent laryngeal nerve injury, hematoma, or injury to nearby organs. None of the patients had drains placed. CONCLUSIONS Adenoma is well localized by US and thus, MIP can be completed under local anesthesia. US provides a very important clinical contribution to the success of MIP. In addition to these, RSUS helps in determining the location of the incision and the shortest way to achieve the lesion; therefore, it provides a small incision and shortens duration of the operation with a minimal dissection.

Use of the neutrophil to lymphocyte ratio compare crp for the early prediction of acute pancreatitis severity

Aim: To determine the usefulness of the neutrophil to lymphocyte ratio (NLR) as a diagnostic tool for the early detection and prediction of acute pancreatitis (AP) severity compared with that of C-reactive protein (CRP). Material and Methods: The medical records of 464 patients hospitalized with AP between 2006 and 2014 were reviewed. The patients were classified into two groups: severe AP (SAP) and mild/moderate AP groups. Lymphocyte and neutrophil counts and CRP levels at the time of admission were noted. Results: Out of the total number of patients (n = 464), 67 had severe AP. The median NLR was significantly higher in the SAP group (median of 11.1) than in the mild/moderate AP group (median of 6.9) (p < 0.0001). The sensitivity and specificity of NLR were 83.6% and 49.4%, respectively, with a cut-off value of 6.8 and an AUC of 0.68. CRP levels were also significantly higher in the SAP group (median of 189 mg/L) than in the mild/moderate AP group (median of 53.5 mg/L) (p < 0.0001). The sensitivity and specificity of the CRP values were 83.6 % and 74.9 %, respectively, with a cut-off value of 113 mg/L and an AUC of 0.83. Conclusion: The NLR was significantly higher in patients with severe AP. However, CRP measurement was superior to NLR as an early predictor of severe disease.

Factors that Affect Drain Indwelling Time after Breast Cancer Surgery

OBJECTIVE The most common procedure to prevent seroma formation, a common complication after breast and axillary surgery, is to use prophylactic surgical drains. Ongoing discussions continue regarding the ideal time for removing drains after surgical procedures. In this study, we aimed to investigate factors that affect drain indwelling time (DIT). MATERIALS AND METHODS From 2014 to 2015, a total of 91 consecutive patients with breast cancer were included in the study. The demographic characteristics of the patients, treatment methods, histopathologic features of the tumor, size of removed breast tissue (BS), tumor size (TS), number of totally removed lymph nodes (TLN), and metastatic lymph nodes (MLN), whether they had neoadjuvant chemotherapy, and the DIT were retrospectively recorded from the hospital database. RESULTS The mean age of the patients was 48.9 years, and the mean DIT was 4.8 days. The mean size of breast removed was 17.3 cm and tumor size was 4.7 cm, and the mean number of metastatic lymph nodes was 3.3, and mean total number of lymph nodes was 14.1. Patients who had neoadjuvant chemotherahpy had longer DIT. There was a positive correlation between the BS, TS, TLN, MLN, length of hospital stay, and DIT. Linear regresion analysis revealed that the BS, TLN, and history of neoadjuvant chemotherahpy were independent risk factors for DIT. CONCLUSION DIT primarily depends on BS, TLN, and history of neoadjuvant chemotherahpy. A policy for the management of removing drains to prevent seroma formation should thus be individualized.