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Papers by Ali Kagan Gokakin

Cumhuriyet medical journal, Jun 1, 2011

Aim. Lymphedema is one of the most important complications that occurs secondary to modified radi... more Aim. Lymphedema is one of the most important complications that occurs secondary to modified radical mastectomy and breast conserving surgery in breast cancer treatment. micronized flavonoid fraction (MFF)(diosmin 90%, hesperidin 10%) is a well known ...

The American Journal of Surgery, 2007

Fistula-in-ano is a common surgical problem. Various materials have been used to perform the seto... more Fistula-in-ano is a common surgical problem. Various materials have been used to perform the seton technique in the treatment of fistula-in-ano. In this study, a novel material, a self-locking cable tie, was used regardless of the fistula type. Seventeen consecutive patients with anal fistula underwent surgery with the cutting seton technique using the novel material. Nine patients had high fistulas. The average tightening was 3.18, the mean fallout time was 17.41 days, and the mean follow-up period was 8.2 months. No recurrences or incontinence were recorded. There are statistically significant differences between superficial and high fistula cases regarding the number of setons tightening, seton fallout time, and complete healing time. The novel material presented here has some advantages: it is cheap, easily available, and easily applied, moreover, a gradual tightening can be performed. We think this novel material is a good choice in the treatment of fistula-in-ano.

Arab Journal of Gastroenterology, 2012

Background and study aims: The diagnostic methods such as upper gastrointestinal endoscopy (UGE) ... more Background and study aims: The diagnostic methods such as upper gastrointestinal endoscopy (UGE) have played an important role in the evaluation of peptic ulcer (PU). Every year, millions of Muslims fast in Ramadan month. The aim of this study was to evaluate the effect of fasting on PU via UGE. Patients and methods: A total of 321 patients in the period from 2009 to 2011, who underwent UGE as a diagnostic work-up mainly for epigastric pain, were analysed. Patients were divided into three groups: Patients who have been evaluated by UGE, in the month just before Ramadan (group I, n = 69), in Ramadan month (group II, n = 132) and in the month just after Ramadan (group III, n = 120). Continuous data were expressed as the mean ± SD, and were compared with one-way analysis of variance (ANOVA) test amongst groups. Categorical data were given as percentages and were compared with the chi-squared test. Results: Epigastric pain was the most common indication for referral in each group. Interestingly, the indication 'bleeding' was found to be the least in group II, but was far from statistical significance. The highest prevalence of duodenal ulcers and duodenitis was found in group II; the differences to the other groups were statistically significant. Conclusion: Duodenal ulcers and duodenitis were found more during Ramadan month. We recommend that, the patients with epigastric pain may fast by taking their medications.

Journal of B.U.ON. : official journal of the Balkan Union of Oncology, 2015

PURPOSE Thyroid tumors of uncertain malignant potential (TT-UMP) constitute a relatively new diag... more PURPOSE Thyroid tumors of uncertain malignant potential (TT-UMP) constitute a relatively new diagnosis. The purpose of this study was to analyze the relationship between immunohistochemical panels, prognostic parameters and TT-UMP. METHODS Group I was composed of patients diagnosed as differentiated thyroid carcinoma (DTC) and Group II of patients diagnosed as TT-UMP. The prognostic scores of patients were calculated using data according to the well-known prognostic scoring systems MACIS, AMES, AGES. Evaluations of antibodies were based on the presence of nuclear staining for p16 and p53, membranous and cytoplasmic staining for epidermal growth factor receptor (EGFR) and cytoplasmic staining for fragile histidine triad (FHIT). RESULTS Statistically significant difference was noted (p< 0.05) between Group I and Group II according to MACIS and AMES. No statistical difference was found in terms of immunostaining between groups when stained with p16, p53 and FHIT. On the other hand, ...

The ageing population of the world has resulted in associated changes in healthcare provision. Th... more The ageing population of the world has resulted in associated changes in healthcare provision. The diagnostic methods such as, Upper Gastrointestinal Endoscopy (UGE) have played an important role in the evaluation of Peptic Ulcer (PU). Every year millions of Muslims in any age fast in Ramadan Month. The goal of this study was to evaluate the effect of fasting in geriatric age on PU via UGE. A total of 108 patients over 65 years old in the period of 2009 to 2011, who underwent UGE mostly to clear up epigastric pain were analyzed. Patients were divided into three groups: patients who have been evaluated via UGE, in the month just before the Ramadan (Group I, n=23), in the Ramadan month (Group II, n=47) and in the month just after the Ramadan (Group III, n=38). Epigastric pain was the most common indication for referral in each group. Interestingly the indication ‘‘bleeding’’ was found to be the least of all in Group II. In Group 2 was found the highest prevalence of especially duodena...

Gerontology & Geriatrics Studies

Mesenteric venous thrombosis (MVT) is an uncommon catastrophic form of mesenteric vascular occlus... more Mesenteric venous thrombosis (MVT) is an uncommon catastrophic form of mesenteric vascular occlusion. This clinical entity is associated with severe and potentially lethal complications. It accounts for 5-15% of the acute causes of mesenteric ischemia and up to 20% of all cases of intestinal infarction. In the literature, successful non-operative treatment options of MVT such as thrombolytic infusion via the superior mesenteric artery (SMA) or directly into the portal (PV) or superior mesenteric veins (SMV) via the transjugular or transhepatic routes have been shown. However; only a limited number of reports has pointed out thrombolysis by using a jejunal mesenteric vein. Here, the case of a patient with acute PVT and MVT, having a history of oral contraceptive usage who was treated successfully with limited bowel resection and thrombolytic infusion via a jejunal vein, is reported.

Transplantation Reports

Abstract Purpose Orthotopic liver transplantation is life-saving in patients with end-stage liver... more Abstract Purpose Orthotopic liver transplantation is life-saving in patients with end-stage liver failure. However, infections and acute rejection are the most important causes of morbidity and mortality. Liver transplantation in the treatment of liver failure has begun to be implemented for the first time in Pamukkale University Medical Faculty Health Research and Training Hospital, and the results of liver transplants are shared in this report. Material and method A total of five cadaveric donor liver transplantation cases were evaluated prospectively. Patients' demografic findings and infectious complications detected after transplantation were examined. Findings Two of the patients was male, three were female. The mean age was 57.8 ± 9.9 years and the mean MELD score was 12.8 ± 2.4. The organisms isolated included Escherichia coli, Acinetobacter baumannii and Pseudomonas aeruginosa. Two patients’ had blood stream infection with urinary tract infection (UTI) and one patients’ had postoperative wound infection after bilary leakage. One patients’ developed pneumonia. One patient was developed tacrolimus-induced severe persistent diarrhea and recovered thereafter reduced tacrolimus dose. One of the patients died of post-op 3 days because of reperfusion syndrome. Conclusion New liver transplantation practices in our country will make many diseases that cause liver failure become treatable as in our transplant center. The duration of hospital stay, intensive care unit stay, invasive interventions, blood transfusions, immunosuppressive treatments cause an increased risk of infection in these patients and high mortality is seen despite antibiotic treatment.

Cumhuriyet Medical Journal, 2013

Aim. The aim of this retrospective study was to determine mean admission time after calls, resusc... more Aim. The aim of this retrospective study was to determine mean admission time after calls, resuscitation success rate, and determine the rate of medical emergency team (MET) calls of clinics in hospital by assessing the incoming calls to MET at intensive care unit. Methods. This study was conducted by collecting emergency call forms of 147 patients. The data including age, gender, medical diagnosis, the name of the caller department, cause of call, occurrence time, call time, attending time, medical care termination time and the outcomes were extracted from the forms or patient files. Event declaration time was accepted as minute time difference between occurrence time and call time. Duration of admission was accepted as minute time difference between call times and attending time. Duration of resuscitation was accepted as minute time difference between attending time and medical care termination time. Results. Mean event declaration time was 3.3 ± 3.0 minutes. Mean duration of admission was 3.7 ± 1.6 minutes. Mean duration of resuscitation was 20.5 ± 12.7 minutes. The resuscitation of 84 patients (63.6%) was successful while 48 patients (36.4%) died at the end of resuscitation. It was found that the patients with a result of successful resuscitation were significantly younger and their duration of resuscitation was significantly shorter. Conclusion. We indicate that MET system is an essential part of in-hospital emergency medical care system. We suggest that a blue code call system should be established by intensive care unit members and announced to all hospital staff.

Ulusal Cerrahi Dergisi, 2005

Journal of B.U.ON. : official journal of the Balkan Union of Oncology

Thyroid tumors of uncertain malignant potential (TT-UMP) constitute a relatively new diagnosis. T... more Thyroid tumors of uncertain malignant potential (TT-UMP) constitute a relatively new diagnosis. The purpose of this study was to analyze the relationship between immunohistochemical panels, prognostic parameters and TT-UMP. Group I was composed of patients diagnosed as differentiated thyroid carcinoma (DTC) and Group II of patients diagnosed as TT-UMP. The prognostic scores of patients were calculated using data according to the well-known prognostic scoring systems MACIS, AMES, AGES. Evaluations of antibodies were based on the presence of nuclear staining for p16 and p53, membranous and cytoplasmic staining for epidermal growth factor receptor (EGFR) and cytoplasmic staining for fragile histidine triad (FHIT). Statistically significant difference was noted (p< 0.05) between Group I and Group II according to MACIS and AMES. No statistical difference was found in terms of immunostaining between groups when stained with p16, p53 and FHIT. On the other hand, in Group II a moderate p...

Journal of Minimal Access Surgery, 2015

Oxidative stress is a complicated process, which was defined as an increase in prooxidants and de... more Oxidative stress is a complicated process, which was defined as an increase in prooxidants and decrease in antioxidants caused by various mechanisms, including inflammation and surgical trauma. The association between acute appendicitis and oxidative stress has been showed in previous studies. However, comparison of oxidative stress in laparoscopic or open appendectomy (OA) has not been established. Patients who were diagnosed as acute appendicitis between October 2012 and January 2013 were randomized to open (OA, n = 50) and laparoscopic appendectomy (LA, n = 50). Blood samples for oxidative stress markers (total oxidant status [TOS] and total antioxidant status [TAS]), C-reactive protein (CRP) and white blood cells (WBC&amp;amp;amp;amp;#39;s) were collected just before the surgery and 24 h after surgery. There were no differences in preoperative values of WBC and CRP between LA and OA groups (P = 0.523 and 0.424), however, in postoperative 24(th) h, CRP was reduced in LA group (P = 0.031). There were no differences in preoperative levels of TOS, TAS, and oxidative stress index (OSI) between LA and OA groups. In the postoperative 24(th) h, TOS and OSI were found to be significantly higher in OA group when compared to LA group (P = 0.017 and 0.002) whereas no difference was detected in TAS level in the postoperative 24(th) h (P = 0.172). This double-blind, randomized clinical trial provides evidence that LA for uncomplicated appendicitis is associated with significantly lower oxidative stress compared with OA. Some of the advantages of LA may be attributed to the significant reduction of oxidative stress in these patients.

Cumhuriyet Medical Journal, 2012

Aim. In the era of minimally invasive surgery; laparoscopic cholecystectomy has become the first ... more Aim. In the era of minimally invasive surgery; laparoscopic cholecystectomy has become the first choice for gallstone disease both for urgent and elective surgery .However, a number of cases still necessitate conversion to open procedures. Identifying the reasons and rates involved in conversion at the early period can help the surgeons in deciding when to exclude the choice of e laporoscopic procedure. The goal of this study is to evaluate the rates and causes of conversion to open cholecystectomy in elective cases. Methods. The study included all of the patients who had undergone elective surgery in our clinic due to gallstone disease from January, 1999 to December, 2010. Detection of malignancy and/or polyps, and existence of acute cholecystitis were accepted as criterion for exclusion. The existence of previous abdominal surgery, demographic parameters, and the causes and rates of conversion to open cholecystectomy were noted and analyzed. Results. Of the 823 patients for whom laparoscopic cholecystectomy was applied, 782 were included in this study.The rate of conversion was 6.1% (n=48) in total. Twenty of these 48 converted patients were male and 28 of them were female with a mean age of 49,27 years (range: 24-89). In male and female patients, the conversion rates were 9,8% and 4,8%, respectively. Adhesions due to inflammation or prior abdominal surgery were found to be the most common reasons for conversion. Conclusion. There is no question that laparoscopic cholecystectomy is the gold standard when all other treatment modalities are considered. Laparoscopic cholecystectomy can be safely applied by experienced hands to all patients with a low conversion rate. Conversion should not be seen as a complication.

Basic and Clinical Sciences, 2013

This is an open-access article distributed under the terms of the Creative Common Attribution Lic... more This is an open-access article distributed under the terms of the Creative Common Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

Turkish Journal of Trauma and Emergency Surgery, 2012

Medikal tedavi peptik ülser perforasyon (PÜP) oranlarının azalmasında önemli bir rol oynamıştır. ... more Medikal tedavi peptik ülser perforasyon (PÜP) oranlarının azalmasında önemli bir rol oynamıştır. Bu çalışmada, Ramazan ayının PÜP üzerine olan etkisi değerlendirildi. GEREÇ VE YÖNTEM PÜP nedeniyle 1999-2009 yılları arasında ameliyat edilen 229 hastanın dosyaları geriye dönük olarak analiz edildi. Hastalar iki gruba ayrıldı. Grup I (n=188) Ramazan ayı dışında ameliyat edilen hastalar, Grup II (n=41) Ramazan ayında, müslümanların oruç tutma döneminde ameliyat edilen hastalar. Grup II'deki hastalar oruç tutma sürelerine göre de değerlendirildi. BULGULAR Grup başına düşen ameliyat sayısı Grup II'de daha fazla idi (p<0.05). Bu farkın oluşmasında predispozan faktörler, antiülser ilaç kullanımı ve demografik özelliklerin rolü olmadığı saptandı. Oruç tutma süresinin perforasyon üzerine küçük bir etkisi olabileceği görüldü. SONUÇ Bu çalışmanın verileri Ramazan orucunun günde 12 saatten daha fazla sürdüğü dönemlerde PÜP'nin rölatif olarak daha fazla görüldüğünü göstermektedir. Predispozan faktöktörü olan hastaların oruç kararı öncesi bilgilendirilmesi gerektiği kanısındayız. Anahtar Sözcükler: Akut karın; peptik ülser perforasyonu; uzamış açlık; Ramazan; acil cerrahi. BACKGROUND Medical treatment has played an important role in the reduction of peptic ulcer perforation (PUP). The goal of this study was to evaluate the effect of fasting on PUP.

Turkish Journal of Trauma and Emergency Surgery, 2014

The effects of sildenafil in liver and kidney injury in a rat model of severe scald burn: a bioch... more The effects of sildenafil in liver and kidney injury in a rat model of severe scald burn: a biochemical and histopathological study organ failure (MOF) still continue to be leading causes of mortality and morbidity in severe burn patients. [1-4] The response to the initial burn is often associated with secondary damage to vital organs such as lung, liver, and kidneys, which are distant from the injured site. [4-9] The pathophysiological mechanism of such remote organ injury in severe burn remains unclear. However, animal models and clinical trials of burn injury implicate that reactive oxygen species (ROS) and reactive nitrogen species (RNS) mediated by elevated proinflammatory mediators released from both the gut and the burn site can act as causative agents in the development of distant organ injury. [1,9-14] The proinflammatory effects of ROS and RNS include endothelial damage, neutrophil reinforcement, cytokine release, and mitochondrial injury. Thus, remote organ injury following severe burn appears to be mediated by ROS and RNS via the formation of oxidative and nitrosative stress as a consequence of inflammatory response. [1,9,15,16] Inflammation has EXPERIMENTAL STUDY

Cumhuriyet Medical Journal, 2012

Abstract Aim. In recent years there has been an increase in the tendency to use autograft in ante... more Abstract Aim. In recent years there has been an increase in the tendency to use autograft in anterior knee reconstruction. Quadrupled hamstring tendons are known to be the hardest and the most powerful grafts. This study aims to report the first two year results of anterior knee reconstructions performed with proximal femoral transfix fixation by using quadrupled hamstring tendon grafts. Methods. Quadrupled hamstring tendon autografts were used in 89 knees of 89 patients [87 male (97.7%), 2 female (2.3%)]. The mean age of the patients was 24 years (range 20-34 years). Five patients were professional and 35 patients were amateur sportsmen. Subjective, clinical, functional, Telos stress device, and radiographic evaluations were applied to all patients at the end of the first and second years. International Knee Documentation Committee (IKDC) scoring and Lysholm scoring were used to assess knee function and activity. Results. Subjectively 92% of the patients expressed their reconstructed knees to be normal with 100% stability. Eighty-seven percent of the patients returned to their normal daily activities and life at pre-injury level. A and B scores were obtained in 87 of 89 patients (97.7%) as average IKDC knee score. The average Lysholm score was 94. A statistically significant difference was determined in the degree of laxity measured by Telos stress device which had a mean value of 13.7 mm preoperatively and 2.8 mm postoperatively. Conclusion. Successful and excellent subjective, objective, functional and radiological results were obtained in the early follow-up period with the endoscopic anterior cruciate ligament reconstruction technique performed by using femoral transfix fixation with quadrupled semitendinosus-gracilis autograft. Keywords: Anterior cruciate ligament, hamstring autograft, arthroscopy Ozet Amac. Son yillarda daha cok on capraz bag rekonstruksiyonunda otogreft kullanma egiliminde artis vardir. Bilinen en sert ve en guclu greft dortlu hamstring tendonlaridir. Amacimiz dortlu hamstring tendon greftini kullanarak proksimal femoral transfix fiksasyonu ile yapilan on capraz bag rekonstruksiyonunun ilk 2 yillik sonuclarini yayinlamaktir. Yontemler. Seksen dokuz hastanin [87 erkek (%97,7), 2 kadin (%2,3)] 89 dizinde dortlu hamstring tendon otogrefti kullanilmistir. Hastalarin yas ortalamasi 24 (20-34 yas arasi) idi. 5 hasta profesyonel, 35 hasta amator sporcuydu. Subjektif, klinik, fonksiyonel, Telos stres cihazi ve radyografik degerlendirmeler, 1. ve 2. Yilin sonunda her hasta icin uygulanmistir. Diz fonksiyon ve aktivitesini degerlendirmek icin International Knee Documentation Committee (IKDC) ve Lysholm diz skoru kullanildi. Bulgular. Subjektif olarak hastalarin %92’si rekonstrukte edilen dizlerini %100 stabilite ile normal kabul etmislerdir. %87’si zedelenme oncesi aktivite duzeyine donmuslerdir. Ortalama IKDC diz skoru olarak 89 hastanin 87’sinde (%97,7) A ve B skorlari elde edildi. Lysholm ortalama skoru 94 olarak bulundu. Telos stres cihazi ile ameliyat oncesi ortalama 13,7 mm ve ameliyat sonrasi ortalama 2,8 mm olculen laksite degerleri arasinda anlamli fark bulundu. Sonuc. Femoral transfix fiksasyonu ile dort katli semitendinosus-grasilis otogrefti kullanarak yapilan endoskopik on capraz bag rekonstruksiyonu tekniginde erken donemde basarili ve mukemmel subjektif, objektif, fonksiyonel ve radyolojik sonuclar elde ettik. Anahtar sozcukler: On capraz bag, hamstring otograft, artroskopi

Ulusal travma ve acil …, 2009

BACKGROUND: The second hit in trauma leads to an exaggerated inflammatory response and multiple o... more BACKGROUND: The second hit in trauma leads to an exaggerated inflammatory response and multiple organ failure. Infection following burn injury is a useful model for two-hit trauma studies. The aim of this study was to investigate the effect of N-acetylcysteine (NAC) ...

International Journal of Gerontology, 2013

Summary Background Peptic ulcer perforation (PUP) constitutes a unique situation characterized by... more Summary Background Peptic ulcer perforation (PUP) constitutes a unique situation characterized by severe pain, leading almost every patient with this complication to seek help in the hospital. However, clinical features of PUP in elderly patients are different from those of young or in adult patients; indeed, symptoms of PUP may be atypical in old age. Materials and methods This was a retrospective study of patients who underwent emergency surgery for PUP between 2002 and 2012. The patients were divided into two age groups. Medical conditions of the patients that may have had an effect on the perforation, such as age, gender, concomitant disease, use of drugs, presence of Helicobacter pylori infection, characteristic of pain (vague abdominal pain or severe epigastric pain), smoking status, and duration symptoms at the time of admission, were evaluated. Results A total of 261 patients were included in this retrospective study. Group I ( n = 202) was composed of adults (age n = 59) was composed of geriatric patients (age ≥65 years). Male dominancy was observed in both groups. Primary closure of the perforation was the most common procedure performed. Hypertension (18.3 % and 52.5%, respectively), and diabetes mellitus (11.9% and 15.3%, respectively) were the most frequent comorbidities in both groups, whereas mortality and morbidity rates were higher in elderly group. Conclusions PUP is a serious condition, particularly in geriatric age requiring emergency surgical management. Primary closure of the perforation was the most common procedure performed in our series.

Cumhuriyet medical journal, Jun 1, 2011

Aim. Lymphedema is one of the most important complications that occurs secondary to modified radi... more Aim. Lymphedema is one of the most important complications that occurs secondary to modified radical mastectomy and breast conserving surgery in breast cancer treatment. micronized flavonoid fraction (MFF)(diosmin 90%, hesperidin 10%) is a well known ...

The American Journal of Surgery, 2007

Fistula-in-ano is a common surgical problem. Various materials have been used to perform the seto... more Fistula-in-ano is a common surgical problem. Various materials have been used to perform the seton technique in the treatment of fistula-in-ano. In this study, a novel material, a self-locking cable tie, was used regardless of the fistula type. Seventeen consecutive patients with anal fistula underwent surgery with the cutting seton technique using the novel material. Nine patients had high fistulas. The average tightening was 3.18, the mean fallout time was 17.41 days, and the mean follow-up period was 8.2 months. No recurrences or incontinence were recorded. There are statistically significant differences between superficial and high fistula cases regarding the number of setons tightening, seton fallout time, and complete healing time. The novel material presented here has some advantages: it is cheap, easily available, and easily applied, moreover, a gradual tightening can be performed. We think this novel material is a good choice in the treatment of fistula-in-ano.

Arab Journal of Gastroenterology, 2012

Background and study aims: The diagnostic methods such as upper gastrointestinal endoscopy (UGE) ... more Background and study aims: The diagnostic methods such as upper gastrointestinal endoscopy (UGE) have played an important role in the evaluation of peptic ulcer (PU). Every year, millions of Muslims fast in Ramadan month. The aim of this study was to evaluate the effect of fasting on PU via UGE. Patients and methods: A total of 321 patients in the period from 2009 to 2011, who underwent UGE as a diagnostic work-up mainly for epigastric pain, were analysed. Patients were divided into three groups: Patients who have been evaluated by UGE, in the month just before Ramadan (group I, n = 69), in Ramadan month (group II, n = 132) and in the month just after Ramadan (group III, n = 120). Continuous data were expressed as the mean ± SD, and were compared with one-way analysis of variance (ANOVA) test amongst groups. Categorical data were given as percentages and were compared with the chi-squared test. Results: Epigastric pain was the most common indication for referral in each group. Interestingly, the indication 'bleeding' was found to be the least in group II, but was far from statistical significance. The highest prevalence of duodenal ulcers and duodenitis was found in group II; the differences to the other groups were statistically significant. Conclusion: Duodenal ulcers and duodenitis were found more during Ramadan month. We recommend that, the patients with epigastric pain may fast by taking their medications.

Journal of B.U.ON. : official journal of the Balkan Union of Oncology, 2015

PURPOSE Thyroid tumors of uncertain malignant potential (TT-UMP) constitute a relatively new diag... more PURPOSE Thyroid tumors of uncertain malignant potential (TT-UMP) constitute a relatively new diagnosis. The purpose of this study was to analyze the relationship between immunohistochemical panels, prognostic parameters and TT-UMP. METHODS Group I was composed of patients diagnosed as differentiated thyroid carcinoma (DTC) and Group II of patients diagnosed as TT-UMP. The prognostic scores of patients were calculated using data according to the well-known prognostic scoring systems MACIS, AMES, AGES. Evaluations of antibodies were based on the presence of nuclear staining for p16 and p53, membranous and cytoplasmic staining for epidermal growth factor receptor (EGFR) and cytoplasmic staining for fragile histidine triad (FHIT). RESULTS Statistically significant difference was noted (p< 0.05) between Group I and Group II according to MACIS and AMES. No statistical difference was found in terms of immunostaining between groups when stained with p16, p53 and FHIT. On the other hand, ...

The ageing population of the world has resulted in associated changes in healthcare provision. Th... more The ageing population of the world has resulted in associated changes in healthcare provision. The diagnostic methods such as, Upper Gastrointestinal Endoscopy (UGE) have played an important role in the evaluation of Peptic Ulcer (PU). Every year millions of Muslims in any age fast in Ramadan Month. The goal of this study was to evaluate the effect of fasting in geriatric age on PU via UGE. A total of 108 patients over 65 years old in the period of 2009 to 2011, who underwent UGE mostly to clear up epigastric pain were analyzed. Patients were divided into three groups: patients who have been evaluated via UGE, in the month just before the Ramadan (Group I, n=23), in the Ramadan month (Group II, n=47) and in the month just after the Ramadan (Group III, n=38). Epigastric pain was the most common indication for referral in each group. Interestingly the indication ‘‘bleeding’’ was found to be the least of all in Group II. In Group 2 was found the highest prevalence of especially duodena...

Gerontology & Geriatrics Studies

Mesenteric venous thrombosis (MVT) is an uncommon catastrophic form of mesenteric vascular occlus... more Mesenteric venous thrombosis (MVT) is an uncommon catastrophic form of mesenteric vascular occlusion. This clinical entity is associated with severe and potentially lethal complications. It accounts for 5-15% of the acute causes of mesenteric ischemia and up to 20% of all cases of intestinal infarction. In the literature, successful non-operative treatment options of MVT such as thrombolytic infusion via the superior mesenteric artery (SMA) or directly into the portal (PV) or superior mesenteric veins (SMV) via the transjugular or transhepatic routes have been shown. However; only a limited number of reports has pointed out thrombolysis by using a jejunal mesenteric vein. Here, the case of a patient with acute PVT and MVT, having a history of oral contraceptive usage who was treated successfully with limited bowel resection and thrombolytic infusion via a jejunal vein, is reported.

Transplantation Reports

Abstract Purpose Orthotopic liver transplantation is life-saving in patients with end-stage liver... more Abstract Purpose Orthotopic liver transplantation is life-saving in patients with end-stage liver failure. However, infections and acute rejection are the most important causes of morbidity and mortality. Liver transplantation in the treatment of liver failure has begun to be implemented for the first time in Pamukkale University Medical Faculty Health Research and Training Hospital, and the results of liver transplants are shared in this report. Material and method A total of five cadaveric donor liver transplantation cases were evaluated prospectively. Patients' demografic findings and infectious complications detected after transplantation were examined. Findings Two of the patients was male, three were female. The mean age was 57.8 ± 9.9 years and the mean MELD score was 12.8 ± 2.4. The organisms isolated included Escherichia coli, Acinetobacter baumannii and Pseudomonas aeruginosa. Two patients’ had blood stream infection with urinary tract infection (UTI) and one patients’ had postoperative wound infection after bilary leakage. One patients’ developed pneumonia. One patient was developed tacrolimus-induced severe persistent diarrhea and recovered thereafter reduced tacrolimus dose. One of the patients died of post-op 3 days because of reperfusion syndrome. Conclusion New liver transplantation practices in our country will make many diseases that cause liver failure become treatable as in our transplant center. The duration of hospital stay, intensive care unit stay, invasive interventions, blood transfusions, immunosuppressive treatments cause an increased risk of infection in these patients and high mortality is seen despite antibiotic treatment.

Cumhuriyet Medical Journal, 2013

Aim. The aim of this retrospective study was to determine mean admission time after calls, resusc... more Aim. The aim of this retrospective study was to determine mean admission time after calls, resuscitation success rate, and determine the rate of medical emergency team (MET) calls of clinics in hospital by assessing the incoming calls to MET at intensive care unit. Methods. This study was conducted by collecting emergency call forms of 147 patients. The data including age, gender, medical diagnosis, the name of the caller department, cause of call, occurrence time, call time, attending time, medical care termination time and the outcomes were extracted from the forms or patient files. Event declaration time was accepted as minute time difference between occurrence time and call time. Duration of admission was accepted as minute time difference between call times and attending time. Duration of resuscitation was accepted as minute time difference between attending time and medical care termination time. Results. Mean event declaration time was 3.3 ± 3.0 minutes. Mean duration of admission was 3.7 ± 1.6 minutes. Mean duration of resuscitation was 20.5 ± 12.7 minutes. The resuscitation of 84 patients (63.6%) was successful while 48 patients (36.4%) died at the end of resuscitation. It was found that the patients with a result of successful resuscitation were significantly younger and their duration of resuscitation was significantly shorter. Conclusion. We indicate that MET system is an essential part of in-hospital emergency medical care system. We suggest that a blue code call system should be established by intensive care unit members and announced to all hospital staff.

Ulusal Cerrahi Dergisi, 2005

Journal of B.U.ON. : official journal of the Balkan Union of Oncology

Thyroid tumors of uncertain malignant potential (TT-UMP) constitute a relatively new diagnosis. T... more Thyroid tumors of uncertain malignant potential (TT-UMP) constitute a relatively new diagnosis. The purpose of this study was to analyze the relationship between immunohistochemical panels, prognostic parameters and TT-UMP. Group I was composed of patients diagnosed as differentiated thyroid carcinoma (DTC) and Group II of patients diagnosed as TT-UMP. The prognostic scores of patients were calculated using data according to the well-known prognostic scoring systems MACIS, AMES, AGES. Evaluations of antibodies were based on the presence of nuclear staining for p16 and p53, membranous and cytoplasmic staining for epidermal growth factor receptor (EGFR) and cytoplasmic staining for fragile histidine triad (FHIT). Statistically significant difference was noted (p< 0.05) between Group I and Group II according to MACIS and AMES. No statistical difference was found in terms of immunostaining between groups when stained with p16, p53 and FHIT. On the other hand, in Group II a moderate p...

Journal of Minimal Access Surgery, 2015

Oxidative stress is a complicated process, which was defined as an increase in prooxidants and de... more Oxidative stress is a complicated process, which was defined as an increase in prooxidants and decrease in antioxidants caused by various mechanisms, including inflammation and surgical trauma. The association between acute appendicitis and oxidative stress has been showed in previous studies. However, comparison of oxidative stress in laparoscopic or open appendectomy (OA) has not been established. Patients who were diagnosed as acute appendicitis between October 2012 and January 2013 were randomized to open (OA, n = 50) and laparoscopic appendectomy (LA, n = 50). Blood samples for oxidative stress markers (total oxidant status [TOS] and total antioxidant status [TAS]), C-reactive protein (CRP) and white blood cells (WBC&amp;amp;amp;amp;#39;s) were collected just before the surgery and 24 h after surgery. There were no differences in preoperative values of WBC and CRP between LA and OA groups (P = 0.523 and 0.424), however, in postoperative 24(th) h, CRP was reduced in LA group (P = 0.031). There were no differences in preoperative levels of TOS, TAS, and oxidative stress index (OSI) between LA and OA groups. In the postoperative 24(th) h, TOS and OSI were found to be significantly higher in OA group when compared to LA group (P = 0.017 and 0.002) whereas no difference was detected in TAS level in the postoperative 24(th) h (P = 0.172). This double-blind, randomized clinical trial provides evidence that LA for uncomplicated appendicitis is associated with significantly lower oxidative stress compared with OA. Some of the advantages of LA may be attributed to the significant reduction of oxidative stress in these patients.

Cumhuriyet Medical Journal, 2012

Aim. In the era of minimally invasive surgery; laparoscopic cholecystectomy has become the first ... more Aim. In the era of minimally invasive surgery; laparoscopic cholecystectomy has become the first choice for gallstone disease both for urgent and elective surgery .However, a number of cases still necessitate conversion to open procedures. Identifying the reasons and rates involved in conversion at the early period can help the surgeons in deciding when to exclude the choice of e laporoscopic procedure. The goal of this study is to evaluate the rates and causes of conversion to open cholecystectomy in elective cases. Methods. The study included all of the patients who had undergone elective surgery in our clinic due to gallstone disease from January, 1999 to December, 2010. Detection of malignancy and/or polyps, and existence of acute cholecystitis were accepted as criterion for exclusion. The existence of previous abdominal surgery, demographic parameters, and the causes and rates of conversion to open cholecystectomy were noted and analyzed. Results. Of the 823 patients for whom laparoscopic cholecystectomy was applied, 782 were included in this study.The rate of conversion was 6.1% (n=48) in total. Twenty of these 48 converted patients were male and 28 of them were female with a mean age of 49,27 years (range: 24-89). In male and female patients, the conversion rates were 9,8% and 4,8%, respectively. Adhesions due to inflammation or prior abdominal surgery were found to be the most common reasons for conversion. Conclusion. There is no question that laparoscopic cholecystectomy is the gold standard when all other treatment modalities are considered. Laparoscopic cholecystectomy can be safely applied by experienced hands to all patients with a low conversion rate. Conversion should not be seen as a complication.

Basic and Clinical Sciences, 2013

This is an open-access article distributed under the terms of the Creative Common Attribution Lic... more This is an open-access article distributed under the terms of the Creative Common Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

Turkish Journal of Trauma and Emergency Surgery, 2012

Medikal tedavi peptik ülser perforasyon (PÜP) oranlarının azalmasında önemli bir rol oynamıştır. ... more Medikal tedavi peptik ülser perforasyon (PÜP) oranlarının azalmasında önemli bir rol oynamıştır. Bu çalışmada, Ramazan ayının PÜP üzerine olan etkisi değerlendirildi. GEREÇ VE YÖNTEM PÜP nedeniyle 1999-2009 yılları arasında ameliyat edilen 229 hastanın dosyaları geriye dönük olarak analiz edildi. Hastalar iki gruba ayrıldı. Grup I (n=188) Ramazan ayı dışında ameliyat edilen hastalar, Grup II (n=41) Ramazan ayında, müslümanların oruç tutma döneminde ameliyat edilen hastalar. Grup II'deki hastalar oruç tutma sürelerine göre de değerlendirildi. BULGULAR Grup başına düşen ameliyat sayısı Grup II'de daha fazla idi (p<0.05). Bu farkın oluşmasında predispozan faktörler, antiülser ilaç kullanımı ve demografik özelliklerin rolü olmadığı saptandı. Oruç tutma süresinin perforasyon üzerine küçük bir etkisi olabileceği görüldü. SONUÇ Bu çalışmanın verileri Ramazan orucunun günde 12 saatten daha fazla sürdüğü dönemlerde PÜP'nin rölatif olarak daha fazla görüldüğünü göstermektedir. Predispozan faktöktörü olan hastaların oruç kararı öncesi bilgilendirilmesi gerektiği kanısındayız. Anahtar Sözcükler: Akut karın; peptik ülser perforasyonu; uzamış açlık; Ramazan; acil cerrahi. BACKGROUND Medical treatment has played an important role in the reduction of peptic ulcer perforation (PUP). The goal of this study was to evaluate the effect of fasting on PUP.

Turkish Journal of Trauma and Emergency Surgery, 2014

The effects of sildenafil in liver and kidney injury in a rat model of severe scald burn: a bioch... more The effects of sildenafil in liver and kidney injury in a rat model of severe scald burn: a biochemical and histopathological study organ failure (MOF) still continue to be leading causes of mortality and morbidity in severe burn patients. [1-4] The response to the initial burn is often associated with secondary damage to vital organs such as lung, liver, and kidneys, which are distant from the injured site. [4-9] The pathophysiological mechanism of such remote organ injury in severe burn remains unclear. However, animal models and clinical trials of burn injury implicate that reactive oxygen species (ROS) and reactive nitrogen species (RNS) mediated by elevated proinflammatory mediators released from both the gut and the burn site can act as causative agents in the development of distant organ injury. [1,9-14] The proinflammatory effects of ROS and RNS include endothelial damage, neutrophil reinforcement, cytokine release, and mitochondrial injury. Thus, remote organ injury following severe burn appears to be mediated by ROS and RNS via the formation of oxidative and nitrosative stress as a consequence of inflammatory response. [1,9,15,16] Inflammation has EXPERIMENTAL STUDY

Cumhuriyet Medical Journal, 2012

Abstract Aim. In recent years there has been an increase in the tendency to use autograft in ante... more Abstract Aim. In recent years there has been an increase in the tendency to use autograft in anterior knee reconstruction. Quadrupled hamstring tendons are known to be the hardest and the most powerful grafts. This study aims to report the first two year results of anterior knee reconstructions performed with proximal femoral transfix fixation by using quadrupled hamstring tendon grafts. Methods. Quadrupled hamstring tendon autografts were used in 89 knees of 89 patients [87 male (97.7%), 2 female (2.3%)]. The mean age of the patients was 24 years (range 20-34 years). Five patients were professional and 35 patients were amateur sportsmen. Subjective, clinical, functional, Telos stress device, and radiographic evaluations were applied to all patients at the end of the first and second years. International Knee Documentation Committee (IKDC) scoring and Lysholm scoring were used to assess knee function and activity. Results. Subjectively 92% of the patients expressed their reconstructed knees to be normal with 100% stability. Eighty-seven percent of the patients returned to their normal daily activities and life at pre-injury level. A and B scores were obtained in 87 of 89 patients (97.7%) as average IKDC knee score. The average Lysholm score was 94. A statistically significant difference was determined in the degree of laxity measured by Telos stress device which had a mean value of 13.7 mm preoperatively and 2.8 mm postoperatively. Conclusion. Successful and excellent subjective, objective, functional and radiological results were obtained in the early follow-up period with the endoscopic anterior cruciate ligament reconstruction technique performed by using femoral transfix fixation with quadrupled semitendinosus-gracilis autograft. Keywords: Anterior cruciate ligament, hamstring autograft, arthroscopy Ozet Amac. Son yillarda daha cok on capraz bag rekonstruksiyonunda otogreft kullanma egiliminde artis vardir. Bilinen en sert ve en guclu greft dortlu hamstring tendonlaridir. Amacimiz dortlu hamstring tendon greftini kullanarak proksimal femoral transfix fiksasyonu ile yapilan on capraz bag rekonstruksiyonunun ilk 2 yillik sonuclarini yayinlamaktir. Yontemler. Seksen dokuz hastanin [87 erkek (%97,7), 2 kadin (%2,3)] 89 dizinde dortlu hamstring tendon otogrefti kullanilmistir. Hastalarin yas ortalamasi 24 (20-34 yas arasi) idi. 5 hasta profesyonel, 35 hasta amator sporcuydu. Subjektif, klinik, fonksiyonel, Telos stres cihazi ve radyografik degerlendirmeler, 1. ve 2. Yilin sonunda her hasta icin uygulanmistir. Diz fonksiyon ve aktivitesini degerlendirmek icin International Knee Documentation Committee (IKDC) ve Lysholm diz skoru kullanildi. Bulgular. Subjektif olarak hastalarin %92’si rekonstrukte edilen dizlerini %100 stabilite ile normal kabul etmislerdir. %87’si zedelenme oncesi aktivite duzeyine donmuslerdir. Ortalama IKDC diz skoru olarak 89 hastanin 87’sinde (%97,7) A ve B skorlari elde edildi. Lysholm ortalama skoru 94 olarak bulundu. Telos stres cihazi ile ameliyat oncesi ortalama 13,7 mm ve ameliyat sonrasi ortalama 2,8 mm olculen laksite degerleri arasinda anlamli fark bulundu. Sonuc. Femoral transfix fiksasyonu ile dort katli semitendinosus-grasilis otogrefti kullanarak yapilan endoskopik on capraz bag rekonstruksiyonu tekniginde erken donemde basarili ve mukemmel subjektif, objektif, fonksiyonel ve radyolojik sonuclar elde ettik. Anahtar sozcukler: On capraz bag, hamstring otograft, artroskopi

Ulusal travma ve acil …, 2009

BACKGROUND: The second hit in trauma leads to an exaggerated inflammatory response and multiple o... more BACKGROUND: The second hit in trauma leads to an exaggerated inflammatory response and multiple organ failure. Infection following burn injury is a useful model for two-hit trauma studies. The aim of this study was to investigate the effect of N-acetylcysteine (NAC) ...

International Journal of Gerontology, 2013

Summary Background Peptic ulcer perforation (PUP) constitutes a unique situation characterized by... more Summary Background Peptic ulcer perforation (PUP) constitutes a unique situation characterized by severe pain, leading almost every patient with this complication to seek help in the hospital. However, clinical features of PUP in elderly patients are different from those of young or in adult patients; indeed, symptoms of PUP may be atypical in old age. Materials and methods This was a retrospective study of patients who underwent emergency surgery for PUP between 2002 and 2012. The patients were divided into two age groups. Medical conditions of the patients that may have had an effect on the perforation, such as age, gender, concomitant disease, use of drugs, presence of Helicobacter pylori infection, characteristic of pain (vague abdominal pain or severe epigastric pain), smoking status, and duration symptoms at the time of admission, were evaluated. Results A total of 261 patients were included in this retrospective study. Group I ( n = 202) was composed of adults (age n = 59) was composed of geriatric patients (age ≥65 years). Male dominancy was observed in both groups. Primary closure of the perforation was the most common procedure performed. Hypertension (18.3 % and 52.5%, respectively), and diabetes mellitus (11.9% and 15.3%, respectively) were the most frequent comorbidities in both groups, whereas mortality and morbidity rates were higher in elderly group. Conclusions PUP is a serious condition, particularly in geriatric age requiring emergency surgical management. Primary closure of the perforation was the most common procedure performed in our series.