Hızır Akyıldız - Academia.edu (original) (raw)
Papers by Hızır Akyıldız
PubMed, 2022
Introduction: Primary function of regulatory T(Treg) cells is to control and regulate the immune ... more Introduction: Primary function of regulatory T(Treg) cells is to control and regulate the immune responses. In many patients with tumor tissues, increased Treg cell numbers have been reported. In this study, we aimed to measure the cellular content of blood samples in patients with gastric cancer (GC) and define their role in tumor progression. Methods: We prospectively evaluated 34 gastric cancer cases and 20 healthy control samples. The blood was collected from both the gastric coronary and peripheral veins of the patients and only from the peripheral vein of the control group. Cellular content and lymphocyte subset including, regulatory T cells, were determined by flow cytometric analysis. Results: The GC patients revealed similar percentages of T cells, B cells, neutrophils, and eosinophils in the venous samples from periphery vein and gastric coronary. The percentage of monocytes from the tumor-draining gastric coronary vein was significantly lower than monocytes from the peripheral vein in gastric cancer patients (p=0.03). T-regulatory cells had a higher percentage in samples obtained from gastric cancer patients compared with the control group. Conclusion: Our findings confirmed that patients with gastric cancer have a significantly higher percentage of regulatory T cells than the control group, suggesting that they may contribute to the tumor progress. Regulatory T cells and monocytes interact in patients with GC, which can be used as a parameter in the clinical follow-up of patients with GC. Key words: Gastric cancer, Treg cell, Flow cytometry, FoxP3.
PubMed, 2021
Aim: In this study, we aimed to evaluate patients who underwent curative surgical treatment for p... more Aim: In this study, we aimed to evaluate patients who underwent curative surgical treatment for primary duodenal adenocarcinoma and to present our experience. Material and methods: Patients diagnosed with primary duodenal adenocarcinoma between 2006 and 2018 participated in the study. The demographic and clinical characteristics of the patients, details of the operation, pathological features of the tumors, short- and long-term follow-up results, and mean survival were evaluated retrospectively. Results: Nine patients with a mean age of 54.7 participated in the study. 55% of the patients were male. The most common presenting symptom was abdominal pain (n: 6; 67%). The most common tumor localization was D2-3 (n: 7; 78%), and the most common surgical operation was pancreaticoduodenectomy (n: 7; 78%). There were no intraoperative complications in any patient. The mean tumor diameter was 3.5 cm. The mean number of lymph nodes dissected was 8.3 and the mean number of metastatic lymph nodes was 2. The most common postoperative complication was pancreatic fistula (n: 3; 33%). The mean length of stay was 21.8 days. One patient developed septic shock and mortality happened within the 30-day period. The most common cause of unplanned admission to the hospital within 90 days was wound infection (n: 2; 22%). One patient developed local recurrence and two patients had systemic metastasis. We found an average survival of 40 months. Discussion: Pancreaticoduodenectomy is the most common approach in its curative surgery and it has a long survival despite the high postoperative complication rate. We recommend radical resection in the surgical treatment of primary duodenal adenocarcinoma. Key words: Adenocarcinoma, Duodenum, Pancreaticoduodenectomy.
PubMed, Oct 1, 2002
Background: This study was performed to evaluate the results of massive lower gastrointestinal bl... more Background: This study was performed to evaluate the results of massive lower gastrointestinal bleeding in the elderly patients. Methods: The data of patients older than 60 years with massive lower gastrointestinal bleeding were retrospectively analyzed between January 1999 and March 2002. Results: There were 14 (52%) males and 13 (48%), females with mean age of 70.2 years (range 60 to 88). Twenty patients were diagnosed with colonoscopy. Angiography was employed in six, scintigraphy in three and r- enteroclysis in two patients. Colonic diverticulosis was the leading etiologic factor (48%). Mean comorbidity and hospital stay were 1.59 and 6.7 days, respectively. Conservative treatment were performed in eighteen, band JCC, ligation in three, surgery in five and embolization in two patients. Mortality rate was 26%. Mortality was high it in patients who had a lower initial diastolic pressure and required more transfusions (p:0.006 and p:0.025, respectively ) Conclusion: Massive lower gastrointestinal system bleeding in the elderly with comorbidities is associated with higher rate of mortality. Surgery in these patients has high mortality rates. Endoscopic and conservative diagnosis and treatment methods should be the first choice in the elderly. Key words: Bleeding, lower gastrointestinal system, elderly.
Indian Journal of Surgery, Aug 2, 2019
The aim of this study was to evaluate patients who had to be applied with packing because of abdo... more The aim of this study was to evaluate patients who had to be applied with packing because of abdominal trauma and to identify the factors affecting mortality from the findings on admission and the laboratory values that can be immediately examined. A retrospective analysis of 42 patients accepted to our level one trauma center between January 1998 and December 2017 was carried out. The patients were evaluated in respect of demographic characteristics, vital parameters, trauma type, injury severity score (ISS), the presence of additional injuries, transfusion amount, the need for intensive care, mortality rates, complications, the number and types of operations performed, the number of packings, the need for re-laparotomy, imaging methods, and radiological interventions. Of these parameters, the effects on mortality of findings on admission and the laboratory values that could be immediately tested were examined in particular. Packing was applied to 27 patients due to blunt trauma and to 15 patients due to penetrating trauma. Thirty-one patients had hypotension, and 24 of them had hemorrhagic shock status upon admission. Average ISS value was 34.5 ± 9.9 (16-59). Twenty of the 42 patients died (47.6%). ISS level, hypotension, and hemorrhagic shock on admission were found to be significant risk factors of death in univariate analysis. In multivariate analysis however, only the presence of hemorrhagic shock was a statistically significant factor related to mortality. The presence of hemorrhagic shock on admission is a strong predictor of mortality in patients undergoing damage control surgery.
PubMed, Oct 1, 2001
We analyzed 59 cases of intraabdominal solid organ injury treated at the Surgical Emergency Servi... more We analyzed 59 cases of intraabdominal solid organ injury treated at the Surgical Emergency Service of Istanbul Medical School between January 1996 and January 2001. Fifty-six of these cases suffered blunt and 3 penetrating trauma. Twenty-three cases had injuries involving the liver, 14 spleen, 5 kidney, 6 liver and spleen, 6 liver and kidney, 6 spleen and kidney and four liver and kidney. In 4 of splenic and 5 of hepatic injuries Grade IV injuries were detected. Among the cases, 21% were Grade I, 45% were Grade II, 19% were Grade III, and 15% were Grade IV. Associated injuries were: head trauma in 34 cases (57.6%--Glasgow Coma Score under 7 in 6 cases), thoracic trauma in 19 cases (32%), pelvic fracture in 6 cases (10%), vertebral compression fracture in 3 cases (5%). One patient with splenic (Grade III) and hepatic (Grade II) injury, and one patient with Grade IV splenic injury required surgery during close follow-up due to hemodynamic instability. Our failure rate for conservative treatment of solid organ injuries is 3.3%. Three patients with polytrauma in the ICU died (5% mortality rate). Conservative management in solid organ injuries is gaining more popularity every day. Our work, and current studies accept physiologic parameters in the follow-up of solid organ injuries. Conservative treatment guided with hemodynamic stability, accounts almost a 98% success rate.
Turkish journal of trauma & emergency surgery, Oct 1, 2005
Background: Lower gastrointestinal bleeding is a commun clinical entity. Although colonoscopic ex... more Background: Lower gastrointestinal bleeding is a commun clinical entity. Although colonoscopic examination is the first choice for diagnosis, it may not be enough to reveal the cause of bleeding in all subjects. Methods: Eight patients who had massive lower gastrointestinal bleeding having normal colonoscopic findings were retrospectively evaluated at the Department of Trauma and Emergency Surgery, Istanbul University, Faculty of Medicine Results: There were 5 male and 3 female patients with mean age of 51 (28 to 82). Patients received a mean of 13 U (range 2 to 23) with transfused erythrocyte concentrates. Four patients had found to be normal during angiographic, scintigraphy or enterocylytic examinations. Angiography was diagnostic in 4 patients, and identified bleeding from ileocolic pseudoaneurisms (n= 2) branches of jejunal artery (n=2). Embolization procedure were performed in these 4 patients and 3 of them developed intestinal necrosis and underwent surgery. One did not require further treatment. Two of the patients who underwent surgery expired due to sepsis. Patients were hospitalized for a mean of 17 days (range 5 to 37). Conclusion: Despite employment of all diagnostic procedures, the cause of bleeding were not detected in half of patients who had normal colonoscopic findings. If angiographic treatment is necessary, superselective arterial embolization should be performed.
Turkish journal of trauma & emergency surgery, Oct 1, 2001
... Dr. Cemalettin ERTEKÍN, Dr. Hizir AKYILDIZ, Dr.Kovhan TAVÍLOGLU Dr.Recep GÜLOGLU, Dr.Mehmet K... more ... Dr. Cemalettin ERTEKÍN, Dr. Hizir AKYILDIZ, Dr.Kovhan TAVÍLOGLU Dr.Recep GÜLOGLU, Dr.Mehmet KURTOGLU* ÖZET: Çahsmamizda ... soiid organlarda yaralanma saptanan liastalarda eger hemodinami stabil ise BT çekilerek yaralanmanm varhgindan emin olunmali ve ...
PubMed, 2021
Aim: In this study, we aimed to determine the clinical value and prognostic significance of the N... more Aim: In this study, we aimed to determine the clinical value and prognostic significance of the Neutrophil / Lymphocyte Ratio in patients undergoing curative surgery due to esophageal cancer. Material and method: Patients who underwent curative resection for esophageal cancer between 2015-2019 were included in the study. Two groups, Group1 (low NLR) and Group2 (high NLR), were created. Demographic and clinical features, intraoperative and postoperative results, tumor characteristics and mean survival were compared in the groups. Results: A total of 48 patients participated in our study. Group 1 consisted of 18 patients and Group 2 consisted of 30 patients. Male sex was dominant in both groups (66.7% vs 73.3%, p. 0.431). Preoperative CEA was higher in Group 2 (3.97 vs 9.57, p. 0.032). Tumor diameter was larger in Group2 (3.33 vs 5.40 cm, p. 0.000). Adenocarcinoma was higher in Group 2 (33% vs 53.3%, p. 0.047), while squamous cell carcinoma was higher in Group 1 (66.7% vs 33.3%, p. 0.047). Lymph node positivity was higher in Group 2 (66.7% vs 93.3%, p. 0.024). The anastomosis leak was higher in Group 2 (0% vs 20%, p. 0.048). Postoperative hospital stay was longer in Group 2 (13.27 vs 23.9 days, p. 0.009). 90-day readmission was higher in Group1 (33.3% vs 3.3%, p. 0.008). Survival duration was shorter in Group 2 (29 vs 15 months, p. 0.005). Conclusion: This study revealed that preoperative high NLR was associated with poor survival, along with greater tumor diameter, increased lymph node metastasis rate, and increased anastomosis leakage in patients with esophageal cancer. These results suggest that modifying inflammatory responses and modulating the immune system may improve survival outcomes in patients with esophageal cancer. Key words: Esophagus cancer, Neutrophil/lymphocyte ratio, Preoperative neutrophil/lymphocyte ratio, Prognosis.
Turkish journal of trauma & emergency surgery, Nov 1, 2009
Background: Intestinal perforation is one of the major causes of obligatory surgical intervention... more Background: Intestinal perforation is one of the major causes of obligatory surgical intervention. There can be many different causes of perforation. The aim of this study was to evaluate the unusual causes and the surgical treatment. Methods: In our clinic, we operated 675 patients due to intestinal perforation over a period of six years. Perforation due to brid, trauma, colorectal tumor, mesenteric ischemia, hernias, and iatrogenic injuries were considered as usual causes and excluded from the study. The remaining 37 patients (22 male, 15 female; mean age 53.2; range 25 to 80 years) were analyzed. For statistical analysis, Mann-Whitney U and chi-square tests were used, and p < 0.05 was considered significant. Results: A localized or generalized peritonitis was the most common symptom. Leukocytosis was found in 18 patients and free abdominal air was seen in 20 patients; bedside ultrasonographic examination was done in 17 patients. The most prevalent etiological factors were non-Hodgkin lymphoma, Crohn disease and internal herniation, respectively. Eight patients died; their time to laparotomy was significantly longer (8.7 days), and half of them had malignant small bowel tumor in perforation etiology. Conclusion: Mortality and morbidity rates are high in intestinal perforations due to unusual causes. Delayed laparotomy and malignant etiology may be the main factors.
Turkish Journal of Surgery, 2006
Turkiye Klinikleri Journal of Surgical Medical Sciences, 2006
Acta Cirurgica Brasileira, 2020
Conceptıon and design of the study; acquisition, analysis and interpretation of data; technical p... more Conceptıon and design of the study; acquisition, analysis and interpretation of data; technical procedures; statistics analysis; manuscript preparation and writing; final approval.
PubMed, Nov 10, 2019
Backround: The association of rectal prolapse and colorectal cancer is quite rare and only a few ... more Backround: The association of rectal prolapse and colorectal cancer is quite rare and only a few cases have been reported previously in the literature. It is unclear whether colorectal cancer triggers rectal prolapse. Case presentation: A 77-year-old male patient presented to our emergency department with complete rectal prolapse, and an anterior resection was performed after rectal digital examination revealed a mass. The pathology result came back as mucinous adenocarcinoma in the sigmoid colon and the postoperative period was uneventful. Conclusions: Considering the age group in which rectal prolapse is most commonly seen, and the change in bowel habits, chronic constipation and irritation chronic seen in rectal prolapse may be responsible for the development of rectum cancer, therefore endoscopic screening should not be overlooked in rectal prolapse cases. Key words: Anorectal emergencies, Colon cancer, Rectal prolapse.
PubMed, Sep 1, 2009
Background: The aim of this experimental study was to investigate the effects of melatonin and ph... more Background: The aim of this experimental study was to investigate the effects of melatonin and phospholipid on adhesion formation and the correlation with vascular endothelial growth factor (VEGF) expression in rats. Methods: Sixty Wistar-Albino rats were divided into four groups as sham, control and two study groups, each including 15 rats. In the sham group, laparotomy was the only procedure. Left lower parietal peritoneum was abraded after laparotomy and serosal defects formed on the cecum, ileum and right uterine horn in the study and control groups. Ringer lactate was then applied to the control group, while melatonin and phospholipid suspension were applied separately in the two study groups. Relaparotomy was performed in all groups on the 15th day to score and evaluate the adhesion formation. Results: Adhesion formation was significantly lower in the sham, melatonin and phospholipid groups than in the control group (p<0.05). VEGF staining was significantly higher in the control group with adhesion areas compared to the other groups (p<0.05). When VEGF staining was compared, there was no significant difference between VEGF- stained and normal areas in the melatonin and phospholipid groups. Conclusion: Melatonin and phospholipid decreased the adhesion formation in an experimental adhesion model in rats. There is a correlation between adhesion severity and VEGF expression.
PubMed, May 10, 2012
Context: Solitary fibrous tumor is an uncommon spindle cell tumor which were first described in 1... more Context: Solitary fibrous tumor is an uncommon spindle cell tumor which were first described in 1931 at pleura; it should be seen rarely in extra-pleural localization. Case report: We report the ninth case of pancreatic solitary fibrous tumor in a 24-year-old woman who presented with mild epigastric pain radiating to the back and chronic constipation. Imaging studies confirmed a solitary mass in the epigastric region that begins from posterior of stomach, fills little curvature and extends to pelvis, invades vascular structures by encircling them and extends to retroperitoneal regions that was considered as it may have mesenchymal origin. The patient underwent an enucleation of the mass which was diagnosed as solitary fibrous tumor, supported by immunohistochemical studies showing positivity for CD34, vimentin and SMA. Conclusion: There is limited data regarding biological behavior of solitary fibrous tumors with extra-pleural localization, because they are rare tumors. They are generally asymptomatic and slow growing tumors and it is difficult to distinguish them from other mesenchymal tumors. These issues as well as the prior nine cases are discussed.
PubMed, Sep 15, 2004
Background/aims: The ingestion of caustic substances is a common condition, which may result in s... more Background/aims: The ingestion of caustic substances is a common condition, which may result in serious injuries of the upper gastrointestinal system. The purpose of this study is to assess the outcomes of patients who had a history of the ingestion of caustic substances. Methodology: Between January 1995 and May 2002, 53 patients with clinical and/or endoscopic signs of caustic agents injury admitted to the Emergency Surgery Service of University of Istanbul, Istanbul Medical School, were retrospectively evaluated. Results: The group consisted of 29 females and 24 males with a mean age of 33 years (range 15 to 77). Caustic ingestion was accidental in 31 (59%) and suicidal in 22 (41%). Twenty-five (47%) patients had history of acid ingestions, 21 (40%) alkaline and 7 (12%) unknown agents. The findings of upper gastrointestinal tract endoscopy in 37 patients were as follows: i) fourteen patients had Grade I esophagitis, ii) fourteen patients had Grade II esophagitis; four with gastric mucosal burn, three with gastric and duodenal mucosal burn, five with pharyngeal mucosal burns, iii) two patients had gastric and duodenal mucosal burns, iv) four patients had gastric mucosal burn, vi) three patients had esophageal, gastric and duodenal mucosal burn. Eight patients (15%) with signs of acute abdomen underwent urgent surgery (six of these cases were acid ingestions and seven were suicidal ingestions); four of these patients with esophageal necrosis and gastric perforation, two with esophageal, gastric, duodenal and jejunal necrosis, one with local necrosis in the gastric fundus, and one had normal findings at laparotomy. The mean follow-up period was 11.6 months (range 1 to 42 months). During the follow-up one patient presented with pyloric stenosis, which required surgery. The mortality rate was 11%. Conclusions: Suicidal caustic ingestion and acid ingestion seem to cause more severe injuries. Early admission to the hospital with clinical and endoscopic evaluation and early surgery when required may reduce morbidity and mortality.
Annali Italiani Di Chirurgia, Jun 3, 2020
The discovery of ectopic adrenal tissue in the hernial sac is very rare, and in the majority of r... more The discovery of ectopic adrenal tissue in the hernial sac is very rare, and in the majority of reported cases it is in children, while it is never described in adult subjects. This could be due to a progressive previous atrophy of the ectopic tissue or to an insufficient examination of the sac removed surgically. The most frequent site of these ectopias is the kidney, adjacent to the adrenal glands. The presence of ectopic adrenal tissue is important because of its neoplastic and hyperplastic potential. We report a case of a 69-year-old male patient who underwent a surgical operation of a left inguinal hernia and that the presence of ectopic adrenal tissue was reported in the pathologist's report. Preoperative abdominal ultrasound should therefore be performed in patients destined for an inguinal hernia surgery, because also the rare existence of ectopic adrenal tissue in the hernial sac should be kept in mind. KEY WORDS: Adrenal, Adult, Ectopia, Herni sac.
Erciyes medical journal, 2020
The shift in stomach cancer localization has led to new perspectives in the treatment of proximal... more The shift in stomach cancer localization has led to new perspectives in the treatment of proximal one-third of the stomach cancer, focusing on the type of resection between total gastrectomy and proximal gastrectomy. We compared the results of patients with proximal gastric cancer, which were treated either with PG or TG regarding postoperative complications, symptoms of reflux esophagitis, the number of dissected lymph nodes, short-term survival, and the compliance to the postoperative planned diet. Materials and Methods: This study included 58 patients who underwent surgery for proximal gastric adenocarcinoma. Of the patients, 32 patients underwent total gastrectomy, while 26 patients underwent proximal gastrectomy. The total and proximal gastrectomy groups were retrospectively compared concerning the number of lymph nodes dissected, postoperative reflux symptoms, dietary compliance, and short-term survival. Results: Reflux symptoms were seen in 10 patients (31.2%) who underwent total gastrectomy versus in 12 patients (46.1%) treated with proximal gastrectomy (p=0.08). Mean number of lymph nodes dissected was 24.6±13.5 in patients treated with total gastrectomy, whereas 18.8±6.1 in patients who underwent proximal gastrectomy (p=0.06). Dietary compliance was better in the PG group (p=0.03), while no significant differences were detected between groups about postoperative complications and short-term survival. Conclusion: In the surgical treatment of proximal gastric cancers, proximal gastrectomy performed using an anti-reflux technique, maybe an alternative to total gastrectomy, providing better functional results without compromising oncologic principles.
PubMed, 2022
Introduction: Primary function of regulatory T(Treg) cells is to control and regulate the immune ... more Introduction: Primary function of regulatory T(Treg) cells is to control and regulate the immune responses. In many patients with tumor tissues, increased Treg cell numbers have been reported. In this study, we aimed to measure the cellular content of blood samples in patients with gastric cancer (GC) and define their role in tumor progression. Methods: We prospectively evaluated 34 gastric cancer cases and 20 healthy control samples. The blood was collected from both the gastric coronary and peripheral veins of the patients and only from the peripheral vein of the control group. Cellular content and lymphocyte subset including, regulatory T cells, were determined by flow cytometric analysis. Results: The GC patients revealed similar percentages of T cells, B cells, neutrophils, and eosinophils in the venous samples from periphery vein and gastric coronary. The percentage of monocytes from the tumor-draining gastric coronary vein was significantly lower than monocytes from the peripheral vein in gastric cancer patients (p=0.03). T-regulatory cells had a higher percentage in samples obtained from gastric cancer patients compared with the control group. Conclusion: Our findings confirmed that patients with gastric cancer have a significantly higher percentage of regulatory T cells than the control group, suggesting that they may contribute to the tumor progress. Regulatory T cells and monocytes interact in patients with GC, which can be used as a parameter in the clinical follow-up of patients with GC. Key words: Gastric cancer, Treg cell, Flow cytometry, FoxP3.
PubMed, 2021
Aim: In this study, we aimed to evaluate patients who underwent curative surgical treatment for p... more Aim: In this study, we aimed to evaluate patients who underwent curative surgical treatment for primary duodenal adenocarcinoma and to present our experience. Material and methods: Patients diagnosed with primary duodenal adenocarcinoma between 2006 and 2018 participated in the study. The demographic and clinical characteristics of the patients, details of the operation, pathological features of the tumors, short- and long-term follow-up results, and mean survival were evaluated retrospectively. Results: Nine patients with a mean age of 54.7 participated in the study. 55% of the patients were male. The most common presenting symptom was abdominal pain (n: 6; 67%). The most common tumor localization was D2-3 (n: 7; 78%), and the most common surgical operation was pancreaticoduodenectomy (n: 7; 78%). There were no intraoperative complications in any patient. The mean tumor diameter was 3.5 cm. The mean number of lymph nodes dissected was 8.3 and the mean number of metastatic lymph nodes was 2. The most common postoperative complication was pancreatic fistula (n: 3; 33%). The mean length of stay was 21.8 days. One patient developed septic shock and mortality happened within the 30-day period. The most common cause of unplanned admission to the hospital within 90 days was wound infection (n: 2; 22%). One patient developed local recurrence and two patients had systemic metastasis. We found an average survival of 40 months. Discussion: Pancreaticoduodenectomy is the most common approach in its curative surgery and it has a long survival despite the high postoperative complication rate. We recommend radical resection in the surgical treatment of primary duodenal adenocarcinoma. Key words: Adenocarcinoma, Duodenum, Pancreaticoduodenectomy.
PubMed, Oct 1, 2002
Background: This study was performed to evaluate the results of massive lower gastrointestinal bl... more Background: This study was performed to evaluate the results of massive lower gastrointestinal bleeding in the elderly patients. Methods: The data of patients older than 60 years with massive lower gastrointestinal bleeding were retrospectively analyzed between January 1999 and March 2002. Results: There were 14 (52%) males and 13 (48%), females with mean age of 70.2 years (range 60 to 88). Twenty patients were diagnosed with colonoscopy. Angiography was employed in six, scintigraphy in three and r- enteroclysis in two patients. Colonic diverticulosis was the leading etiologic factor (48%). Mean comorbidity and hospital stay were 1.59 and 6.7 days, respectively. Conservative treatment were performed in eighteen, band JCC, ligation in three, surgery in five and embolization in two patients. Mortality rate was 26%. Mortality was high it in patients who had a lower initial diastolic pressure and required more transfusions (p:0.006 and p:0.025, respectively ) Conclusion: Massive lower gastrointestinal system bleeding in the elderly with comorbidities is associated with higher rate of mortality. Surgery in these patients has high mortality rates. Endoscopic and conservative diagnosis and treatment methods should be the first choice in the elderly. Key words: Bleeding, lower gastrointestinal system, elderly.
Indian Journal of Surgery, Aug 2, 2019
The aim of this study was to evaluate patients who had to be applied with packing because of abdo... more The aim of this study was to evaluate patients who had to be applied with packing because of abdominal trauma and to identify the factors affecting mortality from the findings on admission and the laboratory values that can be immediately examined. A retrospective analysis of 42 patients accepted to our level one trauma center between January 1998 and December 2017 was carried out. The patients were evaluated in respect of demographic characteristics, vital parameters, trauma type, injury severity score (ISS), the presence of additional injuries, transfusion amount, the need for intensive care, mortality rates, complications, the number and types of operations performed, the number of packings, the need for re-laparotomy, imaging methods, and radiological interventions. Of these parameters, the effects on mortality of findings on admission and the laboratory values that could be immediately tested were examined in particular. Packing was applied to 27 patients due to blunt trauma and to 15 patients due to penetrating trauma. Thirty-one patients had hypotension, and 24 of them had hemorrhagic shock status upon admission. Average ISS value was 34.5 ± 9.9 (16-59). Twenty of the 42 patients died (47.6%). ISS level, hypotension, and hemorrhagic shock on admission were found to be significant risk factors of death in univariate analysis. In multivariate analysis however, only the presence of hemorrhagic shock was a statistically significant factor related to mortality. The presence of hemorrhagic shock on admission is a strong predictor of mortality in patients undergoing damage control surgery.
PubMed, Oct 1, 2001
We analyzed 59 cases of intraabdominal solid organ injury treated at the Surgical Emergency Servi... more We analyzed 59 cases of intraabdominal solid organ injury treated at the Surgical Emergency Service of Istanbul Medical School between January 1996 and January 2001. Fifty-six of these cases suffered blunt and 3 penetrating trauma. Twenty-three cases had injuries involving the liver, 14 spleen, 5 kidney, 6 liver and spleen, 6 liver and kidney, 6 spleen and kidney and four liver and kidney. In 4 of splenic and 5 of hepatic injuries Grade IV injuries were detected. Among the cases, 21% were Grade I, 45% were Grade II, 19% were Grade III, and 15% were Grade IV. Associated injuries were: head trauma in 34 cases (57.6%--Glasgow Coma Score under 7 in 6 cases), thoracic trauma in 19 cases (32%), pelvic fracture in 6 cases (10%), vertebral compression fracture in 3 cases (5%). One patient with splenic (Grade III) and hepatic (Grade II) injury, and one patient with Grade IV splenic injury required surgery during close follow-up due to hemodynamic instability. Our failure rate for conservative treatment of solid organ injuries is 3.3%. Three patients with polytrauma in the ICU died (5% mortality rate). Conservative management in solid organ injuries is gaining more popularity every day. Our work, and current studies accept physiologic parameters in the follow-up of solid organ injuries. Conservative treatment guided with hemodynamic stability, accounts almost a 98% success rate.
Turkish journal of trauma & emergency surgery, Oct 1, 2005
Background: Lower gastrointestinal bleeding is a commun clinical entity. Although colonoscopic ex... more Background: Lower gastrointestinal bleeding is a commun clinical entity. Although colonoscopic examination is the first choice for diagnosis, it may not be enough to reveal the cause of bleeding in all subjects. Methods: Eight patients who had massive lower gastrointestinal bleeding having normal colonoscopic findings were retrospectively evaluated at the Department of Trauma and Emergency Surgery, Istanbul University, Faculty of Medicine Results: There were 5 male and 3 female patients with mean age of 51 (28 to 82). Patients received a mean of 13 U (range 2 to 23) with transfused erythrocyte concentrates. Four patients had found to be normal during angiographic, scintigraphy or enterocylytic examinations. Angiography was diagnostic in 4 patients, and identified bleeding from ileocolic pseudoaneurisms (n= 2) branches of jejunal artery (n=2). Embolization procedure were performed in these 4 patients and 3 of them developed intestinal necrosis and underwent surgery. One did not require further treatment. Two of the patients who underwent surgery expired due to sepsis. Patients were hospitalized for a mean of 17 days (range 5 to 37). Conclusion: Despite employment of all diagnostic procedures, the cause of bleeding were not detected in half of patients who had normal colonoscopic findings. If angiographic treatment is necessary, superselective arterial embolization should be performed.
Turkish journal of trauma & emergency surgery, Oct 1, 2001
... Dr. Cemalettin ERTEKÍN, Dr. Hizir AKYILDIZ, Dr.Kovhan TAVÍLOGLU Dr.Recep GÜLOGLU, Dr.Mehmet K... more ... Dr. Cemalettin ERTEKÍN, Dr. Hizir AKYILDIZ, Dr.Kovhan TAVÍLOGLU Dr.Recep GÜLOGLU, Dr.Mehmet KURTOGLU* ÖZET: Çahsmamizda ... soiid organlarda yaralanma saptanan liastalarda eger hemodinami stabil ise BT çekilerek yaralanmanm varhgindan emin olunmali ve ...
PubMed, 2021
Aim: In this study, we aimed to determine the clinical value and prognostic significance of the N... more Aim: In this study, we aimed to determine the clinical value and prognostic significance of the Neutrophil / Lymphocyte Ratio in patients undergoing curative surgery due to esophageal cancer. Material and method: Patients who underwent curative resection for esophageal cancer between 2015-2019 were included in the study. Two groups, Group1 (low NLR) and Group2 (high NLR), were created. Demographic and clinical features, intraoperative and postoperative results, tumor characteristics and mean survival were compared in the groups. Results: A total of 48 patients participated in our study. Group 1 consisted of 18 patients and Group 2 consisted of 30 patients. Male sex was dominant in both groups (66.7% vs 73.3%, p. 0.431). Preoperative CEA was higher in Group 2 (3.97 vs 9.57, p. 0.032). Tumor diameter was larger in Group2 (3.33 vs 5.40 cm, p. 0.000). Adenocarcinoma was higher in Group 2 (33% vs 53.3%, p. 0.047), while squamous cell carcinoma was higher in Group 1 (66.7% vs 33.3%, p. 0.047). Lymph node positivity was higher in Group 2 (66.7% vs 93.3%, p. 0.024). The anastomosis leak was higher in Group 2 (0% vs 20%, p. 0.048). Postoperative hospital stay was longer in Group 2 (13.27 vs 23.9 days, p. 0.009). 90-day readmission was higher in Group1 (33.3% vs 3.3%, p. 0.008). Survival duration was shorter in Group 2 (29 vs 15 months, p. 0.005). Conclusion: This study revealed that preoperative high NLR was associated with poor survival, along with greater tumor diameter, increased lymph node metastasis rate, and increased anastomosis leakage in patients with esophageal cancer. These results suggest that modifying inflammatory responses and modulating the immune system may improve survival outcomes in patients with esophageal cancer. Key words: Esophagus cancer, Neutrophil/lymphocyte ratio, Preoperative neutrophil/lymphocyte ratio, Prognosis.
Turkish journal of trauma & emergency surgery, Nov 1, 2009
Background: Intestinal perforation is one of the major causes of obligatory surgical intervention... more Background: Intestinal perforation is one of the major causes of obligatory surgical intervention. There can be many different causes of perforation. The aim of this study was to evaluate the unusual causes and the surgical treatment. Methods: In our clinic, we operated 675 patients due to intestinal perforation over a period of six years. Perforation due to brid, trauma, colorectal tumor, mesenteric ischemia, hernias, and iatrogenic injuries were considered as usual causes and excluded from the study. The remaining 37 patients (22 male, 15 female; mean age 53.2; range 25 to 80 years) were analyzed. For statistical analysis, Mann-Whitney U and chi-square tests were used, and p < 0.05 was considered significant. Results: A localized or generalized peritonitis was the most common symptom. Leukocytosis was found in 18 patients and free abdominal air was seen in 20 patients; bedside ultrasonographic examination was done in 17 patients. The most prevalent etiological factors were non-Hodgkin lymphoma, Crohn disease and internal herniation, respectively. Eight patients died; their time to laparotomy was significantly longer (8.7 days), and half of them had malignant small bowel tumor in perforation etiology. Conclusion: Mortality and morbidity rates are high in intestinal perforations due to unusual causes. Delayed laparotomy and malignant etiology may be the main factors.
Turkish Journal of Surgery, 2006
Turkiye Klinikleri Journal of Surgical Medical Sciences, 2006
Acta Cirurgica Brasileira, 2020
Conceptıon and design of the study; acquisition, analysis and interpretation of data; technical p... more Conceptıon and design of the study; acquisition, analysis and interpretation of data; technical procedures; statistics analysis; manuscript preparation and writing; final approval.
PubMed, Nov 10, 2019
Backround: The association of rectal prolapse and colorectal cancer is quite rare and only a few ... more Backround: The association of rectal prolapse and colorectal cancer is quite rare and only a few cases have been reported previously in the literature. It is unclear whether colorectal cancer triggers rectal prolapse. Case presentation: A 77-year-old male patient presented to our emergency department with complete rectal prolapse, and an anterior resection was performed after rectal digital examination revealed a mass. The pathology result came back as mucinous adenocarcinoma in the sigmoid colon and the postoperative period was uneventful. Conclusions: Considering the age group in which rectal prolapse is most commonly seen, and the change in bowel habits, chronic constipation and irritation chronic seen in rectal prolapse may be responsible for the development of rectum cancer, therefore endoscopic screening should not be overlooked in rectal prolapse cases. Key words: Anorectal emergencies, Colon cancer, Rectal prolapse.
PubMed, Sep 1, 2009
Background: The aim of this experimental study was to investigate the effects of melatonin and ph... more Background: The aim of this experimental study was to investigate the effects of melatonin and phospholipid on adhesion formation and the correlation with vascular endothelial growth factor (VEGF) expression in rats. Methods: Sixty Wistar-Albino rats were divided into four groups as sham, control and two study groups, each including 15 rats. In the sham group, laparotomy was the only procedure. Left lower parietal peritoneum was abraded after laparotomy and serosal defects formed on the cecum, ileum and right uterine horn in the study and control groups. Ringer lactate was then applied to the control group, while melatonin and phospholipid suspension were applied separately in the two study groups. Relaparotomy was performed in all groups on the 15th day to score and evaluate the adhesion formation. Results: Adhesion formation was significantly lower in the sham, melatonin and phospholipid groups than in the control group (p<0.05). VEGF staining was significantly higher in the control group with adhesion areas compared to the other groups (p<0.05). When VEGF staining was compared, there was no significant difference between VEGF- stained and normal areas in the melatonin and phospholipid groups. Conclusion: Melatonin and phospholipid decreased the adhesion formation in an experimental adhesion model in rats. There is a correlation between adhesion severity and VEGF expression.
PubMed, May 10, 2012
Context: Solitary fibrous tumor is an uncommon spindle cell tumor which were first described in 1... more Context: Solitary fibrous tumor is an uncommon spindle cell tumor which were first described in 1931 at pleura; it should be seen rarely in extra-pleural localization. Case report: We report the ninth case of pancreatic solitary fibrous tumor in a 24-year-old woman who presented with mild epigastric pain radiating to the back and chronic constipation. Imaging studies confirmed a solitary mass in the epigastric region that begins from posterior of stomach, fills little curvature and extends to pelvis, invades vascular structures by encircling them and extends to retroperitoneal regions that was considered as it may have mesenchymal origin. The patient underwent an enucleation of the mass which was diagnosed as solitary fibrous tumor, supported by immunohistochemical studies showing positivity for CD34, vimentin and SMA. Conclusion: There is limited data regarding biological behavior of solitary fibrous tumors with extra-pleural localization, because they are rare tumors. They are generally asymptomatic and slow growing tumors and it is difficult to distinguish them from other mesenchymal tumors. These issues as well as the prior nine cases are discussed.
PubMed, Sep 15, 2004
Background/aims: The ingestion of caustic substances is a common condition, which may result in s... more Background/aims: The ingestion of caustic substances is a common condition, which may result in serious injuries of the upper gastrointestinal system. The purpose of this study is to assess the outcomes of patients who had a history of the ingestion of caustic substances. Methodology: Between January 1995 and May 2002, 53 patients with clinical and/or endoscopic signs of caustic agents injury admitted to the Emergency Surgery Service of University of Istanbul, Istanbul Medical School, were retrospectively evaluated. Results: The group consisted of 29 females and 24 males with a mean age of 33 years (range 15 to 77). Caustic ingestion was accidental in 31 (59%) and suicidal in 22 (41%). Twenty-five (47%) patients had history of acid ingestions, 21 (40%) alkaline and 7 (12%) unknown agents. The findings of upper gastrointestinal tract endoscopy in 37 patients were as follows: i) fourteen patients had Grade I esophagitis, ii) fourteen patients had Grade II esophagitis; four with gastric mucosal burn, three with gastric and duodenal mucosal burn, five with pharyngeal mucosal burns, iii) two patients had gastric and duodenal mucosal burns, iv) four patients had gastric mucosal burn, vi) three patients had esophageal, gastric and duodenal mucosal burn. Eight patients (15%) with signs of acute abdomen underwent urgent surgery (six of these cases were acid ingestions and seven were suicidal ingestions); four of these patients with esophageal necrosis and gastric perforation, two with esophageal, gastric, duodenal and jejunal necrosis, one with local necrosis in the gastric fundus, and one had normal findings at laparotomy. The mean follow-up period was 11.6 months (range 1 to 42 months). During the follow-up one patient presented with pyloric stenosis, which required surgery. The mortality rate was 11%. Conclusions: Suicidal caustic ingestion and acid ingestion seem to cause more severe injuries. Early admission to the hospital with clinical and endoscopic evaluation and early surgery when required may reduce morbidity and mortality.
Annali Italiani Di Chirurgia, Jun 3, 2020
The discovery of ectopic adrenal tissue in the hernial sac is very rare, and in the majority of r... more The discovery of ectopic adrenal tissue in the hernial sac is very rare, and in the majority of reported cases it is in children, while it is never described in adult subjects. This could be due to a progressive previous atrophy of the ectopic tissue or to an insufficient examination of the sac removed surgically. The most frequent site of these ectopias is the kidney, adjacent to the adrenal glands. The presence of ectopic adrenal tissue is important because of its neoplastic and hyperplastic potential. We report a case of a 69-year-old male patient who underwent a surgical operation of a left inguinal hernia and that the presence of ectopic adrenal tissue was reported in the pathologist's report. Preoperative abdominal ultrasound should therefore be performed in patients destined for an inguinal hernia surgery, because also the rare existence of ectopic adrenal tissue in the hernial sac should be kept in mind. KEY WORDS: Adrenal, Adult, Ectopia, Herni sac.
Erciyes medical journal, 2020
The shift in stomach cancer localization has led to new perspectives in the treatment of proximal... more The shift in stomach cancer localization has led to new perspectives in the treatment of proximal one-third of the stomach cancer, focusing on the type of resection between total gastrectomy and proximal gastrectomy. We compared the results of patients with proximal gastric cancer, which were treated either with PG or TG regarding postoperative complications, symptoms of reflux esophagitis, the number of dissected lymph nodes, short-term survival, and the compliance to the postoperative planned diet. Materials and Methods: This study included 58 patients who underwent surgery for proximal gastric adenocarcinoma. Of the patients, 32 patients underwent total gastrectomy, while 26 patients underwent proximal gastrectomy. The total and proximal gastrectomy groups were retrospectively compared concerning the number of lymph nodes dissected, postoperative reflux symptoms, dietary compliance, and short-term survival. Results: Reflux symptoms were seen in 10 patients (31.2%) who underwent total gastrectomy versus in 12 patients (46.1%) treated with proximal gastrectomy (p=0.08). Mean number of lymph nodes dissected was 24.6±13.5 in patients treated with total gastrectomy, whereas 18.8±6.1 in patients who underwent proximal gastrectomy (p=0.06). Dietary compliance was better in the PG group (p=0.03), while no significant differences were detected between groups about postoperative complications and short-term survival. Conclusion: In the surgical treatment of proximal gastric cancers, proximal gastrectomy performed using an anti-reflux technique, maybe an alternative to total gastrectomy, providing better functional results without compromising oncologic principles.