ahmet doğrul - Academia.edu (original) (raw)

Papers by ahmet doğrul

PubMed, May 8, 2023

Background: Hydatid cyst is an endemic zoonotic infection that annual incidence ranges from <1 to... more Background: Hydatid cyst is an endemic zoonotic infection that annual incidence ranges from <1 to 200 per 100,000 individuals. The most common complication of hepatic hydatid cyst reported is rupture of the cysts, most commonly intrabiliary rupture. Direct rupture to hollow visceral organs is rarely seen. We describe here an unusual cystogastric fistula in a patient with liver hydatid cyst. Case presentation: The 55-year-old male patient presented with right upper quadrant abdominal pain. After radiological imaging studies, the diagnose was of hydatid cyst involving the left lateral segment of the liver ruptured into the gastric lumen and resulted in a cystogastric fistula. Gastroscopy revealed that the cyst and its contents protruding from anterior wall to the gastric lumen. Partial pericystectomy and omentopexy were performed and the gastric wall was primarily repaired. There were no complications in the postoperative period and 3-month follow up. Conclusion: This case, to our knowledge, is the first reported case of cystogastric fistula surgically treated in a patient with liver hydatid cyst in the literature. Our clinical experience shows that, although it is a benign disease, complicated hydatid cysts should be evaluated in detail preoperatively, and after the detailed diagnostic work-up, surgical therapy might be planned individually for each case. Key words: Cysto-gastric fistula, Hydatid Cyst, Liver hydatidosis.

Abdominal pain is a common complaint in older patients and represents a challenge for emergency p... more Abdominal pain is a common complaint in older patients and represents a challenge for emergency physicians. In addition to the classical causes of abdominal pain, extra-abdominal causes, e.g., acute myocardial infarction, must be excluded rapidly during the work-up in the emergency department (ED) because urgent and specific interventions may be needed. Moreover, changes in physiological processes in older patients as well as limitations of the physical examination and the presence of limited cognitive function can lead to atypical clinical presentations. Emergency physicians should be familiar with the management of abdominal pain in older patients in the ED and should be able to establish the differential diagnosis. In this chapter, the epidemiology of acute abdominal pain, the current diagnostic approach in the ED, and the specific geriatric approach will be reviewed.

International Journal of Surgery, 2015

European Journal of Radiology Extra, Dec 1, 2006

Experimental and Clinical Transplantation, May 1, 2022

International Journal of Hematology and Oncology, Dec 1, 2012

Ankaferd Blood Stopper (ABS) is a novel topical hemostatic agent. ABS has been approved in Turkey... more Ankaferd Blood Stopper (ABS) is a novel topical hemostatic agent. ABS has been approved in Turkey for clinical hemorrhages, when the conventional control of bleeding by ligature and/or conventional hemostatic measures is ineffective. ABS has many cellular effects and could modulate numerous hemostatic proteins at the tissue and blood. ABS-induced formation of the protein network with vital erythroid aggregation covers the entire physiological hemostatic process. The aim of this study was to assess histopathological alterations due to topical ABS administration at the renal tissue level. Thirty-six Wistar rats weighing 70 to 80 gm were included into the study. The rats were divided into two groups as "the ABS-applied group" (ABS−G) and "the control group" (C−G). The animals in both groups were then again divided into the three subgroups of "postoperative (Postop.) 60th minutes", "Postop. 48th hours", and "Postop. 15th day". Therefore, there were six rats in each of the subgroups at the end of the analyses. The standard renal injury sites in the rats of ABS−G were applied 2 ml. of topical ABS, whereas 2 ml. of topical saline was applied to the renal injury sites of the rats in the C−G group. We detected significant erythrocyte aggregation and the accumulation of siderophages in the kidney tissue just after 60 minutes of ABS application persisting over 15 days. Our results indicated red blood cell accumulation and siderophages following the use of ABS are compatible with the suggested 'mechanism-of-action' of ABS that ABS-induced formation of the protein network with vital erythroid aggregation covers the entire physiological hemostatic process. Further experimental search is needed to find out the molecules inside the ABS protein library leading to the ABS-induced aggregation at the renal tissue level.

Acta Medica, Dec 28, 2022

Introduction: This study investigated the effect of preoperative comprehensive geriatric assessme... more Introduction: This study investigated the effect of preoperative comprehensive geriatric assessment(CGA) and frailty assessment on long-term mortality. Methods: This study which evaluated a total of 81 older patients underwent the CGA prior to general surgery. Katz ADL, the Lawton Brody IADL, the Mini-Nutrition Assessment test (MNAsf), the Mini-Mental State Examination (MMSE), and Yesavage Geriatric Depression Scale (GDS) were performed. Fried criteria were utilized for the assessment of frailty. The Physiological and Operative Severity Scores for the Enumeration of Mortality and Morbidity (POSSUM) score, and the Charlson Comorbidity Index (CCI) were used for operative risk assessment. The patients were screened for 3-year mortality. Results: The median age of the patients was 71 years (range, 65-84 years). 58.02% of the patients were female and 24.69% were in the frail group. The mortality rate of the frail group was significantly higher than those of the pre-frail and robust groups (p: 0.030). The Cox regression analyses revealed that MMSE (p: 0.020), Physiological Severity Score (PSS) (p: 0.034), BUPA score (p: 0.030) and educational background (p: 0.031) were independently correlated with mortality in Model 1, while MNA (p: 0.003), PSS score (p: 0.080) and educational background (p: 0.002) were correlated with mortality in Model 2. ADL, MMSE, CDT, MNA-SF, Fried score, length of hospital stay, PSS score, and BUPA score were the best predictors of mortality (AUC values: 0.61, 0.74, 0.72, 0.73, 0.69, 0.74, 0.64, and 0.66respectively). Conclusion: The results of the study demonstrated that CGA components and frailty predicted long-term mortality in general surgery patients.

The Turkish journal of gastroenterology, Aug 31, 2018

A 65-year-old male patient was referred to our clinic due to complaints of fatigue, intermittent ... more A 65-year-old male patient was referred to our clinic due to complaints of fatigue, intermittent melena, and hematochezia for 2 months. Chronic obstructive pulmonary disease, coronary heart disease, and peripheral arterial disease were noted in his medical history. The patient also had a history of aortofemoral bypass surgery during which an aortofemoral polyester vascular graft had been inserted. The surgery had been performed 2 years previously due to right common iliac artery occlusion. Laboratory test results were unremarkable except for anemia (hemoglobin: 8.7 g/dL [11.7-15.5]), leukocytosis (12.3×109/L [4.1-11.2]), and high C-reactive protein levels (24.3 mg/dL [0-0.8]). Upper gastrointestinal endoscopy was performed on the patient. The endoscopic view of the duodenum is shown in Figure 1.

Objective: The main purpose of the study was to evaluate CE patients in a versatile way with the ... more Objective: The main purpose of the study was to evaluate CE patients in a versatile way with the most commonly used diagnostic methods. In addition, we also investigated correlation between diagnostic parameters and CE cyst properties. Materials and Methods: A total 45 patients had an active or transitional CE cysts according to the WHO-IWGE classification and they have received percutaneous treatment for CE cysts. Serological analyses, molecular characterization of E.granulosus s.l. and direct examination of hydatid material were perfomed. Results: A total of 58 CE cysts were recorded and 34 of 58 hydatid cysts were identified as CE1, 14 as CE2, 2 as CE3a and 8 as CE3b. Direct examination, 30 of 58 hydatid cysts were found to be positive regarding protoscolex. According to serological tests, 37 of 45 patients had positive ELISA results. Most of the isolates (56/58) were identified as E.granulosus sensu stricto (G1-G3 genotypes) and two of them were characterized as E. canadensis (G6/7 genotypes). On the other hand, it is confirmed that serodiagnosis has been influenced by certain cyst characteristics. Conclusion: CE patients should be evaluated using many diagnostic approaches to accurate epidemiological information and to adopt proper clinical management.

Turkish journal of trauma & emergency surgery, 2022

BACKGROUND: Percutaneous cholecystostomy is an alternative or bridge to cholecystectomy (CCY) in ... more BACKGROUND: Percutaneous cholecystostomy is an alternative or bridge to cholecystectomy (CCY) in high-risk patients with acute calculous cholecystitis. Our primary aim was to determine the parameters that could be used in interval CCY decision-making and to predict mortality in high-risk patients. METHODS: The medical records of 127 patients who underwent percutaneous cholecystostomy for acute calculous cholecystitis between 2010 and 2018 were retrospectively analyzed. The primary outcomes were the CCY rate and the factors affecting mortality in high-risk patients. Descriptive statistics and receiver operating characteristic analysis were performed using albumin and elective surgery. RESULTS: Of the 127 patients undergoing percutaneous cholecystostomy, elective CCY was performed only in 43.1% of the highrisk patients. The 30-day and 1 year mortality rates were 11% and 17.3%, respectively. The American Society of Anesthesiologists' (ASA) score, Charlson comorbidity index (CCI), the negative predictive factors described in the Tokyo Guidelines 2018, the American College of Surgeons' (ACS) expected mortality rate, and albumin level were found to be significant factors affecting mortality and elective CCY probability. No mortality was observed, and an 82% elective CCY rate was achieved in patients whose albumin levels were higher than 3.16 mg/dL at initial presentation. CONCLUSION: The plasma albumin level, ASA score, CCI, and ACS expected mortality rate can be used to predict mortality and decide on elective CCY. Percutaneous cholecystostomy is sufficient for resolving inflammation, but medical comorbidities determine the final condition of patients.

European Surgery-acta Chirurgica Austriaca, Oct 13, 2020

Background Bile duct injuries during cholecystectomy are not rare and may have significant long-t... more Background Bile duct injuries during cholecystectomy are not rare and may have significant long-term morbidity. Treatment of these injuries is complex and needs a multidisciplinary approach. This study aims to evaluate the results of revisional surgery performed for recurrent biliary strictures that developed after a prior repair. Methods Patients who had been surgically treated for a major biliary injury during open or laparoscopic cholecystectomy and operated on for recurrent stricture in our institute were reviewed retrospectively. A total of 11 patients who were referred to the surgery clinic were included. Results The median length of stay after revisional surgery was 9 days (range 5-30 days). Five patients (45%) had experienced at least one postoperative complication. The median follow-up period was 36 months (range 5-69 months). Terblanche clinical scores of all patients were 1 or 2 at their last clinical visit. None of the 11 patients required reoperation and no mortality was seen during the postoperative period. Conclusion Although revisional biliary surgery for recurrent biliary strictures is a challenging procedure, these revisions can be performed with favorable results. Meticulous preoperative evaluation and imple-T. Erol () • Ass.

Journal of clinical case reports, 2019

Ameloblastoma is a slow growing odontogenic epithelial neoplasm which originates from remnants of... more Ameloblastoma is a slow growing odontogenic epithelial neoplasm which originates from remnants of the dental lamina with a high recurrence rate, but a low tendency to metastasize. Locally invasive ameloblastoma is often aggressive and destructive, which erodes bone and invades adjacent structures. Despite a benign histology metastatic disease may occur and samples taken from metastatic tumor usually maintains the features of the original tumor. Ameloblastic carcinoma differs from ameloblastoma with malignant cytological features. Here we report an unusual case of ameloblastoma metastatic to lung and liver, unresponsive to systemic treatment with cisplatin and adriamycin, and well controlled with local surgical treatment.

International Surgery, Mar 21, 2017

Intraductal papillary mucinous neoplasms (IPMNs) represent a relatively new clinical entity. IPMN... more Intraductal papillary mucinous neoplasms (IPMNs) represent a relatively new clinical entity. IPMNs have malignant potential which exhibit a broad histological spectrum, ranging from adenoma to invasive carcinoma. Although IPMNs are commonly seen within pancreas, they may develop anywhere within the biliary ductal system and produce mucin which may cause intermittent jaundice. This report details the case of 50 year-old woman presenting with intermittent jaundice who was diagnosed as hepatic IPMN.

Acta Medica, Mar 31, 2018

Objective: Secondary peritonitis or abdominal sepsis and intra-abdominal hemorrhages are associat... more Objective: Secondary peritonitis or abdominal sepsis and intra-abdominal hemorrhages are associated with high mortality rates and still challenging among surgeons. Planned relaparotomy is underestimated one of the treatment options of these intractable clinical entities. This study aimed to identify mortality and factors affecting mortality in the patient treated by planned relaparotomy for persisting intraabdominal infection and hemorrhage in a single institution. Material and methods: This retrospective study performed by collecting patients’ data from the archive of our university hospital and records of operations performed in our department. Forty-two of sixty-two patients treated with PRL for 19 years were included to study. Indications for PRL were secondary peritonitis and intraabdominal hemorrhage. Results: Overall , secondary peritonitis, and intraabdominal hemorrhage groups mortality rates were 52.4%, 59.3%, and 28.5% respectively (p< 0.05). Factors are Presence of malignancy (p= 0,037), mesenteric ischemia (p=0,029), development of organ failure (p=0,001) and presence of anastomosis (p=0,006) were observed relating to mortality. Conclusion: That high mortality rate could be due to underway infection and repeated surgical trauma-related multiple organ failures, independent factors as the presence of malignancy, and mesenteric ischemia raises the risk of mortality in planned relaparotomy patients. The data from this study and the available literature reveals that the factors which predict mortality in patients who undergo a relaparotomy are related to the severity of the disease.

World Journal of Surgery, Jul 31, 2020

Background The influence of preoperative comprehensive geriatric assessment and frailty on postop... more Background The influence of preoperative comprehensive geriatric assessment and frailty on postoperative morbidity, mortality, delirium were examined. Methods A total of 108 patients were evaluated. The Katz Index of Independence in Activities of Daily Living (ADL), the Lawton Brody Instrumental Activities of Daily Living Scale (IADL), the Mini-Nutrition Assessment test (MNA), the Mini-Mental State Examination (MMSE), Yesavage Geriatric Depression Scale (GDS) were performed. Fried Criteria were used to assess physical frailty. We used the Physiological and Operative Severity Scores for the Enumeration of Mortality and Morbidity score (POSSUM), the American Society of Anesthesiologists Score (ASA), and the Charlson Comorbidity Index (CCI) to determine the risk of postoperative morbidity and mortality. Assessment Test for Delirium (4AT) was applied for detection of delirium. Results The median age was 71 years (min-max: 65-84). IADL (p = 0.032), MNA (p = 0.01), MMSE scores (p = 0.026) were found to be significantly lower in patients with morbidity. POSSUM physiology score (p = 0.005), operative score (p = 0.015) and CCI (p = 0.029) were significantly higher in the patients with morbidity. Patients developed morbidity were found to be more frail (p \ 0.001). The patients with delirium were found to have lower IADL (p = 0.049) and MMSE scores (p = 0.004), higher POSSUM physiology score (p = 0.005) and all of them were frail. It was found that frailty (OR = 23.695 95% CI: 6.912-81.231 p \ 0.001), POSSUM operative score (OR:1.118 95% CI: 1.021-1.224 p = 0.016) and preoperative systolic blood pressure (OR:0.937%95 CI: 0.879-0.999 p = 0.048) were independently related factors for postoperative morbidity. Conclusion In our study, CGA and frailty in preoperative period were found to be indicators for postoperative morbidity and delirium.

Turkish Journal of Trauma and Emergency Surgery

Experimental and Clinical Transplantation

European Respiratory Journal, 2020

Transplantation, 2014

Serum ferritin (SF) has been reported to predict mortality in patients before/after liver transpl... more Serum ferritin (SF) has been reported to predict mortality in patients before/after liver transplantation (LT). However, little data has been accumulated on SF in pediatric cases indicated for LT and no study has evaluated the clinical fi ndings. The purpose of the present study was to evaluate the SF concentration in pediatric patients that were indicated for LT. In addition, the study retrospectively evaluated whether the SF concentration was predictive of mortality after LT. Thirty patients indicated for living donor LT because of biliary atresia were retrospectively analyzed in this study. The mean patient age at LT was 62.7 months (range, 5 months to 19 years). The mean SF level the day before surgery was 118.7 ng/mL. The mean SF level at time of the abdominal wall closure was 1477.2 ng/mL. The value increased dramatically after reperfusion. There was a positive correlation between the pre-LT SF value and the postoperative outcome. These results suggest the impact of the SF concentration as a predictor of mortality after LT in pediatric patients. Further studies are therefore necessary to accumulate suffi cient data to confi rm these results.