iskender sayek - Academia.edu (original) (raw)
Papers by iskender sayek
Medical Teacher
Purpose: To define recommendations to the medical schools in Turkey about social accountability w... more Purpose: To define recommendations to the medical schools in Turkey about social accountability which meets the local needs. Methodology of the study: The Association of Evaluation and Accreditation of Medical Education Programs (TEPDAD-Turkey) Social Accountability working group planned a study to determine national recommendations for social accountability of medical schools in two-stages. Delphi technique was used to develop the recommendations and finalize the recommendations in the first stage in which 61 members from 30 different institutions participated. Qualitative analysis was used for open questions in the first round and quantitative analysis for the data which is collected with a rating scale in the second and third rounds of the Delphi study. In the second stage, the recommendations were reviewed and finalized in a consensus workshop in which 68 members from 39 different institutions participated. Results: In the Delphi study 63 recommendations were classified under five themes: the health needs of the society, health service delivery, institutional structure and management, educational program and implementation and development and evaluation of social accountability. In the consensus workshop, the 63 recommendations were evaluated and of which 54 of 63 recommendations were agreed upon. Conclusion: A national framework has been developed by including a wide range of experts from different institutions for the social accountability of medical schools in Turkey. Developing recommendations in a local context will enhance the conceptualization of the recommendations of social accountability in the medical schools. As an accreditation body embedding the principles in the national standards will have a further impact on this process.
Turkiye Klinikleri Journal of Surgery, 1998
Turkiye Klinikleri Journal of Surgery, 1997
International surgery
The aim of this retrospective study was to evaluate the factors on mortality in urban free vertic... more The aim of this retrospective study was to evaluate the factors on mortality in urban free vertical falls. A total of 180 urban vertical free fall victims who survived transport to the emergency room between the period of 1980-1998 were evaluated. Minor bruises, abrasions, haematomas, and soft tissue injuries were not encountered. Serious injuries such as bone fractures, liver lacerations, epi-subdural haematomas, haemothorax, haemomediastinum, retroperitoneal haematomas were evaluated. Of the total, 23% (n = 41) of patients were female and 73% (n = 139) were male. The mean age was 22.3 years (4-75 years). Extremity fractures were found in 6.7% (n = 12), cranial trauma in 14.4% (n = 26), thoracic trauma in 2.2% (n = 4) retroperitoneal trauma in 2.8% (n = 5), vertebral column trauma in 1.7% (n = 3) of cases. The overall number of the pathologies was 59. In-hospital mortality was 8.9% (n = 16). The injury severity scores (ISSs) of non-survivors and survivors were 33 +/- 4, and 5 +/- 0...
The proposal for European Specifications in Medical Education presented in this document is an ad... more The proposal for European Specifications in Medical Education presented in this document is an adaptation of global standards in medical education to the European Region. The proposal covers all three phases of medical education: basic medical education; postgraduate medical education; and continuing professional development. It was developed by an international Task Force set up by the Thematic Network on Medical Education in Europe (MEDINE), chaired jointly by the World Federation for Medical Education (WFME) and the Association of Medical Schools in Europe (AMSE) and sponsored by the Commission of the European Union. The World Health Organization (WHO) Regional Office for Europe, as part of its commitment to ensure quality of health care in Europe, and in the framework of the WHO-WFME Strategic Partnership to Improve Medical Education, has facilitated publication and dissemination of the booklet. In publishing these specifications, MEDINE intends to provide a tool for reform proc...
Bu belgede bulunan Tıp Eğitiminde Avrupa Spesifikasyonları önerisi, tıp eğitimindeki evrensel sta... more Bu belgede bulunan Tıp Eğitiminde Avrupa Spesifikasyonları önerisi, tıp eğitimindeki evrensel standartların Avrupa Bölgesi’ne uyarlanmasıdır. Bu öneri tıp eğitimin üç dönemini de (temel tıp eğitimi, mezuniyet sonrası eğitim, sürekli mesleki gelişim) kapsamaktadır. Bu öneri, MEDINE (Medical Education in Europe) Tematik Ağı içinde oluşturulan bir çalışma grubu tarafından geliştirilmiştir. Bu çalışma, Dünya Tıp Eğitimi Federasyonu (WFME/DTEF) ve Avrupa Tıp Fakülteleri Birliği (AMSE/ATFB) ortaklığı ile yürütülmüş ve Avrupa Birliği Komisyonu tarafından desteklenmiştir. Dünya Sağlık Örgütü Avrupa Bölgesel Ofisi, Avrupa’daki sağlık hizmeti niteliğini artırma hedefi ve Dünya Sağlık Örgütü (WHO)-Dünya Tıp Eğitimi Federasyonu (DTEF) Tıp Eğitimini Geliştirme İşbirliği çerçevesinde bu kitapçığın basılmasını ve dağıtılmasını sağlamıştır. MEDINE bu spesifikasyonları yayınlayarak, reform süreçleri için bir araç ve tıp eğitimi kurumları ile programlarının tanınması ve akreditasyonu için kriter oluş...
The American Journal of Surgery, 1999
BACKGROUND: The adverse effects of elevated intraabdominal pressure (IAP) on abdominal organs are... more BACKGROUND: The adverse effects of elevated intraabdominal pressure (IAP) on abdominal organs are realized, but its influence on anastomotic healing has not been studied. The aim of this study was to evaluate the effect of elevated IAP on healing of colonic anastomoses. METHODS: Thirty rats, which all had right colonic anastomoses, were divided into five groups. Group 1 was the control group, and group 2 had fecal peritonitis. IAP was maintained between 4 to 6 mm Hg in group 3, 8 to 12 mm Hg in group 4, and 14 to 18 mm Hg in group 5 until all rats were sacrificed on day 4. Bursting pressures and tissue hydroxyproline concentrations of anastomoses were then analyzed and compared. RESULTS: Mean ؎ SEM of bursting pressures were 143 ؎ 2.9 mm Hg in group 1, 72 ؎ 14.4 mm Hg in group 2, 77.3 ؎ 7.9 mm Hg in group 3, 57.5 ؎ 11.2 mm Hg in group 4, and 40.1 ؎ 9.6 mm Hg in group 5 (P <0.0001, one-way analysis of variance [ANOVA]). Mean ؎ SEM of tissue hydroxyproline concentrations were 5.3 ؎ 0.3 g/mg in group 1, 4.7 ؎ 0.5 g/mg in group 2, 4.6 ؎ 0.6 g/mg in group 3, 3.6 ؎ 0.5 g/mg in group 4, and 2.4 ؎ 0.2 g/mg in group 5 (P ؍ 0.0026, one-way ANOVA). The bursting pressure and hydroxyproline concentrations had good correlation (P <0.001, r ؍ 0.76). CONCLUSIONS: Elevated IAP delays healing of colonic anastomoses and 4 to 6 mm Hg IAP delays healing as much as fecal peritonitis. More elevated IAP delays healing more than fecal peritonitis. These events may be clinically important and may result from local-systemic effects of IAP.
Techniques in Coloproctology, 2009
Background The aim of this report is to analyse our results and to underline our criteria for day... more Background The aim of this report is to analyse our results and to underline our criteria for day surgery practice. Patients and methods Our patients are selected according to ASA criteria. Occasionally, the patients with some risk factors are selected but only when their concomitant diseases are well controlled. Results We have treated 673 patients with the third and early fourth degree haemorrhoids. We have had patients with several minor problems causing no influence on the success of the procedure. Good haemostasis, preventing postoperative bleeding, is the most important factor. Conclusion Among proctological procedures in haemorrhoid treatment, the PPH technique has firm and wellaccepted position even in ambulatory surgery.
Teaching and Learning in Medicine, 2004
We evaluated whether the faculty development program, the Teaching Skills Improvement Program, me... more We evaluated whether the faculty development program, the Teaching Skills Improvement Program, met medical educators&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; needs at Hacettepe University Faculty of Medicine, Turkey. In a 1997 needs assessment survey, large proportions of 178 medical educators assessed their knowledge of educational issues and teaching skills as good or excellent. Nonetheless, 86% of the respondents stated they would like to participate in a future training program focused on the content indicated in the survey. In 1998, 83 faculty members took part in the program and expressed a high degree of satisfaction with its content and organization, as well as the course trainers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; teaching. Most of the participants got high scores on a test of knowledge related to the course content and performed proficiently in a microteaching session. Six months to a year later, large proportions of the participants reported using many of the training techniques in their teaching program.
Surgical Infections, 2001
SURGICAL INFECTIONS, such as intra-abdomi-nal infections, gynecologic infections, and diabetic fo... more SURGICAL INFECTIONS, such as intra-abdomi-nal infections, gynecologic infections, and diabetic foot infections are frequently polymi-crobial in nature. The presence of both aerobic and anaerobic bacteria at the infection site re-sults in a synergistic polymicrobial mixed in-fection, which ...
Journal of Gastrointestinal Surgery, 2008
Background This study was designed to examine the effects of propolis on the liver and biliary sy... more Background This study was designed to examine the effects of propolis on the liver and biliary system when used as a scolicidal agent. Materials and Methods Thirty Wistar-Albino rats were divided into two groups. Propolis and 0.9% saline (NaCl) were injected into the biliary tract of the rats. Three rats from control group and four rats from propolis group died within 5 days after the procedure. Blood samples of remaining 23 rats were obtained 1 week after and at the end of the experimental study for liver function tests. Six months after the procedure, retrograde and magnetic resonance cholangiography were performed and liver, common bile duct, and duodenum were excised en bloc for histopathological examination. Results Liver function tests were slightly elevated 1 week after the procedure and were found to be normal at the end of the sixth month in both groups. No stricture in the biliary tree was found on the retrograde and magnetic resonance cholangiograms. The tissue samples of the propolis group showed no histomorphological difference from the control group. Conclusions Propolis may be used as a scolicidal agent even in the case of cystobiliary communication with no side effects on liver and biliary tree.
European Radiology, 1997
Percutaneous treatment of a huge congenital splenic cyst in a 23-year-old man is presented. The c... more Percutaneous treatment of a huge congenital splenic cyst in a 23-year-old man is presented. The cyst had been catheterized and drained two times within a 3-month period without injecting any sclerosing agent into the cavity. On the third attempt, catheter drainage and injection of alcohol into the cyst cavity were performed because of insufficient response to drainage alone. He was discharged symptom-free after the procedure. The cyst diminished in size considerably 9 months after the treatment with alcohol. The volume of the cyst was reduced from 5200 to 8 ml. Although percutaneous treatment of a congenital splenic cyst with tetracyclin has been reported, to our knowledge this is the first case of a congenital splenic cyst treated with alcohol as a sclerosing agent. Percutaneous treatment of splenic cyst can obviate the need for partial or total splenectomy and may be an alternative to surgical treatment.
European Journal of Cancer, 2000
Germ line BRCA1 and/or BRCA2 mutations were screened in 50 Turkish breast and/or ovarian cancer p... more Germ line BRCA1 and/or BRCA2 mutations were screened in 50 Turkish breast and/or ovarian cancer patients composed of hereditary, familial, early onset and male cancer groups. Genomic DNA samples were tested by heteroduplex analysis and DNA sequencing. Two truncating BRCA2 mutations, one novel (6880 insG) and one previously reported (3034 delAAAC), were found in two out of six (33%) hereditary breast and/or ovarian cancer patients. A novel truncating (1200 insA) and a missense (2080A3G) BRCA1 mutation was found in two of 27 (7%) individuals in the early onset group. A total of four (8%) disease-causing mutations in 50 breast cancer patients were identi®ed in BRCA1 and BRCA2 genes. In addition, ®ve BRCA1 sequence variants have been identi®ed in 23 patients. These results indicate that BRCA1 and BRCA2 genes are involved in some, but not all, forms of hereditary predisposition to breast cancer in the Turkish population.
Cancer Investigation, 2005
The incorporation of a taxane into an anthracycline-containing regimen in the adjuvant treatment ... more The incorporation of a taxane into an anthracycline-containing regimen in the adjuvant treatment of breast cancer is a promising approach. In this study, we aimed to evaluate the safety and efficacy of four cycles of FEC (fluorouracil 500 mg/m2, epirubicin 70 mg/m2, cyclophosphamide 500 mg/m2, every 3 weeks) followed by four cycles of paclitaxel (175 mg/m2 every 3 weeks) in the adjuvant treatment of node-positive and other high-risk breast cancer patients. A total of 88 female patients were enrolled. Mean age (+/- SD) of the patients was 47 +/- 10 (min: 24; max: 71). The patients were followed for a median of 48 months (min: 20; max: 64). The most common side effects were nausea-vomiting (grade I-II: 91%; grade III: 2%), as well as hematological toxicity (grade I-II: 70%; grade III: 3%). Although all patients experienced some degree of toxicity, it was severe enough to be classified as grade III or IV in only 10 (11%) of the cases. Of note, six (8%) patients had grade I and only one (1%) had grade II cardiotoxicity. No grade III or IV cardiotoxicity was observed. The full eight cycles of study treatment could be administered to 75 patients (85%). Side effects necessitated the reduction of the doses of FEC and paclitaxel in one (1%) and three patients (3%), respectively. Median overall (OS) and disease-free survival (DFS) have not yet been reached. Five-year OS and DFS have been estimated to be 78% and 61%, respectively. We conclude that FEC followed by paclitaxel is a well-tolerated and feasible regimen in the adjuvant treatment of early breast cancer. Its efficacity is comparable with other commonly used regimens and merits evaluation in a phase III study.
British Journal of Surgery, 2000
Background The aim of this study was to investigate the effects of inducible nitric oxide synthas... more Background The aim of this study was to investigate the effects of inducible nitric oxide synthase inhibition by aminoguanidine on endotoxin-induced reduction in mesenteric blood flow. Methods Twenty Sprague–Dawley rats (180–230 g) allocated into four groups were administered either Escherichia coli endotoxin 1 mg/kg intraperitoneally or its solvent saline and were pretreated with either aminoguanidine (15 mg/kg intraperitoneally 20 min before and 2 h after endotoxin injection) or saline. Some 4 h after endotoxin injection, animals were anaesthetized, arterial blood pressure and mesenteric blood flow were measured and the resistance in the mesenteric vascular beds was then calculated. The effect of phenylephrine (1–30 µg/kg intravenously) on these parameters was also investigated. Results Endotoxin did not significantly modify the mean arterial blood pressure but decreased mesenteric blood flow by increasing the vascular resistance (mean(s.e.m.) 7·8(1·0) versus 13·7(1·2) mmHg per mi...
British Journal of Surgery, 2000
Obstructive jaundice leads to a significant increase in septic complications. In addition, endoto... more Obstructive jaundice leads to a significant increase in septic complications. In addition, endotoxaemia may cause a secondary insult. The effects of endotoxaemia and obstructive jaundice‐induced anergy on the kinetics of two early mediators of the response to sepsis, tumour necrosis factor (TNF) α and interleukin (IL) 10, were investigated.
British Journal of Surgery, 1998
Background The role of inducible nitric oxide synthase (iNOS) in endotoxin-induced bacterial tran... more Background The role of inducible nitric oxide synthase (iNOS) in endotoxin-induced bacterial translocation was investigated by using its specific blocker aminoguanidine in 46 albino mice (25–35 g) allocated into four groups. Methods The first group received intraperitoneal saline (control; 0·9 per cent w v−1 sodium chloride 1 ml kg−1; n = 6), the second group intraperitoneal endotoxin (Escherichia coli lipopolysaccharide 055:B5 20 mg kg−1; n = 19), the third group intraperitoneal aminoguanidine (20 mg kg−1, 20 min before and 12 h after saline; n = 6) and the fourth group both endotoxin and aminoguanidine intraperitoneally (n = 15). Some 24 h later, the animals were anaesthetized with ether and blood samples were collected by cardiac puncture together with mesenteric lymph node (MLN), spleen and liver specimens under aseptic conditions. Specimens were then cultured to determine the presence of colony-forming units as an index of bacterial translocation. Results No bacterial growth wa...
ANZ Journal of Surgery, 2005
Background: The aim of the present study was to evaluate the effect of dexamethasone‐pretreatmen... more Background: The aim of the present study was to evaluate the effect of dexamethasone‐pretreatment on the hepatic artery and portal vein of septic rats, which were generated by lipopolisaccarides (LPS) intraperitoneal injection.Method: Thirty‐six albino Wistar rats were used and constructed as LPS (n = 12), control (n = 12), dexamethazone‐pretreatment (n = 6) and dexamethazone‐control (n = 6) groups. Hepatic artery and portal vein rings were excised and placed in Krebs−Henseleit solution. Vessel rings were contracted with phenylephrine adding to the organ chamber in cumulative doses. Then the contraction‐response curves were drawn.Results: In the LPS group, phenylephrine evoked contractions were reduced in both hepatic artery and portal vein rings in comparison to the control group. In the dexamethasone‐control group, phenylephrine‐evoked contractions were increased but not significantly. Dexamethasone‐pretreatment increased the phenylephrine‐evoked contractions close to the value...
ANZ Journal of Surgery, 2000
The aim of the present study was to evaluate the effects of laparotomy and CO2 insufflation on wo... more The aim of the present study was to evaluate the effects of laparotomy and CO2 insufflation on wound healing in a murine incisional wound healing model. Seventy-two male Swiss Albino mice were randomly allocated into three groups of control, laparotomy and CO2 insufflation. A transverse skin incision of 15 mm was made in the dorsum of each mouse, and four interrupted mattress sutures with 4.0 polypropylene thread were laid for wound closure. A median laparotomy was performed in the laparotomy group. CO2 insufflation was performed with an intra-abdominal pressure of 9 mmHg. The retained gas was evacuated from the abdominal cavity at the end of a 60-min period. Mice were killed on the 3rd, 7th and 15th postoperative days. The wound tensile strength and 5-hydroxyproline concentration in the wound tissue were measured. Tensile strength of the incised skin increased as the post-incision period progressed. There was no significant difference between the tensile strengths of the incised skin of control, laparotomy and CO2 insufflation groups throughout the observation period. The skin 5-hydroxyproline concentrations of all groups were not significantly different at the 3rd postoperative day. But laparotomy and CO2 insufflation groups had lower 5-hydroxyproline concentrations at the 7th and 15th postoperative days, when compared to controls (P &amp;lt; 0.02 for 7th and 15th days). CO2 insufflation and laparotomy reduce the 5-hydroxyproline concentration of the wound, suggesting a diminished wound healing capacity.
BMC Medical Education, 2021
Background Clinical training during the COVID-19 pandemic is high risk for medical students. Medi... more Background Clinical training during the COVID-19 pandemic is high risk for medical students. Medical schools in low- and middle-income countries (LMIC) have limited capacity to develop resources in the face of rapidly developing health emergencies. Here, a free Massive Open Online Course (MOOC) was developed as a COVID-19 resource for medical students working in these settings, and its effectiveness was evaluated. Methods The RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework was utilized to evaluate the effectiveness of MOOC in teaching medical students about COVID-19. The data sources included the student registration forms, metrics quantifying their interactions within the modules, students’ course feedback, and free-text responses. The data were collected from the Moodle learning management system and Google analytics from May 9 to September 15, 2020. The research team analyzed the quantitative data descriptively and the qualitative data thematica...
Medical Teacher
Purpose: To define recommendations to the medical schools in Turkey about social accountability w... more Purpose: To define recommendations to the medical schools in Turkey about social accountability which meets the local needs. Methodology of the study: The Association of Evaluation and Accreditation of Medical Education Programs (TEPDAD-Turkey) Social Accountability working group planned a study to determine national recommendations for social accountability of medical schools in two-stages. Delphi technique was used to develop the recommendations and finalize the recommendations in the first stage in which 61 members from 30 different institutions participated. Qualitative analysis was used for open questions in the first round and quantitative analysis for the data which is collected with a rating scale in the second and third rounds of the Delphi study. In the second stage, the recommendations were reviewed and finalized in a consensus workshop in which 68 members from 39 different institutions participated. Results: In the Delphi study 63 recommendations were classified under five themes: the health needs of the society, health service delivery, institutional structure and management, educational program and implementation and development and evaluation of social accountability. In the consensus workshop, the 63 recommendations were evaluated and of which 54 of 63 recommendations were agreed upon. Conclusion: A national framework has been developed by including a wide range of experts from different institutions for the social accountability of medical schools in Turkey. Developing recommendations in a local context will enhance the conceptualization of the recommendations of social accountability in the medical schools. As an accreditation body embedding the principles in the national standards will have a further impact on this process.
Turkiye Klinikleri Journal of Surgery, 1998
Turkiye Klinikleri Journal of Surgery, 1997
International surgery
The aim of this retrospective study was to evaluate the factors on mortality in urban free vertic... more The aim of this retrospective study was to evaluate the factors on mortality in urban free vertical falls. A total of 180 urban vertical free fall victims who survived transport to the emergency room between the period of 1980-1998 were evaluated. Minor bruises, abrasions, haematomas, and soft tissue injuries were not encountered. Serious injuries such as bone fractures, liver lacerations, epi-subdural haematomas, haemothorax, haemomediastinum, retroperitoneal haematomas were evaluated. Of the total, 23% (n = 41) of patients were female and 73% (n = 139) were male. The mean age was 22.3 years (4-75 years). Extremity fractures were found in 6.7% (n = 12), cranial trauma in 14.4% (n = 26), thoracic trauma in 2.2% (n = 4) retroperitoneal trauma in 2.8% (n = 5), vertebral column trauma in 1.7% (n = 3) of cases. The overall number of the pathologies was 59. In-hospital mortality was 8.9% (n = 16). The injury severity scores (ISSs) of non-survivors and survivors were 33 +/- 4, and 5 +/- 0...
The proposal for European Specifications in Medical Education presented in this document is an ad... more The proposal for European Specifications in Medical Education presented in this document is an adaptation of global standards in medical education to the European Region. The proposal covers all three phases of medical education: basic medical education; postgraduate medical education; and continuing professional development. It was developed by an international Task Force set up by the Thematic Network on Medical Education in Europe (MEDINE), chaired jointly by the World Federation for Medical Education (WFME) and the Association of Medical Schools in Europe (AMSE) and sponsored by the Commission of the European Union. The World Health Organization (WHO) Regional Office for Europe, as part of its commitment to ensure quality of health care in Europe, and in the framework of the WHO-WFME Strategic Partnership to Improve Medical Education, has facilitated publication and dissemination of the booklet. In publishing these specifications, MEDINE intends to provide a tool for reform proc...
Bu belgede bulunan Tıp Eğitiminde Avrupa Spesifikasyonları önerisi, tıp eğitimindeki evrensel sta... more Bu belgede bulunan Tıp Eğitiminde Avrupa Spesifikasyonları önerisi, tıp eğitimindeki evrensel standartların Avrupa Bölgesi’ne uyarlanmasıdır. Bu öneri tıp eğitimin üç dönemini de (temel tıp eğitimi, mezuniyet sonrası eğitim, sürekli mesleki gelişim) kapsamaktadır. Bu öneri, MEDINE (Medical Education in Europe) Tematik Ağı içinde oluşturulan bir çalışma grubu tarafından geliştirilmiştir. Bu çalışma, Dünya Tıp Eğitimi Federasyonu (WFME/DTEF) ve Avrupa Tıp Fakülteleri Birliği (AMSE/ATFB) ortaklığı ile yürütülmüş ve Avrupa Birliği Komisyonu tarafından desteklenmiştir. Dünya Sağlık Örgütü Avrupa Bölgesel Ofisi, Avrupa’daki sağlık hizmeti niteliğini artırma hedefi ve Dünya Sağlık Örgütü (WHO)-Dünya Tıp Eğitimi Federasyonu (DTEF) Tıp Eğitimini Geliştirme İşbirliği çerçevesinde bu kitapçığın basılmasını ve dağıtılmasını sağlamıştır. MEDINE bu spesifikasyonları yayınlayarak, reform süreçleri için bir araç ve tıp eğitimi kurumları ile programlarının tanınması ve akreditasyonu için kriter oluş...
The American Journal of Surgery, 1999
BACKGROUND: The adverse effects of elevated intraabdominal pressure (IAP) on abdominal organs are... more BACKGROUND: The adverse effects of elevated intraabdominal pressure (IAP) on abdominal organs are realized, but its influence on anastomotic healing has not been studied. The aim of this study was to evaluate the effect of elevated IAP on healing of colonic anastomoses. METHODS: Thirty rats, which all had right colonic anastomoses, were divided into five groups. Group 1 was the control group, and group 2 had fecal peritonitis. IAP was maintained between 4 to 6 mm Hg in group 3, 8 to 12 mm Hg in group 4, and 14 to 18 mm Hg in group 5 until all rats were sacrificed on day 4. Bursting pressures and tissue hydroxyproline concentrations of anastomoses were then analyzed and compared. RESULTS: Mean ؎ SEM of bursting pressures were 143 ؎ 2.9 mm Hg in group 1, 72 ؎ 14.4 mm Hg in group 2, 77.3 ؎ 7.9 mm Hg in group 3, 57.5 ؎ 11.2 mm Hg in group 4, and 40.1 ؎ 9.6 mm Hg in group 5 (P <0.0001, one-way analysis of variance [ANOVA]). Mean ؎ SEM of tissue hydroxyproline concentrations were 5.3 ؎ 0.3 g/mg in group 1, 4.7 ؎ 0.5 g/mg in group 2, 4.6 ؎ 0.6 g/mg in group 3, 3.6 ؎ 0.5 g/mg in group 4, and 2.4 ؎ 0.2 g/mg in group 5 (P ؍ 0.0026, one-way ANOVA). The bursting pressure and hydroxyproline concentrations had good correlation (P <0.001, r ؍ 0.76). CONCLUSIONS: Elevated IAP delays healing of colonic anastomoses and 4 to 6 mm Hg IAP delays healing as much as fecal peritonitis. More elevated IAP delays healing more than fecal peritonitis. These events may be clinically important and may result from local-systemic effects of IAP.
Techniques in Coloproctology, 2009
Background The aim of this report is to analyse our results and to underline our criteria for day... more Background The aim of this report is to analyse our results and to underline our criteria for day surgery practice. Patients and methods Our patients are selected according to ASA criteria. Occasionally, the patients with some risk factors are selected but only when their concomitant diseases are well controlled. Results We have treated 673 patients with the third and early fourth degree haemorrhoids. We have had patients with several minor problems causing no influence on the success of the procedure. Good haemostasis, preventing postoperative bleeding, is the most important factor. Conclusion Among proctological procedures in haemorrhoid treatment, the PPH technique has firm and wellaccepted position even in ambulatory surgery.
Teaching and Learning in Medicine, 2004
We evaluated whether the faculty development program, the Teaching Skills Improvement Program, me... more We evaluated whether the faculty development program, the Teaching Skills Improvement Program, met medical educators&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; needs at Hacettepe University Faculty of Medicine, Turkey. In a 1997 needs assessment survey, large proportions of 178 medical educators assessed their knowledge of educational issues and teaching skills as good or excellent. Nonetheless, 86% of the respondents stated they would like to participate in a future training program focused on the content indicated in the survey. In 1998, 83 faculty members took part in the program and expressed a high degree of satisfaction with its content and organization, as well as the course trainers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; teaching. Most of the participants got high scores on a test of knowledge related to the course content and performed proficiently in a microteaching session. Six months to a year later, large proportions of the participants reported using many of the training techniques in their teaching program.
Surgical Infections, 2001
SURGICAL INFECTIONS, such as intra-abdomi-nal infections, gynecologic infections, and diabetic fo... more SURGICAL INFECTIONS, such as intra-abdomi-nal infections, gynecologic infections, and diabetic foot infections are frequently polymi-crobial in nature. The presence of both aerobic and anaerobic bacteria at the infection site re-sults in a synergistic polymicrobial mixed in-fection, which ...
Journal of Gastrointestinal Surgery, 2008
Background This study was designed to examine the effects of propolis on the liver and biliary sy... more Background This study was designed to examine the effects of propolis on the liver and biliary system when used as a scolicidal agent. Materials and Methods Thirty Wistar-Albino rats were divided into two groups. Propolis and 0.9% saline (NaCl) were injected into the biliary tract of the rats. Three rats from control group and four rats from propolis group died within 5 days after the procedure. Blood samples of remaining 23 rats were obtained 1 week after and at the end of the experimental study for liver function tests. Six months after the procedure, retrograde and magnetic resonance cholangiography were performed and liver, common bile duct, and duodenum were excised en bloc for histopathological examination. Results Liver function tests were slightly elevated 1 week after the procedure and were found to be normal at the end of the sixth month in both groups. No stricture in the biliary tree was found on the retrograde and magnetic resonance cholangiograms. The tissue samples of the propolis group showed no histomorphological difference from the control group. Conclusions Propolis may be used as a scolicidal agent even in the case of cystobiliary communication with no side effects on liver and biliary tree.
European Radiology, 1997
Percutaneous treatment of a huge congenital splenic cyst in a 23-year-old man is presented. The c... more Percutaneous treatment of a huge congenital splenic cyst in a 23-year-old man is presented. The cyst had been catheterized and drained two times within a 3-month period without injecting any sclerosing agent into the cavity. On the third attempt, catheter drainage and injection of alcohol into the cyst cavity were performed because of insufficient response to drainage alone. He was discharged symptom-free after the procedure. The cyst diminished in size considerably 9 months after the treatment with alcohol. The volume of the cyst was reduced from 5200 to 8 ml. Although percutaneous treatment of a congenital splenic cyst with tetracyclin has been reported, to our knowledge this is the first case of a congenital splenic cyst treated with alcohol as a sclerosing agent. Percutaneous treatment of splenic cyst can obviate the need for partial or total splenectomy and may be an alternative to surgical treatment.
European Journal of Cancer, 2000
Germ line BRCA1 and/or BRCA2 mutations were screened in 50 Turkish breast and/or ovarian cancer p... more Germ line BRCA1 and/or BRCA2 mutations were screened in 50 Turkish breast and/or ovarian cancer patients composed of hereditary, familial, early onset and male cancer groups. Genomic DNA samples were tested by heteroduplex analysis and DNA sequencing. Two truncating BRCA2 mutations, one novel (6880 insG) and one previously reported (3034 delAAAC), were found in two out of six (33%) hereditary breast and/or ovarian cancer patients. A novel truncating (1200 insA) and a missense (2080A3G) BRCA1 mutation was found in two of 27 (7%) individuals in the early onset group. A total of four (8%) disease-causing mutations in 50 breast cancer patients were identi®ed in BRCA1 and BRCA2 genes. In addition, ®ve BRCA1 sequence variants have been identi®ed in 23 patients. These results indicate that BRCA1 and BRCA2 genes are involved in some, but not all, forms of hereditary predisposition to breast cancer in the Turkish population.
Cancer Investigation, 2005
The incorporation of a taxane into an anthracycline-containing regimen in the adjuvant treatment ... more The incorporation of a taxane into an anthracycline-containing regimen in the adjuvant treatment of breast cancer is a promising approach. In this study, we aimed to evaluate the safety and efficacy of four cycles of FEC (fluorouracil 500 mg/m2, epirubicin 70 mg/m2, cyclophosphamide 500 mg/m2, every 3 weeks) followed by four cycles of paclitaxel (175 mg/m2 every 3 weeks) in the adjuvant treatment of node-positive and other high-risk breast cancer patients. A total of 88 female patients were enrolled. Mean age (+/- SD) of the patients was 47 +/- 10 (min: 24; max: 71). The patients were followed for a median of 48 months (min: 20; max: 64). The most common side effects were nausea-vomiting (grade I-II: 91%; grade III: 2%), as well as hematological toxicity (grade I-II: 70%; grade III: 3%). Although all patients experienced some degree of toxicity, it was severe enough to be classified as grade III or IV in only 10 (11%) of the cases. Of note, six (8%) patients had grade I and only one (1%) had grade II cardiotoxicity. No grade III or IV cardiotoxicity was observed. The full eight cycles of study treatment could be administered to 75 patients (85%). Side effects necessitated the reduction of the doses of FEC and paclitaxel in one (1%) and three patients (3%), respectively. Median overall (OS) and disease-free survival (DFS) have not yet been reached. Five-year OS and DFS have been estimated to be 78% and 61%, respectively. We conclude that FEC followed by paclitaxel is a well-tolerated and feasible regimen in the adjuvant treatment of early breast cancer. Its efficacity is comparable with other commonly used regimens and merits evaluation in a phase III study.
British Journal of Surgery, 2000
Background The aim of this study was to investigate the effects of inducible nitric oxide synthas... more Background The aim of this study was to investigate the effects of inducible nitric oxide synthase inhibition by aminoguanidine on endotoxin-induced reduction in mesenteric blood flow. Methods Twenty Sprague–Dawley rats (180–230 g) allocated into four groups were administered either Escherichia coli endotoxin 1 mg/kg intraperitoneally or its solvent saline and were pretreated with either aminoguanidine (15 mg/kg intraperitoneally 20 min before and 2 h after endotoxin injection) or saline. Some 4 h after endotoxin injection, animals were anaesthetized, arterial blood pressure and mesenteric blood flow were measured and the resistance in the mesenteric vascular beds was then calculated. The effect of phenylephrine (1–30 µg/kg intravenously) on these parameters was also investigated. Results Endotoxin did not significantly modify the mean arterial blood pressure but decreased mesenteric blood flow by increasing the vascular resistance (mean(s.e.m.) 7·8(1·0) versus 13·7(1·2) mmHg per mi...
British Journal of Surgery, 2000
Obstructive jaundice leads to a significant increase in septic complications. In addition, endoto... more Obstructive jaundice leads to a significant increase in septic complications. In addition, endotoxaemia may cause a secondary insult. The effects of endotoxaemia and obstructive jaundice‐induced anergy on the kinetics of two early mediators of the response to sepsis, tumour necrosis factor (TNF) α and interleukin (IL) 10, were investigated.
British Journal of Surgery, 1998
Background The role of inducible nitric oxide synthase (iNOS) in endotoxin-induced bacterial tran... more Background The role of inducible nitric oxide synthase (iNOS) in endotoxin-induced bacterial translocation was investigated by using its specific blocker aminoguanidine in 46 albino mice (25–35 g) allocated into four groups. Methods The first group received intraperitoneal saline (control; 0·9 per cent w v−1 sodium chloride 1 ml kg−1; n = 6), the second group intraperitoneal endotoxin (Escherichia coli lipopolysaccharide 055:B5 20 mg kg−1; n = 19), the third group intraperitoneal aminoguanidine (20 mg kg−1, 20 min before and 12 h after saline; n = 6) and the fourth group both endotoxin and aminoguanidine intraperitoneally (n = 15). Some 24 h later, the animals were anaesthetized with ether and blood samples were collected by cardiac puncture together with mesenteric lymph node (MLN), spleen and liver specimens under aseptic conditions. Specimens were then cultured to determine the presence of colony-forming units as an index of bacterial translocation. Results No bacterial growth wa...
ANZ Journal of Surgery, 2005
Background: The aim of the present study was to evaluate the effect of dexamethasone‐pretreatmen... more Background: The aim of the present study was to evaluate the effect of dexamethasone‐pretreatment on the hepatic artery and portal vein of septic rats, which were generated by lipopolisaccarides (LPS) intraperitoneal injection.Method: Thirty‐six albino Wistar rats were used and constructed as LPS (n = 12), control (n = 12), dexamethazone‐pretreatment (n = 6) and dexamethazone‐control (n = 6) groups. Hepatic artery and portal vein rings were excised and placed in Krebs−Henseleit solution. Vessel rings were contracted with phenylephrine adding to the organ chamber in cumulative doses. Then the contraction‐response curves were drawn.Results: In the LPS group, phenylephrine evoked contractions were reduced in both hepatic artery and portal vein rings in comparison to the control group. In the dexamethasone‐control group, phenylephrine‐evoked contractions were increased but not significantly. Dexamethasone‐pretreatment increased the phenylephrine‐evoked contractions close to the value...
ANZ Journal of Surgery, 2000
The aim of the present study was to evaluate the effects of laparotomy and CO2 insufflation on wo... more The aim of the present study was to evaluate the effects of laparotomy and CO2 insufflation on wound healing in a murine incisional wound healing model. Seventy-two male Swiss Albino mice were randomly allocated into three groups of control, laparotomy and CO2 insufflation. A transverse skin incision of 15 mm was made in the dorsum of each mouse, and four interrupted mattress sutures with 4.0 polypropylene thread were laid for wound closure. A median laparotomy was performed in the laparotomy group. CO2 insufflation was performed with an intra-abdominal pressure of 9 mmHg. The retained gas was evacuated from the abdominal cavity at the end of a 60-min period. Mice were killed on the 3rd, 7th and 15th postoperative days. The wound tensile strength and 5-hydroxyproline concentration in the wound tissue were measured. Tensile strength of the incised skin increased as the post-incision period progressed. There was no significant difference between the tensile strengths of the incised skin of control, laparotomy and CO2 insufflation groups throughout the observation period. The skin 5-hydroxyproline concentrations of all groups were not significantly different at the 3rd postoperative day. But laparotomy and CO2 insufflation groups had lower 5-hydroxyproline concentrations at the 7th and 15th postoperative days, when compared to controls (P &amp;lt; 0.02 for 7th and 15th days). CO2 insufflation and laparotomy reduce the 5-hydroxyproline concentration of the wound, suggesting a diminished wound healing capacity.
BMC Medical Education, 2021
Background Clinical training during the COVID-19 pandemic is high risk for medical students. Medi... more Background Clinical training during the COVID-19 pandemic is high risk for medical students. Medical schools in low- and middle-income countries (LMIC) have limited capacity to develop resources in the face of rapidly developing health emergencies. Here, a free Massive Open Online Course (MOOC) was developed as a COVID-19 resource for medical students working in these settings, and its effectiveness was evaluated. Methods The RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework was utilized to evaluate the effectiveness of MOOC in teaching medical students about COVID-19. The data sources included the student registration forms, metrics quantifying their interactions within the modules, students’ course feedback, and free-text responses. The data were collected from the Moodle learning management system and Google analytics from May 9 to September 15, 2020. The research team analyzed the quantitative data descriptively and the qualitative data thematica...