Omer Gunal | Marmara University (original) (raw)

Papers by Omer Gunal

Research paper thumbnail of Prognostic Impact of the Metastatic Lymph Node Ratio on Survival in Rectal Cancer

Lymph-node metastasis is the most important predictor of survival in stage III rectal cancer. The... more Lymph-node metastasis is the most important predictor of survival in stage III rectal cancer. The number of metastatic lymph nodes may vary depending on the level of specimen dissection and the total number of lymph nodes harvested. The aim of this study was to evaluate whether the lymph node ratio (LNR) is a prognostic parameter for patients with rectal cancer. A retrospective review of a database of rectal cancer patients was performed to determine the effect of the LNR on the disease-free survival (DFS) and the overall survival. Of the total 228 patients with rectal cancer, 55 patients with stage III cancer were eligible for analysis. Survival curves were estimated using the Kaplan-Meier method. Cox regression analyses, after adjustments for potential confounders, were used to evaluate the relationship between the LNR and survival. According to the cutoff point 0.15 (15%), the 2-year DFS was 95.2% among patients with a LNR < 0.15 compared with 67.6% for those with LNR ≥ 0.15 (...

Research paper thumbnail of Endoscopic Snare Excision of Adenoma of the Papilla of Vater without Prophylactic Pancreatic-Duct Stent

JOP: Journal of the pancreas

The endoscopic excision of adenomas of the papilla of Vater has gained increased popularity in th... more The endoscopic excision of adenomas of the papilla of Vater has gained increased popularity in the recent years. Temporary pancreatic drainage has been advised to accompany snare papillectomy in order to prevent ductal obstruction and serious pancreatitis. We evaluated treatment outcome of patients who had undergone endoscopic papillectomy without pancreatic drainage. Three consecutive adult patients with adenomas of the papilla of Vater presented with jaundice and pain were treated by endoscopic snare excision between October 2013 and February 2014 in a single center. ERCP procedures revealed papillary tumors and endoscopic biopsy specimens revealed tubular adenoma the papilla of Vater. Adenomas were treated by snare papillectomy method and a biliary stent was inserted as a prophylactic procedure immediately after excision of the adenoma in each case. In addition to physical examination, laboratory tests were repeated in the follow-up period after papillectomy in order to document ...

Research paper thumbnail of Does chosen approach to the inguinal canal affect the outcome of hernial repair?

Surgical technology international, 2009

Access to the posterior inguinal wall is a fundamental part of inguinal hernia repair. The approa... more Access to the posterior inguinal wall is a fundamental part of inguinal hernia repair. The approach to the inguinal canal may affect the course and outcome of the operation. The aim of this study is to compare posterior approach (PA) repair with the standard anterior approach (AA). The study included 91 low-risk unilateral primary inguinal hernia patients who randomly received AA repair or PA repair. Various outcome measures in both groups were compared, and the mean operating time was longer for the AA repair group. Intra-operative complications were the same in both groups. Postoperative complications were more frequent in the AA repair group. The at-rest mean visual analog score (VAS), 24 hours postoperatively, seemed to be higher in the AA repair group. AA patients were able to postoperatively walk sooner than PA patients. Inguinal hernia repair through a PA seems to be less painful, less debilitating, and more easily applicable than the AA. Such advantages may be the reasons to...

Research paper thumbnail of Critical issues in groin hernia management

Surgical technology international, 2009

Today's surgeon faces multiple decisions for each patient who presents with an inguinal herni... more Today's surgeon faces multiple decisions for each patient who presents with an inguinal hernia. The natural history of an untreated inguinal hernia is still unclear for a particular individual. Given the low risk of emergency and death from an inguinal hernia, observation alone is now becoming an acceptable approach for many. For those that desire or require repair, the age of the patient and their comorbidities will influence the choices of anesthetic and surgical technique. Despite our rapid advances in surgical technology, a consensus can not be reached locally or globally on one solution for inguinal hernia repair. Currently, more than six uniquely different surgical techniques are used for the repair of an inguinal hernia. Through the 1980s, the endpoint focused on by hernia surgeons was the incidence of recurrence. Though many experienced operators proved to have near-flawless results with a given technique, it has been difficult to duplicate these results by all surgeons....

Research paper thumbnail of Effect of melatonin on kidney cold ischemic preservation injury

International journal of clinical and experimental medicine, 2013

Melatonin is a potent free radical scavenger of reactive oxygen species, nitric oxide synthase in... more Melatonin is a potent free radical scavenger of reactive oxygen species, nitric oxide synthase inhibitor and a well-known antioxidant secreted from pineal gland. This hormone has been reported to protect tissue from oxidative damage. In this study, we aim to investigate the effect of melatonin on kidney cold ischemia time when added to preservation solution. Thirty male Wistar albino rats were divided equally into three groups; Ringer Lactate (RL) solution, University of Wisconsin (UW) solution with and without melatonin. The serum Lactate Dehydrogenase (LDH) activities of the preservation solutions at 2(nd), 24(th), 36(th), and 48(th) hours were determined. Tissue malondialdehyde (MDA) levels were also measured and a histological examination was performed at 48(th) hour. Melatonin that added to preservation solution prevented enzyme elevation and decreased lipid peroxidation in preservation solution when compared to the control group (p<0.05). The histological examination reveal...

Research paper thumbnail of Captopril prevents the oxidative damage to proteins after renal ischemia reperfusion injury: role of endothelin-1

Prostaglandins, leukotrienes, and essential fatty acids, 1997

Ischemia reperfusion (I/R) injury is one of the leading cause of the transplanted organ loss. In ... more Ischemia reperfusion (I/R) injury is one of the leading cause of the transplanted organ loss. In this experimental study, we investigated the effect of captopril on endothelin and eicosanoid release in I/R injury of the kidney. Rats were subjected to 60 min ischemia and 60 min of reperfusion of the left kidney in control and captopril groups. Tissue protein oxidation products, PGE2 and LTB4 levels and plasma endothelin-1 (ET-1) like activity were determined in sham operated, control and captopril groups. There were no differences in the LTB4 levels among the groups. ET-1 and PGE2 levels and protein oxidation products increased in the control group when compared with the sham. Captopril further increased both PGE2 and ET-1 concentrations and prevented protein oxidation. The increased ET-1 concentrations in the captopril treated group may imply the protective role of endothelin as the significant increase in protein oxidation products was reversed by captopril infusion. This has led u...

Research paper thumbnail of The Rare Coincidence: Nonrecurrent Laryngeal Nerve Pointed by a Zuckerkandl's Tubercle

Case Reports in Medicine, 2012

The safety of thyroid operations mainly depends on complete anatomical knowledge. Anatomical and ... more The safety of thyroid operations mainly depends on complete anatomical knowledge. Anatomical and embryological variations of the inferior laryngeal nerve (ILN), of the thyroid gland itself and unusual relations between ILN and the gland threaten operation security are discussed. The patient with toxic multinodular goiter is treated with total thyroidectomy. During dissection of the right lobe, the right ILN which has nonrecurrent course arising directly from cervical vagus nerve is identified and fully isolated until its laryngeal entry. At the operation, we observe bilateral Zuckerkandl's tubercles (ZTs) as posterior extension of both lateral lobes. The left ILN has usual recurrent course in the trachea-esophageal groove. The right ZT is placed between upper and middle third of the lobe points the nonrecurrent ILN. The coincidence of non-recurrent ILN pointed by a ZT is rare anatomical and embryological feature of this case. Based on anatomical and embryological variations, we suggest identification and full exposure of ILN before attempting excision of adjacent structures, like the ZT which has surgical importance for completeness of thyroidectomy.

Research paper thumbnail of Assessment of Anal Sphincter Function by Sengstaken-Blakemore Tube Anal Manometry

World Journal of Surgery, 2007

Anal manometry is a useful tool for testing the effectiveness of surgical treatment. However, mos... more Anal manometry is a useful tool for testing the effectiveness of surgical treatment. However, most techniques for anal pressure measurement are not easily available because of high cost. The aim of the present study was to introduce an easy and reproducible method for measuring anal pressures in testing the effectiveness of surgical procedures. We used a Sengstaken-Blakemore tube connected to a mercury manometer. After calibration of the system by inflating the distal (gastric) balloon and filling connection lines to the mercury manometer with 0.9% NaCl solution, resting and squeezing anal pressures were measured. The system was used on 50 human subjects (35 with anal fissure and 15 normal volunteers). Left lateral internal sphincterotomy had been performed in the anal fissure cases. Anal pressures were measured preoperatively and on postoperative days (POD) 2 and 20. Preoperative resting anal pressures in the group with anal fissure (83.4 +/- 1 mmHg) were significantly higher than those in the group of normal individuals (52 +/- 1.2 mmHg; p = 0.001). Resting anal pressures after the sphincterotomy (29 +/- 1 mmHg) were found to be significantly lower on POD 2, and resting anal pressure measurements (47 +/- 1 mmHg) on POD 20 were lower than the corresponding preoperative values. These values are closer to those of normal volunteers (p = 0.016). Anal manometry can be performed with this easily constructible and inexpensive system. This reproducible method can be used in the assessment of the results of surgical treatment in patients with anal and perianal diseases.

Research paper thumbnail of Does the approach to the groin make a difference in hernia repair?

Hernia, 2007

Background Laparoscopic and open preperitoneal hernia repair techniques both use the preperitonea... more Background Laparoscopic and open preperitoneal hernia repair techniques both use the preperitoneal space. This study investigated whether the surgical approach to the inguinal canal affects outcome measures. Methods One hundred sixty patients with inguinal hernia were assigned randomly into open anterior , open preperitoneal (39), laparoscopic transabdominal preperitoneal (39), and laparoscopic total extraperitoneal (40) groups according to the surgical method. The peroperative serum tumor necrosis factor-a (TNF-a) levels, interleukin-6 (IL-6) levels, VAS scores at 6 and 48 h, per-and postoperative complications, and recurrence rates were determined as main variables. Results The serum IL-6 levels were 335 ± 1.8, 283 ± 1.8, 283 ± 1.4, and 269.3 ± 1.6 pg/ml in the open anterior, posterior, transabdominal preperitoneal, and total extraperitoneal groups, respectively (P < 0.01). The TNF-a levels were highest in the open anterior group. The pain scores were lower in groups undergoing the posterior approach than in the open anterior approach group. Conclusion The approach to the inguinal canal through the preperitoneal space appears to be less invasive than the transinguinal anterior approach.

Research paper thumbnail of Should We Consider Topical Silver Nitrate Irrigation as a Definitive Nonsurgical Treatment for Perianal Fistula?

Diseases of the Colon & Rectum, 2014

Research paper thumbnail of Healing–promoting effect of bombesin treatment on chronic gastric ulcer in rats

Regulatory Peptides, 2002

To evaluate whether bombesin treatment has a facilitatory effect on the healing of chronic gastri... more To evaluate whether bombesin treatment has a facilitatory effect on the healing of chronic gastric ulcer, following the induction of ulcer by serosal application of acetic acid, rats were given bombesin (30 Ag/kg/day; subcutaneously) or vehicle three times a day for 7, 14 or 21 days until they were decapitated. Neither food intake nor gastric emptying rate in either vehicle-treated or bombesin-treated groups was not statistically different from control rats. Similarly, ulcer indices and gastric myeloperoxidase (MPO) activities at the first and second weeks of injury were not different among the groups. However, in the 3-week ulcer group, bombesin treatment reduced tissue MPO level significantly back to control levels. Moreover, the analysis of the surface epithelium by scanning electron and light microscopy demonstrated a significant reduction in the severity of ulcers by bombesin treatment. Pretreatment with CCK antagonists (L-364,718 or L365,260; 25 Amol/kg/day) before bombesin treatment showed that neither of the CCK antagonists had a significant effect on the bombesin-mediated healing process, suggesting that CCK receptors are not involved in the action of bombesin. In accordance with the previous studies that show its acute gastroprotective effects, bombesin is also effective in promoting the healing process of chronic gastric ulcer in rats. D

Research paper thumbnail of Low incidence of deep venous thrombosis after laparoscopic cholecystectomy

Journal of Hepato-Biliary-Pancreatic Surgery, 1995

ABSTRACT The effects of the increased intraabdominal pressure that occurs during laparoscopic cho... more ABSTRACT The effects of the increased intraabdominal pressure that occurs during laparoscopic cholecystectomy and the effects of the reverse Trendelenburg position adopted for the procedure on deep venous thrombosis (DVT) were investigated prospectively. Thirty patients who underwent laparoscopic and 13 who underwent open cholecystectomy for symptomatic cholelithiasis were investigated for postoperative DVT. Lower extremity venous blood flow was examined by color Doppler ultrasonography before and after operations. Thrombus formation was not found in the femoral, popliteal, or iliac veins of any of the patients who underwent either open or laparoscopic cholecystectomy. None of the patients in either group displayed signs of DVT or pulmonary embolus. We concluded that the incidence of DVT does not increase with laparoscopic cholecystectomy.

Research paper thumbnail of Effect of sex steroids on colonic distension-induced delay of gastric emptying in rats

Journal of Gastroenterology and Hepatology, 2004

The objective of the present study was to examine the effect of gonadal hormones on gastric motor... more The objective of the present study was to examine the effect of gonadal hormones on gastric motor response to non-noxious and noxious stimuli of colonic distension. Methods: Male Wistar albino rats were used. Under ketamine anesthesia some rats underwent castration (n = 24), while the rest of the rats were sham-operated (n = 67) and divided into different groups (n = 7-8 per group). On the 15th day of surgery, liquid gastric emptying studies were commenced. Results: Non-noxious (P < 0.05) or noxious (P < 0.01) colonic distension inhibited gastric emptying rate. Estradiol pretreatment (20 mg/kg per day, for 5 days, s.c.) inhibited gastric motility, while estradiol pretreatment or castration of the rats prior to noxious distension prevented the delay in gastric emptying. In contrast, blockade of testosterone receptors had no effect on the delay in gastric emptying induced by either modes of distension.

Research paper thumbnail of Clinical assessment of spinal and epidural anesthesia in inguinal hernia repair

Journal of Anesthesia, 2002

The current study was done to compare the effect of spinal and epidural anesthesia on surgical ou... more The current study was done to compare the effect of spinal and epidural anesthesia on surgical outcome measures of inguinal herniorrhaphy. Ninety-eight male patients undergoing inguinal hernia repair were randomized to either spinal (SA; n = 39) or epidural (EA; n = 59) anesthesia groups anesthetized with either glycosylated bupivacaine (20 mg) or 0.5 % bupivacaine (100 mg). Anesthesia onset time (AOT), postoperative stand-up time (SUT), first pain sensation time (FPT), operation time (OT), analgesic requirement (AR), hospital stay (HS), visual analogue scores of pain (VAS), per- and postoperative complications, and postanesthesia complications were recorded and compared with each other. FPT was 6.6 +/- 0.6 h and 3.1 +/- 0.4 h and OT was 40 +/- 2 min and 33.1 +/- 1 min in the EA and SA groups, respectively (p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). SUT was also longer in EA group. VAS scores at 12 and 24 h were significantly higher in the EA group (28 +/- 4 mm and 24 +/- 5 mm in EA and 16 +/- 4 and 5 +/- 1 mm in SA; P &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). No statistically significant difference was found between the SA and EA groups with respect to the other outcome measures that were considered. Spinal and epidural anesthesia show some differences from each other with respect to outcome measures such as OT, SUT, FPT, and 12- and 24-h VAS scores.

Research paper thumbnail of Estradiol Treatment Ameliorates Acetic Acid-Induced Gastric and Colonic Injuries in Rats

Inflammation, 2000

To evaluate the role of estrogen treatment on the healing of acetic acid-induced gastric or colon... more To evaluate the role of estrogen treatment on the healing of acetic acid-induced gastric or colonic injury, rats were given 17β estradiol benzoate (0.001, 0.1, and 10 mg/kg) or vehicle for 7 days (following the induction of ulcer) or 4 days (following the induction of colitis) until they were decapitated. Food intake and fecal output were decreased by estradiol treatment but gastric emptying rate was not changed. Estradiol (10 mg/kg) reduced gastric ulcer index and colonic damage score compared to vehicle-treated groups. SEM and light microscopy demonstrated a significant reduction in the severity of ulcers and colitis by estradiol treatment. Gastric microscopic score was not changed by estradiol treatment, whereas in the colonic tissue score was significantly reduced. Elevated gastric MPO levels were reduced in gastric but not in colonic tissues as compared with corresponding vehicle groups. In conclusion, exogenous estradiol treatment at pharmacological doses improves the healing of both gastric and colonic injury induced by acetic acid in rats.

Research paper thumbnail of Does l-carnitine have any effect on cold preservation injury of non-fatty liver in the University of Wisconsin solution?

Hepatology Research, 2007

To evaluate the protective effect of l-carnitine on liver tissue preserved in University of Wisco... more To evaluate the protective effect of l-carnitine on liver tissue preserved in University of Wisconsin (UW) solution. Twenty Wistar Albino rats were divided into two groups, a control (UW) group and a UW plus l-carnitine group. Retrieved liver grafts were preserved in UW and UW plus l-carnitine solutions at +4 degrees C. Preservation solution samples were assessed at 2, 24, 36, and 48 h to measure alanine aminotransferase and acid phosphatase activity. Tissue injury was scored on paraffin sections. No micro or macrovacuolar fat droplets were observed in the tissue slices. l-Carnitine effectively decreased enzyme release when added to UW solution (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). In addition to fatty liver, l-carnitine might be a metabolic adjunct in preservation solutions for non-fatty liver within UW solution.

Research paper thumbnail of Gastric functions in portal hypertension

Digestive Diseases and Sciences, 1996

Page 1. Digestive l)iseases attd Sciences. Vol. 41, No. 3 (March I996), pp. 585-590 Gastric Funct... more Page 1. Digestive l)iseases attd Sciences. Vol. 41, No. 3 (March I996), pp. 585-590 Gastric Functions in Portal Hypertension Role of Endothelin (3MER GONAL, MD, CUMHUR YEGEN, MD, A. OZDEMIR AKTAN, MD, RIFAT YALIN, MD, and BERRAK (~. YEGEN, MD ...

Research paper thumbnail of Appendicular mass imitating a malignant cecal tumor on f18-FDG PET/CT study: a case report

Cases Journal, 2009

Fluoro-Deoxy-Glucose Positron Emission Tomography/Computerized Tomography scan is a very useful m... more Fluoro-Deoxy-Glucose Positron Emission Tomography/Computerized Tomography scan is a very useful method in the diagnosis and follow-up of gastrointestinal malignancies, although it may cause confusion in differential diagnosis.

Research paper thumbnail of Malignant Mesenchymal Tumor of the Breast: Primary Chondrosarcoma

Breast Care, 2009

Zusammenfassung Hintergrund: Primäre mesenchymale Tumoren der Brust sind äußerst selten. Fallberi... more Zusammenfassung Hintergrund: Primäre mesenchymale Tumoren der Brust sind äußerst selten. Fallbericht: Eine 52 Jahre alte Frau stellte sich mit einem schnell wachsenden Tumor der Brust vor. Die klinische Untersuchung bestätigte eine große und runde Wucherung mit gleichmäßigen Rändern im oberen äußeren Quadranten der rechten Brust. Ultraschall zeigte einen echoarmen, festen Tumor (41 36 mm) mit lobulären Konturen. Die Mammografie ließ eine verhältnismäßig gleichmäßig geformte Wucherung mit erhöhter Dichte erkennen, die einen gutartigen Tumor vermuten ließ. Die pathologische Untersuchung eines Feinnadelaspirationsbiopsates ergab jedoch untypische Zellen und indizierte eine chirurgische Exzision. Der Tumor wurde durch lokale Exzision im Gesunden entfernt. Die histopathologische Analyse ergab ein hochgradig malignes Chondrosarkom der Brust. Aufgrund der endgültigen Diagnose und da dieser Tumor üblicherweise nicht strahlenempfindlich ist, führten wir eine modifiziert radikale Mastektomie durch. Die regionalen Lymphknoten und das benachbarte Gewebe waren frei von Metastasen. Der Tumor war Östrogen-und Progesteron-Rezeptor-sowie HER2-negativ. Schlussfolgerung: Das Chondrosarkom neigt zu schnellem Wachstum. In der klinischen Untersuchung zeigt es sich als größere, runde Wucherung. Mammografie-und Ultraschallaufnahmen zeigen einen gleichmäßigen, runden Tumor mit komplexem Echosignal. Normalerweise greift er nicht auf benachbarte Strukturen über. Die chirurgische Entfernung stellt die einzige wirksame Behandlung dar.

Research paper thumbnail of Do not rush for surgery; stent placement may be an effective step for definitive treatment of initially unextractable common bile duct stones with ERCP

Surgical endoscopy, Jan 27, 2015

Endoscopically unextractable common bile duct stones may be challenging for the endoscopist. In t... more Endoscopically unextractable common bile duct stones may be challenging for the endoscopist. In this study, we investigated the rate of stone removal after the endoscopic insertion of a biliary stent in patients with common bile duct stones unextractable via ERCP. Records of patients with common bile duct stone/s who underwent ERCP at single center were retrospectively analyzed. Only patients with common bile duct stone/s who had a stent placed due to unyielding stone removal were eligible for inclusion into this study. Endoscopic biliary stents were placed in cases of unextractable stone. After a follow-up period, a second ERCP procedure was performed. Major outcomes were the rate of stent insertion because of unextractable bile duct stones, the rate of spontaneous stone passage and the rate of stone extraction after the endoscopic insertion of a biliary stent. A total of 66 (28 %) patients had a stent placed due to unyielding attempts for stone removal, and 43 patients were includ...

Research paper thumbnail of Prognostic Impact of the Metastatic Lymph Node Ratio on Survival in Rectal Cancer

Lymph-node metastasis is the most important predictor of survival in stage III rectal cancer. The... more Lymph-node metastasis is the most important predictor of survival in stage III rectal cancer. The number of metastatic lymph nodes may vary depending on the level of specimen dissection and the total number of lymph nodes harvested. The aim of this study was to evaluate whether the lymph node ratio (LNR) is a prognostic parameter for patients with rectal cancer. A retrospective review of a database of rectal cancer patients was performed to determine the effect of the LNR on the disease-free survival (DFS) and the overall survival. Of the total 228 patients with rectal cancer, 55 patients with stage III cancer were eligible for analysis. Survival curves were estimated using the Kaplan-Meier method. Cox regression analyses, after adjustments for potential confounders, were used to evaluate the relationship between the LNR and survival. According to the cutoff point 0.15 (15%), the 2-year DFS was 95.2% among patients with a LNR < 0.15 compared with 67.6% for those with LNR ≥ 0.15 (...

Research paper thumbnail of Endoscopic Snare Excision of Adenoma of the Papilla of Vater without Prophylactic Pancreatic-Duct Stent

JOP: Journal of the pancreas

The endoscopic excision of adenomas of the papilla of Vater has gained increased popularity in th... more The endoscopic excision of adenomas of the papilla of Vater has gained increased popularity in the recent years. Temporary pancreatic drainage has been advised to accompany snare papillectomy in order to prevent ductal obstruction and serious pancreatitis. We evaluated treatment outcome of patients who had undergone endoscopic papillectomy without pancreatic drainage. Three consecutive adult patients with adenomas of the papilla of Vater presented with jaundice and pain were treated by endoscopic snare excision between October 2013 and February 2014 in a single center. ERCP procedures revealed papillary tumors and endoscopic biopsy specimens revealed tubular adenoma the papilla of Vater. Adenomas were treated by snare papillectomy method and a biliary stent was inserted as a prophylactic procedure immediately after excision of the adenoma in each case. In addition to physical examination, laboratory tests were repeated in the follow-up period after papillectomy in order to document ...

Research paper thumbnail of Does chosen approach to the inguinal canal affect the outcome of hernial repair?

Surgical technology international, 2009

Access to the posterior inguinal wall is a fundamental part of inguinal hernia repair. The approa... more Access to the posterior inguinal wall is a fundamental part of inguinal hernia repair. The approach to the inguinal canal may affect the course and outcome of the operation. The aim of this study is to compare posterior approach (PA) repair with the standard anterior approach (AA). The study included 91 low-risk unilateral primary inguinal hernia patients who randomly received AA repair or PA repair. Various outcome measures in both groups were compared, and the mean operating time was longer for the AA repair group. Intra-operative complications were the same in both groups. Postoperative complications were more frequent in the AA repair group. The at-rest mean visual analog score (VAS), 24 hours postoperatively, seemed to be higher in the AA repair group. AA patients were able to postoperatively walk sooner than PA patients. Inguinal hernia repair through a PA seems to be less painful, less debilitating, and more easily applicable than the AA. Such advantages may be the reasons to...

Research paper thumbnail of Critical issues in groin hernia management

Surgical technology international, 2009

Today's surgeon faces multiple decisions for each patient who presents with an inguinal herni... more Today's surgeon faces multiple decisions for each patient who presents with an inguinal hernia. The natural history of an untreated inguinal hernia is still unclear for a particular individual. Given the low risk of emergency and death from an inguinal hernia, observation alone is now becoming an acceptable approach for many. For those that desire or require repair, the age of the patient and their comorbidities will influence the choices of anesthetic and surgical technique. Despite our rapid advances in surgical technology, a consensus can not be reached locally or globally on one solution for inguinal hernia repair. Currently, more than six uniquely different surgical techniques are used for the repair of an inguinal hernia. Through the 1980s, the endpoint focused on by hernia surgeons was the incidence of recurrence. Though many experienced operators proved to have near-flawless results with a given technique, it has been difficult to duplicate these results by all surgeons....

Research paper thumbnail of Effect of melatonin on kidney cold ischemic preservation injury

International journal of clinical and experimental medicine, 2013

Melatonin is a potent free radical scavenger of reactive oxygen species, nitric oxide synthase in... more Melatonin is a potent free radical scavenger of reactive oxygen species, nitric oxide synthase inhibitor and a well-known antioxidant secreted from pineal gland. This hormone has been reported to protect tissue from oxidative damage. In this study, we aim to investigate the effect of melatonin on kidney cold ischemia time when added to preservation solution. Thirty male Wistar albino rats were divided equally into three groups; Ringer Lactate (RL) solution, University of Wisconsin (UW) solution with and without melatonin. The serum Lactate Dehydrogenase (LDH) activities of the preservation solutions at 2(nd), 24(th), 36(th), and 48(th) hours were determined. Tissue malondialdehyde (MDA) levels were also measured and a histological examination was performed at 48(th) hour. Melatonin that added to preservation solution prevented enzyme elevation and decreased lipid peroxidation in preservation solution when compared to the control group (p<0.05). The histological examination reveal...

Research paper thumbnail of Captopril prevents the oxidative damage to proteins after renal ischemia reperfusion injury: role of endothelin-1

Prostaglandins, leukotrienes, and essential fatty acids, 1997

Ischemia reperfusion (I/R) injury is one of the leading cause of the transplanted organ loss. In ... more Ischemia reperfusion (I/R) injury is one of the leading cause of the transplanted organ loss. In this experimental study, we investigated the effect of captopril on endothelin and eicosanoid release in I/R injury of the kidney. Rats were subjected to 60 min ischemia and 60 min of reperfusion of the left kidney in control and captopril groups. Tissue protein oxidation products, PGE2 and LTB4 levels and plasma endothelin-1 (ET-1) like activity were determined in sham operated, control and captopril groups. There were no differences in the LTB4 levels among the groups. ET-1 and PGE2 levels and protein oxidation products increased in the control group when compared with the sham. Captopril further increased both PGE2 and ET-1 concentrations and prevented protein oxidation. The increased ET-1 concentrations in the captopril treated group may imply the protective role of endothelin as the significant increase in protein oxidation products was reversed by captopril infusion. This has led u...

Research paper thumbnail of The Rare Coincidence: Nonrecurrent Laryngeal Nerve Pointed by a Zuckerkandl's Tubercle

Case Reports in Medicine, 2012

The safety of thyroid operations mainly depends on complete anatomical knowledge. Anatomical and ... more The safety of thyroid operations mainly depends on complete anatomical knowledge. Anatomical and embryological variations of the inferior laryngeal nerve (ILN), of the thyroid gland itself and unusual relations between ILN and the gland threaten operation security are discussed. The patient with toxic multinodular goiter is treated with total thyroidectomy. During dissection of the right lobe, the right ILN which has nonrecurrent course arising directly from cervical vagus nerve is identified and fully isolated until its laryngeal entry. At the operation, we observe bilateral Zuckerkandl's tubercles (ZTs) as posterior extension of both lateral lobes. The left ILN has usual recurrent course in the trachea-esophageal groove. The right ZT is placed between upper and middle third of the lobe points the nonrecurrent ILN. The coincidence of non-recurrent ILN pointed by a ZT is rare anatomical and embryological feature of this case. Based on anatomical and embryological variations, we suggest identification and full exposure of ILN before attempting excision of adjacent structures, like the ZT which has surgical importance for completeness of thyroidectomy.

Research paper thumbnail of Assessment of Anal Sphincter Function by Sengstaken-Blakemore Tube Anal Manometry

World Journal of Surgery, 2007

Anal manometry is a useful tool for testing the effectiveness of surgical treatment. However, mos... more Anal manometry is a useful tool for testing the effectiveness of surgical treatment. However, most techniques for anal pressure measurement are not easily available because of high cost. The aim of the present study was to introduce an easy and reproducible method for measuring anal pressures in testing the effectiveness of surgical procedures. We used a Sengstaken-Blakemore tube connected to a mercury manometer. After calibration of the system by inflating the distal (gastric) balloon and filling connection lines to the mercury manometer with 0.9% NaCl solution, resting and squeezing anal pressures were measured. The system was used on 50 human subjects (35 with anal fissure and 15 normal volunteers). Left lateral internal sphincterotomy had been performed in the anal fissure cases. Anal pressures were measured preoperatively and on postoperative days (POD) 2 and 20. Preoperative resting anal pressures in the group with anal fissure (83.4 +/- 1 mmHg) were significantly higher than those in the group of normal individuals (52 +/- 1.2 mmHg; p = 0.001). Resting anal pressures after the sphincterotomy (29 +/- 1 mmHg) were found to be significantly lower on POD 2, and resting anal pressure measurements (47 +/- 1 mmHg) on POD 20 were lower than the corresponding preoperative values. These values are closer to those of normal volunteers (p = 0.016). Anal manometry can be performed with this easily constructible and inexpensive system. This reproducible method can be used in the assessment of the results of surgical treatment in patients with anal and perianal diseases.

Research paper thumbnail of Does the approach to the groin make a difference in hernia repair?

Hernia, 2007

Background Laparoscopic and open preperitoneal hernia repair techniques both use the preperitonea... more Background Laparoscopic and open preperitoneal hernia repair techniques both use the preperitoneal space. This study investigated whether the surgical approach to the inguinal canal affects outcome measures. Methods One hundred sixty patients with inguinal hernia were assigned randomly into open anterior , open preperitoneal (39), laparoscopic transabdominal preperitoneal (39), and laparoscopic total extraperitoneal (40) groups according to the surgical method. The peroperative serum tumor necrosis factor-a (TNF-a) levels, interleukin-6 (IL-6) levels, VAS scores at 6 and 48 h, per-and postoperative complications, and recurrence rates were determined as main variables. Results The serum IL-6 levels were 335 ± 1.8, 283 ± 1.8, 283 ± 1.4, and 269.3 ± 1.6 pg/ml in the open anterior, posterior, transabdominal preperitoneal, and total extraperitoneal groups, respectively (P < 0.01). The TNF-a levels were highest in the open anterior group. The pain scores were lower in groups undergoing the posterior approach than in the open anterior approach group. Conclusion The approach to the inguinal canal through the preperitoneal space appears to be less invasive than the transinguinal anterior approach.

Research paper thumbnail of Should We Consider Topical Silver Nitrate Irrigation as a Definitive Nonsurgical Treatment for Perianal Fistula?

Diseases of the Colon & Rectum, 2014

Research paper thumbnail of Healing–promoting effect of bombesin treatment on chronic gastric ulcer in rats

Regulatory Peptides, 2002

To evaluate whether bombesin treatment has a facilitatory effect on the healing of chronic gastri... more To evaluate whether bombesin treatment has a facilitatory effect on the healing of chronic gastric ulcer, following the induction of ulcer by serosal application of acetic acid, rats were given bombesin (30 Ag/kg/day; subcutaneously) or vehicle three times a day for 7, 14 or 21 days until they were decapitated. Neither food intake nor gastric emptying rate in either vehicle-treated or bombesin-treated groups was not statistically different from control rats. Similarly, ulcer indices and gastric myeloperoxidase (MPO) activities at the first and second weeks of injury were not different among the groups. However, in the 3-week ulcer group, bombesin treatment reduced tissue MPO level significantly back to control levels. Moreover, the analysis of the surface epithelium by scanning electron and light microscopy demonstrated a significant reduction in the severity of ulcers by bombesin treatment. Pretreatment with CCK antagonists (L-364,718 or L365,260; 25 Amol/kg/day) before bombesin treatment showed that neither of the CCK antagonists had a significant effect on the bombesin-mediated healing process, suggesting that CCK receptors are not involved in the action of bombesin. In accordance with the previous studies that show its acute gastroprotective effects, bombesin is also effective in promoting the healing process of chronic gastric ulcer in rats. D

Research paper thumbnail of Low incidence of deep venous thrombosis after laparoscopic cholecystectomy

Journal of Hepato-Biliary-Pancreatic Surgery, 1995

ABSTRACT The effects of the increased intraabdominal pressure that occurs during laparoscopic cho... more ABSTRACT The effects of the increased intraabdominal pressure that occurs during laparoscopic cholecystectomy and the effects of the reverse Trendelenburg position adopted for the procedure on deep venous thrombosis (DVT) were investigated prospectively. Thirty patients who underwent laparoscopic and 13 who underwent open cholecystectomy for symptomatic cholelithiasis were investigated for postoperative DVT. Lower extremity venous blood flow was examined by color Doppler ultrasonography before and after operations. Thrombus formation was not found in the femoral, popliteal, or iliac veins of any of the patients who underwent either open or laparoscopic cholecystectomy. None of the patients in either group displayed signs of DVT or pulmonary embolus. We concluded that the incidence of DVT does not increase with laparoscopic cholecystectomy.

Research paper thumbnail of Effect of sex steroids on colonic distension-induced delay of gastric emptying in rats

Journal of Gastroenterology and Hepatology, 2004

The objective of the present study was to examine the effect of gonadal hormones on gastric motor... more The objective of the present study was to examine the effect of gonadal hormones on gastric motor response to non-noxious and noxious stimuli of colonic distension. Methods: Male Wistar albino rats were used. Under ketamine anesthesia some rats underwent castration (n = 24), while the rest of the rats were sham-operated (n = 67) and divided into different groups (n = 7-8 per group). On the 15th day of surgery, liquid gastric emptying studies were commenced. Results: Non-noxious (P < 0.05) or noxious (P < 0.01) colonic distension inhibited gastric emptying rate. Estradiol pretreatment (20 mg/kg per day, for 5 days, s.c.) inhibited gastric motility, while estradiol pretreatment or castration of the rats prior to noxious distension prevented the delay in gastric emptying. In contrast, blockade of testosterone receptors had no effect on the delay in gastric emptying induced by either modes of distension.

Research paper thumbnail of Clinical assessment of spinal and epidural anesthesia in inguinal hernia repair

Journal of Anesthesia, 2002

The current study was done to compare the effect of spinal and epidural anesthesia on surgical ou... more The current study was done to compare the effect of spinal and epidural anesthesia on surgical outcome measures of inguinal herniorrhaphy. Ninety-eight male patients undergoing inguinal hernia repair were randomized to either spinal (SA; n = 39) or epidural (EA; n = 59) anesthesia groups anesthetized with either glycosylated bupivacaine (20 mg) or 0.5 % bupivacaine (100 mg). Anesthesia onset time (AOT), postoperative stand-up time (SUT), first pain sensation time (FPT), operation time (OT), analgesic requirement (AR), hospital stay (HS), visual analogue scores of pain (VAS), per- and postoperative complications, and postanesthesia complications were recorded and compared with each other. FPT was 6.6 +/- 0.6 h and 3.1 +/- 0.4 h and OT was 40 +/- 2 min and 33.1 +/- 1 min in the EA and SA groups, respectively (p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). SUT was also longer in EA group. VAS scores at 12 and 24 h were significantly higher in the EA group (28 +/- 4 mm and 24 +/- 5 mm in EA and 16 +/- 4 and 5 +/- 1 mm in SA; P &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). No statistically significant difference was found between the SA and EA groups with respect to the other outcome measures that were considered. Spinal and epidural anesthesia show some differences from each other with respect to outcome measures such as OT, SUT, FPT, and 12- and 24-h VAS scores.

Research paper thumbnail of Estradiol Treatment Ameliorates Acetic Acid-Induced Gastric and Colonic Injuries in Rats

Inflammation, 2000

To evaluate the role of estrogen treatment on the healing of acetic acid-induced gastric or colon... more To evaluate the role of estrogen treatment on the healing of acetic acid-induced gastric or colonic injury, rats were given 17β estradiol benzoate (0.001, 0.1, and 10 mg/kg) or vehicle for 7 days (following the induction of ulcer) or 4 days (following the induction of colitis) until they were decapitated. Food intake and fecal output were decreased by estradiol treatment but gastric emptying rate was not changed. Estradiol (10 mg/kg) reduced gastric ulcer index and colonic damage score compared to vehicle-treated groups. SEM and light microscopy demonstrated a significant reduction in the severity of ulcers and colitis by estradiol treatment. Gastric microscopic score was not changed by estradiol treatment, whereas in the colonic tissue score was significantly reduced. Elevated gastric MPO levels were reduced in gastric but not in colonic tissues as compared with corresponding vehicle groups. In conclusion, exogenous estradiol treatment at pharmacological doses improves the healing of both gastric and colonic injury induced by acetic acid in rats.

Research paper thumbnail of Does l-carnitine have any effect on cold preservation injury of non-fatty liver in the University of Wisconsin solution?

Hepatology Research, 2007

To evaluate the protective effect of l-carnitine on liver tissue preserved in University of Wisco... more To evaluate the protective effect of l-carnitine on liver tissue preserved in University of Wisconsin (UW) solution. Twenty Wistar Albino rats were divided into two groups, a control (UW) group and a UW plus l-carnitine group. Retrieved liver grafts were preserved in UW and UW plus l-carnitine solutions at +4 degrees C. Preservation solution samples were assessed at 2, 24, 36, and 48 h to measure alanine aminotransferase and acid phosphatase activity. Tissue injury was scored on paraffin sections. No micro or macrovacuolar fat droplets were observed in the tissue slices. l-Carnitine effectively decreased enzyme release when added to UW solution (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). In addition to fatty liver, l-carnitine might be a metabolic adjunct in preservation solutions for non-fatty liver within UW solution.

Research paper thumbnail of Gastric functions in portal hypertension

Digestive Diseases and Sciences, 1996

Page 1. Digestive l)iseases attd Sciences. Vol. 41, No. 3 (March I996), pp. 585-590 Gastric Funct... more Page 1. Digestive l)iseases attd Sciences. Vol. 41, No. 3 (March I996), pp. 585-590 Gastric Functions in Portal Hypertension Role of Endothelin (3MER GONAL, MD, CUMHUR YEGEN, MD, A. OZDEMIR AKTAN, MD, RIFAT YALIN, MD, and BERRAK (~. YEGEN, MD ...

Research paper thumbnail of Appendicular mass imitating a malignant cecal tumor on f18-FDG PET/CT study: a case report

Cases Journal, 2009

Fluoro-Deoxy-Glucose Positron Emission Tomography/Computerized Tomography scan is a very useful m... more Fluoro-Deoxy-Glucose Positron Emission Tomography/Computerized Tomography scan is a very useful method in the diagnosis and follow-up of gastrointestinal malignancies, although it may cause confusion in differential diagnosis.

Research paper thumbnail of Malignant Mesenchymal Tumor of the Breast: Primary Chondrosarcoma

Breast Care, 2009

Zusammenfassung Hintergrund: Primäre mesenchymale Tumoren der Brust sind äußerst selten. Fallberi... more Zusammenfassung Hintergrund: Primäre mesenchymale Tumoren der Brust sind äußerst selten. Fallbericht: Eine 52 Jahre alte Frau stellte sich mit einem schnell wachsenden Tumor der Brust vor. Die klinische Untersuchung bestätigte eine große und runde Wucherung mit gleichmäßigen Rändern im oberen äußeren Quadranten der rechten Brust. Ultraschall zeigte einen echoarmen, festen Tumor (41 36 mm) mit lobulären Konturen. Die Mammografie ließ eine verhältnismäßig gleichmäßig geformte Wucherung mit erhöhter Dichte erkennen, die einen gutartigen Tumor vermuten ließ. Die pathologische Untersuchung eines Feinnadelaspirationsbiopsates ergab jedoch untypische Zellen und indizierte eine chirurgische Exzision. Der Tumor wurde durch lokale Exzision im Gesunden entfernt. Die histopathologische Analyse ergab ein hochgradig malignes Chondrosarkom der Brust. Aufgrund der endgültigen Diagnose und da dieser Tumor üblicherweise nicht strahlenempfindlich ist, führten wir eine modifiziert radikale Mastektomie durch. Die regionalen Lymphknoten und das benachbarte Gewebe waren frei von Metastasen. Der Tumor war Östrogen-und Progesteron-Rezeptor-sowie HER2-negativ. Schlussfolgerung: Das Chondrosarkom neigt zu schnellem Wachstum. In der klinischen Untersuchung zeigt es sich als größere, runde Wucherung. Mammografie-und Ultraschallaufnahmen zeigen einen gleichmäßigen, runden Tumor mit komplexem Echosignal. Normalerweise greift er nicht auf benachbarte Strukturen über. Die chirurgische Entfernung stellt die einzige wirksame Behandlung dar.

Research paper thumbnail of Do not rush for surgery; stent placement may be an effective step for definitive treatment of initially unextractable common bile duct stones with ERCP

Surgical endoscopy, Jan 27, 2015

Endoscopically unextractable common bile duct stones may be challenging for the endoscopist. In t... more Endoscopically unextractable common bile duct stones may be challenging for the endoscopist. In this study, we investigated the rate of stone removal after the endoscopic insertion of a biliary stent in patients with common bile duct stones unextractable via ERCP. Records of patients with common bile duct stone/s who underwent ERCP at single center were retrospectively analyzed. Only patients with common bile duct stone/s who had a stent placed due to unyielding stone removal were eligible for inclusion into this study. Endoscopic biliary stents were placed in cases of unextractable stone. After a follow-up period, a second ERCP procedure was performed. Major outcomes were the rate of stent insertion because of unextractable bile duct stones, the rate of spontaneous stone passage and the rate of stone extraction after the endoscopic insertion of a biliary stent. A total of 66 (28 %) patients had a stent placed due to unyielding attempts for stone removal, and 43 patients were includ...