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Öğe 2003-2011 Yılları arasında meram tıp fakültesi organ nakli merkezinde yapılan böbrek nakli olgularının sonuçları(2013) Türkmen, Kültigin; Erdur, Fatih Mehmet; Gaipov, Abduzhappar; Yeksan, Mehdi; Selçuk, Nedim Yılmaz; Türk, Süleyman; Erikoğlu, Mehmet; Çolak, Bayram; Tekin, Ahmet; Tonbul, Halil Zeki; Tavlı, ŞakirAMAÇ: Son dönem böbrek yetmezliği (SDBY) hastalarında en iyi tedavi şekli böbrek naklidir. Çalışmamızda, son 8 yılda merkezimizde kadavra ve canlıdan yapılan böbrek nakillerinin(BN) demografik verileri ile birlikte böbrek fonksiyonları ve posttransplant medikal komplikasyonları, hasta- graft sağkalımını araştırmayı hedefledik. GEREÇ ve YÖNTEMLER: Çalışmaya 40ı kadavradan, 26sı canlıdan BN yapılan 66 hasta (kadın/ erkek: 36/30) dahil edildi. Nakil sonrası nefroloji polikliniğine başvurularda yaş, cinsiyet, böbrek yetmezliği nedeni, diyaliz türü-süresi, nakil türü, aldıkları indüksiyon tedavileri, kullandığı idame immünsupresif tedaviler, akut rejeksiyon sayısı ve verilen tedaviler, nakil sonrası 1., 6., 12., 24. ve 60. aylardaki biyokimya-hemogram parametreleri ve medikal komplikasyonlar hasta dosyalarından retrospektif olarak elde edildi. BULGULAR: Alıcıların ortalama yaşı 4111,6 yıldı. Ortalama nakil sonrası süre 32,231,4 ay, kreatinin değerleri 1,40,9 mg/dl tespit edildi. En sık uygulanan immünsüpresif tedavi protokolü ko rtikosteroidtakrolimusmikofenolat mofetil/sodyumdu. Gecikmiş graft fonksiyonu, kronik allograft disfonksiyonu ve akut rejeksiyon oranları sırasıyla %27,3, %25,7 ve %13,6 idi. 1 ve 5 yıllık hasta sağkalımı canlıdan yapılan BNlerinde sırasıyla %100 ve %100, kadavradan yapılan BNlerinde ise %85 ve %85 olarak bulundu. 1 ve 5 yıllık graft sağkalımı canlıdan BN yapılanlarda sırasıyla %100 ve %100, kadavradan BN yapılanlarda ise %80 ve %80 olarak saptandı. En sık görülen medikal komplikasyonlar yeni gelişen diyabet ve dislipidemiydi. Erken ve geç dönemde en sık karşılaşılan enfeksiyon idrar yolu enfeksiyonuydu. SONUÇ: BN, hasta-graft sağkalımının yüksek olduğu bir renal replasman tedavi seçeneğidir. Bununla birlikte metabolik komplikasyonlar açısından yakın takip gereklidir.Öğe Akut Mide Dilatasyonuna Bağlı Mide Nekrozu ve Perforasyonu(2014) Gündeş, Ebubekir; Küçükkartallar, Tevfik; Tekin, Ahmet; Çakır, MuratAkut gastrik dilatasyon ilk olarak 1833 yılında Duplay tarafından tarif edilmiştir. Biz akut mide dilatasyonuna bağlı mide nekrozu ve perforasyonu saptanan 55 yaşındaki bir erkek hastayı literatür eşliğinde sunmak istedik. Mide nekrozu ve perforasyonu oldukça nadir görülür, çünkü mide zengin bir kan dolaşımına sahiptir. Klinik olarak olguların %90'ından fazlasında kusma şikayeti mevcuttur. Tanıyı ve etyolojiyi ortaya koymada bilgisayarlı tomografi önemlidir. Peritonit bulguları olmayan ve endoskopide nekroz gelişmemiş hastalarda medikal tedavi yararlı olabilir. Cerrahi tedavide geç kalınan olgularda mortalite oranı yüksektirÖğe Bile duct ischemia developing after reconstruction of the hepatic artery during the Whipple operation(2015) Çakır, Murat; Küçükkartallar, Tevfik; Tekin, Ahmet; Tuncer, Fatma Betül; Kartal, AdilA pancreaticoduodenectomy is a surgical procedure with a high morbidity and mortality rate. The injury of the hepatic artery may occasionally lead to intraoperative bleeding. Repair of the injured hepatic artery is of great importance in terms of maintaining the vascular supply of the liver. We report a case with an injury of the hepatic artery that was successfully reconstructed with the gastroduodenal artery and then developed a biliary leak due to bile duct ischemia at an early stage. A 33-year-old women complaining of right upper quadrant pain was found to have a solid pseudopapillary tumor of the pancreas. She underwent an immediate pancreaticoduodenectomy, and her hepatic artery was injured during the operation. The arterial ends were sutured with primary anastomosis, because they could be aligned without any tension. The biliary leak occurred on postoperative day 2. We detected bile duct ischemia and reanastomosed the artery. The patient was discharged on postoperative day 8. Surgeons should be prepared for anomalies of the peripancreatic vascular structures during pancreaticoduodenectomy. Computed tomography angiography should be considered to reveal these anomalies before the surgery. Insufficiency of the biliodigestive anastomosis due to bile duct ischemia in the postoperative period should be kept in mind, even in cases of successful repair.Öğe Çok arterli böbrek nakilleri: Erken dönem sonuçlarımız(2012) Erikoğlu, Mehmet; Çolak, Bayram; Tekin, Ahmet; Küçükkartallar, Tevfik; Tavlı, ŞakirAmaç: Böbrek nakli için kullanılan organlarda en sık rastlanan anomali renal arterin sayısal anomalileridir. Çalışmamızda amacımız, kliniğimizde yapılan renal transplantasyon olgularında tespit ettiğimiz arter anomalilerini literatür eşliğinde değerlendirmektir. Gereç ve Yöntem: Hastaların 5’i kadın (%39), 8’i erkek (%61), yaş ortalaması 43.7 (22-73), ortalama takip süresi 30.5 ay (4-90) idi. Hastalardan 7’sine kadavradan, 6’sına canlıdan nakil yapılmıştı. On iki hastada çift, 1 hastada üç renal arter mevcuttu. Altı hastada arterler ex vivo pantolon tarzı yan yana rekonstrüksiyon yapılarak geniş tek arter haline getirildi ve eksternal iliyak artere uç-yan anastomoz yapıldı. Çok küçük alt polar arteri olan bir hasta da alt polar arter bağlandı. Bir hastada arterler ayrı ayrı in situ anastomoz yapıldı. Üç arteri olan hastada üst arterler pantolon tarzı anastomoz yapılarak eksternal iliyak artere uç-yan, alt polar arter ise A. epigastrika inferior’a uç uca anastomoz edildi. Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, Konya, Türkiye Dr. Mehmet Erikoğlu E-posta: [email protected] Makale Geliş Tarihi: 18.05.2012 Makale Kabul Tarihi: 24.11.2012 Bu çalışma 12-16 Ekim 2011 tarihlerinde Antalya'da yapılan TONKKD VIII. Kongresi'nde poster olarak sunulmuştur. Bulgular: Dört hastada (%30.7) gecikmiş greft fonksiyonu, 1 hastada biyopsi ile doğrulanmış (%7.6) akut rejeksiyona rastlandı. Postoperatif dönemde 3 hastada müdahale gerektirmeyen lenfosel, 1 hastada cilt altı enfeksiyonu ve 1 hastada da perirenal hematom tespit edildi. Cilt altı enfeksiyonu antibiyotik tedavisi ile düzeldi. Perirenal hematom saptanan hastada hematom kendiliğinden rezorbe oldu. Sonuç: Çoklu renal arteri olan böbreklerin nakil işleminde kullanılması teorik olarak bazı riskleri de beraberinde getirmektedir. Uzamış soğuk ve sıcak iskemi süresi nedeniyle akut tübüler nekroz, gecikmiş greft fonksiyonu ve rejeksiyon daha sık görülebilmektedir. Çoklu renal arterlerde ex vivo pantolon anastomoz yaparak geniş ve tek bir renal arter anastomozunun vasküler komplikasyon riskini azaltabileceğini düşünmekteyiz.Öğe Comparison of mammography sensitivity after reduction mammoplasty targeting the glandular and fat tissue(2015) Çakır, Murat; Küçükkartallar, Tevfik; Tekin, Ahmet; Selimoğlu, Nebil; Poyraz, Necdet; Belviranlı, Mehmet Metin; Kartal, AdilAmaç: Meme küçültme cerrahisi geçiren kadınların meme kanseri teşhis ve taramasında mamografinin bazı sınırlılıkları vardır. Bu çalışmada postoperatif değişikliğe bağlı meme dokusunda gelişen yapısal bozuklukların mamografiye nasıl yansıdığını araştırmayı amaçladık.Gereç ve Yöntemler: Meme küçültme operasyonu geçiren ve genel cerrahi kliniği tarafından meme kanseri taraması amacıyla mamografi çekilmesi istenen hastaların dosyaları retrospektif olarak incelendi. Hastaların yaş, cerrahi işlem, postoperatif takip süresi, çıkarılan doku miktarı, histopatolojik ve mamografik bulguları değerlendirildi. Hastalar 3 grupta incelendi: 40 yaş üzerinde glandüler doku ağırlıklı redüksiyon mammoplasti uygulanan (1. grup), 40 yaş altında yağ dokusu ağırlıklı redüksiyon mammoplasti uygulanan (2. grup) ve 40 yaş üstünde meme hipertrofisi tanısı almış ve opere edilmeyen (3. grup) hastalardan oluşmaktadır.Bulgular: Hastaların ortalama takip süresi 6 yıldı. Çıkarılan ortalama doku miktarı 1. grupta 1120 gr (6802070), 2. grupta 1220 gr idi. Ameliyat yaş ortalaması 1. grupta 45 , 2. grupta 35 idi. Histopatolojik incelemede tüm gruplar benigndi. Birinci grup hastaların tamamı BIRADS 1-2, 2. grup hastaların 28'i BIRADS 1-2, 4'ü BIRADS 3 ve 8'i BIRADS 0 idi. Üçüncü grup hastaların 35'i BIRADS 1-2, 4'ü BIRADS 3 ve 1'i BIRADS 0'dı.Sonuç: Kırk yaş üzeri hastalarda glandüler doku ağırlıklı meme küçültme cerrahisi uygulanmasının mamografi duyarlılığını artırdığı kanısındayızÖğe Comparison of primary repair and repair with polyglycolic acid coated tube in recurrent laryngeal nerve cuts (an experimental study)(Excerpta Medica Inc-Elsevier Science Inc, 2020) Senturk, Mustafa; Cakir, Murat; Tekin, Ahmet; Kucukkartallar, Tevfik; Yildirim, Mehmet Aykut; Alkan, Selman; Findik, SiddikaBackground: Recurrent laryngeal nerve (RLN) injury is an important complication of thyroid surgery. In our study, we aimed to compare the effects of primary repair and polyglycolic acid (PGA) coated tube repair on nerve function and regeneration in RLN cuts in rats. Methods: Twenty seven rats were used for the study. Group-1 with only nerve cuts, group-2 with primary repair, and group-3 with conduit repair. The study was planned over two-stage surgery. In the first step, nerve defect formation and nerve repair were performed in the same session. In the second step, samples were taken from the subjects for histopathological. Results: Vocal cord mobility was proportionally higher in group-3 than other groups. However, there was no statistically significant difference between the groups (p < 0.239). The mean number of highest axons were detected the group-3. Conclusions: We think that PGA coated conduit can provide a more accurate orientation of nerve fibers by creating an isolated environment when compared to the primary repair. And this may be the cause of functional improvement in the nerve. (C) 2019 Elsevier Inc. All rights reserved.Öğe Concurrent unilateral or bilateral native nephrectomy in kidney transplant recipients(Int Scientific Literature, Inc, 2013) Dinckan, Ayhan; Kocak, Huseyin; Tekin, Ahmet; Turkyilmaz, Serdar; Hadimioglu, Necmiye; Ertug, Zeki; Gunseren, FilizBackground: The aim of this study is to present results of patients who have undergone renal transplantation concurrent with bilateral or unilateral native nephrectomy, with a special focus on polycystic kidney disease (PKD). Material/Methods: We presented the outcome of renal transplantation patients who have undergone native nephrectomy unilaterally (n = 38) and bilaterally (n = 125) and compared the results of patients with PKD and other nephrectomy indications. Results: Overall graft survival in the 1st, 3rd, and 5th years were 93%, 90%, and 89%, respectively, in transplantation with concomitant nephrectomy patients. Overall patient survival in the 1st, 3rd, and 5th years were 97%, 94%, and 94%, respectively. Overall surgical complications rate was 17.7% and medical complication rate was 19%. Patients with PKD had more frequent complications. Conclusions: Despite additional surgery, the long-term results of patients with complications were not affected negatively by early diagnosis and treatment. We believe that native nephrectomy concurrent with transplantation can be successfully performed when indicated in selected patients at experienced centers.Öğe Does endoscopic retrograde cholangiopancreatography have a negative effect on laparoscopic cholecystectomy?(2015) Çakır, Murat; Küçükkartallar, Tevfik; Tekin, Ahmet; Yıldırım, Mehmet Aykut; Kartal, AdilObjective: We have observed that patients who had undergone endoscopic retrograde cholangiopancreatography (ERCP) had some difficulties with laparoscopic cholecystectomy procedures. Through a retrospective study, we planned to compare the surgical procedures between patients who had undergone ERCP and those who had not in order to clarify this.Material and Methods: The results of 122 patients who had undergone ERCP because of choledocholithiasis before undergoing laparoscopic cholecystectomy procedures between 2008 and 2011 were compared to the values of 2140 patients operated because of cholelithiasis only within the same period.Results: Among the patients who underwent surgical procedures following ERCP, 80 (65%) were female and 42 (35%) were male. The average age of the patients was 51.9 years (range: 20-83 years). The operation period after the procedure was 30.14 days (range: 1-93 days). Although the hospitalization period was 4.67 days (range: 1-22 days), the postoperative hospitalization period was 2.68 days (range: 1-15 days). Regarding the difficulty of operation, adhesion in 58 (47.5%) patients, bleeding in two (1.6%) patients, and conversion to open procedure in 12 (9.8) patients were observed. In two (1.6%) patients, bleeding and biliary fistula were the reasons for re-operation.Conclusion: Laparoscopic cholecystectomy is more complicated in patients who underwent ERCP.Öğe An easy way to put the spleen into the bag(Termedia Publishing House Ltd, 2013) Cakir, Murat; Tekin, Ahmet; Kartal, Adil; Tuncer, Fatma BetulIntroduction: Splenectomy is a therapeutic and diagnostic procedure used in a wide range of situations. Laparoscopic splenectomy has become the gold standard in some hematological diseases. The laparoscopically removed spleen is placed into a surgical bag, a step which is sometimes the most time-consuming part of the operation. Aim: To present the method that we employed in laparoscopic splenectomy to place the specimen into the bag and extract it in an easier and simpler way Material and methods: The proximal part of the splenorenal ligament is left undivided in the size of one LigaSure cut length to use as a stalk while placing the spleen into the surgical bag. The bag is advanced from the inferior pole of the spleen toward the superior pole. Only keeping the bag open is sufficient to place the spleen into the bag. Results: Recently, me started to put the spleen into the bag easily before cutting upper attachment of the spleen laparoscopically. So far we applied this procedure in more than eleven cases without complication. Conclusions: Splenectomy is now the gold standard in the treatment of hematologic diseases that are resistant to medical treatment or that are not amenable to medical treatment because of its complications. Through our experience, the method that we describe here easily overcomes one of the most unpleasant parts of laparoscopic splenectomy.Öğe Effectiveness of collagenase in preventing postoperative intra-abdominal adhesions(Elsevier Science Bv, 2013) Cakir, Murat; Tekin, Ahmet; Kucukkartallar, Tevfik; Yilmaz, Huseyin; Belviranli, Metin; Kartal, AdilIntroduction: The purpose of this study is to investigate the effectiveness of Collagenase clastridiopeptidase an enzyme preparation used in enzymatic debridement in preventing adhesions brought about by peritoneal damage. Methods: The study covers a total of 40 rats in 4 groups each having 10 rats. Group 1: The control group. Group 2: Normal saline group. Group 3: Sterile Novuxol (R) group. Group 4: The group where the intraperitoneal and systemic effects of sterile Novuxol (R) were investigated. Adhesion frequency and grades were scored on the post-op 11th day according to Granat. Blood work including hemoglobin, aspartate aminotransferase, alanine aminotransferase, urea, creatinine, and albumin level measurements were performed. Toxicity was investigated histopathologically through samples taken from the liver and the peritoneum from Group 4. Results: Adhesion frequency was found to be 80% on the right and 90% on the left for Group 1, while it was 50% on both left and right for Group 2, and 30% on the right and 10% on the left for Group 3. Adhesion stages were found to be 1: 2.35 +/- 1.42 for Group 1, 0.31 +/- 1.15 for Group 2, and 0.20 +/- 0.41 for Group 3. Adhesion stage of the Sterile Novuxol (R) Group was lower than all the other groups (p < 0.05). Biochemical and hematological parameters were similar in all groups (p > 0.05). Histopathological analysis revealed no hepatotoxicity. Conclusions: According to the results of our study, we believe that Sterile Novuxol (R) can be a good anti-adhesive agent considering its ease of use, non-toxicity, and effectiveness. (C) 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.Öğe The effects of flavanoid on the treatment of hepatopulmonary syndrome(Korean Surgical Society, 2013) Atalay, Talha; Cakir, Murat; Tekin, Ahmet; Kucukkartallar, Tevfik; Kargin, Suleyman; Kartal, Adil; Kaynak, AdnanPurpose: Hepatopulmonary syndrome is an arterial oxygenation disorder brought about by advanced liver failure and pulmonary vascular dilatations. The reason why hypoxia develops in hepatopulmonary syndrome depends on the broadening of perialveolar capillary veins. Our study aims to investigate the effects of Flavanoid on hepatopulmonary syndrome through its inhibition of nitric oxide. Methods: Three groups, each having 8 rats, were formed within the scope of our study. Group I (the control group) only received laparatomy, group II received choledoch ligation, and group III was administered Flavanoid (90% flavonoid diosmin, 10% flavonoid hesperidin) following choledoch ligation. The rats were administered Flavanoid at week two following choledoch ligation. The rats' livers and lungs were examined histopathologically following a five-week follow-up and the perialveolar vein diameters were measured. Arterial blood gases and biochemical parameters were evaluated. Results: It was seen that fibrosis and oxidative damage in the liver with obstructive jaundice as well as hypoxia with pulmonary perialveolar vein sizes were significantly lower than the other group with cirrhosis formed through the administration of Flavanoid. Conclusion: We have concluded that Flavanoid administration might be useful in the treatment of hypoxia in hepatopulmonary syndrome and the delay of cirrhosis contraction.Öğe Enzymatic Debridement in Necrotizing Pancreatitis(Int College Of Surgeons, 2015) Cakir, Murat; Tekin, Ahmet; Kucukkartallar, Tevfik; Vatansev, Husamettin; Kartal, AdilMultiple organ failure and pancreatic necrosis are the factors that determine prognosis in acute pancreatitis attacks. We investigated the effects of collagenase on the debridement of experimental pancreatic necrosis. The study covered 4 groups; each group had 10 rats. Group I was the necrotizing pancreatitis group. Group II was the collagenase group with pancreatic loge by isotonic irrigation following necrotizing pancreatitis. Group III was the collagenase group with pancreatic loge following necrotizing pancreatitis. Group IV was the intraperitoneal collagenase group following necrotizing pancreatitis. The progress of the groups was compared hematologically and histopathologically. There was no difference among the groups regarding the levels of leukocyte, hemogram, and urea. The differences in AST levels between Group I and II; and differences in glucose, calcium, LDH, AST, and amylase between Group II and III; between Group II and IV; between Group I and III; and between Group I and IV were statistically significant (P < 0.05). There were statistically significant differences between Group II and III, and Group II and IV regarding edema, acinar necrosis, inflammatory cell infiltration, hemorrhage, and fat necrosis (P < 0.05). In conclusion, the collagenase preparation used in this experimental pancreatitis model was found to be effective in the debridement of pancreatic necrosis.Öğe Estimation of the capacity of emergency surgery in Konya: Nine-year multicenter study(2016) Küçükkartallar, Tevfik; Çakır, Murat; Tekin, Ahmet; Balasar, Mehmet; Kartal, Adil; Köksal, Hande; Erengül, Bülent; Türk, EminAmaç: Cerrahi acillerin sayısının sürekli artmasına rağmen acil cerrahi yatışları hakkında kısıtlı veri bulunmaktadır. Bu çok merkezli çalışmanın amacı, Konya şehrinde acil genel cerrahi sonuçlarını değerlendirmektir.Gereç ve Yöntemler: Konya'da tüm genel cerrahi acil başvurularının dokuz yıllık sonuçları incelendi (Ocak 2003Ocak 2012). Tüm demografik veriler istatistiksel olarak değerlendirildi.Bulgular: Konya'da yer alan 4 hastaneden 21954 hasta çalışmaya alınmıştır. Konya Numune Hastanesi (7154), Konya Eğitim ve Araştırma Hastanesi (6654), Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi (6400) ve Başkent Üniversitesi Konya Eğitim ve Araştırma Hastanesi (1390) verileri toplandı. Hastaların yaş ortalaması 59,6 ve ortalama hastanede kalış süresi 3,3 gündü. Hastaneye kabul edilen hastaların tanıları; akut apandisit (%59,57), bağırsak tıkanıklığı (%11,12), travma (%7,97), boğulmuş kasık fıtığı (%5,46), akut kolesistit (%4,87), peptik ülser perforasyonu (%4,09), mezenterik iskemi (%2,73), nekrotizan fasiit (%2,73), gastrointestinal sistem kanaması (%1,79) ve diğerleriydi (%1,1).Sonuç: Bu çalışma ile cerrahi kabullerin sürekli arttığı görülmüştür. Non-travmatik akut karın, genel cerrahi acillerinin en sık nedeniydi. Yaşlı hastaların sayısında artış olmasına rağmen, hastanede kalış süresi ve mortalite oranları azalmıştır.Öğe Experiences of Single Incision Cholecystectomy(Ivyspring Int Publ, 2013) Yilmaz, Huseyin; Alptekin, Husnu; Acar, Fahrettin; Ciftci, Ilhan; Tekin, Ahmet; Sahin, MustafaPurpose: Single incision laparoscopic surgery in suitable cases is preferred today because it results in less postoperative pain, a more rapid recovery period, more comfort, and a better cosmetic appearance from smaller incisions. This study aims to present our experiences with single incision laparoscopic cholecystectomy to evaluate the safety and feasibility of this procedure. Methods: A total of 150 patients who underwent single incision laparoscopic cholecystectomy between January 2009 and December 2011 were evaluated retrospectively. In this serial, two different access techniques were used for single incision laparoscopy. Results: Single incision laparoscopic cholecystectomy was performed successfully on 150 patients. Median operative time was 29 (minimum-maximum=5-66) minutes. Median duration of hospital stay was found to be 1.33 (minimum-maximum=1-8) days. Patients were controlled on the seventh postoperative day. Bilier complication was not seen in the early period. Five patients showed port site hernia complications. Other major complications were not seen in the 36-month follow-up period. Conclusion: Operation time of single incision laparoscopic cholecystectomy is significantly shortened with the learning curve. Single incision laparoscopic cholecystectomy seems a safe method.Öğe Gastric necrosis and perforation caused by acute gastric dilatation(Aves, 2014) Gundes, Ebubekir; Kucukkartallar, Tevfik; Tekin, Ahmet; Cakir, MuratAcute gastric dilatation was first defined by Duplay in 1833. We herein present the case of a 55-year-old male patient diagnosed with gastric necrosis and perforation caused by acute gastric dilatation. Since the stomach has a rich blood circulation, necrosis and perforation are rarely seen. Clinically, more than 90% of cases have complaints of vomiting. The most useful method in revealing the diagnosis and aetiology is computerized tomography. Medical treatment is appropriate for cases where no necrosis and peritonitis findings are detected through endoscopy. Delays in surgical treatment increase the risk of mortality.Öğe Gelişme geriliğine sebep olan superior mezenterik arter sendromu(2013) Taşcı, Halil İbrahim; Çakır, Murat; Tekin, AhmetSuperior mezenterik arter sendromu duodenum üçüncü kısmının aorta ve süperior mezenterik arter proksimal kısmı arasında basıya uğraması sonucu ortaya çıkan, nadir görülen ve yaşamı tehdit eden bir klinik tablodur. Bu bası kronik aralıklı, akut total ya da parsiyel obstrüksiyona yol açabilir. Ani gelişen kilo kaybı ve buna bağlı yağ dokuda azalma akut daralmanın etyolojik sebebi olarak kabul edilmektedir. Kilo kaybı ile birlikte giden bulantı, kusma, anoreksi, epigastrik ağrı ve şişkinlik başlıca yakınmalardır. Tanıda baryumlu grafiler, bilgisayarlı tomografi, konvansiyonel anjiografi, tomografik ve manyetik rezonans anjiografi kullanılmaktadır. Tedavide medikal ve cerrahi yaklaşımlar mevcuttur. Bu yazıda tanısı geciken superior mezenter arter sendromlu bir olguyu sunmayı amaçladıkÖğe Hepatocellular Carcinoma Recurring in the Opposite Lobe Nine Years After Regular Right Hepatectomy(Modestum Ltd, 2014) Simsek, Gurcan; Kartal, Adil; Tekin, AhmetA recurrence was detected in the remaining left lobe of a patient who underwent regular right hepatectomy 9 years ago because of HCC (hepatocellular carcinoma). Left lateral segmentectomy was performed on the patient. Following right and left hepatectomies, the patient survives with hyperthrophied segment IV. We think that the FHCC (fibrolamellar HCC) that recurred in the opposite lobe 9 years after is a secondary primary tumor. The patient received no adjuvant therapy after the second resection and no recurrences were seen in the remaining segment IV during the 36-month follow-up.Öğe Hepatocellular Carcinoma Recurring in the Opposite Lobe Nine Years After Regular Right Hepatectomy(Modestum Ltd, 2014) Simsek, Gurcan; Kartal, Adil; Tekin, AhmetA recurrence was detected in the remaining left lobe of a patient who underwent regular right hepatectomy 9 years ago because of HCC (hepatocellular carcinoma). Left lateral segmentectomy was performed on the patient. Following right and left hepatectomies, the patient survives with hyperthrophied segment IV. We think that the FHCC (fibrolamellar HCC) that recurred in the opposite lobe 9 years after is a secondary primary tumor. The patient received no adjuvant therapy after the second resection and no recurrences were seen in the remaining segment IV during the 36-month follow-up.Öğe İleal poş deneyimlerimizin literatür eşliğinde incelenmesi(2015) Çakır, Murat; Doğan, Serhat; Küçükkartallar, Tevfik; Tekin, Ahmet; Tekin, ŞakirAmaç: Restoratif proktokolektomi günümüzde ülseratif kolit ve FAP hastalığında kullanılan sfinkter koruyucu seçkin bir tedavidir. Kliniğimizde yapılan ileal poşlu girişimleri ve sonuçlarını literatür eşliğinde irdelemeyi amaçladık.Gereç ve Yöntemler: Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi'nde 2006-2013 yılları arasında yapılan 35 restoratif proktokolektomi ve J poş ileoanal anastomoz ameliyatlarının sonuçları retrospektif olarak hastaların dosyalarından incelendi. Hastalar yaş, cinsiyet, hastanede kalış süresi, tanı, takip süresi ve poş komplikasyonlarına göre değerlendirildi. Tüm hastalara telefonla ulaşıldı ve kontrol için poliklinik randevusu verildi.Bulgular: Hastaların 19'u erkek (%54) ve 16'sı kadın (%46) idi. Ortalama yaş 45 idi. Ortalama hastanede kalış süresi 11 gündü. Hastaların 22'si (%63) FAP, 12'si (%34) senkron rektum kanseri ile birlikte kolon tümörü veya polibi ve 1'i (%3) ülseratif kolit nedeniyle ameliyat edildi. Tüm hastalara J poş ve koruyucu ileostomi uygulandı. İleostomi kapatıldıktan sonra iki olguda J poş fistülü tespit edildi. Hastalar 6 ay ile 7 yıl arasında takip edildi. Olgulara telefonla ulaşılıp aktif şikâyetleri, defekasyon sayısı üriner ve cinsel disfonksiyonları soruldu. Ortalama günde 5 dışkılama olduğu, 4 (%11) olguda 1 defa olan gece dışkılaması tespit edildi. Yapılan endoskopik kontrol incelemesinde poşit tespit edilmedi.Sonuç: Restoratif proktokolektomi ve J poş ileoanal anastomoz ameliyatı ileri yaş dâhil düşük morbidite ve mortalite oranları ile uygulanabilir bir cerrahi prosedürdür.Öğe Ileosigmoidal knotting, an unusual form of acute intestinal obstruction(Wiley, 2015) Cakir, Murat; Tekin, Ahmet; Kucukkartallar, Tevfik; Kartal, AdilAimIleosigmoidal knotting is an unusual form of acute intestinal obstruction characterized by closed-loop obstruction of both ileum and sigmoid colon. We present 36 cases of ileosigmoidal knotting. MethodsA retrospective analysis was designed to examine preoperative, operative, and postoperative findings of the 36 patients with ileosigmoidal knotting who were surgically treated in Necmettin Erbakan University's Meram Medical Faculty (Konya, Turkey) throughout a 26-year period. ResultsThe mean age was 55 (range, 47-61) years. The most common symptoms were abdominal pain, distention, obstipation, and vomiting, and the most common signs were abdominal tenderness and distention. The preoperative diagnosis was acute obstructed bowel in all patients. After resuscitation, all patients underwent emergency laparotomy. The most common type of ileosigmoidal knotting was type IA, in which the active ileum encircled the passive sigmoid in a clockwise manner. There was gangrene in both ileum and sigmoid colon in all patients. All ischemic bowels including ileum and sigmoid colon were resected and the continuity was carried out using primary anastomosis or Hartmann's procedure. ConclusionsIleosigmoidal knotting is a rare disease but its preoperative diagnosis is difficult. In cases of knotting there is no form of conservative treatment. Resective surgery is absolutely necessary.
