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Öğe Changes in cerebral oxygen saturation with the Trendelenburg position and increased intraabdominal pressure in laparocopic rectal surgery(Turkish Surgical Assoc, 2022) Alkan, Selman; Cakir, Murat; Senturk, Mustafa; Varman, Alper; Buyukbezirci, Gulcin; Yildirim, Mehmet Aykut; Bicer, MehmetObjective: Position changes and increased intra-abdominal pressure in laparoscopic interventions lead to some physiopathological changes. There is no definite information in the literature regarding cerebral oxygen saturation in patients undergoing colorectal surgery. Our aim was to investigate whether there is oxygen saturation change in the brain tissue in pneumoperitoneum and the Trendelenburg position during laparoscopic rectal surgery. Material and Methods: Cerebral oxygen saturation was measured in 35 patients who underwent laparoscopic rectal surgery in the Trendelenburg position. Measurements were made under general anesthesia in the pneumoperitoneum and the Trendelenburg position. Results: The values that are statistically affected by the position are systolic blood pressure, mean arterial blood pressure and cerebral oxygen saturation. The Trendelenburg position does not disturb the cerebral oxygen saturation and it causes an increase in saturation. After pneumoperitoneum occurred, changes in systolic blood pressure, mean arterial blood pressure and brain oxygen saturation were detected. Cerebral oxygen saturation increases with the formation of pneumoperitoneum. Conclusion: The Trendelenburg position and increased intraabdominal pressure during laparoscopic rectal surgery do not impair brain oxygen saturation.Öğe Clinical Evaluation of Acute Pancreatitis Caused by SARS-CoV-2 Virus Infection(Hindawi Ltd, 2021) Vatansev, Hulya; Yildirim, Mehmet Aykut; Kuccukturk, Serkan; Karaselek, Mehmet Ali; Kadiyoran, CengizIntroduction. Coronavirus 2019 disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has spread to more than 200 countries worldwide. We aimed to present acute pancreatitis (AP) cases caused by SARS-CoV-2 viral infection. Methods. The study was conducted retrospectively between April 2020 and June 2020 in Necmettin Erbakan University Meram, Medical Faculty Hospital, and 150 hospitalized patients diagnosed with COVID-19 were included. The degree of acute pancreatitis was determined according to the Atlanta classification. Organ failures of the patients were evaluated in terms of respiratory, cardiovascular, and nephrology according to the modified Marshall scoring (MMS) system, and CTSI (Balthazar score) and Imrie score were determined. Modified Marshall score >= 2 was considered organ failure. Results. A total of 29 patients were diagnosed with acute pancreatitis. All 29 patients with pancreatitis had respiratory failure during hospitalization. After the diagnosis of pancreatitis, there was no change in respiratory failure. According to the Atlanta classification, 19 patients had mild AP and 10 patients had moderate AP. Patients with acute pancreatitis were scored according to the CTSI (Balthazar score), and there were no patients with >= 6 severe pancreatitis. The CTSI score of 4 patients was 3. In addition, the Imrie score of the patients was determined and 8 patients with Imrie score >= 3 were identified. Conclusion. The rate of pancreatic damage in SARS-CoV-2 infection was found to be 19% (n=29) in our study. In our study, we highlight acute pancreatitis as a complication associated with COVID-19 and the importance of pancreatic evaluation in patients with COVID-19 and abdominal pain is demonstrated.Öğe Clinicopathologic and Surgical Characteristics Study of 151 Cases of GIST(Springer, 2021) Senturk, Mustafa; Yildirim, Mehmet Aykut; Cakir, Murat; Kisi, OmerBackground Gastrointestinal stromal tumor (GIST) is the most appearing mesenchymal tumor of the gastrointestinal system. In this study, we are aiming to share the most up to date knowledge about diagnosis and treatment of these tumors by transferring our clinical experience about GISTs. Methods The 151 patients who were operated between 2006-2020 and whose pathological examination was reported as GIST were analyzed retrospectively. Demographic, clinical, and pathological features and treatment methods of patients were evaluated. Results Seeventy-six of the patients were women and 75 of them were men whose age averages were 66.1 (31-86). The most common location was the stomach (55.6%), followed by the small intestine, retroperitoneal, large intestine, rectum, esophagus, and another organ. With surgical intervention, 139 of them had been cured. Twelve of cases were accepted as inoperable. The diameter of tumors in our cases were between 0.4 cm and 35 cm. Determined mitotic activity was <= 5 in 71 patients and 5 < in 80 patients. In 8 of 12 unresectable cases, it has been seen that partial remission after the treatment of 12-month tyrosine kinase inhibitors, C-KIT, was positive in 96.7% of our cases. CD34 and Ki-67 was analyzed in patients. CD34 was found positive in 98 (64.9%) of them, Ki-67 was positive in 82 (54.3%) patients. Patients had been observed for 40 months. Conclusion Despite GISTs are not appearing frequently, nowadays they have started to be seen more frequently than before with the growing present-day diagnostic methods. The ideal treatment is performing radical resection without leaving any tumor cells behind. Tyrosine kinase inhibitors have an important place in unresectable cases.Öğe Clinicopathological Characteristics of Gastroenteropancreatic Neuroendocrine Tumors 10 Years of Experience From a Single Center(Lippincott Williams & Wilkins, 2022) Senturk, Mustafa; Acar, Berkan; Yildirim, Mehmet Aykut; Cakir, Murat; Kucukkartallar, Tevfik; Vatansev, CelalettinObjectives Gastorenteropancreatic neuroendocrine (GEP-NET) tumors are the second most common tumors of the gastrointestinal tract. We aimed to investigate the clinicopathological features and factors affecting the prognosis of patients with GEP-NET. Methods Clinicopathological features of 158 patients were evaluated, including tumor location, TNM stage and grade, pathological features, presence of lymph nodes and distant metastases at the time of diagnosis, maximum tumor diameter and treatment details. Also, follow-up information was analyzed to discover possible prognostic factors. Results The most common primary site is pancreas (45.6%, n = 72). Most of the GEP-NETs were nonfunctional (93.6%, n = 148). Of the 158 patients, 94 (59.5%) were grade 1, 46 (29.1%) grade 2, and 18 (11.4%) grade 3. The 1-year, 3-year, and 5-year survival rates were 82.3% (130/158), 61.4% (70/114), and 47.2% (35/74), respectively. In multivariate analysis, histological grade (P = 0.04) and TNM stage (P < 0.001) were independent prognostic factors for survival in patients with GEP-NET. Conclusions They are increasing in frequency and are the most common tumors in the pancreas. Nonfunctional tumors made up the majority of cases. The main treatment was surgical resection. Histological grade and TNM stage are independent prognostic factors.Öğe 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 Comparison of the efficacy of growth factor collagen and antibiotic collagen on colon anastomosis in experimental animals with peritonitis(Springer India, 2021) Yildirim, Mehmet Aykut; Cakir, Murat; Findik, Siddika; Kisi, Omer; Senturk, MustafaIntroduction In spite of advances in surgical techniques, the significance of anastomosis leak continues in colorectal surgery. There is no ideal method in spite of all studies and technical advances in this field. Our aim of this study was to use fibroblast growth factor collagen (FGF-C) and antibiotic collagen (AB-C) to increase the rate of anastomosis healing in experimental animals with peritonitis. Methods This animal experimental study received ethics committee approval. The animals were divided into three groups of seven animals each; the first group was control, the second group was the fibroblast growth factor collagen group, and the third group was the antibiotic collagen group. Under anesthesia, more than 50% of the colonic lumen was opened 4-5 cm distal to the ileocecal junction to create a defect. Twenty-four hours later, primary anastomosis was performed. The second group had the anastomosis line covered with a cover containing FGF-C. The third group had the anastomosis line covered by material containing AB-C. The experiment was concluded on the postoperative 7th day, and the anastomosis burst pressure, tissue hydroxyproline level, and histopathological assessment were performed. Results Though the burst pressure was higher in the experimental groups, it was not statistically significant. In the second and third groups, vascular proliferation and fibroblastic activity appeared to be better than in the control group. Hydroxyproline values were statistically significant in the experimental groups compared to the control group. Conclusion FGF-C and AB-C may have potential utility in anastomosis healing, especially in those susceptible to infection due to anastomosis leak.Öğe Comparison of two different techniques in emergency surgery of colon diverticulitis: Hartmann's procedure and resection with primary anastomosis(Wiley, 2022) Senturk, Mustafa; Celik, Abdulkadir; cakir, Murat; Yildirim, Mehmet Aykut; Belviranli, Mehmet MetinColon diverticula may require emergency or elective surgery depending on its complications. Our aim is to compare the Hartmann's procedure and resection with primary anastomosis in the patients with colon diverticulitis and to demonstrate the surgical approach of our clinic. Patients were evaluated retrospectively who were operated for colon diverticulitis between January 2010 and January 2020. The patients who underwent emergency surgery for left colon diverticulitis were divided into two groups as patients with primary anastomosis resection (group 1) and Hartmann's procedure (group 2) and the groups were compared. In the aspect of the development of complications there was no remarkable difference between the groups (P = .56). Postoperative early mortality rate was similar in two groups (P = .12). According to the Hinchey classification, 31.7% of the cases were stage I, 9.8% were stage II, 31.7% were stage III, and 26.8% were stage IV. There was not a distinction in morbidity and mortality rates between Hartmann's procedure and resection with primary anastomosis. The best surgical approach should be determined by considering the operation to be performed, the patient's preferences, clinical status, and the predicted results of the surgical treatment of perforated diverticulitis.Öğe Effects of Tumor Volume on Lymph Node Involvement and Prognosis at Stage pt3 Colon Cancers(Springer India, 2022) Senturk, Mustafa; Ozer, Halil; Celik, Abdulkadir; Yildirim, Mehmet Aykut; Cakir, Murat; Vatansev, CelalettinSome studies showed that the increase of tumor size has a negative effect on survival in colon cancers. Our study aims to assess the effects of tumor volume on lymph node positivity and prognosis in stage pT3 colon cancers. All patients who underwent surgery for colon cancer in our clinic were evaluated retrospectively. The study included 213 patients who were diagnosed with colon adenocarcinoma and reported as pathologic. Preoperative abdomen computed tomography scans were used for measurements of tumor volume. Tumor volumes were compared according to the pathological lymph node involvement. Cut-off values were determined with ROC analysis. The cases were divided into groups according to the determined cut-off value and data compared. Mean tumor volume was found to be higher in the lymph node-positive group (p=0.01). The higher number of removed lymph nodes and lymph node positivity was detected more in cases that were above the cut-off value (p=0.003 and p=0.004, respectively). The mean survival time was 37.3 +/- 1.3 months. There was no correlation between tumor volume and the overall survival time (p=0.21). According to data comparison of the lymph node positivity, Kaplan-Meier analysis showed that the increase of the N stage reduces the 5-year survival rate (for the N0, N1, N2 stages, 60%, 52%, 35%, respectively). Tumor volume is correlated with lymph node involvement. It has been shown that increasing the N stage has a negative effect on prognosis. Our study showed that tumor volume has no significant impact on survival but may have an indirect effect on prognosis.Öğe Internal Herniation Due to Appendix Vermiformis Rotation: A Rare Case of an Acute Abdomen(Modestum Ltd, 2012) Erikoglu, Mehmet; Yildirim, Mehmet AykutInternal herniation is a rare occurrence that appears in about 0.2-0.9% of autopsy cases. An 84-year-old female patient presented to our clinic with severely distended the abdomen. Abdominal examination revealed tenderness and rebound mainly in the right side of the abdomen. Following the laparatomy it was observed that the appendix vermiformis was about 12 cm in length and was adhered to the cecum having rotated around itself at 360 degrees. It was also seen that a terminal ileum loop of about 30 cm. had penetrated into the appendix forming a circle having rotated around itself and that this segment was ischemic and a portion was perforated for a length of 1 cm. Further, this rotation had also affected the cecum which showed ischemic changes. A right hemilectomy and segmenter small bowel resection were performed. There were no problems during the follow-ups the patient was discharged on the tenth postoperative day. Although there are several reports detailing various kinds of internal herniation published in literature.Öğe Lifestyle and Chronic Constipation in Medical Students(Hindawi Ltd, 2021) Yildirim, Mehmet Aykut; Cakir, Murat; Bicer, Mehmet; Senturk, Mustafa; Yonar, Harun; Gur, Merve Nur; Akiner, Zeliha NurAim. Constipation is one of the most common complaints of the digestive system indicated with an increase in defecation frequency, difficulty in defecation, and hard and strained defecation. Environmental, personal, and genetic factors may be affecting constipation although the affecting factors have not yet been thoroughly explained. The aim of this study was to investigate constipation frequency and lifestyles in medical students. Method. The population was selected among medical students for the study, which was planned as a survey study. Demographic data of all the participants and the factors suggested to affect constipation were questioned and analyzed. Results. The study covered a total of 425 medical students. Among the students reporting constipation, 2.86% were in their first year of medical school, while 7.53% were in the third year and 9.09% were in the sixth year. The rate of students reporting constipation and familial history was statistically significant. While regular eating habits were reported in the first and third years, this rate was much lower in the sixth year group working at clinical departments. The results of our study did not reveal any significant relationship between daily intake of water and constipation. There was, however, a significant relationship between stress and constipation. Conclusion. The results of our study showed that medical education did not curb constipation frequency. We believe that stress is significant in constipation. The data we collected indicate that regular eating habits and excess liquid intake are not as effective as suggested in the treatment of constipation.Öğe Liver metastasis in colorectal cancer: evaluation of segmental distribution(Termedia Publishing House Ltd, 2019) Kadiyoran, Cengiz; Cizmecioglu, Hilal Akay; Cure, Erkan; Yildirim, Mehmet Aykut; Yilmaz, Pinar DiydemIntroduction: It is known that the liver is the main target for metastasis in colorectal cancer. However, we do not know enough from the literature to describe the segmental distribution of liver metastatic lesions of colorectal cancers. Aim: To investigate which liver segment is affected. Material and methods: A total of 326 patients (female/male, n = 115/221; age: 53 +/- 8/51 +/- 7 years) were included in our study, classified according to their pathological diagnosis. After liver metastases of the patients were determined, they were divided according to Couinaud classification. Results: While the total number of metastases detected in the right lobe was 691 (70.1%), the number of metastases detected in the left lobe was 294 (29.9%), and the difference was highly significant (p < 0.0001). Metastases in the right lobe anterior segment amounted to 279 (40.4%), and metastasis in right lobe posterior segment was 412 (59.6%), and the difference was significant. When the total number of metastatic lesions is evaluated by excluding segment I, the largest number of lesions were observed in segment VIII. The liver segments with the highest number of metastatic lesions were, respectively, VII, IV, VI, V, III, and II. In this case, the fewest metastatic lesions were observed in segment II. Conclusions: Liver metastases of colorectal cancer are more common in the right lobe than in the left lobe. The right lobe posterior segment (segment VI) is the main target of metastases.Öğe Non-surgical acute traumatic perianal injuries(Turkish Surgical Assoc, 2019) Yildirim, Mehmet Aykut; Cakir, MuratObjective: The diagnosis of fecal incontinence is challenging and complex. One of the most significant causes of fecal incontinence is trauma in the perianal area. The most important cause of such trauma is birth trauma. It is hard to evaluate patients and plan treatment. Surgical method is determined by the severity of sphincter damage and injuries formed in the organs in the perianal area. The aim of this study, therefore, was to analyze the cases of patients who had undergone sphincter repair because of acute injuries in the perianal area. Material and Methods: The cases of 15 patients with perianal area injuries who had presented to Necmettin Erbakan University Meram Medical School's General Surgery Clinic between 2010 and 2015 were retrospectively analyzed. Data on age, sex, form of injury, severity of injury, time of first response, form of repair, injury problems, and post-operative complications of the patients were investigated. The patients' long-term results were analyzed. Results: While 5 of the patients were male, 10 were female. 9 of the female patients had birth trauma, while one had injury during sexual intercourse. While all of the patients received sphincteroplasty, 10 had levatoroplasty. All the female patients received vaginoplasty. Conclusion: We are of the opinion that it is significant to have surgical intervention before tissue edema develops.Öğe Reasons for transition to open surgery in laparoscopic cholecystectomy(Bayrakol Medical Publisher, 2021) Senturk, Mustafa; Cakir, Murat; Bicer, Mehmet; Yildirim, Mehmet AykutAim: Laparoscopic cholecystectomy is a minimally invasive surgical technique that has become widespread since the 1980s. Many factors are effective in the conversion to open surgery. This study aimed to investigate the rates and reasons for the conversion to open in laparoscopic cholecystectomy surgeries in our hospital. Material and Methods: This study aimed to examine 3263 cholecystectomy cases with the conversion to open during surgery between June 2014 and June 2019. Patients were examined in terms of age, sex, comorbidities, acute cholecystitis attack status, previous surgery, adhesion, gallbladder wall thickness, revealing surgical anatomical structure, surgical complications, length of hospital stay, and mortality. The results were evaluated statistically. Results: Data of 70 patients, who were performed laparoscopic cholecystectomy with the conversion to open surgery during the procedure, were reviewed. The conversion rate was 2.3%. Among the patients, 28 were female and 42 were male. Sixty-two of the patients had an episode of acute cholecystitis. The most common reason for the conversion was that the anatomy could not be revealed . Discussion: It should be kept in mind that laparoscopic cholecystectomy surgery, which is interpreted as a simple surgical procedure, can always be converted to an open surgery and there may be vital complications.Öğe Role of thiol-disulfide hemostasis in early diagnosis of acute mesentery ischemia: An experimental study(Turkish Assoc Trauma Emergency Surgery, 2022) Yildirim, Mehmet Aykut; Kocabas, Rahim; Kilinc, Ibrahim; Simsek, Gurcan; Senturk, Mustafa; Cakir, Murat; Belviranli, MetinBACKGROUND: Acute mesenteric ischemia (AMI) is a rarely observed acute abdominal disease that may be mortal and is difficult to diagnose early. The aim of our study is to assess the role of Thiol-Disulphide Haemostasis (TDH), a new method for AMI which still has no specific biochemical markers for early diagnosis, and to assess it together with Ischemia-Modified Albumin (IMA) which METHODS: The study included 32 Wistar albino rats in four groups. The 1st group (n=8) was the control group, 2nd group (n=8) was the sham group, 3rd group (n=8) had 3 h of arterial mesentery ischemia and the 4th group (n=8) had 6 h of arterial mesentery ischemia. RESULTS: In the 3rd and 6th h, serum total thiol and native thiol values significantly reduced (p<0.001), while serum disulfide, IMA, and lactate values clearly increased (p<0.001). Serum thiol values were observed to reduce from the 1st h. CONCLUSION: TDH changes in the early period of AMI. The TDH parameters can be used with IMA as diagnostic parameters for patients with suspected AMI in the early period.Öğe Role of thiol-disulfide hemostasis in early diagnosis of acute mesentery ischemia: An experimental study(Turkish Assoc Trauma Emergency Surgery, 2022) Yildirim, Mehmet Aykut; Kocabas, Rahim; Kilinc, Ibrahim; Simsek, Gurcan; Senturk, Mustafa; Cakir, Murat; Belviranli, MetinBACKGROUND: Acute mesenteric ischemia (AMI) is a rarely observed acute abdominal disease that may be mortal and is difficult to diagnose early. The aim of our study is to assess the role of Thiol-Disulphide Haemostasis (TDH), a new method for AMI which still has no specific biochemical markers for early diagnosis, and to assess it together with Ischemia-Modified Albumin (IMA) which METHODS: The study included 32 Wistar albino rats in four groups. The 1st group (n=8) was the control group, 2nd group (n=8) was the sham group, 3rd group (n=8) had 3 h of arterial mesentery ischemia and the 4th group (n=8) had 6 h of arterial mesentery ischemia. RESULTS: In the 3rd and 6th h, serum total thiol and native thiol values significantly reduced (p<0.001), while serum disulfide, IMA, and lactate values clearly increased (p<0.001). Serum thiol values were observed to reduce from the 1st h. CONCLUSION: TDH changes in the early period of AMI. The TDH parameters can be used with IMA as diagnostic parameters for patients with suspected AMI in the early period.Öğe Stent Applications for Palliative Treatment in Advanced Stage Esophageal Cancers(Hindawi Ltd, 2021) Senturk, Mustafa; Cakir, Murat; Yildirim, Mehmet Aykut; Kisi, OmerBackground and Aim. Endoscopic stenting is a generally safe and effective palliative treatment for esophageal malignancies. In this study, we aimed to present endoscopic stent applications, adverse events, and relative advantages of covered versus uncovered stents in our center. Methods. We examined cases of endoscopic stenting for palliative treatment of advanced stage esophageal cancers between January 2014 and July 2019. Age, gender, location of mass, adverse events, survival time, and stent type were evaluated. Outcomes of fully covered and uncovered self-expanding stents were compared with regard to adverse events, including stent migration and occlusion. Results. The mean age of the patients was 66.4 +/- 1, 52 were male, and 8 were female. Patients were followed up for a mean of 133 days. The most common complication due to stenting was migration. 13 patients developed adverse events. Migration was the most common adverse event, occurring in 8 (13%) patients. Although the migration rate of fully covered stents was higher than uncovered stents, there was no statistically significant difference (p=0.47). Stent occlusion was observed in 4 patients. In three cases, it was due to the tumor; an uncovered stent was placed again in these cases. Food-related occlusion developed in one patient. There was no statistical difference in terms of overall adverse event rate when comparing fully covered stents to uncovered stents (p=0.68). Conclusion. Endoscopic stenting is a viable palliative method with low morbidity and mortality in experienced centers. Though there are relative advantages with covered versus uncovered stents in individual cases, the overall adverse event rate is low and relatively similar.Öğe Use the bipolar forceps in thyroid surgery(Excerpta Medica Inc-Elsevier Science Inc, 2018) Yildirim, Mehmet Aykut; Kartal, Adil; Belviranli, Metin; Simsek, Gurcan[Abstract Not Availabe]
