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Öğe Does Large Bowel Enema Reduce Septic Complications in Acute Pancreatitis?(CAHNERS PUBL CO, 1998) Şahin, Mustafa; Yol, Serdar; Çiftçi, Ersin; Baykan, Mahmut; Özer, Şükrü; Aköz, Mehmet; Yılmaz, Osman; Kuru, CüneytBACKGROUND: The source of septic complications in acute pancreatitis was unknown until recent years. The pathogenesis of bacterial translocation from the gut has been accepted as the main source of pancreatic or peripancreatic infection. This study was designed to investigate the role of large bowel enema during acute pancreatitis in preventing bacterial translocation. MATERIALS AND METHODS: Twenty-four Spraque-Dawley rats were used in this study. The rats were divided into two groups. Group I animals received biliopancreatic duct ligation plus colon cleansing by rectal enemas; group II animals received only biliopancreatic duct ligation. Rectal enemas were applied to the first group of animals three times, at 6, 24, and 48 hours after the operation using 10 cc sodium hydrogen phosphate solutions. All animals were sacrificed 72 hours later, and tissue samples were taken from mesenteric lymph nodes, pancreas, spleen, and liver for bacteriologic cultures via a midline laparatomy. Blood and cecum cultures were also prepared. RESULTS: positive mesenteric lymph node cultures were found in all 12 animals in group II but in only 3 of 11 animals of group I (P <0.05). Distant organ cultures were positive in 9 of group II, but the only infected distant organ culture found in group I was the positive liver culture (P <0.05). CONCLUSION: AS a result of this study, we. believe that large bowel enema can reduce the frequency of septic complications in acute pancreatitis by reducing bacterial translocation.Öğe Effect of Pedunculated Seromuscular Flap on Bursting Strength of Intestinal Anastomosis After Corticosteroid Treatment(Lippincott Williams & Wilkins, 2000) Yol, Serdar; Yol, Sinan; Tavlı, Şakir; Şahin, Mustafa; Özer, ŞükrüPURPOSE: This study was designed to investigate the protective effect of a pedunculated seromuscular flap on intestinal anastomosis after corticosteroid treatment. METHODS: Forty male Sprague-Dawley rats were divided into four groups, and all animals underwent intestinal anastomosis. Two groups, with or without seromuscular flap wrapping, received 5 mg cortisone acetate, and two groups received placebo (saline) preoperatively for 16 days. Anastomotic strength was defined as bursting pressure (in millimeters of mercury). The pedunculated seromuscular flap was prepared from a segment of intestine next to the anastomosis. intestinal bursting strength at the anastomotic site was measured at Postoperative Day 8. RESULTS: The anastomotic bursting strength was significantly lower in the steroid groups at Postoperative Day 8 (P < 0.01). The pedunculated seromuscular flap increased the strength of the anastomosis both in the steroid and control groups (P < 0.05). CONCLUSION: The adverse effect of corticosteroids on intestinal anastomoses may be prevented by a pedunculated seromuscular flap.Öğe The Effects of Different Suture Techniques on Wound Healing in Abdomibnal Wall Closure(2001) Şahin, Mustafa; Karademir, Mehmet; Özer, Şükrü; Avşar, Fatih Mehmet; Çağlayan, Osman; Aksoy, Faruk; Aktan, MuratPurpose: The aim this study was to investigate the effects of different suture techniques on the healing of abdominal wall wound. Materials and Methods: 24 male Wistar albino rats were included in this study. The rats were divided into two groups. A 4 cm midline laparatomy was performed after ketamine HCl anesthesia. In Group I, the incision was sutured with 4/0 polypropylene interruptedly and in Group II, the wound was closed with 4/0 polypropylene continuously. The skin was sutured with an interrupted 4/0 silk suture. Then 2 cc of blood was withdrawn for biochemical and hematological tests by cardiac puncture. All the rats were killed on the 7th postoperative day. Tensile strength were measured and tissue samples were taken for hydroxyproline measurements and histopathological evaluation. Meanwhile intraabdominal adhesions were recorded. Results: Tensile strength was 751±31 g in Group I and 622±28 g in Group II. The difference was significant (p<0.05). Hydroxyproline levels were 3.13±0.15 µg/mg tissue in Group I and 2.81±0.15 µg/mg tissue in Group II. The difference was significant (p<0.05). Intraabdominal adhesions were found in 3 rats in Group I and in 6 rats in Group II. There was a significant difference between the two groups regarding tissue fibroblast numbers (p<0.05). There was no significant difference between serological and hematological tests in the two groups. Conclusion: Closing the abdominal wall wound with the interrupted suture technique gave better results than with the continuous suture technique.Öğe The Effects of Different Suture Techniques on Wound Healing in Abdominal Wall Closure(2001) Şahin, Mustafa; Karademir, Mehmet; Özer, Şükrü; Avşar, Fatih Mehmet; Çağlayan, Osman; Aksoy, Faruk; Aktan, MuratPurpose: The aim this study was to investigate the effects of different suture techniques on the healing of abdominal wall wound. Materials and Methods: 24 male Wistar albino rats were included in this study. The rats were divided into two groups. A 4 cm midline laparatomy was performed after ketamine HCl anesthesia. In Group I, the incision was sutured with 4/0 polypropylene interruptedly and in Group II, the wound was closed with 4/0 polypropylene continuously. The skin was sutured with an interrupted 4/0 silk suture. Then 2 cc of blood was withdrawn for biochemical and hematological tests by cardiac puncture. All the rats were killed on the 7th postoperative day. Tensile strength were measured and tissue samples were taken for hydroxyproline measurements and histopathological evaluation. Meanwhile intraabdominal adhesions were recorded. Results: Tensile strength was 751±31 g in Group I and 622±28 g in Group II. The difference was significant (p<0.05). Hydroxyproline levels were 3.13±0.15 ?g/mg tissue in Group I and 2.81±0.15 ?g/mg tissue in Group II. The difference was significant (p<0.05). Intraabdominal adhesions were found in 3 rats in Group I and in 6 rats in Group II. There was a significant difference between the two groups regarding tissue fibroblast numbers (p<O.05). There was no significant difference between serological and hematological tests in the two groups. Conclusion: Closing the abdominal wall wound with the interrupted suture technique gave better results than with the continuous suture technique.Öğe Eksploratis laparotomi (Laparotomiiler nasıl yapılmalı?)(2006) Özer, Şükrü; Çakır, MuratIn this article the steps of laparotomy and important views are discussed. In these preceeding articles, we combined our personal opinions with my colleagues and teachers on this subject. All abdominal operations are diagnostic laparotomies. Abdominal exploration never replaces cautious clinical examination, appropriate lab. tests, endoscopy, radiology and modern imaging techniques. Laparotomy allows us to enter abdominal cavity but only shows us the outer side of the organs. Sterile USG probe must be ready at operation.Laparoscopy without prior endoscopy is not acceptable. You may have witnessed that some chronic pancreatitis patients are consultated to psychiatry. If an abdominal abcess is encountered while abdominal exploration it must be drained as soon as possible. In adults vertical incisions allows beter exploration. By laparoscopy colon wall can be examined better with colonsoscopy light's illumination. Neonatal obstruction is another special problem and diagnosed with clinical and radiological investigation. Supraumblical transvers incision is generally adviced and it is satisfying. Every surgeon encounters different indications for laparotomy.Öğe Foliküler adenom ile papiller karsinom ilişkisi(2011) Erikoğlu, Mehmet; Çolak, Bayram; Aksoy, Faruk; Çakır, Murat; Özer, ŞükrüAmaç: Foliküler adenomlar, tiroidin en yaygın neoplazmı olup kapsüllü ve genellikle soliter lezyonlardır. Bu çalışmamızda amacımız; kliniğimizde son beş yılda yapılmış tiroid ameliyatlarının içinde histopatolojik inceleme sonucu foliküler adenom gelen hastaları değerlendirmek ve papiller tiroid karsinomu ile foliküler adenom arasındaki ilişkiyi araştırmaktır. Hastalar ve Yöntem: Son 5 yılda Anabilim Dalımızda yapılan 1081 tiroid ameliyatı içinde, ameliyat sonrası patolojik inceleme sonucunda foliküler adenom saptanan 144 hasta değerlendirildi. Bulgular: Hastaların 104'ü (%72,2) kadın, 40'ı (%27,7) erkek idi. Ameliyat sonrası foliküler adenom saptanan hastaların patoloji raporları değerlendirildiğinde, 29 hastada (%20.1) foliküler adenom ile papiller karsinom birlikteliği tespit edildi. Foliküler adenom ile papiller karsinomun birlikte görüldüğü 29 hastanın 17' sinde (%59) foliküler adenom boyutu 3 cm' nin üzerinde, 12'sinde (%41) ise adenom boyutu 3 cm' nin altındaydı (p:0.058). Sonuç: Çalışmamızda patolojik incelemede foliküler adenom saptanan hastalarda papiller karsinomun sık görüldüğü tespit edildi. Bu nedenle foliküler neoplazi tespit edilmiş hastalarda eğer aynı ya da karşı tiroid lobunda da nodüller tespit edilmiş ise cerrahi tedavinin total tiroidektomi olması gerektiğini düşünmekteyiz.Öğe The impact of oral feeding on the severity of acute pancreatitis(CAHNERS PUBL CO, 1999) Şahin, Mustafa; Özer, Şükrü; Vatansev, Celalettin; Aköz, Mehmet; Vatansev, Hüsamettin; Aksoy, Faruk; Dilsiz, Alaattin; Yılmaz, Osman; Karademir, Mehmet; Aktan, MuratBACKGROUND: In the management of acute pancreatitis, oral feeding is prohibited and either enteral or parenteral feeding is commenced for the patients in an effort to not increase the secretion of the pancreatic enzymes. PURPOSE: This study was undertaken in an attempt to determine the impact of oral feeding on the severity of acute pancreatitis and to compare this impact with that of parenteral feeding. MATERIALS AND METHODS: Twenty-four female Sprague-Dawley rats were divided into two groups. In both groups, acute pancreatitis was induced by ligation of the main biliopancreatic duct. The rats in group I were fed orally and the rats in group II were fed parenterally, The rats were sacrificed at 48 hours, and blood samples were obtained from the heart upon exposure of the abdominal and thoracic cavities, The pancreas and the left lung were removed for histopathological examination, The levels of lactic dehydrogenase (LDH), serum glutamic oxaloacetic transaminase (SGOT), glucose, calcium and blood urea nitrogen, base deficit, partial oxygen pressure, leukocyte count, and hematocrit level among Ranson criteria and the level of amylase were measured, The pancreas and the lung were examined under a light microscope. RESULTS: The levels of LDH, SGOT, and calcium for the rats in group I were significantly higher when compared with the rats in group II (P <0.05), Similarly, the levels of amylase for the rats in group I were found to be higher when compared with the rats in group II, but the difference was not significant. Inflammatory changes observed in the pancreas were less severe whereas inflammatory changes observed in the lung were more severe for the rats in group I when compared with the rats in group II. CONCLUSIONS: The blood levels of the enzymes were adversely affected for the rats fed orally. In contrast, inflammatory changes observed in the pancreas were more severe for the rats fed parenterally, The study suggests that certain hormones released from the duodenum upon stimulation by oral nutrient intake lessens the severity of pancreatitis through protective effects on the pancreas, whereas the elevated levels of the enzymes cause endothelial damage resulting in destruction in distant organs such as the lung.Öğe The relation between follicular adenoma and papillary thyroid carcinoma [Foliküler adenom ile papiller karsinom ilişkisi](2011) Erikoğlu, Mehmet; Çolak, Bayram; Aksoy, Faruk; Çakır, Murat; Özer, ŞükrüPurpose: Follicular adenomas are the most common neoplasms of the thyroid. They are encapsulated and generally solitary lesions. The aim of this study was to assess those patients diagnosed as having follicular adenomas as a result of histopathological examinations during thyroid surgery in ourclinic over the last five years and to study the relationship between papillary thyroid carcinoma and follicular adenoma. Patients and Method: Of the1081 thyroid operations in the last 5 years, 144 patients who were diagnosedwith follicular adenoma as a result of histopathological examination after surgery were assessed. Results: 104 of the patients (72.2%) were female and40 (27.7%) were male. When the pathological reports of the patients diagnosed with follicular adenoma were considered, 29 patients (20,1%) also had papillary carcinoma. (p:0.058). Conclusion: In our study, we commonly detected accompanying follicular adenoma with papillary carcinoma. Because of this, in patients with a diagnosis of follicular neoplasm we consider that surgical treatment should be a total thyroidectomy if there are nodules determined in the same or opposite thyroid lobe.Öğe Tiroidektomi sonrası geç komplikasyonlar ve nüks(1998) Şahin, Mustafa; Karahan, Ömer; Özer, Şükrü; Çiftçi, Ersin; Bilici, Sami; Paksoy, Yahya; Eryılmaz, M. AkifAmaç: Bu çalışma tiroidektomilerden sonra ortaya çıkan geç komplikasyonlarm sıklığını belirlemek için yapıldı. Yöntem: S.Ü.Tıp Fakültesi Genel Cerrahi kliniğinde 1990-1996 yılları arasında tiroidektomi uygulanan 339 hasta çalışmaya alındı. Hastaların TSH, Ta, T/tve serum kalsiyum değerleri tayin edildi. Bütün hastalar indirekt laringoskopi ve ultrasonografi ile değerlendirildi. Bulgular: Hastaların % 15'inde hipotiroidi, % 5.6'smda nüks, % 4.1'inde hipokalsemi ve % 2.4'ünde vokal kord paralizisi belirlendi. Toplam komplikasyon oranı % 27.1 olarak bulundu. Sonuç: Komplikasyonlardan kaçınmak için operasyon endikasyonunun iyi belirlenmesi, hasta için en uygun operasyonun yapılması, nervus laryngeus inferiorun gözlenmesi ve hormon replasmanı yapılması gerektiği kanaatine varıldı.Öğe Whole Gut Washout Ameliorates the Progression of Acute Experimental Pancreatitis(Excerpta Medica Inc, 2000) Yol, Serdar; Özer, Şükrü; Aksoy, Faruk; Vatansev, CelalettinBACKGROUND: Septic complications are mainly responsible for deterioration of a patient with acute pancreatitis. Intestinal tract is accepted as the main source of pancreatic or peripancreatic infection. MATERIAL AND METHODS: Acute pancreatitis was induced in 40 Sprague-Dawley rats by ligation of the main biliopancreatic duct. Animals were divided into two groups. The first group of animals (n = 20) received high volume polyethylene glycol-3500 (GoLYTELY) for 6 hours through a silastic catheter introduced into the proximal part of the jejunum from a puncture gastrostomy during the initial laparotomy. The second group animals (n = 20) did not receive any treatment. Half of the animals from each group were sacrificed 72 hours later and tissue samples were taken from mesenteric lymph nodes, pancreas, spleen, and liver for bacteriologic cultures. Cecum cultures were also prepared. Blood samples at 72 hours were obtained for the measurement of amylase, lactic dehydrogenase (LDH), lactic acid, alanine aminotransferase (ALT), glucose, calcium, arterial pH, base excess, partial oxygen pressure, bicarbonate, leucocyte count, and hematocrit levels. The pancreas was examined histopathologically. The remaining half of the animals from each group were allowed to survive until death. RESULTS: The levels of amylase, LDH, ALT, lactic acid, pH, pO(2), bicarbonate and base excess for the rats in group I were significantly lower when compared with the rats in group II (P <0.05). Positive mesenteric lymph node cultures were detected in 30% of group I animals whereas they were positive in 90% of group II animals (P = 0.0198). Distant organ cultures were positive in 8 animals (liver 5, spleen 2, pancreas 1) in group II, whereas only one positive distant organ culture (liver) was established in group I (P >0.05). Histopathological scoring observed in the pancreas were less severe for the rats in group I when compared with the rats in group II (P = 0.012). The rats in group I survived longer than the rats in group II (median survival 6.8 days versus 17.3 days, P <0.001). CONCLUSIONS: Whole gut washout with high-volume polyethylene glycol in pancreatitis reduced the blood levels of enzymes and increased the survival. Whole gut washout for acute pancreatitis appears effective to ameliorate the prognostic factors in blood and this modality may be a promising treatment method in acute pancreatitis.
