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Öğe Foreign-body aspiration mimicking asthma in pre-school age group: A case report(2019) Ozbey, Mehmet Yavuz; Topal, Erdem; Ulutaş, Hakkı; Çelik, Muhammet RehaForeign-body aspiration mimicking asthma in pre-school age group: A case reportÖğe Hydatid cysts of the lung lesion size in relation to clinical presentation and therapeutic approach(Surg Today, 2014) Kuzucu, Akın; Ulutaş, Hakkı; Çelik, Muhammet Reha; Yekeler, ErdalPurposes The aim of this study was to assess the relationship between the pulmonary hydatid cyst size and the clinical presentation, surgical approach, and postoperative outcome. We review the problems encountered in treating large pulmonary hydatid cysts and highlight the risks associated with the rupture of the cyst and a delay of the surgical treatment. Methods The medical records of 169 patients surgically treated for lung hydatid cysts were reviewed. Patients were divided into two groups based on cyst size: group 1 (n = 128) with small (\10 cm) cysts and group 2 (n = 41) with giant (C10 cm) cysts. Data related to symptoms, preoperative complications, surgical procedures performed and postoperative morbidity were analyzed and compared. Results In both groups, the most common symptom was chest pain, followed by dyspnea and cough, respectively. There were no differences between the two groups with respect to cyst-associated parenchymal or pleural complications before surgery (p = 0.80). In the large majority of cases, the surgical treatment was cystotomy, removal of the cystic membrane and capitonnage. Wedge resection was performed in nine patients in total (seven in group 1, two in group 2) and one patient in group 2 required a lobectomy. Decortication was required significantly more frequently in group 2 than in group 1 (p = 0.001). Sixteen patients in group 1 and 10 patients in group 2 developed postoperative complications (p = 0.19). There was no peri or postoperative mortality. There was no difference between the groups with respect to the duration of hospitalization (p = 0.17). Two patients with complicated hydatid cysts in group 1 had recurrent lesions during follow-up, whereas there was no recurrence in group 2. Conclusion All pulmonary hydatid cysts should be surgically treated as soon as possible after their diagnosis in order to avoid complications. Most of these lesions, regardless of size, can be surgically managed with procedures that preserve the maximal lung parenchyma and yield excellent outcomes.Öğe Intrapleural fibrinolytic treatment management of 85 cases(Journal of Turgut Ozal Medical Center, 2015) Ulutaş, Hakkı; Çelik, Muhammet Reha; Kuzucu, AkınFibrous cortex developes over the lung in 7-10 days if the benign or malign pleural effusion consisting of blood, coagulum or empyema could not be drained. Thus, clinical conditions like trapped lung, restrictive lung disease, or dyspnea may appear as a result of fibrinous pleuritis. Both streptokinase and tissue plasminogen activator (tPA) are involved in the breakdown of proteins and fibrin. Hence, intrapleural fibrinolytic treatment (IPFT) may prevent invazive procedures by avoiding fibrous cortex develepment if it is applied at a proper time. Materials and Methods: Eighty five cases undergoing IPFT by tube or catheter thoracostomies between 2003-2013 are evaluated retrospectively. Patients have been evaluated according to age, symptoms, diagnosis, and response to treatment. Results: The mean age of the patients was 45.5 (65 males and 20 females). IPFT was performed in 30 patients with empyema, and in 20 and 13 patients due to postoperative or posttraumatic organised hematomas, respectively. Eleven patients underwent IPFT for loculated benign pleural effusions while 9 patients recieved the treatment for loculated malign pleural effusions. Complicated hydropneumothorax was the indication for IPFT in 2 patients. A total of sixty patients received tube thoracostomy while 25 patients underwent catheter thoracostomy. Tree patients had decortication and 4 underwent video assisted thoracoscopic (VATS) drainage due to failure of IPFT. Aseptic pleural space remained in 12 patients at the end of our study. One of the patients required blood transfusion and additional medical treatment for intrapleural hemorrhage secondary to the local absorption of the IPFT. Conclusion: IPFT is a safe, effective treatment which can be performed prior to much invasive surgical procedures in patients with loculated empyema, clotted hemothorax, or postoperative hematoma, and benign or malign pleural effusions which can not be drained due to high fibrinous contents.Öğe Intrapleural Fibrinolytic Treatment: Management of 85 Cases(2015) Kuzucu, Akın; Ulutaş, Hakkı; Çelik, Muhammet RehaAmaç: Komplike plevral efüzyonlarda sadece tüp ve katater torakostomi ile sıvıyı drene etmek her zaman mümkün olmaz. Dreneedilemeyen kan, pıhtı, ampiyem, benign veya malign plevral sıvılarda 7-10 gün içinde akciğer üzerinden fibröz bir kabuk oluşmaya başlar. Budurum ise tuzaklanmış akciğer ve akciğer restriksiyonu, sekonder ampiyem ve dispne ile sonuçlanır. Streptokinaz yada Tissue PlazminojenActivatörü (tPA), fibrin ve diğer bazı proteinleri parçalayarak etki etmekte olup uygun zamanda yapılan fibrinolitik tedavi ile bu süreçkesintiye uğratılıp, akciğer üzerinde fibröz kabuk gelişimi önlenerek hasta daha invaziv işlemlerden kurtarılabilir.Gereç ve Yöntemler: Bu çalışmada 2003- 2013 yılları arasında tüp yada kateter torakostomisi ile intraplevral fibrinolitik tedavi (IPFT)uygulanan 85 olgu retrospektif olarak incelendi. Olgular yaş, cinsiyet, semptom, tanı ve tedaviye yanıt açısından değerlendirildi.Bulgular: Olguların 65i erkek, 20si kadın, yaş ortalaması 45.5 idi. Otuz olguya ampiyem, 13 olguya travma sonrası gelişen organizehematom, 20 olguya postoperatif, 9 olguya malign plevral efüzyon, 11 olguya benign hastalıklara bağlı drene olmayan loküle plevralefüzyon ve 2 olguya hidropnömotoraks sonrası gelişen komplikasyonlar nedeniyle intraplevral fibrinolitik tedavi uygulandı. Olguların 25sinekateter torakostomi, 60 olguya tüp torakostomi uygulandı. Olguların 7sinde IPFT başarısız oldu, 4 olguya dekortikasyon, 3 olguya VATS(video-assisted thoracoscopic surgery) ile debridman uygulandı. Oniki olguda aseptik kısmi poş kaldı. Bir olguda lokal etkiye bağlı, kantransfüzyonu ve medikal tedavi ile kontrol altına alınan intraplevral kanama saptandı.Sonuç: Loküle ampiyemlerde, pıhtılı hemotoraks ve postoperatif organize hematomlarda, yoğun fibrinli, drenajı olmayan malign plevralefüzyon ve benign plevral efüzyonlarda daha invaziv cerrahi girişimlerden önce uygulanacak IPFT güvenli, etkili, başarısı yüksek, yan etkisi azbir uygulamadır.Öğe İntraplevral fibrinolitik tedavi uygulamaları: 85 olguluk seri sunumu(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2015) Ulutaş, Hakkı; Çelik, Muhammet Reha; Kuzucu, AkınAmaç: Komplike plevral efüzyonlarda sadece tüp ve katater torakostomi ile sıvıyı drene etmek her zaman mümkün olmaz. Drene edilemeyen kan, pıhtı, ampiyem, benign veya malign plevral sıvılarda 7-10 gün içinde akciğer üzerinden fibröz bir kabuk oluşmaya başlar. Bu durum ise tuzaklanmış akciğer ve akciğer restriksiyonu, sekonder ampiyem ve dispne ile sonuçlanır. Streptokinaz yada Tissue Plazminojen Activatörü (tPA), fibrin ve diğer bazı proteinleri parçalayarak etki etmekte olup uygun zamanda yapılan fibrinolitik tedavi ile bu süreç kesintiye uğratılıp, akciğer üzerinde fibröz kabuk gelişimi önlenerek hasta daha invaziv işlemlerden kurtarılabilir. Gereç ve Yöntemler: Bu çalışmada 2003- 2013 yılları arasında tüp yada kateter torakostomisi ile intraplevral fibrinolitik tedavi (IPFT) uygulanan 85 olgu retrospektif olarak incelendi. Olgular yaş, cinsiyet, semptom, tanı ve tedaviye yanıt açısından değerlendirildi. Bulgular: Olguların 65’i erkek, 20’si kadın, yaş ortalaması 45.5 idi. Otuz olguya ampiyem, 13 olguya travma sonrası gelişen organize hematom, 20 olguya postoperatif, 9 olguya malign plevral efüzyon, 11 olguya benign hastalıklara bağlı drene olmayan loküle plevral efüzyon ve 2 olguya hidropnömotoraks sonrası gelişen komplikasyonlar nedeniyle intraplevral fibrinolitik tedavi uygulandı. Olguların 25’sine kateter torakostomi, 60 olguya tüp torakostomi uygulandı. Olguların 7’sinde IPFT başarısız oldu, 4 olguya dekortikasyon, 3 olguya VATS (video-assisted thoracoscopic surgery) ile debridman uygulandı. Oniki olguda aseptik kısmi poş kaldı. Bir olguda lokal etkiye bağlı, kan transfüzyonu ve medikal tedavi ile kontrol altına alınan intraplevral kanama saptandı. Sonuç: Loküle ampiyemlerde, pıhtılı hemotoraks ve postoperatif organize hematomlarda, yoğun fibrinli, drenajı olmayan malign plevral efüzyon ve benign plevral efüzyonlarda daha invaziv cerrahi girişimlerden önce uygulanacak IPFT güvenli, etkili, başarısı yüksek, yan etkisi az bir uygulamadır.Öğe Primary idiopathic chylopericardium presenting with cardiac tamponade(Herz, 2014) Karakurt, Cemşit; Çelik, S. F.; Çelik, Muhammet Reha; Elkıran, .Özlem; Ulutaş, Hakkı; Kuzucu, AkınChylopericardium generally occurs after thoracic surgery or trauma. Primary idiopathic chylopericardium is an extremely rare condition especially in children and young adults. In recent years, a few case reports have been published on primary idiopathic chylopericardium due to lymphatic leak and fistula into the pericardium [1, 2, 3]. In this report, we described a 4-year-old boy with primary idiopathic chylopericardium presenting as cardiac tamponade.Öğe Pulmonary pseudocyst secondary to blunt or penetrating chest trauma clinical course and diagnostic issues(European Journal of Trauma and Emergency Surgery, 2015) Ulutaş, Hakkı; Çelik, Muhammet Reha; Özgel, Mehmet; Soysal, Ömer; Kuzucu, AkınPurpose Traumatic pulmonary pseudocysts (TPPs) are rare complications of chest trauma. The aim of this retrospective study was to report the clinical presentations, diagnosis, complications and treatment for a series of TPPs at a hospital in Turkey. Methods The charts of 996 patients who were admitted for thoracic trauma between 1999 and 2012 were retrospectively reviewed. Fifty-two patients had TPPs, and the data collected for these individuals were sex, age, and type of trauma (blunt and/or penetrating). Univariate analysis of categorical data was performed using Pearson’s Chi square test. Results for continuous variables were statistically compared using the Mann–Whitney U test. Results The patients were 42 males and 10 females aged 12–72 years (mean age 33.1 years). Forty-one had blunt trauma and 11 had penetrating trauma. There was no significant difference between the proportion of blunt trauma patients who developed TPP (41/761, 5.3 %) and the proportion of penetrating trauma patients who developed TPP (11/235, 4.6 %) (p[0.05). All 42 patients had pulmonary contusion. Only 10 patients (19.2 %) had TPP identified on their chest X-ray, and thoracic computed tomography revealed TPP clearly in all these cases. Forty-two patients (80.7 %) were diagnosed with TPP on day 1 post-trauma. The hospital stays ranged from 2 to 35 days for the patients with blunt-trauma, and from 4 to 15 days for those with penetrating trauma (means 8.8 and 8.0 days, respectively; p[0.05). Only one patient required thoracotomy for a pseudocyst that did not resolve and became progressively enlarged. This TPP was resected at 6 months post-trauma. One patient died on day 9 post-trauma due to multiple organ failure. The other 40 pseudocysts resolved spontaneously within 1–5 months. Conclusions Traumatic pulmonary pseudocysts are pulmonary lesions that occur after either blunt or penetrating trauma and tend to be overlooked. Most of these lesions are self-limiting, benign lesion.Öğe The role of CD90 in the differential diagnosis of pleural malignant mesothelioma pulmonary carcinoma and comparison with calretının(Pathology & Oncology Research, 2016) Şahin, Nurhan; Akatlı, Ayşe Nur; Çelik, Muhammet Reha; Ulutaş, Hakkı; Şamdancı, Emine; Çolak, CemilAbstract Pleural Malignant Mesothelioma (MM) is a fatal disease that has been associated with asbestos exposure. Differential diagnosis between the pleural infiltration of pulmonary carcinomas and MM is rather difficult particularly for epitheloid type mesothelioma.We aimed to investigate the utility of CD90, a cancer stem cell marker, in the differential diagnosis of MM and lung carcinoma, its prognostic significance and compare its value with that of Calretinin. Ninety pathology specimens including MM (n:30), pulmonary adenocarcinoma (n:30) and pulmonary squamous cell carcinoma (n:30) were used in this study. Immunohistochemical comparision of CD 90 and Calretinin was made in all groups. Calretinin was positive in 20 cases with MM (64.5 %), and was negative in 10 (32.3 %). CD 90 was positive in 25 of these cases (80 %) and negative in 5 (16 %). On the other hand pulmonary adenocarcinomas and squamous cell carcinomas showed positivity with CD90, 63,6 % and 73 %, respectively. We think that CD 90 has no place in the differential diagnosis between mesothelioma and pulmonary carcinoma because of the low specificity in spite of the high sensitivity.Öğe The role of cd90 in the differential diagnosis of pleural malignant mesothelioma pulmonary carcinoma and comparison with calretının(Pathology & Oncology Research, 2016) Şahin, Nurhan; Akatlı, Ayşe Nur; Çelik, Muhammet Reha; Ulutaş, Hakkı; Samdancı, Emine TürkmenAbstract Pleural Malignant Mesothelioma (MM) is a fatal disease that has been associated with asbestos exposure. Differential diagnosis between the pleural infiltration of pulmonary carcinomas and MM is rather difficult particularly for epitheloid type mesothelioma.We aimed to investigate the utility of CD90, a cancer stem cell marker, in the differential diagnosis of MM and lung carcinoma, its prognostic significance and compare its value with that of Calretinin. Ninety pathology specimens including MM (n:30), pulmonary adenocarcinoma (n:30) and pulmonary squamous cell carcinoma (n:30) were used in this study. Immunohistochemical comparision of CD 90 and Calretinin was made in all groups. Calretinin was positive in 20 cases with MM (64.5 %), and was negative in 10 (32.3 %). CD 90 was positive in 25 of these cases (80 %) and negative in 5 (16 %). On the other hand pulmonary adenocarcinomas and squamous cell carcinomas showed positivity with CD90, 63,6 % and 73 %, respectively. We think that CD 90 has no place in the differential diagnosis between mesothelioma and pulmonary carcinoma because of the low specificity in spite of the high sensitivity.Öğe Surgical management of upper and lower lobe bronchiectasis without middle lobe involvement Is middle lobectomy necessary(Journal of pediatric surgery, 2012) Ulutaş, Hakkı; Çelik, Muhammet Reha; Kuzucu, AkınPostoperative quality of life is a crucial factor in decisions regarding surgical management of bronchiectasis. The goal of surgical treatment in such cases is to eradicate diseased portions of lung while preserving as much healthy lung parenchyma as possible. The volume of remaining lung must be sufficient to fill the pleural space. In patients with bronchiectasis, it is extremely unusual to have upperand lower-lobe involvement without middle lobe involvement. A normal-sized middle lobe alone is usually not adequate to fill the right hemithorax. When the disease involves both the upper and lower lung lobes, surgeons must assess whether pneumonectomy is required. Herein, we describe the case of a patient with bronchiectasis who was successfully treated with upper and lower lobectomy and preservation of the middle lobe.Öğe Vanishing lung sendrom: Nadir bir antite(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2015) Çelik, Muhammet Reha; Ulutaş, Hakkı; Kuzucu, AkınVanishing lung sendrom nadir görülen ve dev bül veya büllerin akciğerin büyük oranda kollapsına neden olduğu bir antitedir. Bu çalışmada solunum sıkıntısı, terleme, çarpıntı şikayeti ile acil servise başvuran 20 yaşında, radyografik olarak sağ hemitoraksın tümünü kaplayan dev bül ve çevresinde pnömotoraks saptanan bir erkek hasta sunuldu. Hastaya tüp torakostomi uygulandı ve daha sonra torakoskopik cerrahi ile bül eksizyonu yapıldı. Postoperatif dönemde komplikasyon gelişmedi. Akciğer ekspanse olan olgu postop 6. günü şifa ile externe edildi. Vanishing lung sendromunda en önemli sıkıntı bül, pnömotoraks ayrımının yapılmasında ve altta yatan akciğer parankiminin ne derece sağlıklı olduğunun değerlendirilmesinde yaşanılan zorluktur. Uygun vakalarda bül eksizyonu ile kollabe akciğerin ekspanse olur ve tam bir klinik düzelme sağlanır.Öğe Vanishing lung syndrome a rare entity(Journal of Turgut Ozal Medical Center, 2015) Çelik, Muhammet Reha; Ulutaş, Hakkı; Kuzucu, AkınVanishing lung syndrome is characterised by giant bullae that compress the underlying lung. Differentiating between bullous emphysema and pneumothorax and choosing the right treatment modality can be challenging. The present report describes a case of a giant pulmonary bulla in a young male patient. A 20-year-old male was admitted with complaints of shortness of breath, chest pain, sweating, and tachycardia. Chest X-ray and chest CT images revealed the presence of giant bullae occupying the left hemithorax and pneumothorax. A chest tube was inserted percutaneously under local anesthesia into the pleural cavity and then we performed bullectomy using thoracoscopic surgery. Residual lung re-expansion yielded good postoperative results without complications. It can be very difficult to distinguish a pneumothorax from a giant bulla and preoperative assessment of the extent and distribution of the bullae is vital for the following procedures.
