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Öğe Acute renal failure caused by blunt trauma in a kidney transplant recipient(Medicine Science | International Medical Journal, 2016) Ünal, Bülent; Kayabaş, Üner; Taşkapan, Hülya; Pişkin, Turgut; Baysal, Tamer; Kayhan, BaşakInjuries in renal graft are mostly caused by blunt trauma to the abdomen in any time after transplantation. The response to a trauma depends on the balance between inflammatory and antiinflammatory mediators. Trauma associated renal failure can be confused with acute humoral/cellular rejection in an allograft recipient. Delay in diagnosis and appropriate treatment can cause loss of graft in those patients. A 27-year-old male patient underwent renal transplantation because of unidentified end-stage renal failure. He was admitted to emergency department with abdominal pain on graft region, hematuria and oliguria. He informed that he fell down on his bottom from tabouret in the bath before onset of the complaints. After observing hematoma in renal pelvis of the transplanted kidney by urinary ultrasonography, an ureteral double J stent was applied. The serum creatinine level continuously increased, anuria was observed and creatinine level rose to 7.9 mg/dL. The patient was treated with pulsed doses of methylprednisolone, anti-thymocyte globulin because of acute allograft rejection with preliminary diagnosis. But both radiological findings of renal allograft and the performed immunological tests excluded the diagnosis of renal acute allograft rejection and confirmed the renal kidney failure due to post-traumatic blood clots in the renal pelvis and ureter of the allograft. Then he was discharged with functional graft through applied medical interventions.The application of basic immunophenotyping protocols together with clinical assessment may help to distinguish rejection from the other situations in renal transplant recipient with acute renal failure following blunt trauma.Öğe Acute traumatic diaphragmatic ruptures a retrospective study of 48 cases(Surgery Today, 2011) Dirican, Abuzer; Yılmaz, Mehmet; Ünal, Bülent; Ersan, Veysel; Pişkin, Turgut; Yılmaz, SezaiPurpose. Traumatic diaphragmatic rupture (TDR) is associated with high rates of morbidity and mortality, and the preoperative diagnosis is diffi cult. Methods. Forty-eight patients with TDR were treated in our department between January 2000 and May 2009. The cause, location, size of rupture, associated morbidity and mortality, surgical material for repair, and predictive factors for overall outcome were evaluated. Results. There were 41 male patients (85%) and 7 female patients (15%) with a mean age of 33.8 years (range 17–69 years). Blunt trauma accounted for the injuries of 15 patients (31%) and 33 patients (68%) had penetrating injuries. The diagnosis was preoperatively established in 12 patients (25%) with a plain chest X-ray or/and computed tomography. The location of rupture was on the left side of the diaphragm in 35 patients (73%), on the right side in 10 (21%), and was bilateral in 3 patients (6%). Traumatic diaphragmatic rupture was repaired with interrupted nonabsorbable sutures or polypropylene mesh (8 patients). Postoperative complications were observed in 18 patients (38%). Overall mortality was observed in 7 patients (15%). The mortality was associated with hemorrhagic shock (P = 0.002), a high injury severity score (P = 0.002), and having additional injuries (P = 0.015). Conclusion. The outcome of the patients is associated with presence of hemorrhagic shock, a high injury severity score, and additional organ injury.Öğe Aynı ailede iki primer kas içi kist hidatik olgusu(Dicle Tıp Dergisi, 2011) Dirican, Abuzer; Sümer, Fatih; Ünal, Bülent; Barut, Bora; Işık, Burak; Yılmaz, SezaiÖz: Otuz dokuz yaşındaki bayan hasta sol lumbar şişlik ve ağrı şikayetleri ile polikliniğe başvurdu. Hastanın aile öyküsünde 19 yaşındaki kızının sol gastrokinemius kasında primer kist hidatik sebebiyle bir yıl önce ameliyat olduğu öğrenildi. Hastanın fizik muayenesinde sol lomber bölgede derin palpasyonla ele gelen düzgün sınırlı 6x5 cm boyutlarında ağrılı kitle palpe edildi. Hastanın ecchinococcus granulosus indirekt hemaglutinasyon testi pozitifti. Radyolojik incelemelerde, lezyonun kist hidatikle uyumlu olduğu rapor edildi. Hastanın geçirilmiş kist hidatik öyküsü yoktu. Hastaya spinal anestezi altında parsiyel kistektomi ve drenaj uygulandı. Kistektomi materyali, asellüler lameller tabaka (kist hidatik) olarak rapor edildi. Postoperatif komplikasyon olmadı. Operasyon sonrası hastaya 15 mg/kg/gün Albendazol tedavisi 3 ay süreyle verildi. Hastanın 6 aylık izleminde kist hidatit nüksüne rastlanmadı. Kist hidatiğin endemik olduğu bölgelerde kas içi yerleşimli kistik kitlelerin ayırıcı tanısında kist hidatit de hatırlanmalıdır. Ailede geçirilmiş kist hidatit öyküsünün olması yol gösterici olabilir. Tedavide kist total çıkarılamıyorsa, parsiyel kistektomi ve drenaj kas içi kist hidatiğin cerrahi tedavisinde seçilebilir.Öğe Böbrek nakline başlarken açık donör nefrektomi güvenli bir yaklaşımdır(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2013) Ünal, Bülent; Pişkin, Turgut; Yılmaz, SezaiAmaç: Türkiye’de canlı vericili böbrek nakli, organ bağışının azlığı nedeni ile oldukça önemlidir. Klasik retroperitoneal açık donör nefrektomi, intraperitoneal organ yaralanması ve postoperataif adezyonları önlemesi bakımından faydalı bir yöntemdir. Biz de kliniğimizde açık donör nefrektomi geçiren hastalarda başlangıç deneyimlerimizi sunmayı amaçladık. Gereç ve Yöntemler: Kasım 2010 ve Haziran 2011 tarihleri arasında açık donör nefrektomi yapılan 14 hasta retrospektif olarak analiz edildi. Bu donörlerde demografik özellikler, intraoperatif ve postoperative komplikasyonlar, hastanede kalış süresi, serum kreatinin seviyeleri ( taburculuk zamanında, postoperative maksimum seviyeleri ve şimdiki değerleri) gözden geçirildi. Bulgular: Bu dönemde 14 donör opere edildi. Erkek kadın oranı 8:6 idi. Ortalama yaş 43.57yıl ( 27y-68y), ortalama vücut kitle indeksi 27.71 kg/m2 ( 21.3-36.1 kg/m2) idi. Beş sağ böbrek, 9 sol böbrek nefrektomi yapıldı. İntraoperatif organ yaralanması gözlenmedi. Tüm greftler hemen çalışmaya başladı. Transplante edilen böbreklerde vasküler tromboz olmadı. Bir adet reoperasyon gerektiren major kanama gözlendi (%7.1). Üç hastada minor yara komplikasyonları gözlendi (%21.4). Hiçbir hastada insizyonel herni gözlenmedi. Ortalama hastanede kalış süresi 5.85 gün (4-18gün), ortalama takip süresi 125gün (18-210 gün) idi. Ortalama serum kreatinin, taburculuk zamanında, postoperative en yüksek olduğu seviye ve şimdiki değerleri sırasıyla; 1.04 mg/dL (0.6-1.7 mg/dL); 1.26 mg/dL (0.8-1.9 mg/dL); 1.08 mg/dL (0.78-1.41 mg/dL) idi. Sonuç: Açık donör nefrektomi yaptığımız başlangıç serimizde major komplikasyon ile karşılaşmadık. Bu nedenle böbrek nakline yeni başlayan merkezler için başlangıçta açık donör nefrektominin güvenli bir yöntem olduğu kanaatindeyiz.Öğe Böbrek transplantasyonu yapılan hastalarda anestezi yönetimi(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2013) Aydoğan, Mustafa Said; Çolak, Yusuf Ziya; Pişkin, Turgut; Ünal, Bülent; Toprak, Hüseyin İlksen; Durmuş, MahmutAmaç: Son dönem böbrek yetmezliği olan hastalarda yaşam kalitesini olumlu yönde arttıran en seçkin tedavi yöntemi böbrek transplantasyonudur. Bu araştırmanın amacı, böbrek transplantasyonunun anestezi yönetimi ve sonuçları ile ilgili dikkat edilmesi gereken noktaları sunmaktır. Gereç ve Yöntemler: 2012 yılında son dönem böbrek yetmezliği nedeni ile Turgut Özal Tıp Merkezinde böbrek transplantasyonu yapılan 33 hasta retrospektif olarak değerlendirildi. Hastaların özellikleri, bulguları, takip kayıtları hastanemizin elektornik veri sisteminden ve anestezi takip formundan incelendi. Bulgular: Böbrek tarnsplantasyonu yapılan terminal dönem böbrek yetmelizkli hastaların ortalama yaşı 33,6±14,4 yıl idi. Nakil yapılan böbreklerin 9’u (%27) kadavradan, 24’ü (%73) canlı donörden elde edildi. Hastaların ikisinde (%6) entübasyon güçlüğü gözlendi. Anestezi süresi ortalama 216±64 dakika olup, organların sıcak iskemi süresi 158±110 saniye, total iskemi süresi ortlama 450±178 dakika olarak bulundu. Anestezi idamesinde hastaların 15’inde (%45) desfluran ve 18'inde (%55) izofluran kullanıldı. Hastaların 23’üne (%70) santral kateter ve ikisine (%6) diyaliz kateteri uygulandı. İntraoperatif dönemde 125±20 mg mannitol ve 87±68 mg furosemid verildi. Ameliyat sırasında dört hastaya eritrosit süspansiyonu verildi. Hastalarımızda intraoperatif anestezi ile ilişkili herhangi bir komplikasyon gelişmedi .Hastane kalış süresi ortalama 6,6±3,8 gün bulundu. Bir hasta nakil dışı bir komplikasyon nedeni ile kaybedildi. Sonuç: Böbrek transplantasyonu yapılan hastalarda detaylı preoperatif hazırlık, uygun perioperatif sıvı yönetimi ve hedefe yönelik hemodinamik uygulama gereklidir.Öğe Böbrek Transplantasyonu Yapılan Hastalarda Anestezi Yönetimi(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2014) Aydoğan, Mustafa Said; Çolak, Yusuf Ziya; Pişkin, Turgut; Ünal, Bülent; Toprak, Hüseyin İlksen; Durmuş, MahmutAmaç: Son dönem böbrek yetmezliği olan hastalarda yaşam kalitesini olumlu yönde arttıran en seçkin tedavi yöntemi böbrek transplantasyonudur. Bu araştırmanın amacı, böbrek transplantasyonunun anestezi yönetimi ve sonuçları ile ilgili dikkat edilmesi gereken noktaları sunmaktır. Gereç ve Yöntemler: 2012 yılında son dönem böbrek yetmezliği nedeni ile Turgut Özal Tıp Merkezinde böbrek transplantasyonu yapılan 33 hasta retrospektif olarak değerlendirildi. Hastaların özellikleri, bulguları, takip kayıtları hastanemizin elektornik veri sisteminden ve anestezi takip formundan incelendi. Bulgular: Böbrek tarnsplantasyonu yapılan terminal dönem böbrek yetmelizkli hastaların ortalama yaşı 33,6±14,4 yıl idi. Nakil yapılan böbreklerin 9’u (%27) kadavradan, 24’ü (%73) canlı donörden elde edildi. Hastaların ikisinde (%6) entübasyon güçlüğü gözlendi. Anestezi süresi ortalama 216±64 dakika olup, organların sıcak iskemi süresi 158±110 saniye, total iskemi süresi ortlama 450±178 dakika olarak bulundu. Anestezi idamesinde hastaların 15’inde (%45) desfluran ve 18'inde (%55) izofluran kullanıldı. Hastaların 23’üne (%70) santral kateter ve ikisine (%6) diyaliz kateteri uygulandı. İntraoperatif dönemde 125±20 mg mannitol ve 87±68 mg furosemid verildi. Ameliyat sırasında dört hastaya eritrosit süspansiyonu verildi. Hastalarımızda intraoperatif anestezi ile ilişkili herhangi bir komplikasyon gelişmedi .Hastane kalış süresi ortalama 6,6±3,8 gün bulundu. Bir hasta nakil dışı bir komplikasyon nedeni ile kaybedildi. Sonuç: Böbrek transplantasyonu yapılan hastalarda detaylı preoperatif hazırlık, uygun perioperatif sıvı yönetimi ve hedefe yönelik hemodinamik uygulama gereklidir.Öğe Can an extended right lobe be harvested from a donor with gilbert s syndrome for living donor liver transplantation case report(Transplantation Proceedings, 2012) Yılmaz, Mehmet; Ünal, Bülent; Işık, Burak; Dinçer, Özgür; Pişkin, Turgut; Ersan, Veysel; Gönültaş ,Fatih; Yılmaz, SezaiGilbert’s syndrome (GS) is a common cause of inherited benign unconjugated hyperbilirubinemia that occurs in the absence of overt hemolysis, other liver function test abnormalities, and structural liver disease. GS may not affect a patient’s selection for living-donor liver transplantation (LDLT). Between February 2005 and April 2011, 446 LDLT procedures were performed at our institution. Two of the 446 living liver donors were diagnosed with GS. Both donors underwent extended right hepatectomies, and donors and recipients experienced no problem in the postoperative period. Their serum bilirubin levels returned to the normal range within 1–2 weeks postoperatively. In our opinion, extended right hepatectomy can be performed safely in living liver donors with GS if appropriate conditions are met and remnant volume is 30%. Livers with GS can be used successfully as grafts in LDLT recipients.Öğe Can an extended right lobe be harvested from a donor with gilbert’s syndrome for living-donor liver transplantation? Case report(Transplantation Proceedings, 2012) Yılmaz, Mehmet; Ünal, Bülent; Işık, Burak; Özgör, Dinçer; Pişkin, Turgut; Ersan, Veysel; Gönültaş, Fatih; Yılmaz, SezaiGilbert’s syndrome (GS) is a common cause of inherited benign unconjugated hyperbilirubinemia that occurs in the absence of overt hemolysis, other liver function test abnormalities, and structural liver disease. GS may not affect a patient’s selection for living-donor liver transplantation (LDLT). Between February 2005 and April 2011, 446 LDLT procedures were performed at our institution. Two of the 446 living liver donors were diagnosed with GS. Both donors underwent extended right hepatectomies, and donors and recipients experienced no problem in the postoperative period. Their serum bilirubin levels returned to the normal range within 1–2 weeks postoperatively. In our opinion, extended right hepatectomy can be performed safely in living liver donors with GS if appropriate conditions are met and remnant volume is 30%. Livers with GS can be used successfully as grafts in LDLT recipients.Öğe Circumferential Fence With the Use of Polyethylene Terephthalate Dacron Vascular Graft for All in One Hepatic Venous Reconstruction in Right Lobe Living Donor Liver Transplantation(Transplantation Proceedings, 47(5), 1458–1461., 2015) Ara, Cengiz; Akbulut, Ahmet Sami; İnce, Volkan; Aydın, Cemalettin; Kayaalp, Cüneyt; Ünal, Bülent; Yılmaz, SezaiIntegration of hepatic vein tributaries with a diameter 5 mm into the drainage system in rightlobe living-donor liver transplantation (LDLT) is of vital importance for graft function. Recently, the most commonly emphasized hepatic venous reconstruction model is the all-in-one reconstruction model. In the final stage of this model that aims to form a common large opening, allogeneic vascular grafts are almost always used to construct a circumferential fence. To date, no other study has reported the use of polyethylene terephthalate (Dacron) vascular graft as a circumferential fence in LDLT. We aimed to present the 1st 4 cases of circumferential fences created with Dacron vascular graft. Four right-lobe grafts weighing 522e1,040 g were used. A polytetrafluoroethylene vascular graft was used for the integration of segment 5 vein and segment 8 vein into the drainage model, whereas a Dacron graft was used to creating a circumferential fence. The patency of hepatic outflow evaluated with the use of multidetector computerized tomography at postoperative day 7. Venous outflow obstruction was not detected in any cases. This study suggested that owing to its flexible structure the polyethylene terephthalate vascular graft can be an alternative to allogeneic vascular grafts in forming circumferential fence.Öğe Circumferential fence with the use of polyethylene terephthalate dacron vascular graft for all in one hepatic venous reconstruction in right lobe living donor liver transplantation(Transplantation Proceedings, 2015) Ara, Cengiz; Akbulut, Ahmet Sami; İnce, Volkan; Aydın, Cemalettin; Gönültaş, Fatih; Kayaalp, Cüneyt; Ünal, Bülent; Yılmaz, SezaiIntegration of hepatic vein tributaries with a diameter 5 mm into the drainage system in rightlobe living-donor liver transplantation (LDLT) is of vital importance for graft function. Recently, the most commonly emphasized hepatic venous reconstruction model is the all-in-one reconstruction model. In the final stage of this model that aims to form a common large opening, allogeneic vascular grafts are almost always used to construct a circumferential fence. To date, no other study has reported the use of polyethylene terephthalate (Dacron) vascular graft as a circumferential fence in LDLT. We aimed to present the 1st 4 cases of circumferential fences created with Dacron vascular graft. Four right-lobe grafts weighing 522e1,040 g were used. A polytetrafluoroethylene vascular graft was used for the integration of segment 5 vein and segment 8 vein into the drainage model, whereas a Dacron graft was used to creating a circumferential fence. The patency of hepatic outflow evaluated with the use of multidetector computerized tomography at postoperative day 7. Venous outflow obstruction was not detected in any cases. This study suggested that owing to its flexible structure the polyethylene terephthalate vascular graft can be an alternative to allogeneic vascular grafts in forming circumferential fence.Öğe Combination of allopurinol and hyperbaric oxygen therapy(Pancreas, 2008) Cömert, Bilgin; Işık, Ahmet Turan; Aydın, Sezai; Bozoğlu, Ergun; Ünal, Bülent; Deveci, Salih; Mas, Nuket; Çınar, Eşref; Mas, Mehmet RefikAIM: To investigate the individual and combined effects of allopurinol and hyperbaric oxygen (HBO) therapy on biochemical and histopathological changes, oxidative stress, and bacterial translocation (BT) in the experimental rat acute pancreatitis (AP). METHODS: Eighty-five Sprague-Dawley rats were included in the study. Fifteen of the eighty-five rats were used as controls (sham, GroupⅠ). AP was induced via intraductal taurocholate infusion in the remaining seventy rats. Rats that survived to induction of acute necrotizing pancreatitis were randomized into four groups. Group Ⅱ received saline, Group Ⅲ allopurinol, Group Ⅳ allopurinol plus HBO and Group Ⅴ HBO alone. Serum amylase levels, oxidative stress parameters, BT and histopathologic scores were determined. RESULTS: Serum amylase levels were lower in Groups Ⅲ, Ⅳ and Ⅴ compared to Group Ⅱ (974 ± 110, 384 ± 40, 851 ± 56, and 1664 ± 234 U/L, respectively, P < 0.05, for all). Combining the two treatment optionsrevealed significantly lower median [25-75 percentiles] histopathological scores when compared to individual administrations (13 [12.5-15] in allopurinol group, 9.5 [7-11.75] in HBO group, and 6 [4.5-7.5] in combined group, P < 0.01). Oxidative stress markers were significantly better in all treatment groups compared to the controls. Bacterial translocation into the pancreas and mesenteric lymph nodes was lower in Groups Ⅲ, Ⅳ and Ⅴ compared to Group Ⅱ (54%, 23%, 50% vs 100% for translocation to pancreas, and 62%, 46%, 58% vs 100% for translocation to mesenteric lymph nodes, respectively, P < 0.05 for all). CONCLUSION: The present study confirms the benefit of HBO and allopurinol treatment when administered separately in experimental rat AP. Combination of these treatment options appears to prevent progression of pancreatic injury parameters more effectively.Öğe A confirmatory report for the close interaction of Helicobacter pylori with gastric epithelial MUC5AC expression(J Clin Gastroenterol., 2004) Koçer, Havva Belma; Ulaş, Murat; Üstündağ, Yücel; Erdoğan, Sibel; Karabeyoğlu, Şerif Melih; Yıldırım, Osman; Ünal, Bülent; Cengiz, ÖmerHelicobacter pylori (H. pylori) infection is associated with the development of gastritis and peptic ulcer and is presumed to be a risk factor for low-grade B-cell lymphoma and gastric cancer. H. pylori also causes critical alterations in gastric mucin structure. Our aim was to determine the effect of H. pylori on MUC1, MUC2, and MUC5AC expression. METHODS: Thirty H. pylori-positive and 15 H. pylori-negative antral gastric endoscopic biopsy specimens were evaluated for MUC1, MUC2, and MUC5AC expression with immunohistochemical staining. From the same specimens, we scrutinized the presence of H. pylori infection by hematoxylin and eosin and immunohistochemical staining. RESULTS: In H. pylori infected patients, the expression of MUC5AC was found to be localized to the cells in the superficial epithelium and upper parts of the gastric glands. The number of MUC5AC-expressing cells and the staining intensity of MUC5AC were shown to decrease in patients with H. pylori infection. Histopathology and immunostaining patterns of gastric mucins implied that H. pylori was physically associated with extracellular MUC5AC and MUC5AC-producing cells. H. pylori infection does not significantly affect staining intensity and patterns of MUC1 and MUC2 expressions. MUC1 was not found in dysplastic tissues or intestinal metaplasia areas. MUC5AC was expressed in dysplastic areas, but not in intestinal metaplasia. MUC2 was expressed in both dysplastic and intestinal metaplasia areas. CONCLUSION: H. pylori decreases the amount of MUC5AC expression. With reducing MUC5AC-producing cells and MUC5AC mucin, H. pylori may potentially cause significant alterations of the structure and function of gastric mucins. H. pylori-dependent inhibition of mucin synthesis deserves more investigations to clarify the role of H. pylori and gastric MUC5AC interaction.Öğe Controlling massive hemorrhage from the retropancreatic portal vein as a complication of thromboendovenectomy during liver transplantation with balloon catheter tamponade how to do it(Surgery Today, 2014) Aydın, Cemalettin; Ersan, Veysel; Başkıran, Adil; Ünal, Bülent; Kayaalp, Cüneyt; Yılmaz, Sezait We herein describe two cases of liver transplantation with portal vein thrombosis. In both cases, a tear advancing to the retropancreatic area occurred during portal vein thrombectomy. Hemorrhage from the limited visibility retropancreatic area made it impossible to stop the bleeding by clamping or direct suturing, and the clamping and suturing efforts actually increased the hemorrhage, possibly due to the damaged and thin portal vein wall. First, finger compression over the retropancreatic area was employed to stop the bleeding, then a Foley urinary catheter was introduced into the portal vein under the finger. The balloon of the catheter was inflated with 8 cc of normal saline, and the finger was released. The bleeding was stopped temporarily, and two different venous conduits were sutured to the trimmed portal vein stump in a bloodless surgical area. The venous conduits were easily controlled with vascular clamps after deflating the balloon catheters, and implantation of the liver was then done in a standard manner. Balloon tamponade can be a lifesaving technique that can temporarily stop a hemorrhage to allow for definitive repair in cases of retropancreatic portal vein hemorrhage.Öğe Current approaches to esophageal variceal bleeding(J Turgut Ozal Med Cent, 2015) Ünal, Bülent; Kutlutürk, Koray; Pişkin, Turgut; Otan, Emrah; Aydın, Cemalettin; Yılmaz, SezaiEsophageal varices are collateral veins at the distal esophagus between gastric and azygos veins arising following increased portal pressure. Vein pressure above 10 mmHg is regarded as portal hypertension, in which portal vein-hepatic vein pressure gradient is increased. This status is seen as "clinically important portal hypertension" and it is most common in liver cirrhosis. Acid and esophageal variceal bleeding is the result of portal hypertension, which are the signs of advanced disease with poorer survival rates. Esophageal varices develop in 30% of the patients with compensated cirrhosis and 60-70% of the patients with decompensated cirrhosis. Varice development incidence is around 4-12% in cirrhotic patients without varices. Esophageal variceal hemorrhage has high recurrence, mortality, and morbidity rates requiring immediate medical treatment and these constitute approximately 10% of upper gastrointestinal bleeding, which is one of the major causes of mortality in patients with cirrhosis. Bleeding develops in 30% of the cirrhotic patients with esophageal varices diagnosed during endoscopy. The mortality of the first bleeding episode ranges from 25 to 70% and after the first bleeding episode rebleeding occurs at a rate of 75-80% in six to twelve months. Variceal diameter, grade, degree of red dots, and cirrhosis are among the factors that increase the risk of variceal bleeding. The risk of bleeding in Grade 1 varices is 8% and a higher grade increases the risk of bleeding four to five folds. Pharmacological endoscopic and antibiotic treatment constitutes the basis for esophageal variceal bleeding treatment. In this study, we aimed to evaluate the current approaches to esophageal variceal bleeding.Öğe Delici-kesici alete bağlı diyafragma yaralanmaları: 18 olgunun analizi(Ulusal Cerrahi Dergisi, 2010) Dirican, Abuzer; Ateş, Mustafa; Ünal, Bülent; Yılmaz, Mehmet; Özgör, Dinçer; Yılmaz, SezaiÖz: Amaç: Tüm delici-kesici alete bağlı diyafragma yaralanmaları onarım gerektirmesine karşın, ameliyat öncesi tanı koymak zordur. Bu çalışmanın amacı, DKA bağlı diyafragma yaralanmaları konusunda bir genel cerrahi kliniği olarak deneyimlerimizi aktarmaktır. Hastalar ve Yöntem: Mart 2000- Haziran 2009 tarihleri arasında, İnönü Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı'nda tedavi edilen, delici-kesici alete bağlı diyafragma yaralanmalı 18 hastanın kayıtları retrospektif olarak incelendi. Bulgular: Hastaların 3'ü kadın, 15'i erkek ve yaş ortalamaları 33 (20–69) yıl idi. En sık şikâyetler solunum güçlüğü, karın ve göğüs ağrısıydı. Onbir (%66) hastada diyafragmanın sol tarafında, 6 (%33) hastada sağ tarafında, 1 (%6) hastada ise her iki tarafında yaralanma vardı. On yedi hastaya hastaneye başvurduktan sonra ilk 24 saat içinde orta hat karın insizyonuyla, bir hastaya ise 10 gün sonra lateral torakotomiyle cerrahi müdahale yapıldı. Mortalite, 2 hastada eşlik eden ek organ yaralanmalarına bağlı kanama, bir hastada ise postoperatif gelişen sepsise bağlı olmak üzere 3 (%17) hastada oluştu. Sonuç: Delici-kesici alete bağlı diyafragma yaralanmalarında ameliyat öncesi tanı koymak zordur. Bu hastalarda yüksek oranda yandaş visseral organ yaralanması mevcuttur. Gövdenin umbilikus ile ksifoid arası seviyesinde karına nafiz bıçaklanmalarda diyafragma yaralanması akılda tutulmalıdır. Bu hastaların karın ameliyatları esnasında her iki hemidiyafragma dikkatlice eksplore edilmelidir.Öğe Dev peritoneal mezotelyal kist literatür eşliğinde olgu sunumu(Causapedia, 2015) Sarıcı, Kemal Barış; Soyer, Vural; Onur, Asım; Dirican, Abuzer; Ünal, BülentMezenterik kistler (MK) çok iyi prognoza sahip, nadir görülen genellikle benign karakterde intraabdominal kistik kitlelerdir. Bir kaç mm ile 40 cm arasında değişir. Belli boyuta gelinceye kadar asemptomatik olması ve spesifik bir semptomunun olmamasından dolayı preoperatif doğru tanı koymak gecikebilir. Bu yazımızda, karın ön duvarındaki peritondan kaynaklanan basit bir MK olgusu sunuldu. Elli bir yaşında erkek hasta 4-5 aydır devam eden karında şişlik ve ağrı şikayeti ile kliniğimize başvurdu. Özgeçmiş ve soygeçmiş sorgulamasında önemli bir özelliğe rastlanmadı. Rutin laboratuvar tetkikleri normaldi. Bilgisayarlı abdomen tomografisinde yaklaşık 12x10x11,5 cm boyutta, hafif yoğun içerikli ve düzgün sınırlı kistik lezyon görülüyordu. Kist hidatik serolojisi negatif geldi. MK ön tanısı ile göbek üstü median kesi ile laparotomi yapıldı ve eksplorasyonda sol üst kadran karın ön duvarı ve diyafragma üzerindeki pariyetal peritondan kaynaklı yaklaşık 12 cm çapında kistik lezyon olduğu görüldü. Total eksize edildi. Histopatolojik tanı multiloküle peritoneal inklüzyon kisti olarak rapor edildi. Karın ön duvarından kaynaklı peritoneal basit MK’ler oldukça nadir görülmekle beraber intraabdominal kistik kitle düşünülen hastaların ayırıcı tanısında akılda tutulmalıdır.Öğe Dev Soliter Jejunal Divertikül Perforasyonu(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2009) Dirican, Abuzer; Ünal, Bülent; Sümer, Fatih; Başsüllü, Nuray; Özgür, Dinçer; Kırımlıoğlu, VedatJejunum divertiküllerinin çoğu mezenterik yerleşimli psödodivertiküllerdir. Jejunal divertikül perforasyonu nadir görülen bir akut karın nedenidir ve tedavide segmenter barsak rezeksiyonu önerilir. Elli bir yaşındaki erkek hasta akut karın sebebiyle ameliyat edildi. Ameliyatta Treitz ligamanının 15 cm distalinde Jejunumun antimezenterik tarafında 6.6x9x3cm boyutlarında perfore gerçek divertikül mevcuttu. Divertikülektomi ve primer onarım yapıldı.Öğe The effect of ethyl pyruvate on oxidative stress in intestine and bacterial translocation after thermal injury(J Surg Res, 2008) Karabeyoğlu, Melih; Ünal, Bülent; Bozkurt, Betül; Dolapçı, İştar; Bilgihan, Ayşe; Karabeyoğlu, Işıl; Cengiz, ÖmerBackground. Thermal injury causes a breakdown in the intestinal mucosal barrier due to ischemia reperfusion injury, which can induce bacterial translocation (BT), sepsis, and multiple organ failure in burn patients. The aim of this study was to investigate the effect of ethyl pyruvate (EP) on intestinal oxidant damage and BT in burn injury. Materials and methods. Thirty-two rats were randomly divided into four groups. The sham group was exposed to 21°C water and injected intraperitoneal with saline (1 mL/100 g). The sham EP group received EP (40 mg/kg) intraperitoneally 6 h after the sham procedure. The burn group was exposed to thermal injury and given intraperitoneal saline injection (1 mL/100 g). The burn EP group received EP (40 mg/kg) intraperitoneally 6 h after thermal injury. Twenty-four hours later, tissue samples were obtained from mesenteric lymph nodes, spleen, and liver for microbiological analysis and ileum samples were harvested for biochemical analysis. Results. Thermal injury caused severe BT in burn group. EP supplementation decreased BT in mesenteric lymph nodes and spleen in the burn EP group compared with the burn group (P < 0.05). Also, burn caused BT in liver, but this finding was not statistically signifi- cant among all groups. Thermal injury caused a statistically significant increase in malondialdehyde and myeloperoxidase levels, and EP prevented this effects in the burn EP group compared with the burn group (P < 0.05). Conclusion. Our data suggested that EP can inhibit the BT and myeloperoxidase and malondialdehyde production in intestine following thermal injury, suggesting anti-inflammatory and anti-oxidant properties of EP.Öğe The effect of melatonin against FK506 induced renal oxidative stress in rats(The effect of melatonin against FK506 induced renal oxidative stress in rats, 2011) Ara, Cengiz; Dirican, Abuzer; Ünal, Bülent; Karabulut, Aysun Bay; Pişkin, TurgutBackground: Nephrotoxicity is an important side effect of FK506 and oxidative stress has been considered as one of the possible mechanisms. The present investigation examines the ability of melatonin to protect against FK506-induced renal oxidative stress. Methods: Thirty rats were divided into 3 groups (n = 10 each group). Group A was the sham group. Group B received 14 days FK506 (5 mg/kg/d, intraperitoneally [i.p.]) and group C received FK506 (5 mg/kg/d, i.p.) together with melatonin (4 mg/kg, i.p.) for 14 days. Kidney tissues were harvested to determine the tissue levels of malondialdehyde (MDA), total nitrite and nitric oxide (NO), tumor necrosis factor-a (TNF-a), and interleukin-6 (IL-6). Results: In group C, the levels of TNF-a, IL-6, and NO were lower than in the group B (P < .01, P < .03, and P < .04, respectively) and although MDA levels were lower than in group B, the differences were not statistically significant (P > .05). Conclusion: These results suggest that melatonin has protective effect against FK506-induced renal oxidative stress.Öğe The effect of melatonin against FK506 induced renal oxidative stress in rats(Surgical Innovation, 2011) Ara, Cengiz; Dirican, Abuzer; Ünal, Bülent; Bay Karabulut, Aysun; Pişkin, TurgutBackground: Nephrotoxicity is an important side effect of FK506 and oxidative stress has been considered as one of the possible mechanisms. The present investigation examines the ability of melatonin to protect against FK506-induced renal oxidative stress. Methods: Thirty rats were divided into 3 groups (n = 10 each group). Group A was the sham group. Group B received 14 days FK506 (5 mg/kg/d, intraperitoneally [i.p.]) and group C received FK506 (5 mg/kg/d, i.p.) together with melatonin (4 mg/kg, i.p.) for 14 days. Kidney tissues were harvested to determine the tissue levels of malondialdehyde (MDA), total nitrite and nitric oxide (NO), tumor necrosis factor-a (TNF-a), and interleukin-6 (IL-6). Results: In group C, the levels of TNF-a, IL-6, and NO were lower than in the group B (P < .01, P < .03, and P < .04, respectively) and although MDA levels were lower than in group B, the differences were not statistically significant (P > .05). Conclusion: These results suggest that melatonin has protective effect against FK506-induced renal oxidative stress.
