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Öğe Aim: In the present study, we aimed to compare Dexmedetomidine-Remifentanil and Propofol-Remifentanil combinations in terms of postoperative cognitive functions in hysteroscopy attempts. Material and Methods: A total of 70 ASA I-II patients who were aged between 18 and 65 years were included in the study following the ethics committee approval. The patients were randomized into two groups (n=35), and standard routine monitoring were applied to them. The sedation depth was evaluated with Ramsey Sedation Score (RSS) before and after the sedation; and cognitive functions of the groups were evaluated with the Minimal Mental State Test (MMST). Propofol 1 mg/kg bolus 25-100 µg/kg/min infusion was administered to Group PR, and Dexmedetomidine 1 µg/kg bolus 0.4-0.7 µg/ kg/h infusion dose was administered to Group DR. Remifentanil 0.25 µg/kg bolus 0.04 µg /kg/min infusion was administered to the groups, and the groups were followed to ensure RSS≥4. Result: In cognitive functions, it was observed that there was significant regression in Group PR in postoperative period compared to the preoperative period (p<0.05). The hemodynamic parameters were lower in Group DR than in Group PR at 5th, 10th and 15th minutes following the hysteroscopy (p<0.05). The Modified Aldrete Score in Group DR were high, and pain scores were lower (p<0.05). Satisfaction with the surgeon, patient and anesthetist scores were higher in Group DR. No respiratory depression was observed (p<0.05). Conclusion: We believe that administering Dexmedetomidine-Remifentanil combination in sedation in hysteroscopy ensures better postoperative cognitive function, recovery conditions, analgesia, and patient and surgeon satisfaction compared to the PropofolRemifentanil combination.(2019) Gonultas, Fatih; Kutluturk, Koray; Barut, Bora; Dalda, Yasin; Alan, Saadet; Unal, BulentAim: To compare thyroid fine-needle aspiration biopsy with histopathological examination results. Material and Methods: Postoperative histopathological examination results of 361 patients, who were thyroidectomized between December 2010 and October 2017 in Inonu University Turgut Ozal Medical Center Department of General Surgery and whose preoperative FNAB registries we could reach were evaluated retrospectively. Biopsies made in external centers were included in preoperative FNAB results. FNAB results were examined according to Bethesda 2007 in 6 categories: unsatisfactory, benign, atypia of undetermined significance, follicular lesion-neoplasm or suspicious for a neoplasm, suspicious for malignancy and malignant. Histopathological results of patients with incidental malignancy were presumed benign. Results: Among the 361 patients that were included in the study, 274 were female (75.9%), 87 were male(24.1%). Mean age of the patients in the benign group was 49.1±12.5 years, and 48.6±13.5 years in the malignant group. It was found that FNAB’s sensitivity was 83.9 %, specificity was 92.4%, false positive rate was 16.1% and false negative rate was 7.6%. Conclusion: FNAB is reported as the gold standard for preoperative evaluation of thyroid nodules. In our study, however, it was seen that FNAB was not adequate alone to detect malignancy. This situation suggests the importance of collaboration between radiologist, cytopathologist and clinician.Öğe Assessment of Liver Regeneration in Patients Who Have Undergone Living Donor Hepatectomy for Living Donor Liver Transplantation(Mdpi, 2023) Satilmis, Basri; Akbulut, Sami; Sahin, Tevfik Tolga; Dalda, Yasin; Tuncer, Adem; Kucukakcali, Zeynep; Ogut, ZekiBackground: Inflammation and the associated immune pathways are among the most important factors in liver regeneration after living donor hepatectomy. Various biomarkers, especially liver function tests, are used to show liver regeneration. The aim of this study was to evaluate the course of liver regeneration following donor hepatectomy (LDH) by routine and regeneration-related biomarkers. Method: Data from 63 living liver donors (LLDs) who underwent LDH in Inonu University Liver Transplant Institute were prospectively analyzed. Serum samples were obtained on the preoperative day and postoperative days (POD) 1, 3, 5, 10, and 21. Regenerative markers including alfa-fetoprotein (AFP), des carboxy prothrombin (DCP), ornithine decarboxylase (ODC), retinol-binding protein 4 (RBP4), and angiotensin-converting enzyme isotype II (ACEII) and liver function tests including alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP) and total bilirubin levels were all analyzed. Results: The median age of the LLDs was 29.7 years and 28 LLDs were female. Eight LLDs developed postoperative complications requiring relaparotomy. The routine laboratory parameters including AST (<0.001), ALT (<0.001), ALP (<0.001), and total bilirubin (<0.001) showed a significant increase over time until postoperative day (POD) 3. For the regeneration-related parameters, except for the RBP4, all parameters including ACEII (p = 0.006), AFP (p = 0.002), DCP (p = 0.007), and ODC (p = 0.002) showed a significant increase in POD3. The regeneration parameters showed a different pattern of change. In right-lobe liver grafts, ACEII (p = 0.002), AFP (p = 0.035), and ODC (p = 0.001) showed a significant increase over time. DCP (p = 0.129) and RBP4 (p = 0.335) showed no significant changes in right-lobe liver grafts. Conclusions: Regenerative markers are increased in a sustained fashion following LDH. This is more prominent following right-lobe grafts which are indicative of progenitor-associated liver regeneration.Öğe Bilateral thigh abscess due to rectal fistula: A rare case report with silent clinical presentation(2023) Koroglu, Muhammed; Dalda, Yasin; Ozdes, Huseyin Utku; Ozdemir, Zeynep Maras; Aslanturk, OkanA 53-year-old male patient who underwent a rectal cancer operation nine years ago was evaluated with complaints of pain and swelling in the lateral thigh. Radiological imaging revealed abscess foci in the right thigh muscles. Surgical drainage and debridement were performed but developed recurrence. Contrast-enhanced abdominal tomography was performed due to a positive medical history and it was seen that an enterocutaneous fistula was formed from the anastomosis site of previous cancer surgery to both sides of the thigh. Bilateral thigh abscesses were drained and radical debridement was performed in the same session with surgery for the fistula. Pathological examination of the surgical specimens showed no evidence of cancer and the patient was discharged on the 14th postoperative day with complete resolution of the infection. Hip abscesses are rare, delays in the diagnosis and treatment of the underlying cause in cases of abscess secondary to abdominal or pelvic pathologies lead to an increase in mortality. Therefore, it should be kept in mind that thigh abscesses may be another side of the coin besides being seen as an isolated infection.Öğe Comparison of liver resection and living donor liver transplantation in patients with hepatocellular carcinoma within Milan criteria and well-preserved liver function(Kare Publ, 2023) Karakas, Serdar; Yilmaz, Sezai; Ince, Volkan; Akbulut, Sami; Dalda, Yasin; Akatli, Ayse Nur; Kahraman, Aysegul SagirBackground and Aim: Liver resection (LR) and liver transplantation (LT) are curative treatments for hepatocellular carcinoma (HCC). The main pur-pose of this study was to compare the survival of LR and LDLT in patients with HCC within the Milan criteria. Materials and Methods: The results of the LR (n=67) and LDLT (n=391) groups were compared for overall survival (OS) and disease-free survival (DFS). Twenty-six of the HCCs in the LRs met the Milan and Child A cri-teria. Also, 200 of the HCC patients in the LDLTs met the Milan criteria, of which 70 also met the Child A criteria. Results: Early mortality was higher in the LDLT group (13.9% vs 1.47%; p=0.003). The 5-year OS was higher in the LDLTs than the LRs, but not statistically significant (84.6% vs 74.2%; p=0.287). However, 5-year DFS was better in the LDLT group (96.8% vs 64.3%; p<0.001). When the LRs (n=26) and the LDLTs (n=70) that met both Milan and Child A criteria were compared, 5-year OS was similar (81.4% vs 74.2%; p=0.512), but DFS was better in the LDLTs (98.6% vs 64.3%; p<0.001). Conclusion: LR can be justified as the first-line treatment for HCC patients who meet Milan and Child A criteria in terms of and OS.Öğe Complicated appendicitis with scrotal fistula: case report and review of the literature(Turkish Assoc Trauma Emergency Surgery, 2023) Dalda, Yasin; Buran, Hasan; Sahin, Tevfik Tolga; Saglam, KutayAppendicitis is the most common emergency abdominal surgery today. Although its common complications are well-known, retroperitoneal abscess and scrotal abscess are rare and less known complications. In this study, we presented our patient who presented with appendicitis complicated with retroperitoneal abscess and scrotal fistula after appendectomy, and the literature review we conducted through PubMed. A 69-year-old man was admitted to the emergency department with complaints of abdominal pain, nausea-vomiting continuing for about 7 days, and fever and mental status change in the last 24 h. He was taken to emergency surgery with the preliminary diagnosis of perforation and retroperitoneal abscess. At laparotomy, perforated appendicitis and associated retroperitoneal abscess were seen. An appendectomy was performed, and the abscess was drained. The patient, who stayed in the intensive care unit for 4 days due to sepsis, was discharged on the 15th postoperative day with full recovery. He was admitted 15 days after his discharge because of an abscess from the scrotum. Percutaneous drainage was performed in the patient, whose tomography revealed an abscess extending from the retroperitoneal area to the left scrotum. The patient, whose abscess regressed, was discharged with recovery 17 days after hospitalization. These rare complications associated with appendicitis should be on the minds of surgeons to make an early diagnosis. Delay in treatment may lead to increased morbidity and mortality.Öğe The Effect of Pringle Maneuver Applied during Living Donor Hepatectomy on the Ischemia-Reperfusion Injury Observed in the Donors and Recipients(Mdpi, 2024) Dalda, Yasin; Akbulut, Sami; Sahin, Tevfik Tolga; Tuncer, Adem; Ogut, Zeki; Satilmis, Basri; Dalda, OzlemBackground and Objectives: The aim of this study is to evaluate the clinical and laboratory changes of ischemia and reperfusion injury in the remnant livers of donors with and without Pringle maneuver. Furthermore, we evaluated the recipients who have been transplanted with liver grafts from these donors. Methods and Materials: A total of 108 patients (54 living liver donors and 54 liver recipients) who underwent donor hepatectomy and recipients who living donor liver transplantation, were included in this randomized double-blind study between February 2021 and June 2021. The donors were divided into two groups: Pringle maneuver applied (n = 27) and Pringle maneuver not applied (n = 27). Similarly, recipients with implanted liver obtained from these donors were divided into two groups as the Pringle maneuver was performed (n = 27) and not performed (n = 27). Blood samples from donors and recipients were obtained on pre-operative, post-operative 0 h day (day of surgery), post-operative 1st day, post-operative 2nd day, post-operative 3rd day, post-operative 4th day, post-operative 5th day, and liver tissue was taken from the graft during the back table procedures. Liver function tests and complete blood count, coagulation tests, IL-1, IL-2, IL-6, TNF-alpha, and beta-galactosidase measurements, and histopathological findings were examined. Results: There was no statistically significant difference in the parameters of biochemical analyses for ischemia-reperfusion injury at all periods in the donors with and without the Pringle maneuver. Similarly, there was no statistically significant difference between in the recipients in who received liver grafts harvested with and without the Pringle maneuver. There was no statistically significant difference between the two recipient groups in terms of perioperative bleeding and early bile duct complications (p = 0.685). In the histopathological examinations, hepatocyte damage was significantly higher in the Pringle maneuver group (p = 0.001). Conclusions: Although the histological scoring of hepatocyte damage was found to be higher in the Pringle maneuver group, the Pringle maneuver did not augment ischemia-reperfusion injury in donors and recipients that was evaluated by clinical and laboratory analyses.Öğe Giant hydatid cyst of the liver: a case report with literature review(Springeropen, 2023) Sahin, Emrah; Dalda, Yasin; Dirican, AbuzerHydatid cyst is a parasitic infection most commonly localized in the liver. They may not be diagnosed early because they remain asymptomatic at small sizes and may reach large sizes at the time of diagnosis. In this situation, compression symptoms may occur and they may present with serious complications such as rupture and anaphylactic shock, which are rare. Treatment methods are determined by classification according to the imaging techniques used in the diagnosis. In the present case, echinococcal cysts originating from segments 5, 6, and 7 in the right lobe of the liver, reaching 35 cm in diameter, caused compression symptoms. The diagnosis was made by abdominal tomography showing characteristic daughter vesicles and calcified cystic wall. The patient underwent pericystectomy and had an uneventful postoperative course with no recurrence in the 5-year follow-up.Öğe Is peritoneal dialysis prior to kidney transplantation a risk factor for ureteral stenosis after adult to adult live kidney transplantation(2020) Kutlutürk, Koray; Şahin, Tevfik Tolga; Çimen, Serhan; Dalda, Yasin; Gönültaş, Fatih; Doğan, Sait Murat; Toplu, Sibel; Ünal, Bülent; Pişkin, TurgutAbstract: Objective: Major urinary complications such as urinary leaks, stenosis or urinary tract infections after kidney transplantation can lead to graft or patient loss. The effect of peritoneal dialysis on post-kidney transplantation complications have been discussed but its effect on ureteral stenosis is unknown. In this study, it was aimed to analyze factors effecting major ureteral complications after living donor kidney transplantation and impact of peritoneal dialysis and double J-stents (JJ stents). Material and Methods: This study included 116 adult to adult living donor kidney transplant patients. Factors effecting major urologic complications after living donor kidney transplantation were analyzed. The donors were primary relatives of the recipients. Results: Major urologic complications after living donor kidney transplantation was 8/116 (6.9%). Urinary leak was present in 2 (1.7%) patients. Ureteral stenosis was encountered in 6 (5.2%) patients. Double J stents were used in 84 (72.4%) of the cases. The effect of JJ ureteral stent was not statistically significant for urinary leak, ureteral stenosis (p= 0.074, p= 0.470, respectively). A total of 29 (25%) patients had peritoneal dialysis before kidney transplantation. Preoperative peritoneal dialyses and bacteriuria after kidney transplantation were independent risk factors for ureteral stenosis in multivariate analysis (p= 0.013, and p= 0.010 respectively). Conclusion: In the guidance of the results of the present study, peritoneal dialysis prior to kidney transplantation and bacteriuria are independent risk factors for ureteral stenosis after living donor kidney transplantation. JJ stents have no effect on urologic complications after living donor kidney transplantation.Öğe Management of acute cholecystitis in elderly (?65 years old) patients: A retrospective study comparing early versus delayed cholecystectomy(2023) Barut, Bora; Bağ, Yusuf Murat; Patmano, Mehmet; Gündoğan, Ersin; Tuncer, Adem; Dalda, Yasin; Gönültaş, FatihAim: Acute cholecystitis is the most common causes of acute abdomen in elderly popula tion. This study aimed to present the early postoperative period (? 30 days) outcomes of elderly patients (? 65 years old) with acute cholecystitis who underwent early or delayed cholecystectomy. Materials and Methods: Between January 2016 and December 2020, 74 patients aged 65 and over underwent cholecystectomy for acute cholecystitis were included in the study. The patients were divided into two groups as early (time between diagnosis and chole cystectomy 7 days or less, n= 43, 58.1%) or delayed (time between diagnosis and chole cystectomy over 7 days, n= 31, 41.9%) cholecystectomy. Demographic characteristics, preoperative laboratory and radiological findings, and perioperative data of patients were evaluated, and the groups were compared. Results: The median age of patients was 73 (65-90) years, and 39 (52.7%) were male. Sixty-one (82.4%) patients underwent laparoscopic, 8 open (10.8%) and 5 (6.8%) conver sion cholecystectomy. The rate of laparoscopic cholecystectomy was higher in the delayed group (n= 29, 93.5%) than in the early group (n= 32, 74.4%), but no statistically signifi cant difference was detected (p=.06). The rate of open cholecystectomy was statistically significantly higher in the early group (n=8, 18.6%) than in the delayed group (n=0) (P=.017), the conversion rate was similar between the groups (p=1). There was no signif icant difference between the groups in terms of intraoperative complications (p=1). The length of hospital stay was statistically significantly longer in the early compared to the delayed group (5 (1-21) days and 2 (1-12) days, respectively, p< .001). Conclusion: There was no statistical difference regarding intraoperative complications in patients underwent early or delayed cholecystectomy. We believe that the patient’s clinical presentation and early or delayed cholecystectomy experience of the team are vital in determining the timing of cholecystectomy, as well as the severity of acute cholecystitis.Öğe Marginal ulcer perforation following laparoscopic roux-en-y gastric bypass(2022) Dalda, Yasin; Kayaalp, CüneytMorbid obesity is a major problem of our age with increasing frequency and high comorbidities. It is associated with many chronic diseases and vascular diseases that can result in death. Laparoscopic Roux-en-Y Gastric bypass is one of the accepted safe surgical methods for long-term weight control and reduction of comorbidities in the treatment of obesity. Marginal ulcers are one of the long-term complications seen after this surgery and are not very common. In this case report, we aimed to present a marginal ulcer perforation that developed in a patient who had previously undergone gastric bypass surgery for obesity.Öğe The predictivity of thyroid fine-needle aspiration biopsy varies depending on the radiologist experience: A retrospective cohort study(2019) Gönültaş, Fatih; Kutlutürk, Koray; Dalda, Yasin; Barut, Bora; Alan, Saadet; Ünal, BülentAbstract: Aim: To compare thyroid fine-needle aspiration biopsy with histopathological examination results.Material and Methods: Postoperative histopathological examination results of 361 patients, who were thyroidectomized betweenDecember 2010 and October 2017 in Inonu University Turgut Ozal Medical Center Department of General Surgery and whosepreoperative FNAB registries we could reach were evaluated retrospectively. Biopsies made in external centers were included inpreoperative FNAB results. FNAB results were examined according to Bethesda 2007 in 6 categories: unsatisfactory, benign, atypiaof undetermined significance, follicular lesion-neoplasm or suspicious for a neoplasm, suspicious for malignancy and malignant.Histopathological results of patients with incidental malignancy were presumed benign.Results: Among the 361 patients that were included in the study, 274 were female (75.9%), 87 were male(24.1%). Mean age of thepatients in the benign group was 49.1±12.5 years, and 48.6±13.5 years in the malignant group. It was found that FNAB’s sensitivitywas 83.9 %, specificity was 92.4%, false positive rate was 16.1% and false negative rate was 7.6%.Conclusion: FNAB is reported as the gold standard for preoperative evaluation of thyroid nodules. In our study, however, it wasseen that FNAB was not adequate alone tÖğe Simple recommendation for cases requiring re-excision on breast surgery(Cukurova Univ, Fac Medicine, 2023) Dalda, Yasin; Sahin, Emrah; Kutluturk, Koray[Abstract Not Available]
