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Öğe Diaphragmatic injuries due to stab wounds: Analysis of 18 patients(Turkish Surgical Society, 2010) Dirican A.; Ateş M.; Ünal B.; Yilmaz M.; Özgör D.; Yilmaz S.Purpose: Although all diaphragmatic injuries caused by stab wounds need to be repaired, preoperative diagnosis is often difficult. The purpose of the present study is to share our experience regarding diaphragmatic wounds. Patients and Methods: Eighteen patients with stab wounds causing diaphragmatic injuries treated at General Surgery Clinic of ?nönü University Faculty of Medicine between March 2000 and June 2009 were evaluated retrospectively. Results: There were 15 male and 3 female patients with mean age of 33 (20-69) years. Most common complaints were difficulty in breathing, and abdominal and chest pain. Localization of the injury was on the left side of the diaphragm in 11 (61%) patients and on the right side in 6 (33%) patients, and one (6%) patient had injuries on both sides. Surgery was performed in 17 patients with midline abdominal incision within the first 24 hours after the injury and with lateral thoracotomy in a patient 10 days after injury. Mortality occurred in 3 (17%) patients; in 2 patients due to bleeding from accompanying injuries and in one patient due to postoperative sepsis. Conclusion: Preoperative diagnosis of diaphragmatic injury due to a stab wound is difficult. These patients highly probably have visceral organ injuries in addition to diaphragmatic injuries. Diaphragmatic injuries should be kept in mind in patients with abdominal penetrating stab injuries which are located between umbilicus and xiphoid. Both hemidiaphragms should be explored carefully during abdominal surgery of these patients.Öğe The expression of matrix metalloproteinases in intrahepatic cholangiocarcinoma, hilar (Klatskin tumor), middle and distal extrahepatic cholangiocarcinoma, gallbladder cancer, and ampullary carcinoma: Role of matrix metalloproteinases in tumor progression and prognosis(2009) Kirimlio?lu H.; Türkmen I.; Başsüllü N.; Dirican A.; Karada? N.; Kirimlio?lu V.Background/aims: Carcinomas of the biliary tree are rare tumors of the gastrointestinal tract, with an increasing incidence in recent years. Biliary neoplasms are classified into intra- and extrahepatic cholangiocarcinoma (Klatskin tumor, middle and distal extrahepatic tumors), gallbladder adenocarcinoma, and ampullary carcinoma. We aimed to determine the expression profile of matrix metalloproteinase (MMP)-2, MMP-9 and MMP-14 in the biliary neoplasms classified according to their localization and the relation with the prognosis. Methods: Ten gallbladder adenocarcinoma, 8 distal bile duct carcinomas (distal cholangiocarcinoma), 8 Klatskin tumors, 8 intrahepatic cholangiocarci-nomas and 10 ampullary carcinomas were included in the study. The immunohistochemical expression of MMP-2, MMP-9 and MMP-14 was detected in the nontumoral, metaplastic, dysplastic and tumoral epithelia. The tumor differentiation, angiolymphatic and perineural invasion of the tumor, and presence of lymph node and distant metastasis were determined. Survey of the patients was noted from the patient follow-up data. Results: The nontumoral epithelia of the gallbladder, intrahepa- tic ducts, and Klatskin tumor did not express MMP-'. MMP-2 expression was detected in the distal part of the biliary ducts, in 75% (6/18) of cases and in the nontumoral epithelia of the ampullary region in 50% (5/10) of cases. The metaplastic and dysplastic epithelia were positively stained in all of the gallbladder adenocarcinoma, distal cholangiocarci- noma and ampullary tumors. In the intrahepatic cholangiocarcinoma, the hepatocytes were positively stained but the infiltrative tumors were spared. Klatskin tumors were also not stained with MMP-2. The gallbladder adenocarcinoma, distal cholangiocarcinoma and ampullary carcinomas expressed MMP-2 in 30%, 37% and 40% of the cases, respectively. MMP-9 and MMP-14 were expressed in normal, metaplastic, and dysplastic epithelium and tumoral cells in all of the cases of the groups. Expressions of MMPs were higher in subjects with neural invasion, but there was no correlation between MMP expression and tumor differentiation or angiolymphatic invasion. Conclusions: When tumors of the biliary system are divided as intrahepatic and extrahepatic cholangiocar- cinomas, MMP-2 expression was present in the extrahepatic cholangio- carcinomas including gallbladder carcinomas. Like the intrahepatic cholangiocarcinoma, Klatskin tumors also did not express MMP-2. This can be related with its characteristic growth pattern. MMP-9 and MMP- 14 were present in metaplasia, dysplasia carcinoma sequence in all of the bile tract tumors, suggesting that MMPs play an important role in carcinogenesis. The higher expression of the MMPs with neural invasion suggests the significant role of those tumors in the invasion activity.Öğe Isolated cecal necrosis mimicking acute appendicitis: A case series(2009) Dirican A.; Unal B.; Bassulu N.; Tatl F.; Aydin C.; Kayaalp C.Introduction. Spontaneous non-occlusive ischemic colitis involving the cecum alone (isolated cecal necrosis) is a rare condition that is generally due to a low-flow state: shock. It presents with right lower quadrant abdominal pain and may resemble acute appendicitis. Little is known about postoperative ischemic necrosis of the remaining colon after surgical treatment of isolated cecal necrosis. We report four cases of isolated cecal necrosis mimicking acute appendicitis seen at our institution within a 4-year period. Case presentation. The patients were two men and two women with a mean age at diagnosis of 59 years (range 46-68). The patients were of Turkish ethnic origin. All patients presented to the emergency room with acute abdominal pain and had symptoms of nausea and vomiting. The medical histories for three of the patients revealed end-stage renal failure requiring hemodialysis. The other patient had chronic obstructive pulmonary disease. Right hemicolectomy with anastomosis was performed in three patients and cecal resection with ileocolostomy was performed in the remaining one patient. All of the patients healed without complications. Median follow-up of patients was 24.5 (range: 17-37) months. There was no recurrence of ischemia in the remaining colon during the follow-up period of the patients. Conclusion. Isolated cecal infarction should be included in the differential diagnosis of acute pain in the right lower quadrant of the abdomen, especially in those patients on chronic hemodialysis. While diffuse ischemic disease of the intestine has high morbidity, mortality and recurrence rates, patients with isolated cecal necrosis have a good prognosis with early diagnosis and surgical treatment compared to those with diffuse ischemic disease. © 2009 licensee BioMed Central Ltd.Öğe Peritoneal encapsulation in a patient with incomplete situs inversus(2012) Ince V.; Dirican A.; Yilmaz M.; Barut B.; Ersan V.; Yilmaz S.Peritoneal encapsulation (PE) is an extremely rare congenital condition in which there is abnormal return of the midgut loop to the abdominal cavity in the early stages of development. It may be present in patients with congenital anomalies like incomplete situs inversus. Pre-operative diagnosis is possible with abdominal CT. A 71-year-old man with incomplete situs inversus was admitted to emergency department with symptoms and signs of peritonitis. Computed tomography (CT) of the abdomen showed characteristic features of the PE syndrome. He had exploratory laparotomy performed and arterial occlusion caused ileocaecal ischaemia and PE was observed. Capsule of PE and ileocaecal excision was done. Postoperative recovery was uneventful.Öğe The predictors of mortality in patients with anogenital necrotizing fasciitis (Fournier’s gangrene)(BETA Medical Publishers Ltd, 2020) Simsek A.; Dirican A.; Gecit I.OBJECTIVE To evaluate the predictors of mortality in the Fournier’s gangrene form of necrotizing fasciitis (NF). METHOD The medical records of patients with anogenital NF who were treated in a tertiary care hospital between January 2010 and December 2018 were reviewed, retrospectively. RESULTS This study included 86 patients, 76 males and 10 females. Perianal abscess (30.2%) was the leading precipitating event causing NF. The scrotum and perineum were the most commonly affected sites, 73.2% and 40.7%, respectively. NF extended beyond the urogenital and or anorectal triangle in 30.2% of cases. Escherichia coli (E. coli) was the most common microorganism isolated in tissue cultures (55.3%), and Klebsiella pneumoniae the second most common (15.3%). Admis-sion to the intensive care unit (ICU) was required for 50 patients (58.1%), and the mortality rate was 23.3%. Older age (>60 years), smoking, and extension of the infection beyond the urogenital and or anorectal triangle were all significantly associated with mortality. CONCLUSIONS Age >60 years, smoking, and extension of the infection beyond urogenital and or anorectal triangle were significantly related with mortality in anogenital NF. Prompt diagnosis and timely intervention are essential to prevent spread of the infection. © Athens Medical Society.Öğe The relation between preoperative ultrasonographic thyroid volume analysis and thyroidectomy complications(2009) Karabeyoglu M.; Unal B.; Dirican A.; Kocer B.; Serhat Gur A.; Bozkurt B.; Cengiz O.Objective. To determine the relation between thyroid volume (ThV) and thyroidectomy complications using preoperative ultrasound and ellipsoid volumetric analysis in Turkish patients. Patients and Methods. This prospective study included a total of 500 patients (401 females =80.2% and 99 males = 19.8%) who were operated for benign goiter. According to their ThV estimated by ultrasound hey were classified in three groups: 1.less than 50 ml (n = 269; 53.8%), 2. between 50 and 100 ml (n = 151; 30.2%), 3. more than 100 ml (n = 80; 15.6%). By comparing the association of thyroid volume with peroperative and postoperative complications it was evaluated whether the thyroid volume could be an effective factor participating in morbidity and mortality of patients. Results. Total peroperative complication rate was 2% (n= 10) with trachea injury in 2 (0.4%), bleeding in 8 (1.6%) patients. Peroperative complications were significantly more frequent in patients with large volume (p=0.003). Temporary hypocalcemia rate in patients with less than 50 ml volume was highly significant (p<0.001). Volume average was low in patients with hypocalcemia as compared to patients without hypocalcemia (p<0.001). Both the temporary and permanent vocal cord paralysis (VCP) were significantly more frequent in patients with larger volumes (p=0.002). All four patients with permanent VCP had more than 100 ml volume. Conclusion. Thyroid volume is an important factor affecting thyroidectomy complications. In patients with smaller ThV increased risk of hypocalcemia was found, whereas in those with larger ThV increased risk of recurrent nerve damage and peroperative bleeding was observed.Öğe Screening of gastric cancer in liver transplantation patients: A case report and review of literature(2010) Dirican A.; Unal B.; Bassulu N.; Ozgor D.; Kayaalp C.; Yilmaz S.Liver and other solid organ transplant recipients are at an increased risk of developing several malignancies because of the immuno-suppressive treatment. Generally, patients who had a liver transplant have upper gastrointestinal tract complaints, which makes identification of gastric carcinoma symptoms in those patients difficult. A 58 years old liver transplant male patient presented to the hospital for his routine checkup and dyspeptic complaints. He had received a liver from a cadaver 18 months ago and his postoperative period had been uneventful. An esophagogastroduodenoscopy (EGD) revealed gastric cancer. A subtotal gastric resection with a D2 lymph node dissection was carried out. There was no recurrence during three years follow up. In order to make a timely identification of the occurrence of common malignancies such as gastric cancer, liver transplant recipients must be followed closely.Öğe Subcutaneous hydatid cysts occurring in the palm and the thigh: Two case reports(2008) Dirican A.; Unal B.; Kayaalp C.; Kirimlioglu V.Introduction: Hydatid cyst disease is common in some regions of the world and is usually located in the liver and lungs. This report presents two cases of primary hydatid cysts located subcutaneously: one in the medial thigh and one in the left palm between the index and middle fingers. Case presentations: A 64-year-old male farmer visited our hospital because a swelling on the right medial thigh had grown during the last year. Superficial ultrasound and computed tomography revealed a lesion resembling a hydatid cyst. A germinative membrane was encountered during surgical excision. Pathological examination was compatible with a hydatid cyst. The second case involved a 67-year-old male farmer who complained of a swelling that had grown in his left palm in the last year. The preliminary diagnosis was a lipoma. However, a hydatid cyst was diagnosed during surgical excision and after the pathological examination. The patient did not have a history of hydatid cyst disease and hydatid cysts were not detected in other organs. There has been no disease recurrence after following both patients for 3 years. Conclusion: A hydatid cyst should be considered in the differential diagnosis of subcutaneous cystic lesions in regions where hydatid cysts are endemic, and should be excised totally, with an intact wall, to avoid recurrence. © 2008 Dirican et al; licensee BioMed Central Ltd.
