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Öğe Anesthetic management of a patient with sirenomelia: A case report(AVES, 2012) Yücel A.; Begeç Z.; Erdo?an M.A.; Konur H.; Ergin H.; Ersoy M.O.Sirenomelia or mermaid syndrome is an extremely rare developmental malformation characterized by complete or partial hipotrophy or fusion of the lower limbs. Gastrointestinal and urogenital anomalies are often accompanies with this congenital syndrome. Difficulty in determining the location of the peripheral veins and abnormal venous drainage may limit the use of limb for intravenous access. Associated anomalies should be identified and measures should be taken during the preoperative period. In this report we discussed anesthetic management of a patient diagnosed as sirenomelia syndrome.Öğe Case report of a giant renal oncocytoma(2003) Kiliç S.; Tayfun Altinok M.; Ipek D.; Ergin H.This report represents the third largest renal oncocytoma in English literature. The tumor was considered as a renal cell carcinoma preoperatively based on the physical examination and radiographic findings.Öğe Evaluation of serum levels of immunoglobulins (IgA, IgE, IgG, IgM) complements (C3, C4) and C-reactive protein in bladder cancer: A controlled prospective clinical trial(2005) Kiliç S.; Bayraktar M.; Bayraktar N.; Ergin H.; Beytur A.; E?ri M.Introduction: During the management of a patient with bladder cancer, the aim of a clinician is to diagnose the tumor with a most sensitive and least invasive method. Cystoscopy and urine cytology are standard practice in following these patients; however, cystoscopy is invasive, and urine cytology has low sensitivity. Therefore, this study aims to evaluate the diagnostic and prognostic value of the humoral immunity in the bladder cancer patients by means of measuring serum levels of immunoglobulins, complements and C-reactive protein pre and postoperatively compared with controls. Materials and methods: Blood and urine samples were taken from both tumor and control patients preoperatively and from only tumor patients at postoperative 1 and 3 months. Urine samples were examined immediately for microscopic examination and culturing. Serum samples were stored at -80°C in a deep freeze till processing and assessed blindly by same person at the end of the study. Patients who preoperatively received intravesical BCG instillation therapy, radiotherapy or chemotherapy for their bladder carcinoma diseases were not included in tumor group. Patients who underwent a transurethral procedure for a non-neoplastic genitourinary disease and did not have any documented cancer, served as controls. Results: Mean ages of tumor (20 pts; 1 female, 19 males) and control (41 pts; 3 females, 38 males) patients were 64.2±9.9 and 63.7±8.9, respectively (p=0.846). All tumor patients completed 3 months of follow-up. There was no statistical difference in urinary infection incidences between tumor and control groups. Serum IgA, IgE, IgG, C3 and CRP levels were statistically significantly higher in tumor group than in control group, while lower C4 and indifferent IgM levels were present in tumor group compared to control. However following tumor resection, all of them decreased very significantly. All serum levels, except C4, of 6 patients with visible tumor in their bladders at postoperative 3rd month were similar to those of tumor-negative patients. Although preoperative high levels of IgA, IgE, IgG, C3 and CRP appeared as sensitive, specific and predictive in primary bladder tumor diagnosis, post-treatment levels of any of those above were not found as useful in follow-up, suggesting that these were not diagnostic and prognostic parameters for bladder tumor. No correlation was established between infection and serum levels in both groups since there were not statistically significant differences in serum immunoglobulins, complements and CRP levels between the patients with and without urinary infection in each group. Pathologic stage and grade of the tumor did not correlate with immunoglobulin and C4 levels. However, there was a significant positive correlation between stage and C3 or CRP. There were no differences between the 3rd month serum levels of patients who took no therapy (6 pts) or chemotherapy (5 pts) or intravesical BCG (9 pts) after resections, except C4 which was higher in patients who took chemotherapy than in those who took BCG. Conclusion: Although serum immunoglobulins, complements and CRP appear to be nondiagnostic for primary bladder carcinoma, wider studies with longer follow-up and higher patient population are necessary for more definitive conclusions.Öğe Factors affecting success in surgery for mid- and distal penile hypospadias: A comparative study of Mathieu and TIPU techniques(2006) U?ras M.Y.; Ergin H.; Kiliç S.; Günes A.; BayninC C.Introduction: Surgical repair of hypospadias is influenced by many factors, the most important being the experience of surgeon. In this study, we aimed to determine factors affecting success in Mathieu and TIPU procedures conducted for mid- and distal penile hypospadias. Since we have some differences in patient profile regarding age, previous circumcision and hospital stay, we think that we need our own data to evaluate factors affecting surgical success. Materials and Methods: We retrospectively evaluated our surgical records and retrieved data on primary surgery for mid- and distal penile hypospadias, using either Mathieu or TIPU techniques. We reached patients and refreshed data when necessary. We gathered data on age, family history, previous surgery (circumcision or chordee), native meatal place, existence of chordee, anesthesia technique, type and time of urinary diversion, medications, hospital stay and complications. We analyzed data with software (SPSS 10.0, SPSS inc. ILL, USA) using parametric tests (ANNOVA, Student's T Test, Pearson) and nonparametric (Kruskal Wallis Test, Mann Whitney-U Test) accepted p<0,05 as statistically significant. Results: Among a total of 149 hypospadias patients presented between 1999 and 2004, 54 meeting our criteria were enrolled. Mathieu and TIPU operations were conducted in 34 (63%) and 20 (37%) patients, respectively. Mean age was 9.6±6.2 years. Regarding age groups, 15 patients (27.8%) were at 0-5, 25 (46.3%) at 6-12 and 14 (25.9%) at 12< years of age. Native meatus was placed at coronal, subcoronal, distal and mid penis in 16 (29,.5%), 8 (14.8%), 19 (35.2%) and 11 (20.5%) patients, respectively. Initial operation was successful in 28/34 (82.4%) of Mathieu and 15/20 (75.0%) of TIPU procedures. The difference was not statistically significant (p>0.05). Considering age groups or place of native meatus, success rates of both procedure were not significantly different (p>0.05). Hospital stay ranged between 5 and 33 (mean 8.4±4.7) days. Postoperative complications were as follows: After Mathieu procedure, 5 (14.7%) urethrocutaneous fistulas were seen and 3 were treated surgically. One patient had wound infection and skin disruption with an intact tube. He had debridement, antibiotic therapy and late closure of skin. After treatment of complications, success rate was 32/34 (94.1%). After TIPU procedure, 3 (15.0%) urethrocutaneous fistulas were seen, 2 that applicated were treated surgically. One patient had mental stenosis and another had skin disruption with intact tube, both treated surgically. After treatment of complications, success rate was 19/20 (95.0%). Complication rates of both procedures were similar (p>0.05). Foley and Nelaton catheters were used as urethral stents in 17 (31.5%) and 37 (68.5%) patients, respectively. Complication rate was significantly higher with Foley Catheter (r: 0.45; p=0.001). General and spinal-caudal anesthesia were performed in 30 (55.6%) and 24 (44.4%) patients, respectively. Complication rate was significantly higher with regional anesthesia (r: 0.38; p=0,005). Conclusion: In this series, we encountered factors that affect surgical success, which was in concordance with literature. Due to significantly higher complication rate, Foley catheter is not recommended as drain after both procedures. Regardless of age, we prefer to use general anesthesia in all patients.Öğe Outcomes of bone anchored in situ vaginal wall sling in the treatment of female stress urinary incontinence and literature review(2004) Kiliç S.; Utku V.; Ergin H.; Ipek D.; Gönenç F.Introduction: In this study, we aimed to evaluate outcomes of in situ vaginal wall sling operation combined with Vesica bone anchors that was performed for the treatment of women with stress urinary incontinence. Materials and Methods: Postoperative outcomes of 51 women who underwent this modified sling procedure between 1996 and 1999 were compared with the results in the literature in terms of the efficacy and safety. Results: Mean age was 48.6 (range 29-68). Eight patients had mixed (stress+urge) incontinence preoperatively. Follow-up ranged from 12 to 36 (mean 23.7) months. The sling operation was the single procedure in 43 (84.3%) patients while cystocele repair was combined with sling procedure in 8. Incontinence was cured in 47 (92.1%) patients. Procedure failed in 4 (7.9%) patients. Two of these achieved dryness following re-operation with same technique. Mean suprapubic pain score at postoperative day 1 according to visual analogous scale scored between 0 and 10 was 3.86±1.18. Rates of the de novo detrusor instability and temporary urinary retention, and mean catheterization time were 27.4%, 5.9%, and 3 days, respectively. No patient remained in permanent retention or required intermittent catheterization. Intraoperative bladder perforation, postoperative suprapubic abscess, and suprapubic wound infection were encountered in 3, 1, and 3 patients, respectively. Osteitis pubis, osteomyelitis, and urethral erosion were experienced in no patients. Conclusions: At relatively short follow-up period, a satisfactory success and low complication rates were obtained with in situ vaginal wall sling in the present series. This operation technique is an easy applicable method and allows concomitant vaginal procedures.
