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Öğe Barolith a rare cause of acute appendicitis a case report(Turkish Journal of Trauma and Emergency Surgery, 2013) İnce, Volkan; Işık, Burak; Koç, Cemalettin; Başkıran, Adil; Asım, OnurA barolith consists of inspissated barium associated with feces and is seen, rarely, after barium studies for imaging the gastrointestinal system. The barium used in such studies can enter the appendiceal lumen and, rarely, cause appendicitis by obliterating or narrowing the lumen of the appendix. The appendix fills with barium and the entire appendix is visualized in 80-90% of barium swallow or enema studies, and this is accepted as a reliable sign of a non-diseased appendix Post-examination retention of barium in the appendix is very common (90~95%), and 10% of the patients retain barium in the appendix beyond 72 hours. If the barium is retained for more than two months, complicated appendicitis can result. We present a 46-year-old male who was diagnosed with acute appendicitis due to a barolith and required an appendectomy three months after a double-contrast barium enema study. After barium studies, patients should be informed regarding retention of barium in the appendix and the possibility that it can cause acute appendicitis. Thus, if abdominal pain develops, the patient can be referred quickly to a medical center for the appropriate treatment and the complications of acute appendicitis can be prevented with early intervention.Öğe Barolith a rare cause of acute appendicitis a case report(Turkish Journal of Trauma and Emergency Surgery, 2013) İnce, Volkan; Işık, Burak; Koç, Cemalettin; Başkıran, Adil; Onur, AsımA barolith consists of inspissated barium associated with feces and is seen, rarely, after barium studies for imaging the gastrointestinal system. The barium used in such studies can enter the appendiceal lumen and, rarely, cause appendicitis by obliterating or narrowing the lumen of the appendix. The appendix fills with barium and the entire appendix is visualized in 80-90% of barium swallow or enema studies, and this is accepted as a reliable sign of a non-diseased appendix Post-examination retention of barium in the appendix is very common (90~95%), and 10% of the patients retain barium in the appendix beyond 72 hours. If the barium is retained for more than two months, complicated appendicitis can result. We present a 46-year-old male who was diagnosed with acute appendicitis due to a barolith and required an appendectomy three months after a double-contrast barium enema study. After barium studies, patients should be informed regarding retention of barium in the appendix and the possibility that it can cause acute appendicitis. Thus, if abdominal pain develops, the patient can be referred quickly to a medical center for the appropriate treatment and the complications of acute appendicitis can be prevented with early intervention.Öğe Comparison of the demographic and clinical features of pregnant and non-pregnant patients undergoing appendectomy(2020) Koç, Cemalettin; Akbulut, Ahmet Sami; Çoşkun, Ebru İnci; Sarıcı, Barış; Yılmaz, SezaiAbstract: BACKGROUND: This retrospective study aims to compare the demographic and clinicopathological characteristics of the pregnant and non-pregnant patients who underwent appendectomy with a presumed diagnosis of acute appendicitis. METHODS: Between June 2009 and January 2019, 431 reproductive-aged of female patients underwent appendectomy with a presumed diagnosis of acute appendicitis. Patients were divided into two groups considering their pregnancy status: pregnant group (n=48) and non-pregnant group (n=383). Both groups were compared with respect to demographic, clinical and histopathological features. RESULTS: No statistically significant difference was found between pregnant and non-pregnant groups except total bilirubin level (p=0.019) and ultrasonographic findings (p=0.016). In the non-pregnant group, negative appendectomy and perforation rates were 26% and 10.5%, where these rates for the pregnant group were 20.8% and 4.2%. Sensitivity, specificity and accuracy rates of ultrasonography for the pregnant group were 50%, 100% and 58.5%, where these rates for the non-pregnant group were 67.3%, 57.9% and 65%. The pregnancy date was the first trimester in 52.1%, the second trimester in 29.2% and the third trimester in 16.7% of the pregnants. None of the term births (87.5%) resulted in neither a fetal nor a maternal complication. However, 12.5% of the preterm births resulted in neonatal mortality. CONCLUSION: Although not statistically significant, this study points out relatively lower rates of negative appendectomy and perforated acute appendicitis among pregnant patients, which is related to the overly attentive evaluation of pregnants admitted due to acute abdomen.Öğe Evaluation of liver transplant recipients underwent incidental appendectomies(2020) Koç, Cemalettin; Akbulut, Sami; Sarıcı, Barıs; Yılmaz, SezaiAbstract: OBJECTIVE: To assess the clinicopathological features of liver transplant recipients underwent incidental appendectomies. METHODS: Between September 2002 and July 2019, 2500 patients underwent liver transplantation at our Liver Transplant Institute, including 38 (24 males, 14 females) who also underwent incidental appendectomies. Incidental appendectomies were performed on 24 patients during recipient hepatectomies and on 14 during relaparotomies due to various surgical conditions. The following patient parameters were retrospectively evaluated: age, sex, underlying liver disease, liver transplant type, appendectomy indication, appendix length (mm) and diameter (mm), presence of appendicitis, and histopathological findings. RESULTS: The 38 patients who underwent incidental appendectomies had a mean age of 18.3±21.7 (range: 1–66) years and median appendix lengths and diameters of 55 (range: 19–90) mm and 6 (range: 4–20) mm, respectively. Histopathologically, the appendectomy specimens were classified as follows: vermiform appendix (n=16), lymphoid hyperplasia (n=13), acute appendicitis (n=3), fibrous obliteration (n=3), perforated appendicitis (n=1), mucinous cystadenoma (n=1), and appendiceal serosa invasion by sigmoid adenocarcinoma (n=1). There were no postoperative complications, including wound infections, abscesses, or leakage from the appendiceal stumps, related to the incidental appendectomies. CONCLUSION: This study demonstrated that incidental appendectomies can be successfully performed in immunosuppressed patients. However, additional studies are required to confirm these results.Öğe Histopathological examination of explanted liver after transplantation in patients with cryptogenic cirrhosis(Transplantation Proceedings, 2015) Tardu, Ali; Karagül, Servet; Yağcı, Mehmet Ali; Ertuğrul, İsmail; Sümer, Fatih; Kırmızı, Serdar; Yaylak, Faik; Koç, Cemalettin; Hatipoğlu, Hamit Sinan; Kayaalp, Cüneyt; Yılmaz, SezaiObjectives. Cryptogenic cirrhosis is a common indication for liver transplantation. Diagnosis is made after exclusion of other causes of cirrhosis. In this study, the aim was to evaluate patients with cryptogenic cirrhosis after histopathological examination of explanted liver. Materials and Methods. A retrospective histopathological chart review of 117 patients with cryptogenic cirrhosis who had liver transplantation between November 2009 and June 2014 was performed. Age, sex, operative features, survival rates, and preoperative and postoperative diagnosis were evaluated. Results. During the study period, 123 liver transplantations were performed for these 117 patients. Deceased donor liver transplantations were performed in 23 (18.7%) of the cases. Retransplantations were performed in 5 patients. Median age was 48 years, and female-tomale ratio was 41:76. Hepatosteatosis were observed in 29 patients. Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis were observed in 20 (12%) and 9 (7.7%) of these patients, respectively. Autoimmune hepatitis was observed in 2 patients. The definitive cause of cirrhosis was unclear in 68 (58%) of the patients. Incidental malignant and premalignant lesions were observed in 15 patients. Conclusions. Histopathological examination of the explanted liver after liver transplantation in those patients with cryptogenic cirrhosis may significantly help to diagnose the cause of cirrhosis, such as nonalcoholic steatohepatitis or autoimmune hepatitis, with using the scoring system developed by the International Autoimmune Hepatitis Workgroup. In addition, incidental malignant or premalignant lesions may be observed.Öğe Intraperitoneal rupture of the hydatid cyst disease: Single-center experience and literature review(2020) Koç, Cemalettin; Akbulut, Ahmet Sami; Şahin, Tevfik Tolga; Tuncer, Adem; Yılmaz, SezaiAbstract: BACKGROUND: The primary aim of this study was to present our experience in the intraperitoneal rupture of the hydatid cyst in the guidance of literature data. METHODS: Demographical, clinical, radiological and postoperative follow-up data of 29 patients who underwent surgical treatment in our institution with the diagnosis of intraperitoneal rupture of the hydatid cyst from January 2003 to July 2020 were analysed retrospectively in this study. RESULTS: Among the 29 patients with an age range of from 16 to 79 years (median= 39, IQR=25.5), 16 were male (55.2%), and 13 were female (44.8%). Intraperitoneal rupture of the hydatid cyst was spontaneous in 21 (72.4%), traumatic in seven (24.13%) (two of them were iatrogenic) and was due to shotgun in one patient. Vast majority of the patients were admitted to the emergency department in the first 24 hours after the onset of sign and symptoms. WBC varied from 8.600 to 30.900/mm3 (median=12.100, IQR=5.7). Ruptured cysts were localised in liver (n=25, 86.2%), in spleen (n=2, 6.89%) or in pelvis (n=2, 6.89%) and diameter varied from 40 to 200 mm (median=90, IQR=50). Among the cysts ruptured in liver, 19 (76%) of them were localised in the right lobe. Among the ruptured cysts of the liver, 20 (80%) of them underwent conservative surgery (e.g., partial pericystectomy), the remaining five patients (20%) underwent a radical surgical treatment (e.g., pericystectomy). A biliary orifice was diagnosed during surgical exploration in either cyst cavity or cut surface of the liver in 12 (48%) of the patients. Patients with a dilated common bile duct or a visible biliary duct orifice in cystic cavity underwent common bile duct exploration and T-tube drainage procedure (n=6, 24%). One patient died on postoperative day one, due to cardiopulmonary complications secondary to cyst rupture. All along the postopeartive follow-up of median 1416 days, seven (24.1%) patients were diagnosed for diseased recurrence. CONCLUSION: Intraperitoneal rupture of the hydatid cyst is a life-threatening complication of hydatid cyst disease, for which diagnosis without delay and timing of surgical treatment is essential. Anaphylactic shock require rapidly initiation of medical treatment against allergic reactions. Despite scolocidal agents, vesicular spread into peritoneal cavity accounts for the major risk factor for disease recurrence. Hence, abdominal cavity should be explored cautiously.Öğe An investigation into the factors predicting acute appendicitis and perforated appendicitis(2021) Akbulut, Sami; Koç, Cemalettin; Şahin, Tevfik Tolga; Şahin, Emre; Tuncer, Adem; Demyati, Khaled; Şamdancı, Emine Türkmen; Çolak, Cemil; Yılmaz, SezaiBACKGROUND: To investigate the factors predicting acute appendicitis (AAp) and perforated AAp in patients who underwent surgery with a preliminary diagnosis of AAp. METHODS: Between May 2009 and December 2018, 1316 patients underwent appendectomy with a presumed diagnosis of AAp. To investigate the factors predicting AAp, patients were divided into two groups considering the histopathological presence of inflammatory changes in the appendix: AAp positive (AAp group; n=1043) and AAp negative (Non-AAp group; n=273). Also, to investigate the factors predicting appendiceal perforation, patients with AAp were divided into two groups considering the presence of perforation: non-perforated AAp (n=850) and perforated AAp (n=193). ROC curve analysis was used to identify optimum cut-off values of quantitative variables. The groups were compared using univariate analysis methods and parameters with a p? 0.20 were taken into a multivariate logistic regression model. RESULTS: Multivariate analysis method related to factors predicting AAp showed that gender (male; p=0.034; OR=1.4), WBC (?10.900; p=0.022; OR=1.5), MPV (?29.1; p=0.006; OR=1.6), TBil (?0.61; p=0.034; OR=1.4), CRP (?0.725; p=0.002; OR=1.7), NLR (?5.13; p=0.034; OR=1.5), PNR (<24.04; p=0.001; OR=1.9) and US findings (AAp+; p<0.001; OR=2.9) were independent factors for predicting AAp. Multivariate analysis method related to factors predicting appendiceal perforation showed that age (?32 years; p<0.001; OR=2.5), TBil (?0.67; p=0.046; OR=1.5), CRP (?3.75; p<0.001; OR=3.0) and NLR (?5.69; p=0.006; OR=1.8) were independent factors for predicting perforated AAp. CONCLUSION: We believe that predicting both AAp and perforation will help the clinician evaluate patients who applied to the emergency unit with presumed diagnosis AAp. This approach will also contribute to reducing the negative appendectomy and perforation rates.Öğe Kadavra donörlerde standart harvesting tekniği ile modifiye standart harvesting tekniğinin karşılaştırılması(İnönü Üniversitesi, 2012) Koç, CemalettinGeleneksel olarak, beyin ölümü olmuş hastalar donör olarak kullanılırken, organ alımı için sternotomi ve laparatomi yapılır, ancak sternotomi olmadan da karın içi organların almak mümkündür. Bu çalışmada sternotomi yapılan - yapılmayan, beyin ölümü olmuş donörlerden organ çıkarımını değerlendirip karşılaştırılacağız. Yöntemler: Şubat 2006 ve Kasım 2011 tarihleri arasında, Turgut Özal Tıp Merkezi organ nakli ekibi tarafından 68 beyin ölümü olmuş donörden organ çıkarıldı. Bu kadavralardan organ çıkarım işleminde, standart harvesting tekniği kullanılan (sternotomili) 31 donör grup A, modifiye standart harvesting tekniği kullanılan (sternotomi olmadan) 37 donör grup B olarak tanımlanmıştır. Ortalama yaş, cinsiyet, vücut kitle indeksi (VKİ) ve soğuk iskemi zamanı her iki grupta retrospektif olarak karşılaştırıldı. Demografik ve klinik parametreleri Student t-testi ve Ki-kare testi kullanılarak karşılaştırıldı. Istatistiksel anlamlılık düzeyi p <0.05 olarak belirlendi. Sonuçlar: Organ çıkarımında, % 45.6 (n=31) sternotomili (grup A), % 54.4'ü (n=37) sternotomisiz (grup B) teknik uygulandı. Donörlerin % 53'ü (n=36) erkek ve % 47'si (n=32) kadındı. Yaş ortalaması, grup A'da 40.4 ± 3.4 yıl ve grup B'de 52.4 ± 4.6 yıl (p <0.02) idi. Donörlerin ortalama VKİ, grup A'da 26.2 ± 0.8 kg/m2, grup B'de 23.9 ±0.8 kg/m2 idi. Soğuk iskemi için ortalama süreler, grup A'da 127±6.2 dakika ve grup B'de 47.5 ± 1.8 dakika olarak saptandı (p <0.0001). SONUÇ: Beyin ölümü olmuş unstabil donörlerden, toraks içi organlar kullanılmayacaksa, sternotomi yapılmadan organların çıkarılması soğuk iskemi için geçiş süresini kısaltabilir.Öğe Karaciğer nakli alıcılarında herpes simpleks virüs viremisinin tanısı, klinik görünümleri ve tedavi yönetimi(2021) Köse, Adem; Toplu, Sibel; Gönültaş, Fatih; Koç, Cemalettin; Yakupoğulları, Yusuf; Otlu, Barış; Şamdancı, Emine TürkmenAim: We aimed to evaluate the clinical variations, possible risk factors and results of diagnostic procedures in liver transplant (LT) recipients who suffered from Herpes Simplex Virus (HSV) viremia in the post-transplant period, despite Cytomegalovirus (CMV) prophylaxis. Material and methods: The data of 1100 LT recipients were evaluated retrospectively. HSV DNA RT-PCR detected in blood and vesicular fluid samples of the patients with active painful mucocutaneous vesicular lesions and patients with organ involvement who had biopsy and confirmed HSV viremia were included in the study. The 110 recipients diagnosed with HSV viremia were included. Results: In 110 recipients, total 130 HSV viremia episodes were observed over sixty months. HSV viremia rate was 11.8%. Of the 130 HSV episodes, 120 (92.3%) were mucocutaneous form of the disease. In 10 cases, there was a specific organ involvement. HSV-1 was detected in all of viremia episodes. Sixty-four (49.2%) episodes developed six months after the LT, 41 (31.5%) episodes developed between the 1st and 6th months after LT, and 25 (20.3%) episodes were observed within the first postoperative month. All episodes were treated successfully with different antiviral therapy modalities. Conclusion: Despite CMV prophylaxis performed, HSV viremia may be occurred as a wide range of clinical presentation in LT recipients. It can be seen at any time point after the LT. HSV DNA RT-PCR from serum samples may not be sufficient for diagnosis of viremia, therefore the analysis of the vesicular fluid or the biopsy from the organs may be necessary for supporting the diagnosis.Öğe Karaciğer ve Kolon Malignitesini Taklit Eden Fasiyoliyaz: Üç Olgu Sunumu(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2010) İnce, Volkan; Ara, Cengiz; Koç, Cemalettin; Ersan, Veysel; Barut, BoraFasiyoliyaz tüm dünyada birçok memeli türü konakçılarını enfekte eden zoonotik bir hastalıktır. Türkiye’yi de içine alan Uzak ve Orta Doğu’nun bazı bölümlerinde endemik olarak bildirilen insan fasiyoliyazı, nadir karşılaşılan bir parazitik enfeksiyondur. Parazitin karaciğer dışı yerleşimi çok nadirdir. Günümüze kadar subkütan dokuda, beyinde, akciğerde, epididimde, inguinal lenf bezlerinde ve mide ve kolon gibi gastrointestinal sistemde, karaciğer dışı fasiyoliyazı bildirilmiştir. Bu makalede karaciğer ve kolon malignitesini taklit eden fasiyoliyazlı üç hasta sunulmaktadır.Öğe Kolon Volvulusunda Cerrahi Tedavi: Altı Yıllık Deneyimimiz(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2013) Ateş, Mustafa; Hatipoğlu, Sinan; Dirican, Abuzer; Koç, Cemalettin; Işık, Burak; Yılmaz, MehmetAmaç: Kolon volvulusları acil tedavi gerektiren bir akut batın sebebidir. Tedavide endoskopik dekompresyon gibi nonoperatif girişimler de kullanılmakla beraber gerçek tedavi cerrahidir. Bu çalışmada kolon volvulusu nedeniyle ameliyat edilen olguların sonuçlarının değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Ocak 2005- Mayıs 2011 tarihleri arasında İnönü Üniversitesi Tıp Fakültesi Genel Cerrahi Kliniğinde, kolon volvulusu tanısı ile cerrahi tedavi edilen hastaların dosyaları geriye dönük olarak incelendi. Bulgular: Ameliyat edilen 62 hastanın 55’i (%87,3) erkek, 8’i (%12,7) kadın olup ortalama yaş 67,3 (20-94 arası) idi. Sigmoid kolon volvulusu 62 hastada mevcutken, 1 hastada ise çekal volvulus mevcut idi. Sigmoid kolon volvulusu olan 20 (%31,7) hastaya başlangıç tedavisi olarak endoskopik dekompresyon uygulandı. Endoskopik yaklaşımla 11(%55) hastada başarılı dekompresyon sağlandı. 27 (%42,9) olguya rezeksiyon ve kolostomi, 33 (%52,3) olguya rezeksiyon ve anastomoz, çekal volvulus bulunan 1 (%1,6) olguda sağ hemikolektomi+ileotransversostomi, 1 (%1,6) olguda cerrahi dekompresyon ve 1 (%1,6) olguda ise cerrahi dekompresyon ve sigmoidopeksi yapıldı. Mortalite 4 (%6,3) olguda görüldü. Sonuç: Kolon volvulusu cerrahisinin zamanlaması ve uygun seçenekleri için hastanın klinik durumu göz önünde tutulmalı, uygun vakalarda cerrahi öncesi endoskopik dekompresyon teknikleri de uygulanmalıdırÖğe Laparoscopic Transanal Endoscopic Microsurgery via Single-Port: A Case Report(Turgut Özal Tıp Merkezi Dergisi, 2015) Gönültaş, Fatih; Koç, Cemalettin; Hatipoğlu, Sinan; Yönder, Hüseyin; Karakaş, Serdar; Ateş, Mustafa; Dirican, AbuzerÖz: Transanal endoskopik mikrocerrahi, rektumda bulunan patolojiler için minimal invaziv bir girişim olup, tek portun transanal endoskopik mikrocerrahide kullanımı mümkündür. Bu çalışmada, merkezimizde ilk kez tek port transanal laparoskopik cerrahi yöntemi ile yaptığımız rektal polip eksizyonu olgusunun sunumunu amaçlandık. Tek port, anal kanala yerleştirildikten sonra perianal bölgeye sütürlerle tespit edildi. Standart ve açılı laparoskopik cerrahi aletler yardımı ile rektumdaki polip rezeksiyonu tam kat gerçekleştirildi. Operasyon sonrası komplikasyon gelişmeyen hasta postoperatif birinci günde taburcu edildi. Histopatolojik incelemede, fokal yüksek dereceli displazi tespit edilen rezeksiyon materyalinin cerrahi sınırları negatif idi. Sonuç olarak, rektal polip rezeksiyonunun, anal kanala tek port uygulanarak laparoskopik cerrahi el aletleri yardımıyla rezeksiyonunun mümkün ve güvenli olduğu görüldü.Öğe Liver transplant versus non-liver transplant patients underwent appendectomy with presumed diagnosis of acute appendicitis: Case-control study(2020) Barış Sarıcı, Kemal; Akbulut, Ahmet Sami; Koç, Cemalettin; Tuncer, Adem; Yılmaz, SezaiAbstract: BACKGROUND: This study aims to compare liver transplant and non-liver transplant patients who underwent appendectomy with a presumed diagnosis of acute appendicitis. METHODS: Demographic and clinicopathological features of 13 liver transplant recipients (transplant group) who underwent posttransplant appendectomy with a presumed diagnosis of acute appendicitis were compared with the features of 52 non-liver transplant patients (non-transplant group). They underwent appendectomy with a presumed diagnosis of acute appendicitis during the same time period. The transplant group was matched at random in a 1: 4 ratio with the non- transplant group. While the continuous variables were compared using the Mann Whitney-U test, categorical variables were compared with Fisher’s exact test. A p-value of less than 0.05 was considered statistically significant. RESULTS: A total of 65 patients aged between one year and 84 years were included in this study. While the age of the 52 patients (32 male and 20 female) in the non- transplant group ranged from 17 years to 84 years, the age of the 13 patients (nine male and four female) in the transplant group ranged from one year to 64 years. Statistically significant differences were noted between both groups concerning WBC (p=0.002), neutrophil (p=0.002), lymphocyte (p=0.032), platelets (p=0.032), RDW (p=0.001), CRP (p=0.009), PNR (p=0.042), WNR (p=0.03), and appendiceal length (p<0.001). The negative appendectomy rate was relatively higher in transplant than the non-transplant group but this difference was not statistically significant (30.8% vs. 21.2%; p=0.477). Perforated acute appendicitis occurred more frequently in the transplant group; however, this difference was not statistically significant (30.8% vs. 9.6%; p=0.070). CONCLUSION: WBC and neutrophil were lower in the LT group; however, the CRP and RDW were higher in the LT group. Further, perforation and negative appendectomy rates were higher in the LT group, although this difference was not statistically significant.Öğe Non-Operative Treatment of Intraabdominal Hemorrage due to Warfarin Use: Two Patient Reports(2014) Barut, Bora; İnce, Volkan; Koç, Cemalettin; Yönder, Hüseyin; Dirican, Abuzer; Ateş, MustafaAbstract: Warfarin, K vitaminine bağımlı koagulasyon faktörlerinin inhibisyonuna neden olarak etki gösteren potent bir antikoagulan ajandır ve en tehlikeli yan etkisi kanamadır. Kardiak kapak replasmanı, geçirilmiş derin ven trombozu, pulmoner emboli profilaksisi ve karotis arter trombozu olan hastalarda serebrovasküler hastalık riskini azaltmak amacıyla sıklıkla kullanılmaktadır Warfarin kullanımına bağlı tüm vücut boşluklarında istenmeyen kanamalar meydana gelebilir ve zaman zaman mortal seyreden komplikasyonlara neden olabilir. İntraabdominal, retroperitoneal, intramural, intraluminal, rektus kası içine olan kanamaları olan hastalar akut karın tablosu ile hastaneye başvurabilirler. Bu hastalar için tedavi seçenekleri operatif ve non-operatif olabilir. Bu çalışmada non-operatif izlemle tedavi ettiğimiz, warfarin kullanımına bağlı gelişen intraabdominal kanamalı 2 olguyu litaratür bilgileri eşliğinde sunmayı amaçladık.Öğe Parenteral Beslenme Komplikasyonu Olarak Wernicke Ensefalopatisi(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2011) İnce, Volkan; Kablan, Yüksel; Pişkin, Turgut; Kayaalp, Cüneyt; Ersan, Veysel; Koç, CemalettinHere we described a case of Wernicke’s encephalopathy with thiamin (vitamin B1) deficiency after a prolonged postoperative parenteral nutritional. A 55-year-old male patient with total gastrectomy for gastric cancer had a postoperative intestinal fistula and required a long-term parenteral nutrition. During the treatment, he developed sudden confusional state, ophtalmoplegy, truncal ataxia, hypothermia and hypotension. Wernicke's encephalopathy was diagnosed after neurological evaluation and magnetic resonance imaging. We observed a dramatic response to thiamine replacement, his symptoms recovered quickly and the patient was discharged without any sequelae. Wernicke’s encephalopathy should be considered in the differential diagnosis of the surgical patients with neurological complications, and when suspected early support of thiamine should be provided. In addition, vitamin preparations should be routinely added to solutions of parenteral nutrition.Öğe Percutaneous dilatation tracheostomy at liver transplantation intensive care unit by surgeons(2020) Koç, CemalettinAbstract: Aim: Tracheostomy has evolved to be a routine procedure for prolonged mechanical ventilation patients in the intensive care unit. We aimed to analyze retrospectively our patients underwent percutaneous dilatation tracheostomy due to prolonged mechanical ventilation following liver transplantation. Material and Methods: Data of 34 patients who underwent percutaneous dilatation tracheostomy by general surgeons due to prolonged mechanical ventilation following liver transplantation were analyzed and evaluated retrospectively. Results: Patients did not experience any complications except minor bleeding following liver transplantation. Besides this technique facilitated patient compliance as well as comfort, which were essential during an accurate weaning process. Conclusion: Percutaneous dilatation tracheostomy is a safe method due to its low complication rate and easy applicability in hands of surgeons who are familiar with the neck anatomy.Öğe Plastron apandisiti taklit eden nadir bir akut karın nedeni: Çekum non-hodgkin lenfoması(2016) Barut, Bora; İnce, Volkan; Ersan, Veysel; Koç, Cemalettin; Özdemir, FatihÖz: Primer gastrointestinal lenfoma, ekstranodal yerleşimli lenfomaların en sık görülen şekli olmasına karşın, gastrointestinal sistemin nadir görülen tümörüdür. En sık görülen kolon lenfoması non-Hodgkin lenfomadır, kolonda en sık çekum tutulumu gözlenir. Biz burada akut batın bulguları ile seyreden ve karaciğere metastaz yapmış olan çekum lenfolmalı bir hastayı sunuyoruz.Altmışüç yaşında erkek hasta. Yaklaşık üç haftadır devam eden karın ağrısı, ishal ve karın sağ alt kadranda kitle şikayeti ile hastanemize başvurmuş. Çekilen multisilice tomografi'de karında kitle görünümü tespit edildi. Hastanın takiplerinde genel durumunun bozulması nedeniyle acil operasyona alındı. Ameliyat esnasında çekumda kitle ve karaciğerde iki adet metastatik lezyon izlendi. Hastaya sağ hemikolektomi ve karaciğer metastazektomi yapıldı. Çıkarılan spesmen patoloji sonucu B hücreli lenfoma olarak rapor edildi. Hasta ameliyat sonrası 13. gün pnomoni ve akut respiratuar distres sendromu (ARDS) nedeniyle kaybedildi.Primer gastrointestinal lenfomaların tedavisinde cerrahi, kemoterapi ve radyoterapi başlıca tedavi seçenekleri olmasına karşın hangisinin öncelikli olduğu hala tartışmalıdır.Öğe Scar Endometriosis: A Rare Cause of Pain at Cesarean Scar(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2014) Koç, Cemalettin; Şimşek, Gürcan; İnce, Volkan; Esen, Ebru; Ünal, BülentScar endometriosis is a rare disease. The incidence rate is around %1,6. The aim of this paper is to investigate one of our patient’s symptoms along with the diagnosis methods and surgical therapy used with reference to the literature. A 21-year-old woman was presented with pain and swelling complaints on the cesarean scar. She stated that her complaints were increasing around menstrual cycle. Radiologic examinations showed a vascular, heterogeneous solid mass extending into the rectus muscle. After the excision of the mass, pathologic investigation reported the mass to be endometrioma. Scar endometriosis diagnosis is difficult and it is a rare clinical situation. Scar endometriosis should be considered for female patients with pain around hypertrophic scars probably related to pelvic surgery incisions. In these cases, the relationship between the size of the mass as well as the changes in pain severity with menstrual cycle should be examined.Öğe Sezeryan skarında ağrının nadir bir sebebi: skar endometriozis(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2014) Koç, Cemalettin; Şimşek, Gürcan; İnce, Volkan; Esen, Ebru; Ünal, BülentSkar endometriozis nadir görülen bir hastalıktır. İnsidansı yaklaşık olarak %1,6 civarındadır. Bu olgu sunumunda skar endometriozisi tanısı ile cerrahi tedavi uygulanan hastanın semptomlarının, tanı metodlarının ve uygulanan cerrahi tedavinin literatür eşliğinde irdelenmesi amaçlanmıştır. Yirmi bir yaşında bayan hasta sezeryan skarında ağrı ve şişkinlik yakınması ile başvurdu. Şikayetleri menstrüasyon döneminde artan hastanın radyolojik tetkiklerinde, rektus kası içine uzanan vasküler, heterojen solid kitle tespit edildi. Kitle total olarak eksize edildi. Kitlenin patolojik incelemesi endometrioma olarak rapor edildi. Skar endometriozisi tanısı zor olan ve nadir görülen bir klinik tablodur. Skar endometriozisi özellikle pelvik cerrahi insizyon hattında ortaya çıkan ağrılı ve hipertrofik skarlarda akılda tutulmalı ve kitlenin boyutu ve ağrı şiddetindeki değişikliklerin menstrüel siklusla ilişkisi sorgulanmalıdır.Öğe Subcutaneous emphysema following a gun shot(Turgut Özal Tıp Merkezi Dergisi, 2014) Barut, Bora; İnce, Volkan; Koç, Cemalettin; Karakaş, Serdar; Ünal, BülentSubcutaneous emphysema following a gun shot
