Deneysel kolit modeli üzerine glutamin, N-Asetil sistein ve intrarektal metotreksat'in etkilerin incelenmesi

TEZ7313Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 2009.Kaynakça (s.69-80) var.viii, 81 s. : rnk.res. ; 29 cm.Amaç: Bu çalışmada, TNBS ile oluşturulan deneysel kolit modeli üzerine N -Asetil sistein'in, glutamin'in ve metotreksat'ın etkilerini incelenmesi amaçlandı. Gereç ve yöntem: Bu amaçla 71 Wistar Albino rat kullanıldı. Kontrol grubuna serum fizyolojik dışında uygulama yapılmadı. Etanol grubuna, intrarektal etanol lavmanı verilerek, etkinliği değerlendirildi. NAC grubuna intraperitoneal NAC enjeksiyonu yapıldı. MTX grubuna intrarektal MTX verildi. GLN-NAC grubu deneklerin içme sularına 1g/kg olacak şekilde glutamin karıştırıldı ve intraperitoneal NAC enjeksiyonu yapıldı. GLN-MTX grubuna da içme sularına glutamin karıştırıldıktan sonra intrarektal MTX verildi. Deneyin başında ve sonunda ratların ağırlıkları kaydedildi. Deneyin sonunda, ratlar sakrifiye edildi. Distal kolon çıkarılarak, çalışmanın içeriğinden haberi olmayan, iki patolog tarafından makroskopik olarak değerlendirildikten sonra histopatolojik değerlendirme için patolojiye gönderildi. Antioksidan etkiyi değerlendirmek amacı ile SOD ve MDA seviyelerini ölçmek için hasarlanmış kolondan örnekler alındı.Purpose: In this study, it has been aimed to analyze the effects of N-Acetyl cysteine, glutamine and methotrexate on the experimental colitis model formed by use of TNBS. Materials and Method: For this purpose, 71 Wistar Albino rats have been used. No application except normal saline has been made on the control group. Ethanol group has been subjected to intrarectal ethanol enema, and its efficiency has been evaluated. Intraperitoneal NAC injection was made to the NAC group. Intrarectal MTX has been applied to the MTX group. 1g/kg glutamine has been added to the drinking water of the GLN-NAC experimental group's members; and intraperitoneal NAC injection has been made also for this group. Glutamine has also been added to the drinking water of the GLN-MTX group, and then the group has been subjected to intrarectal MTX. Weights of the rats have been recorded before and after the experiment. At the end of the experiment, the rats have been sacrificed. Distal colon has been removed and macroscopically analyzed by two pathologists who have not been informed about the concept of the study, and it has been sent to pathology for histopathological evaluation. In order to analyze antioxidant effect, samples from the damaged colon have been taken for measuring SOD and MDA levels.Bu çalışma Ç.Ü. Bilimsel Araştırma Projeleri Birimi Tarafından Desteklenmiştir. Proje No:TF2008LTP2

A rare hernia frequently diagnosed during surgery: Amyand's hernia

WOS: 000458742100046

Hydatid disease involvement of primary subcutaneous tissue in the posterior proximal thigh - an unusual localization

WOS: 000254501400024PubMed ID: 18377614

Adana’da (Türkiye) kolorektal kanser sıklığının anatomik lokalizasyon, yaş ve cinsiyete göre 15 yıllık zamansal değişimi: 1993-2008

Giriş ve Amaç: Kanser insidans hızlarının zamansal eğilimlerin analizi, önemli coğrafi farklılıkların yorumlanmasına yeni bakış açıları geliştirilmesini sağlayabilir. Bu çalışmada, Türkiye’nin Akdeniz Bölgesi’nde yer alan Adana’da kolon ve rektum kanser sıklığının anatomik lokalizasyon, cinsiyet ve yaş gruplarına göre 15 yıllık zamansal değişimi değerlendirilmiştir. Yöntem: Onbeş yıl (1993-2008) süresince topluma dayalı yerel kanser kayıt merkezinde histopatolojik tanı ile kaydedilen 47.783 kanser olgusu incelenmiş ve kolorektal kanser tanısı almış 2.749 (%5,8) vakada anatomik yerleşim ile cinsiyet ve yaş grubu arasındaki ilişki 5’er yıllık zaman dilimlerine göre analiz edilmiştir. Bulgular: Onbeş yıllık dönemde sağ kolon kanserlerinde anlamlı artış olduğu gözlenmektedir; (1993-1997 dönemi için %19.8, 1999-2003 için %24.4 ve 2004-2008 için %25.6) (p=0.048). Bu artış kadınlarda istatistiksel olarak anlamlı iken (p=0.041) erkeklerde anlamsızdır. Sağ kolon kanserleri, kadınlarda 50 yaş üzerinde artış gösterirken erkeklerde sadece 70 yaş üzeri grupta artış göstermektedir. Sağ kanserlerdeki artışa karşılık distal kanserlerde azalma görülmez iken her iki cinste de rektum kanserlerinde sürekli bir azalma olduğu görülmektedir. Sonuç: Çalışmada kolon kanserlerinin görülme sıklığının, batı toplumlarına göre daha düşük bulunmasına rağmen yıllar içinde sağ kolonda gözlenen artışın bu ülkelerdeki artışa benzer olduğu saptanmıştır. Sağ kolon kanserlerindeki artışının genç kadınlarda daha fazla olması, son on yılda kullanılan tanı yöntemlerinin farklılığına ve tanıda cinsiyet yanlılığına iflaret ediyor olabilir. Subsegmental kolorektal kanserlerin zamansal değişimi, farklı etiyolojik, demografik ve coğrafik faktörler ve tanı yöntemlerindeki gelişmeler ile ilişkili olabileceğini düşündürmektedir. Elde edilen bulgular, ayrıntılı analitik çalışmalara temel oluşturması ve konuya dikkat çekmesi için kanser hızlarındaki değişimlerin düzenli toplanan kanser istatistikleri ile yakından izlenmesinin önemine işaret etmektedir.Background/aims: Analyzing temporal trends in cancer incidence rates can generate new insights for the significance of geograp- hical and epidemiological variations of the disease. This study evaluated the time trends over a 15-year period in the frequencies of colon and rectum cancers at various subsites by gender and age. Materials and Methods: Data were obtained from a population- based cancer registry in Adana (a Mediterranean city of Turkey). Among the 47.783 microscopically-confirmed cancer cases during the 15-year period (1993 to 2008), 2.749 (5.8%) colorectal cancer cases were analyzed in three separate 5-year time periods. Results: The incidence of right-sided colon cancer was found to be increasing compared to the left-sided colon cancer (p=0.048) over time in total (19.8% in 1993-1997, 24.4% in 1999-2003, and 25.6% in 2004-2008). This proximal shift of cancers demonstrated a significant increase for females (p=0.041), but not for males. The incidence of right-sided colon cancer was found to increase in advanced age groups (over 70) of males and increase in younger age groups (over 50) of females. There was a corresponding continuous decline in the percentage of rectal cancer (not in distal cancers) in both genders. Conclusions: Although the frequency of colorectal cancer ca- ses was found to be lower in our country when compared to Western countries, a similar right-sided colon cancer shift was obser- ved. The apparent shift of colorectal cancer in young female patients may be related to the advances in diagnostic techniques and may indicate possible diagnostic bias for the female gender. These results also emphasize the importance of collecting regular can- cer statistics and of closer follow-up to generate basic epidemiological data and to draw attention to this issue in further detailed analytical research studies

Mide kanserini taklit eden primer mide tüberkülozu

Daha önceden herhangi bilinen bir hastalığı olmayan yemeklerden sonra epigastrik ağrı ve kilo kaybı şikayeti olan, radyolojik ve endoskopik olarak mide kanseri düşünülen ancak endoskopik biyopsi ile tanı konulamayan 42 yaşında kadın hastaya laparotomi ile primer mide tüberkülozu tanısı konuldu. Anti-tüberküloz tedavi sonrası klinik, radyolojik ve endoskopik tam yanıt elde edildi.A 42-year-old female patient with no previous known diseases who had complaints of postprandial epigastric pain and weight loss and who could not be diagnosed by endoscopic biopsy, although gastric cancer was suspected radiologically and endoscopically, was diagnosed with primary gastric tuberculosis by laparotomy and frozen section. Following anti-tuberculosis treatment, a complete clinical, radiological, and endoscopic response was achieved

Outcomes of Total Parathyroidectomy with Autotransplantation versus Subtotal Parathyroidectomy with Routine Addition of Thymectomy to both Groups: Single Center Experience of Secondary Hyperparathyroidism

Background:Secondary hyperparathyroidism is a common acquired disorder seen in chronic renal failure. It may result in potentially seri-ous complications including metabolic bone diseases, severe athero-sclerosis and undesirable cardiovascular events. Parathyroidectomy is required in about 20% of patients after 3-10 years of dialysis and in up to 40% after 20 years. Aims:The aim of the current study was to evaluate the short-term and long-term outcomes of patients with secondary hyperparathyroidism who had undergone total parathyroidectomy with autotransplantation and thymectomy or subtotal parathyroidectomy with thymectomy by the same surgical team during the study period. Study Design: Retrospective comparative study.Methods:Clinical data of 50 patients who underwent parathyroid surgery for secondary hyperparathyroidism between 2003 and 2011 were reviewed retrospectively. Patients were divided into two sub-groups of total parathyroidectomy with autotransplantation or sub-total parathyroidectomy. Thymectomy was routinely performed for both groups. Short term outcome parameters included intact parathy-roid hormone, ionized calcium and alkaline phosphatase levels. Bone pain, bone fractures, persistent or recurrent disease were included in long term outcome parameters.Results:The mean duration of dialysis was eight years. The mean ionized calcium levels dropped significantly in the total parathyroid-ectomy with autotransplantation group (p=0.016). No serious post-operative complications were observed. Postoperative intravenous calcium supplementation was required in four patients in the total parathyroidectomy with autotransplantation group (total PTX+AT) and in three patients in the subtotal parathyroidectomy group (subto-tal PTX). Postoperatively, all patients received oral calcium carbonate and calcitriol. The length of average hospital stay was 5 (3-10) days. Including nine patients who underwent successful renal transplanta-tion pre-operative bone symptoms, hypercalcemia, hyperphosphate-mia, and an increased alkaline phosphatase levels were improved or resolved in all patients. After a mean follow-up of 65 months, three patients (6%) had persistent and one (2%) had recurrent disease.Conclusion:Total parathroidectomy with autotransplantation is a beneficial and safe surgical procedure for patients on chronic di-alysis with otherwise uncontrollable secondary hyperparathroidism and even in patients who have undergone renal transplantation after parathyroidectomy. Careful cervical exploration and routine thymec-tomy should be considered as a routine part of the surgical approach regardless of the preferred techniqueBackground:Secondary hyperparathyroidism is a common acquired disorder seen in chronic renal failure. It may result in potentially seri-ous complications including metabolic bone diseases, severe athero-sclerosis and undesirable cardiovascular events. Parathyroidectomy is required in about 20% of patients after 3-10 years of dialysis and in up to 40% after 20 years. Aims:The aim of the current study was to evaluate the short-term and long-term outcomes of patients with secondary hyperparathyroidism who had undergone total parathyroidectomy with autotransplantation and thymectomy or subtotal parathyroidectomy with thymectomy by the same surgical team during the study period. Study Design: Retrospective comparative study.Methods:Clinical data of 50 patients who underwent parathyroid surgery for secondary hyperparathyroidism between 2003 and 2011 were reviewed retrospectively. Patients were divided into two sub-groups of total parathyroidectomy with autotransplantation or sub-total parathyroidectomy. Thymectomy was routinely performed for both groups. Short term outcome parameters included intact parathy-roid hormone, ionized calcium and alkaline phosphatase levels. Bone pain, bone fractures, persistent or recurrent disease were included in long term outcome parameters.Results:The mean duration of dialysis was eight years. The mean ionized calcium levels dropped significantly in the total parathyroid-ectomy with autotransplantation group (p=0.016). No serious post-operative complications were observed. Postoperative intravenous calcium supplementation was required in four patients in the total parathyroidectomy with autotransplantation group (total PTX+AT) and in three patients in the subtotal parathyroidectomy group (subto-tal PTX). Postoperatively, all patients received oral calcium carbonate and calcitriol. The length of average hospital stay was 5 (3-10) days. Including nine patients who underwent successful renal transplanta-tion pre-operative bone symptoms, hypercalcemia, hyperphosphate-mia, and an increased alkaline phosphatase levels were improved or resolved in all patients. After a mean follow-up of 65 months, three patients (6%) had persistent and one (2%) had recurrent disease.Conclusion:Total parathroidectomy with autotransplantation is a beneficial and safe surgical procedure for patients on chronic di-alysis with otherwise uncontrollable secondary hyperparathroidism and even in patients who have undergone renal transplantation after parathyroidectomy. Careful cervical exploration and routine thymec-tomy should be considered as a routine part of the surgical approach regardless of the preferred techniqu

Aksilla tutulumu olmayan erken evre meme kanserli hastalarda, sentinel lenf nodu biyopsisinin güvenilirliğive etkinliğinin değerlendirilmesi

Amaç: Bu çalışmada klinik olarak aksilla negatif erken evre meme kanserli hastalarda sentinel lenf nodu biyopsisinin etkinliği araştırıldı. Yöntemin sen- tinel lenf nodunu bulma ve yanlış negatiflik oranları hesaplanarak erken evre meme kanserli hastalarda aksillanın değerlendirilmesinde sentinel lenf nodu biyopsisinin yerinin belirlenmesi amaçlandı. Gereç ve Yöntem: Bu prospektif çalışma, erken evre meme kanseri tanısıyla Mart 2006 – Mart 2009 tarihleri arasında Çukurova Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı’nda tedavi edilen 57 hastada yapıldı. Hastalar iki farklı gruba ayrıldı. Grup I’de 35 hastada mavi boya tekniği, Grup II’de 22 has- tada kombine teknik uygulandı. İnvaziv kanser saptanan 46 hastaya sentinel lenf nodu biyopsisi sonrası aksiller lenf nodu diseksiyonu yapıldı. Bulgular: Grup I’de 2 hastada, Grup II’de 1 hastada olmak üzere toplam 3 hastada sentinel lenf nodu saptanamadı. Sentinel lenf nodu bulma oranı tüm hastalar için %94,7 olup bu oran Grup I’de %94,2 , Grup II’de %95,4 idi. Yanlış negatiflik oranı Grup I’de %22,2 , Grup II’de %30 olup tüm hastalar için %26,3 idi. Tekniği öğrenme sürecindeki ilk 15 olgu değerlendirme dışı bırakıldığında tüm grupta sentinel lenf nodu bulma oranı %96,8’e yükselirken yanlış negatiflik oranı %0’a geriledi. Sonuç-Yorum: Bu çalışmada erken evre meme kanserli hastalarda aksillanın evrelemesinde sentinel lenf nodu biyopsisinin etkin ve güvenli bir yöntem olduğu belirlendi. Her merkezin yeterli deneyim kazanıncaya kadar, sentinel lenf nodu biyopsisi ile aksiller lenf nodu diseksiyonunu beraber yapmasının daha güvenli olacağı düşünüldü.Purpose: In this study, sentinel lymph node identification and false negative rates were calculated and determination of the place of sentinel lymph node biopsy in the evaluation of axilla in patients with early stage breast cancer was aimed. Materials and Methods: This prospective study was performed on 57 patients with early stage breast cancer who were treated at the Department of Sur- gery in Medical Faculty of Çukurova University between 2006-2009. Blue dye technique was performed in 35 (Group I ) and the combined technique was performed in 22 patients (Group II). Axillary lymph node dissection was per- formed after sentinel lymph node biopsy on 46 patients who have invasive breast cancer. Results: Sentinel lymph node was not detected in two patients in Group I and one in Group II. Sentinel lymph node identification rate was 94.7% for all pa- tients, and it was 94.2% in Group I and 95.4% in Group II. False negative rate was 26.3% for all patients which was 22.2% in Group I and 30.0% in Group II. Sentinel lymph node identification rate was increased to 96.8% and false negative rate decreased to 0% when the first 15 patients within the learning period was excluded from the statistical analysis. Conclusion: Sentinel lymph node biopsy is a safe and effective technique on staging of axilla in patients with early stage breast cancer. Nevertheless, every medical center should perform sentinel lymph node biopsy and axillary lymph node dissection together untill getting experienced

Comparison of open and laparascopic splenectomy in elective cases

WOS: 000458742100026Purpose: The aim of this study was to compare open splenectomy (OS) and laparoscopic splenectomy (LS) in patients undergoing elective splenectomy. Materials and Methods: The study included 95 patients who underwent elective splenectomy between January 1, 2013 and January 1, 2018 in the Department of General Surgery, Faculty of Medicine, cukurova University. Demographic information, etiology, duration of operation, amount of blood loss and preoperative spleen size were measured. The necessity to switch from laparoscopic surgery to open surgery, duration of hospitalization, postoperative blood products replacement and postoperative complications were examined. Results: A total of 95 patients, 79% (n=75) who underwent OS, and 21% (n=20) who underwent LS were included in our study. The mean age in the study group was 43.0 +/- 17 (18-78) for OS and 39.3 +/- 13.9 in LS (1962). Of the patients who underwent OS, 31 were male (41.3%) and 44 were female (58.7%). Of the patients who underwent LS, 7 were male and 13 were female (65%). Of the 75 cases who underwent OS; 19 (25.3%) were treated for splenomegaly, 16 (21.3%) for immune thrombocytopenic purpura (ITP), 11 (14.7%) for a mass, and 7 (9.3%) cases were operated on for Thalassemia. Of the 20 cases who underwent LS; 12 (60%) cases were operated on for ITP, 3 (15%) cases for hemolytic anemia and 2 (10%) cases for lymphoma.The length of hospital stay, amount of bleeding and spleen size were superior in LS; while the duration of surgery was significantly higher in OS. Conclusion: LS is a stronger alternative to OS because of its lower complication rate, hospitalization time and cost

The Effect of Lymph Node Dissection on Gallstone Formation in Patients Undergoing Total Gastrectomy for Gastric Adenocarcinoma

WOS: 000485683800007Objective: Formation of gallbladder stone is frequently observed after resection for gastric cancer. Extended lymph dissection is shown to be among risk factors. Materials and Methods: We compared patients with limited lymphatic dissection (D1) and extended lymphatic dissection (D2) in terms of gallstone formation and complications. Results: We observed gallbladder stone formation in 13 (12.8%) patients. Gallbladder stone formation was observed in 11.1% of patients in the D1 group and in 14.3% of patients in the D2 group, but no statistically significant difference was found between lymphatic dissections. Of 13 patients, 5 (38.4%) were symptomatic and 3 (23.1%) developed choledocholithiasis. Five patients who were symptomatic were operated without any problems. The groups did not show a statistically significant difference in terms of cumulative survival times. While patients who underwent D2 dissection had more formed gallbladder stone, there were no significant differences between the groups. Conclusion: The complications related to gallbladder stone developed after gastrectomy can be safely managed