Kolesistektomi esnasında laparoskopik cerrahiden açık cerrahiye geçişi etkileyen risk faktörleri

Objective: Laparoscopic cholecystectomy has obvious advantages over open surgery, such as shorter hospital stay, lower morbidity, better cosmetic results and faster return to daily activities. However, in some cases, conversion to open technique may be inevitable for patient safety or for the management of complications having occurred. Although various risk factors have been identified in many studies, variables such as technical facilities, surgical technique and experience affect risk factors. Our study aims to identify these risk factors. Method: In this study, 2,483 cholecystectomy cases performed in the general surgery clinic of our hospital between December 2013 and 2016 were retrospectively analyzed. 110 cholecystectomy cases initiated with open surgery and performed during another operation were excluded from the study, and 88 patients who were started laparoscopic surgery and converted to open surgery were selected for the study. Information on the demographic and clinical characteristics of the patients was obtained from hospital records. The data of an equal number of consecutively selected patients from the patients who were completed laparoscopically were obtained and compared, and whether these factors had a significant effect on conversion to open surgery was evaluated. Results: The rate of conversion from laparoscopic cholecystectomy to open surgery was 3.7%. The most common reason for conversion to open surgery was adhesion due to inflammation (n=65, 73.9%). While male gender, advanced age, diabetes, median incision above the umbilicus, multiple millimetric calculus and increased wall thickness in ultrasonography had a significant effect on the conversion to open surgery (p<0.001), there was no significant correlation with body mass index, pancreatitis, cholangitis, endoscopic retrograde cholangiopancreatography or abdominal surgery, anesthesia evaluation score and laboratory values (p>0.05). The durations of hospitalization and operation were found to be significantly longer in the open group (p<0.001). Conclusion: Male gender, advanced age, presence of diabetes, presence of supra-umbilical median incision, multiple millimetric calculus and increased wall thickness in ultrasonography are associated with increased rates of conversion from laparoscopic cholecystectomy to open surgery. If the coexistence of parameters that we find significant is detected in the preoperative period, it may be possible to take precautions such as involving the experienced surgical team in the operation, planning the operating room, and providing more detailed information to the patient.Amaç: Laparoskopik kolesistektominin, ameliyat sonrası daha kısa hastanede kalış süresi, daha düşük morbidite, daha iyi kozmetik sonuçlar ve günlük aktivitelere daha hızlı dönebilme sağlaması gibi avantajları ile açık cerrahiye göre üstünlüğü aşikardır. Ancak bazı durumlarda açık tekniğe geçmek hasta güvenliği veya meydana gelmiş olan komplikasyonu yönetmek için kaçınılmaz olabilmektedir. Birçok çalışmada çeşitli risk faktörleri tanımlanmış olsa da teknik imkanlar, cerrahi teknik ve tecrübe gibi değişkenler risk faktörlerini etkilemektedir. Çalışmamız bu risk faktörlerinin tespit edilmesini amaçlamaktadır. Yöntem: Çalışmada Aralık 2013-2016 tarihleri arasında hastanemiz genel cerrahi kliniğinde gerçekleştirilmiş 2,483 kolesistektomi olgusu retrospektif olarak incelenmiştir. Açık cerrahiyle başlanan ve başka bir operasyon sırasında uygulanan 110 kolesistektomi olgusu çalışma dışı bırakılarak, laparoskopik başlayıp açık cerrahiye geçilen 88 hasta araştırma için seçilmiştir. Hastaların demografik ve klinik özelliklerine ait bilgiler hastane kayıtlarından elde edilmiştir. Laparoskopik tamamlanan hastalardan ardışık seçilen eşit sayıda hastanın verileri elde edilerek karşılaştırılmış, bu faktörlerin açığa geçişe anlamlı etkisi olup olmadığı değerlendirilmiştir. Bulgular: Laparoskopik kolesistektomiden açığa geçiş oranı %3,7, en sık açığa geçiş nedeni ise enflamasyona bağlı adezyon (n=65, %73,9) olarak bulunmuştur. Açığa geçiş üzerine erkek cinsiyet, ileri yaş, diyabet, göbek üstü medyan kesi, ultrasonografide multipl milimetrik kalkül ve duvar kalınlık artışı olmasının anlamlı etkisi olduğu tespit edilirken (p<0,001), vücut kitle indeksi, pankreatit, kolanjit, endoskopik retrograd kolanjiopankreatikografi ya da batın operasyonu geçirmiş olma öyküsü, anestezi değerlendirme skoru ve laboratuvar değerleri ile anlamlı ilişki tespit edilmemiştir (p>0,05). Yatış ve operasyon süreleri açığa geçilen grupta anlamlı olarak daha uzun bulunmuştur (p<0,001). Sonuç: Erkek cinsiyet, ileri yaş, diyabet varlığı, göbek üstü medyan kesi varlığı, ultrasonografide multipl milimetrik kalkül ve duvar kalınlık artışı olması artmış açığa geçiş oranları ile birliktedir. Anlamlı bulduğumuz parametrelerin birlikteliğinin preoperatif dönemde tespit edilmesi halinde zor kolesistektomi olabileceği ve açığa geçiş riskinin artabileceği düşünülerek eğitim olgusu olarak seçilmeyerek tecrübeli cerrahi ekibin ameliyata dahil edilmesi, ameliyathanenin planlanması, hastaya daha ayrıntılı bilgi verilmesi gibi önlemleri almamız mümkün olabilmektedir

Risk Factors Effecting Conversion from Laparoscopic Cholecystectomy to Open Surgery

Objective:Laparoscopic cholecystectomy has obvious advantages over open surgery, such as shorter hospital stay, lower morbidity, better cosmetic results and faster return to daily activities. However, in some cases, conversion to open technique may be inevitable for patient safety or for the management of complications having occurred. Although various risk factors have been identified in many studies, variables such as technical facilities, surgical technique and experience affect risk factors. Our study aims to identify these risk factors.Method:In this study, 2,483 cholecystectomy cases performed in the general surgery clinic of our hospital between December 2013 and 2016 were retrospectively analyzed. 110 cholecystectomy cases initiated with open surgery and performed during another operation were excluded from the study, and 88 patients who were started laparoscopic surgery and converted to open surgery were selected for the study. Information on the demographic and clinical characteristics of the patients was obtained from hospital records. The data of an equal number of consecutively selected patients from the patients who were completed laparoscopically were obtained and compared, and whether these factors had a significant effect on conversion to open surgery was evaluated.Results:The rate of conversion from laparoscopic cholecystectomy to open surgery was 3.7%. The most common reason for conversion to open surgery was adhesion due to inflammation (n=65, 73.9%). While male gender, advanced age, diabetes, median incision above the umbilicus, multiple millimetric calculus and increased wall thickness in ultrasonography had a significant effect on the conversion to open surgery (p0.05). The durations of hospitalization and operation were found to be significantly longer in the open group (p<0.001).Conclusion:Male gender, advanced age, presence of diabetes, presence of supra-umbilical median incision, multiple millimetric calculus and increased wall thickness in ultrasonography are associated with increased rates of conversion from laparoscopic cholecystectomy to open surgery. If the coexistence of parameters that we find significant is detected in the preoperative period, it may be possible to take precautions such as involving the experienced surgical team in the operation, planning the operating room, and providing more detailed information to the patient

Genetic polymorphism in the serotonin transporter gene-linked polymorphic region and response to serotonin reuptake inhibitors in patients with premature ejaculation

OBJECTIVES: Serotonin plays a central role in ejaculation and selective serotonin reuptake inhibitors have been successfully used to treat premature ejaculation. Here, we evaluated the relationship between a polymorphism in the serotonin transporter gene-linked polymorphic region (5-HTTLPR) and the response of patients with premature ejaculation to SSRI medication. METHODS: Sixty-nine premature ejaculation patients were treated with 20 mg/d paroxetine for three months. The Intravaginal Ejaculatory Latency Time and International Index of Erectile Function scores were compared with baseline values. The patients were scored as having responded to therapy when a 2-fold or greater increase was observed in Intravaginal Ejaculatory Latency Time compared with baseline values after three months. Three genotypes of 5-HTTLPR were studied: LL, LS and SS. The appropriateness of the allele frequencies in 5-HTTLPR were analyzed according to Hardy-Weinberg equilibrium using the χ2-test. RESULTS: The short (S) allele of 5-HTTLPR was significantly more frequent in responders than in nonresponders (

SARIÇAM (Pinus sylvestris L.) MEŞCERELERİ İÇİN YÖRESEL (YALNIZÇAM VE UĞURLU ORMAN İŞLETME ŞEFLİKLERİ) SIKLIĞA BAĞLI HASILAT TABLOSUNUN DÜZENLENMESİ

Bu çalışmada Erzurum Orman Bölge Müdürlüğü, Göle Orman İşletme Müdürlüğü’ne bağlı Yalnızçam ve Uğurlu Orman İşletme Şefliği sınırları içerisinde yer alan sarıçam meşcereleri (Pinus sylvestris L.) için sıklığa bağlı yöresel hasılat tablosu düzenlenmiştir. Bu amaçla değişik yaş, bonitet endeksi ve sıklık derecelerine sahip Sarıçam meşçerelerinden 358 deneme alanı alınmıştır. Bu deneme alanlarından sağlanan veriler kullanılarak; meşcere yaşı, bonitet endeksi ve sıklık derecesinin fonksiyonu olarak, meşcere hacmi, ağaç sayısı, göğüs yüzeyi, orta çap ve orta boy gibi asli (kalan) meşcere özelliklerini tahmin eden regresyon denklemleri geliştirilmiştir. Bu regresyon denklemleri arasında en yüksek ilişkiyi; meşcere hacmi (R2=0.910), daha sonra sırasıyla meşcere göğüs yüzeyi (R2=0.791), ağaç sayısı (R2=0.694), orta çap (R2=0.601) ve orta boy (R2=0.531) vermiştir. Sarıçam’ın kalan ve ayrılan meşcereye ait özelliklerinin meşcere yaşı, bonitet endeksi ve sıklık derecesi arasındaki ilişkiler, istatistiksel olarak anlamlı ve büyüme yasaları ile uyumludur. Anahtar kelimeler: Sıklığa bağlı yöresel hasılat tablosu, Sarıçam, Sıklı

Clinical, Neuroimaging, and Genetic Features of the Patients with L-2-Hydroxyglutaric Aciduria

Aim:L-2-hydroxyglutaric aciduria (L2HGA) is a rare autosomal recessive encephalopathy caused by mutations in the L-2-hydroxyglutarate dehydrogenase gene.Materials and Methods:Here we discuss the clinical and molecular characteristics in patients with L2HGA.Results:There were eight patients with L2HGA. Their median age was 16 (9.5-37) years. Five of them were female and three of them were male. The main symptoms of the patients were psychomotor retardation (8/8), cerebellar ataxia (5/8), extrapyramidal symptoms (7/8) and seizures (4/8). All patients had behavioral problems. Elevated urinary L-2-hydroxy (L-2-OH) glutaric acid was detected and the median level of urine L-2-OH glutaric acid at diagnosis was 146 (60-1460 nmol/mol creat). Characteristic magnetic resonance imaging findings including subcortical cerebral white matter abnormalities with T2 hyperintensities of the dentate nucleus, globus pallidus and putamen were detected. Two patients had homozygous R335X, two patients had homozygous R282Q, two patients had homozygous R302L and one patient had compound heterozygous P302L/A64T mutation in L-2-hydroxyglutarate dehydrogenase (L2HGDH) gene.Conclusion:Because of the slow progression of the disease, the diagnosis of the patients is usually belated. L2HGA must be considered in the differential diagnosis based on clinical findings and specific findings in cranial magnetic resonance imaging. In our study, one of our patients has a novel mutation

Sentinel lymph node biopsy in breast cancer: analysis of 30 cases

Sentinel lenf nodu biyopsisi uygulaması meme kanserinin cerrahi tedavisinde sık olarak uygulanmakta olup aksiller cerrahi diseksiyon tekniğinin yerini almaya başlamıştır. Sonuçları güvenilir olup, aksiller cerrahi diseksiyona göre morbidite ve maliyet oranları daha düşük bir yöntemdir. Çalışmamızda Pamukkale Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı'nda Mayıs 2009 ile Ekim 2010 tarihleri arasında SLNB uygulaması yapılan 30 hastanın analizi yapılmıştır. Sentinel lenf nodu saptanan 30 hastanın 14'ünde (%46,6) SLN tutulumu saptandı, diğer 16 hastada (%54,4) SLN tutulumu saptanmadı ve bu hastalardan 6 tanesine (%37,5) aksiller diseksiyon yapılmadı. SLN tutulumu saptanmayıp aksiller diseksiyon yapılan 9 hastanın (%56,2) aksillasında tutulum saptanmadı, 1 hastanın aksillasında tutulum saptandı. Çalışmamızda yer alan SLN tutulumu saptanmayan fakat aksiller diseksiyon yapılan 10 (%62,5) hastanın sadece 1 tanesinde yanlış negatiflik saptandı ve bu hastanın çalışmaya başlanan ilk hasta olduğu görüldü. SLN bulma oranı %88,2 olarak, doğruluk oranı %76,6 olarak, duyarlılık oranı %88,8 olarak ve yanlış negatiflik oranı %10 olarak bulundu. Sonuçlar analiz edildiğinde literatür ile uyumlu sonuçlar elde edildiği görüldü. Bu çalışmada meme kanserinin cerrahi tedavisinde aksiller diseksiyonun yerini alarak uygulanmaya başlayan SLNB uygulaması, hastalarımızda başarıyla uygulanmış ve klinik sonuçlarımız analiz edilmiştir.Sentinel node biopsy (SNB) has emerged as a potential alternative to routine axillary dissection and is used mostly in the surgical treatment of breast cancer. Comparing with the axillary dissection, it has more reliable results and low morbidity and costs of surgical treatment. On this study, 30 patients that underwent SNB during the period from May 2009 through October 2010 at Pamukkale University General Surgery Department were analysed. Of the 30 patients with an identified a sentinel lymph node (SLN), SLN were positive for metastases in 14 (46,6%), SLN was clearly identified in 16 (54,4%) and of this 16 patient, the axillary dissection was not made in 6 patients (37,5%). With negative SLN, 10 patients underwent to axillary dissection. In this group, the axillary lymph nodes were totally negative in 9 patients (56,2%) and 1 patient had metastases in axillary lymph nodes. Of the 10 patients (62,5%) that underwent to axillary dissection with negative SLN, a false negative result was determined in 1 patient who is the first patient to study. The rate of SLN identification was 88,2%, the rate of accuracy was 76,6%, the rate of sensitivity was 88,8% and the rate of false-negatives was 10%. In conclusion, the results revealed the concordance between the literature. On this study SNB, that has been applied frequently instead of axillary dissection, was performed on our patients successfully and the clinical results were analysed

Sentinel lymph node biopsy in breast cancer: Analysis of 30 cases

Aim: Sentinel lymph node biopsy is performed in the treatment of breast cancer, and it has started to replace the axillary lymph node dissection technique. The results are reliable and it has lower morbidity comparing with axillary dissection.Methods: In this study, we analyzed the patients with sentinel lymph node biopsy in breast cancer surgery.Results: Sentinel lymph node involvement was detected in 14 (46.6%) of 30 patients. In the other 16 patients (54.4%), no involvement of the sentinel lymph nodes was detected and six of these patients (37.5%) did not undergo axillary dissection. None of the nine patients (56.2%) without sentinel lymph node involvement had also no axillary involvement. Axillary involvement was detected only in one patient. In our study, 10 patients (62.5%) who had no sentinel lymph node involvement but had axillary dissection showed false negativity in one patient and it was seen that this patient was the first patient to be included in the study. Sentinel lymph node detection rate was 88.2%, accuracy rate was 76.6%, sensitivity rate was 88.2% and false negative rate was 10%.Conclusion: The use of sentinel lymph node biopsy in the surgical treatment of breast cancer is a safe approach