1995-2004 yılları arasında kliniğimizde tedavi edilen safra yolu yaralanmalarının retrospektif analizi

TEZ5422Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 2005.Kaynakça (s. 46-48) var.vi, 49 s. : res. ; 29 cm.The Retrospective Review of Bile Duct Injuries Managed Between 1995 and 2004 in Our Clinic :Bile duct injuries are still a problem despite the improvements in its diagnosis and management. In this study, the aim was to analyze 54 patients who were operated due to bile duct injuries at the Faculty of Medicine, Department of General surgery of Çukurova University between January 1995 and March 2004, and to compare the outcomes with the literature. Parameters which included demographic data, cholecystectomy indication, operation type, symptoms and findings; preoperative diagnosis, Preoperative and postoperative laboratory values, radiological investigations, injury zone and classification, presence of vascular injury, the duration between injury and reconstruction, operative approach, morbidity, mortality, hospitalization duration and postoperative long-term follow-up were analyzed. The most frequently seen symptom was jaundice (44.4%) and the second frequently seen symptom was biliary fistula (38.8%). Any statistically significance were established between these symptoms and mortality/ Long-term results (p>0.05) The injury zone was detected completely in the preoperative course, on all patients' images of whom was performed PTC. Statistically significance was not established between percutaneous biliary drainage and mortality/Long-term results (P>0.05) The most frequently established injury zone was common hepatic duct (28 patients). The association between injury zone and mortality/ long term results was not statistically significant (P>0.05) Hepaticojejunostomy was determined as the most frequently performed operation by %66.6 (36 patients). The presence of vascular injury was not a prognostic factor for the mortality, however the significance of association between vascular injury and long- term results was statisticcally demonstrated (P>0.05). The early period morbidity was 37% (20 patients) and the Long-term morbidity was 9.2% (5 patients). The wound infection was the most frequently seen complication with 9 patients. However, 5 anastomosis strictures were established in the long-term follow-up. The early period mortality rate was 12.9% (7 patients). The mortality rate of patients who had peritonitis was statistically increasing (P0.05). PTK uygulanan tüm olgularda safra yolu yaralanma yeri tam olarak belirlendi. Sarılık ile başvuran ve tetkiklerde safra yolu dilatasyonu gelişen hastalarda Perkütan bilier drenaj yapılması ile mortalite ve başarı değerlendirmesi arasında istatistiksel olarak anlamlı ilişki saptanmamıştır (P>0.05). En sık yaralanma yeri, ana hepatik kanal (28 hasta) idi. Yaralanma yeri ile rekonstrüktif amaçlı uygulanan operasyon başarı durumu ve mortalite ile ilişkisi irdelendiğinde yaralanma yerinin mortaliteyi ve başarı durumunu etkileyici faktör olmadığı istatistiksel olarak gösterildi (P>0.05). En sık uygulanan operasyon 36 (%66.6) hastayla Roux-en Y hepatikojejunostomidir. Vasküler yaralanma varlığının mortaliteyi etkilemediği (P>0.05), ancak tamirin başarı oranını etkilediği, istatistiksel olarak gösterilmiştir (P<0.05). Erken dönem morbidite 20 (%37) hastada , geç dönem morbidite 5 (%9.2) görüldü. Erken dönemde 9 hasta ile en sık rastlanan komplikasyon yara enfeksiyonu idi. Geç dönemde ise 5 hastada anastomoz striktürü saitandı. Erken dönem mortalite oranı % 12.9'dur (7 olgu). Peritonit ile mortalite arasında ise istatistiksel olarak anlamlı ilişki saptanmıştır (P<0.05) Geç dönemde mortalite %3.7 (2 olgu)'dir. Ortalama takip süresi ise 79.9ay (13-124) olup bu sürede rekürren sarılık veya kolonjit saptanmayan başarılı tedavi oranımız %85.1'dir

Primer hepatik nöroendokrin tümör: Ameliyat öncesi farklı tanılı 5 olgu

Karsinoid tümör olarakta bilinen nöroendokrin tümörler aslında iyi huylu tümör gibi davranan fakat karsinom karakteri gösteren tümörlerdir. Karaciğerde yerleşmiş olan nöroendokrin tümörlerin %80 kadarı metastatik iken karaciğerin primer nöroendokrin tümörleri oldukça nadir görülür. Karaciğerde kitle tanısı ile Ağustos 2003 – Temmuz 2007 tarihleri arasında kliniğimize başvuran 5 hasta cerrahi yöntem ile tedavi edildi. Ultrasonografi, bilgisayarlı tomografi ve manyetik rezonans görüntüleme tüm hastalar için yapıldı. Diğer malign odakları tespit ve ekarte edebilmek için endoskopi ve kolonoskopi planlandı. Tüm hastalara hepatektomi yapıldı. Histopatolojik tanı immünohistokimyasal yöntem ile doğrulandı. Cerrahi yöntem ile tedavi edilen beş hasta histopatolojik olarak hepatik nöroendokrin tümör tanısı aldı. Karın ağrısı en sık gözlenen şikayet idi. Hepatektomi tümörün yerleşim yerine göre yapıldı. Sadece bir hastaya (olgu 2) hepatektomi öncesi tümörün kanlanmasını azaltmak için transarteryal kemoembolizasyon yapıldı. Aynı hastaya gelişen tümör nüksü nedeniyle hepatektomiden 4 yıl sonra tekar transarteryal kemoembolizasyon işlemi uygulandı. R0 rezeksiyona yalnız iki hastada ulaşıldı (olgu 1 ve 3). Primer hepatik nöroendokrin tümörler çok nadir görülen ve asemptomatik seyreden tümörlerdir. Halen daha yüksek duyarlılıkta labaratuvar ve görüntüleme tetkiklerine ihtiyaç duyulmaktadır. Günümüzde hepatektomi primer hepatik nöroendokrin tümör için hala asıl olan tedavi yöntemidir.Neuroendocrine tumors, also known as carcinoid tumors, behave like benign tumors; however, they show the characteristics of carcinoma. While more than 80% of the neuroendocrine tumors found in the liver are metastatic, primary hepatic neuroendocrine tumors are very rare. Five patients with hepatic mass who admitted to our clinic between August 2003 and July 2007 were treated surgically. Ultrasonography, computerized tomography and magnetic resonance imaging were performed in all patients. Endoscopy and colonoscopy were conducted to exclude malignancy of other sites. Hepatectomy was carried out in all patients. Diagnosis was confirmed with immunohistochemical examination. The five patients treated surgically were diagnosed as primary hepatic neuroendocrine tumor histopathologically. Abdominal pain was the most common complaint of all patients. Hepatectomy was conducted in all patients due to tumors originating from the liver lobes. Only one patient (Case 2) underwent transarterial chemoembolization before hepatectomy to reduce tumor bleeding. Owing to tumor recurrence on the left lobe of the liver in Case 2, transarterial chemoembolization was performed four years after hepatectomy. R0 resection was achieved in two patients (Cases 1 and 3). In conclusion, primary hepatic neuroendocrine tumors are very rare and asymptomatic tumors. Thus, high-sensitive laboratory and imaging examinations are required. At present, hepatectomy remains the main treatment for primary hepatic neuroendocrine tumor

Haemangioma of the Breast: Case Report Genel Cerrahi

Memenin tümoral lezyonlarının %0,4'ünü içerenhemanjiyom benign vasküler bir meme lezyonudur.Palpable kitle olarak karşımıza çıkabileceği gibi,insidental olarak da saptanabilir. Kapiller, kavernöz veyavenöz olarak sınıflandırılır. Kavernöz hemanjiyom ensık görülen tipidir. Elli yaşında bayan hasta, yaklaşık 2ay önce fark ettiği sol meme üst dış kadranda bulunan veele gelen kitle şikayetiyle başvurdu. Fizik muayenesindeyaklaşık 1x1 cm boyutlarında kitle saptandı. Ciltdüzeyinde kırmızımsı renk değişikliği görüldü. Sağmeme ve bilateral aksilla muayenesi normal idi.Mamografi, meme magnetik resonans (MR) veultrasonografidesteklemekte idi. Cerrahi rezeksiyon önerilen hastaya,risk anlatıldı, operasyonu kabul etmedi. İki yıldır takipedilen hastanın lezyon boyutunda ve natüründedeğişiklik gözlenmediAs a benign and vascular lesion, hemangioma presentsin the breast with an incidence of 0.4% of all breastlesions. It can be palpable or detected incidentally.Haemangiomas are classified into capillary, cavernous(the most common subtype), and venous; cavernous.A 50-year-old female was admitted to our clinic witha compliant of noticing a mass in the left-lateralquadrant of left breast . On physical examination,1x1cm lesion underlying the skin was detected. Also,a reddish area on the skin was noticed.Mammography, breast ultrasonography (USG) andmagnetic resonance imaging (MRI) findings wereindicative for haemangioma. Surgical excision wasdenied by the patient whose lesion has no change inthe size and/or nature in two years follow u

Hemosuccus pancreaticus A case report and review of the literature

Hemosuccus pancreaticus is a rare clinical condition, defined as a bleeding from an artery around the pancreas or a lesion on the pancreas, to the pancreatic duct. The intensity of bleeding can vary from occult bleeding to life threatening massive acute bleeding. In this article, we aimed to present a 68-year-old man who presented to our clinic with recurrent upper gastrointestinal bleeding and abdominal pain. Endoscopy revealed hemorrhage from ampulla vateri, CT angiographic examination showed an aneurysm of the splenic artery and that the splenic artery was connected to the pancreatic duct.Splenectomy and subtotal pancreatectomy was performed on the patient. The patient was discharged with healing. Hemosuccus pancreaticus should be kept in mind in patients with a history of pancreatitis and peripancreatic aneurysm and upper gastrointestinal bleeding. The early diagnosis and treatment of HP is life-saving. In this study, we aimed to review the basic symptoms and clinical findings, along with the diagnosis and treatment methods of HP

Investigation of sequential properties of snoring episodes for obstructive sleep apnoea identification

In this paper, 'snore regularity' is studied in terms of the variations of snoring sound episode durations, separations and average powers in simple snorers and in obstructive sleep apnoea (OSA) patients. The goal was to explore the possibility of distinguishing among simple snorers and OSA patients using only sleep sound recordings of individuals and to ultimately eliminate the need for spending a whole night in the clinic for polysomnographic recording. Sequences that contain snoring episode durations (SED), snoring episode separations (SES) and average snoring episode powers (SEP) were constructed from snoring sound recordings of 30 individuals (18 simple snorers and 12 OSA patients) who were also under polysomnographic recording in Gulhane Military Medical Academy Sleep Studies Laboratory (GMMA-SSL), Ankara, Turkey. Snore regularity is quantified in terms of mean, standard deviation and coefficient of variation values for the SED, SES and SEP sequences. In all three of these sequences, OSA patients' data displayed a higher variation than those of simple snorers. To exclude the effects of slow variations in the base-line of these sequences, new sequences that contain the coefficient of variation of the sample values in a 'short' signal frame, i.e., short time coefficient of variation (STCV) sequences, were defined. The mean, the standard deviation and the coefficient of variation values calculated from the STCV sequences displayed a stronger potential to distinguish among simple snorers and OSA patients than those obtained from the SED, SES and SEP sequences themselves. Spider charts were used to jointly visualize the three parameters, i.e., the mean, the standard deviation and the coefficient of variation values of the SED, SES and SEP sequences, and the corresponding STCV sequences as two-dimensional plots. Our observations showed that the statistical parameters obtained from the SED and SES sequences, and the corresponding STCV sequences, possessed a strong potential to distinguish among simple snorers and OSA patients, both marginally, i.e., when the parameters are examined individually, and jointly. The parameters obtained from the SEP sequences and the corresponding STCV sequences, on the other hand, did not have a strong discrimination capability. However, the joint behaviour of these parameters showed some potential to distinguish among simple snorers and OSA patients

Abdominal extragenital endometriosis: single centre experience

Amaç: Bu çalışmada semptomatik ekstragenital yerleşimli intraabdominal endometriozis olgularıyla ilgili klinik deneyimimizi sunmayı amaçladık. Gereç ve Yöntem: Bu çalışmada değişik endikasyonlar sebebiyle opere edilen ve nihai histopatojik incelemesinde endometriozis olarak rapor edilen olgular değerlendirildi. Hastaların demografik özelliklerinin yanısıra klinik prezentasyonları, lokalizasyonları, yapılan cerrahiler ve takip süresi içindeki rekürens oranları değerlendirilmiştir. Bulgular: Çalışmamızda histopatolojik olarak konfirme edilmiş 778 endometriozis tanısı almış hastalar retrospektif olarak incelendi. 32 (%4.1) olguda ekstragenital abdominal yerleşim mevcut olup, hastaların tamamı semptomatik idi. Hastaların başvuru esnasındaki en sık semptomları karın ön duvarda ele gelen kitle (n:13 %40.6) ve kronik tekrarlayan abdominal/pelvik ağrı (n:9, %28.1) şeklindeydi. Abdominal ekstragenital endometriozisli olguların %22’sinde (n=7) klinik tanısı preoperatif dönemde konmuştu. Yapılan operasyonlar ise karın ön duvarından kitle eksizyonu, (n=14, %43.8), apendektomi (n=5,%15.7), pelvik kitle eksizyonu (n=6,%18.8), anterior rezeksiyon (n=3,%9.4), sağ hemikolektomi (n=2,%6,3), laparotomi ile birlikte üriner stentleme (n=2,%6,3) idi. Ortalama 42 aylık takip süresinin sonunda 6 olguda (%18.7) nüks izlendi. Sonuç: Endometriozis, ekstragenital tutulum sebebiyle reproduktif dönemde değişik nedenlere bağlı olarak abdominal cerrahi planlanan kadınlarda ayırıcı tanıda düşünülmelidir. Komplet cerrahi eksizyonun yansıra, endometrizis tanısının pre- veya intraoperatif dönemde konulması durumunda yara koruyucu kullanılması nüks oranlarının azalmasını sağlayabilir.Purpose: This study aimed to present our clinical experience on symptomatic intaabdominal extragenital endometriosis cases. Materials and Methods: In this study, patients undergoing surgery various indications and for which final histopathologic results reported as endometriosis were evaluated. Demographic characteristics, clinical presentations, localization of disease, surgical procedures and recurrence rates within follow-up period were presented. Results: Histopathologically confirmed 778 endometriosis patients were retrospectively analyzed. Extragenital abdominal endometriosis were present in 32 (4.1%) patients and all cases were symptomatic. The most common symptoms at index admission were mass detected within abdominal wall (n:13; 40.6%) and chronic recurrence abdominal/pelvic pain (n:9, 28.1%). 22% (n=7) of patients with abdominal extragenital endometriosis were diagnosed preoperatively. The operations performed were as follows: mass excision from the abdominal wall (n=14, 43.8%), appendectomy (n=5, 15.7%), pelvic mass excision(n=6, 18.8%), anterior resection (n=3, 9.4%), right hemicolectomy (n=2, 6,3%) , and laparotomy with urinary stenting (n=2, 6,3%). Recurrence is reported in 6 (18.7%) cases at median follow-up of 42 months. Conclusion: Due to extragenital involvement, endometriosis should be part of differential diagnosis in all women who are reserved for abdominal surgery during reproductive era. Along with the complete excision, wound protector use can potentially decrease recurrence rates in cases diagnosed pre- or intraoperatively as endometriosis

Macroscopic Portal Vein Thrombosis in Hcc Patients

Macroscopic portal vein invasion (PVT) by hepatocellular carcinoma (HCC) in the liver is one of the most important negative prognostic factors for HCC patients. The characteristics of a large cohort of such patients were examined. We found that the percent of patients with PVT significantly increased with increasing maximum tumor diameter (MTD), from 13.7% with tumors of MTD 10cm. There were similar numbers of HCC patients with very large tumors with and without PVT. Thus, MTD alone was insufficient to explain the presence of PVT, as were high AFP levels, since less than 50% of high AFP patients had PVT. However, the percent of patients with PVT was also found to significantly increase with increasing blood alpha-fetoprotein (AFP) levels and tumor multifocality. A logistic regression model that included these 3 factors together showed an odds ratio of 17.9 for the combination of MTD>5.0cm plus tumor multifocality plus elevated AFP, compared to low levels of these 3 parameters. The presence or absence of macroscopic PVT may therefore represent different HCC aggressiveness phenotypes, as judged by a significant increase in tumor multifocality and AFP levels in the PVT positive patients. Factors in addition to MTD and AFP must also contribute to PVT development.PubMedWoSScopu