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Öğe The age and sex distribution of colorectal carcinoma cases in Turkey(H G E Update Medical Publ Ltd., 2000) Degertekin, H; Sari, Y; Yalcan, K; Akgun, Y[Abstract Not Available]Öğe Amebic liver abscess(Springer Verlag, 1999) Akgun, Y; Tacyildiz, IH; Çelik, YAmebiasis and amebic liver abscess (ALA) continue to be a major fatal disease in developing countries where unhygienic environmental conditions prevail. Between January 1975 and December 1984 there were 60 patients and from January 1985 to December 1994 there were 44 patients with ALA who were diagnosed and treated. In the first group, all patients mere operated on, and drainage was performed. The morbidity and mortality rates were 53.3% and 23.3%, respectively. Metronidazole was given to all patients in the second group, and in those who did not respond to the metronidazole percutaneous needle aspiration was applied. Surgical treatment was performed in seven patients because four did not respond to metronidazole therapy and percutaneous needle aspiration, and in three the abscess ruptured into the peritoneal cavity. The lesion disappeared ultrasonographically after 4 months in all patients. The morbidity and mortality rates were 4.5% and 2.2%, respectively. The result of this study suggests that uncomplicated ALA can be managed conservatively with metronidazole and needle aspiration of the abscess. Operative therapy should be performed for complications of the abscess and when conservative therapy fails.Öğe Efficiency of obliteration procedures in the surgical treatment of hydatid cyst of the liver(Blackwell Publishing Asia, 2004) Akgun, Y; Yilmaz, GBackground: Hydatid cyst of the liver (HCL) is a parasitic infestation caused by several species of Echinococcus and is endemic in many sheep-raising areas. The aim of the present study is to evaluate the value of clinical, physical and laboratory findings and to discuss the diagnostic and therapeutic options in 250 patients with HCL. Methods: Between January 1980 and December 1989, 148 patients with HCL were treated surgically, and surgical procedures performed were evaluated retrospectively. On the basis of these findings, a prospective study of 102 patients was initiated between January 1990 and December 1999. Results: External drainage was performed in retrospective and prospective groups, respectively, in 110 and five patients, obliteration procedures in 31 and 82 and resectional procedures in seven and 15. While mean hospitalization time morbidity, mortality and recurrence rates were 16.2 +/- 6.9 days, 37.8%, 2.0% and 6.7% in the retrospective group, these rates were decreased to 7.8 +/- 3.5 days, 10.7%, 0.9% and 1.9%, respectively, in the prospective group. Overall morbidity, mortality and recurrence rates and median hospitalization time were 49.5%, 2.6%, 9.5% and 18.0 +/- 7.4 days in external drainage group, 7.0%, 0% 0.8% and 8.5 +/- 4.5 in obliteration procedures and 9.0%, 4.5%, 0% and 7.3 +/- 1.9 resectional procedures, respectively. Conclusions: External drainage should be performed only in infected HCL. Resection procedures are too radical and extensive for benign lesions. Obliteration procedures are simple and safe methods for the treatment of HCL, and they have low morbidity, mortality and recurrence rates.Öğe Intestinal and peritoneal tuberculosis: changing trends over 10 years and review of 80 patients(Canadian Medical Association, 2005) Akgun, YBackground: To establish the efficiency of minimally invasive procedures in the diagnosis and management of abdominal (intestinal and peritoneal) tuberculosis (AT), I retrospectively and then prospectively evaluated clinical, physical and laboratory findings in patients with AT at a university general-surgery clinic. Diagnostic and therapeutic options were also considered. Methods: Data from the case records of 43 patients diagnosed with AT via laparotomy were collected and analyzed. On the basis of findings from that early analysis, a further 37 patients were studied prospectively. In the latter group, percutaneous aspiration, endoscopy and laparoscopy were used for diagnosis, except in cases with acute abdominal findings or failure of these diagnostic procedures. Morbidity and mortality rates and mean hospitalization time were evaluated for both groups. Results: In the early group of 43 patients, the morbidity rate was 30%; mortality, 12%; and median hospital stay, 18.3 days (standard deviation [SD] 6.2 d). The diagnosis was confirmed by laparotomy in 18 patients in the prospective group: laparoscopy or endoscopy in 10 and percutaneous drainage of an intra-abdominal abscess in 9. Changes in our approach to diagnostic procedures in the prospective group led to decreased morbidity (11%), mortality (0) and median hospital stay (9.3 [SD 4.7] d). Conclusions: Minimally invasive procedures such as laparoscopic, endoscopic and percutaneous biopsy should be used for diagnosis of IPTB as a first step in diagnosis. Laparotomy should be performed only when complications develop or diagnosis remains unclear in spite of these diagnostic modalities.Öğe Intestinal obstruction caused by Ascaris lumbricoides(Williams & Wilkins, 1996) Akgun, YPURPOSE: The aim of this study is to present patients, to discuss causes of morbidity and mortality, and to ascertain prognostic indexes and therapeutic options influencing outcome of patients with intestinal obstruction caused by Ascaris lumbricoides. MATERIALS AND METHODS: During the past 20 years, between 1975 and 1995, a total of 17 patients with intestinal obstruction attributable to A. lumbricoides underwent surgery. Five were adults, and 12 were children. The most frequent symptoms and physical findings were abdominal pain, distention, nausea, vomiting, and constipation. Enterotomy was performed in ten patients and resection in two patients. Manual exposition and advancement of the parasitic bundle toward the colon was attempted in five patients. Morbidity and mortality rates were 29 and 17 percent, respectively, and septic shock was the major cause of death. RESULTS: This study suggests that simple bowel obstruction is the fatal complication of A. lumbricoides infestation, which is seen particularly in preschool and young school-aged children living in unhygienic conditions, and illustrates the need for heightened awareness of A. lumbricoides by the emergency physician in the differential diagnosis. CONCLUSIONS: Early diagnosis and surgical intervention are essential to minimize high morbidity and mortality.Öğe Management of ileosigmoid knotting(Blackwell Science Ltd, 1997) Akgun, YBackground Ileosigmoid knotting is a rare cause of intestinal obstruction. Methods The clinical records of 16 patients treated for ileosigmoid knotting were evaluated retrospectively. Results There were 11 men and five women. The mean age was 45 years. The mean duration of symptoms was 4.4 days. Plain abdominal radiographs showed multiple air-fluid levels in the colon and/or small bowel. At operation, ileum and/or sigmoid colon necrosis was observed in 13 patients, both ileum and total colon necrosis in two, while there was no necrosis in one patient. Resection of necrotic bowel was necessary in 15 patients, Intestinal continuity was restored by primary anastomosis in 12; three required a stoma. The patient without necrosis was treated by detorsion and mesosigmoplasty. Three of 16 (19 per cent) patients died; septic shock was the major cause of death. Conclusion Aggressive preoperative resuscitation, appropriate antibiotic therapy, effective surgery and postoperative metabolic support help minimize morbidity and mortality rates.Öğe Mesosigmoplasty as a definitive operation in treatment of acute sigmoid volvulus(Williams & Wilkins, 1996) Akgun, YPURPOSE: The aim of this prospective study was to present our patients with managed mesosigmoplasty as a definitive method and to discuss the efficiency of this operation in the treatment of acute sigmoid volvulus. METHODS: Fifteen patients with acute sigmoid volvulus were treated by mesosigmoplasty between April 1992 and April 1995. RESULTS: Postoperatively, temporary abdominal distention and constipation were seen in two patients, and one patient died of myocardial infarction. Morbidity and mortality rates were 13.3 and 6.6 percent, respectively. The average follow-up was 28.09 +/- 9.60 months, and recurrences and complaints of undue constipation were not seen. CONCLUSIONS: Our results suggest that the mesosigmoplasty is a definitive procedure and that it is the first and most reliable choice that can be easily performed with minimum morbidity and mortality for patients with acute sigmoid colon volvulus who do not have sigmoid necrosis at laparotomy.Öğe Öğe Öğe
