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Clinical review of tuberculous peritonitis in 39 patients in Diyarbakir, Turkey
(Wiley, 2005) Tanrikulu, AC; Aldemir, M; Gurkan, F; Suner, A; Dagli, CE; Ece, A
Abdominal tuberculosis (TB) is a rare manifestation, which can be overlooked on long-lasting and non-specific findings unless a high index of suspicion is maintained. The purpose of the present study was to investigate the diagnostic features of 39 patients hospitalized with tuberculous peritonitis (TBP) in Dicle University Hospital, Turkey between January 1994 and August 2003. Twenty-two patients were male; patient age ranged between 1 and 59 years (mean: 16.2 +/- 14.4 years). There were 21 patients (54%) under 15 years of age. Thirteen children had a history of familial TB and seven adults had prior history of TB. Six (29%) of 21 pediatric cases had bacille Calmette-Guerin (BCG) scars and results of 5-tuberculin units (TU) tuberculin test were positive in seven children (18%). Of all cases, the most common presenting findings were abdominal pain (95%), ascites (92%) and abdominal distention (82%). Five of the patients had accompanying pulmonary TB, and six patients (15%) had intestinal TB who were admitted to emergency service with acute abdomen, of whom three (8%) had perforation and three (8%) had ileus. Histopathologically 20 cases (51%) were proven on abdominal ultrasonography, and computed tomography revealed most commonly ascites and thickening of peritoneum. No microbiologic evidence was obtained except three positive culture results for Mycobacterium tuberculosis. As a result, TBP should be considered for diagnosis, in patients with non-specific symptoms of abdominal pain, wasting, fever, loss of appetite, abdominal distension and even symptoms of acute abdomen, because early diagnosis and effective treatment will decrease morbidity and mortality. (C) 2005 Blackwell Publishing Asia Pty Ltd.
Diagnosis and surgical treatment of intrabiliary ruptured hydatid disease of the liver
(Sa Medical Assoc, 2004) Taçyildiz, I; Aldemir, M; Aban, N; Keles, C
Background and objectives. The major complication of hydatid disease of the liver is intrabiliary rupture of the cyst. The purpose of this study was to evaluate the outcome of patients with intrabiliary ruptured hydatid disease of the liver. Method. Using a standardised data collection instrument, case records of patients who were operated on for hydatid disease of the liver diagnosed between January 1990 and December 2001 at Dicle University Hospital (DUH) were searched and 192 patients who had been operated for hydatid disease of the liver were detected. Of these, 20 patients (16 females, 4 males) were retrospectively reviewed for intrabiliary ruptured hydatid disease of the liver. Results. Intrabiliary ruptured hydatid disease of the liver was determined in 10.4% (N = 20) of the patients (N = 192) operated for hydatid disease of the liver. The average age of patients was 38.9 +/- 14.05 years (range 20 - 72 years). The duration of the symptoms was 3.4 +/- 2.13 years (range 1 - 8 years). The most frequent symptoms were right upper quadrant/epigastric pain, dyspepsia, jaundice and pruritus. Diagnosis of hydatid cyst was principally made using ultrasonography. Twelve cysts (60%) were located in the right lobe, 5 (25%) in the left lobe, and 3 (15%) in the right and left lobes. The size of the cysts was 12.6 +/- 5.79 cm (range 6 - 20 cm). The average diameter of the common bile duct (CBD) was 20.45 +/- 8.54 mm (range 10 - 40 mm). Dilated CBD in 16 patients (80%) and daughter cysts and debris in the CBD in 10 patients (50%) were found during operation. Partial cystectomy and capitonnage were performed in all patients. In addition, T-tube drainage in 17 patients, omentoplasty plus T-tube drainage in 2 patients and choleclochoduo-denostomy in 1 patient were carried out during operation. An internal opening of the biliary fistula was found and sutured in 12 patients (60%). Wound infections developed in 6 patients (30%), suppuration of the residual cavity in 4 patients, and wound dehiscence in 2 patients. Two patients (10%) died from sepsis-multiple organ failure and hepatic failure. The average period of hospitalisation was 28.75 +/- 19.1 days (range 10 - 103 days). Conclusions. If bile-stained cystic fluid and a dilated CBD is found in patients with hydatid disease of the liver, choledochal exploration should be performed during operation. T-tube drainage may be preferred in the management of intrabiliary ruptured hydatid disease because of low morbidity, the ability to decompress intrabiliary pressure, easier monitoring of the biliary drainage and smaller alteration of the anatomy.
Dichlorvos poisoning after intramuscular injection
(W B Saunders Co, 2004) Guloglu, C; Aldemir, M; Orak, M; Kara, IH
[Abstract Not Available]
Effectiveness of collagenase in the treatment of sacrococcygeal pilonidal sinus disease
(Springer-Verlag, 2003) Aldemir, M; Kara, IH; Erten, G; Taçyildiz, I
Purpose. Sacrococcygeal pilonidal sinus disease (SPSD) is a disease affecting young patients, which results in a long-term loss of productive power, and also tends to have high rates of morbidity since it has no ideal treatment. The main purpose of this study was to investigate the effectiveness of topical collagenase in the treatment of SPSD. Methods. In the present study, 40 patients admitted to our department were separated into two groups. Excision and marsupialization with dressing by bacterial collagenase was performed in the first group, while the treatment was excision and marsupialization without dressing by bacterial collagenase in the second group. Results. We determined that the healing in terms of the width and depth of the wound in the first week and in depth of wound in the second week was better in group I than in group 2 (P = 0.040, P = 0.020, P = 0.048, respectively). The duration of wound healing was 21.9 +/- 1.3 days in group 1, and 28.1 +/- 1.3 days in group 2 (P = 0.0001). The recurrence rate in the intergluteal area, which heals by granulation and has no hair follicles, tends to decrease when a partial closure is obtained. Conclusion. We therefore recommend an excision, marsupialization, and dressing with bacterial collagenase, in cases with noncomplicated SPSD.
Effects of in vivo freezing and mannitol in intestinal ischaemia-reperfusion injury
(Elsevier Sci Ltd, 2003) Aldemir, M; Öztürk, H; Güloglu, C; Büyükbayram, H
Purpose: The main purpose of this study was to investigate whether in vivo freezing and mannitol administration can protect the small intestine against ischaemia-reperfusion (I-R) injury. Methods: Fifty male Sprague-Dawley rats (200-225 g) were divided into 5 groups each containing 10 rats; group SO, sham operation group; group 1, mesenteric ischaemia group; group R, ischaemia-reperfusion (I-R); group FR, I-R plus in vivo freezing; group MR, I-R plus mannitol treatment. Intestinal ischaemia for 30 min and reperfusion for 60 min were applied. Ileum specimens were obtained to determine the tissue levels of malondialdehyde (MDA) and histological changes. Results: The mucosal injury scores of group R were significantly higher than those of the group I (P < 0.0001). The mucosal injury scores in the groups FR and MR were significantly lower than the group R (P < 0.0001 and P < 0.0001, respectively). In the group FR, mucosal injury scores were not significantly different from those of group I (P = 0.123). However, mucosal injury scores of group MR were significantly less when compared to those of group I (P = 0.01). Mean MDA levels of group R were significantly higher than those of the group I (P < 0.0001). Mean MDA levels of groups FR and MR were significantly lower than those of group R (P < 0.0001 and P < 0.0001, respectively.). In addition, MDA levels of group FR were significantly higher than those of group MR (P < 0.0001). Conclusion: In conclusion, these observations suggest that the in vivo freezing of SMA and the pre-treatment with mannitol before reperfusion period may be useful in preventing intestinal reperfusion injury. (C) 2003 Elsevier Science Ltd. All rights reserved.
Effects of molsidomine and lexipafant in hepatic ischaemia-reperfusion injury
(Elsevier Sci Ltd, 2004) Aldemir, M; Boşnak, Mehmet; Al, B; Büyükbayram, H; Taçyildiz, I
Purpose: The purpose of this study was to evaluate the effects of nitric oxide donor molsidomine and platelet-activating factor (PAF) antagonist lexipafant on the hepatic IR injury in rats. Methods: Fifty mate Sprague-Dawley rats (200-225 g) were divided into five groups each containing 10 rats; group SO: Sham operation group; group 1: hepatic ischaemia group; group IR: ischaernia-reperfusion (IR); group M: IR plus pretreatment with molsidomine; group L: IR plus pretreatment with lexipafant. Hepatic ischaemia and reperfusion, each were applied for 45 min. Hepatic specimens were obtained to determine the tissue levels of malondialdehyde (MDA) and histological changes. Blood samples were obtained by cardiac puncture for determination of alanine transaminase (ALT), aspartate transaminase (AST) and lactic dehydrogenase (LDH). Results: The liver damage scores of groups 1, IR, M and L were significantly higher than that of group SO (P < 0.001). The liver damage scores of groups IR and M, were significantly higher than that of group 1 (P = 0.009 and 0.0035, respectively). The liver damage scores of groups M and L were significantly tower than that of group IR (P < 0.001 for both M and L). Mean MDA levels of groups 1 and IR were significantly higher than those of group SO (P < 0.001). Administrations of molsidomine and lexipafant prior to ischaernia-reperfusion (IR) resulted in significant reduction of the MDA values (P < 0.001). A statistically significant (P < 0.001) decrease in the levels of AST, ALT and LDH was observed in groups M and L compared with group IR. Conclusion: In conclusion, these observations suggest that pre-treatment with nitric oxide donor molsidomine and PAF antagonist lexipafant before the reperfusion period may be useful in preventing hepatic reperfusion injury. ((C))2003 Elsevier Ltd. All rights reserved.
Effects of octreotide acetate and Saccharomyces boulardii on bacterial translocation in an experimental intestinal loop obstruction model of rats
(Tohoku Univ Medical Press, 2002) Aldemir, M; Kököglu, ÖF; Geyik, MF; Büyükbayram, H
Intestinal obstruction (IO) induces bacterial translocation (BT) due to mucosal disruption, motility dysfunction, and increased intestinal volume, leading to bacterial overgrowth. This study was conducted to investigate the effects of octreotide acetate (OA) and Saccharomyces boulardii (SB) on the BT and intestinal integrity in an animal model of intestinal loop obstruction (LO). Forty adult male Sprague-Dawley rats (250-300 g) were randomized into 4 groups containing 10 rats each. Complete 10 was created in the distal ileum of rats by a single 3-0 silk suture (LO). Group Sham: Sham (Laparotomy only was performed in this group); group LO: LO; group OA: LO plus OA (100,mug/kg, at 0, 12 hours of obstruction); group (SB): LO plus SB (800 mg/kg/day, via orogastric and preoperative for 3 days). After 24 hours, samples of mesenteric lymph nodes (MLN), liver, spleen and blood were obtained and cultured. The terminal ileum specimens were examined histopathologically. There were no BT in group Sham, but BT was noticed totally in 31 (77.5%) cultures in group LO. This rate was reduced to 30% (n = 12), 10% (n = 4) in the groups OA and SB respectively. Bacterial translocations of MLN and the liver in group LO were significantly higher than those of groups OA and SB. Bacterial translocations of the both spleen and blood in group LO were significantly higher than those of groups OA and SB. The mean bacterial counts, colony-forming units per gram tissue (cfu/g), in the MLN, liver and spleen of group LO were found significantly higher than those of groups OA and SB. The mean villus height in group OA was significantly higher than that of group LO and it in the group SB significantly higher than those of groups LO and OA. The present experimental study has demonstrated that OA and SB may have protective effects against BT in mechanical bowel obstruction and additionally SB preserves intestinal mucosal integrity.
Effects of ursodeoxycholic acid, glutamine and polyclonal immunoglobulins on bacterial translocation in common bile duct ligated rats
(Blackwell Publishing Asia, 2003) Aldemir, M; Geyik, MF; Kökoglu, ÖF; Büyükbayram, H; Hosoglu, S; Yagmur, Y
Background: The present study was conducted to investigate the effects of ursodeoxycholic acid (UDCA), glutamine and i.v. polyclonal immunoglobulins ( IVIG) on the bacterial translocation (BT) and intestinal integrity of obstructive jaundice (OJ) in an animal model. Methods: Fifty rats were randomized into five groups containing 10 rats each. All procedures were performed aseptically under general anaesthesia using intramuscular ketamine ( 25 mg/kg). The abdomen was opened and the common bile duct was identified, mobilized, doubly ligated using 5-0 silk and divided. In group 1 ( the 'sham' group), the rats had a similar incision followed by mobilization of the common bile duct (CBD), without ligation or division. In group 2 rats, only common bile duct ligation (CBDL) was performed. In group 3, CBDL was performed and UDCA was administered by orogastric intubation once daily. In group 4 rats, CBDL was performed and glutamine was given by orogastric intubation once daily. Therapeutic substances were started orally on the day CBDL was fulfilled and were continued for 7 days. In group 5, IVIG was administrated via a femoral vein catheter just before CBDL. The animals were killed at the end of the 7th day, and serum levels of total bilirubin ( TB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and gamma-glutamyl transpeptidase (GGT) were measured. Mesenteric lymph nodes (MLN), liver, spleen and blood were cultured. The terminal ileum specimens were examined histopathologically. Results: Bacterial translocation significantly increased in the MLN and spleen of rats in group 2 as compared to groups 3, 4 and 5 (P < 0.05, P = 0.001, P = 0.001, respectively). The BT of the liver in group 2 was significantly higher than that of group 5 (P < 0.05). In the blood, the BT was significantly higher in group 2 than groups 3, 4 and 5 ( P < 0.05). The bacterial counts, colony- forming units per gram tissue (cfu/g), were found significantly higher in MLN, liver and spleen of rats in group 2 than those of groups 3, 4 and 5 ( P = 0.000). The average villus height in the group 4 was significantly higher than that of groups 2, 3 and 5 ( P = 0.000). Conclusion: The present experimental study has demonstrated that the administration of glutamine, UDCA and IVIG reduce the incidence of BT and additionally glutamine preserves intestinal mucosal integrity.
Epidemiology of burn unit infections in children
(Mosby-Elsevier, 2003) Geyik, MF; Aldemir, M; Hosoglu, S; Tacyildiz, HI
Objective: The aim of this study was to determine the epidemiology of burn unit infections, the effect of these infections on the mortality rate, and antibiotic resistance pattern of the predominant bacteria isolated from children. Patients and method: Epidemiologic data for 610 children, aged 0 to 15 years, admitted to the burn unit at Dicle University Hospital during a 5-year period were collected and analyzed. Results: In 207 patients (33.9%), 279 nosocomial infections were identified. The most common types of infections were burn wound infections (72.4%), urinary tract infections (10.8%), pneumonia (9.3%), and septicemia (7.5%). Pseudomonas aeruginosa (181 isolates) was the most common microorganism. Thirty-six patients (5.9%) died at the hospital. Sepsis was associated with mortality in 18 (50%) cases, pneumonia in 6 (17%), and varied noninfectious reasons in 12 patients (33%). P aeruginosa isolates showed high resistance to commonly used antimicrobials. Antibiotic susceptibility test results suggested that imipenem was the most effective agent for P aeruginosa and Escherichia coli strains. Conclusion: The major type of nosocomial infections in the burn unit was burn wound infections, and the majority of nosocomial infections resulted from multiple drug-resistant, gram-negative bacteria.
Factors affecting mortality and epidemiological data in patients hospitalised with burns in Diyarbakir, Turkey
(Sa Medical Assoc, 2005) Aldemir, M; Kara, IH; Girgin, S; Güloglu, C
Background. Burns continue to be responsible for significant morbidity and mortality in developing countries. In this study we aimed to determine the factors affecting mortality and epidemiological data by examining the records of burned patients. Method. The hospital records of 980 patients who were hospitalised in the Burns Unit at, Dicle University Hospital (DUH) between June 1994 and July 1999 were examined for factors affecting mortality. Factors evaluated included gender, age, burn type, degree and extent of bum, prognosis and length of hospitalisation (LH). We investigated the relationship (if any) between the demographic data, degree and extent of burns and mortality and morbidity rates. Results. The study group consisted of 325 males (33.2%) and 655 females (66.8%). Of the patients 738 (75.3%) were children (age under 15 years), 217 (22.1%) were younger adults (age 15 - 50 years), and 25 (2.6%) were older adults (age over 50 years). The mean age was 11.2 +/- 14.01 years (range 15 days - 95 years). Of the burns 618 (63.1%) were scalds, 199 (20.3%) burns from a flame and 163 (16.6%) electrical burns. The mean extent of bum was 24.3 +/- 14.5% (range 1 - 95%). Seven hundred and eighty-seven (80.3%) of the study group made a full recovery, 131 (13.4%) were discharged from hospital after partial recovery, and 62 (6.3%) died. The mean LH was 11.33 +/- 8.8 days (range I - 67 days). There was a positive correlation between burn extent and mortality (r = 0.35, p < 0.0001) and between age and type of burn (r = 0.60, p < 0.0001). While scalds had the highest frequency among children, flame and electrical burns were most common in the adult and older adult groups. There was also a positive correlation between degree and type of burn (r = 0.32, p = 0.0001), scalds tending to be more superficial while flame and electrical burns were generally more serious. Deaths of patients with extensive burns usually occurred in the first 5 days following injury due to acute renal failure and hypovolaemic shock, while deaths from moderate and minor burns usually occurred after 7 days and were due to wound infection and sepsis. Conclusion. We found positive correlations between age and type of burn, degree and type of burn, and the extent of burn and mortality. The overall mortality rate for our unit was 6.3%.
Falls from flat-roofed houses
(Elsevier Sci Ltd, 2004) Yagmur, Y; Güloglu, C; Aldemir, M; Orak, M
Purpose: High falls from flat-roofed houses are a common cause of death and disability in the south-east part of Turkey; the aim of this study was to describe our experience of such falls seen over a 4-year period in Diyarbakir. Methods: One thousand six hundred and forty-three patients (570 females and 1073 males) who sustained injuries after an accidental fall from a flat-roofed house were entered into the study. Results: The mean age was 18 (1-95) years; 49.4% of patients were under 10 years old; 81.5% were under 30 years old. The mean fall height was 4.5 m (1-20 m). The mortality rate was 5.8% (96 patients). The mean fall height in children under the age of 15 years who died from the fall was 4 m (67 patients) and in patients over the age of 15 years, 9 m (29 patients). The most common injuries were to the head (45.1%) and 93.75% of those (n = 90) who died had a head injury. One hundred patients (6%) were followed because of abdominal bleeding: one of these had fallen from 2 m, the reminder from 4 to 9 m; 12 were operated on and 88 treated conservatively. Conclusion: Craniocerebral trauma is the most common injury in fatal falls from flat roofs and blunt abdominal trauma is an uncommon injury after falling from less than 4 m. (C) 2003 Elsevier Ltd. All rights reserved.
Influence of the platelet-activating factor receptor antagonist BB-882 on intra-abdominal adhesion formation in rats
(Karger, 2003) Otcu, S; Ozturk, H; Aldemir, M; Kilinc, N; Dokucu, AI
Postoperative intra-abdominal adhesion formation is a major clinical problem. We aimed to examine the preventive effect of treatment with the platelet-activating factor (PAF) antagonist (lexipafant, BB-882) on experimentally induced intra-abdominal adhesion formation in rats. Twenty male Sprague-Dawley rats weighing 250 and 290 g were studied. Generation of adhesions in rats by brushing a 1-cm(2) area of the cecum and the peritoneum on the right side of the abdominal wall was followed by intra-abdominal administration of saline and 5 mg/kg in a volume of 0.2 ml PAF receptor antagonist BB-882. After 45 days, formation of adhesions was graded and histological evaluation was processed. The severity of adhesions was significantly less in the BB-882 group than in the control group (p < 0.001, p < 0.05). The average adhesion scores in the control and BB-882 groups were 3.2 +/- 0.6 and 0.6 +/- 0.6, respectively, and the difference between both groups was found to be significant (p < 0.0001). The number of polymorphonuclear leukocytes and fibrotic areas was significantly decreased in the BB-882 group when compared to the control group (p < 0.001, p < 0.002). In conclusion, this study confirms the efficacy of BB-882 in the prevention of postoperative intra-abdominal adhesions in a rat model. Copyright (C) 2003 S. Karger AG, Basel.
The mistakes of surgeons
(Acta Medical Belgica, 2004) Taçyildiz, I; Aldemir, M
Purpose : A foreign body retained in the abdominal cavity following surgery is a serious and medicolegal problem. To emphasize the importance of this operative iatrogenic complication, we reviewed our experience with six patients who had retained abdominal gossypibomas. Methods : The records of six patients with a confirmed diagnosis of gossypiboma after abdominal surgery at Dicle University Hospital, between January 1994 and December 2000, were retrospectively reviewed. Results : Four of the six patients were female and two male. Previously, of the patients, three underwent elective operations and three were operated on for emergency. Types of previous operation were gynaecological in three cases, gastrointestinal in two cases and hepatobiliary in one case. The most common symptoms were mass, nausea, vomiting, abdominal distension and pain. The intestinal obstructions and pseudotumoral syndrome were determined in three and two cases, respectively. Abdominal ultrasonography clearly demonstrated the gossypiboma in four of our patients and CT demonstrated a more precise image of forgotten surgical sponges in the other two patients. One patient died due to ventricular fibrillation, the other five patients were discharged healthfully. Conclusion : Small sponges should not be used during laparotomy. Compresses should only be used intraperitoneally, one by one, mounted on a forceps. Before closing the peritoneum, the surgeon should completely explore the abdominal cavity.
Multiple jejunal diverticulitis with perforation in a patient with systemic lupus erythematosus
(Springer-Verlag, 2004) Yagmur, Y; Aldemir, M; Büyükbayram, H; Taçyildiz, I
A 70-year-old man with systemic lupus erythematosus (SLE) was brought to our Emergency Department after the sudden onset of acute and severe abdominal pain. Physical examination revealed a tender and distended abdomen with guarding and rebound tenderness in the periumbilical region and the left upper quadrant. A plain abdominal X-ray taken with the patient upright showed air fluid levels with dilatation of several loops in the small bowel. As the examination could not rule out bowel ischemia, perforation, or obstruction, an emergency laparotomy was performed, which revealed multiple jejunal diverticulosis, one of which had perforated and adhered to the right colon, causing rotation. The diverticulosis segment was resected and an end-to-end anastomosis was done. The patient had an uneventful postoperative recovery without any complications. This is an unusual cause of peritonitis in a patient with SLE, and we could not find any evidence to suggest involvement of the underlying SLE in the jejunal diverticulosis and diverticulitis in this patient. Nevertheless, the involvement of SLE might be possible and further investigation is warranted.
The nitric oxide donor molsidomine prevents ischemia/reperfusion injury of the adult rat small intestine
(Springer, 2003) Öztürk, H; Aldemir, M; Dokucu, AI; Yagmur, Y; Kilinç, N; Sahin, AH
It is suggested that gastrointestinal mucosal blood flow depends on a balanced release of vasoactive substances from the endothelium. The present study investigated the effects of molsidomine on the small intestine after ischemia-reperfusion (I/R) injury in four groups of 10 rats each composed: (1) SO, sham operation; (2) untreated I/R; (3) ML, I/R plus molsidomine pretreatment; (4) L-NAME, I/R plus N-omega-nitro-L-arginine methyl ester pretreatment. Intestinal ischemia for 45 min and reperfusion for 60 min were applied. Ileum specimens were obtained to determine the tissue level of malondialdehyde (MDA) and histologic changes. Mean MDA levels in the SO, untreated I/R, ML, and L-NAME groups were 95.60 +/- 2.59, 136.90 +/- 4.35, 121.10 +/- 3.38, and 137.40 +/- 4.42 nmol/g wet tissue, respectively. Although the MDA level in the ML group was higher than in the SO group (P < 0.0001), it was significantly lower compared to the untreated I/R and L-NAME groups (P < 0.0001, P < 0.0001). Mucosal injury scores (MIS) in groups 1-4 were 0.2 +/- 0.42, 3.9 +/- 0.73, 1.5 +/- 0.70, and 4.1 +/- 0.56, respectively. In group 3 the MIS was significantly lower than in groups 2 and 4 (P < 0.0001, P < 0.0001). Molsidomine plays a role in attenuating reperfusion injury of the small intestine by depression of tissue MDA levels and MIS and regulates post-ischemic intestinal perfusion while restoring the intestinal microcirculatory blood flow and histologic injury.
Predicting factors for mortality in the penetrating abdominal trauma
(Acta Medical Belgica, 2004) Aldemir, M; Taçyildiz, I; Girgin, S
Purpose : penetrating abdominal trauma (PAT) is still a serious problem all over the world. This study was made to define and discuss the factors that could affect mortality in the PAT. Methods : the records of 1048 patients hospitalized and operated for PAT at Dicle University Hospital (DUH) between January 1990 and December 2001 were retrospectively reviewed. Patients (n = 1048) were divided into two groups : Healthy Group (HG) (n = 942) and Deathly Group (DG) (n = 106). The epidemiological and clinical features were evaluated as probable risk factors for mortality. The risk factors for mortality were revealed using univariate and multivariate analyses. Results : a total of 1048 patients [937 (89.4%) male, 111(10.6%) female] with PAT were included in this study. The mortality rate (22.5%) of female patients was significantly higher than (8.6%) that of male patients (p = 0.000). The mean age was 30.01 +/- 63.9 (14-74) years and 30 +/- 12.5(15-71) years in the HG and DG consecutively (p = 0.85). The average interval between injury and operation (IBIO) was 2.09 +/- 1.3 (0.5-3) and 6.9 +/- 11.4 (1-6.1) hours in the HG and DG respectively (p = 0.000). Presence of shock on admission (PSDA) was determined in 87 patients and in 96 patients in the HG and DG respectively (p = 0.000). The mortality rate (14.9%) in patients presenting gunshot wounds (GSW) was significantly higher than (2.7%) that of patients with stab wounds (SW) (p = 0.000). The average number of injured intraabdominal organs (NIAOI) was 1.98 +/- 1.08 (1-7) and 4.67 +/- 1.99 (1-13) in the HG and DG respectively (p = 0.000). Mortality rates were 72.7% in cardiac injury, 30% in great vessels injuries, 32.6% in cranial injury, and 21.5% in major extremity and pelvic injury (p = 0.000). The average penetrating abdominal trauma index (PATI) was 11.78 +/- 9.44 (1-58) and 46.24 +/- 22.18 (15-119) in the HG and DG respectively (p = 0.000). In multivariate analyses, female gender [Odds Ratio (OR) = 10.74, 95% Confidence Interval (CI) = 3.03-38.12, P = 0.000] the long IBIO (OR = 1.82, CI = 1.39-2.40, P = 0.000), PSDA (OR = 94.45, Cl = 28.32-314.95, P = 0.000), presence of cranial injury (OR = 0.03, cl = 0.002-0.363, P = 0.006) and high PATI (OR = 1.14, Cl = 1.09-1.19, P = 0.000), were found significantly important for mortality. Conclusion : we determined that conditions such as, female gender, long, interval between injury and operation, presence of shock on admission, presence of cranial injury and high PATI were predicting factors for mortality in PAT.
The predictive factors for the necessity of operative treatment in adhesive small bowel obstruction cases
(Acta Medical Belgica, 2004) Aldemir, M; Yagnur, Y; Taçyildir, I
Background: The timely diagnosis of adhesive small bowel obstruction (SBO) can frequently be a clinical dilemma. The objective of this study was to evaluate the predictive factors for the necessity of operative treatment in adhesive SBO cases. Method : The records of hospitalized adhesive SBO patients at Dicle University Hospital (DUH) between January 1998 and December 2001 were prospectively reviewed. The patients divided into two groups as a non-operative group (NOG) and an operative group (OG). The epidemiological, clinical, and laboratory features were evaluated as probable predictive factors for the timing of the surgical treatment. Predictive factors associated with the timing of the surgical treatment were determined using logistic regression models. Results : A total of 180 patients [ 131(72.8%) male, 49(27.2%) female] with SBO were included in this study. One hundred and twenty patients (66.7%) were diagnosed with SBO and treated medically at the hospital. Sixty patients (33.3%) were diagnosed with SBO and underwent surgery. In univariate analyses, age (P = 0.008), length of period of symptoms (P < 0.001), high fever (P < 0.001), tachicardia (P < 0.001), tachypnea (P < 0.001), intractable pain (P < 0.001), hypoactive bowel sounds (P < 0.001), presence of rebound tenderness (P < 0.001), the persisting air-fluid levels in serial the plain abdominal radiographs (P < 0.001), leukocytosis (P < 0.001) and elevated CRP (P < 0.001) were found to be significantly associated with the predictive factors for the timing of operative treatment. In multivariate analyses, the presence of rebound tenderness [Odds Ratio (OR) = 57, 95% Confidence Interval (CI) = 3.5-922.4, p = 0.004], the persisting air-fluid levels (OR = 29, CI = 1.8-466.4, p = 0.018) were found significantly important as the predictive factors for the timing of operation. Conclusion : Presence of rebound tenderness and the persisting air-fluid levels at admission or in hospital should be considered as predictive factors for the timing of an operation in adhesive SBO cases.
Predisposing factors for delirium in the surgical intensive care unit
(Biomed Central Ltd, 2001) Aldemir, M; Özen, S; Kara, IH; Sir, A; Baç, B
Background Delirium is a sign of deterioration in the homeostasis and physical status of the patient. The objective of our study was to investigate the predisposing factors for delirium in a surgical intensive care unit (ICU) setting. Method Between January 1996 and 1997, we screened prospectively 818 patients who were consecutive applicants to the general surgery service of Dicle-University Hospital and had been kept in the ICU for delirium. All patients were hospitalized either for elective or emergency services and were treated either with medication and/or surgery. Suspected cases of delirium were identified during daily interviews. The patients who had changes in the status of consciousness (n=150) were consulted with an experienced consultation-liaison psychiatrist. The diagnosis of delirium was based on Diagnostic and Statistical Manual of Mental Disorders (revised third edition) criteria and established through psychiatric interviews. Patients were divided into two groups: the 'delirious group' (DG) (n=90) and the 'nondelirious group' (NDG) (n=728). During delirium, all abnormal findings related to physical conditions, laboratory features, and additional diseases were evaluated as probable risk factors of delirium. Results Of 818 patients, 386 (47.2%) were male and 432 (52.8%) were female. Delirium developed in 90 of 818 patients (11%). The cases of delirium in the DG were more frequent among male patients (63.3%) than female patients (36.7%) (chi (2) = 10.5, P=0.001). The mean age was 48.9 +/- 18.1 and 38.5 +/- 13.8 years in the DG and NDG, respectively (t=6.4, P=0.000). Frequency of delirium is higher in the patients admitted to the Emergency Department (chi (2) = 43.6, P=0.000). The rate of postoperative delirium was 10.9%, but there was no statistical difference related to operations between the DG and NDG (chi (2) = 013, P=0.71). The length of stay in the ICU was 10.7 +/- 13.9 and 5.6 +/-2.9 days in the DG and NDG, respectively (t=0.11, P=0.000). The length of stay in hospital was 15.6 +/- 16.5 and 8.1 +/-2.7 days in the DG and NDG, respectively (t=11.08, P=0.000). Logistic regression was used to explore the associations between probable risk factors and delirium. Delirium was not correlated with conditions such as hypertension, hypo/hyperpotassemia, hypernatremia, hypoalbuminemia, hypo/hyperglycemia, cardiac disease, emergency admission, age, length of stay in the ICU, length of stay in hospital, and gender. It was determined that conditions such as respiratory diseases (odds ratio [OR] = 30.6, 95% confidence interval [CI] = 9.5-98.4), infections (OR = 18.0, 95% CI = 3.5-90.8), fever (OR = 14.3, 95% CI = 4.1-49.3), anemia (OR = 5.4, 95% CI = 1.6-17.8), hypotension (OR 19.8, 95% CI = 5.3-74.3), hypocalcemia (OR = 30.9, 95% CI = 5.8-163.2), hyponatremia (OR 8.2, 95% CI = 2.5-26.4), azotemia (OR = 4.6, 95% CI = 1.4-15.6), elevated liver enzymes (OR 6.3, 95% CI = 1.2-32.2), hyperamylasemia (OR = 43.4, 95% CI = 4.2-442.7), hyperbilirubinemia (OR = 8.7, 95% CI = 2.0-37.7) and metabolic acidosis (OR = 4.5, 95% CI = 1.1-17.7) were predicting factors for delirium. Conclusion We determined that conditions such as respiratory diseases, infections, fever, anemia, hypotension, hypocalcemia, hyponatremia, azotemia, elevated liver enzymes, hyperamylasemia, hyperbilirubinemia and metabolic acidosis were predicting factors for delirium.
The preventive effect of rofecoxib in postoperative intraperitoneal adhesions
(Acta Medical Belgica, 2004) Aldemir, M; Öztürk, H; Erten, G; Büyükbayram, H
Background : Previous studies showed that nonsteroidal anti-inflammatory (NSAI) drugs suppressed prostaglandin synthesis and were able to prevent adhesion formation following surgical trauma to the peritoneum. The selective suppression inflammatory cascade may prevent adhesion formation. Therefore, we planned this study to experimentally evaluate the effects of Rofecoxib, the selective cyclo-oxygenase-2 inhibitor, in postoperative intraperitoneal adhesions in an animal model. Methods : Male Sprague-Dawley rats were divided into three groups of 10. All rats underwent midline laparotomy under ketamine anaesthesia (25 mg/kg im). In group I (n = 10), the sham operation group (SG); abdominal walls were closed without any process after 2 minutes. In Group 2 (n = 10), the control group (CG); standard serosal damage was constituted and the abdominal wall was closed. In group 3 (n = 10), the COX-2 group (COXG), after serosal damage, the abdominal wall was closed. A 12 mg/kg/day dose of was given orally to the rats during one week. On the 711, postoperative day, all rats were sacrificed and intra-abdominal adhesions were evaluated both macroscopically and microscopically. Results : Macroscopically, no serious adhesion formations were seen in the SG. Multiple adhesion formations of the CG were significantly more than those of the SG (p < 0.0001). It was determined that adhesions of the COXG diminished (p < 0.0001) when macromorphological adhesion scale results of the COXG were compared with those of the CG. The adhesion scores of the CG were compared microscopically with those of the COXG and granulation tissue formation and fibrosis in the COXG were found to be significantly less than those of the CG (respectively p = 0.002, p < 0.0001). Conclusions: We were of the opinion that Rofecoxib, the selective cyclo-oxygenase inhibitor, was effective in the prevention of postoperative peritoneal adhesions.
Risk factors for enteric perforation in patients with typhoid fever
(Oxford Univ Press Inc, 2004) Hosoglu, S; Aldemir, M; Akalin, S; Geyik, MF; Tacyildiz, IH; Loeb, M
A case-control study was performed using the records of patients hospitalized for typhoid fever at Dicle University Hospital, Diyarbakir, Turkey, between 1994 and 1998. Case patients with enteric perforation were compared with control patients with typhoid fever but no enteric perforation. Risk factors for perforation were determined using logistic regression modeling. Forty case patients who had surgery because of typhoid enteric perforation were compared with 80 control patients. In univariate analyses, male sex (p = 0.01), age (p = 0.01), leukopenia (p = 0.01), inadequate antimicrobial therapy prior to admission (p = 0.01), and short duration of symptoms (p = 0.01) were significantly associated with perforation. In multivariate analysis, male sex (odds ratio (OR) = 4.39, 95% confidence interval (CI): 1.37, 14.09; p = 0.01), leukopenia (OR = 3.88, 95% CI: 1.46, 10.33; p = 0.04), inadequate treatment prior to admission (OR = 4.58, 95% CI: 1.14, 18.35; p = 0.03), and short duration of symptoms (OR = 1.22, 95% CI: 1.10, 1.35; p = 0.001) were significant predictors of perforation. A short duration of symptoms, inadequate antimicrobial therapy, male sex, and leukopenia are independent risk factors for enteric perforation in patients with typhoid fever.

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