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Öğe Acute liver failure caused serious mortality: A case report(2006) Al B.; Güloğlu C.; Yağmur Y.; Aldemir M.; Özhasenekler A.Acute liver failure is a rarely seen liver disease and requires emergency treatment. Acute liver failure must be diagnosed rapidly with patients' past history, clinical presentation, physical examination and laboratory evaluation. Treatment should be started immediately, otherwise in a short time hypotension, hypoglycemia, sepsis, encephalopathy, coagulopathy, intracranial and gastrointestinal bleeding would develop and patient would die. Generally the diagnosis of the patient is delayed and liver parenchymal mass decreases and part of liver would be lost. Multiple organ failure would develop with other complications. At this point patient has already lost the chance of life saving procedure i.e. liver transplantation. In this article a 36 years old patient with jaundice, vomiting, weakness, abnormal speaking had resorted to a hospital. He had been treated and sent home. The patient had become worse after a short time, and had resorted to our clinic. He was diagnosed as Acute Live Failure with hepatitis B. Six days later he died.Öğe The effectiveness of hemopoietic growth factors in sepsis(2001) Yilmaz G.; Aldemir M.; Yilmaz R.; Diken H.; Büyükbayram H.; Akgün Y.In this experimental study, consist of 54 Sprague-Dawley rats, we tried to observe the effectiveness of haemopoietic growth factors such as G-CSF and GM-CSF in treatment of sepsis and see if they have any effects on phagocytic activity of macrophages when are administered after establishment of sepsis. In first phase of this study, twenty one rats were randomly divided into three groups of 7 animals each. Cecal ligation and perforation were carried out in each rat and sepsis made up. The Control group received 2 x 0.2 cc %5 dextrose injection subcutaneous (s.c.).. The G-CSF group received 2 x 1 g G-CSF with 0.2 cc %5 dextrose s.c. The GM-CSF received 1 x 2 g GM-CSF with 0.2 cc %5 dextrose s.c. Seventh day survival was considered as criterion in the three groups. In second phase of this study, thirty three rats were randomly divided into three groups of 11 animals each. The same procedures were carried out also in these groups. Leukocyte counts and peripheric spread were analyzed in postoperative 24th and 72th hours, alveolar and peritoneal macrophages were Investigated in postoperative 72nd hour. There was significantly neutrophilic leukocytosis in the G-CSF group according to the control group. Nevertheless, there was no change in the phagocytic activity of alveolar and peritoneal macrophages. GM-CSF brought about positive effect of phagocytic activity of macrophages without change of leucocyte count in the sepsis, but it caused neutrophilic, monocytosis and lymphocytopenia. The seventh day survival rates in control, G-CSF, GM-CSF groups were as; 42.8%, 71.4%, 28.5% respectively. As a result, we saw that G-CSF has no effect on the phagocytic activity of macrophages, while increases the survival by enhancing the count and probably the function of neutrophils. GM-CSF fails to increase survival while effects the phagocytic activities of macrophages positively and enhances the peripheral neutrophil and monosit counts without changing the total number of leukocytes.Öğe The effects of levofloxacin and intravenous immunoglobulins on sepsis due to Streptococcus pneumoniae in splenectomized rats(Turkish Surgical Society, 2003) Aldemir M.; Geyik M.F.; Akalin Ş.; Hoşo?lu S.; Taçyildiz I.; Ayaz C.This experimental study was conducted to investigate the effects of levofloxacin and intravenous immunoglobulins (IVIG) on sepsis due to Streptococcus pneumonia in splenectomized rats. Splenectomy impairs the immune response to bacterial infections. Postsplenectomy sepsis is a serious complication that can result in fulminant bacteriemia and even death. Sixty infant Sprague-Dawley rats were randomized into 5 groups containing 12 rats each. All rats were initially anaesthetized by intramuscularly injection of Ketamine (5 mg/kg). In the group 1, after the abdomen was opened, spleen was mobilized. In the other groups, splenectomy was performed. All of this animals (in the groups 2-5) were inoculated with Streptococcus pneumonia seven days after splenectomy. Fifteen hours after inoculation, blood (0.1 cc) was obtained for bacterial counts (cfu) and immediately drug therapy was given. The saline solution, levofloxacin, IVIG, levofloxacin plus IVIG were given in group 2-5 rats respectively. Twenty-four, 48 and 72 hours after initial therapy, blood samples were obtained from all rats for bacterial counts and biochemical examination (Ig G,A,M) and during 72nd hours rats were sacrificed. After inoculation in the groups 2-5 rats positive cultures were obtained. During 48th and 72nd hours, positive cultures (41.7% and 25%) of rats in groups 3 were significantly lower than (100% and 100%) those of group 2 (p<0.05 and p=0.001, respectively). Positive culture ratio (41.7%) in the group 4 was significantly lower than (100%) that of group 2 (p<0.05). During 24th, 48th and 72nd hours, positive cultures (41.7%, 16.7% and 0%) in the group 5 were significantly lower than those of group 2 (p<0.05, p<0.001 and p<0.001). During 24th, 48th and 72nd hours, bacterial counts in the groups 3-5 were significantly lower than those of group 2 (p<0.001). The IgG levels of groups 4 and 5 were significantly higher than those of groups 2 and 3 (p<0.001). The present experimental study has demonstrated that levofloxacin and IVIG, both alone and combine, are useful on sepsis due to S. pneumonia in splenectomized rats.Öğe The effects of prophylactic antibiotics on the bacterial translocation due to pringle maneuver(Turkish Surgical Society, 2002) Girgin S.; Aldemir M.; Taçyildiz I.-B.; Geyik M.F.This study was undertaken to investigate the effectiveness of prophylactic antibiotics (Cefotaxime and Ceftazidime) on the bacterial translocation related to PM in rats. Bacterial translocation may occur in humans and is associated with an increased incidence of septic morbidity. It has been consistently demonstrated in a number of experimental models, including burns, trauma, shock, and surgery. It has been previously determined that the PM causes bacterial translocation. The prophylactic antibiotics may reduce this translocation. Thirty male Sprague-Dawley rats weighed in at 250-300 gr were divided into 3 groups each were containing 10 rats. After being anaesthetized by intramuscularly injection of Ketamine, midline laparotomy was performed to all rats under sterile conditions. In group 1 (Control), the hepatoduodenal ligament was clamped for 40 min. In group 2 (Cefotaxime), following intramuscularly application of Cefotaxime (30 mg/kg) 30 minutes before the surgical procedures, the PM was performed for 40 min. In group 3 (Ceftazidime), Ceftazidime (30 mg/kg) was applied instead of Cefotaxime before the PM. 1 ml of blood sample was obtained from the portal vein for blood culture. The MLN biopsy and splenectomy were performed for culture. The positive bacterial cultures, obtained from MLN, spleen and blood, were determined most frequently in group 1. It was found that the positive cultures of group 1 (56.7%) were significantly higher than those of group 2 (6.7%) and group 3 (6.7%) (p=0.006, p=0.006, p=0.001, respectively). Microorganisms, obtained from MLN and spleen,were E. coli, C.pneumonia, Mikst, Candida and E.fecalis (respectively, 61.9%, 14.3%, 9.5%, 9.5%, 4.8%). In both cultures of MLN and spleen, the CFU of the group 1 was significantly higher than CFU of group 2 and 3 (p=0.001, p=0.003). In our study, we determined that PM significantly increased bacterial translocation in MLNs, spleen and blood, and prophylactic application of Cefotaxime and Ceftazidime had preventive effect on this translocation.Öğe The effects of topical hypothermia, methylprednisolone and BN 52021 on hepatic ischemia/reperfusion injury(Turkish Surgical Society, 2002) Taçyildiz I.; Aldemir M.; Girgin S.; Büyükbayram H.; Baç B.This study was undertaken to investigate the effectiveness of topical hypothermia, methylprednisolone and BN 52021 on ischemia/reperfusion induced liver injury. The liver is one of the organs most vulnerable to ischemia because of its high metabolic state. Occlusion of the portal triad is often required in complex hepatic surgery in order to decrease parenchymal bleeding. Liver failure due to ischemia-reperfusion injury is a serious problem during liver surgery. Fifty male Sprague-Dawley rats (200-225 gr) were divided into 5 groups each containing 10 rats. Midline laparatomy was fulfilled on all the rats under ketamine anesthesia. In group 1 (Sham), the hepatoduodenal ligament was dissected without any drug administration. In group 2 (İ/R), the ischemia (for 45 min)/ reperfusion (for 45 min) was performed and received no further treatment. In group 3 (Hypothermia), the ischemia plus topical cooling (for 45 min) and reperfusion (for 45 min) was fulfilled. In the group 4 (Steroid), the İ/R was performed and methylprednisolone (30 mg/kg) was administered. In group 5 (BN 52021), the İ/R was performed and BN 52021 (100 mg/kg) was given before ischemia. Liver, ileum and blood samples (for MDA, ALT, AST, LDH and ileal mucosal injury score) were obtained. The levels of ALT,AST, LDH, MDA(ileal, hepatic) and ileal injury score in group İ/R were significantly higher than those of group sham (p>0.0001). When group İ/R was compared with group hipothermia, there were no significant differences with regard to AST, ileal MDA and ileal injury score (p>0.05), whereas levels of ALT, LDH and hepatic MDA were significantly higher (p<0.0001, 0.0001, <0.0001, respectively). When group İ/Rwas compared with group steroid and group BN 52021, it was determined that those agents had significant protective effects on hepatic and ileal injuries (p<0.0001). It was determined that topical hypothermia decreased hepatic İ/R injury, however had no protective effect on ileal injury. We determined that Methylprednisolone and BN 52021 decreased both hepatic İ/R and ileal injury due to splanchnic congestion.Öğe Epidemiological characteristics of electrical injuries of patients applied to the emergency department(2006) Al B.; Aldemir M.; Güloğlu C.; Kara I.H.; Girgin S.BACKGROUND: In this study, we planned to determine the factors affecting the mortality, and morbidity of electrical injuries. METHODS; Medical records of 165 patients (126 males; 39 females; mean age 21.1 years; range 2.5 to 62 years), who were admitted to the Emergency Department of Dicle University School of Medicine for electrical injuries, between January 2003 and April 2004, were retrospectively reviewed. RESULTS: Among these patients, 60 (36.4%) were children, under 12 years old; 95 (57.6%) were adolescents and adults, and 10 (6%) were aged. Of the victims of electrical accidents, 29 (17.6%) were illiterate and 36 (21.8 %) were educated. Ninety-seven (58.8 %) patients were either graduates or still students of elementary, secondary or high school. The cause of exposure to electricity was accident in 99 (60%), and carelessness and parents' negligence in 66 (40%). Sixty-nine (41.8%) patients were exposed to high voltage, and 96 (58.2 %) to low voltage. Because of electrical injury 16 patients had first degree, 96 patients had second degree, and 86 patients had third degree burns. The most frequent complications were contractures of extremities (10.9%) and compartment syndrome (3.6%). Mortality rate was 9.1% (n=15). Eighty percent of the deaths were due to exposure to high voltage. A positive correlation was demonstrated between mortality and complications (p<0.001). Escarotomy was performed in 10 patients, fasciotomy in 16, and amputation in 9. Two of 5 patients who had intraabdominal hemorrhage underwent surgery. CONCLUSION: A serious education of the society with respect to conscious use of of electricity is the most efficient method to decrease electrical accidents.Öğe Etiology, diagnosis and treatment of anal fissure(2007) Girgin S.; Gedik E.; Aldemir M.Anal fissure is a painful ulcer, which is lying longitudinally to dentate line within the anal channel. It is a common illness, which causes morbidity in the healthy population, especially among the young people. Aetiopathogenesis, and the treatment of this illness is contentious, although it was identified long time ago. The treatment of the chronic form of this illness generally requires surgical intervention whereas acute form of the illness responses to medical treatment. Numerous medicines (Botilismus toxin, goniatoxin, glyceril trinitrate, etc), which are aimed to decrease tonus of the internal anal sphincters, which play an important role in the chronic anal fissure's etiopathogenesis and applied surgical methods are currently debatable. In this study we aimed to discuss the diagnostic methods of the anal fissure's aetiopathogenesis, medical, and surgical treatment methods.Öğe Factors affecting morbidity and mortality in hollow visceral injuries following blunt abdominal trauma(2014) Arikanoglu Z.; Turkoglu A.; Taskesen F.; Ulger B.V.; Uslukaya O.; Basol O.; Aldemir M.Background and Aim: Hollow visceral injuries following blunt abdominal trauma are uncommon. The potential risk factors affecting morbidity and mortality are not well known. The purpose of our study was to evaluate the outcomes of hollow viscus perforation after blunt abdominal trauma. Materials and Methods: Patient files of 56 adult patients who were treated with diagnosis hollow viscus injuries due to blunt abdominal trauma between the years 2000 and 2011 at the Dicle University Medical School General Surgery Clinic were retrospectively evaluated by analyzing the relationship between morbidity-mortality and potential risk factors. Results: Fifty-six patients formed the study group, with median age of 37.5±17,0 (range, 16-78) years and a significant male (80.3%) predominance. The median Injury Severity Score was 4 (1-25). The median length of hospital stay 7.5 (1-21) days. The mean age in the group with morbidity (47.1±17.4) was significantly higher than the group without morbidity (34.3±15.8) (p<0.05). Also, re-operation (p=0.0013), treatment modality (p=0.037), cause of injuries (0.0046) were other factors that affect morbidity. Conclusions: These findings suggest that factors affecting morbidity were cause of injuries, re-operation and treatment in patients with hollow viscus injury caused by blunt abdominal trauma. And factors affecting mortality were the injured organ, the presence of shock and median injury severity score. © Societá Editrice Universo (SEU).Öğe Factors affecting mortality in patients with gunshot injuries(2009) Eriş S.; Orak M.; Al B.; Güloğlu C.; Aldemir M.Objective: We planned this study in order to determine the factors affecting mortality in patients with gunshot injuries in more than one organ. Methods: We retrospectively reviewed the hospital records of 714 patients admitted to the Emergency Department of Dicle University, between January 2000 and December 2004. The factors that we considered would affect mortality such as age, sex, attempts suicide, long barrelled gun injuries, pellet injuries, contact/near contact shot, delayed admission time, presence of serious anemia and shock during admission, more than four entrance wounds, injury areas, serious cranial, thorax and abdominal injuries, vascular injuries in the extremities, administration of multiple transfusion, and trauma scores as GCS, RTS, PATI were analyzed. Results: As a result of unvaried statistical analyses, we determined that suicide attempts (p=0.001), presence of serious anemia (p=0.001) and shock (p=0.001) during admission, presence of serious cranial (p=0.001), thorax (p=0.001) and abdominal (p=0.001) injury, femoral artery injury (p=0.001), multiple blood transfusion (p=0.009), , GCS 0-7, GCS 8-12 (p=0.001) and low RTS (p=0.001)were significant factors affecting mortality. Conclusion: Multivariate analysis showed that serious anemia during admission, serious cranial injury, serious abdominal injury and low RTS were independently significant in predicting mortality (p<0.05).Öğe Granulomatous peritonitis due to Ascaris lumbricoides(2000) Aldemir M.; Yilmaz G.; Girgin S.; Akgün Y.Ascaris lumbricoides is one of the most common and most widespread helminthic infections of humans. Infection with ascaris appears to be asymptomatic in the vast majority of cases, but may produce serious pulmonary disease or obstruction of biliary or intestinal tract in a small proportion of infected people. We examined under the light of literature this case which caused the granulomatous peritonitis by ascaris, the adult worm, without any evidence of intestinal perforation.Öğe An important hazard threatened to preschool children: Home accident(2004) Kara I.H.; Gülo?lu C.; Aldemir M.; Erten G.Injuries are one of the most important factors threatened the health of children in developed or developing countries. In this study, the sociodemographic factors such as age, gender and seasonal features of the patients applied to emergency service due to home accidents were aimed to evaluate. In this retrospective study, 305 home injury cases applied to Dicle University Faculty of Medicine Emergency Service between January and December, 2001 and had adequate records were evaluated. Cases were classified according to the types of accidents, age groups, clinics where they were hospitalized and seasons and months which they applied to the hospital. Among home injuries, burns were seen most frequently (186 cases, 61.0%) and followed by falls (30 cases, 9.8%). Home injury incidence was greatest among pre-school children in 0 to 4 age category (142 cases, 46.6%) and also it was greater for males than females at all ages (M/F=191/114, p<0.0001). Hospital applications were found to be mostly in spring (March and April, 31 cases each) (28.2%) and summer (June and July, 30 cases each) (27.2%). Although the average age was 12.6±14.9 years when the whole cases were evaluated, it exhibited significantly different values due to the injury types. Totally 6 cases (4 females and 2 males, 1.97%) were died because of home injuries. Consequently, in order to prevent and control home injuries, it is necessary to take preventive measures and security systems especially for preschool children whom are the most important risk group and to provide the education of parents, teachers and baby-sitters.Öğe The metabolic and hormonal effects of perioperative ibuprofen treatment on surgical stress(2002) Aydin O.; Aldemir M.; Taçyildiz I.; Girgin S.; Sen T.; Baç B.BACKGROUND: Surgical stress induces hormonal and cytokine responses proportional to the extent of the injury. Perioperative administration of cyclo-oxygenase inhibitors reduces cytokine production and nitrogen losses. The objective of this study is to evaluate clinically the metabolic and hormonal effects of ibuprofen which is cyclo-oxygenase inhibitor on surgical stress. METHODS: A prospective clinic study was performed in 20 patients who undergone thyroidectomy. Patients were randomly divided two groups as ibuprofen group (n = 10) and control group (n = 10). In the ibuprofen group, pills containing ibuprofen (400 mg) were administered orally 12 and 2 hours before surgery, and every 8 hours until the third postoperative day. In the both groups, blood samples were collected 24 and 2 hours before surgery and 1, 4, 6, 24, 48, and 72 hours after skin incision for glucose, CRP, leukocytes, ACTH, cortisol determinations. RESULTS: When preoperative values were compared with postoperative values, surgical stress caused significantly changes on the all parameters in the both groups. The highest levels of ACTH and cortisol were at 1st and 6th hours respectively. In both groups, plasma cortisol levels remained elevated for 3 days, whereas plasma ACTH levels returned to the basal level at 1 day. In the ibuprofen group, the levels of ACTH and cortisol were significantly less than those of control group (p < 0.001 and p < 0.001). In the ibuprofen group glucose level (p < 0.001) and count leukocyte (p < 0.001) increased mildly. The level of CRP increased gradually after first day and were high until 3rd days (p < 0.01). In the ibuprofen group the fever increased smaller (p < 0.01). CONCLUSIONS: In conclusion, in perioperative period pretreatment with ibuprofen is able to reduce the neuroendocrine and humoral responses, but it can not completely suppress. Our present study suggests that ibuprofen may be useful in decreasing the surgical stress response in the serious patients.Öğe Sigmoid colon torsion: mortality and relevant risk factors.(2013) Onder A.; Kapan M.; Arikanoglu Z.; Palanci Y.; Gumus M.; Aliosmanoglu I.; Aldemir M.Sigmoid volvulus is an important acute intestinal obstruction, leading to high mortality and requiring urgent operation. The purpose of this study is to analyze risk factors for mortality in patients that were operated on due to sigmoid volvulus at our Department. The retrospective study included 158 patients, who were operated on due to sigmoid volvulus between January 1994-December 2010, in terms of age, gender, complaints at admission, physical signs, period of symptoms before admission, associated diseases, laboratory and radiological parameters, hospital stay, morbidity, and mortality. The study consisted of 135 men (85.4%) and 23 women (14.6%), with a mean age of 62.54 years. Cardiovascular disease and respiratory disease were present in 34 (21.5%) and 42 (26.6%) patients, respectively. Urgent operation was undertaken in 125, while 33 received elective surgery. Abdominal distension and pain was evident in all the patients. Generalized tenderness was detected in 58.2%, while 70.9% had hyperactive bowel sound with tympanism. Plain radiograph revealed an impression of "omega ans" in all patients, while free air was detected in 11.4% of them. Risk factors for mortality included age (p = 0.008), delayed admission (p = 0.001), cardiovascular and respiratory diseases (p = 0.001), fluid-electrolyte imbalance (p =0.001), presence of necrosis (p = 0.001), and major contamination (p = 0.001). Wound infection and intraabdominal abscess were more common in patients that developed mortality (p = 0.001 and p = 0.002). Complications like wound infection and intraabdominal abscess are more frequent in the patients with the risk of mortality. Delayed admission results in higher risk of mortality. Mortality rates can be reduced by early admission, preoperative intensive resuscitation, suitable antibiotics, and emergent and viable surgery.Öğe Thyrotoxic periodic paralysis(2004) Gülo?lu C.; Aldemir M.; Sö?üt Ö.; Behçet A.Thyrotoxic periodic paralysis (TPP) is an uncommon disorder characterized by simultaneous thyrotoxicosis, hypokalaemia, and paralysis and is the most common acquired form of periodic paralysis. It is usually associated with low plasma potassium levels and is often precipitated by physical activity or ingestion of carbohydrates. We reported two the cases with hyperthyroidism who applied to the emergency department with episode of flaccid quadriparalyis and the literature on this subject. In the both cases, physical and laboratory examination revealed the low serum potassium levels, sinus tachycardia and ST segment depression, diffuse goiter, flaccid quadriparalysis. Potassium chloride was applied via parenteral and oral. Meanwhile antithyroid treatment (propylthiouracil and propranolol) were given to they. In first patient, it was determined that intake of high dose diclophenac sodium was the probable precipitating factor. In the both cases, paralysis began to improve in 30 minutes and had completely resolved within about 8-10 hours of admission. Thyrotoxic periodic paralysis should be taken into consideration in the differential diagnosis of all acute episodes of motor paralysis especially in young patients. Thyrothoxic periodic paralysis is treated with cautious replacement of potassium and achievement of an euthyroid state. Early diagnosis is important for planning antithyroid treatment, protecting the patient from further episodes of paralysis and avoidance of precipitating factors.
