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Öğe Akciğer iskemi reperfüzyon hasarında Melatonin ve N-Asetilsisteinin etkileri(2017) Durkan, Atilla; Ülkü, Refikİ/R hasarı akciğer transplantasyonunda mortalite ve morbitideyi etkileyen önemli etkenlerden bir tanesidir. İ/R hasarı konusunda birçok çalışma yapılmış olup, Melatonin ve NAC `in İ/R hasarında akciğeri koruyucu etkisi olduğu birçok çalışmada gösterilmiştir. Bizim yaptığımız bu çalışmada Melatonin ve/veya NAC akciğer İ/R hasarındaki koruyucu etkisini LPDS eşliğinde göstermeye çalıştık. Çalışmada 48 adet Spraque-downey 300 mgr erkek ratlarda Akciğer İ/R hasarında Melatonin ve/veya NAC `ın etkisini değerlendirmeyi amaçladık. Bu çalışma Dicle Üniversitesi Hayvan Yerel Etik Kurulu tarafından onaylandı ve yaklaşık 8 ay kadar çalışma sürdü. Çalışmada 48 adet rat denek olarak 8 farklı grupta kullanıldı. 1. Grup: sol akciğerde iskemi 2. Grup: sol akciğerde iskemi + M 3. Grup: sol akciğerde iskemi + NAC 4. Grup: sol akciğerde iskemi + M + NAC 5. Grup: sol akciğerde iskemi + reperfüzyon 6. Grup: sol akciğerde iskemi + reperfüzyon + M 7. Grup: sol akciğerde iskemi + reperfüzyon + NAC 8. Grup: sol akciğerde iskemi + reperfüzyon + M + NAC Denekler Na-Pentotal ile uyutuldu. Trakeostomi açılarak entube edildi ve mekanik ventilatöre bağlandı. Tidal volüm 10 ml /kg solunum dk'da 70 olarak ventile edildi. Median sternatomi uygulandı , daha sonra pulmoner arterden heparinize edildi. Pulmoner hilus 2 saat klempe edilerek iskemi sağlandı. Daha sonra klemp kaldırılarak 2 saat reperfüzyon sağlandı. Daha sonra bütün ratlar kalpten yapılan ponksiyon işlemi ile sakrifiye edildi Alınan sol akciğerin 1/3 lük kısmı Işık Mikroskopu altında İ/R hasarı değerlendirildi. Akciğerde İ/R bağlı olarak gelişebilecek alveolar hemoraji ve Akciğerdeki inflamatuar yanıta bağlı gelişebilecek ödem ve inflamasyon değerlendirildi. Geri kalan akciğerde İ/R hasarının göstergesi olabilecek MDA düzeyi bakıldı. Ayrıca ratlardan alınan kanda serum TAOK düzeyi ve sol akciğer BAL sıvısında Nötrofil yüzdesine bakıldı.Öğe Can more invasive procedures be avoided in patients with intrathoracic goitre? Patients with intrathoracic goitre and surgery(Scientific Publishers of India, 2018) Oruç, Menduh; Öz, Funda; Durkan, Atilla; Ülkü, RefikObjective: We aimed to evaluate whether patients require an incision other than the neck incision before thyroid surgery. Methods: We analysed data from 30 patients who underwent surgery for retrosternal goitre in our clinic between January 1996 and May 2017. We evaluated patient age, sex, physical examination findings, laboratory results, the surgical technique used, and complications. We used radiography, neck ultrasonography, and thoracic Computed Tomography (CT) to diagnose retrosternal goitre. All patients underwent fine-needle aspiration biopsy and those who were euthyroid underwent surgery. We examined postoperative morbidity, complications, and the duration of hospitalisation. Results: This study involved 30 patients (23 females, 7 males; average age, 44 y (range: 32-69 y)). One undiagnosed event appeared as an intrathoracic mass on thoracic CT; sternotomy was performed and postoperative examination revealed thyroid pathology. Three patients underwent surgery that began with a collar incision and involved complete sternotomy, and three patients underwent partial sternotomy. The duration of hospitalisation for patients in whom the collar incision was sufficient was about 3 d; in cases of partial sternotomy, it was 5 d. The duration of hospitalisation in cases of complete sternotomy was 5.2 d. Infection occurred in three patients and haemorrhage occurred in two patients in the neck incision area; there were no deaths. According to postoperative pathological examination, one patient had Hashimoto’s thyroiditis and all other patients had multinodular goitre. Conclusions: Median Sternotomy (MS) is not necessary in all cases of intrathoracic goitre that extend beyond the thoracic inlet. Thorough preoperative evaluation and good surgical planning are required to avoid unnecessary MS.Öğe Cilt Biyopsisi ile Tanısı Konulan Malign Mezotelyoma Olgusu(2016) Çakmak, Muharrem; Ülkü, Refik; Onat, Serdar; Durkan, Atilla; Öztürk, BülentMalign plevral mezotelyoma plevranın kötü huylu tümörüdür. Tanı plevra biyopsi ile konur. Cilt metastazı ile klinik bulgu veren ve cilt biyopsisi ile tanısı konulan mezotelyoma olgusu çok nadirdir. Burada, cilt metastazı ile gelen ve ciltteki lezyondan alınan biyopsi ile mikst tip mezotelyoma tanısı konulan olguyu sunduk.Öğe Comparison of demographical characteristics, prognostic factors, and surgical outcomes in children and adult patients with pulmonary hydatid cyst(Turkish Respiratory Society, 2017) Oruç, Menduh; Şahin, Atalay; Meteroğlu, Fatih; Onat, Serdar; Durkan, Atilla; Ülkü, Refik; Taylan, MaşukObjective: Pulmonary involvement of hydatid cyst disease (HCD) may cause rupture, anaphylaxis, pneumothorax, and pulmonary hypertension. Our aim was to analyze demographical and clinical characteristics of pulmonary HCD. Methods: Demographical characteristics, laboratory parameters, and clinical features of 171 children and adult patients with pulmonary HCD were analyzed. Age, gender, ELISA test results, duration of hospitalization, surgical method of cyst excision and number, diameter, localization, and perforation status of cysts were recorded. Physical examination, ultrasonography, computed tomography, and serologic tests were used to confirm diagnosis of hydatid cysts. Results: Perforated cysts were observed in 26 children and 22 adults. Twenty-three children and 12 adults had a giant cyst. Extrapulmonary hydatid cysts were observed in 10 children and 21 adults. ELISA IgG positivity was determined in 30 children and 34 adults. Twelve children experienced long-lasting air leakage and responded to drainage. In the adult group, 14 patients had long-lasting air leakage and 3 had empyema and expansion defect. The mean duration of hospitalization for children and adults was 8.9 and 10.45 days, respectively. Conclusion: A better understanding of demographic features, clinical characteristics, complications of disease, and surgical procedures helps to determine optimal follow-up and the therapeutic choice.Öğe Effect of fully charged and discharged batteries on esophageal tissue: an experimental study(E-Century Publishing Corp, 2016) Oruc, Menduh; Yilmaz, Ahmet; Ekin, Nazim; Durkan, Atilla; Sahin, Atalay; Nergiz, YusufThe aim of this study was to compare the effect of charged and discharged alkaline batteries on esophageal tissue, and to determine the impact of duration due to the exposure to alkaline batteries. Thirty-five rabbits were divided into 5 groups each containing 7 rabbits. Alkaline batteries were ingested by rabbits [except for the control group [Group 1]]. Rabbits in Group 2 were exposed to discharged alkaline batteries for 180 minutes. In Group 3-5, the fully charged batteries were left in esophagus for 60, 120, and 180 minutes, respectively. Macroscopic appearance of esophageal mucosa as well as histopathologic examination of battery induced esophageal injury and pH of environment were compared. Battery capsules were intact in each group. No color change was observed in the anode pole of batteries for Group 2. Color change was evident in the anode pole of batteries for 3 rabbits in Group 3, in 4 rabbits in Group 4, and in 7 rabbits from Group 5; while no significant change was observed in any rabbit from Group 2. Histopathologically, mucosal erosion was observed in 7 rabbits of Group 3. In Group 4, mucosal erosion extended to the internal muscular layer. Necrosis was exceeding external muscular layer in Group 5. Alkaline batteries may cause erosion as a result of electrical currency without corrosive substrate leakage. Duration of exposure is an important determinant of tissue injury.Öğe Effects of melatonin and N-acetylcysteine on lung ischemia reperfusion injury(Bayrakol Medical Publisher, 2022) Durkan, Atilla; Çakmak, Muharrem; Ülkü, Refik; Özekinci, Selver; Kale, EbruAim: In our study, we aimed to determine the effects of using melatonin, N-acetyl cysteine, and low potassium dextran solution (LPDS) as a preservative solution on ischemia/reperfusion injury. Material and Methods: A total of 48 male Sprague-Downey rats were used. Rats were divided into 8 groups: group 1: ischemia, group 2: ischemia+melatonin, group 3: ischemia + N-acetylcysteine, group 4: ischemia+melatonin + N-acetylcysteine, group 5: ischemia + reperfusion, group 6: ischemia + reperfusion + melatonin, group 7; ischemia + reperfusion + N-acetyl cysteine, and group 8; ischemia+reperfusion+melatonin+N-acetyl cysteine. Total antioxidant capacity (TAOC), malondialdehyde (MDA) and neutrophil values of each group were determined. The TAOC was obtained by spectrophotometric measurement of the absorption level of the color formed by the hydroxylion formed by the Fenton reaction with orthodianisidine. The MDA value was obtained spectrophotometrically using the thiobarbituric acid method, and the Neutrophil count was obtained as cell count using Papanicolau Stain stain. Results: While the highest TAOC values were in groups 4, 2, 3, 1, the lowest TAOC values were in groups 5,7,6,8. The highest MDA values were in groups 5, 7, 6, 1, 8, whereas the lowest MDA were in groups 4, 2, 3 (p<0.05). Neutrophil in bronchoalveolar lavage increased in groups 5,7,6,3,2,8,4. Discussion: In lung ischemia reperfusion, the use of melatonin and/or N-acetyl cysteine, and LPDS decreases plasma MDA levels and increases TAOC values. Additionally, the use of these antioxidants and preservation solutions decreases cell damage immunohistochemically, the cytokines mediating inflammation, the PMNL, and the inflammatory response associated with them.Öğe The risk factors and management of posttraumatic empyema in trauma patients(Elsevier Sci Ltd, 2008) Eren, Sevval; Esme, Hidir; Sehitogullaric, Abidin; Durkan, AtillaBackground: Posttraumatic empyema increases patient morbidity, mortality and length of hospital stay, and the cost of treatment. The aim of this study was to identify the risk factors for posttraumatic empyema and to review our treatment outcomes in patients with this condition. Methods: A total of 2261 patients who were admitted with thoracic traumas and underwent tube thoracostomy between January 1989 and January 2006 were investigated retrospectively. Posttraumatic empyema developed in 71 patients. Logistic regression was used to assess the association between potential risk factors for posttraumatic empyema. All values were expressed as the mean +/- S.D. Results: Eight hundred and thirty-six (37%) of the patients had penetrating type trauma, white 1425 (63%) had blunt type trauma. The rate of posttraumatic empyema development was 3.1% for all patients. Pulmonary contusion was seen in 221 (9.8%) patients and fractures of more than two ribs were seen in 191 (8.4%) patients. Tube thoracostomy placement was performed in the emergency room in 1728 (76.4%) patients, in the hospital ward in 197 (8.7%), in the intensive care unit in 182 (8.0%), and in the operating room in 154 (6.8%). The duration of tube thoracostomy was 6.11 +/- 2.99 (1-21) days. Retained haemothorax was seen in 175 (7.7%) patients. The mean lengths of hospital and intensive care unit stay were 6.42 +/- 3.45 and 2.36 +/- 2.66 days, respectively. The analysis showed that duration of tube thoracostomy (OR, 2.49, p < 0.001), length of intensive care unit stay (OR, 4.21, p < 0.001), and presence of contusion (OR, 3.06, p < 0.001), retained haemothorax (OR, 5.55, p < 0.001), and exploratory laparotomy (OR, 2.46, p < 0.001) were independent predictors of posttraumatic empyema. The relative risk of posttraumatic empyema was higher than 1 for each of the following risk factors: penetrating trauma (OR, 1.59, p = 0.055), associated injuries (OR, 1.12, p = 0.628) and fractures of more than two ribs (OR, 1.60, p = 0.197). Conclusion: Prolonged duration of tube thoracostomy and length of intensive care unit stay, and the presence of contusion, laparotomy and retained haemothorax are independent predictors of posttraumatic empyema. Use of prophylactic antibiotics may be recommended in patients with these risk factors. (c) 2007 Elsevier Ltd. All rights reserved.
