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Öğe Acute abdomen due to spilled gallstones: a diagnostic dilemma 10 years after laparoscopic cholecystectomy(Oxford University Press, 2020) Kafadar, Mehmet Tolga; Çetinkaya, İsmail; Aday, Ulaş; Başol, Ömer; Bilge, HüseyinLaparoscopic cholecystectomy (LC) carries a significant risk of gallbladder perforation and resulting scattering of bile stones into the abdominal cavity. The retrieval of the spilled stones is not always possible by laparoscopic technique. Most cases do not create long-term problems, although some cases may be complicated in future and create uncertainties regarding the correct diagnosis. Diagnosis can be difficult, and in most cases the patient may require open surgery for management of these complications. Herein, we report a case of acute abdomen due to spilled stones occurring 10 years after LC. In the first stage, definitive diagnosis could not be made with computed tomography examination. Finally, the patient was diagnosed with explorative laparotomyÖğe Acute necrotizing pancreatitis and coronavirus disease-2019 (COVID-19)(NLM (Medline), 2021) Aday, Ulaş; Gedik, Ercan; Kafadar, Mehmet Tolga; Özbek, ErdalCoronavirus disease-19 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV- 2) and has resulted in increased mortality worldwide. Several studies have identified the involvement of the gastrointestinal tract, respiratory tract, and other tissues. Although it has been reported that the angiotensin-converting enzyme-2 receptor affected by SARS-CoV is expressed more in the pancreas than in the lungs, the issue regarding the occurrence of pancreatitis is controversial. SARS Cov-2 rarely causes acute necrotizing pancreatitis without significantly affecting the respiratory and other systems. This paper presents a patient who underwent laparotomy due to acute necrotizing pancreatitis and hemodynamic instability caused by COVID-19 without any known risk factors.Öğe C-erb-b2 expression in luminal b breast cancer has higher axillary lymph node involvement ratio(Bayrakol Medical Publisher, 2022) Degirmencioglu, Gurkan; Kafadar, Mehmet Tolga; Kilic, MehmetAim: In this study, the effect of c-erb-B-2 (HER-2/neu) expression on axillary lymph node involvement in Luminal-B breast cancer was examined. Material and Methods: One hundred seven female patients were included in this study who were classified as Stage 1, Stage 2 and Stage 3 pathologically, with positive Estrogen (ER) and Progesterone Receptor (PR) and with the diagnosis of invasive ductal carcinoma with a single focal mass and not a synchronous tumour and received surgical therapy. The lymph node involvement ratio (LNIR) was divided into two groups as over and below 25%. These acquired data were compared with the groups with positive and negative c-erbB-2 gene expression, axillary LNI status, and LNIR separately. Results: The data of 107 female patients aged between 27 and 87 years were evaluated in this study. The mean age of the patients was 55.69 +/- 12.68 years. LNIR was found to be less than 25% in 76.6% (n: 82) of the patients, and over 25% in 23.4% (n: 25) of the patients. The c-erbB-2 positivity was significantly different in the axilla with and without metastatic lymphadenopathy (p =0.026). There was no statistically significant relationship between tumour diameter and metastatic lymphadenopathy. Although axillary metastatic lymphadenopathy positivity was found to be significant in patients with lymphovascular invasion (p<0.001), it was also found to be significant, as in the group with LNIR>25 (p<0.001). Discussion: This study demonstrated that high expression of c-erbB-2 is associated with poor prognosis of breast cancer by increasing axillary LNI. In hormone (Estrogen and Progesterone) positive patients, if c-erB-2 is also positive, there is greater number of axillary LNI.Öğe Cerrahi uygulanan varis dışı üst gastrointestinal sistem kanamalarında morbidite ve mortaliteye etkili faktörler (Retrospektif çalışma)(2017) Kafadar, Mehmet Tolga; Gedik, ErcanÜst gastrointestinal sistem kanamaları, özefagusun üst kısmı ile Treitz ligamanı arası herhangi bir yerden lümen içine olan kanamaları kapsar. Üst gastrointestinal sistem kanamalarının uzun zamandır %10 olan mortalite oranı ve kanayan peptik ülserler nedeniyle yapılan acil operasyonların insidansı pek değişmemiştir. Ölümlerin çoğu 60 yaş üzeri yaşlı hastalarda ve ciddi kalp hastalığı, kanser, böbrek yetmezliği gibi yandaş ağır hastalığı bulunanlarda olmaktadır. Bu çalışmada cerrahi uygulanan varis dışı üst gastrointestinal sistem kanamalarında, morbidite ve mortaliteyi etkileyen faktörleri belirlemeyi amaçladık. Dicle Üniversitesi Tıp Fakültesi Hastanesi Genel Cerrahi Kliniği ' nde Ocak 1998 ile Mart 2008 tarihleri arasında varis dışı nedenlere bağlı olarak opere edilen, üst gastrointestinal sistem kanamalı, 62 hasta retrospektif olarak incelendi. Hastalarda morbidite ve mortaliteye etkili faktörleri belirlemek için; yaş, cinsiyet, şok mevcudiyeti (?90/60 mmHg TA, >100 Nb), sistemik hastalık varlığı, nabız sayısı, serum hemoglobin, serum beyaz küre, serum üre, serum kreatinin, serum sodyum, serum potasyum, serum albumin değerleri, operasyon süresi, kan transfüzyon sayısı, Rockall risk skoru ve yatış süresi incelendi. Morbidite ve mortaliteye etkili faktörlerin belirlenmesi için univaryant analiz yapıldıktan sonra, p<0.2 olan değerlere Entered lojistik regresyon analizi uygulandı. Çalışmaya dahil edilen 62 hastanın yaş ortalaması 53.41±18.15 (18-80) olup, bunların 55 (%88.7) ' i erkek, 7 (%11.3) ' si kadındı. Hastaların 22 (%35.4) ' sinde morbidite, 18 (%29.1) ' inde ise mortalite gözlendi. Morbiditeye etkili faktörleri belirlemek için yapılan univaryant analizde ileri yaş, uzun operasyon süresi, sistemik hastalık varlığı, şok mevcudiyeti, serum üre değeri, serum kreatinin değeri, serum albumin değeri ve Rockall skorunun ?5 olması belirlendi. Bu değişkenlere yapılan Entered lojistik regresyon analizi sonucunda, serum albumin değeri (p=0.020) ve Rockall skorunun ?5 olması (p=0.029) morbiditeye etkili bağımsız risk faktörleri olarak saptandı. Mortaliteye etkili faktörleri belirlemek için yapılan univaryant analizde ileri yaş, sistemik hastalık varlığı, şok mevcudiyeti, kan transfüzyon sayısı, serum kreatinin değeri ve yüksek Rockall skoru belirlendi. Bu değişkenlere yapılan Entered lojistik regresyon analizi sonucunda, ileri yaş (p=0.018) ve yüksek Rockall skoru (p=0.016) ise mortaliteye etkili bağımsız risk faktörleri olarak saptandı. Cerrahi uygulanan varis dışı üst gastrointestinal sistem kanamalı hastalarda, morbidite ve mortalite oranlarının azaltılması için, hastaların preoperatif risk faktörlerinin ortaya konulması gerekmektedir. Rockall risk skorlama sistemi yardımıyla, morbidite ve mortaliteye etkili faktörlerin ve risk gruplarının belirlenmesinde olumlu sonuçlar alındı. Serum albumin değeri ve Rockall skorunun ?5 olması morbiditeye, ileri yaş ve yüksek Rockall skoru ise mortaliteye etkili bağımsız risk faktörleri olarak saptandı.Öğe Effect of korean red ginseng on colon anastomotic healing: A randomised controlled experimental study(Bayrakol Medical Publisher, 2022) Tali, Ufuk; Kafadar, Mehmet Tolga; Comert, MustafaAim: Although vegetable medicinal products are used worldwide, their beneficial and harmful effects have not been well documented. The aim of this study was to assess the effect of Korean red ginseng (KRG) on the healing of experimental colonic anastomosis in a rat model. Material and Methods: Forty rats were randomized into four groups as follows: control groups (A and B) and KRG groups (C and D). Surgical procedure consisted of a transection and handsewn anastomosis of the ascending colon. Animals daily received either KRG (50m1/kg) or an equal volume of water by gavages 5 days before operation and then the surgery was done. Rats in Groups A and C were sacrificed on postoperative day (POD) 3, rats in Groups B and D were sacrificed on POD 7. Anastomotic complications and anastomotic bursting pressure measurements were recorded. Following these measurements, the anastomotic segment was resected for hydroxyproline (HPO) and histopathological evaluation. Results: No significant differences were found in anastomotic complications. The colonic bursting pressures in the KRG groups were statistically significantly better than in the control groups. The hydroxyproline content was also significantly higher in Group C than in Group A. Histological examination confirmed that KRG treatment significantly increased neovascularization, fibroblastic activity and collagen content compared with controls on POD 7. Discussion: Peri-operative administration of the KRG has a positive influence on the healing of colonic anastomosis in rats.Öğe Effects of carvedilol on liver ischemia-reperfusion injury in rats(Ulusal Travma ve Acil Cerrahi Derneği, 2022) Kafadar, Mehmet Tolga; Gök, Mehmet AliBACKGROUND: The aim of this study was to analyze the potential protective effect of Carvedilol against liver ischemia-reperfusion (I/R) injury in rats. METHODS: A total of 40 Wistar albino rats were randomly divided into four groups (n=10 each). Group I (Sham/Control group) underwent only laparotomy, Group II (Carvedilol group) was administered carvedilol and then underwent laparotomy, Group III (I/R group) underwent laparotomy and hepatic ischemia/reperfusion, and Group IV (I/R + Carvedilol group) was administered carvedilol and then underwent laparotomy and hepatic ischemia/reperfusion. Blood samples were collected for malondialdehyde, glutathione (GSH), and myeloperoxidase (MPO) analysis. Liver sections were obtained for histopathological analysis and stained with hematoxy lin-eosin. Tumor necrosis factor-α (TNF-α) and Caspase-3 primary antibodies were used for the immunohistochemical analysis. RESULTS: Serum GSH levels increased in the I/R + Carvedilol group. MPO activity was increased significantly in the IR group. In I/R + Carvedilol group, serum MPO levels were similar to the control group. Histopathological findings showed reduced dilatation and congestion in vena centralis, regenerative changes in hepatocyte cells with the protected nucleus structure in the I/R + Carvedilol group. Hepatocyte nuclei with increased pycnosis and apoptosis and the dilated vena centralis were observed in I/R group. In the control group, TNF-α showed a positive reaction in macrophage cells around vena centralis. An increase in TNF-α expression was observed in hepatocyte cells of I/R group. Positive expression of caspase-3 in hepatocyte cells and a small number of endothelial and Kupffer cells were seen in I/R group. However, negative caspase-3 expression was seen in hepatocyte, endothelial, and Kupffer cells in I/R + Carvedilol group. CONCLUSION: Carvedilol may prevent initiation of oxidative stress process, inflammation induction and apoptotic progression.Öğe Effects of preoperative oral carbohydrate loading on preoperative and postoperative comfort in patients planned to undergo elective cholecystectomy: A prospective randomized controlled clinical trial(Zemansalamati Publ., 2020) Gök, Mehmet Ali; Kafadar, Mehmet Tolga; Yeğen, Serkan FatihBackground: Cholecystectomy is a widespread abdominal procedure. A period of 8-hour-fasting for this relatively rapid surgery negatively affects the patients’ comfort.Objectives:The current study aimed to evaluate the effects of the presurgical intake of carbohydrates on patients’ comfort.Methods:This prospective study was carried out on 42 cholecystectomy patients (with theAmerican Society of Anesthesiologistsgrade of I-II) divided into two groups. The patients in group 1 underwent laparoscopic cholecystectomy after an 8-hour-fasting period. The subjects in group 2 received a carbohydrate-rich solution with 12.5% dextrose before the surgery (125 g of sugar melted in 1 L of water; 800 and 200 mL 8 and 2 h before the surgery, respectively). Thirst, hunger, and nausea at the 9thpreoperative hour and 30 min before the surgery in addition to nauseaand vomiting at the 2nd, 8th, and 24thpostoperative hours were assessed in both groups.Results:The mean age and body mass index (BMI)values of the patients were 48.38±12.68 years and 29.85±5.20 kg/m², respectively. The mean operational time was 36.5 min (range: 26-114 min). No difference was observed between the two groups in terms of age, BMI, and operational time. The investigation 30 min before cholecystectomy revealed that the rates of hungry and thirsty patients were higher in group 1, compared to those reported for group 2 (P=0.003 and P=0.032). Nevertheless, at the 2ndand 8thpostoperative hours, the rate of patientsʼ complaining of nausea was higher in group 2 in comparison to that of group 1 (P=0.048 and P=0.014).Conclusion:It is suggested that the intake of carbohydrate-rich fluids up to the preoperative 2ndhour decreased presurgical hunger/thirst. The results of this study are in line with the findings of previous studies. It is believed that the intake ofCHO-rich solutions up to 2 h before surgery may provide comfort by decreasing hunger/thirst. Nevertheless, it is necessary to take into account a potential rise in a feeling of nausea among these patientsÖğe Gastrointestinal Stromal Tümörlerde İmmünohistokimyasal Markırların ve Tümör Boyutunun Prognoz Üzerindeki Rolü(2022) Yeğen, Serkan Fatih; Kafadar, Mehmet Tolga; Gök, Mehmet Ali; Kocaoğlu, Aytaç EmreGiriş: Gastrointestinal stromal tümörlerin tanısında genel itibariyle immünohistokimyasal boyanma yöntemleri kullanılmktadır. Bu çalışmanın amacı bu parametreler haricinde immünohistokimyasal boyanma özelliklerinin risk gruplarının belirlenmesindeki yerini saptamaktır. Yöntem: 2008-2019 yılları arasında genel cerrahi kliniğine başvuran 66 hasta çalışmaya dahil edildi ve dosyaları geriye dönük olarak tarandı. Yaş, cinsiyet, klinik prezentasyon, tümör boyutları, patolojik verileri, mitotik indeksi parametreleri değerlendirildi. Bulgular: GİST tanısı almış 66 hastada kadın/erkek oranı 31/55 olup, yaş ortalaması 62 idi. Tümör lokalizasyonlarına bakıldığında en sık mide ve ince barsak lokalizasyonu saptandı. Hastaların patoloji sonuçlarının immünohistokimyasal olarak incelenmesini takiben hastaların tümünde CD117’nin pozitif ve desmin’nin negatif olarak boyandığı saptandı. Maximum tümör çapı 40 cm, minimum tümör çapı 6 cm, ortalama tümör çapı 13.9 cm olarak saptandı. ortalama mitotik indeks 14.1 olarak saptandı. Sonuç: Tümör karakteresteğinin net olarak anlaşılamadığı ve zaman içinde bu karakterestiğin modifiye olduğu göz önünde bulundurulursa tanıya yardımcı ve tedavide yol gösterici parametrelerin önemi daha iyi anlaşılmaktadır. Yapılmakta olan ve yapılacak olan çalışmalar prognoz ve survi tahmininde yeni ve spesifik kriterlerin bulunacağını, bulunması gerektiğini düşünmekteyiz.Öğe Giant juvenile fibroadenoma of the breast: clinical manifestation in two cases(Galenos Yayıncılık, 2020) Kafadar, Mehmet Tolga; Kırşan, Mehmet Ali; Çal, Suat; Okur, Mehmet Hanifi; Girgin, SadullahGiant fibroadenomas are benign masses that usually present as unilateral rapid growths in the breast during puberty. They can spread over a wide area and cause congestion and ulcerations in the breast skin. Definitive diagnosis is made by breast biopsy. Treatment options may vary from simple excision to subcutaneous mastectomy, depending on the size of the mass. Herein, we present two cases of 13- and 14-year-old female patients who were treated for giant breast fibroadenoma. In these extremely rare cases, total mass excision was performed, which preserved the breast skin.Öğe Intrahepatic cholestasis of pregnancy: Is fetoplacental doppler ultrasound useful in the diagnosis and follow-up?(Bayrakol Medical Publisher, 2021) Toprak, Veysel; Kafadar, Mehmet TolgaAim: In this study, we aimed to examine whether Doppler ultrasonography (USG) is an important diagnostic tool for fetal follow-up in case of obstetric cholestasis. Material and Methods: This study included 50 patients diagnosed with obstetric cholestasis and 39 pregnant women turning up for their regular pregnancy follow-up. Pregnants were diagnosed according to definition, symptoms, and laboratory findings. Biochemical tests, bile acid test, upper abdominal USG, Non-Stress Test (NST), obstetric USG, amniotic fluid test, and fetoplacental Doppler USG were performed on all patients. Systole/Diastole (S/D) ratio of Umbilical artery (UA) and Middle cerebral artery (MCA)s, delivery types of patients, weight at birth, Apgar scores, and the existence of meconium were separately recorded. Results: The mean age of the patients with obstetric cholestasis was 26.6 years, while in the control group it was 25.1 years (p = 0.176). No statistical difference was identified with regard to the average of (UA and MCA)/(S/D) ratio of both patient groups. In terms of delivery type, patients' UA and MCA S/D ratio averages were not statistically significant. There was no statistical link between cholestasis story in previous pregnancies, cholestasis in the current pregnancy, bile acid, and high ALP and baby's gender. Discussion: Intrahepatic cholestasis of pregnancy is also a reversible form of cholestasis and it usually emerges in the late pregnancy period and continues until birth. In this study, it was detected that fetoplacental Doppler USG, which is used as a diagnostic tool for obstetric cholestasis, has a low level of predictivity. During our study, Doppler USG use in obstetric cholestasis diagnosis and follow-up was not effective.Öğe Low-dose methotrexate use in idiopathic granulomatous mastitis: An alternative treatment method(S. Karger AG, 2021) Kafadar, Mehmet Tolga; Bahadır, Mehmet Veysi; Girgin, SadullahBackground: Idiopathic granulomatous mastitis (IGM) is a rare, recurrent and progressive breast disease with an unknown etiology. Patients with IGM will probably face stressful, time-consuming treatment procedures with side effects due to medications. There are different treatment modalities in clinical use including medical and surgical interventions. Objective: The aim of this study was to present the results of using the combination therapy of low-dose methotrexate (MTX) and steroid in IGM. Methods: Seventeen patients diagnosed with IGM and treated with MTX were included into the study. Low-dose MTX at 5 mg/week and 8 mg/day prednisone were given for 2-3 months. Results: After 2-3 months of treatment, 10 patients exhibited (58.5%) complete, 3 patients (17.6%) partial recovery, and no response to the treatment process was observed in 4 patients (23.5%). No side effects of MTX and recurrent events were noted in any of the patients. Conclusion: Low-dose MTX and prednisone treatment for IGM patients, who did not respond to steroids alone, should be considered as an alternative treatment method instead of surgical intervention.Öğe Management of acute biliary pancreatitis in cholecystectomized patients(Galenos Yayınevi, 2022) Çiftçi, Ali; Gök, Mehmet Ali; Kafadar, Mehmet TolgaObjective: We aimed to evaluate the patients who were hospitalized, followed up and treated in our clinic with the diagnosis of acute biliary pancreatitis (ABP) after cholecystectomy. Methods: The electronic records of 18 patients with a history of cholecystectomy were reviewed retrospectively. The demographic findings of the patients, time passed after cholecystectomy, methods used in diagnosis, amylase levels, treatment choices, clinical follow- ups, mortality and morbidity rates, and length of hospital stay were evaluated. The Ranson criteria and Apache II score were used to determine the severity of pancreatitis. Results: Thirteen (72.2%) were female and 5 (27.8%) were male. The mean age was 57.83±12.59 (34-77). The mean time elapsed after cholecystectomy was 72.11±38.12 (5-130) months. The mean diameter of the common bile duct (CBD) was measured as 12.39±2.30 (8-15) mm. The average level of amylase was 986.50±323.29 (350-1530) U/L. Fifteen (83.33%) patients had mild, and 3 (16.67%) patients had moderately severe acute biliary pancreatitis. Endoscopic sphincterotomy (ES) was performed on 16 patients during endoscopic retrograde cholangiopancreatography (ERCP). Two patients were operated due to failure of ERCP. Choledochotomy, transduodenal sphincteroplasty and The T-tube drainage were performed on 1 patient. The other patient underwent choledochotomy and choledochoduodenostomy. The average length of stay in hospital was 7.89±4.91 (5-25) days. Conclusion: It should be kept in mind that ABP may develop months or even years after cholecystectomy. The standard treatment for acute pancreatitis caused by CBD stones in patients with cholecystectomy are ERCP and ES. In patients with failed ERCP and ES, the CBD exploration should be performed surgically.Öğe Median arcuate ligament (Dunbar) syndrome: Laparoscopic management and clinical outcomes of a single centre(Wolters Kluwer Medknow Publications, 2021) Kafadar, Mehmet Tolga; Oğuz, Abdullah; Aday, Ulaş; Bilge, Hüseyin; Başol, ÖmerBackground: Median arcuate ligament syndrome (MALS) is a condition characterised by chronic abdominal symptoms associated with median arcuate ligament (MAL) compression of the coeliac artery. Aim: In this observational study, we aimed to evaluate the outcomes of laparoscopic treatment in patients with MALS. Materials and Methods: The data of ten patients with MALS who were subjected to laparoscopic sectioning of the MAL were retrospectively reviewed. The following data were evaluated: age, gender, clinical and diagnostic test findings, American Society of Anaesthesiologists score, operative findings and complications and mortality, hospital stay duration and hospital readmission. The diagnosis of MALS was established by computed tomography (CT) angiography. Results: Six (60%) of ten patients with MALS were female and four (40%) were male. The mean age was 42.4 +/- 12.3. The main symptoms were epigastric pain (100%) and weight loss (60%). CT angiography showed high-grade stenosis of the anterior wall of the proximal coeliac trunk and post-stenotic dilation caused by extrinsic compression of the MAL. Surgical procedure was uneventful in all patients. Operating time was 155.5 min (120-200) and intra-operative blood loss was 150 ml (100-250). Length of stay was 3.1 day (2-9), with no mortality. The post-operative complications developed in two female patients. One of them developed ileus and the other patient developed pulmonary thromboembolism. At 6-month follow-up, all patients were asymptomatic. Conclusion: Laparoscopic decompression is an effective treatment for MALS and can provide symptomatic relief. This method may be the preferred modality of treatment in view of its lack of morbidity and good results.Öğe Our clinical and surgical experience in parathyroid diseases; Evaluation of five years at a single tertiary care center(Cetus Yayınevi, 2023) Hamurcu, Esra; Kafadar, Mehmet Tolga; Bahadır, Mehmet Veysi; Girgin, SadullahBu çalışmada kliniğimize başvuran paratiroid hastalarının sosyo-epidemiyolojik verileri, preoperatif ve postoperatif laboratuvar değerleri, görüntüleme özellikleri ile kliniğimizin paratiroid hastalıkların ı tedavi ederken uyguladığı yaklaşımların ve sonuçlarının retrospektif olarak incelenmesi amaçlandı. YÖNTEM ve GEREÇLER: Bu çalışmaya 2013-2018 yılları arasında paratiroid hastalıkları nedeniyle Dicle Üniversitesi Tıp Fakültesi Genel Cerrahi Ana Bilim Dalı’nda tedavi edilen 200 hasta dahil edildi. Bu hastalara ait klinik ve laboratuvar verileri hasta dosyalarından retrospekt if olarak değerlendirildi. Çalışmaya paratiroid hastalığı tanısı almış ve tedavi seçeneği olarak cerrahi planlanan olgular dahil edildi. BULGULAR: Çalışmadaki 200 hastadan 33’ünün (%16.5) erkek, 167’sinin (%83.5) kadın olduğu gözlendi. Ortalama yaş 51.76 (18 -93) idi. Ek tiroid hastalığı bulunmayan 128 (%64) hastaya unilateral cerrahi yaklaşım ve lokal eksplorasyon ile sadece paratiroid adenom eksizyonu uygulandı. Ek tiroid hastalığı olan 45 (%22.5) hastanın 41’ine bilateral total tiroidektomi, 4’üne sol tamamlayıcı tiroidektomi uygulandı. Hastaların 182 (%91)’sind e patolojik tanı paratiroid adenomu olarak raporlandı. Patolojik tanı ile preoperatif USG bulguları arasında 129 (%75.6) hastada, sintigrafi ile ise 110 (% 73.3) hastada uyum saptandı. Preoperatif yüksek olan serum PTH değerine oranla, intraoperatif, postoperatif 1. gün ve 1. ay çalışılan PTH değerinde anlamlı düşme olduğu görüldü (p<0.001). Preoperatif yüksek olan serum kalsiyum değerindeki postoperatif 1. gün ve 1. ay sonundaki düşmenin istatistiksel olarak anlamlı olduğu te spit edildi (p<0.001). Ameliyat sonrası dönemde bakılan serum fosfor değerlerindeki artışın istatistiksel olarak anlamlı olduğu gözlendi (p<0.05). Postoperatif dönemde 9 (% 4.5) hastada komplikasyon görüldü. TARTIŞMA ve SONUÇ: Çalışmamızda paratiroid bozuklukları tedavisinde, cerrahinin uygun preoperatif de ğerlendirme ile deneyimli ellerde, dikkatli eksplorasyon yaparak, çok düşük komplikasyon oranı ile gerçekleşmesinin mümkün olacağı gösterildi. Kılavuzlara uygun olarak b u hastalıklarda öncelikle tercih edilmesi gereken tedavi yöntemi de cerrahi yaklaşım olmalıdır.Öğe Perforated colorectal cancers: clinical outcomes of 18 patients who underwent emergency surgery(Termedia Publishing House LTD, 2021) Gök, Mehmet Ali; Kafadar, Mehmet Tolga; Yeğen, Serkan FatihIntroduction: Although colon cancer perforations are rare among acute abdominal syndromes, it is a clinical picture with high mortality that requires urgent treatment. Aim: In this study, the clinical results of patients who were operated in emergency conditions due to colorectal cancer perforation were evaluated. Material and methods: The data of 18 patients treated for colorectal cancer perforation in our clinic between February 2014 and February 2017 were retrospectively reviewed. The following data were evaluated: demographic features of the patients, location of the tumour, metastasis, stage of the tumour, number of lymph nodes dissected, survival, type, and prognosis of the surgery. Results: Eight (44%) of 18 patients with perforated colon cancers were female and 10 (56%) were male. The mean age was 65.2 (31-104) years. Four of the patients had liver metastasis only, and 5 had multiple metastases. All cases had sudden abdominal pain and acute abdominal clinical findings. Fourteen of the patients underwent full resection, and 4 of them underwent partial resection and trephine stoma (colostomy). Perioperative mortality was not observed. The long-term mortality rate in our study was 77.7% (n = 14), and the operative mortality rate was 44% (n = 8). Additional organ injuries occurred during resection in 2 patients. Conclusions: Colorectal cancer perforation seen in advanced ages is one of the causes of acute abdominal syndrome, which can be fatal. The general condition of the patient and the size and localization of the perforation should be taken into consideration in the choice of treatment. Curative surgery can also be performed in perforated colorectal cancers. However, partial resection and trephine colostomy should be performed in patients with multiple metastases and poor general condition.Öğe Primary hydatid cyst of the left-sided colon presenting with lower gastrointestinal bleeding; an extremely rare location of extrahepatic hydatid disease(Wolters Kluwer Medknow Publications, 2021) Kafadar, Mehmet TolgaHydatid cyst is an endemic disease especially in underdeveloped and developing countries, affecting mostly the liver and lungs. However, a wide range of unusual anatomical sites in the abdomen have been reported, including the spleen, pancreas, kidney, and ovaries as well as dissemination within the abdominal and pelvic cavities. The location of hydatid disease in the colon is very infrequent, and very few cases have been presented so far. The hydatid cysts located in other sites are mostly due to rupture or extrusion of primary liver or splenic cysts. In this article, we present a case of primary left-sided colon hydatid cyst, resected laparoscopically with the affected intestinal segment. The diagnosis of hydatid cyst was made by macroscopic and microscopic examinations.Öğe Prognostic significance of pretreatment serum lactate dehydrogenase-to-albumin ratio in gastric cancer(Termedia Publishing House Ltd., 2020) Aday, Ulaş; Tatlı, Faruk; Akpulat, Faik V.; İnan, Mazlum; Kafadar, Mehmet Tolga; Bilge, Hüseyin; Başol, Ömer; Oǧuz, AbdullahAim of the study: To investigate the prognostic role of lactate dehydrogenase-to-albumin ratio (LAR) in gastric cancer patients undergoing curative resection. Material and methods: A retrospective study was conducted including resectable gastric cancer patients. According to the time-dependent receiver operating characteristics (ROC) analysis, the optimal threshold for pretreatment LAR was 5.5. The Kaplan-Meier method, Cox regression univariate and multivariate analyses were used to analyze the prognostic factors for disease-free survival and overall survival (OS). Results: The study cohort consisted of 81 patients, mean age was 60.2 ±13.8 (range, 29-87) years and 55 (67.9%) were male. The median OS time was 34.8 and 45 months in patients with LAR ≥ 5.5 (n = 50) and LAR < 5.5 (n = 31), respectively. Kaplan-Meier curves showed that with the increase in LAR there was reduced survival, but it was not statistically significant (p = 0.278). Multivariate analyses revealed that the positive lymph node ratio above 20% was an independent predictor in resectable gastric cancer patients (OR = 6.281, 95% CI: 1.135-34.767, p = 0.035). Conclusions: With the increase in LAR survival in gastric cancer decreased, but it was not statistically significant. Studies involving a large patient series are needed.Öğe The sensitivity of ultrasound in the clinical diagnosis of inguinal hernias in adults: a comparative study(Springer International Publishing AG, 2022) Gök, Mehmet Ali; Büyüközsoy, Ayşegül Karadayı; Kafadar, Mehmet TolgaObjective Ultrasonography (US) is a non-invasive, non-ionizing radiation modality highly successful at diagnosing inguinal hernia. The aim of this study is to demonstrate the accuracy of ultrasound in evaluating defects of fascia in inguinal hernias and compare with surgical findings. Material and methods A total of 33 patients with a sonographic diagnosis of an inguinal hernia are included to study. After US, all patients underwent a blinded surgery and the surgical findings are compared with the US results. Results The sensitivity of US was found to be 100% and 80% for indirect and direct types, respectively. The mean size of the defect was found to be 22 mm (max: 70 mm, min: 6 mm) with US; and 27 mm (max: 50 mm, min: 4 mm) at surgery. The size of defects at US and in surgery were correlated with each other (p = 0.001).Öğe Single versus double Hem-o-lok clips to secure the apendiceal stump during laparoscopic appendectomy: a prospective randomized multicentric clinical trial(Springer Science and Business Media Deutschland GmbH, 2024) Aday, Ulaş; Çetin, Erman; Kafadar, Mehmet Tolga; Oğuz, Abdullah; Bahadır, Mehmet Veysi; Ülger, Burak Veli; Gedik, Ercan; Girgin, Sadullah; Yılmaz, MehmetPurpose: Polymeric clips (Hem-o-lok ligation system) are now widely used to securing the base of the appendix during laparoscopic appendectomy. Studies comparing the use of single or double hem-o-lok clips are limited. The aim of this study was to compare the reliability of a single hem-o-lok clips with a double hem-o-lok clips for closure of an appendiceal stump. Methods: This prospective randomized study includes patients from two centers who underwent laparoscopic appendectomy with the diagnosis of appendicitis between September 2020 and March 2023. Demographic, operative and clinical outcomes of the use of single or double hem-o-lok clips for closure of the appendiceal stump were compared. Factors affecting long postoperative hospital stay were investigated using univariate and multivariate analyzes. Results: One hundred forty two (48.3%) patients in the single hem-o-lok arm and 152 (51.7%) patients in the double hem-o-lok arm were included in the analysis.The shortest operative time was noted in the single hem-o-lok group (52.1 ± 19.9 versus 61.6 ± 24.9 min, p < 0.001). The median hospital stay was 1 day (range 1–10) in the single hem-o-lok group and 1 day (range 1–12) in the double hem-o-lok group, and was shorter in the single hem-o-lok arm (1.61 ± 1.56 vs 1.84 ± 1.69, p = 0.019). Based on multivariate analysis, drain placement was identified as an independent predictive factor for long hospital stay. Conclusions: The use of single hem-o-lok clips for appendiceal stump closure during laparoscopic appendectomy is safe and effective. Trial registration NCT04387370 (http://www.clinicaltrials.gov).Öğe Submucosal giant lipoma of the colon as an unusual cause of partial intestinal occlusion: Report on seven consecutive cases(Aves, 2021) Kafadar, Mehmet Tolga; Dalbaşı, Erkan; Oğuz, Abdullah; Aday, UlaşBackground: Colonic lipomas begin to be symptomatic when they reach a certain size, although the presentation can vary. In this study, we aimed to evaluate our experiences with the management of patients who presented with symptomatic giant colonic lipomas. Methods: The data of 7 patients with single colonic lipoma were retrospectively reviewed. The following data were evaluated: age, gender, clinical and diagnostic findings, American Society of Anesthesiologists (ASA) score, operative findings, postoperative complications, mortality, hospital stay duration, and hospital readmission. The diagnosis of colonic lipoma was established by computed tomography (CT). Results: In this study, 4 (57.1%) of 7 patients with colonic lipoma were female, and 3 (42.9%) were male. The mean age was 56.7 years (range, 45-69). The main symptoms were abdominal pain (100%), and constipation (71.4%). The findings of intestinal occlusion detected on CT confirmed the diagnosis in all patients. Colon lipoma was located in the ascending colon in 2 patients, in the hepatic flexure in 2 patients, in the transverse colon in 2 patients, and in the cecum in 1 patient. The surgical procedure was uneventful in all patients. Four (57.1%) patients underwent laparoscopic colonic resection, while in the remaining 3 (42.9%) patients, a laparotomy was performed. The mean operating time was 185.7 min (150-210). Length of stay was 7.1 days (6-10), with no mortality. The mean diameter of the lesions was 7.4 cm (6-9). At a 6-month follow-up, all patients were asymptomatic with no signs of recurrence. Conclusion: Although colon lipomas are rare, they are of great importance because they can be symptomatic and can be confused with colon malignancies in the differential diagnosis. Being able to make a definitive preoperative diagnosis will change the surgical strategy. A minimally invasive surgical approach should be employed to resect symptomatic colonic lipomas with an experienced surgical team in eligible patients whenever possible.
