Yazar "Taçyildiz, I" seçeneğine göre listele
Listeleniyor 1 - 8 / 8
Sayfa Başına Sonuç
Sıralama seçenekleri
Öğe Diagnosis and surgical treatment of intrabiliary ruptured hydatid disease of the liver(Sa Medical Assoc, 2004) Taçyildiz, I; Aldemir, M; Aban, N; Keles, CBackground 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.Öğe Effectiveness of collagenase in the treatment of sacrococcygeal pilonidal sinus disease(Springer-Verlag, 2003) Aldemir, M; Kara, IH; Erten, G; Taçyildiz, IPurpose. 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.Öğe Effects of molsidomine and lexipafant in hepatic ischaemia-reperfusion injury(Elsevier Sci Ltd, 2004) Aldemir, M; Boşnak, Mehmet; Al, B; Büyükbayram, H; Taçyildiz, IPurpose: 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.Öğe The mistakes of surgeons(Acta Medical Belgica, 2004) Taçyildiz, I; Aldemir, MPurpose : 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.Öğe Multiple jejunal diverticulitis with perforation in a patient with systemic lupus erythematosus(Springer-Verlag, 2004) Yagmur, Y; Aldemir, M; Büyükbayram, H; Taçyildiz, IA 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.Öğe Penetrating chest injuries(Springer Verlag, 1998) Inci, I; Özçelik, C; Taçyildiz, I; Nizam, Ö; Eren, N; Özgen, GPenetrating chest injuries are a challenge to the thoracic or trauma surgeon, Penetrating thoracic trauma, especially that due to high-velocity gunshot wounds, is increasing at an alarming rate in our region, We report our experience with penetrating chest injuries mainly due to high-velocity gunshot wounds. During a period of 6 years we retrospectively reviewed the hospital records of 755 patients admitted to the Department of Thoracic and Cardiovascular Surgery, Dicle University School of Medicine, with the diagnosis of penetrating thoracic trauma. The mean age was 27.48 years, and 89.8% were male. The causes of penetrating injury were stab wounds in 45.3% and gunshot wounds in 54.7%. About 30% of the wounds were due to high-velocity gunshots; and among the gunshot wounds 56.2% were due to high-velocity shots, The most common thoracic injury was hemothorax (n = 190) followed by hemopneumothorax (n = 184), Isolated thoracic injuries were found in 53% of the patients. Nonoperative management was sufficient in 92% of the patients. Thoracotomy was performed in 8.1%, The mean duration of hospitalization was 11.2 days, The mean injury severity score (ISS) was 20.17 +/- 13.87. The morbidity was 23.3% and the mortality 5.6%. Fifty percent of all deaths were due to adult respiratory distress syndrome, Altogether 17% of patients with an ISS >25 died, whereas only 0.9% of those with a score <16 died. The mortality due to firearms was 8.95%. We concluded that in civilian practice chest tube thoracostomy remains by far the most common method of treating penetrating injury to the chest, The easy availability of high-velocity guns will continue to increase the number of civilians injured by these weapons.Öğe Predicting factors for mortality in the penetrating abdominal trauma(Acta Medical Belgica, 2004) Aldemir, M; Taçyildiz, I; Girgin, SPurpose : 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.Öğe Spontaneous liver hematoma and a hepatic rupture in HELLP syndrome(Springer-Verlag, 2002) Aldemir, M; Baç, B; Taçyildiz, I; Yagmur, Y; Keles, CSubcapsular liver hematomas and ruptures are unusual fatal complications of HELLP (hemolysis. elevated liver enzymes. and low platelets) syndrome (HS). We present two cases of a spontaneous rupture of subcapsular liver hematoma occurring in HS and review the literature on this subjects. One case demonstrated a secondary rupture of a subcapsulary liver hematoma due to HS in one patient and HS associated with preeclampsia in another. The defects were on the media] and lateral sectors of the left lobe in one patient and on the medial sector of the right lobe in the other patient. In case 1 deep mattress sutures and omentoplasty were performed. and in the other case a defective area was closed with an absorbable gelatin sponge with a hemostatic effect. In addition, the liver was compressed by abdominal towels. A high index of suspicion and immediate recognition are keys to proper diagnosis and management of affected patients. The multidisciplinary approach to the management of these patients led to a remark-able decrease in the mortality rates. Less aggressive treatment is preferable to aggressive intervention such as a hepatic resection in such patients with coagulopathy.
