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Öğe Factors affecting morbidity and mortality in gangrenous cholecystitis(Acta Medical Belgica, 2006) Girgin, S.; Gedik, E.; Tacyildiz, I. H.; Akguen, Y.; Bac, B.; Uysal, E.Introduction : Gangrenous cholecystitis is a serious complication of acute cholecystitis. Male gender, older age, leukocytosis, cardio-vascular diseases and diabetes were reported as factors that increase the risk of gangrenous cholecystitis. The aim our study was to determine variables affecting morbidity and mortality as well as to define the independent risk factors in Gangrenous Cholecystitis. Methods : Fifty three patients who had been treated for Gangrenous Cholecystitis were reviewed. The variables are defined as follows : age, gender, systemic diseases, Mannheim Peritonitis index, aspartate aminotransferase, alanine aminotransferase, white blood cell count and type of surgery. In order to determine the independent risk factors that might affect morbidity and mortality in Gangrenous Cholecystitis, we made use of multivariate logistic regression analysis. Results : The independent risk factors affecting on morbidity were age (P = 0.037), existing systemic disease (P 0.047) and >= 29 Mannheim Peritonitis index (P = 0.008), and the independent risk factors affecting on mortality were age (P = 0.046), white blood cell count (P = 0.035). Pre-operative and post-operative third day aspartate aminotransferase and alanine aminotransferase average values were compared, there was a significant difference (P < 0.0001, P < 0.0001 respectively). Conclusions : We found that older age, >= 29 Mannheim Peritonitis index and existence of systemic diseases were independent risk factors affecting morbidity. Older age and lower of white blood cell count were independent risk factors affecting mortality. We believe that further comprehensive studies, involving prospective, multi-center and a large number of patients, are needed.Öğe The Independent Risk Factors of Mortality and Morbidity from upper Gastrointestinal System Haemorrhages after Surgery(Acta Medical Belgica, 2009) Kafadar, T.; Gedik, E.; Girgin, S.; Tacyildiz, I. H.; Bac, B.Background : The aim this study was to determine the variables influencing the morbidity and mortality of operated patients with upper gastrointestinal haemorrhage (UGIH) and to define the independent risk factors. Patients and methods : The medical records of 62 patients with upper gastrointestinal haemorrhage who underwent operation were reviewed for variables including age, gender, shock, association with co-morbidity, pulse rate, haemoglobin levels, white blood cell count. serum urea, creatinine, sodium and potassium level. time of operation, blood transfusion unit, Rock all risk score and the length of hospital stay. In order to determine the independent risk factors related to mortality and morbidity, we carried out logistic regression analysis. Results : Morbidity and mortality rates were 35.4% (22 patients) and 29 1% (18 patients), respectively. The independent risk factors affecting morbidity were. serum albumin level and Rockall score >= 5. and the independent risk factors affecting mortality were advanced age. and high Rockall score. Conclusion : To decrease the postoperative morbidity and mortality rates in patients with UGIH requiring surgery, their pre-operative risk factors should be demonstrated. We believe that the establishment of interventional indication on time and the evaluation of the intra-operative surgical region and technique in combination with the patient- and disease-related factors would help reduce morbidity and mortality rates.Öğe Risk factors affecting morbidity in typhoid enteric perforation(Springer, 2008) Gedik, E.; Girgin, S.; Tacyildiz, I. H.; Akgun, Y.Introduction Typhoid enteric perforation is a cause of high morbidity and mortality. This study aim is to determine the factors affecting morbidity in patients with typhoid enteric perforation. Materials and methods Ninety-six patients with typhoid enteric perforation were reviewed. The variables are defined as follows: Age, gender, complaints, perforation-operation interval, typhoid fever treatment before the perforation or not, white blood cell (WBC) count, hemoglobin level (Hgb), intraoperative peritonitis intensity, the number of perforations, and type of surgery were examined. To determine the independent risk factors that might affect morbidity in typhoid enteric perforation, we made use of multivariate logistic regression analysis. Results Nine variables were applied the univariate analysis, which were greater than 30 years (P = 0.218), male gender (P = 0.02), preoperative treatment (P = 0.147), less than or equal to 48 h perforation-operation interval (P = 0.013), greater than 4,000 K/UL WBC (P = 0.388), less than 8 g/dL Hgb (P = 0.026), greater than 29 Mannheim Peritonitis Index (P < 0.0001), multiple perforation number (P = 0.614), and primary repair (P = 0.105). Logistic regression analysis showed that Mannheim Peritonitis Index (P = 0.014) and perforation-operation interval (P = 0.047) were defined as independent risk factors affecting morbidity. Conclusions If liquid electrolyte, blood, antibiotics, and parenteral nutrition are applied in typhoid enteric perforation cases adequately, then severe peritonitis becomes an independent risk factor that affects morbidity. Early diagnosis and appropriate surgery type would decrease morbidity and mortality.Öğe Surgical management of pyogenic liver abscess(Verduci Publisher, 2011) Onder, A.; Kapan, M.; Boyuk, A.; Gumus, M.; Tekbas, G.; Girgin, S.; Tacyildiz, I. H.Background and Aim: Although Pyogenic Liver Abscess (PLA) has lower mortality rate in recent years due to the broad spectrum antibiotic usage, developed imaging techniques and improved intensive care services, it is still a potentially fatal disease. The objective of this study is to examine the treatment methods and our case load with the current literature. Materials and Methods: Of 55 patients with PLA, between January 2000 and December 2009, records of 28 who received surgical drainage treatment have retrospectively been analysed. Results: Nineteen (67.9%) of the patients were male, while 9 (32.1%) were female. Average age was 41.07 (15-76). Seven (25%) had associated disease. The most common symptoms were fever and abdominal pain. Twenty three (82.1%) patients had single and 5 (17.9%) had multiple cavitary lesion. Nineteen (67.9%) patients had abscess on the right and 7 (25%) had on the left one, while 2 (7.1%) had on both lobes. All were treated surgically, because of 11 (39.3%) inappropriate localization for percutaneous treatment, 6 (21.5%) insufficient percutaneous drainage, 6 (21.5%) intraabdominal free rupture and 5 (17.7%) multiple cavitary lesion. We observed 5 pulmonary complications, 5 wound infections and 2 perihepatic collections. The average hospital stay was 11.2 days. We observed only two deaths (7.1%). Conclusions: Surgical treatment is the sole option for the patients with PLA who; (a) can't be treated by percutaneous drainage or had an unsuccessful one, (b) have multiple abscess cavity, (c) are thought to have perforated abscess, (d) have additional abdominal pathology requiring laparatomy.
