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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 factors affecting mortality in complicated emergency cases who were transferred to our center after being operated on(2002) Akgun Y.; Yilmaz G.BACKGROUND: To find out the deficiencies related to education and experience of surgeons about the surgical treatment of emergency patients, and to investigate their effects on mortality. METHODS: The records of 214 patients, who were transferred to our department after being operated with the diagnosis of abdominal trauma or acute abdomen in last 7 years, were reviewed. RESULTS: Total mortality rate was 34.1%.1t was seen that 14.5% in patients who underwent efficient surgical treatment and 42.1 % in patients whose treatment was inefficient. CONCLUSION: In centre when intensive care unit does not exist, immediately transportation of emergency operated patients with high risk will decrease morbidity and mortality rates. Participation of the surgeons who deal with emergency surgery to the post graduating courses adapting their experiences to the current improvements has also importance. Key words: Abdominal trauma, acute abdomen, postoperatively transported patients, mortality, surgery training.Öğe Factors effecting mortality in Fournier's gangrene(2005) Akgün Y.; Yilmaz G.BACKGROUND: Fournier's gangrene is the most serious and life threatening infection. The aim of this retrospective study is to describe effective factors on mortality in Fournier's gangrene. METHODS: Thirty three patients with Fournier's gangrene were investigated retrospectively. The variables such as age, gender, etiological and predisposing factors, symptoms, physical signs, intervals between symptoms and hospital admission, laboratory findings, types of microorganisms isolated from the wound scrapings, the number of surgical debridements, the length of hospitalisations were evaluated and their effects on mortality were analysed. The diagnosis of Fournier's gangrene was established with a detailed anamnesis nad physical examination. Ultrasonographic (US) and computerized tomographic examinations were performed in case of suspected involvement of adjacent tissues. RESULTS: The overall mortality rate was 33.3% in this series. The median duration of symptoms was 6.5 days in patients who survived and 10 days in patients who died (p<0.05). Only the increase in mortality in the presence of tachycardia and anaemia were was statistically significant. CONCLUSION: It was concluded that early diagnosis, stabilization of hemodynamic status, repeated debridements of whole necrotic tissue combined with antibiotherapy, before establishment of anemia and tachicardia due to multiple organ failure, might decrease mortality in patients with Fournier's gangrene.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 Intestinal and peritoneal tuberculosis(2002) Akgün Y.; Yilmaz G.; Taçyildiz I.BACKGROUND: Abdominal tuberculosis (tbc) is still a medical problem in developing countries. Since it imitates many abdominal diseases, diagnosis can be easily missed unless the disease is suspected. METHODS: The aim of this study to evaluate the value of clinical, physical and laboratory findings and to discuss the diagnostic and therapeutic options in 121 patients with intestinal and peritoneal tbc. The diagnosis was made by histopathological examination of biopsy material and isolation of mycobacterium bacillus in cultures or smears of ascites fluid. RESULTS: The diagnosis was confirmed with laparotomy in 102, laparoscopy in 4, colonoscopy in 6, and percutaneous aspiration in 9 patients. There were intestinal tbc in 67 (55.3%) patients and peritoneal tbc in 54 (44.6%). Intestinal involvement was commonly located at ileocecal area. Anti tuberculous chemotherapy was started and avoided from extensive resection in surgical treatment. There were a total of 87 complications in 52 patients (42.9%) at the postoperative period. Wound infection was the most frequent complication. Overall mortality rate was 13.2%. The mortality rate in emergency operation was 20.5% while 3.4% in elective conditions. There were no morbidity and mortality in patients whose diagnosis were made by conservative procedures. CONCLUSIONS: Laparoscopic endoscopic and percutaneous aspiration procedures are useful for diagnosis in the selected cases of intestinal and peritoneal tbc. Laparotomy should be performed only when complication develops or diagnosis is uncertain. Extensive resection should be avoided in surgical treatment of intestinal tbc. Early diagnosis and treatment will decrease the complications that can be develop during the progress of the disease and consequently the mortality rates.Öğe Respiratory syncytial virus epidemiology in Turkey(2005) Kanra G.; Tezcan S.; Yilmaz G.; Acunas B.; Aslan Ş.; Aslan Y.; Belet N.Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections in infants and young children worldwide. This study was conducted to determine the prevalence of RSV among high-risk children admitted with respiratory symptoms in a developing country. This is a multicenter study conducted among children less than 24 months of age and admitted to the hospital with respiratory symptoms. The inclusion criteria included: lower respiratory tract symptoms on admission, gestational age less than 35 weeks, and admission age less than six months, or children less than 24 months of age with a diagnosis of bronchopulmonary dysplasia requiring medical treatment or intervention during the last six months or with an uncorrected congenital heart disease (other than patent ductus arteriosus). Nasopharyngeal samples were obtained with one of the three standard methods: nasopharyngeal aspirate, nasopharyngeal wash or nasopharyngeal swab. RSV antigen was determined by enzyme immunoassay using Abbott TESTPACK RSV (No. 8100/2027-16). Statistical analysis was performed using Student's t-test and chi-square test. In this study, 332 children (135 females, 40.7%; 197 males, 59.3%) were included, and the nasopharyngeal specimens of 98 (29.5%) children were determined to be RSV-positive. There were no differences in sex, age of gestation, age of admission, family education, number of siblings and smoking at home for RSV-positive and -negative cases. Furthermore, underlying disease and duration of hospital and intensive care unit stay were similar among groups. Only otitis media was more common among RSV-positive cases. No fatality at hospital was recorded. Frozen samples revealed more negative results. Most cases presented during winter and the number of RSV-positive cases was higher in cold and economically poor areas. Premature children and children with underlying medical con dition acquire RSV irrespective of other sociodemographic risk factors, and most of them are hospitalized. Thus, an RSV vaccine seems the most effective mode of protection to decrease morbidity and mortality.
