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Biomedical subjects

E M Sözüer

Publications and source records attributed to E M Sözüer.

12 recordsLinked to original sources
PubMed2001

Laparoscopic cholecystectomy for symptomatic gallstones in diabetic patients.

PURPOSE: To find out whether diabetes mellitus is a risk factor in patients who undergo laparoscopic cholecystectomy because of symptomatic gallbladder stones. PATIENTS AND METHODS: Eight hundred sixty-two patients with symptomatic gallbladder stones underwent laparoscopic cholecystectomy at our institution between January 1993 and July 2000. Age, sex, risk classification of the American Society of Anesthesiologists (ASA), laboratory tests, operative records, morbidity, and length of hospital stay for each patient were analyzed. RESULTS: There were 184 (21%) diabetic and 678 (79%) nondiabetic patients. The ASA class I applied to 534 nondiabetic (control) patients (79%), and ASA class II to 161 diabetic (study) patients (88%). There was no significant difference between the diabetic and nondiabetic patients regarding leukocyte count, bilirubin, or amylase levels. Operative and postoperative complication rates were significantly higher in the diabetic patients. Conversion to open surgery was required in 19 of 678 patients in the control group (2.8%) and 13 of 184 in the study group (7.1%). The operative time and length of hospital stay were not significantly different in the two groups. CONCLUSIONS: Although they had the same symptoms and laboratory findings, laparoscopic cholecystectomy in diabetic patients is associated with more morbidity and a higher conversion rate than in nondiabetic patients.

Cholecystectomy, Laparoscopic↗
PubMed2001

[Traumatic splenic injuries].

Splenectomy is the frequently used surgical method for the treatment of traumatic splenic injuries. In this study, the patients who had traumatic splenic injuries were investigated and the results of surgical treatments were evaluated. There were 225 patients with traumatic splenic injuries, which contains 55 (24%) female and 170 (76%) male. The mean age was 29 (range 16-71) years. Severity of splenic injury was classified according to Moore organ injury scaling and there were 23 (10%) patients in grade 1, 96 (43%) in grade II, 75 (33%) in grade III, 24 (11%) in grade IV and 7 (3%) in grade V. Splenectomy was performed in 203 (90%) patients, splenoraphy in 18 (8%) and partial splenectomy in 4 (2%) patients. The overall mortality was 12%. A positive correlation was estimated between the combined trauma and the mortality (Fisher's Chi-Square test; chi 2 = 9,538, p < 0.002). In conclusion, non-operative treatment methods may prevent unnecessary splenectomies, especially in grade I and II blunt or penetrating splenic injuries. Combined injuries are the major factor increasing the mortality.

Adolescent↗
PubMed2000

Laparoscopy for diagnosis and treatment of acute abdominal pain.

PURPOSE: To evaluate the role of laparoscopy in the diagnosis and treatment of unexplained acute abdominal pain. PATIENTS AND METHODS: Fifty-six patients with acute abdominal pain (41 women, 15 men; median age 27) who attended our hospital between July 1996 and July 1999 and in whom a definite diagnosis could not be made by conventional methods underwent diagnostic laparoscopy. RESULTS: The laparoscopic procedure was performed under general anesthesia in 43 patients and local anesthesia in 13 patients. The median duration of laparoscopy was 16 minutes. The sensitivity and specificity of diagnostic laparoscopy were found to be 98% and 96%, respectively. The most frequent diagnosis was acute appendicitis (38%). Laparoscopic treatment of the surgical pathology was possible in 36 patients; in seven patients, conversion to laparotomy was necessary. The median postoperative hospital stay was 1 day in the diagnostic laparoscopy group. The median treatment cost was lower in the diagnostic laparoscopy group than in the therapeutic laparoscopy or laparotomy groups. There was no mortality or morbidity in the laparoscopy groups. CONCLUSIONS: Laparoscopy is an effective method for the diagnosis and treatment of surgical pathologies in patients in whom the diagnosis cannot be made with physical examination and noninvasive methods.

Abdomen, Acute↗
PubMed2000

Solitary subcutaneous hydatid cyst: a case report.

In the absence of hepatic and pulmonary involvement, hydatid disease of other organs is extremely rare. In this paper, we report on a patient who had a solitary subcutaneous hydatid cyst in the submandibular region.

Child↗
PubMed2000

The role of oxygen free radicals and nitric oxide in organ injury following hemorrhagic shock and reinfusion.

BACKGROUND: Vital organ injury due to tissue hypoperfusion is a major complication of hemorrhagic shock. Nitric oxide (NO) has been implicated in the pathophysiology of hemorrhagic shock. AIMS: To determine the effects of L-arginine on the central organ injury due to severe hemorrhagic shock and reinfusion and the relationship among endogenous antioxidants, superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GSH-Px) in dogs. METHODS: After induction of anesthesia, twenty six mongrel dogs were hemorrhaged to a mean arterial pressure (MAP) of 35 +/- 3.3 mmHg where they were held for 1 hr. Five minutes prior to the end of the shock period, either saline (5 mL/kg), L-arginine (250 mg/kg), or NG-nitro-L-arginine-methyl-ester (L-NAME) (25 mg/kg) was administered i.v., being followed by reinfusion of shed blood. MAP was monitored. Blood samples were taken for the measurement of blood urea nitrogen (BUN), creatinine, aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), intraerythrocytic SOD, CAT, GSH-Px, and serum nitrite and nitrate levels. Tissue samples from liver, kidney and small intestines were taken for histological studies and liver samples were also taken for the mesurement of SOD, CAT, GSH-Px tissue levels. RESULTS: L-arginine treatment reduced MAP. In contrast, L-NAME treatment significantly increased MAP. L-arginine treatment increased BUN and creatinine. L-NAME treatment significantly increased the activity of hepatic enzymes. L-arginine decreased the reinfusion injury in the liver and the small intestine histopathologically. In addition, L-arginine caused significant decreases in the intraerythrocytic and the liver SOD, CAT and GSH-Px levels from the shock levels. CONCLUSION: L-arginine has a preventive role in liver and intestine following hemorrhagic shock and reinfusion. Inhibition of NO synthesis aggravates reinfusion injury.

Animals↗
PubMed1998

Diagnostic peritoneal lavage in blunt abdominal trauma victims.

Diagnostic peritoneal lavage (DPL) is an accepted method for evaluating patients with suspected intra-abdominal injury, especially in those with blunt abdominal trauma for whom early operative intervention may be life-saving. To evaluate this method in blunt abdominal trauma victims, we prospectively studied 2010 patients with blunt abdominal trauma who underwent DPL between 1978 and 1996 in our emergency department (at the regional tertiary university medical centre). The patients were then divided into three groups based on their DPL results. Of the total of 2010 patients, 719 (35.8%) met the criteria for positive DPL, indicating the need for laparotomy; 1213 (60.3%) had a negative DPL; and the remainder (78 patients, 3.9%) had equivocal DPL results. All the patients with positive DPL underwent emergency laparotomies which were therapeutic in 547 (76.1%) and non-therapeutic in 156 (21.7%) who had intra-abdominal haemorrhage. Sixteen patients out of 719 (2.2%) had no organ injuries in explorative laparotomy. When the 2010 cases in this study were evaluated, overall rates of specificity, sensitivity and positive predictive rates were found to be 87.3%, 96.3% and 76.1% respectively; the false positive rate was 23.9%, the false negative rate 1.8% and the negative predictive value 98.2%. Complications related to DPL developed in 31 patients (1.5%) out of the 2010 undergoing DPL. It is evident from the results that DPL is a reliable method. However, the criteria for positive DPL should be re-assessed based on the fact that the method itself had a false positivity rate of 23.9% leading to unnecessary operations.

Abdominal Injuries↗
PubMed1996

Development of collaterals in intermittent and permanent ischemia of the liver.

The ischemia caused by the hepatic dearterialization as therapy for hepatic malignancies is transient because of the rapid formation of collaterals. In order to prevent this transient repeated ischemia has been suggested. An experimental study was planned to compare the collateral occurrence in persistent ischemia and transient repeated ischemia of the liver. Fourteen dogs (seven persistent ischemia, seven transient repeated ischemia) were used in this study. Hepatic dearterialization were performed in both groups. In the first group (persistent ischemia), the hepatic artery was ligated proximal to the gastroduodenal artery. In the second group (transient repeated ischemia), the hepatic artery was occluded externally in the same region as the first group by means of a device modified from 8 guage Foley catheter and after occlusion for one hour it was reopened. Occlusions were repeated twice in a day. Five dogs in the first group and six dogs in the second group completed a three week ischemia period and angiography were then performed in all. The dogs were sacrificed after the angiography and examined for possible abscess formation, arterial thrombosis, peritoneal adhesions and liver necrosis. After angiography, the two groups were also examined for collateral occurrence. Only one collateral occurred in the transient repeated ischemia group, but in the persistent ischemia group, collaterals occurred in all dogs. This difference between two groups is statistically significant (Fischer Absolute Chi Square Test, p = 0.013). Transient repeated ischemia is superior to persistent ischemia because of fewer collaterals, but in practise, total dearterialization of the liver is impossible.

Animals↗
PubMed1994

Diagnosis and surgical treatment of hepatic hydatid disease.

In this report, 226 patients with hydatid disease admitted to the Surgical Department of Erciyes University (Kayseri) and Sişli Etfal Hospital (Istanbul) in Turkey between 1978 and 1990 were reviewed retrospectively. 102 patients (45.1%) were male and 124 (54.9%) female. The most frequent symptom was right upper abdominal pain (66%). The most frequent signs were hepatomegaly (43.8%) and palpable mass (39%). 167 patients (73.9%) were examined with ultrasonography which has a diagnostic value of 94%. Preoperative complications were infection of cyst (7%), intrabiliary rupture (3.5%) and anaphylactic shock (0.4%). Patients were operated on by various techniques; omentoplasty (101), external drainage of residual cavity (64), marsupialization (25), capitonnage (15), introflexion (10), pericystectomy (6), and hepatic resection (5). Main postoperative complications were wound infection (12%) and biliary fistula (2.6%). Total mortality rate was 1.8% in this series.

Adolescent↗
PubMed1992

Diagnosis and surgical treatment of hepatic hydatid disease.

In this report two hundred and twenty six patients with hydatid disease were admitted to the Surgical Department of Erciyes University (Kayseri) and Sişli Etfal Hospital (Istanbul) between 1978 and 1990 and reviewed retrospectively. One hundred and two patients (45.1%) were male and 124 (54.9%) female. In the patients with hydatid cysts the most frequent symptom was right upper abdominal pain (66%). The most frequent signs were hepatomegaly (43.8%) and palpable mass (39%). One hundred and sixty seven patients (73.9%) were examined with ultrasonography which has a diagnostic value of 94%. Preoperative complications were infection of cyst (7%), intrabiliary rupture (3.5%) and anaphylactic shock (0.4%). All patients were operated on by using various surgical techniques; omentoplasty (101), external drainage of residual cavity (64), marsupialization (25), capitonnage (15), introflexion (10), pericystectomy (6), and hepatic resection (5). The main postoperative complications were wound infection (12%) and biliary fistula (2.6%). The total mortality rate was 1.8% in this series.

Activities of Daily Living↗
PubMedDate not supplied

Factors effecting the complications in the natural history of acute cholecystitis.

BACKGROUND/AIMS: Gangrenous cholecystitis, empyema, gallbladder perforation, and biliary peritonitis are severe complications of acute cholecystitis associated with increased morbidity and mortality. This study aimed to evaluate perioperative factors associated with complications of acute cholecystitis. METHODOLOGY: Between January 1993 and October 2000, we performed cholecystectomy in 368 patients with acute cholecystitis. All perioperative data were collected on age, sex, medical history, symptoms, laboratory tests, ultrasound, operative and microbiological findings, morbidity and mortality. RESULTS: There were 305 cases (83%) of acute uncomplicated cholecystitis, 26 (7.1%) of gangrenous cholecystitis, 23 (6.3%) of empyema of the gallbladder, 12 (3.3%) of gallblader perforation, and 2 (0.5%) emphysematous cholecystitis. Risk factors for complicated cholecystitis included male gender, advanced age, associated diseases, temperature above 38 degrees C, and white blood cell count on admission greater than 18,000. Laparoscopic cholecystectomy was attempted on 36 patients (11.8%) with uncomplicated and seven patients (11.1%) with complicated acute cholecystitis. The conversion rate to open cholecystectomy was 19.4% for uncomplicated cases, 28.6% for complicated cases. There were no differences in operative complications between complicated and uncomplicated cases, however, length of hospital stay, postoperative morbidity and mortality were significantly higher in complicated cases. CONCLUSIONS: Sex (male), advanced age, presence of associated disease, high temperature (> 38 degrees C) and leukocytosis are all remarkable risk factors inducing complications in acute cholecystitis. Laparoscopic cholecystectomy can be performed with success in uncomplicated cases.

Acute Disease↗