Biomedical subjects

Hakan Yanar

Publications and source records attributed to Hakan Yanar.

15 recordsLinked to original sources

PubMed2007

Fat embolism syndrome.

Fat embolism syndrome (FES) was first described in 1862, but its frequency today is still unclear. A diagnosis of FES is often missed because of a subclinical illness or coexisting confusing injuries or disease. Fat embolism syndrome develops most commonly after orthopedic injuries, but it has also been reported after other forms of trauma such as severe burns, liver injury, closed-chest cardiac massage, bone marrow transplantation, and liposuction. Although FES usually presents as a multisystem disorder, the most seriously affected organs are the lung, brain, cardiovascular system, and skin. Fat embolism syndrome is a self-limiting disease and treatment should be mainly supportive. Many drugs have been used to treat FES, but the results are inconclusive.

Embolism, Fat↗

PubMed2007

Association between reduced levels of MEFV messenger RNA in peripheral blood leukocytes and acute inflammation.

OBJECTIVE: Familial Mediterranean fever (FMF) is associated with more than 70 missense mutations in the MEFV gene. The purpose of this study was to investigate the relative expression of messenger RNA (mRNA) for the MEFV gene in peripheral blood leukocytes (PBLs) obtained from patients with FMF during attacks of acute abdominal inflammation as well as during asymptomatic periods. METHODS: We studied 16 patients with FMF during an attack of acute peritonitis and 17 otherwise healthy individuals who were undergoing surgery because of acute appendicitis. Blood samples were collected from both groups of patients during both acute inflammatory and asymptomatic periods. Relative levels of MEFV mRNA in PBLs were detected with real-time reverse transcriptase-polymerase chain reaction using LightCycler, with 2 sets of primers for the MEFV gene (exons 7-10 and exons 2-3) and with primers for CIAS1 and PSTPIP1 genes. Expression levels were compared with beta(2)-microglobulin as an internal control. RESULTS: MEFV expression was reduced in FMF patients during asymptomatic periods as compared with the non-FMF controls (P < 0.001). We observed a further decrease in MEFV expression in FMF patients during periods of inflammation (P = 0.01). Reduced levels of MEFV mRNA were also noted during the preoperative period as compared with asymptomatic periods in control patients with acute appendicitis (P = 0.01). CIAS1 expression in PBLs from patients with FMF was also found to be lower than that in the control patients. However, CIAS1 expression did not change with acute inflammation. CONCLUSION: This study confirmed that reduced expression of the MEFV gene is associated with inflammation and that it may be one of the pathogenic mechanisms of the attacks of inflammation in FMF patients, along with disease-associated variations in pyrin.

Acute Disease↗

PubMed2006

Rupture of abdominal aortic aneurysm into sigmoid colon: a case report.

Primary aorto-colic fistula is rarely reported in the literature. Although infrequently encountered, it is an important complication since it is usually fatal unless detected. Primary aorto-colic fistula is a spontaneous rupture of abdominal aortic aneurysm into the lumen of the adjacent colon loop. Here we report a case of primary aorto-colic fistula in a 54-year old male. The fistulated sigmoid colon was repaired by end-to-end anastomosis. Despite inotropic support, the patient died of sepsis and multiorgan failure on the first postoperative day.

Aortic Aneurysm, Abdominal↗

PubMed2006

Ultrasound guided percutaneous cholecystostomy in high-risk patients for surgical intervention.

AIM: To assess the efficacy and safety of ultrasound guided percutaneous cholecystostomy (PC) in the treatment of acute cholecystitis in a well-defined high risk patients under general anesthesia. METHODS: The data of 27 consecutive patients who underwent percutaneous transhepatic cholecystostomy for the management of acute cholecystitis from January 1999 to June 2003 was retrospectively evaluated. All of the patients had both clinical and sonographic signs of acute cholecystitis and had comorbid diseases. RESULTS: Ultrasound revealed gallbladder stones in 25 patients and acalculous cholecystitis in two patients. Cholecystostomy catheters were removed 14-32 d (mean 23 d) after the procedure in cases where complete regression of all symptoms was achieved. There were statistically significant reductions in leukocytosis, (13.7 x 10(3)+/-1.3 x 10(3) microg/L vs 13 x 10(3)+/-1 x 10(3) microg/L, P < 0.05 for 24 h after PC; 13.7 x 10(3)+/-1.3 x 10(3) microg/L vs 8.3 x 10(3)+/-1.2 x 10(3) microg/L, P < 0.0001 for 72 h after PC), C -reactive protein (51.2+/-18.5 mg/L vs 27.3+/-10.4 mg/L, P < 0.05 for 24 h after PC; 51.2+/-18.5 mg/L vs 5.4+/-1.5 mg/L, P < 0.0001 for 72 h after PC), and fever (38+/-0.35 centigrade vs 37.3+/-0.32 centigrade, P < 0.05 for 24 h after PC; 38+/-0.35 centigrade vs 36.9+/-0.15 centigrade, P < 0.0001 for 72 h after PC). Sphincterotomy and stone extraction was performed successfully with endoscopic retrograde cholangio-pancreatography (ERCP) in three patients. After cholecystostomy, 5 (18%) patients underwent delayed cholecystectomy without any complications. Three out of 22 patients were admitted with recurrent acute cholecystitis during the follow-up and recovered with medical treatment. Catheter dislodgement occurred in three patients spontaneously, and two of them were managed by reinsertion of the catheter. CONCLUSION: As an alternative to surgery, percutaneous cholecystostomy seems to be a safe method in critically ill patients with acute cholecystitis and can be performed with low mortality and morbidity. Delayed cholecystectomy and ERCP, if needed, can be performed after the acute period has been resolved by percutaneous cholecystostomy.

Aged↗

PubMed2006

Malignant phyllode tumor metastatic to the duodenum.

Phyllode tumor (PT) is extremely rare tumor of the breast. Distant metastasis occurs in 10%-20% of patients with malignant phyllode tumor. The most common sites of metastases are the lungs and bones. Although theoretically any organ may have metastasis, an isolated duodenum metastasis has not been documented as yet in the English-language literature. We report herein a case with a isolated duodenal metastasis from PT of breast in a 31 year-old-woman who underwent right mastectomy 4 years before because of the recurrent malignant PT. She presented to our hospital with massive upper gastrointestinal bleeding. Clinical evaluation revealed a huge mass originated from duodenum. Urgent laparotomy and pancreaticoduodenectomy were carried out in order to remove the bleeding duodenal mass. The pathologic examination of the resected specimen showed a malignant spindle cell tumor consistent with metastatic malignant PT. Our case of gastrointestinal bleeding due to an isolated duodenal metastasis as a result of hematogenous spread from malignant phyllode tumor of breast is unique in the English literature and pancreaticoduodenectomy is a curative treatment for patients with isolated duodenal involvement.

Adult↗

PubMed2006

Fournier's gangrene: risk factors and strategies for management.

OBJECTIVE: The prognosis of Fournier's gangrene (FG) depends on early diagnosis and management. In this study, our objective was to identify the distinct features of FG that may influence the clinical outcome. METHODS: A retrospective chart review was performed in patients with a diagnosis of FG between January 1999 and December 2003. Etiological and predisposing factors, causative microbiological organisms, and clinical outcome were investigated. RESULTS: Twenty-five men (71%) and 10 women (29%) were included in the study. Mean age was 59.7 +/- 10.7 (range: 43-88) years. As a predisposing factor, diabetes mellitus (DM) was found to be in 46% of patients. All patients were treated by immediate debridement and wide-spectrum antibiotics. More than one bacterium was found in 75% of the patients' tissue cultures, and most frequently E. coli (43%) was identified. Although there were no etiological factors in 25 patients (71%), various etiological factors were found in 10 patients (29%). Multiple debridements were performed in the majority of the cases. The overall mortality rate was 40%. The mortality rates were found to be relatively higher in patients with diabetes mellitus (DM; 50%), with delayed admission to the hospital (45%), and in patients presenting with sepsis at the first admission to the hospital (78%) compared with others. In the logistic regression model, the presence of sepsis was as the only significant independent risk factor for mortality in FG. CONCLUSIONS: Despite the use of contemporary effective antibiotic treatment, aggressive debridements, and state-of-the-art intensive care conditions, FG still has high mortality and morbidity rates. In our series mortality rates were found to be higher in patients with delayed admission to the hospital, those with DM, and those who initially presented with sepsis.

Aged↗

PubMed2006

Identification of a morphometrical parameter that predicts the response to splenectomy in patients with idiopathic thrombocytopenic purpura.

Idiopathic thrombocytopenic purpura (ITP) is an isolated thrombocyte disease that has no correlation with other causes of clinical thrombocytopenia in adults. About 70% of patients with ITP were successfully treated by medical care and splenectomy, but nearly 30% of ITP patients do not respond to these treatments. The aim of this study is to evaluate the predictive factors that affect the success of treatment in 26 patients with ITP. Thirteen patients with ITP responded to splenectomy (responsive group), whereas 13 other patients were resistant to medical treatment and splenectomy (resistant group). The control group consisted of 13 patients who had undergone posttraumatic splenectomy. Age, sex, spleen weight, the number of follicles per mm(2), and the length of time between diagnosis and splenectomy were retrospectively analyzed. No significant difference was found between the groups with respect to these variables. Mean maximum follicle diameter (MMaFD), mean minimum follicle diameter (MMiFD), and the number and distribution of CD56 (+) cells were evaluated for each spleen specimen. There was no statistical difference in the distribution of CD56 (+) cells between the ITP patients and the control group, but the number of CD56 (+) cells was significantly higher in the control group than in patients with ITP. While MMiFD showed no statistical difference between the groups of ITP patients, a MMaFD of 350 microm and above was significantly more likely in the resistant group than in the other groups. In conclusion, this study has shown that the MMaFD is a significant predictor of the response to splenectomy.

Adolescent↗

PubMed2005

Traumatic injuries to the subclavian and axillary arteries: a 13-year review.

PURPOSE: By reviewing our experience, we evaluated the presentation, management, and long-term outcome of patients with subclavian and axillary artery injuries resulting from trauma. METHODS: We retrospectively reviewed the data of 38 patients who received treatment for subclavian or axillary artery injuries in the Emergency and Trauma Department of Medical Faculty of Istanbul, Istanbul University between January 1989 and July 2002. RESULTS: Arterial injuries were repaired with an end-to-end anastomosis in 10 (26.3%) patients, primary repair in 6 (15.7%), autologous vein graft interposition in 16 (42%), ligation in 5 (13.1%), and a proximal subclavian-brachial artery bypass in 1 (2.6%). One (2.6%) of the arterial reconstructions failed in the perioperative period. Fourteen (36%) patients presented with a neurological deficit, which recovered after the intervention in 2 (5.2%) patients. A wound infection developed in 8 (21%) patients and 2 (5.2%) patients died of concomitant injuries. Thirteen (36.1%) of the remaining 36 patients were followed up for a mean period of 7 months. CONCLUSION: Successful management of subclavian and axillary artery injuries requires prompt diagnosis because the occult nature of these injuries necessitates a high index of suspicion. Although revascularization procedures are often successful, it is the associated neurological, orthopedic, and soft tissue injuries that affect the functional outcome of the limb.

Adolescent↗

PubMed2005

Idiopathic necrotizing fasciitis: risk factors and strategies for management.

The prognosis of necrotizing fasciitis (NF) depends on early diagnosis and management. Idiopathic NF may be more challenging, because it occurs in the absence of a known causative factor. Therefore, our purpose in this study was to identify the distinct features of idiopathic NF that may be important in early recognition of this disease and determine the factors associated with mortality. A retrospective chart review was performed in patients with a diagnosis of NF between 1988 and 2003. Patients were classified as idiopathic and secondary NF, and data were analyzed in terms of etiological and predisposing factors, causative microbiological organisms, and clinical outcome. The study included 98 patients, 63 men and 35 women, with a diagnosis of NF. The median age was 55.5 years (range, 13 - 80). Idiopathic NF occurred in 60 of 98 patients (61%). The principal anatomic sites of infection for NF were perineal localisation in 55 patients (66%) and extremities in 31 patients (32%). Characteristics that distinguish patients with idiopathic NF from secondary NF were as follows: age older than 55 years (P = 0.0001), presence of comorbid illnesses like DM (P = 0.007) or chronic renal failure (P = 0.041), and perineal localization (P = 0.008). By logistic regression analysis, independent risk factors for idiopathic NF remained age > 55 years and perineal localization as statistically significant factors, when all the significant variables found in univariate analysis were included in the model. The majority of patients (82%) had polymicrobial infections. The mortality rate was 35 per cent. All patients were treated with radical surgical debridement and a combination of antibiotics. Female gender, presence of malignant disease, and diabetes mellitus (DM) were found to be associated with increased mortality as independent factors in logistic regression analysis, when all of these three factors were included in the model. Understanding the distinct clinical characteristics and the factors associated with mortality in patients with NF may lead to rapid diagnosis and improve the survival rates. Therefore, idiopathic NF is a crucial entity that requires serious suspicion for its diagnosis.

Adolescent↗

PubMed2005

A rare case of splenic infarct presenting with acute abdominal pain due to polyarteritis nodosa: case report and review of the literature.

A 44 year-old man presented to the Emergency Department of American Hospital with severe pain persisting in the left upper quadrant for several hours. A computed tomographic scanning (CT scan) and celiac digital substraction angiography (DSA) of the abdomen demonstrated a splenic infarct. Histopathological examinations showed diffuse acute vasculitis, thrombosis, panvasculitis which led us to diagnose the case as "polyarteritis nodosa". The diagnosis is usually difficult to establish and it is usually delayed due to variable clinical manifestations dependent on the site and the extent of arterial involvement.

Abdomen, Acute↗

PubMed2004

Venous thromboembolism prophylaxis after head and spinal trauma: intermittent pneumatic compression devices versus low molecular weight heparin.

Although there are alternative methods and drugs for preventing venous thromboembolism (VTE), it is not clear which modality is most suitable and efficacious for patients with severe (stable or unstable) head/spinal injures. The aim of this study was to compare intermittent pneumatic compression devices (IPC) with low-molecular-weight heparin (LMWH) for preventing VTE. We prospectively randomized 120 head/spinal traumatized patients for comparison of IPC with LMWH as a prophylaxis modality against VTE. Venous duplex color-flow Doppler sonography of the lower extremities was performed each week of hospitalization and 1 week after discharge. When there was a suspicion of pulmonary embolism (PE), patients were evaluated with spiral computed tomography. Patients were analyzed for demographic features, injury severity scores, associated injuries, type of head/spinal trauma, complications, transfusion, and incidence of deep venous thrombosis (DVT) and PE. Two patients (3.33%) from the IPC group and 4 patients (6.66%) from the LMWH group died, with their deaths due to PE. Nine other patients also succumbed, unrelated to PE. DVT developed in 4 patients (6.66%) in the IPC group and in 3 patients (5%) in the LMWH group. There was no statistically significant difference regarding a reduction in DVT, PE, or mortality between groups ( p = 0.04, p > 0.05, p > 0.05, respectively). IPC can be used safely for prophylaxis of VTE in head/spinal trauma patients.

Adolescent↗

PubMed2004

Can endoscopic injection of epinephrine prevent surgery in gastroduodenal ulcer bleeding? An analysis of 107 cases.

BACKGROUND: Gastroduodenal ulcers are still a common cause of severe upper gastrointestinal bleeding. Endoscopy has gained popularity worldwide over conventional open surgery for the treatment of upper gastrointestinal bleeding. This study aims to assess the efficacy of endoscopic injection of epinephrine in the treatment of gastroduodenal ulcer bleeding. METHODS: This study was conducted between March 2000 and March 2003. We analyzed 107 consecutive patients admitted to our department of trauma and emergency surgery with upper gastrointestinal bleeding. Endoscopy was performed on all 107 patients and bleeding ulcers were treated with injection of diluted epinephrine. RESULTS: Recurrent bleeding was seen in 21 patients (19.6%), all of whom underwent a second endoscopy. Four patients (3.7%) required a third endoscopy session and nine patients (8.5%) needed surgery after endoscopy failed. There were two mortalities (1.9%). The nine patients who required surgery and the two patients who died were all in the Forrest Ia and Ib groups of acute UGI hemorrhage. DISCUSSION: Endoscopic injection therapy with epinephrine reduces operation rates and can be used safely in adequate hemostasis of gastroduodenal ulcers.

Adult↗

PubMed2004

Seasonality in the incidence of abdominal aortic aneurysm ruptures: a review of eight years.

BACKGROUND: Ruptured abdominal aortic aneurysm (RAAA) is a highly mortal entity. In recent years, the role of seasonality has been proposed in the incidence of RAAA. In this study, we sought possible correlations between monthly atmospheric pressures and the number of patients admitted with RAAA. METHODS: Twenty-four patients who were admitted to our Trauma and Emergency Surgery Department with a diagnosis of RAAA from January 1995 to May 2003 were retrospectively evaluated. Data were collected from patient records, admission charts, hospital death certificate registry, and operating-room records. Only patients whose diagnosis of RAAA was confirmed during surgery were included. Atmospheric pressure records of Istanbul for individual months covering the study period were obtained from the Meteorology Office. The incidences of RAAA and the mean monthly atmospheric pressures were compared. RESULTS: Most of the patients were admitted in winter months. Admissions culminated in January with six patients, at which time the mean atmospheric pressure was 765.5 mmHg. There were no admissions in May, during which the mean atmospheric pressure was 760.8 mmHg. The distribution of monthly admissions for RAAA was not statistically significant (p>0.05). The mean atmospheric pressures tended to run a higher course before the months in which increased admissions were seen. CONCLUSION: Our findings do not corroborate the presence of a relationship between the incidence of RAAA and the atmospheric pressure.

Aortic Aneurysm, Abdominal↗

PubMed2003

[Malign melanoma of the small bowel as a cause of occult intestinal bleeding: case report].

Although the metastases from extra- abdominal tumors to the small bowel are rare, cutaneous melanoma is the most common source. A 78 year old man with occult intestinal bleeding due to malign melanoma of the small bowel was admitted to our clinics. The patient was managed successfully by small bowel resection with end to end anastomosis. Patient is alive three months after the surgery and is in pretty good condition.

Aged↗

PubMedDate not supplied

The effects of beta-aminopropionitrile on colonic anastomosis in rats.

Wound contraction is a clinically important biological process because it frequently results in contractures, strictures, and stenosis. If collagen synthesis could be altered to minimize the contracture, then the outcome could be improved. Lathyrism produces poorly cross-linked collagen in healing anastomosis, keeping a larger portion of the synthesized collagen soluble. Ultimately, the amount of contracting collagen is reduced, lowering the bulk and lessening the contracture. The aim of this study was to observe the effects of a lathyrogen, beta-aminopropionitrile (BAPN), on the healing of colonic anastomosis. Thirty rats were divided into three groups. Colostomy and anastomosis were performed on all rats. Intraperitoneal saline solution (control) and either intraperitoneal (ip) or oral (po) BAPN were administered. The rats were killed 1 week later. Anastomotic healing was assessed by bursting pressure and the hydroxyproline content of the anastomotic tissues. Granulation tissue thickness, number of fibroblasts, inflammatory cells, and growing capillaries in granulation tissue per unit area were determined. Collagen fibril diameters were estimated, and spatial arrangements of fibrils were examined by an electron microscope. All results were evaluated by Mann-Whitney U-test. The analyses of anastomotic tissues from BAPN-treated rats showed a significantly reduced mean bursting pressure (158.9 +/- 12.3, 171.3 +/- 13.9, ip and po, respectively), hydroxyproline content (8.9 +/- 2.6, 10.1 +/- 2.7), granulation tissue thickness (24.3 +/- 2.6, 16.1 +/- 5.2), number of inflammatory cells (37.8 +/- 4.3, 25 +/- 4.3), fibroblasts (3.2 +/- 1.1, 2.8 +/- 0.7), and a significantly reduced collagen fiber diameter (15 +/- 2, 20 +/- 3) compared with those of control group (236.9 +/- 9, 14 +/- 4.4, 26.8 +/- 4.8, 39 +/- 2.6, 6.9 +/- 1.1, and 35 +/- 5, respectively). As a result, collagen fibers were flimsy, and lost their regular parallel alignment in the BAPN groups. On the other hand, a number of growing capillaries were found to be significantly increased in these groups (16.5 +/- 1.1, 18.2 +/- 0.7) compared to the control (6.7 +/- 1.3). Thus, it is suggested that BAPN may be useful in the prevention of gastrointestinal stricture formation.

Aminopropionitrile↗