Biomedical subjects

Korhan Taviloglu

Publications and source records attributed to Korhan Taviloglu.

13 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

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↗

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↗

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↗

PubMed2003

Colon injury following percutaneous endoscopic gastrostomy tube insertion.

Percutaneous endoscopic gastrostomy (PEG) is used to provide a safe route for enteral feeding. However, serious complications may occur during the procedure, such as transverse colon injuries. It can be difficult to diagnose a colon injury after the procedure in a patient with cobormidities. Herein, we present a case of transverse colon injury following insertion of a PEG tube, discuss the possible complications of PEG, and review the recent literature. This case demonstrates the importance of careful PEG tube insertion and close follow-up of the patient's clinical status after a PEG procedure.

Aged↗

PubMed2003

Staged abdominal re-operation for abdominal trauma.

BACKGROUND: To review the current developments in staged abdominal re-operation for abdominal trauma. METHODS: To overview the steps of damage control laparotomy. RESULTS: The ever increasing importance of the resuscitation phase with current intensive care unit (ICU) support techniques should be emphasized. CONCLUSIONS: General surgeons should be familiar to staged abdominal re-operation for abdominal trauma and collaborate with ICU teams, interventional radiologists and several other specialties to overcome this entity.

Abdominal Injuries↗

PubMed2002

The European experience with vascular injuries.

The rich and diverse heritage of the management of vascular injuries in the 45 independent European countries prevents the authors from revealing a uniform picture of the European experience, but some trends are clearly emerging. In countries with a low incidence of penetrating trauma and increasing use of interventional vascular procedures, the proportion of iatrogenic vascular trauma exceeds 40% of all vascular injuries, whereas on other parts of the continent, armed conflicts are still a major cause of vascular trauma. National vascular registries, mostly in the Scandinavian countries, produce useful, nationwide data about vascular trauma and its management but suffer still from inadequate data collection. Despite a relatively low incidence of vascular trauma in most European countries, the results are satisfactory, probably in most cases because of active and early management by surgeons on call, whether with vascular training or not, treating all kinds of vascular surgical emergencies. In some countries, attempts at developing a trauma and emergency surgical specialty, including expertise in the management of vascular injuries, are on their way.

Amputation, Surgical↗

PubMed2002

Endoscopic band ligation: alternative treatment method in nonvariceal upper gastrointestinal hemorrhage.

BACKGROUND: In the treatment of acute upper gastrointestinal (GI) bleeding, endoscopic band ligation (EBL) may be performed for nonfibrotic superficial lesions. This method has recently gained popularity in the treatment of nonvariceal upper GI bleeding. PATIENTS AND METHODS: Band ligation was performed in 13 patients who were admitted with active upper GI bleeding between December 1998 and February 2001. The sources of the bleeding were Mallory-Weiss syndrome in four patients, Dieulafoy's ulcer in five patients, gastric ulcer near a gastrojejunostomy anastomosis in two patients, gastric angiodysplasia in one patient, and the primary repair site in the stomach of a gunshot wound in one. RESULTS: Bleeding from all lesions except one was managed successfully with EBL. The single failure was in bleeding from a gastric Dieulafoy's lesion. Injection sclerotherapy with 1:10,000 epinephrine solution and EBL was not successful. Rebleeding occurred twice in one patient, and the second rebleeding necessitated surgical treatment. CONCLUSION: Our results revealed that EBL is a very promising technique in acute nonvariceal upper GI bleeding. Its effectiveness and safety with few complications will allow this modality to be used more widely.

Adult↗

PubMed2002

[Massive lower gastrointestinal bleeding in the elderly].

BACKGROUND: This study was performed to evaluate the results of massive lower gastrointestinal bleeding in the elderly patients. METHODS: The data of patients older than 60 years with massive lower gastrointestinal bleeding were retrospectively analyzed between January 1999 and March 2002. RESULTS: There were 14 (52%) males and 13 (48%), females with mean age of 70.2 years (range 60 to 88). Twenty patients were diagnosed with colonoscopy. Angiography was employed in six, scintigraphy in three and r- enteroclysis in two patients. Colonic diverticulosis was the leading etiologic factor (48%). Mean comorbidity and hospital stay were 1.59 and 6.7 days, respectively. Conservative treatment were performed in eighteen, band JCC, ligation in three, surgery in five and embolization in two patients. Mortality rate was 26%. Mortality was high it in patients who had a lower initial diastolic pressure and required more transfusions (p:0.006 and p:0.025, respectively ) CONCLUSION: Massive lower gastrointestinal system bleeding in the elderly with comorbidities is associated with higher rate of mortality. Surgery in these patients has high mortality rates. Endoscopic and conservative diagnosis and treatment methods should be the first choice in the elderly. Key words: Bleeding, lower gastrointestinal system, elderly.

Aged↗

PubMedDate not supplied

The results of caustic ingestions.

BACKGROUND/AIMS: The ingestion of caustic substances is a common condition, which may result in serious injuries of the upper gastrointestinal system. The purpose of this study is to assess the outcomes of patients who had a history of the ingestion of caustic substances. METHODOLOGY: Between January 1995 and May 2002, 53 patients with clinical and/or endoscopic signs of caustic agents injury admitted to the Emergency Surgery Service of University of Istanbul, Istanbul Medical School, were retrospectively evaluated. RESULTS: The group consisted of 29 females and 24 males with a mean age of 33 years (range 15 to 77). Caustic ingestion was accidental in 31 (59%) and suicidal in 22 (41%). Twenty-five (47%) patients had history of acid ingestions, 21 (40%) alkaline and 7 (12%) unknown agents. The findings of upper gastrointestinal tract endoscopy in 37 patients were as follows: i) fourteen patients had Grade I esophagitis, ii) fourteen patients had Grade II esophagitis; four with gastric mucosal burn, three with gastric and duodenal mucosal burn, five with pharyngeal mucosal burns, iii) two patients had gastric and duodenal mucosal burns, iv) four patients had gastric mucosal burn, vi) three patients had esophageal, gastric and duodenal mucosal burn. Eight patients (15%) with signs of acute abdomen underwent urgent surgery (six of these cases were acid ingestions and seven were suicidal ingestions); four of these patients with esophageal necrosis and gastric perforation, two with esophageal, gastric, duodenal and jejunal necrosis, one with local necrosis in the gastric fundus, and one had normal findings at laparotomy. The mean follow-up period was 11.6 months (range 1 to 42 months). During the follow-up one patient presented with pyloric stenosis, which required surgery. The mortality rate was 11%. CONCLUSIONS: Suicidal caustic ingestion and acid ingestion seem to cause more severe injuries. Early admission to the hospital with clinical and endoscopic evaluation and early surgery when required may reduce morbidity and mortality.

Accidents↗