Biomedical subjects

M M Ozmen

Publications and source records attributed to M M Ozmen.

At least 19 recordsLinked to original sources

PubMed2004

New technique for inguinal hernia repair.

We compared a new fascia transversalis based hernioplasty with mesh repair techniques which leave the fascia transversalis intact. We prospectively randomized 180 consecutive patients with inguinal hernia to undergo one of the three hernia repair techniques. Hernias were repaired either by using the new fascia transversalis repair-Coskun's hernia repair (FTR), based on the plication of fascia using continuous sutures and followed by a second layer of interrupted or continuous sutures between inguinal ligament and conjoint tendon to distribute the tension, or one of the two mesh repair techniques: anterior (Lichtenstein) or posterior (preperitoneal) repair. Parameters such as age, sex, hernia cause, operation time, type of anesthesia, surgeon's seniority, complications, hospital stay and follow-up were evaluated. Recurrence rates were determined through clinical examination. Effect of prostatism, co-morbid disease, operation time, complications and Nyhus type of hernia on recurrences were also analysed. Most patients in each group were operated on under general anesthesia (78% vs. 80% vs. 85% for FTR, Lichtenstein, and preperitoneal repair, respectively) and by surgeons in training (average 78%). Patients were followed up for a median of 36 months. FTR had less complications and an acceptable time for operation whereas preperitoneal repairs needed more seniority, longer operation time, and caused more complications. There were only 3 (1.6%) recurrences, none in the FTR group and two the in Lichtenstein group during first postoperative year. There was no recurrence in preperitoneal repair group. All patients with recurrences had an operation time longer than 60 min and were operated on by surgeons in training. Two patients with recurrences had prostatism symptoms and chronic cough. We conclude that the new FTR is as effective as mesh repair (either anterior or posterior) with an acceptable rate of recurrences, fewer complications, and that it can be performed by the surgeons in training.

Adolescent↗

PubMed2004

The evaluation of the peak flow velocity and cross-sectional area of the femoral artery and vein following totally extraperitoneal vs preperitoneal open repair of inguinal hernias.

BACKGROUND: Both totally extraperitoneal (TEP) and preperitoneal (PPOR) approaches involve the placement of prosthetic material preperitoneally. As the prosthetic material overlies the femoral artery and vein, we aimed to assess its effect on the velocity and the diameter of the artery and vein, using colour Doppler ultrasonography in both approaches. METHODS: Eighty patients with unilateral groin hernia were prospectively randomised to have either TEP repair (n = 40) or PPOR (n = 40). All patients underwent colour Doppler ultrasound study 6 months after the procedure, and all patients were followed up for 5 years to evaluate real recurrence rates. RESULTS: Our study revealed that neither mean diameter nor mean flow velocity is changed by the insertion of the mesh preperitoneally. Change was only observed in the peak systolic femoral arterial blood velocity, which was significantly decreased in the PPOR group. We also found that no patient in this study developed a clinically significant deep-vein thrombosis during 6 months of follow-up. CONCLUSIONS: It is concluded that the insertion of a prosthetic mesh during TEP or PPOR does not influence the mean peak flow velocity and the cross-sectional area of the vessels in the inguinal region and can be used safely for open and laparoscopic preperitoneal approaches.

Adult↗

PubMed2003

The effect of immunonutrition on bacterial translocation, and intestinal villus atrophy in experimental obstructive jaundice.

BACKGROUND & AIMS: Spontaneous bacterial infection and septicemia due to increased bacterial translocation (BT) in patients with obstructive jaundice result in significant morbidity and mortality. The present study evaluates the effects of enteral nutrition with immune enhancing feeds on BT and intestinal villus histopathology promoted by obstructive jaundice. METHODS: Fifty male Wistar-albino rats weighing 250-300g were assigned into five equal groups of 10. Animals in Groups I, II, and III were fed with standard chow, those in Group IV were given glutamine 1g/kg/day and the remaining 10 animals in Group V were fed with an arginine, omega-3 fatty acids, and RNA-supplemented enteral diet for (1g/kg/day amino acid and 230 kcal/kg) 7 days preoperatively. Group I underwent sham operation and the remaining animals in all other groups underwent common bile duct ligation. After operation, Group I had standard chow, Groups II and IV had glutamine, Groups III and V had an arginine omega-3 fatty acids, and RNA-supplemented enteral diet for 7 days. All animals were sacrificed on the 8th postoperative day and evaluated both biochemically and histopathologically. Samples from blood, liver, mesenteric lymph nodes and spleen were cultured under aerobic conditions. RESULTS: Significantly less BT was observed in groups fed with an arginine, omega-3 fatty acids, and RNA-supplemented enteral diet or glutamine in pre-and postoperative periods as compared to others (P<0.001). Histologic evaluation also showed significant reduction in villus atrophy in these groups. CONCLUSIONS: Enteral immunonutrition using glutamine or arginine, omega-3 fatty acids, and RNA-supplemented enteral diet during both pre-and postoperative periods seems to reduce BT and decrease atrophy of intestinal mucosal villi in rats with obstructive jaundice.

Animals↗

PubMed2001

Does splanchnic ischemia occur during laparoscopic cholecystectomy?

BACKGROUND: Although it has been been shown that the elevation of abdominal pressure causes splanchnic ischemia, the pathophysiological changes that occur during laparoscopic cholecystectomy are still under investigation. Our aim was to evaluate the changes in nitric oxide (NO), malondialdehyde (MDA), and gastric intramucosal pH (pHi) during laparoscopic surgery to verify whether splanchnic ischemia had occurred. METHODS: Forty patients (11 men and 29 women) scheduled for cholecystectomy were randomly divided to undergo either open (OC) or laparoscopic cholecystectomy (LC). Repeated blood samples were collected for the measurement of NO and MDA concentrations. End-tidal carbon dioxide (ETCO2) levels were measured using a capnograph, and pHi was assessed using a tonometric nasogastric catheter. RESULTS: Although no significant change in pH was observed in the LC group during the procedure, it decreased significantly in the OC group and then returned to normal immediately after the procedure. ETCO2 did not change in the LC group but it increased in the OC group. Although it was not statistically significant, NO concentrations were slightly increased in the LC group. The same magnitude of increase was seen in MDA levels but it was not significant. Neither NO nor MDA levels changed in the OC group. CONCLUSION: LC has no adverse effects on gut perfusion. Even if the abdominal organs are hypoperfused during the procedure, compensates for this hypoperfusion so that it pulsatile NO secretion does not cause any harm. Since LC is a short procedure, the significance of these events for extended procedures still needs to be clarified.

Biomarkers↗

PubMed2001

Corona mortis: an anatomic study in seven cadavers and an endoscopic study in 28 patients.

BACKGROUND: The corona mortis is defined as the vascular connections between the obturator and external iliac systems. While detailed information on the arterial anastomoses in corona mortis is available, a complete description of the venous system is lacking. Although the tiny anastomoses behind the pubic symphysis between the obturator and external iliac arteries have been described in classical anatomy textbooks, these texts neglect to mention that these anastomoses can be life threatening. Attention needs to be paid to these anastomoses between the arterial and the venous system located over the superior pubic ramus during laparoscopic procedures. METHODS: Fifty retroinguinal regions were dissected in seven cadavers and 28 patients. RESULTS: During the dissections, a venous anastomosis on the superior pubic ramus was a consistent finding in 96% of cases. This vein coursed vertically to the inferior border of the superior pubic ramus and connected to the obturator vein. Accessory branches of the obturator artery were observed in only 8% of the dissections. The tiny connections between the obturator and external iliac arteries are less important, since their diameter is <1 mm. CONCLUSIONS: We have termed the venous connection between the external iliac and obturator veins over the superior pubic ramus "the communicating vein". This structure forms the corona mortis. Surgeons dealing with direct, indirect, femoral, or obturator hernias need to be aware of these anastomoses and their close proximity to the femoral ring. In classical anatomy textbooks, a description of the veins that form corona mortis is found less often than descriptions of the arteries. Since a venous connection is more probable than an arterial one, its importance must be appreciated by surgeons in order to avoid venous bleeding.

Cadaver↗

PubMed2001

Presentation and outcome of incarcerated external hernias in adults.

BACKGROUND: Incarcerated external hernias are the second most common cause of small-intestinal obstructions. The purpose of this study was to examine the presentation and management of incarcerated external hernia. METHODS: The records of 385 consecutive patients undergoing emergency surgical operation for incarcerated external hernias in a large volume teaching hospital between August 1996 and October 1999 were analyzed. The patients' ages ranged from 15 to 100 years (mean 55.1). There were more men than women (250 and 135, respectively), and 165 (42.9%) patients were over 60 years of age. Inguinal and umbilical hernias were encountered most frequently, in 291 (75.5%) and 48 (12.5%) patients, respectively. The intestine was resected in 53 patients, 31 of whom were over 60 years of age (58.5%). Two hundred fifty-two (84.9%) patients presented 48 hours or more from the onset of symptoms. Significant concomitant diseases were noted in 52 men and 19 women. RESULTS: The overall complication rate amounted to 19.5%, major complications 15.1%. The most serious postoperative complications were pulmonary and cardiovascular. Adult respiratory distress syndrome developed in 10 patients, and congestive heart failure developed in 14 patients. Postoperative mortality was 2.9%. Nine (81.8%) of the dead patients were older than 60. Nine (81.9%) of the dead patients were admitted to hospital more than 24 hours after incarceration. Mortality was high in patients with serious coexisting diseases whereas morbidity was linked with the duration of symptoms prior to admission. CONCLUSIONS: Older age, severe coexisting diseases, and late hospitalization were the main causes of unfavorable outcomes of the management of incarcerated hernias.

Comorbidity↗

PubMed2001

Emergency hernia repairs in elderly patients.

BACKGROUND: Emergency hernia repairs comprise one of the most common procedures performed in elderly patients and also carry a high risk of mortality and morbidity. The aim of this study was to examine the factors that might have an influence on the outcome of emergency hernia repairs in elderly patients. METHODS: A review was made of 189 (120 male and 69 female) patients aged more than 65 years who underwent emergency hernia repair between December 1996 and January 2001 at the surgical emergency unit of our hospital. The patients' ages ranged from 65 to 100 years (mean 72.1). Concomitant diseases were present in 86 (45.5%) patients. Of 189 incarcerated hernias, there were 145 (76.7%) bowel obstructions and 91(48%) strangulations. Necrotic bowel was resected in 36(19%) patients. RESULTS: While overall mortality was 5%, it was found to be 19.4% after bowel resection. Major complications were observed in 48 (25%) patients. Mortality and morbidity were clearly linked with bowel resection. Coexisting cardiopulmonary diseases, misdiagnosis, American Society of Anesthesiologists class, and late admission were also found to be responsible for unfavorable outcomes. CONCLUSIONS: In elderly patients with external hernias early elective surgery should be preferred, and local anesthesia might be the best in order to avoid the increased risks of emergency hernia repairs.

Aged↗

PubMed2001

Laparoscopic herniorrhaphy: preference rate among surgeons in Ankara, Turkey.

OBJECTIVE: To determine the surgeons' and the surgical residents' choice for inguinal hernia repair. DESIGN: A questionnaire study. SUBJECTS: One hundred and forty two respondents who work in surgical clinics as surgeons or residents. SETTING: University hospitals and non-academic teaching hospitals in Ankara, Turkey. MAIN OUTCOME MEASURE: The preference rates of open and laparoscopic hernia repairs for respondents' own inguinal hernias: "If you had an inguinal hernia, how would you prefer to have it repaired?" RESULTS: Only 14.1% of the respondents preferred a laparoscopic hernia repair. Eight of 63 residents (12.7%) and 12 of 79 surgeons (15.2%) chose laparoscopic technique for their own hernia (p=0.67). Personal laparoscopic herniorrhaphy experience significantly affected the choice. Among 118 respondents who had performed no laparoscopic hernia repair, only 12 (10.2%) preferred laparoscopic technique for their own inguinal hernias, whereas the preference rate rose to 33.3% in other 24 participants who had previously done laparoscopic hernia repair (p=0.03). The only independent variable in multivariate analysis was personal experience on laparoscopic herniorrhaphy (SE:0.33, Wald 11.73, Sig:0.0006). The majority of the respondents who preferred open hernia repair stated that it was a better known technique. Other common reasons for open repair were being better repair and the advantage of local anesthesia. Top three reasons for choosing laparoscopic hernia repair were less pain, short hospital stay and early return to normal activity. CONCLUSION: Majority of surgeons and residents still prefer open hernia repair.

Attitude of Health Personnel↗

PubMed1999

Effect of CO(2) insufflation on bacteremia and bacterial translocation in an animal model of peritonitis.

BACKGROUND: The widespread adoption of the laparoscopic approach has created some concern over the potential for increased risk of bacteremia and sepsis due to increased intraabdominal pressure in patients with intraabdominal infection and peritonitis. This study examines the effect of the CO(2) pneumoperitoneum on bacteremia and bacterial translocation. METHODS: New Zealand white rabbits were assigned into three groups of 10 animals. In group 1, 100 ml of sterile saline was infused into the peritoneal cavity under 10 mmHg CO(2) insufflation for 1 h. Group 2 received 100 ml of saline containing 10(9) CFU/ml (colony-forming units) E. coli strain 0163 and 10 mmHg CO(2) insufflation for 1 h. Group 3 received an identical bacterial inoculum, followed by a 10-cm midline laparotomy. Blood samples were taken for culture by cardiac puncture at various intervals during the experiment. At 6 h after being subjected to the experimental procedures, the rabbits were killed and their organs were cultured quantitatively for translocating bacteria. RESULTS: In group 1, neither blood nor organ cultures were positive, whereas in group 2 all blood cultures became positive in 1 h, and intraperitoneally infused bacteria translocated to the lung and kidney in all rabbits. In group 3, blood cultures became positive in 1 h, all but two of the rabbits had translocated bacteria in their lungs, and kidney samples from two of the rabbits were culture-positive. CONCLUSIONS: Our results indicate that both CO(2) pneumoperitoneum and laparotomy increase the incidence of bacterial translocation from the peritoneal cavity into the bloodstream. Thus, the risk of translocation to extraperitoneal organs such as lung and kidney is increased significantly by laparoscopy. Therefore, laparoscopic surgery should be avoided or used cautiously in the setting of acute peritonitis.

Animals↗

PubMed1999

Role of technetium tetrofosmin scintimammography in the diagnosis of malignant breast masses and axillary lymph node involvement: a comparative study with mammography and histopathology.

OBJECTIVE: To assess the role of Technetium-99m (99mTc) tetrofosmin scintimammography in the detection of breast cancer and involvement of axillary nodes. DESIGN: Open study. SETTING: General hospital, Turkey. SUBJECTS: 128 women who presented with masses in the breast. INTERVENTIONS: Scintimammography, standard mammography, and either excision or fine-needle aspiration biopsy to confirm the diagnosis. MAIN OUTCOME MEASURES: Sensitivity, specificity, and positive and negative predictive value of scintimammography compared with mammography. RESULTS: Sensitivity, specificity, and positive and negative predictive value (%) of 99mTc scintimammography were 95, 96, 97 and 92, respectively. The corresponding figures for standard mammography were 87, 26, 68 and 52. Scintimammography changed the 34 false positive mammograms into true negatives, at the expense of four false negatives. The sensitivity of scintimammography in detecting axillary lymph node metastases was 72% and specificity 100%. CONCLUSION: Scintimammography with 99mTc tetrofosmin seems to be of value in the detection of breast malignancy and axillary metastases. It may help to avoid unnecessary operations in patients whose mammograms do not give a definite diagnosis.

Adult↗

PubMed1999

Laparoscopic versus open appendectomy: prospective randomized trial.

Although classic open surgery is simple, expeditious, and effective, it has some drawbacks, including wound sepsis, delayed recovery, operative difficulties, and possibility of unnecessary appendectomies for false appendicitis. The aim of this study was to assess the applicability and safety of laparoscopic appendectomy (LA) in a prospectively randomized trial. Seventy nonselective patients with suspected appendicitis were randomized to laparoscopic (n = 35, 17 male) or open appendectomy (n = 35, 15 male) and operated on an emergency basis. Operative findings, operating time, postoperative complications, and length of hospital stay were compared. We found that LA is associated with a shorter hospital stay, fewer postoperative complications, and better diagnostic accuracy, and it is recommended as the procedure of choice for the diagnosis and management of acute appendicitis.

Adult↗

PubMed1996

Effect of cisapride on gallbladder emptying and plasma CCK in normal and vagotomized human subjects.

Previous studies have provided conflicting results of cisapride on gallbladder emptying in response to a meal. We studied six volunteers and six patients after a truncal vagotomy in a double-blind, placebo-controlled, prospectively randomized study using 10 mg cisapride four times a day for three days. Gallbladder volume was quantitated using ultrasonography, and plasma CCK levels were measured with a sensitive and specific radioimmunoassay using the DINO antibody before and for 90 min after a fatty, mixed meal. Plasma effect was observed on the gallbladder either in normal subjects or vagotomized patients. Paradoxically, residual volume (RV) was increased in the vagotomized patients after treatment with cisapride: RV cisapride 7.1 (4.1-15.9) ml, RV placebo 5.1 (3.8-14) ml, P < 0.05. Further work is required to clarify the mechanisms of action of cisapride on the gallbladder and the sphincter of Oddi. The use of cisapride during litholytic therapy may impair gallbladder emptying and delay stone clearance.

Adult↗

PubMed1996

Standardization of a technique for BrIDA cholescintigraphy.

Calculation of ejection fraction by cholescintigraphy is a well-established technique to quantify motor function of the gallbladder. All previous cholescintigraphic studies of gallbladder emptying have exclusively used the anterior projection for gallbladder visualization. This may lead to inaccuracies because attenuation of gamma rays may vary depending on the state of gallbladder filling and body habitus. The use of geometric means may prevent these errors. In this study, 7 health volunteers were examined after the administration of 150 MBq 99Tcm-bromotrimethyl-IDA (99Tcm-BrIDA) without any stimulus and 9 volunteers ingested a maxied, fatty meal 35-40 min after BrIDA injection. Imaging was done using a dualheaded camera in a dynamic study of 140 one-minute frames. A plateau of activity was reached between 70 and 90 min post-injection of BrIDA and between 55-60% of maximal counts were achieved in the gallbladder region of interest (ROI) between 35 and 40 min. Significant emptying was seen in all nine subjects after the meal. No significant difference in ejection fraction was seen between the anterior projection and the geometric mean of the data from the anterier and posterior projections. The slope of the gallbladder filling curve from the anterior camera data was different from that obtained from the geometric mean, but the correlation coefficient was not significantly different. In conclusion, adequate counts are achieved in the gallbladder ROI 35-40 min after BrIDA injection, when the stimulus can be administered to study gallbladder emptying. There is no advantage to imaging in the anterior and posterior projections and data obtained from the anterior projection alone are adequate for gallbladder emptying studies.

Adult↗

PubMed1995

Gallbladder motility, gallstones, and the surgeon.

Cholecystectomy is one of the commonest surgical procedures in the Western world, with more than half a million procedures performed annually in the United States alone. In recent years, studies of gallstone pathogenesis and gallbladder disease have increasingly focused on abnormal gallbladder motility in the pathogenesis of some, if not all, gallbladder conditions. The control of gallbladder motility is complex and depends on an intricate interplay of neural and hormonal factors. An understanding of the control of gallbladder motility is crucial to the understanding of the mechanisms of gallstone formation and may help to explain the failure to cure symptoms after cholecystectomy in up to one third of patients. The purpose of this article is to outline mechanisms controlling gallbladder motility, examine recent developments in our understanding of this complex process, and relate changes in motility to common disease conditions of the gallbladder. The role of altered motility in the pathogenesis of gallstones is discussed and the effects of commonly performed surgical procedures such as truncal vagotomy and cholecystectomy on upper gut physiology are reviewed.

Cholecystectomy↗

PubMed1995