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Biomedical subjects

Ramazan Eryilmaz

Publications and source records attributed to Ramazan Eryilmaz.

17 recordsLinked to original sources
PubMed2006

Closure of fascial defect at trocar sites after laparoscopic surgery.

As laparoscopic surgery evolves, a growing number of different abdominal operations can now be performed. This necessitates the use of multiple large trocars. Herniation through the fascial defect created by trocar entry in laparoscopic interventions has been reported at a rate of 1-6%. We describe a simple closure technique for fascial defects at trocar sites after laparoscopic surgery. To facilitate the closure of the fascial defects of > or = 10 mm trocar entry sites, the surgeon places the upper end of a dissecting forceps through the fascial defect and tilts it so that the abdominal of the peritoneum comes into contact with its flat surface. The assistant retracts the skin and subcutaneous tissue and the "J" needle with the appropriate suture material is then used to take a stitch through the fascia under direct vision. The sharp end of the needle is prevented from coming into contact with any deeper structure as it slides on the flat surface of the dissecting forceps. The stitch is then pulled up to lift the edge of the fascia and the needle is passed from the opposite edge of the fascia in the same manner and then the suture is ligated. The aforementioned technique is easy to perform and facilitates the closure of the fascial defect at trocar sites, and there is no extra cost for the procedure.

Fascia↗
PubMed2005

Umbilical pilonidal sinus disease: predisposing factors and treatment.

Pilonidal sinus disease is a common problem of sacrococcygeal region. However, it is also observed in the periumbilical area. There are only a few reports about umbilical pilonidal sinus in the literature. In this study, 26 patients (24 men (92 %), 2 women (8 %) with a mean age of 22 years) with umbilical pilonidal sinus disease were included. Predisposing factors, patient characteristics, treatment modalities, and their results have been studied. Male sex, young age, hairiness, deep navel, and poor personal hygiene were found to be predisposing factors. Twenty-five patients were treated conservatively. However, two patients failed to respond to conservative treatment. Those patients underwent surgery where umbilectomy was carried out without reconstruction. One patient was also operated on for the preoperative misdiagnosis of irreducible umbilical hernia. Patients were followed for 14-96 months. We recommend conservative treatment in patients with umbilical pilonidal sinus. Surgery should be performed in recurrent cases resistant to conservative treatment. The importance of differential diagnosis of umbilical pilonidal sinus from other umbilical pathologies is also emphasized.

Adolescent↗
PubMed2005

Management of lactational breast abscesses.

The purpose of the present prospective study was to compare incision and drainage against needle aspiration for the treatment of breast abscesses in lactating women. During the 3-year study period, patients with breast abscesses were randomized 1:1 to undergo either incision and drainage (23 patients) or needle aspiration (22 patients). Ultrasound guidance was not used for any of these patients. Age, parity, localization of abscess, whether or not nipples were cracked, duration of symptoms and lactation, abscess diameter, pus culture results, breast infection history during any previous period of lactation, healing time, recurrence, cosmetic outcome in the case of incision and drainage, and volume of pus removed and number of aspirations needed in the case of aspiration were recorded. The treatment value of each of these techniques was investigated. Student's t-test, Fisher's exact test, a Chi-square test and the Mann-Whitney U-test were used for statistical analysis. In the incision and drainage group all patients were treated successfully, but 1 patient (4%) had a recurrence 2 months after complete healing and 16 patients (70%) in this group were not pleased with the cosmetic outcome. In the needle aspiration group, overall 3 patients were treated with a single aspiration and 10 patients (45%) with multiple aspirations, but 9 patients (41%) did not heal following needle aspiration and subsequently required incision and drainage in addition. No recurrences were observed in the needle aspiration group during the follow-up period. The risk factors for failure of needle aspiration for breast abscesses were abscesses larger than 5 cm in diameter, unusually large volume of aspirated pus, and delay in treatment. In conclusion, breast abscesses smaller than 5 cm in diameter on physical examination can be treated with repeated aspirations with good cosmetic results. Incision and drainage should be reserved for use in patients with larger abscesses.

Abscess↗
PubMed2005

A new alloantigen-independent control for chronic allograft nephropathy rat models.

BACKGROUND: Isografts are used as controls in many transplant experiments. Our laboratory and others have noticed histological changes in control isograft groups of rats similar to allograft groups, suggesting alloantigen-independent factors contributing to chronic allograft nephropathy. However, the isograft model as a nonalloantigen control is flawed because of the potential of unrecognized minor antigen differences between rats. We designed a study using autografts to isolate alloantigen-independent factors in the rat renal transplant allograft model. MATERIALS AND METHODS: Male Lewis rats weighing 150-250 g underwent a procedure designed to mimic the injury of renal transplant, in which the left kidney was perfused with cold University of Wisconsin solution and subjected to similar cold and warm ischemic times as Lewis isograft rats undergoing renal transplanation. RESULTS: Six autograft rats were compared to five isograft and three single nephrectomy rats. Autograft rats showed normal kidney function according to serum BUN, Cr, and urinary protein. At 360 days, four of six autografts displayed normal renal parenchymal histology, whereas the remaining two autografts displayed histological changes scored as Banff acute rejection 1a and 1b. At sacrifice time, four of five isografts showed histological changes scored as Banff chronic rejection 1 and the single nephrectomy group showed normal histology in the remaining native kidney. CONCLUSIONS: Our data demonstrate that the chronic nephropathy observed in the isograft cannot be completely freed from suspicion of immunological origin. We propose that the autograft model for rat renal transplant research is a better nonimmunologic control than the isograft model for chronic allograft nephropathy.

Animals↗
PubMed2005

The effect of the degree of histologic inflammation on gallbladder perforation during laparoscopic cholecystectomy.

PURPOSE: Laparoscopic cholecystectomy (LC) is the gold standard operation for the treatment of symptomatic gallstones. Intraoperative gallbladder perforation is a common complication encountered during the surgery. The purpose of this study was to identify the effects of inflammation on gallbladder perforation during LC. METHODS: Between July 1997 and March 2003, 509 patients underwent LC for symptomatic gallstone disease at the Department of Surgery at Vakif Gureba Training Hospital. Data were collected retrospectively. Patients with and without gallbladder perforation were compared in terms of gender, age, anatomic difficulty, experience of the surgeon, omental and other organ adhesions to the gallbladder, and the findings of inflammation on the resected gallbladder. RESULTS: Intraoperative gallbladder perforation occurred in 85 patients (16.6%). Although no differences were found between the perforated and nonperforated groups regarding age, gender, and chronic inflammation on the resected gallbladder, there were significant differences in terms of acute inflammation, anatomical difficulty, experience of the surgeon, and omental and organ adhesions. CONCLUSION: Acute inflammation, degree of anatomic difficulty, the experience of the surgeon, and omental or other organ adhesions were associated with gallbladder perforation during LC.

Adult↗
PubMed2004

[Is interval appendectomy necessary after conservative treatment of appendiceal masses?].

BACKGROUND: This prospective study was conducted to investigate whether interval appendectomy was necessary after successful conservative treatment of appendiceal masses. METHODS: Thirty-seven patients with a diagnosis of appendiceal mass by physical examination and ultrasonography were initially treated conservatively with broad-spectrum antibiotics, anti-inflammatory drugs, and, if required, intravenous fluid treatment. Interval appendectomy was ruled out in 28 patients who responded well to conservative treatment, three of whom were then lost to follow-up. The remaining 25 patients (9 females, 16 males; mean age 25 years; range 17 to 54 years) were monitored for recurrent appendicitis and other causes of appendiceal mass. The mean follow-up period was 35 months (range 6 to 66 months). RESULTS: The mean duration of abdominal symptoms was nine days (range 3 to 20 days). The mean length of hospital stay was 14 days (range 10 to 21 days) in patients who responded to conservative treatment. Recurrent appendicitis developed in three patients (12%; 2 males, 1 female). Two patients who presented with acute appendicitis within six months after discharge and one patient who developed chronic abdominal right lower quadrant pain unresponsive to medical treatment a year after discharge underwent appendectomy. No other complications were seen with conservative treatment. CONCLUSION: We do not recommend routine interval appendectomy in patients who benefit from conservative treatment for an appendiceal mass unless recurrent appendicitis develops.

Adolescent↗
PubMed2004

Peutz-Jeghers syndrome: report of 6 cases in a family and management of polyps with intraoperative endoscopy.

BACKGROUND/AIMS: Peutz-Jeghers syndrome is an uncommon, autosomal dominantly inherited disorder characterized by mucocutaneous melanin pigmentation and gastrointestinal hamartomatous polyps. The purpose of this study was to present six cases of Peutz-Jeghers syndrome in a family. METHODS: Enteroclysis, upper and lower gastrointestinal endoscopy, and thyroid, abdominal, and testicular or breast ultrasonography were performed in all subjects. Tumor markers including CEA, alpha-FP, CA 19-9, CA 15-3, and CA 125 were measured. Management of polyps and complications were evaluated. RESULTS: History of the patients were as follows: patient 1 (40-year-old male) underwent surgery 20 years previously; patients 2 and 3 (19-year-old female and 17-year-old male) had undergone surgery three times between the ages of 11 and 18 years, and two times between the ages of 15 and 17 years, respectively; patient 4 (16-year-old male) had undergone surgery three times at the age of 13 years; patients 5 and 6 (14-year-old and 11-year-old males) had no history of surgery. All surgical procedures had been performed due to intestinal obstruction. Hyperpigmentation of the lips and oral mucosa were observed in all patients except patient 1, whose pigmentation disappeared 20 years previously. Patient 2 also had pigmentation of hands and feet. Enteroclysis showed small bowel polyps in all subjects except patients 1 and 6. During colonoscopy, different sizes of polyps were observed at different locations of the colon, and polyps larger than 1 cm were removed. Patients 2 and 3 underwent surgery due to complication of small bowel polyps; 69 polyps in patient 2 and 17 polyps in patient 3 were removed via intraoperative endoscopic procedure. Hamartomatous lesions were confirmed by histopathological examinations. Microscopic study of polyps of patients 2 and 3 revealed dysplastic changes. None of the patients had evidence of malignancy as of June 2003. Peutz-Jeghers syndrome demonstrated autosomal dominant inheritance in this family. CONCLUSIONS: The major problem during follow-up of patients with Peutz-Jeghers syndrome is the management of small bowel polyps. When encountered during surgery, intraoperative enteroscopic polypectomy should be performed.

Adolescent↗
PubMed2004

[A case of Rapunzel syndrome].

Trichobezoars are concretions of hair casts in the stomach associated with trichotillomania and trichophagia. The condition is termed Rapunzel syndrome when formation of a huge trichobezoar extends to the small bowel, resulting in gastrointestinal obstruction. We present a 19-year-old girl who had complaints of colicky abdominal pain, nausea and vomiting seven years after surgical treatment for a gastric trichobezoar. Gastric endoscopy was performed with an initial diagnosis of recurrent trichobezoar, which revealed a huge one. The patient underwent laparotomy, during which a huge trichobezoar with a long tail was totally removed by an anterior gastrotomy. Following removal of the lesion, the antrum was observed with multiple ulcers secondary to extensive pressure. Postoperative period was uneventful. A subsequent psychiatric consultation revealed depressive personality disorder.

Adult↗
PubMed2003

Timing of cholecystectomy for acute biliary pancreatitis: outcomes of cholecystectomy on first admission and after recurrent biliary pancreatitis.

Biliary stones are the leading cause of acute pancreatitis. Although cholecystectomy and selective endoscopic retrograde cholangiography (ERC) comprise the current treatment in patients with acute biliary pancreatitis (ABP), the time of intervention is still controversial. In this study we evaluated the outcomes of cholecystectomy on first admission for ABP and in patients with recurrent biliary pancreatitis. A series of 43 patients with ABP between January 1997 and November 2000 were evaluated retrospectively. Patients were classified into two groups. Group I included 27 patients who underwent cholecystectomy on first admission before discharge from the hospital. Group II comprised 16 patients who had recurrent biliary pancreatitis and then underwent cholecystectomy. The severity of the pancreatitis was determined by Ranson's criteria. Age, gender, length of hospital stay, severity of pancreatitis, amylase level, and complications of cholecystectomy were evaluated in both groups. Patients in group I underwent cholecystectomy during the original hospital admission and patients in group II during an admission for a recurrence. There were 24 patients with a Ranson's score </= 3 in group I and 12 in group II. The mean hospital stays were 15.29 days (range 4-48 days) and 36.66 days (range 15-123 days) in groups I and II, respectively ( p = 0.006). Morbidity was 11% without mortality in group I and 43% with one mortality in group II ( p = 0.023). Definitive treatment of ABP can be accomplished effectively and safely by cholecystectomy following clinical improvement, with selective ERC performed during the first admission (delayed cholecystectomy). Waiting to perform cholecystectomy (interval cholecystectomy) may result in recurrent biliary pancreatitis, which may increase morbidity and the length of the hospital stay.

Acute Disease↗
PubMed2003

Surgical treatment of sacrococcygeal pilonidal sinus with the Limberg transposition flap.

BACKGROUND: Pilonidal sinus is a common chronic disease of the sacrococcygeal region. Although many surgical methods have been suggested, an ideal method is still lacking because of high recurrence rates. METHODS: This prospective study was conducted in 63 patients who were treated with the use of a rhomboid excision and Limberg flap closure for sacrococcygeal pilonidal sinus. The follow-up period ranged from 4 to 52 months (mean, 25 months). RESULTS: The mean hospital stay was 3 days (range, 2-7 days) and the mean time to return to work was 15 days (range, 12-26 days). Early wound complications and recurrence were encountered in 6% and 3%, respectively. Nineteen percent had numbness at the operation site and 63% were not pleased with cosmetic appearance of the scars. CONCLUSIONS: The results favor rhomboid excision and Limberg flap closure in the treatment of sacrococcygeal pilonidal sinus, especially in recurrent cases and in patients with extensive involvement. Low recurrence rates, shorter hospital stay, and time off from work may outweigh the disadvantages related to unfavorable cosmetic appearance.

Adolescent↗
PubMed2003

[The comparison of incision and drainage with skin excision and curettage in the treatment of acute pilonidal abscess].

BACKGROUND: To compare therapeutic values of incision and drainage, with skin excision and curettage in surgical treatment of the patients with acute pilonidal abscess. METHODS: In this prospective study, patients with acute pilonidal abscess were divided into two groups. The first group of patients were treated with incision and drainage and the second with skin excision and curettage. Two treatment modalities were compared in terms of healing time, time of returning to active work and development of chronic pilonidal sinus rates with chi-square and student-t test. RESULTS: Development of chronic pilonidal sinus rate was 76% in incision and drainage group and 24% in skin excision and curettage group (p<0.001). Healing time and time of returning to active work were 27 and 35 days in skin excision and curettage group, 19 and 26 days in incision and drainage group, respectively (p<0.001). CONCLUSION: Skin excision and curettage, which is associated with lower rates of development of chronic pilonidal sinus, may be the treatment of choice in acute pilonidal abscess.

Abscess↗
PubMed2002

Choledochal cysts in adults and the importance of differential diagnosis.

BACKGROUND/PURPOSE: Choledochal cysts, congenital cystic dilatations of the hepatobiliary tree, present diagnostic dilemmas. In countries where hydatid disease is endemic, this rare pathology may be overlooked. The importance of this issue led us to reexamine our clinical material to evaluate our findings and management. METHODS: This study examined 12 patients (11 females, 1 male) who were treated at the University of Istanbul, Cerrahpasa Medical Faculty, with the diagnosis of choledochal cyst between 1981 and 2000. The cases were examined retrospectively, and the complaints, diagnostic methods, findings, and management were discussed. RESULTS: Ten of the cysts were type I (83.3%), one was type II (8.3%), and one was type IV (8.3%). Three of the patients underwent operation with the diagnosis of liver hydatid cyst, but during the operation the cysts were found to be choledochal cysts. In six of the patients, the cysts were correctly diagnosed, and they were excised. CONCLUSIONS: Contemporary approaches to treating choledochal cysts focus on total removal of the cyst. In a country where hydatic diseases are endemic, hepatobiliary cystic lesions are often misdiagnosed clinically and radiologically as hydatid cysts. Considering that percutaneous and laparoscopic approaches are being increasingly adopted for treatment of hydatid cysts, the problematic area must be subjected to thorough examination for cystic lesions. The possibility of choledochal cysts must always be kept in mind; otherwise, an unfavorable process may begin for both patient and surgeon.

Adolescent↗
PubMed2002

Acute appendicitis during pregnancy.

BACKGROUND: To analyze the diagnosis and surgical treatment of acute appendicitis during pregnancy. METHODS: The records of 24 pregnant patients who underwent surgery with preliminary diagnosis of acute appendicitis between January 1990 and July 2000 were reviewed retrospectively. RESULTS: Between January 1990 and July 2000, there were 31,480 deliveries and the incidence of acute appendicitis was 1/1,312. Twenty patients had pathologically proven acute appendicitis (83.3%). Of the remaining 4 patients, one had hemorrhagic ovarian cyst, one had ovarian cyst rupture and in two cases no surgical pathology was diagnosed. Gestational stage at the diagnosis was first trimester in 7 patients, second trimester in 12 patients and third trimester in 5 patients. Five patients had abortions and premature delivery occurred in 2 patients. CONCLUSION: Diagnosis of acute appendicitis is difficult in pregnancy. Delay in diagnosis and surgery results in increase in complications. Emergency surgical intervention should be performed when acute appendicitis is suspected during pregnancy.

Adolescent↗
PubMedDate not supplied

The effect of scolicidal agents on liver and biliary tree (experimental study).

Hydatid disease of the liver is a parasitic infection. Surgery still remains as the primary choice of treatment. Caustic sclerosing cholangitis is reported following surgical treatment. Hypertonic saline (20%), povidone iodine (1%), and silver nitrate (0.5%) are extensively used as scolicidal solutions. The effects of these scolicidal agents on liver and biliary tree are investigated by direct injection into the common bile duct of rats. At the end of 15 wk, liver function tests, cholangiography, and histopathological examination of the liver and biliary tree were performed. Liver function tests were within normal limits, except elevation of alkaline phosphatase in 2 and 1 rats of the silver nitrate and povidone iodine groups, respectively. Differences were not statistically significant (p > .05). Cholangiograms of the rats in all groups were normal. Histopathologic changes comprising low-grade inflammatory changes were induced in all study groups. The intensity of the lesions were more remarkable with silver nitrate and minimal with hypertonic saline. We suggest that direct injection of scolicidal agents into the cyst should be avoided particulary in case of biliary communication. If this is to be practiced, hypertonic saline should be preferred as a scolicidal agent.

Animals↗
PubMedDate not supplied

Prevention of adhesion formations following repair of abdominal wall defects with prosthetic materials (an experimental study).

BACKGROUND/AIMS: Adhesion formation after abdominal surgery or incisional hernia repair with prosthetic materials may cause chronic pain, intestinal obstruction, enterocutaneous fistulae, difficulty in reoperative procedures and infertility in females. The aim of this study was to compare different modalities in terms of adhesion prevention in a rat model of abdominal wall defect repaired with prosthetic materials. METHODOLOGY: Forty-eight female Wistar-Albino rats were divided into four groups. In all rats, laparotomy was performed through a 3-cm midline incision and an abdominal wall defect (2 x 3 cm) was created in rats in groups II, III and IV. Following procedures were performed in all rats: seroza of the cecum was abraded and sutured with 4-0 silk and two ischemic buttons were created by ligating with 4-0 silk on the left and right sides of abdominal parietal peritoneum. In Group I, abdominal closure was obtained with a running 4-0 prolene suture. In Group II, abdominal wall defect was repaired with polypropylene mesh. In Group III, Seprafilm, an absorbable adhesion barrier, was laid over the abdominal viscera and defect was repaired with polypropylene mesh. In Group IV, defect was repaired with Composix mesh. Adhesion density score, adhered organ and strength of mesh incorporation were evaluated. Biochemical analysis and histopathological examination were performed. RESULTS: Groups II and III had more adhesion density scores than groups I and IV, (P < 0.001). Group II had more cecal and ischemic button adhesions than groups I, III and IV, (P < 0.001). Strength of mesh incorporation was higher in groups II and III than group IV, (P < 0.001). Abscess formation was more common in group IV than those in groups II and III, (P < 0.001). There were no differences between groups, regarding serum levels of C-reactive protein and fibrinogen. The most common adhered organ was omentum. CONCLUSIONS: There is no single treatment modality to prevent adhesion formation after abdominal wall defect repaired with prosthetic materials. While intraperitoneal adhesions were less common in Seprafilm group, adhesions to mesh were less common in the Composix mesh group.

Abdominal Wall↗
PubMedDate not supplied

Which repair in umbilical hernia of adults: primary or mesh?

In classic literature, knowing that small defects can be repaired primarily in umbilical hernias of adults, mesh repair should be reserved for larger defects. Conventional repair methods have resulted in high rates of recurrence. Therefore, this prospective study investigated the repair techniques in umbilical hernias of adults. The patients who underwent primary umbilical hernia operation between 1998 and 2003 were reviewed. Primary repair was conducted in defects less than 3 cm, whereas larger defects were repaired with polypropylene mesh. Postoperative complications, the length of hospital stay, and recurrence in follow-up were recorded. Of 111 patients, primary repair was carried out on 63 patients, and 48 underwent polypropylene mesh repair. Recurrence rate was significantly higher in the primary repair group (14%) compared with polypropylene mesh repair group (2%). In conclusion, contrary to the general tendency that small defects can be repaired primarily, polypropylene mesh should be used in all umbilical hernias regardless of the size of the defect.

Adult↗