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Öğe Adrenokortikal adenom kaynaklı primer hiperaldosteronizmin tedavisinde laparoskopik adrenalektomi(2009) Hasdemir, Ahmet Oğuz; Çöl, Cavit; Çakmaz, Rıdvan; Küçükpınar, TevfikPrimer hiperaldosteronizm (PHA) renal kaynaklı olmayan sekonder hipertansiyon sebebleri arasında en sık rastlanan nedendir. Hipertansif hastalar arasında PH prevalansı %0.5-2 olarak bildirilmektedir. Bu çalışmada aldosteron üreten adenomun neden olduğu PHA tanısıyla tedavi edilen iki olgunun klinik özellikleri ve geç sonuçları incelenmiştir. I. OLGU: Elli yedi yaşında erkek hasta, hipertansiyon ve hipopotasemi (3.1 mmol/L) saptanması üzerine yapılan tetkiklerinde hastanın kan değerlerinde aldosteron 650.00 pg/ml (20-240), plazma renin aktivitesi 0,20 ng/ml/sn (0.20-3.40) ve adrenal BT incelemesinde sol adrenal bez üst kesiminde 12x20 mm boyutunda adenom saptandı. II. OLGU: Elli beş yaşında kadın hasta, halsizlik, ve hipertansiyon yakınmaları nedeniyle yapılan tetkiklerinde, potasyum düzeyi normal (4.4 mmol/L), aldosteron 520 pg/ml, plazma renin aktivitesi 0,20 ng/ml/sn ve adrenal BT incelemesinde sol adrenal bezde 24x31mm adenom saptandı. Her iki hasta preoperatif dönemde spironolactone 100 mg/gün kullandı ve potasyum replasmanı yapıldı. Hastalara laparoskopik adrenalektomi yapıldı. Olguların patolojik incelemesi "adrenal kortikal adenom (Conn Sendromu)" olarak rapor edildi. PHA en sık idiopatik veya adenoma bağlı olarak gelişmektedir. Adenoma bağlı hiperaldosteronizmin en uygun tedavisi adrenalektomidir. Normokalemik hiperaldosteronizm olgularında adrenal bezde adenom varlığı adrenalektomi ile tedaviyi gerektirir. Laparoskopik adrenalektomi, hastanede kalış süresi ve iyileşme süresinin daha kısa olması, daha az postoperatif ağrı ve komplikasyon oranlarının daha düşük olması nedenleriyle minimal invaziv bir yöntem olarak açık adrenalektomiye tercih edilmelidir.Öğe Akut sağ kolon volvulusu: Olgu sunumu(2009) Hasdemir, Ahmet Oğuz; Kordon, Özgür; Çakmaz, Rıdvan; Türkeli, Vildan; Çöl, CavitAkut sağ kolon volvulusu, çoğunlukla tanısı operasyon sırasında konan ve nadir görülen bağırsak tıkanması nedenlerinden biridir. Bu yazıda, sağ kolon volvulusu’nun klinik özellikleri ve tedavi yöntemlerinin tartışılması amaçlandı. İnkarsere sol inguinal herni nedeniyle beş gün önce ameliyat edildiği merkezden karın ağrısı distansiyon ve kusma gelişmesi nedeniyle sevk edilen 81 yaşındaki erkek hasta “ileus” tanısıyla ameliyata alındı. Çekum ve sağ kolonun ileri derecede distandü olduğu, saat yönünde dönerek karnın sol tarafına yerleştiği görüldü. Hastaya genişletilmiş sağ hemikolektomi yapıldı. Sağ kolon volvuluslarına cerrahi yaklaşım tartışmalıdır. Literatüre baktığımızda, sağ hemikolektomi, konservatif yaklaşımlarda rekürrens ve mortalite riski daha yüksek olduğundan, uygun tedavi seçeneği olarak görünmektedir.Öğe The assessment of urinary function following extended lymph node dissection for colorectal cancer(Elsevier Sci Ltd, 2005) Çöl, Cavit; Hasdemir, Oğuz; Yalçın, Erol; Güzel, Hakan; Tunç, Gündüz; Bilgen, Köksal; Küçükpınar, TevfikAims. The aim of the current study is to demonstrate whether the effects of extended systematic lymph-node dissection (ESLND) on urinary dysfunctions differ from those of curative radical, surgery (CRS) only for rectal cancer. Methods. We present data about our patients who underwent rectal. resection for rectal. cancer over 5 years. One hundred and seventy patients with rectal, cancer were reviewed with respect to surgical. procedures and post-operative urinary problems. Results. We performed CRS on 146 patients and CRS + ESLND on 24 patients, and analysed the incidence of post-operative urinary dysfunction in both groups. Urinary incontinence rates were 39 and 58%, urinary retention rates were 4 and 16%, for the patients from CRS group and CRS+ESLND group, respectivety. Conclusions. We conclude that the addition of ESLND to CRS does not increase the frequency of post-operative urinary dysfunction, apart from an increased risk of urinary retention.Öğe The association between thyroid malignancy and chronic lymphocytic thyroiditis: should it alter the surgical approach?(Via Medica, 2011) Büyükaşık, Oktay; Hasdemir, Ahmet Oğuz; Yalçın, Erol; Celep, Bahadır; Şengül, Serkan; Alkoy, Seval; Çöl, CavitBackground: The relation between thyroid neoplasms and chronic lymphocytic thyroiditis (CLT) is controversial. While it is accepted that focal lymphocytic thyroiditis develops secondarily to malignancy, it is not clear whether diffuse lymphocytic thyroiditis has a tendency to develop into thyroid cancer. The aim of this study was to investigate the relation between CLT and malignant tumours of the thyroid and evaluate the surgical approach to CLT cases. Material and methods: In this study, 917 patients operated on for thyroid diseases were investigated retrospectively. Seventy-seven (8.4%) patients histopathologically diagnosed as having CLT (either non-specific or Hashimoto's thyroiditis) were investigated for any concurrent malignant neoplasm. Fifteen patients in whom CLT and thyroid malignancy were coexisting were included in the study. Results: In the pathological evaluation of 917 cases, malignancy in the thyroid was found in 97 (10.6%) cases. Seventy-seven cases were categorised as CLT. Of these 77, 16(20.8%) were Hashimoto's thyroiditis (specific CLT) and the other 61(79.2%) were non-specific CLT. In 15 cases, thyroid malignancy was found to be concurrent with CLT. Of the malignities, nine (60%) were papillary carcinoma, three (20%) medullar carcinoma, one (6.6%) follicular carcinoma, one (6.6%) Hurthle cell carcinoma, and one (6.6%) lymphoma. In our series, the rate of the development of malignancy against the background of CLT was 19.48%, while the rate in the groups without CLT was 9.76%, with a statistically significant difference between the groups (p = 0.008). Conclusions: CLT cases should be evaluated more carefully in terms of malignancy. If a nodule is detected on thyroiditis, the minimal surgical intervention should be lobectomy. Total thyroidectomy should be considered as preferable to subtotal thyroidectomy because of its many advantages such as controlling thyroiditis, removing the probability of reoperation, and hormonal stability. (Pol J Endocrinol 2011; 62 (4): 303-308)Öğe Billroth II rezeksiyonlu hastalarda gastrik stump kanseri(2011) Hasdemir, Ahmet Oğuz; Büyükaşık, Oktay; Kahramansoy, Nurettin; Yılmaz, Erdal; Çöl, CavitOBJECTIVES The patients who had Billroth II gastric resections according to clinicopathological features of gastric stump cancer (GSC) were evaluated. METHODS Seven cases of GSC treated between 1995 and 2005 years were reviewed retrospectively. RESULTS In the study, there were 6 men and 1 woman enrolled and mean age was 52.4±10.7 years. The time duration between Billroth-II procedure and occurrence of GSC was 20.0±9.2 (6-31) years. Five patients (71.4%) received a curative resection. Two patients underwent a palliative resection because of peritoneal seeding and lymph node conglomerates at the coeliac trunc. Two patients who were classifed stage IIIA performed curative resection were disease free for 5 years. CONCLUSION It is necessary for the patients who received partial gastrectomy to carry out the endoscopy follow-up, especially in patients with Billroth II reconstruction procedure than 10 years. Curative resection has to be the goal of surgical management in patients with resectable GSC.Öğe A case report of an extraintestinal gist presenting as a giant abdominopelvic tumor(2013) Çöl, Cavit; Yılmaz, FahriÖğe A case report of an Extraintestinal gist presenting as a giant Abdominopelvic tumor(2013) Çöl, Cavit; Yilmaz, Fahri[No abstract available]Öğe Cesarean scar endometrioma : case series(Baishideng Publishing Group Inc, 2014) Çöl, Cavit; Yılmaz, Edip ErdalAIM: To evaluate endometrioma located at cesarean scatrix. METHODS: Medical data of 6 patients who presented to our institution with abdominal wall endometrioma were evaluated retrospectively and reviewed literature in this case series. The diagnostic approaches and treatment is discussed. RESULTS: All patients had a painful mass located at abdominal scars with history of cesarean section. The ages ranged from 31 to 34 and Doppler ultrasonography (US) detected hypoechoic mass with a mean diameter of 30 mm. Initial diagnosis was endometrioma in 4 and incisional hernia in 2 of 6 patients. Treatment was achieved with surgical excision in 5 patients, and one is followed by hormone suppression therapy with gonadotropin. CONCLUSION: Malignant or benign tumors of abdominal wall and incisional hernias should be kept in mind for diagnosis of endometrioma. Imaging methods like doppler US, computed tomography and magnetic resonance imaging should be used for differential diagnosis. Definitive diagnosis can only be made histopathologically. The treatment should be complete surgical excision and take care against intraoperative auto-inoculation of endometrial tissue in order to prevent recurrences. (c) 2014 Baishideng Publishing Group Inc. All rights reserved.Öğe The clinical and histopathological characteristics of cutaneous Malignant Melanoma(2007) Çöl, Cavit; Tunç, Gündüz; Yandakçı, Kemal; Hasdemir, Oğuz; Yalçın, ErolThe most effective method of treatment of cutaneous malignant melanoma (CMM) is surgical excision performed in the early stages. Our aim was to evaluate the descriptive characteristics of CMM. Patients and Methods: Fifty-five patients with malignant melanoma (32 males, 23 females; mean age 50.9 ±12.9; years, range 26 to 76 years) were evaluated retrospectively. Surgical excision alone was performed on stage I and II patients. Regional lymph-node dissection was performed together with surgical excision on patients with palpabl lymph nodes (stages III and IV) detected during preoperative examination. Descriptive characteristics such as anatomical locations, histological subtypes and stages of the CMM were examined; the tumor size and thickness, adjuvant chemotherapy and immunotherapy rates, local recurrence rates were evaluated. Results: Palpabl lymph nodes were identified in 74% (n=41) of the patients. Lymph-node dissection was performed together with surgical excision on these patients. The average tumor thickness and tumor size were 2.1±1.3 mm and 21.7±11.6 mm respectively. Conclusion: Width of surgical margins and wide surgical resection with lymph-node dissection for CMM will have no effect on loco-regional recurrence, distant metastases and survival rates. The complications and benefits must be meticulously evaluated before application of lymph-node dissection.Öğe The clinical characteristics of female patients with Fournier's gangrene(Springer London Ltd, 2009) Hasdemir, Ahmet Oğuz; Büyükaşık, Oktay; Çöl, CavitIntroduction and hypothesis Our aim was to review our experience with Foumier's gangrene in female patients. Methods A retrospective review of ten consecutive female patients with Fournier's gangrene was performed. Etiological and predisposing factors, causative microbiological organisms, and clinical outcome were investigated. Results Mean age of the patients was 52.7 years, and the mean duration of hospitalization was 17.6 days. The etiologic origin of the gangrene was anorectal, dermatological, and urogenital infection in 50%, 20%, and 10% of patients, respectively. All patients underwent aggressive surgical debridement and a diverting colostomy. Nine patients survived, and one patient died for an overall mortality rate of 10%. Conclusions Fournier's gangrene occurred in females with a pattern similar to that in males. We believe that a colostomy is an integral part of management for patients requiring extensive debridement, especially if the infection arises in the anorectal region.Öğe A combination of plasma DAO and citrulline levels as a potential marker for acute mesenteric ischemia(Taylor & Francis Ltd, 2013) Çakmaz, Rıdvan; Büyükaşık, Oktay; Kahramansoy, Nurettin; Erkol, Mehmet Hayri; Çöl, Cavit; Boran, Çetin; Buğdaycı, GülerIntroduction: There is no valid and reliable diagnostic test for early diagnosis of acute mesenteric ischemia (AMI). The aim of this study was to measure the plasma levels of diamine oxidase (DAO) and citrulline in AMI to gain insight into its early diagnosis. Material and methods: A total of 21 Wistar albino rats were divided into three groups, that is, control group, short-term ischemia group, and prolonged ischemia group. The superior mesenteric artery was occluded for 15 min in the short-term ischemia group and for 12 h in the prolonged ischemia group. Twelve hours later, the experiment was terminated and plasma DAO and citrulline levels were measured. Intestinal tissue was evaluated for the histopathological changes. Results: Compared to the control group, the short-term and prolonged ischemia groups showed significant increases in the plasma levels of DAO, whereas the plasma citrulline levels decreased significantly. Prolonged ischemia caused a larger increase in the plasma DAO levels and a larger decrease in the plasma citrulline levels compared to the short-term ischemia (p =0.011 and p =0.021, respectively). Intestinal damage was shown to develop more in the prolonged ischemia group (p =0.001). Conclusion: In the early period of AMI, the plasma DAO levels increase while citrulline levels decrease, and the extent of these changes depends on the duration of ischemia.Öğe Difficult duodenum: Treatment with biliogastric diversion plus serosal patch(John Wiley & Sons Ltd, 2010) Büyükaşık, Oktay; Hasdemir, Ahmet Oğuz; Çöl, Cavit[No Abstract Available]Öğe Diffuse gastric mantle cell lymphoma resembling gastrointestinal stromal tumors(Mosby Inc., 2014) Yılmaz, Bülent; Poşul, Emrah; Çöl, Cavit; Üyetürk, Ümmügül; Boran, Çetin; Aktaş, Gülan; Kurt, MevlütAn 81-year-old man was admitted to our gastroenterology unit because of anemia. He had experienced anorexia, nausea, fatigue, and weight loss (6 kg) during the past 4 months. The results of physical examination were unremarkable; there was no lymphadenopathy, hepatosplenomegaly, or palpable abdominal mass.Öğe The effect of an intraperitoneal injection of melatonin on serum amylase levels in acute pancreatitis(2009) Çöl, Cavit; Dinler, Kahraman; Hasdemir, Ahmet Oğuz; Buğdaycı, GülerContext: Several experimental studies have been carried out to explain the physiopathological mechanisms and to introduce endocrinological, enzymatic, biochemical and histopathological changes in organisms during acute pancreatitis. Objective: To evaluate the effect of an intraperitoneal injection of melatonin on serum amylase levels. Design: Experimental acute pancreatitis was experimentally caused through pancreatic duct ligation in 20 Winstar Albino rats. The rats were then divided into two groups: control and melatonin groups. Intervention: The serum amylase level was measured on the 7th day after acute pancreatitis had developed. In the melatonin group, an intraperitoneal injection of melatonin (20 mg/kg/day) was performed starting from the 2nd day after pancreatic duct ligation. Main outcome measure: The levels of serum amylase were measured with an auto analyzer. Results: It was found that the mean (±SD) level of serum amylase in the control group was 947±182 IU/mL while it was 358±177 IU/mL in the experimental group (P<0.001). Conclusions: The 20 mg/kg/day intraperitoneal injection of melatonin which was carried out for one week attenuated the serum amylase levels to a statistically significant degree. The researchers believe that intraperitoneal injections of melatonin decrease the severity of acute pancreatitis.Öğe Environmental boron contamination in waters of Hisarcik area in the Kutahya Province of Turkey(Pergamon-Elsevier Science Ltd, 2003) Çöl, Meltem; Çöl, CavitOur aim was to determine boron levels in waters of rich boron mine areas in Turkey. There is a naturally occurring high level of boron in the ground waters of some parts of Turkey. Our study area is Hisarcik village in the Kutahya Province of Turkey which has a large number of boron mines. Boron occurs in combined form, usually borax (Na2B4O7.10H(2)O) and colemanite (Ca2B6O11-5H(2)O). Water samples were collected from many springs in order to determine boron concentrations and the amount of boron that is exposed to 88 samples from the drinking water (tap water), 37 from ground water and 257 from stream or pond water (surface water). Urine samples taken from 42 residents in this area were analyzed for boron and compared with its levels in drinking waters. The inductively coupled plasma/mass spectrometry (ICP/MS) method was used for the analysis of boron concentrations. Water boron contents at differing locations of this area ranged from 2.05 to 29.00 mg B/I. Mean value of boron was 10.20 +/- 4.08 mg B/I. Total urinary boron excretion was ranged from 0.04 to 50.70 mg B/I and mean value was 8.30 +/- 10.91 mg B/I. Current information on sources, occurrence, pollution potential and toxicity of environmental boron is discussed.Öğe Erişkin bir hastada gastrik volvulusa yol açan mobil dalak: Olgu sunumu(2012) Büyükaşık, Oktay; Hasdemir, Ahmet Oğuz; Kahramansoy, Nurettin; Çöl, Cavit; Erkol, HayriGezici dalağa bağlı gastrik volvulus erişkin yaşta çok nadir görülmektedir. Literatürde şu ana kadar sadece iki olgu bildirilmiştir. 82 yaşında erkek hasta bir haftadır bulantı, kusma, gaita yapamama yakınmalarıyla acil polikliniğimize başvurdu. Fizik muayenede ve bilgisayarlı tomografide sol alt kadranda düzgün konturlu solid kitle saptandı. Eksplorasyonda karın sol alt kadranını dolduran, üzerinde iki adet kitle olan, 13x13x15 cm ebadında kısmen iskemi alanları olan mobil dalak saptandı. Dalağın uzun pedikülünün mide antrum-korpus bileşkesi civarındaki bantlarla birlikte mideyi kardiyopilorik hat boyunca rotasyona uğrattığı ve gastrik pasajı engellediği saptandı. Splenektomi ve anterior gastropeksi yapıldı. Hasta postoperatif 6. günde sağlıklı bir şekilde taburcu edildi.Öğe Erişkin bir hastada omfalomezenterik kanal açıklığı: Olgu sunumu(2008) Hasdemir, Ahmet Oğuz; Büyükaşık, Oktay; Dinler, Kahraman; Yalçın, Ercan; Çöl, CavitErişkin bir hastada göbekten intestinal içerik gelmesi ile kendini gösteren omfalomezenterik kanal açıklığı tespit edildi. Medyan laparatomi ile göbek, omfalomezenterik kanal ve ilişkili olduğu ileal segment rezeke edilerek tedavisi sağlandı. Postoperatif komplikasyon olmadı. Göbekten gelen fekaloid, safralı, seropürülan ve hatta seroz akıntı varlığında altta yatan omfalomezenterik kanal ya da umbliko-intestinal fistülün varlığı araştırılmalıdır.Öğe Evaluation of the effects of melatonin administration intraperitoneally on rats with acute pancreatitis induced by ductal ligation(2010) Çöl, Cavit; Dinler, Kahraman; Hasdemir, Oğuz; Büyükaşık, Oktay; Fırat, Tülin; Kükner, AyselBackground/aims: The aim of this study was to address the protective effects of exogenous melatonin injections intraperitoneally on the histopathological changes in a model of obstructive acute pancreatitis. Methods: In this study, ductal ligation technique was used in 20 adult male Wistar Albino rats to develop a model of obstructive acute pancreatitis and beginning pancreatic atrophy. Melatonin 20 mg/kg solution was injected in one group of rats intraperitoneally for one week and results were compared with the control group regarding histopathological findings in the pancreatic tissue. Results: The apoptosis rate in control group rats was 30.5%, while it was 12.7% in the melatonin group. Pancreatic edema, hemorrhage and polymorphonuclear leukocyte infiltration decreased remarkably in the melatonin group compared to the control group. Conclusions: Injection of exogenous melatonin in rats with obstructive acute pancreatitis for seven days prevents acinar cell degeneration, apoptosis and polymorphonuclear leukocyte infiltration.Öğe Exogenous melatonin treatment reduces hepatocyte damage in rats with experimental acute pancreatitis(Wiley, 2010) Çöl, Cavit; Dinler, Kahraman; Hasdemir, Oğuz; Büyükaşık, Oktay; Buğdaycı, Güler; Terzi, HakanBackground/purpose The hormone melatonin affects cellular immunity in particular and the immune system in general both directly and indirectly. We report our evaluation of the effects of decreasing and increasing serum melatonin levels on hepatocyte damage in rats with experimental acute pancreatitis. Methods Winstar Albino rats with experimentally induced acute pancreatitis were divided into three groups of ten rats each: (1) control (induced acute pancreatitis only); (2) rats with induced acute pancreatitis plus surgical pinealectomy (no melatonin injections); (3) rats with induced acute pancreatitis plus injections of exogenous melatonin. The effects of melatonin levels were evaluated using biochemical and histopathological parameters. Results Rats undergoing the pinealectomy had increased amylase and lactate dehydrogenase (LDH) levels, while those receiving injections of exogenous melatonin had decreased amylase, aspartate transaminase, LDH, and bilirubin levels but increased levels of alanine transferase levels. Conclusion Melatonin may have a therapeutic or protective effect on acute pancreatitis and obstructive jaundice.Öğe Gastrointestinal stromal tümörler(2009) Büyükaşık, Oktay; Hasdemir, Ahmet Oğuz; Dirican, Abuzer; Çöl, CavitAmaç: Gastrointestinal stromal tümör (GİST), gastroinestinal sistemin en sık görülen mezenşimal tümörüdür. Bu tümörlerin kökeni, diferansiyasyonu, sınıflaması ve prognozu tartışmalıdır. Bu çalışmada GİST’le ilgili klinik deneyimlerimizi aktararak, tanı ve tedavisi ile ilgili güncel literatür bilgilerinin paylaşılması amaçlandı. Gereç ve Yöntem: 2003-2009 tarihleri arasında cerrahi girişimde bulunulan ve patolojik tanısı GİST olan 9 olgu retrospektif olarak incelendi. Hastaların demografik, klinik, patolojik özellikleri ve tedavi yöntemleri değerlendirildi. Bulgular: Hastaların 6’sı kadın, 3’ü erkek olup yaş ortalaması 65.7±14.2’idi. Olguların 4’ü (%44) mide, 3’ü (%33) ince barsak ve 2’si (%22) ekstraintestinal kaynaklı idi. İki hastaya preoperatif histolojik tanı kondu. Diğer hastaların tanısı postoperatif konuldu. İki olguya tümörün komplikasyonları nedeniyle acil koşullarda cerrahi girişim uygulandı. Unrezektabl bir olguya imatinib tedavisi sonrası parsiyel remisyon gelişmesi üzerine küratif cerrahi girişim uygulandı. Olgular tümörün biyolojik davranışı yönünden değerlendirildiğinde, 4 hastanın (%44) yüksek risk grubunda, 4 hastanın (%44) orta risk grubunda, bir olgunun ise (%11) düşük risk grubunda olduğu saptandı. Sonuç: GIST’in esas tedavi yöntemi cerrahi olmakla birlikte, tirozin kinaz inhibitörlerinin kullanımı ile hastalıkla iyi yaşam süresi, hastalıksız yaşam süresi ve sağ kalımda önemli başarılar elde edilmiştir. Bu tümörlerin erken tanısının sağlanması ve ileri immünhistokimyasal yöntemlerle tanısının konabilmesi, aşılması gereken engeller olarak durmaktadır.
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