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Öğe Amyand Hernilerde Apendektomi İle Eşzamanlı Fıtık Onarımında Greft Kullanımı Güvenli Midir?(2017) Şahiner, İbrahim Tayfun; Kendirci, MuratAmaç: İnguinal herni kesesi içinde apendiks vermiformis varlığı ile tanımlanan Amyand herni inguinal hernilerin yaklaşık %1ini oluşturur. Bu durum akut apandisit tablosu ile acil servise başvuruya neden olabileceği gibi, perioperatif insidental olarak da tespit edilebilir. Amyand herni tespit edilen hastalarda apendektominin yapılıp yapılmaması, apendektomi yapılınca fıtık onarımında sentetik greft kullanımının güvenirliği halen tartışma konusudur. Bu çalışmada kliniğimizde Amyand herni tanısı konulan ve cerrahi tedavisi yapılan hastaların sonuçları bildirilmiştir. Gereç ve Yöntem: 1 Ocak 2016 ile 31 Aralık 2016 tarihleri arasında takip ve tedavisi yapılan Amyand herni olguları retrospektif olarak incelenmiştir. Hastaların demografik verileri, preoperatif laboratuvar testleri ve radyolojik incelemeleri, peroperatif tedavi yaklaşımları, postoperatif yara yeri değerlendirmeleri not edildi. Bulgular: Hastaların tamamının erkek cinsiyet olduğu görüldü. Hastaların ortalama yaşı 48 (26-68 yıl) olarak bulundu. Hastaların 3’üne (%42.8) elektif inguinal herni operasyonu planlanırken 4’ü (%57.2) inkarsere sağ inguinal herni nedeni ile acil ameliyat edilmiştir. İnkarsere sağ inguinal herni tanısı ile ameliyat edilen 4 hastanın 3’ünde (%75) akut apandisit tablosu mevcut iken diğer bir hastada (%25) apendiks enflamasyonu tespit edilmedi. Tüm hastalara herniorafiye ek olarak apendektomi uygulanırken, herni onarımı Lichtenstein prosedürü ile prolen mesh tespiti yöntemi ile yapıldığı görüldü. Sonuç: Amyand herni oldukça nadir görülen, sıklıkla operasyon sırasında tanı alan bir durumdur. Amyand herni tespit edilen hastada herni onarımına apendektominin eklenmesi ve herniorafide sentetik mesh kullanımı güvenlidir.Öğe Analysis of factors associated with mortality in major burn patients(2019) Guldogan, Cem Emir; Kendirci, Murat; Gündoğdu, Emre; Yastı, Ahmet ÇınarObjective: Major burn injury is a type of trauma with high morbidity and mortality rates at all age groups. There is no consensus on the provided guide-lines regarding the prediction of severity of the victims. Not being accessible to sophisticated clinical and blood monitoring in developing countries, it remains a challenge for them. The aim of the present study was to analyze the factors that have an effect on mortality and serve as a guide for burn treatment. Factors affecting mortality in major burn patients treated in a burn treatment center of a third step hospital with over 30% of burns of the total body surface area were evaluated, and parameters indicating severity were specifically determined. Material and Methods: Medical records and follow-up notes of patients hospitalized in Ankara Numune Education and Research Hospital Burn Center between 2008 and 2014 were evaluated retrospectively. Data on age, gender, comorbidities, burn percentage, locality, type of burn, process of the burn (suicide or accident), presence of inhalation injury, results of blood hemogram and biochemical tests, length of hospitalization, type of surgical pro-cedures performed, presence of multitrauma, and ventilatory support requirement were analyzed to determine the factors affecting mortality. White blood cell count, hemoglobin count, platelet count, and lactate dehydrogenase level were examined at admission, at the middle of the clinical course, and at the end of treatment (at both exitus date or discharge date). Results: A total of 224 patients were hospitalized with burns ? 30% total body surface area. Of the 224 patients, 81.7% were males, and 18.4% were fe-males. In the mortality group, 41.3% were males, and 58.5% were females. Gender (female, p< 0.041), age (p< 0.001), age group (0–14/15–59/> 60 years, p< 0.001), total body surface area (p< 0.001), type of burn (flame, p< 0.002), presence of inhalation injury (p< 0.001), process of the burn (p< 0.002), time spent between the event and admission to the hospital (p< 0.001), length of hospitalization (p< 0.001), presence of comorbidity (p< 0.038), diabetes mellitus (p< 0.05), ventilation support (p< 0.001), lactate dehydrogenase values (lactate dehydrogenaseadmission, p< 0.001; lactate dehydrogenasemiddle, p< 0.015; lactate dehydrogenaselast, p< 0.001), white blood cell count (p< 0.001), and platelet count (p< 0.043) were found to be significant for univariate analyses. These parameters were further evaluated using multivariate analyses. Lactate dehydrogenaselast level (p< 0.001), age (p< 0.001), length of hospitalization (negative odds ratio), p< 0.001), presence of inhalation injury (p< 0.029), total body surface area burned (p< 0.029), and leukocytosis (p< 0.006) were found to be significantly associated with mortality; however, leukocytosis and length of hospitalization did not pose risk for mortality with regard to odds ratios. Conclusion: Early recognition of the factors affecting morbidity and mÖğe Clinical infection in burn patients and its consequences(Turkish Association of Trauma and Emergency Surgery, 2017) Güldoğan, Cem Emir; Kendirci, Murat; Tikici, Deniz; Gündoğdu, Emre; Yastı, Ahmet ÇınarBACKGROUND: Burn injuries facilitate invasive infections and sepsis not only by destroying the continuity of the protective skin barrier but also through systemic effects. The burn wound, blood, and urine samples are frequently cultured to determine the pathogen agent. The aim of this study was to analyze pathogen growth in patients’ cultures confirmed as “infection positive” by the hospital Infection Control Committee and to assess the clinical implications of these growths. METHODS: Hospitalized patients included in the study were those with a total burned body surface area of >10% and “presence of infection” confirmed by the Infection Control Committee. The patients were evaluated with respect to age, gender, burn etiology, the total body surface area burned (TBSA), the presence of inhalation injury, sepsis, positive cultures, the microorganisms cultured in wound-blood-urine samples, and septic focus. RESULTS: Of the total 36 (10.3%) “infection-positive” patients, 26 (72.2%) were male; the mean age of patients was 44±21 years. The mean burned TBSA of the whole group was 45.58%±23.1%. Acinetobacter baumannii was the most isolated organism in the wound cultures. In patients with confirmed infection, there was a correlation between the pathogen isolated in urine cultures and mortality rates (p=0.023). Sepsis was diagnosed in 23 (63.9%) patients, of whom 21 had inhalation injuries. There was a significant correlation between inhalation injury and sepsis (p=0.015), and both the presence of sepsis or inhalation injury increased mortality (p=0.027 and p=0.009, respectively). CONCLUSION: According to the study data, the TBSA burned demonstrated a greater significance for mortality, although the presence of sepsis and/or urinary tract infection should also be noted as a cause of mortality in burned patients. © 2017 TJTES.Öğe Comparison of effects of vessel-sealing devices and conventional hemorrhoidectomy on postoperative pain and quality of life(International Scientific Information, Inc., 2018) Kendirci, Murat; Şahiner, İbrahim Tayfun; Şahiner, Yeliz; Güney, GüvenBackground: The aim of this study was to investigate the early and late results of use of LigaSure, Harmonic Scalpel, and conventional hemorrhoidectomy in hemorrhoidectomy, to determine the least painful method, and to investigate the relationship between pain perception and personal differences in hemorrhoid bundles. Material/Methods: Ninety patients undergoing hemorrhoidectomy between 2014 and 2017 were retrospectively evaluated. We investigated the duration of hospitalization and the presence of bleeding, incontinence, perianal wetness, urinary retention, stenosis, and recurrence during follow-up after surgery. Analgesic requirement was determined by Patient-Controlled Analgesia, as well as pain score by use of the Visual Analog Score and patient satisfaction by Short Form-36. We also assessed the relationship between pain and lateral thermal damage, the number of peripheral nerves, number of excised bundles, and the number of thrombosed vessels, as determined by histopathological examination. Results: No differences were found among the 3 methods in the duration of hospitalization, the presence of bleeding, fecal incontinence, perianal wetness, urinal retention, anal stenosis, recurrence rate, VAS, analgesic consumption, or results of the SF-36. There was no difference in the number of bundles, thrombosed vessels, or number of nerve fibers in a bundle, but the LigaSure Hemorrhoidectomy had more lateral thermal damage (p<0.001). While there was a difference between VAS of day 1 and 7 according to the hemorrhoid bundles, there was no difference in the other parameters. Conclusions: There was no difference among the 3 methods in terms of complications, postoperative pain, or patient satisfaction, and pain intensity was positively correlated with the number of excised bundles. © Med Sci Monit.Öğe Comparison of primary midline closure, limberg flap, and karydakis flap techniques in pilonidal sinus surgery(International Scientific Information, Inc., 2018) Erkent, Murathan; Şahiner, İbrahim Tayfun; Bala, Mesut; Kendirci, Murat; Yıldırım, Murat Baki; Topcu, Ramazan; Bostanoğlu, Settar; Dolapçı, MeteBackground: Pilonidal sinus (PS) is a common disease of the sacrococcygeal-natal region. There are many treatment options, but there is still no consensus on the ideal treatment. We compared the results of our PS patients who were treated with primary midline closure (PMC), Limberg flap repair (LFR), and Karydakis flap (KF). Material/Methods: The data for 924 PS patients from 2013 to 2017 were retrospectively examined. Demographic data, surgical procedures, schedules, and recurrence rates were examined. Results: The mean age was 28.4 years (14–77 years), 82.5% were male (n=762), and 17.5% were female (n=162). PMC was performed on 53.7% (n=496) of the patients, 32.5% (n=300) received LFR, and 13.9% (n=128) underwent KF. PMC was the first choice among females but LFR was the first choice in recurrent patients. The recurrence rate was 10.8% in the PMC group, 8% in the LFR group, and 3.1% in the KF group. In Short Form Survey-36 (SF-36) scores, the best cosmetic outcomes were observed in cases of PMC (p<0.05). Overall, wound dehiscence (WD) was observed in 7.5%, surgical site infection (SSI) in 2.4%, and seroma in 8.5% of all patients. The KF group had the lowest complication rates (p<0.01). Conclusions: According to the results of this study, the reason for preferring PMC among women is cosmetic concerns. PMC still remains important for treatment, but it should be noted that the recurrence rates due to inadequate excision are mostly observed in cases of PMC. Considering their low recurrence rates, LFR or KF should be considered first. When low recurrence rates, patient comfort, and cosmetic results are evaluated together, KF in particular emerges as a method preferred by physicians and patients. © Med Sci Monit, 2018.Öğe Does lymph node ratio (metastasis/total lymph node count) affect survival and prognosis in gastric cancer?(SAUDI MED J, 2022) Topcu, Ramazan; Şahiner, İbrahim Tayfun; Kendirci, Murat; Erkent, Murathan; Sezikli, İsmail; Tutan, Mehmet B.Objectives: To investigate the influence of the metastatic lymph node/total lymph node ratio (N- ratio) on survival and prognosis in surgically treated gastric carcinomas. Methods: A retrospective review of 73 patients who underwent curative resection at the Department of General Surgery, Hitit University Faculty of Medicine, Turkey. Receiver operating characteristic analysis was used to calculate the cut-off value for the N-ratio of the patients. The N-ratio cut-off value was determined to be 0.32. Patients were divided into 2 groups: below 0.32 (Group 1) and 0.32 and above 0.32 (Group 2). Results: Group 2 patients had a total lymph node mean of 25.10 +/- 13.64 while Group 1 patients had a total lymph node mean of 18.77 +/- 9.36 (p=0.04). In Group 2, the mean of metastatic lymph node was 15.97 +/- 10.30 (p<0.001). The mortality rate of Group 1 was 18% while Group 2 was 51.7%, and were statistically significant (p=0.0039). The estimated survival duration of Group 2 was 24.22 months, and Group 1 was 48.01 months (p=0.001). The mean estimated survival time for the entire group was 40.92 months. We differentiated patients from the development of mortality cut-off value in ROC analysis with 65.2% sensitivity and 72% specificity. This ratio was found to be 0.32, which was statistically significant (p=0.003). Ratios greater than 0.32 raised the risk of mortality by 4.8 times, which was statistically significant (p=0.003). Conclusion: The N-ratio could be a new metric to evaluate prognosis following curative gastrectomy and improve the existing tumor lymph node metastasis staging system.Öğe General surgery specialism in Turkey: Work power currently, continuity at quality and quantity(2020) Yastı, Ahmet Çınar; Uçar, Ahmet Deniz; Kendirci, MuratObjective: As one of the oldest and main branches of medicine, process of General Surgery speciality training is long, expensive and difficult. Along with the principle of using limited sources wisely, there is a need for national forward planning in order to keep the number of General Surgery specialists in the proper level and in the proper quality. This study is made for the assurement of training quality specialists and for the sustainability in the best conditions after determining of the number of general surgeons, work force, and working conditions. Material and Methods: The number of General Surgery specialists (professors, associate professors, specialists or General Surgery subspecialists) and assistants who actively work in our country from the end of 2017 in the public sector, private sector, and university hospitals, is examined. These numbers were subjected to cross evaluation according to the provinces, academic titles and number of assistants. The estimated ratio of the existing number of General Surgery specialists to upcoming five and ten years were calculated according to the data of Turkish Statistical Institute. Results: From the end of 2017, 3957 General Surgery specialists are actively working in 1031 of 1499 health facilities. Four hundred and forty of them are titled as professors, 324 of them are titled as associate professors. For every 25 thousand people, there exist 1.22 surgeons. Ten years ago, this ratio was calculated as 1.27. The number of assistans, which was 1005 ten years ago, is decreased to 768 today, but the increase of the number of specialists is 409. Conclusion: The number of General Surgeons in our country is above the ideal ratio, which is one for 25 thousand people. In case rate of increase of the number of General Surgeons for the last 10 years continues, when the decrease of population growth rate is considered, there will be an uncontrolled increase in the number of surgeon per 25 thousand people. Just as the distribution of General Surgery specialists -whether or not having an academic title- is not balanced, the number of instructor per assistant is also excessive.Öğe İnsizyonel herni gelişiminde risk faktörlerinin saptanması(Hitit Üniversitesi, 2019) Erkent, Murathan; Şahiner, İbrahim Tayfun; Kendirci, Murat; Topcu, RamazanAmaç: İnsizyonel herniler; karında uygulanan cerrahi girişimlerden sonra sık karşılaşılan sorunlardan biridir. Görülme sıklığı % 13 oranlarında bildirilmektedir. Önemli oranda iş gücü kayıplarına, morbiditeye ve hatta mortaliteye yol açıp, hayat kalitesini olumsuz yönde etkileyebilirler. Bu amaçla insizyonel herni gelişmemesi için önlem alma adına risk faktörlerini irdelemeyi amaçladık. Gereç ve Yöntem: Retrospektif olarak 2013 Kasım – 2017 Aralık tarihleri arasında kliniğimizde ameliyat edilen 128 insizyonel herni tanılı hastanın verileri analiz edildi. Hastaların demografik verileri, etyolojileri (hastalara yapılan ilk cerrahi nedenler), vücut kitle indeksleri, komorbideteleri ve ilk ameliyatı sonrasında cerrahi alan enfeksiyonu (CAE) gelişip gelişmediği gibi parametreler incelendi. Bulgular: İlk cerrahi nedenler incelendiğinde en çok %53.9 u (n:69) jinekolojik ameliyatlar ve brid ileus nedeniyle laparotomi yapılmış hastaların ameliyat edildiği gözlendi. Hastaların vücut kitle indekslerine (VKİ) bakıldığında ise %64.1 i (n:82) VKİ 25-80 olarak saptandı. Hastaların komorbiditelerine (yandaş hastalıklar) bakıldığında ise ilk sırada %38.3 (n:49) ile Kronik ostrüktif akciğer hastalığı (KOAH) saptanırken, ikinci sıklıkta %19.5 ile (25) Diyabetes Mellituslu (DM) hastalar olarak saptandı. Hastaların ilk ameliyatlarında cerrahi alan enfeksiyonu (CAE) % 87.5 (n:112) hastada saptanmadı. Sonuç: Yüksek VKİ ve obezite önemli nedenlerdendir. Bu çalışmada da hastaların büyük çoğunluğunu VKİ yüksek olan hastalar oluşturmaktadır. Ayrıca yandaş hastalık olarak KOAH ve DM in önemli birer hastalık olduğu ve risk faktörü oluşturduğu bu çalışmada da görülmüştür. Ayrıca bu çalışmada da 16 CAE gelişen hastada ek girişim veya medikal tedaviye rağmen insizyonel herni geliştiği gözlendi. Sonuç olarak değiştirilebilen risk faktörleri kontrol altına alınabilirse insizyonel herni gelişimi önlenebilir.Öğe Nadir bir akut karın nedeni: Jejunal divertikül perforasyonu(Gazi Üniversitesi Tıp Fakültesi, 2018) Topcu, Ramazan; Şahiner, İbrahim Tayfun; Kendirci, MuratJejunal divertikülozis nadir görülen bir hastalıktır. Prevalansı yaşla doğru orantılı olarak artmakta, 6. ve 7. dekadlarda en üst düzeye ulaşmaktadır. Jejunal divertiküller genellikle asemptomatik seyirlidir ancak, perforasyon geliştiğinde ciddi morbidite ve hatta mortaliteye neden olabilir. Acil servise karın ağrısı ile başvuran, ilk muayenede ve görüntülemede anormal bulgu saptanmayan, yatışının 48. Saatinde akut karın nedeniyle ameliyata alınan ve jejunal divertikül perforasyonu saptanan, intraoperatif arrest nedeniyle exitus gelişen hasta ile ilgili deneyimimizi paylaşmak istedik.Öğe Palyatif Bakım ve Yoğun Bakım Ünitelerinde Basınç Ülserine Yapılan Geleneksel Pansuman ve Topikal L-Prolin Uygulanmasının Karşılaştırılması(2020) Şahiner, Yeliz; Kendirci, MuratAmaç: Basınç ülseri yoğun bakım ve palyatif bakım merkezlerinde sık karşılaşılan bir sorundur. Tedavi süreci uzun, zor ve büyük ölçüde maliyetlidir. Hasta, hasta yakını ve hekim için aşılması gereken bir sorun olan basınç ülseri tedavisinde yara bakımı önemlidir. Bu çalışmada, konvansiyonel yöntem ve L-prolin ile yapılan tedavilerinin etkinliği karşılaştırılmıştır. Yöntem: Haziran 2018-2019 tarihleri arasında anestezi ve cerrahi yoğun bakım, palyatif bakım ve kronik yara servisinde basınç ülseri tanısı almış, evre I-III yarası olan 96 hastanın verileri incelendi. Hastalar konvansiyonel pansuman (Grup 1, n=47) ve L-prolin topikal tedavisi uygulan (Grup 2, n=49) olarak ayrıldı. Hastaların demografik verileri, yandaş hastalıkları, yara yeri, ebatları, tedavisi için uygulanan yaklaşım, pansuman sayıları, tedavi süreleri, nihai yara durumları karşılaştırıldı. Bulgular: Gruplar arasında yara evresi, yeri, büyüklüğü ve pansuman sayısı açısından fark belirlenmedi (p>0.05). Hastanede yatış günleri karşılaştırıldığında, Grup 2’de anlamlı derecede düşük bulundu (p=0.002). Tam iyileşme açısından gruplar karşılaştırıldığında, Grup 2’de anlamlı derecede tam iyileşme sağladığı görüldü (p=0.017). Yara evresinde gerileme açısından karşılaştırmada, grup 2’de yaralarının evrelerinde gerileme olduğu görüldü (p=0.001). Yara boyutlarında küçülme açısından gruplar karşılaştırıldığında, Grup 2’de yara ebatlarında küçülme olduğu görüldü (p=0.001). Sonuç: L-prolin içeren topikal krem uygulamasının özellikle evre I ve II üzere basınç ülserinde güvenle ve etkili bir şekilde kullanılabileceği görüldü.Öğe Perineal approach in rectal prolapse surgery: reliability of the altemeier procedure(Galenos Publishing House, 2017) Şahiner, İbrahim Tayfun; Kendirci, MuratAim: We compared the efficacy of the Altemeier and Thiersch procedures performed in patients treated for rectal prolapse diagnosis in our clinic.Method: Twenty-three patients who underwent Altemeier and Thiersch operation in our clinic between January 2014 and December 2016 were reviewed retrospectively. Demographic data such as age, gender, accompanying diseases, physical examination findings, anesthesia risk scores, anesthesia method, operation duration, hospitalization days, complications, and follow-up periods were noted. Assessment of quality of life was done by evaluating the Wexner incontinence score.Results: Of the 23 patients operated for rectal prolapse, 78.2% were female (n=18) and the mean age of all patients was 65.7 years. On physical examination, anal tone was absent in 13 patients and decreased in 10 patients. The mean preoperative Wexner incontinence score was 13.9 . Mean duration of operation was 14.6 minutes in Thiersch method and 42.8 minutes in the Altemeier group. The duration of hospital stay was 4 days in the Thiersch group and 5.73 days in the Altemeier group. There were no major complications in 12 patients undergoing the Altemeier procedure. Hemorrhage developed on the anastomotic line in one patient, and wound infection developed in another patient. One patient died due to myocardial infarction on the 2nd postoperative day. Perianal abscess was detected in one patient in the Thiersch group. In the Altemeier group, the postoperative 6-month Wexner score was 9.13. A decrease in the Wexner scores of 14 patients was detected. In the Thiersch group, no decrease was detected in any of the patients compared to the preoperative period.Conclusion: Altemier is a safe and easy procedure because it can be performed under regional anesthesia, enables resection, and has low short-term recurrence and complication rates.Öğe Retrospective clinical study of the effects of T-tube placement for bile duct stricture(International Scientific Information, Inc., 2017) Şahiner, İbrahim Tayfun; Kendirci, MuratBackground: T-tube placement in the common bile duct (CBD) is a surgical alternative to bile duct reconstruction in cholecystectomy for cholecysto-choledocholithiasis, or gallstones. The aim of this retrospective clinical study was to investigate the incidence of late complications of T-tube placement. Material/Methods: Retrospective review identified 35 patients who had T-tube placement during cholecystectomy. Clinical data were collected on surgical indications, patient demographics, and clinical symptoms. Ultrasound (US) was used measure the diameter of the common bile duct (CBD), intrahepatic ducts, and presence or absence of stones in the CBD. Data from laboratory investigations included the aspartate aminotransferase-to-platelet ratio index (APRI), which was used as a non-invasive method to evaluate both cholestasis and liver fibrosis. Results: Of the 35 patients included in the study, 33 (94.3%) underwent open cholecystectomy, CBD exploration, and T-tube placement due to cholecysto-choledocholithiasis. The remaining two patients (5.7%) underwent primary CBD repair and T-tube placement secondary to CBD injury. The mean follow-up period after T-tube placement was 69 months. In patients with T-tube placement, the CBD diameters ranged from 4-21 mm, were normal in 20 patients (57.1%), dilated in 15 patients (42.9%), with the mean CBD diameter being 8.91±4.82 mm. No residual or recurrent CBD calculus and no clinical or laboratory evidence of cholangitis or cholestasis were found. Conclusions: A retrospective clinical study at a single surgical center, showed that T-tube placement during open cholecystectomy and CBD exploration was a safe procedure that did not result in late complications. © Med Sci Monit.Öğe Son bir yıl içindeki nekrotizan fasiitis tanısı alan hastaların değerlendirilmesi(Dicle Üniversitesi Tıp Fakültesi, 2017) Şahiner, İbrahim Tayfun; Kendirci, Murat; Dolapçı, MeteAmaç: Kliniğimize başvuran nekrotizan fasiitis hastalarının tanı, takip ve tedavisi ile ilgili deneyimleri paylaşmak. Yöntemler: 01.01.2016 ve 01.01.2017 tarihleri arasında kliniğimize başvuran nekrotizan fasiitis tanısı alan hastaların kayıtları incelendi. Hastaların yaş, cinsiyet, ek hastalık, toplam ameliyat sayısı, hastanede yatış gün sayısı ve tedaviye yanıtları incelendi. Bulgular: Nekrotizan fasiitis tanısı alan toplam 13 hasta kliniğimizde takip ve tedavi oldu. Hastaların %62'si erkek (n:8), %38'i kadın (n:5) cinsiyet idi. Hastaların ortalama yaşı 61 yaş (38 -80 yaş) olarak bulundu. Hastaların %69'unda (n:9) diyabetes mellitus tanısı var iken, 2 kadın hastanın over karsinomu nedeni ile bir yıl önce ameliyat geçirdikleri ve sonrasında kemo-radyoterapi aldıkları belirlendi. Diğer 2 hastanın anamnezlerinde geçirilmiş perianal apse ve fistül hikâyesi olduğu görüldü. Hastaların tümünde nekrotizan fassiitin başlangıç bölgesi perianal bölge idi. Hastaların tanı aldıktan sonra debritman için ortalama 3 kez ameliyata alındığı (min:2, max:6), debritmanı sonrası hastaların %69'una (n:9) negatif basınçlı kapama yöntemi uygulandığı, %31 hastaya ise (n:4) flep ile kapama uygulandığı görüldü. Tüm hastalardan debritman esnasında doku kültürü alındı ve nekrotizan fasiitis kültür sonucu ile doğrulandı. Hastaların %77'sinde (n:10) antibiyoterapi olarak seftriakson+ metranidazol kombinasyonu yeterli gelmiş iken geri kalan hastalarda imipenem grubu antibiyotik desteği gerekli olmuştur. Ortalama hastanede yatış gün sayısının24 gün olduğu (min:4, max:71) görüldü. Hastaların %92'si (n:12) başarılı bir şekilde şifa ile taburcu edilirken overCa zemininde gelişen nekrotizan fassitisli bir olgu postoperatif 34. gününde sepsis nedeniyle kaybedildi. Sonuç: Nekrotizan fasiitis erken tanı konularak tedavi edilmediğinde sıklıkla mortalite ile seyredebilen bir hastalıktır. Hastaların birçoğu immünsüpresif hasta olup tanı için gecikmeler yaşanabilir. Erken tanı konulan, tedavi için hızlı ve agresif debritman uygulanan hastalarda yüz güldürücü sonuçlar elde edilebilmektedir.Öğe The role and importance of ostomy in the management of recto-vaginal fistula(E-Century Publishing Corporation, 2017) Şahiner, İbrahim Tayfun; Kendirci, MuratBackground: Although rare, recto-vaginal fistulas (RVF), defined as an abnormal epithelial connection between the rectum and vagina, has a significant adverse consequences in terms of the life quality. The most common etiological factors involve the obstetric causes in developing countries, while cancer surgery and radiotherapy are responsible for the majority of the cases in the developed world. The surgical management encompasses a wide range of procedures from simple interventions to more complex ones. Ostomy represents a therapeutic option aimed at achieving infection control through the deportation of the feces away from the site of fistula, allowing tissue repair and preparation prior to definitive repair. A complete diversion of the feces is essential, with no closure of the ostomy until complete healing. Methods: Six patients with RVF referred to the Erol Olçok Training and Research Hospital, Medical Faculty of Hitit University in 2015-2017 were included and their data were evaluated retrospectively. After detailed information provided to patients, written informed consent obtained. Local Ethics committee approved. Demographic data, type of fistula, comorbid conditions, initial and subsequent surgery with their outcomes were reported. Complete blood counts and routine biochemistry tests were also performed before and after ostomy to assess infectious processes. Results: Patient numberone and two had RVF due to RT given for cancer treatment, while patients number four, five and 6 had RVF after cancer surgery. Patient number three had chronic constipation resulting from paraplegia and the subsequent prolonged pressure on the recto-vaginal septum, giving rise to RVF. Permanent Hartmann colostomy was performed in our patients no 1 and 2, due to the presence of comorbid VVF as well as the presence of cervical cancer, while the same procedure was applied in-patient no 2 due to the presence of lung metastases. In-patient no 3, colostomy was not closed at the discretion of the patient, since she was bed-ridden and the temporary colostomy was able to provide better feces control, although RVF healing occurred. In patients, no 4, 5 and 5, RVF spontaneously healed after temporary ileostomy, with subsequent closure of ileostomy. Conclusions: In these patients, temporary or permanent ostomy may be performed to control infections, to manage fecal discharge in bed-ridden or demented patients, and to prevent complications arising from infections and adhesions of intestines after RT depending on the general wellbeing and life expectancy of the patients. Although the decision to choose permanent ostomy is not an easy task for both the patient and physician, it should be performed after adequate consultation with the patient, when needed. © 2017, E-Century Publishing Corporation. All rights reserved.Öğe Tiroid nodül çapı ve malignite ilişkisi: gerçekten nodül çapı arttıkça malignite olasılığı artmakta mıdır?(Akdeniz Üniversitesi Tıp Fakültesi, 2017) Er, Sadettin; Akın, Tezcan; Baba, Savaş; Berkem, Hüseyin; Kendirci, Murat; Topcu, Ramazan; Özel, İlyas Hakan; Yüksel, Bülent CavitAmaç: Tiroid nodülleri tiroid glandının en önemli patolojilerindendir. Tiroid nodüllerinde, bazı özelliklerin bulunması nodülün malign olma olasılığını artırmaktadır. Çalışmamızda, bu parametrelerden özellikle nodül çapının malignite ile olan ilişkisini ve ek olarak bunun yanında ultrasonografi de karşılaştığımız diğer risk faktörlerinin malignite açısından destekleyici özelliklerini incelemeyi amaçladık.Gereç ve Yöntemler: Çalışma Ankara Numune Eğitim ve Araştırma Hastanesi Genel Cerrahi Kliniği'nde 2006-2012 yılları arasında opere edilen toplam 271 olgu üzerinde yapılmıştır. Olgular; yaş, cinsiyet, USG ( nodül boyutu, yapısı, sayısı, ekojenitesi, kontur özellikleri, kalsifikasyon durumu) bulgularına ve İİAB sonuçlarına göre değerlendirildi.Bulgular: Çalışmaya dahil edilen 271 hastanın, 227'si(%83,8) kadın, 44'ü(%16) erkekti. Hastaların yaş ortalaması 49,2 ± 13 idi. Tek nodül çapı ile malignite arası değerlendirme yapıldığında; hastaların nodül çapı ile postoperatif sonuç arasında anlamlı bir ilişki olduğu görüldü (p=0,001). Benign nodüller içerisinde çapı 1 cm'den az olanların oranı daha az iken, malign nodüller içerisinde ise çapı 1 cm'den az olanların oranı daha fazla tespit edildi. Multinodüler grupta ise malignite ve çap arasındaki ilişki anlamlı bulunmadı (p=0,679). Sonuç: Nodül çapı ile malignite arasında anlamlı bir ilişki mevcut olup, bu ilişki soliter nodüllerde daha anlamlı olmakla beraber, küçük çaplı nodüller daha malign bulunmuştur. Nodül çapı tiroid nodül takibinde önemlidir ancak, benign-malign ayrımında tek başına çok anlam ifade etmemektedir.
