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Öğe A 17 year old female patient with sigmoid volvulus : considering the diagnosis(2014) Uğur, Mustafa; Aydoğan, Akın; Akküçük, Seçkin; Davran, Ramazan; Kaplan, AydınSigmoid volvulus genç erişkinlerde oldukça nadir görülen bir hastalıktır. Bu durum tanı ve tedavi girişimlerinde gecikmeye neden olarak kolonda hayatı tehdit eden iskemi ve nekroz gelişmesine yol açabilir. Bu yazıda giderek artan karın ağrısı, konstipasyon, obstipasyon ve distansiyon şikayetleriyle acil servise başvuran 17 yaşındaki genç kız hastada sigmoid volvulus tanısından şüphelenilerek yapılan tomografik incelemede tanısı doğrulanan olguyu sunduk. Tanıdaki en önemli adım karın ağrısı, konstipasyon, distansiyon gibi şikayetlerle başvuran hastalarda ayrıntılı bir öykü, fizik muayene ve uygun laboratuar testlerinin incelenmesi ile hekimin tanıdan şüphelenmesidir. Genç hastalarda erken tanıya götürecek en önemli yol öncelikle tanının akılda bulundurulmasıdır. Böylece tanıyı doğrulayacak ileri radyolojik ve endoskopik incelemelerin zaman kaybedilmeden planlanması mümkün olacaktır.Öğe Can postoperative atelectasis be prevented by local bupivacaine infusion/infiltration after emergency upper midline laparotomy? Randomized clinical trial(İnönü Üniversitesi, 2019) Kılıç, Erol; Uğur, MustafaAim: To investigate the effectivity of conventional analgesia and transfascial local bupivacaine infusion used for postoperative pain management on the development of postoperative atelectasisin patients undergoing upper abdominal surgery by midline laparotomy. Materials and Methods: The prospective study included patients that underwent emergency UAS by midline laparotomy and were administered conventional analgesia (CA) (nonsteroidal anti-inflammatory drugs [NSAIDs] + opioids) or transfascial bupivacaine infusion (TBI) (NSAIDs + bupivacaine) following extubating. Results: The groups were similar with regard to age, preoperative ASA status, surgical indications, and operative time (p>0.05). Mean Visual Analogue Scale scores at 0-8, 08-24, and 24-48 h and the requirement of opioids were lower in the TBI group compared to the CA group (p<0.05). The median length of intensive care unit stay was significantly lower in the TBI group compared to the CA group (4 and 5 days, respectively) (p<0.05). The incidence of postoperative atelectasis and the requirement of noninvasive ventilation and reintubation were lower in the TBI group compared to the CA group (p>0.05). Conclusion: Transfascial bupivacaine infusion/infiltration is effective not only in providing postoperative analgesia but also in the prevention of postoperative atelectasis.Öğe COVID-19 pandemisi döneminde onkolojik ve acil cerrahi vakalarının yönetimi(2022) Dal, Mehmet Burak; Uğur, Mustafa; Duymuş, Mehmet Esat; Temiz, MuhyittinAmaç: Acil cerrahi vakalara Genel Cerrahide önemli bir yer tutmaktadır. COVID-19 salgını döneminde, hastaların salgından etkilenme korkusu ve davranış şekillerinin karmaşıklığı bu hastalıkların teşhis ve tedavisini zorlaştırmaktadır. Yöntem: Üçüncü basamak olan merkezimizde, COVID pandemisi sırasında akut apandisit, kolesistit ve kolorektal kanser tanısı ile cerrahi geçiren hastaların bilgisayarlı veri tabanı retrospektif olarak pandemi öncesi ve pandemi dönemi şeklinde gözden geçirildi. Bulgular: Çalışma süresi boyunca 1100 hasta apandisit, 500 hasta kolesistit, 120 hasta onkolojik hastalıklar nedeni ile ameliyat edildi. Ortalama yaş her iki dönem için benzerdi, pandemi öncesi dönemde 34.06 ± 16.7 pandemi döneminde 36,72 ± 15,31 yaş ortalaması mevcuttu. Semptom başlaması ile hastaların hastaneye başvuru süreleri her iki döneme benzerdir (34,55 ± 31,51 ile 34,35 ± 37,94 sa, P = 0,968). Laboratuvar testler arasında anlamlı bir farklılık göstermemiştir. WBC değerleri pandemi öncesi dönemde 12.73 ± 4.3 × 103 idi pandemi sonrası dönemde 13.62 ± 4.62×103 (P = 0.1308) idi. Pandemi öncesi ve pandemi döneminde tüm hastalar en az 1 görüntüleme yöntemi kullanılmıştır. Sonuç: COVID-19 pandemisinin ilk aşamasında, komplike acil cerrahi gereksinimi oranında önemli bir artış vardı. Hastalar bundan kaçınmaları için semptomların başlaması ile acil polikliniklere başvurmaları şiddetle teşvik edilmelidir.Öğe Effects of temporary abdominal closure methods on mortality and morbidity in patients with open abdomen(Ulusal Travma ve Acil Cerrahi Derneği, 2018) Kılıç, Erol; Uğur, Mustafa; Yetim, İbrahim; Temiz, MuhyittinBACKGROUND: Open abdomen (OA) in which the abdomen is closed with temporary abdominal closure methods is the most effective in patients who develop severe abdominal sepsis or abdominal compartment syndrome. Major techniques used are Vacuum-Assisted Closure Method (VACM) and non-vacuum assisted closure method (NVACM). In the present study, the effects of different abdominal closure methods on morbidity and mortality were evaluated. METHODS: In the study, the temporary abdominal closure methods of the patients with OA during 2013–2016 were studied retrospectively. OA etiopathologies, mortality prediction scores, final abdominal closure periods and methods, hospitalization periods, complications (enteroatmospheric fistula, mesh infection, and incisional hernia), and mortality rates of patients who underwent VACM and NVACM were determined and compared. RESULTS: The present study included 123 patients who underwent VACM (n=65) and NVACM (n=58). There was no difference between the groups in terms of age, gender, and etiopathogenesis (p>0.05). The mean APACHE 4 and Multiple Organ Dysfunction Score (MODS) scores in the VACM/NVACM groups in treatment period were 47/63 and 11/14, respectively (p<0.05). The mean intensive care and hospitalization periods in the VACM/NVACM groups were 11/16 (days) and 22/28 (days), respectively (p<0.05). The collection and abscess development rates in the VACM and NVACM groups were 46.2% and 77.6%, respectively (p<0.05). The rate of enteroatmospheric fistula (EAF) development in the VACM and NVACM groups were 15.4% and 56.9%, respectively (p<0.05). The mean abdominal closure times in the VACM and NVACM groups were 13 and 17 days, respectively (p<0.05). Mortality rate in the VACM and NVACM groups were 18% (n=18) and 55% (n=32), respectively (p<0.05). CONCLUSION: In patients with OA, the temporary abdominal closure technique VACM has lower complication and mortality rates and shorter hospitalization period than other methods. Therefore, it is an effective and safe method for the treatment of OA.Öğe Evaluation of preoperative anxiety in cancer patients: Experience of a single center(2022) Duymuş, Mehmet Esat; Urfalı, Senem; Uğur, Mustafa; Dal, Mehmet Burak; Dönmez, Yasemin; Bağ, Yusuf Murat; Temiz, MuhyittinAnxiety disorder is observed in half of the patients in the preoperative period. Psychological disorders are also frequently observed in cancer patients and need to be supported. The aim of the present study is to determine the level of preoperative anxiety in patients with malignant and benign diagnoses who were planned for elective surgery and to reveal its relationship with socio-demographic data. A tertiary hospital-based cross-sectional study was conducted in the general surgery clinic between June 1, 2021- March 31, 2022, on 158 patients who underwent elective surgery. Participants were evaluated in two groups depending on their diagnosis; the cancer group and the benign group. The socio-demographic data were recorded and the level of anxiety was determined by the Beck Anxiety Inventory (BAI). The median age of par- ticipants was 55 (19-78) years. There were 72 (45.6%) patients in the cancer group and 86 (54.4%) patients in the benign group. There was no significant difference in age, gender, marital status, job, level of income, and family cancer history between the two groups. There were significant differences between the groups in level of education, and previous surgical history (p=0.035, and p=0.037, respectively). BAI scores of the cancer group and control group were 10.5 (0-35) and 5 (0-49), respectively (p<0.001). The level of anxiety in the cancer group was also significantly higher than in the benign group (p<0.001). Cancer patients have more anxiety during the preoperative period than patients who were with benign diseases. We believe that previous surgical history and education level are other factors that affect anxiety.Öğe Myasthenis gravisli hipertroidi hastasında radyoaktif iyot tedavisinin klinik sonuçları(2013) Aydoğan, Füsun; Aydoğan, Akın; Akküçük, Seçkin; Üstün, İhsan; Gökçe, Cumali; Uğur, MustafaMiyastenia gravis kas güçsüzlüğü ve yorgunlukla karakterize otoimmün bir hastalıktır. Myastenia gravis diğer otoimmun hastalıklar ile birlikte görülebilir. Miyastenia gravis hastalarında % 2-17.5 hipertiroidizm görülür. Hipertiroidizmin myastenia gravis klinik seyrini etkilediği bildirilmektedir. Bu vaka takdiminde miyastenia gravisi bulunan ve 3 ay önce hipertiroidi teşhisi konulan 27 yaşında bir bayan hasta sunulmuştur. Olguya, rad- yoaktif iyot tedavisi uygulanmış ve 3 ay sonra ötiroid olduğu ve miyestania şikâyetlerinin tedaviye daha iyi yanıt verdiği izlenmiştir.Öğe The Treatment of Adolescent Pregnant and Adolescent Mothers Aged 13–18 Years With Non-Obstetric Surgery Indications: The opinions of Turkish surgeons(Logos Medical Publishing, 2022) Atıcı, Ahmet; Çelikkay, Mehmet Emin; Dolapçıoğlu, Kenan; Uğur, Mustafa; Dirican, Emre; Görür, Sadık; Akçora, BülentIntroduction: Adolescent pregnancy (AP) is defined as pregnancy in girls between the ages of 13–19 while adolescent motherhood (AM) describes adolescents who become mothers during this period. The current study aimed to gather the opinions of surgeons working in Pediatric Surgery, General Surgery, Gynaecology, and Urology in Turkey on which departments and specialists should perform the surgical management of these patients. Methods: A questionnaire designed to gather the opinions of Turkish surgeons working in Pediatric Surgery, General Surgery, Gynaecology, and Urology on the management of non-obstetric surgical diseases that occur in AP and AM was distributed using Google Forms. Results: The questionnaires were answered by pediatric surgeons (n=80), gynaecologists (n=62), general surgeons (n=45) and urologists (n=37). As seen in the responses, while 62,2% of general surgeons believed that all patients under the age of 18 should be considered as children and treated by pediatric surgeons, 88,5% of gynaecologists, 56,8% of urologists, and 52,5% of pediatric surgeons disagreed. The differences between the responses were also found to be significant (p<0.001). Conclusion: The results indicated that most pediatric surgeons working in Turkey ––and a significant number of adult surgeons from other specialisms –– believed that the surgical treatment of AP and AM patients should not be managed exclusively by pediatric surgeons. Further, the results suggested that in Turkey, pediatric surgeons and adult surgeons failed to agree on this issue, and thus, additional legal regulations are required to guide medical professionals on this issue to mitigate instances of malpractice cases and improve child safety in medical settings. Ultimately, we believe that the best solution is to reduce the number of adolescents becoming pregnant via education on abstinence and/or contraception © Logos Medical Publishing. All Rights Reserved.Öğe The Treatment of Adolescent Pregnant and Adolescent Mothers Aged 13–18 Years With Non-Obstetric Surgery Indications: The opinions of Turkish surgeons(2023) Atıcı, Ahmet; Çelikkaya, Mehmet Emin; Dolapçıoğlu, Kenan Serdar; Uğur, Mustafa; Dırıcan, Emre; Görür, Sadık; Akçora, BülentIntroduction: Adolescent pregnancy (AP) is defined as pregnancy in girls between the ages of 13–19 while adolescent motherhood (AM) describes adolescents who become mothers during this period. The current study aimed to gather the opinions of surgeons working in Pediatric Surgery, General Surgery, Gynaecology, and Urology in Turkey on which departments and specialists should perform the surgical management of these patients. Methods: A questionnaire designed to gather the opinions of Turkish surgeons working in Pediatric Surgery, General Surgery, Gynaecology, and Urology on the management of non-obstetric surgical diseases that occur in AP and AM was distributed using Google Forms. Results: The questionnaires were answered by pediatric surgeons (n=80), gynaecologists (n=62), general surgeons (n=45) and urologists (n=37). As seen in the responses, while 62,2% of general surgeons believed that all patients under the age of 18 should be considered as children and treated by pediatric surgeons, 88,5% of gynaecologists, 56,8% of urologists, and 52,5% of pediatric surgeons disagreed. The differences between the responses were also found to be significant (p<0.001). Conclusion: The results indicated that most pediatric surgeons working in Turkey –– and a significant number of adult surgeons from other specialisms –– believed that the surgical treatment of AP and AM patients should not be managed exclusively by pediatric surgeons. Further, the results suggested that in Turkey, pediatric surgeons and adult surgeons failed to agree on this issue, and thus, additional legal regulations are required to guide medical professionals on this issue to mitigate instances of malpractice cases and improve child safety in medical settings. Ultimately, we believe that the best solution is to reduce the number of adolescents becoming pregnant via education on abstinence and/or contraceptionÖğe Where should the damage control surgery be performed, at the nearest health center or at a fully equipped hospital ?(2016) Uğur, Mustafa; Akküçük, Seçkin; Koca, Yavuz Savaş; Oruç, Cem; Aydoğan, Akın; Kılıç, Erol; Yetim, İbrahim; Temiz, MuhyittinBACKGROUND: Transport of casualties from a combat area to a fully equipped hospital where all techniques of damage control surgery (DCS) can be performed requires a great deal of time. Therefore, prior to transport, prompt control of hemorrhage and contamination should be achieved, and resuscitative procedures should be performed at the nearest health center. The aim of the present study was to investigate the effect of the location at which DCS was performed on rates of mortality.METHODS: The present retrospective study included 51 combat casualties who underwent DCS at the present clinic or at hospitals nearest the combat area due to high kinetic energy gunshot injuries to the abdomen between 2010 and 2015. Patients were evaluated in terms of acidosis, hypothermia, coagulopathy, and mortality.RESULTS: Patients were divided into 2 groups depending on the location where the first step of DCS was performed: (1) at the present hospital or (2) at other hospitals. Group 1 comprised 26 patients (51%), and Group 2 comprised 25 (49%). Total mortality occurred in 23 (45.1%) patients, including 15 (57.7%) patients in Group 1 and 8 (32%) in Group 2. In Group 1, mean time from injury to hospital admission was longer, and deep acidosis, hypothermia, and coagulopathy were more marked.CONCLUSION: Initial surgical control of hemorrhage and contamination in patients injured by high kinetic gunshots should be promptly achieved at the nearest health center. In this way, acidosis, hypothermia, and coagulopathy can be prevented, and the risk of mortality can be reduced
