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Öğe Anaesthetic Management of Anaphylactic Shock Caused by Nonruptured Hydatid Cyst of the Liver(Univ West Indies Faculty Medical Sciences, 2014) Davarci, I.; Tuzcu, K.; Karcioglu, M.; Yetim, I.; Aydogan, A.; Turhanoglu, S.Hepatic hydatid cyst (HC) caused by Echinococcus granulosus is still endemic in many parts of the world, and it is a common health problem, especially in developing countries. The rupture of the HC can cause anaphylactic shock or even death during surgical treatment. We present a case report regarding anaphylactic reaction due to surgery to the liver for HC which has an aberrant venous drainage incidentally detected during surgical operation in a 50-year old female patient. She was successfully treated with adrenaline, antihistamines, steroids, colloid or crystalloid fluids. After the surgery, she was transferred from the intensive care unit to the surgical ward on the first postoperative day. The possibility of anaphylaxis should be kept in mind; despite all the precautionary measures, nonrupture of the hydatic cyst and absence of spillage of the cyst to the circulation or into the surrounding tissues, anaphylaxis can still occur. Therefore, close monitoring for early diagnosis and appropriate management of anaphylaxis are essential to stabilize the patient and produce the best outcome.Öğe Comparison of the Protoscolocidal Effectiveness of Hypertonic Saline, Povidone-Iodine and Albendazole Solutions in an Experimental Lung Hydatid Cyst Model(Sage Publications Ltd, 2011) Yetim, T. Durgun; Basoglu, A.; Sengul, A. Taslak; Yetim, I.; Bekdemir, O. Serdar; Hokelek, M.Secondary hydatidosis is an important problem encountered during the surgical treatment of hydatid cysts. This study describes an experimental model of secondary hydatidosis by cyst inoculation, used to explore whether simultaneous inoculation of protoscolocidal agents could prevent secondary hydatidosis. Fertile cyst fluid was injected into the pleural space of rabbits alone (group 1, n = 8), and in combination with 2% albendazole solution (group 2, n = 8), 20% hypertonic saline (group 3, n = 8) or 10% povidone-iodine (group 4, n = 8). Computed tomography imaging of the thorax, indirect haemagglutination (IHA) titres and eosinophil counts were used to determine cyst development. After 16 months, three control rabbits had pneumothorax, seven had cysts and four had parenchymal nodules. Histopathological investigation of nodules revealed 87.5% cyst formation. Pleural thickening was observed in rabbits from all groups. Cyst formation rates, IHA titres and eosinophilia counts were higher in group 1 than in groups 2 - 4. This study demonstrated the experimental formation of secondary hydatidosis and found that topical protoscolocidal agents were beneficial in preventing cyst recurrence.Öğe Effect of Gentamicin-absorbed Collagen in Wound Healing in Pilonidal Sinus Surgery: a Prospective Randomized Study(Sage Publications Ltd, 2010) Yetim, I.; Ozkan, O. V.; Dervisoglu, A.; Erzurumlu, K.; Canbolant, E.Pilonidal sinus is a common disease that causes the loss of many working hours, but treatment is variable and problematic. The effect of gentamicin-absorbed collagen on healing, infection and recurrence, and length of hospital stay were examined after pilonidal sinus surgery. Patients undergoing surgical treatment for pilonidal sinus were randomly assigned into two groups each of 40 patients. Both groups were treated with excision and primary closure under local anaesthesia. Group 1 (control) received oral antibiotics for 7 days post-operatively. In group 2, prior to wound closure, gentamicin-absorbed collagen sponges were placed on the sacral fascia and these patients did not receive oral post-operative antibiotic therapy. Patients in group 2 had a significantly shorter mean wound healing time, significantly lower infection and recurrence rates, and a significantly shorter hospital stay than those in group 1. It is concluded that implantation of a gentamicin-containing collagen sponge on the wound area in pilonidal sinus decreased the rates of infection and recurrence, and shortened the hospital stay.Öğe Effect of Local Gentamicin Application on Healing and Wound Infection in Patients with Modified Radical Mastectomy: a Prospective Randomized Study(Sage Publications Ltd, 2010) Yetim, I.; Ozkan, O. V.; Dervisoglu, A.; Erzurumlu, K.; Canbolant, E.This study investigated the effects of Gentacoll implants on healing in patients (n = 44) undergoing modified radical mastectomy and axillary dissection. Group I, the Gentacoll group (n = 22), underwent surgery followed by insertion of 10 x 10 x 0.5 cm Gentacoll implants (280 mg collagen sponge plus 200 mg gentamicin sulphate) into the axillary area and under the flap area of the breast before wound closure. Group II, the control group (n = 22), underwent surgery without the application of Gentacoll. Neither group received oral or parenteral post-operative antibiotic therapy. Outcome measures included wound infection, seroma formation, total drainage volumes, drain removal time and duration of hospital stay. Postoperative infection rate, seroma formation, drainage volumes and duration of hospital stay were significantly reduced in the Gentacoll group compared with the control group. In conclusion, the application of Gentacoll significantly improved postoperative outcomes in patients undergoing modified radical mastectomy.Öğe Is advanced age a significant risk factor for laparoscopic cholecystectomy?(Edizioni Minerva Medica, 2010) Yetim, I.; Dervisoglu, A.; Karakose, O.; Buyukkarabacak, Y.; Bek, Y.; Erzurumlu, K.Aim. There have been a few reports about the outcome of laparoscopic cholecystectomy (LC) in the elderly patients. The aim of this study was to assess if morbidity and mortality may be increased in the geriatric patients because of high incidence of co-morbidity. Methods. From November 2000 to January 2009, 146 patients aged 60 years and older who underwent LC were reviewed. Patients were placed into two groups by ages: Group A (age = 60-74 years, N.=126), Group B (age >= 75, N.=20). Results. One hundred forty six patients underwent LC for benign gallbladder disease during this study period There was no difference in operative time, ASA, distribution of sex between the two groups. Most patients were treated with LC for symptomatic cholelithiasis (82.5%) in both groups. There were sixty eight cases (53.96%) in the Group A and 14 (70%) patients in the Group B had co-morbid diseases (P>0.005). Conversion rates and morbidity was not different significantly according to ages for either group (P>0.05). The rate of conversion to OC was 9.5% in the Group A and 5% in the Group B. Five complications were occurred in the four patients. There was only one bile duct injury in the Group A. Conversion rates and postoperative complications were not affected by gender and co-morbid diseases (P>0.05) in our study whereas acute cholecystitis were found as a risk factor for conversion to open surgery and complications according to the cases preoperatively diagnosis (P=0.001). Conclusion. LC should be recommended with acceptable morbidity and mortality in the elderly. Morbidity and conversion to OC are not increased with advanced age even in the extremely elderly patients. Acute cholecystitis is correlated with a high risk factor for morbidity and conversion to OC.Öğe LATE ONSET DYSPHAGIA AFTER THYROIDECTOMY: THYROID REMNANT OR THYROGLOSSAL HYPERPLASIA?(Editura Acad Romane, 2010) Yetim, I.; Ozkan, O.; Cumali, G.; Tulindurgun, Y.; Guvenc, D.; Nazan, S.; Ramazan, D.Lingual thyroid is a rare developmental disorder, and it is the result of failure of the thyroid gland to descend from the tongue root to its normal site. The ectopic thyroid with a functioning gland is even rarer. In this case, we present a 44-year-old female patient with a complaint of foreign body sensation, progressive dysphagia and dyspnea due to ectopic thyroid tissue. Her complaints were totally resolved after L-thyroxine treatment. Here we report a patient with functioning ectopic thyroid tissue who had had bilateral subtotal thyroidectomy 10 years ago clue to multinodular goiter. In conclusion, if progressive dysphagia, dyspnea, and foreign body sensation occurs in a patient who had thyroidectomy and living in an endemic goiter region, lingual thyroid may be underlying disorder.Öğe Reduction of Postoperative Haemorrhage with the Use of a Haemostatic Thrombin Matrix in Patients Who Underwent Decortication(Field House Publishing Llp, 2012) Yetim, T. D.; Yetim, I.OBJECTIVE: To assess the efficacy of two measures for the control of postoperative haemorrhage in patients with fibrothoracic disease secondary to symptomatic extraparenchymal restrictive disease (e.g. empyema, haematoma) undergoing decortication. METHODS: This randomized, prospective study was performed in 50 adult patients with fibrothoracic disease secondary to symptomatic extraparenchymal restrictive disease who were scheduled to undergo decortication. Patients were randomized to receive either electrocautery plus hot compressor application or a thrombin-added haemostatic matrix (THM) for intraoperative haemostasis (n = 25 per group). Control of postoperative haemorrhage was compared between groups by evaluation of pre- and postoperative blood characteristics and mean postoperative drainage volume and blood transfusion requirements. RESULTS: Mean postoperative drainage and blood transfusion volumes were significantly lower in the THM group versus the electrocautery plus hot compress group. There was no difference in preoperative and postoperative blood tests in the THM group, whereas significant differences were observed in the electrocautery plus hot compress group. There were no infections, systemic allergies or sensitization, or reoperations in either group. CONCLUSIONS: Compared with electrocautery plus hot compress, the use of a THM significantly reduced postoperative haemorrhage and blood transfusion requirements in patients who underwent decortication.Öğe The Relationship between Mortality and Inflammation in Patients with Gastrointestinal Bleeding(Sage Publications Ltd, 2009) Koseoglu, Z.; Ozkan, O. V.; Semerci, E.; Aslan, A.; Yetim, I.; Ucar, E.; Kuvandik, G.The objective of this study was to investigate the association between mortality and inflammation in patients who were admitted to the emergency room with gastrointestinal bleeding. Patients (n = 96) managed at two medical centres were included in the study. Initial levels of serum C-reactive protein (CRP), haemoglobin and albumin, and leucocyte and thrombocyte counts for 28 patients who died were compared with those for the 68 patients who survived and were successfully discharged. The data were analysed using the chi(2)-test. Serum levels of CRP and leucocyte counts were significantly higher, and albumin and haemoglobin were significantly lower in patients who died compared with patients who survived. The increased levels of serum CRP and leucocyte counts, and decreased levels of albumin and haemoglobin were found to be independent risk factors for mortality. It is concluded that increased serum CRP levels and leucocyte counts combined with decreased albumin and haemoglobin levels on admission to the emergency room may be used as predictive factors of mortality in patients with gastrointestinal bleeding.Öğe Surgical outcomes of a civil war in a neighbouring country(Bmj Publishing Group, 2016) Akkucuk, Seckin; Aydogan, A.; Yetim, I.; Ugur, M.; Oruc, C.; Kilic, E.; Paltaci, I.Objectives The civil war in Syria began on 15 March 2011, and many of the injured were treated in the neighbouring country of Turkey. This study reports the surgical outcomes of this war, in a tertiary centre in Turkey. Methods 159 patients with civilian war injuries in Syria who were admitted to the General Surgery Department in the Research and Training Hospital of the Medical School of Mustafa Kemal University, Hatay, Turkey, between 2011 and 2012 were analysed regarding the age, sex, injury type, history of previous surgery for the injury, types of abdominal injuries (solid or luminal organ), the status of isolated abdominal injuries or multiple injuries, mortality, length of hospital stay and injury severity scoring. Results The median age of the patients was 30.05 (18-66years) years. Most of the injuries were gunshot wounds (99 of 116 patients, 85.3%). Primary and previously operated patients were transferred to our clinic in a median time of 6.284.44h and 58.11 +/- 44.08h, respectively. Most of the patients had intestinal injuries; although a limited number of patients with colorectal injuries were treated with primary repair, stoma was the major surgical option due to the gross peritoneal contamination secondary to prolonged transport time. Two women and 21 men died. The major cause of death was multiorgan failure secondary to sepsis (18 patients). Conclusions In the case of civil war in the bordering countries, it is recommended that precautions are taken, such as transformation of nearby civilian hospitals into military ones and employment of experienced trauma surgeons in these hospitals to provide effective medical care. Damage control procedures can avoid fatalities especially before the lethal triad of physiological demise occurs. Rapid transport of the wounded to the nearest medical centre is the key point in countries neighbouring a civil war.
