I am a General Surgeon. I am interested in Advanced Laparoscopic Surgery. Address: Ankara Bilkent City Hospital General Surgery Bilkent / Ankara / Turkey
We studied the demographics, surgical procedures, and complication rates in 3 months periods befo... more We studied the demographics, surgical procedures, and complication rates in 3 months periods before and after the first case was announced. RESULTS: A total number of 462 patients were analyzed between the ages of 19-88, 184 of which (39.8%) were females and 278 were males (60.2%). 253 of these patients were diagnosed with AA and underwent surgery before March 11 whereas 209 patients were diagnosed and treated after March 11. DISCUSSION: There was no statistical difference between the two groups in terms of complication rates before and after the pandemic. Although the rate of open appendectomy was increased after the pandemic, no statistical difference has been found. CONCLUSION: No change was observed in terms of hospital admissions, methods of treatment, complication rates, length of stay before and after the COVID-19 pandemic. KEY WORDS: Acute Appendicitis, COVID-19, Appendectomy 4.5% of all abdominal pain is caused by AA 6. Delays in making a diagnosis can cause a variety of complications, which could potentially cause serious morbidity and mortality 7. AA can be classified into two groups; complicated and non-complicated. Presence of abscess, phlegmon, gangrene, perforation indicates complicated appendicitis 8,9. Main reasons for complications to occur are delays in either admission, or reaching a definitive diagnosis. Complicated AA cases can cause labor loss in healthcare and increase costs. The first COVID-19 case in Turkey was identified on 11 March 2020. Similar to most other countries, raising number of COVID-19 cases increased the workload in our healthcare system. Concerns have been voiced regarding whether the focus on COVID-19 has caused delays in diagnosing certain conditions and therefore lead to complications 10. On this basis, we aimed to compare the characteristics and management of AA cases before and after COVID-19.
We studied the demographics, surgical procedures, and complication rates in 3 months periods befo... more We studied the demographics, surgical procedures, and complication rates in 3 months periods before and after the first case was announced. RESULTS: A total number of 462 patients were analyzed between the ages of 19-88, 184 of which (39.8%) were females and 278 were males (60.2%). 253 of these patients were diagnosed with AA and underwent surgery before March 11 whereas 209 patients were diagnosed and treated after March 11. DISCUSSION: There was no statistical difference between the two groups in terms of complication rates before and after the pandemic. Although the rate of open appendectomy was increased after the pandemic, no statistical difference has been found. CONCLUSION: No change was observed in terms of hospital admissions, methods of treatment, complication rates, length of stay before and after the COVID-19 pandemic. KEY WORDS: Acute Appendicitis, COVID-19, Appendectomy 4.5% of all abdominal pain is caused by AA 6. Delays in making a diagnosis can cause a variety of complications, which could potentially cause serious morbidity and mortality 7. AA can be classified into two groups; complicated and non-complicated. Presence of abscess, phlegmon, gangrene, perforation indicates complicated appendicitis 8,9. Main reasons for complications to occur are delays in either admission, or reaching a definitive diagnosis. Complicated AA cases can cause labor loss in healthcare and increase costs. The first COVID-19 case in Turkey was identified on 11 March 2020. Similar to most other countries, raising number of COVID-19 cases increased the workload in our healthcare system. Concerns have been voiced regarding whether the focus on COVID-19 has caused delays in diagnosing certain conditions and therefore lead to complications 10. On this basis, we aimed to compare the characteristics and management of AA cases before and after COVID-19.
A case of an intra-abdominal sharp foreign body with migration to the mesentery vessels, causing ... more A case of an intra-abdominal sharp foreign body with migration to the mesentery vessels, causing intestinal necrosis in a 20-year-old patient is presented. Emergency surgery with 75 cm small bowel resection was performed.
Introduction. Management of open abdomen (OA) with enteroatmospheric fistula (EAF) in morbid obes... more Introduction. Management of open abdomen (OA) with enteroatmospheric fistula (EAF) in morbid obese patient with comorbid disease is challenging. We would like to report the management of septic OA in morbid obese patient with EAF which developed after strangulated recurrent giant incisional hernia repair. We would also like to emphasize, in this case, the conversion of EAF to ileostomy by the help of second Negative Pressure Therapy (NPT) on ostomy side, and the chance of new EAF occurrence was reduced with intrarectal NPT. Case Presentation. 62-year-old morbid obese woman became an OA patient with EAF after strangulated recurrent giant hernia. EAF was converted to ostomy with pezzer drain by the help of second NPT on ostomy. Colonic distention was reduced with the third NPT application via rectum. Abdominal reapproximation anchor (ABRA) system was used for delayed abdominal closure. Conclusions. Using the 2nd NPT on ostomy side may help in the maturation of the ostomy created in a difficult condition in an open abdomen. Using the 3rd NPT through rectum may decrease the chance of EAF formation by reducing the pressure difference between intraluminal pressure and extraluminal pressure in hollow viscera.
ÖZET Metanol odunun distilasyonu ile elde edilir. Zehirlenmesi genellikle ya viskiye kar›flmas›yl... more ÖZET Metanol odunun distilasyonu ile elde edilir. Zehirlenmesi genellikle ya viskiye kar›flmas›yla kazara ya da bilinçli olarak intihar amac›ylad›r. Hafif toksisiteden sonra serum yar›lanma ömrü 14-20 saat, fliddetli toksisiteden sonra 24-30 saattir. Tedavide gastrik lavaj, fomepizol, etanol ve hemodializ kullan›l›r. Bu çal›flma ile olgu eflli¤inde metanol zehirlenmelerinin gözden geçirilmesi amaçlanm›flt›r. 28 yafl›nda erkek hasta acil servisimize bulan›k görme ve sa¤ baca¤›nda kar›ncalanma flikayeti ile baflvurdu. Anamnezinden yaklafl›k 8 saat önce suisid amaçl› 200 cc kolonya ve 10 adet akineton içti¤i ö¤renildi. FM'de genel durumu iyi, bilinç aç›k, oryante, koopere TA: 120/80 mmHg, Nb: 88/dk SS: 14/dk idi. Göz konsültasyonunda görme 0.6 olarak de¤erlendirildi. Laboratuvar de¤erlendirmesinde AKG'de pH: 7.28, pO 2: 131.1, pCO2: 30.5, HCO3: 20.8, biyokimyada AST: 197 U/L, ALT: 141 U/L, ALP: 188 U/L, GGT: 252 U/L, LDH: 248 U/L, di¤er parametreler normaldi. Hasta metanol intoksikasyonu kabul edilerek fomepizol 15 mg/kg yükleme, 12 saatte bir 10 mg/kg idame 3 kez verildi. %20'lik etanol yükleme dozu 0,6 g/kg ve idame dozu saatte 0,11 g/kg'dan verildi. Hasta geliflinin 38. saatinde flikayetlerinin geçmesi üzerine kendi iste¤iyle taburcu edildi. SUMMARY Methanol is produced by the distillation of the wood. Its poisoning happens either by mixing with whisky accidentally or consciously by suicidal purposes. Its half-life is 14-20 hours after mild toxicity, 24-30 hours after severe toxicity. It may cause severe ocular and neurological damage after severe toxicity. Treatment parameters are gastric lavage, fomepizole, ethanol and hemodialysis. In this presentation we aimed to review methanol poisoning and its results. A 28-year-old male patient admitted to the emergency department with the complaints of blurred vision and sensation of tingling. It was learned from his history that he took 200 mL of cologne and 10 tablets of akineton® for suicidal purposes. In the physical examination, his overall position was good, conscious, oriented and cooperated. His blood pressure was 120/80 mmHg, pulse was 88/min and respiration rate was 14/min. His visual acuity was evaluated as 0.6. His laboratory parameters are: pH: 7.28, pO 2: 131.1, pCO2: 30.5, HCO3: 20.8 in blood gas analysis; AST: 197 U/L, ALT: 141 U/L, ALP: 188U/l, GGT: 252 U/L, LDH: 248 U/L in biochemical evaluation. The patient was accepted as methanol poisoning and given fomepizole as 15 mg/kg loading, and then three times 10 mg/kg every 12 hours. Then, 20% ethanol solution was given as 0,6 g/kg loading, 0,11 g/kg every hour. 38 hours after the admission he was asymptomatic and discharged with advises.
ÖZET Ankara Numune Hastanesi Kanser Cer rahisi Kliniğinde, 1976-1982 yıllan arasında meme kanser... more ÖZET Ankara Numune Hastanesi Kanser Cer rahisi Kliniğinde, 1976-1982 yıllan arasında meme kanseri nedeniyle radikal mastektomi veya simple mastektomi + aksiller disseksiyon ameliyatı yapılan 100 hastanın aksiller lenf düğümlerinin histolojik kesitleri yeniden incelen di. Dominant proliferatif reaksiyon olarak sinüs hisiositozis gösteren 54 hastanın 48'i operasyon dan sonra S yıl ve daha fazla süredir sağdı. Ger minal merkez hiperplazi gösteren 41 hastadan 9'u 5 yıl üzerinde sürvî göstermişlerdi. Bul gularımız sinüs histiositozisin uzun bir yaşam süresiyle ve germinal merkez hiperplazisinin kötü bir prognozla ilişkili olduğuna dair daha önce yaptığımız ön çalışmayla ve literatür bilgisiyle uyumluydu. İlave olarak lenf düğümlerindeki proliferatif reaksiyonların görünümü ve bunun cerrahi müdahaleden sonra sürvi ile ilişkisini, değişik immiin reaksiyonların meme kar-sinomunun büyümesini baskılayabileceği veya hızlandıracağı şeklinde izah eden hipotezi de destekliyordu. Anahtar Kelimeler: Sinüs Histiositozis, Germinal Merkez Hiperplazisî Meme Kanseri. T Kİ Tıp Bil Araş Dergisi C.8, S.4,1990,383-389 SUMMARY The histologic sections of axillary lymph nodes of 100 patients treated for carcinoma of breast in Surgical Oncology Clinic-Numune Hospital-Ankara, between 1976 and 1982 were reexamined , 48 of 54patient who revealed sinus histiocytosis as dominant proliferative reaction, were alive for five years or more. In contrast, 9 of 41 patients who had germinal center hyperplasia had survived in five years or more. Our data are similar to that in the literature and our previous study showing along survival with sinus his tiocytosis and a poor prognosis with germinal center hyperplasia. In addition our data support the hypothesis suggesting that there is a relation between certain proliferative reactions of lymph nodes and survival after the operative interven tion. Inhibitor or activator effects of immune reactions (as lypressed in the theory) on the growth of mammary carcinoma appear to significantly influence the ultimate prog nosis.
Hepatic rupture with resulting hemoperitoneum due to metastatic cancer is uncommon. Reports in th... more Hepatic rupture with resulting hemoperitoneum due to metastatic cancer is uncommon. Reports in the literature have described a wide variety of neoplasms causing this usually fatal phenomenon. We describe a rare case of spontaneous rupture of hepatic metastases from gastric leiomyosarcoma. A 72-year-old male patient with sudden onset severe epigastric pain was rushed into emergency service. After examination, the patient underwent urgent operation withe possible diagnosis of perforated gastric or duodenal ulcer. During exploration, we determined bleeding mass on the diaphragmatic side of the left lobe of the liver and a mass on the posterior wall of the stomach. Hemostasis was provided.
SUMMARY Tumors of the duodenal bulb are rare and only ¡91 benign duodenal tumors have been report... more SUMMARY Tumors of the duodenal bulb are rare and only ¡91 benign duodenal tumors have been reported in the medical literature. About 10.6% of all benign duodenal tumors are Brunner's gland tumor and are extremely rare. We present one more patient with Brunner's gland adenoma located in the duodenal bulb manifested by duodenal obstruction and anemia. The initial symptoms and signs were that of a peptic ulcer clinically that could be a pitfall in the diagnosis preoperatively. Key Wordi: Brunnerj gland adenoma duodenal obs truction.
Intravesical BCG is a good treatment choice for vesical carcinomas. Nevertheless, it can also bec... more Intravesical BCG is a good treatment choice for vesical carcinomas. Nevertheless, it can also become a mortal toxin when applied in a wrong way. The application routes of the prescribed drug should be rigorously described to patients and detailed instructions regarding the ways of application such as intravesi-cal application should be given to the persons taking this medicine (Ref. 9). Full Text in free PDF www.bmj.sk.
Introduction: Poisonings are important causes of emergency department visits. It is especially ve... more Introduction: Poisonings are important causes of emergency department visits. It is especially very common in youths and women. In this study we aimed to define clinical and demographic features of poisoning cases admitted to our hospital. Material and Methods: Poisoning cases admitted to emergency department of Ankara Atatürk Hospital between the dates of January 2006 and January 2007 were evaluated prospectively. Demographic features of patients, poisoning agents, aim of intake of poisonous agent, admission times, treatment methods, consultations, durations of emergency department treatment and outcomes were recorded. Data were expressed as Mean ± Standard deviation, median and percentage. Results: Between these dates, 0.5% of emergency department visits was poisonings. 412 patients were included in the study. Mean age of the patients was 28.6±11.5 years. %33.5 of the patients was male (n=138), 66.5% was female (n=274). Mean admission time to the hospital was 175.0±228.2 minutes. It was detected that 65% of the patients were poisoned with a single agent and 72.1% took the agent orally. The most common poisoning agents are tablets (59,5% n=245), carbon monoxide (CO) (20,6%, n=85) and alcohol (8.7%, n=36). 75.7% of the patients were discharged from the hospital, 2.9% were hospitalized and 21.4% were sent to another hospital. No death was observed Conclusion: It was seen that poisoning cases are mostly seen in young females, occur mostly with single agents, and clinically require good care.
SUMMARY Ecballium elaterium is a plant belonging to Cucurbitaceae family. The juice is widely use... more SUMMARY Ecballium elaterium is a plant belonging to Cucurbitaceae family. The juice is widely used, by people in the eastern Mediterranean region, to treat sinusitis, because of its inherent anti-inflammatory properties. A 38-year-old man was presented to the emergency department with shortness of breath, burning and sting sense of the eye and (eyelid swelling) periorbital edema. In this presentation we aimed to show the adverse effects of Ecballium elaterium used for treatment purposes ÖZET Ecballium elaterium Cucurbitaceae ailesinden bir bitkidir. Do¤al antiinflamatuvar özelli¤inden dolay› Akdeniz bölgesi halk› taraf›ndan sinüzit tedavisi için s›k kullan›lmaktad›r. Elli yafl›nda erkek hasta acil servise nefes darl›¤›, gözde yanma ve batma hissi ve göz kapaklar›nda flifllik flikayetleriyle baflvurmufltur. Bu sunumda tedavi amaçl› kullan›lan Ecballium elaterium'a ba¤l› geliflen olumsuz etkilerin gösterilmesi amaçlanm›flt›r.
A retrospective study of 122 patients, who were operated between January 1989 and December 2001, ... more A retrospective study of 122 patients, who were operated between January 1989 and December 2001, was performed D1 dissection was performed in the operations. In this study, initiatives that do not leave macroscopic tumor behind were evaluated as curative resections. The patients who underwent total gastrectomy were mostly reconstructed with omega loop and Braun anastomosis. Among the patients, 81 (66.4%) were male and 41 (33.6%) female. The youngest patient was 26 and the oldest 82 years old. The average age of patients was 58.9 years. Fifty seven patients (46.7%) were treated with curative (R1) resection, while 20 (16.4%) with palliative resection, 20 (16.4%) with surgical bypass, 5 (4.2%) with gastrostomy, 2 (1.6%) with nutritional jejunostomy, and 18 (14.7%) underwent only explorative laparotomy. Patients who were operated were identified as follows: 3 of the patients (2.4%) were in Stage IA, 4 (3.2%) in Stage IB, 23 (18.8%) in Stage II, 11 (9.1%) in Stage IIIA, 16 (13.2%) in Stage IIIB, and 55 (53.3%) in Stage IV. The average life expectancy in the survival analysis of all patients was 44 (± 3) months and the 5-year survival rate was 42.5%. Survival results were found to be consistent with western-sourced results. These results have led to the need of comparison of D1 and D2 dissections with a prospective randomized study.
Wandering spleen is the displacement of the spleen due to the loss or weakening of the ligaments ... more Wandering spleen is the displacement of the spleen due to the loss or weakening of the ligaments of the spleen and is seen very rarely with an incidence of less than 0.5 %. It can cause portal hypertension, but gastric variceal hemorrhage is a quite rare condition within the spectrum of this uncommon disease. We report a 22yearold woman with wandering spleen presenting with lifethreatening gastric variceal hemorrhage. Her diagnosis was made by computerized tomography. Endoscopic therapy was not adequate to stop the bleeding, and urgent splenectomy was performed. After surgery she has been well with no symptoms until now.
The intestinal protozoan parasite E. histolytica is the causative organism responsible for human ... more The intestinal protozoan parasite E. histolytica is the causative organism responsible for human amebiasis and amebic dysentery. Although it is primarily an infection of the colon, it may also be spread by hematogenous path to other organs, especially the liver. In general, the clinical spectrum of colorectal amebia-sis ranges from the state of asymptomatic carrier to severe fulminant necrotizing colitis with bleeding and perforation. Here we present an extremely rare case of necrotizing amebiasis of small bowel with a fatal outcome (Fig. 1, Ref. 4). Full Text (Free, PDF) www.bmj.sk.
Lipomas are benign soft tissue tumors. They can rarely be mesenterically located and symptomatic.... more Lipomas are benign soft tissue tumors. They can rarely be mesenterically located and symptomatic. It is very important to conduct the differential diagnosis of large intra-abdominal mass lesions. Radiological imaging techniques are often used for diagnosis, but when these techniques are not sufficient or when it becomes obligatory to cure symptoms of the lesion, surgical excision should be performedThis study aimed to present a patient with complaints and symptoms of an intra- abdominal giant mass lesion, the pathological diagnosis of which the revealed a giant mesenteric lipoma.
The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology, 2006
Hepatic rupture with resulting hemoperitoneum due to metastatic cancer is uncommon. Reports in th... more Hepatic rupture with resulting hemoperitoneum due to metastatic cancer is uncommon. Reports in the literature have described a wide variety of neoplasms causing this usually fatal phenomenon. We describe a rare case of spontaneous rupture of hepatic metastases from gastric leiomyosarcoma. A 72-year-old male patient with sudden onset severe epigastric pain was rushed into emergency service. After examination, the patient underwent urgent operation with possible diagnosis of perforated gastric or duodenal ulcer. During exploration, we determined bleeding mass on the diaphragmatic side of the left lobe of the liver and a mass on the posterior wall of the stomach. Hemostasis was provided.
We studied the demographics, surgical procedures, and complication rates in 3 months periods befo... more We studied the demographics, surgical procedures, and complication rates in 3 months periods before and after the first case was announced. RESULTS: A total number of 462 patients were analyzed between the ages of 19-88, 184 of which (39.8%) were females and 278 were males (60.2%). 253 of these patients were diagnosed with AA and underwent surgery before March 11 whereas 209 patients were diagnosed and treated after March 11. DISCUSSION: There was no statistical difference between the two groups in terms of complication rates before and after the pandemic. Although the rate of open appendectomy was increased after the pandemic, no statistical difference has been found. CONCLUSION: No change was observed in terms of hospital admissions, methods of treatment, complication rates, length of stay before and after the COVID-19 pandemic. KEY WORDS: Acute Appendicitis, COVID-19, Appendectomy 4.5% of all abdominal pain is caused by AA 6. Delays in making a diagnosis can cause a variety of complications, which could potentially cause serious morbidity and mortality 7. AA can be classified into two groups; complicated and non-complicated. Presence of abscess, phlegmon, gangrene, perforation indicates complicated appendicitis 8,9. Main reasons for complications to occur are delays in either admission, or reaching a definitive diagnosis. Complicated AA cases can cause labor loss in healthcare and increase costs. The first COVID-19 case in Turkey was identified on 11 March 2020. Similar to most other countries, raising number of COVID-19 cases increased the workload in our healthcare system. Concerns have been voiced regarding whether the focus on COVID-19 has caused delays in diagnosing certain conditions and therefore lead to complications 10. On this basis, we aimed to compare the characteristics and management of AA cases before and after COVID-19.
We studied the demographics, surgical procedures, and complication rates in 3 months periods befo... more We studied the demographics, surgical procedures, and complication rates in 3 months periods before and after the first case was announced. RESULTS: A total number of 462 patients were analyzed between the ages of 19-88, 184 of which (39.8%) were females and 278 were males (60.2%). 253 of these patients were diagnosed with AA and underwent surgery before March 11 whereas 209 patients were diagnosed and treated after March 11. DISCUSSION: There was no statistical difference between the two groups in terms of complication rates before and after the pandemic. Although the rate of open appendectomy was increased after the pandemic, no statistical difference has been found. CONCLUSION: No change was observed in terms of hospital admissions, methods of treatment, complication rates, length of stay before and after the COVID-19 pandemic. KEY WORDS: Acute Appendicitis, COVID-19, Appendectomy 4.5% of all abdominal pain is caused by AA 6. Delays in making a diagnosis can cause a variety of complications, which could potentially cause serious morbidity and mortality 7. AA can be classified into two groups; complicated and non-complicated. Presence of abscess, phlegmon, gangrene, perforation indicates complicated appendicitis 8,9. Main reasons for complications to occur are delays in either admission, or reaching a definitive diagnosis. Complicated AA cases can cause labor loss in healthcare and increase costs. The first COVID-19 case in Turkey was identified on 11 March 2020. Similar to most other countries, raising number of COVID-19 cases increased the workload in our healthcare system. Concerns have been voiced regarding whether the focus on COVID-19 has caused delays in diagnosing certain conditions and therefore lead to complications 10. On this basis, we aimed to compare the characteristics and management of AA cases before and after COVID-19.
A case of an intra-abdominal sharp foreign body with migration to the mesentery vessels, causing ... more A case of an intra-abdominal sharp foreign body with migration to the mesentery vessels, causing intestinal necrosis in a 20-year-old patient is presented. Emergency surgery with 75 cm small bowel resection was performed.
Introduction. Management of open abdomen (OA) with enteroatmospheric fistula (EAF) in morbid obes... more Introduction. Management of open abdomen (OA) with enteroatmospheric fistula (EAF) in morbid obese patient with comorbid disease is challenging. We would like to report the management of septic OA in morbid obese patient with EAF which developed after strangulated recurrent giant incisional hernia repair. We would also like to emphasize, in this case, the conversion of EAF to ileostomy by the help of second Negative Pressure Therapy (NPT) on ostomy side, and the chance of new EAF occurrence was reduced with intrarectal NPT. Case Presentation. 62-year-old morbid obese woman became an OA patient with EAF after strangulated recurrent giant hernia. EAF was converted to ostomy with pezzer drain by the help of second NPT on ostomy. Colonic distention was reduced with the third NPT application via rectum. Abdominal reapproximation anchor (ABRA) system was used for delayed abdominal closure. Conclusions. Using the 2nd NPT on ostomy side may help in the maturation of the ostomy created in a difficult condition in an open abdomen. Using the 3rd NPT through rectum may decrease the chance of EAF formation by reducing the pressure difference between intraluminal pressure and extraluminal pressure in hollow viscera.
ÖZET Metanol odunun distilasyonu ile elde edilir. Zehirlenmesi genellikle ya viskiye kar›flmas›yl... more ÖZET Metanol odunun distilasyonu ile elde edilir. Zehirlenmesi genellikle ya viskiye kar›flmas›yla kazara ya da bilinçli olarak intihar amac›ylad›r. Hafif toksisiteden sonra serum yar›lanma ömrü 14-20 saat, fliddetli toksisiteden sonra 24-30 saattir. Tedavide gastrik lavaj, fomepizol, etanol ve hemodializ kullan›l›r. Bu çal›flma ile olgu eflli¤inde metanol zehirlenmelerinin gözden geçirilmesi amaçlanm›flt›r. 28 yafl›nda erkek hasta acil servisimize bulan›k görme ve sa¤ baca¤›nda kar›ncalanma flikayeti ile baflvurdu. Anamnezinden yaklafl›k 8 saat önce suisid amaçl› 200 cc kolonya ve 10 adet akineton içti¤i ö¤renildi. FM'de genel durumu iyi, bilinç aç›k, oryante, koopere TA: 120/80 mmHg, Nb: 88/dk SS: 14/dk idi. Göz konsültasyonunda görme 0.6 olarak de¤erlendirildi. Laboratuvar de¤erlendirmesinde AKG'de pH: 7.28, pO 2: 131.1, pCO2: 30.5, HCO3: 20.8, biyokimyada AST: 197 U/L, ALT: 141 U/L, ALP: 188 U/L, GGT: 252 U/L, LDH: 248 U/L, di¤er parametreler normaldi. Hasta metanol intoksikasyonu kabul edilerek fomepizol 15 mg/kg yükleme, 12 saatte bir 10 mg/kg idame 3 kez verildi. %20'lik etanol yükleme dozu 0,6 g/kg ve idame dozu saatte 0,11 g/kg'dan verildi. Hasta geliflinin 38. saatinde flikayetlerinin geçmesi üzerine kendi iste¤iyle taburcu edildi. SUMMARY Methanol is produced by the distillation of the wood. Its poisoning happens either by mixing with whisky accidentally or consciously by suicidal purposes. Its half-life is 14-20 hours after mild toxicity, 24-30 hours after severe toxicity. It may cause severe ocular and neurological damage after severe toxicity. Treatment parameters are gastric lavage, fomepizole, ethanol and hemodialysis. In this presentation we aimed to review methanol poisoning and its results. A 28-year-old male patient admitted to the emergency department with the complaints of blurred vision and sensation of tingling. It was learned from his history that he took 200 mL of cologne and 10 tablets of akineton® for suicidal purposes. In the physical examination, his overall position was good, conscious, oriented and cooperated. His blood pressure was 120/80 mmHg, pulse was 88/min and respiration rate was 14/min. His visual acuity was evaluated as 0.6. His laboratory parameters are: pH: 7.28, pO 2: 131.1, pCO2: 30.5, HCO3: 20.8 in blood gas analysis; AST: 197 U/L, ALT: 141 U/L, ALP: 188U/l, GGT: 252 U/L, LDH: 248 U/L in biochemical evaluation. The patient was accepted as methanol poisoning and given fomepizole as 15 mg/kg loading, and then three times 10 mg/kg every 12 hours. Then, 20% ethanol solution was given as 0,6 g/kg loading, 0,11 g/kg every hour. 38 hours after the admission he was asymptomatic and discharged with advises.
ÖZET Ankara Numune Hastanesi Kanser Cer rahisi Kliniğinde, 1976-1982 yıllan arasında meme kanser... more ÖZET Ankara Numune Hastanesi Kanser Cer rahisi Kliniğinde, 1976-1982 yıllan arasında meme kanseri nedeniyle radikal mastektomi veya simple mastektomi + aksiller disseksiyon ameliyatı yapılan 100 hastanın aksiller lenf düğümlerinin histolojik kesitleri yeniden incelen di. Dominant proliferatif reaksiyon olarak sinüs hisiositozis gösteren 54 hastanın 48'i operasyon dan sonra S yıl ve daha fazla süredir sağdı. Ger minal merkez hiperplazi gösteren 41 hastadan 9'u 5 yıl üzerinde sürvî göstermişlerdi. Bul gularımız sinüs histiositozisin uzun bir yaşam süresiyle ve germinal merkez hiperplazisinin kötü bir prognozla ilişkili olduğuna dair daha önce yaptığımız ön çalışmayla ve literatür bilgisiyle uyumluydu. İlave olarak lenf düğümlerindeki proliferatif reaksiyonların görünümü ve bunun cerrahi müdahaleden sonra sürvi ile ilişkisini, değişik immiin reaksiyonların meme kar-sinomunun büyümesini baskılayabileceği veya hızlandıracağı şeklinde izah eden hipotezi de destekliyordu. Anahtar Kelimeler: Sinüs Histiositozis, Germinal Merkez Hiperplazisî Meme Kanseri. T Kİ Tıp Bil Araş Dergisi C.8, S.4,1990,383-389 SUMMARY The histologic sections of axillary lymph nodes of 100 patients treated for carcinoma of breast in Surgical Oncology Clinic-Numune Hospital-Ankara, between 1976 and 1982 were reexamined , 48 of 54patient who revealed sinus histiocytosis as dominant proliferative reaction, were alive for five years or more. In contrast, 9 of 41 patients who had germinal center hyperplasia had survived in five years or more. Our data are similar to that in the literature and our previous study showing along survival with sinus his tiocytosis and a poor prognosis with germinal center hyperplasia. In addition our data support the hypothesis suggesting that there is a relation between certain proliferative reactions of lymph nodes and survival after the operative interven tion. Inhibitor or activator effects of immune reactions (as lypressed in the theory) on the growth of mammary carcinoma appear to significantly influence the ultimate prog nosis.
Hepatic rupture with resulting hemoperitoneum due to metastatic cancer is uncommon. Reports in th... more Hepatic rupture with resulting hemoperitoneum due to metastatic cancer is uncommon. Reports in the literature have described a wide variety of neoplasms causing this usually fatal phenomenon. We describe a rare case of spontaneous rupture of hepatic metastases from gastric leiomyosarcoma. A 72-year-old male patient with sudden onset severe epigastric pain was rushed into emergency service. After examination, the patient underwent urgent operation withe possible diagnosis of perforated gastric or duodenal ulcer. During exploration, we determined bleeding mass on the diaphragmatic side of the left lobe of the liver and a mass on the posterior wall of the stomach. Hemostasis was provided.
SUMMARY Tumors of the duodenal bulb are rare and only ¡91 benign duodenal tumors have been report... more SUMMARY Tumors of the duodenal bulb are rare and only ¡91 benign duodenal tumors have been reported in the medical literature. About 10.6% of all benign duodenal tumors are Brunner's gland tumor and are extremely rare. We present one more patient with Brunner's gland adenoma located in the duodenal bulb manifested by duodenal obstruction and anemia. The initial symptoms and signs were that of a peptic ulcer clinically that could be a pitfall in the diagnosis preoperatively. Key Wordi: Brunnerj gland adenoma duodenal obs truction.
Intravesical BCG is a good treatment choice for vesical carcinomas. Nevertheless, it can also bec... more Intravesical BCG is a good treatment choice for vesical carcinomas. Nevertheless, it can also become a mortal toxin when applied in a wrong way. The application routes of the prescribed drug should be rigorously described to patients and detailed instructions regarding the ways of application such as intravesi-cal application should be given to the persons taking this medicine (Ref. 9). Full Text in free PDF www.bmj.sk.
Introduction: Poisonings are important causes of emergency department visits. It is especially ve... more Introduction: Poisonings are important causes of emergency department visits. It is especially very common in youths and women. In this study we aimed to define clinical and demographic features of poisoning cases admitted to our hospital. Material and Methods: Poisoning cases admitted to emergency department of Ankara Atatürk Hospital between the dates of January 2006 and January 2007 were evaluated prospectively. Demographic features of patients, poisoning agents, aim of intake of poisonous agent, admission times, treatment methods, consultations, durations of emergency department treatment and outcomes were recorded. Data were expressed as Mean ± Standard deviation, median and percentage. Results: Between these dates, 0.5% of emergency department visits was poisonings. 412 patients were included in the study. Mean age of the patients was 28.6±11.5 years. %33.5 of the patients was male (n=138), 66.5% was female (n=274). Mean admission time to the hospital was 175.0±228.2 minutes. It was detected that 65% of the patients were poisoned with a single agent and 72.1% took the agent orally. The most common poisoning agents are tablets (59,5% n=245), carbon monoxide (CO) (20,6%, n=85) and alcohol (8.7%, n=36). 75.7% of the patients were discharged from the hospital, 2.9% were hospitalized and 21.4% were sent to another hospital. No death was observed Conclusion: It was seen that poisoning cases are mostly seen in young females, occur mostly with single agents, and clinically require good care.
SUMMARY Ecballium elaterium is a plant belonging to Cucurbitaceae family. The juice is widely use... more SUMMARY Ecballium elaterium is a plant belonging to Cucurbitaceae family. The juice is widely used, by people in the eastern Mediterranean region, to treat sinusitis, because of its inherent anti-inflammatory properties. A 38-year-old man was presented to the emergency department with shortness of breath, burning and sting sense of the eye and (eyelid swelling) periorbital edema. In this presentation we aimed to show the adverse effects of Ecballium elaterium used for treatment purposes ÖZET Ecballium elaterium Cucurbitaceae ailesinden bir bitkidir. Do¤al antiinflamatuvar özelli¤inden dolay› Akdeniz bölgesi halk› taraf›ndan sinüzit tedavisi için s›k kullan›lmaktad›r. Elli yafl›nda erkek hasta acil servise nefes darl›¤›, gözde yanma ve batma hissi ve göz kapaklar›nda flifllik flikayetleriyle baflvurmufltur. Bu sunumda tedavi amaçl› kullan›lan Ecballium elaterium'a ba¤l› geliflen olumsuz etkilerin gösterilmesi amaçlanm›flt›r.
A retrospective study of 122 patients, who were operated between January 1989 and December 2001, ... more A retrospective study of 122 patients, who were operated between January 1989 and December 2001, was performed D1 dissection was performed in the operations. In this study, initiatives that do not leave macroscopic tumor behind were evaluated as curative resections. The patients who underwent total gastrectomy were mostly reconstructed with omega loop and Braun anastomosis. Among the patients, 81 (66.4%) were male and 41 (33.6%) female. The youngest patient was 26 and the oldest 82 years old. The average age of patients was 58.9 years. Fifty seven patients (46.7%) were treated with curative (R1) resection, while 20 (16.4%) with palliative resection, 20 (16.4%) with surgical bypass, 5 (4.2%) with gastrostomy, 2 (1.6%) with nutritional jejunostomy, and 18 (14.7%) underwent only explorative laparotomy. Patients who were operated were identified as follows: 3 of the patients (2.4%) were in Stage IA, 4 (3.2%) in Stage IB, 23 (18.8%) in Stage II, 11 (9.1%) in Stage IIIA, 16 (13.2%) in Stage IIIB, and 55 (53.3%) in Stage IV. The average life expectancy in the survival analysis of all patients was 44 (± 3) months and the 5-year survival rate was 42.5%. Survival results were found to be consistent with western-sourced results. These results have led to the need of comparison of D1 and D2 dissections with a prospective randomized study.
Wandering spleen is the displacement of the spleen due to the loss or weakening of the ligaments ... more Wandering spleen is the displacement of the spleen due to the loss or weakening of the ligaments of the spleen and is seen very rarely with an incidence of less than 0.5 %. It can cause portal hypertension, but gastric variceal hemorrhage is a quite rare condition within the spectrum of this uncommon disease. We report a 22yearold woman with wandering spleen presenting with lifethreatening gastric variceal hemorrhage. Her diagnosis was made by computerized tomography. Endoscopic therapy was not adequate to stop the bleeding, and urgent splenectomy was performed. After surgery she has been well with no symptoms until now.
The intestinal protozoan parasite E. histolytica is the causative organism responsible for human ... more The intestinal protozoan parasite E. histolytica is the causative organism responsible for human amebiasis and amebic dysentery. Although it is primarily an infection of the colon, it may also be spread by hematogenous path to other organs, especially the liver. In general, the clinical spectrum of colorectal amebia-sis ranges from the state of asymptomatic carrier to severe fulminant necrotizing colitis with bleeding and perforation. Here we present an extremely rare case of necrotizing amebiasis of small bowel with a fatal outcome (Fig. 1, Ref. 4). Full Text (Free, PDF) www.bmj.sk.
Lipomas are benign soft tissue tumors. They can rarely be mesenterically located and symptomatic.... more Lipomas are benign soft tissue tumors. They can rarely be mesenterically located and symptomatic. It is very important to conduct the differential diagnosis of large intra-abdominal mass lesions. Radiological imaging techniques are often used for diagnosis, but when these techniques are not sufficient or when it becomes obligatory to cure symptoms of the lesion, surgical excision should be performedThis study aimed to present a patient with complaints and symptoms of an intra- abdominal giant mass lesion, the pathological diagnosis of which the revealed a giant mesenteric lipoma.
The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology, 2006
Hepatic rupture with resulting hemoperitoneum due to metastatic cancer is uncommon. Reports in th... more Hepatic rupture with resulting hemoperitoneum due to metastatic cancer is uncommon. Reports in the literature have described a wide variety of neoplasms causing this usually fatal phenomenon. We describe a rare case of spontaneous rupture of hepatic metastases from gastric leiomyosarcoma. A 72-year-old male patient with sudden onset severe epigastric pain was rushed into emergency service. After examination, the patient underwent urgent operation with possible diagnosis of perforated gastric or duodenal ulcer. During exploration, we determined bleeding mass on the diaphragmatic side of the left lobe of the liver and a mass on the posterior wall of the stomach. Hemostasis was provided.
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bleeding mass on the diaphragmatic side of the left lobe of the liver
and a mass on the posterior wall of the stomach. Hemostasis was provided.
Material and Methods: Poisoning cases admitted to emergency department of Ankara Atatürk Hospital between the dates of January 2006 and January 2007 were evaluated prospectively. Demographic features of patients, poisoning agents, aim of intake of poisonous agent, admission times, treatment methods, consultations, durations of emergency department treatment and outcomes were recorded. Data were expressed as Mean ± Standard deviation, median and percentage.
Results: Between these dates, 0.5% of emergency department visits was poisonings. 412 patients were included in the study. Mean age of the patients was 28.6±11.5 years. %33.5 of the patients was male (n=138), 66.5% was female (n=274). Mean admission time to the hospital was 175.0±228.2 minutes. It was detected that 65% of the patients were poisoned with a single agent and 72.1% took the agent orally. The most common poisoning agents are tablets (59,5% n=245), carbon monoxide (CO) (20,6%, n=85) and alcohol (8.7%, n=36). 75.7% of the patients were discharged from the hospital, 2.9% were hospitalized and 21.4% were sent to another hospital. No death was observed
Conclusion: It was seen that poisoning cases are mostly seen in young females, occur mostly with single agents, and clinically require good care.
dissection was performed in the operations. In this study, initiatives that do not leave macroscopic tumor behind were
evaluated as curative resections. The patients who underwent total gastrectomy were mostly reconstructed with omega
loop and Braun anastomosis. Among the patients, 81 (66.4%) were male and 41 (33.6%) female. The youngest patient
was 26 and the oldest 82 years old. The average age of patients was 58.9 years. Fifty seven patients (46.7%) were treated
with curative (R1) resection, while 20 (16.4%) with palliative resection, 20 (16.4%) with surgical bypass, 5 (4.2%) with
gastrostomy, 2 (1.6%) with nutritional jejunostomy, and 18 (14.7%) underwent only explorative laparotomy. Patients who
were operated were identified as follows: 3 of the patients (2.4%) were in Stage IA, 4 (3.2%) in Stage IB, 23 (18.8%) in
Stage II, 11 (9.1%) in Stage IIIA, 16 (13.2%) in Stage IIIB, and 55 (53.3%) in Stage IV. The average life expectancy in the
survival analysis of all patients was 44 (± 3) months and the 5-year survival rate was 42.5%. Survival results were found
to be consistent with western-sourced results. These results have led to the need of comparison of D1 and D2 dissections
with a prospective randomized study.
conduct the differential diagnosis of large intra-abdominal mass lesions. Radiological imaging techniques are often used
for diagnosis, but when these techniques are not sufficient or when it becomes obligatory to cure symptoms of the lesion,
surgical excision should be performedThis study aimed to present a patient with complaints and symptoms of an intra-
abdominal giant mass lesion, the pathological diagnosis of which the revealed a giant mesenteric lipoma.
bleeding mass on the diaphragmatic side of the left lobe of the liver
and a mass on the posterior wall of the stomach. Hemostasis was provided.
Material and Methods: Poisoning cases admitted to emergency department of Ankara Atatürk Hospital between the dates of January 2006 and January 2007 were evaluated prospectively. Demographic features of patients, poisoning agents, aim of intake of poisonous agent, admission times, treatment methods, consultations, durations of emergency department treatment and outcomes were recorded. Data were expressed as Mean ± Standard deviation, median and percentage.
Results: Between these dates, 0.5% of emergency department visits was poisonings. 412 patients were included in the study. Mean age of the patients was 28.6±11.5 years. %33.5 of the patients was male (n=138), 66.5% was female (n=274). Mean admission time to the hospital was 175.0±228.2 minutes. It was detected that 65% of the patients were poisoned with a single agent and 72.1% took the agent orally. The most common poisoning agents are tablets (59,5% n=245), carbon monoxide (CO) (20,6%, n=85) and alcohol (8.7%, n=36). 75.7% of the patients were discharged from the hospital, 2.9% were hospitalized and 21.4% were sent to another hospital. No death was observed
Conclusion: It was seen that poisoning cases are mostly seen in young females, occur mostly with single agents, and clinically require good care.
dissection was performed in the operations. In this study, initiatives that do not leave macroscopic tumor behind were
evaluated as curative resections. The patients who underwent total gastrectomy were mostly reconstructed with omega
loop and Braun anastomosis. Among the patients, 81 (66.4%) were male and 41 (33.6%) female. The youngest patient
was 26 and the oldest 82 years old. The average age of patients was 58.9 years. Fifty seven patients (46.7%) were treated
with curative (R1) resection, while 20 (16.4%) with palliative resection, 20 (16.4%) with surgical bypass, 5 (4.2%) with
gastrostomy, 2 (1.6%) with nutritional jejunostomy, and 18 (14.7%) underwent only explorative laparotomy. Patients who
were operated were identified as follows: 3 of the patients (2.4%) were in Stage IA, 4 (3.2%) in Stage IB, 23 (18.8%) in
Stage II, 11 (9.1%) in Stage IIIA, 16 (13.2%) in Stage IIIB, and 55 (53.3%) in Stage IV. The average life expectancy in the
survival analysis of all patients was 44 (± 3) months and the 5-year survival rate was 42.5%. Survival results were found
to be consistent with western-sourced results. These results have led to the need of comparison of D1 and D2 dissections
with a prospective randomized study.
conduct the differential diagnosis of large intra-abdominal mass lesions. Radiological imaging techniques are often used
for diagnosis, but when these techniques are not sufficient or when it becomes obligatory to cure symptoms of the lesion,
surgical excision should be performedThis study aimed to present a patient with complaints and symptoms of an intra-
abdominal giant mass lesion, the pathological diagnosis of which the revealed a giant mesenteric lipoma.