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Laparoscopic Transabdominal Preperitoneal Mesh Hernioplasty: A Medical College Experience  [PDF]
Mushtaq Chalkoo, Mujahid Ahmad Mir, Hilal Makhdoomi
Surgical Science (SS) , 2016, DOI: 10.4236/ss.2016.72015
Abstract: Objectives: To determine the feasibility and patient’s outcome of laparoscopic transabdominal preperitoneal mesh hernioplasty for inguinal hernias. Patients and Methods: This study was carried out from March 2011 to April 2014. A total of 130 patients underwent laparoscopic transabdominal preperitoneal mesh hernioplasty (TAPP) for uncomplicated inguinal hernia. Of this, 10 patients presenting with bilateral inguinal hernias were operated in the single sitting. A 15 cm × 12 cm polypropylene mesh was used in all cases. Operative morbidity, postoperative pain, seroma formation, evidence of superficial infection, chronic groin pain and hernia recurrence were noted. The majority of the patients were discharged within 24 hours and follow-up was done at 1 week, 1 month, and 6 months. Results: 130 patients presenting with uncomplicated inguinal hernias were operated over a period of three years in the department of surgery, Govt. Medical College Srinagar. The mean age of the patients was 39.18 years (range: 18 - 70 years). The median duration of operation was 48.5 minutes (range: 18 - 120 minutes). None of the procedure was converted to open inguinal hernia repair. Postoperative pain was observed in 9.23% of the cases and was easily controlled by oral analgesics. Six patients (4.62%) developed seroma, out of which one required aspiration while others settled conservatively. Two patients (1.54%) developed wound infection and one patient (0.77%) had recurrence. None of the patients developed scrotal hematoma or neuralgia. Return to normal activity after TAPP repair was found to be after a median of 16.1 days. Conclusion: Transabdominal preperitoneal repair for inguinal hernia using proline mesh may be a safe and effective procedure with low morbidity, early return to normal activity and with a very low recurrence after six months follow-up.
An Early Experience of Stapled Hemorrhoidectomy in a Medical College Setting  [PDF]
Mushtaq Chalkoo, Shahnawaz Ahangar, Naseer Awan, Varun Dogra, Umer Mushtaq, Hilal Makhdoomi
Surgical Science (SS) , 2015, DOI: 10.4236/ss.2015.65033

Background: Stapled hemorrhoidectomy, popularly known as Longo technique is in use for the treatment of hemorrhoids since its first description to surgical fraternity in the world congress of endoscopic surgeons in 1998. Objectives: To evaluate the feasibility, patient acceptance, recurrence and results of stapled haemorrhoidectomy in our early experience. Methods: Between Jan 2012 and Dec 2013, 42 patients with symptomatic GRADE III and IV hemorrhoids were operated by stapled hemorrhoidectomy by a single surgeon at our surgery department. The evaluation of this technique was done by assessing the feasibility of the surgery; and recording operative time, postoperative pain, complications, hospital stay, return to work and recurrence. Results: All the procedures were completed successfully. The mean (range) operative time was 30 (20 - 45) min. The blood loss was minimal. Mean (range) length of hospitalization for the entire group was 1 (1 - 3) days. Only 3 patients required more than 1 injection of diclofenac (75 mg) while as rest of the patients were quite happy switching over to oral diclofenac (50 mg) just after a single parenteral dose. All the patients returned to their routine work in less than a week’s time. The mean (range) follow-up was 6 (4 - 12) months. There were no major intraoperative or postoperative complications except for retention of urine in 8 patients. The patients are still on regular follow-up and have not had recurrence as yet. Conclusion: Stapled hemorrhoidectomy technique is a safe alternative to the traditional Milligan-Morgan technique. It can be performed as an office procedure, is well tolerated by patients and is cost effective than conventional surgical therapy.

Laparoscopic Surgery for Meckel’s Diverticulum Presenting as Small Bowel Obstruction: A Case Report  [PDF]
Mushtaq Chalkoo, Mumtaz-Din Wani, Hilal Makhdoomi, Ankush Banotra, Yassar Arafat, Awhad Mueed, Syed Shakeeb
Surgical Science (SS) , 2016, DOI: 10.4236/ss.2016.711067
Abstract: Meckel’s diverticulum is not commonly encountered surgical entity and presents unique challenges for a pediatric surgeon, as it is prone to varied complications. A 14-year-old boy was admitted with us with a 48-hour history of lower abdominal pain and multiple episodes of vomiting. Radiological imaging studies revealed a high-grade partial small bowel obstruction. A fleeting conservative management was tried. The diagnostic laparoscopy revealed a small bowel obstruction secondary to a Meckel’s diverticulum. The diverticulum was resected using an endovascular GIA stapler. The patient was discharged on postoperative day four, tolerating a regular diet. Laparoscopy is a useful diagnostic and therapeutic means for a patient with a small bowel obstruction due to an uncertain etiology.
An Analysis of War Weaponry Trauma Victims from a Medical College Setting in Kashmir Valley  [PDF]
Mumtazdin Wani, Mushtaq Chalkoo, Peer Hilal Ahmad Makhdoomi, Ankush Banotra, Awhad Mueed, Yassar Arafat, Syed Shakeeb
Surgical Science (SS) , 2017, DOI: 10.4236/ss.2017.81002
Abstract: Background: Kashmir valley, being a known conflict zone keeps on receiving war victims due to scuffles between civilians and the government forces. Such upsurges have been noted in the recent past in 2008 and 2010; however, a new face of upheaval took place in the month of July 2016. Herein, we present an analysis of 500 abdominal trauma victims reported to our department at Government Medical College Srinagar, Kashmir, India. Methods: Government Medical College Srinagar Kashmir is a tertiary care teaching hospital situated in the heart of Kashmir valley. Being one of the referral hospitals, for trauma, we received a total figure of 6149 trauma victims out of which 500 were purely of abdominal in nature managed by the department of surgery. The study conducted was a short analysis of these abdominal trauma patients that reported from 8th July to 8th November 2016. Results: The result of analysis of 500 abdominal trauma patients is reported herein. The male female ratio of patients was 19.8:1 (male = 95.2%, female = 4.8%). The age range was from 5 years to 65 years with majority reported in the age range of 15 - 30 years. The number of bullet injuries was =85 and the pellet injuries were =349. The commonest organs involved were small intestines, spleen, large bowel and liver in descending order. Penetrating injuries were seen in =60.4%, non-penetrating were seen in =39.6%. The patients were grouped into conservative, non operative and operative group. The commonest morbidity observed was wound sepsis and a total mortality reached to a figure of 2%. Conclusion: This short study of analysis of trauma victims has explored the newer horizons of trauma management and we believe and conclude that specialized trauma hospitals with skilled manpower and modern gadgets of handling trauma is need of an hour especially in developing countries like ours.
De-Noising of ECG Signals by Design of an Optimized Wavelet  [PDF]
Vahid Makhdoomi Kaviri, Masoud Sabaghi, Saeid Marjani
Circuits and Systems (CS) , 2016, DOI: 10.4236/cs.2016.711314
Abstract: In this paper, a different method for de-noising of ECG signals using wavelets is presented. In this strategy, we will try to design the best wavelet for de-nosing. Genetic algorithm tests wide range of quadrature filter banks and the best of them will be chosen that minimize the Signal-to-Noise Ratio (SNR). Furthermore, the wavelet function and scaling function related to these filters are reported as the best wavelet for de-noising. Simulation results for de-noising of a noisy ECG signal show that using obtained wavelet by proposed method improves the SNR of about 2.5 dB.
Hospital community benefits and the effect of Schedule H: A difference-in-difference approach  [PDF]
Helen Schneider, Hilal Yilmaz
Health (Health) , 2013, DOI: 10.4236/health.2013.510226

Since 1969 private, nonprofit hospitals have qualified for tax exemption as charitable institutions and in exchange for the preferential tax treatment were required to provide community benefits. However, in the absence of mandatory reporting of community benefits at the federal level and in the absence of a clear definition of community benefits, the previous literature provides but ambiguous evidence regarding hospitals’ supply of community benefits. Responding to policymakers’ concerns, the Internal Revenue Service (IRS) mandates all private, non-profit hospitals to report charity care at cost as well as unreimbursed Medicaid costs starting with the tax year 2008. Using data from hospitals in California before and after tax year 2008 (2009 filing), this study examines whether changes in the IRS 990 Schedule H had a significant effect on the supply of community benefits by non-profit hospitals relative to for-profit hospitals. Empirical results suggest that nonprofit hospitals do not supply more community benefits relative to for-profit hospitals for both definitions of community benefits reported in Schedule H. Although the supply of community benefits increased for all hospitals after 2008, the increase was not higher for nonprofits. Moreover, nonprofits supplied significantly less community benefits according to some definitions. Thus, minimum charity care standard is justified.

Hilal Turgut
Tarih Kültür ve Sanat Ara?t?rmalar? Dergisi , 2012,
Abstract: zetH zla de i en ve kal c olmayan bah e tasar mlar g ebe hayattan yerle ik hayata ge en Türk toplumunun de i im süreci i in nemli ipu lar verebilirdi. Ancak de erlendirme yap labilecek bah e rnekleri ok az bulunmakta ve olanlar n da de i ime u ray p u ramad klar net olarak bilinmemektedir. Bu al mada; farkl sanat ak mlar ile tan m olan, o unun varl n ancak kitaplardan bildi imiz tarihi Türk Bah elerinin havuz detaylar n n incelenerek Türk bah e kültürü hakk nda bilgi edinilmesi ama lanm t r. al mada, a rl kl olarak son tan k olan Sedad Hakk Eldem’in kaynaklar Türk dünyas n n nemli sanat kollar ndan olan tarihi belge niteli i ta yan minyatürler, gezgin notlar , e itli rehber nitelikli kaynaklar incelenmi tir. al mada minyatürlerin tercih edilme sebebi, minyatürlerin ince ayr nt lar n g sterildi i resimler olmas n n yan s ra Türk resminden nce minyatür sanat rneklerinin var olmas ve ar iv niteli inde al malar olarak de erlendirilebilmesidir. Minyatürde g rünümden ok fikir ve ger eklik n plandad r. al man n sonucunda bundan sonra yap lacak Türk Bah esi al malar i in daha detayl bir bak a s ortaya konulmas umut edilmektedir. The fast changes and non-permanent designs in Historical Turkish gardening could have given us important hints about the process of how nomadic Turkish people transformed into the settled life. But there are few samples of these designs to know if they underwent any changes. This study aims at giving information about the pool structures in the historical Turkish gardens, which are closely related to the Turkish culture. In doing so, the study examines the works of Sedad Hakki Eldem, together with miniatures, travel notes and various guiding notes. The reason why miniatures are chosen is because they are not only the pictures which give details but they were also existing in Turkish culture before the painting was used, so that miniatures could be evaluated as archives. In miniatures, idea and realism are more important rather than the look. As a result of this work, we expect to have a more detailed understanding of Turkish gardens for future use.RésuméLes dessins des jardins en pleine mutation peuvent donner des indices importants relatifs au processus de changement de la société Turque qui passe de la vie nomade à la vie urbaine. Cependant, il y a très peu d’exemples de jardin pour pouvoir évaluer ces changements, nous ne savons d’ ailleurs pas si ces transformations/changements ont eu lieu. Dans cette étude, nous avons voulu obtenir des renseignements au sujet de la culture du jardin
The effect of stopping power ratios of different protocols on %DD curve
Hilal ACAR
Turkish Journal of Oncology , 2009,
Abstract: OBJECTIVES: The effects of the stopping power ratios of different protocols on %DD curve were investigated in this study. METHODS: Percentage ionization curve was measured at SSD=95 cm using 10x10 standard cone and 6, 8, 10, 12, 15 and 18 MeV electron energies. Stopping power ratios at each depth were determined as recommended by the three protocols. %DD curves were then found and compared. The stopping power ratios of the different protocols were determined and plotted against R50. RESULTS: The stopping power ratios of the different protocols did have an effect on %DD curves. The clearest difference was seen at the surface. The maximum difference was 1.45% at 10 MeV, while the minimum difference was 0.09% at 6 MeV. CONCLUSION: Stopping power ratios as found using realistic electron beams provide more accurate surface doses, as reported in the literature.
Comparison of IAEA absorbe dose protocols TRS 277, TRS 381 and TRS 398 for different electron energies
Hilal ACAR
Turkish Journal of Oncology , 2007,
Abstract: OBJECTIVES: In this study, calculation of absorbed doses according to three different IAEA protocols for 6, 8, 10, 12, 15, and 18 MeV electron energies were compared. METHODS: Absorbe dose measurements were made at SSD=95 cm distance, 10 x 10 cm standart cone and reference depth. Electron energies was measured with five different cylindirical chambers and three different paralel plate chambers. Polarity and recombination effects were measured for all ionization chambers and energies before absorbed dose measurements. RESULTS: After the measurements, calculations were made according to three different protocols. For Marcus parallel plate chambers, the ratio of absorbe dose protocols was between -2.04% to 2.64%. Except from Marcus for other parallel plate chamber difference was between 0.11% to 3.38% for 6 MeV, 0.33% to 1.37% for 8 MeV, 0.12% to 1.71% for 10 MeV, 1.35% to 0.23% for 12 MeV, 1.69% to 0.24% for 15 MeV and 0.22% to 1.74% for 18 MeV. CONCLUSION: Contrary to photon energies, difference between absorbe dose protocols for electron beam energies was high. The reason of the difference was arise from the fact that TRS 277 assumes perturbation factor of parallel plate chambers was “1”. As a result, TRS 398 protocol enables us to calculate much more accurate absorbe dose.
Energy and field size dependence of polarity
Hilal ACAR
Turkish Journal of Oncology , 2010,
Abstract: OBJECTIVES: The aim of this study was to investigate polarity effects of electron beams with different energies. METHODS: Energy dependence of polarity error was investigated at dmax and SSD=95 for 6, 8, 10, 12, 15 and 18 MeV electron beams from Phillips SL-25 LINAC. Field size dependence of polarity effect was investigated at dmax and SSD=95 cm using 6x6, 10x10, 14x14 and 20x20 cm2 standard electron cones for 6, 8, 10, 12, 15 and 18 MeV electron beams from Phillips SL-25 LINAC. RESULTS: Polarity effect decreased as electron beam energy increased. While polarity error was 0.52% for high energies, it increased up to 4.5% for low energies. Moreover, polarity error increased as field size increased for the same electron energy. CONCLUSION: In conclusion, especially for low energies and wide field sizes, polarity error is measured and used in absolute dose calculations for parallel plate chambers.
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