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Porto-systemic shunt using adrenal vein as a conduit; an alternative procedure for spleno – renal shunt
Unal Aydin, Pinar Yazici, Murat Kilic
BMC Surgery , 2007, DOI: 10.1186/1471-2482-7-7
Abstract: A 26-year-old male suffered from recurrent variceal bleeding was considered for surgical therapy. Although we planned to perform a distal splenorenal shunt procedure, it was observed to be difficult. Therefore left adrenal vein was used as a conduit between left renal vein and splenic vein after splenic artery was ligated. He did well and was discharged from the hospital on the postoperative day 6. In the follow up period for nine months, endoscopic and ultrasonographic examinations were normal.We concluded that, in case of failure to perform distal splenorenal shunt due to technical problems, alternative porto-systemic shunt procedure using the adrenal vein as a vascular conduit can be safely employed.In spite of new therapeutic modalities such as pharmacologic, endoscopic (sclerotherapy or band ligation), and transjugular intrahepatic portosystemic shunt (TIPSS), surgical decompressive shunts still have an important place in the treatment of portal hypertension (PHT). One of the serious complications of PHT is variceal bleeding which can lead to death. Nevertheless, the success rate of the endoscopic and combined medical treatments is about 50%. A few surgical procedures such as Sugiura procedure for esophageal varices and Hassab-Paquet (A complete gastroesophageal devascularization with splenectomy) procedure for gastric varices have also been performed for PHT [1,2]. In case of failure of those procedures, surgical methods should be considered. Distal spleno-renal shunt (DSRS) and/or portocaval shunt are still regarded as the most popular surgical procedures in these patients [3]. Type of the surgical shunt should be chosen in the light of prognosis, anatomic variations and surgical experience.The technique of DSRS was first described by Warren in 1967. DSRS is originally end to side anastomosis between splenic and left renal veins [4]. End to side anastomosis may be unfavorable due to scar tissues or inappropriate diameter between the two veins. A few cases had
Leptin and NUCB2/Nesfatin-1 in Acute Appendicitis  [PDF]
Unal Bakal, Mehmet Sara?, Harun Ciftci, Tugay Tartar, Ahmet Kazez, Suleyman Aydin
International Journal of Clinical Medicine (IJCM) , 2015, DOI: 10.4236/ijcm.2015.612120
Abstract: Objective: Appetite loss is seen in 90% to 95% of patients with acute appendicitis; however, the cause of this symptom remains unknown. This study is performed to determine whether changes in the blood levels of two anorexigenic hormones, leptin and NUCB2/nesfatin-1, can help to diagnose acute appendicitis in children and whether these two parameters can distinguish acute appendicitis from abdominal pain. Methods: Sixty children with comparable ages and body mass indices are divided into three groups of 20 children each: those with acute appendicitis, those with abdominal pain, and controls. The blood sample with acute appendicitis is taken preoperatively (T1), and subsequent samples are taken 24 hrs postoperatively (T2) and 3 days postoperatively (T3). The blood sample with abdominal pain subjects is also taken in the corresponding times with those with acute appendicitis while blood sample from controls is only taken in the T1 corresponding time. Leptin and NUCB2/nesfatin-1 levels are measured by enzyme-linked immunosorbent assay. Results: The serum leptin levels are significantly higher preoperatively than postoperatively in all three groups. The NUCB2/nesfatin-1 levels at T1 in acute appendicitis are significantly higher than those at T2 in all three groups, but are restored at T3 to levels similar to those of controls. Neutrophil percentage has a sensitivity of 100%, and specificity of 76.32%, NUCB2/nesfatin-1 level has a sensitivity of 47% and specificity of 95%, and the leptin level has a sensitivity of 64% and specificity of 51% in the diagnosis of acute appendicitis. Conclusions: High preoperative leptin and NUCB2/nesfatin-1 levels may be a causative factor for appetite suppression observed in patients with acute appendicitis. High preoperative and low postoperative serum leptin and NUCB2/nesfatin-1 concentrations may serve as new candidate biomarkers that help to distinguish acute appendicitis from abdominal pain in children in addition to high CRP concentration, high WBC count, and neutrophilia.
Success of microvascular surgery; repair mesenteric injury and prevent short bowel syndrome: a case report
Unal Aydin, Omer V Unalp, Pinar Yazici, Adem Guler
BMC Emergency Medicine , 2007, DOI: 10.1186/1471-227x-7-11
Abstract: We present a 19-year-old boy with blunt abdominal trauma which caused serious mesenteric injury. Because ultrasound revealed free intraabdominal fluid, he underwent emergency laparotomy. Adequate vascularization of approximately 20 cm of proximal jejunal segment and approximately 20 cm of terminal ileum was observed. Nevertheless, the mesentery of the rest of the small intestine segments was ruptured completely. We performed an end-to-end anastomosis between a distal branch of the superior mesenteric artery in the mesentery of the ileal segment and a branch of the superior mesenteric artery using separate sutures of 7.0 monofilament polypropylene. The patient's gastrointestinal passage returned to normal on the postoperative day 2. He recovered without any complication and was discharged from hospital on the postoperative day seven.In this case report, we emphasize the importance of preservation of injured mesenteric artery due to abdominal trauma which could have resulted in short bowel syndrome.Although isolated small bowel or superior mesenteric artery (SMA) injury due to blunt abdominal trauma is quite rare, abdominal trauma is the reason of short bowel syndrome (SBS) in approximately 10% of the patients. Treatment and management of the SBS are difficult. SBS as a result of major intestinal resection due to isolated SMA injury was reported in the literature before. To our knowledge, this is the first case in the literature that the small intestine segment was preserved by arterial anastomosis to prevent SBS in a young patient with blunt abdominal injury. In this case report, we emphasized the importance of preservation of injured mesenteric artery due to abdominal trauma which could have resulted in SBS.19-year-old man was brought to the emergency service after a high speed car crash. On arrival at the emergency department, the patient was monitorized and maintained a heart rate of 120 beats/minute (sinus tachycardia), with a blood pressure of 90/40 mmHg. Fluid
Management of small bowel volvulus in a patient with simultaneous pancreas-kidney transplantation (SPKT): a case report
Unal Aydin, Pinar Yazici, Huseyin Toz, Cuneyt Hoscoskun, Ahmet Coker
Journal of Medical Case Reports , 2007, DOI: 10.1186/1752-1947-1-106
Abstract: Small bowel volvulus (SBV) is rarely encountered in adults. SBV generally occurs in a normal abdominal cavity and its etiology is still not clear. There are two categories of small bowel volvulus: a) primary small-bowel volvulus, in which there are no predisposing anatomical abnormalities, and b) secondary small-bowel volvulus, in which an acquired or a congenital abnormality causes rotation of the bowel [1]. There are a few reports in the literature that small bowel volvulus occurs as a late postoperative complication. The reported operations include gastrostomy [2], gastrectomy [3] and total hip replacement [4]. In this case report, a young woman underwent exploratory laparotomy due to small bowel volvulus after simultaneous pancreas-kidney transplantation (SPKT). This is the first report in the literature of small bowel volvulus secondary to SPKT.A 24-year-old female with a 14-year history of type I diabetes mellitus that was complicated by nephropathy, neuropathy, and retinopathy underwent SPKT at Ege University School of Medicine's Organ Transplantation Center. In the fifth postoperative month, she was admitted to the hospital with progressive abdominal distension and mild pain. The patient's prior surgical history indicated that her pancreas was located in the retroperitoneal region in the right iliac fossa and her kidney was located to the left. After Y graft interpositioning was performed between the splenic and superior mesenteric artery of the pancreatic graft on the back-table, anastomosis was performed on the right external iliac artery. The portal vein of the graft was end-to-side anastomosed to the recipient external iliac vein. The duodenal part of the graft, which was transected on both sides with circular stapler, was side-to-side anastomosed to the recipient jejunum 30 cm distal to the Treitz ligament (Figure 1a). After completing the transplant of the pancreas, the kidney transplant was performed on the left side. Although both grafts functioned a
Minimally invasive treatment of patients with bronchobiliary fistula: a case series
Unal Aydin, Pinar Yazici, Fatih Tekin, Omer Ozutemiz, Ahmet Coker
Journal of Medical Case Reports , 2009, DOI: 10.1186/1752-1947-3-23
Abstract: We present three Turkish patients with bronchobiliary fistula secondary to previous hepatic surgery due to hydatid cyst in two, a 19-year-old and a 47-year-old man, and iatrogenic trauma of the common bile duct by endoscopy in a 35-year-old man. All of the patients were successfully treated by minimally invasive methods including percutaneous drainage and endoscopic retrograde cholangiopancreatography.We suggest that bronchobiliary fistula could be managed through conservative treatment methods which do not require in-hospital follow-up, particularly in uncomplicated cases. Otherwise, surgical management can be unavoidable.Bronchobiliary fistula (BBF) is a relatively unusual entity, which is defined as an abnormal communication of the biliary system with the bronchial tree resulting in bilioptysis (bile-stained sputum). It was first described by Peacock in 1850 [1]. Patients with BBF usually present with expectoration of bile as a cardinal symptom. Therefore, the diagnosis is based on clinical symptoms as well as clinical history. The underlying factors are hepatic trauma, previous hepatobiliary surgery, hydatid disease, and other hepatic disorders [2,3]. There are still no definite guidelines for the optimal management of this rare condition because most of the reports on BBF are only in the form of case reports. In a 5-year period, we encountered two cases with BBF secondary to hepatobiliary surgery and one due to previous endoscopic intervention. All of the patients were of Turkish ethnic origin.A 19-year-old boy was admitted to the hospital with symptoms of abdominal tenderness located in the epigastric region and vomiting. Ultrasonography (US) demonstrated a hydatid cyst nearly 12 cm in size. The patient underwent cystotomy through a drainage procedure. His recovery was uneventful and he was discharged from the hospital on the fifth postoperative day. One month later, the patient presented with cough productive of greenish sputum. The cough had persisted for 2
Effects of retinoic acid on compensatory lung growth
Sami Karapolat, Aydin Sanli, Ahmet Onen, Unal Acikel, Oya Sivrikoz
Journal of Cardiothoracic Surgery , 2008, DOI: 10.1186/1749-8090-3-37
Abstract: Twentyone adult male Wistar albino rats from the same colony were used. They were divided into three groups (Group A, B and C). Group A undergone only left posterolateral thoracotomy. In Group B and C, the rats were subjected to left posterolateral thoracotomy and left pneumonectomy. In Group C, rats were given intraperitoneal Retinoic acid during the operation and continued to be given everyday postoperatively. Rats were sacrificed on the 10th day and their total body, right lung weights and right lung volumes were measured.The volume and weight indices of the lung were found to be higher in Group C. In histopathological examination, there was a reduction in the mean number of alveoli in Group B and C. A significant rise in the mean dimension and average wall thickness of the alveolar structure were determined in Group C.Retinoic acid contributes to the compensatory growth of the residual lung tissue.One of the most serious problems that may develop after lung resection is the situation that the existent remaining lung tissue becomes insufficient and can not provide enough oxygenization for the body. In most of these cases, no symptom is seen during rest, but with efforts, complaints like shortness of breath, palpitation and quick tiring due to insufficient oxygenization occur. This situation restricts the functional capacity, lengthens the time to return to daily activities and worsens the postoperative quality of life [1,2]. The hospitalization and loss of labour also increase.There occurs some growth in the residual lung tissue physiologically postoperatively. The volume, weight, collagen content, protein and cell size increase in the residual lung [3]. However, its not being in desirable degrees creates problems. This is especially important for the patients having limited respiratory reserve in the respiratory function tests performed preoperatively. Thus, providing a dimensional increase in the residual lung tissue contributes to the improvement of respirator
Is it more dangerous to perform inadequate packing?
Unal Aydin, Pinar Yazici, Murat Zeytunlu, Ahmet Coker
World Journal of Emergency Surgery , 2008, DOI: 10.1186/1749-7922-3-1
Abstract: Although small wounds of the liver parenchyma can be managed with electrocautery or simple suturing and hemodynamically stable patients, mostly with low-grade hepatic injuries due to blunt injury, can be managed nonoperatively, the treatment strategy of the patients sustaining major hepatic trauma is still controversial. Particularly deeper lacerations of the hepatic tissue are challenging for the surgeon. Abbreviated and necessary procedures such as packing procedure only done to keep the patients alive are called "damage control surgery" (DCS). In contrast, prolonged and extensive surgical procedures performed on critically injured patients often results in poor outcome with high mortality rates of 46% and 80% for grade IV and V injuries, respectively [1]. The majority of these deaths (54%) have been attributable to hemorrhage with resulting coagulopathy, acidosis, and hypothermia [2]. Peri-hepatic packing (PHP) procedure, which is the basic damage control technique to arrest hepatic hemorrhage, is one of the cornerstones of the trauma surgery and currently, this is the most commonly accepted and performed method for major liver trauma. The main goal after packing is to correct acidosis, hypothermia, and coagulopathy, the lethal triad causing death [3]. The literature review has allowed for emphasis on the most common problems of PHP, adequacy of particular indications, their evolution, timing, the results in general and critical situations in particular [4].This procedure requires caution during application, close observation after operation and experience to repair the injury in the re-look operation. Particularly, in some primary or secondary health care centers where a well-established intensive care unit or hepatobiliary or trauma surgeon is not available, the management of the trauma patients with severe hepatic injury is very difficult and mostly impossible. Thus, the damage control surgery, PHP for liver injury, has become the most common choice for tempor
Occurrence of Gregarina typographi (Apicomplexa, Gregarinidae) and Metschnikowia typographi (Ascomycota, Metschnikowiaceae) in Ips sexdentatus (Coleoptera: Curculionidae, Scolytinae) Populations in Kastamonu (Turkey)
Sabri Unal,Mustafa Yaman,Onur Tosun,Cicek Aydin
Journal of Animal and Veterinary Advances , 2012,
Abstract: In this study, Ips sexdentatus (Coleoptera: Curculionidae, Scolytinae) populations from Kastamonu (Turkey) were investigated for the occurrence of entomopathogens. Two species were encountered in the duration of this study and these were Gregarina typographi (Apicomplexa, Gregarinidae) and Metschnikowia typographi (Ascomycota, Metschnikowiaceae). Within the I. sexdentatus samples used in this study total infection rate of the pathogens G. typographi and M. typographi was calculated as 28.9%. Measurements of the Metschnikowia species identified from I. sexdentatus were as follows: mean length 16.86±2.2 μm and mean width 2.8±0.3 μm (n = 125). The ascospores of this pathogen were characteristically needle-shaped and therefore, easily distinguishable under the light microscope. The occurrence rate for the ascomycete pathogen (M. typographi) was 3.1%. The gregarine pathogen measured 108.1-203.5 μm and was identified as Gregarina typographi. The occurrence rate for the Gregarine pathogen was 25.8%. The first report for Turkey (Kastamonu) of an ascomycete fungus, Meschnikowia typographi from the pine bark beetle Ips sexdentatus (Boerner) is given in this study.
Corneal topographic changes in premenopausal and postmenopausal women
Erdinc Aydin, Helin Demir, Fazli Demirturk, Ahmet Cal?skan, Hakan Aytan, Unal Erkorkmaz
BMC Ophthalmology , 2007, DOI: 10.1186/1471-2415-7-9
Abstract: Thirty-six postmenopausal women with mean ages of 49.2 (range 39 to 57) were enrolled in this randomized, prospective study, comparing with 26 healthy controls with mean ages of 38.5 +/- 4.9 (range 32 to 49). Subjects were determined to be postmenopausal, by the Gynecology and Obstetrics Department, based on blood Follicular Stimulating Hormone (FSH), Luteinizing Hormone (LH), Estradiol, Progesterone levels and clinical complaints. Complete ophthalmic examination and CVK using Haag-Streit System was performed in both premenopausal and postmenopausal women.Mean horizontal curvature and vertical curvature of central corneal power in premenopausal women were 43.5 +/- 1.25 Diopter (D), and 44.1 +/- 1.53 D. Mean horizontal curvature and vertical curvature of central corneal power in postmenopausal women were 43.9 +/- 1.4 D, and 44.6 +/- 1.3 D. The mean keratometric astigmatisms of premenopausal and postmenopausal women were 0.81 +/- 0.57 D (4–179 degrees), 0.74 degrees +/- 0.5 D (1–180 degrees) respectively. No significant corneal curvature changes were detected between premenopausal and postmenopausal groups (P > 0.05). On the other hand, we only found negative but significant correlation between horizontal corneal curvature and estrogen level of postmenopausal women (r = -0.346, p = 0.038).Menopause is physiologic process and may also affect corneal topographic changes. In postmenopausal women, corneal steeping was observed minimally compared to premenopausal women. The results suggest that changes in estrogen level of women with menopause are associated with slightly alteration of horizontal curvature of cornea.Corneal functions can be regulated by sex hormones that have been reported by epidemiologic studies; however, the mechanism of this phenomenon is not apparent. The estrogen receptor (ER), progesterone receptor (PR) and androgen receptor (AR) were found in the nuclei of human corneal epithelial, stromal and endothelial cells [1-3].The corneal variables, which ch
Isolated cecal necrosis mimicking acute appendicitis: a case series
Abuzer Dirican, Bulent Unal, Nuray Bassulu, Faik Tatl?, Cemalettin Aydin, Cuneyt Kayaalp
Journal of Medical Case Reports , 2009, DOI: 10.4076/1752-1947-3-7443
Abstract: The patients were two men and two women with a mean age at diagnosis of 59 years (range 46-68). The patients were of Turkish ethnic origin. All patients presented to the emergency room with acute abdominal pain and had symptoms of nausea and vomiting. The medical histories for three of the patients revealed end-stage renal failure requiring hemodialysis. The other patient had chronic obstructive pulmonary disease. Right hemicolectomy with anastomosis was performed in three patients and cecal resection with ileocolostomy was performed in the remaining one patient. All of the patients healed without complications. Median follow-up of patients was 24.5 (range: 17-37) months. There was no recurrence of ischemia in the remaining colon during the follow-up period of the patients.Isolated cecal infarction should be included in the differential diagnosis of acute pain in the right lower quadrant of the abdomen, especially in those patients on chronic hemodialysis. While diffuse ischemic disease of the intestine has high morbidity, mortality and recurrence rates, patients with isolated cecal necrosis have a good prognosis with early diagnosis and surgical treatment compared to those with diffuse ischemic disease.Ischemic colitis usually results from atherosclerosis and low blood flow. Acute colonic ischemia is a common cause of colitis in the elderly, in whom colonic ischemia is a cause of morbidity. However, ischemic colitis involving the cecum alone is quite rare, with only a few case reports in the literature. Isolated ischemic involvement of the right colon has been reported with increasing frequency, particularly in association with shock [1,2]. Cecal infarction presents with right lower quadrant pain, and therefore may resemble acute appendicitis. As this variant of ischemic colitis is less common, it may not be considered in the differential diagnosis of right lower quadrant pain. Given the possibility of cecal perforation, an early diagnosis and surgical treatment ar
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