Browsing by Author "Kara, E"
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Item Case of Lemierre's syndrome presenting with thyroid abscessKara, E; Sakarya, A; Keles, C; Borand, H; Pekindil, G; Göktan, CLemierre's syndrome is an uncommon condition characterized by post-anginal septicemia due to anaerobes. Reported here is a case of Lemierre's syndrome presenting with thyroid and liver abscesses. At presentation, the 70-year-old female patient complained of fever, jaundice and neck pain. Computed tomography (CT) and ultrasound confirmed the presence of a left-sided internal jugular vein thrombosis as well as abscesses in the left thyroid lobe and the right lobe of the liver with pleural effusion. The thyroid abscess was treated with a left lobectomy.Item Effects of octreotide and propranolol on colonic mucosa in rats with portal hypertensive colopathyAydede, H; Sakarya, A; Erhan, Y; Kara, E; Ilkgul, O; Ozdemir, NBackground/Aims: The aim of the study is to clarify the effects of actreotide and propranolol, agents used in the treatment of portal hypertension, on mucosal changes in portal hypertensive colopathy. Methodology: Portal hypertension was induced in all rats by partial portal vein ligation, and after the operation all rats were caged for a 10-week period. Then, animals were divided into three groups and for two weeks medical treatment were administered to the individual groups as follows: Control group, octreotide 100 mup/kg/12 hours, subcutaneously. Propranolol group, propranolol 20 mg/kg/day, intraperitoneally. In order to assess the portal hypertensive colopathy, criteria such as mean diameters of dilated vessels in colonic mucosa, and the existence of mucosal edema, capillary ectasia, hyperemia and hemorrhage inflammation were used. Results: When parameters were compared for the control versus propranolol groups, mucosal edema and hyperemia and hemorrhage criteria were found to be significant for the propranolol group; control versus octreotide groups, mucosal edema, capillary ectasia, and hyperemia and hemorrhage criteria were found to be significant for the octreotide group; octreotide versus propranolol groups, capillary ectasia and mucosal edema criteria were found to be significant for the octreotide group. Conclusions: The mucosal changes in portal hypertensive colopathy could be corrected by drugs modifying portal blood flow, octreotide may find a place in the treatment of portal hypertensive colopathy.Item Effect of polyethylene glycol 4000 on adhesion formation following thyroid surgery in ratsSakarya, A; Ilkgül, Ö; Aydede, H; Erhan, Y; Içöz, G; Kapkaç, M; Alkanat, M; Kara, EBackground & objectives: Difficulties in dissection encountered during. reoperative thyroid surgery could be minimised by preventing formation of adhesions in the,operative field. We studied the prevention of adhesion formation in rats after thyroid surgery by using polyethylene glycol 4000 (PEG 4000). Methods: Twenty two rats in two equal groups were studied. Right hemithyroidectomy was performed in both groups with 0.9 per cent saline being instilled in. the operative field in the control group and PEG 4000 solution in the study group. After 10 days, all rats were re-explored and the remaining thyroid tissue of the right lobe was excised. The specimens were scored according to the thickness of the connective tissue over the remainder of the thyroid gland. Results: The connective tissue thickness over the remaining tissue of the thyroid gland in the control and study groups was 272.04 +/- 77.10 and 172.90 +/- 48.92 mum respectively. The decrease of the connective tissue thickness over, the remainder of thyroid gland in the study group Was significant (P<0.05). Interpretation & conclusion: In this animal model although application of PEG 4000 did not completely prevent adhesion formation, a significantly decreased amount of adhesions was found.Item Endometriosis associated with relapsing ascites and pleural effusionsHasdemir, PS; Ikiz, N; Ozcakir, HT; Kara, E; Guvenal, TItem Value of P53 protein expression and its relationship with short-term prognosis in colorectal cancerErhan, Y; Korkut, MA; Kara, E; Aydede, H; Sakarya, A; Ilkgül, ÖItem Life-threatening abdominal injury during a soccer game: a rare clinical caseKara, E; Içöz, G; Ersin, S; Çoker, ASoccer (football) is a popular sport worldwide and can result in severe abdominal injuries. Nevertheless, the necessity of surgical intervention for abdominal organ injuries has been reported rarely. We report a case who was injured during a soccer game who underwent abdominal surgery. Distal subtotal pancreatectomy, splenectomy, cholecystectomy, and choledochotomy + T-tube drainage were performed. He was discharged on the postoperative seventh day without any complication.Item Perforation of the stomach due to chest tube complication in a patient with latrogenic diaphragmatic ruptureIcoz, G; Kara, E; Ilkgül, Ö; Yetgin, S; Tunçyürek, R; Korkut, MADiagnosis of diaphragmatic injury is difficult. A case of iatrogenic diaphragmatic rupture is reported in which perforation of a herniated stomach occurred following left lobectomy and partial resection of the diaphragm for lung cancer. On the second postoperative day, bile-stained fluid coming out from the chest tube revealed gastrointestinal leakage. This rare complication of chest tube insertion, early diagnosis and treatment are emphasized.Item Effects of Silymarin and Pentoxifylline on Matrix Metalloproteinase-1 and-2 Expression and Apoptosis in Experimental Hepatic FibrosisKara, E; Coskun, T; Kaya, Y; Yumus, O; Vatansever, S; Var, ABACKGROUND: Many therapeutic strategies ha,e been proposed to treat liver fibrosis, but no drugs have been proved effective. Matrix metalloproteinases (MMPs) have been reported to play a role in some cellular cascades of hepatic inflammation and fibrosis. OBJECTIVE: The purpose of this study was to investigate whether silymarin and pentoxifylline (PTX) have hepatoprotective and antifibrotic effects in experimental hepatic fibrosis. METHODS: Sprague-Dawley rats were divided into 4 groups: silymarin group (silymarin 4 mg/kg . d(-1) orally, common bile duct ligation [CBDL]); PTX group (PTX 2 mg/kg . d(-1) intraperitoneally, CBDL); sham group (common bile duct [CBD] exploration only); and control group (saline 1 mL/d orally, CBDL). The CBD was explored and dissected Sufficiently to allow passage of a 3/0 silk suture via midline laparotomy. Oil day 10, all animals were euthanized via cervical dislocation. Then, 5-cm(3) liver samples from the right lobe were removed for histomorphologic evaluation and 3-mL blood samples were taken via cardiac puncture for biochemical analyses. Apoptosis was determined using the terminal deoxynucleotidyltransferase-biotin nick end-Libel (TUNEL) staining method. Plasma levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyltransferase; total and indirect bilirubin concentration; hepatic MMP-1 and -2 and tissue inhibitor of MMP (TIMP)-1 and -2 activity; and transforming-growth factor (TGF)-beta(1) concentration were Measured. Collagen content was determined by measuring hydroxyproline in liver samples. Malondialdehyde (MDA) was used to estimate lipid peroxidation. RESULTS: Thirty-two adult male Sprague-Dawley rats were divided into 4 groups: silymarin group (n = 7), PTX group (1) 7), sham group (n = 9), and control group (n 9). Compared with the control group (14.6 [2.44]), mean (SD) hepatocyte apoptosis (as measured by the ratio of TUNEL-positive cells) was significantly Suppressed in the silymarin group (1.2 [0.13]; P = 0.001) and the PTX group (3.8 [0.34]; P 0.001). Mean (SD) MMP-2 activity in the silymarin group (57.35 [9.89] mu g/mL; P = 0.04) and the PTX group (46.88 [9.56] mu g/mL; P 0.04) was significantly lower than that observed in the control group (232.32 [79.76] mu g/mL). Compared with the control group (1.37 [0.38] mu g/mL), TIMP-2 activity was significantly lower in the silymarin group (0-55 [0-13] mu g/mL; P = 0.04) and the PTX group (0.42 [0.09] mu g/mL; P = 0.01). Compared with the control group (909.17 [117.35] mu g/mL), TGF-beta(1) was significantly lower in the silymarin group (518.24 [30-34] mu g/mL; P = 0.01) and the PT X group (519.57 [47.27] mu g/mL; P = 0.01). Histomorphologic changes were significantly greater in the sham group than in the silymarin and PTX groups: hemorrhage (2.44 [0.29] vs 1.29 [0.18] and 1.57 [0.20], respectively; both, P = 0.04.); sinusoidal dilatation (2.22 [0.22] vs 1.57 [0.20] and 1.71 [0.18]; both, P = 0.04); presinusoidal polymorphonuclear cell infiltration (3.44 [0.24] vs 2.57 [0.20] and 2.14 [0.26]; P = 0.03 and P = 0.008, respectively); and inflammation (3.44 [0.24] vs 2.57 [0.20] and 2.14] [0.26]; P = 0.03 and P 0.008, respectively). In the control group, all biochemical markets were elevated, Supporting the presence of liver injury. Compared with the control group (630.00 [46.80] U/L), plasma AST activity was significantly lower in the silymarin group (443.11 [78.73]; P = 0.04) and the PTX group (349.42 [34.00]; P = 0.03). Compared with the control, group (191.12 [32.93] U/L), plasma ALT activity was significantly lower in the silymarin group (86.14 [4.97]; P = 0.04) and the PTX group (84.14 [11.21]; P = 0.04). MDA concentration was significantly lower in the silymarin group compared with the control group (0.08 [0.01] VS 0.22 [0.03] nmol/mL; P = 0.004); MDA was also significantly lower in the silymarin group than in the PTX group (0.11 [0.02]; P = 0.03). CONCLUSIONS: Silymarin and PTX were associated with lower histopathologic liver damage, hepatocyte apoptosis, and regulation of extracellular matrix proteins. Lipid peroxidation in heparocytes was significantly lower in the silymarin group Compared with the PTX group. Silymarin and PTX appeared to have hepatoprotective effects in this experimental liver fibrosis model, but further clinical and experimental studies are needed. (Curr Ther Res Clin Exp. 2008;69:488-502) (C) 2008 Excerpta Medica Inc.Item Laparoscopic repair of acquired lumbar herniaSakarya, A; Aydede, H; Erhan, MY; Kara, E; Ilkgul, O; Yavuz, CLumbar hernias are rare; approximately 300 cases have been described in the literature since their first description. They are typically subdivided by categories such as congenital or acquired and by their location. Acquired lumbar hernias may follow trauma, poliomyelitis, loin incision, and the use of iliac crest as a donor site for bone grafting. Although they tend to grow in size and have a 25% risk of incarceration and 8% risk of strangulation, surgery is indicated once the lesion is confirmed. Many techniques have been described for surgical repair of lumbar hernias, including primary repair, local tissue flaps, and conventional mesh repair. All these open techniques require a large incision plus extensive dissection to expose the area. The first laparoscopic repair of lumbar hernia was described in 1996. The laparoscopic approach for lumbar hernia has significant advantages: it enables exact localization of the anatomic defect, the mesh can be placed deep into the defect allowing intraabdominal pressure to hold it in position, and it also has all the well-known advantages of the laparoscopic approach. We present two cases of laparoscopically repaired acquired lumbar hernias.Item Gastric Metastasis of Merkel Cell Carcinoma: Case ReportTemiz, P; Ayhan, S; Adigüzel, L; Kara, E; Okçu, GMerkel cell carcinoma (MCC) of skin is a rare tumor with aggressive behavior. Local recurrences, regional lymph node and distant metastases of MCC are frequent but to date metastasis to upper gastrointestinal tract was reported only a few. We present a 75-year-old man who had primary MCC at his left thigh. The tumor was excised and the patient was directed to local radiotherapy. He had developed abdominal and thoracal subcutaneous metastatic nodules within 5 and 8 months after surgical excision, respectively. In the tenth month, a second operation had to be performed because of a perforated duodenal ulcer and incidentally a submucosal yellow-white nodule measuring 2 cm in diameter was found in the wall of gastric cardia and excised. This lesion was histologically identical to the primary tumor, hence, gastric metastasis of MCC. The patient rejected further therapy and died 17 months after the initial diagnosis. Differential diagnosis of MCC and distinction of gastrointestinal MCC metastasis from primary neuroendocrine tumors may be difficult. Clinical information and histopathological features along with the results of immunohistochemical stainings are very important in this distinction.Item Antiphospholipid antibody syndrome (APS) presenting as splenic thrombosis and acute acalculous cholecystitisKara, E; Ayden, HAntiphospholipid syndrome is an uncommon auto-immune disease presenting with various clinical manifestations that may lead to surgical intervention and sometimes even life-threatening emergencies. This syndrome presents with venous and arterial thrombosis of many organs such as liver, kidney and of the skin etc. Clinical manifestations may mimic hematological disorders and be misdiagnosed in some cases due to the complexity of the symptoms. In the present study, a 65-year-old man with APS syndrome presenting with severe abdominal organ pathologies that required surgical intervention, is reported.Item Adipocytokine levels of colon cancer patients before and after treatmentKosova, F; Coskun, T; Kaya, Y; Kara, E; Ari, ZAims and background: In the present study, we investigated the associations between pre- and post-treatment levels of adiponectin, ghrelin, resistin, visfatin and leptin levels in malign and benign groups Methods and study design: 20 malign colon carcinoma groups and 20 benign groups were included in this study. Serum levels of leptin, adiponectin, resistin, ghrelin, and visfatin were measured by Elisa kits (Milipore Corporation, Billerica, MA, USA). Results: In the malign group, serum ghrelin (71.90 +/- 23.7) levels significantly decreased (p<0.05) when compared to those in the benign (88.00 +/- 16.9) group. However, serum resistin (4.92 +/- 2.2, 3.39 +/- 1.1) levels increased statistically significantly (p<0.05). In the malign group, serum visfatin (0.85 +/- 0.6, 0.83 +/- 0.5), adiponektin (60.31 +/- 23.1, 56.39 +/- 25.9) and leptin (3.08 +/- 1.4, 3.74 +/- 1.3) levels were not statistically significantly different from those in the benign group. In the malign treatment group, serum adiponectin (102.64 +/- 50.3, 66.64 +/- 27.0) levels were increased significantly (p<0.05); however, serum visfatin (1.17 +/- 0.9, 0.68 +/- 0.3), ghrelin (85.52 +/- 29.5, 82.18 +/- 18.0), leptin (5.65 +/- 2.8, 3.16 +/- 1.1), and resistin (5.96 +/- 2.8, 5.65 +/- 1.7) levels did not change significantly (p<0.05) compared to those in the respective benign treatment group. Conclusions: We showed that adipocytokines were involved in the carcinogenic process. The present results suggest that resistin and ghrelin may be important biomarkers of colon cancer. Furthermore, an in vitro study will also be necessary to evaluate the direct function of these adipocytokines in cancer cells. In addition, it will be appropriate to conduct new studies with a large number of patients at different stages (Tab. 1, Fig. 2, Ref. 24). Full Text in PDF www.elis.sk.Item Comparison of Standard Open Wound Care and Vacuum-assisted Closure Therapy in Fournier's GangreneBali, ZU; Akdeniz, CB; Muezzinoglu, T; Üçer, O; Kara, EObjective: Management of Fournier's gangrene (FG) includes large wound debridement, broad-spectrum antibiotic, wound care and re-debridement if necessary. The aim of our study was to compare standard open wound care and vacuum-assisted closure (VAC) therapy in patients with FG. Materials and Methods: Thirty-three patients (29 males and 4 females) who underwent surgery for FG were enrolled in the present study. The data was evaluated retrospectively. The patients were divided into two groups according to wound care after large wound debridement. Standard open wound care with antibiotic pomade was performed twice a day in 14 patients arid VAC therapy was performed every 48-72 hours in 17 patients. The data of the two groups were compared. Results: Twenty-three (69.7%) patients had Diabetes Mellitus and 20 patients (60%) had poor hygiene. The re-debridement rate in patients who received standard open wound care was statistically higher than in those who underwent VAC therapy (p=0.016). There were no statistically significant differences in mortality rate, length of hospital stay and need for reconstruction between the groups. When the data were analyzed, no statistically significant difference was found in FG Severity index score, length of hospital stay and mortality rate. However, the relationship between mortality rate and location of lesion was statistically significant (p=0.03). Four patients died, 3 (75%) due to wide necrotizing fasciitis extending to the abdominal wall. Conclusion: The present study showed that the technique used for wound care did not influence mortality, need for reconstruction and length of hospital stay. The only advantage of VAC therapy was decreased re-debridement rate in patients with FG.Item Effect of mesh and its localisation on testicular flow and spermatogenesis in patients with groin herniaAydede, H; Erhan, Y; Sakarya, A; Kara, E; Ilkgül, Ö; Can, MIn this study, the long-term effects of mesh and its localisation (i.e. anterior or posterior) on testicular perfusion and testicular function were evaluated in groin hernia patients. Testicular function has been evaluated with spermiogram and testicular perfusion with colour Doppler ultrasonography. Group I : consisted of 30 posterior preperitoneal mesh repair patients Group 11 : consisted of 30 anterior tension-free repair patients. The operation types were randomised with a systematic sampling method. There was no statistically significant difference between pre-operative and postoperative spermiogram results for both groups. No statistically significant difference was found between the two groups in terms of Doppler flow parameters (PSV, EDV, RI and PI) for pre-operative, early and late postoperative periods. When Doppler flow parameters were compared for group I, statistically significant differences were found between preoperative and early postoperative values. No statistically significant difference was found between pre-operative and late postoperative values. This is also true for early postoperative values versus late postoperative values. When Doppler flow parameters were compared for group II, statistically significant differences were found between pre-operative and early postoperative values. No statistically significant difference was found between pre-operative and late postoperative values. This is also true for early postoperative values versus late postoperative values. These results support the idea that inguinal mesh application is still a safe procedure in patients with no children or who are undergoing infertility treatment, where testicular function is important.Item Effects of rofecoxib, a selective cyclooxygenase-2 inhibitor, on endothelial dysfunction, lipid peroxidation, and hepatocyte morphology in rats with sepsis-induced liver damageKara, E; Var, A; Vatansever, S; Cilaker, S; Kaya, Y; Coskun, TBackground: Sepsis remains a difficult problem for clinicians, with its systemic effects and high morbidity and mortality rates. The roles of oxidative stress, endothelial dysfunction, and lipid peroxidation in sepsis-induced organ damage are being investigated. Objective: The aim of this study was to investigate the effects of selective cyclooxygenase (COX)-2 inhibition on tissue lipid peroxidation, endothelial dysfunction, and hepatic cell morphology in a rat model of sepsis. Methods: Thirty rats with sepsis induced by cecal ligation and puncture were divided equally into 3 groups: treatment group (rofecoxib 1 mg/kg PO), control group (saline 1 ml, PO), and sham group (sham surgery only). All the rats were sacrificed I day after sepsis induction. The livers were removed using a median laparotomy for histopathologic and biochemical analysis. Results: Histomorphologic hepatic damage and lipid peroxidation were significantly reduced in the rofecoxib treatment group compared with the control group (P < 0.05 and P = 0.001, respectively). Endothelial nitric oxide synthase and inducible nitric oxide synthase staining of liver samples was statistically significantly reduced in the treatment group compared with the control group (both, P < 0.001). The hepatic nitric oxide level and malonyldialdehyde activity decreased significantly (,P < 0.001 and P = 0.001, respectively) in the rofecoxib group compared with the control group. Hepatic myeloperoxidase activity was similar between the treatment and control groups. Conclusion: Further investigation of selective COX-2 inhibition as an alternate therapeutic choice for sepsis-induced hepatic damage should be considered.Item Gallstone ileus presenting as gastric outlet obstruction (Bouveret's syndrome)Sakarya, A; Erhan, MY; Aydede, H; Kara, E; Ozkol, M; Ilkgül, O; Özsoy, YGallstone ileus is an uncommon condition that may result when a gallbladder or commonduct stone enters into the intestinal tract, usually as a result of an internal fistula between the gallbladder and the duodenum. It most frequently occurs in the terminal ileum. Gastric outlet obstruction syndrome due to the impaction of a gallstone in the duodenum passing through a cholecystoduodenal fistula was first reported in 1896 by Bouveret concern in 1-3% of patients with gallstone ileus. Since the first case-report, 300 other cases has been documented in the literature. Here we report a case of Bouveret's syndrome in order to increase awareness of this unusual cause of gastric outlet obstruction.Item The effect of tadalafil on anastomotic healing in ischemic small intestine in ratsKaya, Y; Coskun, T; Ayhan, S; Kara, E; Sakarya, A; Var, ATo investigate the effect of tadalafil on anastomotic healing in an ischemic small intestine. Standardized transection and anastomosis in the small intestine were performed in 48 male Sprague-Dawley rats divided into four equal groups (n = 12): group 1, normal anastomosis; group 2, ischemic anastomosis; group 3, normal anastomosis+tadalafil treatment; group 4, ischemic anastomosis+tadalafil treatment. Ischemia was established by ligating 2 cm of mesentery on either side of the anastomosis. Tadalafil was given to the rats once a day at dose of 5 mg/kg. The anastomotic bursting pressures and hydroxyproline concentrations were measured on postoperative day 4. A histopathological evaluation of the anastomoses was also performed. The bursting pressure and hydroxyproline concentration in group 2 were significantly lower than those in the other groups. There was no difference in the hydroxyproline concentration among groups 1, 3, and 4. While there was no difference between groups 3 and 4, the bursting pressures were significantly higher in groups 3 and 4 than in group 1. The histopathological evaluation revealed no significant differences in inflammatory cell infiltration, vascularization, or anastomotic collagen deposition among the groups. Tadalafil treatment improved the anastomotic bursting pressure and the hydroxyproline concentration in both normal and ischemic small intestine anastomosis.Item Evaluation of Risk Factors and Severity of a Life Threatening Surgical Emergency : Fournier's Gangrene (A Report of 15 Cases)Kara, E; Müezzinoglu, T; Temeltas, G; Dinçer, L; Kaya, Y; Sakarya, A; Coskun, TBackground : Fournier's gangrene is a rare, rapidly progressive, necrotising fasciitis of the external genitalia and perineum with high morbidity and mortality. Patients & Methods : 15 patients with Fournier's gangrene were enrolled. Gender, age, aetiology, predisposing factors, symptomatology, associated diseases, hospital stay, FGSI, and body surface area were analysed. Results : Ten males and five females were enrolled in the study. The mean age was 54 years (range 23-81). E.coli and acinetobacter were the common organisms cultured. All patients were treated with a common approach of resuscitation, broad-spectrum antibiotics, and wide surgical excision. Common predisposing factors included diabetes mellitus (73.3%), poor personal hygiene (60%), obesity (33.3%), psychosis (20%) and decubitus ulcers (13.2%). Whereas five (33.3%) patients developed synergistic gangrene of the scrotum secondary to anorectal disease, five (33.3%) had a urological source of infection. Mean BSA and FSGI scores were 15.93 +/- 3.13 and 6.02 +/- 0.95, respectively. Serum glucose > 140 mg/dl, the existence of septic shock on admission, the spread of gangrene to the perineum and abdominal wall (Groups C and D), BSA >= 24 cm(2), a cutaneous source of infection and FGSI scores >= 7 were factors affecting mortality rates with statistical significance (p < 0.05). There was a direct correlation between the culture of mixed type micro-organisms and the cutaneous source of infection (p < 0.05). The extent of gangrene correlated with higher FGSI scores (7) (p < 0.05). Mortality and morbidity rates were as 20% (n=3) and 60% (n= 9). Conclusion : Aggressive surgical debridement and combined antibiotherapy are essential in the management of Fournier's gangrene. FGSI and BSA are useful to assess the severity and prognosis of the disease.Item Hepatic perfusion changes in an experimental model of acute pancreatitis: Evaluation by perfusion CTTutcu, S; Serter, S; Kaya, Y; Kara, E; Nese, N; Pekindil, G; Coskun, TPurpose: It is known that acute pancreatitis may cause secondary changes in several organs. Liver is one of these involved organs. In different experimental studies hepatic damages were shown histopathologically in acute pancreatitis but there are a few studies about perfusion disorders that accompany these histopathologic changes. Perfusion CT (pCT) provides the ability to detect regional and global alterations in organ blood flow. The purpose of the study was to describe hepatic perfusion changes in experimental acute pancreatitis model with pCT. Materials and methods: Forty Sprague-Dawley rats of both genders with average weights of 250 g were used. Rats were randomized into two groups. Twenty rats were in control group and 20 in acute pancreatitis group. pCT was performed. Perfusion maps were formed by processing the obtained images with perfusion CT software. Blood flow (BF) and blood volume (BV) values were obtained from these maps. All pancreatic and liver tissues were taken off with laparotomy and histopathologic investigation was performed. Student's t test was used for statistical analyses. Results: In pCT we found statistically significant increase in blood volume in both lobes of liver and in blood flow in right lobe of the liver (p < 0.01). Although blood flow in left lobe of the liver increased, it did not reach statistical significance. Conclusion: The quantitative analysis of liver parenchyma with pCT showed that acute pancreatitis causes a significant perfusion changes in the hepatic tissue. Systemic mediators seem to be effective as well as local inflammatory changes in perfusion changes. (C) 2009 Elsevier Ireland Ltd. All rights reserved.Item A case of a diaphragmatic rupture complicated with lacerations of stomach and spleen caused by a violent cough presenting with mediastinal shiftKara, E; Kaya, Y; Zeybek, R; Coskun, T; Yavuz, CIntroduction: Diapraghmatic rupture is a clinical case that is mostly seen following a blunt thoracoabdominal trauma or is rarely reported as spontaneously induced by various factors. Clinical Picture: A 28-year-old man presented as an emergency with shortness of breath and severe abdominal pain following a violent cough. His chest radiography and computed tomography demonstrated left diaphragmatic rupture, mediastinal shift and herniation of gastric fundus into the pleural cavity. Treatment: Left thoracotomy for the replacement of herniated gastric fundus and median laparotomy for the repair of serosal layer of gastric fundus and a diaphragmatic gap were performed. Outcome: He made an uneventful recovery. Conclusions: Diaphragmatic ruptures may be caused by violent coughing with serious life-threatening complications.