Browsing by Author "Sakarya, A"

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    Effects of octreotide and propranolol on colonic mucosa in rats with portal hypertensive colopathy
    Aydede, H; Sakarya, A; Erhan, Y; Kara, E; Ilkgul, O; Ozdemir, N
    Background/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.
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    Effect of polyethylene glycol 4000 on adhesion formation following thyroid surgery in rats
    Sakarya, A; Ilkgül, Ö; Aydede, H; Erhan, Y; Içöz, G; Kapkaç, M; Alkanat, M; Kara, E
    Background & 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.
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    A pilot comparative study between serological and genetic investigations in relationship to clinical outcomes on patients with cystic echinococcosis
    Altintas, N; Karamil, SA; Turkum, O; Akil, M; Sakarya, A; Bozkaya, H; Soltys, J; Altintas, N
    The aim of this study was to investigate whether Enzyme-Linked Immunosorbent Assays (ELISA) and Western Blotting (WB) methods could contribute to the assessment of clinical outcomes in genotype-defined cystic echinococcosis (CE) patients. Twenty-nine human isolates and blood samples have been taken from patients who underwent surgery or percutaneous aspiration (PAIR) for therapeutic purposes at Ege University and Manisa Celal Bayar University Hospitals. All sera of patients were screened for the presence of E. granulosus IgG antibodies using in-house approved ELISA and WB methods. According to the ELISA results, five patients had high, thirteen patients had medium and eight patients had low specific antibody level response which ranged 1/640 -1/5000. Despite confirmed WB positivity three patients were found to be negative by ELISA. Immunoblot analysis of EgAg showed many protein bands with size of 8, 12, 20, 22, 24, 36, 75 and 90 kDa. Among of them, 8 - 12 kDa bands (90 %), 20 - 22 kDa and 36 kDa bands presented strong reactivity against human serum specimens. No serum samples from healthy control reacted with EgAg. Phylogenetic analysis of resulting COX1 and NAD1sequences has revealed that all patients in our study were infected with the E. granulosus G1-G3 genotype. There was no consistent correlation between results of ELISA and WB, the number or size of cysts and genotype. Our study brings a unique contribution in terms of relationship between serological investigation, disease genotypes and clinical outcomes.
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    Value of P53 protein expression and its relationship with short-term prognosis in colorectal cancer
    Erhan, Y; Korkut, MA; Kara, E; Aydede, H; Sakarya, A; Ilkgül, Ö
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    Molecular Analysis of Cattle Isolates of Echinococcus granulosus in Manisa Province of Turkey
    Altintas, N; Oztatlici, M; Altintas, N; Unver, A; Sakarya, A
    Echinococcus granulosus is the causative agent of cystic echinococcosis (CE) in humans and many domestic animals, and still one of the most important global health problem in the world and in Turkey. Infection with metacestode causes severe illness and high economic losses. Several strains of Echinococcus have been identified based on the epidemiological and biological characteristics of strains. In this study, a total of 18 individual hydatid cyst samples from cattle were examined. They were obtained from central slaughterhouse in the province of Manisa/Turkey between 2010-2012. The total genomic DNA (gDNA) was extracted using RTA-DNA Isolation Kit (Gebze/Kocaeli, Turkey) according to manufacturer instructions from protoscoleces and cystic germinal membranes. The aim of this study was to provide molecular characterization of E. granulosus isolates which were obtained from cattles by using polymerase chain reaction (PCR) in Manisa province of Turkey. After PCR, to investigate the genetic characteristics of isolates, deoxyribonucleic acid sequencing of the mitochondrial cytochrome c oxidase subunit 1 (CO1) and nicotinamide adenine dinucleotide dehydrogenase subunit 1 (NAD1) genes were performed with ABI Prism Genetic Analyzer 3100 instrument. As a result of our study, all (18) cattle isolates were detected as E. granulosus sensu stricto (G1-G3 complex). This is the first molecular study report genotyping of Echinococcus isolates from cattle in Manisa province.
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    Effect of oncological treatment on serum adipocytokine levels in patients with stage II-III breast cancer
    Coskun, T; Kosova, F; Ari, Z; Sakarya, A; Kaya, Y
    Adipose tissue-derived hormones (adipocytokines), such as adiponectin, leptin, resistin and visfatin, and the pancreatic hormone insulin, have been suggested to play a role in carcinogenesis. We therefore hypothesized that the oncological treatment of breast cancer may alter the serum levels of these adipocytokines and insulin. In this study, we aimed to compare the serum levels of adipocytokines and insulin between the pre-and post-treatment period in patients with breast cancer. In this prospective study, 20 consecutive patients with stage II and III breast cancer underwent breast-conserving surgery or total mastectomy and/or axillary dissection. The patients received adjuvant chemotherapy and radiotherapy, if necessary. Blood samples were obtained during the preoperative period and postoperatively after completion of the adjuvant therapy. There was no statistically significant difference between the pre-and post-treatment levels of visfatin, adiponectin and leptin. However, the serum insulin and resistin levels and insulin resistance were found to be statistically significantly increased following treatment (P<0.05). Post-treatment resistin levels were positively correlated with insulin resistance (r=0.45, P<0.05). Therefore, oncological treatment of stage II and III breast cancer did not affect visfatin, adiponectin and leptin levels, but statistically significantly increased resistin levels and insulin resistance. In addition, the post-treatment resistin levels were positively correlated with insulin resistance, suggesting that resistin may be involved in the development of insulin resistance in breast cancer patients following treatment.
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    Laparoscopic repair of acquired lumbar hernia
    Sakarya, A; Aydede, H; Erhan, MY; Kara, E; Ilkgul, O; Yavuz, C
    Lumbar 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.
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    Effect of portal vein occlusion on the pancreas
    Aydede, H; Erhan, Y; Ikgül, O; Cilaker, S; Sakarya, A; Vatansever, S
    Background: The effects of portal vein occlusion on the pancreas are not clearly understood. Therefore, we studied histomorphological changes induced in the rat pancreas by various periods of portal vein occlusion. Materials and methods: Sixty female Wistar albino rats were randomly allocated into four groups of 15 each. In Group I (control), rats underwent sham laparotomy to expose the portal vein proximal to its bifurcation. In Groups II-IV, rats underwent laparotomy followed by portal vein occlusion by clamping for 15, 30, and 60 minutes respectively. The pancreas was removed immediately after sham laparotomy in Group I and immediately after clamp release in Groups II-IV. Pancreatic tissue specimens were subjected to histochemical analysis for cell typing and diagnosis, immunohistochemical analysis for identification of the inflammatory markers tumor necrosis factor-a (TNF-alpha), interleukin-1 beta (IL-1 beta), endothelial nitric oxide synthase (eNOS), and inducible NOS (iNOS), and TUNEL analysis was carried out for identification of apoptotic cells. Results: Histochemistry revealed signs of inflammation in pancreatic tissue from rats subjected to portal vein occlusion. Immunohistochemistry revealed that the expression of proinflammatory cytokines TNF-alpha and IL-1 beta and the oxidative damage indicator iNOS in rat pancreatic tissue increased progressively with the duration of portal vein occlusion. TUNEL assay revealed no signs of apoptosis in any of the groups. Conclusion: We conclude that portal vein occlusion triggers an inflammatory response in the pancreas that worsens the longer the occlusion lasts.
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    Laparoscopic cholecystectomy and postoperative pain relief
    Uncu, H; Aker, Y; Sakarya, A; Kaya, Y; Yurttas, O
    The purpose of this prospective study was to compare the effects of intraperitoneal lignocaine and piroxicam (a nonsteroidal antiinflamatory drug) in relieving postoperative pain after laparoscopic cholecystectomy. In the first group (n=15) intramuscular piroxicam 40 mg was used immediately at completion of surgery. Piroxicam tablet 20 mg was given to the patients once 24 hours after the injection. In the second group (n=15) 40 mi of 0.5% lignocaine were instilled into the right subdiaphragmatic space at the end of surgical intervention. Postoperative pain was evaluated by using a verbal rating scale at postoperative 1,2,6,12,24 and 48 h in the two groups. Pain was significantly less (P<0.05) in patients who received lignocaine into the peritoneal cavity in the early postoperative period and at the time of discharge. Subdiaphragmatic instillation of lignocaine was found more effective than proxicam in reducing postoperative pain after laparoscopic cholecystectomy.
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    The protective mechanisms of defibrotide on liver ischaemia-reperfusion injury
    Aydemir, EO; Var, A; Uyanik, BS; Ilkgül, Ö; Aydede, H; Sakarya, A
    During some surgical interventions, temporary occlusion of the hepatic blood supply may cause ischaemia-reperfusion (I/R) injury and hepatic dysfunction. In this study the protective effect of defibrotide (DEF) was evaluated in a rat model of liver I/R injury. Four groups of rats were subjected to the following protocols: saline infusion without ischaemia, DEF infusion without ischaemia, DEF infusion with hepatic I/R, and saline infusion with hepatic I/R. After a midline laporatomy, liver ischaemia was induced by 45 min of portal occlusion. DEF 175 mg/kg(-1) was infused before ischaemia in 10 ml of saline. The same volume of saline was infused into the control animals. At the end of the 45-min reperfusion interval, the animals were sacrified. Superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) enzyme activities were determined in haemolysates, and malondialdehyde (MDA) level in the liver tissue was measured. Tissue MDA levels were significantly higher in the I/R plus saline group compared to the sham operation control groups (p < 0.01 and p < 0.05, respectively). Tissue MDA levels decreased in the DEF plus I/R group compared to the I/R plus saline group (p < 0.05), but DEF could not reduce tissue lipid peroxidation to the levels of the control sham operation groups. SOD and GSH-Px enzyme activities were significantly higher in DEF-treated animals than in the other groups (p < 0.05). These results suggest that DEF protects liver against I/R injury by increasing the antioxidant enzyme levels. Copyright (C) 2003 John Wiley Sons, Ltd.
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    Effect of mesh and its localisation on testicular flow and spermatogenesis in patients with groin hernia
    Aydede, H; Erhan, Y; Sakarya, A; Kara, E; Ilkgül, Ö; Can, M
    In 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.
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    Gallstone ileus presenting as gastric outlet obstruction (Bouveret's syndrome)
    Sakarya, A; Erhan, MY; Aydede, H; Kara, E; Ozkol, M; Ilkgül, O; Özsoy, Y
    Gallstone 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.
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    The effect of tadalafil on anastomotic healing in ischemic small intestine in rats
    Kaya, Y; Coskun, T; Ayhan, S; Kara, E; Sakarya, A; Var, A
    To 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.
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    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, T
    Background : 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.
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    A case of large mucinous adenocarcinoma arising in a long-standing fistula-in-ano
    Erhan, Y; Sakarya, A; Aydede, H; Demir, A; Seyhan, A; Atici, E
    Background. Chronic anal fistulas are not rare conditions, however, the development of a carcinoma in a long-standing fistula-in-ano is rare. Methods: The case of a 77-year-old male with a large perianal mucinous adenocarcinoma arising in a long-standing fistula-in-ano is presented. Results: Perianal biopsy revealed mucinous adenocarcinoma. Abdominal CT, double contrast barium examination and flexible sigmoidoscopy revealed no other tumoral lesion in the colon and rectum. Conclusion: The patient underwent abdominoperineal resection including wide tumor excision on the gluteal region. The final reconstruction was performed by bilateral gracilis musculocutaneous flaps. Due to clinical and histopathological evidence it was thought that a curative resection had been performed. To date he is clinically disease free. Copyright (C) 2003 S. Karger AG, Basel.
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    Preoperative ultrasound to predict technical difficulties of conventional cholecystectomy
    Uncu, H; Yorulmaz, I; Aker, Y; Kaya, Y; Sakarya, A; Çiftdogan, C
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    Fine needle aspiration biopsy in the evaluation of thyroid nodules
    Uncu, H; Aker, Y; Sakarya, A; Kaya, Y
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    Comparison of prolene and progrip meshes in inguinal hernia repair in terms of post-operative pain, limitation of movement and quality of life
    Kaya, A; Sahin, ST; Kaya, Y; Coskun, T; Sakarya, A
    Objective: The study aimed to compare the techniques applying prolene mesh and progrip-self fixating mesh in terms of post-operative pain, limitation of movement and quality of life. Material and Methods: The study was conducted from November 2014 to January 2016 in Department of Surgery, Manisa Celal Bayar University Hospital. The study recruited 50 male patients, aged 18 and over and was carried out as a double blinded procedure. Twenty-five patients were randomly selected to receive hernia repair by progrip self-fixating mesh and 25 patients were treated with hernia repair with suture fixation method by using prolene grafts, and patients' pain follow-up was performed with face-to-face or telephone interviews with VAS (Visual Analogue Scale) and return to daily routine activities were evaluated with SF-36 (Short Form-36) quality of life scale. Recurrent hernias and emergency cases were excluded. Results: The pain scores were lower and a statistically significant difference was achieved in patients in whom progrip self-fixating mesh was used in the early postoperative period. Both methods gave statistically similar results in terms of pain and quality of life. Conclusion: In the literature, there are some evidence that the repair applied with progrip self-fixating graft has more positive outcomes compared to the repairs applied with suture fixation. It is concluded that there is a need for longer follow-ups and larger series of cases in order to achieve a definite result.
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    Case of Lemierre's syndrome presenting with thyroid abscess
    Kara, E; Sakarya, A; Keles, C; Borand, H; Pekindil, G; Göktan, C
    Lemierre'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.