Browsing by Author "Tireli M."

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    Is tomography severity index a predictor of prognosis and complications for acute pancreatitis?; [Tomografi şiddet i̇ndeksi akut pankreatitte prognozu ve komplikasyonlarin belirlemede yararlimidir?]
    (Turkish Surgical Society, 2003) Tireli M.
    The mainstay of the treatment in acute pancreatitis is the evaluation of severity of the disease. Various methods of clinical, radiological and biochemical as Ranson criteria, Glasgow scale, APACHE II scorring, peritoneal lavage, abdominal computerized tomography etc. have been used to determine the severity score of the disease. However nobody is still in agreement on a common diagnostic tool in acute pancreatitis. In fact, tomography severity index (TSI) is considered to be superior to the others. In this study, tomography severity index, Ranson criteria and Glasgow scale were compared in terms of the efficacy in determining further complications and also the prognosis of ninety patients with acute pancreatitis. While Ranson criteria and Glasgow scale were used in first 48 hours, tomography severity index was used in the first five days of admission. The patients with 3≥ scores for Ranson criteria and Glasgow scale and the ones with 6≥ scores for TSI were accepted as severe pancreatitis. In this study, the sensitivity and specificity of TSI were better than Ranson criteria and Glasgow scale but no differences were found for sensitivity among these three parameters. The specificity of TSI was better than Glasgow scale with statistically significance (p<0.05). However, no statistically difference was found between the specificity of Ranson criteria and TSI. On the other hand, TSI was superior to Ranson criteria and also Glasgow scale in terms of positive predictive value (p<0.05). TSI was also showed better results with statistically significance for demonstration of pancreatic necrosis, indication of necrosectomy and visualization of peripancreatic fluid collection when compared to Ranson criteria and Glasgow scale (p<0.05). Mortality did not seem to be affected statistically by the three parameters (p>0.05). In conclusion, TSI are better than Ranson and Glasgow scoring systems for prediction of the severity of the disease and local pancreatic complications.
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    Results of 21 patients with pancreatic necrosis and/or abscess treated by continous closed lesser sac or site lavage; [Pankreatik nekroz veya abseli 21 hastanin kapali sürekli Bursa omentalis veya loj lavaji yöntemiyle tedavisi]
    (Turkish Surgical Society, 2005) Tireli M.
    Purpose: The aim of this study was to evaluate the results of necrosectomy and continuous closed lavage of the lesser sac or site in the treatment of pancreatic necrosis and/or abscess. Background: Despite in its improvement in diagnosis and treatment, acute necrotizing pancreatitis is still associated with a high incidence of mortality and morbidity. The management of sterile necrosis is still controversial. Criteria for surgical intervention in sterile necrosis and choice of technique in debridement of necrosis (conventional passive drainage, continuous lavage of the lesser sac or open abdomen) are still matters of debate. Materials and Methods: Between February 1991 and August 2003, 21 patients with necrotizing pancreatitis were treated with necrosectomy followed by continuous closed lesser sac or site lavage. Results: Among our patients, 11 had infected necrosis and 6 had sterile necrosis. Additionally, two patients had infected necrosis and abscess, and two had pancreatic abscesses. Eight cases of acute attack were managed at another clinic however, upon development of large necrosis or abscesses, these patients were subsequently transferred to our clinic. 13 patients were treated at our clinic right from the start. Reasons for surgery in 21 patients were as follows: absence of definite diagnosis (4), pancreatic abscesses (4), infected necrosis (4), persistence or advancement of organ complication despite intensive therapy (3), presentation of sepsis signs (3), organized necrosis (2) and symptomatic pseudocyst (1). Six patients (28.6%) were documented with serious organ-system dysfunction. Three patients (14.3%) died and among those who lived nine patients developed serious complications. The hospitalization period for patients who survived averaged between 10-65 days. (Mean: 34.0). Conclusion: Infected pancreatic necrosis and/or abscess can be treated surgically; but management of sterile necrosis is still controversial. Conservative strategies can be applied succesfully to manage most patients with sterile necrosis. Necrosectomy supplemented by postoperative closed continuous lavage of the site not only offers debridement of devitalized tissue, but also prevents development of new necrosis through nonsurgical removal of necrotic tissue and biologically active and bacterial compounds.
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    Acute necrotizing pancreatitis: The results of the management of 38 patients; [Akut nekrotizan pankreatit: Otuz sekiz hastanin tedavi sonuçlari]
    (2006) Tireli M.; Yildirim A.; Güçlü C.; Çalik B.; Diliüz B.
    BACKGROUND: We evaluated the patients who underwent surgical or nonoperative treatment for acute necrotizing pancreatitis. METHODS: The study included 38 patients (22 males, 16 females; mean age 51.3 years; range 16 to 79 years) with acute necrotizing pancreatitis. Surgical treatment was performed in 23 patients, while 15 patients were treated conservatively. RESULTS: Gallstone (in 17 patients) was the most common cause of pancreatitis. Twenty-five patients had sterile necrotizing pancreatitis, while 13 patients had infected necrotizing pancreatitis. Fifteen of the 25 cases with sterile necrosis were treated conservatively. The other 10 patients were initially treated by conservative methods, and were later treated surgically (due to six incorrect diagnosis, three organ failures, and one symptomatic pseudocyst). We applied continuous lavage to six of those patients and conventional drainage to four of them. Mortality rate was 23.7% globally; 24.0% in the sterile necrosis group and 23.1% in the infected necrosis group. Mortality rate was 21.7% in the surgical treatment group, and 26.7% in the conservative treatment group. There were no statistically significant differences between those groups (p>0.05). Eleven of the 29 patients who survived had some complications. CONCLUSION: The management of sterile pancreatic necrosis is still a matter of debate. Most patients with sterile necrosis can be treated with conservative methods. Indication for surgery in sterile necrosis should be based on persisting or advancing organ complications and sepsis signs despite intensive care therapy. The patients with infected necrosis should be treated surgically. Surgical intervention is best deferred until the demarcation of necrosis is complete.
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    Gastric carcinoma demonstrating rhabdoid features
    (2010) Karadeniz T.; Ayhan S.; Turna A.; Tireli M.
    Rhabdoid tumor, first described as an aggressive kidney tumor in infants and children and also observed less commonly in extra-renal locations, is seen very exceptionally in the gastrointestinal system. Gastrointestinal tumors with rhabdoid features are also extremely rare. A 59-year-old man with a long history of nausea, vomiting and weakness had been diagnosed as "diffuse-type gastric carcinoma" by the evaluation of endoscopic biopsy specimen at an other hospital. The total gastrectomy specimen showed an ulcerated mass measuring 7x4x4 cm located at the lesser curvature. The tumor penetrated the entire gastric wall and invaded the perigastric fat. The histopathological and immunohistochemical evaluation revealed a gastric carcinoma with rhabdoid features. The tumor was presented to emphasize the importance of clinical, morphological and immunohistochemical differential diagnosis from diffuse type gastric carcinoma as it has a very poor prognosis and is rarely seen in the gastrointestinal system.
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    The results of the surgical treatment of alkaline reflux gastritis
    (H.G.E. Update Medical Publishing Ltd., 2012) Tireli M.
    Background/Aims: Alkaline reflux gastritis (ARG) is a major complication of gastric surgery. The symptoms of ARG may be intractable and remedial surgery may be required in this patients. The goal of this study was to present our experience reviewing surgical treatment of reflux gastritis. Methodology: During a 19-year period, we surgically treated 35 patients who had refractory ARG. Previously, gastric surgery was distal gastrectomy-gastrojejunostomy in 20 patients; truncal vagotomy-gastrojejunostomy in 11 and truncal vagotomy-pyloroplasty in 4 patients. Of 20 patients who underwent distal gastrectomy, 13 were treated with Roux-en-Y gastrojejunostomy, six with jejunal segment between the gastric pouch and duodenum (Henley technique) and one with conversion of Billroth II to Billroth I. Of 11 patients who initially underwent vagotomy-gastrojejunostomy, 8 were treated with Billroth II type gastrectomy and Roux-en-Y gastrojejunostomy and 3 with dismantling of a gastrojejunostomy, conversion of pyloroplasty. Four patients who originally underwent vagotomy pyloroplasty were managed with Billroth II type gastrectomy and Roux-en-Y gastrojejunostomy. Results: Mortality rate of this series was zero. Long-term follow-up was obtained in 29 (83.0%) patients. According to Visick criteria, twelve patients (41.4%) reported exellent; ten (34.5%) good; three (10.3%) fair and four (13.8%) unsatisfactory results respectively. Conclusions: Remedial gastric surgery can be indicated in patients who had persistent ARG symptoms despite conservative management. Careful patient selection is essential to achieve best results. © H.G.E. Update Medical Publishing S.A.
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    Factors affecting breast cancer treatment delay in Turkey: A study from Turkish Federation of Breast Diseases Societies
    (Oxford University Press, 2015) Ozmen V.; Boylu S.; Ok E.; Canturk N.Z.; Celik V.; Kapkac M.; Girgin S.; Tireli M.; Ihtiyar E.; Demircan O.; Baskan M.S.; Koyuncu A.; Tasdelen I.; Dumanli E.; Ozdener F.; Zaborek P.
    Background: One of the most important factors in breast cancer (BC) mortality is treatment delay. The primary goal of this survey was to identify factors affecting the total delay time (TDT) in Turkish BC patients. Methods: A total of 1031 patients with BC were surveyed using a uniform questionnaire. The time between discovering the first symptom and signing up for the first medical visit (patient delay time; PDT) and the time between the first medical visit and the start of therapy (system delay time; SDT) were modelled separately with multilevel regression. Results: The mean PDT, SDT and TDT were 4.8, 10.5 and 13.8 weeks, respectively. In all, 42% of the patients had a TDT >12 weeks. Longer PDT was significantly correlated with disregarding symptoms and having age of between 30 and 39 years. Shorter PDT was characteristic of patients who: had stronger self-examination habits, received more support from family and friends and had at least secondary education. Predictors of longer SDT included disregard of symptoms, distrust in success of therapy and medical system and having PDT in excess of 4 weeks. Shorter SDT was linked to the age of >60 years. Patients who were diagnosed during a periodic check-up or opportunistic mammography displayed shorter SDT compared with those who had symptomatic BC and their first medical examination was by a surgeon. Conclusion: TDT in Turkey is long and remains a major problem. Delays can be reduced by increasing BC awareness, implementing organized population-based screening programmes and founding cancer centres. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.