Browsing by Author "Tulay, CM"

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    Langerhans cell histiocytosis: A rare cause of pathological rib fracture
    Yolcu, A; Tulay, CM; Temiz, P; Aydogdu, I
    Langerhans cell histiocytosis, formerly known as histiocytosis X, represents clonal proliferations of the antigen-presenting dendritic cells, which are normally found in many organs. It is a rare disease which tends to affect children and adolescents. In particular, adult-onset type is very rare. Herein, we present a female adult diagnosed with Langerhans cell histiocytosis of the rib without any systemic involvement which was successfully treated with surgery.
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    Do we really know the duration of pain after rib fracture?
    Tulay, CM; Yaldiz, S; Bilge, A
    Introduction: The duration of pain after rib fracture is the question physicians are most frequently asked. The duration of pain following a traumatic rib fracture without any comorbidity is not widely published. Aim: We report our experience to investigate the duration of pain following isolated traumatic rib fractures without any traumatic comorbidity. Material and methods: We examined 182 patients with isolated rib fracture without any trauma to other body parts. The numeric rating scale (NRS) for pain was used to rate the level of pain. The NRS pain scores were evaluated in the emergency department at presentation, on the 15th day, and at the 3rd and 6th months of trauma. The Mann-Whitney U test was performed for the statistical analysis. Results: The pain level of young patients on the 15th day and at the third month and sixth month was lower than that in the old group, and the difference was statistically significant. While patients with two rib fractures had a higher pain level in the emergency room than those with one rib fracture, there was no statistically significant difference at other time points. In patients with anterior fractures, the pain level was significantly lower than in the lateral and posterior regions, whereas in the lateral fractures, the pain score was significantly higher than others at all time points except at the 6th month. The pain score of displaced fractures was significantly higher than that of non-displaced ones at all time points except the 6-month follow-up. Conclusions: Rib fractures cause significant pain and need appropriate medication. The time of the 6th month could be an important milestone.
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    Oblique Chest X-Ray: An Alternative Way to Detect Pneumothorax
    Tulay, CM; Yaldiz, S; Bilge, A
    Purpose: To identify occult pneumothorax with oblique chest X-ray (OCXR) in clinically suspected patients. Methods: In this retrospective study, we examined 1082 adult multitrauma patients who were admitted to our emergency service between January 2016 and January 2017. Clinical findings that suggest occult pneumothorax were rib fracture, flail chest, chest pain, subcutaneous emphysema, abrasion or ecchymosis and moderate to severe hypoxia in clinical parameters. All of these patients underwent anteroposterior chest X-ray (APCXR), but no pneumothorax could be detected. Upon this, OCXR was performed using mobile X-ray equipment. Results: Traumatic pneumothorax was observed in 421 (38.9%) of 1082 patients. We applied OCXR to 26 multitrauma patients. Occult pneumothorax was evaluated at 22 patients (2.03%) in 1082 multitrauma patients. The 22 patients who had multitrauma occult pneumothorax on OCXR were internated at intensive care unit (ICU) and follow-up was done using OCXR and APCXR. Conclusions: OCXR can be an alternative imaging technique to identify occult pneumothorax in some trauma patients at emergency room and also follow period at ICU.
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    A thymic neuroendocrine carcinoma presenting with upper gastrointestinal bleeding: A case report
    Yaldiz, S; Yaldiz, D; Tulay, CM; Isisag, A
    Neuroendocrine carcinomas of the thymus are rare clinical entities, which can be complicated by endocrine abnormalities. These tumors are frequently associated with ectopic adrenocorticotropic hormone production giving rise to Cushing's syndrome. Herein, we describe a 23-year-old male case with upper gastrointestinal bleeding as the initial presentation of a thymic neuroendocrine carcinoma. This case was reported due to its extremely exceptional occurrence.
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    Video-Assisted Thoracoscopic Surgery for the First Episode of Primary Spontaneous Pneumothorax
    Tulay, CM; Yaldiz, S
    The aim of this study was to evaluate the use of a videothoracoscopic surgical (VATS) approach as the first-line treatment for primary spontaneous pneumothorax (PSP). One hundred sixteen patients who were diagnosed with pneumothorax and underwent surgery with VATS technique between January 2016 and January 2018 were included in the study. We observed 60 patients with a first episode of PSP and 56 patients with recurrent PSP who had undergone prior chest tube application. Surgery was done in the first 24 h after hospital admission. Duration of hospital stay and pneumothorax recurrence rate were recorded. Pain level was assessed on the fifteenth day after surgery using the numerical rating scale (NRS). Recurrent pneumothorax patients who were treated with chest tube application after their first episode were asked to evaluate their preference for surgery over chest tube via a questionnaire. Intraoperative bleb/bullous structures were detected in 102 (87.93%) of 116 patients. In the questionnaire of 56 patients with recurrent pneumothorax who had previously undergone chest tube, 44 (78.6%) stated that they would immediately accept operation instead of the chest tube, if recommended. The length of hospitalization was significantly less in patients who underwent surgery in the first episode. There was no statistical difference between pain scores. Employing VATS as the first-line treatment for PSP provides benefits of early return to normal daily life, better clinical satisfaction, and psychosocial outcomes.
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    Dyspnea: perfus?on ?ndex and tr?age status
    Tulay, CM; Gurmen, ES
    Purpose: To determine the relationship between perfusion index and the emergency triage classification in patients admitted to the emergency department with dyspnea. Methods: Adult patients who presented with dyspnea and whose perfusion index values were measured with Masimo Radical-7 device at the time of admission, at the first hour and the second hour of admission were included in the study. The PI and oxygen saturation measured by finger probes were compared and the superiority of their effects on the emergency triage classification was compared. Results: For the 0.9 cut- off value of the arrival PI level according to the triage status; sensitivity 79.25%; specificity 78.12%; positive predictive value is 66.7 and negative predictive value is 87.2. A statistically significant correlation was found between the triage status and the 0.9 cut- off value of the admission PI level. We can say that the ODDS rate of red triage is 13.63 times (95% CI: 5.99-31.01) times higher in cases with a PI level of 0.9 and below. In the ROC analysis, the cut-off value of 1.1 and above the admission PI level was determined as the most appropriate point for discharge. Conclusion: The perfusion index can help to determine the triage classification in emergency departments for dyspnea.
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    Pulmonary papillary adenoma: A case report and review of the literature
    Tan, A; Coban, S; Kandiloglu, AR; Nese, N; Özamrak, BG; Tulay, CM
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    Comparative analysis of two different Turkish hospital reports on polytrauma patients with thoracic trauma
    Yaldiz, S; Tulay, CM; Yaldiz, D; Arpat, AH; Bayülgen, A; Pirzirenli, MG; Balta, C
    BACKGROUND: The present study aims to assess whether there are any differences in the management and outcome of polytrauma patients with thoracic trauma in trauma units of two different hospitals in the same country; one hospital is near the Syrian border. METHODS: A retrospective analysis (January 2012 to January 2014) of 348 polytrauma casualties with thoracic trauma from Manisa Celal Bayar University Hospital (MH) were compared according to age, gender, mechanism of injury, associated injuries, abbreviated injury scale (AIS), injury severity score (ISS), treatment modalities, and mortality with 917 patients of Sanliurfa Training and Research Hospital (SH) registry (near the Syrian border). RESULTS: Of the 348 patients in the MH, 230 (66%) and of the 917 patients in the SH, 697 (76%) were males (p<0.001). Mean age was 45.6 +/- 18.3 yrs in the MH group and 26.4 +/- 22.4 yrs in the SH group (p<0.001). The SH patients had a larger proportion of stab wounds (MH; 9% vs. SH; 17%, p<0.05), gunshot injuries (MH; 5% vs. SH; 18%, p<0.05), higher mean ISS (MH; 30.2 +/- 8.4 vs. SH; 42.8 +/- 10.2, p<0.001), and increased mortality (MH; 2.6% vs. SH; 11.1%, p<0.001). AIS(abdomen) was the highest component in the SH registry (AIS(abdomen) = 4.8 +/- 0.7), whereas AIS extremities were the highest component in the MH registry (AIS(extremities) = 3.6 +/- 0.2). CONCLUSION: Significantly different demographic features, mechanisms of injury, worse outcomes and higher mortality rates in SH demonstrate and reflect the surgical challenges depending on the combat environment. Two hospitals in Turkey, one seemingly adjacent to a war zone and another with the more standard civilian experience highlight the impact of the Syrian conflict on the Turkish healthcare system.
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    Outcomes of coronary artery bypass surgery in syrian refugees
    Demir, D; Abanoz, M; Tulay, CM; Aydin, MS; Kasapoglu, BO; Merdanoglu, M; Altiparmak, IH; Gücü, A
    Background: In recent years, an increasing number of individuals have become refugees as a result of wars and domestic disturbance in their countries. The struggle for life of refugees under difficult conditions, increasing health problems, and insufficient Access to health services result in the loss of human lives. The aim of the present study was to present the outcomes of coronary artery bypass surgery in Syrian refugees. Methods: We performed emergency or elective bypass surgery to 53 Syrian refugees who ran away from civil war in Syria, between 2012 and 2014. The preoperative, intraoperative, and postoperative data of the patients were evaluated. Results: Of the patients, 18.9% sustained myocardial infarction, 34% had diabetes, 28.3% had COPD, and 52.8% were smokers. Two patients had emergency surgery and 51 patients had elective surgery. In the postoperative period, five patients (9.4%) were found to have atrial fibrillation. Cerebrovascular disease was observed at three patients (5.7%) in the postoperative period, and one patient had wound infection. A total of three patients (5.7%) died. Conclusion: The authors believe that under appropriate conditions, refugee patients should also receive therapy for chronic disorders in addition to emergency interventions.
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    Lung cancer from suspicion to treatment: An indicator of healthcare access in Turkey
    Kizilirmak, D; Kaya, ZY; Gökçimen, G; Havlucu, Y; Özyurt, BC; Gündogus, B; Esendagli, D; Kaya, BS; Yilmam, I; Aydemir, Y; Çolak, M; Afsin, E; Çetin, N; Idikut, A; Degirmenci, C; Tapan, ÖO; Gürkan, CG; Kocatürk, CI; Simsek, GÖ; Kalafat, CE; Niksarlioglu, EYÖ; Serdaroglu, ME; Karcioglu, O; Özyurt, S; Madran, EK; Bayrak, BY; Alasgarova, Z; Toprak, OB; Uçar, EY; Topal, BN; Baris, SA; Guliyev, E; Güzel, E; Küçük, S; Ocakli, B; Ketencioglu, BB; Selçuk, NT; Akyüz, MS; Özgür, ES; Yetkin, NA; Çetinkaya, PD; Deniz, PP; Atli, S; Çetindogan, H; Karakas, FG; Yilmaz, ES; Ergün, D; Ergcn, R; Tulay, CM; Ünsal, M; Demirkaya, I; Marim, F; Kaya, I; Demirdögen, E; Dilektasli, AG; Ursavas, A; Çelik, P
    Background: Lung cancer is the leading cause of cancer-related deaths worldwide. Before beginning lung cancer treatment, it is necessary to complete procedures such as suspecting lung cancer, obtaining a pathologic diagnosis, and staging. This study aimed to investigate the processes from suspicion of lung cancer to diagnosis, staging, and treatment initiation. Metbods: The study was designed as a multicenter and cross-sectional study. Patients with lung cancer from various health institutions located in all geographic regions of Turkey were included in the study. The socio-demographic and clinical characteristics of the patients, the characteristics of the health institutions and geographic regions, and other variables of the lung cancer process were recorded. The time from suspicion of lung cancer to pathologic diagnosis, radiologic staging, and treatment initiation, as well as influencing factors, were investigated. Results: The study included 1410 patients from 29 different medical centers. The mean time from the initial suspicion of lung cancer to the pathologic diagnosis was 48.0 +/- 52.6 days, 39.0 +/- 52.7 days for radiologic staging, and 74.9 +/- 65.5 days for treatment initiation. The residential areas with the most suspected lung cancer cases were highly developed socioeconomic zones. Primary healthcare services accounted for only 0.4% of pa-tients with suspected lung cancer. The time to pathologic diagnosis was longer in the Marmara region, and the wait time for staging and treatment initiation was longer in Eastern and Southeastern Anatolia. Patients who presented to chest disease referral hospitals with peripheral lesions, those with early-stage disease, and those who were diagnosed surgically had significantly longer wait times. Conclusion: The time between pathologic diagnosis, staging, and treatment initiation in lung cancer was longer than expected. Increasing the role of primary healthcare services and distributing socioeconomic resources more equally will contribute to shortening the time to diagnosis and improve treatment processes for lung cancer.