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Öğe A rare case: Isolated superior mesenteric vein injury occurring after blunt abdominal trauma(Turkish Association of Trauma and Emergency Surgery, 2020) Kubat, MehmetIntraabdominal vascular injuries due to blunt abdominal trauma are rare. It is very difficult to visualize superior mesenteric vein (SMV) and portal vein injuries under emergency conditions. In this case study, we reported a low-speed car accident, a patient with isolated SMV injury as a result of a blunt abdominal trauma that arose from a collision with a steering wheel. A 62-year-old male patient was admitted to the emergency department with minimal distention and diffuse tenderness in the abdomen. The presence of diffuse fluid in the abdomen and suspected liver injury were reported in ultrasonography. The presence of fluid in perihepatic and perisplenic areas was detected in abdominal tomography. No solid organ injury was observed. Laparotomy revealed an injury in the small intestine mesentery.There was a defect on SMV under splenic vein combination. End side vein anastomosis and primary repair were performed. During six months follow-up, the patient did not have active complaints, and there was no pathology in the SMV and portal vein.We think that the use of vascular repair techniques applied by experienced surgeons in hemodynamically stable superior mesenteric venous injuries is important concerning continuity of anatomical and functional integrity. © 2020 Turkish Association of Trauma and Emergency Surgery.Öğe Colonoscopic polypectomy: Analysis of 429 cases(2022) Sengul, Serkan; Kubat, MehmetAim: It is well known that most colorectal cancers develop from colon polyps. Therefore, removing polyps found during colonoscopy, regardless of their size and characteristics, is critical because of the risk of developing colorectal cancer. This study aimed to evaluate the outcomes of colonoscopic polypectomy performed in our clinic. Materials and Methods: The data of patients who underwent colonoscopy for various reasons between January 2018 and December 2020 and who had polypectomy performed during the procedure were evaluated retrospectively. These patients were divided into two groups, single polypectomy, and multiple polypectomy cases. Results: Single polyp was detected in 72% (n=309) of the 429 patients included in the study, whereas multiple polyps were detected in 28% (n=120). Of these patients, 62.9% (n=270) were male and 37.1% (n= 159) were female. The median age of patients with a single polyp (61.0) was lower than that of patients with multiple polyps (65.0) (p= 0.014). In patients with a single polyp, the most common localization was rectum (32.4%), and the most common histopathological subtype was tubular adenoma (50.8%). In patients who underwent multiple polypectomies, the most common localization was a sigmoid colon (25.5%), while the most common histopathological subtype was again tubular adenoma (48.1%). There was no statistically significant difference between the two groups in the severity of dysplasia (p = 0.838). A significant difference was found between polyp diameter and dysplasia severity in adenomatous polyps in both groups (p<0.001). Conclusion: Colonoscopic polypectomy effectively reduces the risk of colorectal cancer by removing precancerous polyps. Colon polyps are often prominent in the rectosigmoid region and more common in the male gender. An increase in the number of colon polyps is observed with age. In our country, a multicenter prospective study with many participants is required to characterize polyps.Öğe Comparison of tumor volume dependent mean diameter with the longest diameter and tumor volume in assessing axillary lymph nodes in breast cancer(College of Physicians and Surgeons Pakistan, 2020) Kubat, Mehmet; Karabulut, ZülfikarObjective: To investigate the effectiveness of tumor volume dependent mean diameter (Rmax) in determining axillary lymph node metastasis positivity instead of the largest diameter (Dmax) in breast cancer. Study Design: Descriptive study. Place and Duration of Study: Department of General Surgery, Ankara Training and Reseach Hospital, Turkey, from January 2009 to December 2018. Methodology: Patients with breast cancer, who underwent modified radical mastectomy and lumpectomy and axillary lymph node dissection due to invasive carcinoma, included in this study. Approximate vTm was calculated from the obtained tumor specimen dimensions using ellipsoid volume formula. From the sphere volume formula, Rmax, which gives the same vTm value, was reversely calculated. Efficacy and usability of Rmax value were evaluated on nomograms that are available online; and are used most frequently owing to its ease of use. Results: In 305 patients, mean Dmax was 3.4 ±1.8 cm, mean vTm was 17.9 ±35.9 cm3, and mean Rmax was 2.6 ±1.4 cm. For the distinction of ALNM positive and negative patients, Dmax significant [Area Under Curve (AUC) 0.709], Rmax significant [AUC 0.748] and vTm significant [AUC 0.748] efficacy was considered. Conclusion: When the relationships of Dmax and vTm with ALNM were compared in breast cancer cases, the efficacy of vTm is higher. It was found that vTm and Rmax can be used instead of Dmax. The relation of Rmax parameter with ALNM was found to be higher. When Rmax was used in nomogram samples, which are currently used in predicting ALNM positivity, it increased nomogram efficacy. © 2020 College of Physicians and Surgeons Pakistan. All rights reserved.Öğe Crystallized phenol treatment vs excision and primary closure in pilonidal sinus disease: A randomized clinical trial in adolescent patients(2022) Şengül, Serkan; Güler, Yılmaz; Çalış, Hasan; Kubat, Mehmet; Karabulut, ZülfikarIntroduction: Pilonidal sinus is a chronic inflammatory disease seen in the intergluteal sulcus. A wide variety of treatment modalities have been described for the management of this disease, however optimal therapy remains controversial. The study aims to compare phenol treatment, a minimally invasive method used in the treatment of pilonidal sinus disease, with the commonly practiced surgical methods of excision and primary closure in the adolescent age group. Patients and methods: Adolescent patients who presented with pilonidal sinus disease between January 2018 and December 2018 were randomized into 2 groups as phenol treatment and surgical treatment (after obtaining consent for the study). Early complications and recurrence rates after 24 months of follow-up were the two main endpoints of the study. Results: A total of 100 patients (phenol group n = 50, surgery group n = 50) were included in the study. Both groups were similar in terms of age, gender, and BMI. The mean duration of the procedure was 12.4 ± 2.84 min in the phenol group and 42.3 ± 7.22 min in the surgery group (p = 0.00). There was no difference in postoperative complications between the groups (p = 0.22). After 24 months of follow-up, recurrence was found in 8% (n = 4) of the cases in the phenol group and 10% (n = 5) of the cases in the surgery group (p = 0.5). Conclusion: In our study, phenol treatment and excision/primary closure methods for pilonidal sinus disease have similar complication and recurrence rates. However, phenol treatment seems to be the method of choice in the adolescent age group as it has the advantage of being a minimally invasive method and it does not affect subsequent surgical treatments. Level of evidence: Level II treatment study.Öğe Effect of propolis on wound healing in sacrococcygeal pilonidal disease: A randomized controlled clinical trial(Univ Karachi, 2021) Kubat, Mehmet; Karabulut, Zulfikar; Sengul, SerkanWound healing and recurrence are the leading problems encountered in sacrococcygeal pilonidal sinus disease. Propolis has a place in both traditional and complementary medicine, and in vitro and in vivo studies have reported its anti-inflammatory, anti-oxidant, anti-bacterial, anti-fungal and immunostimulant properties. In the present study, we discuss the effect of propolis on wound healing in sacrococcygeal pilonidal diseases treated with marsupialization. Patients who were admitted to our clinic with sacrococcygeal pilonidal disease were analyzed prospectively, with a total of 33 patients divided into study and control groups. All patients underwent marsupialization surgery, and the wound areas were analyzed post-operatively, on the 0, 7th, 14th, 28th days and on the day of complete recovery. An acceleration of wound healing was observed from the first week that was found to be even faster between days 14 and 28. The complete recovery score in the study group was significantly lower. Propolis can be used to accelerate wound healing when the marsupialization method is preferred in patients diagnosed with uncomplicated sacrococcygeal pilonidal cyst due to its low cost, good patient compliance, low side effect profile, lack of toxicity and high efficacy.Öğe Efficacy of blood parameters as indicators of the need for overdue urgent cholecystectomy in elderly patients with acute cholecystitis(Turkish Assoc Trauma Emergency Surgery, 2023) Kubat, Mehmet; Sengul, Serkan; Sahin, SerdarBACKGROUND: Although early cholecystectomy is recommended for patients with acute cholecystitis, conservative treatment followed by delayed cholecystectomy (DC) is a highly preferred modality, especially in older adult patients. However, some severe cases require overdue urgent cholecystectomy (OC). This study aimed to evaluate the ability of laboratory findings and Tokyo severity classification (TokyoSC) to differentiate those with the need for OC among elderly patients.METHODS: Laboratory/radiological/clinical findings of geriatric patients with acute cholecystitis on admission and TokyoSC were retrospectively analyzed. The DC and OC groups were compared. RESULTS: The mean age of the 164 patients was 72.3 +/- 6.4 years. White blood cell, neutrophil (NEU), immature granulocyte (IG), C-reactive protein, neutrophil-to-lymphocyte ratio (NLR), and TokyoSC parameters were all significant at P<0.001 in differentiation. NLR had a specificity of 98%, and TokyoSC had a sensitivity of 98%. CONCLUSION: NLR, NEU, IG, and TokyoSC were effective in differentiating patients who needed OC while planning conservative treatment + DC for older adult patients who were followed up due to acute cholecystitis. If the NLR is >9.9 and TokyoSC is moderate/ high, early cholecystectomy should be preferred instead of conservative treatment + DC in aged patients.Öğe Efficacy of blood parameters as indicators of the need for overdue urgent cholecystectomy in elderly patients with acute cholecystitis(2023) Kubat, Mehmet; Şengül, Serkan; Şahin, SerdarBACKGROUND: Although early cholecystectomy is recommended for patients with acute cholecystitis, conservative treatment followed by delayed cholecystectomy (DC) is a highly preferred modality, especially in older adult patients. However, some severe cases require overdue urgent cholecystectomy (OC). This study aimed to evaluate the ability of laboratory findings and Tokyo severity classification (TokyoSC) to differentiate those with the need for OC among elderly patients. METHODS: Laboratory/radiological/clinical findings of geriatric patients with acute cholecystitis on admission and TokyoSC were retrospectively analyzed. The DC and OC groups were compared. RESULTS: The mean age of the 164 patients was 72.3±6.4 years. White blood cell, neutrophil (NEU), immature granulocyte (IG), C-reactive protein, neutrophil-to-lymphocyte ratio (NLR), and TokyoSC parameters were all significant at P<0.001 in differentiation. NLR had a specificity of 98%, and TokyoSC had a sensitivity of 98%. CONCLUSION: NLR, NEU, IG, and TokyoSC were effective in differentiating patients who needed OC while planning conservative treatment + DC for older adult patients who were followed up due to acute cholecystitis. If the NLR is >9.9 and TokyoSC is moderate/ high, early cholecystectomy should be preferred instead of conservative treatment + DC in aged patients.Öğe Küçük Umbilikal Hernilerin Onarımında Sütür Onarım ile Meş Onarımının Karşılaştırılması: Retrospektif Kohort Çalışması(2023) Kubat, Mehmet; Sengul, SerkanAmaç: Küçük çaplı umbilikal hernilerin onarımında meş kullanımı gerekliliği klinik pratikte halen tartışmalı bir konudur. Çalışmamızda onarımında sık kullanılan meş ve sütür onarımı tekniklerinin ?3 cm çaplı umbilikal hernilerin; nüks, postoperatif ağrı ve hasta memnuniyeti açısından karşılaştırılması amaçlandı. Yöntem: Merkezimizde 3 yıllık süre içerisinde ameliyat edilen ?3 cm çaplı umbilikal hernilerin kayıtları retrospektif olarak değerlendirildi. Çalışmaya dahil edilen 218 hasta; meş onarımı ve sütür onarımı grupları ayrıldı. Nüks gelişmesi, dinlenirken ve fiziksel aktiviteyle ağrı, tedaviden memnuniyet açısından değerlendirildi. Bulgular: Meş onarımı ve sütür onarımı grupları arasında; nüks açsından anlamlı fark görülmedi (p=0,662). Meş onarımı grubunda, dinlenirken ağrı (p=0,002) ve fiziksel aktiviteyle ağrı (p=0,003) anlamlı daha fazla görülürken bu sonuçlar hasta memnuniyetinde anlamlı farklılık ile sonuçlanmadı (p=0,928). Sonuç: Küçük çaplı umbilikal hernilerin (?3 cm çap) onarımında sütür onarımı, daha az postoperatif ağrıya neden olması, nüks ve hasta memnuniyeti açısından meş onarımına göre fark görülmesi nedeniyle güvenle tercih edilebilir bulunmuştur.Öğe Laryngopharyngeal lesion awareness of physicians performing upper gastrointestinal endoscopy: Survey study(2022) Orhan Kubat, Gözde; Kubat, Mehmet; Demirtaş, Mahmut; Özgürsoy, Ozan BarışIntroduction: Early diagnosis of cancers in the laryngeal and pharyngeal (LF) region is important for minimally invasive treatment and prolongation of survival. In the practice of otolaryngology diseases, hypopharyngeal cancers are mostly diagnosed in the late period. The aim of this study is to evaluate the approaches of gastroenterology and general surgery specialists to LF region lesions during upper gastrointestinal (UGI) endoscopic procedures. Materials and Methods: Endoscopist physicians who agreed to participate in our study and performed UGI endoscopy were asked to fill out the online questionnaire and the results were evaluated. Survey results; It is based on demographic information, professional experience and characteristics of the procedure, endoscopy evaluation criteria, whether anatomical regions are evaluated and laryngeal and hypopharyngeal region lesions can be defined. Results: It was observed that 88% of the 100 participants who participated in the survey evaluated the LF region, and 71% encountered lesions in the hypopharynx, 62% with lesions obstructing the esophagus entrance, and 52% with laryngeal lesions. It was determined that 23.7% of the physicians who encountered hypopharyngeal lesions and 11.5% of the physicians who encountered laryngeal lesions took biopsies from the lesions in these regions. As the endoscopic experience increased, the identifiability of the lesions increased statistically significantly (p<0.05). The identifiability of the lesions was found to be statistically significantly lower in the group who thought that the education received during their residency was insufficient (p<0.05). Conclusion: With the routine evaluation of LF structures during endoscopy of the UGI, it is possible to diagnose lesions in this region at an early stage. In this age, where minimally invasive and organ-preserving endoscopic treatments are at the forefront, routine evaluation of LF regions should be included in the UGI endoscopy training required to increase the accuracy of diagnostic approaches. To increase the early diagnosis rate, endoscopists should be informed about the examination of anatomical regions in detail, and they should be encouraged to take biopsies in suspicious cases. In this period, the percentage of biopsy should be increased by performing simultaneous otolaryngology consultation.Öğe TİROİD İNCE İĞNE ASPİRASYON BİYOPSİSİ SONUCU ÖNEMİ BELİRSİZ ATİPİ TANISI KONULAN HASTALARIN DEĞERLENDİRİLMESİ(2020) Şahin, Serdar; Kubat, Mehmet; Çavuşoğlu, Nadir Turgut; Üstün, HüseyinAmaç: Tiroid bezi hastalıkları en önemli endokrinsorunlardan biridir. Tiroid ince iğne aspirasyon biyopsisi(TİİAB)’nin ana rolü; hastaları cerrahi ve konservatif tedaviseçenekleri açısından ayırt etmektir. Bu çalışma ile AnkaraEğitim ve Araştırma Hastanesi’nde tiroidektomi operasyonuuygulanmış hastalara ilişkin tiroid ince iğne aspirasyonbiyopsisi (TİİAB) sonuçları ile histopatoloji raporsonuçlarının karşılaştırılarak, tiroid nodüllerindeki İİABetkinliğinin değerlendirilmesi amaçlanmıştır.Gereç ve Yöntemler: Ankara Eğitim ve AraştırmaHastanesi’nde 2007-2012 yılları arasında TİİAB sonucuönemi belirsiz atipi tanısı konulan ve tiroidektomioperasyonu yapılan hastaların histopatolojik verilerikarşılaştırıldı.Bulgular: Çalışmamıza toplam 87 hasta dahil edildi.Hastaların 77’si (%88.5) kadın, 10 (%11.5)’u ise erkekti.Yetmiş yedi kadın hastanın 55’ine (%71.4) benign, 22’sine(%28.6) malign nodül teşhisi konuldu. On erkek hastanın8’ine (%80) benign, 2’sine (%20) malign nodül teşhisikonuldu.Sonuç: Önemi belirsiz atipi teşhisi konan hastalar, yaş vecinsiyet gibi demografik özellikleri, radyolojik inceleme,ayrıntılı öykü ve fizik muayene dahil olmak üzere klinikolarak bir bütün olarak değerlendirilmeli ve cerrahi kararlarıbu özelliklere göre verilmelidir.Öğe Utility of immature granulocyte in severity of helicobacter pylori infection(2022) Şengül, Serkan; Kubat, Mehmet; Güler, Yılmaz; Çalış, Hasan; Karabulut, ZülfikarIntroduction: Helicobacter pylori infection is a chronic bacterial infection associated with some extragastric diseases as well as gastric involvements that occur most commonly worldwide. In our study, we aimed to investigate the usability of immature granulocytes as a basic indicator that can reflect the severity of helicobacter pylori inflammation, to the best of our knowledge, for the first time. Materials and methods: Patients who underwent upper gastrointestinal endoscopy between April 2019 and April 2020 and were diagnosed with antral gastritis were included in this study. The relationship between helicobacter infection and its severity detected in gastric biopsies of patients and immature granulocyte count (IGC), immature granulocyte percentage (IG%), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and mean platelet volume (MPV) were investigated. Results: Of the 868 patients, 210 were HP negative, 658 were HP positive (218 mild HP positive, 293 moderate HP positive, and 147 severe HP positive). There were statistically significant differences between the HP negative and HP positive groups in terms of IGC, IG%, NLR, and PLR. However, IG% and IGC were not clinically useful because the median IG% (0.3 vs 0.3) and IGC (0.02 vs 0.02) were the same in the HP negative and total HP positive groups. Conclusion: In our study, IGC and IG% were not found useful to detect H. pylori intensity and severity of inflammation.Öğe Validation and Efficiency of a Scoring System Used in the Differentiation of Uncomplicated Appendicitis(2022) Kubat, Mehmet; Şahin, SerdarObjective: Various parameters are used to differentiate between complicated and uncomplicated appendicitis cases, and scoring systems are even created where these parameters are used together. The aim of this study was to evaluate the effectiveness of one of these scoring systems by external validation. Methodology: Retrospective evaluation was performed on the clinical, radiological and laboratory findings of patients who underwent an appendectomy between January 2018 and January 2021. Scoring was performed using the previously described scoring systems for each patient considered to have acute appendicitis as a result of imaging. They were divided into complicated appendicitis and uncomplicated appendicitis groups, according to clinical and pathological evaluation results. Results: While evaluating 425 patients, ultrasonography was used in 48% and tomography in 52% of the patients. Significant effectiveness of the score of ?6 was observed in the group using tomography (p<0.001, AUC: 0.838, Sensitivity 83.3%, positive predictive value 50.8%, specificity 84.3%, negative predictive value 96.3%). Significant effectiveness of the score of ?5 was observed in the ultrasonography group (p<0.001, AUC: 0.790, Sensitivity 85.7%, positive predictive value 39.0%, specificity 72.2%, negative predictive value 96.1%). Conclusion: The scoring system created for the selection of uncomplicated appendicitis cases has been shown to be effective and has been externally validated. Since each of the parameters used in the scoring system has higher efficiency than its independent effectiveness, scoring systems that evaluate clinical, radiological and laboratory variables together, give better results in clinical practice.Öğe Value of neutrophil-to-platelet ratio, immature granulocyte-to-lymphocyte ratio, red blood cell distribution width-to-lymphocyte ratio in differentiating complicated acute appendicitis(2022) Kubat, Mehmet; Şengül, SerkanBACKGROUND: The discovery that medical treatment could be successful in cases with uncomplicated acute appendicitis (UCAA) has revealed the need for successfully differentiating cases with complicated acute appendicitis (CAA). The present study examined the usability of neutrophil-to-platelet ratio (NPR), immature granulocyte-to-lymphocyte ratio, and red blood cell distribution width-to-lymphocyte ratio (RDWLR) in the CAA/UCAA differentiation. METHODS: A retrospective evaluation was made of patients undergoing appendectomy between January 2019 and December 2020. According to pathological and clinical findings, the patients were divided into negative appendectomy, CAA and UCAA groups. Laboratory parameters and associated ratios were evaluated by comparing the groups. RESULTS: The study included 348 patients. Of the patients, 11.2% had CAA, 81.6% had UCAA, and 7.2% had negative appendectomy. The neutrophil-to-lymphocyte ratio (AUC=0.742), platelet-to-lymphocyte ratio (AUC=0.707), immature granulocyte-to-lymphocyte ratio (AUC=0.782), monocyte-to-lymphocyte ratio (AUC=0.720), and RDWLR (AUC=0.711) were found significant in the differentiation between complicated and uncomplicated AA. The NPR (AUC=0.789) was found to be significant in the differentiation between positive and negative appendectomy. CONCLUSION: It was concluded that the immature granulocyte-to-lymphocyte ratio, NPR, monocyte-to-lymphocyte, and RDWLR, which have not been previously studied in patients with acute appendicitis (AA), could be used to differentiate between complicated and uncomplicated AA groups.
