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Öğe Anaesthetic management of an extremely obese woman undergoing open gastric bypass(Lippincott Williams & Wilkins, 2006) Akbay, Buket Kocaman; Hayıt, Feray; Pehlivan, Mevlüt; Ağartan, Canan…Öğe Assessment of anal sphincter function by sengstaken-blakemore tube anal manometry(Springer, 2007) Günal, Ömer; Gürleyik, Emin; Arıkan, Yüksel; Pehlivan, MevlütBackground: Anal manometry is a useful tool for testing the effectiveness of surgical treatment. However, most techniques for anal pressure measurement are not easily available because of high cost. The aim of the present study was to introduce an easy and reproducible method for measuring anal pressures in testing the effectiveness of surgical procedures. Materials and methods: We used a Sengstaken-Blakemore tube connected to a mercury manometer. After calibration of the system by inflating the distal (gastric) balloon and filling connection lines to the mercury manometer with 0.9% NaCl solution, resting and squeezing anal pressures were measured. The system was used on 50 human subjects (35 with anal fissure and 15 normal volunteers). Left lateral internal sphincterotomy had been performed in the anal fissure cases. Anal pressures were measured preoperatively and on postoperative days (POD) 2 and 20. Results: Preoperative resting anal pressures in the group with anal fissure (83.4 +/- 1 mmHg) were significantly higher than those in the group of normal individuals (52 +/- 1.2 mmHg; p = 0.001). Resting anal pressures after the sphincterotomy (29 +/- 1 mmHg) were found to be significantly lower on POD 2, and resting anal pressure measurements (47 +/- 1 mmHg) on POD 20 were lower than the corresponding preoperative values. These values are closer to those of normal volunteers (p = 0.016). Conclusions: Anal manometry can be performed with this easily constructible and inexpensive system. This reproducible method can be used in the assessment of the results of surgical treatment in patients with anal and perianal diseases.Öğe Does L-carnitine increase serum TNF -? and IGF-1 during liver regeneration in the rat?(2009) Pehlivan, Mevlüt; Coşkun, Abdurrahman; Zengin, Ahmet; Aslaner, Arif; Yavuz, TevfikAmaç: Rat deneysel parsiyel hepatektomi modelinde L-karnitin uygulamasının 72. saate kadar IGF- 1, TNF ? ve lipid peroksidasyonuna etkisini araştırmayı amaçladık. Yöntem ve gereç: Atmış rat kontrol, düşük (100 mg/kg) ve yüksek doz (200 mg/kg) L-karnitin olmak üzere 3 gruba ayrıldı. Her bir grup, parsiyel hepatektomiden sonra 24 ve 72. saat olmak üzere 2 alt gruba ayrıldı. Yedi gün intra-peritoneal L-karnitin uygulamasından sonra parsiyel (% 70) hepatektomi yapıldı. L-karnitin, parsiyel hepatektomiden sonra da ratlara verilmeye devam edildi. Tüm gruplarda cerrahi operasyondan önce, 24 ve 72 saat sonra serum IGF-1, TNF-? ve doku malondialdehid düzeyleri ölçüldü. Bulgular: Kontrol grubunda, serum TNF-? düzeyleri, rejenerasyon boyunca anlamlı derecede arttı. Düşük doz (100 mg/kg) L-karnitin, TNF-? düzeylerini azaltırken yüksek doz (200 mg/kg) artırdı. IGF-1 düzeyi, kontrol grubunda cerrahi operasyondan sonra ilk 24 saate azalırken daha sonra artmaya başladı. L-karnitin gruplarında IGF-1 düzeylerinde benzer değişimler gözlendi. Malondialdehid düzeyleri kontrol grubunda ilk 24 saatte artarken daha sonra azalmaya başladı. Benzer şekilde L-karnitin gruplarında malondialdehid düzeyleri ilk 24 saatte artarken daha sonra doza bağımlı olarak azaldı. Sonuç: Karaciğer rejenerasyonunda sitokinler, büyüme faktörleri ve metabolik yollar olmak üzere üç temel unsur bulunmaktadır. Enerji metabolizmasındaki etkilerine ilaveten, yüksek doz L-karnitinin, IGF-1, TNF-? düzeyini artırarak ve malondialdehid düzeyini de azaltarak karaciğer rejenerasyonunu hızlandırabileceğini düşünmekteyiz.Öğe Does L-carnitine increase serum TNF -alpha and IGF-1 during liver regeneration in the rat?(Tubitak Scientific & Technical Research Council Turkey, 2009) Pehlivan, Mevlüt; Coşkun, Abdurrahman; Zengin, Ahmet; Aslaner, Arif; Yavuz, TevfikAim: We sought to evaluate the effect of L-carnitine administration on the levels of IGF-1, TNF-alpha, and lipid peroxidation during hepatic regeneration for up to 72 h in an experimental partial hepatic resection rat model. Materials and methods: Sixty rats were divided into 3 groups: control and low-dose (100 mg/kg) and high-close (200 mg/kg) L-carnitine. Each group was divided into 2 sub groups (24 and 72 h after partial hepatectomy). Partial (70%) hepatectomy was performed after 7 days of intra-peritoneal administration of L-carnitine. After partial hepatectomy, L-carnitine was also administered to rats until sacrifice. Serum IGF-1, TNF-alpha, and tissue inalondialdehyde levels were determined in all groups before and at 24 and 72 h after surgery. Results: Serum TNF-alpha increased significantly in the control group during the regeneration period. The low close of L-carnitine (100 mg/kg) decreased the elevation of TNF-alpha whereas the high dose (200 mg/kg) increased it. In the control group, the IGF-1 level decreased in the first 24 h after surgery and then increased. The IGF-1 level behaved similarly in the L-carnitine groups. The inalondialdehyde level in the control group increased during the first 24 h and then decreased. Similarly in the L-carnitine groups, the malondialdehyde level increased during the first 24 h and then decreased significantly in a close-dependent manner. Conclusion: Three types of biochemical pathways are essential in liver regeneration: cytokine, growth factor, and metabolic pathways. We conclude that, in addition to its effects on energy metabolism, high-dose L-carnitine may promote liver regeneration by increasing IGF-1, TNF-alpha, and decreasing malondialdehyde.Öğe Does pregnancy interval after laparoscopic sleeve gastrectomy affect maternal and perinatal outcomes?(Taylor & Francis Ltd, 2019) Başbuğ, Alper; Kaya, Aşkı Ellibeş; Doğan, Sami; Pehlivan, Mevlüt; Göynümer, GökhanBackground: Obesity is a global health epidemic and is associated with many maternal and neonatal complications. Laparoscopic sleeve gastrectomy (LSG) is among the surgical treatments for obesity. The appropriate timing of pregnancy following LSG remains controversial and few studies have evaluated this public health issue. Objective: To evaluate the effect of pregnancy timing after LSG on maternal and perinatal outcomes. Study design: We performed a retrospective observational study of 23 pregnant women who underwent LSG at a tertiary hospital in Turkey. Women who became pregnant within 18 months of undergoing LSG were included in the early pregnancy after LSG group, and those who became pregnant after 18 months were included the late pregnancy after LSG group. Maternal and perinatal outcomes were evaluated, including gestational diabetes mellitus (GDM), pregnancy-associated hypertensive disorders, preterm birth, mode of delivery, small and large for gestational age births (small for gestational age (SGA), large for gestational age (LGA)), birth injury, and congenital malformations. Results: Body mass index (BMI) at conception was higher in the early pregnancy after LSG group than in the late pregnancy after LSG group (30.48 versus 27.25, respectively; p = .03). Pregnancy interval after LSG did not impact maternal-fetal complications or mode of delivery. After a 75 g oral glucose tolerance test (OGTT) for GDM, 75% (n = 6) of the early pregnancy group presented with early dumping syndrome, compared to only 13.3% (n = 2) of the late pregnancy after LSG group (p = .009). Conclusions: LSG may reduce obesity-related gestational complications, such as GDM and LGA. The interval between LSG and conception did not impact maternal or neonatal outcomes. Screening for GDM can result in dumping syndrome in pregnancies after LSG.Öğe Early enteral and glutamine enriched enteral feeding ameliorates healing of colonic anastomosis: Experimental study(Turkish Association of Trauma and Emergency Surgery, 2006) Gökpınar, İbrahim; Gürleyik, Emin; Pehlivan, Mevlüt; Özcan, Ömer; Özaydın, İsmet; Aslaner, Arif; Gültepe, MustafaBACKGROUND: To investigate the effects of postoperative early enteral and glutamine enriched enteral feeding on the healing of experimental colonic anastomosis. METHODS: Forty Wistar-albino rats were equally divided into 4 groups. Colonic transsection and anastomosis situated at the distal left colon was performed on all animals. Animals in groups 1 and 2 received late total enteral nutrition (TEN) and in groups 3 and 4 early TEN. Glutamine was added to TEN protocol in groups 2 and 4. The colonic segment including the anastomosis was excised at the end of the 7th day postoperatively. Bursting pressure of the anastomosis and tissue hydroxyproline levels were determined. RESULTS: Bursting pressure levels were 111.6 and 95.8 centimeters of water (cmH2O) in early and late nutrition groups, respectively (p=0.022). Comparison of late TEN groups showed a significant difference in favor of group with glutamine (95.8 vs 138.5 cmH2O; p<0.0001). Highest bursting pressures (139 and 138.5 cmH2O) were measured in both early and late TEN groups with glutamine. Tissue hydroxyproline level in early TEN group (2440.3 ?g) was significantly higher than late TEN group (1509.6 ?g; p=0.024). Comparison of late TEN groups showed a considerable but not statistically significant difference (p=0.276) in favor of group with glutamine (1509.6 vs 1981.6 ?g). CONCLUSION: Postoperative early TEN significantly ameliorates the resistance of the anastomosis and collagen synthesis. Glutamine enrichment in nutritional protocol decreases and reverses the disadvantages of late TEN regarding the resistance of anastomosis. A similarly positive, albeit weaker, effect of glutamine supplementation is also seen on collagen synthesis.Öğe Early glutamine-enriched enteral feeding facilitates colonic anastomosis healing: Light microscopic and immunohistochemical evaluation(Elsevier Gmbh, 2007) Güven, Aysel; Pehlivan, Mevlüt; Gökpınar, İbrahim; Gürleyik, Emin; Çam, MeryemProblems related to colonic anastomosis heating constitute the major morbidity in colorectal surgery. Patients without appropriate nutritional support are at higher risk of postsurgical complications, mainly due to reduced wound heating. Therefore, we investigated the effect of early and late postoperative total enteral. nutrition (TEN) and glutamine addition on colon anastomosis heating using tight microscopy and immunohistochemistry (IGF-I immunolabelling). In this study, 40 Wistar-albino rats underwent distal. left colonic transection and anastomosis. The rats were then divided into four groups given different diets: delayed total enteral. nutrition (dTEN; beginning 3 days postoperatively), delayed TEN with added glutamine (dTEN+ Glutamine), early TEN (eTEN; beginning within 6 h postoperatively), and early TEN with added glutamine (eTEN+Glutamine). Colon segments, including the anastomosis, were excised 7 days postoperatively and evaluated histopathologically for inflammation, mucosal heating, submucosal-muscular layer repair, the amounts of necrosis and vascularisation and immunohistochemically for IGF-I labelling. The inflammation and necrosis scores in the dTEN and dTEN+Glutamine groups were significantly greater than in the eTEN and eTEN+GLutamine groups. The IGF-I immunoreactivity increased in the eTEN, eTEN+Glutamine, and dTEN+Glutamine groups compared to dTEN (p<0.05). We concluded that early TEN and glutamine enrichment in the postoperative period improve anastomosis heating via IGF-I. (c) 2007 Elsevier GmbH. All rights reserved.Öğe Evaluation of Different Surgical Techniques to Repair Iatrogenic Esophageal Injury; an Experimental Study(Journal Neurological Sciences, 2015) İş, Merih; Pehlivan, Mevlüt; Akyüz, Fevzullah; Çelikoğlu, Erhan; Gökçe, Aysun; Aytekin, Hikmet; Altay, TamerObjective: Esophageal perforation during anterior spine surgery is a rare but serious complication that may lead to death, if not managed properly. Optimal management of these injuries is still debated, which varies from conservative approach to different types of surgical repair. The purpose of this study was to evaluate and compare the healing process following various surgical techniques to repair experimentally induced esophageal injury in rodents. We hypothesized that repair techniques that involve flap rotation along with primary suture was superior to primary suture alone. Material and Methods: Fifty male Sprague-Dawley rats were used for this study. Esophageal injury was induced by a vertical incision through all layers of its wall. Groups were determined according to the repair techniques used, i.e., Group-1 (sham, no injury), Group-2 (primary suture), Group 3 (primary suture plus muscle flap), Group 4 (primary suture omental flap) and Group 5 (untreated). Esophageal segments repaired were obtained fourteen days after the injury/repair surgery for histopathological evaluation. Results: Total histopathological damage scores were highest in Group 5. Lower total scores were obtained in Group 3 than in Group 2 and 5, whereas total scores between Groups 2 and 4, 2 and 5, and 3 and 4 were similar. Infiltration and submucosal/muscular healing scores were higher in Group 2 than in 3. There was no difference in any of the parameters between groups 2 and 4, 2 and 5, and 3 and 4. Conclusions: Primary suture closure reinforced by a muscle flap provides better healing in a rat model of iatrogenic esophageal injury. Primary suture reinforced by omentum, or primary suture alone may be considered as second options for repair.Öğe Gastric cancer in pregnancy(Elsevier Sci Ireland Ltd, 2003) Özdemir, İsmail; Pehlivan, Mevlüt; Demirci, Fuat…Öğe Malignant Mesenchymal Tumor of the Breast: Primary Chondrosarcoma(Karger, 2009) Gürleyik, Emin; Yıldırım, Ümran; Günal, Ömer; Pehlivan, MevlütBackground: Primary mesenchymal tumors are an extremely rare malignancy of the breast. Case Report: A 52-year-old woman presented with a rapidly growing breast mass. Physical examination established a large and round mass with regular margins in the upper-outer quadrant of the right breast. Ultrasound showed a hypoechoic solid mass (41 x 36 mm) with lobulated contours. Mammography revealed a hyperdense and relatively regular-shaped mass giving the impression of a benign tumor. However, a pathologic report of atypical cells after fine needle aspiration necessitated surgical excision. The mass was removed with a wide local excision. The tumor was diagnosed as a high-grade chondrosarcoma of the breast by histopathological analysis. Following the final diagnosis, we performed a modified radical mastectomy based on the knowledge that this malignancy is generally refractory to radiotherapy. The regional lymph nodes and local adjacent tissues were free of metastasis. The tumor was negative for estrogen and progesterone receptors as well as HER2. Conclusion: Chondrosarcoma tends to grow rapidly. Physical examination usually reveals a large, round mass. The tumor is regular-shaped, round, and complex echoic on mammography and ultrasound. It usually does not invade regional structures. Surgery remains the only effective treatment.Öğe Nightmare of lumbar disc surgery: iliac artery injury(Elsevier Science Bv, 2006) Döşoğlu, Murat; İş, Merih; Pehlivan, Mevlüt; Yıldız, K. HakanIntra-operative injuries of pelvic vessels are quite infrequent but serious complications of lumbar disc surgery. Injury may cause laceration of the vessel with acute life threatening retropentoneal haemorrhage, formation of pseudoaneurysms or arteriovenous fistulae in the late phase. It is important for surgeons to be aware of these potentially fatal complications. Authors reported a case of major vascular injury recognised intra-operatively during posterior lumbar discectomy and repaired immediately. (c) 2004 Elsevier B.V. All rights reserved.Öğe Ocular abnormalities in morbid obesity(Consel Brasil Oftalmologia, 2019) Teberik, Kuddusi; Eski, Mehmet Tahir; Doğan, Sami; Pehlivan, Mevlüt; Kaya, MuratPurpose:Obesity is associated with eye diseases, but the underlying structural changes and pathogenic mechanisms have not been examined in detail. Here, we assessed the effects of morbid obesity on the morphometric indices of eye disease. Methods: Morbidly obese volunteers (n=101, body mass index [BMI] >= 40) and healthy individuals (n=95, BMI: 18.50-24.99) were examined by Goldman applanation tonometry, pachymetry, and spectral domain optical coherence tomography. Intraocular pressure, anterior chamber depth, axial length, central corneal thickness, retinal nerve fiber layer thickness, central fovea! thickness, and choroidal thickness were compared between groups. Results: Uncorrected intraocular pressure was significantly greater in the morbidly obese group than in the healthy control group (15.5 +/- 2.5 vs. 14.5 +/- 2.6 mmHg, p=0.009), whereas axial length, anterior chamber depth, and central corneal thickness did not differ between the groups. The mean retinal nerve fiber layer thickness at the temporal quadrant was reduced in the morbidly obese group (72.7 +/- 13.6 vs. 85.05 +/- 52.6 mu m, p=0.024). Similarly, the mean retinal thicknesses at nasal and temporal 1500-mu m locations were lower in the morbidly obese group (346.6 +/- 18.2 vs. 353.7 +/- 18.8 mu m, p=0.008; 323.1 +/- 20.3 vs. 330.0 +/- 18.9 mu m, p=0.001). The mean choroidal thickness was also reduced in almost all measurement locations (fovea, temporal 500 and 1000 mu m, and nasal 500, 1000, and 1500 mu m) of the obese group (p <0.05). Weight and BMI were negatively correlated with subfoveal choroidal thickness (r=-0.186, p=0.009; r=-0.173, p=0.015). Conclusion: Morbid obesity is associated with elevated uncorrected intraocular pressure and signs of neuropathy and retinopathy. Obesity may thus increase the risks of glaucoma and glaucomatous optic neuropathy.Öğe The rare coincidence: Nonrecurrent laryngeal nerve pointed by a Zuckerkandl's tubercle(Hindawi Limited, 2012) Gürleyik, Emin; Doğan, Sami; Günal, Ömer; Pehlivan, MevlütThe safety of thyroid operations mainly depends on complete anatomical knowledge. Anatomical and embryological variations of the inferior laryngeal nerve (ILN), of the thyroid gland itself and unusual relations between ILN and the gland threaten operation security are discussed. The patient with toxic multinodular goiter is treated with total thyroidectomy. During dissection of the right lobe, the right ILN which has nonrecurrent course arising directly from cervical vagus nerve is identified and fully isolated until its laryngeal entry. At the operation, we observe bilateral Zuckerkandl's tubercles (ZTs) as posterior extension of both lateral lobes. The left ILN has usual recurrent course in the trachea-esophageal groove. The right ZT is placed between upper and middle third of the lobe points the nonrecurrent ILN. The coincidence of non-recurrent ILN pointed by a ZT is rare anatomical and embryological feature of this case. Based on anatomical and embryological variations, we suggest identification and full exposure of ILN before attempting excision of adjacent structures, like the ZT which has surgical importance for completeness of thyroidectomy. © Copyright 2012 Emin Gurleyik et al.
