Browsing by Author "Akkapulu, Nezih"

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Factors affecting mortality in rectus sheath hematoma: A retrospective study
(2018) Arer, Ilker Murat; Akkapulu, Nezih; Hargura, Abdirahman Sakulen; Kus, Murat; Yabanoglu, Hakan; Aytac, Huseyin Ozgur; 0000-0002-3583-9282; 0000-0001-7392-961X; 0000-0002-1161-3369; 0000-0001-6529-7579; AAJ-7913-2021; AAM-8548-2021; AAJ-7865-2021; AAJ-7870-2021
Aim: Rectus sheath hematoma is a rare clinical condition. Because it could mimic various intra-abdominal pathologies suspicious approach and attention is needed for proper diagnosis and management of rectus sheath hematoma. The aim of this study is a review of factors affecting mortality in patients with rectus sheath hematoma besides clinical features, diagnosis modalities, treatment periods and results of patients with rectus sheath hematoma. Material and Method: Twenty-three patients with rectus sheath hematoma from January 2012 to March 2017 in a tertiary care center were included in the study. Patients' files were reviewed retrospectively. Reviewed variables were demographic and clinical features, symptom and findings, co-morbidities, medications, laboratory findings, diagnostic modalities, APACHE II scores, treatment approaches, transfused blood products and length of hospital stay. Results: Fifteen (65.2%) of the patients were women, and 8 (34.8%) of the patients were men. The mean age was 61.9 +/- 13.5. Seventeen (74%) of the patients had abdominal pain. Twenty (87%) of the patients had anticoagulant and antiplatelet therapy. The mean hematoma diameter was 6.3 +/- 3.6 cm. The mean APACHE II score for the patients was 13.1 +/- 7.3. One patient had undergone surgery. There was mortality in 3 (13%) of the patients. The median length of stay in hospital was 5 (5) days. Discussion: The diagnosis of rectus sheath hematoma should be kept in mind while assessing old female patients and patients on anticoagulants with a complaint of abdominal pain. In our study, we identify risk factors such as higher APACHE - II scores, the presence of a transient ischemic attack, need for transfusion of more units of packed erythrocytes and more extended hospital stay as factors associated with mortality.
Prophylactic Oral Calcium Supplementation Therapy to Prevent Early Post Thyroidectomy Hypocalcemia and Evaluation of Postoperative Parathyroid Hormone Levels to Detect Hypocalcemia: A Prospective Randomized Study
(2017) Arer, Ilker Murat; Kus, Murat; Akkapulu, Nezih; Aytac, Huseyin Ozgur; Yabanoglu, Hakan; Caliskan, Kenan; Tarim, Mehmet Akin; 0000-0001-7392-961X; 0000-0003-0268-8999; 0000-0002-3583-9282; 0000-0001-6529-7579; 0000-0002-1161-3369; 0000-0002-8767-5021; 28039060; AAM-8548-2021; AAK-2011-2021; AAJ-7913-2021; AAJ-7870-2021; AAJ-7865-2021; AAJ-7201-2021
Background: Postoperative hypocalcemia is the most common complication after total thyroidectomy. Postoperative parathyroid hormone (PTH) measurement is one of the methods to detect or prevent postoperative hypocalcemia. Prophylactic oral calcium supplementation is another method to prevent early postoperative hypocalcemia. The aim of this study is to detect the accurate timing of PTH and evaluate efficacy of routine oral calcium supplementation for postoperative hypocalcemia. Methods: A total of 106 patients were performed total thyroidectomy. Rotuine oral calcium supplementation was given to group 1 and no treatment to group 2 according to randomization. Serum calcium and PTH level of patients in group 2 at postoperative 6, 12 and 24 h and patients in both groups at postoperative day 7 were evaluated. Patients were compared according to age, sex, operation findings, serum calcium and PTH levels and symptomatic hypocalcemia. Results: Half of the patients (50%) were in group 1. Most of the patients were female (83%). The most common etiology of thyroid disease was multinodular goiter (64.1%). Oral calcium supplementation was given to 18 (33.9%) patients in group 2. Symptomatic hypocalcemia for group 1 and 2 was found to be 1.9 and 33.9% respectively (p < 0.05). No statistical difference can be observed regarding the timing of serum biomarkers. Conclusion: Serum PTH levels at postoperative 12 and 24 h can predict early post-thyroidectomy hypocalcemia. Prophylactic oral calcium supplementation therapy can prevent early post-thyroidectomy hypocalcemia with advantages of being cost effective and safe. (C) 2016 IJS Publishing Group Ltd.
Prospective Observational Study on acute Appendicitis Worldwide (POSAW)
(2018) Akkapulu, Nezih; 0000-0001-7392-961X; 29686725; AAM-8548-2021
Background: Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis. The aim of this study is to describe the worldwide clinical and diagnostic work-up and management of AA in surgical departments. Methods: This prospective multicenter observational study was performed in 116 worldwide surgical departments from 44 countries over a 6-month period (April 1, 2016-September 30, 2016). All consecutive patients admitted to surgical departments with a clinical diagnosis of AA were included in the study. Results: A total of 4282 patients were enrolled in the POSAW study, 1928 (45%) women and 2354 (55%) men, with a median age of 29 years. Nine hundred and seven (21.2%) patients underwent an abdominal CT scan, 1856 (43.3%) patients an US, and 285 (6.7%) patients both CT scan and US. A total of 4097 (95.7%) patients underwent surgery; 1809 (42.2%) underwent open appendectomy and 2215 (51.7%) had laparoscopic appendectomy. One hundred eighty-five (4.3%) patients were managed conservatively. Major complications occurred in 199 patients (4.6%). The overall mortality rate was 0.28%. Conclusions: The results of the present study confirm the clinical value of imaging techniques and prognostic scores. Appendectomy remains the most effective treatment of acute appendicitis. Mortality rate is low.
Subcapsular Hydatid Cyst of the Liver
(2017) Kus, Murat; Arer, Ilker Murat; Akkapulu, Nezih; Yabanoglu, Hakan; 0000-0001-6529-7579; 0000-0001-7392-961X; 0000-0002-1161-3369; AAJ-7870-2021; AAM-8548-2021; AAJ-7865-2021
Hydatid cyst disease is an important health problem in Turkey. The disease localized in liver in most of the cases, but also be exits everywhere in the body. One of the rare complications of liver's hydatid cyst is subcapsular perforation. We present a 53 year male patient with subcapsular perforation of liver hydatid cyst
Total Versus Subtotal Gastrectomy for Signet Ring Cell Carcinoma of the Stomach
(2017) Arer, Ilker Murat; Yabanoglu, Hakan; Akdur, Aydincan; Akkapulu, Nezih; Kus, Murat; 0000-0002-1161-3369; 0000-0002-8726-3369; 0000-0001-7392-961X; 0000-0001-6529-7579; 29056122; AAJ-7865-2021; AAA-3068-2021; AAM-8548-2021; AAJ-7870-2021
Objective: To determine the adequate surgery type for the treatment of signet ring cell of stomach in terms of postoperative complications and survival. Study Design: Comparative analytical study. Place and Duration of Study: Baskent University Adana Teaching and Research Center, Adana, Turkey, between 2006 and 2015. Methodology: A total of 46 patients with the diagnosis of gastric signet ring cell, who underwent total or subtotal gastrectomy, were enrolled in this study. Patients were compared according to age, gender, tumor location, TNM stage, survival and mortality rates, operation time, complication and recurrence. Comparisons between groups were performed by using Mann-Whitney U-test for the data not normally distributed. The categorical data were analyzed by using the Chi-square test or Fisher's exact test, where applicable. Kaplan-Meier test was used for survival curve and Long-rank test was used for survival differences between groups. Values of p < 0.05 were considered statistically for all tests. Results: Of the 46 patients, 29 (63.0%) were male. The mean age was 56.6 +/- 13.2 years. The median tumor size was 5.0 cm (IQR: 3.0-6.6). Twenty-six (56.5%) patients were in total gastrectomy, whereas 20 (43.5%) were in subtotal gastrectomy group. Five-year cumulative survival rate was 0.487. Five-year overall survival rate for early and advanced signet ring cell carcinoma was 0.830 and 0.164, respectively (p<0.001). Five-year overall survival rate for total and subtotal gastrectomy groups were 0.422 and 0.582, respectively (P=0.417). Complications were observed in 17.4% (n=8) of all 46 patients. Conclusion: Subtotal gastrectomy can be performed safely for patients with gastric signet ring cell carcinoma and is equal to total gastrectomy with respect to prognosis and complication rates.