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Öğe Association of paraoxonase (PON1) polymorphisms and activity with colorectal cancer predisposition(Taylor & Francis Ltd, 2021) Demirel, Tugrul; Yaylim, Ilhan; Ergen, Hayriye Arzu; Gunay, Mustafa Kayihan; Tekant, Yaman; Isbir, TurgayParaoxonase 1 (PON1) is a well recognised member of human endogeneous free radical scavenging systems and its polymorphism and enzyme activity are attributed to various different cancer formations. We aimed to study the Paraoxonase 1 (PON1) polymorphism and enzyme activity in colorectal cancer patients. Peripheral blood samples for DNA extraction were collected from 54 colorectal cancer patients and 85 healthy individuals. Polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) techniques were used for determination of the PON1192 polymorphism. The frequency of AA genotype was greater than BB and AB genotypes in all groups (n:65 with 46.8%; n:15 with 10.8% and n:59 with 42.4%, respectively). In both tumor groups, PON activities were significantly lower than the control group (p < 0.05). The AA genotype was significantly more frequent than the AB and BB genotypes in colorectal cancer patients. Although the rectum cancer patients' number is low in our study, we hypothesise that decreased enzyme activity of PON 1 related to 192 gene polymorphisms might have a role in the formation of an oxidative microenvironment for cancerous DNA damage which may tend to increase distally in the colon. Further studies considering the location and the stage of the colorectal tumors with more patients may put a broadly wider view on this polymorphism and enzyme activity with respect to cancer formation.Öğe Evaluation of celiac artery and common hepatic artery variations by CT-angiography and new classification model(Springer France, 2023) Turkyilmaz, Zeliha; Kula, Osman; Celik, Ahmet Onur; Demirel, Tugrul; Gunay, BurakPurposeKnowledge of anatomical variations is important in all interventional procedures. This study aims to evaluate the variations and prevalence of celiac trunk (CeT) and its branches.MethodsThe computerized tomography-angiography (CT-A) findings of 941 adult patients were evaluated retrospectively. Variations of the CeT and common hepatic artery (CHA) were evaluated according to the number of branches and their origin. Findings were compared with classical classification methods. A new classification model has been defined.ResultsNormal (complete) trifurcation was detected in 856 (90.9%) of them, where left gastric artery (LGA), splenic artery (SpA) and CHA branches were derived from the CeT. Among 856 complete trifurcation cases, 773 (90.3%) had non-classical trifurcation patterns. The rate of classic trifurcation was 8.8%, while non-classic trifurcation was 82.1% in all cases. In one case (0.1%), LGA and left hepatic artery together and right hepatic artery and SpA together appeared as a double bifurcation. Complete celiacomesenteric trunk was observed only in 4 (0.42%) cases. In seven cases (0.7%), LGA, SpA and CHA were coming out of abdominal aorta (AAo) independently. CHA normal anatomy (Michels Type I) was detected in 618 (65.5%) patients. We found that 49 (5.2%) of our cases were ambiguous according to the Michels Classification. We have described five different variations of hepatic arteries directly arising from the AAo.ConclusionPreoperative recognition of anatomical variations of CeT, superior mesenteric artery and CHA is of primary importance in both surgical and radiological procedures. With careful evaluation of CT-angiographies, it is possible to detect rare variations.Öğe Mid-term Results of Laparoscopic Conversion of Gastric Bypass to Duodenal Switch for Weight Regain: the Review of the Literature and Single-Center Experience(Springer, 2023) Demirel, TugrulBackgroundWeight regain after Roux-en-Y gastric bypass (RYGB) is a nightmare for the patients and the surgeons and is mostly regarded as irreversible. However, conversions to duodenal switch (DS) have been done previously with promising success. The current paper reports a single center's mid-to-long-term follow-up outcomes.MethodsThe data from all patients undergoing a conversion of RYGB (and one anastomosis gastric bypass (OAGB)) to DS were reviewed retrospectively. The demographic, operative, and weight loss parameters were analyzed, including age, duration of surgery, weight loss, body mass index (BMI), and morbidity/mortality.ResultsSeventeen patients were operated on between January 2013 and December 2021. The mean BMI was 45 kg/m2 (33-70) before conversion. The overall average %EWL was 74.4%, the least was 52% at 6 months, and the most was 91% at 24 and 36 months. All comorbidities resolved after conversion. One patient had a gastro-gastrostomy leak needing prompt surgical repair on the same day of diagnosis. Three patients had other complications: a duodenal stump leak, an intrabdominal abscess, and an ileus. All resolved without surgery. One sudden death happened on the 5th postoperative day.ConclusionLaparoscopic conversion of gastric bypass operations to DS is a complicated procedure that may have severe complications despite excessive patience and expertise but can be performed in a single step. The mid-to-long-term outcomes are promising for weight loss and control of associated co-morbidities.Öğe Relationship between SIRI, SII values, and Alvarado score with complications of acute appendicitis during the COVID-19 pandemic(Turkish Assoc Trauma Emergency Surgery, 2022) Cakcak, Ibrahim Ethem; Turkyilmaz, Zeliha; Demirel, TugrulBACKGROUND: The aim of the study was to investigate the clinical variations of Systemic Inflammatory Response Index (SIRI), Systemic Inflammation Index (SII), and Alvarado Score during the COVID-19 pandemic period. METHODS: Between March 2019 and March 2021, 161 consecutive patients who had surgery due to acute appendicitis were retrospectively recruited from Trakya University in Edirne, Turkey. Group I included patients who had surgery during the COVID-19 pandemic and Group II included patients who had surgery before the COVID-19 pandemic period. A total of 80 patients volunteered for Group I and 81 patients for Group II. The neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio, and lymphocyte/monocyte ratio were calculated. SII was calculated by the formula: platelet (P) x neutrophil (N)/lymphocyte (L). NLR was calculated by dividing the neutrophil count by the number of lymphocytes. SIRI was defined as follows: SIRI = (neutrophil x monocyte/lymphocyte). The Alvarado score was also calculated by using patient history, clinical examination, and laboratory findings. RESULTS: There was a significant difference between the two groups in terms of displacing pain, nausea/vomiting, right lower quadrant tenderness, rebound, hyperthermia, leukocytosis, and total Alvarado score (p<0.001). There was a significant difference between two groups in comparison of C-reactive protein, SIRI, and SII values (p<0.001). Group I patients had higher values of these parameters than Group II. CONCLUSION: Based on the results obtained from this study, we conclude that COVID-19 pandemic has caused an increase in patients with acute appendicitis admitted to the hospital. This late diagnosis of acute appendicitis caused more complications during COVID-19 pandemic. Alvarado score, SIRI, and SII can be used as a marker to indicate whether complications of acute appendicitis occurred pre-or post-operatively. Therefore, Alvarado score, SIRI, and SII are directly proportional to the complication of acute appendicitis.Öğe Retrieval of a missed intraperitoneal gallstone with early second look laparoscopy Missed gallstones after laparoscopic cholecystectomy(Bayrakol Medical Publisher, 2021) Turkyilmaz, Zeliha; Sunar, Orhan; Demirel, Tugrul; Kula, OsmanThe perforation of the gall bladder is the most common complication in laparoscopic cholecystectomy (LC). Retrieval of spilled gallstones is routine when possible. However, it Is not infrequent to leave some. Although significantly rare, abandoned gallstones may cause late and subtle symptoms and even severe intra-abdominal complications. In this study, we present a 60-year-old male patient who had an attack of acute cholecystitis and underwent laparoscopic cholecystectomy 6 weeks later. A second emergency laparoscopy was performed to remove the unremoved gallstone presenting with mild complaints. Postoperative CT might locate missed gallstones in the peritoneal cavity, and early laparoscopy may prevent severe late complications.Öğe Trans-mesocolic Pull-Through Maneuver: A Safe Operative Technique for Short and Thick Mesentery in Severe Obesity(Springer India, 2022) Demirel, TugrulAlthough right gastric artery ligation is efficient to enhance a lower-tension anastomosis, still in severe intra-abdominal adiposity, antecolic approach may not provide sufficient length for a safe duodenoenterostomy anastomosis. Combining right gastric artery ligation with trans-mesocolic pull-through overcomes the thick mass of the transverse colon to achieve low-tension anastomosis. Trans-mesocolic pull-through operative technique was performed in duodenal switch, duodenojejunal bypass, and single anastomosis duodenoileal bypass with sleeve gastrectomy procedures. Demographic data, body mass index, operation time, perioperative, and postoperative complications were analyzed. A total of 70 patients were included in the study between January 2013 to December 2016. The male/female ratio was 0.4 (male/female: 20/50). The mean age was 41.1 years (age:18-67). A total of 28 patients had single anastomosis duodenoileal bypass with sleeve gastrectomy, 34 had duodenal switch, and 8 had duodenojejunal bypass operations. The mean BMI was 51.9 kg/m(2) (35-64), mean duration of surgery was 232.9 min (134-346), and mean hospital stay was 5.2 days (3-9). No early or late postoperative mortality was observed. The overall complication rate related with operative technique was 4.3% (n:3) including post-pyloric duodenal necrosis, duodenal stump fistula, and intra-abdominal abscess. A total of 67 patients were discharged uneventfully with a follow-up of mean of 75.9 (52-96) months in term. The current paper put into a modified approach with right gastric artery ligation and pull-through of the gastric sleeve and may be a safe technique in short and thick mesentery patients for a low-tension anastomosis.Öğe What has changed? The impact of the COVID-19 pandemic on the management of acute biliary pancreatitis(Turkish Assoc Trauma Emergency Surgery, 2023) Turkyilmaz, Zeliha; Demirel, Tugrul; Cakcak, Ibrahim Ethem; Aytin, Yusuf EmreBACKGROUND: The COVID-19 pandemic thoroughly changed the daily practices of medicine. We retrospectively evaluated the impact of the COVID-19 pandemic on our management strategies for patients with acute biliary pancreatitis (ABP).METHODS: A total of 91 patients with ABP who were treated at Trakya University Faculty of Medicine between March 15, 2019 and March 15, 2021 were retrospectively recruited. Patients were classified as pre-COVID and COVID-era patients. The comorbidity markers, data from laboratory tests, inflammatory markers, and radiological examinations were evaluated. Length of stay, need for an intensive care unit, morbidity, mortality, recurrent ABP, and definitive treatment rates were evaluated, and the data of the two periods were compared.RESULTS: Two groups of patients, 57 in the pre-COVID period and 34 in the COVID period, were included in the study. We found that ABP admissions decreased significantly during periods of increased national COVID-19 diagnoses. Type 2 diabetes mellitus was significantly higher in the COVID period patients (P=0.044), and COVID patients had significantly higher total (P=0.004), direct bilirubin (P=0.007), and lipases (P<0.001). The cholecystectomy rate after an attack decreased from 26% in the pre-COVID period toCONCLUSION: COVID strikingly reduced the admissions of ABP patients in the early stages of the disease to hospitals, leading to inevitable admissions in advanced severity. Moreover, a significant increase was detected in the recurrence rates of ABP. This can be explained by the reduction in cholecystectomy performed.