Browsing by Author "Koc, Bora"

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Complications Following Endoscopic Retrograde Cholangiopancreatography: Minimal Invasive Surgical Recommendations
(Public Library Science, 2014) Koc, Bora; Bircan, Huseyin Yuce; Adas, Gokhan; Kemik, Ozgur; Akcakaya, Adem; Yavuz, Alpaslan; Karahan, Servet
Background: ERCP has a complication rate ranging between 4% and 16% such as post-ERCP pancreatitis, hemorrhage, cholangitis and perforation. Perforation rate was reported as 0.08% to 1% and mortality rate up to 1.5%. Besides, injury related death rate is 16% to 18%. In this study we aimed to present a retrospective review of our experience with post ERCP-related perforations, reveal the type of injuries and management recommendations with the minimally invasive approaches. Methods: Medical records of 28 patients treated for ERCP-related perforations in Okmeydani Training and Research Hospital between March 2007 and March 2013 were reviewed retrospectively. Patient age, gender, comorbidities, ERCP indication, ERCP findings and details were analyzed. All previous and current clinical history, laboratory and radiological findings were used to assess the evaluation of perforations. Results: Between March 2007 and March 2013, 2972 ERCPs were performed, 28 (0.94%) of which resulted in ERCP-related perforations. 10 of them were men (35.8%) and 18 women (64.2%). Mean age was 53.36 +/- 14.12 years with a range of 28 to 78 years. 14 (50%) patients were managed conservatively, while 14 (50%) were managed surgically. In 6 patients, laparoscopic exploration was performed due to the failure of non-surgical management. In 6 of the patients that ERC-Prelated perforation was suspected during or within 2 hours after ERCP, underwent to surgery primarily. There were two mortalities. The mean length of hospitalization stay was 10.46 +/- 2.83 days. The overall mortality rate was 7.1%. Conclusion: Successful management of ERCP-related perforation requires immediate diagnosis and early decision to decide whether to manage conservatively or surgically. Although traditionally conventional surgical approaches have been suggested for the treatment of perforations, laparoscopic techniques may be used in well-chosen cases especially in type II, III and IV perforations.
Cutaneous Necrosis as a Result of Isosulphane Blue Injection in Mammarian Sentinel Lymph Node Mapping: Report of Two Cases
(Sage Publications Ltd, 2014) Bircan, Huseyin Y.; Ozcelik, Umit; Koc, Bora; Kemik, Ozgur; Demirag, Alp
Skin-sparing mastectomy with sentinel lymph node biopsy (SLNB) and synchronous breast reconstruction are widely used in breast cancer surgery nowadays. Difficulties in feeling confident in this technique and postoperative surgical complications are the major obstacles against the widespread usage of this technique. Compared with the other surgical techniques, the complications are hard to treat. Cutaneous necrosis because of methylene blue used for sentinel lymph node mapping in patients who underwent skin-sparing mastectomy and SLNB is already reported in the literature. We present here two cases with cutaneous necrosis because of isosulphane blue injection after skin-sparing mastectomy and SLNB as a rare complication of dye injection.
The Effects of Aging on Lymphocyte Subgroups in Males and Females
(int Scientific Literature, inc, 2014) Inal, Ali; Koc, Bora; Bircan, Huseyin Yuce; Ogan, Ebru; Yavuz, Alpaslan; Kemik, Ozgur
Background: Age-associated immune senescence is a catch-all phrase that has been used to describe a plethora of changes to the immune system across the lifespan. Aging is associated with a decline in immune function. Our aim in this study was to investigate how lymphocyte subgroups in peripheral blood are affected by aging among males and females. Material/Methods: Study participants were 70 healthy individuals from 3 different age groups, observed from January 2010 to January 2012. The average levels of CD3+, CD4+, CD8+, CD19+, CD16+/CD56+, CD3+/CD69+, and CD19+/CD69+ were determined for each group and compared in terms of age and sex. Results: We found significant reduction in the level of CD3+T cells related with age, but no significant changes in CD19+ B cell levels (p<0.005). Aging significantly reduces activated B cell (CD19+/CD69+) levels in males (p<0.005). Conclusions: Our results show that there may be differences between males and females in terms of immune senescence.
Laparoscopic Treatment of Gallstone Ileus
(Sage Publications Ltd, 2014) Bircan, Huseyin Y.; Koc, Bora; Ozcelik, Umit; Kemik, Ozgur; Demirag, Alp
Gallstone ileus is a rare complication of cholelithiasis that has high morbidity and mortality. An intestinal obstruction can be caused by migration of a large gallstone through a biliary enteric fistula or by impaction within the intestinal tract. In this study, we present the case of an 81-year-old woman with a mechanical bowel obstruction by a gallstone that was treated by laparoscopy.
Massive Alimentary Tract Bleeding Due To Cytomegalovirus Infection in an Elderly Patient
(Pagepress Publ, 2014) Koc, Bora; Bircan, Huseyin Yuce; Altaner, Semsi; Cinar, Ozlem; Ozcelik, Umit; Yavuz, Alpaslan; Kemik, Ozgur
In recent years, cytomegalovirus (CMV) has been recognized as an important common pathogen in immunocompromized patients. This is due to the increasing number of immunosuppressive medications, intensive cancer chemotherapy use, recurrent transplantations, progressively aging population, and the higher number of human immunodeficiency virus infections. Cytomegalovirus infection especially interests the gastrointestinal tract, anywhere. from the mouth to the anus. Namely, the most commonly affected area is the colon, followed by duodenum, stomach, esophagus and small intestine. The most frequent manifestations of CMV colitis are: diarrhea. fever, gastrointestinal bleeding and abdominal pain. We report here the case of an 82-year-old woman, who was treated for non Hodgkin lymphoma: she was admitted to the emergency, department for abdominal pain and diffuse arthralgia following massive upper and lower-gastrointestinal bleeding, due to duodenal and colonic ulcers related to CMV infection.
Obese Patients After Laparoscopic Adjustable Gastric Banding Complications and the Influence on Body Mass Index and Comorbidities
(H G E Update Medical Publishing S A, 2014) Koc, Bora; Karahan, Servet; Adas, Gokhan; Kemik, Ozgur
Background/Aims: The aim of this study is to present the advantages of LAGB (Laparoscopic adjustable gastric banding), its effects on weight loss and influence on comorbidities such as diabetes and hypertension. Methodology: 90 middle-aged obese patients with body mass index [BMI] of 35-50 kg/m(2) underwent LAGB between October 2007 and April 2010. Results: There were 33 men and 57 women underwent LAGB. The ages of the cases ranged from 22 to 39 years [mean 29.5 years]. The percentage of decrease on BMI at the 3, 6, 12, 24 month marks were 9.85%, 14.8%, 25.8% and 32.9%, respectively. No early operative complications were recorded. Pouch dilation occured in 6 patients and band erosion-migration was observed in 3 patient. Conclusion: LAGB is a safe and effective approach in short-term management of morbid obesity. Weight loss, complications and resolution of comorbidities are comparable with the other obesity procedures.
The Preliminary Experience in the Emergency Department of a Newly Opened Penitentiary Institution Hospital in Turkey
(Medknow Publications & Media Pvt Ltd, 2014) Koc, Bora; Tutal, Firat; Urumdas, Mehmet; Ozkurt, Yalcin; Erus, Tugcan; Yavuz, Alpaslan; Kemik, Ozgur
Background: Emergency cases become a widespread problem in prisons across Turkey. The opening of a new prison hospital in January 2012 within the catchment of Silivri Penitentiary Institution gave a unique opportunity to treat the inmates quickly. Aims: The study was to conduct an extensive review for documentation of prisoners healthcare problems leading to emergency admission following the first year after the opening of Penitentiary Institution Hospital and point to decrease redundant hospital transfers of this individual cohort. Materials and Methods: A cross-sectional study was carried out where 12,325 visits to the Silivri Penitentiary Institution Hospital for emergency visits from the period of 1st January 2012 to the 31st December 2012 were identified from electronic medical records. After obtaining consent from the local IRB, data including details of the type, cause and nature of the complaints of the illnesses were processed. Results: In the 12-month period, there were 12,325 visits to the emergency department, of which 4328 for surgical conditions (35.1%), 2684 for medical disorders (21.8%), 1867 for sports injuries (15.2%), 1327 for Ear Nose Throat (ENT) problems (10.8%), 827 for psychiatric disorders (6.70%), 396 for violence injury (3.2%), 169 for self harm (1.4%), and 727 for miscellaneous (5.8%). The most common cause of emergency visits was sports injuries, followed by non-specific abdominal pain and ENT problems. Eighteen prisoners re-attended 243 times, ranging from 8 visits to a maximum of 56 visits. Conclusion: Inmates in prison have a wide range of complaints, and sometimes these complaints do not suggest an illness. Prison population exhibited substantially higher prevalence rates of diseases than the civilian population. We conclude that this new healthcare system in prisons will prevent redundant hospital transfers and guarantee detainees have access to the same health care that is offered to non-detained population.
The Use of Ercp During Pregnancy: Is It Safe and Effective
(H G E Update Medical Publishing S A, 2014) Akcakaya, Adem; Koc, Bora; Adas, Gokhan; Kemik, Ozgur
Cholangitis and pancreatitis are the most gruesome complications that can be potentially fatal for the mother and fetus. The management of bile stone disease complicated with duct stones during pregnancy is challenging. Conservative treatment instead of surgery has always been advocated due to the increased risk for fetal compromise. Minimally invasive therapy with ERCP has been suggested as an effective therapeutic option for the management of pancreaticobiliary diseases during pregnancy. The main topics of discussion are the risks stemming from the endoscopic procedure itself, drugs used for sedation and the adverse effects of radiation exposure on the fetus. In this manuscript, we want to present the efficiency and feasibility of the ERCP for the management of hepatobiliary and pancreatic diseases in pregnancy.