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Öğe Bridge Treatment For Early Cholecystectomy İn Geriatric Patients With Acute Cholecystitis: Percutaneous Cholecystostomy(TURKISH ASSOC TRAUMA EMERGENCY SURGERY, 2017) Kesici, Uğur; Zeren, Sezgin; Bayhan, Zülfü; Koçak, Cengiz; Korkmaz, Mehmet; Algın, Mustafa Cem; Yaylak, Faik; Ekici, Mehmet FatihBACKGROUND: The main cause of acute cholecystitis (AC) is gallstones, and the incidence of gallstones in elderly patients is high. METHODS: In this study, we aimed to investigate the efficacy of percutaneous cholecystostomy (PC) before early cholecystectomy in geriatric patients with AC. This retrospective study included 85 patients undergoing laparoscopic or conventional cholecystectomy during early stage of calculous AC. RESULTS: All patients were over 65 years old and were divided into two groups: Group I, PC plus early cholecystectomy and Group II, only cholecystectomy without PC. Data on age, sex, status of PC before surgery, postoperative complications, postoperative mortality, surgical method, and postoperative hospitalization duration were recorded in our study. The average age in the groups I and II was 75.7±7.5 and 73.7±7.2 years, respectively, indicating insignificant difference (p=0.223). Although postoperative complication rate was two fold in the non-PC group, the PC plus cholecystectomy group has a few complications (p=0.032). Postoperative mortality was evidently lower in patients who first underwent PC and followed by cholecystectomy (p=0.017). The average hospitalization duration in groups I and II were 5.6±2.4 days and 11.2±7.7 days, respectively (p<0.001). CONCLUSION: Urgent laparoscopic cholecystectomy is still the best surgical treatment modality for calculous AC. Further, our study results showed that in geriatric patients, bridge treatment, such as PC, can be useful for reducing postoperative complication rates.Öğe Efeitos Antimicrobianos Do Fentanil E Da Bupivacaína: Estudo İn Vitro(Elsevier, 2020) Demirci, Mehmet; Kesici, Sevgi; Kesici, UğurStudy objective: In this study, we aimed to compare the antimicrobial effects of bupivacaine and fentanyl citrate and to reveal the impact on antimicrobial effect potential in the case of combined use. Design: In vitro prospective study. Setting: University Clinical Microbiology Laboratory. Measurements: In our study, in vitro antimicrobial effect of 0.05 mg.mL(-1) fentanyl citrate, 5 mg.mL(-1) bupivacaine were tested against Staphylococcus aureus American Type Culture Collection (ATCC) 29213, Pseudomonas aeruginosa ATCC 27853, Klebsiella pneumoniae ATCC 13883, Escherichia coli ATCC 25922 and Candida albicans ATCC 10231 as Group F (Fentanyl Citrate) and Group B (Bupivacaine), respectively. S. aureus ATCC 29213, P. aeruginosa ATCC 27853, Klebsiella pneumoniae ATCC 13883 and Escherichia coli ATCC 25922 were cultured onto Mueller Hinton agar (Oxoid, UK) plates and Candida albicans ATCC 10231 were cultured onto Sabouraud dextrose agar (Oxoid, UK) plates for 18-24 hours at 37 degrees c. Main results: In terms of inhibition zone diameters, S. Aureus ATCC 29213, P. aeruginosa ATCC 27853, and C. albicans ATCC 10231 values obtained after 12 and 24 hours of incubation were significantly higher in Group F than Group B (p < 0.001). In terms of inhibition zone diameters, E. coli ATCC 25922, and K. pneumomiae ATCC 13883 values obtained after 12 and 24 hours of incubation were significantly higher in Group B than Group F (p < 0.001, E. coli 122. hour p = 0.005). Conclusions: Addition of fentanyl to Local Anesthetics (LAs) is often preferred in regional anesthesia applications in today's practice owing especially to its effect on decreasing the local anesthetic dose and increasing analgesia quality and patient satisfaction. However, when the fact that fentanyl antagonized the antimicrobial effects of LAs in the studies is taken into account, it might be though that it contributes to an increase in infection complications. When the fact that fentanyl citrate, which was used in our study and included hydrochloric acid and sodium hydroxide as protective agents, broadened the antimicrobial effect spectrum of LAs, had no antagonistic effect and showed a synergistic antimicrobial effect against E. Coli is considered, we are of the opinion that the addition of fentanyl to LAs would contribute significantly in preventing the increasing regional anesthesia infection complications. (C) 2020 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda.Öğe Malignant Melanoma Metastasis to Sigmoid Colon: New Endoscopic Appearance Detected for the First Time(College of Physicians and Surgeons Pakistan, 2020) Kesici, UğurMalignant melanoma (MM) develops as a result of malignant transformation of melanocytes. It accounts for 4% of all skin cancers. MM metastases usually occur in regional lymph nodes, bones and central nervous system. In this case report, a case of a 50-year male, who was found to have MM infiltration on colonoscopy performed for the etiology of anemia, is discussed. The patient underwent gastroscopy and colonoscopy for the determination of the primary tumor. Colonoscopic examination showed multiple submucosal hyperpigmented areas and a sessile polyp with a diameter of 4-5 mm in the sigmoid colon. Biopsies of hyperpigmented lesions were consistent with MM infiltration. Gastrointestinal tract (GIT) metastases are rare in MM. In literature, MM metastases to GIT have endoscopic appearances of 3 types. Typically, on endoscopy, ulceration with nodule or mass is visualised. However, in this case, an appearance of 'only submucosal melanosis without mass or nodule' was identified, distinct from previously described three endoscopic views and it was verified histopathologically. This case will help increase awareness of endoscopists in terms of being careful to look for MM metastasis on endoscopic examinations, which may be defined as 4th type of endoscopic appearance.Öğe Üst Gastrointestinal Sistem Endoskopisi Yapılan Hastalarda İntestinal Metaplazi Ve Helikobakter Pylori Skorlarının Karşılaştırılması(Çukurova Üniversitesi Tıp Fakültesi, 2018) Kesici, UğurAmaç: Bu çalışmada dispeptik yakınmaları nedeniyle üst gastrointestinal system (GİS) endoskopisi yapılan hastalarda helicobacter pylori (HP) ile intestinal metaplazi (İM) arasındaki ilişkinin ortaya konulması amaçlanmıştır. Gereç ve Yönetim: Bu çalışmaya üst GİS endoskopisi yapılan 15-84 yaş arası hastalar dahil edildi. Hastaların demografik olarak yaş ve cinsiyetleri ile histopatolojik olarak İM ve HP skorları kaydedildi. Hastalar 15-49 yaş arası ve 50 yaş üstü olmak üzere sırasıyla Grup A ve Grup B olmak üzere iki gruba ayrıldı. İM ve HP skorları arasında çeşitli değişkenlere göre korelasyon olup olmadığı araştırıldı. Bulgular: Bu çalışmaya 15-84 yaş arası 200 hasta dahil edildi. Grup B’deki hastalarda IM görülme oranı istatiksel olarak anlamlı düzeyde yüksekti. HP negatif olan hastalarda ise; Grup B’deki hastalarda IM oranı, Grup A’ya göre anlamlı olarak yüksekti. Grup B’deki erkek hastalarda IMS hafif ve orta görülme oranı istatiksel olarak anlamlı düzeyde yüksekti. Sonuç: Literatürde HP pozitifliği ile İM gelişimi arasında anlamlı bir ilişki olduğunu gösteren çalışmaların yanısıra bu çalışmamızla uyumlu olarak HP pozitifliği ile İM gelişimi arasında anlamlı bir ilişki olmadığını bildiren çalışmalar da bulunmaktadır. Çalışmamızda İM gelişimi için en önemli risk faktörünün 50 yaş üzeri erkek cinsiyet olduğu sonucuna varılmıştır.
