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Öğe Comparison of laparoscopic and conventional cystotomy/partial cystectomy in treatment of liver hydatidosis(Hindawi Ltd, 2019) Bektaşoğlu, Hüseyin Kazım; Hasbahçeci, Mustafa; Taşcı, Yunus; Aydoğdu, İbrahim; Malya, Fatma Ümit; Kunduz, Enver; Dolay, KemalIntroduction. Hydatidosis is a zoonotic infection and treatment is mandatory to avoid complications. Surgery remains the first choice in the treatment especially for CE2-CE3b cysts. Open or laparoscopic approaches are available. However, comparative studies are limited. Materials and Methods. Data of patients who underwent cystotomy/partial cystectomy for liver hydatidosis between January 2012 and September 2016 (n=77) were evaluated retrospectively. Recurrent cases and the patients with previous hepatobiliary surgery were excluded. 23 patients were operated upon laparoscopically and named as Group 1. 48 patients operated conventionally named as Group 2. Demographics, cyst characteristics, operative time, length of hospital stay, recurrences, and surgery related complications were evaluated. Results. Groups were similar in terms of demographics, cyst characteristics, and operative time. The length of hospital stay was 3.4 days in Group 1 and 4.7 days in Group 2 (p=0,007). The mean follow-up period was 17.8 months and 21.7 months, respectively (p=0.170). Overall complication rates were similar in two groups (p=0.764). Three conversion cases occurred (13%). One mortality was seen in Group 2. Four recurrences occurred in each group (17% versus 8.3%, respectively) (p=0.258). Conclusions. Laparoscopy is a safe and feasible approach for surgical treatment of liver hydatidosis. Recurrence may be prevented by selection of appropriate cases in which exposure of cysts does not pose an intraoperative difficulty.Öğe Management of pancreatic head adenocarcinoma: from where to where?(Baishideng Publishing Group Inc, 2019) Dolay, Kemal; Malya, Fatma Ümit; Akbulut, SamiPancreatic head adenocarcinoma (PHAC) is one of the most aggressive malignancies, and it has low long-term survival rates. Surgery is the only option for long-term survival. The difficulties associated with PHAC include higher frequencies of regional or distant lymph node metastases and vascular involvement, and positive resection margins in pancreatic and retroperitoneal tissues. Radical resections increase margin negativity and life expectancy; however, the extend of the surgery applied is controversial. Thus, western and eastern centers may use different approaches. Multiorgan, peripancreatic nerve plexus, and vascular resections have been discussed in relation to radical surgery for pancreatic cancer as have the roles of neoadjuvant and adjuvant therapy regimens. Determining the appropriate limits for surgery, standardizing definitions and surgical techniques according to guidelines, and centralizing pancreatic surgery within high-volume institutions to reduce mortality and morbidity rates are among the most important issues to consider. In this review, we evaluate the basic concepts underlying and the roles of radical surgery for PHAC, and lymphadenectomy, nerve plexus, retroperitoneal tissue, vascular, and multivisceral resections, total pancreatectomy, and liver metastases are discussed.Öğe Mesenchymal stem cell therapy in COVID-19 pneumonia: a prospective, randomized clinical research(Turkiye Klinikleri, 2022) Şahin, Ayça Sultan; Kaya, Ebru; Turgut, Gürsel; Dolay, Kemal; Kocataş, AliObjective: Deficiencies in immune-regulatory mechanisms such as immune activation and T-regulatory cells are classically referred to as cytokine storms. Mesenchymal stem cells (MSCs) act as living anti-inflammatory cells that can rebalance cytokine/immune responses to restore balance in patients with coronavirus disease-2019 (COVID-19) acute respiratory distress syndrome by reducing the activation of T and B cells, and dendritic and natural killer cells. The aim of this study is to provide immune modulation with stem cell transplantation by reducing the damage caused and COVID-19 infection to tissues and organs. Material and Methods: In this prospective randomized sin-gle-center clinical trial, patients were divided into 3 groups: intubated without comorbidity (n=7); intubated with comorbidity (n=7); not intu-bated (n=7). Dosage of MSCs transplantation for each group was 1 mil-lion cell/kg intravenous at days 0, 2, and 4. age, gender, APACHE II scores, procalcitonin, C-reactive protein (CRP) and leukocyte values, and cluster of difference 4 (CD4), CD8, interleukin 2 (IL-2), and IL-6 levels, morbidities, number of days in intensive care unit, mortality were recorded. Clinical results, changes in inflammatory and immune function levels, and side effects were evaluated. Each patient’s improvement in oxygenation and symptoms were recorded in the days after MSC transplantation. After treatment, lymphocyte, CRP, tumor necrosis fac-tor-? level, and IL-6 levels were recorded. Results: There was no sta-tistically significant difference between the three groups in terms of stem cell therapy patients’ age and exit/discharge days and mortality. Patients who were in the group of “intubated, no comorbidity” had significantly higher CD19 and CD19+HLA-DR+ values compared with patients in the groups of “intubated with comorbidity” and “not intubated.” CRP, FiO2, IL-6 and SpO2 values were significantly different across periods. Conclusion: Our study may found a useful effect of MSCs on severe COVID-19 pneumonia and showed reversal of hypoxia and downregu-lation of cytokine storm in patients with severe COVID-19 following 3 intravenous doses with no adverse effects assignable to the treatment. © 2022 by Türkiye Klinikleri.Öğe A rare subepithelial lesion in the stomach: gastric adenomyoma(Blackwell Publishing Ltd, 2021) Abbasov, Aykhan; Aslan, Ekrem; Ekici, Asiye Işın Doğan; Dolay, KemalGastric adenomyomas are rare benign tumours and most often localized in the gastric antrum. The tumour generally consists of glandular cells and smooth muscle bundles. The size of a gastric adenomyoma (GA) can be up to 4.5 cm and can affect patients any age of their life. In cases with GA most of the patients are asymptomatic. However, non-specific gastrointestinal symptoms such as epigastric pain, vomiting and nausea can be seen. Differential diagnosis of GA difficult due to non-specific radiological and endoscopic findings. Imaging techniques and endoscopic examinations can not distinguish GAs from other intramuscular lesions of the stomach. Surgical excision is used in both diagnosis and treatment. In this article, we present a 46-year-old male patient with long-term dyspeptic complaints admitted to our department and diagnosed as gastric adenomyoma by performing subtotal gastrectomy.Öğe Vaginal reconstruction with the modified rectosigmoid colon: surgical technique, long-term results and sexual outcomes(Taylor & Francis Ltd, 2018) Özkan, Ömer; Özkan, Özlenen; Cinpolat, Anı; Doğan, Nasuh Utku; Bektaş, Gamze; Dolay, Kemal; Gürkan, Alihan; Arıcı, Cumhur; Doğan, SelenAlthough vaginal reconstructions with intestinal segments require particularly complex surgical procedures, this technique has become popular with respect to fairly good functional and esthetic outcomes. This study describes cases of vaginal reconstruction performed using a modified rectosigmoid colon held in an ischemic state in order to reduce secretion and denervated in order to prevent defecation problems. Vaginal reconstructions with rectosigmoid colon were performed on 43 patients. In this retrospective study, 34 patients had Mullerian agenesis, while nine had undergone male to female sex reassignment surgery in which adequate vaginal depth had not been achieved. A rectosigmoid colon with its vascular pedicle was used and left in an ischemic state. All nerve structures within the pedicle were excised intraoperatively. Follow-up period was between 12 and 60 months. Partial necrosis occurred in one patient which was reconstructed with local flap. Hematoma developed beneath the skin incision in two cases, but resolved with conservative treatment. A good esthetic outcome was achieved in all cases. Sexual function was assessed using the Female Sexual Function Index (FSFI) in 15 patients. Fourteen out of 15 patients scored above 26.5 on this scale and were determined as having no sexual dysfunction (FSFI score 26.5). In conclusion, vaginal reconstruction with denervated rectosigmoid held in an ischemic state appears to be a reasonable option among several available reconstruction techniques.
