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Öğe Cholangiocarcinoma presenting with hypercalcemia and thrombocytopenia(Hindawi Publishing Corporation, 2014) Battal, Muharrem; Gürbulak, Bünyamin; Bostancı, Özgür; Yılmaz, Müveddet Banu; Özdenkaya, Yaşar; Karatepe, O?uzhanMalignant hypercalcemia and thrombocytopenia may result from bone metastasis of cholangiocarcinoma (CC). Our case was 53-year-old man admitted to emergency department with symptoms of anorexia, weight loss, nausea, vomiting, and general fatigue in February 2012. His laboratory findings showed hypercalcemia and thrombocytopenia. CT showed a large multinodular mass in the right lobe and, extending through left lobe of the liver. We considered the diagnosis of hypercalcemia of malignancy with elevated calcium levels and suppressed PTH level with the existence of skeletal bone metastasis and the absence of parathyroid gland pathology. Treatment of hypercalcemia with IV saline, furosemide, and calcitonin improved the patient symptoms. After the 8th day of admission, calcium level, thrombocytopenia, and other symptoms were normalized. Patient was sustained surgically inoperable and transferred to medical oncology department for the purpose of palliative chemotherapy and intended radiotherapy for bone metastasis. Hypercalcemia relapsed 4 weeks after discharge and patient died at the 5th month after admission due to disseminated metastasis. We should be aware of CC with symptomatic hypercalcemia and rarely low platelet count. The correction of hypercalcemia provides symptomatic relief and stability of patients.Öğe Impact of allyl disulfide on oxidative damage and liver regeneration in an experimental hepatectomy model(Editura Celsius, 2015) Battal, Muharrem; Kartal, Abdülcabbar; Çitgez, Bülent; Yılmaz, Bahri; Akçakaya, Adem; Karatepe, O?uzhanBackgraund: We investigated the effects of allyl disulfide (a garlic extract) on tissue damage, regeneration, proliferation and oxidative damage in an experimental liver resection model. Materials and Methods: In the study, 24 female Wistar albino rats weighing approximately 200-250 g were used. Group 1: The rats in the experimental group all received a 70% hepatectomy and were fed an Allyl disulfide (30 µg/kg/day, Allyl disulfide, Sigma-Aldrich, formula: C6H10S2, CAS Number: 2179-57-9, formula weight: 146.27 g/mol) in supplement to a regular diet for 1 week both preoperatively and postoperatively. Group 2: The rats in the control group also underwent a 70% hepatectomy and were given regular food and water for 1 week both preop and postop. Group 3: In the sham group, all rats were sacrificed 7 days after surgery. For biochemical evaluation, SGOT, SGPT, bilirubin, CRP and MDA were studied. In a histopathological examination, the fattening of the liver tissue, existence of (macro-micro vesicular), fibrosis, pleomorphism at hepatocyte nuclei, portal inflammation, existence of intralobular inflammatory cells, dilation at sinusoids, congestion, congestion at the central vein, regeneration, existence of Kupffer cells in the sinusoidal lumen and ki-67 proliferation index at hepatocytes were examined. Results: A significant difference between group 1 and group 2 was observed regarding the existence of regeneration, (p:0.06), the occurrence of nuclear pleomorphisms (p:0,001) and the fibroblast activity status (p:0.001). Significant differences were found between the experimental groups in regard to Kupffer cell increase and dilation and the hyperemia status in the sinusoid lumens (p:0.013 and p:0.001, respectively). In the Allyl disulfide group, the proliferation index was significantly higher than that of the other groups (p:0,001), while the average plasma MDA value was lower than that of the other groups (p: 0,042). No significant differences were found among the groups with respect to tissue MDA values (p:0,720). No significant difference was found for SGPT (ALT) and SGOT (AST) levels between Group 1 and the other groups (p:0.247 and p:0.539, respectively). The average total bilirubin (T. Bili) values were 0,12, 0,08 and 0,04 in the allyl disulfide group, control group and Sham group, respectively. This difference among the groups is statistically significant (p:0.001). The average direct bilirubin (D. Bili) values were 0,06, 0,02 and 0,02 in the allyl disulfide group, control group and Sham group, respectively. This variation among the groups is also statistically significant (0.001). Conclusion: We observed that the use of Allyl disulfide supplementation after major hepatectomy has a positive impact on liver regeneration, proliferation and oxidative damage. Abbreviations: Postop: post-operative, Preop: pre-operative, SGOT(AST): serum glutamic oxaloacetic transaminase, SGPT(ALT): serum glutamate-pyruvate transaminase, CRP: C- Reactive protein, MDA: Malondialdehyde, DAS: Garlic extract diallyl sulfide, AGE: aged garlic extract.Öğe Impact of GLP-1 analogue on oxidative damage and hepatic regeneration in experimental 70% hepatectomy model(Update Medical Publishing, 2015) Battal, Muharrem; Çitgez, Bülent; Kartal, Abdülcabbar; Kemik, Ahu; Yıldırım, Pınar; Özdenkaya, Yaşar; Yılmaz, Ahmet; Karatepe, O?uzhanBackground/Aims: The purpose of our study is researching into impact of glucagon like peptide 1 (GLP 1) analogue on liver regeneration after major hepatectomy. Methodology: 24 wistar albino rats were consecutively divided into 3 groups. Group 1: Control (sham) group day 14 (n=8), Group 2: Liver resection group day 14 (n=8); 70% Liver resection was performed, Group 3: Study group day 14 (n=8); Subsequent to performing 70% liver resection, GLP-1 analogue was administered 2 times a day (10 mu gr/70 kg x 2 times). After 14 day, rats were sacrificed. Oxidative stress and antioxidant enzymes and mitochondrial permeability transition, cytochrome-c, Bax, Bcl-2, caspase-3, caspase-8 and caspase-3 activity were examined. Results: 70% Liver resection induced oxidative stress of liver tissue was ameliorated by GLP 1 induction. Administration of GLP increased Bcl-2 expression. Decreased expression of cytochrome-c was accompanied by a decrease caspase-3, caspase-8, and Bax expression and caspase-3 activity. Conclusions: Glp 1 induction plays a regenerative role in the major hepatectomy. This effect is dependent on modulation of the antiapoptotic and antioxidative pathways by GLP 1 expression.Öğe The difficulties encountered in conversion from classic pancreaticoduodenectomy to total laparoscopic pancreaticoduodenectomy(Medknow Publications and Media Pvt. Ltd., 2016) Battal, Muharrem; Yılmaz, Ahmet; Öztürk, Gökmen; Karatepe, OğuzhanBackground: Recently, total laparoscopic pancreatectomy has been performed at many centres as an alternative to open surgery. In this study, we aimed to present the difficulties that we have encountered in converting from classic open pancreaticoduodenectomy to total laparoscopic pancreatectomy. Materials and Methods: Between December 2012 and January 2014, we had 100 open pancreaticoduodenectomies. Subsequently, we tried to perform total laparoscopic pancreaticoduodenectomy (TLPD) in 22 patients. In 17 of these 22 patients, we carried out the total laparoscopic procedure. We analysed the difficulties that we encountered converting to TLPD in three parts: Preoperative, operative and postoperative. Preoperative difficulties involved patient selection, preparation of operative instruments, and planning the operation. Operative difficulties involved the position of the trocars, dissection, and reconstruction problems. The postoperative difficulty involved follow-up of the patient. Results: According to our experiences, the most important problem is the proper selection of patients. Contrary to our previous thoughts, older patients who were in better condition were comparatively more appropriate candidates than younger patients. This is because the younger patients have generally soft pancreatic texture, which complicates the reconstruction. The main operative problems are trocar positions and maintaining the appropriate position of the camera, which requires continuous changes in its angles during the operation. However, postoperative follow-up is not very different from the classic procedure. Conclusion: TLPD is a suitable procedure under appropriate conditions.
