Nevra Elmas | Ege University (original) (raw)

Papers by Nevra Elmas

Annals of coloproctology, May 16, 2024

One of the possible causes of chronic constipation is colonic duplication. Although seldom asympt... more One of the possible causes of chronic constipation is colonic duplication. Although seldom asymptomatic, its diagnosis is important due to the risk of malignancy that it carries. We present a case of a young female patient with long-standing constipation who was referred to Kolorektal Cerrahi Clinic (Izmir, Turkey) after scans revealed tubular type of colonic duplication. We successfully performed a laparoscopic total colectomy, and she recovered well. Identifying the type of duplication is important to ensure adequate resection and treatment. A proper workup, including carcinoembryonic antigen levels, must be done as well. Multiple surgical techniques and procedures have been introduced for this condition, but resection of the duplicated colon with its native lumen should be the management of choice, especially in tubular type of duplications such as in our case. In centers where laparoscopic services are available, laparoscopy could be a better option, as it provides multiple benefits of minimally invasive surgery. Attention should also be paid to anatomical details during surgery to ensure better results and outcomes.

BJS open, Sep 2, 2022

Background: The optimal timing of surgery following chemoradiotherapy (CRT) is controversial. Thi... more Background: The optimal timing of surgery following chemoradiotherapy (CRT) is controversial. This trial aimed to assess disease recurrence and survival rates between patients with locally advanced rectal adenocarcinoma (LARC) who underwent total mesorectal excision (TME) after a waiting interval of 8 weeks or less (classic interval; CI) versus more than 8 weeks (long interval; LI) following preoperative CRT. Methods: This was a phase III, single-centre, randomized clinical trial. Patients with LARC situated within 12 cm of the anal verge (T3-T4 or N+ disease) were randomized to undergo TME within or after 8 weeks after CRT. Results: Between January 2006 and January 2017, 350 patients were randomized, 175 to each group. As of February 2022, the median follow-up time was 80 (6-174) months. Among the 322 included patients (CI, 159; LI, 163) the cumulative incidence of locoregional recurrence at 5 years was 10.1 per cent in the CI group and 6.9 per cent in the LI group (P = 0.143). The cumulative incidence of distant metastasis at 5 years was 30.8 per cent in the CI group and 18.6 per cent in the LI group (sub-HR = 1.78; 95 per cent c.i. 1.14 to 2.78, P = 0.010). The disease-free survival (DFS) in each group was 59.7 and 69.9 per cent respectively (P = 0.157), and overall survival (OS) rates at 5 years were 73.6 versus 77.9 per cent (P = 0.476). Conclusion: Incidence of distant metastasis decreased with an interval between CRT and surgery exceeding 8 weeks, but this did not impact on DFS or OS.

Abdominal Imaging, Oct 13, 2020

Purpose Given the lack of information about abdominal imaging findings and correlation with clini... more Purpose Given the lack of information about abdominal imaging findings and correlation with clinical features of COVID-19, we aimed to evaluate the changes in hepatic attenuation during the course of disease. Our aim was to correlate the liverto-spleen ratio (L/S), clinical, laboratory findings, and lung CT scores of patients with COVID-19 who had two consecutive chest CTs. Methods A retrospective search was performed between March 1, 2020 and April 26, 2020 to identify patients who had positive RT-PCR tests and two unenhanced chest CTs. Scans that were obtained at hospital admission and follow-up were reviewed to assess L/S and lung CT scores. Patients were divided into two groups based on lung CT scores (non-progressive vs progressive). Patient demographics, laboratory findings, length of hospital stay, and survival were noted from electronic medical records. Results Twenty patients in the progressive group and 7 patients in the non-progressive group were identified. The mean L/S of the progressive group (1.13 ± 0.3) was lower than that of the non-progressive group (1.21 ± 0.29) at hospital admission but there was no significant difference between the two groups (p = 0.547). L/S at follow-up was significantly different between the groups as the mean L/S values of the progressive and non-progressive groups were 1.02 ± 0.23 and 1.25 ± 0.29, respectively (p = 0.009). L/S was negatively correlated with AST and ALT (r = − 0.46, p = 0.016 and r = − 0.534, p = 0.004, respectively). There were significant differences between the two groups in terms of WBC, neutrophil, lymphocyte, monocyte, and platelet counts that were obtained at hospital admission. Length of hospital stay was significantly longer in patients in the progressive group (p = 0.035). Conclusions Decrease in L/S may be observed in patients with elevated lung CT scores at follow-up. WBC, neutrophil, lymphocyte, monocyte, and platelet counts at hospital admission may predict the progression of COVID-19.

Focal liver lesions present a common diagnostic problem, especially in the presence of diffuse he... more Focal liver lesions present a common diagnostic problem, especially in the presence of diffuse hepatocellular disease and cirrhosis [2]. The differential diagnosis includes focal fatty infiltration, liver metastases, incidental hemangiomas and hepatocellular cirrhosis [3]. Ultrasound (US) and computed tomography (CT) have not always been able to detect small hepatocellular carcinomas (HCCs) measuring less than 2 cm, especially in patients with atrophic livers due to advanced cirrhosis [1].

Springer eBooks, 1993

Color Doppler sonography has opened a new window into the evaluation of the portal venous system.... more Color Doppler sonography has opened a new window into the evaluation of the portal venous system. This modality allows flow direction and frequency to be depicted a real-time vascular image superimposed on a continuously updated gray scale tissue image [1,2]. Color Doppler sonography permits prompt visualization of the major portal vessels and confirmation of their patency. Detection of the presence of collaterals, which frequently from following portal hypertension, is another application of color Doppler imaging [3]. In this study, patients with known portal hypertension due to various cause were examined by color Doppler ultrasonography and computed tomography (CT) portography. Patency of the portal system, flow direction, and portosystemic collaterals were studied by each method. The contribution of the modalities to the diagnosis and their advantages and limitations are evaluated.

Turkish Journal of Medical Sciences, 1997

... Bu olgularda predispozan etken olarak çoğunlukla uzun süreli RİA kullanımı öyküsü bildirilmek... more ... Bu olgularda predispozan etken olarak çoğunlukla uzun süreli RİA kullanımı öyküsü bildirilmektedir [8-11]. ... Türkiye Ekopatoloji Dergisi ALPAY ÇETİN, AYŞENUR AKYILDIZ İĞDEM, MUZAFFER ER, YETER EKİCİ, NUSRET ERDOĞAN KARACİĞERDE İNFLAMATUAR ...

Akademik Gastroenteroloji Dergisi, 2020

Giriş ve Amaç: Bu çalışmada malign ile benign portal ven trombozunun ayrımında 3 Tesla manyetik r... more Giriş ve Amaç: Bu çalışmada malign ile benign portal ven trombozunun ayrımında 3 Tesla manyetik rezonans görüntülemede difüzyon ağırlıklı görüntülemenin rolünün araştırılması amaçlanmaktadır. Gereç ve Yöntem: Ocak 2011 - Aralık 2016 tarihleri arasında 3 Tesla manyetik rezonans görüntüleme ünitesinde elde edilmiş abdomen manyetik rezonans görüntüleme incelemeleri portal ven trombozu mevcut olguları tespit etmek için retrospektif olarak değerlendirildi. Kontrastsız görüntüler ile karşılaştırıldığında arteriyel faz kontrastlı görüntülerde ≥%15 kontrast tutulumu gösteren portal ven trombozu malign olarak kabul edildi. Tromboz saptanan portal venin çapı ölçülüp difüzyon ağırlıklı görüntülerde portal ven trombozu sinyal intensitesi kaydedildi. İki bağımsız gözlemci tarafından malign ve benign portal ven trombozlarının görünür difüzyon katsayısı değerleri ölçüldü. Bulgular: Malign portal ven trombozu bulgusu olan 23 olgu [19 erkek, 4 kadın; ortanca yaş 63 (52-83)] ve benign portal ven trom...

Surgical Oncology, 2021

BACKGROUND A fundamental aspect of oncosurgical planning in organ resections is the identificatio... more BACKGROUND A fundamental aspect of oncosurgical planning in organ resections is the identification of feeder vessel details to preserve healthy organ tissue while fully resecting the tumors. The purpose of this study was to determine whether three-dimensional (3D) cancer case models of computed tomography (CT) images will assist resident-level trainees in making appropriate operative plans for organ resection surgery. METHODS This study was based on the perception of surgery residents who were presented with 5 different oncosurgical scenarios. A five-station carousel including cases of liver mass, stomach mass, annular pancreas, pelvic mass and mediastinal mass was formed for the study. The residents were required to compare their perception level of the cases with their CT images, and 3D models in terms of identifying the invasion of the mass, making differential diagnosis and preoperative planning stage. RESULTS All residents have given higher scores for models. 3D models provided better understanding of oncopathological anatomy and improved surgical planning. In all scenarios, 70-80% of the residents preferred the model for preoperative planning. For surgical choice, compared to the CT, the model provided a statistically significant difference in terms of visual assessment, such as tumor location, distal or proximal organotomy (p:0.009). In the evaluation of presacral mass, the perception of model was significantly better than the CT in terms of bone-foramen relationship of chondrosarcoma, its origin, geometric shape, localization, invasion, and surgical preference (p:0.004). The model statistically significantly provided help to evaluate and prepare the case together with the colleagues performing surgery (p:0.007). Commenting on the open-ended question, they stated that the tumor-vessel relationship was clearly demonstrated in the 3D model, which has been very useful. CONCLUSIONS With the help of 3D printing technology in this study, it is possible to implement and evaluate a well-structured real patient scenario setup in cancer surgery training. It can be used to improve the understanding of pathoanatomical changes of multidisciplinary oncologic cases. Namely, it is used in guiding the surgical strategy and determining whether patient-specific 3D models change pre-operative planning decisions made by surgeons in complex cancer mass surgical procedures.

International Journal of Surgery Case Reports, 2020

INTRODUCTION: Persistent Müllerian duct syndrome (PMDS) is a rare form of internal male pseudoher... more INTRODUCTION: Persistent Müllerian duct syndrome (PMDS) is a rare form of internal male pseudohermaphroditism characterized by the presence of rudimentary Müllerian structures in a virilized male often presenting as undescended testes. Thus, each patient diagnosed with undescended testes should promptly be investigated for PMDS because the early diagnosis has direct effects on outcome and prognosis. CASE REPORT: A 26-year-old-male complained of long-standing abdominal pain two years ago and was diagnosed having bilateral undescended testes in the pelvic region. He underwent the orchidopexy about one year ago but, after 5 months of orchidopexy, he first complained of discomfort in the left and then right inguinal region due to an incisional hernia that presumed to have the ovotesticular disorder of sexual development. On the pelvic MRI exam, the Müllerian duct structures were observed and he was diagnosed as having PMDS. DISCUSSION: In this case the patient had bilateral cryptorchidism with testes fixed in the para iliac region with respect to the uterus, indicating the female type of PMDS which is a rare type of PMDS. The case is proven genetically and Müllerian duct remnants have been resected to avoid malignant transformation. CONCLUSION: Persistent Mullerian duct syndrome (PMDS) is a rare finding and may present as long-standing abdominal pain. Each patient diagnosed with undescended testes should promptly be investigated for PMDS. Diagnosis and management aim to preserve fertility and prevent malignant changes. Therefore, familiarity with this rare condition will lead to adequate management and prevention of complications.

Türk Radyoloji Seminerleri, 2016

Diagnostic and Interventional Imaging, 2015

Diagnostic and Interventional Radiology

Japanese Journal of Radiology, Nov 7, 2020

Purpose To assess the use of virtual monochromatic images (VMI) for discrimination of affected an... more Purpose To assess the use of virtual monochromatic images (VMI) for discrimination of affected and non-affected bowel walls in patients with Crohn's disease (CD) as well as to compare mural enhancement between patients with and without CD. Materials and methods This retrospective study included 61 patients (47 with CD, 14 without CD). Attenuation value (AV), signal-to noise ratio (SNR), and contrast-to-noise ratio (CNR) were obtained at VMI energy levels from 40 to 110 keV in 10 keV increment. Analyses were performed among affected and non-affected bowel walls in CD patients, as well as from bowel walls in patients without CD. Image quality and mural enhancement were evaluated at VMI energy levels at 40, 70, and 110 keV. Results At all energy levels of VMI, each quantitative data for AV, SNR, and CNR showed statistically significant difference between diseased and non-diseased bowel walls in CD patients. In the quantitative assessment of patients with and without CD, the optimal AV and SNR were obtained at 40 keV, and the optimal CNR was obtained at 70 keV. For the qualitative assessment, the best image quality and mural enhancement were obtained at 70 keV and 40 keV, respectively. Conclusion VMI are helpful for the differentiation of affected bowel walls in CD patients, providing high diagnostic accuracy.

The Journal of Tepecik Education and Research Hospital, 2010

Erişkin yaş grubundaki kolorektal kanser riski yüksek olgularda BT ko!onografı.nin kolorektal lez... more Erişkin yaş grubundaki kolorektal kanser riski yüksek olgularda BT ko!onografı.nin kolorektal lezyonları saptamadaki tanısal etkinliğini klasik kolonoskopi ile kıyaslamak. GEREÇ VE YÖNTEM: yapıldığı yer Ege Üniversitesi Tıp Fakültesi Hastanesi Radyoloji Anabilimdalıdır. O lgulara önce BT kolonografi daha sonra kolonoskopi tetkiki yapıldı. BT kolonografı 16 alınaçi ı çok kesitli bir BT cihazı kullanarak yüz üstü ve sırt üstü konumlarda kontrastlı ve kontrastsız olarak alınan 1.25 mm kesit kalınlığındaki görüntülerle yapıldı. Tüm olgularda cihaz yazılımı içinde bulunan "Shaded Surface Display" (Üç Boyutlu Görüntüleme) yazılımı ile sanal kolonoskopik görüntüler elde edildi. Klasik kolonoskopi altın standart olarak kabul edilerek sanal kolonoskopide saptanan bütün !ezyonlar ve polipler için duyarlılık, özgüllük hesaplamatarı yapıldı ve Colıen'in Kappa uyum analizi gerçekleştirildi. BULGULAR: Olgularm tümü birlikte değerlendirildiğinde sanal kolonos!copinin lezyon saptamadaki duyarlılığı %81.5, özgüllüğü %78.9 olarak hesaplandı. Polipler için hesaplanan duyarlılık %83,3 ve özgüllük %76,9 olarak bulundu. Dört mm ve üzeri çaptaki poliplerde BT kolonograt1nin duyarlılığı % l 00 idi. Lezyonlarm tümü ve polipler için yapılan Co hen Kappa uyum analizinde sanal koloııoskopiy!e kolonoskopi arasındaki ilişki katsayısı orta-iyi derecedeydi (K=O.S0-0.60). SONUÇ: BT kolonogratl, 4 mm'den küçük palipleri saptamadaki etkinliğinin ve Kappa uyum analizi sonuçlarını oı~ca-iyi derecede olması nedeniyle bir tarama testi olarak güvenilir değildir. Bu tetkikin !ezyonlarm ilk tanısından çok, kolonoskopi ile saptanmış olan lezyonların morfolojik özelliklerinin izlernde kullanılması daha faydalı olabilir,

Ince barsak lezyonlarinin radyolojik olarak goruntulenmesi oldukca guctur. Herlinger'in popul... more Ince barsak lezyonlarinin radyolojik olarak goruntulenmesi oldukca guctur. Herlinger'in popularize ettigi enteroklizis yontemi sayesinde ince barsak lezyonlarinin spesifik olarak goruntulenebilecegi dusunulmektedir. Bu calismada gastrointestinal sistem yakinma ve bulgulari ile klinigimize basvuran 21 olgu retrospektif olarak incelenmistir. Opere edilen olgularin; yedisinde Crohn, altisinda duz kas hucreli tumor, dordunde ince barsak lenfomasi, birinde posttravmatik darlik, birinde anjiofollikuler lenf nodu hiperplazisi (Castleman hastaligi), birinde postoperatif darlik, birinde adeno karsinom saptanmistir. Tum olgularda enteroklizisin anatomik olarak lezyonu lokalize ettigi, lezyonun dogasi ve yayilimi hakkinda bilgi verdigi gorulmustur. Biz enteroklizis tekniginin ince barsak lezyonlarinin tespiti konusunda oldukca duyarli bir yontem oldugu dusuncesindeyiz.

Annals of Medicine & Surgery

Medical Journal of Ege University, 2001