Ramazan Yildiz | Gulhane Military Medical Academy (original) (raw)
Papers by Ramazan Yildiz
![Research paper thumbnail of 2-[18f]-Fluoro–2-deoxy-d-glucose positron emission tomography in the evaluation of breast lesions and axillary involvement: a comparison with mammography and histopathological diagnosis](https://attachments.academia-assets.com/115214913/thumbnails/1.jpg)
](Turkish Journal of Medical Sciences, 2012
The objective of this prospective study was to evaluate the potential role of 2-[18f]-fluoro-2-de... more The objective of this prospective study was to evaluate the potential role of 2-[18f]-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET) in the differentiation of malignant and benign breast masses and the evaluation of axillary lymph node involvement. The secondary objective of this study was to assess the value of FDG PET in the initial staging of patients with breast cancer. Materials and methods: We evaluated 82 lesions in 79 consecutive patients (mean age of 54.4 ± 13.0; age range: 25-82 years) with FDG PET. While ultrasounds were performed in all cases, of the 79 patients, 72 had mammography and 58 had whole-body bone scintigraphy. All patients had a histopathological diagnosis made by 2 experienced pathologists. Results: The sensitivity and positive predictive value of FDG PET in the differentiation of breast masses was found as 78% and 98%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of FDG PET in the detection of metastatic axillary invasion was 50%, 76%, 53%, and 64%, respectively. FDG PET changed the stage of 41 patients (52%) by either downstaging [33 (41%) patients] or upstaging [8 (11%) patients], respectively. Conclusion: Our results suggest that FDG PET has limited value in differentiating between malignant and benign breast lesions and in the detection of metastatic axillary lymph nodes. However, FDG PET appears to have great impact in the initial staging of patients with breast cancer and could be very helpful in the management of selected cases.
Journal of the Senologic International Society, Oct 10, 2012
INTRODUCTION: BI-RADS 4 breast lesions are high probability of malignancy and the most comon indi... more INTRODUCTION: BI-RADS 4 breast lesions are high probability of malignancy and the most comon indication of breast biopsy in this group. OBJECTIVES: In this study; we investigated the corralation between Gail risk scores and BI-RADS category of these patients for estimating malignancy befor biopsy. MATERIAL AND METHODS: In a prospective manner between 2007-2011, the age of over 35 patient's Gail risk scores who had biopsy indication for BI-RADS 4 category calculated before biopsy and final pathology results compared with the calculated risk scores. Statistically, P less than 0.05 was considered significant. Dependence between categorical variables were evaluated with chi-square test. RESULTS: In this study 246 women have been included, patient’s average age was 47.9 (35-82) year. Pathologic results were benign in 196 (%79.67), malign in 50 (%20.33) patients.The diagnosis of benign lesions were 4A in 178, 4B in 11, 4C in 7 patient. The diagnosis of malign lesions were 4A in 35, 4B in 9, 4C in 6 patient. Statistically, there was a relationship between advanced BI-RADS category with increased risk of malignancy (p=0.001). Total of 47 (%19.1) patients Gail risk score were above the critical value of 1.7. Patients with pathologically diagnosed malign were above the critical value of 1.7 only 8/35 (%22.85) in 4A, 1/9 (%11.1) in 4B, 1/6 (16.6) in 4C. Malign diagnosed patient’s of 9/50 of Gail risk score were above the value of 1.7. However patients with pathologically diagnosed benign were 39/178 (%21.81) in 4A, 3/11 (%27.27) in 4B and 3/7 (%42.85) in 4C above the value of 1.7. CONCLUSION: For women with Gail risk score above 1.7 is recommended close follow-up or prophylactic preventions. According to the results of our study before the biopsy, to determine the risk of malignancy BIRADS category is valuable. But Gail risk score to assess the risk of malignancy is thought to provide any contribution in Turkish women.
Clinical Nutrition Supplements, 2009
Poster presentations symptoms (CES-D > 16) and a trend for a higher proportion of subjects experi... more Poster presentations symptoms (CES-D > 16) and a trend for a higher proportion of subjects experiencing exacerbations in the previous year than subjects with low FFMI but normal BMI (p = 0.05). Conclusion: These results imply that functional effects of disturbances in body composition are not only dependent on the FFMI but also on other body compartments.
Gülhane tıp dergisi, 2015
Plastic and Reconstructive Surgery, Nov 1, 2012
Backgrounds: Diverse opinions are encountered in the literature regarding the indications, incisi... more Backgrounds: Diverse opinions are encountered in the literature regarding the indications, incisions to be chosen or reconstruction method following prophylactic mastectomy. In addition, the biggest handicap in most studies concerning either patient's satisfaction or operation results is the lack of group homogeneity. The purpose of the study was to evaluate the patient satisfaction rate and the operation technique used in homogeneous group of patient for prophylactic mastectomy.
Gulhane Medical Journal, 2015
Doğan ALHAN(*), Serbülent GÜZEY(*), Andaç AYKAN(*), İsmail ŞAHİN(*), Selçuk IŞIK(*), Ramazan YILD... more Doğan ALHAN(*), Serbülent GÜZEY(*), Andaç AYKAN(*), İsmail ŞAHİN(*), Selçuk IŞIK(*), Ramazan YILDIZ(**), Meme koruyucu cerrahi sonrası radyoterapi zemininde gelişen anjiosarkom: Olgu sunumu Giriş Anjiosarkom nadir rastlanan ve vasküler endotelyal dokudan köken alan bir tümördür. Yumuşak doku sarkomları içerisinde %1 oranında izlenen tümörün meme dokusu tutulum oranı ise %8'lere kadar ulaşmaktadır (1).
British Journal of Radiology, Apr 1, 2016
To investigate the correlation between apparent diffusion coefficient (ADC) values and prognostic... more To investigate the correlation between apparent diffusion coefficient (ADC) values and prognostic factors in patients with invasive ductal carcinoma (IDC). Methods: 48 lesions belonging to 47 patients with histopathologically proven IDC were examined using conventional MR and diffusion-weighted imaging at a 3.0-T system. All of the patients had modified radical mastectomies or breast-sparing surgery plus axillary lymph node dissection. The ADC values acquired from the ADC maps consisted of six different b-values (0, 50, 100, 500, 1000 and 1500 s mm 22) and were compared with the patients' ages, tumour size, histological grade of the lesions, tumour localization, lesions' distance to skin surface and nipples, the existence of axillary lymph node involvement, the number of involved axillary lymph nodes, oestrogen/progesterone receptor status, peritumoral lymphovascular invasion status and the existence of human epidermal growth factor 2 (c-erbB-2) overexpression. Results: A statistically significant relationship was found regarding axillary lymph node involvement (p 5 0.027), and oestrogen/progesterone receptor status (p 5 0.013). No significant relationship was detected regarding other prognostic factors (p. 0.05). Conclusion: Among various prognostic factors, ADC values were significantly correlated with only axillary lymph node positivity and oestrogen/progesterone receptor status. Advances in knowledge: In the present study, the relationship between ADC values of IDC lesions that are acquired at a high magnetic field (3.0 T) system by using multiple b-values and some specific prognostic factors that were not evaluated before in the medical literature was investigated.
Archives of Clinical and Experimental Surgery (ACES), 2016
The British Journal of Radiology, 2016
To investigate the correlation between apparent diffusion coefficient (ADC) values and prognostic... more To investigate the correlation between apparent diffusion coefficient (ADC) values and prognostic factors in patients with invasive ductal carcinoma (IDC). Methods: 48 lesions belonging to 47 patients with histopathologically proven IDC were examined using conventional MR and diffusion-weighted imaging at a 3.0-T system. All of the patients had modified radical mastectomies or breast-sparing surgery plus axillary lymph node dissection. The ADC values acquired from the ADC maps consisted of six different b-values (0, 50, 100, 500, 1000 and 1500 s mm 22) and were compared with the patients' ages, tumour size, histological grade of the lesions, tumour localization, lesions' distance to skin surface and nipples, the existence of axillary lymph node involvement, the number of involved axillary lymph nodes, oestrogen/progesterone receptor status, peritumoral lymphovascular invasion status and the existence of human epidermal growth factor 2 (c-erbB-2) overexpression. Results: A statistically significant relationship was found regarding axillary lymph node involvement (p 5 0.027), and oestrogen/progesterone receptor status (p 5 0.013). No significant relationship was detected regarding other prognostic factors (p. 0.05). Conclusion: Among various prognostic factors, ADC values were significantly correlated with only axillary lymph node positivity and oestrogen/progesterone receptor status. Advances in knowledge: In the present study, the relationship between ADC values of IDC lesions that are acquired at a high magnetic field (3.0 T) system by using multiple b-values and some specific prognostic factors that were not evaluated before in the medical literature was investigated.
ABSTRACT We aim to share our clinic experience with Amyand's hernia, which is rare condition ... more ABSTRACT We aim to share our clinic experience with Amyand's hernia, which is rare condition and has ongoing discussion about it's treatment. The files of patients with Amyand's hernia during the last ten years were reviewed retrospectively. The patients' demographic characteristics, diagnosis, treatment and early complications were assessed. Amyand's hernia was found on seven patients. All patients were male and mean age was 42. Four patients were operated with a diagnosis of strangulated right inguinal hernia, while others were undergoing elective surgery. One patient also had ileus. Inflamed appendix was viewed in two patients and normal appendix was viewed in five patients. All patients underwent appendectomy via hernia incision. Hernia have been treated with prolene mesh in four patients, using the method of darning in one patient and anatomical repair method in two patients. None of patients was observed early complications. Amyand's hernia especially has ongoing discussion in terms of treatment approach (appendectomy? or mesh application?). These cases are rare and diagnosed usually intraoperatively. The appropriate treatment approach in these cases such as performed appendectomy or not, should be decided according to the surgeon's intraoperative findings. In cases with appendicitis, hernia repair should be tought with anatomic repair, the method of darning or using biological materials resistant to infection along with using prosthetic materials. OZET Bu yazida, nadir gorulen ve tedavi yaklasimi acisindan tartismalarin devam ettigi Amyand fitigi ile ilgili tecrubelerimizi paylasmayi amacladik. Son on yilda Amyand fitigi tanisi alan hastalarin dosyalari retrospektif olarak incelenerek, demografik ozellikler, tani, tedavi ve erken donem komplikasyonlar acisindan degerlendirmeler yapildi. Toplam 7 hastada Amyand fitigi saptandi. Hepsi erkek olan hastalarin yas ortalamasi 42 olarak saptandi. Hastalardan 4'u inkarsere sag inguinal fitik tanisiyla, digerleri ise elektif sartlarda ameliyat edildi. Bir hastada ayni zamanda ileus tablosu mevcuttu. Iki hastada apendiks vermiformis inflame iken, 5 hastada normal olarak izlendi. Tum hastalara fitik kesisinden apendektomi uygulandi. Fitik 4 hastada prolen yama kullanilarak, 1 hastada ag orme yontemiyle ve 2 hastada anatomik tamir yontemiyle (yamasiz onarim) tedavi edilmisti. Hastalarin hicbirinde erken donem komplikasyon izlenmedi. Amyand fitigi ozellikle tedavi yaklasimi acisindan (apendektomi? yama uygulamasi?) tartismalarin devam ettigi nadir gorulen ve genellikle ameliyat sirasinda tani konulabilen olgulardir. Bu olgularda cerrah, uygun tedavi yaklasimina, ameliyat sirasindaki bulgulara gore karar vermelidir. Apandisit bulgularinin eslik ettigi olgularda; prostetik materyaller kullanmanin yani sira, anatomik tamir (yamasiz onarim), ag orme yontemi veya enfeksiyona direncli biyolojik materyallerle fitik tamiri yontemlerinin de kullanilabilecegi akilda bulundurulmalidir.
Gulhane Medical Journal, 2015
Ulusal Cerrahi Dergisi, 2011
Worldviews on Evidence-Based Nursing, 2016
Although there are a limited number of studies showing effects of neck stretching exercises follo... more Although there are a limited number of studies showing effects of neck stretching exercises following a thyroidectomy in reducing neck discomfort symptoms, no study has specifically dealt with and examined the effect of neck stretching exercises on neck pain and disability. To analyze the effect of neck stretching exercises, following a total thyroidectomy, on reducing neck pain and disability. A randomized controlled trial was conducted. The participants were randomly assigned either to the stretching exercise group (n = 40) or to the control group (n = 40). The stretching exercise group learned the neck stretching exercises immediately after total thyroidectomy. The effects of the stretching exercises on the participants' neck pain and disability, neck sensitivity, pain with neck movements as well as on wound healing, were evaluated at the end of the first week and at 1 month following surgery. When comparing neck pain and disability scale (NPDS) scores, neck sensitivity and pain with neck movement before thyroidectomy, after 1 week and after 1-month time-points, it was found that patients experienced significantly less pain and disability in the stretching exercise group than the control group (p < .001). At the end of the first week, the NPDS scores (mean [SD] = 8.82 [12.23] vs. 30.28 [12.09]), neck sensitivity scores (median [IR] = 0 [.75] vs. 2.00 [4.0]) and pain levels with neck movements (median [IR] = 0 [2.0] vs. 3.5 [5.75]) of the stretching exercise group were significantly lower than those of the control group. However, there was no significant difference between the groups with regard to the scores at the 1-month evaluation (p > .05). Neck stretching exercises done immediately after a total thyroidectomy reduce short-term neck pain and disability symptoms.
Ajci, Oct 5, 2013
Primer omentum torsiyonu ve nekrozu nadir karın ağrısı sebeplerindendir. Sıklıkla apandisit ön ta... more Primer omentum torsiyonu ve nekrozu nadir karın ağrısı sebeplerindendir. Sıklıkla apandisit ön tanısı ile ameliyata alınan omentumu torsiyone ve nekroz olmuş hastaların preoperatif teşhisi oldukça zordur. 22 yaşındaki erkek hasta acil servise ani başlangıçlı sağ alt kadran ağrısı ile başvurdu. Laparotomide normal apendiks ve uzun aksı boyunca torsiyone olarak nekroze uğramış omentum gözlendi. Torsiyone olmuş nekrotik omentum dokusu eksize edildi. 55 yaşında bayan hasta sağ alt kadran ağrısı ile acile başvurdu. Laparotomide 5x6 cm. boyutunda nekroze omentum gözlendi. Nekroze omentum dokusu eksize edildi. Sonuç olarak sunulan iki olgu ve literatürlerden çıkarımımız; akut batın bulguları olan hastalarda omental torsiyon ve idiyopatik omental nekrozda göz önünde bulundurulmalıdır. Anahtar kelimeler: Omental infarkt, omental nekroz, akut batın.
SpringerPlus, 2015
Sentinel lymph node biopsy (SLNB) is the current standard of care for breast cancers with no clin... more Sentinel lymph node biopsy (SLNB) is the current standard of care for breast cancers with no clinically palpable axillary lymph nodes. Almost 50 % of sentinel lymph node positive patients have negative non-sentinel nodes and undergo non-therapeutic axillary dissection. Five different scoring systems, reported in the literature, were compared for their predictive ability of non-SLN involvement in patients with SLN positive breast cancer. 242 patients who underwent breast surgery and SLNB were included in the study. Of these, 70 who were confirmed to have SLN metastasis and received complementary ALND and constituted the final study population. The nomograms (MSKCC, M.D. Anderson Cancer Center, Tenon model, Stanford and Turkish) were statistically compared for their prediction of non-SLN metastasis (95 % confidence interval). We have determined only two clinicopathologic (multifocality and size of the primary tumor) situations which have a statistically significant association between SLN metastasis with using a multivariate logistic regression analysis. Multifocality (P = 0.001) and size of the primary tumor (P = 0.001) were associated with a higher probability of-SLN metastasis. No predictive model was constructed that showed good area under the curve (AUC) discrimination in the validation series. Currently published predictive models lack accuracy when applied to a different population. Multi-institutional heterogenic population studies are important to determine the exact combination of scoring systems and/or nomograms.
Archives of Clinical and Experimental Surgery (ACES), 2014
International Wound Journal, 2011
Our study reviewed nine patients who were treated with the VAC™ Abdominal Dressing System after s... more Our study reviewed nine patients who were treated with the VAC™ Abdominal Dressing System after suffering pelvic fractures and soft tissue loss after high-energy pelvic trauma. Between March 2008 and August 2009, our clinic treated nine patients with complicated perineal injuries from high-energy pelvic trauma with multiple irrigation and debridement procedures and broad-spectrum antibiotics. Protective ostomies were created for all nine patients. Required interventions were made for associated injuries, and VAC™ application was started. All patients were male, with an average age of 24·3 (range 21-32) years, and a mean injury severity score of 36·4 (range 16-59). Wound diameters ranged from 15 to 30 cm, and wound depths ranged from 5 to 25 cm. The injuries included one traumatic bilateral hemipelvectomy, and three unilateral and two bilateral lower extremity amputations. Intensive care unit length of stay averaged 12 (6-19) days, and average hospital length of stay was 44·12 (31-64) days. Beginning at an average of day 17 (±5·9 days) post-injury, wound cultures detected no bacterial colonisation. One patient died on the sixth day after injury from septic complications. Two patients' wounds were closed by primary closure, and six patients' wounds were closed by split thickness grafts after an average of 31·4 (17-50) days. Optimal treatment of high-energy perineal injuries requires early and extensive debridement and rich irrigation. The application of the VAC™ system as temporary coverage of large complex wounds in the pelvic region enhances wound healing and facilitates an early grafting process.
International Surgery, 2013
The aim of the present study was to investigate the effect of hyperbaric oxygen therapy (HBOT) on... more The aim of the present study was to investigate the effect of hyperbaric oxygen therapy (HBOT) on colon anastomosis after chemoradiotherapy (CRT). Sixty female Wistar-Albino rats were divided into 5 groups and underwent left colon resection and end-to-end anastomosis. CRT simulation was performed on 2 sham groups before the anastomosis, and 1 of these groups was administered additional postoperative HBOT. Two groups were administered CRT before the anastomosis, and 1 of them received additional postoperative HBOT. On postoperative day 5, all groups underwent relaparotomy; burst pressure was measured and samples were obtained for histopathologic and biochemical analysis. There was a significant weight loss in the CRT groups and postoperative HBOT had an improving effect. Significantly decreased burst pressure values increased up to the levels of the controls after HBOT. Hydroxyproline levels were elevated in all groups compared to the control group. Hydroxyproline levels decreased with HBOT after CRT. No significant difference was observed between the groups regarding fibrosis formation at the anastomosis site. However, regression was observed in fibrosis in the group receiving HBOT after CRT. Preoperative CRT affected anastomosis and wound healing unfavorably. These unfavorable effects were alleviated by postoperative HBOT. HBOT improved the mechanical and biochemical parameters of colon anastomosis in rats.
Clinical Nuclear Medicine, 2010
To improve the surgical success and reduce the complication rates, we combine our routine preoper... more To improve the surgical success and reduce the complication rates, we combine our routine preoperative ultrasound (US) mapping technique with radioguided occult lesion localization (ROLL) in patients with papillary thyroid cancer recurrences in central compartment. In the morning of surgery, biopsy proven recurrent/persistent tumoral lesions were plotted on a sketch and injected with Tc-99m labeled macroaggregated albumin under US guidance. Thyroid bed exploration was carried out based on the location of biopsy proven lesion with the guidance of intraoperative gamma probe and neck map. The lymphoadipose tissues showing high count rates were resected and labeled separately for histopathologic study. Despite extensive scarring in some patients probe safely guided to lesions. Noninjected tumor foci were searched and successfully resected in the light of neck map that showing topographic relation of injected and noninjected lesions. Among total of 41 excised lesions, 28 metastatic foci ranging from 3 to 38 mm in largest diameter were recognized at final histologic examination. Combination of preoperative mapping with ROLL was found helpful by the operating surgeons in all patients, respectively. Except 2 patients with known distant metastases, undetectable thyroglobulin levels were reached 6 weeks after surgery. The use of preoperative US-mapping with ROLL in patients with nonpalpable recurrent/persistent papillary thyroid cancer in central compartment is technically safe and effective method. Combination of techniques provides better information about topographical relations of recurrent/persistent lesions during surgery.
Turkish Journal of Medical Sciences, 2012
The objective of this prospective study was to evaluate the potential role of 2-[18f]-fluoro-2-de... more The objective of this prospective study was to evaluate the potential role of 2-[18f]-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET) in the differentiation of malignant and benign breast masses and the evaluation of axillary lymph node involvement. The secondary objective of this study was to assess the value of FDG PET in the initial staging of patients with breast cancer. Materials and methods: We evaluated 82 lesions in 79 consecutive patients (mean age of 54.4 ± 13.0; age range: 25-82 years) with FDG PET. While ultrasounds were performed in all cases, of the 79 patients, 72 had mammography and 58 had whole-body bone scintigraphy. All patients had a histopathological diagnosis made by 2 experienced pathologists. Results: The sensitivity and positive predictive value of FDG PET in the differentiation of breast masses was found as 78% and 98%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of FDG PET in the detection of metastatic axillary invasion was 50%, 76%, 53%, and 64%, respectively. FDG PET changed the stage of 41 patients (52%) by either downstaging [33 (41%) patients] or upstaging [8 (11%) patients], respectively. Conclusion: Our results suggest that FDG PET has limited value in differentiating between malignant and benign breast lesions and in the detection of metastatic axillary lymph nodes. However, FDG PET appears to have great impact in the initial staging of patients with breast cancer and could be very helpful in the management of selected cases.
Journal of the Senologic International Society, Oct 10, 2012
INTRODUCTION: BI-RADS 4 breast lesions are high probability of malignancy and the most comon indi... more INTRODUCTION: BI-RADS 4 breast lesions are high probability of malignancy and the most comon indication of breast biopsy in this group. OBJECTIVES: In this study; we investigated the corralation between Gail risk scores and BI-RADS category of these patients for estimating malignancy befor biopsy. MATERIAL AND METHODS: In a prospective manner between 2007-2011, the age of over 35 patient's Gail risk scores who had biopsy indication for BI-RADS 4 category calculated before biopsy and final pathology results compared with the calculated risk scores. Statistically, P less than 0.05 was considered significant. Dependence between categorical variables were evaluated with chi-square test. RESULTS: In this study 246 women have been included, patient’s average age was 47.9 (35-82) year. Pathologic results were benign in 196 (%79.67), malign in 50 (%20.33) patients.The diagnosis of benign lesions were 4A in 178, 4B in 11, 4C in 7 patient. The diagnosis of malign lesions were 4A in 35, 4B in 9, 4C in 6 patient. Statistically, there was a relationship between advanced BI-RADS category with increased risk of malignancy (p=0.001). Total of 47 (%19.1) patients Gail risk score were above the critical value of 1.7. Patients with pathologically diagnosed malign were above the critical value of 1.7 only 8/35 (%22.85) in 4A, 1/9 (%11.1) in 4B, 1/6 (16.6) in 4C. Malign diagnosed patient’s of 9/50 of Gail risk score were above the value of 1.7. However patients with pathologically diagnosed benign were 39/178 (%21.81) in 4A, 3/11 (%27.27) in 4B and 3/7 (%42.85) in 4C above the value of 1.7. CONCLUSION: For women with Gail risk score above 1.7 is recommended close follow-up or prophylactic preventions. According to the results of our study before the biopsy, to determine the risk of malignancy BIRADS category is valuable. But Gail risk score to assess the risk of malignancy is thought to provide any contribution in Turkish women.
Clinical Nutrition Supplements, 2009
Poster presentations symptoms (CES-D > 16) and a trend for a higher proportion of subjects experi... more Poster presentations symptoms (CES-D > 16) and a trend for a higher proportion of subjects experiencing exacerbations in the previous year than subjects with low FFMI but normal BMI (p = 0.05). Conclusion: These results imply that functional effects of disturbances in body composition are not only dependent on the FFMI but also on other body compartments.
Gülhane tıp dergisi, 2015
Plastic and Reconstructive Surgery, Nov 1, 2012
Backgrounds: Diverse opinions are encountered in the literature regarding the indications, incisi... more Backgrounds: Diverse opinions are encountered in the literature regarding the indications, incisions to be chosen or reconstruction method following prophylactic mastectomy. In addition, the biggest handicap in most studies concerning either patient's satisfaction or operation results is the lack of group homogeneity. The purpose of the study was to evaluate the patient satisfaction rate and the operation technique used in homogeneous group of patient for prophylactic mastectomy.
Gulhane Medical Journal, 2015
Doğan ALHAN(*), Serbülent GÜZEY(*), Andaç AYKAN(*), İsmail ŞAHİN(*), Selçuk IŞIK(*), Ramazan YILD... more Doğan ALHAN(*), Serbülent GÜZEY(*), Andaç AYKAN(*), İsmail ŞAHİN(*), Selçuk IŞIK(*), Ramazan YILDIZ(**), Meme koruyucu cerrahi sonrası radyoterapi zemininde gelişen anjiosarkom: Olgu sunumu Giriş Anjiosarkom nadir rastlanan ve vasküler endotelyal dokudan köken alan bir tümördür. Yumuşak doku sarkomları içerisinde %1 oranında izlenen tümörün meme dokusu tutulum oranı ise %8'lere kadar ulaşmaktadır (1).
British Journal of Radiology, Apr 1, 2016
To investigate the correlation between apparent diffusion coefficient (ADC) values and prognostic... more To investigate the correlation between apparent diffusion coefficient (ADC) values and prognostic factors in patients with invasive ductal carcinoma (IDC). Methods: 48 lesions belonging to 47 patients with histopathologically proven IDC were examined using conventional MR and diffusion-weighted imaging at a 3.0-T system. All of the patients had modified radical mastectomies or breast-sparing surgery plus axillary lymph node dissection. The ADC values acquired from the ADC maps consisted of six different b-values (0, 50, 100, 500, 1000 and 1500 s mm 22) and were compared with the patients' ages, tumour size, histological grade of the lesions, tumour localization, lesions' distance to skin surface and nipples, the existence of axillary lymph node involvement, the number of involved axillary lymph nodes, oestrogen/progesterone receptor status, peritumoral lymphovascular invasion status and the existence of human epidermal growth factor 2 (c-erbB-2) overexpression. Results: A statistically significant relationship was found regarding axillary lymph node involvement (p 5 0.027), and oestrogen/progesterone receptor status (p 5 0.013). No significant relationship was detected regarding other prognostic factors (p. 0.05). Conclusion: Among various prognostic factors, ADC values were significantly correlated with only axillary lymph node positivity and oestrogen/progesterone receptor status. Advances in knowledge: In the present study, the relationship between ADC values of IDC lesions that are acquired at a high magnetic field (3.0 T) system by using multiple b-values and some specific prognostic factors that were not evaluated before in the medical literature was investigated.
Archives of Clinical and Experimental Surgery (ACES), 2016
The British Journal of Radiology, 2016
To investigate the correlation between apparent diffusion coefficient (ADC) values and prognostic... more To investigate the correlation between apparent diffusion coefficient (ADC) values and prognostic factors in patients with invasive ductal carcinoma (IDC). Methods: 48 lesions belonging to 47 patients with histopathologically proven IDC were examined using conventional MR and diffusion-weighted imaging at a 3.0-T system. All of the patients had modified radical mastectomies or breast-sparing surgery plus axillary lymph node dissection. The ADC values acquired from the ADC maps consisted of six different b-values (0, 50, 100, 500, 1000 and 1500 s mm 22) and were compared with the patients' ages, tumour size, histological grade of the lesions, tumour localization, lesions' distance to skin surface and nipples, the existence of axillary lymph node involvement, the number of involved axillary lymph nodes, oestrogen/progesterone receptor status, peritumoral lymphovascular invasion status and the existence of human epidermal growth factor 2 (c-erbB-2) overexpression. Results: A statistically significant relationship was found regarding axillary lymph node involvement (p 5 0.027), and oestrogen/progesterone receptor status (p 5 0.013). No significant relationship was detected regarding other prognostic factors (p. 0.05). Conclusion: Among various prognostic factors, ADC values were significantly correlated with only axillary lymph node positivity and oestrogen/progesterone receptor status. Advances in knowledge: In the present study, the relationship between ADC values of IDC lesions that are acquired at a high magnetic field (3.0 T) system by using multiple b-values and some specific prognostic factors that were not evaluated before in the medical literature was investigated.
ABSTRACT We aim to share our clinic experience with Amyand's hernia, which is rare condition ... more ABSTRACT We aim to share our clinic experience with Amyand's hernia, which is rare condition and has ongoing discussion about it's treatment. The files of patients with Amyand's hernia during the last ten years were reviewed retrospectively. The patients' demographic characteristics, diagnosis, treatment and early complications were assessed. Amyand's hernia was found on seven patients. All patients were male and mean age was 42. Four patients were operated with a diagnosis of strangulated right inguinal hernia, while others were undergoing elective surgery. One patient also had ileus. Inflamed appendix was viewed in two patients and normal appendix was viewed in five patients. All patients underwent appendectomy via hernia incision. Hernia have been treated with prolene mesh in four patients, using the method of darning in one patient and anatomical repair method in two patients. None of patients was observed early complications. Amyand's hernia especially has ongoing discussion in terms of treatment approach (appendectomy? or mesh application?). These cases are rare and diagnosed usually intraoperatively. The appropriate treatment approach in these cases such as performed appendectomy or not, should be decided according to the surgeon's intraoperative findings. In cases with appendicitis, hernia repair should be tought with anatomic repair, the method of darning or using biological materials resistant to infection along with using prosthetic materials. OZET Bu yazida, nadir gorulen ve tedavi yaklasimi acisindan tartismalarin devam ettigi Amyand fitigi ile ilgili tecrubelerimizi paylasmayi amacladik. Son on yilda Amyand fitigi tanisi alan hastalarin dosyalari retrospektif olarak incelenerek, demografik ozellikler, tani, tedavi ve erken donem komplikasyonlar acisindan degerlendirmeler yapildi. Toplam 7 hastada Amyand fitigi saptandi. Hepsi erkek olan hastalarin yas ortalamasi 42 olarak saptandi. Hastalardan 4'u inkarsere sag inguinal fitik tanisiyla, digerleri ise elektif sartlarda ameliyat edildi. Bir hastada ayni zamanda ileus tablosu mevcuttu. Iki hastada apendiks vermiformis inflame iken, 5 hastada normal olarak izlendi. Tum hastalara fitik kesisinden apendektomi uygulandi. Fitik 4 hastada prolen yama kullanilarak, 1 hastada ag orme yontemiyle ve 2 hastada anatomik tamir yontemiyle (yamasiz onarim) tedavi edilmisti. Hastalarin hicbirinde erken donem komplikasyon izlenmedi. Amyand fitigi ozellikle tedavi yaklasimi acisindan (apendektomi? yama uygulamasi?) tartismalarin devam ettigi nadir gorulen ve genellikle ameliyat sirasinda tani konulabilen olgulardir. Bu olgularda cerrah, uygun tedavi yaklasimina, ameliyat sirasindaki bulgulara gore karar vermelidir. Apandisit bulgularinin eslik ettigi olgularda; prostetik materyaller kullanmanin yani sira, anatomik tamir (yamasiz onarim), ag orme yontemi veya enfeksiyona direncli biyolojik materyallerle fitik tamiri yontemlerinin de kullanilabilecegi akilda bulundurulmalidir.
Gulhane Medical Journal, 2015
Ulusal Cerrahi Dergisi, 2011
Worldviews on Evidence-Based Nursing, 2016
Although there are a limited number of studies showing effects of neck stretching exercises follo... more Although there are a limited number of studies showing effects of neck stretching exercises following a thyroidectomy in reducing neck discomfort symptoms, no study has specifically dealt with and examined the effect of neck stretching exercises on neck pain and disability. To analyze the effect of neck stretching exercises, following a total thyroidectomy, on reducing neck pain and disability. A randomized controlled trial was conducted. The participants were randomly assigned either to the stretching exercise group (n = 40) or to the control group (n = 40). The stretching exercise group learned the neck stretching exercises immediately after total thyroidectomy. The effects of the stretching exercises on the participants' neck pain and disability, neck sensitivity, pain with neck movements as well as on wound healing, were evaluated at the end of the first week and at 1 month following surgery. When comparing neck pain and disability scale (NPDS) scores, neck sensitivity and pain with neck movement before thyroidectomy, after 1 week and after 1-month time-points, it was found that patients experienced significantly less pain and disability in the stretching exercise group than the control group (p < .001). At the end of the first week, the NPDS scores (mean [SD] = 8.82 [12.23] vs. 30.28 [12.09]), neck sensitivity scores (median [IR] = 0 [.75] vs. 2.00 [4.0]) and pain levels with neck movements (median [IR] = 0 [2.0] vs. 3.5 [5.75]) of the stretching exercise group were significantly lower than those of the control group. However, there was no significant difference between the groups with regard to the scores at the 1-month evaluation (p > .05). Neck stretching exercises done immediately after a total thyroidectomy reduce short-term neck pain and disability symptoms.
Ajci, Oct 5, 2013
Primer omentum torsiyonu ve nekrozu nadir karın ağrısı sebeplerindendir. Sıklıkla apandisit ön ta... more Primer omentum torsiyonu ve nekrozu nadir karın ağrısı sebeplerindendir. Sıklıkla apandisit ön tanısı ile ameliyata alınan omentumu torsiyone ve nekroz olmuş hastaların preoperatif teşhisi oldukça zordur. 22 yaşındaki erkek hasta acil servise ani başlangıçlı sağ alt kadran ağrısı ile başvurdu. Laparotomide normal apendiks ve uzun aksı boyunca torsiyone olarak nekroze uğramış omentum gözlendi. Torsiyone olmuş nekrotik omentum dokusu eksize edildi. 55 yaşında bayan hasta sağ alt kadran ağrısı ile acile başvurdu. Laparotomide 5x6 cm. boyutunda nekroze omentum gözlendi. Nekroze omentum dokusu eksize edildi. Sonuç olarak sunulan iki olgu ve literatürlerden çıkarımımız; akut batın bulguları olan hastalarda omental torsiyon ve idiyopatik omental nekrozda göz önünde bulundurulmalıdır. Anahtar kelimeler: Omental infarkt, omental nekroz, akut batın.
SpringerPlus, 2015
Sentinel lymph node biopsy (SLNB) is the current standard of care for breast cancers with no clin... more Sentinel lymph node biopsy (SLNB) is the current standard of care for breast cancers with no clinically palpable axillary lymph nodes. Almost 50 % of sentinel lymph node positive patients have negative non-sentinel nodes and undergo non-therapeutic axillary dissection. Five different scoring systems, reported in the literature, were compared for their predictive ability of non-SLN involvement in patients with SLN positive breast cancer. 242 patients who underwent breast surgery and SLNB were included in the study. Of these, 70 who were confirmed to have SLN metastasis and received complementary ALND and constituted the final study population. The nomograms (MSKCC, M.D. Anderson Cancer Center, Tenon model, Stanford and Turkish) were statistically compared for their prediction of non-SLN metastasis (95 % confidence interval). We have determined only two clinicopathologic (multifocality and size of the primary tumor) situations which have a statistically significant association between SLN metastasis with using a multivariate logistic regression analysis. Multifocality (P = 0.001) and size of the primary tumor (P = 0.001) were associated with a higher probability of-SLN metastasis. No predictive model was constructed that showed good area under the curve (AUC) discrimination in the validation series. Currently published predictive models lack accuracy when applied to a different population. Multi-institutional heterogenic population studies are important to determine the exact combination of scoring systems and/or nomograms.
Archives of Clinical and Experimental Surgery (ACES), 2014
International Wound Journal, 2011
Our study reviewed nine patients who were treated with the VAC™ Abdominal Dressing System after s... more Our study reviewed nine patients who were treated with the VAC™ Abdominal Dressing System after suffering pelvic fractures and soft tissue loss after high-energy pelvic trauma. Between March 2008 and August 2009, our clinic treated nine patients with complicated perineal injuries from high-energy pelvic trauma with multiple irrigation and debridement procedures and broad-spectrum antibiotics. Protective ostomies were created for all nine patients. Required interventions were made for associated injuries, and VAC™ application was started. All patients were male, with an average age of 24·3 (range 21-32) years, and a mean injury severity score of 36·4 (range 16-59). Wound diameters ranged from 15 to 30 cm, and wound depths ranged from 5 to 25 cm. The injuries included one traumatic bilateral hemipelvectomy, and three unilateral and two bilateral lower extremity amputations. Intensive care unit length of stay averaged 12 (6-19) days, and average hospital length of stay was 44·12 (31-64) days. Beginning at an average of day 17 (±5·9 days) post-injury, wound cultures detected no bacterial colonisation. One patient died on the sixth day after injury from septic complications. Two patients' wounds were closed by primary closure, and six patients' wounds were closed by split thickness grafts after an average of 31·4 (17-50) days. Optimal treatment of high-energy perineal injuries requires early and extensive debridement and rich irrigation. The application of the VAC™ system as temporary coverage of large complex wounds in the pelvic region enhances wound healing and facilitates an early grafting process.
International Surgery, 2013
The aim of the present study was to investigate the effect of hyperbaric oxygen therapy (HBOT) on... more The aim of the present study was to investigate the effect of hyperbaric oxygen therapy (HBOT) on colon anastomosis after chemoradiotherapy (CRT). Sixty female Wistar-Albino rats were divided into 5 groups and underwent left colon resection and end-to-end anastomosis. CRT simulation was performed on 2 sham groups before the anastomosis, and 1 of these groups was administered additional postoperative HBOT. Two groups were administered CRT before the anastomosis, and 1 of them received additional postoperative HBOT. On postoperative day 5, all groups underwent relaparotomy; burst pressure was measured and samples were obtained for histopathologic and biochemical analysis. There was a significant weight loss in the CRT groups and postoperative HBOT had an improving effect. Significantly decreased burst pressure values increased up to the levels of the controls after HBOT. Hydroxyproline levels were elevated in all groups compared to the control group. Hydroxyproline levels decreased with HBOT after CRT. No significant difference was observed between the groups regarding fibrosis formation at the anastomosis site. However, regression was observed in fibrosis in the group receiving HBOT after CRT. Preoperative CRT affected anastomosis and wound healing unfavorably. These unfavorable effects were alleviated by postoperative HBOT. HBOT improved the mechanical and biochemical parameters of colon anastomosis in rats.
Clinical Nuclear Medicine, 2010
To improve the surgical success and reduce the complication rates, we combine our routine preoper... more To improve the surgical success and reduce the complication rates, we combine our routine preoperative ultrasound (US) mapping technique with radioguided occult lesion localization (ROLL) in patients with papillary thyroid cancer recurrences in central compartment. In the morning of surgery, biopsy proven recurrent/persistent tumoral lesions were plotted on a sketch and injected with Tc-99m labeled macroaggregated albumin under US guidance. Thyroid bed exploration was carried out based on the location of biopsy proven lesion with the guidance of intraoperative gamma probe and neck map. The lymphoadipose tissues showing high count rates were resected and labeled separately for histopathologic study. Despite extensive scarring in some patients probe safely guided to lesions. Noninjected tumor foci were searched and successfully resected in the light of neck map that showing topographic relation of injected and noninjected lesions. Among total of 41 excised lesions, 28 metastatic foci ranging from 3 to 38 mm in largest diameter were recognized at final histologic examination. Combination of preoperative mapping with ROLL was found helpful by the operating surgeons in all patients, respectively. Except 2 patients with known distant metastases, undetectable thyroglobulin levels were reached 6 weeks after surgery. The use of preoperative US-mapping with ROLL in patients with nonpalpable recurrent/persistent papillary thyroid cancer in central compartment is technically safe and effective method. Combination of techniques provides better information about topographical relations of recurrent/persistent lesions during surgery.