Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Practical Utility of Diagnostic Clinical Breast Examination in the Diagnosis of Breast Cancer(2021) Turan, Muberra; Sozen, Fisun; Eminsoy, Muzaffer G.; Sencelikel, Tugce; Kut, Altug; Yildirim, Sedat; Oksuz, Ergun; 0000-0002-5723-5965; 34646704; K-8238-2012Objectives We aimed to investigate the effectiveness of physician-performed diagnostic clinical breast examination (DCBE) for the diagnosis of breast cancer in clinical practice and to determine the rates of breast cancer diagnosed with DCBE compared to the results of breast ultrasonography (US), mammography (MG), and histopathology. Methods In the retrospective cohort study, the files of female patients diagnosed with breast cancer and admitted to the general surgery outpatient clinics of a university hospital over a 10-year period (2011-2021) were examined. Patients with complete DCBE findings in their files were identified and analyzed (n = 1,091). The examinations of the patients were performed by general surgery specialists with 5-22 years of experience and by radiologists with 4-15 years of experience. Results The mean age of breast cancer diagnosis of the patients was 55.1 +/- 13.5 years. While the sensitivity of IX:BE was found to be 88.9%, MG sensitivity was 89.8% and breast US sensitivity was 95.1%. Cancer was detected by MG, breast US, and DCBE in 47.9% (n = 523), by breast US and DCBE in 38.9% (n = 424), by MG and breast US in 5.6% (n = 61), by DCBE alone in 3.6% (n = 39), by MG and KBE in 2.4% (n = 26), and by breast US alone in 1.6% (n = 18). Early-stage breast cancer (p = 0.00) consisted of 73.2% (n = 383) of cancers detected with DCBE, breast US and MG, 74.6% (n = 316) of cancers detected with DCBE and breast US, 93.4% of cancers detected with breast US and MG (n = 57), 92.3% (n = 24) of cancers detected with DCBE and MG, 94.4% (n = 17) of cancers detected with breast US alone, and 69.2% of cancers detected with DCBE alone (n = 27). Conclusions CBE still maintains its importance in societies where screening participation and awareness of breast cancer are low. A breast cancer diagnosis is often done after a complaint of a palpable mass in the breast, and only then are more advanced-stage breast cancers are seen. CBE is among the important diagnostic methods preventing breast cancer from being overlooked, especially in places where health resources are limited.Item Analysis of Quality of Life, Depression, and Sexual Function in Patients on the Liver Transplant List(2021) Fidan, Cihan; Akdur, Aydincan; Kirnap, Mahir; Selcuk, Haldun; Yildirim, Sedat; Moray, Gokhan; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0002-8726-3369; 34609310; AAJ-8097-2021; AAA-3068-2021Background: I he only treatment in patients developing liver failure is liver transplantation. According to the Ministry of Health, the number of patients waiting for a liver transplantation is 2141, the average waiting period for liver transplantation is approximately 5 years, and 15-18% of these patients lose their life while waiting for transplantation. In these patients, limitations in daily activities and depression-anxiety are commonly found. The aim of this study was to analyze life quality, depression symptoms, and existence of sexual functional disorders of patients waiting for liver transplantation. Methods: A total of 74 patients, who were registered in Baskent University Hospital between 2015 and 2018, were included into the study. Short Form-36, Beck Depression Inventory, and Arizona Sexual Experiences Scale were applied to 56 patients who approved study. Results: Most of the patients were male (64.3%), and the mean age was 46 (18-64). Short Form-36 scores were low in all patients. The mean Beck Depression Inventory score of patients was found as 18.4 +/- 11.3, and they were suffering from moderate depressive symptoms. According to Arizona Sexual Experiences Scale, total mean scores of males was found as 16.3 +/- 5.5, and for females, it was 19.5 +/- 5.3 with a statistically significant difference (P < .05). It was found that sexual dysfunction mostly had moderate to mild. Conclusion: Depression and sexual dysfunction are common in patients with chronic liver diseases, and their life qualities deteriorate significantly. It is anticipated that evaluation of these patients in terms of psychological issues and sexual dysfunction will increase their quality of life during the organ waiting period and affect their well-being post-transplant.Item Surgical Interventions for Late Complications of Arteriovenous Fistulas(2014) Belli, Sedat; Yabanoglu, Hakan; Aydogan, Cem; Parlakgumus, Alper; Yildirim, Sedat; Haberal, Mehmet; 25058786Our aim was to determine the most effective surgical treatment for arteriovenous fistula (AVF) complications after all other methods of salvage have failed. We evaluated 110 patients for 139 complications that occurred after the initial AVF placement and for whom surgical intervention was the last hope for retaining fistula access. Vascular steal syndrome and venous hypertension were the most common complications seen in our patients. The anastomoses of 17 of the vascular steal syndrome cases were narrowed either by stitches or by a polytetrafluoroethylene graft. The second most performed revision surgery was excision of the aneurysm and repair with primary suturing, followed by excision of the aneurysm and interposition grafting. Successful surgical outcomes were achieved in 111 of 139 procedures after revision surgery without constructing a new AVF. AVF salvage surgery is of paramount importance in order to increase the patency rate, which prolongs survival and increases the patient's quality of life.Item Outcomes of Surgical Treatment of Primary Signet Ring Cell Carcinoma of the Colon and Rectum: 22 Cases Reviewed With Literature(2014) Belli, Sedat; Aytac, Huseyin Ozgur; Karagulle, Erdal; Yabanoglu, Hakan; Kayaselcuk, Fazilet; Yildirim, Sedat; 25437572Colorectal primary signet ring cell carcinoma (PSRCCR) is a rare entity with a dismal prognosis, mainly because of delayed diagnosis. The objective of this study was to investigate the clinicopathologic features and prognostic factors for PSRCCR. This is a retrospective study including the data of 22 patients with PSRCCR who underwent surgery. Patients were categorized by age, sex, tumor site, and stage. Fifteen patients were male. Median age was 40 years. Sites for metastases were lymph nodes (86.4%), peritoneum (40.9%), and liver (9.1%). Most of the patients (91%) had stage III or IV tumors. The rates of curative and palliative resections performed were equal. Mean overall survival and mean progression-free survival times were found to be 33.3 +/- 7.1 months (95% confidence interval, 19.4-47.2 months) and 11.8 +/- 3.5 months (95% confidence interval, 4.9-18.7 months), respectively. It was concluded that site of the tumor, presence of bowel obstruction, peritoneum and lung metastases, adjacent organ infiltration, TNM stage, and efficiency of surgery have significant effects on survival. All in all, these aggressive tumors are generally diagnosed at advanced stages. Depending on the situation, survival is shorter. A high degree of vigilance is required for these patients to avoid the negative impact of late diagnosis on survival.Item Results of Surgery in General Surgical Patients Receiving Warfarin: Retrospective Analysis of 61 Patients(2015) Belli, Sedat; Aytac, Huseyin Ozgur; Yabanoglu, Hakan; Karagulle, Erdal; Parlakgumus, Alper; Nursal, Tarik Zafer; Yildirim, Sedat; 25692422The aim of this study is to investigate postoperative complications, mortality rates, and to determine the factors affecting mortality on the patients receiving warfarin therapy preoperatively, as well as comparing the results obtained from emergency and elective surgeries. Surgical outcomes of 61 patients on long-term oral anticoagulation with warfarin who underwent surgery in our center were retrospectively reviewed over an 8-year period. Thirty-three (54.1%) patients were female, with a mean age of 53 years. Mitral valve replacement (62.3%) was the most frequent indication for chronic anticoagulation therapy. Twelve out of 61 (19.2%) patients underwent emergency surgery; 59 (96.7%) operations were classified as major surgery. We did not observe any thromboembolic events on patients receiving our bridging therapy protocol. Cardiopulmonary dysfunction (CPD; 19.7%) and hemorrhage (16.4%) were the most encountered postoperative complications. Presence of CPD, bleeding, endocarditis, and mortality were statistically significant for emergency surgeries when compared with the results obtained from elective surgeries. There were 5 (8.2%) deaths observed during follow-up. It was found that advanced age, prolonged duration of operations, and presence of CPD had a statistically significant effect on mortality (P < 0.05). The patients receiving oral anticoagulant had high postoperative complication and mortality rates. This case was more evident in emergency surgeries. It is recommendable that as mortality is more apparent in the patients who undergo emergency surgeries-being older, having long duration of operations as well as CPD. Therefore during the postoperative follow-up process, the patients should be closely monitored.Item Vascular Variations and Anastomosis Techniques in Renal Transplant Donors(2015) Haberal, Mehmet; Arer, Ilker Murat; Yabanoglu, Hakan; Caliskan, Kenan; Parlakgumus, Alper; Yildirim, Sedat; Moray, GokhanPurpose: We aimed to share our experience about vascular variations and anastomosis tecniques in renal transplant donors. Material and Methods: 128 donor nephrectomy performed in our hospital between February 2010 and June 2014 were included in our study. Donors were retrospectively analyzed according to age, sex, comorbidity, operation history, site of nephrectomy, vascular variation and anastomosis techniques. Results: 21 (% 16,4) patients have left-sided, 19 (% 14,8) have right-sided and 13 (% 10,2) have bilateral vascular variation. 29 (% 21,2) unilateral double renal artery, 8 (% 6,3) unilateral double renal artery and vein, 4 (% 3,2) unilateral triple renal artery, 3 (% 2,4) early branching renal artery, 2 (% 1,6) unilateral double renal vein and 2 (% 1,6) polar artery are vascular variations observed. of 92 (% 71,9) recepients anastomosis type was end to side between renal artery and external iliac artery and end to side between renal vein and external iliac vein, 32 (% 25) end to end between renal artery and external iliac artery and end to side between renal vein and external iliac vein, 4 (% 3,1) end to side between renal artery and external iliac artery and end to side between renal vein and external iliac vein and end to side between 2nd renal artery and external iliac artery. Conclusion: Preoperative evaluation of renal vasculature of transplant donors is an important issue in means of decreasing peroperative vascular complications and decision for nephrectomy site.Item EFFECTS OF LOWER GASTROINTESTINAL TRACT SURGERY ON SURVIVAL IN ELDERLY AND OCTOGENARIAN PATIENTS(2018) Aydin, Huseyin Onur; Avci, Tevfik; Tezcaner, Tugan; Karagulle, Erdal; Yildirim, Sedat; 0000-0003-3795-5794; 0000-0002-8522-4956; 0000-0002-3641-8674; 0000-0001-5225-959X; 0000-0002-5735-4315; S-8185-2018; C-6247-2017; AAD-9865-2021; AAF-1698-2021; AAF-4610-2019Introduction: Life expectancy has significantly increased in the last decade. The decision to perform surgery has always been challenging in elderly patients. We aimed to evaluate outcomes in patients who underwent surgery for lower gastrointestinal tract diseases and investigate factors influencing morbidity and mortality, particularly in octogenarian patients, and the effects of age on prognosis and survival in the postoperative period. Materials and Method: This study included patients aged >= 70 years who underwent lower gastrointestinal tract surgery; patients were divided into three groups as 70-75 years, 75-79 years, and >= 80 years. Age, gender, type of surgery, ASA score, length of hospital stay, morbidity, 30-day mortality, and overall survival were evaluated. Results: The surgery was performed to 598 patients due to lower gastrointestinal tract diseases. There was a significant increase in the ASA score with increasing age (Chi-square=35.472; p<0.001). The survival rate was significantly higher in patients with malignancies than in those with benign diseases, and in patients who underwent elective surgery than in those who underwent emergency surgery (p<0.001). When patients were examined according to age groups, the overall survival was similar across groups (p=0.217). Conclusion: There was no significant difference between octogenarian and younger patients for complications and survival. Thus, planned surgical interventions in elderly patients will not negatively affect survival and surgical interventions and can be safely performed in these patients.Item Retroperitoneal cystic lesion mimicking malign sarcoma as a complication of lost gallstones during laparoscopic cholecystectomy(2018) Aydin, Huseyin Onur; Soy, Ebru Hatice Ayvazoglu; Avci, Tevfik; Yildirim, SedatItem Role of preoperative C-reactive protein value and neutrophil ratio in the determination of conversion from laparoscopic appendectomy to open appendectomy(2018) Aydin, Huseyin Onur; Avi, Tevfik; Tezcaner, Tugan; Kirnap, Mahir; Yildirim, Sedat; Moray, Gokhan; 0000-0003-3795-5794; 0000-0003-3795-5794; 0000-0003-2498-7287; 30394496; AAH-9198-2019; S-8185-2018; AAF-4610-2019; M-1422-2019BACKGROUND: In this study, we aimed to investigate the factors causing conversion from laparoscopic appendectomy (LA) to open appendectomy (OA) in patients with acute appendicitis and to investigate the role of preoperative C reactive protein (CRP) and neutrophil ratio in this conversion and determine a cut-off point for these parameters. METHODS: Records of patients who underwent LA due to acute appendicitis at our general surgery department between January 2011 and January 2017 were retrospectively evaluated. The preoperative American Society of Anesthesiology (ASA) scores, Alvarado scores, white blood cell count, C-reactive protein level, and neutrophil ratio were evaluated. RESULTS: LA was performed in 394 patients with an initial diagnosis of acute appendicitis. A conversion to OA (cOA) was performed in 17 patients (4.31%). A CRP value of >= 108.5 mg/L and a neutrophil ratio of >= 81.5% were found to be statistically significant for the cOA (p<0.001). CONCLUSION: Our study results showed that male gender, age, elevated neutrophil ratio, and CRP value were the main risk factors for cOA in patients who were scheduled for LA due to acute appendicitis.Item Long-term and Perioperative Outcomes of Laparoscopic and Open Surgery for Rectal Cancer(2018) Aydin, Huseyin Onur; Ekici, Yahya; Karakayali, Feza Yarbug; Tezcaner, Tugan; Ozgun, Gonca; Yildirim, Sedat; Moray, GokhanObjectives: The necessity of comparing oncologic results with the use of minimally invasive surgery in rectal cancer has arisen. The aim of the present study was to evaluate the treatment approach in rectal cancer and to compare the outcomes of laparoscopic and open surgery. Methods: Patients who underwent surgery for rectal carcinoma between January 2006 and January 2016 in our institution were evaluated. The results were compared between the two groups according to open or laparoscopic surgery. Clinical characteristics, preoperative and postoperative results, pathological examination results, and disease-free survival rates were compared after the surgical procedure. Results: A total of 121 patients were included in the study. Of the patients, 50 underwent open, and 71 underwent laparoscopic surgery. The median follow-up times were 56.75 months in the open surgery group and 55.2 months in the laparoscopic surgery group. Pathological examination revealed similar numbers of lymph nodes in both groups (p>0.05). The duration of hospital stay was statistically significantly lower in the open surgery group than in the laparoscopic group (p<0.05). The rates of disease-free survival were 74% in the open surgery group and 82.5% in the laparoscopic group, and no statistically significant difference was found (p>0.05). Conclusion: There was no significant difference in complication and recurrence between laparoscopic and open surgery for rectal cancer in our study. The duration of hospital stay of patients was statistically significantly lower in the laparoscopic group than in the open surgery group. Laparoscopic or open surgical options could be preferred according to the clinical suitability of the patient, experience of the surgeon, and resources of the center in rectal cancer treatment.