Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
Browse
13 results
Search Results
Item Analysis of Bleeding Following Carotid Endarterectomy(2022) Hafez, Izzet; Diken, Adem, I; Ozyalcin, Sertan; Alemdaroglu, Utku; Tunel, Huseyin A.; https://orcid.org/0000-0002-8782-7603; ABE-8722-2020BACKGROUND: Carotid artery stenosis is one of the main causes of cerebral stroke. Carotid endarterectomy is still the most important technique for treatment. We aimed to reveal the factors which cause major bleeding and need for reoperation in patients treated with carotid endarterectomy and the primary closure technique. METHODS: Data of 97 patients who received conventional carotid endarterectomy and primary closure at our clinic between 2015 and 2020 were retrospectively analyzed. In line with these data, situations that could lead to major bleeding after surgery such as preoperative blood thinner drug use history, preoperative and postoperative complete blood counts, bleeding times and comorbid diseases were examined. RESULTS: Four of 97 patients included in the study (4.1%) were reoperated. Among these patients, 2 (50%) were receiving only anticoagulant treatment, while the other 2 (3.1%) were receiving only antiplatelet treatment. The difference between two groups was statistically significant. When the postoperative first day and total drain amounts of the patients in reoperated and nonreoperated group the difference was found significant (P<0.001). CONCLUSIONS: In our study, while no significant relationship could be found between antiplatelet use in the preoperative period and the prevalence of major bleeding, it was revealed that use of anticoagulant drugs for any reason in the preoperative period may lead to postoperative major bleeding even though the treatment has been stopped before surgery. History of preoperative anticoagulant drug used in patients taken in for reoperation is an issue that needs to be examined and paid attention to.Item Effects of Two Different Treatment Techniques on the Recovery Parameters of Moderate Carpal Tunnel Syndrome: A Six-Month Follow-up Study(2016) Celik, Guner; Ilik, Mustafa Kemal; 26657237Purpose: The optimal therapy for moderately severe carpal tunnel syndrome (CTS) remains unclear. In this study, the authors aimed at comparing the clinical and electrophysiologic recovery of CTS after local steroid injection and operation. Methods: This is a clinical prospective study consisting of 100 patients with moderate CTS. The patients were diagnosed electrophysiologically with isolated median nerve neuropathy and had CTS symptoms for at least 3 months. While the patients undergoing local steroid injection were defined as injection group (42 women, 8 men and n = 50), other participants undergoing surgery were defined as operation group (47 women, 3 men and n = 50). The severity of the symptoms and electrophysiologic findings were evaluated before and at the first, third, and sixth months after the treatment. Results: The authors found that all parameters were improved at the end of the first month in both groups. However, the recovery of all parameters increased at the third month and was statistically higher in operation group, compared with injection group. Furthermore, the recovery rate of distal sensory latencies and the visual analog scale scores was decreased in injection group at the third month. The authors observed that the recovery continued in both groups in the sixth month, and the rates of recovery were markedly lower in injection group than in operation group, compared with those obtained at the first month. Conclusions: The clinical recovery was more pronounced than the electrophysiologic recovery. And surgery is more effective technique than steroid injection for the treatment of the moderate CTS in the long term.Item Morbidity and Mortality of Colorectal Cancer Surgery in Octogenarians(2016) Torer, NurkanObjectives The aim of this study was to determine common problems, preoperative assessment criteria, and postoperative morbidity and mortality of octogenarians with colorectal cancer. Materials and method We screened the medical records of patients aged 80 years or older (study group) and that of patients of 50-59 years of age (control group) who were operated for colon cancer. Demographic features, comorbidities, American Society of Anaesthesiologists (ASA) score, urgency of operation, tumor localization, presence of colostomy, duration of hospital stay, admission to and duration of stay in the intensive care unit (ICU), TNM (Tumor, Node, Metastasis) stage, postoperative morbidity, and mortality rates were recorded. Results The medical records of 23 patients aged above 80 years and 39 patients aged between 50-59 years were screened retrospectively. The two groups did not differ significantly with respect to the morbidity rate but the mortality rate was significantly higher in the study group (p = 0.583 and p = 0.016, respectively). The study group patients needed significantly more ostomy creation procedures. In the analysis of the octogenarian groups, the ASA score or the presence of comorbidities had no discernible effect on the morbidity and mortality rates. Conclusion Specific preoperative evaluations are needed for prediction of mortality risk in geriatric patients. Rational criteria for performing protective ostomy should also be determined in octogenarians.Item Perioperative SARS-CoV-2 infection among women undergoing major gynecologic cancer surgery in the COVID-19 era: A nationwide, cohort study from Turkey(2021) Ayhan, Ali; Oz, Murat; Ozkan, Nazli Topfedaisi; Aslan, Koray; Altintas, Mufide Iclal; Akilli, Huseyin; Demirtas, Erdal; Celik, Osman; Ulgu, Mustafa Mahir; Birinci, Suayip; Meydanli, Mehmet Mutlu; 0000-0002-5240-8441; 33223221; AAJ-5802-2021; AAX-3230-2020Objective. The objective of this study was to determine the rate of perioperative SARS-CoV-2 infection among gynecologic cancer patients undergoing major surgery. Methods. The database of the Turkish Ministry of Health was searched in order to identify all consecutive gynecologic cancer patients undergoing major surgery between March 11, 2020 and April 30, 2020 for this retrospective, nationwide, cohort study. The inclusion criteria were strictly founded on a final histopathological diagnosis of a malignant gynecologic tumor. COVID-19 cases were diagnosed by reverse transcriptase polymerase chain reaction testing for SARS-CoV-2. The rate of perioperative SARS-CoV-2 infection and the 30-day mortality rate of COVID-19 patients were investigated. Results. During the study period, 688 women with gynecologic cancer undergoing major surgery were identified nationwide. The median age of the patients was 59 years. Most of the surgeries were open (634/688, 92.2%). There were 410 (59.6%) women with endometrial cancer, 195 (28.3%) with ovarian cancer, 66 (9.6%) with cervical cancer, 14 (2.0%) with vulvar cancer and 3 (0.4%) with uterine sarcoma. The rate of SARS-CoV-2 infections confirmed within 7 days before or 30 days after surgery was 46/688 (6.7%). All but one woman was diagnosed postoperatively (45/46, 97.8%). The rates of intensive care unit admission and invasive mechanical ventilation were 4/46 (8.7%) and 2/46 (4.3%), respectively. The 30-day mortality rate was 0%. Conclusion. In the COVID-19 era, gynecologic cancer surgery may be performed with an acceptable rate of perioperative SARS-CoV-2 infection if the staff and the patients strictly adhere to the established infection control measures. (c) 2020 Elsevier Inc. All rights reserved.Item Decision Analysis in Quest of the Ideal Treatment in Adult Spinal Deformity Adjusted for Minimum Clinically Important Difference(2020) Acaroglu, Emre; Yuksel, Selcen; Ates, Can; Ayhan, Selim; Bahadir, Sinan; Nabi, Vugar; Vila-Casademunt, Alba; Perez-Grueso, Francisco Javier Sanchez; Obeid, Ibrahim; 0000-0003-0153-3012; 32622065; U-5409-2018BACKGROUND: Surgery appears to yield better results in adult spinal deformity treatment when fixed minimum clinically important difference values are used to define success. Our objective was to analyze utilities and improvement provided by surgical versus nonsurgical treatment at 2 years using Oswestry Disability Index with treatment-specific minimum clinically important difference values. METHODS: From a multicenter database including 1452 patients, 698 with 2 years of follow-up were analyzed. Mean age of patients was 50.95 +/- 19.44 years; 580 patients were women, and 118 were men. The surgical group comprised 369 patients, and the nonsurgical group comprised 329 patients. The surgical group was subcategorized into no complications (192 patients), minor complications (97 patients) and major complications (80 patients) groups to analyze the effect of complications on results. Minimum clinically important differences using Oswestry Disability Index were 14.31, 14.96, and 2.48 for overall, surgical, and nonsurgical groups. Utilities were calculated by visual analog scale mapping. RESULTS: Surgical treatment provided higher utility (0.583) than nonsurgical treatment (0.549) that was sensitive to complications, being 0.634, 0.564, and 0.497 in no, minor, and major complications. Probabilities of improvement, unchanged, and deterioration were 38.3%, 39.2%, and 22.5% for surgical treatment and 39.4%, 10.5%, and 50.1% for nonsurgical treatment. Improvement in the surgical group was also sensitive to complications with rates of 40.1%, 39.3%, and 33.3%. CONCLUSIONS: Our results suggest that surgical treatment has less disease burden and less chance of deterioration, but equal chances for improvement at 2 years of follow-up. As it appears to be a better modality in the absence of complications, future efforts need be directed to decreasing the complication rates.Item A multi-institutional analysis of sequential versus 'sandwich' adjuvant chemotherapy and radiotherapy for stage IIIC endometrial carcinoma(2019) Onal, Cem; Sari, Sezin Yuce; Yildirim, Berna Akkus; Yavas, Guler; Gultekin, Melis; Guler, Ozan Cem; Akyurek, Serap; Yildiz, Ferah; 0000-0002-2742-9021; 30887753; D-5195-2014Objective: To analyze the outcomes of sequential or sandwich chemotherapy (ChT) and radiotherapy (RT) in patients with node-positive endometrial cancer (EC). Methods: Data from 4 centers were collected retrospectively for 179 patients with stage IIIC EC treated with postoperative RT and ChT (paclitaxel and carboplatin). Patients were either treated with 6 cycles of ChT followed by RT (sequential arm; 96 patients) or with 3 cycles of ChT, RT, and an additional 3 cycles of ChT (sandwich arm; 83 patients). Prognostic factors affecting overall survival (OS) and progression-free survival (PFS) were analyzed. Results: The 5-year OS and PFS rates were 64% and 59%, respectively, with a median followup of 41 months (range, 5-167 months). The 5-year OS rates were significantly higher in the sandwich than sequential arms (74% vs. 56%; p=0.03) and the difference for 5-year PFS rates was nearly significant (65% vs. 54%; p=0.05). In univariate analysis, treatment strategy, age, International Federation of Gynecology and Obstetrics (FIGO) stage, pathology, rate of myometrial invasion, and grade were prognostic factors for OS and PFS. In multivariate analysis, non-endometrioid histology, advanced FIGO stage, and adjuvant sequential ChT and RT were negative predictors for OS, whereas only non-endometrioid histology was a prognostic factor for PFS. Conclusion: Postoperative adjuvant ChT and RT for stage IIIC EC patients, either given sequentially or sandwiched, offers excellent clinical efficacy and acceptably low toxicity. Our data support the superiority of the sandwich regimen compared to the sequential strategy in stage IIIC EC patients for OS.Item Biphasic Pulmonary Blastoma Associated with Cerebral Metastasis(2016) Kilic, Dalokay; Yilmaz, Cem; Tepeoglu, Merih; Vural, Cigdem; Caner, Hakan; 26768884Pulmonary blastoma is a very rare malignant tumor of the lungs. A biphasic pulmonary blastoma was histologically diagnosed by a characteristic finding as it was mainly constituted of immature tumor tissue that had both epithelial and mesenchymal components. We present a case of a 68-year-old man with biphasic pulmonary blastoma. The patient underwent cranial metastatectomy and left lung upper lobectomy. Although the tumor was resected, there was rapid metastasis to the cranial, liver, kidney and multiple bones. Although radiotherapy and chemotherapy were administrated, the patient died about 6 months postoperatively. Close follow-up and aggressive chemotherapy should be considered for such tumours. In the light of this case, the authors review the pathologic, clinical, radiological and therapeutic features of this very rare malignant lung tumor.Item Recurrent Pleomorphic Adenoma of the Submandibular Gland(2016) Inan, Serhat; Aydin, Erdinc; Babakurban, Seda Turkoglu; Akcay, Eda Yilmaz; 0000-0001-6864-7378; 0000-0001-6831-9585; 0000-0001-5067-4044; 29392015; AAJ-1407-2021; AAJ-2379-2021; AAK-1960-2021; AAI-8856-2021Pleomorphic adenoma (PA) is the most common benign tumor of salivary glands. Most PAs occur in the parotid (80%), followed by the submandibular gland (10%) and minor salivary and sublingual glands (10%). Submandibular gland PAs usually manifest in the submandibular area as a painless hard mass. Although several recurrent parotid gland PA cases have been reported in the literature, recurrent submandibular gland PA is quite rare. Complete surgical removal of tumor of the submandibular gland and keeping the capsule intact are important to prevent recurrence. Here we present a rare case of submandibular gland PA recurrence that occurred 5 years after the first surgery and methods to prevent recurrence.Item Submandibular Gland Surgery: Our Clinical Experience(2016) Erbek, Selim Sermend; Koycu, Alper; Topal, Ozgul; Erbek, Hatice Seyra; Ozluoglu, Levent Naci; 0000-0002-2150-0237; 0000-0001-6305-5023; 29392010; AAI-8020-2021; ABI-6777-2020Objective: The aim of this study was to assess the demographic findings and surgical results of patients who underwent submandibular gland excision at a tertiary care center. Methods: The clinical characteristics and histopathological results of 45 patients who had undergone submandibular gland excision between 1997 and 2014 were evaluated in detail. Results: Twenty-eight (62.2%) and 17 (37.8%) patients presented with a complaint of a painful mass and painless mass, respectively. Histopathologic investigation of the surgical specimen revealed sialolithiasis in 14 patients (31.1%), chronic sialadenitis in 16 (35.6%), benign tumor in 12 (26.7%), malignant tumor in two (4.4%), and mucocele extravasation in one. As complications, permanent paralysis of the marginal mandibular branch of the facial nerve was seen in one patient (2.2%), temporary paralysis of the marginal mandibular branch of the facial nerve was seen in seven (15.6%), orocutaneous fistula was seen in one (2.2%), and temporary paralysis of the hypoglossal nerve was seen in one (2.2%). Conclusion: This study revealed that in patients presenting with complaints of a submandibular gland mass, sialolithiasis, sialadenitis, and benign masses were the mostly diagnosed pathologies. Transcervical submandibular gland excision is a satisfactory procedure with low complication and recurrence rates when it is performed on selected patients and obeyed to surgical techniques.Item Estimation of the capacity of emergency surgery in Konya: Nine-year multicenter study(2016) Türk, Emin; Kucukkartallar, Tevfik; Cakir, Murat; Tekin, Ahmet; Balasar, Mehmet; Kartal, Adil; Koksal, Hande; Erengul, Bulent; 0000-0003-4766-3373; 28149121; AAJ-5609-2021Objective: Although the number of surgical emergencies continues to increase, comprehensive data on emergency surgical admissions are scarce. The aim of this multicenter study was to evaluate the causes, management, and outcomes of the general surgical emergencies in the city of Konya, Turkey. Material and Methods: The relevant details of the cases admitted and considered to be general surgical emergencies in Konya over a nine-year period (January 2003-January 2012) were analyzed. All demographic data were analyzed statistically. Results: The study group comprised 21954 cases from 4 hospitals in Konya: 7154 from Konya Numune Hospital, 6,654 from Konya Education and Research Hospital, 6,400 from Necmettin Erbakan University Meram Medical Faculty, and 1,390 from Baskent University Konya Education and Research Hospital. Their mean age was 59.6 years, and the average hospitalization time was 3.3 days. The diagnoses of the admitted patients were as follows: acute appendicitis (59.57%), bowel obstruction (11.12%), trauma (7.97%), strangulated inguinal hernia (5.46%), acute cholecystitis (4.87%), peptic ulcer perforation (4.09%), mesenteric ischemia (2.73%), necrotizing fasciitis (2.73%), gastrointestinal system bleeding (1.79%), and others (1.1%). Conclusion: The findings of the study indicate a steady increase in surgical admissions to emergency units. Nontraumatic acute abdomen was the most common reason for general surgical emergencies. Although the number of elderly patients increased, the hospital stay and mortality rates decreased over the study period.