Araştırma Çıktıları | TR-Dizin | WoS | Scopus | PubMed
Permanent URI for this communityhttps://hdl.handle.net/11727/4806
Browse
5 results
Search Results
Item Factors affecting parametrial involvement in cervical cancer patients with tumor size <= 4 cm and selection of low-risk patient group(2021) Akilli, Huseyin; Tohma, Yusuf Aytac; Gunakan, Emre; Kucukyildiz, Irem; Tunc, Mehmet; Haberal, Nihan Reyhan; Ayhan, Ali; 0000-0002-5240-8441; 0000-0001-9418-4733; 0000-0001-8854-8190; 0000-0001-9852-9911; 33506671; AAX-3230-2020; AAE-6482-2021; ABI-1707-2020; AAK-4587-2021Objective: The primary aim of this study was to evaluate the factors affecting parametrial involvement in cervical cancer patients with tumor size <= 4 cm and selection of the low-risk patient group based on long-term oncologic outcomes. Material and Methods: Cervical cancer patients operated in the gynecologic oncology division between 2007 and 2013 were retrospectively evaluated. One-hundred and sixty-eight patients with tumor size <= 4 cm were identified. Of these, 159 (86.8%) underwent radical hysterectomy plus pelvic-para- aortic lymphadenectomy and nine (13.2%) underwent fertility-sparing surgery [radical trachelectomy (n= 7); large conization (n=2)]. Factors affecting parametrial invasion, including lymphovascular space invasion (LVSI), deep stromal invasion (DSI), lymph node metastases, and tumor size, were evaluated. Statistical analyses were performed using SPSS 23.0 (IBM Corp., Armonk, NY, USA). Results: Median age was 49.5 years and median tumor size was 2.5 cm ( 0.45-4 cm). In both univariate and multivariate analyses, the risk of parametrial involvement was increased with LVSI with a hazard ratio (HR) of 3.45 [95% confidence interval (CI): 1.1-10.8] and DSI with a HR of 4.1 (95% CI: 1.18-14.8), while tumor size of <= 2 cm was only significant in univariate analyses. Furthermore, 26 early-stage patients were identified with low-risk factors and they had no parametrial involvement, lymph node metastases, recurrence, or death from disease over 77 months. Conclusion: Parametrial involvement in low-risk cervical cancer is very rare and less radical procedures may be safe in these patients.Item Management of a Patient in the State of Total Occlusion of Aorta Due to Takayasu Arteritis in Preconceptional and Pregnancy Period(2021) Gunakan, Emre; Akay, Tankut; Esin, Sertac; 0000-0001-8854-8190; ABI-1707-2020Objectives: Total aortic occlusion is a severe complication of Takayasu arteritis (TAK). Pregnancy follow-up in the state of total aortic occlusion due to TAK has not been reported before. Case presentation: A 35 year-old nulliparous woman with total aortic occlusion in the distal aorta due to TAK, admitted with pregnancy desire. She had developed a collateral vessel system which has maintained the lower body circulation. She was informed about the potential risks after an evaluation and she admitted to our clinic at the seventh week of pregnancy, and acetylsalicylic acid was prescribed. At 20th gestational week anomaly screening was in normal limits although the uterine artery Doppler had lower S/D, PI and RI values. She was followed-up regularly in every two weeks. Vascular examination was performed by using an ankle brachial index (ABI) by duplex ultrasound. At 20th gestational week ankle brachial index score was 0.8-0.9 which indicates mild disease. Around 28th gestational week her claudication got worse again and ABI was in moderate level (0.5-0.8) and low molecular weight heparin was started. Until 37th gestational week her disease was stable, ABI was above 0.5, her blood pressure was in normal limits, no vascular complication occurred and the baby's growth percentile was at 25th centile. At 37th gestational week a 2,640 g baby was delivered. Patient was discharged without any complications at third post-operative day. Conclusions: Complicated TAK patients may have good obstetric outcomes with a multidisciplinary approach in experienced tertiary centers.Item Survival impact of number of removed para-aortic lymph nodes in stage I epithelial ovarian cancer(2021) Gunakan, Emre; Akilli, Huseyin; Kara, Atacan Timucin; Altundag, Ozden; Haberal, Asuman Nihan; Meydanli, Mehmet Mutlu; Ayhan, Ali; 0000-0002-5240-8441; 0000-0003-0197-6622; 0000-0001-8854-8190; 34410474; AAX-3230-2020; W-9219-2019; ABI-1707-2020Purpose The survival effect of presence or absence of lymphadenectomy in early-stage epithelial ovarian cancer (EOC) was priorly shown but the effect of number of removed lymph nodes kept in background. We aimed to evaluate the survival impact of number of removed lymph nodes and their localizations in stage I EOC. Methods This study included 182 patients. The best cut-off levels for number of pelvic and para-aortic lymph nodes (PaLN) were 24 and 10, respectively. Univariate and multivariate survival analyses were performed for these cut-offs and other prognostic factors. Results The median age of the patients was 49. The median number of removed pelvic and paraartic lymph nodes were 29 and 9, respectively. The median overall (OS) and progression-free survival (PFS) were 67 and 50 months, respectively. The 5-year OS rate was 89.6%. Recurrence occured in 24 (19.5%) patients. In univariate analyses tumor grade (p: 0.005), pelvic LN number (p: 0.041) and PaLN number (p: 0.004) were the factors that were significantly associated with PFS. Tumor grade and PaLN number were independently and significantly associated with PFS in multivariate analyses (p: 0.015 and p: 0.017, respectively). In OS analyses, age, tumor grade, presence of LVI, number of pelvic and PaLNs were the significantly associated factors (p < 0.05 for all). In multivariate analyses, age and PaLN number were independently and significantly associated with OS (p: 0.011 and p: 0.021, respectively). Conclusions The number and localizations of removed lymph nodes may have a survival affect in stage I EOC. We also think that this study may constitute a kernel point for larger prospective series on lymph node number and lymphatic regions.Item Early pregnancy after bariatric surgery: a single-institute preliminary experience(2020) Gunakan, Emre; Bulus, Hakan; Tohma, Yusuf Aytac; 0000-0001-9418-4733; 31840970; AAE-6482-2021Background/aim: Pregnancy after bariatric surgery is an issue of growing importance with increasing number of women undergoing bariatric surgery. Therefore, in this study we present patients who conceived after sleeve gastrectomy and evaluate the obstetric outcomes. Materials and methods: This retrospective case-control study includes 23 women who conceived after laparoscopic sleeve gastrectomy. Patients were evaluated in two groups according to the number of months between surgery and conception (group 1: <= 12 months; group 2: >12 months). Results: The mean body mass index of patients before surgery and at the time of conception was 46.6 kg/m(2) and 29.7 kg/m(2), respectively. Nine patients (39.1%) had a history of infertility. There was no statistical difference between groups 1 and 2 for haemoglobin, ferritin, and 25-OH Vit-D levels or maternofoetal complication rates and pregnancy outcomes. Enteral nutrition requirements and intravenous iron replacement needs were higher in group 1, although this difference was not statistically significant. Conclusion: Pregnancy in the first years after sleeve gastrectomy seems to have similar obstetric outcomes compared to pregnancies occurring later, but it remains a controversial issue. Although the results did not have statistical significance in our study, well-designed prospective series may determine the role of enteral nutrition and intravenous iron replacement in patient management.Item A Pregnant Woman with Jaundice in the Intensive Care Unit(A Pregnant Woman with Jaundice in the Intensive Care Unit, 2020) Yesiler, Fatma Irem; Sahinturk, Helin; Gunakan, Emre; Gedik, Ender; Zeyneloglu, Pinar; 0000-0003-0159-4771; 0000-0001-8854-8190; AAJ-1419-2021Acute fatty liver of pregnancy (AFLP) is a life-threatening disorder characterized by maternal liver failure, and it occurs in the third trimester of pregnancy or postpartum period. The resultant effects include coagulopathy, electrolyte abnormalities, and the multiple organ dysfunction syndrome (MODS), which may require liver transplantation. Therefore, pregnant women having MODS should be managed in an intensive care unit (ICU) with multidisciplinary inputs to facilitate the appropriate supportive care. We present a successful case report of a pregnant women admitted to the ICU with jaundice and MODS without the need for liver transplantation and organ support therapies. A 20-year-old patient in her first pregnancy at 31 weeks gestation who presented with nausea, vomiting, and jaundice was admitted to our hospital. She was referred from a rural medical center (a center 608 kilometers away) to the ICU due to the possible diagnosis of acute liver failure requiring liver transplantation. Acute physiology and chronic health assessment score was 12, sepsis related organ failure score was 8, and Glasgow coma scale was 15 on ICU admission. AFLP was considered in the patient and an emergency delivery was performed by caesarean section. She recovered with intensive care support after pregnancy delivery without the need for liver transplantation. The patient was discharged from the ICU and hospital after 6 and 10 days, respectively. AFLP should be suspected in the differential diagnosis of a pregnant woman with jaundice and hyperbilirubinemia who is admitted to the ICU in the third trimester of pregnancy or postpartum period. Intensivist should not delay in the diagnosis of AFLP due to its morbid complications and high mortality. Early diagnosis, prompt pregnancy delivery, and intensive care support in the peripartum and postpartum periods may improve maternal and fetal outcomes