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Ulku A, Topal U, Erdogan O, Yavuz B, Yalav O, Dalci K, Eray IC, Saritas AG, Akcam AT. Effect of main pancreatic duct suture ligation on the prevention of clinically relevant pancreatic fistula after distal pancreatectomy: analysis of 82 consecutive patients. Eur Rev Med Pharmacol Sci 2023; 27:10522-10530. [PMID: 37975375 DOI: 10.26355/eurrev_202311_34328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE This study aimed to examine the factors linked to the development of clinically significant pancreatic fistulas following distal pancreatectomy (DP) and to assess the efficacy of suture ligation of the main pancreatic duct. PATIENTS AND METHODS A single-center retrospective study was performed on the medical records of 82 patients who underwent DP in our institution between January 2011 and December 2019. RESULTS There were 28 males (34.1%) and 54 females (65.9%). The patients' age ranged from 18 to 86 years (median: 55.5 years). Indications for DP included primary pancreatic disease (n=63, 76.8%) and non-pancreatic disease (n=19, 23.2%). Postoperative mortality and morbidity rates were 3.7% and 48%, respectively. Pancreatic parenchymal closure was accomplished by a hand-sewn technique or mechanical stapling in 89 and 13 patients, respectively. Identification of the pancreatic duct and suture ligation was performed in 46 patients (56.1%). Pancreatic fistula was developed in 20 patients (24.4%); 12 fistulas were classified as Grade B, and 8 as Grade C. Biochemical leaks (Grade A) were identified in 8 patients (9.8%). Multivariate analysis indicated that failure to ligate the main pancreatic duct was the only variable associated with an increased risk for pancreatic leak (p=0.031; odds ratio=0.233; 95% confidence interval, 0.062-0.879). CONCLUSIONS Pancreatic leak remains a common complication after DP. The incidence of leaks is reduced significantly when the main pancreatic duct is identified and directly ligated during DP.
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Affiliation(s)
- A Ulku
- Department of General Surgery, Faculty of Medicine, Cukurova University, Adana, Turkey.
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Boga I, Ozemri Sag S, Duman N, Ozdemir SY, Ergoren MC, Dalci K, Mujde C, Parsak CK, Rencuzogullari C, Sonmezler O, Yalav O, Alemdar A, Aliyeva L, Bozkurt O, Cetintas S, Cubukcu E, Deligonul A, Dogan B, Ornek Erguzeloglu C, Evrensel T, Gokgoz S, Senol K, Tolunay S, Akyurek E, Basgoz N, Gökçe N, Dundar B, Ozturk F, Taskin D, Demirtas M, Cag M, Diker O, Olgun P, Tug Bozdogan S, Dundar M, Bisgin A, Temel SG. A Multicenter Study of Genotype Variation/Demographic Patterns in 2475 Individuals Including 1444 Cases With Breast Cancer in Turkey. Eur J Breast Health 2023; 19:235-252. [PMID: 37415649 PMCID: PMC10320635 DOI: 10.4274/ejbh.galenos.2023.2023-2-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/30/2023] [Indexed: 07/08/2023]
Abstract
Objective Breast cancer (BC) is the most common cancer type in women and may be inherited, mostly in an autosomal dominant pattern. The clinical diagnosis of BC relies on the published diagnostic criteria, and analysis of two genes, BRCA1 and BRCA2, which are strongly associated with BC, are included in these criteria. The aim of this study was to compare BC index cases with non-BC individuals in terms of genotype and diagnostic features to investigate the genotype/demographic information association. Materials and Methods Mutational analyses for the BRCA1/BRCA2 genes was performed in 2475 individuals between 2013-2022 from collaborative centers across Turkey, of whom 1444 with BC were designated as index cases. Results Overall, mutations were identified in 17% (421/2475), while the percentage of mutation carriers in cases of BC was similar, 16.6% (239/1444). BRCA1/BRCA2 gene mutations were detected in 17.8% (131/737) of familial cases and 12% (78/549) of sporadic cases. Mutations in BRCA1 were found in 4.9%, whereas 12% were in BRCA2 (p<0.05). Meta-analyses were performed to compare these results with other studies of Mediterranean-region populations. Conclusion Patients with BRCA2 mutations were significantly more common than those with BRCA1 mutations. In sporadic cases, there was a lower proportion with BRCA1/BRCA2 variants, as expected, and these results were consistent with the data of Mediterranean-region populations. However, the present study, because of the large sample size, revealed more robust findings than previous studies. These findings may be helpful in facilitating the clinical management of BC for both familial and non-familial cases.
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Affiliation(s)
- Ibrahim Boga
- Cukurova University AGENTEM (Adana Genetic Diseases Diagnosis and Treatment Center), Adana, Turkey
- Department of Medical Genetics, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Sebnem Ozemri Sag
- Department of Medical Genetics and Genetic Diseases Diagnosis Center, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Nilgun Duman
- Department of Medical Genetics, Bezmialem Vakif University, Dragos Hospital, Istanbul, Turkey
| | - Sevda Yesim Ozdemir
- Department of Medical Genetics, Uskudar University Faculty of Medicine, Istanbul, Turkey
| | - Mahmut Cerkez Ergoren
- Department of Medical Genetics, Near East University Faculty of Medicine, Nicosia, Cyprus
- Near East University, DESAM Institute, Nicosia, Cyprus
| | - Kubilay Dalci
- Department of General Surgery, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Cem Mujde
- Cukurova University AGENTEM (Adana Genetic Diseases Diagnosis and Treatment Center), Adana, Turkey
| | - Cem Kaan Parsak
- Department of General Surgery, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Cagla Rencuzogullari
- Cukurova University AGENTEM (Adana Genetic Diseases Diagnosis and Treatment Center), Adana, Turkey
| | - Ozge Sonmezler
- Cukurova University AGENTEM (Adana Genetic Diseases Diagnosis and Treatment Center), Adana, Turkey
| | - Orcun Yalav
- Department of General Surgery, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Adem Alemdar
- Department of Translational Medicine, Bursa Uludag University Institute of Health Sciences, Bursa, Turkey
| | - Lamiya Aliyeva
- Department of Medical Genetics and Genetic Diseases Diagnosis Center, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Ozlem Bozkurt
- Department of Medical Pathology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Sibel Cetintas
- Department of Radiation Oncology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Erdem Cubukcu
- Department of Medical Oncology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Adem Deligonul
- Department of Medical Oncology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Berkcan Dogan
- Department of Medical Genetics and Genetic Diseases Diagnosis Center, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
- Department of Translational Medicine, Bursa Uludag University Institute of Health Sciences, Bursa, Turkey
| | - Cemre Ornek Erguzeloglu
- Department of Translational Medicine, Bursa Uludag University Institute of Health Sciences, Bursa, Turkey
| | - Turkkan Evrensel
- Department of Translational Medicine, Bursa Uludag University Institute of Health Sciences, Bursa, Turkey
- Department of Medical Oncology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Sehsuvar Gokgoz
- Department of General Surgery, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Kazim Senol
- Department of General Surgery, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Sahsine Tolunay
- Department of Medical Pathology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Esra Akyurek
- Department of Medical Genetics, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Neslihan Basgoz
- Department of Medical Genetics, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Nuriye Gökçe
- Department of Medical Genetics, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Bilge Dundar
- Department of Medical Genetics, Erciyes University Faculty of Medicine, Kayseri, Turkey
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, United States of America
| | - Figen Ozturk
- Department of Pathology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Duygu Taskin
- Department of Medical Genetics, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | | | - Murat Cag
- Department of Vascular Surgery and Transplantation, Strasbourg University Nouvel Hospital, Strasbourg, France
| | - Omer Diker
- Department of Medical Oncology, Near East University Faculty of Medicine, Nicosia, Cyprus
| | - Polat Olgun
- Department of Medical Oncology, Near East University Faculty of Medicine, Nicosia, Cyprus
| | - Sevcan Tug Bozdogan
- Cukurova University AGENTEM (Adana Genetic Diseases Diagnosis and Treatment Center), Adana, Turkey
- Department of Medical Genetics, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Munis Dundar
- Department of Medical Genetics, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Atil Bisgin
- Cukurova University AGENTEM (Adana Genetic Diseases Diagnosis and Treatment Center), Adana, Turkey
- Department of Medical Genetics, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Sehime Gulsun Temel
- Department of Medical Genetics and Genetic Diseases Diagnosis Center, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
- Department of Translational Medicine, Bursa Uludag University Institute of Health Sciences, Bursa, Turkey
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Rencuzogullari A, Atar C, Topal U, Coğal İ, Saritas AG, Yalav O, Dalci K, Eray İC. Analysis of appendiceal neoplasms in 1,423 appendectomy specimens: a 10-year retrospective cohort study from a single institution. Rev Assoc Med Bras (1992) 2023; 69:e20220714. [PMID: 37222313 DOI: 10.1590/1806-9282.20220714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/24/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVE This study aimed to reveal the incidence, clinicopathological, and oncological outcomes of appendiceal neoplasms. METHODS This is a retrospective cohort study from a single institution. Patients with a pathological diagnosis of malignancy who underwent appendectomy between January 2011 and 2021 were included in the study, and groups were formed according to pathological type. Clinical, pathological, and oncological results were compared in these groups. RESULTS The incidence of neoplasia was 2.38% (n=34) in a cohort of 1,423 appendectomy cases. Of the cases, 56% (n=19) were female. The median age in the entire cohort was 55.5 (range: 13-106) years. In the cohort, the rate of neuroendocrine tumor mucinous cystadenoma adenocarcinoma, and low-grade appendiceal mucinous neoplasm, according to the American Joint Committee on Cancer classification of appendiceal neoplasms, was 32.3% (n=11), 26.4% (n=9), 26.4% (n=9), and 14.7% (n=5), respectively. Neuroendocrine tumor patients (median age: 35 years) were younger than the other groups (p=0.021). Secondary complementary surgery was performed in 66.7% (n=6) of adenocarcinoma patients and 27.3% (n=3) of neuroendocrine tumor patients. Right hemicolectomy was performed in all neuroendocrine tumor patients requiring secondary surgery, while right hemicolectomy was performed in three adenocarcinoma patients and cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in three adenocarcinoma patients. After a median follow-up of 44.4 months (95% confidence interval: 18.6-70.1), the mean survival rate was 55% in appendiceal adenocarcinoma patients compared to 100% in neuroendocrine tumor patients. CONCLUSION Appendiceal neoplasms are rare but remain an important cause of mortality. Appendiceal adenocarcinomas are associated with poorer oncological outcomes compared to other neoplasms.
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Affiliation(s)
- Ahmet Rencuzogullari
- Cukurova University, Faculty of Medicine, Department of General Surgery - Adana, Turkey
| | - Cihan Atar
- Cukurova University, Faculty of Medicine, Department of General Surgery - Adana, Turkey
| | - Ugur Topal
- Cukurova University, Faculty of Medicine, Department of General Surgery - Adana, Turkey
| | - İbrahim Coğal
- Cukurova University, Faculty of Medicine, Department of General Surgery - Adana, Turkey
| | - Ahmet Gokhan Saritas
- Cukurova University, Faculty of Medicine, Department of General Surgery - Adana, Turkey
| | - Orcun Yalav
- Cukurova University, Faculty of Medicine, Department of General Surgery - Adana, Turkey
| | - Kubilay Dalci
- Cukurova University, Faculty of Medicine, Department of General Surgery - Adana, Turkey
| | - İsmail Cem Eray
- Cukurova University, Faculty of Medicine, Department of General Surgery - Adana, Turkey
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Soran A, Ozbas S, Ozcinar B, Isik A, Dogan L, Senol K, Dag A, Karanlik H, Aytac O, Cakmak GK, Dalci K, Dogan M, Sezer YA, Gokgoz S, Ozyar E, Sezgin E. Correction: Intervention for Hepatic and Pulmonary Metastases in Breast Cancer Patients: Prospective, Multi-institutional Registry Study-IMET, Protocol MF 14-02. Ann Surg Oncol 2023; 30:1074. [PMID: 36484906 DOI: 10.1245/s10434-022-12931-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Atilla Soran
- Division of Surgical Oncology, Breast Surgical Oncology, UPMC Magee-Womens Hospital, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA.
| | - Serdar Ozbas
- Breast Surgery, Private Practice, Ankara, Turkey
| | - Beyza Ozcinar
- General Surgery Department, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Arda Isik
- General Surgery Department, Training and Research Hospital, Medeniyet University Goztepe, Istanbul, Turkey
| | - Lutfi Dogan
- Department of Surgical Oncology, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Kazım Senol
- General Surgery Department, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Ahmet Dag
- General Surgery Department, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Hasan Karanlik
- Surgical Oncology Unit, Istanbul University Institute of Oncology, Istanbul, Turkey.,Breast Oncology Unit, American Hospital, Istanbul, Turkey
| | - Ozgur Aytac
- General Surgery Department, Baskent University Faculty of Medicine, Adana, Turkey
| | - Guldeniz Karadeniz Cakmak
- General Surgery Department, Zonguldak Bulent Ecevit University, Faculty of Medicine, Zonguldak, Turkey
| | - Kubilay Dalci
- General Surgery Department, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Mutlu Dogan
- Department of Medical Oncology, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Yavuz Atakan Sezer
- General Surgery Department, Trakya University, Faculty of Medicine, Edirne, Turkey
| | - Sehsuvar Gokgoz
- General Surgery Department, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Enis Ozyar
- Department of Radiation Oncology, Acibadem Hospitals Group, Istanbul, Turkey
| | - Efe Sezgin
- Department of Food Engineering, Izmir Institute of Technology, Izmir, Turkey
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Akkoc Y, Dalci K, Karakas HE, Erbil-Bilir S, Yalav O, Sakman G, Celik F, Arikan S, Zeybek U, Ergin M, Akkiz H, Dilege E, Dengjel J, Dogan-Ekici AI, Gozuacik D. Tumor-derived CTF1 (cardiotrophin 1) is a critical mediator of stroma-assisted and autophagy-dependent breast cancer cell migration, invasion and metastasis. Autophagy 2023; 19:306-323. [PMID: 35722965 PMCID: PMC9809961 DOI: 10.1080/15548627.2022.2090693] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Macroautophagy/autophagy is an evolutionarily conserved cellular stress response mechanism. Autophagy induction in the tumor microenvironment (stroma) has been shown to support tumor metabolism. However, cancer cell-derived secreted factors that initiate communication with surrounding cells and stimulate autophagy in the tumor microenvironment are not fully documented. We identified CTF1/CT-1 (cardiotrophin 1) as an activator of autophagy in fibroblasts and breast cancer-derived carcinoma-associated fibroblasts (CAFs). We showed that CTF1 stimulated phosphorylation and nuclear translocation of STAT3, initiating transcriptional activation of key autophagy proteins. Additionally, following CTF1 treatment, AMPK and ULK1 activation was observed. We provided evidence that autophagy was important for CTF1-dependent ACTA2/α-SMA accumulation, stress fiber formation and fibroblast activation. Moreover, promotion of breast cancer cell migration and invasion by activated fibroblasts depended on CTF1 and autophagy. Analysis of the expression levels of CTF1 in patient-derived breast cancer samples led us to establish a correlation between CTF1 expression and autophagy in the tumor stroma. In line with our in vitro data on cancer migration and invasion, higher levels of CTF1 expression in breast tumors was significantly associated with lymph node metastasis in patients. Therefore, CTF1 is an important mediator of tumor-stroma interactions, fibroblast activation and cancer metastasis, and autophagy plays a key role in all these cancer-related events.Abbreviations: ACTA2/α-SMA: actin, alpha 2, smooth muscle CAFs: cancer- or carcinoma-associated fibroblasts CNT Ab.: control antibody CNTF: ciliary neurotrophic factor CTF1: cardiotrophin 1 CTF1 Neut. Ab.: CTF1-specific neutralizing antibody GFP-LC3 MEF: GFP-fused to MAP1LC3 protein transgenic MEF LIF: leukemia inhibitory factor IL6: interleukin 6 MEFs: mouse embryonic fibroblasts MEF-WT: wild-type MEFs OSM: oncostatin M TGFB/TGFβ: transforming growth factor beta.
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Affiliation(s)
- Yunus Akkoc
- Koç University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey,Department of Biotechnology, Sabanci University Nanotechnology Research and Application Center (SUNUM), Istanbul, Turkey
| | - Kubilay Dalci
- Faculty of Medicine, Department of General Surgery, Çukurova University, Adana, Turkey
| | - Hacer Ezgi Karakas
- Department of Biotechnology, Sabanci University Nanotechnology Research and Application Center (SUNUM), Istanbul, Turkey
| | - Secil Erbil-Bilir
- Department of Biotechnology, Sabanci University Nanotechnology Research and Application Center (SUNUM), Istanbul, Turkey
| | - Orcun Yalav
- Faculty of Medicine, Department of General Surgery, Çukurova University, Adana, Turkey
| | - Gurhan Sakman
- Faculty of Medicine, Department of General Surgery, Çukurova University, Adana, Turkey
| | - Faruk Celik
- Department of Molecular Medicine, Istanbul University Aziz Sancar Institute of Experimental Medicine, Istanbul, Turkey
| | - Soykan Arikan
- Department of General Surgery, Ministry of Health Samatya Training and Research Hospital, Istanbul, Turkey
| | - Umit Zeybek
- Department of Molecular Medicine, Istanbul University Aziz Sancar Institute of Experimental Medicine, Istanbul, Turkey
| | - Melek Ergin
- Faculty of Medicine, Department of Pathology, Çukurova University, Adana, Turkey
| | - Hikmet Akkiz
- Faculty of Medicine, Department of Gastroenterology, Çukurova University, Adana, Turkey
| | - Ece Dilege
- Koç University Hospital, Department of General Surgery, Koç University Medical School, Istanbul, Turkey,School of Medicine, Koç University, Istanbul, Turkey
| | - Joern Dengjel
- Department of Biology, University of Fribourg, Fribourg, Switzerland
| | - A. Isin Dogan-Ekici
- School of Medicine, Department of Pathology, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Devrim Gozuacik
- Koç University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey,Department of Biotechnology, Sabanci University Nanotechnology Research and Application Center (SUNUM), Istanbul, Turkey,School of Medicine, Koç University, Istanbul, Turkey,CONTACT Devrim Gozuacik Koç University School of Medicine, Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey; Department of Biotechnology, Sabanci University Nanotechnology Research and Application Center (SUNUM), Istanbul, Turkey; School of Medicine, Koç University, Istanbul, Turkey
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6
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Dalci K, Gumus S, Saritas AG, Onan HB, Akeam AT, Ulku A, Sakman G. Multimodal Treatment of Chylous Fistula: A Retrospective Case-Control Study. Lymphology 2023; 56:82-90. [PMID: 38621386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Chylous fistulas (CF) are rare surgical complications and there is no standard treatment. This study presents the treatment modalities performed on patients who developed CF over a 10-year period. During the observation period, CF developed in 29 patients, 16 of whom were women. The mean age was 55.76± 13.48. Lymphatic duct injury was mostly seen in the abdomen (58.6%) and the most common reason was nephrectomy (20.7%). Extended lymphatic dissection due to malignancy was performed in 82.7% of all cases. Chylous leakage started postoperatively on 3.78±3.94 days (range: 1-19 days). Fasting, total parenteral nutrition (TPN), and somatostatin treatment were applied to all patients, and 75.8% of the fistulas were resolved completely with medical treatment. Surgical ligation of the lymphatic canal was performed in 7 patients. One was not successful and underwent percutaneous embolization of the thoracic lymphatic leakage cavity. All fistulas were resolved in 18.18±10.4 days. The resolution time and hospital stay were significantly higher in thoracic fistulas (p=0.017; p=0.003, respectively). In addition, malignant cases had longer resolution time (32.40±28.72 vs 16.27±11.25, p=0.036) and hospital stay (35.0±29.74 vs 16.25±14.05p= 0.002 respectively) than non-malignant. There was no chylothorax, chylous ascites, or recurrence at 20.55±22.88 months follow-up. Treatment of CF with fasting, TPN, and somatostatin analogs are effective. Other interventions such as surgical ligation with or without fibrin glue and interventional radiology treatments may be considered when conservative treatments fail.
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Affiliation(s)
- K Dalci
- Cukurova University, Department of General Surgery, Adana, Turkey
| | - S Gumus
- Education and Research Hospital, Department of Oncology, Hatay, Turkey
| | - A G Saritas
- Cukurova University, Department of General Surgery, Adana, Turkey
| | - H B Onan
- Cukurova University Department of Radiology, Adana, Turkey
| | - A T Akeam
- Cukurova University, Department of General Surgery, Adana, Turkey
| | - A Ulku
- Cukurova University, Department of General Surgery, Adana, Turkey
| | - G Sakman
- Cukurova University, Department of General Surgery, Adana, Turkey
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7
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Soran A, Ozbas S, Ozcinar B, Isik A, Dogan L, Senol K, Dag A, Karanlik H, Aytac O, Karadeniz Cakmak G, Dalci K, Dogan M, Sezer YA, Gokgoz S, Ozyar E, Sezgin E. ASO Visual Abstract: Intervention for Hepatic and Pulmonary METastases in Breast Cancer Patients-Prospective, Multi-Institutional Registry Study: IMET; Protocol MF 14-02. Ann Surg Oncol 2022; 29:6337-6338. [PMID: 35933547 DOI: 10.1245/s10434-022-12320-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Atilla Soran
- Division of Surgical Oncology, Breast Surgical Oncology, UPMC Magee-Womens Hospital, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA.
| | - S Ozbas
- Breast Surgery, Private Practice, Ankara, Turkey
| | - B Ozcinar
- General Surgery Department, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - A Isik
- General Surgery Department, Training and Research Hospital, Medeniyet University Goztepe, Istanbul, Turkey
| | - L Dogan
- Department of Surgical Oncology, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - K Senol
- General Surgery Department, Uludag University Faculty of Medicine, Bursa, Turkey
| | - A Dag
- General Surgery Department, Mersin University Faculty of Medicine, Mersin, Turkey
| | - H Karanlik
- Surgical Oncology Unit, Istanbul University Institute of Oncology, Istanbul, Turkey
- Breast Oncology Unit, American Hospital, Istanbul, Turkey
| | - O Aytac
- General Surgery Department, Baskent University Faculty of Medicine, Adana, Turkey
| | - G Karadeniz Cakmak
- General Surgery Department, Zonguldak Bulent Ecevit University, Faculty of Medicine, Zonguldak, Turkey
| | - K Dalci
- General Surgery Department, Cukurova University Faculty of Medicine, Adana, Turkey
| | - M Dogan
- Department of Medical Oncology, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Y A Sezer
- General Surgery Department, Trakya University Faculty of Medicinee, Edirne, Turkey
| | - S Gokgoz
- General Surgery Department, Uludag University Faculty of Medicine, Bursa, Turkey
| | - E Ozyar
- Department of Radiation Oncology, Acibadem Hospitals Group, Istanbul, Turkey
| | - E Sezgin
- Department of Food Engineering, Izmir Institute of Technology, Izmir, Turkey
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8
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Soran A, Ozbas S, Ozcinar B, Isik A, Dogan L, Senol K, Dag A, Karanlik H, Aytac O, Karadeniz Cakmak G, Dalci K, Dogan M, Sezer YA, Gokgoz S, Ozyar E, Sezgin E. Intervention for Hepatic and Pulmonary Metastases in Breast Cancer Patients: Prospective, Multi-institutional Registry Study-IMET, Protocol MF 14-02. Ann Surg Oncol 2022; 29:6327-6336. [PMID: 35876920 DOI: 10.1245/s10434-022-12239-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/06/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND One fourth of early-stage breast cancer cases become metastatic during the follow-up period. Limited metastasis is a metastatic disease condition in which the number of metastatic sites and the extent of the disease both are limited, and the disease is amenable to metastatic intervention. This prospective study aimed to evaluate intervention for limited metastases in the lung, liver, or both. METHODS The study enrolled luminal A/B and/or human epidermal growth factor receptor 2 (HER2)-neu+ patients with operable lung and/or liver metastases in the follow-up assessment after completion of primary breast cancer treatment and patients with a diagnosis of metastasis after 2014. Demographic, clinical, tumor-specific, and metastasis detection-free interval (MDFI) data were collected. Bone metastasis in addition to lung and liver metastases also was included in the analysis. The patients were divided into two groups according to the method of treatment for metastases: systemic therapy alone (ST) group or intervention (IT) group. RESULTS Until June 2020, 200 patients were enrolled in the study. The demographic data were similar between the two groups. The median follow-up time was 77 months (range 55-107 months) in the IT group (n = 119; 59.5%) and 57 months (range 39-84) in the ST-only group (n = 81; 40.5%). The median MDFI was 40 months (range 23-70 months) in the IT group, and 35 months (range 13-61 months) in the ST-only group (p = 0.47). The groups had similar surgeries for the primary tumor and axilla. Most of the patients had liver metastases (49.5%, n = 99), and 42% (n = 84) of the patients had lung metastases. Both lung and liver metastases were found in 8.5% (n = 17) of the patients. The primary tumor was estrogen receptor/progesterone receptor-positive in 75% (n = 150) of the patients, and 32% (n = 64) of the patients had HER2-neu+ tumors. Metastatic-site resection was performed for 32% (n = 64) of the patients, and 27.5% (n = 55) of the patients underwent metastatic ablative interventions. In the Kaplan-Meier survival analysis, the hazard of death (HoD) was 56% lower in the IT group than in the ST-only group (hazard ratio [HR], 0.44; 95% confidence interval [CI] 0.26-0.72; p = 0.001). The HoD was lower in the IT group than in the ST-only group for the patients younger than 55 years (HR, 0.32; 95% CI 0.17-0.62; p = 0.0007). In the multivariable Cox regression model, HoD was significantly lower for the patients who underwent intervention for metastases and had an MDFI longer than 24 months, but their liver metastases doubled the risk of death compared with lung metastases. CONCLUSION Metastasis-directed interventions have reduced the risk of death for patients with limited lung/liver metastases who are amenable to interventions after completion of primary cancer treatment. For a select group of patients, such as those with luminal A/B or HER2-neu+ breast cancer who are younger than 55 years with limited metastases to the lung and liver or an MDFI longer than 24 months, surgical or ablative therapy for metastases should be considered and discussed on tumor boards.
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Affiliation(s)
- Atilla Soran
- Division of Surgical Oncology, Breast Surgical Oncology, UPMC Magee-Womens Hospital, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA.
| | - S Ozbas
- Breast Surgery, Private Practice, Ankara, Turkey
| | - B Ozcinar
- General Surgery Department, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - A Isik
- General Surgery Department, Training and Research Hospital, Medeniyet University Goztepe, Istanbul, Turkey
| | - L Dogan
- Department of Surgical Oncology, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - K Senol
- General Surgery Department, Uludag University Faculty of Medicine, Bursa, Turkey
| | - A Dag
- General Surgery Department, Mersin University Faculty of Medicine, Mersin, Turkey
| | - H Karanlik
- Surgical Oncology Unit, Istanbul University Institute of Oncology, Istanbul, Turkey.,Breast Oncology Unit, American Hospital, Istanbul, Turkey
| | - O Aytac
- General Surgery Department, Baskent University Faculty of Medicine, Adana, Turkey
| | - G Karadeniz Cakmak
- General Surgery Department, Zonguldak Bulent Ecevit University, Faculty of Medicine, Zonguldak, Turkey
| | - K Dalci
- General Surgery Department, Cukurova University Faculty of Medicine, Adana, Turkey
| | - M Dogan
- Department of Medical Oncology, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Y A Sezer
- Department of Medical Oncology, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - S Gokgoz
- General Surgery Department, Uludag University Faculty of Medicine, Bursa, Turkey
| | - E Ozyar
- Department of Radiation Oncology, Acibadem Hospitals Group, Istanbul, Turkey
| | - E Sezgin
- Department of Food Engineering, Izmir Institute of Technology, Izmir, Turkey
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Dalci K, Gumus S, Saritas AG, Gul MO, Rencuzogullari A, Akcam AT, Ulku A, Ergin M, Sakman G. Modified techniques versus Hadfield's procedure in patients with periductal mastitis. BMC Surg 2022; 22:40. [PMID: 35120473 PMCID: PMC8817489 DOI: 10.1186/s12893-022-01496-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 01/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Periductal mastitis (PM) is a rare disease characterized by chronic inflammation of the terminal mammary ducts. Complete removal of terminal lactiferous ducts with Hadfield procedure is a previously defined technique in treatment but carries various complications risks. This study aims to evaluate the effectiveness of modified techniques in the treatment of PM. METHODS Twenty women who underwent surgery due to PM between January 2012 and December 2019 were retrospectively analyzed. Types of PM were determined. All patients were operated on with three different incisions [Hadfield's operation with periareolar incision (n:11), periareolar combined radial incision (n:7), and round block incision (n:2)]. RESULTS The mean age was 37.5 ± 6.5 years (range: 24-49). Sixty percent of patients had type 3 PM. In Hadfield's procedure, NAC retraction (n:2), seroma (n:1), and hematoma (n:1) were seen. In the periareolar incision combined radial incision group only one patient had complications (seroma) and none in the round block method. Follow-up was 12 ± 1.5 months and disease relapse occurred in two patients in the Hadfield group. Patients who underwent round block were more satisfied with the appearance of the nipple. CONCLUSIONS In the treatment of PM, the main principle of surgical treatment is the excision of the affected canal with a clear margin. Apart from the classical Hadfield procedure, the round block method and periareolar combined radial incision techniques can be performed in the treatment of PM.
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Affiliation(s)
- Kubilay Dalci
- Department of General Surgery, Cukurova University, Sarıcam, 01330, Adana, Turkey
| | - Serdar Gumus
- Department of Surgical Oncology, Cukurova University, Sarıcam, 01330, Adana, Turkey.
| | - Ahmet Gokhan Saritas
- Department of General Surgery, Cukurova University, Sarıcam, 01330, Adana, Turkey
| | - Mehmet Onur Gul
- Department of Surgical Oncology, Cukurova University, Sarıcam, 01330, Adana, Turkey
| | - Ahmet Rencuzogullari
- Department of General Surgery, Cukurova University, Sarıcam, 01330, Adana, Turkey
| | - Atilgan Tolga Akcam
- Department of General Surgery, Cukurova University, Sarıcam, 01330, Adana, Turkey
| | - Abdullah Ulku
- Department of General Surgery, Cukurova University, Sarıcam, 01330, Adana, Turkey
| | - Melek Ergin
- Department of Pathology, Cukurova University Adana, Sarıcam, 01330, Adana, Turkey
| | - Gurhan Sakman
- Department of General Surgery, Cukurova University, Sarıcam, 01330, Adana, Turkey
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Eray IC, Dalci K, Gumus S, Yalav O, Saritas AG, Boz A, Rencuzogullari A. The role of C-reactive protein ratio in predicting mortality in patients with Fournier gangrene. Ann Coloproctol 2022:ac.2021.00843.0120. [PMID: 35109644 DOI: 10.3393/ac.2021.00843.0120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 12/13/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose This study aimed to determine the C-reactive protein (CRP) ratio for the survival of patients with Fournier gangrene (FG). Methods Fifty-two patients with FG between January 2011 and September 2018 were retrospectively analyzed. Data on clinical presentation, Fournier Gangrene Severity Index (FGSI), CRP ratio, management, and outcome were analyzed. The CRP ratio was calculated as preoperative CRP/postoperative CRP value that measured 48 hours after surgical intervention. Possible alternative cutoff points for the FGSI and CRP were determined by receiver operating characteristic (ROC) analyses. The risk factors related to the prognosis were evaluated by univariate and multivariable logistic regression analyses. Results The mean CRP ratios were 6.7±6.6 in the survivor group and 1.2±0.8 in the non-survivor group (P=0.001). FGSI was significantly higher in the non-survivor group compared to survivor group (8.5±2.5 vs. 3.5±2.2, P=0.001). There was a negative correlation between FGSI and CRP ratio (r=-0.51). ROC analysis determined the cutoff value as 1.78 for CRP (sensitivity, 86%; specificity, 82%; AUC, 0.90) to predict death. The incidence of death for patients with CRP ratio of ≤1.78 increased 26.7 fold for those with CRP ratio of >1.78 (95% confidence interval [CI], 4.8-146.5; P=0.001). In the multivariable logistic regression model, CRP ratio (odds ratio [OR], 10.3; 95% CI, 1.5-72.2; P=0.019) and FGSI (OR, 17.8; 95% CI, 2.6-121.1; P=0.003) were independent risk factors for death. Conclusion The CRP ratio is a simple method to use to predict mortality in FG.
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Affiliation(s)
- Ismail Cem Eray
- Division of Colorectal Surgery, Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Kubilay Dalci
- Division of Colorectal Surgery, Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Serdar Gumus
- Department of Surgical Oncology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Orcun Yalav
- Division of Colorectal Surgery, Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Ahmet Gokhan Saritas
- Division of Colorectal Surgery, Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Asli Boz
- Department of Medical Education, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Ahmet Rencuzogullari
- Division of Colorectal Surgery, Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
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Dalci K, Saritas AG, Topal U, Aydin E. Risk Factors in the Development of Rectus Sheath Hematoma and Treatment Modalities. Chirurgia (Bucur) 2021; 116:1-7. [PMID: 34749846 DOI: 10.21614/chirurgia.116.ec.2448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2021] [Indexed: 11/23/2022]
Abstract
Background: In this study,we aim to present the clinical features of patients with rectus sheath hematoma(RSH), as well as the condition's therapeutic management and results. Methods: The study included patients who were diagnosed with and received treatment for spontaneous RSH between the years 2010 and 2020. The demographic and clinical features of the patients, as well as follow-up parameters, were analyzed retrospectively. Results: Our study included 53 patients. The number of female patients was twice as many as the number of male patients. The median age was 65.7 +-14.68 years, and 63.3% of the patients were over the age of 65. The most frequently used anticoagulant was warfarin (30.1%), and it was most often used for heart diseases (54.7%). The international normalized ratio value at the time of admission to the hospital was 1.93+1.18, and the hemoglobin value was 11.2 gr/dl. The average hematoma diameter was 74 mm, and the most common stage was typeI (75.6%). Of the patients, 90.6% were followed up conservatively. The average duration of hospital stay was 15.1 days, and mortality occurred in eight patients during their hospital stay. Conclusion: Spontaneous RSH should be consideredfor elderly female patients who have used anticoagulants. Most patients are followed up medically, but mortality is still high.
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Abstract
Malignant melanoma of the gastrointestinal tract is usually a metastasis from a cutaneous source. Primary gastric melanoma is an extremely rare clinical entity, with few reported cases worldwide. It is often advanced at the time of diagnosis and is associated with a poor outcome. We report a case of a 57-year-old male who presented to the emergency department with complaints of fatigue, haematemesis and melena. Laboratory investigation indicated a haemoglobin level of 7.4g/dl, for which the patient received a transfusion. Upper gastrointestinal endoscopy revealed a bleeding mass in the body of stomach which provisional histology was suggestive of a malignant mesenchyimal tumour but subsequent cytomorphology and immunophenotyping were consistent with malignant melanoma, with positive S-100, HMB-45 and Melan-A. Dermatological exam indicated two lesions suspicious for the primary site of metastasis but were ultimately diagnosed as benign lesions, one junctional nevus and other one seborrheic keratosis, on biopsies. Ophthalmologic exam showed no other probable sites of origin. PET/CT showed accumulation of tracer in the stomach, jejunum and perigastric lymph nodes. For this reason, primary advanced gastric melanoma was suspected in this patient. Since the patient had recurrent upper gastrointestinal bleeding that required frequent blood transfusion, a total gastrectomy with partial small bowel resection was performed. We report this case to present initial diagnostic challange and discuss performing surgery for recurrent tumour bleeding.
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Affiliation(s)
- K Dalci
- Cukurova University, Adana, Turkey
| | - Z Teke
- Cukurova University, Adana, Turkey
| | - C Atar
- Cukurova University, Adana, Turkey
| | - F Doran
- Cukurova University, Adana, Turkey
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Dalci K, Topal U, Unal AG, Sarıtas AG, Guney IB, Uguz AH, Sakman G. Should tall cell thyroid cancers be evaluated differently from well-differentiated thyroid cancers? Ann Ital Chir 2021; 92:123-130. [PMID: 34031288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE In this study, we aimed to investigate the clinical features of Papillary thyroid carcinoma(PTC) Tall cell variant(TCV), long-term outcomes and surgical experience in papillary thyroid carcinoma. MATERIAL-METHOD 33 patients who were operated in our clinic between August 2012 and March 2018 and diagnosed as TCV in their pathology evaluation were included in the study. The demographic and clinical features of the patients, pathological features of the tumor and long-term results were examined. RESULTS A total of 33 patients were included in our study. The mean age was 55.2(18-85) years. The female sex was more dominant (75.8%). The most common presenting complaint was swelling in the neck (75.7%).Total thyroidectomy was performed in 84.8% and completion thyroidectomy after lobectomy was performed in 15.2%. Neck dissection was performed in 33% of the patients. The mean tumor diameter was 3.6 (1-10) cm. The tumor was multifocal in 36.3% of the patients. The capsule invasion rate of the tumors was present in 69.7% of the patients, extrathyroidal rate was 39.4%, Metastatic lymph nodes were detected in 30.3% of the cases. The mean follow-up duration was 39.3+22.4(5.25-78.63) months. 39.4% of patients had distant metastasis during follow-up. Disease free survival rate was 57.6%, total survival was 42.4 + 3.8 (34.7-50.0) months. CONCLUSION TCV is closely associated with larger tumor diameter, multifocal location, extrathyroidal spread and lymph node involvement, We believe that more aggressive surgery should be performed in the treatment of TCV cases and it is important to follow up the patients more closely. KEY WORD Esophagus cancer, Neutrophil/lymphocyte ratio, Preoperative lymphocyte /neutrophil ratio, Prognosis.
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Topal U, Eray IC, Rencuzogullari A, Dalci K, Yalav O, Alabaz O. The effect of anorectal manometric examination on the surgical treatment plan in chronic anal fissure. Ann Ital Chir 2021; 92:59-63. [PMID: 32129179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Although lateral internal sphincterotomy (LIS) is the most preferred surgical treatment for chronic anal fissure, In this study, we aimed to investigate the effect of preoperative anorectal manometry on surgical treatment choice in patients presenting with anal fissure. MATERIAL AND METHODS Between January-2015 and August-2017 and whose physical examination revealed chronic anal fissure findings were included in the study. Patients were divided into two groups as Group 1 LIS and Group 2 non-LIS. In addition to the demographic characteristics of the patients, anal manometry findings and its effect on surgical treatment options were examined. RESULTS 20 patients (M/F:13/7) were included in the study. The mean age was 48.3+17.4 in Group 1 and 45.25 +24.45 in Group 2 (p:0.797). In the preoperative manometric examination, resting pressure(mmHg) range was 93.2+15.9 in Group 1, and44+11.2 in Group 2 (30-57) (p:0.001). Endurance to squeezing time was shorter in Group 2 (p:0.0138). There were no differences between the groups in terms of mean squeezing pressure, rectal sensation, and rectoanal inhibitor reflex (p>0.05). Of the four patients with low sphincter pressures, 3 underwent botulinum toxin injection and 1 underwent advancement flap instead of LIS. There was no significant difference between preoperative and postoperative CCFI scores in the LIS group (0.6±1.8 vs. 1.2±1.85, p>0.05). CONCLUSION In the treatment of chronic anal fissure, non-LIS methods were selected in 20% of the patients with the help of preoperative anal manometric examination. Manometric examination is important to minimize the risk of incontinence and to determine the choice of treatment correctly. KEY WORDS Anal fissure, Anal incontinence, Anal manometry.
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Yalav O, Topal U, Yavuz B, Dalci K. Comparison of Transhiatal and Transthoracic Approaches in Esophageal Cancer Surgery. Cyprus J Med Sci 2020; 5:65-76. [DOI: 10.5152/cjms.2020.1359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Guney IB, Dalci K, Teke ZT, Kucuker KA. A prospective comparative study of ultrasonography, contrast-enhanced MRI and 18F-FDG PET/CT for preoperative detection of axillary lymph node metastasis in breast cancer patients. Ann Ital Chir 2020; 91:458-464. [PMID: 32213685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AIM We aimed to evaluate; (i) the accuracy of ultrasonography (US), contrast-enhanced magnetic resonance imaging (cMRI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for detection of axillary lymph node metastases (ALNMs), (ii) the role of late prone imaging, and (iii) the effect of PET/CT on preoperative staging of breast cancer. MATERIAL AND METHODS From June 2015 to January 2019, 236 breast cancer patients were preoperatively exam ined using US, cMRI, and PET/CT and whom underwent pathological evaluations of axillary lymph nodes were analyzed. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy (ACC) of US, cMRI, and PET/CT for ALNMs were determined. RESULTS There were 235 female and one male in our study. The mean age was 55,6±11,3 years. Of 158 patients who were histopathologically evaluated, 85 patients (36%) were negative and 73 patients (30.9%) were positive for ALNMs. The remaining 78 patients who were only radiologically evaluated with US and/or cMRI, 24 patients (10.2%) were negative and 54 patients (22.9%) were positive for ALNMs. The sensitivity, specificity, PPV, NPV, and ACC of PET/CT were 80.0%, 92.2%, 92.0%, 80.3%, and 85.7%, re spectively. The axillary lymph node, which was suspicious in supine imaging, remained in the suspicious group again in prone imaging in PET/CT. CONCLUSIONS There is no single absolute modality for de tecting ALNMs in breast cancers to replace sentinel lymph node biopsy or axillary lymph node dissection. If ALNM is suspected based on PET/CT, axillary lymph node dissection without sentinel lymph node biopsy might be a better option because it is related to high possibilities of ALNM. KEY WORDS Axillary lymph node metastasis, Magnetic resonance imaging, Ultrasonography, 18F-FDG PET/CT.
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Yalav O, Topal U, Ünal AG, Dalci K. Primary actinomycosis of the breast in postmenopausal women. Ann Ital Chir 2019; 8:S2239253X19031232. [PMID: 31869310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Actinomycosis is a chronic infection caused by actinomyces species characterized by an abscess formation, tissue fibrosis, and draining sinuses. Primary actinomycosis of the breast is rare. PATIENTS AND METHODS In this paper we present a 64-year-old postmenopausal woman. For the diagnosis of primary actinomycosis of the breast, mammography, ultrasonography, MRI, and histopathologic examinations are required. Microbiological culture and histopathology are of the most importance during the process of diagnosis. In our case, at the intersection of the sternum and the lower inner quadrant of the right breast, there was a 1 cm wide fistula opening, and an abscess. A. israelii has been isolated from the microbiological culture taken from the lesion RESULTS: An optimal surgical resection of infected tissues has been performed as the treatment with the wound left open for tertiary healing The patient was given sulbactam 4*1 gr/day intravenously for 4 weeks post-op.. Recurrence was not detected during the yearly follow up procedures CONCLUSIONS: Actinomycosis should be considered when differentially diagnosing clinical instances of suppurative or granulomatous infections of the breast and mass regions that can't be ruled out as malignancies. Early diagnosis will save the patient from unnecessary surgical operations and ineffective antibiotic treatments. KEY WORDS Actinomycosis, Breast abscess, Breast diseases.
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Dalci O, Dalci K, Papadopoulos D, Ng A, Darendeliler M. Prevalence of malocclusion in an orthodontic population of pre-adolescent and adolescent children with sleep disordered breathing. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Saritas AG, Dalci K, Topal U, Beydola S, Acıkalın A, Rencuuzogullari A. Psoriasis, a rare disease of the nipple-areola A case report. Ann Ital Chir 2019; 8:S2239253X19031086. [PMID: 32390650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Psoriasis is a chronic inflammatory skin disease with an incidence of 1-3%. Psoriasis usually occurs in the scalp, knee, elbow, sacral region and joints. The nipple-areola complex involvement is rarely encountered in the literature. CASE REPORT 31-year-old female patient, who presented at the dermatology outpatient clinic with a lesion characterized by bright, pearlescent-white squamous lesions on an erythematous plaque, limited to the nipple-areola complex for the past three years, and who was diagnosed with "Psoriasis" following incisional biopsy. CONCLUSIONS The benign or malignant distinction should be made for lesions observed in the nipple-areola complex. It should not be forgotten that psoriasis may also be present in the differential diagnosis of dermatitis-like benign lesions that do not respond to long-term and various drug treatment, although they are rare. KEY WORDS Complex Benign lesions, Breast, Nipple areola, Psoriasis.
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Ulku A, Yalav O, Saritas AG, Rencuzogullari A, Dalci K, Eray IC, Yagmur O, Akcam AT. Long-term Outcomes of Surgical Management of Insulinoma: Single Center Experience. Dicle Tıp Dergisi 2018. [DOI: 10.5798/dicletip.424975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ulku A, Akcam AT, Rencuzogullari A, Dalci K, Yalav O, Eray IC, Saritas G. Effect of Dosage and Type of Hepatitis B Immunoglobulin on Hepatitis Antibody Levels in Liver Transplant Recipients. Transplant Proc 2017; 49:575-579. [PMID: 28340836 DOI: 10.1016/j.transproceed.2017.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The current study aimed to evaluate the effect of dosage and type (intramuscular [IM] vs intravenous [IV]) of hepatitis B immunoglobulin (HBIG) on hepatitis antibody level in liver transplant recipients. METHODS Between September 2000 and August 2016, patients who underwent orthotropic liver transplantation for chronic liver failure or hepatocellular carcinoma secondary to chronic hepatitis B virus (HBV) were retrospectively reviewed from a prospectively maintained database. The analyses of risk factors for postoperative short- and long-term anti-hepatitis B surface antibody levels (as classified level I: 0 to 100 U; II: 100 to 500 U; III: 500 to 1000 U; IV: >1000 U) were performed based on demographic characteristics, hepatitis B envelope antigen, hepatitis B core antibody, HBV DNA, delta antigen, HBIG administration dosage during unhepatic phase (5000 or 10,000 I/U; IM or IV), and type of administration in post-transplant period. Patients who were followed for less than 12 months were excluded from long-term analysis. RESULTS The mean follow-up of 58 orthotropic liver transplant patients was 72 (±45) months. No adverse events were observed during both IM and IV type of administration. Compared with IM type, IV administration was associated with a significantly higher HBV antibody level in the short term (for IM and IV: level I: 24% vs 6%; II: 49% vs 18%; III: 12% vs 35%; IV: 15% vs 41%, respectively, P = .007). In the long term, IV administration of hepatitis B immunoglobulin (HBIG) was reported as the sole factor causing higher antibody level (P = .002). Longer follow-up was associated with decreased levels of anti-hepatitis B surface antibody. CONCLUSION IV HBIG administration in preoperative anhepatic phase and postoperative prophylaxis is associated with higher antibody level both the short and long term without any adverse event.
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Affiliation(s)
- A Ulku
- Department of General Surgery, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - A T Akcam
- Department of General Surgery, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - A Rencuzogullari
- Department of General Surgery, Faculty of Medicine, Cukurova University, Adana, Turkey.
| | - K Dalci
- Department of General Surgery, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - O Yalav
- Department of General Surgery, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - I C Eray
- Department of General Surgery, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - G Saritas
- Department of General Surgery, Faculty of Medicine, Cukurova University, Adana, Turkey
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Akcay I, Okoh AK, Yalav O, Eray IC, Rencuzogullari A, Dalci K, Elkan H, Alparslan AH. The prognostic value of pro-calcitonin, CRP and thyroid hormones in secondary peritonitis: a single-center prospective study. ULUS TRAVMA ACIL CER 2016; 20:343-52. [PMID: 25541846 DOI: 10.5505/tjtes.2014.98354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Infections and sepsis remain the leading cause of morbidity and mortality in secondary peritonitis. Clinicians are still challenged with the task of finding an early and reliable diagnosis of septic complications. The role of inflammatory markers (Procalcitonin (PCT), C-reactive Protein (CRP) and thyroid hormones in determining the severity of secondary peritonitis was evaluated in this study. METHODS On the preoperative and first, third, fifth, seventh, and fourteenth postoperative days, PCT, CRP, and thyroid hormone concentrations were measured in serum taken from eighty-four consecutive patients who were operated on for secondary peritonitis between January 2008 and January 2010. All data was entered and analyzed using the Statistical Package for Social Sciences, version 15.0 and clinical parameters were compared using the student's t-test. RESULTS For the groups diagnosed with perforated viscus, PCT concentrations were significantly low in contrast to high thyroid hormone levels in patients who developed postoperative complications or died when compared to patients whose postoperative course was uneventful or discharged. The PCT concentration significantly correlated with the CRP concentration and WBC count. CONCLUSION In the absence of postoperative complications, PCT is a better predictor of outcome than CRP in secondary peritonitis. Our study showed that a low thyroid hormone level can serve as an important prognostic parameter of disease severity in secondary peritonitis.
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Affiliation(s)
- Idris Akcay
- Department of General Surgery, Dr. Yaşar Eryılmaz Doğubeyazıt State Hospital, Ağrı, Turkey
| | - Alexis K Okoh
- Department of General Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Orcun Yalav
- Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Ismail C Eray
- Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Ahmet Rencuzogullari
- Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Kubilay Dalci
- Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Hasan Elkan
- Department of General Surgery, Balıklıgöl State Hospital, Şanlıurfa, Turkey
| | - Ali H Alparslan
- Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
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Rencuzogullari A, Okoh AK, Akcam TA, Roach EC, Dalci K, Ulku A. Hemobilia as a result of right hepatic artery pseudoaneurysm rupture: An unusual complication of laparoscopic cholecystectomy. Int J Surg Case Rep 2014; 5:142-4. [PMID: 24531018 DOI: 10.1016/j.ijscr.2014.01.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 01/03/2014] [Accepted: 01/09/2014] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Laparoscopic cholecystectomy has many complications which may be seen due to anatomical variations, lack of experience of the surgeon or three dimensional visualization, or insufficient exposure of the surgical field; including vascular injuries. Here we present a case of pseudoaneurysm of the right hepatic artery leading to hemobilia after rupturing into the biliary system. PRESENTATION OF CASE A 43-year-old male patient presented to our clinic 3 weeks post laparoscopic cholecystectomy with right upper quadrant pain, melena and hematemesis. After stabilizing the patient, Doppler ultrasonography, abdominal computer tomography and selective right hepatic artery angiography were performed and a pseudoaneurysm was established on the anterior posterior bifurcation of right hepatic artery. Right hepatic artery ligation and a T-tube placement after choledocotomy were performed. The patient recovered completely. DISCUSSION Pseudoaneurysms of the hepatic artery may arise as a complication of laparoscopic cholecystectomy. Clip encroachments, mechanical or thermal injury during the procedure are likely to be precipitating factors. Today, transarterial embolization (TAE) is the gold standard for the management of hemobilia, and if it fails, the next step in management is surgical. Surgery is limited to extra-hepatic or gallbladder bleeding, and for TAE failure. CONCLUSION In cases of GI bleeding the awareness of the surgeon should be drawn to a clinical suspicion of hemobilia and an underlying hepatic artery pseudoaneurysm that can arise as a complication. CT angiography should be performed for early diagnosis and management in such patients.
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Affiliation(s)
| | - Alexis K Okoh
- Ankara University School of Medicine, Department of Surgery, Turkey
| | - Tolga A Akcam
- Cukurova University School of Medicine, Department of Surgery, Turkey
| | | | - Kubilay Dalci
- Cukurova University School of Medicine, Department of Surgery, Turkey
| | - Abdullah Ulku
- Cukurova University School of Medicine, Department of Surgery, Turkey
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Sönmez D, Dalci K, Şen Tunç E. Treatment of an avulsed maxillary permanent central incisor by autotransplantation of a primary canine tooth. Int Endod J 2008; 41:623-32. [DOI: 10.1111/j.1365-2591.2008.01405.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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