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Abstract
Inflammation plays an important role in the pathogenesis of many cancer types and is associated with thyroid malignancy. The systemic immune-inflammation index (SII) is a new inflammation marker that can be calculated from routine complete blood count (CBC). This study investigated the association between SII, a marker derived from routine CBC, and different thyroid diseases. The objective was to determine if this simple inflammation marker can distinguish between benign and malignant thyroid diseases. The medical records of all patients who underwent surgical treatment for thyroid disease between January 2018 and January 2022 were systematically evaluated. The routine preoperative CBC parameters' demographic, clinical, and laboratory data were recorded. A total of 241 patients were included in the study, and the patients were grouped as having multinodular goiter (n = 125), lymphocytic thyroiditis (n = 44), and papillary thyroid carcinoma (PTC) (n = 73) according to pathological results. The SII was defined as the ratio of the total count of neutrophils × platelets divided by the lymphocyte count. Subgroup analysis of patients was performed according to the presence of follicular variant or thyroiditis, micro or macro carcinoma, or bilaterality of the tumor. The SII level was significantly higher in the PTC group than in the lymphocytic thyroiditis and multinodular goiter groups (P < .001). When we grouped the patients according to the presence of PTC as benign or malignant, the optimum cutoff point for SII level was found 654.13, with 73.8% sensitivity and 72.3% specificity from ROC analysis. In the subgroup analysis of patients with PTC, the SII level was similar according to the clinicopathological characteristics of the tumor. The differential diagnosis of thyroid diseases is important for patient management. We found that preoperative SII levels were significantly elevated in patients with PTC compared to those with benign thyroid disorders, and this simple marker can be used for the differentiation of benign and malignant thyroid disease.
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Affiliation(s)
- Selahattin Vural
- Department of General Surgery, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Ali Muhtaroğlu
- Department of General Surgery, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Mert Güngör
- Department of General Surgery, Faculty of Medicine, Giresun University, Giresun, Turkey
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Vural S, Muhtaroğlu A, Uygur FA. The relationship between preoperative CEA and CA19-9 status and patient characteristics and lymph node involvement in early-stage colon cancer. Eur Rev Med Pharmacol Sci 2023; 27:4563-4569. [PMID: 37259737 DOI: 10.26355/eurrev_202305_32462] [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: 06/02/2023]
Abstract
OBJECTIVE Colon cancer is a primary human cancer that accounts for approximately one-tenth of all cancers and is one of the three most common cancers in incidence and mortality. This study investigated the relationship between serum preoperative carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9), patient characteristics and lymph node (LND) involvement in early-stage colon cancer. PATIENTS AND METHODS A total of 154 patients who had undergone surgery for early-stage colon cancer were included in this study. Patient demographics regarding age and gender, laboratory parameters, tumor size, and tumor laterality were recorded. CEA and CA19-9 positivity was defined as patients whose tumor markers were above the cut-off values, and patients were grouped according to CEA and CA19-9 positivity. Patients were compared according to the CEA and CA19-9 status and pathological LND involvement. RESULTS We found that patients in the CEA (+) and CA19-9 (+) groups were significantly older than the others. Our study detected LND involvement in histopathological examination in 25% of patients. LND pathological participation was significantly higher in the CEA (+) CA19-9 (+) group, and being age 65 years or older was found to be a risk factor for pathological LND involvement. CONCLUSIONS Clinicians should pay more attention to LND involvement when both CEA and CA19-9 are elevated preoperatively in early-stage colon cancer patients. Preoperative CEA and CA19-9 status of patients is important in predicting LND involvement and, as a result, the prognosis of these patients.
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Affiliation(s)
- S Vural
- Department of General Surgery, Faculty of Medicine, Giresun University, Giresun, Turkey.
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3
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Aydın İ, Sengul I, Vural S, Kesicioğlu T, Sengul D. Incarcerated obturator hernia, an extremely rare cause of intestinal obstruction: case series. ULUS TRAVMA ACIL CER 2023; 29:633-637. [PMID: 37145045 DOI: 10.14744/tjtes.2022.42361] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Protrusion of abdominal contents through the obturator foramen is a rare type of abdominal wall hernia. It is usually seen unilaterally and right-sided. Predisposing factors are old age, high intra-abdominal pressure, pelvic floor dysfunction, and multiparity. Obturator hernia has one of the highest mortality rates of all abdominal wall hernias, with a difficult diagnostic process that can be misleading even for the most experienced surgeons. Therefore, to suspect and easily diagnose an obturator hernia, it is important to understand its characteristics. Computerized tomography scanning remains the best diagnostic tool with the highest sensitivity. Conservative ap-proach is not recommended in obturator hernia cases. Once diagnosed, urgent surgical repair is indicated to prevent further ischemia, necrosis, and risk of perforation that can lead to peritonitis, septic shock, and death. Although open repair is a widely used and effective method for reducing abdominal hernias, including obturator, laparoscopic repairs have been described and become preferred. In this study, we present female patients aged 86, 95, and 90 years who were operated with the diagnosis of obturator hernia on computed tomography. The diagnosis of obturatory hernia should always be kept in mind, especially in the presence of acute mechanical intestinal obstruction findings in an elderly woman.
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Affiliation(s)
- İsmail Aydın
- Department of General Surgery, Giresun University Faculty of Medicine, Giresun-Türkiye
| | - Ilker Sengul
- Department of General Surgery, Giresun University Faculty of Medicine, Giresun-Türkiye
| | - Selahattin Vural
- Department of General Surgery, Giresun University Faculty of Medicine, Giresun-Türkiye
| | - Tuğrul Kesicioğlu
- Department of General Surgery, Giresun University Faculty of Medicine, Giresun-Türkiye
| | - Demet Sengul
- Department of Pathology, Giresun University Faculty of Medicine, Giresun-Türkiye
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Oğuz ID, Vural S, Cinar E. Peristomal Pseudoverrucous Lesions: A Rare Skin Complication of Colostomy. Cureus 2023; 15:e38068. [PMID: 37234144 PMCID: PMC10208549 DOI: 10.7759/cureus.38068] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
A 56-year-old female patient with colostomy presented with skin-colored cobblestone and verrucous asymptomatic papules on her peristomal skin for three months; she was referred to dermatology. Histopathology revealed irregular acanthosis, tongue-like extension of rete ridges of mature squamous epithelium without atypical morphology, hyperkeratosis, and inflammation of the skin. The histopathologic appearance was evaluated as compatible with pseudoepitheliomatous hyperplasia. No signs of malignancy, fungus, or koilocytes were found. The lesions were diagnosed as pseudoepitheliomatous hyperplasia by clinical and histopathologic findings. In this case report, we review pseudoepitheliomatous hyperplasia associated with colostomy.
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Affiliation(s)
- Işıl D Oğuz
- Dermatology, Giresun University Faculty of Medicine, Giresun, TUR
| | - Selahattin Vural
- General Surgery, Giresun University Faculty of Medicine, Giresun, TUR
| | - Esma Cinar
- Pathology, Giresun University Faculty of Medicine, Giresun, TUR
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Kesicioglu T, Sengul I, Aydın I, Vural S, Sengul D. Revisiting surgical management of breast cancer in a geriatric population. Rev Assoc Med Bras (1992) 2022; 68:1504-1508. [PMID: 36449765 PMCID: PMC9720761 DOI: 10.1590/1806-9282.20220961] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Breast cancer is a leading cause of death not only in the young population but also in the elderly. There are no consensus treatment guidelines for elderly breast cancer patients. We purposed to discuss surgical treatment options for breast cancer cases over 80 years concerning morbidity and mortality. METHODS This retrospective study includes 58 patients over 80 years of age at the time of surgery for breast cancer between 2006 and 2017. A sum of 58 cases (54 females and 4 males), over 80 years of age, with an average age of 84.5±4.07 (80-94) years were included in the study. The modified radical mastectomy was the most common surgical modality in 30 (51.7%) cases, and the axillary intervention was performed on 41 (70.7%). Axillary dissection and sentinel lymph node biopsy were performed for 30 (51.7%) and 11 (18.9%) cases, respectively. RESULTS Minor and major complications were observed in 8 (13.8%) cases. The average follow-up period of the patients was 37.5 (1-120) months. During the follow-up period, breast cancer-related mortality was observed in 9 (15.52%) cases. No statistical differences were detected in mortality with/without axillary intervention and chosen surgical modality. CONCLUSIONS Comorbidity, the American Society of Anesthesiologists score, and life expectancy should be considered in the management and surgical planning of patients over 80 years of age with breast cancer. Minimally invasive approaches should be preferred for the elderly whenever feasible and applicable in the light of oncologic surgery principles in order to reduce complications and mortality rates.
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Affiliation(s)
- Tugrul Kesicioglu
- Giresun University, Faculty of Medicine, Department of General Surgery – Giresun, Turkey
| | - Ilker Sengul
- Giresun University, Faculty of Medicine, Department of General Surgery – Giresun, Turkey.,Giresun University, Faculty of Medicine, Division of Endocrine Surgery – Giresun, Turkey.,Corresponding author:
| | - Ismail Aydın
- Giresun University, Faculty of Medicine, Department of General Surgery – Giresun, Turkey
| | - Selahattin Vural
- Giresun University, Faculty of Medicine, Department of General Surgery – Giresun, Turkey
| | - Demet Sengul
- Giresun University, Faculty of Medicine, Department of Pathology – Giresun, Turkey
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Aydin I, Sengul I, Gungor M, Kesicioglu T, Sengul D, Vural S, Yimaz E. Ambulatory Laparoscopic Appendectomy: Does the Conventional Approach Need a Reappraisal? Cureus 2022; 14:e29215. [PMID: 36128563 PMCID: PMC9478505 DOI: 10.7759/cureus.29215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 11/05/2022] Open
Abstract
A Deucalione, acute abdomen remains significant in abdominal pain. The entity of acute abdomen accounts for up to 10% of all emergency admissions. The differences between countries' income and level of prosperity are pertinent, particularly in terms of severity, radiological modalities, and surgical management of the condition. Of note, surgical modalities have been the most widely used treatment modality, and current evidence indicates that the laparoscopic approach, per se, is the most effective surgical therapy with a lower incidence of wound infection, post-intervention morbidity, shorter hospital stay, and better quality of life scores compared to the conventional method. In light of this, the present study aimed to evaluate ambulatory appendectomy in a series of sequential laparoscopic appendectomies (LApp), which included both complicated and uncomplicated cases.
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Eroglu O, Comertpay E, Vural S, Badem ND, Isbasaran P, Neselioglu S, Erel O, Deniz T. Diagnostic value of oxidative stress markers in patients presenting with primary dysmenorrhea to the emergency department. Niger J Clin Pract 2022; 25:636-640. [PMID: 35593606 DOI: 10.4103/njcp.njcp_1595_21] [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] [Indexed: 11/04/2022]
Abstract
Background and Aim Primary dysmenorrhea (PD) is a common presentation for emergency departments. This study investigates the diagnostic value of oxidative stress and ischemia markers in patients with PD. Materials and Methods The participants were classified into the PD group (patients with PD) and the control group (healthy volunteers). Thiol/Disulfide Homeostasis (TDH) parameters (Ds, Disulfide; NT, Native Thiol; TT, Total Thiol) and serum ischemia modified albumin (IMA) levels of the groups were measured. The Numeric Rating Scale (NRS) was used for pain assessment. Bivariate correlation analysis was performed to test the relationship between NRS and oxidative stress parameters. A P < 0.05 was considered significant. Results A total of 135 patients (PD group, n = 83; Control group, n = 52) were included in the study. PD group had statistically higher oxidant biomarkers (Ds level, Ds/NT ratio and Ds/TT ratio) and lower antioxidant biomarkers (NT/TT ratio) compared to the control group (p = 0.001; 0.003; 0.002, and 0.002, respectively). Serum IMA level in the PD group was higher than in the control group (P = 0.000). There was a positive correlation between IMA and NRS score (r = 0.342, P < 0.01), but no correlation was found between the other oxidative stress parameters and NRS. Conclusions PD is characterized by increased oxidative stress and ischemia in the endometrium, which can be detected by TDH parameters and serum IMA. NRS score in PD patients is positively correlated with serum IMA level, which suggests IMA level can be valuable to determine the severity of endometrial ischemia and pain in patients with PD.
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Affiliation(s)
- O Eroglu
- Department of Emergency Medicine, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - E Comertpay
- Department of Emergency Medicine, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - S Vural
- Department of Emergency Medicine, Yozgat Bozok University, Faculty of Medicine, Yozgat, Turkey
| | - N Dindar Badem
- Department of Medical Biochemistry, Faculty of Medicine, Kırıkkale University, Kırıkkale,, Turkey
| | - P Isbasaran
- Department of Emergency Medicine, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - S Neselioglu
- Department of Clinical Biochemistry, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - O Erel
- Department of Clinical Biochemistry, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - T Deniz
- Department of Emergency Medicine, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
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Kesicioglu T, Sengul I, Aydın I, Vural S, Sengul D. Management of appendicitis in coronavirus disease 2019, severe acute respiratory syndrome coronavirus 2, pandemic era: decreasing incidence with increasing complicated cases? Rev Assoc Med Bras (1992) 2022; 68:685-690. [PMID: 35584497 DOI: 10.1590/1806-9282.20220160] [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] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/09/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study aimed to examine the impact of the coronavirus disease 2019 (COVID-19) pandemic on appendicitis and the relevant outcomes in a tertiary hospital, designated as a "pandemic institution" by the Ministry of Health, between pre-COVID-19 and post-COVID-19, i.e., between 2019 and 2020, of the identical period in terms of the annual schedule. METHODS The data of cases with acute appendicitis, who were followed up at the Department of General Surgery, a 400-bed, tertiary care, a university-affiliated education and research hospital, providing health care to a population of approximately 450,000 people, during the novel coronavirus SARS-CoV-2, during the identical time intervals of pre-COVID-19 (March 12, 2020 to November 12, 2020) and post-COVID-19 (March 12, 2019 to November 12, 2019), were retrospectively analyzed in a detail. RESULTS Of the 212 appendectomy operations in total, 99 (46.7%) were performed in the pre-COVID-19 and 113 (53.3%) were performed in post-COVID-19. Compared to the pre-pandemic period, patients who had undergone appendectomies in post-COVID-19 revealed significantly lower neutrophil counts and significantly greater appendix diameters (p<0.001 for both). A significantly lower (p=0.041) acute appendicitis with abundant gangrenous appendicitis and phlegmonous appendicitis (p=0.043 and p=0.032, respectively) was recognized in post-COVID-19 compared with pre-COVID-19 interval. CONCLUSION The number of appendectomy operations decreased in the COVID-19 pandemic. Patients operated during the pandemic period had wider appendix diameter and lower neutrophil levels. The pathological diagnosis was less frequent acute appendicitis, more frequent gangrenous appendicitis, and phlegmonous appendicitis in the pandemic period.
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Affiliation(s)
- Tugrul Kesicioglu
- Giresun University Faculty of Medicine, Department of General Surgery - Giresun, Turkey
| | - Ilker Sengul
- Giresun University Faculty of Medicine, Department of General Surgery - Giresun, Turkey
- Giresun University Faculty of Medicine, Division of Endocrine Surgery - Giresun, Turkey
| | - Ismail Aydın
- Giresun University Faculty of Medicine, Department of General Surgery - Giresun, Turkey
| | - Selahattin Vural
- Giresun University Faculty of Medicine, Department of General Surgery - Giresun, Turkey
| | - Demet Sengul
- Giresun University Faculty of Medicine, Department of Pathology - Giresun, Turkey
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Vural S, Aydin I, Kesicioglu T. Association of Serum C-Reactive Protein Level and Treatment Duration in Acute Cholecystitis Patients Treated Conservatively. Cureus 2022; 14:e22146. [PMID: 35308770 PMCID: PMC8919242 DOI: 10.7759/cureus.22146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 01/08/2023] Open
Abstract
Background: Acute cholecystitis (AC) is one of the most common gastrointestinal diseases that require hospitalization and surgical treatment. The treatment of the disease depends upon the severity of the disease and the patients’ medical status. Objective: In this study, we aimed to investigate if there is an association between the serum C-reactive protein (CRP) value and treatment response and the duration and length of hospital stay in AC patients who are treated conservatively. Methodology: The medical records of all patients with the diagnosis of AC who were treated with conservative management were included in the study. The demographic and laboratory data including CRP level at first admission to hospital, length of hospital stay, and complications during the conservative treatment were obtained from the patients’ records. Patients were divided into two groups according to the treatment response and length of hospital stay. Group 1 patients were defined as patients who responded to the medical treatment in less than three days, and Group 2 patients were defined as patients who did not respond to the medical treatment in three days and stayed at the hospital for more than three days. Results: We identified 101 patients with AC treated medically. Mean age (51.3 ± 16.3, 59.5 ± 15.7; p = 0.013), total leukocyte count (11.8 ± 4.4, 8.2 ± 2.8; p = 0.0005), and CRP value (19.3 ± 13.9, 9.6 ± 5.2; p = 0.0003) were higher in Group 2 compared to Group 1. Correlation analyses demonstrated a significant positive association between the length of hospital stay, total leukocyte count (r = 0.35; p = 0.0002), and CRP value (r = 0.59; p = 0.0004). Conclusion: We found that CRP level is associated with treatment duration and hospital stay in AC patients. However, large-scale, prospective further studies are needed to confirm our results and to determine whether CRP levels can be used to discriminate which patient would benefit from medical treatment.
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Gundogdu M, Botsalı A, Vural S. The therapeutic outcomes of one-minute application of sodium hydroxide versus phenol in the chemical cauterization of ingrown toenails. J Cosmet Dermatol 2022; 21:2590-2596. [PMID: 35122368 DOI: 10.1111/jocd.14830] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/26/2022] [Accepted: 02/01/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Ingrown nails are frequently encountered in dermatology practice. The recurrence tendency of the disorder makes chemical cauterization essential during surgical procedures. In studies comparing nail matrix cauterization with sodium hydroxide (NaOH) versus phenol, phenol's application time was highly variable. OBJECTIVE To compare the therapeutic outcomes of matrix cauterization for a standard duration of one minute for NaOH versus phenol in stage II and III ingrown nails MATERIAL AND METHODS: The medical records of patients undergoing matrix cauterization with 10% NaOH or 88% phenol were evaluated. The primary outcome measure was the lack of recurrences on long-term follow-up. The secondary outcome measures were complete healing duration, patient-reported pain scores, and adverse effects related to the procedure. RESULTS Enrolled in this study were 62 ingrown toenail sides treated with 10% NaOH and 56 ingrown toenail sides treated with 88% phenol. The mean follow-up duration was 25.17 months. Recurrence was observed in four nail sides of the NaOH group (%6.45) and three nail sides of the phenol group (%5.35). The difference between the recurrence rates did not reach statistical significance. Patients treated with both methods were free of pain on the post-procedural tenth day. The visual analog scale pain scores and complete healing duration were similar between the two groups (p>0.05). CONCLUSION In a large group with long-term follow-up results, the short-term and long-term post-operative treatment outcomes were similar between the one-minute applications of 10% NaOH versus 88% phenol groups.
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Affiliation(s)
- M Gundogdu
- Ordu State Hospital, Department of Dermatology and Venereology, Ordu, Turkey
| | - Ayşenur Botsalı
- University of Health Sciences, Gülhane Training and Research Hospital, Ankara, Turkey
| | - S Vural
- Koç University School of Medicine, Department of Dermatology and Venereology, Istanbul, Turkey
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Aydin I, Kesicioglu T, Vural S, Gulmez M, Sengul D, Sengul I. Analysis of patients with emergency surgery in a pandemic hospital. Ann Ital Chir 2022; 93:254-258. [PMID: 35476755] [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: 06/14/2023]
Abstract
AIM This study aimed at comparing the patients that received emergency management surgery (surgery and medical treatment) in our hospital, which is a pandemic hospital and provides emergency surgery, with the pre-pandemic period. MATERIAL AND METHODS Data of the patients who received treatment at the emergency surgery clinic of our hospital between March 12 and May 12, 2020, were compared with those of the patients treated between March 12 and May 12, 2019. RESULTS A 55% decrease was observed in the number of patients hospitalized in the emergency surgery clinic. There was a 37% decrease in the number of patients with medical treatment, a 63% decrease in the number of the operated patients, and a 60% decrease in the number of patients hospitalized due to trauma. CONCLUSION Patients requiring urgent surgical treatment hesitate to apply to the pandemic hospital. Histopathologically, delayed surgery might be concerned with significantly more-inflammatory alterations which may lead to irreversible histopathologic and cytostructural changes in the era of emergency surgery. Therefore, we assume that it would be more useful to follow up and treat COVID-19 suspected and positive patients in the pandemic hospitals and to provide the emergency branch service in other hospitals in case of a possible second wave. KEY WORDS COVID-19, SARS-CoV-2, Pandemic, Trauma, Emergency surgery, Emergency.
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Vural S, Kerl K, Doğan PE, Vollmer S, Puchta U, He M, Arakawa Y, Heper AO, Karal A, Hartmann D, Boyvat A, Prinz JC, Arakawa A. Lesional activation of T c 17 cells in Behçet's disease and psoriasis supports HLA-class I-mediated autoimmune responses. Br J Dermatol 2021; 185:1209-1220. [PMID: 34254298 DOI: 10.1111/bjd.20643] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Behçet's disease (BD) presents with lymphocytic and neutrophilic vasculitis of unknown aetiology. HLA-B*51 ERAP1 and IL12R/IL23R are genetic risk factors. IL-23 regulates IL-17A, which controls recruitment and activation of neutrophils. OBJECTIVES To determine pathological changes in BD skin lesions related to the complex genetic predisposition METHODS: We characterised the expression of IL-17A and IL-23A in various cell types by immunohistological double staining of sections from papulopustular skin lesions (PPL) of acute attacks of BD and lesions of psoriasis vulgaris (PV), another HLA-class I-associated T-cell mediated autoimmune disease in which excessive T-cell derived IL-17A production promotes neutrophil activation. RESULTS We found that in BD lesions, as in psoriasis, actively expanding CD8+ T cells were the predominant source of IL-17A. IL-17A+ CD8+ T (Tc17) cells outnumbered infiltrating IL-17A+ CD4+ T cells. Unlike the epidermal localisation of CD8+ T cells in psoriasis, Tc17 cells in BD lesions infiltrated mainly the perivascular tissue and also the blood vessel walls of dermis and subcutaneous tissue. They colocalised with a marked IL-23A expression by CD11c+ dendritic cells (DCs) and CD68+ macrophages. IL-17A expression was associated with extensive recruitment of neutrophils around blood vessels that formed neutrophil extracellular traps (NETs). CONCLUSIONS In BD, the genetic predisposition may mediate antigen-specific activation and differentiation of a Tc 17 response, possibly targeting endothelial antigens. Neutrophils recruited by IL-17A in this process may enhance tissue damage by extensive NET formation (NETosis). Thus, the IL-23/IL-17 axis presumably controls neutrophilic inflammation in BD vasculitis in the context of a predominant antigen-specific CD8+ T-cell response.
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Affiliation(s)
- S Vural
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian-University Munich, Munich, D-80337, Germany.,Department of Dermatology, Koç University School of Medicine, Istanbul, 34010, Turkey
| | - K Kerl
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian-University Munich, Munich, D-80337, Germany
| | - P E Doğan
- Department of Dermatology, Ankara University, 06100, Ankara, Turkey
| | - S Vollmer
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian-University Munich, Munich, D-80337, Germany
| | - U Puchta
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian-University Munich, Munich, D-80337, Germany
| | - M He
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian-University Munich, Munich, D-80337, Germany
| | - Y Arakawa
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian-University Munich, Munich, D-80337, Germany
| | - A O Heper
- Department of Pathology, Ankara University, 06100, Ankara, Turkey
| | - A Karal
- Department of Dermatology, Ankara University, 06100, Ankara, Turkey
| | - D Hartmann
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian-University Munich, Munich, D-80337, Germany
| | - A Boyvat
- Department of Dermatology, Ankara University, 06100, Ankara, Turkey
| | - J C Prinz
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian-University Munich, Munich, D-80337, Germany
| | - A Arakawa
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian-University Munich, Munich, D-80337, Germany
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Abstract
Since idiopathic granulomatous lobular mastitis, also known as idiopathic granulomatous mastitis or granulomatous lobulitis, was first described by Kessler and Wolloch in 1972, no consensus on the ideal and definitive treatment for this phenomenon has been reached thus far. Idiopathic granulomatous lobular mastitis mostly frequently observed in women of childbearing age within a few years of pregnancy with a higher incidence in patients of Hispanic, Native American, Middle Eastern, and African descent. This entity, per se, is a rare, benign, chronic inflammatory breast condition of unknown aetiology mimicking two common breast disorders. The first is breast inflammations or infection, such as cystic neutrophilic granulomatous mastitis; granulomatous mastitis due to Corynebacterium;other infections with granulomas, mycobacteria, fungi, cat scratch disease, and Brucella; granulomatosis with polyangiitis (Wegener's granulomatosis); sarcoidosis; and squamous metaplasia of lactiferous ducts. The second is breast carcinoma in some challenging cases. Of note, no consensus, per se, has been declared on its therapeutic management. The following vignette case described in this report involves idiopathic granulomatous lobular mastitis imitating breast carcinoma. It is important to note that, the aetiology of idiopathic granulomatous lobular mastitis is unknown, its diagnosis is difficult, and physicians should be vigilant and aware of this condition in order of abstaining from an overtreatment for malignancy or overlooking a true malignancy.
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Affiliation(s)
- Ismail Aydin
- General Surgery, Giresun University Faculty of Medicine, Giresun, TUR
| | - Tugrul Kesicioglu
- General Surgery, Giresun University Faculty of Medicine, Giresun, TUR
| | - Selahattin Vural
- General Surgery, Giresun University Faculty of Medicine, Giresun, TUR
| | - Ilker Sengul
- Endocrine Surgery, General Surgery, Giresun University Faculty of Medicine, Giresun, TUR
| | - Kivanc Yilmaz
- Pathology, Ministry of Health-Giresun University Education and Research Hospital, Giresun, TUR
| | - Demet Sengul
- Pathology, Giresun University Faculty of Medicine, Giresun, TUR
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İlgen U, Botsalı A, Vural S. Hidradenitis suppurativa and amyloidosis: a possible association with the pyrin inflammasome. Clin Exp Dermatol 2021; 46:949. [PMID: 33577081 DOI: 10.1111/ced.14607] [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] [Received: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 11/28/2022]
Affiliation(s)
- U İlgen
- Department of Rheumatology, Trakya University Medical School, Edirne, Turkey
| | - A Botsalı
- Department of Dermatology, Gülhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - S Vural
- Department of Dermatology, Koç University Hospital, İstanbul, Turkey
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15
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Vural S, Baumgartner M, Lichtner P, Eckstein G, Hariry H, Chen WC, Ruzicka T, Melnik B, Plewig G, Wagner M, Giehl KA. Investigation of gamma secretase gene complex mutations in German population with Hidradenitis suppurativa designate a complex polygenic heritage. J Eur Acad Dermatol Venereol 2021; 35:1386-1392. [PMID: 33559291 DOI: 10.1111/jdv.17163] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 01/14/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory disease affecting apocrine gland-bearing skin in the axilla, groin and under the breasts. Mutations of the gamma secretase gene complex, which is essential in the activation of Notch signalling pathways, were shown in some families with HS and in a few sporadic cases. Although an imbalance in Notch signalling is implicated in the pathogenesis, the exact mechanism of HS development is yet unknown. OBJECTIVES We aim to investigate the genetic basis of HS by determining the presence of mutations of gamma secretase gene complex in a cohort of HS patients and by searching for a disease-causing pathogenic variant in a multi-generational HS family using parametric linkage analysis. METHODS Thirty-eight patients clinically diagnosed with HS were included in this study. All exons and exon-intron boundaries of the genes encoding gamma secretase complex consisting of six genes: APH1A, APH1B, PSENEN, NCSTN, PSEN1 and PSEN2 were sequenced by Sanger technique. Genetic mapping with parametric linkage analysis for the patients in the family was performed with eight affected and four healthy individuals. The logarithm of odds was calculated. RESULTS In a sporadic patient with early-onset, severe lesions in axilla and groin, a novel single-nucleotide deletion causing frameshift in exon 1 of the NCSTN gene was identified ((NM_015331.3): c.38delG, p.(Gly13Glufs*15)). The LOD score of 1.5 was never exceeded in any region of the genome, pointing towards intricate multi-genic inheritance pattern within the affected family. CONCLUSIONS The gamma secretase gene complex mutations were rare in our cohort (3.2%). Besides, our analysis indicates a possible complex multi-genic inheritance in a seemingly autosomal dominantly inherited large HS family. Genetics of both familial and sporadic HS may be complicated in most cases, and the role of other potential genes such as autoinflammatory and modifier genes as well as environmental factors may influence the pathogenesis.
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Affiliation(s)
- S Vural
- Department of Dermatology and Allergy, Ludwig-Maximilian-University of Munich, Munich, Germany.,Department of Dermatology and Venereology, Koç University School of Medicine, İstanbul, Turkey
| | - M Baumgartner
- Department of Dermatology and Allergy, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - P Lichtner
- Institute of Human Genetics, Technical University Munich, Neuherberg, Germany.,Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - G Eckstein
- Institute of Human Genetics, Technical University Munich, Neuherberg, Germany.,Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - H Hariry
- Gemeinschaftpraxis, Gütersloh, Germany
| | - W C Chen
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - T Ruzicka
- Department of Dermatology and Allergy, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - B Melnik
- Gemeinschaftpraxis, Gütersloh, Germany.,Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany
| | - G Plewig
- Department of Dermatology and Allergy, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - M Wagner
- Institute of Human Genetics, Technical University Munich, Neuherberg, Germany.,Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - K A Giehl
- Department of Dermatology and Allergy, Ludwig-Maximilian-University of Munich, Munich, Germany
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16
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Taşkın B, Vural S, Altuğ E, Demirkesen C, Kocatürk E, Çelebi İ, Ferhanoğlu B, Alper S. Coronavirus 19 presenting with atypical Sweet's syndrome. J Eur Acad Dermatol Venereol 2020; 34:e534-e535. [PMID: 32452542 PMCID: PMC7283742 DOI: 10.1111/jdv.16662] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- B Taşkın
- Department of Dermatology and Venereology, School of Medicine, Koç University, Istanbul, Turkey.,Department of Dermatology and Venereology, VKV American Hospital, Istanbul, Turkey
| | - S Vural
- Department of Dermatology and Venereology, School of Medicine, Koç University, Istanbul, Turkey
| | - E Altuğ
- Department of Pulmonary Medicine, VKV American Hospital, Istanbul, Turkey
| | - C Demirkesen
- Department of Pathology, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - E Kocatürk
- Department of Dermatology and Venereology, School of Medicine, Koç University, Istanbul, Turkey
| | - İ Çelebi
- Department of Radiology, VKV American Hospital, Istanbul, Turkey
| | - B Ferhanoğlu
- Department of Hematology and Oncology, VKV American Hospital, Istanbul, Turkey
| | - S Alper
- Department of Dermatology and Venereology, School of Medicine, Koç University, Istanbul, Turkey.,Department of Dermatology and Venereology, VKV American Hospital, Istanbul, Turkey
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17
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Hurdogan O, Yilmaz I, Bay SB, Vural S, Tugcu D, Kebudi R, Gun F, Ozkan B, Bilgic B, Firat P, Yilmazbayhan D, Ozluk Y. DICER1 Hotspot Mutations in Pleuropulmonary Blastoma: A Case Series From a Tertiary Center. Pediatr Dev Pathol 2020; 23:204-209. [PMID: 31603374 DOI: 10.1177/1093526619878602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/15/2022]
Abstract
Pleuropulmonary blastoma (PPB) is a potentially aggressive, rare childhood neoplasia. We investigated histopathological features, survival, and DICER1 hotspot mutations among PPB patients. Archive records at our institution were reviewed, covering a 20-year period. Thirteen children (6 males and 7 females) with a mean age of 30.5 (range 6-83) months were included. The tumor subtypes were type I in 6 (46%), type II in 4 (31%), and type III in 3 (23%). Only tumors with type II and type III histology showed anaplasia (4/7, 57%). Median follow-up was 28 (range 9-216) months. Three-year overall survival rate was 83.3% and 3-year progression-free survival rate was 25%. Progression was seen in 60% (3/5) of type I and 66.7% (4/6) of type II and type III cases. Two patients died of disseminated disease at 9 and 44 months. Hotspot missense mutations on DICER1 gene were detected in all 11 patients with available tumor tissue. We found an additional novel germline loss-of-function mutation (c.5436dupT; p.E1813*) in 1 case. To the best of our knowledge, this is the first study to investigate hotspot missense mutations on DICER1 gene among the largest series of Turkish children with PPB.
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Affiliation(s)
- O Hurdogan
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - I Yilmaz
- Department of Pathology, Sultan Abdulhamid Han Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - S B Bay
- Division of Pediatric Hematology-Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - S Vural
- Department of Pediatric Oncology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - D Tugcu
- Department of Pediatric Hematology-Oncology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - R Kebudi
- Division of Pediatric Hematology-Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey.,Department of Pediatric Oncology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - F Gun
- Department of Pediatric Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - B Ozkan
- Department of Thoracic Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - B Bilgic
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - P Firat
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - D Yilmazbayhan
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Y Ozluk
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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18
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Sengul D, Sengul I, Egrioglu E, Ozturk T, Aydin I, Kesicioglu T, Vural S, Tosum A, Bekci T. Can cut-off points of 10 and 15 mm of thyroid nodule predict malignancy on the basis of three diagnostic tools: i) strain elastography, ii) the Bethesda System for Reporting Thyroid Cytology with 27-gauge fine-needle, and iii) histopathology? J BUON 2020; 25:1122-1129. [PMID: 32521915] [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: 06/11/2023]
Abstract
PURPOSE This study evaluated whether the cut-offs 10 and 15 mm can help distinguish malignant from benign nodules regarding three diagnostic tools: i) strain elastography (SE), ii) the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), iii) histopathology. METHODS From 2012 to April 2015, a retrospective analysis was conducted by enrolling the data of 425 consecutive eligible patients with 500 thyroid nodules. The efficacy of the nodule size, as of the cut-offs, on the estimation for malignancy had been analysed on the basis of the three diagnostic tools. RESULTS Of the 500 thyroid nodules examined, 80 (16.0%) were under 10 mm and 420 (84.0%) were over 10 mm in diameter. No significant difference was found between over 10 mm with i) TES (Tsukuba Elasticity Score) 4 and 5, area under the curve (AUC) 0.531, ii) TBSRTC (The Bethesda System for Reporting Thyroid Cytopathology) III, IV, V, VI, undetermined and malignant cytology, AUC 0.517, iii) malignant histopathology, AUC 0.509. Similarly, no significance difference was recognized between over 15 mm with i) TES 4 and 5, AUC 0.623, ii) undetermined and malignant cytology, AUC 0.455, iii) malignant histopathology, AUC 0.515 by McNemar test. However, size over 15 mm may strengthen the prediction among TES 4 and 5 and malignant histopathology, as weakens in undetermined and malignant cytology. CONCLUSIONS These preliminary data of 3-year single-center study suggest that assignment of 10 and 15 mm as the cut-off points of the thyroid nodules may not be predictive of malignancy on the basis of three diagnostic tools. Nevertheless, higher cut-off may corrobarate the correlation with TES 4 and 5 and malignant histopathology while attenuation with TBSRTC III, IV, V, and VI, confront with the lower one, 10 mm.
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Affiliation(s)
- Demet Sengul
- Department of Pathology, Giresun University Faculty of Medicine, TR28100 Giresun, Turkey
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Vural S, Karaman S, Yilmaz S, Ozcelik GS, Akinci N. Chemotherapy-induced rhabdomyolysis in chidren with leukemia: a case report. Leuk Res 2019. [DOI: 10.1016/s0145-2126(19)30415-1] [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: 10/25/2022]
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20
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Vural S, Gündoğdu M, Gökpınar Ili E, Durmaz C, Vural A, Steinmüller‐Magin L, Kleinhempel A, Holdt L, Ruzicka T, Giehl K, Ruhi H, Boyvat A. 多发性化脓性汗腺炎患者 pyrin 突变. Br J Dermatol 2019. [DOI: 10.1111/bjd.17973] [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: 10/26/2022]
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21
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Vural S, Gündoğdu M, Gökpınar İli E, Durmaz C, Vural A, Steinmüller‐Magin L, Kleinhempel A, Holdt L, Ruzicka T, Giehl K, Ruhi H, Boyvat A. Pyrin mutations in complex hidradenitis suppurativa. Br J Dermatol 2019. [DOI: 10.1111/bjd.17956] [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: 11/30/2022]
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22
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Vural S, Gündoğdu M, Gökpınar İli E, Durmaz CD, Vural A, Steinmüller-Magin L, Kleinhempel A, Holdt LM, Ruzicka T, Giehl KA, Ruhi HI, Boyvat A. Association of pyrin mutations and autoinflammation with complex phenotype hidradenitis suppurativa: a case-control study. Br J Dermatol 2019; 180:1459-1467. [PMID: 30488432 DOI: 10.1111/bjd.17466] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a rare, debilitating neutrophilic dermatosis characterized by chronic inflammation of hair follicles. Many inflammatory conditions may accompany HS. OBJECTIVES To investigate the association of variants of the MEFV gene with a complex HS phenotype. METHODS Firstly, we identified the clinical characteristics of 119 patients with HS with a complex phenotype (Hurley stage III disease and/or additional inflammatory symptoms). Then, we searched for MEFV variants among these patients. The odds ratios (ORs) for pathogenic MEFV mutations were calculated using data from these patients with HS and 191 healthy controls. RESULTS The male/female ratio was higher, and the mean age of onset was earlier, in our complex HS group compared with patients with HS in general. Five of the patients with HS (4·2%) had a diagnosis of familial Mediterranean fever (FMF) with a standardized morbidity ratio of 45 [95% confidence interval (CI) 16·50-99·84, P < 0·001] when compared with the frequency of FMF in the general Turkish population. Of the patients with complex HS, 38% were positive for pathogenic variants of MEFV. The OR for carrying a pathogenic MEFV allele was 2·80 (95% CI 1·31-5·97, P < 0·001). CONCLUSIONS The frequency of MEFV mutations in the group of patients with complex HS was higher than that in healthy controls, suggesting that MEFV mutations may contribute to the pathogenesis of HS. Understanding the role of autoinflammation in HS is of fundamental importance for the development of novel therapies.
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Affiliation(s)
- S Vural
- Department of Dermatology and Venereology, Ankara University, Ankara, Turkey.,Department of Dermatology, Koç University, Istanbul, Turkey
| | - M Gündoğdu
- Department of Dermatology and Venereology, Ankara University, Ankara, Turkey
| | - E Gökpınar İli
- Department of Medical Genetics, Ankara University, Ankara, Turkey
| | - C D Durmaz
- Department of Medical Genetics, Ankara University, Ankara, Turkey
| | - A Vural
- Department of Neurology, Koç University, Istanbul, Turkey
| | | | - A Kleinhempel
- Institute of Laboratory Medicine, Ludwig Maximilian University of Munich, Munich, Germany
| | - L M Holdt
- Institute of Laboratory Medicine, Ludwig Maximilian University of Munich, Munich, Germany
| | - T Ruzicka
- Department of Dermatology and Allergy, Ludwig Maximilian University of Munich, Munich, Germany
| | - K A Giehl
- Department of Dermatology and Allergy, Ludwig Maximilian University of Munich, Munich, Germany
| | - H I Ruhi
- Department of Medical Genetics, Ankara University, Ankara, Turkey
| | - A Boyvat
- Department of Dermatology and Venereology, Ankara University, Ankara, Turkey
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23
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Kesicioglu T, Turan R, Dulger A, Vural S, Ayraler A. Lower serum selenium levels are associated with diverticular disease of the colon. J Med Allied Sci 2019. [DOI: 10.5455/jmas.30318] [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: 11/03/2022] Open
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24
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Eyvaz K, Kement M, Balin S, Acar H, Kündeş F, Karaoz A, Civil O, Eser M, Kaptanoglu L, Vural S, Bildik N. Clinical evaluation of negative-pressure wound therapy in the management of electrical burns. ULUS TRAVMA ACIL CER 2018; 24:456-461. [PMID: 30394501 DOI: 10.5505/tjtes.2018.80439] [Citation(s) in RCA: 3] [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 In this study, we aimed to evaluate the clinical efficacy and safety of negative-pressure wound therapy (NPWT) in the treatment of the patients with electrical burns. METHODS This study was retrospectively performed using a database placed prospectively in the burn center of our hospital. All consecutive patients with electrical burns treated using NPWT at our center between August 2008 and December 2012 were included. The treatment results in our study were grouped as successful or unsuccessful considering the treatment objectives in accordance with therapy indications. RESULTS In total, 39 patients were included in our study; of them, 36 (92.3%) were men. The average age was 34.9±9.8 years (range, 17-63 years). The majority of the patients in our study (92.3%) had been exposed to high voltage electricity. The mean total burned body surface area (TBSA) was 19.3±9.8 (range, 4-44). Six patients (15.4%) had TBSAs ≥30%, 31 (79.5%) had third degree burns, and 8 (20.5%) had fourth degree burns. In our study, indications of NPWT included bone and/or tendon exposed deep wounds that are not suitable for early grafting or flap applications owing to the lack of supporting tissue in 27 (69.2%) patients, graft fixation in 8 (20.5%) patients, and secondary grafting following graft loss in 4 (10.3%) patients. The general success rate of NPWT was 90.7% according to indications and treatment objectives in our study. CONCLUSION In the light of our results, NPWT may contribute to the present conventional treatments used in severe electrical burns.
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Affiliation(s)
| | - Metin Kement
- Department of General Surgery, University of Health Sciences, Kartal Dr. Lütfi Kırdar Training and Research Hospital, İstanbul-Turkey.
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25
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Vural S, Arakawa A, Arakawa Y, Prinz JC. The therapeutic potential of TNF-α antagonists in toxic epidermal necrosis: insights from two cases and adverse event reports. J Eur Acad Dermatol Venereol 2018; 32:e418-e419. [PMID: 29705991 DOI: 10.1111/jdv.15006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- S Vural
- Department of Dermatology and Allergology, Clinics of the Ludwig-Maximilian University, Munich, Germany
| | - A Arakawa
- Department of Dermatology and Allergology, Clinics of the Ludwig-Maximilian University, Munich, Germany
| | - Y Arakawa
- Department of Dermatology and Allergology, Clinics of the Ludwig-Maximilian University, Munich, Germany.,Department of Dermatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - J C Prinz
- Department of Dermatology and Allergology, Clinics of the Ludwig-Maximilian University, Munich, Germany
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26
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Bac I, Horváth O, Flaig M, Vancsik T, Vural S, Ruzicka T, Sárdy M. 033 Increased expression of IL-31, IL-31RA and OSMRβ in bullous pemphigoid. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.037] [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: 10/17/2022]
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Abstract
BACKGROUND The aim of the present study was to investigate the demographic and clinical characteristics of electrical injuries, type of electrical current and the importance of electrocardiography in clinical course. METHODS Fifty-three patients (50 males [94.3%], 3 females [5.7%]; mean age 34.5±9.6; range 19 to 61 years) with electrical injuries treated in the burn center between 2011 and 2012 were retrospectively analyzed. The patients were evaluated for demographic and clinical characteristics, electrocardiographic findings and clinical outcomes. RESULTS The electrocardiography findings of the patients were as follows: twenty-seven normal, twelve sinus tachycardia, three atrial fibrillation, seven right bundle brunch block, and four ventricular extra-systole. There was no mortality among patients with electrocardiographic findings of normal, right bundle brunch block, and ventricular extra-systole. Four patients with sinus tachycardia and one patient with atrial fibrillation died. Electrocardiographic findings of the patients wounded by high-voltage electricity were: two normal, two sinus tachycardia, and one atrial fibrillation. DISCUSSION Mortality was higher in patients with sinus tachycardia and atrial fibrillation in the electrocardiography at the time of admission. These ECG findings were more often in patients wounded by high-voltage electricity. Therefore, electrocardiographic findings and type of the electrical current may provide prognostic value in the clinical course of patients.
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Affiliation(s)
- Aslı Vural
- Department of Cardiology, Kırıkkale Yüksek İhtisas Hospital, Kırıkkale, Turkey
| | - Taner Sarak
- Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey
| | - Selahattin Vural
- Department of General Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Ahmet Çınar Yastı
- Department of General Surgery, Ankara Numune Training and Research Hospital, Ankara; Department of General Surgery, Hitit University Faculty of Medicine, Çorum, Turkey
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28
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Ozturk K, Tasci I, Yasar M, Akay C, Alcigir M, Vural S, Mas MR, Turker T, Saglam K. Effects of rapamycin treatment on pancreatic fibrosis, cellular apoptosis and oxidative stress in experimental chronic pancreatitis model. Acta Gastroenterol Belg 2015; 78:3-7. [PMID: 26118571 DOI: pmid/26118571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE Rapamycin reduces hepatic fibrosis by inhibiting hepatic stellate cell activation. The present study investigated whether rapamycin treatment could modify the degree of fibrosis, cellular apoptosis and oxidative stress (OS) in an experimental model of CP. METHODS Fifty-five male, Sprague-Dawley rats weighing 200-400g were randomized into four groups. CP was induced by intraductal trinitrobenzene sulfonic acid (TNBS) infusion in group A (n = 15) and group B (n = 15). Group C (n = 15) received intraductal TNBS and was killed for histologic confirmation at four weeks. Group D (n = 10) received intraductal saline instead of TNBS. Group A and group D received oral rapamycin (2 mg/kg/d) for two weeks after CP was induced while group B received oral tap water instead of rapamycin. Blood and pancreatic tissue specimens were collected and oxidative stress parameters, fibrosis and cellular apoptosis were determined. RESULTS Tissue and blood malondialdehyde (MDA) levels were significantly lower in rapamycin treated group compared to controls (p < 0.001). Superoxide dismutase (SOD) and glutathion peroxidase (GSH-Px) activities were also significantly higher in the active treatment group (p < 0.001 for both). Tissue and blood MDA, SOD, GSH-Px measurements was similar in rapamycin group and pancreatic cannulation group (p > 0.05). Histopathologic fibrosis scores were similar in rapamycin and control groups. Apoptotic cell counts tended to be lower in rapamycin treated animals. CONCLUSIONS Administration of rapamycin alleviated OS and, in part, prevented apoptotic cell death in experimental CP, but did not reduce fibrosis.
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Altuntas YE, Unel S, Gezen FC, Aksakal N, Civil O, Vural S, Ozates M, Oncel M. Stereotactic excision of additional lesions detected with intraoperative ultrasound examination during radiofrequency dissecting sealar (habib®) assisted hepatic metastasectomy: report of 4 cases. Indian J Surg 2014; 76:61-5. [PMID: 24799786 DOI: 10.1007/s12262-012-0554-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 06/04/2012] [Indexed: 11/30/2022] Open
Abstract
Intraoperative ultrasound has been using to achieve a proper resection strategy in patients undergoing a hepatic colorectal metastasectomy. This study aims to describe and reveal the place of stereotactic metastasectomy in nonpalpable colorectal liver metastases (CLM). A chart review was initiated for all patients underwent resection for CLM between 2006 and 2011. The data concerning perioperative data and intraoperative strategy were abstracted. Among the 58 patients, who underwent a resection for CLM, 4 (6.9 %) (all men, median age 65.5, range 49-72, years) necessitated a stereotactic metastasectomy. Preoperative evaluations showed 1 (n = 1), 2 (n = 2), or 3 (n = 1) lesions, and intraoperative ultrasound (IUS) found an additional lesion in a case. Stereotactic marking was performed for nonpalpable lesions located in segments IVA, II, and VI and at the junction of segments V and VI. The margins were negative for all lesions both resected with conventional and stereotactic techniques. The examinations of the stereotactic resection materials revealed metastatic adenocarcinoma (patients n = 2), focal nodular hyperplasia (n = 1), and abnormal benign liver histology probably induced by chemotherapy (n = 1). The median (range) operation and hospitalization periods were 217.5 (150-310) minutes and 5.5 (2-9) days. No complications were observed except biliary fistula in a case, which spontaneously disappeared within 2 weeks. A patient died due to systemic disease including hepatic metastases 33 months after the liver surgery. Stereotactic metastasectomy may be feasible for the removal of nonpalpable CLM. Further evaluations are necessitated to understand the accurate place of this novel technique.
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Affiliation(s)
- Yunus E Altuntas
- General Surgery Department of Kartal Education and Research Hospital, Istanbul, Turkey ; Altayçeşme Mah. Varna Sok. No:15/B D:2 Menekşe Sit., Maltepe, Istanbul, 34843 Turkey
| | - Sacide Unel
- Radiology Department of Kartal Education and Research Hospital, Istanbul, Turkey
| | - Fazlı C Gezen
- General Surgery Department of Kartal Education and Research Hospital, Istanbul, Turkey
| | - Nihat Aksakal
- General Surgery Department of Kartal Education and Research Hospital, Istanbul, Turkey
| | - Osman Civil
- General Surgery Department of Kartal Education and Research Hospital, Istanbul, Turkey
| | - Selahattin Vural
- General Surgery Department of Kartal Education and Research Hospital, Istanbul, Turkey
| | - Mustafa Ozates
- Radiology Department of Kartal Education and Research Hospital, Istanbul, Turkey
| | - Mustafa Oncel
- General Surgery Department of Kartal Education and Research Hospital, Istanbul, Turkey ; Medical College of Gumushane University, Gumushane, Turkey
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Vural S, Civil O, Kement M, Altuntas YE, Okkabaz N, Gezen C, Haksal M, Gundogan E, Oncel M. Risk factors for early postoperative morbidity and mortality in patients underwent radical surgery for gastric carcinoma: A single center experience. Int J Surg 2013; 11:1103-9. [DOI: 10.1016/j.ijsu.2013.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 09/14/2013] [Indexed: 02/05/2023]
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Tunger O, Vural S, Cetin C, Keles G, Borand H, Gazi H. Clinical Aspects and Risk Factors of NosocomialStenotrophomonas maltophiliaBacteremia Episodes in a Turkish Intensive Care Unit. J Chemother 2013; 19:658-64. [DOI: 10.1179/joc.2007.19.6.658] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Gezen C, Altuntas YE, Kement M, Aksakal N, Okkabaz N, Vural S, Oncel M. Laparoscopic and conventional resections for low rectal cancers: a retrospective analysis on perioperative outcomes, sphincter preservation, and oncological results. J Laparoendosc Adv Surg Tech A 2012; 22:625-30. [PMID: 22731804 DOI: 10.1089/lap.2011.0479] [Citation(s) in RCA: 6] [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: 11/12/2022] Open
Abstract
BACKGROUND This study aims to compare the results of laparoscopic and conventional techniques in patients with low rectal cancers. SUBJECTS AND METHODS A retrospective data analysis was initiated in patients underwent laparoscopic or conventional surgery for cancers located in the low (<6 cm) rectum. Patient and tumor-related information, outcomes of operations, and survival were compared between the groups. RESULTS Among 142 patietns (91 men [64.1%]; mean±standard deviation age, 57.7±14.6 years) who had tumors located <6 cm from the dentate line, 92 (64.8%) were operated on with the laparoscopic technique. Demographics, tumor stage, and localization (2.9±2.0 versus 2.9±2.1 cm from the dentate line in laparoscopic and conventional arms, respectively; P=.968) were similar. However, there were more patients in the laparoscopic group who received neoadjuvant chemoradiation therapy (92.4% versus 80.0%; P=.03), since there were significantly fewer cases with stage I tumors in this group (3.3% versus 14%; P=.33). The conversion rate was 14.1% (n=13). The amount of bleeding and the requirement for transfusion decreased (P<.05 for both), and the possibility of sphincter-saving procedures (66.3% versus 34.0%; P<.001) increased, in the laparoscopy group. Other parameters were identical. In the laparoscopy group, the number of harvested lymph nodes (10.2±5.4 versus 12.4±6.0; P=.025) and the rate of vascular invasion (27.5% versus 47.8%; P=.021) were less, and Kaplan-Meier analysis revealed an improved survival (P=.042), although the follow-up period was significantly shorter in this group (P<.001). CONCLUSIONS Laparoscopic surgery for low rectal cancers may be technically feasible and oncologically safe. Laparoscopy may increase the possibility of sphincter preservation.
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Affiliation(s)
- Cem Gezen
- General Surgery Department, Kartal Education and Research Hospital, Istanbul, Turkey.
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Baştürk E, Kement M, Yavuzer D, Vural S, Gezen C, Gözü HI, Karadayı A, Oncel M. The role of insulin-like growth factor 1 in the development of benign and malignant thyroid nodules. Balkan Med J 2012; 29:133-8. [PMID: 25206982 DOI: 10.5152/balkanmedj.2011.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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: 05/26/2011] [Accepted: 10/14/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This study aims to investigate the role of IGF-1 in the development of nodular thyroid disease. MATERIAL AND METHODS A total number of 100 consecutive patients operated for nodular thyroid disease in our institution were included in this prospective study. In addition to classical pathological examinations, nodules and extranodular healthy tissues were sampled and immunochemically stained for IGF-1. The materials were independently evaluated using an Allred Scoring System ranging from 0 to 8. If the score was ≥1, the tissue was accepted as IGF-1 positive. RESULTS IGF-1 positivity was observed in 88% and 58% of the samples obtained from nodules and extranodular healthy tissues, respectively. Allred 8-unit scores were higher in benign nodules (n=89; 4.1±2.3) and papillary carcinomas (n=7; 6.7±1.3), than in extranodular healthy tissues in the same patients (2.3±2.3 and 3.3±1.9, respectively); and higher in papillary carcinomas than in benign nodules, when the scores were compared to each other (p<0.01 for all comparisons). CONCLUSIONS Allred 8-unit scores for IGF-1 increase in the presence of benign thyroid nodules, papillary cancer. The results of our study support the findings of previous studies demonstrating the role of IGF-1 in the development of thyroidal nodules.
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Affiliation(s)
- Engin Baştürk
- Department of 1 General Surgery, Kartal Training and Research Hospital, İstanbul, Turkey
| | - Metin Kement
- Department of 1 General Surgery, Kartal Training and Research Hospital, İstanbul, Turkey
| | - Dilek Yavuzer
- Department of 1 General Surgery, Kartal Training and Research Hospital, İstanbul, Turkey
| | - Selahattin Vural
- Department of 1 General Surgery, Kartal Training and Research Hospital, İstanbul, Turkey
| | - Cem Gezen
- Department of 1 General Surgery, Kartal Training and Research Hospital, İstanbul, Turkey
| | - Hülya Ilıksu Gözü
- Department of 1 General Surgery, Kartal Training and Research Hospital, İstanbul, Turkey
| | - Ayşe Karadayı
- Department of 1 General Surgery, Kartal Training and Research Hospital, İstanbul, Turkey
| | - Mustafa Oncel
- Department of 1 General Surgery, Kartal Training and Research Hospital, İstanbul, Turkey
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Gezen C, Kement M, Altuntas YE, Aksakal N, Okkabaz N, Civil O, Vural S, Oncel M. Safety and effectiveness of 5-mm and 10-mm electrothermal bipolar vessel sealers (LigaSure) in laparoscopic resections for sigmoid colon and rectal cancers. J Laparoendosc Adv Surg Tech A 2012; 22:572-7. [PMID: 22458835 DOI: 10.1089/lap.2012.0083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND LigaSure™ (Covidien, Mansfield, MA) has been used in cases undergoing laparoscopic colon and rectal resections. This study aims to analyze the efficacy and safety of the 5-mm and 10-mm devices. SUBJECTS AND METHODS Patients who received a laparoscopic or hand-assisted laparoscopic operation for a tumor located in the sigmoid colon or rectum since 2006 were abstracted from a prospectively designed database, and findings were analyzed in two groups based on size of the device used during the procedure. The videotapes of the procedures were watched, and operation reports were read to obtain further information on specific intra- and postoperative complications. Demographics, tumor and operation-related information, and postoperative data were compared. RESULTS Among 215 (128 [59.5%] males; median age, 59.5±13.8 years) patients, data obtained from the 5-mm (n=32) and 10-mm (n=183) groups were identical regarding demographics and data related to tumor (localization and stage) and operation (number of harvested lymph nodes, conversion rates, operation time, intraoperative bleeding, transfusion requirement, reoperation rates, complications, 30-day mortality, and length of hospital stay). However, more patients underwent an anterior resection in the 10-mm group than in the 5-mm group (31.7% versus 15.6%, P<.05). Further analyses found device-related bleeding in 8 (3.7%) cases (2 [6.3%] versus 6 [3.3%] in the 5-mm versus 10-mm group, respectively, P>.05), requiring further attempts for hemorrhage control (n=6), conversion to open surgery (n=1), or relaparotomy (n=1). CONCLUSIONS The 5-mm and 10-mm LigaSure devices are similarly effective and safe during laparoscopic sigmoid colon and rectal resections. Severe bleeding from larger vessels may be observed, requiring conversion to open surgery or relaparotomy.
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Affiliation(s)
- Cem Gezen
- General Surgery Department, Kartal Education and Research Hospital, Istanbul, Turkey.
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Kement M, Ozlem N, Colak E, Kesmer S, Gezen C, Vural S. Synergistic effect of multiple predisposing risk factors on the development of bezoars. World J Gastroenterol 2012; 18:960-4. [PMID: 22408356 PMCID: PMC3297056 DOI: 10.3748/wjg.v18.i9.960] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 09/25/2011] [Accepted: 01/07/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To describe the clinical characteristics of patients with gastric or intestinal bezoars recently treated in our hospital.
METHODS: In this study, a retrospective chart review of consecutive patients with gastrointestinal bezoars, who were treated at the Samsun Education and Research Hospital between January 2006 and March 2011, was conducted. Data on demographic characteristics, clinical presentation, history of risk factors, diagnostic procedures, localization of bezoars, treatment interventions, and postoperative morbidity and mortality rates were collected and evaluated.
RESULTS: Forty-two patients [26 (61.9%) males and 16 (31.1%) females] with a mean ± SD (range) age of 55.8 ± 10.5 (37-74) years were enrolled in this study. Thirty-six patients (85.7%) had one or more predisposing risk factors for gastrointestinal bezoars. The most common predisposing risk factor was a history of previous gastric surgery which was identified in 18 patients (42.8%). Twenty three patients (54.8%) had multiple predisposing risk factors. Phytobezoars were identified in all patients except one who had a trichobezoar in the stomach. Non-operative endoscopic fragmentation was performed either initially or after unsuccessful medical treatment in 14 patients with gastric bezoars and was completely successful in 10 patients (71.5%). Surgery was the most frequent treatment method in our study, which was required in 28 patients (66.7%). Intestinal obstruction secondary to bezoars was the most common complication (n = 18, 42.8%) in our study.
CONCLUSION: The presence of multiple predisposing factors may create a synergistic effect in the development of bezoars.
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Gezen C, Altuntas YE, Kement M, Vural S, Civil O, Okkabaz N, Aksakal N, Oncel M. Complete versus partial mobilization of splenic flexure during laparoscopic low anterior resection for rectal tumors: a comparative study. J Laparoendosc Adv Surg Tech A 2012; 22:392-6. [PMID: 22393925 DOI: 10.1089/lap.2011.0409] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The aim of the current study is to compare the results after partial and complete splenic flexure mobilization (SFM). SUBJECTS AND METHODS The records of laparoscopic and hand-assisted laparoscopic procedures for primary rectal tumor patients were abstracted from a prospectively designed database. The phrenicocolic and splenocolic ligaments were divided via a four-trocar technique in the partial SFM group, and dissection was continued with the separation of gastrocolic and pancreaticomesocolic attachments via a five-trocar procedure in the complete SFM group. The following data were compared between the groups: Demographics, intra- and postoperative information, and pathological features. RESULTS In total, 122 cases (77 [63.1%] male, 58.2±13.2 years old) who underwent a partial (n=36, 29.5%) or a complete (n=86, 70.5%) SFM were included. Reservoir creation (48.8% versus 19.4%, P=.003) was more common and conversion (8.1% versus 22.2%, P=.039) was less frequent in the complete SFM group, but there were significantly more T4 tumors in the partial group (16.7% versus 2.3%, P=.008). Demographics, other intra- and postoperative parameters, and pathological features were identical. CONCLUSIONS In our study, complete SFM decreased conversion rates, but this finding may be related to the higher rate of T4 tumors in the partial SFM group. Complete SFM assures an increase in reservoir creation in patients receiving a low anterior resection. Because other parameters are identical, the decision for the level of SFM is better left to the surgeon in cases undergoing a low anterior resection, but complete SFM may be preferred in cases who are candidates for a reservoir formation.
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Affiliation(s)
- Cem Gezen
- General Surgery Department, Kartal Education and Research Hospital, Istanbul, Turkey.
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Abstract
Mammary cancer is one of the leading causes of death in pet population. Early diagnosis and malignancy detection is important for prognosis. The levels of neopterin, sialic acid and nitric oxide in serum of dogs with malignant mammary tumours were evaluated to investigate the importance of these biochemical parameters for malign mammary tumour. Twelve healthy dogs and twenty dogs with malignant mammary tumours were used as research materials. Blood samples were collected from both groups for neopterin analysis by enzyme-linked immunosorbent assay, whereas nitric oxide and sialic acid were measured by modified nitrate reductase method and spectrophotometry, respectively. Tissue specimens were evaluated and defined as malignant tumours. Serum nitric oxide and sialic acid levels in dogs with mammary tumours were significantly higher than those in the healthy dogs. Serum neopterin levels were not found significantly different in dogs with mammary tumours compared to healthy dogs. Malignancy of canine mammary tumours are accompained by an elevation of nitric oxide and sialic acid levels.
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Affiliation(s)
- N Tascene
- Department of Biochemistry, Faculty of Veterinary Medicine, Ankara University, Ankara, Turkey.
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Ozkan Z, Kement M, Kargı AB, Censur Z, Gezen FC, Vural S, Oncel M. An interesting journey of an ingested needle: a case report and review of the literature on extra-abdominal migration of ingested foreign bodies. J Cardiothorac Surg 2011; 6:77. [PMID: 21615959 PMCID: PMC3123183 DOI: 10.1186/1749-8090-6-77] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 05/26/2011] [Indexed: 12/13/2022] Open
Abstract
Swallowed foreign bodies encounter a major problem especially in children, but fortunately they mostly do not cause any related complication and are easily passed with the stool. In this paper, an interesting journey of a needle is presented. A 20-year old female admitted to our emergency service after she had swallowed a sewing machine needle, which is initially observed in the stomach in the plain abdominal radiography. During the follow-up period, the needle traveled through bowels, and surprisingly was observed in the left lung on 10th day of the follow-up. It was removed with a thoracotomy and pneumotomy under the fluoroscopic guidance. The postoperative period was uneventful and the patient was discharged from the hospital on the day 5. We also review the literature on interesting extra-abdominal migrations of swallowing foreign bodies.
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Affiliation(s)
- Zeynep Ozkan
- General Surgery Department, Kartal Education and Research Hospital, Istanbul, Turkey
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Kement M, Karabulut M, Gezen F, Demirbas S, Vural S, Oncel M. Mild and Severe Anal Incontinence after Lateral Internal Sphincterotomy: Risk Factors, Postoperative Anatomical Findings and Quality of Life. Eur Surg Res 2011; 47:26-31. [DOI: 10.1159/000324902] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
<i>Aim:</i> This study aims to evaluate the risk factors for incontinence after lateral internal sphincterotomy (LIS) and assess quality of life in different levels of incontinence. <i>Methods:</i> All consecutive patients (n = 253) with chronic anal fissure who underwent LIS between 2003 and 2006 were retrospectively reviewed. All patients were questioned for possible anal incontinence according to the Wexner Incontinence Score (WIS). Demographics, vaginal delivery history, additional procedures and surgeon’s experience were evaluated as risk factors. Endoanal ultrasound (EUS) was performed in incontinent patients to assess the thickness of the remaining internal sphincter and to evaluate any injury in the external sphincter. Quality of life was questioned with SF-36. <i>Results:</i> Twenty-eight (11.7%) patients suffered from incontinence (mean WIS = 3.6 ± 2.5). The search for a risk factor was unsuccessful when continent and incontinent groups were compared. In subgroup analyses, patients were found to be suffering from mild (WIS <5, n = 19) or severe (WIS >5, n = 9) incontinence. Vaginal delivery history was found more often in the severely incontinent subgroup than in the continent group (p < 0.05). Also, vaginal delivery history and the additional procedures were more frequently observed in the severely incontinent subgroup than in the mildly incontinent subgroup. EUS did not find any external sphincter injury in these cases. WIS had negative correlations with the physical and mental component scores of SF-36. <i>Conclusion:</i> In our opinion, the threat for incontinence is unpredictable; however, vaginal delivery history may increase the risk of severe incontinence.
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Gözü HI, Yavuzer D, Kaya H, Vural S, Sargın H, Gezen C, Sargın M, Akalın S. Alterations of NIS expression in functioning thyroid nodules. Kulak Burun Bogaz Ihtis Derg 2010; 20:285-292. [PMID: 20961282] [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: 05/30/2023]
Abstract
OBJECTIVES This study aimed to analyze both the level and the cell site of the sodium-iodide symporter (NIS) protein expression in autonomously functioning thyroid nodules (AFTNs) and extranodular thyroid tissues. In addition, this study sought to compare the clinical results of patients with the levels of human NIS (hNIS) protein expression. PATIENTS AND METHODS The histological slides consisted of 36 AFTNs and 31 extranodular thyroid tissues from 28 patients (5 males, 23 females; mean age 54.5±11.0 years; range 37 to 72 years) who underwent surgery for toxic multinodular goitre. The expression of NIS protein was investigated by immunohistochemistry in paraffin-embedded tissue sections using anti-hNIS monoclonal antibody by the labeled streptavidin-biotin method. RESULTS The percentage of hNIS positive follicular cells was significantly higher in the AFTNs (13.33±12.09) than in the extranodular thyroid tissues (1.35±3.03). Staining for hNIS was mostly confined to the cell membrane in the AFTNs (88.9%) and in the extranodular thyroid tissues (54.5%). The clinical parameters and nodule volume did not establish any correlation with hNIS immunoreactivity. CONCLUSION Our data indicate that functioning nodules express higher amounts of NIS protein than the extranodular thyroid tissue, but the level of hNIS immunoreactivity was lower than had been reported in the previous literature. This result may be due to interindividual variability between different populations, and iodine status. Furthermore, the localization of the NIS protein might not give an indication of its functional status.
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Affiliation(s)
- Hülya Ilıksu Gözü
- Department of Endocrinology, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
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Alici A, Kement M, Gezen C, Akin T, Vural S, Okkabaz N, Basturk E, Yegenoglu A, Oncel M. Apical lymph nodes at the root of the inferior mesenteric artery in distal colorectal cancer: an analysis of the risk of tumor involvement and the impact of high ligation on anastomotic integrity. Tech Coloproctol 2010; 14:1-8. [PMID: 20066459 DOI: 10.1007/s10151-009-0547-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2009] [Accepted: 07/23/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND What level of arterial ligation is best in left-sided colon cancer and rectal cancer remains controversial. This study aims to assess the necessity and risk of high ligation from an oncological and technical perspective. METHODS The lymph nodes at the origin of the inferior mesenteric artery (IMA) were separated as apical nodes in all patients operated for distal colorectal cancer in our department. The number and status of the nodes were prospectively assessed, and demographic and tumor-related variables were evaluated as risk factors for apical tumor invasion. Anastomotic leaks were also evaluated. RESULTS A hundred and three patients (52 [50.5%] males, 60.3+/-12.9 years old) were included. The number of non-apical lymph nodes harvested was 14.5+/-7.1 with an additional 4.4+/-3.2 apical nodes at the high ligation site. Tumor invasion of apical nodes was observed in 6 (5.8%) patients. Two of these (1.9%) had no other positive nodes (skip metastases). Although none of the variables evaluated was found significant for predicting apical node positivity, tumor invasion was detected in 8.5 and 22.2% of patients with pT3 and pN2 cancers, respectively. Among patients, who had an anastomosis (n = 84, 81.6%), anastomotic leak was observed in 7(8.3%) and 1 (1.2%) of these patients required emergency relaparotomy. There was no mortality related to high ligation. CONCLUSIONS High ligation of IMA may be routinely performed in patients with distal colorectal cancer, since tumor invasion of apical lymph nodes is neither rare (>5%) nor predictable, and skip metastases may also occur. This is especially true in case of an advanced disease for which apical node positivity peaks. The anastomotic leak rate is less than 10%, and mortality is low after high ligation of IMA.
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Affiliation(s)
- A Alici
- Department of General Surgery, Kartal Education and Research Hospital, Istanbul, Turkey
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Gozu HI, Bircan R, Krohn K, Müller S, Vural S, Gezen C, Sargin H, Yavuzer D, Sargin M, Cirakoglu B, Paschke R. Similar prevalence of somatic TSH receptor and Gsalpha mutations in toxic thyroid nodules in geographical regions with different iodine supply in Turkey. Eur J Endocrinol 2006; 155:535-45. [PMID: 16990652 DOI: 10.1530/eje.1.02253] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Differences in iodine intake could account for the variable prevalences reported for somatic TSH receptor (TSHR) mutations in toxic thyroid nodules (TTNs). However, this question has not been settled, since no study has yet determined the TSHR mutation prevalence in regions with different iodine supplies in the same population using the same methodology. Therefore, we studied the prevalence of somatic TSHR mutations in TTNs from patients living in iodine-deficient or -sufficient regions in Turkey. DESIGN AND METHODS We screened 74 TTNs for somatic TSHR mutations. Exons 9 and 10 of the TSHR and 7 and 8 of the Gsalpha were screened by denaturing gradient gel electrophoresis. Determination of X-chromosome inactivation was used for clonality analysis. RESULTS TSHR mutations were identified in 52 (70.2%) of 74 TTNs. A Gsalpha mutation was identified in one TTN. Three new TSHR mutations were detected (A627V, I640K, I486N). No significant difference between frequencies of TSHR mutations in iodine deficient/sufficient regions was found. The frequency of non-random X-chromosome inactivation was similar in iodine-sufficient or -deficient regions and in TSHR mutation positive or negative hot nodules. CONCLUSIONS These findings suggest that TTNs in iodine deficient/sufficient areas predominantly arise from aberrant growth of a single cell. Our results suggest that neither the prevalence of TSHR mutations nor that of monoclonal TTNs is related to iodine supply.
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Affiliation(s)
- Hulya Iliksu Gozu
- Section of Endocrinology and Metabolism, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Turkey
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Suslu N, Vural S, Oncel M, Demirca B, Gezen FC, Tuzun B, Erginel T, Dalkiliç G. Is the insertion of drains after uncomplicated thyroid surgery always necessary? Surg Today 2006; 36:215-8. [PMID: 16493528 DOI: 10.1007/s00595-005-3129-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2004] [Accepted: 07/12/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE We conducted a prospective, randomized study to evaluate the necessity of drainage after uncomplicated thyroid surgery. METHODS The subjects were 135 patients who underwent thyroid surgery between September 2002 and February 2004. The patients were randomized into two groups according to whether drains were inserted at the time of surgery. Group 1 consisted of 68 patients with drains and group 2 consisted of 67 patients without drains. The indications for surgery, procedures performed, local complications (such as infection, seroma, and bleeding or hematoma), necessity for reoperation, and hospital stay were recorded. RESULTS There were 110 (81.5%) women and 25 (18.5%) men, with a median age of 46.9 +/- 12.5 years. The mean hospital stay was 2.6 +/- 1.0 days in group 1 and 1.3 +/- 0.7 days in group 2 (P = 0.001). Local complications developed in five (7.3%) patients from group 1, as wound infections in two (2.9%), seroma in one (1.5%), and hemorrhage in two (2.9%); and in two (3%) patients from group 2, as seroma in one (1.5%) and hematoma in one (1.5%). Both of the group 1 patients with postoperative hemorrhage required reoperation within 8 h after initial surgery. The hematoma in the group 2 patient was treated successfully with needle aspiration. CONCLUSION These findings suggest that the routine use of drains may be abandoned in uncomplicated thyroid surgery, since serious postoperative bleeding rarely occurs and hematomas can be treated by needle aspiration if drains have not been placed. Furthermore, the use of drains prolongs hospital stay and increases the risk of infection.
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Affiliation(s)
- Nimet Suslu
- General Surgery Department, Artvin State Hospital, Artvin, Turkey
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Tunger O, Vural S, Cetin C, Keles G, Borand H, Gazi H. P17.03 Stenotrophomonas maltophilia bacteremia: an analysis of 35 episodes. J Hosp Infect 2006. [DOI: 10.1016/s0195-6701(06)60274-0] [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: 11/30/2022]
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Gezen FC, Cinçin TG, Oncel M, Vural S, Erdemir A, Dalkiliç G, Menteş C, Tüzün B. Noninvasive management strategy in hemodynamically unstable patients with blunt trauma. ULUS TRAVMA ACIL CER 2006; 12:43-50. [PMID: 16456750] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Non-operative management in abdominal injuries may reduce non-therapeutic laparatomies without increasing mortality. The aim of this study is to evaluate the results of a recently used non-invasive management strategy, in trauma patients in our institution. METHODS A retrospective chart review was performed. The sixty-three patients (50 males; 13 females; range 8 to 61 years) with abdominal injuries who were unstable during their admissions to our institution between July 1st, 2000 and July 1st, 2001 (the first year of the NIMS implementation) were identified and divided into three groups according to the presence or absence of surgical intervention and the timing of the operation. RESULTS There were 63 blunt abdominal trauma patients who were unstable during admission. Patients in Group 1 (n=14) and Group 2 (n=10) had urgent laparotomy during the resuscitation therapy or after a median observation period of 7 hours (range, 2 to 20). Group 3 patients (n=39) did not require surgical intervention. CONCLUSION Most of the trauma patients who respond to initial fluid replacement do not require surgery. Close monitoring and repeated abdominal examinations (NIMS) can be the main criteria for surgical intervention, although they are not the most reliable techniques in the diagnosis of solid organ injuries in all patients and of hollow organ injuries in conscious patients.
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Affiliation(s)
- F Cem Gezen
- 1st Department of General Surgery Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey.
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Yildiz H, Oncel M, Kurt N, Vural S, Gezen C, Dalkilic G, Olcay E. The relationship between the level of thirteen different substances and enzymes in blood and peritoneal fluid and the duration of mechanical intestinal obstruction: an experimental study on rats. ULUS TRAVMA ACIL CER 2003; 9:183-8. [PMID: 12923693] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
PURPOSE The aim of this study is to analyze the relationship between the changes in blood and peritoneal fluid and the duration of mechanical intestinal obstruction. METHODS A mechanical intestinal obstruction was surgically carried out in 52 Wistar albino rats. The blood and peritoneal fluid were sampled immediately (Group 1, n=13), and at 6 hours (Group 2, n=13), at 24 hours (Group 3, n=13), and at 48 hours (Group 4, n=13) following the procedure. RESULTS Blood and peritoneal fluid ammonia concentrations, as well as blood aldolase activity have risen progressively over time (p<0.05), although not all pair-wise comparisons were statistically significant (P>0.05). CONCLUSIONS Our data suggest that peritoneal fluid and blood ammonia levels and blood aldolase levels rise according to duration of the intestinal obstruction. Since the results were not available to determine cut-off levels, future research is required to confirm these results and determine whether ammonia or aldolase can be used in clinical practice to predict the presence and duration of a mechanical intestinal obstruction.
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Affiliation(s)
- Hakan Yildiz
- General Surgery Service, Kartal Dr. Lutfi Kirdar Education and Research Hospital, Istanbul, Turkey
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Abstract
OBJECTIVE The aim of this study was to evaluate the diagnostic effectiveness of kinematic magnetic resonance fluoroscopy (KMRF) on patients with patellofemoral incongruency. MATERIALA AND METHODS: 17 patients (20 knees) and 10 healthy volunteers (20 knees), all men (mean age 29.4 years, S.D. 9, range 16-50), were included to our study. Only male subjects were studied because of potential biomechanical differences between sexes. KMRF was used to perform kinematic MR imaging of patellar alignment and tracking in 10 healthy subjects and 17 patients with a provisional clinical diagnosis of abnormal patellofemoral joints. The patellofemoral joints were examined with the knee in different angles of active flexion. At each knee position, real time kinematic and axial MRF image was used to focus on the sagittal plane, followed by an axial image focused through the middle of the patella. Three angles were measured: patellar tilt angle (PTA), sulcus angle (SA) and congruence angle (CA). RESULTS Five patterns of malalignment were identified and studied. Two patellofemoral joints were normal, 10 had lateralization of the patella, 2 had patellar tilt, 2 had lateralization and patellar tilt (i.e. excessive lateral pressure syndrome) and 4 had medialization of the patella. CONCLUSION KMRF is an effective method in evaluating patellofemoral incongruency. Short time duration of investigation, ability to get nearly real time images, suitable temporal contrast resolution and investigation from very different angles of knee are important advantages of the method.
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Affiliation(s)
- Mustafa Harman
- Department of Radiology, University of Yuzuncu Yil Faculty of Medicine, Van, Turkey.
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Abstract
Although arginine plays an important role in many aspects of inflammation and wound healing, the mechanism is not clear. We aimed to evaluate the effect of L-arginine administration on wound healing and neutrophil activity and on the interaction of these effects. Sixteen rats were divided into two groups: control group and L-arginine group. L-arginine was given intraperitoneally. The rats underwent incisional wounding and were killed on the 7th day of wounding. Blood neutrophil counts, neutrophil adhesivity index, tensile strengths and hydroxyproline level of skin were determined, histopathological and electron microscopical evaluation of healing was performed. Wound scores in the control group were significantly lower (p < 0.05). Hydroxyproline and collagen levels of skin were significantly increased in the L-arginine group (p < 0.05). Blood neutrophil counts and neutrophil adhesivity index in the L-arginine group were significantly increased (p < 0.05), as were the inflammatory cells in the skin. L-arginine may be used during the first phase of healing to induce inflammation in high risk patients.
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Affiliation(s)
- N Z Cantürk
- Department of General Surgery, School of Medicine, Kocaeli University, Turkey
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Oncel M, Kurt N, Remzi FH, Sensu SS, Vural S, Gezen CF, Cincin TG, Olcay E. The effectiveness of systemic antibiotics in preventing postoperative, intraabdominal adhesions in an animal model. J Surg Res 2001; 101:52-5. [PMID: 11676554 DOI: 10.1006/jsre.2001.6245] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Postoperative intraabdominal adhesions can be prevented by antibiotic lavage. We assessed whether systemic antibiotics could prevent adhesion formation in a rat model. METHODS Cecal abrasion was performed in the peritoneal cavities of 40 Wistar albino rats. Twenty rats were treated with a 5-day course of cefepim and metronidazole; the remaining animals were given saline injections. The animals were sacrificed 14 days after surgery. Adhesion severity scores and histopathologic findings were compared. RESULTS The median adhesion severity score was 2 (0-3) in the antibiotic group and 2.5 (1-4) in the controls (P = 0.03). In tissue specimens from controls, the adhesions were marked by mature collagen bundles. In treated rats, the adhesions were immature, characterized by early inflammatory cells, less collagen formation, and no collagen bundles. CONCLUSIONS Postoperative systemic antibiotics slow adhesion formation and reduce the severity of the adhesions.
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Affiliation(s)
- M Oncel
- General Surgery Department, Kartal Education and Research Hospital, Istanbul, Turkey.
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Oncel M, Kurt N, Küçük HF, Uzun H, Eser M, Sagiroglu T, Vural S, Olcay E. Helicobacter pylori eradication after duodenal ulcer perforation. Indian J Gastroenterol 2001; 20:251. [PMID: 11817789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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