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Publication Open Access Isolated omental metastasis of renal cell carcinoma after extraperitoneal open partial nephrectomy : a case report(Elsevier, 2016) Sağlıcan, Yeşim; N/A; N/A; N/A; N/A; Acar, Ömer; Sağ, Alan Alper; Falay, Fikri Okan; Selçukbiricik, Fatih; Tabak, Levent; Esen, Tarık; Faculty Member; Faculty Member; Teaching Faculty; Faculty Member; Faculty Member; Faculty Member; School of Medicine; 237530; N/A; N/A; N/A; N/A; N/A; 50536INTRODUCTION: Metachronous metastatic spread of clinically localized renal cell carcinoma (RCC) affects almost 1/3 of the patients. They occur most frequently in lung, liver, bone and brain. Isolated omental metastasis of RCC has not been reported so far. CASE PRESENTATION: A 62-year-old patient previously diagnosed and treated due to pulmonary sarcoidosis has developed an omental metastatic lesion 13 years after having undergone open extraperitoneal partial nephrectomy for T1 clear-cell RCC. Constitutional symptoms and imaging findings that were attributed to the presence of a sarcomatoid paraneoplastic syndrome triggered by the development this metastatic focus complicated the diagnostic work-up. Biopsy of the [18F]-fluorodeoxyglucose (+) lesions confirmed the diagnosis of metastatic RCC and the patient was managed by the resection of the omental mass via near-total omentectomy followed by targeted therapy with a tyrosine kinase inhibitor. DISCUSSION: Late recurrence of RCC has been reported to occur in 10-20% of the patients within 20 years. Therefore lifelong follow up of RCC has been advocated by some authors. Diffuse peritoneal metastases have been reported in certain RCC subtypes with adverse histopathological features. However, isolated omental metastasis without any sign of peritoneal involvement is an extremely rare condition. CONCLUSION: To our knowledge, this is the first reported case of metachronously developed, isolated omental metastasis of an initially T1 clear-cell RCC. Constitutional symptoms, despite a long interval since nephrectomy, should raise the possibility of a paraneoplastic syndrome being associated with metastatic RCC. Morphological and molecular imaging studies together with histopathological documentation will be diagnosticPublication Open Access Response to "Clarification needed for case presented in 'the excision of the buccal fat pad for cheek refinement: volumetric considerations'"(Oxford University Press (OUP), 2019) N/A; N/A; Sezgin, Billur; Tatar, Sedat; Böge, Medine; Özmen, Selahattin; Yavuzer, Cahit Reha; Faculty Member; Faculty Member; School of MedicinePublication Open Access The time course changes in expression of aquaporin 4 and aquaporin 1 following global cerebral ischemic edema in rat(Medknow Publications, 2016) Akdemir, G.; Kaymaz, F,; Akalan, N,; Akdemir, E. S.; N/A; Özdemir, Yasemin Gürsoy; Faculty Member; School of Medicine; 170592Background: The aim of this global cerebral ischemia study was to study the changes in expression levels of aquaporin 4 (AQP4) and AQP1 over time. Methods: Sprague-Dawley type male rats were divided into six groups. Sham group and ischemia/reperfusion were performed on five other groups using the four-vessel occlusion model. Reperfusion was done 30 min after the occlusion, and each group was tested at 1, 6, 12, 24, and 48 h for brain wet-dry weight ratio and AQP4 and AQP1 expression levels using immunohistochemistry. To prove ischemia development exists in both hippocampal neurons and epithelia of choroid plexus, hematoxylin, and eosin and neuronal marker (NeuN) immune-staining have been applied to the sham experimental group at 48 h. AQP4 expression levels are also measured with western blotting. Results: After ischemia/reperfusion it is observed that the decrease in brain water content between 12 and 24 h was statistically significant (P < 0.01). In parallel and based on immunohistochemical staining, AQP4 expression levels did not exhibit any statistically significant change. AQP4 levels did not show any statistically significant change in western blotting. AQP1 expression in choroid plexus epithelial cells decreased at the 12 and 24 h but increased in 48 h (P < 0.05). Conclusions: Lack of change in AQP4 expression levels is thought as its dual role in formation and elimination of ischemic brain edema. Decrease in AQP1 expression levels in 24 h can be explained with necrosis in choroid plexus after ischemia and the increase in 48 h mark can be related to recovery in choroid plexus.Publication Open Access Laparoscopic colon resection in patients with situs inversus totalis: is it the same operation as in patients without situs inversus totalis?(Medknow Publications, 2019) Karabay, Önder; Gürbüz, Bülent; Zenger, Serkan; N/A; Balık, Emre; Buğra, Dursun; Faculty Member; Faculty Member; School of Medicine; 18758; N/ASitus inversus totalis (SIT) is a rare condition. In this case, a patient who underwent laparoscopic anterior resection for repeated sigmoid colon diverticulitis with SIT was presented. Laparoscopy surgery in patients with this condition has some important technical differences than standard laparoscopic procedures. Therefore, it may be more appropriate to request surgical experience to perform safe laparoscopic surgery in patients with SIT.Publication Open Access Gamma Knife radiosurgery for anterior clinoid process meningiomas: a series of 61 consecutivepatients(Elsevier, 2020) YIlmaz, Meltem; Şengöz, Meriç; N/A; Akyoldaş, Göktuğ; Hergünsel, Ömer Batu; Peker, Selçuk; Faculty Member; Graduate School of Health Sciences; School of Medicine; N/A; N/A; 11480Objective: gamma Knife radiosurgery (GKRS) outcomes for anterior clinoid process (ACP) meningiomas have not been specifically reported within any meningioma series. We present the initial and largest series in the literature that describes the presenting features, radiosurgery parameters, and radiologic and long-term clinical outcomes for 61 patients with ACP meningiomas treated with GKRS. Methods: medical records were reviewed for 61 consecutive patients at a single center who underwent GKRS for ACP meningioma between 2008 and 2016. Results: of 61 patients with ACP meningiomas, 49 (80%) were treated with GKRS as primary treatment, and 12 (20%) were treated with GKRS as an adjuvant therapy. Before GKRS, 29 patients presented with visual impairment and 50 patients presented with headache. Median patient age was 54.9 years. Median tumor volume was 3.2 cm(3), and median margin dose was 12.0 Gy. The median radiologic follow-up time after GKRS was 75 months. During follow-up, tumor volume regressed in 37 cases (61%) and remained unchanged in 24 cases (39%). None of the patients experienced tumor volume progression. Tumor volume <3 cm(3) was an independent predictor of tumor volume regression after GKRS (univariate analysis, P = 0.047; multivariate analysis, P = 0.049). Of 29 patients who presented with visual impairment, 16 (55%) improved after GKRS. None of the 61 patients developed new neurologic deficits after GKRS. Conclusions: GKRS provides a high rate of tumor volume control for ACP meningiomas as well as a low complication rate. Excellent tumor volume control was associated with smaller tumor size only.Publication Open Access The potential prognostic significance of the Laboratory Risk Indicator for the Necrotizing Fasciitis (LRINEC) score in necrotizing fasciitis(Editura Celsius, 2019) Gönüllü, Doğan; İlgün, Ahmet Serkan; Demiray, Okan; Sayar, Samed; Er, Ahmet Muzaffer; Köksoy, Ferda Nihat; N/A; Kır, Gülay; School of MedicineBackground: we discuss the role of Laboratory Risk Indicator for the Necrotizing Fasciitis (LRINEC) on the prognosis of this disease. Necrotizing Fasciitis (NF) is characterised by rapid spreading of infection and necrosis of the soft tissues and fascia. Methods: thirty patients (17 male, 13 female, mean age 57.5 years) were treated between 2011-2016 (in our center); they were analysed retrospectively regarding age, sex, isolated microbiological agents, modalities of treatment and mortality rate. Results: the majority of the infections were detected in the perineum (14 patients). Other sites of infection were: the presacral region (3 patients), as well as abdominal region after elective (10 patients) and emergency surgery (2 patients), respectively. 53.3% of patients had at least one predisposing comorbid factor such as diabetes mellitus, hypertension, cardiomyopathy and congestive heart failure. The tissue cultures were positive in 12 patients. Mean LRINEC score on admission was 8.5 +/- 2.85. There was a strong correlation between LRINEC score and patient age (p=0.018, R=0.43). LRINEC score was affected by neither gender nor the presence of any comorbidities. The patients were classified according to Wang and Wong staging system, as follows: one patient in stage 1, 15 patients in stage 2 and 14 patients in stage 3. Patients with higher Wang and Wong stages had significantly higher LRINEC scores. The mortality rate was 16.7%. The mean LRINEC score of deceased patients compared to patients who were successfully treated was 9.2 +/- 2.2 and 8.36 +/- 2.9. Conclusion: even though LRINEC score and Wang and Wong stage were significatly related with ICU stay, their direct effect on mortality wasn't significant in our study. / Context: discutăm despre rolul indicatorului de risc de laborator pentru fasceita necrozantă (LRINEC) asupra prognosticului acestei boli. Fasceita necrozantă (NF) se caracterizează prin răspândirea rapidă a infecţiei şi a necrozei ţesutului moale şi a fasciei. Metode: Treizeci de pacienţi (17 bărbaţi, 13 femei, vârsta medie 57,5 ani) au fost trataţi în perioada 2011-2016; au fost analizaţi retrospectiv în ceea ce priveşte vârsta, sexul, agenţii microbiologici izolaţi, modalităţile de tratament şi rata mortalităţii. Rezultate: Majoritatea infecţiilor au fost detectate în perineu (14, 46,7%), alte localizări ale infecţiei fiind regiunea presacrală (3, 10%), regiunea abdominală după intervenţie chirurgicală de elecţie (10,33,3%) şi intervenţie chirurgicală de urgenţă (2, 6.7%). 53,3% dintre pacienţi au prezentat cel puţin un factor comorbid predispozant, cum ar fi diabetul zaharat, hipertensiunea, cardiomiopatia şi insuficienţa cardiacă congestivă. Culturile de ţesut au fost pozitive la 12 (40%) pacienţi. Scorul mediu LRINEC la internare a fost de 8,5 ± 2,85. A existat o corelaţie puternică între scorul LRINEC şi vârsta pacientului (p = 0,018, R = 0,43). Scorul LRINEC nu a fost afectat nici de sex, nici de prezenţa oricăror comorbidităţi. Pacienţii au fost clasificaţi conform sistemului de stadializare Wang şi Wong: 1 pacient în stadiul 1 (3,3%), 15 în stadiul 2 (50%) şi 14 în stadiul 3 (46,7%); pacienţii cu stadii Wang şi Wong mai mari aveau scoruri LRINEC semnificativ mai ridicate. Rata mortalităţii este de 16,7%. Scorul mediu LRINEC al pacienţilor decedaţi a fost de 9,2 ± 2,2 şi al pacienţii în viaţă de 8,36 ± 2,9. Concluzii: Chiar dacă scorul LRINEC şi stadiul Wang şi Wong au fost semnificativ legate de internarea la terapie intensivă, efectul lor direct asupra mortalităţii nu a fost semnificativ în studiul nostru.Publication Open Access Sparing sphincters and laparoscopic resection improve survival by optimizing the circumferential resection margin in rectal cancer patients(Elsevier, 2016) Keskin, M.; Bayraktar, A.; Sivirikoz, E.; Yeğen, G.; Karip, B.; Sağlam, E.; Bulut, M. T.; N/A; Balık, Emre; Faculty Member; School of Medicine; 18758The goal of rectal cancer treatment is to minimize the local recurrence rate and extend the disease-free survival period and survival. For this aim, obtainment of negative circumferential radial margin (CRM) plays an important role. This study evaluated predictive factors for positive CRM status and its effect on patient survival in mid- and distal rectal tumors. Patients who underwent curative resection for rectal cancer were included. The main factors were demographic data, tumor location, surgical technique, neoadjuvant therapy, tumor diameter, tumor depth, lymph node metastasis, mesorectal integrity, CRM, the rate of local recurrence, distant metastasis, and overall and disease-free survival. Statistical analyses were performed by using the Chi-squared test, Fisher exact test, Student t test, Mann-Whitney U test and the Mantel-Cox log-rank sum test. A total of 420 patients were included, 232 (55%) of whom were male. We observed no significant differences in patient characteristics or surgical treatment between the patients who had positive CRM and who had negative CRM, but a higher positive CRM rate was observed in patients undergone abdominoperineal resection (APR) (P < 0.001). Advanced T-stage (P < 0.001), lymph node invasion (P = 0.001) and incomplete mesorectum (P = 0.007) were encountered significantly more often in patients with positive CRM status. Logistic regression analysis revealed that APR (P < 0.001) and open resection (P = 0.046) were independent predictors of positive CRM status. Moreover, positive CRM was associated with decreased 5-year overall and disease-free survival(P = 0.002 and P = 0.004, respectively). This large single-institution series demonstrated that APR and open resection were independent predictive factors for positive CRM status in rectal cancer. Positive CRM independently decreased the 5-year overall and disease-free survival rates.Publication Open Access A novel modular dynamic stabilization system for the treatment of degenerative spinal pathologies(Turkish Neurosurgical Society, 2019) Çevik, Orhun Mete; Erbulut, Deniz Ufuk; Goel, Vijay; N/A; Özer, Ali Fahir; Yaman, Onur; Şentürk, Salim; Öktenoğlu, Bekir Tunç; Sasani, Mehdi; Süzer, Süleyman Tuncer; Faculty Member; Doctor; Doctor; Faculty Member; School of Medicine; 1022; N/A; N/A; N/A; N/A; 221691Aim: to show the preliminary clinical results of the Orthrus modular dynamic stabilization system that is a new instrumentation system intended for degenerative diseases of the lumbar spine. Material and methods: the system utilizes two different types of screws that can be used in conjunction with different types of rods such as titanium, carbon fiber or PEEK. The first type of screw is a double headed screw to interconnect to the upper and lower level with independent rods. The second type of screw is a sliding screw to be used on a immovable vertebrae that allows movement in two planes on the tip. Results: the system has been used on 36 patients with pathology varying from degenerative disc disease to degenerative lumbar scoliosis. Satisfactory results have been obtained in a all 36 patients in the 12-month follow-up period. Conclusion: the Orthrus dynamic system shows better clinical results than the available dynamic systems on the market. It also proves to provide similar fusion with considerably less postoperative morbidity which makes it a better method to treat adult degenerative spine diseases for carefully chosen patients.Publication Open Access Superiorly based nasolabial island flap for reconstruction of the lateral lower eyelid(TÜBİTAK, 2017) Tatar, Sedat; Yontar, Yalçın; N/A; Özmen, Selahattin; Faculty Member; School of MedicineBackground/aim: Various flap procedures have been described and used for the lower eyelids; however, the nasolabial flap is rarely employed. We herein aimed to present the clinical results of using the superiorly based nasolabial island flap for repair of surgical defects extending to the lateral lower eyelid. Materials and methods: Nine patients with a mean age of 62 + 6 years underwent surgery for reconstruction of the lower eyelid. Results: The diagnosis of lesions was nodular basal-cell carcinoma (n = 5), superficial basal-cell carcinoma (n = 1), well-differentiated squamous-cell carcinoma (n = 1), and basosquamous-cell carcinoma (n = 2). According to the classification reported by Spinelli and Jelks, 6 surgical defects were located at zones II and IV, while 3 were at zones II and V. Five patients required posterior lamellar reconstruction. Lagopthalmos (n = 1), ectropion (n = 1), and transient numbness of the ipsilateral upper lip (n = 1) were noted as postoperative complications. Conclusion: Despite the low number of patients, the present series demonstrated that lower eyelid defects involving zone IV or zone V can be repaired safely and reliably with the superiorly based nasolabial island flap, along with its use shown in the literature for zone II or zone III defects. The technique for raising the flap is fairly simple, with predictable surgical results. In addition, the superiorly based nasolabial island flap provides a reliable means of obtaining good wound healing with acceptable aesthetics, as well as functional results of both the donor site and reconstructed area.Publication Open Access Surgery for cystic pancreatic lesions in the post-Sendai era: a single institution experience(Hindawi, 2015) Kleeff, J.; Michalski, C.; Kong, B.; Roth, S.; Friess, H.; Siveke, J.; Esposito, I.; N/A; Erkan, Murat Mert; Faculty Member; School of Medicine; 214689