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Publication Open Access Quadrant and dermatomal analysis of sensorial block in ultrasound-guided erector spinae plane block(Aves, 2022) Selvi, Onur; Tulgar, Serkan; Şerifsoy, Talat Ercan; Lance, Robert; Thomas, David Terence; Gürkan, Yavuz; Faculty Member; Koç University Research Center for Translational Medicine (KUTTAM) / Koç Üniversitesi Translasyonel Tıp Araştırma Merkezi (KUTTAM); School of Medicine; 154129Objective: as a novel procedure now gaining popularity, erector spinae plane block has been the subject of many studies. However, dermatomal coverage of the sensory block caused by erector spinae plane block has been rarely studied. The goal of this study is to evaluate the sensory block resulting from erector spinae plane block applied at the T9 vertebral level. Materials and methods: this observational, prospective, blinded study was conducted on 50 adult patients undergoing laparoscopic abdominal surgery. All patients underwent bilateral erector spinae plane block at the T9 level after completion of the surgery while under general anesthesia. In order to further evaluate the sensory blockade, we divided the hemiabdomen-hemithorax region into 4 quadrants: dorsal-medial, dorsallaterel, ventral-lateral, and ventral-medial. The sensorial evaluation was performed using the pinprick test, 2 hours following the application of erector spinae plane block. Results: a total of 28 female and 22 male patients were examined in this study. Complete failure of the block was recorded in 7 patients, with no thoracic/lumbar segmental or quadrant involvement. Successful sensory block was achieved in 67% of the dorsolateral quadrants, 58% of the dorsomedial quadrants, 69% of the ventrolateral quadrants, and 55% of the ventromedial quadrants. Conclusion: cutaneous sensory block of erector spinae plane block at T9 vertebral level revealed variable results and low failure rates. Administration of erector spinae plane block for postoperative analgesia in thoracoabdominal surgeries requires further randomized controlled trials to confirm its effectiveness and convenience.Publication Open Access Does resection of heterotopic ossification of the elbow result in satisfactory functional outcomes?(Galenos Yayınevi, 2019) Kapıcıoğlu, Mehmet; Sağlam, Yavuz; Ersen, Ali; Atalar, Ata, Can; Durmaz, Hayati; N/A; Demirhan, Mehmet; Faculty Member; School of Medicine; 9882Objective: heterotopic ossification (HO) is a common cause of elbow stiffness following surgical treatment of elbow trauma. In this study, our aim was to evaluate the mid-term functional outcomes of open surgical procedures for HO. Methods: in this retrospective study approved by the institutional review board (IRB), all patients who were diagnosed as having stiff elbow due to HO and underwent surgical resection at a single institution from 2006 to 2013 were included. Intrinsic (inside the joint) pathologies were excluded. Range of motion (ROM) in sagittal and coronal planes, complications, functional scores such as Quick Disabilities of the Arm, Shoulder and Hand Score (Q-DASH), and Mayo Elbow Performance Score (MEPS) were evaluated before and after surgery. Results: there were 19 patients (16 males, 3 females) with a mean age of 38.6 (range 15-69) years. At an average follow-up of 36 +/- 8 months, the mean flexion-extension arc was improved from 27.4 degrees to 99.2 degrees (p<0.001) and mean supination-pronation arc was improved from 48.9 degrees to 102.3 degrees (p<0.001). The mean Q-DASH score was decreased from 68.2 to 17.1 (p<0.001) and mean MEPS was improved from 37.5 to 85.6 (p<0.001). Conclusion: excision of heterotopic bone and releasing contracted tissues around elbow can provide a substantial increase in range of motion and improvement in clinical scores.Publication Open Access Aberrant methylation profile and microsatellit instability in Turkish sporadic colorectal carcinoma(Galenos Yayınevi, 2019) Ekmekçi, Cumhur Gökhan; Güllüoğlu, Mine; Dizdaroglu, Ferhunde; Özbek, Uğur; N/A; Kapran, Yersu; Faculty Member; School of Medicine; 168101Objective: genomic DNA obtained from paraffin blocks of the intended colorectal cancer cases was evaluated for promoting colorectal cancer by investigating the promoter methylation of 6 different gene promoter regions and microsatellite instability. Methods: DNA was isolated from the paraffin tissue of 76 sporadic colorectal cancer patients by cross sections from the areas determined to be tumorous. The methylation specific PCR (MS-PCR) method was used for these DNA samples fo rmethlylation studies in promoter region of six different APC, hMLH1, p16INK4A, p15, p73 and DAPK1 genes. In the same samples, the presence of microsatellite instability (MSI). Results: the fequencey of methylation was 24% for hMLH1, 31.5% for APC, 19.6% for DAPK1, 42.8% for p16, 30% for p15, 17% for p73. We calculated a methylation index (MI=ratio between the number of genes methylated and the number of genes analyzed). MI was ranged from 0-0.83, with an average of 0.271 corresponding to 1.6 genes/sample and median was 0.225 and there were 15 samples which doesn't methylated in any loci. We analysed MSI in C-kit (21%), hMSH2 (18%) and APC (15%), microsatellite region. Conclusion: we observed APC methylation was common then the other population for Turkish patient. P16 was the most commenest methylated loci among the 6 of gene and it seems storongly related with female patients. P73 was releated with left colorectal cancer and additionally it was related with the MSI.Publication Open Access Lumbar plexus block performance for femur fracture for a Hamamy syndrome patient(Aves, 2022) Gürkan, Yavuz; Kalyoncu, İlayda; Gedik, Cemil Cihad; Manici, Mete; Gönen, Emel; Faculty Member; Resercher; Researcher; Faculty Member; Faculty Member; School of Medicine; 154129; 353184; 327612; 113502; 220454NAPublication Open Access Clinicopathologic and prognostic features in gallbladder malignancies: retrospective analysis of 5206 cases(Galenos Yayınevi, 2019) Ferhatoglu, Murat Ferhat; Kıvılcım, Taner; Kartal, Abdulcabbar; Gürkan, Alp; N/A; Şenol, Kazım; Doctor; School of MedicineAim: Gallbladder cancer is the sixth most common cancer of the gastrointestinal system. Clinical presentation may not be distinguished from cholelithiasis or cholecystitis and most patients are diagnosed intraoperatively or in the postoperative histologic examination. In this study, we aimed to investigate the association of incidentally detected gallbladder cancer with gallbladder premalignant lesions, age, gender, ultrasonography features and gallbladder stones. Methods: demographic and clinical characteristics and pathology results of 5206 patients who underwent cholecystectomy between January 2012 and December 2015 were evaluated retrospectively. Results: three thousand eight hundred and eighty four (74.6%) patients were female. Pathologic reports showed pre-malignant and malignant lesions in 102 (1.95%) cases. Metaplasia was significantly more common in females, while no significant difference was found in development of dysplasia and cancer between genders. Gallbladder stone was found to be a risk factor for the development of metaplasia. Gallbladder wall thickening and advanced age are the most important risk factors for gallbladder cancer. Conclusion: female gender and gallstone are important risk factors for the development of metaplasia. Advanced age, gallstone and gallbladder wall thickening on ultrasonography are the most important factors in the development cancer. Cholecystectomy should be kept in mind as the most effective method to prevent cancer development in elderly patients with gallbladder stones. / Amaç: safra kesesi kanseri, gastrointestinal sistemin en yaygın altıncı kanseridir. Klinik prezentasyon safra kesesi taşı veya kolesistitden ayırt edilemez ve çoğu hasta intraoperatif veya postoperatif histolojik incelemede tanı alır. Bu çalışmada, insidental olarak tespit edilmiş safra kesesi kanserli olguların safra kesesi pre-malign lezyonları, yaş, cinsiyet, ultrasonografi özellikleri ve safra kesesi taşı ile ilişkisi araştırılmıştır. Yöntemler: Ocak 2012-Aralık 2015 tarihleri arasında kolesistektomi uygulanan 5206 hastanın demografik ve klinik özellikleri, patoloji sonuçları retrospektif olarak değerlendirildi. Bulgular: hastaların 3884’ü (%74,6) kadındı. Patoloji raporlarında 102 (%1,95) olguda pre-malign ve malign lezyonlar olduğu tespit edildi. Metaplazi kadınlarda anlamlı olarak daha fazla iken, displazi ve kanser gelişimi arasında cinsiyete göre anlamlı bir fark bulunamadı. Safra kesesi taşı metaplazi gelişiminde bir risk faktörü olarak bulundu. Safra kesesi duvar kalınlaşmasının ve ileri yaşın safra kesesi kanseri gelişimi için en önemli risk faktörleri olduğu tespit edildi. Sonuç: metaplazi gelişiminde kadın cinsiyet ve taş varlığı önemli faktörlerdir. Ultrasonografide safra kesesi duvar kalınlaşması, ileri yaş, safra kesesinde taşı varlığı kanser gelişiminde en önemli faktörlerdir. Kolesistektomi, ileri yaşta safra kesesi taşı olan hastalarda kanser gelişimini önlemek için en etkili yöntem olarak akılda tutulmalıdır.Publication Open Access Comparison of crystal violet staining assay and XTT methods in the evaluation of biofilm formation in Candida parapsilosis candidemia isolates(Design Oriented Community (DOC), 2021) Can, Füsun; Doğan, Özlem; Ataç, Nazlı; Babuççu, Gizem; Faculty Member; Faculty Member; Researcher; School of Medicine; Graduate School of Health Sciences; 103165; 170418; N/A; N/AObjective: biofilm formation is one of the most important virulence factors of Candida species which leads to permanent infection foci by adhering to foreign materials and which are difficult to treat. Candida parapsilosis, which is one of the most common causes of candidemia in our country, is frequently isolated as a causative agent in catheterrelated infections. The most commonly used methods for evaluating the biofilm formation of Candida species are measuring cell viability with XTT (2,3-bis (2-methoxy-4-nitro-5- sulfophenyl)-5-[(phenylamino) carbonyl]-2H-tetrazolium hydroxide) and evaluating the total biofilm mass with crystal violet (CV). The aim of this study is to evaluate the biofilm formation ability of C. parapsilosis candidemia isolates by XTT and (CV) methods and compare these methods with each other. Materials and methods: C. parapsilosis isolates sent from various hospitals between 2015 and 2019 were included in the study retrospectively, and the species-level identification was performed using the matrix- assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF/MS) The biofilm formation of the isolates was compared based on the optical density (OD) values obtained by crystal violet and XTT methods. The biofilm formation of the isolates was evaluated by categorizing them into low, medium and high biofilm groups as ± 20% according to the median value of all strains. Results: totally, 79 C. parapsilosis candidemia isolates were included in this study and categorical compatibility between CV and XTT methods in low, medium and high biofilm groups was found as 69.6%, 60.6% and 73.9%, respectively. The OD values of the XTT method in the high biofilm group were found statistically significantly higher when compared with the values from the CV method. Conclusion: the compatibility of XTT and crystal violet methods in terms of biofilm measurement in C. parapsilosis isolates was considered acceptable, and no major variations were detected between the categories. According to these results, when evaluating the biofilm levels of C. parapsilosis isolates, high OD values obtained by the XTT method should be confirmed with the CV method.Publication Open Access Endovascular treatment of iliofemoral deep vein thrombosis in pregnancy using US-guided percutaneous aspiration thrombectomy(Aves, 2017) Gedikoğlu, Murat; N/A; Oğuzkurt, Levent; Faculty Member; School of MedicinePURPOSE: We aimed to describe ultrasonography (US)-guided percutaneous aspiration thrombectomy in pregnant women with iliofemoral deep vein thrombosis. METHODS: This study included nine pregnant women with acute and subacute iliofemoral deep vein thrombosis, who were severe symptomatic cases with massive swelling and pain of the leg. Patients were excluded from the study if they had only femoropopliteal deep vein thrombosis or mild symptoms of deep vein thrombosis. US-guided percutaneous aspiration thrombectomy was applied to achieve thrombus removal and uninterrupted venous flow. The treatment was considered successful if there was adequate venous patency and symptomatic relief. RESULTS: Complete or significant thrombus removal and uninterrupted venous flow from the puncture site up to the iliac veins were achieved in all patients at first intervention. Complete relief of leg pain was achieved immediately in seven patients (77.8%). Two patients (22.2%) had a recurrence of thrombosis in the first week postintervention. One of them underwent a second intervention, where percutaneous aspiration thrombectomy was performed again with successful removal of thrombus and establishment of in line flow. Two patients were lost to follow-up after birth. None of the remaining seven patients had rethrombosis throughout the postpartum period. Symptomatic relief was detected clinically in these patients. CONCLUSION: Endovascular treatment with US-guided percutaneous aspiration thrombectomy can be considered as a safe and effective way to remove thrombus from the deep veins in pregnant women with acute and subacute iliofemoral deep vein thrombosis.Publication Open Access Gonadotropin-releasing hormone agonist triggering of oocyte maturation in assisted reproductive technology cycles(Turkish Society of Obstetrics and Gynecology, 2015) Türkgeldi, Lale Wetherilt; Seyhan, Ayşe; Türkgeldi, Engin; Ata, Mustafa Barış; Faculty Member; Faculty Member; School of Medicine; Koç University Hospital; N/A; 182910Gonadotropin-releasing hormone agonists (GnRHa) have gained increasing attention in the last decade as an alternative trigger for oocyte maturation in patients at high risk for ovarian hyperstimulation syndrome (OHSS). They provide a short luteinizing hormone (LH) peak that limits the production of vascular endothelial growth factor, which is the key mediator leading to increased vascular permeability, the hallmark of OHSS. Initial studies showed similar oocyte yield and embryo quality compared with conventional human chorionic gonadotropin (hCG) triggering; however, lower pregnancy rates and higher miscarriage rates were alarming in GnRHa triggered groups. Therefore, two approaches have been implemented to rescue the luteal phase in fresh transfers. Intensive luteal phase support (iLPS) involves administiration of high doses of progesterone and estrogen and active patient monitoring. iLPS has been shown to provide satisfactory fertilization and clinical pregnancy rates, and to be especially useful in patients with high endogenous LH levels, such as in polycystic ovary syndrome. The other method for luteal phase rescue is low-dose hCG administiration 35 hours after GnRHa trigger. Likewise, this method results in statistically similar ongoing pregnancy rates (although slightly lower than) to those of hCG triggered cycles. GnRHa triggering decreased OHSS rates dramatically, however, none of the rescue methods prevent OHSS totally. Cases were reported even in patients who underwent cryopreservation and did not receive hCG. GnRH triggering induces a follicle stimulating hormone (FSH) surge, similar to natural cycles. Its possible benefits have been investigated and dual triggering, GnRHa trigger accompanied by a simultaneous low-dose hCG injection, has produced promising results that urge further exploration. Last of all, GnRHa triggering is useful in fertility preservation cycles in patients with hormone sensitive tumors. In conclusion, GnRHa triggering accompanied by appropriate luteal phase rescue protocols is a relatively safe option for patients at high risk for OHSS. / Gonadotropin salgılayıcı hormon agonistleri (GnRHa), ovaryan hiperstimülasyon sendromu (OHSS) açısından yüksek riskli olan hastalarda oosit matürasyonunun tetiklenmesi için bir alternatif olarak dikkat çekmişlerdir. Kısa süren bir lüteinizan hormon (LH) piki yarattıkları için OHSS’nin patogenezinde yatan artmış damar geçirgenliğinin sorumlusu vasküler endoteliyal büyüme faktörünün üretimini sınırlandırırlar. İnsan koryonik gonadotropin (hCG) ve GnRHa ile oosit matürasyonunun tetiklenmesini karşılaştıran ilk çalışmalarda, elde edilen oosit sayısı ve embryo kalitesi açısından iki grup arasında fark yokken, GnRHa kullanılan grupta gebelik oranlarının daha düşük ve gebelik kaybı oranlarının daha yüksek olduğu gözlenmiştir. Bu nedenle, taze transfer sikluslarında luteal fazın kurtarılması için iki yöntem geliştirilmiştir. Bunların ilki yoğun luteal faz desteği (iLPS) olup, yüksek doz progesteron ve östrojen verilmesini luteal fazing aktif takibini gerektirir. iLPS ile tatminkar fertilizasyon ve klinik gebelik oranları sağlanmış, polikistik ove sendromu gibi endojen LH seviyeleri yüksek olan hastalarda özellikle faydalı bulunmuştur. Luteal fazın kurtarılması için önerilen diğer yöntem ise GnRHa’dan 35 saat sonra düşük doz hCG uygulanmasıdır. Bu yöntemle, konvansiyonel hCG’dekine yakın (fakat bir miktar daha düşük) gebelik oranları elde edilmiştir. GnRHa kullanımı OHSS oranlarını belirgin biçimde düşürmekle birlikte, hiç bir yöntemin OHSS’yi tamamen ortadan kaldıramadığı bilinmelidir. hCG almayan ve doğrudan kriyoprezervasyon yapılan hastalarda dahi OHSS olguları bildirilmiştir. GnRHa ile oosit matürasyonunun tetiklenmesi sırasında, doğal sikluslardakine benzer bir folikül stimulan hormone artışı sağlanır. Bu artışın olası faydaları göz önüne alınarak ikili tetikleme (dual triggering) metodu geliştirilmiştir. GnRHa ile tetikleme sırasında düşük doz hCG uygulanmış, umut vadeden sonuçlar alınmıştır. Ayrıca, GnRHa ile oosit matürasyonu sağlanmasının, hormonlara duyarlı kanseri olan hastalarda fertilite korunmasında faydalı olabileceği gösterilmiştir. Sonuçta, GnRHa ile tetiklemeyi takiben uygun luteal faz kurtarma protokollerinin uygulanması OHSS açısından yüksek risk taşıyan hastalarda büyük ölçüde güvenli bir yöntemdir.Publication Open Access Screening for hepatic fibrosis and steatosis in Turkish patients with type 2 diabetes mellitus: a transient elastography study(Aves, 2019) Demir, Meryem; Yılmaz, Yusuf; N/A; Deyneli, Oğuzhan; Faculty Member; School of MedicineBackground/aims: non-alcoholic fatty liver disease is highly prevalent in patients with type 2 diabetes mellitus (T2DM). The aim of the present study was to investigate the potential usefulness of transient elastography (TE), which is a technique that allows measuring both fibrosis and liver fat content simultaneously, as a screening tool for hepatic involvement in Turkish patients with T2DM. Materials and methods: we obtained liver stiffness measurements (LSMs, as a measure of fibrosis) and controlled attenuation parameter (CAP, as a marker of steatosis) in 124 (46 males and 78 females; mean body mass index (BMI): 33.2 +/- 6.6 kg/m(2)) Turkish patients with T2DM. The prevalence rates of overweight, obesity, and metabolic syndrome in our sample were 28.2%, 64.5%, and 77.4%, respectively. Probe-specific LSM cut-off values were used to define advanced fibrosis (>= F3) and cirrhosis (F4) (M probe: F3=9.6-11.4 kPa, F4 >= 11.5 kPa and XL probe: F3=9.3-10.9 kPa, F4 >= 11.0 kPa). Mild, moderate, and severe steatosis were defined as CAP 222-232 dB/m, CAP 233-289 dB/m, and CAP >= 290 dB/m, respectively. Results: advanced fibrosis and cirrhosis were identified in 21 (16.9%) and 10 (8.0%) patients, respectively. TE-defined hepatic steatosis (CAP>222 dB/m) was detected in 117 (94.3%) patients. Mild, moderate, and severe steatosis were identified in 0, 29, and 88 patients, respectively. Conclusion: TE is a useful non-invasive imaging modality to screen for liver involvement in Turkish patients with T2DM. High rates of TE-defined fibrosis and steatosis in our sample reflect the presence of an elevated mean BMI.Publication Open Access Carotid atherosclerosis and lectin-like oxidized low density lipoprotein receptor-1 levels in hemodialysis patients(Prusa Medical Publishing, 2022) Kahvecioğlu, Serdar; Dağel, Tuncay; Gönenli, Mehmet Gökhan; Doctor; School of Medicine; N/A; 237468Objectives: atherosclerotic cardiovascular disease risk is increased in hemodialysis patients. Oxidized low density lipoprotein has an important role in atherosclerotic process and it exerts this effect via lectin like oxidized low density lipoprotein-1 (LOX-1). Carotid artery intima-media thickness (CIMT) is accepted as a god indicator of subclinical atherosclerosis. In this study, we aimed to investigate LOX-1 and CIMT levels in hemodialysis patients. Methods: twenty-eight patients treated with hemodialysis at least 6 months and 19 healthy subjects were enrolled in this study. Serum LOX-1 levels and simultaneously with CIMT were measured in hemodialysis patients and healthy control group. Results: CIMT value was found to be statistically significantly higher in the hemodialysis group compared to control group (0.9 mm in hemodialysis group vs. 0.7 mm in control group, p < 0.001). There was no statistically significant difference between groups in terms of LOX-1 levels. (0.172 ng/ml in hemodialysis group vs. 0.213 ng/ml in healthy control group, p > 0.05). Conclusions: although cardiovascular risk markers like CIMT, CRP were higher in hemodialysis group as expected, increase in LOX-1 levels was not detected.