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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 Surgical management of cardiac cystic echinococcosis in a pediatric patient: a case report(Oxford University Press (OUP), 2022) Altın, H.F.; Aydemir, N.A.; Biçer, Mehmet; Kozan, Şima; School of Medicine; Koç University HospitalCystic echinococcosis, a zoonotic parasitic disease, is endemic to many countries worldwide. This slowly progressing disease is seen rarely in the paediatric age group. In terms of cyst localization, cardiac involvement is infrequent. We report the case of a successful surgical and medical management of a paediatric hydatid disease patient with involvement of the heart.Publication Open Access Treatment of trichiasis by releasing follicle roots of eyelashes: a new technique(Lippincott Williams and Wilkins (LWW), 2021) Ağaoğlu, Galip; Karademir, Sacit Hüsnü; Faculty Member; School of Medicine; Koç University HospitalTrichiasis is an acquired condition in which eyelashes are misdirected toward the ocular surface, resulting in eye irritation and ocular morbidities. Different treatment modalities have been described, including surgical and non-surgical methods. The goal of this article is to present a novel technique for treatment of trichiasis, with a brief review of treatment options. Through a supratarsal incision, each misdirected eyelash follicle root was reached and freed from surrounding tissues by meticulous dissection. Then, hair shafts on the lid margin were redirected upward and glued to 2 bars extending horizontally across the upper eyelid. Two years after operation, the corrected eyelashes maintained their normal upward direction. To the best of our knowledge, this is the first reported case of chronic trichiasis treated by this technique. The main advantage of the technique, unlike most of the other treatment methods, is that follicles of the affected eyelashes are not removed or destroyed, which is appreciated from the aesthetic point of view, especially in female patients. We believe that any plastic surgeon with basic knowledge of blepharoplasty and hair transplantation can perform this technique without much difficulty. So far, there is no recurrence; however, long-term follow-up with a large series of patients is required for drawing better conclusions.Publication Open Access Is fibroid location associated with hemorrhage and complication rates following laparoscopic myomectomy?(SpringerOpen, 2020) Aslan, Kiper; Orhan, Adnan; Suer, Ebru; Düzok, Nergis; Özerkan, Kemal; Uncu, Gürkan; Türkgeldi, Engin; Ata, Mustafa Barış; Faculty Member; Faculty Member; School of Medicine; Koç University Hospital; N/A; 182910Objective: to determine whether hemorrhage and complication rates vary according to the location of the dominant fibroid following laparoscopic myomectomy. Background: laparoscopic myomectomy is associated with less postoperative pain, analgesic requirement, shorter hospitalization period, and less febrile complications when compared to conventional laparotomy. Despite the advantages, complications like hemorrhage, blood transfusion, bowel and urinary tract injury, and conversion to laparotomy may be seen in laparoscopic myomectomy. We do not know whether the fibroid location affects these complications. Materials and methods: women, who underwent laparoscopic myomectomy at two different tertiary academic hospitals, were analyzed retrospectively. Only women with at least one intramural fibroid (Monroe type 3, 4, or 5) were included. Patients were categorized according to localization of the dominant fibroid, i.e., anterior uterine wall, posterior uterine wall, and fundus. Change in hemoglobin levels before and after surgery and complication rates were compared across categories. Results: two hundred nineteen women with a mean age of 35.7 +/- 6 years were included. There were 81 women with fundal fibroid, 56 with anterior wall, and 72 with posterior wall fibroid. The other ten women with intraligamentary and isthmic fibroid were excluded. The mean fibroid diameter was 6.7 +/- 2.6, 6.6 +/- 2.3, and 6.7 +/- 2.3 cm in the fundal, anterior, and posterior groups, respectively (p = 0.9). The median (25th-75th percentile) changes in hemoglobin levels were 1.5 (0.8-2.2), 1.3 (0.6-2.1), and 1.3 (0.9-2) g/dl in fundal, anterior, and posterior wall groups, respectively (p = 0.55). There were 5 (6.2%), 5 (8.9%), and 2 (2.8%) complications in fundal, anterior, and posterior wall groups, respectively (p = 0.33). Conclusion: the incidence of hemorrhage or complication does not seem to vary depending on the fibroid location. However, the sample size was limited; observed values suggest that fibroid location does not affect hemorrhage and complication rates.Publication 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 Astrocytic outer retinal layer thinning is not a feature in AQP4-IgG seropositive neuromyelitis optica spectrum disorders(BMJ Publishing Group, 2021) Lu, A.; Zimmermann, HG.; Specovius, S.; Motamedi, S.; Chien, C.; Bereuter, C.; Lana-Peixoto, MA.; Fontenelle, MA.; Ashtari, F.; Kafieh, R.; Dehghani, A.; Pourazizi, M.; Pandit, L.; D Cunha, A.; Kim, HJ.; Hyun, JW.; Jung, SK.; Leocani, L.; Pisa, M.; Radaelli, M.; Siritho, S.; May, E.F.; Tongco, C.; De Sèze, J.; Senger, T.; Palace, J.; Roca-Fernández, A.; Leite, MI.; Sharma, SM.; Stiebel-Kalish, H.; Asgari, N.; Soelberg, K.K.; Martinez-Lapiscina, EH.; Havla, J.; Mao-Draayer, Y.; Rimler, Z.; Reid, A.; Marignier, R.; Cobo-Calvo, A.; Tanriverdi, U.; Yildirim, R.; Aktas, O.; Ringelstein, M.; Albrecht, P.; Tavares, IM.; Bichuetti, DB.; Jacob, A.; Huda, S.; Soto de Castillo, I.; Petzold, A.; Green, AJ.; Yeaman, MR.; Smith, TJ.; Cook, L.; Paul, F.; Brandt, AU.; Oertel, FC.; GJCF International Clinical Consortium for NMOSD.; Altıntaş, Ayşe; Faculty Member; Koç University Research Center for Translational Medicine (KUTTAM) / Koç Üniversitesi Translasyonel Tıp Araştırma Merkezi (KUTTAM); School of Medicine; 11611Background: patients with anti-aquaporin-4 antibody seropositive (AQP4-IgG+) neuromyelitis optica spectrum disorders (NMOSDs) frequently suffer from optic neuritis (ON) leading to severe retinal neuroaxonal damage. Further, the relationship of this retinal damage to a primary astrocytopathy in NMOSD is uncertain. Primary astrocytopathy has been suggested to cause ON-independent retinal damage and contribute to changes particularly in the outer plexiform layer (OPL) and outer nuclear layer (ONL), as reported in some earlier studies. However, these were limited in their sample size and contradictory as to the localisation. This study assesses outer retinal layer changes using optical coherence tomography (OCT) in a multicentre cross-sectional cohort. Method: 197 patients who were AQP4-IgG+ and 32 myelin-oligodendrocyte-glycoprotein antibody seropositive (MOG-IgG+) patients were enrolled in this study along with 75 healthy controls. Participants underwent neurological examination and OCT with central postprocessing conducted at a single site. Results: no significant thinning of OPL (25.02 +/- 2.03 mu m) or ONL (61.63 +/- 7.04 mu m) were observed in patients who were AQP4-IgG+ compared with patients who were MOG-IgG+ with comparable neuroaxonal damage (OPL: 25.10 +/- 2.00 mu m; ONL: 64.71 +/- 7.87 mu m) or healthy controls (OPL: 24.58 +/- 1.64 mu m; ONL: 63.59 +/- 5.78 mu m). Eyes of patients who were AQP4-IgG+ (19.84 +/- 5.09 mu m, p=0.027) and MOG-IgG+ (19.82 +/- 4.78 mu m, p=0.004) with a history of ON showed parafoveal OPL thinning compared with healthy controls (20.99 +/- 5.14 mu m); this was not observed elsewhere. Conclusion: the results suggest that outer retinal layer loss is not a consistent component of retinal astrocytic damage in AQP4-IgG+ NMOSD. Longitudinal studies are necessary to determine if OPL and ONL are damaged in late disease due to retrograde trans-synaptic axonal degeneration and whether outer retinal dysfunction occurs despite any measurable structural correlates.Publication Open Access Giant benign skin tumors: a retrospective analysis and compilation of noteworthy characteristics(Medknow Publications, 2020) Özmen, Selahattin; Tatar, Sedat; Sezgin, Billur; Faculty Member; Faculty Member; School of Medicine; N/A; N/A; 133762Background/aim: benign skin tumors are soft-tissue lesions that present with poor cosmesis along with pain, functional limitations, deformity, and hypoesthesia. Rapid progression and giant forms should be evaluated and differentiated from malignant transformation. The aim of this study is to evaluate the patients operated for giant benign skin tumors and to assess clinical experience about indications, size, location, and histopathological results and follow-up period. Materials and methods: the present study included 16 consecutive patients who underwent surgery for giant benign skin tumors between 2015 and 2018 based on the literature definition of "giant benign skin tumors." Demographic parameters, indications, symptoms, pathological results, and postoperative complications were evaluated retrospectively. Results: sixteen patients (11 males and 5 females) were operated for giant benign skin tumors. The mean age of the patients was 53.38 (range: 37-72) years. Tumor locations were on the scalp for four patients, the upper extremity for three patients, lower extremity for three patients, trunk for five patients, and generalized for one patient. Pain was the most common symptom, and hypoesthesia, functional limitations, ulceration, and infection were also observed. Total excision was performed for all patients. No major complications and recurrence were observed. Conclusion: clinical follow-up is an option for patients presenting to clinic with lesions that are small in size and asymptomatic. However, a detailed history and examination along with total excision and histopathological examination should be planned in patients with rapid progression or with benign skin tumors of giant size.Publication Open Access The role of endobronchial ultrasonography elastography for predicting malignancy(Bayçınar Tıbbi Yayıncılık ve Reklam Hizmetleri, 2020) Çağlayan, Benan Niku; İliaz, Sinem; Bulutay, Pınar; Armutlu, Ayşe; Uzel, Fatma Işıl; Öztürk, Ayşe Bilge; Faculty Member; Doctor; Teaching Faculty; Teaching Faculty; Faculty Member; School of Medicine; Koç University Hospital; 230719; 168584; 133565; 133567; N/A; 147629Background: this study aims to investigate the role of endobronchial ultrasonography elastography in predicting malignancy. Methods: between January 2016 and December 2016, a total of 221 lymph nodes were biopsied using the endobronchial ultrasonography-guided transbronchial needle aspiration from 119 consecutive patients (69 males, 50 females; mean age 63.2±12.4 years; range, 16 to 86 years) were included. Lymph nodes were scored by elastography according to their colors in four categories before the procedure. The strain ratio was calculated based on the region of interest after three measurements. Results: of the patients, 93 were diagnosed with a malignancy through endobronchial ultrasonography-guided transbronchial needle aspiration biopsy. The mean lymph node score of benign versus malignant lesions was 2.2±1.0 and 3.2±1, respectively (p<0.001). There was a positive correlation between the lymph node scores and lymph node diameter, strain ratio, and fluorodeoxyglucose uptake value (p<0.01). With a cut-off value of ?3 of lymph node scoring, the sensitivity for malignancy was 79% and specificity was 60%. The mean strain ratio for malignant and benign lymph nodes was 22.2±30.1 and 5.2±1.7, respectively (p<0.001). With a cut-off value of ?2.47 of strain ratio, the sensitivity for malignancy was 75% and specificity was 65%. The combined use of positron emission tomography and lymph node score or strain ratio yielded 80.4% and 61.2% sensitivity and 80% and 70.3% specificity for malignancy, respectively. Conclusion: endobronchial ultrasonography elastography is useful in predicting malignancy of the lymph nodes. When combined with positron emission tomography, specificity and positive predictive value for malignancy increase. / Amaç: bu çalışmada endobronşiyal ultrasonografi elastografinin maligniteyi öngörmedeki rolü araştırıldı. Çalışma planı: Ocak 2016 - Aralık 2016 tarihleri arasında, endobronşiyal ultrasonografi eşliğinde transbronşiyal iğne aspirasyon biyopsisi ile 119 ardışık hastadan (69 erkek, 50 kadın; ort. yaş 63.2±12.4 yıl; dağılım 16-86 yıl) toplam 221 lenf nodu çalışmaya alındı. Lenf nodları işlem öncesinde elastografi ile renklerine göre dört kategoride skorlandı. Gerginlik oranı, üç ölçüm sonrasında ilgili bölgeye göre hesaplandı. Bulgular: hastaların 93""üne endobronşiyal ultrasonografi eşliğinde transbronşiyal iğne aspirasyon biyopsisi ile malignite tanısı konuldu. Benign ve malign lenf nodlarının ortalama skoru sırası ile 2.2±1.0 ve 3.2±1 idi (p<0.001). Lenf nodunun skoru ve lenf nodunun çapı, gerginlik oranı ve florodeoksiglukoz alım değeri arasında pozitif bir ilişki vardı (p<0.01). Lenf nodu skorunun ?3""lük eşik değeri ile malignite için duyarlılık %79 ve özgüllük %60 idi. Malign ve benign lenf nodlarının ortalama gerginlik oranı sırası ile 22.2±30.1 ve 5.2±1.7 idi (p<0.001). Gerginlik oranının ?2.47""lik eşik değeri ile malignite duyarlılığı %75 ve özgüllüğü %65 idi. Pozitron emisyon tomografisi ve lenf nodu skoru veya gerginlik oranı birlikte kullanıldığında, malignite duyarlılığı sırası ile %80.4 ve %61.2 ve özgüllüğü %80 ve %70.3 idi. Sonuç: endobronşiyal ultrasonografi elastografi, lenf nodu malignitelerini öngörmede yararlıdır. Pozitron emisyon tomografisi ile birlikte kullanıldığında, malignite özgüllüğü ve pozitif öngördürücü değeri artar.Publication Open Access A novel Fontan Y-graft for interrupted inferior vena cava and azygos continuation(Oxford University Press (OUP), 2022) Çicek, Murat; Köse, Banu; Yılmaz, Emine Hekim; Aydemir, Numan Ali; Özkök, Serçin; Yurtseven, Nurgül; Erdem, Hasan; Sasmazel, Ahmet; Department of Mechanical Engineering; Lashkarinia, Seyedeh Samaneh; Pekkan, Kerem; Rezaeimoghaddam, Mohammad; Rasooli, Reza; Faculty Member; Researcher; Department of Mechanical Engineering; Graduate School of Sciences and Engineering; College of Engineering; N/A; 161845; N/A; N/AObjectives: to evaluate the hemodynamicdynamic advantage of a new Fontan surgical template that is intended for complex single-ventricle patients with interrupted inferior vena cava-azygos and hemi-azygos continuation. The new technique has emerged from a comprehensive pre-surgical simulation campaign conducted to facilitate a balanced hepatic flow and somatic Fontan pathway growth after Kawashima procedure. Methods: for 9 patients, aged 2 to 18 years, majority having poor preoperative oxygen saturation, a pre-surgical computational fluid dynamics customization is conducted. Both the traditional Fontan pathways and the proposed novel Y-graft templates are considered. Numerical model was validated against in vivo phase-contrast magnetic resonance imaging data and in vitro experiments. Results: the proposed template is selected and executed for 6 out of the 9 patients based on its predicted superior hemodynamic performance. Pre-surgical simulations performed for this cohort indicated that flow from the hepatic veins (HEP) do not reach to the desired lung. The novel Y-graft template, customized via a right- or left-sided displacement of the total cavopulmonary connection anastomosis location resulted a drastic increase in HEP flow to the desired lung. Orientation of HEP to azygos direct shunt is found to be important as it can alter the flow pattern from 38% in the caudally located direct shunt to 3% in the cranial configuration with significantly reversed flow. The postoperative measurements prove that oxygen saturation increased significantly (P-value = 0.00009) to normal levels in 1 year follow-up. Conclusions: the new Y-graft template, if customized for the individual patient, is a viable alternative to the traditional surgical pathways. This template addresses the competing hemodynamic design factors of low physiological venous pressure, high postoperative oxygen saturation, low energy loss and balanced hepatic growth factor distribution possibly assuring adequate lung development.Publication Open Access Extreme living donation: a single center simultaneous and sequential living liver-kidney donor experience with long-term outcomes under literature review(Bilimsel Tıp Yayınevi, 2021) Yankol, Yücel; Acarlı, Koray; Karataş, Cihan; Kanmaz, Turan; Koçak, Burak; Kalayoğlu, Münci; Faculty Member; Faculty Member; School of Medicine; Koç University Hospital; N/A; N/A; 220671; N/AObjective: living liver and kidney donor surgeries are major surgical procedures applied to healthy people with mortality and morbidity risks not providing any direct therapeutic advantage to the donor. In this study, we aimed to share our simultaneous and sequential living liver-kidney donor experience under literature review in this worldwide rare practice. Material and methods: between January 2007 and February 2018, a total of 1109 living donor nephrectomies and 867 living liver donor hepatectomies were performed with no mortality to living-related donors. Eight donors who were simultaneous or sequential living liver-kidney donors in this time period were retrospectively reviewed and presented with their minimum 2-year follow-up. Results: of the 8 donors, 3 of them were simultaneous and 5 of them were sequential liver-kidney donation. All of them were close relatives. Mean age was 39 (26-61) years and mean BMI was 25.7 (17.7-40). In 3 donors, right lobe, in 4 donors, left lateral sector, and in 1 donor, left lobe hepatectomy were performed. Median hospital stay was 9 (7-13) days. Two donors experienced early and late postoperative complications (Grade 3b and Grade 1). No mortality and no other long-term complication occurred. Conclusion: expansion of the donor pool by utilizing grafts from living donors is a globally-accepted proposition since it provides safety and successful outcomes. Simultaneous or sequential liver and kidney donation from the same donor seems to be a reasonable option for combined liver-kidney transplant recipients in special circumstances with acceptable outcomes. / Giriş ve amaç: canlı karaciğer ve böbrek verici ameliyatları tamamen sağlıklı bireylere uygulanan cerrahi işlemlerdir. Bu cerrahiler vericiye doğrudan bir faydası olmayan, ölüm ve komplikasyon riski taşıyan büyük bir işlemdir. Bu çalışmamızda dünya genelinde çok yaygın olmayan eş zamanlı veya birbirini takip eden canlı karaciğer ve böbrek verici ameliyatı deneyimimizi literatür irdemesi ile birlikte paylaştık. Gereç ve yöntem: Ocak 2007-Şubat 2018 tarihleri arasında merkezimizde, alıcısı ile yakınlık ilişkisi olan vericilere toplam 1109 canlı böbrek verici ameliyatı ve 867 canlı karaciğer verici ameliyatı verici kaybı yaşanmadan gerçekleştirilmiştir. Bunlardan eş zamanlı veya birbirini takip edecek şekilde canlı karaciğer ve böbrek verici ameliyatı olan 8 verici minimum 2 yıllık takipleri ile incelenmiştir. Bulgular: bu 8 vericiden 3 tanesi eş zamanlı ve 5 tanesi birbirini takip edecek şekilde canlı karaciğer ve böbrek verici ameliyatı olmuşlardır. Hepsi alıcının yakın akrabasıydı. Ortalama yaş 36 (26-61) ve ortalama BMI 25,7 kg/m (17,7-40) idi. Vericilerden 3’üne sağ lob verici hepetektomisi, 4’üne verici sol lateral sektör hepatektomisi ve 1’ine sol lob verici hepetektomisi gerçekleştirilmiştir. Median hastanede kalış süresi 9 (7-13) gündü. Vericilerden 2’sinde erken dönemde komplikasyon gelişmiştir (Dindo Grade 3b ve Grade 1). Verici ölümü ve başka bir geç dönem komplikasyonu gelişmiştir. Sonuç: verici havuzunun genişletilmesinde canlı vericilerin güvenli olarak başarılı sonuçlar ile kullanılması dünya genelinde kabul görmektedir. Aynı vericinin eş zamanlı veya takip eden ameliyatlar ile karaciğer ve böbrek vericisi olması özel durumlarda kombine karaciğer ve böbrek alıcıları için güvenli bir seçenek olabilmektedir.
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