Publications by authors named "Erkan Ozturk"

27 Publications

  • Page 1 of 1

Atypical Metastasis to the Head and Neck Region: An Analysis of 11 Patients.

Turk Arch Otorhinolaryngol 2018 Dec 26;56(4):210-216. Epub 2018 Oct 26.

Department of Otorhinolaryngology, İstanbul University School of Medicine, İstanbul, Turkey.

Objective: We present 11 patients with distant metastases to the head and neck from an infraclavicularly located primary tumor and discuss the management strategies including the clinical presentation, treatment modalities, and prognosis.

Methods: The retrospective data of the pathology reports and operation notes of 1239 patients who had undergone any kind of oncological surgical intervention between 2005 and 2017 were analyzed. All of the 11 patients included in the study were evaluated in our department's tumor board, and all patients with an operable lesion had undergone surgery. Inoperable patients were treated with chemotherapy and/or radiotherapy.

Results: The average age of the patients was 64.3 (48-88) years. Primary tumors were located in the lung (2), breast (2), ovary (2), prostate (2), kidney (1), and colon (1) and the primary lesion could not be determined in one patient. The most common symptom was newly occurred painless swelling (9/11, 81.8%) at the metastatic site. Four patients without any other distant metastases were operated. Of these four patients, two died during follow-up due to systemic disease, and the other two are alive and disease-free. Three of the seven inoperable patients were treated with chemotherapy and the other four with radiotherapy. The prognosis of this group was worse.

Conclusion: Although metastasis to the head and neck is not common, it is vital to keep in mind while approaching a patient with a lesion at the head and neck region especially if there is a history of lung, breast, and genitourinary cancers. Despite the poor prognosis, diminishing the tumor burden would increase the treatment success.
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http://dx.doi.org/10.5152/tao.2018.3633DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340327PMC
December 2018

Impact of Routine Plain X-ray on Postoperative Management in Cochlear Implantation.

J Int Adv Otol 2018 Dec;14(3):365-369

Department of Otorhinolaryngology, Istanbul University School of Medicine, Istanbul, Turkey.

Objectives: To determine the benefit of a routine plain radiography (X-ray) for confirming the optimal electrode position in cochlear implant surgery.

Materials And Methods: In total, 245 patients (135 males and 111 females) who underwent cochlear implantation in a single tertiary referral center were included in this study. Postoperative plain X-ray findings and electrophysiological tests were retrospectively analyzed.

Results: The mean age was 11.4±14.6 years (range, 1-70 years). Overall, 196 (80%) patients were pediatric patients (age, <18 years) and 49 (20%) were adults (age, >18 years). The mean rotation of electrode arrays was 1.03±0.17 turns. The plain X-ray revealed that electrode misplacement was present in 5 patients (2%); incomplete insertion in 3 patients, and tip rollover and electrode migration in 1 patient each. A revision was performed for the last patient who had an extracochlear electrode position in the plain X-ray.

Conclusions: Postoperative imaging is mostly used to confirm the electrode array position after cochlear implant surgery. In addition, intraoperative evaluations have low positive predictive value and sensitivity. Thus, this study revealed that postoperative radiological imaging should be considered even when all intraoperative electrophysiological measures and surgical reports are normal.
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http://dx.doi.org/10.5152/iao.2018.4252DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6354525PMC
December 2018

Posttraumatic Intramuscular Hemangioma Arising from Scalene Muscles in Supraclavicular Region.

Turk Arch Otorhinolaryngol 2017 Jun 22;55(2):87-90. Epub 2017 May 22.

Department of Otorhinolaryngology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey.

Intramuscular hemangiomas (IMH) account for <%1 of all hemangiomas and are rarely located in the head and neck region. The most common site of origin in the head and neck is the masseter muscle, whereas IMH originating from the scalene muscles are rarely seen. Surgical excision of intramuscular hemangioma is considered the main treatment modality. Here we present the case of a male patient aged 17 with IMH that occured after blunt trauma in the supraclavicular region, fed by the thyrocervical and costocervical trunks, and with an arteriovenous shunt.
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http://dx.doi.org/10.5152/tao.2017.2138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5782949PMC
June 2017

Comprehensive analysis of parotid mass: A retrospective study of 369 cases.

Auris Nasus Larynx 2018 Apr 1;45(2):320-327. Epub 2017 May 1.

Department of Otorhinolaryngology, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul 34093, Turkey. Electronic address:

Objective: To present the results of patients who underwent superficial or total parotidectomy because of parotid gland tumors in our tertiary care clinic.

Methods: The data of 362 patients who underwent parotid surgery from January 2008 to November 2015 were collected and analyzed in demographic, histopathological features, and complications.

Results: Three hundred sixty-nine cases (performed in 359 patients) were analyzed and we assessed complications of parotid surgery such as transient or permanent facial paralysis and Frey's syndrome. Pleomorphic adenomas and Warthin's tumors consisted 74% of all parotid gland tumors. These tumors were generally located in the superficial lobe and tail of the parotid gland (81%). Also, tumor size in the positive surgical margin group was larger than in the negative surgical margin group (p=0.012).

Conclusions: Most of parotid gland tumors are benign. However, the frequency of malignancy increases in deep lobe of parotid gland. High grade malignant tumors have more tendency to have positive surgical margin during surgery, and facial paresis preoperatively.
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http://dx.doi.org/10.1016/j.anl.2017.04.003DOI Listing
April 2018

A Rare Complication of Cochlear Implantation After Magnetic Resonance Imaging: Reversion of the Magnet.

J Craniofac Surg 2017 Jun;28(4):e372-e374

Department of Otolaryngology and Head and Neck Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.

Cochlear implants are mechanical devices used for patients with severe sensory-neural hearing loss, which has an inner magnet. It is proven that 1.5 Tesla magnetic resonance imaging (MRI) scanners are safe to use in patients with cochlear implant. In our patient, the authors aim to introduce a rare complication caused after a 1.5 Tesla MRI scanning and the management of this situation; the reversion of the magnet of the implant without displacement and significance of surgery in management.
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http://dx.doi.org/10.1097/SCS.0000000000003724DOI Listing
June 2017

Prevention of Intraabdominal Adhesions: An Experimental Study Using Mitomycin-C and 4% Icodextrin.

Balkan Med J 2017 01 5;34(1):35-40. Epub 2017 Jan 5.

Department of Surgery, Gülhane Training and Research Hospital, Ankara, Turkey.

Background: Intraabdominal adhesions remain a significant cause of morbidity and mortality. Moreover, intraabdominal adhesions can develop in more than 50% of abdominal operations.

Aims: We compared the anti-adhesive effects of two different agents on postoperative adhesion formation in a cecal abrasion model.

Study Design: Experimental animal study.

Methods: Forty Wistar albino type female rats were anesthetized and underwent laparotomy. Study groups comprised Sham, Control, Mitomycin-C, 4% Icodextrin, and Mitomycin-C +4% Icodextrin groups. Macroscopic and histopathological evaluations of adhesions were performed.

Results: The frequencies of moderate and severe adhesions were significantly higher in the control group than the other groups. The mitomycin-C and Mitomycin-C +4% Icodextrin groups were associated with significantly lower adhesion scores compared to the control group and 4% Icodextrin group scores (p=0.002 and p=0.008, respectively). The adhesion scores of the Mitomycin-C group were also significantly lower than those of the 4% Icodextrin group (p=0.008).

Conclusion: Despite its potential for bone marrow toxicity, Mitomycin-C seems to effectively prevent adhesions. Further studies that prove an acceptable safety profile relating to this promising anti-adhesive agent are required before moving into clinical trials.
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http://dx.doi.org/10.4274/balkanmedj.2015.1359DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5322518PMC
January 2017

Nasal chondromesenchymal hamartoma: a rare nasal benign tumor.

Kulak Burun Bogaz Ihtis Derg 2016 Sep-Oct;26(5):300-3

Department of Otolaryngology, İstanbul Faculty of Medicine, İstanbul University, 34093 Fatih, Çapa, İstanbul, Turkey.

Nasal chondromesenchymal hamartoma (NCMH) is a rare nasal benign tumor, which arises from the nasal cavity or paranasal sinuses. In this article, we present a five-year-old male patient with rhabdomyosarcoma unity in remission that emerged with nasal obstruction. Synchronous diagnosis of pediatric tumors such as pleuropulmonary blastoma in the literature is a remarkable finding. We found a mass within the left nasal cavity originating from superior portion of nasal septum, extending to the olfactory cleft and resected all tumor via endoscopic surgical approach. Histopathological diagnosis revealed that NCMH contained cartilaginous and mesenchymal components. In conclusion, NCMH is a rare surgically treated benign tumor that can be synchronously diagnosed with pleuropulmonary blastoma and should be kept in mind for differential diagnosis of unilateral pediatric nasal mass.
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http://dx.doi.org/10.5606/kbbihtisas.2016.70852DOI Listing
March 2017

The Effectiveness of Neck Stretching Exercises Following Total Thyroidectomy on Reducing Neck Pain and Disability: A Randomized Controlled Trial.

Worldviews Evid Based Nurs 2016 Jun 15;13(3):224-31. Epub 2016 Jan 15.

Professor, Department of General Surgery, Gulhane Military Medical Academy, Turkey.

Background: Although there are a limited number of studies showing effects of neck stretching exercises following a thyroidectomy in reducing neck discomfort symptoms, no study has specifically dealt with and examined the effect of neck stretching exercises on neck pain and disability.

Objective: To analyze the effect of neck stretching exercises, following a total thyroidectomy, on reducing neck pain and disability.

Methods: A randomized controlled trial was conducted. The participants were randomly assigned either to the stretching exercise group (n = 40) or to the control group (n = 40). The stretching exercise group learned the neck stretching exercises immediately after total thyroidectomy. The effects of the stretching exercises on the participants' neck pain and disability, neck sensitivity, pain with neck movements as well as on wound healing, were evaluated at the end of the first week and at 1 month following surgery.

Results: When comparing neck pain and disability scale (NPDS) scores, neck sensitivity and pain with neck movement before thyroidectomy, after 1 week and after 1-month time-points, it was found that patients experienced significantly less pain and disability in the stretching exercise group than the control group (p < .001). At the end of the first week, the NPDS scores (mean [SD] = 8.82 [12.23] vs. 30.28 [12.09]), neck sensitivity scores (median [IR] = 0 [.75] vs. 2.00 [4.0]) and pain levels with neck movements (median [IR] = 0 [2.0] vs. 3.5 [5.75]) of the stretching exercise group were significantly lower than those of the control group. However, there was no significant difference between the groups with regard to the scores at the 1-month evaluation (p > .05).

Linking Evidence To Action: Neck stretching exercises done immediately after a total thyroidectomy reduce short-term neck pain and disability symptoms.
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http://dx.doi.org/10.1111/wvn.12136DOI Listing
June 2016

Comparison of five different popular scoring systems to predict nonsentinel lymph node status in patients with metastatic sentinel lymph nodes: a tertiary care center experience.

Springerplus 2015 29;4:651. Epub 2015 Oct 29.

Department of Surgery, Gulhane Military Medical Academy, Etlik, 06018 Ankara, Turkey.

Sentinel lymph node biopsy (SLNB) is the current standard of care for breast cancers with no clinically palpable axillary lymph nodes. Almost 50 % of sentinel lymph node positive patients have negative non-sentinel nodes and undergo non-therapeutic axillary dissection. Five different scoring systems, reported in the literature, were compared for their predictive ability of non-SLN involvement in patients with SLN positive breast cancer. 242 patients who underwent breast surgery and SLNB were included in the study. Of these, 70 who were confirmed to have SLN metastasis and received complementary ALND and constituted the final study population. The nomograms (MSKCC, M.D. Anderson Cancer Center, Tenon model, Stanford and Turkish) were statistically compared for their prediction of non-SLN metastasis (95 % confidence interval). We have determined only two clinicopathologic (multifocality and size of the primary tumor) situations which have a statistically significant association between SLN metastasis with using a multivariate logistic regression analysis. Multifocality (P = 0.001) and size of the primary tumor (P = 0.001) were associated with a higher probability of-SLN metastasis. No predictive model was constructed that showed good area under the curve (AUC) discrimination in the validation series. Currently published predictive models lack accuracy when applied to a different population. Multi-institutional heterogenic population studies are important to determine the exact combination of scoring systems and/or nomograms.
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http://dx.doi.org/10.1186/s40064-015-1442-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4628030PMC
November 2015

Efficacy of wound infiltration with lornoxicam for postoperative analgesia following thyroidectomy: a prospective, randomized, double-blind study.

Turk J Med Sci 2015 ;45(3):700-5

Background/aim: Postoperative pain control constitutes a major problem and studies have focused on reducing opioid requirements using regional techniques. We aimed to investigate the efficacy of wound infiltration with lornoxicam on postoperative pain control following thyroidectomy.

Materials And Methods: In this prospective, randomized-controlled study, 80 patients scheduled for thyroidectomy were randomly assigned to 2 groups. After the thyroidectomy was performed, patients in group I underwent wound infiltration with 4 mg of lornoxicam and patients in group II received the same amount of saline. Rescue analgesia was provided with additional doses oflornoxicam delivered by an on-demand patient-controlled analgesia device. Total analgesic consumption during the postoperative 24 h, and pain intensities assessed using a visual analog scale score at 0, 2, 4, 8, 12 and 24 h postoperatively were recorded.

Results: Pain scores during the postoperative 24 h were slightly lower in group I than in group II, but the difference was not significant (P > 0.05). The mean analgesic consumption was 8.87 ± 1.87 mg and 10.33 ± 1.25 mg in groups I and II, respectively (P > 0.05).

Conclusion: Wound infiltration with lornoxicam neither improved postoperative pain control nor decreased total analgesic consumption.
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http://dx.doi.org/10.3906/sag-1402-125DOI Listing
September 2015

A low cost training phantom model for radio-guided localization techniques in occult breast lesions.

J Surg Oncol 2015 Sep 6;112(4):449-51. Epub 2015 Aug 6.

Women's Cancer Center, Dana-Farber/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Radio-guided localization (RGL) for identifying occult breast lesions has been widely accepted as an alternative technique to other localization methods, including those using wire guidance. An appropriate phantom model would be an invaluable tool for practitioners interested in learning the technique of RGL prior to clinical application. The aim of this study was to devise an inexpensive and reproducible training phantom model for RGL. We developed a simple RGL phantom model imitating an occult breast lesion from inexpensive supplies including a pimento olive, a green pea and a turkey breast. The phantom was constructed for a total cost of less than $20 and prepared in approximately 10 min. After the first model's construction, we constructed approximately 25 additional models and demonstrated that the model design was easily reproducible. The RGL phantom is a time- and cost-effective model that accurately simulates the RGL technique for non-palpable breast lesions. Future studies are warranted to further validate this model as an effective teaching tool.
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http://dx.doi.org/10.1002/jso.23984DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4583351PMC
September 2015

The effects of hyperbaric oxygen therapy on experimental colon anastomosis after preoperative chemoradiotherapy.

Int Surg 2013 Jan-Mar;98(1):33-42

1 Department of Surgery.

The aim of the present study was to investigate the effect of hyperbaric oxygen therapy (HBOT) on colon anastomosis after chemoradiotherapy (CRT). Sixty female Wistar-Albino rats were divided into 5 groups and underwent left colon resection and end-to-end anastomosis. CRT simulation was performed on 2 sham groups before the anastomosis, and 1 of these groups was administered additional postoperative HBOT. Two groups were administered CRT before the anastomosis, and 1 of them received additional postoperative HBOT. On postoperative day 5, all groups underwent relaparotomy; burst pressure was measured and samples were obtained for histopathologic and biochemical analysis. There was a significant weight loss in the CRT groups and postoperative HBOT had an improving effect. Significantly decreased burst pressure values increased up to the levels of the controls after HBOT. Hydroxyproline levels were elevated in all groups compared to the control group. Hydroxyproline levels decreased with HBOT after CRT. No significant difference was observed between the groups regarding fibrosis formation at the anastomosis site. However, regression was observed in fibrosis in the group receiving HBOT after CRT. Preoperative CRT affected anastomosis and wound healing unfavorably. These unfavorable effects were alleviated by postoperative HBOT. HBOT improved the mechanical and biochemical parameters of colon anastomosis in rats.
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http://dx.doi.org/10.9738/CC130.2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3723167PMC
August 2014

One-staged silicone implant breast reconstruction following bilateral nipple-sparing prophylactic mastectomy in patients at high-risk for breast cancer.

Aesthetic Plast Surg 2013 Apr 16;37(2):303-11. Epub 2013 Jan 16.

Department of Plastic and Reconstructive Surgery, Gulhane Military Medical Academy, Ankara, Turkey.

Background: There is little consensus regarding the indications, ideal incision, or reconstruction method for prophylactic mastectomy. In addition, the biggest limitation in studies that assess either patient satisfaction or operation results is the lack of group homogeneity.

Methods: In our center, 21 bilateral prophylactic mastectomies, due to breasts at high risk for cancer, and simultaneous breast reconstruction using submuscular medium-height high-profile silicone implants were performed between 2008 and 2012. The patients were divided into two groups: small-breasted (9 patients) and large/ptotic-breasted (12 patients). A periareolar incision was used in the 9 patients and a vertical mastopexy incision was used in the 12 patients who needed nipple-areola complex repositioning.

Results: The rates of general satisfaction and aesthetic outcomes, assessed using the Michigan Breast Satisfaction Questionnaire, were 100 and 90.4%, respectively. Seroma occurred in three patients and venous congestion of the nipple-areola complex developed in four patients, which resolved spontaneously. No nipple-areola necrosis, implant exposition, or capsule contractures were encountered. Only three patients underwent fat injection for contour restoration.

Conclusion: We obtained very good aesthetic results with low complication rates using this technique in a homogeneous group of patients.

Level Of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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http://dx.doi.org/10.1007/s00266-012-0044-6DOI Listing
April 2013

A rare pathology that caused high-level intestinal obstruction: Left paraduodenal hernia.

Ulus Cerrahi Derg 2013 9;29(2):92-5. Epub 2013 Jul 9.

Department of General Surgery, Gülhane Military Medical Academy, Ankara, Turkey.

The aim of this report is to assess clinical findings and surgical treatment of left paraduodenal hernia, which is an unusual type of internal herniation, in light of the literature. The diagnosis and treatment course of a 42-year-old male patient with findings of intestinal obstruction was assessed and presented together with literature search. The patient underwent surgery with a preliminary diagnosis of intestinal obstruction and the definitive diagnosis of internal herniation was made intraoperatively. Nearly two-thirds of the small intestine was found to be herniated into the retroperitoneal space from the left paraduodenal region. Small bowel loops were pulled out of the hernia sac and anatomically positioned in the intraperitoneal area. The hernia sac was repaired primarily. The patient was discharged on the fourth postoperative day, uneventfully. Left paraduodenal hernia should be considered as a part of differential diagnosis in patients who have recurring abdominal pain episodes accompanied by symptoms suggestive of intestinal obstruction. Timely diagnosis is important to prevent complications. Reduction of hernia content followed by primary repair of the defect appears to be a safe and effective treatment.
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http://dx.doi.org/10.5152/UCD.2013.27DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4379842PMC
May 2015

The value of serum fibrinogen level in the diagnosis of acute appendicitis.

Ulus Travma Acil Cerrahi Derg 2012 Sep;18(5):384-8

Depertment of General Surgery, Gülhane Military Medical Faculty, Ankara, Turkey.

Background: The aim of this study was to investigate the importance of serum fibrinogen level in the diagnosis of acute appendicitis.

Methods: This study was performed on 201 patients who admitted to our clinic. Symptoms, signs, duration of symptoms, and laboratory indicators of appendicitis were recorded, in keeping with the Alvarado score for acute appendicitis. The ultimate diagnosis was based on histopathological results. Serum fibrinogen levels were detected before surgery. The sensitivity, specificity, and predictive values of single test and test combinations were calculated at different cut-off levels.

Results: During the study period, 201 patients underwent surgery for suspected acute appendicitis. Appendicitis was confirmed in 179 (89%) patients. The mean age was 24.8±7.7 (range, 20-57) years, and 154 (76.6%) patients were male and 47 (23.4%) female. The best diagnostic cut-off point for fibrinogen was found at 245.5 mg/dl, for white blood cells (WBC) at 11,900x109/L and for Alvarado score at 7.

Conclusion: The use of fibrinogen blood level may be a new diagnostic acute-phase reactant in the diagnosis of acute appendicitis. The formulation of a triple test is recommended as criteria in deciding emergency surgery or observation.
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http://dx.doi.org/10.5505/tjtes.2012.58855DOI Listing
September 2012

A comparison of single breath and re-breathe diffusing capacity in emphysema patients and controls.

Respir Physiol Neurobiol 2012 Jul 24;183(1):15-9. Epub 2012 May 24.

Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.

In emphysema patients, gas dilutional alveolar volume is underestimated by a 10s single breath maneuver at total lung capacity (TLC) compared with re-breathing at functional residual capacity (FRC); corresponding underestimation of single breath diffusing capacity (DLCO) in emphysema has not been demonstrated. The purpose of this study was to quantify the degree to which re-breathe DLCO at FRC (DLCO(RB)) differs from single breath DLCO at TLC (DLCO(SB)) in emphysema. In 37 consecutively recruited patients with moderate to severe emphysema (FEV1/FVC 40%±10% predicted), DLCO(RB) as % predicted of 91 controls without cardiopulmonary disease was 79%±24%, significantly greater than % predicted DLCO(SB) (44%±19%; p<0.0001). DLCO(RB)/DLCO(SB) was inversely proportional to FEV1% predicted (R = -0.47, p=0.004), and FEV1/FVC (R = -0.54, p<0.001). These data indicate that a 10s single breath DLCO maneuver progressively under-represents re-breathe lung diffusing capacity in emphysema as airflow obstruction increases.
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http://dx.doi.org/10.1016/j.resp.2012.05.009DOI Listing
July 2012

Combination of preoperative ultrasonographic mapping and radioguided occult lesion localization in patients with locally recurrent/persistent papillary thyroid carcinoma: a practical method for central compartment reoperations.

Clin Nucl Med 2010 Nov;35(11):847-52

Department of Nuclear Medicine, Gülhane Military Medical Academy, Ankara, Turkey.

Purpose: To improve the surgical success and reduce the complication rates, we combine our routine preoperative ultrasound (US) mapping technique with radioguided occult lesion localization (ROLL) in patients with papillary thyroid cancer recurrences in central compartment.

Materials And Methods: In the morning of surgery, biopsy proven recurrent/persistent tumoral lesions were plotted on a sketch and injected with Tc-99m labeled macroaggregated albumin under US guidance. Thyroid bed exploration was carried out based on the location of biopsy proven lesion with the guidance of intraoperative gamma probe and neck map. The lymphoadipose tissues showing high count rates were resected and labeled separately for histopathologic study.

Results: Despite extensive scarring in some patients probe safely guided to lesions. Noninjected tumor foci were searched and successfully resected in the light of neck map that showing topographic relation of injected and noninjected lesions. Among total of 41 excised lesions, 28 metastatic foci ranging from 3 to 38 mm in largest diameter were recognized at final histologic examination. Combination of preoperative mapping with ROLL was found helpful by the operating surgeons in all patients, respectively. Except 2 patients with known distant metastases, undetectable thyroglobulin levels were reached 6 weeks after surgery.

Conclusions: The use of preoperative US-mapping with ROLL in patients with nonpalpable recurrent/persistent papillary thyroid cancer in central compartment is technically safe and effective method. Combination of techniques provides better information about topographical relations of recurrent/persistent lesions during surgery.
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http://dx.doi.org/10.1097/RLU.0b013e3181f48403DOI Listing
November 2010

Management and mid- to long-term results of early referred bile duct injuries during laparoscopic cholecystectomy.

Hepatogastroenterology 2009 Jan-Feb;56(89):17-25

Gulhane School of Medicine, Department of General Surgery, 06018 Etlik, Ankara, Turkey.

Background/aims: Bile duct injuries (BDI) usually need operative repair and remain as a challenge even for surgeons who specialize in hepatobiliary surgery. The objective of this study was to define the presentation, in-hospital management, and mid- to long-term outcome of BDIs during laparoscopic cholecystectomy (LC) referred to a tertiary center in their early period.

Methodology: From January 1996 to January 2006, 31 patients with BDI sustained during or after LC were treated at our institution. Patients were referred to our center from 18 community hospitals in their first 15 postoperative days. Patients' charts were retrospectively reviewed; presentation, management, and follow-up details recorded at the primary hospitals and at our institution were documented.

Results: There were 5 patients with type-A and one with type-C injury, according to Strasberg classification. The remainders had a major BDI. The mean time to referral was 3.45 (median 2) days. Treatment methods chosen after referral were as follows: drainage-observation in 2 patients (6.5%), nasobiliary drainage in 4 (12.9%), endoscopic sphincterotomy plus biliary stenting in 1 (3.2%), and surgical intervention (duct-to-duct anastomosis or biliary-enteric reconstruction) in 24 patients (77.4%). Although a success rate of 83.3% was achieved in the early period, 10 patients (32.3%) had late postoperative complications (stricture and cholangitis), and of these, 3 required endoscopic stent placement, and 7 patients underwent a biliary diversion with Roux-en-Y Hepaticojejunostomy. One out of 24 patients with long-term follow-up developed biliary cirrhosis, and one patient with malignancy expired.

Conclusions: Minor BDIs can be satisfactorily treated with endoscopic interventions. Extended lateral injuries, complete CBD transsections, and long segment stenosis usually require surgical therapy. Duct-to-duct anastomosis may be an option as the first-line therapy in selected patients after early referral, though many patients eventually require a Roux-en-Y hepaticojejunostomy.
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June 2009

Comparison of two different oxygen delivery methods in the early postoperative period: randomized trial.

J Adv Nurs 2009 Jun 3;65(6):1237-47. Epub 2009 Apr 3.

School of Nursing, Gulhane Military Medical Academy, Ankara, Turkey.

Aim: This paper is a report of a study conducted to compare the effects of two different oxygen delivery methods on both patient peripheral oxygen saturation and patient satisfaction.

Background: One of the most serious problems encountered in the early postoperative period is hypoxemia. Giving oxygen to patients in the perioperative period reduces the incidence of hypoxemia. Oxygen is generally delivered to patients through oxygen masks or nasal cannulae. Previous studies have shown that face masks and nasal cannulae are effective in the early postoperative period.

Method: A randomized trial was conducted between 2007 and 2008 with patients undergoing thyroidectomy. In the early postoperative period, 5 L/minute of oxygen was given to patients via an oxygen mask (n = 53) or nasal cannulae (n = 53). Peripheral oxygen saturation were measured by pulse oxymeter every 5 minutes for a 30-minute period. The Postoperative Nausea Vomiting Scale was used and patient satisfaction was evaluated using a 10-point scale.

Results: Average peripheral oxygen saturation for the nasal cannulae group was statistically significant higher than that in the mask group. This difference arose from more frequent removal of the oxygen mask than the nasal cannulae by patients and healthcare professionals. Average satisfaction scores for patients in the nasal cannulae group were statistically significantly higher than those in the mask group.

Conclusion: During the early postoperative period, using nasal cannulae for patients undergoing thyroidectomy increases oxygenation.
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http://dx.doi.org/10.1111/j.1365-2648.2009.04984.xDOI Listing
June 2009

Idiopathic granulomatous mastitis.

Saudi Med J 2009 Jan;30(1):45-9

Department of General Surgery, Gulhane Military University Medical School, Ankara, Turkey.

Objective: To discuss the clinical and radiological features and treatment approaches in 14 patients diagnosed with idiopathic granulomatous mastitis (GM).

Methods: We retrospectively evaluated the clinical features, radiological findings, and treatment approaches in 14 patients with idiopathic GM in the General Surgery Department, Gulhane School of Medicine, Ankara, Turkey between April 2000 and June 2006.

Results: The mean age of the patients was 34.5 years (range 27-41 years). The complaints at admission were a mass in the breast in 7 (50%) patients, an abscess and a mass in 6 (42.8%), and a skin fistula in one (7.2%). Granulomatous mastitis was unilateral in all subjects (on the right in 5 patients and on the left in 9). All of the patients underwent ultrasonographic evaluation. Mammography was performed in 8 and magnetic resonance imaging in 5 patients. Seven patients (50%) were suspected to have breast carcinoma according to radiological findings. We performed large excision in 11, incisional biopsy plus abscess drainage in one, and incisional biopsy plus abscess drainage plus medical treatment (prednisolone, methotrexate) in 2 patients. Due to the development of abscess after 9 months, drainage and large excision were also performed in one patient who received medical treatment.

Conclusion: Idiopathic GM is a disease that generally affects young women of reproductive age and may be mistaken for breast carcinoma in clinical and radiological evaluations. The gold standard for the diagnosis is histopathologic evaluation.
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January 2009

Lightning strike: an unusual etiology of gastric perforation.

Am J Emerg Med 2008 Oct;26(8):966.e5-7

Department of General Surgery, Gulhane Military Medical Academy, Ankara 06018, Turkey.

Lightning strike is an unusual form of trauma in terms of being one of the leading causes of death from natural phenomenon. Lightning strike can cause severe damage to many systems and results in a high mortality. The most common cause of death in the lightning strike victim is cardiopulmonary arrest. The most vulnerable subjects for lightning strike are individuals who work in open fields, farmers, and swimmers. The cardiac and neurological injuries are the most serious injuries. Burns, tinnitus, blindness, and secondary blunt trauma have also been reported. Gastrointestinal complications have been documented very rarely. In this study, we present a case of gastric perforation after lightning strike. No report related to gastric perforation caused by lightning strike has been identified in the literature.
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http://dx.doi.org/10.1016/j.ajem.2008.01.049DOI Listing
October 2008

Preoperative administration of oral carbohydrate-rich solutions: Comparison of glucometabolic responses and tolerability between patients with and without insulin resistance.

Nutrition 2009 Jan 11;25(1):72-7. Epub 2008 Oct 11.

Gulhane Military Medical Academy, Department of Surgery, Surgical Nutrition Audit Team, Etlik, Ankara, Turkey.

Objective: Preoperative carbohydrate loading with clear fluids is thought to reduce surgery-related insulin resistance (IR). However, IR per se is already present in some patients scheduled for elective surgery. Data on the safety of preoperative oral carbohydrate loading in patients with IR undergoing surgery is lacking. We aimed to evaluate the effects of preoperative carbohydrate loading on the glucometabolic state and gastric content of patients with and without IR.

Methods: Thirty-four non-diabetics received 800 mL of a special carbohydrate-containing drink on the evening before the operation and then 400 mL 2 h before surgery. Blood samples for glucose, insulin, and cortisol levels were taken immediately before the second dose, at 40 and 90 min after intake of the drink, and at the onset of surgery. Patients with a homeostasis model assessment IR score >2.5 were considered to have IR. The differences between patients with and without IR were then evaluated.

Results: Eight of the 34 patients had IR and the remaining 26 did not. Glucose levels in the IR group were higher than those in the non-IR group, but the differences did not reach significance. The initially elevated insulin concentrations then tended to decrease to the corresponding levels detected in the non-IR group. The cortisol concentrations were similar in both groups.

Conclusion: Patients with IR receiving a carbohydrate-rich drink before surgery appear not to be affected adversely by the beverage. Furthermore, they also obtain the probable beneficial effects related to these drinks and, like patients without IR, can undergo surgery safely.
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http://dx.doi.org/10.1016/j.nut.2008.07.021DOI Listing
January 2009

Can SAPS II predict operative mortality more accurately than POSSUM and P-POSSUM in patients with colorectal carcinoma undergoing resection?

World J Surg 2008 Apr;32(4):589-95

Department of Surgery, Gulhane School of Medicine, 06018 Etlik, Ankara, Turkey.

Background: This study assessed the APACHE II (Acute Physiology and Chronic Health Evaluation II), SAPS II (Simplified Acute Physiology Score-II), POSSUM (Physiologic and Operative Severity Score for Enumeration of Morbidity and Mortality), and P-POSSUM (Portsmouth-POSSUM) in patients with colorectal cancer undergoing curative or palliative resection.

Methods: Predicted mortality rates and the observed/expected mortality ratio were computed by means of each scoring system. The results were compared between survivors and nonsurvivors and between elective and emergency operations. Each model was assessed for its accuracy to predict the risk of death using receiver operator characteristic (ROC) curve analysis, and risk stratification was generated as well.

Results: Some 224 patients were enrolled in the study. The overall 30-day mortality rate was 3.6% (n = 8). Predicted mortality rates generated by APACHE II, SAPS II, POSSUM, and P-POSSUM were 9.1%, 3.7%, 13.4%, and 5.2%, respectively. All the scoring systems assigned higher scores to those patients who died than to those who survived. Areas under the curve calculated by ROC curve analysis for APACHE II, SAPS II, POSSUM, and P-POSSUM were 0.786, 0.854, 0.793, and 0.831, respectively. Best stratification was achieved by the SAPS II score.

Conclusions: SAPS II and P-POSSUM were determined to be better predictors for patients with colorectal cancer undergoing resection. SAPS II also was found to have a higher degree of discriminatory power in colorectal resection for carcinoma. The predictive value of this useful severity score in several surgical subgroups must be examined to evaluate its routine use in risk-adjusted audit.
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http://dx.doi.org/10.1007/s00268-007-9321-yDOI Listing
April 2008

Effects of preoperative carbohydrate loading on glucose metabolism and gastric contents in patients undergoing moderate surgery: a randomized, controlled trial.

Nutrition 2008 Mar 21;24(3):212-6. Epub 2007 Dec 21.

Department of Surgery, Gulhane Military Medical Academy, Ankara, Turkey.

Objective: Despite contrary evidence, the practice of overnight fasting before elective surgery maintains its place in tradition. However, prolonged starvation, by its catabolic action, may increase the detrimental effects of surgery. In this study, we evaluated the effects of preoperative carbohydrate loading on the gastric contents of patients and perioperative metabolism.

Methods: Seventy patients scheduled for cholecystectomy or thyroidectomy randomly were assigned to the treatment or control group. Patients in the treatment group (n = 34) received 800 mL of a carbohydrate-rich fluid on the evening before surgery and 400 mL of the same fluid 2 h preoperatively. Conversely, control patients (n = 36) underwent overnight fasting. Plasma glucose and serum insulin levels were obtained across the perioperative period and during anesthesia induction. The volume and pH of preoperative residual gastric contents also were measured.

Results: Preoperative plasma glucose levels were found to remain significantly higher in patients who had received the carbohydrate-rich fluid. Serum insulin levels that were elevated initially in the study group returned to control levels by the time of anesthesia induction. There was no statistical difference between the two groups with respect to gastric residue contents or gastric fluid pH.

Conclusion: The preoperative intake of carbohydrate-rich fluids does not appear to alter the amount or pH of gastric contents, suggesting that this is a safe procedure, in terms of aspiration risk. Furthermore, the intake of such fluid might prevent energy malnutrition.
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http://dx.doi.org/10.1016/j.nut.2007.11.003DOI Listing
March 2008

Accurate positioning of the 24-hour pH monitoring catheter: agreement between manometry and pH step-up method in two patient positions.

World J Gastroenterol 2007 Dec;13(46):6197-202

Department of General Surgery, Gulhane Military Medical Academy, Kent Koop Mh. 11.Cd. Guneyce Merkez Sit. A/10, 06370, Batikent Ankara, Turkey.

Aim: To investigate the agreement between esophageal manometry and pH step-up method in two different patient positions.

Methods: Eighteen subjects were included in the study. First, the distance from the nose to the proximal border of the lower esophageal sphincter (LES) was measured manometrically. Then a different investigator, who was blinded to the results of the first study, measured the same distance using the pH step-up method, with the patient in both upright and supine positions. An assessment of agreement between the two techniques was performed.

Results: In the supine position, the measurement of only one subject was outside the range accepted for correct positioning (< or = 3 cm distal or proximal to the LES). In the upright position, errors in measurement were recognized in five subjects. Bland-Altman plots revealed good agreement between measurements obtained manometrically and by the pH-step up method with the patient in the supine position.

Conclusion: In the case of nonavailability of manometric detection device, the pH step-up method can facilitate the positioning of the 24 h pH monitoring catheter with the patient in the supine position. This should increase the use of pH-metry in clinical practice for subjects with suspected gastroesophageal reflux disease if our results are supported by further studies.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171229PMC
http://dx.doi.org/10.3748/wjg.v13.i46.6197DOI Listing
December 2007

Preoperative and postoperative administration of hyperbaric oxygen improves biochemical and mechanical parameters on ischemic and normal colonic anastomoses.

J Invest Surg 2006 Jul-Aug;19(4):237-44

Department of Surgery, Gulhane Military Medical Academy, Ankara, Turkey.

Colonic anastomotic leaks are a major postoperative complication, causing increased mortality and morbidity. Tissue ischemia is one of the most important factors that disrupt anastomotic healing. It is possible to reverse inadequate tissue oxygenation by using increased atmospheric pressure and hyperoxia, which are obtained from hyperbaric oxygen treatment (HBO). Our aim was to investigate the effects of preoperative and postoperative HBO treatment on normal and ischemic colonic anastomoses in rats. Eighty male Wistar Albino rats, weighing between 180 and 240 g, were divided into 8 equal groups. A 1-cm segment of left colon was resected 3 cm proximal to the peritoneal reflection in all groups and colonic anastomosis was performed. In groups 2, 4, 6 and 8, colonic ischemia was established by ligating 2 cm of mesocolon on either side of the anastomosis. Control groups (1 and 2) received no HBO. HBO treatment was given preoperatively in groups 3 and 4, postoperatively in groups 5 and 6, and both preoperatively and postoperatively in groups 7 and 8. HBO treatment was applied for 2 days in the preoperative period and 4 days in the postoperative period. Relaparotomy was performed on postoperative day 5 and a perianastomotic colon segment 2 cm in length was excised for detection of biochemical and mechanical parameters of anastomotic healing and histopathological evaluation. HBO treatment increased tissue hydroxyproline levels in all groups, and this difference was significant in normal anastomosis groups receiving preoperative HBO compared to controls (p = .013 for group 1 vs. group 3; p = .023 for group 1 vs. group 5). This improvement was more evident in ischemic and normal groups treated by administration of combined pre- and postoperative HBO (p = .021 and p = .013). HBO treatment also increased the mean bursting pressure values in all groups, and again, a statistically significant increase was noted in the ischemic groups compared to controls (p = .002 for group 2 vs. group 6; p = .001 for group 2 vs. group 8). Histopathological evaluation of anastomotic line fibrosis was not found to show significant differences between the groups. Adequate tissue oxygenation is the main factor in wound and anastomosis healing. HBO treatment has a positive effect on biochemical and mechanical parameters of ischemic and normal colon anastomoses in rats. It is possible to see this effect more clearly with combined HBO treatment applied before and after ischemic anastomosis.
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http://dx.doi.org/10.1080/08941930600778230DOI Listing
September 2006

[Evaluation of occult lymph node metastasis in lower lip cancers and approach to N(0) neck metastasis].

Kulak Burun Bogaz Ihtis Derg 2002 Jan-Feb;9(1):41-5

2nd Department of Otolaryngology, SSK Training Hospital, Ankara, Turkey.

Objectives: In this study, we evaluated the incidence of occult lymph node metastasis and the approach to N0 necks in carcinoma of the lower lip.

Patients And Methods: Sixty-eight patients who underwent surgery for squamous cell carcinoma of the lower lip were monitored for a minimum period of three years. All the patients were males (mean age 54 years; range 36 to 69 years). Preoperatively, 15 and 53 patients had N+ and N0 necks, respectively. Depending on the tumor localization, unilateral or bilateral suprahyoid neck dissections were performed. Nine patients underwent radical neck dissection following detection of metastasis on histopathologic examination.

Results: Histopathologic examination revealed metastasis in four patients (4/15; 26%) with N+ necks and in five patients (5/53; 9.4%) with N0 necks. Four patients (6.7%) developed late cervical lymph node metastasis at level 3. No evidence of neck disease was encountered in 93% of patients.

Conclusion: Suprahyoid neck dissection appears to be effective in detecting occult lymph node metastasis. With improved surgical and histopathologic techniques and consideration of skip metastasis, more aggressive treatment approaches may be employed and better survival rates may be obtained.
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October 2002