Publications by authors named "Oktay Irkorucu"

70 Publications

The effect of Farnesoid X receptor agonist tropifexor on liver damage in rats with experimental obstructive jaundice.

Acta Cir Bras 2021 25;36(9):e360902. Epub 2021 Oct 25.

MD. University of Sharjah - College of Medicine - Clinical Sciences Department - Sharjah, UAE.

Purpose: To investigate experimentally the effects of Tropifexor, a farnesoid X receptor agonist, on liver injury in rats with obstructive jaundice.

Methods: Forty healthy Wistar albino female rats were divided randomly in selected groups. These groups were the sham group, control group, vehicle solution group, Ursodeoxycholic acid group and Tropifexor group. Experimental obstructive jaundice was created in all groups, except the sham one. In the blood samples obtained, aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), total bilirubin and direct bilirubin levels were established and recorded. Additionally, liver malondialdehyde, myeloperoxidase and catalase enzyme activity in the tissue samples were studied. Histopathological analysis was also performed.

Results: No statistical difference was found between the control group and the Tropifexor group when AST, ALT and ALP values were compared. However, it was found that the Tropifexor group had statistically significant decreases in the values of GGT, total bilirubin and direct bilirubin (p < 0.05). Additionally, Tropifexor decreased the median values of malondialdehyde and myeloperoxidase, but this difference was not statistically significant compared to the control group. Finally, the Tropifexor group was statistically significant in recurring histopathological liver damage indicators (p < 0.05).

Conclusions: Tropifexor reduced liver damage due to obstructive jaundice.
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http://dx.doi.org/10.1590/ACB360902DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8555997PMC
November 2021

The reliability of breast cancer surgery in a regional pandemic hospital during the COVID-19 pandemic: Delay or Do?

J BUON 2021 Jul-Aug;26(4):1379-1385

Department of General Surgery, Adana City Training and Research Hospital, Adana, Turkey.

Purpose: The purpose of this study was to examine the effect of COVID-19 infection on the morbidity and mortality rates of breast cancer patients performed in the East Mediterranean region of Turkey during the COVID-19 pandemic and to share the results of those investigations.

Methods: This retrospective study included all breast cancer patients that underwent surgery during the COVID-19 pandemic in the General Surgery Clinic of Adana City Training and Research Hospital, a regional pandemic hospital, between March 11, 2020 and December 25, 2020. The patients were evaluated preoperatively and postoperatively (the first 30 days) in terms of COVID-19 infection. Moreover, these patients were also evaluated in terms of admission to the hospital, length of hospital stay, and mortality due to COVID-19 infection during the follow-up period of the study.

Results: Included in the study were 139 patients that underwent surgery for breast cancer during the pandemic period, with no observed mortality or morbidity associated with COVID-19 in any patient postoperatively within the first 30 days. In addition, within 121.22±70.05 days, the mean and standard deviation of the study's follow-up period, 19 patients (15.7%) were admitted to the hospital with a suspected COVID-19 infection (after the first 30 days postoperatively) and 6 of them (4.3%) returned a positive PCR test. All of the COVID-19 positive patients (6 patients, 4.3%) were hospitalised and 3 of them (2.2%) died due to the COVID-19 infection.

Conclusion: Breast cancer surgery can be performed safely during the COVID-19 pandemic period after taking the necessary precautions.
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September 2021

Relationship between Lymph Node Metastasis and a Low 18F-FDG PET/CT Axillary SUVmax Value in Breast Cancer.

J Coll Physicians Surg Pak 2021 May;30(5):511-516

Department of Pathology, University of Health Sciences, Adana City Education and Research Hospital, Turkey.

Objective:  To evaluate breast cancer patients with low F18-fluorodeoxy-glucose positron emission tomography/computed tomography scan (FPET) of axilla standardised maximum uptake value (SUVmax) along with their histopathological findings regarding axillary lymph node metastasis (LNM).

Study Design: A descriptive study. Place and Duration of the Study: Adana City Education and Research Hospital, Turkey, from January 2015 to October 2018.

Methodology: The current study analysed the findings of 113 patients according to age, histopathological axillary LNM, estrogen and progesterone receptor status, tumour size, histological grade, Ki-67, HER2 and preoperative FPET SUVmax findings. Histopathological and immunohistochemical comparisons were made between FPET axilla SUVmax and univariate and multivariate parameters in breast carcinoma in terms of LNM.

Results: The authors analysed the receiver operator characteristic curve for the FPET axilla SUVmax and set the cut-off value to 1.84 to predict LNM. However, it was also found that the SUVmax detected metastases in the axilla at values lower than 1.84. In the multivariate analysis, a statistically significant relationship was found between axilla LNM cases that have FPET axilla SUVmax less than 1.84, a Ki-67 index greater than 15% and tumour size greater than 2 cm (p <0.05).

Conclusion: Values that were above the axilla SUVmax limit of 1.84 in FPET helped determine LNM. However, further evaluation of patients is needed comparing axilla SUVmax of less than 1.84 in FPET together with the Ki-67 proliferation index and tumour size. Key Words: Breast, Cancer, Lymph nodes, Metastasis, PET, Pathology.
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http://dx.doi.org/10.29271/jcpsp.2021.05.511DOI Listing
May 2021

The Adjunctive Effect of DuraSeal® vs. 2-Octyl-Cyanoacrylate on Delayed Repair of Gastric Perforation: An Experimental Study.

J Invest Surg 2021 Feb 28:1-7. Epub 2021 Feb 28.

General Surgery, Health Sciences University, Adana Training and Research Hospital, Adana, Turkey.

Objective: Delayed primary suture closure of gastric perforation is prone to dehiscence hence the repaired area should be buttressed to avoid re-operation. We aimed to investigate whether DuraSeal®(DS) has a potent adjunctive effect on delayed closure of gastric perforation comparing with 2-octly-cyanoacrylate(CYN) in an experimental model.

Methods: Sixty rats were randomly divided into 6 groups. All subjected to gastric perforation, subsequently perforation areas were repaired by primary suturing, delayed repair was performed 12 h after surgery. According to DS or CYN application on anastomosis, the groups were classified as control(C), delayed control(CD), closure with CYN(CYN), delayed closure with CYN(D-CYN), closure with DS(DS), delayed closure with DS(D-DS).After euthanization on POD 7,anastomotic bursting pressure(ABP) were measured. Tissue samples were taken for histopathological examination and hydroxyproline(TH) assessment.

Results: Delayed condition significantly reduced ABP and TH levels in CD group comparing with all groups(p < 0.01).Either CYN or DS application on delayed repaired area significantly raised the measure of ABP and TH up to the levels of C group(p < 0.05,comparing with CD).Microscopically,either CYN or DS application significantly improved tissue necrosis, submucosal bridging and collagen formation comparing with CD group(p < 0.012).There were no difference regarding ABP, TH and tissue healing between each CYN and DS groups.

Conclusion: DuraSeal® application on sutured gastric perforation area yielded a significant adjunctive effect both in normal and delayed conditions. However, DuraSeal® revealed no superior effect to CYN in both condition.Our results demonstrated that the clinical use of DuraSeal® can be considered for reinforcing the sutured line in patients undergoing delayed surgery for gastric perforation.
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http://dx.doi.org/10.1080/08941939.2021.1887414DOI Listing
February 2021

Acute appendicitis in pregnancy: 50 case series, maternal and neonatal outcomes.

Ulus Travma Acil Cerrahi Derg 2021 Mar;27(2):255-259

Department of General Surgery, Adana City Training and Research Hospital, Adana-Turkey.

Background: During pregnancy, the most common indication for non-obstetric surgery in acute abdomen is appendicitis. In pregnancy, appendicitis may be confused with pregnancy-related pathologies and may cause a delay in diagnosis or unnecessary surgery. The present study aims to evaluate the maternal and neonatal outcomes of patients undergoing appendectomy during pregnancy.

Methods: This study was designed retrospectively between 2011-2017. Appendicitis detection rates, admission and laboratory features, operation results and obstetric results were evaluated in pregnant women who underwent surgery for a preliminary diagnosis of acute appendicitis.

Results: The findings showed that 2593 patients underwent an appendectomy, 1154 of them were women and 50 of them were pregnant. Negative laparotomy was detected in 12 (16%) patients. Six (12%) of these 50 patients had a laparoscopic appendectomy and 44 (88%) had an appendectomy with laparotomy. The mean time to operation after admission to hospital was 10.5±11 hours. No maternal mortality was observed. Preterm labor occurred in four (8%) patients. Two patients (4%) were in the second trimester and two patients (4%) were in the third trimester. Two (4%) newborns born in the second trimester died postpartum. One of these newborns had multiple anomalies. Appendectomy was not characterized by an increased risk of perinatal mortality.

Conclusion: Delay in the diagnosis and surgery of acute appendicitis during pregnancy may increase the risk of perinatal mortality and should not be delayed in diagnosis and surgery in pregnancy.
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http://dx.doi.org/10.14744/tjtes.2020.24747DOI Listing
March 2021

Shear Wave Elastography and Shear Wave Velocity Value for Idiopathic Granulomatous Mastitis.

Authors:
Oktay Irkorucu

Acad Radiol 2021 03 6;28(3):438. Epub 2020 Aug 6.

Sağlık Bilimleri University, Adana Health Research and Training Center, Department of General Surgery, Adana, Turkey. Electronic address:

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http://dx.doi.org/10.1016/j.acra.2020.04.048DOI Listing
March 2021

Margin dilemma in vacuum-assisted excisional BIOPSY to treat benign phyllodes tumors.

Authors:
Oktay Irkorucu

Breast 2020 10 4;53:101. Epub 2020 Jul 4.

Sağlık Bilimleri University, Adana Health Research and Training Center, Department of General Surgery, Mahfesıgmaz Mahallesi, 79043 Sokak, Hacı Omay Apt. Kat:2 No:2, Çukurova, Adana, Turkey. Electronic address:

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http://dx.doi.org/10.1016/j.breast.2020.06.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7377327PMC
October 2020

The influence of platelet-rich plasma (PRP) on colonic anastomosis healing impaired by intraperitoneal 5-flourouracil application. An experimental study.

Acta Cir Bras 2020 Jul 6;35(5):e202000504. Epub 2020 Jul 6.

MD, Department of General Surgery, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey. Acquisition of data.

Purpose: 5-flourourasil (5-FU) is commonly used for early intraperitoneal chemotherapy in colorectal or appendiceal cancer patients with peritoneal carcinomatosis. Due to its effect, anastomosis healing can be impaired and leads to anastomotic leakage. In this study, we aimed to investigate the potential healing effect of platelet-rich plasma (PRP) on colonic anastomosis impaired by intraperitoneal 5-flourouracil application.

Methods: After ten rats were sacrificed for preparing PRP, forty Wistar-albino rats were subjected to colonic anastomosis, and randomly allocated into four groups including 10 rats each. According to receiving PRP and/or 5-FU application, the groups were formed as control (C), 5-FU without PRP (CT), anastomosis with PRP (C-PRP), and 5-FU with PRP (CT-PRP). CT and CT-PRP groups also received 5-FU intraperitoneally on postoperative day 1 (POD 1). All animals were euthanized on pod 7. The body weight change, anastomotic bursting pressure (ABP), tissue hydroxiprolin (TH) and histopathological examination of each group were analyzed.

Results: 5-FU application significantly reduced ABP levels when compared with group C, C-PRP and CT-PRP (for each comparison, p<0,01). PRP application in CT-PRP group raised the measure of ABP up to the levels of C group. Although tissue hydroxyproline levels (THL) levels of CT-PRP group were found higher than CT group, it was not significant (p=0.112). Microscopically, comparing with CT group, PRP application significantly promoted the healing of colonic anastomosis subjected to 5-FU application by improving tissue edema, necrosis, submucosal bridging and collagen formation (p<0.05). Tissue healing in CT-PRP group was observed as good as the control groups. (C, C-PRP, p=0.181, p=0.134; respectively).

Conclusion: PRP administration on colonic anastomosis significantly promotes the healing process of anastomosis in rats receiving 5-FU. This result encourages further clinical use of PRP to reduce the frequency of AL in patients receiving EPIC.
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http://dx.doi.org/10.1590/s0102-865020200050000004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7341987PMC
July 2020

Comparison of open appendectomy and laparoscopic appendectomy with laparoscopic intracorporeal knotting and glove endobag techniques: A prospective observational study.

Turk J Surg 2017 1;33(4):258-266. Epub 2017 Dec 1.

Department of Anesthesiology and Reanimation, Kars State Hospital, Kars, Turkey.

Objective: Despite the recent increase in the use of laparoscopic appendectomy procedures to treat acute appendicitis, laparoscopic appendectomy is not necessarily the best treatment modality. The aim of this study is to examine the value of laparoscopic intracorporeal knotting and glove endobag in terms of various parameters and in terms of reducing the costs related to laparoscopic appendectomy procedures.

Material And Methods: Seventy-two acute appendicitis patients who underwent laparoscopic appendectomy and open appendectomy surgery were enrolled in the study and were evaluated prospectively. The patients were divided into two groups: group 1 was treated with laparoscopic appendectomy using laparoscopic intracorpreal knotting and glove endobag (n=36) and group 2 was treated with open appendectomy (n=36). The two groups were statistically compared in terms of preoperative symptoms and signs, laboratory and imaging findings, operation time and technique, pain score, gas and stool outputs, duration of hospital stay, return to normal activity, and complications.

Results: No statistically significant differences were found between the groups in relation to gender, age, body mass index, or pre-operation findings, which included loss of appetite, vomiting, time when pain started, displacement of pain, defense, rebound, imaging methods, and laboratory and pathology examinations (p>0.05). Moreover, there were no differences between the groups with respect to drain usage, hospital stay time, or complications (p>0.05). In contrast, a statistically significant difference was found between the groups in terms of operation time, pain scores, gas-stool outputs, and return to normal activity in the laparoscopic appendectomy group (p=0.001).

Conclusion: Laparoscopic appendectomy can be performed in a facile, safe, and cost-effective manner with laparoscopic intracorporeal knotting and glove endobag. By using these techniques, the use of expensive instruments can be avoided when performing laparoscopic appendectomy.
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http://dx.doi.org/10.5152/turkjsurg.2017.3583DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5731561PMC
December 2017

Approach to the Assessment of Vocal Cord Movement by Ultrasonography.

World J Surg 2018 04;42(4):1214

Department of General Surgery, Adana Health Research and Training Center, Sağlık Bilimleri University, Adana, Turkey.

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http://dx.doi.org/10.1007/s00268-017-4238-6DOI Listing
April 2018

Granulomatous mastitis: We need a useful classification system.

Authors:
Oktay Irkorucu

Am J Surg 2018 09 21;216(3):642. Epub 2017 Aug 21.

Sağlık Bilimleri University, Adana Health Research and Training Center, Department of General Surgery, Adana, Turkey. Electronic address:

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http://dx.doi.org/10.1016/j.amjsurg.2017.08.007DOI Listing
September 2018

Can isolated pancreaticojejunostomy reduce pancreas fistula after pancreaticoduodenectomy with Roux-en-Y reconstruction?

Ulus Cerrahi Derg 2016 1;32(4):248-251. Epub 2016 Dec 1.

Clinic of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey.

Objective: Pancreaticoduodenectomy is a surgical procedure which is commonly accepted in cases of ampulla of Vater, head of pancreas, distal common bile duct neoplasms and severe chronic pancreatitis. Pancreatic fistula is still a serious problem after reconstruction. Yet, there is no consensus on a single reconstruction method.

Material And Methods: The reconstruction methods on patients who had pancreaticoduodenectomy due to pancreatic tumor, and results of these reconstruction methods were retrospectively analyzed. Anastomosis was performed on all patients in the form of Roux-en-Y, but they varied as follows; Type 1: Only pancreatic anastomosis to the Y limb, Type 2: Pancreas and hepatic canal anastomosis together to the Y limb.

Results: 31 patients participated in the study. 21 of them were male, and 10 were female. In our study, postoperative complications included pancreatic fistula, hemorrhage, abscess, wound site infection, and pulmonary infection. Although more complications were observed in group 2 than in group 1, there was no statistically significant difference. There was one mortality in each group.

Conclusion: In our opinion, one of the reasons of leakage is that anastomosis of both the biliary and pancreatic ducts to the same loop increases anastomotic pressure due to the raised output thus leading to fistula formation. A limitation of our study was the low number of patients. Reconstruction of the pancreas and bile secretions through separate anastomosis may reduce the rate of pancreatic fistulas.
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http://dx.doi.org/10.5152/UCD.2016.3174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5245715PMC
December 2016

Comparison of 1869 thyroid ultrasound-guided fine-needle aspiration biopsies between general surgeons and interventional radiologists.

Ann Med Surg (Lond) 2016 Sep 2;10:92-102. Epub 2016 Aug 2.

Health Sciences University Adana Numune Training and Research Hospital, Department of Interventional Radiology, Adana, Turkey.

Background: Thyroid nodules are commonly encountered problems in clinical practice. For patients who have a thyroid nodule, the fine-needle aspiration biopsy (FNAB) is the most important test, as it is the most reliable diagnostic method for distinguishing between benign thyroid nodules and cancerous nodules. FNAB is able to be performed either via an ultrasound (USG) or alone and is the first choice when it comes to diagnosing thyroid nodules, given that it is cheap, safe and provides accurate results.

Objective: In this study-a retrospective analysis of FNAB via USG - our aim is to evaluate the multiple variables related to FNAB procedures, including the experience of the person performing the biopsy, the age and gender of the patient, the number of nodules, the size of the nodule(s) and the number of lams recorded from the cytopathology report on non-diagnostic rates, conducted at an invasive radiology clinic and at a general surgery clinic.

Materials And Methods: A total of 1062 patients involving 1869 nodules, examined using FNAB via USG, were reviewed retrospectively from records dated between November 2011 and July 2014 and from pathology reports taken from the ANEAH General Surgery clinic and Interventional Radiology clinic. Cytopathology results were classified according to the 2007 Bethesda System for Reporting. Gender, age, number of nodules, diameter of the nodules, biopsied nodules, location of the nodules, number of lams, symptoms and the date of biopsies were the parameters used to examine the factors involved in non-diagnostic cytopathology invasive radiology. These parameters were inspected at both of the clinics (ANEAH General Surgery clinic and Interventional Radiology clinic). In analyzing the results, the statistical significance level was set at 0.05, where in cases that the p value was under 0.05 (p < 0.05), it was determined that no significant relationship existed. In this study, data were analyzed using SPSS 20 software.

Results: Of the nodules reviewed, 1620 were found on females and 249 on males. The age of the patients ranged from 10 to 87 years, with the mean age being 50 years. In the general surgery clinic, 470 nodules of 341 patients were aspirated, and in the interventional radiological clinic, 1399 nodules of 721 patients were aspirated. In the literature review conducted to compare statistical assessments of FNAB via USG, no significant difference was found between the ANEAH General Surgery clinic and the Invasive Radiology clinic (p > 0.05). In the invasive radiology clinic, non-diagnostic rates decreased with the increase in experience of the person who conducted the biopsy (p = 0.001).

Conclusion: The results from both of the clinic's rates of non-diagnostic FNAB, performed via USG, were found to be acceptable. Our study also demonstrates that USG-guided FNAB can be performed with a low non-diagnostic rate as experience grows.
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http://dx.doi.org/10.1016/j.amsu.2016.07.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4995479PMC
September 2016

Evaluating the effect of infliximab on the healing of left colonic anastomosis in the presence of intra-abdominal sepsis.

Arab J Gastroenterol 2016 Jun 11;17(2):84-9. Epub 2016 Jul 11.

Adana Numune Training and Research Hospital, Department of Pathology, Adana, Turkey.

Background And Study Aims: Infliximab (IFX) is a chimeric anti-TNF-α body which is effectively used in the treatment of inflammatory bowel diseases and a variety of autoimmune diseases. The effect of IFX on the healing of intestinal anastomosis has been evaluated in several studies, however with conflicting results. Furthermore, the effect of IFX on colonic anastomosis in sepsis has not been evaluated to date. In this study, we aimed to investigate whether IFX has an adverse effect on the healing process of colonic anastomosis either under normal or septic condition.

Material And Method: The efficiency of IFX was assessed with respect to anastomotic bursting pressure (ABP), tissue hydroxyproline levels (THL) and histopathological examination of left colonic anastomosis in 40 male rats. The rats were randomly allocated into four groups of 10 rats each as control (C), septic control (SC), control IFX (C-IFX) and septic IFX (S-IFX).

Results: The anastomotic bursting pressure was measured at 182±19.1, 158±15.4, 161±26.8 and 100±10.3mm/Hg, in C, SC, C-IFX and S-IFX; respectively. IFX administration did not influence the anastomotic strength under normal condition whereas in sepsis significantly induced the reduction of APB. The mean THL was almost similar in both control groups (p=0.87), whilst IFX reduced the level of TH in sepsis comparing with control groups (p=0.01). IFX significantly impaired immune response in sepsis resulting in poor anastomotic healing in S-IFX group.

Conclusion: Our study demonstrated that IFX had no detrimental effect on the healing of colonic anastomosis under normal condition whilst significantly impaired the healing process in sepsis.
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http://dx.doi.org/10.1016/j.ajg.2016.05.001DOI Listing
June 2016

The potential efficacy of Survanta (r) and Seprafilm (r) on preventing intra-abdominal adhesions in rats.

Acta Cir Bras 2016 Jun;31(6):389-95

PhD, Department of Pathology, Cukurova University Medical Faculty, Adana, Turkey. Histopathological examinations, manuscript review.

Purpose: To investigate the potential efficacy of beractant (Survanta(r)) and Seprafilm(r) on the prevention of postoperative adhesions.

Methods: Forty Wistar-albino female rats were used. The rats were randomly allocated into four groups of 10 rats each as control group (CG), beractant group (BG), Seprafilm(r) group (SG), and combined group (COG). All rats underwent cecal abrasion via midline laparotomy. Before abdominal closure, isotonic saline, beractant, Seprafilm, and combined agents were intraperitoneally administered. Adhesions were classified macroscopically with Canbaz Scoring System on postoperative day 10. Ceacum was resected for histopathological assessment.

Results: Macroscopic adhesion scores were significantly lower in BG, SG, and COG than CG (p<0.05); (45%, 15%, 25%, and 15%; respectively). Histopathological assessment revealed a reduced inflammation and fibrosis score in the study groups than CG (p<0.05). In BG, adhesion development, inflammation and fibrosis scores were lower than SG; however, it was not statistically significant.

Conclusions: Intra-abdominal application of beractant is significantly effective for the prevention of adhesion formation with no adverse effect by covering the whole peritoneal mesothelium with excellent gliding properties in a rat model. The combination of both agents is also effective in reducing adhesion formation, however, not superior to single beractant application.
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http://dx.doi.org/10.1590/S0102-865020160060000005DOI Listing
June 2016

Management for pilonidal disease: Before you compare, use a classification system.

Asian J Surg 2016 Oct 16;39(4):260-1. Epub 2016 Jun 16.

Department of General Surgery, Adana Numune Research and Training Hospital, Adana, Turkey. Electronic address:

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http://dx.doi.org/10.1016/j.asjsur.2016.04.004DOI Listing
October 2016

A Giant Aggressive Angiomyxoma of the Pelvis Misdiagnosed as Incarcerated Femoral Hernia: A Case Report and Review of the Literature.

Case Rep Surg 2016 5;2016:9256749. Epub 2016 May 5.

Department of Pathology, Cukurova University Medical Faculty, Adana, Turkey.

Aggressive angiomyxoma (AA) is an uncommon mesenchymal tumor that is mostly derived from the female pelvic and perineal regions. AA is a locally infiltrative slow growing tumor with a marked tendency to local recurrence. Painless swelling located around the genitofemoral region is the common symptom; thus, it is often misdiagnosed as a gynecological malignancy or a groin hernia. A 35-year-old female patient who previously underwent surgery for left femoral hernia operation resulting in surgical failure was reoperated for a giant AA located in the pelvis. The tumor was completely excised with free margins. Histopathologic examination revealed an AA. The tumor size was measured as 24 × 12 × 6 cm with a weight of 4.2 kg. Immunohistochemically, the cells show positive staining with vimentin, desmin, estrogen, and progesterone receptor. S100, MUC4, CD34, and SMA were negative in the tumor cells. AA should be considered in the differential diagnosis of any painless swelling located in the genitofemoral region, particularly in women of reproductive age. The principle treatment should be complete surgical excision with tumor-free margins. Long-term follow-up and careful monitoring are essential due to its high tendency of local recurrence in spite of wide excision of the tumor. Adjuvant antihormonal therapy yields promising results for preventing recurrence.
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http://dx.doi.org/10.1155/2016/9256749DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4871960PMC
June 2016

Zuckerkandl tubercle in thyroid surgery: Is it a reality or a myth?

Authors:
Oktay Irkorucu

Ann Med Surg (Lond) 2016 May 6;7:92-6. Epub 2016 Apr 6.

Adana Numune Research and Training Hospital, Department of General Surgery, Adana, Turkey.

Background: Zuckerkandl tubercle (ZT) is a lateral projection from the lateral thyroid lobe which is a constant landmark for finding the recurrent laryngeal nerve during thyroid surgery. It is the condensed thyroid parenchyma located in the cricothyroid junction. Even today, ZT and its relationship with recurrent laryngeal nerve (RLN) is not well known by all surgeons. The objectives of the present study were to find out the incidence of ZT in our thyroidectomies and to investigate whether the ZT has a relationship with RLN. We also discussed how to prevent RLN injury during thyroidectomy.

Materials And Methods: One hundred operations were performed by the same surgeon included in this study. All operations performed with intraoperative neuromonitorization (IONM) for proving the visualization of RLN. In each patient, particularly the ZT and its relationship with RLN searched and recorded. We also analyzed the patients in terms of sex, age, clinical diagnosis, and types of performed operations.

Results: In 100 operations, 173 thyroid lobectomies were considered. 87 of these lobectomies were in right side and 86 in left side. The ZT was determined in 127 of 173 (73.41%) lobectomies. ZT was detected in 68 (78.16%) of right thyroid lobes whereas in 59 (68.60%) of left thyroid lobes. We observed that the ZT was detected more frequently in the right side. In 115 (90.55%) of these occasions, the recurrent nerve was directed upwards covered by the ZT.

Conclusions: If it is present, ZT is a real constant landmark pointing to the RLN. In order to find and protect RLN during thyroid surgery, a careful, bloodless, and meticulous dissection should be carried out around the ZT. Although our results are encouraging, further researches are still needed on this topic.
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http://dx.doi.org/10.1016/j.amsu.2016.03.030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4840449PMC
May 2016

The comparison of CT fistulography and MR imaging of perianal fistulae with surgical findings: a case-control study.

Abdom Radiol (NY) 2016 08;41(8):1474-83

Department of General Surgery, Numune Teaching and Research Hospital, Adana, Turkey.

Purpose: The purpose of this study was to evaluate the diagnostic efficacies of CT fistulography and MRI, in the diagnostic work-up of perianal fistula patients.

Materials And Methods: All 41 patients who were included in the study (36 males and 5 females, with an average age of 41 years) underwent CT fistulography and MRI examinations prior to surgery. The fistula characteristics obtained from these examinations were compared with the surgical findings. The comparative results were evaluated by means of the Kappa analysis method.

Results: CT fistulography predicted the correct perianal fistula classification in 30 (73.1%) of the 41 patients, whereas MRI correctly defined fistula classification in 38 (92.7%) of these patients (the K values were 0.621 and 0.896, respectively; with p < 0.001). CT fistulography depicted 29 secondary extensions in 16 patients, whereas MR imaging revealed 28 secondary extensions in 15 patients. A substantial agreement was found between surgical findings and two modalities (K value was 0.789 and 0.793 for CT fistulography and MRI, respectively, with a p value < 0.001). In terms of locations of internal openings, CT fistulography was able to detect the locations in 28 patients (68.2%), whereas MRI was more successful in this aspect, with a number of 35 patients (85.3%). Granulation tissues, inflammation and edema around the fistula, abscesses, and fistular wall fibrosis were also evaluated.

Conclusion: CT fistulography and MRI have different advantages in the diagnosis of perianal fistulas. A good command of knowledge concerning the issue may be a key factor in modality decision.
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http://dx.doi.org/10.1007/s00261-016-0722-yDOI Listing
August 2016

The Effect of Platelet-Rich-Plasma on the Healing of Left Colonic Anastomosis in a Rat Model of Intra-Abdominal Sepsis.

J Invest Surg 2016 Oct 29;29(5):294-301. Epub 2016 Jan 29.

d Department of Pathology , Adana Numune Training and Research Hospital , Adana , Turkey.

Objective: The aim of this study was to investigate the effect of platelet-rich plasma (PRP) on the healing of colonic anastomosis in the presence of sepsis.

Materials And Method: Fifty Wistar-albino male rats were used. Ten healthy rats were euthanized to prepare PRP, the rest were subjected to colonic anastomosis and randomly allocated into four groups of 10 rats each as anastomosis without PRP (C), without PRP in sepsis (SC), anastomosis with PRP (C-PRP), and with PRP in sepsis (S-PRP). Sepsis was induced by cecal ligation and puncture procedure. All animals were euthanized on postoperative day 7. The body weight change, anastomotic bursting pressure (ABP), tissue hydroxyproline (TH) and histopathological examination of each group were analyzed by using one-way analysis of variance (ANOWA) and Tukey's HSD post-hoc test to assess the differences between the groups.

Results: There was no statistical difference among the groups in terms of body weight changes. The ABP was measured at a mean value of 179.5 ± 10.3, 129.3 ± 14.2, 209 ± 14.4, and 167.5 ± 7.5 mm-Hg, in group C, SC, C-PRP, and S-PRP, respectively. The ABP and TH of C-PRP group was significantly higher than three groups (p < .05, for each comparison). In sepsis, PRP significantly raised the mean ABP and TH levels up to the levels of C group. Tissue regeneration was significant with increased collagen formation in C-PRP group than the other groups (p < .05). The healing effect of PRP in the presence of sepsis was significant than S-group (p < .05), while similar to C group (p = .181).

Conclusion: PRP application to colonic anastomosis promotes the healing process in rats with intra-abdominal sepsis.
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http://dx.doi.org/10.3109/08941939.2015.1111473DOI Listing
October 2016

Pancreatic Gastrointestinal Stromal Tumor after Upper Gastrointestinal Hemorrhage and Performance of Whipple Procedure: A Case Report and Literature Review.

Am J Case Rep 2015 Aug 3;16:509-13. Epub 2015 Aug 3.

Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey.

Background: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the gastrointestinal system. These types of tumors originate from any part of the tract as well as from the intestine, colon, omentum, mesentery or retroperitoneum. GIST is a rare tumor compared to other types of tumors, accounting for less than 1% of all gastrointestinal tumors.

Case Report: A 56-year-old male patient was hospitalized due to an upper gastrointestinal hemorrhage and the start of abdominal pain on the same day. In the upper gastrointestinal endoscopy that was performed, a solitary mass was found in the second section of the duodenum and a blood vessel (Forrest type 2a) was seen. The extent and location of the mass was detected by abdominal tomography. After hemodynamic recovery, a Whipple procedure was performed without any complications. A subsequent histopathological examination detected a c-kit-positive (CD117) pancreatic GIST with high mitotic index.

Conclusions: The most effective treatment method for GISTs is surgical resection. In patients with a head of pancreatic GIST, the Whipple procedure can be used more safely and effectively.
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http://dx.doi.org/10.12659/AJCR.893803DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4527206PMC
August 2015

Effectiveness of Limberg and Karydakis flap in recurrent pilonidal sinus disease.

Clinics (Sao Paulo) 2015 May 1;70(5):350-5. Epub 2015 May 1.

Kars State Hospital General Surgery, Kars, Merkez, Turkey.

Objective: Sacrococcygeal pilonidal sinus is common in young men and may recur over time after surgery. We investigated whether a factor exists that can aid in the determination of the preferred technique between the early Limberg flap and Karydakis flap techniques for treating recurrent pilonidal sinus.

Materials And Methods: This prospective and randomized study enrolled 71 patients with recurrent pilonidal sinus in whom the Limberg flap or Karydakis flap techniques were applied for reconstruction after excision. Patients were divided into two groups as follows: 37 patients were treated with the Limberg flap technique and 34 patients were treated with the Karydakis flap technique. Fluid collection, wound infection, flap edema, hematoma, partial wound separation, return to daily activities, pain score, complete healing time, painless seating and patient satisfaction were compared between the groups. ClinicalTrial.gov: NCT02287935.

Results: The development rates of total fluid collection, wound infection, flap edema, hematoma, and partial wound separation were 9.8%, 16%, 7%, 15% and 4.2%, respectively; total flap necrosis was not observed in any patient (p<0.001). During the average follow-up of 28 months, no patients (0%) developed recurrent disease. The two groups differed with respect to early surgical complications (p<0.001).

Conclusion: In this study, use of the Limberg flap was associated with lower complication rates, shorter length of hospital stay, early return to work, low pain score, high patient satisfaction and better complete healing duration. Therefore, we recommend the Limberg flap for treatment of recurrent pilonidal sinus.
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http://dx.doi.org/10.6061/clinics/2015(05)08DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4449468PMC
May 2015

Performance of venous port catheter insertion by a general surgeon: a prospective study.

Int Surg 2015 May;100(5):827-35

1 Adana Numune Training and Research Hospital, Department of General Surgery, Adana and Kars State Hospital General Surgery, Kars, Turkey.

As part of the vascular access procedures, venous ports, commonly referred to as catheters, are placed under the skin to enable safe and easy vascular access for administration of repeated drug treatments. 122 patients who had received a venous port catheter insertion procedure in the general surgery department between January 1012 and January 2014 were involved in this study. Patients were divided into two groups: those who had undergone a fluoroscopy (group 1) and those who had not undergone a fluoroscopy (group 2). Complications that emerged during and after the port catheter insertion procedure and successful insertion rates were recorded in the database. Data of these patients were presented in a prospective manner. There were 92 to 30 patients in groups 1 and 2, respectively. In group 1, the mean age was approximately 56.8, total catheter stay time was 20,631 days, and mean time of port use was 224.2 days. In group 2, the mean age was approximately 61.2, total catheter stay time was 13,575 days, and mean time of port use was 452.5 days. Successful insertion rate was 100% and 90% in groups 1 and 2, respectively (P < 0.05). The proper insertion of the port catheter accompanied by monitoring methods can decrease procedure-related complications. Statistical comparisons between the two groups in terms of malposition and successful insertion rates also support this view (P < 0.05). The findings support the view that in cancer patients, a venous port catheter insertion accompanied by a fluoroscopy can be safely performed by general surgeons.
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http://dx.doi.org/10.9738/INTSURG-D-14-00214.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4452970PMC
May 2015

Evaluation of mean platelet volume as a diagnostic biomarker in acute appendicitis.

Int J Clin Exp Med 2015 15;8(1):1291-5. Epub 2015 Jan 15.

Namik Kemal University, Faculty of Medicine, Department of General Surgery Tekirdag, Turkey.

Background: Diagnosis of acute appendicitis remains to be challenging with up to 30% negative exploration rates. In addition to careful clinical history and physical examination, we still need easily applicable, cheap and effective biomarker.

Patients And Methods: A retrospective case-controlled study was designed in two groups, both containing 100 patients, acute appendicitis and control. Leukocyte count, neutrophil percentage, platelet count and meal platelet volume (MPV) were compared.

Results: MPV values for acute appendicitis and control groups were 7.4 ± 0.9 fL (5.6-10.6) and 9.1 ± 1.6 fL (5.1-13.1). For the diagnosis of acute appendicitis, ROC analysis revealed 74% sensitivity and 75% specificity for a cut-off value of 7.95 fL of MPV, however, the diagnostic value of leukocyte count and/or neutrophil ratio was superior.

Conclusion: Our results suggest that, MPV value is an important parameter in the diagnosis of acute appendicitis, but in terms of sensitivity and specificity, leukocyte count and/or neutrophil percentage is superior.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4358583PMC
March 2015

Evaluation of power Doppler sonography in acute cholecystitis to predict intraoperative findings: a prospective clinical study.

Ulus Travma Acil Cerrahi Derg 2015 Jan;21(1):51-6

Department of General Surgery, Adana Numune Training and Research Hospital, Adana.

Background: This study aimed to evaluate the diagnostic value of gray-scale and power Doppler sonography for acute cholecystitis and show a correlation between sonographic and intraoperative findings, quantitively.

Methods: Forty chronic and forty acute cholecystitis patients were examined. Early laparoscopic cholecystectomy was performed for acute cholecystitis. Demographic characteristics, sonographic findings, and adhesion scores were analyzed. Data were collected prospectively (clinicaltrials.gov: NCT02156947).

Results: Wall thickness (≥3 mm) and vascularity increased in acute cholecystitis (p<0.01 and <0.01). Vascularity was found to be moderately correlated with adhesion (p<0.01, r=0.59) but it did not affect the difficulty of the operation by means of perforation, conversion rate, and operation time. In addition, wall thickness did not correlate with adhesion formation (p=0.36). Sensitivity and specifity of wall thickness and vascularity were found to be 96.9%, 72.7%, and 68%, 87.2%, respectively. When both diagnostic measurements were taken into account, sensitivity was calculated 69.7% and specificity reached up to 97.6%.

Conclusion: Vascularity correlated with adhesion but failed to predict operation difficulty. Specificity of gray-scale sonography could be improved with power Doppler examination; however, desired diagnostic accuracy could not be obtained with only quantitive measurements of sonography.
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http://dx.doi.org/10.5505/tjtes.2015.64505DOI Listing
January 2015

The effects of vardenafil and pentoxifylline administration in an animal model of ischemic colitis.

Clinics (Sao Paulo) 2014 Nov;69(11):763-9

Department of General Surgery, Adana Adana Numune Training and Research Hospital, Adana, Turkey.

Objectives: Vardenafil enhances dilatation of vascular smooth muscle and inhibits platelet aggregation. The purpose of this study was to evaluate the clinical effects of vardenafil and pentoxifylline administration in an experimental model of ischemic colitis.

Methods: Forty female Wistar albino rats weighing 250-300 g were randomized into five experimental groups (each with n = 8) as follows:1) a sham group subjected to a sham surgical procedure and administered only tap water; 2) a control group subjected to a standardized surgical procedure to induce ischemic colitis and administered only tap water; 3) and 4) treatment groups subjected to surgical induction of ischemic colitis followed by the postoperative administration of 5 mg/kg or 10 mg/kg vardenafil, respectively; and 5) a treatment group subjected to surgical induction of ischemic colitis followed by postoperative administration of pentoxifylline at 50 mg/kg/day per day as a single dose for a 3-day period. All animals were sacrificed at 72 h post-surgery and subjected to relaparotomy. We scored the macroscopically visible damage, measured the ischemic area and scored histopathology to determine the severity of ischemia. Tissue malondialdehyde levels were also quantified.

Results: The mean Gomella ischemic areas were 63.3 mm2 in the control group; 3.4 and 9.6 mm2 in the vardenafil 5 and vardenafil 10 groups, respectively; and 3.4 mm2 in the pentoxifylline group (p = 0.0001). The mean malondialdehyde values were 63.7 nmol/g in the control group; 25.3 and 25.6 nmol/g in the vardenafil 5 and vardenafil 10 groups, respectively; and 22.8 nmol/g in the pentoxifylline group (p = 0.0001).

Conclusion: Our findings indicate that vardenafil and pentoxifylline are effective treatment options in an animal model of ischemic colitis. The positive clinical effects produced by these drugs are likely due to their influence on the hemodynamics associated with vascular smooth muscle and platelet functions.
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http://dx.doi.org/10.6061/clinics/2014(11)10DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4255201PMC
November 2014

The appearance of free-air in the abdomen with related pneumatosis cystoides intestinalis: Three case reports and review of the literature.

Int J Surg Case Rep 2014 16;5(12):909-13. Epub 2014 Oct 16.

Adana Training and Research Hospital Department of General Surgery, Adana, Turkey.

Introduction: Pneumatosis sistoides intestinalis (PSI) is a rare condition with unknown origin, defined as the appearance of gas-filled cysts in the intestinal wall. It usually occurs due to respiratory infections, tumor or collagen disease, traumas, immunosuppression.

Presentation Of Case: Three patients with PSI were examined that followed up and treated in our clinic. The first patient was hospitalized for emergency treatment of previously diagnosed free-air under the diaphragm. He had a defense on physical examination and free-air was detected in X-ray and abdomen CT. We decided to laparatomy and peroperatively, stenotic pylorus with an abnormally increased stomach and gas-filled cysts were seen in the terminal ileum. Antrectomy and gastrojejunostomy with partial ileum and cecum resection and end ileostomy were performed. The second patient underwent laparatomy because of intraperitoneal free-air and acute abdomen. Partial ileum and cecum resection and ileotransversostomy were performed. The third patient with intraperitoneal free-air was treated with antibiotics, oxygen treatment and bowel rest.

Discussion: PSI is usually asymptomatic. Plain radiographs, USG, CT, upper gastrointestinal endoscopy, colonoscopy can use for diagnosis. Treatment of PSI depends on the underlying cause; include elemental diet, antibiotics, steroids, hyperbaric oxygen therapy and surgery.

Conclusion: In patients with asymptomatic and symptomatic PSI are different treat. Symptomatic PSI can be safely treated antrectomy and gastrojejunostomy with partial ileum and cecum resection.
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http://dx.doi.org/10.1016/j.ijscr.2014.09.031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4275820PMC
December 2014

Efficacy of pentoxifylline and tadalafil in rat model of ischemic colitis.

J Invest Surg 2014 Dec;27(6):349-53

1Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey.

Objective: The aim of this study is to investigate the efficacy of tadalafil against pentoxifylline in rat model of ischemic colitis (IC).

Material-methods: Thirty-two Wistar albino rats were subjected to laparotomy and left colon devascularization to create an IC model and then randomly placed into four groups. Group-1 (sham group) was administered 0.9% NaCl following laparotomy, group 2 (control group) was administered 0.9% NaCl following induced IC, group 3 was given pentoxifylline (n = 8), and group 4 was given tadalafil. On the third day; macroscopic findings, Gomella's ischemic area and Wallace scoring, histopathological analysis, and Chiu scoring were performed, and malondialdehyde (MDA) measurement in ischemic colon tissue was carried out through chemical analysis.

Results: Significant differences were observed in acidic fluid, bowel dilatation, and serosal change (p < .05). The ischemic area measured 63.3 mm(2) in the control group, 2.8 mm(2) in the pentoxifylline group (p = .0001), and 2.4 mm(2) (p = .0001) in the tadalafil group. A significant difference was seen between the sham group and the control and pentoxifylline groups (p < .01), in terms of Wallace score and Chiu classification. Similarly, a significant difference was determined between the control group and pentoxifylline and tadalafil groups (p < .01), but no significant difference was established between the pentoxifylline group and tadalafil group (p = .33). MDA measurement was found on an average to be 63.7 in the control group, 22.7 in group 3 and 22.8 in group 4 (p = 001).

Conclusion: Although tadalafil is superior to pentoxifylline, both drugs are considered to have positive effects.
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http://dx.doi.org/10.3109/08941939.2014.971204DOI Listing
December 2014

Nerve monitoring in the hands of less experienced surgeons.

Indian J Surg 2014 Jun 15;76(3):257-8. Epub 2013 Aug 15.

Department of General Surgery, Adana Numune Research and Training Hospital, Adana, Turkey.

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http://dx.doi.org/10.1007/s12262-013-0963-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4141063PMC
June 2014

Abolition of anti-adhesiogenic effect of heparin by protamine sulfate.

Int J Surg 2014 29;12(7):729-33. Epub 2014 May 29.

Department of Surgery, Adana Numune Training and Research Hospital, Adana, Turkey.

Objective: Intraabdominal adhesion is a frequently encountered condition after surgery and can end up in important complications. The objective of this study is to test whether the antiadhesiogenic effect of heparin could be antagonized by administration of protamine in a rat model.

Material And Methods: A laparotomy with caecal abrasion model was used in 40 Wistar rats. Single dose of 1 cc saline was injected subcutaneously (SC) in one group (control); 50 IU/kg heparin was injected SC in Group 2; 50 IU/kg protamine SC given to Group 3; 50 IU/kg heparin and 50 IU/kg protamine was given SC to Group 4 for 3 consecutive days. Each group consisted of 10 rats. All rats were sacrificed one week later for macroscopic and microscopic examination and they were scored for adhesion using Mazuji adhesion scale.

Results: There was significant difference in the heparin group with respect to Mazuji adhesion score, histopathological score (fibrosis, inflammation and vascular proliferation) and S-100 staining (P < 0.05). Additionally, the inflammation was more severe in the mucosa and submucosa compared to serosa in the heparin group (P < 0.01). With respect to fibrosis and vascular proliferation, apart from submucosal fibrosis, heparin group was statistically superior to the control group by means of each layer (P < 0.01).

Conclusion: It seems that heparin is effective preventing adhesion in this rat model. Abolition of heparin's antiadhesiogenic effect by protamine administration is likely exerted via its antithrombine activity. Clinical application of our findings in intraabdominal surgery warrants further investigation.
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http://dx.doi.org/10.1016/j.ijsu.2014.05.061DOI Listing
December 2014
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