Publications by authors named "Serap Yucel"

29 Publications

  • Page 1 of 1

3 Tesla MRI in diagnosis and follow up of children with pneumonia.

Clin Imaging 2021 Jun 1;79:213-218. Epub 2021 Jun 1.

Ondokuz Mayis University Faculty of Medicine, Department of Biostatistics and Medical Informatics, Samsun, Turkey.

Purpose: To investigate the utilization of 3-Tesla (3 T) magnetic resonance imaging (MRI) in detection of pulmonary abnormalities in children with pneumonia.

Materials And Methods: Forty-seven children with pneumonia prospectively underwent 3 T thoracic MRI and posteroanterior (PA) chest radiography (CR). Of these, 15 patients also underwent contrast-enhanced thorax computed tomography (CT) or high-resolution CT (HRCT). The MRI protocol included axial and coronal T2-weighted spectral presaturation with inversion recovery (SPIR) Multivane-XD and axial echo-planar diffusion-weighted imaging (EPI DWI) with respiratory gating. Kappa statistics, Cochran Q, and McNemar tests were used to investigate the results.

Results: Agreement between CR and MRI was substantial in detecting consolidation/infiltration (k = 0.64), peribronchial thickening (k = 0.64), and bronchiectasis (k = 1); moderate in detecting cavity (k = 0.54) and pleural effusion (k = 0.44); and fair in detecting empyema (0.32) and bilateral involvement of lungs (k = 0.23). MRI was superior to CR in detecting bilateral involvement (p < 0.001), lymph node (p < 0.001), pleural effusion (p < 0.001), and empyema (p = 0.003). MRI detected all the consolidation/infiltration also detected on CT imaging. A kappa test showed moderate agreement between MRI and CT in detecting pleural effusion and ground-glass opacity (GGO), and substantial or almost perfect agreement for all other pathologies. No statistically significant difference was observed between MRI and CT for detecting pneumonia-associated pathologies by the McNemar test.

Conclusion: Thoracic 3 T MRI is an accurate and effective technique for evaluating children with pneumonia. MRI detected more pathologies than CR and had similar results to those of thorax CT.
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http://dx.doi.org/10.1016/j.clinimag.2021.05.027DOI Listing
June 2021

Frequency of complications and risk factors associated with computed tomography guided core needle lung biopsies.

Ann Saudi Med 2021 Mar-Apr;41(2):78-85. Epub 2021 Apr 1.

From the Department of Radiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.

Background: Although transthoracic needle biopsy (TTNB) is an effective method for diagnosis of lung tumors, it has some complications. It is crucial to know the frequency and severity of the complications of TTNB and its risk factors in order to avoid them.

Objectives: Evaluate the complications and risk factors of computed tomography guided core needle lung biopsies (CT-CNLB).

Design: Prospective evaluation of complications.

Setting: Single center in Turkey.

Patients And Methods: For CT-CNLBs performed between October 2017 and March 2018, the complications of biopsies were noted and classified as major and minor based on guidelines of the Society of Interventional Radiology.

Main Outcome Measures: The complications and risk factors for complications were evaluated.

Sample Size: 123 adult patients.

Results: The most common complications were pulmonary hemorrhage (30.9%) and pneumothorax (22%). Increased overall pulmonary hemorrhage was observed with underlying emphysema (=.022), non-peripheral location of the lesion (<.001), increased needle pathway (<.001), fissure penetration (=.011), increased number of pleura penetrations (=.024), prolonged needle time across pleura (=.037), and decreased lesion size (=.033). The pneumothorax rate increased with non-peripheral location of the lesion (<.007), fissure penetration (=.021), prolonged needle time across the pleura (P=.013), and decreased lesion size (=.002). In the logistic regression analyses for he two most common complications, the only risk factor for both alveolar hemorrhage and pneumothorax was a non-peripheral location of the lesion (<.001, OR=14.7, 95% CI=3.9-55.4 for alveolar hemorrhage) and (=.001, OR=156.2, 95% CI =7.34-3324.7 for pneumothorax).

Conclusion: Most common complications of CT-CNLB were pneumothorax and pulmonary alveolar hemorrhage with a 5.7% major complication rate. Choosing the shortest possible trans-pulmonary needle pathway minimizes the risk of complications.

Limitations: Limited number of patients, absence of rare complications as death, air embolism, and needle tract seeding.

Conflict Of Interest: None.
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http://dx.doi.org/10.5144/0256-4947.2021.78DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8020651PMC
April 2021

Outcomes of patients with anal cancer treated with volumetric-modulated arc therapy or intensity-modulated radiotherapy and concurrent chemotherapy.

J Cancer Res Ther 2021 Jan-Mar;17(1):51-55

Department of Radiation Oncology, Istanbul University Medical Faculty, Istanbul, Turkey.

Aims: To evaluate the results of chemoradiation with intensity-modulated radiation therapy (IMRT) or volumetric-modulated arc therapy (VMAT) for the treatment of anal canal cancer patients at three institutions that had advanced devices.

Materials And Methods: A retrospective analysis was performed for patients treated with 5-fluorouracil and mitomycin-based chemotherapy and IMRT or VMAT for anal cancer from 2011 to 2013. Complete response (CR) rates, colostomy-free survival (CFS), disease-free survival (DFS), overall survival (OS), and toxicities were investigated. Toxicities were evaluated with the Common Terminology Criteria for Adverse Events, Version 3.0.

Results: Fifteen patients were included in the analysis. The majority of patients had T2 (53.3%) and N0 (40%) disease according to the staging system that was developed by the American Joint Committee on Cancer. CR was observed in 14 patients (93%), and the median follow-up was 26 months (13-42 months). The 3-year CFS, DFS, and OS were 86%, 86%, and 88%, respectively. Acute Grade 3 toxicities were observed as 6% of hematological, 26% of gastrointestinal, and 26% of dermatological.

Conclusion: Early results confirm that IMRT or VMAT for anal cancer treatment reduces acute toxicities while maintaining high control rates.
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http://dx.doi.org/10.4103/jcrt.JCRT_774_16DOI Listing
March 2021

Prognostic factors in medically inoperable early stage lung cancer patients treated with stereotactic ablative radiation therapy (SABR): Turkish Radiation Oncology Society Multicentric Study.

Clin Respir J 2020 Nov 17;14(11):1050-1059. Epub 2020 Aug 17.

Faculty of Medicine, Radiation Oncology Department, Ankara University, Ankara, Turkey.

Objective: We identified factors influencing outcomes in patients with medically inoperable early stage lung cancer (MIESLC) treated with stereotactic ablative radiation therapy (SABR) at 14 centers in Turkey.

Materials And Methods: We retrospectively analyzed 431 patients with stage I-II MIESLC treated with SABR from 2009 through 2017. Age; sex; performance score; imaging technique; tumor histology and size; disease stage radiation dose, fraction and biologically effective dose with an α/β ratio of 10 (BED ); tumor location and treatment center were evaluated for associations with overall survival (OS), local control (LC) and toxicity.

Results: Median follow-up time was 27 months (range 1-115); median SABR dose was 54 Gy (range 30-70) given in a median three fractions (range 1-10); median BED was 151 Gy (range 48-180). Tumors were peripheral in 285 patients (66.1%), central in 69 (16%) and <1 cm from mediastinal structures in 77 (17.9%). Response was evaluated with PET/CT in most cases at a median 3 months after SABR. Response rates were: 48% complete, 36.7% partial, 7.9% stable and 7.4% progression. LC rates were 97.1% at 1 year, 92.6% at 2 years and 91.2% at 3 years; corresponding OS rates were 92.6%, 80.6% and 72.7%. On multivariate analysis, BED > 100 Gy (P = .011), adenocarcinoma (P = .025) and complete response on first evaluation (P = .007) predicted favorable LC. BED > 120 Gy (hazard ratio [HR] 1.9, 95% confidence interval [CI] 1.1-3.2, P = .019) and tumor size (<2 cm HR 1.9, 95% CI 1.3-3, P = .003) predicted favorable OS. No grade 4-5 acute side effects were observed; late effects were grade ≤3 pneumonitis (18 [4.2%]), chest wall pain (11 [2.5%]) and rib fracture (1 [0.2%]).

Conclusion: SABR produced encouraging results, with satisfactory LC and OS and minimal toxicity. BED > 120 Gy was needed for better LC and OS for large, non-adenocarcinoma tumors.
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http://dx.doi.org/10.1111/crj.13240DOI Listing
November 2020

Can Point Shear Wave Elastography Be Used as an Early Indicator of Involvement?: Evaluation of the Pancreas and Liver in Children With Cystic Fibrosis.

J Ultrasound Med 2020 Sep 20;39(9):1769-1776. Epub 2020 Apr 20.

Kayseri Education and Research Hospital, Kayseri, Turkey.

Objectives: The aim of this study was to determine the effect of cystic fibrosis (CF) on pancreas and liver elasticity in young children using point shear wave elastography and to determine the relationship with clinical findings.

Methods: Twenty-two patients with genetically proven CF, who were admitted to our pediatric gastroenterology clinic, and 22 healthy control participants were enrolled in the study. The shear wave velocity (SWV) of the liver and pancreas were measured with point shear wave elastography.

Results: The 22 patients with CF included 45.5% girls with a mean age ± SD of 35 ± 35.8 months (range, 5-123 months). The 22 healthy control participants included 41.2% girls with a mean age of 58.9 ± 44.4 months (range, 2-159 months). The mean SWV of the pancreas in the patients with CF (1.06 ± 0.26 m/s) was significantly higher than that of the healthy control participants (0.85 ± 0.23 m/s; P = .01). The mean SWV of the liver in the patients with CF (1.46 ± 0.24 m/s) was significantly higher than that of the healthy control participants (1.12 ± 0.21 m/s; P = .001). The SWV of the pancreas and liver did not show any significant differences depending on ursodeoxycholic acid use, malnutrition status, and the presence of the F508 deletion mutation.

Conclusions: This study showed an increased SWV of the pancreas in children with CF, contrary to the literature. We also found an increased liver SWV even in the absence of CF-related liver disease. Ultrasound elastography may be a useful method of evaluating early changes in the pancreas and liver before the obvious clinical, laboratory, and B-mode ultrasound signs of CF-related involvement.
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http://dx.doi.org/10.1002/jum.15281DOI Listing
September 2020

Neoadjuvant hyperfractionated accelerated radiotherapy plus concomitant 5-fluorouracil infusion in locally advanced rectal cancer: A phase II study.

World J Gastrointest Oncol 2018 Jan;10(1):40-47

Department of Radiation Oncology, Istanbul Medical Faculty, Istanbul University, Istanbul 34093, Turkey.

Aim: To evaluate the efficacy and tolerability of neoadjuvant hyperfractionated accelerated radiotherapy (HART) and concurrent chemotherapy in patients with locally advanced infraperitoneal rectal cancer.

Methods: A total of 30 patients with histopathologically confirmed T2-3/N0+ infraperitoneal adenocarcinoma of rectum cancer patients received preoperative 42 Gy/1.5 Gy/18 days/bid radiotherapy and continuous infusion of 5-fluorouracil (325 mg/m). All patients were operated 4-8 wk after neoadjuvant concomitant therapy.

Results: In the early phase of treatment, 6 patients had grade III-IV gastrointestinal toxicity, 2 patients had grade III-IV hematologic toxicity, and 1 patient had grade V toxicity due to postoperative sepsis during chemotherapy. Only 1 patient had radiotherapy-related late side effects, ., grade IV tenesmus. Complete pathological response was achieved in 6 patients (21%), while near-complete pathological response was obtained in 9 (31%). After a median follow-up period of 60 mo, the local tumor control rate was 96.6%. In 13 patients, distant metastasis occurred. Disease-free survival rates at 2 and 5 years were 63.3% and 53%, and corresponding overall survival rates were 70% and 53.1%, respectively.

Conclusion: Although it has excellent local control and complete pathological response rates, neoadjuvant HART concurrent chemotherapy appears to not be a feasible treatment regimen in locally advanced rectal cancer, having high perioperative complication and intolerable side effects. Effects of reduced 5-fluorouracil dose or omission of chemotherapy with the aim of reducing toxicity may be examined in further studies.
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http://dx.doi.org/10.4251/wjgo.v10.i1.40DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5767792PMC
January 2018

The role of PET and MRI in evaluating the feasibility of skin-sparing mastectomy following neoadjuvant therapy.

J Int Med Res 2018 Feb 14;46(2):626-636. Epub 2018 Jan 14.

1 Department of General Surgery, Faculty of Medicine, 221266 Bezmialem Vakif University , Istanbul, Turkey.

Objective To investigate the role of positron emission tomography (PET) and magnetic resonance imaging (MRI) in evaluating the feasibility of skin-sparing mastectomy in patients with locally-advanced breast cancer (LABC) who will undergo neoadjuvant chemotherapy (NAC) by evaluating the sensitivity and specificity of PET and MRI compared with skin biopsy results before and after NAC treatment. Methods Patients with LABC who were treated with NAC between November 2013 and November 2015 were included in this study. Demographic, clinical, radiological and histopathological features of the patients were recorded. Results A total of 30 patients were included in the study with a mean age of 52.6 years (range, 35-70 years). Sensitivity and specificity for detecting skin involvement in LABC was 100%/10% (62%/85%) with MRI and 60%/80% (12%/92%) with PET before (after) NAC, respectively. When radiological skin involvement was assessed in relation to the final histopathological results, the preNAC PET results and histopathological skin involvement were not significantly different; and there was no difference between postNAC MRI and histopathological skin involvement. Conclusions As preNAC PET and postNAC MRI more accurately determined skin involvement, it might be possible to use these two radiological evaluation methods together to assess patient suitability for skin-sparing mastectomy in selected patients.
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http://dx.doi.org/10.1177/0300060517719837DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5971500PMC
February 2018

Acoustic Radiation Force Impulse Quantification in the Evaluation of Thyroid Elasticity in Pediatric Patients With Hashimoto Thyroiditis.

J Ultrasound Med 2018 May 24;37(5):1143-1149. Epub 2017 Oct 24.

Departments of Radiology, Ondokuz Mayis University School of Medicine, Samsun, Turkey.

Objectives: To evaluate the parenchymal elasticity of the thyroid gland with acoustic radiation force impulse imaging in pediatric patients with Hashimoto thyroiditis and to compare it with healthy volunteers.

Methods: Twenty-six patients with Hashimoto thyroiditis and 26 healthy volunteers between 6 and 17 years were included. The shear wave velocity (SWV) values of both thyroid lobes in both groups were evaluated.

Results: The age and sex characteristics of the controls and patients with Hashimoto thyroiditis were similar. The SWV of the thyroid gland in patients with Hashimoto thyroiditis (mean ± SD, 1.67 ± 0.63 m/s) was significantly higher than that in the control group (1.30 ± 0.13 m/s; P < .001). There was no significant difference between the thyroid lobes in both groups. A receiver operating characteristic curve analyses showed an optimal cutoff value of 1.41 m/s, with 73.1% sensitivity, 80.8% specificity, a 79.2 % positive predictive value, and a 75.0% negative predictive value (area under the curve, 0.806; P < .001). In patients with Hashimoto thyroiditis, there was a positive correlation between the SWV values versus anti-thyroperoxidase (Pearson r = 0.46; P = .038). There were no correlations between age, body mass index, thyroid function test results, and anti-thyroglobulin values and versus SWV values. Also, no significant differences were seen between the groups for gland size, gland vascularity, and l-thyroxine treatment.

Conclusions: Acoustic radiation force impulse elastography showed a significant difference in the stiffness of the thyroid gland between children with Hashimoto thyroiditis and the healthy group. Using acoustic radiation force impulse elastography immediately after a standard ultrasound evaluation may predict chronic autoimmune thyroiditis.
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http://dx.doi.org/10.1002/jum.14459DOI Listing
May 2018

A Rare Concha Variation: Coronal Cleft.

J Craniofac Surg 2017 May;28(3):e242-e244

*Department of Radiology †Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.

Nasal turbinates are embryologically derived from a series of outgrowths from the foetal lateral nasal wall. These outgrowths form a series of ridges, referred to as "ethmoturbinals" and have several vital functions. Several different turbinate variations have been reported so far. The authors presented 3 patients of coronal clefted concha who were diagnosed with magnetic resonance imaging. Computed tomography scans and nasal endoscopic examinations are also performed subsequently. These patients are the first coronal clefted concha cases in the literature and also the first radiological study defining concha cleft. This shows paucity of data documenting variations in the lateral nasal wall. Understanding the anatomy and the anatomic variations of the nasal cavity and nasal turbinates is critical to guide the procedure due to its close proximity to vital structures such as orbita and skull base, especially for functional endoscopic sinus surgery that is a widely used technique nowadays.
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http://dx.doi.org/10.1097/SCS.0000000000003451DOI Listing
May 2017

Shear wave velocity of the healthy thyroid gland in children with acoustic radiation force impulse elastography.

J Med Ultrason (2001) 2018 Jan 19;45(1):75-80. Epub 2017 Apr 19.

Department of Radiology, School of Medicine, Ondokuz Mayıs University, 55270, Atakum, Samsun, Turkey.

Purpose: Acoustic radiation force impulse imaging is a kind of shear wave elastography that can be used in children for differentiating thyroid pathologies. Possible changes in the healthy thyroid gland in children may create difficulties in the use of shear wave velocities (SWV) in thyroid pathologies. The aim of this study was to define the normal values of SWV for the healthy thyroid gland in children, elucidate the correlation of the SWV values with potential influencing factors, and evaluate intra-operator reproducibility of the SWV.

Methods: Between January 2015 and December 2015, a total of 145 healthy children (81 girls, 64 boys; mean age, 10.5 ± 3.14 years; range 6-17 years) were enrolled in the study. The SWV and volume of the thyroid gland were determined.

Results: The mean shear wave velocity of the thyroid gland was 1.22 ± 0.20 m/s. There was no correlation between age and the mean SWV of the thyroid gland (Spearman Rho = 0.049, p = 0.556). There was also no correlation between the thyroid gland volume or BSA and the mean SWV. The only correlation detected was between BSA and total thyroid gland volume (p < 0.001).

Conclusion: In the present study, the SWV of the healthy thyroid gland in children was determined. There was no correlation between the SWV of the thyroid gland and age, BSA, or thyroid gland volume.
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http://dx.doi.org/10.1007/s10396-017-0788-3DOI Listing
January 2018

Spontaneous Epidural Pneumocephalus.

J Craniofac Surg 2016 Nov;27(8):e748-e749

*Department of Radiology†Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.

Spontaneous epidural pneumocephalus is a rare condition. The authors reported a 35-year-old male patient with tinnutus, dull headache, and swelling on his head. Patient had a history of head trauma and skull fracture from when he was 5 years old. Cranial computed tomography revealed increase in pneumatization of right mastoid air cells and large epidural air in temporoparietal region. Inner table of right temporal bone got thinner, causing communication of mastoid air cells with epidural space. Epidural air had septations and exerted mass effect on the right parietal lobe with minimal midline shift. Thinning of also right parietal bone caused extension of epidural air into the right parietal subcutaneous tissue and hence subcutaneous swelling. There was no obvious fracture line. Spontaneous epidural pneumocephalus is extremely rare condition that may cause severe complications. There are several etiologic factors. Head trauma can be the eliciting factor in the authors' patient. It is important to be familiar with its presentation and imaging findings to make early diagnosis and treatment.
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http://dx.doi.org/10.1097/SCS.0000000000003090DOI Listing
November 2016

Effects of Boron-Based Gel on Radiation-Induced Dermatitis in Breast Cancer: A Double-Blind, Placebo-Controlled Trial.

J Invest Surg 2017 Jun 4;30(3):187-192. Epub 2016 Oct 4.

c Department of Radiation Oncology , Bezmialem Vakif University , Istanbul , Turkey.

Aim: This study is aimed to evaluate the effects of boron on radiation-induced skin reactions (RISR) in breast cancer patients.

Material And Methods: After 47 patients with invasive ductal carcinoma underwent radiotherapy, 23 (49%) received a boron-based gel, and 24 (51%) received placebo. Assessments were performed according to the Radiation Therapy Oncology Group (RTOG) skin scale and a Five-Point Horizontal Scale (FPHS).

Results: At the end of the fifth week of radiotherapy, the RTOG scores in the boron group were significantly lower than those in the placebo group (p = .024). The FPHS score was higher in the placebo group than in the boron group, and this difference was not statistically significant (p = .079).

Conclusion: Using the RTOG scoring system, we revealed that the application of a boron-based gel diminished RISR. The mechanism of action is unclear but may be related to antioxidant, wound healing, and thermal degradation effects of boron.
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http://dx.doi.org/10.1080/08941939.2016.1232449DOI Listing
June 2017

Impact of Superoxide Dismutase-Gliadin on Radiation-induced Fibrosis: An Experimental Study.

In Vivo 2016 Jul-Aug;30(4):451-6

Department of Radiation Oncology, Medical Faculty, Istanbul University, Istanbul, Turkey.

Aim: Radiation-induced fibrosis (RIF) has since long been considered as irreversible. Further understanding of its mechanisms has led to trials investigating RIF treatment and prevention. The effect of superoxide dismutase (SOD)-gliadin, an oral form of SOD that resists gastrointestinal inactivation, on RIF treatment was evaluated in this experimental study.

Materials And Methods: A total of 36 Wistar albino mice were randomly distributed into four groups. According to group, 25 Gy radiation or sham-radiation were performed on day 0. Acute and late reactions were recorded. After 6 months, mice were treated with SOD-gliadin, 10,000 units per kg per day, or placebo. SOD-gliadin and placebo treatments were administered daily for 8 days by oral gavage. Later the mice were sacrificed, dissected and histopathologically analyzed. Accumulated hyaline and collagen at the dermis is an indicator of fibrosis. Therefore measurements of the dermal thickness were used to quantify the degree of RIF. Additionally, the morphological changes were analyzed, and the differences reported.

Results: The mean and standard deviation for dermal thickness were 0.45±0.09 mm in the sham-irradiated placebo-treated group, 0.51 mm±0.16 mm in the sham-irradiated SOD-gliadin-treated group, 0.92 mm±0.23 mm in the irradiated placebo-treated group and 0.71 mm±0.17 mm in the irradiated SOD-gliadin-treated group. The difference in mean dermal thickness between irradiated placebo-treated and irradiated SOD-gliadin-treated mice was statistically significant (p=0.002).

Conclusion: Quality of life while prolonging survival has an increasing importance in patients with cancer. RIF can be a crucial problem after all radiotherapy modalities. SOD-gliadin has advantageous effects on conditions that call for an increased expression of antioxidant enzymes. The results of our study suggest that oral SOD-gliadin may prevent or ameliorate RIF and patients can benefit from the positive effects of SOD.
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July 2017

Chronomodulated oxaliplatin plus Capecitabine (XELOX) as a first line chemotherapy in metastatic colorectal cancer: A Phase II Brunch regimen study.

Cancer Chemother Pharmacol 2016 Jul 6;78(1):143-50. Epub 2016 Jun 6.

Institute of Oncology, Department of Radiation Oncology, Istanbul University, Istanbul, Turkey.

Purpose: The aim of this study was to evaluate safety and toxicity of chronomodulated capecitabine administered in the morning and at noon according to a specific time schedule (Brunch Regimen: Breakfast and Lunch) as a part of first-line XELOX chemotherapy in patients with metastatic colorectal cancer.

Methods: A total of 30 treatment-naïve colorectal cancer patients with metastatic disease were included. Oxaliplatin 130 mg/m(2) on day 1 plus chronomodulated oral capecitabine 2000 mg/m(2) per day were administered (50 % dose at 8:00 a.m. and 50 % dose at 12:00 noon on days 1-14, every 21 days). All adverse events, treatment responses and survival were evaluated. In addition, pharmacokinetic profile of capecitabine was examined in a subset of 5 patients.

Results: Median age was 57.1 years (range 32-77 years). Median follow-up was 19 months (range 3-36 months). Three patients (10 %) had complete response, 13 patients (43.3 %) had partial response and 4 patients (13.3 %) had stabile disease. Ten patients had progressive disease at their first evaluation (33.3 %). The median progression-free survival (PFS) was 10 months (range 2-36 months). There were no grade 4 toxicities. One patient (3.3 %) had grade 3 neutropenia. Hand-foot syndrome developed in three patients (10 %): 6.6 %, grade 1 and 3.3 %, grade 2.

Conclusions: Chronomodulated XELOX seems to represent a promising therapeutic option in the first-line treatment of metastatic colorectal carcinoma due to good tumor control and favorable toxicity profile. Phase III randomized trials are required to assess the actual clinical efficacy and side effect profile of this regimen.
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http://dx.doi.org/10.1007/s00280-016-3067-xDOI Listing
July 2016

Giant Congenital Pelvic AVM Causing Cardiac Failure, Diplegia, and Neurogenic Bladder.

Pol J Radiol 2015 13;80:388-90. Epub 2015 Aug 13.

Department of Radiology, Ondokuz Mayis University, Faculty of Medicine, Samsun, Turkey.

Background: Pelvic arteriovenous malformations (AVMs) are uncommon lesions and only a rare number of male cases have been reported. Their clinical presentations are variable and imaging modalities have an important place in diagnosis and treatment planning.

Case Report: We present the imaging findings of a giant congenital pelvic AVM that was diagnosed in a 30-year-old male patient eight years ago and which progressed despite follow-up and treatment, causing cardiac failure, diplegia, and neurogenic bladder.

Conclusions: Pelvic AVMs are uncommon lesions and they can present with various symptoms based on their locations and sizes. Delays in the diagnosis and treatment can cause local and systemic complications. Imaging is very important in the diagnosis of pelvic AVM.
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http://dx.doi.org/10.12659/PJR.894700DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4540055PMC
December 2015

Primary adrenal lymphoma with multiple vertebral metastasis.

Spine J 2016 Mar 22;16(3):e179. Epub 2015 Oct 22.

Department of Radiology, Ondokuz Mayis University Faculty of Medicine, 55200 Samsun, Turkey.

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http://dx.doi.org/10.1016/j.spinee.2015.10.007DOI Listing
March 2016

"Snake eye" appearance on a teenage girl with spontaneous spinal ischemia.

Spine J 2015 Oct 9;15(10):e45. Epub 2015 Jun 9.

Department of Radiology, Ondokuz Mayis University Faculty of Medicine, 55139 Kurupelit, Samsun, Turkey.

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http://dx.doi.org/10.1016/j.spinee.2015.06.002DOI Listing
October 2015

Adjuvant chemoradiotherapy after D2 resection in gastric cancer: a single-center observational study.

J Cancer Res Clin Oncol 2015 Feb 5;141(2):361-7. Epub 2014 Sep 5.

Department of Radiation Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey.

Purpose: Previous studies demonstrated survival benefits in association with the addition of chemoradiotherapy after surgery in gastric cancer. This study aimed to examine the efficacy in terms of loco-regional control and survival and safety of 5-FU-based adjuvant chemoradiotherapy after D2 curative surgery.

Methods: This study included 228 patients (81 female, 147 male) treated for gastric cancer with curative surgery plus adjuvant chemoradiotherapy. Majority of the patients underwent at least D2 lymph node resection. Median three cycles of fluorouracil chemotherapy were administered, and 45-Gy radiotherapy was delivered at 1.8 Gy/fraction concomitantly during the second cycle of chemotherapy. Local control, regional control, distant metastasis and overall survival rates were estimated.

Results: The median age of the patients was 54 years (range 25-74 years). The most common grade III toxicities were nausea (10%) and neutropenia (9%). During radiotherapy, grade IV local skin reaction occurred in one patient. Median duration of follow-up was 47 months. Local, regional and distant recurrence developed in 9 (4%), 41 (18%) and 45 (20%) patients, respectively. Overall 5-year survival rate was 57.2%, and disease-free 5-year survival rate was 53.8%. Multivariate analysis identified less than 15 lymph node involvement as an independent predictor of better survival (p < 0.001).

Conclusions: Concomitant 5-FU-based chemoradiotherapy seems to be an effective and tolerable adjuvant regimen on local control and survival in curatively resected node-positive stomach cancer, particularly when combined with D2 resection.
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http://dx.doi.org/10.1007/s00432-014-1816-yDOI Listing
February 2015

Neoadjuvant chronomodulated capecitabine with radiotherapy in rectal cancer: a phase II brunch regimen study.

Cancer Chemother Pharmacol 2014 Oct 8;74(4):751-6. Epub 2014 Aug 8.

Department of Radiation Oncology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.

Purpose: The aim of this study was to evaluate efficacy and safety of chronomodulated capecitabine administered according to a specific time schedule (Brunch Regimen: Breakfast and Lunch) as a part of neoadjuvant chemoradiation therapy in patients with locally advanced rectal cancer.

Methods: Eighty-five patients with stage II and III rectal cancer were included. Patients received capecitabine (1,650 mg/m(2) per day; 60% dose at 8:00 AM and 40% dose at 12:00 noon) administered during pelvic radiation (total 50.4 Gy in 28 fractions, 1.8 Gy daily dose between 2:00 p.m. and 4:00 p.m.). After chemoradiotherapy, patients underwent surgery. The primary endpoints were pathological complete response (pCR) rate and toxicity.

Results: In 17 patients (20%), total tumor regression was achieved according to Dworak pathological grading system. Grade III diarrhea occurred in nine patients (10.5%), while only one patient had grade 3 thrombocytopenia. Grade II or III proctitis were seen in nine (10.5%) subjects, and grade I or II cystitis in six (6.9%). Only three patients (3.3%) developed hand and foot syndrome (both grade I-II). There were no grade IV toxicities.

Conclusions: Brunch Regimen for locally advanced rectal cancer consisting of neoadjuvant chronomodulated capecitabine and concurrent radiation therapy is effective and well tolerated with good safety profile, particularly with regard to the occurrence of hand and foot syndrome, in patients with locally advanced rectal cancer.
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http://dx.doi.org/10.1007/s00280-014-2558-xDOI Listing
October 2014

Assessment of multifocality and axillary nodal involvement in early-stage breast cancer patients using 18F-FDG PET/CT compared to contrast-enhanced and diffusion-weighted magnetic resonance imaging and sentinel node biopsy.

Acta Radiol 2015 Aug 10;56(8):917-23. Epub 2014 Jul 10.

Department of Surgery, Bezmialem Vakif University School of Medicine, Istanbul, Turkey.

Background: Non-invasive evaluation of the extent of axillary nodal involvement in early-stage breast cancer (ESBC) patients and accurate assessment of multifocality are both challenging. Few reports have explored whether 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) might be more useful than other diagnostic methods in these contexts.

Purpose: To prospectively evaluate the diagnostic utility of FDG PET/CT, contrast-enhanced, and diffusion-weighted magnetic resonance imaging (DCE-MRI and DWI), and sentinel lymph node biopsy (SNB), in detection of axillary metastatic lymph nodes in ESBC patients; and to explore the utilities of FDG PET/CT and DCE-MRI for identification of multifocality.

Material And Methods: Twenty-four female patients (mean age, 47 ± 9.9 years; range, 24-68 years) with ESBC underwent whole-body FDG PET/CT and breast MRI prior to operation. SNB and axillary lymph node dissection (ALND) were performed on all patients, as was mastectomy or wide local tumor excision. Histopathological findings served as the gold standard when evaluating either multifocality or axillary nodal involvement.

Results: The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy, of PET/CT and DCE-MRI, used to detect multifocality, were as follows: 67% versus 78%, 100% versus 53%, 100% versus 50%, 83% versus 80%, and 88% versus 63%. SNB afforded the highest sensitivity (93%) in terms of detection of axillary metastasis. The sensitivity, NPV, and accuracy of PET/CT were 67%, 62%, and 75% respectively, thus higher than the equivalent values of either DCE-MRI or DWI.

Conclusion: For assessment of multifocality in ESBC patients, highly specific results of PET/CT should be taken into account along with DCE-MRI findings. For evaluation of axillary nodal involvement, PET/CT has higher sensitivity, NPV, and accuracy values than DCE-MRI and DWI and may guide a surgical decision to proceed or not to SNB or ALND.
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http://dx.doi.org/10.1177/0284185114539786DOI Listing
August 2015

Bone health in breast cancer patients: a comprehensive statement by CECOG/SAKK Intergroup.

Breast 2014 Oct 27;23(5):511-25. Epub 2014 Jun 27.

Yeditepe University Hospital, Istanbul, Turkey.

Bone is the most common site of distant metastases in breast cancer that can cause severe and debilitating skeletal related events (SRE) including hypercalcemia of malignancy, pathologic fracture, spinal cord compression and the need for palliative radiation therapy or surgery to the bone. SRE are associated with substantial pain and morbidity leading to frequent hospitalization, impaired quality of life and poor prognosis. The past 25 years of research on the pathophysiology of bone metastases led to the development of highly effective treatment options to delay or prevent osseous metastases and SRE. Management of bone metastases has become an integral part of cancer treatment requiring expertise of multidisciplinary teams of medical and radiation oncologists, surgeons and radiologists in order to find an optimal treatment for each individual patient. A group of international breast cancer experts attended a Skeletal Care Academy Meeting in November 2012 in Istanbul and discussed current preventive measures and treatment options of SRE, which are summarized in this evidence-based consensus for qualified decision- making in clinical practice.
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http://dx.doi.org/10.1016/j.breast.2014.05.023DOI Listing
October 2014

Feasibility of breast conserving surgery in multifocal breast cancers.

Am J Surg 2014 Sep 7;208(3):457-64. Epub 2013 Oct 7.

Department of General Surgery, Bezmialem Vakıf Üniversitesi, Tıp Fakültesi Hastanesi, Fatih/Istanbul 34083, Turkey.

Background: Multifocal breast cancers (MFBCs) present a challenge to surgeons. Although its feasibility is still controversial, breast-conserving surgery (BCS) is not contraindicated for MFBCs. The investigators retrospectively evaluated the feasibility of BCS and reviewed histopathologic findings in patients with MFBC.

Methods: A total of 222 patients with MFBC who were treated with either BCS (119 patients) or mastectomy (103 patients) at a single institution between January 2002 and December 2011 were retrospectively evaluated.

Results: The median follow-up time was 55 months (range, 10 to 102 months). Lymphovascular invasion and lymph node involvement were significantly less frequent in the BCS group (48.8% vs 62.2% for lymphovascular invasion, P = .04; 52.1% vs 71.8% for lymph node involvement, P = .002). There were no differences in local recurrence rates between the 2 groups. The overall survival rates were 92% in the BCS group and 72% in the mastectomy group (P = .000).

Conclusions: BCS is a feasible and safe procedure for the removal of multifocal tumors. Extended lymphovascular invasion is associated with mortality in patients who undergo mastectomy.
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http://dx.doi.org/10.1016/j.amjsurg.2013.08.008DOI Listing
September 2014

Successful treatment of triple primary tumor.

Int J Surg Case Rep 2013 27;4(11):1013-6. Epub 2013 Aug 27.

Istanbul University, School of Medicine, Department of Plastic and Reconstructive Surgery, Istanbul, Turkey.

Introduction: The occurrence of multiple primary tumors is rare. Only limited number of cases with triple malignancy have been reported. We report here a rare case of a woman presented synchronous triple tumors, in her lung, breast, skin.

Presentation Of Case: A 56-year-old woman presented with invasive ductal carcinoma of breast, non-small cell lung cancer and malignant melanoma. The patient undergone mastectomy and malignant melanoma tumor excision on-site. After operation stereotactic radiotherapy was given to her lung tumor. Six course of chemotherapy was given to her. She is alive with no progression.

Discussion: The patient was diagnosed with melanoma and staging by FDG/PET. There is not any study about routine using PET/CT in the melanoma staging.

Conclusion: This is a very rare synchronous triple tumor case.
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http://dx.doi.org/10.1016/j.ijscr.2013.08.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3825933PMC
November 2013

An unusual case caused by a common reason: Mondor's disease by oral contraceptives.

Int J Surg Case Rep 2013 3;4(10):855-7. Epub 2013 Aug 3.

Bezmialem Vakif University, Medical Faculty, Turkey. Electronic address:

Introduction: Mondor's disease (MD) of the breast is a rare condition at breast clinics. We do not have enough data to establish its real prevalence. As a known data, most of the patients that were admitted to breast clinics are not breast cancer. Also MD is a rare entity and diagnosing this entity and informing the patient about it is very important. We present here this case to remind breast clinic practitioners that MD can be seen without trauma (neither surgical nor physical). Also clinical and radiological findings and the treatmentof the MD were discussed.

Presentation Of Case: A 35 year old woman was admitted our clinic with cutaneous breast retraction. She had no risk for thrombosis else using oral contraceptives. Mondor's Disease was diagnosed and supported by radiological findings. Rheumatologic and hematologic causes were also explored. Patient healed in four weeks only with non-steroidal anti-inflammatory drug.

Discussion: Mondor's Disease is rarely related with breast cancer. This rare entity can be diagnosed with doubt and patient should be informed about it. Anti-coagulant treatment does not required if disease is idiopathic.

Conclusion: Mondor's Disease should be reminded at a patient with retracted breast skin.
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http://dx.doi.org/10.1016/j.ijscr.2013.07.026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3785854PMC
September 2013

Dobrava hantavirus infection complicated by panhypopituitarism, Istanbul, Turkey, 2010.

Emerg Infect Dis 2012 Jul;18(7):1180-3

Acıbadem Hospital, Istanbul, Turkey.

We identified Dobrava-Belgrade virus infection in Turkey (from a strain related to hantavirus strains from nearby countries) in a patient who had severe symptoms leading to panhypopituitarism, but no known risk for hantavirus. Our findings emphasize the need for increased awareness of hantaviruses in the region and assessment of symptomatic persons without known risk factors for infection.
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http://dx.doi.org/10.3201/eid1807.111746DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3376800PMC
July 2012

Blind or ultrasound-guided corticosteroid injections and short-term response in subacromial impingement syndrome: a randomized, double-blind, prospective study.

Am J Phys Med Rehabil 2012 Aug;91(8):658-65

Department of Physical and Rehabilitation Medicine, Sisli Etfal Education and Research Hospital, Istanbul, Turkey.

Objective: The aim of this study was to compare the accuracy of blind vs. ultrasonography-guided corticosteroid injections in subacromial impingement syndrome and determine the correlation between accuracy of the injection location and clinical outcome.

Design: Forty-six patients with subacromial impingement syndrome were randomized for ultrasonography-guided (group 1, n = 23) and blind corticosteroid injections (group 2, n = 23). Magnetic resonance imaging analysis was performed immediately after the injection. Changes in shoulder range of motion, pain, and shoulder function were recorded. All patients were assessed before the injection and 6 wks after the injection.

Results: Accurate injections were performed in 15 (65%) group 1 patients and in 16 (70%) group 2 patients. There was no statistically significant difference in the injection location accuracy between the two groups (P > 0.05). At the end of the sixth week, regardless of whether the injected mixture was found in the subacromial region or not, all of the patients showed improvements in all of the parameters evaluated (P < 0.05).

Conclusions: Blind injections performed in the subacromial region by experienced individuals were reliably accurate and could therefore be given in daily routines. Corticosteroid injections in the subacromial region were very effective in improving the pain and functional status of patients with subacromial impingement syndrome during the short-term follow-up.
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http://dx.doi.org/10.1097/PHM.0b013e318255978aDOI Listing
August 2012

Pregnancy a short time after multimodal therapy for bilateral breast cancer: a case report and review of literature.

J Oncol Pharm Pract 2011 Dec 21;17(4):440-3. Epub 2010 Sep 21.

Department of Radiation Oncology, Regional Training and Research Hospital, Erzurum, Turkey.

Pregnancy occurring after multimodal therapy in a woman with breast cancer with a 1-year follow-up period is a relatively rare condition and has been defined as pregnancy-associated breast cancer. A patient can become pregnant after chemotherapy for breast cancer while she is on tamoxifen. However, the effects of tamoxifen on fetus and on the course of the pregnancy are still unknown. Here, we present a 39-year-old woman treated with chemotherapy and radiotherapy for bilateral breast cancer, and who became pregnant while taking tamoxifen.
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http://dx.doi.org/10.1177/1078155210384755DOI Listing
December 2011

Quality of life assessments with SF 36 in different musculoskeletal diseases.

Clin Rheumatol 2008 Mar 13;27(3):327-32. Epub 2007 Sep 13.

Department of Physical Medicine and Rehabilitation, Sisli Etfal Education and Research Hospital, Serakent Sitesi Sumbul Blok, No:16/24 80360 Kagithane, Istanbul, Turkey.

The aim of this study is to evaluate comparatively the life quality of patients with knee osteoarthritis (KO), shoulder impingement syndrome(SIS), fibromialgia(FM), or osteoporosis(OP) using SF 36 and establish the impact of these diseases on quality of life (QoL). A total of 193 patients with one of the above-mentioned different diagnoses completed SF 36 scale. The diseases were compared to each other with SF 36 subgroups scores. There were significant differences among patients with KO and SIS, SIS and FM with respect to all SF 36 subgroups scores. According to these assessments, QoL of KO and FM patients was worst than that of SIS. The QoL scores of KO patients were worse than those of FM patients considering the physical function, while QoL scores of FM patients were lower than those of KO patients with respect to their general well-being. Scores of physical function and pain in KO patients were lower than those of OP patients. In domains of social functioning, emotional role, energy, pain, and general health condition QoL of FM patients was worse than that of OP patients. Quality of life of SIS patients was less affected than the patients of the other disease groups. In spite of their young age, FM patients appear to be the group with the worst quality of life scores.
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http://dx.doi.org/10.1007/s10067-007-0717-8DOI Listing
March 2008

[Demographic features and difficulties in rehabilitation in patients referred to hand rehabilitation unit for phalangeal fractures].

Acta Orthop Traumatol Turc 2006 ;40(4):274-9

Department of Physical Therapy and Rehabilitation (Fiziksel Tip ve Rehabilitasyon Kliniği), Sişli Etfal Training and Research Hospital, Istanbul, Turkey.

Objectives: We evaluated demographic and occupational features of patients with phalangeal fractures of the hand, etiologies and types of injuries, and the results of rehabilitation.

Methods: The study included 91 fingers of 62 patients (54 males, 8 females; mean age 28+/-13 years; range 4 to 59 years) who were referred to our hand rehabilitation unit for phalangeal fractures. Demographic features, the cause and localization of injury, the type of surgery, time from surgery to rehabilitation, and the follow-up period were determined. At the end of rehabilitation, range of motion (ROM) of the phalangeal joint and total ROM of the injured fingers were assessed using the Strickland-Glogovac rating system.

Results: A great majority of injuries were caused by work accidents, followed by sport injuries and falls occurring in students. Sixty patients (96.8%) were right-handed. The fractures occurred in the dominant hand in 29 patients (46.8%). The majority of patients (n=45) were primary school graduates. The most common mechanism of injury was accidents related to heavy work machinery (n=18). The most commonly injured finger and the phalanx were the third finger (n=25, 27.5%) and the proximal phalanx (n=59, 56.7%), respectively. Only 27 patients (43.6%) had a sufficient follow-up with a mean of 79.7+/-46.6 days (range 30 to 254 days). Following rehabilitation, the mean ROM and the total ROM were 45.0+/-22.9 degrees and 63.3+/-16.1 degrees for the injured joint and the thumb, and 31.3+/-22.5 degrees and 122+/-60.3 degrees for the injured joint and the other fingers, respectively.

Conclusion: Our data provide important insight into appropriate treatment and rehabilitation of phalangeal fractures, in particular, shortcomings in the treatment and follow-up.
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January 2007