Browsing by Author "Erhan Y."
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Item Ovarian dysgerminoma with contralateral gonadoblastoma in a 46XY phenotypic female: Swyer syndrome(1996) Taneli C.; Genc K.; Erikci V.; Balik E.; Erhan Y.; Ozdemir N.; Veral A.A 15-year-old girl was admitted to the pediatric surgery department with primary amenorrhea and right inguinal swelling of one year duration. On physical examination, the patient presented with a female phenotype, but no breast development; somewhat hirsute with hypertrophic clitoris. Ultrasound examination disclosed a palpable mass originating from the right ovary. At operation, a right salpingo-ooferectomy was performed, and a biopsy specimen was obtained from the left ovary which did not appear normal. Histopathologic examination revealed a right ovarian disgerminoma and a left gonadoblastoma. One month after the first operation, a left gonadectomy was performed with accompanying cliteroplasty. An original case of Swyer syndrome is reported in a patient with female phenotype, dysgerminoma of the right and gonadoblastoma of the the left ovaries.Item Value of P53 protein expression and its relationship with short-term prognosis in colorectal cancer(King Faisal Specialist Hospital and Research Centre, 2002) Erhan Y.; Korkut M.A.; Kara E.; Aydede H.; Sakarya A.; Ilkgül Ö.[No abstract available]Item Ectopic liver (choristoma) associated with the gallbladder encountered during laparoscopic cholecystectomy(Springer New York LLC, 2002) Sakarya A.; Erhan Y.; Aydede H.; Kara E.; Ilkgül Ö.; Çiftdoğan C.Ectopic liver has been but rarely described usually in the vicinity of liver such as on the gallbladder, hepatic lig-aments, diaphragm, thoracic cavity, adrenal glands, pancreas, omentum, spleen, esophagus and umblical cord. A simple classification for anomalous liver tissues found on the wall of gallbladder is 1. Accessory liver lobe 2. Ectopic nodule 3. Aberrant microscopic tissue. Ectopic nodules of liver tissue attached to the gallbladder are completely detached from the liver and has been described by various names such as accessory lobe, ectopic liver, accessory liver and heterotopic liver but the specific pathological term for this entity is choristoma introduced by Albert in 1904 meaning displacement. Several possible mechanisms may explain ectopic liver at various sites such as the development of an accessory lobe of the liver with atrophy or regression of the original connection to the main liver or migration of pars hepatica to the rudiment of various organs. In this paper we present a case of ectopic liver or choristoma attached to the gallbladder encountered during an elective laparoscopic cholecystectomy which was successfully removed with the gallbladder. © 2002, Springer-Verlag New York Inc.Item p53 and Ki-67 expression as prognostic factors in cystosarcoma phyllodes(2002) Erhan Y.; Zekioglu O.; Ersoy Ö.; Tugan D.; Aydede H.; Sakarya A.; Kapkaç M.; Özdemir N.; Özbal O.; Erhan Y.We have reviewed the histopathological, clinical outcome and immunohistochemical status in 21 women with cystosarcoma phyllodes (CSP) tumors of the breast. We assessed 12 tumors as histopathologically benign and 9 tumors as malignant. The median patient ages in benign and malignant CSP tumors were 39.6 and 45.4 years of age, respectively. The stromal cellularity, stromal cellular atypism, high mitotic activity, atypic mitoses, stromal overgrowth, infiltrative tumor contour, and heterologous stromal elements were significant features of the malignant CSP tumors. Benign CSP tumors were predominantly of fibroadenomatous architecture with cellular stroma (mild or moderate) and some distortion and elongation of glandular elements. Five malignant CSP tumors were stained positively with p53, and 6 malignant CSP tumors were stained immunohistochemically with Ki-67. All benign CSP tumors were negatively stained for p53 and Ki-67. The patients with benign CSP tumors were treated with local excision (n = 11) and with subcutaneous mastectomy (n = 1). Malignant CSP tumors were treated with wide local excision (n = 1), partial mastectomy (n = 1), simple mastectomy (n = 2), and modified radical mastectomy (n = 5). Two patients with a high mitotic rate and high values of p53 and Ki-67 received additional radiotherapy and chemotherapy. One case had liver metastasis. This tumor had high mitotic figures, strornal overgrowth, severe stromal cellularity, and 20% Ki-67 and mild p53 positivity. We suggest that p53 and Ki-67 can play an important role in predicting prognosis and yielding additional therapy besides conventional prognostic factors in the treatment of the CSP patients.Item Ileocolic intussusception due to ileal lymphoma (Case report)(2002) Aydede H.; Sakarya A.; Erhan Y.; Ilkgül Ö.; Kara E.; Özkul M.Intussusception occurs rarely in adults. It presents with a variety of acute, intermittent, and chronic symptoms, thus making its preoperative diagnosis difficult. In adults, intussusceptions are mostly caused by organic lesions and the majority of these lesions are benign tumours. Computed tomography scanning and endoscopy have proved to be the most useful diagnostic methods. Confirmation of diagnosis and treatment of adult intussusception is surgical, with surgical resection of the intussusception without reduction being the preferred treatment in adults, as almost half of both colonic and enteric intussusceptions are associated with malignancy. We report the case of a patient with ileocolic intussusception due to an ileal lymphoma.Item Effect of mesh and its localisation on testicular flow and spermatogenesis in patients with Groin Hernia(ARSMB-KVBMG, 2003) Aydede H.; Erhan Y.; Sakarya A.; Kara E.; Ilkgül Ö.; Can M.In this study, the long-term effects of mesh and its localisation (i.e. anterior or posterior) on testicular perfusion and testicular function were evaluated in groin hernia patients. Testicular function has been evaluated with spermiogram and testicular perfusion with colour Doppler ultrasonography. Group I: consisted of 30 posterior preperitoneal mesh repair patients Group II: consisted of 30 anterior tension-free repair patients. The operation types were randomised with a systematic sampling method. There was no statistically significant difference between pre-operative and postoperative spermiogram results for both groups. No statistically significant difference was found between the two groups in terms of Doppler flow parameters (PSV, EDV, RI and PI) for pre-operative, early and late postoperative periods. When Doppler flow parameters were compared for group I, statistically significant differences were found between pre-operative and early postoperative values. No statistically significant difference was found between pre-operative and late postoperative values. This is also true for early postoperative values versus late postoperative values. When Doppler flow parameters were compared for group II, statistically significant differences were found between pre-operative and early postoperative values. No statistically significant difference was found between pre-operative and late postoperative values. This is also true for early postoperative values versus late postoperative values. These results support the idea that inguinal mesh application is still a safe procedure in patients with no children or who are undergoing infertility treatment, where testicular function is important.Item A case of large mucinous adenocarcinoma arising in a long-standing fistula-in-ano(2003) Erhan Y.; Sakarya A.; Aydede H.; Demir A.; Seyhan A.; Atici E.Background: Chronic anal fistulas are not rare conditions, however, the development of a carcinoma in a long-standing fistula-in-ano is rare. Methods: The case of a 77-year-old male with a large perianal mucinous adenocarcinoma arising in a long-standing fistula-in-ano is presented. Results: Perianal biopsy revealed mucinous adenocarcinoma. Abdominal CT, double contrast barium examination and flexible sigmoidoscopy revealed no other tumoral lesion in the colon and rectum. Conclusion: The patient underwent abdominoperineal resection including wide tumor excision on the gluteal region. The final reconstruction was performed by bilateral gracilis musculocutaneous flaps. Due to clinical and histopathological evidence it was thought that a curative resection had been performed. To date he is clinically disease free. Copyright © 2003 S. Karger AG, Basel.Item Effects of octreotide and propranolol on colonic mucosa in rats with portal hypertensive colopathy(2003) Aydede H.; Sakarya A.; Erhan Y.; Kara E.; Ilkgul O.; Ozdemir N.Background/Aims: The aim of the study is to clarify the effects of octreotide and propranolol, agents used in the treatment of portal hypertension, on mucosal changes in portal hypertensive colopathy. Methodology: Portal hypertension was induced in all rats by partial portal vein ligation, and after the operation all rats were caged for a 10-week period. Then, animals were divided into three groups and for two weeks medical treatment were administered to the individual groups as follows: Control group, saline 0.5mL/day, intraperitoneally. Octreotide group, octreotide 100μg/kg/12 hours, subcutaneously. Propranolol group, propranolol 20mg/kg/day, intraperitoneally. In order to assess the portal hypertensive colopathy, criteria such as mean diameters of dilated vessels in colonic mucosa, and the existence of mucosal edema, capillary ectasia, hyperemia and hemorrhage, inflammation were used. Results: When parameters were compared for the control versus propranolol groups, mucosal edema and hyperemia and hemorrhage criteria were found to be significant for the propranolol group; control versus octreotide groups, mucosal edema, capillary ectasia, and hyperemia and hemorrhage criteria were found to be significant for the octreotide group; octreotide versus propranolol groups, capillary ectasia and mucosal edema criteria were found to be significant for the octreotide group. Conclusions: The mucosal changes in portal hypertensive colopathy could be corrected by drugs modifying portal blood flow, octreotide may find a place in the treatment of portal hypertensive colopathy.Item Pure invasive micropapillary carcinoma of the male breast: Report of a rare case(2005) Erhan Y.; Erhan Y.; Zekioǧlu O.[No abstract available]Item Effect of selective gut decontamination on peritoneal fibrinolytic activity in rats; [Ratlarda oluşturulan selektif baḡirsak dekontaminasyonunun peritoneal fibrinolitik aktivite üzerine etkisi](Turkish Surgical Society, 2005) Ilkgül Ö.; Erhan Y.; Aydede H.; Var A.; Onur E.Purpose: Our goal with this experiment was to determine the influence of selective decontamination of the digestive tract (SDD) on peritoneal fibrinolytic activity in rats. Materials and Methods: Animals were divided into five groups. Group 1 was subjected to SDD-treated peritoneal adhesion. Group 2 was subjected only to perioneal adhesion. Group 3 was SDD-treated, whereas Group 4 was labeled as the control group. Group 5 was subjected to simple laparotomy. The rats in Group 1 and Group 3 were given SOD (tobramycin 20 mg/l and polymyxin E 25 mg/l) by gavage twice daily for 3 days preceding surgical operation. Control groups were fed orally with standard chow. After a 72-hour waiting period following the operation, biopsies of undamaged parietal peritoneum were obtained from the fibrinolytic parameters in order to measure tissue-type plasminogen activator (tPA) and plasminogen activator inhibitor type-1 (PAI-1). Results: Average tPA levels were low in both the sdd-treated group and the sdd+adhesion model group, however no statistical significance was elicited. PAI-1 levels were higher in sdd-treated groups than in other groups, but no significantly meaningful difference was obtained. Conclusion: These results suggest that pretreatment with sdd reduces the peritoneal fibrinolytic activity and might also enhance the peritoneal adhesion formation in rats.Item Subcutaneous administration of live lactobacillus prevents sepsis-induced lung organ failure in rats(2005) Ilkgul O.; Aydede H.; Erhan Y.; Surucuoglu S.; Gazi H.; Vatansever S.; Taneli F.; Ulman C.; Kose C.; Bengmark S.The leading cause of death in intensive care units around the world is the syndrome of exaggerated and prolonged systemic inflammation response (SIRS), which if not controlled will lead to irreversible, often multiple, organ dysfunction and organ failure syndrome (MODS). Host phagocytic cells, predominantly macrophages and neutrophils, and their soluble products, play a central role. Accumulation of neutrophils is often observed, especially in the lungs, intestines, liver and kidneys. Neutrophilic infiltration of distant organs, and especially of the lungs, has been a characteristic finding of patients dying from sepsis. However, the mechanisms responsible for the exuberant inflammation and neutrophil infiltration are not yet fully understood. It has recently been demonstrated that this, at least in part, is due to an inhibition of neutrophil apoptosis, and there is a suggested association with activation of nuclear factor - κB (NF-κB), reduced activity of caspases-9 and -3 and maintenance of mitochondrial transmembrane potential.Item Invasive lobular carcinoma of the male breast(2006) Erhan Y.; Zekioglu O.; Erhan Y.[No abstract available]Item A case of peristomal pyoderma gangrenosum following enterocutaneous fistula; [Enterokutan fistül açilimini takiben gelişen peristomal piyoderma gangrenozum](2006) Şahin M.T.; Öztürkcan S.; Ermertcan A.T.; Erhan Y.; Türkdoǧan P.Pyoderma gangrenosum (PG) is an uncommon ulcerative skin disorder that is often associated with underlying systemic diseases, the most common of which is inflammatory bowel disease. It can rarely develop after minor trauma or surgery. Most reports of this condition developing after abdominal surgery have been reported following ostomy formation. Peristomal pyoderma gangrenosum (PPG), an unusual variant of PG, has been reported almost exclusively in patients with inflammatory bowel disease and is frequently misdiagnosed. We describe a 62-year-old woman with refractory PG, which has developed at surgical site of enterocutaneous fistula operation. As PG can mimic a necrotizing soft tissue infection, multiple unnecessary surgical procedures can be performed on such a patient, without improvement. A right diagnosis, based upon the distinctive clinical features and a compatible histology, is essential to avoid surgical procedure that often tends to exacerbate this unusual process.Item Early stage gastric cancer and treatment options; [Erken evre mide kanseri ve tedavi seçenekleri](2006) Güler Y.; Erhan Y.; Aydede H.Early stage gastric cancer is defined as gastric adenocarcinoma limited to mucosa and submucosa. Most important diagnostic tests are serial endoscopies and multipl biopsies. Only treatment is total resection. Surgical procedure for antral tumors is subtotal gastrectomy and for the tumors placed at corpus and cardia total gastrectomy. Multifocal tumors are treated with total gastrectomy independent of their localisations. Radical lymph node dissection must be done for every patient with N2 disease. But, in small tumors limited to mucosa and type IIa tumors limited lymph node dissection (D1) is required. After D2 dissection for patients that lymph node (-), survey is excellent. For older and high risk patients noninvzsive surgical procedures (laser, endoscopic mucosal resection, laparoscopic wedge resection) can be choosen alternatively.Item Effect of portal vein occlusion on the pancreas: An experimental model(2006) Aydede H.; Erhan Y.; Ikgül O.; Cilaker S.; Sakarya A.; Vatansever S.Background: The effects of portal vein occlusion on the pancreas are not clearly understood. Therefore, we studied histomorphological changes induced in the rat pancreas by various periods of portal vein occlusion. Materials and methods: Sixty female Wistar albino rats were randomly allocated into four groups of 15 each. In Group I (control), rats underwent sham laparotomy to expose the portal vein proximal to its bifurcation. In Groups II-IV, rats underwent laparotomy followed by portal vein occlusion by clamping for 15, 30, and 60 minutes respectively. The pancreas was removed immediately after sham laparotomy in Group I and immediately after clamp release in Groups II-IV. Pancreatic tissue specimens were subjected to histochemical analysis for cell typing and diagnosis, immunohistochemical analysis for identification of the inflammatory markers tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), endothelial nitric oxide synthase (eNOS), and inducible NOS (iNOS), and TUNEL analysis was carried out for identification of apoptotic cells. Results: Histochemistry revealed signs of inflammation in pancreatic tissue from rats subjected to portal vein occlusion. Immunohistochemistry revealed that the expression of proinflammatory cytokines TNF-α and IL-1β and the oxidative damage indicator iNOS in rat pancreatic tissue increased progressively with the duration of portal vein occlusion. TUNEL assay revealed no signs of apoptosis in any of the groups. Conclusion: We conclude that portal vein occlusion triggers an inflammatory response in the pancreas that worsens the longer the occlusion lasts. © 2006 by the Société Internationale de Chirurgie.Item Late diagnosis of a lateral abdominal wall hematoma presenting with nonspecific findings: Report of a case(2007) Ilkgül Ö.; Özden S.; Özsoy Y.; Yoleri L.; Erhan Y.; Aydede H.We report a case with a late diagnosis of posttraumatic lateral abdominal wall hematoma. The patient was admitted with a giant hematoma presenting with pleural effusion, anemia and weight loss on postoperative 30th day after a blunt trauma. Computerized tomography analysis revealed a hematoma extending from axilla to the gluteus. Fine-needle aspiration revealed an exudative fluid and five l i t e rs of fluid collection was drained. Misdiagnosed lateral abdominal wall hematomas can be diagnosed with nonspecific findings as in this case.Item Pretreatment with pro- and synbiotics reduces peritonitis-induced acute lung injury in rats(Lippincott Williams and Wilkins, 2007) Tok D.; Ilkgul O.; Bengmark S.; Aydede H.; Erhan Y.; Taneli F.; Ulman C.; Vatansever S.; Kose C.; Ok G.BACKGROUND: To study whether enteral pretreatment with a synbiotic composition of lactic acid bacteria and bioactive fibers can reduce peritonitis-induced lung neutrophil infiltration and tissue injury in rats. MATERIALS AND METHODS: Rats were divided into five groups, and subjected to induction of peritonitis-induced lung injury using a cecal ligation and puncture model (CLP). All animals were pretreated for 3 weeks prior the CLP by daily gavage with either (1) a synbiotic composition (10 CFU of Pediococcus pentosaceus 5-33:3, 10 CFU of Leuconostoc mesenteroides 77:1, 10 CFU of L. paracasei subspecies paracasei, 10 CFU of L. plantarum 2362 plus fermentable fibers), (2) fermentable fibers alone, (3) nonfermentable fibers, (4) a probiotic composition (10 CFU of P. pentosaceus 5-33:3, 10 CFU of L. mesenteroides 77:1, 10 CFU of L. paracasei subsp. paracasei, 10 CFU of L. plantarum 2,362), or (5) a heat-killed probiotic composition. All animals were killed 24 hours after CLP and lung tissue samples were studied for degree of neutrophil infiltration and levels of tumor necrosis factor (TNF)-α, Interleukin (IL)-1β. In addition the lung wet-to-dry tissue weight ratio, the myeloperoxidase activity, and malondialdehyde content were also assessed. RESULTS: No mortality was encountered in any of the groups. Histologic signs of lung injury (number of neutrophils and TNF-α, IL-1β staining) were observed in all groups except the synbiotic and probiotic treated groups. Myeloperoxidase activity and malondialdehyde content were significantly lower in the two lactobacillus- pretreated groups, with no difference between them. Heavy infiltration of lung tissue with neutrophils was observed only in fiber-treated (302.20 ± 7.92) and placebo-treated (266.90 ± 8.92) animals. This was totally abolished in the synbiotic-treated group (34.40 ± 2.49). Lung edema (wet-to-dry lung weight ratio) was significantly reduced in the synbiotic-treated group (4.92 ± 0.13 vs. 5.07 ± 0.08 and 5.39 ± 0.10, respectively). CONCLUSION: Three weeks of preoperative enteral administration of a synbiotic composition reduced peritonitis-induced acute lung injury in rats in a CLP model. © 2007 Lippincott Williams & Wilkins, Inc.Item Chronic pain after Lichtenstein and preperitoneal (posterior) hernia repair(Canadian Medical Association, 2008) Erhan Y.; Erhan E.; Aydede H.; Mercan M.; Tok D.Background: Hernia repair is one of the most common surgical procedures, and some patients suffer from chronic pain after hernia surgery. The aim of the present study was to evaluate chronic postherniorrhaphy pain in men who underwent Lichtenstein mesh repair or preperitoneal (posterior) repair. Methods: Our study included 94 male inpatients. Two surgeons experienced in both Lichtenstein and preperitoneal hernia repair performed the procedures. We controlled postoperative pain with systemic analgesic therapy. We evaluated the patients over the subsequent 12 months, using a questionnaire to focus on chronic pain and its limitations to their quality of life. Results: The overall incidence of chronic pain at 2 months was 5%. About 6% of patients who underwent Lichtenstein repair (n = 70) and 4% of patients who underwent preperitoneal repair (n = 24) experienced chronic pain. All patients with chronic pain rated their pain as slight or moderate. Their pain was present occasionally and was related to physical stress. None of the patients were unable to work. After 12 months of follow-up, the overall incidence of chronic pain decreased to 3%, with 3 patients in Lichtenstein group reporting chronic pain with slight limitations in sports and social activities. Conclusion: The incidence rates of chronic pain after Lichtenstein and preperitoneal repair were 6% and 4%, respectively. Inpatient status might have resulted in low incidences with both approaches. © 2008 Canadian Medical Association.Item Ondansetron, granisetron, and dexamethasone compared for the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy: A randomized placebo-controlled study(2008) Erhan Y.; Erhan E.; Aydede H.; Yumus O.; Yentur A.Background: Laparoscopic cholecystectomies are associated with an appreciably high rate of postoperative nausea and vomiting (PONV). This study was designed to compare the effectiveness of ondansetron, granisetron, and dexamethasone for the prevention of PONV in patients after laparoscopic cholecystectomy. Methods: A total of 80 American Society of Anesthesiologists (ASA) physical class I-II patients scheduled for laparoscopic cholecystectomy were included in this randomized, double blind, placebo-controlled study. All patients received a similar standardized anesthesia and operative treatment. Patients were randomly divided into four groups (n = 20 each). Group 1, consisting of control patients, received 0.9% NaCl; group 2 patients received ondansetron 4 mg i.v.; group 3 patients received granisetron 3 mg i.v.; and group 4 patients received dexamethasone 8 mg i.v., all before the induction of anesthesia. Both nausea and vomiting were assessed during the first 24 h after the procedure. Results: The total incidence of PONV was 75% with placebo, 35% with ondansetron, 30% with granisetron, and 25% with dexamethasone. The incidence of PONV was significantly less frequent in groups receiving antiemetics (p < 0.05). The differences between dexamethasone, granisetron, and ondansetron were not significant. Conclusions: Prophylactic dexamethasone 8 mg i.v. significantly reduced the incidence of PONV in patients undergoing laparoscopic cholecystectomy. Dexamethasone 8 mg was as effective as ondansetron 4 mg and granisetron 3 mg, and it was more effective than placebo. © 2007 Springer Science+Business Media, LLC.Item Do clinical and immunohistochemical findings of pure Mucinous breast carcinoma differ from mixed Mucinous breast carcinoma ?(ARSMB-KVBMG, 2009) Erhan Y.; Ciris M.; Zekioglu O.; Kapkac M.; Makay Ö.; Ozdemir N.Mucinous carcinoma of the breast is a relatively rare histologic type with two subtypes: pure and mixed. It has a favourable prognosis with a low risk of axillary metastases. The prognosis for pure mucinous carcinoma (PMC) was much better than for the mixed mucinous carcinoma (MMC). The aim of the study is to determine suitable candidates for breast or axillary conservation in mucinous carcinoma subtypes. The slides of 26 pure and 23 mixed mucinous carcinomas of the breast were evaluated. The clinical, pathological and immunohistochemical features between PMCs and MMCs were compared. MMC displayed greater metastatic potential (p < 0.05), p53 positivity (p < 0.05) and c-erbB-2 positivity (p < 0.001) than PMCs. PMCs smaller than 2 cm had less metastatic capacity and extranodal invasion compared to MMCs smaller than 2 cm (p < 0.001 and p < 0.01, respectively). MMCs smaller than 2 cm displayed weaker ER positivity but greater c-erbB-2 positivity than PMCs smaller than 2 cm (p < 0.01). In conclusion, MMC had worse prognostic factors than PMC with both types of mucinous carcinoma showing similar ER and PR positive status. Even if PMCs and especially smaller PMCs display more favourable prognostic features, including less axillary lymph node involvement, it is appropriate to use sentinel lymph node biopsy to make better axillary assessment.