Browsing by Author "Tireli, M"
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Item Chronic Hematoma Mimicing Recurrent Breast Carcinoma and Contribution of Magnetic ResonanceBasara, I; Örgüc, S; Tireli, MLocal recurrence of breast carcinoma after breast conservative therapy is an unwanted situation with a high possibility. Paranchymal distortion and edema secondary to surgery and radiotheraphy results in difficulties in the mammographic and ultrasonographic evaluation of the breast. After treatment of breast carcinoma, sensitivity of mammography decreases below the normal population. Breast magnetic resonance imaging (MRI) can be helpful in the discrimination of scar tissue in the region of operation from local recurrence. Advanced MRI applications such as diffusion weighted imaging (DWI) and proton (H-1) MR spectroscopy also have contribution in diagnosis. In this case report we aimed to determine the contribution of MRI and advanced MRI techniques to a lesion which was detected by conventional methods in an operated breast carcinoma patient.Item Gastric Carcinoma Demonstrating Rhabdoid FeaturesKaradeniz, T; Ayhan, S; Turna, A; Tireli, MRhabdoid tumor, first described as an aggressive kidney tumor in infants and children and also observed less commonly in extra-renal locations, is seen very exceptionally in the gastrointestinal system. Gastrointestinal tumors with rhabdoid features are also extremely rare. A 59-year-old man with a long history of nausea, vomiting and weakness had been diagnosed as diffuse-type gastric carcinoma by the evaluation of endoscopic biopsy specimen at an other hospital. The total gastrectomy specimen showed an ulcerated mass measuring 7x4x4 cm located at the lesser curvature. The tumor penetrated the entire gastric wall and invaded the perigastric fat. The histopathological and immunohistochemical evaluation revealed a gastric carcinoma with rhabdoid features. The tumor was presented to emphasize the importance of clinical, morphological and immunohistochemical differential diagnosis from diffuse type gastric carcinoma as it has a very poor prognosis and is rarely seen in the gastrointestinal system.Item The Results of the Surgical Treatment of Alkaline Reflux GastritisTireli, MBackground/Aims: Alkaline reflux gastritis (ARG) is a major complication of gastric surgery The symptoms of ARG may be intractable and remedial surgery may be required in this patients. The goal of this study was to present our experience reviewing surgical treatment of reflux gastritis. Methodology: During a 19-year period, we surgically treated 35 patients who had refractory ARG. Previously, gastric surgery was distal gastrectomy-gastrojejunostomy in 20 patients; truncal vagotomy-gastrojejunostomy in 11 and truncal vagotomy-pyloroplasty in 4 patients. Of 20 patients who underwent distal gastrectomy, 13 were treated with Roux-en-Y gastrojejunostomy, six with jejunal segment between the gastric pouch and duodenum (Henley technique) and one with conversion of Billroth II to Billroth I. Of 11 patients who initially underwent vagotomy-gastrojejunostomy, 8 were treated with Billroth II type gastrectomy and Roux-en-Y gastrojejunostomy and 3 with dismantling of a gastrojejunostomy, conversion of pyloroplasty. Four patients who originally underwent vagotomy pyloroplasty were managed with Billroth II type gastrectomy and Roux-en-Y gastrojejunostomy. Results: Mortality rate of this series was zero. Long-term follow-up was obtained in 29 (83.0%) patients. According to Visick criteria, twelve patients (41.4%) reported exellent; ten (34.5%) good; three (10.3%) fair and four (13.8%) unsatisfactory results respectively. Conclusions: Remedial gastric surgery can be indicated in patients who had persistent ARG symptoms despite conservative management. Careful patient selection is essential to achieve best results.Item Results from treatment of 21 patients with pancreatic necrosis and/or abscess by continous closed lesser sac or site lavageTireli, MPurpose: The aim of this study was to evaluate the results of necrosectomy and continuous closed lavage of the lesser sac or site in the treatment of pancreatic necrosis and/or abscess. Background: Despite in its improvement in diagnosis and treatment, acute necrotizing pancreatitis is still associated with a high incidence of mortality and morbidity. The management of sterile necrosis is still controversial. Criteria for surgical intervention in sterile necrosis and choice of technique in debridement of necrosis (conventional passive drainage, continuous lavage of the lesser sac or open abdomen) are still matters of debate. Materials and Methods: Between February 1991 and August 2003, 21 patients with necrotizing pancreatitis were treated with necrosectomy followed by continuous closed lesser sac or site lavage. Results: Among our patients, 11 had infected necrosis and 6 had sterile necrosis. Additionally, two patients had infected necrosis and abscess, and two had pancreatic abscesses. Eight cases of acute attack were managed at another clinic however, upon development of large necrosis or abscesses, these patients were subsequently transferred to our clinic. 13 patients were treated at our clinic right from the start. Reasons for surgery in 21 patients were as follows: absence of definite diagnosis (4), pancreatic abscesses (4), infected necrosis (4), persistence or advancement of organ complication despite intensive therapy (3), presentation of sepsis signs (3), organized necrosis (2) and symptomatic pseudocyst (1). Six patients (28.6 %) were documented with serious organ-system dysfunction. Three patients (14.3 %) died and among those who lived nine patients developed serious complications. The hospitalization period for patients who survived averaged between 10-65 days. (Mean: 34.0). Conclusion: Infected pancreatic necrosis and/or abscess can be treated surgically; but management of sterile necrosis is still controversial. Conservative strategies can be applied succesfully to manage most patients with sterile necrosis. Necrosectomy supplemented by postoperative closed continuous lavage of the site not only offers debridement of devitalized tissue, but also prevents development of new necrosis through nonsurgical removal of necrotic tissue and biologically active and bacterial compounds.Item Factors affecting breast cancer treatment delay in Turkey: a study from Turkish Federation of Breast Diseases SocietiesOzmen, V; Boylu, S; Ok, E; Canturk, NZ; Celik, V; Kapkac, M; Girgin, S; Tireli, M; Ihtiyar, E; Demircan, O; Baskan, MS; Koyuncu, A; Tasdelen, I; Dumanli, E; Ozdener, F; Zaborek, PBackground: One of the most important factors in breast cancer (BC) mortality is treatment delay. The primary goal of this survey was to identify factors affecting the total delay time (TDT) in Turkish BC patients. Methods: A total of 1031 patients with BC were surveyed using a uniform questionnaire. The time between discovering the first symptom and signing up for the first medical visit (patient delay time; PDT) and the time between the first medical visit and the start of therapy (system delay time; SDT) were modelled separately with multilevel regression. Results: The mean PDT, SDT and TDT were 4.8, 10.5 and 13.8 weeks, respectively. In all, 42% of the patients had a TDT >12 weeks. Longer PDT was significantly correlated with disregarding symptoms and having age of between 30 and 39 years. Shorter PDT was characteristic of patients who: had stronger self-examination habits, received more support from family and friends and had at least secondary education. Predictors of longer SDT included disregard of symptoms, distrust in success of therapy and medical system and having PDT in excess of 4 weeks. Shorter SDT was linked to the age of >60 years. Patients who were diagnosed during a periodic check-up or opportunistic mammography displayed shorter SDT compared with those who had symptomatic BC and their first medical examination was by a surgeon. Conclusion: TDT in Turkey is long and remains a major problem. Delays can be reduced by increasing BC awareness, implementing organized population-based screening programmes and founding cancer centres.Item Factors affecting time to seeking medical advice and start of treatment in breast cancer (BC) patients in TurkeyOzmen, V; Boylu, S; Ok, E; Canturk, Z; Celik, V; Kapkac, M; Girgin, S; Tireli, M; Ihtiyar, E; Demircan, O; Baskan, MS; Koyuncu, A; Tasdelen, I; Dumanli, E; Ozdener, F