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Öğe Are we on the side of over-diagnosis and treatment in BI-RADS 4A breast lesions?(2021) Avci, Tevfik; Erkent, Murathan; Turnaoglu, Hale; Borcek, Pelin; Kaya, Pelin; Karakaya, EmreAim: In BI-RADS 4A lesions, a malignancy rate of between 2% and 10% has been detected. Many patients avoid biopsy even though biopsy is recommended because of its low malignancy rates. The aim of this study is to investigate the need for biopsy of patients with BI-RADS 4A lesions.Materials and Methods: 392 patients classified as BI-RADS 4A in our hospital between January 2011 and December 2019 were retrospectively analyzed. Clinical and demographic characteristics of the patients, complaints, physical examination findings, USG (ultrasound), MMG (mammography) and magnetic resonance imaging (MRI) findings, invasive surgical procedure or noninvasive procedure performed, pathology results were analyzed. Results: The mean age was 44.29 years (range, 15–93 years). The most common complaint was palpable mass (36.5%). While 88.5% of examined pathologies were evaluated as benign lesions, 7.1% were malignant. The rate of malignancy increased with age, and this difference was statistically significant (p = .000). Malignancy increases with lesions size but it was not statistically significant (p = .052). Palpable mass was more common in malignant lesions (55.2%) (p = .014). Comparing the radiological evaluations of BI-RADS 4A lesions with the post-biopsy pathology results, size increase, more than three lobulations, border irregularities, and cystic areas did not make a statistically significant difference in terms of benign, premalignant, and malignant pathologies; however, intraductal localization was observed more frequently in benign and premalignant lesions than in malignant lesions, and this difference was statistically significant (p = .003).Conclusion: We anticipate that the criteria developed with this study (more than three lobulations, border irregularity, cystic areas, and intraductal locations), applied to a wide range of patients, can be a source for future studies and can be used safely in other clinics. As a result, we strongly recommend biopsy for patients with postmenopausal and palpable masses if the criteria we used for detecting BI-RADS 4A are also present.Öğe The effect of surgeon’s fatigue on early term patency and complications of arteriovenous fistulas: A prospective cohort study(2018) Yabanoglu, Hakan; Bali, Cagla; Avci, Tevfik; Arer, İlker Murat; Yildirim, SedatAim: Examining the effect of surgeon’s fatigue on early term patency and complications of arteriovenous fistula (AVF). Material and Methods: AVFs created for hemodialysis in patients with end-stage renal failure were included in the study. The patients were divided into 2 groups as those operated in the first operation of that day (Group 1) and those operated after the first or second operations (Group 2). The patients were compared with respect to clinical, demographics, postoperative, surgical variables, and operation duration. Results: A total of 100 patients underwent AVF operation. No statistically significant differences were found between the groups with respect to clinical, demographic, surgical, and postoperative variables. Efficiency of dialysis was found to be higher and complication rate lower in Group 1. But no statistical significance was obtained in terms of early dialysis efficiency and complication rates in between the groups (p>0.05). Complication rate was higher in Group 2 when compared according to operation time as 120, 120-240, and 240< minutes. But no statistical significance was obtained in this manner (p>0.05). Conclusions: Although not statistically significant, surgical fatigue factor and long operation time increase the rate of early complications and reduce early dialysis efficiency. We think that early term patency of AVF can also be affected by the complication rate. The effect of this variable can be statistically significant with studies having larger sample size.Öğe Results of Surgery Versus Conservative Follow up of Adrenal Incidentaloma(2017) Kirnap, Mahir; Akdur, Aydincan; Ayvazoglu Soy, Ebru; Avci, Tevfik; Moray, GokhanAim: The incidence of adrenal incidentaloma has increased recently due to increased magnetic resonance imaging (MRI), computed tomography scans (CT) and ultrasonography (USG). In our study, we aimed to demonstrate our radiologic, hormonal and clinical follow up of adrenal incidentalomaÖğe Surgical and endovascular treatment for mesenteric ischemia(2019) Aydin, Huseyin Onur; Ayvazoglu Soy, Ebru Hatice; Avci, Tevfik; Tezcaner, Tugan; Boyvat, Fatih; Yildirim, SedatAim: Mesenteric ischemia is a rare, highly fatal, surgical emergency. In addition to open surgical (OS) intervention, endovascular treatment (ET) was also recommended for treatment in last years. Surgical resection becomes inevitable in the cases of intestinal ischemia. We aimed to assess patient-related factors and compare treatment outcomes in mesenteric ischemia treated by OS and ET. Material and Methods: Patients treated for mesenteric vascular occlusion at our hospital between 2013 and 2018 were retrospectively evaluated. Duration of symptoms, time from symptom onset to treatment, treatment used and surgery used, re-laparotomy need, duration of intensive care unit stay, duration of hospital stay, and 30-day and 1-year mortality rates were evaluated. Results: Twenty patients with mesenteric ischemia were evaluated. The OS group had a significantly higher CCI score than the ET group (p<0.05). The most common comorbidities in the OS and ET groups were coronary artery disease and hypertension, respectively. The duration of symptoms and time from symptom onset to treatment were significantly shorter in the OS group than the ET group (p<0.05). The OS group most commonly had SMA emboli while the ET group most common had chronic SMA occlusion (p<0.05). Thirty-day and 1-year mortality rates were significantly greater in the OS group than the ET group (p<0.05). Conclusion: Mesenteric ischemia is a highly morbid and fatal condition. ET significantly reduces morbidity and mortality in the face of signs of intestinal ischemia. On the other hand, OS would be inevitable for patients with signs of diffuse peritoneal irritation or those with suspected intestinal necrosis.Öğe Surgical therapy of medullary thyroid cancer and our clinical experiences(2019) Akdur, Aydincan; Yabanoglu, Hakan; Arer, Ilker Murat; Hargura, Abdirahman Sakulen; Kocer, Nazim Emrah; Avci, TevfikAim: Medullary thyroid cancer (MTC) is a rare neuroendocrine tumor that originates from the thyroid parafollicular C cells and produces calcitonin. It is a quite aggressive disease with a potential to cause serious morbidity and mortality. In this study we aimed to report treatment outcomes of MTC, which has a bad prognosis and is difficult to manage.Material and Methods: The medical records of 1287 patients who were operated on for thyroid cancer between 2009 and 2018 were retrospectively assessed. Twenty-one patients (1.6%) were diagnosed with MTC. Results: Eleven (52.4%) patients were females. The age range of the patients was 54(14-85) years. Sixteen (76.2%) cases were sporadic and 5 (23.8%) were familial. Twelve patients underwent bilateral total thyroidectomy + central and unilateral neck dissection, 5(23.8%) bilateral total thyroidectomy + central and bilateral neck dissection, 4(19%) bilateral total thyroidectomy. Pathology examination revealed lymph node metastasis in 13(61.9%) patients. Three (14%) patients had simultaneous papillary thyroid cancer. Mean duration of follow-up was 52(3-96) months. Five (23.8%) patients suffered recurrence cervical lymph nodes (6 months later), lungs and bone metastasis (at 12th and 18th months), lungs (at 12thmonth), mediastinal lymph nodes (at 15th months), liver metastasis (at 6th months). Seven (33%) patients underwent chemo-radiotherapy. Conclusion: Surgery is the gold standard to control loco-regional disease and the only curative method among the available therapies in MTC treatment. Despite having a low incidence, MTC may still lead to serious mortality and morbidity in delayed cases and/or when loco-regional control cannot be achieved. Keywords: Medullary Thyroid Cancer; Surgery; Recurrence.
