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Öğe Aim: In the present study, we aimed to compare Dexmedetomidine-Remifentanil and Propofol-Remifentanil combinations in terms of postoperative cognitive functions in hysteroscopy attempts. Material and Methods: A total of 70 ASA I-II patients who were aged between 18 and 65 years were included in the study following the ethics committee approval. The patients were randomized into two groups (n=35), and standard routine monitoring were applied to them. The sedation depth was evaluated with Ramsey Sedation Score (RSS) before and after the sedation; and cognitive functions of the groups were evaluated with the Minimal Mental State Test (MMST). Propofol 1 mg/kg bolus 25-100 µg/kg/min infusion was administered to Group PR, and Dexmedetomidine 1 µg/kg bolus 0.4-0.7 µg/ kg/h infusion dose was administered to Group DR. Remifentanil 0.25 µg/kg bolus 0.04 µg /kg/min infusion was administered to the groups, and the groups were followed to ensure RSS≥4. Result: In cognitive functions, it was observed that there was significant regression in Group PR in postoperative period compared to the preoperative period (p<0.05). The hemodynamic parameters were lower in Group DR than in Group PR at 5th, 10th and 15th minutes following the hysteroscopy (p<0.05). The Modified Aldrete Score in Group DR were high, and pain scores were lower (p<0.05). Satisfaction with the surgeon, patient and anesthetist scores were higher in Group DR. No respiratory depression was observed (p<0.05). Conclusion: We believe that administering Dexmedetomidine-Remifentanil combination in sedation in hysteroscopy ensures better postoperative cognitive function, recovery conditions, analgesia, and patient and surgeon satisfaction compared to the PropofolRemifentanil combination.(2019) Gonultas, Fatih; Kutluturk, Koray; Barut, Bora; Dalda, Yasin; Alan, Saadet; Unal, BulentAim: To compare thyroid fine-needle aspiration biopsy with histopathological examination results. Material and Methods: Postoperative histopathological examination results of 361 patients, who were thyroidectomized between December 2010 and October 2017 in Inonu University Turgut Ozal Medical Center Department of General Surgery and whose preoperative FNAB registries we could reach were evaluated retrospectively. Biopsies made in external centers were included in preoperative FNAB results. FNAB results were examined according to Bethesda 2007 in 6 categories: unsatisfactory, benign, atypia of undetermined significance, follicular lesion-neoplasm or suspicious for a neoplasm, suspicious for malignancy and malignant. Histopathological results of patients with incidental malignancy were presumed benign. Results: Among the 361 patients that were included in the study, 274 were female (75.9%), 87 were male(24.1%). Mean age of the patients in the benign group was 49.1±12.5 years, and 48.6±13.5 years in the malignant group. It was found that FNAB’s sensitivity was 83.9 %, specificity was 92.4%, false positive rate was 16.1% and false negative rate was 7.6%. Conclusion: FNAB is reported as the gold standard for preoperative evaluation of thyroid nodules. In our study, however, it was seen that FNAB was not adequate alone to detect malignancy. This situation suggests the importance of collaboration between radiologist, cytopathologist and clinician.Öğe Assessment of Liver Regeneration in Patients Who Have Undergone Living Donor Hepatectomy for Living Donor Liver Transplantation(Mdpi, 2023) Satilmis, Basri; Akbulut, Sami; Sahin, Tevfik Tolga; Dalda, Yasin; Tuncer, Adem; Kucukakcali, Zeynep; Ogut, ZekiBackground: Inflammation and the associated immune pathways are among the most important factors in liver regeneration after living donor hepatectomy. Various biomarkers, especially liver function tests, are used to show liver regeneration. The aim of this study was to evaluate the course of liver regeneration following donor hepatectomy (LDH) by routine and regeneration-related biomarkers. Method: Data from 63 living liver donors (LLDs) who underwent LDH in Inonu University Liver Transplant Institute were prospectively analyzed. Serum samples were obtained on the preoperative day and postoperative days (POD) 1, 3, 5, 10, and 21. Regenerative markers including alfa-fetoprotein (AFP), des carboxy prothrombin (DCP), ornithine decarboxylase (ODC), retinol-binding protein 4 (RBP4), and angiotensin-converting enzyme isotype II (ACEII) and liver function tests including alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP) and total bilirubin levels were all analyzed. Results: The median age of the LLDs was 29.7 years and 28 LLDs were female. Eight LLDs developed postoperative complications requiring relaparotomy. The routine laboratory parameters including AST (<0.001), ALT (<0.001), ALP (<0.001), and total bilirubin (<0.001) showed a significant increase over time until postoperative day (POD) 3. For the regeneration-related parameters, except for the RBP4, all parameters including ACEII (p = 0.006), AFP (p = 0.002), DCP (p = 0.007), and ODC (p = 0.002) showed a significant increase in POD3. The regeneration parameters showed a different pattern of change. In right-lobe liver grafts, ACEII (p = 0.002), AFP (p = 0.035), and ODC (p = 0.001) showed a significant increase over time. DCP (p = 0.129) and RBP4 (p = 0.335) showed no significant changes in right-lobe liver grafts. Conclusions: Regenerative markers are increased in a sustained fashion following LDH. This is more prominent following right-lobe grafts which are indicative of progenitor-associated liver regeneration.Öğe Bilateral thigh abscess due to rectal fistula: A rare case report with silent clinical presentation(2023) Koroglu, Muhammed; Dalda, Yasin; Ozdes, Huseyin Utku; Ozdemir, Zeynep Maras; Aslanturk, OkanA 53-year-old male patient who underwent a rectal cancer operation nine years ago was evaluated with complaints of pain and swelling in the lateral thigh. Radiological imaging revealed abscess foci in the right thigh muscles. Surgical drainage and debridement were performed but developed recurrence. Contrast-enhanced abdominal tomography was performed due to a positive medical history and it was seen that an enterocutaneous fistula was formed from the anastomosis site of previous cancer surgery to both sides of the thigh. Bilateral thigh abscesses were drained and radical debridement was performed in the same session with surgery for the fistula. Pathological examination of the surgical specimens showed no evidence of cancer and the patient was discharged on the 14th postoperative day with complete resolution of the infection. Hip abscesses are rare, delays in the diagnosis and treatment of the underlying cause in cases of abscess secondary to abdominal or pelvic pathologies lead to an increase in mortality. Therefore, it should be kept in mind that thigh abscesses may be another side of the coin besides being seen as an isolated infection.Öğe Clinicopathological Characteristics and Survival Analysis of Primary Mesenteric Liposarcoma: A Retrospective Study(Mdpi, 2025) Ogut, Zeki; Tuncer, Adem; Dalda, Yasin; Gozukara Bag, Harika Gozde; Bozan, Mehmet BugraBackground and Objectives: Primary mesenteric liposarcoma (LPS) is an exceptionally rare malignancy, with most literature data limited to isolated case reports or small series. This papers aims to evaluate the clinicopathological features, treatment outcomes, and prognostic factors in patients with mesenteric LPS. Materials and Methods: Thirteen patients diagnosed with primary mesenteric LPS between 2010 and 2022 were retrospectively analyzed. Data included demographics, tumor location, histological subtype, surgical treatment, recurrence, and survival. Results: The median age was 56 years (range, 22-74), with a slight male predominance (53.8%). Most tumors arose from the small bowel (53.8%) and colonic (38.5%) mesenteries, with one involving the gastric mesentery. The predominant histological subtypes were myxoid (46.1%) and dedifferentiated (23.1%). R0 resection was achieved in 76.9% of patients. During a median follow-up of 55.2 months, nine patients (69.2%) developed recurrence. Mortality was higher in patients with dedifferentiated LPS (66.7%) than in those with myxoid LPS (40%). Five-year survival rate was 100% in patients without recurrence and 28.6% in those with recurrence (p = 0.112, not significant). Patients who received adjuvant chemoradiotherapy suggested longer survival (110.7 vs. 46.2 months; p = 0.620). Conclusions: This 12-year study highlights the aggressive nature of mesenteric LPS, particularly the dedifferentiated subtype which showed the poorest prognosis. Complete resection remains the primary treatment; however, it has high recurrence rates. To diminish the catastrophic poor results of the postoperative period, multidisciplinary treatment strategies become a keystone.Öğe Comparison of liver resection and living donor liver transplantation in patients with hepatocellular carcinoma within Milan criteria and well-preserved liver function(Kare Publ, 2023) Karakas, Serdar; Yilmaz, Sezai; Ince, Volkan; Akbulut, Sami; Dalda, Yasin; Akatli, Ayse Nur; Kahraman, Aysegul SagirBackground and Aim: Liver resection (LR) and liver transplantation (LT) are curative treatments for hepatocellular carcinoma (HCC). The main pur-pose of this study was to compare the survival of LR and LDLT in patients with HCC within the Milan criteria. Materials and Methods: The results of the LR (n=67) and LDLT (n=391) groups were compared for overall survival (OS) and disease-free survival (DFS). Twenty-six of the HCCs in the LRs met the Milan and Child A cri-teria. Also, 200 of the HCC patients in the LDLTs met the Milan criteria, of which 70 also met the Child A criteria. Results: Early mortality was higher in the LDLT group (13.9% vs 1.47%; p=0.003). The 5-year OS was higher in the LDLTs than the LRs, but not statistically significant (84.6% vs 74.2%; p=0.287). However, 5-year DFS was better in the LDLT group (96.8% vs 64.3%; p<0.001). When the LRs (n=26) and the LDLTs (n=70) that met both Milan and Child A criteria were compared, 5-year OS was similar (81.4% vs 74.2%; p=0.512), but DFS was better in the LDLTs (98.6% vs 64.3%; p<0.001). Conclusion: LR can be justified as the first-line treatment for HCC patients who meet Milan and Child A criteria in terms of and OS.Öğe Complicated appendicitis with scrotal fistula: case report and review of the literature(Turkish Assoc Trauma Emergency Surgery, 2023) Dalda, Yasin; Buran, Hasan; Sahin, Tevfik Tolga; Saglam, KutayAppendicitis is the most common emergency abdominal surgery today. Although its common complications are well-known, retroperitoneal abscess and scrotal abscess are rare and less known complications. In this study, we presented our patient who presented with appendicitis complicated with retroperitoneal abscess and scrotal fistula after appendectomy, and the literature review we conducted through PubMed. A 69-year-old man was admitted to the emergency department with complaints of abdominal pain, nausea-vomiting continuing for about 7 days, and fever and mental status change in the last 24 h. He was taken to emergency surgery with the preliminary diagnosis of perforation and retroperitoneal abscess. At laparotomy, perforated appendicitis and associated retroperitoneal abscess were seen. An appendectomy was performed, and the abscess was drained. The patient, who stayed in the intensive care unit for 4 days due to sepsis, was discharged on the 15th postoperative day with full recovery. He was admitted 15 days after his discharge because of an abscess from the scrotum. Percutaneous drainage was performed in the patient, whose tomography revealed an abscess extending from the retroperitoneal area to the left scrotum. The patient, whose abscess regressed, was discharged with recovery 17 days after hospitalization. These rare complications associated with appendicitis should be on the minds of surgeons to make an early diagnosis. Delay in treatment may lead to increased morbidity and mortality.Öğe Donör Hepatektomi Sırasında Pringle Manevrası Uygulamasının Donör ve Recipientte İskemi-Reperfüzyon Hasarı Gelişmesi Üzerine Etkisi(İnönü Üniversitesi, 2022) Dalda, Yasin; Akbulut, Ahmet SamiAmaç: Bu çalışmanın amacı hem Pringle manevrası uygulanan ve uygulanmayan donörlerin remnant karaciğerlerinde hem de bu donörlerden elde edilen karaciğer greftlerinin transplante edildiği alıcılarda iskemi ve reperfüzyon hasarının klinik ve laboratuvar yansımalarını değerlendirmektir. Gereç ve Yöntem: Bu randomize çift kör araştırmaya Şubat 2021 ve Haziran 2021 tarihleri arasında donör hepatektomi yapılan 54 donör ve canlı vericili karaciğer nakli yapılan 54 alıcı olmak üzere toplam 108 hasta dahil edildi. Donörler Pringle manevrası yapılan (n=27) ve yapılmayan (n=27) olmak üzere iki gruba ayrıldı. Benzer şekilde bu donörlerden elde edilen karaciğerin implante edildiği alıcılarda Pringle manevrası yapılan (n=27) ve yapılmayan (n=27) olmak üzere iki gruba ayrıldı. Donör ve alıcılardan pre-operatif, post-operatif 0. saat, post-operatif 1. gün, post-operatif 2. gün, post-operatif 3. gün, post-operatif 4. gün, post-operatif 5. günlerde kan numuneleri ve back table sırasında greftten karaciğer dokusu alındı. Çalışmaya dahil edilen parametreler arasında rutin hemogram ve biyokimya parametrelerinin yanında, IL-1, IL-2, IL-6, TNF-? ve ?-galaktozidaz ölçümleri ve histoloji laboratuvarında alınan dokularda iskemi-reperfüzyon hasarının bulguları incelendi. Bulgular: Pringle manevrası yapılan ve yapılmayan donör grupları arasında tüm zamanlarda alınan iskemi-reperfüzyon hasarına yönelik bakılan biyokimyasal analizlerde istatistiksel olarak anlamlı farklılık bulunmadı. Benzer şekilde Pringle manevrası yapılan ve yapılmayan greftlerin implante edildiği alıcı grupları arasında da istatistiksel olarak anlamlı farklılık saptanmadı. Her iki alıcı grubu arasında perioperatif kanama (p=0,248) ve erken dönemde görülen safra yolu komplikasyonları (p=0,685) açısından da istatistiksel olarak anlamlı bir farklılık saptanmadı. Karaciğer greftinden yapılan histopatolojik incelemelerde Pringle manevrası yapılan grupta hepatosit hasarı skorlaması istatistiksel olarak anlamlılık gösterecek kadar yüksek bulunmuştur (p=0,001). Sonuçlar: Her ne kadar histolojik olarak hepatosit hasarı skorlaması Pringle manevrası yapılan grupta yüksek bulunmuş olsa da Pringle manevrasının donörlerde ve bu donörlerden elde edilen karaciğer greftinin implante edildiği alıcılarda iskemi-reperfüzyon hasarına laboratuvar ve klinik olarak negatif yansıması olmamıştır. Anahtar Kelimeler: İskemi-reperfüzyon hasarı, karaciğer nakli, Pringle manevrasıÖğe Early relaparotomy in recipients after living donor liver transplantation: causes, risk factors, and consequences(Tubitak Scientific & Technological Research Council Turkey, 2024) Barut, Bora; Ceylan, Cengiz; Zengin, Akile; Guzel, Mehmet; Dalda, Yasin; Yilmaz, SezaiBackground/aim: Despite advancements in surgical methodologies and the extensive perioperative and postoperative care administered to recipients, the prevalence of complications requiring early relaparotomy following living donor liver transplantation (LDLT) remains persistent. This study sought to analyze the determinants influencing relaparotomy occurrences in the initial 30 days following LDLT. Additionally, it was aimed to evaluate the impact of early laparotomy on both graft and patient survival within this distinct patient cohort. Materials and methods: The study encompassed recipients (n = 535) aged 18 years and older who underwent primary LDLT at our institution from January 2019 to December 2021. Exclusion criteria involved patients necessitating early retransplantation. Early relaparotomy was specified as surgical intervention within the initial 30 days following LDLT. Results: The study enrolled a total of 535 patients, among whom 85 (15.9%) underwent early relaparotomy. The median age of the patients was 54 (range: 41-60) years, with a predominant male representation (66.2%). Univariate analysis comparing the laparotomy and nonrelaparotomy groups revealed statistically significant differences in the creatinine (p = 0.043) and sodium (p = 0.025) levels, graft side (p < 0.001), etiology (p = 0.005), and blood loss (p = 0.012). In the multivariate analysis, creatinine (p = 0.039; OR = 1.668; 95% CI = 1.027-2.709) and left lobe graft (p < 0.0001; OR = 3.611; 95% CI = 1.960-6.652) emerged as independent risk factors for relaparotomy. Conclusion: The primary causes of early relaparotomy following LDLT include postoperative bleeding, biliary leakage, and vascular complications. Preoperative elevation in creatinine and sodium levels, the presence of Budd-Chiari syndrome, utilization of a left lobe graft, and intraoperative blood loss are identified as risk factors associated with early relaparotomy after LDLT. Patients undergoing early relaparotomy exhibit inferior survival rates compared to those who do not.Öğe The Effect of Pringle Maneuver Applied during Living Donor Hepatectomy on the Ischemia-Reperfusion Injury Observed in the Donors and Recipients(Mdpi, 2024) Dalda, Yasin; Akbulut, Sami; Sahin, Tevfik Tolga; Tuncer, Adem; Ogut, Zeki; Satilmis, Basri; Dalda, OzlemBackground and Objectives: The aim of this study is to evaluate the clinical and laboratory changes of ischemia and reperfusion injury in the remnant livers of donors with and without Pringle maneuver. Furthermore, we evaluated the recipients who have been transplanted with liver grafts from these donors. Methods and Materials: A total of 108 patients (54 living liver donors and 54 liver recipients) who underwent donor hepatectomy and recipients who living donor liver transplantation, were included in this randomized double-blind study between February 2021 and June 2021. The donors were divided into two groups: Pringle maneuver applied (n = 27) and Pringle maneuver not applied (n = 27). Similarly, recipients with implanted liver obtained from these donors were divided into two groups as the Pringle maneuver was performed (n = 27) and not performed (n = 27). Blood samples from donors and recipients were obtained on pre-operative, post-operative 0 h day (day of surgery), post-operative 1st day, post-operative 2nd day, post-operative 3rd day, post-operative 4th day, post-operative 5th day, and liver tissue was taken from the graft during the back table procedures. Liver function tests and complete blood count, coagulation tests, IL-1, IL-2, IL-6, TNF-alpha, and beta-galactosidase measurements, and histopathological findings were examined. Results: There was no statistically significant difference in the parameters of biochemical analyses for ischemia-reperfusion injury at all periods in the donors with and without the Pringle maneuver. Similarly, there was no statistically significant difference between in the recipients in who received liver grafts harvested with and without the Pringle maneuver. There was no statistically significant difference between the two recipient groups in terms of perioperative bleeding and early bile duct complications (p = 0.685). In the histopathological examinations, hepatocyte damage was significantly higher in the Pringle maneuver group (p = 0.001). Conclusions: Although the histological scoring of hepatocyte damage was found to be higher in the Pringle maneuver group, the Pringle maneuver did not augment ischemia-reperfusion injury in donors and recipients that was evaluated by clinical and laboratory analyses.Öğe Effect of the COVID-19 Pandemic on the Management of Breast Cancer Patients(Mdpi, 2024) Dalda, Yasin; Akbulut, Sami; Kucukakcali, Zeynep; Ogut, Zeki; Dalda, Ozlem; Alan, Saadet; Isik, BurakBackground: The COVID-19 pandemic has significantly affected breast cancer patients by causing delays in diagnosis and treatment processes. This study aims to investigate the effects of the pandemic on the treatment process and short-term outcomes of breast cancer patients. Methods: This retrospective, cross-sectional, single-center study included 414 patients who underwent surgery for breast cancer at the Inonu University General Surgery Clinic between March 2018 and June 2021. The patients were divided into two groups: pre-pandemic (Pre-COVID-19; n = 240) and pandemic (COVID-19 Era; n = 174) periods. The groups were compared in terms of demographic, clinical, and histopathological variables. Results: During the pandemic period, the use of neoadjuvant therapy (from 21.3% to 34.5%) and preoperative PET-CT imaging (from 80.4% to 90.8%) rates increased, while breast-conserving surgery (from 27.9% to 19.0%) and the presence of comorbid diseases (from 45.0% to 29.9%) decreased significantly. While there was no significant difference between the groups in terms of the time from diagnosis to surgery (25 vs. 28.5 days, p = 0.121), the time to report the pathology result after surgery decreased during the pandemic period (28 vs. 23 days, p < 0.001). There was no significant difference between the groups in terms of immunohistochemical (ER, PR, Ki-67, E-cadherin, and c-erbB2), histopathological (lymphovascular invasion, perineural invasion, comedo necrosis, modified Bloom-Richardson grade, and TNM classification), and clinical (recurrence, metastasis, and axillary lymph node metastasis) features of the tumor. The mortality rate in the Pre-COVID-19 group (7.1%) was significantly higher than in the COVID-19 Era group (2.3%) (p = 0.049). Finally, in terms of the survival analysis, a statistically significant difference was found between the Pre-COVID-19 and COVID-19 Era groups in terms of the mean follow-up duration of the patients (p = 0.044). Conclusions: The study results show that the use of neoadjuvant therapy and radical surgery preference increased in breast cancer treatment during the pandemic period, but there was no significant change in tumor biology and histopathological features. Breast-conserving surgery rates, comorbidity rates, and pathology reporting times were significantly shortened. Long-term follow-up periods of 3 and 5 years are needed to see the impact of the pandemic on breast cancer patients.Öğe Factors associated with complications of parathyroidectomy in the elderly: A single-center experience(2025) Gozukara Bag, Harika Gozde; Dalda, Yasin; Öğüt, Mehmet Zeki; Isik, BurakAim: The expanding older adult population has led to a corresponding increase in parathyroidectomy procedures among geriatric patients. Due to the prevalence of comorbidities and reduced physiological reserves, elderly patients may experience a greater incidence of postoperative complications. This study aims to evaluate the relationship between clinical parameters and complications associated with parathyroidectomy in individuals aged 65 years and above. Materials and Methods: This is an observational study included patients aged 65 years and older who underwent parathyroid surgery at a tertiary care center between January 2009 and February 2022. Demographic, clinical, surgical, and laboratory data were analyzed. Patients were divided into two groups according to the presence or absence of postoperative complications. A subgroup analysis was conducted for patients who developed permanent hypocalcemia. Statistical comparisons were made between groups. DEXA T scores were obtained from the lumbar spine and hip regions. Results: Elderly patients accounted for 5.9% (23/388) of all parathyroidectomy cases. The overall postoperative complication rate was 21.7%, and the rate of permanent hypocalcemia was 17.4%. Statistically significant differences were found between the patients with and without complications in terms of free T3, preoperative ALP, PTH, and postoperative calcium levels. Histopathological findings (adenoma vs. hyperplasia) and the number of excised adenomas were significantly associated with complications and permanent hypocalcemia. Mortality was significantly higher in the complication group (p=0.017). No cases of persistent hyperparathyroidism were observed during follow-up. A significant association was found between preoperative phosphorus levels and DEXA T-scores. Conclusion: Parathyroidectomy in elderly patients carries a notable risk of postoperative complications. Identifying high-risk patients based on clinical and biochemical parameters may help guide preoperative planning and postoperative monitoring.Öğe Gastric Cancer Surgery Before and During the COVID-19 Pandemic in Turkey: A Multicenter Comparison of Prognostic Factors, Mortality, and Survival(Mdpi, 2025) Dalda, Yasin; Akbulut, Sami; Ogut, Zeki; Yilmaz, Serkan; Sahin, Emrah; Dalda, Ozlem; Tuncer, AdemBackground/Objectives: The COVID-19 pandemic disrupted global cancer care. This study compared gastric cancer surgical outcomes before and during the pandemic in Turkey. We also aimed to analyze the impact of the pandemic and factors on survival and mortality in gastric cancer patients. Materials and Methods: This retrospective, multicenter cohort study included 324 patients from three tertiary centers in Turkey who underwent gastric cancer surgery between January 2018 and December 2022. Patients were stratified into Pre-COVID-19 (n = 150) and COVID-19 Era (n = 174) groups. Comprehensive demographic, surgical, pathological, and survival data were analyzed. To identify factors independently associated with postoperative mortality, a multivariable logistic regression model was applied. For evaluating predictors of long-term survival, multivariable Cox proportional hazards regression analysis was conducted. Results: The median time from diagnosis to surgery was comparable between groups, while the time from surgery to pathology report was significantly prolonged during the pandemic (p = 0.012). Laparoscopic surgery (p = 0.040) and near-total gastrectomy (p = 0.025) were more frequently performed in the Pre-COVID-19 group. Although survival rates between groups were similar (p = 0.964), follow-up duration was significantly shorter in the COVID-19 Era (p < 0.001). Comparison between survivor and non-survivor groups showed that several variables were significantly associated with mortality, including larger tumor size (p < 0.001), greater number of metastatic lymph nodes (p < 0.001), elevated preoperative CEA (p = 0.001), CA 19-9 (p < 0.001), poor tumor differentiation (p = 0.002), signet ring cell histology (p = 0.003), lymphovascular invasion (p < 0.001), and perineural invasion (p < 0.001). Multivariable logistic regression identified total gastrectomy (OR: 2.14), T4 tumor stage (OR: 2.93), N3 nodal status (OR: 2.87), and lymphovascular invasion (OR: 2.87) as independent predictors of postoperative mortality. Cox regression analysis revealed that combined tumor location (HR: 1.73), total gastrectomy (HR: 1.56), lymphovascular invasion (HR: 2.63), T4 tumor stage (HR: 1.93), N3 nodal status (HR: 1.71), and distant metastasis (HR: 1.74) were independently associated with decreased overall survival. Conclusions: Although gastric cancer surgery continued during the COVID-19 pandemic, some delays in pathology reporting were observed; however, these did not significantly affect the timing of adjuvant therapy or patient outcomes. Importantly, pandemic timing was not identified as an independent risk factor for mortality in multivariable logistic regression analysis, nor for survival in multivariable Cox regression analysis. Instead, tumor burden and aggressiveness-specifically advanced stage, lymphovascular invasion, and total gastrectomy-remained the primary independent determinants of poor prognosis. While pandemic-related workflow delays occurred, institutional adaptability preserved oncologic outcomes.Öğe Giant hydatid cyst of the liver: a case report with literature review(Springeropen, 2023) Sahin, Emrah; Dalda, Yasin; Dirican, AbuzerHydatid cyst is a parasitic infection most commonly localized in the liver. They may not be diagnosed early because they remain asymptomatic at small sizes and may reach large sizes at the time of diagnosis. In this situation, compression symptoms may occur and they may present with serious complications such as rupture and anaphylactic shock, which are rare. Treatment methods are determined by classification according to the imaging techniques used in the diagnosis. In the present case, echinococcal cysts originating from segments 5, 6, and 7 in the right lobe of the liver, reaching 35 cm in diameter, caused compression symptoms. The diagnosis was made by abdominal tomography showing characteristic daughter vesicles and calcified cystic wall. The patient underwent pericystectomy and had an uneventful postoperative course with no recurrence in the 5-year follow-up.Öğe Impact of the COVID-19 Pandemic on Colorectal Cancer Surgery: Surgical Outcomes and Tumor Characteristics in a Multicenter Retrospective Cohort(Mdpi, 2025) Sahin, Emrah; Akbulut, Sami; Ogut, Zeki; Yilmaz, Serkan; Dalda, Yasin; Tuncer, Adem; Kucukakcali, ZeynepBackground: Colorectal cancer (CRC) is a leading cause of cancer-related mortality worldwide. The COVID-19 pandemic disrupted healthcare systems globally, raising concerns about delays in CRC diagnosis and treatment, and their potential negative effects on surgical outcomes. However, the extent of this impact remains uncertain. Aim: To compare the clinical characteristics, treatment strategies, and outcomes of CRC patients between the Pre-COVID-19 and COVID-19 Era groups, and to identify independent predictors of metastasis and mortality. Methods: This retrospective multicenter study included 397 CRC patients who underwent surgical treatment between 1 July 2018, and 1 August 2021, at three tertiary medical centers. Patients were divided into two groups: Pre-COVID-19 (n = 213) and COVID-19 Era (n = 184). Demographic data, tumor characteristics, surgical approach, postoperative complications, and survival outcomes were analyzed. Logistic regression analysis was conducted to identify independent predictors of metastasis and mortality. Results: The median age was 64 years (95% CI: 63-66), with 59.2% being male. Compared to the Pre-COVID-19 group, patients in the COVID-19 Era had significantly larger tumors (p < 0.001), with a significantly higher total LN retrieved (p = 0.006), more advanced T-stage (p = 0.007), higher N2 lymph node involvement (p = 0.027), and poorer tumor differentiation (p = 0.030). Intestinal perforation was more frequent in the Pre-COVID-19 group (p = 0.042). Multivariate analysis revealed increased odds of mortality associated with the positive LN retrieved (OR: 1.14; p = 0.001), moderate tumor differentiation (OR: 2.99; p = 0.043), poor differentiation (OR: 4.57; p = 0.023), undifferentiated histology (OR: 6.95; p = 0.028), intestinal obstruction (OR: 2.67; p = 0.007), intestinal perforation (OR: 11.76; p < 0.001), and distant metastasis (OR: 2.86; p = 0.008). Regarding metastasis, elevated preoperative CEA (OR: 1.02; p = 0.002), lymph node involvement (OR: 4.87; p = 0.002), and perineural invasion (OR: 2.17; p = 0.033) were independently associated with increased odds of metastasis. Conclusions: Although overall survival did not differ significantly between groups, patients treated during the COVID-19 Era exhibited more advanced histopathological characteristics, including a higher proportion of T4 tumors, increased N2 lymph node involvement, and poorer differentiation grades. Despite no significant differences in postoperative complications between groups, it is noteworthy that preoperative intestinal perforation was less frequent in the COVID-19 Era cohort.Öğe Is peritoneal dialysis prior to kidney transplantation a risk factor for ureteral stenosis after adult to adult live kidney transplantation(2020) Kutlutürk, Koray; Şahin, Tevfik Tolga; Çimen, Serhan; Dalda, Yasin; Gönültaş, Fatih; Doğan, Sait Murat; Toplu, Sibel; Ünal, Bülent; Pişkin, TurgutAbstract: Objective: Major urinary complications such as urinary leaks, stenosis or urinary tract infections after kidney transplantation can lead to graft or patient loss. The effect of peritoneal dialysis on post-kidney transplantation complications have been discussed but its effect on ureteral stenosis is unknown. In this study, it was aimed to analyze factors effecting major ureteral complications after living donor kidney transplantation and impact of peritoneal dialysis and double J-stents (JJ stents). Material and Methods: This study included 116 adult to adult living donor kidney transplant patients. Factors effecting major urologic complications after living donor kidney transplantation were analyzed. The donors were primary relatives of the recipients. Results: Major urologic complications after living donor kidney transplantation was 8/116 (6.9%). Urinary leak was present in 2 (1.7%) patients. Ureteral stenosis was encountered in 6 (5.2%) patients. Double J stents were used in 84 (72.4%) of the cases. The effect of JJ ureteral stent was not statistically significant for urinary leak, ureteral stenosis (p= 0.074, p= 0.470, respectively). A total of 29 (25%) patients had peritoneal dialysis before kidney transplantation. Preoperative peritoneal dialyses and bacteriuria after kidney transplantation were independent risk factors for ureteral stenosis in multivariate analysis (p= 0.013, and p= 0.010 respectively). Conclusion: In the guidance of the results of the present study, peritoneal dialysis prior to kidney transplantation and bacteriuria are independent risk factors for ureteral stenosis after living donor kidney transplantation. JJ stents have no effect on urologic complications after living donor kidney transplantation.Öğe Management of acute cholecystitis in elderly (?65 years old) patients: A retrospective study comparing early versus delayed cholecystectomy(2023) Barut, Bora; Bağ, Yusuf Murat; Patmano, Mehmet; Gündoğan, Ersin; Tuncer, Adem; Dalda, Yasin; Gönültaş, FatihAim: Acute cholecystitis is the most common causes of acute abdomen in elderly popula tion. This study aimed to present the early postoperative period (? 30 days) outcomes of elderly patients (? 65 years old) with acute cholecystitis who underwent early or delayed cholecystectomy. Materials and Methods: Between January 2016 and December 2020, 74 patients aged 65 and over underwent cholecystectomy for acute cholecystitis were included in the study. The patients were divided into two groups as early (time between diagnosis and chole cystectomy 7 days or less, n= 43, 58.1%) or delayed (time between diagnosis and chole cystectomy over 7 days, n= 31, 41.9%) cholecystectomy. Demographic characteristics, preoperative laboratory and radiological findings, and perioperative data of patients were evaluated, and the groups were compared. Results: The median age of patients was 73 (65-90) years, and 39 (52.7%) were male. Sixty-one (82.4%) patients underwent laparoscopic, 8 open (10.8%) and 5 (6.8%) conver sion cholecystectomy. The rate of laparoscopic cholecystectomy was higher in the delayed group (n= 29, 93.5%) than in the early group (n= 32, 74.4%), but no statistically signifi cant difference was detected (p=.06). The rate of open cholecystectomy was statistically significantly higher in the early group (n=8, 18.6%) than in the delayed group (n=0) (P=.017), the conversion rate was similar between the groups (p=1). There was no signif icant difference between the groups in terms of intraoperative complications (p=1). The length of hospital stay was statistically significantly longer in the early compared to the delayed group (5 (1-21) days and 2 (1-12) days, respectively, p< .001). Conclusion: There was no statistical difference regarding intraoperative complications in patients underwent early or delayed cholecystectomy. We believe that the patient’s clinical presentation and early or delayed cholecystectomy experience of the team are vital in determining the timing of cholecystectomy, as well as the severity of acute cholecystitis.Öğe Marginal ulcer perforation following laparoscopic roux-en-y gastric bypass(2022) Dalda, Yasin; Kayaalp, CüneytMorbid obesity is a major problem of our age with increasing frequency and high comorbidities. It is associated with many chronic diseases and vascular diseases that can result in death. Laparoscopic Roux-en-Y Gastric bypass is one of the accepted safe surgical methods for long-term weight control and reduction of comorbidities in the treatment of obesity. Marginal ulcers are one of the long-term complications seen after this surgery and are not very common. In this case report, we aimed to present a marginal ulcer perforation that developed in a patient who had previously undergone gastric bypass surgery for obesity.Öğe Mucoepidermoid Carcinoma of the Breast: A Systematic Review of Clinicopathologic, Immunohistochemical, and Molecular Features(Wiley, 2025) Akbulut, Sami; Dalda, Yasin; Ivanova, Mariia; Fusco, NicolaBackground: Mucoepidermoid carcinoma (MEC) of the breast is a very rare salivary gland-like tumor, accounting for 0.2%-0.3% of all breast cancers (BC). This study aims to review the literature on MEC of the breast. Methods: This systematic review focuses on MEC of the breast, conducted in line with PRISMA 2020 guidelines and registered in PROSPERO under ID CRD420251089598. Searches were performed in PubMed, Medline, Scopus, Web of Science, and Google Scholar, using terms such as mucoepidermoid carcinoma, breast, and similar terms. No language restrictions were applied. Studies published between January 1, 1979, and July 1, 2025, were included. Results: Median age was 57 years (95% CI: 53-60). The most common presentation was a palpable breast mass (64.7%), followed by incidental detection via mammography (10.6%). Tumors were located in the left breast (49.4%) and in the right breast (43.5%). The most frequent tumor localization was the upper-outer quadrant (20.0%). Median tumor size was 21 mm (95% CI: 19-30). Modified radical mastectomy (30.6%) was the most common surgical approach, followed by breast-conserving surgery with sentinel or level dissection (29.4%), and simple mastectomy or its variants (17.6%). Immunohistochemistry revealed positivity for P63 (52.9%), CK5/6 (41.2%), CK7 (45.9%), Ki67 (44.7%), ER (24.7%), PR (4.7%), and HER2 (9.4%) with TNBC phenotype (36.5%), genetic alterations (16.5%), and distant metastasis (9.4%). Follow-up data revealed 7 deaths, of which 5 were due to MEC, and these five patients consistently exhibited poor prognostic features. Compared to the 63 survivors with follow-up data, they showed significantly higher rates of axillary lymph node positivity (p = 0.005) and advanced N stage (p = 0.001); in addition, all five had high-grade tumors (p = 0.001) and documented distant metastases (p < 0.001). Conclusion: Breast MEC is a rare malignancy with generally favorable prognosis in low-grade cases, but high-grade tumors show more aggressive behavior. In this study, all disease-related deaths occurred in high-grade tumors with axillary node involvement, advanced N stage, and distant metastasis-highlighting their prognostic significance. CK5/6, CK7, and P63 were frequently positive, whereas hormone receptors were usually negative. Close follow-up is essential, especially for high-grade tumors.Öğe The predictivity of thyroid fine-needle aspiration biopsy varies depending on the radiologist experience: A retrospective cohort study(2019) Gönültaş, Fatih; Kutlutürk, Koray; Dalda, Yasin; Barut, Bora; Alan, Saadet; Ünal, BülentAbstract: Aim: To compare thyroid fine-needle aspiration biopsy with histopathological examination results.Material and Methods: Postoperative histopathological examination results of 361 patients, who were thyroidectomized betweenDecember 2010 and October 2017 in Inonu University Turgut Ozal Medical Center Department of General Surgery and whosepreoperative FNAB registries we could reach were evaluated retrospectively. Biopsies made in external centers were included inpreoperative FNAB results. FNAB results were examined according to Bethesda 2007 in 6 categories: unsatisfactory, benign, atypiaof undetermined significance, follicular lesion-neoplasm or suspicious for a neoplasm, suspicious for malignancy and malignant.Histopathological results of patients with incidental malignancy were presumed benign.Results: Among the 361 patients that were included in the study, 274 were female (75.9%), 87 were male(24.1%). Mean age of thepatients in the benign group was 49.1±12.5 years, and 48.6±13.5 years in the malignant group. It was found that FNAB’s sensitivitywas 83.9 %, specificity was 92.4%, false positive rate was 16.1% and false negative rate was 7.6%.Conclusion: FNAB is reported as the gold standard for preoperative evaluation of thyroid nodules. In our study, however, it wasseen that FNAB was not adequate alone tÖğe Prognostic and Predictive Significance of B7-H3 and CD155 Expression in Gastric Cancer Patients(Mdpi, 2025) Dalda, Ozlem; Bozdag, Zehra; Akbulut, Sami; Gokce, Hasan; Dalda, Yasin; Akatli, Ayse Nur; Huz, MustafaBackground/Objectives: This study aimed to characterize the expression patterns of B7 homolog 3 (B7-H3) and cluster of differentiation 155 (CD155), two immune-related transmembrane glycoproteins, in resectable gastric adenocarcinoma and to elucidate their clinicopathological, prognostic, and molecular implications. Methods: The study included 112 patients who underwent gastrectomy for gastric adenocarcinoma between 2020 and 2025, along with 30 samples of normal gastric tissue obtained from sleeve gastrectomy specimens. Histological subtype, grade of differentiation, TNM stage, and invasion parameters were re-evaluated. Immunohistochemical expression of B7-H3 and CD155 was quantified for membranous, stromal and membranous/cytoplasmic staining patterns. Quantitative reverse transcription polymerase chain reaction (RT-PCR) was performed on 29 tumor and 25 normal samples to confirm mRNA expression levels, with fold change >= 2 considered biologically significant upregulation and <= 0.5 considered downregulation. Machine learning models were developed to predict metastasis and mortality based on clinical and immunohistochemical features. Results: 78.5% of tumors were at an advanced stage (T3-T4), and metastasis was present in 22.3% of patients. Perineural invasion (PNI) and lymphovascular invasion (LVI) were observed in 67.9% and 88.4% of cases, respectively. Increased B7-H3 and CD155 expression were significantly associated with advanced tumor stage, metastasis, and the presence of PNI and LVI (all p < 0.05). In metastatic tumors, median membranous B7-H3, stromal B7-H3, and CD155 scores were 60, 130, and 190, respectively, compared with 20, 90, and 120 in non-metastatic tumors. A significant positive correlation was found between stromal B7-H3 and CD155 expression (r = 0.384, p < 0.001), indicating parallel upregulation. Quantitative RT-PCR confirmed significant overexpression of both genes in tumor tissues relative to normal controls. B7-H3 was upregulated in 75.9% and CD155 in 58.6% of samples, with co-upregulation in 55.2%. Fold-change levels were markedly higher in metastatic versus non-metastatic cases (B7-H3: 7.69-fold vs. 3.04-fold; CD155: 7.44-fold vs. 1.79-fold). ML analysis using the XGBoost model achieved 91.1% accuracy for metastasis prediction (F1-score 0.800). Key variables included pathological T4b stage, perineural invasion, N3b status, T4a stage, and CD155 score. The mortality model yielded 86.7% accuracy (F1-score 0.864), with metastasis, differentiation status, nodal involvement, age, lymph node ratio, and perineural invasion emerging as principal predictors. Conclusions: Combined evaluation of B7-H3 and CD155, supported by immunohistochemical staining and RT-PCR quantification of B7-H3 and CD155 mRNA expression levels, provides meaningful prognostic insights and supports their potential as dual molecular biomarkers for aggressive gastric adenocarcinoma phenotypes.
