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Öğe Bone grafts and nuclear medicine: Review(Turkiye Klinikleri, 2005) Kekilli E.; Ya?mur C.; Ertem K.; Türk Bilen B.Bone grafts find application in multiple settings: joint fusion and reconstruction, bone infection and resection, prothesis complications, congenital malformation and cosmetic adjustments, cranio-maxillofacial reconstruction, as well as the treatment of various trauma injuries such as fractures resulting in delayed unions and non-unions. Bone grafts have often played the roles of scaffolds, bridges, spacers, defect fillers, and bone-loss replacements. There is a growing trend in bone graft usage today. The use of autolog bone grafts is widespread in Turkey. Nuclear medicine has proven to be a helpful adjunct in the determination of graft viability. In particular, the status of vascular anastomoses can be shown on bone scintigraphy short periods after cortical and pedicle bone grafts. With added knowledge of individual pathophysiology, the interpretation of scintigraphic results is greatly facilitated. Non-vascularized bone grafts improve with revascularisation and remineralisation. In cancellous autografts, the vascular response is much greater than in cortical grafts. The entire cancellous bed may be completely revascularized within approximately 1 to 2 weeks. Healing of vascularized bone grafts and pedicles is similar to the process manifested in fractures. Allograft bone simply provides calcium scaffolding and does not possess bone-growing cells or proteins. Previous studies utilizing bone scintigraphy have shown that allograft healing proceeds not unlike that of autografts, with the exception that revascularisation and remineralisation are delayed. The authors review the current literature on bone grafting procedures and discuss the possible applications of nuclear medicine in this setting. Copyright © 2005 by Türkiye Klinikleri.Öğe A dilemma: Prophylaxis for pulmonary embolism after surgical or invasive interventions for hemodialysis(2006) Alat I.; Türker G.; Akpinar M.B.; Taşkapan H.; Kekilli E.; E?ri M.; Aydin Ö.M.Aim. This study was designed to investigate if it needs to do prophylaxis for pulmonary embolism in the patients treated with different kinds of dialysis or not, and if it is, to find a proper method for prophylaxis. Methods. Ten numbers of patients with central venous catheters (CVC group), 13 numbers of patients with arteriovenous fistula (AVF group) were enrolled in this study. Eleven patients treated with peritoneal dialysis (PD group) were utilized as a control group. Clinical and laboratory examinations to exclude pulmonary embolism were carried out in both AVF and PD groups at the onset and after three months. Same examinations were performed in CVC group at the onset and after 3 weeks (mean: 21 days). Examinations to exclude pulmonary embolism consist of medical history, clinical examinations, d-dimer measures, chest x-ray, respiratory function tests, blood gas analyses, ventilation-perfusion scintigraphies. Results. Neither clinical nor laboratory findings in any stages reflected any suspicion for pulmonary embolism. None of the patients in any groups was admitted with pulmonary embolism in any period of follow-up. There was not any statistically difference between the outcomes of all first examinations and of all second ones (P>0.005). Neither obvious nor subclinical pulmonary embolism was detected in any case. None of the patients had deep venous thrombosis in any stage of follow-up. Conclusion. Conventional techniques of haemodialysis do not lead to pulmonary embolism unless deep venous thrombosis due to any intervention occurs in the patients. Thus, prophylactic anticoagulant usage to prevent pulmonary embolism is not necessary in haemodialysis patients. To shorten the length of stay of central venous catheters is the most important factors for pulmonary embolism prophylaxis in haemodialysis patients.Öğe Factors affecting the accuracy of18f-fdg pet/ct in detecting additional tumor foci in breast cancer(BETA Medical Publishers Ltd, 2021) Simsek A.; Kutluturk K.; Comak A.; Akatli A.; Kekilli E.; Unal B.OBJECTIVE To evaluate the effectiveness of18F-FDG PET/CT for detecting additional tumor foci in breast cancer. MATERIAL-METHOD The data were reviewed retrospectively of 232 women who underwent18F-FDG PET/CT examination prior to breast cancer surgery between January 2013 and December 2018. RESULTS Additional tumor foci were suspected in 95 cases on18F-FDG PET/ CT, which were confirmed by histopathological analysis in 81 cases. The sen-sitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of18F-FDG PET/CT in detection of additional tumor foci were 77.7%, 79.48%, 66.3%, 87.32%, and 79.23%, respectively. The false negative and false positive rates were 22.22% and 20.51%, respectively. In univariate analysis, only the patient’s age was positively associated with accuracy of 18 F-FDG PET/CT in detecting additional tumor foci. The accuracy was lower in women aged ?50 years, with a substantial increase in false positive findings in women in that age group. CONCLUSIONS18F-FDG PET/CT alone cannot replace conventional diagnostic procedures for evaluating additional tumor foci in breast cancer, as a substantial increase in false positive findings is recorded with this method in women aged ?50 years old. © Athens Medical Society.Öğe The mechanical or electrical induction of medullary angiogenesis: Will it improve sternal wound healing?(2004) Alat I.; Inan M.; Gurses I.; Kekilli E.; Germen B.; Harma A.; Eskin A.We induced angiogenesis in the tibial medulla and cortex of rabbits by electrical and mechanical stimulation, with the aim of future application to ischemic disease. Sixteen New Zealand rabbits were divided into 4 groups: in Group 1, a K wire was inserted into the medullary channel; in Group 2, a hole was drilled into the tibia; in Group 3, electrical stimulation was applied to the medullary channel; and in Group 4 (the control group), nothing was done. The interventions were applied during a 21-day period, after which all animals were evaluated scintigraphically and histopathologically. All 3 interventional groups were significantly superior to the control group in regard to medullary and cortical vascularity: the P values were 0.021 in all comparisons to control. However, the most fibrotic changes in the medulla occurred in the group that had been treated with electricity (P=0.008). Slight fibrotic changes occurred in the hole group (P=0.040), and none occurred in the K-wire group. In sum, all 3 interventions are capable of inducing medullary angiogenesis, but electricity is inferior in regard to fibrotic change. We believe that this present study can establish a baseline for further work that explores clinical applications to problematic ischemic conditions, including delayed sternal wound healing after cardiac surgery.Öğe Postoperative Radiotherapy in Salivary Gland Carcinoma: A Single Institution Experience(2017) Temelli Ö.; Kekilli E.; Kizilay A.BACKGROUND: Salivary gland carcinoma are rare tumors and the main treatment is surgical. The addition of radiotherapy to surgery decreases locoregional relapses in high risk patients. Aim of our study is to retrospectively evaluate local control and survival and the factors affecting them in patients who received postoperative radiotherapy. MATERIALS AND METHODS: The medical records of 30 patients with salivary gland tumors operated on and referred to our clinic for adjuvant RT between January 2004 and June 2015 were retrospectively evaluated. RT was applied to the primary tumor or its lymphatics in a median dose of 60 Gy (48-66 Gy) in 1.8-2 Gy/fraction. The number of patients receiving concomitant chemotherapy was 8 (27%) and 22 (73%), respectively. RESULTS: The mean duration of follow-up was 47 months (range: 3-132 months). The mean duration between surgery and RT was 51 days and mean duration of RT was 43 days. Tumors were located in the parotid gland in 25 patients (83%), in the submandibular gland in four patients (14%), and in the sublingual gland in one patient (3%). Histopathologically, the most common tumor was adenoid cystic carcinoma (27%), followed by mucoepidermoid carcinoma (20%), and skin SCC metastatic to the parotid gland. Five-year overall survival (OS), five-year disease specific survival (DSS), and five-year disease free survival (DFS) were 50%, 50%, and 54%, respectively. Regional recurrence and distant organ metastasis developed in 5 (17%) and 9 (30%) patients, respectively. OS, DSS, and DFS were significantly decreased in patients with lymph node metastasis compared to the patients with no metastasis (p=0.002). DFS was better in Stage 1-2 patients compared to Stage 3-4 patients (p=0.019). OS and DFS were significantly in radiotherapy time in less than 45 days (p=0.01). A duration between surgery and radiotherapy of more than 42 days was associated with low DFS (p=0.042). No prognostic significance of age, gender, type of the salivary gland, T stage, tumor diameter, surgical margin, PNI, LVI, and extracapsular involvement was found among the other variables. CONCLUSION: Adjuvant RT is an efficacious and safe method of treatment in high risk patients operated on for salivary gland tumor.
