Yazar "Simsek, A." seçeneğine göre listele
Listeleniyor 1 - 8 / 8
Sayfa Başına Sonuç
Sıralama seçenekleri
Öğe The factors affecting development of low anterior resection syndrome (LARS) in patients undergoing sphincter preserving surgery for rectal cancer(Athens Medical Soc, 2020) Simsek, A.; Bayraktar, H.; Dirican, A.; Ozgor, D.; Ates, M.OBJECTIVE To investigate the incidence of major low anterior resection syndrome (LARS), using the LARS score, in patients who underwent sphincter-preserving surgery for rectal cancer, and to explore the factors affecting major LARS development. METHOD The medical records were retrospectively reviewed of patients, who were operated for rectal cancer at a tertiary center between January 2009 and October 2017. The inclusion criteria were: The absence of other colorectal or proctologic diseases, the application of anterior resection (high anterior resection, low anterior resection, extremely low anterior resection), follow-up of more than one year after the primary surgery, and follow-up of more than one year after protective ileostomy closure, and the absence of an unreversed stoma, ongoing treatment with chemotherapy or radiotherapy, recurrence, and metastatic disease. LARS was diagnosed using the LARS score developed by Emmertsen and Laurberg. RESULTS For the study period, 81 patients met the inclusion criteria, including 45 (55.5%) men and 36 (44.4%) women, with a mean age of 60.1 years. Of the 81 patients, 56 (69.1%) underwent chemotherapy and 43 (53%) underwent radiotherapy. Major LARS was detected in 29.6% of the patients. Univariate analysis revealed that radiotherapy, lower tumor location and a short interval after ileostomy closure had an effect on LARS development, and multivariate analysis indicated that incidence of LARS was higher in middle and lower rectal cancer. CONCLUSIONS There appears to be no harm in creating a protective ileostomy for LARS development, with regard to anastomosis safety and the planning of the adjuvant therapy. Neither radiotherapy, nor type of surgery had an effect on major LARS. As was expected, a high rate of major LARS was reported in lower rectal tumors.Öğe Factors affecting the accuracy of 18F-FDG PET/CT in detecting additional tumor foci in breast cancer(Athens Medical Soc, 2021) Simsek, A.; Kutluturk, K.; Comak, A.; Akatli, A.; Kekilli, E.; Unal, B.OBJECTIVE To evaluate the effectiveness of F-18-FDG PET/CT for detecting additional tumor foci in breast cancer. MATERIAL-METHOD The data were reviewed retrospectively of 232 women who underwent F-18-FDG PET/CT examination prior to breast cancer surgery between January 2013 and December 2018. RESULTS Additional tumor foci were suspected in 95 cases on F-18-FDG PET/ CT, which were confirmed by histopathological analysis in 81 cases. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of F-18-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 F-18-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. CONCLUSIONS F-18-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.Öğe Factors affecting the accuracy of 18F-FDG PET/CT in evaluating axillary metastases in invasive breast cancer(Wolters Kluwer Medknow Publications, 2019) Kutluturk, K.; Simsek, A.; Comak, A.; Gonultas, F.; Unal, B.; Kekilli, E.Background and Aim: There are conflicting results of studies on accuracy of positron emission tomography (PET)/computed tomography (CT) for axillary staging. The aim of this study is to determine the factors affecting the efficacy of 18F-fluorodeoxyglucose (F-18-FDG) PET/CT in detecting axillary metastases in invasive breast cancer. Materials and Methods: Data of 232 patients with invasive breast cancer who underwent F-18-FDG PET/CT examination before surgery between January 2013 and September 2017 were reviewed retrospectively. Histopathological examination of axillary lymph nodes (ALNs) was used as a reference to assess the efficacy of F-18-FDG PET/CT in detecting axillary metastases. Results: While 134 (57.8%) patients had axillary metastases as detected in F-18-FDG PET/CT scans, histopathologically axillary metastases were detected in 164 (70.7%) patients. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of F-18-FDG PET/CT in detection of axillary metastasis were 72.56%, 77.94%, 88.8%, 54%, and 74.1%, respectively. The false-negative and false-positive rates were 27.4% and 22%, respectively. In univariate analysis, patients' age, estrogen receptor positivity, higher ALN SUVmax, greater tumor size, and lymph node size determined by F-18-FDG PET/CT were all significantly associated with accuracy of F-18-FDG PET/CT for axillary metastasis. In multivariate analysis, tumor size determined by F-18-FDG PET/CT and ALN SUVmax were independent variables associated with axillary metastasis. The accuracy of F-18-FDG PET/CT for axillary metastasis was higher in patients with a larger tumor (>= 19.5 mm) and a higher ALN SUVmax (>= 3.2). Conclusion: F-18-FDG PET/CT should not be routinely used for axillary staging, especially in patients with small tumors. It cannot eliminiate the necessity of sentinel lymph node biopsy. When it is used, both visual information and optimal cut-off value of axillary node SUVmax should be taken into consideration.Öğe Management of thrombosis in a pediatric renal transplant patient with factor VII deficiency A dilemma concerning recombinant factor VIIa(Athens Medical Soc, 2020) Yalcin, M.; Simsek, A.; Tabel, Y.; Dogan, S. M.; Piskin, T.Hemorrhagic complications in surgical patients with congenital factor VII deficiency are a major concern. Replacement therapy is required, in which recombinant factor VIIa is the first treatment choice, by virtue of its higher efficacy and no risk of infection. Because of the risk of vascular thrombosis, recombinant factor VIIa treatment may result in catastrophic outcomes, including graft loss in transplant patients. We present the case of a 7-year-old male who underwent renal transplantation and who developed renal thrombosis after recombinant factor VIIa substution therapy for factor VII deficiency.Öğe Predictive value of umbilical artery Doppler for adverse perinatal outcome in patients with HELLP syndrome(Verduci Publisher, 2013) Simsek, Y.; Celen, S.; Simsek, A.; Danisman, N.; Mollamahmutoglu, L.OBJECTIVE: In this study, we aimed to evaluate in a prospective design the importance of pathologic umbilical artery (UA) Doppler findings as a predictive marker for neonatal outcome in patients with HELLP syndrome. PATIENTS AND METHODS: A total of 45 pregnant women at 24-42 weeks of gestation with a diagnosis of HELLP syndrome were included. The study group consisted of 20 patients with abnormal UA Doppler results, and the remaining 25 HELLP syndrome patients with normal UA Doppler results were assigned to the control group. All patients were followed up until delivery, and the neonatal characteristics were compared. RESULTS: Baseline characteristics of the groups were similar. In the study group, gestational week at delivery and infant birth weight were significantly lower (p < 0.05). The rates of significant neonatal morbidity, neonatal mortality, and neonatal intensive care unit (NICU) admission were significantly higher in study group patients (p < 0.05). CONCLUSIONS: UA Doppler abnormalities can be considered predictive of poor neonatal prognosis in patients with HELLP syndrome, as they were significantly related with higher rates of neonatal mortality and significant morbidity.Öğe The predictors of mortality in patients with anogenital necrotizing fasciitis (Fournier's gangrene)(Athens Medical Soc, 2020) Simsek, A.; Dirican, A.; Gecit, IOBJECTIVE To evaluate the predictors of mortality in the Fournier's gangrene form of necrotizing fasciitis (NF). METHOD The medical records of patients with anogenital NF who were treated in a tertiary care hospital between January 2010 and December 2018 were reviewed, retrospectively. RESULTS This study included 86 patients, 76 males and 10 females. Perianal abscess (30.2%) was the leading precipitating event causing NF. The scrotum and perineum were the most commonly affected sites, 73.2% and 40.7%, respectively. NF extended beyond the urogenital and or anorectal triangle in 30.2% of cases. Escherichia coli (E. coli) was the most common microorganism isolated in tissue cultures (55.3%), and Klebsiella pneumoniae the second most common (15.3%). Admission to the intensive care unit (ICU) was required for 50 patients (58.1%), and the mortality rate was 23.3%. Older age (>60 years), smoking, and extension of the infection beyond the urogenital and or anorectal triangle were all significantly associated with mortality. CONCLUSIONS Age >60 years, smoking, and extension of the infection beyond urogenital and or anorectal triangle were significantly related with mortality in anogenital NF. Prompt diagnosis and timely intervention are essential to prevent spread of the infection.Öğe Predictors of splenectomy response in patients with immune thrombocytopenia(Athens Medical Soc, 2021) Simsek, A.; Dogan, S. M.OBJECTIVE To evaluate the predictors of the response to splenectomy in patients with immune thrombocytopenia. METHOD The medical records were reviewed retrospectively of patients who had undergone total splenectomy for immune thrombocytopenia at a tertiary center between January 2009 and December 2019. RESULTS This study included 40 patients (28 females and 12 males) with immune thrombocytopenia. A complete response was obtained in 31 (77.5%) patients, with 9 (22.5%) patients failing to respond to splenectomy. The response was stable in 25 patients (62.5%), and 5 patients (12.5%) had a recurrence. The postoperative mortality rate was 2.5%; one patient developed an ischemic stroke and died. Multivariate analysis demonstrated that an extended time from diagnosis to splenectomy, a lower demand for transfusion of blood components, and a shorter length of hospitalization were positively associated with a complete response. CONCLUSIONS Splenectomy should be considered as the therapeutic approach to immune thrombocytopenia, with a high curative potential in suitable patients. An extended time from diagnosis to splenectomy, lower demand for transfusion of blood components, and shorter length of hospitalization were found to be positively associated with a complete response after splenectomy.Öğe Vacuum-assisted closure in the treatment of peripancreatic fluid collection after pancreas transplantation(Athens Medical Soc, 2020) Dogan, S. M.; Simsek, A.; Gurbuz, H.; Piskin, T.Following improvements in immunosuppressive therapy and the reduction of surgical complications, pancreatic transplantation has gained in popularity. The management of peripancreatic fluid collection (PPFC) is a major concern, especially in the case of retroperitoneal implantation. Percutaneous drainage catheters may be ineffective for clearing large pieces of pancreatic debris. The cases are presented here of three patients who were treated successfully with vacuum-assisted closure (VAC) for PPFC after pancreas transplantation.
