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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 Management of thoracoepigastric flap necrosis in patients with breast cancer(Permanyer Publications, 2021) Simsek A.Thoracoepigastric flap is rarely used for reconstruction of the large chest wall defects due to potential for necrosis and delayed wound healing. This article presents three patients with breast cancer, who underwent mastectomy and chest wall reconstruction with thoracoepigastric flap and subsequently developed distal flap necrosis. The negative pressure wound therapy may eliminate the need for additional graft and/or flap surgery in patients with large necrosis size. © 2021 Publicaciones Permanyer. All rights reserved.Öğe Management of thrombosis in a pediatric renal transplant patient with factor vii deficiency a dilemma concerning recombinant factor VIIa(BETA Medical Publishers Ltd, 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, includ-ing 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. © 2020, BETA Medical Publishers Ltd. All rights reserved.Öğe Perianal Infections in Patients With Hematologic Malignancy: The Risk of Fournier's Gangrene Leading to Mortality and Irreversible Organ Damage(NLM (Medline), 2022) Simsek A.INTRODUCTION: The efficacy of surgical intervention for perianal infection in patients with hematologic malignancy is not well-established. OBJECTIVE: This article presents a case series of perianal infection progressing to Fournier's gangrene (FG) in patients with hematologic malignancy to guide physicians, because to the author's knowledge, there were no randomized or prospective studies presenting the management strategies reported herein. It was hypothesized that surgery might reduce mortality and morbidity in patients with inflammation spreading beyond the perianal region, in patients with abscess formation, and in those who show no improvement with medical therapy. MATERIALS AND METHODS: The data of 4 adults with hematologic malignancy who developed perianal infection progressing to FG between January 2010 and December 2018 were reviewed retrospectively. Patients younger than 18 years and patients without hematologic malignancies or FG were excluded. The primary outcome was mortality. The secondary outcome was irreversible organ damage. RESULTS: Four male patients with a mean age of 36.75 years ± 13.1 standard deviation (range, 23-52 years) reported fever and dull anal pain during treatment for hematologic malignancy. A broad-spectrum antibiotic regimen was administered as initial empiric therapy at onset of fever and was de-escalated based on the culture results and clinical response. However, FG arose in all cases approximately 8.75 days ± 6.94 (range, 3-17 days) after onset of anal pain. All patients underwent surgical debridement, and diverting ostomy was performed in 3 cases. One patient died of overwhelming sepsis (25%), and 1 patient required orchiectomy (25%). CONCLUSIONS: Clinical suspicion of FG may be effective in reducing mortality in patients with hematologic malignancy, especially in cases with fever accompanied by anal pain. Surgical intervention may improve the prognosis for patients with inflammation spreading beyond the perianal region, patients with abscess formation, those who show no improvement in medical therapy, and those who develop FG. Diverting ostomy may improve survival in patients with FG.Öğe The predictors of mortality in non-traumatic splenectomies(IBEPEGE - Inst. Bras. Estudos Pesquisas Gastroent., 2020) Simsek A.Background – There are quite a few studies examining prognostic factors in non-traumatic splenectomies compared to traumatic ones. Objective – This study aimed to evaluate the predictors of mortality in patients who underwent splenectomy for non-traumatic spleen diseases. Methods – Medical records of the patients, who had undergone total splenectomy for non-traumatic spleen diseases at a tertiary center between January 2009 and December 2019, were retrospectively reviewed. Exclusion criteria included patients younger than 18 years of age, partial splenectomies, splenectomies applied to facilitate surgery for malignancy on contiguous organs, and splenectomies performed during liver transplantation. Iatrogenic splenic injuries were regarded as trauma and these cases were also excluded. Results – The current study included 98 patients. Nine (9.2%) patients died. In univariate analysis, age, the presence of hematological neoplasia, hematocrit, hemoglobin, white blood cell counts, neutrophil-to-lymphocyte ratio, indications for splenectomy, application of emergency surgery, surgical technique, and transfusion of blood components were all significantly associated with mortality. In multivariate analysis, the presence of hematological malignancy [P=0.072; OR=7.17; (CI: 0.386–61.56)], the application of emergency surgery [P=0.035; OR=8.33; (CI: 1.165–59.595)] and leukocytosis [P=0.057; OR=1.136; (CI: 0.996–1.296)] were found to be positively associated with mortality. Conclusion – Hematologic neoplasia, emergency surgery, and leukocytosis were the independent predictors of mortality in patients, who were operated on for non-traumatic spleen diseases. A thorough preoperative evaluation, early therapeutic intervention, and advanced surgical techniques are important and can serve to minimize complications and mortality in case of inevitable splenectomy. Immunological research can provide new therapeutic opportunities that may impact positively on patients by minimizing morbidity and mortality. © 2020, IBEPEGE - Inst. Bras. Estudos Pesquisas Gastroent. All rights reserved.Öğe The predictors of mortality in patients with anogenital necrotizing fasciitis (Fournier’s gangrene)(BETA Medical Publishers Ltd, 2020) Simsek A.; Dirican A.; Gecit I.OBJECTIVE 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%). Admis-sion 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. © Athens Medical Society.Öğe A rare cause of abdominal pain; giant mesenteric lipoma(Surgical Society of Northern Greece, 2018) Ögüt M.Z.; Simsek A.; Kilci M.B.; Kocaaslan H.; Ara C.[No abstract available]Öğe What is the source of violence against healthcare staff in emergency rooms: Are communication skills sufficient to prevent violence?(Surgical Society of Northern Greece, 2020) Simsek A.Background: Violence towards healthcare staff occurs most commonly in emergency rooms. The purpose of this study is to answer the question what the source of violence against healthcare staff in emergency is rooms and evaluate the role of good communication on preventing violence. Material and Methods: This is a survey research involving 320 subjects which were selected randomly. It was performed in the Emergency Room of a Teaching and Research Hospital. One study subgroup involved patients and the family members (n: 160), and second subgroup involved the healthcare staff (n: 160). Results: The rate of verbal and/or physical offenses that healthcare staff was opposed was 77.5%. There was no significant difference between two groups in terms of communication skill, and their views regarding work environment of the healthcare staff. High level of education of healthcare staff showed a high level of correlation with positive perception of social relation by patients/patients' relatives. An attempt to communicate mutually resulted in a positive manner between two groups. Among healthcare staff there was no statistical significance in terms of whether they were exposed to violence according to both communication skills (greeting and addressing patient/patient's relatives by their first name; p: 0.625 and 0.505, respectively). Among patient/patient's relatives there was no statistical significance in terms of whether they had quarrel with healthcare staff according to both communication skills (greeting healthcare staff and knowing healthcare staff identity; p: 0.417 and 0.189, respectively). Conclusion: There is no doubt that good communication result in a positive manner between healthcare staff and patient/patient's relatives. Hence, significance of communication training should be emphasized. However, good communication alone is not enough on preventing violence. There must be more to do on preventing violence. © 2020 Surgical Society of Northern Greece. All rights reserved.Öğe Why potential donors and recipients not proceed to live kidney transplantation, Malatya algorithm(Asociacion Regional de Dialisi y Transplantes Renales de Capital Federal y Provincia de Buenos Aires, 2020) Simsek A.; Doğan S.M.; Gurbuz H.; Ulutas O.; Toplu S.; Turgut A.; Yildirim I.O.Introduction: In some countries, organ donation is not widespread enough due to medical, cultural, ethical and socioeconomic factors. Living-donor kidney transplant constitutes the main source of kidney donation. Aim: To evaluate the causes of cancellation of living-donor kidney transplant and improve the effectiveness of transplant programs. Methods: Medical records of possible donors and recipients who were evaluated for living-donor kidney transplant at a tertiary medical center between November 2010 and September 2019 were reviewed retrospectively. Results: Evaluations were performed on 364 potential donors and 338 living-donor kidney transplant recipients; 207 of the latter (61.24%) underwent living-donor kidney transplant. Immune disorders represented the majority of cancellations (38.84%). Fifty-six donors (15.38%) were rejected mainly due to renal disorders (39%). Conclusion: Timely referral of patients to transplant centers must be guaranteed in order to overcome immune problems. Transplant centers should invest in programs adequate both for their resources and for their patients: paired kidney exchange, desensitization protocols, future research, etc. © 2020, Asociacion Regional de Dialisi y Transplantes Renales de Capital Federal y Provincia de Buenos Aires. All rights reserved.
