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Öğe Complicated Meckel's diverticulum and therapeutic management [Komplike Meckel divertikülü ve tedavi yönetimi](2013) Erol V.; Yoldaş T.; Cin S.; Çalişkan C.; Akgün E.; Korkut M.Objective: In this study we aimed to investigate the treatment options and compare patient management with the literature for patients operated on for an acute abdomen who encountered complications due to inflammation of the Meckel's diverticulum in our clinic. Material and Methods: Between October 2007 and October 2012, 14 patients were retrospectively analysed who had been operated on in the General Surgery Department, Ege University Medical Faculty Hospital, because of an acute abdomen and mechanical intestinal obstruction, and Meckel's diverticulitis (MD) was identified as an etiological factor perioperatively and histopathologically. Results: Fourteen patients were retrospectively analysed who were operated on for Meckel's diverticulitis and its complications. Radiologically, in abdominal computed tomography pathologies compatible with mechanical intestinal obstruction, Meckel's diverticulitis and peridivertiküler abscess were reported, and free air in the abdomen was detected on direct abdominal X-ray. Fourteen patients were operated on because of complicated Meckel's diverticula (obstruction, diverticulitis, perforation) and diverticulum excision was performed on 3 (21.4%) patients; right hemicolectomy + ileotransversostomi was performed on 1 (7.1%) patient and partial small bowel resection and end-to-end anastomosis was performed on 10 (71.5%) patients. Conclusion: Meckel's diverticulum is a vestigial remnant of an omphalomesenteric channel in the small bowel. It is a real congenital diverticular anomaly that contains three layers of the small bowel. If Meckel's diverticula are detected, incidental complications may occur such as ulceration, bleeding, bowel obstruction, diverticulitis or perforation, surgical excision should be performed. Meckel's diverticulitis does not have specific clinical and radiological findings. Delayed diagnosis can lead to lethal septic complications. Complications associated with Meckel's diverticulitis, especially if a definite diagnosis is not reached during the preoperative period, should be considered in the differential diagnosis. The presence of a complicated diverticulum indicates the appropriate approach should be emergency surgical intervention. © Copyright 2013 by Turkish Surgical Association.Öğe The importance of staging systems for the determination of prognosis of well-differentiated thyroid cancer [Iyi diferansiye tiroid kanserlerinde evreleme sistemlerinin prognozun belirlenmesindeki yeri](2013) Erol V.; Makay O.; Içöz G.; Köse T.; Ertan Y.; Yararbaş U.; Akyildiz M.; Yilmaz M.Objective: In this study we aimed to determine the significance of the staging systems (EORTC, De Groot, MACIS, and TNM) on the prognosis of well differentiated thyroid cancer patients who underwent surgery in our clinic. Material and Methods: This retrospective study included 181 patients who were operated between December 1995-December 2007, with diagnosis of thyroid cancer. In order to obtain data related to cancer staging, a computer program for PDA was developed to enter determined parameters easily. Survival analyses were performed. The findings were compared with the prescribed rates by the staging systems. Results: According to the De Groot staging system, stage 1 and stage 2 patients' results were compatible, stage 3 and 4 patients' results were determined to be different (stage 3; 87% versus 66.6%, stage 4; 35% versus 100%, p=0.04). In the MACIS staging system, 20-year survival rates are determined and there is insufficient follow-up period in this study for compaison. Compared to the EORTC staging system, stage 3 and stage 4 patients' results were determined different (stage 3; 51% versus 100%, stage 4; 33% versus 50%, p=0.02). The most consistent results in terms of prognosis was determined in comparison with the TNM staging system (stage 1; 100% versus 97.8%, stage 4; 45.3% versus 50%). Conclusion: Until recently, in order to be able to predict the behavior of the tumor, many classification systems were made up for well differentiated thyroid cancer. In this study, we concluded that in the determination of the prognosis of well-differentiated thyroid cancer, the TNM staging system can determine the prognosis in a manner consistent with the clinical findings. © Copyright 2013 by Turkish Surgical Association.Öğe Isolated metastasis of uterine leiomyosarcoma to the pancreas: Report of a case and review of the literature(Elsevier Ltd, 2014) Ozturk S.; Unver M.; Ozturk B.K.; Bozbiyik O.; Erol V.; Kebabci E.; Olmez M.; Zalluhoglu N.; Bayol U.INTRODUCTION Metastatic tumors of the pancreas are uncommon and rarely detectable clinically. Metastases to the pancreas are rare. We present a patient with pancreatic metastases from a leiomyosarcoma of the uterus and review the literature about the clinical features of pancreatic metastasis and its surgical management. PRESENTATION OF CASE A 40-year-old woman, who underwent hysterectomy, left oophorectomy, omentectomy and lymp node dissection for leiomyosarcoma of the uterus. At the follow up, the patient complained of non-specific abdominal discomfort. Preoperative diagnosis were pancreatic pseudocyst, cystadenoma or cystadenocarcinoma. At laparotomy, a cystic mass was found in the tail of the pancreas which was invased to the transverse colon mesenterium and the spleen. Distal pancreatectomy with splenectomy and transverse colon resection was performed. Histologically, the tumor was evaluated as poorly differentiated leiomyosarcoma. DISCUSSION Metastatic lesions of the pancreas are uncommon and less than 2% of all pancreatic malignancies. However a few cases of leiomyosarcoma with metastases to the pancreas have been reported in the literature. Before deciding that the lesion in the pancreas was metastasis, primary leiomyosarcoma of the pancreas had to be ruled out. Histologically, leiomyosarcoma of the pancreas contains interlacing spindle cells with varying degrees of atypia and pleomorphism. The surgical approach to the pancreatic metastases must be aimed complete excision of the tumor with a wide negative margin of clear tissue and maximum preservation of pancreatic remnant if possible. CONCLUSION In the absence of widespread metastatic disease, aggressive surgical approach with negative margins must be aimed. © 2014 The Authors.Öğe Multicentricity in thyroid papillary microcarcinomas [Tiroid papiller mikrokarsinomlarinda multisentrisite](2010) Erol V.; Makay Ö.; Ertan Y.; Içöz G.; Akyildiz M.; Yilmaz M.; Yetkin E.Purpose: In this study we aimed to determine, the multcentricity rates in patients with papillary microcarcinoma and the surgical method that should be applied. Materials and Methods: A total of 1818 patients underwent thyroid surgery and we evaluated 379 patients retrospectively, who were reported to have thyroid cancer histopathologically. In these patients, 137 patients with papillary microcarcinoma were determined. We reviewed medical records of patients, for mulicentricity and frequency of microcarcinoma. Patients were classified according to MACIS, EORTC and TNM classification systems for thyroid cancer. Results: Thirty-three (24%) of 137 patients with papillary microcarcinoma were detected to be multicentric. In 7 (21%) there were two or more tumor foci. The incidence of cancer was 33% in the other lobe when there was more than one foci in the same lobe. In all patients preoperative ultrasonography of the thyroid gland was multinodular. Ultrasonographic findings suspicious for malignancy were sought and in 44% patients these findings were present. Fine needle aspiration biopsy was performed in 31 patients and results of 23 patients were benign. Frozen section was performed 58 patients, where 17 patients had a benign frozen section report. Conclusion: The risk of multicentricity in papillary microcarcinoma patients should be taken into account for determining the optimal surgical treatment. To prevent missing microcarcinoma foci, ultrasonography should be applied meticulously.Öğe Papillary Thyroid Cancer, Macrofollicular Variant: The Follow-Up and Analysis of Prognosis of 5 Patients(Hindawi Publishing Corporation, 2014) Erol V.; Makay Ö.; Ertan Y.; Içöz G.; Akyildiz M.; Yilmaz M.Objective. The main aim of this study was to comparatively analyze the recurrence and prognosis of this rare variant with the literature by analyzing the follow-up data of 5 patients diagnosed with papillary cancer macrofollicular variant. Methods. The demographic data, radiological and pathological data, and prognostic data of 5 patients who underwent surgery for thyroid cancer and were diagnosed with papillary cancer macrofollicular variant pathologically were retrospectively analyzed. Results. The mean age of patients whose mean follow-up period was determined as 7.2 years was 41, and the male/female ratio was 4/1. All patients underwent total thyroidectomy. The pathology report of 2 patients (40%) revealed macrofollicular variant of papillary microcancer, and 3 patients papillary cancer macrofollicular variant. Central dissection was performed in one patient (20%) due to macroscopic pathologic lymph node and 4 metastatic lymph nodes were reported. Also, locoregional recurrence was present in 3 out of 5 patients (60%). Conclusions. Although an impression of earlier and increased risk of recurrence in papillary carcinoma with macrofollicular variant has been documented, more studies with extensive follow-up times and large populations are required. © 2014 Varlik Erol et al.Öğe Prognostic factors of survival and recurrence pattern in differentiated thyroid cancer: A retrospective study from Western Turkey(Institute of Experimental Endocrinology, 2014) Erol V.; Makay O.; Icoz G.; Kose T.; Yararbas U.; Kumanlioglu K.; Akyildiz M.Objectives. The aim of this study was to determine prognostic factors in patients with well-differentiated thyroid cancer (WDTC). Methods. This retrospective study included 181 well-differentiated thyroid cancer patients who were operated between Decembers 1996-2007. Total of 181 patients [139 (76.8%) women and 42 (23.2%) men with a mean age of 46.3 years] who were subjected to a complete follow-up, were enrolled in the study. The mean follow-up period was 7.1 years (range 3.1 to 14.9 years). Medical records were reviewed regarding to age, gender, extent of surgery, tumor size, multifocality, clinical stage, capsule infiltration, extracapsular invasion, histological type, lymph node metastasis, distant metastasis, radioactive iodine treatment and prognosis. Results. During follow-up, in 41 (22.6%) patients locoregional recurrences were detected and 5 (2.7%) patients passed away. Determined statistically significant prognostic factors were as follows; tumor size (histopathologically), extent of surgery, histological type, lymph node metastasis, tumor invasion (capsule and extracapsular) and clinical stage. Conclusions. Well-differentiated thyroid cancer is a disease with good prognosis when detected early and appropriate treatment applied. Despite the prognosis, it is good to apply the right treatment and reduce recurrence and mortality rates, prognostic factors are well known and must be considered in patient management. © 2014, Institute of Experimental Endocrinology. All rights reserved.Öğe A rare cause of mechanical obstruction: Intestinal myeloid sarcoma [Nadirbir mekanik barsak tikaniklig? nedeni: Intestinal miyeloid sarkom](AVES Ibrahim Kara, 2014) Yoldaş T.; Erol V.; Demir B.; Hoşcoşkun C.Myeloid sarcoma is a rare aggressive tumour that originates from immature extramedullary myeloid cells. It can be seen as a relapse in patients with acute myeloid leukaemia. Sometimes it can be seen in the form of a solid tumour without any evidence of leukaemia. A case of a 44-year-old male patient who was admitted with symptoms and signs of mechanical intestinal bowel obstruction was operated on. The operation findings showed small bowel obstruction due to a mass. The mass was then resected with end-to-end intestinal anastomosis. The resected mass pathology results were consistent with myeloid sarcoma. The post-operative period was uneventful and adjuvant therapy was applied. In this case report we aimed to evaluate the clinical signs and treatment modalities of small intestinal myeloid sarcoma. ©Copyright 2014 by Turkish Surgical Association.Öğe Receiver operating characteristic analysis and discriminative effect of neutrophil- to-lymphocyte ratio in patients with suspected appendicitis(A. CARBONE Editore, 2016) Ozturk S.; Unver M.; Yoldas O.; Dizen H.; Erol V.; Bozbiyik O.; Guner M.; Pehlivanoglu K.; Kebapci E.; Aydin C.; Akbulut G.Introduction: Acute appendicitis (AA) is one of the most common causes of abdominal pain and emergent abdominal surgery. The incidence is approximately 10% during the lifetime. Although appendectomy is a most common surgical procedure worldwide, it's complication rate is 5-28% A delay in diagnosis of AA is associated with prolonged hospitalization, an increased rate of perforation (34%-75%), wound infection (0%-11%), pelvic abscess (1%-5%) and late intra-abdominal adhesions. Appendectomy is first described by McBurney in 1894 and still remains the standart procedure for AA. Although patients with AA often present with a characteristic symptom complex and physical findings, atypical presentations are common. The aim of this study was to assess the diagnostic value of neutrophil-to-lymphocyte ratio (NLR) in patients who were operated for suspected acute appendicitis and to assess the discriminative effect of this ratio between uninflamed, uncomplicated and complicated appendicitis. Materials and methods: The medical records of 3212 patients who underwent appendectomy for suspected acute appendicitis during a 10-year period were reviewed retrospectively. Patients were divided into 3 groups; group 1, 208 consecutive patients who had uninflamed appendix at appendectomy; group 2, 2111 consecutive patients who had uncomplicated acute appendicitis at appendectomy; group 3, 893 patients who had complicated appendicitis (perforated appendix or peri-appendicular abscess) at appendectomy. Data for three groups of patients were analyzed to calculate the sensitivity and specificity of the NLR in the diagnosis of acute appendicitis. Receivers operating characteristic (ROC) curves were used to evaluate this ratio in a relation with true diagnosis and severity of acute appendicitis. Results: 1792 (55.8%) of the patients were male and 1420 (44.2%) of them were female. The mean age of the groups were 30.28±14.18, 29.98 ± 12.63 and 33.81±16.27 respectively. The discriminative effect of NLR was higher between uninflamed and complicated appendicitis groups with a cut-off value of 3,94. The recommended cut-off value of the preoperative NLR was decided using ROC curve analyses. The recommended cut-off value of the NLR was based on the most prominent point on the ROC curve for sensitivity (82.2%) and specificity (56.5%). The area under the ROC curve was 0.74. Conclusion: AA is one of the most common surgical emergencies and the most common source of infection in communityacquired intra-abdominal infections. However the diagnosis is often challenging and the decision to operate, observe or further work-up on a patient is often unclear. Initial management of patients with suspected AA is based on the history of the patient, physical examination, basic laboratory tests reflecting the inflammatory response and radiologic imaging. NLR is a helpful biochemical parameter for the diagnosis of acute appendicitis but it has limited value on differentiating patients with complicated appendicitis from patients with uninflamed and uncomplicated appendicitis.Öğe Review of thyroid cytology and histology slides in a tertiary centre leads to a change in planned surgical treatment for patients with thyroid nodules(2011) Erol V.; Makay O.; Nart D.; Ertan Y.; Icoz G.; Vcral A.; Akyildiz M.; Yilmaz M.; Yetkin E.Aim. Histology and cytology consultations of thyroid fine needle aspiration biopsy (FNAB) of thyroidectomy specimens can change management of the patient. We aimed to determine compliance rates of pathology results between urban centers and a tertiary institution and its impact on patient management. Methods. This retrospective study includes 101 patients, who were referred to our center, between January 2008 and December 2008. After admission, all FNAB or thyroidectomy specimens of patients managed elsewhere were consulted by the pathology department. Comparison of FNAB and histology reports of our institution and the medical centers elsewhere had been carried out. Results. A total of 76% concordance rate was found between the FNAB results of other centers and consultation results. The highest concordance was observed in the malignant cytology group (77%). The cytological or histological outcomes of 24 (23.7%) patients were interpreted differently. After second opinion, patient management changed in 21 of the 101 patients. Conclusion. Since FNAB results can change the type of surgical treatment and the management plan, the results especially reported as suspicious may need a second opinion. We suggest that cytology or histology results of thyroid patients referred to tertiary centers for further evaluation and treatment should always be reviewed.Öğe Spontaneous intestinal intramural hematoma: What to do and not to do [Spontan intestinal intramural hematom: Yapi{dotless}lmasi{dotless} ve yapi{dotless}lmamasi{dotless} gerekenler](2013) Yoldaş T.; Erol V.; Çalişkan C.; Akgün E.; Korkut M.Objective: Spontaneous intestinal intramural hematoma is a rare complication of anticoagulant treatment. In this study, we retrospectively evaluated 14 patients with the diagnosis of intramural hematoma of the small intestine who were followed-up and treated in our clinic, and we aimed to determine the diagnosis and treatment of intramural hematoma with current approaches. Material and Methods: Between February 2007-October 2012 14 patients with a diagnosis of small intestinal intramural hematoma were retrospectively analyzed. Nine patients were followed due to clinical findings and 5 patients who had undergone operation of the small intestine and histopathologically diagnosed as intramural hematoma were evaluated in our department. Results: Abdominal computed tomography demonstrated ileal and jejunal wall thickening in 10 patients, while findings were consistent with mesenteric vascular disease in four. Five patients were operated on due to mechanical bowel obstruction and acute abdomen. The other 9 patients were followed up with medical treatment and 8 of these patients were already using warfarin due to cardiac bypass and valve replacement. Conclusion: Spontaneous intestinal intramural hematoma is a cause of small bowel obstruction due to intramural hematoma, which is encountered more rarely. Patients who presented with abdominal pain and symptoms of obstruction with a history of anticoagulant drug use and having elevated International Normalized Ratio (INR) levels, should be considered in the differential diagnosis of intramural hematoma and investigated. Early diagnosis and medical followup without surgery is very important because it can provide a good response to treatment in the majority of patients. © Copyright 2013 by Turkish Surgical Association.
