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Öğe Autonomic nerve involvement and venous leakage in diabetic men with impotence(Wiley, 1999) Colakoglu, Z; Kutluay, E; Ertekin, C; Altay, B; Killi, R; Alkis, AObjective To determine the neurophysiological and vascular factors in diabetic impotence, particularly the role of autonomic neuropathy on venous leakage and erectile impotence. Patients and methods Thirty-four diabetic men with impotence were investigated using Various neurophysiological and radiological methods, The results were compared with those from patients with idiopathic penile Venous leakage for autonomic neuropathy, especially for spontaneous cavernosal activity (SCA). Results Of the neurophysiological tests, the SCA was most frequently abnormal, with the loss of normal periodic oscillations, Penile venous leakage, either alone or with arterial insufficiency, was the most frequent vascular problem (67%) in patients with diabetic impotence, in whom the SCA was absent in most (83%). Conversely, the SCA was normal in all impotent patients with idiopathic venous leakage. Conclusion Venous leakage in diabetic patients is probably produced by autonomic dysfunction of the penile vascular innervation or degeneration of penile smooth muscles, because the SCA was absent more often in these patients.Öğe Bilateral Breast Involvement In Acute Lymphoblastic-Leukemia - Color Doppler Sonography Findings(Amer Roentgen Ray Soc, 1995) Memis, A; Killi, R; Orguc, S; Ustun, EeÖğe Biliary complications following adult-to-adult living donor liver transplantation(Elsevier Science Bv, 2002) Karasu, Z; Tokat, Y; Memis, A; Ersoz, G; Yuzer, Y; Killi, R; Akarca, U; Gunsar, F; Batur, YÖğe Biliary reconstructions and complications encountered in 50 consecutive right-lobe living donor liver transplantations(Wiley, 2003) Icoz, G; Kilic, M; Zeytunlu, M; Celebi, A; Ersoz, G; Killi, R; Memis, A; Karasu, Z; Yuzer, Y; Tokat, YBiliary complications appear to be the leading cause of postoperative complications after living donor liver transplantation (LDLT). The aim of this study is to analyze the complications, treatment modalities, and outcomes of biliary anastomoses in a series of 50 consecutive right-lobe LDLTs. Median patient age was 45 years, and median right-lobe graft volume was 740 g. Graft-recipient weight ratio was 0.69 to 1.80. Median follow-up time was 15 months (range, 2 to 38 months). Eleven of 50 patients died, resulting in an overall allograft and patient survival rate of 78%. In biliary reconstruction, a duct-to-duct (D-D) anastomosis or a standard Roux-en-Y (R-Y) anastomosis was performed. Twenty-nine grafts (58%) had a single duct for anastomosis. Seventeen grafts (34%) had two bile duct orifices, and four grafts (8%) had three bile duct orifices. A D-D anastomosis was performed in 36 cases (72%), whereas R-Y reconstruction was preferred in 14 cases (28%). The overall incidence of biliary anastomotic complications was 30% in this series. Five patients developed biliary leaks, presumably from the cut surface, and all of them healed spontaneously. Two bilomas were drained percutaneously. Anastomotic strictures occurred in 8 patients (16%) and were significantly greater than in the R-Y group (P =.03). Although strictures seemed to develop more frequently in allografts with multiple bile ducts, this did not reach statistical significance (P =.05). All strictures were managed by nonsurgical measures initially. Restenosis occurred in 2 patients, both of whom had an R-Y anastomotic stricture. These anastomoses were revised surgically, giving a reoperation rate of 4% for biliary problems. No graft or patient was lost because of biliary problems. Our data suggest that D-D anastomosis is a safe and feasible method of biliary reconstruction in LDLT by preserving physiological bilioenteric continuity and allowing easy access through endoscopic techniques.Öğe Biliary reconstructions and complications encountered in 50 consecutive right-lobe living donor liver transplantations(Wiley, 2003) Icoz, G; Kilic, M; Zeytunlu, M; Celebi, A; Ersoz, G; Killi, R; Memis, A; Karasu, Z; Yuzer, Y; Tokat, YBiliary complications appear to be the leading cause of postoperative complications after living donor liver transplantation (LDLT). The aim of this study is to analyze the complications, treatment modalities, and outcomes of biliary anastomoses in a series of 50 consecutive right-lobe LDLTs. Median patient age was 45 years, and median right-lobe graft volume was 740 g. Graft-recipient weight ratio was 0.69 to 1.80. Median follow-up time was 15 months (range, 2 to 38 months). Eleven of 50 patients died, resulting in an overall allograft and patient survival rate of 78%. In biliary reconstruction, a duct-to-duct (D-D) anastomosis or a standard Roux-en-Y (R-Y) anastomosis was performed. Twenty-nine grafts (58%) had a single duct for anastomosis. Seventeen grafts (34%) had two bile duct orifices, and four grafts (8%) had three bile duct orifices. A D-D anastomosis was performed in 36 cases (72%), whereas R-Y reconstruction was preferred in 14 cases (28%). The overall incidence of biliary anastomotic complications was 30% in this series. Five patients developed biliary leaks, presumably from the cut surface, and all of them healed spontaneously. Two bilomas were drained percutaneously. Anastomotic strictures occurred in 8 patients (16%) and were significantly greater than in the R-Y group (P =.03). Although strictures seemed to develop more frequently in allografts with multiple bile ducts, this did not reach statistical significance (P =.05). All strictures were managed by nonsurgical measures initially. Restenosis occurred in 2 patients, both of whom had an R-Y anastomotic stricture. These anastomoses were revised surgically, giving a reoperation rate of 4% for biliary problems. No graft or patient was lost because of biliary problems. Our data suggest that D-D anastomosis is a safe and feasible method of biliary reconstruction in LDLT by preserving physiological bilioenteric continuity and allowing easy access through endoscopic techniques.Öğe Budd-Chiari Syndrome in an afibrinogenemic patient: A paradoxical complication(Springer, 2006) Oruc, N; Tokat, Y; Killi, R; Tombuloglu, M; Ilter, TÖğe Carotid atherosclerosis assessed by sonography in Behcet's disease(B M J Publishing Group, 2004) Keser, G; Ozmen, M; Aksu, K; Tamsel, S; Kitapcioglu, G; Kabasakal, Y; Inal, V; Oksel, F; Killi, R; Doganovsargil, EÖğe Carotid steal: Report of ten cases(Amer Inst Ultrasound Medicine, 1998) Ozbek, SS; Memis, A; Killi, R; Pourbagher, MA; Demirpolat, G; Oran, I; Pourbagher, AThe blood flow may be diverted from the external to the internal carotid artery via the carotid bulb in the absence of flow in the common carotid artery. We aimed to investigate the prevalence, hemodynamics, and clinical features of this condition. Reviewing the records of color duplex ultrasonographic examinations, we found carotid steal in 12 carotid arteries of 10 patients. In three patients flow in the ipsilateral external carotid artery was bidirectional. The steal had been demonstrated angiographically in six patients. The cause of the phenomenon was atherosclerosis, Takayasu arteritis, or trauma. Awareness of this pathway of collateral circulation may contribute to diagnostic work-up and expand management alternatives.Öğe Color Doppler imaging in glaucoma patients with asymmetric visual field loss(Amer Soc Contemporary Ophthalmology, 2000) Ates, H; Uretmen, O; Killi, R; Akkin, C; Andac, KWith color Doppler imaging, we attempted to determine whether glaucoma patients with asymmetric visual field losses had evidence of asymmetric blood flow velocities in the central retinal artery despite similar intraocular pressure (IOP) curves in both eyes. We found that eyes with more severe visual field damage had an increased local resistance to blood flow in the central retinal artery. Thus vascular factors might have important roles in the pathogenesis of primary open-angle glaucoma.Öğe Color Doppler imaging of choroidal circulation in patients with asymmetric age-related macular degeneration(Karger, 2003) Uretmen, O; Akkin, C; Erakgum, T; Killi, RWe aimed at evaluating the possible role of choroidal perfusion abnormalities in the development of choroidal neovascularisation (CNV) in patients with age-related macular degeneration (AMD). Twenty-six patients who had non-exudative AMD in the first eye and CNV secondary to AMD in the fellow eye were enrolled. Blood flow velocities, vessel pulsatilities and resistivities were measured from ophthalmic artery, nasal and temporal posterior ciliary arteries using colour Doppler imaging. Systolic and diastolic velocities were lower in eyes with CNV for all vessels, except for the systolic velocity of the nasal posterior ciliary artery (p >0.05). Pulsatility and resistivity indices were higher in eyes with CNV for all vessels. This difference was statistically significant for the resistivity index of the nasal and temporal posterior ciliary arteries (p = 0.032 and p = 0.021, respectively) and the pulsatility index of the nasal posterior ciliary artery (p = 0.035). We have shown that in patients with AMD choroidal blood flow is more impaired in the eyes with CNV than in the fellow eyes.Öğe Color Doppler imaging of choroidal circulation in patients with asymmetric age-related macular degeneration(Karger, 2003) Uretmen, O; Akkin, C; Erakgum, T; Killi, RWe aimed at evaluating the possible role of choroidal perfusion abnormalities in the development of choroidal neovascularisation (CNV) in patients with age-related macular degeneration (AMD). Twenty-six patients who had non-exudative AMD in the first eye and CNV secondary to AMD in the fellow eye were enrolled. Blood flow velocities, vessel pulsatilities and resistivities were measured from ophthalmic artery, nasal and temporal posterior ciliary arteries using colour Doppler imaging. Systolic and diastolic velocities were lower in eyes with CNV for all vessels, except for the systolic velocity of the nasal posterior ciliary artery (p >0.05). Pulsatility and resistivity indices were higher in eyes with CNV for all vessels. This difference was statistically significant for the resistivity index of the nasal and temporal posterior ciliary arteries (p = 0.032 and p = 0.021, respectively) and the pulsatility index of the nasal posterior ciliary artery (p = 0.035). We have shown that in patients with AMD choroidal blood flow is more impaired in the eyes with CNV than in the fellow eyes.Öğe Functional reversal of factor V Leiden mutation following liver transplantation in a patient with Budd-Chiari syndrome(W B Saunders Co, 2003) Karasu, Z; Kilic, M; Killi, R; Celebi, A; Nart, D; Akdeniz, M; Tokat, YÖğe Functional reversal of factor V Leiden mutation following liver transplantation in a patient with Budd-Chiari syndrome(W B Saunders Co, 2003) Karasu, Z; Kilic, M; Killi, R; Celebi, A; Nart, D; Akdeniz, M; Tokat, YÖğe Hepatocellular carcinoma in liver transplant era: A clinicopathologic analysis(Elsevier Science Inc, 2003) Nart, D; Arikan, C; Akyildiz, M; Yuce, G; Demirpolat, G; Zeytunlu, M; Karasu, Z; Aydogdu, S; Killi, R; Yuzer, Y; Tokat, Y; Kilic, MHepatocellular carcinoma (HCC) is one of the most common tumors in the world, and the prognosis is usually poor. Today, liver transplantation (LT) is a radical but frequently curative treatment modality for HCC. In selected patients, it cures HCC and the underlying cirrhosis at the same time. The present clinicopathological study examined the importance of tumor characteristics for their effects on recurrence and survival rates after LT for HCC. Forty-two native hepatectomy specimens among 250 consecutive orthotopic liver transplantations contained HCC. Patients were predominantly men (30 men, 12 women), ranging in age from 1 to 61 years (median 51). While 20 patients received cadaveric organs, 22 were transplanted from living donors. In 14 patients (33%) HCC presented as a solitary nodule, 5 (12%) as two nodules; 2 (5%) as three nodules; and 21 patients (50%) as more than three nodules. The maximal diameter of the largest tumor not larger than 3 cm in 28 patients (66%), exceeding this size in 14 patients (34%). There was a significant correlation between nodule number and tumor size (r = 0.36, P = 0.05). While 23 patients had no sign of vascular involvement, 17 tumors showed microscopic invasion and two large vessel involvement. There was a positive correlation between vascular invasion and nodule number (r = 0.41, P = 0.05). The histopathological grade of differentiation of the tumors was assessed as "well" in seven patients (14%), moderate in 28 (72%), and poor in 7 (14%). The differentiation was significantly poorer when vascular invasion was observed (r = 0.43, P = .01). According to the TNM classification, 11 patients (26%) were stage I, 6 (14%) stage II, 13 (31%) stage III, and 12 (29%) stage IV. After a median follow-up of 10 months (1-50 months), the overall mortality was 18% (n = 8). Patient survival at 6 month, 1, and 4 years was 88%, 80%, and 60%, respectively. The outcome was significantly poorer for TNM stage IV versus stage I, II, and III tumors to (P = .02). Tumor recurred in three patients at 4,6, and 50 months after liver transplantation. The sites of recurrence were bone, lung, and adrenal glands. In conclusion, liver transplantation represents a safe and feasible treatment for hepatocellular carcinoma with excellent outcomes compared with other treatment modalities. Liver transplantation offers excellent survival rates and chance for cure in stages I, II, and III hepatocellular carcinoma in cirrhotic patients.Öğe Hepatocellular carcinoma in liver transplant era: A clinicopathologic analysis(Elsevier Science Inc, 2003) Nart, D; Arikan, C; Akyildiz, M; Yuce, G; Demirpolat, G; Zeytunlu, M; Karasu, Z; Aydogdu, S; Killi, R; Yuzer, Y; Tokat, Y; Kilic, MHepatocellular carcinoma (HCC) is one of the most common tumors in the world, and the prognosis is usually poor. Today, liver transplantation (LT) is a radical but frequently curative treatment modality for HCC. In selected patients, it cures HCC and the underlying cirrhosis at the same time. The present clinicopathological study examined the importance of tumor characteristics for their effects on recurrence and survival rates after LT for HCC. Forty-two native hepatectomy specimens among 250 consecutive orthotopic liver transplantations contained HCC. Patients were predominantly men (30 men, 12 women), ranging in age from 1 to 61 years (median 51). While 20 patients received cadaveric organs, 22 were transplanted from living donors. In 14 patients (33%) HCC presented as a solitary nodule, 5 (12%) as two nodules; 2 (5%) as three nodules; and 21 patients (50%) as more than three nodules. The maximal diameter of the largest tumor not larger than 3 cm in 28 patients (66%), exceeding this size in 14 patients (34%). There was a significant correlation between nodule number and tumor size (r = 0.36, P = 0.05). While 23 patients had no sign of vascular involvement, 17 tumors showed microscopic invasion and two large vessel involvement. There was a positive correlation between vascular invasion and nodule number (r = 0.41, P = 0.05). The histopathological grade of differentiation of the tumors was assessed as "well" in seven patients (14%), moderate in 28 (72%), and poor in 7 (14%). The differentiation was significantly poorer when vascular invasion was observed (r = 0.43, P = .01). According to the TNM classification, 11 patients (26%) were stage I, 6 (14%) stage II, 13 (31%) stage III, and 12 (29%) stage IV. After a median follow-up of 10 months (1-50 months), the overall mortality was 18% (n = 8). Patient survival at 6 month, 1, and 4 years was 88%, 80%, and 60%, respectively. The outcome was significantly poorer for TNM stage IV versus stage I, II, and III tumors to (P = .02). Tumor recurred in three patients at 4,6, and 50 months after liver transplantation. The sites of recurrence were bone, lung, and adrenal glands. In conclusion, liver transplantation represents a safe and feasible treatment for hepatocellular carcinoma with excellent outcomes compared with other treatment modalities. Liver transplantation offers excellent survival rates and chance for cure in stages I, II, and III hepatocellular carcinoma in cirrhotic patients.Öğe Image-Directed and Color Doppler Ultrasonography In the Diagnosis of Postbiopsy Arteriovenous-Fistulas of Native Kidneys(John Wiley & Sons Inc, 1995) Ozbek, Ss; Memis, A; Killi, R; Karaca, E; Kabasakal, C; Mir, SUsing image-directed and color Doppler ultrasonography (ICDUS), we examined 65 patients with single kidney biopsy and diagnosed one arteriovenous fistula (AVF) in each of 8 kidneys. Three of them were associated with pseudoaneurysms. Three of the patients with AVF who presented with macrohematuria underwent angiography. Therapeutic percutaneous embolization was performed in 2 of them. The remaining 6 patients were followed up with ICDUS. All the lesions had disappeared at the end of a 6-month period. We conclude that ICDUS is an easy and noninvasive imaging technique in the diagnosis of postbiopsy native renal AVFs. (C) 1995 John Wiley & Sons, Inc.Öğe Image-Directed Color Doppler Ultrasonography In the Evaluation of Superficial Solid Tumors(John Wiley & Sons Inc, 1995) Ozbek, Ss; Arkun, R; Killi, R; Memis, A; Dagdeviren, A; Sevinc, EImage-directed color Doppler ultrasonography (ICDUS) studies of 86 patients with superficial solid masses yielded significantly lower resistive index (RI) values in acute inflammatory lesions, but no significant difference between the maximum systolic flow velocities (S) of the patient groups with malignant, benign, and acute inflammatory lesions. When analyzed separately, the malignant soft-tissue tumor subgroup was shown to have significantly higher mean RI compared to that of the malignant node subgroup. We conclude that RI may be useful in the differentiation of acute inflammatory masses from other pathological entities. Malignant soft-tissue tumors, especially sarcomas, may have different Doppler features from those of carcinomatous tumors. (C) 1995 John Wiley and Sons, Inc.Öğe Increased thickness of the carotid artery intima-media assessed by ultrasonography in Behcet's disease(Clinical & Exper Rheumatology, 2005) Keser, G; Aksu, K; Tamsel, S; Ozmen, M; Kitapcioglu, G; Kabaroglu, C; Killi, R; Bayindir, O; Doganavsargil, EObjective. Behcet's disease (BD), is a unique systemic vasculitis, which affects almost all types and sizes of blood vessels. Carotid intima-media thickness (IMT) is an endothelial cell dysfunction (ECD) parameter which may also be associated with atherosclerosis. We aimed to search carotid IMT and plaque formation in BD, using high-resolution B-mode Doppler ultrasonography (USG). Methods. We studied 114 BD patients (M/F: 68146; mean age 38.15 +/- 9.44 years; disease duration 121 +/- 79 months), being followed tip by Ege University; Rheumatology Department. A e and sex-matched, 77 healthy, controls, and as the disease control group 46 non-matched SLE patients were also included. Exclusion criteria for all the study participants were, hypertension, hyperlipidemia, diabetes mellitus, obesity and history of cardiovascular or cerebrovascular disease. Comparison of the three groups were made by ANOVA and for post-hoc confirmation, Bonferoni test was used. Results. The carotid IMT in BD (mean +/- SD, 0.55 +/- 0.14 min) was significantly higher than in healthy controls (0.48 +/- 0.09 min) (p = 0.004), but signficantly lower than in SLE (0.66 +/- 0.24 mm) (p = 0.001). Likewise, plaque frequency in BD (5/114) was significantly higher than in health), controls (0/77), but significantly lower than in SLE (8146) (p < 0.001). Conclusion. Despite significantly higher carotid IMT and plaque frequency in BD compared with healthy controls, these parameters in BD were not as marked as in SLE. Less severe carotid artery abnormalities in BD, may partially explain why cardiovascular morbidity and mortality do not seem to be increased in BD, unlike in SLE.Öğe Intraovarian stromal artery Doppler indices in predicting ovarian response(Sci Printers & Publ Inc, 2002) Altundag, M; Levi, R; Adakan, S; Goker, ENT; Killi, R; Ozcakir, HT; Tavmergen, EOBJECTIVE: To determine the value of ovarian stromal artery Doppler indices in the prediction of ovarian response in in vitro fertilization-embryo transfer (IVF-ET) cycles. STUDY DESIGN: Forty-five cases were involved in the study. Following controlled ovarian hyperstimulation and detection of at least three follicles > 17 mm in diameter by transvaginal sonography in both ovaries, human chorionic gonadotropin was administered and follicle aspiration performed at the 34th-36th hour. The patients were separated into two groups according to the number of oocytes collected. Group I consisted of 8 (18%) patients who had three or fewer oocytes (low-responder cases); group II consisted of 37 (82%) patients who had 4 or more oocytes (good-response cases). RESULTS: A significant negative correlation was found between both the stromal ovarian artery pulsatility index and the number of aspirated follicles (r = -.31, P = .04) and number of oocytes collected (r = -.32, P=.03). Although there was no significant correlation between the resistance index and number of aspirated follicles (r = .24, P = .12), a significant negative correlation was determined between the resistance index and number of oocytes collected (r = -.30, P = .04). Pulsatility and resistance indices were signifificantly different between the two groups (1.6 +/- 0.5 and 1.2 +/- 0.5, P = .02, versus 0.7 +/- 0.08 and 0.6 +/- 0.08, P =. 03, respectively). CONCLUSION: Blood flow in the vessels that supply blood to the follicles in the ovaries in the early follicular phase correlates significantly with ovarian response.Öğe Leydig cell tumor of the testis: Comparison of histopathological and immunohistochemical features of three azoospermic cases and one malignant case(Blackwell Publishing Asia, 2001) Hekimgil, M; Altay, B; Yakut, BD; Soydan, S; Ozyurt, C; Killi, RLeydig cell tumors of the testis are rare, mostly presenting as a testicular mass or as endocrinological symptoms. Here, three patients who were admitted for investigation of primary infertility and one patient presenting with a testicular mass are reported. The histological features were reviewed and an immunohistochemical study was done using a panel of antibodies against cytokeratin, vimentin, inhibin A, S-100, Ki-67, follicle-stimulating hormone, luteinizing hormone, prolactin, p53, bcl-2, and c-erbB2. The latter case (lost during follow up of metastatic disease) demonstrated massive tumor necrosis, extension through the tunica albuginea, and a high mitotic activity and MIB-1 score. Only this malignant case was bcl-2 positive. Of the two oncogenic markers studied, none of the cases were positive for c-erb2, while p53 was positive in more than 50% of cells in the malignant case and in one case of infertility with a large tumor, hemorrhage, focal necrosis and atypical cytological features. We recommend the evaluation of infertile men for Leydig cell tumors, and we believe that a panel of antibodies, including Ki-67, p53 and bcl-2, used for immunohistochemical analysis could be of diagnostic value in the identification of malignant and borderline cases of Leydig cell tumor.