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Öğe Axillary Lymph Node Status in Multicentric Breast Tumors and Breast Tumors with Nipple Involvement(KARGER, 2012) Cakir, Murat; Tekin, Ahmet; Kucukkartallar, Tevfik; Vatansev, Celalettin; Aksoy, Faruk; Kartal, Adil; Tuncer, Fatma B.Background: Axillary lymph node dissection plays an important role in breast cancer management in terms of staging, prediction of prognosis, determination of adjuvant therapy, and local control of the primary tumor. The objective of this study was to evaluate the axillary lymph node involvement in multicentric breast tumors and breast tumors with nipple involvement in comparison with unifocal tumors. Patients and Methods: We reviewed the records of 267 patients with stage I or IIA disease. The rates of axillary lymph node metastasis (ALNM) in patients with unifocal tumors, multicentric tumors, or nipple involvement were compared. Results: 209 (78%) patients had unifocal tumors, 24 (8%) had multicentric tumors, and 34 (12%) had nipple involvement. The incidence of ALNM was 9.76% in patients with unifocal tumors, 24.84% in patients with multicentric tumors, and 36.71% in patients with nipple involvement. Hence, the incidence of ALNM was significantly higher in patients with nipple involvement or multicentric tumors than in patients with unifocal tumors. Conclusion: Our data suggest that compared to unifocal tumors, breast tumors with nipple involvement or multiple foci show a significantly higher incidence of ALNM which is a predictor of a poor prognosis.Öğe Comparison of mammography sensitivity after reduction mammoplasty targeting the glandular and fat tissue(AVES, 2015) Cakir, Murat; Kucukkartallar, Tevfik; Tekin, Ahmet; Selimoglu, Nebil; Poyraz, Necdet; Belviranli, Mehmet Metin; Kartal, AdilObjective: Mammography may have some limitations in the diagnosis and screening of breast cancer for women who have previously undergone breast reduction surgery. This study aimed to investigate how the structural defects in the breast tissue formed by postoperative changes are reflected on mammography. Material and Methods: The records of patients who had previously undergone breast reduction surgery and who were requested to undergo mammography for breast cancer screening by the general surgery clinic were retrospectively studied. The patients' ages, surgical procedures, postoperative follow-up periods, amount of removed material, and histopathological and mammographic results were studied. The patients were classified into 3 groups: those older than 40 years who underwent reduction mammoplasty targeting predominantly the glandular tissue (group 1), those younger than 40 years who underwent reduction mammoplasty targeting predominantly the fat tissue (group 2), and those older than 40 years who were diagnosed with breast hypertrophy and were not operated (group 3). Results: The mean follow-up period of the patients was 6 (2-10) years. The mean value of resected tissue was 1120 g (680-2070) in group 1 and 1220 g (720-1980) in group 2. The mean age at the time of surgery was 45 (40-70) years for group 1 and 35 (24-40) years for group 2. All patients in group 1 were classified in Breast Imaging-Reporting and Data System (BI-RADS) category 1-2; 28 patients in group 2 were classified in BI-RADS 1-2, 4 were classified in BI-RADS 3, and 8 were classified in BI-RADS 0. In group 3, 35 patients were classified in BI-RADS 1-2, 4 were classified in BI-RADS 3, and 1 was classified in BI-RADS 0. Conclusion: We believe that breast reduction surgery targeting predominantly the glandular tissue in patients older than 40 years increases mammographic sensitivity.Öğe A different approach for sterilization of liver hydatid cysts(W J G PRESS, 2007) Tekin, Ahmet; Kucukkartallar, Tevfik; Kartal, Adil[Abstract not Available]Öğe Early laparoscopic cholecystectomy for acute cholecystitis(TURKISH ASSOC TRAUMA EMERGENCY SURGERY, 2009) Tekin, Ahmet; Kucukkartallar, Tevfik; Belviranli, Metin; Vatansev, Celalettin; Aksoy, Faruk; Tekin, Sakir; Kartal, AdilBACKGROUND The aim of this study, was to assess the clinical results of treatment by laparoscopic cholecystectomy (LC) in patients with acute cholecystitis. METHODS Between 1994 and 2006, LC was performed in 3876 patients in Selcuk University Meram Medicine Faculty. The clinical, biochemical, radiologic, and operative data of 182 (101 F, 81 M) consecutive patients with acute cholecystitis operated 3 days after the onset of symptoms were analyzed retrospectively to determine the complications and morbidity after operation. RESULTS The conversion rate was 31 (17.03%) in acute cholecystitis. Postoperative length of stay was found as 4 days in the successful LC group and 7 days in the conversion group. For acute cholecystitis, we found a statistical difference between the successful LC group and the conversion group in terms of length of postoperative hospitalization time and gallbladder wall thickness. We identified the following factors as associated with conversion: male gender, pericholecystic collection L seen on ultrasound, gangrenous cholecystitis, and gallbladder wall thickness >1 cm. CONCLUSION LC is a safe approach in selected patients with acute cholecystitis. Male gender, pericholecystic collection seen on ultrasound, gangrenous cholecystitis, and gallbladder wall thickness >1 cm are associated with a higher risk of conversion to open surgery.Öğe Effectiveness of collagenase in preventing postoperative intra-abdominal adhesions(ELSEVIER SCIENCE BV, 2013) Cakir, Murat; Tekin, Ahmet; Kucukkartallar, Tevfik; Yilmaz, Huseyin; Belviranli, Metin; Kartal, AdilIntroduction: The purpose of this study is to investigate the effectiveness of Collagenase clastridiopeptidase an enzyme preparation used in enzymatic debridement in preventing adhesions brought about by peritoneal damage. Methods: The study covers a total of 40 rats in 4 groups each having 10 rats. Group 1: The control group. Group 2: Normal saline group. Group 3: Sterile Novuxol (R) group. Group 4: The group where the intraperitoneal and systemic effects of sterile Novuxol (R) were investigated. Adhesion frequency and grades were scored on the post-op 11th day according to Granat. Blood work including hemoglobin, aspartate aminotransferase, alanine aminotransferase, urea, creatinine, and albumin level measurements were performed. Toxicity was investigated histopathologically through samples taken from the liver and the peritoneum from Group 4. Results: Adhesion frequency was found to be 80% on the right and 90% on the left for Group 1, while it was 50% on both left and right for Group 2, and 30% on the right and 10% on the left for Group 3. Adhesion stages were found to be 1: 2.35 +/- 1.42 for Group 1, 0.31 +/- 1.15 for Group 2, and 0.20 +/- 0.41 for Group 3. Adhesion stage of the Sterile Novuxol (R) Group was lower than all the other groups (p < 0.05). Biochemical and hematological parameters were similar in all groups (p > 0.05). Histopathological analysis revealed no hepatotoxicity. Conclusions: According to the results of our study, we believe that Sterile Novuxol (R) can be a good anti-adhesive agent considering its ease of use, non-toxicity, and effectiveness. (C) 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.Öğe Effects of Caffeic Acid Phenethyl Ester (CAPE) on Hepatopulmonary Syndrome(SPRINGER/PLENUM PUBLISHERS, 2011) Tekin, Ahmet; Turkyilmaz, Serdar; Kucukkartallar, Tevfik; Cakir, Murat; Yilmaz, Huseyin; Esen, Hasan; Ates, BurhanThe aim of this study was to investigate the effects of caffeic acid phenethyl ester (CAPE) on inflammatory and related histopathological changes in the lung and liver in experimental hepatopulmonary syndrome (HPS) model. Forty Sprague Dawley rats were used in this study. The animals were divided into four groups of ten rats each. Group 1 and 2 was subjected the common bile duct (CBD) but not ligated, Group 3; (cirrhosis + saline): the CBD was ligated and was given intraperitoneal saline infusion treatment during 5 weeks. Group 4; (cirrhosis + CAPE): the CBD was ligated and was given intraperitoneal CAPE infusion treatment during 5 weeks. A 5-week waiting period was observed for the development of cirrhosis and the rats' lungs and liver were taken for histopathological examination. The induction of HPS resulted in a significant increase in serum bilurubin, AST, ALT, and NO levels, and decrease PO2 and O-2 saturation. The use of CAPE significant decrease these parameters. Histopathological examination revealed less congestion, portal inflammation, and nodular formations of the liver, and less congestion, emphysematous and inflammatory changes and smallest perialviolar vascular diameters, in the lung in the cirrhosis + CAPE groups than in the other groups. CAPE treatment may be a potential approach for the treatment of hepatopulmonary syndrome in the future.Öğe The effects of oral liquid and intravenous glutamine on bowel adaptation in a rabbit short bowel syndrome model(TURKISH SOC GASTROENTEROLOGY, 2010) Tekin, Ahmet; Yemis, Mustafa; Kucukkartallar, Tevfik; Vatansever, Celalettin; Cakir, Murat; Yilmaz, Huseyin; Toy, HaticeBackground/aims: The aim of this study was to examine whether liquid glutamine given to rabbits after resection is as effective as intravenous (iv) glutamine and to study the positive effects of glutamine on mucosal atrophy that occurs after bowel resection. Methods: Thirty rabbits with an average weight of 2500 g were used. On the third day, 30 rabbits were divided into three groups as follows: Group I (controls): bowel resection + oral total parenteral nutrition, Group II (oral liquid L-glutamine): Bowel resection + oral total paranteral nutrition + oral liquid L-glutamine, and Group III (iv L-glutamine): bowel resection + oral total paranteral nutrition + iv L-glutamine. On the postoperative 7(th) day, all subjects were sacrificed to examine intestinal adaptation indicators. Results: There was an increase in average villas height and crypt depth in Group III compared to the other groups (p=0.0001). In Group II, the villus height and crypt depth increased more than in Group I, but the difference was less significant (p=0.038). There was no significant difference between groups in terms of average goblet cell proliferation. Conclusions: In our experimental study, it was observed that the orally given L-glutamine liquid in the rabbit intestinal adaptation model prevented mucosal atrophy after 50% bowel resection and even increased mucosa mass. However, iv glutamine led to similar and even better results. Neither route of glutamine administration was determined to have an effect on goblet cell proliferation.Öğe Enzymatic Debridement in Necrotizing Pancreatitis(INT COLLEGE OF SURGEONS, 2015) Cakir, Murat; Tekin, Ahmet; Kucukkartallar, Tevfik; Vatansev, Husamettin; Kartal, AdilMultiple organ failure and pancreatic necrosis are the factors that determine prognosis in acute pancreatitis attacks. We investigated the effects of collagenase on the debridement of experimental pancreatic necrosis. The study covered 4 groups; each group had 10 rats. Group I was the necrotizing pancreatitis group. Group II was the collagenase group with pancreatic loge by isotonic irrigation following necrotizing pancreatitis. Group III was the collagenase group with pancreatic loge following necrotizing pancreatitis. Group IV was the intraperitoneal collagenase group following necrotizing pancreatitis. The progress of the groups was compared hematologically and histopathologically. There was no difference among the groups regarding the levels of leukocyte, hemogram, and urea. The differences in AST levels between Group I and II; and differences in glucose, calcium, LDH, AST, and amylase between Group II and III; between Group II and IV; between Group I and III; and between Group I and IV were statistically significant (P < 0.05). There were statistically significant differences between Group II and III, and Group II and IV regarding edema, acinar necrosis, inflammatory cell infiltration, hemorrhage, and fat necrosis (P < 0.05). In conclusion, the collagenase preparation used in this experimental pancreatitis model was found to be effective in the debridement of pancreatic necrosis.Öğe The Increase of Intra-Abdominal Pressure Can Affect Intraocular Pressure(HINDAWI LTD, 2015) Ece, Ilhan; Vatansev, Celalettin; Kucukkartallar, Tevfik; Tekin, Ahmet; Kartal, Adil; Okka, AndmehmetObjective. This study aims to explore the usage of intraocular pressure measurements as the early indicator of the increase in intra-abdominal pressure. Methods. In this prospective study, 40 patients undergoing elective surgery were included. Patients were divided into four groups of 10 patients. The control group (Group C) was not subjected to laparoscopic intervention. Laparoscopic surgery was, respectively, performed with an intra-abdominal pressure of 9, 12, and 15 mmHg in Groups L (low), M (medium), and H (high pressure). Intraocular pressure was measured binocularly in each patient at three different times (before, during, and end of surgery) using a contact tonometer. Results. Patients' gender, age, body mass index (BMI), American Society of Anesthesiology (ASA) class, and operative times were not different among the groups. No complications occurred with either the surgery or measurement of intraocular pressure. Intubation was associated with a severe rise in IOP (P < 0.05). An increase in intraocular pressure was seen in groups M and H (P < 0.05). Conclusion. Intraocular pressure was increased in the groups with an intra-abdominal pressure of 12 mmHg or more. Measuring the intraocular pressure might be a useful method to estimate the intra-abdominal pressure.Öğe Mechanical intestinal cleansing and antibiotic prophylaxis for preventing bacterial translocation during the pringle maneuver in rabbits(SPRINGER, 2011) Erenoglu, Bulent; Gokturk, Huseyin Savas; Kucukkartallar, Tevfik; Sahin, Mustafa; Tekin, Ahmet; Tatkan, Yuksel; Bodur, SaitWe investigated the effectiveness of mechanical intestinal cleansing and antibiotic prophylaxis in preventing bacterial translocation (BT) during the Pringle maneuver in rabbits. Forty-eight rabbits were allocated to one of the following four groups: a control group (group 1); an antibiotic group, given 100 mg/kg intravenous ceftizoxime (group 2); a mechanical intestinal cleansing group, given a Fleet enema (group 3); and a mechanical intestinal cleansing plus antibiotic group (group 4). After performing laparotomy, we dissected the portal region and turned the portal triad, using tape. Pringle maneuver was applied for 30 min in all groups. Blood samples were collected from the portal vein for blood culture before the Pringle maneuver. All groups underwent relaparotomy 30 min after the Pringle maneuver, to obtain portal blood, mesenteric lymph nodes (MLNs), and splenic tissue for culture. All cultures from the portal vein specimens taken before the Pringle maneuver were negative. The rate of bacterial isolation in the portal vein (P < 0.001), MLNs (P < 0.01), and splenic (P < 0.001) cultures was significantly lower in group 4 than in the other groups. It was also lower in group 3 than in groups 1 and 2 (P < 0.05 for all). The combination of mechanical intestinal cleansing and preoperative broad-spectrum antibiotics was most effective for preventing BT during the Pringle maneuver.Öğe Preventing oxygen free radical damage by proanthocyanidin in obstructive jaundice(AVES, 2017) Savdan, Mervan; Cakir, Murat; Vatansev, Husamettin; Kucukkartallar, Tevfik; Tekin, Ahmet; Tavli, SakirObjective: Tissue damage and endotoxemia in obstructive jaundice are attributed to the increase in oxygen free-radicals. We aimed at evaluating the possible protective effect of grape seed proanthocyanidin extract (GSPE), which is a potent exogenous free-radical scavenger and antioxidant. Material and Methods: The study was performed at the Necmettin Erbakan University Meram School of Medicine Research and Application Center for Experimental Medicine Laboratory with ethical approval. 30 Wistar-Albino rats were used and were divided into 3 groups. The common bile duct was identified and only dissected in the first group (sham). Following dissection of the common bile duct it was ligated with 4/0 silk just above the pancreas in the second group (control). After ligation of the common bile duct, 100mg/kg/day GSPE was administered via orogastric lavage for 10 days in the third group. Results: Biochemical values revealed a statistically significant difference between Group I and the others. There was no difference between Group II and III regarding biochemical values. There was a statistically significant difference, however, between Group II and III with regards to nitric oxide levels. There was a statistically significant difference between Group I and the other groups concerning hepatic and pulmonary tissue damage on histopathologic evaluation. There was no difference among the groups with regards to renal tubular damage. Conclusion: Proanthocyanidin is an effective natural antioxidant in decreasing the level of tissue damage caused by oxygen free-radicals.Öğe Single Incision Laparoscopic Appendectomy with Two Port: A Case of Appendiceal Mucocele(SPRINGER INDIA, 2013) Vatansev, Celalettin; Simsek, Gurcan; Kucukkartallar, TevfikLaparoscopic appendectomy for the neoplasm of the appendix remains a controversial subject in the literature. The main concern regarding laparoscopic treatment for the neoplasm of the appendix is incomplete resection and rupture of the tumor into the peritoneal cavity. There is a slight increase in the rate of invasion of the surgical margins in laparoscopic interventions. However, the prognosis of the neoplasm of the appendix treated with laparoscopic appendectomy is not different from an open surgical technique. A series of cases have been reported in the literature concerning the success rate of single-incision laparoscopic appendectomy used in the treatment of acute appendicitis. In our clinic, two-port laparoscopic appendectomy through a single incision was successfully performed on a 45-year-old male patient diagnosed with an appendiceal mucocele. Despite some concerns in the literature about laparoscopic treatment of neoplasms of the appendix, we suggest that single-incision laparoscopic appendectomy can be successfully performed in patients diagnosed with neoplasms of the appendix.Öğe Spontaneous Infarction in a Fibroadenoma of the Breast(KARGER, 2011) Toy, Hatice; Esen, Haci H.; Sonmez, Fatma C.; Kucukkartallar, TevfikBackground: Fibroadenomas are common neoplasms in young women but occur in a wide age range from adolescent females to octogenians. Case Report: A 21-year-old female patient presented with a 10-week history of a mass in her breast. Ultrasound examination demonstrated a 3.5 x 3 cm, well-circumscribed, semisolid mass. An excisional biopsy but no fine needle aspiration was performed. The patient had no history of pregnancy or lactation, or trauma or infection to the area of the lesion. The histopathological examination showed a spontaneously infarcted fibroadenoma. Conclusions: Spontaneous infarction is an uncommon complication in fibroadenoma of the breast, and there are very few reported cases in the literature.
