Browsing by Author "Toktas, Osman"

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Assessment of Stromal Elastin Fibers in Breast Cancer and Fibroadenomas: Is There a Correlation With Ultrasound Elastography Findings
(Galenos Yayincilik, 2022) Toprak, Nursen; Aras, Ibrahim; Toktas, Osman; Yokus, Adem; Gunduz, Ali Mahir
Objective: The stiffness of a breast lesion provides information on the likelihood of malignancy. The most important factor affecting this stiffness is the composition of the extracellular matrix (ECM). The aim of this study was to assess the elastin fiber contents of malignant breast lesions and fibroadenomas and investigate any relationship between the shear wave velocity (SWV) measured by ultrasonography, and the elastin fiber content of lesions. Materials and Methods: Consecutive patients with breast lesions were enrolled. The SWV values of the lesions were analyzed. Histopathological analysis of elastin in excised lesions was performed by the method of Shivas and Douglas. Breast cancer patients were reviewed according to their lymph node status and tumor diameter. The relationship between SWV value and tissue elastin fiber score was analyzed. The correlation between breast cancer grade and elastin fiber score in malignant lesions was investigated. Results: A total of 167 consecutive breast lesions in 167 patients were included in this study (75 invasive cancer, 92 fibroadenomas). High elastic fiber score was significantly more common (p = 0.001) in malignant lesions (n = 61; 81.3%) than fibroadenomas (n = 13; 14.1%). There was a negative correlation between the mean SWV and the elastin fiber score of fibroadenomas (p = 0.001). A low grade in breast cancer was associated with high elastin fiber score (p = 0.01). Conclusion: Malignant lesions tend to have higher elastin fiber scores than fibroadenomas. Elastin fiber assessment may provide additional prognostic information in malignant lesions. Changes in elastin fiber content may account for the variation in elasticity in fibroadenomas.
Does Arfi Elastography Complement B-Mode Ultrasonography in the Radiological Diagnosis of Idiopathic Granulomatous Mastitis and Invasive Ductal Carcinoma
(Sage Publications Ltd, 2022) Toprak, Nursen; Toktas, Osman; Ince, Suat; Gunduz, Ali Mahir; Yokus, Adem; Akdeniz, Huseyin; Ozkacmaz, Sercan
Background Idiopathic granulomatous mastitis (IGM) is a chronic, unpleasant autoimmune inflammatory condition and is clinically and radiologically often confused with breast malignancy. Purpose To investigate the contributions of qualitative and quantitative aspects of acoustic radiation force impulse (ARFI) elastography to the differential diagnosis between IGM and invasive ductal carcinoma (IDC) in the breast. Material and Methods Ninety-four women with IDC and 39 with IGM were included in the study. Shear wave velocity (SWV) was calculated for all lesions using quantitative elastography. Next, each lesion's correspondence on qualitative elastographic images to those on the B-mode images was evaluated: pattern 1, no findings on elastography images; pattern 2, lesions that were bright inside; pattern 3, lesions that contained both bright and dark areas; and pattern 4, lesions that were dark inside. Pattern 4 was subdivided into 4a (dark area same size as lesion) and 4b (dark area larger than lesion size). Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were calculated. Results The mean SWV based on ARFI elastography was 3.78 +/- 1.26 m/s for IGM and 5.34 +/- 1.43 m/s for IDC lesions (P < 0.05). Based on qualitative ARFI elastography, IDC lesions were mostly classified as pattern 4b, while IGM lesions were mostly classified as pattern 1 or 2 (P = 0.01). Evaluation of both the qualitative and quantitative aspects of ARFI elastography yielded a sensitivity of 89% and specificity of 84%. Conclusion ARFI elastography may facilitate the differential diagnosis between IGM and IDC.
The Effect of Diaphragmatic Plication on Pulmonary Function Test, Dyspnea Score and Arterial Blood Gases: Analysis 11 Patients With Diaphragmatic Elevation
(derman Medical Publ, 2011) Cobanoglu, Ufuk; Sayir, Fuat; Mergan, Duygu; Toktas, Osman
Aim Diaphragmatic evantration or paralysis in adults is associated with respiratory distress. In this study, we aimed to compare preoperative and postoperative pulmonary function tests, arterial blood gas analyses and dyspnea scores of the cases in whom plication had been performed for diaphragmatic elevation. Material and Methods Between January 2004 and March 2010 eleven adult patients who had undergone diaphragmatic plication due to diaphragmatic paralysis and eventration were analyzed. There were 7 (63.63%) men and 4 (36.37%) women aged 28-65 (mean 38 +/- 2.9). Diaphragmatic plication was performed. Pulmonary function test, dyspnea scores, and arterial blood gases in the preoperative and postoperative period were studied. Results Dyspnea was present in all of the cases and a decrease in both FVC, FEV1, FEV1/FVC values of pulmonary function test and partial pressure of oxygen in the arterial blood were observed. In chest x-ray and thorax computed tomography, it was detected that right or left diaphragm was elevated. Diaphragmatic paralysis was detected by fluoroscopy in 6 patients. Transthoracally, diaphragmatic plication was performed to the cases. There were no postoperative complications or deaths. In postoperative six and twelve months, significant improvements in the symptoms, the values of pulmonary function tests, partial pressure of oxygen in the arterial blood and dyspnea scores of the patients were observed. Conclusions Diaphragmatic plication is a safe and effective procedure for adult patients with dyspnea due to unilateral diaphragmatic elevation. Lung expansion is easily achieved by performing diaphragm plication.
The Effect of Using a Larger Port on Reducing the Complications of Laparoscopic Cholecystectomy: a Randomized Trial
(derman Medical Publ, 2019) Toktas, Osman; Cikman, Oztekin; Peksen, Caghan; Elasan, Sadi; Yuzkat, Nurettin
Aim: Laparoscopic cholecystectomy (LC) is the gold standard treatment method for cholelithiasis. There are many complications related to LC and many different microinvasive interventions have been performed to decrease the complication rate. In this study, we aimed to demonstrate the surgical results of the LC that was performed with a 15-mm port tool. Material and Method: Two-hundred patients who underwent LC in our clinic were included in this study. These cases were randomized as 10-mm port tool group (n-100) and 15-mm port tool group (n-100) according to the port-tool diameter that was used in LC. The gallbladder extraction time, port site complications, length of hospital stay, postoperative pain and cosmesis scores were compared between two groups.Results: The gallbladder extraction time was 135.3 sec in the 10-mm port tool group and 13.4 sec in the 15-mm port tool group (p<0.05). The complication rate was 53% (53cases) in the 10-mm port tool group and 13% (13cases) in the 15-mm port tool group (p<0.05). The duration of hospitalization was the same in both groups. The port site pain was 5.4 (2-9) in the 10-mm port tool group and 4.3 (1-7) in the 15-mm port tool group (p<0.05). None of the patients in either group had port site hernias or infections, and there was no significant difference between the two groups with regard to the port site incision scarring. Discussion: It was thought that it can reduce the operation time, the need for fascial expansion, gallbladder perforations during removal, and postoperative port site pain. Moreover, it does not increase the risk of a port site infection or a hernia and is not different from wound scarring.
The Efficiency of Apparent Diffusion Coefficient Quantification in Diagnosis of Acute Cholecystitis and in Differentiation of Cholecystitis From Extrinsic Benign Gallbladder Wall Thickening
(Springer, 2014) Beyazal, Mehmet; Avcu, Serhat; Celiker, Fatma Beyazal; Yavuz, Alpaslan; Toktas, Osman
The aim of the current study was to assess the efficiency of the apparent diffusion coefficient (ADC) measurement in diagnosis of acute cholecystitis and in differentiation of cholecystitis from extrinsic benign gallbladder wall thickening. Forty patients who were diagnosed to have acute cholecystitis by ultrasonographic examination were included in this study. The control group consisted of 18 patients without symptoms of gallstones and cholecystitis whose gallbladder walls were thickened due to cirrhotic ascites. Both groups were examined using diffusion weighted imaging, and the mean ADC values were compared using Student's t-test. The diagnoses of the 40 patients were proven by histopathological examination. The mean ADC values of patients diagnosed with cholecystitis (1.68 +/- A 0.36 x 10(-3) mm(2)/s) were significantly lower than the mean ADC values of the control group (2.35 +/- A 0.24 x 10(-3) mm(2)/s) (p < 0.05). Receiver operating characteristics curve analysis based on ADC revealed a cut-off value of 2.04 x 10(-3) mm(2)/s for the diagnosis of cholecystitis, with a sensitivity of 94 % and a specificity of 89.7 %. ADC value quantification may be an efficient method for making a diagnosis of cholecystitis and in differential diagnosis of cholecystitis from the extrinsic benign gallbladder wall thickening that can be seen during the course of cirrhotic ascites.
Hepatic Artery Pseudoaneurysm: Delayed Presentation After a Blunt Trauma
(int Scientific information inc, 2015) Batur, Abdussamet; Yavuz, Alpaslan; Toktas, Osman; Bora, Aydin; Bulut, Mehmet Deniz
Background: Ruptured hepatic artery pseudoaneurysm is a rare condition that is life-threatening if not diagnosed and treated rapidly. We present a case of a spontaneously ruptured hepatic artery pseudoaneurysm that occurred after a blunt trauma, and provide a review of the current literature on this topic. This case study demonstrates a spontaneously ruptured hepatic artery pseudoaneurysm which emerged following a blunt trauma and it also presents current literature studies on the topic. Case Report: A man at the age of 34 years with blunt trauma dating back to 1.5 month was admitted to the emergency department of a hospital with hematemesis and epigastric tenderness. He also had a duodenal ulcer, blood in the gastric lumen and a large pseudoaneurysm that developed from the left hepatic artery. Soon after the diagnosis, the patient worsened and underwent distal gastrectomy and cholecystectomy that included removing the bleeding aneurysm. Conclusions: Ruptured hepatic artery pseudoaneurysm stands as a deadly condition which has to be diagnosed and managed as soon as possible. Physicians need to take aneurysms of abdominal arteries into consideration after routine diagnostic practises as long as the cause of gastrointestinal haemorrhage is unidentified.
Impact of 18f-Fdg Pet/Ct in the Management Decisions of Breast Cancer Board on Early-Stage Breast Cancer
(Springer int Publ Ag, 2024) Ozdemir, Abdulselam; Guven, Mustafa; Binici, Serhat; Uygur, Serhat; Toktas, Osman
Purpose Breast cancer is the most common malignancy accounting for 11.7% of all cancer cases, with a rising incidence rate. Various diagnostic methods, including 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT), play a crucial role in breast cancer diagnosis and staging. However, the unnecessary use of advanced imaging techniques such as PET/CT in early-stage breast cancer can have negative effects on both economics and patients. We aimed to investigate the impact of PET/CT on the management decisions of early-stage breast cancer patients by the breast cancer tumor board.Methods A retrospective analysis was performed on a cohort of 81 patients with early-stage breast cancer who were evaluated by breast cancer tumor board from January 2015 to December 2020. Demographic, clinical, and radiographic data, along with surgical procedures and treatment options, were documented and analyzed.Results The results showed that 18F-FDG PET/CT had a moderate impact on treatment decisions of breast cancer tumor board, as only treatment decisions were changed in 14,86% of the patients. The surgical procedure decision of breast cancer tumor board changed in 12.35% of patients, while 87.65% of patients had consistent decisions before and after PET/CT. Pathological assessments revealed invasive ductal carcinoma as the most prevalent tumor type, and molecular subtypes were predominantly luminal B. PET/CT use had limited impact on surgical procedures and did not significantly alter treatment decisions of breast cancer tumor board in this early-stage breast cancer cohort.Conclusions In conclusion, this study highlights the importance of adherence to the guidelines and appropriate use of PET/CT in early-stage breast cancer management. PET/CT should be reserved for cases where it is clinically warranted, considering the potential economic burden and minimal impact on treatment decisions of breast cancer tumor board in this patient population.
Ingested Intraabdominal Foreign Bodies That Require Surgical Intervention
(Turkish Assoc Trauma Emergency Surgery, 2016) Kiziltan, Remzi; Yilmaz, Ozkan; Aras, Abbas; Toktas, Osman; Batur, Abdulsamet; Agar, Fatma; Kotan, Cetin
BACKGROUND: The aim of the present study was to review cases that required surgical intervention to remove ingested foreign bodies. METHODS: Medical records of 7 patients who underwent surgical intervention at the Yuzuncu Yil University Department of General Surgery between 2009 and 2014 after ingesting foreign bodies were reviewed. RESULTS: Female: male ratio was 5:2; mean age was 25 (16-35). Four patients had swallowed pins, 1 patient had swallowed a sewing pin, 1 patient had swallowed a safety pin, and 1 patient had swallowed a wristwatch. The patient who had swallowed the wristwatch had psychiatric disorders. All other patients stated that they had swallowed the objects by accident. CONCLUSION: Most ingested foreign bodies pass smoothly through the gastrointestinal (GI) tract within a week, but those that migrate out of the lumen require surgical intervention due to complications including perforation, abscess, fistula, and peritonitis. Early diagnosis and intervention is crucial to reduce morbidity and mortality. It is believed that sharp and pointed objects that migrate outside of the lumen ought to be removed, lest they cause complications.
Intrahepatic Splenosis After Splenectomy Performed for Idiopathic Thrombocytopenic Purpura
(Aves, 2015) Toktas, Osman; Yavuz, Alpaslan; Iliklerden, Umit; Yilmaz, Deniz; Bayram, Irfan
The term splenosis describes autotransplantation or implantation of ectopic splenic tissue within the abdominal cavity or in any other unusual body compartment. In addition to the diagnostic dilemma it causes, splenosis may also lead to persistence or recurrence of hematologic dysfunctions by its preserved immune activity especially in cases of splenectomy due to hematologic indications. Herein, we present a 40-year-old female who had splenectomy for idiopatic thrombocytopenic purpura, and was identified to have splenic tissue within left lobe of the liver during further assessment of ongoing thrombocytopenia.
A Novel First-Line Treatment Alternative for Noncomplicated Idiopathic Granulomatous Mastitis: Combined Intralesional Steroid Injection With Topical Steroid Administration
(Karger, 2021) Toktas, Osman; Konca, Can; Trabulus, Didem Can; Soyder, Aykut; Koksal, Hande; Karanlik, Hasan; Soran, Atilla
Background: Idiopathic granulomatous mastitis (IGM) is a rare form of nonlactational mastitis. Due to the small number of case series and consequently inadequate prospective studies, there is still no consensus on the optimal treatment of IGM. In this study, we aimed to compare the efficacy of intralesional steroid injection with concomitant topical steroids to systemic steroid therapy only in the treatment of noncomplicated IGM. Methods: Between June 2015 and April 2018, the patients' data was prospectively collected and analyzed retrospectively. The study included a total of 78 female patients diagnosed with IGM. Patients were divided into 2 groups: the local steroid treatment group (intralesional steroid injection with topical steroid administration; group 1, n = 46) and the peroral systemic steroid treatment group (group 2, n = 32). Response to the therapy, side effects, recurrence, the need for surgical treatment, and complication rates were compared. Results: Forty-three patients (93.5%) in group 1 achieved a partial or complete response compared to 23 patients (71.9%) in group 2 after 3 months; this difference was significant (p = 0.012). The recurrence rates were significantly lower in group 1 (8.7%) compared to group 2 (46.9%; p = 0.001), and the need for surgical treatment was significantly less in group 1 (2.2%) than in group 2 (9.4%; p = 0.001). While the complication rates were similar between groups, a higher rate of systemic side effects was observed in group 2. Conclusion: Based on the results of our study, combined steroid injection and topical steroid treatment in IGM is as effective as systemic steroid treatment. We suggest that this combination therapy of topical steroids and local steroid injection should be used as first-line therapy in patients with noncomplicated IGM.
Özefagus Kanserinde Torakoskopik-laparoskopik Özofajektomi: Yüksek Volümlü Merkezden İlk 7 Olgu
(2016) Pekşen, Çağhan; İlilkerden, Ümit; Can, Alper; Göy, Burhan; Kotan, M. Çetin; Toktas, Osman; Yerlikaya, Baran
Amaç: Yıllardır özefagus kanseri için konvansiyonel özefajektomi tekniğini kullandık. Son yıllarda yaygın olarak kullanılan minimal invaziv özefajektomi tekniğini kliniğimizde uyguladığımız ilk yedi olguyu literatür eşliğinde sunmayı amaçladık. Gereç ve Yöntem: Aralık 2013- Nisan 2014 yılları arasında kliniğimize başvuran özefagus SCC tanılı erken evre 7 hasta çalışmaya alındı. Hastalara 3 aşamalı ameliyat yapıldı. Sağ torakoskopik 4 trokar yöntemi ile torakal özefagus tamamen serbeştleştirildi. Batına 4 port girilerek laparoskopik olarak mide endo GIA ile tüp haline getirildi. Sol servikal insizyonla proksimal özefagus bulunup piyes yukarı çekildi. Özefagogastrostomi tek kat anastomoz yapıldı. Bulgular: Hastaların ortalama yaşı 58.57 ± 7.1 olup hastaların 5'i kadın, 2'si erkek idi. 5 hastada ameliyat torakoskopik-laparoskopik yaklaşımla gerçekleştirildi ve servikal anastomoz ile tamamlanabildi. 1 hastada batına laparotomi, 1 hastaya da mini laparotomi yapıldı. 2 hastada açık cerrahide çok nadir karşılaştığımız şilotoraks komplikasyonu gelişti. Bu hastalardan biri ex oldu. Sonuç: Minimal invaziv teknikler diğer alanlarda olduğu gibi, özofagus cerrahisinde de giderek artan oranda kabul görmektedir. Temel eğitim ve öğrenme peryodu sonrasında minimal invaziv özofajektomi yüksek hasta potansiyeline sahip merkezlerde uygulanabilecek, teknik olarak açık cerrahiden daha zor olmayan bir yöntem olarak görülse de işlem tecrübesi ve olası komplikasyonlara zamanında ve doğru yaklaşımın tekniğin başarı oranına önemli ölçüde etki ettiği kanaatindeyiz
Persistent Hyperparathyroidism: How Many Cases Can Be Prevented
(Springer india, 2021) Toktas, Osman
The need for surgery for persistent or recurrent hyperparathyroidism results from incomplete resection of abnormal parathyroid glands or adenoma of the remaining gland 6 months after successful surgery. Secondary surgeries can cause major problems, such as healthcare costs and surgical complications, some of which can be disastrous. Preventive medicine is one of the most effective ways to avoid these problems. In this study, our aim is to determine the main causes of persistent hyperparathyroidism and recurrent hyperparathyroidism and prevent these secondary surgeries. We reviewed data of patients who had been reoperated on for persistent hyperparathyroidism and recurrent hyperparathyroidism between July 2015 and November 2018 in our clinic. Patients who underwent reoperation for other reasons, patients under 18 years of age, and patients with missing follow-up information were excluded from the study. Thirty-six patients (7 man and 29 women) were included in the study, and the mean age was 56 SD15.2 years. Thirty of them suffered from persistent hyperparathyroidism, and six (16.7%) of them suffered from recurrent hyperparathyroidism. Ultrasonography was used for localization, which was performed by the department of endocrinology, or, alternatively, radiology, technetium 99m-sestamibi scintigraphy, computer tomography, and magnetic resonance imaging were used. Single imaging modality was used for 19 (52.7%) patients, while more than one imaging modality was used for 17 (47.2%) patients. In the first surgery, 21 (58.3%) patients underwent focus parathyroidectomy, while 15 (41.7%) patients underwent conventional bilateral neck exploration parathyroidectomy. In 29 persistent hyperparathyroidism patients, the causes of persistent hyperparathyroidism were pre-op imaging in 18 (62.0%) patients, inexperience of surgeon in 6 (20.6%) patients, and ectopic localization of parathyroid adenoma in 5 (17.4%) patients. Success was achieved in 35 (97.2%) patients after a second surgery, while 1 (2.8%) persistent hyperparathyroidism patient was followed up with medical treatment because no pathological parathyroid adenoma was detected in the imaging studies or in the second exploration. Hyperparathyroidism can persist after a first surgery due to localization discordance in pre-op imaging modalities, inadequate surgical experience, and sometimes because parathyroid adenoma cannot be found despite all efforts. In more than 80% of cases, persistent hyperparathyroidism can be prevented with careful pre-op image studies and surgeries performed by experienced surgeons.
Pleural Effusion Resultant After Upper Abdominal Surgery: Analysis of 47 Cases
(derman Medical Publ, 2011) Cobanoglu, Ufuk; Bartin, Mehmet Kadir; Mergan, Duygu; Yilmaz, Ozkan; Demir, Ali; Toktas, Osman
Aim Postoperative pulmonary complications, following upper abdominal surgery, occur at a rate which is higher, than lower abdominal surgery. One of these complications is pleural effusion. In this study, the frequency and causes of pleural effusions and the changes of the blood gas values and pulmonary functions of the patients with pleural effusions, occured after upper abdominal surgery are discussed in the accompaniment of the literature. Material and Methods 148 patients to whom upper adominal surgery is performed and in 47 of these patients pleural effusion is developed (31.75%), were examined restrospectivitely. Preoperative and postoperative pulmonary function tests (PFT) and arterial blood gas (ABG) results and the blood proteins, albumin values were recorded. The anesthesia type, the surgery properties, involving type of surgery and the surgical incision were determined. Results Pleural effusion is detected bilaterally in 8 patients (17: 02), at the right side in 21 patients (44.69%), and at the left side in 18 patients (38.29%). The 40.42% (19 cases) of the patients who has pleural effusion in the postoperative period, had liver and gallbladder surgery, the % 23.41 (11 cases) had spleen and pancreas surgery and the % 36.17 (17 cases) had the other surgical procedures. Conclusions While the upper abdominal surgery, impairment of the integrity of the diaphragm's peritoneum that covers the abdominal cavity where there is a highliquid pressure, may cause the liquid transition to the pleural space that has a negative pressure. Hypoalbuminemia and hipoproteinemia, that will occur due to the changes of oral intake and diet regulation in the postoperative period, may cause a reason for the pleural effusion. For this reason, doctors who performed these surgery procedures, should not ignore this complication, in the period of postoperative follow-ups of the patients.
Relationship Between Proliferative Breast Lesions and Breast Cancer Risk Factors
(Galenos Yayincilik, 2021) Toktas, Osman; Elasan, Sadi; Iliklerden, Umit Haluk; Erten, Remzi; Karayil, Ali Riza; Ozdemir, Abdulselam; Senturk, Enes
Objective: The prognosis of breast cancer (BC) is determined directly based on the stage of disease at the time of diagnosis. Proliferative breast lesions (PBLs) are an important risk factor for BC development. The risk of developing BC varies according to the presence of extent of proliferation in the breast lesions. We aimed to investigate the effect of BC risk factors on the PBLs in this study. Materials and Methods: Patients who visited the surgical clinic of the university during the past 6 years who presented with PBLs with or without atypia by fine/core needle aspiration biopsy were included in this study. The relationship between PBLs and BC risk factors such as the age, mass size, Body Mass index (BMI), smoking, sports activity, BC family history, the use of hormone replacement therapy, number of pregnancies, and the duration of breastfeeding were compared. Results: A total of 74 (96.1%) of all patients were women and three were men. The median age of the patients was 38 (range: 19-74) years; the cut-off value of age was 35.5 years. The mean age of patients with PBL-with atypia (PBL-WA) was higher (p=0.005) in the malignant group based on the final pathology and radiological imaging features (for both, p<0.001). The mean size of the mass was large at 2.53 +/- 1.33 (1-6) cm; and the cut-off value of the tumor size was 2.5 cm. The mean size was greater in the PBL-WA patients (p=0.171) in the malignant group based on the final pathology and radiological characteristic (respectively, p=0.004 and p=0.016). The mean BMI was 26.8 +/- 4.4 kg/m(2) (18.8-35.1) and the cut-off value was 25.4 kg/m(2). BMI was greater in the PBL-WA group and in the malignant group based on the final pathology (respectively, p=0.002 and p=0.001). Smoking was positive in 66.2% (n=51) of the patients, and it was high in the PBL-WA patients (p=0.001). The percentage of patients with no sports activity was 63.6% (n=49), while it was 20.8% (n=16) for those with once a week sports activity and 15.6% (n=12) for those with twice a week activity. There was family history of BC in 16.9% (n=13) of all patients. The number of positive cases of family history of BC was greater in the malignant group (p=0.001). Hormone replacement therapy was recorded in 11.7% (n=9) of the patients. The mean numbers of pregnancies (2.1 +/- 2.4) and breastfeeding duration (32.5 +/- 37.4 months) were low in the benign groups due to the relatively lower average age of the patients. Conclusion: Based on our analysis, age is an extremely important aspect for assessing PBLs. The age of the patient was statistically significantly greater in the patients with malignant lesions in all groups. The factors lesion size, BMI, smoking habit, and BC family history were also more frequent in the malignant groups. The rate of sports activity was lower in the malignant groups. Thus, it is necessary to evaluate patients individually when evaluating PBLs. It is recommended to evaluate PBLs together with BC risk factors for the better understanding.
Small Bowel Obstruction Caused by Giant Meckel's Diverticulum
(2016) Toktas, Osman; Batur, Abdussamet
Meckel divertikülü (MD) omfalomezenterik kanalın tam olmayan kapanmasından kaynaklanır. Gastrointestinal sistemin en sık rastlanan konjenital anomalisi olup %1-3 oranında görülür. Çoğu hasta asemptomatiktir. Ancak barsak obstrüksiyonu, hemoraji, divertikülit, perforasyon veya diğer umblikal lezyonlar gibi komplikasyonlarla semptomatik hale gelebilirler. Bu komplikasyonlar volvulus, adezyon Littre hernisi, invajinasyon gibi çeşitli mekanizmalarla gelişir. İnce barsak obstrüksiyonu, tüm semptomatik olguların 1/3'ünü oluşturan ve erişkinlerde en sık görülen kliniktir. Bu makalede,19 yaşındaki erkek hastada MD'nin bir komplikasyonu olan intestinal obstrüksiyonu sunmayı amaçladık. İnce barsak rezeksiyonuna gerek kalmadan hastaya divertikülektomi yapıldı.
Synchronized Occurrence of Oncocytic Variant of Papillary Carcinoma of the Thyroid and Esophageal Squamous Cell Carcinoma Metastasis: Case Report
(2015) Buğday, İnci; Bayram, İrfan; Bulut, Mehmet Deniz; Toktas, Osman; Bulut, Gülay; Erten, Remzi
Tiroide metastaz oldukça nadirdir. Son yıllarda tiroide metastazda artış görülmektedir. Bu da ince iğne aspirasyon biyopsisinin daha sık kullanılıyor olmasıyla ilişkili olabilir. Senkronize tiroid papiller karsinom onkositik varyantı ile özellikle özogafus kaynaklı tiroide metastaz birlikteliği oldukça nadir görülür. Bu yazıda 56 yaşında bayan hastada, tiroid sol lobda metastatik palpabl kitle gelişimine sebep olan primer özofageal skuamöz hücreli karsinom ile sağ lobda tiroid papiller karsinom onkositik varyantı birlikteliğini sunmaktayız.
Torakoskopik-laparoskopik Özefajektomi Yapılan 13 Olguda Azigos Veninin Polimer Klipsle Kapatılması
(2019) İliklerden, Ümit; Toktas, Osman; Kotan, M. Çetin
Amaç: Özefagus kanserinin tedavisinde cerrahi hala enönemli kısmı oluşturmaktadır. Cerrahi, konvansiyonelyöntemler ile yapılabildiği gibi minimal invaziv yöntemlerlede yapılabilinmektedir. Bu çalışmada minimal invazivMcKeown özefajektomi yapılan olgularda azigos venininpolimer klips ile kapatıldığı olguları literatür eşliğindetartışmayı amaçladık.Gereç ve Yöntem: Mayıs 2014-Mayıs 2016 yılları arasındamerkezimizde özefagus kanseri nedeniyle minimal invazivMcKeown özefajektomi yapılan 13 olgu çalışmaya alındı.Transhiyatal özefajektomi, torakotomi ve azigos venin sütürile kapatıldığı özefajektomi olguları çalışma dışı bırakıldı.Bulgular: Olguların yaş ortalaması 53,8 olup, 10 olgu kadınve 3 olgu erkek idi. Tümör lokalizasyonu 10 olguda orta, 3olguda alt özefagusta idi. Olguların 11’i neoadjuvantkemoradyoterapi almış iken 2 olgu almamıştı. On olguyatorakoskopik-laparoskopik özefajektomi yapıldı, 3 olguya datorakotomik-laparoskopik özefajektomi yapıldı. Bütünolgularda azigos veni polimer klips ile kapatıldı veözefagogastrostomi servikal bölgede yapıldı. Ortalamaameliyat süresi 210 dk idi. Ortalama hastanede kalış süresi12,9 gün idi. Dört olguda patolojik tam yanıt vardı. Çıkarılanortalama lenf nodu sayısı 9,6 idi. İki olguda komplikasyonolarak şilotoraks gelişti ve bunlardan birisi 26. gündekaybedildi. Hiçbir olguda azigos venine bağlı herhangi birkomplikasyon ve kanama yaşanmadı.Tartışma: Özefajektomi de önemli damarsal yapılardanbirisi olan azigos veninin polimer klips ile kapatılmasının,maliyet ve kullanım kolaylığı açısından üstünlüğü olupgüvenle kullanılabileceğini düşünmekteyiz.
Transcervical Resection of Two Parathyroid Adenomas Located on the Anterior Mediastinum
(Aves, 2018) Toktas, Osman; Iliklerden, Umit; Yerlikaya, Baran; Kotan, Cetin; Batur, Abdussamet
The mediastinum is a possible location of ectopic parathyroid adenoma. Most ectopic parathyroid glands in the mediastinum are found in the superior mediastinum within the thymus. In this article, two cases with ectopic mediastinal parathyroid adenomas that were excised via transcervical resection are presented. Preoperative examination of the two cases was performed. Laboratory tests supported hyperparathyroidism. For both patients, the results of radiologic and scintigraphic examinations of the cases were compatible with parathyroid adenoma masses in the anterior mediastinum. Transcervical resection was performed via suprasternal incision through the sternal notch and the posterior wall of the sternum space by blunt dissection with the finger. The soft lesions were removed en bloc in both cases. The parathyroid hormone levels of the two cases decreased dramatically after the operation. Transcervical resection may be an alternative method to major surgery in anterior mediastinal small masses.
Treatment of Idiopathic Granulomatous Mastitis: Local Steroid Administration Vs. Systemic (Oral) Steroid
(Springer india, 2023) Toktas, Osman; Toprak, Nursen; Elasan, Sadi; Calli, Iskan; Binici, Serhat
Idiopathic granulomatous mastitis is characterized by non-caseating granuloma and microabscess formation limited to mammary gland lobules. It is a form of chronic mastitis of unknown pathogenesis. In this study, the effectiveness of intralesional steroid injection with topical steroids is compared to systemic steroid therapy in the treatment of idiopathic granulomatous mastitis. Between June 2017 and December 2020, patients were collected and assessed. Idiopathic granulomatous mastitis was diagnosed histopathologically by tru-cut biopsy in patients with breast mass, pain, and erythema with suspicion of idiopathic granulomatous mastitis. Included in the study were one hundred and eleven patients who were diagnosed with idiopathic granulomatous mastitis and were treated with local or oral administration of corticosteroids, with at least 6 months of follow-up. The patients were divided into 2 groups: a local corticosteroid-treatment group (n = 57) and a peroral corticosteroid-treatment group (n = 54). Demographic characteristics, treatment responses, recurrence rates, side effects of the steroid, and the need for surgery were compared. The rate of smoking was 12.3% in the local corticosteroid-treatment group and 20.4% in the peroral corticosteroid-treatment group. There was no history of oral contraceptive use in either group. Previous steroid use was significantly lower in the local corticosteroid-treatment group (10.5%) compared to the peroral corticosteroid-treatment group (55.6%) (p = 0.001). Previous antibiotic use was significantly lower in the local corticosteroid-treatment group (75.4%) compared to the peroral corticosteroid-treatment group (100%) (p = 0.001). Those who responded after the first course of treatment were 96.5% in the local corticosteroid-treatment group versus 75.9% in the peroral corticosteroid-treatment group (p = 0.001). Complete responders after the third course of treatment was 98.2% in the local corticosteroid-treatment group versus 87.0% in the peroral corticosteroid-treatment group (p = 0.003). Recurrence had been 7% of the patients in the local corticosteroid-treatment group compared to 37% in the peroral corticosteroid-treatment group (p = 0.001). Steroid-related side effects were lower in the local corticosteroid-treatment group (0 compared to the peroral corticosteroid-treatment group (11.1%) (p = 0.010). Surgery was performed in 3.5% of the local corticosteroid-treatment group and in 57.3% of the peroral corticosteroid-treatment group (p = 0.001). A comparative open-label study in idiopathic granulamatous mastitis between local infiltration of corticosteroid compared to oral methyl prednisilone both used as single modality therapy has shown better and sustained response to local infiltration of corticosteroids.
Treatment Results of Intralesional Steroid Injection and Topical Steroid Administration in Pregnant Women With Idiopathic Granulomatous Mastitis
(Galenos Yayincilik, 2021) Toktas, Osman; Toprak, Nursen
Objective: Idiopathic granulomatous mastitis (IGM) is an inflammatory and chronic benign breast disease that has proven difficult to diagnose and treat. Since most treatment modalities cannot be used in pregnant patients, the choice of treatment is more difficult and the need for surgery is more pressing. In this first and innovative study, we assess the results of local corticosteroid therapy of IGM in pregnant women. Materials and Methods: Pregnant women with IGM were evaluated between June 2017 and May 2019. The six pregnant women were treated using intralesional steroid injections and topical steroid administration. The treatment response was evaluated, both clinically and radiologically, at the end of 2 weeks and once more at the end of 1 month. Results: The median patient age was 26 years. The mean duration of complaints was 4.3 months. The median number of children was 2, and the mean breastfeeding time was 41 months. The predominant complaints at onset were a breast mass or local pain and inflammation in four (66.7%) patients and a breast mass with pain and without signs of local skin inflammation in two (33.3%) patients. Diagnosis was made using a tru-cut biopsy in two patients, and with an incisional biopsy in four patients who had abscess drainage and fistulation to the skin. Five (83.3%) patients achieved a complete response, and one (16.7%) patient responded only partially after the first course of treatment. A second course of treatment was given to the patient with partial response. All patients achieved complete response at the end of the second course of treatment. The mean follow-up time was 19.5 months. During the follow-up period, one patient experienced a recurrence at 4 months after giving birth, and she then received a third course of treatment. Topical and systemic side effects of the corticosteroids were not observed in any patient. Conclusion: While the state of pregnancy generally precludes the use of most drugs, the use of local corticosteroid in the treatment of IGM is effective in terms of treatment response, treatment duration, need for surgery, and reduced recurrence and side effects.