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    Anti-inflammatory and anti-oxidant role of ursolic acid in cerulein-induced acute pancreatitis in rats
    (Acad Nacional Medicina Mexico, 2023) Turkoglu, Ahmet; Ibiloglu, Ibrahim; Kaplan, Ibrahim; Arslan, Serkan; Halil-Ocal, Ibrahim; Gumus, Metehan
    Background: Ursolic acid (UA) is found in many plants, and has been reported to have anti-protease, antioxidant, anti-inflammatory, antimicrobial, nephroprotective, hepatoprotective, and cardioprotective effects. Objective: The purpose of this study was to investigate the effects of ursolic acid in cerulein-induced acute pancreatitis (AP). Materials and methods: Thirty-two Wistar albino rats were randomly assigned to 4 equal groups: Sham, acute pancreatitis, treatment, and ursolic acid group. Results: Serum amylase levels in the AP and treatment groups were significantly higher than in the others (p < 0.05). In addition, serum IL-113, IL-6, and TNF-& alpha; levels were significantly higher in the AP group in comparison with the treatment group. Although pancreatic tissue total oxidant activity in the AP and treatment groups was similar, pancreatic tissue total antioxidant capacity was significantly higher in the treatment group than in the AP group. Conclusions: Damage to the pancreas and remote organs in AP was observed to be reduced by UA. In addition, oxidative stress was observed to be decreased by the effect of UA.
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    The antioxidant effects of pomegranate extract on local and remote organs in a mesenteric ischemia and reperfusion model
    (Taylor & Francis Ltd, 2016) Kilic, Elif; Turkoglu, Ahmet; Keles, Aysenur; Ekinci, Aysun; Kesgin, Siddika; Gumus, Metehan
    Objectives: We investigated whether pomegranate extract plays a protective antioxidant role against mesenteric ischemia-reperfusion injury (IR), which can lead to a systemic response and damage distant organs, such as the lung, liver, and kidney. Methods: Forty female Wistar-Albino rats were separated into four groups: laparotomy, laparotomy + PG, mesenteric IR, and mesenteric IR and pomegranate (IR + PG). In the laparotomy + PG and IR + PG groups, pomegranate (225 mg/kg) was given by oral gavage at the beginning of the study. Ischemia was induced for 30 minutes, and reperfusion was subsequently allowed for 60 minutes in the IR and IR + PG groups. The malondialdehyde (MDA) and total antioxidant activity (AOA) levels were evaluated in blood samples. Additionally, all tissues were removed for the measurement of AOA and total oxidant status as well as for subsequent histopathological evaluation. The oxidative stress index was calculated. Results: Histopathological changes in all organs were significantly higher in the IR group and significantly lower in the IR + PG group vs. the other groups. Serum MDA levels were significantly lower in the IR + PG group than in the IR group. No significant difference was found in AOA levels of the groups. Discussion: These data may explain the positive protective effects of pomegranate based on the histopathologic findings in ischemic conditions in an intestinal IR injury model.
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    Associated organ injuries in pancreatic injuries, morbidity, and mortality
    (Tubitak Scientific & Technological Research Council Turkey, 2012) Onder, Akin; Gumus, Metehan; Kapan, Murat; Boyuk, Abdullah; Arikanoglu, Zulfu; Girgin, Sadullah
    Aim: Pancreatic injuries are rarely seen due to the retroperitoneal location of the organ. Associated organ and vascular structures usually accompany injury. In this study, the effect of ductal injury and associated organ injuries on morbidity and mortality was investigated. Materials and methods: Between January 2004 and October 2010, 26 patients with abdominal trauma who developed pancreatic injury and underwent surgery at the Dicle University General Surgery Department were evaluated retrospectively. Results: Of the 26 patients, 20 were males (76.9%) and 6 (23.1%) were females. The mean age of the patients was 24.96 +/- 9.4 (14-56) years. Of the injuries, 21 (80.8%) were related to penetrating trauma and 5 (19.2%) were related to blunt trauma. Of the patients, 6(23.1%) were stage I, 12(46.2%) were stage II, 5 (19.2%) were stage III, and 3 (11.5%) were stage IV The most commonly injured associated organs were the stomach (50%) and vascular structures. Eighteen patients underwent primary suturing, 5 underwent distal pancreatectomy, 3 underwent Roux-en-Y pancreaticojejunostomy., Common postoperative complications included intraabdominal abscess and pancreatic fistula. Mortality occurred in 3 (11.5%) patients, 2 of them due to hemorrhagic shock resulting from vascular injury and 1 of them as a result of fistula-induced sepsis and multi-organ failure. Conclusion: A good exploration should be done in all abdominal traumas, remembering that pancreatic injury could occur. Mortality may increase during the early period in patients who have vascular injuries. Morbidity and late mortality may increase in patients with ductal injuries.
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    Atypical Trajectory of a Thoracoabdominal Gunshot Injury without Penetration
    (Romanian Legal Med Soc, 2010) Gumus, Metehan; BoyuK, Abdullah; Gumus, Hatice; Kapan, Murat; Onder, Akin
    Atypical trajectories of gunshot injuries are a major problem in forensic pathology. Thoracoabdominal gunshot injuries represent some of the most challenging injuries. A 25 years-old man applied to emergency department in consequence of multiple gunshot wounds. Thoracoabdominal helical computed tomography (CT) no injury at the intrabdominal and intrathoracic tissues. There was only a subcutenous tissue laceration of 50 cm in length, through from thoracic to abdominal walls. The patient medically managed and no surgical intervention was performed due to thoracoabdominal injury. In conclusion a trajectory of gunshot may not always be straight as is in our case. Helical CT is a useful tool in determining the real trajectory and therefore reduces the ratio of unnecessary surgical interventions.
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    Breast Microcalcification: Diagnostic Value of Calcified and Non-calcified Cores on Specimen Radiographs
    (Wiley, 2013) Gumus, Hatice; Mills, Pippa; Fish, David; Gumus, Metehan; Devalia, Haresh; Jones, Sue E.; Sever, Ali R.
    To determine if the specimen without calcification, as depicted on specimen radiography, made any contribution to the final histopathological diagnosis in comparison to the specimen with calcification. The records of 1312 stereotactic vacuum-assisted biopsies for breast microcalcifications between February 2000 and December 2010 were reviewed retrospectively. Following specimen x-ray the biopsy tissues with and without microcalcifications were sent in two separate pots (pot 1 and pot 2 respectively). The number of cores in each pot and the number of calcium specks within the cores were recorded. In 1135 of the 1312 (86%) cases the histopathological findings were similar for pot 1 and pot 2. In 165 cases (13%) the diagnosis was made solely on pot 1 while cores in pot 2 did not reveal any additional pathology. In 12 biopsies (1%) the significant pathology was only present in the specimen without any calcification. For microcalcification only breast lesions the specimen containing calcium will yield a correct diagnosis in 99% of cases. Cores containing no calcification rarely contribute to the diagnosis on their own, but in 87% of cases an accurate diagnosis would still have been made even if the targeted calcification had been missed.
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    Causes of failure in removing calcium in microcalcification-only lesions using 11-gauge stereotactic vacuum-assisted breast biopsy
    (Turkish Soc Radiology, 2012) Gumus, Hatice; Gumus, Metehan; Devalia, Haresh; Mills, Philippa; Fish, David; Jones, Peter; Uyar, Asur
    PURPOSE The aim of this study was to determine the causes and rate of failure in removing calcification in microcalcification-only lesions using 11-gauge stereotactic vacuum-assisted breast biopsy. MATERIALS AND METHODS In total, 1365 microcalcification-only lesions were included in this study. The breast biopsy database was reviewed retrospectively. The biopsies were divided into two groups based on whether the specimen X-ray showed calcium within the cores. Breast composition, lesion size, calcification distribution, density on mammography, and the number of specimens were compared between the two groups. RESULTS In 11 (0.8%) biopsies, no calcium in the specimen radiography could be identified. Re-biopsy was performed in five cases. The initial biopsy result was unchanged at the second biopsy in three cases containing calcium, while in the other two cases, a benign biopsy result was upgraded to atypical ductal hyperplasia and ductal carcinoma in situ, respectively. In six cases, the biopsy was not repeated despite the absence of calcium in the specimen X-ray. In three of these cases, calcifications were reported histopathologically and deemed to be too small to be identified on specimen X-ray. In two of six patients, sufficient information was found in the cores without microcalcification to indicate the need for surgery. One patient refused re-biopsy. A statistically significant higher failure rate was observed in low-density calcification compared with intermediate or high-density calcification on mammography. CONCLUSION The failure to retrieve microcalcification is uncommon when an 11-gauge vacuum-assisted breast biopsy is used. Low-density calcifications have a higher rate of failure. In cases in which no calcium is observed in specimen radiography, repeated biopsy is recommended.
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    Clinical and multidetector computed tomography findings of patients with median arcuate ligament syndrome
    (Elsevier Science Inc, 2012) Gumus, Hatice; Gumus, Metehan; Tekbas, Guven; Onder, Hakan; Ekici, Faysal; Cetincakmak, Mehmet Guli; Bilici, Aslan
    Objectives: The present study aimed to present the clinical and multidetector computed tomography (MDCT) findings of patients who were diagnosed with the median arcuate ligament (MAL) syndrome on MDCT retrospectively. Methods: Seven hundred forty-four patients in whom MDCT angiography was performed were retrospectively analyzed for investigating incidental MAL syndrome. Results: Twenty-one patients were shown to have MAL syndrome. Of 21 patients, 18 with MAL syndrome were asymptomatic. Three patients had some symptoms. On MDCT angiography, proximal narrowing of the arteries was observed in 21 patients. Conclusions: MDCT is a minimally invasive and useful tool for the diagnosis of MAL syndrome. (c) 2012 Elsevier Inc. All rights reserved.
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    Comparison of the early complications of total and subtotal thyroidectomy in the multinodular goitre
    (Aves, 2011) Durgun, Cemalettin; Boyuk, Abdullah; Girgin, Sadullah; Kapan, Murat; Onder, Akin; Gumus, Metehan; Tacyildiz, Ibrahim Halil
    Purpose: In the recent years, total thyroidectomy is increasingly being accepted in the surgical treatment of benign multinodular goitre due to the high rate of recurrence after bilateral subtotal thyroidectomy. The aim of this study is to compare early postoperative complications of total and bilateral subtotal thyroidectomy in benign multinodular goitre. Materials and Methods: In our study, the findings of 419 patients operated due to multinodular goitre between January 2005 - December 2009 in Dicle University Medical School Department of General Surgery were retrospectively evaluated. Patients were divided into two groups as total thyroidectomy and bilateral subtotal thyroidectomy. Results: The mean age of patients was 41.72 +/- 12.55. 329 (78.5%) patients were women and 90 (21.5%) were men. A total of 263 (62.8%) patients underwent total and 156 (37.2%) patients bilateral subtotal thyroidectomy. Six (2.3%) of total thyroidectomy patients and 3 (1.9%) of bilateral subtotal thyroidectomy patients had recurrent laryngeal nerve injury. Bilateral subtotal thyroidectomy group revealed no permanent damage whereas in total thyroidectomy group one (0.4%) patient did. Hypocalcemia was observed in 40 (15.2%) patients in the total thyroidectomy group and in 27 (17.3%) patients in the bilateral subtotal thyroidectomy group. One (0.4%) patient in total thyroidectomy group suffered from permanent hypocalcemia whereas it wasn't observed in bilateral subtotal thyroidectomy group. Haematoma occurred in 3 (1.9%) patients treated with bilateral subtotal thyroidectomy and in 3 (1.1%) treated with total thyroidectomy, wound infection occured in one (0.6%) patient subjected to bilateral subtotal thyroidectomy and 3 (1.1%) patients treated with total thyroidectomy. Conclusion: In conclusion, our study supports total thyroidectomy for multinodular goitre involving both lobes as a safe technique with low complication rate.
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    The diagnostic efficiency of CT and MRI in ileosigmoid knotting
    (Tubitak Scientific & Technological Research Council Turkey, 2014) Atamanalp, Sabri Selcuk; Kantarci, Abdulmecit; Aydinli, Bulent; Ozturk, Gurkan; Arslan, Sukru; Korkut, Ercan; Gumus, Metehan
    [Abstract Not Available]
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    An easily overlooked cause of mortality in trauma: rupture of diaphragm
    (Edizioni Luigi Pozzi, 2016) Taskesen, Fatih; Arikanoglu, Zulfu; Boyuk, Abdullah; Gumus, Metehan; Yasti, Ahmet Cinar; Onder, Akin; Kapan, Murat
    BACKGROUND: The purpose of our study was to share our experience in patients with traumatic diaphragmatic rupture. METHODS: Patients underwent surgery for traumatic diaphragm rupture between 2005 and 2010 were reviewed. RESULTS: There were sixty-two patients with traumatic diaphragm rupture. The mean age of the study group was 28.7 years (range 15-62 years). Diaphragmatic rupture was left sided in 43 patients (69%), right sided in 17 (28%) and bilateral in 2 (3%). Thoracotomy applied in 8 patients, laparotomy in 50, thoracoabdominal approach in 4. Mortality seen at 4 (64%) patients and hemorrhagic shock was the reason in two and pneumonia and sepsis in two. CONCLUSIONS: Diaphragm ruptures are inftegent injuries, however, are easily overlooked due to mask effect of accompaning visceral injuries, and it should be kept in mind at lower thoracic or upper abdominal traumas to prompt and proper management to lower the risk of mortality.
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    The Effective Factors on Morbidity Due to Penetrating Small Intestine Injuries
    (Aves, 2012) Onder, Akin; Kapan, Murat; Basol, Omer; Boyuk, Abdullah; Gumus, Metehan; Gul, Mesut; Girgin, Sadullah
    Objective: In this study, we aimed to investigate the effective factors on morbidity due to small intestine penetrating injuries. Material and Methods: Between January 2006 and December 2010, 114 patients who underwent surgery due to penetrating small intestine injuries were retrospectively reviewed. Results: The mean age was 32.8 +/- 12.3years (15-77), and there were 96 patients, (84.2%) male and 18 (15.8%) female patients. The most common etiologic cause was gun-shot injuries (66.7%).Fifty-one (44.7%) patients had isolated small intestine injuries and 63 (55.3%) had small intestine and additional organ injuries. Colon was the most common additional organ injured (66.7%) Most commonly, 68 (59.7%) patients underwent primary suture. T Postoperative morbidity occurred in 30 patients (25%) and the most common complication was wound infection. The morbidity was significantly higher in the patients with small intestine and additional organ injuries (p=0.006). The morbidity was higher in patients who exhibited signs of peritonitis (p=0.048) and had colonic injuries (p=0.002). The number of blood transfusions was effective in mortality (p<0.001). The mean length of hospital stay was 6.9 +/- 2.9 (1-21) days, significantly longer in the patients who developed morbidity (p=0.002). Seven (6.1%) patients died due to hemorrhage in 6 patients and anastomotic leakage in 1 patient. Conclusion: Small intestine injuries significantly increase the postoperative morbidiy when accompanied by additional intraabdominal organ injuries, especially the colon.
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    Effects of Ellagic Acid on Copper, Zinc, and Biochemical Values in Serum and Liver of Experimental Cholestatic Rats
    (Humana Press Inc, 2011) Gumus, Metehan; Yuksel, Hatice; Evliyaoglu, Osman; Kapan, Murat; Boyuk, Abdullah; Onder, Akin; Aldemir, Mustafa
    Ellagic acid (EA) is a natural polyphenolic compound. Although, modulator effects of EA on copper (Cu) and zinc (Zn) levels in some liver diseases have been reported in experimental animals, its effects in obstructive jaundice (OJ) has not been clarified. We aimed to evaluate potential effects of EA on Cu and Zn levels in liver and serum of cholestatic rats. Forty Wistar albino rats were equally divided into four groups. First group was used as controls. Second group received EA (60 mg(-1) kg(-1) day(-1)) for 8 days. Third was OJ group, and fourth group was OJ plus EA group. After 8 days, blood and liver samples were obtained. Higher serum and liver Cu and lower serum and liver Zn levels were found in OJ group (p < 0.05) compared with other groups. However, these differences reached to significant levels for Cu in serum and for Zn in lever. Higher serum copper levels were decreased, and lower liver Zn levels were increased by EA treatment in cholestatic rats (p < 0.05). Also, higher Cu/Zn ratio in OJ group was decreased by EA treatment both in liver (p < 0.05) and in serum (p < 0.05). Significantly higher serum bilirubin, alkaline phosphatase, alanine aminotransferase, and aspartate aminotransferase values were found in OJ and OJ + EA groups compared with the control and EA groups (p < 0.05). In conclusion, result of the current study indicated that ellagic acid has modulator effects on Cu and Zn levels in liver and serum of cholestatic rats.
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    Effects of Intra-Abdominal Hypertension on the Endocrine Functions of the Pancreas in Rats
    (Lippincott Williams & Wilkins, 2011) Boyuk, Abdullah; Balik, Ahmet; Gumus, Metehan; Erdogan, Fazli; Gumustekin, Kenan; Kiziltunc, Ahmet; Polat, Kamil Yalcin
    Background: Intra-abdominal hypertension (IAH) has negative effects on the functions of intra-and extra-abdominal organs and systems. Intra-and extraperitoneal hemorrhage, diffuse intestinal and retroperitoneal edema, intestinal ileus or obstruction, necrotizing pancreatitis, intra-abdominal packing, intra-abdominal sepsis, and pneumoperitoneum can all cause IAH. No studies were found in the literature relating to the effects of IAH on the endocrine functions of the pancreas. Therefore, the objective of this study was to investigate the effects of IAH on the endocrine functions of the pancreas. Methods: Forty male rats were divided into four groups: control, sham control, and two study groups, each containing 10 rats. In one of the study groups, animals were subjected to IAH of up to 20 mm Hg and in the other study group to 25 mm Hg, for 3 hours. At the end of the study, blood samples were collected for biochemical analysis and pancreatic tissue samples for histopathologic examination. Results: The results showed that glucagon levels were increased in the study groups (p < 0.001) and insulin levels were decreased (p < 0.001). There were no differences between the control and sham control groups. Histopathologic examination showed inflammatory cell infiltration in exocrine pancreatic tissue and vascular congestion in the islets of Langerhans. Conclusion: IAH causes an increase in glucagon levels and a decrease in insulin levels. These changes may be due to both the direct effects of IAH and the indirect effects of other organs that are affected by IAH.
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    The effects of roflumilast on the pancreas and remote organs in a cerulein-induced experimental acute pancreatitis model in rats
    (Springer, 2016) Uslukaya, Omer; Turkoglu, Ahmet; Yazgan, Umit Can; Kaplan, Ibrahim; Ibiloglu, Ibrahim; Kapan, Murat; Gumus, Metehan
    Systemic damage in acute pancreatitis (AP) can be characterized by oxidative stress and the release of pro-inflammatory cytokines. Roflumilast has been shown to be a potent anti-inflammatory and antioxidant agent. In the present study, we aimed to investigate the effect of roflumilast in cerulein-induced AP. Thirty-two male rats were divided into four groups: group 1 (sham), group 2 (Roflumilast), group 3 (AP), and group 4 (AP + Roflumilast). AP was induced by injecting 4 x 75 mu g/kg of body weight at an interval of 1 h. Rats were killed after 12 h following the last cerulein administration. AP was confirmed by measuring the serum amylase level and inflammatory features. Morphological changes were observed in the pancreas. Amylase levels were higher in the AP and AP + Roflumilast groups than the sham and Roflumilast groups. The serum levels of TNF-alpha, IL-1 beta, and IL-6 increased in the AP group, whereas they decreased in the Roflumilast group. The total oxidant activity (TOA) was higher and the total antioxidant capacity (TAC) was lower in the AP group. The administration of roflumilast decreased the TOA and increased the TAC in comparison with the AP group (p < 0.05 for both). Roflumilast significantly decreases oxidative stress and inflammatory mediators in the plasma, pancreas, and lung in cerulein-induced AP rats.
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    Ellagic acid ameliorates lung injury after intestinal ischemia-reperfusion
    (Wolters Kluwer Medknow Publications, 2011) Boyuk, Abdullah; Onder, Akin; Kapan, Murat; Gumus, Metehan; Firat, Ugur; Basarali, Mustafa Kemal; Alp, Harun
    Background: The aim of this study was to investigate the possible protective role of antioxidant treatment with ellagic acid (EA) on lung injury after intestinal ischemia-reperfusion (I/R) injury using biochemical and histopatological approaches. Materials and Methods: Forty rats were divided into four groups as control, control + EA, I/R, and I/R + EA. The control and control + EA groups were also anesthetized and subjected to laparotomy, but without clamp application. The control + EA and I/R + EA groups were given EA (85 mg/kg) orally prior to experiment. The I/R and I/R + EA groups underwent 30 minutes of intestinal ischemia and 1 hour of reperfusion. In all groups, serum total antioxidant capacity (TAC) and malondialdehyde (MDA) levels were determined. TAC, total oxidative status (TOS), and oxidative stress index (OSI) in lung tissue were measured. Lung tissue histopathology was also evaluated by light microscopy. Results: TAC levels were higher in control, EA, and I/R + EA groups while TOS, OSI, and MDA levels were lower in these groups compared with I/R group. Serum MDA levels were significantly higher in I/R + EA group than that of control group. Lung tissue TAC levels were lower in I/R + EA group while OSI values were higher in that groups compared with EA group. Histological tissue damage was milder in the EA treatment group than in the I/R group. Conclusion: These results suggest that EA treatment protected the rats lung tissue against intestinal I/R injury.
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    Factors affecting morbidity in penetrating rectal injuries: a civilian experience
    (Turkish Assoc Trauma Emergency Surgery, 2011) Gumus, Metehan; Kapan, Murat; Onder, Akin; Boyuk, Abdullah; Girgin, Sadullah; Tacyildiz, Ibrahim
    BACKGROUND The principles of the treatment of rectal injuries have been determined based on the experiences gained from military injuries. While adopting these principles in civilian life, it is essential to know the characteristics of civilian rectal injuries as well as the risk factors affecting morbidity. METHODS The characteristics of 29 inpatients who had been treated due to rectal injuries caused by gunshot wounds and penetrating devices were evaluated. In order to determine the risk factors, the patients were divided into two groups regarding the presence of morbidity (Group 1, with morbidity; Group 2, without morbidity) and compared. RESULTS Severe fecal contamination, perianal or gluteal injuries, duration of trauma- treatment interval, and isolated extraperitoneal injury were significant factors that affected the development of morbidity. The length of hospital stay was significantly longer in Group 1 as compared to Group 2. CONCLUSION Although rectal injuries are rarely encountered, they carry high morbidity and mortality. Awareness of the risk factors and planning of a patient-based treatment are essential for the success of the therapy. The rate of morbidity is substantially decreased when patients are treated in time. Thus, the awareness of both patients as well as physicians managing trauma about rectal injuries should be increased.
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    Factors affecting mortality in patients with splenic injuries
    (Edizioni Luigi Pozzi, 2018) Uslukaya, Omer; Bozdag, Zubeyir; Gumus, Metehan; Turkoglu, Ahmet; Boyuk, Abdullah; Yilmaz, Edip Erdal; Gunduz, Ercan
    AIM: Mortality in splenic injuries can create medico-legal problems. Though many studies exist regarding splenic injuries, there are not a sufficient number investigating the factors in splenic injuries influencing mortality. In this study, we aimed to investigate the factors affecting mortality in splenic injuries. MATERIALS AND METHODS: All 237 patients with splenic injury between 2005 to 2014 were retrospectively analyzed. The patients were divided into two groups, survivors and non-survivors. Age, gender, mechanism of injury, grade of splenic injury, pulse, respiratory rate, systolic blood pressure, hemoglobin levels, number of transfusions, surgical procedure, ISS, RTS and hospitalization period were recorded. Univariate and multivariate analysis were used to compare survivors and non-survivors. RESULTS: The average age of the patients was 32 and most (82.7%) were male. Mortality was observed in 18 patients (7.6%). Mortality was found significantly lower in patients who had isolated splenic injury (p=0.048). In univariate analyses, decreased RTS (p<0.001), increased number of blood transfusion (p<0.001), decreased hemoglobin level (p=0, 025) and increased ISS (p<0.001) were found significant in non-survivors. In multivariate analysis; number of transfusions, ISS and RTS were found as independent risk factors for mortality. CONCLUSIONS: We found high number of transfusions, high ISS and low RTS as independent risk factors for mortality in patients with splenic injury.
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    Factors Affecting the Postsurgical Length of Hospital Stay in Patients with Breast Cancer
    (Aves, 2015) Gumus, Metehan; Satici, Omer; Ulger, Burak Veli; Oguz, Abdullah; Taskesen, Fatih; Girgin, Sadullah
    Objective: Breast cancer is the most common malignancy and the most common cause of mortality in women worldwide. In addition to the increasing incidence of breast cancer, the length of hospital stay (LOS) after breast cancer surgery has been decreasing. Because LOS is key in determining hospital usage, the decrease in the use of hospital facilities may have implications on healthcare planning. The purpose of this study was to evaluate the factors affecting postoperative LOS in patients with breast cancer. Materials and Methods: Seventy-six in patients with breast cancer, who had been treated between July 2013 and December 2014 in the General Surgery Clinic of Dicle University, were included in the study. The demographic characteristics of the patients, treatment methods, histopathological features of the tumor, concomitant diseases, whether they underwent neoadjuvant chemotherapy or not, and the length of drain remaining time were retrospectively recorded. Results: There was a correlation between drain remaining time, totally removed lymph node, the number of metastatic lymph node, and LOS. LOS of patients treated with neoadjuvant chemotherapy was longer. The patients who underwent breast-conserving surgery had a shorter LOS. Linear regression analysis revealed that the drain remaining time and the number of metastatic lymph nodes were independent risk factors for LOS. Conclusion: Consideration should be given to cancer screening to diagnose the patients before lymph node metastasis occurs. In addition, drains should be avoided unless required and, if used, they should be removed as early as possible for shortening LOS.
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    Factors that Affect Drain Indwelling Time after Breast Cancer Surgery
    (Aves, 2016) Uslukaya, Omer; Turkoglu, Ahmet; Gumus, Metehan; Bozdag, Zubeyir; Yilmaz, Ahmet; Gumus, Hatice; Kaya, Seyhmus
    Objective: The most common procedure to prevent seroma formation, a common complication after breast and axillary surgery, is to use prophylactic surgical drains. Ongoing discussions continue regarding the ideal time for removing drains after surgical procedures. In this study, we aimed to investigate factors that affect drain indwelling time (DIT). Materials and Methods: From 2014 to 2015, a total of 91 consecutive patients with breast cancer were included in the study. The demographic characteristics of the patients, treatment methods, histopathologic features of the tumor, size of removed breast tissue (BS), tumor size (TS), number of totally removed lymph nodes (TLN), and metastatic lymph nodes (MLN), whether they had neoadjuvant chemotherapy, and the DIT were retrospectively recorded from the hospital database. Results: The mean age of the patients was 48.9 years, and the mean DIT was 4.8 days. The mean size of breast removed was 17.3 cm and tumor size was 4.7 cm, and the mean number of metastatic lymph nodes was 3.3, and mean total number of lymph nodes was 14.1. Patients who had neoadjuvant chemotherahpy had longer DIT. There was a positive correlation between the BS, TS, TLN, MLN, length of hospital stay, and DIT. Linear regresion analysis revealed that the BS, TLN, and history of neoadjuvant chemotherahpy were independent risk factors for DIT. Conclusion: DIT primarily depends on BS, TLN, and history of neoadjuvant chemotherahpy. A policy for the management of removing drains to prevent seroma formation should thus be individualized.
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    Factors that impact the upgrading of atypical ductal hyperplasia
    (Aves, 2013) Gumus, Hatice; Mills, Philippa; Gumus, Metehan; Fish, David; Jones, Sue; Jones, Peter; Devalia, Haresh
    PURPOSE The purpose of this study was to identify the factors that may have an impact on upgrading atypical ductal hyperplasia (ADH) lesions to malignancy. MATERIALS AND METHODS Between February 1999 and December 2010, the records of 150 ADH lesions that had been biopsied were retrospectively reviewed. The biopsy types included 11-gauge stereotactic vacuum-assisted biopsy (SVAB) (n=102) and ultrasonography (US)-guided 14-gauge automated biopsy (n=48). The patients were divided into two groups: those who had cancer in the final pathology and those who did not. Variables associated with underestimation of ADH lesions were compared between the groups. RESULTS The underestimation rates according to the biopsy types were 41.7% (20/48) for the US-guided 14-gauge automated biopsy and 20.6% (21/102) for the 11-gauge SVAB (P = 0.007). The rate of underestimation was significantly higher in lesions greater than 7 mm than it was in smaller lesions, with both US-guided 14-gauge automated biopsy and 11-gauge SVAB (P = 0.024 and P = 0.042, respectively). The rate of underestimation was significantly higher with the 11-gauge SVAB (P = 0.025) in lesions that were suspicious (R4) and highly suggestive of malignancy (R5) than in those that were probably benign (R3). CONCLUSION The underestimation rate in ADH lesions was significantly higher with US-guided 14-gauge automated biopsy compared to the 11-gauge SVAB. The underestimation rate was also significantly higher in lesions greater than 7 mm regardless of the biopsy type, and in lesions biopsied using SVAB that were regarded as suspicious (R4) or highly suggestive of malignancy (R5) on imaging.