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Demirkol M.O.,Koç University | Demirkol M.O.,VKF American Hospital | Acar O.,Koç University | Ucar B.,VKF American Hospital | And 4 more authors.
Prostate | Year: 2015

Background There is an ongoing need for an accurate imaging modality which can be used for staging purposes, metastatic evaluation, predicting biologic aggresiveness and investigating recurrent disease in prostate cancer. Prostate specific membrane antigen, given its favorable molecular characteristics, holds a promise as an ideal target for prostate cancer-specific nuclear imaging. In this study, we evaluated our initial Results of PSMA based PET/CT imaging in prostate cancer. Methods A total of 22 patients with a median age and serum PSA level of 68 years and 4.15 ng/ml, respectively underwent Ga-68 PSMA PET/CT in our hospital between Februrary and August 2014. Their charts were retrospectively reviewed in order to document the clinical characteristics, the indications for and the Results of PSMA based imaging and the impact of Ga-68 PSMA PET/CT findings on disease management. Results The most common indications were rising PSA after local ± adjuvant treatment followed by staging and metastatic evaluation before definitive or salvage treatment. All except 2 patients had prostatic ± extraprostatic PSMA positive lesions. For those who had a positive result; treatment strategies were tailored accordingly. Above the PSA level of 2 ng/ml, none of the PSMA based nuclear imaging studies revealed negative Results. Conclusions PSMA based nuclear imaging has significantly impacted our way of handling patients with prostate cancer. Its preliminary performance in different clinical scenarios and ability to detect lesions even in low PSA values seems fairly promising and deserves to be supplemented with further clinical studies. © 2015 Wiley Periodicals, Inc.


PubMed | Acibadem University, VKF American Hospital, Koç University and Bogazici University
Type: | Journal: SpringerPlus | Year: 2015

[This corrects the article DOI: 10.1186/s40064-015-1274-2.].


PubMed | Acibadem University, VKF American Hospital, Koç University and Bogazici University
Type: | Journal: SpringerPlus | Year: 2015

In this study we aimed to report a comparative analysis between open and robotic nephron sparing surgeries (NSS) from a single institutional database.Patients who have undergone NSS during the robotic era of our institution were included in this study. Open (n=74) and robotic (n=59) groups were compared regarding trifecta outcome. Trifecta was defined as; warm ischemia time (WIT) <25min, negative surgical margins and the absence of perioperative complications.A total of 57 (77%) and 45 (76%) patients in the open and robotic groups, respectively achieved the trifecta outcome. Overall trifecta rate was 77% (n=102/133). The only statistically significant difference between trifecta positive and trifecta negative patients was the length of hospitalization (LOH). Except LOH; none of the tested parameters were shown to be predictive oftrifectaoutcome on univariate and multivariate analyses. Concerning trifecta positive patients; those in the open surgery group had larger tumors with a higher degree of morphometric complexity and were hospitalized for a longer period of time. Additionally, operative duration was significantly higher in the robotic group.In our cohort, no significant difference in achieving the trifecta outcome was reported after open and robotic NSS. Length of hospitalization was the only parameter that differed significantly between trifecta positive and trifecta negative patients. Surgical approach was not a significant predictor of simultaneous achievement of trifecta outcomes. Irrespective of the trifecta definition; larger and more complicated tumors were handled via open NSS.


PubMed | VKF American Hospital, Koç University and Acibadem University
Type: | Journal: International journal of surgery case reports | Year: 2016

Metachronous metastatic spread of clinically localized renal cell carcinoma (RCC) affects almost 1/3 of the patients. They occur most frequently in lung, liver, bone and brain. Isolated omental metastasis of RCC has not been reported so far.A 62-year-old patient previously diagnosed and treated due to pulmonary sarcoidosis has developed an omental metastatic lesion 13 years after having undergone open extraperitoneal partial nephrectomy for T1 clear-cell RCC. Constitutional symptoms and imaging findings that were attributed to the presence of a sarcomatoid paraneoplastic syndrome triggered by the development this metastatic focus complicated the diagnostic work-up. Biopsy of the [18F]-fluorodeoxyglucose (+) lesions confirmed the diagnosis of metastatic RCC and the patient was managed by the resection of the omental mass via near-total omentectomy followed by targeted therapy with a tyrosine kinase inhibitor.Late recurrence of RCC has been reported to occur in 10-20% of the patients within 20 years. Therefore lifelong follow up of RCC has been advocated by some authors. Diffuse peritoneal metastases have been reported in certain RCC subtypes with adverse histopathological features. However, isolated omental metastasis without any sign of peritoneal involvement is an extremely rare condition.To our knowledge, this is the first reported case of metachronously developed, isolated omental metastasis of an initially T1 clear-cell RCC. Constitutional symptoms, despite a long interval since nephrectomy, should raise the possibility of a paraneoplastic syndrome being associated with metastatic RCC. Morphological and molecular imaging studies together with histopathological documentation will be diagnostic.


Eroglu E.,VKF American Hospital | Yip M.,Flinders Medical Center | Oktar T.,Istanbul University | Kayiran S.M.,VKF American Hospital | Mocan H.,HM Pediatrics Clinic
Journal of Pediatric and Adolescent Gynecology | Year: 2011

Labial adhesion is a common finding in prepubertal girls. Traditionally, topical estrogen cream application has been the choice of conservative treatment, however, topical betamethasone treatment has also recently been employed with some success. In this retrospective study, we analysed 131 children with labial adhesions. Eleven of 71 (15.4%) patients were treated successfully with topical estrogen cream only, and 5 of 32 (15.6%) patients were treated successfully with betamethasone cream only. We successfully treated 5 of 28 (28.5%) patients with a combination of estrogen and betamethasone creams. The mean time of treatment for each regimen of therapy was 4 weeks. There was no significance between the single-therapy estrogen and single-therapy betamethasone groups (P = 1.00), between single-therapy estrogen and the combination therapy (P = .16), and the single therapy betamethasone to combination therapy (P = .35) groups. There was also no significant difference between combination estrogen and betamethasone therapy and the combined data of the single therapies (relative risk 1.85; 95% confidence interval 0.89-3.89; P =.11). For the treatment of prepubertal labial adhesions, topical estrogen and betamethasone creams were found to have similar success rates, with limited satisfactory results. The combination therapy was mildly more efficacious than each of the single therapies but was not found to be statistically significant. Surgical separation is recommended if conservative treatment fails. © 2011 North American Society for Pediatric and Adolescent Gynecology.


Ozsoy M.,Medical University of Vienna | Acar O.,VKF American Hospital | Sarica K.,Dr Lutfi Kirdar Kartal Research And Training Hospital | Saratlija-Novakovic Z.,KBC Advanced Technologies | And 5 more authors.
World Journal of Urology | Year: 2015

Purpose: To investigate the impact of gender differences on treatment success, intraoperative and postoperative complications in patients undergoing ureteroscopy (URS). Materials and methods: A prospectively maintained database of 927 consecutively performed ureteroscopies on solitary ureteral stones in four different centers was retrospectively analyzed. Stones were detected with preoperative computed tomography scans or intravenous urography imaging. Patients received intravenous antibiotics as perioperative prophylaxis. Patients with symptomatic urinary tract infections (UTI) prior to surgery were excluded. Follow-up was up to 2 weeks after URS or stent removal. Results: Two hundred and eighty-six women and 641 men were included in this study. Mean stone size was 9 mm (range 2–35 mm). A double-J stent was placed in 240 (83 %) women and 527 (82 %) men at the end of surgery (p = 0.075). There was no significant gender difference in terms of stent dislocation (p = 0.239). Two hundred and fifty-one women (87 %) and 564 men (87 %) were stone-free after the first procedure (p = 0.917). Intraoperative complications were observed in 14 (4.8 %) women and 37 (5.9 %) men (p = 0.313). Severe UTI presenting with fever (>38 °C) and requiring prolonged hospitalization with parenteral antibiotics were observed in 11 (3 %) women and 8 (1 %) men postoperatively. This difference was statistically significant (p = 0.025). Conclusion: No significant differences between female and male patients harboring ureteral stones with respect to intraoperative complications were detected. Although stone characteristics were comparable between groups, a small number of women had significantly more severe UTI’s postoperatively. Our current therapy regimen for URS seems to be efficient and safe both for females and males. © 2014, Springer-Verlag Berlin Heidelberg.


Sasani M.,VKF American Hospital | Sasani H.,Istanbul University | Ozer A.F.,VKF American Hospital
Journal of Spinal Cord Medicine | Year: 2010

Background/Objective: Cerebellar hemorrhage is a very infrequent and unpredictable complication of spinal surgery. To the best of our knowledge, cerebellar hemorrhage resulting from the insertion of a lumbo-peritoneal shunt through which cerebrospinal fluid (CSF) is slowly drained has not been documented to date. Methods: Case report. Results: A 47-year-old woman presented with lower extremity weakness. Spinal arteriovenous malformation was diagnosed, and she underwent surgery. Her neurologic status improved; however, CSF collected subcutaneously as a cyst and leaked 21 days after surgery. The patient underwent urgent surgery during which the dural defect was repaired and a lumbo-peritoneal catheter was put in place to treat the CSF leakage. The lumbo-peritoneal drainage system was removed when bilateral cerebellar hemorrhage was seen 12 days later. Physical therapy was stopped, and conservative treatment was initiated consisting of bed rest, analgesics, sedatives, and careful monitoring of blood pressure. The patient's headache gradually resolved; physical therapy was restarted to rehabilitate this patient with paraparesis. Conclusions: Remote cerebellar hemorrhage seems to be life threatening and entails significant morbidity. Cerebellar symptoms, and even a late sudden headache after spinal surgery, may be signs of remote cerebellar hemorrhage, which is a rare complication. © 2010 by the American Paraplegia Society.


Acar O.,VKF American Hospital | Esen T.,VKF American Hospital | Esen T.,Koç University | Lack N.A.,VKF American Hospital
The Scientific World Journal | Year: 2013

The effective treatment of castrate-resistant prostate cancer (CRPC) has proven to be very challenging. Until recently, docetaxel was the only therapeutic demonstrated to extend overall patient survival. Yet recently, a considerable number of new therapeutics have been approved to treat CRPC patients. These remarkable advances now give new tools for the therapeutic management of late-stage prostate cancer. In this review, we will examine mechanistic and clinical data of several newly approved therapeutics including the chemotherapeutic cabazitaxel, antiandrogen enzalutamide, endocrine disruptor abiraterone acetate, immunotherapy sipuleucel-T, and bone-targeting radiopharmaceutical alpharadin. In addition, we will examine other promising therapeutics that are currently in Phase III trials. © 2013 Ömer Acar et al.


Tefekli A.,Bahcesehir University | Cezayirli F.,VKF American Hospital
The Scientific World Journal | Year: 2013

The roots of modern science and history of urinary stone disease go back to the Ancient Egyptians and Mesopotamia. Hippocrates defined the symptoms of bladder stones. The first recorded details of "perineal lithotomy" were those of Cornelius Celsus. Ancient Arabic medicine was based mainly on classical Greco-Roman works. Interestingly, the Fourth Lateran Council in 1215 forbade physicians from performing surgical procedures, as contact with blood or body fluids was viewed as contaminating to men. With Renaissance new procedures could be tried on criminals. The first recorded suprapubic lithotomy was carried out by Pierre Franco in 1561. In 1874, Bigelow developed a lithotrite, which was introduced into the bladder under anaesthesia (called as "litholopaxy"). Young was the first to report ureteroscopy (1929). With advances in intracorporeal lithotripsy techniques, ureteroscopy became the treatment of choice for ureteric stones. In 1976, Fernstrom and Johannson established percutaneous access to remove a renal stone. However, with the introduction of the first extracorporeal shock wave machine in 1980, a dramatic change in stone management was observed. Civilization in parallel with scientific developments has brought us to a point where we try not to "cut" our patients for stone disease, as Hippocrates admonishes, but rather manage them with minimal invasive alternatives. © 2013 Ahmet Tefekli and Fatin Cezayirli.


PubMed | VKF American Hospital and Koç University
Type: Journal Article | Journal: Neuromodulation : journal of the International Neuromodulation Society | Year: 2015

The purpose of this study was to determine the blood-flow-enhancing effect of electroacupuncture (EA) in an experimental rat model of testicular torsion.At the first stage, 3D color Doppler ultrasound (3D-CDUS) scans were made to detect baseline perfusion of each testicle in 12 male albino Wistar rats. Then, the left testicles of all rats were twisted 180 clockwise, and 3D-CDUS recordings were repeated. In the next step, 10-Hz EA was applied for 5min over the T13 and L4 dermatome territories in the study group of six rats. In the control group of six rats, acupuncture needles were inserted in the same manner, but EA was not applied. Baseline, posttorsion, and postintervention (EA and manual needling) 3D-CDUS perfusion recordings were interpreted as volumetric data, and group comparisons were performed.After EA, we observed statistically significant perfusion improvements in both the ipsilateral torsed and contralateral nontorsed testicles. In the control group, testicular perfusion did not show a significant change after manual needling.EA can improve testicular blood flow bilaterally in a rat model of unilateral testicular torsion at 180.

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