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Öğe Conventional Tools for Predicting Satisfactory Response to Neoadjuvant Chemotherapy in HR+/HER2-Breast Cancer Patients(Karger, 2023) Oprea, Adela Luciana; Gulluoglu, Bahadir; Aytin, Yusuf Emre; Eren, Ozgur Can; Aral, Canan; Szekely, Tiberiu-Bogdan; Tastekin, EbruAim: The aim of the study was to assess the role of Magee Equation 3 (MagEq3), IHC4 score, and HER2-low status in predicting satisfactory response (SR) to neoadjuvant chemotherapy (NAC) in HR+/HER2- breast cancer (BC) patients. Methods: In a retrospective study, female patients of any age with T1-4, N0-2, M-0 HR+/HER2- BC who received NAC and underwent adequate locoregional surgical treatment were included. Patients were grouped according to 2 outcomes: (a) overall response to NAC in breast and axilla by using residual cancer burden (RCB) criteria and (b) axillary downstaging after NAC by using N staging. 2 cohorts for overall response were overall SR (RCB 0-1) and no SR (RCB 2-3). On the other hand, for axillary downstaging, 2 cohorts constituted from axillary SR (ypN(0) and ypN(0i+)) and no SR (ypN(mic-N3)). MagEq3 and IHC4 scores were calculated from their pathological tumor slides in each patient. HER2 status was categorized as either no or low. In addition, patient age, family history, tumor histology, stage at admission, and Ki-67 status were compared between cohorts according to predefined outcomes. Results: In a total of 230 BC patients, 228 patients were included to compare according to their RCB levels. The mean age of patients with overall SR was significantly lower than those without. Patients with high Ki-67 expression, high (>30) MagEq3 score, high ICH4 quartile, and HER2-low status had significantly more overall SR. On the other hand, only patients with high Ki-67 expression had significantly more axillary SR. MagEq3 score levels, ICH4 quartiles, and HER2 status were similar between patients with axillary SR and not. Conclusion: MagEq3 and IHC4 tools seemed to be useful to predict those HR+/HER2- BC patients who are most likely to get benefit from NAC. But, only high Ki-67 expression level significantly predicted satisfactory axillary downstaging in HR+/HER2- BC patients.Öğe Effects of the Covid-19 Pandemic on Patients with Fournier's Gangrene(Zamensalamati Publ Co, 2023) Turkyilmaz, Zeliha; Aytin, Yusuf EmreBackground: The first case of COVID-19 infection in Turkey was reported on March 11th, 2020, and declared a pandemic by the World Health Organization (WHO) in March 2020, introducing new regulations to national health systems. Some patients with non-COVID-19 presentations may have been adversely affected by this pandemic. Objectives: The present study aimed to investigate the effect of COVID-19 on patients with Fournier's gangrene during the pandemic and the impact of the COVID-19 pandemic on the clinical management and patient outcomes for Fournier's gangrene. Methods: This retrospective cross-sectional study was conducted between March 2018 and March 2022 at the General Surgery Department of Trakya University. Patients were stratified into pre-pandemic and pandemic groups based on the date of March 11th, 2020, when the first Covid-19 case was reported in Turkey. Data collection and retrospective analysis were completed for all patients who were operated on for Fournier's gangrene originating from the perianal region. Demographic characteristics, predisposing factors, as well as laboratory and clinical results of the patients treated during the pandemic, were compared with the patients treated before the pandemic. Results: A total of 43 patients were included in the study (pre-pandemic: 24, pandemic: 19). There was a statistically significant difference between the pre-pandemic and pandemic groups in terms of the median length of hospital stay (7 vs. 16 days, p<0.001) and the median number of debridement (4 vs. 2, p=0.002). Conclusion: In the presence of life-threatening surgical pathologies, such as Fournier's gangrene, the number of admissions did not decrease despite the pandemic. Precautions taken to reduce the risk of transmission in pandemic conditions and more aggressive surgical applications can reduce the number of debridement procedures and shorten the length of hospital stay. Subsequently, this is associated with similar treatment outcomes, lower morbidity, and reduced treatment costs.Öğe The evaluation of morbidity in gastrointestinal tumor patients underwent cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC)(Turkish Surgical Assoc, 2022) Aytin, Yusuf Emre; Cakcak, Ibrahim Ethem; Sagiroglu, TamerObjective: In this study, we aimed to determine the postoperative morbidity rate and identify demographic, clinical, and treatment-related variables that may be potential risk factors for morbidity in gastrointestinal tumor patients undergoing hyperthermic intraperitoneal chemotherapy (HIPEC) with or without cytoreductive surgery (CRS). Material and Methods: In this retrospective study, 60 patients who had undergone HIPEC due to gastrointestinal tumor between October 2017 and December 2019 were included. Systemic toxicities were graded and evaluated according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 3.0 criteria. Results: Mean age of the patients was 60.43 +/- 12.83. Primary tumor localization was the stomach in 33 patients (55%), colon in 21 (35%), rectum in five (8.3%), and appendix in one patient (1.7%). PCI mean value was 9.51 +/- 10.92. CC-0 was applied in 37 (61.7%) patients, CC-1 in 11 (18.3%), CC-2 in 6 (10%), and CC-3 in six patients (10%). Morbidity was observed in 50 (83.33%) of the 60 patients participating in the study according to NCI-CTCAE v3.0 classification. Mild morbidity rate was 46.6%, severe morbidity rate was 36.6%, and mortality rate was 11.66%. Enteric diversion application, length of stay in the ICU, and length of hospital stay were shown to have a statistically significant effect on the NCI-CTCAE morbidity score (p= 0.046, p= 0.004, p< 0.001). Conclusion: With proven beneficial effects on survival in patients with locally advanced gastrointestinal tumors, CRC and HIPEC are acceptable in these patients despite their increased morbidity and mortality rate. With new studies on this subject, morbidity and mortality rates may be reduced.Öğe An experimental study: the effect of S. boulardii on abemaciclib-induced diarrhea(Tubitak Scientific & Technological Research Council Turkey, 2023) Cakcak, Ibrahim Ethem; Aytin, Yusuf Emre; Sayin, Sezin; Kucukarda, Ahmet; Gokyer, Ali; Gokmen, Ivo; Ozcan, ErkanBackground/aim: In our study, we aimed to investigate the protective effects of Saccharomyces boulardii on abemaciclib-induced diarrhea model, which is a commonly used drug in breast cancer. Materials and methods: Thirty rats were divided into 3 groups as control (Group 1), abemaciclib (Group 2), and abemaciclib + Saccharomyces boulardii (Group 3) groups. The clinical status, body weight, and defecation status were monitored daily. At the end of the 15-day experiment period, the rats were killed with high-dose anesthesia and the resected small intestine segments were evaluated histopathologically. Lesions were classified according to thickening of the villus, inflammation and edema of mucosa and intraepithelial leukocyte accumulation. Then, mean values of both crypt depths and villi thicknesses were calculated for each rat. Normal distribution assumption was controlled with the Shapiro-Wilk test. One-way analysis of variance for normally distributed variables in the comparisons of more than two independent groups and Kruskal-Wallis test for nonnormally distributed variables were used. The significance value was accepted as 0.05. Results: There was one death in Group 3, but none in the others. There were no findings of mucositis in Group I. There was mild diarrhea and weight loss in only one rat in Group 1. For the comparison of the severity of diarrhea (72.5%/39%) and weight loss (72.5%/45%), a decrease was found in Group 3 according to Group 2 (p < 0.01). Histopathological findings such as edema, inflammation, and intraepithelial leukocyte accumulation also showed a decrease in Group 3 compared to Group 2 (p < 0.01). Conclusion: Saccharomyces boulardii should be considered as a treatment option in abaemaciclib (chemotherapy)-induced diarrhea. Further comparative studies and in vivo human randomized controlled studies can be conducted in the future.Öğe Inflammatory markers in the prognosis of gastric cancer(2022) Cakcak, İbrahim Ethem; Aytin, Yusuf Emre; Koçyiğit, Beliz; Kayabaş, Merve Yaren; Cansız, Sıla NurWe aimed to investigate whether these parameters can determine the prognosis of gastric cancer. In our study, patients who applied to Trakya University School of Medicine, Department of General Surgery for surgical treatment with a diagnosis of gastric cancer between January 2015 and March 2021 were evaluated, retrospectively. In this study, we have 219 consecutive gastric cancer patients who applied for surgical treatment between January 2015 and March 2021. There are 156 (71.2%) male patients and 63 (28.7%) female patients. The mean age is 65.6±11.2. 158 (72%) of our patients were over the age of 60. When each TNM stage was compared with each other, a statistically significant difference was found in the NLR, PLR, PNI, SIRI, and SII parameters. There was a statistically significant difference between the GPS when we compare the early stage and the advanced stage cancer. In our study, we showed that high SIRI, SII, NLR, PLR, and GPS as inflammatory and nutritional markers and low PNI value may be negative predictive factors for prognosis in gastric cancer patients.Öğe Kliniğimizde intraoperatif sıcak kemoterapi uygulanmış gastrointestinal tümör hastalarında morbidite değerlendirilmesi(Trakya Üniversitesi, 2019) Aytin, Yusuf Emre; Sağıroğlu, TamerÇalışmamızın amacı sitoredüktif cerrahi uygulanan ve sonrasında intraoperatif sıcak kemoterapi işlemi yapılan, lokal ileri evre veya peritonel yayılım gösteren gastrointestinal tümör hastalarında postoperatif morbidite oranımızı belirlemek ve morbidite için potansiyel risk faktörü olabilecek demografik, klinik ve tedaviyle ilgili değişkenleri ortaya koymaktır. 2017 Ekim ve 2019 Aralık ayları arasında kliniğimizde gastrointestinal tümöre bağlı opere edilmiş ve intraoperatif sıcak kemoterapi uygulanmış 60 hasta çalışmaya dahil edilmiştir. Hastalara ait veriler retrospektif olarak, arşivlenmiş hasta dosyalarından ve hasta kayıt programından toplanmıştır. Morbidite düzeylerini belirlemek üzere sitoredüktif cerrahi ve intraoperatif sıcak kemoterapi işlemi sonrası morbidite değerlendirmesinde kabul görmüş, Ulusal Kanser Enstitüsünün Advers Olaylar için Ortak Terminoloji Kriterleri v3.0 sınıflama sistemi üzerinden morbidite skorlamaları yapılmıştır. Skorlar ve sınıflamadan elde edilen ağırlık grupları ile yaş, cinsiyet, primer tümör odağı, peritoneal karsinomatöz indeksi, sitoredüksiyon tamamlanma düzeyi, neoadjuvan tedavi almış olması, operasyon esnasında splenektomi veya enterik diversiyon yapılmış olması, komorbid hastalık varlığı, operasyon süresi, yoğun bakım ünitesi yatış süresi ve hastane yatış süreleri karşılaştırılmıştır. Hastaların 22 tanesinde postoperatif ağır morbidite izlenmiş olup, ağır morbidite oranımız %36.6 olarak hesaplanmıştır. İşlem sonrası mortalite oranımız %11,6'dır. Yaş, cinsiyet, primer tümör odağı, peritoneal karsinomatöz indeksi, sitoredüksiyon tamamlanma düzeyi, neoadjuvan tedavi durumu, operasyon esnasında splenektomi yapılması,komorbidite varlığı ile morbidite veya morbidite ağırlığı arasında anlamlı fark bulunmamıştır. Peroperatif enterik diversiyon açılan hastalarda morbidite oranının daha yüksek olduğu gösterilmiş olup (p:0.003), mümkünse bu işlemden kaçınılması önerilmektedir. Bu sonuçlar doğrultusunda mevcut prosedürün morbidite oranının konservatif cerrahi tekniklere göre yüksek olduğu; ancak uygulanan cerrahinin büyüklüğü ve kemoteröpatik sitotoksik etki de göz önüne alınınca bu oranın kabul edilebilir olduğu kanaatindeyiz. Bu konu ile ilgili farklı klinik deneyimlerin sunulması, operasyon sonrası görülebilecek beklenmeyen olaylarla ilişkili faktörlerin belirlenmesinde ve komplikasyonların daha iyi yönetilerek morbidite oranlarının azaltılmasında etkili olacaktırÖğe A rare cause of mechanical intestinal obstruction due to small bowel intussusception: A solitary Peutz-Jeghers type hamartomatous polyp(Turkish Assoc Trauma Emergency Surgery, 2022) Aytin, Yusuf Emre; Turkyilmaz, ZelihaPeutz-Jeghers Syndrome (PJS) is a rare autosomal dominant disorder which is characterized by hyperpigmentation in mucocutaneous membranes and hamartomatous polyps in the gastrointestinal tract (GIT). Common complications reported in patients with PSJ are bleeding and mechanical intestinal obstruction due to the hamartomatous polyps. There is also an increased risk of gastrointestinal and extra-intestinal malignancies in patients with PJS. A 28-year-old female patient was admitted to the emergency service with complaints of abdominal pain and vomiting. In addition to distention and tenderness on abdominal examination, revealed hyperpigmented lesions on her lips. An abdominal examination did not reveal any scar from the previous abdominal operation. The patient with suspected mechanical intestinal obstruction at pre-diagnosis demonstrated intussusception in the distal jejunal loops on abdominal tomography. In the diagnostic laparoscopy observed intussusception in jejunal loops. After a minimal suprapubic incision, small intestine loops were checked through alexis with bidigital palpation and no other intraluminal mass were detected. Laparoscopy-assisted jejunojejunal resection and anastomosis was performed for the intussusception segment, where the polyb is located. It has been recommended that endoscopic polyps removal should be performed to avoid multiple surgical resections, which lead to short bowel syndrome. It has been recommended that endoscopic polyps removal should be performed to avoid multiple surgical resections, which lead to short bowel syndrome. By the nature of the disease, there may be multiple polyps simultaneously in the GIT and the associated risk of recurrent intussusception attacks in patients with PJS. To prevent short bowel syndrome and intra-abdominal adhesions due to repeated, laparotomies treatment with combined endoscopy and laparoscopic/laparoscopy-assisted surgery should be preferred in patients with PJS.Öğe What has changed? The impact of the COVID-19 pandemic on the management of acute biliary pancreatitis(Turkish Assoc Trauma Emergency Surgery, 2023) Turkyilmaz, Zeliha; Demirel, Tugrul; Cakcak, Ibrahim Ethem; Aytin, Yusuf EmreBACKGROUND: The COVID-19 pandemic thoroughly changed the daily practices of medicine. We retrospectively evaluated the impact of the COVID-19 pandemic on our management strategies for patients with acute biliary pancreatitis (ABP).METHODS: A total of 91 patients with ABP who were treated at Trakya University Faculty of Medicine between March 15, 2019 and March 15, 2021 were retrospectively recruited. Patients were classified as pre-COVID and COVID-era patients. The comorbidity markers, data from laboratory tests, inflammatory markers, and radiological examinations were evaluated. Length of stay, need for an intensive care unit, morbidity, mortality, recurrent ABP, and definitive treatment rates were evaluated, and the data of the two periods were compared.RESULTS: Two groups of patients, 57 in the pre-COVID period and 34 in the COVID period, were included in the study. We found that ABP admissions decreased significantly during periods of increased national COVID-19 diagnoses. Type 2 diabetes mellitus was significantly higher in the COVID period patients (P=0.044), and COVID patients had significantly higher total (P=0.004), direct bilirubin (P=0.007), and lipases (P<0.001). The cholecystectomy rate after an attack decreased from 26% in the pre-COVID period toCONCLUSION: COVID strikingly reduced the admissions of ABP patients in the early stages of the disease to hospitals, leading to inevitable admissions in advanced severity. Moreover, a significant increase was detected in the recurrence rates of ABP. This can be explained by the reduction in cholecystectomy performed.
