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Öğe Bilateral elastofibroma dorsi: proper positioning for an accurate diagnosis(Elsevier Science Bv, 2002) Kara, M.; Dikmen, E.; Kara, S.A.; Atasoy, P.Elastofibroma dorsi is a rare, slow-growing, ill-defined soft tissue tumor of the chest wall, most commonly located beneath the rhomboid major and latissimus dorsi muscles. It is usually unilateral, and bilateral involvement occurs in only 10% of patients. We report herein a case of a 56-year-old woman with bilateral elastofibroma dorsi. The patient was found to have bilateral involvement of the tumor following a physical examination with proper positioning. An elastofibroma should be considered in the differential diagnosis of tumors deeply located at the periscapular area. Meticulous physical examination may reveal a nonpalpable coexisting tumor with deep subscapular location and help the accurate diagnosis of bilateral elastofibroma dorsi, hence preventing a secondary operation. (C) 2002 Elsevier Science B.V. All rights reserved.Öğe Detection of telomerase activity in bronchial lavage as an adjunct to cytological diagnosis in lung cancer(Elsevier Science Bv, 2003) Dikmen, E.; Kara, M.; Dikmen, G.; Cakmak, H.; Dogan, P.Objective: Definitive diagnosis of lung cancer with conventional methods may sometimes be difficult in clinical practice. Telomerase is a ribonucleoprotein DNA polymerase that maintains the telomeric region of chromosomes during successive rounds of cell division. Telomerase activity in body cavity fluids has been advocated to be a potential diagnostic marker for malignancy. We investigated the diagnostic value of telomerase activity in bronchial lavage samples of patients undergoing diagnosis of lung cancer. Methods: A total of 29 bronchial lavage samples were collected from patients in whom the diagnosis was confirmed with cytological and/or histological examinations. Patients were classified as lung cancer patients (Group 1, n = 22) and patients with benign disease (Group 2, n = 7). Telomerase activity was determined with polymerase chain reaction-based TRAP (The telomeric repeat amplification protocol) assay. Results: Cytological examination was diagnostic in 12 (54.5%) of 22 patients in Group 1, and in all seven patients of Group 2 (P = 0.063). Telomerase activity was positive in 16 (72.7%) of Group I patients, while it was positive in only 1 (14.3%) sample of a lung abscess in Group 2 (P = 0.011). The sensitivity rate of cytological examination when combined with telomerase activity (81.8%) was significantly greater than that of cytological examination alone (54.5%) (P = 0.031). The sensitivity and specificity of telomerase activity were 72.7 and 85.7%, respectively. Telomerase activity had a positive predictive value as 0.94 and negative predictive value as 0.50. Diagnostic accuracy of telomerase activity was 75.8%. Conclusion: Telomerase activity in bronchial lavage is a highly sensitive diagnostic biomarker for malignancy and a potential complementary diagnostic technique to cytological examination in the diagnosis of lung cancer. (C) 2002 Elsevier Science B.V. All rights reserved.Öğe Diagnostic implications of telomerase activity in pleural effusions(European Respiratory Soc Journals Ltd, 2003) Dikmen, G.; Dikmen, E.; Kara, M.; Şahin, E.; Dogan, P.; Özdemir, N.The aim of the present study was to investigate the diagnostic efficacy of telomerase activity for discrimination of malignant and benign pleural effusions. Pleural effusions were collected from 109 consecutive patients in whom the diagnosis was confirmed with cytological and/or histological examinations. Cytological samples were classified as malignant (n=63) and benign (n=46). Telomerase activity was determined with the polymerase chain reaction-based telomeric repeat amplification protocol assay. Telomerase activity was detected in 52 (82.5%) and nine (19.6%) samples from the malignant and benign groups, respectively, which was a significant difference. The sensitivity rate of cytological examination when combined with telomerase activity (92.1%) was significantly greater than that of cytological examination alone (53.9%). The sensitivity and specificity of telomerase activity were 82.5 and 80.4%, respectively. Diagnostic accuracy of telomerase activity was 81.6%. Telomerase activity is a highly sensitive diagnostic biomarker for malignancy and may be used as an adjunct to cytological findings in determining malignant pleural effusions.Öğe Human hepatocyte growth factor levels in patients undergoing thoracic operations(European Respiratory Soc Journals Ltd, 2006) Dikmen, E.; Kara, M.; Kısa, Ü.; Atinkaya, C.; Han, S.; Sakinci, U.Human hepatocyte growth factor (hHGF) is the most potent mitogen identified for alveolar type II cells, and may have other important functions in the repair of the alveolar epithelium and compensatory lung growth. A study was conducted to evaluate the changes of serum hHGF levels in patients who underwent thoracic surgical procedures. The patients comprised 17 males and 14 females with a mean age of 47.1 +/- 13.5 yrs, who underwent either lung resection (LR group) or nonlung resection (norLR group) thoracic procedures. The changes of hHGF levels were analysed in the pre- and post-operative periods in both groups. The pre-operative hHGF levels did not differ between the LR and the nonLR groups, which were 333.2 +/- 72.9 pg center dot mL(-1) and 343.6 +/- 125.3 pg center dot mL(-1), respectively. The hHGF levels in the LR group significantly increased up to 433.6 +/- 128.1 pg center dot mL(-1) and 430.8 +/- 128.2 pg center dot mL(-1) in post-operative days 1 and 3, respectively. However, the same levels in the nonLR group appeared as 333.2 +/- 77.0 pg center dot mL(-1) and 311.9 +/- 73.0 pg center dot mL(-1), respectively. In conclusion, the increases of serum human hepatocyte growth factor levels following pulmonary resection may imply the important role of human hepatocyte growth factor in lung regeneration or compensatory lung growth in humans.Öğe Predictors of clinical outcome following extended thymectomy in myasthenia gravis(Elsevier Science Bv, 2003) Özdemir, N.; Kara, M.; Dikmen, E.; Nadir, A.; Akal, M.; Yucemen, N.; Yavuzer, S.Objective: Thymectomy remains as the optimal treatment of choice in patients with myasthenia gravis (MG), however, the selection criteria for surgery remains controversial. Methods: We examined the data charts of patients with MG underwent extended thymectomy. We investigated the possible correlations between the clinicopathologic features and clinical outcomes, and analyzed the data to clarify the effect of prognostic factors on clinical outcome. Results: A total of 61 patients with a mean age of 35.8 +/- 12.2 years (range, 13-66 years) were analyzed. The overall improvement/remission and clinical worsening rates were 81.9 and 18.1%, respectively. Ossermann stage (P = 0.011) and presence of mediastinal ectopic thymic tissue (P = 0.007) showed a significant correlation with the clinical outcome. Multivariate analysis confirmed Ossermann stage (P = 0.0158), and presence of mediastinal ectopic thymic tissue (P = 0.0100) as independent predictors on clinical outcome. Conclusion: Ossermann stage and the presence of mediastinal ectopic thymic tissue are potential predictors on clinical outcome in patients with MG undergoing extended thymectomy. (C) 2002 Elsevier Science B.V. All rights reserved.Öğe Prognostic implications of microscopic proximal bronchial extension in non-small cell lung cancer(Elsevier Science Inc, 2002) Kara, M.; Dikmen, E.; Kilic, D.; Sak, S.D.; Orhan, D.; Köse, S.K.; Kavukcu, S.Background. The loss of approximately one third of early stage lung cancer patients undergoing complete resection by the end of 5 years implies the existence of unknown or undetected factors at the time of operation. We investigated the possible correlation between microscopic proximal bronchial extension (MPBE) and survival with clinicopathologic features in patients with non-small cell lung cancer. Methods. The bronchial tree with the tumor was dissected and extracted from the lung parenchyma in a total of 62 surgical specimens with non-small cell lung cancer. The tumor-related bronchus was sectioned into serial blocks at a thickness of 5 mm in the transverse plane. Histologically, cut serial sections were examined for MPBE. Results. A total of 15 (24.2%) specimens showed MPBE, whereas 47 (75.8%) specimens showed no evidence of MPBE. The median survival time of MPBE-positive patients was 10.0 months, whereas that of MPBE-negative patients was 42.0 months. The 5-year survival rates of MPBE-positive and MPBE-negative groups were 13.3% and 35.8%, respectively, which was a significant difference (P = 0.0203). Multivariate analysis revealed lymph node status (p = 0.0161), histology (p = 0.0268), and MPBE-positivity (p = 0.0447) as independent prognostic factors. Conclusions. Microscopic proximal bronchial extension has an adverse effect on survival in non-small cell lung cancer.Öğe Routine chest CT screening in high risk cardiac transplant patients may improve survival(Elsevier Science Inc, 2005) Rosenbaum, D. H.; Bhojani, R. A.; Kaiser, P.; Dikmen, E.; Paul, M.; Yancy, C.; DiMaio, J. M.…Öğe Routine computed tomography screening of the chest in high-risk cardiac transplant recipients may improve survival(Elsevier Science Inc, 2005) Rosenbaum, D.H.; Bhojani, R.A.; Dikmen, E.; Kaiser, P. A.; Paul, M.C.; Wait, M.A.Background: Multiple studies have demonstrated an increased incidence of lung cancer in the heart transplant population. We reviewed our cardiac transplantation experience with respect to the development of bronchogenic carcinoma and explored the role of routine chest computed tomography (CT) in its surveillance. Methods: We performed a review of our cardiac transplantation experience, highlighting the incidence of lung cancer, and we analyzed our recent experience with screening chest CT in lung cancer surveillance in this patient group. Results: Eighteen patients developed 20 cases of bronchogenic carcinoma for an incidence of 6.83%. In 10 cases, the patients underwent surgical resection; however, in the remaining cases, the patients were either treated with chemotherapy and/or radiation or they died before initiation of therapy. The actuarial 1-, 2- and 5-year overall survival rates were 49%, 29% and 13%, respectively. The median survival of patients who underwent surgical resection was 28 months (3 to 85 months), whereas the median survival of patients who were either ineligible for surgery or died before initiation of treatment was only 1 month (1 to 13 months). All patients diagnosed with lung cancer by chest CT underwent surgical resection; however, only 37.5% of patients diagnosed with lung cancer by chest X-ray were found at,in appropriate stage for resection (p = 0.025). Conclusions: Cardiac transplant recipients have a significant risk of developing bronchogenic carcinoma. Routine chest CT screening in high-risk patients may enable clinicians to identify disease earlier, which is essential for the option of surgical resection and, therefore, prolonged survival.Öğe An uncommon soft tissue tumour of the chest wall: Dermatofibrosarcoma protuberans(Acta Medical Belgica, 2006) Kara, M.; Saray, A.; Dikmen, E.; Atasoy, P.Dermatofibrosarcoma protuberans is a slow-growing tumour with propensity for local recurrence. We report herein a case of a 36-year-old man, who presented with a huge, recurrent tumour arising from the left upper anterior part of his chest wall. We performed a wide excision with 4 cm free skin margins. Reconstruction was performed with a pedicled latissimus dorsi musculocutaneous flap and free split skin grafts. Histologic and immunohistochemical studies revealed the lesion to be dermatofibrosarcoma protuberans.Öğe W-Plasty Technique in Tracheal Reconstruction: A New Technique?(Karger, 2008) Han, S.; Han, U.; Atinkaya, C.; Cavusoglu, T.; Osmanoglu, G.; Dikmen, E.Background: Tracheal stenosis and dehiscence of anastomosis due to excessive tension are well-known problems after long-segment tracheal resections. The aim of this study was to evaluate the efficacy of the W-plasty technique to prevent these two complications. Methods: Animals were divided into a study and a control group. Each group consisted of 6 animals. In the control group, we performed a 5-cm tracheal segment resection, and then reconstruction was performed with an interrupted technique with 6/0 Prolene sutures. In the study group, we used the W-plasty technique with 6/0 Prolene interrupted sutures. The animals were sacrificed on the 30th day postoperatively and tracheal resection including the entire anastomosis site was performed. The traction and pullout test was applied to each specimen and all the specimens were analysed histopathologically. The intraluminal diameter and the thickness of the tracheal wall at the level of anastomoses were measured by using a micrometer. The pattern of the reaction and localization were recorded. Results: The traction and pullout test results were 131.6 +/- 4.3 g and 187.5 +/- 6.4 g in the control and the study group, respectively, which was a significant difference (p = 0.004). The intraluminal diameters were 3.3 +/- 1.2 mm and 4.3 +/- 0.9 mm in the control and study group, respectively (p = 0.134). In contrast to the control group, early inflammatory and late fibroblastic reactions were negative in the study group. Conclusion: Considering the outcomes of this study, we think that the W-plasty technique has much more advantages than the standard techniques in terms of anastomosis durability and development of stenosis. Copyright (C) 2008 S. Karger AG, Basel
