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Öğe Contemporary assessment of laryngotracheal trauma(Mosby-Elsevier, 2005) Bhojani, Rehal A.; Rosenbaum, David H.; Dikmen, Erkan; Paul, Michelle; Atkins, B. Zane; Zonies, David; DiMaio, J. MichaelObjectives: Laryngotracheal trauma is a rare and potentially deadly spectrum of injuries. We sought to characterize the contemporary mechanisms, diagnostic modalities, and outcomes common in laryngotracheal trauma today. Methods: We performed a retrospective analysis of all laryngotracheal trauma cases at 2 major metropolitan hospitals between 1996 and 2004, detailing mechanisms, associated injuries, diagnostic modalities, and outcomes of laryngotracheal trauma. Results: We identified 71 patients with a mean age of 32.8 +/- 13.3 years (range, 15-71 years). In our series penetrating trauma was the cause in 73.2% of patients; however, blunt trauma had a significantly higher mortality (63.2% vs 13.5%, respectively; P < .0001). Blunt mechanisms involved older patients (38.5 +/- 15.2 years vs 30.1 +/- 11.9 years, P = .017), and these patients were more likely to require emergency airways than those with penetrating trauma (78.9% vs 46.2%, P = .017). The requirement of an emergency airway was an independent predictor of mortality (P = .0066). Conclusion: Laryngotracheal trauma is a deadly spectrum of injuries with a mortality of 26.8%. Blunt mechanisms are decreasing in frequency. This might reflect improvements in automobile safety. Additionally, violent crime is on the increase, producing penetrating injuries with increasing frequency. The most fundamental intervention for patients with laryngotracheal injury is airway control. Either routine intubation or a tracheostomy can secure the airway. Blunt trauma and the requirement of an emergency airway are independent predictors of mortality. Laryngotracheal trauma requires prompt recognition, airway protection, and skillful management to lessen the mortality of this deadly spectrum of injuries.Öğe Contemporary techniques and safety of cardiovascular procedures in the surgical management of renal cell carcinoma with tumor thrombus(Mosby-Elsevier, 2006) Lubahn, Jordon G.; Sagalowsky, Arthur I.; Rosenbaum, David H.; Dikmen, Erkan; Bhojani, Rehal A.; Paul, Michelle C.; DiMaio, J. MichaelObjective: Renal cell carcinomas often form venous thrombi that extend into the vena cava. Frequently, cardiovascular consultation is necessary for complete surgical excision. We sought to investigate the risk factors, surgical techniques, and outcomes of patients treated for renal cell carcinoma with venous extension. Methods: We reviewed the records of 46 consecutive patients who underwent surgical management of renal cell carcinoma with venous extension between 1991 and 2005. Data on patient history, staging, surgical techniques, morbidity, and survival were analyzed. Results: There were 29 men and 17 women with a mean age of 60.2 +/- 12.0 years. Twenty-five (54%) procedures were completed with cardiovascular assistance. Nephrectomy was performed in 44 (96%) cases. Three (7%) patients underwent right heart venovenous bypass, and 2 (5%) patients underwent cardiopulmonary bypass with circulatory arrest. Fourteen (32%) patients had perioperative complications, including 1 (2%) perioperative death. Patients who required cardiovascular procedures ( inferior vena cava clamping, right heart venovenous bypass, and cardiopulmonary bypass with circulatory arrest) had higher risks of perioperative complications ( P <.02). The 1-, 2-, and 5-year overall survival rates were 78%, 69%, and 56%. Conclusions: This large series demonstrates that aggressive treatment of renal cell carcinoma with venous thrombus provides favorable outcomes. Our 5-year survival is among the highest of recent reviews, and our perioperative morbidity and mortality rates are comparable with those of other series. Tumors that require cardiovascular procedures are associated with increased complications when compared with radical nephrectomy and thrombectomy alone. Nevertheless, this aggressive treatment approach offers encouraging patient survival.Öğe Management of gastrostomy to prevent perforation in acute severe corrosive esophagitis and gastritis: An experimental study(Aves, 2011) Han, Serdar; Han, Unsal; Atinkaya, Cansel; Osmanoglu, Gokhan; Cavusoglu, Tarik; Dikmen, ErkanBackground/aims: Symptomatic treatment is still the most commonly preferred treatment modality for acute severe esophagitis and gastritis. Clinical results of this treatment range from pathologies like stricture formation to loss of life. In our study, we aimed to demonstrate the effect of immediate gastrostomy in preventing perforation due to corrosive trauma. Methods: We used 32 rats in two study groups. In Group I (n: 16 rats), 1 ml of corrosive agent (10% NaOH solution) was administered and immediate gastrostomies were performed within 2 hours. In Group II (n: 16 rats), 1 ml corrosive agent (10% NaOH solution) was administered and the rats were treated symptomatically; no operation was performed. Results: Acute death was observed in 5 rats just after the corrosive agent was administered at the beginning of the study. Three rats from Group II died due to esophageal and gastric perforation within one week (25%). Necrosis was reported in 5 non-gastrostomized rats; however, no necrosis was observed in the gastrostomized group (p=0.037). Conclusions: Severe acute corrosive esophagitis and gastritis may be fatal. Furthermore, survivors may suffer from lifelong associated problems. From this study, we concluded that immediate gastrostomy in acute corrosive esophagitis and gastritis may play an important role in preventing necrosis and perforation risk.Öğe RADIOSENSITIVITY OF HUMAN BRONCHIAL EPITHELIAL CELLS WITH GENETIC ALTERATIONS(Gazi Univ, Fac Med, 2005) Dikmen, Z. Gunnur; Dikmen, Erkan; Dogan, PakizePurpose: To analyze the proliferation rates and the radiosensitivity of human bronchial epithelial cells (HBECs) with genetic alterations including human telomerase reverse transcriptase (hTERT), Cdk4 (cyclin dependent kinase 4), knockdown p53 and mutant K-ras overexpression. Materials and Methods: HBECs obtained from human bronchus specimens were placed into short-term culture and were serially transfected with retroviral constructs containing Cdk4 and hTERT, resulting in continuously growing immortalized normal human bronchial epithelial cell lines. These cell lines were used to produce knock-down p53, mutant K-ras and knockdown p53 plus K-ras expressing cell lines; the proliferation rates and the radiosensitivity of these cell lines were evaluated. The control cells and the Cdk4, hTERT, knockdown p53 and K-ras expressing cells were irradiated (1 Gy-10 Gy) and the fraction survival was determined 1 week later. Results: The proliferation rates of the cells expressing both knockdown p53 and K-ras were higher than those of the other cell lines and show a loss of contact inhibition in vitro. The HBECs infected with both knockdown p53 and mutant K-ras were more radioresistant compared to cells infected with only mutant K-ras or knockdown p53. Conclusion: HBECs expressing knockdown p53 in addition to mutant Kras have higher proliferation rates and additionally they lose the ability of growth arrest in response to DNA damage signals such as irradiation.Öğe Radiosensitivity of human bronchial epithelial cells with genetic alterations(2005) Dikmen, Z. Günnur; Dikmen, Erkan; Doğan, PakizeAmaç: Bu çalışmada, insan bronşiyal epitel hücrelerinin hTERT (insan telomeraz "reverse" transkriptazı), Cdk4 (siklin bağımlı kinaz 4), "knockdown" p53 ve mutant K-ras onkogeni ile enfekte edilmesiyle elde edilen hücre serilerinin hücre kültürü ortamında büyüme hızlarının ve radyoterapiye karşı hassasiyetlerinin karşılaştırılması amaçlanmıştır. Metodlar: İnsan bronş dokusu örneklerinden elde edilen bronşiyal hücreler, öncelikle Cdk4 ve hTERT ile enfekte edilerek ölümsüzleştirildi. Daha sonra bu hücreler, "knockdown" p53, mutant K-ras ve "knockdown" p53 'le birlikte mutant K-ras eksprese eden hücre serilerinin elde edilmesinde kullanıldı. Bulgular: Hem "knockdown" p53, hem de K-ras ekspresyonu gösteren hücrelerin büyüme hızlarının in vitro şartlarda diğer hücre serilerine oranla daha yüksek olduğu ve kontakt inhibisyon özelliklerini kaybettikleri saptandı. Kontrol hücreleri ile Cdk4, hTERT, "knockdown" p53 ve K-ras ile enfekte edilmiş olan hücrelere 1 Gy ile 10 Gy arasında farklı dozlarda radyoterapi uygulandı, 1 hafta sonra canlı kalan hücrelerin oranı belirlendi. Sonuç: Bu çalışmanın sonuçları, hem"knockdown" p53 hem de mutant K-ras ile enfekte edilen bronşiyal epitel hücrelerinin, sadece K-ras veya "knockdown" p53 ile enfekte edilenlere oranla in vitro şartlarda yüksek proliferasyon hızına sahip olduklarını ve ayrıca DNA hasarına yol açan radyoterapiye cevap olarak büyüme duraklamasına girme özelliklerini kaybettiklerini ortaya koymaktadır.
