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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 Disclosure of unnoticed rib fractures with the use of ultrasonography in minor blunt chest trauma(Elsevier Science Bv, 2003) Kara, M.; Dikmen, E; Erdal, H.H.; Simsir, I.; Kara, S.A.Objective: Rib fractures are the most common injuries resulting from blunt chest trauma. The sensitivity of chest X-rays in showing the rib fractures is limited particularly in those involving the cartilage part of the rib. We investigated the possible rib fractures, those overlooked on chest X-rays, with the use of ultrasonography in minor blunt chest trauma. Methods: A total of 37 patients, with minor blunt chest trauma showing no evidence of a rib fracture on chest X-rays, were examined with ultrasonography performed with a 7.5-MHz linear transducer. Logistic regression analysis was done to outline the clinical predictors of these insidious rib fractures. Results: A total of 15 (40.5%) patients showed rib lesions, whereas 22 (59.5%) patients had no evidence of rib lesions. Fracture of the rib associated with a subperiosteal hematoma was the most common finding in ten (66.7%) patients followed by the fracture of the rib alone in four (26.7%) patients, and subperiosteal hematoma alone in one (6.7%) patient. A total of eight (53.3%) patients had bony rib fractures, whereas seven (46.7%) patients had chondral rib fractures. Age (P = 0.617), gender (P = 0.552), type of etiology (P = 0.954), duration of pain (P = 0.234) and site of trauma (P = 0.740) did not appear as significant predictors for these rib fractures. However, the involved part of the rib showed a significant correlation with either age (P = 0.042) or duration of pain (P = 0.033). Bony rib fractures significantly occurred in elderly patients, and the duration of pain in patients with bony rib fractures was significantly longer than that of patients with chondral rib fractures. Conclusions: Ultrasonography is a useful imaging method in showing the rib fractures those overlooked on chest X-rays in minor blunt chest trauma, and no significant clinical feature exists as a predictor for these insidious fractures. However, bony rib fractures significantly Occur in elderly patients and result in a longer duration of pain. (C) 2003 Elsevier B.V. All rights reserved.Öğe Giant ancient schwannoma of the posterior mediastinum cytologically misdiagnosed as a malignant tumour. A case report(Acta Medical Belgica, 2002) Kara, M.; Özkan, M.; Sak, S.D.; Aksu, O.; Kavukcu, S.We report a case of a 45-year old woman who was found to have a giant mediastinal tumour with radiological degenerative changes. She underwent thoracotomy to remove the mass, which was eventually diagnosed histologically as an ancient schwannoma, whereas cytological interpretation of the accompanying pleural fluid was malignant. Ancient schwannoma is a rare variant of schwannoma, histologically showing atypical features that may result in erroneous diagnosis of a malignant tumour. Clinical and radiological findings are important aids for further consideration of surgical removal of these potentially resectable tumours.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 The lung endothelin system: a potent therapeutic target with bosentan for the amelioration of lung alterations in a rat model of diabetes mellitus(Springer, 2015) Cayir, A.; Ugan, R. A.; Albayrak, A.; Kose, D.; Akpinar, E.; Cayir, Y.; Kara, M.Purpose The aim of this study is to show the effect of a new mechanism on endothelin (ET) receptors in the physiopathology of diabetes-related pulmonary injury. We tested the hypothesis that dual ET-1 receptor antagonism via bosentan can reverse diabetes-induced lung injury. Methods The rats (24 male) were separated into four groups: group 1 (HEALTHY): Control group; group 2 (DM): Streptozotocin 60 mg/kg (i.p.); group 3 (DM + BOS1): Diabetes + bosentan 50 mg/kg per-os; group 4 (DM + BOS-2): Diabetes + bosentan 100 mg/kg per-os. The bosentan treatment was initiated immediately after the onset of STZ-induced diabetes and continued for 6 weeks. Results In the treatment group, SOD activity was significantly increased, although GSH and MDA levels and TNF-alpha and TGF-beta gene expression were decreased. Bosentan 50 mg/kg and bosentan 100 mg/kg showed a significantly down-regulatory effect on ET-1, ET-A, and ET-B mRNA expression. Conclusions In conclusion, increased endothelin levels in the lung associated with diabetes may be one cause of endothelial dysfunction, cytokine increase, and oxidant/antioxidant imbalance in the pathogenesis of complications that may develop during diabetes. With its multiple effects, bosentan therapy may be an effective option against complications that may develop in association with diabetes.Öğe Nonsurgical treatment of a catamenial pneumothorax with a Gn-RH analogue(Karger, 2002) Akal, M.; Kara, M.Catamenial pneumothorax is a rarely encountered entity characterized by recurrent pneumothorax concurrent with menstruation. Numerous mechanisms have been postulated in the etiology of catamenial pneumothorax and treatment is still controversial. We report a case of a catamenial pneumothorax successfully treated with a Gn-RH analogue supporting the efficacy of this regimen and the endometriosis theory as an underlying cause of the disease. Copyright (C) 2002 S. Karger AG, Basel.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 Significance of ligature technique on the formation of pulmonary artery stump thrombosis in a canine model(2005) Işik, F.; Kara, M.; Tunçözgür, B.; Dizbay Sak, S.; Erekul, S.; Kavukçu, Ş.Background : Thrombo-embolism following pulmonary resection is a serious complication with a fatal outcome. We have tried to clarify the role of ligature techniques used in pulmonary resection on the formation of pulmonary artery stump thrombosis, which may lead to a subsequent pulmonary thrombo-embolism. Material and methods : Two groups of 10 mongrel dogs underwent a standard left pneumonectomy under anesthesia. The transfixation, or the continuous ligature technique, was applied to close the pulmonary artery stump in each group. Morphological evaluation of the ligated pulmonary artery was carried out, including the macroscopic thrombus formation and microscopic findings. Results : The transfixation ligature technique showed a significantly greater incidence of macroscopic thrombosis in the pulmonary artery stump when compared with the continuous ligature technique (p = 0.033). This was confirmed by microscopic changes (p = 0.020). Conclusion : Thrombus formation in the pulmonary artery stump is more likely to occur following the closure of the stump with the transfixation ligature technique compared with the continuous ligature technique.Öğe Successful removal of a giant recurrent mediastinal liposarcoma involving both hemithoraces(Elsevier Science Bv, 2001) Kara, M.; Özkan, M.; Sak, S.D.; Kavukcu, E.Primary liposarcomas of the mediastinum are unusual tumors. We report herein a case of a 52-year-old woman, who was found to have a mediastinal tumor involving both hemithoraces and radiologically showing non-resectable-invasive features to the adjacent vital structures. She had a history of left thoracotomy for mediastinal schwannoma 14 years previously. The patient underwent an exploratory thoracotomy following a preoperative misdiagnosis of an ancient schwannoma. Complete removal of the tumor was accomplished through a right posterolateral thoracotomy with a subsequent histological diagnosis of a recurrent low-grade liposarcoma. A resectable liposarcoma should be considered in the differential diagnosis of a mediastinal tumor, although radiologically, the tumor presents with invasive features. (C) 2001 Elsevier Science B.V. All rights reserved.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.
