Can, Halil; Dolgun, Muge; Özgen, Utku; Gömleksiz, Cengiz; Diren, Furkan; Aydoseli, Aydin; Aras, Yavuz; Sencer, Altay

Objective: Nowadays due to developing imaging techniques, vestibular schwannoma cases are monitored more frequently. In this study, the results of the patients who underwent surgery in the Department of Neurosurgery, Istanbul University Istanbul School of Medicine were retrospectively evaluated. Methods: Radiological and clinical findings of 18 patients with vestibular schwannoma diagnosed in our clinic from 2012 to 2017 were evaluated. After describing the possible treatment methods of the disease in detail, oral and written informed consent was obtained from all of them. Results: In our study, 18 patients, consisting of 13 women and 5 males, were examined. Eleven patients were found with a mass diameter below 3 cm, and seven patients were found with mass diameter above 3 cm. All patients underwent mass resection with retrosigmoid craniotomy. Total resection was performed in 11 patients, and subtotal resection was done in 7 patients. In seven patients with total resection (63.6%), a newly developed facial paresis was observed. The newly developed glossopharyngeal nerve paresis was observed in three patients (27.2%), and also abducens nerve paresis in three patients (27.2%). The facial nerve was preserved at a rate of 42% in tumors larger than 3 cm in size. The CSF fistula developed in one patient (5.5%); hydrocephalus developed in one patient (5.5%). Conclusion: In cases of vestibular schwannoma, microsurgery, radiosurgery, and wait/follow approaches are monitored. Although gold is standard microsurgery in tumors sized above 3 cm, the treatment plan for tumors under 3 cm in size is controversial. In this study, postoperative facial paresis was developed in all patients with total resection, which were below the mass size of 3 cm. The fact that the abducens and glossopharyngeal nerve paresis in patients with total resection have been seen less frequently in patients with subtotal resection is a factor that can affect the decision of total-subtotal resection. Therefore, the treatment plan should be taken into consideration (total resection/subtotal resection + radiosurgery) considering the existing neuromonitoring facilities in tumors larger than 3 cm in size.

Karabakan, Mehmet; Bozkurt, Aliseydi

Objective: Various chronic diseases, including hypertension (HT), diabetes mellitus (DM), and coronary artery disease (CAD), together with the medications used in the treatment of these conditions, are considered a part of the erectile dysfunction (ED) etiology. The neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) provide information about many diseases. The NLR and PLR increase in systemic inflammation, certain gynecological and gastrointestinal cancers, CAD, various oncological diseases, and especially in acute coronary syndromes. In this study, the relationship between PLR, NLR, and ED severity were examined in patients with ED. Methods: All data from patients were screened retrospectively. Body mass index, the International Index of Erectile Function-5 (IIEF-5) scores, age, fasting blood glucose, whole blood count, lipid, and hormone profile values were measured. The PLR and NLR values from both the patient and control groups were evaluated. The IIEF-5 questionnaire was used to measure the quality of erection in all the groups. A total of 131 patients with ED were divided into four groups: severe (34 patients), moderate (32 patients), mild-to-moderate (36 patients), and mild ED (29 patients). In addition, a control group was formed with 26 healthy men. Results: No statistically significant difference was observed between the groups in terms of the mean age, hypertension, smoking status, alcohol use, DM, CAD, and cholesterol and triglycerides levels. The mean PLR values were 125.3 +/- 41.4, 120.6 +/- 36.1, 118.2 +/- 50.4, 104.9 +/- 3.2, and 107.5 +/- 37.4 in the severe, moderate, mild-to-moderate, mild ED, and control groups, respectively. There was no significant difference in the PLR ratio among the ED groups and controls (p>0.05). The mean NLR values were 2.40 +/- 1.22, 2.34 +/- 0.88, 2.26 +/- 1.22, 2.1 +/- 0.87, and 1.76 +/- 0.7 in the severe, moderate, mild-to-moderate, mild ED, and control groups, respectively. Compared with the control group, this value was statistically significant for patients with all ED groups (p<0.05). Conclusion: The NLR value was found to be higher in patients with ED. The NLR value may be related to ED, and it can give valuable information in patients with ED.

Tuncer, Osman Nuri; Onk, Oruc Alper; Karahan, Umit; Erkut, Bilgehan

The prevalence of congenital inferior vena cava anomalies is difficultto pinpoint and is estimated to occur in 0.05-8.7% of the population. These abnormalities are often asymptomatic and are incidentally identified in patients undergoing imaging investigations for other reasons. Inferior vena cava agenesis maybe a risk factor for deep venous thrombosis due to inadequate venous drainage. We describe thecase of an 84-year-old female who was hospitalized due to unprovoked deep venous thrombosis and inferior vena cava agenesiswas foundin a further investigation.

Balci, Mecdi Gurhan; Eken, Huseyin; Tayfur, Mahir; Isik, Arda; Ayerden, Dila

Carcinomas of the large bowel are the third most commonly seen cancer in both males and females and are the second reason of deaths resulting from cancer. The most frequently seen microscopic type of large bowel cancer is adenocarcinoma. Signet-ring cell carcinoma is a rarely seen microscopic subtype of large bowel carcinomas and may be accompanied by other microscopic types. The diagnosis of signet-ring cell carcinomas is made while the count of signet ring cells is over 50% of the tumor cells. The presence and ratio of signet-ring cells should be noted because the prognosis of signet-ring cell carcinoma is very bad. In our case, it is viewed mixt mucinous signet-ring cell carcinoma including mucinous components in the large bowel. This report is presented because it is rarely seen and because the prognosis is very bad and is necessary be specified in the report.

Karabakan, Mehmet; Akdemir, Serkan; Akdemir, Alp Ozgur; Öztekin, Cetin Volkan; Guzel, Ozer; Gökkaya, Cevdet Serkan; Çetinkaya, Mesut

Objective: Serum prostate-specific antigen (PSA) levels are very important in the diagnosis of prostate cancer. Besides prostate cancer, PSA levels can also be increased by cystoscopy, prostate biopsy, prostatitis, and manipulation. There are also studies reporting that ejaculation affects serum PSA levels. In this study, we aimed to investigate the effects of ejaculation frequency on serum PSA level. Methods: A total of 135 male patients aged in the range of 48-69 years who presented with lower urinary tract symptoms at the urology outpatient clinic between October 2009 and August 2012 were included in the study. Three groups divided according to ejaculation frequency (Group 1, Group 2, and Group 3) were compared by total and free PSA (t/f PSA) values, age, International Prostate Symptom Score (IPSS), prostate volumes, and PSA density (PSAD). Results: There was no significant difference between t/f PSA values, age, IPSS, prostate volumes, and PSAD values of the groups. Conclusion: In our study, ejaculation frequency was found to have no effect on serum PSA levels.

Dinçer, Murat; Dinçer, Selvi; Bozkurt, Aliseydi; Kandirali, Engin; Semerciöz, Atilla

Renal cell cancer (RCC) is the most common cancer of the kidney. Thyroid gland rarest side of RCC metastasis which usually occur after 10 years. We present a very rare case of metastatic RCC in the thryoid gland in a patient who was referred to our clinic because of a neck mass 17 monts after radical nephrectomy.

Karabakan, Mehmet; Aktas, Binhan Kagan; Bulut, Suleyman; Gökkaya, Cevdet Serkan; Özden, Cuneyt; Baykam, Mehmet Murat; Memis, Ali

Objective: Invasive surgical interventions creating acute stress may give rise to immunological and hormonal disturbances in patients undergoing surgery. Previous studies reported elevations in serum prostate-specific antigen (PSA) level following coronary bypass and myocardial infarction. The current study aims to investigate the effect of surgical stress on serum PSA level. Methods: Thirty-three patients who underwent open renal stone surgery, without any known infectious prostatic disorder or prostate cancer that may elevate serum PSA level, were included in the study. In all patients, serum levels of total and free PSA (tPSA and fPSA), follicle-stimulating hormone (FSH), luteinizing hormone (LH), total and free testosterone, C-reactive protein (CRP), fibrinogen, albumin, and ferritin and erythrocyte sedimentation rate (ESR) were measured both at baseline and post-operative day 3. Wilcoxon signed-rank test was used for the statistical analysis. Results: The mean age of patients was 53.9 +/- 8 (40-66). The mean baseline and post-operative levels of the measured serum parameters are given in Table 1. All of them differed significantly between baseline and post-operative day 3, except for LH, tPSA, and fPSA. CRP, fibrinogen, ferritin, and ESR are known as acute phase reactants of the post-operative endocrine response. However, serum total and free testosterone levels, albumin, and FSH decreased on the contrary acute phase reactants in the present study. Conclusion: According to our results, serum PSA level was not affected by acute surgical stress.

Dinçer, Muhammet Murat; Bozkurt, Aliseydi; Semerciöz, Atilla; Dinçer, Selvi Tabak; Kandirali, Engin

Böbrek hücreli kanseri (BHK) böbreğin en sık görülen kanseridir. Tiroid bezi nadir metastaz bölgeleridir ve tiroid metastazları genellikle on yıl sonra ortaya çıkar. Olgumuzda, radikal nefrektomi (RN)'den 17 ay sonra boyunda şişlik şikayeti ile başvuran tiroide metastaz yapmış BHK'lı olguyu inceledik.

Eken, Hüseyin; Çınar, Hamza; Büyükakıncak, Sercan; Topgül, Koray

Laparoskopik hepatobiliyer cerrahi girişimler öncesinde olası komplikasyonların önüne geçilebilmesi için anatominin ve potansiyel varyasyonların bilinmesi gerekmektedir. Biliyer sistemde intrahepatik ve ekstra hepatik düzeyde gelişimsel çok sayıda varyasyonlar mevcuttur. İlk laparoskopik kolesistektominin uygulanmasından günümüze kadar geçen sürede deneyimin artmasına bağlı olarak komplikasyon oranları %0,5'ler düzeylerine inmiştir. Bu çalışmada kronik taşlı kolesistit nedeniyle ameliyata alınan hastada operasyon sırasında anatomik varyasyon (çift duktus ve çift sistik arter) tespit edilerek, safra yolunun anatomik varyasyonları kısaca gözden geçirilmiştir.

Aktas, Binhan Kagan; Bulut, Suleyman; Erbay, Guven; Karabakan, Mehmet; Gökkaya, Cevdet Serkan; Memis, Ali

Objective: In this study, we aimed to evaluate the role of various comorbidities that lead to removal of a penile prosthesis due to infection. Methods: We reviewed the records of 50 patients who underwent malleable penile prosthesis implantation between January 2010 and May 2014. The patients were classified into 2 groups: Group 1 (n=11) contained patients whose prosthesis was removed due to infections that developed in the post-operative period; Group 2 (n=39) patients did not have any infectious complications. The 2 groups were compared regarding the presence of diabetes mellitus (DM), hypertension (HT), smoking habit, atherosclerotic heart disease (ASHD), Peyronie disease, and the level of mean preoperative glycosylated hemoglobin (HbA1c). Results: There were no differences between the 2 groups regarding the presence of DM, HT, smoking habit, ASHD, and Peyronie disease (p>0.05). However, there was a significant difference (p=0.006) between patients whose prostheses were removed due to infection and patients who did not have any infectious complications regarding the mean preoperative HbA1c level (10.7 +/- 1.6 and 7.4 +/- 1.19, respectively). Conclusion: Having a normal HbA1c level is more important than being diabetic or not, regarding penile prosthesis removal due to postoperative infection.