Person: MALYA, FATMA ÜMİT
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- PublicationOpen AccessCyst Fluid Carcinoembryonic Antigen Level Difference between Mucinous Cystic Neoplasms and Intraductal Papillary Mucinous Neoplasms.(2020-12-11T00:00:00Z) Köker, İbrahim Hakkı; Ünver, Nurcan; Malya, Fatma Ümit; Uysal, Ömer; Keskin, Elmas Biberci; Şentürk, Hakan; MALYA, FATMA ÜMİT; UYSAL, ÖMER; BİBERCİ KESKİN, ELMAS; ŞENTÜRK, HAKANBackground/aims: The role of cyst fluid carcinoembryonic antigen (CEA) level in differentiating mucinous pancreatic cystic lesions (PCLs) is controversial. We investigated the role of cyst fluid CEA in differentiating low-risk (LR)-intraductal papillary mucinous neoplasms (IPMNs) from high-risk (HR)-IPMNs and LR-mucinous cystic neoplasms (MCNs). Methods: This was a retrospective study of 466 patients with PCLs who underwent endoscopic ultrasound-guided fine-needleaspiration over a 7-year period. On histology, low-grade dysplasia and intermediate-grade dysplasia were considered LR, whereas high-grade dysplasia and invasive carcinoma were considered HR. Results: Data on cyst fluid CEA levels were available for 50/102 mucinous PCLs with definitive diagnoses. The median CEA (range) levels were significantly higher in HR cysts than in LR cysts (2,624 [0.5-266,510] ng/mL vs. 100 [16.8-53,445]ng/mL, p=0.0012). The area under the receiver operating characteristic curve (AUROC) was 0.930 (95% confidence interval [CI], 0.5-0.8; p<0.001) for differentiating LR-IPMNs from LR-MCNs. The AUROC was 0.921 (95% CI, 0.823-1.000; p<0.001) for differentiating LR-IPMNs from HR-IPMNs. Both had a CEA cutoff level of >100ng/mL, with a negative predictive value (NPV) of 100%. Conclusion: Cyst fluid CEA levels significantly vary between LR-IPMNs, LR-MCNs, and HR-IPMNs. A CEA cutoff level of >100ng/mL had a 100% NPV in differentiating LR-IPMNs from LR-MCNs and HR-IPMNs.
- PublicationOpen AccessA novel sutureless colonic anastomosis with self-gripping mesh: an experimental model.(2014-05-15) CIPE, G; Malya, FATMA ÜMİT; HASBAHCECI, M; ATUKEREN, P; BUYUKPINARBASILI, NUR; KARATEPE, O; MUSLUMANOGLU, M; MALYA, FATMA ÜMİT; BÜYÜKPINARBAŞILI, NURIntroduction: Anastomotic leakage is one of the most feared complications of colorectal surgery. High morbidity and mortality rates are related to this complication and several studies had been performed to test new techniques which are suggested to reduce leakage rates. The aim of our study was to evaluate the safety and effectiveness of a novel technique sutureless anastomosis with self-gripping mesh in an animal model by examining wound healing process in anastomosis. Methods: In this study sixteen Norwegian Wistar Albino female rats were used. The rats' weights ranged from 250 to 300 g. The rats were divided into control and study groups. The control group underwent a colocolic anastomosis using the conventional method of hand-sewing with single-layer interrupted nonabsorbable sutures. The study group underwent a colocolic anastomosis using self-gripping mesh without sutures. These rats were sacrificed on the 10th postoperative day. The sample pieces obtained from the groups were subjected to anastomotic bursting pressure tests, to a test for hydroxyproline levels in the tissue and to histopathological examinations. The tissue was evaluated in terms of quantity of inflammatory cells, fibroblasts, neovascularization level and collagen content and classified according to the Ehrlich-Hunt model. Statistical analysis was done by using Mann-Whitney U test. Results: The burst pressure mean ± range of control and study groups were 162 ± 78 and 123 ± 35, respectively (P = 0.049). The mean peritoneal adhesion grades were 3.2 ± 0.7 in the study group and 2.3 ± 0.7 in the control group (P = 0.036). The operative time was significantly shorter in the study group. The difference between the groups by mean of hydroxyproline levels was found to be significant (P = 0.001). According to histopathological examinations by means of the Ehrlich-Hunt model, the fibroblast activation and collagen fiber ratio were higher in the study group and the difference between these measurements was statistically significant (P = 0.006; P = 0.028). Conclusion: This study showed that use of self-gripping meshes for colocolic anastomosis in rats is a safe and feasible method. It is suggested that the most important advantage of this technique is the shorter operative time.
- PublicationOpen AccessComparison of Weight Loss, Ghrelin, and Leptin Hormones After Ligation of Left Gastric Artery and Sleeve Gastrectomy in a Rat Model.(2017-03-24) YARDIMCI, ERKAN; BOZKURT, SÜLEYMAN; CENGIZ, MB; Malya, FATMA ÜMİT; YARDIMCI, ERKAN; BOZKURT, SÜLEYMAN; MALYA, FATMA ÜMİTBACKGROUND Ligation of the left gastric artery (LLGA), which supplies the fundus of the stomach, may reduce the appetite hormone ghrelin, resulting in weight control. The aim of this study was to compare LLGA and sleeve gastrectomy (SG) in terms of postoperative outcomes in a rat model. MATERIAL AND METHODS Fifteen male Wistar albino rats, weighing >350 grams (range 350-525 grams), were enrolled in LLGA (N=5), SG (N=5), and control (N=5) groups. Blood samples were drawn preoperatively and also during the first and fourth week postoperatively to assay ghrelin and leptin hormone levels. Body weight was measured in each group. RESULTS The maximum reduction in ghrelin level (41.5%) was found in the LLGA group. Considerable% total weight loss (TWL) (mean 24.1%) was observed in the SG group, and slight%TWL was noted in the control and LLGA groups (means of 0.1% and 2.1%, respectively). There was no significant difference in mean percent weight change between the LLGA and the SG groups (p=0.08). Blood sample analysis revealed no statistically significant changes in ghrelin or leptin levels between the groups (p=0.9 and p=0.3, respectively). CONCLUSIONS We present evidence that LLGA causes the same reduction in ghrelin hormone levels as SG at 4 weeks after surgery in a rat model. However, LLGA did not cause the same%TWL as SG. The mechanism of weight loss in SG is most likely due to restriction and to the effects of the procedure, rather than due to neurohormonal changes.
- PublicationOpen AccessNonclosure of the Peritoneum during Appendectomy May Cause Less Postoperative Pain: A Randomized, Double-Blind Study(2019-01-01) BEKTAŞOĞLU, HÜSEYİN KAZIM; Hasbahceci, Mustafa; YIĞMAN, SAMET; YARDIMCI, ERKAN; KUNDUZ, ENVER; MALYA, FATMA ÜMİT; BEKTAŞOĞLU, HÜSEYİN KAZIM; YIĞMAN, SAMET; YARDIMCI, ERKAN; KUNDUZ, ENVER; MALYA, FATMA ÜMİTObjective: We aim to evaluate the effect of peritoneal closure on postoperative pain and life quality associated with open appendectomy operations. Methods: This is a single-center, prospective, randomized, and double-blinded study. Here, 18-65-year-old patients who underwent open appendectomy for acute appendicitis were included. Demographic data of the patients, operation time, length of hospital stay, pain scores using a 10 cm visual analogue scale (VAS) on the first postoperative day, quality of life assessment using the EuroQol-5D-5L questionnaire on postoperative 10th day, deep wound dehiscence, bowel obstruction, and mortality data were recorded. Results: In total, 112 patients were included in the study. The demographic data showed no significant difference between the groups. The median VAS score was lower in the group with open peritoneum, but this difference was not statistically significant (3 vs. 4, p=0.134). The duration of surgery was significantly shorter in the peritoneal nonclosure group (31.0 ± 15.1 vs. 38.5 ± 17.5 minutes, p=0.016). Overall complication rates and life quality test (EuroQol-5D-5L) results were similar between groups. Conclusion: Nonclosure of the peritoneum seems to shorten the duration of surgery without increasing complications during open appendectomy. Postoperative pain and life quality measures were not affected by nonclosure of the peritoneum. This trial is registered with NCT02803463.
- PublicationOpen AccessIntraoperative palpation of sentinel lymph nodes can accurately predict axilla in early breast cancer(2019-01-01) Ozkurt, Enver; Yardimci, ERKAN; Tukenmez, Mustafa; Ersoy, YELİZ EMİNE; Yilmaz, Ravza; Cabioglu, Neslihan; Karanlik, Hasan; Kulle, Cemil Burak; Malya, FATMA ÜMİT; Onder, Semen; Gucin, ZÜHAL; Igci, Abdullah; Ozmen, Vahit; Dinccag, Ahmet Sait; Muslumanoglu, Mahmut; YARDIMCI, ERKAN; ERSOY, YELIZ EMINE; MALYA, FATMA ÜMİT; GÜCİN, ZÜHALRecent randomized trials have shown that completion axillary lymph node dissection (ALND) is not required in all patients with a positive sentinel lymph node (SLN) who will receive radiation therapy. Although routine intraoperative pathologic assessment (IPA) becomes unnecessary and less indicated by breast surgeons in the United States and some European countries, it is still widely used all around the world. In this prospective study, the feasibility of intraoperative nodal palpation (INP) as opposed to IPA of the SLN has been analyzed. Between March 2014 and June 2015, 305 patients with clinical T1-2/N0 breast cancer from two different breast clinics (cohort A; [n = 225] and cohort B; [n = 80]) who underwent any breast surgery with sentinel lymph node biopsy (SLNB) were included in this study. Surgeons evaluated the SLNs by manual palpation before sending for IPA, and findings compared with the final pathology. The positive predictive values (PPV) of INP and IPA were 81.8% and 97.9%, respectively, whereas the negative predictive values (NPV) of INP and IPA were 83% and 92.4%. The accuracies of INP and IPA were 82.6% and 94.1%, respectively. If patients with SLNB including micrometastasis were also considered in the final pathologic assessment (FPA) (-) group that would not require a further axillary dissection, the revised NPV of INP and FPA were found to be 92.6% and 98.1%, respectively. The revised accuracy of INP also found to be increase to 86.9%. Our study, which is the only prospective one about palpation of dissected SLNs in the literature, suggests that INP can help to identify patients who do not need ALND, which encourages omitting IPA in cT1-2 N0 breast cancer.
- PublicationOpen AccessMucinous Pancreatic Cysts: Comparison of Cyst Size and Location in Certain Mucinous Cyst Subgroups(2021-09-01T00:00:00Z) KÖKER, İBRAHİM HAKKI; Elagoz, Sahende; GÜCİN, ZÜHAL; MALYA, FATMA ÜMİT; ŞENTÜRK, HAKAN; KÖKER, İBRAHİM HAKKI; GÜCİN, ZÜHAL; MALYA, FATMA ÜMİT; ŞENTÜRK, HAKANBackground: There are studies reporting that the location of intraductal papillary mucinous neoplasia (IPMN) predicts malignancy. Therefore, we evaluated the cyst location’s relationship with malignancy, and the possibility of using cyst size and location to distinguish between non-main duct (non-MD)-IPMNs, mucinous cystic neoplasia (MCN), and cystic pancreatic ductal adenocarcinoma (PDAC). Methods: We performed a retrospective analysis of data from 122 patients with a definite cyto-histological diagnosis of non-MDIPMNs, LR-MCNs, and cystic PDACs via endoscopic ultrasound fine-needle aspiration between October 2011 and October 2020. We grouped the cyst locations as head, uncinate, neck (HUN), and corpus or tail (CT). On histology, low-grade dysplasia and intermediategrade dysplasia were considered low risk (LR), whereas high-grade dysplasia and invasive carcinoma were considered high risk (HR). Results: Of the 122 patients (61 (50%) women, median age 61.5 years (range 19-85), there were 34 (27.9%) LR-non-MD-IPMNs, 33 (27%) HR-non-MD-IPMNs, 19 (15.6%) LR-MCNs, and 36 (29.5%) cystic PDACs. We found no significant difference between LRand HR-non-MD-IPMN locations (P = .803). Low-risk non-MD-IPMNs were significantly smaller than HR-non-MD-IPMNs (P < .001), LR-MCNs (P = .002), and cystic PDACs (P < .001). The area under the receiver operating characteristic curve (AUROC) was 0.819 (95% CI: 0.716-0.902; P < .0001), and demonstrated a cyst size cut-off <2.2 cm to differentiate LR cysts, while cysts <1.6 cm had a negative predictive value (NPV) of 100% in non-MD-IPMNs. Conclusion: Cyst location is not predictive of malignancy in non-MD-IPMNs. Low-risk non-MD-IPMNs were smaller than HR-non-MDIPMNs, LR-MCNs, and cystic PDACs. The cyst size cut-off was 2.2 cm; however, <1.6 cm had a 100% NPV differentiating LR- from HR-non-MD-IPMNs
- PublicationOpen AccessManagement of pancreatic head adenocarcinoma: From where to where?(2019-03-01T00:00:00Z) Dolay, Kemal; MALYA, Fatma Ümit; AKBULUT, AHMET SAMİ; MALYA, FATMA ÜMİTPancreatic head adenocarcinoma (PHAC) is one of the most aggressive malignancies, and it has low long-term survival rates. Surgery is the only option for long-term survival. The difficulties associated with PHAC include higher frequencies of regional or distant lymph node metastases and vascular involvement, and positive resection margins in pancreatic and retroperitoneal tissues. Radical resections increase margin negativity and life expectancy; however, the extend of the surgery applied is controversial. Thus, western and eastern centers may use different approaches. Multiorgan, peripancreatic nerve plexus, and vascular resections have been discussed in relation to radical surgery for pancreatic cancer as have the roles of neoadjuvant and adjuvant therapy regimens. Determining the appropriate limits for surgery, standardizing definitions and surgical techniques according to guidelines, and centralizing pancreatic surgery within high-volume institutions to reduce mortality and morbidity rates are among the most important issues to consider. In this review, we evaluate the basic concepts underlying and the roles of radical surgery for PHAC, and lymphadenectomy, nerve plexus, retroperitoneal tissue, vascular, and multivisceral resections, total pancreatectomy, and liver metastases are discussed.
- PublicationOpen AccessThe correlation between breast cancer and urinary iodine excretion levels(2018-02-01) Malya, FATMA ÜMİT; Kadioglu, HÜSEYİN; Hasbahçeci, Mustafa; Dolay, KEMAL; Guzel, MEHMET; Ersoy, YELİZ EMİNE; MALYA, FATMA ÜMİT; KADIOĞLU, HÜSEYİN; DOLAY, KEMAL; GÜZEL, MEHMET; ERSOY, YELIZ EMINEObjective To compare urinary iodine excretion levels in patients with breast cancer and control subjects. Methods In this prospective pilot study, patients with breast cancer and normal controls were recruited. Age and menopausal status were recorded. Levels of serum thyroid-stimulating hormone, blood urea nitrogen and creatinine and urine iodine concentration (UIC) were measured. UIC levels were divided into three categories: low (<100 µg/l), normal (100-200 µg/l) or high (>200 µg/l). Results A total of 24 patients with breast cancer and 48 controls were included in the study. There were no statistically significant differences between the two groups with regard to thyroid-stimulating hormone, blood urea nitrogen or creatinine levels. When considered overall, there was no statistical difference in UIC between patients and controls. However, comparisons within each category (low, normal or high UIC) showed a significantly higher percentage of patients with breast cancer had a high UIC compared with controls. Conclusions A high UIC was seen in a significantly higher percentage of patients with breast cancer than controls. UIC may have a role as a marker for breast cancer screening. Further studies evaluating UIC and iodine utilization in patients with breast cancer are warranted.
- PublicationOpen AccessThe Role of C-Reactive Protein in the Early Prediction of Serious Pancreatic Fistula Development after Pancreaticoduodenectomy(2018-01-01T00:00:00Z) MALYA, Fatma Ümit; Hasbahceci, Mustafa; Tasci, Yunus; KADIOĞLU, HÜSEYİN; GÜZEL, Mehmet; Karatepe, Oguzhan; DOLAY, Kemal; MALYA, FATMA ÜMİT; KADIOĞLU, HÜSEYİN; GÜZEL, MEHMET; DOLAY, KEMALIntroduction. Despite recent advances in surgical techniques, pancreatic fistulas are common. We aimed to determine the role of C-reactive protein in the prediction of clinically relevant fistula development. Materials and Methods. Data from patients who underwent pancreaticoduodenectomy between 2012 and 2015 is collected. Postoperative 1st, 3rd, and 5th day (POD1, POD3, and POD5) C-reactive protein (CRP) levels, postoperative pancreatic fistula (POPF) development, other complications, length of hospital stay, and mortality were recorded. Results. Of 117 patients, 43 patients (36.8%) developed complications (including fistulas). Of the patients developing fistulas, 21 (17.9%) had POPF A, 2 (1.7%) had POPF B, and 7 (6.0%) had POPF C. POD5 CRP and POD3 CRP were shown to be significantly correlated with mortality and development of clinically relevant POPF (p = 0 001 and p = 0 0001, resp.) and with mortality (p = 0 017), respectively. The development of clinically relevant POPFs (B and C) could be predicted with 90% sensitivity and 82.2% specificity by POD5 CRP cut-off level of 19 mg/dL and with 100% sensitivity and 63.6% specificity by the difference between POD5 and POD1 CRP cut-off level of > 2.5 mg/dL. Conclusion. CRP levels can effectively predict the development of clinically relevant pancreatic fistulas.
- PublicationOpen AccessJejunogastric intussusception: a rare complication of gastric surgery.(2013-01-01) CIPE, G; Malya, FATMA ÜMİT; HASBAHCECI, M; ERSOY, YELİZ EMİNE; KARATEPE, O; MUSLUMANOGLU, M; MALYA, FATMA ÜMİT; ERSOY, YELIZ EMINEJejunogastric intussusception is a rare complication of gastric surgery. It usually presents with severe epigastric pain, vomiting, and hematemesis. A history of gastric surgery can help in making an accurate and early diagnosis which calls forth an urgent surgical intervention. Only reduction or resection with revision of the previously performed anastomosis is the choice which is decided according to the operative findings. We present a case of JGI in a patient with a history of Billroth II operation diagnosed by computed tomography. At emergent laparotomy, an efferent loop type JGI was found. Due to necrosis, resection of the intussuscepted bowel with Roux-en-Y anastomosis was performed. Postoperative recovery was uneventful.
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