Radical surgical management of perianal giant condyloma acuminatum of Buschke and Löwenstein: long-term results of 11 cases

Yildiz, Alp,Leventoglu, Sezai,Yildiz, Aybala,Inan, Arda,Mentes, Bedrettin Bulent 대한대장항문학회 2023 Annals of Coloproctolgy Vol.39 No.3

Purpose: Perianal Buschke-Löwenstein tumor (BLT) is characterized by an exophytic cauliflower-like mass surrounding the perianal region. Its tendency to infiltrate the adjacent tissues, its massiveness, and its high recurrence rate cause difficulties in treatment. The aim of this study is to report our strategy with wide local excision and flap reconstruction for BLT.Methods: From November 2002 to June 2019, 11 patients (9 men) with a mean age of 33.45 years (range, 19–54 years) were operated on for BLT. All patients underwent wide local excision and V-Y flap reconstruction, supplemented with other flaps whenever needed. No additional modalities were used.Results: Two patients had a history of anal intercourse while all patients were human immunodeficiency virus-negative. The mean tumor length was 15.54 ± 1.34 cm (range, 10–26 cm). Human papillomavirus 6 was the most common type identified. Partial wound dehiscence developed in 3 patients, while anal stenosis, mucosal ectropion, or local recurrence was not observed during the mean follow-up period of 50.45 ± 1.75 months (range, 10–196 months).Conclusion: In patients with perianal BLT, wide local excision and flap reconstruction result in a high healing rate without significant complications.

Metastases from Rectum and Thyroid Cancers in Same Cervical Lymph Node - A Case Report -

Bulent Yildiz,Abdulkadir Reis,Evren Fidan,Feyyaz Ozdemir,Halil Kavgaci,Fazil Aydin 대한병리학회 2010 Journal of Pathology and Translational Medicine Vol.44 No.5

An excisional biopsy targeting a cervical lymph node was performed on a 49-year-old female patient with metastatic rectal cancer. The biopsy revealed rectal and papillary thyroid cancer metastasis in the same lymph node. A thin-needle thyroid aspiration biopsy was performed, and the result was papillary thyroid carcinoma. The patient, who received chemotherapy for the metastatic rectal cancer, died due to disease progression about 5 months after a secondary primary tumor was detected. Metastasis of multiple malignancies in the same lymph node is extremely rare. A metastases of rectal and thyroid cancers to the same lymph node has not been reported until now. Our patient is the first case in the literature.

Sepsis and Meningitis due to Listeria Monocytogenes

Orhan Yildiz,Bilgehan Aygen,Duygu Esel,Uner Kayabas,Emine Alp,Bulent Sumerkan,Mehmet Doganay 연세대학교의과대학 2007 Yonsei medical journal Vol.48 No.3

Purpose: This study focused on the effect of immuno-compromising conditions on the clinical presentation of severe listerial infection. Patients and Methods: Nine human listeriosis cases seen from 1991-2002 were reviewed. All adult patients, from whose blood, peritoneal fluid or cerebrospinal fluid (CSF) the L. monocytogenes was isolated, were included in this retrospective study. Results: Listeriosis presented as primary sepsis with positive blood cultures in 5 cases and meningitis with positive CSF cultures in 4 cases. All of these patients had at least one underlying disease, most commonly, hematologic malignancy, diabetes mellitus, amyloidosis and hepatic cirrhosis; 55.6% had received immunosuppressive or corticosteroid therapy within a week before the onset of listeriosis. The patients were adults with a mean age of 60 years. Fever, night sweats, chills and lethargy were the most common symptoms; high temperature (>38℃), tachycardia, meningeal signs and poor conditions in general were the most common findings on admission. The mortality rate was 33.3% and was strictly associated with the severity of the underlying disease. Mortality differences were significant between sepsis (20%) and meningitis (50%) patients. Conclusion: Listeriosis as an uncommon infection in our region and that immuno- suppressive therapy is an important pre-disposing factor of listeriosis. Sepsis and meningitis were more common in this group of patients and had the highest case-fatality rate for food-borne illnesses.

First-Line Mono-Chemotherapy in Frail Elderly Patients with Metastatic Colorectal Cancer

Varol, Umut,Dirican, Ahmet,Yildiz, Ibrahim,Oktay, Esin,Degirmenci, Mustafa,Alacacioglu, Ahmet,Barutca, Sabri,Karabulut, Bulent,Uslu, Ruchan Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.7

Background: Unlike for fit elderly metastatic colorectal cancer (mCRC) patients, general approaches to initial treatment for the frail older mCRC patients are not clear. Our aim was to evaluate the efficiency and safety of first-line single-agent treatment in one such group. Materials and Methods: We retrospectively evaluated mCRC patients aged 70 or older with an Eastern Cooperative Oncology Group performance score of 2. They had no prior treatment and underwent first-line single-agent capecitabine or other monotherapies until disease progression or unacceptable toxicity. Results: Thirty-six patients were included. Most (n:28, 77.8%) were treated with capecitabine. One patient achieved a complete response and 5 patients had a partial response for an overall response rate of 16.6%. Twelve patients (33.3%) remained stable. Median progression free survival was 5 months (confidence interval (CI), %; 3.59-6.40) and median overall survival was 10 months (95 CI%; 8.1-11.8). Grade 3-4 toxicity was found in 6 patients (16.6%). Febrile neutropenia was not observed and there were no toxicity-associated deaths. Conclusions: Capecitabine is a safe chemotherapeutic agent with moderate activity for first-line treatment of older metastatic colorectal cancer patients with limited performance status.

Poster Session : PS 0446 ; Infectious Disease ; Fever of Unknown Cause Which is the Cause of Intestinal Tuberculosis

( Tugrul Burak Genc ),( Yildiz Okuturlar ),( Ozlem Harmankaya ),( Suut Gokturk ),( Bulent Durdu ),( Samet Sayilan ),( Selcuk Sezikli ),( Meral Mert ),( Abaki Kumbasar ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: In developing countries, tuberculosis (tbc) incidence is reduced; but immunocompromised patients still remain at high risk for the disease. Malignancy and Crohn`s disease should be considered in the differential diagnosis of gastrointestinal (GIS) tbc in immunocompromised patients. We present here the clinical course of a patient with fever of unknown origin and rectal bleeding. Methods: A 31-year-old male cachectic patient was admitted to hospital with abdominal pain, fever and diarrhea. The history of the patient revealed systemic lupus erythematosus, lupus nephritis and left middle cerebral artery infarction. Right hemiparesis was present. He was on warfarin 5mg/day, cilazapril 2,5mg/day, methylprednisolone 4mg/day, mycophenolate mofetil 2g/day, hydroxychloroquine 200mg/ day, levodopa+benserazide 375mg/day, levetiracetam 1 g/day. Creatinine was 2,79mg/dL, and C-reactive protein was 10 mg/dL. No pneumonic infi ltration was shown. Blood, urine and faeces cultures, Chlamydia IgM, mycoplasma IgM, toxoplasma IgM, EBV IgM, CMV IgM and PPD test were negative. Transesophageal echocardiography excluded infective endocarditis. Empiric antibiotic treatment with ceftriaxone, piperacillin-tazobactam and moxifi oxacin, and antifungal fi uconazole was started. On the 15th day hematochezia occured. Colonoscopy revealed three different massive lesions straightening the lumen in caecum, hepatic fi exure of colon and transverse colon (figure-1). Results: Pathologic examination demonstrated granulomatous lesion. Considering the positive results of Tbc-PCR treatment, the patient was diagnosed as GIS tbc and isoniazid, rifampicin, pyrazinamide and ethambutol were started. Conclusions: The ileocecal region is the most frequent localization of intestinal tbc. Colonic tbc is often localized in proximal colon and caecum, and usually associated with ileal tbc. It is rarely seen in transverse colon. Our patient is a rare case of gastrointestinal tbc presenting without pneumonic infi ltration and with an unusual localization in colon.

Slide Session : OS-END-37 ; Endocrinology : The Relationship Between Epicardial Adipose Tissue Thickness and Vitamin D in Patients with Metabolic Synrome

( Irem Kirac Utku ),( Yildiz Okuturlar ),( Esra Demir ),( Ozlem Harmankaya ),( Bulent Demir ),( Gonul Aciksari ),( Turgut Uygun ),( Alev Kural ),( Hanise Ozkan ),( Meral Mert ),( Abaki Kumbasar ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Metabolic syndrome is a systemic disorder and manifests a group of conditions such as abdominal obesity, dyslipidaemia, hypertension, coronary artery diseases. The importance of epicardial adipose tissue recognized its contribution to inflammation by pro-inflammatory cytokines discharge has been proved. Several investigations were performed on vitamin D receptor in different tissues except bone. In this study the epicardial adipose tissue thickness (EATT) and the levels of vitamin D were measured and compared with healthy control group. Methods: A total of 148 patients (84 patients who had metabolic syndrome without diabetes and 64 healthy individuals) were enrolled into the study. In all patients, the EATT was calculated by ecocardiography and the level of serum 25(OH) vitamin D was monitored. Results: It has been observed that the EATT in patients with metabolic syndrome increases significiantly compared with healthy control group (p<0.001). No significant difference between patients and control group was found on the levels of 25 (OH) vitamin D (p=0.507). There was no correlation between 25 (OH) vitamin D and the EATT (p=0.622). Conclusion: We observed that the EATT increased in patients with metabolic syndrome. In contradiction to the literature; the levels of 25(OH) vitamin D has not been found high in patients with metabolic syndrome. The reason of this can be small number of patients in our study. A significant correlation was not found between the EATT and the levels of 25 (OH) vitamin D. Further studies with a larger patient population are required assess the relationship.

An Update on Contraception in Polycystic Ovary Syndrome

Seda Hanife Oguz,Bulent Okan Yildiz 대한내분비학회 2021 Endocrinology and metabolism Vol.36 No.2

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in reproductive-aged women, characterized by hyperandrogenism, oligo/anovulation, and polycystic ovarian morphology. Combined oral contraceptives (COCs), along with lifestyle modifications, represent the first-line medical treatment for the long-term management of PCOS. Containing low doses of estrogen and different types of progestin, COCs restore menstrual cyclicity, improve hyperandrogenism, and provide additional benefits such as reducing the risk of endometrial cancer. However, potential cardiometabolic risk associated with these agents has been a concern. COCs increase the risk of venous thromboembolism (VTE), related both to the dose of estrogen and the type of progestin involved. Arterial thrombotic events related to COC use occur much less frequently, and usually not a concern for young patients. All patientsdiagnosed with PCOS should be carefully evaluated for cardiometabolic risk factors at baseline, before initiating a COC. Age, smoking, obesity, glucose intolerance or diabetes, hypertension, dyslipidemia, thrombophilia, and family history of VTE should be recorded. Patients should be re-assessed at consecutive visits, more closely if any baseline cardiometabolic risk factor is present. Individual risk assessment is the key in order to avoid unfavorable outcomes related to COC use in women with PCOS.

Second-Line Capecitabine and Oxaliplatin Combination for Gemcitabine-Resistant Advanced Pancreatic Cancer

Bayoglu, Ibrahim Vedat,Varol, Umut,Yildiz, Ibrahim,Muslu, Ugur,Alacacioglu, Ahmet,Kucukzeybek, Yuksel,Akyol, Murat,Demir, Lutfiye,Dirican, Ahmet,Cokmert, Suna,Yildiz, Yasar,Karabulut, Bulent,Uslu, Ruc Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.17

Background: The role of second-line therapy in metastatic pancreatic cancer is not clear. In this study, we aimed to explore the second-line efficiency of capecitabine and oxaliplatin (XELOX) in patients with advanced pancreatic cancer who have received gemcitabine-based first-line therapy. Materials and Methods: We retrospectively evaluated 47 patients with locally advanced or metastatic pancreatic cancer previously treated with gemcitabine-based first-line regimens. Treatment consisted of oxaliplatin $130mg/m^2$ and capecitabine $1000mg/m^2$ twice daily with a 3 week interval, until unacceptable toxicity or disease progression. Results: Median number of cycles was 4 (range, 2-10). The overall disease control rate was 38.3%. The median overall survival and progression-free survival from the start of second-line therapy were 23 weeks (95%CI: 16.6-29.5 weeks) and 12 weeks (95%CI: 9.8-14.4 weeks), respectively. The most common grade 3-4 toxicities were nausea, vomiting and hematologic side effects. Conclusions: Our result suggests that the combination of capecitabine and oxaliplatin was tolerated with manageable toxicity and showed encouraging activity as second-line treatment of advanced or metastatic pancreatic cancer patients with ECOG performance status 0-2.

Adjuvant Radiotherapy for Gastric Carcinoma: 10 years Follow-up of 244 cases from a Single Institution

Misirlioglu, Hasan Cem,Coskun-Breuneval, Mehtap,Kucukpilakci, Bulent,Ugur, Vahide Isil,Elgin, Yesim,Demirkasimoglu, Taciser,Kara, Sakire Pinar,Ozgen, Aytul,Sanri, Ergun,Guney, Yildiz Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.20

Background: Postoperative chemoradiotherapy (CRT) of gastric carcinoma improves survival among high-risk patients. This study was undertaken to analyse long-term survival probability and the impact of certain covariates on the survival outcome in affected individuals. Materials and Methods: Between January 2000 and December 2005, 244 patients with gastric cancer underwent adjuvant radiotherapy (RT) in our institution. Data were retrieved retrospectively from patient files and analysed with SPSS version 21.0. Results: A total of 244 cases, with a male to female ratio of 2.2:1, were enrolled in the study. The median age of the patients was 52 years (range, 20-78 years). Surgical margin status was positive or close in 72 (33%) out of 220 patients. Postoperative adjuvant RT dose was 46 Gy. Median follow-up was 99 months (range, 79-132 months) and 23 months (range, 2-155 months) for surviving patients and all patients, respectively. Actuarial overall survival (OS) probability for 1-, 3-, 5- and 10-year was 79%, 37%, 24% and 16%, respectively. Actuarial progression free survival (PFS) probability was 69%, 34%, 23% and 16% in the same consecutive order. AJCC Stage I-II disease, subtotal gastrectomy and adjuvant CRT were significantly associated with improved OS and PFS in multivariate analyses. Surgical margin status or lymph node dissection type were not prognostic for survival. Conclusions: Postoperative CRT should be considered for all patients with high risk of recurrence after gastrectomy. Beside well-known prognostic factors such as stage, lymph node status and concurrent chemotherapy, the type of gastrectomy was an important prognostic factor in our series. With our findings we add to the discussion on the definition of required surgical margin for subtotal gastrectomy. We consider that our observations in gastric cancer patients in our clinic can be useful in the future randomised trials to point the way to improved outcomes.