Experience of the Endoscopists Matters in Endoscopic Retrograde Cholangiopancreatography in Billroth II Gastrectomy Patients

Erkan Caglar,Deniz Atasoy,Mukaddes Tozlu,Engin Altınkaya,Serkan Dogan,Hakan Senturk 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.1

Background/Aims: Altered anatomy is a challenge in endoscopic retrograde cholangiopancreatography (ERCP) for patients withBillroth II anastomosis. In this study, we investigated the overall success and role of endoscopist experience. Methods: Data of patients who underwent ERCP between 2014 and 2018 after a previous Billroth II operation were retrievedretrospectively from 2 tertiary ERCP centers. The procedures were performed by 2 endoscopists with different levels of experience. Clinical success was defined as extraction of the stone, placement of a stent through a malignant stricture, and clinical and laboratoryimprovements in patients. Results: Seventy-five patients were included. The technical success rate was 83% for the experienced endoscopist and 75% for theinexperienced endoscopist (p=0.46). The mean (±standard deviation) procedure time was 23.8±5.7 min for the experienced endoscopistand 40.68±6.07 min for the inexperienced endoscopist (p<0.001). In total, 3 perforations (4%) were found. The rate of afferent loopperforation was 6.25% (1/16) for the inexperienced endoscopist and 0% (0/59) for the experienced endoscopist (p=0.053). Conclusions: ERCP in patients who had undergone Billroth II gastrectomy was time consuming for the inexperienced endoscopistwho should beware of the unique adverse events related to ERCP in patients with altered anatomy.

Blockchain Suitability Assessment of Manufacturing Functions Defined by the ISA95 Standard

Erkan Yalcinkaya,Antonio Maffei 대한산업공학회 2020 Industrial Engineeering & Management Systems Vol.19 No.4

The number of security incidents related to the manufacturing industry has been steadily increasing over the past decade. The most prominent security risks impacting the manufacturing industry are intellectual property theft, supply chain interruptions, industrial espionage, data breaches, and ransomware attacks. Blockchain is an emerging technology that offers distributed, highly available, resilient, and traceable ledger-based databases and thus opens new ways of dealing with conventional security challenges in the confidentiality, integrity, and availability domains. ISA95 outlines manufacturing functions in a number of areas and characterizes the information flows. Moreover, ISA95 constitutes a common blueprint for the manufacturing industry and this research paper systematically assesses the suitability of the blockchain technology for the ISA95 enterprise core functions and sub-functions as a way to ultimately increase the confidentiality, integrity, and availability of manufacturing systems.

Pretreatment Photopenia on 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography Scans Predicts Poor Prognosis in Nasopharyngeal Cancer Patients Undergoing Concurrent Chemoradiotherapy

Erkan Topkan,Ugur Selek,Hüseyin Mertsoylu,Yurday Ozdemir,Ahmet Kucuk,Nese Torun,Ali Ayberk Besen 대한이비인후과학회 2020 Clinical and Experimental Otorhinolaryngology Vol.13 No.4

Objectives. To investigate the influence of pretreatment primary tumor or nodal photopenia (PP) on 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT), an indicator of tumor ischemia, on survival results of nasopharyngeal cancers (NPCs) treated with concurrent chemoradiotherapy (C-CRT). Methods. The pre-C-CRT FDG PET-CT scans of 104 patients with NPC (cT1-4 N0-3 M0) were retrospectively examined to determine the presence of PP (PP+). Our primary endpoint was the influence of PP+ on overall survival (OS), while the progression-free survival (PFS) and locoregional PFS (LRPFS) constituted the secondary endpoints. Results. The PP+ was detected in 29 (27.9%): nine (8.7%), seven (6.7%), and 13 (12.5%) in the primary tumor alone, primary tumor plus neck nodes, and neck nodes alone, respectively. Because the PP+ cases were small by count per location, all comparative analyses were performed according to overall PP+/ PP– status instead of per detected site. At a median follow-up of 67.8 months (range, 9 to 130 months), the median survival times were not reached (NR) for the entire population, while 5-year OS, LRPFS, and PFS rates were 73.3%, 68.2%, and 63.4%, respectively. Comparatively the PP+ patients exhibited significantly poorer median OS (49.8 months vs. NR, P<0.001), LRPFS (40.7 months vs. NR, P=0.001), and PFS (31.8 months vs. NR, P=0.002) durations than their PP– counterparts. Furthermore, the PP+ retained its independent prognostic significance in multivariate analysis (P<0.001). Conclusion. Present results uncovered the pre-C-CRT PP as an independent predictor of poor prognosis for NPC patients, which underscore the requirement for the fortification of the local and systemic treatments in hypoxic NPCs.

Theoretical Models for Tie Bar Maximum Axial Force Demand in Composite Plate Shear Walls–Concrete Filled

Erkan Polat 한국강구조학회 2022 International Journal of Steel Structures Vol.22 No.4

This paper presents theoretical models developed for the prediction of the maximum axial force demands of tie bars of planar composite plate shear walls–concrete fi lled (C-PSW/CF). In the development of the theory, a previously benchmarked fi nite element (FE) wall model was used with some modifi cations. The results from the FE models were used to demonstrate the formation of the tie bar axial force demands, passive lateral confi ning pressure, concrete confi nement, eff ectively confi ned concrete core and to develop theoretical models for the prediction of tie bar maximum force demands. The proposed method accounts for various aspects of wall geometry such as horizontal and vertical tie bar spacings, steel plate thickness, and wall thickness. The predictions of the proposed theoretical models were compared with the predictions of FE analyses by performing a parametric study involving C-PSW/CF having diff erent tie bar spacings, plate thickness, wall thickness, and wall depths. Past experimental research available in the literature were used to evaluate the signifi cance of the theoretical model in predicting tie bar maximum axial force demands. Tie bar axial force demand due to the confi nement eff ect is not currently considered in the design of tie bars and there is no theoretical approach in the literature that considers the eff ect of confi nement on the tie bar axial force demand. The theoretical models presented in this study allow the determination of the maximum axial force demands due to the confi nement eff ect on planar C-PSW/CF tie bars without the need for complex and costly numerical analysis.

Long-Term Palliative Effect of Stenting in Gastric Outlet Obstruction Due to Transarterial Chemoembolization with Yttrium-90 in a Patient with Metastatic Neuroendocrine Tumor

Erkan Caglar,Gulen Doğusoy,Levent Kabasakal,Ahmet Dobrucali 대한소화기내시경학회 2016 Clinical Endoscopy Vol.49 No.5

Internal radioembolization with yttrium-90 is a promising treatment method, predominantly for liver tumors. However, the shifting of yttrium-90-loaded spherules into the arteries and veins that supply the duodenum and stomach, leading to ulceration, hemorrhage, perforation, and outlet obstruction of these organs, is one of the major undesirable consequences of this technique. We report a case of gastric outlet obstruction (GOO) due to antropyloric stenosis with ulceration, edema, and inflammation following transarterial yttrium-90 treatment for a metastatic neuroendocrine tumor in a 58-year-old man. Stenting was used for palliation in this case. GOO improved after stenting and recovery of oral intake was permanent after stent removal.

A Fuzzy TOPSIS Approach Based on Trapezoidal Numbers to Material Selection Problem

Erkan Celik,Muhammet Gul,Alev Taskin Gumus,Ali Fuat Guneri 한국데이타베이스학회 2012 Journal of information technology applications & m Vol.19 No.3

Material selection is a complex problem in the design and development of products for diverse engineering applications. This paper is aimed to present a fuzzy decision‐making approach to deal with the material selection in engineering design problems. A fuzzy multi criteria decision‐making model is proposed for solving the material selection problem. The proposed model makes use of fuzzy TOPSIS (Technique for Order reference by Similarity to Ideal Solution) with trapezoidal numbers for evaluating the criteria and ranking the alternatives. And result is compared with fuzzy VIKOR (VlseKriterijumska Optimizacija I Kompromisno Resenje in Serbian, means Multi criteria Optimisation and Compromise Solution) which is proposed by Jeya Girubha and Vinodh [2012]. The present paper is aimed to also improve literature of fuzzy decision making for material selection problem.

Efficacy and Safety of Intravitreal Dexamethasone Implants for Treatment of Refractory Diabetic Macular Edema

Erkan Unsal,Kadir Eltutar,Pınar Sultan,Sezin Ozdogan Erkul,Ozen Ayranci Osmanbasoglu 대한안과학회 2017 Korean Journal of Ophthalmology Vol.31 No.2

Purpose: To evaluate the safety and efficacy of intravitreal dexamethasone (IVD) implants in eyes with diabeticmacular edema that did not respond to previous treatment. Methods: We included 46 eyes of 46 patients in this retrospective study. Each month, we recorded patient visualacuity with logarithm of the minimum angle of resolution using the Early Treatment Diabetic RetinopathyStudy chart, central macular thickness measurements with optical coherence tomography, intraocular pressure(IOP), and posttreatment complication occurrence. Results: The mean follow-up time was 8.95 ± 1.33 months (range, 6 to 12). Best-corrected visual acuity improvedsignificantly in the first 4 months after IVD, but no statistically significant change was observed over the following2 months. Although a statistically significant decrease in central macular thickness was observed in thefirst 3 months, the change was not statistically significant in the following 3 months. There was a statisticallysignificant increase in IOP in the first 2 months, but no statistically significant change was observed in the followingmonths. IOP was controlled with medication in all patients with elevated IOP. Of the 26 phakic patients,two had cataracts requiring surgery. Conclusions: Cases of refractory diabetic macular edema that did not respond to previous treatment, such asanti-vascular endothelial growth factor injections and laser photocoagulation, exhibited improvements in visualacuity and decreases in retinal thickness after IVD implantation. Both functional and anatomical effects wereobserved in the first 3 months after injection. Repeat injections and frequent examination might be required forcontinued improvement. Side effects, such as cataracts and elevation of IOP, may require medical or surgicaltreatment.

Evaluation of prophylactic and therapeutic effects of ruscogenin on acute radiation proctitis

Erkan Yavuz,Onur Olgac Karagulle,Gulcin Ercan,Atilla Celik,Hakan Yigitbas,Busra Yaprak Bayrak,Rumeysa Tartar,Ramazan Kusaslan,Yuksel Altine,Osman Bilgin Gulcicek 대한외과학회 2018 Annals of Surgical Treatment and Research(ASRT) Vol.94 No.4

Purpose: Radiation proctitis (RP) is inflammation and damage to the rectum, manifested secondary to ionizing radiation utilized for treatment. In this study, we evaluated the anti-inflammatory therapeutical and protective effects of ruscogenin in a model of acute RP. Methods: Thirty-two Sprague-Dawley rats were divided into 4 groups (n = 8) as sham, control, treatment, and prophylaxis groups. Prophylaxis group and treatment group were dosed ruscogenin by oral gavage for 14 days pre- and postradiation. At the end of the 28th day, all subjects were sacrificed. Results: Histopathological analysis showed a significant increase in cryptitis abscess, cryptitis and reactive atypia, and depth of lymphocytic infiltration of the control group, compared to the other groups (P < 0.05), while treatment and prophylaxis groups showed significant decreases (P < 0.05). Immunohistochemical analysis indicated that immunoreactivity were significantly higher in control group (P < 0.05, P < 0.001, and P < 0.01, respectively), but vice versa for treatment and prophylaxis groups. There was not any significant difference for fibroblast growth factor 2 immunoreactivity. The epithelium of control rectums indicated an increase in TNF-α immunoreactivity while other groups had significant decrease (P < 0.01). Electron microscopical findings were parallel to light microscopy. Conclusion: In this study, ruscogenin was observed to be effective on prophylaxis or treatment of acute RP. Although there are various reports on the treatment of the rectum damaged by acute RP in the literature, this could be the first study since there is no research indicating the ultrastructural effect of ruscogenin.

Results of Endoscopic Surgery in Patients with Pituitary Adenomas : Association of Tumor Classification Grades with Resection, Remission, and Complication Rates

Erkan, Buruc,Barut, Ozan,Akbas, Ahmet,Akpinar, Ebubekir,Akdeniz, Yasemin Sefika,Tanriverdi, Osman,Gunaldi, Omur The Korean Neurosurgical Society 2021 Journal of Korean neurosurgical society Vol.64 No.4

Objective : The endoscopic endonasal transsphenoidal approach is a widely-used method for the surgical treatment of pituitary adenomas. We aimed to evaluate the results of endoscopic surgery by comparing preoperative classification methods and investigating their relationship with postoperative resection and remission rates and complications. Methods : We retrospectively reviewed the medical records of 236 patients (118 males) who underwent surgery for pituitary adenomas. Preoperative Knosp classification, tumor size (TS), suprasellar extension (SSE), postoperative resection and remission rates, and complications were evaluated. Results : The follow-up period was 3 months to 6 years. The patients' ages ranged between 16 and 84 years. Endocrinologically, 114 patients (48.3%) had functional adenoma (FA), and 122 patients (51.7%) had non-functional adenoma (NFA). Among the FA group, 92 (80.7%) showed remission. A statistically significant difference was found between patients with and without remission in terms of the Knosp, TS, and SSE classifications (p<0.01). Knosp, TS, and SSE classification grades were found to be correlated with the resection rates (p<0.01). Meningitis was seen in seven patients (3.0%), diabetes insipidus in 16 (6.9%; permanently in two [0.9%]), and rhinorrhea in 19 (8.1%). Thirty-six patients (15.3%) developed pituitary insufficiency and received hormone replacement therapy. Conclusion : The resection categories and remission rates of FAs were directly proportional to the adenoma sizes and Knosp grades, while the degree of suprasellar growth further complicated resection and remission rates. Adenoma sizes less than 2 cm and SSEs less than 1 cm are associated with favorable remission and resection rates.

Mucocutaneous Lesions of Behcet's Disease

Erkan Alpsoy,Christos Constantin Zouboulis,George Edward Ehrlich 연세대학교의과대학 2007 Yonsei medical journal Vol.48 No.4

Behcet's disease is particularly prevalent in “Silk Route” populations, but it has a global distribution. The diagnosis of the disease is based on clinical criteria as there is as yet no pathognomonic test, and mucocutaneous lesions, which figure prominently in the presentation and diagnosis, may be considered the diagnostic hallmarks. Among the internationally accepted criteria, painful oral and genital ulcers, cutaneous vasculitic lesions and reactivity of the skin to needle prick or injection (the pathergy reaction) are considered hallmarks of Behcet's disease, and often precede other manifestations. Their recognition may permit earlier diagnosis and treatment, with salutary results. This paper describes the various lesions that constitute the syndrome and focuses on those that may be considered characteristic.