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Öğe Age-related clinical features in older patients with acute appendicitis(Lippincott Williams & Wilkins, 2003) Gürleyik, Günay; Gürleyik, EminAcute appendicitis, the most common cause of abdominal surgical emergency, shows a different pathogenesis, clinical course and outcome in the elderly. Age-specific factors are effective on preoperative clinical diagnosis and on the stage of this infectious disease. We aimed to present our experience with a series of elderly patients with appendicitis who were subjected to appendectomy. Operative and hospital records of patients with appendicitis were retrospectively reviewed. Patients who were 50 years of age or older were the main constituents of the study. Demographic features, preoperative clinical diagnosis, abdominal interventions, and postoperative morbidity and mortality were analysed as the main criteria. A total of 109 older patients have constituted 4.3% of our appendectomy cases. Besides right lower quadrant transversal incisions, surgery was performed via vertical incisions in 28.4% of cases with a diagnosis of acute abdomen. In the elderly, the perforation rate was significantly higher than in paediatric and adult patients (P < 0.001). The proportion of the elderly among perforated cases was significantly increased when compared with non-perforated cases (12.9 versus 2.9%; P < 0.001). Postoperative morbidity was noted in 35.8% of elderly patients, in 73.8% of perforated, and in 11.9% of non-perforated cases (P < 0.001). The mortality rate was 5.5% in the elderly group, 11.9% in patients with perforated, and 1.5% in patients with non-perforated appendicitis. No mortality was noted in patients younger than 50 years. The precise diagnosis of appendicitis is relatively low in the elderly. Despite the uncommon occurrence of appendicitis, the perforation rate is still unfavourable. Postoperative morbidity and mortality is unacceptably high. Advancing age adversely affects clinical diagnosis, the stage of disease and the outcome of patients. Perforated appendicitis and septic progression is the main cause of undesirable outcomes. (C) 2003 Lippincott Williams & Wilkins.Öğe Anatomy and motor function of extra-laryngeal branching patterns of the recurrent laryngeal nerve; an electrophysiological study of 1001 nerves at risk(Taylor & Francis Ltd, 2022) Gürleyik, Emin; Gürleyik, GünayIntroduction Safe thyroid surgery depends on a deep knowledge of human neck anatomy, including the recurrent laryngeal nerve (RLN). Anatomic variations such as extra-laryngeal terminal branching (ETB) are common. Patients and methods We studied the ETB pattern of 1001 RLNs at risk in 596 patients. We identified and exposed the location of division points on the cervical part of bifid RLN. The function of nerve branches was assessed through intraoperative nerve monitoring (IONM). Results Bifid RLNs was identified in 39.6% of patients. The nerve-based prevalence of ETB was 28.5%. The prevalence of ETB for the right and left RLN was 21.8% and 35.5%, respectively (p < 0.001). The location of the division point was found in the middle, distal, and proximal segments in 48.8%, 33.3%, and 18% of bifid RLNs, respectively. Electrophysiological monitoring revealed motor functions in all anterior and in 7% of posterior branches. The rate of injury was 0.4%, and 1.1% in single trunk and bifid nerves, respectively (p = 0.360), and 3.9% in nerves with proximal branching (p = 0.084). Conclusions The ETB prevalence is high and showing division points in different cervical segments of the RLN. All anterior branches and some posterior branches contain motor fibers. Knowledge and awareness of these anatomic and functional variations are mandatory for every thyroid surgeon to avoid misidentification and misinterpretation of human RLN anatomy.Öğe Appendicular mass imitating a malignant cecal tumor on f18-FDG PET/CT study: A case report(2009) Günal, Ömer; Doğan, Semih; Gürleyik, EminFluoro-Deoxy-Glucose Positron Emission Tomography/Computerized Tomography scan is a very useful method in the diagnosis and follow-up of gastrointestinal malignancies, although it may cause confusion in differential diagnosis. We present a 48-year-old man admitted with a right lower quadrant mass. Upon an unyielding colonoscopy due to inability to pass beyond the hepatic flexure, a Fluoro-Deoxy-Glucose Positron Emission Tomography/Computerized Tomography strongly suggested a right colonic or cecal malignancy. Eventual laparatomy revealed a periappendiceal plastron due to appendicitis that was subsequently proven histological diagnosis. Although Fluoro-Deoxy-Glucose Positron Emission Tomography/Computerized Tomography is a reliable diagnostic tool for colonic malignancies, it can misdiagnose such masses due to inflammatory process around the cecum. © 2009 licensee BioMed Central Ltd.Öğe Assessment of anal sphincter function by sengstaken-blakemore tube anal manometry(Springer, 2007) Günal, Ömer; Gürleyik, Emin; Arıkan, Yüksel; Pehlivan, MevlütBackground: Anal manometry is a useful tool for testing the effectiveness of surgical treatment. However, most techniques for anal pressure measurement are not easily available because of high cost. The aim of the present study was to introduce an easy and reproducible method for measuring anal pressures in testing the effectiveness of surgical procedures. Materials and methods: We used a Sengstaken-Blakemore tube connected to a mercury manometer. After calibration of the system by inflating the distal (gastric) balloon and filling connection lines to the mercury manometer with 0.9% NaCl solution, resting and squeezing anal pressures were measured. The system was used on 50 human subjects (35 with anal fissure and 15 normal volunteers). Left lateral internal sphincterotomy had been performed in the anal fissure cases. Anal pressures were measured preoperatively and on postoperative days (POD) 2 and 20. Results: Preoperative resting anal pressures in the group with anal fissure (83.4 +/- 1 mmHg) were significantly higher than those in the group of normal individuals (52 +/- 1.2 mmHg; p = 0.001). Resting anal pressures after the sphincterotomy (29 +/- 1 mmHg) were found to be significantly lower on POD 2, and resting anal pressure measurements (47 +/- 1 mmHg) on POD 20 were lower than the corresponding preoperative values. These values are closer to those of normal volunteers (p = 0.016). Conclusions: Anal manometry can be performed with this easily constructible and inexpensive system. This reproducible method can be used in the assessment of the results of surgical treatment in patients with anal and perianal diseases.Öğe Clinical importance of solitary solid nodule of the thyroid in endemic goiter region(Medknow Publications, 2005) Gürleyik, Emin; Coşkun, Özgür; Aslaner, ArifContext: Endemic area and iodine supplementation may affect the pathogenesis of the nodule which commonly occurs in endemic thyroid enlargement due to iodine deficiency. Aims: To establish pathological changes in solitary solid and larger nodule of the thyroid in endemic area. Setting and Design: Retrospective study in Surgical Department of University Hospital. Methods and Material: We determined 44 surgically treated patients with solitary solid nodule in endemic goiter area in which the population routinely receives iodinated salt. The thyroid nodule was preoperatively evaluated with blood chemistry, ultrasound, nuclear scanning and FNAC. The results of preoperative evaluation, surgical interventions, and histopathological examination were analyzed. Statistical analysis: Student t test and Fisher's exact test. Results: Twenty (45%;20/44) patients with hot (autonomous) nodule have received the diagnosis of toxic adenoma. Twenty four patients had solitary solid and cold nodule. Total thyroidectomy was performed on two patients with papillary cancer (PTC) diagnosed by FNAC from cold nodules. Forty two patients have been treated with total excision of the lobe including hyper or hypoactive solitary solid nodule. Pathological examination has reported two more cases of PTC and one case of insular cancer arising from cold nodules. Completion thyroidectomy was performed on these 3 patients. Conclusions: Solitary solid and large nodule is a common indication for thyroid surgery in endemic goiter area. High incidence of hyperthyroidism due to single autonomous nodule, and high rate of malignant change (mainly papillary cancer) in solitary hypoactive nodule arises from this series in endemic thyroid enlargement.Öğe Coexistence of Right Nonrecurrent Nerve and Bifurcated Recurrent Laryngeal Nerve Pointed by Zuckerkandl's Tubercle(Cureus Inc, 2017) Gürleyik, Emin; Doğan, Sami; Çetin, FuatThe recurrent laryngeal nerve (RLN) has many anatomical variations and various relations with adjacent structures. Identification and total exposure of the cervical part of the RLN was performed during operations on the thyroid gland. An extremely rare anatomical variation of the nerve was encountered during the surgical procedure. Coexistence of both right RLN and non-RLN was observed in one patient surgically treated with total thyroidectomy. We first exposed the right RLN with an extralaryngeal terminal bifurcation at its usual position. Thereafter, we also identified an ipsilateral non-RLN joining the anterior branch of the RLN just before laryngeal entry. A Zuckerkandl's tubercle has pointed out the junction of the two nerves. In this period, the incidence of coexistence of non-RLN and RLN was 0.2% in our series. A non-recurrent course is a rare anatomical variation of the inferior laryngeal nerve. The coexistence of both non-RLN and RLN is an extremely rare anatomical finding which should be taken into account during thyroid surgery.Öğe Critical issues in groin hernia management.(2009) Günal, Ömer; Gürleyik, EminAccess to the posterior inguinal wall is a fundamental part of inguinal hernia repair. The approach to the inguinal canal may affect the course and outcome of the operation. The aim of this study is to compare posterior approach (PA) repair with the standard anterior approach (AA). The study included 91 low-risk unilateral primary inguinal hernia patients who randomly received AA repair or PA repair. Various outcome measures in both groups were compared, and the mean operating time was longer for the AA repair group. Intra-operative complications were the same in both groups. Postoperative complications were more frequent in the AA repair group. The at-rest mean visual analog score (VAS), 24 hours postoperatively, seemed to be higher in the AA repair group. AA patients were able to postoperatively walk sooner than PA patients. Inguinal hernia repair through a PA seems to be less painful, less debilitating, and more easily applicable than the AA. Such advantages may be the reasons to select it as a standard procedure of choice.Öğe Displacement of the Recurrent Laryngeal Nerve in Patients with Recurrent Goiter Undergoing Redo Thyroid Surgery(Hindawi Ltd, 2018) Gürleyik, Emin; Çetin, Fuat; Doğan, Sami; Yekenkurul, Erman; Önsal, Ufuk; Gürsoy, Fatih; İpor, AlperThyroid reoperations are surgically challenging because of scarring and disturbances in the anatomy of the recurrent laryngeal nerve (RLN). This study was conducted on 49 patients who underwent redo surgery. 61 RLNs were identified and completely exposed. Their functional integrity was evaluated using intraoperative nerve monitoring (IONM). Indications for secondary surgery, anatomical changes secondary to recurrent goiter mass and prior surgery, and results of IONM were studied. Frequent indications for redo surgery were multinodular goiter (MNG) in 19 (38.8%) and results of cytology in 14 (28.5%) patients. The mean time interval between primary and redo thyroid surgery was 23.4 years. We laterally approached 41 (67.2%) thyroid lobes between the sternocleidomastoid and sternohyoid muscles. 16 (26.2%) RLNs were found to be adherent to the lateral surface of the corresponding thyroid lobe. The functional integrity of all RLNs was confirmed by IONM. The remnant thyroid tissue can then lead to goiter recurrence requiring secondary surgery after a long period of time. The indications for redo surgery were similar to primary cases. Lateral displacement of the RLN which is adherent to the lateral surface of recurrent goiter mass is common anatomic variation. Thyroid reoperations based on awareness of anatomical disturbances can be performed safely by an experienced surgeon with support of ancillary electrophysiological technology.Öğe Does the approach to the groin make a difference in hernia repair?(2007) Günal, Ömer; Özer, Ş.; Gürleyik, Emin; Bahçebaşı, TalatBackground: Laparoscopic and open preperitoneal hernia repair techniques both use the preperitoneal space. This study investigated whether the surgical approach to the inguinal canal affects outcome measures. Methods: One hundred sixty patients with inguinal hernia were assigned randomly into open anterior (42), open preperitoneal (39), laparoscopic transabdominal preperitoneal (39), and laparoscopic total extraperitoneal (40) groups according to the surgical method. The peroperative serum tumor necrosis factor-? (TNF-?) levels, interleukin-6 (IL-6) levels, VAS scores at 6 and 48 h, per- and postoperative complications, and recurrence rates were determined as main variables. Results: The serum IL-6 levels were 335 ± 1.8, 283 ± 1.8, 283 ± 1.4, and 269.3 ± 1.6 pg/ml in the open anterior, posterior, transabdominal preperitoneal, and total extraperitoneal groups, respectively (P < 0.01). The TNF-? levels were highest in the open anterior group. The pain scores were lower in groups undergoing the posterior approach than in the open anterior approach group. Conclusion: The approach to the inguinal canal through the preperitoneal space appears to be less invasive than the transinguinal anterior approach. © Springer-Verlag 2007.Öğe Öğe Early enteral and glutamine enriched enteral feeding ameliorates healing of colonic anastomosis: Experimental study(Turkish Association of Trauma and Emergency Surgery, 2006) Gökpınar, İbrahim; Gürleyik, Emin; Pehlivan, Mevlüt; Özcan, Ömer; Özaydın, İsmet; Aslaner, Arif; Gültepe, MustafaBACKGROUND: To investigate the effects of postoperative early enteral and glutamine enriched enteral feeding on the healing of experimental colonic anastomosis. METHODS: Forty Wistar-albino rats were equally divided into 4 groups. Colonic transsection and anastomosis situated at the distal left colon was performed on all animals. Animals in groups 1 and 2 received late total enteral nutrition (TEN) and in groups 3 and 4 early TEN. Glutamine was added to TEN protocol in groups 2 and 4. The colonic segment including the anastomosis was excised at the end of the 7th day postoperatively. Bursting pressure of the anastomosis and tissue hydroxyproline levels were determined. RESULTS: Bursting pressure levels were 111.6 and 95.8 centimeters of water (cmH2O) in early and late nutrition groups, respectively (p=0.022). Comparison of late TEN groups showed a significant difference in favor of group with glutamine (95.8 vs 138.5 cmH2O; p<0.0001). Highest bursting pressures (139 and 138.5 cmH2O) were measured in both early and late TEN groups with glutamine. Tissue hydroxyproline level in early TEN group (2440.3 ?g) was significantly higher than late TEN group (1509.6 ?g; p=0.024). Comparison of late TEN groups showed a considerable but not statistically significant difference (p=0.276) in favor of group with glutamine (1509.6 vs 1981.6 ?g). CONCLUSION: Postoperative early TEN significantly ameliorates the resistance of the anastomosis and collagen synthesis. Glutamine enrichment in nutritional protocol decreases and reverses the disadvantages of late TEN regarding the resistance of anastomosis. A similarly positive, albeit weaker, effect of glutamine supplementation is also seen on collagen synthesis.Öğe Early glutamine-enriched enteral feeding facilitates colonic anastomosis healing: Light microscopic and immunohistochemical evaluation(Elsevier Gmbh, 2007) Güven, Aysel; Pehlivan, Mevlüt; Gökpınar, İbrahim; Gürleyik, Emin; Çam, MeryemProblems related to colonic anastomosis heating constitute the major morbidity in colorectal surgery. Patients without appropriate nutritional support are at higher risk of postsurgical complications, mainly due to reduced wound heating. Therefore, we investigated the effect of early and late postoperative total enteral. nutrition (TEN) and glutamine addition on colon anastomosis heating using tight microscopy and immunohistochemistry (IGF-I immunolabelling). In this study, 40 Wistar-albino rats underwent distal. left colonic transection and anastomosis. The rats were then divided into four groups given different diets: delayed total enteral. nutrition (dTEN; beginning 3 days postoperatively), delayed TEN with added glutamine (dTEN+ Glutamine), early TEN (eTEN; beginning within 6 h postoperatively), and early TEN with added glutamine (eTEN+Glutamine). Colon segments, including the anastomosis, were excised 7 days postoperatively and evaluated histopathologically for inflammation, mucosal heating, submucosal-muscular layer repair, the amounts of necrosis and vascularisation and immunohistochemically for IGF-I labelling. The inflammation and necrosis scores in the dTEN and dTEN+Glutamine groups were significantly greater than in the eTEN and eTEN+GLutamine groups. The IGF-I immunoreactivity increased in the eTEN, eTEN+Glutamine, and dTEN+Glutamine groups compared to dTEN (p<0.05). We concluded that early TEN and glutamine enrichment in the postoperative period improve anastomosis heating via IGF-I. (c) 2007 Elsevier GmbH. All rights reserved.Öğe Effects of Erdosteine on Experimental Acute Pancreatitis Model(Coll Physicians & Surgeons Pakistan, 2017) Karapolat, Banu; Karapolat, Sami; Gürleyik, Emin; Yaşar, MehmetObjective: To create acute pancreatitis condition experimentally in rats using cerulein, and to reveal histopathological effects in pancreatic tissue with erdosteine. Study Design: An experimental study. Place and Duration of Study: Department of General Surgery, Duzce University, Turkey, from June to October 2014. Methodology: Thirty male Wistar albino rats were divided into three groups. No procedures were applied to Group 1. The rats in Group 2 and Group 3 were injected cerulein, to establish an experimental pancreatitis model and the blood amylase and lipase values were examined. The rats in Group 3 were given 10 mg/kg erdosteine. This treatment was continued for another 2 days and the rats were sacrificed. The pancreatic tissues were examined histopathologically for edema, inflammation, acinar necrosis, fat necrosis, and vacuolization. Results: The lipase and amylase values and the histopathological examination of pancreatic tissues evidenced that the experimental acute pancreatitis model was established and edema, inflammation, acinar necrosis, fat necrosis, and vacuolization were observed in the pancreatic tissues. The statistical results suggest that erdosteine can decrease the edema, inflammation, acinar necrosis, fat necrosis and vacuolization scores in the tissues. Conclusion: The severity of acute pancreatitis, induced by cerulein in rats, is reduced with the use of erdosteine.Öğe Extralaryngeal terminal division of the inferior laryngeal nerve: Anatomical classification by a surgical point of view(2013) Gürleyik, EminBackground. Complete anatomic knowledge including all variations of the inferior laryngeal nerve (ILN) is mandatory for thyroid surgeon. Extralaryngeal terminal division (ETD) of the ILN has significant importance for the safety of thyroidectomy. Material and Methods. Surgical dissection of 200 ILNs was performed on 100 cases. The presence of ETD of the nerve was determined intraoperatively. We propose by a surgical point of view a regional (segmental) classification of ETD of the ILN along its cervical course. Results. ETD has been observed in 54/200 nerves (27%). Great majority are bifurcated nerves (trifurcation 2%). Four types of ETD are classified. In type 1 (arterial; 46.3%), ETD has occurred near inferior thyroid artery (ITA). In type 2 (postarterial; 31.5%), division has been found on postarterial segment. In type 3 (prelaryngeal; 11%), division has been located very close to laryngeal entry point. In type 4 (prearterial; 11%), ETD has occurred before the nerve crossing the ITA. Conclusions. ETD of the ILN is a common anatomical variation. The bifurcation occurs in the ILN at various distances from laryngeal entry point. The classification increasing surgeons' awareness may help to simplify identification and exposure of terminal branches. Preservation of both extralaryngeal terminal branches of the ILN has paramount importance for the safety of thyroid operations. © 2013 Emin Gurleyik.Öğe Incidental Papillary Thyroid Microcarcinoma in an Endemic Goiter Area(Hindawi Ltd, 2016) Gürleyik, Emin; Gürleyik, Günay; Karapolat, Banu; Önsal, UfukClinical and pathological characteristics of incidental papillary thyroid microcancer cases, surgical, medical, and nuclear treatment methods, and patients' outcome were studied during follow-up period of 102 months. We studied 37 patients with incidental papillary thyroid microcancer (I-PTM). The surgical procedure was total thyroidectomy in 29 and hemithyroidectomy in 8 patients. Size, multifocality, and bilateralism of PTMfoci, thyroid capsule invasion, and presence of lymphovascular invasion were histopathological parameters. We analysed adjuvantmedical and nuclear treatment and patients' outcome during follow-up period of 102 (61-144) months. The prevalence rates of I-PTM were 9.4% in 395 thyroidectomy cases. Histopathological examination reported unifocal disease in 30 and multifocal disease in 7 (18%) patients. Multifocal disease was bilateral in 6 (20.1%) patients. The mean size of the PTMfoci was 4.88 mm. The rate of thyroid capsule invasion was 5.4%. All patients received a suppressive dose of LT4 to achieve a low serum TSH level. Adjuvant surgical and nuclear treatment was not performed in our cases. We did not find any negative changes in blood chemistry and ultrasound imaging, and any unfavourable events as locoregional and systemic recurrence. In conclusion, diagnosis of I-PTM is common that multifocality and bilateralism appear as pathologic features. The prognosis is excellent after surgical treatment and TSH suppression. Routine adjuvant nuclear treatment is unnecessary in majority of patients.Öğe Intraoperative Monitoring and Preservation of Anatomic Integrity of Palsied Recurrent Laryngeal Nerve is Extremely Meaningful During Redo Thyroid Surgery(Coll Physicians & Surgeons Pakistan, 2022) Gürleyik, EminRedo thyroid surgery on patients with unilateral recurrent laryngeal nerve (RLN) palsy certainly poses a great surgical challenge. We present a case of a patient with unilateral vocal cord (VC) palsy who underwent redo thyroid surgery under intraoperative neuromonitoring. The patient's normal speaking voice was maintained after the primary surgery, even though preoperative laryngoscopy showed an immobile right VC with a normal structure. During reoperation, surgical exploration revealed the anatomical integrity of palsied RLN with extralaryngeal terminal bifurcation. The electrophysiological stimulation of the vagus nerve and palsied RLN generated wave amplitudes (V1: 242, R1: 347, R2: 352 and V2: 152 mu V). Despite positive amplitudes, postoperative laryngoscopy confirmed RLN palsy and corresponding VC paralysis but preserved the structure of the immobile VC. Even palsied RLN should be monitored during redo surgery. A positive signal delineates at least partial neural transmission despite VC palsy. The preservation of anatomical integrity of palsied RLN for eventual partial conductivity may be vital in preserving the normal structure of VC and maintaining the patient's voice despite its immobility.Öğe Intraoperative Monitoring of External Branch of the Superior Laryngeal Nerve: Functional Identification, Motor Integrity, and its Role on Vocal Cord Function(Taylor & Francis Inc, 2018) Gürleyik, Emin; Gürleyik, GünayPurpose: Beside recurrent laryngeal nerve (RLN), protection of the external branch of the superior laryngeal nerve (EBSLN) is required for complication-free thyroid surgery. This study investigates the contribution of intraoperative neuromonitoring (IONM) to identification and motor integrity of the EBSLN. Methods: This prospective study was performed on 245 EBSLNs in 147 patients with thyroid surgery. The rate of visual identification, contribution of IONM to functional localization, the rate and levels of recordable waveform amplitude from vocal cord (VC) movement were determined during surgery. Results: 164 (66.9%) EBSLNs were visually identified and additional 74 branches were functionally identified by IONM. Additional identification rate of IONM was 30.2%. Seven (2.9%) EBSLNs could not be identified during surgery. Cricothyroid muscle (CTM) twitch established functional integrity in 97.1% of EBSLNs. Electrophysiological stimulation of 151 (63.4%) EBSLNs created waveform amplitude >100 mu V that mean amplitude level was calculated as 186 mu V, and an amplitude >300 mu V was recorded in 19 of 151 (12.6%) EBSLNs. Conclusions: In addition to visual identification, surgeons can functionally localize the EBSLN with the assistance of IONM that CTM twitch is a reliable evience for functional integrity of the EBSLN. In the majority of patients, stimulation of the EBSLN creates recordable waveform amplitude thus the EBSLN appears to be a second source of motor innervations for intrinsic laryngeal muscles.Öğe Inverse 'D' incision technique in treatment of pilonidal sinus disease; excision with minimal tissue loss, closure without tension and lateral location of the suture line(Korean Surgical Society, 2019) Doğan, Sami; Çetin, Fuat; Gürleyik, EminPurpose: Surgical excision is the preferred treatment modality for sacrococcygeal pilonidal sinus (PS). Notably, the desirable features of an ideal surgical intervention are excision with minimal tissue loss, closure without tension, and a lateral suture line. The present study aimed to investigate early outcomes of surgical excision through the inverse D ((sic)) incision based on tissue loss, wound tension, and suture line location. Methods: This prospective study was comprised of 80 patients with PS in whom excision of PS was performed through the '(sic).' incision to minimize tissue loss with a tensionless primary surgical wound closure. The suture line was located laterally in all patients. Early and late postoperative complications, duration of hospital stay, return to work, and recurrence rates were investigated. The mean duration of the follow-up period was 36 months. Results: Sixty-three patients (78.8%) were male. PS in all patients was surgically removed by subcutaneous excision through a '(sic).' incision. Laterally placed surgical wounds were closed primarily with interrupted vertical mattress sutures. No general complications were encountered. Five patients (6.3%) experienced early postoperative surgical site complications. On average, the duration of hospital stay and return to work were 2.4 days and 3.8 days, respectively. Recurrence was seen in 1 case (1.3%) during the follow-up period. Satisfaction score was high in 83.8% of patients. Conclusion: The method of sinus excision using the '(sic).' incision with a primary suture facilitates excision with minimal tissue loss and closure without tension with an off-midline suture. It is both a simple and effective surgical technique for the treatment of sacrococcygeal PS.Öğe Location of motor fibers within branches of the recurrent laryngeal nerve with extralaryngeal terminal bifurcation; Functional identification by intraoperative neuromonitoring(Mosby-Elsevier, 2015) Gürleyik, EminBackground. Extra laryngeal terminal bifurcation (ETB) of the recurrent laryngeal nerve (RLN) is an anatomic variation that threatens the safety of thyroid operation. Therefore, it is important to identify motor function in nerve branches to preserve appropriate motor activity. Intraoperative neuromonitoring (IONM) is an accepted procedure to identify motor function of the RLN. Methods. We established the operative anatomy of RLNs with ETB in 47 patients. The main trunk, bifurcation point, and the branches were identified and exposed completely during thyroid operation. The location of motor fibers within nerve branches was investigated by identifying motor function via IONM. Wave amplitudes were recorded after electrophysiologic stimulation. Results. A total of 61 RLNs had ETBs with anterior and posterior branches. Bifurcation occurred early along the pre-arterial (proximal) segment in 13% of bifid RLNs. IONM showed motor function in all anterior branches. IONM identified motor activity in 4 (18%) posterior branches of 22 right, 3 (8%) posterior branches of 39 left, and 7 (12%) posterior branches of all 61 RLNs with ETB. The rate of recorded wave amplitudes of motor function in seven posterior branches was between 14 and 78% of those of corresponding anterior branches. Conclusion. In the RLN, the anterior branch always and the posterior branch uncommonly contain motor fibers. Wave amplitude analysis showed that motor function in the posterior branch is weaker than that in the anterior branch. On the basis of the location of motor fibers in both branches, total exposure and preservation of anatomy and function of all branches of the RLN is mandatory for complication-free thyroid surgery. Electrophysiologic testing may be as an important adjunct to visualization of the nerve with anatomic variation.Öğe Malignant Mesenchymal Tumor of the Breast: Primary Chondrosarcoma(Karger, 2009) Gürleyik, Emin; Yıldırım, Ümran; Günal, Ömer; Pehlivan, MevlütBackground: Primary mesenchymal tumors are an extremely rare malignancy of the breast. Case Report: A 52-year-old woman presented with a rapidly growing breast mass. Physical examination established a large and round mass with regular margins in the upper-outer quadrant of the right breast. Ultrasound showed a hypoechoic solid mass (41 x 36 mm) with lobulated contours. Mammography revealed a hyperdense and relatively regular-shaped mass giving the impression of a benign tumor. However, a pathologic report of atypical cells after fine needle aspiration necessitated surgical excision. The mass was removed with a wide local excision. The tumor was diagnosed as a high-grade chondrosarcoma of the breast by histopathological analysis. Following the final diagnosis, we performed a modified radical mastectomy based on the knowledge that this malignancy is generally refractory to radiotherapy. The regional lymph nodes and local adjacent tissues were free of metastasis. The tumor was negative for estrogen and progesterone receptors as well as HER2. Conclusion: Chondrosarcoma tends to grow rapidly. Physical examination usually reveals a large, round mass. The tumor is regular-shaped, round, and complex echoic on mammography and ultrasound. It usually does not invade regional structures. Surgery remains the only effective treatment.
