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    Diagnosing between papillary carcinoma and reactive papillary changes in an infarcted thyroid nodule after fine needle aspiration and accompanied by a synchronous brain stem astrocytoma
    (Kare Publ, 2018) Goret, Ceren Canbey; Goret, Nuri Emrah; Ozkan, Omer Faruk; Karaayvaz, Muammer
    A 22-year-old patient underwent fine needle aspiration of a nodule at the outer center of the right lobe of the thyroid, and it was reported to be Bethesda system category IV, Hurthle cell follicular neoplasia. The patient, who persented to Onsekiz Mart University Research and Application Hospital, underwent surgery. During right total thyroidectomy, an almost totally infarcted nodule and papillary structures around these infarcted areas were detected. Herein, we report on diagnostic challenges faced in confirming whether the infarcted nodule was a case of reactive papillary changes or an underdiagnosed papillary carcinoma and how the challenges were overcome using immunohistochemistry analysis and molecular genetic testing. In addition, we examined the case along with a literature review because an accompanying synchronous brain stem astrocytoma was detected in the patient after thyroidectomy.
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    Intraoperative Endoscopic Retrograde Cholangiopancreatography in patients with complex benign biliary tract pathologies A case series
    (Edizioni Luigi Pozzi, 2018) Ozkan, Omer Faruk; Akbal, Erdem; Goret, Ceren Canbey; Goret, Nuri Emrah; Ozturk, Aydin; Cikman, Oztekin; Kocak, Erdem
    INTRODUCTION: This study presents data about the intraoperative performance of Endoscopic Retrograde Cholangiopancreatography (ERCP) for different types of cases with acute, complex pathologies of the biliary tract. MATERIALS AND METHODS: We retrospectively enrolled cases with intraoperative ERCP performed for different acute complex bile duct pathologies (including injury and cystic stump leak). All patients were analyzed according to demographic findings, etiologies, management and results. RESULTS: Intraoperative ERCP was performed in 4 patients of whom 2 (50%) were female and 2 (50%) were male with different diagnoses. The median age of patients was 468 (range of 28-75) years. The diagnosis was bile duct injury in three patients and one had a complicated hydatid cyst with jaundice (T Bil: 18 mg dl(-1)). All patients were in septic condition. Patients underwent laparotomy and intraoperative ERCP was performed successfully by using the Rendezvous technique. For the last patient, intraoperative ERCP was used for diagnosis and management of bile leak in the cavity. CONCLUSION: Intraoperative endoscopic retrograde cholangiopancreatography is a safe and effective method for treatment of acute complex bile duct pathologies.
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    SCOLICIDAL POTENCY OF BILE AGAINST ECHINOCOCCUS GRANULOSUS
    (Knowledgeworks Global Ltd-Kgl, 2025) Aydin, Isa Caner; Ilhan, Noyan; Seker, Ahmet; Ofluoglu, Cem Batuhan; Mulkut, Firat; Goret, Nuri Emrah; Cetin, Kenan
    Cysto-biliary fistulas are commonly diagnosed, either before or after surgical intervention, in patients with enlarged or advanced-stage hydatid cysts (HCs). Analysis of cystic contents in these patients shows that diminished scolex vitality is more common in patients with cysto-biliary fistulas. This study aims to demonstrate the scolicidal effects of bile on Echinococcus granulosus (EG) scolices at various bile concentrations and over specific periods. The time- and concentration-based scolicidal potency was analyzed in EG scolex samples obtained from HC patients. The integrity of the cyst wall and the scolicidal effect of the contents were evaluated using a vital staining technique with 0.1% eosin. Bile samples were collected from patients with cholelithiasis who were scheduled for surgery. Scolicidal efficacy of 100% was observed in all samples at the 1/4 bile concentration after 10 min and at the 1/8 concentration after 60 min. At a 1/16 concentration, scolicidal efficacy was 66% at 1 min, 89% at 10 min, 93% at 30 min, and 98% at 60 min. At a 1/32 bile concentration, scolicidal efficacy was 59% at 1 min, 68% at 10 min, 89% at 30 min, and 95% t 60 min. At a 1/64 concentration, the scolicidal efficacy was 53% at 1 min, 58% at 10 min, 77% at 30 min, and 93% at 60 min. After 1 hr, reasonable scolicidal efficacy was determined up to a 1/64 concentration; however, significant decreases in scolicidal efficacy were observed at 1/128 and 1/256 bile concentrations. Theoretically, bile, which is an endogenous secretion, can be used as a suitable and potent scolicidal agent. This study lays the groundwork for future in vivo clinical trials utilizing synthetic bile acids for scolicidal purposes or for studies evaluating the scolicidal effects of bile in patients who develop cysto-biliary fistulas.
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    The effect of pycnogenol on lymphatic nodes and adhesion during in a peritoneal adhesion model in rats
    (Acta Cirurgica Brasileira, 2018) Goret, Ceren Canbey; Goret, Nuri Emrah; Kiraz, Asli; Ozkan, Omer Faruk; Karaayvaz, Muammer
    Purpose: To investigate the effects of pycnogenol on peritoneal adhesions and additionally to investigate the immunohistochemical effects of free oxygen radicals and reactive lymph nodes detected in the adhesive tissue that was sampled surrounding the cecum on intra-abdominal adhesions. Methods: Twenty-seven Wistar Albino rats were divided into three groups. In group 1 (sham), laparotomy was performed and stitched up. In group 2 (control), after laparotomy was performed, punctate hemorrhage was induced by cecal abrasion in the cecum and each rat was intraperitoneally administered 2 cc of saline. In group 3 (experimental), after laparotomy was performed, punctate hemorrhage was induced by cecal abrasion in the cecum and each rat was intraperitoneally administered a sterile Pycnogenol derivative. The rats in all groups were re-laparotomized on postoperative day 7; samples were obtained from the peritoneal tissue surrounding the cecum, and the rats were sacrificed. Results: In group 3, there was a statistically significant difference in terms of inflammation, lymph node size, and free oxygen radicals; these parameters tended to increase. In terms of fibrosis evaluated using H&E and MT, there was no significant difference between groups 2 and 3. Conclusions: No positive outcomes indicating that pycnogenol reduces intra-abdominal adhesions were obtained. However, it caused severe inflammation in the tissue. Moreover, a significant increase in lymph node size was detected secondary to inflammation. Additionally, in immunohistochemical analyses conducted to detect oxidative stress, pycnogenol increased the production of free oxygen radicals in the tissue.