A Demir

Publications (9)9.19 Total impact

• Article: Diagnosis and treatment of spontaneous pneumomediastinum.

  M Z Gunluoglu, L Cansever, A Demir, C Kocaturk, H Melek, S I Dincer, M A Bedirhan
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  ABSTRACT: Due to its rarity there is no clear policy on the management of spontaneous pneumomediastinum (SPM). We treated 23 SPM patients between January 1 996 and November 2 006. There were 20 males and 3 females and their mean age was 27. Clinical records of the patients were collected and analyzed. The most frequent symptoms were neck swelling (n = 20) and rhinolalia (n = 15). Onset of the symptoms was acute. A preceding factor was found in 19 (83 %) patients; these included vigorous cough, forced physical activity, vigorous sneezing and enormous efforts during spontaneous vaginal delivery. Chest X-ray was sufficient to show mediastinal free air in 18 patients. Computerized chest tomography showed pneumomediastinum in all patients. Twenty patients were treated expectantly. Subcutaneous air drainage was needed to drain massive subcutaneous emphysema in three patients. Acute onset of typical symptoms, the existence of a preceding factor and the exclusion of other possible causes of pneumomediastinum with the help of CT are sufficient to make a diagnosis of SPM. A surgical intervention is generally not needed for the treatment of this entity.
  The Thoracic and Cardiovascular Surgeon 07/2009; 57(4):229-31. · 0.88 Impact Factor
• Article: Surgical treatment of superior sulcus tumors: results and prognostic factors.

  A Demir, A Sayar, C I Kocaturk, M Z Gunluoglu, H Akýn, M Metin, L Cansever, A Olcmen, S I Dincer, M A Bedirhan, A Gurses
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  ABSTRACT: This study aims to investigate the treatment modalities and factors influencing survival in surgically treated superior sulcus tumors. Sixty-five cases of surgically treated non-small cell carcinoma of the lung occurring as superior sulcus tumors between 1994 and 2007 were retrospectively reviewed. Twenty-five patients underwent induction radiotherapy (RT), 10 had induction chemoradiotherapy (CT/RT). In thirty patients surgery was performed directly. The mortality rate was 6.2 %. Pathological stage was T3 in 55, T4 in 10, N0 in 52, and N1 in 5 and N2 in 8 patients. Overall 5- and 10-year survival rates were 31 % and 28 %, respectively. Complete resection rate was 90 % for patients who received induction CT/RT and 80 % for patients who either received induction RT alone or patients in whom surgery was performed directly. In patients who received neoadjuvant therapy with complete tumor resection, the median survival time was 33 months (28 months for patients who received induction RT alone and 36 months for patients who received induction CT/RT), and the 5-year survival rate was 41 %. Median survival time and 5-year survival rate of patients treated by direct surgery with complete resection was 24 months and 37 %, respectively ( P = 0.87). Five-year survival and 10-year survival rates were significantly higher after complete resection than after incomplete resection (38 % and 34 % vs. 0 %, P = 0.0001). In multivariate analysis, only N2 disease ( P = 0.04) and incomplete resection ( P = 0.03) were found to be poor prognostic factors. The presence of N2 disease and incomplete resection are the two most important factors affecting survival. Induction CT/RT may increase the ability to achieve complete surgical resection.
  The Thoracic and Cardiovascular Surgeon 04/2009; 57(2):96-101. · 0.88 Impact Factor
• Article: Vascular endothelial growth factor gene polymorphisms in Turkish patients with sarcoidosis.

  E C Seyhan, E Cetinkaya, S Altin, M Z Gunluoglu, A Demir, V Koksal, H Issever
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  ABSTRACT: Polymorphism at +813 locus of vascular endothelial growth factor (VEGF) gene is considered to decrease predisposition to sarcoidosis. Our study aimed to investigate the roles of this polymorphism in the development and extent of sarcoidosis. We examined polymorphisms of the VEGF gene in 90 cases with histopathological diagnosis of sarcoidosis and in 110 healthy subjects. VEGF +813 gene polymorphisms were determined using a polymerase chain reaction-based method after DNA isolation. A significant increase in the frequency of the T allele was found in healthy subjects (odds ratio 0.55; 95% confidence interval 0.32-0.97, P<0.05). Our results suggest that increase in rarer T allele at + 813 locus of VEGF gene may diminish susceptibility to sarcoidosis in Turkish population.
  Tissue Antigens 06/2008; 72(2):162-5. · 2.59 Impact Factor
• Article: Prognostic factors in resected T3 non-small cell lung carcinoma: perineural invasion as a new prognostic factor.

  A Demir, M Z Gunluoglu, H V Kara, N Buyukpinarbasili, S I Dincer
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  ABSTRACT: Currently the best prognostic indicator for resected non-small cell lung cancer (NSCLC) is the TNM stage. Moreover, certain histopathological properties of the tumor (such as lymphatic, vascular and perineural invasion) can help to predict the survival of the patients. Between 1997 and 2004, the results of surgical treatment were retrospectively analyzed for 153 patients with T3 non-small cell lung cancer. One hundred and twenty-four of them had had complete (R0) resections, and 29 had had incomplete (R1) resections. The prognostic factors evaluated by univariate and multivariate analysis were: type of resection; N status; subgroup of pT3; effect of adjuvant therapy; tumor size; histological type; tumor differentiation; lymphatic invasion; vascular invasion; and perineural invasion. The overall 5-year survival rate was 32 % in R0 patients, and 8 % in R1 patients ( P = 0.0002). The presence of N2 disease, vascular invasion, and perineural invasion were found to be significant prognostic indicators in univariate analysis ( P = 0.0058, P = 0.033, and P = 0.0058, respectively). Among these indicators, N2 disease and perineural invasion were also found to be significant prognostic factors in multivariate analyses ( P = 0.013, and P = 0.003, respectively). Incomplete resection, N2 disease, vascular and perineural invasion were found to be prognostic indicators for the survival of T3 NSCLC patients. Of these indicators, perineural invasion was found to be the strongest predictor of poor prognosis and independently affected the patients' survival.
  The Thoracic and Cardiovascular Surgeon 04/2008; 56(2):93-8. · 0.88 Impact Factor
• Article: Factors affecting morbidity in chronic tuberculous empyema.

  Y Sonmezoglu, A Turna, A Cevik, A Demir, A Sayar, Y Dincer, M A Bedirhan, A Gurses
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  ABSTRACT: Chronic empyema is not a rare complication of pulmonary tuberculosis. Various treatment modalities ranging from open drainage to pneumonectomy, depending on the status of the disease, have been used to treat this complication. However, the best strategy for this disease remains unknown. This study examined the results of different treatment strategies for chronic tuberculous empyema. Between January 1993 and December 2002, 36 patients (29 male and 7 female) with an average age of 29.3 years (range 13 - 52 years) presented with chronic tuberculous empyema characterized by empyema cavity and persistent pleural infections that were secondary to tuberculosis. The series consisted of patients who had had tube thoracostomy and underwater drainage without complete re-expansion. All patients were treated with open drainage. Of these, 6 patients had Eloesser flap for complete drainage of pleural pus and resolution of pleural infection. Eloesser-flap drainage resulted in a higher morbidity compared to the open-drainage-only method ( P = 0.011). Pneumonectomy, used as a final therapeutic option, resulted in more complications postoperatively ( P = 0.034). Antituberculosis therapy lasting six months or longer reduced the morbidity rate (54 % vs. 33.3 %), but the difference was not significant. Our findings indicate that open drainage leads to better results compared to those of Eloesser flap in patients with chronic tuberculous empyema. Patients who underwent pneumonectomy were expected to have higher complication rates and the procedure must therefore be avoided when possible.
  The Thoracic and Cardiovascular Surgeon 04/2008; 56(2):99-102. · 0.88 Impact Factor
• Article: Results of multimodal treatment of two patients with thoracic primitive neuroectodermal tumor. Is surgery really helpful for survival?

  M Z Gunluoglu, H V Kara, A Demir, S I Dincer
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  ABSTRACT: Primitive neuroectodermal tumors (PNET) belong to the group of small round cell tumors and are rarely seen. They are rapidly progressive tumors, despite usually being treated by a multimodal therapy which includes surgery and chemoradiotherapy. We present two patients with PNET of the thorax treated in our clinic. The first patient had a huge tumor in the right hemithorax, which shifted the mediastinum to the contralateral hemithorax. Diagnosis was established by transthoracic fine-needle aspiration biopsy and the tumor was treated by surgical resection. Surgery resulted in a microscopically incomplete resection. Chemoradiotherapy was given postoperatively. The patient had local recurrence after seven months and died of cranial metastasis. The second patient had a small tumor on the right costovertebral angle which protruded towards the skin and was diagnosed by incisional biopsy. The tumor responded very well to preoperative chemotherapy and complete resection was achieved surgically. Postoperative chemoradiotherapy was also given. This patient had bone metastasis, local recurrence and pleural pulmonary metastasis after 6, 18 and 28 months, respectively, and died 30 months after the operation.We discuss the limited effect of surgery on the treatment of thoracic PNET on the basis of the results of these patients in whom we performed surgery.
  The Thoracic and Cardiovascular Surgeon 11/2007; 55(7):460-1. · 0.88 Impact Factor
• Article: Delayed diagnosis of a complete bronchial rupture after blunt thoracic trauma.

  A Demir, A Olcmen, H V Kara, S I Dincer
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  ABSTRACT: Bronchial ruptures due to blunt chest traumas are rarely encountered injuries. They can be missed in the emergency room depending on the clinical findings. We present a case report of a previously healthy 32-year-old woman who received multiple rib and clavicula fractures on the right side in a traffic accident. The plain radiograms taken on the first and fifth day showed no other pathological findings than the above-mentioned fractures. Her control chest radiography, which was taken 7 weeks later, showed a totally opaque left hemithorax but no findings of pneumothorax were present. Fiberoptic bronchoscopy and virtual bronchoscopy showed a left main bronchial rupture. The patient was treated with an end-to-end anastomosis via left posterolateral thoracotomy.
  The Thoracic and Cardiovascular Surgeon 01/2007; 54(8):560-2. · 0.88 Impact Factor
• Article: The value of mediastinoscopy in preoperative evaluation of mediastinal involvement in non-small-cell lung cancer patients with clinical NO disease.

  A Gürses, A Turna, M A Bedirhan, T Ozalp, C Kocatürk, A Demir, M Ozcan, N Urer
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  ABSTRACT: The efficacy of mediastinal lymph node examination using cervical mediastinoscopy in operable non-small cell lung cancer patients without radiological nodal involvement on computerized tomography (CT) has been elusive. The value of mediastinoscopy as a staging modality for assessing the mediastinal lymph node status was evaluated in 79 patients with presumed resectable non-small-cell lung cancer (NSCLC) with mediastinal nodes smaller than 1 cm (NO) form the CT scan. Sixty-one patients who did not have nodal involvement at mediastinoscopy and had complete medical records underwent complete resection. Negative predictive value (NPV) of the CT scan according to mediastinoscopy was 92.4 %. Histopathological examination of the surgical specimen showed the NPV of mediastinoscopy to be 93.4 %. Only 4 patients (3 patients with N2, 1 patient with N3 disease) were not correctly staged using CT scanning and mediastinoscopy. According to the pathological examination, the NPV of CT was found to be lower (76.5 %) in patients with adenocarcinoma, but the difference was not statistically significant (p > 0.128) Although the likelihood of surgical-pathological N2 is slightly higher in patients with adenocarcinoma, radiological examination of patients with cNO NSCLC disease can be as accurate as mediastinoscopy in appropriately staging mediastinal lymph node involvement.
  The Thoracic and Cardiovascular Surgeon 06/2002; 50(3):174-7. · 0.88 Impact Factor
• Source

  Available from: Seyyit Ibrahim Dincer

  Article: Primary tracheal schwannoma: a case report.

  S I Dincer, A Demir, H V Kara, N Fener, S Altin
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  ABSTRACT: We present a rare case of primary tracheal schwannoma in a 49-year-old man who had experienced obstructive airway symptoms for 4 years. Computed Tomography (CT) showed an intratracheal polipoid mass lesion originating from the left lateral wall. Fibre-optic bronchoscopy revealed the diagnosis of an intratracheal poylpoid mass obstructing 70% of the lumen. After diagnosing a benign lesion by punch biopsies with bronchoscopy, thoracotomy was performed and the tumour was totally excised. Histopathological examination revealed a benign neurogenic tumour of schwann cell origin.
  Acta chirurgica Belgica 106(2):254-6. · 0.43 Impact Factor