Ozay Ozkaya's research while affiliated with Okmeydani Training and Research Hospital and other places

Purpose: The toll-like receptors (TLRs) stand at the interface of innate immune activation. We hypothesize to decrease the response of innate immunity activated by TLR4 by a safe, short-term, systemic immunosuppression. Methods: Two silicone block implants were placed into two dorsal subcutaneous pockets in 32 rats that were subdivided into four groups: The two study groups were the IV DEX group (single intravenous injection of dexamethasone 1 h before surgery) and the IV DEX + IP DEX group (in addition to a single intravenous injection of dexamethasone 1 h before surgery, intraperitoneal dexamethasone was administered for 10 days after surgery), and the two control groups were the untreated control group and the saline-treated control group. After 10 weeks, all animals were killed to determine capsular thickness, inflammatory cell density, presence of pseudoepitheliomatous hyperplasia, edema, necrosis, vascularization, TLR4 expression and myofibroblast proliferation. Results: No significant difference was observed in any parameter between the untreated and saline-treated control groups (p > 0.05). Capsular thickness, myofibroblast proliferation, TLR4 expression density were statistically different among study groups compared to control (p < 0.05). Conclusions: This study demonstrates the relationship between toll-like receptors and fibrous capsule after implant surgery. Decreasing the innate immunity by a safe, short-term perioperative systemic immunosuppression resulted in decreased TLR4 expression and myofibroblast differentiation which could be a new research field in profibrotic pathophysiology underlying breast capsule formation. No level assigned: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Objective: Coronoid process hyperplasia (CPH) of the mandible is a rare condition that can be defined as an abnormal bony elongation of histologically normal bone with the symptoms of progressive, painless difficulty in opening the mouth. The purpose of this study is to evaluate the outcomes of five patients with CPH treated by coronoidectomy, relative to post surgery jaw function. Methods: Five patients with CPH were included in this study. The diagnosis of CPH was confirmed by radiographic and clinical examination of the mandible. All five patients underwent bilateral intraoral coronoidectomy under general anesthesia. The mean maximum interincisal mouth opening for the patients was determined by measurements taken pre-surgery, intraoperative, and at longest follow-up. All five patients underwent postsurgical physical therapy directed towards jaw function. Results: All the patients with limited mouth openings presented with a preoperative maximum interincisal mouth opening of 12.4 mm (range 9-20.3 mm), which was increased to 37 mm (range 22-52 mm) in the operating room after bilateral intraoral coronoidectomy and 42 mm (range 32-52 mm) during the late follow-up. Conclusions: Patients with limited jaw function related to bilateral CPH can benefit by undergoing bilateral coronoidectomies and physiotherapy.

Prominent ears are relatively common, with an incidence in whites of about five percent¹. It is inherited as an autosomal dominant trait and is commonly caused by a combination of two defects: (1) underdevelopment of antihelical folding and (2) overdevelopment of the conchal wall. Many techniques have been described to correct the antihelical fold. In 1958 after Gibson and Davis2 showed the ability of injured cartilage to bend away from the side of injury, Stenstrom described scoring of the anterior auricular cartilage to create an antihelical fold, Chongchet’s technique used sharp scoring of the lateral scaphal cartilage to form an antihelix with a scalpel.2-4 Stenstrom, in contrast, used a rasp to blindly score the antihelix.3 Many different instruments have been used for scoring, including scalpels, rasps, abraders, diamond burr drills, Adson-Brown forceps, hypodermic needles and bipolar cautery.5 We present in this paper, a new instrument which can be used for scoring,a fine skin hook.

Lip carcinoma is one of the most common cancers of the head and neck region. Lower lips are more frequently affected. Squamous cell carcinoma accounts for more than 95% of the cases. The aim of treatment is to achieve the highest cure rates with adequate excision with clear surgical margins while leaving the smallest defect sizes behind for reconstruction. Excised tissue is known to shrink when removed, in relation with its retractile properties. In this study, the evaluation of the amount of shrinkage in excised lip cancer specimens and determination of the relation between surgical and histopathologic margins were aimed.The study included 21 consecutive excised lip specimens for the treatment of squamous cell carcinoma of the lip. The volume of the specimen, tumor length, and margin distance measurements were measured and recorded step by step from before surgical excision to histopathologic evaluation. Specimens were evaluated in a standardized fashion by the same pathologist after 48 hours of fixation. For data analysis, Number Cruncher Statistical System 2007 and Power Analysis and Sample Size 2008 Statistical Software (Kaysville, UT) were used.The surgical margins of the excised lip specimen shrink up to 41% to 47.5% from before excision to histopathologic evaluation. The most significant step was the excision step, followed by the formalin fixation step. The histopathologic process itself and the duration of formalin fixation did not result a significant change in surgical margins. The tumor tissue itself did not show a significant shrinkage.

Aim. The classic inguinal lymph node dissection is the main step for the regional control of the lower extremity melanoma, but this surgical procedure is associated with significant postoperative morbidity. The permanent lymphedema is the most devastating long-term complication leading to a significant decrease in the patient's quality of life. In this study we present our experience with modified, saphenous vein sparing, inguinal lymph node dissections for patients with melanoma of the lower extremity. Methods. Twenty one patients (10 women, 11 men) who underwent saphenous vein sparing superficial inguinal lymph node dissection for the melanoma of lower extremity were included in this study. The effects of saphenous vein sparing on postoperative complications were evaluated. Results. We have observed the decreased rate of long-term lymphedema in patients undergoing inguinal lymphadenectomy for the lower extremity melanoma. Conclusion. The inguinal lymphadenectomy with saphenous vein preservation in lower extremity melanoma patients seems to be an oncologically safe procedure and it may offer reduced long-term morbidity.

Cubital tunnel syndrome is the second most common peripheral nerve compression syndrome. It is the most common peripheral neuropathy of the ulnar nerve. The surgical treatment of the cubital tunnel syndrome is widely described in the literature, however the variations of the standard muscular anatomy in the medial humeral epicondyle region may create technical difficulties during surgical management. The epitrochleoanconeus muscle, which is an aberrant muscle of this region, is a rare cause of cubital tunnel syndrome. A case with ulnar nerve compression at the elbow caused by an uncommon etiological factor, hypertrophic epitrochleoanconeus muscle, and its surgical management is reported.

The etiology of nasal septal perforations involves iatrogenic, traumatic, inflammatory, infectious, neoplastic, and caustic causes. To ensure successful closure, an appropriate interpositional graft material should be selected, and this graft material should be covered with healthy tissue. The study included 18 New Zealand white rabbits weighing 2 to 2.5 kg. Nasal septal perforations were created in group 1. After the creation of defects in group 2, repair was performed with cartilage graft and bilateral mucoperichondrial advancement flaps. After septal nasal perforations in group 3, the defect was covered with fingernail and bilateral mucoperichondrial flaps. At week 12, the rabbits were sacrificed. The septum site that had been repaired with fingernail was intact. No nail exposition, wound site decomposition, or re-perforation was observed. No findings of a breach of the structural integrity of the fingernails or disintegration were encountered. Fingernails can be used as an interpositional graft material in place of cartilage in eligible cases for the repair of nasal septal perforations. Fingernails have several properties that enable their use in such cases, such as form preservation that is similar to cartilage, the lack of live cells, easy availability, and a lack of donor-site morbidity at removal.

Giriş: Hidradenit süpürativa apokrin bezlerin kronik, tek- rarlayan apseler, sinüsler ve skarlar ile karakterize inflamatuar deri hastalığıdır. 300 ile 600 erişkin hastada bir görülme sıklığı olup puberteden önce ve 40 yaşından sonra ortaya çıkması nadirdir. Bu çalışmada hidradenit süpürativalı olguların klini- ğimizde yapılan tedavileri retrospektif olarak taranmış sonuç- ları değerlendirilmiştir Gereç ve Yöntem: Mayıs 2008-Şubat 2012 tarihleri ara- sında medikal tedaviye dirençli, kronik ve rekürren hidradenit süpürativalı hastalar retrospektif olarak değerlendirildi. Hasta- ların yaş, cinsiyet, anatomik lokalizasyon, cerrahi tedavi şekli, defekt alanı, komplikasyon ve takip süresi değerlendirip; cer- rahi teknikler karşılaştırılmıştır Bulgular: Toplam 24 hastadan oluşan grubumuzun or- talama yaşı 39,4; ortalama takip süresi 11,8 aydı. Defekt bo- yutları 2x1 cm ile 25x15 cm arasında değişmekteydi. Eksizyon sonrası oluşan defektlere primer kapama, greftle kapama, konvansiyonel fleplerle veya perforatör ada flepleri ile kapa- ma gibi cerrahi seçenekler uygulandı. Postoperatif dönemde total flep kaybı görülmezken, 5 hastada enfeksiyon gelişti. Paraskapuler flep ile rekonstrüksiyon yapılan hastalara geç dönemde flep tabanının köpek kulağı deformitesi nedeniyle revizyon ameliyatı yapıldı. Deri grefti konan hastalar ise geç dönemde ameliyat bölgesinde kontraktür, renk değişikliği ve kötü skar oluşumu nedeniyle polikliniğimize başvurdu. Sonuçlar: Hidradenit süpürativa eksizyonu sonrasında oluşan doku defektlerini kapatmak için çeşitli tedavi yön- temleri kullanılabilir. Konvansiyonel fleplerle özellikle aksiller bölgede yapılan aksiyel bazlı fleplerin estetik sonuçlarının kötü olması ve revizyon gerektirmesi perforatör bazlı flep ile rekonstrüksiyonu ön plana çıkarmaktadır. Konvansiyonel fleplere oranla perforatör ada bazlı fleplerin kullanımı daha dikkatli bir cerrahi gerektirmesine rağmen uzun pedikülü ve rahat hareket olanağı ile sekonder revizyon gerektirmeyecek biçimde bölgesel rekonstrüksiyona olanak sağlar.