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Objective Liposarcomas are relatively rare tumors. Prognostic and predictive factors and treatment options are limited. We herein presented our 10-year experience with liposarcomas. Materials and Methods Adult patients with liposarcoma treated between 2005 and 2015 in our center were included. Demographic and clinicopathologic features of patients were retrieved from patient files. Statistical Analyses Outcomes in terms of disease-free survival (DFS) and overall survival (OS) were assessed along with potential prognostic factors using Kaplan–Meier analyses. Results A total of 88 patients were included. The median age was 52. Rates of well-differentiated (WDLS), dedifferentiated (DDLS), myxoid (MLS), and pleomorphic liposarcomas (PLS) were 42, 9.1, 37.5, and 4.5%, respectively. Only 10% of patients had high-grade tumors and 93% had localized disease. Ninety-six percent of patients (n = 84) underwent surgery. Adjuvant chemotherapy was delivered to 16 patients. The most common regimen was ifosfamide–doxorubicin. Recurrences were observed in 30 patients, 21 had local, and 9 had distant metastasis. Five-year DFS of patients with the localized disease was 68%. All patients with PLS had relapses and those had the highest distant relapse rates among all subtypes. Multivariate analysis showed T stage and grade were associated with DFS. Five-year OS of the entire population was 68%. Five-year OS was 79, 76, 50, and 0% in WDLS, MLS, DDLS, and PLS, respectively (p = 0.002). Conclusion Management of liposarcomas is still challenging. Surgery is the mainstay of treatment. Novel effective therapies are needed, particularly in advanced disease settings.

OBJECTIVE To evaluate the importance of preoperative neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-monocyte ratio (NMR) in prostate cancer patients, who underwent robot-assisted radical prostatectomy (RARP). STUDY DESIGN Observational study. PLACE AND DURATION OF STUDY Urology Department, Antalya Training and Research Hospital, Turkey, between March 2015 and September 2019. METHODOLOGY Four hundred and fifty-four patients underwent RARP were scanned. Clinical characteristics and pathological features of patients were recorded. Patients were excluded, if they had persistent PSA; a history of any autoimmune or inflammatory disease; anti-inflammatory agents use; blood transfusion within 3 months; or a follow-up time shorter than 3 months. Systemic inflammation markers were calculated and correlated with patients' data and biochemical recurrence (BCR). Biochemical recurrence was defined as two repetitive measurements of PSA levels ≥0.2 ng/mL at 3 months after the radical prostatectomy. Mann-Whitney U-test, Fisher's exact test, and Pearson Chi-square test, ROC curve, Kaplan-Meier survival analyses, and Cox proportional hazard regression model were used as statistical methods. RESULTS Four hundred and two patients were eligible. The median age at RP was 65.5 (61-69) years and median PSA of the patients was 8.3 (5.76-12.61) ng/ml. Median NLR, LMR, PLR, and NMR were 2 (1.55-2.61), 3.86 (3.14-5), 105.69 (85-134.29), 7.82 (6.25-9.71); and optimal cut-off values were 2.33, 3.75, 106.6, and 8.75, respectively. Low LMR was found as an important predictor of biochemical recurrence (hazard ratio, HR=1.769, 95% confidence interval, CI=1.091 - 2.868, p=0.021). A significant association was found between lower LMR and decreased BCR -free survival (p

Aim:To analyze the role of De Ritis (aspartate aminotransferase/alanine aminotransferase) ratio in predicting biochemical recurrence (BCR) after radical prostatectomy (RP).Methods:We retrospectively evaluated 425 patients with localised prostate cancer who underwent RP from 2009 to 2018. Patients with neo-adjuvant treatment, elevated liver enzymes, postoperative early hormone therapy, incomplete clinicopathological data and a follow-up of less than 6 months were excluded from the study. Demographic, clinical, pathological and follow-up data of the patients were recorded. Patients with and without BCR were compared. Sensitivity and specificity of De Ritis ratio in predicting BCR were calculated.Results:According to the maximum value of the Youden index, optimal threshold of De Ritis ratio for BCR was 1.1. Sensitivity, specificity, positive predictive value and negative predictive value were 69.7%, 61.1%, 37.6% and 85.7%, respectively. Multivariate analysis showed that the De Ritis ratio (HR=1.968, p=0.014) was a significant predictor factor for BCR. BCR-free survival rate was significantly lower in patients with higher De Ritis ratio.Conclusion:Our study suggests that elevated De Ritis ratio and detailed pathological findings could be an independent predictive factor for BCR after RP.

Bone pelvic dimensions and body habitus may have effects on robot-assisted radical prostatectomy (RARP). In this study, we examined the effects of body mass index, bone pelvis measurements and prostate measurements on console time (CT), decrease in postoperative hemogram level (DHL) and surgical margin(SM) in patients who underwent RARP for clinically localized prostate cancer in our institution. The data of transperitoneal RARP cases performed by a single surgeon between November 2016 and August 2020 were analyzed retrospectively. It was included in 125 patients who met the study criteria. Bone and soft tissue measurements were made on magnetic resonance imaging T2-weighted imaging in the mid-sagittal and transvers plane. In multivariate linear regression analyzes, only soft tissue width/transverse diameter of the prostate and CT were found to be correlated (p = 0.026). For the DHL, no pelvic dimension and body habitus had a significant association on multivariate linear regression analysis. In multivariate analyzes, a statistically significant difference was found only between pathological Gleason Score and SM (p = 0.008). Although we found statistically significant associations between prostate diameters and pelvic bone measurements and operative difficulties, we believe that further studies are needed to confirm these results. Such information can help identify patients with challenging anatomy and can be used in robotic surgery training to achieve optimal patient outcomes after RARP.

Background Although the immune checkpoint inhibitors (ICIs) became a vital part of cancer care, many patients do not respond to treatment. Some of the patients in this group, which is considered to have hyperprogressive disease (HPD), have a shorter overall survival compared to progressive disease (PD). Therefore, biomarkers are needed to differentiate between HPD and PD. Here, we evaluated PILE score to differentiate HPD from PD in patients treated with ICI. Methods Ninety-five patients treated with anti-PD-1 or anti-PD-L1 inhibitors for any type of cancer with progression according to RECIST criteria in the first control imaging were included. HPD was defined according to Russo's work. The PILE scoring system was calculated, including PIV (< median vs. ≥ median), LDH (normal and > normal), and ECOG performance status (0 vs. ≥ 1). The relationship between PILE score and HPD was examined. Results The median follow-up was 6.6 months and the median OS of all cohort were 11.18 ± 1.36 months. The patients in the HPD group had decreased OS (4.77 ± 0.89 vs. 13.94 ± 1.80 months, p

Nephrometry scores are designed to characterize tumors and stratify the surgical complexity. It remains unclear as to which nephrometry score can accurately predict the surgical outcomes. We aimed to assess the utility of radius, exophytic/endophytic, nearness, anterior/posterior, location (RENAL), preoperative aspects and dimensions used for anatomic classifications (PADUA), and centrality index (C-index) nephrometry scores for predicting the strict Trifecta achievement from a single institution series robotic-assisted partial nephrectomy (RAPN). We retrospectively identified the prospectively maintained robotic surgery database records of 91 patients who underwent RAPN between June 2015 and September 2020 in Antalya Training and Research Hospital. The main outcome of the study was the achievement of strict Trifecta (negative surgical margin, no major urologic complications, warm ischemia time ≤25 min, and ≥85% preservation of estimated glomerular filtration rate). A multivariable analysis was performed to identify the factors of strict Trifecta success. The mean patient age was 55.82 ± 13.37 years with a median clinical tumor size of 3.5 cm (IQR 2.5–4.9). The median RENAL, PADUA, and C-index score were 7(IQR 6–8), 8(IQR 7–10), and 2.01(IQR 1.64–2.72), respectively. A strict Trifecta could be achieved in 54 patients (59.3%). Clinical tumor size (P = 0.011), RENAL risk groups (low:reference; intermediate; P = 0.040; high; P = 0.009), PADUA risk groups (low:reference; intermediate; P = 0.044; high; P = 0.001) and C-index risk groups (low:reference; high; P = 0.015) were the independent predictors of strict Trifecta attainment in the multivariate analysis. None of the nephrometry scores were a superior predictor compared to other nephrometry scores in comparative analysis. RENAL, PADUA, and C-index scores were all independent predictors of a strict Trifecta achievement. Our comprehensive comparison of the three scores identified that none of the nephrometry scores proved to be inferior to others nephrometry scores.

Objective:The aim of this study was to assess the usefulness of neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR) and neutrophil-to-monocyte (NMR) as biomarkers in men who had a prostate-specific antigen (PSA) level of 4 to 10 ng/mL and who subsequently underwent prostate biopsy.Materials and Methods:We retrospectively analyzed the records of 546 patients who underwent multicore (≥12) TRUS-guided biopsy at our institution between April 2010 and November 2017. Age, PSA level, f/t PSA, NLR, PLR, LMR, NMR, Gleason score in patients with prostate cancer (PCa) and biopsy results were collected. Histological results were categorized into three groups as benign prostatic hyperplasia, prostatitis and PCa.Results:The median age of patients was 64 years. The mean total PSA level and f/t PSA ratio were 6.52±1.76 and 0.2±0.09, respectively. The mean NLR, LMR, PLR and NMR were 2.46±1.46, 3.94±2.07, 120.69±60.73 and 8.52±7.97, respectively. The f/t PSA ratio in the PCa group was significantly lower compared to the other two groups (p

The aim of this study is to assess the erectile function of patients before and after transrectal ultrasound prostate biopsy comparatively in order to determine the appropriate time to evaluate erectile function before radical prostatectomy. A total of 44 patients underwent transrectal ultrasound biopsy. We used the International Index of Erectile Function-5 questionnaire to assess all the patients. In total, 44 volunteered patients were included in this study. All patients were evaluated with the International Index of Erectile Function-5 questionnaire before the biopsy and at 4 weeks after the transrectal ultrasound biopsy. A total of 50% of patients were potent before the biopsy was done. A month after the biopsies, erectile dysfunction was reported by 29 of 44 patients (66%) as mild in 10 (22.7%), as mild-moderate in 14 (31.8%), as moderate in 4 (9.1%), and severe in 1 (2.3%). The differences were statistically significant in the first month of the biopsy ( p

Objective:To present our experience of 267 consecutive patients treated with robotic-assisted laparoscopic prostatectomy (RALP) and assess the perioperative and postoperative outcomes.Materials and Methods:Materials and Methods: We retrospectively analyzed the data of 267 men who underwent RALP in our clinic between March 2015 and April 2018. Preoperative clinical data including age, serum prostate-specific antigen (PSA), biopsy Gleason score, and number of positive cores were noted. Perioperative parameters such as operative time and intraoperative complications were recorded. Postoperative parameters including hematocrit change, length of hospital stay, and catheter removal date were noted. Pathological outcomes included pathological Gleason score; positive surgical margin (PSM) status; extracapsular, lymphovascular, perineural, and seminal vesicle invasion; and lymph node positivity. The Clavien-Dindo system was used to classify surgical complications.Results:The mean age of the patients was 64.2±6.4 years and the median PSA was 8.27 ng/dL. The mean operative time was 196.4±59.4 min and median hematocrit decrease was 3.9%. The overall PSM rate was 21.34% and this rate increased significantly with final pathological stage from 12.97% for pT2 to 35.48% for pT3 (p

Objective To report our initial experience and short-term results in post-chemotherapy robot-assisted retroperitoneal lymph node dissection (RA-RPLND) for advanced testicular cancer. Material and methods We analyzed prospectively collected data of 5 patients who underwent post-chemotherapy RA-RPLND between August 2017 and May 2018. All patients had a diagnosis of non-seminomatous germ cell tumor (NSGCT) of testis and received three or four cycles of BEP chemotherapy for their clinical stage IIC disease before the surgery. Perioperative parameters (operation time, estimated blood loss and intraoperative complications) and postoperative findings (change in hematocrit, duration of hospitalization and postoperative complications) were noted. Pathological outcomes and postoperative radiological imaging in the 3rd month were investigated. Results RA-RPLND was completed successfully in all patients, and none of them required conversion to open surgery or early intervention. The median operation time was 309 minutes (range, 275-360), and median estimated blood loss was 180 mL (range, 150-210). One patient required postoperative transfusion of 1U red blood cells. The histologic examination of the specimens revealed necrosis in 3, and mature teratoma in 2 patients. The median hospitalization time after surgery was 2 days. During a median follow-up of 10 months (range 7-12), there were no retroperitoneal recurrences or distant metastasis in radiological imaging. No major complication (Clavien ≥3) or death occurred. The only minor complication was transfusion of red blood cells in one patient (Clavien 2) and the overall complication rate was 20 percent. Conclusion Post-chemotherapy RA-RPLND appears to be a feasible and oncologically safe procedure with acceptable operative morbidity. However, this technique should be applied in centers highly experienced in robotic surgery, considering that RPLND is a surgery with fatal complications.

Her seyden once size tesekkur etmek istiyorum, bilgi caginda, bilgiden yoksun, bilgiden uzak isini yapadurmak yerine, saglik alanindaki inovasyon, teknoloji ve yapay zeka kulvarlarindaki merakiniz ve hekimseniz hastaniza en dogru taniyi koyup, en dogru tedaviyi vermek gayesi yada alan uzmani iseniz de bu alanlarda gelisime inanarak okumayi sectiginiz, konfor alaninizi bozmayi kabul ettiginiz icin.Bu kitapta sagligimizin geleceginin buyuk bir kismini olusturacak olan, sagligin son trendlerini sunduk. Gelecegin hekimlik ve saglik anlayisindaki son gelismeleri, literatur destegi ile bilimin getirdigi sarsici etkiler ve gelecek perspektifini en guncel bilgiler isiginda bu kitapta bulacaksiniz.

Purpose: To investigate the effects of pure binaural beats on anxiety and pain scores in male patients undergoing diagnostic cystoscopy (DC) and ureteral stent removal (USR) under local anesthesia....

Objective:The aim of this study is to analyze the complications of all robot-assisted surgeries performed in our clinic and to investigate the effect of the learning curve on complications occurred.Materials and Methods:Data on a total of 342 robotic surgeries performed in our clinic between March 2015 and February 2018 was retrospectively analyzed. Two surgeons, who performed the surgery, were experienced in urological laparoscopic procedures. Intraoperative and postoperative complications were evaluated. According to the experience of robotic surgery, the complications were divided into two groups as those occurred in the first 18 months (March 2015-August 2016) and in the second 18 months (September 2016-February 2018). The complications were classified according to the Clavien-Dindo classification.Results:A total of 32 complications occurred in 31 of 342 patients undergoing robot-assisted surgery. The overall complication rate was 9.4%. The number of minor complications was 20 (62.5%), and the number of major complications was 12 (37.5%). Among all, 6.2% were intraoperative complications, 62.5% were postoperative complications, and 31.3% were medical complications. It was observed that the number of complications was plateaued after August 2016 and there was a statistically significant difference between the first and the second 18 months (p