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Öğe A new limb-salvaging technique for the treatment of late stage complicated Charcot foot deformity: Two-staged Boyd's operation(2012) Altındaş, M.; Kılıç, A.; Ceber, MehmetBackground: Depending on the stage of disease, several operative and non-operative treatment options exist for diabetic patients with Charcot foot deformity. In the early stages of the disease, the most effective treatment is total-contact cast application. In patients with multiple bone fractures and deformations, surgical interventions are generally required for the reconstruction of foot architecture. Exostectomy, osteotomy, arthrodesis, and internal-external fixation are some of these operative methods. However, recurrence of ulcer and infection is very likely following these surgical procedures. If the lesion and infection reach to midfoot and hindfoot region, a major amputation is usually required for treatment. Methods: We have been performing Boyd's operation for the last 10 years in diabetic foot patients who had complicated lesions in midfoot and hindfoot regions. Furthermore, since 2004, we have been doing the same operation for complicated Charcot foot deformities. So far, we have treated 11 patients. Results: The mean age of the patients was 53.4. ±. 10.2 years, and the mean duration of diabetes mellitus (DM) was 17.5. ±. 7.2 years. All patients had chronic infections with fractures of the tarsal bones for at least 2 years. Durable wound coverage and ankylosis were achieved in all patients with two-staged Boyd's operation. No recurrence is detected in any of the patients during mean post-operative follow-up period of 2.1. ±. 0.8 years. Conclusion: Boyd's operation is a reliable option for the treatment of patients with late stage Chatcot foot deformity. © 2011 European Foot and Ankle Society.Öğe A reliable method for treatment of nonhealing ulcers in the hindfoot and midfoot region in diabetic patients: Reconstruction with abductor digiti minimi muscle flap(2013) Altındaş, M.; Ceber, Mehmet; Kılıç, A.; Sarac, M.; Diyarbakirli, M.; Baghaki, S.The foot has a unique anatomic composition and a perfect architecture, which is necessary for mobilization. However, this complex structure is also responsible for healing problems in foot reconstruction. After 25 years of experience in diabetic foot surgery practice, we observed that some hindfoot ulcers are like an iceberg in that they have much more involvement in the plantar fat pad than the skin, and the lateral midfoot region is a common site for ulcer formation. Also the fifth tarsometatarsal joint region is a prominent anatomic structure vulnerable to repetitive trauma and ulcer formation that may easily spread to other parts of the foot. These ulcers should be reconstructed with well-vascularized tissues such as muscle flaps after debridement. Between 2003 and 2010, 17 diabetic patients with foot ulcers, involving bone and joint, were reconstructed with abductor digiti minimi muscle flap. When it is needed, the flap is covered with a small split-thickness skin graft. In all cases, complete healing was achieved. The muscle flap functioned well as a versatile and shock absorbent coverage without recurrence of the ulcer during a mean follow-up period of around 2 years. Diabetic foot ulcers should be evaluated and treated individually depending on their location and affected tissue composition. The most appropriate reconstructive option should be selected for each lesion. The abductor digiti minimi muscle flap is extremely useful for the reconstruction of small-to moderate-sized defects that have exposed bone, joint, or tendons in the hindfoot and lateral plantar midfoot. Copyright © 2012 by Lippincott Williams & Wilkins.Öğe Changes in expression of Slit1 and its receptor Robo2 in trigeminal ganglion and inferior alveolar nerve following inferior alveolar nerve axotomy in adult rats: a pilot study(Churchill Livingstone, 2015) Ceber, Mehmet; Mihmanli, Ahmet; Kılıç, Ulkan; Şener, Ümit; Yüksek, A.; Durak, M. A.; Tülübaş, FetiThe objective of this study was to analyze changes in expression pattern of Slit1 and Robo2, and to clarify the relationship between these changes and functional recovery of the axotomized inferior alveolar nerve (IAN) without repair using a rat IAN axotomy model. Slitl and Robo2 were weakly expressed in samples taken from trigeminal ganglion (TG) and IAN of sham surgery rats. In axotomized rats, expression levels increased significantly from day 2 to day 28 post-axotomy, with peaks on days 14 (Slit1) and 7 (Robo2) after axotomy (relative to sham: Slit1 in TG P < 0.0005, Slitl in IAN P = 0.003, Robo2 in TG P < 0.0005, and Robo2 in IAN P < 0.0005). Over-expressed Slitl and Robo2 in both the TG and IANs of axotomized rats did not return to sham levels during the 28-day observation period of this study. The regeneration and functional recovery of axotomized IAN was evaluated by jaw opening reflex (JOR) recorded before and after axotomy. JOR occurrence (0% on day 7, 35% on day 14, and 85% on day 28) increased gradually, and the relative threshold of electrical stimulation eliciting JOR decreased gradually (1000.0 +/- 0.0% on day 7, 854.3 +/- 132.5% on day 14, and 302.6 +/- 92.3% on day 28). On day 28 after axotomy, JOR occurrence and the relative JOR threshold had almost returned to those of sham rats. These findings suggest that Slitl and Robo2 are involved in the regeneration and functional recovery of the axotomized IAN.Öğe Does Reduction Mammaplasty Play a Role in Weight-Loss Motivation and Quality of Life Improvement in Symptomatic Macromastia Patients?(Medknow Publications & Media Pvt Ltd, 2016) Ceber, MehmetObjective: The purpose of this study was to evaluate whether reduction mammaplasty is a motivator for postoperative weight loss and to understand how this affected specific quality of life parameters. Material and Methods: All patients who underwent a reduction mammaplasty by the senior author at our department between April 2011 and January 2014 were contacted and invited to participate in a standardized telephonic questionnaire. The outcome questionnaire included data on whether the patients felt that the reduction mammaplasty was a motivator for weight loss and specific information regarding their pre- and postoperative weight and dress size. Additional data points queried included quality of life changes, exercise capacity, satisfaction, symptomatic relief (neck and back pain, intertrigo, shoulder grooving), and whether they would undergo the procedure again. Results: Forty-five women participated in the questionnaire. A total of 66.7% (n=30) participants stated that reduction mammaplasty was a motivator for future weight loss (group A), and 33.3% (n=15) participants felt that reduction mammaplasty was not a motivator for future weight loss. When the pre- and postoperative weights of women in group A were compared, there was a significant difference seen following reduction mammaplasty (p<0.001). Group B had a non-significant decrease in weight (p=0.23). The mean weight loss in group A was 6.66 +/- 1.44 kg) and group B was 1.13 +/- 2.16 kg. There was a statistically significant difference in weight loss between the groups (p<0.001). There was a statistically significant difference between pre- and postoperative body mass index (BMI) in group A (p<0.001), whereas the difference was not statistically significant in group B. There was a statistically significant difference in BMI between the groups (p<0.001). There was a statistically significant decrease in dress size in group A and B (p<0.001). There was a 73% improvement in postoperative exercise in group A and 13.3% improvement in group B. Conclusion: Reduction mammaplasty not only improves the patients' symptoms of macromastia and their breast shape but also is a motivator for postoperative weight loss.Öğe Management of Diabetic Neurotrophic Foot Ulcers with Total Contact Cast: A Serial of 44 Cases(Ortadogu Ad Pres & Publ Co, 2011) Altındaş, Muzaffer; Ceber, Mehmet; Baghaki, SemihObjective: Ulcers related to diabetic neuropathy are the most common problems of insensitive feet. Acute and progressive diabetic foot infections threatening the extremity and even life arise as the result of sudden exacerbation of these mostly chronic lesions. Bone, joint and tendon involvements are present in a big proportion of these diabetic foot lesions. Surgical interventions are almost always required for their treatment. Total contact cast (TCC) is a non-surgical treatment prominenced in the last two decades and became a 'gold standard' treatment modality for management of cases without bone and joint involvement. We have been using TCC for management of neurotrophic ulcers related to diabetes since the beginning of 2000s. In this paper, we aimed to introduce total contact cast technique and present of our outcomes. Material and Methods: The number of the cases with chronic neurotrophic plantar ulcers and had TCC was 44. The cast was removed in the first week as one subject could not tolerate it. The mean age of our cases was 59 years, the mean time of living with diabetes was 20.3 years and mean time of living with ulcers was 27 months. Results: Healing of the wounds were provided in all of our cases. Mean TCC number was slightly above two, we provided healing with a single cast in 14 (32.5%) cases. We experienced cast pinch complications in nine (20.45%) cases. We saw that the ulcer recured at the same site in 11 of 43 cases (25.5%). Conclusion: We believe that information and experiences obtained from these applications will contribute the solution of the problems in this area along with total contact cast being an effective and reliable treatment method in insensible feet.Öğe Reduction Mammaplasty Effect on Pulmonary Function and Arterial Blood Gas in the Overweight Female(Springer, 2015) Ceber, Mehmet; Yüksek, Adnan; Mutlu, Levent Cem; Bali, İlhan; Topçu, BirolThis study sought to prospectively determine whether reduction mammaplasty improves the results of pulmonary function tests (PFTs) and arterial blood gas (ABG) measurements among overweight or obese women with macromastia and assess whether these changes are correlated with participant weight and body mass index (BMI) changes. Thirty women who were overweight or obese and underwent bilateral reduction mammaplasty were included in this study. PFT and ABG measurements were performed within a 4-week period before reduction mammaplasty and 3 months after reduction mammaplasty. The following selected PFT parameters were used to diagnose the restrictive patterns of ventilatory defects: forced vital capacity (FVC), forced expiratory volume at one second (FEV1), the ratio of FEV1 to FVC expressed as a percentage (FEV1/FVC%), and the average FVC flow rate of 25-75 % (FEF 25-75 %). The ABG measurements included PaO2, PaCO2, HCO3, oxygen saturation, and pH. A significant difference was found between certain preoperative and postoperative PFTs (i.e., predicted FVC%, predicted FEV1% and predicted FEF 25-75 %) and between all of the preoperative and postoperative ABG measurements (pH, PaO2, PaCO2, HCO3, and Sat O-2). A significant positive correlation was found between specimen weight and improvements in FEF 25-75 % and Sat O-2. A significant positive correlation was found between the percentage reduction in BMI and the improvements in FEF 25-75 % and FVC. Overweight or obese women who underwent reduction mammaplasty showed significant improvements in certain PFT and all of the ABG measurements at 3 months after surgery. The more resected breast tissue predicts greater improvements in FEF 25-75 % and Sat O-2, and greater reductions in BMI predicted increased improvements in FEF 25-75 % and FVC.Öğe The effects of topical treatment with curcumin on burn wound healing in rats(Springer, 2013) Kulaç, Mustafa; Aktaş, Cevat; Tülübaş, Feti; Uygur, Ramazan; Kanter, Mehmet; Erboğa, Mustafa; Özen, Oğuz Aslan; Ceber, Mehmet; Topçu, BirolThe present study was designed to determine the role of topical treatment with curcumin (Cur) on burn wound healing in rats. The Wistar-albino rats were randomly allotted into one of three experimental groups: 4th, 8th and 12th day (post burn) and all groups include subgroups which Burn and Burn + Cur. Each group contains 12 animals. Burn wounds were made on the back of rat and Cur was administered topically. At the end of the study, all animals were sacrificed and the wound tissues removed for analyse to biochemical and histopathological changes. There was a significant increase in the hydroxyproline levels in the skin of the Cur groups. Cur treated wounds were found to heal much faster as indicated by improved rates of inflammatory cells, collagen deposition, angiogenesis, granulation tissue formation and epithelialization which were also confirmed by histopathological and biochemical examinations. Our data also indicate that there is a rise in the expression of proliferating cell nuclear antigen in skin tissues of Cur-treated rats in the Burn group. The results clearly substantiate the beneficial effects of the topical application of Cur in the acceleration of wound healing.Öğe The relationship between changes in the expression of growth associated protein-43 and functional recovery of the injured inferior alveolar nerve following transection without repair in adult rats(Churchill Livingstone, 2015) Ceber, Mehmet; Şener, Ümit; Mihmanli, Ahmet; Kılıç, Ulkan; Topçu, Birol; Karakas, MerveObjective: The objective of this study was to analyze the changes in the expression of growth associated protein-43 (GAP-43) in trigeminal ganglions (TGs) and in the distal stumps of transected inferior alveolar nerves (IANs), and to clarify the relationship between these changes and functional recovery of the transected IAN without repair using a rat IAN axotomy model. Material and methods: Following transection, GAP-43 expression was measured at multiple time points. The functional recovery of the transected IAN was evaluated based on the compound muscle action potentials recorded from the digastric muscle. Results: GAP-43 expression in TGs was significantly higher at 2, 7, 14, 28, and 56 days following IAN transection compared to that in samples from sham-operated rats (p < 0.0005, p < 0.0005, p < 0.0005, p = 0.007, and p = 0.023, respectively). GAP-43 expression in the distal stumps of transected IANs was significantly higher at 2, 7, 14, and 28 days following IAN transection compared to that in samples taken from sham rats (p < 0.0005, p < 0.0005, p < 0.0005, and p = 0.009, respectively). GAP-43 expression in the distal stumps of transected IANs returned nearly to sham levels by day 56 following IAN transection. On days 7, 14, 28, and 56 following transection, the amplitude of the compound muscle action potential gradually increased, the latency gradually decreased, and the duration gradually increased. The amplitude, latency, and duration of the compound muscle action potentials nearly returned to sham levels on post-transection day 56. Conclusions: Time-dependent changes in the expression of GAP-43 in both TGs and distal stumps of transected IANs without repair are synchronously consistent with the regeneration and functional recovery of the transected IAN. The recovery of the amplitude, latency, and duration of the compound muscle action potentials indicates increased myelination and increased axon density of the regenerated nerve fibers. (C) 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.Öğe The role of the three phase bone scintigraphy in the evaluation of the patients with idiopatic carpal tunnel syndrome(Springer, 2016) Ceber, Mehmet; Şahin, E.; Topçu, Birol; Alp, Recep[No Abstract Available]
