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Öğe A rare condition secondary to aberrant right subclavian artery syndrome: Aphagia lusoria(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2022) Ada, Fatih; Guler, Salih; Demir, Fatmagul; Sahin, EkberDysphagia lusoria is a well-described clinical entity caused by aberrant right subclavian artery. Herein, we present a 42-year-old male case with aberrant right subclavian artery-associated aphagia and progressed to aphagia lusoria presentation. To the best of our knowledge, this is the first associated case presented with aphagia.Öğe Analyses of Preoperative Presumptive Diagnosis in Lung and Mediastinal Lesions(Derman Medical Publ, 2010) Sahin, Ekber; Karadayi, Sule; Nadir, Aydin; Celik, Burcin; Sezer, Hafize; Kaptanoglu, MelihAim The aim of this study was to investigate the correlation of preoperative presumptive and final histological diagnosis in patients without previous histological evaluation. Matherial and Methods We enrolled sixty-five patients who were operated for lung and mediastinal lesions between December 2005 and December 2008. In all patients, three presumptive diagnosises were established and they were compared to final histological diagnosis. ROC curve was used for analysing data. Results Postoperative histological diagnosis were as follows: lung cancer 23.1 % (15/65), hydatid cyst 23.1% (15/65), sarcoidosis 13.8% (9/65), tuberculosis 9.2% (6/65) and other disease 30.8 % (20/65). Sensitivity of presumption in the diagnosis of lung cancer, hydatid cyst, tuberculosis and sarcoidosis were 80%, 93.3%, 50%, 66.7% respectively. Conclusion We think that the exploratory thoracotomy should be performed when the lung cancer and hydatid cyst are suspected for diagnosis. For accurate diagnosis of tuberculosis and sarcoidosis, more detailed and careful preoperative laboratory studies should be done.Öğe An analysis of 214 cases of rib fractures(HOSPITAL CLINICAS, UNIV SAO PAULO, 2011) Karadayi, Sule; Nadir, Aydin; Sahin, Ekber; Celik, Burcin; Arslan, Sulhattin; Kaptanoglu, MelihINTRODUCTION: Rib fractures are the most common type of injury associated with trauma to the thorax. In this study, we investigated whether morbidity and mortality rates increased in correlation with the number of fractured ribs. MATERIALS AND METHODS: Data from 214 patients with rib fractures who applied or were referred to our clinic between January 2007 and December 2008 were retrospectively evaluated. The patients were allocated into three groups according to the number of fractures: 1) patients with an isolated rib fracture (RF1) (n = 50, 23.4%), 2) patients with two rib fractures (RF2) (n = 53, 24.8%), and 3) patients with more than two rib fractures (RF3) (n = 111, 51.9%). The patients were evaluated and compared according to the number of rib fractures, mean age, associated chest injuries (hemothorax, pneumothorax, and/or pulmonary contusion), and co-existing injuries to other systems. FINDINGS: The mean age of the patients was 51.5 years. The distribution of associated chest injuries was 30% in group RF1, 24.6% in group RF2, and 75.6% in group RF3 (p < 0.05). Co-existing injuries to other systems were 24% in group RF1, 23.2% in group RF2, and 52.6% in group RF3 (p < 0.05). Two patients (4%) in group RF1, 2 patients (3.8%) in group RF2, and 5 patients (4.5%) in group RF3 (total n = 9; 4.2%) died. CONCLUSION: Patients with any number of rib fractures should be carefully screened for co-existing injuries in other body systems and hospitalized to receive proper treatment.Öğe Analysis of 264 Patients with Stab and Gunshot Wounds in Abdominal and Thoracic Regions(DRUNPP-SARAJEVO, 2010) Korkmaz, Ilhan; Karadayi, Sule; Guven, Fatma Mutlu Kukul; Eren, Sevki Hakan; Sahin, Ekber; Nadir, Aydin; Beydilli, Inan; Kaptanoglu, MelihIntroduction: Penetrating traumas are life-threatening situations which can be encountered in emergency services. In this study, epidemiological data, treatment approaches and the results pertaining to penetrant abdominal and/or thoracic injuries, which occured due to gunshot or stab wounds, are evalauted retrospectively. Material-method: Two hundred and sixty four patients who admitted to emergency department with penetrating thoracic and/or abdominal trauma between 2002 and2009 were retrospectively analyzed. Patients were divided into 3 groups according to their shock indexes including Low risk (<= 0.5), medium risk (> 0.5-<= 1) and high risk (> 1) groups. Results: The study group included 244 male (92.4%) and 20(7.6%) female participants. Age distribution of the groups was as follows; 58 (22.0%) patients were in the 0-19 years group, 139 patients (52.6%) were in the 20-40 years group and 67 patients (25.4%) were over 40 years. Two hundred and fifteen injuries (81.4%) were caused by stab wounds and 49 (18.6%) were due to gunshots. When the patients were evaluated considering the injury site, isolated thoracic trauma was seen in 93 patients (35.3%) and isolated abdominal injuries were found in 74 patients (28.0%). The most common organ injuries among the patients who underwent laparotomy (n=73) were as follows; bowel injury in 28 patients (38.3%), stomach injuries in 20 patients (27.4%) and liver-spleen injuries in 17 patients (23.28 %). Of 189 patients with thoracic trauma, 17 patients (8.9 %) had hemothorax, 44 (23.28 %) had pneumothorax, 46 (24.33 %) had hemopneumothorax and 2 patients (1.05 %) had pulmonary contusion. Seven patients (2.65 %) died. Two patients were considered as exitus in the initial examination. Two of the 5 exitus cases had shock index ranging within the medium risk group and 3 were in the high-risk group. Conclusion: It must be considered that penetrating trauma patients with medium or high shock index have a higher mortality rate. Therefore, those patients must be closely monitored and the health services should be improved for immediately and appropriately transferring them.Öğe A case of non-Hodgkin's lymphoma presented with tension chylothorax(EKIN TIBBI YAYINCILIK LTD STI-EKIN MEDICAL PUBL, 2011) Sahin, Ekber; Celik, Burcin; Nadir, Aydin; Kaptanoglu, MelihWe present an unusual case of diffuse large B-cell lymphoma which initially presented as tension chylothorax. A 24-year-old man was admitted to our clinic with the complaints of dyspnea, fever, and sweating. Chest X-ray revealed a massive right pleural effusion. The patient was diagnosed with chylothorax and a right tube thoracostomy was performed. Thorax computed tomography revealed parenchymal infiltration in the right lower lobe, right hydropneumothorax, and multiple paratracheal lymphadenopathies. The general status of the patient was poor, and the submandibular lymph node was excised for pathological diagnosis. The general status of the patient gradually got worse and on the 13(th) day of the admission, intubation and mechanical ventilation were instituted. The pathological diagnosis of the lymph node was reported as diffuse large B-cell lymphoma, and the patient died only two days after the histopathological diagnosis. Chylothorax may arise as a complication of lymphoma. While, there are no reports on the frequency of this occurrence, it is associated with a high mortality rate when the patient presents with tension chylothorax.Öğe Diagnostic and therapeutic approaches in tracheobronchial rupture: analysis of 23 patients(EKIN TIBBI YAYINCILIK LTD STI-EKIN MEDICAL PUBL, 2010) Sahin, Ekber; Nadir, Aydin; Karadayi, Sule; Celik, Burcin; Manduz, Sinasi; Akkas, Yuecel; Kaptanoglu, MelihBackground: In this article we examined diagnostic and therapeutic results of tracheobronchial ruptures which we treated. Methods: In our study the records of 23 patients (19 mates, 4 females; mean age 21.0 +/- 15.8 years; range 1 to 64 years) who were admitted to and treated in our clinic between June 1992 and October 2008 due to tracheobronchial rupture caused by trauma or iatrogenic factors were examined retrospectively. Patients were evaluated in terms of injury type, localization of lesion. diagnostic and therapeutic methods. Results: A bronchus was ruptured in 17 patients (73.9%) and trachea was ruptured in six patients (26.1%). Bronchoscopy provided the diagnosis in 91%. Computed tomography was performed in four patients (17%). Eleven of the ruptures were in the right bronchial tree (47.8%), whereas six were in the left bronchial tree (26.1%) and six were in the trachea (26.1%). While surgical therapy was performed in 17 patients (73.9%), conservative therapy was administered in six (26.1%) patients. Morbidity occurred in two (8.7%) patients and one patient died (4.3%). Conclusion: Immediate or delayed surgical treatment can be successful in rupture or complete disruption of tracheobronchial ruptures. Multitrauma patients should be surgically treated as soon as cardiopulmonary status was stabilized. If there is a suspicion of tracheobronchial trauma. bronchoscopy should not be spared. If suspicion continues, repetitive bronchoscopy shouldn't be avoided.Öğe An experimental model to study pneumothorax in Rats(ACADEMIC JOURNALS, 2010) Akkas, M. D. Yucel; Sahin, Ekber; Celik, Burcin; Nadir, Aydin; Karadayi, Sule; Gumus, Cesur; Cinar, Ziynet; Kaptanoglu, MelihResearchers have used various techniques to form pneumothorax in animals, but to date, no standard method or rate of pneumothorax has been defined. We tried to develop a standard and a safe method of pneumothorax model in this study. 12 female Wistar Albino rats weighing 200-220 g were used. Two groups (6 rats in each) were formed. Open pneumothorax was formed by 0.5 cm incision through the right, 5(th) intercostal space. The first group was held in open pneumothorax position for 1 min and the second group, for 2 min and the incisions were sutured. After 48 h, computed tomography of the rats were obtained and the pneumothorax rates were measured. The mean pneumothorax value was greater in Group II (13.89%) than in Group I and it was statistically significant (p < 0.05). The above mentioned method produces low rates of pneumothorax (10 - 15%), without injuring lung tissue. It should be useful for researchers, who plan to study lung physiology with low rates of pneumotohorax.Öğe Factors determining the complications in Nuss procedure(BAYCINAR MEDICAL PUBL-BAYCINAR TIBBI YAYINCILIK, 2018) Katrancioglu, Ozgur; Akkas, Yucel; Sahinoglu, Tuba; Sahin, Ekber; Karadayi, Sule; Katrancioglu, NurkayBackground: This study aims to share our experiences in complications developing in patients who underwent Nuss procedure and the management of these complications. Methods: In the study, files of 59 patients (50 males, 9 females; mean age 17.6 +/- 5.1 years; range, 2.5 to 33 years) who were applied Nuss procedure for pectus excavatum in our clinic between July 2007 and May 2016 were retrospectively assessed. Patients' age, gender, surgical method-complications and hospitalization durations were recorded. Fisher's chisquare test and logistic regression analysis were used for data evaluation. Results: Nuss procedure was performed in all patients without severe complications such as death, organ injury or massive hemorrhage. The most frequently observed postoperative earlyperiod complication was minimal pneumothorax (n=16, 27.1%), while bar dislocation was most frequently observed in the lateperiod (n=5, 8.3%). Conclusion: Being male and/or over 23 years of age were determined as risk factors for complication development after Nuss procedure. Still, being a minimally invasive and manageable approach with its success in correcting the deformity, short operation duration, and low complication rates, Nuss procedure can be safely performed in selected patients.Öğe The heterodox nature of "Turban Pins" in foreign body aspiration; the central anatolian experience(ELSEVIER IRELAND LTD, 2007) Kaptanoglu, Melih; Nadir, Aydin; Dogan, Kasim; Sahin, EkberObjective: The aim of this study is to determine the age and sex distribution and the nature of aspirated foreign bodies (FBs). We also compared Turban Pins (TP) with other FBs and discussed the extracting techniques. Methods: From 1987 through 2006, 414 patients were managed and the records of the patients were retrospectively reviewed. Results: Girls (56%) were influenced much more than the boys (44%). The median age was 4, however median age for girls and boys were 11 and 2, respectively. The 50% of the foreign body aspiration (FBA) were observed in the first years of life. There was also a great tendency to occur in the adolescent age group (32%), especially for girls. The most commonly aspirated foreign body was Turban pin (TP) (n = 121) among 332 foreign bodies. FBs were successfully removed by rigid bronchoscopy in 94% of the patients. In patients who had a negative history (n = 49), bronchoscopy was performed according to clinical suspicion, and it revealed foreign bodies in 41%. Thoracotomy was performed in eight (2.4%) patients. We had no mortality. Conclusions: These cases showed us that the type and age groups of FBA varies according to cultural conditions. We found that TP aspiration has different characteristics and it deserves a special attention. Suspicion is an important indication for bronchoscopy. We prefer rigid bronchoscopy because success rate is satisfactory. (c) 2006 Elsevier Ireland Ltd. All rights reserved.Öğe Investigation of wound healing in rat lung tissues in the postpartum period(SPANDIDOS PUBL LTD, 2012) Karadayi, Sule; Sahin, Ekber; Nadir, Aydin; Tuncer, Ersin; Silig, Yavuz; Korkmaz, Ilhan; Tanzer, Fatos; Sezer, Hafize; Kaptanoglu, MelihTo assess the wound healing capabilities of damaged lung tissue in the postpartum period, we investigated the parameters related to wound healing in a rat model of lung damage. Rats were divided into six groups: IA, I B, II, IIIA, IIIB and IV (n=7 in each group). Group IA included rats not in the postpartum period that were sacrificed on the third day after lung injury, group IB included rats not in the postpartum period that were sacrificed on the tenth day after lung injury, group II included rats not in the postpartum period that did not receive lung injury, group IIIA included rats in the postpartum period that were sacrificed on the third day after lung injury, group IIIB included rats in the postpartum period that were sacrificed on the tenth day after lung injury and group IV included rats in the postpartum period without lung injury. Wound healing was evaluated histopathologically and measurements of hydroxyproline levels, serum alanine and glutamine were taken. A significant difference in serum alanine levels was evident between groups IA and IIIA. Significant differences were also observed between serum alanine and glutamine levels in groups IB and IIIB. In conclusion, we demonstrated that serum alanine levels were reduced in the postpartum period following lung injury, which may be expected to negatively impact wound healing in this period. The administration of exogenous alanine for traumatic events occurring during the postpartum period may thus contribute positively to wound healing capabilities during this period.Öğe Is esophagoscopy necessary for corrosive ingestion in adults?(WILEY-BLACKWELL PUBLISHING, INC, 2009) Celik, Burcin; Nadir, Aydin; Sahin, Ekber; Kaptanoglu, MelihP>The aim of the study was to determine whether early esophagoscopy is really necessary for the patients who have ingested a corrosive agent. Patients who were followed up with the diagnosis of corrosive ingestion in our clinic between the years 1998 and 2008 were studied retrospectively. The data were collected through the medical records of the patients and from interviews with them. The analyzed parameters included age, gender, the nature and the amount of the ingested agent, whether the event was accidental or suicidal, diagnostic tools, treatment and the results of the treatment, and long-term follow up. Over a 10-year period, a total of 124 cases of corrosive ingestion cases were determined. Of these, 64 (51.6%) were male and 60 (48.4%) were female. The mean age was 38 +/- 17.5 years. The most commonly ingested corrosive agents were sodium hypochlorite in 50 (40.3%) patients and hydrochloric acid in 33 (26.6%) patients. The mean admission time for the emergency department after ingestion of the corrosive agent was 2.5 +/- 3.7 hours. Ingestion was accidental in 82% of the patients and as a result of a suicide attempt in 18%. The amount of ingested corrosive agent in the suicidal group (190 +/- 208.3 mL) was higher than that of accidental group (66 +/- 58.3 mL) (P = 0.012). Nine patients underwent esophagoscopy, six of which were performed in other clinical centers. Only three (2.4%) patients experienced esophageal stricture, which were treated with repeated dilatations. In the long-term follow up, we could get in touch with only 63 patients and none of them had complications due to corrosive ingestion. The follow-up period ranged from 1 to 120 months (median 45 +/- 29.2 months). Based on our study, early esophagoscopy appears to be unnecessary in adult patients who ingested the corrosive agent accidentally. A larger prospective study is needed to answer the question.Öğe Is the Abramson technique effective in pectus carinatum repair?(ELSEVIER SINGAPORE PTE LTD, 2018) Katrancioglu, Ozgur; Akkas, Yucel; Karadayi, Sule; Sahin, Ekber; Kaptanoglu, MelihBackground: The minimally invasive pectus carinatum (PC) surgery described by Abramson has been performed in many centers. We have been using this technique since 2011. This article describes our experience with PC correction. Methods: Between 2011 and 2016, 32 patients at our institution underwent minimally invasive repair of a PC deformity. All patients presented with cosmetic complaints. The deformity involved the lower sternum (all had chondrogladiolar type PC), and three patients had asymmetrical deformities. All operations followed the principles defined by Abramson. Results: Satisfactory esthetic results were achieved in our patients. The hospital stay averaged 5.3 days (range 4-7 days). The most common early complication was pneumothorax, and the most common late complication was wire suture breakage. Conclusion: The Abramson technique is an effective, minimally invasive procedure for PC with shorter operating and hospitalization times and low morbidity rates. (C) 2016 Asian Surgical Association and Taiwan Robotic Surgical Association. Publishing services by Elsevier B.V.Öğe Post-thoracotomy wound separation (DEHISCENCE): A disturbing complication(HOSPITAL CLINICAS, UNIV SAO PAULO, 2013) Nadir, Aydin; Kaptanoglu, Melih; Sahin, Ekber; Sarzep, HakanOBJECTIVES: We described the treatment of dehiscence of thoracotomy incisions in patients who underwent thoracic surgery in the present study. METHODS: Twenty-four patients with either partial or complete dehiscence of their thoracotomy incisions were included in the study from 2005 to 2010. The patients were evaluated regarding their age, sex, indication for thoracotomy, and surgical approaches. We also described our method of re-closure. RESULTS: The male/female ratio was 17/7. The youngest and oldest patients were 15 and 75 years old, respectively, and the mean age was 43 years. Among the indications for thoracotomy, empyema was the most common reason (determined in eight [33%] patients), followed by vertebral surgery (determined in six [25%] patients). Bacterial growth was detected in the wound site cultures from 13 (54%) patients. For the patients with dehiscence of their thoracotomy incisions, an en block approximation technique with debridement was performed under general or local anesthesia in 16 (66%) and eight (33%) of the cases, respectively. Three patients exhibited an open thorax with dehiscence of the thoracotomy incision. Thoracoplasty was required in two patients. Using this method, successful closure was obtained in 91.7% (n = 22) of the patients with dehiscence of their thoracotomy incisions. CONCLUSION: Dehiscence of the thoracotomy incision is an important complication that causes concern in patients and their thoracic surgeons and strongly affects the success of the surgery. An en block approximation technique with significant debridement that enables removal of the necrotic tissues from the wound site can successfully be applied to patients with dehiscence of their thoracotomy incisions.Öğe Spontaneous rib fractures(EUROPEAN RESPIRATORY SOC JOURNALS LTD, 2012) Akkas, Yucel; Katrancioglu, Ozgul; Arslan, Sulhattin; Sahin, Ekber…Öğe Surgical treatment in malignant pleural effusion(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2021) Karadayi, Sule; Sahin, EkberMalignant pleural effusion can be described as the presence of exudate in the pleural space, accompanied by the detection of cancer cells in pleural fluid or tissue, which is the indicator of the disease in its advance stages, and survival time of these patients ranges between 3 and 12 months. Treatment options for malignant pleural effusion vary from observation in asymptomatic patients to pleurectomies or even extrapleural pneumonectomies in severe cases.Öğe The effects of chlorhexidine gluconate and silver nitrate on rabbit lung: an experimental study(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2011) Sahin, Ekber; Elagoz, Sahande; Celik, Burcin; Nadir, Aydin; Karadayi, Sule; Akkas, Yucel; Kaptanoglu, MelihBackground: In this study, we investigated the effects of chlorhexidine gluconate and silver nitrate on the lungs and determine their utility in operations for pulmonary hydatid cysts. Methods: Thirty New Zealand Wistar albino rabbits weighing between 2750 and 3000 grams were used in the study and divided into three groups. In the first (control) group, normal saline (0.09% NaCl); in the second group, silver nitrate (0.5%); and in the third group, chlorhexidine gluconate (0.04%) was administered intrathraceally. Thirty days after the procedure, the tracheobronchial and parenchymal changes in the subjects were evaluated histopathologically. Tracheobronchial changes were evaluated with respect to tracheal pathology whereas peribronchial lymphocytic infiltration and parenchymal changes were evaluated with respect to interstitial lymphocytic infiltration, hemorrhage-edema, fibrosis and pneumonitis. Results: The rate of interstitial lymphocytic infiltration was higher in the chlorhexidine gluconate group than in the control group, and the rates of fibrosis and fibrin accumulation were higher in the silver nitrate group than in the control group. No statistically significant differences in other parameters were found between the groups. Conclusion: The results of the study indicate that chlorhexidine gluconate (0.04%) has minimal negative effects on the rabbit lung and tracheobronchial mucosa and is a more reliable agent than silver nitrate.Öğe Therapeutic approaches in tracheal stenosis: analysis of fifteen cases(EKIN TIBBI YAYINCILIK LTD STI-EKIN MEDICAL PUBL, 2010) Sahin, Ekber; Nadir, Aydin; Celik, Burcin; Karadayi, Sule; Manduz, Sinasi; Arslan, Sulhattin; Kaptanoglu, MelihBackground: In this study, results of treatment of patients who had tracheal stenosis were evaluated. Methods: The clinical records of 15 patients (6 males, 9 females; mean age 39+/-23.2 years; range 8 to 70 years) who were treated for tracheal stenosis between June 1992 and October 2008 were analyzed retrospectively. The diagnostic method, localization, therapeutic approach and results of tracheal stenosis were investigated. Results: Tracheal stenosis was due to tracheostomy in six, prolonged intubation in five and malignancy in four patients. Rigid bronchoscopy was the most frequent diagnostic tool. Eight patients were treated conservatively. Diathermic resection was the first treatment of choice in nine patients. Resection and end-to-end anastomosis was used in seven patients and tracheal stent was used in six patients. Stents of three patients were removed within 12 to 18 months. Median duration of hospitalization was 12 days. Morbidity was seen in four patients; mortality was seen in three patients. Conclusion: The success rate in tracheal stenosis treated by surgery is 71 to 97% and it is 65 to 70% by conservative methods. Surgical options should be considered first, but conservative methods should keep in mind.Öğe Thirteen years of migration of Kirschner wires: A mediastinal foreign body(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2023) Ozbey, Mahmut; Turkmen, Ufuk; Sahin, EkberKirschner wires used for orthopedic fixation can rarely migrate over time. A 26-year-old male patient in whom two Kirschner wires were inserted 13 years ago for the stabilization of the right sternoclavicular joint dislocation and migrated into the anterior mediastinum and left hilum was admitted to our clinic. Incidentally detected Kirschner wires on chest radiography were removed by superior mini-sternotomy. In conclusion, since migration of Kirschner wires may cause serious complications, these patients should be followed closely and the wires should be removed once migration is detected.Öğe Thoracic splenosis accompanied by diaphragmatic hernia(CMA-CANADIAN MEDICAL ASSOC, 2009) Sahin, Ekber; Karadayi, Sule; Nadir, Aydin; Kaptanoglu, Melih…Öğe Tissue specific epigenetic silencing of the distinct tumor suppressor genes in lung cancer(ACADEMIC JOURNALS, 2010) Arslan, Sulhattin; Karadayi, Sule; Ozdemir, Ozturk; Sahin, Ekber; Ozdemir, Semra; Akkurt, IbrahimThe role of aberrant methylation of the cytosine-guanine dinucleotide islands in the promoter region of tumor suppressor genes in lung cancer development is increasingly recognized. DNAs extracted from cancer tissue biopsies of 40 patients with lung cancer were used. Methylated sites of tumor suppressor genes were examined by bisulfate treatment and methylation-specific PCR method. Strip Assay was used to access the promoter profiles of cytosine-guanine dinucleotide islands. Some of the tumor specimens evaluated showed fully inactive methylated pattern profiles for the tumor suppressor genes that were studied and some showed partially inactive methylated patterns. In lung cancers, the prevalence of SFRP2, p16, DAPK1, HIC1, MGMT promoter methylation status were 11/40(27.5), 8/40(20), 30/40(75), 16/40(40%) and 10/40(25%), respectively. DAPK1 gene inactivation was seen in all (5/5, 100%) the adenocarcinoma type of tumors and was fully hypermethylated in 13/19 squamous cell type (68.4%), 6/9 SCLC (66.7%), and 4/7 malign epithelial (57.1%) tumors. Our results confirm the importance of methylation in the molecular pathogenesis of lung cancer with the majority of tumors having one or more tumor suppressor genes islands methylated for some tumor suppressor genes promoters.
