Browsing by Author "Harman, Ali"

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Akciğer malign tümörlerinde radyofrekans ve mikrodalga ablasyon yöntemleriyle tedavi etkinliğinin değerlendirilmesi
(Başkent Üniversitesi Tıp Fakültesi, 2017) Kesim, Çağrı; Harman, Ali
Bu çalışma retrospektif olarak tasarlanmış olup oligometastatik akciğer hastalığının ve primer akciğer tümörlerinin radyofrekans ve mikrodalga ablasyon ile tedavisini takiben, hastalıksız sağ kalım, toplam sağ kalım ve bölgesel nüks oranı gibi çeşitli parametreler vasıtasıyla etkinliğini belirleme, yan etkilerini karşılaştırma ve bu iki ablatif tedavi yöntemini birbiriyle kıyaslamak için oluşturulmuştur. Bölgesel nüks oranı, toplam sağ kalım, hastalıksız sağ kalım ve yan etki profili; radyofrekans ablasyon ve mikrodalga ablasyon için ayrı ayrı değerlendirilmiş ve karşılaştırılmıştır. İstatistik analizleri için SPSS programı kullanılmış olup Independent Samples Test, Two-Sample Kolmogorov-Smirnov Test, Ki-Kare testi gibi parametrik ve non-parametrik analiz yöntemlerine başvurulmuştur. Kasım 2008 – Mayıs 2015 tarihleri arasında Başkent Üniversitesi Tıp Fakültesi, Ankara Hastanesi, Radyoloji Anabilim Dalı, Girişimsel Radyoloji bölümünde; primer ve metastatik akciğer tümörü bulunan toplam 26 hastanın 40 tümörüne yönelik perkütan radyofrekans ve mikrodalga ablasyon tedavileri yapılmış ve yan etki profilini belirlemek ve varsa bölgesel nüksü tespit etmek, toplam ve hastalıksız sağ kalımı saptamak amacıyla hastaların medikal dosyaları ve radyolojik tetkikleri retrospektif olarak analiz edilmiştir. Bu çalışmaya dâhil ettiğimiz 26 hastanın 6 tanesi kadın 20 tanesi erkek olup yaşları 23-77 (58,78±11,24) arasında idi. 26 hastanın toplam 40 tümörü olup bunlardan 26 tanesine radyofrekans ablasyon, 14 tanesine mikrodalga ablasyon tedavileri uygulandı. Tümör boyutları 5 mm – 45 mm arasında olup (16,25 ±10,65 mm) 6 tanesi primer akciğer kanserlerine 34 tanesi ise metastazlara ait idi. Ortalama takip süresi 36,18±21,42 ay olup bu süre içerisinde 1 hastanın takip süreci hakkında yeterli bilgi olmadığı için çalışmadan çıkarılmış 8 hasta ölmüş ve 17 hasta da sağ olarak takiplerine devam etmekteydi. Ablasyon prosedürleri esnasında 4 hastada tedavi girişimi gerektiren major komplikasyon gelişmiş olup bunlardan 3 tanesi pnömotoraks 1 tanesi hemotoraks idi. Radyofrekans ve mikrodalga ablasyon tedavi yöntemleri bölgesel ilerlemeyi kontrol altına alarak, toplam sağ kalım ve hastalıksız sağ kalım sürelerini uzatarak akciğer tümörlerinin tedavisinde kendine çok önemli bir yer edinmiştir. Bu faydalarının yanında, düşük komplikasyon oranları ve hastanede yatış süresini diğer tedavi yöntemlerine göre oldukça kısaltması nedeniyle günlük pratikte gün geçtikçe kendine daha fazla yer bulmaktadır. This study designed retrospective to evaluate the efficiency of radiofrequency and microwave ablation of oligometastatic disease of lung and primary lung tumours. For this purpose, we analysed total survival, disease free survival and local reccurence parameters and beside it determined the complications of these procedures, compare each other by means of side effects. Local tumour progression, total survival, disease free survival and complication ratios are evaluated seperately for radiofrequency and microwave ablation compared with each other. Findings analyzed with SPSS software. Parametric and non-parametic tests are used for calculations such as Independent Samples Test, Two-Sample Kolmogorov-Smirnov Test, Chi-Square test and for the survival analyses Kaplan-Meier method. In this study, we included 26 patients with 40 lung tumours who has been under radiofrequency and microwave ablation procedures between October 2008 – May 2015 in the Başkent University Medical Faculty, Ankara Hospital, Radiology department, Interventional Radiology section. On the purpose of calculate the total and disease free survival, determine local tumour progression rates and complicatons of the procedures. Files of the patients are examined retrospectively. 6 women and 20 men of 26 patients were aged between 23-77 (58,78±11,24). 14 tumours were treated with microwave ablation and 26 tumours were treated with radiofrequency ablation. Tumour diameters were between 5 mm – 45 mm ( 16,25 ±10,65 mm) and 6 of 40 were primary lung cancers and 34 of 40 were metastases of other cancers which were dominantly primary colorectal cancers. Median follow-up was 36,18±21,42 month. Just 1 patient had stopped follow-up and therefore we excluded him from the study. 8 patients died between this perid and 17 patients still in follow-up currently. During the ablation procedures 4 major complications occured which are necessitate curative atempt. 3 of 4 was pneumothorax and 1 of 4 was hemothorax Radiofrequency and microwave ablation procedures are very effective for the treatment of the lung tumours by controlling the local progression, increasing the total and disease free survival of patients. Under favour of all these benefits, with low complicaton rates and lesser hospitalisation period, these procedures get more place in the daily practice of the treatment of lung tumours day by day.
Clinical results of carotid artery stenting versus carotid endarterectomy
(2016) Derle, Eda; Akinci, Tuba; Kibaroglu, Seda; Harman, Ali; Kural, Feride; Cinar, Pinar; Kilinc, Munire; Akay, Hakki T.; Can, Ufuk; Benli, Ulku S.; 0000-0002-7386-7110; 0000-0002-4226-4034; 0000-0002-9975-3170; 0000-0003-2122-1016; 0000-0002-3964-268X; 0000-0001-8689-417X; 27744460; AAI-8830-2021; AAJ-2956-2021; K-9824-2013; AAL-9808-2021; AAJ-4403-2021; AAJ-2999-2021
Objective: To review our results of carotid artery stenting (CAS) and carotid endarterectomy (CEA). Methods: We evaluated the medical records of patients undergoing carotid artery revascularization procedure, between 2001 and 2013 in Baskent University Hospital, Ankara, Turkey. Carotid artery stenting or CEA procedures were performed in patients with asymptomatic carotid stenosis (=70%) or symptomatic stenosis (=50%). Demographic data, procedural details, and clinical outcomes were recorded. Primary outcome measures were in 30-day stroke/transient ischemic attacks (TIA)/amaurosis fugax or death. Secondary outcome measures were nerve injury, bleeding complications, length of stay in hospital, stroke, restenosis (ICA patency), and all-cause death during long-term follow-up. Results: One hundred ninety-four CEA and 115 CAS procedures were performed for symptomatic and/or asymptomatic carotid artery stenosis. There is no significant differences 30-day mortality and neurologic morbidity between CAS (13%) and CEA procedures (7.7%). Length of stay in hospital were significantly longer in CEA group (p=0.001). In the post-procedural follow up, only in symptomatic patients, restenosis rate was higher in the CEA group (p=.045). The other endpoints did not differ significantly. Conclusions: Endovascular stent treatment of carotid artery atherosclerotic disease is an alternative for vascular surgery, especially for patients that are high risk for standard CEA. The increasing experience, development of cerebral protection systems and new treatment protocols increases CAS feasibility.
Comparison of Transforaminal and Interlaminar Epidural Steroid Injection in Managing Lumbar Radiculopathy
(2017) Rahatli, Feride Kural; Harman, Ali; Boyvat, Fatih; Zararsiz, Gokmen; https://orcid.org/0000-0002-4226-4034; https://orcid.org/0000-0002-7386-7110; AAL-9808-2021; K-9824-2013; F-4230-2011
Purpose: Epidural steroid injection is a commonly used low risky symptomatic treatment option of lumbar radiculopathy in patients with poor response to conservative management. The purpose of this prospective study was to compare the efficacy of transforaminal and interlaminar epidural steroid injection. Materials and methods: In this study computed tomography guided lumbar epidural steroid injections were performed in 87 patients, steroid injections were made by transforaminal and interlaminar technique. The effectiveness of this treatment was evaluated by visual analogue scale at 2 weeks ( acute), 3 months (sub-acute) and 6 months ( chronic) after the injection. Results: In interlaminar group 78.1% patients had effective pain relief at acute term and 73.4% patients had effective pain relief at sub-acute and chronic term. In transforaminal group 82.6% patients had effective pain relief at acute term and 73.9% patients had effective pain relief at sub-acute and chronic term. Transforaminal group showed slightly better pain relief in all terms but the difference was not statistically significant. Patients with symptom duration more than 6 months had statistically significant higher pain relief than the patients with symptom duration less than 6 months in acute term but there was no statistically significant difference between sub-acute and chronic terms. Conclusion: In the current study transforaminal epidural steroid injections for the treatment of lumbar radiculopathy resulted in better pain relief than interlaminar epidural steroid injections in all terms but the difference was not statistically significant.
Diagnosis and Treatment of Takayasu Arteritis in Turkey: A Single Center Results
(2015) Akay, Tankut; Harman, Ali; Yucel, Eftal; Ozyer, Umut; Gultekin, Bahadir; 0000-0002-4300-009X; 0000-0002-7386-7110; AAK-9071-2021; ABA-7388-2021; K-9824-2013
Background: This study aims to evaluate clinical, laboratory, and radiological features as well as the surgical and endovascular procedure outcomes of patients with Takayasu arteritis in our hospital. Methods: Hospital records of 38 patients who were followed with the diagnosis of Takayasu arteritis between April 2002 and January 2014 were retrospectively evaluated. Records included the clinical history of Takayasu arteritis, comorbid diseases, laboratory and angiographic findings at the time of diagnosis, and mode of treatment. Results: The female/male ratio was 3.75:1. According to angiographic classification; 11 patients were type 1, three patients were type 2a, three patients were type 2b, four patients were type 3, six patients were type 4, and 11 patients were type 5. Eighteen of 38 patients were administered endovascular or surgical intervention (8 surgeries and 10 endovascular procedures). There was no early mortality. Conclusion: Demographic and angiographic features of our patients were similar to those of Japan and Mediterranean populations. The long-term follow-up of endovascular procedure success, and the management of restenosis may be among challenges to be faced in the future. Bypass surgery remains the gold standard for achieving long-term patency. Endovascular treatment may provide short-term symptom relief in patients who are not suitable for surgical treatment.
AN EFFECTIVE BRIDGING TIPS TECHNIQUE TO LIVER TRANSPLANTATION FOR BUDD-CHIARI SYNDROME
(2020) Boyvat, Fatih; Harman, Ali; Soy, Ebru H. Ayvazoglu; Haberal, Mehmet A.
The Effectiveness of Computed Tomography-Guided Lumbar Epidural Steroid Injections for Spinal Pain Management: A Single Center Experience with 2-Year Follow-Up
(2017) Harman, Ali; Duman, Enes; Ozdemir, Adnan; 0000-0002-7386-7110; 0000-0001-5221-1879; K-9824-2013; K-4333-2018
Purpose: To determine the therapeutic value and long-term effects of Computed Tomography (CT)-guided translaminar and transforaminal lumbar epidural steroid injections for spinal pain management. Materials and methods: Between December 2011 and June 2013, 428 CT-guided epidural steroid injections of the lumbar spine for 310 patients were assessed retrospectively. There were 325 Translaminar (TL) (in 225 patients) and 103 Transforaminal (TF) (in 85 patients) injections performed. The clinical effectiveness of the injection after the therapy was assessed using Visual Analog Scale (VAS). The patients were classified into three groups (A-C) after injections according to the reduction in the VAS's. Results: Technical success rate of 100% without any major complication related to needle placement or drug administration. There were 27 (6.3%) reported minor complications (n: 3 orthostatic hypotension (0.7%) and n: 24 transient motor weaknesses of lower extremities (5.6%). The mean visual analog scores before and after the injections were recorded as 8.9 +/- 1.1 and 4.8 +/- 2.5 retrospectively (p 0.001). In 23 of 310 patients epidural injections were repeated in different times during study and 73 epidural injections (n: 61 TL and n: 12 TF) were performed. Conclusion: CT guided epidural injection in the lumbar spine is safe, repeatable and efficacious pain management technique. Both translaminar and transforaminal epidural steroid injections can provide reliable pain relief for up to average 5.5 and 5.6 months respectively.
Emergency Cholecystectomy vs Percutaneous Cholecystostomy Plus Delayed Cholecystectomy for Patients with Acute Cholecystitis
(2014) Karakayali, Feza Y.; Akdur, Aydincan; Kirnap, Mahir; Harman, Ali; Ekici, Yahya; Moray, Gokhan; https://orcid.org/0000-0002-1874-947X; https://orcid.org/0000-0002-8726-3369; https://orcid.org/0000-0002-7386-7110; https://orcid.org/0000-0003-2498-7287; 24919616; AAB-3888-2021; AAA-3068-2021; AAH-9198-2019; K-9824-2013; AAE-1041-2021
BACKGROUND: In low-risk patients with acute cholecystitis who did not respond to nonoperative treatment, we prospectively compared treatment with emergency laparoscopic cholecystectomy or percutaneous transhepatic cholecystostomy followed by delayed cholecystectomy. METHODS: In 91 patients (American Society of Anesthesiologists class I or II) who had symptoms of acute cholecystitis 272 hours at hospital admission and who did not respond to nonoperative treatment (48 hours), 48 patients were treated with emergency laparoscopic cholecystectomy and 43 patients were treated with delayed cholecystectomy at 24 weeks after insertion of a percutaneous transhepatic cholecystostomy catheter. After initial treatment, the patients were followed up for 23 months on average (range 7-29). RESULT: Compared with the patients who had emergency laparoscopic cholecystectomy, the patients who were treated with percutaneous transhepatic cholecystostomy and delayed cholecystectomy had a lower frequency of conversion to open surgery [19(40%) vs 8(19%); P=0.029], a frequency of intraoperative bleeding >= 100 mL [16(33%) vs 4(9%); P=0.006], a mean postoperative hospital stay (5.3 +/- 3.3 vs 3.0 +/- 2.4 days; P=0.001), and a frequency of complications [17(35%) vs 4(9%); P=0.003]. CONCLUSION: In patients with acute cholecystitis who presented to the hospital 272 hours after symptom onset and did not respond to nonoperative treatment for 48 hours, percutaneous transhepatic cholecystostomy with delayed laparoscopic cholecystectomy produced better outcomes and fewer complications than emergency laparoscopic cholecystectomy.
Endovascular Management of Arterial Complications Following Renal Transplant Biopsy
(2018) Ozyer, Umut; Harman, Ali; Soy, Ebru H. Ayvazoglu; Aytekin, Cuneyt; Boyvat, Fatih; Haberal, Mehmet; 0000-0002-4300-009X; 0000-0002-7386-7110; 0000-0002-0993-9917; 0000-0002-3462-7632; AAK-9071-2021; K-9824-2013; AAC-5566-2019; F-4230-2011; AAJ-8097-2021
Endovascular Management of Hematomas in Pediatric Transplant Patients
(2022) Ozen, Ozgur; Boyvat, Fatih; Harman, Ali; Karakaya, Emre; Haberal, Mehmet; 0000-0002-4879-7974; 0000-0001-7122-4130; 0000-0002-3462-7632; 35570602; AAD-5466-2021; AAN-1681-2021; AAJ-8097-2021
Objectives: Transcatheter arterial embolization is used to control active hemorrhage at different anatomic locations. Because hematomas can suddenly deteriorate and become life threatening for transplant patients, they require prompt diagnosis and intervention rather than conservative management. Here, we evaluated computed tomography in treatment planning and transcatheter embolization effectiveness for hematoma management in pediatric liver transplant patients. Materials and Methods: Between June 2012 and December 2021, 10 pediatric liver transplant patients were referred to our interventional radiology unit. Computed tomography and angiograms were reviewed for hematoma location and presence of extravasation. We analyzed correlations between computed tomography and angiography findings and technical and clinical success of the endovascular interventions. Results: Active leak of contrast material during arterial phase was detected on 9/10 CT scans. Although there was no active bleeding on CT in 1 patient, active arterial bleeding was detected on angiography. On the contrary, in 2 patients, although active bleeding was observed on computed tomography, it was not detected on angiography. Source of bleeding was superior mesenteric artery branches in 4, hepatic artery branch in 2, superior epigastric artery in 1, and phrenic artery in 1 patient. Six of 8 patients with active bleeding were treated with endovascular procedures. The remaining 2 patients received surgery: 1 had bleeding from liver cut surface originating from a hepatic artery branch and received open surgery because the bleeding branch was too thin for catheterization, and 1 was hemodynamically unstable and selective catheterization of the internal thoracic artery would take time. Two patients received embolization procedures with N-butyl 2-cyanoacrylate (glue) diluted with iodized oil, and 1 patient had coil and glue with iodized oil. Embolization with coils was performed in 3 patients. Rate of success with transcatheter arterial embolization was 75%. No complications related to patient comorbidities or embolization procedures were shown. No deaths occurred due to progression of the hematoma. Conclusions: Transcatheter arterial embolization is effective and safe for treatment of pediatric liver transplant patients with hematomas. Computed tomography has value in identifying the bleeding source and its anatomic relationships and may enhance our intervention abilities to become quicker, more effective, and more secured.
Endovascular Treatment of Active Bleeding after Liver Transplant
(Başkent Üniversitesi, 2007-06) Harman, Ali; Boyvat, Fatih; Hasdogan, Baris; Aytekin, Cuneyt; Karakayali, Hamdi; Haberal, Mehmet
Objectives: To evaluate the incidence of active bleeding complications following transplant and the efficacy of interventional radiologic management. Materials and Methods: Between June 2000 and February 2007, 14 liver transplant patients with active bleeding were treated via endovascular techniques (coils, glue, or graft-covered stents). Active bleeding was spontaneous in 6 patients through the inferior epigastric artery (n=1), the inferior phrenic artery (n=1), the superior mesenteric artery (n=2), the internal mammary artery (n=1), and the hepatic artery (n=1). In 8 patients, active bleeding was due to transhepatic biliary or endovascular interventions. Hemobilia (n=2) due to pseudoaneurysm formation after transhepatic biliary interventions was embolized with coils. Hepatic artery rupture was observed in 6 patients during endovascular interventions performed on hepatic artery stenosis or thrombosis that had been treated with graft-covered stents. Technical success, clinical improvement, and complications were documented. Results: Active bleeding was stopped by endovascular intervention in 13 of 14 patients. Embolizations with coils or glue were successful. In 1 patient with hepatic artery bleeding, the graft-covered stent failed to seal the rupture site, and this patient underwent reoperation. Conclusion: Arterial bleeding complications after liver transplant during the early and late postoperative period, due either to spontaneous active bleeding or to percutaneous or endovascular interventions, can be successfully managed with interventional radiologic techniques.
Evaluation of Safety and Efficacy of Liver Biopsy Following Liver Transplant
(2015) Kirnap, Mahir; Akdur, Aydincan; Reyhan, Nihan Haberal; Aytekin, Cuneyt; Harman, Ali; Yildirim, Sedat; Moray, Gokhan; Haberal, Mehmet; 0000-0003-2498-7287; 0000-0001-9852-9911; 0000-0002-3462-7632; 0000-0002-5735-4315; 0000-0002-8726-3369; 0000-0002-7386-7110; 0000-0001-5134-168X; 25894180; AAE-1041-2021; AAK-4587-2021; AAJ-8097-2021; AAF-4610-2019; AAH-9198-2019; AAA-3068-2021; K-9824-2013
Objectives: Liver biopsy is a diagnostic tool for liver pathology after liver transplant. However, biopsy can cause life-threating complications. There is limited knowledge about efficacy and complications of liver biopsy after liver transplant. Our aim was to evaluate the risk and benefit of liver biopsy after liver transplant and quality of biopsy specimens. Materials and Methods: We retrospectively analyzed all liver biopsies performed after liver transplant between January 2000 and October 2014. All patients were monitored for minimum 24 hours after biopsy. Results: We performed 245 liver biopsies in 159 liver transplant patients. Fifteen biopsies (6%) were nondiagnostic. In the samples, there were 102 cases (41%) of acute rejection, 79 cases (35%) of cholangitis, and 49 cases (20%) of cholestasis observed. Complications after biopsy were seen in 23 patients (9%) and biopsies. There were 7 patients who had severe abdominal pain followed by fever. We diagnosed 4 patients who had intercostal/subcapsular bleeding and 12 patients who had vasovagal reaction. All patients were treated with analgesic agents and monitored for 24 hours. No blood transfusion or surgery was required. Conclusions: Liver biopsy after liver transplant is an invasive diagnostic tool for liver pathology. However, it can be used safely in experienced centers.
Fluoroscopically Guided Retrograde Double-J Stent Removal in Renal Transplant Patients
(2018) Aytekin, Cuneyt; Harman, Ali; Ozyer, Umut; Akdur, Aydincan; Boyvat, Fatih; Haberal, Mehmet; 0000-0002-7386-7110; 0000-0002-4300-009X; 0000-0002-8726-3369; 0000-0002-3462-7632; K-9824-2013; AAK-9071-2021; AAA-3068-2021; F-4230-2011; AAJ-8097-2021
Karotis Arter Stenozlarında Endovasküler Tedavi Etkinliğinin Belirlenmesi
(Başkent Üniversitesi Tıp Fakültesi, 2014) Bekin Sarıkaya, Pelin Zeynep; Harman, Ali
Serebrovasküler hastalıklar, tüm dünyada, erişkinlerde, kanser ve kalp hastalıklarından sonra en önemli ölüm sebebidir. İnmelerin en önemli sebeplerinden biri karotis arter stenozudur. Bu çalışmanın amacı; merkezimizde 2000-2014 yılları arasında karotis arter stenozu nedeniyle endovasküler tedavi uygulanan 114 hastanın retrospektif olarak değerlendirilmesi ve elde edilen verilerin mevcut literatür bilgileri ile karşılaştırılmasıdır. Çalışmada Başkent Üniversitesi Tıp Fakültesi Ankara Hastanesi Girişimsel Radyoloji Ünitesinde 01/01/2000-01/02/2014 tarihleri arasında selektif karotis anjiyografi sonrası karotis endovasküler stent uygulaması yapılan 114 hasta incelenmiştir. Hastaların 83’ü erkek (%72,8), 31’i kadın (%27,2) olup yaşları 41-86 (ortalama 69±8,7) arasındaydı. İnceleme retrospektif olup hastaların, demografik bilgileri (yaş, cinsiyet, eşlik eden diğer sistemik hastalıkları), işlem öncesi stenoz oranları ve stenozun bulunduğu taraf, plak tipi, kullanılan stent tipi, işlem sırasında antikoagülasyon tedavi kullanımı, işlem sırasında emboli koruyucu sistemi (EKS) kullanımı, işlem sırasında predilatasyon ve postdilatasyon uygulanması, işlem sonrasında damar oklüzyon cihazı kullanımı, stent yerleştirilmesinde başarı oranı, erken dönem komplikasyonlar (<30 gün), stentte restenoz görülme sıklığı, hastaların 6. ay, 1. sene, 2. sene, 5. sene kontrolleri ve bu kontrollerde uygulanan radyolojik görüntüleme sonuçları, taburculuk süreleri değerlendirilmiştir. Karotis stenozu gelişen kadın hastalarda hipertansiyon eşlik etme oranı, erkeklere göre daha yüksektir (p<0,01). Erken komplikasyon gelişimi ile ülsere plak varlığı arasında anlamlı farklılık saptanmadı (p>0,05). Oransal olarak Nitinol stent kullanılan hastalarda, Wallstent kullanılan hastalara göre erken komplikasyon gelişimi yüksek olarak izlendi (p=0,062). Hastaların hepsinde stent yerleştirme işlemi, bazı hastalarda ek işlemlere gerek duyulsa da, başarıyla gerçekleştirildi. İlk 30 gün içerisinde 13 hastada (%11,4) embolik olaylar ve enfarkt oluşumu izlendi. Bu hastaların birinde embolik olaylara bağlı eksitus görüldü. Geç dönemde farklı düzeylerde stenoz gelişimi ii izlendi. Kontrolleri mevcut olan 97 hastanın 11’inde (%11,3) farklı düzeylerde stenoz geliştiği izlendi. Bu hastaların 4‘ünde (%4,1) tam oklüzyon geliştiği anlaşıldı. Yine hastaların 4’ünde (%4,1) işlem gerektirmeyen %50’nin altında stenoz gelişimi mevcut iken, 3’ünde (%3,09) %50 üzerinde stenoz gelişimi saptandı. Stenoz gelişmeme olasılığı birinci yılın sonunda %98, ikinci yılın sonunda %96, beşinci yılın sonunda %87 olarak belirlendi. Ortalama stenoz gelişim süresi 4,86±0,11 yıl olarak hesaplandı. Merkezimizde karotis arter stenozlarında uyguladığımız endovasküler tedavide stentlerin açık kalım oranları, erken komplikasyon oranları, literatürdeki çalışmalar ile benzer bulunmuştur. Bununla birlikte olgu sayısının artması ve takip sürelerinin uzatılması ile uygulanan tedavi etkinliği ve komplikasyonları konusunda daha iyi fikir sahibi olabiliriz.
Lumbal radikülopatili hastalarda bilgisayarlı tomografi eşliğinde yapılan epidural steroid enjeksiyonunun etkinliğinin değerlendirilmesi
(Başkent Üniversitesi Tıp Fakültesi, 2009) Kural Emiroğlu, Feride; Harman, Ali
Bel ağrısı ve ağrıya eşlik eden radiküler semptomlar günümüzde ciddi tıbbi ve sosyoekonomik sorunlardan biridir. Hastaların yarısından fazlasında sosyal yaşamda ciddi kısıtlamalara yol açan tablonun en sık nedenleri lumbal intervertebral disk herniyasyonu ve spinal stenozdur. Konservatif tedaviye yanıtsız lumbal radikülopatide cerrahi tedavi öncesinde veya cerrahi tedavinin uygulanamadığı durumlarda ağrının giderilmesinde epidural steroid enjeksiyonu sık kullanılan düşük riskli bir tedavi seçeneğidir. Lumbosakral radiküler ağrı tedavisinde epidural aralığa enjeksiyon körlemesine, floroskopi eşliğinde veya Bilgisayarlı Tomografi eşliğinde yapılabilir. İleriye dönük olarak yapılan bu çalışmada Ocak - Aralık 2008 tarihleri arasında 88 hastaya Bilgisayarlı Tomografi eşliğinde epidural steroid enjeksiyonu yapılmış ve bu tedavinin etkinliği ve komplikasyonları değerlendirilmiştir. Hastaların ağrı düzeyleri işlem öncesi görsel ağrı skalası kullanılarak tespit edilmiş ve işlem sonrası 15.gün, 3.ay, 6.ay ‘da hastalar aranarak ağrı düzeyleri sorulmuştur. İşlem öncesinde ve sonrasında ağrı düzeyleri karşılaştırılarak görsel ağrı skalasında %50 veya daha fazla azalma yeterli yanıt, %50 den daha az azalma yetersiz yanıt olarak nitelendirilmiştir. İşlemden sonra ağrı düzeylerinde değişiklik olmayan hastalar ise enjeksiyona yanıtsız kabul edilmiştir. Çalışmamızın sonunda hastaların %74’ünde yeterli yanıt, %17’sinde yetersiz yanıt saptanmıştır. Hastaların %9’unda enjeksiyona yanıt saptanmamıştır. Bilgisayarlı Tomografi eşliğinde yapılan epidural steroid enjeksiyonu bel ağrısı olan hastalarda teknik başarısı yüksek, komplikasyon oranı düşük güvenle uygulanabilir bir tedavi seçeneğidir Nowadays low back pain and concomitant radicular sympthoms is one of the common medical and socioechonomical problems. Lumbar intervertebral disc herniation and spinal stenosis are the two most common causes of this table which leads serious restriction in the social lifes of more than half of the patients. Epidural steroid injection is a commonly used low risky sympthomatic treatment option of lumbar radiculopathy in patients with poor response to conservative management before the surgical procedure and in patients whom surgery is not an option. Epidural steroid injection can be made blindly or under either floroscopy or computered tomography guidence. In this prospective study computered tomography guided epidural steroid injections were performed in 88 patients between january- december 2008, the effectiveness and complications of this treatment were evaluated. Patients pain levels were assessed with the use of visual analog scale before and after the injections (15. day, 3. month, 6. month). The patients with reduction in the visual analog scale of equal or more than 50%after the injection was classified as sufficient answer and the patients with reduction in the visual analog scale of less than 50%after the injection was classified as insufficient answer. The patients who do not have any change in the visual analog scale was classified as negative answer. In the end of our study we found sufficient answer in 74%and insufficient answer in 17%of the patients. 9%of the patients do not show any answer to epidural steroid injection. Computered tomography guided epidural steroid injection is a treatment choice which can be performed safely in patients with low back pain, has low complication rate and high technical achievement.
Our Living Donor Protocol for Liver Transplant: A Single-Center Experience
(2020) Karakaya, Emre; Akdur, Aydincan; Soy, Ebru H. Ayvazoglu; Harman, Ali; Coskun, Mehmet; Haberal, Mehmet; 0000-0002-0993-9917; 0000-0002-4879-7974; 0000-0002-3462-7632; 0000-0002-8726-3369; 0000-0001-5630-022X; 33187462; K-9824-2013; AAC-5566-2019; AAD-5466-2021; AAJ-8097-2021; AAA-3068-2021; AAM-4120-2021
Objectives: The shortage of deceased donor organs is a limiting factor in transplant. The growing discrepancy between the wait list demand versus the supply of deceased donor organs has created an incentive for consideration of living donor liver transplant as an alternative. Here, we describe our evaluation process and donor complications. Materials and Methods: Since 1988, we have performed 659 (449 living donor and 210 deceased donor) liver transplants. The most important evaluation criteria is the relationship between donor and recipient, and we require that the donor must be related to the recipient. The evaluation protocol has 5 stages. Donor complications were defined as simple, moderate, and severe. Results: We retrospectively investigated data for 1387 candidates, and 938 (67.7%) were rejected; subsequently, 449 living donor liver transplants were performed. There were no complications in 398 of the donors (88.7%). Total complication rate was 11.3%. Simple complications were seen in 31 patients (6.9%). Moderate complications were seen in 19 patients (4.2%). We had only 1 severe complication, ie, organ failure from unspecified liver necrosis, which resulted in death. Conclusions: The relationship between donor and recipient and donor safety should be the primary focus for living donor liver transplant. Donor selection should be made carefully to minimize complications and provide adequately functional grafts.
Percutaneous Biopsy of Hepatocellular Cancer Using Coaxial Needle System and Track Cauterization to Prevent Bleeding and Seeding
(2018) Boyvat, Fatih; Haberal, Mehmet; Harman, Ali; Akdur, Aydincan; Ozyer, Umut; Selcuk, Haldun; Moray, Gokhan; 0000-0002-3462-7632; 0000-0002-7386-7110; 0000-0002-8726-3369; 0000-0002-4300-009X; 0000-0002-8445-6413; 0000-0003-2498-7287; F-4230-2011; AAJ-8097-2021; K-9824-2013; AAA-3068-2021; AAK-9071-2021; AAJ-6976-2021; AAE-1041-2021
Percutaneous Transhepatic TIPS for Budd-Chiari Syndrome As a Bridge to Liver Transplantation
(2022) Boyvat, Fatih; Harman, Ali; Soy, Ebru H. Ayvazoglu; Ozen, Ozgur; Akdur, Aydincan; Moray, Gokhan; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0001-7122-4130; AAJ-8097-2021; AAN-1681-2021
Percutaneous Transhepatic Tips for Budd-Chiari Syndrome: Direct Simultaneous Puncture of Portal Vein and Inferior Vena Cava
(2018) Boyvat, Fatih; Harman, Ali; Soy, Ebru H. Ayvazoglu; Aytekin, Cuneyt; Moray, Gokhan; Boyacioglu, Sedat; Haberal, Mehmet; 0000-0002-7386-7110; 0000-0002-0993-9917; 0000-0003-2498-7287; 0000-0002-9370-1126; 0000-0002-3462-7632; F-4230-2011; K-9824-2013; AAC-5566-2019; AAE-1041-2021; AAE-7637-2021; AAJ-8097-2021
Percutaneous Ultrasound Guided Biliary Interventions After Pediatric Liver Transplantation Using Fine Needle and 0.014 Inch Guide-Wire
(2016) Boyvat, Fatih; Harman, Ali; Soy, Ebru H. Ayvazoglu; Ozyer, Umut; Kirnap, Mahir; Moray, Gokhan; Haberal, Mehmet; https://orcid.org/0000-0002-7386-7110; https://orcid.org/0000-0002-0993-9917; https://orcid.org/0000-0002-4300-009X; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-3462-7632; F-4230-2011; K-9824-2013; AAC-5566-2019; AAK-9071-2021; AAH-9198-2019; AAE-1041-2021; AAJ-8097-2021
The Role of Choice-Lock Catheter and Trocar Technique in Percutaneous Ablation of Symptomatic Renal Cysts
(2014) Ozkan, Burak; Harman, Ali; Emiroglu, Baris; Arer, Ilker; Aytekin, Cuneyt; 25035702
Background: The most common benign lesions of the kidney are simple cysts. They are acquired lesions and mostly affect the elderly population. Objectives: To describe the usage of choice-lock catheter and trocar technique in percutaneous renal cyst treatment and determining long-term outcomes. Patients and Methods: This retrospective study was carried out between February 2000 and July 2011 Eighty-eight cysts all of which were Bosniak type-1 cysts were selected in 75 patients. The treatment indications were flank pain, hydronephros is and hypertension. The choice-lock catheter was used for 84 cysts with the trocar technique. Ninety-five percent ethanol was used as the sclerosing agent. Maximum volume of the injected ethanol was 175 ml. The mean follow-up time after the treatment procedure was 23 months. Sixty-four cysts were located in the cortical and 24 cysts were located at the parapelvic region. Results: Fifty-seven cysts had complete regression, while 31 cysts regressed partially After the procedure, pain was relieved in 44 (82%) patients and the pain alleviated in four (8%). Normotension was obtained in five (62.5%) of the eight hypertensive patients and no hydronephrosis was detected in nine patients. There were no relationship between the localization and the regression rate. No major complications occurred. Conclusions: Percutaneous ethanol sclerotheraphy in simple cysts is a safe, cost-effective and minimally invasive method. We consider that this technique may be an alternative solution in the percutaneous cyst treatment.