Browsing by Author "Reyhan, Nihan Haberal"

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17 Years Of Pediatric Liver Transplantation Experience For Cirrhosis And Hepatocellular Carcinoma
(2022) Ozcay, Figen; Sezer, Oya Balci; Sarialioglu, Faik; Boyvat, Fatih; Coskun, Mehmet; Reyhan, Nihan Haberal; Haberal, Mehmet; https://orcid.org/0000-0002-3462-7632; AAJ-8097-2021
Baskent University Expanded Criteria for Hepatocellular Carcinoma: The Importance of the Histopathological Features as a Part of the Evaluation Criteria for Liver Transplantation
(2018) Ozgun, Gonca; Ozdemir, B. Handan; Moray, Gokhan; Reyhan, Nihan Haberal; Akdur, Aydincan; Kirnap, Mahir; Haberal, Mehmet; https://orcid.org/0000-0002-7528-3557; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0001-9852-9911; https://orcid.org/0000-0002-8726-3369; https://orcid.org/0000-0002-3462-7632; X-8540-2019; AAE-1041-2021; AAK-4587-2021; AAA-3068-2021; AAH-9198-2019; AAJ-8097-2021
Baskent University Expanded Criteria for Hepatocellular Carcinoma: The Importance of the Histopathological Features as a Part of the Evaluation Criteria for Liver Transplantation
(2018) Ozgun, Gonca; Ozdemir, B. Handan; Moray, Gokhan; Reyhan, Nihan Haberal; Akdur, Aydincan; Kirnap, Mahir; Haberal, Mehmet; 0000-0002-7528-3557; 0000-0003-2498-7287; 0000-0001-9852-9911; 0000-0002-8726-3369; 0000-0002-3462-7632; X-8540-2019; AAE-1041-2021; AAK-4587-2021; AAA-3068-2021; AAH-9198-2019; AAJ-8097-2021
Choroidal Thickness in Ocular Sarcoidosis during Quiescent Phase Using Enhanced Depth Imaging Optical Coherence Tomography
(2014) Gungor, Sirel Gur; Akkoyun, Imren; Reyhan, Nihan Haberal; Yesilirmak, Nilufer; Yilmaz, Gursel; https://orcid.org/0000-0001-6178-8362; https://orcid.org/0000-0002-2860-7424; https://orcid.org/0000-0001-9852-9911; https://orcid.org/0000-0002-8632-2873; https://orcid.org/0000-0002-2589-7294; 24912003; AAD-5967-2021; AAK-7713-2021; AAK-4587-2021; AAD-7299-2020; AAK-6987-2021
Purpose: To evaluate the choroidal thickness in patients with ocular sarcoidosis during quiescent phase using enhanced depth imaging optical coherence tomography (EDI-OCT) and comparing it with normal subjects. Method: Eighteen eyes of 9 patients with ocular sarcoidosis (8 women, 1 man, mean age: 59.12 +/- 18.49 years) were enrolled in this study. Their subfoveal choroidal thickness was measured using EDI-OCT in the quiescent phase of uveitis, and compared with the age-, sex-, and spherical equivalent-matched normal subjects (6 women, 3 men, mean age: 59.6 +/- 14.22 years). Results: The mean subfoveal choroidal thickness was 281.76 +/- 88.1 mm in patients with sarcoidosis and 342.32 +/- 71.02 mm in controls. Significant differences were found at points between nasal 1500 mm and temporal 1000 mm to the fovea between patients and control group (p = 0.002, at fovea). Conclusions: Patients with ocular sarcoidosis had thinner choroids in the quiescent phases when compared to normal subjects.
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.
Good Outcomes of Patients with Stage IB Endometrial Cancer with Surgery Alone
(2014) Rahatli, Samed; Dizdar, Omer; Kucukoztas, Nadire; Oguz, Arzu; Yalcin, Selim; Ozen, Ozlem; Reyhan, Nihan Haberal; Tarhan, Cagla; Yildiz, Ferah; Dursun, Polat; Altundag, Ozden; Ayhan, Ali
Background: Most patients with endometrial cancer have stage I disease. Adjuvant therapy in stage IB (formerly IC) endometrial cancer is controversial, treatment options including observation or brachytherapy/radiotherapy in grade 1-3 patients with or without chemotherapy. The purpose of this study was to assess the outcomes of our patients with stage IB endometrioid endometrial cancer. Materials and Methods: Sixty two patients with stage IB endometrial cancer and endometrioid histology were retrospectively evaluated. All patients were initially treated surgically by the same surgeon with comprehensive staging, i.e. total abdominal hysterectomy, bilateral salphingooopherectomy, bilateral pelvic and paraaortic lymph node dissection and omentectomy. Adjuvant radiotherapy was discussed with patients and utilized by those who accepted. Adjuvant chemotherapy was not given to any of the patients. Results: Median age was 62 (range, 42-95). Ninety percent of the patients had grade 1-2 disease. Thirteen patients (21%) received intra vaginal brachytherapy (IVBT) and one received whole pelvic radiotherapy (WPRT). Median follow-up time was 46 months (range, 9-77 months). Three patients experienced recurrence (4.8%), two of them died on follow-up and one was still alive at last visit. Two patients with recurrence had FIGO grade 2 tumors and one had a grade 3 tumor. Two patients (3.2%) died without evidence of recurrent disease. Relapse free survival at 5 years was 94.4% and overall survival was 93.1%. Conclusions: Patients with stage IB disease in our study demonstrated relatively low recurrence rates with this stage of endometrial cancer.
Liver Stiffness Measurement Using Acoustic Radiation Force Impulse (ARFI) in Living And Deceased Donor Orthotopic Liver Transplantation Patients
(2016) Haberal, Murat; Turnaoglu, Hale; Ozdemir, Adnan; Uslu, Nihal; Reyhan, Nihan Haberal; Moray, Gokhan; Haberal, Mehmet; https://orcid.org/0000-0002-8211-4065; https://orcid.org/0000-0002-0781-0036; https://orcid.org/0000-0003-0652-5396; https://orcid.org/0000-0002-6733-8669; https://orcid.org/0000-0001-9852-9911; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-3462-7632; R-9398-2019; AAK-8242-2021; AAH-9023-2020; ABC-5258-2020; AAK-4587-2021; AAE-1041-2021; AAJ-8097-2021
Liver Transplant for Hepatocellular Carcinoma: Pathologic Point Of View
(2017) Ozgun, Gonca; Reyhan, Nihan Haberal; Ozdemir, Binnaz Handan; Haberal, Mehmet; 0000-0001-9852-9911; 0000-0002-7528-3557; 0000-0002-3462-7632; 28301999; AAK-4587-2021; X-8540-2019; AAJ-8097-2021
Primary liver cancer is the fifth most common cancer overall and the second most common cause of cancer mortality worldwide. Hepatocellular carcinoma accounts for up to 90% of all primary hepatic malignancies and represents a major international health problem. It is a complex and heterogeneous malignancy, frequently occurs in the setting of a chronically diseased organ, and has multiple confounding factors. Liver transplant for hepato cellular carcinoma has been established as a standard treatment in selected patients. Liver resection and locoregional therapies could be other options for treatment. Pathologic evaluation of hepatocellular carcinoma is a complicated process that includes tumor grading and evaluation of microvascular invasion. Although macrovascular invasion can be detected with imaging techniques, microvascular invasion is diagnosed pathologically. Pathologic evaluation provides additional information about the tumor biology, using immunohistochemical and molecular methods to predict patient outcomes. Hepatocellular carcinoma requires a multidisciplinary approach to determine the most appropriate treatment, as well as requires accurate timing of various treatments for optimal outcomes.
Liver Transplant for Nonhepatocellular Carcinoma Malignancy
(2017) Reyhan, Nihan Haberal; 0000-0001-9852-9911; 28302003; AAK-4587-2021
Liver transplant is now an acceptable and effective treatment for specific nonhepatocellular malignancies. Worldwide, hilar cholangiocarcinoma accounts for 3% of all primary gastrointestinal malignancies and for 10% of primary hepatobiliary malignancies. For patients who have early-stage, unresectable cholangiocarcinoma, liver transplant preceded by neoadjuvant radiotherapy can result in tumor-free margins, accomplish a radical resection, and treat the underlying primary sclerosing cholangitis when present. Hepatic epithelioid hemangioendothelioma is a rare tumor of vascular origin with a variable malignant potential. Excellent results have been reported with liver transplant for patients with unresectable hepatic epithelioid hemangioendo thelioma, with 1-year and 10-year survival rates of 96% and 72%. Hepatoblastoma is the most common primary hepatic malignancy in children. The long-term survival rate after transplant ranges from 66% to 77% in patients with unresectable tumors and good response to chemotherapy. Metastatic liver disease is not an indication for liver transplant, with the exception of cases in which the primary tumor is a neuroendocrine tumor. Indication for liver transplant for hepatic metastasis from neuroendocrine tumors is mainly for patients with unresectable tumors and for palliation of medically uncontrollable symptoms. Posttransplant survival in those patients with low tumor activity index is excellent, despite recurrence of the tumor. Some recent data on liver transplant for unresectable hepatic metastases from colorectal cancer have reported limited survival benefits compared with previous reports. However, due to the high rate of tumor recurrence in a very short time after liver transplant, especially in the era of organ shortage, this indication has not been favored by the transplant community. The indications for liver transplant for nonhepatocellular carcinoma malignancy and its limitations have evolved dramatically over the past decades and will continue to be redefined through future research and investigations.
Risk Factors for Residual Disease After Cervical Conization in Patients with Cervical Intraepithelial Neoplasia Grades 2 and 3 and Positive Surgical Margins
(2016) Ayhan, Ali; Tuncer, Hasan Aykut; Reyhan, Nihan Haberal; Kuscu, Esra; Dursun, Polat; 0000-0001-9852-9911; 0000-0002-5434-1025; 0000-0002-0992-6980; 27038228; AAK-4587-2021; K-1760-2018; AAJ-5802-2021; AAI-8792-2021
Objective: To evaluate risk factors for the persistence of cervical intraepithelial neoplasia (CIN) grade >= 2 following repeat surgical procedures in patients with CIN grades 2 and 3 and positive surgical margins. Study design: This study included patients with CIN grades 2 and 3 and positive surgical margins following loop electrosurgical excision procedures (LEEP), who had undergone additional surgery between 2007 and 2014. Factors associated with CIN grade >= 2 on biopsy results after the second operation were assessed by multiple logistic regression analysis. Factors considered included patient age, parity, menopausal status, smoking, referral cytology, initial LEEP pathology, time interval between LEEP and surgical procedures, presence of disease on endocervical sampling, endocervical surgical margins, glands, disease surrounding >= 50% of the cervical circumference and requirement for multiple sweeps on initial LEEP to excise a lesion. The forward likelihood ratio method was used and significance was set at p < 0.05. Results: Repeat surgical procedures were performed in 104 patients, 75 with CIN 2 and 29 with CIN 3, with 43 (41.3%) reported as normal or CIN 1. However, 57 (54.8%) patients had CIN >= 2 lesions and four (3.8%) had previously undiagnosed cervical cancer. Factors associated with CIN >= 2 lesions included requirement for multiple sweeps (vs. a single sweep; odds ratio [OR] 5.967; 95% confidence interval [CI] 2.183-16.311, p < 0.001) and involvement of >= 50% of the cervical circumference (vs. <50%; OR 5.073; 95% CI 1.501-17.146, p = 0.009). Conclusion: As lesions requiring multiple sweeps for excision and/or surrounding >= 50% of the cervical circumference during initial conization are associated with recurrent CIN >= 2 lesions, attention should be paid during resection to prevent margin positivity. If surgical margins are positive, however, repeat surgical procedures should be considered in patients with CIN 2 and CIN 3 lesions and these risk factors. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
A Single-Center Retrospective Clinicopathologic Study of Endomyocardial Biopsies After Heart Transplant at Baskent University Hospital in Ankara, 1993-2014
(2015) Terzi, Ayen; Sezgin, Atilla; Tunca, Zeynep; Deniz, Ebru; Ayva, Ebru Sebnem; Reyhan, Nihan Haberal; Mulderrisoglu, Haldun; Ozdemir, Binnaz Handan; 0000-0002-2280-8778; 0000-0002-7528-3557; 0000-0002-1225-1320; 0000-0001-9852-9911; 25894188; AAK-1967-2021; X-8540-2019; F-7546-2013; AAK-4587-2021
Objectives: The purpose of this study was to investigate the frequency and prognostic importance of acute cellular rejection after heart transplant. Materials and Methods: All 84 heart transplant patients at our center from January 1993 to January 2014, including all 576 endomyocardial biopsies, were evaluated with retrospective review of clinical records and endomyocardial biopsies. Routine and clinically indicated endomyocardial biopsies after heart transplant were graded for acute cellular rejection (2005 International Society for Heart and Lung Transplantation Working Formulation). Survival analysis was performed using Kaplan-Meier method. Results: There were 61 male (73%) and 23 female recipients. Median age at heart transplant was 29 years (range, 1-62 y). Posttransplant early mortality rate was 17.9% (15 patients). In the other 69 patients, 23 patients died and 46 patients (66.7%) were alive at mean 69.3 +/- 7.2 months after heart transplant. Mean follow-up was 35.4 +/- 29.8 months (range, 0.07-117.5 mo). Mean 8.4 +/- 4.2 endomyocardial biopsies (range, 1-19 biopsies) were performed per patient. Median first biopsy time was 7 days (range, 1-78 d). The frequency of posttransplant acute cellular rejection was 63.8% (44 of 69 patients) by histopathology; 86% patients experienced the first episode of acute cellular rejection within 6 months after transplant. There were 18 patients with acute cellular rejection >= grade 2R on >= 1 endomyocardial biopsy in 44 patients with acute cellular rejection. No significant difference was observed between survival rates of patients with grade 1R or >= grade 2R acute cellular rejection, or between survival rates of patients with or without diagnosis of any grade of acute cellular rejection. Acute cellular rejection was not related to any prognostic risk factor. Conclusions: Acute cellular rejection had no negative effect on heart recipient long-term survival, but it was a frequent complication after heart transplant, especially within the first 6 months.
The Use of Mycophenolate Mofetil in Experimental Encapsulating Peritoneal Sclerosis
(2015) Huddam, Bulent; Basaran, Murat; Kocak, Gulay; Azak, Alper; Yalcin, Funda; Reyhan, Nihan Haberal; Duranay, Murat; 0000-0001-9852-9911; 26159779; AAK-4587-2021
Encapsulated peritoneal sclerosis (EPS) is a rare complication of long-term peritoneal dialysis usually associated with the inadequacy and early termination of dialysis modality. Adequate treatment of peritoneal fibrosis has not been achieved by medical intervention so far. Mycophenolate mofetil (MMF), which inhibits inosine monophosphate dehydrogenase reversibly and highly selectively, is the most widely used drug for maintenance immunosupression in renal transplantation. Recent studies have shown that MMF has also antifibrotic effects. In this study, we evaluated the effects of MMF on EPS model in rats based on antifibrotic effects. Twenty-four Wistar albino rat have been randomly divided into four groups. Group I (control group) received isotonic saline intraperitoneally (i.p) 2 ml/day for (0-3rd weeks). Group II (chlorhexidine (CG) group) received CG 2 ml/day i.p. for (0-3rd weeks). Group III (chlorhexidine + MMF group) received CG (2 ml/day) i.p. for (0-3rd weeks) plus MMF 30 mg/kg/day peroral (4th-6th weeks). Group IV (resting group) received CG 2 ml/day) i.p. (0-3rd weeks) plus peritoneal resting without any treatment (4th-6th weeks) At the end of the sixth weeks, all of the rats were killed. All of the groups were analyzed in terms of peritoneal thickness, degree of inflammation, vasculopathy, neovascularization and fibrosis. Also, the parietal peritoneal tissue samples were evaluated for matrix metalloproteinase 2 (MMP-2) by using the immunohistochemical analysis. When the CG group was compared with the MMF group, the medication resulted in a statistically significant reduction in peritoneal thickness, inflammation and fibrosis score (53.23 +/- A 16.24 vs. 17.22 +/- A 3.62, 1 +/- A 1.225 vs. 1 +/- A 0, 1.6 +/- A 0.548 vs. 0.2 +/- A 0.447, respectively, all p < 0.05). In the resting group, no beneficial effects on morphological abnormality of the peritoneum were observed as compared with MMF group. However, according to immunohistochemical analysis of the expression of MMP-2 on peritoneal samples, the highest expression of MMP-2 was observed in the MMF group. MMF was effective for the treatment of encapsulating peritoneal fibrosis in our rat model. Most recently, MMF may be first choice for EPS due to antifibrotic effect.