Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item 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-9824-2013Background: 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.Item 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-1041-2021BACKGROUND: 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.Item 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-9824-2013Objectives: 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.Item Transjugular Intrahepatic Portosystemic Shunt: Where Are We?(2014) Altun, Reskan; Yildirim, Emre; Ocal, Serkan; Akbas, Enver; Harman, Ali; Korkmaz, Murat; Selcuk, Haldun; https://orcid.org/0000-0003-3719-9482; https://orcid.org/0000-0002-7386-7110; https://orcid.org/0000-0002-9333-782X; https://orcid.org/0000-0002-8445-6413; 25141319; F-3628-2015; C-2392-2009; ABH-4817-2020; K-9824-2013; AAM-1330-2020; AAJ-6976-2021Background/Aims: The purpose of this study was to evaluate the technical/hemodynamic success, complications, and biochemical/hematologic consequences of transjugular intrahepatic portosystemic shunt (TIPS) created with 10-mm bare stents in our patients. Materials and Methods: Data of 27 cirrhotic patients (18 men and 9 women; mean age, 39.7 +/- 18.7 years) with a median MELD score 14 (range 7-31) treated with TIPS between January 2000 and August 2010 were evaluated retrospectively. Results: The indications were refractory bleeding varices in 48.2%, refractory ascites in 22.2%, and Budd-Chiari syndrome in 29.6% of the patients. Technical and hemodynamic success rates were 96.3% and 92.3%, respectively. Mean portosystemic pressure gradient decreased from 21.5 +/- 5.3 mm Hg to 9 +/- 2.7 mm Hg (p<0.05). The rate of primary stent patency was 76.9% 1 year after the procedure. No statistically significant difference in shunt dysfunction was found between the groups of patients treated for Budd-Chiari syndrome and other indications (p>0.05). One patient (3.7%) had shunt dysfunction due to thrombosis within 24 hours. New and/or worsening hepatic encephalopathy occurred in 34.6% of patients. Increased age (>= 40 years) was significantly related to hepatic encephalopathy in both univariate and multivariate analyses (p<0.05). Thirty-day mortality rate and 1-year transplant-free survival rate were 0% and 80.7%, respectively. Conclusion: Transjugular intrahepatic portosystemic shunt procedure is a safe treatment for many patients with cirrhosis, but post-procedure hepatic encephalopathy and shunt dysfunction are still problems. Especially, patient age should be taken into consideration in predicting hepatic encephalopathy risk.Item Ultrasound-Guided Brachiocephalic Vein Catheterization in Infants Weighing Less than Five Kilograms(2015) Aytekin, Cuneyt; Ozyer, Umut; Harman, Ali; Boyvat, Fatih; 0000-0002-4300-009X; 0000-0002-7386-7110; 0000-0001-5134-168X; 26044899; F-4230-2011; AAK-9071-2021; K-9824-2013Purpose: To describe our experience with the use of ultrasound-guided supraclavicular brachiocephalic vein approach for central vein catheterization in infants weighing less than 5 kg. Methods: A retrospective review was performed for infants who underwent ultrasound-guided central vein catheterization from January 2012 to November 2014. Infants weighing less than 5 kg with supraclavicular brachiocephalic vein access were included in the study. Indications for central venous access, venous access side, catheter type and complications were evaluated. Results: Thirty-four catheterizations in 34 infants weighing from 1.5 to 4.9 kg (median 3.48 kg) were included in the study (aged 11 days to 7 months and 10 days, weight range 1.5 to 4.9 kg). Technical success rate was 97% (33 of 34 infants). No technical or clinical major complications were observed. Conclusions: Ultrasound-guided supraclavicular brachiocephalic vein access is a favorable alternative for central venous catheterization in low-weight infants with regard to high technical success rate and absence of major complications.Item 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-8097-2021Objectives: 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.Item 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-4230-2011Purpose: 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.Item 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-4333-2018Purpose: 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.Item 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-4120-2021Objectives: 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.Item 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; 25035702Background: 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.