Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
Browse
225 results
Search Results
Item Predisposing Risk Factors for Isolated Bile Leakage After Pancreaticoduodenectomy(2023) Aydin, Huseyin Onur; Soy, Ebru Hatice Ayvazoglu; Kirnap, Mahir; Moray, Gokhan; 38131350AIM: Isolated bile leakage (IBL) from hepaticojejunostomy, following pancreaticoduodenectomy, is a serious complication that increases morbidity and mortality. We aimed to assess the frequency of IBL development after pancreaticoduodenectomy and its underlying factors. MATERIALS AND METHODS: Patients who underwent pancreaticoduodenectomy for pancreatic diseases between January 2005 and January 2016 were retrospectively evaluated. Patients were dichotomized according to those with and without postoperative IBL. RESULTS: In the 111 patients who underwent pancreaticoduodenectomy during our study period, 8 patients (7.2%; 5 men/3 women) developed IBL. Risk of IBL development was significantly elevated among male patients, those with pre-operative serum albumin < 3.5 g/dL, and those with previous cholangitis (P < 0.05). DISCUSSION: Male sex, preoperatively low levels of serum albumin, and preoperative history of cholangitis can be listed as risk factors for IBL development. Physicians should pay attention to the risk of postoperative IBL development in such patients.Item The Effectiveness of Low- Dose Versus High- Dose 99m Tc MIBI Protocols for Radioguided Surgery in Patients with Primary Hyperparathyroidism(2014) Gencoglu, Esra A.; Aras, Murat; Moray, Gokhan; Aktas, Ayse; https://orcid.org/0000-0003-4631-1683; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0003-0149-2265; 24323310; ABG-1864-2020; AAE-1041-2021; AAI-8772-2021ObjectiveThe aim of this study was to compare the efficacy of low-dose and high-dose Tc-99m methoxy isobutyl isonitrile (MIBI) protocols in intraoperative localization of parathyroid adenomas by means of a gamma probe in patients with primary hyperparathyroidism (PHPT).Patients and methodsThe study included 62 patients with PHPT who were divided into two groups. Group 1 consisted of 32 patients who were injected with a low dose (1 mCi) of Tc-99m MIBI in the surgical suite 10 min before incision. Group 2 included 30 patients who were intravenously administered a high dose (15 mCi) of Tc-99m MIBI 2 h before surgery. With the aid of a gamma probe, intraoperative localization of parathyroid adenomas was performed in both groups of patients who underwent minimally invasive parathyroidectomy. All lesions thought to be parathyroid adenomas were excised and subsequently evaluated histopathologically.ResultsAll parathyroid adenomas in both groups were localized and excised by means of an intraoperative gamma probe. The sensitivity, specificity, and accuracy of low-dose and high-dose Tc-99m MIBI protocols in the intraoperative localization of adenomas in patients with PHPT were 100%.ConclusionIn the light of these findings, we conclude that low-dose Tc-99m MIBI may be preferred to intraoperative identification of parathyroid adenomas by means of a gamma probe in PHPT patients because it appears to be as effective as high-dose Tc-99m MIBI. Moreover, the low-dose protocol does not have the disadvantages of high-dose protocol.Item A Prospective Clinical Study of Flow-Mediated Dilatation in Burn Injury(2014) Turk, Emin; Caliskan, Mustafa; Karagulle, Erdal; Aydogan, Cem; Oguz, Hakan; Kulaksizoglu, Sevsen; Yildirim, Erkan; Moray, Gokhan; Haberal, Mehmet; https://orcid.org/0000-0003-4766-3373; https://orcid.org/0000-0002-8522-4956; https://orcid.org/0000-0003-1547-1297; https://orcid.org/0000-0002-7613-2240; https://orcid.org/0000-0002-9057-722X; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-3462-7632; 24165669; AAJ-5609-2021; JYO-9455-2024; C-6247-2017; AAJ-5296-2021; AAI-8932-2021; ABI-3856-2020; AAE-1041-2021; AAJ-8097-2021Item Locoregional Therapy and Recurrence of Hepatocellular Carcinoma After Liver Transplant(2014) Kirnap, Mahir; Boyvat, Fatih; Akdur, Aydincan; Karakayali, Feza; Arslan, Gulnaz; Moray, Gokhan; Haberal, Mehmet; https://orcid.org/0000-0002-8726-3369; https://orcid.org/0000-0002-1874-947X; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-3462-7632; 24635819; AAH-9198-2019; F-4230-2011; AAA-3068-2021; AAB-3888-2021; AAE-1041-2021; AAJ-8097-2021Objectives: Locoregional therapy may decrease the tumor stage and enable liver transplant in patients who have hepatocellular cancer. The purpose of the present study was to assess the relation between locoregional therapy and recurrence of hepatocellular carcinoma after transplant. Materials and Methods: In 50 patients who had liver transplant for treatment of end-stage liver disease from hepatocellular carcinoma and cirrhosis, outcomes were evaluated for associations with locoregional therapy before transplant and Milan criteria. Results: Most patients had locoregional therapy before transplant (31 patients [62%]: transarterial catheter radiofrequency ablation alone, 16 patients; chemoembolization alone, 10 patients; both transarterial catheter radiofrequency ablation and chemoembolization, 5 patients). Follow-up at median 90 months after transplant showed that 9 patients (18%) had recurrence at median 45 months (range, 120 +/- 12 mo) (recurrence: locoregional therapy, 5 of 31 patients [16%]; no locoregional therapy, 4 of 19 patients [21%]; not significant). Locoregional therapy was associated with a significantly lower frequency of recurrence in patients who were outside the Milan criteria. Conclusions: In patients who have liver transplant for treatment of hepatocellular carcinoma, preoperative locoregional therapy may decrease recurrence in patients who are outside the Milan criteria.Item Posttransplant Malignancies in Liver Transplant Recipients(2014) Akdur, Aydincan; Kirnap, Mahir; Yildirim, Sedat; Altundag, Ozden; Moray, Gokhan; Haberal, Mehmet; https://orcid.org/0000-0002-8726-3369; https://orcid.org/0000-0002-5735-4315; https://orcid.org/0000-0003-0197-6622; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-3462-7632; 24635818; AAA-3068-2021; AAH-9198-2019; AAF-4610-2019; W-9219-2019; AAE-1041-2021; AAJ-8097-2021Objectives: The incidence of malignancy is higher in solid-organ transplant recipients compared with the general population. In the present study, we present our experience with de novo malignancies encountered after both deceased-donor and living-donor liver transplants. Materials and Methods: We retrospectively reviewed the medical records of 335 patients who underwent an orthotopic liver transplant at our institution between September 2001 and December 2012 to identify subjects with de novo malignancies. Results: Fourteen patients (4.1%) developed de novo malignancies after liver transplant. De novo malignancies included lymphoproliferative disorders after liver transplant in 7 patients (treated with chemotherapy), thyroid papillary carcinoma in 1 patient (treated with total thyroidectomy and radioactive iodine therapy), squamous cell carcinoma in 2 patients (treated with surgical resection), gastric stromal tumor in 1 patient (treated with surgical resection), ovarian carcinomas in 1 patient (treated with radical surgical resection and chemotherapy, who died within 1 year of diagnosis), lung cancer in 1 patient (treated with chemotherapy, but he had bone metastasis and died within 1 year of diagnosis), and neuroblastoma in 1 patient (treated with chemotherapy). In all patients, immunosuppression was changed to sirolimus. Conclusions: Transplant recipients generally have advanced stage cancers at the time of diagnosis with a poor prognosis. Because some neoplasms are common, early detection of cancer is important to decrease cancer-related mortality and morbidity.Item Postoperative Gastrointestinal Bleeding After an Orthotopic Liver Transplant: A Single-Center Experience(2014) Fidan, Cihan; Kirnap, Mahir; Akdur, Aydincan; Ozcay, Figen; Selcuk, Haldun; Arslan, Gulnaz; Moray, Gokhan; Haberal, Mehmet; https://orcid.org/0000-0002-9093-1524; https://orcid.org/0000-0002-8726-3369; https://orcid.org/0000-0002-5214-516X; https://orcid.org/0000-0002-8445-6413; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-3462-7632; 24635817; F-5830-2019; AAH-9198-2019; AAA-3068-2021; ABG-5684-2020; AAJ-6976-2021; AAE-1041-2021; AAJ-8097-2021Objectives: The overall incidence, causes, and treatment of posttransplant gastrointestinal bleeding, have been previously described. In this study, we examined the causes and treatment of postoperative gastrointestinal bleeding after orthotopic liver transplant. Materials and Methods: Clinical data of 335 patients who underwent an orthotopic liver transplant at our institution between September 2001 and December 2012 were analyzed retrospectively. The diagnosis and treatment of postoperative gastrointestinal bleeding after an orthotopic liver transplant were reviewed. Results: Gastrointestinal bleeding occurred in 13 patients (3.8%) after an orthotopic liver transplant. Five patients (38.4%) were adult and 8 patients (61.6%) were pediatric. The sites of the bleeding were Roux-en-Y anastomosis bleeding in 5 cases, peptic ulcer in 3 cases, erosive gastritis in 3 cases, gastric and esophageal varices in 1 case, and hemobilia in 1 case. These 13 patients with gastrointestinal bleeding were managed with conservative treatment, endoscopic treatment, radiologic interventional embolism, or exploratory laparotomy. No patients died because of gastrointestinal bleeding. During follow-up, 4 patients died because of sepsis and 1 patient died of recurrence of hepatocellular carcinoma. Conclusions: Gastrointestinal bleeding after liver transplant and its incidence, causes, and treatment are not well-described in the literature. Diagnosis and management of gastrointestinal bleeding requires a multidisciplinary approach involving surgeons, hepatologists, advanced and experienced endoscopists, and interventional radiologists.Item Acute Renal Injury in Liver Transplant Patients and Its Effect on Patient Survival(2014) Kirnap, Mahir; Colak, Turan; Baskin, Esra; Akdur, Aydincan; Moray, Gokhan; Arslan, Gulnaz; Haberal, Mehmet; https://orcid.org/0000-0002-8372-7840; https://orcid.org/0000-0003-4361-8508; https://orcid.org/0000-0002-8726-3369; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-3462-7632; 24635816; AAH-9198-2019; AAJ-8554-2021; B-5785-2018; AAA-3068-2021; AAE-1041-2021; AAJ-8097-2021Objectives: Acute renal injury is a common complication in liver transplant patients. Acute kidney injury is due to nephrotoxic drugs used after liver transplant, infections, and hemorrhage. Though it is generally reversible, it has effects on grafts and patients survival. In this retrospective observational study carried out at a single center, the effects of acute renal disease on liver recipient's survival were investigated. Materials and Methods: Liver transplant recipients of live-donor and deceased-donor transplants between January 2002 and May 2013 were included in this study; there were 310 liver transplant patients (mean age, 28 y; age range, 6 mo-62 y; 165 males, 145 females). The acute kidney disease diagnosis and staging was based on the nephrology department evaluation and daily serum creatinine levels. Patients with acute kidney injury before undergoing liver transplant and those undergoing a transplant for the second time were excluded. Kidney functions were evaluated by the nephrology department 1 week, 3 months, and 1 year after the liver transplant. Results: Acute kidney disease rates in these patients were 5%, 8%, and 12%. Four patients developed chronic kidney failure during follow-up. The mortality rate was higher (18%) in acute renal failure patients compared with those that did not have acute renal failure. The mortality rate was 11% in patients without acute renal failure. Conclusions: Acute renal injury is common after liver transplant and has an effect on mortality.Item Early Pulmonary Complications of Liver Transplant(2014) Dogrul, Mustafa Ilgaz; Akcay, Sule; Bozbas, Serife Savas; Dedekarginoglu, Balam Er; Eyuboglu, Fusun Oner; Moray, Gokhan; Haberal, Mehmet; https://orcid.org/0000-0002-7230-202X; https://orcid.org/0000-0002-5525-8207; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-3462-7632; 24635815; AAI-8064-2021; AAR-4338-2020; AAE-1041-2021; AAJ-8097-2021Objectives: Pulmonary complications are a leading problem after a liver transplant. This study sought to predict postoperative early complications by a chest radiograph performed after a transplant among adult orthotopic liver transplant recipients. Materials and Methods: One hundred thirty-five patients (43 women, 92 men; mean age, 40 y; range, 16-66 y) were included and their medical data reviewed retrospectively. A postoperative chest radiograph of each patient was evaluated to check for pulmonary complications. Results: Smoking history was noted in 61 patients (45.2%). Postoperative first chest radiograph evaluation showed normal findings in 56 patients (41.5%). Right pleural effusion was found in 25 patients (18.5%), and atelectasis was found in 25 (18.5%). Bilateral pleural effusion was the second most-frequent finding on postoperative radiograph (14.8%). Effusion accompanied by atelectasis was found in 3 patients (2.2%). Other postoperative chest radiograph findings were consolidation (n=2, 1.5%), left pleural effusion (n=2, 1.5%), and bronchiectasis (n=2, 1.5%). Conclusions: We investigated the reflection of the first chest radiograph after liver transplant on postoperative early complications. Postoperative first chest radiograph can be an inexpensive and accessible diagnostic tool for predicting postoperative problems.Item Hepatic Angiosarcoma and Liver Transplant: A Report of 2 Cases With Diagnostic Difficulties(2014) Terzi, Aysen; Deniz, Emine Ebru; Haberal, Nihan; Moray, Gokhan; Ozdemir, Binnaz Handan; https://orcid.org/0000-0002-1225-1320; https://orcid.org/0000-0001-9852-9911; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-7528-3557; 24635809; F-7546-2013; AAK-4587-2021; AAE-1041-2021; X-8540-2019Angiosarcoma is a rare primary malignant mesenchymal tumor of the liver. The prognosis of hepatic angiosarcoma is poor with an average life expectancy of 6 months after diagnosis. Diagnosing hepatic angiosarcoma is challenging because of nondiagnostic liver biopsy or specious history and radiologic presentation. We report 2 cases with hepatic angiosarcoma which were diagnosed histopathologically in the native liver after liver transplant. One of 2 patients was lost to follow-up, and another patient died of relapsing hepatic angiosarcoma 18 months after the liver transplant.Item A Case of Cerebral Tuberculosis After Liver Transplant and Literature Review(2014) Tunca, M. Zeyneb; Akcay, Eda Yilmaz; Moray, Gokhan; Ozen, Ozlem; Ozdemir, B. Handan; https://orcid.org/0000-0001-6831-9585; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-9082-1317; https://orcid.org/0000-0002-7528-3557; 24635807; AAK-1960-2021; AAE-1041-2021; AAK-4468-2021; X-8540-2019The risk of active tuberculosis is high in solid-organ recipients. We evaluated the clinical presentation of tuberculosis. Pulmonary locations were the most frequent, and extrapulmonary locations were rarely seen. Among extrapulmonary sites, intracranial tuberculosis is rare, with a few case reports reported in the literature. We report a case of 27-year-old man, who received deceased-donor liver transplant due to hepatitis B virus-related chronic liver failure. One month after the liver transplant, neurologic symptoms developed, then he had attacks of tonicclonic convulsions. Cerebral stereotactic needle biopsy of left temporal lobe was performed. Histopathologically gliosis, rare lymphocyte infiltration, and epithelioid histiocytes were seen. Histochemical staining by Ziehl Neelsen stain noted acid-fast resistant bacillus. The case was diagnosed as granulomatous inflammation which led to tuberculosis. In addition to antituberculosis therapy, he was given antiviral therapy for prophylaxis. During therapy, reactivation of hepatitis B virus was noted, and the recurrent diseases of hepatitis B virus-related viral hepatitis was diagnosed on serial biopsies. Ten months after transplant, he died from liver failure. Tuberculosis is a serious opportunistic infection in transplant recipients. The incidence of transplant recipients worldwide ranges from 0.35% to 15%. In nonrenal transplant, rejection within 6 months before the onset of tuberculosis and type of primary immunosuppressive regimen were predictors of tuberculosis infection occurring 12 months after transplant. The diagnosis and effective management of tuberculosis after transplant warnings recognition of the epidemiologic and clinical characteristics of tuberculosis in transplant recipients.