Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Anesthetic Management in Pediatric Orthotopic Liver Transplant For Fulminant Hepatic Failure and End-stage Liver Disease(2014) Camkiran, Aynur; Araz, Coskun; Balli, Sevgi Seyhan; Torgay, Adnan; Moray, Gokhan; Pirat, Arash; Arslan, Gulnaz; Haberal, Mehmet; https://orcid.org/0000-0003-1470-7501; https://orcid.org/0000-0002-4927-6660; https://orcid.org/0000-0002-6829-3300; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-3462-7632; 24635805; AAJ-4576-2021; AAJ-5221-2021; AAE-1041-2021; AAJ-8097-2021Objectives: We assessed the anesthetic management and short-term morbidity and mortality in pediatrics patients who underwent an orthotopic liver transplant for fulminant hepatic failure or end-stage liver disease in a university hospital. Material and Methods: We retrospectively analyzed the records of children who underwent orthotopic liver transplant from May 2002 to May 2012. Patients were categorized into 2 groups: group fulminant hepatic failure (n=22) and group end-stage liver disease (n=19). Perioperative data related to anesthetic management and intra-operative events were collected along with information related to postoperative course and survival to hospital discharge. Results: Mean age and weight for groups fulminant hepatic failure and end-stage liver disease were 8.6 +/- 2.7 years and 10.8 +/- 3.8 years (P= .04) and 29.2 +/- 11.9 kg and 33.7 +/- 16.9 kg (P= .46). There were no differences between the groups regarding length of anhepatic phase (65 +/- 21 min vs 73 +/- 18 min, P= .13) and operation time (9.1 +/- 1.6 h vs 9.5 +/- 1.8 h, P= .23). When compared with the patients in group fulminant hepatic failure, those in group end-stage liver disease more commonly had a Glasgow Coma score of 7 or less (32% vs 6%, P= .04). Compared with patients in group fulminant hepatic failure, those in group end-stage liver disease were more frequently extubated in the operating room (31.8% versus 89.5% P <.001). Postoperative duration of mechanical ventilation (2.78 +/- 4.02 d vs 2.85 +/- 10.21 d, P = .05), and the mortality rates at 1 year after orthotopic liver transplant (7.3% vs 0%, P = .09) were similar between the groups. Conclusions: During pediatric orthotopic liver transplant, those children with fulminant hepatic failure require more intraoperative fluids and more frequent perioperative mechanical ventilation than those with end-stage liver disease.Item Success of Eculizumab in the Treatment of Atypical Hemolytic Uremic Syndrome(2015) Baskin, Esra; Gulleroglu, Kaan; Kantar, Asli; Bayrakci, Umut; Ozkaya, Ozan; 0000-0003-1434-3824; 0000-0003-1434-3824; 0000-0003-4361-8508; 25384530; F-3294-2013; AAJ-8833-2021; B-5785-2018Disorders of complement regulation are the most important etiology of atypical hemolytic uremic syndrome (aHUS). Recent studies demonstrate that eculizumab is beneficial in long-term aHUS treatment. We present a series of children with aHUS resistant to/dependent on plasma exchange (PE) who were treated with eculizumab. This was a retrospective study in which data were retrieved from the medical files of children who had received PE as treatment for aHUS. The data retrieved included age, sex, presenting symptoms, presence of diarrhea/vomiting, hospitalization duration, laboratory data on admission and follow-up, need for transfusion or dialysis, response to PE, response to eculizumab and outcome. Of the 15 children diagnosed with aHUS in 2011 and 2012 in our departments, ten were resistant to, or dependent on, plasma therapy and treated with eculizumab; these children were enrolled in the study. Three patients had relapses, and seven had a new diagnosis. Nine children had oliguria or anuria, and eight required dialysis. Hypertension was observed in six patients. Neurologic involvement developed in six patients, with the symptoms including seizures, loss of balance, vision loss and severe confusion. Five and five patients were resistant to and dependent on plasma therapy, respectively. Following the start of eculizumab treatment, all patients achieved full recovery of renal function and hematologic parameters. In our ten pediatric patients with aHUS who did not respond to PE, eculizumab was a lifesaving therapy and improved their quality of life. Early eculizumab use was a rescue therapy for renal function. Our results show that eculizumab is an effective treatment for aHUS. However, more studies are needed on the long-term efficacy and safety of eculizumab in children with aHUS and to determine the optimal duration of treatment.Item Large-for-Size Liver Transplant: A Single-Center Experience(2015) Akdur, Aydincan; Kirnap, Mahir; Ozcay, Figen; Sezgin, Atilla; Soy, Hatice Ebru Ayvazoglu; Yarbug, Feza Karakayali; Yildirim, Sedat; Moray, Gokhan; Arslan, Gulnaz; Haberal, Mehmet; 0000-0002-8726-3369; 0000-0002-5735-4315; 0000-0003-2498-7287; 0000-0002-3462-7632; 0000-0002-0993-9917; 0000-0002-5214-516X; 25894137; AAA-3068-2021; AAF-4610-2019; AAE-1041-2021; AAJ-8097-2021; AAH-9198-2019; AAC-5566-2019; ABG-5684-2020Objectives: The ideal ratio between liver transplant graft mass and recipient body weight is unknown, but the graft probably must weigh 0.8% to 2.0% recipient weight. When this ratio > 4%, there may be problems due to large-for-size transplant, especially in recipients < 10 kg. This condition is caused by discrepancy between the small abdominal cavity and large graft and is characterized by decreased blood supply to the liver graft and graft dysfunction. We evaluated our experience with large-for-size grafts. Materials and Methods: We retrospectively evaluated 377 orthotopic liver transplants that were performed from 2001-2014 in our center. We included 188 pediatric transplants in our study. Results: There were 58 patients < 10 kg who had living-donor living transplant with graft-to-body-weight ratio > 4%. In 2 patients, the abdomen was closed with a Bogota bag. In 5 patients, reoperation was performed due to vascular problems and abdominal hypertension, and the abdomen was closed with a Bogota bag. All Bogota bags were closed in 2 weeks. After closing the fascia, 10 patients had vascular problems that were diagnosed in the operating room by Doppler ultrasonography, and only the skin was closed without fascia closure. No graft loss occurred due to large-for-size transplant. There were 8 patients who died early after transplant (sepsis, 6 patients; brain death, 2 patients). There was no major donor morbidity or donor mortality. Conclusions: Large-for-size graft may cause abdominal compartment syndrome due to the small size of the recipient abdominal cavity, size discrepancies in vascular caliber, insufficient portal circulation, and disturbance of tissue oxygenation. Abdominal closure with a Bogota bag in these patients is safe and effective to avoid abdominal compartment syndrome. Early diagnosis by ultrasonography in the operating room after fascia closure and repeated ultrasonography at the clinic may help avoid graft loss.Item The Role of Nutritional and Dietary Habits in Etiology in Pediatric Vocal Fold Nodule(2022) Korkmaz, Muge Ozcelik; Tuzuner, ArzuObjectives. In pediatric pediatric vocal fold nodule (VFN) patients, different causes have been suggested in the development of the vocal cord nodule, including laryngopharyngeal reflux (LPR). It is known that the content of consumed foods, obesity, and other dietary behaviors are among the risk factors for the devel-opment of reflux. The aim of this study was to evaluate dietary and food consumption habits in pediatric VFN patients.Methods. This prospective-controlled study included 50 children with VFNs (age range 5-14 years) and 50 age-matched children without any voice disorders as a control group. BMI values of each participant were evaluated according to age-percentile range. The voice usage habits and personality structure of all the children were ques-tioned. All patients underwent laryngeal examination and voice analysis. The Turkish Pediatric Voice Handicap Index (t-PVHI) and Child Voice Handicap Index-10 (t-CVHI) were completed by patients or their parents. The examination findings of all patients were evaluated with the reflux finding score (RFS), and their complaints were questioned with the reflux symptom index (RSI). In addition, eating and drinking at night, fast eating and exces -sive food consumption habits and the frequency of consumption of packaged foods defined as junk food, carbon-ated beverage were questioned. The data obtained were compared statistically between the two groups.Results. There was no significant difference between the study and control groups in terms of age, gender distri-bution, median BMI value, voice usage habits, and personality structure. In the study group, t-PVHI, t-CVHI, jit-ter, schimmer values, the mean RFS, and RSI scores were significantly higher than those of the control group. The number of children with high consumption of junk food and carbonated drinks was higher in the study group. There was no significant difference between the two groups in terms of dietary habits.Conclusion. Food consumption habits may play a role in childhood voice problems in this population.Item MRI Findings in Childhood PRES: What is Different than the Adults?(2016) Donmez, F. Y.; Guleryuz, P.; Agildere, M.; 0000-0003-4502-106X; 0000-0003-4223-7017; 25293448; AAE-5528-2021; AAB-5802-2020Posterior reversible encephalopathy syndrome (PRES) is a clinical scenario with convulsion, vision abnormalities, altered mental status, and headaches in the presence of an underlying etiology, and the diagnosis can be made by support of radiological studies. In this study, we evaluated the magnetic resonance imaging (MRI) findings of PRES in children and compared our findings with that of the known features in adults, and reviewed the possible pathophysiological reasons that may cause the difference. A total of 29 children (13 male, 16 female, aged 1-17 years, mean age: 10 years) diagnosed as having PRES were retrospectively reviewed. Clinical records were analyzed for the clinical symptoms and the underlying etiology. MR images were evaluated for the distribution of lesions, contrast enhancement, diffusion restriction, and hemorrhage. Presenting symptoms and underlying etiologies were variable. Frontal lobe (66 %) edema was almost as common as parietal and occipital involvement. Cerebellar involvement was present in almost half of the patients (48 %), which was more frequent than in the adult patients. Contrast enhancement is another finding that was found to be more common in children than in the adults (39 %). Four patients had diffusion restriction (15 %) and four patients had hemorrhage (%15), which are almost the same frequency as in the adults. The increased incidence of cerebellar involvement may show that the posterior circulation in children is more vulnerable than the adults. The contrast enhancement in children, which is seen more commonly than in the adults, may show that the pathophysiology in children may be more commonly related to blood-brain barrier breakdown, which can support the theory of the toxic endothelial injury.Item Etiologies, outcomes, and prognostic factors of pediatric acute liver failure: A single center's experience in Turkey(2016) Ozcay, Figen; Karadag-Oncel, Eda; Baris, Zeren; Canan, Oguz; Moray, Gokhan; Haneral, Mehmet; 0000-0003-2498-7287; 0000-0002-3462-7632; 0000-0002-5214-516X; 0000-0003-0614-4497; 27782894; AAE-1041-2021; AAJ-8097-2021; ABG-5684-2020; AAB-4153-2020; AAI-9386-2021Background/Aims: Our aim was to determine the etiologies, outcomes, and prognostic indicators in children with acute liver failure. Materials and Methods: Ninety-one patients who were followed for pediatric acute liver failure (PALF) over a 15-year period were included. Patients who survived with supportive therapy were designated as Group 1, while those who died or underwent liver transplantation were designated as Group 2. Results: There were 37 (40.6%) patients in Group 1 (spontaneous recovery) and 54 (59.4%) patients in Group 2. Thirty-two patients (35.2%) underwent liver transplantation. Infectious and indeterminate causes were the most common etiologies (33% each). Among the infectious causes, hepatitis A (76%) was the most frequent. Hepatic encephalopathy grade 3-4 on admission and during follow-up and high Pediatric Risk of Mortality (PRISM) and Pediatric End-Stage Liver Disease (PELD) scores within the first 24 h were related with a poor prognosis. Group 2 had a more prolonged prothrombin time, higher international normalized ratio, more prolonged activated partial thromboplastin time (aPTT), and higher levels of total and direct bilirubin, ammonia, and lactate (for all, p<0.01). Conclusion: Infectious and indeterminate cases constituted the most common etiology of PALF, and the etiology was related to the prognosis in our series. Although high PELD and PRISM scores were related to poor prognoses, no sharp thresholds for individual laboratory tests could be elucidated. Liver transplantation was the only curative treatment for patients with poor prognoses and resulted in high survival rates (1-, 5-, and 10-year survival rates of 81.3%, 81.3%, and 75%, respectively) in our study.