Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Evaluation of Early Results of Triamcinolone Acetonide Treatment in the Treatment of Idiopathic Granulomatous Mastitis Introduction(2023) Karabacak, H.; Balas, S.; 37916345Objective: Idiopathic granulomatous mastitis (IGM) is a rare, benign, chronic inflammatory breast disease with an unknown etiology. IGM patients may develop painful or painless masses, palpable lymph nodes, and skin findings that can mimic breast cancer, including retractions, skin edema, ulceration, and fistula formation. This presents a significant diagnostic challenge in clinical practice. The present study aimed to assess the early outcomes of triamcinolone acetonide treatment in patients with idiopathic granulomatous mastitis.Patients and methods: After obtaining the necessary approvals from the ethics committee, patients who were admitted to the breast endocrine department of the general surgery clinic of our hospital between 2014 and 2022 with complaints of a mass, discharge, and fistula formation and who were histopathologically diagnosed with granulomatous mastitis after radiological examination by tru-cut biopsy were prospectively enrolled in the study.Results: Among the 136 patients with granulomatous mastitis, the mean age was 30.09 +/- 4.14 years, the symptom duration averaged 3 weeks (range: 1-5), the follow-up period extended for 20 weeks (range: 3-72), and the mean recurrence duration was 1.08 +/- 0.28 months. Complaints included discharge (52.2%), mass (51.5%), redness (45.6%), and pain (27.2%). Masses were predominantly on the left side (61.0%) compared to the right side (38.0%).Conclusions: In conclusion, the heterogeneous phenotype of IGM and the lack of randomized controlled trials pose challenges. Long-acting triamcinolone acetonide proves effective in managing IGM by resolving the inflammatory process and the disease itself. Its low side effects and ease of use make it a valuable treatment modality.Item Management and Outcomes of Penile Fracture: 10 Years' Experience from A Tertiary Care Center(2014) Ozorak, Alper; Hoscan, Mustafa Burak; Oksay, Taylan; Guzel, Ahmet; Kosar, Alim; https://orcid.org/0000-0002-7887-9575; 24057767; A-8837-2018To evaluate our experience on diagnosis and management of penile fractures. This retrospective study included 31 patients who were treated for penile fracture between 2002 and 2012. We analyzed the etiology of penile fracture, concomitant pathologies such as urethral injury, deep or superficial dorsal vein ruptures, treatment modalities (surgery or conservative treatment) and complications of treatment modalities. The mean age of the patients was 32 years (range, 23-47 years). In 27 patients (87 %), the cause of penile fracture was sexual intercourse. Patients presented with swelling, pain and popping or cracking sound in penis. The diagnosis of penile fracture was established clinically in all of the patients. There were no urethral injuries or dorsal vein ruptures. Ten patients who refused surgical treatment were treated conservatively and remaining 21 patients with early surgical intervention. Among conservatively treated patients, two suffered from erectile dysfunction, two from painful erection and another two from penile curvature. No serious complications such as erectile dysfunction, penile curvature or painful erection were observed in surgically treated patients. Penile fracture can be diagnosed easily with history and physical examination, and favorable functional results can be achieved with early surgical repair.Item The History of Liver Transplantation in Turkey(2014) Moray, Gokhan; Arslan, Gulnaz; Haberal, Mehmet; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-3462-7632; 24635786; AAE-1041-2021; AAJ-8097-2021Liver transplantation is the definitive treatment for end-stage liver diseases. The first successful liver transplant was performed in the United States by Thomas Starzl in 1967. The first successful solidorgan transplant in Turkey was a living-related kidney transplant performed by Dr. Haberal in 1975. After much effort by Dr. Haberal, the Turkish parliament enacted a law about organ transplantation in 1979. After clinical and experimental studies, the first liver transplant in Turkey was performed by Dr. Haberal in 1988. The first successful partial living-donor liver transplant in children in Turkey was performed by the same team on March 15, 1990. On April 24, 1990, the first living-donor liver transplant was performed on a child in Turkey using a left lateral segment by Dr. Haberal and coworkers. On May 16, 1992, Dr. Haberal performed a simultaneous living-donor liver and kidney transplantation to an adult from the same donor. There currently are 30 liver transplantation centers in Turkey. According to data from the Ministry of Health, there presently are 2065 patients in Turkey who are waiting for a liver transplantation. From January 2002 to June 2013, there were 6091 liver transplants performed in Turkey (4020 living-donor [66%] and 2071 deceased-donor liver transplants [34%]). From January 2011 to June 2013, there were 2514 patients who had liver transplants in Turkey, and 437 patients (17%) died. The number of liver transplants per year in Turkey reached 1000 transplants in 2012 and more than 1150 transplants in 2013 (15.1/million/y). Therefore, Turkey has one of the highest volumes of liver. transplantation per population worldwide, with 90% survival within 1 year after transplantation.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 Results of Liver Transplant in Elderly Patients: A Single Center Experience(2015) Akdur, Aydincan; Fidan, Cihan; Soy, Ebru Ayvazoglu; Kirnap, Mahir; Karakayali, Feza Yarbug; Torgay, Adnan; Yildirim, Sedat; Moray, Gokhan; Haberal, Mehmet; 0000-0002-5735-4315; 0000-0002-9093-1524; 0000-0002-8726-3369; 0000-0002-3462-7632; 0000-0002-1874-947X; 0000-0002-0993-9917; 0000-0003-2498-7287; 0000-0002-6829-3300; 25894140; AAF-4610-2019; AAH-9198-2019; F-5830-2019; AAA-3068-2021; AAJ-8097-2021; AAB-3888-2021; AAC-5566-2019; AAE-1041-2021; AAJ-5221-2021Objectives: With the increased life span, the need for liver transplant for elderly patients also increased in the world. In this study, we reviewed our experience to determine the outcomes and problems of patients aged > 60 years who had liver transplants. Materials and Methods: Data of recipients aged > 60 years were reviewed retrospectively. We analyzed 16 elderly patients who had liver transplant for chronic liver disease between 2001 and 2014 in our center. Results: In our series, there were 5 women and 11 men between age 60 and 65 years. The mean Child-Pugh score was 7.9 +/- 1.7 and Model for End-Stage Liver Disease score was 14.1 +/- 5.1. Primary liver disease was hepatitis B in 9 patients (34.5%), most of them with hepatocellular carcinoma. The other causes of liver failure were hepatitis C (n = 4), alcoholic cirrhosis (n = 2), and cryptogenic cirrhosis (n = 2); 1 patient had both hepatitis B and hepatitis C virus, and 1 patient had both hepatitis B virus and alcoholic cirrhosis. There were 9 patients who had hepatocellular carcinoma. Mortality was observed in 4 patients. The reasons for mortality were sepsis (n=3) and hepatocellular carcinoma (n=1). Conclusions: Liver transplant can be safely performed and has acceptable long-term outcomes in low-risk elderly recipients. Age alone should not be a contraindication for liver transplant in elderly patients.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 Results of Pediatric Liver Transplant: A Single-Center Experience(2015) Moray, Gokhan; Tezcaner, Tugan; Akdur, Aydincan; Ozcay, Figen; Sezgin, Atilla; Kirnap, Mahir; Yildirim, Sedat; Arslan, Gulnaz; Haberal, Mehmet; 0000-0002-3641-8674; 0000-0002-8726-3369; 0000-0002-3462-7632; 0000-0002-5735-4315; 0000-0002-5214-516X; 0000-0003-2498-7287; 25894129; AAH-9198-2019; AAD-9865-2021; AAA-3068-2021; AAJ-8097-2021; AAF-4610-2019; ABG-5684-2020; AAE-1041-2021Objectives: Liver transplant is an established curative therapy for children with chronic end-stage liver disease or acute liver failure. In this study, we aimed to evaluate pediatric liver transplant in terms of outcomes, complications, and long-term follow-up results. Materials and Methods: Pediatric patients who had liver transplant in our institution were included. We retrospectively evaluated demographic features including body weight, Child-Pugh score, etiology of liver disease, graft source, perioperative outcomes, perioperative complications, postoperative complications, and long-term results. Outcomes of treatment of complications and revision transplant were evaluated. Results: Between September 2001 and December 2013, there were 188 pediatric liver transplants performed in our institution. Most grafts (90.9%) were obtained from living-related donors. There were 13 patients (6.9%) who had an intervention because of a hemorrhage postoperatively. Biliary leakage was observed in 33 patients (17.5%) and biliary stricture during follow-up was observed in 32 patients (17%). Thrombosis rates in the hepatic artery and portal vein were 12.3% and 0.5%. Revision transplant was performed in 11 patients (5.8%); reason for revision transplant was rejection in 50% patients. The remaining children were alive with good graft functioning after treatment of complications and revision transplant. The overall 5- and 10-year survival rates were 82.3% and 78.9%. Conclusions: The overall outcomes of pediatric liver transplant at our center are very promising. With improved care of younger children and the combined efforts of the parents and medical team, the number of the children receiving transplants will increase in the future.Item Rituximab Therapy for Rejection in Pediatric Heart Transplant(2018) Erdogan, Ilkay; Varan, Birgul; Sezgin, Atilla; Pirat, Arash; Zeyneloglu, Pinar; 0000-0002-6719-8563; 0000-0003-2312-9942; 0000-0001-6887-3033; 27210774; ABB-1767-2021; C-3736-2018; ABB-2220-2021Objectives: Humoral rejection is the B-cell-mediated production of immunoglobulin G antibody against the transplanted heart. Antibody-mediated rejection may be resistant to standard immunosuppressive therapy and is associated with high mortality and graft loss. Rituximab can be used to treat antibodymediated rejection in heart transplant recipients. This retrospective study describes our experience with rituximab treatment in children with heart transplants. Materials and Methods: We present 7 pediatric patients with antibody-mediated rejection who were treated with plasma exchange and rituximab therapy. Rituximab was given at a dose of 375 mg/m2 by slow infusion in the intensive care unit after 5 days of plasmapheresis, in addition to a conventional regimen consisting of steroids, mycophenolate mofetil, and tacrolimus. The peripheral blood count and sodium, potassium, serum urea nitrogen, creatinine, aspartate aminotransferase, and alanine aminotransferase levels were measured in all patients before and after treatment. Results: Seven patients were treated with plasma exchange and rituximab. We repeated this therapy in 5 patients because of refractoriness or recurrent rejection. After diagnoses of antibody-mediated rejection, 4 patients died within 6 months (mortality rate of 57.1%). We did not observe any adverse effects or complications related to rituximab. Conclusions: Rituximab can be used in humoral rejection after pediatric heart transplant. However, the success of the treatment is controversial, and further study is needed to find an effective treatment for antibody-mediated rejection and steroid-resistant cellular rejection in children.Item Pediatric Liver Transplantation Experience(2016) Haberal, Mehmet; https://orcid.org/0000-0002-3462-7632; AAJ-8097-2021Background In this study, we aimed to evaluate pediatric liver transplantation in terms of outcomes, complications, and long-term follow-up results. Materials and methods Between September 2001 and August 2015, 215 pediatric liver transplants were performed in our institution. Results Posttransplant biliary complications were biliary leakage (16.2 %) and biliary stricture (14.8 %). Complication rates in hepatic artery and portal vein were 16.7 % and 4.6 %. Overall mortality rate was 17.8 %. The overall 5aEuroyear survival rate was 82.3 % and 10-year survival rate was 78.9 %. Conclusion With improved care of younger children and the combined efforts of the parents and medical team, the number of the children receiving transplants with good outcomes will continue to increase.Item Decompression of Left Ventricle During Venoarterial Extracorporeal Membrane Oxygenation Support as a Step to Transplant(2016) Gultekin, Bahadir; Ersoy, Ozgur; Akkaya, Ilknur; Kayipmaz, Cagri; Pirat, Aras; Sezgin, Atilla; 27805509; ABA-7388-2021Objectives: Left ventricular distention can be recognized during the use of venoarterial extracorporeal membrane oxygenation as a key complication. Left ventricular decompression may decrease pulmonary pressure, minimize ventricular distention, and allow myocardial recovery. Materials and Methods: We applied venoarterial extracorporeal membrane oxygenation to 4 patients while on a wait list for cardiac transplant. Results: Two patients with severe heart failure developed high end-diastolic pressures leading to left ventricular distention. We used atrial venting methods to decrease the pressure. Conclusions: Here, we discussed the strategies to manage ventricular distention by conservative, interventional, and surgical means.