PubMed İndeksli Yayınlar Koleksiyonu
Permanent URI for this collectionhttps://hdl.handle.net/11727/4810
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Item Novel Clinically Weight-Optimized Dynamic Conformal Arcs (WO-DC A) for Liver SBRT: A Comparison with Volumetric Modulated Arc Therapy (VMAT)(2021) Topkan, Erkan; 0000-0001-8120-7123; 34611405; AAG-2213-2021Purpose: To evaluate the feasibility of shortening the duration of liver stereotactic radiotherapy (SBRT) without jeopardizing dosimetry or conformity by utilizing weight-optimized dynamic conformal arcs (WO-DCA) as opposed to volumetric modulated arc therapy (VMAT) for tumors away from critical structures. Methods: Nineteen patients with liver metastasis were included, previously treated with 50 Gy in 4 fractions with VMAT technique using two partial coplanar arcs of 6 MV beams delivered in high-definition multi-leaf collimator (HD-MLC). Two coplanar partial WODCA were generated on Pinnacle treatment planning system (TPS) for each patient; and MLC aperture around the planning target volume (PTV) was automatically generated at different margins for both arcs and maintained dynamically around the target during arc rotation. Weight of the two arcs using optimization method was adjusted between the arcs to maximize tumor coverage and protect organs at risk (OAR) based on the RTOG-0438 protocol. Results: The WO-DCA plans successfully "agreed" with the standard VMAT for OAR (liver, spinal cord, stomach, duodenum, small bowel, and heart) and PTV (D-mean, D-98%, D-2%, CI, and GI), with superior mean quality assurance (QA) pass rate (97.06 vs 93.00 for VMAT; P < 0.001 and t = 8.87). Similarly, the WO-DCA technique additionally reduced the beam-on time (3.26 vs 4.43; P < 0.001) and monitor unit (1860 vs 2705 for VMAT; P < 0.001) values significantly. Conclusion: The WO-DCA plans might minimize small-field dosimetry errors and defeat patient-specific VMAT QA requirements due to the omission of MLC beam modulation through the target volume. The WO-DCA plans may additionally enable faster treatment delivery times and lower OAR without sacrificing target doses in SBRT of liver tumors away from critical structures.Item How safe is pregnancy after liver transplantation? A large case series study at tertiary referral center in Turkey(2020) Gulumser, Cagri; Kinap, Mahir; Yanik, Filiz Bilgin; Uysal, Nihal Sahin; Moray, Gokhan; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0003-2498-7287; 0000-0001-5385-5502; 0000-0002-4066-9038; 30227751; AAJ-8097-2021; AAE-1041-2021; AAA-9475-2020; C-6543-2018Objective: To investigate pregnancy outcomes and to define preventative measures against to risk factors and complications in pregnancy after liver transplantation. Secondary aim is to report postpartum allograft functions in these patients. Method: This is a case series study. All pregnant women with liver transplantations performed in our hospital were enrolled. Patients' hospital medical records, electronic records Neonatal Intensive Care Unit (NICU) records were used to collect data. Obstetric characteristics and antenatal complications, risk factors, pregnancy and neonatal outcomes, all aspects of liver transplant variables and allograft functions after pregnancy were studied. Results: A total of 11 patients were included in the study. All of them were singleton. Mean maternal age was 29.3 +/- 3.9 years. And mean gestational week of delivery was 37.2 +/- 2.2. 78% of the women were delivered at term (>37 weeks) only two babies were preterm and discharged from NICU without any complications. Birth weight (gr median +/- SD) was 2575 +/- 345. Five (45%) patients were nulliparous, majority of the cases (8/11, 72%) were conceived of pregnant with natural way. Live birth rate was 81% (9/11). Only one patient for each has suffered from fetal growth restriction, maternal anemia, maternal hyperthyroidism, and ulcerative colitis. Vaginal bleeding was seen in five women during the pregnancy. There was no maternal death, stillbirth or neonatal death. The mode of delivery for all live birth pregnancies was C-section. And none of them was emergency C-section. No complication of allograft function was seen after pregnancy. Conclusion: Pregnancy in women with liver transplantation is not associated with poor pregnancy outcomes and complications for both the mother and the neonates when these patients followed up at tertiary referral center with multidisciplinary approaches.Item The Frequency of Lysosomal Acid Lipase Deficiency in Children With Unexplained Liver Disease(2019) Ozcay, Figen; Canan, Oguz; 0000-0002-5214-516X; 30540705; ABG-5684-2020Objectives: Evidence suggests that lysosomal acid lipase deficiency (LAL-D) is often underdiagnosed because symptoms may be nonspecific. We aimed to investigate the prevalence of LAL-D in children with unexplained liver disease and to identify demographic and clinical features with a prospective, multicenter, cross-sectional study. Methods: Patients (aged 3 months-18 years) who had unexplained transaminase elevation, unexplained hepatomegaly or hepatosplenomegaly, obesity-unrelated liver steatosis, biopsy-proven cryptogenic fibrosis and cirrhosis, or liver transplantation for cryptogenic cirrhosis were enrolled. A Web-based electronic data collection system was used. LAL activity (nmol/punch/h) was measured using the dried blood spot method and classified as LAL-D(<0.02), intermediate (0.02-0.37) or normal (>0.37). Asecond dried blood spot sample was obtained from patients with intermediate LAL activity for confirmation of the result. Results: A total of 810 children (median age 5.6 years) from 795 families were enrolled. The reasons for enrollment were unexplained transaminase elevation (62%), unexplained organomegaly (45%), obesity-unrelated liver steatosis (26%), cryptogenic fibrosis and cirrhosis (6%), and liver transplantation for cryptogenic cirrhosis (<1%). LAL activity was normal in 634 (78%) and intermediate in 174 (21%) patients. LAL-D was identified in 2 siblings aged 15 and 6 years born to unrelated parents. Dyslipidemia, liver steatosis, and mild increase in aminotransferases were common features in these patients. Moreover, the 15-year-old patient showed growth failure and microvesicular steatosis, portal inflammation, and bridging fibrosis in the liver biopsy. Based on 795 families, 2 siblings in the same family were identified as LAL-D cases, making the prevalence of LAL-D in this study population, 0.1% (0.125%-0.606%). In the repeated measurement (76/174), LAL activity remained at the intermediate level in 38 patients. Conclusions: Overall, the frequency of LAL-D patients in this study (0.1%) suggests that LAL-D seems to be rare even in the selected high-risk population.Item The curative treatment of familial hypercholesterolemia: Liver transplantation(2019) Kirnap, Nazli Gulsoy; Kirnap, Mahir; Tutuncu, Neslihan Bascil; Moray, Gokhan; Haberal, Mehmet; 31626710; AAH-9198-2019Background Familial hypercholesterolemia (FH) is an autosomal dominant genetic disorder characterized by premature mortal cardiovascular complications. Liver transplantation (LT) is the only curative treatment option. In this study, the long-term clinical follow-up data of 8 patients who underwent LT with a diagnosis of FH in our center are presented. Materials and Methods A total of 638 LT were performed between December 1985 and June 2019 at Baskent University, of which 8 patients underwent LT with a diagnosis of FH and were evaluated retrospectively. Results Of the 8 patients, 4 underwent deceased donor and 4 living donor transplantation. Five patients had preoperative cardiovascular disease and consequent interventional operations. There was significant reduction in postoperative LDL-C and TC levels starting from the first week, and stabilizing at the first month and first year. The median survival time of patients was 5 years (2-12 years). All patients are still alive. None of the complications of patients with preoperative cardiovascular complications had progressed. Conclusion Liver transplantation is the preferred curative treatment for the pathophysiology of FH. In our study, LDL-C levels were brought under control with LT performed on patients with FH. Median 5-year follow-up of patients showed that the progression of cardiac complications was abated.