Başkent Üniversitesi Yayınları
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Item Hepatic Abscesses After Liver Transplant: 1997–2008(Başkent Üniversitesi, 2009-12) Malek-Hosseini, Seyed Ali; Janghorban, Parisa; Nikeghbalian, Saman; Salahi, Roohallah; Salahi, Heshmatallah; Bahador, Ali; Kakaie, Farzad; Kazemi, KorushObjectives: Infectious complications (such as liver abscesses) remain one of the major causes of posttransplant morbidity and mortality. Management may be problematic and is often based on experience with hepatic abscess in nontransplant patients. We reviewed our experience with hepatic abscess in liver transplant recipients to assess their presentation, clinical features, treatment, and outcome. Materials and Methods: A retrospective review of all liver transplant in Shiraz transplant center from September 1997 through September 2008 was performed. Hepatic abscess was defined as a parenchymal hepatic lesion consistent with abscess (as described by a radiologist), positive liver or concurrent blood cultures, or both (within 24 hours), and compatible clinical findings. Results: Of 560 liver recipients, we identified 5 patients (23-42 y) who had experienced 7 episodes of hepatic abscess, 30-240 days after transplant. All patients had received liver from deceased donors. Biliary reconstruction was done by duct-to-duct anastomosis in 4 and hepatico-jejunostomy in 1 case. Pretransplant diagnoses included hepatitis B cirrhosis, autoimmune hepatitis (2 cases), Caroli disease, and cryptogenic cirrhosis. Liver aspirates showed E. coli in 4 cases, and Aspergillus in 1 case. The main predisposing factor was bile-to-duct anastomosis stricture in 3, diabetes mellitus in 2, and hepatic artery thrombosis in 1 of the patients. Two patients died owing to liver and multiorgan failure, despite percutaneous and operative drainage with broad spectrum antibiotics and antifungals. Conclusions: Hepatic abscess, a rare complication after liver transplant, was associated with hepatic artery thrombosis, biliary anastomosis stricture, and diabetes mellitus. Mortality was higher than in patients who had not undergone transplant. Prolonged antibiotic therapy and drainage are required to improve the outcome in these patients.Item Effects of Surgical Technique on Postoperative Renal Function After Orthotopic Liver Transplant(Başkent Üniversitesi, 2009-03) Gholami, Siavosh; Malek-Hosseini, Seyed Ali; Nikeghbalian, Saman; Salahi, Heshmatollah; Bahador, Ali; Kazemi, Kourosh; Kakaei, Farzad; Rajaei, ElnazObjectives: The classic technique for orthotopic liver transplant consists of the total excision of the retrohepatic inferior vena cava during native hepatectomy. Controversy about the effects of the classic technique on postoperative renal function continues. The aim of this study was to evaluate the effects of the chosen hepatectomy technique on postoperative renal function. Materials and Methods: Of 253 patients who received an orthotopic liver transplant between June 2006 and July 2008 in the Shiraz transplant unit, only 15 underwent operation with the classic technique. Patient demographics and factors including cold ischemic time, warm ischemic time, operative time, transfusions, blood loss, and early postoperative renal function were assessed retrospectively. The criteria for acute renal failure were a serum creatinine level of > 133 µmol/L (1.5 mg/dL), an increase in the baseline serum creatinine level by 50%, or oliguria requiring renal replacement therapy. Results: All patients received a liver from a deceased donor, and none required venovenous bypass during the operation. The minimum mean arterial blood pressure value of the patients during clamping was 65 ± 19 mm Hg. The mean preoperative plasma creatinine level was 87.51 ± 39.78 µmol/L (0.99 ± 0.45 mg/dL). During the first week after transplant, 7 patients (46.6%) experienced acute renal failure, and 3 of those 7 required renal replacement therapy. By the sixth postsurgical month, 4 of those 7 patients had died (1 from adult respiratory distress syndrome, 2 from sepsis, and 1 from recurrent cholangiocarcinoma). In all other patients, the plasma creatinine level had returned to the normal range by the third postsurgical week 3 or during short-term follow-up. Conclusions: Use of the classic technique for orthotopic liver transplant may increase the rate of postoperative renal failure, but that complication usually resolves during short-term follow-up.Item Neurologic Complications After Renal Transplant(Başkent Üniversitesi, 2008-09) Yardimci, Nilgul; Haberal, Mehmet; Zileli, Turgut; Benli, Sibel; Sevmis, Sinasi; Colak, TuranObjectives: Neurologic complications are a significant cause of morbidity and mortality in patients who undergo transplants. We sought to evaluate the nature and incidence of neurologic complications in patients undergoing a renal transplant. Patients and Methods: Between January 2005 and December 2007, 132 adults (35 women, 97 men; mean age, 34.32 ± 0.90 years) underwent a renal transplant at our institution. Associated comorbid medical conditions, presenting neurologic symptoms, and type of immunosuppression were obtained from patients' medical records. Results: Major indications for renal transplant were hypertensive nephropathy (14.4%), vesicoureteral reflux (11.4%), and idiopathic causes (21.2%). Mean follow-up was 17.26 ± 0.89 months (range, 2 weeks to 40 months). Twenty neurologic complications were found in 18 patients (6 women, 12 men; mean age, 33.83 ± 2.37 years). Presenting symptoms included posterior leukoencephalopathy syndrome, 1 (5.6%); cephalgia, 10 (55.6%); cerebral infarcts, 2 (11.1%); seizure, 3 (16.7%); tremor, 2 (11.1%); encephalopathy, 1 (5.6%); and sinus thrombosis, 1 (5.6%). Immunosuppressive agents were the primary cause of 16 of the 20 neurologic complications. Effectiveness and complications of cyclosporine were screened for a total of 1858.50 months, tacrolimus for 853.50 months, and sirolimus for 620 months; 50.2% of the neurologic complications appeared during the first 3 months after transplant; the blood level of immunosuppressive medications did not need to be higher than normal in every case. Discussion: In addition to cyclosporine and tacrolimus, we suggest (for the first time) sirolimus as a cause of neurocomplications after renal transplant.Item Are Perianal Burns Really that Dangerous?(Başkent Üniversitesi, 2023-06) Ebral Yiğit; Güler TekeşABSTRACT OBJECTIVES: This study aimed to evaluate burns involving the genitals, perineum, and buttocks of pediatric patients and to compare mortality-related factors with the existing literature. MATERIALS AND METHODS: We retrospectively investigated 67 pediatric patients admitted for emergency surgery at the Burn Center of Gazi Yaşargil Training and Research Hospital, Turkey, between January 2019 and June 2022. RESULTS: Mean age of the 67 patients was 3.37 ± 3.73 years. The patients mostly resided in the city, and 17 patients were admitted to the hospital within 1 or more days of the injury. Patients in the 0- to 4-year age group ranked highest in occurrence of perineal burns; the incidence gradually decreased after 4 years of age. Scalding occurred in 59 patients, flame burns in 4 patients, and perineal injuries from electrical burns in 4 patients. Perineal wound culture results were positive for 40.9% patients, with Staphylococcus epidermis being the most common bacteria (37.9%). No patient underwent colostomy as a result of a perianal burn; 2 patients (3.0%) developed sepsis, and 1 patient (1.5%) died. CONCLUSIONS: The risk of temporary colostomy or ileostomy is reduced in perineal burns when there is adequate early, aggressive, and extensive debridement, in addition to antimicrobial therapy.