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Öğe Chylous ascites after liver transplantation Incidence and risk factors(Liver Transplantation, 2012) Yılmaz, Mehmet; Akbulut, Ahmet Sami; Işık, Burak; Ara, Cengiz; Özdemir, Fatih; Aydın, Cemalettin; Kayaalp, Cüneyt; Yılmaz, SezaiIn this study, we evaluated the diagnosis, epidemiology, risk factors, and treatment of chylous ascites developing after liver transplantation (LT). Between 2002 and 2011, LT was performed 693 times in 631 patients at our clinic. One-hundred fifteen of these patients were excluded for reasons such as retransplantation, early postoperative mortality, and insufficient data. Chylous ascites developed after LT (mean 6 SD ¼ 8.0 6 3.2 days, range ¼ 5-17 days) in 24 of the 516 patients included in this study. Using univariate and multivariate analyses, we examined whether the following were risk factors for developing chylous ascites: age, sex, body mass index, graft-to-recipient weight ratio, Model for End-Stage Liver Disease score, vena cava cross-clamping time, total operation time, Child-Pugh classification, sodium level, portal vein thrombosis or ascites before transplantation, donor type, albumin level, and perihepatic dissection technique [LigaSure vessel sealing system (LVSS) versus conventional suture ligation]. According to a univariate analysis, a low albumin level (P ¼ 0.04), the presence of ascites before transplantation (P ¼ 0.03), and the use of LVSS for perihepatic dissection (P < 0.01) were risk factors for developing chylous ascites. According to a multivariate Cox proportional hazards model, the presence of pretransplant ascites [P ¼ 0.04, hazard ratio (HR) ¼ 2.8, 95% confidence interval (CI) ¼ 1.1-13.5] and the use of LVSS for perihepatic dissection (P ¼ 0.01, HR ¼ 5.4, 95% CI ¼ 1.5-34.4) were independent risk factors. In conclusion, the presence of preoperative ascites and the use of LVSS for perihepatic dissection are independent risk factors for the formation of chylous ascites. To our knowledge, this study is the most extensive examination of the development of chylous ascites. Nevertheless, our results should be supported by new prospective trials.Öğe Font tasarlama süreçleri ve temel ipuçları(İnönü Üniversitesi Kültür Ve Sanat Dergisi, 2017) Özdemir, FatihFont tasarlamak uzun ve zahmetli bir süreçtir. Detaylı ve hassas ölçümlü bu süreç aynı zamanda teknik birçok bilgiye de sahip olmayı gerektirir. Bu teknik süreçler, grafik tasarım eğitiminin bir parçası olarak yazı ve tipografi derslerinde lisans düzeyinde öğrencilere kazandırılmalıdır. Bu süreç tek bir makalenin konusu olamayacak kadar geniş olduğu için bu makalenin hedefi, mutlaka bilinmesi gereken ana çerçeve hakkında ipuçları vermek ve tasarlanmış bir fontun dijital ortama aktarılırken dikkat edilmesi gereken noktalara işaret etmektir. Bu noktadan hareketle Latin alfabesinde yer alan, günümüzde de yaygın olarak kullanılan bazı özel karakterleri ve tanımları anlamamız, tarihsel oluşum süreçlerini bilmemiz ve anlamlarını kavramamız gerekmektedir.Öğe Gıorgıo de chırıco resimlerinde mitoloji ve melankoli(İnönü Üniversitesi, 2012) Özdemir, Fatih; Koca, BinnazGeorgio de Chirico’nun zaman algımızı şaşkına çevirdiği metafizik mekânlarında, Antik Yunan ve Roma yapılarıyla birlikte mitolojik konular da tuvaldeki zaman diliminde kendilerini var etmişlerdir. Chirico, birbiriyle ilgisiz görünen nesneleri ve mekânları resimlerinde bir araya getirerek kullanmasıyla Sürrealist kuşağı etkilemiştir. Chirico’nun resimlerinde mitolojik figürleri bulabiliriz. Her ne kadar bu figürlerin çıkışı mitolojiye dayandırılsa da, mitoloji ile ilgilenen İsviçreli Arnold Bocklin’in resimlerinden etkilendiği anlaşılmaktadır. Chirico’nun resimlerinin çoğunda klasik köklerin çarpıcı derecede belirgin olduğu görülür. Bu makale, Chirico’nun resimlerindeki alt metinleri ve görsel anlatım dilini inceleyerek resimlerde kendini var eden mitolojik temalar ve melankoliyi ortaya koymayı amaçlar.Öğe Liver transplant in patients with viral hepatitis and human immunodeficiency virus coinfection the first 2 cases in Turkey(Experimental and Clinical Transplantation, 2016) İnce, Volkan; Özdemir, Fatih; Bayındır, Yaşar; Toprak, Hüseyin İlksen; Kutlu, Ramazan; Işık, Burak; Kayaalp, CüneytObjectives: The outcomes of liver transplant in human immunodeficiency virus-infected patients are improving with advances in antiretroviral treatment. Data about such cases are rare in Turkey. We present the first 2 living-donor liver transplants performed in Turkey in patients with viral hepatitis/human immunodeficiency virus coinfection. Case 1: A 47-year-old man infected with human immunodeficiency virus with chronic hepatitis B and D and hepatocellular carcinoma within the Milan criteria had been taking antiretroviral medication before his liver transplant. An unrelated right lobe liver transplant was performed uneventfully in this patient, who was human immunodeficiency virus RNA-negative and had a CD4 T-cell count of 500/μL. Antiretroviral treatment continued in the early postoperative period, and a triple immuno-suppressive regimen consisting of cyclosporine, mycophenolate mofetil, and steroids was initiated. Burkholderia cepacia pneumonia developed postoperatively, and was treated successfully. The patient was discharged on postoperative day 18, and is still alive 58 months after the operation. Case 2: A 62-year-old man with human immuno-deficiency virus and chronic hepatitis C virus infection was taking antiretroviral treatment before the liver transplant. The patient was hepatitis C virus RNA-positive, human immunodeficiency virus RNA-negative, and had a CD4 T-cell count of 620/μL. His son was the donor, and a right lobe liver transplant was performed uneventfully in antiretroviral treatment continued in the early postoperative period and a triple immunosuppressive regimen consisting tacrolimus, mycophenolate mofetil, and steroids was initiated. Broad-spectrum β-lactamase-positive Escherichia coli bacteremia and hospital-acquired pneumonia developed postoperatively and were treated successfully. The patient was discharged on postoperative day 19, and remains alive 13 months after the operation. Conclusions: Living-donor liver transplant is a promising treatment choice for end-stage liver disease in human immunodeficiency virus-infected patients.Öğe Liver transplant in patients with viral hepatitis and human ımmunodeficiency virus coinfection the first 2 cases in turkey(Experimental and Clinical Transplantation, 2016) İnce, Volkan; Özdemir, Fatih; Bayındır, Yaşar; Toprak, Hüseyin İlksen; Kutlu, Ramazan; Işık, Burak; Kayaalp, CüneytObjectives: The outcomes of liver transplant in human immunodeficiency virus-infected patients are improving with advances in antiretroviral treatment. Data about such cases are rare in Turkey. We present the first 2 living-donor liver transplants performed in Turkey in patients with viral hepatitis/human immunodeficiency virus coinfection. Case 1: A 47-year-old man infected with human immunodeficiency virus with chronic hepatitis B and D and hepatocellular carcinoma within the Milan criteria had been taking antiretroviral medication before his liver transplant. An unrelated right lobe liver transplant was performed uneventfully in this patient, who was human immunodeficiency virus RNA-negative and had a CD4 T-cell count of 500/μL. Antiretroviral treatment continued in the early postoperative period, and a triple immunosuppressive regimen consisting of cyclosporine, mycophenolate mofetil, and steroids was initiated. Burkholderia cepacia pneumonia developed post - operatively, and was treated successfully. The patient was discharged on postoperative day 18, and is still alive 58 months after the operation. Case 2: A 62-year-old man with human immunodeficiency virus and chronic hepatitis C virus infection was taking antiretroviral treatment before the liver transplant. The patient was hepatitis C virus RNA-positive, human immunodeficiency virus RNAnegative, and had a CD4 T-cell count of 620/μL. His son was the donor, and a right lobe liver transplant was performed uneventfully in antiretroviral treatment continued in the early postoperative period and a triple immunosuppressive regimen consisting tacrolimus, mycophenolate mofetil, and steroids was initiated. Broad-spectrum β-lactamasepositive Escherichia coli bacteremia and hospitalacquired pneumonia developed postoperatively and were treated successfully. The patient was discharged on postoperative day 19, and remains alive 13 months after the operation. Conclusions: Living-donor liver transplant is a promising treatment choice for end-stage liver disease in human immunodeficiency virus-infected patients. Key words: Human immunodeficiency virus, Liver transplant, Hepatitis B virus, Hepatitis C virus, CoinfectionÖğe Living donor liver transplantation for budd chiari syndrome resection and reconstruction of the suprahepatic inferior vena cava with the use of cadaveric aortic allograft case report(Transplantation Proceedings, 2015) Çetinkünar, Süleyman; İnce, Volkan; Özdemir, Fatih; Ersan, Veysel; Yaylak, Faik; Ünal, Bülent; Yılmaz, SezaiBackground. Living-donor liver transplantation with inferior vena cava resection and reconstruction is rarely indicated for Budd-Chiari syndrome. The aim of this case presentation was to present and discuss the inferior vena cava reconstruction with the use of cadaveric aortic allograft after resection of the suprahepatic inferior vena cava in a patient with Budd-Chiari syndrome who was treated with living-donor liver transplantation. Case Report. A 29-year-old male patient with end-stage liver disease and suprahepatic inferior vena cava obstruction was referred to our center. He was scheduled for living-donor liver transplantation. The suprahepatic inferior vena cava was resected and reconstruction was achieved by means of interposition of the cadaveric aortic allograft between the right atrium and inferior vena cava. Postoperative course was uneventful. Discussion. Liver transplantation and vena cava reconstruction is indicated in some patients with end-stage liver disease and Budd-Chiari syndrome. Limitations in cadaveric organ donation may be compensated for with the use of living-donor liver. In this condition, various aspects of inferior vena cava reconstruction may be discussed. Conclusions. Budd-Chiari syndrome due to suprahepatic inferior vena cava obstruction close to the right atrium may be treated with vascular reconstruction with the use of a cadaveric aortic allograft.Öğe The management of acute appendicitis in liver transplant patients: How effective is the Alvarado score?(2017) İnce, Volkan; Barut, Bora; Özdemir, Fatih; Kutlutürk, Koray; Gönültaş, Fatih; Onur, Asım; Kutlu, Ramazan; Yılmaz, SezaiAbstract: OBJECTIVE: The incidence of acute appendicitis after liver transplantation (LT) is extremely low, reported to be 0.09% to 0.49%, but the efficacy of the Alvarado score in this patient group has not been studied. This study was an investigation of the clinical management of patients who developed acute appendicitis after LT and the usefulness of the Alvarado score in the diagnosis.METHODS: The study was performed using the data of 7 patients treated for acute appendicitis who were among 1990 patients who underwent LT between March 2002 and July 2017. The Alvarado score of the patients was calculated and reliability was analyzed.RESULTS: In this study, the incidence of acute appendicitis in LT patients was 0.35%. All of the patients were in the adult age group; 86% were male. The mean age was 46.4±10.7 years and the timeframe for the development of appendicitis after transplantation was a median of 12 months (range: 4-101 months). The median Alvarado score was 7 . All of the patients had an Alvarado score above 5 and 71% had a score of 7 or more.CONCLUSION: Acute appendicitis is very rare in LT patients. As with non-transplant patients, Alvarado scoring can be safely performed in LT patients.Öğe No mortality or pancreatic fistula after full thickness suture pancreaticogastrostomy in 39 patients who underwent pancreaticoduodenectomy(International Surgery, 2015) Özdemir, Fatih; Başkıran, Adil; Ara, Cengiz; Ateş, Mustafa; Sağır Kahraman, Ayşegül; Maraş Özdemir, Zeynep; Yılmaz, SezaiPancreaticoduodenectomy is considered the standard operation for periampullary tumors. Despite major advances in pancreatic surgery, pancreatic fistula is still an important cause of morbidity and mortality after pancreaticoduodenectomy. Meticulous surgical technique and proper reconstruction of the pancreas are essential to prevent pancreatic fistula. Pancreaticogastrostomy is a safe method for reconstruction of the pancreas after pancreaticoduodenectomy. Regardless of pancreatic texture or duct diameter, the reconstruction is performed by passing full-thickness sutures through both the anterior and posterior sides of the pancreas. In this study, we report 39 cases of reconstruction with pancreaticogastrostomy after pancreaticoduodenectomy without mortality or pancreatic fistula.Öğe Partial cholecystectomy a technique that makes hilar dissection easier in recipient hepatectomy(Transplant Proc., 2014) Ara, Cengiz; Özdemir, Fatih; Ateş, Mustafa; Özgör, Dinçer; Kutlutürk, KorayBackground. Intraoperative blood loss and red blood cell transfusion requirements have a negative impact on outcome after orthotopic liver transplantation. In this study we compared blood transfusion requirements, bile duct injury, and dissection of hepatic artery rates in the patients with or without partial cholecystectomy during recipient hepatectomy. Methods. From December 2008 to August 2011, 100 recipient hepatectomies were performed by the same surgeon. Patients were divided into 2 groups. The first group included patients with partial cholecystectomy, and the other group patients without partial cholecystectomy. Each group consisted of 50 patients. Results. In recipient hepatectomy group without partial cholecystectomy, intraoperative blood transfusions were in the range of 3e11 units (mean, 6.3 units). In this group there were 4 hepatic artery dissections and 2 bile duct injuries. In the group with partial cholecystectomy, intraoperative blood transfusions were in the range of 0e7 units (mean, 3.1 units). In this group there was 1 hepatic artery dissection. There were no operative mortalities in either group. Conclusions. We recommend partial cholecystectomy during recipient hepatectomy of cirrhotic patients, particularly with hydropic gallbladders, because bleeding from the points of adherent gallbladder during mobilization of the liver is diminished and fewer artery dissections and bile duct injuries develop, because the procedure facilitates dissection of the hilar structures.Öğe Partial cholecystectomy a technique that makes hilar dissection easier in recipient hepatectomy(Transplant Proc., 2014) Ara, Cengiz; Özdemir, Fatih; Ateş, Mustafa; Özgör, Dinçer; Kutlutürk, KorayIntraoperative blood loss and red blood cell transfusion requirements have a negative impact on outcome after orthotopic liver transplantation. In this study we compared blood transfusion requirements, bile duct injury, and dissection of hepatic artery rates in the patients with or without partial cholecystectomy during recipient hepatectomy. Methods. From December 2008 to August 2011, 100 recipient hepatectomies were performed by the same surgeon. Patients were divided into 2 groups. The first group included patients with partial cholecystectomy, and the other group patients without partial cholecystectomy. Each group consisted of 50 patients. Results. In recipient hepatectomy group without partial cholecystectomy, intraoperative blood transfusions were in the range of 3e11 units (mean, 6.3 units). In this group there were 4 hepatic artery dissections and 2 bile duct injuries. In the group with partial cholecystectomy, intraoperative blood transfusions were in the range of 0e7 units (mean, 3.1 units). In this group there was 1 hepatic artery dissection. There were no operative mortalities in either group. Conclusions. We recommend partial cholecystectomy during recipient hepatectomy of cirrhotic patients, particularly with hydropic gallbladders, because bleeding from the points of adherent gallbladder during mobilization of the liver is diminished and fewer artery dissections and bile duct injuries develop, because the procedure facilitates dissection of the hilar structures.Öğe Plastron apandisiti taklit eden nadir bir akut karın nedeni: Çekum non-hodgkin lenfoması(2016) Barut, Bora; İnce, Volkan; Ersan, Veysel; Koç, Cemalettin; Özdemir, FatihÖz: Primer gastrointestinal lenfoma, ekstranodal yerleşimli lenfomaların en sık görülen şekli olmasına karşın, gastrointestinal sistemin nadir görülen tümörüdür. En sık görülen kolon lenfoması non-Hodgkin lenfomadır, kolonda en sık çekum tutulumu gözlenir. Biz burada akut batın bulguları ile seyreden ve karaciğere metastaz yapmış olan çekum lenfolmalı bir hastayı sunuyoruz.Altmışüç yaşında erkek hasta. Yaklaşık üç haftadır devam eden karın ağrısı, ishal ve karın sağ alt kadranda kitle şikayeti ile hastanemize başvurmuş. Çekilen multisilice tomografi'de karında kitle görünümü tespit edildi. Hastanın takiplerinde genel durumunun bozulması nedeniyle acil operasyona alındı. Ameliyat esnasında çekumda kitle ve karaciğerde iki adet metastatik lezyon izlendi. Hastaya sağ hemikolektomi ve karaciğer metastazektomi yapıldı. Çıkarılan spesmen patoloji sonucu B hücreli lenfoma olarak rapor edildi. Hasta ameliyat sonrası 13. gün pnomoni ve akut respiratuar distres sendromu (ARDS) nedeniyle kaybedildi.Primer gastrointestinal lenfomaların tedavisinde cerrahi, kemoterapi ve radyoterapi başlıca tedavi seçenekleri olmasına karşın hangisinin öncelikli olduğu hala tartışmalıdır.Öğe Popüler müzik albüm kapaklarının tasarım sorunları(İnönü Üniversitesi Sanat Ve Tasarım Dergisi, 2011) Özdemir, FatihGörsel iletişim, grafik tasarım ve yazı eğitimi alan bir tasarımcı, toplumla görsel anlamda iletişim kurarken, o toplumu çok iyi tanımalı, ihtiyaçlarını çok iyi bilmelidir. Sürekli değişen ve gelişen kültür anlayışı ve toplum yapısı içerisinde kendini güncel tutmalı, bununla birlikte kültürün sanata yansımalarını da kavrayabilmelidir. İnsanların beğenileri arasındaki benzer noktaları fark edebilmeli, yapacağı tasarımlarda hedef kitlesinin işitsel beğenilerine paralel olarak görsel beğenilerini anlamalı, daha etkili sonuçlara ulaşabilmek için bu yönde planlamalar yapmalıdır. Toplumdaki değişimlerin müziğe nasıl yansıdığını ve tasarım kültürünü nasıl etkilediğini bilen tasarımcı, yapacağı işlerde nasıl bir tavır belirlemesi gerektiğini ve hedef kitlesine ulaşmaya çalışırken nasıl bir yol izlemesi gerektiğini bilecektir. Böylece, hedef kitlenin dinlediği müzik türü, onun beğendiği yazı karakterleri ve tipografi ile doğru orantılı olacağından, hedef kitleyi kalbinden vurmak için en doğru atışı yapabilecektir. Bu araştırma, 2000’li yılların ikinci yarısında yayınlanan popüler müzik albümlerinin dış görselleri ile içerikleri arasındaki ilişkileri temel alarak, seçilen fontlarla ve yapılan tasarımlarla, biçim içerik ilişkilerini incelemek amacı ile yapılmıştır. Yapılan araştırmada, bu dönem içerisinde piyasaya çıkan albüm kapakları incelenmiş, tasarımlarıyla içerdikleri müzik türü arasındaki ilişkiler ortaya konmaya çalışılmıştır.Öğe Popüler müzik kültürünün tipografiye yansımaları.(İnönü Üniversitesi, 2007) Özdemir, FatihBu arastırma, popüler müzik üreten grup ve kisilerin albüm kapaklarının, biçim içerik iliskisi göz önüne alınarak, görsel sorunlarının incelenmesi, böylece üretilecek albüm kapaklarının niteliklerinin artması ve tasarımcının hedef kitlesine dogru ulasabilmesinin yollarını incelemek amacıyla yapılmıstır. Arastırmada agırlıklı olarak 2000 yılı sonrasında Türkiye'de yayınlanan pop müzik albümlerinin kapakları incelenmistir. Popüler kültürün tanımları yapılmıs, popüler müziklerle popüler kültür arasındaki paralellik ortaya konmaya çalısılmıstır. Popüler kültürün müzige, sosyal hayata ve grafik tasarıma olan yansımaları arastırılmıstır. Grafik tasarımın temel ilkeleri arastırılmıs, tipografik kurallar ve estetik kaygılar dahilinde albüm kapaklarının görsel sorunları ortaya koyulmaya çalısılmıstır. Müzik tarihinde önemli yere sahip olan klasiklesmis albümler ve kapakları incelenmis, günümüz popüler kültürünün ortaya koydugu albüm kapakları ile karsılastırılmıstır. Bu karsılastırma sonucunda aradaki farklar ve kapak tasarımlarının gelisim süreci ortaya konmustur. Albüm kapaklarındaki görsel sorunlar incelenmis, kullanılan materyaller ve tipografi ile albüm içerigini olusturan müzik türü arasındaki iliski arastırılmıstır. Bulguların yorumlanmasından sonra, arastırma probleminin sonuçları saptanmıs; bu sonuçlar kullanılarak, albüm kapakları üzerindeki biçim-içerik sorunları ve görsel sorunlar ortaya konmustur. Bu sorunların giderilebilmesine yönelik çözüm önerileri getirilmistir. IV Arastırmanın sonuçları söyle özetlenebilir: Türkiye'de yayınlanan ve tez kapsamında incelenen popüler müzik albüm kapaklarının çogu, aynı fabrikadan çıkmısçasına sıradandır. Bu kapaklar, estetik, biçim - içerik gibi kaygılardan uzak, tamamen ticari kaygılar göz önüne alınarak üretilmis; tamamen tüketim kültüründen beslenen kullan/at tarzında degersiz islerdir. Yayınlandıkları dönemin sosyo-kültürel yapısını da yansıttıgı için, albümler ve kartonetleri aynı zamanda birer belge niteligindedir.Öğe Posterior sector biliary duct injury during laparoscopic cholecystectomy: Case report(2019) Karakaş, Serdar; Usta, Sertaç; Özdemir, FatihAbstract: Biliary injuries are common after a cholecystectomy. One of the most important reasons for biliary injury during laparoscopic cholecystectomy (LC) is variant anatomy of the extrahepatic bile duct. Described in this report is a rare complication of a LC that included a posterior right sectoral duct injury. A 45- year-old woman was referred with peritonitis, including a large quantity of fluid in the abdomen. She had undergone an LC at a state hospital 14 days before the referral. Pouchography revealed a connection between the site of fluid collection and the posterior sector of the right main bile duct. An exploratory laparotomy revealed a dissected right posterior sector channel. A Roux-en-Y hepaticojejunostomy was constructed with no complication. Surgical experience, training, and maintaining a critical view toward safety are the most important factors to prevent bile duct injuries after LC. Care taken with anatomical variance of the extrahepatic biliary tree is also a key factor in the prevention of iatrogenic biliary injuries. Posterior sector injuries should be kept in mind; however, hepaticojejunostomy is a feasible method to overcome this potential complication after the elimination of any intra-abdominal infection.Öğe Rapid detection of bloodstream pathogens in liver transplantation patients with film array multiplex polymerase chain reaction assays comparison with conventional methods(Transplantation Proceedings, 2015) Otlu, Barış; Bayındır, Yaşar; Özdemir, Fatih; İnce, Volkan; Çuğlan, Serpil; Hopoğlu, Murat; Yakupoğulları, Yusuf; Kızılkaya, Canan; Kuzucu, Çiğdem; Işık, Burak; Yılmaz, SezaiBackground. Bloodstream infection (BSI) is an important concern in transplant patients. Early intervention with appropriate antimicrobial therapy is critical to better clinical outcome; however, there is significant delay when conventional identification methods are used. Methods. We aimed to determine the diagnostic performance of the FilmArray BloodCulture Identification Panel, a recently approved multiplex polymerase chain reaction assay detecting 24 BSI pathogens and 3 resistance genes, in comparison with the performances of conventional identification methods in liver transplant (LT) patients. A total of 52 defined sepsis episodes (signal-positive by blood culture systems) from 45 LT patients were prospectively studied. Results. The FilmArray successfully identified 37 of 39 (94.8%) bacterial and 3 of 3 (100%) yeast pathogens in a total of 42 samples with microbial growth, failing to detect only 2 of 39 (5.1%) bacterial pathogens that were not covered by the test panel. The FilmArray could also detect additional pathogens in 3 samples that had been reported as having monomicrobial growth, and it could detect Acinetobacter baumannii in 2 samples suspected of skin flora contamination. The remaining 8 blood cultures showing a positive signal but yielding no growth were also negative by this assay. Results of MecA, KPC, and VanA/B gene detection were in high accordance. The FilmArray produced results with significantly shorter turnaround times (1.33 versus 36.2, 23.6, and 19.5 h; P < .05) than standard identification methods, Vitek II, and Vitek MS, respectively. Conclusions. This study showed that the FilmArray appeared as a reliable alternative diagnostic method with the potential to mitigate problems with protracted diagnosis of the BSI pathogens in LT patients.Öğe Rapid detection of bloodstream pathogens in liver transplantation patients with filmarray multiplex polymerase chain reaction assays comparison with conventional methods(Transplantation Proceedings, 2015) Otlu, Barış; Bayındır, Yaşar; Özdemir, Fatih; İnce, Volkan; Çuğlan, Songül; Hopoğlu, Murat; Yakupoğulları, Yusuf; Kızılkaya, Cana; Kuzucu, Çiğdem; Işık, Burak; Yılmaz, SezaiBackground. Bloodstream infection (BSI) is an important concern in transplant patients. Early intervention with appropriate antimicrobial therapy is critical to better clinical outcome; however, there is significant delay when conventional identification methods are used. Methods. We aimed to determine the diagnostic performance of the FilmArray BloodCulture Identification Panel, a recently approved multiplex polymerase chain reaction assay detecting 24 BSI pathogens and 3 resistance genes, in comparison with the performances of conventional identification methods in liver transplant (LT) patients. A total of 52 defined sepsis episodes (signal-positive by blood culture systems) from 45 LT patients were prospectively studied. Results. The FilmArray successfully identified 37 of 39 (94.8%) bacterial and 3 of 3 (100%) yeast pathogens in a total of 42 samples with microbial growth, failing to detect only 2 of 39 (5.1%) bacterial pathogens that were not covered by the test panel. The FilmArray could also detect additional pathogens in 3 samples that had been reported as having monomicrobial growth, and it could detect Acinetobacter baumannii in 2 samples suspected of skin flora contamination. The remaining 8 blood cultures showing a positive signal but yielding no growth were also negative by this assay. Results of MecA, KPC, and VanA/B gene detection were in high accordance. The FilmArray produced results with significantly shorter turnaround times (1.33 versus 36.2, 23.6, and 19.5 h; P < .05) than standard identification methods, Vitek II, and Vitek MS, respectively. Conclusions. This study showed that the FilmArray appeared as a reliable alternative diagnostic method with the potential to mitigate problems with protracted diagnosis of the BSI pathogens in LT patients.Öğe Resim-İş Eğitimi Programları Grafik Ana Sanat Ders İçerikleri ve İşleniş Biçimleri ?(2014) Türker, İ Halil; Özdemir, FatihTürkiye'de Resim-iş eğitimi programlarındaki öğretim elemanları ile dersler, ders içerikleri ve işleniş biçimleri konularında yapılan görüşmeler sırasında, tüm fakültelerde uygulanması öngörülen Eğitim Fakülteleri ortak programının uygulama aşamasında bölümden bölüme değişiklikler gösterdiği fark edilmiştir. Bu farklılıkların ortaya konması ve mevcut durumun göz önüne serilerek yapılabileceklerin tartışmaya açılması fikri, bu araştırmanın yapılmasına sebep olmuştur. Araştırmanın amacı; Türkiye'deki Güzel Sanatlar Eğitimi Grafik Ana Sanat Dallarında 6 dönem boyunca okutulan derslerin mevcut durumunun ne olduğunun ortaya konulmasıdır. Veriler, bir anket aracılığı ile toplanmıştır. Ankette grafik ana sanat derslerinde var olan durum ve uygulamada karşılaşılan sorunlar ile ilgili sorular yer almaktadır. Araştırma sonucunda, elde edilen veriler değerlendirilmiş ve ortak uygulamaya yönelik alternatif bir içerik önerisi sunulmuştur.Öğe Temporary parenteral tacrolimus requirement due to unexplained low through levels in a liver transplant patient with short bowel syndrome(International Journal of Organ Transplantation Medicine, 2014) İnce, Volkan; Özdemir, Fatih; Işık, Burak; Yılmaz, Sezai; Kayaalp, CüneytAn adequate level of tacrolimus in serum should be obtained to prevent acute rejection following liver transplantation. Because of good gastrointestinal absorption of oral tacrolimus, adequate trough levels can be achieved even in patients with short bowel syndrome. Rarely, adequate through levels cannot be obtained by oral administration of the drug for several reasons such as inadequate absorption, having a discordant patient, laboratory error, and/or interactions with other drugs and foods. Here, we described a 16-year-old patient who had undergone massive intestinal resection due to mesenteric torsion 5 years previously and required liver transplantation for cryptogenic cirrhosis. Her remnant small bowel length was 90 cm. After a successful living donor liver transplantation, oral tacrolimus administration resulted in inadequate through levels in some parts of the postoperative period. We checked up all the potential reasons but could not identify any cause. An intravenous tacrolimus including immunosuppressive regimen was temporarily required. She maintained adequate blood levels of tacrolimus by parenteral route for a while; thereafter, oral administration resulted in enough blood drug levels. She was discharged with oral tacrolimus therapy. We concluded that very rarely, adequate blood levels of tacrolimus cannot be achieved by oral administration for unexplained reasons. In such cases, temporary administration of parenteral tacrolimus can be life-saving.
