Yazar "Şahin, Tevfik Tolga" seçeneğine göre listele
Listeleniyor 1 - 12 / 12
Sayfa Başına Sonuç
Sıralama seçenekleri
Öğe Analysis of patients with acute liver failure after liver surgery: Single center experience(2022) Sağlam, Kutay; Yılmaz, Sezai; Usta, Sertaç; Şahin, Tevfik Tolga; Zengin, Akile; İspir, MukadderLiver transplantation is the lifesaving treatment option for rare acute liver failure that develops due to iatrogenic bile duct injuries or after major hepatectomy. The aim of the study is to analyze patients with acute liver failure due to iatrogenic bile duct injury or major hepatectomy on the waiting list for emergency liver transplantation. Between the years 2011-2020, 9 patients (5 female/4 male; median age: 30 years old, (range:4-63 years)) with acute liver failure related to bile duct injury or major hepatectomy for whom urgent liver transplantation was planned were included in this study. Eight patients were accepted for urgent liver transplantation. Acute liver failure developed in 6 patients due to hepatoduodenal ligament injury during cholecystectomy, and in 3 patients due to major hepatectomy. The patients were listed for urgent transplantation within the mean of 1.5 days (range:0-3 days) after acute liver failure. Two patients had living donor and 1 patient had cadaveric liver transplantation. Acute hepatic failure, especially after iatrogenic bile duct injuries associated with vascular injuries, seems to be more fatal than post hepatectomy liver failure. In these cases of acute liver failure, which is a difficult situation to decide, emergency liver transplantation should be kept in mind as the treatment option.Öğe Analysis of risk factors of mortality in abdominal trauma(2020) Gönültaş, Fatih; Kutlutürk, Koray; Gök, Ali Fuat Kaan; Barut, Bora; Şahin, Tevfik Tolga; Yılmaz, SezaiAbstract: BACKGROUND: The present study aims to analyze blunt and penetrating abdominal traumas that were evaluated in our emergency department, the treatment approaches and risk factors of mortality. METHODS: Six hundred and sixty-four patients were admitted to our emergency department for surgical evaluation for trauma between January 2009 and April 2019. After the exclusion of dead on arrival, patients with missing data and patients without abdominal trauma were excluded from this study. Hundred and thirteen patients with abdominal trauma admitted to our department were evaluated in this study. Demographic, clinical, prognostic and mortality related factors were retrospectively analyzed. RESULTS: The mean age of the patients was 36.08±16.1 years. There were 90 male patients. Eighty patients (70.8%) had blunt abdominal trauma (BAT). Twenty-eight patients (24.7%) had isolated liver and two patients (1.7%) had isolated spleen injury. Combined liver and spleen injury was found in two patients (1.7%). Twenty-two (19.4%) patients had mortality. Causes of mortality were an irreversible hemorrhagic shock (40.9%) and central nervous system (13.6%) injuries. BAT was the main mechanism of injury in patients with mortality (86.4% versus 67%; p<0.001). The frequency of retroperitoneal injury was significantly higher in patients with mortality (50% versus 16.5%, p<0.001). The frequency of extra-abdominal injury in patients with mortality was higher (68.1% versus 49.4%; p=0.047). Mean arterial pressure at admission was found to be significantly lower in patients with mortality (67±26.8 mmHg versus 84.3±17 mmHg; p=0.02). The number of packed erythrocytes transfused in patients with mortality was higher (8.8±8.6 versus 3.3±5.9 units; p=0.047). Mean international normalized ratio (INR) was significantly higher in patients with mortality (4.3±7.1 versus 2.7±4; p=0.016). Mean lactate dehydrogenase level was higher in patients with mortality (1685.7±333.8 versus 675.8±565.3 IU/mL; p<0.001). Mean alanine aminotransferase (ALT) was significantly higher in patients with mortality (430±619 versus 244±448 IU/mL; p<0.001). Mean alkaline phosphatase (ALP) level in patients with mortality was higher (76.9±72.8 versus 67.3±27.8 IU/mL; p=0.003). The presence of retroperitoneal injury and ALT >516 IU/mL were independent risk factors o mortality. CONCLUSION: We have found certain laboratory variables to increase in patients with mortality. These are related to the severity of trauma. Retroperitoneal injury and increased ALT levels being risk factors of mortality is the most important finding of this study. Our results can guide other centers in the evaluation of trauma patients, and high-risk groups can be identified.Öğe Associating liver partition and portal vein ligation for staged hepatectomy for extensive alveolar echinococcosis: First case report in the literature(BAISHIDENG PUBLISHING GROUP INC, 8226 REGENCY DR, PLEASANTON, CA 94588 USA, 2018) Akbulut, Sami; Çiçek, Egemen; Kolu, Mehmet; Şahin, Tevfik Tolga; Yılmaz, SezaiAlveolar echinococcosis (AE) is a zoonotic disease that is caused by Echinococcus multilocularis that affects liver and a variety of organs and tissues. It differs from other echinococcal disease because it shows tumor like behavior in the affected organ and tissues. The treatment of choice is concomitant medical therapy and resection with negative margins. Nevertheless, resection with the intent of negative margins (R0) may lead to serious complications such as liver failure. In the present case report, we used Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) procedure, which was defined in 2012 by Schnitzbauer et al, in a 28-year-old male patient to avoid complications of major liver resection in order to treat alveolar echinococcosis. Until now, we have not encountered any study using ALPPS procedure for the treatment of alveolar echinococcosis. In the present case report we aimed to show that ALPPS procedure can be safely performed for margin-negative resection of primary or recurrent AE that shows a tumor like behavior. It is our opinion that this procedure should be performed in centers that have expertise and sufficient technical capacity to perform liver transplantation and advanced liver surgery.Öğe Comprehensive analysis of impacts of lymph node yield on patient survival and recurrence in patients with stage II rectal cancer: A single institution study(2019) Civil, Osman; Okkabaz, Nuri; Şahin, Tevfik Tolga; Yazıcıoğlu, Burc M.; Tiryaki, Çağrı; Güneş, Abdullah; Çiftci, AliAbstract: Aim: Pathologic evaluation of rectal cancer is very important. Lymph node yields may be related to surgical technique or inadequate harvesting in the pathology department. The importance of lymph node yields >12 have been emphasized by many researchers to be adequate for staging. In stage II rectal cancer, the impacts of lymph node yield on locoregional recurrence and patient survival have not been studied. The aim of the present study is to evaluate the impact of lymph node yield on outcome and prognosis of the patients with stage II rectal cancer.Material and Methods: Patients with stage II rectal cancer who were operated in our institution between 2008 and 2013 were retrospectively analyzed to determine the impact of lymph node yield on survival, locoregional and distant metastasis.Results: Overall, local and distant recurrence rates were 13.9%, 4.65% and 9.30%; respectively. We did not find any significant difference in terms of locoregional and distant metastasis rates among Group I (lymph node<12) and II (lymph nodes>12) (p>0.05). The 5-year survival of the patients in Group 1 versus Group 2 were 86.7% versus 82%; respectively (p>0.05).Conclusions: Results of the present study emphasize that lymph node yields may not have an impact on patient survival or recurrence. However, the patient groups were heterogeneous and the volume was low, therefore, more studies with higher volumes are needed.Öğe Comprehensive analysis of the efficacy of liver transplantation in pediatric patients with Wilson’s disease(2023) Sarıcı, Barış; Şahin, Tevfik Tolga; Ara, Cengiz; Aydın, Cemalettin; Karakas, Serdar; İnce, Volkan; Varol, FatmaAim: The aim of the present study is to evaluate the results of liver transplantation (LT) in pediatric Wilson disease (WD) with a specific sub-analysis in patients with neuropsychiatric symptoms. Materials and Methods: Demographic, operative, laboratory and neurologic findings of 23 pediatric patients with WD that underwent LT were analyzed by examining the patient charts. Results: Median age of the patients was 13 ( 7 to 17) years. Median Wilson’s Index scores of the patients were 7 (5-13). Median Child-Pugh Score, MELD-Na and PELD scores of the patients were 10 (5-12), 19 (8-34) and 25.4 (8.4-30.7); respectively. Eight patients (34.8%) had Kayser-Fleischer rings on examination. Five patients (21.7%%) presented with acute decompensated Wilson’s disease. Fifteen patients (65.2%) received living donor liver transplantation. Totally, 10 patients (43,4%) had nervous system involvement in the preoperative period. Two patients fully recovered; 2 patients showed partial recovery. On the other hand, 4 patients showed no improvement and 2 patients had progression of their disease in the postoperative period. Conclusions: The results of the present study show that LT is an effective and safe alternative in end-stage liver failure in WD. However, in these patients, nervous system involvement may not improve despite successful LT.Öğe Early portal vein thrombosis after pediatric liver transplantation: Assesment of risk factors(2023) Karakas, Serdar; Şahin, Tevfik Tolga; Sarıcı, Barış; Usta, Sertaç; Kutlutürk, Koray; Varol, Fatma İlknur; Sağlam, KutayAim: Despite advancements in surgical techniques, early portal vein thrombosis (ePVT) continues to be one of the major complications of liver transplantation (LT) in pediatric age group. Possible risk factors are portal vein diameter < 5 mm, infancy, patient body weight < 10 kg and high graft recipient weight ratios (GRWR > 4.0). We retrospectively evaluated our records of pediatric LTs’ in terms of ePVT and possible risk factors determining development of this dreaded complication. Materials and Methods: Between January 2018 and January 2022, 228 LTs were performed for pediatric age (under the age of 18) group at Inonu University, Liver Trans- plantation Institute. Among these patients, 212 were eligible for the study. Patients with ePVT were defined as Portal Vein Thrombüs Group (PVTG) and patients with no Portal Vein thrombosis were defined in control group (CG). ePVT was described as detection of impeded portal venous outflow with imaging studies either perioperatively or within postoperative 3 days . Demographic, clinical and operative variables were retrospectively evaluated. Results: Among 212 LTs, 24 cases were complicated with ePVTs (11.3 %). Preoperative platelet counts, etiology of Budd-Chiari, postoperative hepatic artery thrombosis (HAT) and lower age were significantly higher for early PVT. In multivariate analysis, preop- erative platelet levels, etiology of Budd-Chiari and postoperative HAT were significantly higher for PVT. One and 5 years overall survivals (OS) for PVTG and CG were 50.0 % - 50.0 % and 69 % - 63 % respectively. No significant OS difference was observed despite much more patients were died in PVTG. Conclusion: High preoperative platelet counts, Budd-Chiari syndrome and postoperative HAT are predictive factors for ePVT. Anti-thrombotic prophylaxes can be considered in high-risk patients. Venous jump grafts seem to have no effect on ePVT. Despite PVT increases the mortality rates, it can be resolved easily with immediate reoperation.Öğe The impact of tumor localization on prognosis of the patients following liver transplantation for hepatocellular carcinoma(2020) Başkıran, Adil; Sarıgöz, Talha; Şahin, Tevfik Tolga; İnce, Volkan; Usta, SertaçAim: Hepatocellular carcinoma usually occurs in the setting of liver cirrhosis and therefore, resection is not possible in majority ofthe cases. Orthotopic liver transplantation (OLS) is a gold standard treatment option in hepatocellular carcinoma. The aim of thepresent retrospective study was to evaluate the prognosis of hepatocellular carcinoma localized in left or right side of the liver inpatients who underwent OLS.Materials and Methods: 120 patients received OLS for hepatocellular carcinoma between 2007 and 2018 in the institute of livertransplantation. Tumors that were centrally located were excluded from the analysis. The remaining 104 patients were divided intotwo groups; Group 1 (right lobe, n=85 [81.7%]), Group 2 (left lobe, n=19 [18.3%]). The clinical and demographic data of the patientsalong with preoperative laboratory values such as alpha fetoprotein (AFP), gamma-glutamyl transpeptidase (GGT) and thrombocytecount were retrospectively evaluated.Results: The Median age in Group 1 and 2 were 54 (4-72) and 50.5 (37-68) years, respectively. Preoperative AFP levels in Group 1and 2 were 9.25 (1-10800) ng/ml and 13 (1.5-317) ng/ml, respectively. The Model for end stage liver disease (MELD) scores in Group1 and 2 were 12 (6-52) and 9 (6-21), respectively. None of the clinical, demographic and laboratory values along with disease-freesurvival, early mortality and recurrence were significantly different among the study groups (p>0.05).Conclusions: Although there is a big discrepancy in terms of patient’s numbers in right and left-sided tumors, our data failed toshow any survival difference among the groups. Further studies, especially in hepatocellular carcinoma beyond the Milan criteria,are needed to validate our results.Öğe Intraperitoneal rupture of the hydatid cyst disease: Single-center experience and literature review(2020) Koç, Cemalettin; Akbulut, Ahmet Sami; Şahin, Tevfik Tolga; Tuncer, Adem; Yılmaz, SezaiAbstract: BACKGROUND: The primary aim of this study was to present our experience in the intraperitoneal rupture of the hydatid cyst in the guidance of literature data. METHODS: Demographical, clinical, radiological and postoperative follow-up data of 29 patients who underwent surgical treatment in our institution with the diagnosis of intraperitoneal rupture of the hydatid cyst from January 2003 to July 2020 were analysed retrospectively in this study. RESULTS: Among the 29 patients with an age range of from 16 to 79 years (median= 39, IQR=25.5), 16 were male (55.2%), and 13 were female (44.8%). Intraperitoneal rupture of the hydatid cyst was spontaneous in 21 (72.4%), traumatic in seven (24.13%) (two of them were iatrogenic) and was due to shotgun in one patient. Vast majority of the patients were admitted to the emergency department in the first 24 hours after the onset of sign and symptoms. WBC varied from 8.600 to 30.900/mm3 (median=12.100, IQR=5.7). Ruptured cysts were localised in liver (n=25, 86.2%), in spleen (n=2, 6.89%) or in pelvis (n=2, 6.89%) and diameter varied from 40 to 200 mm (median=90, IQR=50). Among the cysts ruptured in liver, 19 (76%) of them were localised in the right lobe. Among the ruptured cysts of the liver, 20 (80%) of them underwent conservative surgery (e.g., partial pericystectomy), the remaining five patients (20%) underwent a radical surgical treatment (e.g., pericystectomy). A biliary orifice was diagnosed during surgical exploration in either cyst cavity or cut surface of the liver in 12 (48%) of the patients. Patients with a dilated common bile duct or a visible biliary duct orifice in cystic cavity underwent common bile duct exploration and T-tube drainage procedure (n=6, 24%). One patient died on postoperative day one, due to cardiopulmonary complications secondary to cyst rupture. All along the postopeartive follow-up of median 1416 days, seven (24.1%) patients were diagnosed for diseased recurrence. CONCLUSION: Intraperitoneal rupture of the hydatid cyst is a life-threatening complication of hydatid cyst disease, for which diagnosis without delay and timing of surgical treatment is essential. Anaphylactic shock require rapidly initiation of medical treatment against allergic reactions. Despite scolocidal agents, vesicular spread into peritoneal cavity accounts for the major risk factor for disease recurrence. Hence, abdominal cavity should be explored cautiously.Öğe An investigation into the factors predicting acute appendicitis and perforated appendicitis(2021) Akbulut, Sami; Koç, Cemalettin; Şahin, Tevfik Tolga; Şahin, Emre; Tuncer, Adem; Demyati, Khaled; Şamdancı, Emine Türkmen; Çolak, Cemil; Yılmaz, SezaiBACKGROUND: To investigate the factors predicting acute appendicitis (AAp) and perforated AAp in patients who underwent surgery with a preliminary diagnosis of AAp. METHODS: Between May 2009 and December 2018, 1316 patients underwent appendectomy with a presumed diagnosis of AAp. To investigate the factors predicting AAp, patients were divided into two groups considering the histopathological presence of inflammatory changes in the appendix: AAp positive (AAp group; n=1043) and AAp negative (Non-AAp group; n=273). Also, to investigate the factors predicting appendiceal perforation, patients with AAp were divided into two groups considering the presence of perforation: non-perforated AAp (n=850) and perforated AAp (n=193). ROC curve analysis was used to identify optimum cut-off values of quantitative variables. The groups were compared using univariate analysis methods and parameters with a p? 0.20 were taken into a multivariate logistic regression model. RESULTS: Multivariate analysis method related to factors predicting AAp showed that gender (male; p=0.034; OR=1.4), WBC (?10.900; p=0.022; OR=1.5), MPV (?29.1; p=0.006; OR=1.6), TBil (?0.61; p=0.034; OR=1.4), CRP (?0.725; p=0.002; OR=1.7), NLR (?5.13; p=0.034; OR=1.5), PNR (<24.04; p=0.001; OR=1.9) and US findings (AAp+; p<0.001; OR=2.9) were independent factors for predicting AAp. Multivariate analysis method related to factors predicting appendiceal perforation showed that age (?32 years; p<0.001; OR=2.5), TBil (?0.67; p=0.046; OR=1.5), CRP (?3.75; p<0.001; OR=3.0) and NLR (?5.69; p=0.006; OR=1.8) were independent factors for predicting perforated AAp. CONCLUSION: We believe that predicting both AAp and perforation will help the clinician evaluate patients who applied to the emergency unit with presumed diagnosis AAp. This approach will also contribute to reducing the negative appendectomy and perforation rates.Öğe Is peritoneal dialysis prior to kidney transplantation a risk factor for ureteral stenosis after adult to adult live kidney transplantation(2020) Kutlutürk, Koray; Şahin, Tevfik Tolga; Çimen, Serhan; Dalda, Yasin; Gönültaş, Fatih; Doğan, Sait Murat; Toplu, Sibel; Ünal, Bülent; Pişkin, TurgutAbstract: Objective: Major urinary complications such as urinary leaks, stenosis or urinary tract infections after kidney transplantation can lead to graft or patient loss. The effect of peritoneal dialysis on post-kidney transplantation complications have been discussed but its effect on ureteral stenosis is unknown. In this study, it was aimed to analyze factors effecting major ureteral complications after living donor kidney transplantation and impact of peritoneal dialysis and double J-stents (JJ stents). Material and Methods: This study included 116 adult to adult living donor kidney transplant patients. Factors effecting major urologic complications after living donor kidney transplantation were analyzed. The donors were primary relatives of the recipients. Results: Major urologic complications after living donor kidney transplantation was 8/116 (6.9%). Urinary leak was present in 2 (1.7%) patients. Ureteral stenosis was encountered in 6 (5.2%) patients. Double J stents were used in 84 (72.4%) of the cases. The effect of JJ ureteral stent was not statistically significant for urinary leak, ureteral stenosis (p= 0.074, p= 0.470, respectively). A total of 29 (25%) patients had peritoneal dialysis before kidney transplantation. Preoperative peritoneal dialyses and bacteriuria after kidney transplantation were independent risk factors for ureteral stenosis in multivariate analysis (p= 0.013, and p= 0.010 respectively). Conclusion: In the guidance of the results of the present study, peritoneal dialysis prior to kidney transplantation and bacteriuria are independent risk factors for ureteral stenosis after living donor kidney transplantation. JJ stents have no effect on urologic complications after living donor kidney transplantation.Öğe Outcomes of surgery for gallbladder cancer: A single-center experience(2018) Başkıran, Adil; Şahin, Emrah Kemal; Karadağ, Neşe; Şahin, Tevfik Tolga; Barut, Bora; Özgor, Dinçer; Dirican, AbuzerOBJECTIVE: Gallbladder cancer (GBC) is a rare clinical entity that has a poor prognosis. Radical resection with meticulouslymph node dissection is the only treatment option. The aim of the present study is to evaluate the efficacy of radical resection for GBC in the early postoperative period with the viewpoint of clinicopathological correlation.METHODS: Patients (n=24) who underwent radical resection with lymph node dissection for GBC between 2015 and 2017were included. Demographic data, histopathologic tumor type, preoperative tumor markers, pathologic tumor size/stage(depth of invasion), lymph node metastasis and metastasis rates, and postoperative early mortality were evaluated. Thepatients were grouped in two groups according to lymph node metastases: Group 1 (without lymph node metastasis) andGroup 2 (with lymph node metastasis).RESULTS: The median age of the patients in Group 1 and Group 2 was 65 (range, 42–89) years and 68 (range, 48–87)years, respectively (p>0.05). The female/male ratio in Group 1 and Group 2 was 4/4 and 13/3, respectively (p>0.05). Therewas a tendency for increased metastasis in Group 2 compared with Group 1 (31% vs. 0%) (p>0.05). Also, 88% of the tumors in Group 2 were in the advanced stage, whereas the rate was 37% in Group 1 (p<0.05). There was early postoperativemortality in seven patients who underwent resection. Four of the seven patients (43%) were from Group 2 and three (37%)from Group 1 (p>0.05).CONCLUSION: Lymph node metastasis in GBC indicates advanced tumor stage. This causes a more complex surgical resection and therefore results in higher early postoperative mortality.Öğe The Predictive Value of the Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratio in Patients with Recurrent Idiopathic Granulomatous Mastitis(2020) Akbulut, Ahmet Sami; Şahin, Tevfik TolgaThe Predictive Value of the Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratio in Patients with Recurrent Idiopathic Granulomatous Mastitis
