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Öğe Chylous ascites after liver transplantation incidence and risk factors(Liver Transpl., 0–0., 2012) Yılmaz, Sezai; Akbulut, Ahmet Sami; Işık, Burak; Ara, Cengiz; Özdemir, Ramazan; Aydın, Cemalettin; Kayaalp, Cüneyt; Yılmaz, SezaiIn this study, we evaluated the diagnosis, epidemiology, risk factors, and treatment of chylous ascites developing after livertransplantation (LT). Between 2002 and 2011, LT was performed 693 times in 631 patients at our clinic. One-hundred fifteenof 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 includedin this study. Using univariate and multivariate analyses, we examined whether the following were risk factors for developingchylous ascites: age, sex, body mass index, graft-to-recipient weight ratio, Model for End-Stage Liver Disease score, venacava cross-clamping time, total operation time, Child-Pugh classification, sodium level, portal vein thrombosis or ascitesbefore 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 presenceof ascites before transplantation (P ¼ 0.03), and the use of LVSS for perihepatic dissection (P < 0.01) were risk factors fordeveloping chylous ascites. According to a multivariate Cox proportional hazards model, the presence of pretransplant asci-tes [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 dis-section (P ¼ 0.01, HR ¼ 5.4, 95% CI ¼ 1.5-34.4) were independent risk factors. In conclusion, the presence ofpreoperative ascites and the use of LVSS for perihepatic dissection are independent risk factors for the formation of chylousascites. To our knowledge, this study is the most extensive examination of the development of chylous ascites. Neverthe-less, our results should be supported by new prospective trials. Liv er Transpl 18:1046-1052, 2012.VC2012 AASLD.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 Circumferential Fence With the Use of Polyethylene Terephthalate Dacron Vascular Graft for All in One Hepatic Venous Reconstruction in Right Lobe Living Donor Liver Transplantation(Transplantation Proceedings, 47(5), 1458–1461., 2015) Ara, Cengiz; Akbulut, Ahmet Sami; İnce, Volkan; Aydın, Cemalettin; Kayaalp, Cüneyt; Ünal, Bülent; Yılmaz, SezaiIntegration of hepatic vein tributaries with a diameter 5 mm into the drainage system in rightlobe living-donor liver transplantation (LDLT) is of vital importance for graft function. Recently, the most commonly emphasized hepatic venous reconstruction model is the all-in-one reconstruction model. In the final stage of this model that aims to form a common large opening, allogeneic vascular grafts are almost always used to construct a circumferential fence. To date, no other study has reported the use of polyethylene terephthalate (Dacron) vascular graft as a circumferential fence in LDLT. We aimed to present the 1st 4 cases of circumferential fences created with Dacron vascular graft. Four right-lobe grafts weighing 522e1,040 g were used. A polytetrafluoroethylene vascular graft was used for the integration of segment 5 vein and segment 8 vein into the drainage model, whereas a Dacron graft was used to creating a circumferential fence. The patency of hepatic outflow evaluated with the use of multidetector computerized tomography at postoperative day 7. Venous outflow obstruction was not detected in any cases. This study suggested that owing to its flexible structure the polyethylene terephthalate vascular graft can be an alternative to allogeneic vascular grafts in forming circumferential fence.Öğe Circumferential fence with the use of polyethylene terephthalate dacron vascular graft for all in one hepatic venous reconstruction in right lobe living donor liver transplantation(Transplantation Proceedings, 2015) Ara, Cengiz; Akbulut, Ahmet Sami; İnce, Volkan; Aydın, Cemalettin; Gönültaş, Fatih; Kayaalp, Cüneyt; Ünal, Bülent; Yılmaz, SezaiIntegration of hepatic vein tributaries with a diameter 5 mm into the drainage system in rightlobe living-donor liver transplantation (LDLT) is of vital importance for graft function. Recently, the most commonly emphasized hepatic venous reconstruction model is the all-in-one reconstruction model. In the final stage of this model that aims to form a common large opening, allogeneic vascular grafts are almost always used to construct a circumferential fence. To date, no other study has reported the use of polyethylene terephthalate (Dacron) vascular graft as a circumferential fence in LDLT. We aimed to present the 1st 4 cases of circumferential fences created with Dacron vascular graft. Four right-lobe grafts weighing 522e1,040 g were used. A polytetrafluoroethylene vascular graft was used for the integration of segment 5 vein and segment 8 vein into the drainage model, whereas a Dacron graft was used to creating a circumferential fence. The patency of hepatic outflow evaluated with the use of multidetector computerized tomography at postoperative day 7. Venous outflow obstruction was not detected in any cases. This study suggested that owing to its flexible structure the polyethylene terephthalate vascular graft can be an alternative to allogeneic vascular grafts in forming circumferential fence.Öğe Comparison of the demographic and clinical features of pregnant and non-pregnant patients undergoing appendectomy(2020) Koç, Cemalettin; Akbulut, Ahmet Sami; Çoşkun, Ebru İnci; Sarıcı, Barış; Yılmaz, SezaiAbstract: BACKGROUND: This retrospective study aims to compare the demographic and clinicopathological characteristics of the pregnant and non-pregnant patients who underwent appendectomy with a presumed diagnosis of acute appendicitis. METHODS: Between June 2009 and January 2019, 431 reproductive-aged of female patients underwent appendectomy with a presumed diagnosis of acute appendicitis. Patients were divided into two groups considering their pregnancy status: pregnant group (n=48) and non-pregnant group (n=383). Both groups were compared with respect to demographic, clinical and histopathological features. RESULTS: No statistically significant difference was found between pregnant and non-pregnant groups except total bilirubin level (p=0.019) and ultrasonographic findings (p=0.016). In the non-pregnant group, negative appendectomy and perforation rates were 26% and 10.5%, where these rates for the pregnant group were 20.8% and 4.2%. Sensitivity, specificity and accuracy rates of ultrasonography for the pregnant group were 50%, 100% and 58.5%, where these rates for the non-pregnant group were 67.3%, 57.9% and 65%. The pregnancy date was the first trimester in 52.1%, the second trimester in 29.2% and the third trimester in 16.7% of the pregnants. None of the term births (87.5%) resulted in neither a fetal nor a maternal complication. However, 12.5% of the preterm births resulted in neonatal mortality. CONCLUSION: Although not statistically significant, this study points out relatively lower rates of negative appendectomy and perforated acute appendicitis among pregnant patients, which is related to the overly attentive evaluation of pregnants admitted due to acute abdomen.Öğe Evaluation of Vaccine Hesitancy, Anti-Vaccination, and Anxiety Levels for Medical Secretaries During COVID-19 Pandemic(2022) Akbulut, Ahmet Sami; Işıklı, Ayşe Gökçe; Boz, Gülseda; Tunç, Zeynep; Sarıtaş, Hasan; Unsal, Selver; AliObjective: This study aimed to evaluate the vaccine hesitancy, anti-vaccination, and anxiety levels of medical secretaries during the pandemic. Methods: This cross-sectional study was conducted on 161 medical secretaries working at the time of the Study. Sociodemographic characteristics form, Coronavirus Anxiety Scale (CAS), Vaccine Hesitancy Scale (VHS) adapted to the pandemic, and Anti-vaccination Scale (AVS) were used in the questionnaire form used to collect the data of the study. Results: Median (IQR) CAS, VHS, and AVS scores of the participants were 2 (IQR=3), 32 (IQR=10), and 58 (IQR=16), respectively. 35.4 % of the participants were exposed to the COVID-19, and 87% were vaccinated against COVID-19. Participants' hesitations about the childhood and COVID-19 vaccines were 15.5 % and 49.1%, respectively. A significant relationship was found between the presence of Coronavirus anxiety and educational status (p=0.035), hesitancy against childhood vaccine (p=0.016), and working in COVID-19 Units (p=0.044). A statistically significant relationship was found between VHS scores and hesitancy against childhood vaccine (p=0.001), hesitancy against COVID-19 vaccine (p<0.001), vaccination against COVID-19 (p=0.014), belief that the COVID-19 vaccine is protective (p<0.001), and make COVID-19 vaccination mandatory (p<0.001). A significant relationship was found between AVS scores and vaccination against COVID-19 (p=0.002), hesitancy against COVID-19 vaccine (p<0.001), and belief that the COVID-19 vaccine is protective (p<0.001), making COVID-19 vaccination mandatory (p<0.001). Conclusion: The concern about their parents’ exposure to COVID-19 is high among secretaries. COVID 19 vaccine hesitancy is high among secretaries. During the pandemic, higher rates of anxiety were detected in secretaries and those working in COVID-19 units and lower in the high school education.Öğe Histopathological examination of acute appendicitis tissue in children during the COVID-19 pandemic(2022) Gürünlüoğlu, Semra; Gül, Mehmet; Akbulut, Ahmet Sami; Ateş, Hasan; Akpınar, Necmettin; Çin, Ecem Serbest; Kuştepe, Elif KayhanIn this study, we prospectively investigated the histopathological features of the removed appendix tissue in pediatric patients who were operated on with the preliminary diagnosis of appendicitis. A catarrhal appendicitis group (n=43), a phlegmonous appendicitis group (n=28), a gangrenous appendicitis group (n=19), a perforated appendi- citis group (n=35), and an appendicitis +COVID-19 group (n=7) were formed. The control group consisted of 21 children. A section of each patient's appendix tissue from the part with the highest diameter was taken for histopathological examination. The sections were routinely stained with hematoxylin and eosin (H&E). The two patholo- gists evaluated all H&E sections in a light microscope. The evaluation results were analyzed statistically. No significant differences in age and gender were found between all groups. The results of neutrophil and lymphocyte counts in all tissue layers of all groups were significantly different. Neutrophil count in the mucosa and muscularis propria in the appendix tissues of the control group were found to be zero. Among all groups, the highest number of neutrophil counts in the mucosa and muscularis propria were found in the perforated group. Among all groups, the highest number of lymphocyte counts in mucosa and muscularis propria were found in the Covid-19 group. The mucosal erosion, intraluminal neutrophils, and reactive lymphoid hyperplasia were negative in all samples in the control group. Neutrophil accumulation in the mucosa and muscularis propria layers in appendix tissue together with other inflammation findings are important in the histopathological diagnosis of appendicitis. In patients with Covid-19 infection, appendicitis may occur, in which case, severe accumulation of lymphocytes appears in the mucosal layer in addition.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 Karaciğer nakli yapılan hastaların anksiyete, depresyon ve öz bakım yetileri ve etkileyen faktörlerin değerlendirilmesi(İnönü Üniversitesi, 2020) Akbulut, Ahmet SamiAmaç: Bu çalışmanın amacı karaciğer nakli olan hastalarda depresyon, anksiyete ve öz bakım yetisi üzerinde etkili olan faktörleri değerlendirmektir. Materyal ve Metot: İnönü Üniversitesi Karaciğer Nakli Enstitüsünde karaciğer nakli olan ve ≥18 yaşındaki hastalar bu tanımlayıcı ve kesitsel çalışmaya dahil edildi. Örneklem büyüklüğü analizi minimum hasta sayısının 301 olması gerektiğini göstermiştir (güven seviyesi =% 95, güven aralığı = 2,5, nüfus = 1382). Üç yüz yirmi hasta ile yüzyüze görüşüldü ve anketlere sağlıklı cevap veren 316 hasta çalışmaya dahil edildi. Çalışmanın bağımlı değişkenleri hastaların durumluk– sürekli anksiyete, deperesyon düzeyleri ve öz bakım yetisi olarak belirlenmiştir. Çalışmanın bağımsız değişkenleri olarak sosyodemografik özellikler, safra yolu komplikasyonları, karaciğer kanseri, başkasına karaciğer nakli önerme durumu ve poliklinik kontrolüne geliş sıklığı belirlendi. Bulgular: Safra yolu komplikasyonu olan hastalarda Öz bakım gücü puanlarının düşük (p=0.002) ve durumluk kaygı puanlarının yüksek (p=0.004) olduğu görülmüştür. Karaciğer kanseri olan hastalarda Öz bakım gücü puanlarının düşük (p=0.006), depresyon (p=0.003) ve sürekli kaygı (p=0.009) puanlarının yüksek olduğu görülmüştür. Aylık gelir düzeyi <3000 TL olan hastalarda depresyon (p<0.001) ve sürekli kaygı (p=0.003) puanlarının yüksek olduğu görülmüştür. Başka hastalara karaciğer nakli olmalarını önermem diyen hastalarda Öz bakım gücü puanlarının düşük (p=0.002), depresyon (p<0.001), durumluk kaygı (p=0.02) ve sürekli kaygı (p<0.001) puanlarının yüksek olduğu görülmüştür. Sonuç: Safra yolu komplikasyonu, karaciğer kanseri varlığı, düşük aylık gelir düzeyi ve aylık poliklinik kontrolü sıklığı gibi faktörlerin öz bakım yetisi, depresyon ve kaygı gelişimi üzerinde etkili birer faktör oldukları sonucuna varılmıştır.Öğe Liver transplant versus non-liver transplant patients underwent appendectomy with presumed diagnosis of acute appendicitis: Case-control study(2020) Barış Sarıcı, Kemal; Akbulut, Ahmet Sami; Koç, Cemalettin; Tuncer, Adem; Yılmaz, SezaiAbstract: BACKGROUND: This study aims to compare liver transplant and non-liver transplant patients who underwent appendectomy with a presumed diagnosis of acute appendicitis. METHODS: Demographic and clinicopathological features of 13 liver transplant recipients (transplant group) who underwent posttransplant appendectomy with a presumed diagnosis of acute appendicitis were compared with the features of 52 non-liver transplant patients (non-transplant group). They underwent appendectomy with a presumed diagnosis of acute appendicitis during the same time period. The transplant group was matched at random in a 1: 4 ratio with the non- transplant group. While the continuous variables were compared using the Mann Whitney-U test, categorical variables were compared with Fisher’s exact test. A p-value of less than 0.05 was considered statistically significant. RESULTS: A total of 65 patients aged between one year and 84 years were included in this study. While the age of the 52 patients (32 male and 20 female) in the non- transplant group ranged from 17 years to 84 years, the age of the 13 patients (nine male and four female) in the transplant group ranged from one year to 64 years. Statistically significant differences were noted between both groups concerning WBC (p=0.002), neutrophil (p=0.002), lymphocyte (p=0.032), platelets (p=0.032), RDW (p=0.001), CRP (p=0.009), PNR (p=0.042), WNR (p=0.03), and appendiceal length (p<0.001). The negative appendectomy rate was relatively higher in transplant than the non-transplant group but this difference was not statistically significant (30.8% vs. 21.2%; p=0.477). Perforated acute appendicitis occurred more frequently in the transplant group; however, this difference was not statistically significant (30.8% vs. 9.6%; p=0.070). CONCLUSION: WBC and neutrophil were lower in the LT group; however, the CRP and RDW were higher in the LT group. Further, perforation and negative appendectomy rates were higher in the LT group, although this difference was not statistically significant.Öğe Liver transplant with a marginal donor graft containing a hydatid cyst—a case report(Transplantation Proceedings, 2013) Eriş, Cengiz; Akbulut, Ahmet Sami; Sakçak, İbrahim; Kayaalp, Cüneyt; Ara, Cengiz; Yılmaz, SezaiLiver transplantation has become the standard treatment for acute failure and end-stage liver disease, but there are fewer donor organs available than patients on the waiting list. The donor pool may be increased by using marginal donor candidates. Some infectious and metabolic diseases have been transmitted to the recipient via marginal donor grafts. Hydatid cyst disease is rarely transmitted to a recipient from the donor graft. A literature search showed only 2 previous cases of liver transplantation using a donor graft that contains a hydatid cyst. We treated a 19-year-old woman who experienced acute on chronic end-stage liver failure secondary to cryptogenic cirrhosis. The liver graft from a 97-year-old marginal cadaveric donor contained a calcified hydatid cyst. No complication was associated with the hydatid cyst at 3 years after transplantation. The present case shows that donor livers with an inactive, calcified hydatid cyst may be used for emergency liver transplantation after considering the location, size, and relation of the cyst to vascular and biliary structures. The cyst may be resected on the back table with a successful treatment outcome.Öğe Living donor liver transplantation for Budd–Chiari syndrome(Medicine, 2016) Ara, Cengiz; Akbulut, Ahmet Sami; İnce, Volkan; Karakaş, Serdar; Başkıran, Adil; Yılmaz, SezaiBackground: The aim of the study was to report the detailed surgical techniques of living donor liver transplantation (LDLT) in patients with Budd–Chiari syndrome (BCS). Methods:Demographic and surgical techniques characteristics of 39 patients with BCS who underwent LDLT were retrospectively reviewed. Thirty-two of them had native vena cava inferior (VCI) preservation and 6 had retrohepatic VCI resection with venous continuity established by cryopreserved VCI (n=4) or aortic graft (n=2). In 1 patient, the anastomosis was established between the graft hepatic vein (HV) and the suprahepatic VCI. For preservation of the native VCI, immediately before the graft implantation, the thickened anterior, and right/left lateral walls of the recipient VCI were resected caudally and cranially until the intact vein wall was reached, and then an anastomosis was created between the (HV) of the graft reconstructed as a circumferential fence and the reconstructed recipient VCI. For resection of the retrohepatic VCI, the anastomosis was created with the same technique in all 6 patients in whom VCI was reformed by using a vascular graft. Results: Post-LT complications developed in 19 of the patients. Complications related to the biliary anastomosis accounted for 12 of these cases, with 11 treated by PTC and/or ERCP, and 1 by hepaticojejunostomy. Two of the 39 patients developed recurrent BCS and were treated by interventional radiological methods. Thirteen patients died and none were related to the BCS recurrence. Conclusion: Favorable outcomes are achievable with LDLT treatment of patients with BCS, which carries important implications for countries with inadequate cadaveric donor pools. Abbreviations: BCS = Budd–Chiari Syndrome, DDLT = deceased donor liver transplantation, ERCP = endoscopic retrograde cholangiopancreatography, HV = hepatic vein, INR = International Normalized Ratio, IRHV = inferior right hepatic vein, JLTS = Japanese Liver Transplantation Society, LDLT = living donor liver transplantation, LT = liver transplantation, PTFE = polytetrafluoroethylene, VCI = vena cava inferior.Öğe Living donor liver transplantation for Budd–Chiari syndrome(Medicine, 95(43), 5136–0., 2016) Ara, Cengiz; Akbulut, Ahmet Sami; İnce, Volkan; Karakaş, Serdar; Başkıran, Adil; Yılmaz, Sezai; Karakaş, SerdarAbstract Background: The aim of the study was to report the detailed surgical techniques of living donor liver transplantation (LDLT) in patients with Budd–Chiari syndrome (BCS). Methods:Demographic and surgical techniques characteristics of 39 patients with BCS who underwent LDLT were retrospectively reviewed. Thirty-two of them had native vena cava inferior (VCI) preservation and 6 had retrohepatic VCI resection with venous continuity established by cryopreserved VCI (n=4) or aortic graft (n=2). In 1 patient, the anastomosis was established between the graft hepatic vein (HV) and the suprahepatic VCI. For preservation of the native VCI, immediately before the graft implantation, the thickened anterior, and right/left lateral walls of the recipient VCI were resected caudally and cranially until the intact vein wall was reached, and then an anastomosis was created between the (HV) of the graft reconstructed as a circumferential fence and the reconstructed recipient VCI. For resection of the retrohepatic VCI, the anastomosis was created with the same technique in all 6 patients in whom VCI was reformed by using a vascular graft. Results: Post-LT complications developed in 19 of the patients. Complications related to the biliary anastomosis accounted for 12 of these cases, with 11 treated by PTC and/or ERCP, and 1 by hepaticojejunostomy. Two of the 39 patients developed recurrent BCS and were treated by interventional radiological methods. Thirteen patients died and none were related to the BCS recurrence. Conclusion: Favorable outcomes are achievable with LDLT treatment of patients with BCS, which carries important implications for countries with inadequate cadaveric donor pools. Abbreviations: BCS = Budd–Chiari Syndrome, DDLT = deceased donor liver transplantation, ERCP = endoscopic retrograde cholangiopancreatography, HV = hepatic vein, INR = International Normalized Ratio, IRHV = inferior right hepatic vein, JLTS = Japanese Liver Transplantation Society, LDLT = living donor liver transplantation, LT = liver transplantation, PTFE = polytetrafluoroethylene, VCI = vena cava inferior. Keywords: anastomosis technique, Budd–Chiari syndrome, liver transplantation, living donor liver transplantation, technical difficultiesÖğe MACHINE LEARNING-BASED CLASSIFICATION OF HBV AND HCV-RELATED HEPATOCELLULAR CARCINOMA USING GENOMIC BIOMARKERS(2022) Akbulut, Ahmet Sami; Tunç, Zeynep; Çolak, CemilObjective: It is crucial to know the underlying causes of hepatocellular carcinoma (HCC) for optimal management. This study aims to classify open access gene expression data of HCC patients who have an HBV or HCV infection using the XGboost method. Material and Methods: This case-control study considered the open-access gene expression data of patients with HBV-related HCC and HCV-related HCC. For this purpose, data from 17 patients with HBV+HCC and 17 patients with HCV+HCC were included. XGboost was constructed for the classification via tenfold cross-validation. Accuracy, balanced accuracy, sensitivity, specificity, the positive predictive value, the negative predictive value, and F1 score performance metrics were evaluated for a model performance. Results: With the feature selection approach, 17 genes were chosen, and modeling was done using these input variables. Accuracy, balanced accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and the F1 score obtained from the XGboost model were 97.1%, 97.1%, 94.1%, 100%, 100%, 94.4%, and 97%, respectively. Based on the variable importance findings from the XGboost, the ALDOC, GLUD2, TRAPPC10, FLJ12998, RPL39, KDELR2, and KIAA0446 genes can be employed as potential biomarkers for HBV-related HCC. Conclusion: As a result of the study, two different etiological factors (HBV and HCV) causing HCC were classified using a machine learning-based prediction approach, and genes that could be biomarkers for HBV-related HCC were identified. After the resulting genes have been clinically validated in subsequent research, therapeutic procedures based on these genes can be established and their utility in clinical practice documented.Öğe Postoperative pulmonary complications after liver transplantation assessment of risk factors for mortality(Transplantation Proceedings, 2015) Aydın, Cemalettin; Otan, Emrah; Akbulut, Ahmet Sami; Otan, Emrah; Akbulut, Ahmet Sami; Karakaş, Serdar; Kayaalp, Cüneyt; Karagül, Servet; Çolak, Cemil; Yılmaz, SezaiBackground. The aim of this study was to identify the risk factors related to mortality in liver transplant (LT) patients with post-transplantation pulmonary complications. Method. Patients who underwent liver transplantation in our clinic between January 2010 and January 2012 were retrospectively reviewed for post-transplantation pulmonary complications. Demographic, clinical, radiologic, and postoperative chart data of 153 patients with pulmonary complications were analyzed using an independent samples Student t test, Pearson’s c2 test, Fisher’s exact test, and Yate’s corrected c2 test. Mortality was analyzed using a multiple logistic regression model. The best-fit breakpoint resulting in a cut-off value for the variables of interest was determined using ROC curves and the Youden index. Results. The 153 patients with pulmonary complication were divided into 2 groups: mortality (n ¼ 53) and survival (n ¼ 100). Univariate analyses showed significant differences between these 2 groups with respect to MELD score (P ¼ .035), duration of mechanical ventilation (P > .001), pneumonia (P ¼ .01), and endotracheal culture results (P ¼ .001). In the multivariate analysis, hemoglobin (P ¼ .03, odds ratio [OR]: 1.239), MELD score (P ¼ .027, OR: 1.064), duration of mechanical ventilation (P ¼ .003, OR: 1.091), and age (P ¼ .042, OR: 1.001) were significant risk factors for mortality. The best-fit breakpoint analysis yielded cut-off values for hemoglobin (>11.2, sensitivity: 50.9%, specificity: 70%), MELD score (>16, sensitivity: 73.6%, specificity: 42%) and duration of mechanical ventilation (>3, sensitivity: 62.3%, specificity: 76%). Conclusion. Advanced age, high hemoglobin level, high MELD score, and long-term mechanical ventilation are significant risk factors for mortality in liver transplant patients with postoperative pulmonary complications.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 MastitisÖğe Relationship between COVID-19 and Community Mobility: Sample from Malatya Province(2022) Yılancı, Veli; Akbulut, Ahmet Sami; , Ali; İşlek, Hüseyin; Zeren, Fatma; Bentli, RecepAfter the WHO defined the COVID-19 as a pandemic on March 11, 2020, measures such as wearing masks, keeping social distance, and staying at home were taken to reduce transmission worldwide. Community mobility is one of the important factors contributing to the uncontrolled spread of the epidemic. The aim of the study is to examine the relationship between the number of COVID-19 cases in the first half of 2021 in Türkiye's Malatya province and Google community mobility reports. The number of COVID-19 cases in Malatya between 01 January 2021 and 31 May 2021 was obtained from the Malatya Provincial Health Directorate. Community mobility data in the relevant period was obtained from Google community mobility. To examine the relationship between the number of COVID-19 cases and community mobility, wavelet coherence analysis was used. The Google mobility data used in the study consists of six different categories covering markets and pharmacies, parks, residential, retail, and recreational areas, public transport stops and workplaces. According to the results of wavelet coherence analysis, the increase in mobility in markets and pharmacies, retail and recreation areas, parks, workplaces, and transportation stations has increased the number of COVID-19 cases. The direction of the relationship between COVID-19 and residential mobility was found to be negative. In other words, the increase in the time spent in residences leads to a decrease in the number of COVID-19 cases. According to the results of wavelet coherence analysis, it was observed that in five of the six categories included in the study, there was a significant relationship between the number of cases and these categories, for the period examined at various frequencies. Depending on the degree of interactions at short- and long-term frequencies covered in the study, policy makers can determine short- and long-term policies to direct human mobility and thereby control the pandemic.Öğe Spatial clustering and hot spot analysis of the COVID-19 pandemic in Malatya province(2022) Zeren, Fatma; Akbulut, Ahmet Sami; , Ali; İşlek, Hüseyin; Bentli, Recep; Mentese, Emin YahyaIt was revealed that what caused the disease that emerged with respiratory symptoms (fever, cough, shortness of breath) towards the end of 2019 in Wuhan city of China's Hubei province, and later named as COVID-19 by WHO was SARS-CoV-2 virus. The COVID-19 epidemic affected Turkey very quickly as it did the entire world, and the first official case in Turkey was detected in March 2020. In this study, how the COVID-19 cases are clustered in the districts of Malatya and the structure of this clustering as well as whether the cluster has changed over time was revealed by using the spatial exploratory analysis approach. For this purpose, Global and Local Moran I statistics that measure spatial interaction were used. For the hot spot analysis, Getis-Ord’s Gi* statistic was used. Moran I, which measures the spread of COVID-19 among districts, is statistically significant, and the spread effect is close to medium, although not very strong. It has been determined that Yazıhan and Akçadağ districts are the riskiest districts on average as of the period under consideration according to Lokal Moran I statistics. According to the Getis-Ord’s Gi* statistics, Yazıhan district is the one that is most suitable for the spread of the epidemic for Malatya, again being a hot spot location. It has been observed that Yazıhan district is frequently in the hot spot according to the monthly analysis of the Gi*statistics. In this context, it is important for Yazıhan district to increase the necessary measures in the coming periods and to make efforts to raise awareness of the citizens.Öğe Unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis(World Journal of Gastroenterology, 2013) Yılmaz, Mehmet; Akbulut, Ahmet Sami; Kutlutürk, Koray; Şahin, Nurhan; Arabacı, Ebru; Ara, Cengiz; Yılmaz, SezaiTo investigate the prevalence and implications of unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis. METHODS: The demographic and histopathological data of 1621 patients (≥ 16 years-old) who underwent appendectomy to treat an initial diagnosis of acute appendicitis between January 1999 and November 2011 were retrospectively assessed. Microscopic findings were used to classify the patients under six categories: appendix vermiformis, phlegmonous appendicitis, gangrenous appendicitis, perforated appendicitis, supurative appendicitis, and unusual histopathologic findings. The demographic and clinicopathologic characteristics of patients with unusual histopathologic findings were evaluated in detail, and re-analysis of archived resected appendix specimens was carried out. RESULTS: A total of 912 males and 709 females, from16 to 94 years old, were included in the study and comprised 789 cases of suppurative appendicitis, 370 cases of appendix vermiformis, 243 cases of perforated gangrenous appendicitis, 53 cases of flegmaneous appendicitis, 32 cases of gangrenous appendicitis, and 134 (8.3%) cases of unusual histopathological findings. The unusual histopathological findings included fibrous obliteration (n = 62), enterobius vermicularis (n = 31), eosinophilic infiltration (n = 10), mucinous cystadenoma (n = 8), carcinoid tumor (n = 6), granulomatous inflammation (n = 5), adenocarcinoma (n = 4; one of them mucinous), and mucocele (n = 3), adenomatous polyp (n = 1), taenia sup (n = 1), ascaris lumbricoides (n = 1), appendiceal diverticula (n = 1), and B cell nonhodgkin lymphoma (n = 1). None of the 11 patients with subsequent diagnosis of tumor were suspected of cancer prior to the appendectomy. CONCLUSION: Even when the macroscopic appearance of appendectomy specimens is normal, histopathological assessment will allow early diagnosis of many unusual diseases.Öğe Unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis(World Journal of Gastroenterology, 19(25), 4015–0., 2013) Yılmaz, Mehmet; Akbulut, Ahmet Sami; Kutlutürk, Koray; Şahin, Nurhan; Arabacı, Ebru; Ara, Cengiz; Yılmaz, SezaiAIM: To investigate the prevalence and implications of unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis. METHODS: The demographic and histopathological data of 1621 patients (≥ 16 years-old) who underwent appendectomy to treat an initial diagnosis of acute appendicitis between January 1999 and November 2011 were retrospectively assessed. Microscopic findings were used to classify the patients under six categories: appendix vermiformis, phlegmonous appendicitis, gangrenous appendicitis, perforated appendicitis, supurative appendicitis, and unusual histopathologic findings. The demographic and clinicopathologic characteristics of patients with unusual histopathologic findings were evaluated in detail, and re-analysis of archived resected appendix specimens was carried out. RESULTS: A total of 912 males and 709 females, from 16 to 94 years old, were included in the study and comprised 789 cases of suppurative appendicitis, 370 cases of appendix vermiformis, 243 cases of perforated gangrenous appendicitis, 53 cases of flegmaneous appendicitis, 32 cases of gangrenous appendicitis, and 134 (8.3%) cases of unusual histopathological findings. The unusual histopathological findings included fibrous obliteration (n = 62), enterobius vermicularis (n = 31), eosinophilic infiltration (n = 10), mucinous cystadenoma (n = 8), carcinoid tumor (n = 6), granulomatous inflammation (n = 5), adenocarcinoma (n = 4; one of them mucinous), and mucocele (n = 3), adenomatous polyp (n = 1), taenia sup (n = 1), ascaris lumbricoides (n = 1), appendiceal diverticula (n = 1), and B cell non-hodgkin lymphoma (n = 1). None of the 11 patients with subsequent diagnosis of tumor were suspected of cancer prior to the appendectomy. CONCLUSION: Even when the macroscopic appearance of appendectomy specimens is normal, histopathological assessment will allow early diagnosis of many unusual diseases.
