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Acute Pancreatitis: A Rare but Serious Complication for Living Liver Donors; Risk Factors and Outcomes
(Baskent Univ, 2022) Baskiran, Adil; Kement, Metin; Barut, Bora; Ozsay, Oguzhan; Karakas, Serdar; Koc, Cemalettin; Yilmaz, Sezai
Objectives: The purposes of this study were to determine the incidence of acute pancreatitis after living donor hepatectomy and to investigate potential risk factors and outcomes. Materials and Methods: Clinical data of all donors who underwent donor hepatectomy between January 2015 and December 2016 in our liver transplant institute were reviewed. Donor data were obtained from a prospectively maintained database. The donors were divided into 2 groups according to whether they developed postoperative pancreatitis. The following data were compared between the 2 groups: demo graphic information (age, sex), body mass index, type of hepatectomy (right, left, or left lateral), intraoperative cholangiographic findings, operative time, blood loss, graft data (graft weight, remnant liver ratio), duration of postoperative hospital stay, and postoperative morbidity and mortality (if any). Pancreatitis severity and treatment outcomes were also examined in patients with postoperative pancreatitis. Results: Our study included 348 donors who underwent donor hepatectomy for living-donor liver transplant. Postoperative pancreatitis developed in 6 donors (1.7%). We found no statistical differences between patients with and without postoperative pancreatitis in terms of demographic and intraoperative findings. Neither loco-regional nor systemic complications of pancreatitis developed in any of the patients. Therefore, all were classified as having mild pancreatitis according to revised Atlanta classification. The mean APACHE II score was 5.2 +/- 1.2 points (range, 4-7 points). All patients with postoperative pancreatitis received conservative-supportive treatment. Conclusions: Although postoperative pancreatitis is a rarely reported complication in living liver donors, it should always be considered, especially in patients who unpredictably deteriorate in the postoperative period. Proper recognition and timely treatment can help avoid serious consequences.
Aim: In the present study, we aimed to compare Dexmedetomidine-Remifentanil and Propofol-Remifentanil combinations in terms of postoperative cognitive functions in hysteroscopy attempts. Material and Methods: A total of 70 ASA I-II patients who were aged between 18 and 65 years were included in the study following the ethics committee approval. The patients were randomized into two groups (n=35), and standard routine monitoring were applied to them. The sedation depth was evaluated with Ramsey Sedation Score (RSS) before and after the sedation; and cognitive functions of the groups were evaluated with the Minimal Mental State Test (MMST). Propofol 1 mg/kg bolus 25-100 µg/kg/min infusion was administered to Group PR, and Dexmedetomidine 1 µg/kg bolus 0.4-0.7 µg/ kg/h infusion dose was administered to Group DR. Remifentanil 0.25 µg/kg bolus 0.04 µg /kg/min infusion was administered to the groups, and the groups were followed to ensure RSS≥4. Result: In cognitive functions, it was observed that there was significant regression in Group PR in postoperative period compared to the preoperative period (p<0.05). The hemodynamic parameters were lower in Group DR than in Group PR at 5th, 10th and 15th minutes following the hysteroscopy (p<0.05). The Modified Aldrete Score in Group DR were high, and pain scores were lower (p<0.05). Satisfaction with the surgeon, patient and anesthetist scores were higher in Group DR. No respiratory depression was observed (p<0.05). Conclusion: We believe that administering Dexmedetomidine-Remifentanil combination in sedation in hysteroscopy ensures better postoperative cognitive function, recovery conditions, analgesia, and patient and surgeon satisfaction compared to the PropofolRemifentanil combination.
(2019) Gonultas, Fatih; Kutluturk, Koray; Barut, Bora; Dalda, Yasin; Alan, Saadet; Unal, Bulent
Aim: To compare thyroid fine-needle aspiration biopsy with histopathological examination results. Material and Methods: Postoperative histopathological examination results of 361 patients, who were thyroidectomized between December 2010 and October 2017 in Inonu University Turgut Ozal Medical Center Department of General Surgery and whose preoperative FNAB registries we could reach were evaluated retrospectively. Biopsies made in external centers were included in preoperative FNAB results. FNAB results were examined according to Bethesda 2007 in 6 categories: unsatisfactory, benign, atypia of undetermined significance, follicular lesion-neoplasm or suspicious for a neoplasm, suspicious for malignancy and malignant. Histopathological results of patients with incidental malignancy were presumed benign. Results: Among the 361 patients that were included in the study, 274 were female (75.9%), 87 were male(24.1%). Mean age of the patients in the benign group was 49.1±12.5 years, and 48.6±13.5 years in the malignant group. It was found that FNAB’s sensitivity was 83.9 %, specificity was 92.4%, false positive rate was 16.1% and false negative rate was 7.6%. Conclusion: FNAB is reported as the gold standard for preoperative evaluation of thyroid nodules. In our study, however, it was seen that FNAB was not adequate alone to detect malignancy. This situation suggests the importance of collaboration between radiologist, cytopathologist and clinician.
AKRABA YAŞLI CANLI DONÖRLERDEN YAPILAN BÖBREK NAKİLLERİ
(2014) Pişkin, Turgut; Barut, Bora; Usta, Sertaç; Gönültaş, Fatih; Kayabaş, Üner
Öz: AMAÇ: Son dönem böbrek hastalığının en iyi tedavi yöntemi böbrek nakli yapılmasıdır. Organ kısıtlılığı nedeni ile yaşlı donörlerin kullanımı giderek artmaktadır. Bizde Kasım 2010 ile Aralık 2013 tarihleri arsaında yaşı >= 60 olan canlı donörlerden 15 böbrek nakli yaptık. Bu çalışmamızda da bu 15 böbrek nakli ile ilgili deneyimlerimizi ve sonuçlarımızı paylaşmak istedik.GEREÇ VE YÖNTEMLER: Biz merkezimizde Kasım 2010 ile Aralık 2013 tarihleri arasında 98 böbrek nakli yaptık. Bunların 15'ini yaşı >= 60 olan canlı akraba donörlerden alıcılara naklettik. Bu 15 donör ve bunların alıcılarının verileri geriye doğru toparlanıp incelendi. BULGULAR: Donörlerin ve alıcılarını sırası ile yaş ortalamaları 64, 3 ve 40.1 idi. Alıcılar için ortalama takip süresi 18.8 aydı. Bu sürede graft sağkalımı %100'dü. Ancak bir alıcımız nakil sonrası dördüncü ayında intrakranial kanama nedeni ile foksiyone greftle kaybedildi. İnfeksiyon, teknik nedenler, tekrarlayan hastalık yada rejeksiyon nedeni ile börek kaybedilmedi. Donörlerimizde hayatlarını herhangi bir problem olmaksızın saglıklı bir şekilde sürdürmektedirler.SONUÇ: Yaşlı donörler ideal donörler değildir. Ancak alıcıların başka bir donörü yoksa yaşlı donörlerden nakil yapmak bu hastalar icin bir seçenek olmaktadır.
Analysis of risk factors of mortality in abdominal trauma
(2020) Gönültaş, Fatih; Kutlutürk, Koray; Gök, Ali Fuat Kaan; Barut, Bora; Şahin, Tevfik Tolga; Yılmaz, Sezai
Abstract: 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.
Association of signal transducer and activator of transcription, interleukin-6, and interleukin-10 positivity with antiviral treatment in cirrhotic liver samples from patients with the hepatitis B or C virus
(2018) Kırımlıoğlu, Vedat; Karıncaoğlu, Melih; Barut, Bora; Dirican, Abuzer; Kayaalp, Cüneyt; Gözeneli, Orhan; Yılmaz, Sezai; Kırımoğlu, Saime Hale; Tatlı, Faik
Abstract: Objective: Terminal liver disease due to viral hepatitis infections is an important health problem. This study aimed to compare the expression of members of the signal transducer and activator of transcription (STAT) family (STAT-1, -2, -3, -5a, and -5b) and interleukin (IL)-6 and IL-10 in hepatectomy material from patients who received antiviral treatment and underwent a liver transplantation due to terminal liver failure. Methods: The study consisted of 45 patients who underwent a liver transplantation due to chronic liver failure associated with viral hepatitis (hepatitis C virus [HCV] or hepatitis B virus [HBV]). The patients were divided into three groups according to the drug treatments they received prior to the liver transplantation: Group A: lamivudine, Group B: adefovir, and Group C: interferon or interferon + ribavirin. Results: In the study population, 9 (20%) patients were females and 36 (80%) were males. The mean age was 45.7 (29–69) years. STAT-2, -3, and IL-6 expression were significantly higher in hepatocytes in Group A (p<0.05). Conclusion: High STAT-3, high IL-6, and low STAT-1 expression were associated with optimum hepatocyte regeneration and liver metabolic function. In this regard, lamivudine was the most effective drug in the present study
Aynı ailede iki primer kas içi kist hidatik olgusu
(Dicle Tıp Dergisi, 2011) Dirican, Abuzer; Sümer, Fatih; Ünal, Bülent; Barut, Bora; Işık, Burak; Yılmaz, Sezai
Öz: Otuz dokuz yaşındaki bayan hasta sol lumbar şişlik ve ağrı şikayetleri ile polikliniğe başvurdu. Hastanın aile öyküsünde 19 yaşındaki kızının sol gastrokinemius kasında primer kist hidatik sebebiyle bir yıl önce ameliyat olduğu öğrenildi. Hastanın fizik muayenesinde sol lomber bölgede derin palpasyonla ele gelen düzgün sınırlı 6x5 cm boyutlarında ağrılı kitle palpe edildi. Hastanın ecchinococcus granulosus indirekt hemaglutinasyon testi pozitifti. Radyolojik incelemelerde, lezyonun kist hidatikle uyumlu olduğu rapor edildi. Hastanın geçirilmiş kist hidatik öyküsü yoktu. Hastaya spinal anestezi altında parsiyel kistektomi ve drenaj uygulandı. Kistektomi materyali, asellüler lameller tabaka (kist hidatik) olarak rapor edildi. Postoperatif komplikasyon olmadı. Operasyon sonrası hastaya 15 mg/kg/gün Albendazol tedavisi 3 ay süreyle verildi. Hastanın 6 aylık izleminde kist hidatit nüksüne rastlanmadı. Kist hidatiğin endemik olduğu bölgelerde kas içi yerleşimli kistik kitlelerin ayırıcı tanısında kist hidatit de hatırlanmalıdır. Ailede geçirilmiş kist hidatit öyküsünün olması yol gösterici olabilir. Tedavide kist total çıkarılamıyorsa, parsiyel kistektomi ve drenaj kas içi kist hidatiğin cerrahi tedavisinde seçilebilir.
Başlangıçta negatif bulgulu veya palpe edilemeyen benign meme lezyonlu kadınlarda yaş gruplarına göre takip protokolu: mamografik ve ultrasonografik bi-rads değerlendirmesi ve ultrasonografi eşliğinde ince iğne aspirasyon biyopsisi
(Meme Sağlığı Dergisi, 2007) Doğan, Reşat; Söğütlü, Gökhan; Kutlu, Ramazan; Gürses, İclal; Çakır, İsmail; Barut, Bora; Deniz, Sümer
Öz: AMAÇ: Benign karakterli nonpalpabl meme lezyonlarının ve başlangıçta negatif mamografik ve/veya ultrasonografik (US) bulgularla karakterize olguların zaman içerisindeki doğal seyrini ve optimal takip protokollerini, US ve/veya mamografi ile değerlendirerek ortaya koymak. GEREÇ VE YÖNTEM: 1998-2004 yılları arasında, belirli bir zaman periyodunda, kliniğimizce takip edilen 167 hasta bu çalışmanın materyalini oluşturdu. Ortalama yaş 44.8 ± 9.3 idi. İlk başvuruda hastalar fizik muayene, diagnostik mamografi (35 yaş üzeri) ve US (tüm hastalar) ile değerlendirildiler. İlk başvuruda ve takipte toplam 66 hastaya (%39.5) biyopsi uygulandı. Hastalar, mamografik ve/veya utrasonografik olarak BI-RADS (Breast imaging reporting and data system)’a göre sınıflandırılarak belirli bir izlem protokolüne tabi tutuldular. BULGULAR: İlk başvuruda kitle saptanan %25.2 olgunun son değerlendirmede %22’sinin kitlelerinin rezolve olduğu, %65’inin değişmeden kaldığı ve %13 oranında ise boyutlarında artış olduğu gözlendi. İlk başvuruda, benign kalsifikasyon saptanan olguların (%10.8) %91.6’sında kalsifikasyonlarında bir değişiklik gözlenmedi. %0.6’sında kalsifikasyonlar yok oldu. İlk başvurudan sonra, BI-RADS progresyonunu, pozitif aile hikayesi,menopoz, oral kontraseptif ve hormon replasman tedavisinin istatistiksel olarak etkilemediği gözlendi. BI-RADS 2 (n=58) ve 3 (n=6) grubunda uygulanan, US eşliğinde ince iğne aspirasyon biyopsilerinin %100’ünde benign bulgular saptandı. SONUÇLAR: Negatif veya nonpalpabl benign mamografik ve/veya ultrasonografik bulgular içeren hastaların çoğunluğunda takipte aynı bulgular devam etmektedir. Bu anlamda, mamografik ve/veya ultrasonografik bulgular BI-RADS‘a göre değerlendirilerek, başlangıçta benign bulgulara sahip hastaların, rutin takiplerinin (biyopsi yapılmaksızın) güvenilir bir yol olduğu ortaya çıkmaktadır. Bununla birlikte, olguların yaklaşık yarısı herhangi bir takip süresinde biyopsiye maruz kalmaktadırlar. Bu açıdan da, US eşliğinde ince iğne biyopsisinin güvenilir olduğu düşüncesindeyiz.
Carcinoid tumors of appendix presenting as acute appendicitis
(2019) Barut, Bora; Gönültaş, Fatih
Abstract: BACKGROUND: We aim to present the data of patients who underwent appendectomy due to acute appendicitis, and incidental carcinoid tumor was detected on pathology. METHODS: Retrospective analysis of the patient charts between January 1999 and September 2018 were performed. RESULTS: 2778 appendectomy was performed due to acute appendicitis. Appendiceal carcinoid tumor was detected in 12 (0.43%) patients. Eight patients were (66.7%) female. Median age 37.5 years (range: 21–60). The median tumor size was 0.7 cm (range: 0.1–2.5). No perforation was detected. Eleven patients underwent appendectomy, and one patient had right hemicolectomy. The median followup period was 41.5 months (range: 22–49). There were no recurrences. CONCLUSION: Appendix carcinoid tumors are quite rare, usually asymptomatic and diagnosed incidentally on histopathological examination after appendectomy. The treatment of carcinoid tumors of the appendix is directly related to the tumor size, localization, presence of lymphovascular and mesoappendix invasion, mitotic activation rate and level of Ki67. Thus, it is important to follow the histopathological results after appendectomy. The prognosis of appendix carcinoid tumors is very good if the appendix is non-perforated.
Co-existence of idiopathic cecal ulcer and incidental appendix carcinoid tumor
(Aves, 2016) Ince, Volkan; Barut, Bora; Karakas, Serdar
Idiopathic cecal ulcer or solitary cecal ulcer is a rare entity that can only be diagnosed by histopathological evaluation. Generally, it is diagnosed by histolopathological evaluation of biopsy specimens obtained by colonoscopy that is performed for lower gastrointestinal bleeding. It can also be diagnosed after surgical resection performed for acute abdomen or cecal mass mimicking malignancy. Cecal carcinoid tumor is a rare cause of this condition; however, coexistence of cecal ulcer and appendix carcinoid tumor has not been previously reported. In this case, we present a 73-year-old woman who clinically presented as acute appendicitis with cecal wall thickening, underwent right hemicolectomy and was subsequently diagnosed with cecal ulcer, serosal abscess and coexisting appendix carcinoid tumor.
Cytomegalovirus associated severe pneumonia in three liver transplant recipients
(J Infection Developing Countries, 2020) Kose, Adem; Yalcinsoy, Murat; Samdanci, Emine Turkmen; Barut, Bora; Otlu, Baris; Yilmaz, Sezai; Bayindir, Yasar
Introduction: Cytomegalovirus (CMV), is the most common opportunistic infection, remains a cause of life-threatening disease and allograft rejection in liver transplant (LT) recipients. The purpose of this case series is to state that CMV may lead to severe pneumonia along with other bacteria. Methodology: CMV pneumonia was diagnosed with the thoracic computed tomography (CT) scan findings, bronchoscopic biopsy, real time quantitative Polymerase Chain Reaction (qPCR) and clinical symptoms. For extraction of CMV DNA from the clinical sample, EZ1 Virus Mini Kit v2.0 (Qiagen, Germany) was used, and aplification was performed with CMV QS-RGQ Kit (Qiagen, Germany) on Rotor Gene Q 5 Plex HMR (Qiagen, Germany) device. Results: All recipients had severe pneumonia, leukopenia, thrombocytopenia and at least two-fold increase in transaminases on seventh, twenty-eighth and twenty-second days after surgery, respectively. Thoracic CT scan revealed as diffuse interstitial infiltration in the lung parenchyma. Bronchoscopy, Gram-staining and culture from bronchoalveolar lavage (BAL) fluid were performed in all of them. During bronchoscopy, a bronchial biopsy was administered to two recipients. One recipient could not be performed procedure because of deep thrombocytopenia. PCR results were positive from serum and BAL fluid. Bronchial biopsy was compatible with CMV pneumonia. However, Pseudomonas aeruginosae was found in two cases and Klebsiella pneumoniae in one case BAL fluid cultures. Conclusions: CMV pneumonia can be seen simultaneously with bacterial agents due to the indirect effects of the CMV. It should be kept in mind that CMV pneumonia may cause severe clinical courses and can be mortal.
Deceased donor liver transplantation from donors with central nervous system malignancy: Experience of the Inonu University
(Kare Publ, 2017) Ince, Volkan; Ersan, Veysel; Ozdemir, Fatih; Barut, Bora; Koc, Cemalettin; Isik, Burak; Kayaalp, Cuneyt
OBJECTIVE: Liver transplantation from deceased donors with a central nervous system (CNS) malignancy has some risk of tumor transmission to the recipient. Though the risk is small, this group of donors is regarded as marginal. The use of marginal grafts may be an acceptable alternative practice in order to expand the donor pool in countries where there is a shortage of donated organs. The aim of this study was to examine and present the outcomes of liver transplantations performed using donors with a CNS tumor. METHODS: Between March 2002 and July 2017, 1990 (deceased donor: n=399, 20%; living donor: n=1591, 80%) liver transplantations were performed at the center. Of the 399 deceased donors, 17 (4.2%) had a CNS tumor. The data of donors with a CNS tumor and of recipients who survived for more than 1 month (n=11) were retrospectively reviewed. Demographic data, the grade of the CNS tumor, tumor transmission to recipient data, and survival rates were analyzed. RESULTS: Only 2 (18%) grafts were provided locally, 6 (54%) were offered to the transplantation center after all of the national centers had declined them, and 3 (37%) were made available to us by the national coordination center for patients with a documented notification of urgency. High-grade (grade III-IV) brain tumors were detected in 7 (64%) donors, while low-grade (grade I-II) tumors were found in 2 patients. The remaining 2 donors were not pathologically graded because the diagnosis was made radiologically. The 1-, 3-, and 5-year overall and tumor-free survival of the patients was estimated at 100%, 70%, and 45%, respectively. CONCLUSION: A median survival of 40 months (range: 13-62 months) was achieved in recipients of grafts from a donor with a CNS tumor and no donor-related malignant transformation was observed.
Determination of risk factors affecting mortality in patients with gastrointestinal perforation after pediatric liver transplantation
(Wiley, 2019) Barut, Bora; Akbulut, Sami; Kutluturk, Koray; Koc, Cemalettin; Ozgor, Dincer; Aydin, Cemalettin; Selimoglu, Ayse
Gastrointestinal perforation (GIP) is one of the most serious complications occurring after liver transplantation (LT), especially in pediatric patients. This study aimed to determine the risk factors affecting mortality in pediatric patients with GIP after LT. GIP developed in 37 (10%) of 370 pediatric patients who underwent LT at our institute. Patients were divided into two groups: alive (n = 22) or dead (n = 15), and both groups were compared in terms of demographic and clinical parameters using univariate analysis. There was no statistically significant difference between groups in either demographic or clinical parameters, except for perforation site (P = 0.001) and median follow-up (P = 0.001). Stomas arose in 17 (45.9%) patients: 76% of patients with stomas and 45% of those without survived (P = 0.052). Kaplan-Meier analysis indicated that patients with stomas had a significantly higher overall survival (P = 0.029) and that patients with duodenal and colonic perforation had a significantly lower overall survival. Multivariate analysis showed that re-perforation was an independent risk factor for mortality (P = 0.035; OR: 17.674; 95% CI for OR: 1.233-253.32). Although there are many options for management of GIP, including primary repair, resection plus anastomosis, and resection plus end or loop ostomy, gastrointestinal diversion is still the best option.
Diaphragmatic Hernia Following Donor Hepatectomy
(Lippincott Williams & Wilkins, 2016) Koc, Cemalettin; Ince, Volkan; Otan, Emrah; Ersan, Veysel; Barut, Bora; Baskiran, Adil; Ozdemir, Fatih
[Abstract Not Available]
Ectopic Balloon Device Placement to Correct the Positional Hepatic Venous Outflow Obstruction in Liver Transplantation
(Baskent Univ, 2020) Tolan, Huseyin Kerem; Barut, Bora; Kutluturk, Koray; Kayaalp, Cuneyt; Yilmaz, Sezai
Objectives: Hepatic vein outflow obstruction in liver transplantation can lead to graft or patient loss. We used an intrauterine balloon to overcome this complication in 13 liver transplant recipients. Here, we report the results of these cases; our report, as far as we know, involves the highest number of patients on this issue. Materials and Methods: Positional hepatic vein outflow obstruction was diagnosed in 13 of 651 liver transplant recipients between January 2014 and December 2016. The grafts were repositioned by intrauterine balloon placed to the right subdiaphragmatic area. Data of donors, recipients, and grafts and postoperative courses were analyzed. Results: Of the 13 patients, 9 were men, with age range of patients of 22 to 70 years. The amount of saline used to inflate the balloon was variable (200-450 cm(3)), and hepatic vein outflow obstruction was relieved after balloon implantation in all patients. There were no balloon-related complications. Removal was done at bedside, without any additional sedation or any additional skin incision on days 2 to 15. Doppler ultrasonography scans were performed before and after the balloon removal. There were no vascular complications after removal. Conclusions: Intrauterine balloon can be safely and efficiently used for hepatic vein outflow obstruction during liver transplant when needed.
Effect of Pre-Transplant Covid-19 Exposure on Post-Liver Transplant Clinical Outcomes
(Elsevier Science Inc, 2023) Akbulut, Sami; Barut, Bora; Garzali, Ibrahim Umar; Sarici, Kemal Baris; Tamer, Murat; Unsal, Selver; Karabulut, Ertugrul
Background. COVID-19 has led to an unprecedented global health crisis. This situation caused an immediate reduction in solid organ transplantation activity. This study aimed to present the follow-up results of patients with chronic liver disease who underwent liver transplantation (LT) after a history of COVID-19 infection. Methods. Sociodemographic characteristics and clinicopathological data of 474 patients who underwent LT at Inonu University Liver Transplant Institute between March 11, 2020 and March 17, 2022 were prospectively recorded and analyzed retrospectively. Among these, the data of 35 patients with chronic liver disease who were found to be exposed to COVID-19 infection in the pre-LT period were analyzed for this study. Results. The median body mass index, Child score, and Model for end-stage liver disease/ Pediatric end-stage liver disease scores of the 35 patients were calculated as 25.1 kg/m2 (IQR: 7.4), 9 points (IQR: 4), and 16 points (IQR: 10), respectively. Graft rejection occurred in 4 patients at a median of 25 days post-transplant. Five patients underwent retransplantation at a median of 25 days post-transplant. The most common cause of retransplantation is early hepatic artery thrombosis. There were 5 deaths during postoperative follow-up. Mortality developed in 5 (14.3%) patients exposed to COVID-19 infection in the pretransplant period, whereas mortality occurred in 56 (12.8%) patients not exposed to COVID-19 infection. There was no statistically significant difference in mortality between the groups (P = .79). Conclusions. The results of this study showed that exposure to COVID-19 before LT does not affect post-transplant patients and graft survival.
FOLLOW-UP PROTOCOL OF PATIENTS WITH NEGATIVE FINDINGS OR NON-PALPABL BENIGN BREAST LESIONS: MAMOGRAPHIC AND ULTRASONOGRAPHIC BI-RADS ASSESSMENT AND ULTRASONOGRAPHY GUIDED FINE NEEDLE ASPIRATION BIOPSY
(Aves, 2007) Dogan, Resat; Sogutlu, Gokhan; Kutlu, Ramazan; Grses, Iclal; Cakir, Ismail; Barut, Bora; Deniz, Sumer
BACKGROUND: The purpose of this investigation was to analyze the natural course and optimum follow-up protocols of benign characterized nonpalpable breast lesions or the cases with negative mammographic or ultrasonographic (US) findings initially by evaluating with US and/or mammography. MATERIALS AND METHODS: 167 patients those have been followed by our clinic between 1998-2004 were included in this study. The mean age was 44,8. The patients were evaluated by physical examination, diagnostic mammography (above 35 years old) and ultrasonography (all patients) in the fi rst admittance. Biopsy was applied to 66 patients (39.5%) totally. Patients were classifi ed according to breast imaging reporting and data system (BI-RADS) and a certain follow-up protocol was initiated. RESULTS: In the cases (10,8 %) in whom benign calcifations were detected in their fi rst admittance, no changes in the calcifations were observed in 91,6 %. In 0,6 %, calcifations disappeared. In 25,2 % of the cases in whom mass was detected initially; the masses resolved in 22 %, remained same in 65 % and increased in size in 13 % in the fi nal evaluation. After the fi rst admittance, it was seen that menopause, oral contraceptives and hormone replacement therapy didn't aff ect the BI_RADS progression statistically. Benign pathological fi ndings were obtained in 100 % of US guided fi ne needle aspiration biopsies (FNAB) applied to BI-RADS 2 (n=58) and 3 (n=6) groups. CONCLUSIONS: Although in the follow-ups of the most of the patients with benign nonpalpable breast lesions or with negative mammographic and/or ultrasonographic lesions, clinical fi ndings remain the same, nearly half of the patients are subjected to biopsy in any time of their follow-up period. We think US guided FNAB is safe and reliable. On the other hand, mammographic and ultrasonographic BI-RADS can be evaluated together in the routine follow-ups of the patients with negative or benign fi ndings without biopsy relaibly in this manner.
Graft-versus-host disease after living donor liver transplantation: an unpredictable troublesome complication for liver transplant centers
(Lippincott Williams & Wilkins, 2020) Gonultas, Fatih; Akbulut, Sami; Barut, Bora; Kutluturk, Koray; Yilmaz, Sezai
Objective The aim of this study was to report on graft-versus-host disease (GvHD) following living donor liver transplantation (LDLT). Methods Between May 2002 and January 2019, a total of 2387 LT procedures were performed in our Liver Transplantation Institute. Seven patients (0.29%) were admitted to our outpatient clinic with signs and symptoms compatible with GvHD following LT. Demographic, clinical and histopathological characteristics of patients with GvHD were retrospectively evaluated. Results There were six male and one female patient aged from 18 months to 67 years. Acute GvHD was detected in six patients and chronic GvHD in one. Grade II GvHD was detected in six patients, and Grade IV was detected in one patient. Time from LT to GVHD ranged from 4 to 657 days (median: 59 days). Time from beginning of clinical findings to histopathological diagnosis ranged from 2 to 160 days (median: 7 days). Initial clinical manifestations were as follows: skin rash + diarrhea (n = 2), skin rash (n = 2), skin rash + flushing (n = 1), diarrhea (n = 1), and skin rash + fever (n = 1). Despite intensive treatments, five out of seven patients (71.4%) died due to sepsis (n = 4) and gastrointestinal hemorrhage (n = 1). The remaining two patients are still alive without complications. Conclusion GvHD is a life-threatening complication despite aggressive treatment. To achieve success in GvHD, preventive measures, early diagnosis, early initiation of treatment, antimicrobial prophylaxis, and proper supportive care should be ensured.
Hepatic Venous Outflow Obstruction After Living-Donor Liver Transplant: Single Center Experience
(Baskent Univ, 2021) Koc, Suleyman; Akbulut, Sami; Soyer, Vural; Yilmaz, Mehmet; Barut, Bora; Kutlu, Ramazan; Yilmaz, Sezai
Objectives: In this study, we share our approach for care of patients with hepatic venous outlet obstruction after living-donor liver transplant. Materials and Methods: We retrospectively examined the demographic, clinical, and radiologic data of 35 patients who developed hepatic venous outlet obstruction after living-donor liver transplant. Patients were subgrouped on the basis of onset (8 patients with early onset [< 30 days post-transplant] and 27 patients with late onset [>= 30 days posttransplant]) and postoperative survival (24 survivors, 11 nonsurvivors). Results: Patients ranged in age from 1 to 61 years (24 adults and 11 children). All adult patients had undergone right lobe living-donor liver transplant. In the pediatric group, 8 had undergone left lateral segment and 3 had undergone left lobe living-donor liver transplant. Nineteen adult patients and all 11 pediatric patients underwent hepatic venous reconstruction, with all procedures based on common large-opening drainage models using various vascular graft materials. Development of hepatic venous outlet obstruction occurred at mean posttransplant day 233 +/- 298.5 in the adult patients and mean posttransplant day 139 +/- 97.8 in the pediatric patients. After development of obstruction, the patients underwent 1-6 sessions (1.5 +/- 1.1 sessions) of balloon angioplasty. After the first balloon angioplasty procedure, 25% of the adults and 36.3% of the pediatric patients developed recurrence. The early-onset and late-onset subgroups showed statistically significant differences in serum albumin (P=.01), underlying causes (P<.001), time from transplant to obstruction (P=.02), and time from transplant to last visit (P=.02). The survivor and nonsurvivor subgroups showed statistically significant differences in total bilirubin (P=.03) and time from transplant to last visit (P=.03). Conclusions: Common large-opening reconstruction minimizes hepatic venous outlet obstruction development after living-donor liver transplant. Balloon angioplasty and/or stenting is almost always the first option in the care of this complication.
İdiyopatik çekal ülser ve insidental apendiks karsinoid tümörü birlikteliği
(Ulusal Cerrahi Dergisi, 2016) İnce, Volkan; Barut, Bora; Karakaş, Serdar
Öz: İdiyopatik çekal ülser (İÇÜ) ya da soliter çekal ülser, oldukça nadir karşılaşılan ve kesin tanısı histopatolojik olarak konulan bir klinik durumdur. Çoğu zaman alt gastrointestinal sistem kanaması araştırılırken kolonoskopik biyopsi ile tanı konurken, nadir olarak da akut karın nedeniyle ya da çekumda kitle görüntüsüyle maligniteyi taklit etmesi nedeniyle cerrahi rezeksiyon sonrası tanı konur. Çekal karsinoid tümör, hastalığın nadir sebeplerinden biridir, ancak apendiks karsinoid tümör birlikteliği daha önce bildirilmemiştir. Bu çalışmada, akut apandisit kliniği ile başvuran ve çekumda duvar kalınlaşması saptanan 73 yaşındaki kadın hastaya sağ hemikolektomi yapılıp patoloji sonucu izole çekal ülser ve serozal apse ve eşlik eden apendiks karsinoid tümörü olan olgu sunulmaktadır. Başlık (İngilizce): Co-existence of idiopathic cecal ulcer and incidental appendix carcinoid tumor Öz (İngilizce): Idiopathic cecal ulcer or solitary cecal ulcer is a rare entity that can only be diagnosed by histopathological evaluation. Generally, it is diagnosed by histolopathological evaluation of biopsy specimens obtained by colonoscopy that is performed for lower gastrointestinal bleeding. It can also be diagnosed after surgical resection performed for acute abdomen or cecal mass mimicking malignancy. Cecal carcinoid tumor is a rare cause of this condition; however, coexistence of cecal ulcer and appendix carcinoid tumor has not been previously reported. In this case, we present a 73-year-old woman who clinically presented as acute appendicitis with cecal wall thickening, underwent right hemicolectomy and was subsequently diagnosed with cecal ulcer, serosal abscess and coexisting appendix carcinoid tumor.
İleal poş anal anastomoz sonrası ortaya çıkan dirençli pruritus ani nin intradermal metilen mavisi enjeksiyonu ile tedavisi
(Akademik Gastroenteroloji dergisi, 2006) Işık, Burak; Yılmaz, Sezai; Söğütlü, Gökhan; Barut, Bora; Kayaalp, Cüneyt; Yılmaz, Sezai
Complications regarding ileal pouch-anal anastomosis performed for ulcerative colitis and familial polyposis coli are frequently accompanied by pruritus ani. Local treatments, cautions targeting correction of hygiene and dietary modifications are usually insufficient. In this study, we aimed to present the treatment of three patients with resistant pruritus ani after ileal pouch-anal anastomosis, with intradermal methylene blue injection.

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