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    Analysis of magnetic resonance imaging findings of children with neurologic complications after liver transplantation
    (Springer-Verlag Italia Srl, 2017) Ozturk, Mehmet; Akdulum, Ismail; Dag, Nurullah; Sigirci, Ahmet; Gungor, Serdal; Yilmaz, Sezai
    Objective To analyze the magnetic resonance imaging findings in children diagnosed with neurologic complications after liver transplantation (LT). Materials and methods A total of 39 patients diagnosed with neurologic complications following LT between 2010 and 2016. Neuroradiologic imaging was performed using cranial magnetic resonance imaging (MRI). Descriptive statistics regarding age, gender, type of complication, diagnostic and therapeutic modalities were calculated and presented as number and percentage. Results Our series consisted of 18 girls and 21 boys. Cryptogenic hepatitis (n = 13, 32%), metabolic diseases (Wilson's disease, tyrosinemia and glycogen storage disease) (n = 7, 18%) and fulminant toxic hepatitis (n = 4, 11%) constitute the most frequent indications for LT. The indications for neuroradiological imaging were convulsion and alteration of mental status. Conclusion These central nervous system complications may present in a variable spectrum and convulsions and altered mental state were the most frequent clinical pictures. Imaging studies were normal in approximately one-third of cases; the most frequent pathologic findings were diffuse cerebral edema, atrophy, and PRES. Clinical history, careful examination and integrated analysis of radiologic data as well as close collaboration and multidisciplinary approach are of utmost importance for establishing the diagnosis rapidly and accurately.
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    Analysis of magnetic resonance imaging findings of children with neurologic complications after livertransplantation
    (Sprınger-verlag ıtalıa srl, vıa decembrıo, 28, mılan, 20137, ıtaly, 2017) Ozturk, Mehmet; Akdulum, Ismail; Dag, Nurullah; Sigirci, Ahmet; Gungor, Serdal; Yilmaz, Sezai
    Objective To analyze the magnetic resonance imaging findings in children diagnosed with neurologic complications after liver transplantation (LT). Materials and methods A total of 39 patients diagnosed with neurologic complications following LT between 2010 and 2016. Neuroradiologic imaging was performed using cranial magnetic resonance imaging (MRI). Descriptive statistics regarding age, gender, type of complication, diagnostic and therapeutic modalities were calculated and presented as number and percentage. Results Our series consisted of 18 girls and 21 boys. Cryptogenic hepatitis (n = 13, 32%), metabolic diseases (Wilson's disease, tyrosinemia and glycogen storage disease) (n = 7, 18%) and fulminant toxic hepatitis (n = 4, 11%) constitute the most frequent indications for LT. The indications for neuroradiological imaging were convulsion and alteration of mental status. Conclusion These central nervous system complications may present in a variable spectrum and convulsions and altered mental state were the most frequent clinical pictures. Imaging studies were normal in approximately one-third of cases; the most frequent pathologic findings were diffuse cerebral edema, atrophy, and PRES. Clinical history, careful examination and integrated analysis of radiologic data as well as close collaboration and multidisciplinary approach are of utmost importance for establishing the diagnosis rapidly and accurately.
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    Evaluation of Early and Late Complications of Pediatric Liver Transplantation with Multi-slice Computed Tomography: A High-Volume Transplant Single-Center Study
    (Aves, 2021) Ozturk, Mehmet; Dag, Nurullah; Sigirci, Ahmet; Yilmaz, Sezai
    Background: To present abdominal multi-slice computed tomography (MSCT) results following transplantation in pediatric patients with a liver transplantation (LT), and to create awareness of early (<3 months) and late (>3 months) complications that may occur. Methods: This retrospective study included 119 children with an LT performed in our hospital from 2014 to 2017. The descriptive statistics relating to patients' age, gender, transplantation indications, transplantation technique, and MSCT findings were calculated, and are presented as numbers and percentages. The complications were divided into 4 groups: vascular, biliary, parenchymal, and extraparenchymal. Results: The LT procedures were performed with organs from living donors for 83 patients, and from deceased donors for 36 patients. Hepatic artery and portal vein complications were mostly seen in the early period (n = 18), and hepatic vein complications were also observed in the late period (n = 6). The most commonly encountered biliary complications were stenosis/stricture (n = 13) and bile leak/ bilioma (n = 9). Stenosis/stricture frequently occurred in the late period. The most common parenchymal complications were ischemic infarct (n = 8) in the early period, and abscess (n = 4) and recurrent hepatoblastoma (n = 2) in the late period. Hematoma (n = 7), intestinal perforation (n = 3), and focal spleen infarct (n = 3) were among the most commonly observed extraparenchymal abdominal complications. Conclusion: The complications occurring after pediatric LT varied according to the time after surgery and the transplantation technique used. Using MSCT, different abdominal complications can be assessed simultaneously, greatly contributing to diagnosis and treatment.
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    Investigation of the prognostic value of psoas muscle area measurement in pediatric patients before liver transplantation: A single-center retrospective study
    (Wiley, 2021) Dag, Nurullah; Karatoprak, Sinan; Ozturk, Mehmet; Karatoprak, Nur Betul; Sigirci, Ahmet; Yilmaz, Sezai
    Background: In this study, our aim is to investigate the prognostic value of psoas muscle area (PMA) evaluation before liver transplantation (LT) in pediatric patients. Methods: Two hundred seventy-six patients under 18 years of age who underwent LT between January 2012 and December 2019 were included in the study. The patients' demographic, laboratory, clinical, and imaging data were scanned retrospectively. PMA was measured at the L4/5 level using computed tomography images. To determine reproducibility, a different radiologist evaluated 30 randomly selected patients. Results: In patients with end-stage liver disease (ESLD), PMA was significantly lower than in patients with acute liver failure (P < .001). In patients with ESLD, a weakly significant correlation was found between PMA and 1-year survival after LT (r: .251, P = .030), hospitalization period (r: -.275, P = .039), and pediatric ESLD score (r: -.338, P < .001). Interobserver correlation was excellent (ICC: .941, 95% CI: .925, .971). Conclusion: In children with ESLD, PMA evaluated before LT can be used as a negative prognostic factor.
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    Nodular Fasciitis of the Breast: Case Reports of a Male and a Female Patient
    (Gazi Univ, Fac Med, 2020) Dag, Nurullah; Sendur, Halit Nahit; Gultekin, Serap; Yilmaz, Guldal Esendagli
    Nodular fasciitis (NF) is a benign lesion that originates from the excessive proliferation of fibroblasts. NF is rare in the breast. The majority of affected patients are female. In this presentation, NF imaging findings with elastography features of a male and a female patients are presented. A 41-year-old female patient had a lesion that the upper external quadrant of the left breast in the BIRADS 3 category. 6 months later, the lesion sizes increased and lesion' edges were angular. The lesion was upgraded to BI-RADS 4B category. A 48-year-old male patient had a lesion in the BI-RADS 5 category. Both of the lesions were hard on strain elastography. US-guided core biopsies were not diagnostic and pathologist recommended total excision. After surgery, the both lesions were diagnosed as NF pathologically. NF is a very rare lesion that mimics breast carcinoma clinically and radiologically.
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    Percutaneous radiological biliary interventions after failed endoscopic treatment in living liver donors: experience of a high-volume transplantation center
    (Wiley, 2021) Karatoprak, Sinan; Kutlu, Ramazan; Karatoprak, Nur Betul; Dag, Nurullah; Yilmaz, Sezai
    This study aimed to evaluate the role of percutaneous radiological treatments for biliary complications (BCs) in donors after living donor liver transplantation (LDLT). We retrospectively evaluated BCs in donors involved in 1839 LDLTs between May 2009 and January 2019 at our centre. BCs were classified according to the modified Clavien-Dindo classification (MCDC). Patients treated with percutaneous transhepatic biliary intervention (PTBI) were identified. Complications requiring endoscopic, interventional or surgical treatment (MCDC grades III-IV) involved 123 (6.6%) donors. Complications comprised leakage, n = 73 (60%); stricture, n = 36 (29%); and both leakage and stricture, n = 14 (11%). Percutaneous drainage of biloma formations under ultrasound guidance was performed in 57 donors, endoscopic treatment in 83 and PTBI in 14. Of 83 patients who received endoscopic treatment, 13 were referred for PTBI due to failure or uncannulation. Eight of 14 patients were successfully treated with PTBI. Six patients were treated with a rendezvous procedure combining percutaneous and surgical treatments. In 13 patients, no BCs were developed after catheter or stent removal. In donors with BCs, the treatment should progress from the least invasive method to surgery. In some patients, percutaneous radiological treatments eliminate the need for surgery or can guide surgical treatment.
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    Scoliosis After Liver Transplantation in Pediatric Patients
    (Aves, 2022) Dag, Nurullah; Ozturk, Mehmet; Sigirci, Ahmet; Yilmaz, Sezai
    Objective: Little is known about the development of scoliosis after pediatric liver transplantation. In this study, we aimed to evaluate the frequency of scoliosis and its relationship with potential risk factors in children after liver transplantation. Methods: Pediatric liver transplantations (under of age 18) performed between January 2009 and December 2017 at Malatya Inonu University Institute of Liver Transplantation were scanned retrospectively. In the spinal axis, >10 degrees lateral deviations were accepted as scoliosis. The curve patterns were classified according to the Lenke classification. Results: Among 287 pediatric liver transplantationss, 17 of them were scoliosis (6%). Nine patients were females and eight were males. The median Cobb angle was 12 degrees at the time of diagnosis and then 17 degrees at the last follow-up. According to the Lenke classification, 11 patients had type 5 curve pattern. During the follow-up period (ranging from 1 to 11 years), scoliosis progression was slow and no patient requiring surgical treatment was detected. Conclusion: We found that the prevalence of scoliosis increased after pediatric liver transplantation, but we do not have any definite information about the cause. Comparable new studies with more patients are needed to make a definitive conclusion in this regard.