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Öğe The magnetic resonance imaging assessment of optic nerve sheath diameter in pediatric acute liver failure patients(Verduci Publisher, 2022) Dogan, G. M.; Sigirci, A.; Okut, G.; Cicek, E.; Dogan, S. M.; Yilmaz, S.; Arslan, A. K.OBJECTIVE: To evaluate the di-agnostic value of optic nerve sheath diameter (ONSD) using brain MRI in the pretransplantation period in the pediatric acute liver failure patients, and correlate the ONSD with clinical grade of hepatic encephalopathy (HE) and MRI findings. PATIENTS AND METHODS: Forty acute liver failure patients and 40 control group patients were retrospectively analyzed. The high signal intensities in T2W (T2-weighted image), FLAIR (Fluid Attenuated Inversion Recovery) and DWI (diffusion-weighted imaging) sequences were evaluated and ONSD were measured. The patients were grouped first into 5 according to their West Haven score, and HE grade 0 and grade 1 were accepted as low grade HE, HE grade 2, 3 and 4 were accepted as high grade HE. The patients were grouped to 2 according to the MRI findings as low grade and high grade MRI group. RESULTS: The mean value of ONSD was 6.0 +/- 1.80 and 4.94 +/- 1.27 in all the patients and in the control group, respectively. There was statistically significant difference between both the ONSD and the low grade-high grade HE groups (p=0.01), and between the ONSD and the low grade-high grade MRI groups (p<0.001). CONCLUSIONS: Although high ONSD values do not make the diagnosis of cerebral edema, it may cause suspicion in the early period. MRI can be helpful in the diagnoses of increased intracranial pressure like ultrasound. Our study is the first study to compare ONSD and MRI findings in addition to HE grades. The widespread use of MRI in children in recent years may help determine the normal range of ONSD values.Öğe Management of thrombosis in a pediatric renal transplant patient with factor VII deficiency A dilemma concerning recombinant factor VIIa(Athens Medical Soc, 2020) Yalcin, M.; Simsek, A.; Tabel, Y.; Dogan, S. M.; Piskin, T.Hemorrhagic complications in surgical patients with congenital factor VII deficiency are a major concern. Replacement therapy is required, in which recombinant factor VIIa is the first treatment choice, by virtue of its higher efficacy and no risk of infection. Because of the risk of vascular thrombosis, recombinant factor VIIa treatment may result in catastrophic outcomes, including graft loss in transplant patients. We present the case of a 7-year-old male who underwent renal transplantation and who developed renal thrombosis after recombinant factor VIIa substution therapy for factor VII deficiency.Öğe Outcomes of Kidney Transplantations From the Same Deceased Donor to Two Different Recipients: A Single-Center Experience(Elsevier Science Inc, 2017) Piskin, T.; Unal, B.; Kutluturk, K.; Yildirim, I. O.; Berktas, B.; Dogan, S. M.; Yagmur, J.Background. Kidney transplantation is the best treatment method for end-stage renal disease. Technically, left kidney transplantation is easier than right kidney, and the complication rates in the right are higher than the left kidney. We performed 28 kidney transplantations from 14 deceased donors between November 2010 and May 2016. Our aim was to share our outcomes and experiences about these 28 patients. Methods. We performed 182 kidney transplantations between November 2010 and May 2016. Fifty-four kidney transplantations were performed from deceased donors. Thirty-two of these were performed from 16 of the same donors. These 32 recipients' data were collected and, retrospectively analyzed. We excluded the transplantations from two same donors to their four recipients in this study. The remaining 28 recipients were included in the study. Results. The left and right kidney recipients' 'numbers were equal (14:14). The left kidney:right kidney rate was 11:3 in the first kidney transplantation recipient group; in the second kidney transplantation recipient group, the rate was 3:11. The difference was statistically significant (P =.002). We found no statistical differences for sex, mean age, and body mass index of recipients, total ischemic time of grafts, hospitalization times, creatinine levels at discharge time, and current ratio of postoperative complications of recipients (P >.05). Conclusions. There were no differences in the left or the right kidneys or in the first and the second kidney transplantations during the long follow-up period.Öğe Predictors of splenectomy response in patients with immune thrombocytopenia(Athens Medical Soc, 2021) Simsek, A.; Dogan, S. M.OBJECTIVE To evaluate the predictors of the response to splenectomy in patients with immune thrombocytopenia. METHOD The medical records were reviewed retrospectively of patients who had undergone total splenectomy for immune thrombocytopenia at a tertiary center between January 2009 and December 2019. RESULTS This study included 40 patients (28 females and 12 males) with immune thrombocytopenia. A complete response was obtained in 31 (77.5%) patients, with 9 (22.5%) patients failing to respond to splenectomy. The response was stable in 25 patients (62.5%), and 5 patients (12.5%) had a recurrence. The postoperative mortality rate was 2.5%; one patient developed an ischemic stroke and died. Multivariate analysis demonstrated that an extended time from diagnosis to splenectomy, a lower demand for transfusion of blood components, and a shorter length of hospitalization were positively associated with a complete response. CONCLUSIONS Splenectomy should be considered as the therapeutic approach to immune thrombocytopenia, with a high curative potential in suitable patients. An extended time from diagnosis to splenectomy, lower demand for transfusion of blood components, and shorter length of hospitalization were found to be positively associated with a complete response after splenectomy.Öğe Should Interventional Radiology or Open Surgery Be the First Choice for the Management of Ureteric Stenosis After Transplantation? Dual-Center Study(Elsevier Science Inc, 2017) Simsek, C.; Dogan, S. M.; Piskin, T.; Okut, G.; Cayhan, K.; Aykas, A.; Tatar, E.Background. Ureteric stenosis (US) is the most common urologic complication after kidney transplantation. In this dual-center retrospective study we compared the efficacy and safety of open surgery versus interventional radiology for the management of US. Methods. From 2009 to January 2016, US was treated by surgical revision in 22 (7.8%) out of 281 recipients at one center (group 1) and managed by percutaneous nephrostomy with antegrade nephroureteral stenting (PNAS) in 22 (14.2%) out of 155 recipients at the other center (group 2). Results. Three patients in group 1 required reintervention and again were treated with open surgery. With a mean follow-up of 42.1 +/- 38.7 months, graft function improved in all but one patients (95%). Three patients in group 2 were admitted with relapse of US not amenable to 2nd PNAS, and 2 of them were managed with surgery. These 3 and 2 other cases with improved graft function after PNAS lost their grafts and returned to hemodialysis. The remaining 17 patients (77%) still have functioning grafts. There was no statistically significant difference between the efficacy of PNAS and open surgery for the management of post-transplantation US. However; a benefit in favor of open surgery existed for type 2 urinary tract obstruction in terms of decreased reintervention rate and much better protection of the graft function and survival. Conclusions. Both interventional radiology and open surgery have acceptable efficacy rates in the management of ureteric complications after renal transplantation. Open surgery is a better treatment option for type 2 obstruction.Öğe Vacuum-assisted closure in the treatment of peripancreatic fluid collection after pancreas transplantation(Athens Medical Soc, 2020) Dogan, S. M.; Simsek, A.; Gurbuz, H.; Piskin, T.Following improvements in immunosuppressive therapy and the reduction of surgical complications, pancreatic transplantation has gained in popularity. The management of peripancreatic fluid collection (PPFC) is a major concern, especially in the case of retroperitoneal implantation. Percutaneous drainage catheters may be ineffective for clearing large pieces of pancreatic debris. The cases are presented here of three patients who were treated successfully with vacuum-assisted closure (VAC) for PPFC after pancreas transplantation.
