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Öğe The 2-Stage Liver Transplant: 3 Clinical Scenarios(Baskent Univ, 2015) Gedik, Ender; Bicakcioglu, Murat; Otan, Emrah; Toprak, Huseyin Ilksen; Isik, Burak; Aydin, Cemalettin; Kayaalp, CuneytThe main goal of 2-stage liver transplant is to provide time to obtain a new liver source. We describe our experience of 3 patients with 3 different clinical conditions. A 57-year-old man was retransplanted successfully with this technique due to hepatic artery thrombosis. However, a 38-year-old woman with fulminant toxic hepatitis and a 5-year-old-boy with abdominal trauma had poor outcome. This technique could serve as a rescue therapy for liver transplant patients who have toxic liver syndrome or abdominal trauma. These patients required intensive support during long anhepatic states. The transplant team should decide early whether to use this technique before irreversible conditions develop.Öğe Abdominal compartment syndrome due to distended rectal stump(Aves, 2007) Yilmaz, Mehmet; Isik, Burak; Ugras, Murat; Soeguetlue, Goekhan; Ara, Cengiz; Yilmaz, SezaiAbdominal compartment syndrome is a serious and life-threatening condition that requires early recognition and urgent decompressive laparotomy. This case report describes an abdominal compartment syndrome due to a distended rectal stump. The patient had a previous sigmoid resection with colostomy performed for sigmoid volvulus. As far as we know, this is the first report of abdominal compartment syndrome due to rectal stump. In such cases, high index of suspicion and early intervention affect the clinical course.Öğe Aborted Donor Hepatectomies for Living Donor Liver Transplantation: A Single Center Experience(Lippincott Williams & Wilkins, 2016) Kutluturk, Koray; Otan, Emrah; Dirican, Abuzer; Yilmaz, Mehmet; Isik, Burak; Ozdemir, Fatih; Ince, Volkan[Abstract Not Available]Öğe Acute acalculous cholecystitis induced by aortic dissection: report of a case(Turkish Assoc Trauma Emergency Surgery, 2010) Sogutlu, Gokhan; Isik, Burak; Yilmaz, Mehmet; Karadag, Nese; Hoca, Onur; Olmez, Aydemir; Cinpolat, OezguerAcute acalculous cholecystitis (AAC), inflammation of the gallbladder without evidence of calculi, comprises approximately 10% of all cases of acute cholecystitis. Although the mechanism of AAC has not yet been sufficiently clarified, the most commonly postulated theories regarding its pathogenesis are bile stasis, sepsis and ischemia. We present a case of AAC associated with ischemia of the gallbladder caused by aortic dissection Bakey type III.Öğe Advanced MRI findings in patients with breast hamartomas(Turkish Soc Radiology, 2011) Erdem, Gulnur; Karakas, Hakki Muammer; Isik, Burak; Firat, Ahmet KemalPURPOSE Although it has been stated that breast hamartomas are rare tumors, radiologists frequently encounter them in their daily practices. Fat, glandular and fibrous tissues all produce a mass of disorganized but mature specialized cells. Because hamartomas do not have specific diagnostic histological features, the clinical and radiological findings are important in their diagnosis. The aim of this study is to present the advanced magnetic resonance imaging (MRI) findings of breast hamartomas. MATERIALS AND METHODS Eight patients with breast hamartomas were examined using MRI techniques in addition to ultrasonographic and/or mammographic findings. RESULTS Each of the lesions examined showed a gradual enhancement pattern in its time-signal intensity curve on dynamic contrast-enhanced MRI. On MR spectroscopy, water and lipid peaks were detected that resembled normal breast tissue. The diffusion features of the lesions were variable due to the different ratios of the tissue elements constituting them on diffusion-weighted imaging (DWI). CONCLUSION Advanced MRI findings may clarify diagnoses by providing additional information following sonography, especially in lactating or pregnant women, in whom mammographic examination is not preferred.Öğe Alpha-fetoprotein and albumin inversely relate to each other and to tumor parameters in patients with hepatocellular carcinoma(Kare Publ, 2024) Carr, Brian; Guerra, Vito; Ince, Volkan; Isik, Burak; Yilmaz, SezaiBackground and Aim: Alpha-fetoprotein (AFP), an oncofetal protein and biomarker in hepatocellular carcinoma (HCC), has unclear roles and ac-tions.To evaluate the relationships between AFP, liver function tests, and HCC aggressiveness. Materials and Methods: A retrospective analysis of an HCC patient data-base was conducted to examine the relationships between baseline serum AFP values, liver function tests, and tumor characteristics. Results: Statistically significant positive trends were observed between AFP levels and both AST and bilirubin, along with negative trends between AFP and albumin. Significant correlations were also found between AFP and MTD, multifocality, and PVT. Increases in MTD, multifocality, and PVT were noted even at low AFP levels, indicating both AFP-independent and AFP-dependent processes. However, these parameter changes were minimal compared to the substantial changes in AFP levels. Relationships between AFP-related liver and tumor characteristics were found to be sim-ilar but inverse to those for albumin, with normal albumin levels associated with more favorable tumor characteristics. Additionally, serum levels of albumin and AFP were inversely related. Conclusion: AFP and albumin levels significantly, but inversely, correlate with tumor parameters, suggesting that albumin may suppress HCC func-tions and could serve as a potential prognostic marker.Öğe Analysis of Risk Factors Affecting the Development of Infection in Artificial Vascular Grafts Used for Reconstruction of Middle Hepatic Vein Tributaries in Living Donor Liver Transplantation(Lippincott Williams & Wilkins, 2019) Koc, Cemalettin; Akbulut, Sami; Ozdemir, Fatih; Kose, Adem; Isik, Burak; Yologlu, Saim; Yilmaz, SezaiBackground. To analyze the risk factors affecting the development of infection in artificial vascular grafts (AVGs) used for reconstruction of middle hepatic vein (MHV) tributaries in living donor liver transplantation (LDLT). Methods. Between January 2009 and January 2018, 1253 right lobe LDLTs were performed at our Transplant Institute, and MHV tributaries of the 640 right lobe liver grafts were reconstructed with AVG. Reconstructed MHV tributaries were removed due to AVG infection in 25 of these patients (case group; n = 25). To determine risk factors for AVG infection, right lobe LDLT patients without AVG infections were selected as control group (n = 615). Both groups were compared about demographic parameter, transcystic catheter usage, bile leakage, type of biliary anastomosis (duct-to-duct, telescopic duct-to-duct), number of graft biliary duct (=1 versus >1), number of biliary anastomosis (=1 versus >1), AVG thrombosis, AVG types (Dacron versus polytetrafluoroethylene). Univariate analyses were used for comparison of different variables, and variables with P <= 0.20 were taken into logistic regression model. Results. Univariate analysis shows that statistically significant differences were found between groups regarding bile leakage (P < 0.001), graft thrombosis (P = 0.002), transcystic catheter (P = 0.049), and AVG types (P = 0.013). Variables with P <= 0.20 were taken into logistic regression model. Multivariate analysis shows that bile leakage (odds ratio, 13.3) and AVG thrombosis (odds ratio, 9.8) were determined as independent and strong risk factors for development of AVG infection. Conclusions. This study revealed that bile leakage and graft thrombosis are independent and strong risk factors for infections of AVGs used for anterior sector drainage reconstruction.Öğe Appendiceal Enterobius vermicularis infestation in adults(Int College Of Surgeons, 2007) Isik, Burak; Yilmaz, Mehmet; Karadag, Nese; Kahraman, Latif; Sogutlu, Gokhan; Yilmaz, Sezai; Kirimlioglu, VedatThe objective of this study is to evaluate the incidence of Enterobius vermicularis in the appendices of the adult population and a possible relationship between E. vermicularis and acute appendicitis. E. vermicularis was identified in 18 (2%) of 890 patients. Six hundred sixty-five operations were performed for presumptive diagnosis of acute appendicitis, and E. vermicularis was found in 12 (2%) patients. The histopathological examination revealed acute inflammatory cells in four cases (33%). Three of these four specimens included luminal ova and one E. vermicularis. Histopathological examination of six cases revealed E. vermicularis in 225 incidental appendectomies with no evidence of either acute or chronic inflammatory cells. This study suggests a relationship between the presence of E. vermicularis ova and acute inflammation, but the presence of the pinworm in the lumen of the appendix is coincidental. On the other hand E. vermicularis in the appendix lumen can cause symptoms of acute appendicitis.Öğe Artificial vascular graft migration into hollow viscus organs in patients who underwent right lobe living donor liver transplantation(Taylor & Francis Ltd, 2020) Koc, Cemalettin; Akbulut, Sami; Bilgic, Yilmaz; Otan, Emrah; Sarici, Baris; Isik, Burak; Bayindir, YasarBackground:To share our experience with hollow viscus migration of artificial vascular grafts (AVG) used for venous reconstruction of the right anterior sector in living donor liver transplantations (LDLT). Methods:Clinical, radiological, and endoscopic data of 13 right lobe LDLT patients (range: 26-67 years) with a diagnosis of postoperative AVG migration into adjacent hollow viscus were analyzed. Results:Biliary complications were detected in 12 patients. A median of four times endoscopic retrograde cholangiopancreatography (ERCP) procedures were performed in 11 patients prior to AVG migration diagnosis. A median of 2.5 times various percutaneous radiological interventional procedures were performed in eight patients prior to AVG migration diagnosis. The site of migration was the duodenum in eight patients, gastric antrum in four, and Roux limb in the remaining one patient. The migrated AVS were made of polytetrafluoroethylene (PTFE) in 10 patients and polyethylene terephthalate (Dacron) in three. The migrated AVGs were endoscopically removed in seven patients and surgically removed in six. Only one patient died due to sepsis unrelated to AVG migration. Conclusion:AVG migration into the adjacent hollow viscus following right lobe LDLT is a rare and serious complication. Repetitive ERCP, interventional radiological procedures, infection related to biliary leakage, and thrombosis of AVGs are among the possible risk factors.Öğe Barolith as a rare cause of acute appendicitis: a case report(Turkish Assoc Trauma Emergency Surgery, 2013) Ince, Volkan; Isik, Burak; Koc, Cemalettin; Baskiran, Adil; Onur, AsimA barolith consists of inspissated barium associated with feces and is seen, rarely, after barium studies for imaging the gastrointestinal system. The barium used in such studies can enter the appendiceal lumen and, rarely, cause appendicitis by obliterating or narrowing the lumen of the appendix. The appendix fills with barium and the entire appendix is visualized in 80-90% of barium swallow or enema studies, and this is accepted as a reliable sign of a non-diseased appendix Post-examination retention of barium in the appendix is very common (90 similar to 95%), and 10% of the patients retain barium in the appendix beyond 72 hours. If the barium is retained for more than two months, complicated appendicitis can result. We present a 46-year-old male who was diagnosed with acute appendicitis due to a barolith and required an appendectomy three months after a double-contrast barium enema study. After barium studies, patients should be informed regarding retention of barium in the appendix and the possibility that it can cause acute appendicitis. Thus, if abdominal pain develops, the patient can be referred quickly to a medical center for the appropriate treatment and the complications of acute appendicitis can be prevented with early intervention.Öğe A Case of Tubo-ovarian Abscess due to Salmonella enterica Following an In Vitro Fertilization Attempt(Galenos Yayincilik, 2019) Yakupogullari, Yusuf; Isik, Burak; Gursoy, Nafia Canan; Bayindir, Yasar; Otlu, Baris[Abstract Not Available]Öğe Chylous ascites after liver transplantation: Incidence and risk factors(Wiley-Blackwell, 2012) Yilmaz, Mehmet; Akbulut, Sami; Isik, Burak; Ara, Cengiz; Ozdemir, Fatih; Aydin, Cemalettin; Kayaalp, CuneytIn 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 +/- SD = 8.0 +/- 3.2 days, range = 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 = 0.04), the presence of ascites before transplantation (P = 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 = 0.04, hazard ratio (HR) = 2.8, 95% confidence interval (CI) = 1.1-13.5] and the use of LVSS for perihepatic dissection (P = 0.01, HR = 5.4, 95% CI = 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. Liver Transpl, 2012. (C) 2012 AASLD.Öğe Circumferencial Fence of an Autologous Saphenous Vein Graft after Unification of Right Portal Vein Branches in Right Lobe, with Anomalous Portal Venous Branching, Living Donor Liver Transplantation; Malatya Approach(Wiley-Blackwell, 2011) Yilmaz, Sezai; Isik, Burak; Kutlu, Ramazan; Ozgor, Diner; Yilmaz, Mehmet; Ara, Cengiz; Dirican, Abuzer[Abstract Not Available]Öğe COLON PERFORATION FOLLOWING CORONARYARTERY BYPASS GRAFTING(Istanbul Univ, Faculty Medicine, Publishing Office, 2006) Isik, Burak; Nisanoglu, Vedat; Yilmaz, Mehmet; Sogutlu, GokhanAlthough incidence of gastrointestinal complications following cardiac surgery is low, concomitant mortality is high. Intestinal ischemia is the most life-threatining one among these complications. In this paper, two cases of colon perforation, one of which with a mortal course, following coronary artery bypass grafting are presented. Delay with a concern of a negative laparotomy increases high mortality rate of ischemic intestinal complications rather than an early and curative procedure in a patient with a recent cardiac surgical procedure.Öğe A Combination of Blood Lymphocytes and AST Levels Distinguishes Patients with Small Hepatocellular Carcinomas from Non-cancer Patients(Springer, 2021) Carr, Brian, I; Bag, Harika Gozukara; Ince, Volkan; Akbulut, Sami; Ersan, Veysel; Usta, Sertac; Isik, BurakPurpose HCC patients typically present at an advanced tumor stage, in which surgical therapies cannot be used. Screening ultrasound exams can increase the numbers of patients diagnosed with small tumors, but are often not used in patients at risk for HCC. We evaluated clinically available and cheap potential blood tests as biomarkers for screening patients at risk for HCC. Methods A comparison was made of commonly used blood count and liver function parameters in a group of patients (n = 101) with small HCCs (<= 3 cm) or without HCC (n = 275), who presented for liver transplantation in our institute. Results Significant differences were found for blood lymphocytes and AST levels. This 2-parameter combination was found to be significantly different between patients with small HCCs versus no HCC. Using the combination of lymphocytes and AST levels to dichotomize the HCC patients, only blood levels of alpha-fetoprotein among the tumor characteristics were found to be significantly different among the 2 HCC groups, as well as levels of blood total bilirubin, ALKP, and PLR ratio. The results were confirmed using a separate smaller cohort of non-transplanted small size HCC patients. Conclusion The combination of elevated blood levels of lymphocyte counts and AST levels holds promise for screening of patients with chronic liver disease who are at risk for HCC.Öğe Comparison of Intracorporeal Knot-tying Suture (Polyglactin) and Titanium Endoclips in Laparoscopic Appendiceal Stump Closure: A Prospective Randomized Study(Lippincott Williams & Wilkins, 2012) Ates, Mustafa; Dirican, Abuzer; Ince, Volkan; Ara, Cengiz; Isik, Burak; Yilmaz, SezaiBackground: Laparoscopic appendectomy is a well-described surgical technique. However, concerns still exist regarding whether the closure of the appendiceal stump should be done with a clip, an endoloop, staples, or other techniques. Therefore, several modifications to the original technique with new materials have been introduced for appendiceal stump closure. The aim of this study was to compare intracorporeal (polyglactin) knot-tying suture with titanium endoclips in appendiceal stump closure during laparoscopic appendectomy. Methods: The study was carried out as a prospective randomized clinical trial between April 2010 and February 2011. Patients with a presentation of appendicitis were included into the study. Two groups were defined-patients with the titanium endoclip and patients with the knot-tying (polyglactin) suture. The results in terms of operating time, complication rates, and hospital stay were analyzed. Results: Sixty-one patients who underwent laparoscopic appendectomy were enrolled in the titanium endoclip group (n = 30) or the knot-tying (polyglactin) suture group (n = 31). No statistically significant differences were detected between the groups in terms of the distribution of age, sex percentage, appendix localization, and histopathologic diagnosis (P > 0.05). One patient required a second operation on postoperative day 10 because of intraperitoneal abscess. The mean operative time for the endoclip group (41.27 +/- 12.2 min) was shorter than that for the knot-tying group (62.81 +/- 15.4 min) (P = 0.001). No statistically significant differences were detected between the groups in terms of hospital stay, follow-up time, and preoperative and postoperative complications (P > 0.05). Conclusions: In laparoscopic appendectomy, using a titanium endoclip for optimizing and controlling the appendiceal stump closure is safe and is associated with shorter operation time. This also simplifies the procedure, so it can be a useful alternative to intracorporeal knot-tying for appendiceal stump closure.Öğe CONGENITAL TRANSMESENTERIC DEFECT : INTERMITTENT INTESTINAL OBSTRUCTION DUE TO INTERNAL HERNIATION(Istanbul Univ, Faculty Medicine, Publishing Office, 2011) Ince, Volkan; Isik, Burak; Gozeneli, Orhan; Ersan, Veysel; Koc, CemalettinInternal hernias are a rare cause of intestinal obstruction. Intestinal obstruction occurs as a result of herniation, developing of congenital or acquired defects. Mortality rates reach 20% if surgical intervention is not made on time. We describe a 27-years-old female patient complained of intermittent obstruction, with no history of previous operations, treated with timely surgical intervention when irreversible changes have not been developped in herniated small bowell by only the reduction of hernia and closure the transmesenteric defect.Öğe Consequences of the Use of Extended Criteria Donors in Living Donor Liver Transplantation(Int Scientific Literature, Inc, 2015) Dirican, Abuzer; Ozsoy, Mustafa; Ates, Mustafa; Ersan, Veysel; Gonultas, Fatih; Isik, Burak; Yilmaz, SezaiBackground: Donor selection criteria are being continuously modified to expand the potential donor pool in living donor liver transplantation (LDLT). This retrospective study reports our center's experience in utilizing extended criteria donors for LDLT. Material/Methods: The charts of 342 LDLT donors who underwent right hepatectomy between September 2007 and December 2010 were reviewed. Donors who were older than 55 years, and/or with BMI >30, and/or with a remnant liver volume of <30% were defined as extended criteria donors. The surgical complications in the extended criteria donors and non-extended criteria donors were compared. Results: There were 61 extended criteria donors (21 male, 40 female; mean age 41 years) and 281 non-extended criteria donors (189 male, 92 female; mean age 31 Years). Surgical morbidities were observed in 70 (20.4%) of donors. The number of patients with complications according to Clavien's system were: Grade I, 30 (43%); Grade II, 11 (16%); Grade IIIa, 12 (17%); Grade IIIb, 16 (23%); and Grade IV, 1 (1%). Postoperative complications were observed in 17 (28%) of 61 extended criteria donors, and 53 (19%) of 281 non-extended donors (p>0.05). However, only the Grade IIIb complication rate in donors with extended criteria was significantly higher than in non-extended criteria donors (p=0.04). Complications developed in 3 of 7 donors aged >55 years and with BMI >30. There was no donor mortality. Conclusions: Although there was no statistical difference between the 2 groups' postoperative complication rates, Grade IIIb complications were statistically significantly higher in the extended group. Having more than 1 extended criteria may increase the donor's postoperative complications in LDLT. Thus, the elimination of the donors should be considered in the presence of more than 1 extended criteria.Öğe Conversion to Stoppa Procedure in Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair(Soc Laparoendoscopic Surgeons, 2012) Ates, Mustafa; Dirican, Abuzer; Ozgor, Dincer; Gonultas, Fatih; Isik, BurakBackground and Objectives: Conversion to open surgery is an important problem, especially during the learning curve of laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. Methods: Here, we discuss conversion to the Stoppa procedure during laparoscopic TEP inguinal hernia repair. Outcomes of patients who underwent conversion to an open approach during laparoscopic TEP inguinal hernia repair between September 2004 and May 2010 were evaluated. Results: In total, 259 consecutive patients with 281 inguinal hernias underwent laparoscopic TEP inguinal hernia repair. Thirty-one hernia repairs (11%) were converted to open conventional surgical procedures. Twenty-eight of 31 laparoscopic TEP hernia repairs were converted to modified Stoppa procedures, because of technical difficulties. Three of these patients underwent Lichtenstein hernia repairs, because they had undergone previous surgeries. Conclusion: Stoppa is an easy and successful procedure used to solve problems during TEP hernia repair. The Lichtenstein procedure may be a suitable option in patients who have undergone previous operations, such as a radical prostatectomy.Öğe Correction of Portal Venous Narrowing With Saphenous Vein Graft During Right Lobe Living Donor Hepatectomy(Lippincott Williams & Wilkins, 2015) Koc, Cemalettin; Ozdemir, Fatih; Soyer, H. Vural; Dirican, Abuzer; Isik, Burak; Yilmaz, Mehmet; Yilmaz, Sezai[Abstract Not Available]
