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    The Assessment of Hepatosteatosis in Living-Donor Liver Transplant: Comparison of Liver Attenuation Index and Histopathologic Results
    (Baskent Univ, 2017) Kahraman, Aysegul Sagir; Karakas, Hakki Muammer; Kirimlioglu, Hale; Kahraman, Bayram; Yilmaz, Sezai; Kirimlioglu, Vedat
    Objectives: The purpose of the study was to determine the diagnostic value of computed tomography densitometry in the quantification of hepatosteatosis. Materials and Methods: Fifty-one potential liver donors, ranging in age from 19 to 52 years (mean age: 32.4 years +/- 10.2), participated in the study. The mean hepatic attenuation and mean splenic attenuation were determined using regions of interest measurements. The difference between the mean hepatic attenuation and mean splenic attenuation (or liver attenuation index), with liver attenuation index = mean hepatic attenuation - mean splenic attenuation were calcu lated. Computed tomography densitometric para meters were correlated with histopathologic results. Results: From the histopathologic analysis, the degree of macrovesicular hepatosteatosis was 0% to 8% (mean: 1.1% +/- 2%). Seven donors (13.7%) had a degree of macrovesicular steatosis of > 5%, and 12 donors (23.5%) had >= 2%. Of the 29 normal donors with histopathologic verification, computed tomography densitometry predicted <= 5% of the hepa to steatosis in 27 donors, and >= 2% hepato-steatosis in 2 subjects. The liver attenuation index was sig nificantly correlated to the histopathologic results. The mathematical relation between liver attenuation index and the degree of histopathologic hepatosteatosis was calculated using the least-squares methods, which provided quadratic polynomials. Conclusions: Computed tomography densitometry is a rapid, robust, noninvasive technique for the assessment of hepatosteatosis. When used in conjunction with clinically stable reference measurements of spleen, the density measurements of liver correctly predicted the presence of fatty infiltration with significant sensitivity (77%) and specificity (75%). This technique, which was refined during the course of our liver transplant program, minimizes the need for highly invasive percutaneous liver biopsies.
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    Beneficial Effects of Aminoguanidine on Skin Flap Survival in Diabetic Rats
    (Hindawi Publishing Corporation, 2012) Ozturk, Ayse; Firat, Cemal; Parlakpinar, Hakan; Bay-Karabulut, Aysun; Kirimlioglu, Hale; Gurlek, Ali
    Random flaps in DM patients have poor reliability for wound coverage, and flap loss remains a complex challenge. The protective effects of aminoguanidine (AG) administration on the survival of dorsal random flaps and oxidative stress were studied in diabetic rats. Two months after the onset of DM, dorsal McFarlane flaps were raised. Forty rats were divided into four groups: (1) control, (2) AG, (3) DM, and (4) DM + AG groups. Flap viability, determined with the planimetricmethod, and free-radical measurements were investigated. In addition, HbA1c and blood glucose levels, body weight measurements, and histopathological examinations were evaluated. The mean flap necrotic areas (%) in Groups I to IV were 50.9 +/- 13.0, 32.9 +/- 12.5, 65.2 +/- 11.5, and 43.5 +/- 14.7, respectively. The malondialdehyde (MDA) and nitric oxide (NO) levels were higher in the DM group than in the nondiabetic group, while the reduced glutathione (GSH) levels and superoxide dismutase (SOD) activity were reduced as a result of flap injury. In the diabetic and nondiabetic groups, AG administration significantly reduced the MDA and NO levels and significantly increased GSH content and SOD enzyme activity. We concluded that AG plays an important role in preventing random pattern flap necrosis.
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    Diffuse Cecal Ganglioneuromatosis in a Patient with von Reklinghausen's Disease: Case Report
    (Ortadogu Ad Pres & Publ Co, 2012) Dirican, Abuzer; Yilmaz, Mehmet; Unal, Bulent; Ates, Mustafa; Kirimlioglu, Hale; Yilmaz, Sezai
    A 41-year-old female with 'cafe au lait' and multiple skin neurofibromas was admitted with a complaint of constipation, abdominal pain and distention. The colonoscopic investigation was normal, however computed tomography revealed a mass in the cecal wall;Thereon, right hemicolectomy was performed to the patient. Histopathologic examination revealed ganglioneuromatosis of the cecum. There was not any recurrence after three years of follow-up. An intestinal manifestation of von Recklinghausen's disease should be kept in mind in a patient who has multiple neurofibromas and 'cafe au lait' spots with intractable constipation and intestinal obstruction.
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    EARLY BILIARY COMPLICATIONS IN 128 CONSECUTIVE LIVING DONOR LIVER TRANSPLANT RECIPIENTS PERFORMED IN ONE YEAR: A NEW SURGICAL TECHNIQUE.
    (John Wiley & Sons Inc, 2009) Kirimlioglu, Vedat; Yilmaz, Sezai; Yilmaz, Mehmet; Kayaalp, Cuneyt; Isik, Burak; Unal, Bulent; Kirimlioglu, Hale
    [Abstract Not Available]
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    The effect of calcineurin inhibitor and alemtuzumab treatment to the rat liver regeneration.
    (Wiley, 2006) Kirimlioglu, Vedat; Kirimlioglu, Hale; Yilmaz, Sezai; Kayaalp, Cuneyt; Yologlu, Saim
    [Abstract Not Available]
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    Effect of leflunomide on liver regeneration after partial hepatectomy in rats
    (Springer, 2010) Karaman, Abdurrahman; Kirimlioglu, Hale; Tas, Erkan; Karadag, Nese; Gulsul, Cebrail; Fadillioglu, Ersin; Demircan, Mehmet
    Partial hepatectomy (PH) can be an inevitable surgical therapy in some conditions, such as hepatic malignancies, trauma or partial liver transplantation. Its capacity for regeneration distinguishes the liver from other essential organs. Regeneration is a complex process involving growth factors, cytokines, transcription factors, hormones, and oxidative stres products. In the event of ineffective or total absent liver regeneration, the lifethreatening picture of acute liver failure may supervene. In the present research, we studied the effect of leflunomide, a novel immunosuppressive and anti-inflammatory agent against autoimmune disease, on hepatic regeneration after PH in Wistar Albino rats. Thirty-five Wistar albino rats were divided into five groups: group 1, control; group 2, sham; group 3, drug control (was treated with leflunomide 10 mg/kg/d/i.g.); group 4, PH; group 5, PH + leflunomide. As for PH, approximately 70% of the rat liver was surgically removed under general anesthesia. On postoperative day 3, all rats were humanely killed. Catalase (CAT), superooxide dismutase (SOD) and myeloperoxidase (MPO) activities with malondialdehyde (MDA), nitric oxide and protein carbonyl (PC) levels were determined in remnant liver tissue. Inflammatory process and liver regeneration were evaluated with H&E and KI67, respectively. The tissue levels of MDA, PC and MPO were lower in group 5 than levels in group 1. PH significantly decreased the enzymatic activity of CAT (p < 0.05) and SOD. This reduction was significantly improved by the treatment with leflunomide. Histopathologically the enhancement of the liver parenchymal regeneration in the group 5 was significantly greater than the group 4. The findings imply that oxidative stress products play a preventive role in liver regeneration after PH and leflunomide ameliorates the regeneration probably by the radical scavenging and antioxidant activities.
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    THE EFFECTS OF ANTIVIRAL DRUGS ON REGENERATION IN CIRRHOTIC LIVERS: A STUDY OF STATS, INTERLEUKINS AND KI-67
    (John Wiley & Sons Inc, 2009) Kirimlioglu, Hale; Dirican, Abuzer; Tatli, Faik; Aydin, Burcu; Yilmaz, Sezai; Kirimlioglu, Vedat
    [Abstract Not Available]
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    Evaluation of the effects of resveratrol and bevacizumab on experimental corneal alkali burn
    (Elsevier Sci Ltd, 2013) Doganay, Selim; Firat, Penpe Gul; Cankaya, Cem; Kirimlioglu, Hale
    Purpose: To evaluate the effects of resveratrol and bevacizumab on experimental corneal neovascularization. Method: A corneal alkali burn was performed in 62 eyes of 31 male white Vienna rabbits. Resveratrol (group 1), dimethyl sulfoxide (group 2), bevacizumab (group 3) and 0.9% NaCl (group 4) were administered to both eyes of the rabbits by subconjunctival injection for 7 days. Corneal photos were taken at 15 days after alkali injury. Inflammatory index scores and neovascularization areas were calculated. Results: In bevacizumab group both inflammatory index scores and the calculation of the corneal neovascularization area was significantly less than the groups. Conclusion: The subconjunctival administration of bevacizumab inhibits corneal neovascularization effectively in the rabbit corneal alkali burn model. No effect of resveratrol to the corneal neovascularization on experimental model of the corneal alkali burn was seen at the doses of usage. (C) 2012 Elsevier Ltd and ISBI. All rights reserved.
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    Expression of matrix metalloproteinases in gallbladder carcinoma and their significance in carcinogenesis
    (Lippincott Williams & Wilkins, 2008) Karadag, Nese; Kirimlioglu, Hale; Isik, Burak; Yilmaz, Sezai; Kirimlioglu, Vedat
    The correlation between matrix metalloproteinase (MMP)-2, MMP-9, and MMP-14 expression on the prognostic parameters of gallbladder carcinoma (GBC) and their role in carcinogenesis were evaluated. Carcinomas of the gallbladder (n = 20) and chronic cholecystitis (n = 10) were studied for the expression of MMP-2, MMP-9, and MMP-14 by immunohistochemistry. In all of the cases, metaplastic and dysplastic epithelial alterations, and (in GBC histologic type, grade of differentiation, level of infiltration, perineural and angiolymphatic invasion, liver invasion, and lymph node involvement were noted. MMP-2, MMP-9, MMP-14 were expressed in tumor epithelium in 9 (45%), 20 (100%), and 20 (100%) of the cases, respectively. MMP stromal expression including muscle layer, vascular endothelium, fibroblasts, and lymphoid cells were detected in all cases. MMP-2 was not expressed in normal, metaplastic, and dysplastic epithelia. In contrast, MMP-9 and MMP-14 immunoreactivities were present in antral-type metaplastic areas as moderate (grade 2) and strong in dysplastic epithelia (grade 3). Only in mucinous-type GBC was the expression of the MMPs lower than in the other types. No significant correlation was detected with the grade of differentiation, level of infiltration, perineural and angiolymphatic invasion, liver invasion, or lymph node involvement. These data suggest that MMP-9 and MMP-14 overexpression may have an important role in tumorigenesis. MMP-2, MMP-9, and MMP-14 were expressed in GBC epithelium but also the expression in the stromal component may be essential for the malignant potential of GBC.
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    The expression of matrix metalloproteinases in intrahepatic cholangiocarcinoma, hilar (Klatskin tumor), middle and distal extrahepatic cholangiocarcinoma, gallbladder cancer, and ampullary carcinoma: Role of matrix metalloproteinases in tumor progression and prognosis
    (Aves, 2009) Kirimlioglu, Hale; Turkmen, Ilknur; Bassullu, Nuray; Dirican, Abuzer; Karadag, Nese; Kirimlioglu, Vedat
    Background/aims: Carcinomas of the biliary tree are rare tumors of the gastrointestinal tract, with an increasing incidence in recent years. Biliary neoplasms are classified into intra- and extrahepatic cholangiocarcinoma (Klatskin tumor, middle and distal extrahepatic tumors), gallbladder adenocarcinoma, and ampullary carcinoma. We aimed to determine the expression profile of matrix metalloproteinase (MMP)-2, MMP-9 and MMP-14 in the biliary neoplasms classified according to their localization and the relation with the prognosis. Methods: Ten gallbladder adenocarcinoma, 8 distal bile duct carcinomas (distal cholangiocarcinoma), 8 Klatskin tumors, 8 intrahepatic cholangiocarcinomas and 10 ampullary carcinomas were included in the study. The immunohistochemical expression of MMP-2, MMP-9 and MMP-14 was detected in the nontumoral, metaplastic, dysplastic and tumoral epithelia. The tumor differentiation, angiolymphatic and perineural invasion of the tumor, and presence of lymph node and distant metastasis were determined. Survey of the patients was noted from the patient follow-up data. Results: The nontumoral epithelia of the gallbladder, intrahepatic ducts, and Klatskin tumor did not express MMP-2. MMP-2 expression was detected in the distal part of the biliary ducts, in 7.5% (6118) of cases and in. the nontumoral epithelia of the ampullary region in 50% (5110) of cases. The metaplastic and dysplastic epithelia were positively stained in all of the gallbladder adenocarcinoma, distal cholangiocarcinoma and ampullary tumors. In the intrahepatic cholangiocarcinoma, the hepatocytes were positively stained but the infiltrative tumors were spared. Klatskin tumors were also not stained with MMP-2. The gallbladder adenocarcinoma, distal cholangiocarcinoma and ampullary carcinomas expressed MMP-2 in 30%, 37% and 40% of the cases, respectively. MMP-9 and MMP-14 were expressed in normal, inetaplastic, and dysplastic epithelium and tumoral cells in all of the cases of the groups. Expressions of MMAs were higher in subjects with neural invasion, but there was no correlation between MMP expression and tumor differentiation or angiolymphatic invasion. Conclusions: When tumors of the biliary system are divided as intrahepatic and extrahepatic cholongiocarcinomas, MMP-2 expression was present in the extrahepatic cholangiocarcinomas including gallbladder carcinomas. Like the intrahepatic cholangiocarcinoma, Klatskin. tumors also did not express MMP-2. This can be related with its characteristic growth pattern. MMP-9 and MMP-4 were present in metaplasia, dysplasia carcinoma sequence in all of the bile tract tumors, suggesting that MMPs play art important role in carcinogenesis. The higher expression of the MMPs with neural invasion suggests the significant role of those tumors in the invasion activity.
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    HEPATIC ARTERY THROMBOSIS IN 153 CONSECUTIVE LIVER TRANSPLANT RECIPIENTS PERFORMED IN YEAR 2008: A NEW SURGICAL TECHNIQUE.
    (John Wiley & Sons Inc, 2009) Kirimlioglu, Vedat; Yilmaz, Sezai; Nisanoglu, Vedat; Ara, Cengiz; Aydin, Cemalettin; Ozgor, Dincer; Kirimlioglu, Hale
    [Abstract Not Available]
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    IMPACT OF VENOUS DRAINAGE ON HISTOPATHOLOGY OF THE ANTERIOR SEGMENT OF RIGHT LIVING-RELATED LIVER GRAFTS
    (John Wiley & Sons Inc, 2008) Kirimlioglu, Vedat; Yilmaz, Sezau; Kirimlioglu, Hale; Yilmaz, Mehmet
    [Abstract Not Available]
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    Kaposi's sarcoma after liver transplantation from a donor with a history of ventriculoperitoneal shunt and craniotomy for primary central nervous system lymphoma: Report of a case
    (Springer, 2008) Isik, Burak; Yilmaz, Sezai; Kirimlioglu, Vedat; Kirimlioglu, Hale; Yilmaz, Mehmet; Sogutlu, Gokhan; Ara, Cengiz
    The transplantation of organs from donors who have undergone shunt surgery or craniotomy for a malignant central nervous system (CNS) tumor is controversial. We report a case of Kaposi's sarcoma (KS) developing as a result of immunosuppression in the recipient of a liver transplant from a donor who underwent craniotomy and ventriculoperitoneal shunt surgery for primary CNS lymphoma. Polymerase chain reaction assay did not isolate human herpes virus-8 in the Kaposi lesions. To our knowledge, this is the only case ever reported of KS developing after liver transplantation from a donor with lymphoma. Thus, with appropriate screening to exclude possible dissemination, patients with a history of high-grade primary CNS lymphoma treated by ventriculoperitoneal shunt and craniotomy may be accepted as donors.
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    LIVING DONOR LIVER TRANSPLANTATION FOR HEPATOCELLULAR CARCINOMA: TWO-CENTER PRELIMINARY RESULTS
    (John Wiley & Sons Inc, 2009) Tokat, Yaman; Yilmaz, Sezai; Kirimlioglu, Vedat; Kirimlioglu, Hale; Kayaalp, Cuneyt; Yuzer, Yildiray
    [Abstract Not Available]
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    Matrix metalloprotein expression in gastrointestinal stromal tumors
    (Springer, 2007) Kirimlioglu, Hale; Isik, Burak; Kirimlioglu, Vedat
    [Abstract Not Available]
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    Matrix metalloproteinase expression in nontumoral pancreas, pancreatic intraepithelial neoplasia and ductal pancreas carcinoma: Role in carcinogenesis and prognosis
    (Springer, 2007) Kirimlioglu, Hale; Kirimlioglu, Vedat; Yilmaz, Sezai
    [Abstract Not Available]
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    Ocular Surface and Dry Eye in Graves' Disease
    (Taylor & Francis Inc, 2011) Gurdal, Canan; Sarac, Ozge; Genc, Ipek; Kirimlioglu, Hale; Takmaz, Tamer; Can, Izzet
    Purpose: To evaluate the tear function tests and the ocular surface damage in Graves' disease (GD) patients either with or without thyroid associated orbitopathy (TAO). Methods: Forty-two eyes of 21 randomly selected patients with GD, and 30 eyes of 15 healthy subjects were included in this prospective study. The presence of TAO was evaluated clinically. The palpebral fissure height, degree of proptosis, ocular surface disease index (OSDI), Schirmer tear test, tear break-up time (TBUT), and conjunctival impression cytology were assessed. The results were first compared between the patient and the control groups. Results were then compared between the patients with TAO (group I) and without TAO (group II). Results: The mean OSDI score in the patient group was 44.79 +/- 11.83 and it was 21.17 +/- 9.89 in the control group (p = 0.001). The mean Schirmer tear test score was 14.4 +/- 8.32 mm and 24.9 +/- 3.57 mm in the patient and control group, respectively (p = 0.001). The mean TBUT in the patient group was 7.1 sec. In the control group it was significantly increased to 10 sec (p = 0.003). The mean proptosis and interpalpebral distance did not show any difference between the GD patients and controls (p > 0.05). The patients with GD showed significant ocular surface damage in which 75.71% had grade 2-3 squamous metaplasia in temporal interpalpebral conjunctiva. Twenty-four (57%) eyes composed group I. There were no differences in the mean OSDI score, Schirmer tear test score, TBUT, and the amount of ocular surface damage between group I and group II (p > 0.05). Conclusions: Dry eye findings and the ocular surface damage in GD were most likely associated with the ocular surface inflammation. Before the development of the classic findings of TAO, ocular surface inflammation can be the only presenting clinical sign in GD.
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    A Rare Benign Laryngeal Tumor: Angiomyolipoma
    (Lippincott Williams & Wilkins, 2010) Durgun, Yesim; Firat, Cigdem; Miman, Murat Cem; Kirimlioglu, Hale
    Angiomyolipoma is a mesenchymal neoplasm containing adipose tissue, blood vessels, and smooth muscle fibers. Arising most frequently in the kidney, the tumor may exceptionally be at the head and neck region. The literature has 1 single published report of laryngeal angiomyolipoma, which was resected through laryngofissure. In this study, a 58-year-old man presented with laryngeal angiomyolipoma with swallowing discomfort. The tumor was removed by an endolaryngeal approach.