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Öğe Angiographic Morphology of Anterior Communicating Artery Aneurysms and Their Association with Rupture Risk(Turkish Neurosurgical Soc, 2021) Kaya, Veysel; Kolu, Mehmet; Kaya, Ahmet Turan; Gezer, Mehmet; Sarac, Kaya; Tetik, Bora; Yildirim, Ismail OkanAIM: To estimate the rupture risk of anterior communicating artery (AComA) and AComA-related aneurysms according to their localization, angiographic architecture, and morphological features. MATERIAL and METHODS: In this study, 124 patients with AComA and AComA-related anterior system aneurysms were retrospectively evaluated. The aneurysms were classified according to their morphological appearance and angiographic architecture. The size, size ratio, angiographic architecture, and aneurysmal dome orientation of ruptured and non-ruptured aneurysms were compared using digital subtraction angiography (DSA) 3D images. RESULTS: There was a significant relationship between rupture risk and the size ratio (p=0.043), morphological properties of the aneurysm (p<0.001), aneurysm dome orientation (OR 1.29, 95% CI 1.32-6.818), and aneurysm type according to the angiographical architecture (p<0.005). CONCLUSION: In determining the rupture risk of AComA and AComA-related aneurysms, size alone is not a sufficient parameter with aneurysm morphology proving to be more efficacious. Grouping of aneurysms according to angioarchitecture, and its significant correlation with aneurysm rupture, may help to understand the underlying mechanisms in the formation and rupture of aneurysms. From this, more specific treatment protocols can be created, helping to improve the clinical evaluation of AComA aneurysms.Öğe Associating liver partition and portal vein ligation for staged hepatectomy for extensive alveolar echinococcosis: First case report in the literature(Baishideng Publishing Group Inc, 2018) Akbulut, Sami; Cicek, Egemen; Kolu, Mehmet; Sahin, Tevfik Tolga; Yilmaz, SezaiAlveolar echinococcosis (AE) is a zoonotic disease that is caused by Echinococcus multilocularis that affects liver and a variety of organs and tissues. It differs from other echinococcal disease because it shows tumor like behavior in the affected organ and tissues. The treatment of choice is concomitant medical therapy and resection with negative margins. Nevertheless, resection with the intent of negative margins (R0) may lead to serious complications such as liver failure. In the present case report, we used Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) procedure, which was defined in 2012 by Schnitzbauer et al, in a 28-year-old male patient to avoid complications of major liver resection in order to treat alveolar echinococcosis. Until now, we have not encountered any study using ALPPS procedure for the treatment of alveolar echinococcosis. In the present case report we aimed to show that ALPPS procedure can be safely performed for margin-negative resection of primary or recurrent AE that shows a tumor like behavior. It is our opinion that this procedure should be performed in centers that have expertise and sufficient technical capacity to perform liver transplantation and advanced liver surgery.Öğe Associating liver partition and portal vein ligation for staged hepatectomy for extensive alveolar echinococcosis: First case report in the literature(BAISHIDENG PUBLISHING GROUP INC, 8226 REGENCY DR, PLEASANTON, CA 94588 USA, 2018) Akbulut, Sami; Çiçek, Egemen; Kolu, Mehmet; Şahin, Tevfik Tolga; Yılmaz, SezaiAlveolar echinococcosis (AE) is a zoonotic disease that is caused by Echinococcus multilocularis that affects liver and a variety of organs and tissues. It differs from other echinococcal disease because it shows tumor like behavior in the affected organ and tissues. The treatment of choice is concomitant medical therapy and resection with negative margins. Nevertheless, resection with the intent of negative margins (R0) may lead to serious complications such as liver failure. In the present case report, we used Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) procedure, which was defined in 2012 by Schnitzbauer et al, in a 28-year-old male patient to avoid complications of major liver resection in order to treat alveolar echinococcosis. Until now, we have not encountered any study using ALPPS procedure for the treatment of alveolar echinococcosis. In the present case report we aimed to show that ALPPS procedure can be safely performed for margin-negative resection of primary or recurrent AE that shows a tumor like behavior. It is our opinion that this procedure should be performed in centers that have expertise and sufficient technical capacity to perform liver transplantation and advanced liver surgery.Öğe Canlı vericili karaciğer naklinde GD-EOB-DTPA enjeksiyonu sonrası elde edilen dinamik karaciğer MRG: Karaciğerin fonksiyonel rezervi ile postoperatif komplikasyonların karşılaştırılması(İnönü Üniversitesi, 2017) Kolu, MehmetAmaç: Gadolinyum-Ethoksibenzil-Dietilentriamin pentaasetik asit (Gd-EOB-DTPA) enjeksiyonu sonrası yapılan Manyetik Rezonans Görüntüleme (MRG) ile karaciğer fonksiyonel rezervini ve transplantasyon sonrası komplikasyonların hepatosit fonksiyonu üzerinde etkisini değerlendirmeyi amaçladık. Gereç ve Yöntem: Bu prospektif çalıĢmamız 30 karaciğer donörü ve bu dönörlerin 30 karaciğer alıcısı olmak üzere toplam 60 hasta içermekte olup donörlerin tümüne preoperatif dönemde, alıcıların tamamına ise postoperatif dönemde Gd-EOB-DTPA enjeksiyonu sonrası MRG incelemesi yapıldı. Ayrıca 11 alıcı hastasına preoperatif dönemde Gd-EOB-DTPA ile MRG incelemesi yapıldı. MRG görüntüleri iki ayrı radyolog tarafından bağımsız olarak değerlendirildi. Kantitatif MRG parametreleri olan karaciğer ortalama relative liver enhancement (RLE) değeri, biliyer sinyal değeri ve kalitatif MRG parametreleri olan karaciğer kontrastlanmasının vizüel değerlendirilmesi, biliyer sinyalin vizuel değerlendirilmesi elde edildi. Ayrıca alıcı hastalarının preoperatif dönemde Child-Pugh ve Model for End-stage Liver Disease (MELD) skorlaması ile postoperatif dönemde total bilirubin ve INR değerleri incelendi. MRG parametreleri, labaratuvar sonuçları ve skorlamalar istatistiksel olarak değerlendirildi. Bulgular: Kantitatif parametreler olan karaciğer ortalama RLE değeri, biliyer sinyal değeri, preoperatif alıcı hastalarında ve postoperatif komplikasyon gelişen alıcı hastalarında, donör ve postoperatif komplikasyon gelişmeyen alıcı hasta grubuna göre istatistiksel olarak anlamlı düşük saptandı (p<0,001). Kalitatif parametreler (karaciğer kontrastlanmasının vizüel değerlendirilmesi, biliyer sinyalin vizuel değerlendirilmesi) de preoperatif alıcı ve postoperatif komplikasyon gelişen alıcı hasta gruplarında, donör ve postoperatif komplikasyon gelişmeyen alıcı hasta grubuna göre istatistiksel olarak anlamlı düşük saptandı (p<0,001). Ayrıca postoperatif dönemde bilirubin değerleri ile RLE ve biliyer sinyal değerleri arasında negatif korelasyon saptandı (p=0.005, r=-0.496 p<0,001, r=-0.624). INR değerleri ile bu MRG parametreleri arasında ise korelasyon saptanmadı (p=0.837, p=0.813). Sonuç: Karaciğer fonksiyonel rezervini ve karaciğer transplantasyonu sonrası gelişebilecek komplikasyonların greft fonksiyonu üzerindeki etkisini belirlemede, gadoksetik asit ile elde edilen MRG parametrelerinin önemli bir potansiyele sahip olabileceğini düşünmekteyizÖğe Coexistence of duodenum derived aggressive fibromatosis and paraduodenal hydatid cyst: A case report and review of literature(Baishideng Publishing Group Inc, 2018) Akbulut, Sami; Yilmaz, Mehmet; Alan, Saadet; Kolu, Mehmet; Karadag, NeseIntra-abdominal aggressive fibromatosis is a locally aggressive tumor mostly originating from the mesentery or retroperitoneal space, infiltrating adjacent tissues, and very rarely metastasizing to distant organs. There are only two case reports in the English language literature where intra-abdominal aggressive fibromatosis originated from the intestinal wall. In this study, we aimed to report a case of aggressive fibromatosis originating from the muscularis propria layer of the duodenum and invading pancreas. Another interesting aspect of this case is that a primary paraduodenal hydatid cyst was incidentally detected in the surgical specimen. A 46-year-old female patient presented to our clinic with postprandial nausea and vomiting. A contrast-enhanced abdominal computerized tomography revealed a mass lesion with a size of 100 mm x 80 mm which originated from the distal pancreas and compressed the gastric pilor externally. Upon exploration the distal part of duodenum, proximal jejunum, and pancreatic mass were noted to form a conglomerated structure. Therefore, the fourth part of the duodenum, a 25 cm part of the proximal jejunum, distal pancreas, and the spleen were excised en-bloc. The pathology report of the specimen indicated fibromatosis with a diameter of 55 mm that originated from the muscularis propria of the duodenum and extended into the pancreatic parenchyma. There was also an incidentally detected 10 mm paraduodenal hydatid cyst. No tumor recurrence was detected at a follow-up period of 24 mo. In conclusion, the most ideal treatment of desmoid-type fibromatosis is surgical resection of the mass lesion with clean surgical borders. Although rare, this tumor may originate from the intestinal wall. Histopathological verification is of great significance for a proper diagnosis.Öğe Coexistence of duodenum derived aggressive fibromatosis and paraduodenal hydatid cyst: a case report and review of literature(World journal of gastroıntestınal surgery, 2018) Akbulut, Sami; Yilmaz, Mehmet; Alan, Saadet; Kolu, Mehmet; Karadag, NeseIntra-abdominal aggressive fibromatosis is a locally aggressive tumor mostly originating from the mesentery or retroperitoneal space, infiltrating adjacent tissues, and very rarely metastasizing to distant organs. There are only two case reports in the English language literature where intra-abdominal aggressive fibromatosis originated from the intestinal wall. In this study, we aimed to report a case of aggressive fibromatosis originating from the muscularis propria layer of the duodenum and invading pancreas. Another interesting aspect of this case is that a primary paraduodenal hydatid cyst was incidentally detected in the surgical specimen. A 46-year-old female patient presented to our clinic with postprandial nausea and vomiting. A contrast-enhanced abdominal computerized tomography revealed a mass lesion with a size of 100 mm x 80 mm which originated from the distal pancreas and compressed the gastric pilor externally. Upon exploration the distal part of duodenum, proximal jejunum, and pancreatic mass were noted to form a conglomerated structure. Therefore, the fourth part of the duodenum, a 25 cm part of the proximal jejunum, distal pancreas, and the spleen were excised en-bloc. The pathology report of the specimen indicated fibromatosis with a diameter of 55 mm that originated from the muscularis propria of the duodenum and extended into the pancreatic parenchyma. There was also an incidentally detected 10 mm paraduodenal hydatid cyst. No tumor recurrence was detected at a follow-up period of 24 mo. In conclusion, the most ideal treatment of desmoid-type fibromatosis is surgical resection of the mass lesion with clean surgical borders. Although rare, this tumor may originate from the intestinal wall. Histopathological verification is of great significance for a proper diagnosis.Öğe Determination of Absence of Right Internal Jugular Vein During Ultrasonographic Guided Central Venous Cannulation(Aves, 2017) Erdogan, Mehmet Ali; Colak, Yusuf Ziya; Kacmaz, Osman; Kolu, Mehmet; Toprak, Huseyin Ilksen[Abstract Not Available]Öğe Efficiency of mechanical thrombectomy in acute ischemic stroke patients(2020) Kolu, Mehmet; Yıldırım, İsmail Okan; Turan Kaya, Ahmet; Kamışlı, Suat; Kaplan, Yüksel; Durak, Mehmet Akif; Gürbüz, Şükrü; Saraç, KayaAbstract: The aim of this single-center study is to assess the outcomes in patients with acute ischemic stroke underwent endovascular mechanical thrombectomy. The data and outcome of patients who were admitted due to acute ischemic stroke caused by a large vessel occlusion in the anterior or posterior circulation and treated with endovascular stent retriever mechanical thrombectomy between 2014 and 2018 were retrospectively evaluated. Recanalization success was assessed based on Thrombolysis in Cerebral Infarction (TICI) scores, and the TICI grades 2b and 3 were considered as ‘successful’. Functional outcomes of the patients were assessed by modified Rankin Scale (mRS) at the 3rd month follow up and a score of ?2 points was considered as ‘good clinical outcome’. Successful recanalization was achieved in 34 patients (69%). At the 3rd month follow-up, 23 patients (46,9%) had mRS scores of ?2 points. The overall mortality rate at the 90th day was %30 (n=15). After endovascular thrombectomy, symptomatic intracranial hemorrhage was seen in 9 patients, groin hematoma due to vascular access in 5 patients, which did not require additional treatment, and pseudoaneurysm in 3 patients. Stent retriever mechanical thrombectomy is an effective and safe procedure in patients admitted due to acute ischemic stroke caused by large vessel occlusion.Öğe Endovascular treatment of ruptured anterior circulation aneurysms within 24 hours: Clinical and angiographic results(2020) Kolu, Mehmet; Cigdem, Gulyara; Dere, Osman; Kaya, Veysel; Yildirim, Ismail Okan; Sarac, KayaAim: In this study, angiographic and clinical results after endovascular treatment were evaluated in patients with a ruptured brain aneurysm.Materials and Methods: A total of 32 patients, who admitted to the hospital between May 2018 and January 2020 due to aneurysmal subarachnoid hemorrhage (SAH), were included in the study. Cranial digital subtraction angiography (DSA) imaging was performed within the first 24 hours to patients with SAH detected on computed tomography and endovascular embolization was performed in 32 patients, who were considered as suitable for endovascular treatment. The pretreatment clinical scorings of the patients were evaluated according to the Hunt-Hess scale. Aneurysm occlusion was performed according to the Raymond-Ray classification. The patients were evaluated with the clinical outcome modified ranking scale (mRS) during their follow-up periods.Results: The endovascular treatment was successfully performed in all patients. In the first angiograms for control purposes after embolization, it was seen that the aneurysms were completely closed (RR1) in 81.25%, partial neck remained (RR2) in 12.5%, and the aneurysms were closed incompletely (RR3) in 6.25% of the patients. Intraprocedural complications developed in five patients (15.6%). There was an aneurysmal rupture in 1 patient (3.1%) and thromboembolic complications in 4 patients (12.5%). The procedure-related morbidity and mortality rates were 9.3% and 3.1%, respectively. No patients had postprocedural hemorrhagic complications. In the 3rd month, mRS was 0 in 21 (65.6%) patients, 1 (3.1%) in 1 patient, and 2 (6.25%) in 2 patients. A total of 11 (34.3%) patients died. A second procedure was performed in 2 (6.25%) of the patients who were followed because there was an RR3 residue.Conclusion: The endovascular embolization process can be applied in the treatment of intracranial aneurysms causing subarachnoid hemorrhage, and it is a safe and effective treatment method.Öğe Endovascular treatment of ruptured anterior circulation aneurysms within 24 hours: Clinical and angiographic results(2020) Kolu, Mehmet; Çiğdem, Gulyara; Dere, Osman; Kaya, Veysel; Yıldırım, İsmail Okan; Saraç, Kayaaneurysm.Materials and Methods: A total of 32 patients, who admitted to the hospital between May 2018 and January 2020 due to aneurysmalsubarachnoid hemorrhage (SAH), were included in the study. Cranial digital subtraction angiography (DSA) imaging was performedwithin the first 24 hours to patients with SAH detected on computed tomography and endovascular embolization was performed in32 patients, who were considered as suitable for endovascular treatment. The pretreatment clinical scorings of the patients wereevaluated according to the Hunt-Hess scale. Aneurysm occlusion was performed according to the Raymond-Ray classification. Thepatients were evaluated with the clinical outcome modified ranking scale (mRS) during their follow-up periods.Results: The endovascular treatment was successfully performed in all patients. In the first angiograms for control purposes afterembolization, it was seen that the aneurysms were completely closed (RR1) in 81.25%, partial neck remained (RR2) in 12.5%, and theaneurysms were closed incompletely (RR3) in 6.25% of the patients. Intraprocedural complications developed in five patients (15.6%).There was an aneurysmal rupture in 1 patient (3.1%) and thromboembolic complications in 4 patients (12.5%). The procedure-relatedmorbidity and mortality rates were 9.3% and 3.1%, respectively. No patients had postprocedural hemorrhagic complications. In the3rd month, mRS was 0 in 21 (65.6%) patients, 1 (3.1%) in 1 patient, and 2 (6.25%) in 2 patients. A total of 11 (34.3%) patients died. Asecond procedure was performed in 2 (6.25%) of the patients who were followed because there was an RR3 residue.Conclusion: The endovascular embolization process can be applied in the treatment of intracranial aneurysms causing subarachnoidhemorrhage, and it is a safe and effective treatment method.Öğe Evaluation of risk factors of diagnostic failure in fine needle biopsy in pulmonary nodules; conventional computed tomography versus computed tomography flouroscopy(2020) Kolu, Mehmet; Yıldırım, İsmail OkanAbstract: Aim of this study was to determine the risk factors of diagnostic failure of o fine needle aspiration biopsy (FNAB) procedures under the guidance of conventional computed tomography (CCT) and CT fluoroscopy (CTF) comparing their diagnostic performance by single operator in pulmonary lesions. Total of 241 patients underwent FNAB procedure (123 CCT guided and 118 CTF-guided). All pulmonary nodules were classified by size (?10 mm, 11-20 mm, 21-30 mm and >30 mm) and diagnostic yield was calculated according to the lesion size. Independent risk factors for diagnostic performance of CCT and CTF-guided FNAB were determined using multivariate logistic regression analysis. Sensitivity, specificity, PPV, NPV, and diagnostic accuracy of CCT-guided FNAB were 88.2%, 100%, 100%, 70%, and 90.7%, respectively. For CTF-guided FNAB were 91.4%, 100%, 100%, 79.4%, and 93.5%, respectively. In multivariate logistic regression analysis, small lesions (OR 1,096; 95% CI, 1.045- 1.148 p<0.001) and lesions without pleural contact (OR 1.661; 95% CI, 1.414-1,951 p<0.001) were found to be significant independent risk factors for CCT-guided FNAB procedure. No independent risk factor was determined for CTF-guided FNAB. Small nodule size and lack of contact with pleura are independent risk factors associated with diagnostic failure and may decrease diagnostic accuracy of CCT Guided FNAB. However, real-time imaging capability of CT fluoroscopy increases diagnostic accuracy in difficult pulmonary nodules.Öğe Karaciğer Nakil Alıcısı Bir Çocuk Olguda Santral Venöz Katetere Bağlı Gelişen Venöz Stenoz(2017) Erdoğan, Mehmet Ali; Çolak, Yusuf Ziya; Kaçmaz, Osman; Kolu, Mehmet; Toprak, Hüseyin İlksenÖz: Santral venöz kateterizasyon klinik pratikte yaygın olarak uygulamaktadır. Santral venöz kateterizasyonun trombotik, stenotik ve infeksiyöz komplikasyonları yaşamı tehdit edicidir. Kronik hemodiyaliz hastalarının %5 ile 50'sinde subkalvien vende stenoz oluştuğu bildirilmiştir. Özellikle yetişkinlerden daha küçük çapta damarlara sahip olduklarından çocuklarda santral kateterler, venöz stenoz riski taşıdığı düşünülmektedir. Bu sunuda, yaklaşık 30 gün önce karaciğer nakli nedeniyle opere olan ve sağ internal jugüler veninin normal olduğu görülen çocuk olguda, geçici santral venöz katater sonrasında gelişen venöz stenozu sunmayı amaçladık. Santral venöz kanülasyonun önemli bir komplikasyonu olan venöz stenozun geçici kanülasyon sonrasında ve kısa süre sonra gelişebileceği, ayrıca USG rehberliği ile bunun kolayca belirlenemeyeceğini gördükÖğe Living Liver Donor With Fasciola Hepatica: First Case Report in the Literature(Baskent Univ, 2021) Akbulut, Sami; Sahin, Tevfik Tolga; Kolu, Mehmet; Isik, Burak; Bayindir, Yasar; Yilmaz, SezaiThe major advantage of preoperative magnetic resonance cholangiopancreatography is that living liver donor candidates with complicated biliary tracts may not be exposed to unnecessary laparotomy. To the best of our knowledge, the case presented here features a condition so far not seen by the Liver Transplantation Society. A 27-year-old woman who presented to our clinic as a living liver donor candidate was evaluated but did not have a preoperative magnetic resonance cholangiopancreatography due to technical factors. After parenchymal transection, the right hepatic duct was incised just distal to the bifurcation when 8 fasciola hepatica parasites left the orifice of the remnant bile duct. The common bile duct was then irrigated, and the remnant bile duct orifice was closed, followed by a cholangiography, which showed no suspicious lesions in the biliary tracts. In addition, no suspicious lesions were identified during the postoperative cholangiography of the graft implanted in the recipient. The donor and recipient had postoperative enzyme-linked immunosorbent assay immunoglobulin G antibody titers of 12 and 4 U/mL (cutoff value = 10) for fasciola hepatica, respectively. Both the recipient and the donor received 2 doses of triclabendazole (10 mg/kg) during the postoperative period.Öğe Ultrason Rehberliğinde Yapılan Santral Venöz Kanülasyon Sırasında Sağ İnternal Jugüler Ven Yokluğunun Tespiti(Turkish Journal of Anaesthesiology and Reanimation, 2017) Erdoğan, Mehmet Ali; Çolak, Yusuf Ziya; Kaçmaz, Osman; Kolu, Mehmet; Toprak, Hüseyin İlksenYıl: 2017Cilt: 45Sayı: 3ISSN: 2667-677XSayfa Aralığı: 179 - 180 Metin Dili: Türkçe Öz: Başlık ( ): Determination of Absence of Right Internal Jugular Vein During Ultrasonographic Guided Central Venous Cannulation Öz ( ):Öğe Y-stent assisted coiling of ruptured wide neck intracranial aneurysm in the acute phase(Sage Publications Inc, 2021) Yildirim, Ismail Okan; Kolu, Mehmet; Durak, Mehmet Akif; Tetik, Bora; Pasahan, Ramazan; Gurbuz, Sukru; Sarac, KayaBackground The objective of the present study is to analyze the outcomes of patients with subarachnoid hemorrhage (SAH) in the acute phase after treatment with Y-stent-assisted coiling (YSAC) embolization. Methods This retrospective study assessed of 30 patients with acutely ruptured wide-neck aneurysms following YSAC treatment between April 2013 and October 2019. The demographic data, aneurysm occlusion grade, procedural and periprocedural complications, and clinical outcomes were assessed. Results The procedure was completed in 30 cases (90.1%) and technical failure occurred in 3 cases (9.1%). Immediate control angiography revealed that total occlusion Raymond-Ray Class 1 (RR1) was achieved in 21 (70%), neck filling (RR2) in eight (26.6%) and sac filling (RR1) in one (3.3%) aneurysm. Upon angiographic follow-up, RR1 occlusion was observed in 15 (71.4%) patients, RR2 in three (14.3%) patients and RR3 in three (14.3%) patients. In-stent thrombus developed in five (16.6%) patients; procedural ischemic events were observed in four (13.3%) patients; and two (6.6%) patients were symptomatic. A periprocedural asymptomatic intracranial hemorrhage was detected in two patients. At discharge, 17 (56.6%) patients were in good clinical condition, six (20%) were in a severe disability condition, and seven (23.3%) patients had died. At the final follow-up visit (mean: 18.9 months), 16 (76,2%) of 21 patients were in a good clinical condition and five (23.8%) had severe disabilities. Conclusions Y-stent assisted coiling in might be a feasible and promising option for treatment in acute phase in selected wide-necked ruptured intracranial aneurysms.
