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    The Effects of BMI on Respiratory and Hemodynamic Parameters in Laparoscopic Bariatric Surgery: An Observational Study
    (Mary Ann Liebert, Inc, 2019) Ayyildiz, Ayse; Pamuk, Gulsun A.; Uzumcugil, Filiz; Akca, Basak; Yilbas, Aysun A.; Sahin, Tolga; Ozmen, Mahir
    Background: Previous reports addressing morbidly obese patients grouped body mass indexes (BMIs) within wide ranges, such as >40 or 40-60 kg/m(2). We aimed to investigate whether the effects of pneumoperitoneum differ in narrow ranged subgroups of BMI in morbidly obese patients. Materials and Methods: Eighteen to 65 year-old, ASA I-II 75 patients were included. The subgroups of BMI were 40 <= x < 45, 45 <= x < 50, and >= 50 kg/m(2). Plato pressure (Pp), peak inspiratory pressure, and etCO(2) were recorded beside vital parameters. Dynamic compliances (C-dyn = Vt/PIP-PEEP) were calculated. Arterial blood gases were obtained before pneumoperitoneum (t(1)), at the end of pneumoperitoneum before desufflation (t(2)), and after desufflation (t(3)). Results: Pneumoperitoneum caused similar alterations in hemodynamic parameters and respiratory mechanics in Group I (n = 24), II (n = 28) and III (n = 23). Pp at t(1) and t(2) was significantly higher in Group II and III (p < 0.017). Cdyn were significantly lower at t(1) and t(2) in Group III (p < 0.01). The number of patients who required adjustments during pneumoperitoneum was significantly higher in Group III (p < 0.01). Conclusion: The Cdyn and airway pressures in laparoscopic bariatric surgery revealed statistically significant difference between BMI >= 50 kg/m(2) and BMI of 40 <= x < 45 kg/m(2). We suggest that BMIs of 40 <= x < 45 and >= 50 kg/m(2) should not be described in one group, but grouped separately in future studies addressing respiratory mechanics.
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    Evaluation of relationships between clinical and radiological characteristics and tumor markers in hepatocellular carcinoma
    (2019) Oral, Alihan; Sahin, Tolga
    Aim: The aim of this study was to evaluate AFP, CEA and CA 19-9 levels in patients with HCC and non-HCC cirrhosis, and also to investigate the relationship between tumor radiological and clinical characteristics and these markers.Material and Methods: 572 patients with cirrhosis who were followed for cirrhosis between January 2010 and January 2019 in the gastroenterology outpatient clinic of Demiroglu Bilim University Faculty of Medicine were included in the study. Demographic (age, gender, BMI), laboratory (AFP, CEA, CA 19-9) and imaging findings of the cases were retrospectively screened and recorded. The patients were divided into two main groups as HCC and without HCC.Results: In the study, 252 patients were HCC and 320 patients were non-HCC. AFP values and male gender ratio were higher in HCC group, whereas CEA and CA 19-9 values were similar between the two groups. (respectively, p 0.001; p 0.013; p=0.157; p=0.294). A significant positive correlation was found between tumor size and AFP levels, but no correlation was found between CEA and CA 19-9 and tumor sizes. (for AFP r=0.202, p 0.001). CEA level was significantly higher in patients with macrovascular invasion (p =0,011). Conclusion: In our study, positive correlation was found between tumor size and AFP levels in patients with HCC, and a significant correlation was found between CEA and macrovascular invasion. Our study showed that AFP and CEA are valuable markers that can be used to determine prognosis and survival in HCC patients.
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    LIVING DONOR LIVER TRANSPLANTATION FOR GIANT HEMANGIOMA
    (Wiley, 2019) Ince, Volkan; Sahin, Tolga; Ersan, Veysel; Ara, Cengiz; Yilmaz, Sezai
    [Abstract Not Available]
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    Microvascular Venous Invasion in Hepatocellular Carcinoma: Why Do Recurrences Occur?
    (Springer, 2020) Isik, Burak; Gonultas, Fatih; Sahin, Tolga; Yilmaz, Sezai
    Purpose Hepatocellular carcinoma is the most common primary cancer of the liver. It is almost always associated with cirrhosis and it is usually diagnosed in later stages of the disease. Furthermore, recurrence rate following liver transplantation ranges between 15 and 30%. The most important factor determining the recurrence is vascular invasion. Methods In this review, the issue of microvascular invasion causing hepatocellular carcinoma recurrence is reviewed. Macroscopic vascular invasion is almost easy to diagnose on radiologic evaluation. However, microscopic vascular invasion is almost always diagnosed with pathologic evaluation. On the other hand, microscopic vascular invasion is associated with early recurrences and reduced disease-free survival. The type of vessel that is invaded determines the nature of the spread of the tumor cells. Invasion of the hepatic venous tributaries leads to systemic metastasis whereas portal venous invasions lead to intrahepatic spread of the tumor. Microscopic vascular invasion should be diagnosed before liver transplantation or liver resection in order to deliver the appropriate therapy to the patients. Results Yet, there is no ideal marker to suggest microscopic vascular invasion before any intervention. Markers such as alpha-fetoprotein, des carboxy prothrombin, or gamma-glutamyl transferase have been found to be correlated with microscopic vascular invasion. These parameters are not very efficient to be used in routine clinical practice. Conclusion Therefore, further research is needed to define ideal marker associated with microscopic vascular invasion.
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    Preoperative evaluation of liver volume in living donor liver transplantation
    (Kare Publ, 2018) Baskiran, Adil; Kahraman, Aysegul Sagir; Cicek, Ipek Balikci; Sahin, Tolga; Isik, Burak; Yilmaz, Sezai
    OBJECTIVE: The aim of the present study was to retrospectively evaluate the difference between the preoperative estimated volume and the actual intraoperative graft volume determined in donor right hepatectomies and to evaluate the possible effect of age, gender, and body mass index on the difference. METHODS: A total of 225 donor hepatectomies performed at the center between 2016 and 2017 were evaluated for the study. Left hepatectomies and left lateral segmentectomies were excluded from the analysis. As a result, 174 donor right hepatectomies were included in the study. Volumetric analysis was performed with dynamic hepatic computed tomography (CT), including non-contrast analysis, followed by non-ionic, contrast-enhanced arterial, portal, and hepatic-phase, thin-slice scanning. Volumetric analysis was performed based on the CT images using automatic volume calculating software. RESULTS: The mean preoperatively estimated graft volume was 800 +/- 112 g and the mean intraoperatively measured actual graft volume was 750 +/- 131 g. There was a statistically significant difference (p=0.003). Age and body mass index had a significant impact on the discrepancy between the predicted and actual graft volume, while gender did not. CONCLUSION: A thorough preoperative evaluation of the donor graft volume should be performed in order to prevent donor morbidity and mortality, as well as small-for-size and large-for-size phenomena in the implanted grafts. Physicians working in the field of transplantation should be aware of the fact that a difference of 10% between the predicted and the actual graft volume is usually encountered.
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    Psychosocial Outcomes of Donors Whose Recipients Died After Living Donor Liver Transplantation
    (Springer, 2020) Ispir, Mukadder; Cumhur, Birgul; Sahin, Tolga; Otan, Emrah; Kayaalp, Cuneyt; Yilmaz, Sezai
    Purpose Our aim was to investigate the psychosocial outcomes of the donors whose recipients died after living donor liver transplantation (LDLT). Methods Forty-one donors whose recipients died and 87 donors whose recipients were alive after LDLT at Inonu University Liver Transplantation Institute between 2012 and 2017 were included into the study. Demographic data form, Beck anxiety scale, Beck depression scale, Beck Hopelessness Scale, Posttraumatic Growth Inventory, Decision Regret Scale, Multidimensional Scale of Perceived Social Support, and general evaluation questionnaire (24 questions) were used in all donors by face to face questioning. In addition to the descriptive statistical analysis, chi-square and student'sttests were used to evaluate the differences between the groups. Results Recipient death after living donor liver transplantation is a factor that negatively increases the level of anxiety, depression, hopelessness levels, and repentance of donors, and adversely affects the psychological growth of the donors after donation experience. Conclusion Regular follow-up of the donors should be done psychosocially in the postoperative period, especially the donors whose recipients have died should be followed up more frequently, and their support and treatment should be provided when needed. The donors should also be informed about the psychosocial implications of operative management and postoperative period. More studies are needed regarding the psychosocial problems of the donors.
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    The safety of alpha fetoprotein in diagnosis of hepatocellular carcinoma in patients with type 2 diabetes mellitus
    (2019) Sahin, Tolga; Kocak, Erdem
    Aim: Diabetes mellitus is closely associated with many types of cancer including hepatocellular carcinoma (HCC). Alpha feto protein is still used as a biomarker for HCC worldwide but relation between type 2 diabetes mellitus (T2DM) and AFP is unclear. We aimed to investigate relations between AFP, T2DM and metabolic markers in this study.Material and Methods: 208 HCC patients were enrolled to study. 50 patients had T2DM (T2DM+HCC) and 158 patients were non-diabetic (NDM+HCC). 50 healthy people enrolled to the study as control group. Serum AFP levels were compared between healthy control group, T2DM+HCC group and NDM+HCC group. Serum AFP levels were compared with age, BMI, HgbA1c, fasting plasma glucose level (FPG), serum insulin level and insulin resistance (HOMA-IR).Results: AFP levels were higher in T2DM + HCC group patients according to healthy control group (p0,01). Mean AFP level was 201.97 ± 1093,89 in NDM + HCC group and 43.73 ± 85.67 in T2DM + HCC group. AFP levels were significantly higher in NDM + HCC group according to T2DM + HCC group (p0.05). Serum AFP levels were negatively correlated with increasing age and FPG (p0.05). Conclusion: HCC is an aggressive tumour that usually develops on cirrhotic liver and AFP levels are important for the diagnosis of HCC. Our study showed AFP levels could be significantly lower in the presence of T2DM. This study showed AFP could not be a reliable marker in cirrhosis for screening or diagnosis of the HCC in patients with T2DM.
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    What Are the Immune Obstacles to Liver Xenotransplantation Which Is Promising for Patients with Hepatocellular Carcinoma?
    (Springer, 2020) Yilmaz, Sezai; Sahin, Tolga; Saglam, Kutay
    Purpose Liver transplantation is the most important achievement in the twentieth and twenty-first century. It is the gold standard treatment for hepatocellular carcinoma. However, it provides the best results when performed under strict selection criteria. Nevertheless, organ supply is overwhelmed by the number of patients on the waiting list. There are certain strategies to expand the donor pool such as split liver transplantation, use of extended criteria donors, and living donor liver transplantation. Xenotransplantation can also be a strategy in decreasing the organ shortage. We reviewed the current status of xenotransplantation. Methods We evaluated the historical attempts of xenotransplantation to humans and also made a summary of the preclinical studies in the field. Results Molecular biology and genetic engineering are developing with an incredible speed. There are great achievements made in cell therapy, 3D bioprinting of the organs, and ultimately xenotransplantation. There is a vast amount of problems to be handled before evaluating the efficacy of xenotransplantation in the treatment of hepatocellular carcinoma. Major problems include antibody-mediated rejection to antigens such as galactose alpha 1-3 galactose, N- glycolylneuraminic acid, beta 1,4-Nacetylgalactosaminyltransferase, lethal thrombocytopenia, and erythrocyte sequestration. Antibody mediated rejection to these specific antigens are addressed using gene editing technology including CRISPR Cas9, TALEN and other recombination methods. Although hyperacute rejection is reduced, long-term survival could not be achieved in experimental models. Conclusion The future is yet to come, there are developments made in the field of genetic editing, immunosuppressive medication, and pretransplant desensitization techniques. Therefore, we believe that xenotransplantation will be in clinical practice, at least for treatment of critically ill patients.