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Öğe Assessment of Liver Regeneration in Patients Who Have Undergone Living Donor Hepatectomy for Living Donor Liver Transplantation(Mdpi, 2023) Satilmis, Basri; Akbulut, Sami; Sahin, Tevfik Tolga; Dalda, Yasin; Tuncer, Adem; Kucukakcali, Zeynep; Ogut, ZekiBackground: Inflammation and the associated immune pathways are among the most important factors in liver regeneration after living donor hepatectomy. Various biomarkers, especially liver function tests, are used to show liver regeneration. The aim of this study was to evaluate the course of liver regeneration following donor hepatectomy (LDH) by routine and regeneration-related biomarkers. Method: Data from 63 living liver donors (LLDs) who underwent LDH in Inonu University Liver Transplant Institute were prospectively analyzed. Serum samples were obtained on the preoperative day and postoperative days (POD) 1, 3, 5, 10, and 21. Regenerative markers including alfa-fetoprotein (AFP), des carboxy prothrombin (DCP), ornithine decarboxylase (ODC), retinol-binding protein 4 (RBP4), and angiotensin-converting enzyme isotype II (ACEII) and liver function tests including alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP) and total bilirubin levels were all analyzed. Results: The median age of the LLDs was 29.7 years and 28 LLDs were female. Eight LLDs developed postoperative complications requiring relaparotomy. The routine laboratory parameters including AST (<0.001), ALT (<0.001), ALP (<0.001), and total bilirubin (<0.001) showed a significant increase over time until postoperative day (POD) 3. For the regeneration-related parameters, except for the RBP4, all parameters including ACEII (p = 0.006), AFP (p = 0.002), DCP (p = 0.007), and ODC (p = 0.002) showed a significant increase in POD3. The regeneration parameters showed a different pattern of change. In right-lobe liver grafts, ACEII (p = 0.002), AFP (p = 0.035), and ODC (p = 0.001) showed a significant increase over time. DCP (p = 0.129) and RBP4 (p = 0.335) showed no significant changes in right-lobe liver grafts. Conclusions: Regenerative markers are increased in a sustained fashion following LDH. This is more prominent following right-lobe grafts which are indicative of progenitor-associated liver regeneration.Öğe Concomittant Liver Transplantation and Low Anterior Resection in Patient with Neuroendocrine Tumor and Chronic Hepatitis B Infection(Springer, 2022) Tuncer, Adem; Ogut, Zeki; Usta, Sertac; Akbulut, Sami; Sahin, Tevfik Tolga; Yilmaz, Sezai[Abstract Not Available]Öğe Coronavirus Precautions: Experience of High Volume Liver Transplant Institute(Aves, 2022) Baskiran, Adil; Akbulut, Sami; Sahin, Tevfik Tolga; Tuncer, Adem; Kaplan, Kuntay; Bayindir, Yasar; Yilmaz, SezaiBackground: To present the struggle of a high volume liver transplant center against coronavirus infectious disease-2019 pandemic. Methods: Between March 2020 and December 2020, the demographic and clinical data of staff and liver transplant candidates diagnosed with coronavirus infectious disease-2019 in our Liver Transplant Institute were prospectively analyzed. Results: First, 32 healthcare staff were diagnosed with coronavirus infectious disease-2019, and 6 of them were surgeons. Six staff were asymptomatic, while 24 staff had mild or moderate and 2 staff had severe coronavirus infectious disease-2019. All the staff recovered from the disease without any permanent sequela and returned to duty after 2 consecutive negative polymerase chain reaction results within 24-hour intervals. Second, during the preoperative investigation, 6 living liver donor candidates and 13 recipients were tested positive for coronavirus infectious disease-2019 (son = 6, unrelated = 3, cousin = 3, daughter = 2, cadaveric = 1). Eleven patients received favipiravir and 8 did not receive any treatment because they were asymptomatic. Only one recipient who had severe coronavirus infectious disease-2019 died due to multiple organ failure syndrome. One recipient died in the early postoperative period. The median duration from the initial diagnosis of the patients till the transplant procedure was 21-days (min-max: 14-105 days). During the time of operation, the polymerase chain reaction tests of the donors and the recipients were negative, and the thorax tomography images showed no signs of viral pneumonia. Conclusion: Meticulous precautions, multidisciplinary approach, team effort, and organization of facilities can increase the quality of care of these patients in the coronavirus infectious disease-2019 era. Healthcare workers have shown tremendous effort and are the true heroes of this era.Öğe Ectopic liver tissue (choristoma) on the gallbladder: A comprehensive literature review(Baishideng Publishing Group Inc, 2020) Akbulut, Sami; Demyati, Khaled; Ciftci, Felat; Koc, Cemalettin; Tuncer, Adem; Sahin, Emrah; Karadag, NeseBACKGROUND Liver tissue situated outside the liver with a hepatic connection is usually called an accessory liver, and that without a connection to the mother liver, is called ectopic liver tissue. AIM To identify studies in the literature on ectopic liver tissue located on the gallbladder surface or mesentery. METHODS We present two patients and review published articles on ectopic liver tissue located on the gallbladder surface accessed via PubMed, MEDLINE, Google Scholar, and Google databases. Keywords used included accessory liver lobe, aberrant liver tissue, ectopic liver tissue, ectopic liver nodule, heterotopic liver tissue, hepatic choristoma, heterotopic liver tissue on the gallbladder, and ectopic liver tissue on the gallbladder. The search included articles published before June 2020 with no language restriction. Letters to the editor, case reports, review articles, original articles, and meeting presentations were included in the search. Articles or abstracts containing adequate information on age, sex, history of liver disease, preliminary diagnosis, radiologic tools, lesion size, surgical indication, surgical procedure, and histopathological features of ectopic liver tissue were included in the study. RESULTS A total of 72 articles involving 91 cases of ectopic liver tissue located on the gallbladder surface or mesentery were analyzed. Of these 91 patients, 62 were female and 25 were male (no gender available for 4 patients), and the age range was 5 d to 91 years. Forty-nine patients underwent surgery for chronic cholecystitis or cholelithiasis, and 14 patients underwent surgery for acute cholecystitis. The remaining 28 patients underwent laparotomy for other reasons. Cholecystectomy was laparoscopic in 69 patients and open in 11 patients. The remaining 19 patients underwent various other surgical procedures such as autopsy, liver transplantation, living donor hepatectomy, Whipple procedure, and liver segment V resection. Histopathologically, hepatocellular carcinoma was detected in the ectopic liver tissue of one patient. CONCLUSION Ectopic liver tissue is a rare developmental anomaly which is usually detected incidentally. Although most studies suggest that ectopic liver located outside the gallbladder has a high risk of hepatocellular carcinoma, this is not reflected in statistical analysis.Öğe Effect of COVID-19 Pandemic on Patients Who Have Undergone Liver Transplantation: Retrospective Cohort Study(Mdpi, 2023) Akbulut, Sami; Yagin, Fatma Hilal; Sahin, Tevfik Tolga; Garzali, Ibrahim Umar; Tuncer, Adem; Akyuz, Musap; Bagci, NazlicanBackground: In liver transplant (LT) recipients, immunosuppressive therapy may potentially increase the risk of severe COVID-19 and may increase the mortality in patients. However, studies have shown conflicting results, with various studies reporting poor outcomes while the others show no difference between the LT recipients and healthy population. The aim of this study is to determine the impact of the COVID-19 pandemic on survival of LT recipients. Methods: This is a retrospective cohort study analyzing the data from 387 LT recipients diagnosed with COVID-19. LT recipients were divided into two groups: survival (n = 359) and non-survival (n = 28) groups. A logistic regression model was used to determine the independent risk factors for mortality. Machine learning models were used to analyze the contribution of independent variables to the mortality in LT recipients. Results: The COVID-19-related mortality rate in LT recipients was 7.2%. Multivariate analysis showed that everolimus use (p = 0.012; OR = 6.2), need for intubation (p = 0.001; OR = 38.4) and discontinuation of immunosuppressive therapy (p = 0.047; OR = 7.3) were independent risk factors for mortality. Furthermore, COVID-19 vaccination reduced the risk of mortality by 100 fold and was the single independent factor determining the survival of the LT recipients. Conclusion: The effect of COVID-19 infection on LT recipients is slightly different from the effect of the disease on the general population. The COVID-19-related mortality is lower than the general population and vaccination for COVID-19 significantly reduces the risk of mortality.Öğe The Effect of Pringle Maneuver Applied during Living Donor Hepatectomy on the Ischemia-Reperfusion Injury Observed in the Donors and Recipients(Mdpi, 2024) Dalda, Yasin; Akbulut, Sami; Sahin, Tevfik Tolga; Tuncer, Adem; Ogut, Zeki; Satilmis, Basri; Dalda, OzlemBackground and Objectives: The aim of this study is to evaluate the clinical and laboratory changes of ischemia and reperfusion injury in the remnant livers of donors with and without Pringle maneuver. Furthermore, we evaluated the recipients who have been transplanted with liver grafts from these donors. Methods and Materials: A total of 108 patients (54 living liver donors and 54 liver recipients) who underwent donor hepatectomy and recipients who living donor liver transplantation, were included in this randomized double-blind study between February 2021 and June 2021. The donors were divided into two groups: Pringle maneuver applied (n = 27) and Pringle maneuver not applied (n = 27). Similarly, recipients with implanted liver obtained from these donors were divided into two groups as the Pringle maneuver was performed (n = 27) and not performed (n = 27). Blood samples from donors and recipients were obtained on pre-operative, post-operative 0 h day (day of surgery), post-operative 1st day, post-operative 2nd day, post-operative 3rd day, post-operative 4th day, post-operative 5th day, and liver tissue was taken from the graft during the back table procedures. Liver function tests and complete blood count, coagulation tests, IL-1, IL-2, IL-6, TNF-alpha, and beta-galactosidase measurements, and histopathological findings were examined. Results: There was no statistically significant difference in the parameters of biochemical analyses for ischemia-reperfusion injury at all periods in the donors with and without the Pringle maneuver. Similarly, there was no statistically significant difference between in the recipients in who received liver grafts harvested with and without the Pringle maneuver. There was no statistically significant difference between the two recipient groups in terms of perioperative bleeding and early bile duct complications (p = 0.685). In the histopathological examinations, hepatocyte damage was significantly higher in the Pringle maneuver group (p = 0.001). Conclusions: Although the histological scoring of hepatocyte damage was found to be higher in the Pringle maneuver group, the Pringle maneuver did not augment ischemia-reperfusion injury in donors and recipients that was evaluated by clinical and laboratory analyses.Öğe Effect of the COVID-19 pandemic on patients with presumed diagnosis of acute appendicitis(Baishideng Publishing Group Inc, 2022) Akbulut, Sami; Tuncer, Adem; Ogut, Zeki; Sahin, Tevfik Tolga; Koc, Cemalettin; Guldogan, Emek; Karabulut, ErtugrulBACKGROUNDAcute appendicitis (AAp) is the most frequent cause of acute abdominal pain, and appendectomy is the most frequent emergency procedure that is performed worldwide. The coronavirus disease 2019 (COVID-19) pandemic has caused delays in managing diseases requiring emergency approaches such as AAp and trauma.AIMTo compare the demographic, clinical, and histopathological outcomes of patients with AAp who underwent appendectomy during pre-COVID-19 and COVID-19 periods.METHODSThe demographic, clinical, biochemical, and histopathological parameters were evaluated and compared in patients who underwent appendectomy with the presumed diagnosis of AAp in the pre-COVID-19 (October 2018-March 2020) and COVID-19 (March 2020-July 2021) periods.RESULTSAdmissions to our tertiary care hospital for AAp increased 44.8% in the COVID-19 period. Pre-COVID-19 (n = 154) and COVID-19 (n = 223) periods were compared for various parameters, and we found that there were statistically significant differences in terms of variables such as procedures performed on the weekdays or weekends [odds ratio (OR): 1.76; P = 0.018], presence of AAp findings on ultrasonography (OR: 15.4; P < 0.001), confirmation of AAp in the histopathologic analysis (OR: 2.6; P = 0.003), determination of perforation in the appendectomy specimen (OR: 2.2; P = 0.004), the diameter of the appendix (P < 0.001), and hospital stay (P = 0.003). There was no statistically significant difference in terms of interval between the initiation of symptoms and admission to the hospital between the pre-COVID-19 (median: 24 h; interquartile range: 34) and COVID-19 (median: 36 h; interquartile range: 60) periods (P = 0.348). The interval between the initiation of symptoms until the hospital admission was significantly longer in patients with perforated AAp regardless of the COVID-19 or pre-COVID-19 status (P < 0.001).CONCLUSIONThe present study showed that in the COVID-19 period, the ultrasonographic determination rate of AAp, perforation rate of AAp, and duration of hospital stay increased. On the other hand, negative appendectomy rate decreased. There was no statistically significant delay in hospital admissions that would delay the diagnosis of AAp in the COVID-19 period.Öğe High-Level Procalcitonin in Patient with Mixed Fibrolamellar Hepatocellular Carcinoma: A Case Report and Literature Review(Springer, 2022) Akbulut, Sami; Tuncer, Adem; Ogut, Zeki; Sahin, Tevfik Tolga; Koc, Cemalettin[Abstract Not Available]Öğe Histopathological Evaluation of Gallbladder Specimens Obtained From Living Liver Donors(Elsevier Science Inc, 2023) Akbulut, Sami; Sarici, Kemal Baris; Toprak, Serhat; Tuncer, Adem; Ciftci, Felat; Karadag, Nese; Gurluler, ErcumentBackground. Cholecystectomy is routinely performed during living donor hepatectomy both to see the structure of the biliary tract and to determine the demarcation line based on the biliary tract junction. This study aims to present the general histopathological features of the gallbladder specimen obtained from living liver donors (LLD). Methods. Data from 2577 LLDs who underwent living donor hepatectomy (n = 2511) or aborted living donor hepatectomy (n = 66) in our Liver Transplantation Institute between September 2005 and June 2021 were analyzed retrospectively. Age, gender, macroscopic (length, diameter, and wall thickness), and microscopic (histopathological) features of the gallbladder of the LLDs were recorded for use in this study. Results. A total of 2493 LLDs (men: 1486, women: 1007) with a median age of 29 years (interquartile range [IQR]: 13) met the inclusion criteria in this study. The median length, width and wall thickness of the gallbladder specimens were measured as 70 mm (IQR: 20), 50 mm (IQR: 20), and 2 mm (IQR: 1), respectively. The most common histopathological findings are normal structure (2026; 81.3%), chronic cholecystitis (n = 446; 17.9%), adenomyomatosis (n = 9), and papillary hyperplasia (n = 6), respectively. The most common pathologic findings in the gallbladder lumen are cholesterolosis (n = 207; 0.4%), cholelithiasis (n = 53), cholesterol polyp (n = 31), and noncholesterol polyp (n = 19), respectively. Significant differences were detected between the male and (content) (P < .001), and lymph node around the gallbladder (P = .015). Conclusions. The results we obtained in this study are true gallbladder pathologies that can be detected in healthy people. In this study, it was shown that the diameter and size of the gallbladder were larger in men, whereas the incidence of cholesterolosis and cholelithiasis was higher in women.Öğe Intraperitoneal rupture of the hydatid cyst disease: Single-center experience and literature review(2020) Koç, Cemalettin; Akbulut, Ahmet Sami; Şahin, Tevfik Tolga; Tuncer, Adem; Yılmaz, SezaiAbstract: BACKGROUND: The primary aim of this study was to present our experience in the intraperitoneal rupture of the hydatid cyst in the guidance of literature data. METHODS: Demographical, clinical, radiological and postoperative follow-up data of 29 patients who underwent surgical treatment in our institution with the diagnosis of intraperitoneal rupture of the hydatid cyst from January 2003 to July 2020 were analysed retrospectively in this study. RESULTS: Among the 29 patients with an age range of from 16 to 79 years (median= 39, IQR=25.5), 16 were male (55.2%), and 13 were female (44.8%). Intraperitoneal rupture of the hydatid cyst was spontaneous in 21 (72.4%), traumatic in seven (24.13%) (two of them were iatrogenic) and was due to shotgun in one patient. Vast majority of the patients were admitted to the emergency department in the first 24 hours after the onset of sign and symptoms. WBC varied from 8.600 to 30.900/mm3 (median=12.100, IQR=5.7). Ruptured cysts were localised in liver (n=25, 86.2%), in spleen (n=2, 6.89%) or in pelvis (n=2, 6.89%) and diameter varied from 40 to 200 mm (median=90, IQR=50). Among the cysts ruptured in liver, 19 (76%) of them were localised in the right lobe. Among the ruptured cysts of the liver, 20 (80%) of them underwent conservative surgery (e.g., partial pericystectomy), the remaining five patients (20%) underwent a radical surgical treatment (e.g., pericystectomy). A biliary orifice was diagnosed during surgical exploration in either cyst cavity or cut surface of the liver in 12 (48%) of the patients. Patients with a dilated common bile duct or a visible biliary duct orifice in cystic cavity underwent common bile duct exploration and T-tube drainage procedure (n=6, 24%). One patient died on postoperative day one, due to cardiopulmonary complications secondary to cyst rupture. All along the postopeartive follow-up of median 1416 days, seven (24.1%) patients were diagnosed for diseased recurrence. CONCLUSION: Intraperitoneal rupture of the hydatid cyst is a life-threatening complication of hydatid cyst disease, for which diagnosis without delay and timing of surgical treatment is essential. Anaphylactic shock require rapidly initiation of medical treatment against allergic reactions. Despite scolocidal agents, vesicular spread into peritoneal cavity accounts for the major risk factor for disease recurrence. Hence, abdominal cavity should be explored cautiously.Öğe An investigation into the factors predicting acute appendicitis and perforated appendicitis(2021) Akbulut, Sami; Koç, Cemalettin; Şahin, Tevfik Tolga; Şahin, Emre; Tuncer, Adem; Demyati, Khaled; Şamdancı, Emine Türkmen; Çolak, Cemil; Yılmaz, SezaiBACKGROUND: To investigate the factors predicting acute appendicitis (AAp) and perforated AAp in patients who underwent surgery with a preliminary diagnosis of AAp. METHODS: Between May 2009 and December 2018, 1316 patients underwent appendectomy with a presumed diagnosis of AAp. To investigate the factors predicting AAp, patients were divided into two groups considering the histopathological presence of inflammatory changes in the appendix: AAp positive (AAp group; n=1043) and AAp negative (Non-AAp group; n=273). Also, to investigate the factors predicting appendiceal perforation, patients with AAp were divided into two groups considering the presence of perforation: non-perforated AAp (n=850) and perforated AAp (n=193). ROC curve analysis was used to identify optimum cut-off values of quantitative variables. The groups were compared using univariate analysis methods and parameters with a p? 0.20 were taken into a multivariate logistic regression model. RESULTS: Multivariate analysis method related to factors predicting AAp showed that gender (male; p=0.034; OR=1.4), WBC (?10.900; p=0.022; OR=1.5), MPV (?29.1; p=0.006; OR=1.6), TBil (?0.61; p=0.034; OR=1.4), CRP (?0.725; p=0.002; OR=1.7), NLR (?5.13; p=0.034; OR=1.5), PNR (<24.04; p=0.001; OR=1.9) and US findings (AAp+; p<0.001; OR=2.9) were independent factors for predicting AAp. Multivariate analysis method related to factors predicting appendiceal perforation showed that age (?32 years; p<0.001; OR=2.5), TBil (?0.67; p=0.046; OR=1.5), CRP (?3.75; p<0.001; OR=3.0) and NLR (?5.69; p=0.006; OR=1.8) were independent factors for predicting perforated AAp. CONCLUSION: We believe that predicting both AAp and perforation will help the clinician evaluate patients who applied to the emergency unit with presumed diagnosis AAp. This approach will also contribute to reducing the negative appendectomy and perforation rates.Öğe Laparoscopic surgery for a liver gunshot injury(2019) Gündoğan, Ersin; Kayaalp, Cüneyt; Tuncer, AdemAbstract: Recently, non-operative follow-up in non-penetrating abdominal injuries is often preferred. However, emergency laparotomy still remains the most exclusive method of treatment for gunshot wounds of the abdomen and laparoscopic approach is rarely reported in selected cases. In this study, our aim is to share our experience in a case with abdominal gunshot wound who was treated by a laparoscopic surgery. A 52-year-old male patient admitted with a gunshot wound that was penetrating to the abdomen. The gunshot line was from left subcostal to the right mid-axillary. He was hemodynamically stable but had abdominal sensitivity. Computed tomography confimed the liver injury. Laparoscopic exploration was performed with three ports. A tunnel-shaped injury was detected through the liver segments 4–7 and hemostasis of the bleeding liver parenchyma was achieved by laparoscopy. No other abdominal organ injuries were detected. The patient had an uneventful postoperative course and discharged on the third day and had no complaints during the six months follow-up. In certain circumstances, laparoscopy can be used both for diagnosis and treatmentof penetrating gunshot wounds and may reduce the risk of unnecessary laparotomyÖğe Liver transplant versus non-liver transplant patients underwent appendectomy with presumed diagnosis of acute appendicitis: Case-control study(2020) Barış Sarıcı, Kemal; Akbulut, Ahmet Sami; Koç, Cemalettin; Tuncer, Adem; Yılmaz, SezaiAbstract: BACKGROUND: This study aims to compare liver transplant and non-liver transplant patients who underwent appendectomy with a presumed diagnosis of acute appendicitis. METHODS: Demographic and clinicopathological features of 13 liver transplant recipients (transplant group) who underwent posttransplant appendectomy with a presumed diagnosis of acute appendicitis were compared with the features of 52 non-liver transplant patients (non-transplant group). They underwent appendectomy with a presumed diagnosis of acute appendicitis during the same time period. The transplant group was matched at random in a 1: 4 ratio with the non- transplant group. While the continuous variables were compared using the Mann Whitney-U test, categorical variables were compared with Fisher’s exact test. A p-value of less than 0.05 was considered statistically significant. RESULTS: A total of 65 patients aged between one year and 84 years were included in this study. While the age of the 52 patients (32 male and 20 female) in the non- transplant group ranged from 17 years to 84 years, the age of the 13 patients (nine male and four female) in the transplant group ranged from one year to 64 years. Statistically significant differences were noted between both groups concerning WBC (p=0.002), neutrophil (p=0.002), lymphocyte (p=0.032), platelets (p=0.032), RDW (p=0.001), CRP (p=0.009), PNR (p=0.042), WNR (p=0.03), and appendiceal length (p<0.001). The negative appendectomy rate was relatively higher in transplant than the non-transplant group but this difference was not statistically significant (30.8% vs. 21.2%; p=0.477). Perforated acute appendicitis occurred more frequently in the transplant group; however, this difference was not statistically significant (30.8% vs. 9.6%; p=0.070). CONCLUSION: WBC and neutrophil were lower in the LT group; however, the CRP and RDW were higher in the LT group. Further, perforation and negative appendectomy rates were higher in the LT group, although this difference was not statistically significant.Öğe Management of acute cholecystitis in elderly (?65 years old) patients: A retrospective study comparing early versus delayed cholecystectomy(2023) Barut, Bora; Bağ, Yusuf Murat; Patmano, Mehmet; Gündoğan, Ersin; Tuncer, Adem; Dalda, Yasin; Gönültaş, FatihAim: Acute cholecystitis is the most common causes of acute abdomen in elderly popula tion. This study aimed to present the early postoperative period (? 30 days) outcomes of elderly patients (? 65 years old) with acute cholecystitis who underwent early or delayed cholecystectomy. Materials and Methods: Between January 2016 and December 2020, 74 patients aged 65 and over underwent cholecystectomy for acute cholecystitis were included in the study. The patients were divided into two groups as early (time between diagnosis and chole cystectomy 7 days or less, n= 43, 58.1%) or delayed (time between diagnosis and chole cystectomy over 7 days, n= 31, 41.9%) cholecystectomy. Demographic characteristics, preoperative laboratory and radiological findings, and perioperative data of patients were evaluated, and the groups were compared. Results: The median age of patients was 73 (65-90) years, and 39 (52.7%) were male. Sixty-one (82.4%) patients underwent laparoscopic, 8 open (10.8%) and 5 (6.8%) conver sion cholecystectomy. The rate of laparoscopic cholecystectomy was higher in the delayed group (n= 29, 93.5%) than in the early group (n= 32, 74.4%), but no statistically signifi cant difference was detected (p=.06). The rate of open cholecystectomy was statistically significantly higher in the early group (n=8, 18.6%) than in the delayed group (n=0) (P=.017), the conversion rate was similar between the groups (p=1). There was no signif icant difference between the groups in terms of intraoperative complications (p=1). The length of hospital stay was statistically significantly longer in the early compared to the delayed group (5 (1-21) days and 2 (1-12) days, respectively, p< .001). Conclusion: There was no statistical difference regarding intraoperative complications in patients underwent early or delayed cholecystectomy. We believe that the patient’s clinical presentation and early or delayed cholecystectomy experience of the team are vital in determining the timing of cholecystectomy, as well as the severity of acute cholecystitis.Öğe Management of irreducible giant rectal prolapse: A case report and literature review(Elsevier Sci Ltd, 2021) Tuncer, Adem; Akbulut, Sami; Ogut, Zeki; Sahin, Tevfik TolgaIntroduction and importance: Rectal prolapse is defined as herniation of mucosa or full-thickness of the rectal wall through the anal canal. It has a negative impact on the quality of life and therefore, it should be treated as soon as diagnosis is confirmed. Definitive treatment is surgical and it depends on the clinical characteristics of the patients. We aimed to present the one of the largest rectal prolapse case in the literature. Case presentation: A 32-years-old male patient with a history of severe constipation was admitted to our institution with a giant rectal prolapse. The prolapsed segment was incarcerated, and a semi-emergent procedure was performed though a mid-line laparotomy. The sigmoid colon was redundant and therefore sigmoid colon and the upper two thirds of rectum were resected and end to end anastomosis was performed. The patient was discharged postoperative day 7 without any complication. Clinical discussion: Rectal prolapse has a negative impact on quality of life and should be operated as soon as the diagnosis is reached. The surgical strategy depends on the compliance of the patient as well as the experience of the surgical team. Conclusion: Clinicians should know that chronic constipation together with other factors may result in rectal prolapse which may become disproportionately large in size.Öğe Nomenclature of appendiceal mucinous lesions according to the 2019 WHO Classification of Tumors of the Digestive System(Aves, 2020) Koc, Cemalettin; Akbulut, Sami; Akatli, Ayse Nur; Samdanci, Emine Turkmen; Tuncer, Adem; Yilmaz, SezaiBackground/Aims: To analysis the appendiceal mucinous lesions according to the World Health Organization (WHO) 2019 classification of tumors of the digestive system (non-neuroendocrine tumors of the appendix vermiformis) Materials and Methods: Clinical and histopathological data of 37 patients with histopathologically proven appendiceal mucinous lesion from January 2010 to May 2019 were evaluated retrospectively. Pathology slides were re-evaluated by two pathologists according to the WHO 2019 classification of tumors of the digestive system. Results: Totally 37 patients (male:19 female: 18) aged 23 to 93 years were analyzed. Majority of the patients (75.7 %) had underwent appendectomy due to preliminary diagnosis of acute appendicitis (n=22) or periappendiceal tumoral lesions (n=9), the others (n=9) underwent incidental appendectomy. Whereas acute appendicitis was histopathologically diagnosed in 16 (43.2%) patients, perforation was diagnosed in 12 (32.4%) patients (perforation without appendicitis=3, perforation with appendicitis=6). According to the initial, pathology reports were prepared as follows: mucocele (n= 10), mucinous cystadenoma (n=9), low-grade mucinous neoplasm (n=6), mucinous adenocarcinoma (n=5), mucosal hyperplasia (n=5), hyperplastic polyp (n=1), adenomatous polyp (n=1). On the basis of the WHO 2019 classification, pathology reports were prepared as follows: low-grade mucinous neoplasm (n=17), simple retention cysts (n=6), hyperplastic polyp (n=6), mucinous adenocarcinoma (n=5), ruptured appendiceal diverticula (n=2), sessile serrated lesion (n=1). Conclusion: The term of appendiceal mucinous lesion, which is recently introduced into medical literature is suitable to distinguish between lesions with and without malignancy potential. The WHO 2019 classification system has been an important step in simplifying the classification of non- neuroendocrine tumors of the appendix vermiformis.Öğe A Recipient and Donor Both Have COVID-19 Disease. Should We Perform a Liver Transplant?(Springer, 2021) Tuncer, Adem; Akbulut, Sami; Baskiran, Adil; Karakas, Ezgi Erdal; Baskiran, Deniz Yavuz; Carr, Brian; Yilmaz, SezaiCoronavirus 2019 (COVID-19) is a new infectious disease that continues to spread globally. There is growing concern about donor-induced transmission of Coronavirus 2 (SARS -CoV-2). For liver transplantation, the COVID-19 PCR test is routine, in addition to epidemiological history and clinical and radiological examination 24-48 h before surgery. One of the liver transplant candidates was found to be infected with COVID-19, as well as the planned donor candidate. Since COVID-19 will be a high-risk operation for both the recipient and the donor, the operation was postponed by giving medical treatment. After the treatment and quarantine process was over, the patient and the donor then had a negative COVID-19 PCR test and the patient received a living donor liver transplant. We present a case of donor and recipient who initially both tested positive for COVID-19. This liver transplantation scenario has not previously been reported in the literature.Öğe Squamous Cell Carcinoma Arising from Perianal Buschke-Lowenstein Tumor (Giant Condyloma Acuminatum): Comprehensive Literature Review(Springer, 2022) Ates, Mustafa; Akbulut, Sami; Tuncer, Adem; Sahin, Emrah; Karabulut, Ertugrul; Sarici, Kemal BarisPurpose This study aims to provide an overview of the literature on carcinoma arising from giant perianal condyloma acuminatum. Methods We present a new case of squamous cell carcinoma arising from giant perianal condyloma acuminatum. We also conducted a systematic search of the medical literature using PubMed, Medline, Google, and Google Scholar related to carcinoma arising from giant perianal condyloma acuminatum. The following search terms were used in various combinations: condyloma acuminatum, giant condyloma acuminatum, Buschke-Lowenstein tumor, squamous cell carcinoma, and verrucous carcinoma. The search included articles published before in the English language November 2020. Results A total of 55 article concerning 97 patients with carcinoma (squamous cell carcinoma, verrucous carcinoma, basaloid cell carcinoma, carcinoma insitu) arising from giant perianal condyloma acuminatum meeting the aforementioned criteria were included. The patients were aged from 24 to 82 years (median: 49.6, IQR: 21); 20 were female (median age: 52.5, IQR: 20.5), and 75 were male (median age: 53, IQR: 17.5). The gender data of the remaining two patients could not be obtained. The histopathological features of tumors arising from giant condyloma acuminatum are as follows: squamous cell carcinoma (n = 56), squamous cell carcinoma in situ (n = 16), verrucous carcinoma (n = 19) and basaloid cell carcinoma (n = 1), squamous cell carcinoma + verrucous carcinoma (n = 1), squamous cell carcinoma + squamous cell carcinoma in situ (n = 1), squamous cell carcinoma + basaloid cell carcinoma (n = 1) and malignant behavior (n = 2). Conclusion Giant condyloma acuminatum is a rare variant of anogenital warts. It is known that this tumor, which is mostly thought to be benign, has a high potential for local recurrence and transformation into invasive cancer. Therefore, it is vital that the tumor is resected with clean surgical margins, even if it looks benign, and that aggressive treatment options are not avoided when necessary.Öğe The use of ischemia modified albumin as a predictive and prognostic biomarker in patients with non-acetaminophen- induced acute liver failure(2022) Aktas, Aydin; Gunes, Orgun; Budak, Fatma Olmez; Diller, Nilufer; Tuncer, Adem; Akbulut, Sami; Taskapan, Mehmet CagatayAim: This study aimed to investigate to usability of ischemia modified albumin (IMA) and IMA/albumin ratio (IMAR) values in the follow-up of ALF patients. King College criteria (KCC) and Model for End-Stage Liver Disease (MELD) score are the most commonly used criteria in the follow-up of patients with acute liver failure (ALF). However, these criteria cannot always predict prognosis and the need for liver transplantation (LT). Materials and Methods: IMA and IMAR values of 23 ALF patients and 43 healthy volunteers were measured. Then IMA and IMAR values were compared with KCC and MELD score to predict LT requirement and prognosis in ALF patients. Results: IMA and IMAR values were significantly higher in ALF patients compared healthy volunteers (p=0.001, p=0.001; respectively). IMA and IMAR values predicted LT requirement in ALF patients such as KCC and MELD (?30) score (p=0.006, p=0.04, p=0.001, p=0.03; respectively). IMA values were found to better than KCC in predicting mortality (p=0.008, p=0.02; respectively). MELD (?30) score failed to predict mortality (p=0.44). Conclusion: IMA and IMAR values can be used as diagnostic biomarkers in ALF pa- tients. IMA is a better prognostic biomarker in the follow-up of ALF patients.Öğe Xanthogranulomatous appendicitis: A comprehensive literature review(Baishideng Publishing Group Inc, 2021) Akbulut, Sami; Demyati, Khaled; Koc, Cemalettin; Tuncer, Adem; Sahin, Emrah; Ozcan, Mehmet; Samdanci, EmineBACKGROUND Xanthogranulomatous inflammation is characterized histologically by a collection of lipid-laden macrophages admixed with lymphocytes, plasma cells, neutrophils, and often multinucleated giant cells with or without cholesterol clefts. AIM To review the medical literature on xanthogranulomatous appendicitis (XGA). METHODS We present a patient with XGA and review published articles on XGA accessed via the PubMed, MEDLINE, Google Scholar, and Google databases. Keywords used were appendix vermiformis, appendectomy, acute appendicitis, and XGA. The search included articles published before May 2020, and the publication language was not restricted. The search included letters to the editor, case reports, review articles, original articles, and meeting presentations. Articles or abstracts containing adequate information about age, sex, clinical presentation, white blood cells, initial diagnosis, surgical approach, histopathological and immunohistochemical features of appendectomy specimens were included in the study. RESULTS A total of 29 articles involving 38 patients with XGA, were retrospectively analyzed. Twenty (52.6%) of the 38 patients, aged 3 to 78 years (median: 34; IQR: 31) were female, and the remaining 18 (47.4%) were male. Twenty-five patients were diagnosed with acute appendicitis, ruptured appendicitis, or subacute appendicitis, and the remaining 13 patients underwent surgery for tumoral lesions of the ileocecal region. Twenty-two of the patients underwent urgent or semi-urgent surgery, and the remaining 16 patients underwent interval appendectomy. CONCLUSION Xanthogranulomatous inflammation rarely affects the appendix vermiformis. It is associated with significant diagnostic and therapeutic dilemmas due to its variable presentation. It is often associated with interval appendectomies, and a significant number of patients require bowel resection due to the common presentation of a tumoral lesion. XGA is usually identified retrospectively on surgical pathology and has no unique features in preoperative diagnostic studies.