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Öğe AKRABA YAŞLI CANLI DONÖRLERDEN YAPILAN BÖBREK NAKİLLERİ(2014) Pişkin, Turgut; Barut, Bora; Usta, Sertaç; Gönültaş, Fatih; Kayabaş, ÜnerÖz: AMAÇ: Son dönem böbrek hastalığının en iyi tedavi yöntemi böbrek nakli yapılmasıdır. Organ kısıtlılığı nedeni ile yaşlı donörlerin kullanımı giderek artmaktadır. Bizde Kasım 2010 ile Aralık 2013 tarihleri arsaında yaşı >= 60 olan canlı donörlerden 15 böbrek nakli yaptık. Bu çalışmamızda da bu 15 böbrek nakli ile ilgili deneyimlerimizi ve sonuçlarımızı paylaşmak istedik.GEREÇ VE YÖNTEMLER: Biz merkezimizde Kasım 2010 ile Aralık 2013 tarihleri arasında 98 böbrek nakli yaptık. Bunların 15'ini yaşı >= 60 olan canlı akraba donörlerden alıcılara naklettik. Bu 15 donör ve bunların alıcılarının verileri geriye doğru toparlanıp incelendi. BULGULAR: Donörlerin ve alıcılarını sırası ile yaş ortalamaları 64, 3 ve 40.1 idi. Alıcılar için ortalama takip süresi 18.8 aydı. Bu sürede graft sağkalımı %100'dü. Ancak bir alıcımız nakil sonrası dördüncü ayında intrakranial kanama nedeni ile foksiyone greftle kaybedildi. İnfeksiyon, teknik nedenler, tekrarlayan hastalık yada rejeksiyon nedeni ile börek kaybedilmedi. Donörlerimizde hayatlarını herhangi bir problem olmaksızın saglıklı bir şekilde sürdürmektedirler.SONUÇ: Yaşlı donörler ideal donörler değildir. Ancak alıcıların başka bir donörü yoksa yaşlı donörlerden nakil yapmak bu hastalar icin bir seçenek olmaktadır.Öğe Analysis of patients with acute liver failure after liver surgery: Single center experience(2022) Sağlam, Kutay; Yılmaz, Sezai; Usta, Sertaç; Şahin, Tevfik Tolga; Zengin, Akile; İspir, MukadderLiver transplantation is the lifesaving treatment option for rare acute liver failure that develops due to iatrogenic bile duct injuries or after major hepatectomy. The aim of the study is to analyze patients with acute liver failure due to iatrogenic bile duct injury or major hepatectomy on the waiting list for emergency liver transplantation. Between the years 2011-2020, 9 patients (5 female/4 male; median age: 30 years old, (range:4-63 years)) with acute liver failure related to bile duct injury or major hepatectomy for whom urgent liver transplantation was planned were included in this study. Eight patients were accepted for urgent liver transplantation. Acute liver failure developed in 6 patients due to hepatoduodenal ligament injury during cholecystectomy, and in 3 patients due to major hepatectomy. The patients were listed for urgent transplantation within the mean of 1.5 days (range:0-3 days) after acute liver failure. Two patients had living donor and 1 patient had cadaveric liver transplantation. Acute hepatic failure, especially after iatrogenic bile duct injuries associated with vascular injuries, seems to be more fatal than post hepatectomy liver failure. In these cases of acute liver failure, which is a difficult situation to decide, emergency liver transplantation should be kept in mind as the treatment option.Öğe Early portal vein thrombosis after pediatric liver transplantation: Assesment of risk factors(2023) Karakas, Serdar; Şahin, Tevfik Tolga; Sarıcı, Barış; Usta, Sertaç; Kutlutürk, Koray; Varol, Fatma İlknur; Sağlam, KutayAim: Despite advancements in surgical techniques, early portal vein thrombosis (ePVT) continues to be one of the major complications of liver transplantation (LT) in pediatric age group. Possible risk factors are portal vein diameter < 5 mm, infancy, patient body weight < 10 kg and high graft recipient weight ratios (GRWR > 4.0). We retrospectively evaluated our records of pediatric LTs’ in terms of ePVT and possible risk factors determining development of this dreaded complication. Materials and Methods: Between January 2018 and January 2022, 228 LTs were performed for pediatric age (under the age of 18) group at Inonu University, Liver Trans- plantation Institute. Among these patients, 212 were eligible for the study. Patients with ePVT were defined as Portal Vein Thrombüs Group (PVTG) and patients with no Portal Vein thrombosis were defined in control group (CG). ePVT was described as detection of impeded portal venous outflow with imaging studies either perioperatively or within postoperative 3 days . Demographic, clinical and operative variables were retrospectively evaluated. Results: Among 212 LTs, 24 cases were complicated with ePVTs (11.3 %). Preoperative platelet counts, etiology of Budd-Chiari, postoperative hepatic artery thrombosis (HAT) and lower age were significantly higher for early PVT. In multivariate analysis, preop- erative platelet levels, etiology of Budd-Chiari and postoperative HAT were significantly higher for PVT. One and 5 years overall survivals (OS) for PVTG and CG were 50.0 % - 50.0 % and 69 % - 63 % respectively. No significant OS difference was observed despite much more patients were died in PVTG. Conclusion: High preoperative platelet counts, Budd-Chiari syndrome and postoperative HAT are predictive factors for ePVT. Anti-thrombotic prophylaxes can be considered in high-risk patients. Venous jump grafts seem to have no effect on ePVT. Despite PVT increases the mortality rates, it can be resolved easily with immediate reoperation.Öğe Extraction of kidney via suprapubic or inguinal incision in total laparoscopic donor nephrectomy(2019) Sümer, Fatih; Gündoğan, Ersin; Altunkaya, Neslihan; Aydın, Mehmet Can; Usta, Sertaç; Doğan, Sait Murat; Pişkin, Turgut; Kayaalp, CüneytAbstract: Introduction: The objective of this study was to investigate the results of the fist 48 patients who underwent total laparoscopic transperitoneal donor nephrectomy at a single institution and to present the impact of the kidney extraction site on ischemia time. Materials and Methods: The study included patients who underwent kidney donor surgery between February 2017 and December 2018. Evaluation of the kidney transplantation candidates was performed by the kidney transplantation council. A total of 4 trocars were used for a right-side nephrectomy, and 3 trocars were used for a left-side nephrectomy. The kidneys were extracted through a suprapubic incision in the fist 18 cases and through the inguinal region in the last 30 cases. A comparison was made of the demographic characteristics and the intraoperative and postoperative results of the 2 groups. Results: Of the study patients, 30 were female and 18 were male, with a mean age of 48.0±9.6 years (range: 30–71 years). All of the patients underwent a total laparoscopic transperitoneal donor nephrectomy. Four patients underwent a right-side nephrectomy and 44 underwent a left-side nephrectomy. There was no case of conversion to open surgery. The mean operative time was 251.4±72.4 minutes (range: 127–420 minutes). In the fist 18 cases, the organ was extracted through a suprapubic incision and the ischemia time was 318±140 seconds (range: 150–720 seconds). In the last 30 cases, the organ was extracted through an inguinal incision and the mean ischemia time was 151.5±55.1 seconds (range: 80–265 seconds). The mean length of hospital stay was 5.4±1.1 days (range: 3-10 days). Conclusion: The application of minimally invasive surgery in healthy individuals undergoing donor nephrectomy leads to better physical, psychological, and social outcomes. Surgical experience and the choice of extraction site can shorten the warm ischemia time signifiantly. Extraction through the inguinal region is recommended, as it provides for a faster removal and shortens the warm ischemia time. Laparoscopic donor nephrectomy can be used safely in centers with experience performing advanced laparoscopyÖğe A gallstone impacting to stomach wall imitating a gastric tumour(Pakistan Journal of Medical Sciences, 2011) Yılmaz, Mehmet; Dirican, Abuzer; Usta, Sertaç; Başkıran, Adil; Işık, BurakAuthors describe a case of 78 years old female who presented with the right upper abdominal pain. Ultrasonography showed a gallstone. The patient underwent laparascopic cholecystectomy. The laparoscopic procedure was converted to laparotomy because the adhesions between gallblader and stomach could not be dissected on the correct plane. A gallstone impacted to the stomach antrum wall was observed during dissection. When dense adhesions are noted between the gallbladder and stomach during a routine laparascopic cholecystectomy, one should consider an impacted gallstone on the gastric wall via a cholecystogastric connection.Öğe The impact of tumor localization on prognosis of the patients following liver transplantation for hepatocellular carcinoma(2020) Başkıran, Adil; Sarıgöz, Talha; Şahin, Tevfik Tolga; İnce, Volkan; Usta, SertaçAim: Hepatocellular carcinoma usually occurs in the setting of liver cirrhosis and therefore, resection is not possible in majority ofthe cases. Orthotopic liver transplantation (OLS) is a gold standard treatment option in hepatocellular carcinoma. The aim of thepresent retrospective study was to evaluate the prognosis of hepatocellular carcinoma localized in left or right side of the liver inpatients who underwent OLS.Materials and Methods: 120 patients received OLS for hepatocellular carcinoma between 2007 and 2018 in the institute of livertransplantation. Tumors that were centrally located were excluded from the analysis. The remaining 104 patients were divided intotwo groups; Group 1 (right lobe, n=85 [81.7%]), Group 2 (left lobe, n=19 [18.3%]). The clinical and demographic data of the patientsalong with preoperative laboratory values such as alpha fetoprotein (AFP), gamma-glutamyl transpeptidase (GGT) and thrombocytecount were retrospectively evaluated.Results: The Median age in Group 1 and 2 were 54 (4-72) and 50.5 (37-68) years, respectively. Preoperative AFP levels in Group 1and 2 were 9.25 (1-10800) ng/ml and 13 (1.5-317) ng/ml, respectively. The Model for end stage liver disease (MELD) scores in Group1 and 2 were 12 (6-52) and 9 (6-21), respectively. None of the clinical, demographic and laboratory values along with disease-freesurvival, early mortality and recurrence were significantly different among the study groups (p>0.05).Conclusions: Although there is a big discrepancy in terms of patient’s numbers in right and left-sided tumors, our data failed toshow any survival difference among the groups. Further studies, especially in hepatocellular carcinoma beyond the Milan criteria,are needed to validate our results.Öğe İnsidental Meckel divertiküllü hastada safra taşı ileusunun tek aşamalı cerrahi tedavisi: Olgu sunumu(Ulusal Cerrahi Dergisi, 2012) İnce, Volkan; Usta, Sertaç; Ünal, Bülent; Yılmaz, MehmetYıl: 2012Cilt: 28Sayı: 4ISSN: 1300-0705Sayfa Aralığı: 222 - 224 Metin Dili: Türkçe Öz: İntestinal obstrüksiyonun nadir sebeplerinden birisi de safra taşlarıdır. Tekrarlayan kolesistit atakları sonucu oluştuğu düşünülen bilio-enterik ya da koledoko-enterik fistüllerden gastrointestinal sisteme geçip sıkışan büyük safra taşları mekanik obstrüksiyona yol açmaktadır. Bu tür hastalarda cerrahlara düşen görev hastanın şikayetini gidermek ve altta yatan patolojiyi ortadan kaldırmaktır. Aralıklı obstrüksiyon ile takip edilen 54 yaşında erkek hastanın tek aşamalı cerrahi ile hem rastlantısal saptanan Meckel divertikülünün hem de safra taşı ileu- sunun başarılı tedavisi sunulmaktadır. Başlık (İngilizce): Treatment of gallstone ileus by single stage surgery of a patient with incidental Meckel diverticulum: a case report Öz (İngilizce): Gallstones are rare causes of intestinal obstruction. Mechanical ob- struction occurs by impaction of large gallstones in the gastrointest- inal tract following entry via a bilio-enteric or choledocho-enteric fis tula, thought to occur as a result of recurrent cholecystitis. The duty of surgeons in the treatment of these patients is to resolve the patient’s complaint and eliminate the underlying pathology. A 54 year old male patient admitted for intermittent obstruction was successfully treated by single stage surgery for incidental Meckel diverticulum and gall- stone ileus.Öğe "İnsidental Meckel divertiküllü hastada safra taşı ileusunun tek aşamalı cerrahi tedavisi: Olgu sunumu "(2012) İnce, Volkan; Usta, Sertaç; Ünal, Bülent; Yılmaz, Mehmet TuğrulÖz:İntestinal obstrüksiyonun nadir sebeplerinden birisi de safra taşlarıdır. Tekrarlayan kolesistit atakları sonucu oluştuğu düşünülen bilio-enterik ya da koledoko-enterik fistüllerden gastrointestinal sisteme geçip sıkışan büyük safra taşları mekanik obstrüksiyona yol açmaktadır. Bu tür hastalarda cerrahlara düşen görev hastanın şikayetini gidermek ve altta yatan patolojiyi ortadan kaldırmaktır. Aralıklı obstrüksiyon ile takip edilen 54 yaşında erkek hastanın tek aşamalı cerrahi ile hem rastlantısal saptanan Meckel divertikülünün hem de safra taşı ileu- sunun başarılı tedavisi sunulmaktadır.Öğe LIVING DONOR LIVER TRANSPLANTATION FOR HEPATIC EPITHELIOID HEMANGIOENDOTHELIOMA: SINGLE CENTER EXPERIENCE(2023) Ersan, Veysel; Ince, Volkan; Usta, Sertaç; Barut, Bora; Samdancı, Emine; Carr, Brian; Yılmaz, SezaiIntroduction: Hepatic epithelioid hemangioendothelioma (HEHE) is a rare malignant vascular tumor of the liver. Liver transplantation (LT) is the treatment of choice for patients with advanced-stage HEHE. The aim of this study is to present the results of HEHE patients treated with living donor LT. Material and Method : Between March 2002 and December 2021, 3121 liver transplantations were performed at our institute, 2632 of these were living donor LT. Demographic characteristics, symptoms and clinical findings, laboratory, radiological, and posttransplant histopathological examinations, recurrence rates, disease-free survival, and overall survival rates of the patients were analyzed. Results: The mean age was 41.7 years and %57.6 of the patients were women. Five patients were referred to our institute with signs of chronic liver failure. Four of these patients (57.1%) had Budd-Chiari syndrome. The median follow-up was 35.0 (12.8 - 119.4) months. In all patients, the tumor recurrence rate after transplantation was 71.4%. The overall survival rate for 1 and 5 years was 100 – 57.1% and the disease free survival rate for 1 and 5 years was 71.4 - 38.1%, respectively. Conclusion: Living donor liver transplantation can be considered a viable treatment option for selected HEHE patients. However, multicenter collaborations are crucial to enhance our understanding of this rare malignancy and improve treatment outcomes for these patients.Öğe Multiple renal arteries in patients with kidney transplantation initial experiences of the new kidney transplant center(Fırat Tıp Dergisi, 2015) Usta, Sertaç; Soyer, Vural; Sarıcı, Kemal Barış; Pişkin, Turgut; Ünal, BülentObjective: Multiple renal artery grafts of kidney transplant patients developing complications and results for long-term kidney function were evaluated. Material and Method: From 2010 to 2014, 115 kidney transplant patients were evaluated retrospectively. A sum of, 115 donor nephrectomies were performed in our instution. Kidney were transplanted with a single artery to 99 patients and sixteen (approximate 14%) with more than one. For five of these 16 patients, the organs were transplanted from a cadaver and eleven were transplanted from living donors. Results: Mean age was 38,5 years (range 9–58 years), mean follow up time was 22,5 month (min. 3,5 and max. 41 month) and mean cold ischemia time was 153 minutes for living donor transplantations and 1396 minutes for cadaveric transplantation, and also warm ischemia time was 236 seconds for living donor transplantation. In all cases, the grafted kidney began to function immediately after reperfusion. Fourteen of the recipients had no any early kidney dysfunction, a problem that is usually attributed to prolonged anastomosis time. Conclusion: Transplanting kidneys with multiple renal arteries may result in significant risks. Prolonged cold or hot ischemia time may elevate incidence of non functional graft and rejection. Results of this study points that unifying artery anastomosis at the backtable would reduce the risk.Öğe Non-operative management of perforated peptic ulcer: A single-center experience(2019) Usta, Sertaç; Liman, Rumeysa Kevser; Dincer, Mürşit; Karabulut, KorayAbstract: BACKGROUND: Perforation is a rare complication of peptic ulcer. Although the most widely accepted treatment for peptic ulcer perforation is surgery, non-operative treatment can be an option in selected patients. In this study, we aimed to present our non-surgical treatment experience in peptic ulcer perforation. METHODS: In this study, the data of the patients who were treated due to peptic ulcer perforation between January 2012 and September 2017 in our clinic were retrospectively reviewed. The diagnosis was reached by physical examination and radiologic findings. After obtaining the informed consent from the patients, non-operative treatment was performed to the selected patients who had normal vital parameters and did not have findings of generalized peritonitis in the abdominal examination. Oral food and fluid intake were stopped and intravenous fluid, antibiotics and pantoprazole were administered to all patients in this study. RESULTS: A total of 41 patients were treated due to the diagnosis of peptic ulcer perforation in our clinic during the study period. Out of 41 patients, while 35 of the patients were operated, six of them were treated non-operatively. There were peritoneal irritation signs and symptoms in the upper quadrants on physical examination in all of the patients. None of them had generalized peritonitis. Abdominal X-ray and computed tomography were obtained from all of the patients. None of the patients in the non-operative group underwent any interventional procedure or surgery during the follow-up period. The median length of hospital stay was four days in this group. All of the patients were discharged uneventfully. CONCLUSION: Standard treatment of peptic ulcer perforation in most of the patients is still surgical repair. Non-surgical treatment should be kept in mind as an option in the selected patients who had normal vital parameters and did not have any findings of generalized peritonitis in the abdominal examination. In this way, it may be possible to avoid unnecessary surgery and reduce the possible morbidity and mortality associated with the operation.Öğe Outcomes of left lobe donor hepatectomy for living donor liver transplantation a single center experience(Transplantation Proceedings, 2013) Usta, Sertaç; Ateş, Mustafa; Dirican, Abuzer; Işık, Burak; Yılmaz, SezaiLiving-donor liver transplantation (LDLT) is an excellent option for patients with end-stage liver disease in situations of donor shortage. The aims of this study were to evaluate our experience with left-lobe donor hepatectomy for LDLT and to grade postoperative complications using the 5-tier Clavien classification system. Data from medical records of 60 adult living liver donors (30 men, 30 women) who underwent left-lobe hepatectomy between November 2006 and April 2012 were reviewed. The median donor age was 31.7 8.9 (range, 19 – 63) years. Sixteen complications were observed in 12/60 (20%) donors. Complications developed in 6/15 (40%) donors who underwent left hepatectomy and in 6/45 (13.3%) donors who underwent left lateral segmentectomy. Seven of 16 (43.7%) complications were Grade I and 2 (12.5%) were Grade II. Major complications consisted of 4 (25%) Grade IIIa and 3 (18.7%) Grade IIIb complications; no Grade IVb or V complications occurred. The most common complication was biliary, occurring in 7 (11.6%) donors and comprising 43.7% of all 16 complications. The mean duration of follow-up was 30 7.1 (range, 2–58) months. No donor mortality occurred. Left-lobe donor hepatectomy for LDLT, which does not benefit the completely healthy donor, was performed safely and with low complication rates, but carries the risk of morbidity. Low morbidity rates following living-donor hepatectomy can be expected when surgical and clinical monitoring and follow-up are adequate and the surgeon has gained increased experience.Öğe Outcomes of left lobe donor hepatectomy for living donor liver transplantation a single center experience(Transplantation Proceedings, 2013) Usta, Sertaç; Ateş, Mustafa; Dirican, Abuzer; Işık, Burak; Yılmaz, SezaiLiving-donor liver transplantation (LDLT) is an excellent option for patients with end-stage liver disease in situations of donor shortage. The aims of this study were to evaluate our experience with left-lobe donor hepatectomy for LDLT and to grade postoperative complications using the 5-tier Clavien classification system. Data from medical records of 60 adult living liver donors (30 men, 30 women) who underwent left-lobe hepatectomy between November 2006 and April 2012 were reviewed. The median donor age was 31.7 8.9 (range, 19 – 63) years. Sixteen complications were observed in 12/60 (20%) donors. Complications developed in 6/15 (40%) donors who underwent left hepatectomy and in 6/45 (13.3%) donors who underwent left lateral segmentectomy. Seven of 16 (43.7%) complications were Grade I and 2 (12.5%) were Grade II. Major complications consisted of 4 (25%) Grade IIIa and 3 (18.7%) Grade IIIb complications; no Grade IVb or V complications occurred. The most common complication was biliary, occurring in 7 (11.6%) donors and comprising 43.7% of all 16 complications. The mean duration of follow-up was 30 7.1 (range, 2–58) months. No donor mortality occurred. Left-lobe donor hepatectomy for LDLT, which does not benefit the completely healthy donor, was performed safely and with low complication rates, but carries the risk of morbidity. Low morbidity rates following living-donor hepatectomy can be expected when surgical and clinical monitoring and follow-up are adequate and the surgeon has gained increased experience.Öğe Peptik ülser perforasyonuna eşlik eden gastrik schwannoma(Dicle Tıp Dergisi, 2011) İnce, Volkan; Ateş, Mustafa; Dirican, Abuzer; Şamdancı, Emine; Usta, SertaçÖz: Gastrik schwannoma, sinir hücresi kılıfından kaynaklanan, nadir görülen benign bir neoplazidir. Kesin tanısı histopatolojik ve immünohistokimyasal inceleme yöntemler ile konan gastrik schwannomalar cerrahi rezeksiyon sonrası mükemmel bir seyir gösterdiklerinden, bu tümörlerin, malignite potansiyeli olan gastrointestinal stromal tümörlerden (GİST) ayırıcı tanısı klinik öneme sahiptir. Bu yazıda peptik ülser perforasyonuna eşlik eden gastrik schwannomalı bir olgu literatür eşliğinde sunuldu.Öğe Posterior sector biliary duct injury during laparoscopic cholecystectomy: Case report(2019) Karakaş, Serdar; Usta, Sertaç; Özdemir, FatihAbstract: Biliary injuries are common after a cholecystectomy. One of the most important reasons for biliary injury during laparoscopic cholecystectomy (LC) is variant anatomy of the extrahepatic bile duct. Described in this report is a rare complication of a LC that included a posterior right sectoral duct injury. A 45- year-old woman was referred with peritonitis, including a large quantity of fluid in the abdomen. She had undergone an LC at a state hospital 14 days before the referral. Pouchography revealed a connection between the site of fluid collection and the posterior sector of the right main bile duct. An exploratory laparotomy revealed a dissected right posterior sector channel. A Roux-en-Y hepaticojejunostomy was constructed with no complication. Surgical experience, training, and maintaining a critical view toward safety are the most important factors to prevent bile duct injuries after LC. Care taken with anatomical variance of the extrahepatic biliary tree is also a key factor in the prevention of iatrogenic biliary injuries. Posterior sector injuries should be kept in mind; however, hepaticojejunostomy is a feasible method to overcome this potential complication after the elimination of any intra-abdominal infection.Öğe Primer hiperparatiroidiye eşlik eden tiroid patolojileri: yüksek tiroid papiller mikrokarsinom oranı(Ulusal Cerrahi Dergisi, 2014) Kutlutürk, Koray; Otan, Emrah; Yağcı, Mehmet Ali; Usta, Sertaç; Aydın, Cemalettin; Ünal, Bülent[Abstract Not Acailable]Öğe Prognostic role of platelet lymphocyte ratio (PLR) among patients with hepatocellular carcinoma undergoing liver transplantation(2023) Garzali, Ibrahim Umar; Hargura, Abdirahman Sakulen; İnce, Volkan; Usta, Sertaç; Aloun, Ali; Carr, Brian I.; Yılmaz, SezaiAim: Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide, but it is so aggressive that is the third most common cause of cancer related death. We aim to study the role of PLR in prognosis of HCC and to see if it can be a predictor of overall survival and disease-free survival among HCC patients that received liver transplantation in our center. Materials and Methods: This is a single center retrospective analysis of prospectively collected data. The study was carried out in liver transplant institute of Inonu University, Malatya, Turkey. Consecutive patients that received liver transplantation for HCC and survive for at least 90 days post transplantation were included in the study. Data was collected regarding age, gender, presence or absence of cirrhosis, cause of cirrhosis, number of nodules, maximum size of the tumor, preoperative PLR, pre-transplant GGT, type of transplant, presence or absence of microvascular invasion, overall survival and disease-free survival. The study was censored on June 2022. Data was analyzed using SPSS version 25. Results: Platelet lymphocyte ratio was found to be significantly associated with some poor prognostic factors of HCC in our patients. We found that PLR is significantly associated with maximum tumor diameter (MTD) and total tumor diameter (TTD) with p= <0.0001 and 0.0016 respectively. Univariate analysis revealed that PLR is a predictor of worse DFS or OS but when subjected to multivariate analysis, we found that PLR is not an independent predictor of OS and DFS. Conclusion: Platelet lymphocyte ratio is associated with poor prognostics feature of hepatocellular carcinoma.Öğe Pseudoangiomatous stromal hyperplasia of the breast presenting as a giant breast tumor a case report(J Breast Health, 2015) Kutlutürk, Koray; Usta, Sertaç; Ünal, Bülent; Karadağ, Neşe; Akatlı, Ayşe NurPseudoangiomatous stromal hyperplasia (PASH) of the breast is a benign proliferative lesion of mammary stroma. It is identified as stromal cleavage surrounded by spindle-shaped stromal cells histomorphologicaly. Generally, it is determined in premenopausal women incidentally during breast biopsy. Clinically, it is rarely emerges as a palpable mass. PASH may be confused with low-grade angiosarcoma, hamartomas and phyllodes tumors in histopathological examination. Here, we report a giant left breast lesion that caused breast asymmetry and pain, and treated by total excision of the mass. The patient was a 39 years old women. Histopathologic examination of the specimen was evaluated as PASH. No additional medical treatment and clinical follow-up was recommended to patient. Within four months of the patient fallow-up, no problem occured.Öğe Pseudoangiomatous Stromal Hyperplasia of The Breast Presenting As A Giant Breast Tumor: A Case Report(AVES,, 2015-01) Kutluturk, Koray; Usta, Sertaç; Ünal, Bulent; Karadag, Nese; Akatli, Ayse NurPseudoangiomatous stromal hyperplasia (PASH) of the breast is a benign proliferative lesion of mammary stroma. It is identified as stromal cleavage surrounded by spindle-shaped stromal cells histomorphologicaly. Generally, it is determined in premenopausal women incidentally during breast biopsy. Clinically, it is rarely emerges as a palpable mass. PASH may be confused with low-grade angiosarcoma, hamartomas and phyllodes tumors in histopathological examination. Here, we report a giant left breast lesion that caused breast asymmetry and pain, and treated by total excision of the mass. The patient was a 39 years old women. Histopathologic examination of the specimen was evaluated as PASH. No additional medical treatment and clinical follow-up was recommended to patient. Within four months of the patient fallow-up, no problem occured.Öğe Sol lob ve sol lateral segment canlı donör hepatektomi sonuçlarımız(İnönü Üniversitesi, 2012) Usta, SertaçKaraciğer nakli programına 2006 yılında Turgut Özal Tıp Merkezi?nde başlanılmış olup, günümüze kadar donör morbiditesi olmaksızın, nakillerin % 78.9 CVKN ve %9.8 sol lob CVKN?dir. Bu çalışma ile kliniğimizde canlı vericili sol lob karaciğer nakli için yapılan sol donör hepatektomiye ait sonuçlar retrosepktif olarak incelenmiştir. Materyal ve Metot: Kasım 2006-Nisan 2012 tarihleri arasında, CVKN için yapılan sol lob donör hepatektomiye ait verilerinretrospektif olarak incelenmesi. Bulgular: Sol lob donör hepatektomi olan 60 hasta, çalışmaya dâhil edildi. Ortalama donör yaşı 31.7±8.9 (30/30 erkek/ kadındı) idi. Donörlerin 55 tanesi (%91.6) en az 4. dereceden alıcı ile akrabaydı. 5 tanesi (%8.3) akrabalık dışında donörler idi. On-beş donöre sol hepatektomi (segment 2,3 ve 4) (%25), 45 donöre sol lateral segment rezeksiyonu (%75) yapıldı. Ortalama takip süresi 30± 7.1 (2-58ay) idi. Toplam 60 donörün 12 sinde (%20) toplam 16 komplikasyon tespit edildi. Sol hepatektomi yapılan 6 donörde (%50) ve sol lateral segmentektomi yapılan 6 donörde (%50) komplikasyon gelişti. Gelişen 16 komplikasyonun 7 tanesi (%43.7 ) Grade I ve 2 tanesi (%12.5) Grade II komplikasyonlardı. Gelişen major komplikasyonlardan 4 tanesi Grade IIIa (%25), 3 tanesi Grade IIIb (%18.7) idi. Grade IV ve Grade V komplikasyonumuz olmadı. 16komplikasyon arasında en sık görülen, 7 adet ile (%43.7) safra yolu komplikasyonlarıydı. Donör ölümü hiç olmadı. Sonuç: Sağlıklı bir donör adayında, kendisine fayda sağlamayacak komplike bir cerrahi işleme ait morbidite ve mortalite, kaygılara neden olmaktadır. Deneyimli merkezlerde, uygun hasta seçimi ve yoğun postoperatif takiple sağlıklı bireylerden düşük morbiditeyle güvenilebilir şekilde sol lob karaciğer grefti elde edilebilir.
