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Öğe Application of IWA standard water balance in strategic water loss analysis: Benefits and problems(Yildiz Technical University, 2021) Yilmaz S.; Ozdemir O.; Firat M.Water losses occurring in distribution systems have effect on the operating cost, water and energy efficiency, service quality, customer satisfaction, maintenance and new resource demand. The standard water balance recommended by International Water Association (IWA) were used for defining, analyzing, regularly monitoring the water balance and sub-components, and determining the weakness and strengths of system. Water Utilities in Turkey are required to fill the water balance annually in order to analyze and monitor the performance with the regulation published in year 2014. However, in the use of this table, important problems are experienced due to the lack of technical, technological, personnel and economic conditions, data representing the field are not used and in many cases the real performance of the system is not revealed. In this study, the importance of IWA water balance in water loss management and monitoring system performance is emphasized, and the benefits and advantages are detailed by analyzing the pilot regions. In addition, problems encountered during filling the water balance, mistakes made, incomplete or incorrectly filled data and other problems were discussed. It is thought that this study will constitute a reference for the technical personnel in Utilities for measuring the data, analyzing the components and interpreting the results. © Yildiz Technical University, Environmental Engineering Department. All rights reserved.Öğe Clinical and imaging findings in childhood posterior reversible encephalopathy syndrome(Iranian Child Neurology Society, 2018) Gungor S.; Kilic B.; Tabel Y.; Selimoglu A.; Ozgen U.; Yilmaz S.; Sigirci A.Objective Posterior reversible encephalopathy syndrome (PRES) is characterized by typical radiologic findings in the posterior regions of the cerebral hemispheres and cerebellum. The symptoms include headache, nausea, vomiting, visual disturbances, focal neurologic deficits, and seizures. The aim of this study is to evaluate the clinical and radiological features of PRES in children and to emphasize the recognition of atypical features. Materials & Methods We retrospectively examined 23 children with PRES from Mar 2010-Apr 2015 in Inonu University Turgut Ozal Medical Center in Turkey. We compared the clinical features and cranial MRI findings between underlying diseases of PRES. Results The most common precipitating factors were hypertension (78.2%) and medications, namely immunosuppressive and antineoplastic agents (60.8%). Manifestations included mental changes (100%), seizures (95.6%), headache (60.8%), and visual disturbances (21.7%) of mean 3.6 (range 1-10) days’ duration. Cranial magnetic resonance imaging (MRI) showed bilateral occipital lesions in all patients, associated in 82.6% with less typical distribution of lesions in frontal, temporal or parietal lobes, cerebellum, corpus callosum, basal ganglia, thalamus, and brain stem. Frontal involvement was predominant, observed in 56.5% of patients. Clinical recovery was followed by radiologic resolution in all patients. Conclusion PRES is often unsuspected by the clinician, thus radiologists may be the first to suggest this diagnosis on an MRI obtained for seizures or encephalopathy. Atypical MRI finding is seen quite often. Rapid diagnosis and treatment are required to avoid a devastating outcome. © 2018, Iranian Child Neurology Society. All rights reserved.Öğe Comment on "the Risk of Going Small: Lowering GRWR and Overcoming Small-For-Size Syndrome in Adult Living Donor Liver Transplantation"(Lippincott Williams and Wilkins, 2021) Akbulut S.; Sahin T.T.; Yilmaz S.[No abstract available]Öğe Comparison of patients with hepatitis B virus-associated hepatocellular carcinoma: Data from two hospitals from Turkey and China(John Wiley and Sons Inc, 2023) Carr B.I.; Rui F.; Ince V.; Yilmaz S.; Zhao X.; Feng Y.; Li J.Aims: There are many studies on the incidence of hepatitis B virus (HBV)-associated hepatocellular carcinoma (HCC), but very little is known about the HCC features in different populations. The study aimed to compare characteristics in two cohorts of patients with HBV-associated hepatocellular carcinoma from Turkey and China. Methods: Data on patients with HBV-associated HCC diagnosed by imaging or liver biopsy were retrospectively collected from Shandong Provincial Hospital (n = 578) and Inonu University Hospital (n = 359) between January 2002 and December 2020, and the liver function and HCC characteristics were compared. Continuous variables were compared using Student's t-test or Mann–Whitney U test and categorical variables were compared using the ?² test or Fisher's exact test. Results: The patients in the Turkish cohort had significantly worse Child-Pugh scores (Child-Pugh A: 38.3% vs. 87.9%; Child-Pugh B: 40.3% vs. 11.1%; Child-Pugh C: 21.4% vs. 1.0%; p < 0.001) and significantly higher levels of aspartate aminotransferase (66.5 [38.0?126.0] vs. 36.0 [27.0?50.0] IU/L; p < 0.001), alanine aminotransferase (47.5 [30.0?87.3] vs. 33.0 [24.0?45.0] IU/L; p < 0.001), total bilirubin (20.8 [13.7?39.3] vs. 17.9 [13.8?24.0] mg/dL; p < 0.001), and lower albumin levels (32.0 [26.0?39.0] vs. 40.0 [36.1?43.8] g/L; p < 0.001) than patients in Chinese cohort. The tumor characteristics showed the Barcelona Clinic Liver Cancer (BCLC) score (BCLC 1: 5.1% vs. 71.8%; BCLC 2: 48.7% vs. 24.4%; BCLC 3: 24.4% vs. 3.8%; BCLC 4: 21.8% vs. 0; all p < 0.001), maximum tumor diameter (5.0 [3.0?9.0] vs. 3.5 [2.5?6.0] cm; p < 0.001), alpha-fetoprotein values (27.7 vs. 13.2 ng/mL; p < 0.001), and percentage of patients with portal vein tumor thrombus (33% vs. 6.1%; p < 0.001) were all significantly worse in the Turkish cohort compared with Chinese cohort. Conclusions: HBV-associated HCC from the Turkish cohort had worse liver function and more aggressive clinical characteristics than patients from the Chinese cohort. © 2023 The Authors. Portal Hypertension & Cirrhosis published by John Wiley & Sons Ltd on behalf of Chinese Medical Association.Öğe Determination of the most economical leakage level in the district-metered area with the optimization algorithm(EDP Sciences, 2024) Yilmaz S.; Ateş A.; Firat M.Failures and breaks occurring in water distribution networks (WDSs) create significant leakage volumes annually. System operating conditions deteriorate due to the increase in the rate of failure and leakage. Therefore, the failure rate and leakage volume should be reduced by applying the most appropriate methods. For this, the most economically suitable level must first be defined in each system or district-metered area. This study aims to define the most economical leakage level with the optimization algorithm in the district-metered area in water distribution systems. For this, network characteristics, subscriber information and water consumption, water production cost, failure rates, and other data in the isolated measurement area are considered. Ant lion optimization algorithm was used as the optimization algorithm in the study. The definition of the methods to be applied to reach the defined ELL level constitutes a reference for the implementers. Water utilities can continue their loss reduction strategies in the most economically efficient way with the help of this method. In the selected regions of the study area, pressure management application and active leakage method application were economical. Thus, it is possible to create a more effective and efficient leakage management plan in the isolated measurement area. It is thought that the results obtained from the study will serve as a reference for practitioners and technical personnel, especially in terms of determining the appropriate leakage target level for each isolated region. © The Authors, published by EDP Sciences.Öğe Diaphragmatic injuries due to stab wounds: Analysis of 18 patients(Turkish Surgical Society, 2010) Dirican A.; Ateş M.; Ünal B.; Yilmaz M.; Özgör D.; Yilmaz S.Purpose: Although all diaphragmatic injuries caused by stab wounds need to be repaired, preoperative diagnosis is often difficult. The purpose of the present study is to share our experience regarding diaphragmatic wounds. Patients and Methods: Eighteen patients with stab wounds causing diaphragmatic injuries treated at General Surgery Clinic of ?nönü University Faculty of Medicine between March 2000 and June 2009 were evaluated retrospectively. Results: There were 15 male and 3 female patients with mean age of 33 (20-69) years. Most common complaints were difficulty in breathing, and abdominal and chest pain. Localization of the injury was on the left side of the diaphragm in 11 (61%) patients and on the right side in 6 (33%) patients, and one (6%) patient had injuries on both sides. Surgery was performed in 17 patients with midline abdominal incision within the first 24 hours after the injury and with lateral thoracotomy in a patient 10 days after injury. Mortality occurred in 3 (17%) patients; in 2 patients due to bleeding from accompanying injuries and in one patient due to postoperative sepsis. Conclusion: Preoperative diagnosis of diaphragmatic injury due to a stab wound is difficult. These patients highly probably have visceral organ injuries in addition to diaphragmatic injuries. Diaphragmatic injuries should be kept in mind in patients with abdominal penetrating stab injuries which are located between umbilicus and xiphoid. Both hemidiaphragms should be explored carefully during abdominal surgery of these patients.Öğe Effect of intratechal morphine on postoperative stress response and postoperative analgesic requirements on cardiac patients in major abdominal surgery(2000) To?al T.; Türköz A.; Durmuş M.; Şahin S.; Yilmaz S.; Ersoy M.Ö.This study investigated the use of single dose intratechal (IT) morphine on cardiac patients undergoing major abdominal surgery and its effect on postoperative stress response, hemodynamic response and postoperative analgesic requirements. ASA class III 20 patients were randomized to receive either 10 ?g/kg of intratechal morphine or control group. Induction were performed by fentanyl 5 ?g/kg, thiopentone 2-4 mg/kg and vecuronium 0.08 mg/kg and anaesthesia was maintained by 33% N2O/O2 mixture with sevoflurane. There were no significant differences in the serum cortisol, glucose, BUN, creatinine, ALP, ALT, AST, CK, CK-MB concentrations recorded in the two groups pre and postoperatively. Cortisol, CK and CK-MB concentrations increased in both groups postoperatively. Plasma glucose concentrations increased in control group postoperatively. There were no significant differences of hemodynamic parameters between the two groups. Analgesic requirements of control group increased postoperatively comparing IT group. Three patients died postoperatively, other side effects were clinically insignificant. In conclusion IT morphine had no effect upon hemodynamic response, did not inhibit the stress response to surgery perioperatively on cardiac patients but we demonstrated the decrease of the postoperative analgesic requirements.Öğe Enhanced role of multipair donor swaps in response to size incompatibility: The first two 5-way and the first 6-way liver paired exchanges(Elsevier B.V., 2024) Yilmaz S.; Sönmez T.; Ünver M.U.; Ince V.; Akbulut S.; Sarici K.B.; Isik B.A significant portion of liver transplantations in many countries is conducted via living-donor liver transplantation (LDLT). However, numerous potential donors are unable to donate to their intended recipients due to factors such as blood type incompatibility or size incompatibility. Despite this, an incompatible donor for one recipient may still be a viable donor for another patient. In recent decades, several transplant centers have introduced liver paired exchange (LPE) programs, facilitating donor exchanges between patients and their incompatible donors, thereby enabling compatible transplants. Initially, LPE programs in Asia primarily involved ABO-i pairs, resulting in 2-way exchanges mainly between blood type A and B recipients and donors. This practice has led to a modest 1% to 2% increase in LDLTs at some centers. Incorporating size incompatibility alongside blood type incompatibility further enhances the efficacy and significance of multiple-pair LPEs. Launched in July 2022, a single-center LPE program established at Inonu University Liver Transplant Institute in Malatya, Türkiye, has conducted thirteen 2-way, nine 3-way, four 4-way, two 5-way, and one 6-way LPEs until February 2024. In 2023 alone, this program facilitated 64 LDLTs, constituting 27.7% of the total 231 LDLTs performed. This paper presents the world's first two 5-way LPEs and the first 6-way LPE. © 2024 The AuthorsÖğe Gastric perforation during chest tube placement for acute diaphragmatic rupture and review of the literature(Elsevier BV, 2006) Yilmaz M.; Isik B.; Ara C.; Yilmaz S.; Kutlu R.; Kocak O.; Ugras M.[No abstract available]Öğe Hydatid liver cyst causing portal vein thrombosis and cavernous transformation: A case report and literature review(Research Institute for Gastroenterology and Liver Diseases, 2016) Kirmizi S.; Kayaalp C.; Yilmaz S.A 33-year-old male with abdominal distention after meals was admitted to the hospital. He had a history of surgery for hydatid liver cyst. The cyst was located at the liver hilum and there were portal venous thrombosis and cavernous transformation. It had been treated with partial cystectomy, omentoplasty and albendazole. Two years later at the admission to our center, his laboratory tests were in normal ranges. Abdominal imaging methods revealed splenomegaly, portal vein thrombosis, cavernous transformation and the previously operated hydatid liver cyst. Upper gastrointestinal endoscopy demonstrated esophageal and gastric fundal varices. Due to his young age and low risk for surgery, the patient was planned for surgical treatment of both pathologies at the same time. At laparotomy, hydatid liver cyst was obliterated with omentum and there was no sign of active viable hydatid disease. A meso-caval shunt with an 8 mm indiameter graft was created. In the postoperative period, his symptoms and endoscopic varices were regressed. There were four similar cases reported in the literature. This one was the youngest and the only one treated by a surgical shunt. Hydatid liver cysts that located around the hilum can lead to portal vein thrombosis and cavernous thrombosis. Treatment should consist of both hydatid liver cyst and portal hypertension. To the best of our knowledge, this was the first case of surgically treated portal vein thrombosis that was originated from a hydatid liver cyst. © 2016 RIGLD, Research Institute for Gastroenterology and Liver Diseases.Öğe In memoriam of Thomas Earl Starzl, the pioneer of liver transplantation(Baishideng Publishing Group Inc, 2022) Yilmaz S.; Akbulut S.Starzl's nearly 3000 publications that contribute to the science of transplantation in every field have been the most important resources for every scientist working in this field. For those of us who work in the liver transplant field, his contributions throughout his life have shaped our career and passion, even for those who have never met, spoken to, or worked with him. If we are able to help patients with liver failure today by offering them the chance of transplantation, it is because of Starzl's passionate work and efforts. Thanks to Starzl's scientific legacy, hundreds of scientists serve humanity and thousands of patients can hold on to life. It has been an honor for us to write this article about Professor Starzl. ©The Author(s) 2022.Öğe Individual patient assessment and therapy decision-making in a live donor-based liver transplant institute(Springer International Publishing, 2021) Carr B.I.; Yilmaz S.; Isik B.; Kutlu R.Patients with HCC present with both their tumor and underlying liver disease, requiring input from several disciplines for optimal therapeutic decision-making. We describe our method, which emphasizes the importance of a multidisciplinary approach and a tumor board. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2021. All rights reserved.Öğe Inter-ictal psychosis and its treatment in an adolescent with epilepsy and borderline intellectual functioning: A case report(2011) Tufan A.E.; Özel Ö.Ö.; Yilmaz S.; U?urlu G.K.; Bilici R.; Namli M.Psychosis seen in patients with epilepsy can be classified as "ictal", "post-ictal" or "inter-ictal" according to the time of onset of psychotic symptoms in relation with seizures. This case presentation was thought to be important because of problems in making the diagnosis of inter-ictal psychosis and that the literature in our country on the relationship of epilepsy and psychosis in childhood and adolescence is limited. Irritability, auditory and visual hallucinations and persecutory delusions that increase in between seizures and reduce with them were observed in a 14 years-old male patient. He has been receiving treatment for epilepsy since he was 7 years old. No other stressor or psychoactive substance use were defined. The patient was using carbamazepine 1200 mg/ day, levatiracetam 500 mg/ day and pyrimidone 500 mg/ day at the time of presentation. Epileptiform activity at the left fronto-temporo-central area was observed with electroencephalography while I.Q. was found to be 75 (Borderline IQ) with the Porteus Labyrinths test. The patient was thought to fulfill the diagnosis for Psychotic Disorder NOS (inter-ictal psychosis) developing on borderline intellectual functioning and quetiapine 25 mg/ day was started. The dose was titrated gradually to 200 mg/ day. Quetiapine can be a choice for the treatment of inter-ictal psychosis and that further studies are needed to better evaluate the prevalence and treatment response of psychotic symptoms in children and adolescents with epilepsy.Öğe Liver transplantation from an upper midline incision(2011) Kayaalp C.; Aydin C.; Unal B.; Baskiran A.; Ozgor D.; Aydinli B.; Yilmaz S.Objectives: To evaluate the minimally invasive incision to the recipient of a liver transplant. Materials and Methods: A 55-year-old man with cirrhosis due to hepatitis B accompanied by hepatocellular carcinoma underwent a right lobe, living-donor liver transplant using an 18-cm long, upper midline incision. The recipient hepatectomy was performed from the left to the right side (from medial to lateral). Deep retractors and long surgical instruments were preferred. Results: The surgical procedure was completed without problem. Both the recipient hepatectomy and implantation of the right liver took 8 hours. Postoperative recovery of the patient was rapid, and he was discharged 8 days after surgery, uneventfully. Conclusions: An upper midline incision can be preferred for liver transplant for selected cases. Minimally invasive surgery is an option for liver transplant recipients as well. © Başkent University 2011 Printed in Turkey. All Rights Reserved.Öğe Liver transplantation in the middle east(Springer International Publishing, 2021) Yilmaz S.The Middle East has a diverse ethnicity and religious background, and Islam is the main religion. There are contradictory views among Islamic scholars and lawmakers on the legitimacy of organ donation from deceased donors. There are common features affecting organ transplantation in Middle Eastern countries that include inadequate preventive medicine, uneven health infrastructure, poor awareness within the medical community and lay public regarding the importance of organ donation and transplantation, and poor government support for organ transplantation. In addition, there is a lack of team spirit among physicians dealing with transplantation, lack of planning for organ procurement and transplant centers, and lack of effective health insurance. Living liver donors are the main sources of the organ donation for transplantation. Turkey and Iran are the two countries that have performed a large number of liver transplants institutionally. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2021. All rights reserved.Öğe Living related donor liver transplantation with atrio-caval anastomosis of inferior vena cava graft stored in deep-freeze for budd-chiari syndrome(Iranian Society for Organ Transplantation, 2015) Yaylak F.; Ince V.; Barut B.; Unal B.; Kilic M.; Yilmaz S.We have previously reported our experience in inferior vena cava resection and reconstruction techniques during liver transplantation for Budd-Chiari syndrome. Herein, we present on a case that demonstrates the importance of experience in complex vascular reconstruction techniques for living donor liver transplantation. A 15-year-old boy was scheduled for living donor liver transplantation for Budd-Chiari syndrome. Venous occlusion was extended up to the right atrial orifice of the supra-hepatic vena cava. Retro- and supra-hepatic segments of the vena cava was resected. Inferior vena cava graft stored in deep-freeze was available. Venous reconstruction was performed with end-to-end atrio-caval anastomosis. Surgical treatment was completed with the implantation of the right liver lobe donated by the patient's mother. Post-surgical course was uneventful.Öğe Multiple Swaps Tested: Rehearsal for Triple and Five-Liver Paired Exchanges(Elsevier Inc., 2023) Yilmaz S.; Kizilay A.; Bayramov N.; Tekin A.; Emre S.Despite several advances in living donor liver transplant (LDLT), many potential living liver donors cannot donate their organs to their relatives because of blood group incompatibility and unsuitable anatomy. Liver paired exchange (LPE) can be used to overcome incompatibilities between living donor–recipient pairs. In this study, we report the early and late results of 3 and 5 LDLTs performed simultaneously to initiate the more complex LPE program. By demonstrating that our center is capable of performing up to 5 LDLTs, we have taken an essential step for establishing a complex LPE program. © 2023 Elsevier Inc.Öğe An overlooked complication after laparoscopic surgery: Trocur site hernias [1] [Laparoskopik cerrahi sonrasi gozden kacan bir komplikasyon: Trokar yeri hernileri](1998) Yilmaz S.; Kirimloglu V.; Caglikulekci M.; Kayaalp C.; Atalay F.; Akoglu M.[No abstract available]Öğe Peritoneal encapsulation in a patient with incomplete situs inversus(2012) Ince V.; Dirican A.; Yilmaz M.; Barut B.; Ersan V.; Yilmaz S.Peritoneal encapsulation (PE) is an extremely rare congenital condition in which there is abnormal return of the midgut loop to the abdominal cavity in the early stages of development. It may be present in patients with congenital anomalies like incomplete situs inversus. Pre-operative diagnosis is possible with abdominal CT. A 71-year-old man with incomplete situs inversus was admitted to emergency department with symptoms and signs of peritonitis. Computed tomography (CT) of the abdomen showed characteristic features of the PE syndrome. He had exploratory laparotomy performed and arterial occlusion caused ileocaecal ischaemia and PE was observed. Capsule of PE and ileocaecal excision was done. Postoperative recovery was uneventful.Öğe PREDICTIVE BIOMARKERS OF LIVING DONOR LIVER TRANSPLANTATION(University of Ankara, 2023) Çiftçi Ö.F.; Şahin T.T.; Yüce H.; Yilmaz S.; Türkmen N.B.; Yaşar Ş.; Çoban T.Objective: Liver transplantation using a living donor (LDLT) is currently the most popular method used in the worldwide. Appropriate biomarkers that predict graft status should be used to detect early post-transplant complications that may lead to a rejection reaction. Material and Method: The study involved a total of 44 liver recipients and 44 liver donors, from whom preoperative blood samples were taken and immunoassay and spectrophotometric studies were carried out. The levels of serum neopterin, interferon-gamma (IFN- y), indoleamine-2,3 dioxygenase (IDO), and -glutathione S transferase (a-GST) were assessed using an enzyme-linked immunosorbent test. The activity of glutathione reductase (GR) and glucose-6-phosphate dehydrogenase (G6PD) in erythrocytes was measured using spectrophotometry. Result and Discussion: "Neopterin, IDO, and G6PD levels were significantly higher in the recipient group than in the donor group. The differences in gender and blood groups were statistically insignificant. The rejection reaction developed in 25% of patients and none survived. These findings may facilitate the identification of novel predictive biomarkers for the diagnosis of acute rejection reactions after LDLT. The clinical use of novel non-invasive biomarkers may provide time and cost advantages. © 2023 University of Ankara. All rights reserved.
