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Öğe Characteristics of steatohepatitic hepatocellular carcinoma in a series of predominantly virus-related cirrhosis(Springer, 2013) Aykutlu, U.; Uguz, A.; Unalp, O.; Nart, D.; Karasu, Z.; Sozbilen, M.; Yilmaz, F.Öğe Comparison of Isolated and Concomitant Liver Injuries: is Hepatic Trauma Entirely Responsible for the Outcome ?(Acta Medical Belgica, 2010) Yazici, P.; Aydin, U.; Sozbilen, M.Objective : This study was undertaken to examine both isolated and concomitant liver injuries to clarify the role of liver trauma on outcome. Patients and methods : This retrospective study was a review of all abdominal trauma patients who presented with liver injuries, with or without concomitant injury at Ege University School of Medicine over a 3-year period. Presentation, injury grade, management, and outcomes were analyzed. Patients with isolated hepatic injury (Group A) were compared with patients who had concomitant hepatic injury (liver and spleen/small bowel) (Group B). Significance was set at 95% confidence intervals. Results : Of 368 patients, 80(21%) presented with liver injury. Of these, the aetiology was as follows : 53 (66.2%) blunt injury, 19 (23%) penetrating injury, and 8 (10%) gun shot trauma. There were 38 patients in Group A and 42 in Group B. Of these 42 patients, 19 were diagnosed with serious types of injury; eight thoracic, three open long bone fracture, one intra-cardiac, one intracranial. Six additional patients were observed with injuries to large abdominal vessels. Eleven patients (28.9%) with isolated hepatic injury were managed non-operatively. Mortality, intensive care unit and hospital length of stay, and transfusion requirements were significantly higher in Group B. Only the number of transfused blood units and the grade of liver injury were found to be effective on outcome whereas stepwise regression analysis revealed that injury type (penetrating) and blood transfusion were predictive for mortality. Conclusion : This study highlighted that although isolated liver injury results in good outcome with non-operative management, concomitant injuries to the liver lead to a higher failure and mortality rate. However, liver injury itself is rarely responsible for death.Öğe Comparison of Patients in Whom Double-J Stent Had Been Placed or Not Placed After Renal Transplantation in a Single Center: A Follow-up Study(Elsevier Science Inc, 2015) Alci, E.; Ustun, M.; Sezer, T.; Yilmaz, M.; Ozdemir, M.; Unsal, M. G.; Uguz, A.; Sozbilen, M.; Toz, H.; Hoscoskun, C.Background. Double-J (DJ) stents play an important role in modern urology to prevent undesirable side effects after surgery. We aimed to investigate the relationship of DJ stents with the demographic characteristics, surgical complications, urinary tract infection (UTI), and hematuria in the patients who underwent renal transplantation (Tx). Methods. Data of 354 patients who underwent renal Tx between 2008 and 2011 at Ege University were evaluated retrospectively; 331 patients were included in this study. The term DJ (-) represents patients in whom a DJ stent was not placed. "Primary DJ term" represents patients in whom the DJ stent was placed during the first Tx. "Secondary DJ term" represents the patients who had DJ after Tx for any complication. Results. Two hundred fifty-four (76.7%) patients were in the DJ (-) group, 52(15.7%) were in the primary DJ group, and 25(7.6%) were in the secondary DJ group. There were significant differences between the groups in terms of anastomosis type (P = .000), stay-in-hospital time (P = .000), surgical complication (P = .000), re-operation (P = .000), percutaneous nephrostomy (P = .000), UTI (P = .000), first-time UTI (P = .000), recurrent UTI (P = .000), positive hemoculture (P = .000), hematuria (P = .000), duration of dialysis before Tx (P = .000), live/deceased donor (P = .000), and delayed graft function (P = .009). Conclusions. Our choice is to use the DJ stent in selected high-risk patients and to keep the indications for DJ stent wider in deceased donor transplants by considering possible surgical complications. The use of the stent only in selected cases will decrease surgical complications due to stent placement.Öğe Comparison of Patients in Whom Double-J Stent Had Been Placed or Not Placed After Renal Transplantation in a Single Center: A Follow-up Study(Elsevier Science Inc, 2015) Alci, E.; Ustun, M.; Sezer, T.; Yilmaz, M.; Ozdemir, M.; Unsal, M. G.; Uguz, A.; Sozbilen, M.; Toz, H.; Hoscoskun, C.Background. Double-J (DJ) stents play an important role in modern urology to prevent undesirable side effects after surgery. We aimed to investigate the relationship of DJ stents with the demographic characteristics, surgical complications, urinary tract infection (UTI), and hematuria in the patients who underwent renal transplantation (Tx). Methods. Data of 354 patients who underwent renal Tx between 2008 and 2011 at Ege University were evaluated retrospectively; 331 patients were included in this study. The term DJ (-) represents patients in whom a DJ stent was not placed. "Primary DJ term" represents patients in whom the DJ stent was placed during the first Tx. "Secondary DJ term" represents the patients who had DJ after Tx for any complication. Results. Two hundred fifty-four (76.7%) patients were in the DJ (-) group, 52(15.7%) were in the primary DJ group, and 25(7.6%) were in the secondary DJ group. There were significant differences between the groups in terms of anastomosis type (P = .000), stay-in-hospital time (P = .000), surgical complication (P = .000), re-operation (P = .000), percutaneous nephrostomy (P = .000), UTI (P = .000), first-time UTI (P = .000), recurrent UTI (P = .000), positive hemoculture (P = .000), hematuria (P = .000), duration of dialysis before Tx (P = .000), live/deceased donor (P = .000), and delayed graft function (P = .009). Conclusions. Our choice is to use the DJ stent in selected high-risk patients and to keep the indications for DJ stent wider in deceased donor transplants by considering possible surgical complications. The use of the stent only in selected cases will decrease surgical complications due to stent placement.Öğe Comparison of Patients in Whom Double-J Stent Had Been Placed or Not Placed After Renal Transplantation in a Single Center: A Follow-up Study(Elsevier Science Inc, 2015) Alci, E.; Ustun, M.; Sezer, T.; Yilmaz, M.; Ozdemir, M.; Unsal, M. G.; Uguz, A.; Sozbilen, M.; Toz, H.; Hoscoskun, C.Background. Double-J (DJ) stents play an important role in modern urology to prevent undesirable side effects after surgery. We aimed to investigate the relationship of DJ stents with the demographic characteristics, surgical complications, urinary tract infection (UTI), and hematuria in the patients who underwent renal transplantation (Tx). Methods. Data of 354 patients who underwent renal Tx between 2008 and 2011 at Ege University were evaluated retrospectively; 331 patients were included in this study. The term DJ (-) represents patients in whom a DJ stent was not placed. "Primary DJ term" represents patients in whom the DJ stent was placed during the first Tx. "Secondary DJ term" represents the patients who had DJ after Tx for any complication. Results. Two hundred fifty-four (76.7%) patients were in the DJ (-) group, 52(15.7%) were in the primary DJ group, and 25(7.6%) were in the secondary DJ group. There were significant differences between the groups in terms of anastomosis type (P = .000), stay-in-hospital time (P = .000), surgical complication (P = .000), re-operation (P = .000), percutaneous nephrostomy (P = .000), UTI (P = .000), first-time UTI (P = .000), recurrent UTI (P = .000), positive hemoculture (P = .000), hematuria (P = .000), duration of dialysis before Tx (P = .000), live/deceased donor (P = .000), and delayed graft function (P = .009). Conclusions. Our choice is to use the DJ stent in selected high-risk patients and to keep the indications for DJ stent wider in deceased donor transplants by considering possible surgical complications. The use of the stent only in selected cases will decrease surgical complications due to stent placement.Öğe FACTORS CD10, CYTOKERATIN 19 AND STAGING-GRADING SYSTEMS IN PREDICTING THE PROGNOSIS OF PANCREATIC NEUROENDOCRINE TUMORS (PNET)(Editura Acad Romane, 2012) Uguz, A.; Unalp, O. V.; Yeniay, L.; Farajov, R.; Yoldas, T.; Sezer, T. O.; Ipek, N. Y.; Nart, D.; Yilmaz, F.; Sozbilen, M.; Coker, A.Objective. This study was undertaken to examine prognostic factors in patients with pancreatic neuroendocrine tumors (PNET) undergoing surgical treatment to evaluate the prognostic value of recently introduced immunohistochemical staining methods of CD10 and cytokeratin 19. Materials and Methods. Tumors were classified on the basis of 2004 WHO Classification Guidelines and European Neuroendocrine Tumor Society (ENETS) grading system. Immunohistochemical staining with Ki-67, CD10 and cytokeratin 19 was performed. Results. A total of 36 patients with a mean age of 53.7 +/- 12.0 years were included. Overall, 33 patients had a long-term follow-up with 10 patients (30.3%) experiencing recurrence. Seven patients (21.1%) died. Clinical parameters that were associated with recurrence included liver metastasis at the time of surgery and extra-pancreatic invasion (p < 0.005). Positive surgical margins, extra-pancreatic invasion, and multi-focal disease were associated with reduced survival (p < 0.05). In addition, there was an association between survival and WHO 2004 classification (p < 0.05). Conclusions. Although vascular and peripancreatic invasion showed increased risk of recurrence, they were unrelated to survival. Of the histopathological examinations, Ki-67 and mitotic activity showed a correlation with both recurrence and survival, while immunohistochemical staining with cytokeratin 19 and CD 10 did not provide adequate prognostic information.Öğe Is a High Body Mass Index Still a Risk Factor for Complications of Donor Nephrectomy?(Elsevier Science Inc, 2015) Uguz, A.; Unsal, M. G.; Unalp, O. V.; Sezer, T.; Celtik, A.; Sozbilen, M.; Toz, H.; Hoscoskun, C.Background and Aim. The incidence of obesity is increasing all around the world and Turkey is no exception. In Turkey, 80.1% of all kidney transplants performed in 2013 were living donor kidney transplants. In this study we compare the early postoperative complications of living kidney donors with a body mass index (BMI) over 30 to those with BMIs under 30. Patients and Method. All donor nephrectomies performed at the Ege University School of Medicine Hospital between May 2013 and May 2014 were included in the study. Donors' demographics, preoperative BMI, operation time, length of hospital stay, postoperative complications, and perioperative blood creatinine levels were analyzed. Results. There were a total of 72 donors, 50 of whom had a BMI below 30 (group 1), whereas 22 had a BMI of 30 or higher (Group 2). The median age was 47 (+/- 12.6) and 52.2 (+/- 8.4) for Groups 1 and 2, respectively. The median BMI was 26.1 (+/- 2.3) for Group 1 and 31.8 (+/- 1.5) for Group 2. There was no significant difference in operation time (P = .980) between the 2 groups. There was no difference in the length of hospitalization with an average hospital stay of 3 days for both groups. No major complications were observed in either group. There was no difference in minor complication rates for both groups. Conclusion. High BMI donors can safely donate their kidney with no significant increase in complication rates at high-volume transplantation centers.Öğe Is a High Body Mass Index Still a Risk Factor for Complications of Donor Nephrectomy?(Elsevier Science Inc, 2015) Uguz, A.; Unsal, M. G.; Unalp, O. V.; Sezer, T.; Celtik, A.; Sozbilen, M.; Toz, H.; Hoscoskun, C.Background and Aim. The incidence of obesity is increasing all around the world and Turkey is no exception. In Turkey, 80.1% of all kidney transplants performed in 2013 were living donor kidney transplants. In this study we compare the early postoperative complications of living kidney donors with a body mass index (BMI) over 30 to those with BMIs under 30. Patients and Method. All donor nephrectomies performed at the Ege University School of Medicine Hospital between May 2013 and May 2014 were included in the study. Donors' demographics, preoperative BMI, operation time, length of hospital stay, postoperative complications, and perioperative blood creatinine levels were analyzed. Results. There were a total of 72 donors, 50 of whom had a BMI below 30 (group 1), whereas 22 had a BMI of 30 or higher (Group 2). The median age was 47 (+/- 12.6) and 52.2 (+/- 8.4) for Groups 1 and 2, respectively. The median BMI was 26.1 (+/- 2.3) for Group 1 and 31.8 (+/- 1.5) for Group 2. There was no significant difference in operation time (P = .980) between the 2 groups. There was no difference in the length of hospitalization with an average hospital stay of 3 days for both groups. No major complications were observed in either group. There was no difference in minor complication rates for both groups. Conclusion. High BMI donors can safely donate their kidney with no significant increase in complication rates at high-volume transplantation centers.Öğe Is a High Body Mass Index Still a Risk Factor for Complications of Donor Nephrectomy?(Elsevier Science Inc, 2015) Uguz, A.; Unsal, M. G.; Unalp, O. V.; Sezer, T.; Celtik, A.; Sozbilen, M.; Toz, H.; Hoscoskun, C.Background and Aim. The incidence of obesity is increasing all around the world and Turkey is no exception. In Turkey, 80.1% of all kidney transplants performed in 2013 were living donor kidney transplants. In this study we compare the early postoperative complications of living kidney donors with a body mass index (BMI) over 30 to those with BMIs under 30. Patients and Method. All donor nephrectomies performed at the Ege University School of Medicine Hospital between May 2013 and May 2014 were included in the study. Donors' demographics, preoperative BMI, operation time, length of hospital stay, postoperative complications, and perioperative blood creatinine levels were analyzed. Results. There were a total of 72 donors, 50 of whom had a BMI below 30 (group 1), whereas 22 had a BMI of 30 or higher (Group 2). The median age was 47 (+/- 12.6) and 52.2 (+/- 8.4) for Groups 1 and 2, respectively. The median BMI was 26.1 (+/- 2.3) for Group 1 and 31.8 (+/- 1.5) for Group 2. There was no significant difference in operation time (P = .980) between the 2 groups. There was no difference in the length of hospitalization with an average hospital stay of 3 days for both groups. No major complications were observed in either group. There was no difference in minor complication rates for both groups. Conclusion. High BMI donors can safely donate their kidney with no significant increase in complication rates at high-volume transplantation centers.Öğe Patient with hepatocellular carcinoma on the waiting list for liver transplantation: Abdominal seeding due to prior surgery: A case report(Elsevier Science Inc, 2007) Aydin, U.; Yazici, P.; Sozbilen, M.; Kece, C.; Tamsel, S.; Kilic, M.Hepatocellular cancer (HCC) is the most common primary malignant hepatic tumor that accounts for over 80% of primary liver tumors. Hepatic resection is a well-accepted therapy for HCC, but 70% to 100% of patients, depending on patient selection, baseline tumor characteristics, and follow-up duration, develop cancer recurrence after resective surgery. Orthotropic liver transplantation is considered more appropriate in cases with HCC related to cirrhosis. Both procedures may result in recurrence. In some cases, diagnosis of recurrent HCC is difficult because of unexpected localization of the tumor. For these patients, aggressive diagnostic tests might be useful for appropriate therapy. We report a case of a 48-year-old man undergoing resection for HCC, who experienced early recurrence of HCC in the pelvic region.Öğe Results of Surgery-Related Complications in Donors of Right Lobe Liver Graft: Analysis of 272 Cases(Elsevier Science Inc, 2014) Ozsoy, M.; Unalp, O. V.; Sozbilen, M.; Alper, M.; Kilic, M.; Zeytunlu, M.Background. Living donor liver transplantation has been a new light of hope for patients with end-stage liver failure on the cadaveric waiting list. However, living donor liver transplantation still has ethical problems which cannot be overcome. Exposure of healthy donor candidates to major surgery which can be fatal is the largest of these ethical problems. In this study, we aimed to determine our rate of complications associated with surgery in donors who underwent right lobe donor hepatectomy. Materials and Methods. Between September 2004 and December 2009, 548 liver donor candidates were examined. The right liver lobe donor hepatectomy was performed on 272 donor candidates who passed the elimination system. Demographic data as well as intra-operative findings, complication rates, and numbers were collected retrospectively. Donor complications were categorized according to the Clavien classification. Results. Two hundred seventy-two donors who underwent right lobe donor hepatectomy were included in this study. One hundred sixteen (42.6%) of 272 donors were female, whereas 156 (57.4%) were male. There was no donor mortality. Grade 1 and grade 2 complications were observed in 105 (38%) of 272 donors. The most common complications were fever of unknown origin (20.9%) and prolonged hyperbilirubinemia (3.6%). Grade 3 complications and grade 4 complications were observed in 6 donors (2%) and 3 donors (1%), respectively. Three donors were underwent re-operation due to bleeding. The re-laparatomy rate in our series was detected as 1.10%. One donor, categorized as grade 4B according to the Clavien classification, had small bowel perforation and intra-abdominal sepsis secondary to mechanical bowel obstruction. Conclusions. Donor mortality is a fact of living donor liver transplantation that cannot be ignored like donor morbidity. However, right liver lobe donor hepatectomy can be performed successfully with minimal complication rates with multidisciplinary and rigorous donor care in the preoperative and postoperative period.Öğe Simultaneous air transportation of the harvested heart and visceral organs for transplantation(Elsevier Science Inc, 2008) Aydin, U.; Yazici, P.; Kazimi, C.; Bozoklar, A.; Sozbilen, M.; Zeytunlu, M.; Kilic, M.Background. The purpose of this study was to evaluate the duration for organ procurement including both heart and visceral organs and outcomes of the simultaneous transportation of the teams back to the recipient hospitals. Patients and Methods. Between March 2005 and March 2007, 37/82 organ procurement was performed in the district hospitals and transported to our institution for organ transplantation. Combined heart and visceral organ procurement which was simultaneously transported to the recipient hospitals by one air vehicle was reviewed. After both the thoracic and abdominal cavities were entered, all intra-abdominal organs were mobilized allowing exposure of the inferior mesenteric vein and aorta. The supraceliac abdominal aorta was elevated. The attachments of the liver in the hilar region were incised and both kidneys and pancreas prepared for removal. After the inferior mesenteric vein and aorta were cannulated, simultaneous aortic cross-clamping was performed and cold preservation solution infused. Harvested organs were packed with ice and removed to the back table for initial preparation and packaging for air transport. Results. The mean duration of 6 procurement procedures was 63 minutes (range 50-75 minutes) to aortic clamping, and 27.5 minutes (range, 20-40 minutes) between clamping and harvesting. Mean cold ischemia times for 6 hearts, 6 livers, 12 kidneys, 2 pancreas, and 1 small intestine were 2.4 hours (range, 2-3.5 hours), 5 hours (range, 3-8 hours), 10.3 hours (range, 8-15 hours), 6.7 hours, and 9.5 hours, respectively. No graft complication was observed to be associated with the procurement procedure. Conclusion. Better collaborations between surgical teams and rapid procurement techniques provide simultaneous air transportation back to the recipient hospital with reduced cold ischemia times of the visceral organs.Öğe TELBIVUDIN: MORE CAUTION IS NEEDED IN LIVER TRANSPLANT RECIPIENTS(Elsevier Science Bv, 2014) Karasu, Z.; Turan, I.; Duman, S.; Sozbilen, M.; Gunsar, F.; Ersoz, G.; Akarca, U.
