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Öğe Active Immunoprophylaxis With Hepatitis B Virus (HBV) Vaccination Is Not an Effective Strategy for Prevention of HBV Recurrence after Liver Transplantation.(Wiley-Blackwell, 2014) Turan, Ilker; Mut, Deniz; Sozbilen, Murat; Erensoy, Selda; Gunsar, Fulya; Ersoz, Galip; Akarca, Ulus S.; Karasu, ZekiÖğe ARE THE PAIRED IMPLANT BIOPSIES FROM CADAVERIC DONORS NECESSARY?(Wiley-Blackwell, 2005) Sen, Sait; Nalbantoglu, Ilke; Toz, Huseyin; Doganavsargil, Basak; Sozbilen, Murat; Ertilav, Muhittin; Hoscoskun, CuneytÖğe Close Monitoring for Polyneuropathy/Myopathy Is Warranted Among Liver Transplant Recipients on Long-Term Treatment With Telbivudine.(Wiley-Blackwell, 2014) Karasu, Zeki; Turan, Ilker; Duman, Soner; Sozbilen, Murat; Gunsar, Fulya; Ersoz, Galip; Akarca, Ulus S.Öğe Comparison between allogenic and autologous vascular conduits in the drainage of anterior sector in right living donor liver transplantation(Blackwell Publishing, 2007) Kilic, Murat; Aydin, Unal; Sozbilen, Murat; Ozer, Ilter; Tamsel, Sadik; Demirpolat, Gulgun; Atay, Yuksel; Alper, Mehmet; Zeytunlu, MuratCongestion of the anterior sector may lead to graft failure in right lobe grafts. Selective drainage of the prominent segment 5 and/or 8 veins is proposed to overcome this problem. Different vascular conduits may be used during drainage of the anterior sector. In this study, we evaluated the efficiency of the vascular conduits. Between June 1999 and December 2005, 190 patients underwent living donor right lobe liver transplantation and reconstruction of segment 5 and/or 8 veins was performed in 48 patients (25.2%). Two groups were formed according to the types of vascular conduits. Cryopreserved cadaveric iliac artery (n = 28) and cryopreserved cadaveric iliac vein (n = 8) were used in group A. In group B, recipient saphenous vein (n = 6), recipient umbilical vein (n = 5) and recipient collateral omental vein (n = 1) were used for reconstruction. The graft-recipient weight ratio, mean duration of anhepatic phase and MELD scores between two groups were not significantly different. All of the conduits were found to be patent just after reperfusion and in the early postoperative period by Doppler ultrasonography. In follow-up period of 1 year, four (11%) patients died in group A, two patients (16%) in group B. One of these patients died because of sepsis started from the saphenous vein incision site. None of the patients dying in the two groups were lost due to venous outflow problems. This study proves the efficacy of drainage of segment 5 and/or 8 veins using cryopreserved cadaveric vascular conduits. Every effort should be employed to store cadaveric iliac vessels, otherwise, whole other additive surgical intervention to ensure vascular conduit may lead uninvited serious complication.Öğe EASY AND FAST TECHNIQUE FOR FASCIA CLOSURE IN RENAL TRANSPLANT RECEPIENT PATIENTS(Wiley-Blackwell, 2013) Sezer, Taylan Ozgur; Yyldyrym, Hayrullah; Uouz, Alper; Unalp, Omer Vedat; Fyrat, Ozgur; Solak, Ylhami; Sozbilen, Murat; Hocokun, CuneytÖğe Effects of ropivacaine on pain after laparoscopic cholecystectomy: A prospective, randomized study(Health Communications Inc, 2007) Sozbilen, Murat; Yeniay, Levent; Unalp, OmerVedat; Makay, Ozer; Pirim, Alihan; Ulukaya, Sezgin; Uyar, Meltem; Ersin, SinanPostoperative pain after laparoscopic cholecystectonny is an ongoing problem. To relieve this pain, practitioners have used many anesthetic and analgesic drugs. This study was undertaken to assess the effects of incisional and intraperitoneal administration of ropivacaine on postoperative pain and stress response in patients undergoing laparoscopic cholecystectomy. In this prospective, singleblinded, randomized study, 45 patients with ASA (American Society of Anesthesiologists) scores I and II who were about to undergo laparoscopic cholecystectomy were divided into 3 groups. After cholecystectomy, a total of 40 mL of 3.75% ropivacaine was administered preincisionally and intraperitoneally to patients in group 1 (n=1 4); preincisionally and intraperitoneally to patients in group 2 (n=1 7); and intraperitoneally and locally at incision sites to patients in group 3 (n=14). Blood levels of epinephrine and norepinephrine were examined preoperatively, 15 min after insufflation, and attheend of the operation. Visual analog pain scale scores and analgesic requirements were used for 24-h postoperative follow-up of pain levels reported by patients. No statistically significant difference was found among the 3 groups with respect to visual analog pain scale scores, total analgesic requirements, and accompanying pain, nausea, and vomiting. The earliest analgesic requirements were seen in group 2 (P <.005), and less shoulder pain was noted in group 3 (P <.005). Norepinephrine and epinephrine levels showed no statistically significant differences between the 3 groups. Administration of ropivacaine preoperatively and postoperatively for laparoscopic cholecystectomy has similar effects on postoperative pain and the stress response of patients.Öğe Efficacy of Hepatitis B Virus Vaccination in Liver Transplant Recipients After Hepatitis B Immunoglobulin Discontinuation(Wiley-Blackwell, 2013) Turan, Ilker; Mut, Deniz; Erensoy, Selda; Sozbilen, Murat; Unalp, Omer V.; Gunsar, Fulya; Ersoz, Galip; Akarca, Ulus S.; Karasu, ZekiÖğe Gastric remnant cancer: an old problem with novel concerns(Springer, 2009) Firat, Ozgur; Guler, Adem; Sozbilen, Murat; Ersin, Sinan; Kaplan, HasanBackground and aims The patients with cancers in the remnant stomachs after previous partial resections for benign diseases constitute a peculiar subset of the patients with gastric cancer. They are generally at advanced stages on admissions due to disregarding the symptoms related to cancer. Patients and methods Twenty six patients with cancer arising from the remnant stomach were analyzed. Clinicopathologic features such as age, gender, time interval between the initial operation and diagnosis of gastric remnant cancer, preoperative symptoms, surgical management, and tumor characteristics like size, location, histopathology, depth of invasion, lymph node involvement, presence of distant metastasis, and stages were documented. Results None of the cancers were diagnosed by routine surveillance and all the patients were symptomatic at the time of diagnosis. Twenty five patients were qualified for surgery. The resectability rate was 61% (n = 16). The ability to perform a curative resection and tumor location at the anastomotic site were determined as the factors significantly influencing survival (p < 0.05). Conclusion Curative resection has to be the goal of surgical management in patients with gastric remnant cancer. Concerning clinician should be sceptical about a newly developing cancer in order to detect it in an early stage and enhance resectability.Öğe Glasgow coma scale and APACHE-II scores affect the liver transplantation outcomes in patients with acute liver failure(Zhejiang Univ Sch Medicine, 2013) Guler, Necdet; Unalp, Omer; Guler, Ayse; Yaprak, Onur; Dayangac, Murat; Sozbilen, Murat; Akyildiz, Murat; Tokat, YamanBACKGROUND: The timing and selection of patients for liver transplantation in acute liver failure are great challenges. This study aimed to investigate the effect of Glasgow coma scale (GCS) and APACHE-II scores on liver transplantation outcomes in patients with acute liver failure. METHOD: A total of 25 patients with acute liver failure were retrospectively analyzed according to age, etiology, time to transplantation, coma scores, complications and mortality. RESULTS: Eighteen patients received transplants from live donors and 7 had cadaveric whole liver transplants. The mean duration of follow-up after liver transplantation was 39.86 +/- 40.23 months. Seven patients died within the perioperative period and the 1-, 3-, 5-year survival rates of the patients were 72%, 72% and 60%, respectively. The parameters evaluated for the perioperative deaths versus alive were as follows: the mean age of the patients was 33.71 vs 28 years, MELD score was 40 vs 32.66, GCS was 5.57 vs 10.16, APACHE-II score was 23 vs 18.11, serum sodium level was 138.57 vs 138.44 mmol/L, mean waiting time before the operation was 12 vs 5.16 days. Low GCS, high APACHE-II score and longer waiting time before the operation (P<0.01) were found as statistically significant factors for perioperative mortality. CONCLUSION: Lower GCS and higher APACHE-II scores are related to poor outcomes in patients with acute liver failure after liver transplantation.Öğe Hepatic artery pseudoaneurysm as a cause of gastrointestinal system bleeding: A case report with a brief review of the literature(Aves, 2012) Unalp, Omer Vedat; Karaca, Can Avni; Sezer, Taylan Ozgur; Yeniay, Levent; Sozbilen, Murat; Coker, AhmetA hepatic artery pseudoaneurysm is, by definition, a pulsatile hematoma due to a leakage of blood through a tear or disruption of the arterial wall, and the blood is contained only by the hepatic parenchyma or surrounding hematoma. It can be a very rare cause of gastrointestinal system bleeding. These pseudoaneurysms are usually very well managed by angiographic intervention. However, in some cases, surgery is inevitable. Herein, we present a 63-year-old female presenting with gastrointestinal system bleeding 45 days after surgery for cholangiocarcinoma. She was found to be bleeding from a pseudoaneurysm of the hepatic artery and underwent surgical intervention.Öğe A heterogeneous liver lesion in a 48-year-old woman(Aves, 2017) Kusbeci, Mahmut; Buldur, Serhat; Mutlu, Eren; Uguz, Alper; Guneyli, Serkan; Bozkaya, Halil; Cinar, Celal; Unalp, Omer Vedat; Sozbilen, MuratÖğe A Horseshoe Kidney From a Live Donor as a Renal Transplant: Case Report(Baskent Univ, 2013) Sezer, Taylan Ozgur; Solak, Ilhami; Sozbilen, Murat; Firat, Ozgur; Yilmaz, Mumtaz; Toz, Huseyin; Sarsik, Banu; Isayev, Ceyhun; Harman, Mustafa; Hoscoskun, CuneytObjectives: This case report presents our experience regarding a horseshoe kidney from live donor to be used as a renal transplant. Materials and Methods: The recipient was a 48-year-old man with chronic renal failure owing to hypertension who had been on hemodialysis for 2 years. The donor was his 43-year-old sister who had an uncomplicated horseshoe kidney with negative results on a urinalysis. An aortogram showed that the arterial supply to the kidney consisted of 2 superior arteries (1 on each side) and 1 inferior accessory artery that was divided to feed the lower fused parenchyma of the kidney. Results: Surgery was performed via a retroperitoneal lumbotomy incision; the left half of the kidney was mobilized. The left kidney was procured by clamping the inferior accessory renal artery, transecting the parenchyma within the demarcation boundary. The transplant kidney was placed in the recipient's contralateral iliac fossa. The graft vein was anastomosed to the recipient's external iliac vein, the artery to the external iliac artery, and the ureter to the bladder. After perfusing the graft, no urine leakage was detected from the transacted surfaces, and the graft began producing urine. There were no complications after surgery. The patient was discharged on the 10th day after surgery with a creatinine level of 0.07 mu mol/L. Maintenance immunosuppressive treatment included tacrolimus, mycophenolate mofetil, and prednisolone. Conclusions: We believe using a horseshoe kidney as a renal allograft after a detailed preoperative evaluation may help expand the donor pool.Öğe Inter-individual and inter-organ variability in the bioactivation of paracetamol by human liver and kidney tissues(Elsevier Science Bv, 2018) Arzuk, Ege; Turna, Burak; Sozbilen, Murat; Orhan, HilmiParacetamol (PAR) overdose is associated with massive hepatic injury; it may induce kidney toxicity as well. It is essential to measure organ-specific activities of related CYPs for evaluating the overdose cases. Available HPLC-based methods require high amounts of tissue samples. In order to develop liquid chromatography mass spectrometry (LC-MS)-based methods to process small amounts of human tissues, liver and kidney samples were obtained. Individual microsomes were prepared and incubated with PAR (for quantifying bioactivation), with nifedipine (for measuring CYP3A4 activity) and with p-nitrophenol (for measuring CYP2E1 activity). The small amount of tissue microsomes was sufficient to measure both the formation of NAPQI and the activities of CYP enzymes. Although the sample size in group was relatively low, both NAPQI formation and activity of CYP2E1 were significantly higher in males compared to females in kidney. Considerable variations in the metabolic capacity of individuals were observed for both organs.Öğe Interindividual variability in generating acetaminophen reactive metabolite NAPQI by various human liver and kidney microsomes(Elsevier Ireland Ltd, 2013) Arzuk, Ege; Turna, Burak; Sozbilen, Murat; Orhan, HilmiÖğe Is D-dimer a predictor of strangulated intestinal hernia?(Springer, 2006) Icoz, Gokhan; Makay, Ozer; Sozbilen, Murat; Gurcu, Baris; Caliskan, Cemil; Firat, Ozgur; Kurt, Zahide; Ersin, SinanBackground: The goal of this study was to assess the relevance of serum D-dimer measurement as a possible reliable marker for the diagnosis of strangulated intestinal hernia. Methods: Consecutive patients admitted with nontraumatic acute abdominal gastrointestinal disorders were recruited prospectively in a tertiary referral hospital. The study was conducted in 159 patients between August 2002 and April 2004. D-dimer, lactate dehydrogenase, serum amylase, and international normalized ratio (INR) levels were tested in the emergency room prior to surgical intervention. For each patient, 15 variables, including D-dimer, were available for analysis. Results: Thirty-three (20.7%) of the 159 patients had intestinal ischemia, and 28 (85%) of these 33 patients had D-dimer level > 300 ng/ml. Plasma levels of D-dimer in patients with intestinal ischemia were significantly higher than in patients without ischemia (P < 0.05). There were 29 (18.2%) patients in the hernia group with incarceration (n = 22) or strangulation requiring resection (n = 7). D-dimer levels in patients requiring intestinal resection were insignificantly higher than in patients without resection (P > 0.05). Six (85%) of the 7 hernia patients requiring resection had D-dimer levels > 360 ng/ml. The D-dimer variable correlated best with the leukocyte count in patients with hernia requiring resection. Levels of lactate dehydrogenase, serum amylase, and INR did not show any correlation with D-dimer levels. Conclusions: To help predict ischemic events, the increasing use of the D-dimer assay in clinical practice could be extended to patients presenting with intestinal emergencies. An elevated D-dimer level on admission had a high sensitivity for identifying patients with intestinal ischemia, although it had a low specificity. Whether it is predictive or preventive for resection in strangulated intestinal hernia patients still remains a question.Öğe Laparoscopic cholecystectomy in a patient with situs inversus totalis(W J G Press, 2006) Aydin, Unal; Unalp, Omer; Yazici, Pinar; Gurcu, Baris; Sozbilen, Murat; Coker, AhmetCurrently, laparoscopic cholecystectomy is an undoubtfully optimal treatment of cholelithiasis. What about performing this procedure on a patient with situs inversus totalis and what are the difficulties of this operation for a right-handed surgeon? We presented a 35-year-old man with unknown situs inversus totalis who was admitted with epigastric pain and digestive problems. Ultrasonography and computed tomography of the abdomen confirmed the diagnosis of a gallstone. Besides, the liver and gallbladder were on the left side and the spleen was on the right. All systems were left-right reversal as mirror image in all diagnostic studies. Laparoscopic cholecystectomy was safely performed, despite of difficulties of situs inversus. The patient was discharged on postoperative day 1. It should be considered that existence of other anomalies may easily cause uninvited injuries. In the patients with situs inversus, laparoscopic cholecystectomy can be safely managed by an experienced surgeon through laparoscopy, and also hepatobiliary surgery. (c) 2006 The WJG Press. All rights reserved.Öğe LAPAROSCOPIC VERSUS OPEN RENAL PROCUREMENT FOR ADULT RECIPIENTS OF LIVING DONOR RENAL TRANSPLANTATION: A RETROSPECTIVE STUDY(Wiley-Blackwell, 2013) Sezer, Taylan Ozgur; Hocokun, Cuneyt; Sen, Sait; Fyrat, Ozgur; Yyldyrym, Hayrullah; Unalp, Omer Vedat; Yavas, Hakan Haldun; Toz, Huseyin; Sozbilen, MuratÖğe Long-term outcome of kidney transplantation from elderly living and expanded criteria deceased donors(Informa Healthcare, 2015) Tanrisev, Mehmet; Hoscoskun, Cuneyt; Asci, Gulay; Sozbilen, Murat; Firat, Ozgur; Ertilav, Muhittin; Ozkahya, Mehmet; Toz, HuseyinThe imbalance between organ demand and supply causes the increasing use of suboptimal donors. The aim of this study is to investigate the survival and allograft function of kidney transplantation from standard (SLD) and elderly living (ELD), standard criteria (SCDD) and expanded criteria deceased (ECDD) donors. All patients transplanted from 1997 to 2005 were investigated according to the donor characteristics. Data were collected retrospectively during the 83.4 +/- 43.1 months of follow-up period. ELD was defined as donor age >= 60 years. ECDD was defined as UNOS criteria. A total of 458 patients were divided into four groups: SLD (n:191), ELD (n:67), SCDD (n:154), and ECDD (n:46). Seven-year death-censored graft survival in SLD, ELD, SCDD, and ECDD were 81.6%, 64.8%, 84.7%, and 68.3%, respectively (p = 0.003). The death-censored graft survival in ELD group was lower than in SLD (p = 0.007) and SCDD (p = 0.007) groups, while in ECDD group it was lower than in SCDD group (p = 0.026). Patient survival was similar. In ECDD group, 83% of total deaths occurred within the first 3 years, mainly due to infections (66.6%) (p < 0.05). Estimated glomerular filtration rate (eGFR) was lower in ELD (compared with SLD and SCDD); and ECDD (compared with SCDD) at last visit. In multivariate analysis, ELD, experience of an acute rejection episode and presence of delayed graft function were the independent predictors for death censored graft loss. Transplantation of a suboptimal kidney provides inferior graft survival and function. A higher number of deaths due to infection in the early post-transplant period in the ECDD group are noteworthy.Öğe omega-3 Fatty Acids Have No Impact on Serum Lactate Levels After Major Gastric Cancer Surgery(Sage Publications Inc, 2011) Makay, Ozer; Kaya, Tayfun; Firat, Ozgur; Sozbilen, Murat; Caliskan, Cemil; Gezer, Gulten; Uyar, Mehmet; Ersin, SinanBackground: Preoperative and intraoperative nutrition support in patients undergoing major surgery results in decreased incidence of morbidity and mortality. Studies investigating the role of omega-3 fatty acids in these patients are increasing. Some are focused on perfusion at the cellular level. This study was undertaken to address the effect of postoperative administration of omega-3 fatty acids on cellular hypoperfusion associated with major gastric surgery. Methods: Twenty-six patients undergoing gastric cancer surgery were randomly assigned to receive parenteral nutrition (PN) supplemented with a combination of omega-6 and omega-3 fatty acids (Omegaven, 0.2 g/kg/d; Lipovenoes 10%, 0.6 g/kg/d) or with omega-6 fatty acid (Lipovenoes 10%, 0.8 g/kg/d) for 5 days. Blood samples were taken preoperatively, postoperative day 1, and on the last day of PN therapy (day 5). Results: Patients receiving omega-3 and omega-6 fatty acids showed neither lower serum lactate levels nor lower rates of complications compared with patients receiving omega-6 only. There were no statistically significant differences between the groups in other biochemical parameters, complications, or length of hospital stay or mortality. Conclusion: PN with omega-3 fatty acid supplementation does not have a significant impact on cellular hypoperfusion and lactate clearance after major gastric surgery. (JPEN J Parenter Enteral Nutr. 2011;35:488-492)Öğe Prognostic value of somatostatin receptor-2 positivity in gastroenteropancreatic neuroendocrine tumors in reference to known prognostic factors(Turkish Soc Gastroenterology, 2012) Yeniay, Levent; Gurcu, Baris; Unalp, Omer; Yilmaz, Funda; Nart, Deniz; Sozbilen, Murat; Coker, AhmetBackground/aims: Identification of the predictive factors for the prognosis of gastroenteropancreatic neuroendocrine tumors is important but rather challenging due to the rarity of the condition. This study aimed to examine the association between somatostatin receptor-2 positivity and known prognostic factors for gastroenteropancreatic neuroendocrine tumor to identify the value of somatostatin receptor-2 positivity itself as a predictive factor for prognosis. Materials and Methods: Records of 41 gastroenteropancreatic neuroendocrine tumor patients (24 females, 17 males) were retrospectively reviewed. The relations between somatostatin receptor-2 positivity and known prognostic factors including tumor stage, Ki-67 positivity, vascular or perineural invasion, lymph node metastasis, presence of necrosis, and soft tissue extension were analyzed. Results: Sixty percent of the patients had histologically confirmed somatostatin receptor-2 positivity with 45% exhibiting focal and 15% showing diffuse staining characteristic. No significant relation was found between somatostatin receptor-2 positivity and any of the known prognostic factors for gastroenteropancreatic neuroendocrine tumor: versus stage, p=0.67; vs. lymph node metastasis, p=0.51; vs. vascular invasion, p=0.11; vs. extension to surrounding soft tissue, p=0.54; vs. necrosis, p=0.23; vs. lymphatic invasion, p=0.25; and vs. perineural invasion, p=0.42. Conclusions: Somatostatin receptor-2 positivity, either focal or diffuse, does not seem to predict prognosis in gastroenteropancreatic neuroendocrine tumors. However, growing evidence supports the benefits of somatostatin analogues as adjunctive treatment in this group of patients.
