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Research Interests: Oncology, Immunohistochemistry, Medicine, Pancreatic Cancer, Angiogenesis, and 15 moreMultivariate Analysis, Neovascularization, Humans, Female, Male, Clinical Sciences, Middle Aged, Prognosis, factor VIII, Overall Survival, Predictive value of tests, Adenocarcinoma, Colorectal Neoplasms, Pancreatic ductal adenocarcinoma, and Pancreatic neoplasms
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Research Interests: Carcinoma and Gallbladder
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The presence of Herpes Simplex Virus-1 (HSV-1) esophagitis in patients with liver transplantation has been reported rarely. Among the reports that are accessible in the literature, none could have shown tissue positivity for Herpes... more
The presence of Herpes Simplex Virus-1 (HSV-1) esophagitis in patients with liver transplantation has been reported rarely. Among the reports that are accessible in the literature, none could have shown tissue positivity for Herpes virus-1 DNA via Polymerase Chain Reaction (PCR) in patients with liver transplantation. This case is presented as the patient was diagnosed with herpes esophagitis based on the histopathological findings and HSV-1 DNA positivity (detected by PCR) in the biopsy material and was treated with Ganciclovir. Due to the specific action of Ganciclovir against CMV infections, it is natural that the drug cannot use in the treatment of HSV infections. However it is reported that ganciclovir has been reduced the incidence of symptomatic HSV infections after liver transplantation. We report on a patient after liver transplantation with HSV-1 esophagitis, who was successfully treated with Ganciclovir. We assume that most transplant centers according to their protocols ...
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Özet Kolorektal kanserli hastaların büyük çoğunluğu tanı konulduğunda 65 yaşın üstündedir. Bu çalışmada, kolorektal kanser cerrahisinde karşılaşılan morbidite ve mortalitenin hasta yaşı ile ilişkisinin araştırılması amaçlandı. Kolorektal... more
Özet Kolorektal kanserli hastaların büyük çoğunluğu tanı konulduğunda 65 yaşın üstündedir. Bu çalışmada, kolorektal kanser cerrahisinde karşılaşılan morbidite ve mortalitenin hasta yaşı ile ilişkisinin araştırılması amaçlandı. Kolorektal kanser nedeniyle ...
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OBJECTIVES Vascular complications after liver trans-plant can be lethal. High levels of suspicion and aggressive use of diagnostic tools may help with early diagnosis and treatment. Here, we share our experiences regarding this topic.... more
OBJECTIVES Vascular complications after liver trans-plant can be lethal. High levels of suspicion and aggressive use of diagnostic tools may help with early diagnosis and treatment. Here, we share our experiences regarding this topic. MATERIALS AND METHODS Adult and pediatric patients who had liver transplant between February 1997 and June 2018 in our clinic were included in the study. Patients were grouped according to age (pediatric patients were those under 18 years old), male versus female, indication for transplant, type of liver transplant, type of vascular complication, treatment, and survival after treatment. We analyzed the statistical incidence of vascular complications according to age, male versus female, and type of liver transplant. RESULTS Our analyses included 607 liver transplant procedures, including 7 retransplants, with 349 (57.4%) from living donors and 258 (42.6%) from deceased donors. Of total patients, 539 were adults (89.8%) and 61 were children (10.2%). Vascular complications occurred in 25 patients (4.1%), with hepatic artery complications seen in 13 patients (2.1%) (10 adults [1.8%] and 3 children [4.9%]), portal vein com-plications seen in 9 patients (1.5%) (6 adults [1.1%] and 3 children [4.9%]), and hepatic vein complications seen in 3 patients (0.5%) (2 adults [0.36%] and 1 child [1.6%]). Rate of vascular complications was statistically higher in pediatric patients (11.4% vs 3.3%; P = .007) and higher but not statistically in recipients of livers from living donors (5.2% vs 2.7%; P = .19). Twelve patients (48.8%) were treated with endovascular approach, and 11 (0.44%) required surgical treatment. Two patients underwent immediate retransplant due to hepatic artery thrombosis. CONCLUSIONS Because vascular complications are the most severe complications after liver transplant, there must be close follow-up of vascular anastomoses, particularly early postoperatively, with radiologic methods. In cases of vascular complications, emergent treatment, including endovascular interventions, surgery, and retransplant, must be performed.
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Research Interests: Carcinoma and Gallbladder
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Yasal uyarı: Bu sitede yayınlanan resim, yazı ve diğer uygulamaların her hakkı Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş. 'ye aittir. Kaynak gösterilmeden kullanılamaz. Bu site hekimleri sağlık... more
Yasal uyarı: Bu sitede yayınlanan resim, yazı ve diğer uygulamaların her hakkı Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş. 'ye aittir. Kaynak gösterilmeden kullanılamaz. Bu site hekimleri sağlık alanında bilgilendirmeye yönelik hazırlanmıştır. ...
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The combination of hepatitis B immunoglobulin and potent nucleos(t)ide analogs after liver transplantation is considered as the standard of care for prophylaxis against hepatitis B virus recurrence. However, the recommended doses, route... more
The combination of hepatitis B immunoglobulin and potent nucleos(t)ide analogs after liver transplantation is considered as the standard of care for prophylaxis against hepatitis B virus recurrence. However, the recommended doses, route of administration, and duration of HBIG administration remain unclear. Moreover, hepatitis B immunoglobulin-free prophylaxis with potent nucleos(t)ide analogs has shown promising disease outcomes in preventing hepatitis B virus recurrence. The current recommendations, produced by the Turkish Association for the Study of the Liver, Acute Liver Failure and Liver Transplantation Special Interest Group, suggest a reduced need for hepatitis B immunoglobulin administration with effective long-term suppression of hepatitis B virus replication using potent nucleos(t) ide analogs after liver transplantation.
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Research Interests: Treatment Outcome, Medicine, Safety, Hepatitis B, Humans, and 15 moreInternal Medicine, Female, Male, Efficacy, Liver Transplantation, Recurrence, Middle Aged, Retrospective Studies, Lamivudine, Adenine, Immunoglobulins, Tenofovir, End Stage Liver Disease, Antiviral Agents, and Postoperative Complications
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OBJECTIVE To evaluate the correlation of stereologically estimated mean nuclear volume of tumor cells with other clinicopathologic prognostic features and survival in pancreatic ductal adenocarcinoma. STUDY DESIGN The study included 27... more
OBJECTIVE To evaluate the correlation of stereologically estimated mean nuclear volume of tumor cells with other clinicopathologic prognostic features and survival in pancreatic ductal adenocarcinoma. STUDY DESIGN The study included 27 patients with primary pancreatic ductal adenocarcinoma. A stereologic method proposed by Gundersen et al was used for the estimation of mean nuclear volume in hematoxylin and eosin-stained histologic sections of each case. Mean nuclear volume values were compared statistically with histopathologic prognostic feature groups and survival. RESULTS The mean nuclear volume values of tumor cells ranged from 296.83 to 982.79 microns 3 (mean, 633.906 +/- 212.310). Higher values of mean nuclear volume were significantly related to advanced tumor stage and the presence of distant metastasis (Kruskal-Wallis, P = .036; Mann-Whitney U, P = .020). In contrast, nodal stage, tumor grade, perineural invasion, lymphatic and blood vessel invasion, and size of tumor show...
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Knowing the nature of anatomic disturbances in arteriovenous fistulas in hemodialysis patients is crucial in the management. Duplex ultrasonography and intraarterial angiography are the main imaging techniques applied in clinical... more
Knowing the nature of anatomic disturbances in arteriovenous fistulas in hemodialysis patients is crucial in the management. Duplex ultrasonography and intraarterial angiography are the main imaging techniques applied in clinical practice. Despite being the gold standard, necessity of hospitalization, nephrotoxic properties of the radiocontrast medium used, exposure to radiation and invasive nature of the procedure limit the application of the intraarterial angiography. MR angiography, being an emerging technique in visualization of vascular structures, is devoid of aforementioned handicaps. We applied MR angiography to four patients and yielded successful visualization. We suggest that MR angiography might be a good alternative to intraarterial angiography in patients with residual renal function and when hospitalization was not desired.
Ocular toxoplasmosis after solid organ transplantation occurs usually within the first three months of primary infection or reactivation of latent infection. There are a few reports of ocular toxoplasmosis following liver transplantation... more
Ocular toxoplasmosis after solid organ transplantation occurs usually within the first three months of primary infection or reactivation of latent infection. There are a few reports of ocular toxoplasmosis following liver transplantation in the literature, however, no reports were detected in the national data. In this report a 35-year-old female patient diagnosed as ocular toxoplasmosis following reactivation in the second year after liver transplantation, was presented. The case was successfully treated with trimethoprim/sulfamethoxazole and clindamycin. This case was presented to emphasize late presentation of toxoplasmosis in transplantation patients and to withdraw attention to the importance of serological investigations done before transplantation.
Research Interests: Medicine, Humans, Female, Liver Transplantation, Recurrence, and 3 moreAdult, Time Factors, and Clindamycin
Peliosis hepatis (PH) is a rare condition characterized by the presence of cystic, blood filled cavities within the hepatic parenchyma. Regardless of the reason, surgery should be performed under meticulous control of hemorrhage, if it is... more
Peliosis hepatis (PH) is a rare condition characterized by the presence of cystic, blood filled cavities within the hepatic parenchyma. Regardless of the reason, surgery should be performed under meticulous control of hemorrhage, if it is thought to be unavoidable. In this case report, ominous results of clinically misdiagnosed PH have been presented. PH should be kept on mind in all patients with hepatic mass, especially presented by sudden onset distention of the abdomen. Every effort should be done for the differential diagnosis with other cystic conditions like hydatid cyst in endemic areas.
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Research Interests: Nutrition and Dietetics, Ischemia Reperfusion Injury, Clinical Nutrition, Liver, Female, and 15 moreAnimals, Blood sampling, Animal Model, Enzyme, L-carnitine, Experimental, Rats, Reperfusion injury, Ischemia–reperfusion, Aspartate Aminotransferases, Portal vein, Experimental Model, Alanine Transaminase, Hepatectomy, and Carnitine
Peliosis hepatis (PH) is a rare condition characterized by the presence of cystic, blood filled cavities within the hepatic parenchyma. Regardless of the reason, surgery should be performed under meticulous control of hemorrhage, if it is... more
Peliosis hepatis (PH) is a rare condition characterized by the presence of cystic, blood filled cavities within the hepatic parenchyma. Regardless of the reason, surgery should be performed under meticulous control of hemorrhage, if it is thought to be unavoidable. In this case report, ominous results of clinically misdiagnosed PH have been presented. PH should be kept on mind in all patients with hepatic mass, especially presented by sudden onset distention of the abdomen. Every effort should be done for the differential diagnosis with other cystic conditions like hydatid cyst in endemic areas.
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The spleen plays a central role in the generation of both cellular and antibody responses during graft rejection. Although changes in lymphocyte function have been extensively analyzed in vitro, there have been limited attempts at... more
The spleen plays a central role in the generation of both cellular and antibody responses during graft rejection. Although changes in lymphocyte function have been extensively analyzed in vitro, there have been limited attempts at quantitating the structural changes in the lymphoid compartments within the spleen during graft rejection. We describe here a means of quantitating the histological changes in the spleen using immunohistochemical techniques and computerized image analysis. Allograft rejection at 6 days after transplant is characterized by a threefold increase in the T cell-rich areas of the periarteriolar lymphoid sheaths (PALs). The follicular areas are enlarged and germinal centers appear in 55% of the white pulp regions. Acute xenograft rejection, 4 days after transplant, is specifically accompanied by a 2.3-fold increase in the marginal zone (MZ) and an increase in the numbers of B cells in the red pulp of the spleen. The expansion of both PALs and follicular/germinal centers during xenograft rejection is comparable to that observed during allograft rejection. We also investigated the effect of two immunosuppressants, leflunomide and cyclosporine, on the spleen of rats with hamster hearts. Leflunomide, which prevents acute xenograft rejection, prevented the increase in PALs and significantly reduced the areas comprising the MZ and follicles. Cyclosporine, which does not alter the tempo of xenograft rejection and only partially inhibited xenospecific antibody production, inhibited the increase in PALs and the appearance of germinal centers, while permitting a modest increase in the area of MZ and follicles. These observations collectively suggest that both T cell-dependent and T cell-independent responses are stimulated by the transplanted xenograft. However, the T cell-independent responses that initiate xenograft rejection are characterized by very modest increases in the area of MZ and follicles within the white pulp of the spleen.
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The purpose of our study was to investigate the immunohistochemical expression of TGF-beta1 and p27 in pancreatic adenocarcinomas and to compare the findings with the clinicopathological features and survival. We also aimed to evaluate... more
The purpose of our study was to investigate the immunohistochemical expression of TGF-beta1 and p27 in pancreatic adenocarcinomas and to compare the findings with the clinicopathological features and survival. We also aimed to evaluate the expression of TGF-beta1 and p27 in the context of other cell cycle and proliferation markers such as cyclin D1 and Ki-67. We examined TGF-beta1 and p27 expression immunohistochemically in 63 cases of invasive ductal adenocarcinoma of the pancreas. Standard streptavidin-biotin immunperoxidase method was used for immunostaining and the stained slides were examined microscopically using semiquantitative criteria. TGF-beta1 stained the cytoplasms of the tumor cells in 43 cases [68.3%]. There was a statistically significant difference among TGF-beta1 staining scores in terms of clinicopathologic factors such as blood vessel invasion, stage and distant metastasis [p < 0.05]. Of the 63 tumors evaluated 23 [36.5%] were positive for p27 within the nucle...
Ocular toxoplasmosis after solid organ transplantation occurs usually within the first three months of primary infection or reactivation of latent infection. There are a few reports of ocular toxoplasmosis following liver transplantation... more
Ocular toxoplasmosis after solid organ transplantation occurs usually within the first three months of primary infection or reactivation of latent infection. There are a few reports of ocular toxoplasmosis following liver transplantation in the literature, however, no reports were detected in the national data. In this report a 35-year-old female patient diagnosed as ocular toxoplasmosis following reactivation in the second year after liver transplantation, was presented. The case was successfully treated with trimethoprim/sulfamethoxazole and clindamycin. This case was presented to emphasize late presentation of toxoplasmosis in transplantation patients and to withdraw attention to the importance of serological investigations done before transplantation.
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Peliosis hepatis (PH) is a rare condition characterized by the presence of cystic, blood filled cavities within the hepatic parenchyma. Regardless of the reason, surgery should be performed under meticulous control of hemorrhage, if it is... more
Peliosis hepatis (PH) is a rare condition characterized by the presence of cystic, blood filled cavities within the hepatic parenchyma. Regardless of the reason, surgery should be performed under meticulous control of hemorrhage, if it is thought to be unavoidable. In this case report, ominous results of clinically misdiagnosed PH have been presented. PH should be kept on mind in all patients with hepatic mass, especially presented by sudden onset distention of the abdomen. Every effort should be done for the differential diagnosis with other cystic conditions like hydatid cyst in endemic areas.
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Our aim was to determine perioperative risk factors for early bacterial infection after liver transplantation. Retrospectively examining medical records using Centers for Disease Control and Prevention (CDC) definitions to identify... more
Our aim was to determine perioperative risk factors for early bacterial infection after liver transplantation. Retrospectively examining medical records using Centers for Disease Control and Prevention (CDC) definitions to identify nosocomial infections, we analyzed data on 367 adult patients. The incidence of infection was 37.3% (n = 137): namely, surgical site (n = 74; 20.2%) [corrected], blood stream (n = 64; 17.4%), pulmonary (n = 49; 13.4%), urinary system (n = 26; 7.1%). Significant risk factors within the first 30 days were as follows: deceased donor, Model for End-Stage Liver Disease (MELD) &gt;20, albumin level &lt;2.8 g/dL, intraoperative erythrocyte transfusion &gt;6 U, intraoperative fresh frozen plasma &gt;12 U, bilioenteric anastomosis, postoperative intensive care unit stay &gt;6 days, and postoperative length of stay &gt;21 days. Significant risk factors detected within the first 90 days were as follows: MELD &gt;20, preoperative length of stay &gt;7 days, reoperation, postoperative length of intensive care unit stay &gt;6 days, and postoperative length of stay &gt;21 days. Variability was observed in risk factors according to localization of infection. As a result, except for MELD, type of donor, and biliary anastomosis, the others are preventable factors for early bacterial infection. In addition, the same risk factors showed variability according to the site of infection.
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