Publications by authors named "Fatih Ozdemir"

42 Publications

Acute Necrotizing Encephalopathy of Childhood: A Single-Center Experience.

Turk J Med Sci 2021 Mar 23. Epub 2021 Mar 23.

Background/aim: Acute necrotizing encephalopathy is a rare type of acute encephalopathy characterized by multi-focal brain lesions and associated severe neurological findings and various organ dysfunctions may accompany it.

Material And Methods: Patients with acute necrotizing encephalopathy of childhood diagnosed by pediatric neurology and pediatric intensive care at Sami Ulus Maternity, Child Health and Diseases Training and Research Hospital between 2007 and 2020 were included in this study.

Results: Nine patients (six females, three males) with a mean age of 4.05±1.94 years (age range 1-6.5) were included in this study. The interval range between fever and encephalopathy in patients was 1-4 days. Influenza A (3H1N1, one untyped) was detected in four patients, influenza B in three patients, and no cause was found in two patients. Major clinical findings other than febrile encephalopathy in all patients were a hemodynamic shock in seven patients, seizures in six patients, vomiting in five patients, dystonia in three patients, and flaccid paralysis in the upper extremity in one patient. Despite all our treatment approaches, including plasmapheresis, moderate to severe neurological sequelae was observed in all of our patients, who survived even with significant radiological improvement. Three patients for whom we could not perform plasmapheresis died.

Conclusion: Our study revealed that thalamic involvement increased as the interval shortened, and brainstem involvement increased in patients over four years of age. The presence of persistent vomiting accompanying encephalopathy during the parainfectious period and plasmapheresis treatment being a treatment option that could prevent mortality were cautionary for our study.
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http://dx.doi.org/10.3906/sag-2102-47DOI Listing
March 2021

First Report of Fusarium culmorum and Microdochium bolleyi Causing Root Rot on Triticale in Kazakhstan.

Plant Dis 2021 Mar 3. Epub 2021 Mar 3.

CIMMYT Turkey, CIMMYT Uluslararası Buğday ve Mısır Geliştirme Merkezi, Şehit Cem Ersever Caddesi No : 9/11, Tarla Bitkileri Araştırma Enstitüsü Kampüsü içi, Ankara, Ankara, Turkey, 06170;

Triticale (×Triticosecale Wittmack) is obtained from wheat × rye crossing. It is positioned between wheat and rye in terms of resistance to soilborne pathogens including Gaeumannomyces graminis var. tritici, Fusarium culmorum, F. avenaceum, and Bipolaris sorokiniana (Arseniuk and Góral 2015). In 2019, seven triticale fields were surveyed in Almaty Province, Kazakhstan to examine soil-borne fungal pathogens. A total of 28 symptomatic plants with stunting, rot or discolored root were collected to identify causal agents. The overall disease incidence was approximately 8 to 10% in the fields. Fungi were isolated from 3-5 mm pieces excised from symptomatic tissues. The pieces were exposed to surface disinfection in 1% sodium hypochlorite solution for 2 min, rinsed three times with sterile distilled water, blotted dry, and plated on 1/5 strength potato dextrose agar (PDA) amended with 0.01% streptomycin. Plates were left in the dark at 23°C for 7 days. A total of 34 fungal colonies were isolated of which nineteen isolates, originally from six fields showed the cultural characteristics of B. sorokiniana. This species was previously reported to cause common root rot on triticale in Kazakhstan (Özer et al. 2020). Ten isolates from four fields produced pale orange and cottony mycelium with red pigmentation on the agar, which is typical of Fusarium-like growth. The remaining isolates (n=5) from two fields produced salmon-colored and scarce aerial mycelium with no soluble pigmentation, similar to Microdochium spp. Fusarium isolates produced thick-walled and curved macroconidia with 3-4 septa (n=50, 25.7 to 37.6 × 4.1 to 7.3 μm in size) and notched basal cell on PDA, but microconidia were absent, which matches the description of F. culmorum (Wm.G. Sm.) Sacc. (Leslie and Summerell 2006). Microdochium isolates produced swollen, brown, and thick-walled chlamydospores and hyaline, one-celled, and thin-walled conidia (n=50, 5.4 to 9.3 × 1.5 to 3.0 μm in size) formed on ampullate and cylindrical conidiogenous cells on oatmeal agar (OA). These morphological features are consistent with previous observations for Microdochium bolleyi (R. Sprague) de Hoog & Herm.-Nijh. (Hong et al. 2008). To confirm morphological preliminary identifications, the portion of the translation elongation factor 1-alpha (EF1-α) gene was amplified with EF1/EF2 primers (O'Donnell et al. 1998) for representative Fusarium isolates (n=4) for each field. Additionally, the internal transcribed spacer (ITS) of ribosomal DNA was amplified with ITS1/ITS4 primers (White et al. 1990) for representative Microdochium isolates (n=2) for each field. BLASTn queries against NCBI GenBank revealed that the EF1-α sequences of Fusarium isolates (MW311081-MW311084) shared 100% identity with F. culmorum strain CBS 110262 (KT008433). The ITS sequences of M. bolleyi isolates (MW301448-MW301449) matched that of M. bolleyi strain CBS 137.64 (AM502264) with 100% sequence similarity. Pathogenicity test was conducted on pregerminated seeds of triticale cv. Balausa. A plastic pot (17 cm height, 9 cm in diam) was filled with a sterile mixture of vermiculite, peat, and soil (1:1:1, v/v/v). Mycelial plugs (1 cm in diam) were cut from the margin of a growing culture of representative isolates (Kaz_Fus123 and Kaz_Mb01) and placed onto the mixture in the pot. A sterile agar plug was employed as a control treatment. One pregerminated seed was put on the plug and covered with the mixture. The pots were transferred to a growth chamber set at 23 ± 2°C and a photoperiod of 14 hours. The experiment was performed twice using 5 replication pots per isolate. Four weeks after inoculation, discoloration of the crown was observed on all the inoculated roots, whereas no symptoms were observed on the control plants. Koch's postulates were fulfilled by reisolating and identifying the pathogen based on the morphology described above. This is the first report of M. bolleyi and F. culmorum causing root rot on triticale in Kazakhstan. Although B. sorokiniana is the most primary pathogen that may limit yield in the production of triticale in Kazakhstan, F. culmorum and M. bolleyi have been found to be less frequent and less aggressive pathogens, respectively. Further studies are needed to better understand the potential distribution and impact of these pathogens on triticale.
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http://dx.doi.org/10.1094/PDIS-12-20-2659-PDNDOI Listing
March 2021

Evaluation of the international severity score for FMF (ISSF) scores in Turkish children diagnosed with FMF: a single-center experience.

Clin Rheumatol 2021 Feb 22. Epub 2021 Feb 22.

Department of Pediatric Rheumatology, University of Health Scienes Dr. Behcet Uz Children's Education and Research Hospital, Izmir, Turkey.

Aims: The aim of this study is to evaluate our patients with the newly developed international severity score for FMF (ISSF) and make comparisons with the literature.

Methods: This cross-sectional study included patients with FMF, were between 6 months and 18 years old, and were using colchicine/colchicine+IL-1 inhibitor for at least 6 months. The patients were classified as mild, intermediate, and severe based on their scores between 1 and 10. In addition to scoring, those who have additional pathological or silent mutation were compared based on these classifications.

Results: Our patients consist of 88 women 72 men total 160. The mean age, age of onset, and age of diagnosis were 12 ± 4.3, 4.9 ± 3.7, and 7.5 ± 4 years, respectively, and the mean diagnostic delay was 2.6 ± 3years. When our large patient population is evaluated with ISSF, the disease severity is mostly intermediate. According to ISSF, mild, intermediate, and severe diseases were 21.3%, 70.5%, and 8.1%, respectively. The duration of attacks shorten with increasing age (p > 0.05), and there is an increase in the involvement of other organs during the attacks among patients older than 7 years.

Conclusions: ISSF appears as a suitable and effective tool for the physicians in the follow-up of the disease severity in pediatric FMF patients. Key Points • Our article is the first study to evaluate ISSF performance in the pediatric population. • International severity score for FMF (ISSF) appears as a suitable and effective tool for the physicians in the follow-up of the disease severity in pediatric FMF patients. • We think that the addition of pathogenic mutations and inheritance model to the ISSF scoring system as important determinants of disease severity, especially when comparing different patients, can be evaluated in future studies.
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http://dx.doi.org/10.1007/s10067-021-05652-4DOI Listing
February 2021

Anomalous left coronary artery from the pulmonary artery repair outcomes: Preoperative mitral regurgitation persists in the follow-up.

J Card Surg 2021 Feb 16;36(2):530-535. Epub 2020 Dec 16.

Pediatric Cardiovascular Surgery Department, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.

Objective: This study aims to present the midterm outcomes of surgical correction of the anomalous left coronary artery from the pulmonary artery (ALCAPA) with a focus on mitral regurgitation (MR).

Methods: Medical records of 36 ALCAPA patients who underwent surgery in a single center were retrospectively reviewed.

Results: There were one (2.7%) neonate, 19 (52.7%) infants, 15 (41.6%) children, and 1 (2.7%) adult patient operated. Coronary reimplantation, tube reconstruction, and coronary artery bypass surgery techniques were performed in 29 (80.5%), 6 (16.6%), and 1 (2.7%) patient, respectively. Sixteen (44.4%) patients had a low ejection fraction and 13 (36.1%) patients had at least moderate MR preoperatively. None of our patients underwent a concomitant mitral surgery during the initial repair. Three and two patients died in the early and late postoperative period, respectively. Two patients underwent reoperation due to MR and pulmonary stenosis, separately. Preoperative MR was the only factor associated with at least moderate MR at the final follow-up (p < .01) and the presence of preoperative moderate or over-moderate MR estimated at least moderate MR at the final follow-up with 100% sensitivity and 80% specificity.

Conclusion: Although the mitral valve was not repaired in the first operation, the reoperation rate is low. However, a moderate or higher preoperative MR predicted MR at the last follow-up. Performing annuloplasty in such patients can be a strategy to be researched.
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http://dx.doi.org/10.1111/jocs.15247DOI Listing
February 2021

The Importance of AFP in Liver Transplantation for HCC.

J Gastrointest Cancer 2020 Dec;51(4):1127-1132

Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey.

Introduction: The most common biomarker for HCC is serum alpha-fetoprotein (AFP). AFP is used for screening and diagnosing HCC, and also, it is used for predicting prognosis and monitoring the response to treatment.

Discussion: AFP secretion is associated with poor tumor histologic grade and aggressive tumor biological behavior. The risk of dropout on the waiting list for liver transplantation and the risk of tumor recurrence after liver transplantation are associated with high AFP serum levels. Therefore, using AFP levels for selecting patients to include on the liver transplantation waiting lists is critical. It is also known that a low AFP serum level before liver transplantation has limited informative value, but high AFP levels prior to liver transplantation indicate a higher risk for HCC recurrence.

Conclusion: AFP's performance as a screening, diagnostic, and prognostic marker for HCC is not ideal, but it is the most frequently used biomarker in the management of HCC.
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http://dx.doi.org/10.1007/s12029-020-00486-wDOI Listing
December 2020

Modified Closed Coronary Transfer is a Good Alternative to the Trap-Door Method During Arterial Switch Operation: a Retrospective Propensity-Matched Comparison.

Braz J Cardiovasc Surg 2020 06 1;35(3):329-338. Epub 2020 Jun 1.

Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital Department of Pediatric Cardiovascular Surgery Istanbul Turkey Department of Pediatric Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.

Objective: To compare the early and long-term results of patients in whom was performed modified closed coronary transfer with the results of patients in whom was performed trap-door transfer techniques by utilizing propensity-matching analysis to provide optimal identical patient matching for the groups.

Methods: From August 2015 to December 2017, 127 consecutive patients underwent arterial switch operation due to simple and complex transposition of the great arteries, with or without additional arch and complex coronary pattern, by a single surgical team included into the study. Of these, in 70 patients it was performed modified closed coronary transfer technique and in 57 patients it was performed trap-door style coronary transfer technique. The patients were divided into two groups in terms of coronary transfer method. In the final model, after propensity matching, 47 patients from each group having similar propensity score were included into the study.

Results: There was no significant difference between the groups regarding patient characteristics. Cross-clamp time and operation time were significantly lower in the modified technique group compared with the other group (P=0.03 and P=0.05, respectively). When compared the early and late postoperative outcomes, there was no significant difference between the groups. Postoperative echocardiographic findings were mostly similar between the groups.

Conclusion: The patients in whom was performed our modified technique demonstrate overall good outcomes and the current technique ensures shorter arterial cross-clamp and operation times. It may be an alternative method to the trap-door technique for the coronary transfer during the arterial switch operation.
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http://dx.doi.org/10.21470/1678-9741-2019-0263DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7299582PMC
June 2020

Liver Transplantation for Hepatocellular Carcinoma: Malatya Experience and Proposals for Expanded Criteria.

J Gastrointest Cancer 2020 Sep;51(3):998-1005

Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey.

Survival was examined from a Turkish liver transplant center of patients with HCC, to identify prognostic factors. Data from 215 patients who underwent predominantly live donor liver transplant for HCC at our institute over 12 years were included in the study and prospectively recorded. They were 152 patients within and 63 patients beyond Milan criteria. Patients beyond Milan criteria were divided into two groups according to presence or absence of tumor recurrence. Recurrence-associated factors were analyzed. These factors were then applied to the total cohort for survival analysis. We identified four factors, using multivariate analysis, that were significantly associated with tumor recurrence. These were maximum tumor diameter, degree of tumor differentiation, and serum AFP and GGT levels. A model that included all four of these factors was constructed, the 'Malatya criteria.' Using these Malatya criteria, we estimated DFS and cumulative survival, for patients within and beyond these criteria, and found statistically significant differences with improved survival in patients within Malatya criteria of 1, 5, and 10-year overall survival rates of 90.1%, 79.7%, and 72.8% respectively, which compared favorably with other extra-Milan extended criteria. Survival of our patients within the newly defined Malatya criteria compared favorably with other extra-Milan extended criteria and highlight the usefulness of serum AFP and GGT levels in decision-making.
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http://dx.doi.org/10.1007/s12029-020-00424-wDOI Listing
September 2020

The poor long-term outcomes of owl's eye pulmonary reconstruction technique after arterial switch operation.

Interact Cardiovasc Thorac Surg 2020 07;31(1):113-120

Department of Pediatric Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.

Objectives: This study aims to compare the early- and long-term outcomes of patients who undergo owl's eye pulmonary artery (PA) reconstruction to those of patients who undergo conventional PA reconstruction.

Methods: From January 2016 to January 2017, 64 consecutive patients underwent an arterial switch operation. The patients were divided into 2 groups in terms of neo-PA reconstruction method: 30 patients who underwent neo-PA reconstruction by owl's eye technique were defined as group 1 and 34 patients who underwent neo-PA reconstruction by the conventional approach were defined as group 2. In the final model, after propensity matching, 23 patients from each group with similar propensity scores were included in the study.

Results: There was no significant difference between the groups regarding patient characteristics and operative findings. In the early period, the duration of intensive care unit and hospital stays and the rate of mild neo-pulmonary stenosis (neo-PS) were significantly higher in the owl's eye group (P = 0.04, 0.04 and 0.03). In the late period, the rate of severe neo-PS and reintervention was significantly higher in the owl's eye group (P = 0.02 and 0.04). Furthermore, the rates of 3-year freedom from pulmonary reintervention and freedom from moderate-severe neo-PS were significantly lower in group 1 (P = 0.04). In addition, the owl's eye reconstruction was the only factor independently related to moderate-severe neo-PS in the long term (hazard ratios = 11.2, P = 0.02).

Conclusions: We have abandoned the owl's eye method for neo-PA reconstruction of the neo-PA because of serious complications. According to our series and the literature, reconstruction of the neo-PA with an oversized, pantaloon-shaped fresh autologous pericardial patch is still superior to the other techniques.
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http://dx.doi.org/10.1093/icvts/ivaa067DOI Listing
July 2020

Political Orientations and Morality Judgments in the Turkish Context: Considering the Roles of the Needs for Cognition and Recognition.

Psychol Rep 2021 Feb 13;124(1):318-347. Epub 2020 Jan 13.

Department of Psychology, 52984Middle East Technical University, Ankara, Turkey.

The aims of this study were to test: (a) the association of political orientations with morality orientations, specified by moral foundations theory, on a sample of young adults from Turkey, representing a collectivistic culture; and (b) the statistically mediating roles of needs for cognition and recognition in the links between political orientation and morality endorsements. According to the results (a) right-wing orientation and need for recognition were associated with all the three binding foundations (i.e., in-group/loyalty, authority/respect, and purity/sanctity); (b) right-wing orientation was associated with binding foundations also indirectly via the role of need for recognition; (c) regarding individualizing foundations, left-wing orientation and need for cognition were associated with fairness/reciprocity, whereas only gender was associated with harm/care; and (d) left-wing orientation was associated with fairness dimension also indirectly via the role of need for cognition. The cultural relevance of moral foundations theory as well as the roles of needs for cognition and recognition are discussed.
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http://dx.doi.org/10.1177/0033294119899903DOI Listing
February 2021

Intraperitoneal rupture of the hydatid cyst: Four case reports and literature review.

World J Hepatol 2019 Mar;11(3):318-329

Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey.

Background: Most patients with hydatid cysts are asymptomatic, and they are diagnosed incidentally during radiological evaluations performed for other reasons. However, some patients develop symptoms and complications due to cyst size, location, and the relationship between the cyst and adjacent structures. The most serious complications that can occur are rupture of the cysts into the biliary tract, vascular structures, hollow viscus, and peritoneal cavity. We aimed to describe the management of four cases of intraperitoneal rupture of hydatid cysts.

Case Summaries: Four patients aged between 27 and 44 years (two men and two women) were admitted to our clinic with sudden abdominal pain ( = 4), hypotension ( = 3), and anaphylaxis ( = 2). Three of the perforated cysts were located in the liver, and one was located in the spleen. Two patients developed cyst rupture after minor trauma, and the other two developed spontaneous rupture. Enzyme-linked immunosorbent assay IgG results were positive for two patients and negative for the other two. All patients received albendazole treatment after surgical intervention (range: 2-6 mo). Two patients developed hepatic abscesses requiring drainage; one of these patients also developed hydatid cyst recurrence during postoperative follow-up (range: 25-80 mo).

Conclusion: Intraperitoneal rupture is a life-threatening complication of hydatid cysts. It is important to manage patients with surgical intervention as soon as possible with aggressive medical treatment for anaphylactic reactions.
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http://dx.doi.org/10.4254/wjh.v11.i3.318DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6447420PMC
March 2019

Analysis of Risk Factors Affecting the Development of Infection in Artificial Vascular Grafts Used for Reconstruction of Middle Hepatic Vein Tributaries in Living Donor Liver Transplantation.

Transplantation 2019 09;103(9):1871-1876

Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey.

Background: To analyze the risk factors affecting the development of infection in artificial vascular grafts (AVGs) used for reconstruction of middle hepatic vein (MHV) tributaries in living donor liver transplantation (LDLT).

Methods: Between January 2009 and January 2018, 1253 right lobe LDLTs were performed at our Transplant Institute, and MHV tributaries of the 640 right lobe liver grafts were reconstructed with AVG. Reconstructed MHV tributaries were removed due to AVG infection in 25 of these patients (case group; n = 25). To determine risk factors for AVG infection, right lobe LDLT patients without AVG infections were selected as control group (n = 615). Both groups were compared about demographic parameter, transcystic catheter usage, bile leakage, type of biliary anastomosis (duct-to-duct, telescopic duct-to-duct), number of graft biliary duct (=1 versus >1), number of biliary anastomosis (=1 versus >1), AVG thrombosis, AVG types (Dacron versus polytetrafluoroethylene). Univariate analyses were used for comparison of different variables, and variables with P ≤ 0.20 were taken into logistic regression model.

Results: Univariate analysis shows that statistically significant differences were found between groups regarding bile leakage (P < 0.001), graft thrombosis (P = 0.002), transcystic catheter (P = 0.049), and AVG types (P = 0.013). Variables with P ≤ 0.20 were taken into logistic regression model. Multivariate analysis shows that bile leakage (odds ratio, 13.3) and AVG thrombosis (odds ratio, 9.8) were determined as independent and strong risk factors for development of AVG infection.

Conclusions: This study revealed that bile leakage and graft thrombosis are independent and strong risk factors for infections of AVGs used for anterior sector drainage reconstruction.
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http://dx.doi.org/10.1097/TP.0000000000002583DOI Listing
September 2019

Isolated cardiac hydatid cyst mimicking myocardial ischaemia in a female patient.

Cardiol Young 2018 Oct 7;28(10):1160-1161. Epub 2018 Aug 7.

2Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center,Department of Pediatric Cardiovascular Surgery,Turkish Republic Ministry of Health,İstanbul,Turkey.

Hydatid disease is a zoonotic parasitic infection endemic in livestock-raising countries. Isolated cardiac hydatid cyst is a very rare disease, and chest pain, palpitations, cough, and dyspnoea are the most common presenting symptoms. Here a case of isolated cardiac hydatid cyst in a female patient with chest pain and electrocardiographic changes mimicking myocardial ischaemia is presented.
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http://dx.doi.org/10.1017/S1047951118000653DOI Listing
October 2018

Optimizing Winter Wheat Resilience to Climate Change in Rain Fed Crop Systems of Turkey and Iran.

Front Plant Sci 2018 1;9:563. Epub 2018 May 1.

Socioeconomics Program, The International Maize and Wheat Improvement Center (CIMMYT), Texcoco, Mexico.

Erratic weather patterns associated with increased temperatures and decreasing rainfall pose unique challenges for wheat breeders playing a key part in the fight to ensure global food security. Within rain fed winter wheat areas of Turkey and Iran, unusual weather patterns may prevent attaining maximum potential increases in winter wheat genetic gains. This is primarily related to the fact that the yield ranking of tested genotypes may change from one year to the next. Changing weather patterns may interfere with the decisions breeders make about the ideotype(s) they should aim for during selection. To inform breeding decisions, this study aimed to optimize major traits by modeling different combinations of environments (locations and years) and by defining a probabilistic range of trait variations [phenology and plant height (PH)] that maximized grain yields (GYs; one wheat line with optimal heading and height is suggested for use as a testing line to aid selection calibration decisions). Research revealed that optimal phenology was highly related to the temperature and to rainfall at which winter wheat genotypes were exposed around heading time (20 days before and after heading). Specifically, later winter wheat genotypes were exposed to higher temperatures both before and after heading, increased rainfall at the vegetative stage, and reduced rainfall during grain filling compared to early genotypes. These variations in exposure to weather conditions resulted in shorter grain filling duration and lower GYs in long-duration genotypes. This research tested if diversity within species may increase resilience to erratic weather patterns. For the study, calculated production of a selection of five high yielding genotypes (if grown in five plots) was tested against monoculture (if only a single genotype grown in the same area) and revealed that a set of diverse genotypes with different phenologies and PHs was not beneficial. New strategies of progeny selection are discussed: narrow range of variation for phenology in families may facilitate the discovery and selection of new drought-resistant and avoidant wheat lines targeting specific locations.
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http://dx.doi.org/10.3389/fpls.2018.00563DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5938555PMC
May 2018

Living-Donor Liver Transplant for Fibrolamellar Hepatocellular Carcinoma With Hilar Lymph Node Metastasis: A Case Report.

Exp Clin Transplant 2018 Apr 9. Epub 2018 Apr 9.

From the Department of General Surgery, Liver Transplantation Institute, Inonu University, Malatya, Turkey.

Fibrolamellar hepatocellular carcinoma is a rare primary malignant liver neoplasm. Benefits from liver transplant for patients with fibrolamellar hepatocellular carcinoma have not yet been reported. Here, we report a 19-year-old female patient who presented with abdominal pain. A computed tomography scan revealed bilobar and multiple solid lesions with the largest measuring 15 cm in diameter on the right lobe of her liver. Her blood alpha-fetoprotein level and viral hepatitis markers were normal. A fine-needle biopsy of the largest lesion detected fibrolamellar heptocellular carcinoma. Because no distant metastasis was evident and the carcinoma was unresectable, a right lobe living-donor liver transplant with hilar lymph node dissection was performed. A pathology report revealed poorly differentiated fibrolamellar hepatocellular carcinoma, and further testing indicated microvascular invasion and hilar lymph node metastasis. The largest tumor measured 12 cm. She was discharged on postoperative day 14. During postoperative month 22, multiple vertebral metastases were detected, and she died with diffuse metastasis during postoperative month 26. Our patient, with poor prognostic criteria such as hilar lymph node metastasis, microvascular invasion, and poor differentiation, had 22 months of tumor-free survival and 26 months of overall survival after having undergone living-donor liver transplant.
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http://dx.doi.org/10.6002/ect.2017.0040DOI Listing
April 2018

Assessment of the mental health of carers according to the stage of patients with diagnosis of Alzheimer-type dementia.

Neurol Sci 2018 May 5;39(5):903-908. Epub 2018 Mar 5.

Ordu University Faculty of Medicine, Department of Family Medicine, Ordu, Turkey.

In this study, the aims were to assess the mental health state of carers for patients with Alzheimer-type dementia (AD) according to stage of disease and to collect data with the aim of determining precautions to reduce the load of the patient and disease on the carer. The study included 120 patients with stages determined, according to the clinical dementia rating scale (CDR), and 120 patient relatives above the age of 18 who cared for these patients every day, for the whole day or part of the day, and who accepted participation in the research. This prospective and cross-sectional study performed a detailed neurological examination of patients, and after completing the "personal information form" with the interviewer, each patient had CDR and mini-mental test (MMSE) applied to determine stage of dementia and physical state. Carers first completed the "personal information form" and then had the short symptom inventory (SSI) applied. According to the stage of patients, there were significant differences determined in the points for all sub-scales belonging to the SSI of carers. As the disease stage increased, all sub-scale points for the SSI increased. With the transition of disease stages from 0.5-1 to stage 2, from stage 2 to 3, and with the inverse reduction in MMT scores, the points obtained by carers on the SSI sub-scales increased. This data shows that with progressing disease stage, the load on the carer increases and mental health begins to dysfunction.
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http://dx.doi.org/10.1007/s10072-018-3293-6DOI Listing
May 2018

Valve repair to avoid prosthetic valve pathology: Mid-term results in mitral valve repair.

Turk Gogus Kalp Damar Cerrahisi Derg 2018 Jan 9;26(1):14-21. Epub 2018 Jan 9.

Department of Anesthesiology and Reanimation, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey.

Background: In this study, we aimed to present our results of mitral valve repair.

Methods: Between January 2007 and November 2016, a total of 128 patients (72 males, 56 females; mean age 51.8±17.2 years; range 16 to 84 years) who underwent mitral valve repair in our heart center were retrospectively analyzed. There were mitral regurgitation in 86.7% (n=111), mitral stenosis in 7.8% (n=10), and mixed type valve disease in 5.5% of the patients (n=7). Mitral ring annuloplasty was performed in 80.5% (n=103), implantation of the artificial chordae in 36.7% (n=47), open mitral commissurotomy in 13.3% (n=17), and Alfieri procedure in 6.3% (n=8) of the patients. Sixty-two patients (48.8%) underwent isolated mitral valve repair, while concomitant surgical procedures were performed in the remaining patients. Postoperative mean follow-up was 52 months.

Results: Early (30-day) mortality was observed in seven patients due to low cardiac output. There was no mid-term mortality. During follow-up, various degree of mitral regurgitation was detected in 4 patients (3.6%), regurgitation was severe in two of them and these two require reoperation with the replacement of the valve. Patients with a myxomatous valve pathology who underwent isolated valve repair most benefited from valve repair. Patients with isolated mitral stenosis were the most successful group among the patients with a rheumatic etiology. Postoperative echocardiography showed a significant decrease in the left atrial diameter and pulmonary artery systolic pressures (p<0.01).

Conclusion: Mitral valve repair can be applied as an effective and safe treatment method in patients in whom the mitral valve anatomy is sufficient for repair. We suggest that each patient with mitral valve pathology should be evaluated in terms of reparability.
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http://dx.doi.org/10.5606/tgkdc.dergisi.2018.14503DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7018109PMC
January 2018

The management of acute appendicitis in liver transplant patients: How effective is the Alvarado score?

North Clin Istanb 2017 24;4(3):262-266. Epub 2017 Oct 24.

Department of General Surgery, Inonu University, Liver Transplantation Institute, Malatya, Turkey.

Objective: The incidence of acute appendicitis after liver transplantation (LT) is extremely low, reported to be 0.09% to 0.49%, but the efficacy of the Alvarado score in this patient group has not been studied. This study was an investigation of the clinical management of patients who developed acute appendicitis after LT and the usefulness of the Alvarado score in the diagnosis.

Methods: The study was performed using the data of 7 patients treated for acute appendicitis who were among 1990 patients who underwent LT between March 2002 and July 2017. The Alvarado score of the patients was calculated and reliability was analyzed.

Results: In this study, the incidence of acute appendicitis in LT patients was 0.35%. All of the patients were in the adult age group; 86% were male. The mean age was 46.4±10.7 years and the timeframe for the development of appendicitis after transplantation was a median of 12 months (range: 4-101 months). The median Alvarado score was 7 (range: 5-9). All of the patients had an Alvarado score above 5 and 71% had a score of 7 or more.

Conclusion: Acute appendicitis is very rare in LT patients. As with non-transplant patients, Alvarado scoring can be safely performed in LT patients.
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http://dx.doi.org/10.14744/nci.2017.24381DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5724922PMC
October 2017

Deceased donor liver transplantation from donors with central nervous system malignancy: Experience of the Inonu University.

North Clin Istanb 2017 25;4(3):213-217. Epub 2017 Oct 25.

Department of General Surgery, Inonu University, Liver Transplantation Institute, Malatya, Turkey.

Objective: Liver transplantation from deceased donors with a central nervous system (CNS) malignancy has some risk of tumor transmission to the recipient. Though the risk is small, this group of donors is regarded as marginal. The use of marginal grafts may be an acceptable alternative practice in order to expand the donor pool in countries where there is a shortage of donated organs. The aim of this study was to examine and present the outcomes of liver transplantations performed using donors with a CNS tumor.

Methods: Between March 2002 and July 2017, 1990 (deceased donor: n=399, 20%; living donor: n=1591, 80%) liver transplantations were performed at the center. Of the 399 deceased donors, 17 (4.2%) had a CNS tumor. The data of donors with a CNS tumor and of recipients who survived for more than 1 month (n=11) were retrospectively reviewed. Demographic data, the grade of the CNS tumor, tumor transmission to recipient data, and survival rates were analyzed.

Results: Only 2 (18%) grafts were provided locally, 6 (54%) were offered to the transplantation center after all of the national centers had declined them, and 3 (37%) were made available to us by the national coordination center for patients with a documented notification of urgency. High-grade (grade III-IV) brain tumors were detected in 7 (64%) donors, while low-grade (grade I-II) tumors were found in 2 patients. The remaining 2 donors were not pathologically graded because the diagnosis was made radiologically. The 1-, 3-, and 5-year overall and tumor-free survival of the patients was estimated at 100%, 70%, and 45%, respectively.

Conclusion: A median survival of 40 months (range: 13-62 months) was achieved in recipients of grafts from a donor with a CNS tumor and no donor-related malignant transformation was observed.
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http://dx.doi.org/10.14744/nci.2017.74436DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5724914PMC
October 2017

Retrospective analysis of cases of intestinal invagination treated and followed-up at our clinic.

North Clin Istanb 2017 26;4(2):141-144. Epub 2017 Aug 26.

Department of General Surgery, Inonu University Faculty of Medicine, Malatya, Turkey.

Objective: The purpose of this study was to present data on the diagnosis, treatment, clinical course, and outcome of cases of intestinal invagination.

Methods: Data of 11 patients treated for intestinal invagination at one center between June 2009 and July 2015 were analyzed retrospectively in terms of demographic data, etiological factors, anatomical localization of invagination, admission complaints, physical examination findings, diagnostic imaging modalities used, postoperative complications, and hospital stay.

Results: Of the total, 9 (81.8%) patients were female and 2 (18.2%) were male. Nine (81.8%) cases occurred due to benign causes and 2 to malignant causes. One (9%) patient had jejunojejunal invagination, 5 (45.5%) had ileoileal invagination, and 5 (45.5%) had ileocecal invagination. Right hemicolectomy-ileotransversostomy was performed in 5 (45.5%) patients and segmental small bowel resection with end-to-end anastomosis in 6 (54.5%).

Conclusion: Intestinal invagination is a rare cause of acute abdomen in adults that may have a variety of etiologies and therefore may present with different clinical pictures. Abdominal pain, nausea, and vomiting are the most common symptoms. The rate of accurate diagnosis is 30% to 35% using ultrasonography and 50% to 80% using computerized tomography. In adults, the preferred treatment is surgery. As malignant pathologies are responsible for some cases of invagination, oncological principles should be strictly observed in surgical treatment. Though a rare cause of acute abdomen and/or ileus in adults, invagination is a clinical condition that must be kept in mind in the differential diagnosis.
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http://dx.doi.org/10.14744/nci.2017.19970DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5613261PMC
August 2017

Linezolid-related adverse effects in clinical practice in children.

Arch Argent Pediatr 2017 Oct;115(5):470-475

Department of Pediatric Infectious Diseases, Dr. Behçet Uz Children's Hospital, Izmir, Turkey.

Introduction: Linezolid may cause adverse effects such as thrombocytopenia, which were found to be dependent on receiving linezolid for longer than 2 weeks. There are limited studies concerning the safety and timing of linezolid-related adverse effects in children. Objective of this study was to evaluate the incidence of adverse effects associated with linezolid, with especially focusing on the time of occurrence.

Population And Methods: All children (<18 years of age) who received >3 days of linezolid therapy were included in this study. Adverse effects attributed to linezolid and time of occurrence of side effects was evaluated.

Results: A total of 179 children were enrolled to the study. The patients' median age was 4 years (6 days to 17 years). During linezolid treatment, 36 (20.1%) patients experienced adverse effects. The most common adverse effect was thrombocytopenia that was detected in 26 patients (14.5%). Other adverse effects were as following; elevated liver enzymes in 4 patients, leucopenia and anemia in 2 patients, renal function impairment in one patient, and serious skin reactions in 3 patients. Adverse effects were detected within median 7.5 days of therapy (ranging from 4 to 18 days). Among 36 patients, 26 (72.2%) patients had adverse effect on the first 10 days of therapy.

Conclusion: Transient adverse effects were detected in 20.1% of the patients during linezolid therapy. These adverse effects may be detected earlier than ten days of treatment. Linezolid should be prescribed safely in children with monitoring adverse effects especially platelet count and level of liver enzymes.
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http://dx.doi.org/10.5546/aap.2017.eng.470DOI Listing
October 2017

Renoportal anastomosis in living donor liver transplantation with prior proximal splenorenal shunt.

World J Transplant 2017 Feb;7(1):94-97

Fatih Ozdemir, Koray Kutluturk, Bora Barut, Cuneyt Kayaalp, Sezai Yılmaz, Department of Surgery, Liver Transplantation Institute of Inonu University, 44280 Malatya, Turkey.

For transplant surgeons, end-stage liver disease with portal venous thrombosis and a previous splenorenal shunt (SRS) is a significant challenge during liver transplantation. Thrombosis of the portal vein can be corrected by surgical interventions, such as portal venous thrombectomy or surgical removal of the thrombosed portal vein. Even also placement of a graft between the mesenteric vein and the graft portal vein can be performed. If these maneuvers fail, a renoportal anastomosis (RPA) can be performed to achieve adequate graft inflow. A 51-year-old male patient who had a history of proximal SRS and splenectomy underwent living donor liver transplantation (LDLT) due to cryptogenic cirrhosis. LDLT was performed with RPA using a cadaveric iliac vein graft. The early postoperative course of the patient was completely uneventful and he was discharged 20 d after transplantation. To the best of our knowledge, this was the first patient to receive LDLT with RPA after surgical proximal SRS and splenectomy.
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http://dx.doi.org/10.5500/wjt.v7.i1.94DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5324034PMC
February 2017

Reconstruction of Anomalous Portal Venous Branching in Right Lobe Living Donor Liver Transplantation: Malatya Approach.

Liver Transpl 2017 06;23(6):751-761

Liver Transplantation Institute, Inonu University, Malatya, Turkey.

Reconstruction of anomalous portal vein branching (APVB) during right lobe living donor liver transplantation (LDLT) can be challenging. The goal of this article is to describe our surgical technique, named the Malatya Approach, in case of APVB during right lobe LDLT. The technique unifies the APVB and obtains a funnel-shaped common extension with a circumferential fence by a saphenous vein conduit. In total, 126 (10.6%) of 1192 right lobe grafts had APVB that were divided into 2 groups according to the adopted surgical techniques: the Malatya Approach group (n = 91) and the previously defined other techniques group (n = 35). Both groups were compared regarding portal vein thrombosis (PVT), postoperative 90-day mortality and survival. PVT developed in 3 patients (3.3%) in the Malatya Approach group and developed in 10 (28.6%) patients for the other group (P < 0.001). There were 8 (8.8%) 90-day mortalities in the Malatya Approach group (1 PVT related) and 15 patients (9 PVT related) died in the other techniques group (P < 0.001). Mean follow-up time for both groups was similar (999.1 days for the Malatya Approach group versus 1024.7 days for the other group; P = 0.47), but longterm survival in the Malatya Approach group was better than in the other group (84.6% versus 40%; P < 0.001). Multivariate analysis revealed that the Malatya Approach group showed less PVT development and longer survival (P < 0.001). This technique is promising to avoid PVT and mortalities in cases of APVB during right lobe LDLT. Liver Transplantation 23 751-761 2017 AASLD.
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http://dx.doi.org/10.1002/lt.24753DOI Listing
June 2017

The effect of proximal anastomosis on the expansion rate of a dilated ascending aorta in coronary artery bypass surgery: a prospective study.

Cardiovasc J Afr 2017 Mar/Apr 23;28(2):118-124. Epub 2016 Aug 22.

Department of Cardiovascular Surgery, Dr Siyami Ersek Cardiovascular Surgery and Thoracic Hospital, Istanbul, Turkey.

Background: This study was designed to determine the short- and long-term effects of proximal aortic anastomosis, performed during isolated coronary artery bypass grafting (CABG) in patients with dilatation of the ascending aorta who did not require surgical intervention.

Methods: The study was performed on 192 (38 female and 160 male patients; mean age, 62.1 ± 9.2 years; range, 42-80 years) patients with dilatation of the ascending aorta who underwent CABG surgery between 1 June 2006 and 31 May 2014. In group 1 (n = 114), the saphenous vein and left internal mammarian artery grafts were used, and proximal anastomosis was performed on the ascending aorta. In group 2 (n = 78), left and right internal mammarian artery grafts were used, and proximal aortic anastomosis was not performed. Pre-operatively and in the first and third years postoperatively, the ascending aortic diameter was measured and recorded using transthoracic echocardiography at four different regions (annulus, sinus of Valsalva, sinotubular junction and tubular aorta).

Results: A statistically significant difference was found between the groups for the number of grafts used and the duration of aortic cross-clamping and cardiopulmonary bypass. No significant intergroup difference was seen for the mean diameter of the ascending aorta (p > 0.05). Annual changes in the aortic diameter were found to be extremely significantly different in both groups (p = 0.0001). Mean values of the aortic diameter at the level of the sinotubular junction and tubular ascending aorta, mean aortic diameters (p = 0.002 and p = 0.0001, respectively), annual increase in diameter (p = 0.0001 and p = 0.0001, respectively), and mean annual difference in diameter (p = 0.0001 and p = 0.0001, respectively) at one and three years postoperatively were statistically significantly different between the groups.

Conclusion: In patients with ascending aortic dilatation who did not require surgical intervention and who had proximal anastomosis of the ascending aorta and underwent only CABG, we detected statistically significant increases in the diameter of the sinotubular junction and tubular aorta up to three years postoperatively.
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http://dx.doi.org/10.5830/CVJA-2016-071DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5545753PMC
December 2017

The effects of the metabolic syndrome on coronary artery bypass grafting surgery.

Cardiovasc J Afr 2017 Jan/Feb 23;28(1):48-53. Epub 2016 Jul 13.

Department of Cardiovascular Surgery, Dr Siyami Ersek Training and Research Hospital on Thoracic and Cardiovascular Surgery, Istanbul, Turkey.

Background: The metabolic syndrome (MS) is a clustering of factors that are associated with increased cardiovascular risk. A low-grade inflammatory process acts as the underlying pathophysiology, which suggests that the MS may have a detrimental effect on coronary interventions, including coronary artery bypass grafting (CABG) surgery performed with cardiopulmonary bypass (CPB). We aimed to evaluate the effect of the MS on morbidity and mortality rates in the early postoperative period in patients undergoing CABG.

Methods: We prospectively included 152 patients (109 males and 43 females; mean age 60.1 ± 8.6 years) who underwent elective CABG on CPB between January and September 2011. Early postoperative morbidity and mortality rates were compared between subjects with and without the MS. Diagnosis of the MS was based on the American National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria.

Results: Of the study group, 64 patients (42%) had the MS. The two groups were similar in age and gender. In the postoperative period, rates of atrial fibrillation, wound infection, pulmonary complications, and lengths of intubation, hospitalisation and intensive care unit stay were significantly higher in MS patients (p < 0.01). The MS was significantly associated with wound infection (OR 6.64, 95% CI: 1.72-25.75), pulmonary complications (OR 6.44, 95% CI: 1.58-26.33), arrhythmia (OR 5.47, 95% CI: 1.50-19.97) and prolonged intubation (OR 1.17, 95% CI: 1.05-1.32). The mortality rate was 3.1% in the MS group and 1.1% in the non-MS group, with no significant difference (p > 0.05).

Conclusion: The MS was associated with a higher rate of early postoperative morbidity following CABG, without having a significant effect on the mortality rate.
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http://dx.doi.org/10.5830/CVJA-2016-056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423427PMC
March 2017

Diffusion-weighted imaging (DWI) of the liver in assessing chronic liver disease: effects of the presence and the degree of ascites on ADC values.

Abdom Radiol (NY) 2016 Jan;41(1):56-62

Department of Radiology, Turgut Ozal Medical Center, Inonu University School of Medicine, 44315, Malatya, Turkey.

Purpose: The aim of this study was to determine the correlation between the liver and spleen apparent diffusion coefficient (ADC) values of patients with chronic liver disease and the presence and the degree of ascites.

Materials And Method: In this retrospective study, we assessed 107 patients with chronic liver disease and 39 control subjects who underwent upper abdominal MR imaging including echo-planar diffusion-weighted imaging (DWI). Among the 107 cirrhotic patients, 56 were classified as group 1, 25 as group 2, and 26 as group 3 according to the absence, the presence of minimal, and the presence of massive ascites, respectively. The scores of model for end-stage liver disease (MELD) were matched between groups as the standard reference. The liver ADC, spleen ADC, and normalized liver ADC values were compared between the control group and patients' groups.

Results: Patients with massive ascites had significantly higher MELD score compared with the other groups. The MELD score was also significantly higher in patient groups than in control group. The liver and normalized liver ADCs of patients' groups were significantly lower than that of the control group. With some overlap among groups, the measured ADC values decreased as the amount of the ascites increased, and these relationships were statistically significant. Furthermore, compared to control group, patients with massive ascites had significantly higher spleen ADCs.

Conclusion: Our results indicate that the ADC value of the liver and spleen correlates with the presence and the degree of ascites in patients with chronic liver disease, and merits further study.
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http://dx.doi.org/10.1007/s00261-015-0613-7DOI Listing
January 2016

Liver Transplant in Patients with Viral Hepatitis and Human Immunodeficiency Virus Coinfection: The First 2 Cases in Turkey.

Exp Clin Transplant 2016 01 20. Epub 2016 Jan 20.

From the Department of Surgery, Inonu University, Liver Transplantation Transplant Institute, Malatya, Turkey.

Objectives: The outcomes of liver transplant in human immunodeficiency virus-infected patients are improving with advances in antiretroviral treatment. Data about such cases are rare in Turkey. We present the first 2 living-donor liver transplants performed in Turkey in patients with viral hepatitis/human immunodeficiency virus coinfection. CASE 1: A 47-year-old man infected with human immunodeficiency virus with chronic hepatitis B and D and hepatocellular carcinoma within the Milan criteria had been taking antiretroviral medication before his liver transplant. An unrelated right lobe liver transplant was performed uneventfully in this patient, who was human immunodeficiency virus RNA-negative and had a CD4 T-cell count of 500/μL. Antiretroviral treatment continued in the early postoperative period, and a triple immunosuppressive regimen consisting of cyclosporine, mycophenolate mofetil, and steroids was initiated. Burkholderia cepacia pneumonia developed postoperatively, and was treated successfully. The patient was discharged on postoperative day 18, and is still alive 58 months after the operation. CASE 2: A 62-year-old man with human immunodeficiency virus and chronic hepatitis C virus infection was taking antiretroviral treatment before the liver transplant. The patient was hepatitis C virus RNA-positive, human immunodeficiency virus RNA-negative, and had a CD4 T-cell count of 620/μL. His son was the donor, and a right lobe liver transplant was performed uneventfully in antiretroviral treatment continued in the early postoperative period and a triple immunosuppressive regimen consisting tacrolimus, mycophenolate mofetil, and steroids was initiated. Broad-spectrum β-lactamase-positive Escherichia coli bacteremia and hospital-acquired pneumonia developed postoperatively and were treated successfully. The patient was discharged on postoperative day 19, and remains alive 13 months after the operation.

Conclusions: Living-donor liver transplant is a promising treatment choice for end-stage liver disease in human immunodeficiency virus-infected patients.
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http://dx.doi.org/10.6002/ect.2015.0036DOI Listing
January 2016

A 7-year study of the distribution of nosocomial candidemia in children with cancer.

Turk J Pediatr 2015 May-Jun;57(3):225-9

Division of Pediatric Infectious Diseases Dr. Behçet Uz Children's Hospital, İzmir, Turkey.

Candidemia is an important cause of morbidity and mortality in cancer patients. The incidence of candidemia has been reported to have shifted toward nonalbicans species. The aim of this study was to determine the distribution of Candida species resulting in bloodstream infections or catheter-related blood stream infections (CRBSIs) in pediatric hematology-oncology (PHO) patients over a 7-year-period. Medical and computerized microbiology laboratory records of all positive blood fungal cultures during the study period were analyzed retrospectively. The ratio of non-albicans Candida species (81.4%) was nearly four times higher than that of C. albicans candidemia (18.5%). Overall, C. parapsilosis caused the majority (61.4%) of candidemia episodes, followed by C. tropicalis (14.8%), C. famata (2.9%), C. ciferrii (1.4%) and C. glabrata (0.7%). The rate of CRBSIs was significantly higher in C. Parapsilosis candidemia. The overall rate of 30-day mortality in 135 candidemia episodes was 4.44%. Nearly half of the C. parapsilosis candidemia was associated with CRBSIs, suggesting its importance in PHO, in which several types of central venous catheters have been used.
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August 2016

A rare malignancy in a patient with neurofibromatosis: gastric adenocarcinoma.

North Clin Istanb 2015 25;2(2):162-164. Epub 2015 Sep 25.

Department of General Surgery, Inonu University Faculty of Medicine, Malatya, Turkey.

Neurofibromatosis is an autosomal dominant disease that is characterized by cutaneous hyperpigmentation and multiple neurofibromas and often accompanied by localized peripheral and central neural tumors. Gastrointestinal involvement is seen in 25% of the cases. Gastrointestinal stromal tumors, pancreatic and duodenal neuroendocrine tumors are the most common tumors in patients with neurofibromatosis. Neurofibromatosis and gastric adenocarcinoma constitute an extremely rare combination. In this case report we aim to present a patient with neurofibromatosis operated due to gastric adenocarcinoma.
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http://dx.doi.org/10.14744/nci.2015.33042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5175097PMC
September 2015

Living donor liver transplantation for Echinococcus Alveolaris: single-center experience.

Liver Transpl 2015 Aug 3;21(8):1091-5. Epub 2015 Jul 3.

Liver Transplantation Institute, Department of Surgery, İnönü University, Malatya, Turkey.

Echinococcus alveolaris (EA) causes a hepatic zoonotic infection and behaves like a malignant tumor during invasion. Liver transplantation (LT) is the only curative treatment option for this unresectable disease. Here, we share our experience with living donor liver transplantation (LDLT) due to EA from the time between March 2002 and November 2014 at the Liver Transplantation Institute of İnönü University. Ten patients (mean age, 38.6 years) undergoing LDLT because of unresectable EA were evaluated preoperatively, and the operative and follow-up data were analyzed retrospectively. The mean time interval between diagnosis and LT was 27 months. The mean operation time and mean intraoperative blood requirement were 613 minutes and 4 units of packed red blood cells, respectively. Diaphragmatic resections were performed in 3 patients, and vena cava replacement was performed in 2 patients because of difficulties in removing the extended disease. The local recurrence and distant metastasis rates were 10% and 20%, respectively. The mean survival time was 19.5 months (range, 0-54 months), and the mortality rate was 30%. Unresectable hepatic alveolar echinococcosis is a rare indication for LT and presents some technical difficulties during surgery because diaphragmatic resection, vascular reconstruction, or multiple blood transfusions may be needed. LDLT can be performed successfully in patients with this rare infectious disease, with careful follow-up for potential recurrence and metastasis and administration of low-dose immunosuppressive agents.
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http://dx.doi.org/10.1002/lt.24170DOI Listing
August 2015