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Abstract
Alstrom syndrome is a genetic disorder with autosomal recessive inheritance and multiple organ failure. Hearing loss, childhood obesity, diabetes mellitus, and nonalcoholic fatty liver disease are common disorders in this disease. Degree of nonalcoholic fatty liver disease ranges from benign steatosis to cirrhosis. Since it first description in 1959, 89 cases have been reported, and none in the literature underwent liver transplant. In this report, we describe a 19-year-old male patient with a diagnosis of hearingloss, obesity, anddiabetes mellitus startedsince childhood. He was evaluated for bloody vomiting, and grade 3 esophageal varices were detected, with liver cirrhosis findings made with abdominal tomography. The patient had a Model for End-Stage Liver Disease score of 23, and deceased donor liver transplant was planned. After an appropriate donor was identified, the patient underwent liver transplant with an operation lasting approximately 6 hours. Cold ischemia time was about 5 hours, and anastomosis time was about 30 minutes. The patient was extubated on posttransplant day 1. On posttransplant day 10, his vital parameters remained normal, but he had blurred consciousness and loss of orientation. Neurological examination and imaging revealed minimal subdural effusion and mild cerebral cortical dysfunction in electroencephalogram. The patient's symptoms improved after medical treatment, and the patient was discharged on day 13 posttransplant. At the month 24 outpatient follow-up, the patient had no problems. Alstrom syndrome is an autosomal recessive genetic disorder with multiple organ failure. Although various degrees of liver disease have been described in the literature that may progress to cirrhosis of the liver, our present case is considered original because of the absence of liver transplant descriptions in the literature.
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Affiliation(s)
- Fuat Aksoy
- From the Department of General Surgery, Bursa Uludag University, Bursa, Turkey
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2
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Aksoy F, Dundar HZ, Celik F, Ongen G, Nas OF, Saglam K, Gurluer E, Kıyıcı M, Kaya E. Effect of Locoregional Treatments in Hepatocellular Carcinoma: What Are the Pathologic/Radiologic Milan Criteria? EXP CLIN TRANSPLANT 2023; 21:820-825. [PMID: 37965957 DOI: 10.6002/ect.2023.0221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
OBJECTIVES Milan criteria is the most commonly used criteria for patients with hepatocellular carcinoma awaiting liver transplant. The effects of locoregional therapy on downstaging or bridging before liver transplant on survival remain controversial. Considering that the tumor size may change with locoregional therapy and formalin fixation after explantation, we aimed to evaluate the effects of locoregional therapy on radiological and pathological Milan criteria and survival. MATERIALS AND METHODS Demographic data, etiology, preoperative alpha-fetoprotein value, Child-Pugh and Model for End-Stage Liver Disease-Na scores, status of being inside or outside of radiological Milan criteria, status of being inside or outside of Milan criteria in explant (pathological Milan criteria), and the locoregional therapy types and combinations were evaluated for their effects on inclusion in Milan criteria and survival. RESULTS During the study period, 396 patients underwent liver transplant at our center, with 97 because of cirrhosis and hepatocellular carcinoma. When we viewed patients according to preoperative radiologic evaluations, 67.9% were within Milan criteria and 32.1% were outside. When we viewed according to explant (pathological) evaluations, 80.7% of patients were within Milan criteria. Among 97 patients, 71 (73.2%) had locoregional therapy (22 [30.9%] for downstaging, 49 [69.0%] for bridging to transplant), and 12 patients (12.3%) were within Milan criteria on explant examination while outside of Milan criteria before LT. One-year, 3-year, and 5-year survival rates were 80.7%, 76.1%, and 71.6%, respectively. CONCLUSIONS As a result of radiological evaluations, in patients who were outside of Milan criteria and underwent locoregional therapy, explant pathology within Milan criteria had a positive effect on survival; however, after locoregional therapy, there was no significant effect on survival in patients who were still outside of Milan criteria.
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Affiliation(s)
- Fuat Aksoy
- From the Organ Transplantation Center, Bursa Uludag University, Bursa, Turkey
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3
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Ongen G, Nas OF, Hacikurt K, Dundar HZ, Ozkaya G, Kaya E, Hakyemez B. Internal versus external biliary drainage in malignant biliary obstructions: is there a difference in the rate of infection? Acta Radiol 2023; 64:2501-2505. [PMID: 37611191 DOI: 10.1177/02841851231187078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
BACKGROUND Percutaneous biliary drainage is a frequently used method to provide biliary decompression in patients with biliary obstruction. PURPOSE To investigate the between drainage type and infection risk in patients treated with internal-external and external biliary drainage catheterization for malignant biliary obstruction. MATERIAL AND METHODS A total of 410 patients with malignant biliary obstruction who underwent internal-external or external biliary drainage catheterization between January 2012 and October 2016 were retrospectively evaluated. We investigated the correlation between percutaneous biliary drainage technique and infection frequency by evaluating patients with clinical findings, bile and blood cultures, complete blood counts, and blood biochemistry. RESULTS There was no statistically significant difference between the selected patient groups (internal-external or external biliary drainage catheter placed) in terms of age, sex, primary diagnosis, receiving chemotherapy, catheter sizes, and outpatient-patient status. After catheterization, catheter-related infection was observed in 49 of 216 (22.7%) patients with internal-external and 18 of 127 (14.2%) patients with external biliary drainage catheters, according to the defined criteria. There was no difference in infection rate after the biliary drainage in the two groups (P > 0.05). There was also no difference concerning frequently proliferating microorganisms in bile cultures. CONCLUSION Internal-external biliary drainage catheter placement does not bring an additional infection risk for uninfected cholestatic patients whose obstruction could be passed easily in the initial drainage.
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Affiliation(s)
- Gokhan Ongen
- School of Medicine, Department of Radiology, Bursa Uludag University, Bursa, Turkey
| | - Omer Fatih Nas
- School of Medicine, Department of Radiology, Bursa Uludag University, Bursa, Turkey
| | - Kadir Hacikurt
- Department of Radiology, Eastbourne District General Hospital, East Sussex, England
| | - Halit Ziya Dundar
- Department of General Surgery, Bursa Medicana Hospital, Bursa, Turkey
| | - Guven Ozkaya
- School of Medicine, Department of Biostatistics, Bursa Uludag University, Bursa, Turkey
| | - Ekrem Kaya
- School of Medicine, Department of General Surgery, Bursa Uludag University, Bursa, Turkey
| | - Bahattin Hakyemez
- School of Medicine, Department of Radiology, Bursa Uludag University, Bursa, Turkey
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Aksoy F, Gurluler E, Celik F, Sen M, Balkan EA, Dundar HZ, Kaya E. Evaluation of the Trend of Biochemical Functions in the Early Period After Cadaveric Liver Transplantation. Transplant Proc 2023:S0041-1345(23)00207-5. [PMID: 37100737 DOI: 10.1016/j.transproceed.2023.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/12/2023] [Accepted: 03/27/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Monitoring biochemical parameters to detect early complications after liver transplantation (LT) is important. Thus, we aimed to investigate parameter trends indicating liver function in patients who did not develop complications after cadaveric LT. METHODS A total of 266 cadaveric LT operations performed by a single center between 2007-2022 were included in the study. Patients with any early complications were excluded from the study. During the first 15 days, the parameters reflecting the patients' liver integrity and synthesis functions were evaluated. All parameters studied were evaluated at the same time of day and by a single laboratory. RESULTS Regarding synthesis functions, the coagulation parameters (prothrombin time and international normalized ratio) peaked on the first day and then decreased. Regarding tissue hypoxia, there was no significant change in lactate values. Total and direct bilirubin values also decreased after peaking on the first day. No significant change was observed in albumin, another liver synthesis value. CONCLUSIONS Although an increase in aspartate aminotransferase, alanine aminotransferase, total and direct bilirubin, prothrombin time, and international normalized ratio, which was especially seen on the first day, is considered normal, values that do not decrease after the second day or lactate values that increase gradually should be a warning in terms of possible early complications.
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Affiliation(s)
- Fuat Aksoy
- Organ Transplantation Center, Bursa Uludag University, Bursa, Turkey
| | - Ercument Gurluler
- Organ Transplantation Center, Bursa Uludag University, Bursa, Turkey
| | - Fatih Celik
- Organ Transplantation Center, Bursa Uludag University, Bursa, Turkey
| | - Murat Sen
- Organ Transplantation Center, Bursa Uludag University, Bursa, Turkey
| | - Eyup Anil Balkan
- Organ Transplantation Center, Bursa Uludag University, Bursa, Turkey
| | - Halit Ziya Dundar
- Organ Transplantation Center, Bursa Uludag University, Bursa, Turkey
| | - Ekrem Kaya
- Organ Transplantation Center, Bursa Uludag University, Bursa, Turkey.
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Ongen G, Nas OF, Aksoy F, Candan S, Dundar HZ, Ozpar R, Inecikli MF, Gursel BE, Tasar P, Savci G. Comparison of severity and complication rates of acute cholecystitis during pandemic and pre-pandemic periods? Acta Radiol 2022; 64:1363-1370. [PMID: 36412110 PMCID: PMC9692182 DOI: 10.1177/02841851221137048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Cancellations of surgeries for elective cases and late admissions of symptomatic cases during the pandemic period might have increased the number of cases of acute cholecystitis and its complications. Purpose To compare the severity of acute cholecystitis and complication rates during the pandemic and pre-pandemic periods. Material and Methods We evaluated the computed tomography (CT) findings observed for the diagnosis of complications for both acute simple and acute complicated cholecystitis during both the pandemic and pre-pandemic periods. Patients admitted to the hospital between March 2020 and December 2020 made up the study group and the corresponding appropriate patients from one year earlier were studied as the control group. In addition to the CT findings, clinical and laboratory findings, co-morbidities such as diabetes, as well as the admission time to hospital from the onset of the initial symptoms to hospital admission were also evaluated. Results A total of 88 patients were evaluated (54 in the study group, 34 in the control group; mean age = 64.3 ± 16.3 years). The male-to-female ratio was 51/37. The number of patients diagnosed with complicated cholecystitis were significantly higher in the study group ( P = 0.03). Murphy finding and diabetes status were similar between the two groups ( P = 0.086 and P = 0.308, respectively). Admission time to the hospital was significantly different for study and control groups in simple cholecystitis patients ( P = 0.045); with no significant difference in cases of complicated cholecystitis ( P = 0.499). Conclusion Our study reveals the course of acute cholecystitis during the pandemic period was much more serious with higher complications.
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Affiliation(s)
- Gokhan Ongen
- Department of Radiology, School of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Omer Fatih Nas
- Department of Radiology, School of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Fuat Aksoy
- Department of General Surgery, School of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Selman Candan
- Department of Radiology, Kelkit State Hospital, Kelkit, Gumushane, Turkey
| | - Halit Ziya Dundar
- Department of General Surgery, Bursa Medicana Hospital, Bursa, Turkey
| | - Rifat Ozpar
- Department of Radiology, School of Medicine, Bursa Uludag University, Bursa, Turkey
| | | | - Basak Erdemli Gursel
- Department of Radiology, School of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Pinar Tasar
- Department of General Surgery, School of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Gursel Savci
- Department of Radiology, School of Medicine, Bursa Uludag University, Bursa, Turkey
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Aksoy F, Arslan İE, Ozgur T, Dundar HZ, Çelik F, Bican Demir A, Erer Ozbek S, Kiyici M, Ozkan TB, Kaya E. Does Liver Transplant Improve Neurological Symptoms in Wilson Disease? Report of 24 Cases. EXP CLIN TRANSPLANT 2022; 20:1009-1015. [PMID: 36524887 DOI: 10.6002/ect.2022.0206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Wilson disease is an inherited disorder that results in copper accumulation in the tissues with liver injury and failure. Orthotopic liver transplant is one of the treatments of choice for this disease. The aim of this study was to compare the neurological symptoms, before and after orthotopic livertransplant, of patients with liver cirrhosis due to Wilson disease, who represent a special group of patients with liver failure. MATERIALS AND METHODS Between 2007 and 2020, there were 24 patients with Wilson disease resistant to medical treatment who underwent deceased donor orthotopic livertransplant and were followed up for 1 year, 5 years, and 10 years for evaluation with neurological scoring systems. Patients were also evaluated for postoperative complications and survival. RESULTS Of the 24 patients evaluated, there were 13 (54.2%) female patients and 11 (45.8%) male patients, and the mean age was 34 years (range, 14-57 years). One of the patients died from early postoperative sepsis. After orthotopic livertransplant, disease scores returned to normal in 16 patients and improved in the remaining patients. Before transplant, all patients required help in their daily activities. After transplant, there were significant improvements in some symptoms, and the patients became more independent in their daily lives. CONCLUSIONS Our study shows that orthotopic liver transplant provides significant improvement in neurological symptoms and quality of life in patients with Wilson disease.
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Affiliation(s)
- Fuat Aksoy
- From the Organ Transplantation Center, Medical Faculty, Bursa Uludag University, Bursa, Turkey
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Aksoy F, Ak Aksoy S, Dundar HZ, Tunca B, Ercelik M, Tekin Ç, Kıyıcı M, Selimoglu K, Kaya E. Blood-Based Biomarkers in Afp Normal/Stable Hepatocellular Carcinoma: Diagnostic and Prognostic Relevance of Mir-10b for Patients on Liver Transplant List. Transplant Proc 2022; 54:1826-1833. [PMID: 35987859 DOI: 10.1016/j.transproceed.2022.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/22/2022] [Accepted: 05/22/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND As a diagnostic criteria of hepatocellular carcinoma (HCC), the exact threshold of alpha-fetoprotein (AFP) is controversial. In additional, not all HCC tumors are AFP positive or secrete elevated amounts of AFP into the serum. However, the diagnosis of HCC is quite important on the liver transplant list. Therefore, the purpose of this study was to investigate the expression of circulating micro RNAs (miRNAs) in AFP-stable HCC patients. Thus, we aimed to determine a diagnostic biomarker in these patients. METHODS Sixteen miRNAs were evaluated using a real-time quantitative reverse transcription polymerase chain reaction system in AFP-stable HCC and AFP-trending HCC patients. RESULTS In our study, 46.7% (n = 28) of the patients diagnosed with HCC had stable/normal AFP levels. We detected that high expression of miR-24, miR-10b and the low expression of miR-143 were independently and significantly associated with HCC in AFP-stable compared with AFP trending (P < .05). Additionally, we demonstrated that the overexpression of miR-10b was associated with poor disease-free survival in HCC (P = 0.001). CONCLUSIONS Although more clinical validations are needed for the diagnosis of HCC, our current results indicate that the coexistence of high expression of miR-10b and miR-24 may help clinicians adjust in the diagnosis of HCC in patients who are on the liver transplant list but awaiting biopsy for the diagnosis of HCC.
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Affiliation(s)
- Fuat Aksoy
- Organ Transplantation Center, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Secil Ak Aksoy
- Inegol Vocation School, Bursa Uludag University, Inegol, Bursa, Turkey
| | - Halit Ziya Dundar
- Organ Transplantation Center, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey.
| | - Berrin Tunca
- Department of Medical Biology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Melis Ercelik
- Department of Medical Biology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Çagla Tekin
- Department of Medical Biology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Murat Kıyıcı
- Department of Gastroenterology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Kerem Selimoglu
- Organ Transplantation Center, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Ekrem Kaya
- Organ Transplantation Center, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
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Aksoy F, Dundar HZ, Bican Demir A, Kiyici M, Kaya E. Myelitis After Liver Transplant: A Case Report. EXP CLIN TRANSPLANT 2021. [PMID: 34085919 DOI: 10.6002/ect.2020.0278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report a case of neurotoxicity as a side effect of a calcineurin inhibitor (tacrolimus), which is used as an immunosuppressive drug after liver transplant. Our patient had chronic hepatic failure due to Budd-Chiari syndrome and underwent a liver transplant after an appropriate deceased donor organ was obtained. After organ transplant surgery, he was kept under the effect of an immunosuppressive drug (tacrolimus) with daily control of the level of drug in his blood to avoid drug toxicity. Despite the level of drug in his blood being within the ideal range, the patient developed neurotoxicity that presented as weakness of his extremities. Appropriate diagnostic tests were done, and all proved that these signs and symptoms were related to the use of tacrolimus. Therefore, the drug was changed to cyclosporine. After a few months, the patient regained normal neurological functions of his extremities. We should take precautions to monitor neurological symptoms and signs while we administer calcineurin inhibitors.
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Affiliation(s)
- Fuat Aksoy
- From the Department of General Surgery, Bursa Uludag University, Bursa, Turkey
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Senol K, Ferhatoglu MF, Kocaeli AA, Dundar HZ, Kaya E. Clinical Features and Short-Term Outcomes of Bariatric Surgery in Morbidly Obese Patients: Institutional Experience at a Rural Hospital. Bariatr Surg Pract Patient Care 2021; 16:61-67. [PMID: 33763312 PMCID: PMC7984649 DOI: 10.1089/bari.2020.0110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Objective: To prospectively evaluate the postoperative morbidity, mortality, and weight loss evolution of patients who underwent a bariatric procedure during 1 year of follow-up. Methods: Since July 2016, a total of 101 patients' data have been prospectively registered in a database. Comorbidities, operating time, hospital stay, early and late complications rate, and weight loss evolution after 1 year of follow-up were recorded. Results: The mean age was 38.41 ± 11.05 years with a mean body mass index (BMI) of 49.02 ± 5.89 kg/m2 (range 38-67). Laparoscopic sleeve gastrectomy (LSG) was performed in 93 patients (92.07%) and Roux-en-Y gastric bypass (RNYGB) in 8 patients (7.92%). Thirty-day morbidity rate was 7.92% (8/101). Within a mean 9.32 ± 2.25 (range 1-19) months follow-up time, mean percent of the excess of weight loss of 1st, 6th, and 12th months were 22.7 ± 6.1, 67.2 ± 11.2, and 81.4 ± 10.5, respectively. Diabetes (n = 38, 37.6%), hypertension (n = 13, 12.9%), and obstructive sleep apnea (n = 5, 4.9%) were resolved in 76%, 68.4%, and 100% of the patients, respectively (p < 0.001). Conclusions: LSG and RNYGB are safe and highly effective, particularly in patients with a BMI >50 kg/m2. Both techniques have been presented with better clinical outcomes regarding significant comorbidity resolution in the early evolution of weight loss.
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Affiliation(s)
- Kazim Senol
- Department of General Surgery, Faculty of Medicine, Uludag University, Bursa, Turkey
| | | | | | - Halit Ziya Dundar
- Department of General Surgery, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Ekrem Kaya
- Department of General Surgery, Faculty of Medicine, Uludag University, Bursa, Turkey
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Aksoy F, Dundar HZ, Aksoy SA, Tunca B, Tasar P, Ozen Y, Cecener G, Egeli U, Ugras N, Yerci O, Kaya E. Long noncoding RNA BANCR predicts poor clinical outcome in periampullary tumors. Int J Surg 2020. [DOI: 10.1016/j.ijsu.2020.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Dundar HZ, Aksoy F, Aksoy SA, Tasar P, Ugras N, Tunca B, Egeli U, Cecener G, Yerci O, Kaya E. Overexpression of miR-21 Is Associated With Recurrence in Patients With Hepatitis B Virus-Mediated Hepatocellular Carcinoma Undergoing Liver Transplantation. Transplant Proc 2019; 51:1157-1161. [PMID: 31101191 DOI: 10.1016/j.transproceed.2019.01.089] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/21/2019] [Indexed: 01/08/2023]
Abstract
Liver transplantation (LT) is the best treatment option for hepatitis B virus (HBV)-mediated hepatocellular carcinoma (HCC). Nevertheless, recurrence is the most important issue after LT. The aims of the present study were to evaluate the relation of dysregulated expression of microRNAs (miRNAs) in recurrence formation in HBV-mediated HCC cases. A total of 42 HBV-mediated HCC patients were evaluated in this study. Among 21 miRNAs, the expression level of miR-106a and miR-21 were higher and miR-143 and miR145 were lower in patients with HCC compared with noncancerous liver tissues (P = .0388, P = .0214, P = .0321, and P = .002, respectively). Compared with nonrecurrent patients, the expression level of miR-21 was 3.54-fold higher and miR-145 was 2.42-fold lower in patients with recurrence during the 5-year follow-up (P = .004 and P = .032; respectively). In addition, according to multivariate Cox regression analysis, the overexpression of miR-21 was found to be a prognostic indicator in HBV-mediated HCC patients (P = .002). In conclusion, we show a significant association between high expression of miR-21 and recurrence in HBV-mediated HCC. Therefore, up-regulation of miR-21 could serve as a promising prognostic marker for HCC.
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Affiliation(s)
- H Z Dundar
- General Surgery, Uludag University, Bursa, Turkey
| | - F Aksoy
- General Surgery, Uludag University, Bursa, Turkey
| | - S Ak Aksoy
- Medical Biology, Uludag University, Bursa, Turkey.
| | - P Tasar
- General Surgery, Uludag University, Bursa, Turkey
| | - N Ugras
- Pathology, Uludag University, Bursa, Turkey
| | - B Tunca
- Medical Biology, Uludag University, Bursa, Turkey
| | - U Egeli
- Medical Biology, Uludag University, Bursa, Turkey
| | - G Cecener
- Medical Biology, Uludag University, Bursa, Turkey
| | - O Yerci
- Pathology, Uludag University, Bursa, Turkey
| | - E Kaya
- General Surgery, Uludag University, Bursa, Turkey
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Coskun A, Baykal AT, Oztug M, Kazan D, Kaya E, Emiroglu R, Yılmaz S, Dundar HZ, Akgoz M, Berber I, Aktas H, Bilsel G, Karaosmanoglu K, Çetiner B, Arslan C, Yurtsever I, Yazıcı C. Proteomic Analysis of Liver Preservation Solutions Prior to Liver Transplantation. CURR PROTEOMICS 2019. [DOI: 10.2174/1570164615666180905104543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective: Transplantation is the preferred treatment for patients with end-stage liver diseases. However, in clinical practice, functional preservation of the liver is a major concern before the transplantation. Although various protective solutions are used (in combination with hypothermia), the functional preservation time for liver is still limited to hours. We analyzed the preservation medium to detect the proteins released from the liver during storage period.
Material/Methods:
Samples were collected from the pre-transplant preservation mediums of 23 liver donors. For all donors, the cases involved Donation after Brain Death (DBD). 2D-PAGE and LCMSMS methodologies were used to detect the proteins and peptides from the preservation mediums.
Results:
A total of 198 proteins originating from the liver were detected.
Conclusion:
The data provide valuable insights into biomarkers that may be used to evaluate organ injury, functional status, and suitability for transplantation. Additionally, the findings could be valuable for the development of new strategies for effective preservation of solid organs prior to transplantation.
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Affiliation(s)
- Abdurrahman Coskun
- Department of Medical Biochemistry, School of Medicine, Acibadem University, Istanbul, Turkey
| | - Ahmet Tarik Baykal
- Department of Medical Biochemistry, School of Medicine, Acibadem University, Istanbul, Turkey
| | - Merve Oztug
- TUBITAK UME (National Metrology Institute), Gebze, Turkey
| | - Dilek Kazan
- Department of Bioengineering, Engineering Faculty, Marmara University, Istanbul, Turkey
| | - Ekrem Kaya
- Department of General Surgery, School of Medicine, Uludag University, Bursa, Turkey
| | - Remzi Emiroglu
- Department of General Surgery, School of Medicine,Acibadem University, Istanbul, Turkey
| | - Sezai Yılmaz
- Department of General Surgery, School of Medicine, Inonu University, Malatya, Turkey
| | - Halit Ziya Dundar
- Department of General Surgery, School of Medicine, Uludag University, Bursa, Turkey
| | - Muslum Akgoz
- TUBITAK UME (National Metrology Institute), Gebze, Turkey
| | - Ibrahim Berber
- Department of General Surgery, School of Medicine,Acibadem University, Istanbul, Turkey
| | - Hikmet Aktas
- Vocational School of Health Services, Acibadem University Istanbul, Turkey
| | - Gokhan Bilsel
- TUBITAK UME (National Metrology Institute), Gebze, Turkey
| | - Kubra Karaosmanoglu
- Department of Bioengineering, Engineering Faculty, Marmara University, Istanbul, Turkey
| | - Banu Çetiner
- Department of Medical Biochemistry, School of Medicine, Acibadem University, Istanbul, Turkey
| | - Cansu Arslan
- Department of Medical Biochemistry, School of Medicine, Acibadem University, Istanbul, Turkey
| | - Ilknur Yurtsever
- Regenerative and Restorative Medicine Research Center, Medipol University, Istanbul, Turkey
| | - Cevat Yazıcı
- Department of Medical Biochemistry, School of Medicine, Erciyes University, Kayseri, Turkey
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Dundar HZ, Oflaz R, Cinar YS, Sarkut P, Ozkan OF, Kaya E. Is Donor Age an Important Factor in Cadaveric Organ Donation? Istanbul Med J 2018. [DOI: 10.5152/imj.2018.76094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Dundar HZ, Tasar P, Isik O, Kaya E. Anastomotic leaks at the pancreaticojejunostomy following pancreaticoduodenectomy in patients with pancreatic head adenocarcinoma increases the local recurrence rate. Ann Ital Chir 2018; 89:315-319. [PMID: 30337513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION In contrast to colorectal cancer patients, the effect of anastomosis leakage following pancreatic adenocarcinoma surgery on survival and recurrence rate is not clear. The present study aimed to determine the effect of pancreaticojejunostomy (PJ) anastomosis leakage, especially on the local recurrence rate and time of recurrence, in patients that underwent pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma. MATERIALS AND METHODS This retrospective study included 64 pancreatic adenocarcinoma patients that underwent PD between January 2007 and August 2015. PJ anastomosis leakage was evaluated based on International Study Group on Pancreatic Fistula criteria. The effects of PJ anastomosis leakage on local recurrence, disease-free survival, and overall survival were assessed. RESULTS Among the patients, 44 were male and 20 were female, and median age was 61(39-84) years. In all, 11 patients developed PJ leakage. Local recurrence occurred in 5 (45,4%) of the patients that developed PJ leakage, versus in 4 (7,5%) of the patients without leakage (p=0.02). Local recurrence developed earlier in those with leakage than in those without (p= 0,013). In contrast, there weren't any significant differences in disease-free survival, or overall survival. CONCLUSION PJ leakage seems to be associated with more frequent and earlier local recurrence while it did not influence survival. KEY WORDS Leakage, Pancreatic cancer, Recurrence.
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Kirdak T, Dundar HZ, Uysal E, Ocakoglu G, Korun N. Outcomes of Parathyroid Autotransplantation During Total Thyroidectomy: A Comparison with Age- and Sex-Matched Controls. J INVEST SURG 2016; 30:201-209. [PMID: 27700191 DOI: 10.1080/08941939.2016.1232768] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To determine the effect of parathyroid autotransplantation (PA) on postoperative hypocalcemia in cases of total thyroidectomy. MATERIALS AND METHODS Cases undergoing total thyroidectomy and PA were compared with age and sex-matched controls who had not undergone PA. The postoperative percentage changes (PC) of parathyroid hormone (PTH) and calcium (Ca+2) in the first 12-24 hours (12-24hr→preop), between the 1st-3rd weeks (1-3wk→preop) and at the 6th month (6mo→preop), the rates of hypocalcemia (Ca+2< 8mg/dL) and low PTH level (PTH< 15 pg/mL), permanent hypocalcemia, inadvertent parathyroidectomy in both groups were compared. RESULTS The number of patients with PTH12-24hr<15 pg/mL was significantly higher (n:34,(55.7%)) than the number of patients in the control group (n:16(26.2%)), (p=0.001). The rate of decrease in the blood Ca+2 median PC (6mo→preop) was significantly higher in the PA group (4.2%) than the control group (1.1%), (p=0.008). There was no significant difference between the 2 groups in terms of the postoperative frequency of hypocalcemia (p>0.05). In the PA&age≤50 group, the rate of inadvertent parathyroidectomy was higher than that of cases over age 50 (p=0.029). CONCLUSION In spite of the presence of an increased postoperative hypocalcemia trend in cases requiring PA during total thyroidectomy, the rates of transient and permanent hypocalcemia were not different to the control cases. But the frequency of cases with low PTH level in cases undergoing PA was higher than that of the control cases. In cases of 50 years of age and under, who had undergone PA, the possibility of inadvertent parathyroidectomy increased.
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Affiliation(s)
- Turkay Kirdak
- a Department of Surgery , Uludag University Faculty of Medicine , Bursa , Turkey
| | - Halit Ziya Dundar
- a Department of Surgery , Uludag University Faculty of Medicine , Bursa , Turkey
| | - Erdal Uysal
- b Department of Surgery , Sanko University School of Medicine , Gaziantep , Turkey
| | - Gokhan Ocakoglu
- c Department of Biostatistics , Uludag University Faculty of Medicine , Bursa , Turkey
| | - Nusret Korun
- a Department of Surgery , Uludag University Faculty of Medicine , Bursa , Turkey
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Egeli U, Ak S, Cecener G, Tunca B, Tezcan G, Sevinc ED, Kaya E, Dundar HZ, Sarkut P, Ozen Y, Balcin O, Evrensel T, Yerci O, Ugras N. Impact of 3'UTR variation patterns of the KRAS gene on the aggressiveness of pancreatobiliary tumors with the KRAS G13D mutation in a Turkish population. Pancreatology 2016; 16:677-86. [PMID: 27256640 DOI: 10.1016/j.pan.2016.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 04/26/2016] [Accepted: 05/20/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Several studies have demonstrated the importance of mutations in codons 12, 13 and 61 and variations in the 3' untranslated region (3'UTR) of the KRAS gene, frequently observed genetic events in the progression of pancreatobiliary tumors (PBT). However, limited data exist on the clinical effect of these alterations. The aim of the current study was to clarify the frequency of relevant alterations of the 3'UTR regions of the KRAS gene and the effect of KRAS 3'UTR polymorphisms on the prognosis of patients with codon 12, 13 and 61 mutations in a Turkish population with PBT. METHODS Codons 12, 13, and 61 and 3'UTRs of the KRAS gene were screened by single-strand conformation polymorphism (SSCP) analysis and DNA sequencing in 43 patients and 10 controls. Chi-squared and independent sample T tests were used to evaluate the results of the mutation analysis and clinical features of the patients. RESULTS We defined the c.38G > A (rs112445441, p.G13D) (39.54%) mutation and two 3'UTR variations, c.*4066delA (rs560890523) (23.26%) and c.*4065_*4066delAA (rs57698689) (6.98%), in the KRAS gene of Turkish patients. There was a statistically significant relationship between the c.*4066delA (rs560890523) and c.*4065_*4066delAA (rs57698689) variations and invasion and lymph node metastasis status of the patients (p < 0.001). Compared to patients with c.38G > A (rs112445441, p.G13D), patients with c.*4066delA (rs560890523) and c.38G > A (rs112445441, p.G13D) presented more aggressive tumors with highly invasive features. The present study contributes findings regarding the clinical effects of KRAS alterations in PBT. Based on our study, further investigations are required.
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Affiliation(s)
- Unal Egeli
- Department of Medical Biology, Medical Faculty, Uludag University, Bursa, Turkey.
| | - Secil Ak
- Department of Medical Biology, Medical Faculty, Uludag University, Bursa, Turkey
| | - Gulsah Cecener
- Department of Medical Biology, Medical Faculty, Uludag University, Bursa, Turkey
| | - Berrin Tunca
- Department of Medical Biology, Medical Faculty, Uludag University, Bursa, Turkey
| | - Gulcin Tezcan
- Department of Medical Biology, Medical Faculty, Uludag University, Bursa, Turkey
| | | | - Ekrem Kaya
- Department of General Surgery, Medical Faculty, Uludag University, Bursa, Turkey
| | - Halit Ziya Dundar
- Department of General Surgery, Medical Faculty, Uludag University, Bursa, Turkey
| | - Pinar Sarkut
- Department of General Surgery, Medical Faculty, Uludag University, Bursa, Turkey
| | - Yilmaz Ozen
- Department of General Surgery, Medical Faculty, Uludag University, Bursa, Turkey
| | - Ozkan Balcin
- Department of General Surgery, Medical Faculty, Uludag University, Bursa, Turkey
| | - Turkkan Evrensel
- Department of Medical Oncology, Medical Faculty, Uludag University, Bursa, Turkey
| | - Omer Yerci
- Department of Pathology, Medical Faculty, Uludag University, Bursa, Turkey
| | - Nesrin Ugras
- Department of Pathology, Medical Faculty, Uludag University, Bursa, Turkey
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Isik O, Kaya E, Dundar HZ, Sarkut P. Surgical Site Infection: Re-assessment of the Risk Factors. Chirurgia (Bucur) 2015; 110:457-461. [PMID: 26531790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Surgical site infection (SSI) is a well-known complication of general surgery. Although overall SSI rate is relatively low, it is the most common nosocomial infection. SSI adversely affects patient outcomes and healthcare costs. METHODS Patients who underwent general surgical procedures between 2003 and 2009 were included in the study. SSI diagnosed based on the National Nosocomial Infection Surveillance System (NNIS) criteria. Patients were classified into two groups: SSI (+) and SSI (-). Patient demographics, co-morbidities, procedural details, and SSI type and treatment were evaluated. Multivariate analysis was performed to determine independent risk factors of SSI. RESULTS In total, 4690 patients were included. Overall SSI rate was 4.09% (192/ 4690). Colorectal surgery was associated with the highest SSI rate (9.43%) followed by pilonidal sinus (8.79%), upper gastrointestinal (GI) (8.09%), hepatobiliary (6.68%), hernia (0.78%), and breast-thyroid (0.3%) surgery. Procedure type (pilonidal sinus, colorectal, hepatobiliary and upper GI surgery), prolonged preoperative hospital stay, higher ASA score, emergency surgery, dirty- infected wound class, experienced surgeon, prolonged operating time, presence of surgical drains, and intraoperative transfusion were determined as independent risk factors of SSI (p 0.05). CONCLUSION Most of the determined risk factors were surgeon and procedure related. Reduced SSI rate and better outcomes can be achieved by controlling modifiable risk factors.
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Abstract
BACKGROUND Performing transient or permanent ileostomy is one of the common procedures involved in colorectal surgery. Complication rates up to 40% have been reported in ileostomies. In this report, the effect of specific stoma care unit on ileostomy and its complications were investigated. METHODS A total of 141 patients, who were operated and underwent ileostomy, due to different causes, at Department of General Surgery, Uludağ University, Bursa, Turkey, between 2003 and 2006, were examined, retrospectively. Patient records were examined in terms of age, sex, surgery indications, urgent/elective state, benign/malign origin, ileostomy type, complications and stoma care, and education. χ(2) test was used to compare the categorical data. RESULTS Among the patients, 95 (67%) were male and 46 (33%) were female. The mean age was 47 years (17-67). Some of the subjects (49%) were operated urgently and some (51%) were under elective conditions. The ileostomy types used included the following: end ileostomy (43%), loop ileostomy (46%), and double-barrel ileostomy (11%). Permanent ileostomy was performed in 23 patients and transient ileostomy was performed in 118 patients. The patients were operated because of either benign (48%) or malign (52%) causes. Complications developed in 37 (26%) patients. The rate of development of complication was markedly higher in ileostomies performed under urgent conditions (61% vs 39%) (P<0.001). The complications included mucocutaneous separation (12 patients), maceration in the peristomal skin (ten patients), retraction (five patients), necrosis (three patients), prolapsus (three patients), and other metabolic complications (four patients). The complications were treated with care (68%) and surgical revision (32%). CONCLUSION The rate of ileostomy was found to be higher in the male patients compared to female patients. The risk of development of complications was found to be higher in ileostomies performed under urgent conditions. The most common complication observed was mucocutaneous separation. Ileostomy complications can be treated conservatively with professional care and education.
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Affiliation(s)
- Pinar Sarkut
- Department of General Surgery, Faculty of Medicine, Uludağ University, Görükle, Turkey
| | - Halit Ziya Dundar
- Department of General Surgery, Faculty of Medicine, Uludağ University, Görükle, Turkey
| | - Ismail Tirnova
- Department of General Surgery, Faculty of Medicine, Uludağ University, Görükle, Turkey
| | - Ersin Ozturk
- Department of General Surgery, Faculty of Medicine, Uludağ University, Görükle, Turkey
| | - Tuncay Yilmazlar
- Department of General Surgery, Faculty of Medicine, Uludağ University, Görükle, Turkey
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Abstract
Hepatorenal syndrome (HRS) is defined as development of renal dysfunction in patients with chronic liver diseases due to decreased effective arterial blood volume. It is the most severe complication of cirrhosis because of its very poor prognosis. In spite of several hypotheses and research, the pathogenesis of HRS is still poorly understood. The onset of HRS is a progressive process rather than a suddenly arising phenomenon. Since there are no specific tests for HRS diagnosis, it is diagnosed by the exclusion of other causes of acute kidney injury in cirrhotic patients. There are two types of HRS with different characteristics and prognostics. Type 1 HRS is characterized by a sudden onset acute renal failure and a rapid deterioration of other organ functions. It may develop spontaneously or be due to some precipitating factors. Type 2 HRS is characterized by slow and progressive worsening of renal functions due to cirrhosis and portal hypertension and it is accompanied by refractory ascites. The only definitive treatment for both Type 1 and Type 2 HRS is liver transplantation. The most suitable bridge treatment or treatment for patients who are not eligible for transplantation is a combination of terlipressin and albumin. For the same purpose, it is possible to try hemodialysis or renal replacement therapies in the form of continuous veno-venous hemofiltration. Artificial hepatic support systems are important for patients who do not respond to medical treatment. Transjugular intrahepatic portosystemic shunt may be considered as a treatment modality for unresponsive patients to medical treatment. The main goal of clinical surveillance in a cirrhotic patient is prevention of HRS before it develops. The aim of this article is to provide an updated review about the physiopathology of HRS and its treatment.
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Abstract
BACKGROUND There are several studies regarding risk factors affecting surgical site infections (SSIs); nevertheless, there are an insufficient number of studies focusing on risk factors for SSI in hepatobiliary (HPB) surgery. In this study, we aimed to determine risk factors related to HPB surgery. METHODS A total of 1,418 patients were included in this study, all of whom underwent hepatobiliary system surgery in a five-year period between January 2005 and December 2009. Demographic data, patient- and surgery-related risk factors, and laboratory parameters were analyzed retrospectively from a database maintained prospectively. RESULTS The overall incidence of SSI was 3.94% for HPB surgery. In multivariable analysis, blood transfusion (OR: 20.9), the presence of surgical drains (OR: 10.7), a pre-operative hospital stay of more than eight days (OR: 8.1), diabetes mellitus (OR: 6.2), chronic obstructive pulmonary disease (OR: 6.127), inappropriate antimicrobial prophylaxis (OR: 6), obesity (OR: 3.2), the presence of an external-internal biliary drainage catheter (OR: 2), and a direct bilirubin concentrations more than 15 mg/dL (OR: 1.4) were determined as independent risk factors related to SSI. E.coli and Enterococcus spp. were the pathogens isolated most commonly in SSIs. CONCLUSIONS Most of the independent risk factors for hepatobiliary system surgery are similar to those for other general abdominal surgical procedures. The presence of an external-internal biliary drainage catheter and direct bilirubin concentrations higher than 15 mg/dL were found to be specific risk factors for HPB surgery.
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Affiliation(s)
- Ozgen Isik
- Uludag University School of Medicine, Department of Surgery, Gorukle, Bursa, Turkey
| | - Ekrem Kaya
- Uludag University School of Medicine, Department of Surgery, Gorukle, Bursa, Turkey
| | - Pinar Sarkut
- Uludag University School of Medicine, Department of Surgery, Gorukle, Bursa, Turkey
| | - Halit Ziya Dundar
- Uludag University School of Medicine, Department of Surgery, Gorukle, Bursa, Turkey
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Dundar HZ, Sarkut PT, Kaya E. Early outcomes of liver transplants in patients receiving organs from hypernatremic donors: a letter to the editor. EXP CLIN TRANSPLANT 2014; 12:169. [PMID: 24702149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Halit Ziya Dundar
- Department of General Surgery, Uludag University, Faculty of Medicine, Bursa, Turkey
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