Mustafa Özsoy

Live donor liver transplantation for Budd-Chiari syndrome: anastomosis of the right hepatic vein to the right atrium.

A 29-year-old male patient with the diagnosis of endstage liver disease due to Budd-Chiari syndrome was referred to our hospital for liver transplantation. The patient had been diagnosed 4 years earlier and initially was managed with anticoagulant therapy and diuretics. Later, he developed end-stage liver disease, and anticoagulant therapy was withdrawn. He was admitted with massive ascites, jaundice, and fatigue complaints, and his Child and Model for End-Stage Liver Disease scores were 12 and 23, respectively. The workup for the etiology of Budd-Chiari syndrome, including bone marrow biopsy, autoantibodies, and mutations for thrombosis, did not demonstrate a specific cause. Multislice computed tomography of the abdomen and chest and vena cavography were performed, revealing total thrombosis of the inferior vena cava ascending from the renal vein orifices to the diaphragm (Fig. 1). His 22-year-old brother volunteered for right lobe liver donation, and his workup to be a live donor did not show any abnormalities. The donor and the recipient simultaneously underwent surgery for regular live donor liver transplantation. Technically, in these kind of cases, the mobilization of the liver and the piggyback maneuver are not easy because of diffuse fibrotic reactions in the retroperitoneum, which also involves the inferior vena cava. The recipient liver was removed, and the vena cava was observed to be fibrotic and totally thrombosed from the renal vein orifices to the right atrium. The pericardium was cut, and the supradiaphragmatic vena cava was encircled (Fig. 2). As the vena cava was totally obstructed and there was no place to perform an anastomosis on the vena cava, the right atrium was used for the outflow reconstruction. The diaphragm surrounding the vena cava was excised with electrocautery, and the pericardial space was widely exposed (Fig. 3). The suprahepatic vena cava was also fibrotic and did not have enough distance to allow an anastomosis; thus, a Satinsky clamp was placed diagonally on the right atrium without causing any arrhythmia, and the bottom of the atrium was cut 2 cm wide so that anastomosis could be performed (Fig. 4). The fibrotic native vena cava was removed, and anastomosis between the right atrium and right hepatic vein was performed with 5/0 polypropylene sutures in a continuous fashion (Figs. 5 and 6). The pericardium was left open at the end of the procedure. The portal vein, hepatic artery, and bile duct anastomoses were performed in the usual fashion. The patient was hemodynamically stable during the operation, and the postoperative period was uneventful. Mild sinus tachycardia occurring after surgery resolved in 5 days, and the patient did not develop any further arrhythmias. He was taken out of the intensive care unit on postoperative day 4, and he was discharged home on postoperative day 20. His liver function tests recovered gradually after the transplant, and his control echocardiogram

The Results of Vascular and Biliary Variations in Turks Liver Donors: Comparison with Others

Objective. To evaluate liver anatomy with a view to access unerring surgery in liver donors. Summary Background Data. Liver transplantation, the unique curative treatment option for end-stage hepatic failure, has become routinely practicable, which was inconceivable in the past. But, the vascular and biliary anatomy of the liver has not been completely disclosed yet. Methods. From 1994 to 2009, we have done a research on 496 liver donors. The data were accumulated and categorized according to the most widely used classification systems. Results. Of 496 liver donors, 393 (79.1%) underwent the right donor hepatectomy, 98 (19.9%) were performed the left lateral segmentectomy, and 5 donors (1%) underwent the left donor hepatectomy surgery. Given the data regarding to 398 liver donors undergone right and left donor hepatectomy, arteries, bile ducts, and portal vein showed classical anatomy in 107 (21.6%) donors. Variations in all three systems were found in 16 donors (3.2%). In the remaining 275 donors (75.2%), anatomical variations were found at either of arterial, biliary, or portal system. Conclusions. Our study could come up to actual estimate in liver anatomy as any of donors have not been removed in our institute due to high hilar dissection technique.

Unexpected Benefit of the Positron Emission Tomography/Computed Tomography Using 18F-Fluorodeoxyglucose: Report of a Case

The positron emission tomography/computed tomography (PET/CT) has been a new tool utilized in the diagnosis and staging of various cancers. However, common worldwide utilization of the PET/CT includes some economic, legal, and ethic controversies. Although PET/CT scanning can detect colorectal premalignant lesions in an early treatable stage, most governments’ health care system does not pay for it as a screening test because of its economic burden. Thus, people are forced to make vital decisions about their health because of health policies of their governments. Here, we present an unusual case and discuss the utilization of PET/CT for detection of incidental neoplasms.

Meckel Divertikülü’nün Nadir Rastlanan Komplikasyonu: İleus ve Divertikülit Birlikteliği

Gastrointestinal sistemin en sik rastlanan konjenital anomalisi Meckel divertikuludur. Cogunlukla asemptomatiktir. Genellikle komplikasyonlarin gelistigi durumlarda tani alirlar. Klinik yasa bagli degisiklik gostermektedir. Eriskin yas grubunda en sik rastlanan komplikasyon obstruksiyon tablosu iken ikinci sirayi divertikulit almaktadir. Bu makale ile obstruksiyon ve divertikulit tablosunu es seansli barindiran bir olguyu literatur bilgileri isiginda sunmayi amacladik

Safra Kesesi Karsinomunu Taklit Eden Ksantogranülomatöz Kolesistit

Şekil I: A: Mukozal ulserasyon ve kese duvarinda kolesterol kleftleri ve kopuklu makrofajlar ile karakterli ksantomatoz reaksiyon (x100, HE). B: Kolesterol kleftleri ve kopuklu histiositler yani sira az sayida lenfositler ile karakterli ksantogranulomatoz yangi (x200, HE)