4053 research outputs found
Sort by
The Utility of Noninvasive Scoring Systems for Prediction of Hepatic Steatosis in Liver Transplantation Donor Candidates
No full textBackground: The degree of liver steatosis is an important factor for donor selection in living donor liver transplantation. Multidetector computed tomography (MDCT) has long been used in many transplantation centers to determine donor liver steatosis. Noninvasive scoring methods based on laboratory tests have been investigated as potential methods for altering liver biopsy and imaging techniques in evaluating the liver steatosis. In this study, we assess the utility of several noninvasive methods for the evaluation of donor hepatosteatosis. In comparison, MDCT was used for the evaluation of liver steatosis. Methods: A total of 205 donor candidates with significant hepatosteatosis were included in the study and divided into 4 groups according to the degrees of steatosis as measured by MDCT (mild, mid- to moderate, moderate to severe, and severe). In comparison, the aspartate aminotransferase–platelet ratio index (APRI), nonalcoholic fatty liver disease fibrosis score, BARD score, and FIB–4 scores were calculated. Results: The diagnostic performance of APRI in prediction of all degrees of hepatosteatosis on MDCT was significantly higher (P < .01). The BARD score showed the second best performance (P = .018), whereas FIB–4 and nonalcoholic fatty liver disease fibrosis score were not correlated with degree of liver steatosis on MDCT. Conclusion: Some noninvasive scoring methods including APRI and BARD score seem to be more beneficial for the detection of hepatic steatosis in donor candidates and may reduce the need for other invasive and expensive diagnostic techniques. © 2019 Elsevier Inc
Transsphenoidal surgery for pituitary adenomas in pediatric patients: a multicentric retrospective study
No full textIntroduction: Pediatric pituitary adenomas are rare lesions. Incidence is reported between 1 and 10% of all childhood brain tumors and between 3 and 6% of all surgically treated adenomas. Although pituitary adenomas present with symptoms of hormone hypersecretion or neurological disruptions secondary to mass effect, they are almost constantly benign. Characteristics of patients may vary in different studies according to age, gender, size of adenoma, hormonal activity, and recurrence rates. Methods: Data on consecutive pediatric patients who were operated for pituitary adenoma with endoscopic endonasal transsphenoidal surgery (EETS) and transsphenoidal microsurgery (TMS) in the Department of Neurosurgery, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey, in the Neurosurgical Unit of the San Matteo Hospital, Pavia, Italy, and in the Division of Neurological Surgery Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy, between July 1997 and May 2018, were analyzed. Twenty-seven patients (11 males and 16 females), who were 18 years old or younger at the time of surgery, were included in the study. Medical records, images, and operative notes of patients were retrospectively reviewed. Results: There were 16 females (59.3%) and 11 males (40.7%). Mean age was 15.3 ± 3.3 (4–18). Thirty-two surgical procedures were performed for 27 patients (6 children required second operation). Thirteen patients (48.14%) had Cushing’s disease (CD), 5 patients (18.5%) had growth hormone (GH)-secreting adenoma, 5 patients (18.5%) had prolactinoma, and 4 patients (14.8%) had non-functional adenoma. Twenty-two patients (81.4%) met remission criteria, and 5 patients (18.5%) did not meet remission criteria. Four patients met remission criteria after the second operation. Conclusion: Transsphenoidal approach affords effective release of mass effect and not only restoration but also perpetuation of normal endocrine functions in the majority of pediatric pituitary adenoma patients. Satisfactory results are reported with both EETS and TMS in the literature. Despite the technical difficulties in pediatric age, transsphenoidal resection of adenoma is still the mainstay treatment that provides cure in pediatric patients. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature
Kalp Cerrahisinde Postoperatif Perikardiyal Efüzyonun Önlenmesi İçin Posterior Perikardiyal Pencere Tekniği
No full textABSTRACT INTRODUCTION: The aim was to determine the effectiveness of the posterior pericardial window (PW) technique in preventing the development of pericardial effusion (PE) following coronary artery bypass grafting surgery (CABG). METHODS: Patients undergoing coronary surgery were randomly divided into a control or a PW group. We divided 220 patients randomly into 2 groups, the posterior pericardial window group (n=110) and the control group (n=110). Preoperative, intraoperative and postoperative clinical data were collected retrospectively, including incidence of pericardial tamponade, drainage volume, ventilation time and moderate to large pericardial effusion. Evaluations were completed preoperatively, before discharge, and on postoperative 7 and 30 days including electrocardiography, chest radiography, echocardiography. Postoperative causes of morbidity, the duration of intensive care unit and hospital stay were recorded. RESULTS: There was no significant difference in demographic data between two groups (P>.05). Echocardiography evaluations revealed no significant difference between groups preoperatively; however, before discharge the control group had a significantly higher number of patients with early and late cardiac tamponade compared with the PW group (P.05). Ekokardiyografi incelemeleri ameliyat öncesi gruplar arasında anlamlı bir farklılık yoktu; bununla birlikte, taburcu edilmeden önce, kontrol grubunda, perikardiyal pencere grubuna kıyasla, erken ve geç kardiyak tamponad anlamlı olarak yüksek bulundu (P <.05). Perikardiyal pencere grubunda postoperatif plevral efüzyon insidansı kontrol grubundan anlamlı olarak yüksek olarak tespit edildi. Yeni başlangıçlı atriyal fibrilasyon, kontrollerde perikardiyal pencere grubundan anlamlı olarak daha yaygındı (P <.05). TARTIŞMA ve SONUÇ: Posterior perikardiyal pencere tekniği, ciddi komplikasyonlar olmadan kolay uygulanabilir ve güvenli bir yöntemdir. Bu prosedür, geç kardiyak tamponadı ve CABG hastalarında ölümcül bir komplikasyon olabilen efüzyonla ilişkili atriyal fibrilasyonu azaltabilir
Factors Affecting Registration on Kidney Transplant Waiting List
No full textObjective: This study aimed to determine the rate of registration on a kidney transplant waiting list and to investigate related factors in our geographical region. Materials and Methods: We conducted this study with 355 prevalent adult patients undergoing hemodialysis in Turkey. We used a survey to inquire whether the patients have registered on a kidney transplant waiting list. Results: A total of 93 (26.2%) patients were registered on a kidney transplant waiting list. Patients registered on the waiting list were younger, had a higher education level, had been receiving hemodialysis for a longer time, and were mostly male. Patients with cardiovascular disease, diabetes mellitus, or chronic obstructive pulmonary were less likely to register. Patients with higher numbers of comorbid conditions registered less frequently. Independent variables were age, education, presence of cardiovascular disease, and the number of comorbid conditions. Of the registered patients, 40.9% did not visit the transplantation center for reevaluation in the previous year. When we asked non-registered patients the reason for not registering, the most common answers were they were old (52.7%) and that they were not eligible for transplantation (11.1%). Conclusion: Younger, well-educated patients with less comorbidity register more frequently. A substantial proportion of the patients do not go for reevaluation after registration
Treatment outcomes of prostate cancer patients with Gleason score 8-10 treated with definitive radiotherapy
No full textAksu, Melek Gamze/0000-0001-9146-2531; CETIN, ILKNUR ALSAN/0000-0003-4206-6393; Dincbas, Fazilet Oner/0000-0002-4764-9419WOS: 000511421900003PubMed: 31143994Purpose To validate the clinical outcomes and prognostic factors in prostate cancer (PCa) patients with Gleason score (GS) 8-10 disease treated with external beam radiotherapy (EBRT)+ androgen deprivation therapy (ADT) in the modern era. Methods Institutional databases of biopsy proven 641 patients with GS 8-10 PCa treated between 2000 and 2015 were collected from 11 institutions. in this multi-institutional Turkish Radiation Oncology Group study, a standard database sheet was sent to each institution for patient enrollment. the inclusion criteria were, T1-T3N0M0 disease according to AJCC (American Joint Committee on Cancer) 2010 Staging System, no prior diagnosis of malignancy, at least 70Gy total irradiation dose to prostate +/- seminal vesicles delivered with either three-dimensional conformal RT or intensity-modulated RT and patients receiving ADT. Results the median follow-up time was 5.9 years (range 0.4-18.2 years); 5-year overall survival (OS), biochemical relapse-free survival (BRFS) and distant metastases-free survival (DMFS) rates were 88%, 78%, and 79%, respectively. Higher RT doses (>= 78Gy) and longer ADT duration (>= 2 years) were significant predictors for improved DMFS, whereas advanced stage was a negative prognosticator for DMFS in patients with GS 9-10. Conclusions Our results validated the fact that oncologic outcomes after radical EBRT significantly differ in men with GS 8 versus those with GS 9-10 prostate cancer. We found that EBRT dose was important predictive factor regardless of ADT period. Patients receiving 'non-optimal treatment' (RT doses <78Gy and ADT period <2 years) had the worst treatment outcomes
Clinical Prognosis of Renal Retransplant Patients: A Single-Center Experience
No full text1st International Transplant Network Congress -- OCT 17-21, 2018 -- Antalya, TURKEYWOS: 000487349900032PubMed: 31474292Background. Retransplantation is a treatment option in patients with end-stage renal failure due to graft loss. Outcomes of these patients due to high immunologic risk remain unclear. the aim of this study was to evaluate outcomes of renal retransplantation patients retrospectively. Methods. Renal retransplant patients in our unit were evaluated retrospectively between 2010 and 2018. Patients' demographic characteristics, primary diseases, the causes of prior graft loss, immunologic status, desensitization protocols, the induction and maintenance treatments, the complications during the follow-up period, numbers of acute rejections, and the clinical prognosis were all detected from the patients' files. Results. We retrospectively evaluated 17 patients who underwent a second or third renal allograft. of these, 16 received a second and the remaining 1 patient received a third renal allograft. Immunologically, all of the 17 patients had negative flow cytometry crossmatch, 1 patient had a positive complement-dependent cytotoxicity crossmatch (Auto 12%), 16 patients had positive panel reactive antibody, the median HLA-mismatch was 3.5, and the score of donor-specific antibody relative intensity score (RIS) was 6.4 +/- 6.3. Ten pretransplant patients had desensitization treatment. While scores for HLA-MM and HLA-RIS in the patients who had a desensitization therapy were determined higher, no statistical difference was observed (respectively, P = .28 and.55). No acute rejection episode developed. BK virus DNA viremia was detected in 4 patients during the posttransplant 6th month. We observed no patient death or no graft loss during the follow-up period. Conclusion. Although the retransplant patients who had a graft loss previously have high immunologic risks, retransplantation is reliable in these patients, but they should be followed up carefully in terms of BKV nephropathy
Streptozotosin ile İndüklenmiş Diyabetik Sıçanlarda Edaravonun Retinopati Üzerine Olan Terapötik Etkileri
No full textPurpose: To investigate the possible vascular endothelial growth factor inhibition effects of edaravone and to compare bevacizumab on diabetic retinopathy in streptozotocin-induced diabetic rats. Materials and Methods: Thirty-six adult male Sprague Dawley rats were used in the study. Diabetes was induced with streptozotocin (60 mg/kg). After 4 weeks of treatment, the rats were euthanized and blood samples were collected for vascular endothelial growth factor assay. Additionally, enucleation was performed for vascular endothelial growth factor immunohistochemistry and outer nuclear layer measurements. Results: Treatments with both bevacizumab and edaravone signifi cantly decreased outer nuclear layer thickness and retinal vascular endothelial growth factor expression compared to serum physiologic groups. In addition, plasma vascular endothelial growth factor levels were signifi cantly reduced in both bevacizumab and edaravone treated groups compared to the serum physiologic group. Conclusions: Intraperitoneal and intravitreal bevacizumab and intraperitoneal ederavone could diminish the progression of diabetic retinopathy. These fi ndings suggest that edaravone may become one of the therapeutic candidates of diabetic retinopathy in the future.Amaç: Streptozotosin ile diabet oluşturulan sıçanlarda diyabetik retinopatide edaravonun olası vasküler endotelyal growth faktör inhibe edici etkisinin araştırılması ve bevacizumab ile karşılaştırılması. Materyal ve Metod: Bu çalışmada 36 adet Sprague Dawley erkek sıçan kullanılmıştır. Diyabet streptozotosin (60 mg/kg) ile oluşturuldu. Sıçanlara 6 gruba ayrılarak intravitreal veya intraperitoneal olarak edaravone, bevacizumab ve serum fi zyolojik uygulandı. Dört haftalık tedavinin ardından, sıçanlara ötenazi yapıldı ve vasküler endotelyal growth faktör değerlendirmesi için kan örnekleri alındı. Ek olarak, vasküler endotelyal growth faktörün immünhistokimyasal olarak değerlendirilmesi ve dış nükleer tabakanın değerlendirilmesi için enükleasyon yapıldı. Bulgular: Bevacizumab ve edaravone tedavileri ile dış nükleer tabaka kalınlığında ve vasküler endotelyal growth faktör immünhistokimayasal değerlendirmesinde serum fi zyolojik grubu ile karşılaştırıldığında belirgin azalma mevcuttu. Ayrıca, kan vasküler endotelyal growth faktör seviyelerinde bevacizumab ve edaravone ile tedavi edilen gruparda serum fi zyolojik ile tedavi edilen grup ile karşılaştırıldığında belirgin azalma vardı. Sonuç: İntravitreal ve intraperitoneal bevacizumab ile intraperitoneal edaravone diyabetik retinopatinin ilerlemesini yavaşlatabilirler. Bu bulgular edaravonun gelecekte diyabetik retinopati tedavisinde bir aday olabileceğini düşündürtmektedir
Robot-assisted Partial Nephrectomy with Segmental Renal Artery Clamping: A Single Center Experience
No full textWOS: 000497596300010PubMed: 30852838Purpose: the aim of our study is to evaluate the feasibility and effectiveness of robotic partial nephrectomy performed with segmental clamping of tumor-feeding arteries. Materials and Methods: Thirty-six patients with renal tumor who underwent robotic partial nephrectomy with segmental renal artery clamping were included in this study. Prospectively recorded patient demographics, mean operation time, estimated blood loss, warm ischemia time, length of hospital stay, pre- and postoperative renal functions and oncological outcomes were analyzed retrospectively. All complications were graded based on the modified Clavien-Dindo classification system. Surgical success was defined as no conversion from segmental artery clamping to the main renal artery clamping. Results: Mean tumor size was 40 mm and, R.E.N.A.L nephrometry score was 6.74. Mean operation time, estimated blood loss and warm ischemia time were 162 min, 236 ml, and 16 min, respectively. Five postoperative complications were observed. There were no significant differences in terms of renal functional outcomes before and after surgery (P =.18). of 36 patients, 34 were completed successfully; however, main renal artery clamping was required in two patients due to excessive bleeding from the tumor bed. the success rate of the segmental renal artery clamping technique was determined as % 94.4 (34/36) in our study. Conclusion: Segmental renal artery clamping may be considered as a reliable and effective surgical method for vascular control during robotic partial nephrectomy. For this technique, tumor characteristics and intrarenal vascular anatomy should be precisely evaluated by the preoperative contrast-enhanced computerized tomography with 3-D reconstruction
Recurrence of Hepatitis D Virus in Liver Transplant Recipients With Hepatitis B and D Virus-Related Chronic Liver Disease
No full text1st International Transplant Network Congress -- OCT 17-21, 2018 -- Antalya, TURKEYWOS: 000487349900073PubMed: 31405744Purpose. Data on recurrence of hepatitis D virus (HDV) and its long-term impact on liver transplant (LT) are limited. in this study, we investigated the incidence of hepatitis B virus (HBV) and the long-term effect of postoperative HDV recurrence HDV coinfection in our liver transplant patients. Patients and Methods. Between 2004 and 2018, all patients with LT because of HBV (n = 361; 37.3%) were reviewed, and those with HBV and HDV coinfection (n = 104; 30% of all HBV patients) were enrolled in our study. All patients received post-transplant combination therapy with nucleos(t)ide analogue and antihepatitis B immunoglobulins. Breakthrough infection was defined as reemergence of HBV DNA or hepatitis B surface antigen during postoperative treatment. in case of recurrence, another oral nucleos(t)ide analogue was added and antihepatitis B immunoglobulins were stopped. Results. During the study period, the frequency of HDV (+) was decreased (41% to 14%). Median follow-up time was 82 months (range, 1-274 months). Post LT survival and HBV recurrence were 97% (n = 15) and 13.4%, respectively. Only 15 patients (14%) developed breakthrough infection. There was no predictive factor for recurrent HDV infection, including demographics data and concomitant hepatocellular carcinoma (P = .73). Mortality was similar between patients with and without recurrence (2.2% vs 7.1%, P = .35) Conclusions. Patients who received transplants for hepatitis B and D virus cirrhosis had favorable prognosis and good long-term results despite recurrent infection. Close follow-up of patients and effective postoperative viral suppression with appropriate medications seems to be favorable for both prevention and management of recurrence and provides comparable outcome with patients without recurrence
Short Tandem Repeat-Polymerase Chain Reaction (STR-PCR) with Quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) Method Using for Chimerism Analysis
No full textSel, Figen Abatay/0000-0002-1155-1284;WOS: 000486387200015PubMed: 31532093Background: Recently molecular chimerism analysis after allogeneic hematopoietic stem cell transplantation (AHSCT) has become more important. the use of quantitative chimerism methods aims to assess the kinetics of engraftment to determine graft rejection and failure or relapse of the underlying disease after AHSCT. An accurate and sensitive determination of chimerism status is mandatory after AHSCT. This study aimed to compare two chimerism methods: Multiplex Short Tandem Repeat-Polymerase Chain Reaction (STR-PCR) and quantitative Real Time-PCR (qRT-PCR). Methods: Thirty-nine blood samples at +28 day were used to extract DNA. Most patients had been diagnosed with acute leukemia (74.3 %) and other hematological diseases. For Multiplex STR-PCR method, PCR products were separated on an ABI 3130 Genetic Analyzer (Applied Biosystem, USA) and for qRT-PCR, an ABI 7500 (Applied Biosystem, USA) Plate System Real Time Analyzer was used to determine the quantification of chimerism percentage. Results: of the 39 analyzed samples, 82% concordant chimerism results were detected for both STR-PCR and qRT-PCR methods. Ten mixed chimerisms (MC) were found by qRT-PCR whereas of only 3 MC cases were detected by STR-PCR in the discordant group of 7 by qRT-PCR, we observed Acute Graft versus Host Disease (aGVHD). Three MC cases that were detected by both STR- and qRT-PCR methods died because of relapse. Conclusions: the quantitative chimerism method along with multiplex STR-PCR method is important for early detection of MC. qRT-PCR methods can be valuable options in the prevention of graft failure and assisting with fast and early treatment strategies for patients undergoing AHSCT.Istanbul University Scientific Project Unit, Istanbul, Turkey [40818]We would like to thank the nursing staff, the resident physicians and fellows of bone marrow transplantation unit for patient care and the laboratory staff of the Medical Biology Laboratory for excellent assistance. This work was supported by Istanbul University Scientific Project Unit, Istanbul, Turkey under the code: 40818