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Water Vapor Thermal Therapy (RezumTM) for Benign Prostate Hyperplasia: Initial Experience from Turkiye
No full textObjective: Rezumn{''} system is a safe minimal invasive treatment modality for benign prostate hyperplasia (BPH) treatment. The aim of this study was to evaluate the short-term results of Rezumn{''} therapy in our center.Materials and Methods: We retrospectively collected the data of 28 patients with symptomatic BPH who underwent RezumTM therapy in our center. All patients' pre-operative and post-operativepost-void residual volume (PVR), Qmax, international prostate symptom score (IPSS), quality of life (QoL) score, serum total prostate-specific antigen levels were obtained. The number of injections administered during the procedure, operation time, catheter removal time, complications and mean duration of follow-up was recorded.Results: Our study group consisted of 28 patients with a mean age of 65.1 +/- 8.9 years, median prostate volume 64 {[}interquartile range (IQR) 44.8-89.5] mL. The median procedure time was 12 (IQR 11-13.8) minutes, the median catheter removal time was 6.5 (IQR 5-8.8) days for our study group. None of the patients had experienced Clavien-Dindo 3 complications. Pre-operative median Qmax and PVR were 8 (IQR 6-9) mL/s and 110 (IQR 80-187.5) cc and post-operative Qmax and PVR were 12.5 (11-14.8) mL/s and 40 (IQR 18.8-70) cc, respectively. We observed a significant increase in IPSS and QoL score at post-operative 3rd month after the Rezumn{''} therapy. Conclusion: Rezumn{''} procedure is an effective and safe treatment for symptomatic BPH in the short term. Rezumn{''} system provides a significant increase in Qmax and significant decrease in PVR and IPSS. QoL scores after the 3rd month of the procedure is significantly lower compared to the pre-operative status.Keywords: Benign prostate hyperplasia, Rezumn{''} (water vapor therapy), minimal invasive treatment4DEC228-234
COVID-19 in pediatric patients undergoing chronic dialysis and kidney transplantation
No full textThe study aims to present the incidence of COVID-19 in pediatric patients undergoing renal replacement therapy (RRT) and to compare the severity and outcomes of the disease between the dialysis and kidney transplant (KTx) groups. This multicenter observational study was conducted between 1 April and 31 December 2020 in Istanbul. Members of the Istanbul branch of the Turkish Pediatric Nephrology Association were asked to report all confirmed cases of COVID-19 who were on RRT, as well as the number of prevalent RRT patients under the age of 20. A total of 46 confirmed cases of COVID-19 were reported from 12 centers, of which 17 were dialysis patients, and 29 were KTx recipients. Thus, the incidence rate of COVID-19 was 9.3\% among dialysis patients and 9.2\% among KTx recipients over a 9-month period in Istanbul. Twelve KTx recipients and three dialysis patients were asymptomatic (p = 0.12). Most of the symptomatic patients in both the dialysis and KTx groups had a mild respiratory illness. Only two patients, one in each group, experienced a severe disease course, and only one hemodialysis patient had a critical illness that required mechanical ventilation. In the entire cohort, one hemodialysis patient with multiple comorbidities died. Conclusion: While most cases are asymptomatic or have a mild disease course, pediatric patients undergoing dialysis and a kidney transplant are at increased risk for COVID-19. What is Known: In adult population, both dialysis patients and kidney transplant recipients are at increased risk for severe illness of COVID-19 and have higher mortality rate. Children with kidney transplantation are not at increased risk for COVID-19 and most have mild disease course. Data on children on dialysis are scarce. What is New: Pediatric patients undergoing dialysis and kidney transplantation have an increased risk for COVID-19. Most patients undergoing renal replacement therapy either on dialysis or transplanted develop asymptomatic or mild COVID-19 disease with a favorable outcome.1JAN117-12318
Perioperative outcomes following robot-assisted partial nephrectomy for complex renal masses: A Vattikuti Collective Quality Initiative database study
No full textIntroduction: Outcomes of robot-assisted partial nephrectomy (RAPN) depend on tumor complexity, surgeon experience and patient profile among other variables. We aimed to study the perioperative outcomes of RAPN for patients with complex renal masses using the Vattikuti Collective Quality Initiative (VCQI) database that allowed evaluation of multinational data. Methods: From the VCQI, we extracted data for all the patients who underwent RAPN with preoperative aspects and dimensions used for an anatomical (PADUA) score of >= 10. Multivariate logistic regression was conducted to ascertain predictors of trifecta (absence of complications, negative surgical margins, and warm ischemia times {[}WIT] = 10 were included. The median operative time, WIT, and blood loss were 173 (range 45-546) min, 21 (range 0-55) min, and 150 (range 50-3500) ml, respectively. Intraoperative complications and blood transfusions were reported in 2.1\% and 6\%, respectively. In 8.8\% of the patients, postoperative complications were noted, and surgical margins were positive in 10.3\% of the patients. Trifecta could be achieved in 60.7\% of patients. Clinical tumor size, duration of surgery, WIT, and complication rates were significantly higher in the group with a high (12 or 13) PADUA score while the trifecta was significantly lower in this group (48.4\%). On multivariate analysis, surgical approach (retroperitoneal vs. transperitoneal) and high PADUA score (12/13) were identified as predictors of the trifecta outcomes. Conclusion: RAPN may be a reasonable surgical option for patients with complex renal masses with acceptable perioperative outcomes.4OCT-DEC288-2953
Cluster Analysis Revealed Two Hidden Phenotypes of Cluster Headache
No full textObjectiveTo investigate the possible subgroups of patients with Cluster Headache (CH) by using K-means cluster analysis. MethodsA total of 209 individuals (mean (SD) age: 39.8 (11.3) years), diagnosed with CH by headache experts, participated in this cross-sectional multi-center study. All patients completed a semi-structured survey either face to face, preferably, or through phone interviews with a physician. The survey was composed of questions that addressed sociodemographic characteristics as well as detailed clinical features and treatment experiences. ResultsCluster analysis revealed two subgroups. Cluster one patients (n = 81) had younger age at diagnosis (31.04 (9.68) vs. 35.05 (11.02) yearsp = 0.009), a higher number of autonomic symptoms (3.28 (1.16) vs. 1.99(0.95)p < 0.001), and showed a better response to triptans (50.00\% vs. 28.00p < 0.001) during attacks, compared with the cluster two subgroup (n = 122). Cluster two patients had higher rates of current smoking (76.0 vs. 33.0\%p=0.002), higher rates of smoking at diagnosis (78.0 vs. 32.0\%p=0.006), higher rates of parental smoking/tobacco exposure during childhood (72.0 vs. 33.0\%p = 0.010), longer duration of attacks with (44.21 (34.44) min. vs. 34.51 (24.97) minp=0.005) and without (97.50 (63.58) min. vs. (83.95 (49.07) minp = 0.035) treatment and higher rates of emergency department visits in the last year (81.0 vs. 26.0\%p< 0.001). ConclusionsCluster one and cluster two patients had different phenotypic features, possibly indicating different underlying genetic mechanisms. The cluster 1 phenotype may suggest a genetic or biology-based etiology, whereas the cluster two phenotype may be related to epigenetic mechanisms. Toxic exposure to cigarettes, either personally or secondarily, seems to be an important factor in the cluster two subgroup, inducing drug resistance and longer attacks. We need more studies to elaborate the causal relationship and the missing links of neurobiological pathways of cigarette smoking regarding the identified distinct phenotypic classes of patients with CH.MAY 201
Chemoradiation and consolidation chemotherapy for rectal cancer provides a high rate of organ preservation with a very good long-term oncological outcome: a single-center cohort series
No full textAim To report long-term oncological outcomes and organ preservation rate with a chemoradiotherapy-consolidation chemotherapy (CRT-CNCT) treatment for locally advanced rectal cancer (LARC). Method Retrospective analysis of prospectively maintained database was performed. Oncological outcomes of mid-low LARC patients (n=60) were analyzed after a follow-up of 63 (50-83) months. Patients with clinical complete response (cCR) were treated with the watch-and-wait (WW) protocol. Patients who could not achieve cCR were treated with total mesorectal excision (TME) or local excision (LE). Results Thirty-nine (65\%) patients who achieved cCR were treated with the WW protocol. TME was performed in 15 (25\%) patients and LE was performed in 6 (10\%) patients. During the follow-up period, 10 (25.6\%) patients in the WW group had regrowth (RG) and 3 (7.7\%) had distant metastasis (DM). Five-year overall survival (OS) and disease-free survival (DFS) were 90.1\% and 71.6\%, respectively, in the WW group. Five-year OS and DFS were 94.9\% (95\% CI: 88-100\%) and 80\% (95\% CI: 55.2-100\%), respectively, in the RG group. For all patients (n=60), 5-year TME-free DFS was 57.3\% (95\% CI: 44.3-70.2\%) and organ preservation-adapted DFS was 77.5\% (95\% CI: 66.4-88.4\%). For the WW group (n=39), 5-year TME-free DFS was 77.5\% (95\% CI: 63.2-91.8\%) and organ preservation-adapted DFS was 85.0\% (95\% CI: 72.3-97.8\%). Conclusion CRT-CNCT provides cCR as high as 2/3 of LARC patients. Regrowths, developed during follow-up, can be successfully salvaged without causing oncological disadvantage if strict surveillance is performed.1NOV 102
Breast Surgery can be Performed Safely During the COVID-19 Pandemic: A Retrospective Single-Center Analysis
No full textIntroduction: The Coronavirus disease-2019 (COVID-19) outbreak has affected the diagnosis and treatment of various diseases including breast cancer. This study aimed to investigate whether breast surgery can be performed safely during the COVID-19 pandemic. Methods: Patients who underwent surgery for breast cancer or suspicious breast lesions in the pre-pandemic, first wave, and second wave periods of the pandemic were evaluated retrospectively. Results: Data of 220 patients who underwent breast surgery were analyzed. No significant difference was found between the pre-pandemic, first wave, and second wave periods of the COVID-19 pandemic in terms of patient characteristics, complications, types of complication, Clavien-Dindo classification of complications, and complications requiring intervention. No COVID-19 related complication was also observed. Conclusion: Breast surgery can be performed safely in the COVID-19 pandemic. For safe surgery, appropriate precautionary measures against COVID-19 and COVID-19 screening should be initiated. COVID-19-free surgical pathway is also important for safe surgery. With the continuation of surgeries, fear of upstaging, subsequent requirement of more aggressive treatment for tumors, and post-pandemic overload can be prevented.1FEB45-502
Drain use in pancreatic surgery: Results from an international survey among experts in the field
No full textBackground: Drain use in pancreatic surgery remains controversial. This survey sought to evaluate habits, experiences, and opinions of experts in the field on the use of drains to provide interesting insights for pancreatic surgeons worldwide. Methods: An online survey designed via Google Forms was sent in December 2020 to experienced surgeons of the International Study Group for Pancreatic Surgery. Results: Forty-two surgeons (42/63, 67\%) completed the survey. During their career, 74\% (31/42) performed personally >500 pancreatic resectionsof these, 9 (21\%) >1,500. Sixty-nine percent of the respondents (29/42) declared to always use drains during pancreatic resections and 17\% (7/42) in >50\% of the operations. For these participants, the use of drains does not increase but reduces the risk of pancreatic fistula and other complications, and more importantly, helps to detect them earlier and manage them better. By contrast, 2 surgeons (5\%) declared to never apply drains, whereas other 4 (10\%) use drains only in selective cases, deeming that drains increase the risk of infection and other complications. When applied, drains are managed very heterogeneously as for the type of drains, enzyme testing, and removal schedules. Four participants declared to practice continuous irrigation. Twenty-two surgeons (55\%) remove drains routinely within the third postoperative day, other 11 (27.5\%) only in selected cases, whereas 7 (17.5\%) normally keep drains longer. Conclusion: Despite plenty of publications on this topic, drain management in pancreatic surgery remains very heterogeneous. Safety and the surgeon's personal experience seem to play a determining role. (c) 2021 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).1JUL265-27217
Physiotherapy Program Applied After Liver Transplantation: Its Effect on Physical Fitness and Mobility
No full textObjective: To investigate the effects of therapeutic exercises added to the comprehensive chest physiotherapy program after liver transplantation on physical fitness, movement level and kinesophobia. Methods: Forty individuals with liver transplantation were included in the study. Individuals were divided into two groups by using simple randomization method. The first group was included in the comprehensive chest physiotherapy program. In addition to the comprehensive chest physiotherapy, combined therapeutic exercises with respiration were added to the program of the second group. The patients were included in the treatment program for 4 weeks, 1 session a day, and 5 days a week. Physical and demographic characteristics of the individuals were recorded. ``Senior Fitness Test{''}, ``Patient Mobility Scale and Observer Mobility Scale{''}, ``Tampa Kinesophobia scale{''} were used to evaluate physical fitness, movement level and kinesophobia, respectively. Results: Physical and demographic characteristics of the individuals were recorded. ``Senior Fitness Test{''}, ``Patient Mobility Scale and Observer Mobility Scale{''}, ``Tampa Kinesophobia scale{''} were used to evaluate physical fitness, movement level and kinesophobia, respectively. According to the results of ``Senior Fitness Test{''} aerobic endurance, lower extremity muscle endurance, dynamic The improvement in balance and agility parameters was significantly higher in group 2 (p0.05). Conclusion: The therapeutic exercise program added to breathing exercises after liver transplantation increased physical fitness, and also had positive effects on movement level and kinesophobia.3JUN346-3521
Kronik kolite bağlı inflamasyon ve enterik sinir sistemi dejenerasyonu üzerine Akkermansia Muciniphila'nın iyileştirici etkisi
No full textDetection of H. pylori in Pediatric Patients’ Stool Sample by Multiplex Urease PCR
No full textABSTRACT
Background and objectives: This study aims to detect the H. pylori infection in pediatric patients’ stool samples by using
a multiplex urease PCR assay.
Materials and Methods: A retrospective analysis was performed and the H. pylori multiplex urease PCR test from a stool
sample of 55 pediatric patients was evaluated from August 2017 to November 2018 compared with the H. pylori antigen
test and histopathology.
Results: Thirty-six patients (65%) were detected H. pylori-positive including nineteen boys (50%) and nineteen girls
(50 %) by H. pylori multiplex urease PCR test. Fifteen (54 %) of the positive patients were in the 0-6 age range, eighteen
(95%) in the 7-12 age range, and three (38%) in the 13-18 age range. Comparison results with the histopathology and
H. pylori antigen test were showed that the positive predictive value of the multiplex urease PCR test for the stool sample
was 72.22%. The test could detect a negative sample of 100 %.
Conclusions: Due to the results of this study it was showed that the prevalence of H. pylori infection is still high for
pediatric patients. The multiplex urease PCR test for stool samples could be used in the clinic detection of H. pylori as a
non-invasive method and easy to applicable method, but it needs to be evaluated for high specificity and sensitivity to
detect accurate results