Browsing by Author "Karaduman, Didem"

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    Akut koroner sendromda akut böbrek hasarı oluşumunda yol açan risk faktörleri
    (Başkent Üniversitesi Tıp Fakültesi, 2016) Karaduman, Didem; Micozkadıoğlu, Hasan
    Akut koroner sendrom (AKS) hastalarında akut böbrek hasarına (ABH) yol açan risk faktörleri ve ABH gelişim mekanizmaları hala araştırılmaktadır. Hastalar tetkik ve tedavi amacıyla yapılan işlemlerde kontrast maddeye maruz kalmaktadır. Literatürde kontrast öncesi ABH ve total ABH gelişimini ayrı ayrı kıyaslayan çalışmaya rastlanmamıştır. Biz çalışmamızda total ABH gelişimi ve kontrast öncesi ABH gelişimini belirleyen risk faktörleri ve bunların mortalite ile hastane yatış süresi üzerine sonuçlarını ortaya koymayı amaçladık. Akut koroner sendrom tanısıyla koroner yoğun bakıma yatan, ortalama yaşları 63.3 olan (94 Kadın, 227 Erkek) 321 hasta retrospektif olarak çalışmaya dahil edilmiştir. Kardiyojenik şok gelişimi ve hastanede furosemid kullanımı AKS'lilerde kontrast öncesi ABH gelişiminde anlamlı olan risk faktörleri olmuştur. Kardiyojenik şok saptanan hastalarda kontrast öncesi ABH gelişme riski 5.6 kat artmıştır (OR=5.691, %95 GA=1.119-28.945, p=0.036), Hastanede furosemid kullanılanlarda kontrast öncesi ABH gelişme riski 4.3 kat artmıştır (OR=4.395, %95 GA=1.855-10.412 p<0.001). Total ABH gelişiminde en anlamlı risk faktörleri kardiyojenik şok gelişimi, hastanede furosemid kullanımı, yaş artışı ve LDL yüksekliği olmuştur. Kardiyojenik şok olan hastalarda ABH gelişme riski 11.3 kat artmaktadır (OR=11.382, %95 GA=1.940-66.781, p=0.007). Hastanede furosemid kullanılanlarda ABH gelişme riski 5.4 kat fazladır (OR=5.439, %95 GA=2.219-13.337, p<0.001). Yaşın her bir birim artışı ABH gelişme riskini %4.4 arttırmaktadır (OR=1.044, %95 GA=1.003-1.087, p=0.036). Her 1 mg/dL serum LDL seviyesiartışı ABH gelişme riskini %1,4 arttırmaktadır(OR=1.044, %95 GA=1.003-1.087, p=0.036). Çalışmamızda hastanede yatış süresi, hem kontrast öncesi ABH olanlarda hem de total ABH olan hastalarda olmayanlara göre anlamlı olarak daha uzun bulunmuştur (p=0.001). Hastanede mortalite oranı incelendiğinde hem kontrast öncesi ABH olan hem de total ABH olan hastalarda anlamlı olarak daha yüksek bulunmuştur (p<0.001). Akut böbrek hasarı AKS hastalarında sık karşılaşılan ve önemli sonuçları olan bir komplikasyondur. Bu komplikasyonun gelişiminde kontrast maddelerin etkisi dışlandığında kardiyojenik şok gelişimi ve hastanede furosemid kullanımı en önemli risk faktörleri olarak saptanmıştır The risk factors and the development mechanisms of acute kidney injury (AKI) are still under investigation in acute coronary syndrome (ACS) patients. Nearly all patients with acute coronary syndrome (ACS) were exposed to the contrast medium for the diagnosis or the treatment of ACS. No study is found comparing AKI risk factors before the administration of contrast medium and the total AKI risk factors including the contrast medium effect. In our study we aimed to determine the risk factors and outcomes (the hospital mortality and the length of hospital stay) of total AKI and pre-contrast AKI seperately. Totally 321 patients, who admitted to the hospital with acute coronary syndrome with a mean age of 63.3 years (94 female, 227 male) were retrieved in the study. The most important risk factors of pre-contrast AKI were cardiogenic shock and administration of furosemid at the hospital. The patients with cardiogenic shock had a 5.6-fold increased risk of pre-contrast AKI (OR=5.691, %95 CI=1.119-28.945, p=0.036). Administration of furosemid at the hospital increased the risk of pre-contrast AKIas 4.3-fold (OR=4.395, %95 CI=1.855-10.412 p<0.001). The most important risk factors of total AKI were cardiogenic shock, administration furosemid at the hospital, increasing age (OR=1.044, %95 CI=1.003-1.087, p=0.036) and high serum LDL levels (OR=1.014, %95 CI=1.005-1.024, p<0.001). The patients with cardiogenic shock had an 11.3-fold increased risk of total AKI (OR=11.382, %95 CI=1.940-66.781, p=0.007). Furosemid administration at the hospital increased the risk of total AKIas 5.4-fold (OR=5.439, %95 CI=2.219-13.337, p<0.001). Each unit increase in age increased the risk of total AKI as 4.4% (OR=1.044, %95 CI=1.003-1.087, p=0.036). Each 1 mg / dL increase in serum LDL level increased the risk of total AKI as 1.4% (OR=1.014, %95 CI=1.005-1.024, p<0.001). In this study the length of the hospital stay was found significantly longer both in pre-contrast AKI and total AKI than non-AKI patients (both p=0.001). In this study the incidence of the hospital mortality was found significantly higher both in pre-contrast AKI and total AKI than non-AKI patients (both p<0.001). AKI is a common and an important complication of ACS. After exclusion of exposure to contrast medium the most important risk factors for AKI were cardiogenic shock and the administraton of furosemid at the hospital.
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    Treatment outcomes of early stage endometrial cancer patients: single center experience
    (2019) Sedef, Ali Murat; Karaduman, Didem; Besen, Ali Ayberk; Mertsoylu, Huseyin; Kose, Fatih
    Purpose: The aim of this study was to evaluate clinicopathological characteristics and treatment outcomes of early stages endometrial cancer patients in our center. Materials and Methods: This study was a hospital-based retrospective observational case-series study. 116 patients were included in the study from Baskent University Department of Medical Oncology and Gynecological Oncology between the years of 2009-2015. De-novo metastatic patients were not included in the study. Results: The median age of the patients was 58 (range 27-81) years. All of patients had European Cooperative Oncology Group (ECOG) performance score 0 (n:116). Endometrioid histology was the most common histopathological subtype (n:103, 88%). All of the patients were in local and local advanced stage. The significant percentage of patients had grade 2 tumor (n:55, 47.4%). Myometrial invasion was less than 50% in 78 patients (67.2 %). The median follow-up time was 61 months and 8 (6.9%) patients died. All patients underwent standard surgical staging with standard lymphadenectomy. Overall survival (OS) was not reached. There were 14 patients (12.1 %) and 34 patients (29.3 %) treated with adjuvant chemotherapy and radiotherapy, respectively. Conclusion: Though endometrial cancer is the most common gynecological tumors in women, cure rate is very high. Relapse rate was 6 % (7 patients) and most of the relapse were local, 71.4% (5 patients)