Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Pulmonary Embolism in a Liver Donor: A Case Report and Review of the Literature(2023) Esendagli, Dorina; Akcay, Sule; Yildirim, Sedat; Haberal, Mehmet; 0000-0002-6619-2952; 37503803; ABF-9398-2020Liver transplant is an important treatment option for end-stage liver disease, and living related donation is an option to shorten or eliminate the waiting period for the patients, especially when shortage of organs is of concern. It is crucial to provide optimal safety for the donors and to thoroughly examine them preoperatively in order to decrease perioperative and postoperative complications. Here, we report the case of a living donor who had undergone a left liver lobectomy and on postoperative day 2 presented with a radiologically severe pulmonary embolism, despite the absence of any risk factor for venous thromboembolism or pulmonary embolism. The patient was treated with tissue plasminogen activator and heparin infusions and was discharged 1 week later.Item Early Pulmonary Complications of Liver Transplant(2014) Dogrul, Mustafa Ilgaz; Akcay, Sule; Bozbas, Serife Savas; Dedekarginoglu, Balam Er; Eyuboglu, Fusun Oner; Moray, Gokhan; Haberal, Mehmet; https://orcid.org/0000-0002-7230-202X; https://orcid.org/0000-0002-5525-8207; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-3462-7632; 24635815; AAI-8064-2021; AAR-4338-2020; AAE-1041-2021; AAJ-8097-2021Objectives: Pulmonary complications are a leading problem after a liver transplant. This study sought to predict postoperative early complications by a chest radiograph performed after a transplant among adult orthotopic liver transplant recipients. Materials and Methods: One hundred thirty-five patients (43 women, 92 men; mean age, 40 y; range, 16-66 y) were included and their medical data reviewed retrospectively. A postoperative chest radiograph of each patient was evaluated to check for pulmonary complications. Results: Smoking history was noted in 61 patients (45.2%). Postoperative first chest radiograph evaluation showed normal findings in 56 patients (41.5%). Right pleural effusion was found in 25 patients (18.5%), and atelectasis was found in 25 (18.5%). Bilateral pleural effusion was the second most-frequent finding on postoperative radiograph (14.8%). Effusion accompanied by atelectasis was found in 3 patients (2.2%). Other postoperative chest radiograph findings were consolidation (n=2, 1.5%), left pleural effusion (n=2, 1.5%), and bronchiectasis (n=2, 1.5%). Conclusions: We investigated the reflection of the first chest radiograph after liver transplant on postoperative early complications. Postoperative first chest radiograph can be an inexpensive and accessible diagnostic tool for predicting postoperative problems.Item Can the Use of Smokeless Tobacco Products Be Accepted as a Harm Reduction Method in Tobacco Addiction?(2014) Oztuna, Funda; Aytemur, Zeynep Ayfer; Elbek, Osman; Kilinc, Oguz; Kucuk, Cagla Uyanusta; Akcay, Sule; Dagli, Elif; https://orcid.org/0000-0002-8360-6459; AAB-5175-2021The goal of smoking cessation treatment is to keep the patient completely away from tobacco and tobacco products. The aim of harm reduction strategies in tobacco control is to reduce the risks associated with tobacco use. In order to turn it into an opportunity, tobacco companies have developed smokeless tobacco products. Some epidemiological studies have reported that smokeless tobacco products are safer than tobacco smoke. However, this method is not completely harmless. In this review, we will discuss all aspects of tobacco harm reduction methods.Item Post-COVID Syndrome: Pulmonary Complications(2021) Esendagli, Dorina; Yilmaz, Aydin; Akcay, Sule; Ozlu, Tevfik; https://orcid.org/0000-0002-6619-2952; 34284532; ABF-9398-2020Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected millions of people worlwide and caused a pandemic that is still ongoing. The virus can cause a disease named as COVID-19, which is composed of multi systemic manifestations with a pulmonary system predominance. As the time passes, we are dealing more and more with a wide variety of effects and complications of the disease in survivors as far as with concerns about the clinical outcome and the timeline of symptoms in different patients. Since the lungs are the most involved organs and the post-COVID prolonged and persistent effects are mainly related to the pulmonary system, it is crucial to define and predict the outcome and to determine the individuals that can progress to fibrosis and loss of function of lungs. This review summarizes the current literature regarding the pulmonary complications in post-COVID syndrome and the management of these conditions.Item Effect of Smoking on Peripheral Blood Lymphocyte Subsets of Patients With Chronic Renal Failure(2016) Birben, Ozlem Duvenci; Akcay, Sule; Sezer, Siren; Sirvan, Sale; Haberal, Mehmet; 0000-0002-8360-6459; 0000-0002-3462-7632; 27805522; AAB-5175-2021; AAJ-8097-2021Objectives: Smoking is known to suppress the immune system. It is also known that chronic renal failure affects the immune system. However, the number of studies investigating the effects of chronic renal failure and smoking together is limited. In our study, we examined whether smoking affects the diminished response of the immune system in patients with chronic renal failure. Materials and Methods: We compared peripheral blood lymphocyte subsets in smoking and nonsmoking patients with chronic renal failure. We also used the Fagerstrom Test for Nicotine Dependence to evaluate its correlation with the lymphocyte subset count in patients who are current smokers. Results: Our study included 126 patients with chronic renal failure. According to their smoking habits, patients were divided into 2 groups: smokers and nonsmokers. The average age of patients who were smokers was 53.2 +/- 1.5 years, with average age of nonsmokers being 59.2 +/- 2.2 years. The average duration of smoking in smokers was 30.7 +/- 2.7 pack-years. We found that the percentage of cluster of differentiation 16-56 cells (natural killer cells) and lymphocyte percentage were significantly lower among smokers in our study (P < .05). We compared the lymphocyte subset panel to pack-years and found that the rate of cluster of differentiation 16-56 cells decreased as smoking duration increased. Conclusions: Our study revealed that smoking suppresses the immune system, as measured by lymphocyte subsets, in patients with chronic renal failure, similar to that shown in healthy smokers. According to our findings, patients with chronic renal failure, where infection is the primary reason for mortality and morbidity, must be questioned for smoking and referred to smoking cessation clinics. Because of its immunosuppressive effects, smoking behaviors must be solved preoperatively in transplant candidates.Item Role of Procalcitonin in Differential Diagnosis of Pneumonia and Pulmonary Congestion Associated With End-Stage Renal Failure(2016) Akcay, Sule; Dogrul, Ilgaz; Sezer, Siren; Haberal, Mehmet; 0000-0002-8360-6459; 0000-0002-3462-7632; 27805517; AAB-5175-2021; AAJ-8097-2021Objectives: We aimed to determine the role of procalcitonin in distinguishing between infectious and noninfectious causes, specifically the cause of the infiltrative appearances detected on lung radiographs of patients with end-stage renal failure receiving hemodialysis. Materials and Methods: Sixty-six patients between 19 and 87 years of age were enrolled. Patients were divided into 3 groups, with each group consisting of 22 patients: group 1 comprised pneumonia patients without end-stage renal failure, group 2 comprised pulmonary congestion patients with end-stage renal failure, and group 3 were healthy participants. All demographic and clinical characteristics of patients and healthy participants were noted, anteroposterior lung radiographs were taken, and blood samples were obtained for complete blood count, C-reactive protein, and procalcitonin measurements. Patients in group 2 received control posteroanterior lung radiography. Results: Group 1 demonstrated a significantly lower mean procalcitonin value than group 2 (P =.001) but significantly higher mean C-reactive protein and leukocyte levels (P <.05). In terms of mean C-reactive protein and leukocyte levels, there was no difference between groups 2 and 3 (P >.05). The classification performed by recognizing 0.5 ng/mL as the cutoff point for procalcitonin resulted in no significant differences between groups 1 and 2 (P =.103). However, a significant difference (P =.014) was found between these groups when basing the classification as 1.5 ng/mL cutoff point in group 2 and 0.5 ng/mL cutoff point in group 1. Procalcitonin level was below 1.5 ng/mL in all group 2 patients. Conclusions: Our findings support that procalcitonin has no superiority over C-reactive protein in diagnosis of community-acquired pneumonia. Moreover, at procalcitonin values below 1.5 ng/mL in patients with end-stage renal failure who have pulmonary congestion but without clinical signs of infection, infiltrative appearances on lung images may be attributed to hypervolemia, which would in turn prevent unnecessary antibiotic therapies. We believe that measurement of C-reactive protein is still preferable to procalcitonin in revealing the inflammatory response due to its cost-effectiveness and ease in performance and the high diagnostic performance in transplant candidates.Item Relation Between Pulmonary Hypertension and Health-Related Quality of Life in Patients Undergoing Hemodialysis(2016) Kivanc, Tulay; Kal, Oznur; Ciftci, Ozgur; Akcay, Sule; 0000-0002-7751-4961; 0000-0002-8360-6459; 27805514; AAJ-7586-2021; AAB-5175-2021Objectives: Pulmonary hypertension has been reported to occur in a considerable proportion of patients with end-stage renal disease. End-stage renal disease affects the health-related quality of life of patients. There is a lack of specific information on the relation between pulmonary hypertension and health-related quality of life in patients with end-stage renal disease in the literature. We aimed to evaluate this relation in patients undergoing hemodialysis. Materials and Methods: This prospective case-control study included 68 patients treated with hemodialysis and 30 healthy participants as controls. Group 1 comprised hemodialysis patients with pulmonary hypertension, group 2 comprised patients without pulmonary hypertension, and group 3 were healthy subjects. Each patient's health-related quality of life was measured with the Medical Outcomes Study 36-Item Short Form health survey. Doppler echocardiography was performed to determine pulmonary artery pressure in all patients. The groups were compared with respect to health-related quality of life. Results: Pulmonary hypertension was found in 47.1% of patients (mean systolic pulmonary artery pressure of 48.9 +/- 11.8 mmHg). Significant differences were observed among the 3 groups regarding the physical function, physical role, bodily pain, general health, vitality, social function, emotional role, mental health, and physical component summary (P =.001). There was no significant correlation between pulmonary artery pressure and health survey scores. Conclusions: Hemodialysis patients had significantly lower quality of life scores than healthy subjects. There were no significant differences in terms of health survey domains between the hemodialysis patients with and without pulmonary hypertension. This may be due to the severe adverse effects of end-stage renal disease on health-related quality of life. We conclude that, because end-stage renal disease has so many adverse effects on health-related quality of life, the additional effects of pulmonary hypertension on health-related quality of life could not be revealed.Item Radiologically Occult Invasive Pulmonary Aspergillosis in a Patient With Liver Transplant(2018) Esendagli, Dorina; Serifoglu, Irem; Bozbas, Serife Savas; Tepeoglu, Merih; Akcay, Sule; Haberal, Mehmet; 0000-0002-6619-2952; 0000-0002-7230-202X; 0000-0002-9894-8005; 0000-0002-8360-6459; 0000-0002-3462-7632; 29528022; ABF-9398-2020; AAS-6628-2021; AAI-8064-2021; AAK-5222-2021; AAB-5175-2021; AAJ-8097-2021Invasive pulmonary aspergillosis is an infection seen in patients receiving intensive immunosuppressive regimens, such as transplant recipients. Some risk factors that increase the incidence of infection have been determined, and patients defined as having high risk are recommended to take antifungal prophylaxis and be monitored closely. Here, we present a liver transplant patient with mild respiratory symptoms and a normal chest radiography on day 26 posttransplant. However, he had acute renal failure and underwent hemodialysis, which are both defined to increase significantly the risk of aspergillosis. Although the radiographic scan was initially normal, thorax tomography and later bronchoscopy showed findings compatible with pulmonary aspergillosis, and the patient was started on antifungal treatment. The nonspecific mild symptoms and an initial normal radiology can make diagnosis of invasive fungal infections difficult; thus caution and close follow-up of high-risk patients should be performed.Item Clinical Characteristics of Acinetobacter baumannii Infection in Solid-Organ Transplant Recipients(2018) Serifoglu, Irem; Dedekarginoglu, Balam Er; Bozbas, Serife Savas; Akcay, Sule; Haberal, Mehmet; 0000-0002-7230-202X; 0000-0002-8360-6459; 0000-0002-7230-202X; 0000-0002-3462-7632; 29528021; AAS-6628-2021; AAI-8064-2021; AAB-5175-2021; AAJ-8097-2021Objectives: Acinetobacter baumannii, depending on the immune status of the host, may result in one of the most serious hospital infections. Infections involving A. baumannii infection have been recently rising. However, little is known about the clinical features of A. baumannii infection in solid-organ transplant recipients. We aimed to share our clinical experiences with A. baumannii infection in our transplant recipients. Materials and Methods: Between 2011 and 2017, 41 solid-organ transplant patients developed A. baumannii infection at Baskent University Hospital. Medical records were reviewed, and patient demographics, microbiology results, and overall outcome data were noted. Results: Of 41 solid-organ transplant patients with A. baumannii infection, 29 were male and 12 were female patients with mean age of 47.15 +/- 13.24 years. Our infection rate with A. baumannii infection was 6.1%. The most common sites of infection were deep tracheal aspirate (48.8%)and bloodstream (36.6%). Onset of infection 1 year post-transplant was identified in 58.5% of recipients. Risk factors included presence of invasive procedures (56.1%) and administration of high-dose corticosteroids for rejection 1 year before infection (68.3%). Thirty-day mortality rate was 41.5% (17/41 patients)and was not associated with the infection site, microbiological cure, clinical cure, and drug resistance in our study group. Conclusions: Acinetobacter baumannii is an important cause of hospital-acquired infection and mortality worldwide. A major problem with A. baumannii infection is delayed initiation of appropriate antibiotic treatment and the rising numbers of extensively drugresistant organisms. Predicting the potential risk factors, especially in the already at-risk solid-organ transplant population, has an important role in patient outcomes.Item Liver Transplant and Reexpansion Pulmonary Edema: A Case Report(2018) Kara, Sibel; Sen, Nazan; Akcay, Sule; Moray, Gokhan; Kus, Murat; Haberal, Mehmet; 0000-0002-4171-7484; 0000-0002-8360-6459; 0000-0003-2498-7287; 0000-0001-6529-7579; 0000-0002-3462-7632; 29528016; AAI-8069-2021; AAI-8947-2021; AAB-5175-2021; AAE-1041-2021; AAJ-7870-2021; AAJ-8097-2021Hydrothorax occurs frequently in patients with end-stage liver disease and usually requires drainage of pulmonary effusion during the hepatectomy phase of liver transplant. Reexpansion pulmonary edema is a rare but potentially fatal complication seen after rapid reexpansion of the collapsed lung following thoracentesis of pleural fluid or tube drainage of pneumothorax. This condition, which manifests with various degrees of clinical severity, is rarely reported following liver transplantation. Herein, we present a 62-year-old male patient who developed reexpansion pulmonary edema after drainage of massive pleural effusion, which caused a total collapse in the right hemithorax during liver transplant. Six hours after pleural fluid drainage, the patient developed a nonproductive cough, mild tachypnea, shortness of breath, and low oxygen saturation (88%). His chest radiograph showed diffuse heterogeneous opacities in the right hemithorax. Computed tomography of the thorax revealed consolidations containing air bronchograms and ground glass opacities in the parenchyma of the right lung; these findings did not extend to the periphery and were observed less frequently in the inferoposterior left lung. These symptoms and radiologic findings were diagnosed as reexpansion pulmonary edema. Complete clinical and radiologic improvements were achieved within 72 hours of mechanical ventilatory support.
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