Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Use of Biological Prosthesis in a Patient With Kidney and Pancreas Transplant and a Giant Incisional Hernia: Case Report(2015) Ozcelik, Umit; Cevik, Halime; Bircan, Huseyin Yuce; Demirag, Alp; 0000-0003-1073-2494; 0000-0001-7276-3240; 25894161; AAG-8651-2021; R-6394-2019; JWP-7324-2024Objectives: The use of synthetic mesh in transplant patients is controversial. Recent studies have shown that biological prostheses have a greater ability to integrate into tissues, resist bacterial colonization, and reduce cytotoxic or allergic reactions, and provide similar functional results, compared with synthetic prostheses. Biological prostheses do not require any reduction or discontinuation of immunosuppressive therapy. We present the case of a kidney and pancreas transplant recipient who had a giant incisional hernia that was treated successfully with a biological prosthesis. Case Report: A 40-year-old male kidney and pancreas transplant recipient was admitted to our hospital with a giant incisional hernia, 2 years after transplant. The defect on the abdominal wall was 40 x 30 cm. We used 2 biological prostheses (40 x 20 cm and 30 x 20 cm) to close the abdominal wall. The patient was discharged on postoperative day 5 without complications. An abdominal magnetic resonance imaging scan showed complete integrity of the biological prostheses at 1 year after surgery. Conclusions: Transplant recipients have higher risks with use of synthetic prostheses because of being immunosuppressed, compared with other patients. Recent studies show that biological prostheses provided similar functional results without complications compared with synthetic prostheses. These prostheses are versatile and do not require any changes in immunosuppressive therapy. Therefore, they seem to be a better option than synthetic prostheses. In our opinion, biological prostheses are more safe, effective, and reliable than synthetic prostheses, especially for large incisional hernias in transplant recipients. We believe that further larger studies can support our opinion.Item Delaying Renal Transplant after Radical Prostatectomy for Low-Risk Prostate Cancer(2015) Ozcelik, Umit; Bircan, Huseyin Yuce; Karakayali, Feza; Moray, Gokhan; Demirag, Alp; 0000-0002-1874-947X; 0000-0003-1073-2494; 0000-0003-2498-7287; 26640918; AAB-3888-2021; AAG-8651-2021; AAE-1041-2021; R-6394-2019To minimize the recurrence of a previously treated neoplasm in organ recipients, a period of 2 to 5 years without recurrence is advocated for most malignancies. However, prostate cancer is different because of its biological properties, diagnosis, and treatment. Most prostate cancers are detected at a low stage and demonstrate slow growth after detection. Definitive treatment with radical prostatectomy affords excellent results. Renal transplant candidates with early-stage prostate cancer have a higher risk of dying on dialysis than dying from prostate cancer; therefore, renal transplant candidates with organ-confined prostate cancer should be immediately considered for transplant.Item Development of an Information Model for Kidney Transplant Wait List(2015) Bircan, Huseyin Yuce; Ozcelik, Umit; Uysal, Nida; Demirag, Alp; Haberal, Mehmet; 0000-0003-1073-2494; 0000-0002-3462-7632; 26640914; R-6394-2019; AAG-8651-2021; AAJ-8097-2021Objectives: Deceased-donor kidney transplant is unique among surgical procedures that are an urgent procedure performed in an elective population. It has not been possible to accurately determine when a given patient will be called for transplant. Patients on the active transplant list can be called for a transplant at any time. As a result, every effort must be made to optimize their health according to best practices and published clinical practice guidelines. Materials and Methods: Once the patient is placed on the transplant wait list after undergoing an initial extensive evaluation, continued surveillance is required. Therefore, we developed a kidney transplant wait list surveillance software program that alerts organ transplant coordinator on time regarding which patients need a work-up. Results: The new designed software has a database of our waiting patients with their completed and pending controls. The software also has built-in functions to warn the responsible staff with an E-mail. If one of the controls of a recipient delayed, the software sends an automated E-mail to the staff regarding the patients delayed controls. The software is a Web application that works on any platform with a Web browser and Internet connection and allows access by multiple users. The software has been developed with NET platform. The database is SQL server. The software has the following functions: patient communication info, search, alert list, alert E-mail, control entry, and system management. Conclusions: As of January 2014, a total of 21 000 patients were registered on the National Kidney Transplant wait list in Turkey and the kidney transplant wait list had been expanding by 2000 to 3000 patients each year. Therefore computerized wait list programs are crucial to help to transplant centers to keep their patients up-to-date on time.Item Influence of Various Living Donor Kidney Measurements in Relation to Recipient Body Measurements on Posttransplant Allograft Functional Outcomes(2018) Kulah, Eyup; Ozcelik, Umit; Isiklar, Iclal; Cevik, Halime; Bircan, Huseyin Yuce; Karakayali, Feza Y.; Haberal, Mehmet; https://orcid.org/0000-0001-6041-4254; https://orcid.org/0000-0003-1073-2494; https://orcid.org/0000-0002-1874-947X; https://orcid.org/0000-0002-3462-7632; 27356006; AAJ-5764-2021; AAG-8651-2021; R-6394-2019; AAB-3888-2021; AAJ-8097-2021Objectives: Donor kidney measurements may affect outcomes of transplanted allografts. We tested allograft and recipient measurements on kidney allograft outcomes. In this study, we compared the effects of kidney allograft volumes, which were measured using computed tomographic angiography before transplant, and allograft weight, which was measured during surgery, in relation to the recipient's body weight and body mass index on kidney function at 6 and 12 months after transplant. Material and Methods: We included 74 patients (40 female and 34 male patients, mean age of 50.42 +/- 9.75 y) in this study. Results: Intraoperative allograft weight was 182.68 +/- 40.33 g (range, 104-266 g). The allograft volume measured using computed tomographic angiography scanning was 123.34 +/- 24.26 ml (range, 78-181 ml). The estimated glomerular filtration rates of the recipients at 6 and 12 months after transplant correlated negatively with age and recipient body mass index but correlated positively with allograft volume/recipient body weight, allograft volume/recipient body mass index, allograft weight, allograft weight/recipient body weight, and allograft weight/recipient body mass index values, as concluded by univariate analyses. From multivariate analyses, we found variables of interest presumed to significantly affect the 12-month estimated glomerular filtration rates, including recipient age, allograft volume/recipient body weight, allograft volume/recipient body mass index, allograft weight, allograft weight/recipient body weight, and allograft weight/recipient body mass index. Conclusions: Transplanted allograft and recipient body values may be used as predictors of estimated glomerular filtration rates 6 and 12 months after transplant.Item Results of BK Virus Screening in Renal Transplant Recipients(2016) Ozcelik, Umit; Bircan, Huseyin Yuce; Aydin, Mehtap; Kulah, Eyyup; Karakayali, Feza Yarbug; Haberal, Mehmet; https://orcid.org/0000-0003-1073-2494; https://orcid.org/0000-0003-4044-9366; https://orcid.org/0000-0002-1874-947X; https://orcid.org/0000-0002-3462-7632; AAG-8651-2021; R-6394-2019; HLX-0937-2023; AAB-3881-2021; AAB-3888-2021; AAJ-8097-2021Item Effects of a Novel Peritoneal Dialysis: The Open Versus Laparoscopic Preperitoneal Tunneling Technique(2016) Bircan, Huseyin Yuce; Kulah, Eyyup; https://orcid.org/0000-0001-6041-4254; 26638124; R-6394-2019; AAJ-5764-2021The key to achieving adequate continuous ambulatory peritoneal dialysis (CAPD) is that a functioning catheter should enable unrestricted inflow and outflow of the dialysate liquid from the peritoneal cavity with an intact peritoneal membrane. Despite its advantages, complications, such as outflow obstruction, catheter-related infection, and dialysate leakage are still problematic. Various laparoscopic techniques for catheter placement have been investigated. The main purpose of this study was to compare the laparoscopic and open surgical peritoneal dialysis (PD) catheter insertion techniques in a retrospective manner according to catheter survival, complications and the safety of both techniques. The study included end stage renal disease patients in our hospital in whom a PD catheter was placed between 2007 and 2014. Patients were divided into two groups: the open technique (OT) group and the laparoscopic preperitoneal tunneling approach (LA) group. Extracted data included patient demographics, operative data, catheter-related complications and follow-up data. Sixty-nine patients were enrolled into the study. CAPD catheters were placed into 35 patients via LA and 34 via OT. We found that the LA group patients had better survival rates compared with the OT group, especially the long-term survivals. All of the CAPD-related complications, (peritonitis, malposition, outflow obstruction, leakage) were lower in the LA group. However, the peritonitis, malposition and groin hernia rates were also statistically significantly lower in the LA group. When compared with the published data, we recommend laparoscopic CAPD catheter placement with a preperitoneal tunneling technique. The technique is safe and offers a better outcome.Item Anesthesia Management with Ultrasound Guided Thoracic Paravertebral Block for Donor Nephrectomy: A Prospective Randomized Study(2017) Yenidunya, Ozlem; Bircan, Huseyin Yuce; Altun, Dilek; Caymaz, Ismail; Demirag, Alp; Turkoz, Ayda; 28235492; AAR-7467-2020; R-6394-2019Study objective: To determine the efficacy of ultrasound-guided thoracic paravertebral block intraoperatively and 24 hours postoperatively in patients undergoing donor nephrectomy. Design: Prospective randomized controlled study. Setting: Private foundation university hospital; November 2014 to June 2015. Patients: Thirty-two patients undergoing donor nephrectomy (exclusion criteria: coagulation disorders, allergy to local anesthetics, and unwillingness to participate). The final study population comprised 30 patients (15 male, 15 female) randomly assigned to either Group P (paravertebral block, n = 14) or Group M (morphine, n = 16). Interventions: In Group P, a unilateral paravertebral catheter was inserted 1 day preoperatively; on the day of surgery, a single-level unilateral paravertebral block was administered through the catheter before general anesthesia. Infusion of bupivacaine continued intraoperatively and postoperatively. Patients in Group M received only general anesthesia, and morphine patient-controlled analgesia was begun postoperatively. Measurements: Intraoperative analgesic and anesthetic requirement, postoperative numerical rating scale pain scores, additional analgesic consumption during the postoperative period, and incidence of complications related to thoracic paravertebral block (TPVB) like pleural puncture, pneumothorax, epidural spread, injection into the subarachnoid space, intravascular injection, and Homer's syndrome and rate of opioid related adverse reactions like nausea and vomiting, itching, constipation, and respiratory depression. Results: Intraoperative remifentanil consumption was significantly higher in Group M, and postoperative morphine consumption was significantly lower in Group P (P <.001). During the first 24 hours postoperatively, the mean numerical rating scale pain scores were similar and there were no significant differences between the 2 groups. There were no statistically significant differences in the additional analgesic consumption and rate of adverse reactions between the 2 groups. We didn't detect any complication related to TPVB in group P. Conclusions: Continuous thoracic paravertebral block provides good intraoperative stability with a low anesthetic requirement and reduces postoperative morphine consumption for up to 24 hours. Ultrasound guided technique enhanced the safety of TPVB and provides analgesia without major complications. (C) 2016 Elsevier Inc. All rights reserved.Item SUCCESFULLY KIDNEY TRANSPLANTATION IN PEDIATRIC PATIENT WITH INFERIOR VENA CAVA STENT(2020) Igus, Behlul; Bircan, Huseyin Yuce; Karaca, Serdar; Soy, Ebru H. Ayvazoglu; Karakayali, Feza; Haberal, Mehmet A.Item Are there any differences between age groups regarding colorectal surgery in elderly patients?(2014) Bircan, Huseyin Yuce; Koc, Bora; Ozcelik, Umit; Adas, Gokhan; Karahan, Servet; Demirag, AlpBackground: Surgical procedures with curative or palliative intentions in subjects aged over 70 represent a colorectal surgical challenge due to the issue they raise: Benefits versus increased morbidity. In this study, we proposed to compare the impact of surgery with the surgical intervention short-term results and analyze the factors that may influence these results in elderly age groups. Methods: We retrospectively analyzed a database containing information about patients who underwent colorectal surgery from January 2008 to December 2013 at the Baskent University Istanbul Research Hospital and the Okmeydani Training and Research Hospital. Results: A total of 265 patients were enrolled and analyzed in this retrospective study. Of these patients operated during the study period, 110 were between 60 and 69 years of age (group 1), 99 were between 70 and 79 years of age and 56 were older than 80 years of age. In total, there were 138 (52%) men and 127 (48%) women that underwent colorectal surgery. Intraoperative complications did not differ between group 1 and group 2, group 2 and group 3; however, some differences were observed between group 1 and group 3 (p = 0.001). Systemic complications were more frequent in group 3 than in groups 1 (p = 0.039) and 2 (p = 0.002). Furthermore, there were no significant systemic complication differences between groups 1 and 2. The mean length of postoperative hospital stay was 9.91 +/- 2.65 days in the first group, 9.38 +/- 2.44 days in the second group and 11.8 +/- 4.35 days in the third group. Conclusion: Colon surgery for both malignant and non-malignant diseases can be performed safely in different elderly age groups; thus, age should not be considered as an obstacle in elderly patients undergoing colorectal resection.Item Complications Following Endoscopic Retrograde Cholangiopancreatography: Minimal Invasive Surgical Recommendations(2014) Koc, Bora; Bircan, Huseyin Yuce; Adas, Gokhan; Kemik, Ozgur; Akcakaya, Adem; Yavuz, Alpaslan; Karahan, Servet; 25426633Background: ERCP has a complication rate ranging between 4% and 16% such as post-ERCP pancreatitis, hemorrhage, cholangitis and perforation. Perforation rate was reported as 0.08% to 1% and mortality rate up to 1.5%. Besides, injury related death rate is 16% to 18%. In this study we aimed to present a retrospective review of our experience with post ERCP-related perforations, reveal the type of injuries and management recommendations with the minimally invasive approaches. Methods: Medical records of 28 patients treated for ERCP-related perforations in Okmeydani Training and Research Hospital between March 2007 and March 2013 were reviewed retrospectively. Patient age, gender, comorbidities, ERCP indication, ERCP findings and details were analyzed. All previous and current clinical history, laboratory and radiological findings were used to assess the evaluation of perforations. Results: Between March 2007 and March 2013, 2972 ERCPs were performed, 28 (0.94%) of which resulted in ERCP-related perforations. 10 of them were men (35.8%) and 18 women (64.2%). Mean age was 53.36 +/- 14.12 years with a range of 28 to 78 years. 14 (50%) patients were managed conservatively, while 14 (50%) were managed surgically. In 6 patients, laparoscopic exploration was performed due to the failure of non-surgical management. In 6 of the patients that ERC-Prelated perforation was suspected during or within 2 hours after ERCP, underwent to surgery primarily. There were two mortalities. The mean length of hospitalization stay was 10.46 +/- 2.83 days. The overall mortality rate was 7.1%. Conclusion: Successful management of ERCP-related perforation requires immediate diagnosis and early decision to decide whether to manage conservatively or surgically. Although traditionally conventional surgical approaches have been suggested for the treatment of perforations, laparoscopic techniques may be used in well-chosen cases especially in type II, III and IV perforations.