Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Comparison of Predictive Factors for the Diagnosis and Clinical Course of Phyllodes Tumours of the Breast(2015) Yabanoglu, H.; Colakogiu, T.; Aytac, H. O.; Parlakgumus, A.; Bolat, F. A.; Pourbagher, A.; Yildirim, S.; 0000-0002-3583-9282; 0000-0003-0268-8999; 0000-0003-2031-7374; 0000-0002-5735-4315; 0000-0002-1161-3369; 26021788; AAJ-7913-2021; AAK-2011-2021; HJZ-1654-2023; AAF-4610-2019; AAJ-7865-2021Background : To compare predicting factors for the diagnosis and clinical course of benign and malign/borderline phyllodes tumours (PT) of the breast, and to discuss treatment modalities. Methods : Clinical and demographic characteristics of the patients with histopathological diagnosis of phyllodes tumour were examined. Patients were divided into group 1 (benign PT) and group 2 (borderline/malignant PT). Groups were compared in terms of demographic and clinical characteristics. Results. Of the patients studied, 37(68.5%) had benign, 7 (12.9%) had borderline and 10 (18.5) had malignant histopathology.. A statistically significant relationship was detected between the incidence of malignancy and mass diameter (p = 0.001) and age (p = 0.030) when the two groups were compared. Wide surgical excision was performed on 46 (82.5%) patients, simple mastectomy on 7 (13%) patients and modified radical mastectomy on one (1.9%) patient. Ten (18.5%) patients were re-operated for surgical margin positivity. Local recurrence was determined only in one (1.9%) patient. Distant metastasis due to malignant PT developed in two (3.7%) patients. Conclusion : Among the patients who were considered to have PT, malignancy was likely to be present, especially if the patient's age was over 40 and the diameter of the mass was above 33.5 mm. Therefore, in patients with similar characteristics, surgical margins should be kept slightly wider or wider excisions should be preferred with or without simultaneous reconstructive surgery in appropriate cases.Item Effectiveness of Fludarabine- and Busulfan-Based Conditioning Regimens in Patients With Acute Myeloblastic Leukemia: 8-Year Experience in a Single Center(2015) Kasar, M.; Asma, S.; Kozanoglu, I.; Maytalman, E.; Boga, C.; Ozdogu, H.; Yeral, M.; 0000-0001-5284-7439; 0000-0002-8902-1283; 0000-0001-5335-7976; 0000-0003-3856-7005; 0000-0002-9580-628X; 0000-0002-9680-1958; 0000-0002-5268-1210; 26036558; F-6265-2019; AAD-5542-2021; AAI-7831-2021; AAL-3906-2021; ABC-4148-2020; AAD-6222-2021; AAE-1241-2021Objective. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative treatment for acute myeloblastic leukemia (AML). Because the conditioning regimen of busulfan plus cyclophosphamide carries significant risks of toxicity, we evaluated the factors affecting survival after fludarabine replacement instead of cyclophosphamide. Methods. The study included 55 patients who underwent allo-HSCT for AML and received busulfan, fludarabine, and antithymocyte globulin (ATG). Results. Forty-eight patients received a myeloablative regimen; 7 patients received a reduced-intensity conditioning regimen. The neutrophil and platelet engraftment times were 12 days (range 9 to 20) and 12 days (range 7 to 19), respectively. Graft-vs-host disease (GvHD) developed in 10% and 50% of the patients, respectively. Seven patients received donor lymphocyte infusion. Of them, 5 patients developed grade I or II GvHD, one grade IV GvHD. The median follow-up period was 20.6 months. The predicted progression-free survival (PFS) at 1 and 3 years after transplantation was 78% and 74%, respectively. The overall survival (OS) at 1, 3, and 5 years was 76%, 74%, and 62%, respectively. Treatmen-trelated mortality (infection in 1 patient, GvI-ID in 2 patients) occurred in 3 patients (5.5%). Multivariate analysis revealed that OS and PFS were not influenced by age, dose of busulfan or ATG, or presence of cytomegalovirus antigenemia. Acute GvHD and pretransplantation minimal residual disease positivity negatively affected the transplant outcome. The presence of active disease at the time of transplantation was found as an independent risk factor for AML. Conclusions. Busulfan- and fiudarabine-based conditioning regimens are effective for AML, and have acceptable toxicity, morbidity, and mortality.Item Post-transplantation Anemia Predicts Cardiovascular Morbidity and Poor Graft Function in Kidney Transplant Recipients(2015) Demirci, B. Gurlek; Sezer, S.; Sayin, C. B.; Tulal, E.; Uyar, M. E.; Acar, F. N. Ozdemir; Haberal, M.; 0000-0002-3462-7632; 0000-0002-5682-0943; 26036548; IAO-2608-2023; AAJ-8097-2021; AAK-1697-2021Objective. We aimed to investigate whether low post-transplantation-period hemoglobin levels are predictive of cardiovascular morbidity in terms of left ventricular (LV) hypertrophy and vascular stiffness and to determine the contributing factors of post-transplantation anemia in kidney transplant (KT) recipients. Methods. One hundred fifty (mean age, 38.9 +/- 10.8 y; 113 male) KT recipients with functioning grafts were enrolled in the study. All subjects underwent clinical and laboratory evaluations (24-hour urinary protein loss, complete blood count) and transthoracic echocardiography to assess LV systolic function. Arterial stiffness was measured by means of carotid-femoral pulse-wave velocity (PWV). Mean hemoglobin levels were analyzed at the 1st, 6th, 12th, and 24th months after transplantation. Patients were divided into 2 groups according to presence of anemia: patients with anemia (group 1; n = 120) and normal (group 2; n = 30). Results. PWV values (6.8 +/- 1.9 m/s vs 6.4 +/- 1.1 m/s in groups 1 and 2, respectively; P = .002) and LV mass index (LVMI; 252.1 +/- 93.7 g/m(2) vs 161.2 +/- 38.5 g/m(2) groups 1 and 2, respectively; P = .001) were significantly higher in group 1. Estimated glomerular filtration rate and (64 +/- 28.5 m/min vs 77.8 +/- 30 m/min in groups 1 and 2, respectively; P = .001) LV systolic function (57.2 +/- 5.8% vs 77.8 +/- 30% in groups 1 and 2, respectively; P < .005) were significantly lower in group 1. In regression analysis, LV systolic function and LVMI were predictors of post-transplantation hemoglobin levels. Conclusions. Post-transplantation anemia contributes to cardiovascular morbidity by deteriorating LV function and increasing PWV and is therefore associated with poor prognosis for graft survival. Early correction of post-transplantation anemia, especially with the use of erythropoietin, may be beneficial for both graft and recipient survivals.Item High Grade Proteinuria as a Cardiovascular Risk Factor in Renal Transplant Recipients(2015) Guliyev, O.; Sayin, B.; Uyar, M. E.; Genctoy, A.; Sezer, S.; Bal, Z.; Demirci, B. G.; Haberal, M.; 0000-0001-8287-6572; 0000-0002-3462-7632; 0000-0002-5145-2280; 26036546; J-3707-2015; AAJ-8097-2021; AAZ-5795-2021; IAO-2608-2023; AAJ-5551-2021Background. Proteinuria is a marker of graft damage and is closely associated with a higher risk of morbidity, mortality, and cardiovascular disease in kidney transplant recipients (KTRs). Arterial stiffness is a well-known predictor of vascular calcification and systemic arteriosclerosis. In our study, we aimed to investigate. the association between proteinuria and graft/patient survival and to determine whether proteinuria may be a predictor for cardiovascular disease in our KTR population. Methods. Ninety KTRs (31 women; age, 38.7 +/- 11 years, with 45.9 +/- 9.6 months post-transplantation period) with normal graft functions in the 3 to 5 years of the post-transplantation period were enrolled. All patients were evaluated for their standard clinical (age, sex, and duration of hemodialysis) parameters. High-grade proteinuria was defined as proteinuria >500 mg/day in the 24-hour urine collection. All patients were evaluated by means of pulse-wave velocity (PWV) measurement at the initiation of the study. Results. Patients were divided into 2 groups: group 1 (high-grade proteinuria) patients with >= 500 mg/24 hours (n = 30) and group 2 (low-grade proteinuria) patients with <500 mg/24 hours (n = 60). High-grade proteinuria was correlated with higher PWV measurements and lower estimated glomerular filtration levels. Proteinuria appears to precede the elevation of serum creatinine and thus may be a useful marker of renal injury and may also be a contributing factor on deterioration of the graft. Conclusions. High-grade (>500 mg/day) proteinuria in KTRs is strongly associated with poor graft survival and increased risk of cardiovascular events. In our study, we proved the significant difference between high-grade and low-grade proteinuric patients, and we suggest 500 mg/day as the threshold of proteinuria in KTR population.Item Brain-Derived Neurotrophic Factor Levels in Children with Asthma and Isolated Chronic Cough(2016) Guc, Belgin Usta; Asilsoy, Suna; Cihan, Fatma Goksin; https://orcid.org/0000-0002-9432-3008; HOH-3400-2023; AAM-7975-2020Studies show that neurogenic inflammation is implicated in the pathogenesis of chronic cough. Neurotrophins (NTs) regulate the synthesis of neuropeptides, which cause neurogenic inflammation. There is growing evidence suggesting their involvement in airway inflammation. The role of the brain-derived neurotrophic factor (BDNF), a member of the NT family, is not clear in chronic cough. The aim of this study was to evaluate the role of BDNF in children with nonspecific isolated chronic cough and to compare the differences between patients with asthma and healthy controls. In this case-control study, we included 30 patients with chronic cough (5-15 years) as the patient group. As the control group, 28 asthma patients under control, 30 children with asthma attacks, and 30 healthy children were included. Serum BDNF levels were measured by ELISA in all groups. The median of BDNF levels was 708.12 pg/mL (155-974) in the patient group, 952.94 pg/mL (220-1,018) in the controlled asthma group, 852.09 pg/mL (355-1,036) in the uncontrolled asthma patients, and 572.65 pg/mL (213-818) in the healthy children group. There were differences in the patient group and control groups regarding the BDNF levels (for the patient group and the controlled asthma group, P = 0.0014; for the patient group and the uncontrolled asthma patients, P = 0.0009; for the patient group and healthy children group, P = 0.05). The BDNF levels of asthma patients were statistically different from healthy children (P = 0.0001). Neurogenic inflammation was implicated in the pathogenesis of chronic cough. In patients with chronic cough, high BDNF levels may support the presence of asthma.Item Long-Term Results of Pericardial Autologous Patch Enlargement of the Aortic Annulus Using the Manouguian Technique(2016) Demirturk, Orhan Saim; Kiziltan, H. Tarik; Coskun, Isa; Tunel, Huseyin Ali; Tekin, Hatice Goknur; 0000-0002-6193-0848; 0000-0003-1175-1961; 27146233; ABD-7488-2021; AAD-5531-2021Background: The management of a small aortic root at the time of aortic valve replacement is controversial. In cases in which the aortic root is very small the choice of aortic valve type and of root-enlargement method is difficult. The technical challenge of the small aortic root has instigated the creation of methods for annular enlargement. Severe mismatch as a predictor of overall 30-day mortality or midterm mortality reports about long-term results of aortic valve replacement using autologous pericardial patch are scarce. Moreover, no reports about patient series are present in the English medical literature. This retrospective study was designed to address this gap in evidence. Methods: Twenty consecutive patients undergoing aortic valve replacement (with or without mitral valve replacement and/or coronary artery bypass grafting) at Baskent University Adana Medical Center between June 30, 1999 and April 10, 2006 were retrospectively evaluated. All clinical and echocardiographical data belonging to this population were specified. Their perioperational data were assessed. Results: Twenty patients operated using the Manouguian technique for narrow aortic root from June 1999 to April 2006 were followed for 8.54 +/- 3.35 years. Fourteen patients were alive at the end of the follow-up. Six patients had died. Early mortality rate was 5% and late mortality after 8.54 +/- 3.35 years was 30%. Late mortality related to cardiac reasons was 5%. Only one death could be attributed to a cardiac cause which occured in a 36-year-old male patient 3 years and 6 months after the operation. 70% of the patients were alive after a mean follow-up period of 8.54 +/- 3.35 years. Conclusion: The main finding of the present study is that aortic root enlargement using untreated fresh autologous pericardium in Manouguian type operations is a durable option, especially in conditions when homograft or stentless valve use is difficult or economically not feasible. We found that no patient had aneurysmal dilatation or mitral regurgitation after a mean follow-up of 8.54 +/- 3.35 years with autologous untreated pericardium as the enlargement patch.Item Mortality Risk Disparities in Children Receiving Chronic Renal Replacement Therapy for The Treatment of End-Stage Renal Disease Across Europe: An ESPN-ERA/EDTA Registry Analysis(2017) Chesnaye, Nicholas C.; Schaefer, Franz; Bonthuis, Marjolein; Holman, Rebecca; Baiko, Sergey; Bjerre, Anna; Cloarec, Sylvie; Cornelissen, Elisabeth A. M.; Espinosa, Laura; Heaf, James; Stone, Rosario; Shtiza, Diamant; Zagozdzon, Ilona; Harambat, Jerome; Jager, Kitty J.; Groothoff, Jaap W.; van Stralen, Karlijn J.; Baskin, Esra; https://orcid.org/0000-0003-4361-8508; 28336050; B-5785-2018Background We explored the variation in country mortality rates in the paediatric population receiving renal replacement therapy across Europe, and estimated how much of this variation could be explained by patient-level and country-level factors. Methods In this registry analysis, we extracted patient data from the European Society for Paediatric Nephrology/European Renal Association-European Dialysis and Transplant Association (ESPN/ERA-EDTA) Registry for 32 European countries. We included incident patients younger than 19 years receiving renal replacement therapy. Adjusted hazard ratios (aHR) and the explained variation were modelled for patient-level and country-level factors with multilevel Cox regression. The primary outcome studied was all-cause mortality while on renal replacement therapy. Findings Between Jan 1, 2000, and Dec 31, 2013, the overall 5 year renal replacement therapy mortality rate was 15.8 deaths per 1000 patient-years (IQR 6.4-16.4). France had a mortality rate (9.2) of more than 3 SDs better, and Russia (35.2), Poland (39.9), Romania (47.4), and Bulgaria (68.6) had mortality rates more than 3 SDs worse than the European average. Public health expenditure was inversely associated with mortality risk (per SD increase, aHR 0.69, 95% CI 0.52-0.91) and explained 67% of the variation in renal replacement therapy mortality rates between countries. Child mortality rates showed a significant association with renal replacement therapy mortality, albeit mediated by macroeconomics (eg, neonatal mortality reduced from 1.31 [95% CI 1.13-1.53], p=0.0005, to 1.21 [0.97-1.51], p=0.10). After accounting for country distributions of patient age, the variation in renal replacement therapy mortality rates between countries increased by 21%. Interpretation Substantial international variation exists in paediatric renal replacement therapy mortality rates across Europe, most of which was explained by disparities in public health expenditure, which seems to limit the availability and quality of paediatric renal care. Differences between countries in their ability to accept and treat the youngest patients, who are the most complex and costly to treat, form an important source of disparity within this population. Our findings can be used by policy makers and health-care providers to explore potential strategies to help reduce these health disparities. Funding ERA-EDTA and ESPN.Item A case of primer angiosarcoma in a young woman: lessons from multi-modality imaging(2022) Coskun, Mehmet; Hasirci, Senem Has; Ozdemir, Handan; Coskun, Mehmet; Sezgin, Atilla; Muderrisoglu, I. Haldun; Sade, Leyla Elif; 0000-0002-7528-3557; X-8540-2019Item The skills of defibrillation practice and certified life-support training in the healthcare providers in Turkey(2021) Gultekingil, Ayse; 0000-0001-7955-5735; 34669998; AAR-9945-2020Aim of the study Successful cardiopulmonary resuscitation and early defibrillation are critical in survival after in- or out-of-hospital cardiopulmonary arrest. The scope of this multi-centre study is to (a) assess skills of paediatric healthcare providers (HCPs) concerning two domains: (1) recognising rhythm abnormalities and (2) the use of defibrillator devices, and (b) to evaluate the impact of certified basic-life-support (BLS) and advanced-life-support (ALS) training to offer solutions for quality of improvement in several paediatric emergency cares and intensive care settings of Turkey. Methods This cross-sectional and multi-centre survey study included several paediatric emergency care and intensive care settings from different regions of Turkey. Results A total of 716 HCPs participated in the study (physicians: 69.4%, healthcare staff: 30.6%). The median age was 29 (27-33) years. Certified BLS-ALS training was received in 61% (n = 303/497) of the physicians and 45.2% (n = 99/219) of the non-physician healthcare staff (P < .001). The length of professional experience had favourable outcome towards an increased self-confidence in the physicians (P < .01, P < .001). Both physicians and non-physician healthcare staff improved their theoretical knowledge in the practice of synchronised cardioversion defibrillation (P < .001, P < .001). Non-certified healthcare providers were less likely to manage the initial doses of synchronised cardioversion and defibrillation: the correct responses remained at 32.5% and 9.2% for synchronised cardioversion and 44.8% and 16.7% for defibrillation in the physicians and healthcare staff, respectively. The indications for defibrillation were correctly answered in the physicians who had acquired a certificate of BLS-ALS training (P = .047, P = .003). Conclusions The professional experience is significant in the correct use of a defibrillator and related procedures. Given the importance of early defibrillation in survival, the importance and proper use of defibrillators should be emphasised in Certified BLS-ALS programmes. Certified BLS-ALS programmes increase the level of knowledge and self-confidence towards synchronised cardioversion-defibrillation procedures.Item Gender-related clinical and management differences in patients with chronic heart failure with reduced ejection fraction(2020) Kocabas, Umut; Kivrak, Tarik; Yilmaz Oztekin, Gulsum Meral; Tanik, Veysel O.; Ozdemir, Ibrahim; Kaya, Ersin; Yuce, Elif Ilkay; Avci Demir, Fulya; Dogdus, Mustafa; Altinsoy, Meltem; Ustundag, Songul; Ozyurtlu, Ferhat; Karagoz, Ugur; Karakus, Alper; Urgun, Orsan Deniz; Sinan, Umit Yasar; Mutlu, Inan; Sen, Taner; Astarcioglu, Mehmet Ali; Kinik, Mustafa; Ozden Tok, Ozge; Uygur, Begum; Yeni, Mehtap; Alan, Bahadir; Dalgic, Onur; Altay, Hakan; Pehlivanoglu, Seckin; 33063424; AAE-1392-2021Aim Gender-related differences have been described in the clinical characteristics and management of patients with chronic heart failure with reduced ejection fraction (HFrEF). However, published data are conflictive in this regard. Methods We investigated differences in clinical and management variables between male and female patients from the ATA study, a prospective, multicentre, observational study that included 1462 outpatients with chronic HFrEF between January and June 2019. Results Study population was predominantly male (70.1%). In comparison to men, women with chronic HFrEF were older (66 +/- 11 years vs 69 +/- 12 years, P < .001), suffered more hospitalisations and presented more frequently with NYHA class III or IV symptoms. Ischaemic heart disease was more frequent in men, whereas anaemia, thyroid disease and depression were more frequent in women. No difference was seen between genders in the use rate of renin-angiotensin system inhibitors, beta-blockers, mineralocorticoid receptor antagonists, or ivabradine, or in the proportion of patients achieving target doses of these drugs. Regarding device therapies, men were more often treated with an implantable cardioverter-defibrillator (ICD) and women received more cardiac resynchronisation therapy. Conclusion In summary, although management seemed to be equivalent between genders, women tended to present with more symptoms, require hospitalisation more frequently and have different comorbidities than men. These results highlight the importance of gender-related differences in HFrEF and call for further research to clarify the causes of these disparities. Gender-specific recommendations should be included in future guidelines in HFrEF.