Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Comparison of Helical and TomoDirect Techniques with Simultaneous Integrated Boost in Early Breast Cancer Patients(REPORTS OF PRACTICAL ONCOLOGY AND RADIOTHERAPY, 2023) Onal, Cem; Bozca, Recep; Oymak, Ezgi; Guler, Ozan CemBackground: The aim of the study was to perform dosimetric comparisons of helical (H) and TomoDirect (TD) plans for whole-breast irradiation (WBI) with simultaneous integrated boost (SIB) in early-stage breast cancer patients undergoing breast conserving surgery.Materials and methods: Fifty patients, 25 with left-side and 25 with right-side tumors, were determined for a treatment planning system for a total dose of 50.4Gy in 1.8Gy per fraction to WBI, with a SIB of 2.3Gy per fraction delivered to the tumor bed. The planning target volume (PTV) doses and the conformity (CI) and homogeneity indices (HI) for PTV(breast )and PTVboost, as well as organ-at-risk (OAR) doses and treatment times, were compared between the H and TD plans.Results: All plans met the PTV coverage criteria for the H plan, except for mean V107 of PTVbreast for TD plan. The H plan yielded better homogeneity and conformity of dose distribution compared to the TD plan. The ipsilateral mean lung doses were not significantly different between the two plans. The TD plans is advantageous for mean doses to the heart, contralateral breast and lung, spinal cord, and esophagus than the H plans. In both the H and TD plans, the right-sided breast patients had lower heart dose parameters than the left-sided breast patients. The TD plan is superior to the H plan in sparing the contralateral breast and lung by decreasing low-dose volumes.Conclusions: While the OAR dose advantages of TD are appealing, shorter treatment times or improved dose homogeneity and conformity for target volume may be advantageous for H plan.Item Clear Cell Carcinoma of the Uterine Cervix; An Unusual HPV-Independent Tumor: Clinicopathological Features, PD-L1 Expression, and Mismatch Repair Protein Deficiency Status of 16 Cases(TURKISH JOURNAL OF OBSTETRICS AND GYNECOLOGY, 2023) Bulutay, Pinar; Eren, Ozgur Can; Ozen, Ozlem; Haberal, Asuman Nihan; Kapucuoglu, NilgunObjective: Endocervical clear cell carcinoma (c-CCC) is a rare and HPV-independent adenocarcinoma type of cervix. Being usually resistant to conventional chemotherapy. Immunotherapy has recently been added as a preferred regimen as a second-line treatment option for programed cell death-ligand 1 (PD L1)-positive or mismatch repair (MMR) deficient cervical carcinomas. In this study, clinicopathological features, PD-L1 expression, and MMR deficiency status of c-CCCs were investigated. Materials and Methods: Sixteen c-CCC diagnosed cases were included in this study. PD-L1 expression was evaluated using two different PD-L1 clones (22C3 and SP263). MMR deficiency status of the cases was evaluated using four MMR proteins (MLH1, PMS2, MSH2, and MSH6). Results: Most of the c-CCC cases were presented as FIGO Stage I (68.75%). PD-L1 expression in either tumoral or tumor-infiltrating immune cells (TILs) was present in 62.5% (10/16) and 69% (11/16) of the 22C3 and SP263 clones, respectively. Most of the cases with high TIL density were also positive for PD-L1. The PD-L1 expression rate was less than 50% in most of the cases and 12.5% of the cases shared extensive PD-L1 staining. Overall, MMR deficiency was observed in 31.25% of the cases. Most of the MMR-deficient cases (80%) were PD-L1 positive. Conclusion: Although our study cohort is limited, we have shown that PD-L1 expression and MMR deficiency can be found in c-CCCs in variable degrees. These findings suggest that accompanying TIL density and MMR deficiency could be used as candidates for predicting PD-L1 positivity for c-CCCs. However, to indicate the clinical importance of these findings, objective treatment outcomes of cases treated with immunotherapy should be seen.Item Accidental Late PEG Dislodgment in 3 Cases with A Narrow Stoma: Bougie Dilatation Rescue(2023) Koker, Ibrahim Hakki; Yenidunya, Ozlem; Savas, Nurten Akyurek; Tosun, Serife Degirmencioglu; Davutoglu, Can; 0000-0001-5622-4378; 38073451; JAZ-1759-2023Percutaneous endoscopic gastrostomy (PEG) is a simple and effective method of enteral nutrition for many patients who cannot take oral food. The accidental dislodgment of the PEG tube after the maturation of the gastrocutaneous fistula (stoma) is called late dislodgment. If it is not detected early, the stoma lumen gets narrower and does not permit the passage of the replacement tube. In this case, the commonly followed method is to continue enteral nutrition by opening a new gastrocutaneous fistula after the complete closure of the original stoma. Here, we present a stoma-saving bougie dilatation method in 3 cases with severely narrowed stomas after late accidental dislodgment of the PEG tube.Item Acute Cerebral Venous Sinus Thrombosis: Two Different Presentations(2014) Kilicaslan, Buket; Erol, Ilknur; Demir, Senay; Yazici, Nalan; AAW-9958-2021Acute cerebral venous sinus thrombosis is a rare disorder in children, but is often secondary to infections. The clinical features of cerebral venous sinus thrombosis are based on the localization and size of the affected vessel and age of the patient. In this article we encountered two different presentations of acute cerebral venous sinus thrombosis in two children aged 8 and 12 years old.Item Acute Renal Injury in Liver Transplant Patients and Its Effect on Patient Survival(2014) Kirnap, Mahir; Colak, Turan; Baskin, Esra; Akdur, Aydincan; Moray, Gokhan; Arslan, Gulnaz; Haberal, Mehmet; https://orcid.org/0000-0002-8372-7840; https://orcid.org/0000-0003-4361-8508; https://orcid.org/0000-0002-8726-3369; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-3462-7632; 24635816; AAH-9198-2019; AAJ-8554-2021; B-5785-2018; AAA-3068-2021; AAE-1041-2021; AAJ-8097-2021Objectives: Acute renal injury is a common complication in liver transplant patients. Acute kidney injury is due to nephrotoxic drugs used after liver transplant, infections, and hemorrhage. Though it is generally reversible, it has effects on grafts and patients survival. In this retrospective observational study carried out at a single center, the effects of acute renal disease on liver recipient's survival were investigated. Materials and Methods: Liver transplant recipients of live-donor and deceased-donor transplants between January 2002 and May 2013 were included in this study; there were 310 liver transplant patients (mean age, 28 y; age range, 6 mo-62 y; 165 males, 145 females). The acute kidney disease diagnosis and staging was based on the nephrology department evaluation and daily serum creatinine levels. Patients with acute kidney injury before undergoing liver transplant and those undergoing a transplant for the second time were excluded. Kidney functions were evaluated by the nephrology department 1 week, 3 months, and 1 year after the liver transplant. Results: Acute kidney disease rates in these patients were 5%, 8%, and 12%. Four patients developed chronic kidney failure during follow-up. The mortality rate was higher (18%) in acute renal failure patients compared with those that did not have acute renal failure. The mortality rate was 11% in patients without acute renal failure. Conclusions: Acute renal injury is common after liver transplant and has an effect on mortality.Item A 10-Year Experience of Tuberculosis in Solid-Organ Transplant Recipients(2015) Ulubay, Gaye; Kupeli, Elif; Birben, Ozlem Duvenci; Seyfettin, Emine Pinar; Dogrul, Mustafa Ilgaz; Ugurlu, Aylin Ozsancak; Eyuboglu, Fusun Oner; Haberal, Mehmet; 0000-0002-5525-8207; 0000-0002-3462-7632; 0000-0003-2478-9985; 0000-0003-3598-3986; 0000-0002-5826-1997; 25894157; AAR-4338-2020; AAJ-8097-2021; AAB-5064-2021; AAA-2925-2020; AAB-5345-2021Objectives: Tuberculosis remains an important problem in solid-organ transplant patients due to their immunocompromised state. The objective of the present study was to report the incidence, demographic characteristics, and various presentations of tuberculosis in solid-organ transplant recipients. Materials and Methods: We evaluated a total of 999 patients (male/female = 665/334, 661 renal and 338 liver transplants) who underwent solid-organ transplant between 2003 and 2013. The medical records of all patients were retrospectively reviewed. Patients' demographics, transplant type, primary site of tuberculosis specimen culture and pathology results, chest radiograph, and thoracic computed tomography findings, total blood count and chemistry were all recorded. Results: Among the 999 subjects, 19 patients (1.9%) (male/female: 15/4, mean +/- SD age, 42 +/- 18.5 y) were diagnosed with tuberculosis. The majority of patients (85%) were diagnosed with tuberculosis within 6 months after transplant, and 15% were diagnosed within 3 months. Most diagnoses of tuberculosis were based on histopathologic examination of biopsy material. Of these patients, 9 were diagnosed with pulmonary tuberculosis, 8 had extrapulmonary tuberculosis, and 2 had both. Nontuberculosis mycobacteria infections were detected in 3 patients. Conclusions: Even with a negative exposure history, tuberculosis can manifest as different clinic presentations in solid-organ transplant patients on immunosuppressive drugs, particularly in the first 6 months after transplant. Therefore, clinicians should always consider tuberculosis as the potential cause of an infectious disease with unknown cause to successfully diagnose and manage solid-organ transplant recipients.Item Acquired Aquagenic Syringeal Acrokeratoderma: A Case Series of 10 Patients(2015) Erturk Ozdemir, Emel; Ozcan, Deren; Seckin, Deniz; 0000-0002-7450-6886; 24283504; AAQ-6649-2021Aquagenic syringeal acrokeratoderma is a rare acquired disorder that predominantly affects young women. It is most commonly localised on the palms. It is characterised by translucent papules, oedematous plaques and keratoderma developing after brief exposure to water and resolving shortly after drying. We have observed 10 patients with this disorder within 13 months. We think that aquagenic syringeal acrokeratoderma is a more common condition than was originally anticipated as one can easily underdiagnose this entity due to the transient nature of its clinical findings.Item Accuracy of Continuous Noninvasive Arterial Pressure Monitoring in Living-Liver Donors During Transplantation(2015) Araz, Coskun; Zeyneloglu, Pinar; Pirat, Arash; Veziroglu, Nukhet; Firat, Aynur Camkiran; Arslan, Gulnaz; 0000-0003-2312-9942; 0000-0002-4927-6660; 0000-0003-1470-7501; 25894178; C-3736-2018; AAJ-4576-2021Objectives: Hemodynamic monitoring is vital during liver transplant surgeries because distinct hemodynamic changes are expected. The continuous noninvasive arterial pressure (CNAP) monitor is a noninvasive device for continuous arterial pressure measurement by a tonometric method. This study compared continuous noninvasive arterial pressure monitoring with invasive direct arterial pressure monitoring in living-liver donors during transplant. Materials and Methods: There were 40 patients analyzed while undergoing hepatic lobectomy for liver transplant. Invasive pressure monitoring was established at the radial artery and continuous noninvasive arterial pressure monitoring using a finger sensor was recorded simultaneously from the contralateral arm. Systolic, diastolic, and mean arterial pressures from the 2 methods were compared. Correlation between the 2 methods was calculated. Results: A total of 5433 simultaneous measurements were obtained. For systolic arterial blood pressure, 55% continuous noninvasive arterial pressure measurements were within 10% direct arterial measurement; the correlation was 0.479, continuous noninvasive arterial pressure bias was -0.3 mm Hg, and limits of agreement were 32.0 mm Hg. For diastolic arterial blood pressure, 50% continuous noninvasive arterial pressure measurements were within 10% direct arterial measurement; the correlation was 0.630, continuous noninvasive arterial pressure bias was -0.4 mm Hg, and limits of agreement were 21.1 mm Hg. For mean arterial blood pressure, 60% continuous noninvasive arterial pressure measurements were within 10% direct arterial measurement; the correlation was 0.692, continuous noninvasive arterial pressure bias was +0.4 mm Hg, and limits of agreement were 20.8 mm Hg. Conclusions: The 2 monitoring techniques did not show acceptable agreement. Our results suggest that continuous noninvasive arterial pressure monitoring is not equivalent to invasive arterial pressure monitoring in donors during living-donor liver transplant.Item The 2-Stage Liver Transplant: 3 Clinical Scenarios(2015) Gedik, Ender; Bicakcioglu, Murat; Otan, Emrah; Toprak, Huseyin Ilksen; Isik, Burak; Aydin, Cemalettin; Kayaalp, Cuneyt; Yilmaz, Sezai; 0000-0001-9293-8116; 0000-0002-2395-3985; 0000-0002-7175-207X; 0000-0003-4657-2998; 25894175; ABB-5579-2020; AAH-1764-2021; AAN-4023-2020; A-6657-2018; ABI-2971-2020The main goal of 2-stage liver transplant is to provide time to obtain a new liver source. We describe our experience of 3 patients with 3 different clinical conditions. A 57-year-old man was retransplanted successfully with this technique due to hepatic artery thrombosis. However, a 38-year-old woman with fulminant toxic hepatitis and a 5-year-old-boy with abdominal trauma had poor outcome. This technique could serve as a rescue therapy for liver transplant patients who have toxic liver syndrome or abdominal trauma. These patients required intensive support during long anhepatic states. The transplant team should decide early whether to use this technique before irreversible conditions develop.Item Acidosis and Hyperkalemia Caused By Losartan and Enalapril in Pediatric Kidney Transplant Recipients(2014) Sakalli, Hale; Baskin, Esra; Bayrakci, Umut Selda; Moray, Gokhan; Haberal, Mehmet; https://orcid.org/0000-0003-4361-8508; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-3462-7632; 24447308; B-5785-2018; AAE-1041-2021; AAJ-8097-2021Objectives: To evaluate the efficacy and safety of losartan and enalapril in pediatric kidney transplant recipients. Materials and Methods: A retrospective review was performed in 31 pediatric kidney transplant recipients who were treated with losartan (50 mg/d, oral) for 1 to 6 months because of mild hypertension and persistent proteinuria. All patients were treated concurrently with enalapril (5 or 10 mg daily, oral), and 12 patients (39%) also were treated with amlodipine (5 or 10 mg daily, oral). Demographic and clinical characteristics of the patients were reviewed. Results: Losartan use was associated with a significant decrease in mean systolic (before losartan was started, 123 +/- 14 mm Hg; before losartan was stopped, 111 +/- 10 mm Hg; P <= .001) and diastolic blood pressure (before losartan was started, 78 +/- 11 mm Hg; before losartan was stopped, 69 +/- 10 mm Hg; P <= .001) and urinary protein excretion (before losartan was started, 51 +/- 45 mg/m(2)/h; before losartan was stopped, 28 +/- 34 mg/m(2)/h; P <= .001). However, losartan therapy was associated with a significant mean increase in serum potassium level (before losartan was started, 4.0 +/- 0.4 mmol/L; before losartan was stopped, 5.7 +/- 0.5 mmol/L; P <= .001) and decrease in pH (before losartan was started, 7.35 +/- 0.0; before losartan was stopped, 7.23 +/- 0.0; P <= .001). Losartan was stopped because of hyperkalemia and acidosis earlier in patients who were on tacrolimus than cyclosporine immunosuppression (tacrolimus, 3 +/- 1 mo; cyclosporine, 4.7 +/- 0.8 mo; P <= .001). Conclusions: Losartan and enalapril may be beneficial in pediatric kidney transplant recipients by decreasing blood pressure and proteinuria, with maintenance of stable graft function, but may be associated with serious adverse events including hyperkalemia and life-threatening acidosis.