Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Respiratory Complications After Solid-Organ Transplantation(2015) Zeyneloglu, Pinar; 0000-0003-2312-9942; 25871362; C-3736-2018The risk for respiratory complications after solid-organ transplantation continues to be high, even though progress has been achieved with surgical techniques, immunosuppressive agents, and perioperative treatment of transplant recipients. This review is an overview of infectious and noninfectious respiratory complications in liver, kidney, heart, and lung transplant patients. Postoperative respiratory complications are more frequent after liver, heart, and lung transplant recipients, but the incidence is lower in kidney transplant recipients. Lung infiltrates due to multidrug-resistant bacterial infections are increasing and may cause respiratory failure associated with high morbidity and mortality. Treatment strategies including early, broad-spectrum empiric antibiotic therapy, lung protective mechanical ventilation, and appropriate timing of tracheotomy for patients who need prolonged mechanical ventilation. Early recognition and aggressive treatment of these respiratory complications may improve outcomes.Item Early Infections in Renal Transplant Recipients: Incidence, Risk Factors, and Causative Microorganisms(2015) Yabanoglu, Hakan; Aliskan, Hikmet Eda; Caliskan, Kenan; Arer, Ilker; Akdur, Aydincan; Yildirim, Sedat; Moray, Gokhan; Haberal, Mehmet; 0000-0002-1161-3369; 0000-0002-8726-3369; 0000-0002-5735-4315; 0000-0001-9060-3195; 0000-0002-8767-5021; 0000-0002-3462-7632; 0000-0003-0268-8999; 0000-0003-2498-7287; 26640902; AAJ-7865-2021; AAA-3068-2021; AAF-4610-2019; AAE-2282-2021; AAJ-7201-2021; AAJ-8097-2021; AAK-2011-2021; AAE-1041-2021Objectives: This study aimed to compare renal transplant recipients with and without infection with respect to demographic and clinical characteristics as well as risk factors; to determine the incidence of posttransplant infections; and to study the antibiotic resistance patterns of bacterial species identified as the causative organisms in posttransplant infections. Materials and Methods: This study included a total of 136 patients undergoing renal transplant in a 4-year period. The patients were categorized into 2 groups. The 2 groups were compared with each other with respect to general clinical and demographic variables and the number and frequency of infectious attacks within a 1-year follow-up, infection type, and antibiotic resistance patterns. Results: Ninety-two (67.6%) of the subjects were male and 44 (32.4%) were female. A total of 57 (41.9%) patients developed 128 infectious attacks. Urinary tract infections were the most common infections (42.1%). There was a significant correlation between a clinically relevant urinary culture proliferation and postoperative infection rate (P =.002). There was a significant correlation between antimicrobial resistance and the number of infectious attacks (P =.023). There was a significant correlation between the proliferation of Extended Spectrum Beta Lactamase-positive Enterobactericeae species and the number of infectious attacks (P =.000). Conclusions: Presence of a clinically relevant proliferation in the preoperative urinary culture, which was identified as a risk factor for infection, increased the number of infectious attacks. Moreover, Extended Spectrum Beta Lactamase-positive Enterobactericeae species increased the number of infections. These 2 principle results should be taken into account in patient management.Item Lung Biopsy Findings of Patients Who Have Undergone a Liver and Kidney Transplant(2016) Ozgun, Gonca; Tepeoglu, Merih; Ozdemir, Binnaz Handan; Akcay, Eda Yilmaz; Ayva, Ebru Sebnem; Deniz, Emine Ebru; Haberal, Mehmet; 0000-0002-9894-8005; 0000-0002-7528-3557; 0000-0001-6831-9585; 0000-0002-2280-8778; 0000-0002-3462-7632; 27805533; AAK-5222-2021; X-8540-2019; AAK-1960-2021; AAK-1967-2021; AAJ-8097-2021Objectives: Our objective was to analyze the incidence of pulmonary disorders in solid-organ transplant recipients and report on outcomes in these patients. Materials and Methods: Seventy liver and kidney transplant patients, who underwent lung biopsy because of pulmonary symptoms between January 2000 and December 2015, were enrolled in the study. We examined and evaluated histopathologic findings of these patients based on clinical data recorded in patients' files. Results: Patients' mean age was 44.5 +/- 16.4 years. Of 70 patients, 25 underwent liver transplant and 45 patients underwent kidney transplant. Forty-six patients received organs from living donors and 24 from deceased donors. Biopsy results of all patients included nonspecific findings (28), organized pneumonia (2), tuberculosis (6), fungal infections (11), tumors (5), amyloidosis (1), diffuse alveolar damage (4), mixed bacterial infection (1), and bronchopneumonia (12). Forty-two patients (60%) died within 54.1 +/- 53.3 months after transplant and 24.6 +/- 41.9 months after lung biopsy. Autopsies were performed on 14 patients. The causes of fatal lung diseases included fungal infections (8), malignant tumors (4), amyloidosis (1), diffuse alveolar damage (4), and mixed bacterial infection (1). Aspergillosis was the most frequently implicated lung infection, occurring in 54.5% of patients with fungal infections. Conclusions: Pulmonary diseases remain an important cause of morbidity and mortality in solid-organ transplant recipients. Fungal infection, especially aspergillosis, was the leading cause of early death in these patients.Item Culture-Positive Pulmonary Aspergillosis Infection: Clinical and Laboratory Features of Solid-Organ Transplant Recipient(2017) Dedekarginoglu, Balam Er; Bozbas, Serife Savas; Ulubay, Gaye; Eyuboglu, Fusun Oner; Haberal, Mehmet; https://orcid.org/0000-0002-7230-202X; https://orcid.org/0000-0003-2478-9985; https://orcid.org/0000-0002-5525-8207; https://orcid.org/0000-0002-3462-7632; 28260471; AAI-8064-2021; AAB-5064-2021; AAR-4338-2020; AAJ-8097-2021Objectives: Aspergillosis is a common fungal infection among solid-organ transplant recipients. Even after awareness of this infection occurs, there are still gaps in nonculture diagnostic tests, which can delay treatment initiation. Here, we aimed to define the common traits of pulmonary aspergillosis infection among solid-organ transplant recipients, thus shedding light on prevention and early diagnosis. Materials and Methods: We conducted a database search of patients at Baskent University who had a positive aspergillosis culture between January 2010 and March 2016. Among 20 patients identified, 15 (mean age of 50.93 +/- 11.17 y, 2 female and 13 male patients) with solid-organ transplant were included in the study. Results: Of the 15 study patients, 7 were heart transplant, 6 were kidney transplant, and 2 were liver transplant recipients. Three patients had positive aspergillosis cultures from extrapulmonary specimens (1 brain biopsy and 2 wound swap cultures). Other patients with positive cultures were from broncho alveolar lavage (6 patients), sputum (4 patients), both bronchoalveolar lavage and sputum (1 patient), and deep tracheal aspiration specimen (1 patient). Aspergillus fumigatus was the most common species. Mean hospitalization duration was 31.53 days (range, 2-135 d). Although all patients had positive culture results, 7 patients (46.7%) had negative galacto mannan test results at the time of culture specimen collection. Positive galactomannan test results were statistically higher in 6 heart transplant patients (P = .045). All patients had fever at presentation, and 13 patients had been referred to the pulmonary disease department before positive culture results were obtained. Conclusions: Risk factors for pulmonary aspergillosis and its clinical presentation in solid-organ transplant recipients are still unclear. Although the expected time for aspergillosis infection in solid-organ transplant recipients is 6 months after transplant, clinicians must remember the nonspecific presentation of infections in these patients and be aware of the reliability of diagnostic tools.Item Effect of L-arginine on Hemodynamic, Biochemical, and Histopathological Outcomes in a New Zealand Rabbit Model of Renal Ischemia-Reperfusion Injury(2016) Ozulku, Mehmet; Aygun, FatihObjective: In this study, we investigated the effect of L-arginine on hemodynamic, biochemical, and histopathological changes in a rabbit model with renal ischemia. Methods: Forty white New Zealand rabbits were used. The rabbits were divided into two groups as the control group (n=20) and L-arginine group (n=20). They were monitored by cannulating the auricular and femoral arteries. An aortic occlusion catheter was inserted through the contralateral femoral artery and was extended to the distal aspect of the left subclavian artery; it was then inflated, and occlusion was performed for 30 min. All rabbits received 4 mL/kg/h of NaCl infusion during the course of occlusion and within the first 60 min of reperfusion. In the L-arginine group, L-arginine was infused at a dosage of 3 mg/kg/h through the auricular vein during the first 60 min of occlusion and perfusion. Blood samples for biochemical parameters [glucose, lactate, hematocrit, blood urea nitrogen (BUN), and serum creatinine] were obtained in the peri-ischemic period, in the 20th minute of reperfusion, and just before sacrificing (48th hour). A histopathological examination was performed in both renal tissues. Histopathological scoring was performed by taking tubular epithelial cell flattening, brush border loss, cytoplasmic vacuolization, cell necrosis, and tubular lumen obstruction into consideration. All animals were sacrificed 48 h after the procedure. Results: A significant difference was found between the L-arginine and control groups in terms of the hemodynamic outcomes and 48th hour BUN and serum creatinine levels (p<0.05). The histopathological examination revealed a mean score of 3.2 +/- 0.89 in the control group and 2.60 +/- 0.68 in the L-arginine group (p<0.05) (p=0.022). Conclusion: It can be suggested that L-arginine reduces renal ischemia-reperfusion injury and in particular, the histopathological effects.Item Analysis of the patients admitted to emergency department due to urogenital trauma and investigation of factors that affect mortality(2017) Kavalci, Cemil; Sozen, Semih; Celik, Simsek; Akpinar, Cafer; Guven, Fatma Mutlu Kukul; Yel, Cihat; Sait, OmerObjective: To determine the general characteristics of urogenital trauma, and the factors that impact on mortality. Methods: Patients who were over 18 years of age admitted to the emergency service with urogenital injury between 1 January 2010 and 31 December 2014 were evaluated retrospectively. Age, gender, type of trauma, injured urogenital organs, vital parameters, additional organ injuries and mortality rate were investigated. Categorical variables were compared by using Chi-square test and comparing to groups data were performed with the Mann-Whitney and Kruskal-Wallis tests. P < 0.05 was considered statistically significant. Results: The median age of 174 patients was 35 years (interquartile range: 22), and 150 patients (86.2%) were males. It was determined that the incidence of urogenital trauma increased in August and September. The kidney was the most frequently injured organ (41.4%) and the most common cause of injury was traffic accidents (49.4%). Mean arterial pressure and revised trauma score were the lowest while pulse rate was the highest in renal trauma patients (P < 0.05). Mean arterial pressure, revised trauma score and respiratory rate were low in mortal group while pulse rate and Glasgow coma scale scores were significantly higher (P < 0.05). Conclusions: It is determined that the most common injured organs in trauma patients are kidneys and bladder and also no single factor is effective on mortality.Item Scintigraphic, histopathologic, and biochemical evaluation of lycopene effects on renal ischemia reperfusion injury in rats(2017) Börcek, Pelin; Sadic, Murat; Atilgan, Hasan Ikbal; Aydin, Arif; Koca, Gokhan; Korkmaz, Meliha; Karakan, Tolga; Surer, HaticeIntroduction/Objective Medical protection of kidneys against ischemia reperfusion injury is very important. Many agents have been used for the protection of ischemia reperfusion renal tissue injury. We aimed to evaluate the radioprotective effect of lycopene on kidneys in ischemia reperfusion injury with histopathological, biochemical, and scintigraphic parameters. Methods Twenty-one Wistar male albino rats were divided into the following three groups: lycopene, control, and sham group. In the lycopene group, lycopene was started three days before right renal ischemia reperfusion injury and continued for 15 days. In the control group, right renal ischemia reperfusion injury was applied with no medication. In the sham group, neither right renal ischemia reperfusion injury nor medication were applied. On the 15th day, all rats were sacrificed after Tc-99m-dimercaptosuccinic acid (DMSA) scintigraphies were taken. Histopathological, biochemical, and scintigraphic evaluations were made. Results The histopathological score was lower in the lycopene group. In biochemical analysis, myeloper-oxidase levels were lower in the lycopene group than in the control group, but not statistically significant. Malondialdehyde and nitrite levels were lower in the lycopene group than in the control group. The postoperative mean Tc-99m-DMSA uptake values were 44.82 +/- 1.84 in the lycopene group, 38.92 +/- 1.17 in the control group, and 50.21 +/- 1.35 in the sham group. DMSA uptake values were higher in the lycopene group than in the control group. Conclusion Lycopene seems to be an effective agent for protection of kidneys in ischemia reperfusion injury as demonstrated by the histopathological, biochemical, and scintigraphic parameters.Item An Extremely Rare Kidney Tumor: Primary Intraparenchymal Squamous Cell Carcinoma(2017) Ipekci, Tumay; Yuksel, Mustafa; Yildiz, Ali; Inal, Gulsah; Ipekci, Oncel; 0000-0002-2755-0526; AAB-2986-2020Primary squamous cell carcinoma of the renal parenchyma is a rare entity and only 4 cases have been reported in the literature. A 73-year-old female patient presented to our clinic with the complaint of right flank pain. On radiologic evaluation, a 6x5x4 cm hypodense mass showing heterogeneous contrast enhancement was observed in the upper pole of the right kidney. An uneventful laparoscopic radical nephrectomy was performed. Final pathologic diagnosis was squamous cell carcinoma. No pathological involvement was observed on postoperative positron emission tomography/ computed tomography. Our patient is still alive and she has not received any adjuvant treatment.