Başkent Üniversitesi Makaleler

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A Case of Falling Into an Acid Tank From Height After High-Voltage Electrocution
(Başkent Üniversitesi, 2024-12) Burak Özkan; Abdullah Kızmaz; Uğur Bak; Khalid Zeynalov; Süleyman Savran; Abbas Albayati; Çağrİ A. Uysal; Mehmet Haberal
In this case report, we present the management of a dramatic and rare combination of injuries: high-voltage electrical injury, chemical burn, and open tibial and calcaneal fractures resulting from a fall from height. The patient underwent early fasciotomies. After treatments administered by a multidisciplinary team consisting of plastic surgeons, general surgeons, orthopedic specialists, anesthesiologists, and physiotherapists, the patient was discharged without extremity loss after a 135-day hospital stay. This case report discusses the importance of early fasciotomy and debridement in management of extensive burns and fall-related injuries, the potential for extended hospitalization for reconstruction, and the necessity of a multidisciplinary approach.
A Case of Progressive Mortal Thrombosis: Phlegmasia Cerulea Dolens
(Başkent Üniversitesi, 2023-03) Khalid Zeynalov; Burak Ozkan; Tankut Akay; A. Cagri Uysal; Mehmet Haberal
ABSTRACT Phlegmasia cerulea dolens is a very rare set of conditions associated with acute, massive venous thromboembolism. Medical and surgical options can be combined in treatment. Patients may experience sudden onset and severe leg pain, edema, cyanosis, compartment syndrome, and post-venous gangrene amputation and death. Medical and surgical treatments can be combined in treatment. Anticoagulants, thrombectomy, percutaneous procedures and amputations are among the treatment options. We present a 60-year-old female patient with a diagnosis of diabetes mellitus with swelling, pain, and discoloration in the left lower extremity who died due to progressive venous thrombosis despite various treatment modalities. Wound debridement and thrombectomy were performed. On day 10 of hospitalization, the patient was intubated to treat resistant low saturation. Despite the interventions, the patient died on day 10 of hospitalization due to cardiopulmonary arrest. Early diagnosis and treatment are vitally important. As in the case we presented, sometimes patients die as a result of rapid clinical progression and side effects, despite the use of different medical and surgical treatments.
A Clinicoepidemiological and Outcome Analysis of 770 Burn Patients: A 5-Year Retrospective Study in a Private Sector Tertiary Burn Care Center in Indore, Central India
(Başkent Üniversitesi, 2022-09) Rajpal Singh; Shobha Chamania; Sunil Chandiwal; Deepak Tripathi; Deepika Jain; Ankit Mishra; Tasvir Balar; Prashant Srivastava
ABSTRACT OBJECTIVES: Burns are a global public health problem and one of the major causes of disability, with more than 8 million disability-adjusted life-years. Our aim was to contribute a comprehensive analyses of existing burn data from Central India. MATERIALS AND METHODS: We reviewed secondary data of burn patients from 5 years (March 2016 to March 2021) from a single center (Choithram Hospital & Research Centre, India). All burn patients except those with nonhealing and old burn wounds were included. We examined the following: age, sex, socioeconomic status, type of burn, total burn surface area, comorbidities, treatment, and outcome, with data analyzed using Statistical Package for Social Sciences version 20.0. RESULTS: Our study included 770 patients (median age of 28.0 y). Male-to-female ratio was 1.26:1. Burns were common in the reproductive age group of 21 to 40 years (48.6%) and in people of a lower socioeconomic status (65.2%). There was predominance of flame burns (82.0%). The most common mode of burning was accidental (79.4%). The median (interquartile range) of total burn surface area among patients was 25% (12%-45%). Flame burns resulted in significantly greater injury (total burn surface area 30.0%) compared with electric (total burn surface area 23.0%) and scald burns (total burn surface area 11.5%). The commonest comorbidities were hypertension (5.2%) and diabetes (4.7%). We observed significant associations between outcome and age, sex, comorbidities, and treatment modalities. Homograft, autograft, or collagen/other dressing or a combination of these compared with conservative treatment resulted in better healing and reduced hospital stay (P < .001). CONCLUSIONS: Age, sex, type of burn, total burn surface area, comorbidities, and treatment modalities were significantly associated with outcome of burn patients.
A New Method for Determining the Volume Of Blood Loss During Necrectomy in Patients With Deep Burns
(Başkent Üniversitesi, 2023-06) Evgenij V. Zinoviev; Denis O. Vagner; Alexander E. Chukharev
ABSTRACT OBJECTIVES: Most surgery manuals indicate that, for excisions of a burn scab on an area of 1 cm2 with skin plasty, blood loss, taking into account donor zones, is about 1 mL. This volume of alleged blood loss plays an essential role in planning surgical treatment of patients with burn injuries. To date, when volume of lost blood is calculated with the use of existing methods for determining intraoperative blood loss, it is not recommended to excise necrotic tissues on an area of more than 15% of the body surface. In this study, our aim was to develop a new formula for determining intraoperative blood loss during necrectomy in patients with deep burns. MATERIALS AND METHODS: We developed and proposed our own, original method for determining the volume of intraoperative blood loss, based on taking into account hemoglobin and hematocrit indicators, as well as differentiated calculation of the volume of circulating blood. This technique was tested on 109 patients with deep burns (per ICD-10), who were admitted to our department from January 2022 to December 2022 because of thermal lesions. We processed obtained data using Microsoft Office Excel and used generally accepted methods of nonparametric statistics. RESULTS: With the new formula, we determined blood loss of 0.52 mL per 1 cm2 of excised tissue, which is 2 times less than predicted by traditional methods. CONCLUSIONS: Our results showed that the expected intraoperative blood loss may not be 1 mL/1 cm2, as currently prescribed in clinical guidelines, but 0.5 mL/1 cm2 of the excised tissue. Our results allow for possible expansion of the removal of the burn eschar before the development of infectious complications.
A Novel Technique for Hepatic Arterial Reconstruction in Living-Donor Liver Transplant
(Başkent Üniversitesi, 2007-06) Haberal, Mehmet; Sevmis, Sinasi; Karakayali, Hamdi; Moray, Gokhan; Yilmaz, Ugur; Ozcay, Figen; Torgay, Adnan; Aydogan, Cem; Arslan, Gulnaz
Objectives: Arterial reconstruction in patients undergoing living-donor liver transplant is technically difficult because of the small diameter of the vessels in the partial liver graft. In this study, we present our technique for hepatic arterial reconstruction. Methods: Since December 2005, we have performed 54 living-donor liver transplants, which are analyzed retrospectively in this report. In our technique now used at our institution, native and graft hepatic arteries are spatulated from both the anterior and posterior walls to provide a wide anastomosis. Computed tomographic angiography is used to evaluate the vascular anatomy and to measure the diameter of the graft hepatic arteries. Results: Mean follow-up was 7.2 ± 5.5 months (range, 1-17 months). Nine of the 54 recipients died within 4 months of the surgery. At the time of this writing, the remaining 45 recipients (84%) are alive and demonstrating good graft function. In 2 recipients (3.7%) in this series, hepatic artery thromboses developed, which were treated with an interventional radiologic technique. Conclusions: Our arterial reconstruction technique has enabled reconstruction of smaller arteries and arteries of various diameters without an operating microscope. The rate of complications in our patients is similar to that reported in similar individuals.
A Rehabilitation Case Management Model for Severely Burned Victims
(Başkent Üniversitesi, 2022-12) Emilio Gonzalez Silva
ABSTRACT In Chile, since 2007, the treatment of people with major burns is protected by the Explicit Health Guarantees Law, which guarantees access, opportunity, and financing to public and private providers that offer treatment compliance and follow-up. This includes the Emergency Hospital of Public Assistance, located in Santiago, the main National Reference Center for the management of burns in adults throughout the national territory. To favor the counter-referral of severely burned patients after their care at the National Reference Center Emergency Hospital of Public Assistance, a follow-up process has been designed during all in-hospital rehabilitation phases. This has been named the Rehabilitation Case Management model, with the additional emergence of the rehabilitation case manager.
A Study on Employment in Non-Life Insurance Companies: Fuzzy Regression Example
(Başkent Üniversitesi, 2022-12-12) Akgül ,Yusuf; Çamlıbel,Fuat; Şengönül , Ahmet
Purpose: In this study, factors affecting employment in non - life insurance companies were examined. These factors are the financial variables of insurance companies, including financial profit-loss, total net premiums, total assets and technical profit-loss. Methodology: Fuzzy regression method was used as the solution method. Findings: According to the results, the change interval of the financial variables was found significant at h = 09. As a result, the change interval in total assets was % 0.0906, the financial profit was nearly “0”, technical profit/loss was % 0.0392 and the sum of premiums was % 62,04. Also, real employment data was found to be closer to the upper regression limit. Implications: The results obtained by the fuzzy regression method are quite better from the panel data solution method in terms of the consistency of the estimates. When it is desired to generate prediction models for the employment with financial variables of the companies in the sector, the fuzzy regression method is good at creating meaningful models and gives more consistent information about the coefficient of the related arguments. If the results of the study will be interpreted economically and socially; it was observed how internal variables, which are thought to affect the employment capacity of insurance companies, affect employment in insurance companies. It is observed that the increase in the size of premium gain in insurance companies has a positive effect on its employment. This effect will have positive effects on creating new employment in the insurance sector. This increase in employment will also have positive effects for the country's economy. Limitations: However, developing technology and making many insurance transactions online will cause companies to decrease their employment capacity even if their premium gain size increases. For example, there will be a decrease in needed field sales staff and number of agencies. In this case, on the contrary, it will increase the number of unemployed people in insurance sector and in the country. The decrease in employment and increasing unemployment will affect both people and the country's economy negatively. Economically, a negative outlook will occur in the domestic and foreign markets.
ABO Incompatible Kidney Transplantation -Immunological Aspect-
(Başkent Üniversitesi, 2003-12) Aikawa, Atsushi; Yamashita, Mioko; Hadano, Tomomi; Ohara, Takehiro; Arai, Kenji; Kawamura, Takeshi; Hasegawa, Akira
ABO incompatible kidney transplantation (ABOINCKT) has been developed in Japan because of the shortage of cadaveric donors. We have performed 76 living-donor ABOINCKT in our center. Donor blood type antibody was removed by immunoadsorption or plasmapheresis and exchange. Immunosuppression consisted of cyclosporine or tacrolimus, steroid, and cyclophosphamide or azathioprine or mycophenolate mofetil and, recently, basiliximab. Splenectomy was routinely performed during the transplantation surgery. Donor blood type antigen was strongly expressed on the vascular endothelium at all time points and in all conditions posttransplantation. Red blood cell agglutination reaction (RBAR) was positive only in renal tissues from a patient with delayed hyperacute rejection. Donor specific antibody suppression was observed in 18 ABOINCKT recipients with blood type O from a donor with blood type A1 or B. ADCC activity was detected after pre-treatment. Acute humoral rejection in ABOINCKT can result from ADCC, as well as by antigen-antibody reaction. Five year graft and patient survival rates were 75% and 64% in 37 ABOINCKT recipients from June 1989 through December 1996, however they have been 100% in 39 ABOINCKT recipients since January 1997. Accommodation has been produced in ABOINCKT with the co-existence of blood type antigen and antibody. Currently, ABOINCKT is an alternative which should be considered, particularly for blood type O patients with extended waits for cadaveric transplantation and for pediatric patients.
Advances in the Development of Tissue Engineering Applied to the Skin Using Three-Dimensional Bioprinters for the Treatment of Burn Patients
(Başkent Üniversitesi, 2021-06) Alberto Bolgiani; Elida Hermida; Priscilla Alcocer; Giovanni Alcocer
The concept of three-dimensional printing was developed in 1980, and the idea of three-dimensional printing to manufacture objects was established in 1986. In 1993, the technology allowed the printing of plastics and metals, with a series of three-dimensional printers having different applications being subsequently developed. In 2002, Italian researchers developed the dermal regeneration matrix (hyalomatrix) with hyaluronic acid and silastic fibers, mimicking the epidermis. In 2003, Mexican researchers developed an allogeneic keratinocyte culture as a system for the release of growth factors in skin lesions. Over the past 10 years, 15 matrices of dermal regeneration have been developed. This technology has had a great impact on engineering and medicine. In medicine, an important application is tissue engineering, not only for the manufacturing of skin and grafting but also for conducting scientific investigations on the evaluation and discovery of drugs. The use of bioprinting of tissues can allow a layer-by-layer aggregation of cells to be obtained, allowing organization of multiple cell types in a desired structure. After in vitro cell culture, allowing respective growth and maturation to achieve the desired tissue, tissue implantation can then be performed. The three-dimensional bioprinting technique can improve both spatial resolution and reproducibility, allowing optimal conditions for cell incubation and maturation. In addition, with a limited supply of donors, bio-fabrication of organs and tissues can help with future transplant procedures.
Ageing and Immunosuppression in Kidney Transplantation
(Başkent Üniversitesi, 2004-12) Land, Walter Gottlieb
Modern approaches to tailor-made, individualized immunosuppressive therapy for patients receiving organ transplantation require a rethinking of therapeutic strategies when it comes to older persons receiving kidney transplants, especially from deceased older donors. This review article makes the case for the use of calcineurin-inhibitor–free immunosuppressive induction/maintenance protocols in this “worst-case scenario” and discusses the theoretical and clinical data that support this recommendation. We will discuss modern theories of ageing, emphasizing the free-radical theory in relation to new insights into the mechanisms of innate immunity. In this context, a new, modified theory of ageing is presented. Increased generation of reactive oxygen species during ageing, via increased leakage of these oxidizing molecules from mitochondria, may contribute to senescence and age-related diseases by direct damage to intracellular DNA, proteins, and lipids. In addition, free-radical–mediated tissue injury, accompanied by induction of damage-associated molecular patterns, may result in activation of both inflammatory and vascular cells of the innate immune system, contributing (via inflammatory processes) to ageing and age-related diseases such as atherosclerosis. Calcineurin-inhibiting agents have been shown to induce oxidative stress and are thus defined as “proageing” drugs. Their use in older patients may aggravate the preexisting oxidized intracellular state and therefore should be avoided. In contrast, inosine-monophosphate dehydrogenase–inhibiting agents such as mycophenolate mofetil have been shown to even ameliorate oxidative stress and are thus defined as “antiageing” drugs. Therefore, their use for immunosuppression in older patients receiving kidney transplantation is suggested. This recommendation is supported by data from a prospective trial on the application of a calcineurin-inhibitor–free, mycophenolate-mofetil–based indu-ction/maintenance immunosuppressive protocol in older recipients of kidneys from deceased older donors: the 5-year patient and 5-year allograft survival rates are currently 87% and 70%, respectively.
An Outbreak of Chickenpox in Adult Renal Transplant Recipients
(Başkent Üniversitesi, 2007-06) Shahbazian, Heshmatollah; Ehsanpour, Ali
Infection with the varicella-zoster virus, the etiologic agent of chickenpox and herpes zoster, is more serious in immunosuppressed renal transplant recipients than it is in the general population. Chickenpox is a rare infection in adult renal transplant recipients; however, it is significant owing to the severity of its clinical features and its associated high mortality rate. To date, there are no reported outbreaks of primary varicella-zoster virus infection in adult renal transplant recipients. Here, we report 3 patients with chickenpox who presented to our center between May 2006 and June 2006.
Analysis of Marginal Donor Parameters in Liver Transplantation for Primary Biliary Cirrhosis
(Başkent Üniversitesi, 2004-06) Garcia, C E; Garcia, R F L; Gunson, B; Christensen, E; Neuberger, J; McMaster, P.; Mirza, D F
The shortage in cadaveric donor livers is pushing the transplant centers to expand the pool by using “marginal” donors. Primary biliary cirrhosis (PBC) remains an important indication for transplantation. We conducted a retrospective analysis of prospectively collected data in a well-defined group of patients with PBC where 301 consecutive donor-PBC recipient pairs transplanted were analyzed to identify donor and operative factors influencing recipient outcome. Mean follow-up was 56 months. The 1-, 3- and 5-year actuarial patient and graft survival was 93.97%, 90.64%, and 81.75%, and 85.49%, 82.57%, and 75.21%, respectively. Factors showing influence in decreased total patient survival were recipient old age (P = 0.003) and low recipient albumin (P = 0.01). However, the only variables showing an association with decreased patient survival within 90 days are old donor age (P = 0.002) and high donor body weight (P = 0.03) or high body mass index (BMI) (P = 0.055). Cold ischaemic time (CIT) of 18 hours showed statistical significance in patient survival (P = 0.025). Obesity did have a significant adverse impact on survival compared with normal or overweight donors (BMI < 30), decreasing survival by 50% at 5 years. In conclusion, this study of several factors considered “marginal” for transplantation in a recipient population with predictable liver disease (PBC), donor BMI and age were shown to be associated with decreased graft and patient survival.
Are Perianal Burns Really that Dangerous?
(Başkent Üniversitesi, 2023-06) Ebral Yiğit; Güler Tekeş
ABSTRACT OBJECTIVES: This study aimed to evaluate burns involving the genitals, perineum, and buttocks of pediatric patients and to compare mortality-related factors with the existing literature. MATERIALS AND METHODS: We retrospectively investigated 67 pediatric patients admitted for emergency surgery at the Burn Center of Gazi Yaşargil Training and Research Hospital, Turkey, between January 2019 and June 2022. RESULTS: Mean age of the 67 patients was 3.37 ± 3.73 years. The patients mostly resided in the city, and 17 patients were admitted to the hospital within 1 or more days of the injury. Patients in the 0- to 4-year age group ranked highest in occurrence of perineal burns; the incidence gradually decreased after 4 years of age. Scalding occurred in 59 patients, flame burns in 4 patients, and perineal injuries from electrical burns in 4 patients. Perineal wound culture results were positive for 40.9% patients, with Staphylococcus epidermis being the most common bacteria (37.9%). No patient underwent colostomy as a result of a perianal burn; 2 patients (3.0%) developed sepsis, and 1 patient (1.5%) died. CONCLUSIONS: The risk of temporary colostomy or ileostomy is reduced in perineal burns when there is adequate early, aggressive, and extensive debridement, in addition to antimicrobial therapy.
ARTICLE Course of the Wound Process With the Use of Modern Technologies in Local Treatment of Patients With Burns
(Başkent Üniversitesi, 2023) Fayazov Abdulaziz Jalilovich; Ruzimuratov Dilmurod Abdimuratovich; Kamilov Utkur Raimovich; Magdiev Shukhrat Alisherovich
ABSTRACT OBJECTIVES: We aimed to assess the wound-healing process using modern temporary wound dressings in local treatment of patients with burns. MATERIALS AND METHODS: From 2014 to the first half of 2022, the Department of Combustiology of the Republican Research Center of Emergency Medicine, Republic of Uzbekistan, conducted local treatment of 225 patients with superficial burns and 105 patients with deep IIIB/IV degree burns (age range, 1-60 years; mean age 17.5 ± 16.4 years). Most were children and adolescents (n = 146, aged 1-18 years); 79 were people of working age (age range, 19-60 years). The control group (115 patients with superficial burns, 55 patients with deep burns) received traditional local treatment using water-soluble ointments. The study group (110 patients with superficial burns, 50 patients with deep burns) received temporary wound dressings produced by New Dressing Materials CJSC, Russia (Parapran and Voskopran), with various options for local treatment. RESULTS: In 105 patients with deep burns, 122 necrectomy (early-delayed and delayed), 18 osteonecrectomy, and 134 autodermoplasty surgeries were performed. Fifty-two patients with traditional treatment received chemical necrectomy using 20% to 40% salicylic ointment. Less cases of toxic hepatitis, along with improving local reparative properties, were shown in patients who had active surgical tactics in the early stages after injury and temporary wound dressing than in the control group. Local treatment with temporary wound dressing in patients with extensive burns contributed to reduced purulent-septic complications, with no patients having burn sepsis. However, in severely burned patients in the control group, 3 patients (1.8%) had burn sepsis. CONCLUSIONS: Traditional methods of treatment are not acceptable for providing high-quality and qualified care for deep burns. Temporary wound dressings can reduce recovery time, being the most physiologically acceptable covering of burn surface wounds and achieving its main goal of early formation of granulation tissue, reducing secondary inflammatory processes.
Association between Cyclosporine Concentration and Genetic Polymorphisms of CYP3A5 and MDR1 during the Early Stage after Renal Transplantation
(Başkent Üniversitesi, 2006-06) Azarpira, N.; Aghdaie, MH.; Behzad-Behbahanie, A.; Geramizadeh, B.; Behzadi, S.; Malekhoseinie, SA .; Raisjalal, GH.; Rahsaz, M.; Pourgholami, A.; Sagheb, F.
Objectives: Cyclosporine (CsA) has a narrow therapeutic range, and its pharmacokinetic characteristics vary among individuals. It also is a substrate for cytochrome P450 (CYP) 3A and P-glycoprotein, the product of the multidrug resistance 1 (MDR1) and CYP3A5 genes. Some of the single nucleotide polymorphisms (SNPs) in these genes are associated with deficient protein expression and reduced in vivo activity. We postulated that in renal transplant recipients, these SNPs should be associated with interindividual variations in CsA pharmacokinetics. Materials and Methods: In 88 Iranian renal transplant patients receiving CsA, CYP3A5 and MDR1 genotypes were determined by polymerase chain reaction, followed by restriction fragment length polymorphism analysis. Whole blood trough CsA concentrations were measured by radioactive immunosorbent assay. The dose-adjusted concentration (ng/mL per mg/kg/d) was calculated at 1 day (± 2 days), 7 days, and 1 month after transplantation. Results: The MDR-1 wild-type genotype (3435CC) was observed in 17 patients (19%), whereas 45 patients (51%) were heterozygous (3435CT), and 26 patients (30%) were homozygous (3435 TT) for the mutation. In the days immediately after transplantation, we found a correlation between the concentration/dose ratio and the exon 26 MDR single nucleotide polymorphisms (33.3 ± 15.24 µg mg/L/kg in the CT group vs 44.1 ± 28.4 µg mg/L/kg in the TT group, P = .019). This ratio was significantly higher in subjects homozygous for the mutation (3435TT). This significant difference was not seen 1 week or 1 month after transplantation. All patients had the CYP3A5*3/*3 genotype, so no differences among the CYP3A5*1/*3 genotypes were found. Conclusions: MDR-1 (3435CC) polymorphisms are associated with CsA pharmacokinetics and dose requirements in the first few days after renal transplantation. Pharmacogenetic methods could be used to help select the initial dosage and individualize immunosuppressive therapy. According to our results, the major genotype of our recipients is CYP3A5*3/*3. According to the literature, the recommended starting dosage of CsA is 9-14 mg/kg/day; however, the Iranian population has a good response with lower dosages (3-5 mg/kg/day), which may be explained by genetic differences.
Availability of Reduction Mammoplasty for Neck Burn Scar Contracture in Women
(Başkent Üniversitesi, 2022-09) Takatoshi Yotsuyanagi; Ken Yamashita; Ayako Gonda; Chihiro Teramura; Masahiro Onuma; Asako Miyabayashi; Toshimasa Tennoji; Marimi Funahashi; Kaiji Nishibata
ABSTRACT Severe scar contracture can easily occur after a burn injury in the neck region, resulting in a functional decline that affects daily living. Because a hard scar tissue in the neck widely extends into the anterior chest wall in patients with severe burns, excessive forces should be exerted to extend the neck. We found that the impact force by the weight of the breast sometimes intensifies contracture tendency and leads to the recurrence of the contracture in women. To date, medical reports have paid little attention to this. We performed reduction mammoplasty on 3 female patients with neck burn scar contractures before the release of neck scar. About 200 g of tissue were removed from each breast according to the McKissock technique. In 1 case, the skin was moved to the axilla as a skin flap to release the contracture. The remaining neck scar contracture was then reconstructed with a local flap or free flap. In all 3 patients, mammoplasty and neck reconstruction were performed without complications and with good results. No recurrence of contracture occurred. Reduction mammoplasty in advance reduced the level of neck scar contracture and allowed for a variety of reconstruction options, including local skin flaps, and was also effective in preventing postoperative recurrence.
Back Table Procedure for the Modified Piggyback Technique of Liver Transplantation: A Simple Test To Identify Caval Leaks on the Bench
(Başkent Üniversitesi, 2004-12) Orug, Taner; Jarufe, Nicolas; Soonawalla, Zahir; Tekin, Koray; Mirza, Darius F.; Mayer, David
Objectives: In October 2001, we elected to change from the standard orthotopic liver transplantation procedure to the modified piggyback technique with side-to-side cavo-cavostomy, and to document complications such as caval leaks prospectively. Failure to identify and ligate caval tributaries during bench preparation of liver allografts results in troublesome hemorrhage after reperfusion. After our experience with the first 30 piggybacks, we introduced a simple leak test to resolve this problem. Materials and Methods: The leak test consists of inflating the inferior vena cava with preservation solution via the infrahepatic inferior vena cava after closure of the suprahepatic inferior vena cava at the end of the bench procedure. Between October 2001 and July 2002, 112 whole liver transplants were performed in 108 adults. Standard orthotopic liver transplantation (group 1) was performed in 25, modified piggyback without leak test (group 2) was performed in 30, and modified piggyback after leak test (group 3) was performed in 57 patients. The incidence of caval leaks before and after introduction of the test was compared using the chi-square test. Results: Nine patients in group 1 (36%) and 13 in group 2 (43%) required additional sutures to control bleeding from caval branches after reperfusion. In group 3, the leak test identified caval tributaries that required ligation in 20 livers (35%) before implantation; none bled after reperfusion. Of the 37 cases with negative leak test results, 3 (8%) subsequently bled from missed caval branches. Sensitivity, specificity, and accuracy for the leak test were 100%, 92.1%, and 94.7% respectively. Conclusions: Nearly all small branches of the inferior vena cava can be successfully identified during the back table procedure by performing a leak test.
Bacteremia Using the Molecular Adsorbent Recirculating System in Patients Bridged to Liver Transplantation
(Başkent Üniversitesi, 2005-06) Doria, Cataldo; Marino, Ignazio R.
Objective: To retrospectively analyze the incidence and implications of bacteremia in patients supported by a molecular adsorbent recirculating system bridged to liver transplantation. Material and Methods: From September 2000 to April 2003, 30 patients (17 males and 13 females, aged 15-70 years; median age, 52 years) presenting with acute-on-chronic liver failure were treated with a molecular adsorbent recirculating system. Results: Nine patients (30%) developed bacteremia (positive blood culture) during treatment, 100% of them died during the same hospital admission. The most common isolates were Pseudomonas aeruginosa (44.4%) and Escherichia coli (33.3%). Sputum (44.4%) and ascites (33.3%) represented the most common sources of infection followed by urine and purely bloodborne infections (11.1% each). The isolate in the sputum was Pseudomonas aeruginosa 100% of the time, whereas Escherichia coli was found in 66.6% of the ascites cultures. The hemodynamic profile of patients who developed positive blood cultures showed significantly lower systemic vascular resistance indexes compared with those of nonbacteremic patients before and after treatment. There was a statistically significant difference (P = 0.0002) in survival between the bacteremic (who all died) and the nonbacteriemic patients treated. Conclusions: Bacteremia was found to be a negative prognostic factor for patients supported with a molecular adsorbent recirculating system and therefore, a contraindication to starting and/or continuing treatment. Infection should be carefully ruled out prior to initiating treatment using a molecular adsorbent recirculating system. Moreover, prophylaxis with broad-spectrum antibiotics that provide double coverage against Gram-negative bacteria should be mandatory.
Barış Operasyonlarına Kavramsal ve Kuramsal Bakış
(Başkent Üniversitesi, 2018-09-30) Bilgin,Kıvılcım Romya
Uluslararası sistemde çatışmaların çözümü en önemli meselelerin başında gelmektedir. Küreselleşmenin hızıyla uluslararası sistemde değişen güvenlik koşulları uluslararası topluluğu çatışmaların çözümünde birlikte hareket etmeye ve barışçı müdahalelerde bulunmaya daha fazla zorlamaktadır. Bu durum barış operasyonlarının uluslararası sistemde güveliğin sağlanmasındaki öneminin artmasına neden olmaktadır. Barış operasyonlarının uluslararası sistemdeki rolleri, bölgesel ya da küresel sonuçları nelerdir gibi temel soruların cevaplanabilmesi için operasyonların kavramsal ve kuramsal çerçevesinin net bir şekilde ortaya konulması gerekmektedir. Bu yöndeki bir çalışma operasyonların en önemli yürütücüleri olan BM ve NATO’nun geçirdiği değişimin ve bu değişimin 21’nci yüzyılda uluslararası güvenlik sistemine yansımalarının anlaşılması açısından da bir gerekliliktir. Bu amaçla, çalışmada barış operasyonlarının değişen güvenlik ortamındaki rollerine ilişkin kavramsal ve kuramsal bir çerçeve sunulmaya çalışılacaktır.
Basic and Clinical Research in Polyomavirus Nephropathy
(Başkent Üniversitesi, 2004-06) Trofe, Jennifer; Gordon, Jennifer; Roy-Chaudhury, Prabir; Koralnik, Igor; Atwood, Walter; Eash, Sylvia; Alloway, Rita R; Khalili, Kamel; Alexander, J W; Woodle, E Steve
Over the last decade, polyomavirus nephropathy (PVN) has emerged as an important cause of renal allograft dysfunction and graft loss. PVN occurs with a prevalence of 1%-8% in renal transplant recipients and is most commonly reported within the first 12 months posttransplant. The human polyomavirus, BK virus, is thought to be the primary etiologic agent of PVN. Risk factors for PVN are not well defined and are most likely a result of a complex interaction between multiple donor and recipient factors. Definitive diagnosis of PVN is made through histological assessment of a renal allograft biopsy. Recent studies have also evaluated noninvasive urine and serum markers for screening of BK virus replication and as adjunct tools in PVN diagnosis and monitoring. The principal treatment for PVN is immunosuppression reduction, but this must be balanced against the risks of rejection. If rejection occurs concurrently with PVN, a brief increase in immunosuppression to treat the rejection episode followed by a subsequent reduction in immunosuppression is recommended. No antiviral treatments for PVN have been approved by the Food and Drug Administration. Although the antiviral drug cidofovir has shown invitro activity against murine polyomaviruses, and has been effective in some patients, it is associated with significant nephrotoxicity. Small series of patients treated with leflunomide and intravenous immune globulin therapy for PVN have also recently been reported. Retransplantation after graft loss due to PVN is feasible, but experience is limited. Current research is focusing on identifying PVN risk factors, refining screening, diagnostic and monitoring methods, and developing therapy for prophylaxis and treatment of PVN with the goals of decreasing the prevalence of PVN and improving allograft outcomes in renal transplant recipients diagnosed with PVN. This review will present recent advances in basic and clinical research related to PVN and renal transplantation.