Başkent Üniversitesi Makaleler

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    Determinants of Fasting Total Serum Homocysteine Levels in Liver Transplant Recipients
    (Başkent Üniversitesi, 2006-06) Akoglu, Bora; Wondra, Kathrin; Caspary, Wolfgang F.; Dominik, Faust
    Objectives: Homocysteine (HCY) is a sulfur-containing amino acid considered to be a marker for a relative folate deficiency. Hyperhomocysteinemia is a known risk factor for development of cardiovascular disease, vascular dementia, depression, and possibly some carcinogeneses. Liver transplant recipients have an increased risk for cardiovascular disease because of a high incidence of obesity, arterial hypertension, diabetes mellitus, and hyperlipidemia. The aim of this study is to elucidate the determinants for hyperhomocysteinemia as an additional risk factor in these patients. Materials and Methods: Seventy stable liver transplant recipients, 48 men (mean age, 50 ± 11 years) and 22 women (mean age, 52 ± 13 years) had their serum homocysteine levels tested after orthotopic liver transplantation. For mainstay immunosuppression, 53 patients were treated with tacrolimus, 10 with cyclosporine, 3 with mycophenolate mofetil, and 4 with sirolimus. Fasting blood samples were obtained and analyzed immediately (within 1 hour) for total serum homocysteine by high-performance liquid chromatography. Results: In all patients, mean homocysteine levels were 22.7 ± 14 µmol/L (normal range, 9-15 µmol/L). Forty-six patients were found to have homocysteine levels > 15 µmol/L, and all 70 recipients had homocysteine levels > 9 µmol/mL. In our patients, increased homocysteine levels correlated well with body mass index and renal function. Homocysteine levels in patients receiving cyclosporine were higher than those in patients receiving tacrolimus (22.3 ± 6 vs 17.9 ± 12 µmol/L, P < .05). Conclusions: Overall, homocysteine levels are significantly increased in liver transplant recipients. Homocysteine levels correlate well with obesity, renal function, and the particular immunosuppressant protocol. Therefore, a specific treatment for patients after liver transplantation (eg, one with folates) might reduce the risk of complications resulting from hyperhomocysteinemia.
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    Koroner After Cerrahisi Sonrası Erken Dönemde Obezitenin Rolü
    (Başkent Üniversitesi, 2009-01) C. Vuran; C. Çakalağaoğlu; Ö. Kantarcı; B. Yiğiter
    Özet Amaç: Hızlı ve dengesiz beslenmenin yaygınlaşmasına paralel olarak, obez popülasyonda da artış görülmektedir. Obez hastalar her geçen gün artan sayılarda kardiyak cerrahi girişimlere maruz kalmaktadırlar. Çalışmamızda obez hastalarda koroner arter bypass greft cerrahisi uygulamalarının sonuçları sunulmaktadır. Materyal ve Metod: Ocak 2003-Nisan 2004 döneminde kliniğimizde 96 (60E, 36K) obez hastaya koroner arter cerrahisi uygulanmıştır. Obezite kriteri olarak vücut yüzey kütlesi(BMİ) ≥30 kg/m2 değeri kullanılmıştır. Olgular 35-76 (median=58) yaş aralığında, Newyork Kalp Derneği (NYHA) sınıflamasına göre ortalama 3. grupta yer almakta idiler. Ameliyat öncesi anamnezlerde 54 (%56) vakada hipertansiyon, 42 (%44) vakada Diabetes Mellitus, 8 (%1) vakada Kronik Obstrüktif Akciğer Hastalığı, 50 (%52) vakada geçirilmiş Myokard Infarktüsü, 26 (%27) vakada sigara içiciliği bulunmakta idi. Sonuçlar: Angiografilerinde ortalama 2,3 ± 0.8 damar hastalığı saptanmış olup, aralıklı aortik kros klemp tekniği ile ortalama 1,93 ± 0.6 bypass yapılmıştır. Ortalama kros klemp zamanı 38 ± 12 dakika ve ortalama kardiyopulmoner bypass zamanı 76 ± 34 dakika olarak gerçekleşmiştir. Ameliyat çıkışı 5 hastaya inotrop destek gereksinimi olmuştur. Yoğun bakım kalış süresi ortalaması 1,4 ± 0.6 gündür. Erken mortalite(1 aylık) preoperatif myokard infarktüsü hikayesi olan 1 (%1) vaka ile sınırlıdır. Erken dönem morbiditesi olarak 11 (%11) hastada atriyal fibrilasyon oluşmuş ve 1 (% 1) olguda kalıcı olmuş, 2 (%2) vakada mediastinit, 3 (%3)vakada sternal dehissenz, 8 (%8) olguda plevral effüzyon ve 5 (%5) hastada düşük debi saptanmıştır Yorum: Ameliyat sonrası erken dönemde yara enfeksiyonlarında görülen hafif yükselme harici erken dönem mortalite ve morbidite oranlarında belirgin bir artış bulunmadığını ve obez hastalarda da gerektiği durumlarda koroner bypass cerrahisi girişimlerinin güvenli ve emin bir şekilde uygulanabilir olduğunu düşünmekteyiz. Summary Effects of Obesity During the Early Postoperative Period After Coronary Bypass Surgery Objectives: The number of obese persons has increased in paralel to increases in the number of fast food restaurants and poor nutrition.Obese patients are progressively subjected to cardiac surgery. In our study, preoperative results of coronary bypass procedures in obese patients are presented. Materials and Methods: Coronary bypass surgery was performed in 96 obese patients (60men,36 women;mean age,60,4; median age, 58; age range 35-76 years) between January 2003 and April 2004. The criterion for obesity was a body mass index (BMI) of 30 kg/m2 or more. Patients were Newyork Heart Association classification group 3. Preoperatively, 54 patient (56%) had hypertansion, 42 (44%) had diabetes mellitus, 8 (1%) had chronic obstructive pulmonary disease, 50 (52%) had a prior myocardial infarction and 26 (27%) were smokers..Results: A mean of 2,3 ± 0.8 vascular diseases were determined by angiography, and a mean of 1,93 ± 0.6 bypasses had been performed by interrupted aortic cross clamp technique. The mean cross clamp time was 38 ± 12 minutes and, the mean cardiopulmonary bypass time was 76 ± 34 minutes. A high dose inotropic drugs support was required in 5 patients. The mean stay in the intensive care unit was 1,4 ± 0.6 days. Early mortality was limited to 1 patient (%1), who had a history of preoperative myocardial infarction. Regarding early morbidities, atrial fibrillation was seen in 11 patients (11%) and was persistent in 1 patient (1%); mediastinitis, sternal dehiscence, pleural effusion and low output occurred in 2 patients (%2), 3 patients (%3), 8 patients (%8) and 5 patients (%5). Conclusion: Except for a slight increase in wound infections, no marked increase was found regarding mortality and morbidity rates during the early postoperative period after a coronary bypass procedure in obese patients. The coronary bypass procedure, when necessary,can be effectively and safely performed in obese patients.