PubMed Kapalı Erişimli Yayınlar
Permanent URI for this collectionhttps://hdl.handle.net/11727/10764
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Item A New Approach To The Management Of Acute Appendicitis: Decision Tree Method(2022) Erkent, Murathan; Karakaya, Emre; Yucebas, Sait Can; https://orcid.org/0000-0002-3592-5092; 35152124; CAA-2756-2022Background: It is important to distinguish between complicated acute appendicitis (CAA) and noncomplicated acute appendicitis (NCAA) because the treatment methods are different. We aimed to create an algorithm that determines the severity of acute appendicitis (AA) without the need for imaging methods, using the decision tree method. Methods: The patients were analyzed retrospectively and divided into two groups as CAA and NCAA. Age, gender, Alvarado scores, white blood cell values (WBC), neutrophil/lymphocyte ratios (NLR), C-reactive protein value (CRP), albumin value and CRP/Albumin ratios of the patients were recorded. Results: In the algorithm we created, the most important parameter in the distinction between CAA and NCAA is CRP. NLR is predictive in patients with a CRP value of <= 107.565 mg/L, and the critical value is NLR 2.165. In pa-tients with a CRP value of >107.565 mg/L, albumin is the determinant and the critical value is 2.85 g/dL. Age, gen -der, alvarado score and CRP/albumin ratio have no significance in distinguishing between CAA and NCAA. In the statistical analysis, there were significant differences between NCAA and CAA groups in terms of age (39.56 years vs 13,675 years), gender (48.1% male vs 71.4% male), WBC (13,891.10/mL vs 11,614.76/mL), CRP (27 mg/L vs 127 mg/L), albumin (3 g/dL vs 3 g/dL) and CRP/albumin (9.50 vs. 41). Conclusion: Thanks to the algorithm we created, CAA and NCAA distinction can be made quickly. In addition, by avoiding unnecessary surgical procedures in NCAA cases, patients' quality of life can be increased and morbidity rates can be minimized.(c) 2022 Elsevier Inc. All rights reserved.Item A model for acute kidney injury in severe burn patients(2022) Karakaya, Emre; Akdur, Aydincan; Aydogan, Cem; Turk, Emin; Sayin, Cihat Burak; Soy, Ebru Ayvazoglu; Yucebas, Sait Can; Alshalabi, Omar; Haberal, Mehmet; 0000-0002-4879-7974; 0000-0002-8726-3369; 0000-0002-8726-3369; 0000-0002-0993-9917; 0000-0002-3462-7632; 33879373; AAD-5466-2021; AAA-3068-2021; AAA-3068-2021; AAC-5566-2019; AAJ-8097-2021Introduction: In patients with severe burns, morbidity and mortality are high. One factor related to poor prognosis is acute kidney injury. According to the AKIN criteria, acute kidney injury has 3 stages based on urine output, serum creatinine level, and renal replacement therapy. In this study, we aimed to create a decision tree for estimating risk of acute kidney injury in patients with severe burn injuries. Methods: We retrospectively evaluated 437 adult patients with >20% total burn surface area injury who were treated at the Baskent University Ankara and Konya Burn Centers from January 2000 to March 2020. Patients who had high-voltage burn and previous history of kidney disease were excluded. Patient demographics, medical history, mechanism of injury, presence of inhalation injury, depth of burn, laboratory values, presence of oliguria, need for renal replacement therapy, central venous pressure, and prognosis were evaluated. These data were used in a "decision tree method" to create the Baskent University model to estimate risk of acute kidney injury in severe burn patients. Results: Our model provided an accuracy of 71.09% for risk estimation. Of 172 patients, 78 (45%) had different degrees of acute kidney injury, with 26 of these (15.1%) receiving renal replacement therapy. Our model showed that total burn surface area was the most important factor for estimation of acute kidney injury occurrence. Other important factors included serum creatinine value, burn injury severity score, hemoglobin value, neutrophil-tolymphocyte ratio, and platelet count. Conclusion: The Baskent University model for acute kidney injury may be helpful to determine risk of acute kidney injury in burn patients. This determination would allow appropriate treatment to be given to high-risk patients in the early period, reducing the incidence of acute kidney injury. (c) 2021 Published by Elsevier Ltd.Item Treatment of Posttransplant Hepatocellular Carcinoma Recurrence(2022) Haberal, Mehmet; Karakaya, Emre; Akdur, Aydincan; Soy, Ebru Ayvazoglu; https://orcid.org/0000-0002-3462-7632; https://orcid.org/0000-0002-8726-3369; https://orcid.org/0000-0002-0993-9917; 35060449; AAJ-8097-2021; AAA-3068-2021; AAC-5566-2019Objectives: In patients who receive liver transplant to treat hepatocellular carcinoma, 10% to 15% posttransplant recurrence is observed. In the present study, we evaluated the long-term outcomes of patients who had received liver transplant for treatment of hepatocellular carcinoma. Materials and Methods: Of the 683 liver transplants that we performed, 72 were in response to hepatocellular carcinoma. The physical examination and laboratory and imaging results of the patients were retrospectively analyzed and recorded. The recipients were evaluated according to the Baskent criteria and divided into 2 groups: early diagnosis and late diagnosis. Results: Among 72 total patients in our study, 19 (26.3%) were pediatric recipients. Hepatocellular carcinoma recurred in 7 patients (9.7%; 5 adult, 2 pediatric). Except for one patient, all were in the late diagnosis group.The mean survival time of all patients was 137.45 +/- 10 months.The mean survival in the early diagnosis group was longer than in the late diagnosis group. During follow-up, 11 patients died from recurrence and distant metastasis. Conclusions: In patients with hepatocellular carcinoma who received liver transplant, we found that postoperative recurrence of hepatocellular carcinoma and distant metastasis can be treated with surgery and/or with interventional radiology methods, which may improve patient survival after liver transplant.Item Success Rate of Grafts With Multiple Renal Vessels in 3136 Kidney Transplants(2021) Karakaya, Emre; Akdur, Aydincan; Soy, Ebru Ayvazoglu; Moray, Gokhan; Haberal, Mehmet; https://orcid.org/0000-0002-4879-7974; https://orcid.org/0000-0002-8726-3369; https://orcid.org/0000-0002-0993-9917; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-3462-7632; 32967599; AAD-5466-2021; AAA-3068-2021; AAC-5566-2019; AAE-1041-2021; AAJ-8097-2021Objectives: Multiple renal vessels are often detected in living and deceased organ donors. In the past, transplant with multiple renal vessel grafts has been a contraindication because of high vascular and urological complication rates. However, improvements in vascular reconstruction and anastomosis techniques have allowed graft function to be maintained for many years. Here, we retrospectively evaluated transplant of multiple renal vessel grafts and graft survival and postoperative vascular and urological complications. Materials and Methods: From November 1975 to July 2020, there were 3136 renal transplants (716 deceased donors, 2420 living donors) performed in our center. There were 2167 living donors and 643 deceased donors with single renal vessel grafts and 253 living donors and 73 deceased donors with multiple renal vessel grafts. For anastomoses, external iliac, internal iliac, common iliac, and inferior epigastric arteries and external iliac veins were used. Cold ischemia time, anastomosis time, postoperative vascular and urological complications, acute tubular necrosis, creatinine clearance, serum creatinine levels, graft rejection episodes, and graft and patient survival rates were evaluated. Results: With regard to creatinine clearance, cold ischemia and anastomosis time, acute tubular necrosis, rejection episodes, and 1-, 2-, and 5-year posttransplant serum creatinine levels, there were no significant differences between the groups. Graft survival rates in the single renal vessel group were 92.9% at 1 year posttransplant and 78.3% at 5 years posttransplant; rates in the multiple renal vessel group were 93.1% at 1 year and 79.7% at 5 years. The corresponding patient survival rates were 95.5% (1 year) and 92.9% (5 years) for the single renal vessel group and 96.9% (1 year) and 87.2% (5 years) for the multiple renal vessel group. Conclusions: Improved anastomosis and reconstruction techniques have allowed the safe transplant of multiple renal vessel grafts that may remain functional for many years.Item Concurrence of rectocoele and anal incontinence, and outcome of their simultaneous surgical correction(2021) Haberal, Elifcan; Yarbug Karakayali, Feza; Karakaya, Emre; 0000-0002-4879-7974; 34334007; AAD-5466-2021Item Effect of Adipose-Derived Stem Cells on Colonic Anastomosis in Rats Immunosuppressed With Everolimus: An Experimental Study(2021) Karakaya, Emre; Akdur, Aydincan; Atilgan, Alev Ok; Uysal, Ahmet Cagri; Ozer, Huriye Eda Ozturan; Yildirim, Sedat; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0002-8726-3369; 34269651; AAJ-8097-2021; AAA-3068-2021Objectives: Immunosuppressed patients sometimes require colorectal surgery. We investigated whether adipose tissue-derived stem cells contributed to anastomosis healing in rats immunosuppressed with the mTOR inhibitor everolimus. Materials and Methods: Sixty male Sprague-Dawley rats were randomly divided into 4 groups of 14 each, with all groups undergoing descending colon anastomosis; the 4 remaining rats were used for stem cell retrieval. Group 1 (control) underwent surgery only, group 2 received stem cell injection, group 3 received everolimus only, and group 4 received everolimus plus stem cell injection. After treatment, each group was randomly divided into 2 equal subgroups according to the day of euthanasia (posttreatment day 4 or day 7). We measured anastomosis bursting pressure and tissue hydroxyproline level and performed histopathological evaluation. Results: At both posttreatment days 4 and 7, median weight loss in group 3 was higher than in group 1, group 3 had higher severity of intraabdominal adhesion than group 4, and group 2 had mean hydroxyproline level higher than the other groups. At posttreatment day 4, mean bursting pressure was significantly different in group 1 versus groups 2 and 4 (P = .002) and group 2 versus groups 3 and 4 (P < .001). No significant differences were shown in pathological analysis except for vascular proliferation on day 7 (P = .003). Conclusions: Injection of adipose tissue-derived stem cells in the anastomosis site prevented anastomosis leakage by contributing to healing. Injection of adipose tissue-derived stem cells in the anastomosis region, especially in the early period after solid-organ transplant in recipients and after gastrointestinal surgery in immunosuppressed patients, may help reduce mortality and morbidity.Item Balloon Kyphoplasty Is a Safe and Effective Option for the Treatment of Vertebral Compression Fractures in Solid-Organ Transplant Recipients(2020) Sonmez, Erkin; Comert, Serhat; Akdur, Aydincan; Karakaya, Emre; Gulsen, Salih; Yilmaz, Cem; Altinors, Nur; Haberal, Mehmet; 0000-0002-7535-1804; 0000-0002-8726-3369; 0000-0002-3462-7632; 0000-0002-5693-3542; 0000-0002-4879-7974; 0000-0002-2353-8044; 27063841; AAJ-5746-2021; AAA-3068-2021; AAJ-8097-2021; AAI-8820-2021; AAD-5466-2021; AAK-2948-2021Objectives: Solid-organ transplant recipients are at great risk for osteoporotic vertebral compression fractures because of both underlying pretransplant bone diseases and posttransplant immunosuppressive treatments. Balloon kyphoplasty is a minimally invasive procedure that is used to treat painful osteoporotic vertebral compression fractures. It involves injection of polymethylmethacrylate into the vertebral body to stabilize the fracture and to alleviate the pain immediately. In this study, we report the results of balloon kyphoplasty for treatment of vertebral compression fractures in solid-organ transplant recipients. Materials and Methods: We retrospectively reviewed 512 liver transplant and 2248 kidney transplant procedures that were performed in our center between 1985 and 2015. Seven transplant recipients with a total of 10 acute, symptomatic vertebral compression fractures who were unresponsive to conservative treatment for 3 weeks underwent balloon kyphoplasty. Clinical outcome was graded using the visual analog scale. Radiographic evaluation included measurement of the segmental kyphosis by the Cobb method. Results: There were 4 female and 3 male patients in our study group. Ages of patients ranged from 56 to 63 years with an average age of 58.8 years. The affected vertebral levels varied from T12 to L4. Mean follow-up after balloon kyphoplasty was 3.4 years, and mean time interval from transplant to balloon kyphoplasty was 8.6 years. Statistically significant difference is evident 3 years after transplant surgery (P < .05). Sagittal alignment improved (> 5 degrees) in 2 of 7 patients (28%). Conclusions: Transplant recipients are at great risk in terms of vertebral compression fracture development, especially within 1 year after transplant. Although conservative treatment has been the first treatment choice for vertebral compression fracture, long treatment time and high costs may be needed to achieve cure. Experience with our small patient population showed that balloon kyphoplasty was effective and safe for obtaining rapid pain relief and earlier mobilization with fewer complications.Item Coronavirus Disease (COVID-19) in Kidney and Liver Transplant Patients: A Single-Center Experience(2020) Akdur, Aydincan; Karakaya, Emre; Soy, Ebru H. Ayvazoglu; Alshalabi, Omar; Kirnap, Mahir; Arslan, Hande; Ulubay, Gaye; Hekimoglu, Koray; Moray, Gokhan; Haberal, Mehmet; 0000-0002-0993-9917; 0000-0002-0805-0841; 0000-0002-3462-7632; 0000-0003-2478-9985; 0000-0003-2498-7287; 0000-0002-8726-3369; 0000-0002-4879-7974; 32519617; AAC-5566-2019; AAD-9097-2021; AAJ-8097-2021; AAB-5064-2021; AAE-1041-2021; AAA-3068-2021; AAD-5466-2021Objectives: The novel 2019 coronavirus (COVID-19) was first described in December 2019 in Wuhan, China and subsequently announced as a pandemic on March 12, 2020. In several studies, solid-organ transplant recipients were reported to have higher risk for COVID-19. Here, we aimed to determine the frequency of COVID-19 in our kidney and liver transplant patients. Materials and Methods: Our study included 583 transplant patients who were admitted to our outpatient transplant clinics and emergency departments between March 1 and May 1, 2020. Seventy-four of them were liver transplant recipients (46 male, 28 female, of which 14 were pediatric and 60 were adult patients) and 509 of them were kidney transplant recipients (347 male, 162 female, of which 16 were pediatric and 493 were adult patients). We retrospectively evaluated demographic characteristics, currently used immunosuppressant treatment, present complaints, treatment and diagnosis of comorbid diseases, and results of COVID-19 tests. Results: Of 583 transplant recipients, 538 were seen in our outpatient transplant clinics and 45 were seen in our emergency departments. Of these, 18 patients who had had cough and fever were evaluated by respiratory clinic doctors, and nasopharyngeal swab samples were taken. One kidney transplant recipient had a positive COVID-19 test; he was followed with home isolation. He received treatment with hydroxychloroquine (400 mg/day). The other 17 patients had negative tests. There were no mortalities due to COVID-19. Conclusions: Transplant patients also got affected during the COVID-19 pandemic. According to the data of our centers, this effect is not much more different from the normal population. We recommend that transplant recipients should be warned in terms of personal hygiene and should be closely monitored by organ transplant centers. If there is an indication for hospitalization, they should be followed in an isolated unit, with no aggressive changes made to immunosuppressive doses unless necessaryItem Liver and Kidney Transplant During a 6-Month Period in the COVID-19 Pandemic: A Single-Center Experience(2020) Akdur, Aydincan; Karakaya, Emre; Soy, Ebru H. Ayvazoglu; Karakayali, Feza Yarbug; Yildirim, Sedat; Torgay, Adnan; Sayin, Cihat Burak; Coskun, Mehmet; Moray, Gokhan; Haberal, Mehmet; 0000-0002-1874-947X; 0000-0002-6829-3300; 0000-0002-8726-3369; 0000-0002-0993-9917; 0000-0002-3462-7632; 0000-0002-5735-4315; 0000-0002-4879-7974; 0000-0003-2498-7287; 0000-0001-5630-022X; 33143601; AAB-3888-2021; AAJ-5221-2021; AAA-3068-2021; AAC-5566-2019; AAJ-8097-2021; AAF-4610-2019; AAD-5466-2021; AAE-1041-2021; AAM-4120-2021Objectives: With the declaration of COVID-19 as a pandemic, many studies have indicated that elective surgeries should be postponed. However, post-ponement of transplants may cause diseases to get worse and increase the number in wait lists. We believe that, with precautions, transplant does not pose a risk during pandemic. Here, we aimed to evaluate our transplant results, which we safely performed during a 6-month pandemic period. Materials and Methods: Until September 2020, 3140 kidney and 667 liver transplants have been performed in our centers. We evaluated 38 kidney transplants and 9 liver transplants procedures performed during the pandemic (March 1 to September 2, 2020). Recipient and donor candidates were screened for COVID-19 with polymerase chain reaction and thoracic computed tomography. All recipients had routine immunosuppressive protocol. During hospitalization at our COVID-19-free transplant facility, we restricted the interactions during multidisciplinary rounds. Results: During the pandemic, 38 kidney transplants with an average length of hospital stay of 8.1 days were performed. Mean serum creatinine values of recipients were 0.91, 0.86, and 0.74 mg/dL on postoperative days 7, 30, and 90, respectively. During the pandemic, 9 living donor liver transplants (1 adult, 8 pediatric) were performed with an average length of hospital stay of 17.1 days. Mean serum total bilirubin levels were 0.9, 0.5, and 0.4 mg/dL on postoperative days 7, 30, and 90, respectively. Mean serum aspartate aminotransferase levels were 38.1, 28.3, and 22.3 U/L on postoperative days 7, 30, and 90, respectively. All recipients and donors were successfully discharged. Only 1 liver recipient died (on day 55 after discharge as a result of oxalosis-induced heart failure). Conclusions: According to our results, when precautions are taken, transplant does not pose a risk to patients during the pandemic period. We attribute the safety and success shown to our newly developed protocol in response to the COVID-19 pandemic.Item Oxalosis Crystals' Redeposition in Cardiac Tissue Leading to New-Onset Fatal Cardiac Complication After Liver Transplant in Primary Oxalosis Patient: Case Report(2020) AlShalabi, Omar; Soy, Ebru H. Ayvazoglu; Akdur, Aydincan; Karakaya, Emre; Kahraman, Gokhan; Moray, Gokhan; Haberal, Mehmet; 0000-0002-4879-7974; 0000-0002-3462-7632; 0000-0002-0993-9917; 0000-0002-8726-3369; 0000-0003-2498-7287; 33187466; AAD-5466-2021; AAJ-8097-2021; AAC-5566-2019; AAA-3068-2021; AAE-1041-2021Primary oxalosis is a rare hereditary disorder of metabolism resulting in accumulation of calcium oxalate in almost all tissues of the body. All published data point out the improvement of cardiac function after transplant. Here, we report the first case in the literature of an 8-year-old patient with primary oxalosis in which oxalosis implantations increased in cardiac tissue after liver transplant and manifested as new-onset ventricular tachycardia and cardiomyopathy, leading to death.