Fakülteler / Faculties
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Item Transpaeritoneal Laparoscopic Simple Nephrectomy: A Single Center Experience(2014) Cicek, Tufan; Sen, Erhan; Gonen, Murat; Gonulalan, Umut; Kosan, Murat; Ozturk, Bulent; 0000-0003-1944-1722; AAJ-8576-2021; AAA-7140-2021Purpose: In this study, we planned to evaluate the efficacy and perioperative outcomes of transperitoneal laparoscopic simple nephrectomy at Baskent University Konya Application and Research Center. Material and Methods: The demographic and perioperative data of patients who underwent transperitoneal laparoscopic simple nephrectomy at Baskent University Konya Application and Research Center Urology clinic between February 2005 and November 2013 were analyzed retrospectively. Operative time, perioperative laboratory results, the durations of hozpitalization and follow-up, perioperative complications and demographic characteristics of each patient were recorded. Results: Overall, 58 patients were included. 27 patients were male (46%) and 31 patients were female (54%). The mean age was 45.3 +/- 17.12 (6-79). The mean operative time was 104.4 +/- 36.5 (40-185) minutes. The mean hospitalization duration was 2.7 +/- 0.7 (2-5) days. The mean preoperative and postoperative hemoglobin levels were 13.7 +/- 1.74 and 12.4 +/- 1.73 mg/dl, respectively. Postoperative hemoglobin levels were statistically significatly lower than preoperative hemoglobin levels (p<0.001). 4 patients (%6.9) needed blood transfusion. 5 patients had grade I, 4 patients had grade II and 2 patients had grade III complications according to modified Clavien classification system. Conclusion: Transperitoneal laparoscopic simple nephrectomy seems to be a safe and efficacious treatment option as having low complication rates.Item Laparoscopic Transperitoneal Adrenalectomy: Experience with the First 10 Patients(2014) Cicek, Tufan; Karagulle, Erdal; Turk, Emin; Demir, Canan Cicek; Kosan, Murat; 0000-0003-4766-3373; AAJ-5609-2021; JBF-7113-2023; AAK-4857-2021Purpose: In this study we aimed to assess the outcomes and complications of laparoscopic transperitoneal adrenalectomy operation performed in our clinic Materials and Methods: Medical records of patients operated with laparoscopic transperitoneal adrenalectomy between February 2007 and November 2013 at Baskent University Konya Application and Research Center Urology Clinic are examined retrospectively. The demographic characteristics, preoperative and postoperative laboratory results, operation times, complications, and duration of hospital stay and follow- up were recorded. Results: A total of 10 patients underwent laparoscopic transperitoneal adrenalectomy. Seven of these were male and 3 were female. The mean age was 48 +/- 17.4 (27-71) years. The operation time was 104.4 +/- 36.5 (40-185) on average and the mean amount of blood loss was 43.5 +/- 121.2 ml. The average mass size was 41.6 +/- 23.8 (15-90) mm. The mean duration of hospital stay was 3.8 +/- 1.3 (2-6) days. The patients were followed for an average of 45.8 +/- 28.7 (4-85) months. The operation was turned to open technique in two patients. Mean preoperative and postoperative hemoglobin levels of the patients were 13.38 +/- 1.91 and 11.6 +/- 1.7 mg/dl, respectively. Postoperative hemoglobin level was on average lower than the preoperative level (p< 0.001). One patient required blood transfusion. Conclusion: We suggest that the complication rate of laparoscopic adrenalectomy would be lowered by selecting appropriate patients, more detailed assessment of adrenal functions, and increased surgical experience. Laparoscopic transperitoneal adrenalectomy is regarded as a safe and efficient treatment method.Item Involvement and Complications Associated with Brucellosis Connected Rare Evaluation of 46 Cases(2014) Turunc, Tuba; Kursun, Ebru; Demiroglu, Y. Ziya; Aliskan, Eda; 0000-0001-7956-7306; 0000-0001-9060-3195; 0000-0002-9866-2197; GVT-0626-2022; AAG-5020-2020; AAE-2282-2021; AAZ-9711-2021Purpose: The present study of us assesses brucellosis with atypical involvement and its complications aimed to draw attention to the infection that may interfere with many diseases related to infection or not. Material and Method: In our clinic, a total of 447 cases of brucellosis between March 2004 - March 2011 were followed retrospectively. 46 of these cases included in this study which have not specific terms of brucellosis symptoms, signs and / or laboratory data as well as non expected involvement during the course of the disease and / or complications. Results: A total of 46 patients in terms of disease and / or complications evaluated atypical Brucellosis, 17 (39.9%) female and 29 (63.04%) were male. Mean age was 40.8 +/- 10.2. 19 patients (41.3%) blood, 2 cases (4.3%) urine, 4 patients (8.6%), abscess, 1 patient pleural fluid, 1 case (2.1%) mitral valve, 1 patient joint fluid aspiration while 1 patient (2.1%) both peritoneal and pleural fluid samples of Brucella spp. were isolated. Brucellosis related atypical involvement and / or complication was observed in particularly the musculoskeletal system, the central nervous system, cardiovascular system, genitourinary system, and hematologic system, as well as in the skin and mucous membrane of the serous tissues. However, it is found that 37 cases (80.4%) applied for the different sections outside the Department of Infectious Diseases and evaluated respectively. Conclusion: In this study, it is determined that cases were followed with brucellosis (10.2%) atypical disease and / or complications, and the first assesses made by outside the Department of Infectious Diseases. For this reason, we think not only experts in Infectious Diseases, all other branches of physicians should keep in mind in the differential diagnosis of brucellosis.Item Postoperative Effects of Intraoperative Hyperglycemia in Liver Transplant Patients(2015) Komurcu, Ozgur; Camkiran, Aynur; Kaplan, Serife; Torgay, Adnan; Pirat, Arash; Haberal, Mehmet; Arslan, Gulnaz; 0000-0002-6829-3300; 0000-0001-6762-895X; 0000-0002-3462-7632; 0000-0003-1470-7501; 25894186; AAJ-5221-2021; GLV-1652-2022; AAJ-8097-2021Objectives: The aim of this study was to determine the effects of intraoperative hyperglycemia on postoperative outcomes in orthotopic liver transplant recipients. Materials and Methods: After ethics committee approval was obtained, we retrospectively analyzed the records of patients who underwent orthotopic liver transplant from January 2000 to December 2013. A total 389 orthotopic liver transplants were performed in our center, but patients aged < 15 years (179 patients) were not included in the analyses. Patients were divided into 2 groups based on their maximum intraoperative blood glucose level: group 1 (patients with intraoperative blood glucose level < 200 mg/dL) and group 2 (patients with intraoperative blood glucose level > 200 mg/dL). Postoperative complications between the 2 groups were compared. Results: There were 58 patients (37.6%; group 1, blood glucose < 200 mg/dL) who had controlled blood glucose and 96 patients (62.3%; group 2, blood glucose > 200 mg/dL) who had uncontrolled blood glucose. The mean age and weight for groups 1 and 2 were similar. There were no differences between the 2 groups regarding the duration of anhepatic phase (P=.20), operation time (P=.41), frequency of immediate intraoperative extubation (P=.14), and postoperative duration of mechanical ventilation (P=.06). There were no significant differences in frequency of patients who had postoperative infectious complications, acute kidney injury, or need for hemodialysis. Mortality rates after liver transplant were similar between the 2 groups (P=.81) Conclusions: Intraoperative hyperglycemia during orthotopic liver transplant was not associated with an increased risk of postoperative infection, acute renal failure, or mortality.Item Percutaneous Dilational Tracheotomy in Solid-Organ Transplant Recipients(2015) Ozdemirkan, Aycan; Ersoy, Zeynep; Zeyneloglu, Pinar; Gedik, Ender; Pirat, Arash; Haberal, Mehmet; 0000-0003-0767-1088; 0000-0002-3462-7632; 0000-0003-2312-9942; 0000-0002-7175-207X; 26640911; AAF-3066-2021; AAH-7003-2019; AAJ-8097-2021; C-3736-2018; ABI-2971-2020Objectives: Solid-organ transplant recipients may require percutaneous dilational tracheotomy because of prolonged mechanical ventilation or airway issues, but data regarding its safety and effectiveness in solid-organ transplant recipients are scarce. Here, we evaluated the safety, effectiveness, and benefits in terms of lung mechanics, complications, and patient comfort of percutaneous dilational tracheotomy in solid-organ transplant recipients. Materials and Methods: Medical records from 31 solid-organ transplant recipients (median age of 41.0 years [interquartile range, 18.0-53.0 y]) who underwent percutaneous dilational tracheotomy at our hospital between January 2010 and March 2015 were analyzed, including primary diagnosis, comorbidities, duration of orotracheal intubation and mechanical ventilation, length of intensive care unit and hospital stays, the time interval between transplant to percutaneous dilational tracheotomy, Acute Physiology and Chronic Health Evaluation II score, tracheotomy-related complications, and pulmonary compliance and ratio of partial pressure of arterial oxygen to fraction of inspired oxygen. Results: The median Acute Physiology and Chronic Health Evaluation II score on admission was 24.0 (interquartile range, 18.0-29.0). The median interval from transplant to percutaneous dilational tracheotomy was 105.5 days (interquartile range, 13.0-2165.0 d). The only major complication noted was left-sided pneumothorax in 1 patient. There were no significant differences in ratio of partial pressure of arterial oxygen to fraction of inspired oxygen before and after procedure (170.0 [inter quartile range, 102.2-302.0] vs 210.0 [interquartile range, 178.5-345.5]; P=.052). However, pulmonary compliance results preprocedure and postprocedure were significantly different (0.020 L/cm H2O [interquartile range, 0.015-0.030 L/cm H2O] vs 0.030 L/cm H2O [interquartile range, 0.020-0.041 L/cm H2O); P=.001]). Need for sedation significantly decreased after tracheotomy (from 17 patients [54.8%] to 8 patients [25.8%]; P=.004]). Conclusions: Percutaneous dilational tracheotomy with bronchoscopic guidance is an efficacious and safe technique for maintaining airways in solid-organ transplant recipients who require prolonged mechanical ventilation, resulting in possible improvements in ventilatory mechanics and patient comfort.Item Long-Term Follow-up of Over 600 Living Related Kidney Donors: Single-Center Experience(2022) Sayin, Burak; Akdur, Aydincan; Karakaya, Emre; Soy, Ebru H. Ayvazoglu; Haberal, Mehmet; https://orcid.org/0000-0002-4879-7974; https://orcid.org/0000-0002-3462-7632; 35384802; AAD-5466-2021; AAJ-8097-2021Objectives: Kidney transplant is the treatment of choice in patients with end-stage renal disease because it offers improved survival and better quality of life. Although most epidemiologic studies have suggested that living kidney donors have a minimal lifetime risk of developing end-stage renal disease, long-term complications and physiologic and psychologic sequelae resulting from donation remain unclear. Here, we examined the long-term results of living-related kidney donors who donated kidneys at the Baskent University Ankara Hospital over the past 25 years. Materials and Methods: We were able to examine 607 kidney transplant donors (mean age of 52.03 +/- 11.54 years) who were seen at our center from 1986 to 2021 and who agreed to a general health evaluation. Collected data included donor age, sex, blood type, body mass index, duration after donation, blood pressure measurements, biochemical parameters, abdominal ultrasonograph for size, structure, and renal blood flow of the solitary kidney, comorbid conditions, chronic drug use, and surgical procedures after donation. Results: Mean time after donation was 10.4 +/- 3.2 years. Twenty-four donors (3.9%) were diagnosed with diabetes and 21 (3.4%) with thyroid disease, 64 (10.5%) developed hypertension, and 48 (8.8%) developed atherosclerotic cardiovascular disease. Obesity was found to be an increasing problem in our donor population, with 174 (28.6%) developing mild to moderate obesity (body mass index >25 kg/m2). Older age, obesity, smoking, and hyperlipidemia were found to be the major and independent risk factors of both hypertension and atherosclerotic cardiovascular disease in donors. None of our donors developed endstage renal disease. Conclusions: Obesity and hypertension were the most common comorbidities that developed in our kidney donor population. Our principle is to avoid unrelated and nondirected donors because of the possible long-term complications. Unrelated donors may be desperate if a family member needs donation in the future.Item Hemolysis, Elevated Liver Enzymes and Low Platelet Syndrome: Outcomes for Patients Admitted to Intensive Care at A Tertiary Referral Hospital(2017) Gedik, Ender; Yucel, Neslihan; Sahin, Taylan; Koca, Erdinc; Colak, Yusuf Ziya; Togal, Turkan; https://orcid.org/0000-0002-7175-207X; https://orcid.org/0000-0001-5845-2614; 27599183; ABI-2971-2020; ABI-3412-2020Purpose: The aim was to assess outcomes for pregnancies in which hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome develops and the patient requires transfer for critical care. Materials and Methods: The cases of women with HELLP syndrome who delivered at our tertiary center or surrounding hospitals and were admitted to the intensive care between January 2007 and July 2012 were retrospectively analyzed. Results were compared for the surviving and non-surviving patients. Results: Among the 77 women with HELLP syndrome, maternal mortality rate was 14% and 24 (30%) of 81 fetuses and newborns died in the perinatal period. The most common maternal complications were disseminated intravascular coagulation (DIC) (n = 22; 29%), acute renal failure (n = 19; 25%), and postpartum hemorrhage (n = 16; 21%). Compared with surviving women, the non-surviving women had higher mean international normalized ratio (INR) (p < 0.0001); higher mean serum levels of aspartate aminotransferase (AST) (p < 0.0001); higher alanine aminotransferase (ALT) (p < 0.0001); higher lactate dehydrogenase (LDH) (p < 0.0001), and higher bilirubin (p = 0.040) levels; and lower platelet count (p = 0.005). Conclusion: DIC is a major risk factor for maternal outcome among patients with HELLP syndrome who require intensive care. Low platelet count; high AST, ALT, LDH, INR; and total bilirubin are associated with high mortality risk in this patient group. In addition, low platelet count; low fibrinogen level; prolonged activated thromboplastin time; high INR; and high total bilirubin, LDH, blood urea nitrogen, and creatinine are associated with high risk for complications in this patient group.Item Renal Stone Composition Does not Affect The Outcome of Percutaneous Nephrolithotomy in Children(2018) Kaygisiz, Onur; Turegun, Fethi Ahmet; Satar, Nihat; Ozen, Ender; Toksoz, Serdar; Dogan, Hasan Serkan; Piskin, Mehmet Mesut; Izol, Volkan; Sarikaya, Saban; Kilicarslan, Hakan; Cicek, Tufan; Ozturk, Ahmet; Tekgul, Serdar; Onal, Bulent; 29761226Purpose We sought to investigate the association between renal stone composition and percutaneous nephrolithotomy outcomes in pediatric patients and define the characterization of the stone composition. Methods The data of 1157 children who underwent percutaneous nephrolithotomy between 1991 and 2012 were retrieved from the multicenter database of the Turkish Pediatric Urology Society. The study population comprised 359 children (160 girls, 199 boys) with stone analyses. Patients were divided into five groups according to the stone composition [group 1: calcium oxalate; group 2: calcium phosphate; group 3: infection stones (magnesium ammonium phosphate, ammonium urate); group 4: cystine; group 5: uric acid, xanthine stones]. Results Patient characteristics, perioperative, postoperative, and stone characteristics were compared considering the stone composition. There were no significant differences between the groups concerning age, sex, side involved, preoperative hematocrit levels, and solitary renal unit. Patients with cystine stones were more likely to have a history of stone treatment. Groups 2 and 5 had mostly solitary stones. However, group 3 had staghorn stone more often, and group 4 frequently had multiple stones. Overall stone-free rate (79.4%) was similar among the groups. Although stone composition was related to blood transfusion and prolonged operative and fluoroscopy screening times on univariate analysis, it was not a significant predictor of them on multivariate analysis. Conclusions Stone composition was not a predictor of outcomes of pediatric percutaneous nephrolithotomy. However, cystine and infection stones, which are larger and filled multiple calyxes due to the nature of stone forming, were more challenging cases that need multiple tracts.Item Pneumonia in Renal Transplant Recipients: A Single-Center Study(2018) Kara, Sibel; Sen, Nazan; Kursun, Ebru; Yabanoglu, Hakan; Yildirim, Sedat; Akcay, Sule; Haberal, Mehmet; 0000-0002-4171-7484; 0000-0002-1161-3369; 0000-0002-5735-4315; 0000-0002-8360-6459; 0000-0002-3462-7632; 29528008; AAI-8947-2021; AAG-5020-2020; AAJ-7865-2021; AAF-4610-2019; AAI-8069-2021; AAB-5175-2021; AAJ-8097-2021Objectives: Pulmonary infections are a significant cause of morbidity and mortality in solid-organ transplant recipients despite enhanced facilities for perioperative care. The aim of this study was to evaluate the demographic characteristics, clinical course, and outcomes of renal transplant recipients with pneumonia. Materials and Methods: The medical records of all renal transplant recipients from January 2010 to December 2014 were retrospectively reviewed, and patients diagnosed with pneumonia according to Centers for Disease Control and Prevention criteria were evaluated. Pneumonia was classified as community acquired or nosocomial. Patient demographics, microbiologic findings, need for intensive care/mechanical ventilation over the course of treatment, and information about clinical follow-up and mortality were all recorded. Results: Eighteen (13.4%) of 134 renal transplant recipients had 25 pneumonia episodes within the study period. More than half (56%) of the pneumonia episodes developed within the first 6 months of transplant, whereas 44% developed after 6 months (all > 1 year). Eight cases (32%) were considered nosocomial pneumonia, and 17 (68%) were considered community-acquired pneumonia. Bacteria were the most common cause of pneumonia (28%), and fungi ranked second (8%). No viral or mycobacterial agents were detected. No patients required prolonged mechanical ventilation. No statistically significant difference was found in the need for intensive care or regarding mortality between patients with nosocomial and community-acquired pneumonia. Two patients (11%) died, and all remaining patients recovered. Conclusions: The present study confirmed that pneumonia after renal transplant is not a rare complication but a significant cause of morbidity. Long-term and close follow-up for pneumonia is necessary after renal transplant.Item In-Hospital Cardiac Complications in Legionnaires' disease: A Single Center Experience of 32 Patients(2021) Akinci, Sinan; Coner, Ali; 0000-0001-5250-5404; 0000-0002-5711-8873; AAD-5564-2021; ABD-7321-2021Introduction: Legionella species frequently causes Legionnaires' disease (LD), a community-acquired pneumonia (CAP). Although data on cardiac events during the course of CAP can be found in the literature, there has been little research on the same issue in LD patients specifically. This study aimed to investigate cardiac complications in the course of LD. Materials and Methods: A total of 32 patients hospitalized with CAP and who received a definitive diagnosis of Legionella infection were identified from the hospital database and included in the study population. The patients' electronic and written records were evaluated for possible cardiac complications. Results: Mean age was 65 +/- 13.5 years and 50% of the subjects were males. Seven patients died during hospitalization. Cardiovascular events were detected in 11 patients. New-onset atrial fibrillation was the most frequent event and was detected in 8 patients (25%), while two patients experienced a myocardial infarction, and one patient was diagnosed with myocarditis. The cardiovascular events were significantly related to the pneumonia severity index (PSI) score and need for intensive care unit. Conclusion: Although LD rarely involves the heart, it can often cause cardiac complications, and the frequency increases in parallel with the severity of the disease. This study indicates that patients with LD should be carefully followed for possible cardiac complications.