Scopus İndeksli Açık & Kapalı Erişimli Yayınlar
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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 Clinical Outcomes Of Liver Transplantation For Patients Over 60 Years Old; A Single Center Experience(2021) Akdur, Aydincan; Karakaya, Emre; Soy, Ebru H. Ayvazoglu; Karakayali, Feza; Moray, Gokhan; Haberal, Mehmet; 0000-0002-0993-9917; 0000-0002-8726-3369; 0000-0002-3462-7632; AAC-5566-2019; AAA-3068-2021; AAJ-8097-2021Item 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 Analysis of Quality of Life, Depression, and Sexual Function in Patients on the Liver Transplant List(2021) Fidan, Cihan; Akdur, Aydincan; Kirnap, Mahir; Selcuk, Haldun; Yildirim, Sedat; Moray, Gokhan; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0002-8726-3369; 34609310; AAJ-8097-2021; AAA-3068-2021Background: I he only treatment in patients developing liver failure is liver transplantation. According to the Ministry of Health, the number of patients waiting for a liver transplantation is 2141, the average waiting period for liver transplantation is approximately 5 years, and 15-18% of these patients lose their life while waiting for transplantation. In these patients, limitations in daily activities and depression-anxiety are commonly found. The aim of this study was to analyze life quality, depression symptoms, and existence of sexual functional disorders of patients waiting for liver transplantation. Methods: A total of 74 patients, who were registered in Baskent University Hospital between 2015 and 2018, were included into the study. Short Form-36, Beck Depression Inventory, and Arizona Sexual Experiences Scale were applied to 56 patients who approved study. Results: Most of the patients were male (64.3%), and the mean age was 46 (18-64). Short Form-36 scores were low in all patients. The mean Beck Depression Inventory score of patients was found as 18.4 +/- 11.3, and they were suffering from moderate depressive symptoms. According to Arizona Sexual Experiences Scale, total mean scores of males was found as 16.3 +/- 5.5, and for females, it was 19.5 +/- 5.3 with a statistically significant difference (P < .05). It was found that sexual dysfunction mostly had moderate to mild. Conclusion: Depression and sexual dysfunction are common in patients with chronic liver diseases, and their life qualities deteriorate significantly. It is anticipated that evaluation of these patients in terms of psychological issues and sexual dysfunction will increase their quality of life during the organ waiting period and affect their well-being post-transplant.Item Effect of Subcutaneous Topical Ozone Therapy on Second-Degree Burn Wounds in Rats: An Experimental Study(2021) Karakaya, Emre; Akdur, Aydincan; Soy, Ebru Ayvazoglu; Araz, Coskun; Atilgan, Alev Ok; Ozer, Eda Ozturan; Sencelikel, Tugce; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0002-0993-9917; 0000-0002-8726-3369; AAJ-8097-2021; AAC-5566-2019; AAA-3068-2021Burns are one of the most severe traumas, causing coagulative destruction of the skin. The use of various products that accelerate wound healing in patients with burns may affect rates of patient survival and reduce complications. We studied the effects of subcutaneous ozone injection on second-degree burn wounds in an animal model. For this study, 72 Sprague-Dawley male rats were divided randomly into the following three groups: control group, silver sulfadiazine group, and ozone group; each group was then divided randomly into two subgroups (day 7 or day 14 examination and euthanized). Superficial partial-thickness burns were created on the lower back. In the control group, subcutaneous 0.9% serum saline was injected daily into the burn area. In the silver sulfadiazine group, burns were dressed daily with silver sulfadiazine. In the ozone group, subcutaneous ozone was injected daily into the burn area. We performed tissue hydroxyproline level measurements and histopathological evaluations. When groups were compared in terms of weight change, no significant difference was found between day 7 and day 14. With regard to tissue hydroxyproline levels, the ozone group had significantly higher levels on both days 7 and 14 (P < .001). In histopathological evaluations, we determined that wound healing in the ozone group was significantly higher than in the other groups. We found that subcutaneous ozone therapy was more effective than silver sulfadiazine in the healing process of second-degree burn wounds and could be safely used in the treatment of burn wounds.Item The effect of the use of the Gail model on breast cancer diagnosis in bi-rads 4A cases(2021) Karakaya, Emre; Erken, Murathan; Turnaoglu, Hale; Sirinoglu, Tugce; Akdur, Aydincan; Kavasoglu, Lara; 0000-0002-0664-5147; 0000-0002-8726-3369; 0000-0002-3592-5092; 0000-0002-3592-5092; 35677495; AAJ-8219-2021; AAA-3068-2021; ABI-7217-2020; CAA-2756-2022Objective: The BI-RADS classification system and the Gail Model are the scoring systems that contribute to the diagnosis of breast cancer. The aim of the study was to determine the contribution of Gail Model to the diagnosis of breast lesions that were radiologically categorized as BI-RADS 4A. Material and Methods: We retrospectively examined the medical records of 320 patients between January 2011 and December 2020 whose lesions had been categorized as BI-RADS 4A. Radiological parameters of breast lesions and clinical parameters according to the Gail Model were collected. The relationship between malignant BI-RADS 4A lesions and radiological and clinical parameters was evaluated. In addition, the effect of the Gail Model on diagnosis in malignant BI-RADS 4A lesions was evaluated. Results: Among radiological features, there were significant differences between lesion size, contour, microcalcification content, echogenicity, and presence of ectasia with respect to the pathological diagnosis (p< 0.05). No significant difference was found between the lesions' pathological diagnosis and the patients' Gail score (p> 0.05). An analysis of the features of the Gail model revealed that there was no significant difference between the age of menarche, age at first live birth, presence of a first-degree relative with breast cancer, and a history of breast biopsy and the pathological diagnosis (p> 0.05). Conclusion: As a conclusion Gail Model does not contribute to the diagnosis of BC, especially in patients with BI-RADS 4A lesions.Item Risk Factors and Treatment Options for Persistent Hyperparathyroidism After Kidney Transplantation(2020) Kirnap, Nazli Gulsoy; Kirnap, Mahir; Sayin, Burak; Akdur, Aydincan; Tutuncu, Neslihan Bascil; Haberal, Mehmet; 0000-0002-8726-3369; 0000-0002-3462-7632; 0000-0002-1816-3903; 0000-0001-8287-6572; 31924405; AAA-3068-2021; AAJ-8097-2021; ABG-5027-2020; J-3707-2015Background. Kidney transplantation (KT) corrects secondary hyperparathyroidism. However, persistent hyperparathyroidism (pHPT) may be observed in some patients post-KT. This study aims to evaluate the risk factors and treatment options for pHPT. Materials and methods. The study population comprises 1054 patients who underwent KT between January 2001 and May 2019. Serum samples were analyzed for calcium (Ca), phosphorus, creatinine, intact parathyroid hormone (iPTH) and estimated glomerular filtration rate. Results. The prevalence of pHPT following KT is 14%. Ninety pHPT patients were compared with 550 non-pHPT patients. The median duration of pre-KT dialysis was longer, and pre-KT serum Ca, P, and iPTH levels were significantly higher in the pHPT group than the non-HPT group. The pHPT of 46 patients (51%) received medical treatment. The remaining 44 patients (49%) had parathyroidectomy (PTx) if symptoms or signs (or both) of pHPT continued. Subtotal PTx was performed in 35 patients, and minimally invasive PTx was performed in 9 patients. Conclusion. Based on our study results, the most important risk factors for post-KT pHPT are long dialysis duration and high pre-KT iPTH levels. In patients who underwent KT, if pHPT lasts longer than 1 year, surgical treatment is the recommended approach. Based on our experience, the treatment method to be performed in pHPT should be 3+1/2 PTx.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.