Başkent Üniversitesi Yayınları
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Item Response to "A Novel Technique To Reduce Surgical Tissue Trauma" by Claas Brockschmidt and Associates(Başkent Üniversitesi, 2013-02) Brockschmidt, Claas; Wittau, Mathias; Henne-Bruns, DorisItem "A Novel Technique To Reduce Surgical Tissue Trauma" by Claas Brockschmidt and Associates(Başkent Üniversitesi, 2013-02) Zomorrodi, AfsharItem Soft Tissue Sarcomas in Disused Arteriovenous Fistulae(Başkent Üniversitesi, 2013-02) Herbert, Paul E.; Crane, Jeremy S.Item De Novo Postallogeneic Hematopoietic Stem Cell Transplant Membranous Nephropathy(Başkent Üniversitesi, 2013-02) Numata, Akihiko; Muto, Shigeaki; Ando, Yasuhiro; Kusano, Eiji; Yumura, Wako; Takemoto, Fumi; Saito, Osamu; Mori, Masaki; Morishita, YoshiyukiWe report membranous nephropathy in a 61-year-old man after allogeneic hematopoietic stem cell transplant without chronic graft-versus-host disease. A diagnosis of acute myeloid leukemia was made, and the patient received hematopoietic stem cell transplants, twice, from different donors. The first donor was his brother and the second donor was an unrelated man. Human leukocyte antigens between donors and recipient were fully matched. His clinical course was stable without acute or chronic graft-versus-host disease or relapse of acute myeloid leukemia with tacrolimus after the second hematopoietic stem cell transplant. Six months after the second hematopoietic stem cell transplant, tacrolimus was decreased gradually and discontinued because of tacrolimus-induced liver dysfunction. Three months after discontinuing the tacrolimus, the patient developed edema in his leg. The results of a blood analysis showed that plasma albumin level was 21 g/L and plasma total cholesterol level was 11.5 mmol/L, while results from a urinalysis showed proteinuria of 5.6 g/d without hematuria. No abnormalities in the skin, mucosal tissues, and other organs suggestive of chronic graft-versus-host disease were seen. A renal biopsy was done to investigate the cause, which revealed renal disease. Electron microscopic analysis showed dense deposits in the subepithelial region in all glomeruli. Immunofluorescence analysis showed the deposition of IgG4 and C3c in the subepithelial space of all glomeruli. Membranous nephropathy was diagnosed. He then was administered prednisolone at a dosage of 45 mg/d (0.7 mg/kg/d). After prednisolone treatment, urine protein and hypoalbuminemia were markedly improved, and his leg edema disappeared. These results suggest that this membranous nephropathy may have been de novo membranous nephropathy after hematopoietic stem cell transplant because it developed after hematopoietic stem cell transplants without chronic graft-versus-host disease.Item Diabetic Ketoacidosis Associated With Acute Pancreatitis in a Heart Transplant Recipient Treated With Tacrolimus(Başkent Üniversitesi, 2013-02) Im, Moon-Sun; Lee, Hae-Young; Kim, Ki-Bong; Cho, Hyun-Jai; Ahn, Hyo-SukNew-onset diabetes mellitus after transplant is a well-recognized complication of tacrolimus immunosuppression and commonly occurs as a form of type 2 diabetes mellitus. However, tacrolimus-associated acute pancreatitis causing diabetic ketoacidosis has not been reported in heart transplant patients. We report a 22-year-old women hospitalized owing to diabetic ketoacidosis associated with acute pancreatitis 7 months after a heart transplant. Her immunosuppression included tacrolimus. She was admitted with complaints of polydipsia, anorexia, and abdominal pain of 3 days’ duration. Her initial laboratory test revealed a toxic level of tacrolimus (> 30 ng/mL), severe hyperglycemia (39 mmol/L), severe metabolic acidosis (pH 6.9), and ketonuria, although diabetes mellitus had never been diagnosed. Serum amylase and lipase levels and abdominal computed tomography suggested the presence of acute pancreatitis. After correcting the diabetic ketoacidosis and getting the tacrolimus level to the normal range, she was discharged home. Three months later, insulin was replaced with oral hypoglycemic agents. Pancreatitis can present with diabetic ketoacidosis in the recipient of a heart transplant treated with tacrolimus. Clinicians should pay more attention to tacrolimus levels and the risk of pancreatitis.Item Treatment of Liver Transplant Graft-Versus-Host Disease With Antibodies Against Tumor Necrosis Factor-α(Başkent Üniversitesi, 2013-02) Blank, Gregor; Königsrainer, Alfred; Nadalin, Silvio; Handgretinger, Rupert; Kratt, Thomas; Li, JunAcute graft-versus-host disease is uncommon after liver transplant. We recently treated a 60-year-old man with liver transplant for hepatocellular carcinoma. After the primary liver transplant graft did not function, revision liver transplant resulted in excellent function. Subsequently, the patient developed watery diarrhea, systemic inflammatory response syndrome, a skin rash on his limbs and trunk, and palmar erythema. Skin biopsy suggested viral exanthems consistent with cytomegalovirus. Despite treatment for cytomegalovirus, intestinal symptoms worsened. Analysis of peripheral blood with fluorescence-activated cell sorting showed a high proportion of T lymphocytes, with 5% to 10% T cells specific to the second donor, suggestive of graft-versus-host disease. Within 48 hours after beginning therapy with antibodies against tumor necrosis factor-α (infliximab), the skin rash disappeared and endoscopy showed slight improvement of the mucosal regeneration. However, despite antifungal prophylaxis with caspofungin, the patient developed angioinvasive pulmonary aspergillosis and multiple organ failure, and he died. In conclusion, typical clinical symptoms of graft-versus-host disease after liver transplant may include skin rash and gastrointestinal symptoms, and diagnosis may be confirmed by histologic examination and testing for blood chimerism. A consensus for the treatment of graft-versus-host disease still is lacking, but tumor necrosis factor-α is an encouraging target for therapy to decrease the symptoms of graft-versus-host disease and enable mucosal regeneration.Item Emergency Liver Transplant in Patient with Child-Pugh Class C Cirrhosis and Strangulated Umbilical Hernia(Başkent Üniversitesi, 2013-02) Chaudhary, Abhideep; Ray, Ramdip; Agarwal, Shaleen; Pareek, Shishir; Gupta, Subash; Wadhawan, Manav; Ramaswamy, Vasudevan Karisangal; Goyal, Neerav; Daga, SachinThe authors report the case of a patient who presented with small bowel obstruction while awaiting liver transplant for Child-Pugh class C cirrhosis. He underwent emergency liver transplant with resection of the small bowel after the obstruction did not improve with conservative management. The authors believe this is the first case of successful emergency liver transplant with resection of the small bowel in a patient with decompensated Child-Pugh class C liver cirrhosis and strangulated umbilical hernia. This case suggests the possibility of improved outcomes of emergency hernia repair in patients with liver cirrhosis when small bowel resection is combined with liver transplant.Item Treatment of Pure Red-Cell Aplasia With Cyclosporine in a Renal Transplant Patient(Başkent Üniversitesi, 2013-02) Yildirim, Rahsan; Aydinli, Bulent; Gokbulut, Puren; Uyanik, Abdullah; Keles, Mustafa; Bilen, YusufAcquired pure red-cell aplasia is a rare disorder that can be either idiopathic or associated with certain autoimmune diseases, pregnancy, lymphoproliferative disorders, nutritional deficiencies, or medicines. We present a deceased-donor renal transplant patient who developed pure red-cell aplasia associated with mycophenolate mofetil or tacrolimus and was treated with cyclosporine. A 20-year-old woman was transplanted from a deceased donor 1 month earlier and presented to us with symptoms of fatigue, prostration, and palpitation. The results of a laboratory examination revealed anemia. A diagnostic work-up resulted in a diagnosis of pure red-cell aplasia. Mycophenolate mofetil was discontinued. Tacrolimus also was replaced with cyclosporine 2 months after mycophenolate mofetil was halted because of a lack of improvement in anemia. Three months later, her anemia improved with cyclosporine. Starting cyclosporine instead of tacrolimus or mycophenolate mofetil showed good improvement in our patient within 6 months of therapy.Item Pretreatment of Rapamycin Before Allogenic Corneal Transplant Promotes Graft Survival Through Increasing CD4+CD25+Foxp3+ Regulatory T Cells(Başkent Üniversitesi, 2013-02) Wang, Xin; Le, Qihua; Hong, Jiaxu; Xu, Jianjiang; Wang, WentaoObjectives: To evaluate the effect of rapamycin pretreatment before allogenic corneal transplant on CD4+CD25+Foxp3+T regulatory cells (Treg) in recipient mice, and analyze its correlation with graft survival. Materials and Methods: Balb/c mice were intraperitoneally injected with rapamycin or control solution for 2 weeks. They then underwent a corneal transplant with C57/BL6 serving as the donor. Graft status was assessed twice a week. Recipient mice were killed 14 days after surgery, and the percentage of CD4+CD25+Foxp3+Treg in peripheral blood, spleen, and draining lymph nodes was analyzed by flow cytometry. Moreover, CD4+CD25+T cells in corneal grafts and conjunctiva were identified, and expression of Foxp3 mRNA in the grafts was tested. Additionally, the concentration of IL-10 and TGF-β1 in serum and aqueous humor was measured. Results: Pretreatment of rapamycin significantly enhanced the percentage of CD4+CD25+Foxp3+Treg in peripheral blood and draining lymph nodes, preoperatively and postoperatively, which had significant negative correlation with graft opacity and neovascularization. Moreover, rapamycin pretreatment led to a larger number of CD4+CD25+T cells infiltrating in corneal grafts and conjunctiva, increased expression of Foxp3 mRNA in grafts, and elevated concentration of TGF-β1 in aqueous humor. Conclusions: Pretreatment with rapamycin for 14 days before an allogenic corneal transplant enhances the percentage of CD4+CD25+Foxp3+Treg cells in peripheral blood, draining lymph nodes, and grafts, thereby inhibiting graft rejection.Item Effect of Positive End-Expiratory Pressure After Porcine Unilateral Left Lung Transplant(Başkent Üniversitesi, 2013-02) Madke, Gabriel Ribeiro; Andrade, Cristiano Feijó; Pereira, Raoni Bins; Felix, Elaine Aparecida; Cardoso, Paulo Francisco Guerreiro; Mariano, Rodrigo; Moraes, Mikael Marcelo de; Fontena, Eduardo; Grün, Gustavo; Forgiarini, Luiz AlbertoObjectives: To evaluate the effects of 2 different levels of positive end-expiratory pressure on pigs who had unilateral lung transplants. Materials and Methods: A left lung transplant was performed in 12 pigs. The animals were randomized into 2 groups based on positive end-expiratory pressure: group 1 (5 cm H2O) and group 2 (10 cm H2O). Hemodynamics, gas exchange, and respiratory mechanics were measured before and after surgery. Cytokines, oxidative stress, and histologic scores were assessed in the lung tissue of each pig. Results: Pigs in group 2 exhibited a significantly higher mean heart rate (P = .006), static compliance (P = .001), lower mean arterial pressure (P = .003), and airway resistance (P = .001) than did pigs in group 1. There were no postoperative differences between the groups in concentrations of thiobarbituric acid reactive substances, superoxide dismutase, and interleukin 8. At the end of the observation period, pigs in group 2 had higher levels of thiobarbituric acid reactive substances (P = .001) and interleukin 8 (P = .05), and pigs in group 1 had higher levels of superoxide dismutase (P = .05) than they did at baseline. Conclusions: After unilateral lung transplant, higher positive end-expiratory pressure was associated with improved respiratory mechanics, a negative effect on hemodynamics, a stronger inflammatory response, and increased production of reactive oxygen species, but no effect on gas exchange.