Nurettin Ay

Value of serial platelet indices measurements for the prediction of pulmonary embolism in patients with deep venous thrombosis.

Background To date, no validated biomarkers with high sensitivity and specificity have been established for diagnosis of pulmonary embolism (PE) in patients with deep venous thrombosis (DVT). There is a need to develop simple and reliable noninvasive tests that can accurately identify patients with PE, even in small hospitals or clinics. The aim of this study was to investigate the value of mean platelet volume (MPV) and platelet distribution width (PDW) for predicting occurrence of PE in patients with DVT. Methods Records of acute DVT patients were reviewed retrospectively. Group 1 consisted of 50 patients with acute DVT and group 2 consisted of 50 patients with acute DVT who developed PE during follow-up. The control group consisted of patients with uncomplicated primary varicose veins of the lower limbs. Venous peripheral blood samples for measurement of MPV, PDW, and platelet count were drawn on admission, before the treatment, and at the time of PE diagnosis. Results MPV and PDW levels at the time of PE diagnosis were higher in group 2 than group 1 (P<0.001 and P=0.026, respectively). Receiver operating characteristics analysis revealed that a 5.2% increase in admission PDW during follow-up provided 70% sensitivity and 82% specificity (area under the curve, 0.80), and a 6.6% increase in admission MPV during follow-up provided 74% sensitivity and 83% specificity (area under the curve, 0.84) for prediction of PE occurrence in patients with DVT. PDW and MPV levels at the time of PE diagnosis were found to be independent risk factors for the occurrence of PE in patients with DVT. Conclusion Serial measurements of MPV and PDW, and percent change in MPV and PDW appears to be a useful marker for predicting occurrence of acute PE in patients with a first episode of acute proximal DVT.

Comparison of outcomes of laparoscopic intracorporeal knotting technique in patients with complicated and noncomplicated acute appendicitis.

Background and aim In our study we aimed to compare laparoscopic intracorporeal knotting technique (base of the appendix was ligated with 20 cm of 2.0 silk) in patients with complicated acute appendicitis (CAA) and noncomplicated acute appendicitis. Patients and methods Ninety patients (female/male: 40/50, age ranging from 16 to 60 years, median age and interquartile range [IQR]: 25 [20; 32] years) who underwent laparoscopic appendectomy were included in the study. The patients were evaluated for the type of acute appendicitis, duration of operation, duration of hospital stay, and postoperative complications. Results The number of cases diagnosed as CAA was 28 (31.1%), and the number of noncomplicated cases was 62 (68.9%). We found that there was no significant difference in postoperative complication rates between complicated and noncomplicated appendicitis cases. Incision site infection was seen in seven cases (7.8%) and ileus was seen in two cases (2.2%). Bleeding, intra-abdominal abscess, and appendix stump leakage were not observed in any of the cases. Median and IQR duration of operation were 42 (35; 52) minutes and median and IQR duration of hospital stay were detected as 2 (1; 2) (range 1–10) days. Conclusion Laparoscopic intracorporeal knotting technique may be a safe, effective, and reliable technique as the materials needed for closing the appendix stumps are easily available for both CAA cases and noncomplicated cases.

Chyluria and Delayed Graft Function in Early Posttransplant Period in a Renal Transplant Patient

Chyluria mostly occurs because of the leakage of lymphatic fluid into the urinary system from the lymphatic system. The patient reported here with end-stage renal disease caused by the nephrotic syndrome underwent renal transplantation from a living donor. During the early posttransplant period, her daily urine output was 300 to 400 mL, and it was chylous. The only abnormality on physical examination was pretibial edema. On renal biopsy, there was no sign of glomerular disease, acute tubular necrosis, or rejection that could have caused delayed graft function. All factors except surgery were excluded, and a lymphourinary fistula was demonstrated with lymphoscintigraphy. After 15 days, chyluria resolved and she recovered spontaneously. Normal diuresis began, and her creatinine level decreased to less than 1 mg/dL in 3 days. According to our knowledge, this is the first chyluria case secondary to surgery in the posttransplant setting.

Evaluation of telaprevir-containing triple therapy in the treatment of chronic hepatitis C in hemodialysed patients

Abstract Hepatitis C virus (HCV) infection is associated with increased morbidity and mortality in patients undergoing hemodialysis for end-stage renal disease (ESRD). Eradication of HCV before transplantation is therefore of utmost importance in HCV-infected patients with ESRD who are candidates for kidney transplantation. The appropriate treatment for HCV infection in patients with ESRD and suboptimal response rates is still unclear. Here, we present our data from five cases who were being monitored by two healthcare centers for ESRD and HCV infection, who were candidates for kidney transplantation and were treated with a triple regimen containing telaprevir. All patients were started on triple therapy from the beginning including pegylated interferon-alfa2a (135 μg once a week), ribavirin (200 mg three times a week), and telaprevir (750 mg three times a day). Rapid virologic response was observed in all of the patients but treatment was discontinued in one patient at week 6 because the patient developed nausea and vomiting and was unable to feed orally. For the remaining four patients, side effects included weakness, lack of appetite, metallic taste, and mild anemia. The triple therapy with telaprevir seemed to be successful in HCV-infected patients who were candidates for renal transplantation.

Comparing methods of ileostomy closure constructed in colorectal surgery in Turkey

Introduction Stoma construction is a life saver method for emergent and elective operations in colorectal surgery. However, they are associated with high rates of morbidity and mortality. Aim To compare the operative findings, early postoperative complications, and costs of stapled and hand-sewn closures in loop ileostomies that are constructed in emergent and elective colorectal surgery. Material and methods The data of 68 patients requiring loop ileostomies during colorectal surgery were retrospectively evaluated. SPSS (version 20) was used for data analysis. Results The study group consisted of 44 men and 24 women with a mean age of 55.5 years. The ileostomy closures were performed with hand-sewn method in 36 patients (group 1) and stapled method in 32 patients (group 2). The mean operation time was 75.4 min in group 1 and 46.7 min in group 2 (p < 0.001). Early postoperative complications were wound infection (8.8%), small bowel obstruction (6.06%), and anastomotic leakage (2.9%). Total costs, flatulence and faeces outlet time, oral feeding starting time, time of hospital stay, and early postoperative complications were lower in the stapled group. Conclusions Morbidity and mortality rates of stoma construction and its closure are still considerable. Lower anastomotic leakage rate, complication rate, and costs and shorter operative times in the stapled group make this method preferable.

Correlation of serum C-reactive protein and procalcitonin levels in infections of kidney transplant recipients

Objectives. Procalcitonin is a propeptide of calcitonin and has been increasingly used as a biomarker of infection. The aim of this study was to evaluate correlation of serum C-reactive protein (CRP) and procalcitonin (PCT) levels of kidney transplant patients hospitalized due to infection. Methods. There were 121 patients who had kidney transplant in our center between September 2012 and February 2017 and patients with a diagnosis of infection or rejection were included in the study. Simultaneous 106 serum CRP and PCT levels at the beginning or during any time of treatment for post-transplant infection, cytomegalovirus (CMV) positivity, BK virem ia and rejection were evaluated. Results. Median and interquartile ranges of CRP and PCT serum levels were 40 mg/l [24.7-64.9] and 0.19 ng/ml [0.1-0.61], respectively. A significant positive correlation between serum CRP and PCT levels of the patients were observed (r=0.490, p 100 mg/l, correlations with serum PCT levels were as r=0.461 ( p 100 mg/l did not show a statistically significant correlation. Stability of PCT levels in viral infections and rejections might be an advantage for the follow-up of solid organ transplants. We need prospective trials of PCT measurements for the evaluation of post-transplant infections.

Böbrek Transplantasyonu Verilerimiz; Diyarbakır’da Tek Merkez Deneyimi

Amac: Bu calismanin amaci, ulkemizde 1975 yilinda uygulamaya gecen ve hastanemizde ancak 2012 yilinda baslatilan bobrek nakli programinin sonuclarini retrospektif olarak degerlendirmektir. Yontemler: Eylul 2012-Aralik 2016 tarihleri arasinda Organ Nakli Merkezimizde bobrek transplantasyonu uygulanan 115 hasta demografik veriler, immunsupresif protokolu, rejeksiyon durumu, greft kaybi, hasta kaybi, postoperatif cerrahi komplikasyonlar, BK viremi (BKV) ve nefropatisi (BKN), cytomegalovirus (CMV) infeksiyonu, tuberkuloz (TBC) ve posttransplant malignensi acisindan degerlendirildi. Bulgular: On iki olguya (%10,4) kadavradan, 103 olguya (%89,6) canli donorden bobrek transplantasyonu uygulandi. Alicilarin ve donorlerin ortalama yasi sirasi ile 34.65 (12-68) ve 42 (23-72) idi. Erkek/Kadin orani alici ve donorlerde sirasi ile 65/50 ve 48/67 idi. Postoperatif median ve ceyreklerarasi aralik (CAA) taburculuk kreatini 1.03 [0.55-1.48] mg/dl idi. Yedi (%6) olgu akut rejeksiyon tanisi aldi. Dort olguda (%3,4) greft kaybi gozlendi. Mortalite gozlenmedi. Sonuc: Bobrek transplantasyonu programimiz gelisim asamasindadir. Ancak kisa donem sonuclar literatur ile uyumlu gorunmektedir. Uzun sureli takip sonuclari ile daha anlamli sonuclar elde edilebilir.

The effects of hyperoxaemia on tissue oxygenation in patients with a nadir haematocrit lower than 20% during cardiopulmonary bypass

Excessive haemodilution and the resulting anaemia during CPB is accompanied by a decrease in the total arterial oxygen content, which may impair tissue oxygen delivery. Hyperoxic ventilation has been proven to improve tissue oxygenation in different pathophysiological states of anaemic tissue hypoxia. The aim of this study was to examine the influence of arterial hyperoxaemia on tissue oxygenation during CPB. Records of patients undergoing isolated CABG with CPB were retrospectively reviewed. Patients with nadir haematocrit levels below 20% during CPB were included in the study. Tissue hypoxia was defined as hyperlactataemia (lactate >2.2 mmol/L) coupled with low ScVO2 (ScVO2 <70%) during CPB. One hundred patients with normoxaemia and 100 patients with hyperoxaemia were included in the study. Patients with hyperoxaemia had lower tissue hypoxia incidence than patients with normoxaemia (p<0.001). Compared with patients without tissue hypoxia, patients with tissue hypoxia had significantly lower PaO2 values (p<0.001) and nadir haematocrit levels (p<0.001). Nadir haematocrit levels <18% (OR: 5.3; 95% CI: 2.67–10.6; p<0.001) and hyperoxaemia (OR: 0.28; 95% CI: 0.14–0.56; p<0.001) were independently associated with tissue hypoxia. Conclusions: Hyperoxaemia during CPB may be protective against tissue hypoxia in patients with nadir haematocrit levels <20%.