Sertac Cimen

Risks and Benefits of Early Catheter Removal After Renal Transplantation.

Although many advances in renal transplantation have occurred over recent decades, bladder catheterization has remained a constant practice to facilitate the identification of the dome of the bladder by retrograde infusion of antibiotic solutions in its lumen prior to the creation of the cystoureteric anastomosis. In addition, the presence of the Foley catheter prevents possible tension on the newly created anastomosis between the ureter and the bladder as it allows continuous external drainage of urine and is very useful to monitor perioperative fluid balance. Although urethral catheterization provides several benefits, the optimal duration of catheterization remains a subject of controversy. The primary aim of this paper is to review the available scientific literature on the management of urethral catheters after renal transplantation and assess the pros and cons of early vs late catheter removal.

Advances in loco-regional palliation of unresectable cholangiocarcinomas

Cholangiocarcinoma (CC) represents the second most common primary hepatic malignancy after hepatocellular carcinoma, accounting for 10% to 15% of primary liver tumors. Its prognosis is often poor due to its late presentation and its relative resistance to current chemotherapy and radiotherapy regimens. At the time of diagnosis, more than half of the patients are not candidates for surgical therapy due to either invasion of vascular structures or distant metastases. Therefore, for a large proportion of patients, palliation remains the only option for better quality of life and, in some circumstances, longer survival. The main goals of palliative interventions for CC are: restoration of the biliary drainage and resolution of pruritis caused by obstructive jaundice, improvement of the nutritional status and reduction of pain. During the last decades, novel therapies have been introduced to optimize the management of patients with unresectable CC. These therapies can be resource intensive and have some adverse effects; therefore patient selection is crucial. This article discusses the current options for palliation of CC.

Effects of mTOR Inhibitors in Prevention of Abdominal Adhesions

ABSTRACT Purpose of the Study: Postsurgical adhesions can occur after laparotomy and can cause morbidity. Local delivery of sirolimus prevented adhesion formation in various experiments. We analyzed the impact of orally dosed mammalian target of rapamycin inhibitors on abdominal adhesion formation and wound tensile strength in an experimental model. Materials and Methods: Wistar albino rats were divided into sirolimus, everolimus, and control groups (n = 6 per group). Experimental animals underwent midline laparotomy and adhesion induction procedure which included cecum abrasion and mesh implantation. Animals were administered oral sirolimus (4 mg/kg), everolimus (3 mg/kg), or placebo starting on postoperative day 1. Treatments were given until postoperative day 7. At postoperative day 21, adhesions were scored. Meshes were resected with the attached abdominal wall and cecal segment and stained with Sirius red for collagen density analysis. Midline scars were excised for tensile strength measurement. Effects of sirolimus and everolimus on fibroblast proliferation were also assessed. Results: Mean adhesion score of the everolimus group (7.83 ± 1.17) was significantly lower compared to sirolimus (11.00 ± 0.63) and control (11.66 ± 0.51) groups. Mean collagen density of the everolimus group (33.5 ± 7.8) was significantly lower compared to sirolimus (50.7 ± 9.69) and control (53.8 ± 12.4) groups. Mean tensile strength of the control group (26.41 ± 2.10) was significantly higher compared to sirolimus (17.89 ± 1.9) and everolimus (21.37 ± 1.25) groups. It was significantly lower in sirolimus group than everolimus group. Both sirolimus and everolimus treated media inhibited fibroblast proliferation significantly compared to media alone. Conclusions: Everolimus effectively reduced adhesions. Nevertheless, it also reduced wound tensile strength: an effect which seemed to be due to inhibition of fibroblast proliferation.

Kidney transplantation in an adult patient with VACTERL association.

The vertebral, anal, cardiac, tracheoesophageal, renal, and limb birth defects (VACTERL) association is a rare, non-random constellation of congenital abnormalities among which urinary tract anomalies can be included. In the presence of these anomalies, patients are suspected to have a higher rate of renal failure than average. We report a case of a 22-year-old woman with VACTERL association and consequent end stage renal failure. A live-related kidney transplant was carried out successfully and the postoperative course was uncomplicated. The patient had immediate graft function. Risk factors that may complicate kidney transplant surgery in this patient population as well as considerations relevant to peritransplant management are discussed.

Implications of Hyponatremia in Liver Transplantation

Although there are a limited number of quality studies, appropriate peri-operative management of serum electrolytes seems to reduce adverse outcomes in liver transplantation. Hyponatremia is defined as the presence of serum concentration of sodium equal ≤130 mmol/L and it is detected in approximately 20% of patients with end stage liver disease waiting for a liver transplant (LT). This paper will focus on the pathogenesis of dilutional hyponatremia and its significance in terms of both candidacy for LT and post-operative outcomes.

MP62-17 LISTENING TO MUSIC DURING SHOCK WAVE LITHOTRIPSY DECREASES ANXIETY, PAIN AND DISSATISFACTION: A RANDOMIZED CONTROLLED STUDY

included abnormally elevated renal parameters, signs of a concomitant infectious process (fever, leukocytosis, or a positive urine dipstick), pain poorly responding to analgesia, radiolucent stones, or stones smaller than 4-mm or larger than 15-mm in size. 72 patients had been randomly assigned to undergo ESWL directly without pre-stenting (Group A), while 52 patients were assigned for pre-stenting (Group B), with their data and outcomes prospectively collected. Mean patient BMI in both groups was 26.1 and 26.7 kg/m2 (p 1⁄4 0.49), mean skin-to-stone distance was 11 and 10.1 cm (p 1⁄4 0.03), mean stone size was 7.3 and 7.8 mm (p 1⁄4 0.114), and mean stone density was 902 and 1078 Hounsfield units (p 1⁄4 0.005) respectively. RESULTS: 72 patients had undergone emergency ESWL directly without pre-stenting (Group A), while 52 patients had undergone pre-stenting before emergency ESWL (Group B). All 124 patients had their first session of ESWL done within 48 hours of their initial presentation. 8 patients were lost to follow up in Group A, while one patient was lost to follow up in Group B. Four patients’ stones had migrated to the kidney with stenting and were excluded from the study. Stone clearance in both groups was 61% and 44% (p 1⁄4 0.068) after one session, 91% vs 59% (p 1⁄4 <0.001) by the second session, and 95% and 73% (p 1⁄4 0.001) by the third and last session. No patients in Group A crossed over to Group B or required stenting at any point. CONCLUSIONS: Emergency ESWL for upper ureteric calculi offers excellent stone clearance outcomes for properly selected patients with an acute presentation of renal colic that has subsided. Proceeding directly for ESWL without pre-stenting was associated with significantly enhanced stone clearance while sparing the patient multiple invasive interventions and their potential morbidity.

Kidney transplantation in a child with Pierson syndrome

Congenital nephrotic syndrome is commonly associated with mutations in genes that encode podocyte and slit diaphragm proteins or the structural and regulatory proteins of the GBM. These mutations lead to the formation of dysfunctional proteins, which account for the resistance of the renal manifestations to conventional treatment methods. Consequently, patients become renal replacement therapy dependent. Mutation of the LAMB2 gene is associated with Pierson syndrome, which is an autosomal recessive disorder characterized by congenital nephrotic syndrome and ocular abnormalities. In this report, a 2‐year‐old male patient who was diagnosed with Pierson syndrome is presented. He had bilateral microcoria and developmental delay in addition to nephrotic syndrome. His renal function deteriorated rapidly, and he underwent a deceased donor kidney transplantation. He showed dramatic improvement after kidney transplantation; in addition to having good renal function, he started to catch up to his peers in terms of growth. Pierson syndrome should be considered during the diagnostic investigations of children with renal manifestations and ocular abnormalities. Children with Pierson syndrome must be evaluated in terms of kidney transplantation as soon as they are diagnosed.

Impact of specimen adequacy on the assessment of renal allograft biopsy specimens

The Banff classification was introduced to achieve uniformity in the assessment of renal allograft biopsies. The primary aim of this study was to evaluate the impact of specimen adequacy on the Banff classification. All renal allograft biopsies obtained between July 2010 and June 2012 for suspicion of acute rejection were included. Pre-biopsy clinical data on suspected diagnosis and time from renal transplantation were provided to a nephropathologist who was blinded to the original pathological report. Second pathological readings were compared with the original to assess agreement stratified by specimen adequacy. Cohens kappa test and Fishers exact test were used for statistical analyses. Forty-nine specimens were reviewed. Among these specimens, 81.6% were classified as adequate, 6.12% as minimal, and 12.24% as unsatisfactory. The agreement analysis among the first and second readings revealed a kappa value of 0.97. Full agreement between readings was found in 75% of the adequate specimens, 66.7 and 50% for minimal and unsatisfactory specimens, respectively. There was no agreement between readings in 5% of the adequate specimens and 16.7% of the unsatisfactory specimens. For the entire sample full agreement was found in 71.4%, partial agreement in 20.4% and no agreement in 8.2% of the specimens. Statistical analysis using Fishers exact test yielded a P value above 0.25 showing that - probably due to small sample size - the results were not statistically significant. Specimen adequacy may be a determinant of a diagnostic agreement in renal allograft specimen assessment. While additional studies including larger case numbers are required to further delineate the impact of specimen adequacy on the reliability of histopathological assessments, specimen quality must be considered during clinical decision making while dealing with biopsy reports based on minimal or unsatisfactory specimens.

Gastrointestinal stromal tumour in a recipient with kidney transplantation

Immunosuppression is associated with an increased risk of post-transplant malignancies. Gastrointestinal stromal tumours are the most common mesenchymal tumours of the gastrointestinal tract. However, they have seldom been reported recipient with transplantation. In this report, a 46-year-old woman, a recipient with kidney transplantation, who developed a gastric tumour is presented. Removal of this tumour required a partial gastrectomy. Histopathology and immunohistochemistry examinations revealed a high-risk gastric stromal tumour. Adjuvant imatinib mesylate treatment was initiated. There was no evidence of tumour recurrence at 12-month follow-up.

A gastrointestinal stromal tumour with pulmonary metastases mimicking unilateral gynaecomastia

Gastrointestinal stromal tumours (GISTs) represent 1% of primary gastrointestinal cancers. These neoplasms most frequently metastasise to the liver and peritoneum and rarely to the lungs and bones. Treatment of unresectable GISTs involves systemic chemotherapy with tyrosine kinase inhibitors, imatinib and sunitinib being first-line and second-line drugs. We report the case of a 52-year-old man with GIST who developed a right-sided subareolar breast swelling and subsequently discovered to be an invasive metastatic pulmonary GIST. Given that gynaecomastia is a known adverse effect of imatinib and sunitinib, this case report illustrates the importance of including metastatic disease in the differential diagnosis of patients with GIST and with the new onset of soft tissue masses.