Taylan Özgür Sezer

Laparoscopic resection of retroperitoneal schwannoma near the inferior vena.

BACKGROUND Schwannomas are usually benign tumors that arise from the schwann cells in the neural sheaths of peripheral nerves. Most schwannomas occur in the head, neck, or limbs and rarely in the retroperitoneal space. In the retroperitoneal space, schwannomas are most commonly located near the adrenal gland. We report a successfully resected retroperitoneal benign schwannoma near the inferior vena cava (IVC) using laparoscopic surgery. METHODS/RESULTS A 33-year-old woman presented with dull abdominal pain for several months. Magnetic resonance imaging confirmed the existence of a round, sharply demarcated retroperitoneal solid tumor, 42 x 52 mm in size, located between the anterior of the right kidney and the IVC, which was compressed but still patent. The lesion was laparoscopically resected, and pathologic examination revealed a degenerative schwannoma. CONCLUSION Laparoscopic surgery is very useful and feasible in the diagnosis and treatment of retroperitoneal schwannoma, with minimal invasiveness and early postoperative recovery.

Long-term outcomes of kidney transplants with multiple renal arteries: a retrospective study.

OBJECTIVE The aim of this study was to investigate whether kidney transplantations performed using grafts with multiple arteries negatively affected renal function or increased the risk of vascular or urologic complications. METHODS Among 249 kidney transplant patient followed for at least 1 year between 2000 and 2005, we retrospectively evaluated their donor renal artery anatomy to compare postoperative vascular and urologic complications: creatinine clearance at 1, 2, and 5 years, as well as graft survival at 3 and 5 years. RESULTS While 214 (85.9%) displayed a single artery (group 1), 35 (14.1%) showed multiple renal arteries (group 2). Thirty-one of the group 2 allografts had two, three donors had three, and one had four arteries. The postoperative vascular and urologic complications and the creatinine clearance values at 1, 2, and 5 years of both groups were similar. The 3- and 5-year graft survivals among group 1 were 95% and 90%, whereas those of group 2 were 94% and 91% respectively (P < .05). CONCLUSION Our study indicated that multiple renal arteries did not adversely affect postoperative urologic or vascular complications or kidney allograft or patient survival compared with single renal artery cases.

A horseshoe kidney from a live donor as a renal transplant: case report.

OBJECTIVES This case report presents our experience regarding a horseshoe kidney from live donor to be used as a renal transplant. MATERIALS AND METHODS The recipient was a 48-year-old man with chronic renal failure owing to hypertension who had been on hemodialysis for 2 years. The donor was his 43-year-old sister who had an uncomplicated horseshoe kidney with negative results on a urinalysis. An aortogram showed that the arterial supply to the kidney consisted of 2 superior arteries (1 on each side) and 1 inferior accessory artery that was divided to feed the lower fused parenchyma of the kidney. RESULTS Surgery was performed via a retroperitoneal lumbotomy incision; the left half of the kidney was mobilized. The left kidney was procured by clamping the inferior accessory renal artery, transecting the parenchyma within the demarcation boundary. The transplant kidney was placed in the recipients contralateral iliac fossa. The graft vein was anastomosed to the recipients external iliac vein, the artery to the external iliac artery, and the ureter to the bladder. After perfusing the graft, no urine leakage was detected from the transacted surfaces, and the graft began producing urine. There were no complications after surgery. The patient was discharged on the 10th day after surgery with a creatinine level of 0.07 μmol/L. Maintenance immunosuppressive treatment included tacrolimus, mycophenolate mofetil, and prednisolone. CONCLUSIONS We believe using a horseshoe kidney as a renal allograft after a detailed preoperative evaluation may help expand the donor pool.

Abdominal Wall Endometrioma: Ultrasonographic Features and Correlation with Clinical Findings

BACKGROUND The diagnosis of abdominal wall endometrioma (AWE) is often confused with other surgical conditions. Certain factors relating to knowledge of the clinical history of the disease make correct diagnosis and treatment difficult. AIMS To present the clinical findings and ultrasonographic (US) features of AWE with special emphasis on size-related features. STUDY DESIGN This study reviewed abdominal wall endometriomas during a 2-year period in the Radiology Department of Sifa University Hospital, Izmir. METHODS Eleven women (mean age 32.6 years) with 12 scar endometriomas (mean diameter 29.2 mm) were consecutively evaluated by US and Colour Doppler examination (CDUS) prior to surgery. Lesions were grouped into large (≥3 cm) and small nodules. Vascularisation was classified as location (central, peripheral and mixed) and severity (absent, moderately vascular and hypervascular). In each patient, the nature of pain (absent, cyclic: associated with menstruation and continuous), historical and clinical data were documented. Four patients underwent Magnetic Resonance Imaging and their findings were presented. Fishers exact test, χ(2) test for categorical data and the unpaired T-test for continuous variables were used for statistical analysis. RESULTS In all the women, US of the AWE showed the presence of a solid hypoechoic mass (less echogenic than the surrounding hyperechoic fat) within the abdominal wall. There was a significant correlation between AWE sizes with repeated caesareans and the mean time between the last operation and admission to hospital (p<0.05). Large endometriomas showed increased central vascularity (p<0.05). Cyclic pain was more frequent in small lesions, whereas continuous pain was more commonly found in patients with larger lesions (p<0.05). CONCLUSION AWE is often misdiagnosed clinically because endometriosis may occur years after the caesarean section, the pain is often non-cyclic in nature, and there is not always a palpable tender mass. The sonographic and Doppler findings, along with proper correlation with clinical data, may substantially contribute to the correct diagnosis of endometrioma.

Prognostic Factors in Peptic Ulcer Perforations: A Retrospective 14-Year Study

Regarding the complications of peptic ulcer, a perforation remains the most important fatal complication. The aim of our retrospective study was to determine relations between postoperative morbidity and comorbid disease or perioperative risk factors in perforated peptic ulcer. In total, 239 patients who underwent emergency surgery for perforated peptic ulcer in Ege University General Surgery Department, between June 1999 and May 2013 were included in this study. The clinical data concerning the patient characteristics, operative methods, and complications were collected retrospectively. One hundred seventy-five of the 239 patients were male (73.2%) and 64 were female (26.8%). Mean American Society of Anesthesiologists (ASA) score was 1 in the patients without morbidity, but mean ASA score was 3 in the morbidity and mortality groups. Primary suture and omentoplasty was the selected procedure in 228 of the patients. Eleven patients underwent resection. In total, 105 patients (43.9%) had comorbidities. Thirty-seven patients (67.3%) in the morbidity group had comorbid diseases. Thirteen (92.9%) patients in the mortality group had comorbid diseases. Perforation as a complication of peptic ulcer disease still remains among the frequent indications of urgent abdominal surgery. Among the analyzed parameters, age, ASA score, and having comorbid disease were found to have an effect on both mortality and morbidity. The controversial subject in the present study is regarding the duration of symptoms. The duration of symptoms had no effect on mortality nor morbidity in our study.

Large mucinous neoplasm of the appendix mimicking adnexal mass in a postmenopausal woman

Highlights • Appendiceal tumors are rare, late-diagnosed neoplasms that may not be differentiated from adnexal masses.• Pre-operative diagnosis remains difficult and it can be mimicking adnexal mass.• It may be asymptomatic and remain undiagnosed until surgery.• Appendiceal tumor kept in mind in a patient with diagnosed adnexal mass, especially patient had a non-specific clinical symptoms, laboratory and radiologic findings.

Spousal Versus Living Unrelated Renal Transplantation: A Retrospective Analysis of Allograft Outcomes

OBJECTIVE To compare the outcomes of spousal and living unrelated donor (LUD) allografts. PATIENTS AND METHODS The 378 ABO-compatible living and cadaveric kidney transplantations between February 2005 and August 2010 included 25 wife-to-husband (group 1), 15 husband-to-wife (group 2), and 20 LUD cases (group 3). Donor nephrectomy was performed by open surgery. Induction therapy with antithymocyte globulin or anti-interleukin-2 receptor antibody was followed by maintenance regimens using cyclosporine (CsA) or tacrolimus (Tac) plus mycophenolate mofetil (MMF) and corticosteroids. We compared spousal donor and LUDs in terms of clinical characteristics as well as graft and patient survival rates. RESULTS Fifty-six (93.3%) patients underwent induction therapy with either antithymocyte globulin (n = 30) or anti-interleukin-2 receptor antibody (n = 26). Maintenance immunosuppression was administered with Tac + MMF (n = 37; 61.6%) or CsA + MMF (n = 23; 38.4) with corticosteroids. Mean follow-up was 34 ± 16 months. There were four graft losses and five patient deaths. There were no significant differences between spousal and living unrelated transplants in terms of clinical characteristics or biopsy-proven acute rejection episodes. The Kaplan-Meier analysis showed 3-year patient survival rates of 94%, 100%, and 88% in group 1, group 2, and group 3, respectively (P > .05). Overall graft survival rates were 94%, 100%, and 77% in group 1, group 2, and group 3, respectively (P > .05). Graft and patient survival rates were similar at 3 years for wife-to-husband, husband-to-wife, or LUDs. CONCLUSION In conclusion, family members should be encouraged as LUD or spousal donors, based on similar patient and graft survival rates.

Vascular Complications After Renal Transplantation

Renal transplantation has become the treatment of choice for end-stage renal disease due to advances in surgical techniques, perioperative management, and immunosuppressive regimens. Surgical techniques for kidney transplantation were first described in 1951 by Kuss et al. and have since changed very little. The most common surgical procedure is extraperitoneal transplantation in the right iliac fossa, with end-to-side to the external iliac artery or end-to-end anastomosis to the internal iliac artery, and end-to-side anastomosis to the external iliac vein.

Perioperative management of Sneddon syndrome during thyroidectomy

The perioperative management of an adult woman with Sneddon syndrome is presented. This syndrome is characterized by vasculopathy, hypercoagulable state, ischemic cerebral events, livedo reticularis, heart valve disease, and renal insufficiency. During surgery in these patients, the balance between bleeding and thrombosis requires rapid diagnostic information for therapeutic decisions. Thrombelastographic analysis may be a valuable tool to use in monitoring these patients.

Comparison of Preemptive Kidney Transplantation With Nonpreemptive Kidney Transplantation in a Single Center: A Follow-up Study

BACKGROUND AND AIM The effect of preemptive transplantation of kidneys from living donors on patient and allograft survival is controversial. In this study, we aimed to evaluate whether preemptive kidney transplantation performed without the development of patient dialysis-related complications has a favorable effect on patient and graft survival. PATIENTS AND METHOD The study included 334 adult renal transplant recipients. Patients who underwent renal transplantation between January 2008 and December 2012 at a tertiary referral teaching hospital were followed, and outcomes were obtained by retrospective chart review. A total of 244 patients underwent dialysis before renal transplantation, whereas 90 patients underwent preemptive transplantation. RESULTS There were no significant differences between the 2 groups with regard to patients and graft survival rates (P > .05). Patient survival rates in preemptive and nonpreemptive groups were 98.9% and 96.3% in the first year, respectively (P = .199). Graft survival rates in preemptive and nonpreemptive groups were 96.7% and 93.0% in the first year, respectively (P = .163). Patient survival rates in preemptive and nonpreemptive groups were 98.9% and 95.7% in the third year, respectively (P = .155). Graft survival rates in preemptive and nonpreemptive groups were 93.5% and 88.5% in the third year, respectively (P = .138). There was a significant difference among years with regard to ratio of patients with preemptive transplantation (P = .009). The ratio was 17.5% in 2008, whereas it rose to 43.1% in 2012. CONCLUSION Although preemptive kidney transplantation does not provide a significant patient and allograft survival advantage compared to nonpreemptive kidney transplantation, both therapeutic modalities provide good outcomes. Preemptive kidney transplantation has been an increasingly frequent renal replacement therapy option in recent years.