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Permanent URI for this collectionhttps://hdl.handle.net/20.500.14288/3
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Publication Metadata only Entrapped surgical needle in the valveless AirSeal trocar: a case report and literature review(Elsevier Science Inc., 2024) N/A; Aykanat, İbrahim Can; Balbay, Mevlana Derya; School of Medicine; Koç University HospitalBackground: Valveless trocars like AirSeal system are maintain a stable pneumoperitoneum and reduce instrument friction. Case presentation: A 65-year-old man's robotic radical cystectomy was complicated by a missing needle while using AirSeal system. The needle was detected via backward inspection using the endo camera inserted through the trocar, tip at its most distal end let the visualization of the needle within the air channels and confirmed with a trocar X-ray. Conclusion: Our findings suggest that retrograde inspection and targeted radiography of the trocar, prior to patient imaging, can be helpful in locating the lost needle and prevent prolongation of surgeries.Publication Metadata only Outcome and risk factors for mortality in peritoneal dialysis patients: 22 years of experience in a Turkish center(AVES, 2024) Caliskan, Yasar; Goksoy, Yagmur; Sacli, Fadime Sevgi; Mutlu, Ummu; Turkmen, Aydin; Bozfakioglu, Semra; N/A; Demir, Erol; Koç University Transplant Immunology Research Centre of Excellence (TIREX); Graduate School of Health SciencesBackground: European peritoneal dialysis populations have identified and reported mortality and morbidity risk factors. However, no reports are pointing out the factors affecting the outcomes of these patients during more than 2 decades of follow-up in T & uuml;rkiye. This single -center study aims to evaluate patient mortality and peritonitis rates and estimate confounding factors affecting patient mortality over 22 years. Methods: Adult patients who underwent peritoneal dialysis at our center between December 1994 and December 2016 were enrolled in this retrospective cohort study. The primary outcome of the present study was mortality, and the secondary outcomes were technical failure and peritonitis. Results: Two hundred fifty patients were included in this study. The patients were followed up for a median of 39.5 months (range 17-71). Forty-eight (19.2%) patients died. Survival rates at 5, 10, and 15 years were 86.8% (217/250), 64.6% (86/133), and 41.1% (30/73), respectively. The prevalence of diabetes mellitus [14 (29.2%) vs. 20 (9.9%); P < .001] and cardiovascular disease [16 (33.3%) vs. 24 (11.9%); P < 0.001] were significantly higher in the deceased group compared to the survival group. Cardiovascular disease was the leading cause of death [26 (54.1%)]. Age (hazard ratio (HR) 1.06; 95% CI, 1.04-1.09; P < .001), male sex (HR 2.07; 95% CI, 1.10-3.90; P = .024), and transfer to peritoneal dialysis due to vascular access problems (HR 3.91; 95% CI, 1.90-8.07; P < .001) were associated with mortality in multivariate analysis. Also, catheter exit -site infection, peritonitis rate, catheter removal, and technical complications were similar between the groups. The peritonitis rate was 0.2 episodes per patient per year. Conclusion: The mortality rate of the patient population in our center was similar to Europe and the United States. Cardiovascular diseases and diabetes are the leading causes of death in Turkish peritoneal dialysis patients, as in other populations.Publication Metadata only Kidney transplantation in patients recovered from Coronavirus disease 2019(AVES, 2023) Artan, Ayse Serra; Sadioglu, Rezzan Eren; Yalcin, Funda; Demir, Erol; Keven, Kenan; Safak, Seda; Alpay, Nadir; Guller, Nurana; Memikoglu, Osman; Sengul, Sule; N/A; Yelken, Berna; Okan, Ayşe; Türkmen, Aydın; N/A; Koç University HospitalObjective: There is limited information about kidney transplant recipients who recovered from the Coronavirus disease 2019. This study is conducted to investigate the safety of transplantation in this patient population. Methods: Nineteen patients with prior coronavirus disease 2019 were included. We present demographics, clinical characteristics, laboratory findings, and immunosuppressive regimen. Graft functions and patient and allograft outcomes were compared to 19 kidney transplant recipients who did not have coronavirus disease 2019. Results: The median age of participants was 38 (interquartile range, 26-51) years. Most of the recipients were men (n = 30, 78.9%). The most common presenting symptoms of kidney transplant recipients with prior coronavirus disease 2019 were fever (36.8%), fatigue (21.1%), dyspnea (15.8%), cough (10.5%), and myalgia (5.3%). Eight patients (42.2%) were hospitalized, while none required intensive care unit admission and mechanical ventilation. The median wait time for transplantation after the initial diagnosis of coronavirus disease 2019 was 82 days (interquartile range, 57-172). Most recipients in both groups received antithymocyte globulin as an induction agent. Standard doses of maintenance immunosuppression consisting of tacrolimus, mycophenolate derivatives, and corticosteroids were administered. During a follow-up duration of 85 (interquartile range, 39-154) and 134 (interquartile range, 56-240) days for patients and controls, respectively, the rate of complications and graft functions were not statistically significant between groups. Graft and patient survival was 100%. Conclusion: Our study results support the safety of kidney transplantation in patients with prior coronavirus disease 2019. Transplant candidates and donors should be carefully screened for coronavirus disease 2019. We suggest continuing the standard doses of induction and maintenance immunosuppression, especially in patients who recovered without pulmonary sequelae.Publication Metadata only Current induction therapy strategies and Anti-T lymphocyte globulin usage in kidney transplantation: consensus-based recommendations by a Turkish expert panel(AVES, 2024) Cakir, Uelkem; Dinckan, Ayhan; Karadogan, Nayim; Keven, Kenan; Kocak, Hueseyin; Koc, Serkan Kubilay; Sezer, Siren; Toez, Hueseyin; Usalan, Celalettin; Yildiz, Alaattin; N/A; Türkmen, Aydın; N/A; Koç University HospitalThis advisory committee convened to review national and global kidney transplantation dynamics and provide recom-mendations on the use of anti-T lymphocyte globulin (ATLG) for prevention and treatment of rejection after allogeneic kidney transplantation. A critical evaluation of 6 relevant articles released up to October 2022 was performed to reveal their importance in clinical practice. Additionally, 27 key questions on the indication, dosage of ATLG, and risk stratification were used for the Delphi technique with 8 members of the Turkish Society of Nephrology including 5 kidney transplanta-tion (KTx) subcommittee members and a surgeon experienced in solid organ transplantation. The committee declared that T & uuml;rkiye had great potential in KTx; however, increase in transplantation would be possible in the case of raise in the deceased donor transplantation. As a consensus, ATLG was strongly recommended for induction and rejection treatment. Also, committee members recommended the safe dosage range in steroid resistant acute rejection as 2.5-3 mg/kg daily for 5-7 days, and the median of preferred dosage in induction sounded as 2-2.5 mg/kg daily for 3 days in intermediate risk state. Additionally, post-transplant infection and malignancy cases due to immunosuppression were much rarely encoun-tered than they were in the pastPublication Metadata only Predicting chronic kidney disease progression from cardiac fibrosis: an interplay between two major organ systems(AVES, 2024) N/A; Çöpür, Sidar; Dokuyan, Haydar Can; Gümüş, Terman; Kalemoğlu, Ecem; Hasbal, Nuri Barış; Kanbay, Mehmet; School of Medicine; Koç University HospitalObjective: Cardiovascular disease and chronic kidney disease are two major medical conditions leading to significant morbidity, mortality, and medical spending globally; nevertheless, the exact underlying pathophysiological background linking those two conditions is missing without known predictive variables. Methods: We have performed a retrospective cohort study in a tertiary university hospital on 12 patients in order to investigate the association between fibrosis score on cardiac magnetic resonance imaging study and estimated glomerular filtration rate over a 24-month follow-up period. We have referred to fibrosis scores below 1050 as no fibrosis, fibrosis scores between 1050 and 1100 as mild-to-moderate fibrosis, and scores above 1100 as severe fibrosis on T1-weighted imaging. Results: Twelve patients, 9 males and 3 females, with a mean age of 49.3 have been included in this cohort study. We have demonstrated that T1-weighted magnetic resonance imaging global fibrosis score, basal segment fibrosis score, and septal fibrosis score have been negatively associated with baseline and follow-up estimated glomerular filtration rate measurements while only T1-weighted mid-segment fibrosis score has been linked to delta estimated glomerular filtration rate. Additionally, we have demonstrated that the T1-weighted cardiac fibrosis score has been linked to serum C-reactive protein level. Conclusion: We have demonstrated the association between T1-weighted cardiac magnetic resonance imaging fibrosis scores and kidney functions in our cohort study. Our study is significant by being the first clinical study investigating such an association. Nevertheless, there is a clear need for future large-scale randomized clinical trials in order to better understand the link between cardiac fibrosis and kidney functions. © 2024 Turkish Society of Nephrology. All rights reserved.Publication Metadata only Do xenogeneic anti-HLA-A3 antibody cause antibody-mediated rejection in kidney transplant?(AVES, 2024) Ustaakgül, Sebahat; Temurhan, Sonay; Çınar, Çiğdem Kekik; Çiftçi, Hayriye Şentürk; Bayraktar, Adem; Uçar, Ali Rıza; Bakkaloğlu, Hüseyin; Türkmen, Aydın; Savranoğuz, Fatma; N/A; Demir, Erol; Koç University Transplant Immunology Research Centre of Excellence (TIREX); Graduate School of Health SciencesObjective: Anti-thymocyte globulin-Fresenius is used for induction treatment in kidney transplantation. The antibody ofrabbit originated against human leukocyte antigen A3 were demonstrated in the serum of patients who used anti-thymocyte globulin-Fresenius. We investigated whether anti-human leukocyte antigen A3 antibodies detected due to anti-thymocyte globulin administration had any effect on patient and allograft survival in short- and long-term follow-up. Methods: Fifty-one patients who underwent kidney transplantation between 2004 and 2014 were included in the study. Twenty-nine patients who underwent transplantation from deceased donors received an induction therapy consisting of anti-thymocyte globulin-Fresenius. Antibodies against the human leukocyte antigen were identified using the LABScreen panel reactive antibody class I/II kits with the Luminex method. The graft function and loss, patient survival, and the presence of acute/chronic rejection were investigated. Results: Anti-human leukocyte antigen A3 antibody was detected in 41.3% of the patients receiving anti-thymocyte globulin induction (P = .001). This antibody disappeared at 234.4 days posttransplant. No difference was found regarding pretransplant and posttransplant sensitization of the patients who had posttransplant anti-human leukocyte antigen A3 positivity. The anti-thymocyte globulin dose and administration period were similar for anti-human leukocyte antigen A3 antibody-positive and -negative patients (P >.05). There was no significant difference between groups in short-term, first year, and long-term results of serum creatinine, estimated glomerular filtration rate, and proteinuria values (P >.05). Conclusion: We demonstrated that xenogeneic anti-human leukocyte antigen A3 antibody could be detected in posttrans-plant serum of patients receiving anti-thymocyte globulin induction independent of the dose and duration. The development of this antibody was independent of the exposure of the patient to pre- and posttransplant sensitizing event or the presence of human leukocyte antigen A3 in the allograft. While this study did not demonstrate the effect of xenogeneic anti-human leukocyte antigen A3 antibody on graft and patient survival, retrospective multicenter cohort studies are needed on this issuePublication Metadata only Pathologic outcomes of candidates for active surveillance undergoing radical prostatectomy: results from a contemporary Turkish patient cohort(Karger Publishers, 2018) Tinay, Ilker; Aslan, Guven; Kural, Ali Riza; Ozen, Haluk; Akdogan, Bulent; Yildirim, Asif; Ongun, Sakir; Ozkan, Alp; Zorlu, Ferruh; Dillioglugil, Ozdal; Bekiroglu, Nural; Turkeri, Levent; N/A; Esen, Tarık; Faculty Member; School of Medicine; 50536Introduction: To evaluate the pathological outcomes of Turkish men meeting the criteria for Active Surveillance (AS), who elected to undergo immediate radical prostatectomy (RP). Material and Methods: Retrospective analysis including 1,212 patients with clinically localized prostate cancer (PCa) who met the eligibility criteria for AS. The primary outcomes were pathological upstaging and pathological upgrading. Results: Nine hundred ninety-one patients were eligible for analysis after the central review of the submitted data. The mean prostate-specific antigen (PSA) level was 6.89 (0.51-15) ng/mL and the mean biopsy core number was 12 (8-47). The mean tumor positive core on final biopsy pathology was 1.95 (1-6) (16.6% [2.1-33.3%]). Overall, 30.6% of the men experienced a Gleason sum (GS) upgrade and 13.2% had pathological upstaging. For GS upgrade, the percentage of tumor-positive cores and free-to-total-PSA ratio were significant both in univariate analysis and multivariate logistic regression analysis. Variables predicting pathological upstaging were percentage of tumor-positive cores and PSA density, which were significant in univariate analysis. However, only PSA density was significant in multivariate logistic regression. Although biochemical recurrence-free survival was longer in patients without GS upgrade, it was not statistically significant between patients with and without any GS upgrade (mean 133.7 vs. 148.2 months, p = 0.243). A similar observation was made for patients with or without pathological upstaging (mean 117.1 vs. 148.3 months, p = 0.190). Conclusions: Upgrading and upstaging at RP are quite common among Turkish men with clinically low-risk PCa, who are candidates for AS, and a great majority of them experienced long-term PSA control. (c) 2017 S. Karger AG, BaselPublication Metadata only Laparoscopic sacral colpopexy with polyester fiber suture: Ozerkan modification(Springer, 2020) Ozerkan, Kemal; Orhan, Adnan; Kasapoglu, Isil; Uncu, Gurkan; N/A; Ata, Mustafa Barış; Faculty Member; School of Medicine; 182910Introduction and hypothesis Mesh-related problems are significant complications of laparoscopic sacral colpopexy. The conventional technique precludes performing laparoscopic sacral colpopexy without using a mesh. We describe the Ozerkan modification for laparoscopic sacral colpopexy using a polyester fiber suture instead of a standard mesh and report 1-year objective and subjective outcomes. Methods Women diagnosed with stage >= 2 vaginal vault prolapse were prospectively recruited for the Ozerkan modification between 2015 and 2017. The primary outcome was the anatomic success of the repair, defined by objective parameters using the pelvic organ prolapse quantification system (stage 0 or 1). Secondary outcomes were subjective outcomes assessed with the quality of life scores. Results Twenty-two women underwent the Ozerkan modified laparoscopic sacrocolpopexy. Mean operation time was 85.6 min. Mean estimated blood loss was 71 ml. One patient was lost during the clinical follow-up in the outpatient clinic up to 1 year. Nineteen of 21 patients had stage 0 or 1 prolapse at the end of 1 year. Two patients were not satisfied with their pelvic floor after 1 year. Both the objective and subjective cure rates were 90.4%. There were no bladder or bowel complications during the peri- or postoperative period. Conclusions The new modification of laparoscopic sacral colpopexy seems a feasible and safe option to avoid mesh complications in the treatment of vaginal vault prolapse.Publication Metadata only Fundal pressure in the second stage of labor (Kristeller maneuver) and levator aniavulsion(Springer London Ltd, 2021) Takmaz, Taha; Karasu, Ayşe Filiz Gökmen; N/A; Aydın, Serdar; Faculty Member; School of Medicine; 132535N/A