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Öğe Congenital adrenal hyperplasia: A rare cause of renal failure and a successful renal transplantation(2012) Gungor O.; Kircelli F.; Carrero J.J.; Hur E.; Dheir H.; Simsir A.; Okmen F.; Toz H.; Hoscoskun C.Congenital adrenal hyperplasia belongs to a group of autosomal recessive disorders affecting steroid biosynthesis; a rare disease with a prevalence of 1 case per 16,000 population. A 30-year-old phenotypically male patient had been diagnosed with 11-ß hydroxylase deficiency at the age of 16; presenting with ambiguous genitalia, growth retardation, presence of menstrual cycles, severe hypertension, hypokalemia and renal dysfunction. He developed end-stage renal disease due to hypertension and was treated with hemodialysis for 3 years. After careful evaluation, he was approved to undergo renal transplantation. The patient has now finished 6th month after transplantation and is currently under follow-up at our out-patient clinic, having no problems related to the transplant. While early treatment to prevent hypertension is mandatory in patients with congenital adrenal hyperplasia, once renal failure occurs, renal transplantation may the best choice of treatment. In this study, we describe the first report of a successful renal transplantation in an adrenal hyperplasia. © 2012 Dustri-Verlag Dr. K. Feistle.Öğe A feasible technique for intraoperative endoscopy of gastrointestinal bleeding: Clothed endoscopy(2012) Sezer T.Ö.; Yildirim H.; Unalp O.; Yoldas T.; Firat O.; Guler A.; Ersin S.; Hoscoskun C.[No abstract available]Öğe Is mezlocilline prophylaxis effective in clinical renal transplantation?(1992) Tokat Y.; Coker A.; Basci A.; Hoscoskun C.; Kaplan H.; Yararbas O.[No abstract available]Öğe Localization of accessory renal artery infarction using Tc-99m DMSA scintigraphy(2004) Dirlik A.; Ozbek S.S.; Toz H.; Hoscoskun C.; Ozcan Z.The presence of accessory renal arteries has been considered a relative contraindication in the setting of a live related renal transplant program. Failure to properly anastomose the arteries can cause segmental infarction leading to increased morbidity. The authors describe a transplant patient with a well-defined cortical defect on a Tc-99m DMSA study, which was caused by a vascular complication. Although Tc-99m DTPA scintigraphy revealed the hypoperfused area, Tc-99m DMSA provided better delineation of the infarcted parenchymal zone.Öğe Long-term outcomes of kidney transplants with multiple renal arteries: A retrospective study(2012) Sezer T.O.; Solak I.; Toz H.; Kardaslar B.; Er A.; Hoscoskun C.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. © 2012 Elsevier Inc. All rights reserved.Öğe Management of small bowel volvulus in a patient with simultaneous pancreas-kidney transplantation (SPKT): A case report(2007) Aydin U.; Yazici P.; Toz H.; Hoscoskun C.; Coker A.There are several surgical complications which can occur following simultaneous pancreas-kidney transplantation (SPKT). Although intestinal obstruction is known to be a common complication after any type of abdominal surgery, the occurrence of small bowel volvulus, which is one of the rare causes of intestinal obstruction, following SPKT has not been published before. A 24-year-old woman suffering from type I diabetes mellitus with complications of nephropathy resulting in end stage renal disease (ESRD), neuropathy and retinopathy underwent SPKT. On the postoperative month 5, she was brought to the emergency service due to abdominal distention with mild abdominal pain. After laboratory research and diagnostic radiological tests had been carried out, she underwent exploratory laparotomy to determine the pathology for acute abdominal symptoms. Intra-operative observation revealed the presence of an almost totally ischemic small bowel which had occurred due to clockwise rotation of the mesentery. Initially, simple derotation was performed to avoid intestinal resection because of her risky condition, particularly for short bowel syndrome, and subsequent intestinal response was favorable. Thus, surgical treatment was successfully employed to solve the problem without any resection procedure. The patient's postoperative follow-up was uneventful and she was discharged from hospital on postoperative day 7. According to our clinical viewpoint, this study emphasizes that if there is even just a suspicion of acute abdominal problem in a patient with SPKT, surgical intervention should be promptly performed to avoid any irreversible result and to achieve a positive outcome. © 2007 Aydin et al; licensee BioMed Central Ltd.Öğe A new quantitative index for baseline renal transplant scintigraphy with 99mTc-DTPA in evaluation of delayed graft function and prediction of 1-year graft function(Lippincott Williams and Wilkins, 2016) Yazici B.; Oral A.; Gokalp C.; Akgün A.; Toz H.; Hoscoskun C.Purpose: The aims of this study were to assess quantitative indices of baseline renal transplant scintigraphy (RTS) with 99mTc-DTPA for evaluation of delayed graft function (DGF) and prediction of 1-year graft function and to describe a new inclusive index for RTS. Patients and Methods: A total of 179 patients to whom RTS with 99mTc-DTPA was performed within 2 days after kidney transplantation were analyzed retrospectively. Hilson perfusion index, perfusion time (?P), peakto-plateau ratio, peak perfusion-to-iliac artery ratio, T= of graft washout, peak perfusion-to-uptake ratio, and ratio of uptake at 20 to 3 minutes (R20/3) were obtained. In addition, we first described the following formula defined as graft index (GI): GI = (?P × arterial peak × plateau)/(perfusion peak× uptake at 3minutes). At 1 year, a serum creatinine level ofmore than 1.5 mg/dL was considered to be abnormal.Mann-Whitney U, Spearman coefficient of correlation test, and receiver operating characteristic curve were used for statistical analyses. P < 0.05 was considered statistically significant. Results: Mean values of all the indices were significant. The most accurate, sensitive, and specific index for both identification of DGF and prediction of 1-year serum creatinine level of more than 1.5 mg/dL was GI. Area under the curve of GI was 0.94 for identification of DGF and 0.79 for 1-year prediction. Conclusions: The question is, "Which index is the best indicator?" This study demonstrated that the parameters of ?P, plateau, arterial peak, perfusion peak, and uptake at 3 minutes of RTS could be assessed together by the formula of GI, which provides more accurate information to identify DGF and predict 1-year graft function. © 2015 Wolters Kluwer Health, Inc. All rights reserved.Öğe Regressive course of oxalate deposition in primary hyperoxaluria after kidney transplantation(2010) Çelik G.; Sen S.; Sipahi S.; Akkin C.; Tamsel S.; Töz H.; Hoscoskun C.Primary hyperoxaluria (PH) is a rare autosomal recessive disease caused by the functional defect of alanine-glyoxylate aminotransferase (AGT) enzyme in the liver and it is characterized by the deposition of diffuse calcium oxalate crystals. A 38-year-old male patient presented with history of recurrent nephrolithiasis and has received chronic hemodialysis treatment for 2 years. Cadaveric renal transplantation was applied to the case. The patient was reoperated on postoperative day 13 because of the collection surrounding the urethra. During this operation, kidney biopsy was made due to late decrease in creatinine levels. Deposition of diffuse oxalate crystal was detected in allograft kidney biopsy, whereas in the 0-hour biopsy there were no oxalate crystals. Oxalate level was found to be high in a 24-hour urine specimen (118 mgL, normal level: 744 mgL). The patient was identified with primary hyperoxaluria and followed up in terms of systemic oxalate deposition as well as allograft kidney. In the kidney biopsy taken after 18 months, we detected that oxalate crystals almost entirely disappeared. In our case, bilateral preretinal, intraretinal, and intravascular diffuse oxalate crystals were detected, and argon laser photocoagulation treatments were needed for choroidal and retinal neovascularization. Repeated ophthalmic examinations showed the regressive nature of oxalate depositions. In the 18th month, fundus examination and fluorescein angiography revealed that oxalate crystals were significantly regressed. To increase the quality of life and slow down the systemic effects of oxalosis, kidney-only transplantation is beneficial. © 2010 Informa UK Ltd.Öğe Spousal versus living unrelated renal transplantation: A retrospective analysis of allograft outcomes(2012) Solak I.; Sezer T.O.; Toz H.; Tatar E.; Isayev C.; Firat O.; Hoscoskun C.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. © 2012 Elsevier Inc. All rights reserved.Öğe Surgical treatment of primary sacral tumors: complications associated with sacrectomy.(2003) Zileli M.; Hoscoskun C.; Brastianos P.; Sabah D.OBJECT: Sacral tumors are relatively rare, and experience related to resection of these tumors is therefore usually limited to a small number of patients. The purpose of this retrospective study was to review the authors' experience with sacral neoplasms over the last 12 years. METHODS: Based on a review of records in 11 patients who underwent sacrectomy, and the various patient characteristics, presenting symptoms, histological findings for their tumors, as well as the type of surgical treatment used (including a whole spectrum of sacral amputations), and their outcome are reported. CONCLUSIONS: Despite the potential for complications, sacrectomy can be performed successfully, and is an important procedure in the treatment of primary sacral tumors.Öğe Use of kidney donors with hepatitis B, hepatitis C, or brain tumor: A single-center experience(2012) Tatar E.; Turan M.N.; Firat O.; Sezer T.O.; Sozbilen M.; Solak I.; Toz H.; Hoscoskun C.Introduction: With the rapid increase in the number of patients on the waiting lists, the idea of using organs from donors who were previously classified as "marginal" has emerged. The aim of this study was to evaluate the clinical outcomes of the patients who received kidneys from donors with hepatitis B, hepatitis C, or brain tumors. Patients and Method: Between 2003 and 2010, 27 transplantations were performed from donors with hepatitis B, hepatitis C or brain tumors between 2003 and 2010. Demographic and clinical characteristics of donors and recipients were retrospectively collected from medical files. Results: Fifteen patients received kidneys from donors with hepatitis B: 9 from deceased donors having a positive hepatitis B surface antigen (HBsAg) and six from living donors with positive HBsAg having negative results of qualitative hepatitis B DNA analysis. Two of the fifteen recipients were previously diagnosed with chronic active mild hepatitis B infection. The remaining 13, who were HBsAg (-)/anti-HBs(+) at the time of transplantation, underwent hepatitis B immune globulin and lamivudine therapy. Median follow up time was 40 ± 35 months. One patient developed decompensated liver disease owing to noncompliance to lamivudine therapy. Five patients who received grafts from anti-HCV(+) deceased donors were anti-HCV(+) at the time of transplantation with alanine aminotransferase (ALT) levels <40 U/L. All grafts remained functional at a median of 70 months. Seven subjects received grafts from deceased donors with brain tumors, none of whom had a history of a craniotomy or a ventriculoperitoneal shunt. All recipients had serious vascular access problems. No graft loss or de novo malignancies was observed among these patients after a median follow-up of 69 ± 26 months. Conclusion: With appropriate patient selection, the donated organ pool can be expanded by addition of donors with hepatitis or brain tumors. © 2012 Elsevier Inc. All rights reserved.Öğe What kind of changes occurred in clinical characteristics of deceased kidney donor recipients after national allocation system in Turkey? A single-center retrospective analysis(2012) Solak I.; Sezer T.O.; Toz H.; Tatar E.; Sozbilen M.; Firat O.; Hoscoskun C.Objective: Clinical characteristics of recipients of deceased donor renal transplantations were evaluated in the period before versus after implmentation of The National Allocation System (NAS). Patients and Methods: We evaluated retrospectively clinical profiles of the 42 after NAS (June 2008-December 2010) versus 42 consecutive deceased donor renal transplantation patients before NAS. Patient and graft survival rates were assessed using the Kaplan-Meier method; graft function was assessed based on creatinine clearance with the Cockcroft Gault equation. Patient and donor data were obtained from medical records. Results: Recipients were older in the pre-NAS group (39 ± 8 vs 33 ± 8 years, respectively; P =.001) and median duration of preoperative dialysis was longer in the post-NAS group (103 ± 61 months vs 50 ± 36 months, respectively; P =.000). The average number of human leukocyte antigen-mismatched antigens were pre-NAS 3.4 ± 1.0 versus post-NAS 3.9 ± 1.2 (P =.05). Considering the recipients serological status 9 were hepatitis C virus (HCV)(+) and 2 hepatitis B virus (HBV)(+) among the post-NAS versus no HBV(+) and only 1 HCV(+) patient pre-NAS. Kaplan-Meier analysis of graft survival rates showed 90% at 1 and 85% at 3 years pre-NAS. Similar to 95% at 1 and 86% at 3 years for the post-NAS group (P >.05). Likewise, patient survival rates for both groups at 1 and 3 years were 97%. The mean parameter of donor age, allograft loss, cold ischemia time, patient death, number of retransplantations, HBV(+) patients, and delayed graft function were similar between groups (P >.05). Discussion: After NAS the transplant recipients were older, had a longer duration of dialysis, greater number of HLA mismatched antigens and, more HCV(+). No differences were observed in short-term patient and graft survival rates. © 2012 Elsevier Inc. 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