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Öğe Can polyglactin mesh be used for prevention of seroma after mastectomy: an experimental study(Springer Wien, 2014) Yeniay, L.; Unalp, O. V.; Uguz, A.; Unver, M.; Karaca, A. C.; Sezer, T. O.; Yoldas, T.; Demir, H. B.; Zekioglu, O.; Kapkac, M.; Yilmaz, R.Background Seroma formation is still a common problem in breast surgery. Seroma formation is associated with morbidity and financial loss. Fibrin glue was used in several studies for solution, but the results were controversial. On the other hand surgical meshes are promising to prevent the seroma formation. Methods A total of 48 female Sprague-Dawley rats were randomly assigned to four groups. Each underwent radical mastectomy, axillary lymph node dissection, and disruption of the dermal lymphatic vessels. Group 1 is the control group (n = 12). In group 2 (n = 12), 1 x 1 cm polyglactin 910 mesh (Vicryl, Ethicon Johnson&Johson USA) is placed over the chest wall under the skin flaps prior to closure. The animals in group 3 received 0.5 mL fibrin glue (Baxter Healthcare Ltd. United Kingdom) topically throughout the wound before the closure (n = 12). The animals in group 4 (n = 12) received 0.5 mL fibrin glue topically throughout the wound, and 1 x 1 cm polyglactin 910 mesh is placed under the skin flaps prior to the closure. Full thickness tissue samples from both the chest wall and the skin were harvested. The harvested tissue samples were evaluated by a single pathologist in a blind fashion. Results The mean seroma volume of the control group was 1.536 mL whereas the mean seroma volume of the groups 2, 3, and 4 were 1.189, 0.438, and 0.556 respectively. Mean seroma volume was significantly lower, adhesion index and foreign body reaction were higher in group 4. Conclusion Although various studies show controversial results to prevent the seroma formation. This experimental study is an evidence that fibrin glue and polyglican mesh reduce seroma with increasing inflammatory reaction.Öğe Causes of early graft impairment after deceased donor kidney transplantation(Springer, 2012) Karadeniz, N.; Turan, M. N.; Sarsik, B.; Tatar, E.; Toz, H.; Sezer, T. O.; Hoscoskun, C.; Sen, S.; Nisar, K.Öğe Clinical Everolimus Experience in Pediatric Renal Transplant Patients(Elsevier Science Inc, 2013) Dincel, N.; Bulut, I. K.; Sezer, T. O.; Mir, S.; Hoscoskun, C.Objective. Everolimus is a potent immunosuppressive agent that has antiproliferative activities. This study sought to share our experience among renal transplanted children who required conversion from calcineurin inhibitors (CNIs) to the mammalian target of rapamycin inhibitor everolimus. Patients and Methods. Exclusion criteria were multiple organ transplantations, loss of a previous graft due to immunologic reasons, receipt of an organ donated after cardiac death, donor age <5 years or >65 years, panel reactive antibodies >25%, platelets <75,000/mm(3), absolute neutrophil count of <1,500/mm(3), leucocytes <2,500/mm(3), hemoglobin <6 g/dL, severe liver disease, cold ischemia time >40 hours or anti-HLA panel-reactive antibodies >50%. Results. Eighteen renal transplant patients (10 male, 8 female) underwent conversion to everolimus from CNI: 8 from cyclosporine (CsA) and 10 from tacrolimus. The mean age was 12.6 +/- 0.9 years and the mean body mass index 21.8 +/- 1.7 kg/m(2). The mean 2-hour postdose level of CsA before conversion was 671 +/- 142 ng/mL; the patients on tacrolimus showed a mean trough concentration of 4.5 ng/mL. Six (33,3%) were taking mycophenolate mofetil and 12 (66.6%) enteric-coated mycophenolate sodium. No significant changes were observed in either hepatic functions, serum lipids, or hemograms. There was no mortality or graft loss. The mean level of serum creatinine was 1.3 +/- 0.7 mg/dL before and 1.09 +/- 0.6 mg/dL after conversion. Proteinuria observed in only 1 patient was well controlled with angiotensin-converting enzyme inhibitor therapy. All patients responded to statin therapy. One patient developed unilateral lower extremity edema and 1 a lymphocele. Although there were 3 cases (14%) of biopsy-confirmed acute rejection, there was no mortality or graft loss. Conclusions. Everolimus conversion has become an excellent choice, offering safety and efficacy with good outcomes.Öğe Efficacy and Safety of ATG-Fresenius as an Induction Agent in Living-Donor Kidney Transplantation(Elsevier Science Inc, 2017) Yilmaz, M.; Sezer, T. O.; Gunay, E.; Solak, I.; Celtik, A.; Hoscoskun, C.; Toz, H.Background. Induction therapy is mostly recommended for deceased-donor transplantation, whereas it has some controversies in live-donor transplantation. In this study, we described the outcomes of live-donor renal transplant recipients who received ATG-Fresenius (ATG-F) induction. Methods. Live-donor transplantations in patients over 18 years old with ATG-F induction between 2009 and 2015 were included. All patients received quadruple immunosuppression, one of which was ATG-F induction. Biopsies after the artery anastomosis (zero hour) and protocol biopsies at the 6th month and at the 1st first year were obtained. Acute graft dysfunction was defined as a 20% to 25% increase in creatinine level from baseline. All acute rejection episodes were biopsy-confirmed. All episodes were initially treated with intravenous methyl prednisolone (MP) or ATG-F if resistant to MP. Four hundred twenty-two patients with live-donor transplantation were evaluated. The mean age was 40 +/- 13 (18-73) years. The mean panel-reactive antibody levels were 42% +/- 30% and 45% +/- 30% for class I and II, respectively. Results. The mean mismatch number for living unrelated donors (n = 112) was 4.6 +/- 1.0. Acute rejection rate was 29.1% (123 patients) within the first year. The mean cumulative ATG-F doses for per patient and per kilogram were 344 +/- 217 mg and 5.1 +/- 2.7 mg, respectively. Patient survival rates were 98.3% and 96.7% for 12 months and 60 months, respectively. Death-censored graft survival rates were 97.6% and 92.1% for 12 months and 60 months, respectively. Conclusions. ATG-F induction provided excellent graft and patient survival rates without any significantly increased side effects. Increasing sensitized patient numbers, more unrelated donors, increasing re-transplantation numbers, and more desensitization protocols make ATG-F more favorable in an induction regimen.Öğe FACTORS CD10, CYTOKERATIN 19 AND STAGING-GRADING SYSTEMS IN PREDICTING THE PROGNOSIS OF PANCREATIC NEUROENDOCRINE TUMORS (PNET)(Editura Acad Romane, 2012) Uguz, A.; Unalp, O. V.; Yeniay, L.; Farajov, R.; Yoldas, T.; Sezer, T. O.; Ipek, N. Y.; Nart, D.; Yilmaz, F.; Sozbilen, M.; Coker, A.Objective. This study was undertaken to examine prognostic factors in patients with pancreatic neuroendocrine tumors (PNET) undergoing surgical treatment to evaluate the prognostic value of recently introduced immunohistochemical staining methods of CD10 and cytokeratin 19. Materials and Methods. Tumors were classified on the basis of 2004 WHO Classification Guidelines and European Neuroendocrine Tumor Society (ENETS) grading system. Immunohistochemical staining with Ki-67, CD10 and cytokeratin 19 was performed. Results. A total of 36 patients with a mean age of 53.7 +/- 12.0 years were included. Overall, 33 patients had a long-term follow-up with 10 patients (30.3%) experiencing recurrence. Seven patients (21.1%) died. Clinical parameters that were associated with recurrence included liver metastasis at the time of surgery and extra-pancreatic invasion (p < 0.005). Positive surgical margins, extra-pancreatic invasion, and multi-focal disease were associated with reduced survival (p < 0.05). In addition, there was an association between survival and WHO 2004 classification (p < 0.05). Conclusions. Although vascular and peripancreatic invasion showed increased risk of recurrence, they were unrelated to survival. Of the histopathological examinations, Ki-67 and mitotic activity showed a correlation with both recurrence and survival, while immunohistochemical staining with cytokeratin 19 and CD 10 did not provide adequate prognostic information.Öğe Kidney Transplant Recipients with Functioning Grafts for More than 15 Years(Elsevier Science Inc, 2013) Celtik, A.; Alpay, N.; Celik, A.; Sezer, T. O.; Turkmen, A.; Camsari, T.; Toz, H.; Sever, M. S.; Hoscoskun, C.Background. Renal transplantation is the best renal replacement therapy because it significantly improves patient survival. The developments in transplantation and increasing number of patients with end-stage renal disease (ESRD) have unmasked long-term complications secondary to immunosuppressive drugs and chronic renal failure. Methods and Results. Eighty-six renal transplant recipients with grafts that have functioned more than 15 years were included in the study. This cross-sectional retrospective analysis of demographic, clinical, and laboratory findings was conducted in 3 Turkish transplantation centers. The mean age was 30.4 +/- 10.2 years at the time of the transplantation. The mean time between the transplantation and the study was 19.1 +/- 3.6 years. At the time of the study, mean creatinine level was 1.52 +/- 0.60 mg/dL, 70.09% of the patients displayed glomerular filtration rates <60 mL/min/1.73 m(2). Urinary protein excretion was 0.57 +/- 0.65 g/d. Hypertension and hyperlipidemia were the most common comorbid diseases. Twelve patients had diabetes and 9 cardiovascular disease. Seventeen patients had been diagnosed with skin and 5 with non-skin cancer. Conclusions. As the number of recipients with long-term functioning grafts increases, long-term complications become evident, particularly chronic renal failure. Survivors should be evaluated regularly and treated early for risk factors and complications to improve long-term graft and patient survival.Öğe LAPAROSCOPIC INGUINAL HERNIA REPAIR AND EVALUATION OF POSTOPERATIVE QUALITY OF LIFE IN ELDERLY PATIENTS: SINGLE CENTER RESULTS(Oxford Univ Press, 2024) Korucuk, E.; Gumus, T.; Temel, R.; Basci, F.; Sezer, T. O.; Ersin, S.[Abstarct Not Available]Öğe Long-Term Follow-up Results of Renal Transplantation in Pediatric Patients With Focal Segmental Glomerulosclerosis: A Single-Center Experience(Elsevier Science Inc, 2019) Bulut, I. K.; Taner, S.; Keskinoglu, A.; Toz, H.; Sarsik, B.; Sezer, T. O.; Kabasakal, C.Introduction and Aim. Focal segmental glomerulosclerosis (FSGS) is a common cause of end-stage renal disease in children. We analyzed the long-term outcome of pediatric patients with FSGS undergoing renal transplantation. the objective of the study is to report the experience of a single center and determine the incidence of recurrence, rejection, graft loss, and related risk factors. Materials and Method. This retrospective cohort study was performed between 1991 and 2018. Thirty patients with a pathologic diagnosis of primary FSGS were included in the study. the patients were diagnosed with FSGS according to histologic features in biopsies. Results. Twenty-one of the donors were deceased (70%) and 9 were alive (30%). FSGS recurred in only 2 patients. Graft loss occurred in 6 patients (20%). the causes of graft loss were chronic rejection in 4 patients and acute rejection in 2. Our graft survival rate was 100% at 1 year, 91% at 5 years, 80% at 10 years, 70% at 15 years, and 42% at 20 years. Five- and 10-year graft survival rates were 83% and 83% in living donors and 94% and 79% in deceased donors, respectively. According to Kaplan-Meier analysis, there was no statistically significant difference in terms of graft survival between living and deceased donors. Conclusion. This study, with its contribution to literature in terms of long follow-up of FSGS patients from childhood to adulthood, is important. However, further studies are required.Öğe Use of ATG-Fresenius as an Induction Agent in Deceased-Donor Kidney Transplantation(Elsevier Science Inc, 2017) Yilmaz, M.; Sezer, T. O.; Kir, O.; Ozturk, A.; Hoscoskun, C.; Toz, H.Background. Anti-T-lymphocyte globulins (ATG) are most commonly used as induction agents in kidney transplantation (KT). In this study, we investigated the use of ATG as induction therapy in deceased-donor KT. Methods. Among 152 deceased-donor KT recipients transplanted between January 2009 and December 2003, 147 with exact data were enrolled in this study. Delayed graft function was defined as dialysis requirement after KT. Greater than 10% panel-reactive antibody (PRA) was considered as positive. Total ATG (rATG-Fresenius) dosage and induction duration was evaluated. Mean age was 45 +/- 10 years; 91 patients were male and 56 patients were female. Class I and class II PRA-positive patient numbers were 20 (13.6%) and 17 (11.5%), respectively. Pre-transplant dialysis vintage was 108 +/- 63 months. Mean donor age was 42 +/- 17, and cold ischemia time was 16 +/- 5 hours. Eighty-nine patients (60%) had delayed graft function and needed at least one session of hemodialysis after transplantation. Cumulative ATG-F dosage was 676 +/- 274 mg. The mean ATG-F cumulative dosage was 10.6 +/- 3.8 mg/kg. At the end of first year, mean creatinine and proteinuria levels were 1.4 +/- 1,0 mg/dL and 0.3 +/- 0.4 g/d, respectively. Results. Mean follow-up time was 32 +/- 20 months. During follow-up, there were 14 graft failures and 11 patients died. Patient survival for 1 and 2 years were 93% and 92.3%, respectively. Death-censored graft survival rates for 1 and 2 years were 94.8% and 90.8%, respectively. Conclusions. ATG-F induction provides acceptable graft and patient survival in deceased-donor KT. ATG-F infusion is well tolerated. Infection rates seem to be acceptable compared with all transplantation populations.Öğe Use of Suicidal Deaths as Kidney Donors: A Single-Center Experience(Elsevier Science Inc, 2013) Yaprak, M.; Turan, M. N.; Sezer, T. O.; Tatar, E.; Sozbilen, E. M.; Toz, H.; Hoscoskun, C.Objective. Although the number of end-stage renal disease patients on the waiting list has increased, the number of deceased kidney donors has not increased proportionately. Therefore, the use of kidney donors defined as "marginal" has become an issue. Since the acceptance of deaths due to poisoning or suicide as donors has been proposed, we evaluated the clinical courses of kidney transplantations from suicidal death donors. Patients and Methods. We analyzed retrospectively the outcomes of nine deceased donor kidneys (8 males) from suicide victims between 2001 and 2012. Demographic and clinical characteristics of donors and recipients were collected from medical files. Results. The mean donor age was 27.8 +/- 11.9 years. Causes of death were: gunshot wounds to the head (n:4), pesticide intoxication (n:2), methanol intoxication (n:1), hanging (n:1), or carotid artery laceration (n:1). Mean donor creatinine level, urine output per hour, and 24-hour urine volume were 0.94 +/- 0.53 mg/dL, 270 +/- 113 mL, and 5496 +/- 832 mL, respectively. Mean cold ischemia time was 12.3 +/- 5.7 hours. Primary allograft nonfunction occurred in one recipient requiring nephrectomy. The average post-transplantation creatinine level at 1 year was 1.19 +/- 0.62 mg/dL. The mean follow-up was 55 +/- 49 months. Allograft loss occurred due to chronic rejection in three patients at 10, 37, and 40 months. Five patients are still undergoing follow-up with functioning grafts. Conclusion. Brain death cases caused by the suicide should be considered for organ donation.
