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Bozkurt E, Yigman S, Adsay V, Gurses B, Tellioglu G, Bilge O. Primary angiosarcoma of the Pancreas - A case Report and review of the literature. Acta Chir Belg 2024; 124:73-80. [PMID: 38265358 DOI: 10.1080/00015458.2024.2309718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 01/20/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Angiosarcomas are malignant neoplasms that originate from endothelial cells. The symptoms exhibit a non-specific nature, and achieving a preoperative diagnosis is frequently challenging. They are seldom encountered in the abdomen, and their occurrence in the pancreas is even rarer. METHODS Here we document a 67-year-old man with pancreatic angiosarcoma and analyse the literature to outline the clinicopathologic characteristics of this rare phenomenon. RESULTS This patient with family history of pancreas cancer presented with abdominal pain, and the CT-scan revealed a 4 cm mass at the neck of the pancreas but CA19-9 was normal. Radiologic findings were unusual for ordinary pancreas cancer. Fine-needle aspiration biopsy through endoscopic ultrasound revealed "undifferentiated malignant cells for which the diagnosis of "carcinoma" was favoured. Total pancreatectomy, splenectomy and portal vein reconstruction were performed and epithelioid angiosarcoma were diagnosed. Despite an uneventful postoperative period, discharge on postoperative day 8 without any complications, as well as diligent post-discharge clinical care, the patient died 65 days postoperatively, attributed to the presence of extensive metastasis. A comprehensive literature search has identified a limited number of documented cases of primary pancreatic angiosarcoma, with only ten cases reported to date. CONCLUSIONS Pancreatic angiosarcomas are very rare and prone to misdiagnosis. The formation of a more demarcated but high-grade tumour with necrosis is a feature that distinguishes angiosarcomas from ordinary carcinomas of this organ. Pathologic diagnosis is also highly challenging closely resembling undifferentiated carcinomas. Angiosarcomas are highly aggressive when they occur in the pancreas. Prompt diagnosis at an early stage is crucial as surgery with curative intent serves as the primary treatment approach.
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Affiliation(s)
- Emre Bozkurt
- Department of General Surgery, Koç University School of Medicine, Istanbul, Turkey
| | - Samet Yigman
- Department of General Surgery, Koç University School of Medicine, Istanbul, Turkey
| | - Volkan Adsay
- Department of Pathology, Koç University School of Medicine, Istanbul, Turkey
| | - Bengi Gurses
- Department of Radiology, Koç University School of Medicine, Istanbul, Turkey
| | - Gurkan Tellioglu
- Department of General Surgery, Koç University School of Medicine, Istanbul, Turkey
| | - Orhan Bilge
- Department of General Surgery, Koç University School of Medicine, Istanbul, Turkey
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Eren E, Tokac M, Ozcelik U, Sahin T, Tellioglu G, Peksen C, Dinckan A. Comparison of Bipolar vascular sealing and conventional back-table dissection in terms of post-renal transplant drainage and back-table preparation times. Eur Rev Med Pharmacol Sci 2023; 27:6223-6228. [PMID: 37458629 DOI: 10.26355/eurrev_202307_32981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
OBJECTIVE The usage of vessel sealing devices has been gaining popularity in all surgical specialties. Post-renal transplant drain placement is a common practice among transplant surgeons. However, prolonged drainage accompanied by surgical wound complications and perirenal fluid collections is a frequent complication experienced by the recipients. This study aimed to compare Bipolar vascular sealing with conventional back-table dissection in terms of post-renal transplant drainage duration, amount, surgical wound complication, and back-table preparation time. PATIENTS AND METHODS A double-blind clinical study randomizes recipients into 2 groups, using Bipolar vascular sealing (Group 1) and conventional ligation (Group 2) back-table dissection. Variables such as recipient age, gender, body mass index (BMI), cause of end-stage renal disease, amount and duration of surgical drainage, back-table time, and cold ischemia time (CIT) were collected prospectively. RESULTS Ninety-eight consecutive living donor (M/F: 69/29) renal transplant recipients were enrolled in this prospective randomized clinical trial. There were 49 patients in each group. The mean BMI was 26.76±4.57. There was no difference among the groups regarding recipient age, BMI, total drainage, and surgical drainage duration. The surgical site infection rate was not different between the two groups. Group 1 had significantly shorter back-table time, with mean back-table time being 15.26±2.51 minutes in Group 1 and 28.83±6.27 minutes in Group 2 (p<0.001). The CIT was also significantly different between the 2 groups (p<0.001). In Group 1, the recorded CIT was 43.3±11.4, and in Group 2, 57.1±13.3 minutes. CONCLUSIONS The use of Bipolar vascular sealing to seal lymphatic vessels at the back-table is feasible, safe, and easy to perform. It also expedites the dissection and shortens the time required for back-table graft preparation.
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Affiliation(s)
- E Eren
- Department of General Surgery, Istinye University Hospital, Istanbul, Turkey.
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Barutcu Atas D, Yavuz S, Kantarci G, Ozkan HA, Demircan F, Tellioglu G. Tacrolimus-Induced Pure Red Cell Aplasia Following Renal Transplantation: A Case Report and Literature Review. Turk J Nephrol 2021. [DOI: 10.5152/turkjnephrol.2021.4316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Konukoglu O, Saltan Y, Tellioglu G, Mansuroglu D, Balkanay M. Combined Heart-Kidney Transplantations: İs it necessary? J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Acar S, Gencdal G, Tokac M, Eren E, Alkara U, Tellioglu G, Dinckan A, Akyildiz M. Liver Transplantation for Polycystic Liver Disease Due to Huge Liver With Related Complications: A Case Report. Transplant Proc 2017; 49:603-605. [PMID: 28340841 DOI: 10.1016/j.transproceed.2017.01.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Polycystic liver disease is characterized by multiple cystic lesions on the liver. It is an uncommon autosomal dominant disease. The cysts' diameters range from 20 to 30 cm to small microscopic nodules. Generally, more than half of the liver parenchyma is covered. The mass effect of the liver created by the large cysts can cause life-threatening symptoms such as weight loss, reduction of oral intake, and malnutrition. Liver transplantation is the best treatment option in symptomatic patients. We present a patient who had polycystic liver and kidney disease, and we performed liver transplantation because of his life-threatening symptoms.
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Affiliation(s)
- S Acar
- Department of Internal Medicine and Organ Transplantation, Yeniyuzyil University Gaziosmanpasa Hospital, Istanbul, Turkey
| | - G Gencdal
- Department of Gastroenterology and Organ Transplantation, Yeniyuzyil University Gaziosmanpasa Hospital, Istanbul, Turkey
| | - M Tokac
- Department of General Surgery and Organ Transplantation, Yeniyuzyil University Gaziosmanpasa Hospital, Istanbul, Turkey
| | - E Eren
- Department of General Surgery and Organ Transplantation, Yeniyuzyil University Gaziosmanpasa Hospital, Istanbul, Turkey
| | - U Alkara
- Department of Radiology and Organ Transplantation, Yeniyuzyil University Gaziosmanpasa Hospital, Istanbul, Turkey
| | - G Tellioglu
- Department of General Surgery and Organ Transplantation, Yeniyuzyil University Gaziosmanpasa Hospital, Istanbul, Turkey
| | - A Dinckan
- Department of General Surgery and Organ Transplantation, Yeniyuzyil University Gaziosmanpasa Hospital, Istanbul, Turkey
| | - M Akyildiz
- Department of Gastroenterology and Organ Transplantation, Yeniyuzyil University Gaziosmanpasa Hospital, Istanbul, Turkey.
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Tellioglu G, Agcaoglu O, Siperstein A, Berber E. Serum D-dimer as a prognostic marker in patients undergoing radiofrequency ablation of colorectal liver metastasis. J INVEST SURG 2013; 25:295-300. [PMID: 23020269 DOI: 10.3109/08941939.2011.642067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although traditionally used for coagulation disorders, there has been a recent interest in serum D-dimer as a tumor marker. The aim of this prospective study is to determine its value as a tumor marker in patients with colorectal liver metastasis. PATIENTS AND METHODS Between January 2000 and October 2007, 242 patients undergoing laparoscopic radiofrequency ablation (RFA) of colorectal liver metastasis were evaluated prospectively. The relationship of D-dimer levels to pre-ablation parameters, recurrence, and survival was prospectively assessed. All data are expressed as mean ± SEM. RESULTS Preoperative D-dimer levels correlated with liver tumor volume (p = .04) and CEA (p = .003). D-dimer levels increased by a mean of 11.4 ± 1.5 folds after RFA on POD#7 and returned to preoperative values in three months. The rate of the elevation of D-dimer values after RFA was related to tumor volume ablated. The median overall survival was six months for patients with preoperative D-dimer > 1,000 ng/ml vs. 32 months for patients with D-dimer < 1,000 ng/ml (p = .02). On multivariate analysis preoperative serum D-dimer was an independent predictor of overall survival along with CEA and liver tumor burden. CONCLUSION Serum D-dimer levels reflect liver tumor burden and independently predict survival in patients with colorectal liver metastasis undergoing RFA.
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Affiliation(s)
- Gurkan Tellioglu
- Endocrinology and Metabolism Institute, Division of Endocrine Surgery, Cleveland Clinic, Cleveland, OH 44195, USA
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Serdar ZA, Eren PA, Canbakan M, Turan K, Tellioglu G, Gülle S, Ozgezer T, Kara M, Berber I, Titiz MI. Dermatologic findings in renal transplant recipients: Possible effects of immunosuppression regimen and p53 mutations. Transplant Proc 2011; 42:2538-41. [PMID: 20832539 DOI: 10.1016/j.transproceed.2010.05.165] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2010] [Accepted: 05/12/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To analyze the dermatologic lesions and possible effects of immunosuppression treatment and p53 gene mutations on dermatologic findings in renal transplant recipients. MATERIALS AND METHODS The study included 163 renal transplant recipients. After dermatologic examination, cultures, and histopathologic and genetic analyses were performed. A single-strand conformation polymorphism technique was used to analyze p53 gene mutations. Patients were categorized into 3 groups according to time since the transplantation procedure. Results were analyzed using the χ(2) test, using a software program (SPSS version 13.0; SPSS, Inc, Chicago, Illinois). RESULTS Mean (SD) age of the 163 transplant recipients (65 women and 98 men) was 40 (11) years, and posttransplantation follow-up was 65 (55) months. The most frequently observed drug-related lesion was hypertrichosis, in 46 of 150 patients. Of 115 lesions, the most commonly observed were verruca vulgaris (n = 34) from viruses, and pityriasis versicolor (n = 21) from superficial fungal infections. Of the total group, 20 patients (12.2%) were mutation carriers. Compared with the entire cohort, the group with premalignant lesions demonstrated more p53 mutations (11% vs 50%; P = .004). Patients given cyclosporine therapy exhibited more premalignant or malignant cutaneous lesions compared with patients who received other agents (P = .03). CONCLUSION Patients carrying p53 mutations developed a malignant lesion in the late posttransplantation period, which suggests the importance of prediction of risk.
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Affiliation(s)
- Z A Serdar
- Department of Dermatology Haydarpasa Numune Research and Training Hospital Istanbul, Turkey.
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Kara M, Tellioglu G, Bugan U, Krand O, Berber I, Seymen P, Eren PA, Ozel L, Titiz I. Evaluation of intraoperative parathormone measurement for predicting successful surgery in patients undergoing subtotal/total parathyroidectomy due to secondary hyperparathyroidism. Laryngoscope 2010; 120:1538-44. [PMID: 20641075 DOI: 10.1002/lary.21023] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/BACKGROUND The aim of this study is to investigate the predictive value of intraoperative parathormone measurement addressing successful surgical resection in patients with secondary hyperparathyroidism. METHODS The study included 42 consecutive patients operated on between May 2006 and July 2008. Patients were grouped according to successful surgery (Group 1, n = 36) and persistent postoperative hyperparathyroidism (Group 2, n = 6). Serum phosphorus (P), total calcium (tCa), ionized calcium (iCa), intact parathormone (iPTH), and alkaline phosphatase (ALP) were drawn preoperatively and intraoperatively upon 15 minutes after completion of resection (iPTH(15)). The rate of decrease of pith detected by iPTH(15) compared to preoperative values was calculated (iPTH(%)). RESULTS Preoperative P, tCa, iCa, iPTH, and ALP were comparable. Subtotal parathyroidectomy (sPx) (n = 27) and total parathyroidectomy with autotransplantation (tPx) (n = 15) were performed. Mean iPTH(15) value, iPTH(%) rates were 145.9 +/- 12.3 pg/mL, % 91.6 +/- 0.7, and 522.5 +/- 85.4 pg/mL, % 75.1 +/- 2.0 (P = ,001) in Groups 1 and 2, respectively. Mean serum tCa and iCa at POD#1 in Group 1 were 7.6 +/- 0.1 mg/dL, 0.910 +/- 0.4 mmol/L, and Group 2 were 8.3 +/- 0.3 mg/dL, 1.050 +/- 0.4 mmol/L (P < .05), respectively. ALP levels were similar. CONCLUSION iPTH(15) value and iPTH(%) rate accurately predicts the completeness of resection in secondary hyperparathyroidism. The rate of decrease in serum iPTH detected intraoperatively compared to preoperative baseline levels exceeding 90% in sPx, 95% in tPx, accurately predicts the success of surgery. Postoperative normocalcemia without calcium replacement would raise a suspicion about completeness of surgical resection.
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Affiliation(s)
- Melih Kara
- Haydarpasa Numune Research and Training Hospital, 1st General Surgery Clinic, Istanbul, Turkey.
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Kara M, Sagiroglu J, Sekmen U, Tellioglu G, Ozel L, Seymen P, Titiz I. Laparoscopic revision of peritoneal dialysis catheters with outflow obstruction. Turk J Surg 2010. [DOI: 10.5097/1300-0705.ucd.495-10.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kara M, Tellioglu G, Sehirli O, Yildar M, Krand O, Berber I, Cetinel S, Eren PA, Sener G, Titiz I. Evaluation of Gadolinium Pre-Treatment with or without Splenectomy in the Setting of Renal Ischemia Reperfusion Injury in Rats. Ren Fail 2009; 31:956-63. [DOI: 10.3109/08860220903216162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Krand O, Yalti T, Tellioglu G, Kara M, Berber I, Titiz MI. Use of smooth muscle plasty after intersphincteric rectal resection to replace a partially resected internal anal sphincter: long-term follow-up. Dis Colon Rectum 2009; 52:1895-901. [PMID: 19966639 DOI: 10.1007/dcr.0b013e3181b55507] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Patients with very low rectal cancer were treated by intersphincteric rectal resection employing partial internal anal sphincter resection. They then underwent smooth muscle plasty to restore internal anal sphincter function. We assessed the functional and oncological outcomes. PATIENTS AND METHODS Patients were selected if their biopsies revealed well-differentiated or moderately well-differentiated very low rectal tumors with distal tumor margins that permitted preservation of part of the internal anal sphincter. Functional results after closing the loop ileostomy were assessed by use of a standardized questionnaire. Continence was evaluated by use of the Kirwan score. RESULTS Forty-seven patients with T2 to T3 very low rectal carcinomas underwent intersphincteric rectal resection and smooth muscle plasty that extended into the anal canal. All received neoadjuvant treatment. Postoperative morbidity was 38.3%. There were 46 R0 resections based on frozen section analysis; one patient achieved an R0 resection after reexcision of a positive distal margin on the frozen section. The median follow-up period was 67.2 months. One patient had local recurrence. The five-year overall and disease-free survival rates were 85% and 82%, respectively. Six months, one year, and two years after intersphincteric rectal resection, 80%, 87%, and 89%, respectively, had good continence (Kirwan I and II). Evacuation difficulty was detected in two patients with colonic S-pouches. CONCLUSION Providing neodjuvant treatment and preserving at least half of the functional internal anal sphincter mass produces acceptable oncological and functional outcomes in patients undergoing intersphincteric rectal resection for very low rectal cancer. However, whether smooth muscle plasty further improves postoperative continence should be tested by further studies.
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Affiliation(s)
- Osman Krand
- First General Surgery, Haydarpasa Numune Research Training Hospital, Istanbul, Turkey.
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Berber E, Tellioglu G, Harvey A, Mitchell J, Milas M, Siperstein A. Comparison of laparoscopic transabdominal lateral versus posterior retroperitoneal adrenalectomy. Surgery 2009; 146:621-5; discussion 625-6. [PMID: 19789020 DOI: 10.1016/j.surg.2009.06.057] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Accepted: 06/30/2009] [Indexed: 01/11/2023]
Abstract
BACKGROUND For the past 14 years, we have been performing laparoscopic adrenalectomy via the lateral transabdominal as well as the posterior retroperitoneal approach. The aim of this study is to describe patient selection criteria for each approach with comparison of perioperative outcomes. METHODS In patients with smaller tumors, low body mass index (BMI), history of previous abdominal operations, appropriate body habitus, and bilateral pathology, we have performed preferentially the posterior approach. Data regarding clinical pathology, tumor size, BMI, estimated blood loss (EBL), operating time (OT), morbidity, mortality, and duration of stay were analyzed retrospectively. Data are expressed as mean +/- standard error of the mean (SEM). RESULTS One hundred seventy-two laparoscopic adrenalectomy procedures were performed in 159 patients between 1994 and 2008. The lateral approach was used in 69 patients (right side: 39%, left side: 55%, bilateral: 6%) and the posterior approach in 90 patients (right side: 42%, left side: 48%, bilateral: 10%). The incidence of prior abdominal surgery was greater in the posterior group (26% vs 19%, NS). The lateral approach was used in 9% (3/34) of aldosteronoma, 38% (9/24) of Cushing's disease/syndrome, 47% (18/38) of nonsecreting cortical adenoma, 66% (23/35) of pheochromocytoma, 41% (7/17) of malignant lesions, and 73% (8/11) of others. Thirty percent of the bilateral adrenalectomies were performed via lateral and 70% via posterior approach. Two patients in the posterior approach were converted to the laparoscopic lateral approach, and 2 patients in the lateral approach were converted to open. Overall, patient age and sex were similar between groups. BMI was higher in patients undergoing adrenalectomy via lateral vs posterior approach (32.4 vs 28.4; P = .005). Tumor size was larger than 6 cm in 11 (16%) and 1 (1%) of the patients in the lateral and posterior groups, respectively. On univariate analysis, mean OT for lateral and posterior approaches was similar for unilateral cases (157 +/- 7 vs 138 +/- 6 min, respectively; P = NS). This was also true on multivariate analysis when corrected for patient selection factors. EBL was 35 +/- 7 mL for lateral versus 25 +/- 6 mL for posterior approach (P = .05). The duration of stay in lateral and posterior approaches was 1 day in 56% vs 82%, 2 days in 29% vs 13%, and more than 2 days in 15% vs 5% of the patients, respectively. Two patients in the lateral group died postoperatively because of cardiac and pulmonary causes, and 2 patients in the posterior group developed temporary neuralgia. CONCLUSION This series compares 2 different approaches for laparoscopic adrenalectomy. Our study shows that the lateral and posterior techniques have a similar peri-operative outcome when patients are selected for each option based on certain criteria.
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Affiliation(s)
- Eren Berber
- Section of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
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Ozel L, Ozel MS, Toros AB, Kara M, Ozkan KS, Tellioglu G, Krand O, Koyuturk M, Berber I. Effect of early preoperative 5-fluorouracil on the integrity of colonic anastomoses in rats. World J Gastroenterol 2009; 15:4156-62. [PMID: 19725150 PMCID: PMC2738812 DOI: 10.3748/wjg.15.4156] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the effect of chemotherapy on wound healing by giving early preoperative 5-fluorouracil (5-FU) to rats with colonic anastomoses.
METHODS: Sixty Albino-Wistar male rats (median weight, 235 g) were used in this study. The rats were fed with standard laboratory food and given tap water ad libitum. The animals were divided into three groups: Group 1: Control group (chemotherapy was not administered), Group 2: Intraperitoneally (IP) administered 5-FU group (chemotherapy was administered IP to animals at a dose of 20 mg/kg daily during the 5 d preceeding surgery), Group 3: Intravenously (IV) administered 5-FU group. Chemotherapy was administered via the penil vein, using the same dosing scheme and duration as the second group. After a 3-d rest to minimize the side effects of chemotherapy, both groups underwent surgery. One centimeter of colon was resected 2 cm proximally from the peritoneal reflection, then sutured intermittently and subsequently end-to-end anastomosed. In each group, half the animals were given anaesthesia on the 3rd postoperative (PO) day and the other half on the 7th PO day, for in vivo analytic procedures. The abdominal incisions in the rats were dissected, all the new and old anastomotic segments were clearly seen and bursting pressures of each anastomotic segment, tissue hydroxyproline levels and DNA content were determined to assess the histologic tissue repair process.
RESULTS: When the IV group was compared with the IP group, bursting pressures of the anastomotic segments on the 3rd and 7th PO days, were found to be significantly decreased, hydroxyproline levels at the anastomotic segment on the 7th PO day were significantly decreased (P < 0.01).
CONCLUSION: In this study, we conclude that early preoperative 5-FU, administered IV, negatively affects wound healing. However, IP administered 5-FU does not negatively affect wound healing.
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Eren PA, Turan K, Berber I, Canbakan M, Kara M, Tellioglu G, Bugan U, Sevinç C, Turkmen F, Titiz MI. The clinical significance of parathyroid tissue calcium sensing receptor gene polymorphisms and expression levels in end-stage renal disease patients. Clin Nephrol 2009; 72:114-121. [PMID: 19640368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The calcium sending receptor (CaSR) allows parathyroid and kidney tubular cells to regulate PTH secretion and tubular calcium reabsorption. In the present report, we examined the relationship between CaSR gene polymorphisms and parathyroid CaSR expression and serum calcium/parathyroid hormone (PTH) levels and clinical progress in ESRD patients in the Turkish population. METHODS We genotyped the CaSR R990G and Q1011E variants in 192 end-stage renal disease (ESRD) patients by allele-specific PCR. CaSR expression in parathyroid tissues of operated 33 patients was quantified with quantitative reverse transcription-PCR. RESULTS Compared with other genotypes, the ratio of both codon 990-AA and 1011-CC polymorphisms was found higher in operated patients (p = 0.001). In the total patient group PTH levels were found higher in patients with CC1011 genotype than those with CG1011 (1015.15 +/- 925.41 pg/ml; 523.84 +/- 544.6 pg/ml, respectively, p = 0.002). There were statistically important higher Ca2+ levels in the AA990 allele carrying cases than AG990 positive ones (9.3 +/- 1.0 mg/dl vs. 8.8 +/- 0.9, p = 0.006). On the other hand, the expression of CaSR in parathyroid tissue was found inversely proportional with serum PTH level (r = -0.71). CONCLUSION Present data suggest that co-presence of CaSR gene AA990 and CC1011 alleles is a possible risk factor for bad prognosis in secondary hyperparathyroidism. Patients carrying this genotype have tendency to require operation early in their medical therapy period and need postoperative close follow up for possible recurrences.
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Affiliation(s)
- P A Eren
- Departments of Molecular Genetics, Haydarpasa Numune Research and Training Hospital, Istanbul, Turkey.
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Tsinberg M, Tellioglu G, Simpfendorfer CH, Walsh RM, Vogt D, Fung J, Berber E. Comparison of laparoscopic versus open liver tumor resection: a case-controlled study. Surg Endosc 2009. [DOI: 10.1007/s00464-009-0446-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Krand O, Yalt T, Berber I, Kara VM, Tellioglu G. Management of pilonidal sinus disease with oblique excision and bilateral gluteus maximus fascia advancing flap: result of 278 patients. Dis Colon Rectum 2009; 52:1172-7. [PMID: 19581864 DOI: 10.1007/dcr.0b013e31819ef582] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Excision followed by natal cleft depth reduction should be performed, with no leftover midline scar tissue, to prevent recurrence of pilonidal sinus, which is the main problem in the treatment of this disease. We investigated the potential advantages of this advancing flap technique, which we developed. METHOD An S-type incision together with a bilateral gluteus maximus fascia advancing flap was applied on 278 (89 percent) patients, who did not have extensive gluteal involvement, of the 312 patients who had pilonidal sinus disease, between January 1997 and January 2007. No drainage was performed on any patient. RESULTS All patients were discharged within 24 hours. Total complication rate was 7.2 percent and recurrence rate was 0.7 percent. The mean time off from work was 12 +/- 2 days (range, 10 to 22). The mean follow-up period was 66 +/- 32 months (range, 12 to 120). CONCLUSION We suggest that this surgical procedure may successfully be applied to a large majority of the patients. It does not lead to unnecessary excision of healthy tissue because of its significantly simpler nature compared with the full-layer flap technique and its S-type incision, it does not create a midline scar tissue, and it is able to flatten the gluteal sulcus.
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Affiliation(s)
- Osman Krand
- General Surgery Department, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey.
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Berber I, Aydin C, Cevahir N, Yenisey C, Gumrukcu G, Kocbil G, Tellioglu G, Tekin K. Tempol reduces bacterial translocation after ischemia/reperfusion injury in a rat model of superior mesenteric artery occlusion. Surg Today 2009; 39:407-13. [PMID: 19408078 DOI: 10.1007/s00595-008-3900-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Accepted: 10/02/2008] [Indexed: 12/16/2022]
Abstract
PURPOSE We investigated whether Tempol, a water-soluble antioxidant, prevents the harmful effects of superior mesenteric ischemia/reperfusion on intestinal tissues in rats. METHODS The rats were divided into three groups of 10. In group 1, the superior mesenteric artery (SMA) was isolated but not occluded, and in groups 2 and 3 the superior mesenteric artery was occluded for 60 min. After that, the clamp was removed and reperfusion began. In group 3, 5 min before the start of reperfusion, a bolus dose of 30 mg/kg Tempol was administered intravenously and continued at a dose of 30 mg/kg for 60 min. All animals were euthanized after 24 h and tissue samples were collected for analysis. RESULTS There was a significant increase in myeloperoxidase activity, malondialdehyde levels, and the incidence of bacterial translocation in group 2, with a decrease in glutathione levels. These parameters were found to be normalized in group 3. The intestinal mucosal injury score in group 2 was significantly higher than those in groups 1 and 3. CONCLUSION Tempol prevents bacterial translocation while precluding the harmful effects of ischemia/reperfusion injury on intestinal tissues in a rat model of superior mesenteric artery occlusion.
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Affiliation(s)
- Ibrahim Berber
- Department of General Surgery, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
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Tsinberg M, Tellioglu G, Simpfendorfer CH, Walsh RM, Vogt D, Fung J, Berber E. Comparison of laparoscopic versus open liver tumor resection: a case-controlled study. Surg Endosc 2008; 23:847-53. [PMID: 19116739 DOI: 10.1007/s00464-008-0262-9] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Revised: 10/10/2008] [Accepted: 11/15/2008] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although there are data in the literature about the safety and efficacy of laparoscopic liver resections, there are not many studies comparing laparoscopic versus open approaches in a case-matched design. The purpose of this study is to compare the perioperative outcome of laparoscopic versus open liver resections from a single institution. METHODS Thirty-one patients underwent laparoscopic liver resection between April 1997 and August 2007, with a prospective laparoscopic program started in April 2006 (n=25). This group of patients was compared with 43 consecutive patients undergoing open resection who were matched by size of the lesion (5 cm or less for malignant and 8 cm or less for benign), anatomical location (segments 2, 3, 4b, 5, 6), and type of resection (wedge resection, segmentectomy, partial liver resection). Data were obtained from medical records as well as from a prospective database. Statistical analysis was performed using t-test and chi-square. All data are expressed as mean +/- standard error on the mean (SEM). RESULTS Mean age in the laparoscopic group was 57.6+/-2.7 years versus 61.9+/-2.3 years in the open group (p=0.2). There were more women in the laparoscopic group [74% females (n=23) and 26% males (n=8)] versus in the open group [40% females (n=17) and 60% males (n=26)] (p=0.003). There were more patients with malignant lesions in the open group (73%) versus in the laparoscopic group (45%) (p=0.01). Eight patients underwent partial and 23 patients segmental/wedge liver resection in the laparoscopic group versus 15 patients who underwent partial and 28 patients segmental/wedge liver resection in the open group (p=0.7). Mean tumor size was 3.9+/-0.4 cm in the laparoscopic group versus 4.2+/-0.3 cm in the open group (p=0.5). Ten (32%) out of 31 cases in the laparoscopic group were hand-assisted. Inflow occlusion was used in 1 case (3%) in the laparoscopic group versus 16 (37.2%) in the open group. Mean operating time was 201+/-15 min for the laparoscopic group and 172+/-12 min for the open group (p=0.1). Mean estimated blood loss during the procedure was 122.5+/-45.4 cc for the laparoscopic group and 299.6+/-33.6 cc for the open group (p=0.002). Surgical margin was similar for malignant cases in both groups. Mean hospital stay was 3.2+/-1.0 days for the laparoscopic group and 6.8+/-0.7 days for the open group (p=0.004). The incidence of postoperative complications was 13% (n=4) in the laparoscopic and 16% (n=7) in the open group (p=0.7). CONCLUSION This study shows that, with a longer operative time, the laparoscopic approach, despite the learning curve, offers advantages regarding operative blood loss, postoperative analgesic requirement, time to regular diet, hospital stay, and overall cost compared with the open approach for minor liver resections.
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Affiliation(s)
- Michael Tsinberg
- Department of General Surgery, The Cleveland Clinic Foundation, 9500 Euclid Avenue/A 80, Cleveland, OH 44195, USA.
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Berber E, Tsinberg M, Tellioglu G, Simpfendorfer CH, Siperstein AE. Resection versus laparoscopic radiofrequency thermal ablation of solitary colorectal liver metastasis. J Gastrointest Surg 2008; 12:1967-72. [PMID: 18688683 DOI: 10.1007/s11605-008-0622-8] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Accepted: 07/15/2008] [Indexed: 01/31/2023]
Abstract
PURPOSE There is scant data in the literature regarding radiofrequency thermal ablation (RFA) versus resection of colorectal liver metastases. The aim of this study is to compare the clinical profile and survival of patients with solitary colorectal liver metastasis undergoing resection versus laparoscopic RFA. METHODS Between 1996 and 2007, 158 patients underwent RFA (n = 68) and open liver resection (n = 90) of solitary liver metastasis from colorectal cancer. Patients were evaluated in a multidisciplinary fashion and allocated to a treatment type. Data were collected prospectively for the RFA patients and retrospectively for the resection patients. RESULTS Although the groups were matched for age, gender, chemotherapy exposure and tumor size, RFA patients tended to have a higher ASA score and presence of extra-hepatic disease (EHD) at the time of treatment. The main indication for referral to RFA included technical reasons (n = 25), patient comorbidities (n = 24), extra-hepatic disease (n = 10) and patient decision (n = 9). There were no peri-operative mortalities in either group. The complication rate was 2.9% (n = 2) for RFA and 31.1% (n = 28) for resection. The overall Kaplan-Meier median actuarial survival from the date of surgery was 24 months for RFA patients with EHD, 34 months for RFA patients without EHD and 57 months for resection patients (p < 0.0001). The 5-year actual survival was 30% for RFA patients and 40% for resection patients (p = 0.35). CONCLUSIONS This study shows that, although patients in both groups had a solitary liver metastasis, other factors including medical comorbidities, technically challenging tumor locations and extra-hepatic disease were different, prompting selection of therapy. With a simultaneous ablation program, higher risk patients have been channeled to RFA, leaving a highly selected group of patients for resection with a very favorable survival. RFA still achieved long-term survival in patients who were otherwise not candidates for resection.
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Affiliation(s)
- Eren Berber
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA.
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Cocieru A, Xiaocheng Z, Diago T, Quintini C, Irefin S, Tellioglu G, Miller C, Demetris A, Fung JJ, Kelly DM. Hepatic artery (HA) vasospasm in the small-for-size liver graft syndrome (SFSS) is independent of norepinephrine (NE). J Am Coll Surg 2008. [DOI: 10.1016/j.jamcollsurg.2008.06.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
AIM The incidence of urologic complications after renal transplantation has been reported to be between 2.5% and 27%. The aim of this study was to evaluate urologic complications of and their surgical treatment in our series of renal transplantations. MATERIALS AND METHODS We retrospectively evaluated urologic complications among 395 renal transplant recipients in our institute. RESULTS The urologic complications were ureteral leakage (n = 8), stricture of ureteral anastomosis (n = 3), hydronephrosis secondary to stone (n = 2) and bladder outlet obstruction (n = 2), recurrent urinary infection because of vesicoureteral reflux to native kidney (n = 2), renal tumor in native kidney (n = 1), hydroceles (n = 3), technical complications (n = 2), and clot retention (n = 1). CONCLUSION Major urologic complications following renal transplantation are ureteral leakage and stricture resulting from disrupture of the distal ureteral blood supply during the donor operation. Extravesical ureteroneocystostomy over a JJ stent seems feasible to minimize urologic complication. Early diagnosis and endourologic techniques are the mainstays of treatment.
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Affiliation(s)
- B Yigit
- Haydarpasa Numune Research and Educational Hospital, Transplantation Unit, Tibbiye Caddesi, Uskudar Istanbul, Turkey.
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Abstract
OBJECTIVE The aim of this study was to investigate the quality of life of renal donors during long-term follow-up. PATIENTS AND METHODS The short form health survey (SF-36) questionnaire was compared between renal donors and the general population. We evaluated the relationship to postoperative complications and preoperative information with the quality of life. RESULTS Fifty renal donors of mean age 55.8 +/- 12 years (range, 29-70 years) had a mean follow-up of 55.1 +/- 47.2 months (range, 12-168 months). Complications after donor nephrectomy were related with physical function loss (r = -.397; P < .05) and vitality (r = -.463; P = .01). Renal donor candidates who did not have satisfactory information before the operation experienced difficulty with decision making (r = -.555; P = .0001). Physical function, limitation of physical role and limitation of emotional role were comparable to the general population. Pain scale was worse among donors compared with the general population (P = .001). Educational status of renal donors was related to the pain scale and vitality (r = .369; P < .05 and r = .523; P < .05, respectively). General health perception, vitality, mental health, and social functioning were worse compared with the general population (P = .0001, P = .002, P = .0001, and P = .001, respectively). Health problems occurring after donation were related to negation of interfamily relations (r = .695; P = .0001). CONCLUSIONS Reducing complications after nephrectomy will directly increase the quality of the donor's life. Informing renal donor candidates and their families about the postoperative course with consideration of the candidate's and his or her family's educational status is a sociological approach which helps to increase the donor's quality of life. In addition to good patient selection/preparation, meticulous surgery, and follow-up.
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Affiliation(s)
- G Tellioglu
- General Surgery Department and Transplantation Unit, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
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Abstract
AIM The aim of this study was to evaluate the long-term medical risks of living-related donors in our center. PATIENTS AND METHODS 185 living-related donors participated in the study. The factors assessed were creatinine clearance rate (CrCl), serum creatinine (SCr), BUN, hematocrit levels, proteinuria, microalbuminuria and hypertension rates, and renal parenchyma thickness and kidney dimensions predonation as well as at the last follow-up. In addition, we examined postoperative complications. A lombotomy incision was the choice for donor nephrectomy procedure routinely. RESULTS The mean length of hospital stay after donor nephrectomy was 3.2 +/- 0.6 days (range, 2-5 days). Seven donors readmitted during the first month after operation with surgical site infection were treated successfully. Four donors were reoperated for incisional hernia repairs and discharged without complication. The mean follow-up period was 61.6 +/- 50.4 months (range, 2-180 months). Mean ages of the donors at operation and at the last follow-up were 50.9 +/- 12.7 years (range, 20-81 years) and 56.5 +/- 11.9 years (range, 29-77 years), respectively. The male-to-female ratio was 0.69. Mean SCr levels and CrCl rates predonation and at the last follow-up were 0.83 +/- 0.22 mg/dL versus 1.1 +/- 0.2 mg/dL (P < .001), and 103.9 +/- 28.8 mL/min versus 88.3 +/- 25.9 mL/min (P = .03), respectively. SCr levels were within normal limits in all donors at predonation and at the last follow-up. At the last follow-up, CrCl was also within expected normal limits in all donors. Hypertension was detected in 13 donors. Mean predonation and at the last follow-up renal parenchymal thickness, BUN, and hematocrit levels were similar. Kidney dimensions were significantly different at the last follow-up after donation (P = .001). Eleven donors displayed proteinuria and 19 had microalbuminuria at the last follow-up, which had been negative for all donors predonation. There were seven surgical site infections and 4 incisional herniae. CONCLUSION Donor nephrectomy was performed with low surgical morbidity and comparable results of clinical and laboratory data to the age-matched general population.
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Affiliation(s)
- I Berber
- Department of General Surgery and Transplantation Unit, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
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Tellioglu G, Berber I, Kılıcoglu G, Seymen P, Kara M, Titiz I. Doppler Ultrasonography-Guided Surgery for High-Flow Hemodialysis Vascular Access: Preliminary Results. Transplant Proc 2008; 40:87-9. [DOI: 10.1016/j.transproceed.2007.11.059] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Tellioglu G, Kara M, Berber I, Yigit B, Cavdar F, Bugan U, Titiz I. Ultrasonography-Guided Jugular Venous Catheter Insertion for Renal Transplant Recipients Before Renal Transplantation: A Prospective Study. Transplant Proc 2008; 40:90-1. [DOI: 10.1016/j.transproceed.2007.11.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Krand O, Yalti T, Berber I, Tellioglu G. Early vs. delayed closure of temporary covering ileostomy: a prospective study. Hepatogastroenterology 2008; 55:142-145. [PMID: 18507094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND/AIMS Temporary loop ileostomies constructed to protect distal anastomoses are generally closed at 8 to 12 weeks, a period long enough to encounter stoma-related complications, which reduces the quality of life. Early closure may be considered to overcome these adverse effects. This prospective study was designed to investigate the reliability of early closure of loop ileostomies. METHODOLOGY Fifty consecutive patients were sequentially distributed either to group A (delayed closure) or group B (early closure). Anastomotic integrity was examined before closure in all patients. RESULTS There were 25 patients in each group who were comparable in terms of age, sex, comorbid conditions, primary pathology, and tumor stage. Early closure was achieved in 88% (n=22) of the patients in group B. Stoma-related complications were significantly greater in group A patients (44% vs. 16%) (p<0.05) while the complications following closure were similar in both groups (16% vs. 8%) (p>0.05). CONCLUSIONS Early closure during the same hospital admission produces less stoma-related complications with similar accomplishment as the late closure. Early closure of temporary ileostomy is recommended in suitable patients without anastomotic complications.
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Affiliation(s)
- Osman Krand
- Haydarpasa Numune Research and Training Hospital, Istanbul, Turkey
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Abstract
We performed an outcome analysis of 28 pediatric renal transplant recipients whose mean age at transplantation was 15.2 +/- 2 years (range: 11 to 17 years) and the M/F ratio, 0.75. Four patients received cadaveric grafts. One patient needed retransplantation due to primary nonfunction. Mean HLA match was 3.6 (range: 3 to 5). Immunosuppression was cyclosporine (n = 13) or tacrolimus (n = 11) or sirolimus (n = 4), as well as steroids and azathioprine or mycophenolate mofetil. Delayed graft function occurred in four patients. The main complications were arterial hypertension (n = 11), anemia (n = 4), urinary tract infection (n = 10), hypercholesterolemia (n = 7), and cytomegalovirus infection (n = 1). An acute rejection episode (ARE) occurred in four patients. ARE and hypertension rates were similar between the immunosuppressive drug groups. All the patients with graft failure were on cyclosporine (P = .03). Hemodialysis and peritoneal dialysis (median duration: 6 months) were performed preoperatively in 25 and 3 patients, respectively. The length of pretransplant dialysis was longer among patients with graft failure (P > .05). Noncompliance (10.7%) resulted in an ARE in one patient and graft loss in two patients. One patient died with a functioning graft. Primary disease recurred in one patient. The median follow-up period was 44 months (range: 6 to 157 months). Mean serum creatinine level was 1.35 +/- 0.74 mg/dL at the last follow-up. One- and 3-year graft survival rates were 92% and 86%, respectively, and patient survival was 100%, each. Seventeen patients (60.7%) continued their education after the transplantation; six started working. Successful transplantation in the pediatric age group together with intensive rehabilitation posttransplantation are important to make these children productive individuals to the society.
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Affiliation(s)
- I Berber
- Haydarpasa Numune Research and Training Hospital, 1st Department of Surgery and Transplantation, Istanbul, Turkey.
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