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OBJECTIVE: The aim was to investigate the effect of primary tumor resection (PTR) on survival in metastatic breast cancer patients and to assess the power of the neutrophil-to-lymphocyte ratio (NLR) regarding the prediction of prognosis in this patient group. MATERIALS AND METHODS: Female patients diagnosed with and starting treatment for metastatic breast cancer from 2003 to 2016 in the general surgery and oncology clinics at a single center were retrospectively reviewed. Pre-treatment NLR value and survival situations were evaluated. RESULTS: A total of 117 patients were enrolled. The disease-specific survival (DSS) of the patients was 41.4 months. When stratified into PTR and systemic treatment (ST) groups, there was no difference in the survival (p = 0.054); 43.5 months in the PTR group vs 30.7 months in the ST group. When hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative subgroups were analyzed, DSS was significantly longer (p = 0.02) in the PTR group (55.4 months) compared to the ST group (41.8 months). Finally, in patients with an NLR of <2.3, DSS was significantly longer (p = 0.03) in the PTR group (56.1 months) compared to the ST group (25.2 months). CONCLUSION: These results suggest that DSS can be increased with PTR in selected patients with a diagnosis of metastatic breast cancer. NLR may be useful in selecting patients for appropraite treatment modality.

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BACKGROUND: Decreased regional cerebral oxygen saturation (rSO2) is associated with neurological events. We aimed to investigate the effects of carbon dioxide (CO2) insufflation applied to the neck during transoral endoscopic thyroidectomy vestibular approach (TOETVA) surgery on the rSO2. MATERIALS AND METHODS: Patients scheduled for TOETVA and open thyroidectomy (OT) were enrolled between October 2019 and November 2020. Alongside hemodynamic parameters, the rSO2 values of the patients were recorded at 5 different times. These were; before anesthesia induction (T0), 10 minutes after anesthesia induction (T1), 5 minutes after the patient was placed in the operation position (T2), 10 minutes after the CO2 insufflation in the TOETVA group, 10 minutes after the platysma incision in the OT group (T3), 10 minutes after the CO2 desufflation in the TOETVA group, 10 minutes after platysma closure in the OT group (T4), at the end of the surgery (T5). RESULTS: A total of 40 patients, 20 in each group, were included in the study. The surgery duration was 113±26.9 minutes in the OT group, while it was 274.1±78.1 minutes in the TOETVA group (P=0.000). The EtCO2 values during the T3 time interval; group OT 31±2.2, group TOETVA 33.9±2.1 (P=0.000). The rSO2 values of the patients were similar, except for the T3 time interval. While the right rSO2 value we obtained during the T3 time interval in the TOETVA and OT groups were 66.9±9.1 and 73.9±7.8 (P=0.013), the left rSO2 value in the TOETVA and OT groups were 66.3±9.9 and 74.8±6.8 (P=0.003), respectively. CONCLUSIONS: As long as the patients stay within the limits of normocapnia, the CO2 insufflation applied during TOETVA surgery has no negative effects on rSO2.

Asunto(s)

Insuflación , Tiroidectomía , Endoscopía , Humanos , Saturación de Oxígeno , Estudios Prospectivos

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BACKGROUND: Parenchymal fibrosis, which develops in the case of thyroiditis, makes thyroidectomy difficult and increases complication rates. Similar concerns exist within minimally invasive thyroid surgery. This study aimed to evaluate the outcomes of the transoral endoscopic thyroidectomy vestibular approach (TOETVA) procedure in patients with thyroiditis. MATERIALS AND METHODS: The data of 56 patients who underwent TOETVA between February 2018 and March 2020 were analyzed retrospectively. The patients were classified as those who had lymphocytic or Hashimoto thyroiditis (group T) and those who did not (group NT) in the postoperative pathology results. Results were evaluated in terms of intraoperative, postoperative findings, and complications. RESULTS: All patients were female individuals with a median age of 43 (21-76). There were 21 (37%) patients in group T and 35 (63%) patients in group NT. Mean operation times were 174.2±37.4 and 201.4±45.6 minutes in groups T and NT (P=0.025), respectively, and were statistically shorter in group T. Blood loss was 37.9±44.5 and 34.6±46.8 mL (P=0.811) in groups T and NT, respectively. Transient recurrent laryngeal nerve palsy occurred in 1 patient (5%) in group T, 1 (3%) in group NT (P=0.712), and transient hypoparathyroidism occurred in 3 patients (14%) in group T and in 7 (20%) in group NT. There was no difference in terms of intraoperative and postoperative complications. CONCLUSION: Although thyroiditis is a condition that complicates thyroidectomy, TOETVA can be applied with similar complication rates in patients with thyroiditis.

Asunto(s)

Cirugía Endoscópica por Orificios Naturales , Tiroidectomía , Tiroiditis , Parálisis de los Pliegues Vocales , Endoscopía , Femenino , Fibrosis , Humanos , Cirugía Endoscópica por Orificios Naturales/efectos adversos , Estudios Retrospectivos , Tiroidectomía/efectos adversos

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AIM: To assess the relationship between Helicobacter pylori (H. pylori) infection and atrophic gastritis (AG) and intestinal metaplasia (IM) development and to assess the rate of dysplasia or gastric cancer development in patients with AG and/or IM. METHODS: This retrospective endoscopic follow-up study enrolled 2214 patients. The patients were followed for at least five years between 2007 and 2017 at the Department of Endoscopy at Antalya Ataturk Government Hospital. The results of third-year and five-year surveillance biopsy were assessed. RESULTS: The mean follow-up time was 7.77 ± 2.78 years. H. pylori was histologically assessed in 1417 (64.6%) patients. Of 198 patients with severe H. pylori infection, 32 (16%) and 139 (70.3%) developed extensive AG and extensive IM, respectively. There was a significant relationship between H. pylori density and AG and IM degrees. High grade dysplasia, early gastric cancer, and advanced gastric cancer were diagnosed in 73 patients with median age 58.2 (28-80) years, and the incidence rate was 3.29% (73/2214). The annual incidence of gastric neoplastic lesions was 0.46% in total, 0.08% for early GC, and 0.02% for advanced gastric cancer. CONCLUSIONS: H. pylori infection has an important role in the development of AG and IM. H. pylori density is directly related to atrophy and metaplasia degree.

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Gastritis Atrófica/epidemiología , Infecciones por Helicobacter/epidemiología , Lesiones Precancerosas/epidemiología , Neoplasias Gástricas/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Biopsia , Endoscopía Gastrointestinal , Femenino , Estudios de Seguimiento , Mucosa Gástrica/patología , Gastritis Atrófica/microbiología , Gastritis Atrófica/patología , Infecciones por Helicobacter/diagnóstico , Infecciones por Helicobacter/microbiología , Helicobacter pylori , Humanos , Incidencia , Masculino , Metaplasia/patología , Persona de Mediana Edad , Lesiones Precancerosas/microbiología , Lesiones Precancerosas/patología , Estudios Retrospectivos , Factores de Riesgo , Neoplasias Gástricas/microbiología , Neoplasias Gástricas/patología , Turquía/epidemiología

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OBJECTIVES: The Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) was described in 2016 and had its case series published. This study aimed to present the largest TOETVA case series performed in Turkey. MATERIAL AND METHODS: Data from 52 patients who underwent TOETVA procedure between February 2018 and October 2019 were analyzed retrospectively. Demographic data, duration of operation, blood loss, rate of conversion to open surgery, radiological findings, pathological outcomes, and complications were analyzed. RESULTS: All patients were female. Mean duration of the operation was 192 ± 45 minutes, mean blood loss was 39 ± 47 mL, and the ratio of surgical site infection was 6% (3/50). In two (4%) patients, TOETVA was converted to open surgery. Temporary and permanent recurrent laryngeal nerve (RLN) paralysis was observed in 2 (4%) and 0 patients, respectively. Temporary and permanent hypoparathyroidism was observed in 10 (20%) and 0 patients, respectively. CONCLUSION: TOETVA procedure is the most recently defined NOTES technique for endocrine surgery. In experienced healthcare centers, TOETVA can achieve outcomes similar and even better than the ones obtained with open surgery. The complication rates, durations of operation, surgical site infection, and blood loss parameters that we observed in our experience are similar to the ones reported in the literature.

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BACKGROUND AND AIM: In our study we aimed to compare laparoscopic intracorporeal knotting technique (base of the appendix was ligated with 20 cm of 2.0 silk) in patients with complicated acute appendicitis (CAA) and noncomplicated acute appendicitis. PATIENTS AND METHODS: Ninety patients (female/male: 40/50, age ranging from 16 to 60 years, median age and interquartile range [IQR]: 25 [20; 32] years) who underwent laparoscopic appendectomy were included in the study. The patients were evaluated for the type of acute appendicitis, duration of operation, duration of hospital stay, and postoperative complications. RESULTS: The number of cases diagnosed as CAA was 28 (31.1%), and the number of noncomplicated cases was 62 (68.9%). We found that there was no significant difference in postoperative complication rates between complicated and noncomplicated appendicitis cases. Incision site infection was seen in seven cases (7.8%) and ileus was seen in two cases (2.2%). Bleeding, intra-abdominal abscess, and appendix stump leakage were not observed in any of the cases. Median and IQR duration of operation were 42 (35; 52) minutes and median and IQR duration of hospital stay were detected as 2 (1; 2) (range 1-10) days. CONCLUSION: Laparoscopic intracorporeal knotting technique may be a safe, effective, and reliable technique as the materials needed for closing the appendix stumps are easily available for both CAA cases and noncomplicated cases.

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BACKGROUND The most important purpose of transplantation is to improve quality of life (QOL) together with increasing life expectancy. The aim of this study was to compare the QOL of both donors and kidney transplant recipients and a control group at the 3rd and 9th postoperative months by using the SF36 health survey, to investigate the changes in this 6-month period and to evaluate descriptive data and satisfaction of patients and donors. MATERIAL AND METHODS Forty-seven donors and 47 kidney transplant recipients who were operated on in Diyarbakir Gazi Yasargil Training and Research Hospital between August 2012 and March 2015 and had been followed up for at least 9 months and 47 healthy controls were enrolled in the study. RESULTS Physical functioning (PF) was higher at the 9th postoperative month compared to the 3rd month in the recipient group (p=0.028). Donors had higher PF (p=0.007) and functioning physical role (PR; p=0.01) compared to recipients. Recipients had lower PF (p=0.016), PR (p=0.004), and functional-emotional role (ER; p=0.03) at the 3rd month and had lower PR (p=0.002) at the 9th month postoperatively comparing to the control group. Donors had lower PF (p=0.007) and PR (p=0.01) at the 3rd month and had lower PR (p=0.035) at the 9th month postoperatively comparing to the control group. Donors and recipients had similar QOL at the 9th month. CONCLUSIONS During follow-up, we observed an increase in QOL (in some subgroups) at 9 months postoperatively. Donors and recipients had similar QOL (except for PR) with the control group at the 9th month. QOL was better in younger and male patients and educated persons. Donors did not show any regret regarding their donation.

Asunto(s)

Trasplante de Riñón/psicología , Donadores Vivos/psicología , Satisfacción del Paciente , Calidad de Vida/psicología , Receptores de Trasplantes/psicología , Adolescente , Adulto , Factores de Edad , Anciano , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Factores Sexuales , Adulto Joven

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BACKGROUND: Colon polyps need to be excised upon detection during colonoscopy due to the risk of malignancy irrespective of their size. In our study, we retrospectively evaluated the clinicopathological characteristics of polyps detected during colonoscopy. MATERIALS AND METHODS: We assessed 379 patients with polyps detected during colonoscopy between January 2010 and May 2012. The demographics, complaints, colonoscopy findings (shape, place and size of the polyp) and histopathological findings were recorded. We carried out statistical analysis using PASW 18.0 for Windows. RESULTS: There were 227 males (59.9%) and 152 females (40.1%) in the trial. The mean age was 53.8 years (32-90). The most common complaint was rectal bleeding (36.1%), followed by abdominal pain (35.4%). Polyps were detected most commonly in the rectosigmoid region (43.8%), followed by the descending colon (17.4%). Some 239 patients had a single polyp (63.1%) while 140 were found to have multiple polyps (36.9%). While tubular adenoma was the most common pathological type, occurring in 181 patients (47.8%), tubulovillous adenoma (14.2%) and hyperplastic polyp (12.7%) followed, occurring in 54 and 48 patients respectively. While 313 patients (82.6%) did not feature dysplasia, 37 patients (9.7%) exhibited low- grade dysplasia, 28 (7.7%) had high-grade dysplasia and 4 had cancer (1.1%). The rates of villous components and dysplasia were detected to be high among pedunculated polyps and polyps larger than 1 cm (p<0.001). CONCLUSIONS: Due to the fact that large-diameter polyps with malignant potential are commonly located in the left colon and have a high prevalence among the middle-aged individuals, it would be appropriate to screen this population at regular intervals via rectosigmoidoscopy.

Asunto(s)

Adenoma/patología , Colon/patología , Neoplasias del Colon/patología , Pólipos del Colon/patología , Colonoscopía , Adenoma/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Colon/cirugía , Neoplasias del Colon/cirugía , Pólipos del Colon/cirugía , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Adulto Joven

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AIM: To evaluate platelet function in patients with a history of surgical treatment for hepatic hydatid disease (HD). METHODS: This retrospective case-controlled study was performed in a state hospital in Turkey from January 2009 to November 2013. The patients were divided into two groups: those evaluated in the preoperative period (Group 1) and those evaluated in the postoperative period (Group 2). The patient groups were compared with a control group (Group 3). All three groups were evaluated using laboratory records from day 1 of the preoperative period and day 30 of the postoperative period. The haematocrit level (HTC), platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), and percentage of eosinophils (EOS) were compared among the groups. RESULTS: Fifty-three patients who had undergone surgical treatment of hepatic HD and 55 healthy controls were included in the study. The mean follow-up time for all patients was 45 (14-70) months. The patients comprised 33 (62%) females and 20 (38%) males. The control group comprised 37 (67%) females and 18 (33%) males. The median age of the patients was 48 (19-78) years, while that of the control group was 42 (16-64) years. No significant differences in the HTC, PLT, or EOS were present among the groups. The MPV and PDW indicated that platelet function was significantly different between Group 1 and Groups 2 and 3. Additionally, nine patients had undergone previous surgical treatment for HD. In a separate long-term follow-up, these patients exhibited no statistically significant differences in MPV or PDW between the preoperative and postoperative periods. CONCLUSIONS: MPV and PDW can be used in the initial follow-up of patients with hepatic HD, but have limited use in long-term follow-up.

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BACKGROUND AND AIM: This study aims to determine the factors that affect morbidity and mortality in colon and rectum injuries related with trauma, the use of trauma scoring systems in predicting mortality and morbidity. PATIENTS AND METHODS: Besides patient demographic characteristics, the mechanism of injury, the time between injury and surgery, accompanying body injuries, admittance Glasgow coma scale (GCS), findings at surgery and treatment methods were also recorded. With the obtained data, the abbreviated injury scale (AIS), injury severity score (ISS), revised trauma score (RTS) and trauma-ISS (TRISS) scores of each patient were calculated by using the 2008 revised AIS. RESULTS: Of the patients, 172 (88.7 %) were male, 22 (11.3 %) were female and the mean age was 29.15 ± 12.392 (15-89) years. The morbidity of our patients were 32 % and mortality were 12.4 %. ISS (p < 0.001), RTS (p < 0.001), and the TRISS (p < 0.001) on mortality were found to be significant. TRISS (p = 0.008), the ISS (p < 0.001), the RTS (p = 0.03), the trauma surgery interval (TSI, p < 0.001) were observed to have significant effects on morbidity. Regression analysis showed that the ISS (OR 1.1; CI 95 % 1.01-1.2; p = 0.02), the RTS (OR 0.37; CI 95 % 0.21-0.67; p = 0.001) had significant effects on mortality. While the effects of TSI (OR 5.3; CI 95 % 1.5-18.8; p = 0.01) on morbidity were found to be significant. CONCLUSION: Predicting mortality by using scoring systems and close postoperative follow up of patients in the risk group may ensure decreases in the rates of morbidity and mortality.

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AIM: To investigate the diagnostic accuracy of the mean platelet volume and platelet distribution width in acute appendicitis. METHODS: This retrospective, case-controlled study compared 295 patients with acute appendicitis (Group I, 100 patients with other intra-abdominal infections (Group II), and 100 healthy individuals (Group III) between January 2012 and January 2013. The age, gender, and white blood cell count, neutrophil percentage, mean platelet volume, and platelet distribution width values from blood samples were compared among the groups. Statistical analyses were performed using SPSS for Windows 21.0 software. In addition, the sensitivity, specificity, positive and negative predictive values and likelihood ratios, and diagnostic accuracy were calculated. RESULTS: The mean ages of patients were 29.9 ± 12.0 years for Group I, 31.5 ± 14.0 years for Group II, and 30.4 ± 13.0 years for Group III. Demographic features such as age and gender were not significantly different among the groups. White blood cell count, neutrophil percentage and platelet distribution width were significantly higher in Group I compared to groups II and III (P < 0.05). Diagnostically, the sensitivity, specificity and diagnostic accuracy were 73.1%, 94.0%, and 78% for white blood cell count, 70.0%, 96.0%, and 76.0% for neutrophil percentage, 29.5%, 49.0%, and 34.0% for mean platelet volume, and 97.1%, 93.0%, and 96.0% for platelet distribution width, respectively. The highest diagnostic accuracy detected was for platelet distribution width between Group I and Group III (P < 0.01). CONCLUSION: Platelet distribution width analysis can be used for diagnosis of acute appendicitis without requiring additional tests, thus reducing the cost and loss of time.

Asunto(s)

Apendicitis/sangre , Apendicitis/diagnóstico , Plaquetas , Volúmen Plaquetario Medio , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Neutrófilos , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Adulto Joven

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INTRODUCTION: Stoma construction is a life saver method for emergent and elective operations in colorectal surgery. However, they are associated with high rates of morbidity and mortality. AIM: To compare the operative findings, early postoperative complications, and costs of stapled and hand-sewn closures in loop ileostomies that are constructed in emergent and elective colorectal surgery. MATERIAL AND METHODS: The data of 68 patients requiring loop ileostomies during colorectal surgery were retrospectively evaluated. SPSS (version 20) was used for data analysis. RESULTS: The study group consisted of 44 men and 24 women with a mean age of 55.5 years. The ileostomy closures were performed with hand-sewn method in 36 patients (group 1) and stapled method in 32 patients (group 2). The mean operation time was 75.4 min in group 1 and 46.7 min in group 2 (p < 0.001). Early postoperative complications were wound infection (8.8%), small bowel obstruction (6.06%), and anastomotic leakage (2.9%). Total costs, flatulence and faeces outlet time, oral feeding starting time, time of hospital stay, and early postoperative complications were lower in the stapled group. CONCLUSIONS: Morbidity and mortality rates of stoma construction and its closure are still considerable. Lower anastomotic leakage rate, complication rate, and costs and shorter operative times in the stapled group make this method preferable.

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Simple cysts (SCs) of the liver are not associated with the biliary malformations in intrahepatic bile duct biliary. Seen in 0.1% to 7% of adult population, biliary malformations are more common in women. The levels of glycoprotein-like tumor markers (carbohydrate antigen (CA) 19-9) in the cysts and serum could be high. Although studies regarding CA 19-9 exist, sufficient data on cancer antigen (CA) 15-3 are not available. This case is about a 76-year-old woman who complained of painless intra-abdominal mass. The patient with a giant simple cyst extending from the gallbladder to the pelvis had preoparative CA 19-9 and CA 15-3 serum levels of 87.3 IU/L and 37 IU/L respectively. It was observed that CA 19-9 levels had decreased to 36 IU/L and CA 15-3 to 28.1 IU/L in blood samples taken in the third month after the surgery. There is a need for comprehensive studies to investigate the relationship between the size of the cyst and biomarkers (including markers such as CA 15-3) in the assesment of liver SC.

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BACKGROUND: We aimed to investigate the reliability of the Alvarado score (AS) in determining acute appendicitis and the different parameters that affect the AS. METHODS: Three hundred and thirteen patients suspected of acute appendicitis (AA) aged 18-70 years were included in this study. Patient data including AS calculated from emergency services and at discharge, follow-up, and operations were recorded. Patients were divided into three groups according to the AS, as AS <4, AS 5-7 and AS 8-10. AA and appendicitis perforation rates were compared according to the different parameters. RESULTS: The mean age of patients (55% females, 45% males) was 30.8±10.8 years. The AA (appendix perforation) rates of 211 patients who underwent operation were found as: AS ≤4: 56.5% (7.7%), AS 5-7: 75.9% (10%), and AS 8-10: 89% (27.8%). The percentage of negative appendectomy was 19.4%. The scoring was more reliable in males with AS 5-7, and the reliability weakened as body mass index (BMI) increased in all groups. CONCLUSION: Patients with AS ≤4 must be followed up and should be informed at the time of their discharge about the slight possibility of appendicitis. The effect of AS in determining the diagnosis of appendicitis is not influenced by age or symptom duration.

Asunto(s)

Apendicitis/diagnóstico , Índice de Severidad de la Enfermedad , Enfermedad Aguda , Adolescente , Adulto , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Adulto Joven

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BACKGROUND: The aim of this study is to present results of patients who have undergone renal transplantation concurrent with bilateral or unilateral native nephrectomy, with a special focus on polycystic kidney disease (PKD). MATERIAL AND METHODS: We presented the outcome of renal transplantation patients who have undergone native nephrectomy unilaterally (n=38) and bilaterally (n=125) and compared the results of patients with PKD and other nephrectomy indications. RESULTS: Overall graft survival in the 1st, 3rd, and 5th years were 93%, 90%, and 89%, respectively, in transplantation with concomitant nephrectomy patients. Overall patient survival in the 1st, 3rd, and 5th years were 97%, 94%, and 94%, respectively. Overall surgical complications rate was 17.7% and medical complication rate was 19%. Patients with PKD had more frequent complications. CONCLUSIONS: Despite additional surgery, the long-term results of patients with complications were not affected negatively by early diagnosis and treatment. We believe that native nephrectomy concurrent with transplantation can be successfully performed when indicated in selected patients at experienced centers.

Asunto(s)

Supervivencia de Injerto , Fallo Renal Crónico/cirugía , Trasplante de Riñón/métodos , Nefrectomía/métodos , Enfermedades Renales Poliquísticas/cirugía , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tasa de Supervivencia , Resultado del Tratamiento

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Hereditary nonpoliposis colorectal cancers (HNPCC) make up 2-7% of colorectal cancer (CRC) cases. CRC's in these group of patients are usually located in proxymal colon. The incidence of syncronic metacron CRC is 18%. The incidence of having different hystopathological types for these group of tumors varies between 3-9%. APC, p53 and K-ras gene mutations may be seen in HNPCC's. The least frequent mutation is the mutation on K-ras gene. In this report, a syncronic metacron CRC with different hystopathological type and K-ras gene mutation localised in transverse and left colon that has developed on the basis of HNPCC is discussed.

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BACKGROUND: Technical problems such as graft and vascular size are more common in living donor liver transplantation (LDLT) than in deceased donor liver transplantation. It is usually possible to get enough length of vessels on the graft, but the opposite situation is devastating. Finding the suitable vessel graft is life-saving in those situations. In this paper we present a case of gonodal vein interpositioning for hepatic artery reconstruction in an LDLT recipient. To the best of our knowledge, this is the first such case to be reported in the literature. CASE REPORT: A 36-year-old man with cirrhosis secondary to hepatitis B underwent LDLT. Within minutes after completing the anastomosis, the artery was thrombosed. Disrupting the anastomosis showed subintimal dissection of the recipient right hepatic artery extending to the gastro-duodenal junction. A 4 cm segment of gonodal vein, which matched the diameter of the recipient hepatic artery, was used as a bridge. The patient's postoperative recovery was excellent and Doppler ultrasonography demonstrated sufficient hepatic arterial blood flow. At long-term follow-up (18(th) months), the patient's graft is still functioning. CONCLUSIONS: Gonodal vein interposition for hepatic artery reconstruction in living donor liver transplantation has not been previously reported. In light of the urgency of this situation, we believe it can be a life-saving reconstruction.

RESUMEN

Chyluria mostly occurs because of the leakage of lymphatic fluid into the urinary system from the lymphatic system. The patient reported here with end-stage renal disease caused by the nephrotic syndrome underwent renal transplantation from a living donor. During the early posttransplant period, her daily urine output was 300 to 400 mL, and it was chylous. The only abnormality on physical examination was pretibial edema. On renal biopsy, there was no sign of glomerular disease, acute tubular necrosis, or rejection that could have caused delayed graft function. All factors except surgery were excluded, and a lymphourinary fistula was demonstrated with lymphoscintigraphy. After 15 days, chyluria resolved and she recovered spontaneously. Normal diuresis began, and her creatinine level decreased to less than 1 mg/dL in 3 days. According to our knowledge, this is the first chyluria case secondary to surgery in the posttransplant setting.

Asunto(s)

Quilo , Funcionamiento Retardado del Injerto/orina , Trasplante de Riñón/efectos adversos , Adulto , Femenino , Humanos , Orina , Urodinámica

RESUMEN

BACKGROUND: Hem-o-lock (polymer) vascular clips have been used over a long period for vascular control at donor nephrectomies. With our study, safety of hem-o-lock clip use at donor nephrectomies (conventional donor nephrectomy, transabdominal donor nephrectomy and retroperitonoscopic donor nephrectomy) has been evaluated. MATERIAL/METHOD: A total of 883 cases, consisting of conventional donor nephrectomy, transabdominal donor nephrectomy and retroperitonoscopic donor nephrectomy, performed between May 2006 and August 2009 were retrospectively evaluated. Of all cases, 803 were performed conventional donor nephrectomy, 85 were performed endoscopic donor nephrectomy. Five patients who had first undergone endoscopic donor nephrectomy had conversion operations. RESULTS: Vascular control at renal pedicle were obtained either with hem-o-lock clip ot vascular clamps. Cases with conventional donor nephrectomy were divided into two subgroups. Group I: cases which had transfixation sutures with 5.0 prolene in order to prevent clip separation after hem-o-lock clip use; Group II: cases without transfixation sutures. Only hem-o-lock sutures were used at laparoskopic and retroperitonoscopic techniques. Large and X-large clip and were used for renal arteries and two X-large clips were used for renal vein. CONCLUSIONS: The most ideal method for vascular control at donor nephrectomy is controversial. Use of transfixation and hem-o-lock clips at conventional donor nephrectomy may be an alternative method. However for all three methods and at both groups, none of the cases who had undergone nephrectomy had bleeding or donor loss caused by hem-o-lock clips at intraoperative, perioperative anf postoperative periods. For this reason, we believe that use of hem-o-lock clips is a safe and reliable method for vascular control at donor nephrectomies.

Asunto(s)

Nefrectomía/métodos , Seguridad , Instrumentos Quirúrgicos , Donantes de Tejidos , Recolección de Tejidos y Órganos , Hemorragia/cirugía , Humanos , Trasplante de Riñón , Arteria Renal/cirugía , Venas Renales/cirugía , Suturas

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OBJECTIVE: Renal transplantation is an outstanding therapy for end-stage renal failure and has been shown to increase life expectancy and quality of life, while reducing medical expenditure. The presence of IgM antibodies in recipient serum is not a contraindication for renal transplantation. However, the presence of this antibody may have significant clinical implications. IgM autoantibodies have been blamed for a group of accelerated or hyperacute cases of graft rejection. In this study, graft and patient survival outcomes after renal transplantation in LCM IgM-positive recipients have been assessed. MATERIALS AND METHODS: Data from 32 LCM IgM-positive kidney recipients who underwent renal transplantation at the Akdeniz University Transplantation Center between January 2006 and August 2008 were assessed. RESULTS: The mean age was 34 ± 13.5 (9-66). Twenty patients were male, and twelve were female. The mean length of therapy with dialysis was 22.94 ± 30.06 months (0-120). The duration of cold ischemia was 28.63 ± 5.85 minutes (21-42). CONCLUSION: Throughout the follow up period, the mean creatinine level was 1.3 mg/dL (0.69-4.5). Graft loss occurred in only one patient and was due to hemophagocytic syndrome and acute rejection. During follow up, creatinine elevation was seen in 12 patients (4%) in the early postoperative period. These patients were thought to have transplant rejection, and therapy for rejection was given. The therapy was successful. Graft survival was calculated to be 96 ± 3.5%, and none of the patients were lost.