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    The effect of HA330 hemoperfusion adsorbent method on inflammatory markers and end-organ damage levels in sepsis: a retrospective single center study
    (Verduci Publisher, 2022) Erkurt, M. A.; Sarici, A.; Ozer, A. B.; Kuku, I; Bicim, S.; Aydogan, M. S.; Kose, A.
    OBJECTIVE: In this study, we aimed at evaluating the impact of HA330 hemoperfusion adsorbent application on inflammatory markers and end-organ damage markers in patients with sepsis/septic shock. PATIENTS AND METHODS: Patients who were diagnosed with sepsis/septic shock and treated with HA330 hemoperfusion adsorbent in addition to the standard treatment were included in this retrospective study conducted at Inonu University Turgut Ozal Medical Center between January 1, 2019 and January 1, 2021. RESULTS: A total of 150 patients were included in the study. The mean +/- SD age of the patients was 51.9 +/- 17.7 years. 102 patients (68%) were in septic shock. Mean +/- SD APACHE II scores were 15.3 +/- 4.8. The need for mechanical ventilation was noted in 64 patients (42.7%). WBC, neutrophil count, hemoglobin, platelet count, BUN, creatinine, AST, ALT, CRP and procalcitonin levels were measured before and after the procedure. Overall, 104 patients (69.3%) died median (min-max) 2.5 (1-114) days after the cytokine adsorption, while 46 patients (30.7%) recovered from sepsis and were discharged. The increase in BUN levels and decrease in platelet count after the procedure were statistically significant ( p= 0.001, 0.041, respectively) in the overall study population. The laboratory findings in 46 survivors indicated significantly decreased AST and ALT levels after cytokine adsorption compared to baseline pre-treatment levels. WBC, neutrophil count, CRP, procalcitonin, BUN and creatinine values were also decreased after cytokine adsorption in survivors, whereas the change was not statistically significant. There was also a non-significant tendency for an increase in platelet count and hemoglobin levels after cytokine adsorption compared to pre-treatment values in these patients. CONCLUSIONS: Although no effect of HA330 hemoperfusion application on inflammatory markers and end- organ damage markers was demonstrated in our study, we used the HA330 hemoperfusion adsorbent method as a last resort in terminal patients with a mortality rate of approximately 90% and for whom antibiotic treatment did not benefit. Therefore, multicenter, prospective studies are needed to clarify the effect of early HA330 hemoperfusion use in the treatment of sepsis.
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    Effects of agomelatine on rat liver regeneration following partial hepatectomy
    (Taylor & Francis Ltd, 2023) Kose, A.; Ozhan, O.; Parlakpinar, H.; Vardi, N.; Yildiz, A.; Turkoz, Y.; Erdemli, Z.
    Primary or metastatic hepatic malignancies are common. Partial hepatectomy (PH) is the primary treatment for both benign and malignant hepatic neoplasms; it also is used for living donor liver transplantation. The regenerative potential of the liver after PH is 70-80% in humans. We investigated the protective and therapeutic effects of agomelatine (AGM) on rat liver regeneration following PH. We used 32 rats distributed equally into four groups: group 1, sham control; group 2, PH group; group 3, administered 20 mg/kg AGM orally once/day for 7 days following PH; group 4, administered 20 mg/kg AGM orally once/day 3 days before and 7 days following PH for 10 days. Liver samples were analyzed for antioxidants and free radicals. Tissue samples were processed and stained with hematoxylin and eosin to assess histopathological status and stained immunohistochemically for Ki-67. We found that PH reduced antioxidant enzymes and increased tissue reactive oxygen species, whereas AGM treatment had the opposite effect on these parameters. Our biochemical and histopathological findings were consistent. PH caused sinusoid congestion and dilation. Intensity of Ki-67 immunostaining of hepatocytes was increased in group 2, whereas these were reduced in group 4. Intensity of Ki-67 immunostaining of hepatocytes was increased in group 2, whereas it was reduced in the group 4 compared to group 1. We found that AGM was hepatoprotective following PH due to its antioxidant and free radical scavenger properties.
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    Management of wet ascitic type of peritoneal tuberculosis: single center experience
    (Verduci Publisher, 2023) Gonultas, F.; Akbulut, S.; Sarici, K. B.; Toprak, S.; Kilci, B.; Bilgic, Y.; Kose, A.
    OBJECTIVE: We aimed to present our experience with the management of 17 patients with ascites who underwent diagnostic laparoscopy or laparotomy, and histologic con-firmation of wet ascitic type of peritoneal tuber-culosis (TB).PATIENTS AND METHODS: Between Janu-ary 2008 and March 2019, 17 patients whose as -cites were investigated by a gastroenterologist and who were thought to have non-cirrhotic as -cites were referred to our Surgery clinic for peri-toneal biopsy. The clinical, biochemical, radio-logical, microbiological, and histopathological data of the patients who underwent diagnostic laparoscopy or laparotomy were analyzed ret-rospectively. Histopathological examination of peritoneal tissue samples in hematoxylin-eo-sin-stained preparations revealed necrotiz-ing granulomatous inflammation with caseous necrosis and Langhans type giant cells. Eh-rlich-Ziehl-Neelsen (EZN) staining was studied with the suspicion of TB. Acid-fast bacilli (AFB) were detected in EZN stained slide. Histopatho-logical findings were also considered.RESULTS: Seventeen patients aged 18 to 64 years were included in this study. The most common symptoms were ascites and abdomi-nal distention, weight loss, night sweats, fever and diarrhea. Radiological examination revealed peritoneal thickening, ascites, omental cacking, and diffuse lymphadenopathy. Histopathologi-cally, necrotizing granulomatous peritonitis con-sistent with peritoneal TB were detected. While direct laparoscopy was preferred in sixteen pa-tients, laparotomy was preferred in the remain-ing one due to previous surgical procedures. However, seven were converted to open laparot-omy.CONCLUSIONS: Diagnosis of abdominal TB requires high index of suspicion, and the treat-ment should be prompt to reduce the morbidity and mortality associated with delay in treatment.
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    Multidrug-Resistant Bacterial Sepsis and Inferior Vena Cava Thrombosis in Liver Transplant Recipients Used Synthetic Vascular Graft: Three Fatal Cases
    (Avicenna Organ Transplant Center, 2020) Kose, A.; Ince, V; Ozdemir, F.; Kutlu, R.; Bayindir, Y.; Yilmaz, S.
    Synthetic vascular grafts are commonly used in liver transplantation. Thrombosis is a possible complication of using expanded polytetrafluoroethylene (e-PTFE) grafts. Herein, we report on 3 cases of liver recipients who died of intermittent sepsis episodes emerged concurrently with the thrombosis in synthetic vascular grafts and inferior vena cava (IVC) vein. Right lobe liver transplantation from living donors was performed for 3 patients by using e-PTFE grafts between the liver and IVC. Although heparin had been administered, thrombosis was developed in vascular graft and IVC extending to the right atrium; it was developed within 1-4 months of transplantations. All 3 patients suffered from recurrent sepsis episodes (4, 5, and 6 attacks for each patient) by different multidrug-resistant bacterial species. Treatment attempts including thrombolytic and antimicrobial drugs made, and surgical, endoscopic and radiological interventions could not resolve the clinical situation. The patients died of septic complications. We concluded that severe recurrent sepsis attacks may develop in liver transplant recipients when IVC and synthetic vascular graft were thrombosed. Removing the e-PTFE graft may be benefit for the treatment.