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Öğe The causes of death-censored graft loss among kidney transplant recipients(2024) Ciftci, Felat; Simsek, Arife; Piskin, Turgut; Unal, Bulent; Dogan, Sait Murat; Ulutas, Ozkan; Tabel, YilmazAim: This study presents the causes of death-censored graft loss among kidney transplant recipients. Materials and Methods: Medical records of the patients, who had undergone kidney transplantation at a tertiary center between November 2010 and December 2018, were retrospectively reviewed. Death-censored graft loss was described as an irreversible graft failure signified by return to long-term dialysis (or re-transplantation). Inclusion criteria were: patients who had undergone kidney transplantation, and subsequently lost their first graft, and a follow-up of more than one year after kidney transplantation. Results: Of 269 kidney transplant recipients, 33 recipients with a mean age of 33.54 ± 15.37 years (17 male and 16 female) were included in the study. The rate of death-censored graft loss was 12.26%. Of graft failures, 3.03% occurred in the hyperacute phase, 18.18% in the acute phase, and 78.78% in the chronic phase. Chronic allograft nephropathy was the leading cause of graft failure (48.48%). Other causes were medical problems (18.18), immunological problems (18.18%) and surgical complications (15.15%). Conclusion: Identification of the true causes of graft failure described under the heading chronic allograft nephropathy is noteworthy. Comprehensive biochemical, physiological, pathological, immunological, and genetÖğe Distribution of peripheral blood cells after splenectomy in immune thrombocytopenia patients(Mexican Acad Surgery, 2022) Simsek, ArifeBackground: There are some difficulties regarding the evaluation of the post-splenectomy state. Objective: The objective of the study is to compare the post-splenectomy blood changes of immune thrombocytopenia (ITP) patients with those of trauma patients, 1 month and >_ 6 months after surgery. Methods: Medical records of patients, who had undergone total splenectomy for ITP and trauma at a tertiary center between January 2009 and December 2019, were retrospectively reviewed. Results: The current study included 52 patients, who had undergone splenectomy for ITP (57.7%), and trauma (42.3%). Splenectomy, irrespective of the indications, resulted in an increase in hemoglobin concentration, hematocrit, and platelet levels. Neutrophils were responsible for the preoperative leukocytosis in ITP patients, and neutrophilia was ameliorated by splenectomy and also withdrawal of the steroid therapy in some patients. Decreased neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio supported the finding that splenectomy ameliorated inflammation in ITP patients. Splenectomy resulted in a change in percentages of leukocytes in favor of basophils in ITP patients. Conclusions: Splenectomy, irrespective of the indications, resulted in an increase in hemoglobin concentration, hematocrit and platelet levels, lymphocyte, monocyte, and eosinophil counts. Splenectomy ameliorated inflammation in ITP patients and resulted in a change in percentages of leukocytes in favor of basophils.Öğe The evaluation of the effect of vaginal delivery and aging on anal sphincteranatomy and function(Elsevıer masson, corporatıon offıce, 65 camılle desmoulıns cs50083 ıssy-les-moulıneaux, 92442 parıs, france, 2018) Cay, Mahmut; Cetin, Aymelek; Ates, Mustafa; Koleli, Isil; Senol, Deniz; Kose, Evren; Ozgor, Dincer; Simsek, Arife; Ozbag, DavutObjective. - This study was conducted to evaluate the effect of vaginal delivery and aging on anal sphincter anatomy and function. Method. - Asymptomatic thirty women were included in this prospective study. Group 1 included 10 women (age range: 18-50) who had never been pregnant. Group 2 included 10 women (age range: 18-50) who had vaginal delivery. Group 3 included 10 women over 50 who had vaginal delivery. Results. - There was no statistically significant difference between the three groups in terms of resting and squeeze pressures. It was found that sphincter thickness showed statistically significant difference between the group 1 and group 3, and also group 2 and group 3. There was not statistically significant difference between the group 1 and group 2 in terms of sphincter thickness. There was a positive correlation between the age and sphincter thickness in all groups. In terms of sphincter thickness and pressure findings there was a positive correlation between the squeeze pressure and external anal sphincter thickness only in group 3. Conclusion. - The vaginal delivery did not have a negative influence on the structure and function of the anal sphincter in asymptomatic women. However, it was found that anal sphincter thickness changed strongly in a positive manner with aging. (C) 2018 Elsevier Masson SAS. All rights reserved.Öğe Factors Affecting Strangulation and Necrosis in Incarcerated Abdominal Wall Hernias(Aves, 2020) Simsek, Arife; Kocaaslan, Huseyin; Dirican, Abuzer; Ates, MustafaBACKGROUND/AIMS The goal of the present study was to determine the factors affecting strangulation and necrosis in incarcerated abdominal wall hernias (AWHs). MATERIAL and METHODS This was a retrospective study conducted by reviewing the medical records of 44 patients who underwent surgery for incarcerated abdominal wall hernia at a university hospital between April 2009 and January 2018. RESULTS Of the 44 study patients, 28 were men and 16 were women of mean age 68.95 years. Of all, 30 patients (68.2%) had groin hernias (femoral: 7, inguinal: 23) and 14 (31.8%) had ventral hernias (incisional: 8, umbilical: 5, epigastric: 1). The intraoperative findings were strangulation in 24 (54.5%) and necrosis in 20 (45.5%) cases. Accordingly, omental resection was performed in 4, small bowel resection in 14, and large bowel resection in two patients. The hernia was repaired using a polypropylene mesh in 33 patients (of them 20 were Lichtenstein, 8 were on-lay, and 5 were plug-mesh) and without using a mesh in ten patients. The hernia was not repaired in one patient. The mean duration of hospitalization was 7.43 (range: 1-5) days. The mortality rate was 13.6%. In univariate analysis, the mortality was positively related to necrosis (p=0.045). The duration of these symptoms was the only factor that affected strangulation and necrosis. CONCLUSION The mortality rate was high in incarcerated abdominal wall hernias, while necrosis was the most significant variable associated with mortality. The duration of the symptoms was the most significant factor that affected necrosis; therefore, it is essential to perform surgical intervention within the first 24 h of admission.Öğe Living Donor Kidney Transplantation: Why Potential Donors and Recipients do not Achieve it. Malatya Algorithm(Asoc Regional Dialisis Trasplantes Renales, 2020) Simsek, Arife; Dogan, Sait Murat; Gurbu, Huseyin; Ulutas, Ozkan; Toplu, Sibel; Turgut, Asli; Yildirim, Ismail OkanIntroduction: In some countries, organ donation is not widespread enough due to medical, cultural, ethical and socioeconomic factors. Living-donor kidney transplant constitutes the main source of kidney donation. Aim: To evaluate the causes of cancellation of living-donor kidney transplant and improve the effectiveness of transplant programs. Methods: Medical records of possible donors and recipients who were evaluated for living-donor kidney transplant at a tertiary medical center between November 2010 and September 2019 were reviewed retrospectively. Results: Evaluations were performed on 364 potential donors and 338 living-donor kidney transplant recipients; 207 of the latter (61.24%) underwent living-donor kidney transplant. Immune disorders represented the majority of cancellations (38.84%). Fifty-six donors (15.38%) were rejected mainly due to renal disorders (39%). Conclusion: Timely referral of patients to transplant centers must be guaranteed in order to overcome immune problems. Transplant centers should invest in programs adequate both for their resources and for their patients: paired kidney exchange, desensitization protocols, future research, etc.Öğe Mortality after kidney transplantation: 10-year outcomes(Mexican Acad Surgery, 2022) Piskin, Turgut; Simsek, Arife; Murat-Dogan, Sait; Demirbas, Baha T.; Unal, Bulent; Yildirim, Ismail O.; Toplu, Sibel A.Objectives: In the past decade, advances in immunological therapy have increased the survival of kidney recipients and their grafts. However, it has not achieved the desired level of improvement. This study aims to reveal the mortality among kidney recipients. Methods: Medical data of the patients, who had undergone kidney transplantation (KT) between November 2010 and December 2020, were retrospectively reviewed. Inclusion criteria were adult kidney recipients, who had died. Exclusion criteria were pediatric recipients, recipients of en bloc and dual KT, recipients with missing data, and recipients with a primary non-functioning graft. The recipients were grouped according to their donor type; Group 1 (from a living donor) and Group 2 (from a deceased donor). Subgroup analyses were done for mortality by time-period post-transplant and for infectious causes of mortality. Results: Of 314 recipients, 35 (11.14%) died. Twenty-nine recipients were included in the study (Group 1: 17 and Group 2: 12). The most common cause of mortality was infection (58.6%), and the second was cardiovascular disease (CVD) (24.1%). Sepsis developed in 29.4% of infection-related deaths, while COVID-19 constituted 23.5% of infection-related deaths. Conclusion: Early diagnosis and treatment of infectious and CVD are important to improve survival in kidney recipients.Öğe The predictors of malignancy in thyroid nodules with atypia of undetermined significance or follicular lesions of undetermined significance(2020) Simsek, Arife; Kutluturk, KorayAim: This study aimed to evaluate clinical, radiological and laboratory (neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios, and mean platelet value) features that may better define the rate of malignancy in order to contribute to the management of thyroid nodules with AUS/FLUS.Material and Methods: The data of patients with histologic findings of AUS/FLUS on FNA, who underwent surgery at General Surgery Department in a tertiary care hospital between January 2012 and December 2019, were reviewed retrospectively. The patients with any other malign and/or inflammatory diseases and continued on corticosteroid therapy and/or chemotherapy were excluded.Results: The current study included 60 patients (73.3% women), who underwent surgery for 62 thyroid nodules classified as AUS/FLUS. The specimen pathology revealed a thyroid malignancy in 16 patients, including 10 patients with papillary cancer, 5 patients with micro-papillary thyroid cancer, 1 patient with minimally invasive follicular carcinoma. Ten patients had follicular adenoma. The remaining 35 patients (37 nodules) had nodular colloidal hyperplasia and/or chronic lymphocytic thyroiditis. The rates of malignancy (ROM) and neoplasia (RON) were 25.8% and 40.3%, respectively. Nearly half of the cases (41.9%) had chronic lymphocytic thyroiditis. The malignancy rate in cases with chronic lymphocytic thyroiditis was 26.9%, which was similar in cases without (25%). In multivariate analysis, only microcalcifications were found to be positively associated with malignancy (p: 0.1; [OR] 5.185; CI95% 1.4-19.18). Conclusion: Chronic lymphocytic thyroiditis may lead to overestimation of AUS/FLUS results. It was not associated with malignancy in thyroid nodules with AUS/FLUS. Inflammatory values, such as NLR, PLR and MPV, were not useful markers of malignancy. Among all variables only US findings (microcalcifications according to the current study) may be useful in risk-stratification of malignancy in thyroid nodules with AUS/FLUS.Öğe A surgical technique for secondary repair of obstetric anal sphincter injuries; sphinctero-vagino-perineoplasty(Galenos Yayincilik, 2018) Simsek, Arife; Ates, Mustafa; Dirican, Abuzer; Ozgor, DincerObjective: This study was conducted to present the preliminary results of seven patients treated with sphinctero-vagino-perineoplasty for secondary repair of obstetric anal sphincter injuries. Materials and Methods: This retrospective study was conducted on the records of seven patients who underwent secondary repair of obstetric anal sphincter injuries at the colorectal surgery unit of a tertiary care center between February 2015 and December 2017. Results: All patients with solid stool incontinence were fully recovered at postoperative month 3. The Wexner incontinence score was significantly improved (decreased from 14.12 [range: 8-20] to 2.28 [range: 1-4]). The complication rate was 85.7% (wound infection, abscess, hematoma, detachment). Conclusion: Combined repair of anal sphinchters, perineal body, superficial transverse perineal muscles, and bulbospongious muscles, which contribute to anal continence, may improve surgical outcomes in patients with obstetric anal sphincter injuries.Öğe Thigh Abscess Secondary to Intra-abdominal Pathologic Conditions: Three Cases Progressing to Necrotizing Fasciitis(H M P Communications, 2021) Simsek, ArifeIntroduction. Necrotizing fasciitis results in progressive destruction of the fascia and overlying tissue. Mortality primarily depends upon the timing of medical care and the extent of infection. Objective. This article presents a case series of thigh abscesses originating from intra-abdominal pathologic conditions and progressing to necrotizing fasciitis due to delayed diagnosis. Materials and Methods. The data concerning 3 patients with thigh abscess originating from an intra-abdominal pathologic condition and progressing to necrotizing fasciitis are presented. Results. All patients had undergone previous colorectal surgery for malignancy and were admitted to the hospital with pain concentrated in the lower back and spreading down to the buttock, sacrum and coccyx, and leg. Patients had received symptomatic therapy, including nonsteroidal anti-inflammatory drugs, and 1 patient had undergone diskectomy for a herniated disk in the lumbar region. All 3 patients subsequently developed thigh abscesses (initially treated by percutaneous and/or surgical drainage) and received antibiotic therapy. One patient underwent percutaneous drainage, and 2 patients underwent abdominal surgery to address the abdominal abscess. During the course of treatment, thigh abscesses progressed to necrotizing fasciitis, which was treated by surgical debridement with or without negative pressure wound therapy. All patients died of overwhelming sepsis. Conclusions. Thigh abscess may spontaneously arise from surrounding soft tissues, or it may be a sign of intraperitoneal, retroperitoneal, or pelvic pathologic conditions. Deep, vague pain in the back or hip area that spreads downward to the buttock and leg may be an early symptom of these pathologic conditions. Clinical suspicion may be effective in reducing mortality by enabling early surgical intervention, especially in the patient with a previous history of abdominal surgery, radiotherapy, or inflammatory or malignant disease.Öğe Transplantation Using Renal Grafts With Multiple Renal Arteries: A Putative Study on the Impact of Arterial Reconstruction Technique and Site of Implantation on Outcomes(Elsevier Science Inc, 2021) Dogan, Sait M.; Dogan, Gulec; Simsek, Cenk; Okut, Gokalp; Berktas, Bayram; Simsek, Arife; Kutluturk, KorayBackground. In the present retrospective study, we analyzed the outcomes of patients transplanted with grafts with multiple renal arteries (MRAs). Patients and Methods. In total, 89 patients were transplanted with renal grafts with MRAs from 2003 to 2018. Demographic characteristics; type of donor; warm and cold ischemia times; arterial anastomosis technique; complications; graft function at first month, first year, and last outpatient clinic visit; and patient and graft survival were all retrospectively evaluated. Results. The mean age of the patients was 40.4 +/- 13.3 years. Fifty-six patients (62.9%) were male. In total, 42 patients (47.2%) received renal grafts from living related donors. In group A (n = 24; 27%), anastomosis was performed separately to the recipient external or internal iliac arteries; in group B (n = 38; 42.7%), the secondary artery was anastomosed to the main artery in a side-to-side fashion to form a single common orifice; in group C (n = 27; 30.3%), secondary arteries were anastomosed to the main renal artery in an end-to-side fashion. Creatinine clearance at the first month was significantly lower for deceased-donor grafts compared to living-donor renal grafts (P < .05). Creatinine clearance in the first postoperative month was significantly lower in group A and creatinine clearance in the first year was significantly lower in group C (P <.05). The best survival was found for anastomosis to the internal iliac artery (P < .05). Conclusion. MRAs can be safely used and the reconstruction technique does not matter if the graft kidney's arterial supply is preserved and the internal iliac artery is chosen for anastomosis.