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Öğe Autologous hematopoietic progenitor cell mobilization and collection in adult patients presentingwith multiple myeloma and lymphoma: a position-statement from the turkish society of apheresis(tsa)(Pergamon-elsevıer scıence ltd, the boulevard, langford lane, kıdlıngton, oxford ox5 1gb, england, 2017) Vural, Filiz; Erkurt, Mehmet AliAutologous hematopoietic cell transplantation (AHCT) is a routinely used procedure in the treatment of adult patients presenting with multiple myeloma (MM), Hodgkin lymphoma (HL) and various subtypes of non-Hodgkin lymphoma (NHL) in upfront and relapsed/refractory settings. Successful hematopoietic progenitor cell mobilization (HPCM) and collection are the rate limiting first steps for application of AHCT. In 2015, alinost 1700 AHCT procedures have been performed for MM, HL and NHL in Turkey. Although there are recently published consensus guidelines addressing critical issues regarding autologous HPCM, there is a tremendous heterogeneity in terms of mobilization strategies of transplant centers across the world. In order to pave the way to a more standardized HPCM approach in Turkey, Turkish Society of Apheresis (TSA) assembled a working group consisting of experts in the field. Here we report the position statement of TSA regarding autologous HPCM mobilization strategies in adult patients presenting with MM and lymphoma. (C) 2017 Elsevier Ltd. All rights reserved.Öğe Vascular calcification is not related to serum fetuin-A and osteopontin levels in hemodialysis patients(Springer Netherlands, 2018) Ulutaş, O.; Taşkapan, MC.; Doğan, A.; Baysal, T.; Taşkapan, H.Introduction: Vascular calcification (VC) in hemodialysis (HD) patients is a sign of severe cardiovascular disease and can predict cardiovascular outcomes. Fetuin-A and osteopontin (OPN) inhibit VC. Serum fetuin-A levels are lower in patients with end-stage kidney disease (ESKD) and in those who are on chronic HD therapy. However, there are limited data concerning OPN in patients who are on dialysis. The aim of our study was to determine VC in HD patients, the relationship between VC and 25-OH-vitamin D, fetuin-A, and OPN levels, and independent predictors of VC. Materials and methods: Ninety-three patients with ESKD on HD therapy were recruited. Among these patients, 44 were male and 49 were female. The patient group was compared with a group of 20 healthy controls of similar age and sex. A plain radiograph of the hand was taken using a mammography machine for the evaluation of VC. Serum fetuin-A, OPN, and 25-OH-vitamin D levels of both patients and controls were measured. Results: VC was detected in 45 (48.4%) HD patients. When patients were compared with healthy controls, fetuin-A levels (p < 0.029) were significantly lower in patients, whereas OPN (p < 0.000) and VC (p < 0.002) were significantly higher in the patient group. Age [odds ratio (OR) 1.036], the presence of diabetes mellitus (DM) (OR 17.527), and high parathyroid hormone (PTH) levels (OR 1.002) were independent predictors of VC in a logistic regression model including the following factors: age, the presence of DM, HD duration, and serum albumin, phosphate, PTH, 25-OH-vitamin D, fetuin-A, OPN, and calcium levels. No significant correlation was found between patients with VC and patients without VC in terms of fetuin-A, OPN, and 25-OH-vitamin D levels. Conclusions: VC is a frequent sign in patients undergoing HD and is not related to serum fetuin-A and osteopontin levels. Age, the presence of DM, and high PTH levels were independent predictors of VC in patients undergoing HD. Further studies are warranted to understand the mechanism underlying and the factors contributing to VC.Öğe Recurrent gastric bezoar after roux-en-y gastric bypass for morbid obesity(Sprınger ındıa, 7th floor, vıjaya buıldıng, 17, barakhamba road, new delhı, 110 001, ındıa, 2018) Aktaş, Aydın; Sansal, Müfit; Sağlam, Kutay; Sümer, Fatih; Kayaalp, CüneytIn this paper, we described the first case of recurrent gastric bezoar after bariatric surgery. A 66-year-old patient, who had diabetes mellitus (DM) and hypertension (HT) and had LRYGB operation 3years ago, underwent the first endoscopic bezoar evacuation 26months after the operation due to the diagnosis of gastric bezoar following the examination due to the nausea-vomiting and inability to eat. The patient applied again 36months after LRYGB with similar complaints. A 3-cm gastric bezoar, which was detected with the endoscopic examination at the anastomosis site, was evacuated after disintegration. The possibility of a bezoar formation should be kept in mind in patients with Roux-en-Y gastric bypass, who complain of nausea and vomiting. The removal of the bezoar leads to a dramatic improvement in the complications. These patients should follow strictly their diets, chew their food thoroughly, take vitamin supplements, and solve their psychological problems in the postoperative period. Otherwise, gastric bezoar may recur.Öğe Recurrence and occurrence of hepatocellular carcinoma following ledipasvir and sofosbuvir treatment for chronic hepatitis C in patients with advanced liver disease: Turkish multi-center early access program(Elsevıer scıence bv, po box 211, 1000 ae amsterdam, netherlands, 2018) Aladağ, M.Öğe Stem cell mobilization kinetics in elderly patients with multiple myeloma(Pergamon-elsevıer scıence ltd, the boulevard, langford lane, kıdlıngton, oxford ox5 1gb, england, 2018) Dogu, Mehmet Hilmi; Batgi, Hikmetullah; Erkurt, Mehmet Ali; Hacioglu, SibelIn this study, we aimed to investigate whether the procedure and product kinetics differ according to age groups in advanced-age MM patients who underwent autologous HSCT. 59 patients who underwent autologous HSCT were retrospectively analyzed. Then, the patients were divided into two groups as 60-65 years and >= 65 years. It was significantly lower in >= 65 years group (p=0.008) and proportionally, the procedure duration was also significantly shortened in this group (p=0.013). Total number of collected CD34 positive stem cells was 6.20 x 106 (+/- 3.83) in 60-65 years group while it was 5.51 x 106 (+/- 2.48) in >= 65 years group with no statistically significant difference. (p=0.825). In conclusion, there was no significant difference in terms of the number of collected CD34-positive stem cells in this study that investigates the mobilization data, procedure and product kinetics, we think that successful stem cell mobilization can be performed in appropriately selected patients regardless of age. (C) 2018 Elsevier Ltd. All rights reserved.Öğe Solitary cecal diverticulitis, a rare cause of right lower quadrant pain: four cases(Kare publ, concord ıstanbul, dumlupınar mah, cıhan sk no 15, b blok 162 kadıkoy, ıstanbul, 00000, turkey, 2018) Yuksel, Adem; Civil, Osman; Colakoglu, Muhammed Kadri; Sumer, Fatih; Eruyar, Ahmet TugrulSolitary cecal diverticulitis is a rare clinical condition. Like diverticulitis in other segments of the colon, it requires immediate surgical intervention if it is causing complications. Solitary cecal diverticulitis may be misdiagnosed as acute appendicitis, since it causes right lower quadrant pain, or as a cecal tumor or inflammatory bowel disease, due to an intraoperative appearance resembling an inflammatory mass. Four patients with solitary cecum diverticulitis presenting with acute right lower quadrant pain are discussed in this report. Three patients underwent surgery with a preliminary diagnosis of acute appendicitis or cecal tumor, and 1 patient was diagnosed with cecal diverticulitis and treated medically. The treatment approach may change depending on a preoperative or intraoperative diagnosis of cecal diverticulitis. Therefore, in areas where this disease is uncommon, cecum diverticulitis should not be forgotten in the differential diagnosis of acute right lower quadrant pain or inflammatory bowel mass.Öğe Self-expandable metallic stent application for the management of upper gastrointestinal tractdisease(Aves, buyukdere cad 105-9, mecıdıyekoy, sıslı, ıstanbul 34394, turkey, 2018) Emre, Arif; Sertkaya, Mehmet; Akbulut, Sami; Erbil, Ozan; Yurttutan, Nursel; Kale, Ilhami Taner; Bulbuloglu, ErtanObjective: The aim of the present study was to share our experiences of the use of self-expandable metallic stent for the upper gastrointestinal tract disease. Material and Methods: We retrospectively reviewed the medical records of 18 patients who underwent self-expandable metallic stent implantation procedure for anastomosis stricture, anastomosis leak, or spontaneous fistula of the upper gastrointestinal tract at two different surgery clinics. Self-expandable metallic stent implantation procedures were performed while keeping the patient under sedation and the correct stent localization was verified using fluoroscopy. The stent localization and possible stent migration were checked using X-ray films taken a few days after the stenting procedure. Results: Overall, 25 self-expandable metallic stents were implanted in 18 patients (malignant, 13; benign, 5) aged between 19 and 89 years. The indications for self-expandable metallic stent implantation were as follows: malignant gastric stricture (inoperable; n=6), malignant esophageal stricture (inoperable; n=4), staple line leak (laparoscopic sleeve gastrectomy; n=4), esophagojejunostomy anastomotic leak (total gastrectomy+Roux-en-Yesophagojejunostomy; n=2), and stricture (total gastrectomy+Roux-en-Yesophagojejunostomy; n=1), and esophagopleural fistula (pulmonary tuberculosis; n=1). A favorable outcome was achieved in a single session in 15 patients, whereas more than two sessions of stenting were necessary in the remaining three patients. Among the patients who underwent esophagojejunal anastomosis (n=3), self-expandable metallic stents were successfully deployed in a single session in two patients to relieve anastomosis leak (n=1) and anastomosis stricture (n=1); the remaining patients underwent four self-expandable metallic stent implantation procedures to relieve anastomosis leak and subsequent recurrent strictures. No complications developed during the stenting procedure. Three of the four patients who developed mortality had advanced stage esophageal cancer, whereas one patient had morbid obesity and developed staple line leakage. Conclusion: Endoscopic self-expandable metallic stent implantation under fluoroscopic guidance is a low-morbidity and effective procedure for the management of advanced stage tumors of the gastrointestinal tract and the elimination of postoperative complications.Öğe Mucosal ischaemia and bowel gangrene can have different treatment options in sigmoid volvulus(WILEY, 111 RIVER ST, HOBOKEN 07030-5774, NJ USA, 2018) Uylas, Ufuk; Kayaalp, CüneytÖğe Emergency laparoscopic gastrectomy for ıntraperitoneal ruptured gastric gastrointestinal stromal tumor(Humana Press Inc., 2018) Sağlam, K.; Sümer, F.; Gökler, C.; Akatli, AN; Kayaalp, C.Öğe How should we approach to incidentally detected neuroendocrine tumor during living donorhepatectomy?(Lıppıncott wıllıams & wılkıns, two commerce sq, 2001 market st, phıladelphıa, pa 19103 usa, 2018) Akbulut, S.; Samdanci, E; Yilmaz, S.Öğe Evaluation of ıron deficiency anemia frequency as a risk factor in glaucoma(Hındawı ltd, adam house, 3rd flr, 1 fıtzroy sq, london, w1t 5hf, england, 2018) Firat, Penpe Gul; Demirel, Ersan Ersin; Dikci, Seyhan; Kuku, Irfan; Genc, OguzhanPurpose. Iron deficiency anemia is an important public health problem. Also it is considered to be a risk factor for many diseases. The study demonstrates the iron deficiency anemia frequency in glaucoma patients and compares with the normal subjects. We aimed to determine the iron deficiency anemia frequency in glaucoma patients. Methods. Prospective, controlled study in a single university hospital setting. A total of 130 normal subjects (Group 1) and 131 glaucoma patients (Group 2) were included. The erythrocytes parameters, hemoglobin, red blood cell, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin concentration, mean corpuscular hemoglobin, and red blood cell distribution width, and iron status indicators, Fe (iron), total iron binding capacity, and ferritin of the cases, in normal subjects and glaucoma patients were compared. Results. There was no statistically significant difference for the erythrocyte parameters between the groups (p >= 0.05). The number of the patients with iron deficiency anemia in both groups was similar. No statistically significant difference was found in the comparison of erythrocyte parameters and iron status indicators values according to the number of antiglaucomatous agents and visual field changes according to the presence of anemia in Group 2 (p >= 0.05). A statistically significant difference was found only in MCH when the erythrocyte parameters and iron status indicators values of the cases in glaucoma patients were compared with the glaucoma duration (p<0.05). Conclusion. The iron deficiency anemia frequency was like the normal population in glaucoma patients.Öğe C-reactive protein and platelet-lymphocyte ratio as potential tumor markers in low-alpha-fetoprotein hepatocellular carcinoma(KARGER, ALLSCHWILERSTRASSE 10, CH-4009 BASEL, SWITZERLAND, 2018) Carr, Brian I.; Karakülah, GökhanThe hepatocellular carcinoma (HCC) tumor marker alpha-fetoprotein (AFP) is only elevated in about half of the HCC patients, limiting its usefulness in following the effects of therapy or screening. New markers are needed. It has been previously noted that the inflammation markers C-reactive protein (CRP) and platelet-lymphocyte ratio (PLR) are prognostically important and may reflect HCC aggressiveness. We therefore examined these 2 markers in a low-AFP HCC cohort and found that for HCCs > 2 cm, both markers significantly rise with an increasing maximum tumor diameter (MTD). We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Youden index value for each marker, and their area-under-the-curve values for each MTD group. Patients were dichotomized into 2 groups based on the CRP and PLR from the receiver-operating characteristic curve analysis. In the logistic regression models of the 4 different MTD patient groups, CRP and PLR levels were statistically significant to estimate MTD in univariate logistic regression models of MTD groups > 2 cm. CRP and PLR were then combined, and the combination was statistically significant to estimate MTD groups of 3-, 4-, and 5-cm cutoffs. CRP and PLR thus have potential as tumor markers for low-AFP HCC patients, and possibly for screening. (C) 2018 S. Karger AG, BaselÖğe Comparison of hemoglobin levels via measured with pulse co-oximeter and with lab test during living donor hepatectomy(LIPPINCOTT WILLIAMS & WILKINS, TWO COMMERCE SQ, 2001 MARKET ST, PHILADELPHIA, PA 19103 USA, 2018) Çolak, YZ.; Bıçakçıoğlu, M.; Erdoğan, MA.; Toprak, HI.; Yılmaz, S.Öğe Clinical and pathological characteristics of non-hodgkin lymphoma patients in eastern turkey: asingle-center study(Pergamon-elsevıer scıence ltd, the boulevard, langford lane, kıdlıngton, oxford ox5 1gb, england, 2018) Dogan, N. Yildirim; Erkurt, M.; Dogan, A.; Ekinci, O.; Kuku, I.; Kaya, E.Öğe Associating liver partition and portal vein ligation for staged hepatectomy for extensive alveolar echinococcosis: First case report in the literature(BAISHIDENG PUBLISHING GROUP INC, 8226 REGENCY DR, PLEASANTON, CA 94588 USA, 2018) Akbulut, Sami; Çiçek, Egemen; Kolu, Mehmet; Şahin, Tevfik Tolga; Yılmaz, SezaiAlveolar echinococcosis (AE) is a zoonotic disease that is caused by Echinococcus multilocularis that affects liver and a variety of organs and tissues. It differs from other echinococcal disease because it shows tumor like behavior in the affected organ and tissues. The treatment of choice is concomitant medical therapy and resection with negative margins. Nevertheless, resection with the intent of negative margins (R0) may lead to serious complications such as liver failure. In the present case report, we used Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) procedure, which was defined in 2012 by Schnitzbauer et al, in a 28-year-old male patient to avoid complications of major liver resection in order to treat alveolar echinococcosis. Until now, we have not encountered any study using ALPPS procedure for the treatment of alveolar echinococcosis. In the present case report we aimed to show that ALPPS procedure can be safely performed for margin-negative resection of primary or recurrent AE that shows a tumor like behavior. It is our opinion that this procedure should be performed in centers that have expertise and sufficient technical capacity to perform liver transplantation and advanced liver surgery.Öğe Assessment of the relationship between clinical and histopathological features in cases of thyroidectomy(EDIZIONI LUIGI POZZI, VIA PANAMA 68, 00198 ROME, ITALY, 2018) Akbulut, SamiAim: The aim of this study is to evaluate the relationship between clinical parameters and ultimate histopathologic features of patients underwent thyroid surgery. METHOD: Demographic and clinicopathologic parameters of patients who underwent thyroid surgery for benign or malignant disease in our clinic between June 2006 and March 2014 were retrospectively reviewed. Pearson's Chi-Square, Independent Sample T test, ROC Curve and Youden J Index were used to investigate whether there was any relationship between the clinical parameters and permanent histopathologic features of patients. RESULTS: A total of 3059 patients (Benign: 2727; Malign: 332) aged between 15 and 90 years were reviewed. The patients age was higher in malign group (mean +/- SD: 468 +/- 4.2) than benign group (mean +/- SD: 43.7 +/- 12.9 yr) and this difference was statistically significant (p <0.001). The nodule diameter (mean +/- SD: 30.8 +/- 13.5 mm) was greater in malign group than the benign group (mean +/- SD: 28.3 +/- 13.4 mm) and this difference was statistically significant (p = 0.002). The sensitivity and specificity rates of the most appropriate cut-off point (> 26 mm) for the nodule size were 60% and 49.05%, respectively. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of FNAB were calculated as 4.17 %, 100 %, 100 %, 89.96% and 90 %, respectively. CONCLUSION: This study showed that higher age and greater nodule diameter (> 26 mm) are associated with malignancyÖğe Carfilzomib experience in relapsed/refractory multiple myeloma: a single-center experience(Tubıtak scıentıfıc & technıcal research councıl turkey, ataturk bulvarı no 221, kavaklıdere, ankara, 00000, turkey, 2018) Uysal, Ayse; Akad Soyer, Nur; Ozkan, Melda; Sahin, Fahri; Vural, Filiz; Tobu, Mahmut; Tombuloglu, Murat; Saydam, GurayBackground/aim: Carfilzomib (CFZ) is a new-generation proteasome inhibitor with significant activity in relapsed or refractory multiple myeloma (R/R-MM). We have retrospectively evaluated R/R-MM patients who were treated with CFZ plus dexamethasone. Materials and methods: Twenty-one R/R-MM patients who were treated with CFZ plus dexamethasone between October 2013 and January 2016 were screened. The patients were followed until March 2016 after CFZ treatment. Results: Ten (47.6%) of the patients were female and 11 (52.4%) of them were male. The median age was 62 (47-76) years. The median number of prior treatment lines was 3 (2-7). The median number of administered cycles of treatment for CFZ was 4 (1-10). The median overall response rate was 26.3%. The most common hematological adverse events were anemia and thrombocytopenia (38%). The most common nonhematological adverse event was fatigue (71.4%). One patient died because of a cerebrovascular event and 1 patient died because of pneumonia during the treatment period. The median duration of response rate and time to next therapy were 8 (7-9) and 3 (2-16) months, respectively. The median overall survival was 8 (0.5-33) months. Conclusion: Despite the small number of patients, our results suggest that CFZ provides acceptable responses in heavily pretreated R/R-MM patients.Öğe Analysis of risk factors affecting the development of infection in artificial vascular grafts used for reconstruction of middle hepatic vein tributaries in LDLT(LIPPINCOTT WILLIAMS & WILKINS, TWO COMMERCE SQ, 2001 MARKET ST, PHILADELPHIA, PA 19103 USA, 2018) Koç, C.; Akbulut, S.; Işık, B.; Yoloğlu, S; Yılmaz, S.Öğe A nation-wide survey of patients with homozygous familial hypercholesterolemia phenotypeundergoing ldl-apheresis in turkey (a-hıt 1 registry)(Elsevıer ıreland ltd, elsevıer house, brookvale plaza, east park shannon, co, clare, 00000, ıreland, 2018) Kayikcioglu, Meral; Tokgozoglu, Lale; Yilmaz, Mehmet; Kaynar, Leylagul; Aktan, Melih; Durmus, Rana Berru; Gokce, CumaliBackground and aims: Homozygous familial hypercholesterolemia (HoFH) is a genetic condition characterized by lethally high levels of low-density lipoprotein cholesterol (LDL-C) from birth, and requires rapid and aggressive intervention to prevent death due to coronary heart disease and/or atherosclerosis. Where available, lipoprotein apheresis (LA) is the mainstay of treatment to promote survival. Methods: A-HIT1 registry was conducted with the aim of providing insight to the real-life management of HoFH patients undergoing LA in Turkey, where LA procedures are fully reimbursed and widely available. Participating centers provided patient information, including family history, treatment patterns and relevant laboratory values, via a standard questionnaire. Results: The study evaluated 88 patients (mean age: 27 +/- 11 years, 41 women) in 19 centers. All patients were receiving regular LA with a clinical diagnosis of HoFH. Mean age at first symptom disease was 10 +/- 10 years, and at diagnosis it was 12 +/- 11 years; 74.7% were diagnosed before age 15 years; and only 31% before the age of 7. First referral of most patients was to pediatricians. Early onset coronary artery disease was present in 57.8% of patients. Mean age at first LA was 21 +/- 12 years. Only 11 (12.5%) patients were undergoing LA weekly. Mean frequency of apheresis sessions was 19 +/- 13 days. For the last four LA sessions, LDL-C levels reached the target in only in 5.7% of patients. Conclusions: Diagnosis of HoFH is delayed, and LDL targets are not reached. LA frequencies are not optimal. Urgent attention is needed to support the survival of patients with HoFH. (c) 2018 Elsevier B.V. All rights reserved.Öğe A multicenter experience of thrombotic microangiopathies in turkey: the turkish hematologyresearch and education group (threg)-tma01 study(Pergamon-elsevıer scıence ltd, the boulevard, langford lane, kıdlıngton, oxford ox5 1gb, england, 2018) Tekgunduz, Emre; Yilmaz, Mehmet; Erkurt, Mehmet Ali; Kiki, Ilhami; Kaya, Ali Hakan; Kaynar, LeylagulThrombotic microangiopathies (TMAs) are rare, but life-threatening disorders characterized by microangiopathic hemolytic anemia and thrombocytopenia (MAHAT) associated with multiorgan dysfunction as a result of microvascular thrombosis and tissue ischemia. The differentiation of the etiology is of utmost importance as the pathophysiological basis will dictate the choice of appropriate treatment. We retrospectively evaluated 154 (99 females and 55 males) patients who received therapeutic plasma exchange (TPE) due to a presumptive diagnosis of TMA, who had serum ADAMTSI3 activity/antiADAMTS13 antibody analysis at the time of hospital admission. The median age of the study cohort was 36 (14-84). 67 (43.5%), 32 (20.8%), 27 (17.5%) and 28 (18.2%) patients were diagnosed as thrombotic thrombocytopenic purpura (TTP), infection/complement-associated hemolytic uremic syndrome (IA/CAHUS), secondary TMA and TMA-not otherwise specified (TMA-NOS), respectively. Patients received a median of 18 (1-75) plasma volume exchanges for 14 (153) days. 81 (52.6%) patients received concomitant steroid therapy with TPE. Treatment responses could be evaluated in 137 patients. 90 patients (65.7%) achieved clinical remission following TPE, while 47 (34.3%) patients had non-responsive disease. 25 (18.2%) non-responsive patients died during follow-up. Our study present real-life data on the distribution and follow-up of patients with TMAs who were referred to therapeutic apheresis centers for the application of TPE. (C) 2018 Elsevier Ltd. All rights reserved.
