Adam Uslu

Izmir Bozkaya Research and Education Hospital, Ismir, İzmir, Turkey

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Publications (44)53.43 Total impact

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    Erhan Tatar · Adam Uslu · Ahmet Aykas · Tamer Sahin
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    ABSTRACT: HLA typing is the cornerstone of kidney transplantation. Here, we present two full-match kidney transplants with early uneventful course but late c4d-mediated rejection and recurrent pauce-immune necrotizing crescentic glomerulonephritis, as each in one. Case 1: A 49 years old Caucasian female patient, received a six-matched cadaveric kidney and had nonspecific changes in 6th and 12th month protocol biopsies. The first and third year serum creatinin value was 1.8 and 2.0 mg/dl. Immunosuppressive drugs were gradually reduced due to recurrent infections at the 3rd year. She admitted with allograft dysfunction and serum creatinin 5.8 mg/dl. Kidney biopsy of graft dysfunction at the 4th year was diagnosed C4d-mediated rejection. Case 2: A 61 years old Caucasian female patient received a HLA-identical kidney 8.5 years ago from her sibling had a primary vasculitis mediated necrotizing crescentic glomerulonephritis. Her serum creatinin values in the 1st and 8th years were 1.3 and 1.7 mg/dl. In recent years, immunosuppressive dosage has been gradually reduced due to recurrent lower respiratory tract infections. She admitted with hematuria, purpuric rash, dyspnea. and serum creatinin 5.7 mg/dl. Renal biopsy revealed necrotizing crescentic glomerulonephritis. The patient was treated with pulse steroid, double filtration plasmapheresis and rituximab. She is being followed with a functioning graft and with serum creatinin 2.0 mg/dl. In case of recurrent infection, immunosuppressive drugs should be modified cautiously even in patients with full-match grafts to prevent late acute rejection or recurrence of the primary disease.
    International Journal of Clinical and Experimental Medicine 06/2015; 8(6). · 1.42 Impact Factor
  • A Aykas · A Uslu · C Şimşek
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    ABSTRACT: Contrary to TV programs projecting awareness about organ donation in society, concrete evidence exists about adverse influence of negative broadcasts on organ donation rates. We sought to determine the effect of mass media on public opinion toward organ donation and the efficacy of public campaigns and novel social media attempts on donation rates. We conducted a systematic review of relevant literature and national campaign results. Hoaxes about brain death and organ transplantation adversely affect organ donation rates in both Western and Eastern societies. Scientifically controversial and exaggerated press conferences and institutional advertisements create mistrust in doctors, thus reducing organ donation. The overall effect of public education campaigns in promoting organ donation is a temporary 5% gain. Increments in organ donation rates is expected with novel applications of social media (Facebook effect). Communication, based on mutual trust, must be established between medicine and the media. Continuing education programs with regard to public awareness on organ donation should be conducted over social media. Copyright © 2015 Elsevier Inc. All rights reserved.
    Transplantation Proceedings 05/2015; 47(4):1070-2. DOI:10.1016/j.transproceed.2014.09.182 · 0.95 Impact Factor
  • A Aykas · A Uslu · S M Doğan
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    ABSTRACT: In Turkey, donation rates remained low despite the efforts of the Religious Affairs Supreme Council. We sought to determine theological perspectives and behaviors of clergy and theology students toward organ donation. We conducted a systematic review and metaanalysis of observational studies. There were 2154 participants. Eighty-two percent stated Islam allows organ donation. Nineteen had organ donation card (<1%). Fifty-four percent were reluctant to donate organs themselves, 56% lacked sufficient knowledge. Twenty percent referred to school education and periodicals as the source of information. Sixty-nine percent were act as opinion leaders for organ donation. In curriculums of the Faculties of Theology, organ donation as a separate topic has not been found. No articles regarding organ donation have been published in theology journals in their 60-year publication history. A discrepancy exists between the resolutions of the Board of Religious Affairs and attitudes of clergy toward organ donation in Turkey. Theology faculties seem not to pay specific attention to this issue. The Directorate of Religious Affairs and the faculty of theology should meet at a common point immediately in terms of training programs and continuing education with strict audit in context of organ transplantation and donation. Copyright © 2015 Elsevier Inc. All rights reserved.
    Transplantation Proceedings 05/2015; 47(4):1066-9. DOI:10.1016/j.transproceed.2014.09.183 · 0.95 Impact Factor
  • Turkish Journal of Surgery 04/2015; DOI:10.5152/UCD.2015.3015
  • Turkish Journal of Surgery 04/2015; DOI:10.5152/UCD.2015.2822
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    Erhan Tatar · Adam Uslu · Cenk Simsek · Enver Vardar
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    ABSTRACT: Objectives: There has been no improvement in longterm graft survival rates in renal transplant recipients during the past decade. We evaluated patients who underwent renal transplant and experienced late (≥ 3 years) antibody-mediated rejection, after an immunologically uneventful course early after transplant. Materials and Methods: Between 2003 and 2010, twenty-one of 312 patients who had kidney transplants at our center were diagnosed with antibody-mediated rejection according to the Banff 97 criteria. The patients’ information from their files was retrospectively evaluated. Results: Of the 7 male and 3 female patients (mean age, 33 ± 11, range, 18-52 y), 5 received deceased donor kidneys, and 5 had living-related donor kidneys. The average basal and third-year serum creatinine levels were 1.24 ± 0.31 mg/dL and 1.36 ± 0.43 mg/dL (P < .001). The mean follow-up until rejection was 64 ± 23 months (range,37-101 mo). Medical history revealed recurrent bacterial infections in 4 , cytomegalovirus infection and post-transplant diabetes each in one patient and drug withdrawal in 2 patients. For this reason, maintenance immunosuppressive therapy was reduced and/or replaced. In kidney biopsies, 6 patients had acute findings of antibody-mediated rejection, and chronic features were predominant in 4 cases. Renal function improved in 8 patients after treatment, but rejection remained progressive in 2 patients. Three patients lost their grafts during follow-up. Noncompliance was the cause of graft loss in 2 cases. In the remaining 7 patients, the mean follow-up after rejection treatment was 18 ± 14 months (range, 6-48 mo), and the average serum creatinine level was 3.0 ± 0.93 mg/dL (range,2.3-4.7) . Conclusions: Late antibody-mediated rejection can emerge soon after the modification of immunosuppressive drug dosages and may be responsible for graft dysfunction or loss.
    Experimental and clinical transplantation: official journal of the Middle East Society for Organ Transplantation 04/2015; (2015) Suppl 1(Suppl 1):259-262. DOI:10.6002/ect.mesot2014.P67 · 0.80 Impact Factor
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    ABSTRACT: Monitoring of allograft function entails methods more accurate than serum creatinin and creatinin-based GFR equations (eGFR). This prospective trial aimed at investigating the diagnostic accuracy of creatinin and cystatin-C based eGFR with measured GFR (mGFR) and compared them with graft fibrosis detected by protocol biopsies (PBx). Forty-four kidney transplant recipients were enrolled. PBx were obtained post-engraftment and at 6(th) and 12(th) months. GFR measured by Tc99m-DTPA at 3(th) , 6(th) and 12(th) months after transplantation. Significant correlation existed between eGFR and mGFR at 3, 6, and 12 months (p<0.0001). Cystatin-C based Hoek and Larsson equations had the lowest bias and highest accuracy. The sum of interstitial fibrosis and tubular atropy score increased from implantation to 6(th) and 12(th) month (0.52±0.79, 0.84±0.88, 1.50±1.35). This was accompanied by reduction of mGFR from 54.1±15.2, to 49.9±15.2 and 46.8±16.5 ml/min/1.73m(2) , while serum creatinin, cystatin-C, and eGFR remained stable. Neither creatinin nor cystatin C based GFR equations are reliable for detecting insidious graft fibrosis. In the first year after transplantation, mGFR, with its' best proximity to histopathology, can be used to monitor allograft function and insidious graft fibrosis. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Transplant International 02/2015; 28(5). DOI:10.1111/tri.12534 · 3.16 Impact Factor
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    ABSTRACT: Hashimoto's thyroiditis (HT) is considered to be a risk factor for the formation of papillary carcinoma. The association of IgG4-related sclerosing disease with tumor is reported to be as sporadic cases in many organs. In this study, it was intended to re-classify the HT diagnosed cases on the basis of the existence of IgG4 (+) plasma cells; to investigate the clinicopathologic and histopathologic features of the both groups; and in addition, to evaluate the papillary carcinoma prevalence in IgG4 (+) and IgG4 (−) HT cases as well as the prognostic parameters between these groups. Totally 59 cases between the years 2008–2013, 29 of which contain Hashimoto thyroiditis diagnosis in total thyroidectomy materials, and 30 of which contain the diagnosis of HT+papillary carcinoma, were included in the study. The materials were immunohistochemically applied IgG and IgG4; and the cases were classified in two groups as IgG4-positive HT and IgG4-negative HT containing cases, on the basis of IgG4/IgG rate. All histopathologic and clinicopathologic parameters between these two groups, as well as their association with papillary carcinoma were investigated. Thirty eight (64.4%) of total 59 cases were NonIgG4 thyroiditis, and 21 (35.5%) were IgG4 thyroiditis. Tumors were detected in 14 (36.8%) of the NonIgG4 thyroiditis cases, and in 16 (76.1%) of the IgG4 thyroiditis cases. The association of IgG4 thyroiditis with tumor is statistically significant (p < 0.004). Multifocality was found to be at a higher rate in IgG4 thyroiditis cases. Perithyroidal extension was detected in six of the cases with tumor, and five of the six cases were IgG4 thyroiditis cases. The association of IgG4 (+) HT cases with increased papillary carcinoma prevalence is suggestive of that IgG4 (+) plasma cells can play a role in carcinogenesis in papillary carcinomas developed in HTs, without a chronic sclerosing ground. In addition, although the number of cases is limited, the high-association of IgG4 (+) plasma cells with adverse prognostic parameters such as multifocality and extrathyroidal extension is attention-grabbing. To render these possibilities evaluable, studies to be carried out with larger case series are needed.
    Apmis 08/2014; 122(12). DOI:10.1111/apm.12297 · 1.92 Impact Factor
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    ABSTRACT: Extraskeletal Ewing's Sarcoma/Primitive Neuroectodermal Tumor presenting as a breast mass is uncommon. It may pose a diagnostic challenge. In order to increase awareness and identify potential diagnostic pitfalls, we report a 24 year-old woman extraosseous Extraskeletal Ewing's Sarcoma/Primitive Neuroectodermal Tumor arising in the breast.
    01/2014; 40(1):75-77. DOI:10.12865/CHSJ.40.01.15
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    ABSTRACT: Extramedullary plasmacytoma is a rare cause of nonobstructive colonic masses, which is often disregarded. Plasmacytoma is a neoplastic proliferation of plasma cells; when systemic involvement occurs, the disease is named multiple myeloma. Extramedullary plasmacytomas comprise 4% of all plasma cell tumours and occur mainly in the upper respiratory tract; gastrointestinal system involvement is rare. In this case we describe a rare cause of gastrointestinal system mass: extramedullary plasmacytoma involving the left colon.
    Turkish Journal of Surgery 01/2014; 30(4):231-3. DOI:10.5152/UCD.2013.45
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    ABSTRACT: Background: Sentinel lymph node biopsy is a standard method for the evaluation of axillary status in patients with T1-2N0M0 breast cancers. Aims: To determine the prognostic significance of primary tumour-related clinico-histopathological factors on axillary and non-sentinel lymph node involvement of patients who underwent sentinel lymph node biopsy. Study design: Retrospective clinical study. Methods: In the present study, 157 sentinel lymph node biopsies were performed in 151 consecutive patients with early stage breast cancer between June 2008 and December 2011. Results: Successful lymphatic mapping was obtained in 157 of 158 procedures (99.4%). The incidence of larger tumour size (2.543 +/- 1.21 vs. 1.974 +/- 1.04), lymphatic vessel invasion (70.6% vs. 29.4%), blood vessel invasion (84.2% vs. 15.8%), and invasive lobular carcinoma subtype (72.7% vs. 27.3%) were statistically significantly higher in patients with positive SLNs. Logistic stepwise regression analysis disclosed tumour size (odds ratio: 1.51, p=0.0021) and lymphatic vessel invasion (odds ratio: 4.68, p=0.001) as significant primary tumour-related prognostic determinants of SLN metastasis. Conclusion: A close relationship was identified between tumour size and lymphatic vessel invasion of the primary tumour and axillary lymph node involvement. However, the positive predictive value of these two independent variables is low and there is no compelling evidence to recommend their use in routine clinical practice.
    Balkan Journal of Medical Genetics 12/2013; 30(4):415-21. DOI:10.5152/balkanmedj.2013.9591 · 0.17 Impact Factor
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    ABSTRACT: In this retrospective analysis, the clinicopathological features and pattern of metastatic spread of invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC), and mixed ductal/lobular carcinoma (MDLC), together with the type and outcome of surgical intervention, were comparatively evaluated. A total of 633 breast cancer patients with histopathological subtype IDC, ILC or MDLC were included in the study. The mean age was 52.6 ± 12.7 years. Follow-up period ranged between 0 and 33 (median 6.0) years. The groups were compared with respect to age, tumor size, nodal involvement, stage, hormonal therapy, multicentricity, multifocality, bilaterality, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2)/neu, p53, and Ki67 expression, disease-free survival (DFS) and overall survival (OS) rates, and surgical approach. The distribution of patients was as follows: IDC 508 (80.3 %), ILC 78 (12.3 %), MDLC 47 (7.4 %). Among the parameters evaluated, statistically significant differences were observed in mean tumor size (IDC 2.5 ± 1.98 cm, ILC 3.0 ± 1.8 cm, MDLC 3.2 ± 2.4 cm), advanced T stage (T3 + T4) at diagnosis (IDC 14.7 %, ILC 21.4 %, MDLC 25.6 %), N stage (N0 was dominant in IDC and ILC; N3 was dominant in MDLC), tumor-node-metastasis (TNM) stage (stage II was dominant in IDC and ILC; stage III was dominant in MDLC), HER2/neu expression (IDC 23.8 %, ILC 11.8 %, MDLC 21.4 %), and frequency of bone metastasis (IDC 14.3 %, ILC 17.9 %, MDLC 25.5 %). MDLC-type tumors have different histopathological characteristics and are often diagnosed at advanced stage. However, their survival outcomes do not vary significantly from ILC and IDC.
    Breast Cancer 08/2013; DOI:10.1007/s12282-013-0489-8 · 1.51 Impact Factor
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    ABSTRACT: Recurrent episodes of venous thrombosis have been closely correlated with JAK2 V617F mutation. Upto date, JAK2 gene mutation has not been defined as a prothrombic risk factor in renal transplant recipients. Herein; we present a case of portosplenic vein thrombosis in a primary renal transplant recipient with JAK2 V617F mutation who had no history of prior venous thromboembolism or thrombophilia. A 59 year old female caucasian patient with primary kidney transplant admitted with vague abdominal pain at left upper quadrant. Abdominal doppler ultrasound and magnetic resonance imaging angiography demonstrated splanchnic vein thrombosis (SVT). The final diagnosis was SVT due to MPD (essential thrombocytosis, ET) with JAK2 V617F mutation. After 3 months of treatment with warfarin (>=5 mg/day, to keep target INR values of 1.9-2.5), control MRI angiography and doppler USG demonstrated partial (>%50) resolution of thrombosis with recanalization of hepatopedal venous flow. The patient is still on the same treatment protocol without any complication. JAK2 V617F mutation analysis should be a routine procedure in the diagnosis and treatment of kidney transplant patients with thrombosis in uncommon sites.
    BMC Nephrology 07/2013; 14(1):161. DOI:10.1186/1471-2369-14-161 · 1.52 Impact Factor
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    ABSTRACT: Aims and background. Sentinel lymph node biopsy has been accepted as a standard procedure for early stage breast cancer. In this retrospective analysis, the results obtained with different methodological approaches using radiocolloid with or without blue dye were examined. Methods. A total of 158 sentinel lymph node biopsies were performed in 152 patients. Group A (85 patients) underwent lymphatic mapping using a combination of periareolar intradermal radiocolloid and subareolar blue dye injections. Group B (73 patients) underwent only periareolar intradermal radiocolloid injection. One large tin colloid and two small radiocolloids (nanocolloid of serum albumin -NC- and colloidal rhenium sulphide -CS-) were used. Results. Successful lymphatic mapping was attained in 157 of 158 procedures (99.4%). Radiocolloids localized sentinel lymph nodes in 99.4% and blue dye in 75.3% of the cases. The number of sentinel lymph nodes removed was greater in nanocolloid and colloidal rhenium sulphide groups (P ≤0.05). Among 60 metastatic sentinel lymph nodes, frozen section analysis using hematoxylin and eosin staining failed to detect 1 macro- and 10 micrometastasis. Radiocolloid uptake was higher in sentinel lymph nodes accumulating blue dye (1643 ± 3216 counts/10 sec vs 526 ± 1284 counts/10 sec, P <0.001). Higher count rates were obtained by using larger sized colloids (median and interquartile range: tin colloid, 2050 and 4548; nanocolloid, 835 and 1799; colloidal rhenium sulphide, 996 and 2079; P = 0.01). Only 2 extra-axillary sentinel lymph nodes were visualized using periareolar intradermal injection modality. Conclusions. Radiocolloids were more successful than blue dye in sentinel lymph node detection. More sentinel lymph nodes were harvested with small colloids, but different sized radiocolloids were similarly successful. Sentinel lymph nodes having higher radiocolloid uptake tended to accumulate blue dye more frequently. Sentinel lymph nodes manifested higher count rates when a larger colloid was used. Frozen section was very successful in detecting macrometastatic disease in sentinel lymph nodes, but the technique failed in most of the micrometastates.
    03/2013; 99(2):149-53. DOI:10.1700/1283.14184
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    ABSTRACT: The primary objective of this study was to clarify the influence of histotype on the outcome of D1/D2 gastrectomized patients with pathologically proven R0 resection. The secondary objective was to demonstrate overall survival (OS), disease-free survival (DFS), and locoregional recurrence rates following standard curative surgery. All patients had either pure signet-ring cell carcinoma (SRCC)/poorly differentiated adenocarcinoma (PDC) or moderately differentiated adenocarcinoma (MDC) of the stomach, preoperative radiologic evidence of locoregional disease, and no history of neoadjuvant therapy. Standards of surgical treatment were essentially based on the guidelines of the Japanese Research Society for the Study of Gastric Cancer. Between October 2003 and August 2010, seventy-eight patients were enrolled. Twenty-three patients underwent D1 dissection and 55 underwent D2 dissection. The OS and DFS rates were 33.2 ± 5.9 months versus 31.5 ± 4.3 months (p = 0.81) and 28.9 ± 5.6 months vs. 29.3 ± 4.4 months (p = 0.96) in the MDC and SRCC/PDC groups, respectively. Neither the extent of the operation (D1 vs. D2, p = 0.79) nor the histopathologic subtype of the primary tumor (MDC vs. SRCC/PDC, p = 0.91) influenced the OS and DFS. Multivariate logistic regression analysis disclosed pathologic stage (pTNM) as the only significant prognostic determinant of OS (p = 0.007) and DFS (p = 0.0003). Properly performed D1 and D2 dissection in our series resulted in a notable (6.4%) locoregional failure rate. In spite of the satisfactory locoregional control achieved by D1 and D2, there was no improvement in the survival figures of stage IIIA-B and IV gastric cancer patients. The histopathologic subtype of the primary tumor disclosed merely a statistical trend on the outcome measures of gastric cancer after curative surgery.
    Digestion 07/2012; 86(1):67-73. DOI:10.1159/000338298 · 2.03 Impact Factor
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    ABSTRACT: Neurologic problems have a major effect on the survival and quality of life in renal transplant recipients. This study sought to review the incidence and character of neurologic complications after renal transplant. Medical records of 319 renal transplant recipients admitted to the Transplant Outpatient Clinic were reviewed retrospectively for neurologic complications. Of the 319 transplant recipient patients reviewed, 124 patients (39%) were women and 193 patients (61%) were men. The mean patient age was 41 ± 11 years, and the transplanted kidney was received from deceased donors in 161 patients (51%) and living donors in 158 patients (49%). There were 50 patients (16%) who had neurologic complications, most commonly herpes zoster infection associated with immunosuppressive medication. Only 1 patient, who had glioblastoma multiforme, died. Treatment included corticosteroids in 296 patients (93%) and calcineurin inhibitors (including tacrolimus) in 111 patients (35%). Neurologic complications are common after renal transplant. Most complications are associated with immunosuppressive medications.
    06/2012; 10(3):243-6. DOI:10.6002/ect.2011.0130
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    ABSTRACT: This study evaluates the effect of enteric-coated mycophenolate sodium (EC-MPS) on patient and graft survivals, the incidence of rejection episodes, and graft function among de novo and maintenance renal transplant recipients. This open label, multicenter, prospective, post-marketing observational study of 470 renal transplantation patients at 23 centers in Turkey includes 331 de novo patients whose mean age was 29.6 ± 13.2 years and 139 maintenance patients of 34.0 ± 13.0 years. The latter subjects had EC-MPS substituted for mycophenolate mofetil or added to the immunosuppressive therapy. Patients were followed for 12 months to evaluate graft function and treatment failure. The most common primary disease requiring transplantation was glomerulonephritis (24.3%). De novo and maintenance groups were similar in terms of overall rejection rates and acute rejection incidence whereas chronic rejection was evident only among the latter cohort (P < 0.001). Time to an acute rejection episode was significantly longer among maintenance rather than de novo patients (220.8 versus 18.7 months; P = 0.015). Overall, 12 and 36 month survival rates were 91.6 ± 1.3% and 86.9% ± 0.3% among subjects experiencing acute rejection versus 99.7 ± 0.2% and 50.3% for those displaying chronic rejection. Among maintenance group no deterioration of renal function was observed after conversion from mycophenolate mofetil to EC-MPS. The incidences of leukopenia, new-onset anemia, or liver dysfunction were similar between de novo and maintenance patients. Gastrointestinal discomfort was more prevalent among the maintenance group, reaching a significant level at the fourth visit (P < 0.05). EC-MPS dose reduction was required in only 16.7% of patients at visit, it was more frequent among the de novo group (17.9 versus 13.8%). EC-MPS was an effective adjunctive therapy for de novo as well as maintenance renal transplant recipients in the Turkish population due to a relatively low incidence of dose reductions necessitated by adverse events as well as with an increased likelihood of long-term graft survival.
    Transplantation Proceedings 04/2011; 43(3):826-32. DOI:10.1016/j.transproceed.2010.11.020 · 0.95 Impact Factor
  • A Uslu · A Nart
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    ABSTRACT: The primary objective of this review was to clarify the efficacy of commercially available and tested agents for the treatment of first acute rejection episode (ARE) and particularly a steroid-resistant rejection (SRR) seeking to provide generalizable level I evidence for clinical practice. The inclusion criteria were restricted to prospective randomized trials (PRT) that (1) reported outcomes of first, biopsy-proven ARE based on Banff 97 diagnostic criteria; (2) excluded borderline changes that were not considered to be acute rejection; (3) included protocol biopsies confirming reversal or recurrence of rejection; (4) utilized calcineurin inhibitor-based double or triple baseline immunosuppression prior to and after the reversal of ARE and possessed Jadad scores at least 3 upon final assessment by both reviewers. Two PRTs compared rabbit-anti-thymocyte globulin (ATG) to low-dose corticosteroids or OKT3, following a first rejection episode in renal transplantation patients. The analysis of pooled data revealed 25% and 31% absolute risk reduction (ARR), in regard to initial treatment failure and recurrence of ARE, respectively, in favor of ATG treatment. Treatment morbidity showed similar long-term graft and patient survival rates in both arms. Three optimal trials compared the efficacy of various polyclonal or polyclonal versus monoclonal (OKT3) antibodies for the treatment of SRR. The estimated efficacy potential of rabbit-ATG appeared to be 11,4% greater than horse-ATG with particularly Banff grade II but also grade III patients demonstrating the greatest benefit. Among two PRTs comparing ATG to OKT3, ATG tended to show better graft function, fewer recurrent rejections (9% ARR), fewer graft losses due to immunologic failure (7% ARR), and better tolerance. The incidence of malignant tumors was similar in both treatment arms. In conclusion, thymoglobulins, especially those of rabbit origin, displayed greater efficacy for the treatment of ARE and SRR. Application of CD3 monitoring using flow-cytometry provided a reliable guid to prevented excessive immunosuppressive administration.
    Transplantation Proceedings 04/2011; 43(3):841-6. DOI:10.1016/j.transproceed.2010.11.018 · 0.95 Impact Factor
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    ABSTRACT: A prospective study in 82 consecutive patients with mid- and distal rectal adenocarcinomas having specific histology and tumor stage was conducted to asses impact of curative surgery. Patients with moderately differentiated adenocarcinoma (MDAC) with or without mucinous differentiation underwent curative resection. Forty patients were in Stage B1-B2 and 42 patients were in Stage C1-C2. Surgery options were: (1) Abdominoperineal resection (APR) for tumors located within 6cm of the anal verge and (2) Tumor specific mesorectal excision (TSME) and low anterior anastomosis (LAA) for those located between 6 to 12cm from the anal verge. The primary endpoints were overall (OS) and disease-free survival (DFS). Patients in Stage B1-B2 had a local failure rate of 15% compared with 31% of patients in stage C1-C2 (p=0.18). Satellite tumor nodule formation (STN) was observed in one patient in B group and in 13/42 (31%) of Stage C tumors. LR did not vary with mucinous differentiation. Only lymph node involvement (N1-3) (p=0.028) had an impact on locoregional recurrence and both lymph node involvement and STN formation influenced disease-free survival (p=0.008). Preoperative precise detection of Stage C rectal adenocarcinomas is of utmost importance to facilitate the implementation of therapies for downstaging and for better local and distant control following surgery.
    Hepato-gastroenterology 01/2011; 58(106):388-94. · 0.91 Impact Factor
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    ABSTRACT: Cholemia and bacterial translocation with portal endotoxemia are integral in the pathogenesis of obstructive jaundice (OJ). There is sufficient experimental data about hemodynamic and histopathological consequences of OJ. In contrast, pathological information of renal changes in patients with OJ is still lacking. Therefore; the primary objective of this prospective study is to show the specific histopathological changes in kidneys of patients with short-term biliary tract obstruction receiving a standard perioperative medical treatment protocol. Twenty consecutive patients with biliary obstruction were included in the study. Fluid replacement, prevention of biliary sepsis, and portal endotoxemia were mainstays of the perioperative treatment protocol. Fluid and electrolyte balance was maintained by twice daily body weight calculations, central venous pressure, and mean arterial pressure monitoring. Renal function was assessed by glomerular filtration rate estimation by modification of diet in renal disease-7 formula. Kidney biopsy evaluation was focused on tubular changes, thrombotic microangiopathy, endothelial damage, and peritubular capillary (PTC) dilatation with or without C4d staining. Fresh frozen sections were evaluated with immunofluorescence microscopy for glomerular IgG, IgA, IgM, C3, and C1q staining. The mean duration of OJ was 15.5 ± 1.4 days. Body weight increased before surgery through volume expansion (P = 0.001). All patients have shown mean arterial pressure ≥ 70 and ≤ 120 mmHg and renal function was very well preserved in all but one subject during the perioperative period. Despite those favorable figures, dilatation of peritubular venules and acute tubular necrosis were shown synchronously in all cases. C4d staining in PTC and arterioles and thrombotic microangiopathy were entirely absent in the study group. Immune complex deposits in PTCs and in glomeruli were not detected. Three patients had isolated glomerular C4d deposition without accompanying thrombotic microangiopathy and IgG, IgA, IgM, C3, and C1q staining of glomerular capillaries in I immunofluorescence microscopy. This study is the first in the literature to address the histopathological changes that occur in humans with short-term biliary obstruction. Acute tubular necrosis and venous dilatation was observed in all biopsies, without exception, despite the maintenance of strict volume control in all patients. The adequacy of volume control may not be implicated in those results; rather a possible mechanism related to untrapped endotoxin in the gut lumen or systemic circulation might lead to prolonged PTC dilatation and hypoperfusion with synchronous acute tubular necrosis. Absolute recovery of renal function in all patients and the demonstration of solitary acute tubular necrosis with no microvascular-glomerular-interstitial inflammation or injury, suggests that the perioperative treatment regime in this study is fairly efficacious in short-term OJ.
    European journal of gastroenterology & hepatology 09/2010; 22(12):1458-65. DOI:10.1097/MEG.0b013e32833f71f6 · 2.15 Impact Factor

Publication Stats

116 Citations
53.43 Total Impact Points

Institutions

  • 2009–2015
    • Izmir Bozkaya Research and Education Hospital
      Ismir, İzmir, Turkey
    • İzmir Atatürk Eğitim ve Araştırma Hastanesi
      Ismir, İzmir, Turkey
  • 2000–2011
    • Medicalpark Izmir Hospital
      Ismir, İzmir, Turkey
  • 2005
    • Ministry of Health, Turkey
      Engüri, Ankara, Turkey
  • 2004
    • Tepecik Training and Research Hospital
      Ismir, İzmir, Turkey