The impact of the preoperative red blood cell distribution width on weight loss prediction after sleeve gastrectomy.

AIM: We aimed to evaluate whether RDW has a predictive impact on weight loss after obesity surgery. MATERIAL AND METHODS: This was a single-institution retrospective study. Multiple linear regression analysis was used to determine the variables affecting the %EBMIL and %EWL values. Surgery of patients with %EMBIL > 50% and %EWL > 25% was considered successful. RESULTS: Hundred and ten patients were included in the study. The %EBMIL and %EWL values of patients with RDW>14.5% were lower. In the evaluation of successful surgeries, the probability of failure for those with RDW>14.5% is 10.93 times higher for %EBMIL and 21.55 times for %EWL. DISCUSSION: After the linear regression analysis, it was observed that the %EBMIL and %EWL were higher in the patients whose RDW values were 14.5 and below in the preoperative period. In these patients, it is an indication that more weight loss has occurred. Similar to our study, Wise et al. showed that weight loss was greater with a decrease in the RDW value 10. CONCLUSION: Preoperative RDW value can be used as a predictor of weight loss and surgical success. It can provide an idea about whether the patient will lose enough weight and the success of the surgery. KEY WORDS: Prediction, RDW, Sleeve Gastrectomy.

Quality of Life and Psychological Well-Being in Children and Adolescents After Renal Transplantation.

BACKGROUND: Kidney transplantation is the predominant treatment option in patients with end-stage renal disease. The aim of this study was to evaluate the effect of the presence of a psychiatric disorder on the quality of life in children and adolescents after kidney transplantation. METHODS: A total of 43 patients aged 6 to 18 years were included in the study. All participants and their parents were asked to complete the Pediatric Quality of Life Inventory (PedsQL), and families only, the Strengths and Challenges Questionnaire. Psychiatric symptoms and disorders of the patients were evaluated according to the Schedule for Mood Disorders and Schizophrenia for School-Age Children/Now and Lifetime Turkish Version. Patients were divided into 2 groups according to psychiatric symptoms and disorders. RESULTS: The most common psychiatric disorder was attention deficit and hyperactivity disorder (26%). The questionnaires filled out by the patients revealed a lower Total PedsQL Score (P = .003), PedsQL Physical Functionality Score (P = .019), and PedsQL Social Functioning Score (P = .016) in patients with psychiatric disorders. When the parents filled out the questionnaires, the Total PedsQL Score was similar in both groups. The PedsQL Emotional Functionality Score (P = .001) and PedsQL School Functionality Score (P = .004) were significantly lower in patients with psychiatric disorders. The Strengths and Difficulties Questionnaire revealed significantly higher total (P = .014) and hyperactivity/inattention subscale scores (P = .001) in those with a psychiatric disorder. CONCLUSIONS: Psychiatric disorders in kidney transplant patients adversely affect the quality of life.

Is Serum Magnesium Level Associated With Serum Lipid Levels in Kidney Transplant Recipients?

BACKGROUND: Magnesium (Mg) is key in diabetes mellitus, hyperlipidemia, and cardiovascular disease. METHODS: This is a retrospective cross-sectional study including 103 kidney transplant recipients. Patients aged under 18 years, patients treated with Mg supplementation, antihyperlipidemic agents, or diuretics, and patients with active infection or malignancy were not enrolled. Patients were divided into 2 groups according to median serum Mg level. The atherogenic index of plasma was calculated by a logarithmic transformation of the number acquired by dividing the molar concentrations of serum triglyceride by high-density lipoprotein value. RESULTS: The mean serum Mg level was 1.91 ± 0.28 mg/dL. Six patients (5.8%) had hypomagnesemia (Mg <1.5 mg/dL), and 2 (1.9%) had hypermagnesemia (Mg >2.6 mg/dL). Serum Mg level was negatively correlated with body mass index, estimated glomerular filtration rate (eGFR), and tacrolimus trough level and positively correlated with levels of phosphorus, total cholesterol, and low-density lipoprotein (LDL-C). There was no correlation between serum Mg and triglyceride, high-density lipoprotein, atherogenic index of plasma, and cyclosporin A trough level. Patients with Mg >1.87 mg/dL had lower eGFR, tacrolimus, and cyclosporin A trough level and higher total cholesterol and LDL-C compared to those with Mg ≤1.87 mg/dL. In adjusted ordinal analysis, eGFR (hazard ratio (HR): 0.981, 95% CI 0.964-0.999, P = .036) and total cholesterol (HR: 1.015, 95% CI 1.004-1.027, P = .008) were independently associated with serum Mg. In multivariate linear regression analysis, serum Mg level was independently associated with LDL-C (ß = .296, t = 3.079, P = .003) and total cholesterol (ß = .295, t = 3.075, P = .003). CONCLUSION: Serum Mg level may have an important impact on dyslipidemia in kidney transplant recipients.

Nonoperative Management of Leaks After Laparoscopic Sleeve Gastrectomy With Endoscopic Stents in a Tertiary Referral Center.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is a frequently performed operation. Leaks are formidable complications; however, the optimal management of these leaks is controversial. METHODS: We retrospectively reviewed the medical records of 15 patients referred to our tertiary center between 2012 and 2016 with leaks after LSG. RESULTS: In 12 patients with whom ongoing leaks were identified, stents were inserted with the intent of definitive therapy. In addition to attempts at source control, percutaneous drainage was carried out for intraabdominal collection in 9 patients and pleural effusion in 4 patients. The length of stay in the intensive care unit was significantly shorter in patients referred earlier or in those without any intervention. CONCLUSION: LSG leaks can be treated nonoperatively in well-organized centers under meticulously designed protocols, depending on the clinical condition of the patient.

Incidence and risk factors for incisional hernia after abdominal aortic aneurysm and aortic occlusive disease surgery.

BACKGROUND: This study aims to investigate incisional hernia incidence and risk factors after abdominal aortic aneurysm and aortic occlusive disease surgery via a midline laparotomy. METHODS: A total of 110 patients (66 males, 44 females; mean age: 69.3±8.8 years; range, 36 to 88 years) who underwent open elective surgery for aortoiliac occlusive diseases or abdominal aortic aneurysm between January 2005 and December 2016 were retrospectively analyzed. Both patient groups were compared in terms of surgical procedures, sex, age, American Society o f A nesthesiologists s core ( 1-3), b ody m ass i ndex (<25 vs. ≥25 kg/m2), smoking (non-smoker <1 pack/day, smoking ≥1 pack/day), and time to incisional hernia development. RESULTS: Incisional hernia occurred in 14.3% of the patients operated for aortoiliac occlusive disease and in 17.6% of the patients operated for abdominal aortic aneurysm (p=0.643). Incisional hernia was seen in three (5.7%) of 53 patients with a body mass index of <25 kg/m2 and was in 15 (26.3%) of 57 patients with a body mass index of ≥25 kg/m2 (p=0.03). CONCLUSION: High body mass index is a risk factor for incisional hernia in patients undergoing aortic reconstructive surgery.

Acoustic Radiation Force Impulse Elastography May Predict Acute Rejection in Kidney Transplantation.

BACKGROUND: Allograft biopsy that is done as indicated by clinical and laboratory clues about graft rejection provides a definitive diagnosis. Noninvasive methods that may be useful for predicting or diagnosing rejection are important for early diagnosis of possible rejection. PURPOSE: The aim of this study is to investigate the relationship between changes in shear wave velocity (SWV) values and renal allograft kidney biopsy findings. MATERIAL AND METHODS: Thirty-four end-stage renal failure patients who underwent living donor renal transplantation between January 2015 and July 2015 were enrolled in this prospective cohort study. Implantation, sixth-month protocol, and biopsies that were performed with suspicion of acute rejection were evaluated with renal Doppler ultrasound and elastography findings of recipients' preimplantation donor ultrasonography findings. RESULTS: Comparison of renal ultrasound and elastography findings of 2 groups revealed a significant elevation in the resistive index (0.81 vs 0.63, P = .005) and pulsatility index (2.08 vs 1.20, P = .008) values in the rejection group, and no significant difference in the SWV values between the 2 groups. Delta (Δ)-SWV was calculated using the difference between acute rejection values and preimplantation, implantation, and sixth-month values showed a positive correlation between acute rejection (Δ-sixth month, r = 0.498, P = .030), tubulitis (Δ-pretransplant, r = 0.509, P = .037), and inflammation (Δ-pretransplant, r = 0.657, P = .004) scores. However, there were no correlations between Δ-SWV values and glomerulitis and peritubular capillaritis score. CONCLUSION: Changes in SWV may predict acute rejection in kidney transplantation patients if the reference measurements were done at a more stable time after the transplantation.

Increase in interventricular septum thickness may be the first sign of cardiovascular change in kidney donors.

BACKGROUND: Because of the inadequate number of deceased kidney donors, living kidney donation remains an important issue for kidney transplantation. Previous studies have shown that living donation does not differ life expectancy and progression to end-stage renal disease compared with the normal population. In this study, we investigated short-term cardiovascular changes after donor nephrectomy. METHODS: Thirty-four patients who underwent donor nephrectomy between January 2015 and July 2015 at Ege University Renal Transplantation Unit were included in the study. Arterial stiffness, multifrequency bioimpedance analysis, renal ARFI elastography, and echocardiography performed prior to the donor nephrectomy and 6 months after nephrectomy. RESULTS: A total of 34 kidney donors were enrolled in this study. Twenty donors were female (59%) and 14 donors were male (41%). The pathological evaluation of donor kidneys using implantation renal biopsy sample revealed mean Karpinski Renal Score of 1.5 and the mean glomerulosclerosis ratio was 5% for all donated kidneys. Arterial stiffness, systolic and diastolic blood pressure measures, body fluid composition, and left atrial size did not change significantly during the follow-up. However, interventricular septum thickness of donors increased by 1 mm during a 6-month period (9.6 mm vs 10.6 mm, P = .002). CONCLUSION: We observed an increase in interventricular septum thickness in kidney donors during a 6-month follow-up. In order to evaluate the net effect of this change on donor morbidity, prospective studies investigating an increased number of donors with long-term follow-up should be needed.

Pediatric Kidney Transplantation in Patients With Urologic Anomalies.

INTRODUCTION: and Aim. End-stage renal disease owing to structural urologic anomalies is frequent in the pediatric population. Impaired bladder function is thought to have a negative effect on graft function and survival. The aim of this study was to present our single-center experience and long-term follow-up results in pediatric patients who underwent renal transplantation for urologic reasons and to compare graft survival among patients who underwent transplantation for nonurologic reasons. METHOD: The paper records of renal transplanted children (<18 years of age) held by Ege University Medical Faculty between 1998 and 2018 were evaluated retrospectively. Patients with normal bladder function who underwent transplantation for urologic reasons were defined as group A, whereas patients who had impaired bladder function and underwent transplantation for urologic reasons were defined as group B; a control group was defined as group C. RESULTS: Eighty-three patients were included in the study. The creatinine values of the patients at their last visit were no different between groups (P = .930). One-, 5-, and 10-year graft survival rates were 97%, 89%, and 74%, respectively, in group A; 100% for all years in group B; and 97%, 94%, and 80%, respectively, in group C. There was no statistically significant difference in terms of graft survival between groups (P = .351). CONCLUSION: Children with end-stage renal disease owing to urologic abnormalities may be good candidates for kidney transplantation with a favorable prognosis for graft function and survival.

Do Antithymocyte Globulin-Free Acute Rejection Therapies Increase the Risk of Polyoma Nephropathy in Renal Transplant Recipients?

INTRODUCTION: BK virus nephropathy is a serious complication that can lead to allograft kidney loss. Excessive immunosuppression increases the risk. We aimed to evaluate whether there is an increased risk of BK viremia and nephropathy in patients who underwent high-dose immunosuppression because of the development of acute rejection in the early period after kidney transplantation. METHODS: This retrospective cohort study was performed between April 2015 and March 2016. Twenty-nine patients who had biopsy-proven acute rejection in the first 3 months were evaluated for BK viremia and nephropathy. Thirty patients who had transplantations at the same period were the control group. Plasma BK-DNA values were examined at 1, 2, 3, 6, 9, and 12 months after the rejection treatment and at 3, 6, 9, and 12 months in the control group. Presence of polyoma nephropathy was examined with surveillance biopsies at the 6 and 12 months. RESULTS: Acute rejection treatment was started on the 12th day after transplantation (2-37 days). Seventeen cellular rejections and 12 humoral rejections were reported by biopsy. Two of the 12 humoral rejections were suspicious. Only pulse steroid (PS) (n = 18); PS, plasmapheresis, and intravenous immunoglobulin (n = 8); PS and intravenous immunoglobulin (n = 2); and PS and plasmapheresis (n = 1) treatments were performed. In 21 patients in the rejection group and 25 patients in the control group, BK-DNA was not positive at all. Two patients had graft loss at 11 and 36 months in the rejection group. Graft losses were secondary to rejection. CONCLUSIONS: Treatment with antithymocyte globulin-free regimens after acute rejection episodes did not lead to an increase in BK viremia.

Early predictive value of baseline renal transplant scintigraphy in pediatric patients.

OBJECTIVES: The value of baseline renal transplant scintigraphy (RTS) with technetium-99m diethylenetriaminepentaacetic acid (Tc-DTPA) performed within 2 days after transplantation in predicting early renal transplant outcome in pediatric recipients was assessed in this study. PATIENTS AND METHODS: Baseline RTS of 48 pediatric patients were studied retrospectively. Hilson's perfusion index, graft index (GI), time between peak perfusion and iliac artery (ΔP), and the ratios of peak perfusion to plateau (P : Pl), to peak iliac artery (P : A), and to peak uptake (P : U) were obtained. In 14 patients younger than 9 years old, because of faint visualization of iliac artery, the perfusion indices and GI could not be calculated. The 'Bedside Schwartz' formula was used for calculation of follow-up estimated glomerular filtrate rate (eGFR) values. The need for dialysis in the first week or decreasing serum creatinine of less than 10%/day during 3 consecutive days after the transplantation was accepted as delayed graft function (DGF). The patients, whose creatinine reduction ratio was less than 70% on day 7 after transplantation without DGF, were accepted as slow graft function (SGF). RESULTS: The means of GI, P : U, and Hilson's perfusion index were significantly high in SGF/DGF (n=10). GI and P : U had very high accuracy in the diagnosis of DGF/SGF (area under the curve>0.90). A strong correlation was found between P : U and same day and between GI and day 15 eGFR values. GI, P : U, and P : A were significant for the prediction of follow-up eGFR of less than 60 ml/min/1.73 m. GI was more accurate than the others. CONCLUSION: Our experience in this study underlines the importance of RTS, especially with the use of GI and P : U, which are very valuable in diagnosing DGF/SGF and predicting early transplant outcome in pediatric recipients.

Prognostic factors in peptic ulcer perforations: a retrospective 14-year study.

Regarding the complications of peptic ulcer, a perforation remains the most important fatal complication. The aim of our retrospective study was to determine relations between postoperative morbidity and comorbid disease or perioperative risk factors in perforated peptic ulcer. In total, 239 patients who underwent emergency surgery for perforated peptic ulcer in Ege University General Surgery Department, between June 1999 and May 2013 were included in this study. The clinical data concerning the patient characteristics, operative methods, and complications were collected retrospectively. One hundred seventy-five of the 239 patients were male (73.2%) and 64 were female (26.8%). Mean American Society of Anesthesiologists (ASA) score was 1 in the patients without morbidity, but mean ASA score was 3 in the morbidity and mortality groups. Primary suture and omentoplasty was the selected procedure in 228 of the patients. Eleven patients underwent resection. In total, 105 patients (43.9%) had comorbidities. Thirty-seven patients (67.3%) in the morbidity group had comorbid diseases. Thirteen (92.9%) patients in the mortality group had comorbid diseases. Perforation as a complication of peptic ulcer disease still remains among the frequent indications of urgent abdominal surgery. Among the analyzed parameters, age, ASA score, and having comorbid disease were found to have an effect on both mortality and morbidity. The controversial subject in the present study is regarding the duration of symptoms. The duration of symptoms had no effect on mortality nor morbidity in our study.

Large mucinous neoplasm of the appendix mimicking adnexal mass in a postmenopausal woman.

INTRODUCTION: Appendiceal tumors are rare, late-diagnosed neoplasms that may not be differentiated from adnexal masses even by advanced imaging methods and other diagnostic procedures. They may be asymptomatic and remain undiagnosed until surgery. PRESENTATION OF CASE: We report a case of 81-year-old postmenopausal woman presented with abdominal pain. A magnetic resonance imaging revealed right adnexal mass. Laparotomy was performed and detected a 12cm×9cm mucinous tumoral mass arising in the appendix. An appendectomy and a right hemicolectomy with ileo-transverse anastomosis were performed. Histopathological examination was revealed appendiceal mucinous neoplasm with low malignancy potential. DISCUSSION: Gastrointestinal tumors such as appendiceal tumors can mimicking adnexal mass. Therefore, appendiceal tumor kept in mind in a patient with diagnosed adnexal mass, especially patient had non-specific clinical symptoms, laboratory and radiologic findings. CONCLUSION: Gastrointestinal tumors such as appendiceal tumors kept in mind in a patient with diagnosed adnexal mass.

Rare cause of weight loss in a kidney transplant recipient: iron overload.

Various reasons such as malignancies and chronic infections may cause weight loss in kidney transplant patients. In this report, iron overload as a rare cause of weight loss in a kidney transplant patient is presented. Forty-seven-year-old male patient who transplanted from a deceased donor 5 years ago was hospitalized because of 20 kg of weight loss. In medical history, he had history of hemodialysis for 89 months and received 100-300 mg of intravenous iron therapy per week before transplantation and transfused eight units of blood. In physical examination, weight and height were 45 kg and 185 cm, respectively. Respiratory and cardiac auscultation was normal. Laboratory results revealed as follow: glucose 76 mg/dL, urea 60 mg/dL, creatinine 1.35 mg/dL, aspartate aminotransferase 74 U/L, alanine aminotransferase 77 U/L, C-reactive protein 2.59 mg/dL, albumin 3.3 g/dL, globulin 3.4 g/dL, white blood cells 3200/mm(3), hemoglobin 13.1 g/dL and platelets 190,000/mm(3). Chest and abdominal tomography didn't reveal any pathology. Portal Doppler ultrasound showed signs of early cirrhosis. Viral and autoimmune hepatitis markers were negative. Ferritin was 5300 ng/mL and transferrin saturation was 82%. In liver biopsy, hemosiderosis was diagnosed and heterozygous H63D gene mutation was detected. Totally, 19 units of phlebotomy were performed. Liver function tests and serum ferritin decreased gradually. At outpatient follow-up in 6 months, he returned to former weight. In conclusion, there can be several causes of weight loss in kidney transplant patients. Iron overload can come across as a rare cause of weight loss. In these patients, ferritin levels should be checked and diagnosis should be clarified by liver biopsy and gene mutation analysis.

Multiple unrelated malignancies following renal transplantation: an evaluation of four cases.

The risk of de novo malignancy is significantly higher in patients who have undergone organ transplantation than in the general population. Long-term immunosuppressive treatment, in addition to age, genetic predisposition and infectious agents, plays a major role in the development of malignancy. Although skin and hemopoietic system cancers are common, atypical presentations of malignancies may occasionally be seen during long-term follow-up in patients with functioning allografts. In this report, four cases, each with more than one different primary malignancy (one patient with three malignancies and three patients with two malignancies), are presented.

A horseshoe kidney from a live donor as a renal transplant: case report.

OBJECTIVES: This case report presents our experience regarding a horseshoe kidney from live donor to be used as a renal transplant. MATERIALS AND METHODS: The recipient was a 48-year-old man with chronic renal failure owing to hypertension who had been on hemodialysis for 2 years. The donor was his 43-year-old sister who had an uncomplicated horseshoe kidney with negative results on a urinalysis. An aortogram showed that the arterial supply to the kidney consisted of 2 superior arteries (1 on each side) and 1 inferior accessory artery that was divided to feed the lower fused parenchyma of the kidney. RESULTS: Surgery was performed via a retroperitoneal lumbotomy incision; the left half of the kidney was mobilized. The left kidney was procured by clamping the inferior accessory renal artery, transecting the parenchyma within the demarcation boundary. The transplant kidney was placed in the recipient's contralateral iliac fossa. The graft vein was anastomosed to the recipient's external iliac vein, the artery to the external iliac artery, and the ureter to the bladder. After perfusing the graft, no urine leakage was detected from the transacted surfaces, and the graft began producing urine. There were no complications after surgery. The patient was discharged on the 10th day after surgery with a creatinine level of 0.07 µmol/L. Maintenance immunosuppressive treatment included tacrolimus, mycophenolate mofetil, and prednisolone. CONCLUSIONS: We believe using a horseshoe kidney as a renal allograft after a detailed preoperative evaluation may help expand the donor pool.

Abdominal wall endometrioma: ultrasonographic features and correlation with clinical findings.

BACKGROUND: The diagnosis of abdominal wall endometrioma (AWE) is often confused with other surgical conditions. Certain factors relating to knowledge of the clinical history of the disease make correct diagnosis and treatment difficult. AIMS: To present the clinical findings and ultrasonographic (US) features of AWE with special emphasis on size-related features. STUDY DESIGN: This study reviewed abdominal wall endometriomas during a 2-year period in the Radiology Department of Sifa University Hospital, Izmir. METHODS: Eleven women (mean age 32.6 years) with 12 scar endometriomas (mean diameter 29.2 mm) were consecutively evaluated by US and Colour Doppler examination (CDUS) prior to surgery. Lesions were grouped into large (≥3 cm) and small nodules. Vascularisation was classified as location (central, peripheral and mixed) and severity (absent, moderately vascular and hypervascular). In each patient, the nature of pain (absent, cyclic: associated with menstruation and continuous), historical and clinical data were documented. Four patients underwent Magnetic Resonance Imaging and their findings were presented. Fisher's exact test, χ(2) test for categorical data and the unpaired T-test for continuous variables were used for statistical analysis. RESULTS: In all the women, US of the AWE showed the presence of a solid hypoechoic mass (less echogenic than the surrounding hyperechoic fat) within the abdominal wall. There was a significant correlation between AWE sizes with repeated caesareans and the mean time between the last operation and admission to hospital (p<0.05). Large endometriomas showed increased central vascularity (p<0.05). Cyclic pain was more frequent in small lesions, whereas continuous pain was more commonly found in patients with larger lesions (p<0.05). CONCLUSION: AWE is often misdiagnosed clinically because endometriosis may occur years after the caesarean section, the pain is often non-cyclic in nature, and there is not always a palpable tender mass. The sonographic and Doppler findings, along with proper correlation with clinical data, may substantially contribute to the correct diagnosis of endometrioma.

Diagnostic value of ultrasonography in appendicitis.

BACKGROUND: Clinical diagnosis of appendicitis is often difficult in atypical patients. OBJECTIVES: The authors aim to determine the diagnostic accuracy of ultrasonography (US) for acute appendicitis. MATERIAL AND METHODS: 121 consecutive patients with right lower abdomen pain were evaluated. Of them, 25 were excluded due to not having performed a preoperative US and 5 were obese (Body Mass Index > 30). A total of 91 patients were evaluated. The patients were assessed clinically and radiologically. Blood and urine analysis was carried out in all patients. US was performed with a Toshiba Fomio 8 brand machine with 3.75 and 8 MHz linear probes. Patients underwent an operation and an appendicectomy was done. Specimens were sent for histopathology to confirm appendicitis. RESULTS: Ultrasound supported the diagnosis of acute appendicitis in 58 (63.7%) patients. In the US with positive findings, 55 patients (94.8%) had inflamed appendices on histopathology and 5 (8.6%) had normal appendices. The overall sensitivity of ultrasonography was 71.4% and specificity was 78.5%. Positive predictive value (PPV), negative predictive value (NPV) and the diagnostic accuracy of ultrasonography are 94.8%, 33.3%, and 72.5% respectively. CONCLUSIONS: All diagnostic tests are adjunctive to the clinician. US should be the first step in the care of patients with right lower abdominal pain after the physical examination.