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Öğe Antifibrotic Effects of Aldosterone Receptor Blocker (Spironolactone) in Patients with Chronic Kidney Disease(TAYLOR & FRANCIS LTD, 2009) Güney, İbrahim; Selçuk, N. Yılmaz; Altıntepe, Lütfullah; Atalay, Hüseyin; Başarali, M. Kemal; Büyükbaş, SadıkAims. Proteinuria and transforming growth factor beta (TGF-beta) are parameters that can lead to glomerulosclerosis and tubulointerstitial fibrosis. All components of the renin-angiotensin-aldosterone system (RAAS) activate the TGF-beta. Aldosterone may not be inhibited with angiotensin-converting enzyme inhibitors (ACEIs) and/or angiotensin receptor blockers (ARBs) due to aldosterone escape. We aimed to evaluate the effect of spironolactone on parameters leading to fibrosis. Methods. This prospective study included 30 non-diabetic chronic kidney disease (CKD) patients treated with ACEIs and/or ARBs. The patients were divided into two groups that are similar in terms of demographic parameters. 25 mg of spironolactone was added to group 1 (n = 15) for six months, though it was not administered to group 2 (n = 15). Creatinine (U-Cr), protein (U-Prot), and TGF-beta 1 (U-TGF-beta 1) were measured in spot urine sample in the beginning of study and six months later. Results. Twenty-four patients completed the study. There were no significant changes in mean blood pressure, glomerular filtration rate, creatinine, albumin, and plasma aldosterone concentrations during the observation period in either group. U-Prot/U-Cr (mg/mg Cr) was reduced from 2.43 +/- 4.85 at baseline to 1.66 +/- 3.51 at sixth month (p = 0.003) in group 1. In addition, U-TGF-beta 1/U-Cr (ng/mg Cr) was also reduced from 22.50 +/- 6.65 at baseline to 17.78 +/- 10.94 at sixth month (p = 0.041) in the same group. U-TGF-beta 1/U-Cr and U-Prot/U-Cr ratios after the sixth month were not found significant compared with baseline values in group 2. Conclusion. Spironolactone reduced both proteinuria and urinary TGF-beta 1 excretion in CKD patients. We consider that spironolactone would be beneficial to prevent progression of renal fibrosis in CKD.Öğe Association of fetuin-a levels with carotid ıntima media thickness and valvular calcification in hemodialysis and peritoneal dialysis patients(2013) Solak, Yalçın; Atalay, Hüseyin; Bıyık, Zeynep; Türkmen, Kültigin; Yeksan, Mehdi; Türk, Süleyman; İnal, AliGİRİŞ: Fetuin A vasküler kalsifikasyonu önleyen bir negatif akut faz reaktanıdır. Koroner arter hastalığı (KAH) renal replasman tedavisi almakta olan hastalarda en önemli ölüm sebebidir. Diyalize giren son dönem böbrek yetmezliği hastalarında görülen kardiyovasküler hastalığın ana elementi hızlanmış kalsifik aterosklerozdur. Fetuin A seviyeleri açısından hemodiyaliz (HD) ve periton diyalizini(PD) karşılaştıran sınırlı sayıda çalışma mevcuttur. AMAÇ: HD ve PD hastalarında KAH prediktörleri ve valvüler kalsifikasyon ile serum fetuin A düzeyleri arasındaki ilişkiyi araştırmayı amaçladık. GEREÇ ve YÖNTEMLER: 39 HD (24 erkek, 15 kadın) ve 39 PD (25 erkek, 14 kadın) hastası çalışmaya alındı. Karotis intima media kalınlığı (KIMK) ultrason ile ölçüldü ve kalp kapağı kalsifikasyonları ekokardiyografi ile değerlendirildi. Ayrıca serum fetuin-A, CRP, ferritin, fibrinojen, ve albumin seviyeleri saptandı. Fetuin-A düzeylerine göre hastalar çeyreklere ayrıldı. Bulgular: Fetuin-A seviyesi HD hastalarında PD hastalarına göre daha düşüktü (hemodiyaliz 28,65,934 ng/ml, PD 324,8 ng/ml, p0,001). KIMK ile fetuin-A seviyesi arasında anlamlı negatif korelasyon vardı. KIMK, PD hastalarında HDe göre daha düşüktü. Fetuin-A seviyesi ile diyalizÖğe The Association of Glomerular Filtration Rate and Erectile Dysfunction with Severity of Coronary Artery Disease in Patients Presenting with Chest Pain(SPRINGER, 2010) Solak, Yalçın; Akıllı, Hakan; Atalay, Hüseyin; Kayrak, Mehmet; Gök, Hasan; Türk, SüleymanBackground The most common cause of death in patients with chronic kidney disease is cardiovascular. Coexistence of reduced estimated glomerular filtration rate (eGFR) and erectile dysfunction (ED) may predate severe underlying coronary artery disease (CAD). The aim of this study was to evaluate the predictive value of presence and severity of ED and reduced estimated eGFR in the risk stratification of CAD in patients with chest pain. Methods Two hundred and sixty-five consecutive male patients with chest pain were included. All patients underwent exercise stress test (EST), of whom those with positive EST underwent coronary angiography. eGFR was calculated and sexual health inventory for men (SHIM) form was applied to evaluate ED. The relation between SHIM scores, eGFR and the number of arteries with significant lesions was evaluated. Results Of the 265 male patients, 105 had positive EST while the remaining 160 patients had negative EST. ED was present in 62 patients (38.8%) in the EST (-) group and in 64 patients (61%) in the EST (+) group (P = 0.000). In the EST (+) group, coronary angiography (CAG) revealed normal coronary anatomy or insignificant coronary lesions in 19 (18%), one-vessel disease in 45 (43%), two-vessel disease in 22 (21%) and three-vessel disease in 19 (18%) patients, respectively. The lowest ED prevalence (36.8%) was seen in patients who had normal coronary anatomy or insignificant coronary lesions while the highest prevalence was in those with three-vessel disease (89.5%). When eGFR were taken into account, there was a significant difference between the groups as well (107.2 +/- 19.2 ml/min in the EST (-) group versus 94.1 +/- 20.0 ml/min in the EST (+) group; P = 0.001). Conclusion The presence and severity of ED and reduced eGFR are associated with the severity of underlying CAD in patients presenting with chest pain, and they could be implemented in the risk stratification of these patients.Öğe Baking Soda Induced Severe Metabolic Alkalosis in a Haemodialysis Patient(2009) Solak, Yalçın; Turkmen, Kültigin; Atalay, Hüseyin; Türk, SüleymanMetabolic alkalosis is a rare occurence in hemodialysis population compared to metabolic acidosis unless some precipitating factors such as nasogastric suction, vomiting and alkali ingestion or infusion are present. When metabolic alkalosis develops, it may cause serious clinical consequences among them are sleep apnea, resistent hypertension, dysrhythmia and seizures. Here, we present a 54-year-old female hemodialysis patient who developed a severe metabolic alkalosis due to baking soda ingestion to relieve dyspepsia. She had sleep apnea, volume overload and uncontrolled hypertension due to metabolic alkalosis. Metabolic alkalosis was corrected and the patient's clinical condition was relieved with negative-bicarbonate hemodialysis.Öğe Capd-Related Peritonitis After Renal Transplantation(Multimed Inc, 2010) Solak, Yalçın; Atalay, Hüseyin; Polat, İlker; Yeksan, MehdiWe admitted a 53-year-old male for deceased-donor kidney transplantation. He had been on continuous ambulatory peritoneal dialysis (CAPD) for 52 months. His native kidney disease was unknown. He was doing well on CAPD and had never experienced peritonitis. We did not have a measurement of panel reactive antibodies prior to his transplant surgery. The kidney was placed into the right inguinal fossa and his peritoneal dialysis (PD) catheter was left in place. Since he was thought to be immunologically high risk, we administered rabbit antithymocyte globulin (ATG) at a dose of 3 mg/kg body weight as an induction agent, along with 1 g methylprednisolone and mycophenolate mofetil. No surgical complications occurred; however, his urine output was not adequate. Doppler ultrasound ruled out urinary tract obstruction and renal vein thrombosis. Tc-99m DTPA scintigraphy revealed a normally perfused kidney but concentration and excretion were diminished considerably. Percutaneous allograft biopsy was consistent with acute humoral rejection. We instituted 3 days of pulse prednisolone (1 g daily) along with alternate-day double-filtration (cascade) plasmapheresis, daily ATG, and mycophenolate mofetil. During the course of hospitalization, PD was resumed due to uremia. White blood cell (WBC) counts were followed and were typically below 100/mm3. Despite rigorous antirejection therapy, urine output remained below 15 mL per hour. Because of significantly reduced lymphocyte counts, we withheld ATG. Twelve days after transplantation, the patient complained of severe extensive abdominal pain. Peritoneal effluent was cloudy and total effluent WBC count was 27 × 103/mm3, with 75% polymorphs. His abdominal pain was very variable in severity. He did not develop fever. Broad-spectrum antibiotics were started promptly on an empirical basis. Cultures of the peritoneal effluent showed Acinetobacter baumanii sensitive only to aminoglycosides and tigecycline. Tigecycline was given intravenously as 100 mg initial dose then 50 mg twice daily. Despite an initial response, the patient died on the 17th day after transplantation due to refractory septic shock.Öğe Colchicine Treatment in Autosomal Dominant Polycystic Kidney Disease: Many Points in Common(Churchill Livingstone, 2010) Solak, Yalçın; Atalay, Hüseyin; Polat, İlker; Bıyık, ZeynepAutosomal dominant polycystic kidney disease (ADPKD) is the most common of the inherited renal cystic diseases and constitutes 10% of the end stage kidney disease population. ADPKD is caused by PKD1 and PKD2 gene mutations in 85% and 15% of the cases respectively. Its high prevalence and negative impact on health outcomes fostered efforts to explain pathophysiologic pathways of cyst formation in kidneys. Among these are increased apoptosis, unopposed proliferation of tubule cells, impaired polarization and planar cell polarity, impaired cAMP pathway, cilier dysfunction, activated mTOR pathway, increased tumor necrosis factor-alpha (TNF-alpha) production. Many drugs have been tried in an attempt to halt cystogenesis in some point. Despite success to some extent in experimental studies, none reached clinical armamentarium yet. Colchicine, originally extracted from Colchicum autunale, is an anti-inflammatory drug that has been in continuous use for more than 3000 years. It has been used successfully to prevent attacks of familial mediterranien fever and amyloidosis, to treat gout and pseudogout attacks for a few decades. Colchicine principally is a microtubule inhibitor, thus prevents cell migration, division, and polarization. It also has anti-apoptotic, anti-proliferative and anti-inflammatory effects and down-regulates (TNF-a) receptors. As can easily be seen, many of the effects of colchicine have pathophysiologic counterparts in ADPKD. Thus, we hypothesized that colchicine would be beneficial to prevent or at least delay cyst formation in ADPKD patients. Indirect evidence also support our hypothesis, in which taxol and paclitaxel, other two microtubule inhibitors, were shown to delay cyst formation in experimental models of ADPKD. To our opinion, despite its narrow therapeutic index, widespread experience makes colchicine a suitable candidate for prolonged clinical use, should experimental studies show any benefit in ADPKD.Öğe Comparison of Effects of Automated Peritoneal Dialysis and Continuous Ambulatory Peritoneal Dialysis on Health-Related Quality of Life, Sleep Quality, and Depression(Wiley-Blackwell, 2010) Güney, İbrahim; Solak, Yalçın; Atalay, Hüseyin; Yazıcı, Raziye; Altıntepe, Lütfullah; Kara, Fatih; Yeksan, Mehdi; Türk, SüleymanFew studies investigating the effects of automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) on health-related quality of life (HRQoL), depression, and sleep quality exist in the literature. We aimed to determine differences between APD and CAPD modalities with respect to these parameters. Twenty APD and 48 CAPD patients were included in this crosssectional study. Biochemical values were measured at outpatient evaluation. A modified postsleep inventory was used to evaluate sleep quality. Health-related quality of life and depression were evaluated by the Short Form of Medical Outcomes Study and Beck Depression Inventory, respectively. Automated peritoneal dialysis and CAPD patients were compared in terms of sleep quality, HRQoL, and depression. Our results showed that there were no significant differences between APD and CAPD in any of the studied parameters. Moderate or severe sleep problems were found in 60% and 69% of the APD and CAPD patients, respectively. Mean HRQoL scores for any of the 8 Short Form of Medical Outcomes Study-36 domains were similar in the 2 groups. The mean physical component score was 51.1 +/- 21.2 and 48.9 +/- 18.2 in APD and CAPD patients, respectively (P=0.672). The mean mental component score was 47.5 +/- 20.1 in APD patients, whereas it was 42.4 +/- 19.5 in CAPD patients (P=0.291). Depression was detected in 70% of APD and 62.5% of the CAPD patients. The mean Beck Depression Inventory scores were also similar in the 2 groups. This study showed that HRQoL, sleep quality, and depression were similar in APD and CAPD patients.Öğe Constrictive Calcific Pericarditis Masked by Haemodialysis(2009) Solak, Yalçın; Selçuk, Nedim; Tekinalp, Mehmet; Özbek, Orhan; Atalay, HüseyinWe admitted a maintenance haemodialysis patient with hypotension and weakness. He had undergone cadaveric renal transplantation 19 years earlier. He had lost his kidney due to chronic allograft nephropathy 1 year after transplantation and returned to haemodialysis. He had hypotension, especially remarkable during haemodialysis. He also had hepatitis C but no cirrhosis. The patient denied a previous pulmonary tuberculosis. On physical examination, he was hypotensive (80/60 mmHg) but without peripheral oedema, neck vein distention or hepatomegaly. Heart sounds were weakly heard and there was no audible murmur or friction rub. Pericardial calcification was noticed on chest x-ray (Figure 1). Echocardiography could not visualize the pericardium or heart. Only coarse calcification of the pericardium from the subphrenic angle, but no further detail, was visible. Subsequently, we performed computerized tomography of the pericardium (Figure 2), which revealed a crescent-like calcification of the pericardium. There were calcific plaques on the right lower lobe of the pulmonary pleura as well.Öğe Culture-Negative Bilateral Emphysematous Pyelonephritis Presented as Acute Renal Failure and Managed Medically Only(LIPPINCOTT WILLIAMS & WILKINS, 2010) Solak, Yalçın; Türkmen, Kültigin; Atalay, Hüseyin; Türk, SüleymanEmphysematous pyelonephritis is a life-threatening infection especially seen in patients with poorly-controlled diabetes mellitus. Imaging modalities (preferably computed tomography) are required to establish the diagnosis. Treatment modalities include volume resuscitation, broad-spectrum antibiotics, percutaneous drainage, and, as a last resort, nephrectomy. We present a case of a 46-year-old female who had hypertension and type-2 diabetes mellitus and presented with complaints of dysuria, back pain, and decreased urine output. Renal ultrasound and abdominal computerized tomography (CT) revealed air-fluid levels at each perirenal region and collecting systems, consistent with emphysematous pyelonephritis. Her clinical situation improved with vigorous fluid resuscitation and broad-spectrum antibiotic treatment.Öğe Depression and Quality of Life in Continuous Ambulatory Peritoneal Dialysis Patients(Oxford Univ Press, 2006) Yeksan, Mehdi; Güney, İbrahim; Yazıcı, Raziye; Atalay, Hüseyin; Altıntepe, Lütfullah; Türk, Süleyman; Tonbul, H. Zeki[Abstract not Available]Öğe The effect of vardenafil on erectile dysfunction, quality of life and depression in cases with renal failure(OXFORD UNIV PRESS, 2007) Türk, Süleyman; Kan, Seyfullah; Atalay, Hüseyin; Güney, İbrahim; Altıntepe, Lütfullah; Küçür, Rahim; Kılıç, Mehmet[Abstract not Available]Öğe The Effects of Gabapentin Therapy on Pruritus, Quality of Life, Depression and Sleep Quality in Pruritic Hemodialysis Patients(AVES YAYINCILIK, IBRAHIM KARA, 2010) Tol, Hüseyin; Atalay, Hüseyin; Güney, İbrahim; Gökbel, Hakkı; Altıntepe, Lütfullah; Büyükbaş, Sadık; Bodur, SaidObjectives: We aimed to determine possible changes in pruritus, quality of life, depression and sleep quality in pruritic hemodialysis (HD) patients with gabapentin therapy. Patients and Methods: Fourteen adult HD patients (7 men, 7 women; mean age 59.7 +/- 17.2 years; range 41 to 88 years) with history of pruritus of more than eight weeks were assigned to receive 8-week gabapentin (300 mg per day) therapy. The daily pruritus were recorded using visual analogue scale for each period of the study during one week preceding the trial, the active treatment phase, the placebo phase and the intervening 1-week washout period. Sleep quality was determined with a modified post-sleep inventory, quality of life with a short form of Medical Outcomes Study (SF-36), depression using the Beck Depression Inventory. Results: The mean pruritus score and total of post-sleep inventory were decreased significantly with gabapentin therapy (p=0.01 and p=0.002 respectively). Physical and mental component scales of SF-36 increased, whereas cognitive and somatic depression index decreased with gabapentin. Conclusion: We concluded that beneficial effects of gabapentin therapy on pruritus, quality of life, depression and sleep quality are clinically important in HD patients with pruritus. Gabapentin therapy should be taken into account as an important choice of therapy in pruritic HD patients.Öğe Effects of Sildenafil and Vardenafil on Erectile Dysfunction and Health-Related Quality of Life in Haemodialysis Patients: A Prospective Randomized Crossover Study(Oxford Univ Press, 2010) Türk, Süleyman; Solak, Yalçın; Kan, Seyfullah; Atalay, Hüseyin; Kılınç, Mehmet; Ağca, Erhan; Bodur, SaidBackground. Erectile dysfunction (ED) is prevalent in end-stage renal disease (ESRD) and has been associated with impaired health-related quality of life (HRQoL). HRQoL, in turn, is related to morbidity and mortality in ESRD patients. Previous studies have shown improved HRQoL with ED treatment using sildenafil and vardenafil. However, no study has examined the effects of sildenafil or vardenafil on HRQoL in impotent ESRD patients. Furthermore, vardenafil has never been tested and its safety profile has not been determined in ESRD patients. The aim of this randomized crossover study was to compare the effects of sildenafil and vardenafil on measures of HRQoL and on ED scores as well as to determine the safety profile of vardenafil in ESRD patients. Methods. In 32 haemodialysis patients with impotence, ED and HRQoL were evaluated by the International Index of Erectile Function (IIEF-5) and the 36-item Short-Form Health (SF-36) surveys, respectively. Patients were randomized into sildenafil and vardenafil groups. After a 4-week treatment and 2-week washout periods, crossover was performed and an additional 4-week treatment was administered. IIEF-5 and SF-36 surveys were given before and after each treatment period. Adverse effects were evaluated by interview. Friedman tests and Bonferroni-adjusted Wilcoxon signed-rank tests were used to compare groups and for post hoc analysis, respectively. Results. IIEF-5 and SF-36 scores were significantly improved by both sildenafil and vardenafil compared to pretreatment values. There were no differences between sildenafil and vardenafil with respect to the studied parameters. Adverse effect profiles were also similar. No patient dropped out because of side effects. Conclusions. Sildenafil and vardenafil caused similar improvements in ED and HRQoL in haemodialysis patients. Vardenafil was well tolerated in our patient population.Öğe Efficacy and Tolerability of Intravenous Paricalcitol in Calcitriol-Resistant Hemodialysis Patients with Secondary Hyperparathyroidism: 12-Month Prospective Study(TAYLOR & FRANCIS LTD, 2012) Tonbul, Halil Zeki; Solak, Yalçın; Atalay, Hüseyin; Türkmen, Kültigin; Altıntepe, LütfullahRationale/objectives: Data are limited regarding the use of paricalcitol in calcitriol-resistant patients with secondary hyperparathyroidism (SHPT). We aimed to evaluate the effects of paricalcitol in calcitriol-resistant hemodialysis patients with SHPT. Methods: This is a 12-month, open-label, prospective study. Forty patients with calcitriol-resistant and/or calcitriol-intolerant SHPT were included. After a washout period, all patients converted to paricalcitol with a 1: 3 conversion ratio. Serum calcium and phosphorus were monitored monthly, while serum intact parathyroid hormone (iPTH) once in every 3 months. Paricalcitol dose was reduced or discontinued in case of hypercalcemia and/or hyperphosphatemia. Pre- and posttreatment electrolyte and iPTH values were compared with Student's t-test and Wilcoxon signed-rank test, respectively. Main findings: Forty patients completed the study. Mean initiation dose of paricalcitol was 23 +/- 7 mu g/week. Mean serum calcium was 8.9 +/- 0.8 mg/dL at baseline and 9.4 +/- 0.7 mg/dL at study end (p = 0.07). Mean monthly serum phosphorus levels stayed stable. Paricalcitol was effective in reducing iPTH levels when compared with pretreatment values (747.9 +/- 497.2 pg/mL, 307.3 +/- 417.1 pg/mL, respectively; p < 0.001). Thirty-two patients had to discontinue intravenous (IV) paricalcitol at some time during their treatment. Main reasons for discontinuation were as follows: hyperphosphatemia (58%), hypercalcemia (25%), and iPTH < 150 pg/mL (17%). Principle conclusions: Paricalcitol was found to be effective in reducing iPTH levels in calcitriol-resistant patients with SHPT despite relatively frequent drug discontinuation rates.Öğe Enoxaparine-Related Internal Oblique Muscle Hematoma in a Patient With Renal Insufficiency(2010) Solak, Yalçın; Atalay, Hüseyin; Polat, İlker; Yeksan, MehdiLow-molecular-weight heparins (LMWHs) are increasingly being used in thromboembolic settings due to some advantages over unfractioned heparin. However, these beneficial effects may transform into potentially hazardous effects in patients with impaired renal function if standard doses are used. Inappropriately high-doses may lead to hematomas. Enoxaparine is the first and most extensively studied LMWH. The most frequently encountered hematomas related with enoxaparine occur at the rectus sheath and retroperitoneum. Lateral abdominal wall hematomas related with enoxaparine use have rarely been reported to date. We report an internal oblique muscle hematoma in a patient with moderate renal insufficiency despite adequate dose reduction and suggest some take-home points to prevent or treat hematoma complications.Öğe Female sexual dysfunction in end stage renal disease and relation with quality of life and depression(OXFORD UNIV PRESS, 2007) Yazıcı, Raziye; Altıntepe, Lütfullah; Güney, İbrahim; Yeksan, Mehdi; Atalay, Hüseyin; Türk, Süleyman; Tonbul, Halil Zeki[Abstract not Available]Öğe Female Sexual Dysfunction in Peritoneal Dialysis and Hemodialysis Patients(TAYLOR & FRANCIS LTD, 2009) Yazıcı, Raziye; Altıntepe, Lütfullah; Güney, İbrahim; Yeksan, Mehdi; Atalay, Hüseyin; Türk, Süleyman; Tonbul, Halil ZekiBackground. Sexual dysfunction (SD) is a common problem in end-stage renal disease (ESRD). In contrast to basic and clinical research in the field of male SD, the sexual problems of women have received relatively little attention and are often under-treated. We evaluated sexual function in female ESRD patients using the validated Female Sexual Function Index (FSFI) and relation with QOL, depression, and some laboratory parameters. Methods. 117 ESRD patients (85 peritoneal dialysis [PD], 32 hemodialysis [HD], mean age 48.5 +/- 13.9 years) were enrolled. All patients had been dialyzed (PD or HD) for more than three months. In addition, an age-matched married control group of 48 subjects (mean age 47.1 +/- 12.7 years) were enrolled in the study. All patients were asked to complete three questionnaires of the FSFI, Beck Depression Index (BDI) and SF-36. Results. Female sexual dysfunction was found in 80 of the 85 peritoneal dialysis patients (94.1%) and all of the HD patients (100%), but in only 22 subjects of the control group (45.8%). A significant negative correlation was found between total FSFI score and age (r = -0.288, p = 0.002), BDI score (r = -0.471, p < 0.001), mental-physical component score of QOL (r = -0.463, p < 0.001 and r = -0.491, p < 0.001, respectively) in PD and HD patients. The rates of depression were 75.3, 43.8, and 4.2% in the PD and HD patients and control subjects, respectively. Conclusion. Female sexual dysfunction is common problem ESRD. This problem especially related with depression and QOL. Thus, sexual function should be evaluated in female subjects to determine its impact on quality of life.Öğe Hemodiyaliz Hastalarında Oksidatif Aktivitenin Değerlendirilmesi(2007) Büyükbaş, Sadık; İnal, Ali; Atalay, HüseyinAmaç: Kronik böbrek yetmezliği (KBY) oksidan stres artışı ve/veya antioksidan aktivitenin azalması nedeniyle gelişebilen çeşitli komplikasyonlarla (ateroskleroz ve kardiyovasküler bozukluklar) birliktedir. Bu çalışmada ileri kronik böbrek yetmezlikli hemodiyaliz hastalarında lipid peroksidasyonu artışı olup olmadığını araştırmak ve antioksidan enzim aktivitelerini değerlendirmek amaçlandı. Gereç ve Yöntem: Hemodiyaliz tedavisi gören 52 KBY hastası ve 40 sağlıklı kontrol grubunda; lipid peroksidasyonunun bir göstergesi olan malondialdehit (MDA) eritrosit ve plazma düzeyleri, antioksidan savunma sisteminin göstergeleri olan enzimlerden glutatyon peroksidaz'ın (GPx) eritrosit ve serum, süperoksit dismutaz'ın (SOD) eritrosit aktiviteleri ölçüldü. Bulgular: KBY hasta grubunda, hem plazma hem de eritrosit MDA seviyelerinin kontrol grubuna göre önemli oranda arttığı görüldü (p0.001). Bununla beraber KBY grubunda, hem serum hemde eritrosit SOD ve GPx düzeyleri kontrol grubuna göre anlamlı ölçüde azaldığı tespit edildi (p0.001). Sonuç: Bu çalışman sonucunda, hemodiyaliz hastalarında oksidatif stresin önemli ölçüde arttığı buna karşın antioksidan enzim aktivitelerinde azalma olduğu ve bu durumun tedavide dikkate alınması gerektiği kanaatine varıldı.Öğe Hemoperfusion treatment of digital intoxication in chronic hemodialysis patient(2008) Atalay, Hüseyin; Selçuk, N. Yılmaz; Altıntepe, Lütfullah; Güney, İbrahimDiagnosis of Digitalis intoxication depends on good history taking, clinical signs and symptoms, and digoxin level. Sixty one years old female with diabetes mellitus (DM), coronary artery disease (CAD) and end-stage renal failure administered to emergency department with complaints of dyspnea and chest pain. Digoxin 0.50 mg once a day was prescribed by an internal medicine physician and she has been taking the drug for 7 days. In our case digoxin level was decreased to valuable level after hemoperfusion. In conclusion it was observed that hemoperfusion therapy of digitalis intoxication in chronic hemodialysis patient is effective.Öğe Hepatitis B reactivation with fulminant hepatitis during rituximab chemotherapy in a patient with follicular lymphoma(2010) Acar, Kadir; Göktepe, Mevlüt Hakan; Polat, İlker; Atalay, HüseyinA 52-year-old man was diagnosed Follicular lymphoma with autoimmune hemolytic anemia. At time of diagnosis his HBs Ag was (+), Anti-HBs (-), and HBV DNA was negative. Chemotherapy was interrupted after tree cycles of R-CVP due to elevated liver enzyme. At that time HBV DNA became positive. Lamivudine therapy was started, whereas patient died due to fulminant hepatic failure. The high morbidity and mortality of this complication is one of the major obstacles to completing the standard treatment for lymphoma in HBV carriers. Thus, preventive therapy with nucleoside or nucleotide analogs should be started before the chemotherapy to prevent HBV reactivation.
