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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 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 Hastaların oral lezyonları tanımlayabilme özellikleri ve oral lezyonların sıklığının anamnestik olarak belirlenmesi(Selçuk Üniversitesi Tıp Fakültesi, 2011) Polat, İlker; Tunç, RecepOral lezyonlar içinde en sık görüleni oral aftlardır. Değişik çalışmalarda prevalans % 5-50 arası bildirilse de, genel populasyonun ortalama % 20' sinde oral mukozada aftlar, ülserler görülebilir. Behçet hastalığı tekrarlayan oral ve genital ülserler, üveit ve çeşitli deri lezyonlarına neden olabilen sistemik bir vaskülittir. İlk klinik bulgu sıklıkla tekrarlayan oral aft ve/veya ülserlerdir. Meram Tıp Fakültesi İç hastalıkları polikliniklerine başvuran 1000 hastada yaptığımız kesitsel çalışmada resim göstererek yapılan sorgulama ile aft sıklığı %17.8, ülser sıklığı %7.7 idi. Resim göstererek yapılan sorgulamaya oranla, sözel aft sorgulaması gerçek aftlarda %17 oranında kayba, aft dışı yaraların %19'unun aft olarak algılanmasına yol açmaktadır. Sözel ülser sorgulaması gerçek aftlarda %32,4 oranında kayba, aft dışı yaraların %40,9'unun aft olarak algılanmasına yol açmaktadır. Behçet tanısı olmayan hastalarda sözel ve resim göstererek yapılan sorgulamada Kappa katsayısı ile uyum çok düşük idi (Kappa=0,04). Behçet tanılı hastalarda ise 2 yöntem arasındaki uyum orta kuvvette idi (Kappa=0,559). Behçet tanısı olan ve olmayan hastaların sözel ve resim göstererek yapılan sorgulamalara verdikleri cevaplar karşılaştırıldığında arada anlamlı fark mevcuttu. Resim sorgusunun esas alınarak Behçet Hastalığı tanılı hastalar incelendiğinde toplam 62 hastanın tamamı oral lezyon tarifledi. Bu hastaların %30,6'sında ülser olmaksızın yalnızca aft mevcuttu. Muayenede ise BH tanılı hastaların 32'sinde oral lezyona rastlandı ve bunlardan %59'u oral afttı. Çalışmamızda resim göstererek yapılan oral lezyon sorgulamasının belirgin olarak üstün olduğunu ve sadece sözel sorgulama ile atlanabilecek veya yanlış anlaşılabilecek lezyonun tespitinde faydalı olabileceğini bulduk. Özellikle Behçet olmayan kişilerdeki aft bilgisinin düşük olabileceğini, bu nedenle görsel sorgulamanın Behçet tanısı esnasında daha uygun olabileceğini gösterdi.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.
