Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 37
Filtrar
1.
J Ultrasound Med ; 42(2): 419-425, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35811400

RESUMO

OBJECTIVES: We classified congenital heart defects (CHDs) according to cerebral blood flow oxygenation and aimed to evaluate the effect on the size of brain structures in these fetuses. METHODS: The study which was designed retrospectively, included 28 patients with fetal CHDs and 76 patients without fetal anomalies. RESULTS: The width and length of the cavum septum pellucidum significantly increased in the CHD group (P = .002, P = .004). The biparietal diameter and z scores were significantly lower in the single ventricle (SV) (P = .006, P = .019), and the head circumference (HC) and z scores were significantly lower in the transposition of great arteries (TGA) (P = .013, P = .038). The transverse cerebellar diameter, the cerebellar HC and the cerebellar hemisphere area values were lower in the SV (P = .005, P = .017, P = .044). CONCLUSIONS: Brain structure changes are more pronounced in groups with low cerebral oxygenation, especially in the SV and the TGA.


Assuntos
Cardiopatias Congênitas , Transposição dos Grandes Vasos , Feminino , Humanos , Gravidez , Estudos Retrospectivos , Cardiopatias Congênitas/diagnóstico por imagem , Cabeça/diagnóstico por imagem , Feto , Ultrassonografia Pré-Natal
2.
Gynecol Endocrinol ; 38(12): 1104-1108, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36579834

RESUMO

AIM: The purpose of the study was to investigate the biochemical and metabolic abnormalities related to the cutaneous characteristics of PCOS. MATERIAL­METHODS: Patients diagnosed with PCOS were included in the study. Demographic data and accompanying androgen-dependent skin findings (acne, seborrhea, androgenic alopecia, acanthosis nigricans, skin tag, and hirsutism) were recorded. The free testosterone, total testosterone, dehydroepiandrosterone sulfate, androstenedione,17-Hidroksi progesterone, sex hormone binding globulin, prolactin, fasting glucose, fasting insulin, HbA1C, HDL, and triglycerides, follicle-stimulating hormone, luteinized hormone, free androgen index, and HOMA-IR levels of the patients were measured. The hormonal values of the patients with PCOS with and without skin findings were compared. RESULTS: The HOMA-IR values of the acanthosis nigricans (+) PCOS group were significantly higher than the acanthosis nigricans (-) PCOS group (p < .001). The DHEA-SO4, FAI, and FI values of patients with hirsutism (HR) (+) PCOS were found to be statistically higher than patients with HR (-) PCOS (p = .006, p = .015, p = .004). CONCLUSION: PCOS is among the most common endocrine disorders of women of reproductive age and was associated with some hormonal, metabolic, and skin findings. Certain androgenic and metabolic variables developing in PCOS might correlate with cutaneous symptoms.


Assuntos
Acantose Nigricans , Síndrome do Ovário Policístico , Feminino , Humanos , Síndrome do Ovário Policístico/complicações , Androgênios , Hirsutismo , Acantose Nigricans/complicações , Testosterona
3.
J Perinat Med ; 50(4): 391-397, 2022 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-34905668

RESUMO

OBJECTIVES: To compare cardiac structural and functional findings of fetuses with fetal growth restriction (FGR) and small for gestational age (SGA). METHODS: In this prospective cohort study, patients were classified into three groups using Delphi procedure according to fetal weight, umbilical, uterine artery Doppler and cerebroplacental ratio. Fetal cardiac ultrasonographic morphology and Doppler examination was performed to all pregnant women at 36 weeks of gestation. RESULTS: Seventy three patients were included in the study. There were one (6.7%) patient in the control group, 2 (13.3%) in the SGA group and 12 (80%) in the FGR group who needed neonatal intensive care unit (NICU) and NICU requirement was significantly higher in FGR fetuses (p<0.001). Left spherical index was found to be lower only among FGR fetuses (p=0.046). Left ventricular wall thickness was decreased and the right/left ventricular wall ratio was increased in FGR fetuses (p=0.006, p<0.001). Tricuspid/mitral valve ratio and mitral annular plane systolic excursion value was lower in FGR fetuses (p=0.034, p=0.024 respectively). Also, myocardial performance index was remarkably higher in FGR group (p=0.002). CONCLUSIONS: We detected cardiac morphological changes in cases of both SGA and FGR-more pronounced in the FGR cases. Findings related to morphological changes on the left side in FGR cases were considered secondary to volume increase in FGR cases as an indicator of a brain-protective effect. In the FGR group, both systolic and diastolic dysfunctions were detected in the left heart.


Assuntos
Retardo do Crescimento Fetal , Ultrassonografia Pré-Natal , Feminino , Retardo do Crescimento Fetal/diagnóstico , Coração Fetal/diagnóstico por imagem , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Gravidez , Estudos Prospectivos
4.
Int Urogynecol J ; 32(4): 851-858, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33175232

RESUMO

INTRODUCTION AND HYPOTHESIS: Laparoscopic lateral mesh suspension (LLMS) has emerged as a practical, safe, and feasible alternative to sacrocolpopexy (SCP) for treating female genital apical prolapse. Although several prior studies have reported changes in the vaginal axis in women who have undergone SCP or sacrospinous ligament fixation (SSLF) surgery for prolapse, there is a lack of data on changes in the vaginal axis after LLMS. This study was aimed at investigating the level of anatomical correction following LLMS and comparing the vaginal axis on magnetic resonance imaging (MRI) in patients with apical genital prolapse. METHODS: Patients who underwent LLMS and a nulliparous control group were included in this observational prospective case-control study. MRI was performed on the control group and the study group pre- and postoperatively. The angle between the pubococcygeal line and the lower vaginal segment, the angle between the levator plate and the pubococcygeal line, and the angle between the lower and upper vaginal segments were measured and compared. RESULTS: The angles measured between the pubococcygeal line and the lower vaginal segment and between the levator plate and the pubococcygeal line were significantly lower in the preoperative than in the postoperative measurements (p < 0.001). All angles were found to be similar in the nulliparous women and in the patients following LLMS surgery. The Pelvic Organ Prolapse Symptom Score (POP-SS) score decreased significantly after the operation (p < 0.001). CONCLUSION: The vaginal axis was found to be near-normal in patients who underwent LLMS.


Assuntos
Laparoscopia , Prolapso de Órgão Pélvico , Estudos de Casos e Controles , Feminino , Procedimentos Cirúrgicos em Ginecologia , Humanos , Imageamento por Ressonância Magnética , Prolapso de Órgão Pélvico/diagnóstico por imagem , Prolapso de Órgão Pélvico/cirurgia , Estudos Prospectivos , Telas Cirúrgicas , Resultado do Tratamento
5.
J Obstet Gynaecol ; 41(2): 269-274, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32498582

RESUMO

This study aimed to evaluate the effect of a levonorgestrel-releasing intrauterine system (LNG-IUS) on the sexual function of women. Participants who had abnormal uterine bleeding (AUB) complaints with LNG-IUSs were included (study registration: Kanuni Sultan Suleyman Training and Research Hospital, 2018/10/34). The demographic data of all participants were recorded. The female sexual function index (FSFI) questionnaire was used to participants before the insertion of LNG-IUSs and 6 months after its insertion. FSFI scores were calculated at both timepoints and were compared. The total FSFI score after LNG-IUS insertion was significantly higher than the total FSFI score application (p < .001). The scores of the desire, arousal, lubrication, orgasm, satisfaction and pain categories significantly increased after LNG-IUS compared to those before LNG-IUS. As a result, the present study demonstrated that after LNG-IUS insertion, these women had higher FSFI scores.Impact StatementWhat is already known on this subject? There are many publications in the literature comparing the effects of LNG-IUSs, IUSs, OCs and other contraceptive methods on female sexuality. However, there are markedly few studies that compare sexual function before and after LNG-IUS insertion.What do the results of this study add? The total FSFI score after LNG-IUS insertion was significantly higher than the total FSFI score before the insertion (p < .001). The scores of the desire, arousal, lubrication, orgasm, satisfaction and pain categories significantly increased after LNG-IUS insertion compared to those before the application. The number of participants with FSFI scores ≥26.5 before LNG-IUS insertion was 17 (12.5%), and this number increased to 71 (52.5%) after the applicationWhat are the implications of these findings for clinical practice and/or further research? This study contributes to the literature because there are few researches that compare sexual function before and after LNG-IUS insertion. As a result of our study, sexual dysfunction decreased after LNG-IUS, and the scores increased in all sub-groups together with the total FSFI scores.


Assuntos
Dispositivos Intrauterinos Medicados/efeitos adversos , Levanogestrel/farmacologia , Comportamento Sexual , Disfunções Sexuais Fisiológicas , Hemorragia Uterina , Adulto , Anticoncepcionais Femininos/farmacologia , Dispareunia/diagnóstico , Dispareunia/etiologia , Feminino , Humanos , Psicofisiologia , Excitação Sexual , Comportamento Sexual/efeitos dos fármacos , Comportamento Sexual/fisiologia , Comportamento Sexual/psicologia , Disfunções Sexuais Fisiológicas/diagnóstico , Disfunções Sexuais Fisiológicas/etiologia , Inquéritos e Questionários , Resultado do Tratamento , Hemorragia Uterina/diagnóstico , Hemorragia Uterina/etiologia
6.
J Obstet Gynaecol ; 41(1): 112-117, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32131660

RESUMO

This study aimed to examine the possible association between the oxidative stress parameters and clomiphene citrate resistance in polycystic ovary syndrome. The demographic data, hormone profiles and oxidant and antioxidant values of 50 clomiphene citrate-resistant polycystic ovary syndrome patients (Group 1), 32 clomiphene citrate-sensitive polycystic ovary syndrome patients (Group 2) and 87 non-polycystic ovary syndrome patients (Group 3) were compared. The average age, follicle-stimulating hormone, oestradiol, thyroid-stimulating hormone and prolactin values of the three groups were found to be homogeneous. Ferroxidase, catalase and myeloperoxidase levels were determined to be lower in the clomiphene citrate-resistant group compared to clomiphene citrate-sensitive and non-polycystic ovary syndrome groups (p < .001). As a result, Polycystic ovary syndrome patients with clomiphene resistance had lower antioxidant (catalase and ferroxidase) levels compared to those who were sensitive to clomiphene and who did not have polycystic ovary syndrome. The myeloperoxidase levels also demonstrated the same trend, which might be due to a compensation mechanism.Impact StatementWhat is already known on this subject? In the literature, there are many studies evaluating the association between PCOS and oxidative stress. No research related to antioxidants in clomiphene citrate-sensitive and clomiphene citrate-resistant PCOS patients was found in the relevant literature.What do the results of this study add? In this study, the antioxidants catalase and ferroxidase were found to be lower in PCOS women compared to non-PCOS; however, they were the lowest in clomiphene citrate-resistant PCOS women. Interestingly, myeloperoxidase, which is a part of oxidative stress, was also found to be higher in the non-PCOS group.What are the implications of these findings for clinical practice and/or further research? This study contributes to the literature because it is the first to compare the relation between CC and oxidant and antioxidant markers. These markers will be a guide for PCOS management in patients with CC-R.


Assuntos
Antioxidantes/metabolismo , Clomifeno/uso terapêutico , Fármacos para a Fertilidade Feminina/uso terapêutico , Infertilidade Feminina/tratamento farmacológico , Estresse Oxidativo/efeitos dos fármacos , Síndrome do Ovário Policístico/sangue , Adulto , Catalase/efeitos dos fármacos , Ceruloplasmina/efeitos dos fármacos , Estradiol/sangue , Feminino , Hormônio Foliculoestimulante/sangue , Humanos , Infertilidade Feminina/sangue , Infertilidade Feminina/etiologia , Peroxidase/efeitos dos fármacos , Síndrome do Ovário Policístico/complicações , Prolactina/sangue , Estudos Prospectivos , Tireotropina/sangue
7.
Cent Eur J Public Health ; 28(2): 124-129, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32592557

RESUMO

OBJECTIVE: The aim of the study was to evaluate the knowledge and perceptions of the pregnant women presenting to our hospital for seasonal vaccination for influenza and to determine the factors associated with it. METHOD: In this cross-sectional study pregnant woman presenting to our hospital between October 2018 and March 2019 were evaluated. A non-validated, well-detailed questionnaire addressing the vaccination rates, participants' perceptions about the facts behind the vaccination for influenza and the factors associated with refusal of vaccination was performed. Women's knowledge level provided by their healthcare providers was also questioned. RESULTS: A total of 250 participants were included in the study. The average age of the patients was 28.85 ± 5.42 years (range 18-43); and the average pregnancy week was 19 ± 9.75. It was determined that 98% (n = 245) of the participants did not have any vaccinations before, and 98.8% (n = 247) did not have any vaccination during their current pregnancy. 65.2% (n = 163) of the participants did not know that the vaccination for influenza was safe in pregnancy; and 64% (n = 160) did not know that the vaccination for influenza was recommended in pregnancy. The most frequent responses given by the participants to justify their refusal for the vaccination was "my doctor was against" and "it can be harmful to my baby" (25.6% and 24%, respectively). It was determined that 98.4% (n = 246) of the participants were not recommended about the vaccination for influenza by any healthcare centres; and 92.8% (n = 232) did not receive any information on vaccination for influenza. CONCLUSION: The knowledge of the participants on vaccination for influenza was inadequate and had misconceptions. The inadequacy of healthcare employees, government institutions and the media may have played roles in this outcome. The reasons underlying the inadequacy of the healthcare providers on vaccination for influenza may be questioned.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Vacinas contra Influenza/administração & dosagem , Influenza Humana/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Gestantes/psicologia , Vacinação/psicologia , Adolescente , Adulto , Atitude do Pessoal de Saúde , Comunicação , Estudos Transversais , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde , Gravidez , Inquéritos e Questionários , Turquia , Adulto Jovem
8.
J Obstet Gynaecol Res ; 44(9): 1761-1765, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29974589

RESUMO

AIM: Ligation of major vessels supplying ovaries may alter hormones and ovarian reserve due to disturbances of vascular circulation. Our purpose is to measure serum anti-Müllerian hormone (AMH) levels and ovarian volume in patients who had internal iliac artery ligation (IIAL) and/or IIAL plus hysterectomy due to uterine atony. METHODS: Patients who underwent IIAL and IIAL+ hysterectomy were evaluated 6 months after their operations and were compared with the control group. The hormones, ovarian volume and antral follicle count (AFC) were measured in each group. RESULTS: Serum AMH levels in the post-partum 6th month interval were lower in the IIAL group than in the control group and were the lowest in the IIAL+ hysterectomy group. Similar to AMH results, AFC and ovarian volumes were also lowest in the IIAL+ hysterectomy group. CONCLUSION: IIAL and hysterectomy are lifesaving interventions during peripartum hemorrhage; however, they might alter ovarian reserve in the short term.


Assuntos
Hormônio Antimülleriano/sangue , Histerectomia , Artéria Ilíaca/cirurgia , Reserva Ovariana/fisiologia , Ovário/anatomia & histologia , Ovário/irrigação sanguínea , Hemorragia Pós-Parto/cirurgia , Adulto , Estudos Transversais , Feminino , Humanos , Histerectomia/efeitos adversos , Ligadura/efeitos adversos , Folículo Ovariano/fisiologia , Período Pós-Parto , Gravidez , Adulto Jovem
9.
Ginekol Pol ; 89(10): 553-557, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30393843

RESUMO

OBJECTIVES: Hysterectomy is one of the risk factors of pelvic organ prolapse (POP). There is no consensus on whether the route of hysterectomy affects the subsequent development of POP. The aim of the study was to assess POP and sexual function 1 year after a hysterectomy when comparing total abdominal hysterectomy (TAH) with total laparoscopic hysterectomy (TLH). The study applied the pelvic organ prolapse quantification (POP-Q) as the measure of POP and a short-form of the POP/Urinary Incontinence Sexual Function Questionnaire (PISQ-12). MATERIAL AND METHODS: All patients that underwent either TAH or TLH due to benign causes between March 2016 and March 2017 at the tertiary hospital used for the study were included in our prospective cohort study. POP-Q measurements and PISQ-12 scores were assessed 1 year postoperatively. RESULTS: We included 182 patients in the clinical examinations. There were no statistically significant differences in demographic characteristics between the TAH and TLH groups. Also, there we no differences observed in the objective POP measurements between the two study groups. Results of the two groups' PISQ-12 scores were also similar. However, postoperative vaginal lengths were found to be significantly shorter in the patients who had undergone TAH compared with those who had undergone TLH. CONCLUSIONS: TAH and TLH are comparable regarding short-term objective pelvic organ prolapse. Although we found statistically a significant difference in vaginal lengths between the two groups, no clinical significance was found in terms of sexual function.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Histerectomia/efeitos adversos , Prolapso de Órgão Pélvico/etiologia , Vagina/patologia , Adulto , Feminino , Humanos , Histerectomia Vaginal/efeitos adversos , Laparoscopia/efeitos adversos , Pessoa de Meia-Idade , Diafragma da Pelve , Período Pós-Operatório , Comportamento Sexual , Incontinência Urinária/etiologia
13.
Exp Clin Transplant ; 22(4): 318-321, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38742325

RESUMO

Tigecycline is a parenteral glycycline antibiotic that is used to treat severe infections caused by susceptible organisms, butitis also associated with hepatotoxicity. We present 2 similar patients with hepatic steatosis possibly associated with early tigecycline after transplant. In the first case, a 61-year-old woman underwent liver transplant for acute severe hepatitis; 6 days posttransplant, because of nonroutine resistant fever, the patient received tigecycline combined with daptomycin. Retransplant was applied to the patient on day 12 posttransplant because of acute liver failure secondary to hepatic vein thrombosis. After retransplant, biochemical levels gradually increased, exceeding the upper limit of normal. In liver biopsy, the patient had macrovesicular steatosis in 70% to 80% ofthe parenchyma. In the second case, a 53-yearold woman underwent liver transplant for liver cirrhosis. Tigecycline was added to the treatment because of recurrent fever on day 6 after transplant, with treatment also comprising piperacillin-tazobactam and meropenem. On day 15 of the patient's tigecycline treatment, her liver function tests were elevated. In liver biopsy, the patient had 30% to 40% macrovesicular steatosis and canalicular cholestasis in the parenchyma, especially in zone 3. Reports of hepatic steatosis associated with early tigecycline after transplant are quite new to the literature.


Assuntos
Antibacterianos , Fígado Gorduroso , Transplante de Fígado , Tigeciclina , Humanos , Tigeciclina/efeitos adversos , Feminino , Pessoa de Meia-Idade , Transplante de Fígado/efeitos adversos , Antibacterianos/efeitos adversos , Antibacterianos/uso terapêutico , Fígado Gorduroso/induzido quimicamente , Fígado Gorduroso/diagnóstico , Resultado do Tratamento , Biópsia , Minociclina/efeitos adversos
14.
J Forensic Leg Med ; 95: 102491, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36758309

RESUMO

PURPOSE: In the present study, the purpose was to determine the indications of pregnancy termination procedures that are performed before and after the limit of viability (between 10 and 22 weeks) in a tertiary center and to investigate the characteristics of the cases in which fetocide procedure was offered after the limit of viability (22 weeks and later). It also aimed to discuss the legal deadline for the fetocide procedure and legal aspect of pregnancy termination. MATERIAL AND METHOD: The present study was conducted as a result of the retrospective examination of 198 cases who underwent pregnancy termination after the 10th week of pregnancy (the legal limit for voluntary termination of pregnancy in our country) in our clinic and met the study criteria. The cases were divided into two main groups as Early Termination (10-22 weeks) and Late Termination (22 weeks and later). The characteristics of these groups (i.e. reason for termination, termination week) and the characteristics of the cases in which fetocide procedure was performed and the cases that were not (i.e. termination week, reasons for termination) were compared. RESULTS: A total of 171 (86%) cases were under 22 weeks and 27 (14%) were 22 weeks or more. In the cases terminated early, the gestational week was found to be highest [20 + 1 (12+3-21 + 1)] in those with preterm premature rupture of membranes, and lowest in those with fetal gastrointestinal abnormalities. No statistically significant differences were detected between the termination reason and the gestational week in the late-terminated group, and also, although the termination week of 5 patients for whom the fetocide procedure was offered [median = 23 + 1 (22+4-26 + 0] was higher than the week of 22 patients for whom the fetocide procedure was not offered [median = 22 + 4 (22+1-25 + 4], the difference was not found to be statistically significant. CONCLUSION: Since the majority of pregnancy terminations are performed before the viable period, the need for the fetocide procedure in pregnancy terminations is relatively low, and we think that this rate will decrease even more because the rate of early diagnosis of fetal anomalies increases as a result of developments in ultrasonographic imaging. Families who choose the termination of pregnancy search for other countries with appropriate legislation and the loss of time and the indecision of the family might cause the application of pregnancy termination after the viable period because of the limitations in the legal regulations of countries.


Assuntos
Aborto Induzido , Doenças Fetais , Gravidez , Feminino , Humanos , Recém-Nascido , Estudos Retrospectivos
15.
Exp Clin Transplant ; 21(10): 837-840, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-35297331

RESUMO

OBJECTIVES: Liver transplant recipients have been reported to be a high-risk population for severe disease from COVID-19 infection. In this crosssectional, single-center study, we investigated whether liver transplant increased the risk of death and severe disease in patients with SARS-CoV-2 infection. MATERIALS AND METHODS: We collected data and serum anti-SARS-CoV-2 immunoglobulin M and immunoglobulin G results of 91 liver transplant recipients seen from September 2020 to March 2021. Liver transplant recipients were enrolled during presentation for scheduled routine follow-up visits. All patients who required serum anti-SARS-CoV-2 immunoglobulin M and immunoglobulin G tests completed a ques-tionnaire on clinical symptoms during the previous 6 months. RESULTS: Among the 91 patients with SARS-CoV-2 immunoglobulin M and G results, 7 patients had a known history of symptomatic COVID-19 during the previous 6 months. Of the 84 participants who completed the questionnaire, 21 (25%) had positive anti-SARS-CoV-2 immunoglobulin M and G results. These 21 patients also received COVID-19 polymerase chain reaction tests, which were negative in all 21 patients. Overall, only 7 patients stated that they experienced flu-like upper respiratory tract infection symptoms or diarrhea. CONCLUSIONS: We documented past SARS-CoV-2 infection in only 25% of our outpatient liver transplant recipients, and most were asymptomatic. We found no significant relationship between symptoms and seropositivity for SARS-CoV-2.


Assuntos
COVID-19 , Transplante de Fígado , Humanos , COVID-19/diagnóstico , COVID-19/epidemiologia , SARS-CoV-2 , Transplante de Fígado/efeitos adversos , Imunoglobulina G , Imunoglobulina M , Transplantados
16.
Turk J Gastroenterol ; 34(4): 332-338, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36789986

RESUMO

BACKGROUND: The aim of the study was to share the effectiveness of pneumatic dilation in geriatric achalasia patients. METHODS: Achalasia patients over the age of 65 and those under the age of 65 as the control group who received pneumatic dilation as the first-line treatment were evaluated in the study. RESULTS: The average age of geriatric patients was 72.5 ± 55.92 years (65-90), with 50.3% of them being male. Follow-up was conducted for a mean of 64.52 ± 38.73 months. While pneumatic dilation was successful in 98.6% (141/143) of geriatric patients, it was also successful in 94% (141/150) of non-geriatric patients. Remission after single balloon dilatation was observed in 81.8% of geriatric patients, while it was observed in only 52.7% of non-geriatric patients (P = .000). When comparing remission after single dilatation and multiple dilatations, it was observed that geriatric patients who achieved remission after multiple balloon dilatation had higher lower esophageal sphincter pressure and Eckardt scores at the diagnosis and higher lower esophageal sphincter pressure and esophageal body resting pressures after the first balloon dilatation. CONCLUSIONS: The proportion of elders in the world population is increasing daily and this disease has been known to disproportionately afflict this group. Although surgical treatments, in particular per-oral endoscopic myotomy, have recently gained popularity as therapies for achalasia, pneumatic dilation remains the most commonly used in geriatric patients.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Acalasia Esofágica , Humanos , Masculino , Idoso , Idoso de 80 Anos ou mais , Feminino , Acalasia Esofágica/cirurgia , Dilatação , Resultado do Tratamento , Pacientes , Esfíncter Esofágico Inferior/cirurgia
17.
Exp Clin Transplant ; 21(2): 123-131, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36919720

RESUMO

OBJECTIVES: Sarcopenia is an important metabolic disorder associated with end-stage liver disease and is an independent predictor of mortality in liver transplant candidates. We evaluated effects of pretransplant muscle mass, muscle quality, and visceral adipose tissue on mortality after liver transplant. MATERIALS AND METHODS: For 2015-2020, we included 65 liver transplant recipients whose records contained pretransplant liver computed tomography images. We calculated skeletal muscle mass index (muscle tissue area in centimeters squared divided by height in meters squared), visceral-to-subcutaneous fat ratio (visceral adiposity indicator), and intramuscular adipose tissue content ratio (muscle quality indicator). RESULTS: Median age was 55 years (IQR, 45-63 years), and 48 (73.8%) patients were men. During follow-up, 53 (81.5%) study group patients survived; mean survival time was 71.73 ± 3.81 months. The deceased patient group had a statistically higher pretransplant visceral-to-subcutaneous fat ratio than the survival group (P = .046). Survival was 100% for 1 positive indicator, 86.2% for 2 positive indicators, and 70.4% for 3 positive indicators (P = .096). Positive correlation was confirmed between pretransplant skeletal muscle mass index and age (P = .043) and pretransplant body mass index (weight in kilograms divided by height in meters squared) (P < .001). There was a moderate positive correlation between pretransplant intramuscular adipose tissue content ratio and age (R = 0.529, P ≤ .001) and a weak positive correlation with pretransplant body mass index (R = 0.361, P = .003). Furthermore, pretransplant visceral- tosubcutaneous fat ratio showed a weak positive correlation with age (R = 0.306, P = .013) and a weak negative correlation with the Model for End-Stage Liver Disease score (R = -0.301, P = .016). CONCLUSIONS: Pretransplant sarcopenia is an important indicator to predict mortality and morbidity in posttransplant follow-up. Visceral-to-subcutaneous fat ratio is an important parameter to evaluate sarcopenia in liver transplant patients.


Assuntos
Doença Hepática Terminal , Transplante de Fígado , Sarcopenia , Masculino , Humanos , Pessoa de Meia-Idade , Feminino , Sarcopenia/diagnóstico por imagem , Doença Hepática Terminal/patologia , Músculo Esquelético/diagnóstico por imagem , Índice de Gravidade de Doença , Estudos Retrospectivos
18.
Exp Clin Transplant ; 21(2): 139-142, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36919722

RESUMO

OBJECTIVES: The most frequent postoperative morbidity following living donor liver transplant is biliary complications, which can happen for both anatomical and procedural reasons. MATERIALS AND METHODS: We conducted a retrospective analysis of 104 patients who were living liver donors undergoing hepatectomy from January 2011 to April 2022. We evaluated all perioperative finding such as age, sex, remnant liver volume, biliary anatomy, theduration of operation time and hospitalization, and blood loss. RESULTS: Clavien-Dindo classification grade III complications were observed in 24% of all donors, with rate of biliary complications of 7.6% (n = 8). All biliary complications were typified as biliary leakage, and an endoscopic retrograde cholangiopancreatography procedure was performed for 5 patients. We analyzed the clinical and surgical features and discovered that the duration of hospitalization was longer in the biliary leakage group than the group without leakage (15.7 ± 5.8 days vs. 30.8 ± 9.3 days, respectively; P < .08). There was no significant statistical relationship between age, the duration of operation time, intraoperative blood loss, and remnant liver volume versus biliary leakage (P = .074, P = .217, P = .219, and P = .363, respectively). CONCLUSIONS: Early detection and treatment of complications are ensured during the perioperative process by carefuldonor selection andaccurate identification of the patient atrisk for biliary complications.


Assuntos
Doenças Biliares , Transplante de Fígado , Humanos , Transplante de Fígado/efeitos adversos , Transplante de Fígado/métodos , Hepatectomia/efeitos adversos , Doadores Vivos , Estudos Retrospectivos , Fígado/cirurgia , Doenças Biliares/etiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia
19.
Exp Clin Transplant ; 21(12): 952-960, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38263782

RESUMO

OBJECTIVES: Patients undergoing liver transplant are at an increased risk of morbidity and mortality due to the development of infections. We aimed to evaluate the risk factors affecting the incidence of infectious diseases after liver transplant and to present the epidemiological data. MATERIALS AND METHODS: We investigated patients aged ≥18 years who underwent liver transplant between 2012 and 2020 at our center. We collected infections, causative microorganisms, and antibacterial resistance patterns seen during the first 6 months posttransplant. Risk factors affecting the development of infectious diseases were also analyzed and evaluated. RESULTS: Of 112 patients included in our study, 76 (67.9%) were men, and the median age was 50 years (range, 20-66 years). Within month 1 and month 6 after transplant, at least 1 episode of infection occurred in 67 (59.8%) and 80 (71.4%) patients, respectively. Bacterial infections were the most common type (n = 78, 95.1%), followed by fungal (n = 2, 2.4%) and viral (n = 2, 2.4%) infections. The rate of multidrug resistance in bacterial infections was high (n = 38, 52.7%) and was also a risk factor for mortality in the first 6 months after transplant (P < .001). Pretransplant values of international normalized ratio, creatinine, bilirubin, and posttransplant intensive care unit stay, as well as the presence of encephalopathy, were shown to increase the risk of infection after transplant. CONCLUSIONS: Multidrug-resistant bacterial infections are a significant risk factor for mortality in liver transplant patients. Many risk factors that contribute to the development of infections aftertransplant have been included in prognostic scoring systems of liver failure. Consequently, the severity of end-stage liver failure is directly related to the risk of posttransplant infections.


Assuntos
Infecções Bacterianas , Doenças Transmissíveis , Doença Hepática Terminal , Transplante de Fígado , Masculino , Humanos , Adolescente , Adulto , Pessoa de Meia-Idade , Feminino , Fatores de Risco
20.
Viruses ; 15(7)2023 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-37515220

RESUMO

We evaluated neutralizing antibodies against the Omicron variant and Anti-Spike IgG response in solid organ (SOT) or hematopoietic stem cell (HSTC) recipients after a third dose of BNT162b2 (BNT) or CoronaVac (CV) following two doses of CV. In total, 95 participants underwent SOT (n = 62; 44 liver, 18 kidney) or HSCT (n = 27; 5 allogeneic, 22 autologous) were included from five centers in Turkey. The median time between third doses and serum sampling was 154 days (range between 15 to 381). The vaccine-induced antibody responses of both neutralizing antibodies and Anti-Spike IgGs were assessed by plaque neutralizing assay and immunoassay, respectively. Neutralizing antibody and Anti-Spike IgG levels were significantly higher in transplant patients receiving BNT compared to those receiving CV (Geometric mean (GMT):26.76 vs. 10.89; p = 0.03 and 2116 Au/mL vs. 172.1 Au/mL; p < 0.001). Solid organ transplantation recipients, particularly liver transplant recipients, showed lower antibody levels than HSCT recipients. Thus, among HSCT recipients, the GMT after BNT was 91.29 and it was 15.81 in the SOT group (p < 0.001). In SOT, antibody levels after BNT in kidney transplantation recipients were significantly higher than those in liver transplantation recipients (GMT: 48.32 vs. 11.72) (p < 0.001). Moreover, the neutralizing antibody levels after CV were very low (GMT: 10.81) in kidney transplantation recipients and below the detection limit (<10) in liver transplant recipients. This study highlights the superiority of BNT responses against Omicron as a third dose among transplant recipients after two doses of CV. The lack of neutralizing antibodies against Omicron after CV in liver transplant recipients should be taken into consideration, particularly in countries where inactivated vaccines are available in addition to mRNA vaccines.


Assuntos
Vacina BNT162 , Transplantados , Humanos , Formação de Anticorpos , Anticorpos Neutralizantes , Imunoglobulina G , Anticorpos Antivirais
SELEÇÃO DE REFERÊNCIAS
Detalhe da pesquisa