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Biomedical subjects

H Akan

Publications and source records attributed to H Akan.

At least 73 records · Page 4Linked to original sources
PubMed1997

Effects of distilled water and mixture of sorbitol-mannitol irrigation fluids on fluid-electrolyte balance in patients undergoing transurethral prostatectomy.

This study aimed to compare two various irrigation fluids used in transurethral prostatectomy (TURP) with respect to changes in fluid-electrolyte balance and to evaluate the blood loss during TURP. TURP was performed in 50 patients using distilled water and in 42 patients using a mixture of sorbitol and mannitol solution (2.7% sorbitol and 0.54% mannitol) as irrigation fluid. Fluid-electrolyte changes and blood loss were evaluated. None of the patients had transurethral resection syndrome. Decline in serum sodium level was more significant in patients who were operated on with the sorbitol plus mannitol irrigation fluid in contrast to its clinical insignificance (p < 0.05). Decrease in serum sodium concentration in patients with more than 15 g of tissue resected was greater than in patients with less than 15 g of tissue resected (p < 0.05). Blood loss was greater in the distilled water group (p < 0.05). Blood loss was 145.5 +/- 3.4 ml in patients given a blood transfusion. In conclusion, a fluid containing mainly sorbitol must be the irrigation fluid preferred over distilled water because of its non-haemolytic nature, but although not important clinically, it can cause hyponatraemia more than distilled water. Furthermore, it is useful to determine blood loss during TURP before deciding to give a blood transfusion.

Aged↗
PubMed1997

Incidence of graft vs host disease in allogeneic bone marrow transplantation in a single center study from Turkey.

Graft versus host disease (GVHD) is one of the obstacles encountered in allogeneic bone marrow transplantation (alloBMT) and has a direct impact on the transplant outcome and survival. In this report, we summarized the incidence of acute and chronic GVHD among 71 HLA matched and 9 HLA mismatched sibling alloBMTs performed for various hematological malignancies, mainly leukemias seen at Ibn-i Sina Hospital. Fifty-five were male and 25 were female Turkish patients. Median age was 29 (12-48). Cyclophosphamide(CY)+total body irradiation (TBI)(12), CY+total lymphatic irradiation (TLI)(6), busulfan (BU)+CY(58) and ALG/ATG+CY(4) were the regimens used for conditioning. Cyclosporin A (CsA)+short term methotrexate were given for GVHD prophylaxis except for two syngeneic transplants who both received only CsA. In 22 of the patients ABO and in 30 patients sex mismatched bone marrow was given. Thirty-one (38.8%) patients showed acute GVHD (grade I-II: 22, grade III-IV: 9) and 8 (11.6%) showed chronic GVHD. In HLA matched and mismatched patients acute GVHD incidence were 33.7% and 44.4% respectively. All of the HLA mismatched patients that showed acute GVHD were in advanced stage. Of the patients with acute GVHD, 28 (96.5%) disclosed skin, 22 (75.9%) hepatic and 14 (48.3%) gut involvement. In the chronic form three patients had mild limited, two limited, two moderate and one advanced GVHD. Seven of the patients were lost due to GVHD. To determine the graft versus leukemia effect of alloBMT, we compared the disease free survival (DFS) of the 68 leukemia patients. Although the patients who had grade I-II acute GVHD showed a better DFS than the patients who did not have acute GVHD, it did not reach to a significance (15.9 vs 13.6 months: p = 0.43).

Adolescent↗
PubMed1997

HLA DR2: a predictive marker in response to cyclosporine therapy in aplastic anemia.

The effect of immunosuppressive agents on HLA DR2-aplastic anemia (AA) has recently been investigated by different groups. In the present report, we analyzed 40 Turkish AA patients, who received immunosuppressive therapy (IST) and 12 AA's who were transplanted from HLA matched siblings. HLA DR2 frequency was 0.442 and significantly higher in AA's when compared to an unrelated healthy control group (RR: 2.93, 95% confidence interval 1.48-5.77, P = 0.001. Patients received antithymocyte or antilymphocytic globulin (AT/LG) or AT/LG plus cyclosporine-A (CsA) or CsA alone. In DR2+ and DR2- patients overall response rates were 73.3 and 30%, respectively (P = 0.03). When patients were analyzed separately, CsA administration either alone or in combination with AT/LG gave favorable results in the DR2+ group (P = 0.02). In contrast AT/LG presence alone was shown to be inadequate.

Adolescent↗
PubMed1997

Hepatitis B virus infection in allogeneic bone marrow transplantation.

Fourty-four patients who underwent allogeneic bone marrow transplantation (alloBMT) were studied for hepatitis B virus (HBV)-related complications. The mean follow-up period was 15.3 months. Positivity for HBV surface antigen (HBsAg) was observed in 10 patients (22.7%) throughout the study. Four of the 10 patients were HBsAg carriers before alloBMT, while the remaining six became HBsAg(+) after alloBMT. During the follow-up period (from 6 months to 45 months), an elevation in serum ALT activity was observed in the four carriers when immunosuppression was reduced or withdrawn. All of the four HBsAg carriers developed hepatitis, but none of them died of liver failure due to HBV. Only one death due to GVHD and diabetic ketoacidosis was observed in this group. Two of the four carriers received marrow from anti-HBs positive donors and one of them cleared HBsAg from his serum via adoptive immunity 8 months after transplantation. The remaining six patients acquired HBV after alloBMT, but we were unable to demonstrate the source of HBV. Five of them had a moderate increase in serum ALT activity while the other patient had a normal ALT. Two patients seroconverted to anti-HBs spontaneously. Two patients died during the follow-up, one due to intracranial hemorrhage and the other due to GVHD and accompanying pulmonary infection. The rest of the study group (34 patients) remained HBsAg(-) throughout the study. Two of them had an HBsAg(+) donor, but neither developed HBV infection in their follow-up period. The acquisition rate of HBV infection was relatively low in recipients who were positive for anti-HBs compared to those who were negative for anti-HBs (8 vs 19%). Anti-HBs positivity remained for a longer period in recipients who received marrow from anti-HBs positive donors compared to those recipients who had anti-HBs negative donors (median 12 vs 3 months). We think that HBV is a frequent cause of liver dysfunction in alloBMT patients where HBV infection is endemic. Whether the disease is in the form of reactivation of HBsAg-positive recipients, or is acquired from unknown sources in recipients who never had contact with the virus, the course of the disease is not fatal. Silent serologic changes can be demonstrated if viral serologic markers are sought serially. Among them, the disappearance of serum anti-HBs may be important as it increases the risk of HBV contamination in recipients.

Adolescent↗
PubMed1997

Use of high-dose chemotherapy plus granulocyte colony-stimulating factor for the salvage of refractory or resistant-relapse lymphoma patients without stem cell support.

The combination of cyclophosphamide (CY) and etoposide is synergistic, spares bone marrow stem cells and can be given repeatedly in high doses without stem cell support. Thirteen patients with non-Hodgkin's lymphoma (n = 8) or Hodgkin's disease (n = 5), received high-dose chemotherapy (HDC). Median age was 32 years (24-52). Male to female ratio was 10:3. All the patients were in advanced-stage. Karnofsky score prior to HDC was 60% (range 40-90). Six patients showed primary refractoriness and 7 had resistant relapse. HDC consisted of CY 1,500 mg/m2/day and etoposide 300 mg/m2/day, both for 4 days. rhG-CSF was started 24 h after the last dose of chemotherapy as a continuous intravenous infusion at a dose of 0.01 mg/kg/day and stopped when the leukocyte count reached 1 x 10(9)/1 on 3 consecutive days. Overall, 69% (9/13) of patients responded to HDC. Four achieved CR and 5 achieved PR. Two of the patients showed disease progression. The other 2 died during the early period of HDC. Neutrophil and platelet recovery after HDC were 8 (6-16) and 10 (4-14) days, respectively. The major nonhematological toxicities were nausea-vomiting (100%) and diarrhea (61%). The median follow-up was 204 (7-600) days. Two patients relapsed 48 and 185 days after HDC. Eight patients are still alive, 7 progression free. The progression-free survival is 220 (40-285) days. In conclusion, HDC + granulocyte colony-stimulating factor (G-CSF), without stem cell support seems to be promising in refractory or resistant relapse lymphoma patients bringing the need for randomized studies to show the cost effectiveness of HDC + G-CSF compared to HDC + autologous stem cell support.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

Hemorrhagic cystitis as a complication of bone marrow transplantation.

Hemorrhagic cystitis (HC) is one of the most troublesome complications of bone marrow transplantation (BMT) and sometimes may be life-threatening. The etiology and prevalence of HC depends on the type of the transplant and the period after BMT. Here we report about 134 patients transplanted in a single center (89 allogeneic and 45 autologous) between May 1988 and August 1995. Forty-six patients (34.3%) had HC after BMT. Thirty-four (38%) alloBMT patients and 12 (27%) autoBMT patients had HC (p = 0.18). The onset of HC was 7 to 125 days after transplantation. The degree of HC was mild to moderate in 25 (28%) and severe in 9 (10%) allogeneic transplants. In autologous transplants, all of the episodes of HC were mild to moderate. Age, sex, diagnosis and the dosage of mesna used for prophylaxis were not correlated with the incidence of HC. In 36 of 46 (78.2%) patients HC occurred early and as a transient form. Ten (21.7%) were late and long-lasting. In 2 patients who had late starting and long-lasting HC after allogeneic BMT, electron microscopic examinations revealed virus-like structures in bladder epithelial cells.

Adolescent↗
PubMed1997

Allogeneic peripheral blood stem cell transplantation: is there an increased risk of graft vs host disease in leukemia patients?

Fifteen patients with hematological malignancies [9 acute nonlymphoblastic leukemia (ANLL), four chronic myelogenous leukemia (CML), two acute lymphoblastic leukemia (ALL)] received allogeneic peripheral blood stem cell transplantation (alloPBSCT) from HLA-identical sibling donors. Donors received 2.5-15 micrograms/kg/day of recombinant human granulocyte colony stimulating factor (rhG-CSF) for 5-10 days. Administration of rhG-CSF was well tolerated except for mild to moderate bone pain occurring in all the donors which was relieved by oral paracetamol. A total of 40 leukaphereses were performed for the 15 donors using the bilateral antecubital veins. None of the donors needed central venous line insertion. The median number of apheresis procedures for each patient was 3 (2-3). A median of 7.7 (4-38.2) x 10(8)/kg mononuclear cells, 35 (2.4-90.0) x 10(6)/kg CD34+ cells, 1.85 (0.45-4.8) x 10(8)/kg CD3 and 0.3 (0.16-1.01) x 10(8)/kg natural killer cells were given without any manipulation. Cyclosporin A (CsA) plus short-course methotrexate (MTX) (12 patients) and CsA alone (3 patients) were used for graft versus host disease (GVHD) prophylaxis. Median granulocyte and platelet engraftments were done on days 11 (10-31) and 16 (11-54) respectively. Grades II-IV GVHD occurred in 62% of the patients and grades III-IV in 15%. Twelve patients are still alive with full engraftment and disease-free. In conclusion, alloPBSCT is an alternative to allogeneic bone marrow transplantation, because of the ease of collection and rapid hematological recovery. However, there is a trend for increased acute GVHD in our leukemia patients compared to allogeneic bone marrow.

Adult↗
PubMed1997

Acute appendicitis: MR imaging and sonographic correlation.

OBJECTIVE: Acute appendicitis is the most common indication for emergency abdominal surgery. To our knowledge, MR imaging has not been compared with sonography for revealing acute appendicitis. Our aim was to assess and compare the accuracy, advantages, and limitations of MR imaging and sonography in revealing appendicitis. SUBJECTS AND METHODS: The study included 60 consecutive patients suspected of having appendicitis who underwent abdominal sonography and MR imaging. Fat-suppressed T2-weighted fast spin-echo and gadolinium-enhanced fat-suppressed T1-weighted spin-echo axial and coronal images were obtained. The initial MR imaging and sonographic studies were later correlated with the surgical-pathologic findings, follow-up evaluations, and diagnosis at the time of discharge. RESULTS: Surgical, histopathologic, and follow-up results revealed that 34 patients had appendicitis. Of the 26 patients without appendicitis, 15 with symptoms of acute appendicitis had no pathologic diagnoses and the remaining 11 had another diagnosis. Comparison of the sensitivity, accuracy, and negative predictive values for MR imaging and sonography was found to be statistically significant (p < .05, chi-square test), indicating that MR imaging was superior to sonography in revealing appendicitis. We found no statistical difference in specificity and positive predictive value for MR imaging and sonography. CONCLUSION: Despite some disadvantages, we found MR imaging to be superior to sonography in revealing suspected acute appendicitis. MR imaging can be used after suboptimal or nondiagnostic sonography in cases of suspected acute appendicitis.

Acute Disease↗
PubMed1997

Administration of MINE protocol in untreated patients with intermediate and high grade non-Hodgkin's lymphoma.

In recent years, more effective and less toxic treatment protocols have been developed to increase the cure rates in intermediate and high grade non-Hodgkin's lymphoma (NHL). This study was undertaken to investigate the efficacy and toxicity of MINE (ifosfamide, mesna, mitoxantrone and etoposide) combination chemotherapy in patients with intermediate and high grade NHL. Twenty-one patients (16 male, 5 female; age between 26 and 70 years) with NHL were included in the study. An overall response rate of 73% and complete response rate of 56% were achieved and survival rate for responding patients was 80% at the 48th month. Side effects including mild myelosuppression, nausea/vomiting and alopecia were observed. MINE combination seems to be effective and well tolerated without significant toxicity as a first-line therapy in patients with intermediate or high grade NHL.

Adult↗
PubMed1996

Comparison of three different irrigation fluids used in transurethral prostatectomy based on plasma volume expansion and metabolic effects.

OBJECTIVE: To examine changes in the pathophysiology of the transurethral resection (TUR) syndrome with various irrigation fluids. PATIENTS AND METHODS: Three different irrigation fluids (5% mannitol in 21 patients, group A; 1.5% glycine in 18 patients, group B; and a fluid containing 2.7% sorbitol and 0.54% mannitol in 20 patients, group C) were compared during transurethral prostatectomy (TURP) by assessing plasma volume expansion, calculated using the haematocrit dilution method, and several biochemical variables. RESULTS: None of the patients experienced TUR syndrome and none showed a change in plasma osmolality (P > 0.05). However, serum sodium, haemoglobin, haematocrit, total protein and albumin levels declined (P < 0.01). The decrease in total protein and albumin level was greater in group A than in groups B and C (P < 0.01 for both). Although the amount of fluid absorbed was the same in all of the groups (P > 0.05), plasma volume expansion was greater in group A than in B or C (P < 0.05 for both). Hyperammonaemia, encountered in group B, was more evident with increasing weight of the resected tissue. However, this increase was insufficient to cause encephalopathy. CONCLUSION: Although it was not important clinically, mannitol solution could cause more evident hypervolaemia than glycine and sorbitol solutions; glycine solution could cause hyperammonemia, but the solution containing mainly sorbitol had no such adverse effects.

Aged↗
PubMed1996

The importance of the angulation and termination of external jugular vein in central venous catheterization in newborn.

The purpose of this study is to evaluate the termination and angulation of the EJV (External jugular vein) and the number and the position of its valves so as to improve our understanding of the anatomy of the EJV and to make the manuplation easier in central venous catheterization in newborn. The present study was carried out on 50 newborn cadavers (31 male, 19 female). 100 Dissections were bilaterally made. The angle of the termination of the EJV was measured. Its termination angle was also radiologically measured. Its termination was classified into three types: In 72 cases (72%), EJV flowed into the jugulo-subclavian venous confluence; in 26 cases (26%), into the SCV (Subclavian vein) at a distance (1cm) from its junction with the IJV (Internal jugular vein); in 2 cases (%2) into the trunk of the IJV. Its termination types were asymmetrical in 12 cadavers (24%) and symmetrical in 38 (76%). Its termination angle was found both anatomically or radiologically to be within 25 degrees-60 degrees. The valves of the EJV were examined in 10 newborn cadavers. They were most often bi-valvular, in paraostial position and were of a membranous character. It is important to remind the physician about the surprises related to its terminations and angulations during the central venous catheterization.

Cadaver↗
PubMed1996

Pulmonary alveolar microlithiasis associated with calcifications in the seminal vesicles.

Pulmonary alveolar microlithiasis is an inherited disorder of unknown etiology. It is a rare disease characterized by calcified intraalveolar microgranules. Several hypotheses on the etiopathogenesis have been put forward, such as increased intestinal calcium resorption and retention. This case report of pulmonary alveolar microlithiasis is associated with punctate calcifications in the seminal vesicles.

Adult↗