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Basaran G.,Marmara University | Turhal N.S.,Marmara University | Cabuk D.,Marmara University | Yurt N.,Marmara University | And 5 more authors.
Medical Oncology | Year: 2011

Weight gain is a well-known and unwanted complication of adjuvant chemotherapy in breast cancer. We observed that the female Turkish cancer patients frequently gain weight with adjuvant treatment of breast cancer and planned to examine the magnitude of this problem in early breast cancer patients treated at our hospital. A total of 176 early breast cancer patients who received their adjuvant systemic therapy in Marmara University Hospital between 2003 and 2007 are included in the study. We recorded their weight before and after chemotherapy and also a year after chemotherapy to find out whether the change with weight is transitory. We have also recorded demographic information, including the educational level, menopausal status, the type of chemotherapy or hormonal treatment administered stage of disease, marital status, occupation and the underlying diseases to analyze the relationship between change in weight and these parameters. Median age of patients was 53 and 72% of patients were postmenopausal. Educational level was equally distributed for primary education (27%), high school (40%), and university (33%). The majority of the patients (76%) was married, had two children (69%) and was housewife (60%). Family history of any cancer was high (32%). Most of the patients had stage II cancer (56%), received anthracyclines+/- taxane based chemotherapy (98%) and had no underlying disease (68%). The majority also did not smoke (73%) or drink alcohol (93%). A total of 67% and 72% patients gained weight upon completion and one year after completion of chemotherapy. Mean weight before the chemotherapy, upon completion of chemotherapy and one year after completion of chemotherapy were 68.9 kg, 70.6 kg (P = 0.000) and 71.9 kg (P = 0.000) respectively. Mean body mass index was 27.1 at baseline, 27.8 upon completion of chemotherapy (P = 0.000) and 28.3 one year after completion of chemotherapy (P = 0.000). Age, menopausal status, multiparity and presence of comorbid diseases had statistically significant impact on weight gain following adjuvant therapy in breast cancer patients (P = 0.000, P = 0.008, P = 0.015 and P = 0.017 respectively). This study shows that Turkish women with early breast cancer gain weight after adjuvant systemic therapy, in line with European and American counterparts. This increase in weight is maintained at least one year after adjuvant therapy. Given the adverse consequences of weight gain in terms of both breast cancer prognosis and general health, it is necessary to inform patients about this change and to develop strategies for weight maintenance during and after systemic therapy. © 2010 Springer Science+Business Media, LLC.

Ak O.,Kartal Research and Education Hospital | Yildirim M.,Transplant Center | Kucuk H.F.,Transplant Center | Gencer S.,Kartal Research and Education Hospital | Demir T.,Transplant Center
Transplantation Proceedings | Year: 2013

Aim: Infectious complications after renal transplantation (RT) are associated with significant morbidity. They continue to be the most frequent cause of mortality. We investigated the incidence of infections, the causative pathogens, and risk factors contributing to this complication during the first year. Patients and Methods: We included demographic and clinical data of the 124 patients who underwent RT in our hospital from December 2004 to June 2010. for statistical analysis. Results: Fifty (40.3%) RT recipients developed 80 episodes of infection: urinary tract (n = 68; 85%), intraabdominal (n = 4; 5%), surgical wound (n = 3; 3.8%), or central venous catheter (n = 3; 4%). Eight (10%) were bacteremic. The most commonly isolated bacteria scene (76/80) was Escherichia coli (n = 43; 56.5%) followed by Klebsiella spp. (n = 10; 13.2%) and Pseudomonas spp. (n = 10; 13.2%). Cytomegalovirus infection was detected in 2 recipients; fungal and mycobacterial infections, in no case. It was noteworthy that 52.8% of E. coli and Klebsiella spp. produced extended-spectrum beta-lactamase. Ninety percent of infections developed within 6 months after transplantation. When we compared infected versus noninfected cases, the presence of a double J catheter was the most significant risk factor (P =.018; odds ratio [OR] = 0.234; 95% confidence interval [CI] = 0.070-0.781). In contrast to the initial years after the start of RT in our hospital the incidence of infection decreased over time together with a decrease number and durations of catheterization (P =.008; OR = 2.707; 95% CI = 1.292-5.672). Conclusions: Urinary tract infections were the predominant problem with most isolates resistant to extended-spectrum antibiotics. Therefore, invasive catheters and prophylactic antibiotics should not be used for longer than necessary and infection control measures implemented to decrease the incidence of infections and bacterial resistance. © 2013 Elsevier Inc.

Akbas N.B.,Yeditepe University | Dalbayrak S.,Kartal Research and Education Hospital | Kulcu D.G.,Yeditepe University | Yilmaz M.,Kartal Research and Education Hospital | And 2 more authors.
Journal of Neurosurgery: Spine | Year: 2010

Object. Sexuality is an important aspect of human life. Sexual activity may be affected in lumbar disc herniation through different mechanisms. The aim of this study is to evaluate patients' sexual problems and sexual behavior patterns before and after surgical treatment of lumbar disc herniation. Methods. Forty-three patients were included in the study (mean age 41.4 years). A visual analog scale, the Oswestry Disability Index, the Hospital Anxiety and Depression Scale, and a sexuality assessment questionnaire developed for this study were administered to the patients to evaluate pain and sexual dysfunction. Results. Fifty-five percent of the men and 84% of the women reported experiencing sexual problems after the onset of low-back pain. The most common sexual problems were decreased sexual desire (18%) and premature ejaculation together with erectile dysfunction (18%) for the male patients, and decreased sexual desire (47%) for the female patients. The frequency of sexual intercourse before the operation was reduced in 78% of cases compared with the pain-free period. Postoperatively, the patients first attempted sexual intercourse a mean of 26.5 days after surgery. The frequency of intercourse was found to have increased (p = 0.01), while description of any type of sexual problem had decreased (p = 0.005) significantly. Conclusions. Lumbar disc herniation has negative effects on sexual life, and not enough attention is given to the patients' sexual problems by the physicians. Decreased sexual desire and decreased sexual intercourse are the most commonly reported problems. Taking time during examination and giving simple recommendations may improve sexuality and life quality of the patients.

Yildirim M.,Kartal Research and Education Hospital | Kucuk H.F.,Kartal Research and Education Hospital
Transplantation Proceedings | Year: 2011

Aim: We reviewed our renal transplantation experience with multiple renal arteries and veins. Method: We divided the patients who underwent renal transplantation between 2004 and 2009 into two groups according to the vascular structure: multiple (group 1) versus single (group 2). Vascular anastomoses were primarily completed in an end-to-side manner to the external iliac artery and vein. The number of involved vessels was 51 among the 23 patients in group 1. We evaluated the function of the transplanted kidney using scintigraphic studies and serum creatinine levels. Results: The male:female ratios were 15:8 and 73:30, mean ages 31.9 (range = 1264) and 33.4 (range = 1764) years, and the living related:cadaveric donor ratios 18:5 and 75:28 for groups 1 and 2, respectively. There was one case of acute rejection in group 1, and seven cases in group 2. The number of kidneys with delayed function was 11 in group 2 and one in group 1. Two perirenal abscesses, two urinary fistulae, one lymphocele, two hematomas around the kidney, and four renal artery stenoses were seen in group 2. The complication rates were 21.79% in group 1 and 35.92% in group 2. (χ2 = 1.70, P > .05). The mean creatinine levels at 1 month after the transplantation were 1.21 ± 0.38 mg/dL and 1.12 ± 0.31 mg/dL in groups 1 and 2, respectively (P = .215). Conclusion: The incidences of postoperative complications were not different for renal grafts involving multiple versus single vessels. © 2011 Elsevier Inc. All rights reserved.

Demiray M.,Kartal Research and Education Hospital | Kucuk H.F.,Kartal Research and Education Hospital | Yildirim M.,Kartal Research and Education Hospital | Barisik N.O.,Kartal Research and Education Hospital
Transplantation Proceedings | Year: 2012

Aim: The aim of this experimental study was to examine the effects of mycophenolate mofetil (MMF) on liver regeneration in a partial hepatectomy model. Methods: Rats were divided into 3 groups immediately following partial liver resection: saline, controls intraperitoneally (MMF; Group 1); MMF (15 mg/kg/d; Group II), and MMF (30 mg/kg/d; Group III). On days 3 and 7 following liver resection we humanely killed half of the rats in each group to measure alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels and to evaluate Ki-67 using immunohistochemistry. We calculated liver regeneration rates. Results: The difference between ALT levels on days 3 and 7 was not significantly different among the groups (P =.157; P =.292; P >.05, respectively). The AST levels were significantly different at 3 days (P =.018) but not 7 days (P =.385). The Ki-67 level were different among groups at day 3 (P =.002) but not at day 7 (P =.290). Liver regeneration rates were not different among the groups either at 3 or at 7 days (P =.264 and P =.925, respectively). Conclusion: MMF stimulates mitosis but its effect on regeneration is not clear. MMF appeared to show no adverse effects on liver regeneration. © 2012 Elsevier Inc. All rights reserved.

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