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This study aimed to compare the infection rate and infection-related mortality among all renal replacement therapies during the COVID-19 pandemics.One thousand three hundred thirty-six end-stage renal disease (ESRD) patients who had applied for renal replacement therapy between March 2020 and January 2021 were included in the study. COVID-19 infection and mortality rates were compared between patient groups.The COVID-19 infection rate in the whole study group was 13.12% (n: 178). The highest infection rate was in the center hemodialysis, 16.33% (n: 139). There was no COVID-19 infection in home hemodialysis (HHD). Mortality rate was 2.87% (n: 39) in the whole cohort and 3.87% (n: 33) in center hemodialysis (CHD), 1.47% (n:5) in kidney transplant (Tx), and 0.81% (n: 1) in the peritoneal dialysis (PD) group. COVID-19 infection rate of home replacement therapy (HRT) (n: 39) patients was significantly lower than CHD (n: 139) (p 0.001).The COVID-19 infection rate and mortality were significantly lower than those of CHD in all home-based modalities subgroups.

Left ventricular apical thrombusThe study population included 378 patients (mean age: 56.5 ± 12.3 years, male: 318) presenting with AMI between January 2016 and January 2020. Primary percutaneous coronary intervention procedure was performed in all patients. Initial echocardiogram was performed within 7 days of admission. All patients were evaluated with echocardiography at 3rd, 6th and 12th months. Patients were divided into two groups according to the presence of LVAT on echocardiography.The incidence of the LVAT was 8.5% (High CHA2DS2VASc score, low LVEF and the presence of LV apical akinesis/aneurysm may be used for LVAT risk prediction among patients presenting with AMI.

Hat Sanatında devrinin önemli hattatları arasında sayılan Yahyâ Hilmî Efendi, özellikle sülüs ve nesih yazıda fevkalâde kudretli bir hattat idi. Küçük yaşlarda dini ilimlere ve hat sanatına olan merâkı sebebiyle Mehmed Hâşim (ö. 1261/1845), Halil Zühdî (ö. 1280-1290/1863-1874) ve Hüseyin Lütfî (ö. 1280-1290/1863-1874) gibi hocalardan sülüs-nesih dersleri almıştır. Henüz on beş yaşlarında başladığı ve ömrünün çoğunu geçirdiği Bâb-ı Seraskerî’deki memuriyeti nedeniyle hat sanatına ağırlık veremese de Osmanlı hat sanatında sülüs ve nesih yazılarıyla dönemin en meşhur hattatları arasında yer alan ve devrin en büyük nesih üstâdlarından Kazasker Mustafa İzzet Efendi (ö. 1293/1876) ve Mehmed Şevkî Efendi’den (ö. 1304/1887) sonra zikredilmektedir. Şeyh Hamdullah’ın (ö. 926/1520) yazmaya başlayıp yarım bıraktığı Mushaf-ı Şerîfi 350 yıl sonra aynı üslubla tamamlaması ve yine Ramazan-ı Şerîf’te yirmi altı gün gibi kısa sürede bir Mushaf-ı Şerîf yazması, Yahyâ Hilmî Efendi’nin kaleminin sür’atine ve nesih yazıda ne kadar mâhir olduğunu göstermektedir. Mustafa Râkım (ö. 1241/1826) şîvesi taşıyan sülüs-nesih yazılarıyla pek çok eser ortaya koymuştur. Ahir ömrüne kadar birbirinden değerli talebeler yetiştirmiş, talebesi olmayanların ise icâzetnamelerinde musaddık olarak katılmıştır.

INTRODUCTION There is no consensus on an ideal marker of oxidative stress (OS). Disruption of the balance between free radical and antioxidant activity production by increasing oxidative markers results in OS. In this study, we aimed to investigate how OS, which increases mortality and morbidity due to various reasons, is affected by keto/amino therapy in patients with hypoalbuminemia undergoing peritoneal dialysis. MATERIALS AND METHOD Twenty patients who underwent peritoneal dialysis were included in the study. Before starting keto/amino acid therapy, primary kidney diseases were determined, body mass indexes, serum total protein, albumin, C-reactive protein, ferritin, calcium, phosphorus, parathyroid hormone, paraoxonase-1 (PON-1), sialic acid levels, arylesterase (ARE) activities, and malondialdehyde (MDA) levels were measured, and Kt/V values were calculated. Keto/amino acid treatment was initiated for those with an albumin level of

Background Left ventricular systolic dysfunction (LVSD) may develop without coronary artery disease, hypertension (HT), or valvular pathologies in patients with diabetes mellitus (DM), which is defined as diabetic cardiomyopathy (DCM) and its pathophysiology is still unclear. Diabetic retinopathy (DR) is a microvascular complication of DM, and patients with DR have increased risk for the development of heart failure (HF). Two-dimensional speckle tracking echocardiography (2D-STE) evaluates longitudinal deformation in left atrium (LA) myocardium and previous studies utilizing 2D-STE have revealed the detrimental effects of DM on LA functions. Although some studies have shown the association between DR and left ventricle (LV) systolic functions, as far as the researchers of this study investigated, there is no study evaluating the relationship between LA deformation parameters and DR. Hence, we aimed to investigate the relationship between the presence and the degree of DR and LA deformation parameters. Results LA deformation parameters were analyzed in terms of LA reservoir, conduit, and contractile functions according to the degree of DR. LA reservoir strain value was 14.2 ± 3.6 in normal retina group, 12.2 ± 4.1 in non-proliferative diabetic retinopathy (NPDR) group, and 13 ± 3.7 in proliferative diabetic retinopathy (PDR) group (P = 0.04). LA contractile strain was 15.9 ± 6.8 in normal retina group, 13.1 ± 47.4 in NPDR group, and 9.9 ± 4.7 in PDR group (P P P = 0.04), DR presence (OR 0.24; 95% CI 0.11–0.50; P = 0.001), and increasing left atrial volume index (LAVI) (from 33.5 to 52.6; OR 0.62; 95% CI 0.43–0.89; P = 0.01) were associated with decreasing LA function; however, other variables indicated no association. Conclusions Our results showed the relationship between LA deformation parameters and DR, although microvascular involvement is not a certainly defined cardiovascular risk factor. Further prospective studies are needed to determine the clinical importance of DR presence and its degree for deformation parameters.

Right ventricular (RV) perforation is a rare but life-threatening complication of pericardiocentesis and is usually treated surgically. We presented a case of RV free wall perforation, which occurred during pericardiocentesis and tried to be closed percutaneously with the Amplatzer vascular plug-III (AVP-III) device. The occluder device sealed the perforation, but it was in an insecure position; therefore, the patient underwent surgical repair. As an AVP-III device, with a middle disk thicker than the RV myocardium, it may cause the RV myocardium to stretch outwards, so it should not be used for the treatment of RV perforation by the transcatheter way.

Kültürel mirasımızın önemli unsurlarından olan el yazması eserler, kütüphane, müze ve özel koleksiyonlarda muhafaza edilmektedir. Kütüphaneler kıymetli yazma ve matbu eserleri barındıran, koruyan ve bugüne taşıyan merkezlerdendir. Üsküdar’da bulunan Hacı Selim Ağa Kütüphanesi de bünyesinde çeşitli eserler ve koleksiyonlar bulundurmaktadır. Çalışmada Hacı Selim Ağa Kütüphanesi Kemankeş koleksiyonunda yer alan ebru ciltli eserler incelenmiştir. İncelenen eserler ebru sanatı açısından değerlendirilecektir. Geçmişten günümüze ebru sanatı ve kitap sanatlarındaki kullanımı ile ilgili kaynakların değerlendirilmesi yapılmıştır. Yöntem olarak, literatür taraması ve yerinde inceleme yapılarak hazırlanmış ve kütüphane yetkililerinin bilgilerine başvurulmuştur. Kemankeş koleksiyonunda yer alan eserler incelenmiş çok yıpranmış ve tahlili yapılamayanlar dahil edilmemiştir. İncelenen örnekler sonucunda ebru sanatının geçmiş dönemlerde uygulanma şekilleri ve renk kullanımı konusunda bize fikir vermiş ve günümüze nasıl ulaştığını anlamamızı sağlamıştır. Kültürel mirasımıza katkı sağlayan, geçmiş ve gelecek arasında köprü olan bu değerlerimizin korunması, gelecek kuşaklara ak aktarılmasının önemine değinilmiştir.

First identified in China in December 2019, coronavirus disease 2019 (COVID-19) has rapidly evolved into a global pandemic. The presence of haematological malignancies are expected to increase the risk of adverse outcomes from this viral infection due to the immunosuppression brought about by the underlying cancer and the effects of therapy. We present a 55-year-old woman diagnosed with relapsed/refractory Hodgkin’s lymphoma (HL) who had been heavily pretreated with multiagent chemotherapy, autologous hematopoietic stem cell transplantation (autoHCT), allogeneic hematopoietic stem cell transplantation (alloHCT) and was complicated with EBV associated posttransplant lymphoproliferative disease (PTLD) and chronic graft-versus-host-disease (GVHD). The patient was recently treated with brentuximab and donor lymphocyte infusion (DLI) for relapse after alloHCT. She suffered from severe COVID-19 pneumonia and eventually succumbed to acute respiratory distress syndrome (ARDS) and multiorgan failure. Of note, this is the first reported case of COVID-19 in a HL patient who was being treated with brentuximab for relapse after alloHCT.

Geçmişten günümüze ulaşan kültürel mirasımızın sembolü el yazması eserler, bugün özel koleksiyon, müze ve kütüphanelerde muhafaza edilmektedir. Kütüphane, bünyesinde farklı tarihlere ait yazma eserleri barındıran bir hazinedir. Bu kütüphanelerden biri de Süleymaniye Yazma Eserler Kütüphanesi’dir. Bu makalede, Süleymaniye Yazma Eserler Kütüphanesi, Yazma Bağışlar koleksiyonunda bulunan XIX. Yüzyıla ait dört adet Kur’ân-ı Kerîm’in serlevha bezemeleri ele alınmıştır. Eserlerin tamamı Osmanlı tezhip sanatında Batılılaşma dönemi olarak da adlandırılan XIX. yüzyıl tezhip sanatının tezyînat özelliklerini gözler önüne seren örneklerdir. Bu dönemde, serbest formda yapılan yaprak motifleri ve natüralist üslûpta çiçek tasvirleri bezemelerde sıklıkla tercih edilmektedir. Müzehhep serlevha sayfaları, sayfa düzeni, desen, motif, kompozisyon, renk özellikleri, döneminin tezhip anlayışını temsil etmesi ve tezhip sanatı bakımından önemlidir., Manuscripts, symbols of our cultural heritage from past to present, are preserved today in libraries, museums and private collections. The library is a precious treasure that sheds light on today with its manuscripts belonging to various dates. One of these libraries is the Süleymaniye Manuscript Library. In this article, the illuminated headings of four Quran from 19th century, which are in the Manuscript Donations collection of Süleymaniye Manuscript Library, are examined. All of the manuscripts are examples showing the decorative features of the 19th century illumination art, also known as the Westernization period in Ottoman illumination art. In this period, leaf motifs made in free form and flower depictions in naturalist style are frequently preferred for decoration. The illuminated headings of pages are important in terms of representing the art of illumination features of the period and shedding light on the art of illumination, with its page layout, pattern, motif, composition and color features.

WOS: 000425633300017, PubMed ID: 28707314, Nodular lymphocyte predominant Hodgkin's lymphoma (NLPHL) is a rare subtype of Hodgkin's lymphoma. In this study, we aimed to investigate the clinical features and therapeutic outcomes of patients with NLPHL who were diagnosed at different institutes in Turkey. We retrospectively reviewed the records of the patients diagnosed with NLPHL. Adult patients who were diagnosed after 2005 with histological confirmation were selected for the study. Forty-three patients were included in the study. Median age of patients was 37.5years (18-70) at the time of diagnosis. About 60.5% patients were diagnosed as stage I and II NLPHL, and remaining 39.5% had stage III and IV disease. Median follow-up was 46months. During follow-up, none of the patients died. Seven patients relapsed or progressed after initial therapy at a median of 12months. Five of 7 relapsed/refractory patients (71.4%) were salvaged with chemotherapy only (DHAP, ICE), and the remaining 2 (28.6%) were salvaged with chemoimmunotherapy. All of relapsed/refractory patients were able to achieve complete remission after salvage therapy. Lactate dehydrogenase levels were significantly higher in patients with progressive disease compared with nonprogressive disease. Our study showed an excellent outcome with all patients alive at last contact with a median follow up of 46months despite a wide range of different therapeutic approaches. All relapsed and refractory patients were successfully salvaged despite a low frequency of patients received immunotherapy in conjunction with chemotherapy. Our results suggest that immunotherapy may be reserved for further relapses.

Richter’s transformation is a serious complication of chronic lymphocytic leukemia. We present a patient with Hodgkin transformation of chronic lymphocytic leukemia. This patient was admitted to our clinic with the complaints of weakness and fatigue. She had palpable axillary and cervical lymphadenomegaly. Positron emission tomography/ computed tomography scans with fluorodeoxyglucose revealed multiple cervical axillary lymph nodes in the right axilla and the right side of the neck with minimally increased fluorodeoxyglucose uptake and paraaortic, pancreaticoduodenal, aortocaval lymph nodes with intense fluorodeoxyglucose uptake (SUVmax: 10.86). Excisional biopsy of the intraabdominal lymph node was performed which revealed classical Hodgkin disease. Combined chemotherapy was started. She died because of pneumonia after two cycles of the therapy.

Isolated lymphoma of the base of the tongue is a relatively rare condition. The clinical presentation may vary from a submucosal mass with a cystic appearance to an ulcerated lesion. In the present case, a cystic mass was identified in a patient admitted with a sore throat. Pathological examination confirmed diffuse large B-cell lymphoma. The clinical and pathological picture of lymphomas covers a wide spectrum and the rate of occurrence in the oral cavity is 3-5%. Among all malignant tumors of the oral cavity, lymphomas represent the third most common type of tumor, following squamous cell carcinoma and salivary gland neoplasms. Lymphomas of the oral cavity mostly arise from the Waldeyer ring, which is a lymphoid tissue. In our case, no recurrence was observed during the 8-month follow-up period after the patient was administered chemotherapy followed by radiotherapy. In conclusion, although isolated lymphoma of the base of the tongue is extremely rare, it should always be considered in patients presenting with a sore throat and the sensation of a foreign body in the throat.

Bortezomib genellikle multipl myeloma tedavisi için kullanılan bir proteazom inhibitörüdür ve bazı kardiyak yan etkilere sahiptir. Klinik çalışmalardaki bortezomib tedavisiyle ilişkili kalp yetmezliği insidansı tesadüfi olarak kalır. Biz Uluslararası skorlama sistemine göre Evre 3 multipl myeloması olan 82 yaşında bir hastayı sunuyoruz. Bu hastaya kombine kemoterapi (her bir siklusta bortezomib 1,3 mg/m2 D1, D8, D15, D22 ve 40 mg/gün deksametazon [D1–4]) başlandı. Kemoterapisinin 3 siklusunun tamamlanmasından 2 gün sonra (bortezomib tedavisinin 12. dozu) hasta bilateral alt extremitelerde hafif ödem nedeniyle başvurdu. Ekokardiyografide ejeksiyon fraksiyonun tedavi öncesi >%55’den %30–35’e düştüğünü gösterdi. Bu nedenle bortezomib tedavisi kesildi ve konjestif kalp yetmezliği için hasta tedavi edildi. Bortezomib kesilmesinden 3 ay sonra hastanın klinik semptomları düzeldi ve ejeksiyon fraksiyonu normale döndü., Bortezomib is a proteasome inhibitor commonly used for the treatment of multiple myeloma, and it has some cardiac side effects. The incidence of cardiac failure associated with bortezomib therapy in clinical trials remains incidental. We describe a 82-year-old patient with International Staging System Stage III multiple myeloma. Combined chemotherapy with bortezomib 1.3 mg/m2 on days 1, 8, 15, 22 of each cycle and 40 mg/day dexamethasone (days 1 to 4) was started to him. Two days after the end of the 3rd cycle of chemotherapy (12th dose of bortezomib), he admitted with mild edema of bilateral lower extremity. Echocardiography revealed a drop in the left ventricular ejection fraction from pretreatment levels of >55% to 30–35%. Therefore; bortezomib treatment was postponed and he was treated for congestive heart failure. The patient’s symptoms improved and the ejection fraction normalized after three months following discontinuation of bortezomib.

In this multicenter retrospective analysis, we aimed to present clinical, laboratory and treatment results of 94 patients with Hairy cell leukemia diagnosed in 13 centers between 1990 and 2014. Sixty-six of the patients were males and 28 were females, with a median age of 55. Splenomegaly was present in 93.5% of cases at diagnosis. The laboratory findings that came into prominence were pancytopenia with grade 3 bone marrow fibrosis. Most of the patients with an indication for treatment were treated with cladribine as first-line treatment. Total and complete response of cladribine was 97.3% and 80.7%. The relapse rate after cladribine was 16.6%, and treatment related mortality was 2.5%. Most preferred therapy (95%) was again cladribine at second-line, and third line with CR rate of 68.4% and 66.6%, respectively. The 28-month median OS was 91.7% in all patients and 25-month median OS 96% for patients who were given cladribine as first-line therapy. In conclusion, the first multicenter retrospective Turkish study where patients with HCL were followed up for a long period has revealed demographic characteristics of patients with HCL, and confirmed that cladribine treatment might be safe and effective in a relatively large series of the Turkish study population.

Objective Vitamin D is a hormone with a variety of functions, and its deficiency and insufficiency are commonly seen both in the general population and in patients with chronic renal disease. The aim of this study was to compare vitamin D levels in patients with chronic renal disease who are on hemodialysis, peritoneal dialysis, or no renal replacement therapy and patients who underwent renal transplantation. Methods A total of 169 patients who had not used vitamin D for ≥1 year and who had no diabetes mellitus or proteinuria were included in the study. These included: 40 patients with renal transplantation, 40 patients on hemodialysis, 49 patients on peritoneal dialysis, and 40 patients with chronic renal failure stage 1, 2, 3, or 4. 25-Hydroxy vitamin D levels were evaluated in the sera of the patients. Results 25-Hydroxy vitamin D levels in patients with renal transplantation and in predialysis patients were 12.74 ± 10.24 ng/mL and 11.16 ± 12.25 ng/mL, respectively. The levels were 7.77 ± 6.71 ng/mL and 5.96 ± 4.87 ng/mL in patients on hemodialysis and peritoneal dialysis, respectively. Conclusions Vitamin D levels are lower in patients on hemodialysis and peritoneal dialysis compared with the patients with renal transplantation for a variety of reasons. In this study, objective results were obtained supporting the administration of vitamin D supplements without glomerular filtration rate measurement in all patient groups with the diagnosis of chronic renal failure in accordance with the guidelines.

Background and Objectives: The pulmonary function test (PFT) is an important quantification test in the follow-up of sarcoidosis. We aimed to investigate the effect of the presence of lymphadenopathy (LAP) alone or after controlling parenchymal involvement in PFT. Materials and Methods: A total of 63 sarcoidosis patients were enrolled retrospectively in the study. Respiratory functions were evaluated via PFT. Radiological evaluations of the patients were done with chest x-ray and high-resolution computerized tomography (HRCT). Bronchoscopic investigations were performed on all patients. Possible factors that affect PFT were evaluated. Results: There is statistically significant correlation between the bronchoscopic findings and PFT parameters (p

WOS: 000374614700015, PubMed ID: 26810141, We investigated the course of 54 patients presenting with primary central nervous system lymphoma, who were treated in daily practice. The patients were treated with chemotherapy and/or radiotherapy and/or intrathecal chemotherapy. At a median follow-up period of 23 months (range 1-71), median relapse-free survival (RFS) and overall survival (OS) were not reached. Estimated 2-year RFS and OS rates were 42% and 48%, respectively. Ten relapsed PCNSL patients underwent ASCT. Complete remission rate of these patients was 40%, with 20% treatment-related mortality. Estimated 2-year RFS and OS rates were 37% and 40%, respectively. The prognosis of patients with PCNSL, who received off-study treatment, is still dismal. (c) 2016 Elsevier Ltd. All rights reserved.

Background:A higher amylase than normal concentration may reflect one of several medical conditions, including acute inflammation of the pancreas, perforated peptic ulcer, torsion of an ovarian cyst, strangulation ileus, mesenteric ischemia, macroamylasemia, renal failure and mumps. In addition; amylase production by epithelial carcinomas has been well documented. But hyperamylasemia associated with multiple myeloma has been reported only in a few cases. We report a case with hyperamylasemia associated with multiple myeloma in this paper because of rarity.Case report:We report a 64 year old male patient with multiple myeloma. He had hyperamylasemia and no evidence of pancreatic and salivary gland disease, renal failure. The patient had relapse disease after autologous bone marrow transplant. Amylase value is high correlated with his disease status. Combined chemotherapy (lenalidomide 25 mg once daily orally on days 1–21 and dexamethosone 40 mg/day, days 1–4 of repeated 28-day cycles) was started to our patient for multiple myeloma. The amylase level decresed to a normal level after 28 days.Conclusion:Paraneoplastic hyperamylasaemia as a marker to monitor disease progression and treatment response in cases with multiple myeloma. It related to extensive extra-medullary spread, extensive bone destruction and shorter survival time.

Lymphoid malignancies are a heterogeneous group of neoplasms originating from B- and T-lymphocytes with an unexplained etiology. Several autoimmune conditions, especially Sjo - gren syndrome and rheumatoid arthritis (RA) are associated with lymphoma. Immunosuppressive agents like methotrexate may cause Epstein-Barr virus reactivation that can lead to development of lymphoma. The risk of lymphoma, especially Hodgkin lymphoma, is increased up to 2-3 times in RA patients compared to normal population. The cause of increased risk is independent from the immunosuppressive medication. We report here an unusual case of diffuse large B-cell lymphoma in a patient with RA receiving methotrexate treatment, after obtaining the approval of the informed consent of the patient.

Objectives: The aim of this study was to evaluate complianceof the stage II-III colon cancer patients to the adjuvantchemotherapy and to investigate the results of adjuvantchemotherapy in terms of toxicity in the same group of patients.Materials and Methods: Operated, stage II and III colorectalcancer patients post-operatively followed in Departmentof Internal Medicine, Division of Medical Oncologybetween December 2000 and December 2007 were enrolled into this study. Patients who were diagnosed as rectal cancer or who had metastases were excluded. Eleven (21.6%) of the 51 patients either did not accept chemotherapy or adjuvant chemotherapy was not offered. Thirty (58.8%) patients treated with FUFA (5 Fluoro-urasil/leucoverin) chemotherapy regimen and the resting 10 (19.9%) patients were treated with FOLFOX (Oxaliplatin/5 Fluoro-urasil/leucoverin) chemotherapy regimen. Toxicitiesthat emerged after treatment and patient adherence to treatment was evaluated.Results: Patients who were treated with FUFA chemotherapyregimen had better percentages of chemotherapy regimen completion, lesser mucositis and diarrhea rates, except neutropenia and neutropenic fever. Evaluation of patients who were treated with FOLFOX chemotherapy regimen that includes oxaliplatin revealed that completion of chemotherapy regimen rate and chemotherapy-associateddiarrhea rates were similar with the literature. There were differences between our results and literature in rates of neutropenia, neutropenic fever and neuropathy.Conclusions: Less adverse effects were seen in adjuvant chemotherapy application of operated colorectal cancer patients with either stage II or stage III.

Introduction Esophagorespiratory fistula (ERF) is a complication of an esophageal malignancy that has serious effects on the mortality of a patient, whose survival is limited to weeks. Sealing of fistula and recovery of swallowing has greater importance than treating underlying primary malignancy. In this study, we aimed to present our clinic experience in patients with ERF and to discuss the findings together with the literature. Materials and Methods Between January 2003 and December 2008, 326 patients with malignant esophageal disorder were admitted to our clinic, and ERF detected in 18 (5.5%) patients. There were 10 men and 8 women with a mean age of 54.7±11.9 years (range: 34 to 75 y). Metastases in the lung and liver were detected in 4 and 2 patients, respectively. Empyema was found in 3 of the ERF patients. Pneumonic infiltration was detected via radiologic evaluation in 7 (38.9%) of the 18 patients. Two patients did not accept any intervention. A feeding gastrostomy tube was placed in 2 other patients. Fluoroscopy-guided Ultraflex esophageal stent placement was applied to the remaining 14 patients. Eleven (78.6%) patients underwent stent placements during generalized anesthesia via rigid esophagoscopy, and the remaining 3 (21.4%)patients via flexible esophagoscopy with sedation. Results One of the patients who did not accept intervention died after 2 weeks, and the other died 6 weeks after admission. One of the patients who received a feeding gastrostomy tube died 17 weeks after admission, and the other was still alive after a month, when this article was written. Closure of the ERF was seen in all 14 patients who underwent palliative covered self-expandable metallic stent placement in the esophagus. No complications occurred in the stent-placed patients either during or after the procedure. Dyspeptic complaints and pain were treated successfully with medical therapy in 6 and 5 patients, respectively. Symptoms of aspiration disappeared after stent placement. No reopened fistulae were observed during follow-up. Thirteen of the 14 stent-replaced patients died during follow-up. The mean survival rate for these 13 patients was 11.2 weeks (range: 1to 49 wk). The mean length of hospital stay after stent placement in the 14 patients was 3.7 days (1 to 15 d). Discussion Covered self-expandable metallic stent placement in malign ERF patients is a technically simple and safer method for fistula closure and seems to be the most effective method that is easily available.

Background Chronic kidney disease (CKD) is a worldwide disorder which is characterized by the presence of systemic low-grade inflammation. There is also acquired immune deficiency in this patient group which is clinically present with increased incidence of severe infections, poor response to vaccination, and increased risk of virus-associated cancers. Renal transplantation is one of the renal replacement modalities that restore renal functions. Mean platelet volume (MPV) is emerging as a marker of inflammation in many clinical conditions. In this study we aimed to disclose the improvement of paired immune response of ESRF patients after renal transplantation even though they are under immunosuppressive therapy. Methods We retrospectively investigated C-reactive protein, MPV, platelets (PLT), and other hematologic parameters on the day of transplantation and at the end of the 1st and 2nd years after transplantation of 58 preemptive and 112 nonpreemptive renal transplant patients. We compared them with a healthy control group. Results The MPV of the control group was 8.00 ± 0.73. The mean MPV of transplant patients before transplantation and at the end of the 1st and 2nd years after transplantation were 7.66 ± 1.01, 8.06 ± 0.97, and 8.20 ± 0.84, respectively. The initial MPV of the patient group was statistically significantly lower than the control group (P = .04). There was a statistically significant increase of MPV after transplantation. At the end of the 2nd year the difference of MPV between the patient and control groups was gone. Conclusions We detected that CKD patients had a decreased MPV compared with normal individuals and that it normalized at the end of the 2nd year after renal transplantation. We speculated that the decreased MPV in CKD patients is related to increased inflammation and uremic toxins owing to uremia which was improved after renal transplantation.

Aim Cardiovascular diseases and infections are the leading two causes of morbidity and mortality in end-stage renal disease (ESRD) patients. Kidney transplantation is the preferred method for renal replacement owing to better survival. There are reports of irreversibly damaged immune system in dialysis patients, which did not return to normal even after kidney transplantation. The neutrophil-lymphocyte ratio (NLR) is an easily applicable method for evaluation of inflammation. We hypothesized that preemptive kidney transplantation can improve inflammatory state compared with nonpreemptive recipients. To test our hypothesis, we retrospectively investigated pretransplant and posttransplant NLR and C-reactive protein (CRP) levels of ESRD patients and compared them with values in healthy controls. Materials and Methods We retrospectively analyzed NLR, CRP, and other hematologic parameters of ESRD patients who were transplanted between January 2005 and January 2014 on the day of transplantation and at the end of first year. We grouped the patients as preemptive and nonpreemptive ones. We excluded patients with coronary artery disease, obesity, hypotension, hyperthyroidism, uncontrolled diabetes mellitus, hematologic or solid organ cancers, and active documented infection at any evaluation period. Results We included 137 ESRD patient and 34 healthy control individual in our study. Of the 137 ESRD patients, 52 (38%) were transplanted preemptively. Of the patients, 85 were already on either hemodialysis or peritoneal dialysis therapy at the time of transplantation. The white blood cell count value of the patient and control group (7246.72 ± 1460.26 and 76661.76 ± 1286.29, respectively; P = .43), NLR of the control group was significantly lower than patient group (1.98 ± 0.94 and 3.47 ± 2.33, respectively; P = .007). The NLR of the preemptive group was decreased substantially at the end of first year posttransplantation, the NLR of the preemptive group was significantly lower than the nonpreemptive group (3.08 ± 1.32 and 3.71 ± 2.33; P = .01). Conclusions We showed that all ESRD patients had an increased inflammation rate according to CRP and NLR when compared with healthy controls. We also found that improvement of inflammatory state in preemptive patients is significantly better than nonpreemptive patients at the end of first year evaluation.

Background: We aimed to investigate the prognostic value of baseline neutrophil, lymphocyte, and platelet counts along with the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in local and advanced gastric cancer patients. Materials and Methods: In this retrospective cross-sectional study, a total of 103 patients with gastric cancer were included. For all, patient characteristics and overall survival (OS) times were evaluated. Data from a complete blood count test including neutrophil, lymphocyte, monocyte, white blood cell (WBC) and platelet (Plt) count, hemoglobin level (Hb) were recorded, and the NLR and PLR were obtained for every patient prior to pathological diagnosis before any treatment was applied. Results: Of the patients, 53 had local disease, underwent surgery and were administered adjuvant chemoradiotherapy where indicated. The remaining 50 had advanced disease and only received chemotherapy. OS time was 71.6±6 months in local gastric cancer patients group and 15±2 months in the advanced gastric cancer group. Univariate analysis demonstrated that only high platelet count (p=0.013) was associated with better OS in the local gastric cancer patients. In contrast, both low NLR (p=0.029) and low PLR (p=0.012) were associated with better OS in advanced gastric cancer patients. Conclusions: This study demonstrated that NLR and PLR had no effect on prognosis in patients with local gastric cancer who underwent surgery and received adjuvant chemoradiotherapy. In advanced gastric cancer patients, both NLR and PLR had significant effects on prognosis, so they may find application as easily measured prognostic factors for such patients.

Thoracic radiography and high resolution computerized tomography is used to diagnose pulmonary infections in immunosuppressed patients, although in some cases these do not provide enough information about the lesion. Dynamic contrast-enhanced magnetic resonance imaging may be useful in these cases, especially for the characterization of cavitary lesions and assessment of their contrast diffusion.

Acquired pure red-cell aplasia is a rare disorder that can be either idiopathic or associated with certain autoimmune diseases, pregnancy, lymphoproliferative disorders, nutritional deficiencies, or medicines. We present a deceased-donor renal transplant patient who developed pure red-cell aplasia associated with mycophenolate mofetil or tacrolimus and was treated with cyclosporine. A 20-year-old woman was transplanted from a deceased donor 1 month earlier and presented to us with symptoms of fatigue, prostration, and palpitation. The results of a laboratory examination revealed anemia. A diagnostic work-up resulted in a diagnosis of pure red-cell aplasia. Mycophenolate mofetil was discontinued. Tacrolimus also was replaced with cyclosporine 2 months after mycophenolate mofetil was halted because of a lack of improvement in anemia. Three months later, her anemia improved with cyclosporine. Starting cyclosporine instead of tacrolimus or mycophenolate mofetil showed good improvement in our patient within 6 months of therapy.

In this multicenter retrospective analysis, we aimed to present clinical, laboratory and treatment results of 94 patients with Hairy cell leukemia diagnosed in 13 centers between 1990 and 2014. Sixty-six of the patients were males and 28 were females, with a median age of 55. Splenomegaly was present in 93.5% of cases at diagnosis. The laboratory findings that came into prominence were pancytopenia with grade 3 bone marrow fibrosis. Most of the patients with an indication for treatment were treated with cladribine as first-line treatment. Total and complete response of cladribine was 97.3% and 80.7%. The relapse rate after cladribine was 16.6%, and treatment related mortality was 2.5%. Most preferred therapy (95%) was again cladribine at second-line, and third line with CR rate of 68.4% and 66.6%, respectively. The 28-month median OS was 91.7% in all patients and 25-month median OS 96% for patients who were given cladribine as first-line therapy. In conclusion, the first multicenter retrospective Turkish study where patients with HCL were followed up for a long period has revealed demographic characteristics of patients with HCL, and confirmed that cladribine treatment might be safe and effective in a relatively large series of the Turkish study population.

Increased platelet activation contributes to cardiovascular mortality in chronic kidney disease patients (CKD). Larger platelets are more active and this increased activity had been suggested as a predictive biomarker for cardiovascular disease. In this study, we aimed to evaluate mean platelet volume (MPV) as an inflammatory marker in a broadened group of CKD patients. Our study is unique in literature as it covers all types of CKD including renal replacement therapies.200 patients (50 renal transplanted, 50 hemodialysis, 50 peritoneal dialysis, 50 chronic renal failure stages 3-4) were investigated who were between 18 and 76 years of age. The collected data included demographic properties, platelet count, MPV, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and hemoglobin. All of the patients had at least 12 month of therapy of either renal replacement modality.The mean CRP value was detected statistically significantly higher in hemodialysis (HD) patients compared to the resting three groups of patients (p 0.01). Mean CRP level was detected significantly higher in the pre-dialysis group compared to transplanted and peritoneal dialysis (PD) patients (p 0.01). There is no statistically significant difference detected among the mean MPV values of all patient groups (p 0.05).ESR and CRP were significantly increased in hemodialysis patients compared to the other groups. We did not detect a significant difference among MPV between the groups. ESR was detected lowest in transplanted patients. Transplantation is coming forward as the favorable choice of renal replacement therapy which decreases inflammation.

Meropenem is one of the most commonly used antibacterial agents with relatively few side effects. Serious adverse reactions reported with meropenem are rare with an incidence of 1 %. Recently we came across two rare adverse effects of meropenem in one patient with acute renal failure. There was pancytopenia and sepsis, respectively. To the best of ourknowledge, a only few cases have been reported in the literature that document an association between meropenem administration and pancytopenia, and about half of these cases were sepsis. With the use of meropenem becoming more widespread, these two rare but fatal complications of meropenem should be borne in mind.Keywords: Meropenem, Pancytopenia, Sepsis, Fatal complications

Many studies have been conducted to investigate plasma arginine, arginase, and nitric oxide (NO) levels in patients with different types of cancer, and it has been suggested that these might be important factors for patients with cancer. In the present study, plasma arginine, arginase, and nitric oxide levels were evaluated in patients with esophageal cancer. Materials and methods: A total of 100 patients (51 females and 49 males) diagnosed with esophageal cancer but not yet operated on were included in the study. The mean age of the study population was 62.03 ± 12.4 years. Patients treated with radiotherapy or chemotherapy were excluded. The control group included 80 subjects (38 females and 42 males) with a mean age of 57 ± 12.4 years. Plasma arginine, NO levels, and arginase activity were measured. High-performance liquid chromatography, Griess reactions, and modified Geyer and Dabich methods were used to detect the arginine levels, NO levels, and arginase activity. Results: In patients with esophageal cancer, plasma arginine concentrations were significantly lower and NO levels and arginase activity were significantly higher than in the control groups (P < 0.0001, P < 0.0001, and P = 0.005, respectively). The sensitivity of arginase and NO were estimated at 87% and 89%, with respective specificities of 65% and 66%. Between the patients with and without distant organ metastasis, there were no significant differences in arginine/NO levels and arginase activity (P > 0.05). Similarly, there were no significant differences in these parameters between the patients with squamous cell carcinoma and adenocarcinoma (P > 0.05). Conclusion: The results demonstrate that plasma NO levels and arginase activity may be used as markers for the diagnosis of esophageal cancer. However, larger and more comprehensive studies are needed., Amaç: Çeşitli kanserlerde plazma arginin, arginaz ve nitrik oksit (NO) ile ilgili birçok çalışma yapılmış ve buparametrelerin kanser hastaları için belirleyici faktörler olabileceği ileri sürülmüştür. Bu çalışmada özofagus kanserlihastalarda plazma arjinin, arjinaz ve nitrik oksit seviyeleri değerlendirildi.Yöntem ve gereç: Çalışmaya özofagus kanseri tanısı konup henüz opere edilmemiş 51’i kadın ve 49’u erkek olmak üzere100 hasta dahil edildi. Olguların yaş ortalamaları 62,03 ± 12,4 idi. Radyoterapi veya kemoterapi alan hastalar çalışmayadahil edilmedi. Yaş ortalamaları 57 ± 12,4 olan 38 kadın ve 42 erkek olmak üzere 80 bireyden oluşan kontrol grubuoluşturuldu. Olguların plazma arginin ve NO düzeyi ile arginaz aktivitesi ölçüldü. Arginin düzeyi yüksek performanslılikit kromatografi yöntemi, nitrik oksit düzeyi Griess reaksiyonuyla, arginaz aktivitesi ise modifi ye Geyer ve Dabichmetoduyla ölçüldü.Bulgular: Plazma arginin konsantrasyonu özofagus kanserli hastalarda kontrol grubuna oranla belirgin derecededüşük, nitrik oksit düzeyi ve arginaz aktivitesi ise kontrol grubuna oranla önemli derecede yüksek bulundu (sırasıyla P< 0,0001, P < 0,0001 ve P = 0,005). Arginaz ve nitrik oksitin sensitivitesi % 87 ve % 89, spesifi tesi ise % 65 ve % 66 olarakhesaplandı. Arginin, nitrik oksit düzeyleri ve arginaz aktivitesi, uzak organ metastazı olan hastalar ile metastaz olmayanhastalarla kıyaslandığında istatistiksel olarak anlamlı bir fark bulunmadı (P > 0,05). Benzer şekilde bu parametreler yassıepitel hücreli karsinom ve adenokarsinomalı hastalar ile kıyaslandığında da istatiksel olarak anlamlı bir fark saptanmadı(P > 0,05).Sonuç: Elde ettiğimiz sonuçlar özofagus kanserli hastaların tanısında plazma NO düzeyi ile arginaz aktivitesininbir tümör belirteci olarak kullanılabileceğini göstermektedir. Ancak bununla ilgili daha kapsamlı ve ileri düzeydeçalışmalara ihtiyaç vardır.

IgA nephropathy is one of the most common forms of glomerulopathies. It is an immune complex-mediated glomerulonephritis diagnosed by the presence of mesangial IgA deposits that are often associated with mesangial cell proliferation. The IgG, C3, IgM, or other immunoglobulin light chains may be co-existed with IgA. Its pathogenesis suggested that it is responsible for enhancing the production of proinflammatory cytokines, chemokines, and growth factors. Platelet-derived growth factor (PDGF) has also been implicated as a modulator of disease activity. Immune thrombocytopenic purpura (ITP) is a bleeding disorder caused by thrombocytopenia that is not associated with a systemic disease. Its pathogenesis suggested an autoimmune disease in which IgG is thought to damage megakaryocytes, which are the precursors of platelet cells. Several studies reported that PDGF levels were higher in normal subjects than in patients with ITP. Moreover, ITP is a disease related to the antibody. Thus, our aim is to examine whether a similar pathophysiological relationship exist between ITP and IgAN that may be mediated by PDGF and/or IgG. © 2014 Informa Healthcare USA, Inc.