Renal greft biyopsilerde tübüler vakuolizasyon ve önemi

Renal allograft needle biopsy (RANB) is one of the most reliable diagnostic methods. Even though some of the histopathological findings are specific and diagnostic, tubular epithelial cell vacuolization (TECV) is nonspecific. TECV reminds us first the cyclosporine A nephrotoxicity. But a lot of therapeutic agents and tubular ischemia may cause the same histopathologic picture. In this research, we have evaluated ten patients having TECV. We have observed TECV in RANB performed after renal allograft dysfunction following intravenous immunoglobulin (IVIG) administration in two patients, amphotericin B one patient, cyclosporine A three patients and FK506 in one. TECV was also observed in zero hour biopsies from three cadaveric donors. In one of these patients TECV was related with ischemia. In other two, we couldn't make any comment about etiology because of inadequate data of cadaveric donor. Except for the two patients, who have died, the graft dysfunction has resolved after management of etiological factors. TECV is a nonspecific finding which is frequently observed in RANB. The first etiological factor to consider is cyclosporine A. But we should also consider the other therapeutic agents, which may cause the same histopathologic picture.Transplante böbrek iğne biopsisi en güvenilir tanı araçlarından biridir. Bazı histopatolojik bulgular spesifik ve tanı koydu-rucu olmakla birlikte, tübül epitel hücre vakuolizasyonu (TEHV) nonspesifiktir. TEHV bulgusu akla ilk siklosporin A nefrotoksisitesini getirir. Ancak birçok terapötik ajan ve tübüler iskemi bu histopatolojik görünüme yol açabilir. Bu çalışmada TEHV belirlenen 10 olgu sunulmuştur. TEHV olguların ikisinde intravenöz immunglobülin (İVİG), birinde amphoterisin B, üçünde siklosporin A, birinde FK 506 kullanımını takiben gelişen greft disfonksiyonu sonrasında yapılan biopsilerde saptanmıştır. Kadavra vericili üç olgunun sıfır saat biopsilerinde TEHV saptanmıştır. TEHV bunların birinde iskemi ile ilişkili olarak yorumlanmış, ikisinde ise verici bilgileri yetersiz olduğundan etiyoloji için yorum yapılamamıştır. Ölen iki olgu dışında etiyolojik faktörler düzeltildikten sonra greft disfonksiyonları düzelmiştir. TEHV transplant böbrek biopsilerinde sık saptanan, nonspesifik bir bulgudur. Etiolojide ilk akla gelen faktör siklosporin A'dır. Ancak bu görünüme yol açabilecek diğer terapötik ilaçların da gözönünde tutulması gerekir

Nadir bir mekanik barsak tıkanıklığı nedeni: İntestinal miyeloid sarkom

Myeloid sarcoma is a rare aggressive tumour that originates from immature extramedullary myeloid cells. It can be seen as a relapse in patients with acute myeloid leukaemia. Sometimes it can be seen in the form of a solid tumour without any evidence of leukaemia. A case of a 44-year-old male patient who was admitted with symptoms and signs of mechanical intestinal bowel obstruction was operated on. The operation findings showed small bowel obstruction due to a mass. The mass was then resected with end-to-end intestinal anastomosis. The resected mass pathology results were consistent with myeloid sarcoma. The post-operative period was uneventful and adjuvant therapy was applied. In this case report we aimed to evaluate the clinical signs and treatment modalities of small intestinal myeloid sarcoma.Miyeloid sarkom ekstramedüller immatür miyeloid hücrelerden kaynaklanan, nadir görülen agresif seyirli bir tümördür. Akut miyeloid lösemili hastaların relapsı olarak karşımıza çıkabilir. Bazen lösemi tanısı olmaksızın solid bir tümör olarak da görülebilmektedir. Mekanik barsak tıkanıklığı semptomları ile başvuran 44 yaşında erkek hasta opere edildi. Operasyonda ince barsak tıkanıklığına neden olan bir tümör saptandı. Tümör rezeke edilerek uç uca anastomoz uygulandı. Patoloji sonucu miyeloid sarkom olarak rapor edildi. Postoperatif dönem sorunsuz seyretti ve hastaya adjuvan tedavi uygulandı. Bu olgu sunumunda ince barsak miyeloid sarkomunun klinik bulguları ve tedavisinin irdelenmesi amaçland

Aberrant Breast in a Rare Site: A Case Report

Aberrant breast tissue is an anomaly in the embryogenesis of the breast that is found along the mammary ridge or out of that line. We report a case of a 71-year-old female patient with an abdominal aberrant breast tissue found incidentally in a piece of mesenteric biopsy. The histological features were consistent with breast tissue

Kidney Transplant in a Human Immunodeficiency Virus-Positive Patient: Case Report of Drug Interactions

End-stage renal disease in the human immunodeficiency virus-positive population is increasing. Kidney transplant is the optimal therapy for this population rather than dialysis modalities if some criteria are met. These include undetectable plasma human immunodeficiency virus RNA, CD4 cell count over 200 cells/mu L, and the absence of any AIDS-defining illness. Here, we describe the first living-donor kidney transplant in a human immunodeficiency virus-positive recipient in Turkey. The patient, a 52-year-old male diagnosed as human immunodeficiency virus positive, was on antiretroviral therapy, which consisted of 400 mg twice daily darunavir, 100 mg/day ritonavir, and 50 mg/day dolutegravir. He had been negative for human immunodeficiency virus RNA for the past 3 years. The patient developed renal insufficiency without any known cause and started hemodialysis. A living donor transplant from his son was performed, and the patient received ATG Fresenius-S (Neovii Biotech, Rapperswil, Switzerland) induction and a maintenance immunosuppression therapy consisting of methylprednisolone, mycophenolate mofetil, and tacrolimus. There were no incidences of delayed graft function or acute rejection. Because of tacrolimus and ritonavir interaction, tacrolimus trough levels were too high. With tacrolimus withdrawn, tacrolimus trough level decreased to detectable levels 2 weeks later. Antiretroviral therapy was continued on the same dosage. At month 4 posttransplant, the patient's creatinine level was 1.01 mg/dL. At present, the patient has had no complications and no episodes of rejection. Kidney transplant is the most favorable replacement therapy for HIV-positive patients who are under controlled AIDS care with highly active antiretroviral therapy. However, drug interactions should be carefully evaluated

Arterial Mycotic Aneurysm Rupture of Two Kidney Cadaveric Renal Transplantation Recipients Secondary to Enterococci and Candida

Although vascular complications due to the arterial anastomosis are rare in transplant patients, infectious vascular complications around the anastomosis site that carry a risk of rupture can cause significant mortality and morbidity. Signs and symptoms of any infectious process can be masked in patients taking more potent immunosuppressants at the early period after transplantation. Staphylococcus aureus, gram-negative bacilli, and fungi such as Candida albicans can especially produce serious complications. We present two renal transplant patients with an arterial anastomosis aneurysm leading to rupture. Early diagnosis may be life saving due to the silent and insidious presentation of arterial mycotic aneurysms and their high mortality and morbidity rates.Böbrek transplant hastalarında arteryel anastomoz hatlarından kaynaklanan komplikasyonlar son zamanlarda oldukça nadir olsa da, anlamlı mortalite ve morbiditeye sebep olabilecek enfeksiyöz patolojiler hala görülebilmektedir. Transplant sonrası erken dönemde kullanılan güçlü immünsupresif ilaçlar, klinik bulgu ve semptomları maskeleyebilmektedir. Özellikle Staphylococcus aureus, gram negatif basiller ve Candida albicans gibi mantarlar tehlikeli komplikasyonlar oluşturabilirler. Biz burada arteryel anastomoz hattı enfeksiyonuna sekonder rüptür ile komplike olmuş iki transplant hastasını tartışacağız. Yüksek mortalite ve morbidite riski taşımaları sebebiyle, sessiz ve sinsi gidişatlı arteryel mikotik anevrizmaların erken saptanması, hayat kurtarıcı olabilir

Böbrek nakli sonrası gelişen bir sistemik nokardiyoz olgusu -histopatolojik ve mikrobiyolojik değerlendirme

Nokardiyoz; immünsüpresyon uygulaması nedeniyle transplant hastalarında ender görülen fırsatçı bir infeksiyondur. Otuz-beş yaşındaki erkek hastada böbrek naklinden sonra gelişen sistemik nokardiyoz histolojik ve mikrobiyolojik özellikleri ile sunulmuştur.Nocardiosis is a rare oppurtunistic infection which can develop due to immunosuppression after kidney transplantation. In this Article, systemic nocardiosis developing in a 35-year-old male patient following renal transplantation is presented with its microbiological and histopathological features