Renal transplantation ve diyaliz hastalarında HCV nedenli karaciğer hastalığı

Bu tezin, veri tabanı üzerinden yayınlanma izni bulunmamaktadır. Yayınlanma izni olmayan tezlerin basılı kopyalarına Üniversite kütüphaneniz aracılığıyla (TÜBESS üzerinden) erişebilirsiniz.[Abstarct Not Available

Plasmapheresis Therapy in Renal Transplant Patients

In clinical practice, plasmapheresis is utilized to remove circulating immune complexes, endotoxins and high molecular weight molecules such as lipoproteins containing cholesterol. It is useful in certain diseases in rheumatology, oncology, dermatology and nephrology. Renal transplantation is the most exclusive treatment modality in end stage renal failure. Acute and chronic rejections along with the recurrence of the primary kidney disease at the post-transplant period shorten graft survival. Plasmapheresis treatment can be used both at the pre- and post-transplant period in cases of ABO incompatibility, highly sensitized patients, acute and chronic rejections, recurring glomerulonephritis and thrombotic microangiopathies

The Effect of Educational Intervention Based on Chronic Care Model on the Management of Hypertension

Objective: This study was conducted to examine the effect of planned educational intervention based on the chronic care model on the management of patients with hypertension. The chronic care model is a framework for organizing and improving chronic illness care, based on a proactive, planned approach that incorporates patient self-care, provider, and system-level interventions. Several instruments have been developed to evaluate the effects of chronic care model implementation on care and treatment outcomes. The Patient Assessment of Chronic Illness Care questionnaire is used in the instrument to evaluate the delivery of care for patients. Methods: The study was performed as a prospective study conducted with a controlled semiexperimental pattern in matched groups. Totally 30 patients including 15 intervention and 15 control group patients matched in terms of socio-demographic features were monitored for 6 months. The intervention group was trained and monitored by a professional team in line with the components of the model. Life quality scale, hypertension information questions, and chronic care assessment scale were applied to both groups at the beginning and in the sixth month of the study. Results: In the intervention group, positive developments were observed such as improved life quality, improvement in metabolic values, increase in knowledge levels, and satisfaction with chronic care management, and additional comorbidity, which facilitates the end-organ damage of hypertension, was not detected. Conclusions: It was determined that the educational intervention conducted through chronic care model turned out to be influential in terms of improving the metabolic signs and quality of life of patients with hypertension

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