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Suner A, Carr BI, Akkiz H, Karakülah G, Üsküdar O, Yalçın K, Kuran S, Tokat Y, Yilmaz S, Özakyol A, Tokmak S, Ballı T, Yücesoy M, Bahçeci Hİ, Ülkü A, Akçam T, Polat KY, Ekinci N, Şimşek H, Örmeci N, Sonsuz A, Demir M, Kılıç M, Uygun A, Demir A, Delik A, Arslan B, Doran F, Altıntaş E, Temel T, Bektaş A. C-Reactive Protein and Platelet-Lymphocyte Ratio as Potential Tumor Markers in Low-Alpha-Fetoprotein Hepatocellular Carcinoma. Oncology 2018; 96:25-32. [PMID: 30336489 DOI: 10.1159/000492473] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/25/2018] [Indexed: 11/19/2022]
Abstract
The hepatocellular carcinoma (HCC) tumor marker alpha-fetoprotein (AFP) is only elevated in about half of the HCC patients, limiting its usefulness in following the effects of therapy or screening. New markers are needed. It has been previously noted that the inflammation markers C-reactive protein (CRP) and platelet-lymphocyte ratio (PLR) are prognostically important and may reflect HCC aggressiveness. We therefore examined these 2 markers in a low-AFP HCC cohort and found that for HCCs > 2 cm, both markers significantly rise with an increasing maximum tumor diameter (MTD). We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Youden index value for each marker, and their area-under-the-curve values for each MTD group. Patients were dichotomized into 2 groups based on the CRP and PLR from the receiver-operating characteristic curve analysis. In the logistic regression models of the 4 different MTD patient groups, CRP and PLR levels were statistically significant to estimate MTD in univariate logistic regression models of MTD groups > 2 cm. CRP and PLR were then combined, and the combination was statistically significant to estimate MTD groups of 3-, 4-, and 5-cm cutoffs. CRP and PLR thus have potential as tumor markers for low-AFP HCC patients, and possibly for screening.
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Affiliation(s)
- Aslı Suner
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Brian I Carr
- Liver Transplant Institute, İnönü University, Malatya,
| | - Hikmet Akkiz
- Gastroenterology Department, Çukurova University, Adana, Turkey
| | - Gökhan Karakülah
- Liver Transplant Institute, İnönü University, Malatya, Turkey.,Izmir International Biomedicine and Genome Institute, Dokuz Eylül University Izmir, Izmir, Turkey
| | - Oguz Üsküdar
- Gastroenterology Department, Çukurova University, Adana, Turkey
| | - Kendal Yalçın
- Internal Medicine, Dicle University, Diyarbakır, Turkey
| | - Sedef Kuran
- Gastroenterology Department, Çukurova University, Adana, Turkey
| | - Yaman Tokat
- Gastroenterology Department, Çukurova University, Adana, Turkey
| | - Sezai Yilmaz
- Liver Transplant Institute, İnönü University, Malatya, Turkey
| | - Ayşegül Özakyol
- Gastroenterology, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Salih Tokmak
- Gastroenterology Department, Çukurova University, Adana, Turkey
| | - Tuğsan Ballı
- Gastroenterology Department, Çukurova University, Adana, Turkey
| | | | | | - Abdulalh Ülkü
- Gastroenterology Department, Çukurova University, Adana, Turkey
| | - Tolga Akçam
- Gastroenterology Department, Çukurova University, Adana, Turkey
| | | | - Nazım Ekinci
- Internal Medicine, Dicle University, Diyarbakır, Turkey
| | - Halis Şimşek
- Gastroenterology, Hacettepe University, Ankara, Turkey
| | | | - Abdulalh Sonsuz
- Internal Medicine, İstanbul Cerrahpaşa University, Istanbul, Turkey
| | - Mehmet Demir
- Gastroenterology, Hatay Mustafa Kemal University, Antakya, Turkey
| | - Murat Kılıç
- Liver Transplantation, Izmir Kent Hospital, Izmir, Turkey
| | - Ahmet Uygun
- Gastroenterology, Haydarpaşa Sultan Abdülhamid Eğitim Araştırma Hospital, Istanbul, Turkey
| | - Ali Demir
- Department of Gastroenterology, Konya Necmettin Erbakan University, Konya, Turkey
| | - Anıl Delik
- Gastroenterology Department, Çukurova University, Adana, Turkey
| | - Burcu Arslan
- Gastroenterology Department, Çukurova University, Adana, Turkey
| | - Figen Doran
- Gastroenterology Department, Çukurova University, Adana, Turkey
| | | | - Tuncer Temel
- Gastroenterology, Eskişehir Gazi Osman Paşa University, Eskişehir, Turkey
| | - Ahmet Bektaş
- Gastroenterology, Mayıs University, Samsun, Turkey
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Suner A, Carr BI, Akkiz H, Uskudar O, Kuran S, Tokat Y, Tokmak S, Ballı T, Ulku A, AkCam T, Delik A, Arslan B, Doran F, YalCın K, Ekinci N, Yilmaz S, Ozakyol A, Yücesoy M, BahCeci HI, Polat KY, Şimsek H, Ormeci N, Sonsuz A, Demir M, KılıC M, Uygun A, Demir A, Altıntas E, Karakulah G, Temel T, Bektas A. Inflammatory markers C-reactive protein and PLR in relation to HCC characteristics. ACTA ACUST UNITED AC 2018; 5. [PMID: 30662766 PMCID: PMC6333412 DOI: 10.15761/jts.1000260] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction Several markers of systemic inflammation, including blood C-reactive protein, platelet lymphocyte ratio (PLR) and neutrophil lymphocyte ratio (NLR) have been identified as independent prognosticators for hepatocellular carcinoma (HCC). Methods To attempt to understand the significance of these markers, they were examined in relation to 4 tumour parameters, namely maximum tumour diameter (MTD), tumour multifocality, portal vein thrombosis (PVT) and blood alpha-fetoprotein (AFP) levels. Results Using linear and logistic regression models, we found that C-reactive protein and PLR on single variables, were statistically significantly related to the tumour parameters. In a logistic regression final model, CRP was significantly related to MTD, AFP and PVT, and the Glasgow Index significantly related to MTD and AFP. Results of the area under the receiver operating characteristic curves (ROC), showed that the areas for PLR and CRP were statistically significant for high versus low MTD and for presence versus absence of PVT. CRP alone was significant for high versus low AFP. Conclusions These analyses suggest that the prognostic usefulness of the inflammatory markers PLR and CRP (but not NLR) may be due to their reflection of parameter values for tumour growth and invasiveness.
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Affiliation(s)
- Aslı Suner
- Ege University, Faculty of Medicine, Department of Biostatistics and Medical Informatics, İzmir, Turkey
| | - Brian I Carr
- Liver Transplant Inst, Inonu University, Malatya, Turkey
| | - Hikmet Akkiz
- Cukurova University, Gastroenterology Department, Adana, Turkey
| | - Oguz Uskudar
- Cukurova University, Rektorlugu, 01330 Sarıcam/Adana, Turkey
| | - Sedef Kuran
- Cukurova University, Rektorlugu, 01330 Sarıcam/Adana, Turkey
| | - Yaman Tokat
- Cukurova University, Rektorlugu, 01330 Sarıcam/Adana, Turkey
| | - Salih Tokmak
- Cukurova University, Rektorlugu, 01330 Sarıcam/Adana, Turkey
| | - Tugsan Ballı
- Cukurova University, Rektorlugu, 01330 Sarıcam/Adana, Turkey
| | - Abdulalh Ulku
- Cukurova University, Rektorlugu, 01330 Sarıcam/Adana, Turkey
| | - Tolga AkCam
- Cukurova University, Rektorlugu, 01330 Sarıcam/Adana, Turkey
| | - Anıl Delik
- Cukurova University, Rektorlugu, 01330 Sarıcam/Adana, Turkey
| | - Burcu Arslan
- Cukurova University, Rektorlugu, 01330 Sarıcam/Adana, Turkey
| | - Figen Doran
- Cukurova University, Rektorlugu, 01330 Sarıcam/Adana, Turkey
| | | | | | - Sezai Yilmaz
- Inonu University Malatya, 44210 Battalgazi/Malatya, Turkey
| | - Ayşegul Ozakyol
- Eskisehir Osmangazi University, Meselik Yerleskesi, 26040 Odunpazarı/Eskisehir, Turkey
| | - Mehmet Yücesoy
- Erciyes University, Talas Blv., 38030 Melikgazi/Kayseri, Turkey
| | | | | | | | | | | | | | | | - Ahmet Uygun
- Haydarpaşa Sultan Abdülhamid Egitim Araştırma Hospital, Turkey
| | - Ali Demir
- Konya Necmettin Erbakan University, Turkey
| | | | - Gokhan Karakulah
- Izmir International Biomedicine and Genome Institute, Dokuz Eylül University, Izmir, Turkey
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Carr BI, Akkiz H, Guerra V, Üsküdar O, Kuran S, Karaoğullarından Ü, Tokmak S, Ballı T, Ülkü A, Akçam T, Delik A, Arslan B, Doran F, Yalçın K, Altntaş E, Özakyol A, Yücesoy M, Bahçeci Hİ, Polat KY, Ekinci N, Şimşek H, Örmeci N, Sonsuz A, Demir M, Kılıç M, Uygun A, Demir A, Yilmaz S, Tokat Y. C-reactive protein and hepatocellular carcinoma: analysis of its relationships to tumor factors. ACTA ACUST UNITED AC 2018; 15:625-634. [PMID: 29951199 DOI: 10.4172/clinical-practice.1000409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
C-reactive protein (CRP) is a blood marker for inflammation and is an independent prognostic factor for many human cancers. Combined with albumin levels, it forms the basis of the Glasgow Index for cancer prognosis. We reviewed the literature on CRP and HCC and also evaluated blood CRP levels and combination CRP plus albumin levels in a large HCC cohort. In order to understand the prognostic significance of CRP, we retrospectively examined a large HCC cohort and examined the relationship of CRP levels to tumor parameters. We report, that CRP alone and CRP plus albumin combined as well, significantly correlated with parameters of HCC aggressiveness, such as maximum tumor dimension (MTD), portal vein thrombosis (PVT) and blood alpha-fetoprotein (AFP) levels, both as individual parameters and all parameters together (Aggressiveness Index). This extends current thinking, to suggest a possible explanation for the usefulness of blood CRP levels in HCC prognostication.
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Affiliation(s)
- Brian I Carr
- Izmir Biomedicine and Genome Institute, Dokuz Eylul University, Izmir, Turkey, and Liver
Transplant Institute, Inonu University, Malatya, Turkey
| | - Hikmet Akkiz
- Çukurova University Gastroenterology Department, Adana, Turkey
| | - Vito Guerra
- Trials Centre, National Institute for Digestive Diseases, IRCCS "Saverio de Bellis", Castellana, Bari, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ahmet Uygun
- Haydarpaşa sultan Abdülhamid Eğitm Araştrma Hastanesi, Turkey
| | - Ali Demir
- Konya Necmetn Erbakan Üniversitesi, Turkey
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Carr BI, Akkiz H, Üsküdar O, Yalçın K, Guerra V, Kuran S, Karaoğullarından Ü, Altıntaş E, Özakyol A, Tokmak S, Ballı T, Yücesoy M, Bahçeci Hİ, Ülkü A, Akçam T, Polat KY, Ekinci N, Şimşek H, Örmeci N, Sonsuz A, Demir M, Kılıç M, Uygun A, Demir A, Delik A, Arslan B, Doran F, Yilmaz S, Tokat Y. HCC with low- and normal-serum alpha-fetoprotein levels. ACTA ACUST UNITED AC 2018; 15:453-464. [PMID: 29576865 DOI: 10.4172/clinical-practice.1000393] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A large database of 1773 HCC patients in Turkey was examined. 41.9% had alpha-fetoprotein (AFP) levels <20 IU/ml and an additional 16.123% had values between 20-100 IU/ml. This 58% of the cohort (<100 IU/ml AFP levels) was examined in detail. 66% of patients with small (<5 cm) HCCs had low AFP, compared to 49% of patients with larger (>5 cm) HCCs. The mean diameter (MTD) of larger MTD, low AFP tumors was 8.4cm. Therefore, factors other than AFP must contribute to HCC tumor growth. Larger tumors in low AFP patients had both higher platelet levels and increased PVT percent. Linear regression analysis for both MTD and multifocality showed that platelet numbers and presence of PVT were significant variables; whereas for PVT, significant variables were albumin, alkaline phosphatase and MTD. Comparisons between patients with AFP levels <20, 20-<100, 100-<1000 and >1000 IU/ml showed the most significant tumor finding was an increase in PVT percent between each group, and to a lesser extent, MTD. Thus, low- or normal-AFP HCCs constitute the majority of patients and have slightly lower MTD and much lower PVT percent than HCCs associated with elevated blood AFP levels. New, non-AFP markers are thus needed, especially for small HCCs.
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Affiliation(s)
- Brian I Carr
- Izmir Biomedicine and Genome Institute, Dokuz Eylul University, Izmir, Turkey
| | - Hikmet Akkiz
- Çukurova University Gastroenterology Department, Adana, Turkey
| | - Oguz Üsküdar
- Çukurova University Gastroenterology Department, Adana, Turkey
| | | | - Vito Guerra
- IRCCS de Bellis Medical Center, Castellana Grotte, Italy
| | - Sedef Kuran
- Çukurova University Gastroenterology Department, Adana, Turkey
| | | | | | | | - Salih Tokmak
- Çukurova University Gastroenterology Department, Adana, Turkey
| | - Tuğsan Ballı
- Çukurova University Gastroenterology Department, Adana, Turkey
| | | | | | - Abdulalh Ülkü
- Çukurova University Gastroenterology Department, Adana, Turkey
| | - Tolga Akçam
- Çukurova University Gastroenterology Department, Adana, Turkey
| | | | | | | | | | | | | | | | - Ahmet Uygun
- Haydarpaşa sultan Abdülhamid eğitim araştırma hastanesi, Turkey
| | - Ali Demir
- Konya Necmettin Erbakan üniversitesi, Turkey
| | - Anıl Delik
- Çukurova University Gastroenterology Department, Adana, Turkey
| | - Burcu Arslan
- Çukurova University Gastroenterology Department, Adana, Turkey
| | - Figen Doran
- Çukurova University Gastroenterology Department, Adana, Turkey
| | - Sezai Yilmaz
- Izmir Biomedicine and Genome Institute, Dokuz Eylul University, Izmir, Turkey.,Çukurova University Gastroenterology Department, Adana, Turkey.,Dicle üniversitesi, Turkey.,IRCCS de Bellis Medical Center, Castellana Grotte, Italy.,Mersin üniversitesi, Turkey.,Eskişehir Osmangazi üniversitesi, Turkey.,Erciyes üniversitesi, Turkey.,Fırat üniversitesi, Turkey.,İstanbul memorial hastanesi, Turkey.,Dicle üniversitesi, Turkey.,Hacettepe üniversitesi, Turkey.,Ankara üniversitesi, Turkey.,İstanbul Cerrahpaşa üniversitesi, Turkey.,Hatay Mustafa Kemal üniversitesi, Turkey.,Izmir Kent hastanesi, Turkey.,Haydarpaşa sultan Abdülhamid eğitim araştırma hastanesi, Turkey.,Konya Necmettin Erbakan üniversitesi, Turkey.,Inonu university, Malatya.,Florence Nightingale hospital, Istanbul
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5
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Akkiz H, Carr BI, Yalçın K K, Guerra V, Kuran S, Altıntaş E, Üsküdar O, Karaoğullarından Ü, Özakyol A, Tokmak S, Yücesoy M, Bahçeci Hİ, Ülkü A, Akçam T, Yalçın Polat K, Ekinci N, Şimşek H, Örmeci N, Sonsuz A, Demir M, Kılıç M, Uygun A, Ballı T, Demir A, Arslan B, Doran F. Characteristics of Hepatocellular Carcinoma Aggressiveness Factors in Turkish Patients. Oncology 2017; 94:116-124. [PMID: 29207378 DOI: 10.1159/000484564] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 10/24/2017] [Indexed: 01/06/2023]
Abstract
A large cohort of hepatocellular carcinoma (HCC) patients from several collaborating Turkish institutions were examined for the tumor parameters of maximum diameter (MTD), portal vein thrombosis (PVT), and α-fetoprotein (AFP) levels. A relationship was found between MTD and blood platelet levels. Patients with large ≥5 cm tumors who had normal platelet levels had significantly larger tumors, higher percent of PVT, and significantly lower blood total bilirubin and liver cirrhosis than similar ≥5 cm tumor patients having thrombocytopenia. A comparison of patients with and without PVT showed significantly larger tumors, greater multifocality, blood AFP, and C-reactive protein levels, and, interestingly, lower HDL levels in the patients with PVT. Fifty-eight percent of the total cohort had AFP levels ≤100 IU/mL (and 42.1% had values ≤20 IU/mL). These patients had significantly smaller tumors, less tumor multifocality and percent PVT, lower total bilirubin, and less cirrhosis. There was considerable geographic heterogeneity within Turkey in the patterns of HCC presentation, with areas of higher and lower hepatitis B virus, hepatitis D virus, cirrhosis, and tumor aggressiveness parameters. Turkish patients thus have distinct patterns of presentation, but the biological relationships between MTD and both platelets and bilirubin levels are similar to the relationships that have been reported in other ethnic patient groups.
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Affiliation(s)
- Hikmet Akkiz
- Gastroenterology Department, Çukurova Üniversitesi, Adana, Turkey
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6
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Caglar E, Ugurlu S, Seyahi E, Kantarci F, Sonsuz A, Yurdakul S, Yazici H. SAT0178 An Outcome Survey of 40 Patients with Budd-Chiari Syndrome due to BehÇEt’S Syndrome Followed by a Single Center. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Canbakan B, Senturk H, Tahan V, Hatemi I, Balci H, Toptas T, Sonsuz A, Velet M, Aydin S, Dirican A, Ozgulle S, Ozbay G. Clinical, biochemical and histological correlations in a group of non-drinker subjects with non-alcoholic fatty liver disease. Acta Gastroenterol Belg 2007; 70:277-284. [PMID: 18074737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The correlation between biochemistry, imaging-studies and histology is a matter of controversy in non-alcoholic fatty liver disease (NAFLD) and the major pathophysiology of non-alcoholic steatohepatitis (NASH) is still unknown. We aimed to perform a comparative analysis between clinical, biochemical and histological variables of NAFLD. One-hundred and five NAFLD patients (F/M: 51/54), were studied, all with no-alcohol intake. The groups were followed-up for six months. Necroinflammation and fibrosis were more severe in patients with diabetes (p = 0.002, and p = 0.0001, respectively). In comparing NAFL to NASH, plasma nitric-oxide and malondialdehyde levels were significantly higher (p = 0.05, for-both), and vitamin-E and-C levels were significantly lower in NASH (p = 0.002, and 0.001, respectively). The serum ferritin levels were higher in NASH patients (p = 0.016). While the ultrasonographic grade was significantly higher, the liver-spleen density gradient was significantly lower in NASH group (p = 0.017, and 0.005, respectively). Within a six month period, serum ALT levels dropped into the normal range in 23/76 (30.3%) patients and serum ALT in the 6th month correlated significantly with the severity of steatosis, inflammation and fibrosis in initial biopsy (p = 0.023, 0.035, 0.011, respectively). In conclusion, the probability of severe liver disease is higher in patients with elevated-ALT in NAFLD. Serum ferritin levels have some prognostic significance in liver damage and fibrosis. Overt diabetes is predictive of advanced fibrosis and inflammation. However impaired glucose-tolerance is not. The advice on diet and exercise for six months after diagnosis may be a good strategy in NAFLD. The patients with normal-ALT without hepatomegaly, morbid-obesity and diabetes seem to have a good prognosis, however some of these patients may still require liver biopsy.
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Affiliation(s)
- B Canbakan
- Department of Gastroenterology, Cerrahpasa Medical Faculty of Istanbul University.
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9
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Bilir M, Mert A, Ozaras R, Yanardag H, Karayel T, Senturk H, Tahan V, Ozbay G, Sonsuz A. Hepatic sarcoidosis: clinicopathologic features in thirty-seven patients. J Clin Gastroenterol 2000; 31:337-8. [PMID: 11129279 DOI: 10.1097/00004836-200012000-00015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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10
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Sonsuz A, Basaranoglu M, Ozbay G. Relationship between aminotransferase levels and histopathological findings in patients with nonalcoholic steatohepatitis. Am J Gastroenterol 2000; 95:1370-1. [PMID: 10811364 DOI: 10.1111/j.1572-0241.2000.02046.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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11
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12
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Affiliation(s)
- A Sonsuz
- Department of Internal Medicine, Cerrahpasa Medical Faculty, University of Istanbul, Turkey
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13
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Affiliation(s)
- M Başaranoğlu
- Department of Hepatology, Cerrahpasa Medical Faculty, University of Istanbul, Turkey
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14
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Senturk H, Uzunalimoglu O, Batur Y, Simsek I, Mert A, Ozbay G, Cetinkaya H, Ersoz G, Tabak F, Akbaylar H, Akdogan M, Dokmeci A, Sonsuz A, Ozenirler S, Erden E, Tozum N. Long-term efficacy of interferon-alpha and ursodeoxycholic acid in treatment of chronic type C hepatitis. Dig Dis Sci 1997; 42:1438-44. [PMID: 9246043 DOI: 10.1023/a:1018854424403] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Interferon-alpha (IFN) and ursodeoxycholic acid (UDCA) combined have a controversial role in the treatment of chronic type C hepatitis. We studied the long-term efficacy of both drugs alone or in combination. In a three-year period, 108 patients were randomized into three treatment arms: (1) IFN alone 3 MU three times a week (N = 49), (2) IFN 3 MU three times a week + UDCA 250 mg twice a day (N = 45), and (3) UDCA alone 250 mg twice a day (N = 14). Response was defined as complete normalization of serum ALT. For the responders at the end of six months, the treatment was run to 12 months. Nonresponders (NRs) of the first group were crossed over to combination and NRs of the combination received 6 MU three times a week IFN+UDCA for the next six months. The enrollment to the UDCA alone arm was stopped early, since only 1/14 normalized serum ALT at the end of third month. However, 12/14 completed six months and 11 NRs received IFN 3 MU three times a week alone for the next six months. Twelve discontinued treatment due to side effects. Responders were followed-up untreated for 18 months. Sustained response (SR) was defined as persistence of normal serum ALT levels in this period. At the end of six months, 22/45 (48%) from the IFN-alone and 23/39 (58%) from the combination group responded. Twenty NRs from former and 15 of latter group were crossed over. While none of the 20 from the IFN-alone group responded to the combination, 1/15 NRs of the combination group responded to dose escalation. SR was achieved in 9/45 (20%) of the IFN alone and 7/39 (18%) of the combination group. The mean time form the end of the treatment to the relapse was not different between the groups. Five of 11 UDCA NRs responded to IFN with SR in 2. It was concluded that UDCA as a single agent is ineffective in achieving response in the treatment of chronic type C hepatitis. Combined with IFN, it increases response rate insignificantly although this is not sustained.
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Affiliation(s)
- H Senturk
- Department of Internal Medicine, Faculty of Istanbul University, Turkey
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15
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Hamuryudan V, Sonsuz A, Yurdakul S. More on hepatitis C virus and Behçet's syndrome. N Engl J Med 1995; 333:322; author reply 322-3. [PMID: 7596387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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16
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Sonsuz A, Ozdemir S, Akdoğan M, Sentürk H, Ozbay G, Akin P, Gürakar M. Lipoma of the liver. Z Gastroenterol 1994; 32:348-50. [PMID: 7975764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A case of lipoma of the liver with dimensions of 21 x 15 x 18 cm in a 65 year old male patient is presented. The tumour was visualized in ultrasonography as a homogenous lesion with a hyperechogenic image whereas it presented as a lesion having a density between -23 to -60 HU in CT. Angiographical examination showed increased vascularity and pathological accumulation of contrast medium. Histopathological examination revealed a lipoma of liver entirely consisting of mature lipocytes.
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Affiliation(s)
- A Sonsuz
- Istanbul University Cerrahpaşa Medical Faculty, Department of Internal Medicine, Turkey
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