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Artan AS, Mirioğlu Ş, İstemihan Z, Aksoy E, Dirim AB, Çavuş B, Oto ÖA, Çifçibaşı-Örmeci A, Beşışık F, Çalışkan Y, Öztürk S, Yazıcı H, Kaymakoğlu S, Türkmen A. Efficacy and Safety of Sofosbuvir and Ledipasvir for Hepatitis C in Kidney Transplant Recipients: A Single-center Retrospective Observational Study. Balkan Med J 2023; 40:182-187. [PMID: 36960943 PMCID: PMC10175878 DOI: 10.4274/balkanmedj.galenos.2023.2022-10-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
Background Treatment using direct-acting antivirals provides high rates of sustained virologic response and a favorable safety profile for patients with chronic hepatitis C virus infection. However, data on the efficacy of direct-acting antivirals in kidney transplant recipients are still limited. Aims We evaluated the safety and efficacy of fixed-dose sofosbuvir/ledipasvir combination in kidney transplant recipients. Study Design Retrospective, observational, single-center study. Methods Data of 29 kidney transplant recipients who received a fixed-dose safety and efficacy of fixed-dose sofosbuvir/ledipasvir combination for 12 or 24 weeks with or without ribavirin were analyzed. The primary outcome was SVR12, which was defined as undetectable HCV-RNA levels 12 weeks after the treatment. Secondary outcomes were graft function, proteinuria, and calcineurin inhibitor trough level variability. Results The predominant hepatitis C virus genotype was 1b (n = 19, 65.6%). All patients achieved SVR12. No graft failures nor deaths were reported during the study period. Throughout and after the treatment, the levels of aspartate aminotransferase [21 (range: 18-29.5) to 16 (range: 14-20) U/l, p < 0.001] and alanine aminotransferase [22 (range: 15-34) to 14 (range: 12-17.5) U/l, p < 0.001] improved significantly, unlike bilirubin, hemoglobin, and platelet levels. Renal function remained stable. Dose adjustments for calcineurin inhibitors were required. Serious adverse events were not observed. Conclusion Safety and efficacy of fixed-dose sofosbuvir/ledipasvir combination was effective and safe in kidney transplant recipients with hepatitis C virus. However, cautious monitoring of trough levels of calcineurin inhibitorss is needed due to potential drug-drug interactions during the treatment episode.
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Affiliation(s)
- Ayşe Serra Artan
- Division of Nephrology, Department of Internal Medicine, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Şafak Mirioğlu
- Division of Nephrology, Department of Internal Medicine, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
- Division of Nephrology, Department of Internal Medicine, Bezmialem Vakıf University Faculty of Medicine, İstanbul, Turkey
| | - Zulal İstemihan
- Division of Gastroenterohepatology, Department of Internal Medicine, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Elif Aksoy
- Division of Nephrology, Department of Internal Medicine, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Ahmet Burak Dirim
- Division of Nephrology, Department of Internal Medicine, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Bilger Çavuş
- Division of Gastroenterohepatology, Department of Internal Medicine, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Özgür Akın Oto
- Division of Nephrology, Department of Internal Medicine, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Aslı Çifçibaşı-Örmeci
- Division of Gastroenterohepatology, Department of Internal Medicine, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Fatih Beşışık
- Division of Gastroenterohepatology, Department of Internal Medicine, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Yaşar Çalışkan
- Division of Nephrology, Department of Internal Medicine, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
- Center for Abdominal Transplantation, Saint Louis University Faculty of Medicine, Saint Louis, MO, USA
| | - Savaş Öztürk
- Division of Nephrology, Department of Internal Medicine, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Halil Yazıcı
- Division of Nephrology, Department of Internal Medicine, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Sabahattin Kaymakoğlu
- Division of Gastroenterohepatology, Department of Internal Medicine, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Aydın Türkmen
- Division of Nephrology, Department of Internal Medicine, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
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Kayar Y, Dertli R, Konür Ş, Ağın M, Kafee AA, Baran B, Örmeci AÇ, Akyüz F, Demir K, Beşışık F, Kaymakoğlu S, Kaymakoglu S. Mucocutaneous Manifestations and Associated Factors in Patients with Crohn's Disease. Turk J Gastroenterol 2022; 33:945-954. [PMID: 36098365 PMCID: PMC9797716 DOI: 10.5152/tjg.2022.21750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND One-third of all extraintestinal manifestations are mucocutaneous findings in patients with Crohn's disease and there is a relationship between some risk factors. Our aim is to evaluate factors associated with mucocutaneous manifestations in our cohort of patients with Crohn's disease with a follow-up duration of up to 25 years. METHODS In the study, 336 patients with Crohn's disease who were followed up between March 1986 and October 2011 were included. The demographic characteristics, Crohn's disease-related data, and accompanying mucocutaneous manifestations were recorded. The cumulative probability of mucocutaneous extraintestinal manifestations and possible risk factors were analyzed. RESULTS Oral and skin involvement were detected in 109 (32%) and 31 (9.2%) patients, respectively. The cumulative probability of developing oral and skin manifestations were 43.2% and 20.3%, respectively. Cox regression analysis showed that female gender (odds ratio: 3.28, 95% CI: 1.51-7.14, P = .003) and corticosteroid use (odds ratio: 7.88, 95% CI: 1.07-57.97, P = .043) are independently associated with the development of skin manifestations, while family history (odds ratio: 3.59, 95% CI: 2.18-5.93, P < .001) and inflammatory-type disease (odds ratio: 1.776, 95% CI: 1.21-2.61, P = .004) were independently associated with the development of oral ulcers. CONCLUSION Mucocutaneous extraintestinal manifestations are associated with female gender, corticosteroid use, family history, and disease type in a large cohort of patients with Crohn's disease. Defining the specific relationships of immune-mediated diseases will help to better understand the pathogenesis of Crohn's disease and associated mucocutaneous manifestations and to use more effective treatments.
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Affiliation(s)
- Yusuf Kayar
- Division of Gastroenterology, Department of Internal Medicine, Van Teaching and Research Hospital, Health Sciences University, Van, Turkey,Corresponding author: Yusuf Kayar, e-mail:
| | - Ramazan Dertli
- Division of Gastroenterology, Department of Internal Medicine, Van Teaching and Research Hospital, Health Sciences University, Van, Turkey
| | - Şevki Konür
- Department of Internal Medicine, Van Teaching and Research Hospital, Health Sciences University, Van, Turkey
| | - Mehmet Ağın
- Division of Gastroenterology, Department of Pediatrics, Van Teaching and Research Hospital, Health Sciences University, Van, Turkey
| | - Abdullah Al Kafee
- Department of Biomedical Engineering, İstanbul University, İstanbul, Turkey
| | - Bülent Baran
- Division of Gastroenterology, Department of Internal Medicine, Koç University, İstanbul, Turkey
| | - Aslı Çiftçibaşı Örmeci
- Division of Gastroenterology, Department of Internal Medicine, İstanbul University, İstanbul, Turkey
| | - Filiz Akyüz
- Division of Gastroenterology, Department of Internal Medicine, İstanbul University, İstanbul, Turkey
| | - Kadir Demir
- Division of Gastroenterology, Department of Internal Medicine, İstanbul University, İstanbul, Turkey
| | - Fatih Beşışık
- Division of Gastroenterology, Department of Internal Medicine, İstanbul University, İstanbul, Turkey
| | - Sabahattin Kaymakoğlu
- Division of Gastroenterology, Department of Internal Medicine, İstanbul University, İstanbul, Turkey
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Akarca US, Baykam N, Güner R, Günşar F, İdilman R, Kaymakoğlu S, Köksal İ, Tabak F, Yamazhan T. Eliminating Viral Hepatitis in Turkey: Achievements and Challenges. Egypt J Immunol 2022. [DOI: 10.4274/vhd.galenos.2022.2022-9-1] [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: 12/01/2022]
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Çifcibaşi Örmeci A, Çavuş B, Akas R, Istemihan Z, Imanov Z, Şenkal V, Nuriyev K, Bayraktar A, Külle CB, Keskin M, Demir K, Beşişik F, Kaymakoğlu S, Akyüz F. What is the effect of subepithelial lesions of the esophagus on esophageal motility? Eur Rev Med Pharmacol Sci 2022; 26:6300-6309. [PMID: 36111931 DOI: 10.26355/eurrev_202209_29654] [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: 06/15/2023]
Abstract
OBJECTIVE Esophageal motility is regulated both by coordinated stimulation and inhibition of the circular and longitudinal muscle layers of the esophagus. Although there are many diseases known to have an effect on esophageal motility, the effect of subepithelial lesions (SELs) of the esophagus on esophageal motility, which is often detected incidentally, remains still unclear. The aim of this study is to reveal the effect of SELs of the esophagus on esophageal motility evaluating it by high-resolution manometry (HRM). PATIENTS AND METHODS A total of 32 patients with SELs in the esophagus and 12 healthy individuals were included. All patients and controls included in the study underwent HRM using a Unisensor UniTip High Resolution catheter (Laborie, Amsterdam, Netherlands) and endosonographic examination. RESULTS The mean age was 52.60±15.56 years (range: 23-79) and the average body mass index (BMI) was 26.63±4.71 kg/m2. Gender, height, weight, and BMI measurements, smoking status, alcohol use, and DM status did not statistically differ significantly between the groups (p>0.05). Of 32 patients with SELs, 65.6% (n=21) had lesions originating in the muscularis propria, while 34.4% had lesions originating in the submucosa. The rate of abnormal motility both in the supine and in upright positions of patients with SELs was found to be significantly higher than in the control group (p=0.001, p<0.01, respectively). In patients with SELs, the incidence of infective motility was higher than the normal group (p=0.001, p<0.01, respectively). As the size of the lesion increases (>2 cm), the probability of abnormal HRM results increased. CONCLUSIONS SELs of the esophagus have pathological effects on esophageal motility, mainly ineffective esophageal motility disorder.
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Affiliation(s)
- A Çifcibaşi Örmeci
- Gastroenterohepatology, Gastrointestinal Surgery Unit, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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Örmeci AÇ, Bayraktar Ş, Işık AO, Çavuş B, Akas R, İstemihan Z, Sarıdal MK, Akyüz F, Beşışık F, Kaymakoğlu S, İzgi B, Demir K. Is anterior segment OCT superior to slit-lamp biomicroscopic examination for Kayser Flesicher ring in Wilson's disease? Eur Rev Med Pharmacol Sci 2022; 26:5178-5185. [PMID: 35916815 DOI: 10.26355/eurrev_202207_29306] [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: 06/15/2023]
Abstract
OBJECTIVE Detection of the Kayser-Fleischer (KF) ring in the diagnostic scoring and treatment follow-up of Wilson's Disease (WD) is important. Slit lamp (SL) biomicroscopic examination has traditionally been used in the evaluation of the KF ring. The role of Anterior Segment Optical Coherence Tomography (AS-OCT), which is used in various corneal diseases, in the detection of KF rings has attracted attention in recent years. In our study, we tried to demonstrate the effectiveness of AS-OCT in detecting the KF ring by comparing it with SL biomicroscopic examination. PATIENTS AND METHODS 64 of 356 patients followed in our outpatient clinic due to WD were included in the study in the order of their admission to the outpatient clinic. The KF ring was evaluated in both eyes by SL-biomicroscopic examination and AS-OCT. Ophthalmic examination, and findings were performed by the same physician. RESULTS Age range was 18-67 years, mean 33.06±10.83 years, gender was 39.1% (n: 25) female. At the time of diagnosis, the mean age was 19.48 ± 9.36 years, range was minimum 5 years and maximum 51 years. Clinical presentation was mixed type involvement n: 18 (28.1%), hepatic involvement n: 32 (50%), neurological involvement n: 14 (21.9%). The follow-up period was 2-257 months (74.6±76.16). The presence of KF ring was evaluated together with both AS-OCT and slit-lamp examination, the presence of KF could be detected in both AS-OCT and SL biomicroscopic examination in 10 patients (15.6%), in 12 (18.8%) of the cases KF ring is positive in AS-OCT but was negative in Slit-lamp biomicroscopic examination, in 65.6 (n: 42) of the cases OCT and slit-lamp biomicroscopic examination results were negative. CONCLUSIONS The sensitivity of AS-OCT in detecting the KF ring was higher than the slit-lamp biomicroscopic examination. AS-OCT can detect early stage of KF rings in Wilson's Disease patients, so that diagnosis and treatment accuracy can be evaluated effectively.
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Affiliation(s)
- A Ç Örmeci
- Department of Internal Medicine, Division of Gastroenterology, Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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Evirgen S, İliaz R, Akyüz F, Çavuş B, Göktürk S, Örmeci A, Soyer ÖM, Baran B, Pınarbaşı B, Karaca Ç, Demir K, Beşışık F, Kaymakoğlu S. Cyclosporine Therapy as a Rescue Treatment in Steroid Refractory Acute Severe Ulcerative Colitis: A Real Life Data From a Tertiary Center. Turk J Gastroenterol 2022; 33:463-469. [PMID: 35786613 PMCID: PMC9317765 DOI: 10.5152/tjg.2022.21093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 09/23/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Cyclosporine is a rescue treatment alternative to avoid colectomy in corticosteroid refractory acute severe ulcerative colitis. In this study, we aimed to evaluate the long-term efficacy and safety of cyclosporine therapy in acute severe ulcerative colitis patients. METHODS Acute severe ulcerative colitis (basal Lichtiger score > 10) patients who did not respond to 40 mg intravenous methylpredniso- lone therapy after 3-5 days were included in the study. The presence of clinical response and remission was assessed at 1st week, 1st, 6th, and 12th month according to the Lichtiger index. RESULTS In this study, 40 patients, whose steroid refractory acute severe ulcerative colitis and basal Lichtiger score > 10 points were enrolled. The median disease duration was 49.3 months (2-204). All patients received cyclosporine for 132 ± 78 days (7-270). Clinical response was obtained on seventh day in 82.5%. The clinical response rates of the first and sixth months were 72.5% and 62.5%, respectively. A total of 17/40 (42.5%) patients underwent colectomy within 1 year. In the patients who underwent colectomy, the basal LS (14.2 ± 1.9 vs 12.3 ± 1.7) (P = .002) was higher and the basal hemoglobin value (11.8 ± 2.3 vs 10.1 ± 1.5) (P = .037) was lower than those who did not undergo colectomy. CONCLUSION Our findings suggest that cyclosporine treatment may be successfully and safely used in steroid refractory acute severe ulcerative colitis patients. Cyclosporine is a drug that has recently started to come up again with the introduction of new maintenance treatments. Especially in patients who develop a loss of response to infliximab therapy, or where infliximab therapy is contraindicated, or who have azathioprine intolerance, or are unresponsive.
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Affiliation(s)
- Sami Evirgen
- Department of Gastroenterology, Kastamonu University Faculty of Medicine, Kastamonu, Turkey
| | - Raim İliaz
- Department of Gastroenterology, Atlas University Faculty of Medicine, İstanbul, Turkey
| | - Filiz Akyüz
- Department of Gastroenterology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Bilger Çavuş
- Department of Gastroenterology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Suut Göktürk
- Department of Gastroenterology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Aslı Örmeci
- Department of Gastroenterology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Özlem Mutluay Soyer
- Department of Gastroenterology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Bülent Baran
- Department of Gastroenterology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Binnur Pınarbaşı
- Department of Gastroenterology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Çetin Karaca
- Department of Gastroenterology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Kadir Demir
- Department of Gastroenterology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Fatih Beşışık
- Department of Gastroenterology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Sabahattin Kaymakoğlu
- Department of Gastroenterology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
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Torun ES, Erciyestepe M, Yalçınkaya Y, Gül A, İnanç M, Öcal L, Kaymakoğlu S, Peynircioğlu B, Artım-Esen B. A Case of Budd-Chiari Syndrome Associated With Antiphospholipid Syndrome Treated Successfully by Transjugular Intrahepatic Portosystemic Shunt. Clin Med Insights Case Rep 2022; 15:11795476221100595. [PMID: 35601267 PMCID: PMC9121445 DOI: 10.1177/11795476221100595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/27/2022] [Indexed: 11/23/2022]
Abstract
Budd Chiari syndrome (BCS) is defined as obstruction of hepatic venous outflow
that can be located anywhere from small hepatic venules up to the entrance of
inferior vena cava (IVC) into right atrium. Etiologies of BCS include
myeloproliferative disorders, congenital, and acquired hypercoagulable states.
Anticoagulation is the mainstay of treatment for all cases of BCS with a
demonstrable hypercoagulable state. Interventional radiology procedures such as
transjugular intrahepatic portosystemic shunting (TIPS) can be utilized to
reduce portal hypertension and to improve complications related to portal
hypertension. We present a patient with systemic lupus erythematosus who first
presented with fever, weight loss, malar rash, alopecia, livedo reticularis,
symmetric polyarthritis, pancytopenia, and class IV lupus nephritis when she was
23 years old. After receiving an induction treatment of cyclophosphamide and
glucocorticoids, she received a maintenance treatment of azathioprine. She
presented with ascites and abdominal pain when she was 36 and the abdominal
imaging revealed reduced calibration of hepatic venules and intrahepatic segment
of inferior vena cava. Lupus anticoagulant was positive and anti cardiolipin IgM
and IgG were positive. Work up for hereditary hypercoagulable states was
negative. Thus, the diagnosis was secondary antiphospholipid syndrome where BCS
was the first clinical manifestation of the antiphospholipid syndrome. Patient
was anticoagulated with warfarin and received diuretics for ascites. After the
ascites became refractory to diuretics and the patient had multiple vertebral
compression fractures due to volume overload secondary to ascites, she was
successfully treated with TIPS. When control imaging was performed, 50% of
stenosis was observed in the stent. Balloon dilation of the stent was performed.
Interventional radiology techniques like TIPS can be used in BCS patients
secondary to APS, in cases when medical treatment is insufficient to control
complications of portal hypertension. In BCS patients secondary to APS, TIPS
enables clinical improvement but due to the presence of endothelial dysfunction
in APS patients, there is a risk of shunt dysfunction secondary to thrombosis or
stenosis secondary to intimal hyperplasia. Therefore, strict anticoagulation and
regular follow up of patients after TIPS is recommended. In cases with stent
stenosis, reintervention may be necessary.
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Affiliation(s)
- Ege Sinan Torun
- Division of Rheumatology, Department of Internal Medicine, Prof.Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Mert Erciyestepe
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasemin Yalçınkaya
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Murat İnanç
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Lale Öcal
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sabahattin Kaymakoğlu
- Division of Gastroenterohepatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Bora Peynircioğlu
- Department of Radiology, Hacettepe Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Bahar Artım-Esen
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Özden İ, Poyanlı A, Sanlı Y, Kaymakoğlu S. Steroid-induced reconstitution of the biliary tree ravaged by IgG4-related disease. Clin Case Rep 2020; 8:3553-3554. [PMID: 33363974 PMCID: PMC7752589 DOI: 10.1002/ccr3.3109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 04/27/2020] [Revised: 06/05/2020] [Accepted: 06/24/2020] [Indexed: 11/19/2022] Open
Abstract
The steroid-induced, rapid healing of the biliary tree ravaged by IgG4-related disease shows that the point of irreversibility remains to be defined.
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Affiliation(s)
- İlgin Özden
- General Surgery (Hepatopancreatobiliary Surgery Unit)Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Arzu Poyanlı
- RadiologyIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Yasemin Sanlı
- Nuclear MedicineIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Sabahattin Kaymakoğlu
- Internal Medicine (Gastroenterology Unit)Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
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9
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Değertekin B, Demir M, Akarca US, Kani HT, Üçbilek E, Yıldırım E, Güzelbulut F, Balkan A, Vatansever S, Danış N, Demircan M, Soylu A, Yaras S, Kartal A, Kefeli A, Gündüz F, Yalçın K, Erarslan E, Aladağ M, Harputluoğlu M, Özakyol A, Temel T, Akarsu M, Sümer H, Akın M, Albayrak B, Sen İ, Alkım H, Uyanıkoğlu A, Irak K, Öztaşkın S, Uğurlu ÇB, Güneş Ş, Gürel S, Nuriyev K, İnci İ, Kaçar S, Dinçer D, Doğanay L, Göktürk HS, Mert A, Coşar AM, Dursun H, Atalay R, Akbulut S, Balkan Y, Koklu H, Şimşek H, Özdoğan O, Çoban M, Poturoğlu Ş, Ayyıldız T, Yapalı S, Günsar F, Akdoğan M, Özenirler S, Akyıldız M, Sezgin O, Özdoğan O, Kaymakoğlu S, Beşışık F, Karasu Z, İdilman R. Real-world efficacy and safety of Ledipasvir + Sofosbuvir and Ombitasvir/Paritaprevir/Ritonavir ± Dasabuvir combination therapies for chronic hepatitis C: A Turkish experience. Turk J Gastroenterol 2020; 31:883-893. [PMID: 33626001 PMCID: PMC7928249 DOI: 10.5152/tjg.2020.20696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/09/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND/AIMS This study aimed to evaluate the real-life efficacy and tolerability of direct-acting antiviral treatments for patients with chronic hepatitis C (CHC) with/without cirrhosis in the Turkish population. MATERIAL AND METHODS A total of 4,352 patients with CHC from 36 different institutions in Turkey were enrolled. They received ledipasvir (LDV) and sofosbuvir (SOF)±ribavirin (RBV) orombitasvir/paritaprevir/ritonavir±dasabuvir (PrOD)±RBV for 12 or 24 weeks. Sustained virologic response (SVR) rates, factors affecting SVR, safety profile, and hepatocellular cancer (HCC) occurrence were analyzed. RESULTS SVR12 was achieved in 92.8% of the patients (4,040/4,352) according to intention-to-treat and in 98.3% of the patients (4,040/4,108) according to per-protocol analysis. The SVR12 rates were similar between the treatment regimens (97.2%-100%) and genotypes (95.6%-100%). Patients achieving SVR showed a significant decrease in the mean serum alanine transaminase (ALT) levels (50.90±54.60 U/L to 17.00±14.50 U/L) and model for end-stage liver disease (MELD) scores (7.51±4.54 to 7.32±3.40) (p<0.05). Of the patients, 2 were diagnosed with HCC during the treatment and 14 were diagnosed with HCC 37.0±16.0 weeks post-treatment. Higher initial MELD score (odds ratio [OR]: 1.92, 95% confidence interval [CI]: 1.22-2.38; p=0.023]), higher hepatitis C virus (HCV) RNA levels (OR: 1.44, 95% CI: 1.31-2.28; p=0.038), and higher serum ALT levels (OR: 1.38, 95% CI: 1.21-1.83; p=0.042) were associated with poor SVR12. The most common adverse events were fatigue (12.6%), pruritis (7.3%), increased serum ALT (4.7%) and bilirubin (3.8%) levels, and anemia (3.1%). CONCLUSION LDV/SOF or PrOD±RBV were effective and tolerable treatments for patients with CHC and with or without advanced liver disease before and after liver transplantation. Although HCV eradication improves the liver function, there is a risk of developing HCC.
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Affiliation(s)
- Bülent Değertekin
- Division of Gastroenterology and Hepatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, İstanbul, Turkey
| | - Mehmet Demir
- Division of Gastroenterology Mustafa Kemal University School of Medicine, Hatay, Turkey
| | - Ulus S. Akarca
- Division of Gastroenterology and Hepatology, Ege University School of Medicine, İzmir, Turkey
| | - Haluk Tarık Kani
- Division of Gastroenterology and Hepatology, Marmara University School of Medicine, İstanbul, Turkey
| | - Enver Üçbilek
- Division of Gastroenterology, Mersin University School of Medicine, Mersin, Turkey
| | - Emre Yıldırım
- Division of Gastroenterology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Fatih Güzelbulut
- Division of Gastroenterology, Haydarpasa Numune Training and Research Hospital, İstan-bul, Turkey
| | - Ayhan Balkan
- Division of Gastroenterology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Sezgin Vatansever
- Division of Gastroenterology, Kâtip Celebi University, İzmir, Turkey
| | - Nilay Danış
- Division of Gastroenterology and Hepatology, Ege University School of Medicine, İzmir, Turkey
| | - Melek Demircan
- Division of Gastroenterology, Eskisehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Aliye Soylu
- Division of Gastroenterology, Health Sciences University Bakırkoy Hospital, İstanbul, Turkey
| | - Serkan Yaras
- Division of Gastroenterology, Mersin University School of Medicine, Mersin, Turkey
| | - Aysun Kartal
- Division of Gastroenterology and Hepatology, Ankara University School of Medicine, Ankara, Turkey
| | - Ayşe Kefeli
- Division of Gastroenterology, Tokat Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Feyza Gündüz
- Division of Gastroenterology and Hepatology, Marmara University School of Medicine, İstanbul, Turkey
| | - Kendal Yalçın
- Division of Gastroenterology and Hepatology, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Elife Erarslan
- Division of Gastroenterology, Dışkapı Trainining and Research Hospital, Ankara, Turkey
| | - Murat Aladağ
- Division of Gastroenterology and Hepatology, İnonu University School of Medicine, Malatya, Turkey
| | - Murat Harputluoğlu
- Division of Gastroenterology and Hepatology, İnonu University School of Medicine, Malatya, Turkey
| | - Ayşegül Özakyol
- Division of Gastroenterology, Eskisehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Tuncer Temel
- Division of Gastroenterology, Eskisehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Mesut Akarsu
- Division of Gastroenterology and Hepatology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Hale Sümer
- Division of Gastroenterology, Ankara City Hospital, Ankara, Turkey
| | - Mete Akın
- Division of Gastroenterology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Bülent Albayrak
- Division of Gastroenterology, Akdeniz University School of Medicine, Antalya, Turkey
| | - İlker Sen
- Division of Gastroenterology, Health Sciences University, Şişli Etfal Hospital, İstanbul, Turkey
| | - Hüseyin Alkım
- Division of Gastroenterology, Health Sciences University, Şişli Etfal Hospital, İstanbul, Turkey
| | - Ahmet Uyanıkoğlu
- Division of Gastroenterology, Harran University School of Medicine, Urfa, Turkey
| | - Kader Irak
- Division of Gastroenterology, Kanuni Sultan Suleyman Training and Research Hospital, İstanbul, Turkey
| | - Sinem Öztaşkın
- Division of Gastroenterology and Hepatology, İstanbul University School of Medicine, İstanbul Turkey
| | - Çağrı Burak Uğurlu
- Division of Gastroenterology and Hepatology, İstanbul University School of Medicine, İstanbul Turkey
| | - Şevkican Güneş
- Division of Gastroenterology and Hepatology, İstanbul University School of Medicine, İstanbul Turkey
| | - Selim Gürel
- Division of Gastroenterology and Hepatology, Uludag University School of Medicine, Bursa, Turkey
| | - Kenan Nuriyev
- Division of Gastroenterology and Hepatology, İstanbul University School of Medicine, İstanbul Turkey
| | - İsmail İnci
- Division of Gastroenterology and Hepatology, İstanbul University School of Medicine, İstanbul Turkey
| | - Sabite Kaçar
- Division of Gastroenterology, Ankara City Hospital, Ankara, Turkey
| | - Dinç Dinçer
- Division of Gastroenterology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Levent Doğanay
- Division of Gastroenterology, Umraniye Training and Research Hospital, İstanbul, Turkey
| | | | - Ali Mert
- Division of Infectious Diseases, Istanbul Medipol University School of Medicine, İstanbul Turkey
| | - Arif Mansur Coşar
- Division of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Hakan Dursun
- Division of Gastroenterology, Ataturk University, School of Medicine, Erzurum, Turkey
| | - Roni Atalay
- Division of Gastroenterology, Ankara City Hospital, Ankara, Turkey
| | - Sabiye Akbulut
- Division of Gastroenterology, Kartal Kosuyolu Yüksek İhtisas Training and Research Hospital, İstanbul, Turkey
| | - Yasemin Balkan
- Division of İnfectious Diseases, Gaziantep 25 Aralık Government Hospital, Gaziantep, Turkey
| | - Hayrettin Koklu
- Division of Gastroenterology and Hepatology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Halis Şimşek
- Division of Gastroenterology and Hepatology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Osman Özdoğan
- Division of Gastroenterology, Mersin University School of Medicine, Mersin, Turkey
| | - Mehmet Çoban
- Division of Gastroenterology, Ufuk University School of Medicine, Ankara, Turkey
| | - Şule Poturoğlu
- Division of Gastroenterology, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Talat Ayyıldız
- Division of Gastroenterology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Suna Yapalı
- Division of Gastroenterology and Hepatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, İstanbul, Turkey
| | - Fulya Günsar
- Division of Gastroenterology and Hepatology, Ege University School of Medicine, İzmir, Turkey
| | - Meral Akdoğan
- Division of Gastroenterology, Ankara City Hospital, Ankara, Turkey
| | - Seren Özenirler
- Division of Gastroenterology, Gazi University School of Medicine, Ankara, Turkey
| | - Murat Akyıldız
- Department of Gastroenterology, Organ Transplantation Center, Memorial Atasehir Hospital, İstanbul, Turkey
| | - Orhan Sezgin
- Division of Gastroenterology, Mersin University School of Medicine, Mersin, Turkey
| | - Osman Özdoğan
- Division of Gastroenterology and Hepatology, Marmara University School of Medicine, İstanbul, Turkey
| | - Sabahattin Kaymakoğlu
- Division of Gastroenterology and Hepatology, İstanbul University School of Medicine, İstanbul Turkey
| | - Fatih Beşışık
- Division of Gastroenterology and Hepatology, İstanbul University School of Medicine, İstanbul Turkey
| | - Zeki Karasu
- Division of Gastroenterology and Hepatology, Ege University School of Medicine, İzmir, Turkey
| | - Ramazan İdilman
- Division of Gastroenterology and Hepatology, Ankara University School of Medicine, Ankara, Turkey
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10
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Çavuş B, Akyuz F, İliaz R, Akyuz U, Duranyıldız D, Serilmez M, Tekin D, Evirgen S, Karaca Ç, Demir K, Beşışık F, Kaymakoğlu S. Assessment of prognostic and diagnostic value of some biomarkers in hepatocellular carcinoma. Exp Oncol 2020; 42:208-214. [PMID: 32996733 DOI: 10.32471/exp-oncology.2312-8852.vol-42-no-3.15125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is an increasing problem worldwide. Determining a prognosis is important for the management of HCC. AIM We aimed to investigate the impact of interleukin (IL)-29, galectin-3, leptin, fibronectin and protease-activated receptor-1 on the prognosis and diagnosis of patients with HCC. MATERIALS AND METHODS 60 HCC patients (75% male) and 20 healthy volunteers (70% male) were enrolled in this prospective study. Serum samples were obtained during the first admission before any adjuvant or metastatic treatments were administered. Serum biomarkers were determined using ELISA kits. RESULTS All patients had cirrhosis, and the Child - Pugh stages were as follows: 61.5% Child - Pugh A, 35.9% Child - Pugh B and 2.6% Child - Pugh C (61.7% hepatitis B virus, 11.7% hepatitis C virus, 6.7% hepatitis B virus + hepatitis C virus, 11.7% alcoholic and 8.3% cryptogenic). Fifty-three percent of the HCC patients died within a median of 7.5 months. The mean serum level of IL-29 in patients with HCC was higher than that in the control group (32.55 pg/ml vs 11.46 pg/ml, p < 0.015). Galectin-3 levels were significantly higher in the HCC group (6.7 ng/ml vs 1.38 ng/ml, p < 0.001). Fibronectin levels were higher in the control group than in the HCC group (260 635 ng/ml vs 257 353 ng/ml). However, the mean protease-activated receptor-1 and leptin levels were similar between the two groups (p > 0.05). The biomarkers were divided into two groups according to their median level. In the log rank analysis, biomarkers had no effect on survival (p > 0.05). CONCLUSIONS IL-29 and galectin-3 levels were significantly higher in HCC patients. Although IL-29 and galectin-3 can be used as diagnostic markers for HCC, they had no prognostic value in HCC patients.
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Affiliation(s)
- B Çavuş
- Gastroenterohepatology Department, İstanbul Faculty of Medicine, İstanbul University, İstanbul 34093, Turkey
| | - F Akyuz
- Gastroenterohepatology Department, İstanbul Faculty of Medicine, İstanbul University, İstanbul 34093, Turkey
| | - R İliaz
- Gastroenterohepatology Department, İstanbul Faculty of Medicine, İstanbul University, İstanbul 34093, Turkey
| | - U Akyuz
- Gastroenterohepatology Department, Medical Faculty, Yeditepe University, İstanbul 34755, Turkey
| | - D Duranyıldız
- Medical Oncology Department, İstanbul Medical School, İstanbul University, İstanbul 34093, Turkey
| | - M Serilmez
- Medical Oncology Department, İstanbul Medical School, İstanbul University, İstanbul 34093, Turkey
| | - D Tekin
- Medical Oncology Department, İstanbul Medical School, İstanbul University, İstanbul 34093, Turkey
| | - S Evirgen
- Gastroenterohepatology Department, İstanbul Faculty of Medicine, İstanbul University, İstanbul 34093, Turkey
| | - Ç Karaca
- Gastroenterohepatology Department, İstanbul Faculty of Medicine, İstanbul University, İstanbul 34093, Turkey
| | - K Demir
- Gastroenterohepatology Department, İstanbul Faculty of Medicine, İstanbul University, İstanbul 34093, Turkey
| | - F Beşışık
- Gastroenterohepatology Department, İstanbul Faculty of Medicine, İstanbul University, İstanbul 34093, Turkey
| | - S Kaymakoğlu
- Gastroenterohepatology Department, İstanbul Faculty of Medicine, İstanbul University, İstanbul 34093, Turkey
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11
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Kabaçam G, Dayangaç M, Üçbilek E, Erçin CN, Günsar F, Akyıldız M, Akarsu M, Demir M, Kaymakoğlu S, Karasu Z, İdilman R. The COVID-19 pandemic: Clinical practice advice for gastroenterologists, hepatologists, and liver transplant specialists. Turk J Gastroenterol 2020; 31:348-355. [PMID: 32519953 DOI: 10.5152/tjg.2020.20413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a novel acute infectious disease that has rapidly reached staggering pandemic proportions. This review addresses gastroenterologists, hepatologists, liver transplant (LT) specialists, and health-care professionals working in the field of liver diseases and liver transplantation. It has been written based on a limited number of publications, recommendations of national and international liver and organ transplantation societies, and experiences of patients with COVID-19 around the world. The purpose of this review is to provide information addressing questions and concerns about COVID-19, to reveal the effects of the novel disease on patients with chronic liver disease and LT recipients, and to share information about ways in which this pandemic will affect clinical practices. We, the Turkish Association for the Study of the Liver (TASL), would like to remind you that this text is actually not a practical guide. It is imperative to act according to the standards set by health-care institutions and the Ministry of Health, Republic of Turkey.
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Affiliation(s)
- Gökhan Kabaçam
- Clinic of Gastroenterology and Liver Transplantation, Guven Hospital Ankara, Turkey
| | - Murat Dayangaç
- Liver Transplant Unit, Medipol University Hospital, İstanbul Turkey
| | - Enver Üçbilek
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Turkey
| | - Cemal Nuri Erçin
- Department of Gastroenterology, Health Sciences University, Gulhane School of Medicine, Ankara, Turkey
| | - Fulya Günsar
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Murat Akyıldız
- Department of Gastroenterology, Koc University School of Medicine, İstanbul, Turkey
| | - Mesut Akarsu
- Department of Gastroenterology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Mehmet Demir
- Department of Gastroenterology, Hatay Mustafa Kemal University School of Medicine, Hatay, Turkey
| | - Sabahattin Kaymakoğlu
- Department of Gastroenterology, İstanbul University School of Medicine, İstanbul, Turkey
| | - Zeki Karasu
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Ramazan İdilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
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12
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İliaz R, Akyüz F, Yeğen G, Örmeci A, Göktürk S, Akyüz Ü, Baran B, Mutluay Ö, Evirgen S, Karaca Ç, Demir K, Beşışık F, Güllüoğlu M, Kaymakoğlu S. Does the number of mucosal immune cells differ in irritable bowel syndrome and its subtypes? Turk J Gastroenterol 2019; 29:384-391. [PMID: 30249551 DOI: 10.5152/tjg.2018.17491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS Recently, mucosal inflammation has been proposed to be one of the mechanisms underlying the pathophysiology of irritable bowel syndrome (IBS); however, there are controversial results regarding this hypotheses. Our aim was to evaluate immune cell infiltration in rectal and ileal biopsy specimens of patients with IBS and to compare it with those of healthy controls. MATERIALS AND METHODS In total, 36 patients with IBS (15 with diarrhea and 21 with constipation) and 16 healthy volunteers were enrolled. Ileocolonoscopy and ileal/rectal biopsies were performed. Rectal and terminal ileal biopsy specimens were evaluated for mucosal immune cell infiltration using immunohistochemical analysis. Serotonin positivity as well as counts of intraepithelial lymphocytes (IEL) and CD4+, CD8+, CD20+, and CD3+ cells were determined by a single pathologist who is an expert in the gastrointestinal system. RESULTS CD3+ and CD4+ cell counts in rectal and terminal ileal biopsy specimens were lower in the IBS group than in the controls. Conversely, there was no statistically significant difference between the IBS and control groups in terms of serotonin positivity as well as counts of IEL and CD20+ and CD8+ cells. Comparison between the IBS subgroups revealed a higher number of IEL in rectal biopsy specimens of the diarrhea dominant group. In the IBS subgroups, immune cell counts in terminal ileal and rectal biopsy specimens showed a positive correlation. CONCLUSION IBS and its subgroups showed lower immune cell counts than the controls in our study. These results indicate that there is no significant mucosal inflammation in homogeneous groups of patients with IBS. Rectal biopsies may be sufficient for the evaluation of inflammation in IBS.
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Affiliation(s)
- Raim İliaz
- Department of Gastroenterology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Filiz Akyüz
- Department of Gastroenterology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Gülçin Yeğen
- Department of Pathology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Aslı Örmeci
- Department of Gastroenterology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Suut Göktürk
- Department of Gastroenterology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Ümit Akyüz
- Department of Gastroenterology, Yeditepe University School of Medicine, İstanbul, Turkey
| | - Bülent Baran
- Department of Gastroenterology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Özlem Mutluay
- Department of Gastroenterology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Sami Evirgen
- Department of Gastroenterology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Çetin Karaca
- Department of Gastroenterology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Kadir Demir
- Department of Gastroenterology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Fatih Beşışık
- Department of Gastroenterology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Mine Güllüoğlu
- Department of Pathology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Sabahattin Kaymakoğlu
- Department of Gastroenterology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
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13
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Tabak F, Yurdaydın C, Kaymakoğlu S, Akarsu M, Akıncı EG, Akkız H, Alkım C, Çekin AH, Çuvalcı NÖ, Demir K, Değertekin B, Dökmetaş İ, Ersöz G, Hizel K, Kandemir FÖ, Önlen Y, Sonsuz A, Şenateş E, Tosun S, Tözün N, Idilman R, Guidelines Study Group VH. Diagnosis, management and treatment of hepatitis B virus infection: Turkey 2017 Clinical Practice Guidelines. Turk J Gastroenterol 2018; 28:73-83. [PMID: 29303103 DOI: 10.5152/tjg.2017.19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Fehmi Tabak
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Cihan Yurdaydın
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Sabahattin Kaymakoğlu
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Mesut Akarsu
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Esra G Akıncı
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Hikmet Akkız
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Canan Alkım
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ayhan H Çekin
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Nefise Ö Çuvalcı
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Kadir Demir
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Bülent Değertekin
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - İlyas Dökmetaş
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Galip Ersöz
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Kenan Hizel
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Fatma Ö Kandemir
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Yusuf Önlen
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Abdullah Sonsuz
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ebubekir Şenateş
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Selma Tosun
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Nurdan Tözün
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ramazan Idilman
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
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14
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Idilman R, Baykam N, Kaymakoğlu S, Tabak F, Bahçecioğlu HI, Bektaş A, Bulut C, Günşar F, İnan D, Karaosmanoğlu HK, Karasu Z, Kuşçu F, Mete B, Özbakır Ö, Özdoğan OC, Parlak M, Sırmatel F, Topalak Ö, Ünsal B, Guidelines Study Group VH. Turkey 2017 Clinical Practice Guidelines on recommendations for screening diagnosing and managing hepatitis C virus. Turk J Gastroenterol 2018; 28:90-93. [PMID: 29303105 DOI: 10.5152/tjg.2017.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The present guideline updates the Turkish recommendations for the screening, diagnosis and management of Hepatitis
C virus (HCV) infection prepared by the Turkish Association for the Study of the Liver (TASL) and Viral Hepatitis
Society (VHS). The aim of this guidance was to provide updates recommendations to physicians, who are interested
in HCV care on the optimal screening, diagnosis and pre-treatment management for patients with HCV infection
in Turkey. These recommendations, produced by panel experts, were aimed to addresses the management issues
ranging from diagnosis and linkage to care, to the optimal treatment regimen in patients with HCV infection. Recommendations
are based on evidence and opinions of more than 70% of the panelists. This guidance is supported by
the memberships of two societies and not by pharmaceutical companies. This guidance will be updated frequently
as new data become available.
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Affiliation(s)
- Ramazan Idilman
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Nurcan Baykam
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Sabahattin Kaymakoğlu
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Fehmi Tabak
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Halil I Bahçecioğlu
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ahmet Bektaş
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Cemal Bulut
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Fulya Günşar
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Dilara İnan
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Hayat K Karaosmanoğlu
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Zeki Karasu
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ferit Kuşçu
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Birgül Mete
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ömer Özbakır
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Osman C Özdoğan
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Mehmet Parlak
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Fatma Sırmatel
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ömer Topalak
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Belkis Ünsal
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
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15
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Kaymakoğlu S, Köksal İ, Tabak F, Akarca US, Akbulut A, Akyüz F, Bodur H, Çağatay A, Dinçer D, Esen Ş, Güner R, Gürel S, Köse Ş, Şentürk Ö, Şimşek H, Yamazhan T, Yılmaz Y, Idilman R, Guidelines Study Group VH. Recommendation for treatment of hepatitis C virus infection. Turk J Gastroenterol 2018; 28:94-100. [PMID: 29303106 DOI: 10.5152/tjg.2017.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Sabahattin Kaymakoğlu
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - İftihar Köksal
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Fehmi Tabak
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ulus S Akarca
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ayhan Akbulut
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Filiz Akyüz
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Hürrem Bodur
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Atahan Çağatay
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Dinç Dinçer
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Şaban Esen
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Rahmet Güner
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Selim Gürel
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Şükran Köse
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ömer Şentürk
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Halis Şimşek
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Tansu Yamazhan
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Yusuf Yılmaz
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ramazan Idilman
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
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Aygen B, Demir AM, Gümüş M, Karabay O, Kaymakoğlu S, Köksal AŞ, Köksal İ, Örmeci N, Tabak F. Immunosuppressive therapy and the risk of hepatitis B reactivation: Consensus report. Turk J Gastroenterol 2018; 29:259-269. [PMID: 29755010 PMCID: PMC6284666 DOI: 10.5152/tjg.2018.18263] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 04/07/2018] [Indexed: 12/12/2022]
Abstract
This consensus report includes expert opinions and recommendations regarding the screening, and if necessary, the follow-up, prophylaxis, and treatment of hepatitis B before the treatment in patients who will undergo immunosuppressive therapy due to an emergency risk of hepatitis B reactivation. To increase awareness regarding the risk of hepatitis B reactivation in immunosuppressive patients, academicians from several university health research and training centers across Turkey came together and discussed the importance of the subject, current status, and issues in accordance with the current literature data and presented solutions.
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Affiliation(s)
- Bilgehan Aygen
- Department of Infectious Diseases and Clinical Microbiology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Ahmet Muzaffer Demir
- Division of Hematology, Department of Internal Diseases, Trakya University School of Medicine, Edirne, Turkey
| | - Mahmut Gümüş
- Division of Oncology, Department of Internal Diseases, İstanbul Medeniyet University School of Medicine, İstanbul, Turkey
| | - Oğuz Karabay
- Department of Infectious Diseases and Clinical Microbiology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Sabahattin Kaymakoğlu
- Division of Gastroenterology, Department of Internal Diseases, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Aydın Şeref Köksal
- Division of Gastroenterology, Department of Internal Diseases, Sakarya University School of Medicine, Sakarya, Turkey
| | - İftihar Köksal
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Necati Örmeci
- Division of Gastroenterology, Department of Internal Diseases, Ankara University School of Medicine, Ankara, Turkey
| | - Fehmi Tabak
- Department of Infectious Diseases and Clinical Microbiology, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
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17
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Yurdaydın C, Tabak F, Kaymakoğlu S, Akarsu M, Akıncı EG, Akkız H, Alkım C, Çekin AH, Çuvalcı NÖ, Demir K, Değertekin B, Dökmetaş İ, Ersöz G, Hizel K, Kandemir FÖ, Önlen Y, Sonsuz A, Şenateş E, Tosun S, Tözün N, Idilman R, Guidelines Study Group VH. Diagnosis, management and treatment of hepatitis delta virus infection: Turkey 2017 Clinical Practice Guidelines. Turk J Gastroenterol 2018; 28:84-89. [PMID: 29303104 DOI: 10.5152/tjg.2017.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Cihan Yurdaydın
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Fehmi Tabak
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Sabahattin Kaymakoğlu
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Mesut Akarsu
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Esra G Akıncı
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Hikmet Akkız
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Canan Alkım
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ayhan H Çekin
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Nefise Ö Çuvalcı
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Kadir Demir
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Bülent Değertekin
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - İlyas Dökmetaş
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Galip Ersöz
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Kenan Hizel
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Fatma Ö Kandemir
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Yusuf Önlen
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Abdullah Sonsuz
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ebubekir Şenateş
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Selma Tosun
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Nurdan Tözün
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ramazan Idilman
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
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18
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Karadağ Ö, Kaşifoğlu T, Özer B, Kaymakoğlu S, Kuş Y, İnanç M, Keser G, Kiraz S. Viral hepatitis screening guideline before biological drug use in rheumatic patients. Eur J Rheumatol 2015; 3:25-28. [PMID: 27708965 DOI: 10.5152/eurjrheum.2015.150072] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 09/02/2015] [Accepted: 10/14/2015] [Indexed: 01/23/2023] Open
Abstract
Biological drugs (tumor necrosis factor inhibitors, rituximab, tocilizumab, abatacept, and tofacitinib) are important treatment alternatives in rheumatology, particularly for resistant patients. However, they may cause hepatitis B virus (HBV) and hepatitis C virus (HCV) reactivation; for instance, HBV reactivation may occur in a patient who is an inactive hepatitis B surface antigen (HBsAg) carrier or who has resolved HBV infection. Therefore, the screening of patients before biological treatment and the application of a prophylactic treatment, particularly with respect to latent HBV infections, are recommended when necessary. This guideline covers pre-treatment screening and follow-up recommendations, if required, with respect to viral hepatitides in rheumatology patients who are planned to be given biological drugs. Although this guideline is prepared for biological disease-modifying antirheumatic drugs (DMARDs), it is recommended to be used also for target-oriented DMARDS and medium-high dose corticosteroids (>7.5 mg prednisolone/day equivalent). It should be considered that the reactivation risk is higher when more than one immunosuppressive drug is used.
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Affiliation(s)
- Ömer Karadağ
- Department of Internal Medicine, Division of Rheumatology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Timuçin Kaşifoğlu
- Department of Internal Medicine, Division of Rheumatology, Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Birol Özer
- Department of Gastroenterology, Başkent University, School of Medicine, Adana, Turkey
| | - Sabahattin Kaymakoğlu
- Department of Gastroenterohepatology, İstanbul University School of Medicine, İstanbul, Turkey
| | - Yeşim Kuş
- Senior Scientific Advisor at Bristol-Myers Squibb, İstanbul, Turkey
| | - Murat İnanç
- Department of Internal Medicine, Division of Rheumatology, İstanbul University School of Medicine, İstanbul, Turkey
| | - Gökhan Keser
- Department of Internal Medicine, Division of Rheumatology, Ege University School of Medicine, İzmir, Turkey
| | - Sedat Kiraz
- Department of Internal Medicine, Division of Rheumatology, Hacettepe University School of Medicine, Ankara, Turkey
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Pinarbaşi B, Demır K, Oflaz H, Ahishali E, Akyüz F, Elıtok A, Çımen AO, Gölcük E, Güllüoğlu M, İşsever H, Beşişik F, Kaymakoğlu S, Ökten A. Measurement of the coronary flow velocity reserve in patients with non-alcoholic fatty liver disease. Turk J Gastroenterol 2014; 23:720-6. [PMID: 23794311 DOI: 10.4318/tjg.2012.0489] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND/AIMS Endothelial dysfunction is an early and reversible feature in the pathogenesis of atherosclerosis. Coronary flow velocity reserve is a noninvasive test showing endothelial function of epicardial coronary arteries and coronary microcirculatory function. This study was designed to evaluate the carotid intima-media thickness and myocardial microvascular circulation in patients with non-alcoholic fatty liver disease. MATERIALS AND METHODS Twenty-four patients with non-alcoholic fatty liver disease and 28 healthy subjects were studied. According to the pathology of liver biopsies, patients with non-alcoholic fatty liver disease were divided into non-alcoholic fatty liver and nonalcoholic steatohepatitis groups. Coronary diastolic peak flow velocities were measured at baseline, and then dipyridamole infusion was measured by transthoracic Doppler echocardiography. The ratio of hyperemic to baseline diastolic peak velocities was calculated and the intima-media thicknesss of the carotid arteries were measured. RESULTS Baseline average diastolic peak and diastolic mean flow velocities were similar between non-alcoholic fatty liver disease patients and healthy subjects. However, hyperemic average diastolic peak and diastolic mean flow velocities were significantly lower in the patient groups compared to those in the controls (p=0.005 and p=0.002). Coronary flow velocity reserve was 1.65 ± 0.36 and 2.67 ± 0.81 in patients and healthy subjects, respectively (p < 0.001). The intima-media thickness was similar between the patients with non-alcoholic fatty liver disease and healthy subjects. The comparison of patients with non-alcoholic fatty liver and non-alcoholic steatohepatitis within the non-alcoholic fatty liver disease group with respect to coronary flow velocity reserve and intima-media thickness yielded no statistical differences. CONCLUSIONS The present study showed that coronary flow velocity reserve, which establishes coronary microvascular and endothelial functions noninvasively, is significantly impaired in patients with non-alcoholic fatty liver disease. The impaired coronary flow velocity reserve-like early atherosclerotic changes may have value in the prediction of coronary artery disease in patients with non-alcoholic fatty liver disease.
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Affiliation(s)
- Binnur Pinarbaşi
- İstanbul University İstanbul Medical Faculty, Department of Gastroenterohepatology, İstanbul, Turkey.
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20
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Uyanikoğlu A, Danalioğlu A, Akyüz F, Ermış F, Güllüoğlu M, Kapran Y, Demır K, Ozdıl S, Beşişik F, Boztaş G, Mungan Z, Kaymakoğlu S. Etiological factors of duodenal and gastric ulcers. Turk J Gastroenterol 2012; 23:99-103. [PMID: 22706736 DOI: 10.4318/tjg.2012.0435] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND/AIMS We aimed to determine the etiology of patients with duodenal and gastric ulcers. METHODS 140 patients diagnosed with peptic ulcer between April 2002-2009 were enrolled in this prospective study. Two biopsy specimens were collected from the antrum and corpus for histology and one for rapid urease testing, and stool samples were analyzed for Helicobacter pylori antigen. Serum calcium and gastrin levels were also analyzed. RESULTS 82 (58%) patients were male, with a median age of 47.70±15.03 years (range: 16-92). The ulcer was located in the duodenum in 96 patients, stomach in 40, and both duodenum and stomach in 4. The rates of patients positive for Helicobacter pylori antigen in stool, positive in urease testing and positive for Helicobacter pylori presence in antral and corpus samples were 48%, 52%, 67%, and 60%, respectively. 107 (76%) patients were positive for Helicobacter pylori in one of the test methods. 64 (46%) patients had a history of nonsteroidal antiinflammatory drug use within the last month. Mean levels of calcium and gastrin were 9.29±0.40 (7.90-10.20) and 73.96±89.88 (12.86-562.50), respectively. Gastrin level was correlated to inflammatory activity (p<0.05). 19 (13.6%) of the patients were negative for Helicobacter pylori, nonsteroidal anti- inflammatory drug use and hypersecretory illness, and were classified as idiopathic. CONCLUSIONS The most common cause of duodenal and gastric ulcer was Helicobacter pylori, and it was responsible for three-fourths of the cases. About half of the patients had a history of nonsteroidal antiinflammatory drug use, and nonsteroidal antiinflammatory drug and Helicobacter pylori were both responsible for the ulcer in three-fourths of these patients. In about one-tenth of the patients, nonsteroidal antiinflammatory drug use was the cause of ulcer alone, and about one-tenth of the ulcers were classified as idiopathic.
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Affiliation(s)
- Ahmet Uyanikoğlu
- Istanbul University, Faculty of Medicine, Department of Gastroenterohepatology, İstanbul, Turkey.
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21
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Yönal O, Hatemi G, Kaymakoğlu S. Should maintenance therapy be performed in ulcerative proctitis? How long should it be continued? Turk J Gastroenterol 2012; 23 Suppl 2:21-24. [PMID: 23576086 DOI: 10.4318/tjg.2012.0619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Oya Yönal
- Department of Gastroenterology, Memorial Hospital, Piyalepaşa Bulvarı, 34385 Şişli, İstanbul, Turkey.
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22
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Sen F, Pinarbaşi B, Işsever H, Akyüz F, Mungan Z, Kaymakoğlu S. Postprandial platelet-poor plasma 5-hydroxytryptamine concentrations during diarrhea and constipation periods of alternatingtype irritable bowel syndrome patients. Turk J Gastroenterol 2011; 22:270-8. [PMID: 21805417 DOI: 10.4318/tjg.2011.0212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND/AIMS Our aim was to measure concentrations of platelet-poor plasma 5-hydroxytryptamine and to assess any relationship with gastrointestinal symptomatology under fasting and fed conditions in alternating-type irritable bowel syndrome during both constipation and diarrhea periods separately. Results of the two periods were compared with each other as well as with the results of the controls. METHODS Nine patients with alternating diarrhea and constipation symptoms and 9 controls were enrolled. Serial plasma 5-hydroxytryptamine was measured for 1 hour under fasting and for 3 hour after a standard carbohydrate meal. Patients underwent the same measurements during constipation and diarrhea periods separately. Serum 5-hydroxytryptamine concentrations were determined by high-performance liquid chromatography. Symptomatology was assessed throughout the study. RESULTS Patients exhibited higher concentrations of platelet-poor plasma 5-hydroxytryptamine under fed conditions during diarrhea, especially at postprandial 30 minutes (p<0.05) compared with concentrations during constipation. Increases in postprandial plasma 5-hydroxytryptamine concentrations relative to fasting concentrations were also significantly higher during the diarrhea period than during constipation and in controls (p<0.05). Although there was no significant correlation between plasma 5-hydroxytryptamine concentrations and symptom scores, patients had worse postprandial symptomatology during diarrhea compared with controls (p<0.05). CONCLUSIONS Platelet-poor plasma 5-hydroxytryptamine concentrations after meal ingestion differ between constipation and diarrhea periods in alternating-type irritable bowel syndrome. Postprandial symptomatology is also more prominent during diarrhea. These results suggest that differences in plasma levels of serotonin between diarrhea and constipation may underlie the pathogenesis of alternating-type irritable bowel syndrome and could be involved in some aspects of symptomatology.
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Affiliation(s)
- Fatma Sen
- Department of Internal Medicine, İstanbul University Faculty of Medicine, İstanbul, Turkey.
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23
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Akyüz F, Cakaloğlu Y, Pinarbaşi B, Demir K, Akyüz U, Ozdil S, Beşişik F, Boztaş G, Mungan Z, Kaymakoğlu S. Anticoagulant therapy and Budd-Chiari syndrome: is it successful? Hepatogastroenterology 2011; 58:900-903. [PMID: 21830413] [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: 05/31/2023]
Abstract
BACKGROUND/AIMS Anticoagulant therapy is an accepted treatment for Budd-Chiari syndrome (BCS). However, the natural course of untreated patients is unclear. We aimed to evaluate the efficacy of anticoagulant therapy on survival in BCS. METHODOLOGY Between 1995 and 2007, 45 patients diagnosed with BCS based on the clinical, biochemical, radiological and histological findings were retrospectively evaluated with respect to underlying disease, therapeutic interventions, complications and overall outcome. Complications and survival during the follow-up period were compared in between anticoagulant treated and untreated cases. RESULTS Mean patient age was 34.4 +/- 11.8 years and 46.7% (21) of them were male. Median followup time was 24 months (6-132); 8.9% of patients were diagnosed as acute, 31.1% as subacute and 60% as chronic BCS according to disease duration. Centrilobular necrosis was found in 16 of 36 biopsy performed patients. Etiological factors were detected in 60% of patients and 40% of them were cryptogenic. Twenty four of them received anticoagulant therapy, the remaining 21 were followed-up with supportive medical therapy. Five patients who had shunt operation were excluded for survival analyses. Complications were similar between treated and untreated cases (p>0.05). There was a positive correlation between survival and centrilobular necrosis (r=0.376, p=0.037). The mean survival periods were 95.5 months (%95 CI 73-117 months) and 72.5 months (%95 CI 42-103 months) in anticoagulant treated and untreated patients, respectively (p>0.246). CONCLUSION Most patients with BCS are admitted to hospital at the chronic stage and more than half of them have underlying thrombotic risk factor. In our study, no beneficial effects of anticoagulant therapy were observed on the survival and complications of liver disease.
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Affiliation(s)
- Filiz Akyüz
- Department of Gastroenterohepatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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24
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Cakaloğlu Y, Akyüz F, Bozaci M, Ibrişim D, Pinarbaşi B, Demir K, Kaymakoğlu S, Beşişik F, Badur S, Okten A. Prevalence and clinical significance of SEN-H virus in chronic hepatitis B, C and delta infections in Turkey. Turk J Gastroenterol 2008; 19:104-108. [PMID: 19110665] [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: 05/27/2023]
Abstract
BACKGROUND/AIMS SEN viruses are transmitted parenterally and can cause post-transfusion hepatitis. The prevalence and clinical significance of SEN viruses have been investigated in patients with chronic hepatitis C and B but not in D. We aimed to determine the prevalence and clinical significance of SEN viruses- H in patients with chronic hepatitis C, B and delta in Turkey. METHODS SEN viruses-H was analyzed in 85 patients with chronic viral hepatitis (30 HCV, 30 HBV and 25 HDV) and 43 non-professional blood donors. HBV DNA, HCV RNA and HDV RNA were positive in patients with hepatitis B, C and D, respectively. SEN viruses-H DNA was detected by semi-nested polymerase chain reaction method (L2AS, C5S primer in first step, L2AS, D11 in second step) after extraction of DNA from sera (NucleoSpin blood; Macherey-Nagel GmbH & Co KG, Germany). RESULTS SEN viruses-H DNA was found to be positive in 7/30 (23.3%), 10/30 (33.3%), 6/25 (24%), and 7/43 (16.2%) of patients with chronic C, B, and D hepatitis and healthy blood donors, respectively. There was no significant difference in clinical features and treatment response between SEN viruses- H-positive and -negative patients with chronic viral hepatitis. CONCLUSIONS SEN viruses is more frequent in chronic hepatitis patients than in healthy blood donors. These results indicate that SEN viruses has no effect on the clinical course and treatment response of chronic viral hepatitis.
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MESH Headings
- Adult
- Alkaline Phosphatase/blood
- Aspartate Aminotransferases/blood
- Blood Donors/statistics & numerical data
- Comorbidity
- DNA Virus Infections/blood
- DNA Virus Infections/drug therapy
- DNA Virus Infections/epidemiology
- DNA Virus Infections/virology
- DNA, Viral/genetics
- DNA, Viral/isolation & purification
- Female
- Genotype
- Hepatitis B, Chronic/blood
- Hepatitis B, Chronic/drug therapy
- Hepatitis B, Chronic/epidemiology
- Hepatitis B, Chronic/virology
- Hepatitis C, Chronic/blood
- Hepatitis C, Chronic/drug therapy
- Hepatitis C, Chronic/epidemiology
- Hepatitis C, Chronic/virology
- Hepatitis D, Chronic/blood
- Hepatitis D, Chronic/drug therapy
- Hepatitis D, Chronic/epidemiology
- Hepatitis D, Chronic/virology
- Humans
- Male
- Prevalence
- Retrospective Studies
- Torque teno virus/genetics
- Torque teno virus/isolation & purification
- Treatment Outcome
- Turkey/epidemiology
- gamma-Glutamyltransferase/blood
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Affiliation(s)
- Yilmaz Cakaloğlu
- Department of Gastroenterohepatology, Istanbul Medical Faculty, Istanbul, Turkey.
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25
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Pinarbaşi B, Poturoğlu S, Yanar H, Güven K, Akyüz F, Dizdaroğlu F, Güllüoğlu M, Taviloğlu K, Kaymakoğlu S, Mungan Z. A rare cause of hemosuccus pancreaticus: primary splenic artery aneurysm ruptured into pancreatic serous cystadenoma. Turk J Gastroenterol 2008; 19:57-63. [PMID: 18386243] [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: 05/26/2023]
Abstract
Hemosuccus pancreaticus is a rare clinical condition defined as bleeding into the pancreatic duct from a peripancreatic artery. We present here a 57-year-old woman admitted to our clinic with abdominal pain, tar-colored stool and confusion. Further investigations were done because of severe anemia. Abdominal computerized tomography revealed intraabdominal hematoma. Laparotomy was performed, which confirmed that intraabdominal haemorrhagia had occurred with the rupture of a splenic artery aneurysm into a pancreatic serous cystadenoma, which ruptured into the abdomen because of high pressure. This is an interesting case diagnosed with multidisciplinary approaches.
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MESH Headings
- Aneurysm, Ruptured/complications
- Aneurysm, Ruptured/diagnosis
- Aneurysm, Ruptured/surgery
- Angiography
- Celiac Artery/diagnostic imaging
- Cystadenoma, Serous/diagnosis
- Cystadenoma, Serous/etiology
- Cystadenoma, Serous/surgery
- Female
- Gastrointestinal Hemorrhage/diagnosis
- Gastrointestinal Hemorrhage/etiology
- Gastrointestinal Hemorrhage/surgery
- Humans
- Laparotomy
- Middle Aged
- Pancreatic Cyst/diagnosis
- Pancreatic Cyst/etiology
- Pancreatic Cyst/surgery
- Pancreatic Ducts/diagnostic imaging
- Pancreatic Ducts/pathology
- Pancreatic Ducts/surgery
- Rare Diseases
- Rupture, Spontaneous/complications
- Rupture, Spontaneous/diagnosis
- Rupture, Spontaneous/surgery
- Splenectomy
- Splenic Artery/diagnostic imaging
- Splenic Artery/pathology
- Splenic Artery/surgery
- Tomography, X-Ray Computed
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Affiliation(s)
- Binnur Pinarbaşi
- Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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Akyüz F, Demir K, Ozdil S, Aksoy N, Poturoğlu S, Ibrişim D, Kaymakoğlu S, Beşişik F, Boztaş G, Cakaloğlu Y, Mungan Z, Cevikbaş U, Okten A. The effects of rosiglitazone, metformin, and diet with exercise in nonalcoholic fatty liver disease. Dig Dis Sci 2007; 52:2359-67. [PMID: 17429734 DOI: 10.1007/s10620-006-9145-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [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] [Received: 06/27/2005] [Accepted: 11/10/2005] [Indexed: 12/12/2022]
Abstract
Our aim was to evaluate effects of metformin, rosiglitazone, and diet with exercise in nonalcoholic fatty liver disease. Forty-seven patients (mean age, 44+/-10 years; 17 female) whose ALT levels had been high for at least 6 months and with hepatosteatosis detected by liver biopsy and/or USG were enrolled in this study. Of these, 12 were treated with 850 mg/day metformin (group 1), 11 with 4 mg/day rosiglitazone (group 2), and 24 with diet and exercise (group 3) for 1 year. ALT normalization at months 6 and 12 was accepted as treatment response. Liver biopsy was performed in all patients in groups 1 and 2 before treatment and 12 patients (4 in group 1, 8 in group 2) after treatment; but in group 3 it was performed only in patients who approved this procedure (12 patients). Body mass index did not change in groups 1 and 2, but it decreased significantly in group 3 (30+/-3 to 28+/-2 kg/m(2)) at month 12. Treatment response rate was 33.3, 54.5, and 54.2% in groups 1, 2, and 3, respectively, at month 6. This rate was 22.2, 37.5, and 41.2 in groups 1, 2, and 3, respectively, at month 12. Rate of steatosis and stage of fibrosis did not change after treatment. Diet with exercise seems to be superior to metformin and rosiglitazone. Decreasing treatment response at month 12 compared to month 6 may be due to fluctuations of ALT levels. Treatment response should be evaluated histologically.
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Affiliation(s)
- Filiz Akyüz
- Department of Gastroenterohepatology Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Mungan Z, Pinarbaşi B, Kaymakoğlu S. Eosinophilic esophagitis: case report. Turk J Gastroenterol 2007; 18:100-2. [PMID: 17602357] [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: 05/16/2023]
Abstract
Eosinophilic esophagitis is an inflammatory condition of the esophagus characterized by eosinophilic infiltration. It is a condition mainly affecting children; the adult form has only recently gained recognition as a distinct entity. The major symptom among adults with eosinophilic esophagitis is dysphagia. It is often misdiagnosed as gastroesophageal reflux disease because of the similarity in symptoms. An endoscopic biopsy is required to distinguish between the conditions. The cause of eosinophilic esophagitis is poorly understood, but food allergy has been implicated. Topical steroids are the most effective and convenient method for the treatment of eosinophilic esophagitis in adults. The long-term prognosis of eosinophilic esophagitis is uncertain; however, data suggests a benign course. We herein present two eosinophilic esophagitis cases that were the first to be diagnosed in our clinic.
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Affiliation(s)
- Zeynel Mungan
- Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul University, Istanbul Medical Faculty, Istanbul.
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Akyüz F, Yekeler E, Kaymakoğlu S, Horasanli S, Ibrişim D, Demir K, Aksoy N, Poturoğlu S, Badur S, Okten A. The role of thrombopoietin and spleen volume in thrombocytopenia of patients with noncirrhotic and cirrhotic portal hypertension. Turk J Gastroenterol 2007; 18:95-9. [PMID: 17602356] [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: 05/16/2023]
Abstract
BACKGROUND/AIMS To determine the role of thrombopoietin and spleen volume in thrombocytopenia diagnosed in cirrhotic and noncirrhotic portal hypertensive patients. METHODS Seventy- four portal hypertensive patients (group 1: 28 noncirrhotic; group 2: 46 cirrhotic) were enrolled into this study. Spleen volume was measured by magnetic resonance imaging. Thrombopoietin and hyaluronic acid were detected by ELISA in sera. RESULTS Splenic volume was significantly higher in group 1 (1375+/-658.74 ml) than group 2 (981.78+/-512.39 ml). In group 1, thrombopoietin and hyaluronic acid levels were 76.6+/-30.39 pg/ml and 78.17+/-66.67 ng/ml, respectively. These values were significantly higher in group 2, at 99.89+/-38.5 pg/ml and 271.97+/-197.34 ng/ml, respectively (p<0.05). Platelet counts and thrombopoietin levels had a negative correlation with spleen volume in both groups (p<0.05). Serum thrombopoietin levels were not correlated with platelet counts in cirrhotic and noncirrhotic groups; however, thrombopoietin levels were negatively correlated with splenic volume in the whole group (p= 0.044, r= - 0.23). Although spleen volume was significantly larger in noncirrhotic patients, platelet counts were similar in both groups. CONCLUSIONS This study confirms that splenic sequestration is the main factor in the thrombocytopenia in portal hypertensive patients. The balance of thrombopoietin production and degradation may be more important for platelet counts than decreasing synthesis.
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Affiliation(s)
- Filiz Akyüz
- Departments of Gastroenterohepatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul.
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Akyüz F, Ibrişim D, Balik E, Yonal O, Kaymakoğlu S, Buğra D, Mungan Z. Evaluation of malignancy risk and endoscopic follow up in achalasia: case report. Turk J Gastroenterol 2006; 17:46-9. [PMID: 16830277] [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: 05/10/2023]
Abstract
Achalasia is an esophageal motility disorder that is accepted as a risk factor for the development of cancer. Especially in megaesophagus, chronic irritation of foods and bacterial overgrowth may contribute to the formation of high-grade dysplasia and squamous cell carcinoma. We present a case of advanced stage achalasia with high-grade dysplasia detected three years after a cardiomyotomy operation. Cancer risk continues after surgical operation in achalasia, like in this case. In conclusion, endoscopic follow up is necessary for these patients even after surgical treatment.
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Affiliation(s)
- Filiz Akyüz
- Department of Gastroenterohepatology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey.
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Karaca C, Cakaloğlu Y, Demir K, Ozdil S, Kaymakoğlu S, Badur S, Okten A. Risk factors for the transmission of hepatitis C virus infection in the Turkish population. Dig Dis Sci 2006; 51:365-9. [PMID: 16534682 DOI: 10.1007/s10620-006-3139-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [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] [Received: 01/31/2005] [Accepted: 06/15/2005] [Indexed: 02/05/2023]
Abstract
The risk factors for the transmission of hepatitis C virus (HCV) infection varies substantially between countries and geographic regions. The aim of this investigation was to determine the risk factors which may be involved in the transmission of HCV infection in the Turkish population. This study included patients who were admitted to the Department of Gastroenterohepatology, Istanbul Medical Faculty, Istanbul University, between 1996 and 2002 and found to be anti-HCV positive during hospitalization or during follow-up as outpatients. All patients were asked about risk factors for HCV transmission including transfusion, history of operation, hospitalization, hemodialysis, intravenous drug use, suspected sexual contact, tattooing, acupuncture, dental procedures, manicure and pedicure, blood brotherhood rituals, perinatal risk factors, common circumcision rituals, and history of abortion. In our study, total of 320 patients with anti-HCV seropositivity were involved. The numbers and percentages of male and female patients were 139 (43.4%) and 181 (56.6%), respectively. The mean age of the patients was 49.7+/- 12.4 years (range: 18-73 years). HCV-RNA was found to be positive in 297 (92.8%) patients. The most common risk factor was a history of surgery (305; 98%), and the second most common was blood transfusion (123; 39.7%). The numbers and percentages of patients for the other risk factors were as follows: dental procedure, 86 (27.5%); abortion, 66 (21.2%); long-term hospitalization, 37 (11.6%); hemodialysis, 31 (10%); history of jaundice, 15 (4.6%); history of intravenous drug abuse, 10 (3.1%); history of suspected sexual contact, 5 (1.5%); history of manicure and pedicure, 4 (1.2%); history of occupational transmission, 3 (0.9%); history of tattooing, 2 (0.6%); history of acupuncture, 2 (0.6%); circumcision in a common circumcision ritual, 1 (0.3%); and percutaneous needle puncture, 1 (0.3%). None of the patients had a history of blood brotherhood ritual or perinatal transmission. Only one risk factor was detected in 73 (22.8%) patients, two risk factors were detected in 122 (38.2%) patients, three risk factors were detected in 78 (24.5%) patients, and four risk factors were detected in 39 (12.2%) patients, however, in 8 (1.6%) patients no risk factors could be found. In Turkey, the most common risk factor for the transmission of HCV infection is surgery, which can be preventable.
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Affiliation(s)
- Cetin Karaca
- Department of Gastroenterohepatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
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31
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Duman DG, Bor S, Ozütemiz O, Sahin T, Oğuz D, Iştan F, Vural T, Sandkci M, Işksal F, Simşek I, Soytürk M, Arslan S, Sivri B, Soykan I, Temizkan A, Beşşk F, Kaymakoğlu S, Kalayc C. Efficacy and safety of Saccharomyces boulardii in prevention of antibiotic-associated diarrhoea due to Helicobacterpylori eradication. Eur J Gastroenterol Hepatol 2005; 17:1357-61. [PMID: 16292090 DOI: 10.1097/00042737-200512000-00015] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.2] [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: 12/11/2022]
Abstract
BACKGROUND AND AIM Antibiotic-associated diarrhoea may develop during or following Helicobacter pylori eradication. We aimed to evaluate the efficacy and safety of Saccharomyces boulardii in preventing antibiotic-associated diarrhoea in patients receiving antibiotics for H. pylori eradication. METHODS In a multicentre prospective clinical trial, patients with peptic ulcer disease or non-ulcer dyspepsia were enrolled to receive clarithromycin, amoxicillin and omeprazole for H. pylori eradication for 14 days. These patients were then randomized to receive either S. boulardii 500 mg twice daily (treatment group) or no treatment (control group). The primary outcome measure was the development of diarrhoea during (treatment period) or within 4 weeks after treatment (follow-up period). RESULTS Of the 389 patients that were enrolled, 376 completed the study. Within the treatment period, diarrhoea developed in 5.9% of patients in the treatment group and in 11.5% of patients in the control group (P = 0.049); and in the follow-up period, diarrhoea developed in 1.0% of patients in the treatment group and in 3.8% of patients in the control group (P = 0.09). Overall diarrhoea rates throughout the whole study period were 6.9% in the treatment group and 15.6% in the control group (P = 0.007). No significant difference was observed between the treatment and control groups in terms of adverse events. CONCLUSION S. boulardii is an effective and safe treatment for prevention of antibiotic-associated diarrhoea when given concomitantly to patients receiving H. pylori eradication.
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Affiliation(s)
- Deniz Güney Duman
- Department of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkey
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Akyüz F, Kaymakoğlu S, Demir K, Aksoy N, Adalet I, Okten A. Is there any medical therapeutic option in hepatopulmonary syndrome? A case report. Eur J Intern Med 2005; 16:126-128. [PMID: 15833681 DOI: 10.1016/j.ejim.2004.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2004] [Revised: 09/02/2004] [Accepted: 09/20/2004] [Indexed: 11/28/2022]
Abstract
Hepatopulmonary syndrome (HPS) is a well-known complication characterized by abnormalities of arterial oxygenation in patients with chronic liver disease, with or without portal hypertension. There is no definitive treatment for HPS except liver transplantation. We report on a patient with HBV-related liver cirrhosis and HPS who received garlic and lamivudine for 3 years. Signs of liver failure and hypoxemia gradually improved, indicating that lamivudine may improve the functional reserve of the liver, while garlic may help to reduce the signs and symptoms of HPS.
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Affiliation(s)
- Filiz Akyüz
- Istanbul University, Istanbul Medical Faculty, Department of Internal Medicine Hepatology Division, Istanbul, Turkey
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Kaymakoğlu S. Drug-induced hepatitis, drug-induced autoimmunity or classical autoimmune hepatitis: how can we differentiate? Turk J Gastroenterol 2004; 15:123-5. [PMID: 15492907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
MESH Headings
- Adult
- Anemia, Hemolytic, Autoimmune/chemically induced
- Anemia, Hemolytic, Autoimmune/diagnosis
- Anemia, Hemolytic, Autoimmune/immunology
- Autoimmunity/drug effects
- Chemical and Drug Induced Liver Injury, Chronic/diagnosis
- Chemical and Drug Induced Liver Injury, Chronic/etiology
- Chemical and Drug Induced Liver Injury, Chronic/immunology
- Dydrogesterone/adverse effects
- Dydrogesterone/pharmacology
- Female
- Hepatitis, Autoimmune/diagnosis
- Hepatitis, Autoimmune/etiology
- Hepatitis, Autoimmune/immunology
- Humans
- Liver/drug effects
- Liver/pathology
- Progestins/adverse effects
- Progestins/pharmacology
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Karaca C, Pinarbaşi B, Danalioğlu A, Akyüz F, Kaymakoğlu S, Ozdil S, Boztaş G, Mungan Z. Liver abscess as a rare complication of Crohn's disease: a case report. Turk J Gastroenterol 2004; 15:45-8. [PMID: 15264121] [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: 04/30/2023]
Abstract
Pyogenic liver abscess is a rarely seen extraintestinal complication of Crohn's disease. It has different features from other liver abscesses. Its clinical and laboratory findings are not specific and mimic the reactivation of Crohn's disease and diagnosis can be delayed. The radiological methods are very useful in diagnosis and treatment of liver abscess. In this paper, we present a patient with pyogenic liver abscess which developed in the course of Crohn's disease.
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Affiliation(s)
- Cetin Karaca
- Department of Gastroenterohepatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
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35
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Durakoğlu Z, Boztaş G, Sezgil A, Kaymakoğlu S, Dinçer D, Ozdil S, Beşişik F, Mungan Z, Okten A. Alverine induced toxic hepatitis: a case report. Turk J Gastroenterol 2002; 13:226-8. [PMID: 16378311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Drug-induced hepatotoxicity is an important cause of hepatocellular injury. Hepatic necrosis may range from asymptomatic elevations in transaminases to fulminant hepatic failure and death. Alverine is an antispasmodic drug which is especially used in patients with irritable bowel syndrome. Only a few cases of alverine associated hepatotoxicity have been reported previously. We present the case of a patient with alverine induced hepatotoxicity and cholestasis, which has only seldomly been reported in the literature.
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Affiliation(s)
- Ziyaettin Durakoğlu
- Istanbul University, Istanbul Medical Faculty, Department of Gastroenterohepatology, Capa.
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36
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Danalioğlu A, Kaymakoğlu S, Mungan Z, Karaca C, Demir K, Durakoğlu Z, Beşişik F, Boztaş G, Cakaloğlu Y, Okten A. Efficacy of cyclosporin in severe ulcerative colitis attack. Turk J Gastroenterol 2002; 13:130-3. [PMID: 16378293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND/AIMS Cyclosporin-A is used as a alternative medical therapy in steroid resistant ulcerative colitis with severe activity. In spite of its known efficacy, the long term effects of are not entirely clear. METHODS The records of 13 steroid resistant patients treated with cyclosporin-A were retrospectively assessed. Cyclosporin-A had been prescribed orally at a dose of 8 mg/kg/day in four patients and intravenously, 4mg/kg/day in nine patients. Intravenous therapy was changed to oral therapy after one week and patients also received 5-ASA and azathioprine. Steroid treatment was tapered. RESULTS Ten patients responded to treatment in a mean of nine days (range: 2-30 days). Three patients who did not respond underwent total colectomy on day seven, 11 and 19 of therapy. The 10 patients who initially responded received the drug for an average of 4.9 months; four of these relapsed during and one relapsed soon after discontinuation of therapy. Four of the five patients who relapsed underwent colectomy and the one patient who did not accept surgical intervention continued medical therapy. The remaining five patients (38% of the total group; 50% of the patients who initially responded) remained in remission at the end of an average 17 month follow up period. CONCLUSIONS Cyclosporin-A therapy in severe ulcerative colitis that is resistant to steroids, provides initial remission in 80% of patients and allows 40% to retain their colon for one year.
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Affiliation(s)
- Ahmet Danalioğlu
- Istanbul Medical School, Department of Gastroenterology and Hepatology.
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Güvenç S, Kaymakoğlu S, Gürel N, Karşidağ K, Demir K, Dinçer D, Kekik C, Salman S, Yilmaz T, Beşişik F, Cakaloğlu Y. The prevalence of manifest and latent celiac disease in type 1 diabetes mellitus. Turk J Gastroenterol 2002; 13:103-7. [PMID: 16378286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND/AIMS Celiac disease and type 1 diabetes mellitus are both autoimmune diseases which have a common genetic predisposition. The aim of this study was to determine the prevalence of manifest and latent celiac disease in type 1 diabetic patients. METHODS Anti-endomysium IgA was tested by indirect immunofluorescence using sections of human umbilical cord for screening in 100 adult patients with type 1 diabetes mellitus and in 80 age and sex matched controls with no known disease. Distal duodenal biopsy, human leukocyte antigen typing, urinary D-xylose excretion test, stool analysis, biochemistry profile, blood counts, serum ferritin level and small intestinal radiography were performed in anti-endomysium IgA positive cases. Small bowel biopsy specimens consistent with celiac disease were defined as manifest celiac disease, while positive antiendomysium IgA and normal intestinal histology with the presence of human leukocyte antigen class II antigens consistent with the disease were defined as latent celiac disease. RESULTS Anti-endomysium IgA was positive in eight diabetic patients, while it was negative in all controls. Celiac disease was found in a total of six (6%) patients, four with manifest and two with latent disease. Only one patient had symptoms. CONCLUSIONS The prevalence of celiac disease is increased in patients with type 1 diabetes mellitus. Since many patients may be asymptomatic, it is suggested that all diabetic patients should be screened for this disease.
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Affiliation(s)
- Serkan Güvenç
- Istanbul University, Istanbul Medical Faculty, Department of Gastroenterohepatology.
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Emre A, Kalayci G, Ozden I, Bilge O, Acarli K, Kaymakoğlu S, Rozanes I, Okten A, Tekant Y, Alper A, Arioğul O. Mesoatrial shunt in Budd-Chiari syndrome. Am J Surg 2000; 179:304-8. [PMID: 10875991 DOI: 10.1016/s0002-9610(00)00335-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The operations with proven effects on survival in Budd-Chiari syndrome are shunt operations and liver transplantation. PATIENTS AND METHODS Between 1993 and 1999 (June), 13 cases of Budd-Chiari syndrome have been treated surgically. Four cases had concomitant thrombosis of the inferior vena cava; the others had marked narrowing of the lumen due to the enlarged caudate lobe. Mesoatrial (n = 12) or mesosuperior vena caval (n = 1) shunts were constructed with ringed polytetrafluoroethylene grafts. RESULTS The median portal pressure fell from 45 (range 32 to 55) to 20 (range 11 to 27) cm H(2)O (P <0.001). Two patients died in the early postoperative period. One patient who did not comply with anticoagulant treatment had a shunt thrombosis in the second postoperative year. The other 10 patients are alive without problems during a median 42 (range 1 to 76) months of follow-up. CONCLUSION Mesoatrial shunt with a ringed polytetrafluoroethylene graft is effective in Budd-Chiari syndrome cases with thrombosis or significant stenosis in the inferior vena cava.
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Affiliation(s)
- A Emre
- Department of General Surgery, Hepatopancreatobiliary Surgery Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Gürel S, Beşişk F, Demir K, Mungan Z, Kaymakoğlu S, Boztaş G, Cakaloğlu Y, Yeğinsü O, Okten A. After the eradication of Helicobacter pylori infection, relapse is a serious problem in Turkey. J Clin Gastroenterol 1999; 28:241-4. [PMID: 10192611 DOI: 10.1097/00004836-199904000-00011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [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: 01/06/2023]
Abstract
Eradication of Helicobacter pylori (Hp) infection is strongly recommended in duodenal and gastric ulcer. In developed countries the recurrence rate is low; however, in Turkey, the Hp recurrence rate is suspected to be high as the prevalence of Hp infection is--as high as 70-80% in the asymptomatic population. We planned this study to determine the relapse rate of Hp infection after successful eradication therapy in Turkey. Fifty-two cases including 24 patients with duodenal ulcer and 28 patients with nonulcer dyspepsia were examined in this study. The eradication regimen was omeprazole 20 mg twice daily, clarithromycin 500 mg twice daily, and metronidazole 500 mg three times a day for 1 week. All patients underwent upper gastrointestinal tract endoscopy. At least four samples from antrum and corpus were taken to enable histologic diagnosis of Hp infection. After the eradication therapy, endoscopy was repeated at 1, 3, 6, and 12 months, and Hp-positive patients were dropped from study. With the use of this regimen, the Hp eradication rate was 92.3% (48/52). After the eradication of Hp infection, relapse rates were 6.97%, 27.5%, and 11.11% at 3, 6, and 12 months, respectively. The cumulative relapse rate for 1 year was 41.46%. The results of this study revealed that after the eradication of Hp infection, recurrence is encountered very often as a problem in Turkey. We concluded that hygienic and environmental factors can affect these high relapse rates.
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Affiliation(s)
- S Gürel
- Department of Gastroenterohepathology, Istanbul University Medical School, Turkey
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Kaymakoğlu S, Demir K, Cakaloğlu Y, Tuncer I, Dinçer D, Gürel S, Okten A. Combination therapy with hepatitis B vaccine and interferon alfa in chronic hepatitis B. Am J Gastroenterol 1999; 94:856-7. [PMID: 10086686 DOI: 10.1111/j.1572-0241.1999.0856a.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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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Ozkaya-Bayazit E, Demir K, Ozgüroğlu E, Kaymakoğlu S, Ozarmağan G. Helicobacter pylori eradication in patients with chronic urticaria. Arch Dermatol 1998; 134:1165-6. [PMID: 9762044 DOI: 10.1001/archderm.134.9.1165] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Türkoğlu S, Bozaci M, Bozfakioğlu S, Kaymakoğlu S, Badur S. Molecular epidemiology of hepatitis C virus in Istanbul, Turkey. J Microbiol Methods 1996. [DOI: 10.1016/0167-7012(96)83736-5] [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: 12/27/2022]
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Abstract
We investigated the clinical and laboratory findings of hypogonadism and feminization in male patients with viral or alcoholic cirrhosis to determine whether chronic liver disease plays a primary role in the development of sexual dysfunction and hormonal changes. Two groups of male patients with liver cirrhosis (23 alcoholic, 33 viral) age- and Child's grade-matched, and 20 age-matched healthy men, as a control group, were included in this study. Clinical signs of hypogonadism and feminization were examined in the cirrhotic patients. Follicle-stimulating hormone, luteinizing hormone, prolactin, testosterone, free testosterone, estradiol, androstenedione, dehydroepiandrosterone sulfate, and sex hormone-binding globulin were estimated in all groups. Seminal fluid was also analyzed in 7 alcoholic and 15 viral cirrhotics. Serum levels of estradiol, androstenedione, and sex hormone-binding globulin were significantly higher, and free testosterone and dehydroepiandrosterone sulfate levels were significantly lower in both groups of cirrhotics compared with the control group. Child's C patients in both groups of cirrhotics were found to have higher estradiol and lower free testosterone levels than child's A and B patients. Alcoholic and viral cirrhotics had markedly reduced sperm motility and density. The differences between alcoholic and viral cirrhotic patients in the clinical signs of hypogonadism, serum levels of sex steroids, and the results of seminal fluid analysis were not statistically significant. These findings suggest that liver cirrhosis per se, independent of etiology, causes hypogonadism and feminization, and that the degree of hypogonadism and feminization correlates well with the severity of liver failure.
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Affiliation(s)
- S Kaymakoğlu
- Department of Gastroenterohepatology, Istanbul University, Turkey
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Emre A, Acarli K, Alper A, Arioğul O, Okten A, Bilge O, Kaymakoğlu S. [Are devascularization-transsection operations in treatment of bleeding esophageal varices still indicated?]. Chirurg 1993; 64:396-9. [PMID: 8330497] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Sugiura procedure and its modifications were performed in 43 patients who were not suitable for shunt surgery. Four types of devascularisation-transection procedures on the technical basis of Sugiura operation were carried out. Thirteen patients died in the early postoperative period. Highest mortality was recorded in the standard Sugiura procedure (4/8 or 50%) and the lowest in modified Sugiura III (1/7 or 14%) which is the simplest form of all. Mortality in the early postoperative period was higher in emergency procedures. No variceal hemorrhage and hepatic encephalopathy were recorded in the early postoperative period. Based on our experience in relatively limited number of cases, the Sugiura operation and its modifications are not advantageous in emergency conditions and patients with poor liver function. However, these procedures can be performed in Child A-B cases. Limiting the extent of the operation by modifications affects the outcome positively.
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Affiliation(s)
- A Emre
- Institut für hepatopankreatobiliäre Chirurgie, Medizinischen Fakultät, Universität Istanbul
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