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Öğe An Adult Choledochocele Case Presented with Acute Pancreatitis: Treatment by Endoscopic Sphincterotomy and Cyst Unroofing(Korean Soc Gastrointestinal Endoscopy, 2015) Bestas, Remzi; Ekin, Nazim; Ucmak, Feyzullah; Kaya, Muhsin[Abstract Not Available]Öğe Analysis of Our Cases With End Stage Renal Disease in a Period Between 2001 and 2007(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2007) Danis, Ramazan; Ozmen, Sehmus; Akin, Davut; Bestas, Remzi; Atayan, Yahya; Zulfuogullari, Abbas; Yalcin, SuatThe etiology of end stage rectal disease (ESRD) varies with the country, ethnicity, and sex. Climate conditions, socioeconomic status, cultural and environmental factors may play an important role in etiologic distribution of ESRD. We retrospectively analyzed 535 patients in Dicle University School of Medicine, Department of Nephrology. The patients had a creetinine clearance below 15 ml/min per and did not take any type of renal replacement therapy. Hypertension: diabetes mellitus, and urologic disorders were the most common causes of ESRD. It was striking that urologic disorders constituted 11.1% of ESRD cases as the third must common cause, and 42.3% of these subjects had urolithiasis. No difference regarding sex, hemoglobin. parathyroid hormon, erythrupoietin calcium, phosphorus between subjects within different etiologies. In conclusion, hypertension and diabetes mellitus account for half of the ESRD etiology as expected. But urologic disorders, may be preventable when diagnosed early, are more common than world and Turkey registries. More attention must he provided in diagnosis and treatment of urologic disorders. Comprehensive and efficient schedules targeted to early diagnose and treatment of renal stone disease must be initiated.Öğe Brucellosis as a rare cause of granulomatous hepatitis with hepatic and bone marrow granulomas: A case report(Kare Publ, 2021) Yalcin, Kendal; Tuncel, Elif Tugba; Ucmak, Feyzullah; Bestas, RemziBrucellosis is a zoonotic infection that may involve the liver in a variety of ways, however, data on the histopathology of liver effects in brucellosis are limited. Brucellosis is generally characterized by a high fever, joint or back pain, and hepatosplenomegaly. This report illustrates a case of granulomatous hepatitis with granulomas in the liver and bone marrow in a patient who presented with non-specific symptoms, hepatomegaly, splenomegaly, digital clubbing, and laboratory signs of intrahepatic cholestasis. Granulomas were detected in the bone marrow and hepatic specimens. The diagnosis of brucellosis was based on the isolation of Brucella mellitensis in a blood culture and serum agglutination titers of 1:640. Treatment for brucellosis led to improved laboratory and clinical findings. Brucellosis should be considered in regions where it is endemic in cases of an elevated transaminase level and related clinical findings. Brucellosis should also be considered in the differential diagnosis of intrahepatic cholestasis and/ or granulomas in hepatic and bone marrow biopsies. This case report provides valuable histopathological features and detailed information of liver involvement in a case of brucellosis.Öğe Brucellosis Induced Ascites, Cholestasis and Elevated Serum CA 125 Level: Case Report(Ortadogu Ad Pres & Publ Co, 2012) Kaya, Muhsin; Bestas, Remzi; Cangul, Mehmet Sadik; Kaya, BesirGastrointestinal complications of brucellosis are randomly reported, ascites and cholestasis being particularly rare. A 25-year-old female patient with a history of fever, weakness, jaundice, nausea and sweating was admitted to our clinic. The physical examination revealed a temperature of 39.3 degrees C, hepatosplenomegaly and moderate free ascites in the abdomen. Initial laboratory investigation revealed mild anemia, biochemical findings of cholestasis, hypoalbuminemia, elevated serum CA 125 level, increased lymphocyte count in ascidic fluid and low (0.9 g) serum-ascites albumin gradient. After comprehensive evaluation, Brucella melitensis induced ascites, intrahepatic cholestasis and elevated serum CA 125 level were detected. We observed complete clinical and laboratory improvement at the end of anti-brucellosis treatment.Öğe Clinical remission after strict gluten-free diet in a patient with celiac disease, advanced cryptogenic cirrhosis and splenic atrophy(Turkish Soc Gastroenterology, 2012) Kaya, Muhsin; Bestas, Remzi; Cetin, Sedat; Buyukbayram, Huseyin[Abstract Not Available]Öğe Clinicopathological characteristics of patients with oesophageal squamous papilloma in Turkey and comparison with the literature data: The largest case series ever reported from Turkey(Wiley, 2021) Ekin, Nazim; Bestas, Remzi; Cetin, AlpayAim Oesophageal squamous papilloma (ESP) is a rare tumoural lesion of the oesophagus considered to have a benign course. Due to the fact that they are rare lesions, there are not many publications with large case series on ESPs in the literature. In this study, we aimed to investigate the clinical, endoscopic and histopathological characteristics of ESPs. Methods Reports of upper gastrointestinal endoscopies performed in the endoscopy unit within the Division of Gastroenterology of a tertiary care hospital in the Southeastern Anatolia Region of Turkey in the last 8-year period were evaluated retrospectively. Patients who were determined to have oesophageal polypoid lesions during the endoscopic procedure and were then diagnosed with oesophageal squamous cell papilloma in the histopathological examination were included in the study. Results Of 11 541 patients who underwent upper gastrointestinal endoscopy, 51 were diagnosed with a total number of 55 ESPs (0.44%). In addition, 26 of these patients (51%) were female, and the mean age of the patients at the time of diagnosis was 42.2 years. The average size of the ESPs was 3.47 mm, and the most frequent location was the middle oesophagus with 51%. No statistically significant relationship was found between the location of ESPs and gender, endoscopy indication, oesophagitis, lower oesophageal sphincter dysfunction, hiatal hernia, gastroesophageal reflux disease (GERD) and Helicobacter pylori positivity. Conclusion In this study with the largest case series ever reported from Turkey, it was determined that ESPs were seen in younger ages in Turkey and were also smaller in size, which is not in agreement with the literature data. Besides, this study, in which ESPs were most frequently detected in the middle oesophagus, supports the view that GERD may not be the main factor in ESP aetiology.Öğe The Correlation between Serum VEGF Levels and Known Prognostic Risk Factors in Colorectal Carcinoma(H G E Update Medical Publishing S A, 2014) Bestas, Remzi; Kaplan, M. Ali; Isikdogan, AbdurrahmanBackground/Aims: In the present study, we analyzed serum vascular endothelial growth factor (VEGF) levels and its correlation with the other clinicopathological characteristics of patients with colorectal carcinoma (CRC). Methodology: Seventy-one patients (F/M, 29/42; Mean age +/- SD, 53.3 +/- 13.1 years) were included. The results of serum VEGF were analysed with respect to stage, gender, age, CEA, metastases and topographical tumour localization. Results: Patients with stage 3-4 disease had significantly higher values of VEGF (253.41 pg/mL +/- 302.24) than patients with stage 1-2 (49.99 pg/L +/- 100.30) (P<0.003). Patients with the primary tumour localized in the colon had no significantly higher levels of serum VEGF than patients with the primary tumour localized in the rectum (225.97 +/- 324.88 pg/mL vs. 153.76 +/- 205.66 pg/mL, respectively, P = 0.269). The VEGF expression significantly correlated with serum CEA level (P <0.01) and clinical stages of colorectal cancer (P <0.01). The VEGF expression was not correlated with patients' age (P = 0.955) and gender (P = 0.740). Conclusions: The VEGF expression significantly correlated with advanced stage, and metastases but not age, gender, and tumour localization. VEGF may play an important role in the invasion and metastasis of CRC. Therefore, VEGF could be applied as prognostic markers in CRC.Öğe Gaucher's Disease Presenting with Massive Hepatic Fibrosis and Skeletal Abnormalities: A Case Report with Review of the Literature(Ortadogu Ad Pres & Publ Co, 2011) Yalcin, Kendal; Ucmak, Feyzullah; Bestas, Remzi; Unal, Hakan Umit; Necmioglu, Serdar; Mizrak, BulentThe case presented in this manuscript is a 32-year-old female referred to our clinic with massive hepatosplenomegaly, thrombocytopenia, anemia and avascular necrosis at the head of right femur. Gaucher's disease was diagnosed upon observation of specific blood cells in bone marrow and liver. Homozygote N370S mutation was established in the Gaucher's mutation screening. Glycocerebrosidase enzyme level of the patient was quite low (0.66 nmol/hour/mg). Additionally, histological examination of the liver revealed massive hepatic fibrosis without any clinically significant signs of cirrhosis or portal hypertension. Other significant signs of the patient were severe skeletal involvement with stage V/c avascular necrosis of the femoral head and Erlenmeyer flask paralysis. Glycocerebrosidase enzyme replacement therapy was initiated at 60 units/kg after the diagnosis was established. The case presented here is a female patient with signs of hepatic, bone marrow and skeletal system involvement. This rare non-neuropathic type 1 Gaucher's case with massive hepatic fibrosis and pathogonomic skeletal signs has been evaluated in the light of literature.Öğe Increased anti-Echinococcus granulosus antibody positivity in Fasciola hepatica infection(Aves, 2012) Kaya, Muhsin; Bestas, Remzi; Girgin, Sadullah; Cicek, Muttalip; Kaplan, Mehmet AliBackground/aims: Parasitic helminths express some antigen, which often accounts for serological cross-reactions. The aim of this study was to determine the prevalence of anti- Echinococcus granulosus antibody in patients with Fasciola hepatica infection using indirect immunofluorescence assay. Materials and Methods: The study population consisted of the following groups: Fasciola hepatica group (n=22), hydatid disease group (n=22) and healthy control group (n=24). Indirect immunofluorescence assay for Echinococcus granulosus was performed in all groups. Results: Indirect immunofluorescence assay was positive in all patients with hydatid disease, in 13 of 22 (59%) patients with fascioliasis and in 2 of 24 (8%) healthy subjects. The positivity rate of indirect immunofluorescence assay was significantly higher in the hydatid disease group compared to the fascioliasis group (p<0.001) and compared to the control group (p<0.001), and it was significantly higher in the fascioliasis group compared to the control group (p=0.001). Antibody titer was 11100 in 7 patients, 11320 in 12 patients and 111000 in 3 patients with hydatid disease. Indirect immunofluorescence assay was positive in 10 of 15 patients with hepatic phase and in 3 of 7 patients with biliary phase of fascioliasis. The antibody titer was 11100 in 6 and 11320 in 7 patients with fascioliasis. The antibody titer was 11100 in both healthy subjects. Conclusions: Indirect immunofluorescence assay for Echinococcus granulosus may be positive in a majority of patients with Fasciola hepatica infection and in some healthy subjects.Öğe Increased bone mineral density in patients with non-alcoholic steatohepatitis(Baishideng Publishing Group Inc, 2013) Kaya, Muhsin; Isik, Devran; Bestas, Remzi; Evliyaoglu, Osman; Akpolat, Veysi; Buyukbayram, Huseyin; Kaplan, Mehmet AliAIM: To determine the relationship between non-alcoholic steatohepatitis (NASH) and bone mineral density (BMD). METHODS: A total of 38 patients (25 males) with a diagnosis of histologically proven NASH and 42 healthy controls (24 males) were enrolled in the study. Demographic features, clinical findings, complete blood count and routine biochemical analysis, as well as adrenal, thyroid and gonadal functions, were recorded. Additionally, intact parathormone, 25-OH-vitamin-D3, tumor necrosis factor-alpha, interleukin-6, interleukin-1, in-sulin-like growth factor-1 and insulin-like growth factor binding protein-3 levels were measured in both groups. Furthermore, lumbar spine and femoral neck BMD of both groups were measured by the dual-energy X-ray absorptiometry (DXA) method. RESULTS: The mean age was 41 +/- 12 years in the NASH group and 43 +/- 11 years in the control group. Among demographic features, waist circumference was significantly larger in the NASH group compared to the control group (P < 0.019). Among laboratory parameters, serum triglyceride (P < 0.008), alanine transaminase (P < 0.0001), aspartate transaminase (P < 0.001), alkaline phosphatase (P < 0.016), gamma glutamyl transferase (P < 0.0001), ferritin (P < 0.001) and 25-OH-vitamin-D3 levels (P < 0.0001) were significantly higher in the NASH group compared to the control group. Lumbar BMD was significantly higher in the NASH group compared to the control group (1.057 +/- 0.119 g/cm(2) vs 0.941 +/- 0.133 g/cm(2); P < 0.001, respectively). In the NASH group, there was no significant relationship between BMD and fibrosis stage in liver biopsy. CONCLUSION: NASH increases BMD and may be related to an elevated serum 25-OH-vitamin D3 level. (C) 2013 Baishideng Publishing Group Co., Limited. All rights reserved.Öğe Microbial profile and antibiotic sensitivity pattern in bile cultures from endoscopic retrograde cholangiography patients(Baishideng Publ Grp Co Ltd, 2012) Kaya, Muhsin; Bestas, Remzi; Bacalan, Fatma; Bacaksiz, Ferhat; Arslan, Esma Gulsun; Kaplan, Mehmet AllAIM: To identify the frequency of bacterial growth, the most commonly grown bacteria and their antibiotic susceptibility, and risk factors for bacterial colonization in bile collected from patients with different biliary diseases. METHODS: This prospective study was conducted between April 2010 and August 2011. Patients with various biliary disorders were included. Bile was aspirated by placing a single-use, 5F, standard sphincterotome catheter into the bile duct before the injection of contrast agent during endoscopic retrograde cholangiopancreaticography (ERCP). Bile specimens were transported to the microbiology laboratory in blood culture bottles within an anaerobic transport system. Bacteria were cultured and identified according to the standard protocol used in our clinical microbiology laboratory. The susceptibilities of the organisms recovered were identified using antimicrobial disks, chosen according to the initial gram stain of the positive cultures. RESULTS: Ninety-one patients (27% male, mean age 53.7 +/- 17.5 years, range: 17-86 years) were included in the study. The main indication for ERCP was benign biliary disease in 79 patients and malignant disease in 12 patients. The bile culture was positive for bacterial growth in 46 out of 91 (50.5%) patients. The most frequently encountered organisms were Gram-negative bacteria including Escherichia coli (28.2%), Pseudomonas (17.3%) and Stenotrophomonas maltophilia (15.2%). There were no significant differences between patients with malignant and benign disease (58% vs 49%, P = 0.474), patients with acute cholangitis and without acute cholangitis (52.9% vs 50%, P = 0.827), patients who were empirically administered antibiotics before intervention and not administered (51.4% vs 60.7%, P = 0.384), with regard to the bacteriobilia. We observed a large covering spectrum or low resistance to meropenem, amikacin and imipenem. CONCLUSION: We did not find a significant risk factor for bacteriobilia in patients with biliary obstruction. A bile sample for microbiological analysis may become a valuable diagnostic tool as it leads to more accurate selection of antibiotics for the treatment of cholangitis. (c) 2012 Baishideng. All rights reserved.Öğe Percutaneous Endoscopic Gastrostomy: Mortality and Risk Factors for Survival(Elmer Press Inc, 2012) Onder, Akin; Kapan, Murat; Arikanoglu, Zulfu; Gul, Mesut; Bestas, Remzi; Palanci, Yilmaz; Karaman, HaktanBackground: The present study evaluated long-term risk factors for survival in patients who have undergone Percutaneous endoscopic Gastrostomy, as well as morbidity and mortality rates. Methods: The retrospective study included 44 patients who underwent placement of a percutaneous endoscopic gastrostomy tube at various departments at Dicle University Medical Faculty between April 2008-September 2010. Results: The study evaluated 23 women (52.3%) and 21 men (47.7%), with a median age of 50 +/- 20 (17 - 87) years. Median time for Percutaneous endoscopic Gastrostomy placement was 23 +/- 8.3 (5 - 45) minutes per patient. Total morbidity was 15.9%, including wound infection (4), tube occlusion (1), peristomal leakage (1), and abdominal wall bleeding (1). Short-term complications were not associated with albumin level (P = 0.312). The median hospital stay was 49.34 +/- 60.99 (1 - 314) days. The mean follow-up period was 13.07 +/- 13.12 (1 - 41) months. The above-normal level of albumin was found to be effective on survival (P = 0.024). Mortality occurred in 18 (40.9%) patients during the follow-up. Conclusions: Percutaneous endoscopic Gastrostomy is both safe and effective in that it does not require surgical operation and it can be performed under surface anesthesia. The serum albumin level with patients who have undergone percutaneous endoscopic gastrostomyis an effective factor for survival.
