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Öğe Analysis of 1242 cases with upper gastrointestinal system bleeding in Southeastern Turkey: A different etiologic spectrum(2005) Dursun M.; Yilmaz S.; Yükselen V.; Canoruç F.; Tuzcu A.Background/Aims: There are few detailed reports on gastrointestinal system bleeding in Turkey. The aim of this study is to analyze the characteristics of the patients with upper gastrointestinal system bleeding who were hospitalized in our clinic. Methodology: The patients who were hospitalized in Dicle University Hospital Department of Gastroenterology from March 1992 to June 2002 were analyzed retrospectively. Results: During this period of time, 296 females (23.8%) and 946 males (76.2%), total 1242 patients were hospitalized for upper gastrointestinal system bleeding. Mean age was 47 for both sexes. Distribution of the cases was as follows: 31.6% duodenal ulcer (n: 393), 30.5% esophageal variceal bleeding (n: 379), 13.7% erosive gastritis (n: 171), 6.8% erosive duodenitis (n: 85), 4.9% gastric ulcer (n: 62), 2.8% carcinoma (n: 35), and 3.5% other causes. Peptic ulcer related bleeding was the most encountered reason (37.5%, n: 466). Four percent of the cases other than esophageal variceal bleeding underwent urgent surgical intervention. Eleven percent of the cases (n: 138) resulted in death of which 65.9% were esophageal variceal bleeding (n: 91). Conclusions: The most striking result is the very high rate of esophageal variceal bleeding. This finding is in concordance with the high prevalence of the viral hepatitis in the region. © H.G.E. Update Medical Publishing S.A.Öğe The effects of flutamide on lipid profile, insulin sensitivity, hirsutism and gonadotrophins in women with polycystic ovary syndrome(1999) Bahceci M.; Tuzcu A.; Dursun M.; Ertem M.; Yukselen V.In this study, we evaluated metabolic changes and the effects of flutamide in 22 women with PCOS. Flutamide was administered for a 6-month period in a dose of 750 mg/day. The basal and after treatment body mass index, waist: hip ratio, blood glucose, insulin, lipids, Ferriman-Gallwey scoring (FGS), gonadotrophins, testosterone, trasaminazed and glucose: insulin (G:I) ratio were measured. For comparison, ANOVA was used. The sixth month mean FGS was significantly lower than the basal values (18.5±7.4 and 12.5±4.5, P<0.01). The mean basal G:I ratio was 3.31±1.12 and 6.21±2.53 at the sixth month. The sixth month G:I ratio was significantly higher (P<0.001). The total and LDL-cholesterol were decreased by flutamide (from 144±23 to 123±23 and from 88±32 to 60±25 mg/dl respectively. P<0.02 and P<0.01), whereas, the HDL-cholesterol level was increased with flutamide (from 44.8±3.9 to 46.5±3.2 mg/dl and P<0.001). LH (from 14.7±6.7 to 8.4±3 mlU/ml), LH/FSH ratio (from 3.4±1.7 to 1.9±0.6), total testosterone (from 0.87±0.29 to 0.61±0.18 ng/ml) and free testosterone (from 4.29±1.18 to 2.14±0.9 pg/ml) were decreased by flutamide (P<0.05). Thus, we reached three conclusions: 1-Flutamide may improve insulin insensitivity. 2-In PCOS, flutamide decreases total and LDL-cholesterol, and increases HDL-cholesterol. 3-Flutamide may improve the LH/FSH ratio and induce a decrease in testosterone.Öğe The efficacy of flumazenil in subclinical to mild hepatic encephalopathic ambulatory patients: A prospective, randomised, double-blind, placebo-controlled study(SMW supporting association, 2003) Dursun M.; Caliskan M.; Canoruc F.; Aluclu U.; Canoruc N.; Tuzcu A.; Yilmaz S.Hepatic encephalopathy (HE) is a neuropsychiatric syndrome associated with fulminant hepatic failure and chronic liver disease. Its pathogenesis is unclear. One of the factors implicated is enhanced GABA-ergic tone, which is probably related to increased concentrations of cerebral benzodiazepine (BNZ). In the present study, we tested flumazenil, a cerebral BNZ antagonist, in cirrhosis patients with hepatic encephalopathy. Methods: Out of 47 patients, 7 were excluded prior to randomization for various reasons. Twenty patients were included in the flumazenil group and 20 in the placebo group in a prospective, randomized, double-blind, placebo-controlled study. Patients were given flumazenil (1 mg/h, continuous IV infusion) or an equal volume of saline solution for 5 hours. Before and after treatment, portosystemic encephalopathy (PSE) stage and number connection test (NCT) scores were checked every half hour for 5 hours. EEG was recorded 15 minutes before and 1 hour after treatment. Results: While significant improvements were determined in PSE stage and NCT score in the flumazenil group, there were no such improvements in the placebo group. There was no statistically significant difference between pre- and post-treatment EEGs in either group. Conclusion: It was concluded that continuous IV infusion of flumazenil had beneficial and safe effects in the treatment of hepatic encephalopathy patients.Öğe Insulin Sensitivity, ? Cell Function and Serum Lipid Levels in Helicobacter Pylori Positive, Non-Obese, Young Adult Males(2004) Dursun M.; Bahceci M.; Tuzcu A.; Yilmaz Ş.; Canoruç F.It is not clear whether Helicobacter pylori (Hp) infection affects insulin levels and insulin sensitivity. We aimed to determine insulin sensitivity and beta cell function, and to evaluate serum lipids in subjects with and without Hp infection. Eighty non-obese young adult males, 40 of whom were Hp positive and 40 were negative, were included in the study. Two endoscopic biopsy specimens were obtained from each subject. Height, weight and waist-hip circumference were measured, and body mass index (BMI) was calculated. Serum glucose, total, HDL, LDL and VLDL-cholesterol and triglyceride levels were determined. Body fat mass and percentage were determined by bioelectric impedance. Serum insulin levels were measured by the RIA method. HOMA was used as an index of pancreatic beta cell function and insulin sensitivity. The independent-t test was used in the comparison of results. Age, BMI, waist and hip circumferences, and fat percentages did not exhibit any statistical differences. Mean HOMA-B [111.7, in Hp(+) and 112.0 in Hp(-) subjects] and HOMA-S [67.7 in Hp(+) and 60.7 Hp(-) subjects] did not differ amoung the groups. The lipid and aminotransferase levels of the 2 groups were also similar. Conclusion: Hp infection is not associated with impairment of insulin sensitivity and deterioration of the glucose metabolism. It seems to be metabolically neutral in terms of serum lipids and aminotransferase levels.Öğe A patient with gastric carcinoid tumor: Treatment and surveillance options [2](2005) Yilmaz Ş.; Dursun M.; Canoruç F.[No abstract available]Öğe Portal colopathy findings in patients with liver cirrhosis(1999) Goral V.; Kizilay E.; Yukselen V.; Dursun M.; Aras N.; Canoruc F.; Buyukbayram H.Portal hypertension diffusely affects the gastrointestinal (GI) tract. Portal colopathy is a new clinical entity with liver cirrhosis but the frequency and profile of distinct colonic mucosal lesions (portal colopathy) and rectal varices has been little studied in patients with liver cirrhosis. In this study, colonoscopic findings, upper GI endoscopy, portal system colored Doppler ultrasonographic results and the degree of liver dysfunction were prospectively investigated among 25 haemodynamically stable patients with postviral cirrhosis without a history of bleeding. We found the incidence of esophageal varices to be 96%, congestive gastropathy 20% and portal colopathy excluding anorectal varices and hemorrhoids 92% in our patients. Portal colopathic lesions were occasionally localized in the rectosigmoid area, ascending colon, anal canal and transverse colon. The degree of esophageal varices was associated with congestive colopathy but not with anorectal varices and hemorrhoids. While congestive gastropathy had no significant relationship with esophageal varices, congestive colopathy was present in all patients with congestive gastropathy. However, no association was evident between these lesions and the degree of disease severity. Additional studies are required not only to determine the frequency of this entity, but also to understand the pathophysiology of these lesions. Since the colonic lesions, although usually asymptomatic and clinically insignificant, are a potential source of acute or chronic lower GI bleeding, further investigation is needed to reduce the risk of bleeding and offer alternative treatment models.Öğe The prevalence of primary and secondary helicobacter pylori resistance to clarithromycin and probable contributing cofactors: Data from Southeastern Anatolia(2008) Tüzün Y.; Bayan K.; Yilmaz S.; Dursun M.; Ozekinci T.Background/Aims: Antibiotic resistance of Helicobacter pylori is the most important reason for failure in its eradication. We aimed to determine the prevalence of primary and secondary H. pylori resistance to clarithromycin in isolated H. pylori from dyspeptic patients in southeastern Anatolia and to evaluate the cofactors affecting this clinical problem. Methodology: The study involved adult patients who had already been diagnosed with symptomatic H. pylori infection based on rapid urease test, gastric histopathological examination and culture. H. pylori strains were isolated from antral biopsies taken during upper endoscopy in 142 dyspeptic patients with no previous therapy against the microorganism. MICs of clarithromycin were determined by E-test. Patients were treated for 14 days with standard triple-agent protocol. H. pylori eradication rate was assessed after 8 weeks. Each patient was re-interviewed to determine secondary resistance. Primary clarithromycin resistance was defined as pre-treatment resistance, while secondary as after treatment resistance. Strains were considered resistant to clarithromycin if the MIC > 1?g/mL. Results: In total 213-105 women and 108 men-patients was enrolled to the study. The mean age was 35.5±14.1 years. In 142 (66.7%) patients out of the total patients enrolled in the study, H. pylori was detected. H. pylori could be cultured from only 61 (43%) of them. In 16.4% of the cases, primary clarithromycin resistance was noted. After 8 weeks, seventy-seven (54.2%) of the 142 patients were reevaluated. Helicobacter pylori eradication could be achieved in 68.8% of them. The proportion of H. pylori eradication in clarithromycin-sensitive patients was 75.8% and the respective proportion was 10% for resistant cases. In the group where H. pylori was still positive the secondary resistance percentage was found to be 27.2%. Conclusions: The prevalence of primary clarithromycin resistance is relatively high in our geographical area. Secondary resistance rate was 27.2%. None of the criteria of age, gender, presence of endoscopic lesions, detected H. pylori concentration and gastritis activity showed any effect on the primary resistance. © H.G.E. Update Medical Publishing S.A.Öğe Randomized, comparative study of cefotaxime 2 versus 4 grams in spontaneous bacterial peritonitis [5](2007) Ozmen S.; Dursun M.; Y?lmaz S.; Ozmen C.A.; Canoruc F.[No abstract available]Öğe Risk of Helicobacter pylori infection in newborn babies of Helicobacter pylori-positive pregnant women(1998) Dursun M.; Goral V.; Simsek H.; Yukselen V.; Hascelik G.; Canoru F.Helicobacter pylori (H.pylori) is one of the rare organisms that can maintain its life in acidic condition of stomach. A number of studies indicate that it is closely inked to mainly duodenal ulcer as well as peptic ulcer, non-ulcer dyspepsy, gastric cancer and MALT lymphoma. The aim of our study was to determine whether newborn infants of H.pylori-positive mothers are at risk of H.pylori infection A total of 48 mother and their newborn babies were included in the study. Soon after the birth, blood specimens were taken from both mothers and babies. Anti-H.pylori IgG was examined from the blood of the mothers by ELISA. The blood of babies of mothers with anti- H.pylori IgG-positive was investigated for both anti-H.pylori IgG and anti- H.pylori IgA. In 36 (75.0%) of 48 women included in the study, anti-H.pylori IgG antibody was found as positive. In addition, anti-H.pylori IgG was determined to be positive in 32 (89.0%) of 36 babies whose mothers were positive for anti-H.pylori IgG. These 32 babies whose anti-H.pylori IgG was positive were examined for anti-H.pylori IgA. In 3 babies (9.4%), it was found to be positive (p<0.01). In conclusion, owing to IgG's feature of being able to transmit through the placenta, it is clear that the presence of anti- H.pylori IgG in the serum of babies whose mothers are positive for anti- H.pylori IgG antibody cannot be an indicator of H.pylori infection. Determination of anti-H.pylori IgA antibody as positive is important and statistically significant (p<0.01). According to the results of this study, it can be said that at least the possibility of vertical transmission may exist.Öğe Seroepidemiology of delta hepatitis in Turkey(1999) Degertekin H.; Yukselen A.V.; Dursun M.; Yalcin K.Hepatitis Delta Virusu (HDV) infection is an important viral disease and its relationship with HBV and related liver disease is well known. This study investigated the role of HDV infection in acute viral hepatitis, HBsAg carriers and chronic liver disease cases in Turkey. The results of studies undertaken during the last decade were also evaluated. According to these studies, anti-HDV positivity is about 10% in western of Turkey whilst it is higher in the middle and eastern regions and 15-25% in the south-east in viral hepatitis cases. Delta co and superinfections are of equal prevalence in the southeastern region. Anti-HDV positivity is about 4% in HBsAg carriers in our country and the role of HDV infection in chronic liver disease is of great interest. Anti-HDV positivity varies from 20% to 50% in such cases with the highest prevalence in the south-east. However, the high seropositivity of HDV infection has been decreasing in recent years. To conclude, HDV infection remains a serious disease in Turkey, and should be considered in both acute and chronic liver disease. The significantly high rate of HDV infection in a number of liver diseases in south eastern Turkey is of great interest and appears similar to that of some other Mediterranean Countries, some Mediterranien Countries.Öğe An unusual case of fever of unknown origin: Kikuchi-Fujimoto disease(2008) Tüzün Y.; Bayan K.; Altintaş A.; Çil T.; Yilmaz Ş.; Dursun M.Kikuchi-Fujimoto disease (KFD), also called histiositic necrotizing lenfadenitis is a self limited disease, which commonly affects young Asian women. Etiology of KFD is unknown. The disease presents with lymphadenopathy, predominantly in the cervical region, fever, leucopenia and high erythrocyte sedimentation rate. It has occasionally been misdiagnosed as malignant lymphoma. The diagnosis of disease is confirmed by histopathological examination of affected lymph node. Herein, we reported a patient who presented with fever of unknown origin and diagnosed as KFD. We suggest that KFD needs to be considered as one of the differential diagnoses in patients presenting with fever of unknown origin and lymphadenopathy.
