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Öğe BILIARY FASCIOLA GIGANTICA CASE REPORT FROM TURKEY(Southeast Asian Ministers Educ Organization, 2011) Goral, Vedat; Senturk, Senem; Mete, Omer; Cicek, Mutallib; Ebik, Berat; Kaya, BesirWe present a case of Fasciola gigantica-induced biliary obstruction and cholestasis diagnosed and treated via endoscopy and trichlorobendazole treatment. This is the first case of Fasciola gigantica treated via endoscopic biliary extraction during ERCP and drug treatment reported from Turkey.Öğe A Case of Biliary Fascioliasis by Fasciola gigantica in Turkey(Korean Soc Parasitology, Seoul Natl Univ Coll Medi, 2011) Goral, Vedat; Senturk, Senem; Mete, Omer; Cicek, Mutallib; Ebik, Berat; Kaya, BesirA case of Fasciola gigantica-induced biliary obstruction and cholestasis is reported in Turkey. The patient was a 37- year-old woman, and suffered from icterus, ascites, and pain in her right upper abdominal region. A total of 7 living adult flukes were recovered during endoscopic retrograde cholangiopancreatography (ERCP). A single dose of triclabendazole was administered to treat possible remaining worms. She was living in a village of southeast of Anatolia region and had sheeps and cows. She had the history of eating lettuce, mallow, dill, and parsley without washing. This is the first case of fascioliasis which was treated via endoscopic biliary extraction during ERCP in Turkey.Öğe Evaluation of CA 72-4 as a new tumor marker in patients with gastric cancer(H G E Update Medical Publishing S A, 2007) Goral, Vedat; Yesilbagdan, Haluk; Kaplan, Abdurahman; Site, DedeBackground/Aims: The place of CA 72-4, a new tumor marker in the prognosis of stomach cancer were studied. Methodology: Endoscopically and histologically diagnosed 47 gastric patients were studied. CEA, CA 19-9, CA 125, CA 15-3, CA 72-4 levels were measured. Results: We determined that serum CA 72-4 level in the group with cancer was significantly elevated. In patients particularly having liver metastases, CA 724 level was found to be greater. Conclusions: We are of the opinion that serum CA 72-4 level is a valuable parameter in the prognosis of stomach cancer.Öğe Hepatic osteodystrophy and liver cirrhosis(Baishideng Publishing Group Inc, 2010) Goral, Vedat; Simsek, Mehmet; Mete, NuriyeAIM: To investigate the correlation between hepatic osteodystrophy and osteoporosis in patients with liver cirrhosis. METHODS: Bone mineral density of the patients (n = 55) and that of the control group (n = 30) were measured by dual-energy X-ray absorptiometry. All the women in the study were premenopausal. Deoxypyridinoline, pyridinoline and urinary Ca2+ were measured as bone destruction markers, while alkaline phosphatase (ALP), osteocalcin and insulin-like growth factor-1 (IGF-1) were measured as bone formation markers. Furthermore, interleukin-1 (IL-1), IL-6, tumor necrosis factor a (TNF-alpha), vitamin D3, direct bilirubin, albumin, cortisol and parathyroid hormone (PTH) levels were measured. The independent Student t test and chi(2) test were employed in comparing both groups, and the Pearson correlation test was used to determine associations. RESULTS: Comparing cirrhosis and control groups, lumbar total T-score (-1.6 +/- 1.2 g/cm(2) vs -0.25 +/- 1.3 g/cm(2), P < 0.001), lumbar total Z-score (-1.2 +/- 1.23 g/cm(2) vs -0.6 +/- 1.3 g/cm(2), P < 0.001), total femur T-score (-0.05 +/- 1 g/cm(2) vs -0.6 +/- 0.9 g/cm(2), P = 0.003) and total femur Z-score (-0.08 +/- 1.5 g/cm(2) vs 0.7 +/- 0.9 g/cm(2), P = 0.003) showed significantly lower values in the cirrhosis group. Blood ALP level (109.2 +/- 57 U/L vs 62.6 +/- 32.5 U/L, P < 0.001), IL-6 level (27.9 +/- 51.6 pg/mL vs 3.3 +/- 3.1 pg/mL, P = 0.01), TNF-alpha level (42.6 +/- 33.2 pg/mL vs 25.3 +/- 12.3 pg/mL, P = 0.007) and direct bilirubin level (0.9 +/- 0.7 mg/dL vs 0.3 +/- 0.2 mg/dL, P < 0.001) were significantly higher in the cirrhosis group. IGF-1 level (47.7 +/- 26.2 ng/mL vs 143.4 +/- 53.2 ng/mL, P < 0.001), osteocalcin level (1.05 +/- 2.5 ng/mL vs 7.0 +/- 13 ng/mL, P = 0.002) and 24 h urinary Ca2+ (169.6 +/- 227.2 mg/dL vs 287 +/- 168.6 mg/dL, P = 0.003) were significantly lower in the cirrhosis group. Urinary deoxypyridinoline/creatinine (9.4 +/- 9.9 pmol/pmol vs 8.1 +/- 5.3 pmolhimol, P = 0.51), urinary pyridinoline/creatinine (51.3 +/- 66.6 pmol/mu mol vs 29 +/- 25.8 pmol/mu mol, P = 0.08), blood IL-1 level (3.4 +/- 8.8 pg/mL vs 1.6 +/- 3.5 pg/mL, P = 0.29), vitamin D3 level (18.6 +/- 13.3 mu g/L vs 18.4 +/- 8.9 mu g/L, P = 0.95), cortisol level (11.1 +/- 4.8 mu g/dL vs 12.6 +/- 4.3 mu g/dL, P = 0.15) and PTH level (42.7 +/- 38 mu g/dL vs 34.8 +/- 10.9 mu g/dL, P = 0.27) were not significantly different. CONCLUSION: Hepatic osteodystrophy is an important complication encountered in patients with liver cirrhosis and all patients should be monitored for hepatic osteodystrophy. (C) 2010 Baishideng. All rights reserved.Öğe Insulin Resistance in Liver Cirrhosis(H G E Update Medical Publishing S A, 2010) Goral, Vedat; Atalay, Roni; Kucukoren, MehmetBackground/Aims: Liver cirrhosis is a chronic disease by degeneration, regeneration and fibrosis in the liver parenchyma, caused by many diseases. Insulin resistance can be defined as any type of decrease in the effect that may occur at the phases following insulin's secretion from B-cells of the pancreas, where it is produced, until it has the expected effects in the target cells. The aim of the present study is to demonstrate the presence of insulin resistance in LC, which is common in our country and region, and investigate the existence of association between insulin resistance occuring in LC and cytokine levels, age, gender, CRP, Hs-CRP, Child-Pugh score and etiology of LC. Methodology: A total of 79 patients with liver cirrhosis (group 1) were included in the study, and 50 subjects as controls (group 2). Of liver cirrhosis patients, 49 (62%) were male and 30 (38%) were female, with a mean age of 54.71 +/- 14.68. Of the controls, 23 (46%) were male and 27 (54%) were female, with a mean age of 41.9 +/- 11.54. Severity of cirrhosis was assessed by Modified Child-Turcoutte-Pugh score. Seven cases (8.9%) were at the Child-Pugh stage A, 35 cases (44.3%) at the Child-Pough stage B, and 37 cases (46.8%) at the Child-Pough stage C. HOMA-IR was calculated and values >2.7 were regarded as presence of insulin resistance (HOMA-IR +). Serum glucose, albumin, bilirubin values were studied with enzymatic method (Architect C-16000); serum CRP, Hs-CRP values with nephelometric method by Beckman Coulter Image Nephelometer (immunochemistry system); insulin, C-peptide with electrochemiluminance immunological method; prothrombin time with radiation method by ACL-Advance brand device. Results: In this study, glucose (p=0.004), insulin (p=0.010), C-peptide (p<0.001), HOMA-IR (p<0.001), TNF-alpha (p<0.001), IL-2RES (p<0.001), IL-6 (p=0.002), CRP (p<0.001) and HsCRP (p=0.006) levels are elevated in LC patients, compared to control group. Consequently, high HOMA-IR in LC supports the fact that insulin resistance develops in LC, as it is reported in similar studies. When HOMA-IR positive and negative patients within LC patients are compared, it is seen that insulin resistance develops independently of age, etiology, gender, Child-Pugh classification, spleen size, TNF-alpha, IL-1 beta, IL-2RES, IL-6, IL-10, CRP, Hs-CRP (p>0.05) levels.Öğe Insulin Resistance in Liver Cirrhosis (vol 57, pg 309, 2010)(H G E Update Medical Publishing S A, 2011) Goral, Vedat; Atalay, Roni; Kucukoner, Mehmet[Abstract Not Available]Öğe Mast Cells Count and Serum Cytokine Levels in Patients with Irritable Bowel Syndrome(H G E Update Medical Publishing S A, 2010) Goral, Vedat; Kucukoner, Mehmet; Buyukbayram, HuseyinBackground/Aims: Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder. Psychological factors and subtle histopathological changes have been implicated in IBS. In some studies, mast cell infiltration has been determined in colon mucosa of the patients with IBS. The aim of this study was to investigate the relationship between mast cell counts and cytokine levels and IBS. Methodology: 72 consecutive IBS patients fulfilling the Rome III criteria and 50 asymptomatic healthy controls underwent colonoscopic biopsy. 15 patients in diarrhea-predominant IBS group which were performed colonoscopy were made a biopsy from caecum, other 25 patients in diarrhea-predominant IBS and 32 patients in constipation predominant IBS were performed a biopsy from rectum. Additionally, serum cytokines were analysed in the patients with IBS and in control group. Results: The results showed significantly increased mast cells in the IBS-diarrhea group compared to IBS-constipation and the control groups (p<0.0001). The statistical analysis of the inflammatory cytokine data obtained in the present study showed significantly higher levels for the sIL-2 receptor in the IBS-diarrhea group compared to other groups. Conclusions: Histopathologic and laboratory data demonstrate low-grade mucosal inflammation in a subset of patients with IBS. Mast cells and cytokines may be related to the pathophysiologic mechanism of IBS.Öğe Plasma cytokine levels in ulcerative colitis(H G E Update Medical Publishing S A, 2007) Goral, Vedat; Celenk, Tahir; Kaplan, Abdurahman; Sit, DedeBackground/Aims: Some immunological factors are responsible in the pathogenesis of ulcerative colitis. There is a relationship between cytokines and ulcerative colitis. Methodology: In this study 20 ulcerative colitis patients (mean age 36.2 years old, 9 women, 11 men) and 20 healthy control groups (mean age 27.2 years old, 11 women, 9 men) were involved in the study. Results: We established that IL-2Rsp, IL-6, IL-8 and IL-10 levels were different at the patients and control groups (p < 0.005). TNF-alpha and IL-1 beta were similar at the both groups. Conclusions: According to these results, IL-2Rsp, IL-6, II-8 and IL-10 play an important role in the pathogenesis of ulcerative colitis. We consider that these cytokines are beneficial parameters in the diagnosis, treatment and prognosis of ulcerative colitis.Öğe The prevalence of Chilaiditi's syndrome in patients with liver cirrhosis(Galenos Yayincilik, 2009) Goral, Vedat; Cizreli, Derya Topal; Demirtas, DeryaChilaiditi's syndrome, which is interposition of colon between liver and right hemidiaphragm, is not a common radiological finding in the normal population. It is frequently observed in patients with chronic lung disease, asthenic syndrome and in multipar females. The real prevalence of Chilaiditi's syndrome in patients with liver cirrhosis is unknown. Probable contributing factors are: (a) liver atrophy in patients with postnecrotic cirrhosis, (b) an enlarged lower thoracic outlet because of ascites, and (c) increased intracolonic pressure. This study includes 89 patients with liver cirrhosis with ascites (of whom 79 had HBV and 10 had HCV; 58 men, 31 women; mean age : 41.2 years) and 67 healthy individuals (44 men, 25 women; mean age: 43.2 years). The diagnosis of Chilaiditi's syndrome was performed by plain abdominal X-Ray, abdominal ultrasonography and abdominal CT. While the prevalence of Chilaiditi's syndrome was established to be 3.2% in patients with liver cirrhosis with ascites, it was found to be 0% in the healthy individuals. In conclusion, Chilaiditi's syndrome can be observed in patients with liver cirrhosis.Öğe Prevalence of occult HBV infection in haemodialysis patients with chronic HCV(W J G Press, 2006) Goral, Vedat; Ozkul, Hamza; Tekes, Selahattin; Sit, Dede; Kadiroglu, Ali KemalAIM: To study the prevalence and clinical effects of occult HBV infection in haemodialysis patients with chronic HCV. METHODS: Fifty chronic hemodialysis patients with negative HbsAg, and positive anti-HCV were included in the study. These patients were divided into two groups: HCV-RNA positive and HCV-RNA negative, based on the results of HCV-RNA PCR. HBV-DNA was studied using the PCR method in both groups. RESULTS: None of the 22 HCV-RNA positive patients and 28 HCV-RNA negative patients revealed HBV-DNA in serum by PCR method. The average age was 47.2 +/- 17.0 in the HCV-RNA positive group and 39.6 +/- 15.6 in the HCV-RNA negative group. CONCLUSION: The prevalence of occult HBV infection is not high in haemodialysis patients with chronic HCV in our region. This result of our study has to be evaluated in consideration of the interaction between HBsAg positivity (8%-10%) and frequency of HBV mutants in our region. (C) 2006 The WJG Press. All rights reserved.Öğe Pseudoxantoma elasticum, as repetitive upper gastrointestinal hemorrhage cause in a pregnant woman(W J G Press, 2007) Goral, Vedat; Demir, Dogan; Tuzun, Yekta; Keklikci, Ugur; Buyukbayram, Huseyin; Bayan, Kadim; Uyar, AsurPseudoxantoma elasticum is a rare, hereditary, multisystemic disease affecting the skin, eye, and cardiovascular system. A twenty-eight-year-old female has presented to emergency unit with the complaint of gastrointestinal hemorrhage. This patient, who had been monitored in the gastroenterology clinic more than 10 times in the past 8 years, noted a repetitive hemorrhage during her previous pregnancy in her history. The examination of the patient revealed the following signs and symptoms: atrophy in the epithelium of the retina pigment; typical angioid streaks and peau d'orange finding in the fundus; thinning of the retinal nerve fiber in OCT (optic coherence tomography); bilateral and reticular papillary lesions with yellowish-color in the neck region (plucked chicken appearance); presence of bleeding foci in fundus; and nephrocalcinosis in kidneys. In light of these symptoms, the patient was diagnosed with pseudoxantoma elasticum. Skin biopsy confirmed the pseudoxantoma elasticurn diagnose. PXE is an uncommon, hereditary disease. Early diagnosis of pseudoxantoma elasticurn cases, is important for minimalizing systemic complications and informing the other family members through genetic counseling. (C) 2007 WJG. All rights reserved.Öğe RATE OF MICROSCOPIC COLITIS AND CYTOKINE LEVELS IN PATIENTS WITH IRRITABLE BOWEL SYNDROME(Carbone Editore, 2015) Ucmak, Feyzullah; Goral, Vedat; Firat, Ugur; Mete, NuriyeAims: The aim of this study is to determine the rate of microscopic colitis (MC) among patients diagnosed as Irritable Bowel Syndrome (IBS) in accordance with Roma III criteria and to investigate the correlation of cytokine levels with the type of IBS and presence of MC. Methodology: A total of Eighty-nine patients who were diagnosed with IBS based on Rome Ill diagnostic criteria were included in this study. Biopsies taken from caecum, ascending colon, transverse colon, descending colon and rectosigmoid region during colonoscopy were put in separate tubes and histopathologically examined. In addition, serum TNF-alpha, IL-1 beta and IL-6 levels were determined in peripheral blood samples of patients. Results: The frequency of MC was higher in the study groups compared to the general population (22.5% and 20.4% in IBS-D and IBS-C groups, respectively). Specimens taken from caecum, ascending colon, transverse colon and descending colon were more likely to lead to the diagnosis of MC compared to those taken from rectrosigmoid region (p<0.001). No significant difference was found between presence of MC and IL-1 beta, IL-6 and TNF-alpha levels. In addition, TNF-a levels were significantly higher in the IBS-C group (p= 0.013). Conclusion: Rate of MC in IBS patients is higher than the rate in normal population. In IBS patients, biopsy samples obtained solely from rectosigmoid area is not sufficient to preclude MC diagnosis. No difference exists between IBS patients with and without MC in terms of cytokine levels.Öğe The Relation Between Pathogenesis of Liver Cirrhosis, Hepatic Encephalopathy and Serum Cytokine Levels: What is the Role of Tumor Necrosis Factor Alpha?(H G E Update Medical Publishing S A, 2011) Goral, Vedat; Atayan, Yahya; Kaplan, AbdurahmanBackground/Aims: Hepatic encephalopathy (HE) is a major complication of acute or chronic liver disease characterized by neuropsychiatric symptoms. It's etiology and pathogenetical mechanisms are not clearly understood and probably it is multifactorial. In this study, we aimed to investigate the relation between pathogenesis of HE and TNF-alpha, IL-1 beta, IL-2R, IL-6, IL-8 and IL-10, and between the severity of HE and the levels of these cytokines. Methodology: Eighty patients with liver cirrhosis [50 patients with clinical findings of HE (group 1) and 30 without any symptoms of HE (group 2)] and 30 healthy controls (group 3) were included into the study. Serum TNF-alpha, IL-1 beta, IL-2R, IL-6, IL-8 and IL-10 levels of patients and control subjects were studied with the chemiluminescent method. Results: There were statistically significant difference between serum TNF-alpha, IL-1 beta, IL-2R, IL-6 and IL-8 levels of patients with liver cirrhosis and healthy subjects (p<0.05), and between patients with and without HE (p<0.05). There was a correlation between the severity of liver cirrhosis according to Child-Pugh classification and cytokine levels. The severity of HE (grade 1-4) was closely related with cytokine levels, especially TNF-alpha. On the other hand, there was no relation between cytokine levels and the etiological factors. Conclusion: We found a positive correlation between serum inflammatory cytokine levels (TNF-alpha, IL-1 beta, IL-2R, IL-6, IL-8) and the severity of liver cirrhosis. In addition, our findings suggested that this relation is independent from etiological factors.Öğe Seroprevalence of hepatitis B and C viruses in patients with chronic kidney disease in the predialysis stage at a university hospital in Turkey(Karger, 2007) Sit, Dede; Kadiroglu, Ali Kemal; Kayabasi, Hasan; Yilmaz, M. Emin; Goral, VedatBackground: Hepatitis B (HBV) and C (HCV) viruses are the most common viruses that cause viral infections among the hemodialysis patients. Objectives: To assess the prevalence of HBV and HCV in predialytic chronic kidney disease (CKD) patients. Design: A cross-sectional study. Subjects: 171 consecutive predialytic CKD patients. Measurements: Third-generation micro-ELISA assay was used for hepatitis B surface antigen (HBsAg), antibody to hepatitis B core (anti-HBc) and surface antibody (anti-HBs), secretory form of hepatitis B envelop antigen (HBeAg), antibody to secretory form of hepatitis B envelop antigen (anti-HBe), and ELISA for antibody to hepatitis C virus (anti-HCV). Results: The main causes of CKD were 29.8% diabetic nephropathy, 19.9% chronic glomerulonephritis, 16.3% hypertensive nephrosclerosis, 14.0% unknown, 5.3% amyloidosis, 4.7% autosomal-dominant polycystic kidney disease, 4.1% chronic tubuluointerstitial nephritis, 3.5% malignancies, 1.7% benign prostatic hypertrophy, 0.6% Alport syndrome. The seroprevalence of hepatitis was: HBsAg 10.5%, anti-HBc 36.8%, anti-HBs 28.7%, HBeAg 5.3%, anti-HBe 32.7%, anti-HCV 7% and HBsAg+ anti-HCV 0.6%. Conclusions: The seroprevalence of HBsAg and anti-HCV among predialytic CKD patients was similar to our patients in hemodialysis program. Copyright (c) 2007 S. Karger AG, Basel.
