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Öğe Ascitic fluid lymphocyte subgroups and cytokine levels in patients with spontaneous bacterial peritonitis(2009) Goral V.; Aggil C.; Batu S.Objective: Spontaneous bacterial peritonitis (SBP) is a serious complication of liver cirrhosis and has a high mortality rate. Immune system plays a part in all steps of this infection increase. Insufficient serum complement activity in ascitic fluid, reticuloendothelial system dysfunction, all of the insufficient opsonic activity seem related to spontaneous bacterial peritonitis increase. The aim of our study is to investigate the effects of some cytokines and lymphocyte subgroups in ascitic fluid on increase of spontaneous bacterial peritonitis. Methods: The study population consisted of 41 decompensated cirrhotic patients (30 men, 11 women) with different etiologies. Ascitic fluid lymphocyte surface markers (CD3, CD4, CD8, CD16, CD19, CD56) and cytokine levels (IL-6, IL-8, IL-10, TNF-?) were searched in all patients. Results: In culture positive and negative groups, no significant differences were found between CD3, CD4, CD8, CD16, CD19, CD56 with CD4/CD8 ratio from lymphocyte surface markers worked in ascitic fluid (P > 0.05). There was a significant difference between infected and non -infected groups concerning CD4/CD8 ratio and between CD4 and CD8 values concerning lymphocyte surface markers in ascitic fluid. No significant difference was found in ascitic fluid IL-8 and TNF-? levels between infected and non-infected groups. Conclusion: According to the study, Th1 immune response is predominant to Th2 immune response. It also demonstrates that TNF-? might be involved in the pathogenesis of ascites infections.Öğe Biliary Fasciola gigantica case report from Turkey(SEAMEO TROPMED Network, 2011) Goral V.; Senturk S.; Mete O.; Cicek M.; Ebik B.; Kaya B.We 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 Colchicine in the treatment of cirrhosis of the liver(1992) Goral V.; Degertekin H.; Aksoy N.[No abstract available]Öğe Diagnostic value of color doppler ultrasonography in hepatocellular carcinoma(1996) Goral V.; Mumbuc L.; Bilici A.; Kemaneci A.A differential diagnosis of liver tumors was made on the basis of the pattern of blood flow within and around tumors on color Doppler flow images. The study comprised 47 patients with liver mass lesions; 22 patients had hepatocellular carcinoma (HCC), 15 had hemangiomas, 4 had metastatic liver cancers, 3 had liver abscess, 3 had liver cysts. Color Doppler flow imaging and Doppler flow velocity were established and compared according to the Tanaka classification. Color Doppler flow imaging was observed in masses of all of 22 patients with HCC, of 3 patients with liver metastasis, of 3 patients with hemangiomas. Doppler signals were not observed in 1 patient with liver metastasis, in 3 patients with liver abscess, in 3 patients with liver cysts. The mean of maximum blood flow velocity was 80.7 cm/s in HCC, 49.3 cm/s in metastatic liver cancers, 10.3 cm/s in hemangiomas. A basket pattern (a fine blood-flow network surrounding the tumor nodule) was observed in 17 (77%) of the 22 HCC. An image of vessels within the tumor blood flow that runs into and branches within the tumor was observed in 5 (23%) of the 22 HCC. These two findings were observed only in HCC. In three of 15 hemangiomas, a spot pattern (color-stained dots or patches in the central region, of the tumor) was seen. When the blood flow wave pattern was examined, constant leaves could be seen in 6 cases (27.4%), the blood flow also showed pulsating waves in 16 (73.6%) cases with HCC. According to these results, HCCs have some characteristic appearances on color Doppler flow images. Therefore color Doppler ultrasonography can aid in the differential diagnosis of liver mass lesions.Öğe Effect of omeprazole, clarithromycin and amoxicillin therapy on duodenal ulcer and Helicobacter pylori eradication(1997) Goral V.; Tas M.; Gul K.; Canoruc F.Helicobacter pylori (H. pylori) is the most important factor in the pathogenesis of duodenal ulcer (DU). Eradication of H. pylori does lower the recurrence rate of DU. The aim of this study was to evaluate the efficacy, tolerability and compliance of a triple therapy with omeprazole and amoxicillin plus clarithromycin. 24 patients (22 males, 2 females, age range 21-27) with duodenal ulcer were treated for 2 weeks with omeprazole 20 mgr b.i.d. 28 plus amoxicillin 1 g b.i.d. plus daintromycin 250 mg. b.i.d. H. pylori (+) duodenal ulcer cases which were treated for 2 weeks with omeprazole 20 mgr b.i.d. plus amoxicillin 1 gr b.i.d., using as control groups. Diagnosis was made by upper G.I. endoscopy and by obtaining multiple biopsies from antral mucosa. Standard H.E., Giemsa stains and rapid urease test were performed for the diagnosis of H. pylori infection. Patients were endoscoped before and at the end of therapy and 1 month after completion of therapy. Eradication was defined as all tests were negative at the final evaluation. In the third endoscopy H. pylori positivity was found as 8%. The eradication was therefore reached in 22 patients (92%). At the control group, the eradication rate was calculated as 79% (p<0.05). It is concluded that a 2 weeks trial of triple therapy with omeprazole, clarithromycin and amoxicillin is very effective and well tolerated for the eradication of H. pylori infection.Öğe The effect of vitamin E on small intestine damage of ischemia- reperfusion in young rats(1998) Deveci E.; Goral V.; Yilmaz F.; Tacar O.; Demirant A.; Canoruc F.The effect of antioxidant agents on ischemia-reperfusion is well known. In this study 300 mg/kg of vitamin E was administered I.M to young rats for three consecutive. On day three, the mesenteric superior artery was held with atraumatic clamps for 30 minutes to create ischemia, and then exposed to 45 minutes of reperfusion. We took sections from the jejunum for histological examination, then observed the negative effect of ischemia reperfusion and protective effect of vitamin E.Öğe Eosinophilic esophagitis frequency in gastroesophageal reflux disease(2010) Goral V.; Ozcaylak S.; Buyukbayram H.Objective This study compares the frequency of eosinophilic esophagitis in patients with gastroe sophageal reflux disease (GERD). Methods This study was conducted among the patients having gastroesophageal reflux complaints and accepting endoscopic procedure. The patients (50 men, 37 women) involved in the study be tween 16 and 70 years of ages and having GERD complaints were applied a questionnaire consisting of ten questions to define the level of GERD symptoms,and the endoscopic procedures were applied to the patients by the same gas troenterologist. Reflux esophagitis was evaluated according to the Los Angeles classification. The history of the pa tients was reviewed and the allergic histories were evaluated. Total serum Ig E level and eosinophilia count at the esophageal biopsies were calculated. Results There was no meaningful relationship when the patients were evalua ted in terms of their ages, genders, body mass index, habits (smoking, alcohol, tea, coffee, medicine), diarrhea, en doscopic appearance, total Ig E level, and hemogram study as well as number and percentage of eosinophil (P>0,05). When the endoscopic biopsies obtained from the patients were evaluated, no eosinophilic esophagitis has been observed. Conclusion According to the our study, there is no relationship with eosinophilic esophagitis and GERD. Eosinophilic esophagitis should be considered in the differential diagnosis of any cases with refractory reflux who complain of chronic unexplained dysphagia.with history of recurrent food impaction, and atopy or abnor mal endoscopic features.Öğe An epidemiological study of Entamoeba histolytica and Entamoeba dispar infection using polymerase chain reaction(1998) Goral V.; Jetter A.; Walderish B.; Burchard G.-D.; Ackers J.; Britten D.The recent discovery of the existence of Entamoeba dispar (E.dispar) as an amoeba that is constitutively nonpathogenic but morphologically indistinguishable from Entamoeba histolytica (E.histolytica), has raised the question of the validity of most epidemiological studies on amoebiasis. This study was conducted in two villages. The presence of amoeba was determined by microscopic examination of fresh stools and formalin-ether-concentrated specimens. An improved colorimetric 'polymerase chain reaction' (PCR) method was used and ELISA assay was used to detect anti-E.histolytica antibodies in the serum samples. The combined frequencies of E.histolytica/E.dispar according to stool microscopy were 35% in village A, and 28% in village B. According to PCR results, E.histolytica was not detected and E.dispar was found in 21% and 18% of stool samples in A and B villages respectively. Thirty-five percent (92/260) of the sera reacted with E.histolytica antigen and 28% (72/260) of the sera reacted with E.dispar antigen. A correlation between antibody levels and the presence of E.histolytica/E.dispar in stool microscopy could not be detected. A significant correlation was found between antibody responses to E.dispar and E.histolytica antigen (p=0.001). According to our results, the prevalence of E.histolytica in our area seems to be very low. Serology is not helpful in distinguishing E.histolytica from E.dispar in asymptomatic cyst passers in an endemic area.Öğe Histopathological changes in liver of young rats treated with cadmium chloride during pregnancy(1998) Deveci E.; Goral V.; Tacar O.; Yaldiz M.; Canoruc F.In this study, cadmium chloride injection (I.V.) was administered to 17- 21 day pregnant Wistar Albino rats. The weight and liver histology of rats were then investigated. This short time administration of cadmium caused decrease in body weight and degeneration of liver structure in pregnant rats.Öğe Insulin resistance in liver cirrhosis(2011) Goral V.; Atalay R.; Kucukoner M.[No abstract available]Öğe Mast cells count and serum cytokine levels in patients with irritable bowel syndrome(2010) Goral V.; Kucukoner M.; Buyukbayram H.Background/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. © H.G.E. Update Medical Publishing S.A.Öğe Omeprazole, nitrendipine, famotidine and stress-induced ulcers(1997) Inaloz S.S.; Canberk Y.; Ozaydin M.; Sari I.; Yenilmez E.; Ulak G.; Goral V.Background: Omeprazole inhibits gastric acid secretion by blocking the proton pomp of the gastric parietal cell. Nitrendipine is a derivative of dihydropyridine group of calcium channel blockers and administrated for angina and hypertension. Famotidine is one of the newer histamine H2 receptor antagonists and heals gastric and duodenal ulcers by reducing gastric acid output. Objectives: The healing effects of omeprazole, nitrendipine and famotidine on stress-induced gastric ulcers were investigated in rate. Methods: Forty male Wistar-albino rats were separated into five groups (n=8), a control (non-stress) and four experimental (stress) groups. Experimental rats were treated with omeprazole, nitrendipine, famotidine or a placebo after the stresses of starvation and cold-restraint. Results: Macroscopically, the mean area of the affected lesional mucosa was 1/4 of the total gastric mucosa in the famotidine treated group and 1/5 of the total gastric mucosa in the nitrendipine treated group. A considerably decrease was observed in the omeprazole treated group in which the mean area of the lesional mucosa was only in 1/8 of the total gastric mucosa. On microscopic examination, congestive vessels and chronic inflammatory cell infiltrates were significantly reduced in the omeprazole treated group. Tissue regeneration was more prominent in the omeprazole group than me other groups. Conclusion: Omeprazole was found to be superior in terms of the effect on the healing process to nitrendipine and famotidine. Although therapeutic effects of nitrendipine and famotodine were observed, those were less than omeprazole.Öğe Omeprazole, nitrendipine, famotidine and stress-induced ulcers [1](1997) Inaloz S.S.; Goral V.; Sari I.[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 Relation between pathogenesis of liver cirrhosis, hepatic encephalopathy and serum cytokine levels-what is the role of tumor necrosis factor-alpha?(2010) Goral V.; Atayan Y.; Kaplan A.Background and objective: Hepatic encephalopathy (HE) is a major complication characterized with neuropsychiatric symptoms that occurs as a consequence of acute or chronic liver disease. It's etiology and pathogenetical mechanisms are not clearly understood and probably it is multifactorial. There are some reported studies about the role of tumor necrosis factor-alpha (TNF-?) and other inflammatory cytokines on the pathogenesis of HE. In this study, we aimed to investigate the relation between pathogenesis of HE and TNF-?, IL-1?, IL-2R, IL-6, IL-8 and IL-10, relation between the severity of HE and the levels of these cytokines. Methods: 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-?, IL-1 ?, IL-2R, IL-6, IL-8 and IL-l0 levels of patients and control subjects were studied with chemiluminescent method. Results: There were statistical difference between serum TNF-?, IL-1 ?, IL-2R, IL-6, 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-?. 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-?, IL-1?, 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 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 Vertigo: A complication of interferon therapy in a patient with chronic hepatitis C(2000) Goral V.; Meric F.; Aluclu U.; Duzen S.The occurrence of vertigo in a 60-year-old male submitted to interferon therapy in the management of chronic hepatitis C would appear to suggest that vertigo could be a side-effect of the drug and that it should be immediately withdrawn in such cases.
