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Öğe Adult langerhans cell histiocytosis: Differential diagnosis(Turkiye Klinikleri, 2007) Çil T.; Gökalp D.; Tuzcu A.; Işikdoğan A.; Bahçeci M.Langerhans cell histiocytosis is a group of idiopathic disorders characterized by the abnormal proliferation of specialized bone marrow-derived Langerhans cells. There are one to two cases per million population. Most reports are based only on anecdotal experience in adult patients. Surgical excision, radiotherapy and chemotherapy, either alone or in combination are the main treatment options. In this report, we present a rare case of Langerhans cell histiocytosis in a 32 years-old-woman who developed symptomatic diabetes insipidus and multiple bone and cranial metastases during the disease course. This paper discusses controversial treatment modalities. Copyright © 2007 by Türkiye Klinikleri.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 Auricular mucormycosis: a case report.(2007) Oktay M.F.; Askar I.; Kilinç N.; Tuzcu A.; Topçu I.Mucormycosis is a rare, saprophytic, invasive, and fulminant fungal disease. It occurs in immunocompromised patients such as those with diabetes mellitus or blood dyscrasia, or in patients under immunosuppressive therapy. A 17-year-old female patient with diabetic ketoacidosis presented with a black-colored lesion in the auricle and external ear canal. Physical examination showed necrosis of the auricle, external ear canal, and neighboring skin. She also had facial paralysis. Debridement of the necrotic tissues was performed and the samples were submitted for microbiologic and histopathologic examination, which showed nonseptate hyphae. Postoperatively, systemic amphotericin B was empirically administered. The patient died on the seventh day.Öğe A case with lipoid proteinosis intersected with diabetes mellitus(Turkiye Klinikleri, 2009) Gökalp D.; Tuzcu A.; Bahçeci M.; Yildirim M.; Akdeniz S.; Özekinci S.; Urakçi Z.Lipoid proteinosis (LP) is a rare disorder inherited as an autosomal recessive trait. LP is characterized by deposition of hyaline-like material in the skin, mucous membranes, and other tissues. LP has been mapped to chromosome 1q21, the locus for the extracellular matrix protein 1 (ECM1) gene. In this case report, we aimed to present a case with LP accompanied by diabetes mellitus, and to discuss the possible mechanisms of diabetes in LP. A 16-year-old girl presented to the endocrinology department with hyperglycemia. She reported a history of progressive hoarseness of her voice since she was two years old. Our patient meets the clinical and histopathological criteria for the diagnosis of LP. Her fasting glucose was 310 mg/dl. Plasma insulin and C-peptide levels were 5.1 uU/ml and 1.57 ng/ml,respectively. Hemoglobin A1c was 12.3%. HOMA-IR (Homeostasis Model Assessment-Insulin Resistance) ratio was 3.1 (normal range <3.7). Serum islet cell antibodies, anti-GAD antibodies and anti-insulin antibodies were negative. Diabetes mellitus was diagnosed and insulin treatment was initiated. In conclusion, possible mechanism of diabetes mellitus may be result of the diffuse deposition of amorphous material into the capillary vessels or in pancreas. The other possible mechanism responsible for the association of diabetes mellitus and insulin resistance in LP patients may be sharing a mutation at 1q21 locus. Future studies which aimed screening of insulin resistance and diabetes mellitus in LP patients may be helpful to explain this association.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 Horizontal transmission of HBV among students in the Southeastern Anatolia(2000) Degertekin H.; Tuzcu A.; Yalcin K.Background/aim: In this study, the HBsAg Carrier State and horizontal transmission were investigated among primary and high school students in Diyarbakir, where HBsAg positivity is remarkably high. All results were compared with those of similar studies conducted previously in the same schools. Methods: Overall, 150 students from primary school first grade, 150 students from fifth grade, 200 students from eleventh grade and 200 adults were studied. In all cases HBsAg and anti-HBs were screened by ELISA. Results: HBsAg positivity was 2.7%, 6.1% and 6.2% in the first, fifth and eleventh grade students respectively, while anti-HBsAg positivity was 14%, 20% and 21% in these groups. In adults, HBsAg positivity was 10% and anti-HBsAg 49%. Our results were similar to those of a prior study performed in the same school eight years previously (p>0.05). When both the results from the present study and those from the previous one were evaluated, the difference between the first and fifth grade students was found to be significant (2.1% vs. 6.1% and p<0.05) but that between the fifth and eleventh grades was not (6.2%, p>0.05). This trend also applied to HBsAg positivity. Conclusion: It is concluded that in Diyarbakir and probably in Turkey generally the 7-11 year-old period seems to be the most critical age in the horizontal transmission of HBV infection. During high school years, this risk lessens. In addition to HBV vaccination at birth, it would therefore be appropriate to vaccinate first grade students at the age of seven for the next 7-8 years.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.
