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  • Küçük Resim
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    Adult nephrotic syndrome with spontaneous bacterial peritonitis
    (Elsevier (Singapore) Pte Ltd, 2005) Daniş, Ramazan; Özmen, Şehmus; Yılmaz, Şerif; Yazanel, Orhan
    The association of spontaneous bacterial peritonitis with nephrotic syndrome is common in children, but it is extremely rare in adults. Only 14 cases have been reported in the literature. We report two adult cases who developed spontaneous bacterial peritonitis during a course of nephrotic syndrome, and describe the clinical and laboratory findings. Both patients had renal failure at admission and had a diagnosis of nephrotic syndrome due to amyloidosis before the development of peritonitis. The causative agent could not be isolated from ascitic fluid culture in either patient.
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    Akut böbrek yetmezliği hastalarının çok yönlü değerlendirilmesi
    (Dicle Üniversitesi, Tıp Fakültesi, 2000) Yazanel, Orhan; Işıkoğlu, Bünyamin
    Dicle Üniversitesi Tıp fakültesi Hastanesi Nefroloji bölümünde, ocak 1990 ile kasım 1996 yıllan arasında yatırılarak akut böbrek yetmezliği tanısı almış, yaşları 16 ile 76 arasında değişen,54'üı kadın 34'u erkek 88 hasta, değerlendirmeye alındı. Hastaların 41 'i (%46.5) prerenal, dokuz hasta (% 10) postrenal, ve 38 hasta da ( %43.5) içerisinde akut glomerulonefrit, interstisiyel nefrit ve akut tübüler nekrozu içeren intrensek akut böbrek yetmezliği kriterlerine sahipti. Kırksekiz hasta oligurik,17 hasta anurik, 23 hasta da nonoligurik olarak kabul edildiler. Hastaneye yatırıldıklarında 9 hasta üremik komada idi. Otuziki hastanın santral venöz basıncı normalden düşük, 13 hastanın ise 160 cm su' dan yüksekti. Ortalama üre ve kreatinin değerleri sırası ile % 212,4 ± 95,3 mg ve % 7,66 ± 4,15 mg bulundu.En sık karşılaşılan semptom %59 (n:52) oran ile bulantı-kusma idi. Acil hemodializ veya periton diyalizi,özellikle hipervolemi, hiperkalemi ve ciddi asidoz nedeniyle hastaların % 46 'sında (n:40) uygulandı. Başta kardiovasküler komplikasy onlar ve infeksiyon (şok ) olmak üzere mortalite oranı % 28.4 (n:25) olarak tespit edildi. Serimizde mortalite, başlıca ; koma, beraberinde bir veya daha fazla organ disfonksiyonunun birlikte bulunması, şok ve ileri yaş ile ilişkili bulundu.
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    A Case of Sheehan's Syndrome Admitting With Severe Hyponatremia
    (Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2005) Danis, Ramazan; Ozmen, Sehmus; Parmaksiz, Ergun; Ozmen, Cihan Akgul; Yazanel, Orhan
    Postpartum necrosis of pituitary gland is one of the most common reasons of hypopituitarism. It is most commonly due to massive bleeding before or during delivery. Nonspecific symptoms like fatigue and weakness may confuse and delay the diagnosis. Patients with Sheehan's syndrome may rarely present with hyponatremia signs. A 55-year-old woman admitted to our nephrology department with stupor, severe hyponatremia (100 mEq/L), and hypoglycemia (56 mg/L). The diagnosis of Sheehan's syndrome was based on medical history, laboratory and radiological imaging findings. The patient's clinical picture improved dramatically after hormone and sodium replacement therapy. Sheehan's syndrome must be in differential diagnosis of old women with hyponatremia and it must be known that hyponatremia in those patients may be severe.
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    Ev yapımı semizotu konservesinden kaynaklanan bir botulizm salgını
    (1998) Hoşoğlu, Salih; Yazanel, Orhan; Özen, Aynur; Geyik, Mehmet Faruk; Kökoğlu, Ömer Faruk; Ayaz, Celal
    Evde yapılan semizotu konservesinden yiyerek zehirlenen aynı aileden altı botulizm olgusu aynı gün hastaneye başvurdu. Semptom olarak; yorgunluk, yutma güçlüğü, ağız kuruluğu, alt ve üst ekstremitelerde kuvvet kaybı ve boğaz ağrısı tüm olgularda vardı. Üç hastanın bilinci tamamen normal olup diğer üçü konfüze idi. Fizik bulgu olarak; derin tendon reflekslerinde azalma, ataksi, midriyaziz, alt ve üst ekstremitelerde kuvvet kaybı tüm hastalarda vardı. Laboratuvar incelemelerinde; lökositoz, serum AST ve ALT değerlerinde dört-altı kat arasında yükselme vardı. Tedavi olarak sıvı replasmanı yapıldı. Toksin bağırsaktan uzaklaştırılmaya çalışıldı. Hastaların beşi yapay solunum aygıtıyla desteklendiler, iki hasta pnömoni, iki hasta solunum yetmezliği ve bir hasta da hipotansiyon ve kardiyak yetmezlikten kaybedildi. Bir hasta sekel kalmadan düzeldi.
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    A general approach and management in complications of hemodialysis catheters
    (Ortadogu Ad Pres & Publ Co, 2007) Danis, Ramazan; Oezmen, Sehmus; Akin, Davut; Yazanel, Orhan
    Central venous catheters are commonly used vascular access for hemodialysis in renal failure. Semi-rigid double-lumen polyurethane catheters may be considered for short-time use (up to 2-3 weeks). Soft silicone double-lumen or twin-catheters, preferably with subcutaneous tunneling, are highly desirable for prolonged usage. The complications related with catheters may be evaluated under three topics: insertion complications, thrombosis, and infection. Infections is the most common cause of the nosocomial sepsis and the most serious complication in dialysis centers. Catheter dysfunction is one of the common complications. The internal jugular route should be considered for mid-term use in order to facilitate the patient's mobilization and to reduce the risk of infection. The subclavian route should be avoided because of the risk of stenosis and/or thrombosis of the outflow vein. Catheter insertion must be performed by a trained physician with ultrasound guidance. Complications associated with insertion, infection, and thrombosis are a major source of morbidity and mortality in end stage renal disease patients. Diagnosis and management of these complications are discussed in details.
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    Hemodializ hastaları ve aile bireylerinde hepatit B, C ve HIV serolojik işaretleri
    (1995) Canoruç, Fikri; Yazanel, Orhan; Kaplan, Abdurrahman
    [Abstract Not Available]
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    İnsüline bağımsız diabette albumin ekskresyonu ve diabetik komplikasyonlar
    (1999) Yazanel, Orhan; Bilgir, Oktay; Sina, Muhammed; Kadıköylü, Gürhan
    Bu çalışmada, insüline bağımsız 46 diabetli hastada idrarda albumin ekskresyonu ile diabetik komplikasyonlar arasındaki ilişki araştırıldı. Normoalbüminürik hastalar 1. gruba, mikroalbüminürik hastalar 2, gruba ve makroalbüminürik hastalar ise 3. gruba alındı. Birinci gruptaki hastaların mikroalbuminüri ortalamaları 9,9 ± 1,2 /µg / dk, 2. gruptakilerin 57,1 ± 18,24 µg / dk iken 3. gruptakilerin ortalamaları 1,05 ± 0,47 g / 24 saat bulundu. İkinci ve üçüncü gruptaki bu değerler istatistiksel olarak 1. gruptan anlamlı derecede farklı idi (p < 0,01). Her üç grupta da diabetik retinopati ve nöropati, iskemik kalp hastalığı, hipertansiyon ve periferik arter hastalığı sıklığı araştırıldı. Diabetik retinopati sıklığı, sırasıyla gruplarda %28,45 ve 60 idi. Diabetik nöropati sıklığı sırasıyla % 20, 45 ve 50 bulundu. Hipertansiyon % 44, 18, 70 sıklığında iken iskemik kalp hastalığı % 12, 18 ve 30' du. Periferik arter hastalığı 1. grupta %4ve3. grupta % 20 idi. Bu sonuçlar üriner albumin ekskresyonu ile önemli diabetik komplikasyonlar arasında pozitif bir ilişki olduğunu göstermektedir.
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    Nötropenik Kanser Hastalarından İzole Edilen Bakteriyel Ajanların İmipenem Duyarlılıkları
    (Kocaeli Üniversitesi, 1997) Balıkçı, Erdener; Ayyıldız, M. Orhan; Tiftik, Naci; Şit, Dede; Mete, Ömer; Yazanel, Orhan
    ?Hematoloji kliniğinde takip edilen nötropenik kanser hastalarından izole edilen çeşitli bakteriyel ajanların imipeneme duyarlılıkları araştırıldı. İzole edilen toplam 56 bakteriyel etkenin duyarlılık işlemleri agar-disk diffüzyon metoduyla gerçekleştirildi. Etkenlerin 16’sı E. Coli, 10’u Pseudomonas spp, 12’si Enterobacter spp, 5’i Proteus spp, 5’i Klebsiella, 8’i Stafilokok olarak tespit edildi. Bu etkenlerin imipeneme duyarlılıkları sırasıyla 16 E. Coli suşunun 13’ünde (%81,2), 10 Pseudomonas suşunun 8’inde (%80), 12 Enterobacter suşunun 10’unda (%83,3), 5 Proteus suşunun 4’ünde (%80), 5 Klebsiella suşunun 3’ünde (%60), 8 Stafilokok suşunun 6’sında (%75) olarak bulundu.Sonuç olarak imipenemin, nötropenik kanser hastalarındaki bakteriyel ajanlara karşı önemli oranda duyarlılığı olan bir antibakteriyel olduğu gözlendi. 
  • Küçük Resim
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    Predictive factors of cardiovascular disease in patients on maintenance hemodialysis
    (Wiley, 2008) Danış, Ramazan; Özmen, Şehmus; Akın, Davut; Çelik, Fatma; Yazanel, Orhan; 0000-0003-1492-9681; 0000-0002-9567-7940
    OBJECTIVE: The purpose of this study was to identify the role of the methylenetetrahydrofolate reductase (MTHFR) gene mutation and other predictive factors of cardiovascular disease (CVD) in patients on maintenance hemodialysis. METHODS: A total of 144 patients with end-stage renal disease (ESRD) undergoing maintenance hemodialysis for at least 6 months were recruited. The mean age of patients was 44.84 +/- 16.23 years. Serum folate, vitamin B12, homocysteine (tHcy), albumin, lipids, MTHFR C677T mutation, and smoking habits were analyzed relative to the presence of CVD. RESULTS: Forty-two of the 144 patients (29.1%) had CVD. Mean age, duration of dialysis, body mass index, CRP, Kt/V, male sex, diabetes mellitus, and currently smoking were found to be significantly higher in patients with CVD than in those without CVD (p 0.05). The means of serum folate, vitamin B12, tHcy, albumin, and percentage of past smokers were not significant (p 0.05). MTHFR C677T mutation was not found to be associated with CVD risk factors. The mean differences in tHcy levels between the TT and CC and the CT and CC genotype allele groups were significant. CONCLUSION: We recommend that duration of ESRD and CRIP predictors with traditional risk factors be taken into account when examining CVD. We suggest that if patients with ESRD have normal B12 and folate levels, abnormal tHcy level and tHcy metabolism are not risk factors for CVD in patients with ESRD. We do not recommend evaluation of the MTHFR C677T mutation and tHcy level in maintenance hemodialysis patients. The discriminative ability of risk predictors in CVD found in the study present new ideas for researchers studying this subject.
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    The Retrospective Analysis of 84 Patients With Nephrotic Sydrome
    (Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2005) Danis, Ramazan; Ozmen, Sehmus; Parmaksiz, Ergun; Yazanel, Orhan
    The frequency of histologic types of glomerulonephritis vary depending on ethnicity and geographic location. Characteristics of 84 patients with nephrotic syndrome admitted to Dicle University Faculty of Medicine were retrospectively analysed. The mean age of 41 female and 43 male patients was 35.0 years. Forty-seven patients (78.3%) had primary glomerulonephritis and the remaining 13 patients (21.7%) had secondary glomerulonephritis. The basal mean values of patients with NS were as follows: serum creatinine 1.68 mg/dl, serum urea 64.5 mg/dl, renal protein loss 5.7 gr/day, and creatinine clearence 65 ml/min. MPGN and MGN were the most common GN types in biopsies performed with a NS indication. In our study, MPGN, a decreasing type in developed countries, and MGN, the most common type worldwide were at top. Although MPGN is decreasing in western countries it is still common in different regions of our country and is the most common GN type in our region.
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    Role of lean body mass for estimation of glomerular filtration rate in patients with chronic kidney disease with various body mass indices
    (Informa Healthcare, 2009) Ozmen, Sehmus; Kaplan, Mehmet Ali; Kaya, Halil; Akin, Davut; Danis, Ramazan; Kizilkan, Berfin; Yazanel, Orhan
    Objective. Glomerular filtration rate (GFR) is the main tool used to diagnose, treat and follow up renal diseases. Age, gender, ethnicity and obesity all affect the relationship between serum creatinine, muscle mass/body weight and GFR. This study aimed to investigate the role of lean body mass for GFR estimation in patients with chronic kidney disease (CKD) with various body mass indices. Material and methods. In total, 110 Caucasian adult subjects with CKD referred for GFR measurement by 99mTc-DTPA renography were enrolled in the study. The patients were categorized according to body mass index values: 18.5 kg/m2 (underweight), 18.5-24.9 kg/m2 (normal), 25-29.9 kg/m2 (overweight) and 30 kg/m2 (obese). Lean body mass (LBM) and fat mass were measured by leg-to-leg bioimpedance. Predictive factors were identified by linear regression analysis in each group. Results. GFR measured by DTPA, creatinine clearance, Cockcroft and Gault, and Modification of Diet in Renal Disease (four-variable) equations was 3727, 4230, 4227, and 4935 ml/min/1.73 m2, respectively. The predictive role of 1/SCr, age, serum albumin, amount of proteinuria, LBM and fat mass was investigated all groups. None of the factors was significant in underweight and healthy weight groups except for 1/serum creatinine (SCr). LBM/SCr was an independent predictive factor for both overweight and obese groups. 1/SCr accounted for 96.2% of the variability in measured GFR for underweight subjects but only 58.1% of the variability in GFR of obese subjects. Conclusions. The formulae derived from SCr should be used cautiously in overweight and obese subjects. LBM measured by bioimpedance was an independent predictive factor of GFR in obese/overweight subjects and added clinically important diagnostic value to 1/SCr. It needs to be investigated as a parameter in further studies attempting to develop formulae for estimating GFR in larger obese and overweight populations.
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    Serum copper and zinc levels in children with growth hormone deficiency
    (TÜBİTAK, 1994) Haspolat, Yusuf Kenan; Canoruç, Naime; Devecioğlu, M. Celal; Tunçbilek, Olgun; Söker, Murat; Yazanel, Orhan; Narlı, Nejat
    We have investigated serum copper (Cu) and zinc(Zn) levels in 26 patients (20 boys/77%. 6 girls/23%) who were diagnosed with Growth Hormone (GH) deficiency in the Pediatric Endocrinology Department of Dicle University.
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    Snakebite-induced acute kidney injury: Data from Southeast Anatolia
    (Taylor & Francis Inc, 2008) Danis, Ramazan; Ozmen, Sehmus; Celen, Mustafa Kemal; Akin, Davut; Ayaz, Celal; Yazanel, Orhan
    Renal failure is an important complication of snakebite and a major cause of mortality. We aimed to study the clinical profile of snake envenomation in Southeast Anatolia, Turkey, in an adult population. We retrospectively analyzed the records of 200 snakebite victims from 1998 to 2006 at the Dicle University School of Medicine, Diyarbakir, Turkey. Sixteen patients (8%) developed AKI (acute kidney injury). Of those, 25% required dialysis and 18% died. There was no difference between groups in age, arrival time to hospital, and hospital stay time. Both groups received similar hydration and therapy at admission. Disseminated intravascular coagulation (DIC) was observed in 25% of the AKI group and was significantly higher than the non-AKI group (7.1%; p = 0.014). There was no significant difference regarding hemoglobin, platelet levels, and prothrombin time at admission. The prevalence of thrombocytopenia (<150,000 K/UL ) was 60% in the AKI group and 40% in the non-AKI group (p > 0.05). WBC count was significantly higher in the AKI group than in those without AKI (p = 0.001); serum albumin was significantly lower in the AKI group than in those without AKI (p = 0.013). AKI is an important complication of snakebite that may lead to mortality. Despite some troublesome aspects due to its retrospective design, this is a large series from Southeast Anatolia of Turkey in an adult population. Subjects with high WBC, low albumin, and DIC should be closely followed up for the development of AKI.
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    Sıçanlarda etanol ve stresle oluşturulan gastrik mukozal tahribatın E-vitamini ile değişimi
    (1995) Kaplan, Abdurrahman; Yazanel, Orhan; Canoruç, Fikri; Erdinç, Levent; Batun, Sabri
    Çeşitli doku hasarından sorumlu olan serbest ok¬sijen radikalleri ve bu radikallerin elimine edilmesinde kullanılan antioksidan maddelerden E vitamininin et¬kileri bu deneysel çalışmada incelenmiştir. Toplam 34 sıçdn 4 gruba ayrılarak (kontrol grubu, stres grubu, stres+Etanol grubu ve stres+Etanol+E vitamini grubu) mide dokularında serbest oksijen radikallerinin bir me-taboliti olan Malondialdehit (MDA) düzeyleri "thiobar-bitürik asit metodu" ile ölçüldü. MDA düzeyleri stres ve stres+etanol gruplarında kontrol grubuna göre yüksek bulundu(p<0.01). E vitamini verilen stres+Etanol gru¬bunda ise, MDA düzeyleri kontrol düzeylerine yakın bulundu (p>0.05). Sonuç olarak E vitamini lipid perok-sidasyonunu azalttığı, dolayısı ile mokozal tahribata engel olduğu görüldü.
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    Terapötik bronkoskopi ile tedavi edilen postentübasyon trakea stenozları: Beş olgu sunumu
    (2004) Yazanel, Orhan; Yıldız, Tülay; Karakoca, Yalçın; Yıldız, M. Erdem; Sarıman, Nesrin; Karakoca, Sevinay; Karaağaç, Güler
    Benign hava yolu obstrüksiyonları terapötik bronkoskopi ile küratif olarak tedavisi yapılabilen patolojilerdir. Cerrahi tedaviler ile kıyaslandığında hasta açısından son derece rahat olup risk içermemektedir. Trakeostomi ve endotrakeal entübasyon sonrası trakea stenozu nedeniyle başvuran beş hastada, terapöük bronkoskopi yöntemlerinden lazer-stenoük silikon stent tedavileri uygulandı. Trakeostomi ve entübasyon sonrası stenoz gelişen iki hastaya membranöz striktür alanının "Heodimum Yttrium Aliminum Pevroskite (Nd-YAP) " lazer ile vaporizasyonu, mekanik ve/veya balon ile dilatasyonundan sonra stenotik silikon stent implante edildi. Diğer üç hastada ise membranöz striktür alanı Nd-YAP-lazer ile koagüle edilip; mekanik ve balon dilatasyonu ile hava yolu normal genişliğine ulaştırıldı. Takip dönemlerinde restenoz gelişen olgulara tekrar lazer rezeksiyonu uygulandı ve stenotik silikon stent yerleştirildi. Silikon stentle implante halde takiplerinde sorun olmayan hastalarda cerrahi rezeksiyona gerek kalmadan küratif tedavi sağlanmıştır.
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    Ureterosygmoidostomy-associated quadriparesis, non-traumatic rhabdomyolysis, and tetany in an adult
    (Springer, 2008) Ozmen, Sehmus; Danis, Ramazan; Akin, Davut; Gullu, Nezir; Ozmen, Cihan Akgul; Yazanel, Orhan
    We report an adult case of ureterosigmoidostomy-associated quadriparesis, rhabdomyolysis, and tetany which may be the first such case in the literature. A 32-year-old female patient was brought to the emergency room of our hospital, having been unable to walk or use her arms for 24 h. Neurological examination revealed quadriparesis. She had severe hypokalemia (1.27 mmol/l) and metabolic acidosis (pH = 7.05). Creatine kinase value was 2,590 U/l on the third day. She received intensive therapy to correct the hypokalemia and acidosis. On the third day of hospitalization tetany was detected in her upper extremities. The patient regained full muscle power after intravenous potassium chloride, bicarbonate, and calcium replacement therapy.