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Öğe Analysis of 1242 cases with upper gastrointestinal system bleeding in Southeastern Turkey(H G E Update Medical Publishing S A, 2005) Dursun, M; Yilmaz, S; Yükselen, V; Canoruç, F; Tuzcu, ABackground/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.Öğe The efficacy of flumazenil in subclinical to mild hepatic encephalopathic ambulatory patients - A prospective, randomised, double-blind, placebo-controlled study(E M H Swiss Medical Publishers Ltd, 2003) Dursun, M; Caliskan, M; Canoruc, F; Aluclu, U; Canoruc, N; Tuzcu, A; Yilmaz, SObjectives: 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 I 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 The epidemiological aspects of irritable bowel syndrome in Southeastern Anatolia: a stratified randomised community-based study(Wiley, 2005) Yilmaz, S; Dursun, M; Ertem, M; Canoruc, F; Turhanoglu, AEven though studies on the epidemiology of the irritable bowel syndrome (IBS) are increasing day by day, epidemiological data are still unknown in many regions. Our objective was to determine the IBS prevalence, factors associated with this prevalence and probable risk groups in Southeastern Anatolia. The total population in the target region is approximately 6 million. A total of 3000 people (1521 females and 1479 males) randomly selected by stratified cluster sampling were interviewed face-to-face by using a questionnaire comprising demographic features and the Rome 11 criteria which also included probable risk factors and questions related with Bristol scale stool form. The statistical analysis was performed by using a package program called FPI INFO 2000. IBS prevalence was 10.2% according to the Rome TI criteria in our region. Six hundred and twenty-five of 3000 subjects had gastrointestinal symptoms in the last 3 months. IBS rate was higher in women (12.4%) than in men (8.0%), and married subjects had higher IBS rates (11.6%) than singles (6.7%). Those differences were statistically significant (p = 0.000 for both). It was most common in the 35-54-year age group. No difference was observed in terms of settlement (rural/urban), age group, education and occupation. History of abortion in women increased the IBS risk by 1.8 times (p = 0.000 Crude odds ratios = 1.8 (1.3-2.6) 95% confidence intervals). Of the IBS patients, 48.1% had characteristics of diarrhoea-predominance, 38.9% constipation-predominance while 13.0% had none. There was a significant relation between dominant stool form and Bristol scale stool form. IBS prevalence is 10.2% in the first community-based study carried out in this specific subject in Southeastern Anatolia. The dominance of middle age and females remained significant.Öğe Evaluation of optimal gastric mucosal biopsy site and number for identification of Helicobacter pylori, gastric atrophy and intestinal metaplasia(H G E Update Medical Publishing S A, 2004) Dursun, M; Yilmaz, S; Yükselen, V; Kilinç, N; Canoruç, F; Tuzcu, ABackground/Aims: The study is designed to identify the optimal gastric mucosal biopsy site and number for identification of Helicobacter pylori, gastric atrophy and intestinal metaplasia. Methodology: Ninety-two patients were included in the study, gastric biopsies were obtained from 5 different sites: lesser curvature of the mid-antrum (A(1)), greater curvature of the mid-antrum (A(2)), incisura angularis (IA), lesser curvature of the mid-corpus (B-1), greater curvature of the mid-corpus (B-2). Helicobacter pylori was evaluated in sections stained with toluidine blue, and histopathological. examination was performed in sections stained with hematoxylineosin. Results: Seventy-three patients were positive for Helicobacter pylori at least in one biopsy site. Helicobacter pylori was positive in 47 patients (64.3%) in A(1), in 54 patients (73.9%) in A(2), in 60 patients (82.1%) in IA, 44 patients (60.2%) in B-1, and in 42 patients (57.5%) in B-2. The highest positivity determined was in the combination of A(2) and IA sites (95.8%). Gastric atrophy was determined in 35 of 73 patients (27.1% in A(1), 20% in A(2),25.7% in IA, 20% in B-1, and 7% in B-2). Intestinal metaplasia was determined in B-1 of the Helicobacter pylori-positive patients (18% in A(1), 16% in A(2), 30.9% in IA, 21.8% in B-1, 12.7% in B-2). Conclusions: It is considered that taking biopsies from both A(1) and IA sites has the highest sensitivity in detecting Helicobacter pylori. However, it is difficult to define a specific site for detecting gastric atrophy and intestinal metaplasia.Öğe Prevalence of Hepatitis C in adults in the south-eastern region of Anatolia(Wiley, 2004) Dursun, M; Özekinci, T; Ertem, M; Saka, G; Yilmaz, S; Canoruc, F; Çelenk, SAim: There is a limited number of studies on the general population about prevalence of Hepatitis C virus (HCV) in Turkey. The estimated prevalence of HCV in the Southeastern region of the country was obtained from the data of the blood donors. There is no study reflecting the general population of this region, leading us to plan this study. Material and method: Four provinces in the Southeastern Anatolia were randomly selected and sample sizes were determined by Epi Info Programme, and blood samples were collected from 2888 individuals. Questionnaires in which demographic information and probable risk factors for Hepatitis C were investigated and were applied on subjects who gave their consent to participate in the study. Anti-HCV was examined by using Cobas Core II immunochemistry system (Roche). All positive samples were further tested for the presence of HCV RNA by RT-PCR. Crude odds ratios (OR) and 95% confidence intervals (CI) were calculated and Chi-square analyses were performed. Epi Info 2000 Programme was used to perform the analysis. Results: Of the 2888 individuals, 17 (0.6%) were anti-HCV positive and 13 (82%) of them were confirmed as positive for HCV-RNA. No difference was found between rural and urban regions with respect to HCV prevalence (P = 0.51). The prevalence of HCV in 35-44 years of age group was found to be different from those of the other age groups (P = 0.02). It was determined that the risk for HCV in this age group was 4.23 times (P = 0.02; OR = 4.23;1.02-20.15; CI 95%:) higher with a prevalence rate of 1.6%. In this age group, anti-HCV was positive in 6 male (2.4%) and 2 female (0.8%), of whom 7 were living in urban (2.2%) and 1 in rural area (0.5%). The overall prevalence of HCV was not found to be different for sex (P = 0.75). Similarly, there was no difference between the married and single individuals for the prevalence (P = 0.38). Anti-HCV positivity did not change for the level of education. We could not determine any factor that might play a role in transmission of HCV. Conclusion: This is the first population-based study to be performed in order to determine the prevalence of HCV in the south-eastern region of Anatolia (Turkey). This region has a low prevalence of HCV. The extremely rare prevalence of homosexuality and intravenous drug addiction might have a role in this low prevalence. (C) 2004 Elsevier B.V. All rights reserved.Öğe Primary squamous cell carcinoma of the stomach(Lippincott Williams & Wilkins, 2003) Dursun, M; Yaldiz, M; Isikdogan, A; Yilmaz, G; Canoruç, F; Örmeci, N; Yilmaz, SPrimary squamous cell carcinoma of the stomach is extremely rare. To date, only 80 cases have been reported. A 65-year-old man with complaints of epigastric pain and cachexia for the past year is presented. He had a tumour with infiltration of the corpus and antrum of the stomach. The tumour was unresectable, and the patient died within 3 months.Öğe A severe (type II) hepatopulmonary syndrome in a patient with idiopathic portal hypertension and treatment with paroxetine(Van Zuiden Communications, 2005) Yilmaz, S; Dursum, M; Canoruc, F; Bayan, K; Karabulut, A; Akay, HThe hepatopulmonary syndrome has been defined as chronic liver disease accompanied by abnormal pulmonary gas exchange, which might result in arterial deoxygenation, and widespread intrapulmonary vasodilation. Although it has been pointed out that hepatopulmonary syndrome occurs in liver cirrhosis, there are a few studies in the literature reporting noncirrhotic portal hypertension as a cause of hepatopulmonary syndrome. Currently, liver transplantation is the only effective therapy for such patients. On the other hand, there is also a proposal about considering paroxetine, a potent nitric oxide synthase inhibitor, for use in the hepatopulmonary syndrome. We present a patient with severe (type II) hepatopulmonary syndrome caused by idiopathic portal hypertension and discuss the consequences of paroxetine therapy.Öğe An unusual presentation of primary amyloidosis(Saudi Med J, 2004) Dursun, M; Ayyildiz, O; Yilmaz, S; Bilici, AA 65-year-old male patient presented with right upper-quadrant abdominal pain. Ultrasonography revealed hypoechoic lesion in the perihepatic and intraparenchymal area. Computed tomography (CT) showed hypodense lesion in the same localization. A fine needle biopsy specimen of the periliepatic lesion was hemorrhagic. On abdominal CT, the liver showed enhancement, but the spleen did not enhance. The spleen could not be detected by scintigraphic imaging using Tc(99)m sulfur dioxide. A diagnosis of primary amyloidosis was made by renal biopsy. Melphalan 10mg/day for 4 days/month was started. The clinical and radiological follow up demonstrated a resorption of the hematoma. The patient is still alive at the eighth month of therapy.Öğe Upper gastrointestinal bleeding caused by small-cell lung cancer(Springer, 2006) Yilmaz, S; Dursun, M; Canoruç, F; Bayan, K; Büyükbayram, H[Abstract Not Available]
