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Öğe Analysis of inherited thrombophilic mutations and natural anticoagulant deficiency in patients with idiopathic portal hypertension(Springer, 2009) Bayan, Kadim; Tuzun, Yekta; Yilmaz, Serif; Canoruc, Naime; Dursun, MehmetIdiopathic portal hypertension (IPH) is characterized by non-cirrhotic presinusoidal intrahepatic portal hypertension. The etiopathogenesis of the disease is poorly understood. Obliteration with microthrombosis of the small portal vein branches may lead to lesions underlying portal hypertension. We aimed to put forward a comprehensive thrombophilic mutation profile in IPH and its probable contribution to pathogenesis. Eleven patients and 12 controls were included. We used the CVD-StripAssay which is based on the reverse-hybridization principle to identify a total of 12 thrombophilic gene mutations: Factor V R506Q, Factor V H1299R, prothrombin G20210A, Factor XIII V34L, beta-Fibrinogen -455 G-A, PAI-1 4G/5G, platelet GPIIIa L33P, MTHFR C677T, MTHFR A1298C, ACE I/D, Apo B R3500Q and Apo E2/E3/E4, respectively. We also evaluated some blood parameters and protein C, protein S, AT-III levels using commercially available assays. IPH patients and controls were similar in respect to gender distribution (P = 1.000). Mean age was 31.2 in patients and 29.1 in controls (P = 0.622). Pica history was present in 54.5% of the patients. Mean protein C and AT-III levels were lower in patients than that of controls (P = 0.002 and 0.001, respectively). Factor XIII V34L, PAI-1, GPIIIa L33P, MTHFR C677T and MTHFR A1298C frequencies of genetic polymorphisms were found to be significantly higher among patients than that of controls. Apolipoprotein E2/E3/E4 analysis showed an inverse relationship with IPH when E2 plus E4 compared with E3. A higher frequency of Beta-Fibrinogen -455G-A mutation was observed in patients, but this difference did not reach a statistical significance. Our data represent the most comprehensive study to date with respect to thrombophilic gene polymorphisms in IPH. The data support a possible pathogenetic role in IPH, at least by some of the prothrombotic mutations. In order to confirm or refuse this proposal, a larger cohort of patients is needed.Öğe Clarifying the Relationship Between ABO/Rhesus Blood Group Antigens and Upper Gastrointestinal Bleeding(Springer, 2009) Bayan, Kadim; Tuzun, Yekta; Yilmaz, Serif; Dursun, Mehmet; Canoruc, FikriBackground and Aim The relationship between blood group antigens and peptic ulcer disease has been widely evaluated in the past. Data concerning the same association with upper gastrointestinal bleeding are very limited. We aimed to evaluate this association and we thought it was worthwhile to try to determine whether these components take some part in this complication. Methods The study population consisted of 1,098 adults (364 patients and 734 volunteer blood donors as controls). Demographic features, comorbid illnesses, and use of aspirin/nonsteroidal anti-inflammatory drugs (NSAIDs) were recorded. Blood groups were examined by gel centrifugation method. We included only patients with bleeding from peptic ulcer disease and erosive gastropathy. Ulcers were classified by using Forrest's classification system in terms of rebleeding risk. Helicobacter pylori was examined by histology. Results The gender distribution was similar in both groups. The ABO blood group phenotype distribution in patients and controls (respectively) was as follows: 46.2% versus 34.9% for group O, 32.4% versus 39.5% for group A, 15.7% versus 18.4% for group B, and 5.8% versus 7.2% for group AB. Blood group O was found to have higher frequency in the patient group than in the control group (P = 0.004). Rh positivity was also higher in patients than in controls (P = 0.007). H. pylori positivity was similar between blood groups among patients. The rebleeding and mortality rates between blood groups were also similar. Conclusion ABO blood group O had an important role in patients with upper gastrointestinal bleeding. The impact of blood group on rebleeding and mortality may be a focus for further studies.Öğe A comprehensive analysis of 12 thrombophilic mutations and related parameters in patients with inflammatory bowel disease(Springer, 2006) Yilmaz, Serif; Bayan, Kadim; Tuezuen, Yekta; Batun, Sabri; Altintas, AbdullahBackground Possible association of inflammatory bowel disease (IBD) with the most common inherited prothrombotic conditions has been the focus of many investigations. Advance in modern molecular biology is expanding the thrombophilia evaluation steadily. We tried to put forward a comprehensive thrombophilic profile in IBD and to see the probable role of this profile in pathogenesis. Methods A total of 60 adults (33 patients and 27 healthy controls) were included. We used the CVD-StripAssay which is based on the reverse-hybridization principle to identify a total of 12 thrombophilic gene mutations: Factor V R506Q, Factor V H1299R, prothrombin G20210A, Factor XIII V34L, beta-Fibrinogen-455 G-A, PAI-1 4G/5G, platelet GPIIIa L33P, MTHFR C677T, MTHFR A1298C, ACE I/D, Apo B R3500Q and Apo E2/E3/E4, respectively. Besides, we evaluated many related blood parameters such as protein C, protein S, AT-III, IL-6, TNF-alpha, Apo-A1, Apo-B100, homocysteine (tHcy) etc. using commercially available assays. Results The frequencies of genetic polymorphisms were found to be statistically insignificant among patients and controls, except for three: Beta-Fibrinogen-455G-A, MTHFR A1298C and ACE-I/D. Two patients with a history of deep venous thrombosis had more than one polymorphism. Patients with MTHFR C677T and MTHFR A1298C gene mutations had a similar mean tHcy levels with controls. Patients with Apolipoprotein B R3500Q and Apolipoprotein E4 gene mutations had similar mean LDL-cholesterol levels. Mean total cholesterol and triglyceride levels were similar in patients and controls of Apo E2, E3, E4 alleles. Conclusion Predominantly, the presence of genetic mutations that predispose to hypercoagulable states does not appear to be in correlation with IBD. There was a statistical difference between the proportions of the mutated allele frequencies of Beta-Fibrinogen-455G-A, MTHFR A1298C and ACE-I/D in IBD.Öğe Does adding misoprostol to standard intravenous proton pump inhibitor protocol improve the outcome of aspirin/NSAID-induced upper gastrointestinal bleeding?(Springer, 2007) Yilmaz, Serif; Bayan, Kadim; Dursun, Mehmet; Canoruc, Fikri; Kilinc, Nihal; Tuzun, Yekta; Danis, RamazanAspirin and nonsteroidal anti-inflammatory drug (NSAID)-induced gastrointestinal bleeding is recognized as an important health problem. We performed a single-center randomized clinical trial to compare the effect of high-dose intravenous proton pump inhibitor (omeprazole) alone (group 1) with omeprazole in combination with a low-dose prostaglandin analog (misoprostol; group 2) on clinical outcomes in patients with aspirin/NSAID-induced upper gastrointestinal bleeding. Additionally, we evaluated the contribution of Helicobacter pylori eradication therapy on the late consequences. Patients were recruited to the study if they had upper gastrointestinal bleeding with history of taking aspirin or other NSAIDs within the week before the onset of bleeding. All were evaluated in terms of probable risk factors. After the standard treatment protocol, patients with histologically proven H pylori infection were prescribed a triple eradication therapy for 14 days. The primary end points were recurrent bleeding, surgery requirement, and death rates before discharge and at the end of follow-up period. This study lasted for 2 years. A total of 249 patients with upper gastrointestinal bleeding were admitted, and 49.7% of these patients were users of aspirin/NSAIDs. There were 67 patients in group 1 and 56 in group 2. The distributions for gender, age, comorbidity, H pylori infection, and high-risk ulcer rate were similar in both groups. Among aspirin/NSAID users, endoscopy revealed duodenal ulcer in 47 (38.2%), gastric ulcer in 10 (8.1%), and erosive gastropathy in 33 (26.8%). The overall rebleeding occurred in 12.2%, death in 2.4% of the patients. The in-hospital death (P=.414), rebleeding (P=.925), and surgery (P=.547) rates were similar in both treatment groups. After the follow-up period of 3 months, overall rebleeding occurred in 4.1%, and death in 4.8% of the patients. The overall mortality rate was highest in those > 65 years old, who were chronic low-dose aspirin users with comorbidity. One died of transfusion-related graft-versus-host disease. In this pilot study, we indicated that adding misoprostol (600 mu g/day) to standardized proton pump inhibitor treatment did not improve or change the rebleeding or mortality rates of patients with upper gastrointestinal bleeding related to aspirin/NSAID use. Other prospective studies on higher doses of misoprostol are needed to establish the coeffect. One should bear in mind that all blood products must be irradiated before transfused to the host.Öğe Epidemiological and clinical aspects of liver cirrhosis in adult patients living in southeastern anatolia: Leading role of HBV in 505 cases(H G E Update Medical Publishing S A, 2007) Bayan, Kadim; Yilmaz, Serif; Tuzun, Yekta; Yildirim, YasarBackground/Aims: Liver cirrhosis is the terminal condition of liver disorders resulting from various causes. Literature lacks data on epidemiological and clinical aspects of liver cirrhosis in Turkey. We aimed to evaluate the main features of liver cirrhosis in this study. Methodology: We included in the study a total of 505 patients referred to Dicle University Hospital in the last five years and evaluated retrospectively. Demographic features, etiology, clinical findings, disease severity, complications and mortality rates were all recorded. Results: Of the patients, 136 (27%) were female and 369 were (73%) male. Mean age was 50.4. The etiologic spectrum consisted of 368 HBV (72.9%), 41 HCV (8.1%), 12 alcohol (2.4%). Rate for cryptogenic cirrhosis (CC) was 11.1% with mean age of 45.4. HDV superinfection was present in 17.8%. Most of the patients were in Child-Pugh class B. Number of decompensated cirrhosis cases was 278 (55%). Hepatocellular cancer (HCC) was seen in 8.9% of patients and 88% had HBV with a mean age of 60. HCC was seen more commonly in HDV superinfected patients (p=0.035). In-patient mortality was observed in 13.2%. Conclusions: HBV is the leading etiological factor of liver cirrhosis in Southeastern Anatolia and strict measures must be taken against perinatal or horizontal transmission of contagious pathogens. Alcohol had a marginal role in cirrhosis in our region. Although HDV superinfection is decreasing with time, it may increase HCC risk. Patients with cryptogenic cirrhosis were younger and had lower Child-Pugh scores.Öğe The epidemiological aspects of fibromyalgia syndrome in adults living in turkey: A population based study(Taylor & Francis Ltd, 2008) Turhanoglu, Ayse Dicle; Yilmaz, Serif; Kaya, Sedat; Dursun, Mehmet; Kararmaz, Alper; Saka, GuenayObjective: The objectives of this study were to determine the prevalence of the fibromyalgia syndrome [FMS] in Diyarbakir, a city located in the southeastern region of Turkey, and to evaluate associated demographic variables. Methods: This study was conducted in the beginning of 2003. A total of 600 people, randomly selected by stratified cluster sampling, were interviewed in person using a questionnaire consisting of demographic features and history of chronic widespread pain. Individuals with chronic widespread pain were examined by a specialist in physical medicine and rehabilitation in order to confirm or exclude FMS based on the American College of Rheumatology classification criteria. The statistical analysis was performed by using a package program called Epi Info 2000. Results: Fifty-three people were diagnosed with FMS. Based on the study results, the prevalence of FNIS was 8.8 percent in our regional study group. The prevalence was higher in women [12.5 percent] than in men [5.1 percent; P = 0.002, OR = 3.038, 95% CI = 1.5-6.1], and subjects in urban areas [11.4 percent] had a higher FMS rate than subjects in rural areas [5.2 percent; P = 0.011, OR = 2.388, 95% CI = 1.2-4.6]. The FMS was most common in the 50- to 59-year-old age group. No difference was observed in terms of education, occupation, and marital status. Conclusion: To the best of our knowledge, this cross-sectional study is the first report on the prevalence of FMS in Diyarbakir. The FMS prevalence was 8.8 percent in our region. The FMS was found 2.45 times more common in women than in men and found 2.3 times higher in urban areas than in rural areas.Öğe Granular cell tumor of the esophagus and its endoscopic treatment(Turkish Soc Gastroenterology, 2007) Bayan, Kadim; Yilmaz, Serif; Tuezuen, Yekta; Can, Alper; Bueyuekbayram, Hueseyin[Abstract Not Available]Öğe A head to head comparison of oral vs intravenous omeprazole for patients with bleeding peptic ulcers with a clean base, flat spots and adherent clots(Baishideng Publishing Group Inc, 2006) Yilmaz, Serif; Bayan, Kadim; Tuzun, Yekta; Dursun, Mehmet; Canoruc, FikriAIM: To compare the effect of intravenous and oral omeprazole in patients with bleeding peptic ulcers without high-risk stigmata. METHODS: This randomized study included 211 patients [112 receiving iv omeprazole protocol (Group 1), 99 receiving po omeprazole 40 mg every 12 h (Group 2)] with a mean age of 52.7. In 144 patients the ulcers showed a clean base, and in 46 the ulcers showed flat spots and in 21 old adherent clots. The endpoints were re-bleeding, surgery, hospital stay, blood transfusion and death. After discharge, re-bleeding and death were reevaluated within 30 d. RESULTS: The study groups were similar with respect to baseline characteristics. Re-bleeding was recorded in 5 patients of Group 1 and in 4 patients of Group 2 (P = 0.879). Three patients in Group 1 and 2 in Group 2 underwent surgery (P = 0.773). The mean length of hospital stay was 4.6 +/- 1.6 d in Group 1 vs 4.5 +/- 2.6 d in Group 2 (P = 0.710); the mean amounts of blood transfusion were 1.9 +/- 1.1 units in Group 1 vs 2.1 +/- 1.7 units in Group 2 (P = 0.350). Four patients, two in each group died (P = 0.981). After discharge, a new bleeding occurred in 2 patients of Group 1 and in 1 patient of Group 2, and one patient from Group 1 died. CONCLUSION: We demonstrate that the effect of oral omeprazole is as effective as intravenous therapy in terms of re-bleeding, surgery, transfusion requirements, hospitalization and mortality in patients with bleeding ulcers with low risk stigmata. These patients can be treated effectively with oral omeprazole. (c) 2006 The WJG Press. All rights reserved.Öğe Long-term conventional interferon alpha in combination with lamivudine for chronic hepatitis B: Data from Turkey(H G E Update Medical Publishing S A, 2007) Yilmaz, Serif; Bayan, Kadim; Dursun, Mehmet; Canoruc, Fikri; Pasa, Semir; Saka, GuenayBackground/Aims: Standard interferon or lamivudine monotherapy has been shown to induce a low response rate in patients with chronic hepatitis B infection. Genotype D represents almost the whole of chronic HBV infection of Turkish population. The aim of this study was to evaluate the efficacy and safety of the long-term interferon-alpha plus lamivudine on these patients, and thereafter the co-effect of maintenance therapy by lamivudine. Methodology: This prospective study was carried out between the late 1999 and 2005. A total of 37 (24 HBeAg-positive and 13 HBeAg-negative) patients were enrolled in the study. These patients received standard interferon-alpha (9/10 MU) three times sc. a week plus lamivudine 100mg po. daily, for 52 weeks. After the interferon discontinuation, lamivudine monotherapy was assigned to be given until 4-6 months after the occurrence of HBeAg seroconversion in the HBeAg-positive patients and at least three years in HBeAg-negative patients. Response-1 was defined as the response at the end of combination therapy at the 52nd week, and Response-2 as response at the end of the follow-up period under lamivudine monotherapy. An intention-to-treat analysis was performed. Results: Patients' follow-up ranged between 7-67 months, with a mean duration of 29.64 +/- 14.01 months. Twenty-six patients (70.3%) had a Response-1, both virological and biochemical. A biochemical Response-2 was achieved in 24 patients (64.9%), while virological Response-2 in 17 (45.9%). Response-1 and Response-2 were similar between HBeAg-positive and HBeAg-negative patients (p=0.262 and p=0.734, respectively). HBeAg seroconversion was achieved only in 8 (33.3%) of HBeAg-positive patients. Clinical resistance to lamivudine developed only in 9 (24.3%) of the patients. Decompensation or hepatocellular carcinoma did not observe in any case. Conclusions: This study showed the efficacy of the 'long-term' anti-viral maintenance along with the combination therapy in genotype D predominant chronic hepatitis B patients. A low clinical resistance rate to lamivudine was achieved.Öğe MICROCHIMERISM, A DILEMMA IN CURRENT MEDICINE(Nobel Ilac, 2006) Ozmen, Sehmus; Danis, Ramazan; Altintas, Abdullah; Bayan, Kadim; Yilmaz, SerifMicrochimerism refers to presence of a small number of cells or DNA of one individual harbored in another individual. Many studies indicate that cell trafficking occurs between the fetus and mother during pregnancy and between others after organ transplantation or blood transfusions. These cells or DNA can persist in recipient?s blood or tissues for decades, creating a state of physiologic microchimerism. In several recent studies, microchimerism has been shown to have potential roles in pathogenesis of different diseases. However, due to the fact that microchimerism has also been found in healthy individuals and in organs affected by non-autoimmune conditions, an alternative hypothesis has been suggested in which microchimeric cells are associated with the healing process of a tissue injury as opposed to causing disease. As a conclusion of this review of recent studies, we can say that microchimerism studies yielded more questions than answers.Öğe The prevalence of primary and secondary Helicobacter pylori resistance to clarithromycin and probable contributing cofactors(H G E Update Medical Publishing S A, 2008) Tuezuen, Yekta; Bayan, Kadim; Yilmaz, Serif; Dursun, Mehmet; Ozekinci, TuncerBackground/Aims: Antibiotic resistance of Helicobacter pytori is the most important reason for failure in its eradication. We aimed to determine the prevalence of primary and secondary H. pylori resistance to clarithromycin in isolated H. pylori from dyspeptic patients in southeastern Anatolia and to evaluate the cofactors affecting this clinical problem. Methodology: The study involved adult patients who had already been diagnosed with symptomatic H. pylori infection based on rapid urease test, gastric histopathological examination and culture. H. pylori strains were isolated from antral biopsies taken during upper endoscopy in 142 dyspeptic patients with no previous therapy against the microorganism. MICs of clarithromycin were determined by E-test. Patients were treated for 14 days with standard triple-agent protocol. H. pylori eradication rate was assessed after 8 weeks. Each patient was re-interviewed to determine secondary resistance. Primary clarithromycin resistance was defined as pre-treatment resistance, while secondary as after treatment resistance. Strains were considered resistant to clarithromycin if the MIC 1 mu g/mL. Results: In total 213-105 women and 108 men-patients was enrolled to the study. The mean age was 35.5 +/- 14.1 years. In 142 (66.7%) patients out of the total patients enrolled in the study, H. pylori was detected. H. pylori could be cultured from only 61 (43%) of them. In 16.4% of the cases, primary clarithromycin resistance was noted. After 8 weeks, seventy-seven (54.2%) of the 142 patients were reevaluated. Helicobacter pylori eradication could be achieved in 68.8% of them. The proportion of H. pylori eradication in clarithromycin-sensitive patients was 75.8% and the respective proportion was 10% for resistant cases. In the group where H. pylori was still positive the secondary resistance percentage was found to be 27.2%. Conclusions: The prevalence of primary clarithromycin resistance is relatively high in our geographical area. Secondary resistance rate was 27.2%. None of the criteria of age, gender, presence of endoscopic lesions, detected H. pylori concentration and gastritis activity showed any effect on the primary resistance.Öğe Pyloric giant Brunner's gland hamartoma as a cause of both duodenojejunal intussusception and obscure gastrointestinal bleeding(Aves, 2009) Bayan, Kadim; Tuezuen, Yekta; Yilmaz, Serif; Yilmaz, Guelsen; Bilici, AslanObscure gastrointestinal bleeding is an important dilemma. Brunner's gland hamartoma is an extremely rare tumor generally localized in the duodenal bulb. We present a 34-year-old woman who had suffered from several episodes of melena for the past three years. Endoscopic examinations were normal. Computed tomography showed a large target lesion over the right abdomen and an image representing intestinal malrotation, which was supported by enteroclysis. At exploratory laparotomy, ligamenturn of Treitz was located in the mid-to-right side of the columna vertebralis, and the duodenal bulb was found to be invaginated into the proximal jejunum. After longitudinal aduodenotomy, a pedunculated ring-shaped large polyp originating from the pyloric ring was seen and excised. Histology was consistent with Brunner's gland hamartoma. This case with obscure bleeding was original with respect to its rarity and being a huge, ring-shaped tumor with pyloric localization. Moreover, the patient had a rare clinical presentation of duodenojejunal intussusception with accompanying intestinal malrotation.Öğe The Role of CA-125 in Differential Diagnosis of Ascites(Ortadogu Ad Pres & Publ Co, 2010) Tuzun, Yekta; Bayan, Kadim; Altintas, Abdullah; Cil, Timucin; Erdemoglu, Mahmut; Yilmaz, Serif; Dursun, MehmetObjective: CA-125 has been found to be high in almost all the patients with ascites. In this study, we tried to determine cut-off values of CA-125 in serum and ascitic fluid levels in order to discriminate non-ovarian malignancies, ovarian carcinomas and benign diseases. Material and Methods: A total of 119 patients were included in the study. The patients were divided into three groups: non-ovarian malignancies, ovarian carcinoma and benign diseases. Serum and ascitic fluid CA-125 levels were measured by electrochemiluminescence immunoassay, 'ECLIA' method. In determining the discriminitive ability of CA-125 levels between the groups, receiver operating characteristic (ROC) analysis was performed. Results: A total of 119 patients were included in the study: 55 males and 64 females. Of patients, 53 had non-ovarian malignancy, 19 had ovarian carcinoma and 47 had benign diseases. Serum and ascitic fluid CA-125 levels were high in all of the three groups. When cut-off value of ascitic CA-125 was taken as 174 U/mL, the sensitivity and specificity were found to be 69.2% and 25.5%, respectively; however, when the value was accepted as 796.5 U/mL, these rates were observed as 30.8% and 80.9% respectively. In the discrimination between ovarian carcinoma and benign diseases, when the cut-off value of ascitic CA-125 was considered as 411 U/mL, the sensitivity and specificity were obtained as 94.7% and 63.8% respectively. When the value was taken as 971.9 U/mL, the sensitivity and specificity rates were 57.9% and 78.7% respectively. Conclusion: In discriminating between malign and benign ascites, ascitic CA-125 levels rather than serum values are of significance, and it can be suggested that malignancy should be persistently searched when the value is over 1000 U/mL.Öğe Safety of peginterferon alfa-2a (40KD) treatment in patients with chronic hepatitis B infection: An observational, multicenter, open label, non-interventional study in Turkish patients(Aves, 2012) Tozun, Nurdan; Sezgin, Orhan; Gulsen, Murat; Kacar, Sabite; Yenice, Necati; Yilmaz, Serif; Hulagu, SaadettinBackground/aims: Pegylated alfa interferon is the only immunomodulatory drug licensed for hepatitis B. We evaluated the safety and tolerability of peginterferon alfa-2a (40KD) in patients with chronic hepatitis B. Materials and Methods: A total of 113 chronic hepatitis B patients under peginterferon alfa-2a (40KD; 180 mu g/week) treatment were included in this multicenter, open label, non-interventional study, and 66 patients completed the follow-up period. Vital signs, physical examination and laboratory findings, concomitant medications, and adverse events were recorded. A Quality of Life questionnaire (Short Form-36) was performed twice, at the beginning and at the end of the study. Results: There was no significant difference between initial and last visits in terms of physical examination findings and Short Form-36 scores. A total of 27 adverse events were reported in 15 patients (22.7%), with most of them being mild in intensity (70.4%). The rates of the adverse events were similar in the monotherapy and combination therapy groups (peginterferon alfa-2a + lamivudine, peginterferon alfa-2a + adefovir or peginterferon alfa-2a + entecavir therapy groups), at 23.7% and 14.3%, respectively. The dosage of peginterferon had to be reduced in 3 patients (4.5%) due to thrombocytopenia. Overall patient compliance to treatment was detected as 85.9%. Conclusions: Based on the lack of serious adverse events and absence of impairment in Quality of Life, peginterferon alfa-2a (40KD, 180 mu g/week, subcutaneously) treatment for 48 weeks led to a high level of patient compliance and was associated with a high degree of safety and tolerability for the treatment of adult patients with chronic hepatitis B in real-life practice.Öğe Spontaneous bacterial peritonitis: pathogenesis, diagnosis, and management(Univ Catholique Louvain-Ucl, 2006) Ozmen, Sehmus; Dursun, Mehmet; Yilmaz, SerifSpontaneous bacterial peritonitis (SBP) is a bacterial infection of ascitic fluid which arises in the absence of any other intraabdominal infection source. SBP may develop in all cirrhotic patients with ascites. Gram-negative aerobic bacteria and non-enterococcal Streptococcus spp. are the most common organisms isolated from ascites. Diagnosis necessarily relies on paracentesis and requires a high index of suspicion. The incidence of mortality of the first episode varies between 10% and 46%. Early antibiotic treatment is warranted. Renal impairment develops in approximately one-third of patients with spontaneous bacterial peritonitis and is postulated to arise as a result of a further reduction in effective arterial blood volume. Cefotaxime has been the most extensively studied antibiotic for this infection. It is considered to be one of the first choice antibiotics because of low toxicity and excellent efficacy. Although parenteral antibiotics are generally used, studies evaluated the efficacy of several oral antibiotics in patients with relatively good clinical conditions. The reported probability of spontaneous bacterial peritonitis recurrence one year after the first attack averaged 40 to 69%. Selective intestinal decontamination with 400 mg norfloxacin per day decreased the overall probability of recurrence from 68% to 20% in 1 year of follow-up.Öğe An unusual case of fever of unknown origin(Akad Doktorlar Yayinevi, 2008) Tuzun, Yekta; Bayan, Kadim; Altintas, Abdullah; Cil, Timucin; Yilmaz, Serif; Dursun, MehmetKikuchi-Fujimoto disease (KFD), also called histiositic necrotizing lenfadenitis is a self limited disease, which commonly affects young Asian women. Etiology of KFD is unknown. The disease presents with lymphadenopathy, predominantly in the cervical region, fever, leucopenia and high erythrocyte sedimentation rate. It has occasionally been misdiagnosed as malignant lymphoma. The diagnosis of disease is confirmed by histopathological examination of affected lymph node. Herein, we reported a patient who presented with fever of unknown origin and diagnosed as KFD. We suggest that KFD needs to be considered as one of the differential diagnoses in patients presenting with fever of unknown origin and lymphadenopathy.
