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Öğe 4 Yıllık endoskopik retrograd kolanjiyopankreatografi vakalarımızın retrospektif değerlendirilmesi(2016) Kıraç, Cem Onur; Asıl, Mehmet; Demir, AliAmaç: Endoskopik retrograd kolanjiyopankreatografi (ERCP), pankreatikobiliyer hastalıkların tanı ve tedavisinde altın standart yöntemdir. Biz bu çalışmada son 4 yıllık ERCP deneyimimizi gözden geçirmeyi amaçladık.Gereç ve yöntem: Necmettin Erbakan Üniversitesi Tıp Fakültesi Gastroenteroloji Kliniğinde son 4 yılda ERCP yapılan hastalar çalışma kapsamına alındı. Veriler hastane arşiv sisteminden retrospektif olarak elde edildi.Bulgular: 1155 hastaya toplam 1471 ERCP işlemi yapılmıştı. Hastaların 664'ü kadın ve 491'i erkek ve ortalama yaş 60,2 yaş idi (10-97 years). En sık ERCP endikasyonu hiperbilirubinemi ve serum ALP ve GGT düzeylerinde artış idi (703 patients, %47,8). 1250 hastada (%85) standart sfinkterotomla kanülasyon başarılı olurken 217 (%14,8) hastaya iğne uçlu sfinkterotomla önkesi yapılmış ve bu hastaların 104'ü (%7) önkesi sonrası kanüle edilebilmişlerdi. Total kanülasyon başarısı %92,0 idi. 152 hastada ERCP ile ilişkili komplikasyonlar saptandı. En sık komplikasyon 113 hastada (%7,7) saptanan post-ERCP pankreatit idi. İğne uçlu sfinkterotomla önkesi yapılan hastalarda post-ERCP pankreatit gelişme sıklığı belirgin olarak yüksekti (%17,1). 1 hasta şiddetli post-ERCP pankreatit ve buna bağlı multiorgan yetmezliği nedeniyle öldü. ERCP ile ilişkili kanama 5 (%0,3) ve perforasyon 3 (%0,2) hastada saptandı.Sonuç: ERCP çeşitli pankreatikobiliyer hastalıkların tedavisinde hala altın standart yerini korumaktadır. İnvaziv olması nedeniyle ERCP'nin tanı için kullanılmaması ve terapötik amaçla kullanılmasının uygun olacağı kanaatindeyiz.Öğe Bariatric surgery may exacerbate hyperbilirubinemia in patients with Gilbert's Syndrome(2017) Asıl, Mehmet; Bıyık, Murat; Ataseven, Hüseyin; Demir, Ali; Dertli, Ramazan; Polat, HakkıÖğe Duodenal varices diagnosed by endoscopic ultrasound: A case report(2017) Asıl, Mehmet; Dertli, Ramazan; Bıyık, Murat; Ataseven, Hüseyin; Polat, Hakkı; Demir, AliPortal hypertension and associated complications cause significant morbidity and mortality in cirrhotic patients. Variceal development is the most important portal hypertension related complication. Varices most commonly occur around the gastroesophageal junction, but ectopic varices may develop in many gastrointestinal and extra-gastrointestinal localizations. Duodenum is one of the most common localizations for ectopic varices. Diagnosis of duodenal varices is usually made by upper gastrointestinal endoscopy, but endoscopic appearance is not diagnostic and usually further investigations are required in order to make accurate diagnosis. Endoscopic ultrasound is the gold standard method for the examination of gastrointestinal submucosal lesions therefore it is alsouseful in the work up of suspected duodenal varices. Here we present a patient with cryptogenic liver cirrhosis followed in our clinic, whom duodenal lesions suspected of duodenal varices were noticed during upper gastrointestinal endoscopic examination and endoscopic ultrasound was used to confirm the presence of duodenal varices.Öğe Dynamic thiol-disulfide homeostasis is disturbed in hepatitis B virus-related chronic hepatitis and liver cirrhosis(2018) Dertli, Ramazan; Keskin, Muharrem; Bıyık, Murat; Ataseven, Hüseyin; Polat, Hakkı; Demir, Ali; Oltulu, Pembe; Asıl, MehmetBackground/aim: Thiol-disulfide homeostasis is an important antioxidant defense mechanism. This study was conducted to investigatedynamic thiol-disulfide homeostasis in patients with hepatitis B virus-related chronic hepatitis and liver cirrhosis.Materials and methods: Seventy-one treatment-naive patients with chronic hepatitis B (CHB), 50 patients with hepatitis B virusassociated liver cirrhosis, and 45 healthy controls were included in the study. Serum total and native thiol concentrations and serumdisulfide concentrations were measured using an automated method.Results: Mean serum total thiol concentrations in the control, CHB, and cirrhosis groups were 481.64 37.87 µmol/L, 438.50 71.35µmol/L, and 358.07 80.47 µmol/L, respectively (P 0.001), and mean serum native thiol concentrations in the control, CHB, andcirrhosis groups were 452.92 36.43 µmol/L, 400.16 65.92 µmol/L, and 328.15 74.91 µmol/L, respectively (P 0.001). Mean serumdisulfide concentrations in the control, CHB, and cirrhosis groups were 14.38 3.38 µmol/L, 19.19 6.16 µmol/L, and 14.98 5.53µmol/L, respectively (P 0.001). There was a progressive decrease in both mean serum native and total thiol concentrations parallel tothe liver fibrosis stage.Conclusion: : Thiol-disulfide homeostasis is disturbed in patients with hepatitis B virus-related chronic hepatitis and liver cirrhosis.Öğe Effects of diclofenac sodium and octreotide on treatment of caerulein-induced acute pancreatitis in mice(E-Century Publishing Corp, 2015) Cakir, Ozlem Ozer; Esen, Hasan; Toker, Aysun; Ataseven, Huseyin; Demir, Ali; Polat, HakkiBackground: Research continues to develop novel therapeutic modalities that particularly focus on the pathogenesis of acute pancreatitis. This study aimed to assess the effects of diclofenac sodium and octreotide, alone or in combination, on pancreatic enzymes, pancreatic myeloperoxidase activity, histopathology and apoptosis of pancreas cells, using a model of experimentally induced acute pancreatitis. Objectives: We aimed to demonstrate effects of diclofenac sodium, octreotide and their combined use on pancreatic enzymes, activity of pancreatic myeloperoxidase (MPO) activity, histopathology and apoptosis of pancreas on treatment of caerulin-induced experimental acute pancreatitis. Materials and methods: Caerulin-induced acute pancreatitis model was created using a total of 58 male BALB-C mice of 25 gr in seven groups. Serum amylase, lipase levels and pancreatic myeloperoxidase activity were examined as well as apoptotic values in pancreatic acinar cells through TUNNEL method. Histopathology of pancreas was evaluated for presence of edema, hemorrhage, parenchymal necrosis, fat necrosis, leukocyte infiltration, and fibrosis. Results: In the diclofenac sodium group, apoptotic values in the pancreatic acinar cells were found to be statistically lower than in the acute pancreatitis group in terms of parenchymal necrosis and hemorrhage scores (P = 0.007, P = 0.002, and P = 0.052, respectively). No statistically significant differences were found in serum level of amylase, lipase, pancreatic myeloperoxidase activity and the other histopathological scores (P > 0.05). Conclusion: Diclofenac sodium, a cost-effective agent with a favorable side-effect profile, may represent a novel therapeutic agent for the treatment of acute pancreatitis. Findings of this study suggest a better efficacy for diclofenac sodium monotherapy as compared to octreotide alone or octreotide/diclofenac combination.Öğe Evaluation of clinical pharmacist interventions on drug-related problems in the gastroenterology ward(Marmara Univ, 2022) Ceylan, Cengizhan; Sancar, Mesut; Beceren, Ayfer; Demir, Ali; Kus, Coskun; Omurtag, Gulden ZehraIntegrating clinical pharmacists in a multidisciplinary patient care team improves the treatment process by identifying and resolving drug-related problems (DRPs). The aim of the study was to determine the effect of clinical pharmacist intervention for DRPs in the gastroenterology service. The first period of the study was conducted between 15.06.2018 and 15.02.2019. Eighty patients admitted to the gastroenterology ward, who used at least one medication, were included in 'the study group'. The clinical pharmacist participated in ward rounds and made interventions to solve identified DRPs. In the second period of the study, the control group consisted of 80 patients admitted to the same ward between 01.03.2019 and 06.06.2019. DRPs were determined only from the data obtained from the hospital system in the control group. DRPs were classified according to the European Pharmaceutical Care Network (PCNE V9.1). A total of 136 and 46 with an average of 1.7 and 0.57 DRPs per patient (p <= 0.01) were identified in the study and control groups, respectively. Of the DRPs in the study group, 59 were related to treatment effectiveness, while 61 were related to treatment safety. Likewise, 21 DRPs were related to treatment effectiveness in the control group, while 12 were related to treatment (p <= 0.01). 65% of the interventions were made at the physician level and 49% at the drug level. 97% (n=133) of the total interventions were accepted. The number of DRPs was significantly reduced in the control group within the time frame after the clinical pharmacist intervention period. In conclusion, clinical pharmacists' importance in detecting and preventing DRPs in the gastroenterology ward has been demonstrated.Öğe Evaluation of the Efficacy of Tenofovir in Chronic Hepatitis B Patients Unresponsive to Lamivudine(2015) Çifçi, Sami; Kayhan, Yusuf; Güngör, Gökhan; Bıyık, Murat; Asıl, Mehmet; Ataseven, Hüseyin; Demir, AliAmaç: Kronik hepatit B virüs (HBV) enfeksiyonu global bir sağlık problemi olup artmış morbidite ve mortalite ile ilişkilidir. Tedavideki ana hedef HBV replikasyonunu sürekli bir şekilde baskılayabilmektir. Ancak antiviral direnç kalıcı supresyon önünde ciddi bir engel teşkil etmektedir. Ülkemizde lamivude yanıtsız hastalarda tenofovire olan yanıtının değerlendirilmesi ile ilgili yeterli verilerin olmaması nedeniyle, bu çalışmanın yapılması planlanmıştır.Gereç ve Yöntemler: On sekiz yaşından büyük, en az 6 ay lamuvudin kullanmış ve direnç tespit edildikten sonra tenofovir başlanmış 48 hasta çalışmaya alındı. Hastaların tenofovir öncesi ve sonrası HBV DNA düzeyleri, hepatit B e antijen (HBeAg) serokonversiyonu ve hepatit B yüzey antijeni (HBsAg) kaybı oranları retrospektif olarak incelendi.Bulgular: Lamivudin direnci sonrası tenofovir alan hastalarda viral supresyon (HBV DNA 400 kopya/ml) tedavinin 6. ayında %89, 12. ayında %94 ve ortalama 21,4 aylık tedavi sonrası ise %96 oranında saptandı. Alanin aminotransferaz normalizasyonunun tedavinin birinci yılında %60 ve 21,4 aylık izlem süresinin sonunda ise %90 oranında sağlandığı görüldü. Tedavinin birinci yılında HBeAg kaybı %42 hastada tespit edildi. HBsAg kaybı izlem periyodu boyunca hiçbir hastada saptanmadı.Sonuç: Lamivudine yanıtsız kronik hepatit B hastalarında tenofovir etkili ve iyi tolere edilebilen bir tedavi seçeneğidir.Öğe İatrojenik İntrabdominal Kanama Sonrası Transfüzyon ile İlişkili Akut Akciğer Hasarı: Olgu Sunumu(2017) Asıl, Mehmet; Dertli, Ramazan; Bıyık, Murat; Ataseven, Hüseyin; Polat, Hakkı; Demir, AliBirçok hastanın çeşitli nedenlerle kan transfüzyonuna ihtiyacı olmaktadır. Transfüzyonla ilişkili akut akciğer hasarı (TRALI) hayati risk taşıyabilen önemli bir komplikasyon olup transfüzyonla ilişkili ölümlerin en sık nedenidir. TRALI bir tür akut non-kardiyojenik akciğer ödemi tablosudur. TRALI tanısı Ulusal Kalp-Akciğer ve Kan Enstitüsü Çalışma Gurubu (NHLBI) ya da Kanada Konsensus Toplantısı Kriterleri'ne göre konur. Tanı için akut hipoksi gelişimini gösteren parsiyel arteryel oksijen basıncının, solunan havanın fraksiyonel oksijen konsantrasyonuna oranının 300 mmHg'nın altında olması ya da oda havası solurken oksijen satürasyonunun %90 olması parametreleri ile akciğer grafisinde bilateral infiltrasyon varlığı ve volüm yüklenmesi bulgularının olmaması gereklidir. Burada, tanısal parasentez sonrası iyatrojenik intra-abdominal kanama gelişen ve taze donmuş plazma transfüzyonuna bağlı TRALI ortaya çıkan bir olgu sunulmuştur.Öğe The Importance of Liver-Fatty Acid Binding Protein in Diagnosis of Liver Damage in Patients with Acute Hepatitis(Premchand Shantidevi Research Foundation, 2017) Cakir, Ozlem Ozer; Toker, Aysun; Ataseven, Huseyin; Demir, Ali; Polat, HakkiIntroduction: Acute hepatitis is acute inflammation of liver elicited by a large number of causes. It sometimes spontaneously recovers, sometimes may progress to chronic hepatitis. LiverFatty Acid Binding Protein (L-FABP) is a small protein that is abundant in hepatocytes, and which binds most of the longchain fatty acids present in the cytosol. Aim: The present study aimed to investigate the levels of serum and urine L-FABP in acute hepatitis and diagnostic value of serum and urine L-FABP levels in patients with acute hepatitis. Materials and Methods: The present study included a total of 85 patients. Total number of patients with acute hepatitis were 17 (five of acute hepatitis B, one of acute hepatitis A, two of acute hepatitis C, five of autoimmune hepatitis and four of toxic hepatitis), 19 of hepatic encephalopathy, 29 of liver cirrhosis, and 20 controls were included. Serum and urinary L-FABP levels were analyzed by the Enzyme-Linked Immunosorbent Assay (ELISA). Results: Serum L-FABP levels were 9110 +/- 3352.5, 9410 +/- 1355, 9715 +/- 2462 and 3672 +/- 982.5 ng/l in patients with acute hepatitis, hepatic encephalopathy and cirrhosis and control subjects, respectively. There were statistically significant positive correlations between serum levels of L-FABP and Aspartate Aminotransferases (AST), Alanine Aminotransferases (ALT), Creatinine (Cre) and Gamma Glutamyl Transferases (GGT) (p<0.001, p<0.001, p<0.001 and p<0.001, respectively). While the cut-off value of serum L-FABP for all of the patients was 5183 ng/ l {p<0.001 and Area Under Curve (AUC)0.985}, the sensitivity and specificity were 95.4% and 100%, respectively. Positive and negative predictive values for serum L- FABP were 100% and 87%, respectively. Conclusion: Serum and urine L-FABP may be a new diagnostic marker for liver damage in patients with acute hepatitis. However, our study showed that except of aminotransferases, L-FABP should be used for diagnosis of liver damage in patients with acute hepatitis, chronic hepatitis and also cirrhosis.Öğe Influence of aluminum salts on COVID-19 infected patients(Tubitak Scientific & Technological Research Council Turkey, 2020) Demir, Ali; Erayman, Ibrahim; Dogan, Oguz; Kekilli, MuratBackground/aim: Based on the antiviral and antibacterial properties of aluminum salts, we aimed to find out the influence of aluminum salts on COVID-19 infected patients. Materials and methods: We performed an observational retrospective cohort study which includes the patients diagnosed as COVID-19 and received aluminum salts in addition to actual treatments during hospitalization as the treatment group (Alum Group). Patients who received standard COVID-19 treatment protocols in the Infectious Diseases Clinics were included as the Control Group. Clinical findings, laboratory parameters, length of stay, survival, radiological follow-up, intensive care and mechanical ventilation needs, the presence of comorbidity, polymerase chain reaction (PCR) tests, symptoms, symptom recovery times, hospital stay times, treatment protocols, and clinical presence of pneumonia were examined in all patients. Advanced chemical composition analyzes of existing aluminum salts were also performed. Results: A total of 109 patients, 54 in the alum group and 55 in the control group, were included in the study. None of the patients in the aluminum group developed side effects due to the intake of aluminum salt. Survival status was significantly different between the two groups as there were 5 loss in the Control Group and none in the Alum Group (P = 0.023). The symptom recovery time was significantly shorter in the Alum Group; 2 (1-3) vs. 1 (1-2) days, P= 0.003. According to the paired samples analyses of the comparison between hospitalization and discharge, CRP levels significantly drops in the Alum Group (from 54.09 to 27, P = 0.001) but not in the Control Group. The drop was significantly same for the lactate dehydrogenase (LDH) and procalcitonin levels with P = 0.001. Conclusion: It has been observed that aluminum salts have beneficial effects in COVID-19 infected cases. Considering the low systemic toxicity of intermittent oral intake of aluminum salts as food supplements and the fact that pandemic control is still not achieved, the use of aluminum salts is promising.Öğe Is there any potential or additive effect of anemia on hepatorenal syndrome?(2016) Keskin, Muharrem; Bıyık, Murat; Ataseven, Hüseyin; Demir, Ali; Güngör, Gökhan; Akyıldız, Murat; Solak, Yalçın; Gaipov, Abduzhappar; Çifçi, Sami; Polat, HakkıBackground/Aims: Hepatorenal syndrome (HRS) is a severe complication of advanced cirrhosis and is characterized by renal dysfunction and poor survival rates. Although anemia is a non-rare condition in advanced liver cirrhosis, there is no publication regarding the potential or additive effects of anemia on HRS and renal dysfunction in patients with cirrhosis. We investigated whether severe anemia is a precipitant factor for HRS.Materials and Methods: In this prospective study, consecutive patients with cirrhosis with and without renal dysfunction were enrolled. A total of 29 patients with cirrhosis with HRS meeting the HRS diagnostic criteria (9 patients with type 1 HRS and 20 with type 2 HRS) and 37 patients with cirrhosis without HRS were included. The demographic features, laboratory data (particularly anemic parameters), and clinical scores of patients with and without HRS were evaluated.Results: Grades of ascites, Child-Turcotte-Pugh (CTP) scores, and Model of End Stage Liver Disease (MELD) scores were significantly higher in contrast to hemoglobin levels; hematocrit concentrations were significantly lower in patients with type 1 and 2 HRS than in those with non-HRS stable cirrhosis. There was a negative correlation between the hemoglobin-hematocrit and serum creatinine levels. In the logistic regression analysis, the hemoglobin levels and CTP and MELD scores were statistically significant for an onset of HRS.Conclusion: Anemia may contribute to HRS and deteriorated renal function in patients with HRS because anemic hypoxia can lead to microcirculatory renal ischemia in the kidneys and anemia can also activate sympathetic activity and hyperdynamic circulation in the pathogenesis of HRS.Öğe KDIGO (Kidney Disease: Improving Global Outcomes) Criteria As a Predictor of Hospital Mortality in Cirrhotic Patients(2016) Bıyık, Murat; Ataseven, Hüseyin; Bıyık, Zeynep; Asil, Mehmet; Çifçi, Sami; Sayın, Serhat; Demir, Ali; Tombul, Halil ZekiBackground/Aims: Acute kidney injury (AKI) is frequent in cirrhotic patients and is associated with a poor prognosis. Recently, the Kidney Disease: Improving Global Outcomes (KDIGO) organization recommended new criteria for the diagnosis and staging for AKI. The aim of this study was to evaluate the presence of AKI according to KDIGO criteria in cirrhotic patients admitted to the hospital and to determine its association with hospital mortality.Materials and Methods: This retrospective study included 277 cirrhotic patients admitted to the intensive care unit and gastroenterology service of a tertiary referral hospital from January 2008 to January 2012. AKI was diagnosed and classified according to the KDIGO criteria.Results: The overall incidence of AKI in cirrhotic patients was 39%, and the overall hospital mortality was 15.5%. Patients without AKI had a hospital mortality rate of 2.4%, whereas the mortality rate for patients with AKI was 36.1%. The peak AKI stage detected during hospitalization was stage 1 for 58 patients (53.7%), stage 2 for 20 patients (18.5%), and stage 3 for 30 patients (27.7%). Mortality was found to be associated with the presence, stage, and progression of AKI. Multivariate analysis showed that AKI was an independent factor significantly associated with mortality (odds ratio: 9.1; 95% confidence interval: 2.89-29.1; p>0.001).Conclusion: KDIGO criteria can be used to evaluate AKI in cirrhotic patients. The prevalence of AKI in patients with cirrhosis is high, and AKI is associated with mortality. If early preventive measures are taken, it may be possible to prevent AKI progression and thus mortalityÖğe Konya il merkezinde gastroözofageal reflü hastalığı prevalansı(2018) Özer Çakır, Özlem; Çizmecioğlu, Ahmet; Bıyık, Murat; Çifçi, Sami; Ataseven, Hüseyin; Polat, Hakkı; Demir, AliGiriş ve Amaç: Gastroözofageal reflü hastalığı üst gastrointestinal kanalınsık rastlanılan bir hastalığıdır. Anatomik lokalizasyonu nedeniyleözofagusa komşuluğu olan organların hastalıklarını taklit edebildiği gibi;asıl hastalığın şikayetini maskeleyebilmekte hatta oluşan komplikasyonlarıda başka organların fonksiyonlarını bozabilmektedir. Dünyada batıtipi yaşantısı olan toplumlarda daha sık görülmektedir. Türkiye’de hastalıkepidemiyolojisi ile sınırlı veri vardır. Gereç ve Yöntem: Yaşadığımızçevrenin prevalansını belirleyebilmek amaçlı yapılan çalışmada Konya İliMerkez İlçelerinde önceden belirlenmiş rastgele adreslerdeki 2000 kişiile anket görüşmesi yapılmıştır. Bulgular: 1188 kişi ile anket tamamlanabilmiş,(%59 geri dönüş oranı), katılımcıların 581’i kadın (%48.9),607’si erkek (%51.1), yaş ortalaması 41.3412.8 olarak hesaplanmıştır.Aylık semptomlar göz önüne alındığında aylık %10,9 prevalans bulunmuştur.Cinsiyet, medeni hal, eğitim düzeyi, meslek ve gelir durumureflü ile ilişkili bulunmazken yaş ve vücut kitle indeksi ile korelasyonsaptanmıştır (p0.05). Sonuç: Bulunan sonuç itibariyle Konya İli merkezilçelerinde her üç kişiden birinin kilolu ya da obez olduğu saptanmış,reflü prevalansının batı ülkelerine yakın olduğu görülmüştür.Öğe Kronik Hepatit C’de Üçlü Tedavi: Bir Üniversite Hastanesi Gastroenteroloji Kliniğinin Deneyimi(2016) Polat, Hakkı; Demir, Ali; Ataseven, Hüseyin; Bıyık, Murat; Dertli, Ramazan; Asıl, MehmetAmaç: Pegile interferonribavirin kombinasyonu uzun yıllar kronik hepatit C tedavisinde standart tedavi olmuştur. Son yıllarda proteaz inhibitörleri bu kombinasyona ilave edilmiş ve daha yüksek kalıcı virolojik yanıt oranları elde edilebilmiştir. Biz bu çalışmada kliniğimizde takip edilen ve PEG-İFNribavirinproteaz inhibitörü içeren üçlü tedavi alan hastalarımızın verilerini retrospektif olarak değerlendirmeyi amaçladık.Gereç ve Yöntem: Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Gastroenteroloji Kliniğine Aralık 2012-Aralık 2015 tarihleri arasında başvuran ve proteaz inhibitörü içeren 3'lü tedavi verilen 23 kronik HCV hastasının verileri retrospektif olarak incelenmiştir.Bulgular: Hastaların 18'i (%78,3) kadın ve 5'i (%21,7) erkek ve median yaşları 58 yıl (Aralık 42-70 yıl) idi. Toplam 16 hastada (%69,6) kalıcı virolojik yanıt elde edilmişti. Telaprevir kullanan 18 hastanın 13'ünde (%72,2) ve boseprevir kullanan 5 hastanın 3'ünde (%60) kalıcı virolojik yanıt elde edildi. Daha önce PEG IFNribavirin ikili tedavisi alıp nüks olan 11 hastanın 10'unda (%90,1), kısmi yanıt veren 3 hastanın tamamında ve ilk tedavide primer yanıtsız olan 4 hastanın 2'sinde (%50) kalıcı virolojik yanıt elde edildi. Sirotik olan 9 hastanın 7'si (%77,8) planlanan tedavi süresini tamamladı, 5 hastada (%55,6) kalıcı virolojik yanıt elde edildi. Sirozu olmayan 14 hastanın 12'si (%85,7) tedaviyi tamamlarken, bu hastaların 11'inde (%78,5) kalıcı virolojik yanıt elde edildi. 4 hastada (%17,4) çeşitli yan etkiler nedeniyle tedavi süresi tamamlanamadı.Sonuç: İnterferonsuz tedavi rejimlerinin ülkemizde henüz rutin kullanıma girmediği göz önüne alınırsa, seçilmiş vakalarda PEG IFN, ribavirin ve bir proteaz inhibitörü içeren üçlü tedavilerin hala bir seçenek olabileceği kanaatindeyiz.Öğe Liver abscess after implantation of dental prosthesis(Baishideng Publishing Group Inc, 2012) Gungor, Gokhan; Biyik, Murat; Polat, Hakki; Ciray, Hilal; Ozbek, Orhan; Demir, AliPyogenic liver abscesses are rare but a life-threatening important condition. Dental procedures constitute only rare cases of pyogenic liver abscesses, with only a few cases in the literature. We report a patient with liver abscess following a dental procedure. A 74 years old diabetic male patient was admitted to our hospital with complaints of fatigue, 40 degrees C fever, rigors and right upper quadrant pain, 3-4 d after a dental procedure. Physical examination revealed fever and tenderness in the right upper quadrant. Laboratory examination revealed leucocytosis, elevated erythrocyte sedimentation rate and C-reactive protein and moderately elevated transaminases. An abscess was detected in radiological examination in the medial part of the left lobe of liver, neighboring the gall bladder. He was successfully treated with percutaneous abscess drainage and antibiotherapy. (C) 2012 Baishideng. All rights reserved.Öğe Neutrophil gelatinase-associated lipocalin in prediction of mortality in patients with hepatorenal syndrome: a prospective observational study(Wiley, 2014) Gungor, Gokhan; Ataseven, Huseyin; Demir, Ali; Solak, Yalcin; Gaipov, Abduzhappar; Biyik, Murat; Ozturk, BahadirBackground & AimsHepatorenal syndrome (HRS) is a severe complication of cirrhosis which is characterized by renal dysfunction and associated with poor survival. Neutrophil gelatinase-associated lipocalin (NGAL) is a troponin-like biomarker for human acute kidney injury. We aimed to investigate levels of plasma and urine NGAL in HRS and predictive ability of these markers for all-cause mortality, in HRS, stable cirrhosis and control subjects. MethodsA total of 64 patients with cirrhosis (8 patients with type 1 HRS, 22 with type 2 HRS, and 34 without HRS) and 23 control subjects were included in the study. Blood and urine samples were measured with Human NGAL sandwich ELISA. Patients were followed up prospectively. ResultsPatients with type 1 and type 2 HRS had significantly higher plasma and urine NGAL levels compared with stable cirrhosis and control subjects. Cox regression analysis showed that plasma NGAL and MELD-Na scores were independent predictors of mortality. ROC-curve analysis showed that the plot of the plasma NGAL, urine NGAL, MELD-Na and Child-Turcot-Pugh score could predict all-cause mortality in cirrhotic patients' area under the curve (AUC 0.819, 0.686, 0.807 and 0.795 respectively). ConclusionsNGAL could predict mortality in patients with HRS independent of other commonly used risk factors.Öğe Partial Splenic Embolization may be an Option to Overcome Thrombocytopenia Interfering with Triple Therapy in HCV (+) Cirrhotic Patients: A Case Report(2015) Asıl, Mehmet; Bıyık, Murat; Çifçi, Sami; Sayın, Serhat; Uçar, Ramazan; Özbek, Orhan; Ataseven, Hüseyin; Polat, Hakkı; Demir, AliKronik hepatit C nedeniyle interferon içeren tedavi rejimleri uygulanan hastalarda ilaçlara bağlı yan etkilerle sıklıkla karşılaşılmaktadır. Bu yan etkiler bazen ilaçların suboptimal dozlarda verilmesine hatta tedavinin kesilmesine neden olabilmektedir. İnterferon alan hastalarda trombositopeni sık görülür ve tedaviyi zorlaştırır. Biz burada Pegile interferonribavirintelaprevir üçlü tedavisi alan ve tedaviyi etkileyen trombositopeni tedavisi için splenik embolizasyon uygulanılan hepatit C virüs (HCV) () sirotik bir hastayı sunmayı amaçladık. Kırk yedi yaşında kadın hasta kliniğimizde HCV() siroz nedeniyle 6 yıldır takip edilmekteydi. Altı yıl önce 48 hafta pegylated interferon (PEGIFN)ribavirin tedavisi almış ve tedavi sonrası relaps saptanmıştı. Proteaz inhibitörü içeren 3'lü tedavi protokollerinin genotip 1b hastalarda ülkemizde de onaylanmasından sonra hastaya telaprevir içeren 3'lü tedavi protokolü planlandı. Hastanın tedavi öncesi laboratuvar tetkikleri Child A sirozla uyumluydu. Abdominal ultrasonografide kronik karaciğer hastalığı bulguları ve splenomegali saptandı. Tedavi öncesi HCV RNA 756000 copy/ml, Hb: 11,8 g/dL, WBC: 4600/?L, Trombosit: 64000/?L idi. Hastaya Peg IFN ?-2a 135 mcg/hafta, ribavirin 1000 mg/gün ve telaprevir 3x750 mg/gün başlandı. İki hafta içerisinde trombosit sayımı önce 42000 /?L ve ardından 14000 /?L'ye kadar düştü. PEG-IFN dozu kademeli olarak 67,5 mcg/haftaya kadar azaltıldı. Trombositopeni nedeniyle hastaya parsiyel splenik embolizasyon uygulandı. Bir hafta içerisinde trombosit sayısı 45000/?L'ye yükseldi ve PEG-IFN dozu tekrar 135 mcg/haftaya arttırıldı. Tedavinin geri kalan kısmında trombosit sayısı yaklaşık 60000/?L civarında seyretti ve hasta 48 haftalık tedaviyi başarıyla tamamladı. Hastaya tedavi sonu ve tedavi bitiminden 12 hafta sonra bakılan HCV RNA (-) olarak saptandı. PEG-IFN içeren üçlü tedavi tedavi protokolleri uygulanacak olan sirotik hastalarda trombositopeni tedavisinde splenik embolizasyon minimal invaziv bir seçenek olarak kullanılabilir.Öğe Pediatrik endoskop ile tedavi edilen koledokolitiazis olgusu(2013) Çifçi, Sami; Bıyık, Murat; Ataseven, Hüseyin; Uçar, Ramazan; Demir, Ali; Polat, Hakkı; Özer Çakır, ÖzlemGeçirilmiş safra yolu cerrahileri sonrası sık karşılaşılan koledokolitiazis, tanı ve tedavisinde önemli problemler olabilen ciddi bir durumdur. Son yıllarda ultraslim endoskoplar koledokolitiazis tanı ve tedavisinde giderek artan kullanım alanı bulmuştur. Pediatrik endoskop ile tanı ve tedavisi başarılı bir şekilde yapılmış olan 62 yaşında kadın, koledokolitiazis olgusu sunulmuştur.Öğe A polypoid mass in the common bile duct(Aves, 2016) Asil, Mehmet; Dertli, Ramazan; Biyik, Murat; Oltulu, Pembe; Ataseven, Huseyin; Polat, Hakki; Demir, Ali[Abstract Not Availabe]Öğe A polypoid mass in the common bile duct(2016) Asıl, Mehmet; Bıyık, Murat; Oltulu, Pembe; Ataseven, Hüseyin; Dertli, Ramazan; Polat, Hakkı; Demir, AliQuestion: A 73-year-old woman with a prior history of cholecystectomy operation due to cholelithiasis was admitted to our clinic with complaints of abdominal pain in the epigastrium and right upper quadrant. Laboratory studies were unremarkable: Hb: 14.2 g/dL, hematocrit: 42.8%, WBC: 6000 /μL, platelet: 167000/μL, AST: 14 U/L, ALT: 16 U/L, ALP: 69 U/L, GGT: 42 U/L, total bilirubin: 0.57 mg/dL, and direct bilirubin: 0.32 mg/dL. Abdominal ultrasound examination showed dilatation of intrahepatic bile ducts. Endoscopic ultrasound (EUS) (Figure 1) and endoscopic retrograde cholangiopancreatography (ERCP) were then performed (Figure 2). During ERCP, the common bile duct was explored with a stone extraction balloon and a polypoid mass of 0.5 cm (Figure 3) came out of the common bile duct lumen, which was retrieved using a netted snare and sent to the pathology laboratory for histological examination (Figure 4).
