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Öğe Clinical and ultrasonographical findings in patients with multiseptate gallbladder(Tohoku Univ Medical Press, 2004) Erdoğmuş, Beşir; Yazıcı, Burhan; Özdere, Betül Ayça; Akcan, YusufMultiseptate gallbladder is one of the rare congenital malformations of the gallbladder. We present clinical and ultrasonographic findings in seven patients with multiseptate gallbladder. One of them had nausea and right upper quadrant pain, three had recurrent abdominal pain, while the remaining three patients had no symptoms, physical finding and laboratory abnormality which could be attributable to the biliary system. In patients with multiseptate gallbladder, disturbed motility of the gallbladder may be an etiopathogenetic factor for stasis of bile flow and in turn for development of cholelithiasis, cholecystitis and right upper quadrant pain. (C) 2004 Tohoku University Medical Press.Öğe Gastric pseudolipomatosis, usual or unusual? Re-evaluation of 909 endoscopic gastric biopsies(Baishideng Publishing Group Inc, 2003) Alper, Murat; Akcan, Yusuf; Belenli, Olcay; Çukur, Selma; Aksoy, Kamuran A.; Suna, MazlumeMicrovesicular pneumatosis intestinalis, also called "pseudolipomatosis" for resembling fatty infiltration, is characterized by the presence of small gas voids in the gastrointestinal wall, especially in mucosa. These voids are not lined with epithelia. There are few reported cases about colon, duodenum and skin. Because there is only one case report about pseudolipomatosis in the stomach, we re-evaluated 909 endoscopic biopsies taken from gastric corpus to check the presence of pseudolipomatosis. We determined pseudolipomatosis foci in 3 percent (n=27) of biopsies. In two cases there were pseudolipomatosis foci in endoscopic biopsies having otherwise normal histologic findings, while there were pseudolipomatosis foci in endoscopic biopsies of 25 patients with gastritis. H pylori was found in 85 % of biopsies having pseudolipomatosis foci. In this study, we presented some histopathologic characteristics of pseudolipomatosis seen in gastric mucosa.Öğe The importance of serial measurements of cytokine levels for the evaluation of their role in pathogenesis in Familial Mediterraean Fever(I Holzapfel Verlag Gmbh, 2003) Akcan, Yusuf; Bayraktar, Yusuf; Arslan, Serap; Van Thiel, David H.; Zerrin, B.C.K.; Yıldız, OrhanFamilial Mediterranean fever (FMF) is an autosomal recessive disorder characterized by recurrent fever of unknown origin, renal amyloidosis, peritonitis, pleuritis and/or synovitis. There have been many studies to elucidate the etiopathogenesis of FMF. IL-6 is a cytokine that can induce the formation of serum amyloid A and C-reactive protein, both of which are important in development of amyloidosis. IL-6 was determined to be strongly associated in the etiopathogenesis of periodic fever in Chinese-pei dogs. The dogs with this syndrome experience periodic fever, arthritis, renal amyloidosis, a clinical picture very alike of human FMF. Here, we aimed to study mainly whether IL-6 had a similar etiopathogenetic role in human FMF as in Chinese-pei dogs syndrome. The median IL-6 blood levels were found to be higher in patients with acute (n=8) FMF attack (1.85 U/ml) compared to those (n=33) with asymptomatic ones (1.0 U/ml) (p=0.16). There are mainly two results: first; the study should be designed with a larger sample size of patients with acute attack in order to alleviate underestimation of significance, second; sampling time may give various results because of dynamic changes of cytokine levels during acute attack period.Öğe Large pedinculated antral hyperplastic gastric polyp traversed the bulbus causing outlet obstruction and iron deficiency anemia: endoscopic removal(W J G Press, 2003) Alper, Murat; Akcan, Yusuf; Belenli, OlcayWe present here a large (3 cm) hyperplastic gastric polyp prolapsed into duodenum and caused outlet obstruction and iron deficiency anemia in 60 years old male patient. Endoscopic removal was performed successfully.Öğe Latent fatality due to hydatid cyst rupture after a severe cough episode(Tohoku Univ Medical Press, 2005) Erdoğmuş, Beşir; Yazıcı, Burhan; Akcan, Yusuf; Özdere, Betül Ayça; Korkmaz, Uğur; Alçelik, AytekinHydatid disease is a parasitic disease caused by Ecinococcus granulosus characterised by cyst formation in various organs. The infestation mostly involves the liver. Hydatid cysts of the liver can rupture either spontaneously or due to trauma. Incidence of rupture is about 3-17% of all cases with hydatid disease. Unless treated surgically, rupture can result in death. Here, we present a case of hydatid cyst ruptured after a severe cough episode and disseminated first to the subcapsular area, then to the peritoneal space. Probably due to a decrease in parenchymal pressure in the liver after decompressive effect of rupture, the patient felt an improvement in abdominal pain, refused operation, and left the hospital on his own responsibility. This unfortunate relief resulted in a delay of 55 hours in management. The leakage of liquid materials into peritoneal space resulted in a severe inflammatory reaction and eventually death of the patient. The patient died of a late peritonitis rather than anaphylaxis, which is the most common reason for death in such patients. As a conclusion, physicians should be aware of a temporary relief in abdominal pain after cyst rupture that may cause a delay in management and in turn loss of patient due to peritonitis.Öğe Massive gastrointestinal tubercolsis in a young patient without immunosupression(W J G Press, 2003) Sertbaş, Yaşar; Alper, Murat; Akcan, Yusuf; Gürbüz, Yeşim; Öksüz, ŞükrüAlthough the lung is the major site for Mycobacterium tuberculosis infection, gastrointestinal involvement can be present as part of multiorgan disease process or, less commenly, can be seen as primary gastrointestinal tuberculosis. In the cases where the culture is negative, it can be difficult to differantiate tuberculosis from Crohn's disease based on both the clinical and histological features. When side effects of classic antimycobacteria are encountered, we can initially add ciprofloxacin to the treatment of tuberculosis. We reported a case of 19-yr-old patient, who was treated as Crohn's disease and worsen. We began to tuberculosis treatment, and the patient improved clinically and histologically. The main point in this case is that widespread involvement of gastrointestinal tract can be brought about by non resistant strains of Mycobacterium tuberculosis even in immunocompetent patients.Öğe Micropneumatosis coexistent with Helicobacter pylori and its improvement(2003) Belenli, Olcay Kandemir; Akcan, Yusuf; Alper, MuratMicropneumatosis intestinalis is the occurrence of gas-filled circular voids with diameter of 20-200 microns, not lined with epithelium. We report a 39-year-old man with superficial gastritis and Helicobacter pylori infection who also had gastric, duodenal and colonic micropneumatosis. Endoscopic biopsy after treatment for H. pylori gastritis showed no micropneumatosis in gastric, duodenal or colonic mucosal sections. We suggest that H. pylori may be one of the causative factors for micropneumatosis.Öğe Prevalence of Helicobacter pylori in symptomatic patients and detection of clarithromycin resistance using melting curve analysis(Elsevier Science Inc, 2007) Kaya, Ayşe Demet; Öztürk, C. Elif; Akcan, Yusuf; Behçet, Mustafa; Karakoç, A. Esra; Yücel, Mihriban; Tuncer, SerdarBackground: Clarithromycin is often a component of combination therapies for Helicobacter pylori eradication; however, increases in resistance rates have decreased the success of the treatment. Objective: This study was designed to determine the prevalence of H pylori infection in symptomatic patients and to detect clarithromycin resistance rates using melting curve analysis. Methods: Patients scheduled for upper endoscopy at the Endoscopy Unit of the Department of Gastroenterology, Duzce University, Medical Faculty Hospital, Konuralp/Duzce, Turkey, were assessed for enrollment in the study. Two pairs of gastric biopsy specimens (antrum and corpus) were obtained from each study patient. Histopathologic examination, rapid urease test, culture, and polymerase chain reaction (PCR) of the specimens were used to identify H pylori infection. Clarithromycin resistance was detected using melting curve analysis. Results: Seventy-five patients (41 women, 34 men; mean [SD] age, 42.6 [14.5] years [range, 17-70 years]) were included in the study. Using histopathology and rapid urease test, H pylori was detected in 40 (53.3%) of the 75 specimens. H pylori was detected using PCR in 40 (53.3%) specimens and by culture in 10 (13.3%) specimens. The specificity and sensitivity of PCR and culture were interpreted by comparing them with the results of histopathologic examination and urease tests. The specificity and sensitivity of PCR were 68.6% and 72.5%, respectively, and the specificity and sensitivity of culture were 97.1% and 22.5%, respectively. Of the 40 isolates, 21 (52.5%) were susceptible to clarithromycin, 12 (30.0%) were resistant, and a mixed susceptibility pattern was detected in 7 (17.5%) specimens. H pylori isolates from 19 (79.2%) of the 24 patients who had formerly used clarithromycin showed clarithromycin resistance. Conclusions: The prevalence of H pylori infection was 53.3% for the symptomatic patients in this study, and 47.5% of the isolates showed clarithromycin resistance using melting curve analysis. The PCR-based system used in this study was accurate for the detection of H pylori infection as well as clarithromycin susceptibility testing directly in biopsy specimens.Öğe Two successive pregnancies after ursodeoxycholic acid therapy in a previously infertile woman with anti mitochondrial antibody-negative primary biliary cirrhosis(Elsevier Science Inc, 2005) Korkut, Esin; Kısacık, Bünyamin; Akcan, Yusuf; Belenli, Olcay; Bicik, Zerrin; Yücel, OğuzObjective: To describe the benefit of ursodeoxycholic acid (UDCA) for the initiation and completion of a successful pregnancy in a previously infertile woman with primary biliary cirrhosis. Design: Case report. Setting: A university hospital with relevant departments. Patient(s): A 29-year-old woman with primary biliary cirrhosis and failure to conceive for 6 years. Intervention(s): Establishment of diagnosis with a liver biopsy, pretreatment of patient with UDCA before conception, and continuation of UDCA after first trimester until term. UDCA was used in the second pregnancy again after the first trimester. Main Outcome Measure(S): Achievement of a safe conception and full-term pregnancy. Result(S): Two consecutive successful pregnancies, a healthy 3,250-g male infant and a healthy 3,000-g female infant. The second conception occurred in a period without the use of UDCA, implicating a latent beneficial effect of either UDCA orthe previous pregnancy via some possible immune mechanism. Conclusion(s): Ursodeoxycholic acid could help achieve conception in infertile women with primary biliary cirrhosis. The use of UDCA after the first trimester is shown to be safe in two consecutive pregnancies. Although it cannot be conclusive, the unintentional use of UDCA in the first 20 days after conception did not result in any teratogenicity in the first child. (c) 2005 by American Society for Reproductive Medicine.
