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Öğe Alendronat kullanımına bağlı oral ülserler(2008) Cinemre, Hakan; Gökosmanoğlu, Feyzi; Aytuğ, Necip Ö.Bifosfonatlar kemik rezorpsiyonunu ve turnoverını azaltarak etki eden, bu nedenle postmenopozal osteoporoz, multipl myeloma ve maligniteye bağlı osteolizis gibi birçok kemik hastalığında kullanılan ajanlardır. Son yıllarda yaygın kullanımları ile nadir olan komplikasyonlarının görülme sıklığı artmıfltır. En sık gastrointestinal sisteme ait yan etkileri görülmekte olup özafajit, gastrik ülserler, dispepsi, retrosternal yanma nadiren de oral ülserler, çenede osteonekroz ve özafagial daralma bildirilen yan etkileridir. (Romatizma 2008; 23: 35-7)Öğe Anti-Saccharomyces cerevisiae antibodies in acute myocardial infarction(Bmj Publishing Group, 2007) Cinemre, Hakan; Bilir, Cemil; Gökosmanoğlu, Feyzi; Kadakal, FigenBackground: Elevated anti-Saccharomyces cerevisiae antibody (ASCA) immunoglobulin (IgG) and IgA levels were first described in the serum of Crohn disease patients and have increasingly been reported in other inflammatory diseases. The role of in situ and remote inflammation in atherosclerosis is a major area of interest. In this study, we compared ASCA IgG and IgA levels in acute myocardial infarction (AMI) and controls to investigate the possible role of ASCA in AMI. Methods: Serum samples were obtained from 140 consecutive patients who presented to the emergency department with acute chest pain. AMI was diagnosed by electrocardiography and serial enzymes. Patients ruled out for acute coronary event were grouped as controls. ASCA IgA and IgG levels were determined using enzyme-linked immunosorbent assay. Groups were compared for statistically significant difference. Results:ASCA IgG titers ranged between 0.1 and 31.0 RIU/mL (mean 4.92) in the AMI group and 0.1 and 6.0 (mean 0.84) in the controls. The groups were found to differ very significantly (p = .001). ASCA IgA titers ranged between 2.0 and 200.0 RIU/mL (mean 13.73) in the AMI group and 2.0 and 11.5 RIU/mL, (mean 4.25) in controls. The groups differed significantly (p = .32). AMI and controls were also analyzed for ASCA IgA and IgG positivity. Both groups differed significantly from controls (p = .013). Conclusion: Elevated ASCA IgA and IgG levels as well as ASCA positivity in the AMI might suggest use of ASCA as a marker for atherosclerotic plaque instability. It might also provide a link between inflammatory processes and increased cardiovascular risk. Further studies are needed on a Saccharomyces cerevisiae-based diet, related intestinal colonization, and associated inflammation, autoimmune disorders, and cardiovascular events.Öğe Changes in levothyroxine pharmacokinetics following bariatric surgery in obese hypothyroid patients(2021) Gökosmanoğlu, Feyzi; Önmez, AtillaAim: Levothyroxine (L-T4) requirements in obese hypothyroid patients receiving L-T4 therapy decrease following bariatric surgery. L-T4 absorption is also thought to decrease after surgery. The purpose of this study was to evaluate L-T4 requirements in hypothyroidism cases before and after weight loss through bariatric surgery. Methods: Seventy-six cases of hypothyroidism receiving L-T4 replacement therapy and with a body mass index over 40 kg/m2 were included in the study. Patients losing at least 10% of basal body weight following bariatric surgery were assessed in terms of thyroid hormone levels and L-T4 requirements over follow-up of at least one year. The L-T4 requirements of patients in whom euthyroidism was achieved were compared in terms of bariatric surgery procedures and hypothyroidism etiology. Results: Seventy-six patients (56 women, 20 men) with a mean age of 38 years (18-51) were included in the study. Mean weight before bariatric surgery was 121.6 ± 6.8 kg, and mean body mass index was 49.5 ± 1.6 kg/m2. Euthyroidism was confirmed at pre- and post-bariatric surgery evaluation. No statistically significant postoperative changes were determined in thyroid-stimulating hormone or free thyroxine-3 and -4 (p > 0.05). A statistically insignificant decrease was observed in L-T4 dosages after surgery in cases of Hashimoto’s thyroiditis (p = 0.064). A statistically significant decrease was determined in L-T4 dosages in cases of non-Hashimoto hypothyroidism (p = 0.001). L-T4 requirements decreased in both surgical procedures (p = 0.001) Conclusion: Postoperative L-T4 requirements decrease with weight loss. In addition, no decrease appeared to occur in L-T4 absorption following the surgical procedures in this study.Öğe Clinical assessment of patients with acromegaly(Wolters Kluwer Medknow Publications, 2018) Gökosmanoğlu, Feyzi; Önmez, AttilaBackground: In this study, we aimed to retrospectively evaluate treatment outcomes and treatment methods in acromegaly patients. Materials and Methods: The study included 65 acromegaly patients followed in Sakarya University Faculty of Medicine Department of Endocrinology in Turkey between 2004 and 2013. Clinical, biochemical, and radiological data were obtained retrospectively from the medical files of the patients. All cases have been discussed in the endocrinology and pituitary surgery council, and a multidisciplinary treatment approach had been chosen in management. Results: Sixty-five patients were included in the study. Of the patients, 57% were female. Mean age was 45.3 +/- 9.2 years old. Of the cases, 12.3% were microadenomas (n = 8, tumor diameter < 10 mm) and 87.6% were macroadenomas (n = 57, tumor diameter = 10 mm). In our study, 70% remission was achieved with the first operation and medical treatment. Patients with invasive acromegaly without remission after the first operation underwent reoperation, medical treatment, and conventional or stereotactic radiotherapy and achieved 45% remission rate. Conclusion: Pituitary surgery is the first treatment option for acromegaly. In patients who could not be remissioned after the first operation, remission can be achieved by combined therapy consist of reoperation, medical treatment, and conventional or stereotactic radiotherapy.Öğe Determination of cut-off values and sensitivities of tests for the diagnosis of subclinical cushing's syndrome in functional investigation of adrenal incidentalomas(Bayrakol Medical Publisher, 2019) Yıldırım, Abdurrahim; Gökosmanoğlu, Feyzi; Önmez, AttilaAim: The aim of our study was to determine the sensitivities of tests used in the diagnosis of subclinical Cushing's syndrome (SCS) in patients with adrenal incidentalomas using clinical findings and other biochemical parameters. Material and Method: One hundred and twenty-nine patients with adrenal incidentalomas who were followed up by our endocrinology clinic were included in the study. Patients were divided into 4 groups according to the 1-mg DST results and these groups were compared in terms of age, gender, hormonal parameters, and comorbidities associated with Cushing's syndrome. The cut-off value of salivary cortisol level for the diagnosis of SCS was calculated by ROC curve analysis. Result: If the cut-off values of plasma cortisol levels after the 1-mg DST were considered >= 1,8 mu g/dL, >= 3 mu g/dL, and >= 5 mu g/dL, the detection rates of SCS were respectively 22,4%, 1,4%, and 3,8%. When the cut-off value of plasma cortisol levels after the 1-mg DST was considered >= 1,8 mu g/dL, the sensitivity, specificity, and cut-off value of salivary cortisol levels were calculated as 68%, 57%, and 0.195 mu g/dL by ROC curve analysis. Discussion: As the adrenal mass size and patient age increased, cortisol suppression decreased according to the 1-mg DST. As the cut-off value of plasma cortisol level used in the 1-mg DST decreased, the incidence of SCS increased significantly. This leads to overdiagnosis of SCS in asymptomatic patients with adrenal incidentalomas. New cut-off values should be determined for salivary cortisol level according to different populations.Öğe The effects of vildagliptin in liver functions in type 2 diabetic patients(Bayrakol Medical Publisher, 2019) Gökosmanoğlu, Feyzi; Önmez, Attila; Topkaya, SibelAim: In Type 2 diabetic patients, the prevalence of liver disease is high when compared with the general population. For this reason, the hepatic safety of anti-diabetes agent is important. However, there are uncertainties about the long-term efficiency and reliability of vildagliptin treatment. In this study, we have reviewed the findings obtained from the clinical use of vildagliptin and its effects on the liver. Material and Method: The study was conducted on 243 patients who were followed-up in our clinic between September 2016 and May 2018. The data were obtained by reviewing the patient files retrospectively. Result: A decrease was detected in the aminotransferases after the treatment with vildagliptin, which was statistically significant (ALT: decreased from 78 +/- 17 to 48 +/- 14 IU/L (p = 0.029), AST: decreased from 63 +/- 13 to 41 +/- 11 IU/L (p=0.035); GGT: 20.5 +/- 3.2 and 19.1 +/- 6.3 (p=0.682)). Vildagliptin reduces the insulin resistance and Body Mass Index in patients. Discussion: It was determined that Vildagliptin is a safe treatment option for Type 2 Diabetes management.Öğe Hematologic Effects of Levothyroxine in Iron-Deficient Subclinical Hypothyroid Patients: A Randomized, Double-Blind, Controlled Study(Endocrine Soc, 2009) Cinemre, Hakan; Bilir, Cemil; Gökosmanoğlu, Feyzi; Bahçebaşı, TalatContext: In patients with coexisting iron-deficiency anemia and subclinical hypothyroidism, anemia does not adequately respond to oral iron therapy. Objective: We studied whether iron-deficiency anemia might indicate treatment of subclinical hypothyroidism. Design: Patients were assigned to a control or experimental group: 240 mg/d oral iron alone (iron group) or 240 mg/d oral iron plus 75 mu g/d levothyroxine (iron/levothyroxine group). Levels of hemoglobin, hematocrit, red blood cell count, serum iron levels, ferritin, total iron-binding capacity, TSH, and free T-4 were measured before and after treatment. Setting: The study was conducted at a university hospital outpatient clinic. Patients: Fifty-one patients with coexisting iron-deficiency anemia and subclinical hypothyroidism participated in the study. Intervention: Patients were treated as described above in either the iron group or the iron/levothyroxine group. Main Outcome Measure: A clinically satisfactory increase in hemoglobin was regarded as successful. Results: Mean hemoglobin levels increased by 0.4 g/dl in the iron group [95% confidence interval (CI) 0.2-0.7, P = 0.001], whereas it increased by a mean of 1.9 g/dl in the iron/levothyroxine group (95% CI 1.5-2.3, P < 0.0001). The increase in serum iron was greater in the iron/levothyroxine group by a mean of 47.6 mu g/dl (95% CI 34.5-60.6, P < 0.0001). Increases in hemoglobin, red blood cells, hematocrit, and serum ferritin levels after treatment were statistically significantly greater in the iron/levothyroxine group (P < 0.0001). Starting hemoglobin and increase in hemoglobin were negatively correlated in the iron/levothyroxine group (r = -0.531, P = 0.006). Conclusions: Subclinical hypothyroidism should be treated in iron-deficiency anemia patients when both conditions coexist. This would provide a desired therapeutic response to oral iron replacement and prevent ineffective iron therapy. (J Clin Endocrinol Metab 94: 151-156, 2009)Öğe Hemodiyaliz yeterliliğinin solunum fonksiyon testleri üzerine olan etkisi(Düzce Üniversitesi, 2009) Gökosmanoğlu, Feyzi; Cinemre, HakanAmaç: KBY hastalarında hemodiyaliz replasman tedavisi yeterliliğinin solunum fonksiyon testine (SFT) etkisini araştırmayı amaçladık.Yöntem: Haziran 2008-Haziran 2009 tarihleri arasında bölgemiz diyaliz merkezlerinde (Düzce ili ve çevresi) kreatin klirensi 10-15 ml/dk altında olan ve hemodiyaliz programına alınan son dönem böbrek yetmezlikli 71 hastanın kayıtları retrospektif olarak değerlendirildi. Hastalar klinik olarak stabil olduğunda solunum fonksiyon testleri yapıldı.Bulgular: Hastalarda solunum fonksiyon parametreleri olarak FEV-1, FVC, FEV-1/FVC, PEF ve FEF 25-75 `e bakıldı. Bu parametreleri etkileyebilecek faktörler basamaklı çoklu lineer regresyon analizi modeli oluşturularak incelendi. FVC için en yüksek R2'li model iki bileşenli, yaş ve Kt/V olarak saptandı. FEV-1 için üç faktörlü model kuruldu ve bağımsız öngördürücü belirteçlerin yaş ve KtV olduğu saptandı. PEF değeri için ise dört bileşenli modelde yaş ve Kt/V bağımsız öngördürücüler olduğu saptandı.Sonuç: Çalışmamızda hemodiyaliz hastalarında yaş ve diyaliz yeterliliği (Kt/V)'nin solunum fonksiyonları için istatiksel olarak anlamlı düzeyde bağımsız öngördürücü olduklarını bulduk.Öğe Influence of flexible insulin dosing with carbohydrate counting method on metabolic and clinical parameters in type 1 diabetes patients(Open Access Macedonian Journal of Medical Sciences, 2018) Gökosmanoğlu, Feyzi; Önmez, AttilaOBJECTIVE: The purpose of providing and maintaining a proper metabolic control is to prevent the development of chronic complications. In this study, we aimed to determine the influence of flexible insulin dosing with carbohydrate counting method on metabolic and clinical parameters in type 1 diabetes patients. MATERIAL AND METHODS: This study was conducted with patients following up at the Endocrinology Clinic with a diagnosis of type 1 diabetes mellitus between 2012 and 2015. Metabolic and clinical parameters before and after carbohydrate counting were compared. RESULTS: Forty patients were included in the study. Of the patients, 40% (n = 16) were female, and 60% (n = 24) were male, and mean age was 21.5 ± 7 year at the time of diagnosis. Statistically significant differences were not detected when haemoglobin A1c, fasting plasma glucose, post-prandial glucose, LDL-cholesterol, and HDL-cholesterol levels were compared at standard dose insulin use and after carbohydrate counting (P < 0.005). Among the parameters measured when the patients received standard dose of insulin without counting carbohydrate and flexible insulin dosing by counting carbohydrate, statistically, significant differences were not detected for baseline insulin dose, bolus insulin dose, triglyceride level, body mass index, or monthly hypoglycemia episodes (P > 0.05). CONCLUSION: Flexible insulin dosing with carbohydrate counting provides significant improvements in clinical and metabolic control. We detected improvements in lipid profiles and glycemic control. Additionally, patients generally did not gain weight despite flexible nutrition, and frequency of hypoglycemia remained unchanged despite strict glycemic control. © 2018 Feyzi Gokosmanoglu, Attila Onmez. This is an open-access article distributed under the terms.Öğe Kimura Disease's: A Case Report(Deri Zuhrevi Hastaliklar Dernegi, 2009) Cinemre, Hakan; Gökosmanoğlu, Feyzi; Bilir, CemilKimura is a chronic inflammatory disease at oral mucosa which presents as large subcutaneous nodules or masses on the head or neck of adulthood males The lesions characteristics are eosinophilia in lymphocytic infiltration, fibrosis and diffuse vascularity. Eosinophilia and elevated blood IgE can be present. A 62 years old female with inguinal mass and itching was presented (Turkderm 2009, 43 171-3)Öğe Kimura disease's: A case report(2009) Cinemre, Hakan; Gökosmanoğlu, Feyzi; Bilir, CemilKimura is a chronic inflamatuary disease at oral mucosa which presents as large subcutaneous nodules or masses on the head or neck of adulthood males. The lesions characteristics are eosinophilia in lymphocytic infiltration, fibrosis and diffuse vascularity. Eosinophilia and elevated blood IgE can be peresent. A 62 years old female with inguinal mass and itching was presented.Öğe Multiple myeloma bağlı maksiller tutulum sonrası gelişen akut lösemi(2007) Gökosmanoğlu, Feyzi; Cinemre, Hakan; Bilir, CemilMultiple myelom, immünglobulin sekrete eden plazma hücrelerinin malign bir klonunu meydana getiren, transformasyona uğramış B-lenfoid progenitor hücrelerinin proliferasyonunun neden olduğu, kemik iliğini infiltre eden plazma hücrelerinden kaynaklanan, yaşlı popülasyonun neoplastik bir hastalığıdır. Multiple myelom (MM) tüm kemik tümörlerinin %27'sini oluşturur ve bu oran ile kemiğin en sık görülen malign tümörüdür. Lokalize ya da yaygın iskelet sistemi ağrılarının eşlik ettiği kemik tutulumları karakteristiktir. Multiple myelom, genellikle kafatası, klavikula, vertebra, pelvis gibi yassı kemikleri tutar. MM 'da oral bulguların ortaya çıkması, hastalığın ileri dönemde olduğuna işaret eder. Bu nedenle multiple myelom tanılı olguların dikkatli değerlendirilmesi ve bu olgulara multidisipliner yaklaşılmalıdır. Biz, kliniğimizde multiple myelom tanısı alan 60 yaşında kadın bir hastanın takipleri sırasında ikinci molar diş bölgesi lokalizasyonunda myelomatoz maksiUer tutulum sonrası gelişen akut plazma hücreli lösemili bir olgu rapor ettik.Öğe Oral ulcers caused by alendronate use(2008) Cinemre, Hakan; Bilir, Cemil; Gökosmanoğlu, Feyzi; Aytuğ, Necip Ö.Bisphosphonates are the drugs which modulate bone turnover and reduce bone reabsorbsion. Hence, they are used in postmenopausal osteoporosis, multiple myeloma or osteolisis associated with malign cancer. The rare complications are appearing more often now because of their wide use in treatments. Most important possible adverse effects belong to gastrointestinal systems; esophagitis, gastric ulcers, dyspepsia, heartburn and rarely oral ulcers, osteonecrosis on jaws and esophagial stricturs are illustrated.Öğe Oral ulcers caused by Alendronate use(Aves Yayincilik, Ibrahim Kara, 2008) Cinemre, Hakan; Bilir, Cemil; Gökosmanoğlu, Feyzi; Aytuğ, Necip Ö.Bisphosphonates are the drugs which modulate bone turnover and reduce bone reabsorbsion. Hence, they are used in postmenopausal osteoporosis, multiple myeloma or osteolisis associated with malign cancer. The rare complications are appearing more often now because of their wide use in treatments. Most important possible adverse effects belong to gastrointestinal systems; esophagitis, gastric ulcers, dyspepsia, heartburn and rarely oral ulcers, osteonecrosis on jaws and esophagial stricturs are illustrated.Öğe Plevra sıvısıyla seyreden multipl miyelom (vaka sunumu)(2009) Gökosmanoğlu, Feyzi; Cinemre, Hakan; Bilir, CemilPlevra hastalıkları, farklı akciğer hastalıklarının yanında çok çeşitli sistemik hastalıkların tutulumunun sonucu olarak da ortaya çıkabilmektedir. Akciğer ya da akciğer dışı hastalıkların plevrayı etkilemeleri ile ortaya çıkan en sık görünüm, plevrada sıvı birikimidir. Hematolojik maligniteler nadiren plevra sıvısıyla prezente olabilir. Multipl miyelomda plevra sıvısı nadir bulgudur, malign plazma hücreleri infiltrasyonuna bağlı plevra sıvısı ise çok daha nadirdir. Multipl miyelomda plevra sıvısı genellikle benign karakterdedir, hipoalbüminemi, enfeksiyon, amiloidoza bağlı kalp yetmezliği veya böbrek yetmezliği gibi nedenlere bağlı olarak gelişebileceği akılda tutulmalıdır. Biz, kliniğimize multipl miyeloma bağlı bilateral plevra sıvısı ile gelen 70 yaşında bir erkek hastayı rapor ettik.Öğe Predictors of time to remission and treatment failure in patients with Graves' disease treated with propylthiouracil(Canadian Soc Clinical Investigation, 2009) Cinemre, Hakan; Bilir, Cemil; Gökosmanoğlu, Feyzi; Akdemir, Nermin; Erdoğmuş, Beşir; Büyükkaya, RamazanPurpose: Propylthiouracil is one of the thionamides used in the treatment of Graves' disease. The drug has serious side effects and long-term treatment might be needed to achieve remission. We designed this study to evaluate the clinical and thyroid Doppler characteristics that might predict time to remission and treatment failure in propylthiouracil treated Graves' patients. Methods: 26 patients, among 134 presenting to our university hospital outpatient clinic between Feb -July 2007 and with first time diagnosis of clinical thyroid dysfunction, were clinically and ultasonographically diagnosed with Graves' disease. Doppler parameters, serum thyrotropin, free thyroxine and free triiodothyronine were measured at the beginning of the study and thyroid studies were repeated every 4 weeks until remission. Propylthiouracil 300 mg/day was started for each patient at the time of diagnosis and doses were titrated according to repeat thyroid studies. Patients were treated and followed up for 18 months. Results: Treatment failure was associated with smoking (P = 0.001) and male gender (P= 0.037). Stepwise multiple regression analysis revealed that age, free thyroxine and superior thyroid artery flow rate were predictors of time to remission (P= 0.001, 0.002 and 0.003, respectively). Conclusion: The time to remission in Graves patients treated with propylthiouracil can be predicted using age, serum free thyroxine and superior thyroid artery flow rate. This may help early consideration of alternative treatment for the patients requiring prolonged treatment for remission or for those who fail medical treatment. This would decrease unnecessary, long-term propylthiouracil exposure with its serious side effects.Öğe Regression of the Carotid Intima Media Thickness by Propylthiouracil Therapy in Graves' Hyperthyroidism(Elsevier Science Inc, 2012) Bilir, Cemil; Gökosmanoğlu, Feyzi; Çalışkan, Mustafa; Cinemre, Hakan; Akdemir, RamazanIntroduction: One of the cardiovascular effects of hyperthyroidism is increased carotid intima media thickness (CIMT). The aim of this study is to investigate the CIMT in patients with Graves' hyperthyroidism and the effect of propylthiouracil (PTU) therapy on CIMT. Method: Twenty-six patients with Graves' hyperthyroidism and 33 healthy controls were included in the study. CIMT was measured at the right and left external carotid arteries in every patient in both groups. CIMT was measured before and after the PTU therapy in patients with Graves' hyperthyroidism. Results: There was a significant difference in CIMT between the group of Graves' hyperthyroid patients and the control group (0.72 versus 0.55 mm, P < 0.0001) at baseline. Twenty-five of 26 patients with Graves' disease were followed up for 18 months prospectively. Euthyroidism has been achieved in 21 patients. After 18 months of treatment, CIMT decreased significantly compared with the baseline values [0.84 (0.54-1.3) to 0.72 (0.50-1.2), change 0.12 mm, P < 0.001]. Conclusion: Graves' hyperthyroidism is associated with atherosclerosis as assessed by CIMT. Treatment of Graves' hyperthyroidism with PTU decreases the CIMT.Öğe Relationship of Bone Densitometry and Bone Resorption Markers With Menopausal Type and Duration(Turkish League Against Rheumatism, 2010) Akdemir, Nermin; Bilir, Cemil; Cinemre, Hakan; Pekuz, Muhittin; Gökosmanoğlu, FeyziObjective: Menopause age and bone mineral density are positively related and there is a rapid bone loss in the early postmenopausal period. A ratio of 30% of post-menopausal women are affected from osteoporosis developing due to bone loss and this causes 40% risk of fracture in a 50-year old woman. Materials and Methods: In this sudy, serum osteocalcin and urine deoxypridinoline levels were analyzed in 102 postmenapausal and 48 healthy premenopausal controls who presented to gynecology outpatient clinic. Bone densitometry was obtained from all postmenopausal women. Postmenopausal patients were further divided into four groups according to time since menopause: <5 years, 5-9 years, 10-19 years and > 20 years. Results: Mean (SD) age in 48 premenopausal women was 47.7 (3.7) while it was 56.5 (6.8) in 102 post-menopausal women. 34 out of 102 post-menopausal women had surgical menopause due to bilateral oopheroctomy+hysterectomy while the remaining had natural menopause. No significant difference was found in bone-turnover markers between women with surgical and natural menopause. Conclusion: Although there was not a statistically significant difference between bone-turnover markers, bone mineral density stays lower in surgical menopausal patients and this difference disappear only after about 20 years. Also bone turnover markers are usually high up to five years after surgical menopause and return to normal levels after then. Thus, our study suggested that oopheroctomy does not cause additional risk to hysterectomy. We also suggest that there is not a longterm relationship between serum bone turnover markers or bone density and the etiology of menopause. (Turk J Rheumatol 2010; 25: 29-33)
