Browsing by Author "Dogan, E"

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Contrast-Enhanced Ct and Mri Findings of Atypical Hepatic Echinococcus Alveolaris Infestation
(Springer, 2005) Etlik, Ö; Bay, A; Arslan, H; Harman, M; Kösem, M; Temizöz, O; Dogan, E
Diagnosis of liver infestation by Echinococcus alveolaris (EA) is based on serological and radiological findings. In this report, we present a 15-year-old girl with atypical hepatic EA infestation showing central punctate calcifications and contrast enhancement on the portal and late phases of CT and MRI. CT showed a hypodense mass involving more than half of the liver with prominent central calcifications. MRI revealed hypointense signal of the infiltrative mass on both T1- and T2-weighted images. Contrast enhancement is a unique finding in hepatic EA infestation that may cause difficulties with diagnosis. MRI may provide invaluable information in the diagnosis of EA infestation of the liver, either by disclosing the infiltrative pattern of infestation without significant effect to vascular structures, or by the signal characteristics.
The Effect of Colchicine on the Peritoneal Membrane
(Taylor & Francis inc, 2006) Sayarlioglu, H; Dogan, E; Erkoc, R; Ozbek, H; Bayram, I; Sayarlioglu, M; Bozkurt, H
Peritoneal dialysis (PD) is a treatment modality for patients with renal failure. Peritoneal fibrosis is one of the most serious complications after long-term continuous ambulatory peritoneal dialysis (CAPD). Histological studies in both humans and animals show that chronic peritoneal dialysis results in fibrosis of the peritoneal membrane. In our study, we investigated the effect of colchicine on peritoneal alterations induced by hypertonic PD solution in rats. Sprague-Dawley rats intraperitoneally received saline (control group) once daily, for 28 days, or 3.86% glucose (PDF group), or 3.86% glucose plus colchicine (colchicine group). Animals from each group were sacrificed after 28 days with anesthetized ketamine (60 mg/kg BW). For the PD fluid assessment, 1 h before the sacrifice of animals, 10 mL PD fluid of 2.27% glucose was given, and this fluid was obtained after the sacrifice. The levels of transforming endothelial growth factor ss (TGF-ss), tumor necrosis factor alpha (TNF-alpha) and albumin were investigated both in the peritoneal dialysate and blood, and the levels of malondialdehyde (MDA) were investigated only in peritoneal dialysate. The peritoneal membrane was evaluated histologically by light microscopy. When groups were compared in terms of body weight change, the colchicine group significantly lost weight compared to controls and PDF group (-4.7% 4.5, 3.5% 7.2, 3.0% 1.3, respectively, p = 0.018). Also, the blood albumin level was significantly lower for these in the colchicine group compared to those in the PDF group (2.7 0.35 versus 3.2 0.3 g/dL, respectively, p = 0.048). The blood TGF-ss level was significantly lower in the control group, and no difference was observed between the PDF and colchicine groups (294.4 67.5 versus 787.4 237.4 versus 615.3 235.1 pg/mL, respectively, p = 0.004). The mesothelial thickness found in groups was as follows: control group 102 18.9 mu m, PDF group 128.33 33.1 mu m, colchicine group 117 35.6 mu m ( p = 0.34). In conclusion, a rat model for peritoneal dialysis associated peritoneal derangement without fibrosis could be induced. Colchicine could not prevent peritoneal derangement in this model.
Effect of Glucose Concentration on Peritoneal Inflammatory Cytokines in Continuous Ambulatory Peritoneal Dialysis Patients
(Hindawi Ltd, 2004) Sayarlioglu, H; Topal, C; Sayarlioglu, M; Dulger, H; Dogan, E; Erkoc, R
OBJECTIVE : It is known that glucose concentrations of peritoneal dialysis solutions are detrimental to the peritoneal membrane. In order to determine the effect of glucose concentration on cytokine levels of peritoneal fluid of continuous ambulatory peritoneal dialysis (CAPD) patients, a cross-sectional study was performed. Methods: Nine non-diabetic CAPD patients participated in two 8-h dwell sessions of overnight exchanges in consecutive days, with 1.36% and 3.86% glucose containing peritoneal dialysis solutions (Baxter - Eczacibasi). Peritoneal dialysis fluid tumor necrosis factor (TNF)-alpha and interleukin (IL)-6 levels were measured. Results: TNF-alpha levels after 1.36% and 3.86% glucose used dwells were 23 +/- 14 pg/ml and 28 +/- 4 pg/ml, respectively (p = 0.78). The IL-6 levels were 106 +/- 57 pg/ml and 115 +/- 63 pg/ ml ( p = 0.81), respectively. Conclusion: In our in vivo study we found that the glucose concentration of the conventional lactate-based CAPD solution has no effect on basal IL-6 and TNF-alpha levels of peritoneal fluid. Further in vivo studies with non-lactate-based CAPD solutions are needed in order to determine the effect of glucose concentration per se on cytokine release.
Effect of Hormone Replacement Therapy on Cd4+ and Cd8+ Numbers, Cd4+ Ratio, and Immunoglobulin Levels in Hemodialysis Patients
(Taylor & Francis Ltd, 2005) Dogan, E; Erkoc, R; Demir, C; Sayarlioglu, H; Dilek, I; Sayarlioglu, M
Uremia induces a suppression of the immune status. A large clinical literature suggests that estradiol (E-2) plays a critical role in immune function. A large proportion of women hemodialysis patients faced early menopause and inadequate estrogen levels. The aim of the present study is to evaluate the effect of hormone replacement therapy on immune function in terms of CD4(+) numbers (inducer/helper T cells), CD8(+) numbers (cytotoxic/ suppressor T cells), CD4(+)/CD8(+) ratio, and IgG, IgM, IgA levels in woman hemodialysis patients. In our study, 15 female hemodialysis patients (median age 32.6 range 24-45) were treated with triphasic estrogen/progesterone preparation (estradiol 2 mg for 10 days, and afterwards estradiol 2 mg+norethisterone 1 mg for another 10 days, and at the end estradiol 1 mg for 6 days) for 6 months. CD4(+) numbers, CD8(+) numbers, and IgG, IgA, and IgM levels were determined before and after HRT. The "paired-samples T" test was used for statistical analysis of pretreatment and posttreatment values. A significant increase was observed for CD4(+) numbers (582 +/- 435 versus 637 +/- 445, p=0.04) and CD4(+)/CD8(+) ratio (1.4 +/- 0.16 to 2.4 +/- 0.3, p<0.01) after hormone replacement therapy (HRT). Serum immunoglobulin levels were not changed significantly. In conclusion, in postmenopausal hemodialysis patients, HRT significantly increased CD4(+) numbers and CD4(+)/CD8(+) ratio, but no effect was observed in IgM, IgG, and IgA levels. Long-term clinical effects of HRT on immune system should be investigated in dialysis patients with further studies.
Effect of Valsartan on Erythropoietin and Hemoglobin Levels in Stage Iii-Iv Chronic Kidney Disease Patients
(Wiley, 2005) Durmus, A; Dogan, E; Erkoc, R; Sayarlioglu, H; Topal, C; Dilek, I
Angiotensin-converting enzyme inhibitors (ACEIs) were accepted as a potential cause of inadequate epoetin response in chronic kidney disease (CKD) patients. We aimed to determine the effects of valsartan, an angiotensin receptor blocker (ARB), on serum ertyhropoietin levels and on certain biochemical and haematological parameters in hypertensive CKD patients. Twenty-two stage III-IV CKD patients (mean age; 56.8 +/- 8.9 years, 12 male 10 female) were included in the study. Before initiating the treatment, current anti-hypertensive treatments (if any) were discontinued, and blood samples were collected after a washout period of 3 weeks. Valsartan 80 mg/day was started, and additional anti-hypertensive agents were given according to study protocol if needed. One way Anova and paired t-tests were used for statistical comparisons. Serum blood urea nitrogen (BUN), creatinine, uric acid, potassium, haemoglobin and erythropoietin values were measured, and glomerular filtration rates were calculated before and 3, 6 and 90 days after valsartan treatment, a significant reduction in EPO level was observed at 3rd (19.6 +/- 24.0 vs. 13.8 +/- 8.5, p = 0.010), 6th (12.1 +/- 7.6, p = 0.009), and 90th days (8.3 +/- 5.4, p = 0.007). When pre-treatment values were compared with 90th day results, no significant change was observed in terms of hgb, htc, serum BUN, creatinine, uric acid, potassium, and GFR values. In conclusion, valsartan, an ARB, did not decrease haemoglobin levels In stage III-IV CKD patients despite significant reduction in serum erryhropoietin levels, so ARBs may be preferred to ACEIs in CKD patients when indicated.
Effects of Capd on Hepatosteatosis and Lipid Profile
(Oxford Univ Press, 2006) Sayarlioglu, H; Erkoc, R; Etlik, O; Sayarlioglu, M; Dogan, E; Kara, P
Effects of Late Referral To a Nephrologist in Patients With Chronic Renal Failure
(Wiley, 2005) Dogan, E; Erkoc, R; Sayarlioglu, H; Durmus, A; Topal, C
Background: We lack information about the role of late diagnosis of end-stage renal disease (ESRD), late nephrological referral and its impact on biochemical variables and first hospitalization in East Anatolia, Turkey. Methods and Results: For a total of 101 ESRD patients, dialysis was initiated between January 1998 and December 2002 at the Yuzuncu Yil University Hospital. Early referral (ER) and late referral (LR) were defined as the time of first referral or admission to a nephrologist greater or less than 12 weeks, respectively, before initiation of haemodialysis (HD). Results: The need for urgent dialysis was less among the early referral cases compared with the late referral cases (P = 0.03). Patients with LR started dialysis with lower levels of haemoglobin (8.6 vs 9.5 g/dL, P < 0.05) bicarbonate (16 vs 12 mEq/lt, P < 0.03) and albumin (2.9 vs 3.29 mg/dL, P < 0.02) and with higher serum levels of blood urea nitrogen (173 vs 95 mg/dL, P < 0.001), creatinine (10 vs 7.9 mg/dL, P < 0.001) and potassium (5.3 vs 4.8, P < 0.04). Hospitalization duration beginning at dialysis was significantly longer in the LR group (27.3 +/- 24) compared with the ER group (13.4 +/- 7.5, P < 0.001). When the groups were compared in terms of distance between the patients home and hospital, there were significantly more patients living far away from hospital (i.e. > 100 km) in the LR group compared with the ER (P < 0.0001) group. Conclusion: Early referral to a nephrology unit and/or early diagnosis of ESRD results in better biochemical variables, shorter first hospitalization length and a higher percentage of elective construction of AVF and the availability to start with an alternative dialysis modality (i.e. CAPD).
Fatal Lactic Acidosis Due To Leukemic Transformation in a Patient With Non-hodgkin's Lymphoma: Case Report
(Health Communications inc, 2005) Dogan, E; Erkoc, R; Sayarlioglu, H; Alici, S; Dilek, I; Alici, O
Lactic acidosis (LA) associated with hematologic malignancies is uncommon, life-threatening, and generally occurs in adults. Its pathogenesis is poorly understood. This is a case report of LA due to leukemic transformation that occurred in a patient with non-Hodgkin's lymphoma (NHL). A 24-year-old man with NHL was admitted to the hospital with dyspnea. Venous blood gas analysis revealed metabolic acidosis (pH 7.05; HCO3 6 mEq/L; BE 22 mmol/L; anion gap 28 mEq/L); the patient had an elevated plasma lactate concentration (12 mmol/L) and low glucose concentration (38 mg/dL). There was no reason other than leukemia-such as infection, circulatory failure, or drug use-for the development of severe LA. This case report shows that in patients with NHL, leukemic transformation may give rise to LA.
Gas-Forming Infection in a Renal Cyst of a Patient With Autosomal Dominant Polycystic Kidney Disease
(Oxford Univ Press, 2006) Erkoc, R; Sayarlioglu, H; Ceylan, K; Dogan, E; Kara, PS
Incidence of Renal Insufficiency in Cancer Patients
(Health Communications inc, 2005) Dogan, E; Izmirli, M; Ceylan, K; Erkoc, R; Sayarlioglu, H; Begenik, H; Alici, S
The frequency of chronic renal insufficiency among cancer patients is unclear. The aim of this study was to determine the frequency of impaired renal function within a population of cancer patients. One thousand two hundred seventeen patients (563 women, 654 men) with cancer underwent serum creatinine concentration and glomerular filtration rate (GFR) evaluations. The Cockcroft-Gault formula was used to estimate the GFR from the creatinine clearance (Cl-cr). Renal insufficiency was defined as a GFR <= 90 mL/min. Among this population, 72 (5.9%) demonstrated an abnormal serum creatinine concentration (>1.2 mg/dL). According to the Cockcroft-Gault formula evaluations, however, 330 (27.1%) of the patients had an estimated GFR <90 mL/min. Among these, the Cl-cr was between 60 and 89 mL/min in 241 patients (19.8%); 30 and 59 mL/min in 75 patients (6.2%); and 15 and 29 mL/min in 7 patients (0.6%); 7 patients (6%) had a Cl-cr <15 mL/min. As a result, 21.2% of patients demonstrating a normal serum creatinine level had abnormal renal function. Renal function should be evaluated in all cancer patients, regardless of their serum creatinine level, before any drug regimen is administered. The Cockcroft-Gault formula appears to be more accurate than serum creatinine concentration for diagnosing renal insufficiency in patients with cancer, but more prospective studies in this population will be necessary to confirm this finding.
Mycophenolate Mofetil Use in Hepatitis B Associated-Membranous and Membranoproliferative Glomerulonephritis Induces Viral Replication
(Harvey Whitney Books Co, 2005) Sayarlioglu, H; Erkoc, R; Dogan, E; Sayarlioglu, M; Topal, C
Nephropathy and Retinopathy in Type 2 Diabetic Patients Living at Moderately High Altitude and Sea Level
(Marcel dekker inc, 2005) Sayarlioglu, H; Erkoc, R; Dogan, E; Topal, C; Algun, E; Erem, C; Cmal, A
Background: High-altitude-induced hypoxia results in various diseases, such as chronic mountain sickness and high altitude retinal edema, and may affect severity and incidence of some cardiovascular diseases. In order to evaluate the effects of moderately high altitude on diabetic nephropathy and retinopathy, a cross-sectional study was planned. Material Method: Long-term type II diabetic residents of sea level (n = 75, 38 male, 37 female, mean age 51.9 +/- 10.5 in Trabzon and Zonguldak cities) and moderately high altitude (h = 1,727 m, n = 73, 28 male, 45 female, mean age 48.3 +/- 12.1, Van city) were compared. Results: No difference was observed in terms of age, gender, diabetes duration, body mass index, smoking, systolic, diastolic, and mean arterial blood pressure values, serum glucose levels, cholesterol, high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol, hemoglobin, HbAlC, hypertension control, or blood pressure medications and retinopathy incidence. Mean 24 h protein excretion (210.0 +/- 139.9, 127.8 +/- 112.1 mg: P = 0.00). proteinuria prevalence (57.5% versus 33.3%, p = 0.003), and serum creatinine levels (1.04 +/- 0.22 versus 0.84 +/- 0.21,p = 0.00) were significantly higher in the highlanders, glomerular filtration rate (GFR) was significantly lower in sea level (SL) patients (90.9 +/- 26.5 versus 83 +/- 21.1: p = 0.05). Conclusion: Tendency to diabetic nephropathy as indicated by higher proteinuria and creatinine levels is increased among type 2 diabetic patients living at moderately high altitude. Prospective studies are needed to confirm these findings.
Nonketotic Hyperosmolar Coma in a Patient With Type 1 Diabetes-Related Diabetic Nephropathy: Case Report
(Springer, 2005) Dogan, E; Erkoc, R; Sayarlioglu, H; Buyukbese, A
Nonketotic hyperosmolar coma (NHC) is characterized by severe hyperglycemia; absence of, or only slight ketosis; nonketotic acidosis; severe dehydration; depressed sensorium or frank coma; and various neurologic signs. This condition is uncommon in type 1 diabetes. Because of little or no osmotic diuresis, in patients with diabetic nephropathy, increases in plasma osmolality and therefore the likelihood of neurologic symptoms are limited. A 20-year-old male patient with type 1 diabetes with chronic kidney disease on conservative treatment (glomerular filtration rate [GFR], 18 mL/dk) presented with acute nonketotic hyperosmolar syndrome. The patient was admitted presenting with thirst, fatigue, and drowsiness. Blood biochemistry levels were urea 87 mg/dL, creatinine 5.09 mg/dL, glucose 830 mg/dL, glycosylated hemoglobin (HbA(1c)) 8%, C peptide < 0.3 ng/mL, sodium 131 mmol/L, chloride 93 mmol/L, potassium 5.2 mmol/L, and calculated serum osmolality 385 mOsm/kg. The presumptive diagnosis on admission was nonketotic hyperosmolar syndrome precipitated by urinary infection. This is the first case report of hyperosmolar coma in a patient with type 1 diabetes with chronic kidney disease.
Peritoneal Hydatid Cyst: an Unusual Cause of Abdominal Pain in a Haemodialysis Patient
(Oxford Univ Press, 2006) Sayarlioglu, H; Erkoc, R; Soyoral, Y; Etlik, O; Dogan, E; Kotan, C
Relation Between Depression, Some Laboratory Parameters and Quality of Life in Hemodialysis Patients
(Oxford Univ Press, 2005) Dogan, E; Erkoc, R; Eryonucu, B; Sayarlioglu, H; Agargun, MY
Relation Between Depression, Some Laboratory Parameters, and Quality of Life in Hemodialysis Patients
(Taylor & Francis inc, 2005) Dogan, E; Erkoc, R; Eryonucu, B; Sayarlioglu, H; Agargun, MYA
Depression is common in patients with end-stage renal disease (ESRD) and is associated with increased mortality and morbidity. Several investigators have estimated that depression occurs in about 20% to 30% of dialysis patients. The aim of this study was to investigate the relationship between depression, some laboratory parameters, and quality of life (QOL) in hemodialysis patients. Forty-three hemodialysis patients (mean age 40.5 +/- 15.2; M = 28, F = 15) were included in the study. Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and short form with 36 (SF-36) were used for evaluation. Subsequently, patients were divided into two groups according to HAMD scores: group 1, those who had a low HAMD score (between 0 and 7), and group 2, those who had a high HAMD score (over 7). The two groups were compared in terms of anxiety scores, QOL scores, and some laboratory parameters. The group 2 patients (n = 21; M = 13, F = 8) had lower levels of hemoglobin than the group 1 patients (9.5 +/- 1.7 vs. 10.7 +/- 1.4 g/dL, respectively; p < 0.01). Group 2 patients also had lower SF-36 scores than group 1 patients (91.5 +/- 21.3 vs. 74.9 +/- 13.6, respectively; p = 0.03). On the contrary, the patients of group 2 had higher HAMA scores than group 1 patients (16.6 +/- 6.9 vs. 6.3 +/- 3.5, respectively; p < 0.01) and CRP level (10.7 +/- 4.6 vs. 4.5 +/- 3.8, respectively; p < 0.001). A significant correlation was found between depression scores and C-reactive protein (CRP) (r = 0.57, p < 0.001) and HAMA scores (r = -0.43, p < 0.05). In contrast, a negative correlation was found between HAMD scores and albumin (r = -0.43, p< 0.05), hemoglobin (r = -0.38, p = 0.015) and SF-36 scores (r = 0.39, p = 0.032). These findings demonstrate that there is a relationship among high depression score, low levels of hemoglobin and albumin, high CRP level, low SF-36 score, and high anxiety score. Evaluation of psychiatric status should be part of the care provided to hemodialysis patients.
Sheehan Syndrome Presented With Acute Renal Failure Associated With Rhabdomyolysis and Hyponatraemia
(Oxford Univ Press, 2006) Sayarlioglu, H; Erkoc, R; Sayarlioglu, M; Dogan, E; Kara, PS; Begenik, H
Tuberculin Skin Test Results and the Booster Phenomenon in Two-Step Tuberculin Skin Testing in Hemodialysis Patients
(Taylor & Francis Ltd, 2005) Dogan, E; Erkoc, R; Sayarlioglu, H; Uzun, K
Patients with chronic renal failure are at increased risk for tuberculosis (TB). Centers for Disease Control and Prevention (CDC) have recommended annual skin testing for TB, with tuberculin-purified protein derivative (PPD), in patients with chronic renal failure. Uremia alters the macrophage function, which can lead to anergy for skin tests. The aim of this prospective study was to determine the prevalence of positive tuberculin skin test (TST) and the booster effect of TST in hemodialysis patients living in a relatively underdeveloped portion of the country. Material and Methods. Patients were recruited from Van (Yuzuncu Yil University Hospital, Yuksek Ihtisas Hospital) and the Mus State Hospital). At the time of this study, a total of 143 patients were under hemodialysis treatment in these hemodialysis centers, and among them, 124 were included in the study. Informed consent was obtained before inclusion in the study. A positive PPD was an induration of >10 mm in response to five tuberculin units of PPD (RT23-Tween 80), at 72 h. TST-negative patients received a booster TST 10 days later, similar to 10 cm away from the previous intracutaneous injection. The test dose could not be increased due to unavailability of this kind of preparation. The test was performed and interpreted in the same way. Skin testing was performed in June and December 2003. Patients with known active TB are not included in the study. Testing was not done in hospitalized patients to rule out effects of other disease states. Results. Mean age of the patients was 45.3 +/- 16 (range 13-82) years. All patients were on HD treatment twice (n: 14) or three times (n: 110) weekly. Duration of dialysis before TST was 30 +/- 17 (12-84) months. With the first test (n: 14), 11.3% of the patients showed a positive reaction; the second test added (n: 15) 12.1% more TST-positive patients, reaching a total of (n: 29) 23.4% of the patients with a positive TST. The mean induration of the positive TST was 16 +/- 4 mm in the first test and 15 +/- 3 mm in the second. Five (17.2%) of the patients with positive PPD and two of the patients (2.1%) with negative PPD results subsequently developed active TB within 12 months. Conclusion. We found a significant booster effect in our hemodialysis patients using TST-2. Repeat PPD test with the same dosage could detect positive patients more than twofold higher. Among positive PPD patients, TB incidence is considerably high.
Tuberculin Skin Test Results and Tuberculosis Incidence; Report From a High Incidence Area
(Oxford Univ Press, 2005) Dogan, E; Erkoc, R; Sayarlioglu, H; Uzun, K
Tuberculosis in Dialysis Patients, Single Centre Experience From an Endemic Area
(Wiley, 2004) Erkoc, R; Dogan, E; Sayarlioglu, H; Etlik, O; Topal, C; Calka, F; Uzun, K
Because of immunity defect, patients with end-stage renal disease are at increased risk of developing infections, tuberculosis (TB) in particular. The incidence of TB is higher in dialysis patients than in general population. We retrospectively reviewed the charts of dialysis patients with TB in our facility. A total of 287 dialysis patients (153 male, 134 female, 223 haemodialysis (HD), 64 continuous ambulatory peritoneal dialysis (CAPD) patients, mean age 46 +/- 15) were reviewed from October 1997 to January 2002. TB developed in 30 patients (17 male, 13 female, 24 HD and six CAPD). Thirteen patients with TB presented with fever of unknown origin (FUO) and four of them subsequently developed military lesions on chest X-ray. Nine patients had pulmonary TB (four with pleural effusions), five patients had TB lymphadenits, two patients had TB peritonitis and one patient had vertebral TB. TB was presented mostly as FUO among dialysis patients in a region under poor socio-economic conditions. In such areas with endemic TB, dialysis patients who present with FUO should be carefully evaluated for the presence of TB, and test therapy for TB should be performed in otherwise unexplained FUO.