Browsing by Author "Esen, Ramazan"

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Altered Serum Levels of Elements in Acute Leukemia Cases in Turkey
(Asian Pacific Organization Cancer Prevention, 2011) Demir, Cengiz; Demir, Halit; Esen, Ramazan; Sehitogullari, Abidin; Atmaca, Murat; Alay, Murat
Objective: The purpose of the study was to compare serum concentrations of some elements [zinc (Zn), copper (Cu), manganese (Mn), magnesium (Mg), lead (Pb), iron (Fe), cadmium (Cd) and cobalt (Co)] in acute leukemia patients with those of healthy subjects. Methods: The study group consisted of newly diagnosed acute leukemia patients and the controls were matched for socioeconomic stauts and eating habits. The elements levels in the patient group were measured before treatment with an atomic absorption spectrophotometer. The selection criteria for the patients and controls were the lack of recent blood transfusion history and taking any medication with mineral supplement. Results: The acute leukemia group composed of 42 patients and there were 40 persons in the control group. There was no difference between the age of the two groups (p=0.239). Serum levels of Zn, Mg and Mn were significantly lower with acute leukemia than in controls (p<0.001, p=0.011, p<0.001, respectively), while Cu, Pb and Cd were significantly elevated (p=0.003, p<0.001, p<0.001, respectively). There were no significant differences regarding Co and Fe (p=0.323 and p=0.508, respectively) Conclusion: In this study, we found levels of Zn, Mg and Mn to be lowered and of Cu, Pb and Cd to be elevated in patients with leukemia. Further studies are needed to clarify the role of these elements in pathogenesis of acute leukemia.
Alveolar Echinococcosis of the Liver: a Single Center Experience
(Medycyna Praktyczna Sp K Sp Zoo, 2012) Dulger, Ahmet C.; Esen, Ramazan; Begenik, Huseyin; Aytemiz, Enver; Demirtas, Levent; Aslan, Mehmet
INTRODUCTION In humans, alveolar echinococcosis (AE) of the liver is caused by canine tapeworm called Echinococcus multilocularis. The disease is most prevalent in the northern hemisphere and in the eastern part of Turkey. OBJECTIVES The aim of the study was to review the natural history of AE and its clinical and radiological features. PATIENTS AND METHODS The retrospective study involved 23 patients (10 men, 13 women), aged 34-75 years with AE who had been referred to our liver disease clinic in the past 4 years. Only patients with pathologically proven AE were included in the study. The sociodemographic, clinical, and radiological features of AE were also evaluated. RESULTS The main laboratory characteristics of AE included mild eosinophilic leukocytosis with hyper-gammaglobulinemia, elevated C-reactive protein levels, near-normal liver transaminases, and increased levels of cholestatic enzymes and immunoglobulin E. Eight patients (35%) had hepatitis B e antigen-negative hepatitis B infection. Budd-Chiari syndrome was identified in 3 of 23 patients (13%). Eighty-three percent of the patients had a seropositive test result for AE, and approximately one-third of the patients had distant metastasis. Surgical treatment was administered in 4 patients. Four patients died due to complications during follow-up. CONCLUSIONS Patients with AE have numerous complications and advanced disease at the time of diagnosis. The clinical picture of AE comprises a number of hepatic and extrahepatic disturbances related both to destructive and mass effects of the tapeworm.
Aspirin Resistance in Patients With Type Ii Diabetes Mellitus
(Taylor & Francis Ltd, 2014) Tasdemir, Eyyup; Toptas, Tayfur; Demir, Cengiz; Esen, Ramazan; Atmaca, Murat
Background. Diabetic patients exhibit platelet hyperreactivity, which renders them resistant to antithrombotic treatments. We aimed to investigate the prevalence and predictors of aspirin resistance in diabetic patients. Material and methods. A total of 93 diabetic and 37 non-diabetic participants were included into the study. Aspirin resistance was measured with a whole-blood desktop platelet function analyzer (PFA-100) with an epinephrine agonist. Results. Altogether 41.9% patients with DM were aspirin non-responders. Aspirin resistance was observed in 43.2% of nondiabetic patients (p = 0.89). Presence of diabetes mellitus had no effect on aspirin response (RR 0.95 (95% CI 0.44-2.05), p = 0.89) in the whole study population. Hypercholesterolemia was the only predictor of aspirin resistance in multivariate analysis in diabetic patients (RR 3.09 (95% CI 1.17-8.16), p = 0.023). Conclusion. The prevalence of aspirin resistance is comparable in diabetic and non-diabetic patients. Hypercholesterolemia is the only independent predictor of aspirin resistance in diabetic patients.
Author's Reply: Predictors of Aspirin Resistance
(informa Healthcare, 2014) Toptas, Tayfur; Tasdemir, Eyyup; Demir, Cengiz; Esen, Ramazan; Atmaca, Murat
Benign Glycogenic Acanthosis Lesions of the Esophagus
(Turkish Soc Gastroenterology, 2012) Nazligul, Yasar; Aslan, Mehmet; Esen, Ramazan; Yeniova, Abdullah Ozgur; Kefeli, Ayse; Kucukazman, Metin; Celik, Yilmaz
Background/aims: Glycogenic acanthosis is described as benign thickening of the esophageal squamous epithelium of unknown etiology. Although its etiology is unknown, it has been reported that glycogenic acanthosis may be related to gastroesophageal reflux and hiatal hernia. The aim of the present study was to review the patients who were diagnosed with glycogenic acanthosis on upper gastrointestinal endoscopy and to determine whether there is any association between glycogenic acanthosis and gastroesophageal reflux and hiatal hernia. Material and Methods: A total of 504 patients who underwent upper gastrointestinal endoscopy for evaluation of non-ulcer dyspepsia were reviewed retrospectively. Results: Glycogenic acanthosis was detected in 143 (28.3%) of those 504 patients. Of the 143 patients, 82 (57.3%) were male and 61 (42.7%) were female. Patients with glycogenic acanthosis were aged 20-83 years. Gastroesophageal reflux was detected in 50 (34.9%) cases with glycogenic acanthosis, while hiatal hernia was detected in 30 (20.9%) cases. Gastroesophageal reflux was detected in 102 (28.2%) control subjects, while hiatal hernia was detected in 50 (13.8%). Hiatal hernia was significantly higher in glycogenic acanthosis patients than in controls subjects (p<0.05). Glycogenic acanthosis patients had higher gastroesophageal reflux than seen in controls subjects, but the difference between groups was not statistically significant (p>0.05). Conclusions: Our results suggest that glycogenic acanthosis is primarily an age-related disease. We demonstrated that glycogenic acanthosis may be associated with gastroesophageal reflux and hiatal hernia. Further studies are necessary to confirm these findings.
Bone Marrow Biopsy Findings in Brucellosis Patients With Hematologic Abnormalities
(Lippincott Williams & Wilkins, 2012) Demir, Cengiz; Karahocagil, Mustafa Kasim; Esen, Ramazan; Atmaca, Murat; Gonullu, Hayriye; Akdeniz, Hayrettin
Background Brucellosis can mimic various multisytem diseases, showing wide clinical polymorphism that frequently leads to misdiagnosis and treatment delay, further increasing the complication rates. In this study, we aimed to examine bone marrow biopsy findings in brucellosis cases presenting with hematologic abnormalities. Methods Forty-eight brucellosis cases were prospectively investigated. Complaints and physical examination findings of patients were recorded. Patients' complete blood count, routine biochemical tests, erythrocyte sedimentation rate, C-reactive protein and serological screenings were performed. Bone marrow biopsy and aspiration was performed in patients with cytopenia, for bone marrow examination and brucella culture, in accordance with the standard procedures from spina iliaca posterior superior region of pelvic bone. Results Of the 48 patients, 35 (73%) were female and 13 (27%) were male. Mean age was (34.8 15.4) years (age range: 15-70 years). Anemia, leukopenia, thrombocytopenia and pancytopenia were found in 39 (81%), 28 (58%), 22 (46%) and 10 patients (21%), respectively. In the examination of bone marrow, hypercellularity was found in 35 (73%) patients. Increased megacariocytic, erythroid and granulocytic series were found in 28 (58%), 15 (31%) and 5 (10%) patients, respectively. In addition, hemophagocytosis was observed in 15 (31%) patients, granuloma observed in 12 (25%) and increased eosinophil and plasma cells observed in 9 (19%) patients. Conclusion According to the results of our series, hemophagocytosis, microgranuloma formation and hypersplenism may be responsible for hematologic complications of brucellosis. Chin Med J 2012;125(11):1871-1876
Co-Occurrence of Hepatocellular Cancer and Non-Hodgkin Lymphoma
(Medycyna Praktyczna Sp K Sp Zoo, 2013) Dulger, Ahmet C.; Aslan, Mehmet; Olmez, Sehmus; Esen, Ramazan; Tasdemir, Mehmet; Aytemiz, Enver; Kalkan, Nurhan O.
Dekompanse Karaciğer Sirozlu Hastalarda Hepatoselluler Kanser (Hsk) Açısından Tanısal Değerler
(2006) Türkdoğan, Kürşat; Dülger, Ahmet Cumhur; Esen, Ramazan; Tuncer, İlyas
Amaç: Hepatosellüler kanser (HSK) karaciğerin en sık görülen primer malign tümörüdür. Hepatit B'nin yöremizdeki yüksek prevalansı nedeniyle HSK da oldukça sıktır. Bu çalışmada HSK'nın ve dekompanse karaciğer sirozunun özelliklerini araştırmayı ve karşılaştırmayı amaçladık. Yöntem: Çalışmada 2002- 2005 yılları arasında Gastroenteroloji kliniğimizde izlenen HSK'lı ve kronik viral hepatitlere bağlı dekompanse karaciğer sirozlu hastalar prospektif olarak incelendi. Hasta sayısı 75 olup yaş ortalaması 53'dü. Bunların 39'u HSK'li ve 36'sı ise dekompanse karaciğer sirozluydu. İki grubun demografik verileri kaydedilerek; hematolojik, biyokimyasal, serolojik ve radyolojik incelenmeler yapıldı. Verilere Anova analizi ve ki kare testi uygulandı. Bulgular: HSK' lileri Grup1, dekompanse sirozluları grup 2 olarak sınıflandırdık. Grup 1'de erkek/kadın oranı 4.5; grup 2'de 3 idi. Her iki grubun büyük kısmı kırsal kesimde yaşıyordu. Grup 1'in %82'sinde grup 2'nin %92' sinde etyolojik ajan HBV idi. Grup 1'de trombosit sayısı, sedimentasyon, alfa fetoprotein, alkalen fosfataz oranları grup 2'ye göre istatistiksel olarak anlamlı oranda yüksekti (p<0,001; p<0,005; p<0,001; p<0,05). HSK'lı olgularda serum demir ve protrombin zamanı grup 2'ye göre anlamlı derecede düşüktü (<0.05). HSK'li olguların %51.2'sinde tümör sağ lobda yerleşimliydi; tümör çapı olguların %61.5'inde 5 cm'nin üzerinde idi. Sonuç: Çalışmamız özellikle dekompanse sirozlu hastalarda HSK taraması için trombosit sayısı, eritrosit sedimentasyon hızı, alfa fetoprotein, alkalen fosfataz ile serum demir düzeylerinin ve protrombin zamanının önemini ortaya koymaktadır.
Effects of Low Sodium Dialysate in Chronic Hemodialysis Patients With Hypertension
(Oxford Univ Press, 2007) Esen, Ramazan; Erkoc, Reha; Sayarlioglu, Hayriye; Soyoral, Yasemin; Dogan, Ekrem; Sekeroglu, Ramazan; Begenik, Huseyin
Effects of Low Sodium Dialysate in Chronic Hemodialysis Patients: an Echocardiographic Study
(Taylor & Francis Ltd, 2007) Sayarlioglu, Hayriye; Erkoc, Reha; Tuncer, Mustafa; Soyoral, Yasemin; Esen, Ramazan; Gumrukcuoglu, Hasan Ali; Sayarlioglu, Mehmet
Background. Chronic kidney disease (CKD) and hemodialysis (HD) patients who cannot restrict sodium consumption in their diets sometimes develop significant saline excess and hypertension between dialyses. This study assessed the effect of relatively low sodium dialysate dialysis on changes of echocardiography in hemodialysis patients. Methods and Results. Eighteen patients with end stage renal failure on chronic HD were studied (8 females, 10 males) with a mean age 48.3 +/- 14.6 (24-70) years. The mean time on HD was 30.8 +/- 14.0 (12-60) months. Patients with hematocrit levels under 24% were excluded from the study. In all patients, echocardiography was performed thrice weekly before and after eight-week HD treatment with low sodium dialysate hemodialysis by the same operator (135 mEq/L for patients with sodium levels less than 137, 137 for patients with sodium levels over 137). Left atrium (LA) and left ventricle (LV) volumes and ejection fractions were measured, specifically: LV systolic diameter (LVSD), LV diastolic diameter (LVDD), interventricular septum (IVS), tricuspid regurgitation (TR), mitral regurgitation (MR), pulmonary artery pressure (PAP), and inferior vein cava diameter (IVCD). Results. In terms of echocardiographic parameters, LVSD, TR, PAP, and IVCD were statistically decreased after low-sodium dialysate treatments (p = 0.002, 0.04, 0.013, and 0.00, respectively). Predialysis systolic and diastolic blood pressure (BP), post-dialysis systolic blood pressure, and interdialytic weight gain was statistically decreased when compared to basal levels (p = 0.00, p = 0.011, p = 0.022, p = 0.001, respectively). Conclusion A reduction of the dialysate sodium concentration based on the predialysis sodium levels of the patients could reduce the systolic BP and decrease the volume load on the heart as assessed by echocardiography. Within this short period, postdialysis diastolic BP could not be lowered. The effect of this approach should be studied in broad and lengthy series.
Effects of Lowering Dialysate Sodium in Hipertansive Hemodialaysis Patients.
(2006) Esen, Ramazan; Erkoç, Reha
Az sayıda olgu içeren sınırlı sayıda çalısmada hemodiyaliz hastalarında diyalizat sodyumunun azaltılmasının kan basıncını azaltabildiği gösterilmistir.Biz de plazma sodyum (Na)'na göre iki değisik diyalizat sodyumu kullanılan uygulanabilir bir yaklasımın hemodiyaliz hastalarında etkilerini arastırmayı planladık. Kronik olarak hemodiyalize giren 24 hasta tek kör, prospektif, crossover çalısmaya alındı.Diyaliz öncesi plazma sodyum düzeyi 137mEq/L'nin üzerinde olan hastalara diyalizat sodyum konsantrasyonu 137mEq/L, diyaliz öncesi plazma sodyum konsantrasyonu 137mEq/L' ye esit ve altında olan hastalara ise diyalizat sodyum konsantrasyonu 135mEq/L olacak sekilde sekiz hafta diyaliz uygulandı. Ardından hastalar dört hafta boyunca standart 140 mEq/L diyalizat sodyumu ile diyalize alındılar.Hastalar standart diyalizat Na'lu hemodiyaliz olurlarken , düsük diyalizat ve tekrar standart Na uygulanırken son üç diyaliz seansında değerlendirildiler. Hastalar düsük diyalizat sodyumu ile tedavi ve tekrar standart sodyum ile tedaviye geçildiğinde kan basınçları bazal düzeye göre anlamlı olarak azaldı (181.42 ± 24.20/103.18 ± 12.44,148.50 ± 15.68/93.10 ± 10.25,155.24 ± 16.68/93.78 ± 7.19 mmHg; P<0.001). ?nterdialitik kilo alım (?DKA)'ları düsük diyalizat sodyumla tedavi sonrası azaldı (2597.58 ± 673.30, 1756.79 ± 632.77 gr.; P<0.001). Ancak standart sodyum tedavisi sonrası ?DKA arttı ve baslangıçtaki değerle arasında anlamlı farklılık yoktu (2597.58 ± 673.30, 2602.79 ± 807.50; P>0.1). Hastalara düsük diyalizat sodyumu ile tedavi verildiğinde diyaliz öncesi Na konsantrasyonları azaldı (136.88 ± 1.48, 132.96 ± 2.07 mEq/L; P<0.001). Hastalar tekrar standart diyalizat sodyumu ile tedavi edildiklerinde baslangıç değerine göre diyaliz öncesi sodyum konsantrasyonlarında artıs oldu (136.88 ± 1.48, 140.13 ± 2.86 mEq/L; P<0.001). Düsük diyalizat sodyumu ile tedavi sonrası hastaların susama hislerinde azalma oldu. 6 Hastalar yeniden standart sodyumla tedavi olduklarında susama hisleri arttı ve baslangıçla arasında anlamlı farklılık yoktu. Hastalarda diyaliz esnasında gözlenen hipotansif atak sıklığında tüm çalısma süresince anlamlı bir değisiklik olmadı. Hemodiyaliz hastalarında diyaliz öncesi Na konsantrasyonuna göre diyalizat sodyumunun azaltılması, hastalarda ?DKA'yı, susama hissini ve kan basıncını azaltır. Hastalar tekrar standart Na'lu diyalizat ile tedavi olduklarında bu olumlu etki, diyaliz öncesi serum Na düzeyindeki artısa rağmen devam eder.
Endobronchial Aspergilloma: a Case Report
(Elsevier Science Bv, 2016) Sunnetcioglu, Aysel; Ekin, Selami; Erten, Remzi; Parlak, Mehmet; Esen, Ramazan
A 28-year-old male with B-cell acute lymphoblastic leukemia presented to our pulmonary clinic with progressive dyspnea, cough, hemoptysis, and fever. Diagnostic bronchoscopy revealed white masses at the entrance of the right middle lobe bronchus and distal to the right main bronchus. Histopathological examination of the biopsy specimen showed those masses to be hyphae of Aspergillus. (C) 2016 The Authors. Published by Elsevier Ltd.
Endodermal Sinus Tumor Presented With Ascites: a Case Report
(Elmer Press inc, 2012) Dulger, Ahmet Cumhur; Begenik, Huseyin; Esen, Ramazan; Rafet, Mete
We report a case of primary endodermal sinus tumor of the omenturn which may be the fourth reported case in the English literature. A 19-year-old boy presented with ascites. Analysis of ascites revealed high levels of AFP and CA 125. Laparoscopic biopsy showed endodermal sinus tumour. He was treated with four courses of the BEP regimen (bleomycin, etoposide, cisplatin). The patient was died 2 months after the first appearance of the ascites. Endodermal sinus tumor (EST) is a rare neoplasm which usually arises in the testis or ovary. But extragonadal EST especially located in the abdomen is very rare condition. Clinicians should remain vigilant particularly, when there is a low gradient ascites and are high levels of tumor markers in ascites in young patients.
Erythrocyte Catalase and Carbonic Anhydrase Activities in Acute Leukemias
(Asian Pacific Organization Cancer Prevention, 2010) Demir, Cengiz; Demir, Halit; Esen, Ramazan; Atmaca, Murat; Tasdemir, Eyuep
Objective: To determine activity of catalase (CAT) as a antioxidant and carbonic anhydrase (CA) in erythrocytes from acute leukemia cases. Methods: Subjects were recruited from patients attending the outpatient clinics or hospitalised in the ward of the Hematology Department of Yuzuncu Yil University Hospital. Venous blood samples were taken from a total of 67 individuals (31 with acute leukemia and 36 healthy) included in the study. CAT enzyme activity was determined in erythrocytes using Aebi's method and CA by hydration of CO2. Results: CAT activity was found to be significantly decreased (P<0.001) on average in acute leukemia cases as compared to the control group while erythrocyte CA activity was significantly increased (P<0.001). Conclusions: Our findings point to malfunction of the antioxidant system in acute leukemia patients. Hence we need to investigation the cause and also its possible contribution to prognosis. Furthermore, clarification of the relationship between the antoxidant system and CA inhibitors in the pathogenesis of acute leukemia appears warranted.
The Evaluation of Histopathological Findings, Clinical Staging and Treatment Results of Malignant Melanoma Cases
(2021) Türkoğlu, Zarife; Esen, Ramazan
Malign melanom sık görülen kanser tipi değildir. Bu yüzden malign melanom hastaları ile ilgili yeterli veri yoktur. Bu sebeple Yüzüncü Yıl Üniversitesi Hastanesinde malign melanom tanısı konulan ve takip edilen hastaların histopatolojik bulguları, klinik evrelemesi ve demografik verilerinin değerlendirilmesi amaçlandı. Yüzüncü Yıl Üniversitesi Hastanesinde Onkolojik Kayıt Birimi verilerine göre Ocak 2010 ve Aralık 2019 tarihleri arasında, melanom tanısı ile takip edilen 87 erişkin hastanın arşiv dosyaları geriye dönük olarak incelendi. Hastaların 45'i kadın 50'si erkek olup, kadın/erkek oranı 0,9/1 olarak bulundu. Hastaların yaş ortalaması 56.94±16.44 idi (minimum: 24 yaş ve maksimum: 90 yaş). Ortanca yaş, kadın cinsiyette 60, erkek cinsiyette 57 olup benzer idi. Melanom alt tiplerine göre ise, istatistiksel olarak anlamlı fark saptanmadı. Hastaların 73'ü (%81.1) cilt kökenli melanom, 9'u (%10.0) oküler melanom ve 8'i (%8,9) mukozal melanom hastası idi. 5 hastada melanomun primer köken aldığı lokalizasyon belirlenememiştir. Oküler melanomda kadın cinsiyet daha sık iken % 55,5 (e:4 k:5) cilt ve mukozal melanomda erkek cinsiyetin daha baskın olduğu görüldü %50,6 (e:37 k:36) %62,5 (e:5 k:3). Lokalizasyonlarına göre incelendiğinde, ekstremite kökenli melanom sık görülen tipti (n= 32; %33.7). Olguların %22.'i (n=21) baş-boyun, %9,5'i (n=9) gövde yerleşimli idi. 5 olguda (%5,3) ise lokalizasyon hakkında veriye ulaşılamadı. Alt ekstremite yerleşimli olgular tüm ekstremite kökenli melanom olgularının %71,8'ini oluşturmaktaydı. Histolojik tipine göre cilt mukozaları incelendiğinde en sık görülen histolojik tip nodüler melanom idi (n=28; %46.7). Cilt kökenli melanom olgularında alt tiplere göre sağkalım incelendiğinde, akral lentiginöz melanomda ortalama 27.1 ay, lentigo melanomda ortalama 26.7 ay, yüzeyel melanomda ortalama 24.4 ay ve nodüler melanomda ortalama 13.5 ay medyan sağkalıma ulaşıldı. Melanom olgularında lokalizasyonun sağkalım üzerine etkisi anlamlı olarak saptandı (p<0.05). The American Joint Committee on Cancer (AJCC) ile evreleme cilt kökenli melanom olgularının 67'sinde (%91.7) sağlıklı olarak yapılabildi. Bu olgularda en sık izlenen evre %43.2 (n=29) ile evre 4 iken, diğer gözlenen evreler sırasıyla %32.8 Evre 2 (n=22), %19.4 Evre 1 (n=13) ve %4.4 ile Evre 3 (n=3) idi. Toplam 5 hastada adjuvan interferon kullanılmış idi. 3 hastada 10 MU/m2, 1 hastada <10 MU/m2 ve 1 hastada 20 MU/m2 uygulanmıştı. Metastatik cilt melanomu olan ve kemoterapi ile tedavi edilen 17 hastada en sık tercih edilen kemoterapi protokolü 11 hasta ile temozolamid idi. Daha sonra sırasıyla 4 hastada nivolumab, 4 hastada ipilimumab verildiği ve 2 hastada ise vemurafenib kullanıldığı gözlendi. Oküler melanomlu 9 hastanın tamamına cerrahi enükleasyon yapılmıştı. Bu hastaların 7'sinde cerrahi sınır 'negatif' iken, 2'sinde cerrahi sınır bilinmiyordu. 2 hastaya palyatif radyoterapi uygulandı. Yaptığımız bu çalışma Türkiye'de malign melanom olgularını inceleyen en geniş kapsamlı çalışmalardan birisidir.
Exploring Intensivist Involvement: Patient Characteristics, Interventions and Outcomes
(Turkish Assoc Tuberculosis & Thorax, 2024) Arikan, Huseyin; Yeler, Ayvaz; Esen, Ramazan
Introduction: Intensivists play a critical role in the management of intensive care units (ICUs) and in providing high quality care. While international guidelines recommend intensivist staffing for improved patient outcomes, there is a shortage of qualified intensivists in many regions, including T & uuml;rkiye. This study aimed to assess the impact of introducing a full-time intensivist to a medical ICU on patient characteristics, outcomes, and ICU interventions. Materials and Methods: This retrospective study analyzed data from the Internal Medicine ICU at Van Y & uuml;z & uuml;nc & uuml; Y & imath;l University Dursun Odaba & scedil; Medical Center over two periods: Pre- and post-intensivist recruitment. The study included adult patients admitted to the ICU from February 2018 to January 2020. Patient demographics, reasons for ICU admission, APACHE -II and SOFA scores, ICU interventions, and outcomes were recorded and compared between the two periods. Results: Of the 868 patients admitted during the study period, 820 were included in the analysis. There were no significant differences in demographic characteristics between the pre- and post-intensivist periods. However, patients in the post-intensivist period had higher APACHE -II and SOFA scores. Intensive care units mortality rates were comparable between the two periods. The post-intensivist period saw increased use of invasive mechanical ventilation and non-invasive ventilation compared to the pre-intensivist period. Renal replacement therapy usage and enteral nutrition provision also increased in the post-intensivist period. ICU and hospital lengths of stay remained similar between the two periods. Conclusion: The introduction of a full-time intensivist to the medical ICU led to changes in ICU interventions, including increased use of mechanical ventilation and renal replacement therapy. Despite these changes, ICU mortality rates remained unchanged. Further research is needed to explore the longterm impact of intensivist staffing on patient outcomes in T & uuml;rkiye.
A Flare of Ulcerative Colitis Accompanied With Cerebral Sinus Venous Thrombosis and Bilateral Thalamic Infarctus: A Case Report
(Elmer Press inc, 2012) Dulger, Ahmet Cumhur; Begenik, Huseyin; Demirtas, Levent; Esen, Ramazan; Emre, Habib
Ulcerative colitis (UC) is a chronic inflammatory and recurrent disorder that is characterized by bowel inflammation. Some patients with Inflammatory Bowel Disease (IBD) have acute, severe, and sometimes devastating intracranial complications that require immediate medical intervention. Cerebral sinus vein thrombosis is a rare but serious extraintestinal complication associated with ulcerative colitis. Herein we report a 30-year-old man with UC who presented with a flare of gastrointestinal symptoms with mental obtundation and apathy. Total colonoscopy revealed active colitis and cranial MRI showed extensive cerebral sinus venous thrombosis with thalamic infarcts. Because the patient was clinically unstable metilprednisolon with low molecular weight heparin were administered. Two days after treatment the patient was died despite all medical efforts.
Gebelikte Akut Böbrek Yetersizliği
(2006) Sayarlioglu, Hayriye; Dilek, İmdat; Esen, Ramazan; Topal, Cevat; Erkoç, Reha; Doğan, Ekrem
Gelişmekte olan ülkelerde alınan tüm önlemlere rağmen obstetrik kaynaklı akut böbrek yetersizliği (ABY) halen önemli bir problemdir. Bu çalışmada 2000-2004 yılları arasında ABY tanısı ile izlenen 402 hastadan obstetrik nedenli olan 37 olgu değerlendirildi. Bu hastalarda ABY; %40.5 (n=15) doğum sonu kanamaya, %24.2 (n=9) eklampsi ve HELLP sendromuna, % 13.5 (n-5) sepsise, %13.5 (n=5) yeni tanı kronik böbrek yetersizliğine bağlandı. Birinde kronik hipertansiyon zemininde gelişen preeklanıpsi mevcuttu. İki vakada ise ABY düzelmeyince biyopsi yapılarak akut kortikal nekroz tanısı kondu. Olgulardan biri ise sepsise bağlı solunum yetersizliği nedeniyle kaybedildi. Kortikal nekrozu olan 2 vaka kronik hemodiyaliz programına alındı. Gebelik öncesinde saptanmamış, doğum sonu böbrek yetersizliği olarak kliniğimize başvurup tetkik edildikten sonra bilateral atrofık böbrek tespit edilip, kronik böbrek yetmezliği olduğu anlaşılan 5 vaka saptandı. Hastaların 17 sinde diyaliz ihtiyacı gelişti. Diğer hastaların tamamı tanıdan itibaren en geç 6 ay içinde tamamen iyileşti. Obstetrik kaynaklı ABY'de mortalite ve morbidije halen oldukça yüksektir. Obstetrik Kaynaklı ABY'yi önlemek için önlemler enerjik olarak uygulanmalıdır.
Higher Seroprevalence of Hepatitis B Virus Antigen in Patients With Cystic Hydatid Disease Than in Patients Referred To Internal Medicine Clinics in Turkey
(Korean Soc Parasitology, Seoul Natl Univ Coll Medi, 2014) Gultepe, Bilge; Dulger, Ahmet Cumhur; Gultepe, Ilhami; Karadas, Sevdegul; Ebinc, Senar; Esen, Ramazan
Turkey remains an intermediate area for prevalence of hepatitis B virus (HBV) surface antigenemia. The sheepraising areas of Turkey also pose a high risk for cystic hydatid disease (CHD). Both HBV infection and CHD are major public health issues particularly in eastern parts of Turkey; however, there is no data regarding HBV infection in patients who have had CHD. The aims of this study were to evaluate the association between HBV infection and CHD and suggest ways to reduce HBV infection which is still widespread in Turkey. A retrospective study was conducted with 94 adult patients with active CHD referred to the hepatology department, Yuzuncuyil University School of Medicine from December 2010 to December 2012. All subjects came from rural areas of the region and underwent ultrasonography of abdomen which detected CHD of the liver. All the patients were serologically positive for Echinococcus granulosus. The control group consisted of 500 patients (300 men and 200 women) referred to the internal medicine clinics for other reasons. The patients with CHD and in the control group were tested for the existence of HBs antigen according to the standard procedures. The seroprevalence of HBs antigen was significantly higher in patients with active CHD than those in the control group (12.7% vs 5.2%; P=0.0017). Our data indicate that there is significant association between HBV infection and CHD. All patients with CHD should be screened for HBV infection.
Hipertansiyonu Olan Hemodiyaliz Hastalarında Diyalizat Sodyumunun Düşürülmesinin Etkileri
(2010) Erkoç, Reha; Esen, Ramazan
Amaç: Hemodiyaliz hastalarında diyalizat sodyumunun azaltılmasının kan basıncını azaltabildiği sınırlı sayıda çalışmada gösterilmiştir. Bu çalışmada pratik bir şekilde düşük diyalizat Na’u kullanımının etkilerini araştırdık. Gereç ve Yöntem: Hemodiyalize giren 24 hasta tek kör ve çapraz geçişli düzenlemede prospektif olarak çalışmaya alındı. Diyaliz öncesi plazma Na konsantrasyonu >137mEq/L olan hastalara diyalizat Na konsantrasyonu 137mEq/L, diyaliz öncesi plazma Na konsantrasyonu ≤137mEq/L olan hastalara ise diyalizat Na konsantrasyonu 135mEq/L olacak şekilde sekiz hafta diyaliz uygulandı. Ardından hastalar dört hafta boyunca standart (140 mEq/L) diyalizat sodyumu ile diyalize alındılar. Hastalar başlangıçta, düşük Na diyalizat ile hemodiyaliz uygulanıyorken ve tekrar standart Na ile diyaliz uygulanırken son üç diyaliz seansında değerlendirildiler. Bulgular: Hastalara düşük diyalizat Na’u ile hemodiyaliz yapıldığında kan basınçları bazal düzeye göre anlamlı olarak azaldı. Normal sodyuma dönüldüğünde kan basıncı bir miktar artmasına karşı hala bazal değere göre düşüktü.Sistolik kan basıncı sırası ile 181.4 ± 24.2 mmHg, 148.5 ± 15.7 mmHg (p <0.001) ve sonra 155.2 ± 16.7 idi. (bazale göre p<0.001), Diastolik kan basıncı 103.2 ± 12.4 mmHg’den 93.1 ± 10.3 mmHg’ye düştü(p <0.001) ve 93.8. ± 7.2 oldu (bazale göre p<0.001). İnterdialitik kilo alım (İDKA)’ları düşük diyalizat sodyumuyla tedavi ile 2597.6 ± 673.3 gramdan 1756.8 ± 632.8 grama düştü(p<0.001) ve 2602.8 ±807.5 oldu. Hastalara düşük diyalizat Na’u ile tedavi verildiğinde diyaliz öncesi Na konsantrasyonları 136.9 ± 1.48 mEq/L’den, 133.0 ± 2.07 mEq/L’ye azaldı(p<0.001) ve sonra 140.1 ± 2.9 oldu (bazale göre p<0.001). Düşük diyalizat sodyumu ile tedavi sonrası hastaların susama hislerinde azalma oldu. Hastalara yeniden standart sodyumlu diyaliz tedavisi uygulandığında susama hisleri tedavi öncesi aşamayla aynı olacak şekilde arttı. Hastalarda diyaliz esnasında gözlenen hipotansif atak sıklığında tüm çalışma süresince anlamlı bir değişiklik olmadı. Sonuç: Hemodiyaliz hastalarında diyaliz öncesi Na konsantrasyonuna göre diyalizat sodyumunun azaltılması, hastalarda kan basıncını, İDKA’nı ve susama hissini azaltmıştır. Hastalar tekrar standart Na’lu diyalizat ile tedavi olduklarında kan basıncındaki düşme, prediyaliz Na değeri yükselmesine ve IDKA eski haline dönmesine rağmen hala devam etmekteydi.