Browsing by Author "Uzun, K"

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Bronchobiliary Fistula Due To Hydatid Disease of the Liver
(Acta Medical Belgica, 2002) Uzun, K; Özbay, B; Etlik, Ö; Kotan, Ç; Gencer, M; Sakarya, ME
As a complication of hydatid cyst disease of the liver, bronchobiliary fistula is a rare condition and manifests as bilioptysis. We report the case of a 34 year-old man with echinococcosis of the liver who developed a bronchobiliary fistula which manifested as chronic cough and bile stained sputum. A chest X-ray showed an unilateral infiltrate in the costodiaphragmatic angle. Bronchoscopy revealed bile filling the right basal bronchi. Magnetic resonance cystography revealed that the hepatic bile ducts communicated with the right basal pleural space. Percutaneous transhepatic drainage was applied. When the patient was reevaluated, the hydatid cyst had eroded into the pleural space, and a pleural effusion had developed. The condition of the patient deteriorated. Hence, surgical therapy was performed. After surgery, the condition of the patient improved. He was discharged from the hospital in good condition.
Cardiac Troponin I Levels in Patients With Left Heart Failure and Cor Pulmonale
(Westminster Publ inc, 2001) Güler, N; Bilge, M; Eryonucu, B; Uzun, K; Avci, ME; Dülger, H
Cardiac troponin levels are regarded as the most specific of currently available biochemical markers of myocardial damage. Elevated levels of troponin have been previously reported in patients with left heart failure, reflecting small areas of undetected myocardial cell death. The aim of this study was to compare the levels of the cardiac troponin I (cTnI) in patients with left- and right-sided heart failure. Cardiac troponin I levels were studied with immunochemical methods in patients with right heart failure (n = 17) resulting from chronic obstructive pulmonary disease, ischemic left heart failure (n = 23), and nonischemic left heart failure (n = 18) who were admitted to departments of cardiology and chest diseases. Also, cTnI levels were measured in 32 healthy subjects as control group. Protein markers of myocardial injury (cTnI and myoglobin) in patients with left and right heart failure were collected approximately 12 to 36 hours after onset of obvious symptoms. Serum creatine kinase MB band was determined on admission and thereafter twice a day during the first 3 days. Elevated levels of serum cTnI were found in patients with nonischemic (0.83 +/-0.6 ng/mL, p < 0.01) and ischemic left heart failure (0.9 +/-0.5 ng/mL, p < 0.01) when compared to healthy subjects, whereas serum cTnI levels in patients with right heart failure due to chronic obstructive pulmonary disease were not significantly different from those of control subjects (0.22 0.1 vs 0.16 +/-0.1 ng/mL, p > 0.05). In addition, creatine kinase MB band and myoglobin levels were not significantly different between patient and healthy groups. The mean of cTnI levels in ischemic and even nonischemic left heart failure were increased compared to the mean of values in healthy individuals but without significant creatine kinase MB band and myoglobin elevations. But cTnI levels were not increased in patients with right heart failure due to chronic obstructive pulmonary disease. These data indicate that the cTnI levels are abnormal in left heart failure but not in cor pulmonale.
Comparison of the Acute Effects of Salbutamol and Terbutaline on Heart Rate Variability in Adult Asthmatic Patients
(European Respiratory Soc Journals Ltd, 2001) Eryonucu, B; Uzun, K; Güler, N; Bilge, M
This study investigated the effects of beta (2)-adrenergic agonist therapy on heart rate variability (HRV) in adult asthmatic patients by using frequency domain measures of HRV. A randomized crossover design was used. Twenty adult patients with asthma were studied. All patients showed a mild-to-moderate decrease in baseline forced expiratory volume in one second. Any diseases that might have influenced the autonomic function were excluded. All patients had a complete physical examination and medical history that revealed no cardiovascular disease or medication. The study used 200 mug inhaled salbutamol and 500 mug inhaled terbutaline. HRV analysis was performed for each 5-min segment, 5 min before inhalation of the study drug and 5, 10, 15, 20, 25 and 30 min after inhalation. Total power (TP: < 0.40 Hz), high-frequency power (HF: 0.15-0.40 Hz), low-frequency power (LF: 0.04-0.15 Hz) and LF/HF ratio were calculated. The LF and LF/HF ratio increased and TP decreased at 5, 10, 15 and 20 min after the salbutamol and the terbutaline inhalation, HIT did not change significantly after the salbutamol and terbutaline inhalation. Acute salbutamol and terbutaline inhalation produce similar effects on heart rate variability and increase sympathetic modulation in the cardiac autonomic activity.
Comparison of the Short-Term Effects of Salmeterol and Formoterol on Heart Rate Variability in Adult Asthmatic Patients
(Elsevier, 2005) Eryonucu, B; Uzun, K; Güler, N; Tuncer, A; Sezgi, C
Study objectives: We investigated the effects of beta(2)-adrenergic agonists salmeterol and formoterol on heart rate variability (HRV) in adult asthmatic patients using time-domain measures of URV. Patients: Thirty-nine adult patients with asthma were studied. All patients showed a mild-to-moderate decrease in baseline FEV1. Any diseases that might have influenced the autonomic function were excluded. All patients underwent a complete physical examination and medical history that revealed no cardiovascular disease or medication. Methods: The beta(2)-adrenergic inhaled agonists salmeterol, 50 mu g, and formoterol, 12 fig, were used in the study, HRV analysis was performed for each 5-min segment: 5 min and 10 min before inhalation of the study drug, and 5, 10, 15, 20, 25, and 30 min after inhalation. Time-domain parameters of HRV were calculated: (1) the SD all normal-to-nornial intervals, (2) the SD of the mean of all normal-to-normal intervals in all 5-min segments of the entire recording; (3) the root mean square of differences between adjacent normal-to-normal intervals, (4) the mean of the SD of all normal-to-normal intervals in all the 5-min intervals; and (5) the SD of the SD of all normal-to-normal intervals in all the 5-min intervals. Results: Baseline HRV parameters were not significantly different between formoterol and salmeterol groups. There were no significant differences in HRV parameters after formoterol and salmeterol inhalation. The HRV parameters in each 5-min segment in the formoterol group were not statistically significant different when compared to the same segment in the salmeterol group. Conclusion: Salmeterol and formoterol have no short-term adverse effects on HRV.
Concentrations of Copper, Zinc and Various Elements in Serum of Patients With Bronchial Asthma
(Gustav Fischer verlag, 2000) Vural, H; Uzun, K; Uz, E; Koçyigit, A; Çigli, A; Akyol, Ö
In this study, serum copper, zinc, magnesium, iron and calcium concentrations were investigated in 40 patients with bronchial asthma (BA) and in 43 healthy subjects. Copper and calcium levels were found to be increased in patients with BA compared to the control group (p<0.001 and p<0.001 respectively). On the other hand, the serum zinc level was significantly lower in healthy subjects (p<0.01). No changes were found in serum magnesium and iron levels in patients with BA compared to controls. In addition to various elements, certain serum proteins such as albumin, transferrin and ferritin were also assessed to determine whether there was a relationship between the elements and proteins in patients with BA. There was only a significant decrease in albumin concentration in patients with BA (p<0.05).
Demonstrating the Effect of Theophylline Treatment on Diaphragmatic Movement in Chronic Obstructive Pulmonary Disease Patients by Mr-Fluoroscopy
(Elsevier Sci Ireland Ltd, 2004) Etlik, O; Sakarya, ME; Uzun, K; Harman, M; Temizoz, O; Durmus, A
Introduction: The purpose of this study was to determine the increase in diaphragmatic excursion of patients with chronic obstructive pulmonary disease (COPD) treated with theophylline by MR-fluoroscopy which is an innovative method to demonstrate effectiveness of this treatment. Materials and methods: Investigations were performed on a 0.3 T open MR unit. MR-fluoroscopy images of 30 patients with COPD were obtained before and after theophylline treatment. Diaphragmatic movement values were recorded for evaluation. Results: The response of the diaphragmatic movement in COPD patients treated with theophylline was evaluated by MR-fluoroscopy and an increase of 48% in diaphragmatic contractility was determined after the treatment. The increase in contractility was found to be parallel with respiratory function tests and clinical status. Conclusion: Diaphragmatic movement and response to the medical therapy in patients with COPD can be evaluated by MR-fluoroscopy method which can allow accurate measurements. (C) 2003 Published by Elsevier Ireland Ltd.
Diagnostic Value of Uric Acid To Differentiate Transudates and Exudates
(Walter de Gruyter & Co, 2000) Uzun, K; Vural, H; Ozer, F; Imecik, O
Uric acid is known to be an end product of purine metabolism. Increases in uric acid may be found in clinical conditions associated with tissue hypoxia. We have investigated the value of uric acid to differentiate between a transudate and exudate. In this study, we measured uric acid in the pleural fluid and the serum of 110 patients, 30 women and 80 men with a mean age of 49.5+/-19 years. Light's criteria were used to differentiate between a transudate and exudate. Mean serum uric acid was 496.7 +/- 153.4 mu mol/l in patients with transudates and 291.3 +/- 143.1 mu mol/l in patients with exudates. Mean pleural fluid uric acid was 487.7 +/- 165 mu mol/l in patients with transudates and 279.9 +/- 142.1 mu mol/l in patients with exudates. These data showed that the levels of serum and pleural uric acid were higher in transudates than exudates (p<0.01). However, there was no significant difference between pleural fluid/serum uric acid ratio of the two patient groups (p>0.05). The specificity and sensitivity of pleural uric acid for diagnosis of transudate effusions were 73% and 80.6%, respectively. The specificity and sensitivity of pleural uric acid for dia gnosis of transudate effusions from exudates without malignancy were 71.8% and 91.7%, respectively. The sensitivity and specificity of pleural lactate dehydrogenase for diagnosis of exudates were 82% and 89%; the sensitivity and specificity of pleural fluid/serum lactate dehydrogenase were 85% and 890/0; the sensitivity and specificity of pleural fluid/serum protein were 91% and 89%, respectively. Using all three of Light's criteria together, the sensitivity was 91% and its specificity was 94%. Our findings indicate that determination of uric acid in pleural fluid may be of diagnostic value in differential diagnosis of transudates and exudates. The sensitivity of pleural uric acid measurement was higher for exudates without malignancy. However, Light's criteria remain the best means of separating transudates from exudates.
Effects of Cigarette Smoking on the Circadian Rhythm of Heart Rate Variability
(Taylor & Francis Ltd, 2000) Eryonucu, B; Bilge, M; Güler, N; Uzun, K; Gencer, M
Background - The effects of cigarette smoking on the circadian rhythm of heart rate variability (HRV) are not known. Methods - We studied the effects of cigarette smelting on the circadian rhythm of HRV in 24 smoking and 21 non-smelting healthy subjects. Twenty-four hour ambulatory electrocardiograms were recorded and ti me domain parameters of HRV (SDNN [standard deviation of all R-R intervals], SDANN [standard deviation of the averages of R-R intervals in all 5-minute segments of the entire recording], RMSSD [the square root of the mean of the sum of the squares of differences between adjacent R-R intervals]) were determined for the entire 24-hour period and for each 3-hour period. Results - In total, SDNN and SDANN were significantly lower in smokers than non-smokers (116 +/- 26 vs 136 +/- 27, P < 0.05 for SDNN, 109 +/- 25 vs 121 +/- 24, p < 0.05 for SDANN). However, there were no statistical differences between smokers and non-smokers in heart rate (81+/-9 vs 76 +/- 10, P > 0.05) and RMSSD (32 +/- 12 vs 37 +/- 18, P > 0.05). These HRV parameters showed a circadian variation: they increased at night and decreased during the day in both groups. The parameters were lower in smokers than non-smokers during daytime (especially, between 8-14 hours). However, no differences were detected during night-time. Conclusions - Time domain parameters of HRV (SDNN, SDANN and RMSSD) in both smelting and non-smoking healthy subjects have a circadian rhythm. SDNN and SDANN were lower in smokers than non-smelters during daytime.
Evaluation of Diaphragmatic Movement With Mr Fluoroscopy in Chronic Obstructive Pulmonary Disease
(Elsevier Science inc, 2000) Ünal, Ö; Arslan, H; Uzun, K; Özbay, B; Sakarya, ME
The aim of this study was to show reduction of the diaphragmatic excursion with MR fluoroscopy in patients with chronic obstructive pulmonary disease (COPD) and to compare the results with pulmonary function test (PFT). The study included 13 men and 10 women (average age 56.2) with COPD, and 9 men and 6 women (average age 55.8) as a control group. MR fluoroscopy images with Spoiled Gradient-echo pulse sequence was obtained during deep inspiration and expiration. After examination, over cine-loop display, the highest and lowest positions of the diaphragm were identified and the distance of excursion was measured. Differences in the diaphragmatic excursion between patient and healthy subjects were compared. We have also compared MR fluoroscopy results with PFT. In each person of both groups, excursion of the diaphragm was demonstrated clearly in cine-loop display. Differences of excursion between deepest and highest point of diaphragm were on average 26 and 20 mm, respectively, in the right and left side in patients and 69 and 56 mm in healthy group. Significant correlation was found between expiratory volume in 1 s and MR fluoroscopy results. MR fluoroscopy study showed that there were significant statistical differences in diaphragmatic excursion between patients with COPD and healthy subjects. Expiratory volume in 1 s is closely associated with the diaphragmatic excursion. MR fluoroscopy would seem to be a useful method for showing diaphragmatic excursion. (C) 2001 Elsevier Science Inc. All rights reserved.
Extrahepatic Biliary Obstruction Caused by Small-Cell Lung Cancer
(Taylor & Francis Ltd, 2001) Kotan, C; Er, M; Özbay, B; Uzun, K; Barut, I; Ozgoren, E
The pancreas is a rare site of metastasis from small-cell lung cancer (SCLC). We present the case of a pancreatic metastasis of small-cell lung, cancer associated with jaundice, in which, initially, the case was evaluated as a primary pancreatic carcinoma and pancreaticoduodenectomy was performed. We also review the reported cases of pancreatic metastases from SCLC.
Extrapulmonary Tuberculosis in High Prevalence of Tuberculosis and Low Prevalence of Hiv
(W B Saunders Co, 2002) Özbay, B; Uzun, K
The aim of this study was to analyze some clinical and epidemiologic aspects of extrapulmonary tuberculosis (EPTB) diagnosed at the university hospital, and to investigate HIV seropositivity among the patients with extrapulmonary tuberculosis. In this study, the most frequent sites of extrapulmonary tuberculosis were the pleura, meninx, and lymph nodes. Pleural involvement was most common among the young and military servicing males. The authors results show that HIV infection is an unlikely factor in the etiology of extrapulmonary tuberculosis in the authors' region, for the present.
Hematological Malignancy and Pregnancy
(Blackwell Publishing, 2006) Dilek, I; Topcu, N; Demir, C; Bay, A; Uzun, K; Gul, A; Ugras, S
The incidence of hematological malignancies during pregnancy is low, and treatment in this setting is problematic. This study observed 21 pregnancies in 18 patients with hematological malignancies. Patients' ages were between 19 and 43 (median 25) years. Two pregnancies ended with spontaneous abortion, one pregnancy ended with in utero death, three therapeutic abortions were carried out, and 15 infants were born alive but three of them died later. The median birth weight was 2.47 kg. Twelve babies survived to a median age of 36 (range 4-117) months. Eight babies were exposed to chemotherapy during the in utero period. One baby was exposed to chemotherapy during all the trimesters and was born prematurely and later died because of intracranial bleeding. Four babies were exposed to chemotherapy during the first trimester, one of them had low birth weight and floating thumb malformation, two of them had only low birth weight, and one was born healthy, but died at 3 months of age as a result of severe gastroenteritis. Two babies were exposed to chemotherapy during the second and third trimesters; one of them had low birth weight, and the other pregnancy ended in in utero death. One infant was exposed to chemotherapy during the third trimester and was born at term, but died because of pulmonary hemorrhage. We concluded that chemotherapy during all trimesters of pregnancy carries a significant risk for an unfavorable outcome.
Mr Fluoroscopy-Guided Transthoracic Fine-Needle Aspiration Biopsy: Feasibilitty
(Radiological Soc North America, 2003) Sakarya, ME; Unal, O; Ozbay, B; Uzun, K; Kati, I; Ozen, S; Etlik, O
The purpose of this study was to evaluate the feasibility of using an open-configuration magnetic resonance (MR) imaging system with MR fluoroscopic guidance to perform percutaneous transthoracic fine-needle aspiration biopsy in patients with lung masses. Percutaneous transthoracic aspiration biopsy in patients with lung masses. Percutaneous transthoracic aspiration biopsies were performed with MR fluoroscopic guidance in 14 patients. The masses were 2-7 cm in diameter (mean, 4.1 cm). The needle was positioned by using a free-hand technique with MR fluoroscopic guidance. The needle tip reached the target lesion, and biopsy was performed. Analysis of the biopsy specimens facilitated a specific diagnosis in all patients. Pneumothorax was noted in two patients (14%) with chronic obstructive pulmonary disease. Study results showed that the described MR fluoroscopy-guided transthoracic biopsy technique can be used safely and successfully for lung masses. MR fluoroscopy can be used to reach the target lesion easily and accurately. (C) RSNA, 2003.
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.