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Öğe An adverse effect of Helicobacter pylori eradication: Gastroesophageal reflux(British Med Journal Publ Group, 1998) Gunsar, F; Aydm, A; Ersoz, G; Yilmaz, M; Akarca, US; Alkanat, M; Cavusoglu, HÖğe Autoantibodies in patients with nonalcoholic steatohepatitis of unknown etiology(W B Saunders Co-Elsevier Inc, 1999) Akarca, US; Ersoz, G; Gunsar, F; Yilmaz, M; Yildiz, C; Karasu, Z; Batur, YÖğe Biliary complications following adult-to-adult living donor liver transplantation(Elsevier Science Bv, 2002) Karasu, Z; Tokat, Y; Memis, A; Ersoz, G; Yuzer, Y; Killi, R; Akarca, U; Gunsar, F; Batur, YÖğe Biliary reconstructions and complications encountered in 50 consecutive right-lobe living donor liver transplantations(Wiley, 2003) Icoz, G; Kilic, M; Zeytunlu, M; Celebi, A; Ersoz, G; Killi, R; Memis, A; Karasu, Z; Yuzer, Y; Tokat, YBiliary complications appear to be the leading cause of postoperative complications after living donor liver transplantation (LDLT). The aim of this study is to analyze the complications, treatment modalities, and outcomes of biliary anastomoses in a series of 50 consecutive right-lobe LDLTs. Median patient age was 45 years, and median right-lobe graft volume was 740 g. Graft-recipient weight ratio was 0.69 to 1.80. Median follow-up time was 15 months (range, 2 to 38 months). Eleven of 50 patients died, resulting in an overall allograft and patient survival rate of 78%. In biliary reconstruction, a duct-to-duct (D-D) anastomosis or a standard Roux-en-Y (R-Y) anastomosis was performed. Twenty-nine grafts (58%) had a single duct for anastomosis. Seventeen grafts (34%) had two bile duct orifices, and four grafts (8%) had three bile duct orifices. A D-D anastomosis was performed in 36 cases (72%), whereas R-Y reconstruction was preferred in 14 cases (28%). The overall incidence of biliary anastomotic complications was 30% in this series. Five patients developed biliary leaks, presumably from the cut surface, and all of them healed spontaneously. Two bilomas were drained percutaneously. Anastomotic strictures occurred in 8 patients (16%) and were significantly greater than in the R-Y group (P =.03). Although strictures seemed to develop more frequently in allografts with multiple bile ducts, this did not reach statistical significance (P =.05). All strictures were managed by nonsurgical measures initially. Restenosis occurred in 2 patients, both of whom had an R-Y anastomotic stricture. These anastomoses were revised surgically, giving a reoperation rate of 4% for biliary problems. No graft or patient was lost because of biliary problems. Our data suggest that D-D anastomosis is a safe and feasible method of biliary reconstruction in LDLT by preserving physiological bilioenteric continuity and allowing easy access through endoscopic techniques.Öğe Biliary reconstructions and complications encountered in 50 consecutive right-lobe living donor liver transplantations(Wiley, 2003) Icoz, G; Kilic, M; Zeytunlu, M; Celebi, A; Ersoz, G; Killi, R; Memis, A; Karasu, Z; Yuzer, Y; Tokat, YBiliary complications appear to be the leading cause of postoperative complications after living donor liver transplantation (LDLT). The aim of this study is to analyze the complications, treatment modalities, and outcomes of biliary anastomoses in a series of 50 consecutive right-lobe LDLTs. Median patient age was 45 years, and median right-lobe graft volume was 740 g. Graft-recipient weight ratio was 0.69 to 1.80. Median follow-up time was 15 months (range, 2 to 38 months). Eleven of 50 patients died, resulting in an overall allograft and patient survival rate of 78%. In biliary reconstruction, a duct-to-duct (D-D) anastomosis or a standard Roux-en-Y (R-Y) anastomosis was performed. Twenty-nine grafts (58%) had a single duct for anastomosis. Seventeen grafts (34%) had two bile duct orifices, and four grafts (8%) had three bile duct orifices. A D-D anastomosis was performed in 36 cases (72%), whereas R-Y reconstruction was preferred in 14 cases (28%). The overall incidence of biliary anastomotic complications was 30% in this series. Five patients developed biliary leaks, presumably from the cut surface, and all of them healed spontaneously. Two bilomas were drained percutaneously. Anastomotic strictures occurred in 8 patients (16%) and were significantly greater than in the R-Y group (P =.03). Although strictures seemed to develop more frequently in allografts with multiple bile ducts, this did not reach statistical significance (P =.05). All strictures were managed by nonsurgical measures initially. Restenosis occurred in 2 patients, both of whom had an R-Y anastomotic stricture. These anastomoses were revised surgically, giving a reoperation rate of 4% for biliary problems. No graft or patient was lost because of biliary problems. Our data suggest that D-D anastomosis is a safe and feasible method of biliary reconstruction in LDLT by preserving physiological bilioenteric continuity and allowing easy access through endoscopic techniques.Öğe Biliary sphincterotomy plus dilation with a large balloon for bile duct stones that are difficult to extract(Mosby-Elsevier, 2003) Ersoz, G; Tekesin, O; Ozutemiz, AO; Gunsar, FBackground: Bile duct stones are still present in 10% to 15% of patients after the application of conventional endoscopic extraction techniques and require additional procedures for duct clearance. In the vast majority of these cases, there are 2 main problems: large stone size (>15 mm) and tapering of distal bile duct. Methods: Fifty-eight patients in whom endoscopic sphincterotomy and standard basket/balloon extraction were unsuccessful in the removal of bile duct stones underwent dilation with a 10- to 20-mm diameter (esophageal/pyloric type) balloon at the same session. In 18 patients with tapered distal bile ducts (Group 1), 12- to 18-mm diameter balloon catheters were used to enlarge the orifice. In 40 patients with square, barrel shaped and/or large (>15mm) stones (Group 2), the sphincterotomy orifice was enlarged with 15- to 20-mm diameter balloon catheters. After dilatation, standard basket/balloon extraction techniques were used to remove the stone(s). Results: Stone clearance was successful in 16 patients (89%) in Group 1 and 35 (95%) in Group 2. Complications occurred in 9 (15.5%) patients. Conclusion: Dilation with a large-diameter balloon after endoscopic sphincterotomy is a useful alternative technique in patients with bile duct stones that are difficult to remove with standard methods.Öğe Biliary sphincterotomy plus dilation with a large balloon for bile duct stones that are difficult to extract(Mosby-Elsevier, 2003) Ersoz, G; Tekesin, O; Ozutemiz, AO; Gunsar, FBackground: Bile duct stones are still present in 10% to 15% of patients after the application of conventional endoscopic extraction techniques and require additional procedures for duct clearance. In the vast majority of these cases, there are 2 main problems: large stone size (>15 mm) and tapering of distal bile duct. Methods: Fifty-eight patients in whom endoscopic sphincterotomy and standard basket/balloon extraction were unsuccessful in the removal of bile duct stones underwent dilation with a 10- to 20-mm diameter (esophageal/pyloric type) balloon at the same session. In 18 patients with tapered distal bile ducts (Group 1), 12- to 18-mm diameter balloon catheters were used to enlarge the orifice. In 40 patients with square, barrel shaped and/or large (>15mm) stones (Group 2), the sphincterotomy orifice was enlarged with 15- to 20-mm diameter balloon catheters. After dilatation, standard basket/balloon extraction techniques were used to remove the stone(s). Results: Stone clearance was successful in 16 patients (89%) in Group 1 and 35 (95%) in Group 2. Complications occurred in 9 (15.5%) patients. Conclusion: Dilation with a large-diameter balloon after endoscopic sphincterotomy is a useful alternative technique in patients with bile duct stones that are difficult to remove with standard methods.Öğe Biliary sphincterotomy plus huge balloon dilatation for large common bile buct stones and small tapering distal bile ducts.(W B Saunders Co, 2001) Ersoz, G; Tekesin, O; Ozutemiz, OA; Gunsar, FÖğe Biochemical, histological parameters and response to UDCA treatment in primary biliary cirrhosis and primary biliary cirrhosis-autoimmune hepatitis overlap syndrome(Elsevier Science Bv, 2001) Gunsar, F; Akarca, U; Ersoz, G; Karasu, Z; Yuce, G; Batur, YÖğe Clinical and biochemical features and therapy responses in primary biliary cirrhosis and primary biliary cirrhosis-autoimmune hepatitis overlap syndrome(H G E Update Medical Publishing S A, 2002) Gunsar, F; Akarca, US; Ersoz, G; Karasu, Z; Yuce, G; Batur, YBackground/Aims: Primary biliary cirrhosis and autoimmune. hepatitis are two main immune-mediated liver diseases. Some patients display characteristics of both diseases, so called overlap syndrome. The aims of this study were to investigate and to compare the clinical and laboratory, features and responses to therapy in primary biliary cirrhosis and overlap syndrome. Methodology: Twenty-three patients with primary biliary cirrhosis (21 females, 2 males;, median age: 50, years) and 20 with primary biliary cirrhosis-autoimmune hepatitis overlap syndrome (18 females, males; median age: 44 years) were included in the study. All patients with primary biliary cirrhosis were treated with ursodeoxycholic acid., Of patients with overlap syndrome, 16 were treated with ursodeoxycholic acid and 4 with ursodeoxycholic acid plus prednisolone. Histological findings laboratory, and clinical data were compared at the baseline and at the 2nd year of treatment. Results: Fatigue. and pruritus were the most frequent and comparable symptoms in each group: Serum ALT, AST, gamma-glutamyl transpeptidase, total protein, globulin and gammaglobulin levels were higher in patients with overlap syndrome than those in patients with primary biliary cirrhosis. At the end of the 2nd year of the treatment, ALT normalization was achieved in 12 (52%), alkaline phosphatase in 7 (30%) patients with primary biliary cirrhosis. One of the non-responders to ursodeoxycholic, acid,therapy had the histological findings of overlap syndrome in her control biopsy. Fibrosis score, deteriorated in 50% of the,patients. Of ursodeoxycholic acid-treated overlap syndrome patients, 11 completed 2 years of treatment. Three patients were biochemically non-responsive and prednisolone was added to their regimen. Of the remaining 8 patients, 7 (64% of total patients) had normal ALT. Three patients had worse fibrosis score comparing the onset of the treatment. Six of 7 (86%) patients who. were given ursodeoxycholic acid plus prednisolone including ursodeoxycholic acid-non-responsives had normal ALT and 2 of 6 biopsy-controlled patients display deterioration of their fibrosis score. Conclusions: Biochemical tests tended to be higher in patients with overlap syndrome comparing to those with primary biliary cirrhosis. Response to ursodeoxycholic acid treatment in patients with overlap syndrome was comparable with that obtained in primary biliary cirrhosis. Therefore it should be the first-line, treatment., Non-responsive, patients may benefit from the use of ursodeoxycholic acid plus prednisolone combination.Öğe Clinicopathological features of rapidly progressive hepatitis C virus infection in HCV antibody negative renal transplant recipients(Oxford Univ Press, 1998) Ok, E; Unsal, A; Celik, A; Zeytinoglu, A; Ersoz, G; Tokat, Y; Erensoy, S; Akarca, US; Basci, A; Yuce, GBackground. Hepatitis C virus (HCV) infection acquired during dialysis treatment generally shows a relatively benign course after renal transplantation (RTx). However, less is known about the course of HCV infection acquired during or after RTx. Methods. Clinical and histopathological assessment of 15 renal transplant recipients who acquired HCV infection during or after RTx. Results. Alanine aminotransferase levels rose for the first time 1-19 weeks after RTx. HCV RNA was found positive in all patients, but anti-HCV became positive in only nine of them. During a mean follow-up of 21 +/- 12 months, jaundice appeared in 12 patients while ascites and/or hepatic encephalopathy occurred in six. Azathioprine was stopped in all patients. Cyclosporin was also stopped in four patients and in two of them prednisolone was also interrupted for a period of 3-7 weeks. Following this, ascites, hepatic encephalopathy and biochemical disturbances improved, while no deterioration was seen in graft function. Nine of the 15 patients had undergone two consecutive liver biopsies (LB). The first LB revealed cirrhosis in three and chronic hepatitis in six patients; the second LB showed cirrhosis in seven patients. The histological activity index (Knodell's score) progressed from 11.8 +/- 3.5 to 13.8 +/- 3.8. Conclusions. The results suggest that HCV infection acquired during or after RTx may run an unusual and rapidly progressive clinical and histopathological course at least in some of these patients. Decrease or withdrawal of immunosuppressive drugs may improve early hepatic failure without detrimental effect on graft function during that period.Öğe Comparison of peripheral blood lymphocyte subtypes in renal transplant patients with or without hepatitis C infection(Elsevier Science Bv, 2002) Sezis, M; Ersoz, G; Toz, H; Karasu, Z; Kokuludag, A; Ok, E; Celebi, A; Akarca, U; Terzioglu, EÖğe Decline in HDV seroprevalance. Is it true?(W B Saunders Co, 1999) Akarca, US; Ersoz, G; Gunsar, F; Karasu, Z; Batur, Y; Cavusoglu, HÖğe Detection of Helicobacter pylori in gastric cancer tissue by using PCR(W B Saunders Co-Elsevier Inc, 1999) Karasu, Z; Kizilkanat, M; Gurakar, A; Wright, H; Ersoz, G; Akarca, UÖğe Development of hepatocellular carcinoma in hepatitis B virus- and hepatitis C virus-related cirrhosis(Elsevier Science Bv, 2002) Akarca, US; Lebe, E; Karasu, Z; Gunsar, F; Ersoz, G; Batur, YÖğe Diabetes mellitus, insulin resistance and hypocatabolism in chronic HCV infection.(W B Saunders Co, 1996) Gunsar, F; Akarca, US; Ersoz, G; Topalak, O; Tuzun, M; Batur, YÖğe The effect of interferon therapy on erythrocyte membrane Na+,K+ ATP activity in patients with chronic hepatitis B and C virus infections(Academic Press Aust, 1998) Kuralay, F; Tanyalcin, T; Kutay, F; Ersoz, G; Yuce, G; Batur, YIn order to evaluate the effect of alpha interferon on erythrocyte membrane Na-,K- ATPase (EC 3.6. 1.37) activity, 10 patients with chronic hepatitis B virus (HBV) infection and 8 patients with chronic hepatitis C virus (HCV) infection were investigated. Erythrocyte membrane Na+,K+ ATPase activity was determined in controls and in patients with HBV and HCV infection. Na+, K+ ATPase activity was significantly less in untreated patients with (HBV) infection (n = 20; 0.134 +/- 0.073 mu mol of phosphate produced per milligram of protein per hour) and (HCV) infection (n = 11; 0.44 +/- 0.049) when compared to the controls (n = 10; 0.219 +/- 0.055). Among these subjects patients were treated with interferon and following treatment, significant elevation of Na+, K+ ATPase activity was seen in patients with HCV (n = 8; 0.183 +/- 0.044; P = 0.049) and HBV (n = 10, 0.213 +/- 0.095, P = 0.0069) infections when compared with the pre-treatment values (n = 8; 0.152 +/- 0.050) and (n = 10, 0.131 +/- 0.083), respectively. Normalization of serum alanin amino transferase levels (ALT) at treatment cessation was seen in 8 of 10 (%80) HBV infected patients of whom 2 of 8 (%25) had sustained ALT responses within three months after the end of treatment. In HCV infected patients 1 of 8 (%12.5) had sustained response following treatment. At the end of treatment, although Na+, K+ ATPase was restored in both of the patients groups, relative changes in enzyme activity in relation to relative reduction in ALT levels as a response to IFN therapy were not correlated.Öğe The Effect of Trimetazidine on the Cerulein-İnduced Acute Pancreatitis İn Rats(Monduzzi Editore, 1995) Isler, M; Ozutemiz, O; Ersoz, G; Yuce, G; Batur, Y; Papastamatiou, LÖğe The efficacy of interferon-mu induction treatment with or without ribavirin in chronic hepatitis C: Interim analysis(W B Saunders Co, 2001) Senturk, H; Ersoz, G; Ozaras, R; Kaymakoglu, S; Bozkaya, H; Mert, A; Karayalcin, S; Bozdayi, M; Batur, YÖğe Endoscopic injection therapy of bleeding dieulafoy lesion of the stomach(H G E Update Medical Publishing S A, 2005) Yilmaz, M; Ozutemiz, M; Karasu, Z; Ersoz, G; Gunsar, F; Batur, Y; Aydin, A; Tekesin, O; Yonetci, N; Ilter, TBackground/Aims: Dieulafoy's lesion is a rare cause of upper gastrointestinal bleeding and is potentially life threatening. The aim of this study is to determine the clinical features of these lesions and the efficacy of the endoscopic injection sclerotherapy in patients with Dieulafoy's lesion. Methodology: Between January 1994 and December 2001, twenty-eight patients with upper gastrointestinal bleeding due to Dieulafoy's lesion were treated by endoscopic injection sclerotherapy. Efficacy of endoscopic therapy and clinical findings of these cases were analyzed. Results: The study group consisted of 22 male (78.5%) and 6 female (21.5%) patients with a mean age of 57 years (range 22-82 years). Significant comorbidity was present in 22 (78.5%) patients. Hemoglobin values of the patients ranged from 5.4-10.3g/dL at hospitalization. The median transfusion requirement was 5 (range 0-12) units. Dieulafoy's lesion was observed in the proximal half of stomach in 25 cases (89.3%), in the antrum in 2 cases (7.1%) and in the angulus in 1 case (3.5%). Endoscopic injection sclerotherapy was successful in stopping the bleeding in 26 out of 28 patients (92.8%). Conclusions: Dieulafoy's lesions mostly affect the proximal stomach and cause serious upper gastrointestinal bleeding. Endoscopic injection sclerotherapy is an effective and a safe therapeutic method for Dieulafoy's lesion.
