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Öğe Active Immunoprophylaxis With Hepatitis B Virus (HBV) Vaccination Is Not an Effective Strategy for Prevention of HBV Recurrence after Liver Transplantation.(Wiley-Blackwell, 2014) Turan, Ilker; Mut, Deniz; Sozbilen, Murat; Erensoy, Selda; Gunsar, Fulya; Ersoz, Galip; Akarca, Ulus S.; Karasu, ZekiÖğe Adefovir dipivoxil alone or in combination with lamivudine for three months in patients with lamivudine resistant compensated chronic hepatitis B(Springer, 2007) Akyildiz, Murat; Gunsar, Fulya; Ersoz, Galip; Karasu, Zeki; Ilter, Tankut; Batur, Yucel; Akarca, UlusWe studied clinical and laboratory effects of 3 months of lamivudine with adefovir combination and adefovir dipivoxil (AD) alone in the treatment of patients with lamivudine-resistant hepatitis B virus (HBV) infection. Eligible patients were hepatitis B surface antigen-positive men and women with compensated liver disease who were given lamivudine at least more than 6 months and had HBV polymerase gene mutation. Patients were assigned to receive adefovir 10 mg/day (Group 1) or adefovir 10 mg once daily and lamivudine 100 mg once daily combination during first 3 months, and then stopped lamivudine and continued adefovir (Group 2). Median age was 48 years (34 males and 20 females, and 35 were HBeAg-negative). Baseline median ALT, AST, and HBV DNA levels were 66 IU/l, 49 IU/l, and 6.7 log(10) copy/ml, respectively. Median adefovir therapy time and ALT normalization time were 9 and 3.5 months, respectively. There was no significant difference between groups according to the baseline HBV DNA, ALT, HBe Ag status, age, gender, and lamivudine resistance time. Virological and biochemical responses were similar in both groups during therapy. Two patients (8%) had ALT flare more than five times upper limit of normal without any clinical decompensation in Group 1. Mild ALT elevation according to baseline levels were found in 8 (27.6%) and 4 (17.4%) patients, respectively, in Group 2 and Group 1, and no statistically significance between two groups. In conclusion, this study showed that it is not necessary to continue lamivudine therapy while switching to AD therapy. Adefovir alone is effective in the treatment of patients with lamivudine resistant HBV infection and compensated liver disease, without significant clinical and laboratory flares. However, it is not easy to say that switching to AD with cessation of lamivudine is safe, because the study population is not enough for precise conclusion and resistance may be a considerable problem against AD in patients using long-term treatment.Öğe Analysis of Adverse Events Associated with Endoscopic Papillary Large-Balloon Dilation(Springer, 2013) Ustundag, Yucel; Ersoz, Galip; Saritas, UlkuÖğe ASSOCIATION OF HEPATITIS B SURFACE ANTIGEN (HBSAG) LOSS WITH FAMILY HISTORY OF HEPATITIS B(Wiley-Blackwell, 2011) Yapali, Suna; Gunsar, Fulya; Karasu, Zeki; Ersoz, Galip; Akarca, Ulus S.Öğe Chronic inflammatory demyelinating polyneuropathy in an HCV related cirrhotic patient with acute hepatitis B superinfection(Elsevier Science Bv, 2007) Ersoz, Galip; Tekin, Fatih; Bademkiran, FikretÖğe Circadian changes in Critical Flicker Frequency in Cirrhotics and its relation with Sleep Disturbances(Wiley-Blackwell, 2012) Gencdal, Genco; Gunsar, Fulya; Meral, Cenk Emre; Salman, Esin; Gursel, Berna; Oruc, Nevin; Karasu, Zeki; Ersoz, Galip; Akarca, Ulus S.Öğe Close Monitoring for Polyneuropathy/Myopathy Is Warranted Among Liver Transplant Recipients on Long-Term Treatment With Telbivudine.(Wiley-Blackwell, 2014) Karasu, Zeki; Turan, Ilker; Duman, Soner; Sozbilen, Murat; Gunsar, Fulya; Ersoz, Galip; Akarca, Ulus S.Öğe Common SPINK-1 mutations do not predispose to the development of non-alcoholic fatty liver disease(Mexican Assoc Hepatology, 2009) Oruc, Nevin; Ozutemiz, Omer; Akarca, Ulus Salih; Berdeli, Afig; Ersoz, Galip; Gunsar, Fulya; Karasu, Zeki; Ilter, Tankut; Batur, YucelBackground: Non-alcoholic fatty liver disease (NAFLD) is common in obese and diabetics. Serine protease inhibitor Kazal-1 (SPINK-1) protein is highly expressed in the liver and adipose tissue of diabetic and obese suggesting its role in NAFLD. SPINK-1 also behaves as an acute phase reactant protein. Some genetic factors including the genetic variations in SPINK-1 protein have been linked to chronic pancreatitis and diabetes. We therefore hypothesized that SPINK-1 mutations might be a risk factor for the development of NAFLD. Methods: Liver biopsy proven fifty NAFLD cases (20 steatohepatitis, 30 diffuse fatty liver disease and 44 healthy controls were included to the study. Liver function tests were measured. Body mass index was calculated. Insulin resistance was determined by using a homeostasis model assessment (HOMA-IR). Ultrasound evaluation was performed for each subject. Common genetic mutations in the third exon of SPINK-1 gene were analyzed by direct sequencing method. Results: We found two cases with a SNP at N34S location in NAFLD group (allele frequency %4). One subject with diffuse fatty liver disease and other with liver cirrhosis due to NAFLD had N34S mutation. No SNPs were detected in healthy controls. In conclusions, in limited number of patients SPINK-1 mutations were not considered as a risk factor alone for NAFLD development.Öğe COX-2 EXPRESSION IN NON ALCOHOLIC STEATOHEPATITIS WITH AND WITHOUT FIBROSIS(Wiley-Blackwell, 2011) Ulkuden, Burcu; Yapali, Suna; Yilmaz, Funda; Unal, Nalan G.; Gunsar, Fulya; Vardar, Rukiye; Ersoz, Galip; Karasu, Zeki; Akarca, Ulus S.Öğe Decrease in HbA1c accounts for the rapid decline in the measurement of liver stiffness by transient elastography in diabetic patients(Elsevier Science Bv, 2019) Celebi, Tugba; Danis, Nilay; Gunsar, Fulya; Ersoz, Galip; Karasu, Zeki; Turan, Ilker; Ozutemiz, Omer; Akarca, UlusÖğe Diagnostic value of the JAK2 V617F mutation for latent chronic myeloproliferative disorders in patients with budd-chiari syndrome and/or portal vein thrombosis(Aves, 2015) Karakose, Suleyman; Oruc, Nevin; Zengin, Melia; Akarca, Ulus Salih; Ersoz, GalipBackground/Aims: The diagnosis of an underlying myeloproliferative neoplasm (MPN) is often problematic in patients with Budd Chiari syndrome (BCS) or portal vein thrombosis (PVT). This study aimed to assess the diagnostic value of the JAK2 gene V617F gain-of-function mutation for MPN in splanchnic vein thrombosis patients. Materials and Methods: One hundred eleven patients (80 with PVT, 27 with BCS, and 4 with BCS and PVT) were investigated. The control group included 56 volunteers without any known diseases. LightCycler SNP genotyping was performed to detect the JAK2 V617F mutation in DNA extracted from peripheral blood. Results: The JAK2 V617F mutation was identified in six of 28 patients (21.4%) with idiopathic PVT or BCS and in eight of 45 patients (17.8%) with PVT or BCS secondary to a known prothrombotic factor, but in only one of 38 patients (2.6%) with PVT and cirrhosis (p=0.049). Conclusion: The JAK2 V617F mutation is a noninvasive molecular marker for occult MPNs and can be used for the diagnosis of latent MPNs presenting with thrombotic events. Analysis of JAK2 mutation in the patients with idiopathic PVT or BCS showed that 20% had latent MPNs. In addition to this JAK2 mutation, prothrombotic events were observed in a significant number of patients with splanchnic vein thrombosis. JAK2 gene analysis should be included in the research panel for BCS and PVT patients without cirrhosis.Öğe Diurnal changes of critical flicker frequency in patients with liver cirrhosis and their relationship with sleep disturbances(Elsevier Science Inc, 2014) Gencdal, Genco; Gunsar, Fulya; Meral, Cenk Emre; Salman, Esin; Gursel, Berna; Oruc, Nevin; Karasu, Zeki; Ersoz, Galip; Akarca, Ulus S.Background: We aimed to measure the diurnal changes of critical flicker frequency in healthy subjects and cirrhotic patients and to investigate their relationship with sleep disturbance. Methods: Cirrhotic patients and healthy volunteers were included. All groups completed the Pittsburgh Sleep Quality Index and a simple sleep questionnaire. Sleep disturbance was defined as a Pittsburgh Sleep Quality Index score of >5. Critical flicker frequency was measured twice a day to detect diurnal abnormalities. Results: Overall, 59 cirrhotic patients (54.2% males, Mean Age 59 +/- 11 years) and 18 controls (39.9% males, Mean Age 58 +/- 9 years) were included. Sleep disturbances were more common in cirrhotics (66.1%) than controls (38.9%, p < 0.05). In cirrhotics, the critical flicker frequency was not related to decompensation. The nocturnal values were higher than the morning values in cirrhotics (64.4%), but not in controls (p < 0.0001). Additionally, sleep disturbances were more common in cirrhotics who had higher nocturnal values (p < 0.05). Conclusions: Changes in the diurnal critical flicker frequency were observed in cirrhotics but not in controls. Sleep disturbances in cirrhotics appear to be associated with deviations of the diurnal rhythm of critical flicker frequency rather than with clinical parameters such as the clinical stages of cirrhosis and the Model For End-Stage Liver Disease and Child-Pugh scores. (C) 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.Öğe Does matrix metalloproteinase activity predict severity of acute pancreatitis?(Blackwell Publishing, 2006) Aynaci, Murat; Tuncyurek, Pars; Nart, Deniz; Zeytunlu, Murat; Ozutemiz, Omer; Ersoz, Galip; Yilmaz, Funda; Mayer, Jens; Coker, AhmetBackground: Matrix metalloproteinases (MMP) modulate end-organ complications of acute pancreatitis, but the correlation between increased MMP production and histological severity of disease remains unclear. We examined the role of MMD and pancreas histology on experimental acute pancreatitis. Methods: Forty male Wistar albino rats were subjected to cerulein-induced pancreatitis (8, 16, 24 and 32 h groups) or sham treatment. The animals were killed at different time points and pancreatic tissues were harvested to assess MMP (1, 2 and 9) activity and inflammatory changes. Results: Compared with other groups, 8 h group had decreased tissue MMP-1 concentrations. MMP-9 concentrations were lower in 24-h and 32-h groups, as were histological severity scores. MMP-2 activity did not differ among groups. Pancreatitis was prominent in 8-h, 16-h and 24-h groups by means of histology. Conclusion: Induction of pancreatitis by cerulein altered pancreatic MMP levels in the early phase of inflammation. Inhibition of MMP-2 and MMP-9 paralleled histological scores. Therefore, MMP may have a predictive value to assess histological severity.Öğe Efficacy of Fractionated Plasma Separation and Adsorption System (Prometheus) for Treatment of Liver Failure Due to Mushroom Poisoning(H G E Update Medical Publishing S A, 2010) Vardar, Rukiye; Gunsar, Fulya; Ersoz, Galip; Akarca, Ulus Salih; Karasu, ZekiBackground/Aims: Consuming wild mushrooms is an ordinary habit in late summer and autumn in our region. Every year, several cases of hepatic toxicity secondary to mushroom poisoning are observed because of poor identification of the mushrooms. Unfortunately some of them are fatal. Prometheus system is a newly developed extracorporeal liver support device for fractionated plasma separation and adsorption (FPSA) that enables removal of albumin-bound and water-soluble toxins. Therefore, it may be a promising treatment option for patients with liver failure due to mushroom poisoning. Methodology: We studied 8 patients with mushroom poisoning. All patients underwent 1 to 4 consecutive FPSA (Prometheus)-system in addition to medical and supportive treatment such as fluid replacement, Penicillin G, N-acetylcysteine (NAC) and silymarin. A variety of clinical and biochemical parameters were assessed. Results: We had improvement of the biochemical parameters after first treatment with FPSA-system. Seven of 8 patients survived and were discharged to resume an independent life. One patient who had grade III encephalopathy when admitted to hospital died. No major adverse events were observed during the application of this therapy modality. Conclusions: FPSA-system may be a safe and effective treatment option for patient with mushroom poisoning. Early hospitalization is essential in order to be successful. Controlled studies are needed to evaluate the efficacy of this new treatment choice on survival of patients with acute liver failure (ALF) due to mushroom poisoning.Öğe Efficacy of Hepatitis B Virus Vaccination in Liver Transplant Recipients After Hepatitis B Immunoglobulin Discontinuation(Wiley-Blackwell, 2013) Turan, Ilker; Mut, Deniz; Erensoy, Selda; Sozbilen, Murat; Unalp, Omer V.; Gunsar, Fulya; Ersoz, Galip; Akarca, Ulus S.; Karasu, ZekiÖğe Endoscopic biopsy techniques for proximal biliary strictures(Aves, 2017) Tekin, Fatih; Turan, Ilker; Ersoz, Galip; Ozutemiz, OmerÖğe Fractured esophageal self-expandable metallic stent in a patient with advanced lung cancer: a case report and review of the literature(Springer Japan Kk, 2015) Turan, Ilker; Tekin, Fatih; Ersoz, Galip; Tekesin, Oktay; Ozutemiz, OmerSelf-expandable metallic stents (SEMS) are the currently recommended treatment modality for palliation of dysphagia resulting from unresectable malignant esophageal obstruction. The most common post-SEMS-placement complications are migration, perforation, bleeding, and tumor ingrowth or overgrowth. We report herein a patient with advanced lung cancer invading the esophagus with the very rare late complication of spontaneous stent fracture 8 months after esophageal SEMS placement, together with a comprehensive review of the related literature. To the best of our knowledge, this is the first report describing the spontaneous fracture of an esophageal SEMS inserted for the palliative treatment of malignant esophageal obstruction due to extrinsic invasion by lung cancer.Öğe FULLY COVERED SELF-EXPANDABLE METAL STENTS FOR THE ENDOSCOPIC TREATMENT OF PORTAL CAVERNOMA CHOLANGIOPATHY(Mosby-Elsevier, 2019) Ersoz, Galip; Tekin, Fatih; Turan, Ilker; Buyruk, Abdullah M.; Ozutemiz, Omer A.Öğe HBIg discontinuation with maintenance oral anti-viral therapy: Failure of lamivudin but potency with entecavir or tenofovir(Lippincott Williams & Wilkins, 2016) Karasu, Zeki; Turan, Ilker; Yilmaz, Funda; Gunsar, Fulya; Ersoz, Galip; Akarca, UlusÖğe Hyperhomocysteinaernia and factor V Leiden mutation are associated with Budd-Chiari syndrome(Lippincott Williams & Wilkins, 2006) Colak, Yusuf; Karasu, Zeki; Oruc, Nevin; Can, Cenk; Balym, Zuhal; Akarca, UlusSalih; Gunsar, Fulya; Ersoz, Galip; Tokat, Yarnan; Batur, YucelObjectives Budd-Chiarl syndrome (BCS) is characterized by hepatic venous outflow obstruction and may be caused by various prothrombotic disorders. We aimed to study the role of hyperhomocysteinaernia, factor V Leiden mutation and G20210A prothrombin gene mutation in the pathogenesis of the syndrome. Methods Thirty-two patients (16 male, 16 female, aged 19-45years) with angiographically verified BCS and 33 age-matched and sex-matched voluntary healthy controls (15 male, 18 female, aged 19-45 years) were included into the study. Factor V Leiden and prothrombin gene mutations were determined in extracted DNA from peripheric mononuclear cells, using a light cycler amplification system. Plasma homocysteine levels were measured by fluorescence polarization immunoassay. Results The homozygote factor V Leiden mutation was diagnosed in four BCS patients and the heterozygote mutation was diagnosed in five. The frequency of the mutant allele was 20.3% in BCS patients and 7.6% in the controls (P < 0.05). There was no significant difference in prothrombin gene mutation frequency between the two groups. Serum homocysteine levels were significantly higher in the BCS group than in the controls (116.4 +/- 8.8 vs 11.0 +/- 2.7 pmol/l; P < 0.01). BCS patients with the mutant factor V Leiden allele have significantly higher levels of serum homocysteine (22.1 +/- 13.3 vs 14.40 +/- 5.91mol/l; P < 0.05). Conclusions Hyperhomocysteinaemia, especially when associated with the factor V Leiden mutation, is an important risk factor for the development of BCS.
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