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Öğe Diagnostic value of serum procalcitonin in determining the activity of inflammatory bowel disease(Turkish Soc Gastroenterology, 2009) Oruc, Nevin; Oezuetemiz, Oemer; Osmanoglu, Necla; Ilter, TankutBackground/aims: Procalcitonin and C-reactive protein are two acute-phase reactant proteins, although procalcitonin is a more specific marker for bacterial infections. Procalcitonin level might also be helpful to predict the disease activity of inflammatory bowel disease. This study aimed to compare the diagnostic value of serum procalcitonin and C-reactive protein as indicators of disease activity in inflammatory bowel disease. Methods: Patients admitted to the inflammatory bowel disease inpatient clinic with suspected inflammatory bowel disease who had not yet been treated with immunosuppressive treatments were included. Disease activity, white blood cell count, sedimentation rate, serum procalcitonin and C-reactive protein levels were evaluated in 45 newly diagnosed inflammatory bowel disease patients (9 Crohn's disease and 36 ulcerative colitis). Fifty healthy volunteers were analyzed as a control group. Results: Crohn's disease patients had higher procalcitonin and C-reactive protein levels than healthy controls (Procalcitonin: 0.143 +/- 0.081 us. 0.065 +/- 0.008 ng/ml, p<0.05; C-reactive protein: 29 +/- 7.5 vs. 2.9 +/- 0.5 mg/dl, p<0.001, respectively). Ulcerative colitis patients also had slightly higher procalcitonin levels and significantly higher C-reactive protein levels than controls (Procalcitonin: 0.107 +/- 0.042 ng/ml; C-reactive protein: 23 +/- 5.5 mg/dl). Two Crohn's disease patients had procalcitonin value above 1 ng/ml. Receiver operating characteristic curve analysis demonstrated that C-reactive protein is the best marker of disease activity in inflammatory bowel disease while procalcitonin has low sensitivity and specificity. Serum procalcitonin levels were highly correlated with serum C-reactive protein but no other disease activity parameters. Conclusions: Although still within normal ranges, procalcitonin levels were slightly elevated in Crohn's disease but not in ulcerative colitis patients compared to healthy controls. Serum C-reactive protein is a reliable marker for disease activity in inflammatory bowel disease. Procalcitonin has no diagnostic value in determining disease activity.Öğe Dieulafoy's lesion of the anal canal: Report of a case(Turkish Soc Gastroenterology, 2007) Firat, Oezguer; Karakoese, Yueksel; Caliskan, Cemil; Makay, Oezer; Oezuetemiz, Oemer; Korkut, Mustafa AliBackground/aims: Dieulafoy's lesion of the anal canal is a very rare clinical case. Although it was first described in the stomach, there has been an increasing frequency, especially in the last decade, of reports of the lesion in the colorectal region. Methods: Herein, we report one case presenting with massive hematochezia requiring multiple blood transfusions due to a Dieulafoy's lesion in the anal canal. To our knowledge, this is the fourth case in Medline. Surgical oversewing was attempted twice but rebleeding occurred, and local excision through the anal canal was performed. Results: The patient was treated successfully with mucosectomy including the lesion. Conclusions: Sclerotherapy, alcohol and epinephrine injection, thermocoagulation and selective arterial embolization are the options of therapeutic endoscopy and interventional radiology. As for surgical management, oversewing is an alternative technique. However, in our opinion, because of the recurrent and life-threatening manner of this arterial bleeding pattern, local excision, if possible, is the most reliable management of the disease.Öğe Image-based assessment of esophageal stricture in experimental corrosive esophagitis in animals: An objective, adjunct diagnostic tool(Turkish Soc Gastroenterology, 2009) Vardar, Enver; Vardar, Rukiye; Yuekselen, Vahit; Makay, Oezer; Erkan, Nazif; Bayol, Uemit; Oezuetemiz, OemerBackground/aims: Many studies have reported image analysis techniques, such as nuclear morphometry, counting or calculating of mitotic figures or estimation of the ratio of positive-stained areas immunohistochemically. The esophagus is the most commonly involved organ during caustic ingestion, which leads to progressive and devastating results after caustic burn. The aim of this work was to compare the classical stenosis index method with a new objective method based on image analysis that was used to determine experimental stricture of the rat esophagus. Methods: We investigated this technique by randomly allocating 20 rats each to sham laparotomy and corrosive esophagus groups. The images of the sham laparotomy group and corrosive esophagus group were reviewed, analyzed and used in a mathematical operation on the computer. The numbers and the ratio of luminal area and total esophageal area were used to determine the esophageal stricture of the rat, and results were compared with stenosis index ratios. Results: The mean area of the lumen of the esophagus and the ratio of esophageal lumen/total esophageal area were 0.83 (0.51-1.28) mm(2) and 0.21 (0.08-0.37), respectively, in the corrosive esophagus group. In the sham toparotomy group, these values were 1.28 (0.47-3.03) mm(2) and 0.26 (0.13-0.92), respectively. The differences between the two groups in luminal area and ratio of esophageal lumen/total esophageal area were statistically significant (p<0.05). Conclusions: This new technique based on image analysis seems more objective and reproducible than the classical, manual method. It is concluded that the use of this new technique dramatically reduced the subjectivity of the measurement process.Öğe Surgical management of Mirizzi syndrome(Aves, 2008) Aydin, Uenal; Yazici, Pinar; Oezsan, Ismail; Ersoez, Galip; Oezuetemiz, Oemer; Zeytunlu, Murat; Coker, AhmetBackground/aims: Mirizzi syndrome is an unusual presentation of prolonged cholelithiasis. This study aimed to analyze the diagnostic methods, operative strategies, and outcome of the surgical treatment of patients with Mirizzi syndrome. Methods: We retrospectively evaluated the patients with Mirizzi syndrome treated in our General Surgery Clinic. The data collected included demographic variables, clinical presentation, diagnostic methods, surgical procedures, and postoperative complications. Results: The study included 13 male and 21 female patients, with a mean age of 67.2 years. The incidence of Mirizzi syndrome was determined as 0.6% (34/5632), and type II was more frequently observed (52.9%); no patient was determined as type IV. The incidences of types I and III were 35.2% and 11.7%, respectively. Among the preoperative diagnostic evaluations, ultrasonography was the initial imaging study that was performed in all patients. Computerized tomography, magnetic resonance cholangiopancreatography, and endoscopic retrograde cholangiopancreatography were the other radiological studies. Surgical procedures included cholecystectomy for 83% of the patients with type I. The remaining cases and 14 of the type II patients (77.7%) underwent choledochotomy and T-tube insertion following cholecystectomy. Four of the patients with type II variety and all of the type III patients underwent cholecystectomy and roux-en-Y hepaticojejunostomy. All of the patients had complete recovery, with a morbidity rate of 5.8%, and there was no hospital mortality. Conclusions: The essential part of the management of patients with Mirizzi syndrome is to determine the best surgical procedure in the preoperative period. In type I patients, simple cholecystectomy is generally enough, but sometimes T-tube insertion may be required, while the cases with types II-IV require more complex surgical approach, such as cholecystectomy and bilioenteric anastomosis. Roux-en-Y hepaticojejunostomy is an appropriate procedure with good outcome.
