Üstündağ, Yücel | Karakaya, Kemal | Aydemir, Selim

Article | 2009 | Turkish Journal of Gastroenterology20 ( 4 ) , pp.279 - 281

Papilla bölgesinde duodenal divertikül olan hastalarda safra yollarının endoskopik kanülasyonu çok zor olabilmektedir. Yetmiş yaşında bir bayan hasta akut kolanjit ve koledokolithiazis tanılarıyla hastanemize başvurdu. Hastaya sıvı resüsitasyonu ve antibiyotik tedavisi başlandı. Endoskopik retrograd kolanjiyopankreatografide duodenal divertikül nedeniyle safra yolları kanüle edilemedi. Farklı girişimlere rağmen safra yolları kanüle edilemedi. Endoskopik klip yardımıyla divertikülden kısmen everte edilen papilla fikse edildi. Papillanın sabitlenmesi safra yollarının direkt kanulasyonuna imkan sağladı. Kolanjiografide koledokta multip . . .le kalkül izlendi. Sfinkterotomi, safra yollarından taş ekstraksiyonu yapılan hasta Endoskopik retrograd kolanjiyopankreatografiyi takip eden 9. gün iyi durumda taburcu edildi. Bu yazıda, özellikle büyük periampullar divertikül nedeniyle kanülasyonu çok zor olan olgularda, pankreas ve safra yollarının kanülasyonunda etkili ve güvenli bir yöntem olan endoskopik klip yardımıyla safra yolları kanülasyonu yöntemini hatırlatmak istedik. Endoscopic cannulation of the biliary tract may be challenging in cases with juxtapapillary, duodenal diverticula. A 70-yearold woman admitted to the hospital with the diagnosis of choledocholithiasis and acute cholangitis. She was placed on antibiotic treatment and parenteral fluid resuscitation. On endoscopic retrograde cholangiopancreatography, the papilla could not be cannulated because of the duodenal diverticulum. Various attempts at biliary cannulation failed. Endoscopic clips were used for evertion and fixation of a partially everted papilla from the diverticulum and for securing it in an orientation that allowed direct cannulation of the biliary tree. Cholangiography demonstrated multiple calculi within the choledochus. She was discharged from the hospital on the 9th day following endoscopic retrograde cholangiopancreatography in good condition. With this report, we aimed to remind physicians that the clipassisted method is a safe and effective technique for pancreatic and/or biliary cannulation, and should be preferred in patients in whom cannulation is extremely difficult due to large periampullary diverticula Daha fazlası Daha az

Demirci, Hakan | İlikhan, Sevil Uygun | Öztürk, Kadir | Üstündağ, Yücel | Kurt, Ömer | Bilici, Muammer | Köktürk, Furuzan

Article | 2015 | Turkish Journal of Gastroenterology26 ( 6 ) , pp.456 - 460

Background/Aims: In our study, we aimed to assess the effect of vitamin E and C supplementation to triple and quadruple Helicobacter pylori eradication regimens. Materials and Methods: Four hundred patients with H. pylori infection were classified into four groups. Patients in group A (n=100) received amoxicillin, clarithromycin, and lansoprazole for 2 weeks. In group B, patients (n=100) received vitamins C and E for a month, in addition to amoxicillin, clarithromycin, and lansoprazole for 2 weeks. Patients in group C (n=100) received amoxicillin, clarithromycin, lansoprazole, and bismuth subcitrate for 2 weeks, whereas those in gro . . .up D (n=100) received vitamins C and E for a month, in addition to amoxicillin, clarithromycin, lansoprazole, and bismuth subcitrate for 2 weeks. H. pylori eradication was assessed with the C14 urea breath test 2 months after the end of the therapy. The eradication rate was assessed using per-protocol (PP) and intention-to-treat (ITT) analyses. Results: Three hundred forty-eight patients finished the study. The eradication of H. pylori was achieved in 63 of 84 patients (75%) by PP and 63 of 100 (63%) by ITT analysis in group A, 60 of 84 (71.4%) by PP and 60 of 100 (60%) by ITT analysis in group B, 72 of 89 (80.9 %) by PP and 72 of 100 (72%) by ITT analysis in group C, and 76 of 91 (83.5%) by PP and 76 of 100 (76%) by ITT analysis in group D. There was no remarkable change between groups A and B (p>0.05). Similar results were also found between groups D and C (p>0.05).Conclusion: This study revealed that supplementing vitamins C and E to either the triple or quadruple therapies did not provide an additional advantage for achieving significantly higher eradication rates for H. pylori Background/Aims: In our study, we aimed to assess the effect of vitamin E and C supplementation to triple and quadruple Helicobacter pylori eradication regimens. Materials and Methods: Four hundred patients with H. pylori infection were classified into four groups. Patients in group A (n=100) received amoxicillin, clarithromycin, and lansoprazole for 2 weeks. In group B, patients (n=100) received vitamins C and E for a month, in addition to amoxicillin, clarithromycin, and lansoprazole for 2 weeks. Patients in group C (n=100) received amoxicillin, clarithromycin, lansoprazole, and bismuth subcitrate for 2 weeks, whereas those in group D (n=100) received vitamins C and E for a month, in addition to amoxicillin, clarithromycin, lansoprazole, and bismuth subcitrate for 2 weeks. H. pylori eradication was assessed with the C14 urea breath test 2 months after the end of the therapy. The eradication rate was assessed using per-protocol (PP) and intention-to-treat (ITT) analyses. Results: Three hundred forty-eight patients finished the study. The eradication of H. pylori was achieved in 63 of 84 patients (75%) by PP and 63 of 100 (63%) by ITT analysis in group A, 60 of 84 (71.4%) by PP and 60 of 100 (60%) by ITT analysis in group B, 72 of 89 (80.9 %) by PP and 72 of 100 (72%) by ITT analysis in group C, and 76 of 91 (83.5%) by PP and 76 of 100 (76%) by ITT analysis in group D. There was no remarkable change between groups A and B (p>0.05). Similar results were also found between groups D and C (p>0.05).Conclusion: This study revealed that supplementing vitamins C and E to either the triple or quadruple therapies did not provide an additional advantage for achieving significantly higher eradication rates for H. pylor Daha fazlası Daha az

Engin, Hüseyin | Üstündağ, Yücel

Letter | 2009 | Turkish Journal of Gastroenterology20 ( 3 ) , pp.231 - 232

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Akar, Tarık | Dindar, Gökhan

Letter | 2014 | Turkish Journal of Gastroenterology25 ( 4 ) , pp.112 - 113

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Aydemir, Selim | Savranlar, Ahmet | Engin, Hüseyin | Özer, Tülay | Cihan, Alper | Üstündağ, Yücel | Gün, Doğan Banu

Article | 2006 | Turkish Journal of Gastroenterology17 ( 1 ) , pp.50 - 52

Mide adenokanseri nedeniyle subtotal gastrektomi ve gastrojejunostomi yapıldıktan bir sene sonra nüks eden ve midede diffuz, plak tarzında kalsifikasyon gelişen 53 yaşındaki erkek hastayı sunduk. Bu vaka literatürde mide kanseri operasyonundan bir yıl sonra midede tümör kalsifikasyonu tanımlanan ilk vakadır. Bu vaka sebebiyle mide duvar kalsifikasyonu nedenlerini tartıştık. We present the case of a 53-year-old male with subtotal gastrectomy and gastrojejunostomy due to gastric cancer who later developed cancer relapse and diffuse plaque-like calcification in the residual gastric tissue. As far as we know, this is the first case in t . . .he English literature in whom gastric tumor calcification developed one year after gastric cancer operation. We also discuss possible mechanisms of gastric wall calcification in such cases Daha fazlası Daha az

Hişmioğulları, Adnan Adil | Bozdayı, A.Mithat | Rahman, Khalid

Other | 2007 | Turkish Journal of Gastroenterology18 ( 2 ) , pp.65 - 70

Birçok biyokimyasal fonksiyonu olan karaciğerin, en önemli işlevlerinden biri de safra oluşturmasıdır. Safra, aralarında safra asitleri, fosfolipidler ve kolesterolün de olduğu çok sayıda çözünmüş bileşik içerir. Fosfolipidlerin ve kolesterolün hepatositlerde sentezlenerek veziküler ve veziküler olmayan mekanizmalarla hepatositlerin safra kanalikusuna transfer edildiği düşünülmektedir. Safra lipidleri, çoğunlukla kolesterol ve fosfolipidlerden oluşur ve safraya sekresyonları da safra asitleri sekresyonundan etkilenir. Hem salınan hem de ekskrete edilen bir sı- vıdır. En önemli iki fonksiyonu, muhtemelen (i) yağ sindirimi ve absorbsi . . .yonuna yardım eden safra asitlerinin ve (ii) potansiyel toksik materyallerin karaciğer-orijinli metabolitlerinin, vücuttan dışkıyla eliminasyonlarından önce intestinal sisteme taşı nmalarıdır. Hepatositler; üç ayrı yolakla, biyosentez, lipoproteinler ve intrasellüler membranlardan çekilen mevcut moleküllerle safra lipidi yapabilirler. Yeni, sentezlenen safra lipidleri, toplam lipidlerin %20’sinden biraz azını oluşturur. Safrada bulunan kolesterolün eliminasyonunun hepatik ölçütleri, sadece tüm kolesterol homeostazisi ile değil, safra ile ilgili hastalı k koşullarıyla da ilişkilidir. Aşırı safra kolesterol sekresyonu, kolesterol safra taşı oluşumuyla ilişkili olup, safra kesesi kanseri için de esas risk faktörüdür. Bu derlemenin amacı, safra lipid sekresyonuyla ilgili, bazı ana mekanizmaların öneminin vurgulanmasıdır. The liver has many biochemical functions, of which one of the most important is bile formation. Bile is both a secretory and an excretory fluid and two of its most important functions are the delivery to the intestinal tract of: (i) bile acids to assist in fat digestion and absorption; and (ii) liver-derived metabolites of potentially toxic materials prior to their elimination from the body in the feces. Bile contains numerous solutes, including bile acids, phospholipids and cholesterol. Biliary lipids mainly consist of cholesterol and phospholipids and their secretion into bile is affected by the secretion of bile acids. Phospholipids and cholesterol are synthesized in the hepatocytes and are thought to be transferred via vesicle- and non-vesicle-mediated mechanisms into the bile canaliculus. Hepatocytes acquire biliary lipid by three pathways, which are biosynthesis, lipoproteins and existing molecules drawn from intracellular membranes, with the newly synthesized biliary lipid accounting for less than 20% of the total lipids. The hepatic determinants of biliary cholesterol elimination are not limited to total cholesterol homeostasis, but also concern biliary disease conditions, since excess biliary cholesterol secretion is involved in cholesterol gallstone formation, as well as being a major risk factor for gallbladder cancer. The purpose of this review was to highlight some of the major mechanisms involved in biliary lipid secretion Daha fazlası Daha az

Özbakış, Günnur Dengiz | Hekimoğlu, Aşkın | Kandemir, Nilüfer | Kurcer, Zehra

Article | 2012 | Turkish Journal of Gastroenterology23 ( 5 ) , pp.456 - 462

Amaç: Statinlerin lipid düşürücü etkilerinin yanısıra ilave pleiotropik etkileri vardır. Bu çalışmada, statinlerin sıçanlarda indometazinle oluşturulan mide hasarı üzerine etkileri değerlendirildi. Gereç ve Yöntem: Hayvanlar sekiz gruba ayrıldı. Kontrol grubuna distile su, diğer gruplara omeprazol (30 mg/kg), atorvastatin (20-40 mg/kg), simvastatin (20-40 mg/kg) ve rosuvastatin (20-40 mg/kg) oral yolla verildi. Otuz dakika sonra, bütün gruplara yine oral yolla indometazin (25 mg/kg) uygulandı. Altı saat sonra, hayvanlar dekapitasyon ile öldürüldü. Her grup için ortalama ülser indeksleri hesaplandı. Daha sonra, mideler histopatolojik . . . olarak değerlendirildi. Bulgular: Ülser indeksleri kontrol grubunda 1.72±0.16, omeprazol grubunda 0±0.00, atorvastatin, simvastatin ve rosuvastatinin 20 ve 40 mg/kg dozlarında sırasıyla 4.28±0.39, 4.99±0.96, 1.72±0.73, 1.90±0.48, 1.85±0.26 ve 1.67±0.18 tespit edildi. Atorvastatin her iki dozda indometazinle oluşturulan ülser indeksini ve 40 mg/kg dozda erozyon skorunu anlamlı olarak artırmıştır. Simvastatinin 20 mg/kg dozu mononükleer lökosit infilrasyonunu inhibe etmesine rağmen, 40 mg/kg dozu hiperemiyi artırmıştır. Rosuvastatin 20 mg/kg dozda hem mononükleer lökosit hem de nötrofil infiltrasyonlarını, 40 mg/kg dozda ise sadece nötrofil infiltrasyonunu azaltmıştır. Sonuç: Mide rahatsızlığı olan hastalarda, statinler dikkatli kullanılmalıdır. Statin tedavisi mutlaka gerekiyorsa, atorvastatin kullanılmamasını ve diğer statinlerin de etkili en düşük dozlarda kullanılmasını tavsiye etmekteyiz. Background/aims: Statins have additional pleiotropic effects beyond their lipid-lowering effects. In this study, the effects of statins were evaluated in an indomethacin-induced gastric injury model in rats. Materials and Methods: Animals were divided into eight groups. Distilled water (control group), omeprazole (30 mg/kg), atorvastatin (20 and 40 mg/kg), simvastatin (20 and 40 mg/kg), and rosuvastatin (20 and 40 mg/kg) were given orally (gavage). Thirty minutes later, indomethacin (25 mg/kg) was administered orally to all groups. Six hours later, the animals were sacrificed by decapitation. The mean ulcer indexes for each group were calculated, and the stomachs were evaluated histopathologically. Results: The ulcer indexes were as follows: control 1.72±0.16, omeprazole 0±0.00, and atorvastatin, simvastatin and rosuvastatin (at 20 and 40 mg/kg doses, respectively) 4.28±0.39, 4.99±0.96, 1.72±0.73, 1.90±0.48, 1.85±0.26, and 1.67±0.18. Atorvastatin significantly increased the indomethacin-induced ulcer index at both doses and the erosion score at 40 mg/kg dose. Although the 20 mg/kg dose of simvastatin inhibited mononuclear leukocyte infiltration, the 40 mg/kg dose induced hyperemia. Rosuvastatin did not decrease mononuclear leukocyte or neutrophil infiltrations at 20 mg/kg dose, and only neutrophil infiltration at the 40 mg/kg dose. Conclusions: In patients with gastric discomfort, statins must be used carefully. If statin therapy is needed, we recommend to avoid using atorvastatin and to use the other statins only in the minimum effective dose. Top Summary Introduction Materials And Methods Results Discussion Reference Daha fazlası Daha az

Ünler, Gülhan Kanat | Özgür, Gülsüm Teke | Göktürk, Hüseyin Savaş | Korkmaz, Hüseyin | Erinanç, Özgür Hilal

Article | 2016 | Turkish Journal of Gastroenterology27 ( 3 ) , pp.221 - 226

Background/Aims: Chronic gastritis progression is a multistep process of atrophy, intestinal metaplasia (IM), and dysplasia, which may lead to invasive carcinoma. In this study, we identified an association of colonic polyps with gastric IM in patients undergoing colonoscopy.Materials and Methods: This retrospective case-control, cross-sectional study was conducted in a tertiary-care institution in Turkey. Pathology and endoscopy reports were reviewed. The study group comprised 400 patients with colonic adenomatous polyps, and the control group comprised 360 patients without colonic adenomatous polyps on colonoscopy.Results: The ris . . .k of gastric IM was 1.42-fold higher in the study group (p=50 years with colonic polyps was 3.35-fold higher than in those aged Daha fazlası Daha az

Atalay F. | Uygur F. | Cömert M. | Özkoçak I.

Article | 2011 | Turkish Journal of Gastroenterology22 ( 5 ) , pp.523 - 528

Background/aims: Chronic obstructive pulmonary disease is a well-known independent risk factor for the development of postoperative pulmonary and cardiac complications after thoracic or nonthoracic surgery. We aimed to determine the risk factors and complications of abdominal surgery in chronic obstructive pulmonary disease patients. Material and Methods: Thirty-two patients diagnosed with chronic obstructive pulmonary disease out of 89 patients who underwent abdominal surgery at Zonguldak Karaelmas University Medical School Hospital enrolled in the study. Results: Pulmonary and cardiac complication ratios were found high in chronic . . . obstructive pulmonary disease patients. Postoperative pulmonary and cardiac complications were documented in 21.8% and 28.1% of chronic obstructive pulmonary disease patients respectively. There were no differences in terms of complications, according to the severity of the disease in chronic obstructive pulmonary disease patients. While smoking and age did not effect the postoperative complications in chronic obstructive pulmonary disease patients, bronchodilator use increased postoperative cardiac risks. We found that laparoscopic surgery reduced the risk for postoperative pulmonary complications compared with open surgical procedures. No differences were found in terms of complication regarding to the type of incision and the duration of surgery. Conclusion: The patients with chronic obstructive pulmonary disease had high ratio of the pulmonary and cardiac complications. The complication rate was higher for surgical sites closer to the diaphragm such as the upper abdomen. Laparoscopy will reduce the risk for postoperative pulmonary complications compared with open surgical procedures. Based on our preliminary data and considering the lack of controlled trials, bronchodilators should be used with great caution particularly in the individuals with chronic obstructive pulmonary disease and cardiac comorbidity Daha fazlası Daha az