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    An unusual case of ectopic variceal bleeding treated with percutaneous intervention
    (Univ Catholique Louvain-Ucl, 2014) Adam, Gurhan; Gunes, Fahri; Akbal, Erdem; Cinar, Celal; Bozkaya, Halil; Resorlu, Mustafa; Aylanc, Nilufer
    [Anstract Not Available]
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    An Unusual Case of Severe Upper Gastrointestinal Bleeding Treated Using an Endovascular Technique
    (Southeastern Surgical Congress, 2014) Adam, Gurhan; Gunes, Fahri; Cinar, Celal; Bozkaya, Halil; Bas, Sercin; Akbal, Erdem; Uysal, Fatma
    [Anstract Not Available]
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    An unusual gastric ulcer cause: celiac crisis
    (Springer Wien, 2014) Akbal, Erdem; Erbag, Gokhan; Binnetoglu, Emine; Gunes, Fahri; Bilen, Yildiz Garip
    [Anstract Not Available]
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    Angioedema - an unusual serious side effect of risperidone injection
    (Informa Healthcare, 2013) Gunes, Fahri; Batgi, Hikmetullah; Akbal, Ayla; Canatan, Tugba
    [Anstract Not Available]
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    Aromatase inhibitor treatment for breast cancer: short-term effect on bone health
    (Termedia Publishing House Ltd, 2015) Erbag, Gokhan; Uygun, Kazim; Binnetoglu, Emine; Korkmaz, Ayse Nurdan; Asik, Mehmet; Sen, Hacer; Gunes, Fahri
    Aim of this study was to examine the effects of aromatase inhibitors (AIs), which are used in every phase of breast cancer treatment, on the bone mineral density (BMD) of patients with early-stage breast cancer. Material and methods: Menopausal female patients who were diagnosed with stages 1-3 breast cancer and who were planned for anastrazole or letrozole as adjuvant therapy were examined. After the patients' BMD was measured, 45 patients without osteoporosis were included in the study. Six months after AI therapy started, the patients' BMD was measured again. Results: In this study, we tried to show that there was a statistical difference in the BMD of 45 patients before and 6 months after treatment. Among all measurements (femur and lumbar T-scores), the femur Z-score (p = 0.52) was the only score that was not statistically significant. Statistical significance (p < 0.01) was detected in comparative analysis of the other measurements. According to this analysis, a significant loss of BMD was seen even in the first six months after AI treatment was introduced. Conclusions: Female patients with breast cancer are at higher risk for bone loss and fractures than healthy women. In this study, we showed the negative effects on BMD of aromatase inhibitor therapy, one of the main contributions to osteoporosis in women with breast cancer. This study is the first to quantify the short-term effect of AI treatment on BMD in postmenopausal women with breast cancer.
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    Co-occurrence of Papillary and Follicular Thyroid Carcinoma in a Patient with Hodgkin's Disease
    (Galenos Yayincilik, 2013) Asik, Mehmet; Ozkul, Faruk; Toman, Huseyin; Durmus, Ahmet; Anaforoglu, Inan; Gunes, Fahri; Akbal, Erdem
    [Anstract Not Available]
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    Decrease in TSH levels after lactose restriction in Hashimoto's thyroiditis patients with lactose intolerance
    (Springer, 2014) Asik, Mehmet; Gunes, Fahri; Binnetoglu, Emine; Eroglu, Mustafa; Bozkurt, Neslihan; Sen, Hacer; Akbal, Erdem
    We aimed to evaluate the prevalence of lactose intolerance (LI) in patients with Hashimoto's thyroiditis (HT) and the effects of lactose restriction on thyroid function in these patients. Eighty-three HT patients taking l-thyroxine (LT4) were enrolled, and lactose tolerance tests were performed on all patients. Lactose intolerance was diagnosed in 75.9 % of the patients with HT. Thirty-eight patients with LI were started on a lactose-restricted diet for 8 weeks. Thirty-eight patients with LI (30 euthyroid and 8 with subclinical hypothyroidism), and 12 patients without LI were included in the final analysis. The level of TSH significantly decreased in the euthyroid and subclinical hypothyroid patients with LI [from 2.06 +/- A 1.02 to 1.51 +/- A 1.1 IU/mL and from 5.45 +/- A 0.74 to 2.25 +/- A 1.88 IU/mL, respectively (both P < 0.05)]. However, the level of TSH in patients without LI did not change significantly over the 8 weeks (P > 0.05). Lactose intolerance occurs at a high frequency in HT patients. Lactose restriction leads to decreased levels of TSH, and LI should be considered in hypothyroid patients who require increasing LT4 doses, have irregular TSH levels and are resistant to LT4 treatment.
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    Dyspepsia, Irritable Bowel Syndrome, and Hematological Parameters in Recurrent Aphthous Stomatitis
    (Derman Medical Publ, 2017) Kilic, Sevilay; Cevizci, Sibel; Sen, Hacer; Isik, Selda; Gunes, Fahri; Binnetoglu, Emine; Hiz, Meliha Merve
    Aim: The goal of this study was to investigate the relationship between gastrointestinal complaints (dyspepsia, irritable bowel syndrome) and hematological parameters among recurrent aphthous stomatitis (RAS) patients. Material and Method: Forty-four RAS patients with a diagnosis of recurrent oral ulcers in oral mucosa were included in this study. They answered a questionnaire concerning oral aphthous properties, dyspepsia problems, and irritable bowel syndrome. Routine hematological screening and hemoglobin, vitamin B12, folic acid, and TSH were analyzed retrospectively. Data analyses were performed using SPSS. Results: Constipation complaints by females were statistically more frequent than those of males (59.3% vs. 11.8%; p< 0.05). There was a positive, statistically moderate and significant correlation between the time passed without having an aphtha (r= 0.343; p= 0.026) and lymphocyte level (r= 0.383; p= 0.028). However, there was no association between the time passed without having an aphtha and age (r= 0.112; p= 0.473), aphtha recurrence frequency (r= 0.05; p= 0.738), vitamin B12 (r= 0.019; p= 0.929), and Hb levels (r= 0.047; p= 0.781). Discussion: It was determined that there was positive correlation between aphtha size and lymphocyte level. Further studies should be designed in light of the association of RAS and gastrointestinal system disease.
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    Evaluation of epicardial fat tissue thickness in patients with Hashimoto thyroiditis
    (Wiley-Blackwell, 2013) Asik, Mehmet; Sahin, Sinan; Ozkul, Faruk; Anaforoglu, Inan; Ayhan, Semiha; Karagol, Sukriye; Gunes, Fahri
    Objective Hypothyroidism, whether overt or subclinical, has multiple effects on the cardiovascular system. Epicardial fat tissue (EFT) is closely related to cardiovascular disorders and atherosclerosis. Our study aimed to assess EFT thickness and carotid artery intima-media thickness (CIMT) in patients with Hashimoto's thyroiditis (HT) displaying overt and subclinical hypothyroidism (SCH). Design and patients The study included 33 patients with SCH and 24 patients with overt hypothyroidism (OH) with HT as well as 32 healthy controls. EFT thickness, CIMT, thyroid hormone levels and lipid parameters were measured in all subjects. Correlation analysis and linear regression analysis were performed for EFT thickness. Results Mean EFT thickness was 2.89 +/- 0.38, 3.53 +/- 0.92 and 4.56 +/- 1.61mm in control, SCH and OH groups, respectively (P < 0.001). EFT thickness of OH patients was high compared with SCH and control subjects (P < 0.01 and < 0.001, respectively). CIMT of OH patients was high compared with SCH and control subjects (P < 0.01 and < 0.001, respectively). In addition, EFT was significantly thicker in SCH patients than in controls (P < 0.05). Correlation analysis showed that EFT thickness was significantly positively correlated with CIMT, age, body mass index, systolic blood pressure, thyroid-stimulating hormone, total and LDL cholesterol and triglyceride and negatively correlated with free T4. In the regression analysis, EFT thickness retained its independent and positive association with CIMT, patient group (particularly OH) and systolic blood pressure. Conclusions Epicardial fat tissue thickness may be a useful indicator of early atherosclerosis in SCH and OH patients with HT.
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    Evaluation of epicardial fat tissue thickness in patients with hyperthyroidism
    (Springer Wien, 2014) Binnetoglu, Emine; Asik, Mehmet; Altun, Burak; Sen, Hacer; Gazi, Emine; Erbag, Gokhan; Gunes, Fahri
    Thyroid hormones have several effects on the cardiovascular system, and recent studies have found that thyroid disorders affect coronary intima-media thickness (CIMT) in particular. Despite increased CIMT in patients with hyperthyroidism, the extent of the relationship between CIMT and epicardial fat thickness (EFT) in those patients is unknown. Furthermore, there is no report evaluating the relationship between EFT and overt hyperthyroidism (OH) in the literature. In this study, we aim to evaluate the effectiveness of EFT in predicting atherosclerosis as well as CIMT in patients with OH. A total of 30 newly diagnosed, untreated overt hyperthyroid patients and 44 control subjects were included in the study. EFT was measured using a commercially available echocardiography machine (VIVID 7; General Electric Medical Systems, Norway) with a 2.5-MHz probe. The echo-free space between the visceral and parietal pericardium on the anterior wall of the right ventricle was diagnosed as EFT. A linear-array imaging probe of the same echocardiography probe was used to evaluate the CIMT of the right common carotid artery. The hyperthyroid patients had a significantly greater EFT (mean: 4.31 +/- A 1.12 mm) than the healthy subjects (mean: 3.11 +/- A 0.84 mm; p < 0.001). CIMT was also significantly greater in the hyperthyroid patients (mean: 0.62 +/- A 0.17 mm) than in the healthy subjects (mean: 0.50 +/- A 0.11 mm; p < 0.01). In conclusion, the present study shows that mean EFT and CIMT were significantly higher in OH patients, irrespective of confounding factors such as hypertension.
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    Evaluation of liver perfusion in diabetic patients using 99mTc-sestamibi
    (Springer Wien, 2015) Sen, Hacer; Tan, Yusuf Ziya; Binnetoglu, Emine; Asik, Mehmet; Gunes, Fahri; Erbag, Gokhan; Gazi, Emine
    Objective The liver is an important organ for various aspects of glucose metabolism, including glucose uptake, storage, and synthesis. It is a major organ in the metabolic process with perfusion provided by both the portal vein and hepatic artery. In diabetic patients organ perfusion is reduced and this is linked to atherosclerosis, and as a result complications occur. In this study, we aimed to evaluate liver perfusion by scintigraphic methods in diabetic patients. Design and patients We retrospectively investigated 1,100 myocardial perfusion scintigraphies taken between January 2011 and December 2012 at Canakkale Onsekiz Mart University Medical Faculty Nuclear Medicine Department. A total of 66 patients who were diagnosed with diabetes mellitus and had myocardial perfusion scintigraphies were included in the study. The control subjects included 127 patients without diabetes mellitus who were chosen at random. Patients with chronic liver disease were not included in the study. The values from liver regions of interest (liver-ROI) rates and heart regions of interest (heart-ROI) rates were compared between the patients and controls. Results Patients were grouped according to the presence of diabetes. In the diabetes mellitus group, the liver-ROI average was lower (p = 0.66) than in the controls. In the control group, the average liver-ROI/heart-ROI ratios were higher than the ratio in the diabetes mellitus group (p = 0.019). Multivariate variance analysis showed that the diabetes mellitus liver-ROI/heart-ROI ratio was independent of other risk factors (p = 0.003; F: 9.6). Powered by Editorial Manager. and ProduXion Manager. from Aries Systems Corporation. Conclusions This study shows that liver perfusion in diabetic patients is reduced compared with those without diabetes. Prospective studies with larger patient groups are required.
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    EVALUATION OF THE RISK OF ATHEROSCLEROSIS IN PATIENTS WITH ADRENAL INCIDENTALOMA USING THE ULTRASOUND BIOMARKERS EFT AND CIMT
    (Carbone Editore, 2015) Sen, Hacer; Uysal, Fatma; Binnetoglu, Emine; Asik, Mehmet; Erbag, Gokhan; Gunes, Fahri; Eroglu, Mustafa
    Introduction: Adrenal incidentalomas (AIs) are masses frequently observed on radiological examination that have attracted attention due to their coincidence with metabolic disorders. Recently, the relationship between atherosclerosis and adrenal incidentalomas has been noted. Epicardial fat tissue (EFT) and carotid artery intima-media thickness (CIMT) measurements show the development of atherosclerosis (AS). The aim of this study is to evaluate the risk of cardiovascular disease in AI patients using EFT and CIMT readings. Materials and methods: Our study included 63 Al patients and 48 healthy controls. All patients were evaluated for blood pressure, Body Mass index(BMI), EFT, CIMT, and lipid parameters. Al patients were also investigated for hormonal secretion. The relationship between risk of atherosclerosis and EFT, CIMT was analyzed. Results: Control subjects (mean EFT, 3.92 +/- 1.14 mm) had lower EFT than patients with subclinical Cushing's syndrome (SCS) and non-functional adenoma (NFA) (mean EFT, 6.22 +/- 1.97 mm and 5.44 +/- 1.61 mm, respectively) (both P < 0.001). There was no difference in EFT between SCS and NFA patients. CIMT was significantly lower in control subjects (mean CIMT, 0.65 +/- 0.11 mm) than in NFA patients (mean CIMT, 0.75 +/- 0.18 mm) (P < 0.01). The EFT of SCS patients was not significantly different from the EFT of either NFA patients or controls. Conclusion: EFT thickness measurements may be helpful as an early atherosclerosis marker in AI patients.
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    Gastrointestinal bleeding associated with dabigatran in a patient with panhypopituitarism
    (Springer Wien, 2014) Gunes, Fahri; Asik, Mehmet; Temiz, Ahmet; Binnetoglu, Emine; Sen, Hacer; Bilen, Ogun Irem; Akbal, Erdem
    [Anstract Not Available]
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    HFE Gene Mutation Among Turkish Patients with Type 2 Diabetes Mellitus
    (Galenos Yayincilik, 2013) Akbal, Erdem; Gunes, Fahri; Asik, Mehmet; Ozbek, Mustafa; Ureten, Kemal; Altinbas, Mustafa
    Purpose: Hereditary haemochromatosis (HH) is a genetic disease with autosomal recessive trait. Recent studies demonstrated the importance of C282Y gene mutation in the aetiology of HH. Free iron accumulating in pancreas deteriorates insulin secretion and synthesis which can lead to insulin resistance and the development of type 2 diabetes mellitus (T2DM) in patients with HH. There has been no study determining the prevalence of haemochromatosis gene (HFE) mutations and HH in diabetic patients in Turkey. We planned this study in order to investigate the C282Y and H63D mutation that cause HH in T2DM. Material and Method: In this study, we included185 patients with T2DM. Patients older than thirty-five years, not taking vitamin supplementation, iron preparates and/or oral contraceptives and those without any signs of active bleeding were included while patients with any infectious, systemic or immune disease were excluded from the study. Serum transferrin saturation (TS), ferritin, iron, and total iron binding capacity levels were measured after 12 hours of fasting. Results: Ten (5.4%) cases with TS of more than 45% were detected at the first evaluation. The test was repeated in those cases and 6 patients with TS of more than 45% were left according to the second measurement. H63D and C282Y gene polymorphisms were not present in these patients. Discussion: We did not find any correlation between the existence of T2DM and HFE polymorphisms. We assume that screening for HH in T2DM in our population is not needed.
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    Hyperimmunoglobulin D Syndrome: Case Report
    (Turkish League Against Rheumatism, 2015) Sen, Hacer; Sılan, Fatma; Binnetoglu, Emine; Gunes, Fahri; Akurut, Cisem; Uludağ, Ahmet; Özdemir, Öztürk
    Hyperimmunoglobulin D syndrome is a rare autosomal recessive inherited disease characterized by fever attacks, which may be accompanied by chills, headache, abdominal pain, and cervical lymphadenopathy. Typical hyperimmunoglobulin D syndrome patients start to show symptoms in the first years of life. Diagnosis is based on the presence of symptoms with reduction in the enzyme activity of mevalonate kinase or by detecting the mutation in the mevalonate kinase gene that causes the disease. In this article, we present a 21-year-old female patient who started having fever attacks in early childhood and was diagnosed with familial Mediterranean fever; however, in spite of treatment, whose complaints did not resolve. The genetic analysis, which detected homozygote mevalonate kinase gene mutation and resulted in the hyperimmunoglobulin D syndrome diagnosis, is presented with an accompanying discussion of the literature.
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    Increase in the Risk of ST Elevation Myocardial Infarction Is Associated With Homocysteine Level
    (Elsevier Science Inc, 2014) Akyurek, Omer; Akbal, Erdem; Gunes, Fahri
    Background and Aims. The present study aimed to investigate the relationship between coagulation defects and ST elevation myocardial infarction (STEMI) in patients without any known coronary artery risk factors and considered low risk according to the Framingham risk classification. Methods. This study included 76 (73.6% male) STEMI patients without any known risk factors for coronary artery disease and 56 healthy controls (67.8% male) with similar characteristics. Results. Factor V Leiden mutation was noted in two patients and in one control. There were no significant differences in protein C, protein S, or antithrombin 3 values between the patient and control groups (p = 0.405, p = 0.476, and p = 0.221, respectively). None of the participants had antiphospholipid syndrome, factor V deficiency, or factor VII deficiency. Plasma homocysteine level was significantly higher in the patient group (19.0 +/- 3.6) mu mol/L than in the control group (15.8 +/- 4.2) mu mol/L (p = 0.008). Homocysteine levels in both groups were higher in males without a statistically significant difference. Vitamin B12 and folate levels, which are directly related to homocysteine metabolism, did not differ significantly between groups. Correlation analysis showed that the homocysteine level was not correlated with lipid parameters, folate, or vitamin B12. Conclusion. Homocysteine level was significantly higher in acute MI in patients without any risk factors and were considered low risk according to the Framingham risk score. The findings support the hypothesis that homocysteine level may be an independent risk factor for coronary artery disease. (C) 2014 IMSS. Published by Elsevier Inc.
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    Intractable Hiccups Induced by Oral Methylprednisolone Treatment in a Patient with Behcet's Uveitis
    (Turkish Ophthalmological Soc, 2013) Tufan, Hasan Ali; Kocabiyik, Omer; Arikan, Sedat; Gencer, Baran; Kara, Selcuk; Gunes, Fahri
    Corticosteroids are one of the most important drug groups that are used to treat uveitis. Topical, systemic, or periocular administration of these agents vary according to the location and severity of inflammation. Systemic steroids may cause short-term side effects including appetite and behavior changes, flushing, water retention, or long-term side effects including osteoporosis, myopathy, hypertension, Cushing syndrome, cataract, and glaucoma. In this study, we report a patient with Behcet's uveitis who developed persistent hiccups due to the systemic methylprednisolone treatment.
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    Isolated Adrenocorticotropic Hormone Deficiency (ACTH) Associated with Hashimoto's Disease
    (Galenos Yayincilik, 2014) Binnetoglu, Emine; Asik, Mehmet; Sen, Hacer; Gunes, Fahri; Kizildag, Betul; Akbal, Erdem; Tekeli, Zeliha
    Isolated adrenocorticotropic hormone (ACTH) deficiency (IAD) is a rare disease characterized by secondary adrenal insufficiency with low cortisol production and normal secretion of pituitary hormones other than ACTH. Association of IAD with Hashimoto's disease (HD) is rare. This suggests the possibility of common autoimmune process affecting both the pituitary and the thyroid glands. Here, we report two cases of IAD with HD.
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    Less aggressive disease in patients with primary squamous cell carcinomas of the thyroid gland and coexisting lymphocytic thyroiditis
    (Termedia Publishing House Ltd, 2015) Asik, Mehmet; Binnetoglu, Emine; Sen, Hacer; Gunes, Fahri; Muratli, Asli; Kankaya, Duygu; Uysal, Fatma
    Aim of the study: Primary squamous cell carcinoma (SCC) of the thyroid gland is extremely rare. Infrequently, primary SCC of the thyroid gland is accompanied by other thyroid diseases such as Hashimoto's thyroiditis (HT). Recently, studies have demonstrated that differentiated thyroid cancer with coexisting HT has a better prognosis. However, the prognosis of patients with primary SCC of the thyroid gland and coexistent HT has not been clearly identified. We compared the clinical characteristics and disease stages of patients with primary SCC with and without lymphocytic thyroiditis (LT). Material and methods: We reviewed reports of primary SCC of the thyroid gland published in the English literature. Results and conclusions: We identified 46 papers that included 17 cases of primary SCC of the thyroid gland with LT and 77 cases of primary SCC of the thyroid gland without LT. Lymph node metastasis and local invasion rates did not differ between these two groups. Distant metastases were absent in patients with LT, and were observed in 13 (16.9%) patients without LT. A greater proportion of patients without LT had advanced stage disease (stage IV A-B-C) than patients with LT (p < 0.05). Patients with primary SCC of the thyroid gland and coexisting LT had lower tumour-node-metastasis stage and frequency of distant metastasis than those without LT. Lymphocytic infiltration in patients with SCC appears to limit tumour growth and distant metastases.
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    Liver Fatty Acid-binding Protein Is A Diagnostic Marker to Detect Liver Injury Due to Chronic Hepatitis C Infection
    (Elsevier Science Inc, 2013) Akbal, Erdem; Koklu, Seyfettin; Kocak, Erdem; Cakal, Basak; Gunes, Fahri; Basar, Omer; Tuna, Yasar
    Background and Aims. Liver fatty acid-binding protein (L-FABP) is a small molecule. The aim of this study was to examine L-FABP levels and to detect its diagnostic value in chronic hepatitis C (CHC). Methods. We studied 22 patients with CHC and 20 healthy control subjects. Patients with persistently elevated serum aminotransferases and positive HCV RNA were included in the study. Patients with CHC underwent percutaneous liver biopsy. Serum level of L-FABP was determined by ELISA method. Results. Patients with CHC had significantly increased levels of L-FABP compared to controls. A strong correlation between serum L-FABP concentrations and aspartate aminotransferases, alanine aminotransferases, HCV RNA levels and hepatic inflammation was found. When a cut-off value was 29,000 pg/mL for L-FABP, sensitivity and specificity were 75 and 100%, respectively. Positive and negative predictive values for L-FABP were 100 and 78%, respectively. Conclusions. Serum L-FABP is used as a new diagnostic marker to detect liver injury. (C) 2013 IMSS. Published by Elsevier Inc.