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Öğe Association of peripapillary fistula with common bile duct stones and cholangitis(Blackwell Publishing Asia, 2003) Karincaoglu, M; Yildirim, B; Kantarceken, B; Aladag, M; Hilmioglu, FBackground: Peripapillary choledochoduodenal fistula (PCDF) is occasionally detected during endoscopic retrograde cholangiopancreatography. Cholelithiasis and biliary bougienage are two suspected causes of PCDF. Methods: The medical records for 841 patients who underwent endoscopic retrograde cholangiopancreatography between 1993 and 2002 were reviewed for evaluation of PCDF. Results: A total of 327 patients had common bile duct stones, and 16 of these had a PCDF at the papilla of Vater. None of the 16 patients had a history of pancreatitis, duodenal ulcer, or had undergone endoscopic retrograde cholangiopancreatography previously. Seven of the 16 had not undergone biliary surgery. Conclusions: This study indicates that PCDF is a relatively common complication of common bile duct stones and cholangitis. According to the present results, PCDF is more frequently associated with common bile duct stones than with biliary surgery and bougienage.Öğe Bilhaemia: An unexpected complication of liver trauma(Taylor & Francis As, 2001) Yilmaz, S; Kirimlioglu, V; Katz, D; Caglikulekci, M; Ara, C; Hilmioglu, F[Abstract Not Available]Öğe Brain natriuretic peptide and severity of disease in non-alcoholic cirrhotic patients(Wiley, 2005) Yildiz, R; Yildirim, B; Karincaoglu, M; Harputluoglu, M; Hilmioglu, FBackground: Cirrhotic patients have a hyperdynamic systemic circulation. They have insidious cardiac problems besides well-known complications. Brain natriuretic peptide (BNP) relaxes vascular smooth muscle and has a portal hypotensive action. The relations between BNP levels and severity of disease, cardiac dysfunction and esophageal varices were studied in non-alcoholic cirrhotic patients. Methods: Fifty-two non-alcoholic cirrhotic patients were evaluated for decompensation component of cirrhosis. The BNP concentration of echocardiographically examined patients was determined. Results: The BNP levels were significantly higher in ascites, spontaneous bacterial peritonitis and hepatic encephalopathy history group (P = 0.033, P < 0.001, P = 0.014, respectively), but no significant difference were observed for presence of esophageal varices and bleeding history (P = 0.267, P = 0.429). A significant correlation was observed between BNP concentration and Child score (r = 0.427, P = 0.012), interventricular septal thickness (r = 0.497, P < 0.001) and left ventricular posterior wall thickness (r = 0.526, P < 0.001). According to Child-Pugh classification there were no significant difference between groups for echocardiographic measurements and blood pressure (P > 0.05), but plasma BNP levels were significantly higher in Child class B and C patients compared with class A patients (P < 0.05). Conclusion: Increased levels of BNP are more likely related to the severity of disease in non-alcoholic cirrhotic patients. The advanced cirrhosis is associated with more advanced cardiac dysfunction and BNP has prognostic value in progression of cirrhosis. (C) 2005 Blackwell Publishing Asia Pty Ltd.Öğe Choledochal cyst spontaneously rupturing the hepatic artery(Springer, 2000) Kirimlioglu, V; Yilmaz, S; Katz, DA; Hilmioglu, F; Caglikulekci, M; Kayaalp, C; Akoglu, M[Abstract Not Available]Öğe Common bile duct diameters after endoscopic sphincterotomy in patients with common bile duct stones: ultrasonographic evaluation(Springer-Verlag, 2003) Karincaoglu, M; Yildirim, B; Seckin, Y; Kantarceken, B; Aladag, M; Hilmioglu, FBackground: One of the most reliable, frequently used imaging techniques in cholestasis is ultrasonography (US) for the diagnosis of common bile duct (CBD) stones. Methods: In this study, changes in diameters of CBD were determined ultrasonographically before and after endoscopic sphincterotomy (ES) in 46 patients with stone-induced dilated CBD. Results: There was a significant decrease in CBD diameter measured 1 week after ES and extraction of stone (p < 0.001). In 87% of cases, the difference was more significantly pronounced during the first 24 h of ES. The mean CBD diameters on US were 13.70 +/- 3.00 mm. (10-21 mm) before and 9.13 +/- 2.90 mm (4.2-18 mm) 24 h after endoscopic treatment (p < 0.001). After ES, six patients (13%) with inadequate decreases in CBD diameters were found to have residual stones. Conclusion: US can show residual stones in the CBD with the same efficacy as endoscopic retrograde cholangiopancreatography.Öğe Complete treatment of ruptured hepatic cyst into biliary tree by ERCP(Springer, 2001) Hilmioglu, F; Karincaoglu, M; Yilmaz, S; Yildirim, B; Kirimlioglu, V; Aladag, M; Onmus, H[Abstract Not Available]Öğe The effect of dividing the sphincter of oddi at endoscopic sphincterotomy on the filling and emptying aspects of function of the gallbladder(Lippincott Williams & Wilkins, 1999) Taskin, V; Ozyilkan, E; Sare, M; Hilmioglu, FThe effect of dividing the sphincter of Oddi at endoscopic sphincteretomy (EST) on the filling and emptying aspects of gallbladder function has not been definitely established in humans. This prospective study is designed to examine the effects of EST on gallbladder emptying. In 13 patients (8 men and 5 women; mean age, 60.54 years +/- 2.14: range, 45-75 years), postprandial gallbladder emptying was measured ultrasonographically before and after EST (within 1-4 days). The fasting volumes after 8 hours of fasting, at times 0 min and before the test meal was given, residual volume (the smallest postprandial volume), gallbladder ejection fraction (EF), and total ejection volume, at 10, 20, 30, 40, 50, 60, 70, 80, and 90 min after the test meal, were studied. The fasting gallbladder volume and the residual volume tended to decrease after EST, but the differences were not significant (40.21 +/- 10.79 mt and 35.48 +/- 11.21 mt, 17.79 +/- 4.83 mt, and 13.10 +/- 4.83 mt, respectively; p > 0.05). Maximum EF was found to be 19.72% at 40 min and increased to 28.62% at 70 min after EST. Although the difference was not statistically relevant, a trend of improvement was evident after EST. The ejected volumes after EST have depicted a trend toward increase, without reaching to any statistical significance (p > 0.05). Our results demonstrate at least no adverse effects of EST and further support some positive effects on gallbladder kinetics.Öğe Effect of Helicobacter pylori eradication on peptic ulcer disease complicated with outlet obstruction(Blackwell Science Inc, 2000) Taskin, V; Gurer, I; Ozyilkan, E; Sare, M; Hilmioglu, FBackground. At present, the prevalence of Helicobacter pylori (H. pylori) in complicated peptic ulcer and the effect of H. pylori eradication on complicated peptic ulcer have not been fully established. In this study, we report the prevalence of H. pylori in peptic ulcer patients complicated with gastric outlet obstruction, effectiveness of oral eradication therapy on these patients, and their long-term follow up. Patients and Methods. Ten consecutive patients presenting with clinically and endoscopically significant obstructed peptic ulcers were included in this study. During each endoscopy, seven gastric biopsy specimens were obtained and analyzed for H. pylori colonization. Results. The antral mucosal biopsy specimens were positive for H. pylori in nine patients. H. pylori infection was eradicated and complete ulcer healing was observed in all patients. The mean follow-up period was 14 (7-24) months. One patient had duodenal perforation and underwent surgical intervention following medical treatment, despite the eradication of H. pylori. Ulcer recurrence was noted in two (22.2%) of nine patients, and in one of them the recurrent ulcer was complicated with obstruction (11.1%). The mean time to ulcer recurrence was 17 months (range, 10-24 months). The biopsies and CLOtests were H. pylori negative at the time of ulcer or erosion recurrence in two patients. Conclusion. We suggest that H. pylori eradication may improve the resolution in obstructive ulcer cases with colonization.Öğe Gallbladder contractility in patients with cirrhotic versus malignant ascites(Wiley, 2002) Sari, R; Yildirim, B; Sevinc, A; Bahceci, F; Hilmioglu, FPurpose. The aim of this study was to evaluate differences in gallbladder contractility by measuring gallbladder wall thickness, fasting and residual gallbladder volume, and gallbladder ejection fraction in patients with cirrhotic and malignant ascites. Methods, Twenty-four patients (16 women and 8 men) with malignant ascites (2 cervical, 2 colon, 2 stomach, 6 pancreatic, and 12 ovarian carcinomas), aged 59 +/- 12 years, and 26 patients (14 women and 12 men) with cirrhotic ascites, aged 57 +/- 16 years, Were included in the study. After patients fasted overnight for 8 hours, gallbladder wall thickness, fasting gallbladder volume, and gallbladder volume and ejection fraction were measured sonographically at 10, 20, 30, 40, 50, 60, 70, 80, and 90 minutes after ingestion of a standard liquid test meal. Results. The mean gallbladder wall thickness was higher in patients with cirrhotic ascites than in those with malignant ascites (5.5 +/- 1.5 mm [standard deviation] versus 3.1 +/- 0.6 mm, respectively; p < 0.001). The mean fasting gallbladder volume was also higher in patients with cirrhotic ascites than in those with malignant ascites (27.3 +/- 11.5 cm(3) versus 17.6 +/- 8.9 cm(3); p < 0.05). Patients with cirrhotic ascites had significantly higher mean postprandial gallbladder volumes and ejection fractions than did those with malignant ascites at all times except 10 minutes after the meal (p < 0.05). Conclusions. Our findings suggest that gallbladder contractility is greater in patients with cirrhotic ascites than in patients with malignant ascites. (C) 2002 Wiley Periodicals, Inc.Öğe Giant solitary fibrous tumor of the liver with metastasis to the skeletal system successfully treated with trisegmentectomy(Springer, 2000) Yilmaz, S; Kirimlioglu, V; Ertas, E; Hilmioglu, F; Yildirim, B; Katz, D; Mizrak, B[Abstract Not Available]Öğe The importance of serum and ascites fluid alpha-fetoprotein, carcinoembryonic antigen, CA 19-9, and CA 15-3 levels in differential diagnosis of ascites etiology(H G E Update Medical Publishing S A, 2001) Sari, R; Yildirim, B; Sevinc, A; Bahceci, F; Hilmioglu, FBackground/Aims: Clinical usage of tumor markers is being limited due to low specificity. Elevated plasma levels of tumor markers may be seen in diseases other than malignancy, i.e., kidney, liver or circulatory disturbances. Methodology: In our study, we studied serum and ascites fluid alpha-fetoprotein, carcinoembryonic antigen, CA 19-9, CA 15-3 levels in patients with chronic liver disease, spontaneous bacterial peritonitis, malignancy, tuberculous and congestive heart failure in a total of 76 patients. Results: The sensitivity and specificity for ascites fluid alpha-fetoprotein levels were 28.5% and 100%, for serum alpha-fetoprotein levels 28.5% and 98.1%, for ascites fluid carcinoembryonic antigen levels 38.0% and 98.1%, for serum carcinoembryonic antigen levels 57.1% and 90.0%, for ascites fluid CA 19-9 levels 19.0% and 94.5%, for serum CA 19-9 levels 33.3% and 21.8%, for ascites fluid CA 15-3 levels 28.5% and 92.7%, and for serum CA 15-3 levels 47.6% and 81.8%, respectively. Conclusions: In conclusion, the sensitivity of serum and ascites fluid tumor markers was found to be low. High specificity may be due to low number of study participants. Serum and ascites fluid tumor markers are not found to be useful in the differential diagnosis of ascites etiology.Öğe Interval analysis in patients with acute biliary pancreatitis(Lippincott Williams & Wilkins, 2005) Ates, F; Kosar, F; Aksoy, Y; Yildirim, B; Sahin, I; Hilmioglu, FBackground: It has been previously proposed that electrocardiographic abnormalities may be associated with acute pancreatitis. However, there is a lack of data on the QT interval and dispersion value in patients with acute pancreatitis, and no data are also available concerning QT interval and QT dispersion in acute biliary pancreatitis ( ABP). Aims: We aimed to investigate the QT parameters in patients with ABP, to compare them with those of healthy controls, and to analyze the relationship between QT parameters and Ranson score. Methods: The present study included 32 patients with acute biliary pancreatitis and 35 healthy controls. The severity of the pancreatitis was determined by Atlanta criteria: fewer than 3 Ranson criteria or fewer than 8 APACHE II ( the Acute Physiology and Chronic Health Evaluation) points indicated the mild disease ( group 1); 3 or more Ranson criteria or 8 or more APACHE II points or organ failure or systemic complications or local complications indicated the severe disease ( group 2). On admission, all patients underwent a standard 12-lead electrocardiogram, and corrected maximum QTc interval (QTc(max)), corrected minimum QT interval (QTc(min)), and corrected QTc dispersion (QTcd) values of the subjects were measured according to the Bazett formula in this study. Results: QTc(max) and QTcd were significantly longer in patients with ABP than in healthy controls ( 442 6 38 milliseconds versus 413 6 34 milliseconds, P< 0.05; and 67 +/- 21 milliseconds versus 42 +/- 18 milliseconds, P< 0.001, respectively). Similarly, QTc(max) and QTcd were significantly longer in group 2 than in group 1 ( 440 6 38 milliseconds versus 450 +/- 34 milliseconds, P< 0.01; and 66 +/- 9 milliseconds versus 71 +/- 11 milliseconds, P< 0.01, respectively). Correlation analysis showed that there is a significant positive relationship between Ranson scores of patients and QTcmax and QTcd ( P< 0.01 and P< 0.001, respectively). Conclusion: The effect of acute biliary pancreatitis on QT intervals and dispersion appears to be dependent not only on the disease but also on its severity, and these parameters may give additional prognostic information in ABP patients, even in the initial evaluation.Öğe Mirizzi syndrome: Choice of surgical procedure in the laparoscopic era(Lippincott Williams & Wilkins, 1998) Sare, M; Gurer, S; Taskin, V; Aladag, M; Hilmioglu, F; Gurel, MImpaction of a calculus in gallbladder neck or cystic duct or even in its remnant may produce common hepatic duct stricture by direct mechanical impression or associated inflammation. This clinical entity is referred to as Mirizzi syndrome. Four patients were operated on for Mirizzi syndrome. This represents 0.9% of the 444 patients who underwent laparoscopic cholecystectomy in our clinic. Two cases with Mirizzi syndrome type I, one of which had a stone in a gallbladder remnant, were successfully treated by laparoscopic cholecystectomy without any complications, One patient developed a bile leakage; fistulography via a sump drain revealed bile leakage from the laceration site of the stone, and: the patient was reoperated on to perform a Roux-en-Y hepaticojejunostomy. The patient was lost due to cardiopulmonary arrest originating from septic shock. In another case diagnosed as Mirizzi type Il, the operation was converted to an open procedure due to intense inflammation and fibrosis around the area of the Calot's triangle. Subtotal cholecystectomy was done and the defect on the common hepatic duct repaired by means of a gallbladder flap over the T tube.Öğe Needle knife papillotomy(Kenya Medical Assoc, 1998) Taskin, V; Özyilkan, E; Hilmioglu, FThe use of needle knife papillotomy (NKP) to achieve a selective bile duct cannulation is controversial. Despite this, many endoscopy centres have reported successful use of NKP when conventional techniques failed. In this prospective study, we assessed the safety and efficacy of NKP in eighty seven patients. In fifty nine of these patients, cholangiogram had failed and in twenty eight patients endoscopic sphincterotomy was unsuccessful because attempts at selective bile duct cannulation had failed. NKP was found successful in fifty one cases (58.6%) during the initial procedure and overall success rate was 79.3% after the subsequent session. There were complications in four cases (4.6%). There were no procedure related mortality and only two complications required surgical intervention. Based on our results, we consider that NKP is a helpful and safe procedure in patients in whom conventional techniques have failed.Öğe Re.: Zuckerman et al. -: Sensitivity of Ca-125 in patients with liver cirrhosis in the presence of ascites(Lippincott Williams & Wilkins, 2001) Sari, R; Yildirim, B; Sevinc, A; Hilmioglu, F[Abstract Not Available]Öğe Serum and ascites fluid cytokine levels in patients with chronic heart failure(Acta Cardiologica, 2001) Sari, R; Yildirim, B; Sevinc, A; Bahceci, F; Ozdemir, R; Hilmioglu, FObjective - Cytokines that are capable of modulating cardiovascular function were reported to be elevated in patients with advanced heart failure. We evaluated the diagnostic importance of cytokines both in the serum and ascites. Material and methods - We determined serum and ascites fluid TNF-alpha, IL-1 beta, IL-6, IL-8, and soluble IL-2 receptor levels in 14 patients with congestive heart failure (group I) and in 15 patients with chronic liver disease (group 2). Results - Ascites fluid IL-8 and soluble IL-2 receptor levels were found to be significantly elevated in group I when compared with group 2 (p = 0.014 and p = 0.005). There were no statistical differences in serum TNF-alpha, IL-1 beta, IL-6, IL-8, and soluble IL-2 receptor levels and ascites fluid TNF-alpha, 1L- I (IL-1 beta, and IL-6 Ievels. Ascites fluid/serum IL- I (IL-1 beta and IL-8 ratio was lower in group 1 when compared with group 2 (p = 0.001 and p = 0.005). Ascites fluid/serum IL-2 and IL-6 ratio was higher in group I when compared with group 2 (p = 0.035 and p = 0.025). Conclusion - Cytokine levels in ascites fluid, but not in serum, are important in congestive heart failure. Ascites fluid/serum cytokine level ratios were detected to be more conclusive and valid in the diagnosis work-up of ascites aetiology.
