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    Acute acalculous cholecystitis induced by aortic dissection: report of a case
    (Turkish Assoc Trauma Emergency Surgery, 2010) Sogutlu, Gokhan; Isik, Burak; Yilmaz, Mehmet; Karadag, Nese; Hoca, Onur; Olmez, Aydemir; Cinpolat, Oezguer
    Acute acalculous cholecystitis (AAC), inflammation of the gallbladder without evidence of calculi, comprises approximately 10% of all cases of acute cholecystitis. Although the mechanism of AAC has not yet been sufficiently clarified, the most commonly postulated theories regarding its pathogenesis are bile stasis, sepsis and ischemia. We present a case of AAC associated with ischemia of the gallbladder caused by aortic dissection Bakey type III.
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    Acute Liver Failure following Sleeve Gastrectomy with Jejuno-Ileal Bypass
    (Elsevier Sci Ltd, 2021) Aktas, Aydin; Gokler, Cihan; Sansal, Mufit; Karadag, Nese; Kayaalp, Cuneyt
    Introduction: Laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed bariatric surgery in recent years, and some modifications have emerged to improve its efficacy. Melissas has described SG plus jejuno-ileal bypass (JIB), which has reported good results in a few studies. We performed this procedure in 21 cases and in one case, we observed acute liver failure (ALF) that has not been reported before. Case presentation: A 38-year-old female (BMI: 56.1 kg/m(2)) underwent laparoscopic SG plus JIB. There was no sign of diarrhea, malnutrition or liver failure for eight months and her BMI was 43.0 kg/m(2). At the 9th month, she was hospitalized for abdominal pain, jaundice and ALF. The patient was treated by plasmapheresis and molecular absorptive recirculation system. She was planned to undergo liver transplantation but died of multiorgan failure on the 40th day of hospitalization. Conclusion: ALF can be observed following SG plus JIB. JIB reversal before compromising liver functions should be taken into consideration. (C) 2021 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.
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    Albendazole Induced Recurrent Acute Toxic Hepatitis: A Case Report
    (Univ Catholique Louvain-Ucl, 2017) Bilgic, Yilmaz; Yilmaz, Cengiz; Cagin, Yasir Furkan; Atayan, Yahya; Karadag, Nese; Harputluoglu, Murat Muhsin Muhip
    Introduction : Drug induced acute toxic hepatitis can be idiosyncratic. Albendazole, a widely used broad spectrum antiparasitic drug is generally accepted as a safe drug. It may cause asymptomatic transient liver enzyme abnormalities but acute toxic hepatitis is very rare. Case Report : Herein, we present the case of 47 year old woman with recurrent acute toxic hepatitis after a single intake of albendazole in 2010 and 2014. The patient was presented with symptoms and findings of anorexia, vomiting and jaundice. For diagnosis, other acute hepatitis etiologies were excluded. Roussel Uclaf Causality Assessment Method (RUCAM) score was calculated and found to be 10, which meant highly probable drug hepatotoxicity. Within 2 months, all pathological findings came to normal. Result : There are a few reported cases of albendazole induced toxic hepatitis, but at adults, there is no known recurrent acute toxic hepatitis due to albendazole at this certainty according to RUCAM score. Conclusion : Physicians should be aware of this rare and potentially fatal adverse effect of albendazole.
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    Appendiceal Enterobius vermicularis infestation in adults
    (Int College Of Surgeons, 2007) Isik, Burak; Yilmaz, Mehmet; Karadag, Nese; Kahraman, Latif; Sogutlu, Gokhan; Yilmaz, Sezai; Kirimlioglu, Vedat
    The objective of this study is to evaluate the incidence of Enterobius vermicularis in the appendices of the adult population and a possible relationship between E. vermicularis and acute appendicitis. E. vermicularis was identified in 18 (2%) of 890 patients. Six hundred sixty-five operations were performed for presumptive diagnosis of acute appendicitis, and E. vermicularis was found in 12 (2%) patients. The histopathological examination revealed acute inflammatory cells in four cases (33%). Three of these four specimens included luminal ova and one E. vermicularis. Histopathological examination of six cases revealed E. vermicularis in 225 incidental appendectomies with no evidence of either acute or chronic inflammatory cells. This study suggests a relationship between the presence of E. vermicularis ova and acute inflammation, but the presence of the pinworm in the lumen of the appendix is coincidental. On the other hand E. vermicularis in the appendix lumen can cause symptoms of acute appendicitis.
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    Apricot attenuates oxidative stress and modulates of Bax, Bcl-2, caspases, NF?-B, AP-1, CREB expression of rats bearing DMBA-induced liver damage and treated with a combination of radiotherapy
    (Pergamon-Elsevier Science Ltd, 2014) Karabulut, Aysun Bay; Karadag, Nese; Gurocak, Simay; Kiran, Tugba; Tuzcu, Mehmet; Sahin, Kazim
    We evaluated the ability of apricot to attenuate apoptosis and oxidative stress developed during the process of 7,12-dimethylbenz[a]anthracene (DMBA) and radiotherapy in the liver of rats bearing liver damage. Fifty female Wistar rats were divided into 7 groups; (i) normal control rats; (ii) rats fed with standard diet with apricot (20%), (ii) rats fed with standard diet and administrated 6 gray radiotherapy with Co 60 device applied to a single fraction, (iv) rats fed with standard diet and administered intraperitoneally DMBA (20 mg/kg), (v) rats fed with standard diet and administered DMBA and 6 gray radiotherapy, (vi) rats fed with standard rat diet and administered DMBA and supplemented apricot, (vii) rats fed with standard diet supplemented apricot administered DMBA and radiotherapy (RT) for 6 weeks. Expression of Bax, caspase 3, and glutathione activity decreased in the liver but liver expression of NF-kappa B, AP-1, CREB, Bcl-2 and ALT, AST, 5'NT, MDA, NO levels increased in DMBA-induced liver damage rats. In conclusion, the results suggest that apricot supplementation and irradiation given in combination, offer maximum protection against DMBA-induced hepatic carcinogenesis. (C) 2014 Elsevier Ltd. All rights reserved.
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    Body Mass Index is Associated with Immunohistochemical Nuclear Phosphatase and Tensin Homolog Deleted on Chromosome 10 (PTEN) Expression in Stage IB-IC Endometrioid Endometrial Carcinoma
    (Galenos Yayincilik, 2007) Meydanli, Mutlu; Karadag, Nese; Kose, Faruk; Tulunay, Gokhan; Ozfuttu, Ahrnet
    Objective: To examine the relationship between clinicopathologic features and nuclear phosphatase and tensin homolog deleted on chromosome 10 (PTEN) expression in a homogeneous group of Stage IB-IC sporadic endometrioid endometrial cancer (EEC) patients. Materials and Methods: This study was conducted on 65 consecutive EEC patients with FIGO Stage IB-IC disease who underwent initial complete surgical staging. Age, body mass index (BMI), tumor grade, immunohistochemical nuclear PTEN expression and clinical outcome were examined. The median follow-up period was 49 months (range, 8 to 78 months). Results: Immunohistochemical staining revealed positive nuclear PTEN expression in 20 cases (30.8%). Nuclear PTEN was found out to be reduced in 36 cases (55.4%), whereas it was completely lost in nine cases (13.8%). After evaluating the staining status, 45 cases (69.2%) were judged as negative for nuclear PTEN expression. During the follow-up period, clinical recurrence of disease was documented in five of 65 women (7.7%). The 5-year disease free survival rate for patients with positive nuclear PTEN expression was similar to that for patients with negative nuclear PTEN expression (75.2% vs. 91.3%, respectively; p =0.728 [log-rank test]). The mean body mass index (BMI) of positive nuclear PTEN expressing cases was significantly greater than that of patients with negative nuclear PTEN expression (32.5 +/- 6.5 vs. 28.5 +/- 5.0, respectively; p =0.009). Discussion: Lost/reduced nuclear PTEN expression was frequent in FIGO Stage IB/IC EEC. BMI is the only clinicopathologic variable affecting immunohistochemical nuclear PTEN expression.
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    CARCINOMA ERYSIPELOIDES FROM BREAST CANCER MIMICKING AS RADIODERMATITIS: REPORT OF A CASE
    (Aves, 2009) Sogutlu, Gokhan; Aydin, Cemalettin; Karadag, Nese; Olmez, Aydemir; Ozgor, Dincer; Deniz, Sumer
    Carcinoma erysipeloides (CE) is an uncommon metastatic pattern arising from visceral carcinoma. As a consequence of lymphatic blockage by the tumor cells, erysipel like appearance can occur. It may be confused with erysipelas and other infl ammatory lymphedemas. We report a case of CE in a woman previously treated by mastectomy for locally advanced breast carcinoma. The lesion was clinically mimicked a radiation dermatitis.
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    Case Study of Bardet-Biedl Syndrome with Fetal Lobulation and Focal Segmental Glomerulosclerosis
    (Galenos Yayincilik, 2008) Tabel, Yilmaz; Akin, Like Mungan; Karadag, Nese; Akinci, Ayflehan
    Bardet-Biedl syndrome is a genetic autosomal recessive disease characterized by abdominal obesity, mental retardation, dysmorphic extremities, retinal dystrophy or pigmentary retinopathy, hypogonadism or hypogenitalism, and kidney involvement. Patients with renal involvement may present with both structural and functional abnormalities. Here, we present a 15-year-old male with Bardet-Biedl syndrome who has both fetal lobulation, a rare type of structural abnormality, and focal segmental glomerulosclerosis, having not been reported before.
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    Coexistence of duodenum derived aggressive fibromatosis and paraduodenal hydatid cyst: A case report and review of literature
    (Baishideng Publishing Group Inc, 2018) Akbulut, Sami; Yilmaz, Mehmet; Alan, Saadet; Kolu, Mehmet; Karadag, Nese
    Intra-abdominal aggressive fibromatosis is a locally aggressive tumor mostly originating from the mesentery or retroperitoneal space, infiltrating adjacent tissues, and very rarely metastasizing to distant organs. There are only two case reports in the English language literature where intra-abdominal aggressive fibromatosis originated from the intestinal wall. In this study, we aimed to report a case of aggressive fibromatosis originating from the muscularis propria layer of the duodenum and invading pancreas. Another interesting aspect of this case is that a primary paraduodenal hydatid cyst was incidentally detected in the surgical specimen. A 46-year-old female patient presented to our clinic with postprandial nausea and vomiting. A contrast-enhanced abdominal computerized tomography revealed a mass lesion with a size of 100 mm x 80 mm which originated from the distal pancreas and compressed the gastric pilor externally. Upon exploration the distal part of duodenum, proximal jejunum, and pancreatic mass were noted to form a conglomerated structure. Therefore, the fourth part of the duodenum, a 25 cm part of the proximal jejunum, distal pancreas, and the spleen were excised en-bloc. The pathology report of the specimen indicated fibromatosis with a diameter of 55 mm that originated from the muscularis propria of the duodenum and extended into the pancreatic parenchyma. There was also an incidentally detected 10 mm paraduodenal hydatid cyst. No tumor recurrence was detected at a follow-up period of 24 mo. In conclusion, the most ideal treatment of desmoid-type fibromatosis is surgical resection of the mass lesion with clean surgical borders. Although rare, this tumor may originate from the intestinal wall. Histopathological verification is of great significance for a proper diagnosis.
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    Coexistence of duodenum derived aggressive fibromatosis and paraduodenal hydatid cyst: a case report and review of literature
    (World journal of gastroıntestınal surgery, 2018) Akbulut, Sami; Yilmaz, Mehmet; Alan, Saadet; Kolu, Mehmet; Karadag, Nese
    Intra-abdominal aggressive fibromatosis is a locally aggressive tumor mostly originating from the mesentery or retroperitoneal space, infiltrating adjacent tissues, and very rarely metastasizing to distant organs. There are only two case reports in the English language literature where intra-abdominal aggressive fibromatosis originated from the intestinal wall. In this study, we aimed to report a case of aggressive fibromatosis originating from the muscularis propria layer of the duodenum and invading pancreas. Another interesting aspect of this case is that a primary paraduodenal hydatid cyst was incidentally detected in the surgical specimen. A 46-year-old female patient presented to our clinic with postprandial nausea and vomiting. A contrast-enhanced abdominal computerized tomography revealed a mass lesion with a size of 100 mm x 80 mm which originated from the distal pancreas and compressed the gastric pilor externally. Upon exploration the distal part of duodenum, proximal jejunum, and pancreatic mass were noted to form a conglomerated structure. Therefore, the fourth part of the duodenum, a 25 cm part of the proximal jejunum, distal pancreas, and the spleen were excised en-bloc. The pathology report of the specimen indicated fibromatosis with a diameter of 55 mm that originated from the muscularis propria of the duodenum and extended into the pancreatic parenchyma. There was also an incidentally detected 10 mm paraduodenal hydatid cyst. No tumor recurrence was detected at a follow-up period of 24 mo. In conclusion, the most ideal treatment of desmoid-type fibromatosis is surgical resection of the mass lesion with clean surgical borders. Although rare, this tumor may originate from the intestinal wall. Histopathological verification is of great significance for a proper diagnosis.
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    DNA repair proteins may differentiate papillary thyroid cancer from chronic lymphocytic thyroiditis and nodular colloidal goiter
    (Nature Portfolio, 2021) Evren, Bahri; Yilmaz, Sami; Karadag, Nese; Sertkaya, Ayse Cikim; Topaloglu, Omercan; Kilinc, Faruk
    Malignant thyroid lesions are the most common malignancy of the endocrine glands with increasing rates in the last two decades. Papillary thyroid cancer is the most common thyroid malignancy. In our study, we aimed to quantitatively evaluate the levels of DNA repair proteins MSH2, MLH1, MGMT, which are representative blocks of patients diagnosed with papillary carcinoma, chronic thyroiditis, or colloidal goiter. Total or subtotal thyroidectomy material of 90 patients diagnosed with papillary carcinoma, nodular colloidal goiter, or chronic thyroiditis between 2009 and 2012 were retrospectively evaluated. Tissue samples obtained from paraffin blocks were stained with MGMT, MSH2, MLH1 proteins and their immunohistochemistry was evaluated. Prepared sections were examined qualitatively by an impartial pathologist and a clinician, taking into account the staining method under the trinocular light microscope. Although there was no statistically significant difference in MGMT, MSH2, MLH1, follicular cell positivity, staining intensity, and immunoreactivity values, papillary carcinoma cases showed a higher rate of follicular cell positivity, and this difference was more pronounced between papillary carcinoma and colloidal goiter. In the MSH2 follicular cell positivity evaluation, the difference between chronic thyroiditis and colloidal goiter was significant (p=0.023). The difference between chronic thyroiditis and colloidal goiter was significant in the MSH2 staining intensity evaluation (p=0.001). The difference between chronic thyroiditis and colloidal goiter was significant in MLH1 immunoreactivity evaluation (p=0.012). Papillary carcinoma cases were demonstrated by nuclear staining only for MSH2 and MLH1 proteins as opposed to hyperplastic nodules. The higher levels of expression of DNA repair genes in malignant tumors compared to benign tumors are attributed to the functional activation of DNA repair genes. Further studies are needed for DNA repair proteins to be a potential test in the development and progression of thyroid cancer.
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    Does Preoperative Transarterial Chemoembolization for Hepatocellular Carcinoma Increase the Incidence of Hepatic Artery Thrombosis After Living-Donor Liver Transplant?
    (Baskent Univ, 2017) Ince, Volkan; Ersan, Veysel; Karakas, Serdar; Kutluturk, Koray; Karadag, Nese; Kutlu, Ramazan; Yilmaz, Sezai
    Objectives: Transarterial chemoembolization is a potential risk factor for hepatic artery damage, which may lead to severe consequences. We aimed to investigate this controversial issue in our population of liver transplant patients with hepatocellular carcinoma. Materials and Methods: Between March 2006 and December 2016, a total of 262 patients with hepa-tocellular carcinoma underwent liver transplant at our institution. Of these, 22 (8.4%) had preoperative transarterial chemoembolization. We retrospectively reviewed the data of all patients, comparing those who did and did not undergo transarterial chemo embolization. Results: The groups were similar in terms of patient sex, mean age, mean alpha-fetoprotein levels, and Milan criteria. The nontransarterial chemoembolization group had a significantly higher mean Model for End-Stage Liver Disease score. Hepatic artery thrombosis after liver transplantation was diagnosed in 6 of 22 patients (27%) in the transarterial chemoembolization group and in 12 of 240 patients (5%) in the non transarterial chemoembolization group (P = .002). Retransplant was performed in 5 of the 6 patients with hepatic artery thrombosis in the transarterial chemo embolization group and 3 of the 12 patients in the nontransarterial chemoembolization group (P = .04). Conclusions: In patients who undergo transarterial chemoembolization before liver transplantation, the incidence of hepatic artery thrombosis and retrans plantation is significantly higher than in those who do not undergo this intervention. The tissues should be carefully handled at the time of transplantation to prevent trauma that may cause intimal dissection in the fragile vessels.
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    Drug induced autoimmune hepatitis: a single center experience.
    (Allied Acad, 2017) Bilgic, Yilmaz; Harputluoglu, Hakan; Yilmaz, Cengiz; Karadag, Nese; Cagin, Yasir Furkan; Akbulut, Sami; Seckin, Yuksel
    Objective: Many drugs such as minocycline, nitrofurantoin, halothane, non-steroidal anti-inflammatory drugs, anti TNF (Tumor Necrosis Factor) antagonists can induce the autoimmune hepatitis. Herein, we aimed to assess patients suffering from drug induced autoimmune hepatitis who were hospitalized with acute hepatitis like transaminase elevations to our clinic between 2009-2015. Method: The patients were determined using simplified diagnostic criteria of the International Autoimmune Hepatitis Group. Results: We determined 9 patients whose score were compatible with the diagnosis of Autoimmune hepatitis (AIH). Three patients were older than 50, and six patients were between 19 and 31. Seven of nine patients were female. The drugs thought responsible for AIH were as follows; ciprofloxacin alone, amoxicillin plus nimesulid, amoxicillin plus ornidazole, amoxicillin alone, a combined oral contraceptive pill plus a mixture of natural drugs, metronidazole plus dexketoprofen, ramipril plus metronidazole, levofloxacin alone and venlafaxine plus mianserin for each case. Five of nine patients had been followed up conservatively upon discontinuation of drug(s) and did not need any treatment during hospitalization and resolved spontaneously. Four patients received immunosuppressive treatment which was withdrawn in 3 of those 4 patients after 3 to 6 months upon remission without relapse. Conclusion: Drug induced autoimmune hepatitis (DIAIH) can be presented with acute hepatitis of unknown etiology. Female sex seems to be a risk factor for DIAH. Treatment decisions should be given according to patient's clinical status and follow up at acute presentations. There can be no treatment need, but, when needed generally a short course of immunosuppressive treatment can be sufficient.
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    Ectopic liver tissue (choristoma) on the gallbladder: A comprehensive literature review
    (Baishideng Publishing Group Inc, 2020) Akbulut, Sami; Demyati, Khaled; Ciftci, Felat; Koc, Cemalettin; Tuncer, Adem; Sahin, Emrah; Karadag, Nese
    BACKGROUND Liver tissue situated outside the liver with a hepatic connection is usually called an accessory liver, and that without a connection to the mother liver, is called ectopic liver tissue. AIM To identify studies in the literature on ectopic liver tissue located on the gallbladder surface or mesentery. METHODS We present two patients and review published articles on ectopic liver tissue located on the gallbladder surface accessed via PubMed, MEDLINE, Google Scholar, and Google databases. Keywords used included accessory liver lobe, aberrant liver tissue, ectopic liver tissue, ectopic liver nodule, heterotopic liver tissue, hepatic choristoma, heterotopic liver tissue on the gallbladder, and ectopic liver tissue on the gallbladder. The search included articles published before June 2020 with no language restriction. Letters to the editor, case reports, review articles, original articles, and meeting presentations were included in the search. Articles or abstracts containing adequate information on age, sex, history of liver disease, preliminary diagnosis, radiologic tools, lesion size, surgical indication, surgical procedure, and histopathological features of ectopic liver tissue were included in the study. RESULTS A total of 72 articles involving 91 cases of ectopic liver tissue located on the gallbladder surface or mesentery were analyzed. Of these 91 patients, 62 were female and 25 were male (no gender available for 4 patients), and the age range was 5 d to 91 years. Forty-nine patients underwent surgery for chronic cholecystitis or cholelithiasis, and 14 patients underwent surgery for acute cholecystitis. The remaining 28 patients underwent laparotomy for other reasons. Cholecystectomy was laparoscopic in 69 patients and open in 11 patients. The remaining 19 patients underwent various other surgical procedures such as autopsy, liver transplantation, living donor hepatectomy, Whipple procedure, and liver segment V resection. Histopathologically, hepatocellular carcinoma was detected in the ectopic liver tissue of one patient. CONCLUSION Ectopic liver tissue is a rare developmental anomaly which is usually detected incidentally. Although most studies suggest that ectopic liver located outside the gallbladder has a high risk of hepatocellular carcinoma, this is not reflected in statistical analysis.
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    The effect of aminoguanidine against cholestatic liver injury in rats
    (Wiley, 2007) Yilmaz, Mehmet; Ara, Cengiz; Isik, Burak; Karadag, Nese; Yilmaz, Sezai; Polat, Alattin; Coban, Sacit
    We investigated the protective role of aminoguanidine (AG) in rat liver injury induced by chronic biliary obstruction. Secondary biliary cirrhosis was induced by bile duct ligation for 14 days. Swiss albino rats were divided into three groups: Common bile duct ligated (CBDL) rats; Group A, CBDL rats treated with AG as Group B and simple laparotomy group known as the Sham group; Group C. Group B received 200 mg/kg of AG intraperitoneally daily throughout 14 days. The present data showed decreased gama glutamyl transferase (GGT), aspartate aminotransferase (AST), bilirubin and alanine aminotransferase (ALT) levels in the AG treated rats, when compared with CBDL rats (p < 0.05). In the AG treated rats, tissue levels of malondialdehyde (MDA) were significantly lower than that in CBDL rats (p < 0.001). Although the levels of glutathione (GSH) in AG treated rats were higher and myeloperoxidase (MPO) were lower than that in CBDL rats, the difference was not statistically significant(p > 0.05). The levels of interieukin-l alpha\ (IL-1 alpha) and tumor necrosis factor-alpha (TNF alpha) were significantly lower and although the levels of interleukin-6 (IL-6) were lower in AG treated rats than that in CBDL rats, the difference was not statistically significant. Administration of AG in the rats with biliary obstruction resulted in inhibition of ductular proliferation and portal inflammation. The present study demonstrates that intraperitoneal administration of AG in CBDL rats maintains antioxidant defenses, reduces liver oxidative and cytokine damage and ductular proliferation and portal inflammation. This effect of AG may be useful in the preservation of liver injury in cholestasis. Copyright (C) 2006 John Wiley & Sons, Ltd.
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    Effect of Copper Staining in Wilson Disease: A Liver Explant Study
    (Baskent Univ, 2017) Karadag, Nese; Tolan, Kerem; Samdanci, Emine; Selimoglu, Ayse; Akpolat, Nusret; Yilmaz, Sezai
    Objectives: Wilson disease is a rare genetic disease with clinical and histopathologic differential diagnostic challenges. In this study, we evaluated the histo pathologic findings of explanted livers in Wilson disease, with special emphasis on copper histochemistry. Materials and Methods: Our study group was recruited by reviewing archived histopathology reports and the liver transplant clinic patient records retrospectively for patients who had liver transplant for Wilson disease between January 2010 and June 2015, at Turgut Ozal Medical Center. Archival slides were reevaluated. When needed, relevant clinical and laboratory data were obtained from patient medical records. Results: During the selected period, there were 33 patients fitting the study criteria (22 male, 11 female, mean age of 22 +/- 11 y). All patients had mild to moderate septal inflammation. We found that 29 patients (88%) showed glycogenated hepatocyte nuclei and 27 patients (79%) showed nuclear pleomorphism. Other histopathologic findings were cholestasis (48%) and macrovesicular steatosis (39%). There was no special finding in hilar regions except for 2 patients who had recanalized portal vein thrombosis. In terms of copper histochemistry, 2 copper stains, Timm silver sulfide and rhodanine, were performed in all cases, with orcein staining only done for 25 of the cases. Positivity rates for these copper stains were 85%, 82%, and 36%. Periodic acid-Schiff-diastase-and periodic acid-Schiff-positive granules were detected in 7 of 33 patients (21%). Iron deposition was seen in 12 patients (focal and/or minimal in 11, more than focal in 1). There was no dysplasia or malignancy in any of the patients. Conclusions. On routine hematoxylin and eosinstained slides, detection of glycogenated hepatocyte nuclei and the finding of the nuclear pleomorphism should alert the pathologist for the possibility of Wilson disease, especially with cryptogenic liver disease. Timm stain is a more convenient histo chemical stain in revealing copper deposition in liver.
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    Effect of leflunomide on liver regeneration after partial hepatectomy in rats
    (Springer, 2010) Karaman, Abdurrahman; Kirimlioglu, Hale; Tas, Erkan; Karadag, Nese; Gulsul, Cebrail; Fadillioglu, Ersin; Demircan, Mehmet
    Partial hepatectomy (PH) can be an inevitable surgical therapy in some conditions, such as hepatic malignancies, trauma or partial liver transplantation. Its capacity for regeneration distinguishes the liver from other essential organs. Regeneration is a complex process involving growth factors, cytokines, transcription factors, hormones, and oxidative stres products. In the event of ineffective or total absent liver regeneration, the lifethreatening picture of acute liver failure may supervene. In the present research, we studied the effect of leflunomide, a novel immunosuppressive and anti-inflammatory agent against autoimmune disease, on hepatic regeneration after PH in Wistar Albino rats. Thirty-five Wistar albino rats were divided into five groups: group 1, control; group 2, sham; group 3, drug control (was treated with leflunomide 10 mg/kg/d/i.g.); group 4, PH; group 5, PH + leflunomide. As for PH, approximately 70% of the rat liver was surgically removed under general anesthesia. On postoperative day 3, all rats were humanely killed. Catalase (CAT), superooxide dismutase (SOD) and myeloperoxidase (MPO) activities with malondialdehyde (MDA), nitric oxide and protein carbonyl (PC) levels were determined in remnant liver tissue. Inflammatory process and liver regeneration were evaluated with H&E and KI67, respectively. The tissue levels of MDA, PC and MPO were lower in group 5 than levels in group 1. PH significantly decreased the enzymatic activity of CAT (p < 0.05) and SOD. This reduction was significantly improved by the treatment with leflunomide. Histopathologically the enhancement of the liver parenchymal regeneration in the group 5 was significantly greater than the group 4. The findings imply that oxidative stress products play a preventive role in liver regeneration after PH and leflunomide ameliorates the regeneration probably by the radical scavenging and antioxidant activities.
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    Effects of Topical Phenytoin on Nasal Wound Healing After Mechanical Trauma: An Experimental Study
    (Wiley, 2014) Simsek, Gokce; Ciftci, Osman; Karadag, Nese; Karatas, Erkan; Kizilay, Ahmet
    Objectives/HypothesisImpaired postoperative wound healing is the second most common morbidity after synechia formation in endoscopic sinus surgery. The aim of this experimental study was to investigate the potential effects of topical phenytoin on wound healing after nasal mucosal trauma in rats. Study DesignAn experimental study at the Inonu University Faculty of Medicine. MethodsTwenty-four rats were randomized into three groups: 1) phenytoin group (n=8), 2) control group (n=8), and 3) vehicle group (n=8). After damaging the right nasal cavity, in the phenytoin group, 1% topical phenytoin cream was applied for 7 days. The rats in the control group did not receive any treatment. The vehicle group was treated with daily topical cold cream for 1 week. The rats were sacrificed at the end, and the nasal cavities were excised. Tissue edema and inflammatory cell infiltration were compared among the groups. Additionally, proliferating cell nuclear antigen (PCNA) and cluster of differentiation 31 (CD31) immunoexpression levels were evaluated. Furthermore, in biochemical analysis, the tissue levels of vascular endothelial growth factor and (EGF) of the groups were investigated. ResultsIn the phenytoin group, tissue edema and inflammatory cell infiltration were significantly decreased, and PCNA and CD31 immunoexpression levels were more prominent (P<.001) and the tissue EGF levels were significantly higher (P<.01). ConclusionsTopical phenytoin treatment may alter the nasal wound healing after mechanical trauma. The potential beneficial effects of topical phenytoin on nasal mucosa should be investigated by further experimental and human trials. Level of EvidenceNA Laryngoscope, 124:E449-E454, 2014
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    Effects of Verapamil, Nifedipine, and Daflon on the Viability of Reverse-Flow Island Flaps in Rats
    (Lippincott Williams & Wilkins, 2013) Kilinc, Hidir; Aslan, Suleyman Serkan; Bilen, Bilge Turk; Eren, Ahmet Tuna; Karadag, Nese; Karabulut, Aysun Bay
    Reverse-flow flaps are preferable in reconstructive surgery due to their several advantages. However, they may have venous insufficiency and poor blood flow. In this study, effects of various pharmacological agents on the viability of reverse-flow flaps were investigated. Forty Sprague-Dawley rats were used. Superficial epigastric artery- and superficial epigastric vein-based reverse-flow island flaps were preferred. The rats were divided into 4 groups. Group 1 was considered as the control group. Group 2 was given verapamil 0.3 mg/kg per day, group 3 nifedipine 0.5 mg/kg per day, and group 4 Daflon 80 mg/kg per day for 7 days. On day 7, viable flap areas were measured, angiography was performed, serum nitric oxide levels were evaluated, and histopathological examination was done. The mean flap viability rate was 67.59%(+/- 13.12259) in group 1, 77.38% (+/- 4.12506) in group 2, 74.57% (+/- 3.44780) in group 3, and 85.39% (+/- 4.36125) in group 4 (P = 0.001). The mean nitric oxide level was 31.66 mu mol/dL (+/- 2.42212) in group 1, 51.00 mu mol/dL (+/- 2.96648) in group 2, 34.00 mu mol/dL (+/- 2.96648) in group 3, and 47.66 mu mol/dL (+/- 2.80476) in group 4 (P=0.001). On angiography, there were vessel dilations and convolutions in group 2; capillaries became noticeable, and anastomotic vessels extended toward the more distal part of the flaps in group 4. Histological examinations showed severe inflammation in group 3 and minimal inflammation and venous vasodilatation in group 2. Verapamil and Daflon in therapeutic doses significantly increased the viability of reverse-flow island flaps. However, nifedipine did not make a significant contribution to the flap viability. The results of this study will contribute to the literature about the hemodynamics of reverse-flow island flaps and guide further studies on the issue.
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    Expression of matrix metalloproteinases in gallbladder carcinoma and their significance in carcinogenesis
    (Lippincott Williams & Wilkins, 2008) Karadag, Nese; Kirimlioglu, Hale; Isik, Burak; Yilmaz, Sezai; Kirimlioglu, Vedat
    The correlation between matrix metalloproteinase (MMP)-2, MMP-9, and MMP-14 expression on the prognostic parameters of gallbladder carcinoma (GBC) and their role in carcinogenesis were evaluated. Carcinomas of the gallbladder (n = 20) and chronic cholecystitis (n = 10) were studied for the expression of MMP-2, MMP-9, and MMP-14 by immunohistochemistry. In all of the cases, metaplastic and dysplastic epithelial alterations, and (in GBC histologic type, grade of differentiation, level of infiltration, perineural and angiolymphatic invasion, liver invasion, and lymph node involvement were noted. MMP-2, MMP-9, MMP-14 were expressed in tumor epithelium in 9 (45%), 20 (100%), and 20 (100%) of the cases, respectively. MMP stromal expression including muscle layer, vascular endothelium, fibroblasts, and lymphoid cells were detected in all cases. MMP-2 was not expressed in normal, metaplastic, and dysplastic epithelia. In contrast, MMP-9 and MMP-14 immunoreactivities were present in antral-type metaplastic areas as moderate (grade 2) and strong in dysplastic epithelia (grade 3). Only in mucinous-type GBC was the expression of the MMPs lower than in the other types. No significant correlation was detected with the grade of differentiation, level of infiltration, perineural and angiolymphatic invasion, liver invasion, or lymph node involvement. These data suggest that MMP-9 and MMP-14 overexpression may have an important role in tumorigenesis. MMP-2, MMP-9, and MMP-14 were expressed in GBC epithelium but also the expression in the stromal component may be essential for the malignant potential of GBC.